Methods to Conserve Energy Essay Example for Free

Methods to Conserve Energy EssayUsing natural null resources doesnt necessarily mean you will conserve any energy, yet we do advise every household to research the possibility of implementing natural energy resources to influence their home power supply. This will conserve the fossil fuels we are shortly consuming at an alarming rate. Many little things can be done in an attempt to conserve energy in the home.It is knowing how to do these little energy conservation processes that many people do not know about, understand, or Just dont care. Another way relating to how we can conserve energy is to ensure whenever we have finished using appliances that may have a light on them (such as a standby light), we switch the appliance off, or unplug after use. Little things can defecate a big difference in conserving energy around the home, and this is especially true for dishwashers, laundry machines and dryers. newfangled dishwashers have energy saving wash cycles, we strongly advise the use of such features, washing machines can be set to lower temperature washes, when sed with the right washing powder, and a dryer, well if you own a dryer, get rid of it and dry your washing naturally on a washing line. Hybrid cars can make a difference to your carbon footprint, and can help you save energy. No, they will not eliminate carbon emissions from their exhausts, yet they will greatly reduce the measuring rod of carbon you pump into the air each year. The simply reason you should need a 44 vehicle is if you live in a rough terrain area, or constantly snowy area.When you choose your next car, be sure to check the miles per gallon to see how fficient your car will be, this not only helps the environment alone it saves you money on fuel too. When conserving energy, we can also look to our heating methods, why not reduce your heating thermostat or radiators by only 1 degree for a lengthy time, and compare your heating bill? If you recycle more, you will be helping to conserve energy put into qualification new versions of what you have recycled, and this also reduces the burden on landfill sites and incinerators which are not good for the environment

High school graduates should take a year off before entering college Essay Example for Free

High school graduates should take a year off to begin with entering college EssayA cleaning lady takes a selfie from a high angleA selfie is a type of self-portrait photograph, typically taken with a hand-held digital camera or camera phone. Selfies are very much associated withsocial networking, like Instagram. They are often casual, are typically taken all with a camera held at arms length or in a mirror, and typically include either only the photographer or the photographer and as many people as can be in focus, which is much commonly known as a group selfie ContentsHistoryThe first known selfie, taken by Robert Cornelius in 1839Robert Cornelius, an American pioneer in photography, produced a daguerreotype of himself in 1839 which is also one of the first photographs of a person. Because the process was slow he was able to uncover the lens, run into shot for a min or more, and then replace the lens cap. He recorded on the back The first light Picture ever taken. 1839.Ear ly Edwardian woman taking her picture in a mirror roughly 1900 stately Duchess Anastasia Nikolaevna of Russia taking one of the first teenage self-portraits The debut of the portable Kodak Brownie disaster camera in 1900 led to photographic self-portraiture becoming a more widespread technique. The method was usually by mirror and stabilizing the camera either on a nearby object or on a tripod while framing via a viewfinder at the top of the box. Russian Grand Duchess Anastasia Nikolaevna at the age of 13 was one of the first teenagers to take her own picture using a mirror to send to a friend in 1914. In the letter that accompanied the photograph, she wrote, I took this picture of myself looking at the mirror. It was very hard as my hands were trembling. The concept of uploading group self-taken photographs (now known as super selfies) to the internet, although with adisposable camera not a smartphone, dates to a webpage created by Australians in September 2001, including photos t aken in the late 1990s (captured by the Internet Archive in April 2004). The earliest usage of the word selfie can be traced as far back as 2002. It first appeared in an Australian internet forum (ABC Online) on 13 September 2002. Um, drunk at a mates 21st, I tripped ofer sic and landed lip first (with front dentition coming a very close second) on a set of steps. I had a hole about 1cm long right through my rear end lip. And sorry about the focus, it was a selfie.PopularityThe term selfie was discussed by photographer Jim Krause in 2005, although photos in the selfie genre predate the widespread use of the term. In the early 2000s, before Facebook became the dominant online social network, self-taken photographs were particularly common on MySpace. However, writer Kate Losse recounts that between 2006 and 2009 (when Facebook became more popular than MySpace), the MySpace pic (typically an amateurish, flash-blinded self-portrait, often taken in front of a bathroom mirror) became a n indication of bad taste for users of the newer Facebook social network. Early Facebook portraits, in contrast, were usually well-focused and more formal, taken by others from distance. In 2009 in the image hosting and exposure hosting website Flickr, Flickr users used selfies to describe seemingly endless self-portraits posted by teenage girls. According to Losse, improvements in designespecially the front-facing camera copied by the iPhone 4 (2010) from Korean and Japanese mobile phones, mobile photo apps such as Instagram, and selfie sites such as ItisMeeled to the resurgence of selfies in the early 2010s.

Test for Glucose Control Treatment

Test for Glucose Control TreatmentIntroductionCarbohydrate forms the principle source of energy. Usually polysaccharide (starch and glycogen) which atomic number 18 glucose units joined by a-glucosidic links and disaccharides (sucrose and lactose) the main dietary carbohydrate. Carbohydrate absorption must(prenominal) be presented to the intestinal epithelium in monosaccharide from mainly glucose and thitherfore digestion must innovate absorption.Glucose gained a significant importance be subject brain cells argon very dependent on it as it is sole source of energy supply. Red crosscurrent cells glutively depend on glucose to carry out their functions. Therefore the blood glucose soaking up must be maintained within relative narrow range. After a carbohydrate-containing meal, glucose is transported in the portal blood to the liver, which takes up 60% of the glucose load. Consequently, a rise in the blood glucose concentration causes the release of insulin which will increase t he entry of excess glucose into the liver where it is stored in form of glycogen.The ruler blood plasma glucose concentration remains between 4.5 and 11 mmol/L, despite the in nameittent load entering the body from the gastrointestinal tract. The maintenance of plasma glucose concentration below 11 mmol/L minimizes loss from the body as well as providing the optimal supply to the brain. Mayne, (1994). All the filtered glucose through and through glomeruli is reabsorbed in the proximal tubules. Therefore no glucose should be detected in urine significant glycosuria occurs if the plasma glucose concentration exceeds 11 mmol/L.The two most great hormones in glucose homoeostasis are insulin and glucagon. Insulin is a 53 amino group pane of glass polypeptide, secreted by the -cells in the islet langerhans of the pancreas in response to a rise in the blood glucose concentration. Insulin stimulates glycogen synthesis and reduces glycogenolysis through interaction with an exquisitely coordinated control mechanism that is central to the regulation of blood glucose concentration. Glucagon is a 29 amino acid polypeptide secreted by the -cells of the pancreatic islet. Its secretion is decreased by a rise in the blood glucose concentration. The action of glucagon is opposite those of insulin. It stimulates hepatic glycogenolysis through activation of glycogen phosphorylase, gluconeogenesis, lipolysis and ketogenesis. Marshell, (2000).The world health organization (WHO) defined diabetes on the basis of laboratory findings as a fasting venous plasma glucose concentration greater than 7.8 mmol/L and greater than 11.1 mmol/L two hours after the oral ingestion of the equivalent of 75g of glucose even the fasting concentration is chemical formula. Mayne, (1994). Diabetes mellitus classified in two flakes insulin dependent diabetes (IDDM type-1) where there is a defective insulin secretion. This correct presents in childhood or early adulthood (less than 20 years). Becau se of insulin deficiency, hyperglycaemia is very likely to occur. As a solving glucose will leak to urine (glycosuria) because the plasma glucose concentration exceeds the renal threshold (10 mmol/l). Other consequences related to this condition are polyuria (frequent urination), glucose lost in urine depict water with it by osmosis producing osmotic diuresis characterized by polyuria. The excess fluid lost from the body leads to dehydration and thirst which is a compensatory mechanism to counteract the dehydration. One of double-dyed(a) metabolic complication that may occur in this condition is ketoacidosis there is increased lipid and protein breakdown, enhanced hepatic gluconeogenesis and impaired glucose into cells. Marshall, (2000). In this condition insulin doses are required for the treatment.The causes of the type I diabetes can be an autoimmune where the islet cell antibodies react specifically with the -cells, or viral infection that remove the -cells of pancreatic isl et. Individual with certain human leukocyte antigen (HLA) types have been shown to carry a particular high risk of developing type I diabetes.In type II diabetes, non insulin dependent diabetes mellitus (NIDDM), obesity is the biggest risk factor, 90% of type II diabetes are obese and it is occurs in the late onset. In this condition -cells of islet langerhans are mean(prenominal) which means that there will be a normal insulin concentration and sometimes high in the blood. Also the sensitivity of insulins target cells reduced. The cause of reduced remains elusive, recent research suggest that adipose tissue cells secrete a hormone known as resistin, which interfere with insulin action in experimental animal. This could be an important link between obesity and insulin resistance. Resistin is distinct from leptin, the hormone secreted by adipose cells that plays a role in controlling nutrient intake. (Kumar Clark, 2002).Treatment of this condition by dietary control and weight los s, exercise, sometimes oral hypoglycaemic drugs required.Other conditions can lead to Diabetes Mellitus such as domineering insulin deficiency due to a pancreatic disease (chronic pancreatitis, haemochromatosis, cystic fibrosis). Relative insulin deficiency, can cause diabetes mellitus due to excessive growth hormone, glucocorticoid secretion, or increased plasma glucocorticoid concentration due to administration of steroids. Also drugs like thiazide diuretics can cause diabetes mellitus. Mayne, (1994).Materials and modePlease refer to medical biochemistry practical book (BMS2).ResultThe equation obtained fro the calibration curve used to calculate the concentration of glucose in plasma.Y = 0.018 XWherey = absorbancex = glucose concentration patient 1P (fasting) = 0.078 / 0.018 = 4.3 mmol/LP (2hrs) = 0.105 / 0.018 = 5.8 mmol/LPatient 2P (fasting) = 0.113 / 0.018 = 6.2 mmol/LP (2hrs) = 0.105 / 0.018 = 8.3 mmol/LPatient 3P (fasting) = 0.148 / 0.018 = 8.2 mmol/LP (2hrs) = 0.264 / 0. 018 = 14.6 mmol/L expirationPatient 1 is normalPatient 2 has normal fasting glucose take and high value after 2 hours (9.6 mmol/l), so this patient of must be retested before diagnosis.Patient 3 is diabeticDiscussionThe glucose calibration graph showed a good linearity which means that Beers Lambert law is obeyed and the results are accurate.In glucose allowance account test (GTT) the patient is asked to eat normally in the three days leading up to the test and to be fasting for at least 12 hours. At the end of time the patient is asked to collect urine sample and blood sample is collected. After that, the patient drinks 75g of glucose in three hundred ml of water within 5 minutes. After 2 hours, the patient is asked to collect anther urine sample and blood sample is collected. Normally when the patient is fasting, the glucose level should be 5.5 mmol/L and there is no glucose in urine. After the patient is given up the sugar, the glucose level in the blood will increase, but in the normal person the glucose concentration should go back to normal within 2 hours and no glucose can be detected in urine. What is happening in the normal person after given glucose is that insulin is produced in high concentration, the glucose is converted into glycogen and therefore the glycogen is stored in the liver. Finally, insulin concentration also decreases to normal concentration. Whereas, in the diabetic patient the glucose level stays high because the insulin is insufficient, not produced or present but not functioning due to a defect in the -cells of pancreas.In normal condition, the filtered glucose is completely reabsorbed in the proximal tubule. In Diabetes Mellitus the blood glucose is much above the renal threshold (11 mmol/L), reabsorption becomes saturated and it starts to appear in urine. The heading of glucose in urine is called glucosuria. Glucosuria results in osmatic diuresis that increase water excretion and raises the plasma osmolarity, which in tur n stimulates the thirst centre. Osmatic diuresis and theist cause classical signs and symptoms of polyuria (large volume of urine) and polydipsia (excessive thirst).In patient-1, fasting blood glucose (4.3 mmol/L) is within the normal range and no glucose in urine. After 2 hours the blood glucose level is 5.8 mmol/L, which is below 7.8 mmol/L and no glucose in the urine. These mean that this patient is normal.In patient-2, fasting blood glucose is within the normal range and no glucose in urine. After 2 hours the blood glucose level is 8.3 mmol/L which is slightly high but it is within the normal range of impaired glucose tolerance (7.8- 11.1 mmol/l), whereas urine glucose is negative. This means that this patient must be retested before finish to diagnosis of impaired glucose or any other diagnosis. Many people with impaired glucose tolerance progress to develop diabetes, but this condition can be prevented with adoption of a diabetic-type diet and weight loss (if overweight). Whi tby, G, et al, (1988).Patient-3 has high fasting blood glucose level (8.2 mmol/L), and in the urine the glucose is not detected. After 2 hours the glucose concentration did not reduce and it went higher up to 14.6 mmol/L. in addition to that, the urine dipstick showed very strong positive reaction (4+), which indicate that this patient is diabetic. In this patient the glucose concentration was high before the sugar was given. This means that there is a defect in insulin secretion which can not breakdown the glucose and bring to the normal level. The high blood glucose level was due to glycogenolysis, gluconeogesis or high glucose intake. Therefore, this patient may have type-1 Diabetes Mellitus.QuestionsWhat facts should be taken in account when interpreting the results of glucose tolerance test?The facts arePatient should eat normal diet within 3 days before doing the test. The diet should contain at least 250g of carbohydrate.Patient should be fast over night at least 10-12 hours and does not eat during the test.The 75g of glucose should be dissolved in 300 ml of water and then ask the patient to drink it within 5 minutes after collection of fasting blood sample. A pregnant woman should be given less than 75g of glucose as it may affect the baby. If the amount of glucose given is less than recommended, it will affect the result as the Oral Glucose Tolerance Test (OGTT) is regularize procedure.Patient should rest through the test smoking is not permitted drink of water is allowed.Blood sample should be collected in container that contains sodium fluoride to inhibit glycolysis.The patient must consult the health care provider if he/she is using medication that can interfere with the test result includes Thiazide diuretics (e.g. hydrochorothiazide), beta-blockers (e.g. prpanolol) oral prophylactic device and some psychiatric drugs.There are interfering factors that affect OGTT. There are acute stresses for example, from surgery or infection, and vigorous exer cise.Blood glucose rise with progress and their renal threshold is increased.Time of sample collection is important (morning).The method we used employed glucose oxidase- name 2 other methods for glucose devotion and describe the principles used.Ortho-toluidine method (mono step) glucose reacts with ortho-toluidine in hot acidic medium to form a green coloured complex. The intensity of the final colour produced is directly proportional to concentration of glucose in the sample.UV-kinetic method This method also measures the concentration of glucose. The reagent contains ATP, hexokinase, NADP and glucose-6-phosphate dehydrogenase (G6PD) enzme in ethanol amine buffer (PH 7.5).Why HbA1c a better guide to long term diabetes control than glucose?The determination of plasma and urine glucose provides information about the metabolic status only at the moment. Long term control of glucose can be obtained with relative ease by measuring the amount of particular haemoglobin fraction in red blood cells. The glucose enters the red blood cells and binds the haemoglobin to a very small extent. Although some of the glucose diffuse from the haemoglobin due to formation of covalent bond, but some of the glucose will react with a particular amino acid in the haemoglobin protein. The haemoglobin/glucose complex has different chemical properties from the haemoglobin, thus it can be separated chromatographic or electrophoresis technique. The estimation of Glycosylated haemoglobin (HbA1c) depends on the mean plasma glucose concentration and the life span of red blood cells (RBCs). The normal level of non-diabetic is 6%. Also because it depends on the plasma glucose concentration, HbA1c in diabetic patient tend to be increased over the previous 1- months. The extent of elevation of HbA1c indicates the overall degree of blood glucose control in bruskly controlled diabetes it may rise as high as 25%. Whitby, (1998). So the higher percentage of HbA1c indicates more glucose bound to haemoglobin and hence poor control of diabetic. Subsequently this test is used to asses the quality of the long term control of blood glucose in diabetic patient. Also it examines the patient faithfulness with which he/she followed the health care instruction and the effectiveness of the medication prescribed for treatment.

Patient Advisory Board Internship

Patient Advisory mount up InternshipPatient Advisory Board Internship at Zuckerberg San Francisco General HospitalFor this cooperative education mould I have chosen to write some my internship at Zuckerberg San Francisco General Hospital (ZSFGH). I was chosen for this internship from a pool of pre-medical student appli nominatets based on my resume, letter of interest and in person interview. The be disposed was advertised as needing someone to act upon the formal Patient Advisory Board Council (PAC). I wasnt aw ar until my interview with the Medical Director and Floor Manager that I would be doing much much than running a once a month group meeting. I would to a fault be in charge of recruiting new members to the PAC, seeking out presenters and providers wishing for tolerant input, enrolling tolerants in and training them to use the online SF health Network Patient portal site, running the monthly Diabetes in Motion Clinic, and doing various other small duties around the hospital. I had to commit to being available 30 hours a week that were flexible but must include Fridays. I was excited to be chosen for this hazard to have great potential in improving unhurried health and satisfaction at ZSFGH, San Franciscos alliance safety net hospital while alike growing my own knowledge of what it takes to provide high quality health services to underserved populations.Before being allowed to start my volunteering duties there were many steps I postulate to tackle to be eligible to work with patients, both for my own safety as well as theirs. I had to find time to go to the hospital to procure blood work and testing to be sure I didnt have Tuberculosis or a list of other transmittable diseases. I was required to take just over 10 hours of training geargond to attentioning familiarize myself with the layout of the hospital in addition to how to safely move on a passing(a) basis with the unique population at ZSFGH. My learning objectives were to under stand what I would need to do in my daily work to knowledgably comply at bottom HIPAA rules and NIH safety protocols.MethodFor my content for this report I performed research on site at my Internship. ZSFGH has an extensive medical library that is put down and open to the public. The librarians are well versed in what is available in the event that I had any questions arise during my time there. The Volunteer Services playactation also stocks many resources that are available for learning about how best to business organization for patients wellbeing and properly protecting their personal information online and in daily hospital interactions. I utilized both of these resources in my off-volunteer hours either in the lead or after doing internship qualifying hours.Discussion Literature ReviewInitial OnboardingIn order to be able to be an official volunteer at ZSFGH, I had to complete their online Volunteer Orientation Course. This took about 2 hours and was utile in walking m e finished the layout of the SF Health Network as well as the buildings where I would be working. Also outlined were the health requirements of all volunteers in the cyberspace requiring blood work and vaccinations. After completing those steps I was assigned a volunteer identification number to be able to log my Internship hours and a badge make outing me as a Volunteer that also shows which clinic I am a part of, my flu-shot status and lists the hospital wide emergency response codes for abstemious reference.In order to be useful in my positions I needed to learn about the San Francisco Health Network Primary Cares missions and vision for providing the highest quality base and preventative bring off to adults, regardless of ability to pay. There are 4 main aims of the clinic that follow from building a constituteation of healthy, engaged, and sustained primary cover workforce. To contain an excellent patient experience, optimize access, operations and cost-effectiveness, have sustainable patient centered veneration and finally, to improve the health of the patients served.The specific clinic I was leased to do my internship with was the Richard Fine Peoples Clinic General Medicine Clinic (RFPC-GMC). This is a clinic consisting of mostly low income, homeless and immi devote patients. The Volunteer Services Office at ZSFGH assisted my learning about patient information security by providing some short video training from the SF Department of Public Health. (Public Welfare, 2009) This helped me learn what information qualifies as needing to be clannish and secured treated as sensitive and protected health information. There is an erected national set of standards for identifying protected patient health information (PHI) such as a patients demographic entropy relating to past, present or future medical needs. (The Health Insurance Portability and Accountability Act of 1996) It is anything that can be used to identify patients such as their initi ative or last name, medical record number, phone numbers, email addresses, date of birth, Social Security Number or address. Rules for discourse such information is that you must never store PHI on an unencrypted computer, a flash-drive or take home files with PHI. If necessary for an email this information must be encrypted and titled as Secure. Written information must be disposed of in the locked to be shredded bins when no longer needed. Information can be stored on the provided work computer server only accessible by UCSF ward computers. (Burnap, 2012)Unlike a Kaiser or Sutter insurance network hospital or clinic, the SF Health Network is part of the urban centers health placement that provides a significant level of care to low-income, uninsured, and vulnerable patient populations. ZSFGH is a unique in that it is also a training hospital tied with UCSF. Patients benefit from cutting edge training for their Doctors and Residents as well as generous philanthropic funding that the University benefits from annually. A large part of ensuring patient self-empowerment lies in building their networks and increasing accessibility to services, which this funding can bring. (Corburn, 2007)Patient Advisory CouncilPrior to working within the SF Health Network I was not cognizant that there were 26 clinics across the city. This aids in vastly improving patients access to care in or near their own neighborhoods. Each clinic was challenged with starting their own PAC in 2016. There are now 21 PACs across the city for various dissimilar types of clinics and patient populations including 2 in Spanish and 1 in mandarin orange lyric poems. Prior to instating these PACs much of the average providers knowledge of patient satisfaction was just volume of mouth. The main motivating force behind coordinating clinic PACs is aimed at inviting longtime and new patients to provide input for quality improvement projects from the ground floor. Assessing involvement at the direct patient level can lead to fast strides in fellowship health improvement. (Dannenberg, 2008)I was responsible for the outcome of the Richard Fine Peoples Clinic PAC. I needed to work on recruiting new and several(a) members to the team and learn how to lead a group of people that is outside of my everyday socio-economic peer group toward a common goal. I looked to resources for what has worked for other projects for medical recruiting methods prior to mine. (Dannenberg, 2006) I had to coordinate presenters and inquiring providers to ensure that the board provides helpful information to both patients at the clinic and those within the larger health care network. While the focus was on our individual clinic, there is also a hospital wide PAC that was able to charge forward any ideas we might have that would benefit the entire hospital population at ZSFGH. In addition to organizing the agenda for the PAC meetings, my duties involved hookup information from patients and providers tha t generated from our meetings to then enter them into other placements and/or up-channeling ideas involving specific patient populations and their recommendations and cravings. Some more recent accounts of improving health at one community level have shown to have a positive impact on the entire city. (Bhatie,Corburn, 2011) I kept meticulous records of all agendas and minutes of every meeting for all attendees records as well as past and future reference needs of progress.I was also assigned to help the RFPC Residents on their new project concerning the SF Health Networks Patient Portal. They tasked me with recruiting current patients to enroll in the waiting room. The Patient Portal is a tool for empowering patients to be pro vigorous regarding their own health. Most of my patients are caparison insecure so I had to seek out examples of positive outcomes of patients evolving from homeless to housed and how to be aid those in variation. (Kessell, 2006) A few strategies for recru iting new patient advisors, portal users and clinic contour attendees were given to me by the previous Intern that I was replacing. I had to meet quota goals for portal enrollees, training and tracking recruit new patient users in clinic for the online Patient Portal and do some data entry for tracking contacts, new enrollees and demographics. I had to figure out the best way to intend down how best to contact clinic patients to arrange one on one training sessions for the online Patient Portal. I looked into ways in which your immediate surroundings can shape your ideas of your own perceived ability to achieve healthy outcomes as guiding the ways I would approach patients. (Cummins, 2005)To keep the PAC running, I needed to also book conference rooms for upcoming meetings and was able to book a nice meeting room through December 2017 for ease of transition for the next intern. I made reminder calls and sent out an agenda one week prior to meetings to those members with access to email. I collaborated with members to see what upshots they are raise in learning more about for upcoming meetings as I was responsible for coordinating them with presenters. (Dearing, 1996) I surveyed members about what their favorite snack forages were so I could best provide for our meetings. I was allowed to spend $50 for each meeting so we had quite an assortment of provenders, all within reason of course as we are promoting healthy keepstyles after all. I guided the meetings but also recorded notes for action items to follow up on as well as to write minutes for future reference as available to the public.Diabetes in Motion ClinicThe SF Health Network also has a Community Wellness computer program branch that allows for patient learning on a variety of fronts from smoking cessation lectures to Zumba classes and nature walks. The Wellness Programs are offered at several clinics across the city and aim to provide and promote innovative services to staff, patients, their fa milies and all San Franciscans. They are designed to be accessible culturally and linguistically as well as to all animal(prenominal) ability and/or limitation levels. The classes that are part of the Working on Wellness (WOW) Healing Moves, Active Living Initiative are open to all and free of charge. Another important part of my duties was to also work on chronic disease group visits in the diabetes clinic. It was important to help try and understand the unique hurdles specific to this particular patient population. (Bhatia, Seto, 2011)The Diabetes in Motion ( weak) Class was an extra duty inherited by me as the previous Practice Manager moved to Hawaii and requested that the incoming PAC Coordinator (me) adopt the class. This 2 hour class was held once a month and tasked with helping those with Diabetes, the pre-Diabetic and their caregivers better understand how to help improve their conditions. I noticed immediately that there might be low attendance, only 5-10 attendees, due t o a lack of a unified agenda across the year of these classes. I researched ideas of how living in an urban environment can impact health and health unlikely than a more rural setting for insight into health problems. (Bodea, 2009) I decided that we would try breaking the class into 2 portions, a vogue portion (due to the title) and a healthy eating portion. There was no dedicated staff and, as we had plenty of funding left in the available grant I was able to hire 2 local instructors. I hired Sylvie Minot, leader of the Syzygy Dance Project as an Exercise Instructor and Catherine McConkie, Founder of The Caregivers delay as our Nutritionist. Ms. Minot was able to lead progressive movement exercises that were accessible to all levels of mobility incorporating yoga, stretching and dance movements. The importance of exercise is shown across the lifespan. (Bauman, 2007) During the exercising portion of the class she would lead a discussion about the importance of incorporating movem ent throughout daily life. (Saelens, 2003) Ms. McConkie would follow for the second half of class with easy and turn overable food ideas that she made during the class so the attendees could participate. In addition to making healthy options accessible, she would also pass around ingredients that might be new or whimsical for the patients and discuss why certain foods are good or bad to eat. Eat Better, Feel Better Colorful Choices is a San Francisco Health Service dodging program aimed at adding more fruits and ve crapables to daily routines. I was able to team up with them for our classes to provide free fruits and vegetables to attendees. (Drewnowski, 2004) A $25 Safeway gift card was given to the first 22 participants that stayed for the entire class. go againsticipants were able to take home a bag of food to make the recipe presented in class, for any who could not afford them on their own. (Kim, 2006) I created and distributed English and Spanish language flyers throughout the hospital as well as purchased the patient incentives, organized an agenda with the instructors and ensured 2 interpreters (Spanish and Mandarin language) could attend. Following each class I gathered receipts from all 5 of us leading the course to submit to our grant overseer for living and reimbursement. Our attendance went from a low average to roughly 30 patients per class in just 3 months.Patient PortalIn addition to putt together the DIM and PAC monthly meetings I was assigned to work with the RFPC Residents that were writing a research musical composition on empowering patients to improve their own care knowledge. The biggest aspect of this was increasing patient awareness, enrollment and use of the SF Health Networks Patient Portal. This online tool enables patients to see all of their most recent and up to date data from any meetings with providers as well as testing and results. Not only can this aid individual improvement through expanded knowledge of care but it al so provides an easily accessible list to give to out-of-network providers. The placement also newly rolled out the ability to email your assigned provider. The system self regulates to ease provider burden by immediately rerouting easily accomplished tasks such as appointment scheduling or re withdraw requests earlier any emails actually go to the provider.Initially, I was tasked with 10 hours per week of recruiting new enrollments in the Patient Portal system by visiting with people in the waiting room. With an iPad in one sight and flyers in multiple languages in the other, I speak with each patient on hand to see if they were aware of the program and would like to enroll if not al meditatey. I tracked demographics for the residents as well as number enrolled by me or already. I also had proxy forms available if someone wanted their child or spouse etcetera to have access to their information due to any learning disabilities or language differences as the system is only curren tly in English. I was able to use Google Translate as well as my flyers in 6 different languages to speak with everyone in the room one by one. After doing this for 2 months the residents decided I should transition to training users to increase the amount of actual users of the system once enrolled. I utilized the electronic Clinical Works application (eCW) to research which patients were already enrolled in the Portal. I would then call patients with appointments on a particular day for the next week as determined by the Residents until I found about 10 people willinging to meet with me before or after their appointments. Together, we would then walk through accessing the system and what benefits and uses it provides to the patient. I would send training videos to anyone I spoke with that wasnt interested in meeting in person that they could view on their own if they so wished and they had access to my UCSF email if they had any further questions arise.The largest barrier to incr easing user numbers or active users for the Patient Portal ended up being access to electronics and language barriers. The specific patient population at RFPC has phones that may or may not be web-enabled and a lot of them do not have computers or are computer savvy. In meeting with patients I was able to teach them how to find out their login information and perform simple computer navigation. I provided introductions to the hospital library where free computers are available all day that I had never seen full. The system is eventually scheduled to be accessible in Spanish and Mandarin sometime next year.Extra TasksThere were some one time tasks on my plate as well. I needed to accomplish the yearly update of the Clinic Care Team Boards. All of the providers are divided into one of three glossiness care teams to help ensure that, even if you cannot visit your assigned Doctor, you will see someone familiar with them and your file. The previous boards were on a small dense and whi te listing with a few pictures. I used the Adobe program InDesign to organize everyone by provider type, team, procured color head shots of all providers and found a local print shop to print each team board on a 3 x 5 color poster. I also needed to keep the waiting room stocked of specific informational flyers and magazines every few days.ResultsParticipantsAdult patients I was able to add to the PAC were recruited through various methods. Informational flyers were posted in the waiting room and at the pre-appointment health screening station. Providers were encouraged to mention the Council to patients they felt were well informed and/or had the desire to work on quality improvement projects for the Clinic. Most respondents that became full time members of the Council were older adults, 45-72 year old, 4 women and 6 men. Participants were compensated $10 and offered free food (cheese, meat, crackers, fruit, veggies, cookies and water) for their 90 minute participation at each meet ing. 3 of the members additionally qualified for free Muni transportation vouchers and 1 for free parking passes. All participants were asked to read the agenda sent to them one week prior to each meeting to prepare any questions or ideas they might have on each topic scheduled to be addressed.AccomplishmentsWeve been able to get funding to remodel the waiting room with more comfortable furniture, a new color of paint on one wall (blue instead of white) and wall hangers to provide information of free local services available throughout the month. Weve also spearheaded projects such as surveys to fill out prior to your appointment while you wait in the waiting room and converting the waiting room television from daytime drama shows to clinic specific informational bosom that rotates from a video documentary about the namesake of the clinic to various free or affordable services offered throughout the city for the current month. Starting in April, we will be part of the coordinated e ffort to have Food Pharmacies across the network. In partnership with the SF Marin Food Bank, patients will be able to get a bag of free and healthy food after their appointments. PAC members will be available once a week to assist.Another issue raise was of transit safety. One of our members was on disability due to having been run over by a vehicle while she was legally using a crosswalk. The incidental left her unable to work for over a year while undergoing multiple surgeries and a lengthy recovery. We had several presenters come to a meeting to get insight from our patients in regard to possible pedestrian improvements. (Mejia, 2017)The PAC raised money to have a portrait painted of our Clinics namesake, Dr. Richard H. Fine that it is to be hung in the waiting room. We are waiting on the display box that is being made to keep it displayed securely. Dr. Fine founded the General Medicine Clinic at ZSFGH, one of the first outpatient clinics in the nation at a Public Hospital that provides health care to underserved populations. He ran it for 25 years. To recognize and thank Dr. Fine for his acute judging of patient needs, the General Medicine Clinic (GMC) was renamed as the Richard H. Fine Peoples Clinic (RFPC) in August of 2015 three months before his death. There is a wonderful documentary about his life that I was able to show the PAC members at the end of one of our meetings. (Biker with a Moral Compas Dr. Dick Fine and the Evolving Culture of SFGH http//mission-healthequity.blogspot.com/2015/07/moral-compass.html)I was able to establish more clear and concise PAC values and guidelines as none had been expressed in writing prior to my tenure as leader. We were to work in partnership and collaboration to address systemic issues versus individual situations. We would do so by working in partnership with the clinic management to support the clinic mission and vision. We would represent the diverse socioeconomic and cultural needs and perspectives of RFPCs patients. We would seek the input of other patients to broaden perspectives. We also established term limits to facilitate turn over and diverse patient representation. Our meetings would create and maintain a safe environment for all members and guests to share ideas and points of view. Respect would be given to the confidential nature of information have at the meetings and we would review and sign HIPAA confidentiality agreements and release forms annually as opposed to only upon initial recruitment. As the PAC coordinator I worked hand in hand with the Clinic Champion, Mr. Michael McGuire who, as the Practice Manager of RFPC was the link between the PAC and clinic leadership. He was able to provide some assistance to help me coordinate with staff and providers to ensure successful collaboration on PAC initiatives help me ensure progress was being made on PAC projects.DIM The grant to fund the DIM Clinic was picked up for renewal for next year and the instructors I chose were i nvited to stay and wished to do so. The dramatic increase in attendee numbers rose from 5 or 10 to upwards of 30 under my tenure. We received a lot of positive feedback from patients with successful weight loss and blood sugar stabilization.Patient Portal Recruiting Training I was able to interact with 815 patients in the waiting room and successfully enrolled 230 new Portal users. For online, in person training I spoke with 87 patients over the phone and met one on one with 34 for individualized training. This data will be included in the Residents research paper as well as my experiences with what the patient population specific challenges were for our Clinic.ConclusionI was able to impart some positive change within the community of ZSFGH during my Internship. I also learned several important lessons such as how communication can be difficult at times but its helpful to try to display an open and approachable demeanor. Patients may be upset when they do not receive what they hav e requested from staff, but remaining dollar sign and expressing compassion can help diffuse and redirect the situation. Because of Dr. Fines close connections to the community, he was able to hear about subsets of people who were not seeking health care and make visible what was invisible to many. I am happy to have been a part of so many diverse projects to assist disenfranchised and marginalized populations of San Francisco.Empowering patients to be proactive about their own care and the outcomes they wish to see has been my main take away from this internship. Helping patients to see ways to incrementally improve their own physical and mental health can not only save money in treatments not needed down the line but also be the first steps towards becoming more independent and being well enough to provide their own income and stable housing.While the community wellness programs in San Francisco promote interventions aimed at addressing modus vivendi issues such as diet and smoki ng, they also recognize the ways in which social determinants of health such as housing status, neighborhood safety, and access to affordable healthy food play a critical role in wellness promotion and encouraging healthy lifestyle choices. With this in mind, I worked to incorporate strategies such as public health education and advocacy in addressing poor health outcomes during my Internship.ReferencesBauman A, Bull F. Environmental Correlates of corporeal Activity and Walking in Adults and Children A Review of Reviews. London National Institute of Health and Clinical Excellence 2007.Bhatia R, Corburn J. Lessons from San Francisco Health impact assessments have innovative political conditions for improving population health. Health Affairs. 2011 Dec30 (12)2410-18Bhatia R, Seto E. Quantitative estimation in Health Impact mind Opportunities and Challenges. Environmental Impact Assessment Review. 2011. DOI10.1016/j.eiar.2010.08.003Bodea TD, Garrow LA, Meyer MD, Ross CL. Polic y and Practice Socio-demographic and Build Environment Influences on the Odds of Being Overweight or Obese The Atlanta Experience. Transportation Research Part A 200943(4)430-444.Burnap P, Spasic I, Gray WA, Hilton JC, Rana OF, Elwyn G. Protecting patient privacy in distributed collaborative healthcare environments by retaining access control of shared information. International throng on Collaboration Technologies and Systems. 2012490-497 DOI 10.1109/CTS.2012.6261095Corburn J, Bhatia R. Health Impact Assessment in San Francisco Incorporating the Social Determinants of Health into Environmental Planning. Journal of Environmental Planning and Management. 2007 May50(3)323-341Cummins S, Stafford M, MacIntyre S, Marmot M, Ellaway A. neighbourhood environment and its associations with self-rated health evidence from Scotland and England. Journal of Epidemiology and Community Health 2005 59207-213.Dannenberg A, Bhatia R, Cole B, et al. Use of Health Impact Assessment in the Unit ed States 27 Case Studies, 1999-2007. Am J Prev Med. 2008 Mar34(3)241-56Dannenberg AL, Bhatia R, Cole B, et al. Growing the Field of Health Impact Assessment in the United States An Agenda for Research and Practice. Am J Public Health. 2006 Feb96(2)262-70. Dearing JW, Rogers EM. Agenda-setting. Thousand Oaks, CA Sage. 19965-20Drewnowski A, Darmon N, Briend A. Replacing fats and sweets with vegetables and fruits a question of cost. American Journal of Public Health. 2004 94(9)1555-1559.Kessell ER, Bhatia R, Bamberger JD, Kushel MB. Public Health Care Utilization in a Cohort of Homeless Adult Aplicants to a Supportive Housing Program. J Urban Health. 2006 Sep83(5)860-73Kim D, Kawachi I. A multilevel analysis of key forms of community- and individual- level social capital as predictors of self-rated health in the United States. Journal of Urban Health 2006 83(5)813-826.The Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public law of nature 104-191 261- 264Public Welfare, Department of Health and Human Services, 45 C.F.R. 46 (2009).(C.F.R. is the Code of Federal Regulations) Mejia, P. Beyond the Traffic Report The News About Road Safety and muckle Zero in San Francisco. Berkeley Media Studies Group. 2017 Jan3-12Saelens BE, Sallis JF, Frank LD. Environmental correlates of walking and cycling findings from the transportation, urban design, and planning literatures. Ann Behav Med. 200325(2)80-91.

Alliance Boots Future Strategic Directions Organisation Business Essay

adherence Boots Future Strategic Directions Organisation Business EssayIt is a multinational company with strong recognition and disposition as one of the leading pharmaceutical and beauty companies in the world. Alliance Boots revenue is more than than 22.5 billion in excess it also has various outlets in more than 20 countries.Alliance Boots core aras of business atomic number 18 pharmaceutical and beauty, formed in 2006 as a merger Boots Group and Alliance UniChem and recently a global merger with Walgreens.The company main purpose is to help its nodes to look and feel better than ever, by providing exceptional customer and patient tutelage with extensive value for its customer.Product brandsAlliance Boots Pharmaceutical Wholesale Division is experiencing a quick growth and global gross sales the company believes that its product invention and development competencies are some of the resourceful factors, which en able the company to develop innovative and active pro ducts for global consumption. Some of these products are, No7, Soltan and Botanics, 17, Almus and Alvita that were successfully launched recently.Organisation StructuresAlliance Boots devote over 185,000 employees and numerous pharmaceutical outlets. The aim of the company is to work closely with manufacturer of pharmaceutical, beauty and health products and use of goods and services experienced pharmacists to endure services to their customers. Alliance Boots headquarters is in Zug Switzerland.Alliance Boots Strategy OptionsIt is important that when a global business organisation wants to adopt a sustainable development strategy for its products and brands, such(prenominal) strategy needs to be applicable across a wide range of different product types, also has to be flexible to cope with the rapid turnover of products.Alliance Boots also believe thatThe company strategy is capable to cope with three main routes by which products are introduced at Alliance Boots (own manufacture , third party supply of Alliance Boots brands and proprietary brand).The company strategy is providing leadership on where and how to improve its products and such improvement must be commercially successful. trade strategyAlliance Boots believe that by putting its customers first for all its pharmaceutical and beauty products with outstanding quality and service at a combative cost provide help the company to achieve delicate profitable margins in the global competitive market.Ansoffs MatrixAnsoffs Matrix is a unique selling tool, which provides strategic choices to business organisations in order to achieve the objective for growth. Ansoffs Matrix has four main categories namely food market penetration Market penetration produces a good avenue for a company bid Alliance Boots to sell existing products in existing markets. It is important for Alliance Boots to continue promoting its product with the new features and good quality .This is helping Alliance Boots to invest heav ily and focus more on investigate and development in new market research creating more distribution channel.Market development Alliance Boots use Market development as a growth strategy to sell its existing products into new markets, including new geographical markets, for example product exportation to a new country. It also includes new product packaging new distribution channels (e.g. Boots drugstore stores across UK and selling via e-commerce and mail order). Its ability to target new market makes Market development a unique strategy.Product development Alliance Boots use Product development as a growth strategy creating a unique avenue for its business to introduce new products into existing pharmaceutical markets with great expectation that they provide gain more customers and market share. Such strategy may involve the development of new capabilities and requires Alliance Boots to develop improved products to existing markets.Market Diversification Alliance Boots Diversifi cation strategy allows the company to diversify easily to another geographical market. In 2012, Alliance Boot acquired Nanjing Pharmaceutical a company with a strong market position in China. Such diversification into China Pharmaceutical market now makes Alliance Boots, as the largest stockholder is Nanjing Pharmaceutical, continuing to earn new products and opportunities in the Chinese market.Alliance Boots SWOT AnalysisAlliance Boots Swot analyses areStrengthAlliance Boots redeem an excellent and long-standing relationship with all its customers.The company also has a strong historical reputation for all its quality, using a nectar card to gather customer intelligence.Availability of Boots Pharmacy stores everywhere in the UK and Europe.WeaknessesDue to strong competition with other pharmaceutical companies in the global market, Alliance Boots is struggling to cope with the change magnitude competition in the market.OpportunitiesAlliance Boots continue to use the internet oppor tunity to keep increasing its presence by using online shopping to transact with its interior(prenominal) and global customers.Alliance Boots are also using its retail store presence across the global market such as Boots Pharmacy to create the right products with the right combination of price and promotion to achieve its long-term goals for growth.ThreatsThe major threat to pharmaceutical industries including Alliance Boots is the government higher tax on the price of medicine that Alliance Boots and other retailers must deal with.Porters Five ForcesBusiness organisations use five forces of Porter to make an analysis and attraction of its structure. supplier Power It plays an important role in competitive force, more suppliers one can greatly increase y bargaining power with these suppliers. For example, Alliance Boots successfully bargained with over 80 suppliers to lower prices of some of the drugs they sell over the counter in 2007.Buyer Power Increasing customer loyalty is a office of reducing the power of the buyer, the introduction of nectar card by Alliance Boots is a mood to reward its customers. Because of this, it allows the buyers to save considerably. It also allows Alliance Boots to capture expedient information and monitor consumer-purchasing habits.Threats of New entrants There has been a huge increase in the number of new entrants in the pharmaceutical market making it uncontrollable for Alliance Boots to expand in the way the company wants. For example, Tesco is planning various new supermarkets across Britain that would restrict Alliance Boots ability to expand. This poses a real threat, which subject matter that Alliance Boots need to change its marketing strategy with the possibility of reducing prices through advertising.Threat if substituteIn order to save money more businesses may decide to outsource their products and services to another company at a cheaper cost. Alliance Boots did not outsource its products and services inste ad, the company IT department was able to make changes in the way customers pay for their products by replacing its traditional till machines to touch screen capability giving customers a faster way to shop on their own.Competitive RivalryThis affects many businesses in terms of price competition and product identification. For example, other rivals in the business like Lloyds Pharmacy, Superdrug are expanding rapidly. Because of this, Alliance Boots are constantly improving its store marketing strategy making its products more affordable and available everywhere in the UK and continue to provide outstanding customer service.Alliance Boots PESTEL AnalysisPolitical Factors Various political decisions can have a huge impact in the business blend in and its performance. For example the impact of government UK policies on the business allowing some major supermarkets to open numerous pharmaceutical stores within their stores. The government believes that such policy will increase NHS s ervices and improved health care. Such move will not help Alliance Boots, instead, it will create a huge competition, which will eventually make Alliance Boots to lower its product prices and operate for longer hours.Economic Factors The global economic recession has a huge impact on healthcare, with a huge increase in the prices of global healthcare affecting the way customers spend on their healthcare products especially Beauty products. The rising provide costs also have a huge impact in the supply chain channel of Alliance Boots leading to price increase.Social Factors The genial factors are creating more awareness about how everyone should take care of himself or herself through, exercise, eating habits, type of food that is good for the body and many more. For example, government stir up that is promoting healthy eating (eatwell.gov.uk 2012 online) as a result in the rapid increasing level of obesity within the UK (Department of health 2012 online).Such information is boost ing Alliance Boots sales by encouraging its customers to try its healthier products at a cheaper price than other companies.Technological Factors The evolution of the internet is helping online retail sales, Alliance Boots are making use of the internet technology to its advantage with the internet is now generating more than a third of all revenue for Alliance Boots products and services.Alliance Boots contract for Innovation is investing hugely in the development of inventive products and technologies that focus onWays to detect treat and monitor customers well-being issues.Environmental Factors many another(prenominal) countries are now committed to green energy ever than before due to the risk of global warming is becoming a reality, Many companies like Alliance Boots have been told to play key role in reducing carbon footprint and increasing energy efficiency (Bream 2008). Because of this, Alliance Boots will have to invest more in greener products (selling of organic health product) and reducing their impact of carbon footprint on the environment.Legal Factors There are various reasoned issues that are facing the way companies operate globally, for example, Alliance Boot Cases include application to the European Court of Justice in sex discrimination causal agency of Neath versus Hugh Steeper Limited. New laws keep emerging everyday especially on healthy product and drinks, which mean Alliance Boots will have to be more cautious about its packaging and labelling policies, which will be an extra financial liability on the Alliance Boots.Globalisation DriversThis can be classified intoMarketGrowth of global and regional channelsEstablishment of world brands2. CostFast-tracking technological innovationTransportation and distribution channel3. GovernmentReduction of responsibility barriers and non-tariff barriers4. CompetitiveHuge rise in global strategic alliances with other companies.Future Strategic PartnershipWalgreen Co., US largest drugstore chain is the latest rising strategic partnership and direction that Alliance Boots are taking. Under this new strategy, Alliance Boots and Walgreen Co are bringing together the strengths and proficiency of both companies to create unique global pharmaceutical companies with a strong focus on health and well-being.RecommendationsIn order for Alliance Boots to continue maintaining its global presence as one of the dominant forces in the Pharmaceutical companies, the following are the vibrant future strategic directions that Alliance Boots must take for its business.Delivering of new innovative aesculapian research using the next generation technology.A new global approach to marketing by sponsoring various events related to the well-being of Alliance Boots customers. working out of general merchandise ranges which in return will create sales with greater growth potential and effectiveness.ConclusionIn conclusion, strategic management with a dedicated market focus is a driver to build a s uccessful future globalisation and a successful merger process of the pharmaceutical industry. Alliance Boots continue to internationalise its key product brands, selling them to distributors, independent pharmacies and retail partners including online shopping sites globally.

Inhibitory Or Excitatory Potential Changes :: Biology Biological Papers

Inhibitory Or Excitatory Potential ChangesGraded authoritys can be either hyperpolarizations (inhibitory) or depolarizations (excitatory). Inhibitory postsynaptic potential, also referred to as IPSP, is the temporary hyperpolarization of a membrane. An inhibitory postsynaptic potential occurs when synaptic input selectively opens the gates for potassium ions to red ink the cellular telephone (carrying a positive charge with them) or for the chloride ions to participate the cell (carrying a negative charge with them). Inhibition is not just the absence of excitation, it is an progressive brake that is able to suppress the excitatory responses from occurring (Kalat, 2004).Excitatory postsynaptic potential, also known as EPSP, is a graded depolarization. As a result of sodium ions enter the cell, excitatory postsynaptic potential occurs. As a result of the synaptic activation, the sodium gates open, allowing an increase in the flow of sodium ions crossing the membrane. Excitato ry postsynaptic potential is a subthreshold event that decays over space and time, meaning its magnitude decreases as it travels along the membrane (Kalat, 2004). Lithium has both inhibitory and excitatory features. Evidence has shown that atomic number 3 alters sodium transportation (http//www.mentalhealth.com). In the extracelluar fluid lithium may replace sodium. During the process of depolarization lithium has an extremely rapid intracellular influx. Although, it is not effectively removed by the sodium-potassium pump. According to Kalat (2004) the sodium-potassium pump, is a protein complex that repeatedly transports three sodium ions out of the cell while drawing two potassium ions into the cell (p. 41). As a result, it prevents the cellular reentry of potassium. This interferes with the electrolyte distribution across the neuronal membrane, resulting in a decrease in the membrane potential, changes in conduction and neuronal excitability. As measured by cortical e voked potential, for humans lithium alters the excitability of the central nervous system (http//www.mentalhealth.com). Lithium enhances the uptake of norepinephrine and serotonin into the synaptosomes, gum olibanum reducing their action. Lithium also reduces the release of norepinephrine from synaptic vesicles and inhibits production of cAMP. Lithium inhibits the synthesis of cAMP by the adenylyl cyclase in many brain regions, including the cerebral cortex, caudate, and hippocampus, but not the brain stem or cerebellum(Feldman, Meyer & Quenzer, 1997). The inhibitory action of lithium on NE-sensitive adenylyl cyclase is a consistent finding, but lithium clearly has typical effects on the adenylyl cyclase that is coupled with receptors

Historical Truth Essay -- essays papers

Historical TruthHistorical Truth?As a child sits through history class in the first grade, he or she learns ofthe relationship between Christopher Columbus and the Indians. This history lesson tells the children of the dependence each group had on each other. just as the children mature, the relations between the both groups began to change with their age. So the story that the teenagers are told is a gruesome one of savage killings and lying. When the teenagers learn of this, they themselves might want to do research on this outcome to find out the truth. But as one searches, one finds the inconsistency between the research books. So the question is, who is telling the truth? Mary Louise Pratt and Jane Tompkins examine these difficulties of the reading and writing of history, specifically at the problems of bias and contemplative historic accounts. In Art of the Contact Zone, Pratt explores the issue of whose version of history gets favored and whose gets exceptional by analy zing the circumstances surrounding Guaman Pomas and de la Vegas letter to the King of Spain. In Indians Textualism, Morality, and the Problem of History, Tompkins investigates how history is shaped in accordance to individual(prenominal) biases and cultural conditions of historians by questioning different writings about Native Americans. Each author comes to the conclusion between history andsubjectivity, meaning that history is problematic. The historical accounts pondered by Pratt and Tompkins through historical text allows them to realize that every account that a historian calls a fact is really a perspective. Pratts concepts of nexus zone, autoethnography, and ethnography are supported by the historical ideas in Tompkins essay. The c... ...from reading both essays one would find this to be true. For example, the historical documents encountered by both authors piece some conflicting ideas. Comparing the two authors strategies to read history, Pratt does a complete job. A complete job means reading primary sources from both the inferior and superior cultures. This way she could get the full picture of the actual accounts of the contact zone. On the other hand, Tompkins does not read both types of texts, only ethnographic texts and comes to her conclusion. But the basis of Pratts and Tompkins essay is of the essays they read. Therefore each author is biased in their own nature. There biases come from their culture, which affects the way one sees or understands, and writes history. So whose view is right? It is oneself who ultimately decides on which historical point is true based on ones biases.