In what ways do poets portray the exprience of war in Dulce et Decorum Est and in For the Fallen Essay Example for Free

In what ways do poets portray the exprience of war in Dulce et Decorum Est and in For the Fallen Essay Laurence Binyon wrote For the Fallen in 1914, at the beginning of the Great War, while Wilfred Owen composed his Dulce et Decorum Est in 1917-18, by the end of the conflict. This difference in time means that there might be inconsistencies in the portrayal of the war, due to the changing perspectives of the fighting, which in turn would provoke irregularities in the purpose, style and nature of the two poems. In Dulce et Decorum Est, Owen tries to prove us that war has no mighty purpose behind it and that it is just a waste of lives. He describes one soldier dying with verbs such as guttering, choking, drowning and gives an account of the blood which came gargling from the froth-corrupted lungs. This strikingly visceral portrayal of loss of life suggests that he sees nothing spiritual or divine in the sacrifices that the soldiers make for their country. He prefers to depict the experience of the war as true and cruel as it is in reality without sparing the reader. In the poem we are informed about two deaths. The first is due to harsh conditions, when some soldiers dropped behind, while the second is caused by lethal gas that one of the soldier inhales. In both of these cases, the young mens deaths didnt contribute in any way to the protection of their country and they werent even fighting when they passed away. This suggests that war is just a waste of human life which wont secure Englands peace. In For the Fallen, Binyon tells us that the soldiers have fallen in the cause of the free, thus suggesting that they try to make the world a better place, that they fight for something good. This gives war a mighty purpose and to the deaths meaning. This idea of for the greater good is further highlighted in the phrase a glory that shines upon our tears, which conveys the idea that the sacrifices of the soldiers contribute to the welfare of society and thats why everybody should be proud of those who are fighting. It is clear that the two poems depict the meaning and purpose of the war very differently. While Owen indicates that war is a meaningless and cruel waste, Binyon tries to cast a better light upon the deaths of the soldiers, giving their sacrifices a higher significance and thus implying that war with all its faults is for the greater good. In Owens poem the soldiers going to the fight are like old beggars under sacks, coughing like hags blood shot and drunk with fatigue. Many had lost their boots, implying that they cannot face the harsh conditions of the war and that they are even unable to look after their essential belongings. The description of bootless beggars is humiliating, while their tiredness and the hag simile suggests that there are lethargic and hopeless. Their physical appearance isnt attractive either. All these depict the soldiers as tired, old and humiliated men who are unable to face life and are completely incompetent in war. However, in Binyons version the soldiers went with songs to the battle, suggesting their fearlessness and gaiety. They were young, straight of limb, true of eye, steady and aglow. This phrase conveys an admiration for the almost divine soldiers who seem to be the incarnation of some hero from a childs tale powerful, handsome and determined men who save the world. This image of glorious warriors seems to be taken out of a happy-end story rather than the realism to satisfy the audience. Once again the dissimilarity between the two accounts is obvious. Owen sticks to the merciless truth, while Binyon sees something beyond the harsh experience of the war. Actually, he seems to use the brutality of the fighting and the deaths to emphasise the greatness and divinity of the soldiers. In Dulce et decorum Est soldiers die either to the harsh conditions of the war, or due to poisonous gas. The soldier who experienced the later, plunges at the nearest men choking and drowning an image of a helpless, suffering person. Unlike the soldiers in Owens poem, in For the Fallen, the fighters fell with their faces to the foe, not to their companions in the middle of the battle, fearless and brave. The determination which they seem to possess suggests that they believe that their deaths have a higher purpose. This encourages the reader and the mourning families to have faith that their loved ones lives werent wasted, but contrarily represented a salvage for humanity. It seems that the greatest difference between the two poems lies in the way they portray death and their significance. In Dulce et Decorum Est the dying soldiers face is like a devils sick of sin with writhing eyes. The phrase implies that the soldiers committed the greatest sins, most probably killing, which this altered the way they viewed life forever. They seem to be sick not only of the war, but of the persons in which the war transformed them, into devils. The writhing eyes suggests the violent ending that they had, and it possibly implies that they never found peace. The mention of the devil together with this, insinuates that they will never go to heaven, but rather to hell. The phrase incurable sores on innocent tongues further emphasises the idea that the experience of the war severely damaged their character in a negative and irredeemable way. Incurable sores implies that the greatest wounds were not physical, but psychological, and this might be the reason why they will never find peace, not even the moment they die. In For the Fallen death is august and royal, thus dignified and splendid, something rather positive and good. This is because the sacrificed soldiers songs go to up into immortal spheres, suggesting the place where the dead soldiers found peace. This idea is repeated throughout the whole poem. The phrase they shall not grow old, as we that are left to grow old implies that the deceased soldiers are divine, angelic and eternal beings. Due to their valiant death, their gift is that of eternity, as if their vibrant, determined and brave souls were immortalised, and thus they will be forever young, forever in the best of their condition. The deceased soldiers march in the heavenly plains is as the stars that are starry in the time of our darkness. Heavenly and stars suggest that the divine fighters will always light upon the mortal humans, guiding and protecting them. Time of our darkness refers to the war, and how young men, in the hardest periods of their life, left their homes to save their loved ones, as they will always do from heaven. Binyon sees a continuation of life after death, and thats why the choice of the word fallen in the title, because the sacrificed young men never die. Contrarily, they seem to receive a better, divine existence, incomparable to that of their living fellows. This idea might very well surprise Owen, who suggests that the experience of the war turned the innocent soldiers into devils, who will never find peace in heaven, but will burn in hell thus the violent death of the soldier and the obscene cancer which infects him. The differences between the portrayals of the experience of war in the two poems in striking. Binyons account is patriotic one, which glorifies the fallen soldiers and gives meaning and divinity to their deaths. However, considering the time when it was written at the beginning of the Great War we can get a better understanding of the poets reasons for such an idyllic portrayal of the fighting. At the start of it, the government needed to make the idea of warfare an appealing one in order to have young men risking their lives in the battle . Thus the attractive and heroic depiction of the combating soldiers. At the same time, the poem tries to soothe the mourning families, and this explains the almost holly aura that encircles the deaths on the front. However, as time went on, people got tired of the war and the increasing number of deaths. Soldiers returning from the battle spread the world about appalling conditions and cruel, meaningless deaths. Owen, who wrote the poem by the e nd of the conflict, seems to be well informed about the direct experience of the war and at the same time he is aware of the patriotic and idyllic accounts that existed at the beginning of the fighting. This explains the angry, visceral and meaningless deaths which he depicts in his poem, almost as if he was angry about people lying and making war seem a worthy, purposeful thing. And indeed, his poem ends with a call to other people not to tell with such high zest/To children ardent for some glory, / the old Lie: Dulce et decorum est/ Pro patria mori (It is sweet, and honourable to die for ones country). Owen wrote as an answer to other poems such as Binyons which glorify the experience of war, and this is why he chose the title Dulce et decorum est, to arise the memory of the patriotic accounts from the beginning of the war, and then throughout his poem to shatter the old Lie. He personifies this lie with the capital letter, making it seem as a destructive, evil person. This is the reason why Owen sticks to visceral descriptions he prefers not to spare the reader, because he believes that the Lie is even crueller than the merciless reality of the war.

Nurse Strategies to Prevent Elderly Suicide Attempts

Nurse Strategies to Prevent Elderly Suicide Attempts Investigation into nurse strategies to prevent or minimise attempted suicide in patients aged 65 and over. Abstract This dissertation considers the rationale for positive nurse-based intervention in consideration of issues relating to suicide in the elderly. The introduction sets the context, including the historical context, of the issues and discusses the negative effects of ageism on issues relating to suicide in the elderly. The literature review considers selected texts which have been chosen for their specific relevance to the issue and particularly those that espouse the view that ageism is counter productive to a satisfactory quality of life outcome for the elderly person. Conclusions are drawn and discussed with specific emphasis on those measures that are of particular relevance to the nursing profession whether it is in a secondary care facility, a residential home setting or in the primary healthcare team and the community. We can observe, from a recent paper (O’Connell H et al. 2004), the comments that, although there is no doubt that the elderly present a higher risk of completed suicide than any other age group, this fact receives comparatively little attention with factors such as media interest, medical research and public health measures being disproportionately focused on the younger age groups (Uncapher H et al. 2000). Perhaps we should not be surprised at the fact that both suicidal feelings and thoughts of hopelessness have been considered part of the social context of growing old and becoming progressively less capable. This is not a phenomenon that is just confined to our society. We know that the Ancient Greeks tolerated these feelings in their society and actively condoned the option of assisted suicide if the person involved had come to the conclusion that they had no more useful role to play in society (Carrick P 2000). Society largely took the view that once an individual had reached old age they no longer had a purpose in life and would be better off dead. In a more modern context, we note the writings of Sigmund Freud who observed (while he was suffering from an incurable malignancy of the palate: It may be that the gods are merciful when they make our lives more unpleasant as we grow old. In the end, death seems less intolerable than the many burdens we have to bear. (cited in McClain et al. 2003) We would suggest that one of the explanations of this apparent phenomenon of comparative indifference to the plight of the elderly in this regard is due to the fact that the social burden of suicide is often refered to in purely economic terms, specifically relating to loss of social contribution and loss of productivity. (Brechin A et al. 2000). This purely economic assessment would have to observe that the young are much more likely to be in employment and less likely to be a burden on the economic status of the country whereas with the elderly exactly the converse is likely to be true. This results in economic prominence being give to the death of a younger person in many reviews. (Alcock P, 2003). There is also the fact that, despite the fact that we have already highlighted the increase in relative frequency of suicide in the elderly, because of the demographic distributions of the population in the UK, the absolute numbers of both attempted suicides and actual suicides are greater in the younger age ranges and therefore more readily apparent and obvious. The elderly are a particularly vulnerable group from the risk of suicide. In the industrialised world males over the age of 75 represent the single largest demographic group in terms of suicide attempts. Interestingly (and for reasons that we shall shortly discuss) although there is a general trend of increasing suicide rate with age the excess rates associated with the elderly are slowly declining in the recent past (Cattell 2000). We can quantify this statement by considering the statistics. If we consider the period 1983 to 1995 in the UK then we can show that: The suicide rates for men reduced by between 30% and 40% in the age groups 55–64, 65–74 and 75–84 The rates for the most elderly men (males over 85 years) remained fairly static, this group still having the highest rates of any group By way of contrast, the 25- to 34-year-old male group exhibited a 30% increase in suicide rate during the same period, this group are becoming the group with the second highest rate, while the 15- to 24-year-old male group demonstrated a 55% increase in suicide rates. (WHO 2001) Female suicide rates have shown a similar overall decrease, reducing by between 45 and 60% in the 45–84 age group. Elderly women, however, retain the highest rates throughout the life span (Cattell 2000) The ratio of male to female elderly suicide deaths remains approximately 3:1 (Fischer L R et al. 2003) We can suggest that these trends in reduction of suicide, particularly in the elderly are likely to be due, amongst other things, to: The improved detection of those at risk together with the advent of aggressive treatment policies relating to mental illness in the elderly. (Waern M et al. 2003) One of the main reasons, we would suggest, for this obviously changing pattern and the discrepancies in the suicide rates between the age ranges, is the fact that, in direct consideration of the context of our topic, the elderly are more likely to be both amenable to professional help and also, by virtue that a higher proportion are likely to be in direct contact with healthcare professionals either through failing health or nursing homes and hospitals, (Suominen K et al. 2003), have the warning signs of impending suicide recognised and acted upon more promptly than the younger, arguably more independent age group. In specific consideration of the elderly group we should also note that attempted suicide is more likely to be a failed suicide attempt rather than a parasuicide. (Rubenowitz E et al. 2001). There is considerable evidence that the incidence of depression is increased in the presence of a concurrent physical illness (Conwell Y et al. 2002) and clearly this is going to be more likely in the elderly age group. Some sources have cited association rates of between 60-70% of major depression with physical illness in the over 70yr olds. (Conwell Y et al. 2000). Another significant factor is that it is commonly accepted that an attempted suicide is a strong independent risk factor in the aetiology of further suicide attempts. (Conwell Y et al. 1996) This trend is much more marked in the elderly group with a ratio of about 4:1 which compares very badly with the ratios in the younger age groups of between 8:1 and 200:1 (depending on age range, definition and study). (Hepple J et al. 1997) In this dissertation it is intended to gain evidence based knowledge of the scope and significance of the phenomenon of attempted suicide in the elderly. In addition it is intended to gain evidence based knowledge in the use of strategies to ameliorate attempted suicide in the elderly to highlight gaps in the literature available and to suggest recommendations for change in nursing practice It is hoped to be able to suggest areas for research into the phenomenon of attempted suicide in the elderly. The initial strategy was to undertake a library search at the local post graduate library and the local university library (Client: you might like to personalise this) on the key words â€Å"suicide, elderly, prevention strategies, industrialised societies†. This presented a great many papers. About 40 were selected and read to provide an overview of the literature in this area. During this phase, references were noted and followed up and key literary works were assimilated. The bulk of the papers accessed and read were published within the last decade, however a number of significant older references were also accessed if they had a specific bearing on a particular issue. The most significant references were accessed and digested. The dissertation was written referencing a selected sub-set of these works. To increase nurses knowledge and understanding of attempted suicide in the older age group and to highlight through the literature review, evidence based strategies that an be employed to ameliorate attempted suicide amongst the elderly. Literature review Before commencing the literature review, it is acknowledged that the literature on this subject is huge. The parameters of the initial search have been defined above. In addition it should be noted that there is a considerable literature on the subject of assisted suicide which has been specifically excluded from these considerations The literature base for suicide in the elderly is quite extensive and provides a good evidence base for understanding, appropriate action and treatment. (Berwick D 2005) One of the landmark papers in this area is by Hepple and Quinton (Hepple J et al. 1997) which provided a benchmark, not only on the aetiology of the subject, but also in the long term outcomes, which, in terms of potential nursing care input, is extremely important. The paper points to the fact that there is a good understanding of the absolute risk factors for suicide in the elderly but a comparative lack of good quality follow up studies in the area. It set out to identify 100 cases of attempted suicide in the elderly and then follow them up over a period of years. The study was a retrospective examination of 100 consecutive cases of attempted suicide that were referred to the psychiatric services over a four year period. The authors were able to make a detailed investigation (including an interview of many of the survivors), about four years later. Their findings have been widely quoted in the literature. Of particular relevance to our considerations here we note that they found that of the 100 cases identified, 42 were dead at the time of follow up. Of these, 12 were suspected suicides and five more had died as a result of complications of their initial attempt. There were 17 further attempts at suicide in the remaining group. Significantly, the twelve women in the group all made non-lethal attempts whereas all five of the men made successful attempts. The authors were able to establish that the risk of further attempts at suicide (having made one attempt) was in excess of 5% per year and the â€Å"success† rate was 1.5% per year in this group. From this study we can also conclude that the risk of successful repeat attempted suicide is very much greater if the subject is male. The authors were also able to establish that, because of their initial attempt, those at risk of self harm were likely to be in contact with the Psychiatric services and also suffering from persistent se vere depression. We can examine the paper by Dennis (M et al. 2005) for a further insight into the risk factors that are identifiable in the at risk groups. This paper is not so detailed as the Hepple paper, but it differs in its construction as it is a control matched study which specifically considered the non-fatal self harm scenario. The study compared two groups of age matched elderly people both groups had a history of depression but the active study group had, in addition, a history of self harm. The significant differences highlighted by this study were that those in the self harm group were characterised by a poorly integrated social network and had a significantly more hopeless ideation. This clearly has implications for intervention as, in the context of a care home or warden assisted setting, there is scope for improving the social integration of the isolated elderly, and in the domestic setting community support can provide a number of options to remove factors that mitigate towards soci al isolation. This would appear to be a positive step towards reducing the risk of further self harm. The O’Connell paper (O’Connell et al. 2004) is effectively a tour de force on the pertinent issues. It is a review paper that cherry-picks the important information from other, quite disparate, studies and combines them into a coherent whole. It is extremely well written, very detailed, quite long and extremely informative. While it is not appropriate to consider the paper in its entirety, there are a number of factors that are directly relevant to our considerations here and we shall restrict our comments to this aspect of the paper. In terms of the identification of the risk factors associated with attempted suicide in the elderly, it highlights psychiatric illnesses, most notably depression, and certain personality traits, together with physical factors which include neurological illnesses and malignancies. The social risk factors identified in the Dennis paper are expanded to include â€Å"social isolation, being divorced, widowed, or long term single†. The authors point to the fact that many of the papers refered to tend to treat the fact of suicide in reductionist terms, analysing it to its basic fundamentals. They suggest that the actual burden of suicide should also be considered in more human terms with consideration of the consequences for the family and community being understood and assessed. (Mason T et al. 2003) In terms of nursing intervention for suicide prevention, we note that the authors express the hypothesis that suicidality exists along a continuum from suicidal ideation, through attempted suicide, to completed suicide. It follows from this that a nurse, picking up the possibility of suicidal ideation, should consider and act on this as a significant warning sign of possible impending action on the part of the patient. The authors point to the fact that the estimation of the actual significance of the various prevalences of suicide varies depending on the study (and therefore the definition) (Kirby M et al. 1997). In this context we should note that the findings do not support the ageist assumptions expounded earlier, on the grounds that the prevalence of either hopelessness or suicidal ideation in the elderly is reported as up to 17% (Kirby M et al. 1997), and there was a universal association with psychiatric illness, especially depressive illness. If we consider the prevalence of suicidal feelings in those elderly people who have no evidence of mental disorder, then it is as low as 4%. It therefore seems clear that hopelessness and suicidality are not the natural and understandable consequences of the ageing process as Freud and others would have us believe. This has obvious repercussions as far as nursing (and other healthcare) professionals are concerned, as it appears to be clearly inappropriate to assume that suicidality is, in most cases, anything other than one of many manifestations of a mental illness. It also follows from this, and this again has distinct nursing implications, that suicidal ideation and intent is only the tip of the iceberg when one considers the weight of psychological, physical and social health problems for the older person. (Waern M et al. 2002) If one considers evidence from studies that involve psychological autopsies, there is further evidence that psychopathology is involved. Depressive disorders were found in 95% in one study. (Duberstein P R et al. 1994) Psychotic disorders and anxiety states were found to be poorly correlated with suicidal completion. Further evidence for this viewpoint comes from the only study to date which is a prospective cohort study in which completed suicide was the outcome measure. (Ross R K et al. 1990). This shows that the most reliable predictor of suicide was the self-rated severity of depressive symptoms. This particular study showed that those clients with the highest ratings were 23 times more likely to die as the result of suicide than those with the lowest ratings. It also noted that other independent risk factors (although not as strong), were drinking more than 3 units of alcohol per day and sleeping more than 9 hours a night. One further relevant point that comes from the O’Connell paper is the fact that expression of suicidal intent should never be taken lightly in the older age group. The authors cite evidence to show that this has a completely different pattern in the elderly when compared to the younger age groups. (Beautrais A L 2002). The figures quoted show that if an elderly person undertakes a suicide attempt they are very much more likely to be successful than a younger one. The ratio of parasuicides to completed suicides in the adolescent age range is 200:1, in the general population it is between 8:1 and 33:1 and in the elderly it is about 4:1. (Waern M et al. 2003). It follows that suicidal behaviour in the elderly carries a much higher degree of intent. This finding correlates with other findings of preferential methods of suicide in the elderly that have a much higher degree of lethality such as firearms and the use of hanging. (Jorm A F et al. 1995). The paper by Cornwell (Y et al. 2001) considers preventative measures that can be put in place and suggests that independent risk factors commonly associated with suicide in the elderly can be expanded to include psychiatric and physical illnesses, functional impairment, personality traits of neuroticism and low openness to experience, and social isolation. And of these, t is affective illness that has the strongest correlation with suicide attempts. We have discussed (elsewhere) the correlation between impending suicide and contact with the primary care providers. Cornwell cites the fact that 70% of elderly suicides have seen a member of the primary healthcare team within 30 days of their death and therefore proposes that the primary healthcare setting is an important venue for screening and intervention. It is suggested that mood disorders are commonplace in primary healthcare practice but, because they are comparatively common, are underdiagnosed and often inadequately treated (ag eism again). The authors suggest that this fact alone points to the fact that one of the suicide prevention strategies that can be adopted by the primary healthcare team. they suggest that clinicians, whether they are medically qualified or nursing qualified, should be trained to identify this group and mobilise appropriate intervention accordingly. Obviously the community nurses can help in this regard as they are ideally placed to maximise their contact with vulnerable and high risk groups. We have identified the role of a major depressive illness in the aetiology of suicide in the elderly. Bruce (M L et al. 2002) considered the role of both reactive and idiopathic major depression in the population of the elderly in a nursing home setting. This has particular relevance to our considerations as firstly, on an intuitive level, one can possibly empathise with the reactive depressive elements of the elderly person finding themselves without independence in a residential or nursing home and secondly, this is perhaps the prime setting where the nurse is optimally placed to monitor the mood and other risk factors of the patient and continual close quarters. The salient facts that we can take from this study are that there was a substantial burden of major depressive symptomatology in this study group (13.5%). The majority (84%) were experiencing their first major depressive episode and therefore were at greatest risk of suicide. The depression was associated with comorbidity in the majority of cases including â€Å"medical morbidity, instrumental activities of daily living disability, reported pain, and a past history of depression but not with cognitive function or sociodemographic factors.† All of these positive associations which could have been recognised as significant risk factors of suicide in the elderly. Significantly, in this study, only 22% of all of the seriously depressed patients were receiving antidepressant therapy and none were receiving any sort of psychotherapy. In addition to this the authors point to the fact that 31% of the patients who were put on antidepressants were taking a subtherapeutic dose (18% because they were purposely not complying with the dosage instructions). The conclusions that the authors were able to draw from this study were that major depression in the elderly was twice as common in the residential setting as opposed to those elderly patients still in the community. The majority of these depressed patients were effectively left untreated and therefore at significant risk of suicide. There was the obvious conclusion that a great deal more could be done for this study population in terms of relieving their social isolation and depressive illnesses. And, by extrapolation, for their risk of suicide. Ethical considerations. In consideration of the issue of suicide in the elderly we note that there are a number of ethical considerations but these are primarily in the field of assisted suicide which we have specifically excluded from this study. (Pabst Battin, M 1996) Having established the evidence base in the literature that defines the risk factors that are known to be particularly associated with suicide in the elderly, we take it as read that this will form part of the knowledge base for the nurse to be alert to, and to identify those patients who are at particular risk of suicide. It is equally important to be aware of those factors that appear to confer a degree of protection against suicide. This will clearly also help to inform strategies of intervention for the nurse. Studies such as that by Gunnell (D et al. 1994) point to the fact that religiosity and life satisfaction were independent protective factors against suicidal ideation, and this factor was particularly noted in another study involving the terminally ill elderly where the authors noted that higher degrees of spiritual well-being and life satisfaction scores both independently predicted lower suicidal feelings. (McClain et al. 2003). The presence of a spouse or significant friend is a major protective factor against suicide. Although clearly it may not be an appropriate intervention for nursing care to facilitate the presence of a spouse (!) it may well be appropriate, particularly in residential settings, to facilitate social interactions and the setting up of possible friendships within that setting (Bertolote J M et al. 2003) This Dissertation has considered the rationale behind the evidence base for nursing intervention and strategies to prevent or minimise suicide attempts in the elderly age group. We have outlined the literature which is directed at identification of the greatest â€Å"at risk† groups and this highlights the importance of the detection and treatment of both psychiatric disorders (especially major depression), and physical disorders (especially Diabetes Mellitus and gastric ulceration). (Thomas A J et al. 2004) Although we have been at pains to point out the relatively high and disproportionate incidence of suicide in the elderly, we should not loose sight of the fact that it is not a common event. One should not take the comments and evidence presented in this dissertation as being of sufficient severity to merit screening the entire elderly population. (Erlangsen A et al. 2003) The thrust of the findings in this dissertation are that the screening should be entirely opportunistic. The evidence base that we have defined should be utilised to identify those who are in high risk groups, for example, those with overt depressive illnesses, significant psychological and social factors, especially those who have a history of previous attempted suicide. The healthcare professional should not necessarily expect the elderly person to volunteer such information and if the person concerned is naturally withdrawn or reserved, minor degrees of depressive symptoms may not be immediately obvious. (Callah an C M et al. 1996). In terms of direct nursing intervention, this must translate into the need to be aware of such eventualities and the need to enquire directly about them. The nurse should also be aware that the presence of suicidal feelings in a patient with any degree of depression is associated with a lower response rate to treatment and also an increase in the need for augmentation strategies. The nurse should also be aware of the fact that these factors may indicate the need for secondary referral. (Gunnell D et al. 1994). If we accept the findings of Conwell (Y et al. 1991), then the estimated population at risk from significant mood disorder and therefore the possibility of attempted suicide in the elderly, is 74%. This can be extrapolated to suggest that if mood disorders were eliminated from the population then 74% of suicides would be prevented in the elderly age group. Clearly this is a theoretical viewpoint and has to be weighed against the facts that firstly â€Å"elimination† of mood disorders (even if it were possible), would only be achieved by treatment of all existing cases as well as prevention of new cases, and the secondary prevention of sub-clinical cases. We know, from other work, that the detection and treatment of depression in all age ranges is low, and even so only 52% of cases that reach medical attention make a significant response to treatment (Bertolote J M et al. 2003). These statistics reflect findings from the whole population and the detection rates and response rates are likely to lower in the elderly. (Wei F et al. 2003). It follows that although treatment of depressive illness is still the mainstay of treatment intervention as far as suicide prevention is concerned, preventative measures and vigilance at an individual level are also essential. Nursing interventions can include measures aimed at improving physical and emotional health together with improved social integration. Sometimes modification of lifestyle can also promote successful ageing and lead to an overall decrease in the likelihood of suicidal feelings. (Fischer L R et al. 2003) On a population level, public health measures designed to promote social contact, support where necessary, and integration into the community are likely to help reduce the incidence of suicide in the elderly, particularly if we consider the study by Cornwell (Y et al. 1991) which estimated the independent risk factor for low levels of social contact in the elderly population as being 27%. Some communities have provided telephone lines and this has been associated with a significant reduction in the completed suicide in the elderly (Fischer L R et al. 2003) To return to specific nursing interventions, one can also suggest measures aimed at reducing access to, or availability of the means for suicide such as restricting access to over the counter medicines. (Skoog I et al. 1996), Some sources (Cattell H 2000) point to the possibility of introducing opportunistic screening in the primary healthcare setting. The rationale behind this suggestion is the realisation that there is a high level of contact between the suicidal elderly person and their primary healthcare team in the week before suicide (20-50%) and in the month before suicide (40-70% make contact). This is particularly appropriate to our considerations here because of the progressively increasing significance of the role of the nurse within the primary healthcare team particularly at the first point of contact. (Hogston, R et al. 2002) The evidence base for this point of view is strengthened by reference to the landmark Gotland study (Rutz W et al. 1989) which examined the effect of specific training in suicide awareness and prevention in the primary healthcare team by providing extensive suicide awareness training and measures to increase the facilitation of opportunistic screening of the population. Prior to the intervention, the authors noted that, when compared to young adults, the elderly were only 6% as likely to be asked about suicide and 20% as likely to be asked if they felt depressed and 25% as likely to be refered to a mental health specialist. This balance was restored almost to normality after the intervention. Suicide in the elderly is a multifaceted and complex phenomenon. It appears to be the case that the elderly tend to be treated with different guidelines from the young suicidal patient insofar as the increased risk is not met with increased assistance. (Lykouras L et al. 2002). We have presented evidence that the factors included in this discrepancy may include the higher overall number of young suicides, the higher economic burden that society appears to carry for each young suicide together with ageist beliefs about the factors concerning suicide in the elderly. From the point of view of nursing intervention, both in a hospital and in a community setting, there should be greater emphasis placed on measures such as screening and prevention programmes targeted at the at risk elderly. There is equally a need for aggressive intervention if depression or suicidal feelings are overtly expressed, particularly in the relevant subgroups where additional risk factors may be active, for example those with comorbid medical conditions or social isolation or recent bereavement. (Harwood D et al. 2001), Many of the elderly spend their last years in some form of sheltered accommodation, whether this is a nursing home, a hospital, warden assisted housing or being cared for by the family. (Haupt B J et al. 1999) In the vast majority of cases this is associated with a loss of independence, increasing frailty and an increasing predisposition to illness that comes with increasing age. (Juurlink D N et al. 2004). This loss of independence and increasing predisposition to illness is also associated with depressive illnesses of varying degrees. (Bruce M L et al. 2002). These patients are arguably, by a large, more likely to come into contact with the nurses in the community. (Munson M L 1999) The comments that we have made elsewhere relating to the nurse’s role in being aware of the implications for the depressed elderly patient are particularly appropriate in this demographic subgroup. As a general rule, it may be easier to keep a watchful eye on patients who are exhibiting early sig ns of depressive illness or mood disorder in this situation by making arrangements to visit on a regular basis or on â€Å"significant anniversaries† such as the death of a spouse or a wedding anniversary. (Nagatomo I et al. 1998) when the risk factors for suicide increase dramatically (Schulberg H C et al. 1998) The literature in this area is quite extensive and covers many of the aspects of suicide in the elderly. It is noticeable however, that there is a great deal of literature on the subject of risk factors and associations of suicide together with plenty of papers which quote statistics that relate the various trends and incidences. There are, by comparison, only a few papers which emphasise and reflect on the positive aspects of nursing care. The positive steps that can be taken by the nursing profession specifically to help to minimise the burden of suicidal morbidity. There is clearly scope for studies in areas such as the impact that a dedicated community nurse might have on the levels of depression in the community if regular visits were timetabled. It is fair to observe that the community mental health nurses fulfil this role to a degree, but are severely hampered in most cases by sheer weight of numbers in the caseload. (Mason T et al. 2003) Having made these observations, we must conclude that there appears to be an overwhelming case for opportunistic screening of the at risk elderly at any point of contact with a healthcare professional. It is part of the professional remit of any nurse to disseminate their specific professional learning with others. (Yura H et al. 1998). This can either be done on an informal professional basis in terms of mentorship or, if appropriate in a lecture or seminar situation. (Hogston, R et al. 2002). There clearly is little merit in critically evalua

Market Segmentation Targeting And Positioning

Market Segmentation Targeting And Positioning Market segmentation involves aggregating of prospective buyers into groups, or segments that have common needs and will respond similarly to a marketing action.  [1]  Nestle provide a wide range of nutritious food and beverages for everyone to practice a balanced and healthy diet and lifestyle. There are four types of major segmentation variables for consumer markets which include geographic, demographic, psychographic and behavioral. Segment marketing has given the company a clearer picture of their customers and competitors so that the company can come up with a more fine-tuned products and services that satisfied customers needs. Through market segmentation, targeting and positioning, Nestle can reach out to their customers more easily and serve their customers more effectively and efficiently. Segmentation We found out that Nestle classify their market by using geographic, demographic and psychographic segmentation based on consumer characteristics. In geographic segmentation, Nestle has divided their market into urban areas (cities) and rural areas (villages). Besides that, Nestle also uses demographic factor to segment its market, it consists on income level and educational level. The income level and educational level can be categorized as low, middle and high level consumers. Apart from that, Nestle uses psychographic factor to differentiate the market. The segmentation variables that Nestle uses are personality, social class and lifestyle. Nestle can groups individuals according to their personalities such as extrovert, self-disciplined or energetic. Nestle divides their customers into low social class, medium social class and high social class. Targeting A target market is a potential market that a company has decides to concentrate its marketing efforts and resources to enter those markets. Nestle segments its market by regions, income level, educational level, personalities, social class and lifestyle. By applying the information and observations that we get, we can simply identify the target market of Nestle. In this case, we found out Nestle focuses on urban areas rather than rural areas. The consumption of Nestle products is often in cities as compared to villages. This may be due to income and educational level. The people in rural area mostly could not afford the products of Nestle as it is considered as luxuries. They do not have strong sense of health consciousness due to educational background. This makes them the less attractive buyers. For segmentation by income level, Nestle has been targeting on those consumer who earn middle income and high income. People will purchase healthy and nutritious food and beverages when they have enough monetary resources to back up them. Those consumers with higher income tend to be the potential buyers for Nestle because they bring most profit into the company. Furthermore, for educational level Nestle tends to pay more attention to those consumers who has an education background. They will be more concern of their health and they will do more to maintain it. Through education, we can improve our knowledge and develop life skills which can contribute to individual and community health. Those people with an education background are more likely to practice and maintain a healthy and balanced diet as they know health is more important than wealth. For personality segmentation, Nestle is targeting consumers who are more outgoing and outdoorsy. It is because they require more energy and nutrition that they have lost during their activities. By adapting nutritional input to physical needs, they can get the most from their body.  [2]  These people wish to maintain their energy level and quick recovery after a hectic day by adapting a balanced diet that provides them with essential nutrients and energy. In addition, from the social class and lifestyle segments, Nestle is targeting consumers who are belong to the higher social classes. They have high purchasing power so that they can afford more luxuries such as Nestles products. These people are the target market of Nestle because they tend to be more health conscious. Nestles products often emphasize on nutritional value and health benefits that can improve ones lifestyle and health issues. As conclusion, Nestle is able to reach out to their customers that it can serve best and most profitably. Through segmentation and targeting market, Nestle can enhance the profits for their company and increase effectiveness in their marketing campaigns. Positioning Product positioning refers to the place an offering occupies in consumers minds on important attributes relatives to competitive products. Nestle positioned itself as the world leader in Nutrition, Health and Wellness, trusted by all its stakeholders, and to be the reference for financial performance in its industry.   [3]  Nestle uses the slogan Good Food Good Life to enhance lives, throughout life, with good food and beverages.  [4]  Nutrition content in their products is the main focus to strengthen their leadership in nutrition industry. To remain their position in that industry, they must identify their competitive advantages against their competitors. Nestle has listed out four competitive advantages of their company that may help their company to compete with their competitors, that are unmatched product and brand portfolio, unmatched research and development (RD) capability, unmatched geographic presence and lastly people, culture, values and attitude  [5]  . For unmatched product and brand portfolio, Nestle provide the largest range of food and beverages among all the food company. Their products range from global icons to local favourites that can adapt to consumer needs, tastes and preferences, making Nestle as a global brand that relevant to everyone and everywhere. Besides that, it is supported by unmatched RD capability that improves the products through innovation and renovation so that it can meet consumer needs and enhances consumer benefits. Nestle spent over billions of dollar on its RD just to ensure its consumer gets the essential nutrition that their body needed. Nestle has an unmatched geographic presence competitive advantage due to the number of countries where they presence. They have been in most countries for over decades and successfully created a strong relationship between their brands and their consumers.  [6]  This also means that they have has plenty of time to study about the local preferences and behaviors to improve their products taste to match the locals preferences. The most important competitive advantage for Nestle is their people, culture, values and attitude. The Nestle culture created a strong bond between their people with a shared set of behaviors and values into a single way of doing business. Their people are determined to deliver their goals as while as creating value to the public.  [7]   Marketing environment Marketing environment consists of microenvironment (internal environment) and macroenvironment (external environment). It embraces all the marketing team inside a firm and includes all the outside factors of marketing that affect the teams ability to develop and maintain successful customer relationships with their targeted customer group.  [8]  Nestle is using it to improve customer relationship management and adapt new strategies when it comes to challenges and opportunities. Microenvironment Suppliers Suppliers are the one who delivered the resources needed by the company to produce the products or services to the consumers. Any problems that incurred in supplier can greatly affect the company sales and damage customer relationship. We can divide the suppliers of Nestle into two groups that are labour suppliers and material suppliers.  [9]  Labour suppliers are in charge of the supply of labour required by the company to optimize their production level. Labour strikes and labour relations are the most important factor to maintain labour satisfaction for company to improve their efficiency. For material suppliers, they deal with the materials needed by the company to place the finished goods on rack. The quality of the material is everything that the company focuses on as Nestle is in the food and beverages industry. By maintaining the quality and quantity of these two supplies, Nestle is able to produce high quantity product to uphold their sales volume and customer satisfacti on in the long run. Marketing intermediaries It helps the company to promote, sell and distribute its product to the final buyers.  [10]  The physical distribution firms design the delivery chain for the company products to reach their final destination. The firms also in charge with the products safety without getting any damage while storing them temporarily. Marketing service agencies of the company helps to target and promote its products to the right market.  [11]  It acts as a communication channel between the customers and the company by explaining the features of the product and providing feedback with the help of survey for the company to improve the quality of the product.  [12]  Banks and insurance companies are financial intermediaries that help to provide monetary resources and protection to the product and company against risk that may be occurred during the operation of the company. Nestle works together with all marketing intermediaries to ensure their valuable customers have a clear image of their p roducts features. Customer Nestle sells its goods to reseller markets that provide the goods to final user at a reasonable profit. Nestle also deals with customer markets which consists of individuals and households that buy a wide range of its products. Nestle works hard on making the product available whenever the customer needs them to maintain customer satisfaction. Macroenvironment Political environment Nestle adhere to the laws and regulations that involve in its activities and the environment. The government may set quotas on the quantity of the products that it can supply and set the amount of taxes that the company must pays in order to conduct the business. To achieve a balance between them, Nestle participates in legislative and regulatory discussions between international organizations, government representatives, industry, scientific community and consumer associations.  [13]   Economic environment Customer purchasing power is majorly affected by a range of economic factors such as income levels, inflation, taxes, unemployment, exchange rates and mortgage rates  [14]  . The disposable income and living standard of a country may bring big business opportunities for Nestle or the other way round. Cultural environment Before Nestle start its operation in any country, it mainly focus on studying the societys cultural value, preferences and behaviors. This is because Nestle hopes its products can be accepted by the local with warm welcome and be competitive among other companies that operating at the same level.  [15]   Technological environment Technologies are the vital part of Nestle RD. Investment in technology will definitely help the company to reduce production cost and improve product quality. For example, Nestle have developed technologies that allow them to use natural vegetable oils instead of partially hydrogenated fats in Maggi bouillon cubes and seasonings.  [16]  With the help of technology improvement, Nestle can create healthier products across their product range and thus improve health and quality of life in a country.

Global Warming Essay -- Environment Global Warming Climate Change

Global Warming For the last 20 years or so the subject of global warming has spawned heated debate among the world’s brightest minds. Its causes and effects, if either actually exists, have been hotly debated. The most popular hypothesis is called the greenhouse effect with the agreed upon cause being green house gasses. These gasses are all naturally occurring and include water vapor, methane, oxygen, and the now infamous carbon dioxide. Greenhouse gasses exist in the atmosphere and have an effect on our global weather. They trap radiated heat and prevent it from exiting our atmosphere. This supposedly increases global temperatures and is, or will, cause melting of the polar ice caps. This in turn is expected to raise sea level and cause global coastal flooding. A brief geology lesson The world we live on is at least 4.6 billion years old. In that time span it has undergone immense changes. At one time most of the land surface was connected. The continents separated and migrated to their present positions. The force behind this is called plate tectonics. The sea floor is still spreading today and is the driving force for all of the earthquakes and volcanic activity that we experience today. Convection currents created by the tremendous heat and pressure of the inner core move the plates. This core is undergoing massive thermonuclear reactions. The heat produced migrates outward and the currents it produces move the plates. This process also releases enormous amounts of carbon dioxide and water vapor. This has been taking place since the Earth was formed. We know from geologic record that there have been numerous greenhouse and icehouse ages. The question is, is the greenhouse state caused by greenhouse gasses? Probably not, at least not entirely. There are several other factors involved - the most significant being the Milankovitch cycles. These are three cycles that describe the motion of the Earth through space. The first involves the Earth’s orbit around the sun. The orbit is not perfectly round, but elliptical. This means that at one point the Earth is closer to the sun than at other times. This cycle takes about 100,000 years to complete. The second cycle involves the tilt of the Earth’s axis. The Earth’s axis is currently tilted about 23.5 degrees. But this tilt is not constant. Throughout a period of about 40,000 years the tilt changes a f... ...een showing a downward trend since their peak in 1940. Satellite readings continue to show a decrease in temperature. They recorded 1997 as the coolest year since this technology has been implemented. This imagery was also accurate enough to predict â€Å"that â€Å"La Nina† would predominate in 1998, lowering global temperatures significantly"2. That same year Moscow recorded its coldest December in a century3. Conclusion This great world of ours has been around for a long time – at least 4.6 billion years. During that time untold and unimaginable changes have taken place. Countless icehouse and greenhouse ages have come and gone. Continents have been created, destroyed, and migrated over and over again. Thousands, perhaps millions, of species have come and gone. All this, and more, without any influence from man. In geologic terms we have been on this Earth for a very, very short time. The Earth evolves on a time scale that we cannot comprehend. It has developed a balance, a system of checks and balances, which we have little or no control over. To think that we can alter a global climate that has been 4.6 billion years in the making merely shows just how much we have yet to learn.

Hawthornes Puritanical Beliefs Revealed in The Scarlett Letter and You

Hawthorne's Puritanical Beliefs Revealed in The Scarlett Letter and Young Goodman Brown When an author depicts a person or group of people in his or her work, the opinion of the writer most often sifts into the descriptions, whether intentionally or unintentionally. Some writers are very guarded regarding their feelings toward any particular subject, while others are very open and happy to share. Nathaniel Hawthorne belongs to the latter group. The purpose of the majority of his literary work was to share his view of the group of strict Christians known as the Puritans. Hawthorne himself was a direct descendent of Puritans, and he obviously held very particular views of his ancestors. These views are clearly demonstrated in his works The Scarlett Letter and "Young Goodman Brown," in which Hawthorne shows his disdain for the judgement and hypocrisy that was a daily practice of the Puritan church. In the New Testament of the Holy Bible, Matthew wrote in the Gospel of Matthew, Chapter Seven, Verse 1, "Judge not, that you be not judged." This is an often quoted verse of scripture that has been the subject of countless sermons and has been the chastisement to even more Christians. The Puritans, without a doubt, had this verse branded on their hearts, and yet, according to the works of Hawthorne, never practiced the Bible that they quoted so frequently. His disdain toward them and the judgement that they inflict on others, as well as the hypocrisy that they are immersed in from the time of birth. In the second chapter of The Scarlett Letter, Hawthorne shows the reader both the judgement and hypocrisy of a small part of the society - the women. As they wait for the arrival of Hester Prynne, this town's resident adulteress, they... ...n authors Anne Bradstreet and Edward Taylor. Perhaps, had Hawthorne studied these two writers, he may have discovered the bit of beauty that is hiding in stoic Puritanism. Works Cited Baym, Nina. The Norton Anthology of American Literature vol. I. New York: Norton and Co., 1998. McKeithan, D. M. "Hawthorne's 'Young Goodman Brown': An Interpretation." Modern Language Notes (1952): 93-96. Reprinted in Short Story Criticism vol. 29. "A Review of The Scarlet Letter." Littell's Living Age (1850): 203-207. Reprinted in Nineteenth Century Literary Criticism vol.10. Duyckinck, E.A. "Nathaniel Hawthorne." The Literary World (1850): 323-325. Reprinted in Nineteenth Century Literary Criticism vol.10. Macy, John. "Hawthorne." The Spirit of American Literature (1913): 77-96. Reprinted in Nineteenth Century Literary Criticism vol.10.

The Color of Water Essay

The Color of Water by James McBride was a narrative about a immature male child seeking to calculate out his racial individuality but his female parent would non speak about her yesteryear or what race she was. All James knew was that she was white life in a black power vicinity and that fact terrified him. He thought that to turn up he had to cognize his racial individuality but through all the problem and difficult times he went through he learned that his race did non affair. It was his instruction that was the most of import. Ruth attitude about her race effected James through his childhood and as a immature grownup. she negatively affected his racial development. and Ruth finally clears up his inquiries that he has been deceasing to acquire replies from. Ruth McBride’s attitude toward her ain race affected her boy. James McBride. as both a kid and as a immature grownup. Ruth chiefly looked down on her race because of her male parent. All he care about was money and the shop. he did non care about his ain married woman or household. He besides molested Ruth when she was a immature miss. When James was a immature male child he ever questioned her about race. He wanted to cognize if he was black or white and he besides asked what colour The nazarene was. James mother would non wholly reply his inquiry. She responded stating that James was a human and instruction was all that mattered. and that Jesus was the colour of H2O. As a child. James knew that his female parent was white. and that terrified him. He knew that a white lady life in a black vicinity. besides with black childs. was populating in danger. James truly realized his mother’s danger when Ruth and James were walking place and a adult male came up and stole Ruth’s bag. James figured out how strong and brave or crazy his female parent was when she did non contend the larceny back and all she told James was that it was merely a bag and it did non affair. When James grew up. he thought that Ruth was traveling brainsick. and he didn’t esteem her like he did in the yesteryear. If James would hold known about his mother’s yesteryear. it wouldn’t have change much. He might hold been more excusatory for her but that would be about it. Ruth’s impact on James’s racial development is negative. but she had good purposes. James ne'er knows what his racial background is and that bothers him throughout his life. If he would hold known what his mother’s background was possibly so he would understand himself in his eyes. but it does non take your race to calculate out yourself. it takes larning who you are on the interior. Ruth was seeking to do it a positive impact on his racial development. Ruth knew that race did non affair. it was about what was on the interior of the individual. but James did non understand that construct. Race ne'er concerned him by stating he was non traveling to tie in himself with a individual because of their background but he want to cognize about their race. and Ruth had no attentions about their race. which is a better manner to travel at it. Ruth offers James confusion as he grapples with his racial individuality as a younger male child. but she offers him lucidity as a immature grownup. When James was immature. Ruth would reply any of her inquiries and that bothered him but he knew non to force her to her bound or he would acquire the belt. He does non cognize what half of his race is. he know he was black from his male parent but knew nil about his mother’s race. Ruth was non ashamed to be a Jew. but she did non back up Judaism because of her male parent. Tateh. She was non concealing the fact that she was a Jew from James but she did non desire to believe about everything that she ran off from when she left Suffolk. Virginia and her household. more significantly her female parent. Hudis Shilksy. When James turns into the immature grownup he finds out that cognizing your race does non assist you in life like a good instruction does. Even though he has learned this Ruth starts to explicate his inquiries about race to him. In the narrative The Color of Water. James has unanswered inquiries as a kid. At the terminal of the book James learns about Ruth’s race and he finds out his racial individuality. James besides finds out God’s colour. He is the colour of H2O and H2O is neither. black or white. Ruth had harmful memories when she was a Jew because of her male parent and when he might her first hubby. Dennis. she changed her religion and found felicity. Ruth’s race affected Ruth which subsequently on affected her boy James negatively. Her angry about her yesteryear led to James’s confusion about his ain racial individuality. but subsequently on got all his inquiries answered.

Course Management Systems †Moodle Essay

Moodle is an open-source course management system designed to host online courses and facilitate academic interaction between students and their instructors. The program was created by Martin Dougiamas, who formerly worked with WebCT. Because of this the program features many similarities to WebCT, but is more flexible overall due to its open-source nature. Moodle can be accessed via more than eighteen-thousand registered websites and is used by approximately eight million students worldwide. The program supports sixty-one languages as of November 2006 and is constantly expanding. Students simply download the program, register a username and connect using an enrollment key code provided by their professor. The site can host single teacher classes, or link various classes within an academic institution. Moodle also offers the option of designing complete lessons online, which can consist of class material as well as optional end-of-chapter review questions. Instructors have a variety of options for posting assignments on Moodle, and can set their own preferences on how student submitted files can be accepted for grading. Teachers have the option to allow students to upload files, including text documents of various formats as well as images. After grading the instructor has the option to post grades directly, as well as leaving comments regarding their response to the assignment. They can also format assignments for direct editing online, allowing students to type their response directly into the program and submit it for grading. Instructors can also use Moodle as an online grade book for assignments complete in class (offline), so that students can have easy access to their grades. Quizzes can be constructed and assigned to students in Moodle as well, with several format options available. Teachers can design tests consisting of various question formats, including multiple choice, true-or-false and short answer questions. They also have the option of giving students multiple attempts to complete the quiz, and can set other variables such as time limits (quiz is timed and may only be completed within the allotted time limit), or password protection to limit access. Students have a variety of options for interacting with fellow classmates as well as the instructors via chat, forums and surveys. They can also access course-relevant resources via glossaries (which can be student or teacher-defined) and a fully-interactive Wiki (user-defined encyclopedia).