Case Study on Palliative Care: Example Answers

Case Study on Palliative Care: Example Answers Carol is a 48 year old woman who lives with her husband Dean and three children. Carols three children, Josephine (15 years), Harry (12 years) and Sarah (8 years) are aware their mother has cancer, but have not been told of the development of secondary disease or the implications this carries. The family run a small general store in an outer suburb of Perth. Carol was diagnosed with breast cancer three years ago, originally undergoing a right lumpectomy with adjuvant chemotherapy. Last year Carol was diagnosed with bone secondaries. Since that time she has been receiving tamoxifen and attending the oncology clinic for follow-up. The community palliative care nurse visits Carol once a month to monitor her progress and provide emotional support. While visiting Carol the nurse notes that she appears to be in considerable discomfort, though she denies any pain. On questioning Dean, the nurse learns that Carol has been found crying and holding her hip, but refuses to seek medical attention. Why do you think Carol is reluctant to seek medical attention and acknowledge her pain? ANSWER: Carol is reluctant to seek the medical attention because she is fed up with the medical checkups and also she receives no positive improvement in her health so she herself concluded to not to waste the money on her health and let them safe for her three children (Matthews, 2008). As Carol begins to receive palliative care, which members of the palliative care team do you think need to be involved in her care? Briefly describe the role of each. ANSWER: The family members of Carol play an important role in the team of palliative care and especially the role of Dean was very crucial because he is the person who could fill the strength in Carol to fight against this dangerous disease ( Foley, 2001). Investigations of Carols pain revealed bony secondaries. She was offered a course of radiotherapy, but refused as this would mean going to the city (55km away) every day, and she would be away from the shop at the busiest time of the year. Carol agreed to recommencing chemotherapy, and was commenced on regular panadeine forte (two every four hours) for her pain. Carol has been troubled by nausea and vomiting after each course of chemotherapy. On a follow up visit five days after Carols last chemotherapy, the community nurse discovers that Carol is constantly nauseated, vomiting several times a day and unable to keep any fluids down. Identify the possible causes of Carols nausea and vomiting. ANSWER: Chemotherapy involves the killing of cancerous cells from the patients body thus due to these heavier operations on Carols body would make her uneasy and thus she has nausea and vomiting (Ferrell, 2006). Describe the management strategies for the various probable cause(s) of Carols nausea and vomiting. ANSWER: Management strategies should be in order to give her strict instructions to be away from strong odours, not to lay flat after eating, have some light exercise after eating, to eat in smaller amounts and most importantly keep her mind relaxed and try to forget about the chemotherapy (Hesketh, 2005). On a follow-up visit, the community nurse discovers that Carol is only achieving two hours pain relief after her tablets and is taking them more frequently, but is reluctant to consider changing to stronger medication. Identify the appropriate steps for assessing Carols pain. ANSWER: She should be checked to take medicines on her own i.e. someone from her family should take the responsibility to fetch her with medicines; also management should maintain a regular chart of the total amount of daily doses and the time span of pain she have(McMann,  2009). After consultation with the general practitioner, the community nurse discusses changing Carols analgesia to something stronger. Carol is very reluctant as she feels she will only become addicted to hard drugs if she uses them now. Carol expresses concerns about having this type of medication in the house with young children around. What are the possible reasons for Carols reluctance to change her medication, and how could this be overcome? ANSWER: Carol main reason for reluctance was that she wants to be with her family also she wants to save money as she could not afford the hospitals expenses and hence she wants the whole medication to be done at her home. This can be overcome if and only if the management gives some relaxation in the expenses (Visel, 2006). Carol reluctantly agrees to a trial of oral morphine, initially in short-acting form until the dose is titrated. She is commenced on 10mg of oral morphine 4th hourly. What education should the nurse give Carol about commencing and taking morphine? ANSWER: The nurse should tell her to handle some pain and extend the period of taking the morphine from 2 hours interval to 4 hours interval so that she could develop some resistive powers in herself (Bruera, 2003). When should Carol be considered for conversion to controlled (slow) release morphine, and how would the dose be calculated for this? ANSWER: As soon as Carol feels that she has generated enough resistive power then the controlled doses of morphine should be given and the period should be increased rose to the power of 2 i.e. 2, 4, 8, 16 and finally it should be stopped (Bruera, 2003). Identify adjuvant medication that may be helpful in Carols case. ANSWER: Herceptin drug can be used as the adjuvant medication because it interferes with growth of cancer cells and slows their growth and spread in the body (Knox, 2004). Carol is reluctantly taking morphine 30mg every four hours and Naprosyn 500mg b.d. for her pain. When visiting Carol one day the community nurse finds Carol vomiting and complaining of catching a gastro bug from one of the children. On questioning Carol states she has had small frequent amounts of diarrhoea for 5-6 days, and has not had a normal bowel motion for two weeks. Carol is notably dry, complains of thirst, has a coated tongue, and a distended abdomen. What nursing investigations would you carry out? ANSWER: The infection is been spreading in her family due to the contact of virus released by the vomiting of the Carol. Hence personal hygiene should be maintained (Yarbro, 2005). What nursing strategies would you implement to relieve Carols symptoms? ANSWER: For relieving Carols symptoms the basic nursing strategies should ensure that the toiletry area should properly cleaned using diluted bleach, she must wash her hand after using the toilet, her clothes must be washed in warm water, and lastly the nurse should suggest her the BRAT food i.e. Banana Rice Applesauce and Toast as the main food from time to time and drink as much liquid as she discharges in her stools (Yarbro, 2005). Carols appetite has decreased and she is eating only very small amounts of food. She is not nauseous. Dean is finding it hard to accept that Carol doesnt need food and worries that without food Carol will die. What will you tell Dean about Carols loss of appetite? ANSWER: We will tell him not to panic because this loss of appetite is only due to the gastro effects and it will be removed as soon as the medicines perform their proper function (Ko, 2008). What strategies can you use to help Carol increase her intake? ANSWER: After giving her enough liquid food we will ask Carol to perform light exercises which could help her to burn more calories and so she will feel a good hunger for receiving a good nutrition (Ko, 2008). Carol has become increasingly bedbound and is spending many hours sleeping, and at times becomes restless. She has refused all further chemotherapy and blood tests and is aware her time is limited. Carol has told Dean that she would like to die at home. What do you need to consider to ensure that Carol can be cared for at home (eg. equipment, care needs etc)? ANSWER: The main consideration would be based on finding ways so that she must not get any complication in terms of medical facility. Hence important equipments must be installed with a good experienced nurse who remains with Carol in her house for 24 hours (Keir, 2002). The community nurse is called late at night because Carol has become semi-conscious, but is calling out and very restless. On arrival the nurse finds Carol agitated and restless in bed, with an increased respiratory rate, an obvious frown and unable to respond to questions. On questioning Dean states that he was unable to administer her last two doses of morphine slow release tablets. Carol has not taken fluids for several days, nor passed urine for eighteen hours. Identify the possible cause(s) for Carols restlessness and suggest treatments. ANSWER: Carols restlessness is only due to improper metabolism of her body so she should be given liquids as much as she could take and finally she must be made to discharge the urine (smith, 2006). The community nurse suggests insertion of a subcutaneous butterfly needle to administer Carols morphine for pain control. Dean becomes distressed, questioning the need for morphine when his wife is almost unconscious. He accuses the nurse of trying to hurry things along. What is an appropriate nursing response to Deans concerns? ANSWER: Nurse should send Dean outside the room and tell him to keep patience and keep faith, she will do the appropriate nursing of Carol (Kearny, 2006). Carol remains unconscious for several days. Josephine expresses concern that her mother has not had any fluids for several days and questions whether she should be admitted to hospital so intravenous fluids could be commenced. Josephine questions if it is cruel to let her mother die of dehydration? What explanation could the nurse give in response to Josephines concerns? ANSWER: Nurse should give condolence to Josephine and not to worry because she will take care of her mother in every aspects of medical concern (Alexander, 2000). What nursing actions will ensure that Carol is comfortable despite no oral intake? ANSWER: The basic nursing action that a nurse should check Carols pulse rate and blood pressure, if everything is normal then there it is ensured that Carol is comfortable despite of having no oral intake (Alexander, 2000). Dean approaches the palliative care nurse for assistance the next day. He states the children, in particular Sarah, are asking questions he doesnt know how to answer. Sarah asks detailed questions about what will happen to Carol before and after she dies, and appears to have a morbid interest in the details of death. Identify strategies to assist children dealing with death. ANSWER: While assisting children dealing with death the children of small age should be taken away from the house and make them busy in some games while elder children should understand itself how to manage with the condition (Schaefer, 2002). Carol died at 4.30 p.m. on a Sunday afternoon, with Dean, the three children and her mother by her side. Her death was described by the palliative care nurse as peaceful, but her dying as a struggle. What bereavement follow up could be put in place for this family? ANSWER: Carol was a strong fighter and she fights with her disease with silence and lots of courage, this death would keep soul free from the struggles that she had faced during her illness. God bless her soul Amen (Schaefer, 2002).

The Death of Communism Essay -- Exploratory Essays Research Papers

The Death of Communism The United States longest and bloodiest war was the Vietnam War, which was fought from 1959 until 1975.(Communist Manifesto 1) In this war 57,685 Americans were killed, and their were over 2 million Vietnamese deaths.(Communist Manifesto 3) One of the main causes of the war was a commonly held American belief called the Domino Theory. This theory stated that if the U.S. allowed one country to fall to communism, those around it would fall, and then those around it, eventually taking over the whole world. However, the fall of the Soviet Union in 1991 allows to approach communism in a new light. The Communist Manifesto has three sections. The first is an outline of the history of the bourgeois and the proletariat, and a explanation on how the bourgeoisà ­ will bring about their defeat. The second section shows the framework of the communist goals, and their long range plan to abolish private property. The last section criticizes other socialist attempts at the time, calling all workers to unite under communism. The bourgeois Marx speaks of in the manifesto is simply the capitalist of the time. The proletariat are the workers of the world, people who, according to Marx, have "[become] an appendage of the machine."(Marx 3) Marx speaks of their horrible fate saying "they are daily and hourly enslaved by the machine, by the overlooker, and, above all, by the individual bourgeois manufacturer himself."(Marx 3) Marx documents the stages of the proletariatà ­s struggle with the bourgeois: "at first the contest is carried on by individual laborers, then by the workpeople of a factory, then the operatives of one trade, in one locality, against the bourgeois that directly exploits them."(Marx 4) Marx tells ho... ...e Vietnam war rages on. Bloodshed and military advances ground to a halt decades ago, but the real battle lies in creating a Vietnam that can lift itself out of poverty. The war succeeded more in pushing the country deeper into communism than pulling it out. But the outcome is a forgone conclusion: an ideology that no longer fits with the times will not stand. Ask Mother Russia. Works Cited "Communist Manifesto," MicrosoftÆ EncartaÆ 96 Encyclopedia. (c) 1993-1995 Microsoft Corporation. All rights reserved. (c) Funk & Wagnalls Corporation. All rights reserved. Karl Marx and Frederick Engels. "The Communist Manifesto." http: //leftside.uwc.ac.za/Archives/1848-CM/cm.html (25 June 1997). "Vietnam War," MicrosoftÆ EncartaÆ 96 Encyclopedia. (c) 1993-1995 Microsoft Corporation. All rights reserved. (c) Funk & Wagnalls Corporation. All rights reserved.

The Host Chapter 36: Believed

The congregation relaxed, and a more enthusiastic murmur ran around the half circle. I looked at Jamie. He pursed his lips and shrugged. â€Å"Jeb's just trying to get things back to normal. It's been a bad couple of days. Burying Walter†¦Ã¢â‚¬  I winced. I saw that Jeb was grinning at Jared. After a moment of resistance, Jared sighed and rolled his eyes at the strange old man. He turned and strode quickly from the cave. â€Å"Jared got a new ball?† someone asked. â€Å"Cool,† Wes said beside me. â€Å"Playing games,† Trudy muttered, and shook her head. â€Å"If it eases the tension,† Lily responded quietly, shrugging. Their voices were low, close beside me, but I could also hear other, louder voices. â€Å"Easy on the ball this time,† Aaron said to Kyle. He stood over him, offering his hand. Kyle took the offered hand and got slowly to his feet. When he was standing, his head almost hit the hanging lanterns. â€Å"The last ball was weak,† Kyle said, grinning at the older man. â€Å"Structurally deficient.† â€Å"I nominate Andy for captain,† someone shouted. â€Å"I nominate Lily,† Wes called out, getting to his feet and stretching. â€Å"Andy and Lily.† â€Å"Yeah, Andy and Lily.† â€Å"I want Kyle,† Andy said quickly. â€Å"Then I get Ian,† Lily countered. â€Å"Jared.† â€Å"Brandt.† Jamie got to his feet and stood on his toes, trying to look tall. â€Å"Paige.† â€Å"Heidi.† â€Å"Aaron.† â€Å"Wes.† The roll call continued. Jamie glowed when Lily chose him before half the adults were taken. Even Maggie and Jeb were picked for teams. The numbers were even until Lucina came back with Jared, her two small boys bouncing in excitement. Jared had a shiny new soccer ball in his hand; he held it out, and Isaiah, the older child, jumped up and down trying to knock it from his hand. â€Å"Wanda?† Lily asked. I shook my head and pointed to my leg. â€Å"Right. Sorry.† I'm good at soccer, Mel grumbled. Well, I used to be. I can hardly walk, I reminded her. â€Å"I think I'll sit this one out,† Ian said. â€Å"No,† Wes complained. â€Å"They've got Kyle and Jared. We're dead without you.† â€Å"Play,† I told him. â€Å"I'll†¦ I'll keep score.† He looked at me, his lips pressed into a thin, rigid line. â€Å"I'm not really in the mood for playing a game.† â€Å"They need you.† He snorted. â€Å"C'mon, Ian,† Jamie urged. â€Å"I want to watch,† I said. â€Å"But it will be†¦ boring if one team has too much advantage.† â€Å"Wanda.† Ian sighed. â€Å"You really are the worst liar I've ever met.† But he got up and started stretching with Wes. Paige set up goalposts, four lanterns. I tried to get to my feet-I was right in the middle of the field. Nobody noticed me in the dim light. All around, the atmosphere was upbeat now, charged with anticipation. Jeb had been right. This was something they needed, odd as it seemed to me. I was able to get onto all fours, and then I pulled my good leg forward so I was kneeling on the bad. It hurt. I tried to hop up onto my good leg from there. My balance was all off, thanks to the awkward weight of my sore leg. Strong hands caught me before I could fall on my face. I looked up, a little rueful, to thank Ian. The words caught in my throat when I saw that it was Jared whose arms held me up. â€Å"You could have just asked for help,† he said conversationally. â€Å"I -† I cleared my throat. â€Å"I should have. I didn't want to†¦Ã¢â‚¬  â€Å"Call attention to yourself?† He said the words as if he were truly curious. There was no accusation in them. He helped me hobble toward the cave entrance. I shook my head once. â€Å"I didn't want to†¦ make anyone do anything, out of courtesy, that they didn't want to do.† That didn't explain it exactly right, but he seemed to understand my meaning. â€Å"I don't think Jamie or Ian would begrudge you a helping hand.† I glanced back at them over my shoulder. In the low light, neither had noticed I was gone yet. They were bouncing the ball off their heads, and laughing when Wes caught it in the face. â€Å"But they're having fun. I wouldn't want to interrupt that.† Jared examined my face. I realized I was smiling in affection. â€Å"You care about the kid quite a bit,† he said. â€Å"Yes.† He nodded. â€Å"And the man?† â€Å"Ian is†¦ Ian believes me. He watches over me. He can be so very kind†¦ for a human.† Almost like a soul, I'd wanted to say. But that wouldn't have sounded like the compliment it was to this audience. Jared snorted. â€Å"For a human. A more important distinction than I'd realized.† He lowered me to the lip of the entrance. It made a shallow bench that was more comfortable than the flat floor. â€Å"Thank you,† I told him. â€Å"Jeb did the right thing, you know.† â€Å"I don't agree with that.† Jared's tone was milder than his words. â€Å"Thank you also-for before. You didn't have to defend me.† â€Å"Every word was the truth.† I looked at the floor. â€Å"It's true that I would never do anything to hurt anyone here. Not on purpose. I'm sorry that I hurt you when I came here. And Jamie. So sorry.† He sat down right beside me, his face thoughtful. â€Å"Honestly†¦Ã¢â‚¬  He hesitated. â€Å"The kid is better since you came. I'd sort of forgotten what his laugh sounded like.† We both listened to it now, echoing above the lower pitch of adult laughter. â€Å"Thank you for telling me that. It's been my†¦ biggest worry. I hoped I hadn't damaged anything permanently.† â€Å"Why?† I looked up at him, confused. â€Å"Why do you love him?† he asked, his voice still curious but not intense. I bit my lip. â€Å"You can tell me. I'm†¦ I've†¦Ã¢â‚¬  He couldn't find the words to explain. â€Å"You can tell me,† he repeated. I looked at my feet as I answered. â€Å"In part because Melanie does.† I didn't peek to see if the name made him flinch. â€Å"Remembering him the way she does†¦ that's a powerful thing. And then, when I met him in person†¦Ã¢â‚¬  I shrugged. â€Å"I can't not love him. It's part of my†¦ the very makeup of these cells to love him. I hadn't realized before how much influence a host had on me. Maybe it's just human bodies. Maybe it's just Melanie.† â€Å"She talks to you?† He kept his voice even, but I could hear the strain now. â€Å"Yes.† â€Å"How often?† â€Å"When she wants to. When she's interested.† â€Å"How about today?† â€Å"Not much. She's†¦ kind of mad at me.† He barked out a surprised laugh. â€Å"She's mad? Why?† â€Å"Because of†¦Ã¢â‚¬  Was there such a thing as double jeopardy here? â€Å"Nothing.† He heard the lie again and made the connection. â€Å"Oh. Kyle. She wanted him to fry.† He laughed again. â€Å"She would.† â€Å"She can be†¦ violent,† I agreed. I smiled, to soften the insult. It was no insult to him. â€Å"Really? How?† â€Å"She wants me to fight back. But I†¦ I can't do that. I'm not a fighter.† â€Å"I can see that.† He touched my battered face with one fingertip. â€Å"Sorry.† â€Å"No. Anyone would do the same. I know what you must have felt.† â€Å"You wouldn't -† â€Å"If I were human, I would. Besides, I wasn't thinking of that†¦ I was remembering the Seeker.† He stiffened. I smiled again, and he relaxed a little. â€Å"Mel wanted me to throttle her. She really hates that Seeker. And I can't†¦ find it in myself to blame her.† â€Å"She's still searching for you. Looks like she had to return the helicopter, at least.† I closed my eyes, clenched my fists, and concentrated on breathing for several seconds. â€Å"I didn't used to be afraid of her,† I whispered. â€Å"I don't know why she scares me so much now. Where is she?† â€Å"Don't worry. She was just up and down the highway yesterday. She won't find you.† I nodded, willing myself to believe. â€Å"Can you†¦ can you hear Mel now?† he murmured. I kept my eyes closed. â€Å"I'm†¦ aware of her. She's listening very hard.† â€Å"What's she thinking?† His voice was just a whisper. Here's your chance, I told her. What do you want to tell him? She was cautious, for once. The invitation unsettled her. Why? Why does he believe you now? I opened my eyes and found him staring at my face, holding his breath. â€Å"She wants to know what happened to make you†¦ different now. Why do you believe us?† He thought for a moment. â€Å"An†¦ accumulation of things. You were so†¦ kind to Walter. I've never seen anyone but Doc be that compassionate. And you saved Kyle's life, where most of us would have let him fall just to protect ourselves, intended murder aside. And then you're such an appalling liar.† He laughed once. â€Å"I kept trying to see these things as evidence of some grand plot. Maybe I'll wake up tomorrow and feel that way again.† Mel and I flinched. â€Å"But when they started attacking you today†¦ well, I snapped. I could see in them everything that shouldn't have been in me. I realized I already did believe, and that I was just being obstinate. Cruel. I think I've believed since†¦ well, a little bit since that first night when you put yourself in front of me to save me from Kyle.† He laughed as if he didn't think Kyle was dangerous. â€Å"But I'm better at lying than you are. I can even lie to myself.† â€Å"She hopes you won't change your mind. She's afraid you will.† He closed his eyes. â€Å"Mel.† My heart thudded faster in my chest. It was her joy that sped it, not mine. He must have guessed how I loved him. After his questions about Jamie, he must have seen that. â€Å"Tell her†¦ that won't happen.† â€Å"She hears you.† â€Å"How†¦ straightforward is the connection?† â€Å"She hears what I hear, sees what I see.† â€Å"Feels what you feel?† â€Å"Yes.† His nose wrinkled. He touched my face again, softly, a caress. â€Å"You don't know how sorry I am.† My skin felt hotter where he had touched it; it was a good heat, but his words burned hotter than his touch. Of course he was sorrier for hurting her. Of course. That shouldn't bother me. â€Å"C'mon, Jared! Let's go!† We looked up. Kyle was calling to Jared. He seemed utterly at ease, as if he had not been on trial for his life today. Maybe he'd known it would go his way. Maybe he was quick to get over anything. He didn't seem to notice me there beside Jared. I realized, for the first time, that others had. Jamie was watching us with a satisfied smile. This probably looked like a good thing to him. Was it? What do you mean? What does he see when he looks at us? His family, put back together? Isn't it? Sort of? With the one unwelcome addition. But better than it was yesterday. I guess†¦ I know, she admitted. I'm glad Jared knows I'm here†¦ but I still don't like him touching you. And I like it too much. My face tingled where Jared's fingers had brushed it. Sorry about that. I don't blame you. Or, at least, I know I shouldn't. Thanks. Jamie wasn't the only one watching. Jeb was curious, that little smile gathering up the corners of his beard. Sharon and Maggie watched with fire in their eyes. Their expressions were so much the same that the youthful skin and bright hair did nothing to make Sharon look younger than her grizzled mother. Ian was worried. His eyes were tight, and he seemed on the verge of coming to protect me again. To make sure Jared wasn't upsetting me. I smiled, to reassure him. He didn't smile back, but he took a deep breath. I don't think that's why he's worried, Mel said. â€Å"Are you listening to her now?† Jared was on his feet but still watching my face. His question distracted me before I could ask her what she meant. â€Å"Yes.† â€Å"What's she saying?† â€Å"We're noticing what the others think of your†¦ change of heart.† I nodded toward Melanie's aunt and cousin. They turned their backs on me in synchronization. â€Å"Tough nuts,† he acknowledged. â€Å"Fine, then,† Kyle boomed, turning his body toward the ball that sat under the brightest spot of light. â€Å"We'll win it without you.† â€Å"I'm coming!† Jared threw one wistful glance at me-at us-and ran to get in on the game. I wasn't the best scorekeeper. It was too dark to see the ball from where I sat. It was too dark even to see the players well when they weren't right under the lights. I began counting from Jamie's reactions. His shout of victory when his team scored, his groan when the other team did. The groans outnumbered the shouts. Everyone played. Maggie was the goalie for Andy's team, and Jeb was the goalie for Lily's. They were both surprisingly good. I could see their silhouettes in the light from the goalpost lamps, moving as lithely as if they were decades younger. Jeb was not afraid to hit the floor to stop a goal, but Maggie was more effective without resorting to such extremes. She was like a magnet for the invisible ball. Every time Ian or Wes got off a shot†¦ thunk! It landed in her hands. Trudy and Paige quit after a half hour or so and passed me on their way out, chattering with excitement. It seemed impossible that we'd started the morning with a trial, but I was relieved that things had changed so drastically. The women weren't gone long. They came back with arms full of boxes. Granola bars-the kind with fruit filling. The game came to a halt. Jeb called halftime, and everyone hurried over to eat breakfast. The goods were divvied up at the center line. It was a mob scene at first. â€Å"Here you go, Wanda,† Jamie said, ducking out of the group. He had his hands full of the bars, and water bottles tucked under his arms. â€Å"Thanks. Having fun?† â€Å"Yeah! Wish you could play.† â€Å"Next time,† I said. â€Å"Here you go†¦Ã¢â‚¬  Ian was there, his hands full of granola bars. â€Å"Beat ya,† Jamie told him. â€Å"Oh,† Jared said, appearing on Jamie's other side. He also had too many bars for one. Ian and Jared exchanged a long glance. â€Å"Where's all the food?† Kyle demanded. He stood over an empty box, his head swiveling around the room, looking for the culprit. â€Å"Catch,† Jared said, tossing granola bars one by one, hard, like knives. Kyle plucked them out of the air with ease, then jogged over to see if Jared was holding out on him. â€Å"Here,† Ian said, shoving half of his haul toward his brother without looking at him. â€Å"Now go.† Kyle ignored him. For the first time today, he looked at me, staring down at me where I sat. His irises were black with the light behind him. I couldn't read his expression. I recoiled, and caught my breath when my ribs protested. Jared and Ian closed ranks in front of me like stage curtains. â€Å"You heard him,† Jared said. â€Å"Can I say something first?† Kyle asked. He peered down through the space between them. They didn't respond. â€Å"I'm not sorry,† Kyle told me. â€Å"I still think it was the right thing to do.† Ian shoved his brother. Kyle reeled back but then stepped forward again. â€Å"Hold on, I'm not done.† â€Å"Yeah, you are,† Jared said. His hands were clenched, the skin over his knuckles white. Everyone had noticed now. The room was hushed, all the fun of the game lost. â€Å"No, I'm not.† Kyle held his hands up, a gesture of surrender, and spoke to me again. â€Å"I don't think I was wrong, but you did save my life. I don't know why, but you did. So I figure, a life for a life. I won't kill you. I'll pay the debt that way.† â€Å"You stupid jackass,† Ian said. â€Å"Who's got the crush on a worm, bro? You gonna call me stupid?† Ian lifted his fists, leaning forward. â€Å"I'll tell you why,† I said, making my voice louder than I wanted to. But it had the effect I was after. Ian and Jared and Kyle turned to stare at me, fight forgotten for the moment. It made me nervous. I cleared my throat. â€Å"I didn't let you fall because†¦ because I'm not like you. I'm not saying that I'm not†¦ like humans. Because there are others here who would do the same. There are kind and good people here. People like your brother, and Jeb, and Doc†¦ I'm saying that I'm not like you personally.† Kyle stared at me for a minute and then chuckled. â€Å"Ouch,† he said, still laughing. He turned away from us then, his message given, and walked back to get some water. â€Å"Life for a life,† he called over his shoulder. I wasn't sure I believed him. Not sure at all. Humans were good liars.

Habits and Traits of Japanese Beetles, Popillia japonica

Habits and Traits of Japanese Beetles, Popillia japonica Is there a garden pest worse than the Japanese beetle? First, the beetle grubs destroy your lawn, and then the adult beetles emerge to feed on your leaves and flowers. Knowledge is power when it comes to controlling  this pest in your yard. Description The Japanese beetles body is a striking metallic green, with copper-colored elytra (wing covers) covering the upper abdomen. The adult beetle measures just about 1/2 inch in length. There are five distinctive tufts of white hairs line each side of the body, and two additional tufts marking the tip of the abdomen. These tufts distinguish the Japanese beetle from other similar species. Japanese beetle grubs are white, with brown heads, and reach about 1 inch in length when mature. First instar  (a developmental stage between molting) grubs measure just a few millimeters in length. The grubs curl into a C shape. Classification Kingdom - AnimaliaPhylum - ArthropodaClass - InsectaOrder - ColeopteraFamily - ScarabaeidaeGenus - PopilliaSpecies - Popillia japonica Diet Adult Japanese beetles are not picky eaters, and thats what makes them such an impactful pest. Theyll feed on both the foliage and flowers of several hundred species of trees, shrubs, and herbaceous perennials. The beetles eat plant tissues between the leaf veins, skeletonizing the foliage. When beetle populations get high, the pests may completely strip a plant of flower petals and foliage. Japanese beetle grubs feed on organic matter in the soil and on the roots of grasses, including turfgrass. High numbers of grubs may destroy turf in lawns, parks, and golf courses. Life Cycle Eggs hatch in late summer, and grubs begin to feed on plant roots. Mature grubs overwinter deep in the soil, below the frost line. In spring, grubs migrate upward and resume feeding on plant roots. By early summer, the grub is ready to pupate within an earthen cell in the ground. Adults emerge from late June into summer. They feed on foliage and mate during the day. Females excavate soil cavities several inches deep for their eggs, which they lay in masses. In most parts of its range, the Japanese beetle life cycle takes just a year, but in northern areas, it may stretch to two years. Special Behaviors and Defenses Japanese beetles travel in packs, flying and feeding together. Males use highly sensitive antennae to detect and locate female mates. Though Japanese beetles are despised for their voracious appetites for just about anything green, there is one plant that stops them in their tracks, literally. Geraniums have an odd effect on Japanese beetles and may be the key to defeating these pests. Geranium petals cause a temporary paralysis in Japanese beetles, rendering them  completely immobile for as long as 24 hours. While this doesnt kill them directly, it leaves them vulnerable to predators. Habitat With such a variety of potential host plants, Japanese beetles are well suited to live just about anywhere. Popillia japonica inhabits forests, meadows, fields, and gardens. Japanese beetles even find their way to urban backyards and parks. Range: Although the Japanese beetle is native to eastern Asia, this species was accidentally introduced to the U.S. in 1916. Japanese beetles are now established throughout the eastern U.S. and parts of Canada. Intermittent populations occur in the western U.S. Sources: Eureka Alert: Geraniums Could Help Control Devastating Japanese Beetle

Aramco Supply Chain Management Essays

Aramco Supply Chain Management Essays Aramco Supply Chain Management Essay Aramco Supply Chain Management Essay A Users Conference ID#: 2965 Improving Supply Chain Management through Real-Time Operations Monitoring Track: MES Topic: Enterprise Integration Presenter: Ramadan Fan Company: Saudi Aramco  © Copyright 2008, Saudi Aramco. All rights reserved. Agenda Saudi Aramco Overview Saudi Aramco Distribution Operations Supply Chain Management Challenges SIMATIC IT XHQ Implementation Enterprise Monitoring Solution Key Benefits Next Steps Page 2 Saudi Aramco Overview – Global Offices Saudi Petroleum Overseas Ltd. Ltd. Vela Marine Intl. , Ltd. Intl. , Ltd. Saudi Petroleum Intl. , Inc. Intl. , Aramco Overseas Company, AOC (BV) Company, Saudi Petroleum Ltd. Ltd. Aramco Services Company Saudi Aramco Headquarters Page 3 Saudi Aramco Overview – Upstream Downstream Gas Sales Grid Upstream Gas Plants Downstream Gas Plants OIL GAS Wells GOSPs Bulk Plants Refineries Crude Treatment Stabilizers Page 4 Crude Terminals Saudi Aramco Distribution Operations Responsible for domestic fuel distribution through its Bulk Plants and Air Fueling Operations Meet the Kingdom’s growing fuel demand in the most safe, reliable, and environment friendly manner Enhance customer satisfaction through world class services Page 5 Supply Chain Management Challenges Managing remote facilities scattered across the country Tracking product transfer via trucks, pipeline and marine Accessing different operation and business systems Generating operation reports in a timely manner Coordination between sending and receiving plants Responding quickly to customer complaints Page 6 SIMATIC IT XHQ Implementation Corporate strategy to standardize on a single Enterprise Monitoring Solution (EMS) Easy direct access to key operational data Common view of aggregated information Integrate real-time process data with business data Improve performance monitoring through KPI measures Replicate best practices across the enterprise Page 7 Enterprise Monitoring Solution – Distribution Operations SAP System HR LP Finance BW Non-SAP Applications LIMS SAIF Oracle Servers OSI PI Servers PQAS TIIS HCM PM OCRCS Terminal Management Systems Field Automation Lab Systems Siemens Honeywell Tank Gauging Test Instruments Page 8 Enterprise Monitoring Solution – Distribution Operations Site-Specific Dashboards Product Inventory Sales and Transfer Orders Truck Loading/Unloading Pipeline Shipping Quality Assurance Operations Compliance Data Source SAP-HCM, PI SAP-HCM TMS (Siemens/Honeywell) OSI PI PQAS * OCRCS * In-house developed application based on Oracle Page 9 Enterprise Monitoring Solution – Distribution Operations Common Dashboards Management Dashboard Maintenance Dashboard Equipment Dashboard Inspections Dashboard TI Dashboard Safety Dashboard Quality Dashboard Data Source SAP-HR, PM, Finance SAP-PM SAP-PM SAIF * TIIS * SAP-LP LIMS, PQAS * * In-house developed applications based on Oracle Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Enterprise Monitoring Solution – Key Benefits Empowered plants to make quick and informed decisions Enhanced Saudi Aramco customers relationship Graphically related daily operation to production targets Data transparency and sharing among plants Focus on problem areas with data views and drilldowns Page 21 Enterprise Monitoring Solution – Next Steps Visualization of full supply chain Dashboards for high management level Integration with SAP Portal Integration with GIS system Integration with planning and scheduling tools Page 22 Enterprise Monitoring Solution – Distribution Project Team Siemens Ahsan Yousufzai, Manager Ayman Al-Mutawa, Tech. Lead Zulfiqar Naushad, Consultant Ahmed Al-Sahaff, Team Lead Zubair Hassan, Team Lead Maher Al-Khaldi, Developer Asif Iqbal, Developer Faruk Bansir, Developer Saudi Aramco Ahmed Marzooq, IT Mohammed Shabeeb, IT Faris Omar, IT Ziyad Saleh, IT Ali Sallout , Distribution Ramadan Fan, Distribution Mohammed Hazmi, Distribution Murtaza Hussein, Distribution Khalid Khelaiwi, Distribution Khalid Zaid, Distribution Page 23 Closing Remarks â€Å"You can’t improve what you can’t measure† â€Å"Provide the right information, to the right person, at the right time† Page 24 Thank you For more information, please contact: ramadan. [emailprotected] com Page 25

Persuasion and Jane Austen Book Club Essay Example | Topics and Well Written Essays - 1500 words

Persuasion and Jane Austen Book Club - Essay Example In persuasion by Jane Austen, Lady Russell manages to convince Ann that Wentworth is not the best suitor for her leading to Ann turning down Wentworths proposal of marriage. Lady Russell takes advantage of her position in the Elliot family where she has played the role of a mother since the death of Ann’s mother to persuade not to marry Wentworth. Lady Russell together with the rest of Ann’s family believed in the â€Å"value for rank and consequence† (Austen 11) which was the basis of their opposition to the union between their family and Wentworth. Wentworth is not a wealthy individual and therefore represented a lower class compared to that of Ann who is from a lineage baronet. Lady Russell is in this case concerned with Ann’s future since Wentworth cannot promise to sustain her. Lady Russell uses the power of persuasion to control what becomes of Ann’s future. The ability Lady Russell that possess is well highlighted in Austin’s descripti on of the woman who is depicted as being â€Å"a woman of sound rather than quick abilities...she was a benevolent, charitable, good woman...most correct in her notions of decorum...she had a cultivated mind, and was, generally speaking, rational and consistent--but she had prejudices on the side of ancestry" (Austen 42). Although some might consider the influence Lady Russell has over Ann as a selfish disposition that does not take into consideration feelings of her goddaughter, she was motivated by her protective love of Ann. Lady Russell had concerns over the future of her â€Å"most dear and highly valued god-daughter, favorite, and friend† (6). She is therefore worried that just like Anne’s mother was blindly consumed by romance to marry Sir Walter Elliot who is seen as being irresponsible due to careless spending that leaves the family in debts. To avoid what a future in which Lady Russell sees Ann turning suffering for the wrong choice she makes at the monument, she warns Ann â€Å"you’re making the same mistake

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

MGMT - Assignment Example Performance appraisal is a very beneficial process. It is a positive experience and can contribute to the overall wellbeing of the company and organization if implemented properly it helps individuals to perform better, raise their confidence and give them motivation. On the whole it strengthens the relations between management and their subordinates within the organization and paves way for commitment. Performance evaluation is not something which can be ignored and taken lightly (J.Daniels) 2. What are the best performance management practices? Like (Feedback, communication, reword) Some of the best management performance practices are: 1. Performance Appraisals and Feedback 2. Communication For performance appraisals to be effective and produce the desired results, clear cut objectives need to be chalked out. They should have a clear objective of why it is done and what for. Performance appraisal is a process. As stated by Northhouse in his account on performance appraisals that i t is most likely to fail if its objective is not linked to good personnel management and is implemented with a vague purpose and line of thought. (NorthHouse) Different arguments have been put forward by different authors. Kelly believes that Communication of performance is a very integral part of the entire process. (Kelly) She has further argued that anyone who is leading and directing the activities of others under him should know the art of conducting an effective performance review meeting. It should not be taken lightly. It should be seriously and should not be considered as a meaningless chit chat. It should be sought for as an opportunity for improvement by both the manager as well as his sub ordinates. 3. What are the Career Success key elements? Career success key elements are sustained hard work, sincerity to one self and to the organization and commitment to organizational goals. It is important to ensure that the employees are aware of what direction they are treading o n and how effective they have been so far. Employer feedback helps immensely and has a major role to play in the career success. 3. How to conduct a Performance Management Assessment Performance Management is an entire process as mentioned above. However the final phase of the performance management cycle is the performance management Assessment. It offers an excellent opportunity for one to communicate past performances to the employee, evaluate his job satisfaction and chalk out plans for his future performance. During the assessment it is important to develop a supporting environment that states clearly the purpose of the discussion. Key areas of responsibility should be discussed and examples of specific results need to be cited. Similarly clarifying questions need to be asked and employee performance should be acknowledged wherever needed be. Past performances that could have been done better should be discussed with a clear focus on future performance. It is important to ensur e that the employee has an understanding of future expectations regarding performance. It should be concluded on a positive note with an emphasis on the benefits of the conversation. 4. What the traditional approaches to performance management describe succinctly with meaning Following are the traditional approaches to performance management: 1. Essay Appraisal Method: In this the description of the performance of the employee is provided by his superior 2. Straight Ranking Method: