Battle of Valmy in the French Revolutionary Wars

Battle of Valmy in the French Revolutionary Wars The Battle of Valmy was fought September 20, 1792, during the War of the First Coalition (1792-1797). Armies and Commanders French General Charles Franà §ois DumouriezGeneral Franà §ois Christophe Kellermann47,000 men Allies Karl Wilhelm Ferdinand, Duke of Brunswick35,000 men Background As revolutionary fervor wracked Paris in 1792, the Assembly moved towards conflict with Austria. Declaring war on April 20, French revolutionary forces advanced into the Austrian Netherlands (Belgium). Through May and June these efforts were easily repulsed by the Austrians, with the French troops panicking and fleeing in the face of even minor opposition. While the French floundered, an anti-revolutionary alliance came together consisting of forces from Prussia and Austria, as well as French à ©migrà ©s. Gathering at Coblenz, this force was led by Karl Wilhelm Ferdinand, Duke of Brunswick. Considered one of the best generals of the day, Brunswick was accompanied by the King of Prussia, Frederick William II. Advancing slowly, Brunswick was supported to the north by an Austrian force led by the Count von Clerfayt and to the south by Prussian troops under Fà ¼rst zu Hohenlohe-Kirchberg. Crossing the frontier, he captured Longwy on August 23 before advancing to take Verdun on September 2. With these victories, the road to Paris was effectively open. Due to revolutionary upheaval, the organization and command of the French forces in the area were in flux for most of the month. This period of transition finally ended with the appointment of General Charles Dumouriez to lead the Armà ©e du Nord on August 18 and the selection of General Franà §ois Kellermann to command the Armà ©e du Centre on August 27. With the high command settled, Paris directed Dumouriez to halt Brunswicks advance. Though Brunswick had broken through the fortifications of the French frontier, he was still faced with passing through the broken hills and forests of the Argonne. Assessing the situation, Dumouriez elected to use this favorable terrain to block the enemy. Defending the Argonne Understanding that the enemy was moving slowly, Dumouriez raced south to block the five passes through the Argonne. General Arthur Dillon was ordered to secure the two southern passes at Lachalade and les Islettes. Meanwhile, Dumouriez and his main force marched to occupy Grandprà © and Croix-aux-Bois. A smaller French force moved in from the west to hold the northern pass at le Chesne. Pushing west from Verdun, Brunswick was surprised to find fortified French troops at les Islettes on September 5. Unwilling to conduct a frontal assault, he directed Hohenlohe to pressure the pass while he took the army to Grandprà ©. Meanwhile, Clerfayt, who had advanced from Stenay, found only light French resistance at Croix-aux Bois. Driving off the enemy, the Austrians secured the area and defeated a French counterattack on September 14. The loss of the pass forced Dumouriez to abandon Grandprà ©. Rather than retreat west, he elected to hold the southern two passes and assumed a new position to the south. By doing so, he kept the enemys forces divided and remained a threat should Brunswick attempt a dash on Paris. As Brunswick was forced to pause for supplies, Dumouriez had time to establish a new position near Sainte-Menehould. The Battle of Valmy With Brunswick advancing through Grandprà © and descending on this new position from the north and west, Dumouriez rallied all of his available forces to Sainte-Menehould. On September 19, he was reinforced by additional troops from his army as well as by the arrival of Kellermann with men from the Army du Centre. That night, Kellermann decided to shift his position east the next morning. The terrain in the area was open and possessed three areas of raised ground. The first was located near the road intersection at la Lune while the next was to the northwest. Topped by a windmill, this ridge was situated near the village of Valmy and flanked by another set of heights to the north known as Mont Yvron. As Kellermanns men began their movement early on September 20, Prussian columns were sighted to the west. Quickly setting up a battery at la Lune, French troops attempted to hold the heights but were driven back. This action did buy Kellermann sufficient time to deploy his main body on the ridge near the windmill. Here they were aided by Brigadier General Henri Stengels men from Dumouriezs army who shifted north to hold Mont Yvron. Despite the presence of his army, Dumouriez could offer little direct support to Kellermann as his compatriot had deployed across his front rather than on his flank. The situation was further complicated by the presence of a marsh between the two forces. Unable to play a direct role in the fighting, Dumouriez detached units to support Kellermanns flanks as well as to raid into the Allied rear. The morning fog plagued operations but, by midday, it had cleared allowing the two sides to see the opposing lines with the Prussians on the la Lune ridge and the French around the windmill and Mont Yvron. Believing that the French would flee as they had in other recent actions, the Allies began an artillery bombardment in preparation for an assault. This was met by return fire from the French guns. The elite arm of the French army, the artillery, had retained a higher percentage of its pre-Revolution officer corps. Peaking around 1 PM, the artillery duel inflicted little damage due to the long distance (approx. 2,600 yards) between the lines. Despite this, it had a strong impact on Brunswick who saw that the French were not going to break easily and that any advance across the open field between the ridges would suffer heavy losses. Though not in a position to absorb heavy losses, Brunswick still ordered three assault columns formed to test the French resolve. Directing his men forward, he halted the assault when it had moved around 200 paces after seeing that the French were not going to retreat. Rallied by Kellermann they were chanting Vive la nation! Around 2 PM, another effort was made after artillery fire detonated three caissons in the French lines. As before, this advance was halted before it reached Kellermanns men. The battle remained a stalemate until around 4 PM when Brunswick called a council of war and declared, We do not fight here. Aftermath of Valmy Due to the nature of the fighting at Valmy, the casualties were relatively light with the Allied suffering 164 killed and wounded and the French around 300. Though criticized for not pressing the attack, Brunswick was not in a position to win a bloody victory and still be able to continue the campaign. Following the battle, Kellermann fell back to a more favorable position and the two sides began negotiations regarding political issues. These proved fruitless and the French forces began extending their lines around the Allies. Finally, on September 30, Brunswick had little choice but to begin retreating towards the border. Though the casualties were light, Valmy rates as one of the most important battles in history due to the context in which it was fought. The French victory effectively preserved the Revolution and prevented outside powers from either crushing it or forcing it to even greater extremes. The next day, the French monarchy was abolished and on September 22 the First French Republic declared. Sources: History of War: Battle of ValmyBattle of Valmy

Ripple effects by economic facts essays

Ripple effects by economic facts essays There are several things that can cause a ripple effect in our economy. There are economic facts, or things that will happen no matter what, that start to affect more and more people, until they sooner or later effect everybody. The Keynesian Transmission Mechanism is a good example of something that has a ripple effect on everybody. The Keynesian mechanism has three stages, each of which has an effect on something. The first stage is the increase or decrease in the supply of money (A-1). The second stage is for the investment to rise or fall in conjunction with the change of the money supply (B-1). The third and final stage in the mechanism, is for the total expenditure/aggregate demand curve to shift accordingly to the both the money supply, and the investment. There are also some walls that block the mechanism from working, that have ripple effects on the economy. These include the Liquidity trap, and Interest-Insensitive Investment. In the first stage of the Keynesian Transmission Mechanism, the money supply is either raised, or lowered by the Fed. They do this by buying and selling bonds to the public. If they buy bonds back, then they are essentially lowering the money supply, where as if they sell them, then they are raising the money supply. Looking at this alone, one can predict a rise or a fall in the amount of each individual has due to the scarcity of money, or the lack there of. This will have a ripple effect on the economy, because people will save more if they have less, and spend more if they have more (C-1). For example, if the Fed were to increase the money supply would cause a surplus of money in the money market. This in turn will have an effect on the interest rates. The interest rates will lower due to the money surplus (B-1). Because of the lower interest rate, the AD curve will shift to the right. This happens due to a drop in the price level because of the lower interest rate. W ith the l...

History essay- Reading and comprehension of the book Taken Hostage by Essay

History - Reading and comprehension of the book Taken Hostage by David Farber - Essay Example 4, 1979 which turned it into a revolutionary day which is, and will be remembered for a long time; maybe forever. This paper will clarify the reasons behind the hostage crisis in Iran along with its impacts on the US government and its economy. We will also see the facts this event exposed about US government and about the President of that time. Numerous words will be added from the book ‘Taken Hostage’ to justify the claims and to clarify all the details with substantiations. Taken Hostage- Background & Causes of the 1979 hostage crisis After reading the book taken hostage: the Iran hostage crisis and America's first encounter with radical Islam, I have become a big fan of David Farber. Every word of the book holds a clear background of the story that revolves around the historic hostage situation that continued for 444 days. The story, on which the book is based, holds enormous depth within. David Farber’s analysis is based on a narrative point of view which lo oks beyond the day-to-day circumstances of the predicament with the interpretation of the lessons for America’s contemporary war on terrorism.... The reason behind the hostage situation was the anger that many Iranians felt over Jimmy Carter, the US president of that time. Iranians were angry on the US president for allowing Shah Reza Pahlavi, who was the deposed ex ruler of Iran to enter the US for a medical treatment. Broadly, the United States had helped to establish the Shah Reza Pahlavi in the 1950's, and had powerfully backed his regime, despite the fact that Shah's government was dishonest and its human rights record was terrible. It was believed in Iran that this was just the aperture move leading up and American-backed return to the power by the Shah Reza Pahlavi. This became a state that was nothing less than a war, and as a result; Jimmy Carter’s presidency was broke. It was the Ayatollah Khomeini, who after Shah's entrance into the U.S., called for anti-American street demonstrations. The situation got this worst because Americans were not prepared for the crisis which came suddenly and made it the most diff icult decade for America in their entire history (Farber, 12). As stated by Farber (2005), â€Å"A furious mob rallied outside the American embassy in Tehran. There were thousands of people who appeared to be students, mostly men but, woman too. The women were in black, shrouded in chador. A small group cut the thick chain that secured the main gates and filed into the twenty seven acre embassy compound†¦ the embassy personnel were blindfolded with hands tied behind. Now, the 444 days of captivity had begun† (p. 12). At this moment the environment of serious hostility began between America and Iran and is still intact on the present day. This hostage crisis showed entire world the inability of the Carter

Speech Essay Example | Topics and Well Written Essays - 1500 words

Speech - Essay Example lutions to these issues are about making different choices, having priorities and that prove our ability to deliver even where money is little (Laird1999). The importance of education is known to everyone in the society. The Liberal government which I was and still is a part of promised to raise university tuition money from $2,168 to $3,793 in the period between 2012 and 2017. The government, I can assure you is still working on the education benefits to bring this course of action in place for the benefit of our own young people who we are in the making to be the masters of our own house. Our education program has been through controversies over the years while it has still developed into something substantial in the long run. It is of importance to consider programs that encourage all of Canada and Quebec as one to bring together our young people to schools. Our education system will be subsidized as the English schools were subsidized to ensure every young person in this country obtains a decent education. My government will ensure that. The numbers of children out there are encouraged to return to schools. I will also ensure schol arship programs for our students in order to create expansiveness in their studies. We shall avail necessities for free in our public institutions to ensure smooth running of curriculum matters. Seeing children not benefit from our nations resources is disheartening. We therefore emphasize that these children be encouraged to utilize the available material in schools to benefit intellectually. I’ve met a large number of people who can barely make ends meet. Families in the entire country are face quiet crisis of ever rising costs. These costs are evident in the prices of oil and in overall way routine of life. Electricity and other bills are especially high. The government has over the years worked around the issue of matters by creating the Quebec Hydro-electricity. Contribution to this investment to subsidize the costs of fuel

Is the god existing Essay Example | Topics and Well Written Essays - 500 words

Is the god existing - Essay Example However, for many people there is another big question, is the God Existing? of which they are trying to seek an answer. In this paper I will be focusing onto explore this posed question and try to find its answer by means of exploring the contemporary views and assertions in the literature. In the present time, I have seen that many religious scholars from several religions are facing one common question which is that Does God Exist? as if the mankind is drowned in the ocean of uncertainty (Fishel 16). According to Schroeder, contradictions are there among scholars and general public thoughts about reasons why there are frequent floods, earthquakes are increasing, people’s economic lives are disturbed, and opportunities for earth resources are getting dissolved. Even people with high belief systems are stuck in this question that why God is not doing something. If He exists then why not stop mankind’s suffering. This is the question, which certainly has brought people to numerous contradictions (Schroeder 3-5). It seems to me that their thoughts are crumbled and their notions are perplexed that the God is really Existing or not. â€Å"You are here to enable the divine purpose of the universe to unfold. That is how important you are† (Tolle 142). The narration asserts the divine purpose of human existence, which is to connect to God, the Being in Existence. Exploring the literature I find that the human race deviated from its divine purpose and for that reason it got lost on its way and the journey of life ended in trouble, loathsome, uncertainty and suffering. It seems to be like this is the gist of life, which ultimately is associated to the existence of God. A thought of mine enhances that from purpose are the forms as for the forms is there a purpose. When purpose is lost, the existence of a form (the human existence) inevitably gets lost too. The existence of this divine purpose which is to submit to God shows that God does Exist, but it is the lack

Cardiovascular Disease

Cardiovascular Disease Cardiovascular Disease Introduction This paper utilizes qualitative data drawn from a series of focus group discussions with patients living with coronary heart disease which explored their understanding of and adherence to a prescribed monitoring and medication regime. These findings are drawn upon in order to contextualize, from the patients perspective, the outcomes of the Departments of Healths Coronary Heart Disease National Service Framework strategy. The paper focuses attention on the consequences of this regulatory approach to clinical and risk management for those patients already living with coronary heart disease. Case Study Patient is 59 yrs old and had a myocardial infarction 2 years ago. He is obese, a smoker and poorly motivated. The case exemplifies many of the difficulties that frequently arise in managing cardiovascular disease, and suggests potential avenues for improving outcomes through the application of a disease management programme. The Coronary Heart Disease National Service Framework By the mid 1980s, it had been generally accepted by most clinicians that there was strong evidence to support the existence of a linear relationship between cholesterol levels and cardiac mortality (Shaper et al. 1985, Stamler et al. 1986), and that therefore lowering total cholesterol levels would reduce the risk of individuals developing coronary heart disease. This opened the way to the process of establishing a recommended cholesterol threshold level at which treatment should be instigated (Leitch 1989). Since then, the trend has been towards setting ever-lower threshold targets for treatment for those designated as being at high risk of developing coronary heart disease and for those already living with the disease. In 2000, the Department of Health published its Coronary Heart Disease National Service Framework which set out 12 standards for the prevention, diagnosis and treatment of the disease (Department of Health 2000). The National Service Framework standard Number 3 recommended that GPs identify and develop a register of diagnosed patients and those patients at high risk of developing coronary heart disease. Dietary and lifestyle advice (what the document terms ‘modifiable risk factors) was to be offered to these patients, and their medication reviewed at least every 12 months. It was also recommended that statins be prescribed to anyone with coronary heart disease or having a 30% or greater 10-year risk of a ‘cardiac event, in order to lower their blood cholesterol levels to less than 5 mmol/l or by 30% (which ever is greater). These recommendations were vigorously promoted when they were incorporated into the new General Medical Services contract that came into operation in 2003. The relative performance of an individual Primary Care Organization in meeting each of these indicators attracts points on a sliding scale that are then converted into payments for individual GPs. In relation to the management of patients with coronary heart disease, higher payments are received if a Primary Care Organization increases the percentage of patients with coronary heart disease who have their total serum cholesterol regularly monitored, and whose last cholesterol reading was less than 5 mmol/l (Department of Health 2004a). The most recent Department of Health progress report on the National Service Framework argues that the massive growth in statin therapy since 2000; ‘. . . is one of the most important markers of progress on the NSF, and was directly saving up to 9,000 lives per year (Department of Health 2005: 19). Statin prescriptions have been rising at the rate of 30% per year since 2000, and in 2004/5  £750 million was spent on statins, equivalent to some 2.5 million people on statin therapy in England (Department of Health 2005). In July 2004, low doses of statins became available over the counter without prescription for the first time, for those at moderate risk. The Public Health Discourse(S) Of Cardiac Risk The application of risk discourses in the field of public health (or more precisely the ascription of health risk to particular behaviours) as conceptualized within those elements of the risk literature most influenced by Foucauldian notions of governmentality, are seen as serving to construct the socially recalcitrant as distinct from the responsible citizen (Foucault 1977, Turner 1987, Lupton 1995). In a similar way, Dean (1999) argues that once risk has been attributed to particular health behaviours, the distinction is then drawn within public health policies between ‘active citizens who are perceived as able to manage their own heath risks, and ‘at-risk social groups who become the object of targeted interventions designed to manage these risks. Two distinct dimensions or approaches to the conceptualization and public health management of cardiac health risks also emerge from an examination of the ‘guiding values and principles which inform the Department of Healths Coronary Heart Disease National Service Framework (Department of Health 2000).While one approach (described below as the ‘epidemiological model of risk) largely conforms to the individualized ‘at-risk discourse, a second discourse (described below as the ‘social model of risk) which is much more concerned with health risk at a social and material level can also be discerned within the National Service Framework. These two distinct and arguably competing discourses of risk point to a complexity in current public health policy that might not be anticipated from a reading of the governmentality literature alone. The first conceptualization of cardiac risk within the Coronary Heart Disease National Service Framework is one that can be termed the ‘social model of health risk. This model essentially reflects a socio-economic understanding of the determinants of population health, and draws attention to the importance of addressing material, social and psychological risk factors in addition to the known biological factors in heart disease. In the National Service Framework, this social model is reflected in the endorsement (albeit at a rhetorical level) of an interventionist role for the state in addressing these wider determinants of the disease: ‘The Governments actions influence the wider determinants of health which include the distribution of wealth and income. A wide range of its policies will have an impact on coronary heart disease including social and legal policies and policies on transport, housing, employment, agriculture and food, environment and crime (Department of Health 2000: Section 1, Para 17). There is also an explicit acknowledgement that these risk factors disproportionately disadvantage particular sections of society, demonstrated in the higher incidence of coronary heart disease among the manual social classes. It is also acknowledged that there is inequity in health service provision; ‘. . . there are unjustifiable variations in quality and access to some coronary heart disease serv ices, with many patients not receiving treatments of ‘proven effectiveness (Department of Health 2000: Section 1, Para 13). This formal acknowledgement of the governments role in addressing the wider social and economic influences on cardiac health risk could to some degree be said to conform to Becks (1992) notion of the ‘risk society; wherein many of the health risks faced by the population are a consequence of unchecked scientific and industrial ‘progress. Beck asserts that in response a greater public awareness or ‘reflexivity of risk has emerged which reflects a shift from ignorance or private fears about the unknown to a widespread knowledge about the world we have created. The question of whether a reflexivity concerning the social and environmental factors associated with cardiac risk can be discerned in a patients own discourses of cardiac risk is something that will be explored in the discussion below. The second risk discourse emergent within the National Service Framework (Department of Health 2000) is one which reflects a predominantly epidemiological understanding of health risk. In this model, the relative risk of an individual developing heart disease is based upon a calculation of the mean values associated with certain ‘lifestyle behaviours such as smoking, diet and exercise that are drawn from aggregated population data for heart disease incidence. This is a statistical approach that all too often perceives such calculated health risk factors as being realities or causative agents in their own right, often with little acknowledgement of the social and material context of these health behaviours. Nevertheless, it is on the basis of this epidemiological model of health risk that the Department of Health has confidently set national guidelines that now require General Values and principles underlying the CHD National Service Framework Nine stated values underlying development of national policies for CHD Provision of quality services irrespective of gender, disability, ethnicity or age. Ready availability of consistent, accurate and relevant information for the public. Consideration of health impact in regard to social and legal policies and policies on transport, housing, employment, agriculture and food, environment and crime. Public health programmes led by health and local authorities to ensure targets for CHD are met. Reduction in health inequalities. Resources will be targeted at those in greatest need and with the greatest potential to benefit. Evidence-based. CHD policies are to be based on the best available evidence. Integrated approach for the prevention and treatment of CHD in health policy, health promotion, primary care, community care and hospital care. Maintenance of ethics and standards of professional practice. Recognition of the importance of voluntary organizations and carers at home in addressing CHD. Four stated principles underpinning the CHD NSF . Reducing the burden of CHD is not just the responsibility of the NHS. It requires action right across society . The quality of care depends on: ready access to appropriate services ii. the calibre of the interaction between individual patients and individual clinicians iii. the quality of the organization and environment in which care takes place. . Excellence requires that important, simple things are done right all the time. . Delivering care in a more structured and systematic way will substantially improve the quality of care and reduce undesirable variations in its provision. Practitioners to identify and monitor ‘high risk patients and to prescribe the recommended drug treatment regime. It can be argued that this regulatory or ‘managerialist approach to clinical decision-making constitutes a challenge to the discretion that has been traditionally enjoyed by general practitioners in relation to the clinical management of patients. This second ‘official discourse of health risk could be seen as indicative of the regulatory and surveillance forms of governmentality identified within Foucauldian social theory. From this perspective, those social groups whose health behaviour or lifestyle are seen to fall outside the acceptable bounds of self-management then become constructed as ‘at-risk. These are social groups who are seen to, ‘deliberately expose themselves to health risks rather than rationally avoiding them, and therefore require greater surveillance and regulation (Lupton 1995: 76); once identified these groups and individuals then become subject to various health promotion or ‘health improvement initiatives. Implicit in such forms of governmentality as applied within health policy interventions designed to manage risk are a set of assumptions about the nature of human action predicated on the notion of the ‘rational actor model. Jaeger, Renn, Rosa and Webler (2001) have argued such models of rationality operate at three levels of abstraction. In its most general form, it presupposes that humans are capable of acting in a strategic fashion by linking decisions with actions. That is, human beings are goal-orientated who have options available from which they are able to select a course of action appropriate to meeting these goals. The second level of abstraction which the authors term the ‘rational actor paradigm, and which is the level at which rationality is probably understood by policy-makers, contains the following assumptions: all actions are individual choices; individuals can distinguish between ends and means to achieve these ends; individuals are motivated to pursue t heir own self-chosen goals when making decisions about courses of action/behaviour; individuals will always choose a course of action that has maximum personal utility, that is it will lead to personal satisfaction; individuals possess the knowledge about the potential consequences of their actions when they make decisions. Finally, that rational actor theory is not only a normative theory of how people should make decisions about in this case health behaviour, but is also a descriptive model of how people select options and justify their actions (Jaeger et al. 2001: 33). Many of these rational actor assumptions underpin and inform the Coronary Heart Disease National Service Framework. Such assumptions manifest themselves in a seemingly unproblematic approach to the promotion of ‘risky health behaviour change which plays down the influence of culture, habitus and the material basis of group socialization. This uncritical rationality also threatens the sustainability of the National Service Framework strategy in other ways. The social psychological and sociological literature see the notion of ‘trust as constituted through two dimensions, the deliberative or rational and the affective or non-rational. As Peter Taylor-Gooby (2006) has pointed out in his work on the problematic of public policy reform, the rational deliberative processes associated with the achievement of greater efficiency in the provision of public services have unwittingly served to undermine the non-rational processes that contribute to the building of trust in public institutions and in public sector professionals. In this context, the National Service Framework will need to build trust both in terms of the presentation of the biomedical evidence for the effectiveness of statins and other cardiac drug interventions, as well as the more affective elements associated with the belief that the national targets are designed with the best interests of patients in mind rather than being driven by financial considerations alone. Significantly, given its centrality to a ‘disease management strategy, neither the Coronary Heart Disease National Service Framework (Department of Health 2000) nor the NHS Improvement Plan (Department of Health 2004b) which sets out the governments priorities Coronary heart disease and the management of risk 363 for primary and secondary healthcare up to 2008, attempts to define the use of the term ‘risk, and by extension ‘higher risk. Nevertheless, the conception of risk that shapes the practical interventions proposed within both these strategy documents is clearly the epidemiological one that is described above. In the past, such public health interventions have been largely concerned with bringing about health behaviour change, however now the strategy would appear to be less focused on encouraging greater responsibility for the ‘self management of cardiac risk and more on ensuring compliance with clinical management regimes of monitoring and drug treatme nt. Optimising Care Through Disease Management In the last 15 years, there have been dramatic advances in the pharmacotherapy of heart disease, most notably the introduction of angiotensin converting enzyme (ACE) inhibitors. (Jaeger et al. 2001: 33) Unfortunately, numerous studies have suggested that ACE inhibitors are substantially underutilised in heart disease patients. Moreover, there are a multitude of factors which may confound heart disease management heart disease virtually never occurs in isolation, and comorbidities such as hypertension, diabetes, coronary artery disease, chronic pulmonary or renal disease and arthritis occur frequently. The presence of these comorbid conditions may interfere with heart disease management in several ways. In PATIENTs case, pre-existing renal insufficiency may have contributed to her intolerance to ACE inhibitors. In addition, her use of NSAIDs could promote salt and water retention and antagonise the antihypertensive effects of her other medications. (Jaeger et al. 2001: 33) Multiple comorbidities may also result in polypharmacy, which, in turn, may compromise compliance and lead to undesirable drug interactions. Adherence to dietary sodium restriction is often problematic (as in patients case), particularly in older individuals who are either not responsible for preparing their own meals, or who rely heavily on canned goods and prepared foods. Depression, anxiety and social isolation are common in patients with heart disease, and each may interfere with adherence to the heart disease regimen or with the patients willingness to seek prompt medical attention when symptoms recur. Similarly, the high cost of medications may limit access to therapy in patients with restricted incomes. Physical limitations, such as neuromuscular disorders (e.g. stroke or Parkinsonism), arthritis and sensory deficits (e.g. impaired visual acuity), may compromise the patients ability to understand and comply with treatment. Finally, cognitive dysfunction, which is not uncommon in elderly heart disease patients, may further confound heart disease management. Impact on Clinical Outcomes Despite the widely publicised effects of ACE inhibitors, b-blockers, angiotensin receptor blockers and other vasodilators on the clinical course of heart disease, morbidity and mortality rates in patients with established heart disease remains very high. heart disease is the leading cause for repetitive hospitalizations in adults, and in 1997 Krumholz et al. reported that 44% of older heart disease patients were rehospitalised at least once within 6 months of an initial heart disease admission. Remarkably, this rate was no better than that reported in several prior studies dating back to 1985. (Krumholz et al. 1998) From the disease management perspective, it is important to recognise that the majority of heart disease readmissions are related to poor compliance and other psychosocial or behavioural factors, rather than to progressive heart disease or an acute cardiac event (e.g. myocardial infarction). Thus, Ghali et al. reported in 1988 that 64% of heart disease exacerbationswere attributable to noncompliance with diet, medications or both and that 26% were related to environmental or social factors. Similarly, in 1990 Vinson et al. (Vinson, 1995) found that over half of all readmissions were directly attributable to problems with compliance, lack of social support, or process-of care issues, and these authors concluded that up to 50% of all readmissions were potentially preventable. More recently, Krumholz et al, reported that lack of emotional support among older heart disease patients was a strong independent predictor of adverse outcomes, including death and hospitalization Rationale and Objectives The above considerations provide the rationale for a ‘systems approach to heart disease management. The objectives of this approach are as follows: To optimise the pharmacotherapy of heart disease in accordance with current consensus guidelines. (Vinson, 1990) To maximize compliance with prescribed medications and dietary restrictions. To identify and respond to any psychological, social or financial barriers that might interfere with compliance with the prescribed treatment regimen. To provide an appropriate level of follow-up through telephone contacts, home visits and outpatient clinic visits. To enhance functional capacity by providing an individualized programme of exercise and cardiac rehabilitation. To enhance self-efficacy by helping the patient and family understand that heart disease can be controlled, largely through the patients and familys efforts. To reduce the frequency of acute heart disease exacerbations and hospitalizations. To reduce the overall cost of care. The Disease Management Team Although the composition of a disease management team may vary both from centre to centre and from patient to patient, a suggested list of team members are given below: nurse coordinator or case manager dietitian social services representative clinical pharmacist physical therapist/occupational therapist exercise/rehabilitation specialist  · home health specialist patient and family primary care physician cardiologist/other consultants. Each team member provides their own unique expertise and/or perspective, and these are then woven into an integrated package tailored to meet each individual patients needs, expectations, and circumstances. Importantly, not all patients will require the services of all team members, and it is therefore essential to identify a team leader. In most cases, this will be the nurse coordinator or case manager, who, in addition to being the patients primary contact person and educator, is also responsible for coordinating the efforts of other team members, including the selective activation of appropriate consultations on an individualized basis. In addition to the team itself, several other components are essential for effective disease management. First, the patient and family should be provided with comprehensive information about heart disease, including common etiologies, symptoms and signs, standard diagnostic tests, medications, diet, activity, prognosis and the role of the patient and family in ensuring that heart disease remains under control. This information should be provided in a readily understandable patient-friendly format and several patient-oriented heart disease brochures are now commercially available. In addition to these materials, the patient should be given a scale (if not already owned) and a chart to record daily weights, an accurate and detailed list of medications supplemented by medication aids if needed (e.g. a pill box), and specific information about when to contact the nurse, physician, or other team member in the event that questions or new symptoms arise. In this regard, the importance of establishing an effective one-on-one nurse-to-patient relationship cannot be overemphasized, as this interaction will often be critical to the early diagnosis and effective outpatient treatment of heart disease exacerbations. Patient Perspective While the above studies indicate a beneficial effect on costs, hospital readmissions, etc., they do not address concerns related to the patients perspective on this interdisciplinary care. What issues are important to the patient, and what the advantages are to the patient of participating in an heart disease disease management programme? In recent years, it has become increasingly evident that it is insufficient to merely provide high quality medical services. In a competitive market, it is essential that the patient is also satisfied with the medical encounter, both in terms of the process of care as well as the clinical outcomes. Healthcare is an industry, and like all industries, customer satisfaction is critically important. However, unlike most industries, which deal with a tangible product, the healthcare industry deals with a multifaceted service, the myriad qualities of which are difficult to quantify. As a result, the assessment of patient satisfaction is often complex, and the development of a valid and universally accepted instrument for measuring patient satisfaction has been elusive. Despite these problems, several patient satisfaction questionnaires have been developed, (Garg, 1995) and these have been helpful in defining those issues which are important to patients, and in identifying specific concerns that patients often have with respect to current approaches to healthcare delivery. (Garg, 1995) Factors which have been consistently shown to play a pivotal role in determining patient satisfaction include: communication, involvement in decision- making, respect for the individual, access to care and the quality of care provided. (Philbin, 1996) Not surprisingly, problems in each of these areas are frequently cited as factors which diminish patient satisfaction. Several components of the heart disease disease management system will be of direct assistance in answering patients questions and helping her cope with this new and frightening diagnosis. In particular, the nurse case manager will establish an effective rapport with the patient and her family, and provide an ongoing source of information and emotional support. The patient education brochure and other printed materials will help answer many of Patients questions and assist in relieving some of her anxieties. The nurse, clinical pharmacist and physician (s) can provide detailed information and teaching about the medications used to treat heart disease, and the dietitian can directly address the dietary questions and provide an individualized diet that takes Patients current dietary practices and food preferences into account. The social service representative can assist patient with any financial concerns she may have, make provisions to ensure an adequate social support network, and serve as an additional source of emotional support. The physical therapist or exercise specialist can help in providing recommendations about activities and in the development of an exercise or rehabilitation programme. The nurse case manager, social service representative, home care specialist, and physician will provide assistance to patient in making the transition from the hospital back to the home environment, and they also will ensure a high level of follow-up care. Perhaps most importantly, the comprehensive care provided by the disease management team will reassure patient that she truly is being cared for, and that all of her needs and concerns are being met. Invariably, this will lead to a high level of patient satisfaction. In addition, in the case of patient there is good reason to believe that implementation of a disease management programme at the time of her initial hospitalization may have eliminated the need for a second hospitalization. (Young, 1995) To the extent that patient might have to pay for some of the costs of readmission (e.g. deductible or copayment), the disease management programme would also save her money, a benefit which is universally viewed in a favorable light. And finally, based on compelling data from recent clinical trials, optimizing Patients medication regimen should translate not only into an improved quality of life, but also into increased survival. Conclusion In summary, heart disease management systems provide a win-win-win situation. They are a ‘win for the providers, because they improve clinical outcomes and quality of life. They are a ‘win for the payors, because effective disease management programmes decrease health care expenditures. And they are clearly a ‘win for the patients, who reap multiple benefits, including improved quality of life and well-being, enhanced self-efficacy due to a greater sense of health control, improved exercise tolerance and functionality, increased survival (as a result of more optimal utilisation of heart disease medications), and, in some cases, reduced out-of-pocket expenditures. References Department of Health (2000) National Service Framework for Coronary Heart Disease (London: DoH). Department of Health (2004a) GMS Statement of Financial Entitlements (SFE) 2004/5 (London: DH). Department of Health (2004b) The NHS Improvement Plan: Putting People at the Heart of Public Services Cm 6268 (London: The Stationary Office). Department of Health (2005) The Coronary Heart Disease National Service Framework: Leading the Way-Progress Report 2005 (London: DH Publications). Foucault, M. (1977) Discipline and Punish: The Birth of the Prison (London: Allen Lane). Garg R, Yusuf S, for the Collaborative Group on ACE Inhibitor Trials. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. JAMA 1995; 273: 1450-6 Ghali JK, Cooper R, Ford E. Trends in hospitalization rates for heart failure in the United States, 1973-1986. Evidence for increasing population prevalence. Arch Intern Med 1990; 150: 769-73 Jaeger, C., Renn, O., Rosa, E. and Webler, T. (2001) Risk, Uncertainty, and Rational Action (London: James James/Earthscan). Krumholz HM, Butler J, Miller J, et al. Prognostic importance of emotional support for elderly patients hospitalized with heart failure. Circulation 1998; 97: 958-64 Leitch, D. (1989) Who should have their cholesterol concentration measured? What experts in the United Kingdom suggest. British Medical Journal, 298(6688), 1615 1616. Lupton, D. (1995) The Imperative of Health: Public Health and the Regulated Body (London: Sage). Philbin EF, Andreou C, Rocco TA, et al. Patterns of angiotensin-converting enzyme inhibitor use in congestive heart failure in two community hospitals. Am J Cardiol 1996; 77: 832-8 Redfern, J., MacKevitt, C. and

The pool Doctor :: essays research papers

The Pool Doctor The Marketing plan of poll doctor is a little mixed one. Beside the marketing plan of the pool doctor, it is also concerned for the choice of chemicals he has to make as well. Before we begin with the marketing plan of the pool doctor, for reason of ease, I would like to segment the looking ahead section into two parts. The choice of chemical suppliers and the services and products to be offered with the companies marketing plan. As choice of chemicals in an internal procurement decision as well as it influences a major part of marketing strategy. As mentioned in the book, lets start with the first point of the marketing plan, defining the marketing challenge. In this section we need to focus on the marketing strategy in terms of current strategy is it well implemented or a new or modified strategy should be used to improve profitability. The marketing challenge. The marketing challenge facing Jeff is an interesting one. Let us look at the current marketing plan of the poll doctor. In the previous years Jeff had advertised using direct-mail advertising campaigns which had proved futile. Then Jeff tried to put adds in the two news papers, Winnipeg free press and the Jewish post. As we look at the â€Å"selected 1990 media cost† comparing the circulation of the two new paper except the Jewish post, the metro and Winnipeg free press, Jeff has taken a wise decision to advertise in free press because of it’s more circulation. Now as poll doctor wanted to expand it’s operation to St.Boniface and St. vital areas of Winnipeg Jeff should probably try advertising in the Lance, which covers both the areas. As the data provided in the advertising in incomplete, I can not predict in details amount of MAL rates would apply, but a equal amount of adds in Winnipeg Free press should be printed as business is more concentrated in these are as. In addition to direct-mail advertising program Jeff has almost stopped, instead it should be with Aristocrat mailing program and not on it’s own. But there is a need to change the look of the flyer and make it more professional. A sample flyer is included at the end of the plan. As we see the distribution of survey thirty percent of had heard about poll doctor from a friend, thirty percent from fliers, seventeen from Aristocrat and thirteen from Jewish post and rest by others means.

In the Lake of the Woods: Hypothesis Chapters

This chapter briefly states about the disappearance of Kathy, and what she could have been thinking of when In her â€Å"dermatome† phase. It also briefly outlines possible roads she could have taken, let it be with another man or simply Just fed up of her own life with John. This hypothesis demonstrates how profoundly hurt she was by politics and Johns selfish ways. Hypothesis Chapter 2: In this chapter the truth about John in Vietnam has come out, and Kathy is wondering what is with all of these secrets? And she really is starting to reevaluate their marriage o see if it could work. UT as she keeps thinking she starts to realize that they together for all the wrong reasons. This chapter also indicates the severity of their marriage as In a sense John blackmails Kathy Into not bringing up past events, which then seems to the reader as a way of him standing over her and having power over her. The point of the hypothesis chapter Is to Illustrate key reasons for Kitty's disappea rance and to see how inauthentic their marriage was. Hypothesis Chapter 3: This chapter describes the possibility that Kathy took a boat ride to clear her mind, ND during that ride, hit a sandbar and drowned.This is a key chapter as it hypothesis Kathy taking mental notes of what she felt needed to change, indicating she was ready to reform her relationship with John. Hypothesis Chapter 4: Chapter 18 suggests that Kathy disappearance Is one of human error. By miscalculating her trajectory, Kathy has lost hope of returning In the correct direction. It Is In this chapter that we discover more about Kathy sense of self- reliance as well as her affair with Harmon, her dentist, and the deep-seated guilt she till feels.Hypothesis Chapter 5: Lost within the wilderness, Kathy travels on a boat away from the burning cottage. It is alluded to that she has set â€Å"the fire† alight and left to simply escape the life she has with John. Furthermore, inside the â€Å"glittery' â€Å"lux ury and bliss† of a casino, this chapter conveys Kathy prior experiences with Tony and her innermost feelings at that particular moment In time. It adds to our understanding of John and Kathy relationship, and the depth of Tony's character and attitude. Hypothesis Chapter 6:By illustrating Kitty's personal conflicts, O'Brien explores her potential suicide. This values and â€Å"withheld intimacies†. Within her â€Å"decayed marriage† â€Å"the idea of happiness† is Kathy ultimate desire, as her suicide is expressed to be â€Å"a dark calm† from â€Å"the waning of energy'. Hypothesis Chapter 7: In chapter 27 it is hypothesized that John burnt Kathy with boiling water and then took her out on the boat on the lake and dumped her body in the lake. John then decides to â€Å"Join her for a while† as he feels â€Å"an underwater rush in his ears. He sakes up in bed and reaches â€Å"out for Kathy' but she â€Å"wasn't there. † Hypothesis Chapter 8: In this chapter, it questions all the hypothesis and states that no one â€Å"will ever know. † When John is mentioned, he switches out from John to Sorcerer and then back again. John does not know his true identity and he never did. Paragraph: O'Brien illustrates the inauthentic relationship of John and Kathy through his need for â€Å"absolute, unconditional love†. Their lack of communication led to the couple's mistrust towards each other because â€Å"they never communicated, never made love†.This was due to the fact John â€Å"was a dreamer† and constantly withdrawn from emotional situations. We see actions like these taken by John being attributed to this persona which demonstrates how separated John truly is from his physical presence in the world. His experiences with gliding and the â€Å"sorcerer† identity stay with him just like the mirror and the magic from his childhood and continue to shape his experiences with the world. Just like John's mirrors, Kathy disappearances prove to be her way of escaping the controlling ways of John, as Kathy â€Å"†¦ Get[s] this creepy leaning, like [his] always there†.O'Brien does this as a way of displaying John's uncanny need for affection. When John feels able enough to tell Kathy of his plans for the future, Kathy tells him that his plans feel calculated and manipulative, John is â€Å"assailed by the sudden fear of losing her, of bungling thing. † John still views his relationship as things to be rigged rather than nurtured. This is how he attempts to retain power and control of the situation. Riddled with doubts and insecurities on the outside, strangled with shame and secrets on the inside, John was incapable of expressing himself to others.O'Brien purposely added the scene where Kathy has an abortion as a metaphor for John denying Kathy needs throughout the course of the relationship. This is seen in parallel with John's desire to be something more than he already is; a better lover and a more courageous man. When the illusion is shattered and he has lost everything, including his wife, John actually begins to find some clarity. He realizes that inventing a new self was impossible, that he â€Å"never should have given the bucking show in the first place. †

Resisting Stereotypes is unrealistic essays

Resisting Stereotypes is unrealistic essays Look deep in your heart and ask yourself a question: Can you resist stereotyping? The United States consists of immigrants from all countries. All cultures, like people, are different and seeing someone who differs from oneself motivates us to stereotype or label, for example, ones way of talking, dressing, acting, and so on. Though it is impossible to avoid stereotyping, the use of stereotypes may actually be beneficial in some cases. We cannot avoid stereotyping because a human beings mind is created to observe, criticize, and categorize. These tendencies were present in our everyday life and manners from time immemorial. In addition, some stereotypes may take roots from family beliefs and principles. For example, native people in the country may bring up their children to avoid another nation, or immigrants, by teaching them their assumptions and generalizations without any contiguity with the people. This behavior, in my opinion, takes away from their childrens chances to acquire some knowledge and experiences by interacting with other cultures and beliefs. Sometimes stereotypes open our eyes to something we have never realized. They shape how we see ourselves and our values as members of our group, and how we see ourselves as different from members of other groups. For example, Thea Palad in her essay, Fighting Stereotypes, described that she considered herself an American, before her classmate showed her the view of Palad from the view of white American girls. And even though she spent her life in America, she didnt realize that she wasnt like white American girls in school. But it was difficult for me to comprehend how people today could still focus on the shape of my eyes and the texture of my hair, points out the author. For a moment, she lost her identity in society. She wasnt considered one of the fresh off the boat&...

Free Essays on The Belief In The Afterlife In Ancient Egypt

According to many scholars, religion was the most important aspect of life in Ancient Egypt. The Egyptian’s believed that the gods and goddesses, each with special functions governed every inch of human existence. â€Å"Writing about the religion of Ancient Egypt demands a powerful effort of imaginative understand. Even for those of us who posses a strong religious faith, it is hard to conceive of the intensity with which the Egyptians accepted the existence of the supernatural or the extent to which it not only invaded but completely dominated every aspect of their daily existence.†# Egyptians believed that death was a temporary interruption, rather then a complete end to their life. Eternal life could be insured by the gods, preservation of the body, and the â€Å"ka†, â€Å"ba†, akh†. Fearing death the Egyptians developed a belief of the after life very early in their existence. They buried their dead in the sand with possessions they thought they would need in their next life. The Egyptians noticed that if a body was dug up a year later, it looked very much as it had looked in life. Thus, preserving the body became linked with the afterlife. The poor could not afford more then a burial in the sand. While the wealthy began to be buried deeper in more elaborate chambers, mortal decay set it. The mummified body and the tomb were believed to be essential to the after-life. They believe that the mummified body would guarantee passage into the next life. In addition to the Egyptians â€Å"ba† (his body), and his â€Å"ka† (spirit guide), the Egyptians had a soul, which flew away at death. Some cult believed that the soul was a bird with the face of the deceased that flew away at death. During the life the soul lived in the body in his belly or heart, after death it flew freely about the world. It was free to travel the world but had to return to the tomb at night to ward off evil spirits. The first attempts to save the... Free Essays on The Belief In The Afterlife In Ancient Egypt Free Essays on The Belief In The Afterlife In Ancient Egypt According to many scholars, religion was the most important aspect of life in Ancient Egypt. The Egyptian’s believed that the gods and goddesses, each with special functions governed every inch of human existence. â€Å"Writing about the religion of Ancient Egypt demands a powerful effort of imaginative understand. Even for those of us who posses a strong religious faith, it is hard to conceive of the intensity with which the Egyptians accepted the existence of the supernatural or the extent to which it not only invaded but completely dominated every aspect of their daily existence.†# Egyptians believed that death was a temporary interruption, rather then a complete end to their life. Eternal life could be insured by the gods, preservation of the body, and the â€Å"ka†, â€Å"ba†, akh†. Fearing death the Egyptians developed a belief of the after life very early in their existence. They buried their dead in the sand with possessions they thought they would need in their next life. The Egyptians noticed that if a body was dug up a year later, it looked very much as it had looked in life. Thus, preserving the body became linked with the afterlife. The poor could not afford more then a burial in the sand. While the wealthy began to be buried deeper in more elaborate chambers, mortal decay set it. The mummified body and the tomb were believed to be essential to the after-life. They believe that the mummified body would guarantee passage into the next life. In addition to the Egyptians â€Å"ba† (his body), and his â€Å"ka† (spirit guide), the Egyptians had a soul, which flew away at death. Some cult believed that the soul was a bird with the face of the deceased that flew away at death. During the life the soul lived in the body in his belly or heart, after death it flew freely about the world. It was free to travel the world but had to return to the tomb at night to ward off evil spirits. The first attempts to save the...

Compare & contrast Essay Example | Topics and Well Written Essays - 750 words

Compare & contrast - Essay Example Personality From the above brief description, my two friends have very distinct personalities. George is more outgoing and quite a ladies’ man given his athleticism. John on the other hand, is the geek; knows everything, very intelligent and creative but quite boring if you happen to meet him for the first time. At one point, he had interests in quantum physics and would explain in details, what the field of quantum physics entailed, something we did not like and would literally walk away once he started with the complex terminologies. His rich knowledge is however be of help when it comes to tests, as a matter of fact, John has been our private tutor since fourth grade. If it were not for his services to the group as a private tutor, George would have dropped out of high school because all he has maintained over the many years of our friendship has been the muscles and good looks, his grades have been on the floor. With John’s services however, we can today say that ou r handsome friend’s grades are average. His outgoing personality is conversely very useful when it comes to reaching out to the females. Beautiful girls ask to be around us thanks to the quarter back. How we would miss the invitations to parties if George was not our friend. He has literally transformed our social lives with his charms on the females. Family Backgrounds My two friends have unique and interesting family backgrounds. The geek; John, has both his parents not only rich, but also living together. A single mother on the other hand, has raised George the hunky, his father was an alcoholic and walked out of them when he was in the first grade. This makes our group very interesting because when we go visiting at John’s family home, where we often visit because of the bowling alley in their basement, everything seems to be in order unlike at George’s where important toys are not available. John’s father is an investment banker possibly enjoying hug e yearend bonuses; that bowling alley sure looks too expensive to put up without a bonus. What is interesting is that even with the diversity in our family backgrounds, we have over the years made such an enviable pack of three and the disparities in our backgrounds is never visible. The main reason why John declined the offer to go to a private high school was the ‘clique’. He feared the civility in these exclusive schools and was worried that he could be out of touch with the clique if he stayed away too long. This is one sacrifice that we appreciate because we have no idea how life would be if the private tutor left us, those tests would be impossible, or worse still, George would not be a quarter back because he would have dropped out years ago, how sad would that be? Conclusion My friends are very important people to me because each adds value in a unique way. From the brief comparison, it has clearly emerged that these are two very distinct people in terms of pers onality and upbringing yet we hold one common value; true friendship. The ‘clique’ as we like to call ourselves, is what it is because of the different values each one of us adds to the team. Over the years of friendship with George and John, I have come to appreciate that God has good intentions in creating us in unique images, and putting us in the respective families. Through this diversity, we grow to be unique and proceed to make

Music concert report Essay Example | Topics and Well Written Essays - 750 words

Music concert report - Essay Example Other pieces played had incorporation of instruments such as bass guitar, Hammond organ, harmonica, and electric guitar blue rock. Personally, I comprehended the genre associated with heavy metal , boogie rock , Garage rock , southern rock , punk blues hard rock. The band consisted of blend of old generation people with youthful blood in it. The organizers of the event sold their tickets through Ticketmaster.com quite early in time thus facilitating the convergence of a substantial number of people to the function. From the concert I mastered the relevant core blues rock. These were an electric guitar, drum kit and bass guitar which the artists applied to ignite the mood of the people. The electric hugely amplified via the tube guitar in a typical overdrive effect. It was observable that to produce the customized reverberation, two guitars were played in subsequence to riffs and some of the chords on the rhythmical guitar. Synchronically, another artist must be playing corresponding melodic lines and rhythmical solos from the lead guitar. While at the concerts we as the audience were served with cool nice combination of instruments melodies thus widening our zeal and love for the music. Am not a fan of rock but I had to appreciate the model on which it was availed. The musicals created a conducive and soothing environment. The fusion of drumbeats and other instruments provided very nice tranquility and comfort zone.Personally, my main aim for the occasion was to relate with history.