Post Traumatic Stress Disorder (PTSD) Essay -- Post-traumatic stress

Post-traumatic stress disorder (PTSD) is a relatively new diagnosis that was associated with survivors of war when it was first introduced. Its diagnosis was met largely with skepticism and dismissal by the public of the validity of the illness. PTSD was only widely accepted when it was included as a diagnosis in 1980 in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) of the American Psychiatric Association. PTSD is a complex mental disorder that develops in response to exposure to a severe traumatic event that stems a cluster of symptoms. Being afflicted with the disorder is debilitating, disrupting an individual’s ability to function and perform the most basic tasks. Who gets PTSD? Post-traumatic stress disorder can develop at any age, from childhood years to adulthood with any cultural, social, and economic background. Any individual that goes through a particular traumatic event can experience great stress and anxiety that can then develop into a post-traumatic stress disorder. Protective service men and women, victims of rape, abuse, and torture, as well as victims of natural disasters, accidents are examples of a mass variety of individuals that are touched by the post-traumatic stress disorder. PTSD can be caused by witnessing or by being part of a traumatic event such as combat, torture, abuse, natural disaster, motor-vehicle accident and even a sudden loss of a loved one. Many factors play an important role to determining whether an individual is pre-disposed to PTSD. Risk factors are those that contribute to a person to have a higher prevalence of developing PTSD, while resilience factors help the individual to overcome trauma. Risk Factors Sin... ...of the individual to develop the disorder. Identification of individuals with PTSD is a complex decision to make, as there are many contributing factors for different people. However, treatments, prevention, and assessments of the disorder will be improved and enhanced in the near future. Works Cited Foa, E. B., Keane, T. M., Friedman, M. J., & Cohen, J. A. (2000). Effective treatments for PTSD: practice guidelines from the International Society for Traumatic Stress Studies (Second Edition ed.). New York: Guilford Press. Reyes, G., Elhai, J. D., & Ford, J. D. (2008). The Encyclopedia of Psychological Trauma. Hoboken: John Wiley & Sons. Violanti, J. M., & Paton, D. (2006). Who gets PTSD?. Springfield, Illinois: Charles C Thomas. Wilson, J. P., Friedman, M. J., & Lindy, J. D. (2001). Treating psychological trauma and PTSD. New York: Guilford Press.

Eating Christmas in the Kalahari Essay

In his article â€Å"Eating Christmas in the Kalahari† (1969), Richard Borshay Lee tells of his three years spent living with the !Kung San Bushmen, of some of their customs, of how they celebrated Christmas and of how they dealt with ‘gifts’ or rather his gift to them in particular. Lee explains that the local people thought him a miser because he â€Å"maintained a two-month inventory of canned goods† (p 111) which was in direct contrast to the Bushmen â€Å"who rarely had a day’s supply of food on hand†(p 111), and it appeared he was determined to correct this view. Lee writes that it â€Å"is the Tswana-Herero custom of slaughtering an ox for his Bushmen neighbours as an annual goodwill gesture† (p 111) at Christmas. By purchasing the Christmas ox for the Bushmen’s annual feast himself, Lee hoped that it would be seen as a generous (parting) gesture, a ‘thank you’ for their cooperation – as in Western culture – and perhaps also the catalyst for dispelling their view of him as a miser. Lee appears to want the reader to believe that he was confused about his failure to gain the (expected) appreciation from the Bushmen for his generosity but was instead ridiculed for his choice of ox with sarcastic descriptions such as; â€Å"scrawny† (p 112), â€Å"old wreck†(p 111), â€Å"sack of guts and bones†(p 111), â€Å"old†(p 111), â€Å"thin†(p 111) and â€Å"sick†(p 113). Lee further leads us to believe that his confusion became more profound on Christmas Day when the ox was slaughtered and was found to have a thick layer of fat covering the meat. Although Lee indicates that he felt vindicated in his choice of ox, the derision and sarcasm continued throughout the slaughtering process. Lee writes that he later sought clarification and explanation from several of the local people and was eventually told that the Bushmen’s sarcasm or â€Å"obligatory insults over a kill†(p 114), was their ‘custom’ and was a  mechanism used to prevent hunters from getting an inflated ego and/or seeing themselves as better than anyone else. I have a problem with Lee’s account inasmuch as I find it extremely difficult if not impossible to believe that after spending three years living with and studying the lives, activities and customs of the Bushmen, Lee had never once seen, heard nor heard of this ‘custom’ and I would be loathe to place more than a token amount of faith in the honesty and correctness of this or any other of his writings or observations as a result. That the Bushmen included Lee in their customs and constructed a joke around him at his expense are inclusionary actions that would normally indicate an acceptance into a group and I believe that Lee’s writings were self-serving in that he wanted the reader to believe the Bushmen had thought highly enough of him to include him and treat him as they would one of their own. I also believe that Lee has taken liberties with the translations of a number of conversations with various individuals in order for the reader to have no doubt about what it was that Lee himself wanted to convey. I do not believe that words and terms such as; â€Å"arrogance†(p 114), â€Å"hogging†(p 112), â€Å"nevertheless†(p 114), â€Å"scrawny† (p 112), â€Å"rascal†(p 113), â€Å"braggart†(p 113), â€Å"you have always been square with us† (p 111), â€Å"sack of guts and bones†(p 111), â€Å"old wreck†(p 111), â€Å"I suppose†(p 112), â€Å"feeling as we do†(p 112), â€Å"another one pipes up†(p 113), â€Å"you must respond in kind†(p 114), are part of the native language as Lee would allege in his quotes of conversations with the natives. These quotes are peppered with language that is more attributable to a certain class of native of the UK, not one of the Kalahari. From my reading of Lee’s article, I believe it is nothing more than a poorly veiled attempt to elevate his own importance in the mind of the reader and perhaps even his peers. I feel that Lee has done a huge disservice to not only himself and his own credibility but also to that of the profession of anthropology. What does Lee’s article say about his observational strengths in the field if after three years he fails to note what appears to be a very powerful and meaningful hunting custom? In closing, I admit to agreeing with Lee’s statement â€Å"there are no totally generous acts†(p 114). Every act of gift giving is inextricably attached to an expected or preconceived return or reciprocity either in manner or kind and this may be nothing more than ‘feeling good’. ******************** REFERENCES: Lee, Richard Borshay 1969 â€Å"Eating Christmas in the Kalahari† reprinted in A. Podolefsky and P. Brown (eds.), Applying Cultural Anthropology: an introduction. (1991), Mountainview: Mayfield, pp. 110-114.

Health Promotion for Alcohol Essay

Bernadette Ward RN, Midwife, Grad Cert Ed, MPHandTM, MHlth Sci Lecturer, Faculty of Health Sciences, La Trobe University, Bendigo, Australia. B. Ward@latrobe. edu. au Glenda Verrinder RN, Midwife, Grad Cert Higher Ed, Grad Dip Pub and Com Health, MHlth Sci Senior Lecturer, Faculty of Health Sciences, La Trobe University, Bendigo, Australia. ABSTRACT Alcohol misuse in Australia society is a community issue that can be addressed successfully within a health promotion framework. It is important that strategiesarenotperceivedas‘quickfixes’butwork toward addressing some of the underlying structural factors that contribute to the problem. Objective The objective of this article is to demonstrate how nurses can use the Ottawa Charter for Health Promotion framework in addressing alcohol misuse among young people. Primary argument The Ottawa Charter for Health Promotion (1986) provides a useful framework from which to view the health of whole populations over their life course and in doing so work toward strengthening peoples’ health potential (World Health Organization 2005). The relevanceoftheCharterliesnotonlyintheinfluenceit has on establishing health promotion practice, but also theinfluenceithasonhealthpolicydevelopmentand health research (World Health Organization 2005). Conclusion Parents and community members have an important role to play in addressing alcohol misuse among adolescents but they need to be supported by nurses who can provide care within a health promotion framework. KEY WORDS alcohol, youth, Ottawa charter AUSTRALIAN JOURNAL OF ADVANCED NURSING Volume 25 Number 4 114 POINT OF VIEW INTRODUCTION The Ottawa Charter for Health Promotion (WHO 1986) has been ‘phenomenally influential in guiding the development of the concept of health promotion and shaping public health practice’ (Nutbeam 2005). The Charter is now more than 30 years old and, as a landmark document, outlines a clear statement of action that continues to have resonance for nurses around the world. The Charter was re? endorsed in Bangkok at the 2005, 6th Global Conference on Health Promotion as it had been in Mexico? City (2000), Jakarta (1997), Sundsvall (1991) and Adelaide (1988). The principles and action areas have stood the test of time in nursing, health policy development and health research. Itisnowknowntherearemanyfactorswhichinfluence health and illness. There is generally no single cause or single contributing factor which determines the likelihood of health or illness; rather there tends to be a variety of causes. Factors that determine physical and mental health status include income, employment, poverty, education, and access to community resources. These social factors generate people’s life experiences and opportunities which inturnmakeiteasierormoredifficultforpeopleto make positive decisions about their health. While there are many actions that a person can take to protect their own or their families’ health, very often the social context of their lives makes it impossible to take those actions (Talbot and Verrinder 2005). Health promotion and disease prevention strategies at the societal level are now part of the repertoire of nursing interventions. The Ottawa Charter highlights the importance of building healthy public policy, creating supportive environments, strengthening community action, developing personal skills and reorienting health services. Used collectively in any population setting, the action areas have a better chance of promoting health than when they are used in isolation. The Charter also highlights the potential role of organisations, systems and communities, as well as individual behaviours and capacities (Talbot and Verrinder 2005). AUSTRALIAN JOURNAL OF ADVANCED NURSING Volume 25 Number 4 Health promotion strategies have been used effectivelytoaddresshealthissuesthatareidentified as problems by the community. In Australia and throughout other western countries, the misuse of alcohol by young people has been highlighted as a problem (Toumbourou et al 2003). Alcohol misuse amongst adolescents For many Australians, alcohol consumption is a pleasurable part of everyday life (Parliament of Victoria 2004). However in recent years there have been several reports highlighting that the proportion of adolescents consuming alcohol and the amount of alcohol they are drinking is at record levels (AIHW 2008; White and Hayman 2006; Shanahan and Hewitt 1999). The long and short term sequelae associated with risky or high risk alcohol consumption include negative physical, emotional and social consequences (NHMRC 2001). Immediate harms include accidents, injuries, decreased scholastic and sporting performance, aggression, violence, assault, disrupted family relationships, high risk sexual activity,drivingwhileundertheinfluenceofalcohol and delinquent behaviour (Jones and Donovan 2001). Among young people aged 16 to 24 years, alcohol related harm is one of the leading causes of disease andinjuryburden(AIHW2006). Thesefindingsare consistent with population based research in Europe, United States and Canada (Jernigan 2001). CommunityconcernhasbeenreflectedinAustralian media reports about ‘teenage binge drinking’ and the associated harms and generated debate in the Australian media about raising the legal age of alcohol consumption from 18 to 21 years (Editor 2008; Toumbourou et al 2008). In countries outside Australia, studies have demonstrated that raising the legal age for alcohol consumption reduces adolescents’ access to alcohol and the subsequent associated harms (Ludbrook et al 2002; Grube 1997). While there are lessons to be learned from these settings, perceptions of health and how to address the determinants of illness have changed due to a combination of well informed ‘top? down’ and well anchored ‘bottom? up’ approaches to policy making (WHO 2005). Previous reports in Australia 115 POINT OF VIEW have suggested there is little community support for any proposed changes to the current age for alcohol consumption and instead focus is more on the enforcement of current legislation (Loxley et al 2004). Australianparentshaveacriticalroleininfluencing the attitudes and beliefs of young people toward alcohol consumption. However parents have indicated they are looking for information, skills and community support to assist them in guiding their adolescents’ safe use of alcohol (Shanahan and Hewitt 1999). The five action areas of the Ottawa Charter provides strategies from which nurses can support parents to promote health and encourage safe alcohol consumption patterns among adolescents. By using the framework of the Ottawa Charter, nurses have a strong evidence base and useful framework from which to support families and the broader community in addressing the issue of alcohol misuse among young Australians. Reflecting on their own professional setting, nurses can use the Ottawa Charter framework to guide and inform interventions aimed at reducing alcohol related harm among young people. Using the Ottawa Charter as a framework to address the determinants of illness associated with alcohol misuse 1. Action area 1: Build healthy public policy causes of ill health. Community action strategies are an important way of addressing alcohol related harm (Parliament of Victoria 2004). Regulation and restriction of sales, increased server liability, increased alcohol taxes and lowered blood alcohol limits are some of the policy areas which have been shown to be effective in reducing alcohol related harm (Parliament of Victoria 2004). Healthy public policy affects the entire population directly or indirectly. Nurses have a key role in informing and advocating on behalf of clients, families and the broader community and in promoting effective public policy. 2. Action area 2: Create supportive environments Building healthy public policy is one of the solutions to improving health. All public policy should be examined for its impact on health and, where policies have a negative impact on health, strategies implemented to change them. Healthy public policy is needed to ensure that people are safe. In recent years, initiatives to reduce alcohol related harm have increasingly been focused on high risk individuals (Parliament of Victoria 2004). While these strategies may be appropriate for individuals, they do little to reduce the burden of disease at the community level (Midford 2004). There are risks attached to focusing on individual behaviours and victim blaming instead of addressing the structural AUSTRALIAN JOURNAL OF ADVANCED NURSING Volume 25 Number 4 Healthy public policy assists in creating supportive environments that are important in ensuring that everyone lives in a place that is safe and enjoyable. Alcohol misuse is not just something that pertains to young people; it is a problem that impacts on all members of the community. In a society where alcohol is often seen as an integral part of life (Australian Government 2006) and alcohol misuse is implicated in one third of all road accidents (AustralianGovernment2001)whatisdefined as safe needs to be re? considered. Parents commonly supply alcohol to their adolescents (Graham et al 2006; Ward et al 2006; Shanahan and Hewitt 1999) and in Australia enforcement of current legislation to restrict underage access to alcohol is ‘patchy’ (Loxley et al 2004). As a result,manyadolescentsfindaccesstoalcohol easy. In addition, alcohol advertising that is targeted to youth is often linked with social and sexual success and hence contravenes the Alcoholic Beverages Advertising Code (Jones et al 2001). Public policy designed to create supportive environments has resulted in the ‘settings’ approach to health promotion, where working for change occurs through partnerships at the community level (Talbot and Verrinder 2005). Nurses, for example, have a role in 116 POINT OF VIEW facilitating interaction between teachers and parents and between local government and school communities so they can exchange information, ideas, clarify values (McMurray 2003) and identify strategies that will focus on reducing alcohol related harm among young people. Nurses can encourage and establish primary care partnerships to develop alcohol action plans designed to improve the health and wellbeing of adolescents. 3. Action area 3: Strengthen community action 4. Action area 4: Develop personal skills Strengthening community action is important and so there needs to be mechanisms by which the community can participate in decision making as a community and not just as an individual. Communities can determine what their needs are and how they can best be met. Thus greater power and control remains with the people themselves, rather than totally with the ‘experts’. Community development strategies are one means by which this can be achieved. To date in Australia there have not been any formal consultations with youth about raising the legal age of alcohol consumption. Central to the success of the Ottawa Charter is increasing people’s control over their own health and issues that impact on it. The participation of youth groups is critical to the principles of equity and participation. In countries outside Australia, some community mobilisation programs have been effective in changing community factors (e. g. underageaccesstoalcohol)thatinfluence alcohol use amongst young people (Holder et al 1997). There are a number of successful community mobilisation approaches that have focused on reducing alcohol related harm among young people (Hingson and Sleet 2007; Hanson et al 2000). The role for nurses is to draw on these examples to successfully mobilise young people to be involved in the decision making process about issues that impact on their health and wellbeing. Developing personal skills is important if people are to feel more in control of their lives and have more power in decisions that affect them. Helping people develop their skills ensures that people have the information and knowledge necessary to make informed choices. InAustralia,manyparentsfindithard to communicate with their adolescents about alcohol (Shanahan and Hewitt 1999). It is alsoclearthatmanyparentsfindthemselves isolated and powerless to do anything about their adolescents’ alcohol misuse (Shanahan and Hewitt 1999). Systematic reviews of alcohol and other drug education programs in schools indicate that effective school based programs should begin before initiation to alcohol and other drugs and that content should include social skills and resistance training. In addition, community values, societal contexts and information about drug related harm need to be included (Midford et al 2002). Alcohol education programs that provide information alone have limited success (Foxcroft et al 2003). Without an understanding of alcohol related harms and interventions to address those harms, parents and community members cannot support initiatives for changes (Howat et al 2007). Nurses can work with parents, teachers and students to provide formal and informal education (WHO 2005) which informs alcohol related harm reduction policies. 5. Action area 5: Reorient health services Reorienting health care is important in ensuring that health promotion is everybody’s business. Re?orientating health services means that nurses have a pivotal role in fostering intersectoral collaboration between the health sector, police, education, adolescents and parents. There is some evidence to suggest that brief interventions can have some effect in reducing alcohol related harm among young people (Loxley et al 2004). However recent AUSTRALIAN JOURNAL OF ADVANCED NURSING Volume 25 Number 4 117 POINT OF VIEW overseas evidence suggests that in settings that are most commonly used by adolescents, many health practitioners are not comfortable and adequately skilled when working with young people (McPherson 2005). Working in partnership with other health care providers, nurses can encourage positive health practices where brief interventions that focus on harm reduction, can be provided from places where young people congregate (McMurray, 2003). Graham, M. , Ward, B. , Munro, G. , Snow, P. and Ellis, J. 2006. Rural parents, teenagers and alcohol: what are parents thinking? Rural and Remote Health, 6(online):383. Available from: http://www. rrh. org. au/publishedarticles/article_print_383. pdf (accessed May 2008). Grube, J. 1997. Preventing sales of alcohol to minors: results from a community trial. Addiction, 92(S2):S251?260. Hanson, B. , Larrson, S. and Rastam, L. 2000. Time trends in alcohol habits – results from the Kirseberg Project in Malmo, Sweden. Subst. Use Misuse. 35(1&2) 171? 187. Hingson, R. , Azkocs, R. , Herren, T. , Winter, M. , Rosenbloom, D. and DeJong, W. 2005. Effects on alcohol related fatal crashes of a community based initiative to increase substance abuse treatment and reduce alcohol availability. Injury Prevention, 11: 84? 90. Holder, H. , Saltz, R. , Grube, J. , Voas, R. , Gruenewald, P. and Treno, A. 1997. A community prevention trial to reduce alcohol? involved accidental injury and death: overview. Addiction, 92(S2):S155? 171. Howat, P. , Sleet, D. , Maycock, B. and Elder, R. 2007. Effectiveness of Health Promotion in Prevention Alcohol Related Harm, In: McQueen, DV. and Jones, CM. Global Perspectives on Health Promotion Effectiveness. Springer, New York. Jernigan, D. 2001. Global status report: alcohol and young people. World Health Organization: Geneva, Switzerland. Available from: http://libdoc. who. int/hq/2001/WHO_MSD_MSB_01. 1. pdf (accessed May 2008). Jones, S. and Donovan, R. 2001. Messages in alcohol advertising targeted to youth. Australian and New Zealand Journal of Public Health, 25(2):126? 131. Loxley, W. , Toumbourou, J. and Stockwell, T. 2004. The prevention of substance use, risk and harm in Australia: a review of the evidence. Commonwealth of Australia: Canberra, Australia. Available from: http://www. health. gov. au/internet/wcms/publishing. nsf/ Content/health? pubhlth? publicat? document? mono_prevention? cnt. htm/$FILE/prevention_summary. pdf (accessed May 2008). Ludbrook, A. , Godfrey, C. , Wyness, L. , Parrot, S. , Haw, S. , Napper, M. and van Teijlingen, E. 2002. Effective and cost effective measures to reduce alcohol misuse in Scotland: a literature review. University of York: Aberdeen, Scotland. Available from: http:// www. scotland. gov. uk/health/alcoholproblems/docs/lire? 00. asp (accessed May 2008). McPherson, A. 2005. Adolescents in primary care. British Medical Journal, 330(26):465? 467. Midford, R. 2004. Community action to reduce alcohol problems: what should we try in Australia. Centrelines: Newsletter of the National Centres for Drug and Alcohol Research. Available from: http://espace. lis. curtin. edu. au/archive/00000502/01/ Pages_from_ndri012. pdf (accessed May 2008). Midford, R. , Munro, G. , McBride, M. , Snow, P.and Ladzinski, U. 2002. Principles that underpin effective school? based drug education. Journal of Drug Education, 32(4):363? 386. McMurray, A. 2003. Community Health and Wellness (2nd edn). Elsevier: Marrickville, NSW, Australia. National Health and Medical Research Council (NHMRC). 2001. Australian Alcohol Guidelines. Canberra, Australia. Available from: http://www. nhmrc. gov. au/publications/synopses/ds9syn. htm (accessed May 2008). Nutbeam, D. 2005. What would the Ottawa Char ter look like if it were written today? Available from: http://www. rhpeo. org/reviews/2005/19/index.htm (accessed March 2007). CONCLUSION The development of evidence informed practice in nursing includes using robust health promotion models and methods to address complex issues suchasalcoholmisuse. Thefiveactionareasofthe Ottawa Charter integrate the various perspectives on health promotion. Used collectively, they still serve a useful function in directing the practice of nurses who work with young people, their families, and the community. REFERENCES Australian Government Department of Health and Ageing, Ministerial Council on Drug Strategy. 2006. National Alcohol Strategy 2006? 2009. Canberra: Commonwealth of Australia. Available from: http://www. alcohol. gov. au/internet/alcohol/ publishing. nsf/Content/nas? 06? 09 (accessed May 2008). Australian Government Department of Health and Aged Care, National Expert Advisory Committee on Alcohol. 2001. Alcohol in Australia: issues and strategies. A background paper to the National Alcohol Strategy: A Plan for Action 2001 to 2003/04. Canberra: Australia. Available from: http://www. health. gov. au/ internet/drugstrategy/publishing. nsf/Content/00701CF3C77 7718CCA2571790008D615/$File/alcohol_strategy_back. pdf (accessed May 2008). Australian Institute of Health and Welfare 2008. 2007 National DrugStrategyHouseholdSurvey:firstresults. DrugStatisticsSeries No 20, cat. no. PHE 98. AIHW: Canberra, Australia. Available from: http://www. aihw. gov. au/publications/index. cfm/title/10579 (accessed May 2008). Australian Institute of Health and Welfare (AIHW). 2006. Australia’s health 2006. AIHW cat. no. AUS73. Canberra, Australia. Available from: http://www. aihw. gov. au/publications/index. cfm/ title/10321#full_publication (accessed May 2008). Editor. 2008. Confronting the demon of under-age alcohol abuse. The Age, 12 March, p.16, Fairfax: Melbourne, Victoria, Australia. Foxcroft, D. , Ireland, D. , Lister? Sharp, D. , Lowe, G. , and Breen, R. 2003. Primary prevention for alcohol misuse in young people, The Cochrane Library, Oxford: UK. AUSTRALIAN JOURNAL OF ADVANCED NURSING Volume 25 Number 4 118 POINT OF VIEW Parliament of Victoria (Australia). Drugs and Crime Prevention Committee. 2004. Inquiry into Strategies to Reduce Harmful Alcohol Consumption. Discussion Paper. Melbourne, Victoria, Australia. Available from: http://www. parliament. vic. gov. au/ dcpc/Reports/DCPC? DiscussionPaper_Alcohol_2004? 10? 21. pdf (accessed May 2008). Shanahan, P. and Hewitt, N. 1999. Developmental Research for a National Alcohol Campaign. Canberra: Australian Government Department of Health and Aged Care. Available from: http://www. alcohol. gov. au/internet/alcohol/publishing. nsf/Cont ent/3E8AC9F060C5D877CA257261000EC925/$File/alcocamp. pdf (accessed May 2008). Talbot, L. and Verrinder, G. 2005. Promoting health: the primary health care approach (3rd ed). Elsevier: Melbourne, Victoria, Australia. Toumbourou, J. , Duff, C. and Bamberg, J. 2003. Family intervention in the prevention of drug? related harm. Prevention Research Evaluation Repor t, 7, 1? 14. Available from: http://www. druginfo. adf. org. au/downloads/Prevention_ Research_Quarterly/REP_No7_03Aug_Family_intervention. pdf (accessed May 2008). Toumbourou, J. , Moodie, R. , Eyre, J. and Harper, T. 2008. Set boundaries, set an example. The Age, 8 March, p. 5. Fairfax: Melbourne, Victoria, Australia. Ward, B. , Snow, P. , Munro, G. , Graham, M. and Dickson? Swift, V. 2006. It starts with the parents and ends with the parents: the attitudes, knowledge and practices of metropolitan parents in relation to teenage alcohol use. Australasian College of Road Safety Journal, 17(3):20? 28. White, V. and Hayman, J. 2006. Australian secondary school students’ use of alcohol in 2005. The Cancer Council and the Australian Government Department of Health and Ageing. Available from: http://www. health. gov. au/internet/drugstrategy/ publishing. nsf/Content/85D7B21B3E3A993ECA25722500077 55F/$File/mono58. pdf (accessed May 2008). World Health Organization (WHO). 2005. Global health promotion scaling up for 2015: a brief review of major impacts and developments over the past 20 years and challenges for 2015. Paper presented at the 6th Global Conference on Health Promotion, Bangkok, Thailand. Available from: http://www. who. int/healthpromotion/conferences/6gchp/hpr_conference_ background. pdf (accessed May 2008). World Health Organization 2005. WMA Statement on reducing the global impact of alcohol on health and society, World Medical Association, France. World Health Organization. 1986. Ottawa Charter for Health Promotion. Available at: http://www. who. int/hpr/NPH/docs/ ottawa_charter_hp. pdf (accessed May 2008). AUSTRALIAN JOURNAL OF ADVANCED NURSING Volume 25 Number 4 119.

Time-division multiplexing

A user of a home telephone picks up her phone and makes a telephone call to a friend's home telephone in another part of town. Which of the following is likely to be true about this call? A. It uses a single pair of wires on the local loop at each end of the call 2. Which of the following are services that telcos have offered as WAN services over the years? A. Switched analog circuits B. Dedicated digital circuits 3. This chapter claims that IP routers work well as devices that connect to many different types of interfaces, including LANs and WANS.Which of the following answers list the reasons why routers do well in this role? A. Routers have much faster CPUs and can do the hard work to translate the incoming datalink header into the outgoing data-link format D. Routers discard old data-link headers and insert new data-link headers as part of their logic, which treats each Interfaces lower-layer detallds as Independent from each other 4. An enterprise network has many routers that c onnect to both a LAN as well as the WAN. Which of the following statements best describe how routers typically use and think about their WAN connections?B. As a transport service to deliver IP packets to the next Ip router 5. An enterprise builds a WAN design on paper. The main site, where all the servers sit, is shown in the center ofa network diagram. The WAN has a leased line from that site to every remote site, with the remote sites drawn around the edges of the drawing In a big circle. None of the remote sites have a leased line directly between them. Which of the following terms is most typically used to describe this WAN topology? D. Hub-and-spoke 6. A U. S. based company wants to order a leased line between two sites, with the eased line using the traditional T-carrier DSO, DSI, and DS3 types of lines. Which of the following answers describes the speed and distances for the leased line? A. No faster than 43,736 Mbps (T3) D. No literal distance Ilmltatlon 7. A telco customer has purchased a Tl leased line between two sites. The customer has already bought a router for one site, with a serial interface card with a built-in CSU/DSU. Which of the following answers lists other physical parts that the customer will need for that sites installation of the Tl leased line?B. A serial cable 8. A telco customer has a Tl leased line between two sites, called sites A and B. he telco has several switches between sites A and B that use T3 trunks. These switches use the T3 trunks along with time-division multiplexing (TDM) to create the leased line from site A to B. which of the following answers is true about how TDM works in this design? C. The switches map the Tl customer lines to one of 28 different frequencies in the T3 trunks 9. A telco network has TDM switches in the CO, ready to support Tl leased lines to customer sites.Two such switches have a single T3 trunk connecting the two switches, set aside to support T Is that run Just between those two co swltcnes. n lcn 0T tne Tollowlng answers Dest aescrlDes tne numDer 0T customer T Is the telco can support with these switches and the trunk? C. 28 10. A customer ordered a full Tl leased line between two sites. The telco implemented that leased line in its network using the T-carrier technology discussed in this chapter, with DSI, DS2, and DS3 lines plus switches that use time-division multiplexing (TDM) logic.Into which of the following general WAN categories does this service fit? B. Packet switching 1 1 . A telco customer orders a leased line between sites A and B, with requested speed of 1. 024 Mbps. The customer plans to use an external CSU/DSU at each site. The telco uses only T-carrier technology and none of the more modern options like SONET, ATM, MPLS, or Metro Ethernet. Which of the following answers is true about the speeds used on this link? B. The physical line between the telco CO and site B uses a line speed of 1. 2544 Mbps 12.A telco customer orders a leased line between sites A and B, with requested speed of 512 Kbps. The customer plans to use an external CSU/DSU at each site. The telco uses only T-carrier technology and none of the more modern options like SONET, ATM, MPLS, or Metro Ethernet. Which of the following answers is true about the speeds used between the router and the CSU/ DSU? A. THe CSU/DSU controls the router's sending and receiving speeds using clocking 13. Which of the following answers are true about DSI framing and channels? A. Each frame has 193 bits C.The frame groups 8 bits together for each of 24 channels, plus overhead 14. Which of the following data-link protocols was created to be used on leased lines, with support for multiple Layer 3 protocols by including a Type field that identifies the type of packet inside the data-link frame? C. PPP 15. Which fields that exist in both the HDLC and PPP headers have such relatively small use in point-to-point leased lines today, to the point that the PPP standards actually allows the nodes t o simply not bother to include these fields when sending PPP frames?B. Address C. Control 16. Think about the differences in a circuit switching the T-carrier system (ignoring analog circuit switching) versus packet switching. Which of the following answers are true about packet switching, but not about circuit switching? B. The telco switch can queue the data waiting on the congested outgoing to trunk to become available D. The switches look at the bits to find an address, and use that address to make a choice where to send the bits 17.In a Frame Relay network, which of the following terms refers to the customer router that connects to the Frame Relay network? D. Access link 18. Which of the following answers is not true about a Frame Relay network? B. Defined by the telco ahead of time, when the customers orders the service 19. A new Frame Relay customer is considering two competing Frame Relay design for his WAN. One design uses a full-mesh topology of PVCs between the 20 routers . The second design uses a partial mesh that looks like a hub-and-spoke design.Assuming that all other technical details not mentioned in this question are the same when comparing the two designs, which of these answers are true about the partial-mesh design but not true about the full-mesh design? A. Not all routers can send a Frame Relay frame alrectly to eacnotner B Frame Relay Trames, wlll De Torwaraea Dy tne network Dasea on the DLCI field in the Frame Relay 20. Which two of the following WAN services make good use of protocols that enterprise have used for many years, with those protocols being expanded and enhanced to create new types of WAN services?

Bilingual Education Essay Example | Topics and Well Written Essays - 750 words - 1

Bilingual Education - Essay Example A close analysis of these programs and their effectiveness provides one with valuable information on the topic and further indicates the importance of doing more research and drafting legislations that cater for the need of the diverse ethnicity content of the students in public schools.Dual language education has elicited praised by both parents and teachers for the diversity and enrichment that it brings to a classroom, Palmer. She, however, notes that the program consists of various inequalities going by the educational experiences encountered by different students at the school. There is need to critically consider the underlying forces that might be contributing to these challenges. The critical race theory and the two-way immersion have been highlighted as to being vital in uncovering the tensions being witnessed in the dual language education program. The issue of duo language education needs to be looked at objectively. Garca argues that there is more to bilingual language le arning narratives than there is when discussing language. According to Garca (2014), the focus should be shifted from English as a language to the practices exhibited by the emergent individual bilinguals. Garca proposes five misconstructions that together shed light on English as a language, the learning of English, bilingualism and the teaching of English. Garca, provides ways through which trans languaging is viewed through. It attempts to explain the topic and issues surrounding bilingual/dual language education.

Managing a wide range of cultural diversity in the workplace is Essay

Managing a wide range of cultural diversity in the workplace is challenging but not impossible - Essay Example Cultural diversity in work place is difficult to handle, but is manageable. This essay will address the main hurdles in effective management under culturally diverse circumstances and solutions to such problems. Cultural diversity refers to multiculturalism or interaction of individuals from different cultures at one platform. This phenomenon occurs as a result of international migration. People from several diverse cultures and nations migrate to other places usually developed areas for work. This makes management difficult. According to UNESCO (2003) some 175 million people live away from their birth places and this rate was reported to be 200 million by the World Bank in 2009. When individuals from various diverse cultures accumulate in a single organization, the management is faced by following common issues: Where there is cultural diversity, people from different races are provided with several opportunities to interact. An interaction at such a level is sometimes ridden with racial issues that are again quite challenging to manage. In culturally diverse workplaces, sometimes individuals from a contrasting culture fail to absorb or even understand the organizational culture. This is referred to as a cultural shock. Cultural shock leads to negative feelings of helplessness and isolation, usually leading to poor performance at work by the individual. Communication barriers among the co workers due to their diverse cultures also pose a problem in such scenarios and if left un dealt with, can pose serious limitations in the organization’s overall performance. The main issues relating to cultural diversity that might pose a problem for management have been highlighted above. These issues suggest that management of cultural diversity is a difficult task. Now I will discuss how these issues can be dealt with making it possible to manage such a culturally diverse workplace. Cultural diversity can be managed at workplace if certain

Dietary Education Program for Patients at High Risk of Coronary Heart Dissertation

Dietary Education Program for Patients at High Risk of Coronary Heart Disease - Dissertation Example Conclusion and Recommendations P. 47 – P. 50 10. References P. 51 – P. 55 11. Bibliography P. 56 12. Appendices P. 65-83 Tables Table 1 Boolean Table P. 22-23 Table 2 Search Terms Acknowledgement My sincere thanks to people who have helped in the formulation of this paper, from the initial typing of the draft to the editing and correction my heart is filled with thanks. To my supervisor who painstakingly made corrections and suggestions, and to my classmates who also provided inspiration and suggestions, my personal appreciation and thanks. Without you, I wouldn’t be able to fulfil my academic obligations. Abstract Coronary heart disease is a common sickness and a major killer among industrialized countries of the world, Hong Kong not excluded. While we are considered advanced in many areas, in technology, the sciences and in medicine, we have forgotten how to deal with sickness and the common risk factors that kill our people. This is due primarily to our contin uing lifestyles of inactivity and continuous energy intake without regard for the kind of food we take. There are many suggestions contained in the literature on how to reduce CHD risk factors and deaths but the best suggestion so far is education. Through education available for patients and people at high risk of cardiovascular disease and CHD, we can reduce the risk factors and mortality of the disease. The aim of this study is to provide a dietary education approach for long term treatment of people at risk of CHD. Our conclusions and recommendations provided this approach and this is a combination of several strategies. The strategies include a community based education programme for patients and persons at high risk. The program should use the Mediterranean diet, or a pattern of fish, fish oil, olive oil, fruits and vegetables, which has to be combined with physical exercise. Other programmes include the INFO, PEP, FIT, which recommends healthy habits and physical exercise. Th e method used was review of the literature. The critique provided was a comprehensive study that applied various dimensions to include theoretical aspects, ethical issues, including the methodologic concepts, interpretations and presentation methods. The themes are all about dietary education to reduce the risk factors for CHD and to prevent myocardial infarction or cardiac event. In the reviews, we found the themes to be the focus for discussion and the influence of the body of the literature. Changes in major risk factors have positive effects in CHD mortality rates. Common risk factors are almost similar in many studies, such as blood pressure, cholesterol, smoking, obesity and diabetes. A study in Hong Kong concluded that for the period 1989 to 2001, CHD mortality was reduced by 78% due to improvements in treatment and education/information provided to patients and families. Compared to CHD mortality rates in western countries, Hong Kong’s was very low. Treatment, educati on and control of risk factors were attributable to reduction in CHD mortality rates. Chapter 1 Introduction Hospital Authority’s plan of action for the next five years addresses the issue of enhancing quality health care and patient-community relationship, along with adequate resources in meeting healthcare needs. The strategic planning process was led by the Hospital Authority Board and participated in by 750 stakeholders composed of patient groups, representatives, clinicians and heads of agencies. The Strategic Plan introduced a framework for healthcare workers and professionals