Learning Styles Essay Example | Topics and Well Written Essays - 500 words

Learning Styles - Essay Example The score of 3b means that I am a fairly well-balanced individual on the two dimensions of the scale. According to this result, I can learn best as either a visual or a verbal learner. Visual learners are good at remembering best what they see as opposed to verbal learners who work best with words. Visual learners prefer the use of diagrams, timelines, pictures, films, flow charts and demonstrations in order to grasp what is being taught. On the other hand, verbal learners make the best of their learning when written and spoken explanations are made (LeFever, 1995). Being a fairly well-balanced type of learner, I have the qualities of both a visual and a verbal learner. I can, therefore, fit in well in any of the above two teaching environments.I believe these results are quite accurate since I have experienced a positive result while learning in the above two kinds of environments. I also believe that I have an upper hand compared to most students who fall on either side of the scal e since I can be able to adapt to any teaching environment I fall under. ConclusionAfter taking the test and scoring a 3b, I am more confident on the type of learner I am due to the double advantage I possess of being able to learn in both a verbal and a visual environment. College education being mostly in form of lectures, I will capitalize on my verbal learning strength by working in groups and trying to better my understanding by explaining teachings and concepts to other students.

CIPD Diploma (Human Resource Practice Course ) Assignment - 1

CIPD Diploma (Human Resource Practice Course ) - Assignment Example For example, if an organization collects data about worker satisfaction and stores the data without acting on it, it is meaningless. However, is the data collected is accurate and well analysed, it can be of great help to the organization. There are numerous reasons as to why the organization needs to collect HR data. The major reason for collecting data is managerial decision making and action. The management needs to decide on various issues that affects workers and organization success and cannot do so without accurate information. It needs to know what competitors are doing in respect of employees in order to gain competitive advantage; whether workers are satisfied and what can be done to improve their morale in order to increase productivity and other aspects such as absenteeism, labor turnover, and performance levels. Another reason is for legal compliance. The law requires organizations to comply with labor laws such as laws against discrimination, termination and redundancy. To avoid legal litigations for claims of unfair dismissal or termination, the organization needs to collect and record all information regarding workers such as pay, performance levels and disciplinary actions taken to act as evidence in such cases. To avoid discrimination cases, it needs to record information about age of workers, sex, race, religion, disability, pay levels and also recruitment procedures. This data informs the organization whether it is complying with the law and can also be used as evidence in discrimination cases. The health and safety legislation also requires records of accidents, exposure to harzadous substances and training provided to be kept. There are various types of data collected within the organization to support HR practices. Quantitative data such as employee turn over, absenteeism, vacancy forecasts and sales targets are crucial for HR in manpower planning, performance management and

The True Place of Confucianism in Everyday Life Essay

The True Place of Confucianism in Everyday Life - Essay Example Even so, Confucianism was gradually growing, and various communities accepted it so quickly in what would later turn out as an almost complete takeover from Legalism. Prior to this though, Confucianism was temporarily faced out by Buddhism and Taoism, which turned out to be more dominant at the time. This temporal shake was so violent that, when Confucianism returned later, it had to develop using the models of the two doctrines. The Confucianism then was baptised ‘neo-Confucianism’ which comprised of Buddhism and Taoism. It is neo-Confucianism that came to later take over the society and become the foundation for imperial exams, as well as the central philosophy of the scholar-official class. So succinct yet so intensive, Confucianism acted as some constitution to the Chinese at that time. Following closely and abiding strictly by the doctrines contained within, Ruism was a major determinant in pre-1949 Chinese’s life. The first role of this system was to define the relationship between men and women. Right from creation according to Christians, the relationship between men and women was lucid; women were to revere and worked under the supervision of men. Conversely world over, women are regarded as subjects to men. Similarly, Confucianism contained the guidelines with women viewed as a lesser sex. Precisely, Confucianism contained strong dictation of women’s subordination to men, worse yet; the doctrines indicated that women are not allowed to work. For instance, women were considered as ‘yin’ and men were seen as ‘yang’. By nature, ‘yin’ was soft, tranquil and passive while ‘yang’ was by every dimension, an opposite of the latter; being regarded hard and dominating. Unfortunately, this was the basis of the present-day level of gender-related discrimination witnessed in China. Secondly, it is in Confucianism that the Chinese found their religious consolations. Apparently a range of temples were built throughout China, Beijing

CIPD Diploma (Human Resource Practice Course ) Assignment - 1

CIPD Diploma (Human Resource Practice Course ) - Assignment Example For example, if an organization collects data about worker satisfaction and stores the data without acting on it, it is meaningless. However, is the data collected is accurate and well analysed, it can be of great help to the organization. There are numerous reasons as to why the organization needs to collect HR data. The major reason for collecting data is managerial decision making and action. The management needs to decide on various issues that affects workers and organization success and cannot do so without accurate information. It needs to know what competitors are doing in respect of employees in order to gain competitive advantage; whether workers are satisfied and what can be done to improve their morale in order to increase productivity and other aspects such as absenteeism, labor turnover, and performance levels. Another reason is for legal compliance. The law requires organizations to comply with labor laws such as laws against discrimination, termination and redundancy. To avoid legal litigations for claims of unfair dismissal or termination, the organization needs to collect and record all information regarding workers such as pay, performance levels and disciplinary actions taken to act as evidence in such cases. To avoid discrimination cases, it needs to record information about age of workers, sex, race, religion, disability, pay levels and also recruitment procedures. This data informs the organization whether it is complying with the law and can also be used as evidence in discrimination cases. The health and safety legislation also requires records of accidents, exposure to harzadous substances and training provided to be kept. There are various types of data collected within the organization to support HR practices. Quantitative data such as employee turn over, absenteeism, vacancy forecasts and sales targets are crucial for HR in manpower planning, performance management and

The Face of American Poverty Essay Example for Free

The Face of American Poverty Essay Poverty is a social ill that is affecting most developing countries in the world, if not all. This is evidenced by the peoples lack of access to basic commodities such as food, clothing and shelter due to insufficiency of foods to purchase these needs. More often than not, this kind of situation is associated to third world countries like the Philippines and Vietnam and less identified with industrialized countries because people in the latter have more access to a better life and an abundance of job opportunities. United States is a country that could be least likely identified with poverty, however, statistics revealed there are millions of people in America who are living a poor life. This hidden problem of America was magnified to the whole world when hurricane Katrina destroyed properties in southern United States, specially New Orleans. A BusinessWeek article (Farell 2005) reported that the disaster reminded every American of the big class divide in the country. The whites who had more means were able to find a safer place to stay as the disaster hit their homes while the blakcs who have just enough or not even, were left on their rooftops crying for help. They barely had enough to save themselves from the brutal effects of the hurricane. Based on the latest statistics that the bureau released (Current Population Report 20), America, an industrialized country and one of the most powerful countries in the world houses 36. 5 million people, 24. 3 percent of which are Blacks, 10. 3 percent are Asians and 8. percent are non-Hispanic whites. Poverty in the United States is measured by the Bureau of Census using the money income earned by the family members. If the total income of the family is below the familys threshold, every individual in the family is considered as among those people suffering in poverty. There are 48 possible poverty thresholds that may be assigned to each family. These thresholds vary according to family size and ages of th e members of the family. The thresholds are annually updated in consideration of the inflation and other factors. These thresholds in a way reflect the family needs and serve as statistical yardsticks; however, these statistics alone do not provide a comprehensive description of what a family needs to live decently. The measurement, which the bureau uses, was derived from the Office of Management and Budgets Statistical Policy Directive 14. The thresholds that are being utilized to measure poverty were formulated in 1963 by the U. S. Department of Agriculture food budgets initially for families who are under economic stress (U. S. Bureau of Census 20) According to the Current Population Report of the U. S.  Bureau of Census (20), Table 3, People and Families in Poverty by Selected Characteristics: 2005 and 2006, South America has the highest number of people who are living in poverty, it reaches about 14 million and constitutes almost 14 percent of poor Americans. The other regions only registered an average of 11 percent each of the table listing the American people who are living in poverty. Aside from this, the statistics also show that majority of the Americans who are poor are native born. Those who are foreign born and naturalized citizens only comprised a small percentage of Americans living poverty. The bulk of these poor people range from the age bracket of 18 to 64 years oldthe working age. However, the poverty that America defines is a lot different from the definition of poverty in developing countries. As indicated in the research, Understanding Poverty in America, by Robert Rector and Johnson Johnson (n. pag. ), the poor in America are better off compared to those who are considered poor in developing countries. The research revealed that a poor American has a car, a house in good repair and has air-conditioning, clothes washer and cable television among others. According to Results. org (n. pag. ), the face of a poor person in America is a single parent working full time but still has no sufficient funds to pay for their food needs, rent, medical bills and car costs for travel. Results. org (n. pag. ) also revealed that an American who experiences hunger is in a better state than those who are in really poor countries because unlike the latter who really have nothing, Americans still have food to eat the only problem is that the food that they eat is not sufficient to meet a nutritious diet. According to the organization report (n. pag. ), the face of hunger in America is a malnourished child whose parents are not earning enough to purchase healthy and nutritious food and sometimes has to skip meals. The research conducted by Rector and Johnson (n. pag. ) showed that one of the problems of poor Americans is malnutrition, however, this malnourishment that poor Americans face is not under nutrition but obesity. Their findings show that most of the adult Americans are obese because their diets compose mostly of foods that are high in fat. They consume this kind of food more often due to lack of money to purchase food that could provide a better diet. Based on the findings of Rector and Johnson (n. pag. ), poverty is caused by two main factors: the absence of the father in the house and the fact that parents only spend less time at work. The research show that poor families are only supported by 800 work hours per year or 16 hours per week on the average. If the parents spend longer hours at work, then they could earn more and there is a greater possibility that the family would not fall among the list of poor families. In addition to this, the researchers also found out that the absence of a father in the house is also a great factor in the rise of poverty in the United States. Out-of-wedlock pregnancies are becoming more prevalent in the American society and this causes a surge in the number of single parents that are supporting their children. More often than not, the income that these single parents are generating is not enough to sustain their family’s needs thus; they fall within the poverty line. If there were two parents that are earning for the family then there would be more funds to buy the family the needs. Aside from these factors, Isabel Sawhill (n. pag. ) also cited other reasons for the emergence of poverty in the United States. One the reasons that she gave is the lack of employment opportunities among the poor people. This unemployment is actually caused by several reasons such as the mismatch between the required skills of employers and those that are offered by employees. Another reason is the fact that American workers need to compete with cheaper foreign labor. Their competition forces the need for Americans to accept lower wages in order to earn a living and supply the needs of their family. If they do not lower their salary expectations then it is more likely that foreign labor will prevail and complete the job. Another factor that affects unemployment in the United States is racial discrimination. There are employers who prefer to accept white Americans for better paying jobs as compared to the Blacks, Hispanics or Asians. Some American corporations continue to underestimate the capabilities of colored Americans and perceive that the whites are still superior and perform better than any other race. This type of discrimination is one of the reasons why America remains to be a divided nation. Moreover, the geographical location also plays as a factor because there are states that offer more job opportunities compared to other states which only offer a few. More often than not, those states which have more resources geographically and industrially offer more job opportunities as compared to those states which only have a few resources to develop and few corporations to run. Based on the data released by the US Bureau of Labor Statistics (n. pag. ), the region which has the highest unemployment rate are Midwest and West regions registering 5. percent each while the region which has the lowest unemployment rate is Southern United States at 4. 7 percent. Among the states, Texas has the highest employment rate followed by Nevada and Minnesota. In addition to the causes of poverty, researchers (Sawhill n. pag. ) are also blaming the income policy transfers of the government such as the food stamps, Medicaid, Special Supplemental Nutrition Program for Women, Infants and Children and the Temporary Assistance for Needy Families for the prevalence of poverty in the United States. The food stamp program aims to alleviate hunger and malnutrition in the country by providing qualified low-income families with food stamps that can be utilized to purchase food items to complete a nutritious diet. According to the U. S. Department of Agriculture, the average benefit that can be derived from the program per individual is $1 per meal. In order to qualify, a household should have a gross income that falls below 130 percent of the poverty line and do not own assets that are more than $2,000 in value (results. org n. pag. ). The Special Supplemental Nutrition Program for Women, Infants and Children aims to provide pregnant women who have low incomes, new mothers, infants and children that are facing nutritional risks with healthy food, education on nutrition and health care access. Unlike the food stamp program, which provides monetary assistance to families, this government program gives food packages to the concerned individuals to meet their dietary needs (results. org n. pag. ). The Temporary Assistance to Needy Families is the welfare program replacement of the Aid to Families with Dependent Children. This program was created to fight the dependency of the recipient families to the welfare programs of the government. Unlike the other welfare programs which only require that the family’s income fall within the poverty line, this type of government program requires the recipients to work before receiving any assistance and limits the period wherein they can receive assistance from the welfare program. This policy of the government somehow lessens the sense of dependency to welfare programs by the recipients and gives them motivation to work and lift their families out of the poverty line. It has been observed by researchers (Sawhill n. pag. ) that recipients of welfare assistance from the government become so dependent that they no longer have the drive to work harder or worse, no dot exert any effort to support their needs. This kind of dependency was staged in the movie, Million Dollar Baby. In this movie, the mother of Maggie Fitzgerald, the female boxer played by Hillary Swank, got mad when Maggie bought her a house because this would drive them out of the welfare system. Owning the property will force them to find a job that will support their daily needs and take them out of their comfort zone. The family does not want this to happen because they have become so dependent with the welfare system that they cannot seem to live without it anymore. This is the kind of dependency that the government is trying to avoid because not only does this foster indolence it also takes away from the government funds that could be used for other projects that would better benefit the community. It would be better to teach a person how to fish and find provision for his personal needs rather than simply providing the fish to a person who never dare to exert an effort. Having too many children is also a factor in the surge of poverty in the United States because the more children there are, the more dependents the parents have and the more mouths to feed. If a family has fewer children then it would be easier for the family to get by because there are only a few needs to provide for and compete over the family income. There are various ways wherein sociologists try to explain poverty and one of them is using the structural approach which is influenced by Marxists and Functionalists perspectives (School-Portal n. pag. ). In the Marxist perspective, it can be gleaned that poverty is the direct result of the capitalist system. Through capitalism, people are forced to enter into a competition to survive and this competition is affected primarily by education and skills that an individual possesses. People try to attain higher education and learn new skills to have a better standing in a capitalistic world and a better fare at the competition. Employers prefer to hire an applicant who attained a higher level of learning and who has better skills compared to ordinary individuals, as this will foster better company performance and more earnings. Employees work hard to receive higher and more promising salaries. The discrepancy in earnings, ownership of properties and the creation of the social strata causes poverty exist. If people are not driven by competition and the dire to strive for more as compared to the others, there would be no discrepancy and all will just be equal—no rich and no poor. However, this will also advocate laziness among the people and lack of improvement in ones way of living. With regard to the functionalist perspective, everything is seen to be working for the whole and everything has a purpose. In consideration of this ideology, poverty is seen both in the positive and negative light. In its negative aspect, poverty is seen as a warning, something that people should avoid due to its adverse effects such as lack of sufficient food to eat, absence of enough funds to purchase basic needs and wants. On the contrary, poverty is also seen in the positive side, a feel good factor. When one sees he is faring better than the others, it creates a sense of thinking that all the efforts that he has exerted are all worth it. It somehow creates an appreciation of the hardships that he had to go through to achieve the position he is occupying. Another approach that sociologists utilize to explain poverty is the cultural approach. This type of explanation was elaborated by sociologist, Oscar Lewis. According to Lewis, poverty is transferred from generation to generation because the values of the parents toward poverty are passed on to their children. Lewis explained that people experience poverty because of the different cultural values that they have developed through time. These values include resignation and fatalism. People who are resigned feel that there is nothing much that they can do about their situation so they no longer bother to change it or even exert the slightest effort to lift their families out of the impoverished state their they are in. People, who adhere to fatalism, perceive that they are meant to be poor so there is no reason of fighting it. They believe that suffering an impecunious life is their purpose in this world and no matter what they do they will not be able to escape it. Trying to pull ones self out of the hole of poverty will only be a futile undertaking. These kinds of ideologies of the parents foster somehow affects how their children see poverty. Without even realizing it, these principles that they adhere to, is already burying their children to the pit of poverty even at a tender age. Once the minds of their children are shaped with these principles, they will carry this one as they age and like their parents, will be left suffering an impoverished life. The cultural explanation of poverty explains why there are many who continue to depend on the welfare system even if they have the capacity to get out of it. They have been so used to thinking that they are poor and cannot do anything about it that is why they no longer strive to make their lives more bearable. What these people fail to realize are the benefits that can be gained from getting out of the cage of the government welfare system. They has lost their sense of achievement and being able to contribute something fruitful to the country rather than just waiting for the assistance that the government will provide.

Tuberculosis (TB) in Prisons and Immigration Removal Centres

Tuberculosis (TB) in Prisons and Immigration Removal Centres An evidence-based partnership approach to tackling Tuberculosis in Prisons and Immigration Removal Centres in London Abstract Background The World Health Organization (WHO) have declared TB as a global emergency with 8.6 million cases of active TB and 1.3 million deaths. The incidence of TB in the UK remains high compared to most other Western European countries, with 8,751 cases reported in 2012, an incidence of 13.9 per 100,000 population. London accounts for the highest proportion of cases in the UK (39%) and the highest rate of disease (41.8 cases per 100,000). Left untreated, one person with pulmonary TB may infect around 10–15 people every year. People in prison and IRCs represent a population who are at particular risk. National estimates for TB prevalence in the prison population are 208 per 100,000 and amongst Londons 10,000 or so prison population we would expect 20 cases, but we are seeing more than double. The cost of treating ‘normal’ TB is around  £5000 and is much greater for more socially complex cases (estimated at  £50,000– £70,000). There is considerable variation in the delivery of some aspects of TB services. A co-ordinated national TB strategy is required to support locally designed and implemented services, and monitor achievements against national standards. This paper presents findings from a partnership between NHS England, PHE and NOMS to tackle TB across its prison population in the overall approach to the overall TB strategy in London. Aims/objectives To establish whether national NICE guidance for TB in prisons and immigration removal centres is being met. Methods Target population included all 9 prisons and 3 IRCs for which NHS England (London region) are responsible. Methods used: 1) An organisational clinical audit during January 2014 using the NICE baseline assessment tool; 2) Stakeholder engagement through a steering group and a wider reference group. Results Effective stakeholder engagement contributed to a 100% completion rate. All establishments had referral pathways in place and a named contact within the local Multidisciplinary TB team and the local Public Health England health protection team. 2/12 establishments did not screen for TB within 48 hours of arrival. 3/12 did not have a local TB policy. 2/12 did not have a named TB lead. None of the DH funded x ray machines were being used in line with NICE recommendations. Latent TB was not being diagnosed or managed. Conclusions Active and systematic case finding is needed within a prison and IRC setting as well as more rigorous and standardised contingency and follow up care plans after release (or transfer). Introduction The World Health Organization (WHO) have declared TB as a global emergency with 8.6 million people with TB and 1.3 million deaths due to TB (World Health Organisation, 2013). The six point Stop TB Strategy (World Health Organisation, Europe, 2013b) explicitly addresses the key challenges facing TB with the goal to dramatically reduce the global burden of TB by 2015 by ensuring all TB patients benefit from universal access to high-quality diagnosis and patient-centred treatment. However, there have been challenges in developing and implementing program-wide interventions in both high income(Migliori, Sotgiu, Blasi, et al., 2011) as well as middle and low income countries(Cobelens, van Kampen, Ochodo, et al., 2012). England and Wales have responded to the need to tackle TB where the NHS and the Department of Health have developed a national Action Plan for ‘Stopping Tuberculosis in England’(Department of Health, 2004). NICE have also developed a set of National guidance fo r the identification and management of TB across a number of settings(NICE public health guidance, 2011) which highlights the need for a multi-agency approach. There has been little evidence evaluating the implementation of these guidance. What is TB? TB is caused by Mycobacterium tuberculosis, which spreads in airborne droplets when people with the disease cough or sneeze. Most people infected with M. tuberculosis never become ill as their immune system contains the infection. However, the bacteria remain dormant (latent) within the body, and a latent TB infection can cause active disease many years after the initial infection if immunity declines. The symptoms of TB include a persistent cough, weight loss, and night sweats. The BCG vaccine (Bacillus Calmette-Guà ©rin vaccine) protects against TB and it was thought possible to wipe out TB through a vaccination programme. The BCG vaccine is made from a weakened form of a bacterium closely related to human TB. Because the bacterium is weak, the vaccine does not cause any disease but it still triggers the immune system to protect against the disease, giving good immunity to people who receive it. In the past, the BCG vaccination programme was delivered to all teenagers in the UK but as TB is a difficult disease to catch because it requires prolonged exposure to an infected person, it was changed so that now only people inat-risk groups are given the vaccination. The vaccine is 70-80% effective against the most severe forms of TB, such as TB meningitis in children but It is less effective in preventing respiratory disease, which is the more common form in adults(Trunz, Fine Dye, 2006). Even with the high coverage now achieved, BCG is unlikely to have any s ubstantial effect on transmission. Risk factors that seem to be of importance at the population level include poor living and working conditions associated with high risk of TB transmission, and factors that impair the hosts defence against TB infection and disease, such as HIV infection, malnutrition, smoking, diabetes, alcohol abuse, and indoor air pollution. Preventive interventions may target these factors directly or via their underlying social determinants. The identification of risk groups also helps to target strategies for early detection of people in need of TB treatment(Là ¶nnroth, Jaramillo, Williams, et al., 2009). How common is TB in the UK? It has been difficult to eradicate TB both globally and in the UK. Vaccination programs and improvements in housing, nutrition and access to treatment have been largely the reason for a global decrease in TB. However, TB is still rife in less developed countries where poor conditions are still present. Several strains of TB bacteria have developed a resistance to one or more anti-TB medications, making them much harder to treat. Theglobal epidemic of HIV that began in the 1980s has also led to a corresponding epidemic of TB cases. This is because HIV weakens a persons immune system, making them more likely to develop a TB infection. The rapid growth of international travel has allowed people to travel widely and this has helped to spread of the disease. Although the rates of TB have stabilised in the UK over the past seven years, following the increase in the incidence from 1990 to 2005, the incidence of TB in the UK remains high compared to most other Western European countries(Hayward, Darton, Van-Tam, et al., 2003). There were 8,751 cases reported in 2012, an incidence of 13.9 per 100,000 population (Health Protection Agency, 2013b). The majority of TB cases (73%) occurred among people born in high-incidence countries and are generally concentrated to large urban areas with a high proportion of people born outside the UK where the rate of TB among the non UK-born population is almost 20 times the rate in the UK-born (Health Protection Agency, 2013b). London accounts for the highest proportion of cases in the UK (39%) and the highest rate of disease (41.8 cases per 100,000), followed by the West Midlands (12%; 19.3 cases per 100,000). Left untreated, one person with pulmonary TB may infect around 10–15 people every year (Department of Health, 2004). TB in prisons It is important to identify settings where the risk of TB transmission is particularly high. Groups at risk not only include people born in high prevalence areas (e.g. sub-Saharan Africa, South East Asia, Eastern Europe), but also people with reduced immunity (e.g. HIV, diabetes, renal failure), those with alcohol or drug problems and people who are homeless or living in overcrowded conditions (Story, Murad, Roberts, et al., 2007). These risk factors are over represented in prison populations with high levels of social and health needs. A systematic review on the incidence of TB in prisons globally (largely in the USA), showed that TB was about 26x higher than in the general population(Baussano, Williams, Nunn, et al., 2010). In the London prison population, the incidence of TB has been estimated at about 208 per100,000 (Story, Murad, Roberts, et al., 2007). Figure 1: Incidence of TB in different locations and settings[A1] Across the London prison and IRC estate, prisons are at or very close of operational capacity (ranging from 72% 103%) and with the high churn rate which increases the risk of TB transmission and poses significant challenges for TB identification and management (see Table 1). In addition, a significant proportion of the prison population are of a foreign nationality (up to 44% in one prison) and on average, just over one quarter (27%) of the prison population are foreign nationals. The majority of the prison and IRC population are under the age of 39 years old, representing another TB risk factor. Table 1: Summary of Prison Establishments Individuals at high risk for TB are typically unwilling or unable to seek and comply with medical care, and are therefore hard to reach. Individuals at high risk are also more likely to be diagnosed at a late stage of the disease and are less likely to adhere to treatment(Health Protection Agency, 2013b). In prison and IRC settings, overcrowding, late detection, barriers to adequate treatment, and poor implementation of infection control measures might also increase the TB transmission rate and improving prison conditions is a priority for any programme to control TB and reduce its spread back into the community (Levy, Reyes Coninx, 1999). TB has been identified as a key health concern where the need for greater TB control in the prison setting was highlighted in the Chief Medical Officer’s (CMO) action plan for England (Department of Health, 2004). The Department of Health (DH) announced that they were to fund the installation of static Digital X-Ray (DXR) machines in large local prisons receiving people from areas with a high prevalence of TB. This led to the installation of DXR machines in 5 London prisons (and 3 out of London). All participating prisons had their machines signed off and handed over by March 2012 but due to changes in commissioners and providers during the lifetime of the project, the impact of the programme to date has been variable. More recently, the new national partnership agreement(Anon, n.d.) just signed between Public Health England (PHE), NHS England (NHSE) and the National Offender Management Service (NOMS) also draws particular focus and commitment to the epidemiology of TB in pris ons, particularly in those that have access to DXR machines. The agreement sets a priority for this year (2013-14) as: â€Å"Priority 11: Improving the detection and management of TB among prisoners at or near reception.† The commitment in the partnership agreement is to ensure that by April 2014, NHSE, NOMS and PHE will ensure that all fixed digital X-ray machines are fully operational and being used as part of an active care pathway in those prisons where they are currently installed. TB in IRCs Robust data relating to TB in IRCs is not routinely collected or available so there are no estimates of the incidence of TB in these settings. However, a sample of detainees in a single IRC within Southern England identified prevalence rates of 3% for TB (McLaren, Baugh, Plugge, et al., 2013) which is considerably higher than those found among the migrant population in England (Health Protection Agency, 2013b). Detainees at Harmondsworth and Colnbrook are men mostly aged 20-40 (see Table 1) and from disadvantaged areas of the world where TB is still rife. The average length of stay is around 2 weeks; although some have been detained for over 1 year. Guidance for best practice NICE have developed national guidance on the ‘Clinical diagnosis and management of tuberculosis, and measures for its prevention and control(NICE public health guidance, 2011), as well as more specific guidelines for identifying and managing TB among hard to reach groups (NICE public health guidance, 2012). This guidance, consistent with World Health Guidance(World Health Organisation, Europe, 2013a), aims to improve the way tuberculosis (TB) among hard-to-reach groups is identified and managed and makes specific reference to using prison and IRC settings to target these groups. NICE recommend that early identification and effective treatment of active TB provides the best outcomes, reduces onward transmission and reduces the development of drug-resistant forms of the disease. The identification and management of latent TB infection is also highlighted. The NICE guidance is based on the evidence resulting from four large systematic reviews(NICE, 2012a, 2012b, 2012c, 2012d) which informed the key recommendations relating to TB in prisons and IRCs. These include the best ways to identify TB, manage TB, organisational factors and identifying and managing latent TB. Identifying TB There are several approaches to identify latent and/or active TB in different populations. The Mantoux test is a widely used test for latent TB. It involves injecting a substance called PPD tuberculin into the skin and those that are sensitive to PPD tuberculin will develop a hard red bump at the site of the injection, usually within 48 to 72 hours of having the test. This is indicative of a latent TB. A very strong skin reaction may require a chest X-ray to confirm if this is an active TB infection(NHS Choices, 2013). The interferon gamma release assay (IGRA) is a newer type of blood test for TB that is becoming more widely available and can also help diagnosis latent TB. It can be used after a positive Mantoux test or as part of a screening or health check process. An active TB infection is usually diagnosed from a chest X-ray and samples of mucus and phlegm which are checked under a microscope for the presence of TB bacteria. A CT scan, MRI and/or biopsy will also be taken if an extra-pulmonary TB is suspected. A lack of information and awareness about TB services has been highlighted as a barrier to successful identification of TB (Brent Refugee Forum, 2007). Studies have highlighted that members of hard-to-reach groups frequently report incomplete or inaccurate information about the cause and transmission of TB with misconceptions included dirty or wet environment, sharing of domestic objects, and punishment from God (Brent Refugee Forum, 2007). Smoking(Brent Refugee Forum, 2007; Brewin, Jones, Kelly, et al., 2006; Gerrish, Ismail Naisby, 2010), poor diet and malnutrition(Brewin, Jones, Kelly, et al., 2006; Gerrish, Ismail Naisby, 2010), poverty (Brewin, Jones, Kelly, et al., 2006) however, were correctly perceived to affect susceptibility to TB. The fear of medical services as well as anxiety around the associations of TB with death have also been highlighted as barriers to diagnosing TB in high risk groups (Gerrish, Ismail Naisby, 2010; Marais, 2007; Brent Refugee Forum, 2007). Stigma is also highlighted as a major issue when diagnosing and screening for TB. Most studies with hard to reach groups describe a sense of shame and forced or voluntary isolation resulting from a TB diagnosis, although stigma was expressed differently in different groups. Homeless participants in London reported that being diagnosed with TB was embarrassing and rarely discussed among the homeless community because of the stigma attached to TB in this population(Whoolery, 2008). TB patients often face dual stigma—from their own communities and their wider communities. Most studies looking at the barriers to identifying TB have been conducted in immigrant groups in community settings and there is a lack of research into the barriers to identifying TB in prison or IRC populations. In addition, there are limited studies that focus on how to improve these passive case detection approaches or contact tracing approaches. With the difficulties in identifying TB in these hard to reach groups, researchers have sought to evaluate the effectiveness of active screening for TB rather than a passive approach where it is up to the individual to make contact with health services. Active screening has been found to be an effective and cost-effective strategy in immigrants and new entrants (Laifer, Widmer, Simcock, et al., 2007; Monney Zellweger, 2005; Verver, Bwire Borgdorff, 2001), homeless and intravenous drug users(Watson, Abubaker, Story, et al., 2007) in identifying active TB cases are an early stage. In particular, the â€Å"FindTreat† service, which is a Department of Health-funded initiative, aims to strengthen tuberculosis (TB) control among hard-to-reach populations through active case finding using a mobile X-ray unit (MXU)(Jit, Stagg, Aldridge, et al., 2011). In addition, the FindTreat service follows up closely those on treatment and provides support in completing treatment. Although the s ervice used to screen a large number of prisoners, it had mostly stopped since the introduction of DXR machines in prisons for active case finding in new inmates. On average, each year the find and treat service identified 16 people with TB in the hard-to-reach population, who may not have been identified and treated and also managed and supports the treatment for a further 100 or more cases. Despite these studies, there is limited direct evidence for the best methods for screening for TB in prisons(NICE, 2012b). Puisis et al conducted an innovative program of high speed radiographic screening for pulmonary tuberculosis (TB) at a large American correctional facility. The case finding rate for active disease with radiographic screening was approximately double the rate previously achieved with Mantoux skin testing. (Puisis, Feinglass, Lidow, et al., 1996). However, the findings are unclear how much of the difference in prevalence is caused by the different screening strategies and how much reflects different baseline disease prevalence. Another retrospective cohort study, compared the potential impact of limiting screening with mobile X-ray units to prisoners in the UK with symptoms of TB, compared with universal screening regardless of symptoms. Restricting screening just to prisoners with any of the five symptoms would have missed 36.7% of TB cases and more cases of TB would have been missed if screening was limited to a smaller range of symptoms. (S Yates; A Story; AC Hayward, 2009). The st udy is limited because although these symptoms may have been present at the time of screening, it is not known if professionals would have screened for TB based on these symptoms in real practice. Mobile X-ray unit (MXU) screening in those that are homeless, drug users or in prison have also been found to reduce diagnostic delay compared with passive case-detection and cases were less likely to be contagious on diagnosis compared with passive case-detection (Watson, Abubaker, Story, et al., 2007). However, the main limitation of this study is that results for different sub-populations were not reported separately, so it remains unclear whether any one hard-to-reach group benefited significantly from mobile x-ray screening. Chest X-ray screening has also been shown to be more cost-effective than the Mantoux test in immigrants and in prisoners(Jones Schaffner, 2001). However, the start-up costs of implementing the miniature chest radiograph screening were not taken into account. Cons idering the technology and training necessary to implement such a tool in a prison setting, this information could have had an effect on the costs. Active screening seems to increase identification of latent and active TB infection across hard-to-reach groups who are at high risk of infection, compared with passive case-detection, and leads to earlier diagnosis and reduced infective periods in those with active TB. Although the effectiveness and cost effectiveness of mobile X-ray screening is limited in prisons settings, NICE recommend that in prisons housing populations from high incidence areas and where the start-up costs had been largely funded by the DH, it was judged that X-ray screening would be cost effective. For other prisons, initial, symptom-based screening was adequate(NICE public health guidance, 2012). Managing and treating active TB Although TBcan be a very serious disease, it is possible to make a full recovery from most forms of TB with treatment. TB can usually be cured by taking several powerful antibiotics daily for several months. However, the emergence of antibiotic-resistant bacterial strains and the poor adherence to treatment has kept TB high up on the international health agenda with WHO declaring a crisis of multidrug resistant TB (World Health Organisation, 2013). The Health Protection Agency has found that only 79% of people with TB in the UK completed treatment which is below the World Health Organisation target of 85% (Health Protection Agency, 2013c). The mix of drug regimes, treatment isolation and length of time of treatment presents a number of challenges to ensure patients adhere to treatment regimes. Adherence can be particularly difficult in those with multiple needs, e.g. homeless and seeking substance abuse treatment (Whoolery, 2008). Directly Observed Therapy Short course (DOTS) is one method used to increase adherence to TB treatment. DOT is not just the direct supervision of therapy but also considers distinct elements of political commitment; microscopy services; drug supplies; surveillance and monitoring systems and use of highly efficacious regimens (World Health Organisation, Europe, 2013b). It can be difficult to evaluate the effectiveness of DOTS as a complete strategy to increase adherence and the focus of studies have evaluated the direct supervision of therapy. For example, significantly more people adhered to more than six months of treatment when they received DOT in substance misuse(Alwood, Keruly, Moore-Rice, et al., 1994) and in foreign born individuals (MacIntyre, Goebel, Brown, et al., 2003). However, there have been limited studies into prison populations with some suggestions of improved adherence with DOT(Rodrigo, Caylà  , Garcà ­a de Olalla, et al., 2002) and other findings showing no sign ificant differences (Dà ¨ruaz Zellweger, 2004). The effectiveness of DOT across prison and IRC populations still remains unclear. The views of treatment and management of TB can be particularly important when considering adherence. For example, the views on traditional and modern medicine can also vary between different groups which can impact the management of TB. The Brent Refugees Forum reported that Somalis in the UK reported a preference to try traditional medicine as a first choice (Brent Refugee Forum, 2007) whereas Somalis in New Zealand would prefer modern medicine first in response to their experiences of TB related deaths in their home country(van der Oest, Chenhall, Hood, et al., 2005). Some groups preferred approaches to treatment that included both traditional and modern medicines(NICE, 2012a). Talking to the patient to find out their preferences can help patients to make decisions about their treatment based on an understanding of the likely benefits and risks rather than on misconceptions (Nunes V, Neilson J, O’Flynn N, Calvert, N, Kuntze S, Smit, hson H, Benson J,, et al., 2009). Very li ttle is known of the impact of TB treatment on jobs, family and children (NICE, 2012a) and in particular, the psychological impact of isolation. TB treatment should be provided on a voluntary basis and the WHO highlight the importance of â€Å"engaging with patients as partners in the treatment process and respecting their autonomy and privacy† (World Health Organisation, 2013). This can be a particularly important issue when concerned with isolating an individual with a suspected or confirmed case of TB, which should be undertaken on a voluntary basis and involuntary isolation should only be used as a last resort. Few studies have explored the potential benefits that patients may experience when seeking TB treatment. A small number of homeless participants reported that TB treatment helped make further lifestyle changes that improved their health in general. For example, improved living conditions and regaining relationships with family (Whoolery, 2008). Another study reported that immigrants reported a ‘social responsibility’ to seek TB treatment although this was anxiety provoking (Brewin, Jones, Kelly, et al., 2006). Evidence suggests that discussing with the patient why they might benefit from the treatment can improve patient engagement and adherence(Nunes V, Neilson J, O’Flynn N, Calvert, N, Kuntze S, Smit, hson H, Benson J,, et al., 2009). Organisational factors Delays in identifying and successfully managing TB can be the result of individual and service provider factors. The provisions used to deliver care and support can determine how services should be structured to manage people with TB in hard-to-reach groups. These organisational factors can include the settings used to identify and manage TB as well as the type and needs of the healthcare worker. A lack of specialist services and coordination of care can be a major difficulty in TB service provision, since most GPs see few cases of TB a year (Belling, McLaren, Boudioni, et al., 2012; Gerrish, Ismail Naisby, 2010). The complex social and clinical interactions surrounding a patient with TB can be a challenge to participation and adherence and there is a need for TB link workers to facilitate coordination of services (Brent Refugee Forum, 2007; Belling, McLaren, Boudioni, et al., 2012). Healthcare workers may find it challenging to meet the complex care needs of hard-to-reach groups with TB, especially where there are cultural and language barriers that make it difficult to interpret symptoms and explain about the disease and its treatment (Moro, Resi, Lelli, et al., 2005). In addition, service providers can also be afraid of the consequences of contracting TB, including becoming stigmatised. Non clinical healthcare workers may also have limited knowledge about TB, the need for screening and the implications of a positive test result (Joseph, Shrestha-Kuwahara, Lowry, et al., 2004). There is considerable variation in the delivery of some aspects of TB services and more research is needed in the UK on the effectiveness and cost-effectiveness of different service structures to manage TB(NICE, 2012d). In addition to the NICE national guidance, Public Health England have produced London specific guidelines on the management of TB in prisons (Health Protection Agency, 2013a) based on pilot work across a number of London prisons. This guidance aims to minimise the risk of transmission of TB within the prison environment through efficient systems to detect ca

fuel cell technology :: essays research papers

Fuel cell technology 1 Running head: FUEL CELL TECHNOLOGY: TRANSPORTATION AND RESIDENTAL/ COMMERICAL APPLICATIONS Fuel Cell Technology: Transportation and residential/commercial applications   Ã‚  Ã‚  Ã‚  Ã‚   Monique University 2 A fuel cell is an electrochemical energy conversion device. A fuel cell converts the chemicals hydrogen and oxygen into water, and in the process it produces electricity. With a fuel cell, chemicals constantly flow into the cell so it never goes dead as long as there is a flow of chemicals into the cell, the electricity flows out of the cell. Most fuel cells in use today use hydrogen and oxygen as the chemicals. Fuel cell provides a DC (direct current voltage that can be used to power motors, lights or any number of electrical appliances. The fuel cell will compete with many other types of energy conversion devices, including the gas turbine in your city's power plant, the gasoline engine in your car and the battery in your laptop. Combustion engines like the turbine and the gasoline engine burn fuels and use the pressure created by the expansion of the gases to do mechanical work. Batteries converted chemical energy back into electrical energy when needed. Fuel cells should do both tasks more efficiently. Fuel cells improve battered powered cars and gasoline powered cars more efficiently. Fuel-cell-powered electric cars are powered with pure hydrogen. It has the potential to be up to 80% 3 efficient, and with today’s gas prices that would be wonderful. The efficiency of a gasoline-powered car is surprisingly low. All of the heat that comes out as exhaust or goes into the radiator is wasted energy. The engine also uses a lot of energy turning the various pumps, fans and generators that keep it going. So the overall efficiency of an automotive gas engine is about 20%. That is, only about 20% of the thermal-energy content of the gasoline is converted into mechanical work. The efficiency of an electric car is 72% for the car, 40% for the power plant and 90% for charging the car. That gives an overall efficiency of 26%. The overall efficiency varies considerably depending on what sort of power plant is used. If the electricity for the car is generated by a hydroelectric plant for instance, then it is basically free (we didn't burn any fuel to generate it), and the efficiency of the electric car is about 65%.   Ã‚  Ã‚  Ã‚  Ã‚   4 Efficiency is not the only consideration, however. People will not drive a car just because it is the most efficient if it makes them change their behavior.