Decline in Communal Living in the Pacific

Abstract This essay will discuss the major reasons for the decline in communal living in the Pacific. Firstly the essay examines issues in regards to social change which are migration and conflict of interest. Secondly, the essay will discuss concerns from an economic standpoint where education and employment are considered. Thirdly, the essay will look at cultural issues in regards to Westernization and cultural identity. The essay concludes that the Pacific people need to realise in order for communal life to stay alive, these issues must be dealt with.Countries in the Pacific have their own unique way of living. Communal living is seen to be the traditional way of life in the Pacific. People are bound together by their culture and tradition. Therefore, this way of life is slowly declining and being forgotten due to many major reasons. Some of these major reasons for the decline in communal life within the Pacific are likely due to issues such as social change, economic and culture . Firstly one of the issues for the decline in communal living in the Pacific is social change.Migration is an issue related to social change, people looking for a diverse lifestyle elsewhere plays a major role in the decline in communal life in the Pacific. People want to experience a different way of life from the traditional communal way of living (Stahl & Appleyard, 2007). For example, Cook Islanders that still reside in a communal way of living, everything from chores to eating and entertainment are done together with the other members of the family or community, but many are pulling away from this way of life because they prefer to do things on their own..Also, to consider is the migration of people from a different culture and tradition into the pacific, who will have an influence on the Pacific islanders who may turn away from the communal lifestyle. An example of this would be foreign workers migrating into the country and bringing with them their way of life from their cou ntry as well as their culture in which young people could be influenced by this new lifestyle. Therefore, migration is a major factor in the decline of communal life in the Pacific.Another point to consider is conflict of interest within the family in regards to land or religious beliefs. Land issues have been a contributing issue to many disputes within the family. Members of the family fighting over the same piece of land have caused hatred and disarray amongst family members. For instance, in Rarotonga when a person is given a piece of land to occupy and build a dwelling, they must go to court to obtain an occupation right. Once the occupation right is granted the occupier has seven years to build their dwelling.Should they fail to erect a building within the timeline set a member of the family have the right to request that the occupation right be cancelled and a new occupation right be given to another family member. Also in relation to conflict of interest are religious belief s. Families and communities can be set apart because of the difference in religion. For example, Sabbath for a Seventh Day Adventist believer is observed on a Saturday, therefore this is a day of rest and their day at Church, where as Sabbath for the Catholic religion is observed on Sunday.Therefore, issues of land and religious beliefs are a large influence in the decline of communal living. Secondly another issue of importance in regards to the decline of communal living in the Pacific is economic concerns. Education can be seen as a contributing factor to the change in communal living in the Pacific. There are opportunities offered in education, and as people study towards a higher level of education, they have had to move to countries such as New Zealand, Australia, Fiji, and America.When they have completed their studies many people take up employment, whether it is within the township or overseas (Veramu, 2000). Therefore, education and employment contribute to the decline in communal living in the Pacific. Furthermore, employment opportunities are also an economic concern in relation to the decline in the communal lifestyle. The development of towns and cities bring about employment opportunities so therefore, a better pay packet and a new lifestyle encourage people to leave the traditional way of life and migrate to â€Å"greener pastures† overseas.An example of this would be, in the Cook Islands the minimum hourly wage is be $5. 00 NZD per hour as a cleaner, compared to $13. 85 NZD per hour working as a cleaner in NZ (Clarke, 2013). Thus, employment is an issue in regards to the loss of this way of living in the Pacific. Thirdly, cultural values are also an issue in respect to the decline of communal life in the Pacific. A related aspect to culture issues is Westernization in which many Pacific Islanders have adopted the lifestyle and culture of western countries.For instance, in the Cook Islands if there was a marriage ceremony in a village, e veryone in the village would come together and prepare food, and decorate the building where the wedding ceremony would take place as well as the reception, it was an open invitation and everyone in the village(s) would come to celebrate. This no longer occurs as the influence from the west has changed the way people think. Therefore, western culture influence is also responsible for the decline in communal life in the Pacific.Moreover, in relation to culture issues is the loss of cultural identity which many people are experiencing today, therefore this is a concern in the communal decline of life in the Pacific. In the past every person knew how to speak the language of their country, also knowing the protocols of their villages, and genealogy; the majority of people today have forgotten or have not been taught by their parents. For example, from the age a child is able to understand and communicate with people, they are taught by their parents, as well as people in the village ab out life and other experiences.Thus, the cultural loss in one’s identity is a reason for the decline in Pacific communal life. To conclude, it is essential to be aware of the major reasons for the decline in communal life in the Pacific in relation to social impacts, economical concerns and cultural values. The Pacific people must realise that communal life is declining and it is threatening the traditions and culture of the Pacific. Traditional values and issues should be considered more to re-strengthened communal life in the Pacific. Communal life will die out if the issues are not examined and considered by the people in all the Pacific countries as a whole.

Life Suceed In That It Seems To Fail Essay

Life has resilient nature, it never let hope to cut off even in the lurch. It arrives at specific conditioning through entertaining demands at variable intervals and in variable amounts and some times at discretion. This comes up with optimism. Optimism let one to crow over even in inauspicious conditions. In fact life do miracles in lurch conditions and turns the corner. It triumphs, when there is no hope of its victory. Traditional stories, which are being recounted by a man to a child, have the ultimate positive end. They implants in the flesh and blood that every bad and the worst have a well chosen end. And in actual the same comes about. A death bed patient, for an ordinary example, bears a charmed life. A stuck labor in a mine is rescued after a couple of days. These off and then are the very reason that the hope dies but with the last breath. If we dive deep in the history of world, we come up that every time when there was no way out but stars were in the ascendant. Subcontinent’s fate in 17th century was hanging in balance. All India National Congress decided it in complete darkness. Germany, when it was quite at sea, found the hope in the shape of Hitler. USA was quite at its wit’s end and was about to gave up all in vain after ten years war but it made a pile and turned the table by killing Osama. On contrary there are many cases where felicity is left awaited and never comes. A pathetic poor man facing adverse economic situations, for instance, annihilates itself because he/she remains unable to discover light in future. Over all, life is beautiful having optimistic nature and whenever it is being challenged it nails its color to the mast.

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Also I would have to provide all the relevant information, data (analysis and insights from reward data to support development of reward plans and strategy) Help employees understand their role in change, the reasons for it and the results that are expected by Providing data and analysis regarding market positioning. Support the delivery and evaluation of planned one-off and on going people programmes and projects. Keep records of identified risks and plans to mitigate against them Collect,  collate and analyse project metrics, data and report back on key Promote the value of diversity and inclusion in all activities Support employees and managers to apply people policies consistently and fairly. Provide accurate and timely information, data and advice to managers and employees on oganisation’s people policies and procedures and employment law Recognise team and organisational culture and its impact on activity To develop understanding of the organization and its context organisational purpose, key products/services and customers Relevant press relating to the organisation Basic financial and non-financial performance information on the performance of the organisation The sector context in which the organisation operates; legal and market factors that impact performance. Significant issues within the organisation’s environment which impact you and others around you, for example economic, social, political, environmental conditions Diversity and inclusion initiatives and activities within your area The way the organisation, and/or functions   and teams are structured and managed The governance and decision-making processes guiding how you deliver A sense of how things really work in the organisation and the barriers to change The capability and skills that are needed within the organisation How the 10 professional areas in this Map combine together to create an overall human resources offering to the organisation Knows or can access relevant law, in relevant local and international jurisdiction Where to access external information on HR or specialist area good practice and thought leadership. Project management principles and practices How a strategy and in-year operating plan relate Group and individual responses to change. How to collect and provide information required to support business cases and monitor budgets Leading HR is important for professionals even if they are not in leading role as is important that they grow and develop in this area which provide active, insight- led leadership. They can do that by driving themselves, others and activity in organization. The other eight segments identify the activities and knowledge that are required to provide specialist support. *Organizational design ensures that the organization is well design to deliver its objectives and that structural change is effectively managed. *Resources and Talent Planning is making sure that organization identify and attract key people who are able to create competitive advantages. *Performance and Reward builds a high- performance culture by delivering programmes that recognise and reward critical skills, capabilities, experience and performance. Ensures reward system are equitable ( fair) and cost effective. *Employee Relations ensures that the relationship between an organization and its staff is manage appropri ately within clear frame work and that relevant employment law, policies, procedures, communications, negotiations and consultations are followed. *Organizational Development is  making sure that the work force deliver strategic ambition. Ensures that an organization culture value, environmental support enhance its performance and adaptability *Learning and Talent Development ensures people at all levels posses and develop skills, knowledge and experiences to fulfil organizational ambitions. *Employee engagement ensures that all aspects of employment experience, the emotional connections, that employees have with their work, colleagues and organization is positive and understood. *Service and Delivery Information ensures that the delivery of HR services and information to leaders and employees within organization is accurate, timely and cost effective. HR data manage professionally The CIPD in HRPM model out eight behaviours which describe how work activities should be carried out. 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Discussin question Essay Example | Topics and Well Written Essays - 250 words - 1

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ETM 2.0 Research Paper Example | Topics and Well Written Essays - 10000 words

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Individual report Essay Example | Topics and Well Written Essays - 500 words - 3

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Principles of Microeconomics Essay Example for Free

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Issues of State Intervention in the Market Economy

Issues of State Intervention in the Market Economy Free Market Economy The free market economy is designed to operate with a minimum of state intervention. However, as this paper will show, there are certain issues that can only be addressed by state intervention. These include avoidance of unfair trading, employee and supplier exploitation. In many cases, such as the expansion of the power of supermarkets, economists are of the opinion that the state does not go far enough in protecting the public (Marguand, 1977, p.5). This report shows that, whilst a free market is good for economic growth, there is a need for intervention from the state, however limited, to protect public services and the rights of the individual. Introduction Although many economists and politicians have concluded that the â€Å"free market economy† is the most appropriate form of trade, it seldom is allowed to operate without some measure of state intervention. The purpose of this paper is to study the concept of a â€Å"free market economy† and, at the same time provide an understanding of the reasons for and operation of state intervention. To provide an example of how such intervention manifests itself in practice, its recent impact on the Tesco supermarket chain is explored. The basic premise of a free market economy is one where the distribution of resources is determined solely by market forces, without any state interference (Philip Allan Updates, 2006). The main condition of is that exchange of resources should be undertaken freely, without duress or deceit. In a free market, the price of goods or services is agreed between buyers and sellers, and there is no government restriction imposed upon this process. If the state interferes by influencing price for any purpose, be that to aid the consumer or seller, a free market cannot be said to exist. Proponents of the free market system believe that it can provide its own solution to problems and that state interference is a hindrance to that process (Ian Adams, 1998, p.23). Essentially, the free market operation is based on the laws of supply and demand. A buyer, by offering to pay a given amount for a product creates the demand. Conversely, a producer, by offering to sell a product or service at a price creates the supply. In a free market, an exchange between a buyer and seller takes place when the amount offered by a buyer matches the price requested by the seller. The optimum price will normally be determined by the level of demand and supply. If the supply is higher than demand, there being not enough buyers, prices will tend to fall as suppliers compete to sell their products and buyers look to reduce the price offered. In such circumstances, suppliers may also choose to reduce their production or even cease business altogether. The suppliers who remain will be those whose product unit cost is at the lowest level, allowing them to retain profitability levels despite price reductions. When the reverse occurs, in that demand exceeds the number of products available (the supply), prices will rise. In this situation, the seller is in command of the market. An excess demand situation may also lead to existing suppliers increasing production levels, and may tempt new producers into the marketplace. However, businesses that achieve rapid growth, even when an excess demand arises, are typified by sellers who maintain lower than market demand prices, such as supermarkets. Often this is achieved by constraining supplier prices. It can be seen therefore, that a free market is very much based on an enterprise system, where entrepreneurs are the most important factors (Marquand, 1977, p.159). Many economists agree that the free market cannot exist without some state intervention. For example, â€Å"Keyness argument [is][1] that the only way to stop the market wreaking havoc is for the state to intervene in the economy.† (Quoted in Peter Morgan, 1999). However, economists often disagree about the extent of such intervention. In an ideal version of a free market economy, the state role would be limited to ensuring freedom of competition remains and to protect the marketplace from incidences of intimidation, conspiracy or deceit. Therefore, if a situation develops where a group of sellers agree to maintain prices at an artificial level, forming a cartel for the purpose of price fixing irrespective of the market demand, the state may intervene. Similarly, the state may intervene if a large corporation endeavours to force suppliers to meet restrictive conditions including price, in order to an unfair competitive edge over other sellers, or attempts to achieve dominant market share by maintaining artificially low prices. Included within this area is the concept of free and unencumbered competition. This presupposes that no one corporation, or group of corporations, should be allowed to dominant their sector in a way that precludes other suppliers from entry (Erik Ringmar, 2005). In order to address these situations, state intervention usually occurs by the introduction of anti-competition laws and regulations, unless a self-regulatory code of ethics and conduct is agreed. To reduce the incidence of fraud by corporations most states, nationally and internationally, have introduced a combined system of codes and laws designed to combat this problem. In the UK, such laws include the consumer protection act, anti-competition laws and corporate governance regulations, supported by the company’s acts. A significant part of the role of these acts also serves to protect consumers from abuse by corporate action. In this respect, the state considers that the consumer needs to have access to accurate information, such as pricing and content of products, which they might otherwise be denied. In recent decades, state intervention has also focused on protecting the rights of the workforce, to stop workers being exploited, unfairly treated or discriminated against by the businesses they work for. To achieve this many acts have been instigated, the latest of which is the Employment Equality (Age) Regulations 2006 Another area where governments intervene in the free market scenario is to protect and provide public services. These include the National Health Service. Despite the move to greater privatisation on public services, generally the ordinary member of the public favour these being run by the state (Erik Ringmar, 2005, p.136). To fund their role in the economy, the state imposes taxes upon the enterprises that occupy the market. Although in theory, such taxes should be limited to this purpose, in reality governments also use taxation as another form of intervention. For example, in an effort to address health and environmental issues, such as tobacco and alcohol addition and global warming, additional taxes have been levied on products that cause these addition and the use of which exacerbates environmental problems. Thus, in the UK we have seen the introduction of additional levies on such items as cigarettes, beers, wines and spirits, and fossil fuels and energy usage. Margaret Thatcher, during her terms as Prime Minister, was a strong supporter of the free-market, believing it to be a moral and sound way to develop the economy (Ian Adams, 1998, p.79). In the UK, one of the commercial sectors that have benefited most from the freedom of trade under the â€Å"Thatcher† years was Supermarkets. This ethos has been carried through the Blair years, although some ministers now admit that such freedom is not necessarily the right path (Stephen Byers, 2003). As a result, supermarkets have experienced almost unprecedented growth, creating an imbalance in many market sectors, to the extent that the high street is dominated by four major chains, Tesco, Asda, Sainsbury and Safeway (now Morrisons) (Joanna Blythman, 2003). Of these, Tesco’s is the largest and accounts for one eight of all consumers shopping and over a third of groceries. Because of increased concerns over supermarket power and competition issues, the government has taken a direct approach in terms of intervention. For example, the monopolies commission was instrumental in stopping further consolidation of supermarket numbers by subjecting the Tesco, Asda and Sainsbury bids for Safeway, the fourth largest, to full inquiries, allowing Morrisons to succeed (Richard Northedge, 2003). For Tesco’s, a number of similar planned expansion projects, to extend its stores numbers through construction or acquisition, have been thwarted by various government methods. However, the supermarket chain responded to these measures by achieving expansion through a different route. Using the Office of Fair Trading (OFT) own two-market view of grocery retailing, namely that one-stop and convenience shopping were separate markets, Tesco has expanded into the latter field, despite concerns expressed by some ministers (Julia Finch, 2005). The corporation has aggressive ly built a six hundred-store presence in this marketplace, with plans to double this in the near future. In 2002, in response to continuing concerns and complaints regarding the supermarket’s treatment of their suppliers, which included Tesco, the Office of Fair Trading, a government-funded body, introduced a supermarket code of practice (Joanne Blythman, 2003). Since then, there have been no further complaints. However, it is widely believed the reason for this is not so much satisfaction with the working of the code, but more the enormous influence supermarkets such as Tesco’s exercise over their supply chain. It is considered that this influence is used to deflect intervention (Joanna Blythman, 2003). In respect of the protection of employees, over the past few decades the UK government, partially driven by European Commission regulations, has intervened by introducing laws including the Protection of Employee (Fixed Term Work) Act 2003, together with numerous other Acts that deal with a wide range of discrimination issues, such as race, disability and age. In addition, to further reduce the possibility of exploitation of workers and to provide them with a reasonable standard of living, a system of setting a minimum wage was introduced. In an effort to enable employees to bring complaints against employers, a tribunal system, together with an independent body, ACAS[2] has been set up to intercede in these issues. In most cases, supermarket chains, such as Tesco, have pre-empted these regulations, by introducing their own human resource strategy to deal with the issues. For example, before the age discrimination act that came into force in 2006, Tesco had previously taken steps to address the problem. Such was their success in this area that they won the â€Å"Personal Today 2004 Age Positive Award† (Tesco Website 2006), which acknowledged the steps they had undertaken to eliminate age discrimination. Although historically it can be seen that the free market system has led to significant economic growth, a side effect was that it also created problems and, in some cases, misery for many people (Erik Ringmar, 2005). To redress the balance required state intervention. It can be seen from the research carried out for this paper that, certainly in an effort to counteract the power of supermarket giant’s such as Tesco, a free market economy needs to have a certain element of state intervention in order to protect suppliers and employees. References Adams, Ian (1998). Ideology and Politics in Britain Today. Manchester University Press. UK. Anon (2006) Price and resource allocation. Philip Allan Updates. Retrieved 14 December 2006 from http://www.philipallan.co.uk/images/532-T2.pdf Blythman, Joanna (2003). Lord of the aisles. The Guardian, UK. 17 May 2003 Byers, Stephen (2003). I was wrong. Free market trade policies hurt the poor. The Guardian, 19 May 2003 UK. Finch, Julia (2005). Calls for an end to Tesco’s bully-boy tactics have grown too loud to ignore. The Guardian, 12 November 2005. Marquand, David (1997). The New Reckoning: Capitalism, States and Citizens. Polity Press, Cambridge. UK. Morgan, Peter (1999). The new Keynesians: staking a hold on the system? International Socialism Journal. Issue 82, March 1999 Northedge, Richard (2003). Morrisons profits will boost Safeway bid. The Scotsman on Sunday. UK. Ringmar, Erik (2005). Surviving Capitalism: How We Learned to Live With the Market and Remained Almost Human. Anthem Press, UK. Statement (2006) Older Staff. Tesco website. Retrieved 13 December 2006 from http://www.tescocorporate.com/page.aspx?pointerid=DE09B90CFDD44BE995DFE562405EAF38 The Employment Equality (Age) Regulations 2006. Her Majesty’s Stationery Office. London. UK. Footnotes [1] Words in brackets added [2] Advisory, Conciliation and Arbitration Service (UK)

Evidence Based Nursing in Primary Healthcare Team

Evidence Based Nursing in Primary Healthcare Team 189691 Title: Evidence Based Nursing is developing in primary health care . Critically discuss the applications to your practice. (District Nursing) Undergraduate Degree Level Essay 3,250 words Essay The evolution of the nursing profession has witnessed a great many changes of both emphasis and direction in both the delivery and the content of patient care as well as accompanying changes in both the philosophy and the theory of that care. Arguably the nursing profession has historically based its activities and also its philosophies, on tradition and the perpetuation of currently accepted practices which have not been firmly rooted in a general scientifically tested framework.(Roper N 1977). This can be verified by the fact that the nursing literature of the 1970s and 80s has many references from writers and commentators who were arguing for nursing to evolve into a research based profession and highlighting the fact that there was a demonstrable absence of a significant amount of good quality research-based fact which dictated the current practices throughout the profession in general. (Gortner SR 1976). An impartial observer, considering this situation over the intervening years, would probably agree that there has been a clear and marked swing in both the published literature and the actual practice of nursing, towards the underpinning of practice with strong scientific research. Evidence based nursing has emerged as being one of the dominant driving forces in nursing evolution and the advent of evidence based practice has become apparent to the point where it is now and this could be considered to be the â€Å"gold standard† and essential basis for the majority of professional nursing care (Yura H et al 1998) If we look at the issues and considerations that could support this statement, we could point to Hunt’s tour de force on the subject in his seminal paper of 1981 (Hunt J 1981), in which he sums up his belief that each nurse must care enough about her own practice to want to make sure it is based on the best possible information. This plea seemed to strike a chord in the nursing profession to the extent that, over the following few years, there was a noticeable increase in the published papers that both echoed these sentiments and also defined the various barriers to progress in this respect. These were largely quantified as including time constraints, limited access to the literature, a lack of training in critical skills of appraisal and, most fundamentally, a professional ethos and ideology that placed a great emphasis on the practical rather than the intellectual component of knowledge, together with a work environment that did not actively encourage the seeking out, resear ching and recording of new information (after Royle J et al 1996). One could be forgiven for observing that such comments are still relevant to a degree today. In order to present a balanced argument, we can observe that there is not a blind and uniform acceptance of evidence based nursing procedures. There are some who actively criticise evidence base procedures. Haynes (R B et al 1996) points to the fact that a blind following of evidence based practice can promote a concept of a â€Å"cookbook† of procedures that have to be dogmatically followed and it can stifle the holistic consideration of what may be best for each individual patient. We shall return to this point later. White (S 1997) counters this argument with the suggestion that a nurses’ professional training includes both learning the basic pathophysiology and anatomy and acquiring experience. She suggests that it is actually the â€Å"effective application of this experience that requires a sound evidence base.† Research evidence can aid the professional decision making process, but cannot either do the clinical examination or collate the vast amount of sni ppets of information that pass between patient and nurse. White suggests that it is this clinical expertise (derived from learning and experience), that is the crucial element in the application of the evidence based knowledge which separates true evidence based nursing practice from the â€Å"cookbook† approach with Haynes’ vision of the mindless and unquestioning application of â€Å"both guidelines and rules† (White S 1997). Before we leave the general issues relating to evidence based nursing, we shall also cite the analytical work of Pearson (A 2000) who produced an influential treatise on the role of the nurse and nursing in evidence based research. In his paper Pearson makes a fundamental and significant delineation between lay nursing and professional nursing which is defined by the application of research based practices and procedures. He suggests that the evolution of evidence based nursing had its origins in the days of the reforms pushed through by Florence Nightingale, became commonly accepted practice in the 70s and 80s when the â€Å"theoretical constructs of practice began to evolve and be adopted†, and has currently culminated in the advent and emergence of the nurse practitioner and nurse specialist whose professional structure, training and practice is essentially evidence based. This essay is primarily about how evidence based nursing is developing in primary healthcare team with specific reference to personal practice. This is a potentially a vast topic and therefore we will use illustrative examples of specific areas of development. A great deal of a primary healthcare team’s time (particularly that of the nurse) is taken up with the treatment of pressure sores and ulcers. It is instructive to consider the evolution of the evidence base for the treatment of this condition and then to extrapolate the process to other conditions frequently seen in primary care. We can cite the work of Sir James Paget who made the observation in 1862:- Elderly patients with femoral neck fractures and other high risk groups develop them (pressure sores) early, chiefly in the first week, and then made the observation â€Å"They often appear on the day of operation. It is not just the patient, but every part of his or her body, that must survive the operation†. (Bliss MR 1992). The rationale for citing this statement is that it illustrates a comment and observation that may be factually correct, but has no evidence based weight whatsoever other than being a reflection of the author’s opinion. It has no foundation in statistically verifiable fact and may be subject to all forms of objective bias. It obviously was never produced as a result of a randomised controlled trial but, like many other â€Å"pronouncements† by prominent practitioners, it has both influenced and been accepted by generations of healthcare professionals over the years. This exemplifies Roper’s point, cited earlier, relating to the tradition of previous practice being perpetuated by successive generations. The point can be tracked further still by considering a more recent paper by Vohra (Vohra R K et al. 1986). On the face of it, this paper gives a comprehensive overview of the (then) current practices in the treatment of ulceration and pressure sores. It goes into great detail relating to the aetiology, pathophysiology and trends in management of the ulcer patient and has an extensive and current reference section in the paper. The problem form the perspective of this essay is that, although the paper is undoubtedly comprehensive in its approach, virtually the entire paper together with virtually all of the cited references, is opinion based with not a single reference to a good quality randomised controlled trial. (MacLean DS 2003). The paper does make use of comparative studies where one treatment is compared with another, but this in turn exemplifies yet another shortcoming and that is that such trials are good if a healthcare professional has only these two options at their dispo sal for treatment, (which is seldom the case). Modern philosophy would dictate that in good evidence based practice, the nurse would need to be able to cite evidence that one treatment is demonstrably superior to all others for a given set of clinical circumstances and that this evidence is from a repeatable and unbiased source. To give an illustration of this point, MacLean makes the comment:- It is clearly of minimal value to a patient to be able to say to them that a comparison of rubbing a pressure sore with honey has been found more beneficial than rubbing it with butter when the use of a ripple mattress is clearly superior to both of them. If we contrast this paper with another, more recent paper (Bliss et al. 1999), there are a number of very significant differences. This paper is also an overview of the current trends in treatment of ulcers and pressure sores. Firstly the author is a nurse. Secondly, it only cites 12 references (as opposed to over 70 in the Vohra paper) but each is a randomised controlled trial selected to support the various statements made in the paper. This represents a major and fundamental change in presentation, philosophy and practice. It could be suggested by the cynic that such observations are a chance finding in two randomly selected papers. We would suggest that an examination of the literature of the periods involved would support the view that they represent a true reflection of the genuine change in both style and expectation that now pervades the nursing professions and more fundamentally, it also reflects the criteria by which papers are now judged and accepted for publication in the major peer reviewed journals. It is not appropriate to discuss the content of the paper in detail other than to observe the fact that the paper concludes with a description of the classic Gebhardt trial (Gebhardt KS et al 1994) which compared the results of bed rest with intermittent chair nursing on the development of ulceration and in the words of Morris (A 2002):- In many respects, the Gebhardt trial is a reflection of both the calls noted in the previous paper for proper scientific scrutiny to be brought to bear on the subject and the evolution of the expectation of the healthcare professions into the requirement for a firm evidence base for their continued work. In terms of direct impingement on the practical aspects of primary healthcare nursing, the move towards evidence based procedures can be illustrated in the development of scales such as the Waterlow scale (PN 1991). This was developed as a direct recognition of the need for an evidence based tool which would both directly help the nurse assess and quantify the degree of risk together with helping them predict just which was the most effective treatment modality for any individual patient. This was accomplished by allowing a reproducible measurement of ulceration and thereby rendering this area of clinical practice amenable to proper scientific scrutiny and testing. The result of this scale development is that the nurse can identify a treatment that has not only been suggested by previous practice or experience, but one that can be shown to be the most appropriate for a given set of clinical circumstances with the most likely clinical benefit (NT 1996). It is a logical step from this position to the situation where new scales are developed based on evidence based assessments and treatments, to predict the likelihood of healing of ulcers. Such a situation has resulted in the development of tools such as the PUSH scale (Gardener S et al 2005). This represents the currently accepted end-point of a logical progression that we have traced and quantified from the type of opinion based pronouncements of Sir James Paget, past the experience based observations and comparative trials such as those of Vohra, through to the completely evidence based practices of today where a clinically defined situation is identified, a solution is hypothesised and then subjected to validation by appropriate double blinded and unbiased scientific techniques in a randomly controlled clinical setting. It allows the authors (Gardener S et al 2005) to conclude their paper with the comment The PUSH tool provides a valid measure of pressure ulcer healing over time and accurately differentiates a healing from a non-healing ulcer. It is a clinically practical, evidence-based tool for tracking changes in pressure ulcer status when applied at weekly intervals. Such a comment is virtually unchallengeable because of the weight of valid recorded evidence behind it. If we consider new and current moves to examine the evidence base of activities in the primary healthcare team, we can also consider the advent of screening clinics which are commonly nurse-led. (Califf R M et al. 2002). We could consider the current trend for hypertension screening. It is commonly accepted that treating hypertension is of value in preventing both morbidity and mortality, (Cooper R et al. 2000), but a less frequently asked question is â€Å"What is the rationale and the evidence base for providing a screening programme for patients?â€Å" (HTT 2005). Curiously, the evidence base for the screening programmes that have been run has been rather insecure. The main reason for this has been the comparative paucity of definitive information relating to the levels of effective treatment and, as the treatment can realistically only be assessed as effective over a long time span, such studies take many years to yield substantive information. It therefore follows that the evi dence base for screening can only realistically be determined once a rational an proven evidence base for treatment has been established. (Brotons C et al. 2003). This is the position set out in the comprehensive paper by The National Heart, Lung, and Blood Institute Working Group (HTT 2005). A pragmatic view would also have to observe that the position is further complicated by the constant evolution of new drugs and methods of measuring blood pressure which render previous data on the subject out of date by the time that it is assimilated. (Appel L J et al. 2003). This paper is very detailed in its assessment of the situation and it is not practical to consider all of its findings in any depth, but it provides a comprehensive overview of the evidence base for the promotion of hypertensive screening together with the evidence to support the use of different levels of hypertension as the endpoint of the screening process. Perhaps we can conclude this essay about the relevance of evidence base nursing practice to primary health care with the excellent and though-provoking article by Frances Griffiths. (Griffiths F et al. 2005). Although we have been arguing for the use of evidence based practice in modern nursing care, there is one commonly overlooked aspect of this practice which is the subject of the Griffiths paper. As the wealth of good quality information relating to the effectiveness of many clinical interventions and practices increases, this fact alone presents healthcare professionals in general with the increasing dilemma of how to apply the information obtained to the individual patient. The evidence base for a procedure will generally inform clinicians of the likelihood of it being successful in the general population. It will not give any indication, other than a probability, of its chance of success in the individual patient. This is a problem for the nurse (and other healthcare professio nals), as the bulk of current medical practice is on a face-to-face basis with individual patients, rather than dealing with populations. (Fox R C 2002) To illustrate this point, Griffiths points to the fact that it is commonly accepted that epidemiology tells us that smoking is an independent risk factor in the population for myocardial infarction, yet there is no evidence base to tell us which particular individuals will be affected. Similarly there are a multitude of good quality trials which show that there is an increased risk of breast cancer that is linked with hormone replacement therapy but there is nothing that will tell us which individuals are at specific risk. (Willis J 1995) This dilemma is central to the proper understanding of the place of evidence based practice as the balance between good practice based on proper evidence and individual patient care is central to the history of nursing and will not disappear however good the evidence base for a particular treatment becomes. In the words of Haynes (R B et al. 2002):- Diseases always manifest themselves in patients bodies and minds, and in seeking to understand, treat, and predict the outcome of disease, clinicians need to move their focus from the individual to more generalised research. To this end, the nurse would do well to reflect on the fact that assimilation of evidence is central to her practice, but communicating that evidence to patients is a key part of clinical consultations, with a growing evidence base of how it is best achieved. References Appel L J, Champagne C M, Harsha D W, Cooper L S, Obarzanek E, Elmer P J, Stevens V J, Vollmer W M, Lin P H, Svetkey L P, Stedman S W, Young D R; for the Writing Group of the PREMIER Collaborative Research Group. 2003 Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. J Am Med Assoc. 2003 ; 289 : 2083–2093. Bliss M and Bruno Simini 1999 When are the seeds of postoperative pressure sores sown? BMJ, Oct 1999 ; 319 : 863 864 Brotons C, Godycki-Cwirko M, Sammut M R. 2003 New European guidelines on cardiovascular disease prevention in clinical practice. Eur J Gen Pract. 2003 ; 9 : 124–125 Califf R M, DeMets D L. 2002 Principles from clinical trials relevant to clinical practice: part I. Circulation. 2002 ; 106 : 1015–1021 Cooper R, Cutler J, Desvigne-Nickens P, Fortmann S P, Friedman L, Havlik R, Hogelin G, Marler J, McGovern P, Morosco G, Mosca L, Pearson T, Stamler J, Stryer D, Thom T. 2000 Trends and disparities in coronary heart disease, stroke, and other cardiovascular diseases in the United States: findings of the national conference on cardiovascular disease prevention. Circulation. 2000 ; 102 : 3137–3147. Fox R C. 2002 Medical uncertainty revisited. In: Bendelow G, Carpenter M, Vautier C, Williams S, eds. Gender, health and healing: the public/private divide. London : Routledge, 2002 : 236-53. Gardner S, Rita A. Frantz, Sandra Bergquist, and Chingwei D. Shin 2005 A Prospective Study of the Pressure Ulcer Scale for Healing (PUSH) J. Gerontol. A Biol. Sci. Med. Sci., Jan 2005 ; 60 : 93 97. Gebhardt KS, Bliss MR. 1994 Preventing pressure sores in orthopaedic patients. Is prolonged chair nursing detrimental? J Tissue Viability 1994 ; 4 : 51-54. Gortner S R, Bloch D, Phillips T P. 1976 Contributions of nursing research to patient care. J Adv Nurs 1976 ; 1 : 507–18. Griffiths F, Eileen Green, and Maria Tsouroufli 2005 The nature of medical evidence and its inherent uncertainty for the clinical consultation: qualitative study BMJ, Mar 2005 ; 330 : 511 ; Haynes R B, Sackett D L, Gray J A M, et al. 1996 Transferring evidence from research into practice.-The role of clinical care research evidence in clinical decisions ACP Journal Club 1996 Nov-Dec ; 125 : A14–6. Haynes R B, Devereaux P J, Guyatt G H. 2002 Physicians and patients choices in evidence based practice. BMJ 2002 ; 324 : 1350 HTT 2005 The National Heart, Lung, and Blood Institute Working Group on Future Directions in Hypertension Treatment Trials Major Clinical Trials of Hypertension: What Should Be Done Next? Hypertension, Jul 2005 ; 46 : 1 6. Hunt J. 1981 Indicators for nursing practice: the use of research findings. J Adv Nurs 1981 ; 6 : 189–94 MacLean D S 2003 Preventing Managing Pressure Sores Caring for the Aged March 2003 Morris A H 2002 Decision support and safety of clinical environments Qual. Saf. Health Care, March 1, 2002 ; 11 (1) : 69 75. NT 1996 Pressure sore assessments Uses and limitations of standard pressure sore classification and risk assessment systems. Nursing Times July 17 1996 Vol 92 No.29 Pearson A 2000 Nursing Practice and Nursing Science: Building on the Past and Looking to the Future Joan Durdin Oration Paper Series Number 6 2000 PN 1991 A policy that protects The Waterlow pressure sore prevention/treatment policy. Professional Nurse February 1991 Roper N. 1977 Justification and use of research in nursing. J Adv Nurs 1977 ; 2 : 365–71. Royle J A, Blythe J, Ingram C, et al. 1996 The research utilisation process: the use of guided imagery to reduce anxiety. Canadian Oncology Nursing Journal 1996 ; 6 : 20–5. Vohra R K and C N McCollum 1986 Fortnightly Review: Pressure sores BMJ, Oct 1986 ; 309 : 853 – 857 White S. 1997 Evidence-based practice and nursing: the new panacea? British Journal of Nursing 1997 ; 6 :175–7 Willis J. 1995 The paradox of progress. Oxford: Radcliffe Medical Press, 1995. Yura H, Walsh M. 1998 The nursing process. Assessing, planning, implementing, evaluating. 5th edition. Norwalk, CT : Appleton Lange, 1998. ################################################################ 11.9.06 PDG Word count 3,454

Alexander The Great Essay -- miscellaneuos

Alexander The Great Alexander the Great was a man with no equal in History. He was one of the most important forces known to man. Alexander the Great then crossed the Hellespoint, which is now called the Dardanelles and, as head of a Greek army undertook the war on Persia that his father had been planning. The march he had begun was to be one of the greatest in history. Alexander was one of the biggest influenced on people of all time and one of the most powerful personalities. He really molded people into acting the correct way. He brought people together and showed them how to live better. He defiantly changed the lives of many. Alexander the Great was born in 356 BC Philip his father was the brother of Perdiccas III king of Macedonia. His mother’s name was Olympia’s. Olympia’s was the daughter of King Neoptolemus I. He was known wide to be a great powerful man. Alexander had a younger sister named Cleopatra. The whole family had a lot of very important background. It was a fact t hat Alexander and Cleopatra’s parents did not get along. At this time it was a Macedonian tradition to have many wives. Philip had several and Olympia’s hated them all. She felt much hate towards them. When one of her rivals gave birth to a retarded son Arridaeus, there were many rumors that Olympia’s poisoned him. Olympia’s told Alexander that Philip wasn't his real father although he was. He made sure the boy was well educated, even the great philosopher Aristotle was one of Alexander's tutors. Even thought he though him well Philip wasn’t a very good father. He always discouraged Alexander and made him feel worthless. When Alexander the great was 3 his father’s son King Perdiccas died. His young son Amyntas was supposed to take his place as ruler. Philip was supposed to help him but he made his way above him making himself King Philip II. He proved to be a strong ruler, and in a few decades he conquered most of Greece. As a teenager Alexander became friends wit a boy around his age named Hephaestion. It was rumored that they were lovers. At this time Homosexuality was accepted in Greece. Even Alexander's father had many male lovers. Till this day no one really knows the relationship between the two but it is said that throughout their lives they stood by each other. When Alexander turned his father went away to war, leaving Alexander to serve as leader of Macedon. During t... ...me ill, and on June 13 he died in Babylon. He was 32. Historians have said that he died from malaria, but recently it has been said that he died of typhoid fever. The empire was soon torn apart by the struggles that Alexander the Great's advisors and generals had. This was now called the Diadochi. Diadochi is Greek for successors. In 319 the â€Å"Antipater† died and was succeeded as regent by Polyperchon, whom did Antipater’s son Cassander quickly oust. In time Roxanne and her son were also killed by Cassander, who became the king of Macedon in 305 BC. Alexander Aegus was thirteen when he died. He left his empire in his own words, "to the strongest. Whether or not Alexander had plans for any world conquering cannot be determined but he had accomplished greater conquests than any before him. He was one of the greatest generals of all time and one of the most powerful personalities of antiquity. He influenced the spread of Hellenism throughout the Middle East and into Asia; establishing city-states modeled on Greek institutions that flourished long after his death. Alexander will never be superior to any man and will remain forever as "the Great" in the pages of History as we know it.

The Difference Between Life and Breath :: essays research papers

The Difference Between Life and Breath   Ã‚  Ã‚  Ã‚  Ã‚  Respiratory therapists are highly skilled practitioners who provide treatment, management and care of patients with breathing deficiencies and abnormalities. I chose to go into this profession not just for the money, as some might think, but because of my own life experiences in having to deal with taking care of my Dad, who died from third stage emphysema and because my son has asthma. Part of my acceptance into the respiratory program at Ivy Tech was to job shadow a therapist for a day. I chose to do this at St. Clare Medical Center in Crawfordsville. I called to set up my appointment for the job shadow and found out I would be shadowing Pam Ehrie, which was good because I already knew her as she helped to care for my Dad and also cared for my son.   Ã‚  Ã‚  Ã‚  Ã‚  I arrived at the Respiratory Department at 10 a.m. on Monday of the following week and Pam came out to greet me with a scrub jacked and a name tag and briefly explained that I would go with her to make her rounds for the day. â€Å"Oh yesterday would’ve been a much better day to have come,† she exclaimed. â€Å"We had three codes so there was a lot more going on and it would‘ve given you a better idea of what we really do.†   Ã‚  Ã‚  Ã‚  Ã‚  Ã¢â‚¬Å"What are codes?† I ask, although I already had a pretty good idea.   Ã‚  Ã‚  Ã‚  Ã‚  Ã¢â‚¬Å"Oh that is when the patient arrives and they are basically gone, not breathing, and we have to recessitate them back to life.† Pam says. â€Å"I forget that you are just starting into this, so if there is anything that I say and you do not understand it, just ask me.†   Ã‚  Ã‚  Ã‚  Ã‚   Pam is a rather petite, bubbly individual who stands about five foot tall with shoulder length reddish brown hair and green eyes. She is pretty, with a warm smile that hugs you when you first meet her and a friendly face with kind, gentle eyes. Pam has been a therapist for fourteen years and she also went through her schooling at Ivy Tech. She loves her job, co-workers, and helping others. â€Å"It is my passion in life,† she says. She embraces the idea that she is giving a better quality of life to others. She is also the senior Registered Respiratory Therapist on staff at St. Clare Medical Center and she does all of the clinical sequences with the new students at Ivy Tech.

Refugee Displacement and Identity: Finding Home :: Essays Papers

Refugee Displacement and Identity: Finding Home When fleeing persecution, winning trust and welcome in a foreign land depends on the meaning of the label of displacement. According to Daniel, the making of modern refugee identity hinges on the right language affixed to your desperation, and right interpretation of this desperation by powerful authorities; proving modern identity can be a deadly game. Modern identity often takes shape in the blending of lines that weren’t supposed to blend. No matter how coded or enforced, labels never hold all of one’s identity in place. The lines bounding the identity of the refugee are determined by the UN, and dictate a system of values foreign to many would-be refugees. For the Tamil mother from Sri Lanka, individual status as a refugee does not make sense; she is connected to the bones of her son and the soil in which they lie in Canada (Daniel 278). Terms of individuality are relative in the cultural understanding of many displaced peoples: collective identity in family structure supercedes that dictated by Western nation states, though the argument for asylum depends upon cognizance of Western value systems. When lines of identity inevitably blend, relative jurisprudence must be exercised. Lines make excluding circles and methods of excluding people from asylum; our international community divides into unwelcome and welcome nations. As discourse, cultural identity means translating beliefs and feelings from one culture to another. In the process of translation, a screen of cultural values filters understanding of the values and experience of the â€Å"other.† The simple word â€Å"refugee† evokes images and stories particular to a collectively defined identity, invoking â€Å"an image of the radicalized other† (Daniel 272). Finding trust and cultural understanding is crucial in securing safe haven; the human category of refugee is inundated with hydrophobic metaphors and imagined â€Å"racial markers† delimitating the story of the refugee into numbers and race categories (271).

Assessment Of Equipment Diagnostic Radiology Health And Social Care Essay

Handiness and the usage of X-ray equipment in both private and authorities infirmaries is on the addition today in developed and developing states. Quality control of such equipment is of peculiar importance to forestall evitable high doses, radiation escapes and to guarantee dose optimisation. The consequences of quality control in this survey indicate that the end product measured in GHL ( M2 ) ranged between 0.0318 and 0.1192 mGy ( ma ) -1, while comparatively higher values which ranged from 0.0762 to 0.2156 mGy ( ma ) -1 was found in four other infirmaries. The tubing electromotive force truth measured indicates fluctuation among the infirmaries investigated. The divergence in electromotive force truth ranged between 0.9 and 10.9 % in the two units of GHL ( M1 and M2 ) . In the three other infirmaries the scope of divergences are 0.2 to 0.5 % ( PSH ) , 45.5 to 72.7 % ( NOH, the highest ) 22.9 to 23.3 % ( NARH ) . Both GHL ( M1 ) and PSH complied with the demand of  ± 5 % . As r egard timer truth, one-dimensionality of the tubing current and beam alliance ; NOH and NARH exceeded the acceptable bounds of  ±5 % ,  ±10 % and  ±3 % severally. The effect of non-compliance in most portion include: repetition exposures, more disbursals and more significantly, extra dosage to the patient.Keywords: Quality confidence, quality control, environmental monitoring, radiation, X-ray end productIntroductionIn Nigeria, X-rays is the most often used ionizing radiation in medical specialty despite progresss in magnetic resonance imagination and ultrasound techniques. It has maintained a cardinal function in diagnosing of diseases, hurt and in X-ray therapy. In consequence it is the largest manmade beginning of ionising radiation to the universe population ( ICRP, 1991 ; UNSCEAR, 1993 ; Muhogora and Nyanda, 2001 ) . X ray is the major subscriber to the effectual dosage of both the patient and the forces. Because of the radiological hazards involved, it is normally recomm ended that dosage to patient from X-ray be kept every bit low as moderately accomplishable ( ALARA ) with equal image quality ( IAEA, 1996 ) . In add-on, programmes for diagnostic imagination sections, irrespective of the size, should at least contain the undermentioned constituents: equipment quality control, administrative duties, hazard direction and radiation safety programme. Equipment quality control unit carries out rating of equipment public presentation to guarantee proper image quality, every bit good as patient and operator safety ( Papp, 2002 ) . Furthermore, radiation safety unit is to guarantee that patient exposure is kept every bit low as moderately accomplishable and that departmental forces, medical staff and members of the general populace are protected from overexposure to ionising radiation. Presently, there are far above 4000 X-ray machines in Nigeria ( Elegba, 2006 ) out of which less than 5 % are under regulative control. These thereby pose a great jeopardy to the patient, forces and challenges to the regulative organic structure in Nigeria. As a consequence of handiness of X-ray installations, some new while others are 2nd manus ( known locally as Tokunbo ) , there has been a changeless addition in the figure and frequence of X-ray scrutinies in recent times. In Northwestern part of Nigeria for illustration, a study of 124 establishments with beginnings of ionising radiation indicates that 203 X-ray installings were found with merely 90 sealed radiation beginnings ( Mallam et al. , 2004 ) . In the same study, Ahmadu Bello University Teaching Hospital ( ABUTH ) complex on norm carries out over 250 diagnostic X-ray scrutinies per twenty-four hours in the three infirmary installations located in Zaria, Kaduna and Malunfasi. The population of the open persons and the fre quence of exposure is an indicant that one-year collective dosage to patient can be rather important. The quality control ( QC ) programme comprises the regular testing that must be carried out on each major constituent of the system to guarantee optimal public presentation within the system ( West,1993 ) . In diagnostic radiology QC trial is carried out to guarantee that a high quality diagnostic image is produced for a minimal radiation dosage to the patient ( NRPB, 1988 ) . The major equipment in diagnostic radiology to which quality control can be applied include X-ray production, sensing, image processing and image viewing equipment among others. The equipment testing is coupled with everyday environmental monitoring and appraisal of image quality ( Oluwafisoye et al. , 2009 ) .( 1.1 ) Nigerian Nuclear Regulatory Authority ( NNRA )Due to the hurtful effects of ionising radiation, the Nigerian Nuclear Regulatory Authority ( NNRA ) was established by the Nuclear Safety and Radiation Protection Act of 1995. This national regulative organic structure is charged with primary duty of atomic safety and radiation protection. The Act empowered the NNRA to categorise and licence activities affecting exposure to ionising radiation in peculiar, the ownership, production, processing, industry, purchase, sale, import, export, managing, usage, transmutation, transportation, trading, assignment, conveyance, storage, and disposal of any radioactive stuffs, atomic stuffs, radioactive waste, and any equipment breathing ionising radiation. In this respect, the NNRA in her papers made proviso for minimal demand for the equipment care in line with international regulative policies. As portion of the attempt at heightening safety in the usage of ionising radiation in Nigeria, the National Institute of Radiation Protection and Research ( NIRPR ) was established under the counsel of NNRA. The Institute trains forces in the radiation protection. The present measurings were conducted to look into the suitableness of the quality control trials and the stated tolerance degrees for assorted X-ray equipment at four Nigerian infirmaries. Additionally, environmental radiation supervising around the installations was carried out to determine the safety degree of both the patient and forces.( 2 ) MATERIALS AND METHODSQuality control trial ( kVp truth and duplicability, mAs one-dimensionality ) of four government-owned infirmaries, one general infirmary ( GHL ) , two specializer infirmaries [ Psychiatric infirmary ( PSH ) and National Orthopaedic infirmary ( NOH ) ] and one military infirmary ( NARH ) , all located in Lagos were carried out. The GHL has two functional X-ray units depicted as machine 1 ( M1 ) and machine 2 ( m 2 ) . The probe was carried out with the aid of the staff of the radiology section of each infirmary. Meanwhile, each of the X ray installations was used for both pediatric and big scrutinies. In all the infirmar ies there was no old exposure and QC informations available. The information use was done utilizing Microsoft Excel, 2003.( 2.1 ) Measurement of X-ray tubing Output and exposure clip merchandiseX-ray tubing end product is the sum of exposure, in millirontgens ( Mister ) delivered to a point in the Centre of the utile X-ray beam at a distance of 1 meter from the focal topographic point for 1 ma of negatron passing through the tubing. The end product expresses the ability of the tubing to change over electronic energy into X-ray exposure. X-ray tubing end product is the individual most of import parametric quantity to quantify radiation output ( Zoetelief et al, 2006 ) . The free-in-air exposure, FAE ( Mister ) was measured utilizing mill calibrated KV metre ( US made Victoreen X-ray trial device, theoretical account 4000 M+ ) obtained from the Department of Physics ( DOP ) University of Ibadan. The consistence of X-ray tubing end product with the tubing current ( ma ) or tube current exposure-time merchandise ( ma ) was measured for the scope of ma or ma values used in pattern. The sensor ( KV metre ) measures the mean, effectual and maximal extremum tubing electromotive force, power stage, exposure and exposure clip. This system determines the tubing electromotive force with truth of  ± 2 % ( Victoreen, 1995 ) . The internal ionisation chamber that measures exposure has volume of 36 cm3. The exposure clip is measured to an truth of  ± 2 % . The FAE ( Mister ) measured is converted into end product in mGy ( ma ) -1 by multiplying by a factor 0.00877/ ma ( Chang Jong and Hui- Yu, 1999 ) where ma in the denominator is the merchandise of the tubing current and exposure clip set at the clip of measuring of the end product.( 2.2 ) Environmental Monitoring and General ObservationsThe guiding rule used in all regulative paperss is that, radiation doses to the populace and to the people who work with radiation must be kept every bit low as moderately accomplishable ( ALARA rule ) . In kernel, radiation workers and the patient should be monitored at all times when working. The ground for this monitoring is to guarantee that the pattern being followed by the workers in their day-to-day modus operandi are safe and do non ensue in high doses being received. In the present survey, the dose rate at different points of involvement ( the console, entryway door behind the wall, patient waiting seats ) was measured with radiation sensor ( radiation proctor 4 minirad 1000+ ) . This device measures radiation dosage rate in ?Sv/ hour.( 2.3 ) Optical and Radiation Field Congruence/ Beam AlignmentThe beam control system is required for modulating the size of X-ray field country. Therefore, it plays an of import function in dose delivered to the patient because it controls the sum of patient surface country exposed to radiation and image contrast ( due to scattered radiation ) . The parametric quantities taken into consideration in beam control system includ e ; beam alliance, optical radiation field congruity, truth of the x Y graduated tables and illuminator bulb brightness. In this survey optical radiation field and beam alliance were examined.( 2.4 ) Ocular reviewsOne of the three parts of a quality control programme for a radiographic installation is ocular review. This portion includes look intoing the chief constituents of the equipment for proper operation, safety and good mechanical status. It is expected that they should include ; protective lead dress, lead shield of the cell wall, overhead tubing Crane, radiographic tabular array, control panel and other installations such as door and automatic visible radiation.( 3 ) RESULTS AND DISCUSSIONFive X-ray units in four infirmaries were investigated in the survey. Both the QC and environmental appraisal of the installations were carried out. Table 1 presents the radiographic equipment information at assorted infirmaries investigated. The old ages of industry of the equipment scope from 9 to 31 old ages, while the twelvemonth of installing is between 5 and 31 old ages. The consequence of age on the end product of an X-ray machine is good documented ( Mallam et al. , 2004, Ogundare et al. 2004 ) .( 3.1 ) X ray tubing OutputThe consequence of X-ray tubing end product at a distance of 1m each from the focal point of five X-ray units are presented in Table 2. The values of end product obtained in GHL ( M2 ) are comparatively low, those measured in GHL ( M1 ) are higher than those found in M2. It ranged from 0.0318 to 0.1192 mGy ( ma ) -1. However, higher end products are found at the same electromotive force in PSH and NOH. As an illustration, at 80kVp the end products are 0.0796, 0.1676, 0.2156 and 0.0762 mGy ( ma ) -1 for GHL ( M1 ) , PSH, NOH and NARH severally. The fluctuation in the end product could be attributed to the wave form, anode stuff, filtration, and tube age and anode surface harm. Knowledge of the end product value for a given X-ray tubing permit s the finding of both patient and movie exposures. It is besides used in the computation of Entrance Surface Dose ( ESD ) delivered to the patient at the point where the X-ray beam enters the patient. This dosimetry parametric quantity ( ESD ) gives the perspective appraisal of absorbed dosage to the patient. Although the entryway surface dosage is a hapless hazard index, it can be used to gauge the effectual dosage ( ED ) which better quantifies patient hazard ( Gkanatsios and Huda,1997 ) . The fluctuation in the end product among the infirmaries could take to fluctuation in doses delivered to the patients during the scrutinies. The consistence of X-ray tubing end product with ma was measured for a scope of ma for the five X-ray units at different electromotive forces. The consequences are presented in figures 1-3. Furthermore, consequences of end product measured at different kVp above 80 kVp ( GHL and NARH ) show strong correlativity with ma, nevertheless, the end products measured at lower electromotive force of 60 and 75 kVp indicate weak correlativity with ma. The X-ray tubing and the anode current are extremely stabilized at this point ( Suliman and Elshiekh, 2008 ) . The consequences of the tubing electromotive force truth for five X-ray units investigated are presented in tabular arraies 3a-3d. The tabular arraies show the tubing electromotive force set, the tubing electromotive force measured and the magnitude of divergence. It should be noted that the magnitude of divergence in kVp vary from infirmary to infirmary. In GHL, the divergence ranged between 0.9 and10.9 % for the two machines ( M1 and M2 ) . The scopes of magnitude of divergence for the three other infirmaries are ; 0.2 to 0.5 % , 45.5 to 72.7 % ( highest in this survey ) and 22.9 to 23.3 % in PSH, NOH and NARH severally. Both m1 ( GHL ) and PSH comply with the demand of  ± 5 % , while M2 ( GHL ) , NOH and NARH exceeded the demand. The grounds for higher divergence in kVp found in NOH and NARH are multifactorial. The European Commission recommended a high technique of 125 kilovolts IAEA ( 1995 ) which likely consequences in low doses, but the radiotherapists prefer the higher contrast thorax radiogram which consequences from low kVp. Earlier study indicated that increasing the tubing potency ( kVp ) from 8-13 kilovolt in lumbar and pectoral spinal column scrutiny resulted in a dose decrease of 26-36 % ( Martin et al, 1993 ) . The higher divergences outside the tolerance bound as obtained in the present survey show disagreements in kVp between the measured and the set values particularly if the tubings are non adequately maintained. Furthermore, the overly high divergence between the set and the measured kVp could cut down the image contrast ( Livingstone et al, 2004 ) . The unexpected elevated value of proficient parametric quantities which consequences from defective machine could impact both patient dosage and image quality. The tendencies found in GHL ( M2 ) , NOH and NARH require regular and repeated QC trials.( 3.2 ) Quality Control ( QC ) TrialTable 4 is the sum-up of the QC trials carried out on the equipment at different infirmaries. The kVp truth trials show conformity with acceptable bound in GHL ( M1 and M2 ) and PSH while NOH and NARH show non-compliance with acceptable bound of 5 % . As respects the kVp consistence, similar tendency is found in the infirmaries as those found in kVp truth. In footings of timer truth, it is postulated that exposure clip straight affect the entire measure of radiation emitted from an X-ray tubing. Therefore, an accurate exposure timer is critical for decently exposed radiogram and sensible patient radiation exposure. Both GHL and PSH met the the acceptable variableness bound. Since the timer truth in NOH and NARH are above the bound of acceptableness, it is expected that the radiation dosage delivered to the patient will be higher than the expected value required to bring forth the movie. Furthermore, the one-dimensionality of tubing current ( ma ) and beam alliance of both NOH and NARH fell abruptly of the acceptable bound of 10 % and 3 % severally. Regulation of X-ray tubing filament temperature ( along with the exposure clip find the quality of X raies in the X-ray beam ) is done with millampere picker in an X-ray generator. The beam limitation system is required for modulating the size of the X-ray field country. The mechanism contro ls the sum of patient anatomy exposed to radiation beam ( Papp, 2002 ) . This plays a cardinal function in patient dose and image contrast. The addition in country increases the production of the scattered radiation, hence higher patient dosage and wellness hazard. The non-compliance of optical radiation field and radiation field congruity may stem from the displacement in mechanism that moves the shutter, doing improper public presentation. This leads to higher patient dosage and repetition images ( consequence in more movies being used and more disbursals ) .( 3.3 ) Forces DistributionThe saloon chart in figure 4 shows the distribution of forces. It indicates that two classs of forces are losing ; Radiation Protection Officer/ Medical Physicist and Record Officer. The tendency is similar to the earlier work reported elsewhere ( Oluwafisoye et al. , 2009 ) . The tendency shows that radiation protection of the patients, visitants and forces is non the preoccupation of the direction of the infirmaries investigated. The absence of the record officers indicate that record maintaining at the infirmaries is far from being equal. A record maintaining system is necessary to document the quality control processs, the figure of culls and other activitie s traveling on at the X-ray units of the infirmary.( 3.4 ) Visual/ General ObservationsThe consequence of ocular observations is presented in table 5. It shows that all the basic constituents inspected were functional except LED index on the control panel found in GHL ( M2 ) . Table 6 shows the general observations carried out at assorted infirmaries investigated. Columns 1 and 2 show that the chief door taking to the X-ray room is non lead-lined. Columns 3 and 4 indicate that merely NOH has efficient 2nd door and lead-lined. The cells of the four infirmaries are efficient. This indicates that the interior decorator of the console put in topographic point equal steps that prevent the technicians from immaterial beams during exposures. The doors to the units lack automatic control, connoting that during the exposure the doors do non shut automatically as a consequence, controlled entree to the country where radiation exposure may be taking topographic point is non ensured. Lead apron was non provided in NARH. Nevertheless, the lead apron provided in GHL was non efficient. Regulation for good pattern stipulates that lead aprons and baseball mitts should be available in the radiographic room and have a lower limit of 0.5 millimeters of lead tantamount thickness ( Papp,2002 ) . It is besides apparent that technique charts were losing in all the units, an indicant that technique parametric quantities are chosen at random by the radiographers responsible for the exposure of the patient. This could take to hapless matching of patient size and technique parametric quantities. Furthermore, warning visible radiation was non provided in any of the units to warn visitants or other forces of the exposure traveling on in the X-ray room. The forces monitoring badge was merely available in NOH, bespeaking that forces dose supervising in GHL, PSH and NARH are non-existent.( 3.5 ) Dose degreeConsequence of environmental dose monitoring at the chosen locations within and in the immediate environment of each of the X-ray units investigated is presented in table 7. The consequences in all the five units indicate that the dose rate measured at the sofa are by and large really high. At the border of the cell the dosage rates recorded are greater than the background dosage rate by a factor of 7, 20, and 10 in GHL ( M1 ) , PSH and NARH, severally. The dose rate measured within the cell is comparable to the background. This status is safe for the radiographer ; nevertheless, the dose rate is high within the entryway door in GHL ( M1 ) and NARH, it is greater than the backg round dosage rate by a factor of 6 and 7.5 each. In add-on, the dose rate measured at the waiting anteroom of the patients is comparable with the background dosage rate in PSH and NARH, but higher than the background dosage rate by a factor of 10 in NOH. The high dosage rate experienced in NOH could be attributed to damaged door of the X-ray units. Another possible account for the high dosage rate at the waiting anteroom is the direct nexus between the anteroom and the X-ray machine. It is interesting to observe that there were no escapes experienced in the five X-ray units investigated as reported in the earlier survey carried out in Nigeria ( Oluwafisoye et al. , 2009 ) . Apparently, this present survey is the first QC trial and environmental monitoring attempts carried out in the five X-ray units in four infirmaries investigated. This is an indicant that the consequences are preliminary against which future measurings could be compared. Besides, the usage of thermoluminescent dosemeters ( TLD ) for the forces monitoring has ne'er been undertaken in the five units. Personnel monitoring is indispensable, since there is a nexus between the ionizing radiation and coevals of reactive O series [ ROS ] ( Cohen, 2002 ) . These ROS have been implicated in the etiology of over 100 diseases. Radiation is one of the major exogenic beginnings of free groups in adult male and it has been proved that ionising radiation produces ROS in biological system capable of destructing biomolecules such as DNA, lipoids, proteins and saccharide ( Olisekodiaka et al. , 2009 ) . Workers runing X-ray equipment are exposed to long term low doses of ionising radiation which may imp act their antioxidant position. Consequences of the QC trials and monitoring were sent to the direction of the four infirmaries investigated. In Addition, recommendations on the necessity of regular QC trial were forwarded to each infirmary for necessary actions.( 4 ) DecisionQuality control trials of five X-ray units are undertaken with intent of safety and dose optimisation in the X-rays Centres investigated. The ages of three out of five machines are good over 10 old ages. In add-on, the divergence of the measured kVp from set value on the control panel varied among the infirmaries. Two out of the five machines complied with the needed criterion of pattern, while three exceeded the demand. The QC trial carried out on kVp truth and consistence show non- conformity in two infirmaries. The distribution of forces show that, the preoccupation of the authorization of the X-ray unit investigated was the quality of the radiogram produced at the disbursal of safety of the patient. The fluctuation in the end product of th e assorted tubing is an indicant that doses among the infirmaries differ. In each of the X-ray units investigated there was no specialised installation to execute pediatric scrutinies and movie screening.