Public Health Reflective Journal Health And Social Care Essay

Public Health Reflective Journal Health And Social Care Essay Our discussion last Thursday and Friday focused on the Impact of Disease on Health Care Delivery System and Health Social Care. During that time our tutor Kate gave us an activity which we will cite examples have disease affected those areas of health. Things like Financial Issues, Supply and Demands, Lack of Awareness and Knowledge, Skills Shortage and Poor compliance are the cited problems in all groups that occur in a community who are affected with any kinds of disease. We come up this idea of some reasons. Why Financial Issues? Because medicines and manpower are not free which means it needs funding to cope this problem especially when a large portion of individuals who are needed to be rendered with health services. Supply and Demands, still related to financial issues. Lack of Awareness and Knowledge, this contributes the problem because if a community is lack of awareness or knowledge about it health they are very vulnerable to illnesses or diseases. Skills Shortage this pertains to the members of health care system, it talks about how effective are they in rendering their services, are they professional and skilled to give services in an efficient and effective way Another topic we also considered last week was about case study of Philip, that study is very meaningful to us because its talks about Philips health and family problem. That case study gives us information that Health awareness is vital to a human life and we should take care of ourselves. It also gives ideas to health practitioner on how to manage a case that has crucial situation and needs immediate attention. Has this new knowledge changed my understanding? ( have I developed a whole new way of seeing things): Knowing about the topic we tackled last week enlightened my mind on the importance of caring ourselves and a community as a health practitioner. Hearing those facts make me think that we should take care ourselves in many ways like having enough knowledge in health promotion and disease prevention, regular check up to assess our health status whether we are having illness or not, having healthy habit, diet and lifestyle. On the other hand also as a health care provider it is our responsibility to provide health teaching on those individuals we know that needs it or even not because doing this promotes health and gives knowledge to them on avoiding any disease problems. In addition, we should be a role model of health to them because this is one of the effective way were they will believe our health teachings and apply it to their selves. How will I apply this knowledge and understanding in my work situation? In my situation, there are many cases where I can apply this facts and knowledge I gathered in our last weeks discussion. As we know, we can encounter different case of diseases in care homes both communicable and non-communicable disease and we are aware that were susceptible to have that diseases if we are not aware of it. Due to this point, precautions necessary to prevent getting and spread of one disease to another and we can do it by applying the things we discussed about public health in our workplace. In order to avoid ourselves and others from getting any disease we must maintain doing the basic things like hand washing after toileting/diapering, before preparing or eating food, after covering a sneeze or cough, after blowing the nose, before and after treating a sore or wound. Using of proper protective clothing as a first line of defence. 2.) Submitted: 28th of Jan. 2010 Learning a new topic leads to changes in our knowledge and understanding and should also lead to changes in ways of working. Identify any new knowledge, facts or theories that I have learnt from this weeks teaching: Last week, We discussed all the things that are related about public health and itself. I found out that public health is a very broad topic and correlates many components such as health sector, health organisations, etc. I learned that Public Health is vital in helping people to be aware about their health because it promotes good health, prolongs life and prevents society in getting any kind of diseases. It is also a gathered deed for the health of the certain population. In dissemination of all the information related to health, there are agencies that are responsible in data distribution. This agencies and sectors are the one who takes the promotion, prevention, planning, action, and implementation of all the goals in regarding health information dissemination. One of the most common agencies here in United Kingdom is the National Health Service or commonly called NHS. This agency acts as a framework of local organisations responsible for the healthcare of the community and to work with the local community to improve our populations health and well being. There are more agencies that acts or has a role like the NHS in relation to Public Health. On the other hand Health Organisation has a big role in terms of promoting people in health awareness of the community because they are the one who distribute the health information globally such as World Health Organisation. WHO is the organisation that coordinates and directs for health within the United Nations. WHO leads in providing information about global health matters. Every time there is a new case of disease they are the one that conducts the studies on it and share the information all over the globe. For example, last week we had disserted the topic about the different infectious disease ( Swine Flu, Salmonella, HIV/AIDS, Measles, Meningitis, Tuberculosis , and MRSA ) and Non-infectious Disease ( Cancer, Coronary Heart Disease, Cerebro-Vascular Accident, Obesity, Asthma ) which are the products of the studios of WHO. Without WHO we cant gain access or unknowledgeable about these diseases. Match criteria Has this new knowledge changed my understanding? (have I developed a whole new way of seeing things) The topic we discussed doesnt change my understanding about Public Health. The lesson we take up last week adds information about what I know in public health and it makes me understand that it is very important in building healthy community not only in a certain place but globally. It also reminds me that as a health practitioner, we have also the responsibility to share what we have learned about promoting health and preventing diseases. Through this way we can help achieved one of the Public Health goal, which is the Health Awareness. How will I apply this new knowledge and understanding in my work situation? Like what I have said before, we can apply this knowledge by sharing the information about public health and telling them how to prevent diseases. In my situation as an Health Care Assistant in a Care Home, I can share what I have learned by telling to all my colleagues the importance of using protective clothes whilst giving care to a service user and explaining them how to make care a service user who has infectious and non-infectious disease. INTRODUCTION In this assignment, for Part 1, I am going to cite two agencies and named their roles in Public Health in terms of identifying level of health and disease in communities. I will name also epidemiology of two diseases and investigate a chart or graphical form of its incident rate. On other hand I will show the Statistical Data of the two diseases and interpret it base on facts and my understanding. In every agency I will choose two different approaches and strategies in controlling disease and investigate its effectiveness and after that I will make surveillance on how it improves Public Health. In this activity too I need to inspect current priorities to the provision of one disease and gives example on how it relates between prevalence rate, its causes and the requirements for health and social care services. Explore In Part 2, I will do a case study on a given data or on a workplace experience. Analyse its critical factors that affects individuals health then after I am going to put its priorities and evaluate its effectiveness to individuals well being. I will proposed as well changes that can improve its health and set it in action like having implementing campaigns to encourage maximize their health. In this part, I will explain the role of 2 different agencies in identifying levels of health and disease in communities PUBLIC HEALTH It is improving and safeguarding well-being. Public Health is in charge for health safety, health enhancement and health inequalities issues in England. It is responsible moreover for shaping policy, allocating resources, co-ordinating actions and supervising progress. Diagnose and investigate health hazards and health problems in the society. Assess accessibility, effectiveness, and quality of personal and population-based health services. In addition they are the one organised community efforts in aiming prevention of disease and promotion of health. In relation of this, I select two agencies that will partake the goals of public health. There are many agencies that have important roles in the society. I chose two agencies which helps contribute health awareness and protection for any kind of diseases; it is the Department of Health (DOH) and National Health Services (NHS). I will precisely relate this two agency to the two diseases I chose which is the Meningitis and Cerebrovascular Accident. Department of Health has many roles for the society. This agency focuses on issues related to the general health of the citizenry. It also compiles statistics about health issues of their area. It assesses and assures risk management to human health from the environment properly. Promote and protect the health and wellness of the people within the society and community. Promote and protects the public health to prevent disease and illness. Provides research and information for the detection, reporting, prevention, and control of any diseases or health hazard that the department considers to be dangerous that likely affects the public health. Establish a uniform public health program throughout the community which includes continuous service, employment of qualified employees, and a basic program of disease control, vital and health statistics, sanitation, public health nursing, and other preventive heath programs necessary or desirable for the protection of public health. Gather and disseminate information on causes of injury, sickness, death, and disability and the risk factors that contribute to the causes of injury, sickness, death, and disability within the society for their awareness. Implement programs and campaigns necessary or desirable for the promotion or protection of the public health to reduce and control the disease. DOH develops strategic approaches for current health risks. Establish risk analysis framework and maintenance of risk standards. http://www.le.utah.gov/interim/2005/pdf/00000306 National Health Services is a publicly funded healthcare systems in United Kingdom, this agency focus on maintaining peoples health and well-being. This agency is responsible for delivering quality and effective health service to humanity. They also contribute fair access to everyone in relation to peoples need. They are responsible for making payments to independent primary care contractors such as GPs, dentists, opticians and pharmacists in rendering their services to all people who needs it. It provides different caring services such as Emergency Respite Care, where care is provided if an individual; are unable to fulfil your caring responsibilities due to unforeseen circumstances, such as illness.  Domiciliary Care, where somebody comes into your home and takes over some of your responsibilities for a few hours.  Day care centre, where the person you care for spends time at a centre whilst you have a few spare hours to yourself. There are more services rendered by the NHS whi ch develop societies health http://www.health.gov.au/internet/main/publishing.nsf/Content/36D1CF8D85714DBECA25720D001F6860/$File/quaat3.pdf http://www.archive.official-documents.co.uk/document/doh/newnhs/wpaper8.htm In this part, I will investigate the epidemiology of two diseases in graph format and show my understanding and interpretation of the given data: Meningitis is an infection of the meninges, protective membranes that surround the brain and spinal cord. Infection can cause the meninges  to become inflamed and swell, which can damage the nerves and brain. This can cause symptoms such as a severe headache, vomiting, high fever, stiff neck and sensitivity to light. Many people (but not all) also develop a distinctive skin rash. Symptoms can differ in young children and babies. See the symptoms section for more information. Meningitis can be caused by: bacteria, such as streptococcus pneumoniae, the bacteria also responsible for pneumonia, which usually live harmlessly in your mouth and throat, and viruses, such as the herpes simplex virus. Viral meningitis Viral meningitis is the most common and less serious type of meningitis. There are approximately 3,000 cases of viral meningitis reported in England and Wales every year, but experts believe the true number is much higher. This is because in many cases of viral meningitis the symptoms are so mild that they can often be mistaken for flu. Viral meningitis is most common in young children and babies, especially in babies less than one year old. Viral meningitis usually gets better by itself within a couple of weeks, without the need for specific treatment. Bacterial meningitis Bacterial meningitis is extremely serious and should be treated as a medical emergency. If the bacterial infection is left untreated, it can cause severe damage to the brain and infect the blood (septicaemia), leading to death. Treatment requires a transfer to an intensive care unit so the bodys functions can be supported whilst antibiotics are used to fight the infection. There are approximately 2,000 cases of bacterial meningitis in England and Wales every year. The number of cases has dropped sharply in recent years due to a successful vaccination programme that protects against many of the bacteria that can cause meningitis. The treatment for bacterial meningitis has improved greatly. Several decades ago, almost all people with bacterial meningitis would die, even if they received prompt treatment. Now deaths occur in  one in 10 cases, usually as a result of a delay in treatment. Bacterial meningitis is most common in children and babies under the age of three, and in teenagers and young people aged 15-24. The best way to prevent meningitis is to ensure that your familys vaccinations are up to date. Stroke (cerebrovascular accident) A stroke happens when the blood supply to the brain is disturbed in some way. As a result, brain cells are starved of oxygen. This causes some cells to die and leaves other cells damaged. Types of stroke Most strokes happen when a blood clot blocks one of the arteries (blood vessels) that carries blood to the brain. This type of stroke is called an ischaemic stroke. Transient ischemic attack (TIA) or mini-stroke is a short-term stroke that lasts for less than 24 hours. The oxygen supply to the brain is quickly restored and symptoms disappear. A transient stroke needs prompt medical attention because it indicates a serious risk of a major stroke. Cerebral thrombosis is when a blood clot (thrombus) forms in an artery that supplies blood to the brain. Blood vessels that are furred up with fatty deposits (atheroma) make a blockage more likely. The clot prevents blood flowing to the brain and cells are starved of oxygen. Cerebral embolism is a blood clot that forms elsewhere in the body before travelling through the blood vessels and lodging in the brain. In the brain, it starve cells of oxygen. An irregular heartbeat or recent heart attack may make you prone to forming blood clots. Cerebral haemorrhage is when a blood vessel bursts inside the brain and bleeds (haemorrhages). With a haemorrhage, blood seeps into the brain tissue and causes extra damage. (2009) (Meningitis). Available from http://www.nhs.uk/conditions/Meningitis/Pages/Introduction.aspx. [Accessed Feb. 24, 2010] These are the graphs showing the rates of Meningitis and Cardiovascular Accident here in United Kingdom. Source: PHLS Meningococcal Reference Unit Disease Trends Group B- unvaccinated Meningococcal serogroup C Group C- vaccinated with Meningococcal serogroup C conjugate vaccine (MCC) Others Ungroup This graph table shows the effectiveness of meningococcal conjugate vaccine from 1998 2007. As we have seen in the figure, the case reduces every year especially to those who have taken the vaccine. It also shows the successful phased introduction of the meningococcal serogroup C conjugate vaccine (MCC) in 1999 into the National Immunisation Programme in the UK. This graph tells also that the immunity to Meningitis C has been identified in age groups who have not been vaccinated, as bacterium carriage rates are reduced across the population. We can see also in this table that those who didnt take meningococcal vaccine were greatly affective by Meningitis. Source: NOIDS England Wales Final Midi Report for 2005 (Table 3 Final totals for 2005 by sex and age-group) Prevalence of Bacterial Meningitis and Septicaemia by Age Group In this table, we could conclude that ages under 1-4 years old was greatly affected by meningitis as we have seen in the peaks of the graph and 0-11 months was greatly affected by the Pneumococcal and Meningococcal disease. And the same peaks in the number of notifications for the under 4 years and 15-24 age groups can also be seen with meningococcal septicaemia. Source: NOIDS England Wales Final Midi Report for 2005 (Table 3 Final totals for 2005 by sex and age-group) Prevalence of Bacterial Meningitis (without Septicaemia) by Age Group This graph shows the high number of notifications of meningococcal and pneumococcal meningitis (without septicaemia) in England and Wales. Observing this graph will note us that the cases in 2005, age group that is 1 year of age are greatly affected with Meningococcal Meningitis and Pneumococcal Meningitis and 15 to 24 years of age were averagely affected with the certain disease. It also illustrates us that among the group cases under 1 year of age gets the highest peak in having Pneumococcal disease. It is also interesting to note that the pneumococcal meningitis peaks again in the older age groups (45-64 and 65+). Top of Form Bottom of Form This graph shows all the percentages of all six categories are experiencing stroke. Figures for males are in dark gray bars and data for females are in light gray bars, with the number of patients in each age category shown above each bar. All data are patients who are experiencing stroke or CVA. As we observed in the graph the age group from 30 to This illustration shows the Incidence Rate of stroke in United States and United Kingdom. Details are articulated as person per year having stroke in 7 age categories. Individual experiencing strokes, person-years of follow-up was defined as the number of years from birth to the date for first recorded stroke. For individual without strokes, person-years of follow-up were defined as the last available follow-up date during the natural history period. Stroke incidence rates are revealed in data chart beneath the graph. As you see the data its very clear that a UK male has the highest incidence rates. UK Females, US Males and US Females are mostly like has the same incidence rate in occurrence of CVA. In this part, I will choose at least two approaches and strategies that control the incidence of one disease and analyse its effectiveness: As prevention of these diseases and to decrease its rate Department of Health and National Health Services make strategies and campaign to attain their goals. Department of Health formulate the Meningitis C Campaign the purpose of the this campaign was to immunise as many as possible of the countrys 15 million young people and children aged under the age of 18 years in as short a time as possible, immunising those most at risk of disease first. Carrying out of the programme was made according to the risk of disease-those at utmost risk being immunised first. In November 1999, National Childhood Programme introduces the routine immunisation of vaccine at the ages of two, three and four months alongside the DTP, Hib and polio vaccines and in December 1999 adolescent that ages 15 and 17 was also immunised. As a result of the campaign there are around 13 million children have immunised during the first year through the help of general practitioners, nurses, immunisation coordinators and many other health professional. This was pursuing by a widespread draw alongside programme to immunise all other children and adolescents up to the age of 18 years in 2000/2001.   After that the vaccine was made accessible to anyone up to 25 years. National Health Services contributed also a meningitis prevention program here in United Kingdom. The Campaign to promote new Vaccine against Meningitis, this program encouraged all parents to immunised their children against pneumococcal disease which is the causative agent of meningitis. General Practitioners has the big role of this campaign because they are the who will catch-up the campaign for the children ages 0 2 years who is starting their immunisations. This program was imposed by Health Minister Dr. Brian Gibbons. He states that: Immunisation is the best way to protect children from serious disease and the routine childhood programme has been extremely effective in achieving this. The changes will further improve the programme and benefit children. This new vaccine will help save lives and prevent hundreds more cases of serious illness such as meningitis and pneumonia. To maximise the defence against Meningitis C and Hib disease NHS made two changes in the routine program. The present three doses of Meningitis C vaccine will be respaced at three and four months of age with a booster shot at 12 months. Most up-to-date proof shows that the protection offered by this vaccine declines one year after vaccination. To maximise the protection in the first two years of life when the risk of infection is high, we will recommend doses at three and four months of age and a booster dose at 12 months. A booster shot of Hib vaccine will be given at 12 months. In 1992 Hib vaccine was introduced and is presently given to children at two, three and four months of age. Since 1999, there was a small but slow increase in the number of cases in older children being reported. Again, because of this Meningitis prevention program, the disease declined over time. There was a Hib booster campaign happened in 2003. This dose was given to older children to maximise their immunity. This upturned the small increase in infections that had started to occur. A booster dose of Hib vaccine is being added to the childhood immunisation programme as a routine at 12 months to extend protection against Hib disease. The new routine vaccination schedule is as follows: 2 months DTaP/IPV/Hib + pneumococcal vaccine 3 months DTaP/IPV/Hib + MenC vaccine 4 months DTaP/IPV/Hib + MenC + pneumococcal vaccine 12 months Hib/Men C 13 months MMR + pneumococcal vaccine DTaP/IPV/Hib is a single injection that protects against diphtheria, tetanus, pertussis, polio and Hib. MenC protects against meningitis C Hib/ MenC is a combined vaccine protecting against Hib and Meningitis C (2009)( Campaign to promote new Vaccine against Meningitis ) available from www.immunisation.nhs.uk. [Accessed at February 24, 2010] Due to this campaign the rate of meningococcal infection has fallen every year since, and the cases of laboratory-confirmed group C meningococcal disease across all age groups immunised has go down by 90% since the vaccine was implemented. In 2003/04, there were only 65 cases reported and 8 deaths. There was even a good effect in those who were not immunised with a reduction of about 70%, recommending that the vaccine has had a community protection effect. In fact the campaign has been so successful that meningitis C disease now accounts for less than 10% of meningococcal meningitis cases. Even though the campaign made a great success still the health officials and medical professionals need to remain cautious. (2010) ( Meningitis C Campaign) available from http://webarchive.nationalarchives.gov.uk. [Accessed at February 24, 2010] . For Cardiovascular Accident prevention, Department of Health formulated new strategies to fall its rate. They formulated the Stroke: Act F.A.S.T. awareness campaign; F.A.S.T means Face, Arm, Speech, and Time. The Stroke: Act F.A.S.T. awareness campaign aims to teach all health related professionals and the community on the signs of stroke and that prompt emergency treatment can reduce the risk of death and disability. The campaign will notify the community about F.A.S.T. to call 999. F.A.S.T is a simple examination to help people to identify the signs of stroke and be aware of the importance of fast emergency management. Campaign adverts, on Television, radio, internet and flyers, illustrate stroke spreading like fire in the brain to demonstrate that fast emergency action can limit damage and radically raise a persons probability of surviving and of avoiding long-term disability. (2010)( Stroke: Act F.A.S.T. awareness campaign ) available from http://www.dh.gov.uk/en/Publicationsandstatistics. [Accessed at February 24, 2010] If Department of Health has its campaign towards CVA, National Health Services provide also a program to lessen its incidence rate; The National Stroke Awareness Campaign. This campaign is related to F.A.S.T were NHS implemented that all paramedics should know how to assess a person using F.A.S.T before sending them to hospital. They also made a Stroke Association who will support this campaign. This kind of charity is exclusively concerned with fighting stroke towards people in all ages. The charity resources research into prevention, treatment, better methods of rehabilitation and facilitates stroke patients and their families directly through its Rehabilitation and Support Services which include Communication Support, Family and Carer Support, information services, welfare grants, publications and leaflets. In this part, I will investigate current priorities and approaches to the provision of heath services for people with one disease: Treating Meningitis is not easy thing to do because this disease has various types, viral and bacterial meningitis. There is no treatment for Viral Meningitis. The immune system, will create antibodies to annihilate the virus. Until it is known that a child has viral, not bacterial meningitis, he or she will be admitted to the hospital. But once the finding of viral meningitis is complete, antibiotics are stopped, and a child who is recuperating satisfactorily will be sent home. Simply acetaminophen must be given to lessen fevers. Clear fluids and a bland diet including preferred foods should be offered. During recovery, a child desires rest in a gloomy, quiet room. Bright lights, noise and guests may irritate a child with meningitis. Increased anxiety on the brain from build-up of fluid in the meninges is a severe problem. (2010)(Viral Meningitis) available from: http://www.healthscout.com. [Accessed at February 24, 2010) For Bacterial Meningitis may prove fatal within hours. Patients with suspected acute bacterial meningitis should be immediately admitted to the hospital and assessed for whether LP (lichen planus) is clinically safe. Antimicrobials should be given quickly. If LP is late because a CT scan is essential, antibiotic action should be started before the scan and after blood samples have been attained for culture. When the exact organism is recognized and results of susceptibilities are known, treatment can be customized accordingly. After the diagnosis has been confirmed (generally within 12-48 hours of admission to the hospital), the patients antimicrobial therapy can be modified according to the causative organism and its susceptibilities. Supportive therapy, such as fluid replacement, should be continued. Dexamethasone should be continued for Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitides. S pneumoniae (duration of therapy 10-14 days) Penicillin susceptible (minimum inhibitory concentration [MIC] Penicillin intermediate (MIC = 0.1-1.0 microgram/mL): cefotaxime or ceftriaxone Penicillin resistant (MIC à ¢Ã¢â‚¬ °Ã‚ ¥2.0 microgram/mL) or cephalosporin-resistant (MIC à ¢Ã¢â‚¬ °Ã‚ ¥1.0 microgram/mL): vancomycin AND cefotaxime or ceftriaxone. H influenzae (duration of therapy 10-14 days) Beta-lactamase-negative: ampicillin Beta-lactamase-positive: cefotaxime or ceftriaxone. Streptococcus agalactiae (group B streptococci) (duration of therapy 14-21 days) Gentamicin AND ampicillin or benzylpenicillin. Escherichia coli and other gram-negative Enterobacteriaceae: (duration of therapy 21-28 days) Gentamicin AND cefotaxime or ceftriaxone. Listeria monocytogenes (duration of therapy 21-28 days) Gentamicin AND ampicillin or benzylpenicillin. Staphylococcus aureus (duration of therapy depends on microbiological response of CSF and underlying illness of the patient) Methicillin susceptible: nafcillin or oxacillin Methicillin resistant: vancomycin. Staphylococcus epidermidis (duration of therapy depends on microbiological response of CSF and underlying illness of the patient) Vancomycin. Pseudomonas aeruginosa (duration of therapy 21 days) Ceftazidime and gentamicin. Enterococcus species (duration of therapy 21 days) Ampicillin and gentamicin. Acinetobacter species (duration of therapy 21 days) Gentamicin and meropenem. N meningitides (duration of therapy 5-7 days) Penicillin susceptible (MIC Penicillin intermediate (MIC = 0.1-1.0 microgram/mL): cefotaxime or ceftriaxone. (2010) (Bacterial Meningitis) available from: http://bestpractice.bmj.com. [Accessed February 24, 2010] In this part, I will explain by giving examples, the relationship between the prevalence of one disease, its causes and the requirements for health and social care services: Nowadays United Kingdom is still cautious about Meningitis even though the incidence rate is already decreasing radically. To be safe, health organisation are prioritising women and childrens health. They develop a guideline which suggest about ma

Growing afraid Essay

Pip describes the afternoon as being â€Å"raw†, which describes the bitterness of the weather, the weather is almost attacking Pip. The graveyard can be described as very old because â€Å"overgrown with nettles† lays a churchyard, which is uncared for and in an instant it could just crumble away. Pip again adds significant words, as he repeats all of the names on the gravestones, â€Å"Alexander, Bartholomew, Abraham, Tobias and Roger† that have died in this harsh place, Pip reads it as if it were a list with so many people there, who have been there for a long period of time. â€Å"Dark, flat, wilderness beyond the churchyard† again explains the lack of community and the Isolation around the area. Dickens personifies wind as the â€Å"wind was rushing†, as if it were â€Å"rushing† to get Pip who was at the time a â€Å"small bundle of shivers† growing afraid. The marshlands had an effect not only on Pip, but the convict also, the convict had been â€Å"smothered in mud and lamed by stones and cut by flints, and stung by nettles and torn by briars†, showing he had escaped for a long time and had spent most of his time hiding in the marshlands. As the convict roughly treats Pip, he tilts him over, gradually down to the floor, he gives Pip a greater â€Å"sense of helplessness and danger† which adds to the atmosphere significantly. Toward the end of the chapter, a sad atmosphere is created, as the convict â€Å"hugged his shuddering body in both arms clasping himself as if to hold himself together†. The convict limps toward the â€Å"low church wall† producing an image of one who is close to death. Pip creates another childish imagination but this one describes the dead rising up â€Å"stretching up cautiously out of their graves†, showing how much fear he had in him at the time. The marshes are depicted as just a â€Å"long black horizontal line† with the sky being â€Å"just like a row of long angry red lines and dense black lines intermixed†, describing the darkness, and anger in Pip’s world. Charles Dickens leaves you with eerie images of death, of a limping man, as if he were a â€Å"pirate come to life and come down and going back to hook himself up again. We are introduced to Miss Havisham first as an â€Å"immensely rich and grim lady†, a notorious woman who lived in a large house that was heavily barricaded against robbers. She is described as living a life of â€Å"seclusion† which leads us to believe that she is isolated, miserable and depressed. Pip describes her as being the â€Å"strangest lady† he had ever seen. She was dressed in rich materials, satins, lace and silks, all that are symbols of wealth. She had a â€Å"long white veil dependent from her hair† which makes us believe that she is a bit odd wearing bridal wear for no apparent reason. Her hair was white which symbolizes that she is quite old. Another symbol of wealth is created because she had some bright jewels sparkling around her neck. Pip states that the â€Å"bride within the bridal dress had withered like the dress† which is another clue to her being quite old. We are given another unhealthy image of Miss Havisham, of her dying, the book reflects this by stating that there was â€Å"no brightness left but the brightness of her sunken eyes† and her figure had â€Å"hung loose† and had â€Å"shrunk to skin and bone†. She states that she had never seen the sun since she was born, this makes the reader feel that she is again isolated and hiding away from life outside. She is also a cold-hearted person, because she says that her heart was broken with an eager look on her face. We learn that she despises adults, and that she acts like a child, the novel portrays this by stating that she has â€Å"sick fancies† and she orders Pip with an â€Å"impatient movement of the hand† to play. When Estella came to play with Pip, Miss Havisham says to Estella that she can break Pips heart, this indicates that Miss Havisham has set out to seek revenge on men, and that is one of the reasons why she brought Pip to her house. There is a sense that life has ceased for Miss Havisham, the book shows this by stating that her silk stocking â€Å"once white, now yellow had been trodden ragged†. Pip says that the frillings and trimmings on her bridal dress looked like â€Å"earthy paper† which describes it as being fragile, like Miss Havisham herself. After Pip had finished playing cards with Estella, Miss Havisham states â€Å"You shall go home soon†, â€Å"Play the game out† this illustrates to the reader that she is depressed and emotionally hurt, and is not to used to the company of others, so she sends him away. She had an appearance of â€Å"dropped body and soul, within and without, under the weight of a crushing blow† which leads us to believe that the marriage which didn’t take place, has caused her to drop her body and drop her soul. Miss Havisham once again thinks highly of herself, acting as if she owns Pip, she expresses this by stating â€Å"When shall I have you here again? â€Å". We also learn that she is a misguided woman because she says she doesn’t know anything about the days of the week, or the weeks of the year. We first learn that Estella is selfish and speaks in an scornful manner to anyone she isn’t familiar with, the evidence of this is that after Pip politely said that she could go in first, she replied by saying â€Å"Don’t be ridiculous boy; I am not going in† and she also left Pip in the dark by taking the candle with her. When Pip called her name out to play with him, she didn’t come straight away, she took her time, deliberately trying to be awkward. When Miss Havisham tried the jewel on Estella, she obviously had intentions for her to get married. Estella thinks she is better than Pip, the evidence of this is that when she was ordered by Miss Havisham to play with Pip, she replied â€Å"With this boy! Why he is a common labouring boy! â€Å". When Estella asked Pip what games he played, she asked it in the â€Å"greatest disdain† which makes us believe she is strict and again scornful and looks down on lower classes. Estella is used as a weapon, a heartbreaker by Miss Havisham, who as we know wants to treat men as she was treated, Miss havisham illustrates this by stating â€Å"beggar him† to Estella. Estella has no respect for Pip and thinks highly of herself and no one else, the evidence of this is that she says, â€Å"he calls the knaves, jacks this boy! † and â€Å"what coarse hands he has†. This leaves an effect on Pip as he becomes ashamed of his hands. She was watching Pip creating tension, trying to make him do wrong, so that she could insult him more on his faults. Pip tells us this by stating â€Å"she was lying in wait for me to do wrong; and she denounced me for a stupid, clumsy labouring boy† As Pip was whispering to Miss Havisham, even though she wasn’t saying anything, Estella was making Pip say nice things about her with her eyes, the evidence of this is that she was looking at Pip with look of â€Å"supreme aversion†. As the game between Pip and Estella finished, Estella threw all of the cards down as if she â€Å"despised† them for having been won of Pip, this shows that Estella is spiteful, treats Pip disdainfully and she is very proud. Estella was to told feed Pip, so she put the food down on the ground without looking at Pip as if Pip was a â€Å"dog in disgrace†, this shows that Estella again thinks Pip as being lower class and she has contempt for Pip. Estella had made Pip cry, she looked at him with quick delight as being the cause of the tears, this proves she has no feelings and is satisfied for making him cry, this makes her not a likeable character at all. The first Impressions of Miss Havisham`s house is that it is a huge house filled with mystery, â€Å"dismal house, barricaded against robbers† which reflects the owner’s feelings. The house can furthermore be described as bleak and nervous for anyone who approaches it, with its â€Å"great front entrance† having two chains across it. It is a dark, gloomy place, with a sense of bad experiences. The text tells us this by stating, â€Å"the passages were all dark†¦ and still it was dark, and only the candle lighted us†. Miss Havisham`s room was also dark, she obviously prefers darkness, and all of the candles represent the light in the room, the evidence of this is that â€Å"a pretty large room, well lighted with candles† and â€Å"no glimpse of daylight was to be seen in it†. There is a sense of chaos in the room as everything is untidy, dresses and half-packed trunks were scattered about also Miss Havisham only had one shoe on. Everything was left as it was years ago, â€Å"all confusedly heaped about the looking glass†. Pip relates Miss Havisham to a waxwork he had once seen, with her skin sallow. He also makes a reference to death by describing a skeleton in the ashes of a rich dress. Miss Havisham is almost a ghost in her own house, the evidence of this is that â€Å"waxwork and skeleton seemed to have dark eyes that moved†. All of the watches and clocks in her room had stopped at twenty minutes to nine, which is deliberate and could be linked with her marriage that didn’t take place. Pip is made to feel vulnerable, he has no choice but to do what Miss Havisham says, this is because he had the â€Å"desperate idea of starting round the room† meaning that he had to embarrass himself in front of Miss Havisham. She asked Pip if he was sullen and obstinate, he is obviously very misunderstood. Miss Havisham becomes frustrated with him and pitiful for him, the book expresses this by stating â€Å"So new to him† â€Å"So old to me† â€Å"So melancholy to both of us! † Miss Havisham again makes Pip feel discomfort as he is made to shout out â€Å"Estella† in a dark and â€Å"mysterious passage of an un-known house† again he is made to embarrass himself. Another sense that life has seized for Miss Havisham is that there are â€Å"pale, decayed objects† which also creates a deathly and unsettling atmosphere. Pip also describes her clothes as â€Å"grave-clothes† and her â€Å"long veil looking like a shroud† both of which are linked with a corpse. As Pip leaves Miss Havisham`s house, he states that the â€Å"rush of daylight† quite confounded him, this is another clue that the house is a very dark place. Toward the end of the chapter, we feel pity for Pip, because Estella treats him so badly, but he is strong because he refuses to cry in the presence of her, even though his feelings are â€Å"bitter†. This also shows that he wishes he had come from a family who were more of an upper class, than the family he was brought up with, because then maybe Estella would have treated him better.

The Border Security, Economic Opportunity and Immigration...

Everything changed after the terrorist attack in 2001, making most of the American public scared of future terrorist attacks increasing their negative thinking toward immigration. After that horrible day, the government started making changes to their immigration policies, therefore creating awareness of immigrants. These biased thoughts about immigration create concern and angst towards these groups, which lead to prejudices. The media also likes to use realistic threats toward the American people including realistic threats to one’s health, including physical harm or loss of resources. Including immigrants in American society would also threaten the beliefs, values, and ways of life according to the media. Another frame used is one of intergroup anxiety, making society afraid to be rejected by the out group, making American citizens feel more senses of nationalism, decreasing their openness towards immigrants. Political conservatism is a major factor that impacts the way the se threats are perceived, creating fear and anxiety. According to Jost, Glaser, Kruglanski, and Sulloway, â€Å"Political Conservatism is associated with motivational concerns related to the psychological management of uncertainty and fear† (asap) and it is backed up by a set of motives such as intolerance of ambiguity, need for order, structure, and closure. Political conservatism creates conservative newspapers that are more likely to frame the immigration problem in terms of threats towards the AmericanShow MoreRelatedThe Border Security, Economic Opportunity, And Immigration Modernization Act Of 20131776 Words   |  8 Pagesthe â€Å"Border Security, Economic Opportunity, and Immigration Modernization Act† and the â€Å"Safe Communities, Safe Schools Act of 2013.† This assignment seeks to answer why these bills have failed to make it through Congress. 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Illegal immigration, or undocumented immigrants, refers to foreign people entering the United States without government permission or violating the immigration law. This is typically done by sneaking into the country or

The Ten Business Principles As Defined By Greg Fisher

Business Principles In this week’s discussion I will review the ten business principles as defined by Greg Fisher. I will then choose three principles to discuss. I will then explain the business principles that are utilized in my facility, as well as those that are not currently utilized. Upon describing the ones not utilized, I will then give examples on how they can possibly be implement into the facilities practice. In closing I will discuss what principles are and which ones are not important to healthcare system. The health care system in the United States is known for being one of the most costly systems in the world. In 2010 the Affordable Care Act, (ACA) was implemented with the hopes of reshaping the system and decreasing the healthcare cost, (Mason, Gardner, Outlaw, O’Grady, 2016). . Somewhere along the way our country made healthcare a business. Understandings our country healthcare finances can be quit complex. In order to be successful the Chief Nursing Officer, (CNO), business owners and directors must understand the business principles. These individuals are placed in leadership role and therefore must have the characteristics of a leader, (Huber, 2014) The first business principle that I chose, was principle #2 â€Å"Decide who you serve†. In this principle we focus primarily on who we will be serving, (Fisher, 2008).. These individuals are now known as our target group. By having a target group we may focus our care on their needs. I chose thisShow MoreRelatedBrand Community9592 Words   |  39 Pagesclosely, a number of firms with a devoted consumer following, such as: Harley Davidson, Jeep, Apple Computers and Saturn also have a highly visible â€Å"brand community† (Muniz and O’Guinn 2001) or â€Å"brand club† (Langer 1997). 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