Interview With Special Education Teacher Essay

What she finds to be the most satisfying part of her job is when a parent is involved in their child’s education. This involvement and investment helps the student succeed. Unfortunately, there are many parents who don’t return calls or attend meetings, which really hinders the child’s ability to grow since they are not receiving the same support in the home as in the school. She also mentions how great of a staff she works with in her building. This ranges from speech therapy, hearing/ vision assistance, the counseling office, social workers, the career  center, reading services and numerous teachers. The staff has been meeting as a team for the entire ninth grade this school year because they have found that this class has many emotional needs. It is wonderful that there is a group of dedicated people who truly care for the students they work with. The most frustrating issue she and her team have faced this year is not only the common core curriculum and Annual Professional Performance Review (APPR) mandated by New York State, but also the lack of attendance of many of the students. The staff calls Child Protective. Services (CPS) or Persons In Need of Supervision (PINS) program and takes students to court, but there are no concrete threats. The students know that there is no real consequence for not attending school besides failing. Unfortunately, Niagara County does not take the parents to court as Erie County does. It is unfortunate not to be able to hold the parents accountable for their own child’s education and essentially their well-being. Her advice to those starting out in the education field is to be prepared to work hard for less pay than most other fields. However if it is your passion, love it and live it. The students are the pay, is what she said. There are students that truly appreciate the teacher and to see them enter ninth grade and grow to be successful twelfth graders makes her smile. She is still in contact with many of her students and some even ask her for help in college courses. Parents of past students remain in contact, also. It is nice to know that one person can make a difference in the lives of many students and families, alike. Her main advice would be enter the field and don’t get defeated by all the political issues. It will be hard work, but very rewarding work.

Course Project Part

While the initial investment in materials and equipment is steep, the output of this system rapidly accelerates to full potential and sots very little to maintain on an annual basis. The versatility of this system allows for the simultaneous production of a variety of sought after vegetables at reasonable cost and can reproduced In nearly any area of the united States. Project Description This project Is designed to develop a reproducible and self-sustaining aquaplanes system based on $100,000 Initial investor Input.A functioning model will be created to prove the viability of a self contained and symbiotic relationship that combines hydroponics vegetable production with aquaculture production. Hydroponics is the arming of vegetables using only water and loose fill media instead of soil. Aquaculture is the farming of fish in a controlled and sustainable environment. Putting these two systems together provides a source of nutrient rich water for growing plants and a natural filtration system, rich with oxygen, for growing fish.The combined system will be operated and monitored over a five year period to determine the total cost of production for a variety of leafy green vegetables as well as the price per pound of fish created over the same time period. The greatest price actor of getting food to local markets Is the fuel cost from the production location, through one or more levels of storage and packaging and lastly the trip to each point of sale. The system we propose to build would remove the fuel and transportation costs of a variety of vegetables that could easily be grown local to the market in which they are ultimately sold.Each certified organic occupations production facility could support the growth of several varieties of vegetables on a year round basis. This would allow local markets and restaurants the opportunity to provide locally grown organic produce and fish at reduced prices. Creating a system that is both self- sustaining and profitable is the key in the development of a solution that can be marketed. After the initial startup of a location, minimal financial input must be maintained while keeping the operational costs as low as possible to create a viable business model.

Marrige vs Cohabitation

Marriage vs. Cohabitation There are many people that say that getting married before living together is the best way to go. They have many negative things to say about living together also called cohabitation. Linda J Waite is one of this people, she has many negative things to say about cohabitation. She wrote an article called â€Å"The Negative effects of Cohabitation† where she states many down sides of cohabitation which I disagree upon. The three main things that I disagree upon are domestic violence, emotional wellbeing, and wealth.When it comes to hitting, shoving and throwing things, â€Å"cohabiting couples are more than three times more likely than the married to say things get that far out of hand she says in her article. Which I disagree it doesn’t matter if your married or not your partner will still hit you. ‘According to the American association for marriage and family therapy (AAMFT)† in almost 20% of all marriage, couples slap, shove, hit, or otherwise assault each other. Emotional abuse verbal threats, humiliation, or degrading remarks, and controlling behavior are more common.Once you’re married you have to obey your husband’s rules and if we don’t there will be consequences. Married couples are more likely to be in domestic violence in my opinion because they expect more from there couples. Since there married they have to listen and do more to keep the husband happy. â€Å"Marriage is, by design and agreement for the long run. Married people, thus see their relationships as much more stable as cohabiting couples do. † I also disagree with this saying that Linda j. Waite states in her article. The reason why I disagree is because there are many divorce rates now and days.If it was true what she says then there won’t be so many divorce rates. She says states that married couples are happier than cohabitating couples. She also states that children who are in cohabitating couples ar e less likely to succeed and this is a big lie in my opinion. For example, what about if we get married and then we live together, then we realize that the person who we once dated isn’t the person we actually married. Then we realize that we don’t want to be with leading to divorce. In the other hand cohabitation helps you learn the good and bad things about your partner before we ask the question.This can lead to a healthier lovable relationship prior to the one where we get married first then get to learn the good and bad things about our partner. As prior to her statement about the children, I disagree because I have many friends that live with cohabitating families their parents are married. They still go to school and they are being successful. We can’t blame cohabitation to someone being unsuccessful. In fact many children with married families become unsuccessful do to their parent’s divorce. Married couples link their fates-including their financ es. Linda j .Waite states that married couples benefit more in income if there married which I disagree. In fact, cohabitation offers similar benefits to marriage without the potential pain of divorce. â€Å"If you're just living together and if one of you decides they want to leave†¦ † said one participant, â€Å"you can leave and it will just be OK †¦ whereas if you're married you've got to go through lawyers and attorneys, and depending on the type of situation it is it can be an ugly divorce. † So no if were married we do benefit more in wealth it will be the same benefit because couples actually decide to do cohabitation to share expenses . ttp://www. theatlantic. com/health/archive/2012/02/the-marriage-problem-why-many-are-choosing-cohabitation-instead/252505/ People get married because they’re afraid of being lonely for the rest of their lives. There not realizing that by rushing into marriage that they can end up having a divorced life. When yo u live in cohabitation you have the liberty to leave when you want no broken vows. So do we rather want to have a divorced life or be happy that’s the question to ask ourselves before getting married? http://www. gwu. edu/~ccps/rcq/rcq_negativeeffects_waite. html

Act and Rule Utilitarianism Essay Example | Topics and Well Written Essays - 250 words

Act and Rule Utilitarianism - Essay Example Act utilitarianism focuses on the specific act that will bring that good in the end. However, according to the rule utilitarian, this is improbable or even impossible. This begs the question: How does one determine if an act will produce a specific good This is where rule utilitarianism comes into the picture. One first determines what are the rules that if generally followed will produce the best results. The rule utilitarian does not focus on finding the specific act that will produce the best results since any act in accordance to that rule will produce a good.Thus, rule utilitarianism is more acceptable. An act in accordance with rule utilitarianism may or may not appeal to the act utilitarian, but this is better than trying in vain to find out what is that specific act the act utilitarian will accept.Whichever form one may choose, both cannot escape the criticisms against utilitarianism that one may lie, steal, or kill just to enact that which is good. In other words, the end ju stifies the means.

Event Handling And Web Forms Essay Example | Topics and Well Written Essays - 750 words

Event Handling And Web Forms - Essay Example Since their inception in the early 1990's, Web forms have become the essential interface of the transactional Web. They are a central component of e-commerce applications and are used to collect business-critical information. It has also been said that Web forms are changing the paradigm of Business workflows. Do you agree with this? Discuss this in the relation of Business workflows and data collection at various points of these workflows. Any company that is engaged in e-commerce has to deal with information at three stages – ordering of a product, processing of that order and shipping the product to the customer. Different information needs to be available at these three points and also needs to be transferred from one point to another. Web forms are one of the most exciting innovations of modern times. They allow the business to interact directly with clients, prospective customers and even the employees of the organization. With the advent of web forms, business workflows of organizations have changed drastically. The first effect of web forms has been the creation of a platform-independent environment for e-commerce. Business workflows are basically concerned about collecting of information which might be unstructured and then moving this information in a structured format to the back end where it can be used for information processing. Until the advent of web forms, structured data was the purview of database applications and the unstructured information was collected through different tools.

Democratic or Undemocratic Essay Example | Topics and Well Written Essays - 500 words

Democratic or Undemocratic - Essay Example Congress and as well get a better idea as to what takes place within the Congress as well. This is what will be dissertated in the following. Basically the United States has three different branches of government, which are: legislative, executive, and judicial. Each of these different branches has its own features and works in its own separate way. Laws are able to evolve from the action of each branch however, and a legislative history will basically and generally trace its bill from its introduction into Congress through the legislative process. The conference committee is a committee of Congress which is considered as being incredibly major in the process of a bill being passed; the committee is appointed by the House of Representatives and Senate to resolve any disagreements on any particular bill. The first thing that happens when a bill is going to be passed has to do with these conference committees, and they only operate "after the House and the Senate have both passed different versions of a bill. Bills must be printed. Conference committees exist to negotiate a compromise bill that both houses can accept." (45) . Then, both houses of Congress must end up eventually passing the identical legislation in order for the bill to become a law, thus proving their extreme importance in this process overall.

Study Design and Data Collection Strategies Research Paper

Study Design and Data Collection Strategies - Research Paper Example The software and hardware will be used to amalgamate the data that will be drawn from land cover maps, and topographic contour maps. It is assumed that, the database will be effective for integrating data generated internally, and which includes plans for habitat restoration and locations of the habitats. DATA REQUIREMENTS Description Enough of the required data is needed for the development of accurate and comprehensive database of a conservatory. The software to be used will be appropriate for reading topographic contour maps. They will be developed in a way that will make distinguishing of the contour lines easier. This will facilitate connection and determination of points with equal elevation within the required region in the conservatory. By so doing, the management of the conservatory will manage to follow the movement of the endangered species along the contours and, therefore, come up with strategies of protecting them. The software will be remarkably effective in developing the database to be used in recording and handling of the wildlife capacity like for example, bird flocks. The wardens will find it easy to follow and locate the habitats making the management of the threatened species unproblematic. Source: Ronca, (2011) Land cover maps will also be developed after the establishment of the database. Land cover maps are used in an array of spatial resolutions and data formats which suit the users appropriately. They allow for the use of detailed data which can be provided as vector products of at least 0.5 Hectare Map units. Source: Land cover map, 2012 The database with the help of software and hardware will provide data from an approximated distance of one kilometer radius within the conservatory. For geo referencing, LCM 2007, LCM 2000 AND LCM 1990 are used in digital land cover maps. Sources of data The data required for running the database will be received digitally from the satellites located in different areas within the conservatory. The si gnals will be received in the station, and then the information will be converted into data that can be used in the database. The satellites will scan the conservatory and then relay images and pictures to the station to facilitate in the management. This will be achieved through the use of NASA Tera satellites which provide refined global pictures to give a clear view of the land patterns and distribution of ecosystems. They help in providing the best quality land cover maps which enables the policy makers and scientists in charge of natural resources do researches well and monitor objects effectively (Przyborski, 2011). NASA Tera satellites provide more detailed and clear pictures of a place based on digital database of images. They also use MODIS sensor’s vintage, which facilitates collection, of high quality data and also merging of multiple looks into a single image. The MODIS land cover maps have different cover types which includes natural vegetations like wetlands, sa vannas, evergreen forests and deciduous. The cost of NASA Tera satellites is estimated to be $ 424,000. It will be extremely effective in monitoring the movement of the endangered within the conservatory. The satellites provide refined pictures and, therefore, the personnel in charge of the ecosystem will monitor the wildlife successfully (Przyborski, 2011). Data acquisition Ensuring that the required peripheral or hardware is available will

Matching Objectives to Instruction Essay Example | Topics and Well Written Essays - 250 words

Matching Objectives to Instruction - Essay Example For students to learn and remember a concept, they need to see multiple examples.They also need to gain generalization knowledge, and apply the concept via application activity, which is very close to the real world. The lecture and test approach requires students to memorize facts as the main objective (Beirne and Velsor, 2012). The strategy helps the instructor to evaluate the students’ understanding of the lesson content. It fits well in administering history classes and other classes that do not require other activities apart from memorizing facts. If the lecture objective is to make the learners to apply lecture content, then the teacher has several activities to do (Rawlins and Metzger, 2014). After presenting the facts through reading and lecturing, the instructor must show the learners how to make knowledge generalizations from background knowledge. The background knowledge presents itself from discussions, study problems or assignments and provides the students with opportunities to apply the learned principles in papers, laboratory experiments, case studies, examinations and small group projects. The application of the strategy is in teaching mathematics, sciences and other associated subjects that require content

Chp 24 dis Essay Example | Topics and Well Written Essays - 250 words

Chp 24 dis - Essay Example or and the promisee), the amount of consideration (money) to be paid, terms of payment (include date of payment or how the payment is to be made) and in case of interest, then it is also indicated in the note. The above are the conditions and instructions present in a promissory note and after it is signed, it is considered legally binding (Miller and Jentz, 394). In the above mentioned case, even though the defendants were acting only as agents of the real promisor who is Sunshine Sales Corp., the promissory note that they signed did not indicate that and hence they are the once considered to be the promisor in this situation. The defendants indicate that a bank officer promised to type the name but they have no witnesses or evidence of such a conversation and hence it cannot hold water in a court of law. They are therefore liable on the notes and all the evidence from the promissory notes states that. If only they had indicated the name of Sunshine Sales Corp. or they had waited until the name was indicated by the bank officer, then they would not be liable as they are

Cargo Cult Essay Example | Topics and Well Written Essays - 1250 words

Cargo Cult - Essay Example Even though cargo cults continue to be discovered, they ceased to exist as a phenomena â€Å"as soon as anthropologists figured out how to explain† it (Dalton 2000:345), however, they can be seen as a successful (in certain aspects) revitalization movement for the indigenous population, who often needed to vent out their frustration with the new way of life under the colonizers. Cargo cults, as the specific millenarian movements in the Melanesian region are called, were not studied very closely before the twentieth century; after F. E. Williams published The Vailala Madness and the Destruction of Native Ceremonies in the Gulf District in 1923, interest as well as publication on them have increased (Long 1974:403). Usually, a cargo cult is formed when some member of the tribe has a dream (a myth-dream) whereby the rest of the tribe is instructed to follow certain orders, which can include touching things or ritualistic destruction objects, or not going to their garden to work, or dance around open altars (Stephen 1997:1) or even baptism and insistence on giving up local culture in favor of the European (Long 1974:410); what is more, as Worsley notes, there is also the â€Å"cultivation of large gardens and the building of stores, sheds, jetties and landing-grounds for the reception of good which will never come† (Dalton 2000:358). According to the native rituals and social norms of the Melanesians, anyone who could give a lot of material gifts to others was automatically someone to be respected and looked up to. With the arrival of colonials, who brought with them many material products, the natives saw their material wealth and automatically assumed that the colonizers were respectable people. As, on the converse side, the person who could take gifts but could not give anything comparable in return was frowned upon according to the same norms, therefore, the Melanesian, based on their own cultural norms, lost respect in their own eyes. The product s that the colonials brought with them were things that the natives wanted, but which the natives, in their lack of exposure to technology, had no idea how to produce even though they had been seeing them delivered to piers and landing strips. Certain cargo cults were formed, whereby certain mythological stories were exchanged to make sense of just why nothing that arrived was for them but for the colonizers. As per this explanation, the ancestors of the natives were busy making things for their descendants, both within the volcanoes that the locals worshipped, and living amongst the lands of the colonizers, disguised as white men. These ancestors were sending all the cargo that they had accumulated and manufactured to the locals, however, the white colonizers, entrusted with the transport of the cargo, were robbing the natives by changing the labels of the cargo to steal it and claim it as their own (Long 1974: 409). It can be argued that the irrational rituals were created in a bi d to get the wealth of the colonials (Lindstorm 2000:296). Clearly, this shows a sense of resentment on the part of the natives who felt not only threatened by the colonization but also used and abused. As Burridge puts it, the natives have their own rituals and ways for proving â€Å"their integrity as men. But faced with a white man, the moment passes them by. They feel themselves children of sin†

African American Essay Essay Example for Free

African American Essay Essay My name is Michelle Williams-Agwagu and my ethnicity group is African American. African Americans came here by forced immigration. They were not invited here to America, and they certainly did not come here by choice. They were forced and taken on ships that brought them to America just to become slaves to the white people. Upon arrival to America, African Americans were treated poorly. Many of them were torn apart from their family members and some were infants that had no knowledge of whom they were as they became older. The group faced many challenges such as prejudice, segregation, and racism. A set of codes were implemented that all African Americans had to adhere to, or they would be punished by either getting beat by their master or possibly killed. African Americans were not allowed to have any education; therefore, no one was allowed to learn to read or write. The slave owners made sure of that and if any slave did learn to read or write, he or she would be punished by their owner. They were separated from the other people because of the color of their skin and was not allowed to eat, play, drink or have any interaction with the masters or the master’s family members unless it was to do household chores as their servant. They did not have many opinions when it came to making decisions. Unfortunately, African Americans were affected by dual labor market and red lining. In the early stages of African American emancipation, not many of them had education or access to quality higher education. Even if they had this education, they were forced into the lower labor market and regardless of the quality of their education they would start in much lower positions than that of their white counterparts. African Americans were affected by this because they were not given any meaningful jobs with any type of significant pay structure and benefits. The jobs were more short-term than long-term. Red lining is a reality in African American communities across the United States. Red lining is a practice which discriminates against Blacks of all economic sectors when they apply for home and business loans and consumer credit. Blacks, more than any other racial or ethnic group (with the possible exception of Native Americans), receive less credit. Through all the bad treatment that African Americans received from â€Å"white† Americans, they (AA) still participated in reverse discrimination. Reverse discrimination is still a problem here in the United States because it is racism; and racism is racism, no matter how we try to spin it. â€Å"Society classes an African American discriminating against a Caucasian as reverse discrimination because for most of American history, it was the African Americans who were persecuted for something that they could not control their ethnicity. † (Libra, n. d. ) African Americans have also been affected by the glass ceilings form of discrimination, and that is still an ongoing problem also. â€Å"The glass ceiling refers to the barriers that often confront Ethnic Americans and women in trying to reach the upper ladders of corporate America. African Americans do not earn the same pay for comparable positions† (The Glass Ceiling for African, Hispanic (Latino), and Asian Americans, 2008. ) as that of their white counterparts in the same job. Environmental justice issues have plagued African Americans in the past and continue to do so today. In the past century, factories emitting toxic fumes and hazardous waste were positioned near large African American sections of major cities as well as small towns inhabited by mostly African Americans. Today, in areas of Louisiana along the Mississippi River known as â€Å"Cancer Alley†, petroleum and chemical manufacturing plans spew fumes and release carcinogenic chemicals near the water supplies of African Americans. There has long been controversy over this modern issue however no other ethnic or racial group has the desire to have these companies relocate factories near their living areas. African Americans have participated in affirmative action since the very beginning, in fact, affirmative action was implemented in the United States largely for the benefit of this group. Affirmative action makes a valiant attempt to make up for past and current discrimination against a certain group and makes jobs and opportunities that members of this group would not have access to ordinarily. Some African Americans agree with Affirmative Action, while some others disagree with it because they perceive it to be a handout and not being able to get jobs or opportunities on one’s own merit. We, as African Americans have and still face many forms of discrimination. Will it ever end, I do not think so. There have been attempts to close the gap and bring us into that circle of equality but I do not see that ever happening in its entirety, all though we know that all men are â€Å"supposedly† created equal. I culturally identify more with African Americans because it is who I am. However, it is evident that racism with any prefix is a problem in America it is a problem in the entire world, and I hope people will start accepting people as people rather than accepting that they must hate people because of the color of their skin. Reference Page Libra, Themis. (n. d. ). Is reverse discrimination a problem in the United States?. Helium The Glass Ceiling for African, Hispanic (Latino), and Asian Americans (2008). Ethnic Majority.

Student Essay Example for Free

Student Essay Diversity  refers to the differences between individuals. People differ on all kinds of aspects, both visible and non-visible. Examples of differences are gender, age, skills, tenure, learning styles etc. We find these differences in every workplace, though not all differences are always recognised or seen as relevant. Unity in diversity Unity in diversity  is a concept of unity without uniformity and diversity without fragmentation  that shifts focus from unity based on a mere tolerance of physical, cultural, linguistic, social, religious, political, ideological and/or  psychological  differences towards a more complex unity based on an understanding that difference enriches human interactions. The concept of unity in diversity was used in non-Western cultures such as indigenous peoples in North America and Taoist societies in 400-500 B. C. In premodern Western culture it has been implicit in the organic conceptions of the universe that have been manifest since the ancient Greek and Roman civilizations through medieval Europe and into the Romantic era. Diversity of religion in India Throughout Indias history,There had been many religions which  religion  has been an important part of the countrys culture. Religious diversity andreligious tolerance  are both established in the country by the  law  and  custom. A vast majority of Indians, (over 93%), associate themselves with a religion. According to the 2001 census,[1]  80. 5% of the  population of India  practice  Hinduism. Islam  (13.4%),  Christianity  (2. 3%),  Sikhism  (1. 9%),  Buddhism(0. 8%) and  Jainism  (0. 4%) are the other minor religions followed by the people of India. Languages of India The  Languages of India  belong to several  language families, the major ones being the  Indo-Aryan languages  (a subbranch of Indo-European) spoken by 74% of Indians and the  Dravidian languages  spoken by 23% of Indians. Other languages spoken in India belong to the  Austroasiatic,  Tibeto-Burman, and a few minor language families and  isolates. The official language of the Central Government of  Republic of India  is  Standard Hindi, while  English  is the secondary official language. Cuiture of India Indian cultural history spans more than 4,500 years. During the  Vedic period  (c. 1700–500 BCE), the foundations of  Hindu philosophy,  mythology, and  literature  were laid, and many beliefs and practices which still exist today, such as  dharma,  karma,  yoga, and  mok? a, were established. India is notable for its  religious diversity, with Hinduism, Sikhism, Islam, Christianity, and Jainism among the nations major religions. The predominant religion, Hinduism, has been shaped by various historical schools of thought, including those of the  Upanishads,  the  Yoga Sutras, the  Bhaktimovement,  and by  Buddhist philosophy. Indias  languages,  religions,  dance,  music,  architecture,  food, and customs differ from place to place within the country. The Indian culture, often labelled as an amalgamation of several cultures, spans across the  Indian subcontinent  and includes traditions that are several millennia old. Many elements of Indias diverse cultures, such as  Indian religions,  yoga, and Indian cuisine, have had a profound impact across the world. Difference between Andhra Pradesh and Tamil Nadu Andhra Pradesh and Tamil Nadu are two south Indian states. Both are located in the peninsular Deccan plateau, bounded by the Bay of Bengal to the east. Andhra is India’s fourth largest state by area and has the second longest coastline amongst all of the Indian states. AP’s capital is Hyderabad and the official language is Telugu. Tamil Nadu is the southernmost part of Indian peninsula and is the eleventh largest state by area. Since 500 BC it has been the home of the Tamil people with Chennai (Madras) is its capital city. TN is the most urbanized state in India and claims eight UNESCO World Heritage Sites. Economy In comparison to its share of population, Tamil Nadu has the highest number of enterprises in India and is the fifth largest contributor to India’s Gross Domestic Product. It is responsible for the third largest Indian economy in 2008 and is also the most industrialized state in India. TN holds third position on the list of states with the most Foreign Direct Investment (FDI) approvals and has a network of over 100 industrial parks. Andhra Pradesh is called the rice bowl of India and agriculture is its main source of income, however, it is rapidly growing in the fields of Information Technology and biotechnology. In terms of mineral wealth, Andhra Pradesh holds second position and accounts for one third of the total limestone reserves in the country. Tourism Tamil Nadu has the second largest tourism industry in India and it is growing at a rapid rate of around 16%. It is controlled by TTDC- Tamil Nadu Tourism Development Corporation. TTDC promotes tourism with a tagline  Enchanting Tamil Nadu. Botanical gardens in Ooty and Hogenakal Waterfall on Kaveri River are quite famous. Andhra Pradesh is famous for its religious sites and pilgrimages. Triumala Venkateswara Temple, Birla Mandir, Buddha Statue on Hussain Sagar Lake and Ramappa Temple are some of its most famous tourist spots. castes THE FOUR CASTES OR JATIs in Hinduism are Brahman Kshatriya Vaishya Shudra Favourite Indian Cuisine, Popular Foods of the People #1: Andhra Pradesh  You will love Andhra Pradesh especially if you like spices and chillies. This food is consumed in regions where most people are vegetarians. They had to invent delicious foods to be able to cope with their self imposed condition. eg- Hyderabadi Biryani, Mirchi salan, Ghongura pickle, Korikoora. #2: Goa  Goan cuisine comes from the region of Goa. The actual region is located on the Arabian Sea coast. Its main influences are Hindu, Portuguese and certain contemporary techniques. The cuisine is intensely sea food based. The Kingfish is the symbol of the Goan cuisine.

Sound Technique In Citizen Kane Film Studies Essay

Sound Technique In Citizen Kane Film Studies Essay The dramatic film Citizen Kane in 1941 is a story of group of reporters that are trying to interpret the last words of Charles Foster Kane (Orson Welles), who is the millionaire newspaper business man, Rosebud and to examine his lifestyle. The film starts with a news roll detailing Kanes life, and after that the film shows the audience flashbacks from his life and illustrates to the audience of a man who had everything and anything he wanted to a man who died and had nothing. The newsreel reporter Jerry Thompson (William Alland) starts to investigate the people from Kane past such as friends, lovers and colleagues to identify the real meaning of Rosebud. The first scene in the movie when Kane is dying and holding the crystal glass globe in his hand then he whispered a word that is heard spoken by enormous, mouth that fill the screen ROSEBUD. When he said it, no one could hear him because he said it in a low tone; however, only the butler heard it. The sound of Kane saying it and all the noise and silence before he dies illustrates to the audience that the word is something important in the movie and makes them think about the mystery of the movie. After he has pronounced his last dying words, the crystal glass globe rolls from his hand; the ball jumps down two steps (stairs) and smashes into pieces. The audience hears a loud beat when the crystal glass globe shatters into tiny pieces the sound of the shattering globe indicates that the Kane is heartbroken. Through the unclear lens of the globe a nurse is seen entering the room. She lays out the body of Kanes dead body and the music that has been suspended in a minor key finishes on a main musical tones. (Spurr Cameron, 2009). Then the scene cuts suddenly to news announcement, full of loud music that makes the audience forget about the previous scene. However, Rosebud was repeated in more than one scene that was presented in different type of flutes, bass clarinets, and bassoons to create a sense of darkness, vagueness and mystery to the audience. Moreover, a scene that started when the camera pans from top to bottom while focuses on the statue. The audience hears Miss Andersons voice heard before she appears in the shot. The feature of her voice is ordinary sound qualities of the room. The size of the room is shown to the audience when both Miss Anderson and Mr. Thompson the reporter are in the same frame. This scene shows the audience the importance of the large cold stone pillared library room that matches the cold strict character of Miss Anderson. Also the sound of Miss Andersons footsteps, as she walks towards the room to give Mr. Thompson the document he needs about Kane. When Miss Anderson opens the door to the room, the sound of the door that the audience hears which shows them the size of the room and the importance of the room. After the conversation between Mr. Thompson and Miss Anderson, and Miss Anderson leaving the room the audience could hear the closing of the door with music. The sound of the door mixed with music is a transition to the next shot. A next scene shows the audience when Susan Alexander Kane (Dorothy Comingore), who is the Wife of Charles Kane, sitting in her club after the death of her husband and Thompson comes in to talk with her. Thompson sits down, and then Susan tells him who told you, you could sit down? and he replies, I thought maybe we could have a talk together. Then she replies, Well, think again. Why dont you people leave me alone? I am minding my own business. You mind yours. Get out of here. Get out! .When she was saying get out she was shouting with a high tone which illustrated to the audience she is mad and upset. Before he comes in the club the audiences hears heavy rain and thunder this also demonstrates to the audience the anger, tension, and sadness. Also another scene, the audience saw that Kane had grown up from a child into an adult in only two shots. As Charless guardian gives him his sled, and Charles wishing him a Merry Christmas and unexpectedly the audience sees another shot of his guardian after almost fifteen years later, and the phrase is completed and a Happy New Year. This showed the audience that he has grown up, and it showed only by continuing the soundtrack. Another scene, when Kane takes his wife Susan to go to a picnic and suddenly slaps her in a tent near the beach. They are both silently angry at each other while a lady near their tent wildly launching with a loud voice at the background. This illustrated to the audience the misery and sadness of both Kane and Susan. In addition, the director used a numerous number of voices, each saying a sentence or a phrase or sometimes half a sentence and joining the dialogue in an immediate sequence, this action gave the audience an impression that the whole town was talking and also knowing what the whole town was talking about. The director also use the over lapping dialogue which made the scene look more realistic to the audience. Moreover, the director used a technique of putting the sound and audio before of the visual in scene transaction. In other words, when a scene came to a close, the sound and audio would change to the next scene before the image did. Moreover, the opera rehearsal scene where Kanes wife Susan sings; for example, when the camera slowly pans up the walls of the opera hall from Susan beginning her singing presentation to two stagehands both were looking shocked and disgusted of Susans singing. According to Louis Giannetti in Understanding Movies, music is a greatly abstract art, tending toward pure form. When combined with lyrics, music acquires a more focus content because words have specific references. While words and music both express meanings, each does so in a special manner. With or without lyrics, music can be more specific when put together with film images. (Giannetti, 2010). Moreover, according to Understanding Movies, one of the most continuing and popular film genres is the musical whose major raison is song and dance. Like opera and ballet, the narrative elements of musical are usually pretexts for the production numbers, but some musicals are exceptionally sophisticated dramatically. (Giannetti, 2010) The films numerous use of mixture allows to create stability between the images and passing of time that would otherwise seem disjointed and disorganized. In a scene that is illustrating Charless hectic actions as a newspaperman, suddenly a scene where it shows people dancing and singing with music in the background after that the scene shifts to another scene and time passes. Also, another scene where Kane and his first wife Emily (Ruth Warrick) are having breakfast, the scene here is presented in an elegant way where both are dressed fancily, and exchanging loving words, then the words dies away out after seconds. This scene showed the audience of the timing passing. Moreover, in another scene when Emily is disagreeing with Charles over the suitability of hanging an anonymous gift one of his friends has given their son in the nursery. The music in the background demonstrates to the audience that there is something wrong while still maintaining a distressingly joyful attitude, and Kanes rejection into taking his wife Emily seriously while they are having breakfast. The Sound Technique that is Connected to Another Technique Citizen Kane is an excellent example of sounds but it is also connected to different techniques, such as movements and cinematography technique. For example, in Citizen Kane extreme deep focus, diverse camera angles (including low angles that exposed set ceiling) and unusual use of lighting and deep shadows all these techniques were used in the film. Moreover, Citizen Kane had a storytelling technique; changeable narrative forms such as the opening of the film when a newsreel man was talking, and then the interviews and the flashbacks. Sounds in General The music of movies in general has a powerful effect on the audience. The music of any movie is to evoke or enhance emotions in the audience. When audiences listen to music a certain emotional feeling the music awakens the memories that the audience faces in the present or past. Moreover, music is able to move through time and leave at two different points at once. Music helps to enhance the effect of a shot to the audiences. Also, music creates tension in a movie. Citizen Kanes music was considered one of the major things in the movie because the music had an important role when the scene changes from one to another and to develop the emotion and the mood of the film to the audience. The director sometimes used music that would work with the sound effects throughout the film. According to the book Understanding Movies, sound effects also express internal emotions. When there is silence in a film it makes the audience pay more attention to the scene. Any important silences in a film creates to the audience a sense of something approaching or something that is about to happen. Moreover, like the freeze frame, silence in a sound film can be used to represent death, because usually sounds are linked with the presence of continuing life. (Giannetti, 2010). In addition, according to Louis Giannetti, loud sounds tend be forceful, intense, and threatening. On the other hand, quiet sounds strike the audience as delicate, hesitant, and sometimes weak. (Giannetti, 2010) Conclusion In other words, music in films is highly effective to the audience. Music creates tension, brings out emotions, and is definitely one of the most vital aspects of the cinematic experience. Furthermore, it has shown that music is highly complex and artful; it does not only bring the emotional impact on audience by also comprising some of the most dazzling music produced over the year. (Donnelly, 2001). Moreover, sounds help the audience to understand the movie better and also emphases on the vital parts in the movie.

Loyalty to ones king Essay example -- Poetry Poem essays research pape

â€Å"As soon as the Cid caught sight of the King he ordered all his men to halt†¦He knelt down on his hands and knees on the ground and with his teeth he pulled up a mouthful of grass. With tears of joy streaming from his eyes he showed in this way his complete submission to his liege lord, Alfonso.† What would cause a grown man to act in such a manner? The Cid was the ruler of Valencia, and the leader of thousands of soldiers. The Cid has defeated countless enemies and have been victorious in all his wars, he could have been almost thought of as a man without fear. Yet, as soon as he caught sight of the King who has exiled him from his land, he broke down and acted like an animal in front of the King. The ‘loyalty’ and ‘respect’ the Cid has for King Alfonso is the deepest between any characters in the entire poem. Although loyalty and respect is the deepest between the Cid and King Alfonso, there is also a great amount of loyalty and respect a mong different characters also. Such as the Cid and his loyal vassal Minaya, the Cid to his wife Don Jimena, his two daughters Dona Elvira and Dona Sol, and the Cid to his army. Loyalty and respect are very important themes that progresses stronger and stronger throughout the poem, loyalty can do good and bad to loved ones, but in this poem, it eventually led to conflicts with severe consequences.   Ã‚  Ã‚  Ã‚  Ã‚  The Cid stayed loyal to King Alfonso throughout the entire poem. Never once did the Cid say anything bad or offensive towards the King. Although King Alfonso ostracized the Cid from his land, the Cid still respected the King and stayed loyal to him. The Cid was framed by Count Garcia Ordonez, Ordonez accused the Cid of greed. Ordonez told the King that the Cid kept money from him, which upset the King and eventually led to the Cid being exiled from the land. After being exiled, the Cid left the land with a small army and conquered numerous enemies and land.   Ã‚  Ã‚  Ã‚  Ã‚  Even though King Alfonso was the one who sent the Cid away, the Cid tried to regain the position he once had in King Alfonso’s heart. In trying to do so, the Cid sent â€Å"thirty horses, all saddled and bridled, with swords hanging from their saddlebows.† King Alfonso was pleasantly surprised by such an action. This again proves the amount of loyalty and respect the Cid has for King Alfonso. Not only does he still remain loyal to the King, he even sends a great porti... ...uno Gustioz will fight in the Cid’s honor against the Infantes of Carrion: Fernando, Ansur, and Diego Gonzalez. The Cid’s three knights volunteered themselves for the battle and were not picked by the Cid. This shows the amount of loyalty and respect the Cid’s knights has for the Cid. The Cid’s knights were proud to defend their lord’s honor. All three of the Cid’s knights were victorious in all of their duels, and brought honor to the Cid and his family.   Ã‚  Ã‚  Ã‚  Ã‚  Loyalty and respect is a continuing theme in the poem. As the poem progresses, the theme of loyalty and respect evidently grows stronger and stronger. The Cid would not be a successful leader if he did not display such loyalty and respect to his troops. The Cid remained loyal to his king and his troops which paid off. By remaining loyal and fighting alongside his troops, he has gained loyalty back from his troops. The Cid led by example. Loyalty and respect is most evident between King Alfonso and the Cid, there are also strong signs of loyalty between Cid’s family and his vassals. Throughout the poem, Loyalty and respect proved to be good in many ways, but it can also cause harm to your loved ones if it is blind loyalty.

Seven Brides for Seven Brothers :: essays research papers

  Ã‚  Ã‚  Ã‚  Ã‚  A lovable, heartwarming story of love is one of â€Å" Seven Brides for Seven Brothers†. A story of seven men who have no guidance find themselves in love. The two main characters in the play are Adam and Millie. By being husband and wife they help the story out with their own love and romance. The seven brothers fall in love with seven beautiful woman and through out the play we see al the ways they try to get their gals. The singing in this play helps us figure out the songs: â€Å"Bless Your Beautiful Hide†, â€Å"Goin Courtin†, and â€Å"Sobbin Woman†. The style of music they use to get this point across is old fashion, traditional music.   Ã‚  Ã‚  Ã‚  Ã‚  This live performance of â€Å"Bless Your Beautiful Hide† by Adam is a confident and arrogant way to find love. In this song Adam explains how he is here to find himself a wife. That’s just what Adam does too. By hearing this song the viewer gets the hint that the play is a love story about him and this beautiful lady that he is staring at. Adam uses his bass voice to keep the tempo moderately constant. The dynamics change throughout the song with a grand finish of a chershendo. Adam uses accents in the song to emphasize his feelings of getting a wife. An orchestra is accompanying him with the instruments like: trumpets, banjos, and trombones. This sets the mood for the story to take place.   Ã‚  Ã‚  Ã‚  Ã‚  Ã¢â‚¬Å"Goin Courtin† has a different kind of tempo to it than does â€Å"Bless Your Beautiful A Hide†. The tempo in this song is a little faster than the other song. Millie is explaining to the brothers how to get a girl. How to get a girl in nice, gentleman way. Millie uses tone color in this song to make the mood very happy and exciting. Millie uses a slow calm voice to get the instructions across to the boys on how to get a girl. When she get to the â€Å"Goin Courtin† part of the song she speeds thing up to make it more dramatic and to get the brothers to think this is the fun way of getting the gals. She uses body language to help the brothers realize all the excitement that is involved in getting the girls.   Ã‚  Ã‚  Ã‚  Ã‚  Ã¢â‚¬Å"Sobbin Woman† is Adam’s way of explaining to the brothers how to get the woman.

Essay --

Emerging Technology and Graphic Design Research Paper Waianae High School Team Members: Shayna Costa Daisy Monderen Advisor: Michael O’connor Principal: Disa Hauge 85251 Farrington Highway Waianae, Hi 96792 1 Table of Contents Title Page†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 1 Executive Summary†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦..†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦Ã¢â‚¬ ¦.. 2 Communicating Technology and the Targeting Groups†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 3 Emerging Technology Improving the reach of Graphic Design†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦Ã¢â‚¬ ¦.. 4 Reaching Target Groups Through Media†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦..†¦Ã¢â‚¬ ¦. 5 References†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦...†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦6 2 Executive Summary The ambition that our research essay reaches is based on the emerging communication technology, and how graphic design is exceedingly reaching targeted groups through mobile media. The massive developing technology that has been brought up today increasingly develops and helps businesses expand their companies and careers. Social media is the most essential way to promote anything you want at anytime and anywhere, this is also the most common practice of how graphic designers implicitly publicise their business. By the mass mobile access of social media and advancing technology like cell phones, tablets and laptops is how graphic designers are able to create tenacious designs and share them throughout the global communication network. By sharing their designs throughout globe, it will serve as advertisement and recognition for the company and the designer. The designer can also evaluate most appreciated designs and receive feedback from viewers on to what designs work and what designs don’t for each targeted group. Through the increasing users of technology can graphic designers benefit, to showcase the company, themselves and their potential... ...dienc eWhenDesigningAGraphic Elle Smith (2014), â€Å"The Importance of Graphic Design in Social Media† http://smallbusiness.chron.com/importancegraphicdesignsocialmedia38942. html Justice Mitchell (2013), â€Å"Why Graphic Design is Still Important in Social Media† http://justicemitchell.com/justicemitchell/ 2013/1/7/whygraphicdesignisstillimportantinsocialmedia .html Statistic Brain (Dec. 2014) â€Å"Social Networking Statistics† http://www.statisticbrain.com/socialnetworkingstatistics/ U.S Bureau of Labor statistics (2014), â€Å"What Graphic Designers Do† http://www.bls.gov/ooh/artsanddesign/ graphicdesigners. htm Veerle Pieters (2014), â€Å"Feelancing Advice† https://www.graphicdesignblender.com/freelancingadvicefromsuccessfuldesigners 7 Web Designer Depot. (2011, December 27). Designing for your target audience. http://www.webdesignerdepot.com/2011/12/designingforyourtargetaudience/ 8

A Thousand Splendid Suns Essay

â€Å"Come. There is a way to be good again,† said Rahim Khan to Amir. In the novel the Kite Runner by Khaled Hosseini, Amir, the main character, expresses his thoughts and actions due to his baneful choices. The tribulations he faced were all repercussions of the sin committed by his disdainful youth. His sins ravaged the early stages of his life and gave him a troublesome memory full of guilt. As the novel progressed, Amir attempted to disengage the memory of his sin and forget about it. Amir soon faced the long over due road to redemption. Khaled Hosseini’s novel the Kite Runner is about redemption, and that the lifelong pursuit of happiness will never be fulfilled without it. At a young age Amir and Hassan were best friends, even though Amir was roughly expressing it. Amir and Hassan enjoyed many activities together as Khaled expressed in his novel: â€Å"I spent most of the first twelve years of my life playing with Hassan. Sometimes, my entire childhood seems like one long lazy summer day with Hassan, chasing each other between tangles of trees in my father’s yard, playing hide-and-seek, cops and robbers, cowboys and Indians, insect torture†¦ We saw our first Western together, Rio Bravo with John Wayne, at the Cinema Park†¦,† stated Amir. Amir stated all these â€Å"friend-like† activities, yet witnessed the sexual abuse administered by Assef and his goons on Hassan without a peep from his mouth. At this point Amir’s lust for obtaining the kite, so he could finally enjoy love from his father had over come his friendship. That temporary love given to Amir by his father was enough for Amir to attempt to get rid of Hassan permanently, which worked. Amir’s sin committed in his early years set the stage for the rest of his life, for he would seek redemption for his acts. Many years passed, Amir was on his own now in America, with his wife Soraya that could not bare children. Amir received a call from Rahim Kahn who was dying and wanted a last visit from Amir. Amir had jumped at the chance to visit an old friend/father figure and flew to see Rahim. Little did Amir know he was about to face all of the tribulations he had seemed to forget of his past ten fold. Rahim Khan reveals â€Å"Hassan, Amir’s childhood friend, the presumed son of the family servant was in reality, Amir’s half-brother, his father’s illegitimate son with Ali’s wife. † He also reveals that the prolonged redemption is just around the Taliban by saving Amir’s half-nephew Sohrab (Hassan’s son) from Kabul. Amir was in a state of confusion, he expressed his plead to Rahim: â€Å"I can’t go to Kabul,† I had said to Rahim Khan. â€Å"I have a wife in America, a home, a career, and a family. † But how could I pack up and go and go back home when my actions may have caused Hassan a chance at those very same things (talking to himself)? I wished Rahim Khan hadn’t called me. I wished he had let me live on in my oblivion. But he had called me. And what Rahim Khan revealed to me changed things. Made me see how my entire life†¦had been a cycle of lies, betrayal, and deceit. ‘There is a way to be good again’ he’d said. Thus started Amir’s road to redemption. Amir searched through Kabul for Sohrab and an orphanage leader had stated that Sohrab had been sold to a Taliban leader. The Taliban Leader who showboated John Lennon glasses and conducted the stoning ceremony at halftime of the soccer game was the man that Amir had to speak with. As Amir conversed with the Taliban lead he learned of his cruel ways of massacring the Hazaras. Then the Taliban leader revealed, â€Å"What did you think? That you’d put on a fake beard and I wouldn’t recognize you? †¦ I never forget a face. Not ever. † The Taliban revealed himself as Assef, Amir’s childhood enemy. Assef created an ordeal stating that if Amir were to overcome him in a blood brawl, then Sohrab would be Amir’s boy to take. Assef completely demolished Amir by breaking several ribs with his brass knuckles. Amir was barely able to stand, but he withheld the beating for he knew that destiny had brought him to this moment. The moment came when Sohrab had pierced Assef’s eye and he and Amir escaped. Amir had finally accomplished his self-turmoil and had almost completed his redemption by saving his half-brother’s son, and almost dying for him. Amir knew that he had to adopt Sohrab when they got back to a safe haven. This caused some trouble with the embassy for they required legal documents of the orphaned child. Sohrab believed that there was no possible way for him to come to America and he did not want to return to an orphanage, so he attempted suicide. Amir had gone through a father’s worst nightmare when he thought his soon to be adopted son would die. Sohrab survived though, leaving a reckless, unrighteous Muslim, self- centered Amir behind. Amir’s pursuit of happiness was fulfilled as he and his son were flying kites in America. He had redeemed himself as he said to Sohrab, â€Å"Do you want me to run that kite for you? †Ã¢â‚¬ ¦A nod from Sohrab†¦ â€Å"For you, a thousand times over,† and a smile cracked open on Sohrab’s face.

BTEC Business Level 3 Unit 1 P1 Essay

In this assignment I will describe the type of business, purpose and ownership of two contrasting organisations. My two chosen contrasting businesses are ASDA and Oxfam. ASDA is a British supermarket chain which retails food, clothing by George, toys , car wash and general merchandise such as electrical products and cooking appliances. ASDA also have branched out into telecommunications with a mobile network called ASDA mobile. ASDA is Wal-Mart’s largest non-U.S. subsidiary, accounting for almost half of the company’s international sales, in this sense ASDA can be classed as a National business as it can be found all over the country or an International business as it is a part of the Wal-Mart Conglomerate which can be found in America and Canada. Founded as Hindell’s Dairies in 1920 by a group of Yorkshire farmers to protect their incomes due to the decline after World War 1. After a sucessful period which saw them expand and diversify the company was floated in 1949 becoming Associated Dairies and farm Stores Ltd. In 1968 Associated Dairies bought out the Asquith Brothers stores and became the company we know today as ASDA (ASq uith + DAiries). They are currently the 2nd largest chain in the UK. ASDA is what is known as a Ltd Company which means it is a private limited company, a Ltd is owned by family or friends and are quite often larger in size than a sole trader or partnership company. Being a Ltd company gives the owner(s) much more control over decisions and the directions in which the company is going, though you are answerable to shareholders they will be friends and family as they are unable to sell any stock shares on the London Stock Market. From this we can ascertain that it is a profit based company which means it is not under governmental control and run by individuals for purely profit making purposed. Oxfam is a charity organisation that works for no money. Oxfam was originally founded in Oxford, UK, in 1942 as the Oxford Committee for Famine Relief by a group of Quakers, social activists, and Oxford academics; this is now Oxfam Great Britain, still based in Oxford, UK. It was one of several local committees formed in support of the National Famine Relief Committee. Their  mission was to persuade the British government to allow food relief through the Allied blockade for the starving citizens of Axis-occupied Greece. The first overseas Oxfam was founded in Canada in 1963. The organization changed its name to its telegraph address, OXFAM, in 1965. Oxfam falls into the voluntary sector. The voluntary sector consists of self-governing organisations some being registered charities some incorporated non-profit organisations. Voluntary sector work includes things like delivering services, Community and economic development and also advancing in religious faith. Oxfam is an international organisation meaning it spreads across the world. Oxfam is an international confederation of 15 organisations working in more than 90 countries worldwide to find lasting solutions to poverty and related injustice around the world. In all Oxfam’s actions, the ultimate goal is to enable people to exercise their rights and manage their own lives. Oxfam works directly with communities and seeks to influence the powerful to ensure that poor people can improve their lives and livelihoods and have their say. A contrast to either Ltd (private limited company) or the voluntary sector you can also have a business which is known as a PLC; this stands for Public Limited Company. This means that not only do you need a capitol of  £50,000 to start the business up there will be share holders who can have just bought shares on the London Stock Market and can put pressure on the company to make a higher profit so the value of their shares increases, giving less control over the business objectives to the owner(s). In both cases of being a Ltd or a PLC this does offer some benefits to the owner(s) in the way of Limited Liability. This means that even if things go badly for the business and it ends up in debt the business and the owner(s) are classed as legal separate entities, so the debt collectors cannot take any personal money or belongings for the debts owed by the business.

6 steps decision making Essay

In addition to time pressures that we encounter when searching for evidence to support care decisions for individual patients, it may be difficult for clinicians to apply the evidence that we find. The rate limiting step may not be doing the search, but the steps needed in â€Å"setting evidence-based medicine (EBM) in motion.† We present an example of a search for evidence by a Physician Assistant (PA) student that highlights this challenge. PAs receive accelerated training in the medical model and work in teams  under physician supervision. Approximately 40 000 PAs currently work in the  US in a wide range of settings and specialties.  Practising EBM has become an important component of training for PAs.  During an internal medicine rotation, a PA student encountered a common clinical practice unsupported by current  evidence—administration of nebulised albuterol in patients with community acquired pneumonia (CAP). While this practice may  be justified in patients with underlying chronic obstructive pulmonary disease (COPD) who also present with CAP, this student  questioned the grounds for its use in patients with CAP who do not have COPD. Clinical scenario A 68 year old man presented to the emergency department with fever, chills, and a non-productive cough of 1 week’s duration. He had fatigue, headache, rhinorrhoea, and mild nausea, but  denied dyspnoea. He had no history of smoking or COPD. He  had atrial fibrillation and was taking warfarin for stroke prevention. On admission, his temperature was 38.4  °C, heart rate was  108 beats/minute, respiratory rate was 24 breaths/minute,  blood pressure was 156/88 mm Hg, and oxygen saturation was  86% by pulse oximetry on room air. Rales were heard in both  lung bases and in the right middle lobe. Chest radiography  showed a diffuse infiltrate in the right middle and lower lobes. Complete blood count showed a white blood cell count of  22 000 cells/ml with a left shift, and arterial blood gases showed mild respiratory acidosis.  One dose of ceftriaxone was administered parenterally, and a course of azithromycin was started. Albuterol, 5% solution,  delivered by n ebuliser 3 times daily was also ordered, in addition to a combination of inhaled ipratropium and albuterol,  delivered by metered dose inhaler every 4 hours as needed.  During the hospital stay, his pneumonia resolved, but his heart rate increased to 150 beats/minute and his blood pressure rose from 156/88 to 200/110 mm Hg. Clinical question Although there was no institutional protocol for use of  nebulised albuterol for treatment of CAP, the house staff often ordered it.  The PA student queried: In a 68 year old man with CAP and no underlying COPD, does use of nebulised
2 agonists improve symptoms? What is the risk of harm in this  patient? Search strategy Firstly, a treatment guideline was sought to clarify recommendations regarding use of nebulised albuterol for treatment of CAP.  The American Thoracic Society guidelines for management of  CAP1 were rapidly retrieved through PubMed, UpToDate, and  MD Consult. The British Thoracic Society (BTS) guidelines for the management of CAP in adults2 were also found in PubMed.  Both sets of guidelines were relevant to our patient, but neither guideline discussed the use of nebulised albuterol in the  treatment of CAP. The BTS guidelines had a section on general management, which discussed the use of adjunctive therapies  for CAP, but nebulised albuterol was not mentioned. Evidence from controlled clinical trials was mentioned in the guideline for â€Å"bottle blowing,†3 but not for physiotherapy.  Having not fully answered our question with a review of  relevant guidelines (and having not attracted the attention of anyone who could change the patient’s treatment p lan), we  searched PubMed again, this time specifically for studies on the use of albuterol in patients with CAP. No relevant trials were found on the use of nebulisers for CAP.  To identify evidence about harm with the use of albuterol,  PubMed was searched using the terms nebulised albuterol, cardiac arrhythmias, and randomised or controlled clinical trials.  No trials were found. When just the content terms were  searched, 9 articles, not directly relevant to our patient, were found. One prospective, open label study on the effect of  nebulised albuterol (for treatment of asthma) on cardiac rhythm was found.4 10 patients were studied, and although no adverse effect on cardiac rhythm or blood pressure was found, the study did not convince the team that no potential for harm existed in this, or other patients, especially when there  was no clear indication for use of albuterol. Recognising that searching and appraising the literature are not the only important aspects of practicing EBM, we consulted an experienced pulmonologist, who practises and teaches using the EBM model. In addition to reviewing treatment plans for  multiple cases of CAP requiring hospital admission with the  Nurse Practitioner/Physician Assistant service, he recommended review of the Centre for Evidence-Based Medicine  website at Mount Sinai Hospital in Toronto, Ontario, Canada  (www.cebm.utoronto.ca/), which suggested bubble blowing as a method for helping clear secretions.2–3 This served as an  excellent, rapid approach to finding good information on treatment of CAP, and confirmed the evidence previously found in  the literature search.  Application of the evidence to this, and future  patients  The treatment plan for this patient was not altered by the  student’s rapid search for evidence. Changes in usual care for a common illness required a compr ehensive search and discussion among all clinicians in our institution caring for patients  with CAP. The clinical team reviewed the results of the search and because no evidence was found to support use of albuterol in patients like ours, changes were made to future practice. As a result of this process, which took a few hours and evolved over several weeks, orders for bronchodilators for patients with CAP are now made on an individual basis, depending on the  presence of patient comorbid illnesses, such as COPD. 164 Volume 8 November/December 2003 EBM www.evidence-basedmedicine.com EBM notebook Downloaded from ebm.bmj.com on 10 August 2009 Conclusion The need for a rapid search for evidence is sometimes, but not always, important to the care of an individual patient. In this case, the speed of the search did not affect the ability of the PA student to apply the  evidence to the patient. Setting the evidence in motion may require communication of search results to other members of the clinical team and may affect the care of future patients. Although the catalyst for setting EBM in motion was a student, the evidence, including the results of further research, along with the judgment of the experienced pulmonologist,  convinced the clinical team to make changes to usual care and to base future treatment of this common condition on the best available evidence. The basic concept of evidence-based medicine proposes to  make health related decisions based on a synthesis of internal and external evidence. Internal evidence is composed of knowledge acquired through formal education and training, general  experience accumulated from daily practice, and specific  experience gained from an individual clinician-patient relationship. External evidence is accessible information from research.  It is the explicit use of valid external evidence (eg, randomised controlled trials) combined with the prevailing internal evidence that defines a clinical decision as â€Å"evidence-based.† To realise this concept in day to day clinical practice, the Evidence- Based Medicine Working Group proposed a 5 step strategy,  corresponding to step 1 and steps 3 to 6 shown in the left hand column of the table. In teaching this 5 step approach, we encountered several difficulties. We noticed a growing hesitance to accept this strategy  as students advanced in their medical training. In the presence of well established methods of treatment or diagnosis, this  resistance rises even more, regardless of the level of training.We assume that this barrier is associated with the process of socialisation into the health professions. Throughout medical  education students are virtually â€Å"trained† to make decisions under the condition of uncertainty. Advanced students and to a greater extent clinicians lose some of their ability to differentiate between scientific evidence and what seems to be evident. If we intend to implement evidence-based medicine more efficiently, we need to modify the way students and clinicians learn to make decisions. Therefore, an additional step was introduced in our evidencebased medicine teaching programme (step 2 in the table).  Students were to provide answers to their clinical questions based on their current knowledge (internal evidence) before  continuing with the remaining steps of the evidence-based  process.2 Our collective experience concerning this additional step was extremely positive. The students using this new step were satisfied that their pre-existing knowledge had been  integrated into the evidence-based approach. By explicitly  documenting their internal evidence, students used the remaining steps of the process to evaluate not only the best evidence in making a clinical decision but also to assess the accuracy of their internal evidence, the grounds upon which their preconcep- The 6 steps of evidence-based decision making Step Action Explanation  1 Transformation of the clinical problem into 3 or 4 part question (a) relevant patient characteristics and problem(s), (b) leading intervention, (c) alternative intervention, (d) clinical outcomes or goals. 2 Additional step: answer to the question based on â€Å"internal evidence† only Internal evidence: acquired knowledge through professional training and experience (in general and applied to the patient). Should be documented before proceeding to step 3. 3 Finding â€Å"external evidence† to answer the question External evidence: obtained from textbooks, journals, databases, experts. The value of the external evidence will be highly variable, see step 4. 4 Critical appraisal of the external evidence Should answer 3 questions: (1) Are the results valid? (2) Are the results clinically important? (3) Do the results apply to my patient? (or is my patient so different from those in the study that the results do not apply?) 5 Integrating external and internal evidence The 2 sources of information (external and internal) may be supportive, non-supportive, or conflicting. How the decision is made when non-supportive or conflicting will depend on multiple factors. 6 Evaluation of decision making process Once the decision has been made, the process and the outcome are considered and opportunities for improvement are identified. The health authority of Alto Adige in northern Italy initiated and supported a project, the â€Å"Bressanone Model,† in which the effects of implementing evidence-based medicine on the quality of health care were to be shown. In this model we used the six step approach, which proved to be successful in the student  project to teach experienced clinicians.3 The participants were asked to name problems of their day to day practice that lacked either an effective or an efficient solution. The evidence-based medicine support group helped participants to phrase the 3 or 4 part questions. Subsequently, the physicians were asked to submit their individual answers to the questions before continuing with steps 3 to 6. Agreement between internal and external evidence varies. Completing the full process could result in finding evidence that confirms the internal evidence, validating and strengthening the clinician’s or student’s confidence in the decision. The process could also reveal that little evidence exists to support the decision or that the available evidence is equivocal. In such cases, other factors such as cost or inconvenience to the patient may need to be given greater consideration. Possibly, the best external evidence found is not in agreement with the internal evidence. This represents a particularly valuable experience for the clinician or student because it may avoid an ill advised decision. It also shows the fallibility of making decisions on  uncertain ground based on internal evidence alone. This in turn will hopefully promote the routine assimilation of external evidence in clinical decision making. The documentation and  comparison of steps 2 and 5, used as a research tool or quality assurance outcome measure, coul d provide valid information  on the effects of evidence-based medicine on clinical decision making. In case of conflicting internal and external evidence, clinicians have several options. They may change their mind and align it with the external evidence. They may determine that the external evidence is not sufficiently convincing and remain with the  original decision. Or, they may choose to discuss with the  patient the conflict between the internal and external evidence in a manner that enables the patient to take part in the decision making process. This last approach is recommended because  patient preference is considered an essential part of the  evidence-based decision making process1 and decisions often  need to be made in the absence of clear research findings.

Evidence Based Practice in Mental Health Nursing Essay

One of the most common and disabling psychological disorders encountered within mental health and general medical settings is that of an anxiety disorder (Dattilio & Kendall 2000). Research has indicated that people with learning disabilities are more prevalent to psychological disorders than the general population (Hassiotis et al 2000) consequently it could be hypothesised that prevalence rates of anxiety disorders are similar if not greater within the learning disabled population. Professional literature suggests that cognitive-behaviour therapy (CBT) has been an effective treatment against anxiety disorder (Beck 1995) however; this literature has predominately concentrated its focus to within the confines of mental health and general medical settings (Dattilio & Kendall 2000). The ability of people with learning disabilities to identify, evaluate and respond to their dysfunctional thoughts and beliefs, fundamentals of CBT (Beck 1995) have put into question the very use of this treatment programme for this particular client group (Kroese et al 1997). From a professional and personal perspective and through the utilisation of the Seedhouse (1998) ‘Ethical Grid’ responding to an anxiety disorder by way of CBT could be considered an ethically acceptable clinical intervention. Nationally and locally through government directives, ‘Valuing People’ (Department of Health 2001) and initiatives such as Health Action Plans (Department of Health 2002) services have recognised that they need to be more responsive to the mental health needs of people with learning disabilities. As a learning disability nurse wishing to ascertain the effectiveness of CBT as a practical intervention when presented with the dual-diagnosis of anxiety disorder and l earning disability, is through the use of ‘evidence-based practice’. When deciding on the best possible clinical intervention for an identified practice problem it seams logical to convert the issue into a single answerable question (Colyer & Kamath 1999). Several authors have identified that the use of frameworks to inform the development of the clinical question provide the practitioner with a systematic process of formulating an answerable question (Sackett et al 1997 Ridsdale1998). One such framework as described by Sackett et al (1997) is a four- stage process, known by the acronym PICO: Patient or Population Intervention or Indicator Comparison or Control Outcome The construction of an answerable question is the basis of evidence-based practice and should guide the practitioner to how to find an answer (Ridsdale 1998). It is important that each variable under the PICO framework is clearly defined, being as detailed and explicit as possible in order to extend clarification to the question. Working through PICO methodically the practitioner would instigate the process by defining the ‘Patient or Population’. Characteristics such age, gender and diagnosis would need to be deliberated and whilst the aforementioned were easily recognised in the practice area as adult male, identifying appropriate terminology for diagnosis can prove problematic. The term ‘Learning Disability’ is often used interchangeably in literature with terms such as, Mental Retardation and Intellectual Disabilities. ‘Learning Disability’ is a term with contemporary usage within the United Kingdom to describe a client group with significant development delays (Gates 1996). Whilst the idiom ‘Learning Disability’ is the preferred terminology for the question due to its contemporary usage it must be accepted that it’s a term not internationally recognised nor is it a term used for long in the United Kingdom (Gates 1996). Anxiety disorder comes in many facets and can be described as severe psychological disorders in which abnormal or chronic anxiety interferes with daily living (Adams & Bromley 1998). The client in the practice area had described psychological and physiological symptoms that were diagnosed as a social anxiety disorder through rating scales and self-report measures. It is crucial that the practitioner is aware that the term identified for the question as ‘social anxiety’ is often recognised by the synonyms, social phobia or panic disorder (Dattilio & Kendall 2000). The recognition of this inconsistent terminology will enable an evaluation to  take place between the relationships of the chosen term to symptoms displayed by the client. The identification of existing clinical interventions is a valuable part of the process of developing evidenced-based interventions (Meijel 2003). Literature suggests that CBT is an effective treatment for a number of psychological disorders (Embling 2002 Hatton 2002). Central to the model of CBT is that distorted or dysfunctional thinking is prevalent in all psychological disorders (Beck 1995). Analysis of accumulated experience of existing interventions and the aforementioned evidence of its validity led to the application of CBT as the ‘question intervention’. It is not imperative for the question to have a comparison intervention and this was the situation in the clinical problem described, therefore the conclusive element utilising the PICO framework was ‘outcome’. The outcome should be measurable (Sackett et al 1997) and after initially trivialising with the term ‘used’ it became evident that this would not develop into something that could be measured. Discussing whether or not an intervention is ‘effective’ however would provide the question with a measurable outcome. Revision of the terminology identified through the PICO framework would consequently translate the question as – Is cognitive-behaviour therapy an effective intervention for adult males with learning disabilities diagnosed as suffering from social anxiety? A well-formulated search strategy is an essential component in gathering appropriate evidence (Hewitt-Taylor 2002). Ridsdale (1998) discusses a four-stage search strategy that helps to translate the question into a meaningful search – a) Identify the subject elements of the question b) Define the relationship between the subject elements c) Convert the subject elements into search themes d) Decide on the scope of the search Assistance to define the subject elements can be found within the PICO framework – Patient – Learning Disability, Social Anxiety Intervention – CBT Outcome – Effectiveness Once identified an effective means of linking the subject elements of a question for the search process is through the use of ‘operators’. Operators such as: And – Or – Not, form a logical link between the elements of the question and can be used collectively or individually in any electronic database search (Ridsdale 1998). All of the subject elements of the question were required in order provide a conclusive answer therefore the operator required for the search strategy could be identified as ‘And’. The subject elements then require conversion into terms by which references can be retrieved (Ridsdale 1998). A keyword search would apply the terms identified as the subject elements, however making a list of the known synonyms of the subject elements such as Intellectual Disability and Mental Retardation, for inclusion, would substantially develop the search process. Finally the scope of the search decides what is wanted from the search. In order to identify the most appropriate type of evidence that is required for the practice problem the type of question asked must be identified (Sackett et al 1997). The question developed through the PICO framework can be readily identified as questioning, ‘the effectiveness of a therapy’. Sackett et al (1997) proposes that the best available evidence to answer this type of question is comparative / prospective studies and ideally random controlled trials (RCTs) which in turn determine the choice of database (Ridsdale 1998). Sackett et al (1997) provides a comprehensive catalogue of information resources such as databases, journals and web sites along with descriptions  of the type of evidence that can be found within these resources. It was established previously that the best type of evidence for the question would be RCTs and comparative / prospective studies. From the descriptions supplied by Sackett et al (1997) it could be identified that the Cochrane Library supplies the user with full text systematic reviews of effects of health-care interventions along with bibliographies of controlled trials. Further electronic databases identified through Salford University library information services were PsycINFO that contains citations and summaries of journal articles and books in the field of psychology chosen for its congruity with the clinical intervention. ‘Swetswise’ an electronic journal aggregator that provides access to full text publications from several major health care related academic publishers and ‘IngentaConnect’ which offers full text availability for all core Blackwell science and medical journals were chosen due to familiarity of use and extensive subject matter. Other databases considered were CINAHL, EMBASE and AMED however all were discounted due to their general nursing bias. Despite the recognition of Ridsdale’s (1998) four-stage search strategy and its systematic approach the initial search were completed exploiting familiar strategies through the IngentaConnect database. Preconceptions from previous endeavours searching for relevant evidence furnished the belief that a similar strategy would provide sufficient evidence to answer the question. A number of the subject elements were used through keyword searches whilst the operator ‘And’ was used to link each in turn (See Appendix). This easy to use search strategy produced a number of hits however none matched the criteria identified as being the most appropriate type of evidence to answer the question. The search revealed that almost all of the evidence found belonged in either mental health (Heimberg 2002) or general medical settings (Scholing & Emmelkamp 1999). Whenever the term learning disability or mental retardation was utilised they invariable appeared indiscriminately amidst the title or abstract of the article providing no specific relevance to the question. The frustration born out of this strategy led to further searches of electronic databases firstly through another familiar database, Swetswise. Ridsdale (1998) identifies that too many hits will be recovered if the subject element is to general  and this was evident in the first keyword search. The term learning disabilities produced 548 hits (See Appendix) far too many to feasibly scan. The subsequent four searches failed to produce a single hit a possibility also recognised by Ridsdale (1998) who suggests alternative synonyms are utilised in this circumstance. Due to the inability to find any relevant material of value towards answering the question Ridsdale’s (1998) four-stage strategy was then conscientiously adopted in conjunction with the knowledge acquired through lectures received at Salford University. A further search of Swetswise database was completed (See Appendix) which revealed significantly less hits than previously achieved but produced a literature review (Hatton 2002) specifically aimed at the use of CBT and people with learning disabilities. Whilst this evidence did not fulfil previous identified criteria it established that pursuing Ridsdale’s (1998) strategy could provide some success. A similar approach was undertaken while searching the Cochrane Library database which allows the user to restrict the search to the acquisition of systematic reviews and controlled trials whilst using a simple keyword option. Again the subject elements were utilised along with the recognised operator and despite new found co nfidence and knowledge the search strategy revealed no evidence of systematic reviews or RCTs with regards to the question (See Appendix). All systematic reviews or RCTs retrieved belonged within general and mental health settings. The final electronic database to be utilised was PsycINFO (via Ovid) where again Ridsdale’s (1998) four-stage strategy was conscientiously adopted. PsycINFO requires the user to have some prior knowledge of how to use electronic databases and their search strategies, which initially can prove bewildering to the novice. Once familiar with the database and its ability to combine search strategies either through keyword, journal or author the user should find it a practical resource (See Appendix). No systematic reviews or RCTs were found within the results however a further literature review (Feldman & Rivas-Vazquez 2003) aimed at psychosocial interventions and people with intellectual disabilities was unearthed along with evidence from child and adolescence services (Dadds & Spence 1997) and psychiatric services (Carmin & Albano 2003). Hatton (2002) suggests that research evidence on the effects of psychosocial interventions  for people with learning disabilities is sparse, whilst Kroese (1998) adds that therapists are reluctant to engage into therapy with this client group due to their dislike of having to relate to them. In an attempt to discover any type of evidence relating to people with learning disabilities and CBT the Salford University library catalogue was searched (See Appendix). A simple keyword search revealed one book (Kroese et al 1997) attaining the subject elements however again it did not produce the type of evidence recognised as the most appropriate to answer the question. Sackett et al (1997 p.2) defines evidence based practice as: â€Å"†¦the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients†. With this definition in mind it should be established as to what constitutes ‘current best evidence’ and its implications for the practitioner wishing to implement ‘evidence based practice’. Belsey & Snell (2001 p.2) states that, â€Å"†¦evidence is presented in many forms†¦ and the value of evidence can be ranked according to the following classification in descending order of credibility†: I. Strong evidence from at least one systematic review of multiple well-designed randomised controlled trials II. Strong evidence from at least one properly designed randomised controlled trial of appropriate size III. Evidence from well-designed trials such as non-randomised trials, cohort studies, time series or matched case-controlled studies IV. Evidence from well-designed non-experimental studies from more than one centre or research group V. Opinions of respected authorities, based on clinical evidence, descriptive studies or reports of expert committees In accepting this hierarchy of evidence practitioners should concede that the systematic review of multiple well-designed RCTs constitutes ‘best available evidence’ (Colyer & Kamath 1999). Sullivan (1998) adds weight to this argument when he states that RCTs constitute the strongest source of evidence and that the scientific community prefer the quantitative research technique that makes use of empirical data following a systematic process. Whilst a number of RCTs were found (Dadds & Spence 1997 Scholing & Emmelkamp 1999) whilst undertaking the search strategy none belonged within learning disability settings. The only evidence found specific to the original question were literature reviews and a specialist book (Kroese et al 1997) aimed at CBT and learning disabilities. The literature reviews (Hatton 2002 Kroese 1998) revealed that a number of case studies and a case series had demonstrated the potential feasibility of CBT reducing anxiety amongst people with learning disabilities. Whilst the specialist book (Kroese et al 1997) discussed conceptual and contextual issues of CBT and people with learning disabilities suffering anxiety disorders. This type of evidence appears in the lower reaches of the hierarchy of evidence and as such its subjectivity, reliability and validity can be disputed (Sullivan 1998). Whilst acknowledging the hierarchy of evidence and the proposal that comparative / prospective studies and ideally RCTs were the best forms of evidence to answer this type of question (Sackett et al 1997) it appears that in their absence the evidence revealed is the ‘best available’. RCTs are widely acknowledged as the gold standard of evidence-based practice (Rowland & Goss 2000) however it is suggested that they bear little resemblance to day-to-day reality (McInnes et al 2001). RCTs can be pragmatic or explanatory the former is concerned with the overall effectiveness of an intervention whilst the latter examines the impact of specific treatment elements on outcome (Parry 2000) however neither considers the perspectives and uniqueness of the respondents. The evidence recovered for the question (Hatton 2002 Kroese 1998) albeit in the lower reaches of the hierarchy acknowledges the feelings of the respondents due to its qualitative nature (patient centred, holistic and humanistic) therefore making it extremely suitable for the study of nursing phenomena (Parahoo  1997) along with its relevance as regards answering a therapy question (Parry 2000). Kroese (1997) offers a number of reasons why there is this lack of quantitative research evidence surrounding the subject elements in the question. He suggests that people with a learning disability are a devalued population, it is impossible to ensure that changes are due to clinical manipulations if individuals (learning disabled) do not have stable cognitions. Finally there is a conjecture that anxiety in people with learning disabilities is the same as in the general population consequently there is no need for specifically focused research. It emerges that learning disability services continue to adapt research evidence from general and mental health settings (Finlay & Lyons 2001) a similar approach with the RCTs recovered from the search strategy could make them a valued resource however it would take a skilled clinician to make this a feasible option. Reflection is a necessary component of Continuing Professional Development and is a legitimate method for questioning personal effectiveness and responsibility in all aspects of health care (Driscoll & Teh 2001). Through the process of reflection the practitioner recognised his own limitations in identifying appropriate evidence for his clinical problems, along with the often inconclusive, time consuming and frustrating strategies undertaken in the search of evidence in support of his clinical practice. The structured frameworks utilised throughout the process described earlier gave the practitioner a systematic approach to formulating a question, developing a search strategy and identifying appropriate evidence to answer his practice problem. The ability to systematically approach future clinical problems will enable the practitioner to offer his clients a holistic, client centred practice from the best external evidence available. Adams, B. Bromley, B. (1998) Psychology for Health Care Key Terms and Concepts, London, Macmillan Press Beck, J.S. (1995) Cognitive Therapy Basics and Beyond, London, Guildford Press. Belsey, J. Snell, T. (2001) What is Evidence-Based Medicine? [Internet] Available from www.jr2.ox.uk/bandolier (Accessed 7th December 2004) Carmin, C.N. Albano, A.M. (2003) Clinical Management of Anxiety Disorder in Psychiatric Settings: Psychology’s Impact on Evidence-Based Treatment of Children and Adults, Professional Psychology: Research and Practice, Vol. 34, No. 2 pp 170-176. Colyer, H. Kamath, P. (1999) Evidence-based practice A philosophical and political analysis: some matters for consideration by professional practitioners, Journal of Advanced Nursing, Vol. 29, No. 1, pp 188-193 Dadds, M.R. Spence, S.H. (1997) Prevention and Early Intervention for Anxiety Disorders: A Controlled Trial, Journal of Consulting and Clinical Psychology Vol. 65, No. 4, pp 627-635. Dattilio, F.M. Kendall, P.C. (2000) Panic Disorder In: Dattilio, F.M. Freeman, A. Cognitive Behavioural Strategies in Crisis Interventions 2nd Edition, London, The Guildford Press. Driscoll, J. Teh, B. (2001) The potential of reflective practice to develop individual orthopaedic nurse practitioners and their practice, Journal of Orthopaedic Nursing, Vol. 5, pp 95-103 Embling, S. (2002) The effectiveness of cognitive behaviour therapy in depression, Nursing Standard, Vol. 17, Nos. 14-15, pp 33-41 Feldman, L.B. Rivas-Vazquez, R.A. (2003) Assessment and Treatment of Social Anxiety Disorder, Professional Psychology: Research and Practice Vol. 34, No. 4, pp 396-405. Gates, B. (1996) Learning Disability In: Kenworthy, N. Snowley, G. Gilling, C. (Eds) Common Foundations Studies in Nursing Second Edition, London, Churchill Livingston. Hassiotis, A. Barron, P. O’Hara, J. (2000) Mental Health Services for People with Learning Disabilities, British Medical Journal, Vol. 321, Issue 7261, pp 583-584 Hatton, C. 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(1997) Evidence-based medicine: how to practice and teach EBM, London, Churchill Livingston. Scholing, A. Emmelkamp, P.M.G. (1999) Prediction of treatment outcomes in social phobia: a cross-validation, Behaviour Research and Therapy, Vol. 37, pp 659-670 Seedhouse, D. (1998) Ethics The Heart of Health Care 2nd Edition, Chichester, Wiley. Sullivan, P. (1998) Developing evidence-based care in mental health nursing, Nursing Standard, Vol. 12, No. 31, pp 35-38