Orporate finance Essay Example | Topics and Well Written Essays - 4000 words

Orporate finance - Essay Example They also relaxed the stationarity assumptions of the random walk model. Fama (1970) continued the formalisation of the notion of "efficiency" in economic terms. He defined an efficient market as one "in which prices always 'fully reflect' available information". He also stated the conditions that would suffice for efficiency: "(i) there are no transactions costs in trading securities, (ii) all available information is costlessly available to all market participants, and (iii) all agree on the implications of current information for the current price and distributions of future prices of each security." Though adopting a statistical viewpoint, Fama (1970) differentiated information as "weak", "semi-strong" and "strong" forms. Later on, Rubinstein (1975), Beja (1976), Beaver (1981), and Latham (1986) adopted the framework of information economics where the definition is expressed in terms of the actions of individuals, as opposed to the actions of the market as defined by Fama (1970). Specifically, according to Beaver (1981): "A securities market is efficient with respect to a signal yt if and only if the configuration of security prices {Pjt} is the same as it would be in an otherwise identical economy (i.e. with an identical configuration of preferences and endowments) except that every individual receives yt as well as [that individual's own information]." Ray Ball (1994, p. 12-13) has a few criticisms of this school of thought. First, he argues that security prices in the "otherwise identical world" are ultimately priced using CAPM, which is implied by Fama's (1976) model. Secondly, he critiques that this model has confused properties of market with properties of information. Grossman (1976), Grossman and Stiglitz (1980) and Jordan (1983) associated "efficiency" with incentives to produce information. ACCOMPLISHMENTS First, the theory of stock market efficiency has developed prevalent respect for markets. Empirical evidence pointed to the efficiency of the stock markets, changing academic and even non-academic attitudes from suspicion to respect. Furthermore, the pioneer work on "efficiency" coincided with the surge in interest in and respect for markets in general among economists, and subsequently among politicians. The pioneer empirical work thus assumed importance and attracted interest beyond its direct impacts on stock markets. It led the global trend toward liberalising financial and other markets. The theory of stock market efficiency has also changed perceptions about how stock markets work. Before FFJR (1969)'s work, market reaction to information is viewed from a single point in chronological time to broad

3 Ps Self-Assessment Assignment Example | Topics and Well Written Essays - 250 words

3 Ps Self-Assessment - Assignment Example These were due to unavoidable circumstances that were explained to respective lectures in advance. My interpersonal relations with both lecturers and students have also been good without even a single reported case of conflict. This is because I always respect people’s opinions and personality and I have excellent communication skills towards approaching people (Lambert, p. 3-6). My level of preparation for class work has similarly been outstanding with a 46 points rating. This includes my readiness with respect to assignments, presentations, and class readings. My assignments and presentations have always been done and reviewed in time, before submission time, a fact that has facilitated my excellence as I have always had time for revision and editing of my work. Both lectures and classmates have also recommended my preparedness for class readings (Lambert, p. 3-6). My participation is similarly highly rated at 45 points. While I am always ready to participate in discussions and class exercises, I normally allow other people to participate and only engage when called upon. The relatively lower score in my participation can be explained by my passive nature (Lambert, p.

Health Risks Associated with Technology Essay Example for Free

Health Risks Associated with Technology Essay The widespread use of technology has led to some important use health concerns. Some of the move common physical health risks are repetitive strain injuries, computer vision syndrome, and muscular pain. These injuries are on the rise for users of technology. A repetitive strain injury (RSI) is an injury or disorder of the muscles, nerves, tendons, ligaments, and joints. Technology-related RSIs include tendonitis and carpal tunnel syndrome (CTS). Tendonitis is inflammation of a tendon due to repeated motion or stress on that tendon. CTS is inflammation of the nerve that connects the forearm to the palm. Repeated or forceful bending of the wrist can cause tendonitis or CTS of the wrist. Factor that cause these disorders include prolonged typing or mouse usage and continual shifting between a mouse and keyboard (Jones 45-48). If untreated, these disorders can lead to permanent physical damage. Computer vision syndrome (CVS) affects eyesight. Symptoms of CVS are sore, tired, burning, itching, or dry eyes; blurred or double vision; distance blurred vision after prolonged staring at a display device; headache or sore neck; difficulty shifting focus between a display device and documents; difficulty focusing on a screen image; color fringes or afterimages when looking away from a display device; and increased sensitivity to light. Eyestrain associated with CVS is not thought to have serious or long-term consequences (Anderson and Dean) People who spend their workday using the computer sometimes complain of lower back pain, muscle fatigue, and emotional fatigue. Lower back pain sometimes is cause from poor posture. It is advisable to sit properly in a chair while working and take periodic breaks. Users also should be sure their workplace is design ergonomically. Ergonomic studies have shown that using the correct type and configuration of chair, keyboard, display device, and work surface help users work comfortably and efficiently and helps  protect their health (Sanchez). Many physical health risks are associated with using technology. These risks include repetitive strain injuries, computer vision syndrome, and muscular pain. User should take as many preventive measures as possible to avoid these risks. Works Cited Anderson, Cricket Finley and Stacey Anne Dean. â€Å"Computer pains.† The Medical Update Aug. 2014:n. page. Web. 2 October 2014. Jones, Jacob Lee. Medical concerns of the 21st Century. Chicago: Smiley Incorporated, 2014. Print. Sanchez, Jorge Mario. Aches and Pains. 30 Sept. 2014. Course Technology. Web. 5 Aug. 2014.

Physical Exercise Reduce Symptoms Depression Health And Social Care Essay

Physical Exercise Reduce Symptoms Depression Health And Social Care Essay The aim of this essay will be to discuss and apply selected evidence related to nursing practice within a chosen field. Evidence based practice is an approach used by clinicians to deliver the highest quality care to meet the needs of patients and their families. By finding appraising and using the best evidence, health professionals are able to achieve optimum outcomes for all. (Melnyk Finout-Overholt 2005). However, an alternative view suggests that evidence exists to inform and guide practice rather than dictate it. (McKenna et Al 1999). When clinicians apply an evidence based model, the best available evidence, modified by patient circumstances and preferences, is applied to improve the quality of clinical judgements. (McMaster Clinical Epidemiology Group 1997) A recognised framework will be used to identify a question and then a systematic literature search will be carried out to assist in answering this question. A copy of this search will be provided and search parameters will be applied to gain the most relevant literature. After applying these parameters the search will be narrowed down to the five most relevant pieces of research. A table will be provided to show the key findings from each piece of literature, and one piece of research will then be critiqued in depth using a recognised framework. The question identified in this essay is Can physical exercise or activity help to reduce the symptoms of depression in older adults, compared to other forms of treatment? Background and Formulation of Question The question was devised using the PICO framework. This framework often is used to formulate clinical questions (Craig Smyth 2002), and it identifies and defines the essential components of a good clinical question. PICO is an acronym for patient population of interest, intervention, comparison intervention and outcome (National Institute for Health and Clinical Excellence 2007). Patient population of interest shall be older persons diagnosed with depression, intervention shall be physical exercise or activity, the comparison intervention shall be other forms of treatment for depression and the outcome will be a reduction in the symptoms of depression. A well thought out and formulated question maximises the potential for finding relevant evidence for a patient population (Craig Smyth 2002) Depression in older adults refers to depressive syndromes defined in the American Psychiatric Associations Diagnostic and Statistical Manual (DSM-IV) and in the International Classification of Diseases (ICD-10) that arise in people older than age 65 years. In old age, the symptoms of depression often affect people with chronic medical illnesses, cognitive impairment, or disability. (Alexopolous et al 2002). For a major depressive episode to be diagnosed, five of the following symptoms must be present: depressed mood, diminished interest, loss of pleasure in all or almost all activities, weight loss or gain (more than 5% of bodyweight), insomnia or hypersomnia, psychomotor agitation or retardation, fatigue, feeling of worthlessness or inappropriate guilt, reduced ability to concentrate, recurrent thought of death or suicide. At least one of the symptoms must be either depressed mood or diminished interest or pleasure. The episode should last at least 2 weeks, lead to distress or functional impairment, and not be a direct effect of substance use, a medical condition, or bereavement. (Depression Today 2010). Two of the symptoms detailed above must be present for a minor depressive episode to be diagnosed. Between one and four percent of the general elderly population has major depression, and minor depression has a prevalence of between four and thirteen percent (Blazer 2003). Twice as many women as men are affected. Both the prevalence (Palsson et al 2001) and the incidence (Teresi et al 2001) of major depression double after age 70-85 years. Treatment for depression usually involves a combination of anti depressant drugs, talking therapies such as Cognitive Behaviour Therapy or Interpersonal Therapy and self help. (NHS Choices 2010). A recent review concluded that physical exercise programmes can obtain have a beneficial effect on depressive symptoms in older people. Although not appropriate for all older people exercise may improve mood in those undertaking it. (Blake et al 2009) Systematic Literature Search A systematic review of the literature was carried out using the CINAHL and PubMed databases and the search terms depression physical exercise and old* were used. CINAHL was found to be particularly useful as it possible to specify the age group required in the literature search. For the purposes of this search age 65+ was selected. PubMed is the public access version of Medline, a comprehensive database which indexes thousands of journals in the medical sciences field. (TVU 2010a). The Cumulative Index to Nursing and Allied Health Literature Indexes virtually all English language journals from 1983 onwards. This database covers midwifery, nursing and related disciplines (TVU 2010b). Initially the searches indicated a vast array of literature but by applying a systematic review this was reduced. By using a logical search strategy with Boolean techniques the number of documents was limited to thirty. These were then reviewed and five articles were then selected which addressed the ques tion of exercise as a form of treatment for older people diagnosed with depression. The search parameters were limited to studies written in the English language, the age and the subjects, and both sexes were to be included. Harvard (2007) suggests that by applying parameters such as these the most up to date and relevant literature can be sourced. A full record of this search history is attached in appendix 1 and 2. A summary of the findings in the five pieces of research selected is detailed in the table overleaf. This table follows a structure recommended by Timmins McCabe (2005). Author and Year Journal Type of Study Purpose Sample Design Data Collection Key Findings Blake et al 2009 Clinical Rehabilitation Qualitative To assess efficacy of physical exercise in 11 trials totalling 641 participants Varied Varied 1 Exercise not relevant 2009; 23: 873-887 systematic treating depression in older adults to all in group review 2 May improve mood 3 further research needed to establish medium to long term effects and cost effectiveness Mather et al 2002 British Journal of Quantitative To determine whether exercise is effective 86 participants split into RCT clinical 1 Modest improvement Psychiatry (2002) as an addition to anti depressants in reducing two groups interview in symptoms after 10 180:411-415 depressive symptoms in older adults weeks 2 older people should be encouraged to attend exercise classes Brenes et al 2007 Aging Mental Health Quantitative To test feasibility and efficacy of exercise and 37 participants, 32 completed RCT structured 1 Both exercise Jan 2007;11(1):61-68 anti depressants compared with usual the study clinical interview and medication were treatments for older adults with observed shown to be statistically minor depression self reporting more effective than current treatment 2 Exercise also aided physical functioning Kerse et al 2010 Annals of Family Quantitative To assess effectiveness of home based 193 participants, 187 completed RCT structured 1 exercise and social Medicine 8:214-223 (2010) physical exercise plan in treating older the study clinical interview visits showed similar adults with depressive symptoms compared effects in improving to social visits mood an quality of life 2 More research is required Blumenthal et al Archives of Internal Quantitative to assess effectiveness of exercise 156 participants RCT structured 1 after 16 weeks 1999 Medicine 159(19) (1999) compared to antidepressants for treatment clinical interview exercise equally effective of major depression in older as anti depressantsCritical Appraisal The following appraisal was structured by using an approved and recognised framework for completing such tasks. (Polit et al. 2001) The article selected for critical appraisal is Effects of exercise on depressive symptoms in older adults with poorly responsive depressive disorder. (Mather et al. 2002). A copy of the article is attached as appendix 2. The aim of the study was to determine whether exercise is effective as an adjunct to antidepressant therapy in reducing depressive symptoms in older people. This was clearly defined. In the introduction the authors stated that it is widely held that exercise is useful in depression, but that there were few studies on the potential effects that exercise may have as an addition to antidepressant therapies for older adults. The key finding of this study was that at ten weeks older people with poorly responsive depressive disorder showed a modest improvement in depressive symptoms and should therefore be encouraged to attend group exercise activities. The study conducted was a randomised controlled trial. Randomised controlled trials are the most rigorous way of determining whether a relation exists between treatment and outcome and for assessing the cost effectiveness of a treatment. (Sibbald Rowland 1998). Patients were randomly selected to attend either exercise classes or health education talks for ten weeks. Assessments were blind and were conducted at baseline, ten and thirty four weeks. The primary outcome was measured with the 17 item Hamilton Rating Scale for Depression (HRSD). HRSD is a multiple choice questionnaire used by clinicians to measure the severity of major depression in patients. (Hamilton 1960). The nature of both interventions is clearly described by the authors. All participants were outpatients recruited from primary care, psychiatric services and direct advertisement. 1885 patients were screened with a view to recruitment, and 86 were selected at random for the study. To be included patients were require d to have symptoms of depression, and to be older than fifty three years of age. In addition patients had to have been receiving antidepressant therapy for at least six weeks, without evidence of a sustained improvement in their condition. Patients were excluded if there was: alcohol or substance misuse, structured psychotherapy in place, or were already taking regular exercise. Patients with specific medical conditions preventing physical exercise were also excluded. Both groups were informed of the nature of the trial, and all patients gave written informed consent. The study was approved by a medical research ethics committee. There were two groups with 43 patients in each and were comparable in terms of age range and symptom presentation. There was however a heavy preponderance of women in the exercise group. The authors suggest that this may have introduced a bias into the results, and suggest a control group could be introduced in the future without either intervention. The outcomes for both groups were measured in the same way by the proportion of participants achieving a greater than thirty percent reduction in HRSD score from baseline. The results are shown in a statistical format and are recorded in a table. There are twenty four references in the report which support the evidence presented by the authors. The implications for the health service are that structured group exercise sessions can help to make a modest improvement in patients who are not responding to pharmacological treatment and that older people with depressive disorders should be encouraged to attend group exercise activities. It should be noted that one of the authors of the research is co-director of a company providing exercise classes for older people and whose profits support research into aging. Review of Literature This review of literature will show how the five main studies and all available literature assist in answering the set question. The first part of this review will concentrate on the five main studies and the second part will contain evidence from a wide range of sources and relate this combined information to government policy and guidelines. There will also be evidence of how all the information relates back to practice. It is well acknowledged that depression is widespread (Osborn et al 2003) and is the most prevalent mental health problem for older people (Age Concern 2007) The condition affects one in five people over 65 and rises to two in five in those over 85 (Mental Health Foundation 2008). The use of exercise to combat depression is well supported due to its effects on enhancing mood, improving cognitive function and reducing anxiety; it is also less expensive than medication (Louch 2008). A literature review was conducted to examine whether exercise could be an effective form of treatment for older adults with depressive symptoms. Article 1 (Blake, Mo, Malik and Thomas 2008) conducted a systematic review of eleven randomized control trials in order to establish whether physical activity interventions were successful in alleviating depressive symptoms in older people. Trials were included in the review when more than 80% of the participants were greater than sixty years old. In nine of the eleven studies short term positive outcomes were found, although the mode, intensity and duration of the exercise program differed across the studies. The medium to long term effects of exercise as an intervention were less clear. This outcome is backed up by Mead et al (2008) who concluded that exercise seems to improve depressive symptoms in people with a diagnosis of depression, but the effects are moderate and not statistically significant. However a randomized controlled trial conducted by Blumenthal et al (1999) (Article 2) had reached different conclusions. One hundred and fifty six men and women aged over fifty were split into groups randomly to a program of aerobic exercise, antidepressants (sertraline hydrochloride) or combined exercise and medication. After sixteen weeks of treatment the patients did not differ significantly statistically either on Hamilton Rating Scale for Depression or Beck Depression Inventory scores. The study concluded that antidepressant medication had the most rapid effect, but after sixteen weeks exercise was equally effective in reducing symptoms of major depressive disorder. Article 3 (Brenes et al 1999) conducted a pilot study designed as a randomized clinical trial to test the feasibility and efficacy of an exercise program and antidepressant treatment compared with usual care in improving emotional and physical functioning in older adults with minor depression. A total of thirty seven participants aged over sixty five were randomized to treatment: fourteen to exercise, eleven to sertraline and twelve to usual care. Patients who received either exercise or sertraline treatments demonstrated improvement both in clinician led and self reported measures of depressive symptoms. Those participants who received the usual package care experienced small or no improvement in mental state. There are some limitations to this study however. The sample size was small and thus the statistical power was weak. The diagnosis of minor depression was based on self diagnosis rather than clinical interview. It was also not stated in the report what the usual care was. Ther e were however significant trends to suggest that sertraline and exercise could be used as treatments for mild depression in older adults, and that a more in depth study should be undertaken. Article 4 (Kerse et al 2010) published a study comparing the effects of a home based exercise program with regular social contact in improving function, quality of life and mood in older people with depressive symptoms. A randomized controlled trial was conducted in which one hundred and ninety three people aged over seventy five with depressive symptoms received either an individualized physical activity program or social visits delivered over six months. The social visits were of the same time span as the exercise program. Outcome measures were obtained at three, six and twelve months. Both physical and mental well being was measured using a variety of techniques including a short function test, and the Nottingham Extended Activities of Daily Living Scale (Nouri Lincoln 1987). It was concluded that a structured activity program improved mood and quality of life for older people with depressive symptoms as much as the effect of social visits. There was however no control group bein g measured that was receiving usual care. Article 5 (Mather et al 2002) set out to determine whether exercise is effective as an adjunct to antidepressant therapy in reducing depressive symptoms in older people. A randomized controlled trial was conducted in which eighty six participants aged between fifty three and ninety one already receiving anti depressant therapy were given either exercise classes or health education talks over a ten week period. Assessments were made blind at baseline, ten and thirty four weeks using the Hamilton Rating Scale for Depression as the primary outcome. At ten weeks a significantly higher proportion of the exercise group (55% compared with 33%) experienced a greater than 30% decline in depression. In an article in The British Journal of Psychiatry in 2002, Jagadheesan et al critiqued this study and stated that it could have been more meaningful if a control group had been added which received no additional treatment other than continuing antidepressants. (Jagadheesan et al 2002). The majority of research above suggests that physical exercise reduces depression and depressive symptoms in the short term in older adults, but additional well controlled studies are required to determine the long term efficacy. A systematic review carried out by Sjosten Kivela supports these findings (Sjosten Kivela 2002). Direct comparisons between studies is difficult as they differ greatly in characteristics, nature of control comparison group, age of the participants, type and intensity of exercise and outcome measures used to follow up. National Institute for Clinical Excellence guidelines are set out to assist clinicians and patients in making decisions about appropriate treatment for specific conditions. The guidelines for depression suggest that for particularly for patients with mild or moderate depressive disorders, structured and supervised exercise can be an effective intervention that has a clinically significant impact on depressive symptoms. There is also evidence to suggest that individuals with low mood may also benefit from structured and supervised exercise. (NICE 2005). Conclusion Physical exercise is clinically beneficial in the short term for treatment of depressive symptoms in older people. Exercise, although not appropriate for all older persons with depression, may improve mood in this group. Evidence of the cost effectiveness of providing exercise interventions would be beneficial in helping decision making regarding service use and delivery. More well designed research studies are needed to examine the medium and long term benefits of exercise as a treatment for depressive symptoms in older adults, and to examine the types and duration of interventions that have the most positive effect. Word Count 3008 References Age Concern (2007) Mental Health Services Letting Down Older People. [On Line] Available at http://www.ageuk.org.uk/ [Accessed 12 May 2010] London: Age Concern. Alexopoulos, G.S., Buckwalter, K., Olin, J., Martinez, R., Wainscott, C., Krishnan, K.R. (2002) Comorbidity of late-life depression: an opportunity for research in mechanisms and treatment. Biol Psychiatry 2002; 52:543-58. Blake, H., Mo, P., Malik, S., Thomas, S. (2009) How Effective are Physical Activity Interventions for Alleviating Depressive Symptoms in Older People? A Systematic Review Clinical Rehabilitation 2009; 23: 873-887 Blazer, D.G. (2003) Depression in late life: review and commentary. J Gerontol Med Sci 2003; 56A: 249-65. Blumenthal, J.A., Babyak, M.A., Moore, K.A., Craighead, E., Herman, S., Khatri, P., Waugh, R., Napolitano, M.A., Forman, L.M., Appelbaum, M., Doraiswamy, P.M., Krishnan, K.R., (1999) Effects of Exercise Training on Older patients with Major Depression Archives Of Internal Medicine Vol. 159 No.19, October 25, 1999 Brenes, G.A., Williamson, J.D., Messier, S.P., Rejeski, W.J., Pahor, M., Ip, E., Penninx, J.H. (2007) Treatment of Minor Depression in Older Adults: A Pilot Study Comparing Sertraline and Exercise Aging Mental Health, January 2007; 11(1): 61-68 Craig, J.V. (2002). How to ask the right question. In J.V. Craig R.L. Smyth (Eds.), Evidence-based practice manual for nurses (pp. 21-44). Philadelphia: Churchill Livingstone. Depression Today (2010) DSM IV [Online] Available at http://www.mental-health-today.com/dep/dsm.htm [Accessed 8 May 2010] Hamilton, M (1960) A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry. 23: 56-62 Harvard, L. (2007) How to conduct an effective and valid literature search. Nursing Times 103, (45), 32-33 Jagadheesan, K., Chakraborty, S., Sinha, V.K., Nizamie, S.H. (2002) Effects of Exercise on Depression in Old Age The British Journal of Psychiatry (2002) 181: 532 Kerse, N., Hayman, K.J., Moyes, S.A., Peri, K., Robinson, E., Dowell, A., Kolt, G.S., Elley, C.R., Hatcher, S., Kiata, E., Wiles, J., Keeling, S., Parsons, J., Arroll B., (2010) Home-Based Activity Program for Older People With Depressive Symptoms: DeLLITE A Randomized Controlled Trial Annals of Family Medicine 8:214-223 (2010) Louch, P. (2008) Depression in Primary Care [On Line] Available at http://www.depression-primarycare.co.uk/ [Accessed 14 May 2010] Mather, A.S., Rodriguez, C., McMurdo, M.E.T. (2002) Effects of Exercise on Depressive Symptoms in Older Adults with Poorly Responsive Depressive Disorder The British Journal of Psychiatry (2002) 180: 411-415 McKenna, H., Cutliffe, J., McKenna, P., (1999) Evidence-based practice: demolishing some myths. Nursing Standard. 14, 16, 39-42. Date of acceptance: November 15 1999. McMaster Clinical Epidemiology Group (1997) Evidence Based Practice Resources [On Line] Available at http://hsl.mcmaster.ca/resources/topic/eb/nurse.html [Accessed 20 May 2010] Mead, G.E., Morley, W., Campbell, P., Greig, C.A., McMurdo, M., Lawlor, D.A. (2008) Exercise for depression. Cochrane Database of Systematic Reviews 2008. Issue 4. Art. No. CD004366.   Melnyk, B. M., Fineout-Overholt, E. (2005). Evidence-based practice in nursing healthcare: A guide to best practice. Philadelphia, PA: Lippincott Williams Wilkins. Mental Health Foundation (2007) Depression and Suicide in Later Life [On Line] Available at http://www.mentalhealth.org.uk/information/mental-health-a-z/depression-and-suicide-in-later-life/?locale=en [Accessed 12 May 2010] London: Mental Health Foundation National Institute for Health and Clinical Excellence (2005) Depression: Management of depression in primary and secondary care National Institute for Health and Clinical Excellence National Institute for Clinical Excellence (2007) Developing Clinical Questions [Online] Available at: http://www.nice.org.uk/niceMedia/pdf/GuidelinesManualChapter5.pdf [Accessed 8 May 2010] NHS Choices (2010) Treating Depression [On Line] Available at http://www.nhs.uk/conditions/depression/pages/treatment.aspx [Accessed 16 May 2010] Nouri, F.M. Lincoln, N.B. (1987) An Extended Activities of Daily Living Index for stroke patients. Clinical Rehabilitation 1987; 1:301-5. Osborn, P.J., Fletcher, A.E., Smeeth, L., Stirling, S., Bulpitt, C., Nunes, M., Breeze, E., Edmond, S.W.Ng., Jones, D., Tulloch, A. (2003) Performance of a single screening question for depression in a representative sample of 13,670 people aged 75 and over in the UK: Results from the MRC trial of assessment and management of older people in the community. Family Practice; 20: 6, 682-684 Palsson, S., Ostling, S., Skoog, I. (2001) The incidence of first onset depression in a population followed from the age of 70 to 85.Psychol Med 2001; 31: 1159-68. Polit, D.F., Beck, C.T., and Hungler, B.P. (2001) Essentials of nursing research methods, appraisal and utilisation. (5th Ed.) Philadelphia; Lippincott. Sibbald, B. Roland, M. (1998) Understanding controlled trials: Why are randomised controlled trials important? BMJ 1998; 316:201 (17  January) Sjosten, N., Kivela, S.L., (2006) The effects of physical exercise on depressive symptoms among the aged: a systematic review. Int J Geriatr Psychiatry. 2006 May; 21(5):410-8 Teresi, J., Abrams, R., Holmes, D., Ramirez, M., Eimicke, J. (2001) Prevalence of depression and depression recognition in nursing homes. Soc Psychiatry Psychiatr Epidemiol 2001; 36: 613-29. Thames Valley University (2010a) Library Services Databases A-Z [Online] Available at: http://lrs.tvu.ac.uk/eresources/atozlist.jsp?id= [Accessed 2nd May 2010] Thames Valley University (2010b) Library Services Databases A-Z [Online] Available at: http://lrs.tvu.ac.uk/eresources/atozlist.jsp?id= [Accessed 2nd May 2010] Timmins, F. McCabe, C. (2005) How to conduct an effective literature search Nursing Standard November 23: vol 20 no 11 Appendix 1 Copies of Search Strategies

Loneliness in Steinbecks Of Mice and Men Essay -- essays research pap

How true is the statement "Guys like us are the loneliest guys in the world" Personally I believe that this statement is true in every aspect. Loneliness is a big part of the book "Of mice and men." The book shows loneliness in every ones life in the book. The quote says "Guys like us" George is talking about the ranch workers by saying "us" we know they are all lonely because they all show signs of loneliness, they try to fight this by making friends I think that in the book Steinbeck tries to show us that loneliness can be resolved by friendship. George blames Lennie for him being lonely ?I could get a girl, shoot some pool and stay at the cat house? George seems to be in denial as even if Lennie wasn?t there he wouldn?t be able to get all those things because of the depression 1929. Loneliness has made Crook's a very bitter and isolated man. He is truly not able to leave this situation because of his race. The other men at the ranch do not communicate with Crooks unless he is working because he is black. Other than when they are working, the other men ignore Crooks off all of their activities. Crooks is very isolated, and doesn?t seem to want any company. He has become bitter and known to lash out at people because of the loneliness that he has. Crooks's emotions are showed to the reader when he talks to Lennie in his room about having no one to relate to and communicate with. "Maybe you can see now. You got George. You know he's goin' to come back. S'pose you didn't have nobody. S'pose you couldn't go into the bunk house and play rummy `cuase you was black...A guy needs somebody--to be near him." Crooks has never been treated well by anyone because he is black. This has affected Crooks. Crooks's was shocked when... ..."I tried Aunt Clara, ma'am. I tried. I couldn't help it...I'll go right off in the hills an' I'll fin' a cave an' I'll live there so I won't be no more trouble to George." Lennie was basically in denial of his own loneliness. Loneliness has made Lennie want a better life for himself. This involves these soft items and the dream for his and George's farm. He believes at the farm he will not have to deal with all the problems that he has now. Lennie became unrealistic in many ways because of both his condition and his loneliness. Lennie most likely would have never got the farm or the soft items even if he wasn't killed, but his loneliness acts as motivation for these goals. In conclusion to this, yes I do think the statement ?Guys like us are the loneliest guys in the world? is true because loneliness is seen in all the ranch workers life?s, as I?ve just proved.

John Edwards Biography Essay -- Politics President Edwards Essays Pap

John Edwards' Biography Many Americans recognize John Edwards as the second coming of Jimmy Carter; the soft-spoken Democratic Senator from the south. They know him as the running mate of John Kerry in his 2004 Presidential campaign. But before the North Carolina Senator entertained aspirations of President or Vice-President of the United States, John Edwards made a name for himself as a successful trial lawyer, a strong husband and father, and charismatic politician. Born in Seneca, South Carolina on June 10th 1953, Johnny Reid Edwards was raised a Methodist and learned the values of hard work and perseverance from his father, Wallace and mother, Bobbie, while growing up in Robbins, North Carolina. Working alongside his father in the textile mill, John was taught that all Americans should be treated equally and that the voice of every man and woman in the United States should be heard. He grew up without the benefit of a private school education, something of which Edwards is, to this day, extremely proud. He was the first of his family to go to college. John attended North Carolina State University, where he graduated Magna Cum Laude in 1974 with a BS in textile technology, an impressive accomplishment by any standard. But given the values of hard work and perseverance learned by his parents, John Edwards did not quit his schooling after a BS from NC State. He continued on to the University of North Carolina (at Chapel Hill) where he graduated t heir law program Cum Laude in 1977. While attending law school at UNC, he met his wife, Elizabeth Anania, whom he married in 1977. John Edwards dedicated his professional life to helping those who couldn’t help themselves. Following his graduation from law school, John Edwards spent a year clerking for the office of Judge Franklin Dupree, Jr. of the United States District Court (Eastern District). In 1978, he accepted an associate position working for the firm of Dearborn and Ewing, where he practiced law for three years. He jumped ship to work for another firm, Tharrington, Smith and Hargrove, a position he held for two years before being promoted to partner at that firm. He continued as a partner at Tharrington, Smith and Hargrove until 1992, when he left to start his own law practice with fellow lawyer, David Kirby. Edwards and Kirby practiced together for five years, until Edwards decided to try his h... ...inly not out, having overcome before. He and his wife, Elizabeth, have struggled with the loss of a child, Wade (their eldest), in 1996 from a car accident. He was also survived by a younger sister, Cate, a recent Princeton grad. After Wade’s death, John and Elizabeth decided to conceive children again, giving birth to Emma Claire and Jack. And while the tragedy of losing a child cannot be confused with the misfortune of losing an election, the will, courage and perseverance to continue, necessary to overcome is present in John Edwards. It is unlikely that American voters have seen the last of the gentleman from North Carolina. I suspect we could see him again in 2008. But just in case we don’t, it can’t hurt to have a lawyer of his caliber working for the Democrats to amend the Constitution so that Bill Clinton can run again. Works Cited: http://www.johnedwards2004.com/john_edwards.asp http://www.vote-smart.org/bio.php?can_id=CNC68243 http://www2.gwu.edu/~action/2004/edwards/edwards.html http://www.cnn.com/2004/ALLPOLITICS/03/02/elec04.prez.main/index.html http://en.wikipedia.org/wiki/John_Edwards http://news.bbc.co.uk/1/hi/world/americas/3326255.stm

International Human Resource Management Essay

1.0 Executive Summary The world of international HR management (IHRM) is changing. As companies shift operations abroad, IHRM is moving beyond expatriate programs. Today’s IHR managers are charged with scaling and managing overseas HR operations. This shift has not only created new opportunities for IHRM professionals, but also for companies looking to staff operations abroad. Possibly one of the greatest challenges facing the IHRMs is the fact that they are now dealing with not an individual employee but a whole family and their needs as a family in the relocation process. Some IHRMs find it more difficult than others to adjust to the added dimension of having to deal with the spouse and family on a more intimate level than before. After all, they are now relocating them halfway around the world and away from their support structures. They have to be prepared to get a lot more involved in the family as a whole and not just think they have to communicate with the employee only as is often the case when dealing with an employee here at home base. Throughout this assignment, we are examined the implications of differences in national culture for policy and practice in of the following aspects of human resource management: * Performance appraisal * Training and development 2.0 Training and Development Important components of international human resources management include both cross-cultural training and a clear understanding of the overseas assignment as part of a manager’s development. 2.1 Training Cross-cultural training is necessary for expatriates managers and their families before, during and after foreign assignments. As different countries have different culture, regardless how close of those areas, such as Taiwan and Mainland China, USA and Canada. Maybe they are talking the same language, however, their perception of social values, business practices are different. In Western, especially in USA, people are more individualism. In the contrary, Eastern people, such as Chinese and Japanese, people are more collectivism. The social system also different in Western and Eastern, the former is low power distant and the later is higher power distant. When those expatriates arrive, they are foreigners, not the host population, it is necessary to provide much cultural and practical background. Language training is an essential activity for everyone in the family. Although English is the dominant business language worldwide, relying on English puts the expatriates at a disadvantage. The expatriate will be unable to read trade journals and newspapers, which contain useful business information, and will be reliant on translators, which at best only slow down discussions in the process. Evan if expatriates manager is not fluent, a willingness to try communicating in local language makes a good impression on the business community. Foreign language proficiency is also vital for family members to establish a social network and accomplish the everyday tasks of maintaining a household. But cross-cultural training is much more than just language training. It should provide an appreciation of the new culture, including details of its history and folklore, economy, politics, religion, social climate, and business practices. It is easy to recognize that religion is highly important in daily life in the Middle East, but knowledge of the region’s history and an understanding of the specific practices and beliefs is important to avoid inadvertently insulting business associates or social contacts. All this training can be carried out through a variety of techniques. Language skills are often provided through classes and tapes, while cultural training utilizes many different tools. Lectures, reading materials, videotapes, and movies are useful for background information, while cultural sensitivity is more often taught through role playing, simulations and meetings with former expatriates, as well as natives of the countries now living in the parent countries. While all this training in advance of the overseas relocation is important, cultural learning takes place during the assignment as well. After the overseas assignment has ended and the employee has returned, more training is required for the entire family. The employee also must adjust to organization changes, including the inevitable promotions, transfers, and resignations that have taken place during his or her absence. Teenager find reentry particularly difficult, as they are ignorant of the most recent jargon and the latest trends, but often are more sophisticated and mature than their local friends. The employee also must adjust to organizational changes, including the inevitable promotions, transfers and registrations that have taken place during his or her absence. Returnees are anxious to know where to fit in, or if they have been gone for so long that they no longer are on a career path. 2.2 Development In the current global business environment, the overseas assignment should be a vital component in the development of top-executives. It is not only to achieve the advantages for the individual in overseas assignment, but also an organization can gain the competitive advantages from their overseas employee. It is also a chance to provide the host counties employees to broaden their global perspective through a post in the parent-country headquarter, and may make it easier for the organization to recruit and retain better quality managers in the host country. Development is an essential activity to the individual to improve the individual’s ability during the assignment and to well perform their jobs. 3.0 Performance appraisal In evaluating employee performance in international environments, other factors come into plays. For instance, the cultural differences between the United States and England are not as great as those between the United Stated and China, for example. Thus, hostility or friendliness of the cultural environment in which one manager should be considered when appraising employee performance. 3.1 The responsibilities of the evaluation There are also issues to consider regarding who will be responsible for the evaluations: the host-country management or the parent country management. Although local management would generally consider a more accurate gauge, it typically evaluates expatriates from its own cultural perspectives and expectations, which may not reflect those of the parent company. For example, in some countries, a participatory style of management is acceptable, while in other countries, hierarchical values make it disgrace to ask employees for ideas (for e.g. in Japan). This could vastly alter a supervisor’s performance appraisal. Confusion may arise from the use of parent-country evaluation forms if they are misunderstood, either because the form has been improperly translated or not translated at all, or because the evaluator is uncertain what a particular question means. The home-office managements, on the other hand, is often so remote that it may not be fully informed on what is going on in an overseas office. Because they lack access and because one organization may have numerous foreign operations to evaluate, home-office managements often measure performance by quantitative indices, such as profits, market shares, or gross sales. However, simple numbers are often quite complex in their calculations and data are not always comparable. For example, if a company has many operations in Fast East Asia, it must be aware of the accounting practices in each country. Local import tariffs can also distort pricing schedules, which alter gross sales figures, another often compared statistic. Evan when the measurements are comparable, the comparison country will have an affect. For example, factory productivity levels in Vietnam may be below those of similar plants in Thailand. Depending on where the supervisor’s results are compared, different outcomes may occur. Such issues complicate parent country management performance evaluations by numerical criteria, or indices – and can add to the emotional levels in appraisals. 3.2 Evaluation Format Other issues surround the question of selecting the best format to use in performance appraisals, If we have an overseas operation that includes both parent country nationals and host country nationals, we must determine if we will use the same forms for all employee. While most Western countries accept the concept of performance evaluation, some cultures interpret it as a sign of distrust or even an insult to an employee. This complicates a decision to use one instrument like an adjective rating scale for all employees. On the other hand, using different formats for PCNs and HCNs may create a dual track in the subsidiary, in turn creating other problems. The evaluation form presents other problems. If there is universal form for the entire corporation, an organization must determine how it will be translated accurately into the native language of each country. English forms may not be readily understood by local supervisors. For example, clerical and office jobs do not always have identical requirements in all cultures. As a result, some U.S. multinational may be hesitant about evaluating HCNs and TCNs. In some countries, notably those that support the Communist ideology, all workers are rewarded only when the group performs – with punishment or discipline being highly limited. For example, in the hotel industry in the People’s Republic of China. Without the ability to reward good individual performance or to punish poor performance, there is little motivation to have any evaluation at all. Although the subject of international performance appraisal continues to receive research attention, two general recommendations have been suggested as follow: * Modify the normal performance criteria of the evaluation sheet for a particular position to fit the overseas position and site characteristics. Expatriates who have returned from a particular site or same country can provide useful input into revising criteria to reflect the possibilities and constraints of a given location. * Include a current expatriate’s insights as part of evaluation. This means that non-standardized criteria, which are difficult to measure, will be included, perhaps in different basis for each country. This creates some administrative difficulties at headquarters, but in long run will be a more equitable system. Â   Bibliography 1. Peter J. Dowling, Denice E. Welch and Randall S. Schuler, International Human Resource Management – Managing People in a Multinational Context, South Western College Publishing, 3rd Edition 2. Nancy J. Adler, International Dimensions of Organization Behavior, South Western College Publishing, 3rd Edition 3. David A. Decenzo, Stephen P. Robbins, Human Resourc Management, John Wiley & Sons Inc., 7th Edition. 4. Ian Breadwell and Len Holden, Human resource management – a contemporary approach, FT Prentice Hall, 3rd Edition