English Essay - 1042 Words

Distinctively visual representations allow the audience to envisage different purposes crafting emotions which stay with us forever. Graphic depiction is a fundamental characteristic within distinctively visual, thus the audience is able to be exposed to the intense illustrations exemplified by composers. Spudvilla’s portrayal of â€Å"Woolvs in the sitee† demonstrates the child’s inability to reconcile with himself. Contrasting to this notion; the playwright â€Å"Shoe-horn Sonata† to expose the brutal reality of POW camps during WWII. Therefore, distinctively visual forces the audience to succumb to the barriers society creates. It is through distinctively visual representations and graphic depiction that allows the audience to develop a sense of†¦show more content†¦Graphic depictions develop a strong clarification, which enables the audience to illustrate illusions of reality. Misto illuminates social realism through the use of props such as the motel room; fridge, bed, table and suitcases, creating a realistic scene which also develops stage direction and setting. This intrigues the audience into a â€Å"real life† re-enactment developing the feeling of being a part of the play and the reality of war. Misto manipulates our emotions through the use of stage directions exposing a certain mood, mastering characterisation throughout the playwright. This creates an instant connection to the past which adds immediacy to the actions occurring, providing the audience with a profound understanding of Bridie and Sheila. Misto’s clique use of costumes for the women express individuality of Bri die and Sheila, insisting the audience that the two women have respect for themselves and always appear presentable, such as Sheila with her gloves, illuminating the women’s age and era the play was set in. The composer illustrates vivid images to support the theme and context of war. Distinctively visual images represent and secure the audience’s mind and emotions. Human senses profoundly distinguish emotions through the use of unambiguous graphics. Distinctively visual images trigger and engage the full dimension of human resilience essentially manipulating the audience’s emotions. Spudvilla exemplifiesShow MoreRelated Goals for English Essay984 Words   |  4 Pagesgoals in life, you’re going to do anything and everything to accomplish those goals. Therefore why not set higher goals that you will endeavor just with diminutive amount of more effort? One semester of English has gone by and theres another semester to go. Even though I have done fairly well in English the first semester, I would like to do even better the second semester. I can only do better if I have a plan and this plan is the different types of goals I am going to set for myself. You can’t beRead MoreEnglish 111 Evaluation Essay623 Words   |  3 PagesEnglish 111 introduces students to critical thinking and the fundamentals of academic writing. This is a prerequisite English class for higher-level English education. By the end of this course a student will have gained a great deal of practice in the craft of writing. This essay will evaluate the English 111 textbooks, essays, self-reflections, the instructor, and what I personally learned. The English 111 textbook had effective sample essays and diagrams of outlines. The Successful CollegeRead MoreEnglish: Essay and Film Study1298 Words   |  6 Pages Mary Ellen Zaglewski English 1101, Fall 2012, CRN 86404 TR: 9:50-11:05 G211 CRN 89139 TR: 11:15-12:30 G221 Office Hours: 11:30-3:30 MW, 3:30-5:30 TR, others by appointment. Office: G110K E-mail: maryzaglewski@clayton.edu Phone: 678-466-4880 Clayton State University - English 1101 Course Syllabus Course Title: English Composition I Course Description: This course focuses on skills required for effective writing in a variety ofRead MoreEnglish Composition One: To Be an Essay or Not to Be an Essay That Is the Question910 Words   |  4 Pages In the past, the mention to have to write a paper for an assignment caused me to break out in a sweat or my mouth instantly dries, well it does not have that kind of effect on me anymore. The key to successfully completing the essay on time is getting to research the topic at hand as soon as possible or before the process of writing begins. The next step for me would be to find the argument and take a side. Moreover, picking a thesis statement through brainstorming the information I gathered forRead MoreReflecting on English Class 111 Essay703 Words   |  3 PagesReflecting on English 111 My experience into English 111 not only left me anxious, it became a self-revelation. My learning capabilities were challenged because writing did not come natural and the possibility of becoming a prominent writer were going to take a lot of time, effort and hard work. In spite of not knowing what to expect, I entered into this new semester pumped up carrying an â€Å"I can do this† attitude and feeling confident. Oh boy was I scared into complete and utter silence onRead More Teachers Assessment of Writing in English Essay1751 Words   |  8 Pagesaspect of being an English teacher, for me, is assessing my students’ writing. I can remember, so clearly, the day my cooperating teacher handed me a student’s writing and said, â€Å"Read this and give it a grade.† After reading it, I felt an overwhelming and uncomfortable power shadow over me. I didn’t know the rules of assessment. What was I supposed to be looking for anyway? I was able to realize immediately that there is a definite difference between knowing how to write an essay and knowing how toRead More My experience throughout English 101 Essay599 Words   |  3 Pagesthroughout English 101   Ã‚  Ã‚  Ã‚  Ã‚  As writers, many students write to the expectations of their professors and not to their fullest potential. Throughout English 101 I had been writing only to please my professor or to fill the basic requirement to pass English. I always felt that my writing ability was never enough for my professors throughout the previous years. They always wanted clear and concise essays, which for some reason was unreachable by me. However, starting college and taking English 101 helpedRead More My Struggles with English Composition Essay769 Words   |  4 PagesStruggles with English Composition â€Å"†¦As for all the seniors, I want you to challenge yourselves this year and don’t think you’re going to cruise through to graduation.†-Mrs. Smith, County High School. Although some seniors in high school refuse to take a hard schedule, I decided to take a challenging composition course my last year of high school and learned more than ever before from it. My teacher, Mr. Bacz, focused mostly on vocabulary, grammar, and how to right an essay. Each one of theseRead MoreFormal English Essay1311 Words   |  6 Pagesliteracy and language. The writer Helen Keller wrote The Day Language Came into My Life, an essay where she tells the reader her experience with how she learned how to speak, read and write even though she is blind and deaf. Amy Tan wrote Mother Tongue, an essay where she talks about the trouble of speaking English as an immigrant in a new country. Frederick Douglass wrote Learning to Read and Write, an essay where he talks about becoming li terate during a time when slaves were not allowed to readRead MoreEssay about What I Have Learned in My English Writing Class1064 Words   |  5 Pages I have learned many things throughout the course of the term, including such things as: how to write an essay and how to improve on essays that I have already written, how to locate and composite better research through the use of numerous resources found at the campus library, the internet, and the â€Å"Common Sense† textbook, how to cite research, examples, and quotations properly within the contents of my research paper as well as document it accurately according to MLA standards. Through the

What is Beauty - 1209 Words

According to Oxford Dictionary, beauty is defined as â€Å"a combination of qualities, such as shape, color, or form that pleases the aesthetic senses, esp. the sight†. Over a long period of time, the meaning of beauty has changed. The way beauty was seen in the past, have been slightly modified into something totally different today. For many years, there has been that one question that has not been proven, even until now. There are few people who have their own opinion on this issue. There have been many ancient philosophers who have debated on this such issue. Are individuals actually looking or acting as themselves, or is it all an act to fit in with the society? Does each person have their own perceptive on beauty? Is the whole world just pretending to be someone else? Are people dressing or behaving in such way they can impress society? For centuries, beauty has been debated if it was either determined by individual or by society. David Hume explored the view of beauty a nd believed beauty is individual. He felt each person have their own perspective of beauty. There are few people that try to be different from other as much as possible, but the way society thinks of them changes them completely. Conversely, philosophers such as Hegel and Edmund Burke argued that beauty is determined by society. Aristotle, famous Greek philosopher, has also agreed with what David Hume’s theory of beauty. He believed beauty of a person has so many identities that make them who they are.Show MoreRelatedBeauty : What Are Beauty?891 Words   |  4 Pages What is Beauty? Beauty in my opinion is all about who is perceiving it, although there are many things that can be widely accepted as beautiful, whether it s a bountiful orchard of apple trees or the deep vast ocean blue with the waves cascading down with the mystery of life looming in the depths beneath. Beauty can be described as the fresh snow glistening on the pine trees with deer majestic in their natural glory and fat, fluffy hares dancing playfully in the snow or birds in song singing toRead MoreWhat is Beauty Essay977 Words   |  4 PagesThe ideal of what beauty really is changes in our society from time to time. Everyone has their own opinion of what is beautiful. However the opinion that people mostly tend and heed to is that of the prominent and influential characters in today’s society. Those who claim to know what true beauty is and impel humanity to do and be what they want, as if people were their puppets. Television, magazines, and advertisements play an imm ense role in this. Playing with emotions and ridiculing those ‘notRead MoreWhat is Beauty? Essay716 Words   |  3 Pages The common clichà © goes â€Å"beauty is in the eye of the beholder.† Is there any real meaning to that? The expression simply means that beauty has no set meaning, definition, or even value for that matter. It is a collectively undecided notion, since its definition lies solely in observation. It also implies that each individual may interpret the idea of beauty (of people, objects, thoughts, etc.) according to his/her own biased, genetic, emotional, cultural, social, and spiritual needs. HavingRead MoreWhat is Pure Beauty?1540 Words   |  7 PagesEveryone has their own idea of what pure beauty is. According to Websters Dictionary, the definition of beauty is â€Å"the quality or aggregate of qualities in a person or thing that gives pleasure to the senses or pleasurably exalts the mind or spirit† (â€Å"Beauty†). However, the definition of pure beauty has become warped and manipulated into a standard that only a select few can achieve. Nonetheless, beauty is more than what is behind the counter and computer. With these high criteria societyRead MoreWhat is Beauty? Essay704 Words   |  3 PagesWhat is beauty? How do we decide who is attractive and who is not? Society is full of information telling us what is beautiful, but what fact is that information based on? The topic of beauty has been studied, analyzed and controversial for centuries. We all know the feeling you can have when you hear a beautiful song that brings joy to your heart, stand in a field of flowers that excites your eyes, or admire a face that is visually pleasing. As human beings, we are all drawn to beauty, but whatRead MoreWhat is Beauty? Essay1385 Words   |  6 PagesWhat is beauty? People have always attempted to find, create, and pursue it. A quick checkout at the grocery store will reveal a plethora of magazines devoted purely to what they call beauty and the proper pursuit of it. Most have an idea of what they might personally define as beauty, but not as a general, sweeping definition. That which one might la bel ugly another might call absolutely stunning. Some find beauty in cats, others in dogs, just as some favor early morning mountain ranges over a sunRead MoreWhat Does Beauty Mean?1433 Words   |  6 PagesWhat does beauty mean to you? Often times people surgically change their appearance to feel better about themselves. A Majority of the time people are unsatisfied with their bodies, so they alter their looks. These individuals look up to celebrities who have paid thousands of dollars to look a particular way. Cosmetic surgeons are being bombarded by star struck clients demanding specific features of celebrities. Some of the victims believe that getting surgery to look like a celebrity will putRead MoreWhat Is The Story Of Martins Beauty?1708 Words   |  7 Pagessmoking hot, but she couldn’t tell him that. Before she would have joked around about his good looks and how he could make a paper bag look good. But as she took in his casually striking appearance, all those j okes seemed wrong. She still wasn’t sure what had changed between them but things felt different. A sexual energy surrounded them that had never been there before. She felt flirty and feminine in her new clothes. More daring than she had when she woke up that morning. More confident too. She liftedRead MoreMedia Influence on What Is Beauty Essay1481 Words   |  6 PagesEveryone has a different view of what is beautiful. Why are we never happy with how we look? Why are we so quick to compare ourselves to others? The simple answer to these questions is: Media. The media is constantly showing images of what is considered beautiful. These images greatly affect society and often impact the way people view themselves. Most of these images are unrealistic, and send unhealthy expectations to women; however most women are willing to do anything they can to achieve thisRead MoreWhat is Beauty: Unrealistic and Unobtainable Essay954 Words   |  4 PagesWhat is Beauty: Unrealistic and Unobtainable For centuries mankind has unsuccessfully attempted to define beauty. Greek philosophers, including Plato, tried to define beauty as if it were as simple as any other law in nature. However this cannot be so because the idea of what is beautiful has varied throughout cultures and the ages. In the 1800s women who were pale and rather plump were considered objects of desire; but in today’s society, desirable women are slender and tan, among other things

Child Labour in Pakistan free essay sample

Children are the flowers of heaven. They are the most beautiful and purest creation of God. They are innocent both inwardly and outwardly. No doubt, they are the beauty of this world. Early in the morning when the children put on different kinds of clothes and begin to go to schools for the sake of knowledge, we feel a specific kind of joy through their innocence. But there are also other children, those who cannot go to schools due to financial problems, they only watch others go to schools and can merely wish to seek knowledge.It is due to many hindrances and difficulties; desperate conditions that they face in life. Having been forced to kill their aspirations, dreams and other wishes, they are pressed to earn a living for themselves and for their families. It is also a fact that there are many children who play a key role in sustaining the economically life of their family without which, their families would not be able to make ends meet. We will write a custom essay sample on Child Labour in Pakistan or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page These are also part of our society who have forgotten the pleasures of their childhood.When a child in addition to getting education, earns his livelihood, this act of earning a livelihood is called as child Labour. The concept of child Labour got much attention during the 1990s when European countries announced a ban on the goods of the less-developed countries because of child Labour. The International Labour Organization (ILO) defines child Labour as: 1- when a child is working during early age 2- he overworks or gives over time to Labour 3- he works due to the psychologically, socially, and materialistic pressure 4- he becomes ready to Labour on a very low payAnother definition states: â€Å"Child Labour† is generally speaking work for children that harms them or exploits them in some way (physically, mentally, morally or blocking access to education), United Nations International Children’s Emergency Fund(UNICEF) defines â€Å"child† as anyone below the age of 18, and â€Å"child Labour† as some type of work performed by children below age 18. (UNICEF) Child Labour is an important and a serious global issue through which all and sundry countries of the world are directly or indirectly affected, but, it is very common in Latin America, Africa and Asia.

The Ethics of Xenotransplantation an Example of the Topic Science and Technology Essays by

The Ethics of Xenotransplantation Technology has come up with a lot of advances and further development in the lives of humans. Continued efforts of scientists, engineers and other professionals to design and develop tools to address the specific needs of people brought numerous recognitions from those who benefitted on their study. Though research and development, they came up with the realization of ideas and made what was impossible a few years ago. As a result many problems were resolved because of these inventions and ingenuities that humans established. Need essay sample on "The Ethics of Xenotransplantation" topic? We will write a custom essay sample specifically for you Proceed People Frequently Tell EssayLab specialists: How much do I have to pay someone to make my essay today? Essay writers suggest: Follow Essaylab Writing Service Essay Writing Company Affordable Papers Review Online Writing Help For College Students Cheap Essays Not Plagiarized A concrete example of such human ingenuity is the process of xenotransplantation that is now one of the current issues that brought a lot of controversy in the field of medicine and ethical standards. Many articles were written about this emerging approach in surgical procedure on humans. Xenotransplantation refers to the usage of a certain organ or any part of an animal kind to be transferred to a human being. Advocates of this principle stated the big potential of using this approach to provide treatment for those patients suffering from illnesses primarily caused by the organ dysfunction of the concerned patient. They claim that using the animal as the donor for the needed organ of the patient will answer the problem of availability of the human donor since all the organs will not necessarily be coming from a person. Another problem that will be resolved in adapting the system is the high costs of acquiring such organs. On the other hand, xenotransplantation also caused a lot of c ontroversy in many issues concerned. A clear argument that is being thrown to this surgical approach is that humans should not be transplant any organ that will come form any type of animal as its donor. It would be next to impossible for any patient to agree that this approach will be applied to him/her. Nobody would accept the reality of replacing his/her organ with an organ coming form an animal. Another argument throwing against xenotransplantation is on the side of religious people concerned with the sanctity of human body. They believed that a human body should be without any association with any kind animal parts which will be used in replacing the malfunctioned human organs of the patient. Moreover, many surgeons also disagree with the process of using animal organs to replace what is that on human internal structure. Many doctors still believe that the sole donor of a human patient is nothing else but a human also. They warn people of potential problems it might bring when this approach was finally implemented. They cautioned the people not to even attempt to undergo such procedures since could brought more problems rather than solutions. Another current problem this surgical principle is facing is the fact that up to now, only a few operations with xenotransplantation was proved to be successful. There was no clear indication that it was conducted many times and each attempts achieved better results. While the advocates of this principle admitted that more studies should still be made, there are already hindrances for the implementation of that approach. One particular reason is the possible transmission of disease should the animal donor possesses an infection that was not detected during the screening procedures by the medical surgeons. Another hindrance is the establishment compatibility checking techniques of the said organs before doing the surgery process. Many people do not conform to the fact that animal to human organ transplant should ever be given a try in a specific surgical procedure. It is true that people should always look for possibilities to resolve things that are facing the humanity which is the disease or any physical impairment but this should be based on moral standards and customs. Any new procedure or approach that involves human life needs in depth study and tests to prove its worth. After this strenuous methods, a new principle like xenotransplantation process maybe accepted by the people as an advancement in the field of surgical technology. References Veatch, R.( 2000), "The Ethics of Xenotransplantation" Georgetown University Press,Washington D.C.

iPod essays

iPod essays Who would of thought that such a small device could have such a huge impact on our society? Apples iPod wasnt the first MP3 player out on the market for consumers, but it continues to be one of the largest selling portable music machines to date. What started as a trend with very limited popularity is now booming with success. This stylish piece of hardware has over 3 million owners worldwide and is still growing rapidly today. Its hard to believe that something so simple in design could not only be so popular, but a cultural icon as well. The iPod share a little under half of all the units sold in the U.S., that means that while fifty-one percent of profits are going to other digital music players, the rest of the market is buying the iPod. Steve Jobs, CEO of Apple, laughs at the sight of huge groups wearing white headphones. And why not? By the year 2008, the projected sales of portable digital players are slated to rise almost three times more than they are now. One of the most appealing aspects of the iPod would have to be its size. Weighing in at around 5.6 ounces, who could resist the portable tunes holder that can carry almost ten thousand songs. The device itself is no bigger than a deck of playing cards, so its not hard to see how theyve become so popular. The iPod had changed the way we share and listen to music in a big way. I can still remember only being able to chose one disc to play when listening to my cd player. It was such a hassle to keep switching compact discs back and forth when you wanted to listen to a specific song. Now, Apple has made it as easy as the push of a button. You have the choice of thousands of songs at your fingertips. From hip-hop, pop, punk, rock and many others, owners are able to download any genre that they want. And with Apples iTunes program for both the PC and Mac computers, users can download their favorite songs for about a dollar per song. ...

The Kushan Empire

The Kushan Empire The Kushan Empire began in the early 1st century as a branch of the Yuezhi, a confederation of ethnically Indo-Europeans nomads who lived in eastern Central Asia. Some scholars connect the Kushans with the Tocharians of the Tarim Basin in China, Caucasian people whose blonde or red-haired mummies have long puzzled observers. Throughout its reign, the Kushan Empire spread control over much of Southern Asia all the way to modern-day Afghanistan and throughout the Indian subcontinent- with it, Zoroastrian, Buhhdism and Hellenistic beliefs also spread as far as China to the east and Persia to the west. Rise of an Empire Around the years A.D. 20 or 30, the Kushans were driven westward by the Xiongnu, a fierce people who likely were the ancestors of the Huns. The Kushans fled to the borderlands of what is now Afghanistan, Pakistan, Tajikistan, and Uzbekistan, where they established an independent empire in the region known as Bactria. In Bactria, they conquered the Scythians and the local Indo-Greek kingdoms, the last remnants of Alexander the Greats invasion force that had failed to take India. From this central location, the Kushan Empire became a wealthy trading hub between the peoples of Han China, Sassanid Persia and the Roman Empire. Roman gold and Chinese silk changed hands in the Kushan Empire, turning a nice profit for the Kushan middle-men. Given all their contacts with the great empires of the day, it is hardly surprising that the Kushan people developed a culture with significant elements borrowed from many sources. Predominantly Zoroastrian, the Kushans also incorporated Buddhist and Hellenistic beliefs into their own syncretic religious practices. Kushan coins depict deities including Helios and Heracles, Buddha and Shakyamuni Buddha, and Ahura Mazda, Mithra and the Zoroastrian fire god  Atar. They also used the Greek alphabet that they altered to suit spoken Kushan. Height of the Empire By the rule of the fifth emperor, Kanishka the Great from 127 to 140 the Kushan Empire had pushed into all of northern India and expanded east again as far as the Tarim Basin- the original homeland of the Kushans. Kanishka ruled from Peshawar (currently Pakistan), but his empire also included the major Silk Road cities of Kashgar, Yarkand, and Khotan in what is now Xinjiang or East Turkestan. Kanishka was a devout Buddhist and has been compared to the Mauryan Emperor Ashoka the Great in that regard. However, evidence suggests that he also worshiped the Persian deity Mithra, who was both a judge and a god of plenty. During his reign, Kanishka built a stupa that Chinese travelers reported as about 600 feet high and covered with jewels. Historians believed that these reports were fabricated until the base of this amazing structure was discovered in Peshawar in 1908. The emperor built this fabulous stupa to house three of the Buddhas bones. References to the stupa have since been discovered among the Buddhist scrolls at Dunhuang, China, as well. In fact, some scholars believe that Kanishkas forays into the Tarim were Chinas first experiences with Buddhism. Decline and Fall After 225 CE, the Kushan Empire crumbled into a western half, which was almost immediately conquered by the Sassanid Empire of Persia, and an eastern half with its capital in Punjab. The eastern Kushan Empire fell at an unknown date, likely between 335 and 350 CE, to the Gupta king, Samudragupta.   Still, the influence of the Kushan Empire helped spread Buddhism across much of Southern and Eastern Asia. Unfortunately, many of the practices, beliefs, art, and texts of the Kushans were destroyed when the empire collapsed and if not for the historical texts of Chinese empires, this history may have been lost forever.

Fiorello La Guardia Essay Example | Topics and Well Written Essays - 1000 words

Fiorello La Guardia - Essay Example However, in 1933, he became the mayor of New York. He introduced and implemented many infrastructural reforms that totally revamped the map of the New York City. In the subsequent parts of this paper, first, early life and education, political career and then reforms of La Guardia are described. Early life and education Fiorello Henry La Guardia was born on December 11, 1882 in the New York City. La Guardia spent most of his early life in Prescott, Arizona where he attended high school. He also passed his part of life in Hungary. Soon after his father’s death, he secured a job in the American consulate in Budapest, Hungary. In the year of 1906, he returned to New York and become an interpreter at Ellis Island and at the same time, he started and completed Law degree from the New York University in the year of 1910. Due to his Law degree and being an owner of visionary and dynamic personality, La Guardia turned to politics with an intention of serving the people of New York. Po litical career La Guardia became the mayor of New York City after serving in the U.S. House of Representatives (1917, 1918-21, 1923-33). After completing his education, La Guardia joined politics when he was elected as a Republican to the House of Representative in the year of 1916. In 1919, he was honored with the presidency of New York City’s Board of Aldermen. ... Reforms His reforms are permeated in economic, infrastructural, and political grounds. The New York City was experiencing worse economic condition, its budget was controlled and managed by bankers; and one in six New Yorkers subsisted on relief. The 1910 Census revealed that only 26,000 factories had employed three-quarters of a million people (Jeffers, 2002, pp.39). In order to revamp the economic condition, La Guardia introduced and implemented an Economy Bill, putting the city of New York on the road leading to financial stability and also by declaring a war on corruption by implementing measures strengthening merit basis of the civil service. And, at the same time, La Guardia established a humane relief policy. Modernizing the city of New York was envisioned by La Guardia. To meet the needs of a world class metropolis, he devised his ambitious plan for modern new infrastructure. First, La Guardia introduced urban vision to City Hall. As the population was rapidly growing, he clea rly embarked on such infrastructural strategy facilitating and fulfilling the needs of growing population without compromising the quality of life. In order to develop and construct new infrastructure such as bridges, subways, airports, public housing, slum clearance and street repair, he collected engineers, architects and building experts, suggesting each project with a realistic price label and plan for the generous utilization of relief labor (New York World Telegram, 1933). As the mayor of New York, he instead of supporting, fought against Tammany Hall, and, introduced more civic reforms through low-cost housing and social welfare services inside the city of New

Key Issues Identified IM And KM Against The Literature Essay

Key Issues Identified IM And KM Against The Literature - Essay Example They should be aware of customer’s needs in order to provide information in a cost-effective manner. The changes in information requirements are closely knitted with specific changes occurring in the user environment. This kind of environmental conditions comprises of the broader environment or immediate work environment. Information requirements basically change with variations witnessed in the received information. This ultimately results in new information needs or elimination of previous needs. The degree of information relevancy is dependent on the ultimate user. This indicates an individual’s interpretative and subjective response towards information. It is all about making the sensible interpretation of obtained information and then efficiently incorporating it into the knowledge base. Information manager is solely responsible for analysing the wide range of information requirements. It is a recurrent mechanism, where feedback obtained after providing information is used for enhancing organisational functions. Information lifecycle Information life cycle to the certain extent is similar to records management. The document lifecycle can be regarded as a critical component of records management. There are certain factors which are embedded within document control such as creation and record design, authorization, identification, circulation, validation, verification, backup procedures, destruction and retention schedules. This kind of lifecycle of records is expected to vary from one organisation to another.

Rate Law and Activation Energy Essay Example for Free

Rate Law and Activation Energy Essay Introduction In this experiment we are analyzing the relationship between reaction rates at different concentrations and temperatures to determine the true rate constant, activation energy, reaction orders, and half-life of a reaction. The reaction of interest is the addition of a hydroxyl group to the nucleus of Crystal Violet. Crystal Violet, or hexamethylparaosaniline chloride for short, is a strongly colored purple dye with the chemical formula C25H30N3Cl and disassociates completely in solution. The relevant structure for this compound can be seen in figure 1 Figure 1 The base that is being used for the reaction is the strong base Sodium Hydroxide, or NaOH. This molecule also completely disassociates in water. Because measuring the concentrations of reactants is difficult in a simple lab setting, the reaction between Crystal Violet and Sodium Hydroxide will be measured through light absorbance. As the reaction between the chemicals takes place and the Crystal Violet receives the hydroxide the overall intensity of the purple color will decrease thus affecting the absorbance. The absorbance of the solution will be measured with a colorimeter as the reaction takes place and will be interpreted as a direct representation of concentration of Crystal Violet. After the reaction has taken place, through analysis of graphs plotting absorption vs. time, the natural log of absorption vs. time, and the inverse of absorption vs. time the reaction will be determined to be either zeroth, first, or second order with respect to crystal violet. From here the a pseudo rate constant can be determined, and using comparisons of different constants at different concentrations of NaOH solution and different temperatures, the reaction order with respect to hydroxide, the true rate constant for the reaction, and the activation energy for the reaction can all be determined with the following equations respectively. equation 1 Where k2’ is the pseudo rate constant of the reaction using twice the initial OH- concentration as is used in the k1’ reaction and n is equal to the reaction order with respect to OH-. equation 2 Where k’ is a pseudo rate constant based off of absorption and n is the reaction order with respect to OH- determined by equation 1. equation 3 Where k1 is the reaction constant at temperature T1, a is a constant that can be ignored due to the way the equation will be utilized, R is that gas constant, and Ea is the activation energy. Procedure The following materials were needed for the experiment: 4 100mL beakers 250mL beaker 2.5Ãâ€"10-5M Crystal Violet Stock solution 0.10M NaOH Stock solution Distilled Water 10 dry plastic cuvettes and caps Stirring rod Vernier Colorimeter 50mL volumetric pipet 100 µL syringe 2 10mL vials Logger Pro software Vernier computer interface Hot plate Vernier temperature probe 1. First, 100mL of 0.10M NaOH solution was obtained using a 50mL volumetric pipet, and 0.05M was prepared using a the pipet, the stock 0.10M NaOH solution, and distilled water. 2. The Logger Pro software was engaged and both the Vernier colorimeter and temperature probe were plugged into the appropriate channels. The temperature of the room was measured and the colorimeter was calibrated by setting the 0% light and 100% light conditions. 3. The colorimeter was set to 565nm and 1mL of 2.5Ãâ€"10-5M Crystal Violet solution was mixed with 1mL of 0.05M NaOH solution and quickly added to the colorimeter. Data correlating time, temperature, transmittance, and absorbance was then recorded for seven minutes as the reaction between the two solutions took place, and this data was saved. 4. This previous step was repeated two additional times with the 0.05M NaOH solution, and then three times with the 0.10M NaOH solution. 5. Last, two 10mL-vials of 0.05M NaOH and 2.5Ãâ€"10-5M Crystal Violet solution were prepared in a warm bath solution on the hot plate. Once the temperature reached 35ËšC and was recorded, steps BLANK through BLANK were repeated again twice with the heated solutions of Crystal Violet and 0.05M NaOH. All of the data that was collected was saved and distributed between the two lab partners and all excess solutions were disposed of properly under the fume hood. Results The following are the graphs obtained from the absorption and time recordings of the third run for the reaction between 1mL of 0.05M NaOH and 1mL of and 2.5Ãâ€"10-5M Crystal Violet carried out at 22.62ËšC. figure 2 figure 3 figure 4 These plots show that the reaction order with respect to crystal violet is clearly 1st order due to the great r2 value of the linear trend line. Since our pseudo rate constant based off of absorption is equal to the negative slope of our linear plot, our k’ in for the reaction of 1mL of 0.05M NaOH and 1mL of and 2.5Ãâ€"10-5M Crystal Violet carried out at 22.62ËšC is 0.1894. These next three plots are the graphs obtained from the absorption and time recordings of the first run for the reaction between 1mL of 0.10M NaOH and 1mL of and 2.5Ãâ€"10-5M Crystal Violet carried out at 22.50ËšC. figure 5 figure 6 figure 7 As expected, these results still indicate a reaction order of 1 with respect to crystal violet as demonstrated by the linear plot on the figure 6. Our k’ in for the reaction of 1mL of 0.10M NaOH and 1mL of and 2.5Ãâ€"10-5M Crystal Violet carried out at 22.50ËšC is 0.2993. Now that we have two pseudo reaction constants in which the OH- concentration differs by a factor of 2, we can use equation 1 to obtain the reaction order with respect to OH-. Since the reaction order must be an integer we can see that the n must be 1. It is now know that for the reaction, the reaction orders with respect to both reactants are 1. At this point, the true rate constant can be determined using equation 2, where n is 1, the initial concentration of OH- is 0.05, and the pseudo rate constant k’ is 0.1894. These next three plots are the graphs obtained from the absorption and time recordings of the first run for the reaction between 1mL of 0.05M NaOH and 1mL of and 2.5Ãâ€"10-5M Crystal Violet carried out at 36.09ËšC. figure 8 figure 9 figure 10 Once again it is apparent from the three plots that the reaction is first order with respect to crystal violet. However, the reason we performed this last kinetic run was to obtain a value for k at a different temperature. This way we have two sets of values for equation 3 with two temperatures, and two rate constants. With this information we can cut out the pre-exponential factor a and solve for the activation energy. But first k must again be calculated for the reaction at the new temperature. Doing this the same way as done in calculation 2, we obtain a reaction constant of 4.964 – a higher value, which is to be expected with the increase in temperature. Now, manipulating equation 4 we obtain that equation 4 While plugging the proper values provides which after some arithmetic leads to a calculated Ea of 15,254.67J, or 15.25467kJ. The calculation for half-lives for the different conditions is simple, and just requires the following equation. equation 5 When using the rate constant found in calculation 1, t1/2 for the kinetic run for the reaction between 1mL of 0.05M NaOH and 1mL of and 2.5Ãâ€"10-5M Crystal Violet carried out at 22.62ËšC is found to be 0.183 seconds. Error Analysis In this experiment there are several things calculated and several sources of error to take into account. Error needs to be calculated for the rate constants k, for the half-lives, and for activation energy. The errors for the pseudo-rate constants are obtained using the LLS method. Once these are obtained the next step is to calculate the error in the true rate constants. When calculating the error in true rate constant once must apply both the error in the pseudo rate constant and the error in the measurement of volume for the 100 µL syringe as it pertains to the concentration of hydroxide. The error in the syringe is 0.02mL, which for 0.05M NaOH solution leads to an error in concentration of approximately 1Ãâ€"10-3M and 2Ãâ€"10-3M for 0.10M NaOH. Equation 2 is manipulated to solve for the true rate constant. The following equation is used to solve for the error in the true rate constant. equation 6 And when the derivatives are solved is equal to equation 7 And when the numbers are plugged in for the first kinetic run looks like calculation =.08 In other words, the rate constant for the first kinetic run came out to be 3.79 ±.08. Now when calculating the error in the half-life the only thing that has to be taken into consideration is the error in the rate constant, which was just calculated above. Using the same method, equation 5 is solved for half-life, and the error is calculated like so. equation 8 Which after the derivatives are solved is equal to equation 9 And of course after the correct values for example the first kinetic run are plugged in provides calculation = .004 And last but nowhere near least, is the error analysis for the activation energy. With this the error for the true rate constant must again be taken into consideration, and the error for the temperature probe. The error for the true rate constant has already been calculated, while the error for the temperature probe is provided in the lab manual as being  ±0.03K. Taking these into consideration, a very complex process follows. The same process as above was used but involving much more complicated and lengthy derivatives. First equation 3 was manipulated to the following form. equation 10 The derivative of this equation with respect to each variable (T1, T2, K1, and K2) was then taken squared, and multiplied by the square of the respective variables uncertainty. These were added up and the square root was taken as in the above methods. The end result was a calculated error of 2 KJ for the calculated activation energy of 15kJ. Figure 11 Overall this lab was very successful in the use of absorption as a method of monitoring change in concentration. The calculated errors all seem to be about what one might expect. This lab was very analytical outside of one glaring hole. You can see in figure 9 a slight curve in the plot that isn’t found on either figure 3 or figure 6. To me this seems to be because the reactants are heated up to a temperature around 35-36ËšC, but once the chemicals are mixed and placed in the cuvette the temperature is no longer controlled as the reaction takes place for the following seven minutes. Thus, as the temperature falls the rate of the reaction slows, and the pseudo rate constant is lower than it should be. This of course leads to a rate constant lower than it should be, and then the activation energy is affected as well. If I were going to change one thing about the lab, I would try and do something to control the temperature as the reaction persisted. Aside from that, there is little room for error outside of obvious blunders. Conclusion A reasonable value for activation energy was calculated from the data collected in this experiment. There were no major mistakes made in the laboratory, and the calculations all went smoothly. This experiment demonstrated that there are creative ways around difficult problems in the laboratory, such as measuring absorption in place of concentration to follow the progress of a reaction. References- Alberty, A. A.; Silbey, R. J. Physical Chemistry, 2nd ed.; Wiley: New York, 1997. Department of Chemistry. (2013, Spring). CHEMISTRY 441G Physical Chemistry Laboratory Manual. Lexington: University of Kentucky

Henrik Isbens A Dolls House :: A Dolls House Essays

A Doll’s House When the play â€Å"A Doll’s House† by Henrik Ibsen was first performed, society was much different, and the play shocked many people. Today we don't have quite the same problem, but a deeper look at the "meaning" of the play reveals that it is about problems themselves, not a specific issue. Perhaps a play about gay parenting, internet privacy, or AIDS in the workplace can strike chords of concern in our contemporary audience, and Ibsen's works (perhaps) should be viewed in light of their impact upon social awareness rather than as purely historical pieces. If Nora’s story seems somewhat "archaic" to us, because of our own enlightenment, then we can in a sense thank Ibsen for his pioneering work as a social conscience. Rather, what the play symbolizes about our needs in society, to communicate, and to work towards understanding and tolerance, are much more important issues to a modern day audience. It makes us wonder; can we still learn from Ibsen? Yes we can. Many modern day values are presented in this family. Money is still such a vital role in society. If you don’t have it your worthless, and if you do you are nice to have around. People need money, and still today they will go out of their way to get it. At the time Ibsen's wrote and presented this play it was unheard of that a women COULD leave her family in pursuit of herself and her own happiness. Nowadays this idea is commonplace. Ibsen showed that women were first people, not just doll's, not a â€Å"play thing† for her husband. And that women are intelligent and had others needs then raising a family, and taking care of the home.

How cultures use food Essay

1. Outline the way different cultures use the value food? Out of the many different cultures present throughout the world, all value food in most similar ways. Most similarities can be struck between the availability of foods within their regions, specifically enviromental and seasonal ripening in the spring period. Food has become plentiful in Western civilisations over the past few decades, , due to the advances in agriculture allowing maximum growth and larger yields in the shortest amount of time (Chemgeneration 2011). This has also introduced interest into controversial genetically modified foods and the use of hybrid varieties of plants that have more desirable qualities. An example of this is Maize and certain potatoes that secrete a pesticide from the plant to ward of pests and insects, thus removing the need to use pesticides and chemicals (Chemgeneration 2011). Dr Rosalie McCauley (Development Office Department of Agriculture and Food WA, p1), obtained results that genetically modified foods haves been more increasingly used as th e use of farmland increases exponentially at over 6% per year, seeing some 170.3 million hectares of GM foods being grown. In western society, there are a significant percentage of people either being overweight or obese, even Australia that has a population of approx 22 million (Australian Bureau of Statistics p1), with over 60% is considered over weight (ABS 2012, Australian Bureau of Statistics). Most overweight or obese individuals have and unhealthy relationship with food and it was theorised by Dr Carole Hungerford (Good Health in 21st Century) it can be considered ‘an addiction’. There is speculation as to why western society has such an addiction foods such as bread and milk, as we are the only species that drinks milk after weaning, especially that of another animal. Clinical studies and Medical Publications released by Dr J.L. Fortuna (PUBMED, 2010, p1) found clinical similarities for binge eating to that of drug dependences seeing a similar release of serotonin as with other drug dependencies. Though obesity is a prevalent condition around the world, numerous countries do not have the same obesity rates as western culture, some of this is likely to result in the way food is perceived by other cultures. Comparatively, in some cultures around the world, it is part of their culture to abstain from food for a short period of time. A more popularly known fasti ng is the Islamic undertaking of Ramadan where they fast during day light hours (Huda, 2009). Though in western cultures, people have a dislike to feel hungry, and can feel like they have fasted if they miss morning tea during a busy day at work. Numerous cultures throughout history have also used food as offering to their gods or deities to pray for health, or future harvests rain. Egyptian Pharaohs would be entombed with vast pots of food and spices to be used on their journey to the heavens. Some traditional practices continue even today such as the Korean Charye used to honour families ancestors, where special foods are prepared to during the Chuesoerk Ceremonies. The Chuesoerk (Korea.net, 2010) is a three day holiday to celebrate the good harvest received during the spring of that year. These cultural and religious uses for food are worldwide, and often not too distant from Christian practices of thanksgiving celebrated during the Christmas period. In conclusion, all cultures, no matter how distant or unique, have significant celebrations, events or relationships with a large role involving the use or lack of foods. The use of food to bring together communities and families is not dissimilar in almost all countries and demographics on earth; however the individuals use or overuse is not always healthy. References: 1. The Chemical Generation 2001, Viewed 14 January 2014 2. The Chemical Generation 2001, Viewed 14 January 2014 3. Dr Rosalie McCauley, Department of Agriculture and Food, WA, viewed 10 January 2014 4. ABS (2012) Australian health survey: First results, 2011–12. ABS cat. no. 4364.0.55.001. Canberra: Australian Bureau of Statistics. Viewed 14 January 2014 5. Aust Government, National Health and Medical Research Council. Viewed 10 January 2014 6. Hungerford, Dr Carole, 2008, Good health in the 21st century, Revised Edition, Scribe, Victoria. 7. Fortuna, J. Department of Health Science, CALIFORNIA STATE UNIVERSITY, viewed 10 January 2014 8. Huda, About.com, 2009. Viewed 15 January 2014 9. Korea.net, 2010, viewed 11 January 2014 2. What general concepts guide the present western diet? The current concepts of the western diet are based in the influence of proteins, carbohydrates, fats and vitamins and minerals (Whitney and Rolfes, 2013). Although we have come a long way with the introduction of multiculturalism some decades ago, for many western diet is still based around the proteins consisting of meats, predominantly red meat and chicken, carbohydrates with starchy root vegetables. This is often referred to as the ‘meat and three veg’ diet and the previous generations would have grown up with this as their diet staples as they where the majority of foods available for purchase or even grown themselves. With exception to the last 200 years, mankind has been involved in the seasonal use of foods and their diets where restricted by what was available at those times. Today there are vast changes in the way foods are produced to permit year round availability and the creation of food products that have previously been unavailable. Researchers at Bates Collage (Lewiston, ME, USA, 2013) believe that in the last 150 years since the invention of stones mills, the refining process of grain to create white flour, is now a consistent staple within the western diet. It was noted that this is a considerable source of carbohydrates and the cultures that had not encountered this food type previously began to show Heart Disease, Type 2 diabetes and stroke. These are all ailments that had been previously unseen in those areas. Additionally, the belief of receiving good value for money has become one of the most influential concepts and reasoning behind the purchase of processed food in recent times. The perception to receive the best meal, to be filling, quickly and well priced has seen the fast food chain market turn into a billion dollar industry (B.A. Swinburne, 2004). Anna Hodgekiss (U.S. daily Mail editor) explains that the over indulgence of these highly fatty foods have been  linked to short life spans and arrays of health problems. Even with the warnings and proven heath problems that arise, some families can become dependent on foods that are considered â€Å"value for money†. In conclusion, the general concepts to achieve the main food groups are relevant and understood but poorly enacted. The ease and availability of cheap fast food and highly refined products, that arrive ready to eat, are becoming preferential over the more time consuming cooking of foods from the local supermarket. References: 1. Whitney, E and Rolfes, S. Understanding Nutrition 13th Edition, 2013, Wadsworth USA 2. BATES Collage 2014, 2 Andrews Road Lewiston, ME 04240. Viewed 14 January 2014 3. Online book extract B.A. Swinburne, Public Health Nutrition, Chap 7, pp132 (p10). Viewed 14 January 2014 4. Hodgekiss, Anna, U.S. Daily Mail, viewed 14 January 2014 3. Discuss the comparative issues between man and nature? Nature is the world surrounding us, and it is the term we use to describe anything that happens which is out of our control. Such as natural disasters like cyclones, floods and drought. So considering this nature can not only be seen as a friend, but also as an enemy. Man desires to control nature by synthetic, mechanic and industrial plans. Synthetic and Natural medicines desire the same outcomes, of long life and good heath, but the methods to achieve it could not be any more different. Whether it is derived by numerous chemical processes or used in the original form it is found, nature made and manmade are vastly different especially when it comes to health and healing. Some cultures rely almost completely on nature to provide their basic needs such as water, food, shelter and even medicine. Though considered bland and not in line with the â€Å"perfect diet† (Health Schools Australia notes), the health benefits and improved health conditions are  achieved without the use of synthetic medicine, where as Western Diet, requires supplement by manmade medicines. This reliance on the local flora and fauna to provide all essentials and life improving aspects is not a new belief and is understood worldwide, but has been partially replaced by Western perception of that health can only be achieved by Pharmaceutical (Crigger NJ). The perception that health and food are separate and not interrelated because ‘man’ has created medicines that are better than those extracted from the ‘nature’ like Tibetans and non western cultures. In contrast, Western society has adopted that the scientific basis behind the synthetic production of therapeutic medicines is the only medical way to treat disease and illness. Today, it appears the practice of non synthetic medicinal applications is mostly centric to non western cultures. The â€Å"Perfect Diet’’ is deemed as a one shoe fits all remedy for the correct eating and dietary requirements for modern people. Where if we look at the diets of other cultures, such as the Hunza diet or Mediterranean Diet, where the majority of the population has a life expectancy significantly higher than that of the Western counterparts may have something to do with the foods that differ to that of the â€Å"Perfect Western Diet†(Diet Choices, 2014 and Trichopoula, A). One key reason is believed to be the Hunza population in the Himalayas consume more than 200% (Dainca Collins, 2011) of the B17 (also known as Amygdalan) than their western counter parts. This is likely due to the Hunza eating the seeds of all fruits, which is something that is often discarded within western society. Christina Larner (Body and Soul) has identified that Apricot se eds contain the largest concentrations of B17, and has been used a cancer treatment in modern times. However the same seeds are alleged to have caused Cyanidic acid when consumed to excessive quantities, but cases of cyanide toxicity are rare (Christina Larner). In conclusion, man created medicines for health and longevity are proven to be available in the natural world around us. Public perception provides the strongest reasons why man made pharmaceuticals are the main stream choice for western society, where as the isolated communities use the world around them to treat their ailments. 1.Whitney, E and Rolfes, S. Understanding Nutrition 13th Edition, 2013, Wadsworth USA 2.Crigger, N.J. 2009, PUBMED, US National Library of Medicine, viewed 14 January 2014 3.Diet Choices, 2014, Diet Choices, Las Vegas NV, USA, viewed 15 January 2014 < http://dietchoices.com/diet-plans/hunza-diet/> 4.Trichopoula, A. 2000, PUBMED, US National Library of Medicine, viewed 14 January 2014 5.Dainca Collins, 2011, UNDERGROUND HEALTH REPORTER, viewed 15 January 2014 6.Larner, Christina, Body and Soul, viewed 15 January 2014 4) Diversity of foods has been a benefit to the human race? Australia’s culinary heritage has expanded greatly over the last 100 years with numerous population demographics immigrating to Australia. We have observed cultural and culinary delights flood our markets, restaurants and kitchens with sights, smells and aromas from around the world. Many years ago these would have been deemed exotic and bizarre, but are now considered almost staple additions to the average household pantry. Fifty years ago, within our Grandmothers pantry, our available food selections were significantly limited in spices and rare/exotic foods that are now considered normal place. Meat and three veg meals of starchy root vegetables and heavy protein meats where the staple of the diet during those times. It is argued (Potatoes SA) that these staples popularity on Australian kitchen tables where due to the European based settlers focusing on farming practices for this produce over the last 100 years. Pliner and Hoden (cit. Evaluation of food choice behaviours, p 20) stated it was more to do with the neophobic attitude towards foreign foods due to the â€Å"unfamiliarity of foods† that limited the adventurous mindset to the evolving culinary scene. In either case, only since World War 2 did the appearance of multicultural foods and diets start to intermix. One of the most popular entries into our diets is the highly regarded Mediterranean diet consisting of uncooked fresh whole vegetables, whole grains and some fish and seafood but minimal meat. That compared to the past diets of root based vegetables that where often boiled or baked, and argued to lose most of its natural vitamins and minerals during the cooking process, especially seen with water soluble vitamins (Better Health Channel). The high use of tomatoes within the Mediterranean diet, which contain large amounts of the antioxidant lycopene and that is believed to have anti-tumour properties to relieve cancers  particularly in the prostate and multiple-myeloma (Tonia Reinhard, p44-45). Additionally, the vibrant coloured vegetables that contain high amounts of VIT A and C such as Capsicums, Spinach, green leafy vegetables. VIT A is required for vision, the immune system and as an antioxidant. Dr Carole Hungerford (Good health in 21st century, p160) identifies that night blindness is a symptom of VIT A deficiency. Even the fats used are considered healthier with the Olives and olive oil as the principle source of fat. Tonia Reinhard states that Olive oil contains the richest source of mono unsaturated fatty acids, being 77% mono-unsaturated and 14% saturated, this is attributed as to why it helps to prevent cardiovascular disease. In conclusion, the diversity of foods that have spread across the world is bring ing the many health benefits to many. As the world continues to expand and new ideas and foods are embraced, soon the healing and healthy properties of those unique diets will improve the health and well being across the globe. 1.Potatoes South Australia, 2013, Elder House, Adelaide, SA, viewed 15 January 2014 2.Online Thesis – Roininen, Katariina, 2001, Evaluation of food choice behaviour: Development and Validation of health and taste attitude scales, visited 15 January 2014 3.Better Health Channel, July 2013, Victorian Government, viewed 15 January 2014 4.Hungerford, Dr Carole, 2008, Good health in the 21st century, Revised Edition, Scribe, Victoria. 5.Reinhard, Tonia, (2010), SUPERFOODS The Healthiest Foods on the Planet, Cove Press, NSW 5) The future of nutrition In the past and even in some places still today, nutrition has not play a conscious role in conventional medicine, as the focus has and always seems to be about treating disease not the cause. Nutrition based medicine has been labelled with a stigma as ‘alternative’ or new age and not given the same attention as the newest drug on the market. Recently have we begun to see some changes within the health care system which offers clients a  natural alternative to pharmaceuticals. This has began a movement known as Integrative Medicine (OSHER, 2012), where the approach is about taking the best from conventional and alternative medicine and combining them. This combination of practices is reinforcing the tenants of prevention rather than cure, which follows the old adage that â€Å"an ounce of prevention is better than a pound of cure†. We are already seeing this revolutionary ideal take off with the emergence of integrative clinics now established in some major citi es, and where patients even seek further information from their GP on what additional alternative treatments are available for their ailments (Mike Adams, 2005). This wider social consciousness towards natural alternatives is perhaps due to the increased marketing of nutritional supplements within media (Mike Adams, 2005). These messages are making people more curious about their health and what they can do to improve it. In addition, we are seeing nutritional products such as ‘Inner Health Plus’ a pro-biotic supplement, is sometimes prescribed to patients following a course of antibiotics. This behaviour by GP’s is demonstrating a small but important step to the medical and health organisations towards the evolution of nutritional medicine. The popularity of supplements and their advertised health benefits has propelled the sale of many nutritional products, especially Omega 3 supplements derived from fish oil or krill oil (Lisa Schofield, 2013). Omega 3 that is naturally occurring within deep ocean fish species has been proven to be beneficial for arthritis suffers, for heart health, and general wellbeing (Whitney, 2013, pg 161.). Dr Hungerford (Hungerford, 2008) tells us that until recent times, animals who do not manufacture their own omega 3 would have had to eat plants which contain omega 3’s for protection against the cold and other health benefits. However, as we domesticated animals, kept them warm in barns, and fed them the food we grew; the animals did not require as much omega 3 in order to survive. This man made change is a potential reason is why fish still remains one of the best sources of omega 3, as the majority of fish that we consume are wild. (Hungerford, 2008 pg. 6-7). In summary, the stigma of nutritional based medicine is slowly being lifted as media, mainstream medicine and health care practitioners inculcate these practices into their professions. Today, more than ever, people have access to the information and products that can be utilised to improve their health, wellbeing and  diets. As the message becomes clearer and better understood, it is likely that the stigma will be removed completely and nutritionists will be given the same renowned as the doctors and medical professionals that share the same vision for long and healthy life for all. 1.Osher Centre for Integrative Medicine, University of California, 2012, CA, USA, viewed 17 Jan 2014 2.Adams, Mike, 24 July 2005, Natural News, viewed 17 Jan 2014 3.Hungerford, Dr Carole, 2008, Good health in the 21st century, Revised Edition, Scribe, Victoria 4.Schofield, Lisa, 09 Sep 2013, Nutraceuticals World, viewed 17 January 2014 5.Whitney, E and Rolfes, S. Understanding Nutrition 13th Edition, 2013, Wadsworth USA Bibliography ABS (2012) Australian health survey: First results, 2011–12. ABS cat. no. 4364.0.55.001. Canberra: Australian Bureau of Statistics. Viewed 14 January 2014 Adams, Mike, 24 July 2005, Natural News, viewed 17 Jan 2014 Aust Government, National Health and Medical Research Council. Viewed 10 January 2014 B.A. Swinburne, Public Health Nutrition, Chap 7, pp132 (p10). Viewed 14 January 2014 BATES Collage 2014, 2 Andrews Road Lewiston, ME 04240. Viewed 14 January 2014 Better Health Channel, July 2013, Victorian Government, viewed 15 January 2014 Collins, Dainca, 2011, UNDERGROUND HEALTH REPORTER, viewed 15 January 2014 Crigger, N.J. 2009, PUBMED, US National Library of Medicine, viewed 14 January 2014 http://www.ncbi.nlm.nih.gov/pubmed/19671650 Diet Choices, 2014, Diet Choices, Las Vegas NV, USA, viewed 15 January 2014 < http://dietchoices.com/diet-plans/hunza-diet/> Dr Rosalie McCauley, Department of Agriculture and Food, WA, viewed 10 January 2014 Fortuna, J. Department of Health Science, CALIFORNIA STATE UNIVERSITY, viewed 10 January 2014 Hodgekiss, Anna, U.S. Daily Mail, viewed 14 January 2014 Huda, About.com, 2009. Viewed 15 January 2014 Hungerford, Dr Carole, 2008, Good health in the 21st century, Revised Edition, Scribe, Victoria Korea.net, 2010, viewed 11 January 2014 http://www.korea.net/Government/Current-Affairs/Others?affairId=168 Larner, Christina, Body and Soul, viewed 15 January 2014 Osher Centre for Integrative Medicine, University of California, 2012, CA, USA, viewed 17 Jan 2014 Potatoes South Australia, 2013, Elder House, Adelaide, SA, viewed 15 January 2014 Reinhard, Tonia, (2010), SUPERFOODS The Healthiest Foods on the Planet, Cove Press, NSW Roininen, Katariina, 2001, Evaluation of food choice behaviour: Development and Validation of health and taste attitude scales, visited 15 January 2014 Schofield, Lisa, 09 Sep 2013, Nutraceuticals World, viewed 17 January 2014 The Chemical Generation 2001, Viewed 14 January 2014 The Chemical Generation 2001, Viewed 14 January 2014 Trichopoula, A. 2000, PUBMED, US National Library of Medicine, viewed 14 January 2014 Whitney, E and Rolfes, S. Understanding Nutrition 13th Edition, 2013, Wadsworth USA

Improving Communication for People with Learning Disabilitie

learning zone CONTINUING PROFESSIONAL DEVELOPMENT Page 58 Improving communication for people with learning disabilities Page 66 Learning disabilities multiple choice questionnaire Page 67 Read Annette Martyn’s practice profile on type 2 diabetes Page 68 Guidelines on how to write a practice profile Improving communication for people with learning disabilities NS336 Godsell M, Scarborough K (2006) Improving communication for people with learning disabilities. Nursing Standard. 20, 30, 58-65. Date of acceptance: February 6 2006. Summary Patients with learning disabilities have higher healthcare risks than the general population. Similar essay: Collate Information About an Individual's Communication and the Support ProvidedHealth professionals need to develop skills that enable them to communicate effectively with this patient group. Identifying barriers to communication is the first step to reducing or removing them. Suggested strategies to improve healthcare access for patients with learning disabilities include: developing individualised health action plans, simplifying communication styles and providing accessible facilities and tailored resources. learning activities you should be able to: Understand the impact of communication on interaction between healthcare providers and patients with learning disabilities.Describe the relationship between communication and the health inequalities experienced by people with learning disabilities. Identify strategies to improve communication between health providers and patients with learning disabilities. Authors Matthew Godsell and Kim Scarborough are senior lecture rs, Faculty of Health and Social Care, University of the West of England, Bristol. Email: Matthew. [email  protected] ac. uk Introduction Learning disability is not a diagnosis but a term used to describe people with a wide range of strengths and needs.Eighty per cent of children and 60 per cent of adults with learning disabilities live with their families (Gravestock and Bouras 1997), and many people with learning disabilities exceed the expectations of families and professionals in their capacity to learn new skills and develop their talents (NHS Executive 1999). The term ‘learning disability’ says little about an individual’s strengths and needs but it does incorporate three elements that appear in most definitions (Box 1). Emerson et al (2001) state that the number of people with learning disabilities in the UK has not been determined.They estimate that in the UK there could be as many as 350,000 people with severe learning disabilities (intelligence quotie nt (IQ) 50). This means that 2 per cent of patients are likely to have a learning disability (NHS Executive 1999). The ways in which people with learning disabilities are described have changed. Terminology and related facts are listed in Box 2. NURSING STANDARD Keywords Communication; Learning disabilities nursing: attitudes These keywords are based on the subject headings from the British Nursing Index. This article has been subject to double-blind review.For related articles and author guidelines visit our online archive at www. nursing-standard. co. uk and search using the keywords. Aims and intended learning outcomes The aim of this article is to explore the impact of communication on health care for people with learning disabilities. The article discusses how cognition and communication influence interactions between healthcare providers and patients. It also examines how poor communication can contribute to health inequalities that separate people with learning disabilities f rom the rest of the population.The article explores communication strategies that can overcome or reduce barriers to effective health care. After reading this article and completing the 58 april 5 :: vol 20 no 30 :: 2006 Time out 1 Based on a figure of 2 per cent of patients having learning disabilities, it is likely that 40 per 2,000 patients registered with GP services are likely to have learning disabilities. How many patients with learning disabilities are you aware of in your practice area? List some of the reasons that might prevent people with learning disabilities from accessing local health services. Health inequalitiesAlthough people with learning disabilities are living longer, the gap that separates the health status of people with learning disabilities and the general population has increased. Cohen (2001) asserted that gross inequalities in health are politically, socially and economically unacceptable. An investigation into health inequalities by the Disability Rights Commission (Nocon 2004) found that people with learning disabilities have: An increased risk of early death compared with the rest of the population; mortality rates are particularly high for those with more severe impairments.A greater variety of healthcare needs. Many needs that are not met. High rates of unrecognised or poorly managed medical conditions including: hypertension, obesity, heart disease, abdominal pain, respiratory disease, cancer, gastrointestinal disorders, diabetes, chronic urinary tract infections, oral disease, musculoskeletal conditions, osteoporosis, thyroid disease, and visual and hearing impairments.A briefing paper produced by the NHS Service Delivery and Organisation (SDO) Research and Development Programme (NHS SDO 2004) identified barriers to appropriate and timely BOX 1 Definition of a learning disability A person with learning disabilities has: Significant reduction in the ability to understand new or complex information. Reduced ability to cope inde pendently. Impairment starting in childhood that will have a lasting effect on development. (DH 2001) access to health care within and outside services.Many people with learning disabilities find that identifying their healthcare needs is a major challenge. Proactive strategies are required to encourage people to access the full range of services that are available. Some people with learning disabilities have said that negative and unhelpful attitudes from healthcare workers have prevented them from seeking medical help (Bristol and District People First 2003). Support and encouragement are required by carers, allies and friends before people with these concerns are ready to engage with services again.People are more likely to trust service providers when they are convinced that services and practitioners have responded to their needs by improving communication skills and producing information in an accessible format. People with learning disabilities have the same right to access m ainstream services as the rest of the population (Department of Health (DH) 2001). However, mainstream services have been slow to develop the capacity and skills to meet their needs.In the document Valuing People (DH 2001) it was acknowledged that the wider NHS had failed to consider the needs of people with learning disabilities and that overcoming this source of inequality was the most important issue for the NHS to address for this patient BOX 2 Terminology and facts related to learning disabilities ‘Mental handicap’ was a term used to describe people with learning disabilities. It is no longer used in the UK. ‘Mental retardation’ is a term used internationally, however, it is not an accepted term in the UK and some may find this term offensive. Learning difficulty’ is the term used in education to define individuals who have specific learning needs, for example, dyslexia. Some people who are identified as having learning difficulty by education s ervices may also be considered to have a learning disability, but this is not necessarily the case. ‘Mild’, ‘moderate’, ‘severe’ and ‘profound’ are terms to describe different degrees of disability (Figure 1). A person with mild learning disabilities might communicate effectively, learn, live and work with little support.However, a person with profound learning disabilities will require support with activities of daily living, for example, communication, dressing, feeding, washing and mobility. A diagnosis of ‘mental illness’ is not the same as having a learning disability, but people with learning disabilities may have mental health issues as well. Not everyone with learning disabilities requires a social worker or a community nurse. People with learning disabilities may have multiple diagnoses resulting in complex health needs. People with the most profound physical or sensory impairments do not always have the most profound cognitive impairments.NURSING STANDARD april 5 :: vol 20 no 30 :: 2006 59 learning zone nursing attitudes group. The briefing paper produced by the NHS SDO (2004) provided key action points for removing barriers and improving access to health care, which included: Using specialist learning disability teams to aid adaptation of mainstream services to meet the needs of patients with learning disabilities. Developing strategies for health education and health checks for people with learning disabilities that promote timely access to health care.Families and paid carers have an important role in helping people with learning disabilities to access health care. Some people will need assistance to recognise mental health problems and to identify gradual changes in health. Time out 2 Make a list of the ways that you communicate with patients about their health, for example, through appointments and telephone calls. Take three examples from your list and consider reasons why communi cation with a person with learning disabilities might be difficult.Give an example of effective communication between a practitioner and a person with learning disabilities. Policies should address the use of technology to support communication, and the development and dissemination of accessible information. Jones (2003) suggests that managers and commissioners of services should liaise with health, social care and education agencies to ensure consistency in communication policies throughout the lives of people with learning disabilities. Communication can be broadly defined as the exchange of information between a sender and a receiver (Figure 2).Where a person has learning disabilities they may be communicating with an intention to attract a communication partner and commence a two-way dialogue. However, for some people with profound learning disabilities sending a message might be a response to their body and feelings. Their level of cognition might be such that they are unaware of possible communication partners and of how to take the communication further. This is called pre-intentional communication, in which the individual says or does things without intending to affect those around them.It is important to remember that everyone communicates and that the role of communicator and communication partner swaps from one person to the other so that a conversation can develop. The challenge for health professionals is to develop skills that enable them to interpret the messages they receive and make the messages they send understandable. Communication is not only about verbal communication; it is also about nonverbal communication, for example, the use of body language, words and pictures. CommunicationRecommendations have been made to improve communication and access to health services for people with learning disabilities. Jones (2003) states that services supporting people from birth to older age should develop communication policies. FIGURE 1 Estimated pe rcentage of people with learning disabilities according to level of severity Mild Moderate 12% Severe Profound 80% 7% 1% Augmentative and alternative communication systems Systems of communication, such as sign language, symbols and eye pointing, are known as augmentative and alternative communication systems (AACs).AACs can be used to enhance or replace customary pathways, such as speech or writing. The use of photographs of everyday objects, picture boards, line drawing and real objects are good ways to enhance communication with people with learning disabilities (American Speech-Language-Hearing Association (ASHA) 2005). You do not need to attend specialist training to be able to use AACs such as these. More formal AACs, such as Makaton (a form of sign language for people who have learning disabilities that uses keywords to enhance understanding), require preparation but learning a basic vocabulary does not require extensive training.Cognition and communication (Winterhalder 1997 ) Understanding complex information People with learning disabilities have a reduced ability to NURSING STANDARD 60 april 5 :: vol 20 no 30 :: 2006 understand new or complex information (DH 2001), and those who experience difficulties when processing information may find it hard to learn new skills. Intelligence can be quantified as a figure related to an individual’s IQ. However, it might be more useful to think about intelligence in relation to cognitive processes.Smith and Mackie (2000) describe cognitive processes as: ‘†¦the way in which our memories, perceptions, thoughts, emotions and motives guide our understanding of the world and our actions. ’ Intelligence exerts a powerful influence over the ability to process information, the capacity to learn new skills and to adapt knowledge to different situations. Intelligence is an attribute that can guide our understanding of the world, but it is not fixed or static. Teaching and learning strategies can be used to stimulate cognitive processes so that people can approach information, or potentially confusing situations, with more confidence.Similarly, complicated tasks and information can be broken down into small, simple steps so that people can approach them in stages. Attempting to understand another person’s cognitive processes can help practitioners to develop a more empathetic and person-centred approach to care, and can provide an incentive to develop the teaching and learning strategies that are best suited to the individual needs of patients. Coping independently People with learning disabilities may have a reduced ability to cope independently (DH 2001). Independence is defined according to levels of social functioning.Assessment of a patient’s strengths and needs in social functioning is a fundamental stage in developing planned care that is familiar to practitioners from all branches of nursing. Making an accurate assessment of social functioning provides val uable information about the range of activities that a person can undertake on his or her own as well as those activities where a person requires support. Some people with learning disabilities may require assistance with tasks such as washing and dressing, and many need help to have their mode of communication understood.Learning disability and development Learning disability starts before adulthood, affects people of all ages and has a lasting effect on development (DH 2001). A majority of younger people with learning disabilities are living in the community with their parents or carers. Older people with learning disabilities also live in the community but they may have periods of institutional care. Some people will have frequent contact with health services and others have irregular contact. People with learning disabilities are not a homogeneous group. Their perceptions of nurses, NURSING STANDARDFIGURE 2 A model for communication Person communicating: we take turns in this ro le of sender of information. Depending on the person’s cognitive ability, this may be intentional or pre-intentional communication Communication barriers: can be present in the environment as well as being caused by the communicator and communication partner Communication partner: we take turns in this role of the person who receives the information sent, makes sense of it and responds appropriately doctors, health centres, clinics and hospitals will have been shaped by their formative experiences with staff and services.Providing encouragement for people with learning disabilities to attend health checks and to make use of healthcare services can involve changing their perceptions of health professionals. Some people with learning disabilities have not received the treatment they need because they are reluctant to engage with services where they have had bad experiences in the past. To encourage people with learning disabilities to make effective use of healthcare services t hroughout their lives, practitioners need to use their communication skills to initiate and maintain positive relationships. Time out 3Think about the last time you communicated with a person with learning disabilities, or someone who has communication difficulties. Refer to the list you made in Time out 2 about the communication systems you use in your workplace. What are the main barriers to communicating about health with a person who has learning disabilities? How do you remove or reduce barriers to communication? Which environmental factors impede communication? Identify any barriers that you had not previously considered. april 5 :: vol 20 no 30 :: 2006 61 learning zone nursing attitudes Barriers to communicationThere are barriers to communication which can be identified in relation to the person with learning disabilities, the health professional and the environment (Box 3). When barriers have been identified, health professionals can start to think about ways of reducing or removing them. Health professionals exchange information by using terminology that reflects their specialised knowledge. Patients and other people who are not involved in the day-to-day delivery of health care BOX 3 Barriers to communication The person with learning disabilities may: Have limited understanding.Have limited vocabulary or difficulty speaking. Have sensory impairments that limit ability to hear requests or instructions. Have poor understanding of health and healthy living. Be scared of people in uniforms. Be stressed because of illness. Not like new places. Have difficulty waiting and may not understand the concept of time or queuing. Have limited literacy and numeracy skills to read health advice and information, for example, instructions, letters, dosages. Expect contact with nurses to be unpleasant because of previous experiences. The nurse may: Be rushed because of heavy workload.Have biases and assumptions about people with learning disabilities. Have poor listeni ng and attending skills. Be unable to understand augmentative and alternative communication systems. Have limited knowledge of the individual. Have insufficient time to develop a good relationship with the individual or carer. Not use visual aids to support understanding. Use technical jargon and/or long words. Provide written information without thinking of the patient’s ability to read it. Provide information about the next appointment in a way the patient will not understand or remember.The environment may: Be crowded. Busy. Uncomfortable. Have strange smells and noises. Bring back bad memories. Have limited physical access, for example, no hoists. Include unhelpful people. Have poor signage, relying on literacy skills and good sensory abilities. Have no area to sit quietly with limited sensory stimulation while waiting. Be filled with machines and instruments that a person with learning disabilities may not understand. may find it difficult to comprehend the terms and ide as they encounter in healthcare settings. They can find it hard to follow advice or instructions.This could result in patients making inappropriate decisions or exposing themselves to unnecessary risks. For example, patients with learning disabilities who take their own medication may be at risk of overdosing or taking an ineffectual dose, particularly if the route and dosage of a newly prescribed medicine has not been explained clearly and/or recorded in an accessible format. Time out 4 Consider the list of potential barriers to communication and categorise them according to: Barriers that have been addressed for patients with learning disabilities using the services you work in.Barriers that can be remedied quickly. Barriers that need planning to be reduced or removed. Barriers that require financial investment to be reduced or overcome. Discuss this list with your colleagues. Identify strategies for removing barriers and improving communication. Good practice in communication In South Warwickshire, health passports have been developed for people with learning disabilities (Leamington Spa Today 2005). These provide detailed information about an individual’s health, strengths and needs so that practitioners can provide patient-centred care.They are used to improve communication across a range of healthcare providers. Having an alert system incorporated into patient notes which provides individual communication needs could be beneficial, especially where staff do not know individual patients. Health practitioners may use and be involved in developing health action plans. These are plans specific to individuals and are developed to meet their access needs. Health action plans are a way of overcoming some of the barriers to high quality health care (DH 2001).Plans are produced by a group of people including the patient. They encourage the development of a shared understanding about an individual’s health needs. Where training in health action plann ing has been provided for GP surgeries, improvements have been shown in the health of patients with learning disabilities (Smith et al 2004). There are benefits to having a lead person to deal with learning disability issues. In primary healthcare services, a lead person takes an interest in learning disability issues, collates information, NURSING STANDARD 62 april 5 :: vol 20 no 30 :: 2006 ives support and advice to health staff and develops links with specialist services for people with learning disabilities and other agencies (NHS Executive 1999). Time out 5 Does your organisation have a lead person who is involved in initiatives such as joint communication policies and the development and sharing of accessible health information? If yes, find out how he or she is supporting your team to develop skills in communicating with people who have learning disabilities. If no, how might developing this role benefit your team and improve access to health care for patients with learning d isabilities?To improve communication with people with learning disabilities, more time should be allocated to appointments so that there is more time for them to express themselves and understand any information they have received (DH 1999). This is particularly the case if AACs are being used. Reception staff are often aware of people who have difficulties using services. Supporting these key staff to develop effective communication skills and flexibility can improve access to health services (NHS Executive 1999).For example, if staff in reception are aware that someone finds it difficult to wait in a queue, they may offer that person the first appointment. Several resources have been developed by trusts to improve communication. Some examples of these include: Hambleton and Richmondshire Primary Care Trust (PCT), in partnership with Mencap, has developed an accessible ‘Choose and Book’ guide for hospital appointments that uses a combination of pictures and words to ex plain how patients can make choices about hospitals and appointments.Bristol South West PCT, as part of its ‘Expert Patient Programme’, has developed plans that help prepare people with learning disabilities for a visit to the doctor. The Health Facilitation Team at Gloucestershire Partnership NHS Trust (2004) has produced a ‘traffic light assessment’ that conveys information about individuals on admission to hospital. This ensures that important information is clearly communicated to health professionals. Camden PCT (2005) has used this work to develop an online resource. Although people may appear to have limited communication skills, they should not be ignored.These patients should be addressed directly and NURSING STANDARD the information they receive should be provided in a simple way without being patronising. Effective communication often depends on how the information is delivered. Practitioners may have to talk to carers, but they should not forget to address the person with learning disabilities. Practitioners should examine their beliefs about people with learning disabilities and avoid making assumptions about an individual’s strengths and needs. This will help to make health assessments more accurate (DH 1999).It is useful to invite a speaker with learning disabilities to talk to healthcare staff about living with a learning disability and his or her experiences of accessing health services. Time out 6 What beliefs and values do you think society holds about people with learning disabilities? Some examples of negative beliefs and values are that people with learning disabilities: Have a poor quality of life. Have higher pain thresholds. Are dangerous and promiscuous. Will not understand anything. Should not get married or have children. Cannot care for their children. Need institutional care. Cannot work.Are like children not adults. What are your feelings about these statements? How might the presence of any or al l of these beliefs influence the care given to a person with learning disabilities? People with learning disabilities can have additional physical or sensory impairments that should be considered. They are also more likely to have more mental health needs than the general population (DH 2001). Where a patient has additional impairments or health issues these need to be considered during communication. The healthcare environment should be adapted to accommodate people with physical or sensory impairments.Time out 7 In your work place: Do you have a private area to talk to a person who has a large wheelchair? Do you have rooms where glare is controlled and the environment is suitable for people with limited vision? Do you consider the needs of interpreters/ carers and ensure they fully understand information before they pass it on? april 5 :: vol 20 no 30 :: 2006 63 learning zone nursing attitudes Accessible information Accessible information comes in many forms, such as videos, CDs, DVDs and audiotapes. Pamphlets can be produced with accessible information about the services offered.Written information needs to be in plain language, with short sentences and one subject per sentence. Photographs, drawings, symbols and other visual information can be used to support written information. It is important to keep pages uncluttered on plain backgrounds so that text does not detract from graphics. Letters should be large, 16-18 point type size, and fonts that do not have serifs, such as Arial and Comic Sans, should be used. Graphic text, underlining and italics should be kept to a minimum because they can impede readability. Many trusts are now producing resources to enhance accessibility.Some of these include: The United Bristol Healthcare NHS Trust has produced a leaflet called ‘You are coming to the Bristol Royal Infirmary about your heart’, TABLE 1 Using terminology that is easy to understand Health issue Common words that are used Epilepsy Investigat ions EEG (electroencephalogram) Strategies or words that improve understanding Find out more about This word would have to be used, but a photograph of someone having an EEG may help understanding Medicine tablets to help control your epilepsy Having two or more seizures straight after each other or whatever describes status for the individual Taking your medication as we have agreed Things that might make you have a seizure Not being able to have a poo for three days Things you feel in your head and body that make you think you will have a seizure Having a fit or turn, whichever word the person uses which uses pictures and words to introduce some of the staff and explain what happens when patients are admitted to the cardiology department.The Learning Disability Partnership Board in Surrey has developed ‘The Hospital Communication Book’ that combines words, pictures, signs and symbols. Trafford North and South PCTs have produced a toolkit for people with learning disab ilities called ‘Cancer and You’ (Provan 2004). Contact your local Community Learning Disability Team or People First organisation for information about local resources. Simplifying conversation When talking to people with learning disabilities, use approaches similar to those used for written text. Plain language, the use of keywords, short sentences and one subject per sentence should be used. Give people time to process what is being said and to formulate a reply.Use openended questions to assess a person’s understanding and rephrase the question if necessary, as repeating the same question rarely improves understanding. When information is presented during a consultation it is important to check that the person with learning disabilities has understood it. If there is insufficient time during the initial consultation, it may be necessary to make a further appointment to check what the person has understood and retained. For an individual who processes informat ion slowly this might be essential to ensure an accurate assessment and the effective implementation of a treatment plan. Examples of terms that are easier to understand are presented in Table 1.Such terms are only beneficial if the person understands them so, for example, ‘constipation’ could be described as ‘not being able to have a poo’, but the health practitioner needs to know whether the person uses this term to describe defecation. Anti-epileptic drugs Status epilepticus Drug compliance Triggers Constipation Aura Time out 8 Think of four common illnesses that are likely to make a person visit your service. Write these in the first column of a table (see Table 1). Identify the language you use when discussing these illnesses and record these words or phrases in column two. These might be medical terms, health terms or long words. Now spend some time identifying words that are easier to understand and record them in the third column. NURSING STANDARD S eizure 64 april 5 :: vol 20 no 30 :: 2006 ConclusionPeople with learning disabilities may have communication difficulties that have restricted their access to health care and prevented them from receiving the information required to maintain their health. In addition to learning disability, they are more likely to have complex healthcare needs leading to multiple diagnoses. Steps towards better health for people with learning disabilities can be made by providing encouragement and support to attend regular health screening and reviews, and by developing a range of strategies to improve communication between practitioners and individuals with learning disabilities NS RECOMMENDED RESOURCES British Institute of Learning Disabilities (2001) Factsheet No. 005 Communication. www. bild. org. uk/pdf/factsheets/communication. pdf (Last accessed: March 10 2006. British Institute of Learning Disabilities (2005) Your Good Health (a set of 12 illustrated booklets). www. bild. org. uk/publication s/your_very_good_health_details. htm (Last accessed: March 10 2006. ) Communication Matters (updates 2005) What is AAC? www. communicationmatters. org. uk (Last accessed: March 10 2006. ) Communication Matters (updated 2005) How to be a good listener. www. communicationmatters. org. uk (Last accessed: March 10 2006. ) Department of Health. www. dh. gov. uk (Last accessed: March 10 2006. ) Foundation for People with Learning Disabilities (2004) Communication and people with learning disabilities. www. learningdisabilities. org. uk/page. cfm? agecode=ISSICMMT (Last accessed: March 10 2006. ) Foundation for People with Learning Disabilities (2005) Patients with learning disabilities in South Warwickshire have been given a new type of passport to help with their medical appointments. www. learningdisabilities. org. uk/profilenews. cfm? pagecode=ISSICOLN&are acode=ld_communication_news&id=7231 (Last accessed: March 10 2006. ) MENCAP (2003) You and your health: a basic guide to being heal thy. www. mencap. org. uk/download/you_and_your_health. pdf (Last accessed: March 10 2006. ) Plymouth Hospitals NHS Trust (2005) Living with cancer. www. learningdisabilitycancer. nhs. uk/ (Last accessed: March 10 2006. ) Time out 9Complete a SWOT analysis (strengths, weaknesses, opportunities and threats) of your skills and knowledge when communicating with and supporting access to health care for people with learning disabilities. Time out 10 Now that you have completed this article, you might like to consider writing a practice profile. Guidelines are on page 68. References American Speech-LanguageHearing Association (2005) Introduction to Augmentative and Alternative Communication. www. asha. org/public/ speech/disorders/acc_primer. htm (Last accessed: March 9 2006. ) Bristol and District People First (2003) We are People First. (Film) People First, Bristol. Camden PCT (2005) What You Need to Know About Me in Hospital. www. camden. gov. k/ (Last accessed: March 17 2006. ) Cohen J (2001) Countries’ health performance. The Lancet. 358, 9285, 929. Department of Health (1999) Facing the Facts: Services for People with Learning Disabilities: A Policy Impact Study of Social Care and Health Services. The Stationery Office, London. Department of Health (2001) Valuing People: A New Strategy for Learning Disability for the 21st Century. The Stationery Office, London. Emerson E, Hatton C, Felce D, Murphy G (2001) Learning Disabilities: The Fundamental Facts. Foundation for People with Learning Disabilities, London. Gloucestershire Partnership NHS Trust (2004) Traffic light assessment. Unpublished document.Gloucestershire Partnership NHS Trust, Gloucester. Gravestock S, Bouras N (1997) Emotional disorders. In Holt G, Bouras N (Eds) Mental Health in Learning Disabilities: A Training Pack for Staff Working with People who have a Dual Diagnosis of Mental Health Needs and Learning Disabilities. Second edition. Pavilion Publishing, Brighton, 17-26. Jones J (2003) Th e Communication Gap. www. learningdisabilities. org. uk /page. cfm? pagecode= FBFMCHTP04 (Last accessed: March 10 2006. ) Leamington Spa Today (2005) Patients with learning disabilities in South Warwickshire have been given a new type of passport to help with their medical appointments. Leamington Spa Today. January 19, 2005.NHS Executive (1999) Once a Day One or More People with Learning Disabilities are Likely to be in Contact with Your Primary Healthcare Team. How Can You Help Them? Department of Health, Leeds. NHS Service Delivery and Organisation (SDO) Research and Development Programme (2004) Access to Health Care for People with Learning Disabilities. Briefing paper. NHS SDO, London. Nocon A (2004) Background Evidence for the DRC’s Formal Investigation into Health Inequalities Experienced by People with Learning Disabilities or Mental Health Problems. Disability Rights Commission, Stratford upon Avon. Provan K (2004) Cancer and You: Toolkit for Working with People with Learning Disabilities. www. cancerandyou. info/docs/ FullToolkitNov04. pdf (Last accessed: March 9 2006. Smith ER, Mackie DM (2000) Social Psychology. Second edition. Psychology Press, Hove. Smith C, Giraud-Saunders A, McIntosh B (2004) Healthy Lives: Health Action Planning in a Person Centred Way; Including Health in Person Centred Planning. www. valuingpeople. gov. uk/ HealthHealthyLives. htm (Last accessed March 10 2006. ) Winterhalder R (1997) An overview of learning disabilities. In Holt G, Bouras N (Eds) Mental Health in Learning Disabilities: A Training Pack for Staff Working with People who have a Dual Diagnosis of Mental Health Needs and Learning Disabilities. Second edition. Pavilion Publishing, Brighton, 1-6. NURSING STANDARD april 5 :: vol 20 no 30 :: 2006 65