The African Berbers

The Berbers, or Berber, has a number of meanings, including a language, a culture, a location, and a group of people: most prominently it is the collective term used for dozens of tribes of pastoralists, indigenous people who herd sheep and goats and live in northwest Africa today.  Despite this simple description, Berber ancient history is truly complex. Who Are the Berbers? In general, modern scholars believe that the Berber people are descendants of the original colonizers of North Africa. The Berber way of life was established at least 10,000 years ago as Neolithic Caspians. Continuities in material culture suggest that the people living along the coasts of the Maghreb 10,000 years ago simply added domestic sheep and goats in when they became available, so the odds are theyve been living in northwest Africa for much longer. Modern Berber social structure is tribal, with male leaders over groups practicing sedentary agriculture. They are also fiercely successful traders  and were the first to open the commercial routes between Western Africa and sub-Saharan Africa, at locations such as Essouk-Tadmakka in Mali. The ancient history of the Berbers is by no means as tidy. Ancient History of Berbers The earliest historical references to people known as Berbers are from Greek and Roman sources. The unnamed first century AD sailor/adventurer who wrote the Periplus of the Erythrian Sea describes a region called Barbaria, located south of the city of Berekike on the Red Sea coast of east Africa. The first century AD Roman geographer Ptolemy (90-168 AD) also knew of the Barbarians, located on the Barbarian bay, which led to the city of Rhapta, their main city. Arabic sources for the Berber include the sixth-century poet Imru al-Qays who mentions horse-riding Barbars in one of his poems, and Adi bin Zayd (d. 587) who mentions the Berber in the same line with the eastern African state of Axum (al-Yasum). The 9th-century Arabic historian Ibn Abd al-Hakam (d. 871) mentions a Barbar market in al-Fustat. Berbers in Northwest Africa Today, of course, Berbers are associated with people indigenous to northwest Africa, not east Africa. One possible situation is that the northwestern Berbers were not the eastern Barbars at all, but instead were the people the Romans called Moors (Mauri or Maurus). Some historians call any group living in northwest Africa Berbers, to refer to the people who were conquered by Arabs, Byzantines, Vandals, Romans, and Phoenicians, in reverse chronological order. Rouighi (2011) has an interesting idea that the Arabs created the term Berber, borrowing it from the east African Barbars during the Arab Conquest, their expansion of the Islamic empire into North Africa and the Iberian peninsula. The imperialist Umayyad caliphate, says Rouighi, used the term Berber to group the people living nomadic pastoralist lifestyle in northwestern Africa, about the time they conscripted them into their colonizing army. The Arab Conquests Shortly after the establishment of the Islamic settlements at Mecca and Medina in the 7th century AD, the Muslims began expanding their empire. Damascus was captured from the Byzantine Empire in 635 and by, 651, Muslims controlled all of Persia. Alexandria in Egypt was captured in 641. The Arab conquest of North Africa began between 642-645  when general Amr ibn el-Aasi based in Egypt led his armies westward. The army quickly took Barqa, Tripoli, and Sabratha, establishing a military outpost for further successes in the Maghreb of coastal northwestern Africa. The first northwestern African capital was at al-Qayrawan. By the 8th century, the Arabs had kicked the Byzantines completely out of Ifriqiya (Tunisia) and more or less controlled the region. The Umayyad Arabs reached the shores of the Atlantic in the first decade of the 8th century and then captured Tangier. The Umayyads made Maghrib a single province including all of northwestern Africa. In 711, the Umayyad governor of Tangier, Musa Ibn Nusayr, crossed the Mediterranean Sea into Iberia with an army made up mostly of ethnic Berber people. Arabic raids pushed far into the northern regions and created the Arabic Al-Andalus (Andalusian Spain). The Great Berber Revolt By the 730s, the northwestern African army in Iberia challenged Umayyad rules, leading to the Great Berber Revolt of 740 AD against the governors of Cordoba. A Syrian general named Balj ib Bishr al-Qushayri ruled Andalusia in 742, and after the Umayyads fell to the Abbasid caliphate, the massive orientalization of the region began in 822 with the ascent of Abd ar-Rahman II to the role of Emir of Cordoba. Enclaves of Berber tribes from Northwest Africa in Iberia today include the Sanhaja tribe in the rural parts of the Algarve (southern Portugal), and the Masmuda tribe in the Tagus and Sado river estuaries with their capital at Santarem. If Rouighi is correct, then the history of the Arab Conquest includes the creation of a Berber ethnos from the allied but not previously related groups of northwestern Africa. Nonetheless, that cultural ethnicity is a reality today. Ksar: Berber Collective Residences House types used by modern Berbers include everything from movable tents to cliff and cave dwellings, but a truly distinctive form of building found in sub-Saharan Africa and attributed to Berbers is the ksar (plural ksour). Ksour are elegant, fortified villages made completely with mud brick. Ksour have high walls, orthogonal streets, a single gate and a profusion of towers. The communities are built next to oases, but to preserve as much tillable farmland as possible they soar upward. The surrounding walls are 6-15 meters (20-50 feet) high and buttressed along the length and at the corners by even taller towers of a distinctive tapering form. The narrow streets are canyon-like; the mosque, bathhouse, and a small public plaza are situated close to the single gate which often faces east. Inside the ksar there is very little ground-level space, but the structures still permit high densities in the high rise stories. They provide a defensible perimeter, and a cooler micro-climate produced by low surface to volume ratios. The individual roof terraces provide space, light, and a panoramic view of the neighborhood via a patchwork of raised platforms 9 m (30 ft) or more above the surrounding terrain. Sources Curtis WJR. 1983. Type and Variation: Berber Collective Dwellings of the Northwestern Sahara. Muqarnas 1:181-209.Detry C, Bicho N, Fernandes H, and Fernandes C. 2011. The Emirate of Cà ³rdoba (756–929 AD) and the introduction of the Egyptian mongoose (Herpestes ichneumon) in Iberia: the remains from Muge, Portugal. Journal of Archaeological Science 38(12):3518-3523.Frigi S, Cherni L, Fadhlaoui-Zid K, and Benammar-Elgaaied A. 2010. Ancient Local Evolution of African mtDNA Haplogroups in Tunisian Berber Populations. Human Biology 82(4):367-384.Goodchild RG. 1967. Byzantines, Berbers and Arabs in 7th-century Libya. Antiquity 41(162):115-124.Hilton-Simpson MW. 1927. Algerian Hill-forts of today. Antiquity 1(4):389-401.Keita SOY. 2010. Biocultural Emergence of the Amazigh (Berbers) in Africa: Comment on Frigi et al (2010). Human Biology 82(4):385-393.Nixon S, Murray M, and Fuller D. 2011. Plant use at an early Islamic merchant town in the West African Sahel: the archaeobotany of E ssouk-Tadmakka (Mali). Vegetation History and Archaeobotany 20(3):223-239.Rouighi R. 2011. The Berbers of the Arabs. Studia Islamica 106(1):49-76.

Timeline from 1800 to 1810

The 19th century gave us technological changes, fantastic discoveries, and political maneuvering that shook the foundations of global society. Those reverberations are still felt hundreds of years later. Documented here is the first decade of the 1800s with duels, battles, explorations, and births in the U.S. and abroad. 1800 The second federal census was taken in 1800, and determined the population to be 5,308,483. Of that number, 896,849, about 17 percent, were slaves.April 24, 1800: Congress chartered the Library of Congress and allocated $5,000 to purchase books.Nov. 1, 1800: President John Adams moved into the unfinished Executive Mansion, which would later be known as the White House.Dec. 3, 1800: The U.S. electoral congress convened to decide the winner of the election of 1800, which ended in a tie.Nov. 17, 1800: The United States Congress held its first session in its new home, the unfinished Capitol, at Washington, D.C. 1801 Jan. 1, 1801: President John Adams began a tradition of White House receptions on New Years Day. Any citizen could stand in line, enter the mansion, and shake hands with the president. The tradition endured until well into the 20th century.Jan. 1, 1801: The Act of Union, which bound Ireland to Britain, took effect.Jan. 21, 1801: President John Adams nominated John Marshall as Chief Justice of the Supreme Court. Marshall would go on to define the role of the court.Feb. 19, 1801: Thomas Jefferson won the disputed election of 1800—over Aaron Burr and the incumbent John Adams—which was finally resolved after a series of votes in the House of Representatives.March 4, 1801: Thomas Jefferson was inaugurated as president and delivered an eloquent inaugural address in the Senate chamber of the unfinished U.S. Capitol.March 1801: President Jefferson appointed James Madison as secretary of state. As Jefferson was a widower, Madisons wife Dolley began serving the White House hostes s.March 10, 1801: The first census taken in Britain determines the population of England, Scotland, and Wales to be about 10.5 million.March 16, 1801: George Perkins Marsh, an early advocate of conservation, was born in Woodstock, Vermont.April 2, 1801: At the Battle of Copenhagen, the British Navy defeated a Danish and Norwegian fleet in the Napoleonic Wars. Admiral Horatio Nelson was the hero of the battle.May 1801: The Pasha of Tripoli declared war on the U.S. President Jefferson responded by dispatching a naval squadron to fight the Barbary pirates.May 16, 1801:Â  William H. Seward, a senator from New York who would become Lincolns secretary of state, was born in Florida, New York.June 14, 1801: Benedict Arnold, the famous traitor from the American Revolutionary War, died in England at the age of 60. 1802 April 4, 1802: Dorothea Dix, an influential reformer who headed efforts to organize Union nurses in the Civil War, was born in Hampden, Maine.Summer 1802: President Thomas Jefferson read a book by explorer Alexander Mackenzie, who had traveled across Canada to the Pacific Ocean and back. The book helped inspire what would become the Lewis and Clark Expedition.July 2, 1802: Jonathan Cilley, who would be killed in a duel fought between two members of Congress, was born at Nottingham, New Hampshire.July 4, 1802: The U.S. Military Academy opened at West Point, New York.November 1802: Washington Irving published his first article, a political satire signed with the pseudonym Jonathan Oldstyle.Nov. 9, 1802: Elijah Lovejoy, a printer and abolitionist who would be killed for his anti-slavery beliefs, was born in Albion, Maine. 1803 Feb. 24, 1803: The Supreme Court, led by Chief Justice John Marshall, decided Marbury v. Madison, a landmark case that established the principle of judicial review.May 2, 1803: The United States concluded the purchase of the Louisiana Purchase with France.May 25, 1803: Ralph Waldo Emerson was born in Boston.July 4, 1803: President Thomas Jefferson officially gave orders to Meriwether Lewis, who had been preparing for an expedition to the Northwest.July 23, 1803: A rebellion led by Robert Emmet broke out in Dublin, Ireland, and was quickly put down. Emmet was captured a month later.Sept. 20, 1803: Robert Emmet, leader of an Irish rebellion against British rule, was executed in Dublin, Ireland.Oct. 12, 1803: Alexander Turney Stewart, the inventor of the department store and a leading merchant in New York City, was born in Scotland.Nov. 23, 1803: Theodore Dwight Weld, a great organizer of the abolitionist movement, was born in Connecticut.Dec. 20, 1803: The vast territory of the Louisia na Purchase was officially transferred to the U.S. 1804 May 14, 1804: The Lewis and Clark Expedition began its westward voyage by heading up the Missouri River.July 4, 1804: Author Nathaniel Hawthorne was born in Salem, Massachusetts.July 11, 1804: The Vice President of the United States, Aaron Burr, fatally wounded Alexander Hamilton in a duel at Weehawken, New Jersey.July 12, 1804: Alexander Hamilton died in New York City following the duel with Aaron Burr.Aug. 20, 1804: A member of the Corps of Discovery on the Lewis and Clark Expedition, Charles Floyd, died. His death would be the only fatality on the entire expedition.November 1804: Thomas Jefferson easily won reelection, defeating Charles Pinckney of South Carolina.November 1804: Lewis and Clark met Sacagawea at a Mandan village in present-day North Dakota. She would accompany the Corps of Discovery to the Pacific Coast.Nov. 23, 1804: Franklin Pierce, who served as President of the United States from 1853 to 1857, was born in Hillsborough, New Hampshire.Dec. 2, 1804: Napoleon Bonapa rte crowned himself Emperor of France.Dec. 21, 1804: Benjamin Disraeli, the British author and statesman, was born in London. 1805 March 4, 1805: Thomas Jefferson took the oath of office for the second time and delivered a remarkably bitter inaugural address.April 1805: During the Barbary Wars, a detachment of U.S. Marines marched on Tripoli, and after victory, raised the American flag over foreign soil for the first time.August 1805: Zebulon Pike, a young U.S. Army officer, embarked on his first exploring expedition, which would take him to present-day Minnesota.Oct. 21, 1805: At the Battle of Trafalgar, Admiral Horatio Nelson was fatally wounded.Nov. 15, 1805: The Lewis and Clark Expedition reached the Pacific Ocean.December 1805: Lewis and Clark settled into winter quarters at a fort constructed by the Corps of Discovery. 1806 Bernard McMahon published The American Gardener’s Calendar, the first book on gardening published in America.Noah Webster published his first dictionary of American English.March 23, 1806: Lewis and Clark began their return journey from the Pacific NorthwestMarch 29, 1806: President Thomas Jefferson signed into law a bill allocating funds for the building of the National Road, the first federal highway.May 30, 1806: Andrew Jackson, future American president, killed Charles Dickinson in a duel provoked by disagreement over a horse race and insults to Jackson’s wife.July 15, 1806: Zebulon Pike departed on his second expedition, a voyage with mysterious purposes that would take him to present-day Colorado.Sept. 23, 1806: Lewis and Clark and the Corps of Discovery returned to St. Louis, completing their expedition to the Pacific. 1807 Washington Irving published a little satirical magazine, Salmagundi. Twenty issues appeared between early 1807 and early 1808.March 25, 1807: Importing slaves was outlawed by Congress, but the law would not take effect until Jan. 1, 1808.May 22, 1807: Aaron Burr was indicted for treason.June 22, 1807: The Chesapeake Affair, in which a U.S. Navy officer surrendered his ship to the British, created an enduring controversy. Years later, the incident would provoke a duel that would kill Stephen Decatur.July 4, 1807: Giuseppe Garibaldi was born.Aug. 17, 1807: Robert Fulton’s first steamboat left New York City bound for Albany, sailing on the Hudson River. 1808 Jan. 1, 1808: The law banning importing slaves into the U.S. took effect.Albert Gallatin completed his landmark Report on Roads, Canals, Harbors, and Rivers, a comprehensive plan for creating a transportation infrastructure in the United States.November 1808: James Madison won the U.S. presidential election, defeating Charles Pinckney, who had lost to Thomas Jefferson four years earlier. 1809 Feb. 12, 1809: Abraham Lincoln was born in Kentucky. On the same day, Charles Darwin was born in Shrewsbury, England.December 1809: The first book by Washington Irving, A History of New York, an inventive blend of history and satire, is published under the pseudonym Diedrich Knickerbocker.Dec. 29, 1809: William Ewart Gladstone, British statesman and prime minister, was born in Liverpool. 1810-1820

Comparing the Struggle in Dante’s Inferno and Book VI of...

The Infernal Struggle in Dante’s Inferno and Book VI of The Aeneid Does hell have its own history? For Dante, the structural and thematic history of ‘hell’ in the Inferno begins with the Roman epic tradition and its champion poet, Virgil. By drawing heavily from the characteristics of hell in Book VI of The Aeneid, Dante carries the epic tradition into the medieval world and affirms his indebtedness to Virgil’s poetry. Moreover, Virgil becomes a central character in the Inferno as he guides Dante, the pilgrim, who has no knowledge of hell, through his own historical model. Similarly, the protagonist of The Aeneid, Aeneas, lacks the foresight necessary to make the journey through hell on his own and thus places his trust in the†¦show more content†¦The historical relationship between the Aeneid and the Inferno originates with Dante’s own definition of the former as â€Å"the canonic epic model† (Jacoff 3). By definition an â€Å"epic model† dramatizes events of historical or legendary importance (Webs ter). Thus Dante, who â€Å"had no direct access to Homer† and the first epic models of Western literature--The Illiad and The Odyssey--chose Rome’s national epic, The Aeneid, as his historical inspiration (Jacoff 3). Specifically, the Inferno finds its overarching structural and thematic antecedent in Book VI of The Aeneid, where Aeneas descends into the realm of the shades. Here among hell’s carnage Aeneas finds his idea of eternal beauty embodied within the shade of his father, Anchises, who has survived in the heaven-like Elysian Fields. In the Inferno, the pilgrim undertakes the same journey as his historical prototype but instead searches for spiritual absolution in a Christian heaven. The motif of the journey remains, but the specific religious overtones of hell become slippery from the time of Aeneas to the pilgrim. For example, in his essay entitled Imagination and Thought in the Middle Ages, Umberto Eco notes that â€Å"the medieval period was a prolo ngation of the mythopoetic dimension of the Classical period, though

HEALTHCARE - 857 Words

HEALTHCARE FRAUD Abuse AND Prevention Health care fraud is a crime. Fraud is committed when a provider or patient intentionally submits false or misleading information to a health plan for use in determining the amount of health care benefits payable. As a Group Health member, there are steps you can take to prevent health care fraud and to report suspected fraud and abuse. There are a lot of things people can do to prevent Healthcare fraud some things that can be done Start by knowing your benefits and reading your Explanation of Benefits (EOB) statements and any paperwork received from Group Health Cooperative or your health care providers. Be wary of any free medical treatment, as these are usually signs. Rising costs of healthcare†¦show more content†¦Attempts to defraud the Medicare program may take a variety of forms. Billing for services or supplies that were not provided Altering claim forms to obtain a higher reimbursement amount deliberately applying for duplicate reimbursement in order to get paid twice Completing Certificates of Medical Necessity which is where the fraud starts in America. Fraud is a serious crime that should concern all parties of the U.S. health care system and is a costly reality that the government cannot overlook. While not all fraud can be prevented, by learning about the many different types of fraud, patients can be educated on how to protect themselves from fraud. If we use government programs to inform the public that they can be targeted, the dollar amount for these cases for fraud can be reduced. An informed public and a properly funded FBI will go a long ways in the overall crackdown of health care fraud. The Federal Bureau of Investigation is spending large amounts of its budget to crack down on health care fraud. 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Financial Accounting Free Essays

This paper seeks the locate the Balance Sheet, Income Statement and Statement of Cash Flows from the 2007 annual reports of Amazon and Dell respectively and describe the general organization of each of the three sets of financial statements. This will be followed by a determination of whether net income or cash from operating activities which is more useful in the organization for each of the two companies. The last part requires to make one prediction about each company from that company’s financial statements and to reach one additional conclusion about each company from the additional information that may be found in their annual reports. We will write a custom essay sample on Financial Accounting or any similar topic only for you Order Now The required financial statements were indeed found from the two companies. For Amazon, the general organization of each of the three sets of financial statements is as follows: The Statement of Cash Flows was presented first, followed by the Income Statement (or Statement of Operations) and then by the Balance Sheet (Amazon, 2007). Since the Statement of Cash Flows came ahead than the Income Statement, it follows that cash from operating activities is more useful than income for the organization. For Dell, on the other hand, the general organization of each of the three sets of financial statements is as follows: The Balance Sheet was presented first, followed by Income Statement and then by the Statement of the Cash Flows. The more useful for Dell, is the opposite with the case of Amazon, as this time, net income is more important than cash from operating activities because Income Statement came ahead of the Statement of Cash Flows (Dell, 2007). For Amazon, it could be predicted the revenues will grow 39% while total assets to grow by 49% in 2008 based on the Income Statement and Balance Sheet revenues figures for 2007 and 2006. For Dell, it could be predicted the sales will grow by 6% while total assets to grow by 8% based also on historical financial statement figures See Appendix 1. One additional conclusion that could be made for Dell will continue to have higher profitability that Amazon for the year 2008 in terms of return on sales and return on assets in 2007 for both companies. See Appendix 1. How to cite Financial Accounting, Papers Financial Accounting Free Essays Veronica Bradley Financial Accounting August 12, 2012 Internal Controls Case Study 2 Internal Controls LJB Company, a local distributor, has asked your accounting firm to evaluate their system of internal controls because they are planning to go public in the future. The Company has to check the internal controls of a system of checks and balances designed to detect and prevent fraud and errors. The Sarbanes-Oxley Act requires U. We will write a custom essay sample on Financial Accounting or any similar topic only for you Order Now S. companies to enhance their systems of internal control. The company hired has to detect the internal control system and meet the companies requirements. The internal control standards applicable to Sarbanes-Oxley (SOX) apply only to large public companies listed on U. S. exchanges. There is a continuing debate as to whether non-U. S. companies should have to comply with this extra layer of regulation. Debate about international companies (non-U. S. ) adopting SOX-type standards centers on whether the benefits exceed the costs. The concern is that the higher costs of SOX compliance are making the U. S. securities markets less competitive. These activities are the backbone of the company’s efforts to address the risks it faces, such as fraud. The specific control activities used by a company will vary, depending on management’s assessment of the risks faced. This assessment is heavily influenced by the size and nature of the company. The principles of internal control activities are (1) establishment of responsibility, (2) segregation of duties, (3) documentation procedures, (4) physical controls, (5) independent internal verification, and (6) human resource controls. Advise the President of what the company is doing right (they are doing some things well) and also recommend to the President whether or not they should buy the indelible ink machine. When you advise the President, please be sure to reference the applicable internal control principle that applies. The things that the company is doing well are that using the pre- numbered invoices. When the company was not using pre-numbering they violated the documentation procedures. If pre-numbered documents are not used, then it is virtually impossible to account for the documents. This will keep good documentation on some things for future reference to have on hand and things aren’t done more than one time by different people. Pre-numbering helps to prevent a transaction from being recorded more than once, or conversely, from not being recorded at all. Second, the control system should require that employees promptly forward source documents for accounting entries to the accounting department. This control measure helps to ensure timely recording of the transaction and contributes directly to the accuracy and reliability of the accounting records. With the information provided the company should invest in an indelible ink machine. This will put the company in more control of accounting procedures. And with this in hand will help reduce the chance of any fraud going on in the company with the checks being more manageable. Use of physical controls are essential. The accountant’s act of keeping the checks in a safe in his office is in accordance with the physical controls principle. This reflects the safeguarding of assets and enhances the accuracy and reliability of the accounting records. The President should also know what they are doing wrong like the petty cash situation. All employees have access to the petty cash in a desk drawer and are asked to only place a note if they use any of the cash. The company had a hard time getting the employee to admit it was him because the company does not assign individual passwords. The company is violating the establishment of responsibility, and segregation of duties, documentation procedures, independent internal verification and human resource controls. With the petty cash Internal control over a petty cash fund is strengthened by: (1) having a supervisor make surprise counts of the fund to confirm whether the paid petty cash receipts and fund cash equal the fund amount, and (2) canceling or mutilating the paid petty cash receipts so they cannot be resubmitted for reimbursement. With the establishment of responsibility the company is violating that responsibility by not assigning responsibility to specific employees. Control is most effective when only one person is responsible for a given task. Without doing this leave the door open for fraud and other possibilities to of things to occur. With the company hiring convicted felons and sex offenders with them having a human resources department this all would have been avoided. They wouldn’t have to worry about employees using the internet to view porn sites. When the company hires employees they should have an independent verification for each individual employee. This will track all the employees with their computer and signing in and out of the system and all things that require a verification to proceed. An accountant is not certifiable to interview everyone for certain positions unless it is involved with their position. The President of the company needs to do a big evaluation of the system of internal controls to make sure all the standards are being met for planning the future of the company. As discussed earlier in the requirements of the company in order for them to go public in the future. They are going to have to follow all the guidelines for the principles of internal control are: establishment of responsibility; segregation of duties; documentation procedures; physical controls; independent internal verification; and human resource controls. How to cite Financial Accounting, Papers

John Wong (Transurethral Resection of the Prostate)

Questions: Case Study John Wong is an 80 year old male of Chinese origin. Johns medical history includes hypothyroidism and osteoporosis and he smokes 10 cigarettes per day. His gait has recently been increasingly unstable and he has difficulty with simple tasks, such as getting up his house stairs and getting up from chairs. In the last 4 weeks, he has noticed that he has been having difficulty passing urine and some abdominal discomfort. His GP referred him to a urologist and a prostate biopsy was taken. This showed BPH (benign prostate hyperplasia) and it was recommended that he undergo a Transurethral Resection of the Prostate (TURP). While conducting Johns pre-admission assessment it is noted that John is slightly hypertensive and is fidgeting and moving around the waiting room. After some education John states that he is pleased to have the surgery as he hopes it will relieve some of the discomfort he has been experiencing. John tells the nurse that he currently lives alone. Johns surgery is unevent ful during the intra-operative stage. On arrival to PACU John is placed in a supine position. He is drowsy and restless and oxygenated through a facemask on 02 at 5l/min. A wheeze and non-productive cough is noted. John has an IDC insitu with continuous bladder irrigation with output noted to be a reddish pink. A number of blankets are placed on top of him as he is shivering. His observations are T 36.5c, HR 90, RR 30, BP 150/90 and SpO2 91%. John is transferred to the surgical ward after a 65 minute stay in PACU. John remains drowsy but easily rousable. He is oxygenated via intra-nasal cannulae at 2l/min and he states his pain is 3/10. He has 0.9% sodium chloride infusion running at 125ml/hr. Postoperative orders include IVF, analgesia (PRN Endone, 5mg 6hrly and Paracetamol, 1g 4-6hourly), strict FBC and continuous bladder irrigation for 24 hours, with an aim of rose urine output. Four hours after Johns return to the ward he is observed to be in pain and distressed. He is diaphoret ic and restless and states that his bladder feels full and he feels the urge to urinate. At this time, vital signs are noted to be: T 36.9c, HR 91, RR 28, BP 146/91 SPO2 98%. On review of his documentation it is found that his fluid status has a positive 500ml balance and his urine is of red colour. There are blood clots in his urine. Please refer to the rubric on page 14 on the Unit Outline for full marking criteria 1. In relation to your chosen patient, discuss the pathophysiology of their condition and using evidence based practice explore current treatment options for your patients condition, include any pharmacological and nonpharmacological considerations. 2. Critically discuss four (4) components of the PACU discharge criteria outlined in the Aldrete Scale. Utilize the scale provided on LEO as a resource in your case study. 3. Develop a discharge plan to support your patient on discharge. Include any education you deem relevant, any referrals to allied health professional/s required, and discuss your rationale? Answers: 1: As referred to in the case study, the old man named John Wong has been suffering from hypothyroidism and osteoporosis previously. Now that he is diagnosed with benign prostrate hyperplasia. The disorder of hypothyroidism refers to a condition that is caused due to deficient formation of thyroid hormone from the thyroid gland. The hypothalamic-pituitary-thyroid axis is said to administer the secreting of thyroid hormone(Menon, 2014). The disorder of osteoporosis is referred to as a progressive disease of bone whereby the bone density as well as mass declines to a great level resulting in an elevated possibility of fracture. The problem of benign prostate hyperplasia refers to the condition of increasing size of prostate. This involves hyperplasia of epithelial as well as stromal cells that give rise to large discrete nodule development in the transitional portion of prostate. When the nodules grow adequately big, these start affecting the urethra as well as restrict flow of urine f rom bladder (Petkov, Saltirov Petkova, 2011). Both grandular as well as stromal epithelial cells including that of muscular fibers pass through the phase of hyperplasia into benign prostate hyperplasia. Various evidences support the matter that from two various tissues, the one named stromal cell hyperplasia exists; however exact ratio still lacks. This problem disorder is associated strongly with prostate transitional area as well as posterior urethral glands. Symptoms of this disorder at the initial stage arise amidst 30 and 50 years of age within the prostate glands which exist next to the proximal urethra. Here, the growth is said to occur mostly during the transitional zone. Besides the recognized areas, another zone named peripheral zone is also engaged in the condition to a small level. Prostate cancer starts at the peripheral area (Shigemi, Yoshida, Tanaka Suzuki, 2012). For ruling out the chances of cancer, specifically the nodules that are formed within the transitional zone are to be biopsied. It has been stated by the American Urological Association that this disorder of benign prostate hyperplasia is incurable, and so due treatment must be laid upon reducing the indications. Process of treatment relies upon the severity of symptoms. Often a surgeon may recommend any patient for a surgery for instance, transurethral resection of prostate, transurethral needle ablation or transurethral microwave therapy. Normally BPH affects quality of life of a patient. Hence, adequate nursing care is a must besides pharmacological care. A nurse is supposed to convey the advice to the patient to rush to the washroom for urination(Tsukamoto, Masumori, Rahman Crane, 2007). This would make him feel relaxed. He is required to distribute properly his intake of fluid throughout the day. Considerations regarding pharmacology include applying of drugs such as alpha blockers, phytotherapeutics, 5-alpha reductase inhibitors, and anticholinergics. All these drugs are meant to prevent complication as well as changing disease progression that are related to BPH. Also, it is important to consider non-pharmacological treatment as well where patients need to administer self-treatment as well in order to recover soon. 2: Patients generally recover at the post anesthetic care unit (PACU). However, it requires appropriate airway management as well as exact monitoring to avoid difficulties in the process. The Aldrete scale is referred to as a scale that measures recovery used after anaesthesia. This scale involves estimation of consciousness, blood pressure, respiration, and activity. Within the care unit just after anaesthesia, the anesthesiologist, nurse anesthesia, and nurse anesthetist includes patient condition, performed surgery; forms of given anesthesia, fluid input, blood loss and excretion of urine during the time of surgery (Tsukamoto, Masumori, Rahman Crane, 2007).. The nurse engaged at the PACU unit must note the presence of any sort of complications, including variance in stability in blood circulation. Evaluating airway openness of patients, level of consciousness, important signs are regarded as the basic priorities after admission in the care unit. Besides that, few different other categories include body temperature, surgical site, rate of intravenous fluids, drainage tube patency, extreme sensation post surgery, status of vomiting pain, and level of sensation post local anesthesia (Baniahmad, 2012). Assessing surgical site involves proper dressings with no sign of bleeding. Assessing patency of drainage tube refers to the proper check for tube opening.it may be decided to admit him to the intensive care unit or at the general surgical ward. A patient is normally discharged from the care unit once he or she is perfectly fine and meets every criteria of discharge as indicated in the Aldrete scale (Shigemi, Yoshida, Tanaka Suzuki, 2012). The scale is used for scoring respiratory status of patients, their mobility, consciousness, circulation, and pulse oximetry. Depending upon types f surgery as well as that of conditions of patients, post anesthesia, patient often remains in a sedative state, and so safety of patient is an essential goal. Often patients are shifted from intense care unit to that of general ward or even home after urination, moving out of bed and when the patient is capable of taking oral intakes. In the given case scenario, it has been observed that once arrived to the intense care unit, John has been kept in a supine posture. It is an effective approach for ensuring that he is under proper airway management. Airway management refers to a medical process for ensuring existence of an open passageway amidst outside world as well as patient lungs with lowering risk of aspiration. John has been observed to be quite restless, drowsy, and so he had been oxygenated by a facemask. This oxygenated mask happens to be a process that assists easy passage of air. It would enable John to ignore condition of hypoxaemia or that of low level of oxygen within blood (Cohen, 2010). He has normal body temoperature but still he shivered. That might be due to the surgical pain. So, monitoring his body constantly is quite essential. At the time of pre-admission, it was identified that John suffers from hypertension. His blod pressure is quite high far beyond normal standard. Increased blood pressure may worsen his condition and complications. Already it has been mentioned that he is drowsy post surgery. Hence, grading consciousness is essential through Glasgow Coma Scale. This is a scale used in the neurology that refers to a reliable way to document conscious status of a patient to conduct primary as well as henceforth assessment (Ehab, 2009). A patient is usually evaluated against criteria in the given scale along with the result that varies between 3 and 15. The scale is used to determine level of consciousness post head injury and also for monitoring chronic patients within intensive unit. Thus, in case of John it would be justified to use such a scale. It mainly shows the status of central nervous system of a patient. This scale is also referred to as the key human system which receives various signals, coo rdinates them and also affects activities of various parts of human system. So, it is increasingly important to check the status of central nervous system in case of consciousness as well as activity level (Okeke, George, Ogunbiyi Wachtel, 2012). John has been provided with an indwelling catheter with continuous bladder irrigation. Since his urine has been observed to be pinkish in color, PACU nurse must check if that is due to infection that he has recently undergone. The heart rate of John is 90 and this may exhibit his painful situation post surgery. 3: Process discharge planning forms an important part of health care process of a patient to bring about quality care at home for avoiding readmission to health care center. In case of John, an effective discharge plan is required. The plan is described as below (Kim, Lee, Paick Lho, 2006). The nurse at PACU must make patient understand properly about the details his discharge plan. Since John is an aged man he may forget several things at this age about his health status. So, the health care unit must give efforts to arrange someone who may stay beside him constantly, provide information about his health to medical professionals whom John is admitted under, and also deliver care at his home. It has been stated that John resides alone and so a nurse staying by his side is very essential(Martino Strejilevich, 2015). He must be referred to a physician as well as a dietician since he has recently undergone a surgery and that he needs to maintain his health post surgery. He also has feeble gait due to osteoporosis. Post surgery for improving his movement slight aerobic exercises may be beneficial for John. This can include exercises of legs for some period of time every hour. With effective nursing care, through intervention as well as discharge plan, medical professionals may accomplish their objectives of healthcare and thus may enhance the quality of patient life as well as their wellbeing. Discharge Plan Name: John Wong Age: 80 Sex: Male Religion: Chinese origin Diagnosis: Benign Prostate Hyperplasia Surgery: Transurethral Resection of the Prostate Hospital: The CB Hospital Ward no. : 5 Physician: Ms. Amelia A. Objectives: pain management, lung congestion prevention and blood clot prevention. B. 1. Medications: analgesics 2 Exercise: light aerobic exercise, walking for 10-15minutes 3. Treatment: prescribed medicines as scheduled 4. Health teachings: Clinical follow-ups () Use of alternative drugs () Understanding what to do in case of drug side effects () Lab report follow-ups () Relapse prevention () Others () 5. a. Observed indications that required reporting: presence of blood clot in urine b. Interventions: 6. Diet: increasing fluid intake, fibrous diet to avoid constipation. 7. Psychological and spiritual needs: Spiritual counseling () Family therapy () Supportive counseling () Anger management () Discharge details Date and time of discharge: 10am. 13th March, 2015. Accompanied by: nurse aide Transportation mode: hospital vehicle Signature of patient: Signature of nurse: Clinical instructor: References Cohen, P. (2010). From benign prostatic hyperplasia to benign chronic prostatopathy.Medical Hypotheses,74(4), 760. doi:10.1016/j.mehy.2009.04.033 Ehab, R. (2009). Transurethral Electrovaporization of the Prostate as an Alternative to Transurethral Resection: A Five-Year Follow-up.Urotoday International Journal,02(06). doi:10.3834/uij.1944-5784.2009.12.12.ref1 Kim, H., Lee, B., Paick, S., Lho, Y. (2006). Efficacy of Bipolar Transurethral Resection of the Prostate: Comparison with Standard Monopolar Transurethral Resection of the Prostate.Korean Journal Of Urology,47(4), 377. doi:10.4111/kju.2006.47.4.377 Martino, D., Strejilevich, S. (2015). Subclinical hypothyroidism and neurocognitive functioning in bipolar disorder.Journal Of Psychiatric Research,61, 166-167. doi:10.1016/j.jpsychires.2014.12.016 Menon, B. (2014). Hypothyroidism and bipolar affective disorder: Is there a connection?.Indian J Psychol Med,36(2), 125. doi:10.4103/0253-7176.130966 Petkov, T., Saltirov, I., Petkova, K. (2011). S27 TRANSURETHRAL RESECTION OF PROSTATE IN SALINE (TURIS) VERSUS STANDARD MONOPOLAR TRANSURETHRAL RESECTION OF PROSTATE.European Urology Supplements,10(9), 583. doi:10.1016/s1569-9056(11)61468-1 Shigemi, H., Yoshida, Y., Tanaka, K., Suzuki, M. (2012). Hoarseness, Articulation Disorder and Hearing Impairment in Subjects with Hypothyroidism.Pract.Otol. (Kyoto),105(2), 159-165. doi:10.5631/jibirin.105.159 Tsukamoto, T., Masumori, N., Rahman, M., Crane, M. (2007). Change in International Prostate Symptom Score, prostrate-specific antigen and prostate volume in patients with benign prostatic hyperplasia followed longitudinally.International Journal Of Urology,14(4), 321-324. doi:10.1111/j.1442-2042.2007.01596.x Baniahmad, A. (2012). Benign Prostate Hyperplasia Meets Liver X Receptor.Endocrinology,153(8), 3558-3560. doi:10.1210/en.2012-1474 Okeke, L., George, A., Ogunbiyi, A., Wachtel, M. (2012). Prevalence of linea nigra in patients with benign prostatic hyperplasia and prostate carcinoma.International Journal Of Dermatology,51, 41-43. doi:10.1111/j.1365-4632.2012.05564.x

Global and National Health

Questions: 1. Write a report on community health. 2. Explain Identification of a potential health issue and the role of the registered nurse. Answers: Part A Introduction The said assissgnment is about identifying health issues in a city situated in South Australia by reviewing the community, area, population, climate, lifestyle, etc of the said city. The features of a city can determine a lot about the potential health issues the individual living in the city may face, thus, assessment of such conditions before hand can prevent many contagious and dangerous diseases from spreading. Thus, the assessment of the city situated in South Australia called Horizon is based on several aspects which help in arriving at a conclusion for future health hazards in the city along with giving the medical department in the city a chance to prevent the health hazards. City of Horizon Community Assessment Biophysical Assessment Biophysical Assessment is reviewing the physical and biological parameters of an ecosystem which includes every detail of its geology, hydrology and soil. Thus, in the present case, the city of Horizon is undergoing a Biophysical Assessment which will review the citys age profile, gender profile and ethnicity and cultural profile. Age Profile In 2011, the population of Horizon city increased by 15.3 % , making the population of Horizon city having 30,000 residents who are divided by their age structure into different age groups as follows:- Service age group totaling to approximately 2435 in population Dominant group totaling to approximately 2055 in population (Gulliver, Griffiths and Christensen 2010). Five years age group totaling to approximately 2429 in population Gender Profile The gender profile in the city of Horizon is 14,657 females and 13,693 males in total. Ethnicity and Cultural Profile There are many ethnic groups in Australia who share similar cultures and traditions. Some of these ethnic groups in Australia are as follows:- Aboriginal and Torres Strait Islander who are approximately 652 in population in 2011 Australian born who are 24,358 who are approximately 24,358 in population in 2011 Speaks language other than English at home who are approximately 1446 in population in 2011 Psychological Assessment - Psychological Assessment is referred to a technique which is used to derive a conclusion about an individuals capacities, personality and behavior. Communication network The communication network in Horizon city is also varied just like its population and newspapers, television shows and radio are available in different languages other than English (Wakefield, Loken and Hornik, 2010). Volunteer Agencies There are variety of volunteer agencies in the city of Horizon serving working and serving for different causes and issues. Some of them are for the ethnic community in the city of horizon while the others are for the non-English speaking inhabitants of the city. Law enforcement As the city of Horizon is located t the south east coast of South Australia only approximately 320 kilometers away from Adelaide, the law enforcement agencies like the police and the Courts of Adelaide are in charge of the city of Horizon. The police forces and the courts of Adelaide district govern the laws and punish for the crimes and offences in the city of Horizon, thus the jurisdiction of the city of Horizon is with the Adelaide district in Australia. However, the city of Horizon has its prison for offenders (Tremblay et al 2010). Emergency Services There are many hospitals and emergency centers in the city of Horizon. However, the Horizon Hospital and Health Service is one of the most popular features of the city of Horizon. Social Support Services Many social support services function in the city of Horizon that help many needy people like the indigenous groups, non-English population, etc. Physical Environment Physical Environment reviews the different aspects of natural resources in a city. Geography The city of horizon is situated in the Limestone costal region of South Australia, 320 kms away from Adelaide and 530 kms North West of Melbourne. The geography of Australia is diverse having forests, mountains and coastline. Population size The resident population of the city of Horizon in 2016 was 29.803 with a population density of 6.86 person / hectare. Classification The classification in the city of Horizon is divided into suburbs and localities of Cape Arch, Beachside, Yonder Hill, Limestone Point and Woodside. Climate the city of Horizon is situated on a coastline which makes the climate pleasant and humid although out the year attracting many tourists. Air Quality The air quality in the city of Horizon is very good as it is a coastal region. Water Source Availability and Quality As the city of horizon is a city close to a coast, the water source availability is very high on quality and serves as a tourist attraction. Sewage and other waste disposal Sewage and waste disposal in the city of horizon is very well organized and maintained (Owen et al 2010). Housing type and adequacy In the year 2011, 16% of the household types in the city of horizon consist of couples with children. The total number of households in the city of horizon is 11,057. Socio-Cultural features The review of socio-cultural features of a city discusses the manner in which the community and society in the city is organized and structured. Marital Status - In the year 2011, 16% of the household types in the city of horizon consist of couples with children. The city of horizon has household of married couples with and without children. The total number of married couples in Horizon is 6147. Family composition The families in the city of horizon are classified into several groups like couples with children and without children, one parent families, lone individuals, visitors, etc. Education level In the year 2011 around 3296 individuals in the city of horizon had tertiary qualification. In the city of horizon, only 13434 individuals are unqualified (Scannapieco and Ho 2010). Income In the city of horizon, 4 % population have an income of $1,500 or more per week. The nil income index is only 5.4% and 17.4% of individuals earn more than $400-$599 every week. Employment rates and occupation types - Approximately 4,647 individuals in the city of Horizon are employed out of which 48% individuals have full time jobs and the rest work part time. Transport - Princes Highway is which connects the city of Horizon to other parts of Australia. Leadership of Community the city of horizon is home to many dives communities thus the leadership of community id divided in the same manner. Religion There are many religions followed in the city of horizon, however, the most powerful of them all are the Christians and the Western (Roman) Catholic. Community Groups and Organizations Many communities like indigenous communities have their homes in the city of horizon and they have separate organizations. Behavioral features Reviewing cities behavioral features includes analyzing how the society and community uses the natural resources available. Access to goods and services The Princes Highway helps to connect the city of horizon to other parts of South Australia which helps the city to access goods and services from Adelaide and Melbourne. Shopping facilities There is a Horizon shopping mall in the city of horizon which is also a tourist attraction (Brown et al 2010). Sports and Recreation facilities One of the features of the city of Horizon includes a recreation house which will surely have sports activities for the individuals in the city to indulge in. Leisure activities - Horizon Cultural Centre, Romero Vineyard and Wine Complex, Yonder Museum and Library, Horizon Aquatic Centre, Horizon Recreation Centre, Limestone Lake Adventure Park and Playground, Horizon Mall, the Horizon Hotel Limestone Coast Caves are some of the places in the city of horizon which can be used for leisure and attract tourism also. Entertainment facilities There are many entertainment facilities in the city of horizon which includes diverse places like cultural houses, recreation centers, shopping malls, parks, aqua parks and caves. Dinning and eating facilities As fishing is a major industry in Australia, sea food is very popular in the city of Horizon. Additionally, as the city of Horizon is tourist attraction in South Australia, there are many restaurants and dining facilities available in Horizon. Heath System The Horizon Hospital and Health Services is the major health care centre in the city of Horizon which treats the citizens of the city. Additionally, the heath care services available in the city of Horizon helps to prevent the spread to contagious diseases and creating awareness amongst the citizens of the city about health care and its prevention (Lawrence, Hancock and Kisely 2013). Conclusion and Recommendations Thus, after the reviewing the above mentioned aspects of the city of Horizon, it can be concluded that the city is well equipped with most health care facilities and services, however, the city requires to take some care in respect of prevention of contagious diseases which can be spread in the city due to massive tourists who comes from different parts in the world like Africa, having certain regional diseases. Also, as the city is very small in size and population, the shortfall of medical facilities and services can be a matter of concern if contagious diseases affect the entire city. Part B Potential health issue and role of registered nurse City of Horizon, located in Limestone Coast Region of Australia has a population of about 29308 people till 2016. Horizon is a popular tourist destination and has exceptional health care facilities like Pharmacy, Radiology, Physiotherapy, Medical Service and GP clinic. There is aged-care service too. It also has an ethnic group of the population consisting of Aboriginal and Torres Strait Islander group. As the city attracts a large number of tourist, therefore the key health related issue will be a lack of equity in health care and problem of workforce supply and distribution. When any place has a number of citizens and traffic of tourist, there will be an imbalance in health services and quality and safety of health services is compromised. Since horizon community has the ethnic population, achieving health equity is significant (Bungay et al. 2016). Due to continuous shift in demographics and disparities in health care outcome, nursing is a challenge in advanced health care. Health inequity can cost people their lives. Registered nurse have a role in giving holistic care to citizens of Horizon by looking into an environment, culture and socioeconomic status of patients. They can play a role in making lives better for Aboriginal and Torres Islander group of people. This ethnic group of Australia does not have proper access to health care facilities. Due to a different language of aboriginal, the problem occurs in health care delivery. It is necessary for the nurse to understand the language of the ethnic group to give adequate care. The ethnic group faces a high rate of poor health and chronic diseases like renal failure, cardiovascular diseases, and diabetes. They have poor access to health care which is evidenced by the high rate of infectious diseases like HIV/AIDS. Due to lack of knowledge, they indulge in unhealthy and risky behavior like alcoholism and substance abuse. A registered nurse has to look into all these issues and provide appropriate to care about such people (Mohammed et al. 2016). To address all the above issue nurse has to develop cultural competency skills. It is a desired attitude and behavior of nurse that will enable them to work efficiently to handle cross-cultural patients. The nurse has to develop an understanding of the cultural sense of people before starting treatment process. They have to keep cultural values and principals of individual people in mind. This will help in building good relation with patient and gaining patient satisfaction. While handling a diverse group of the population, the nurse should have a high level of awareness, knowledge and skills to maintain continuity in treatment. The key elements in gaining cultural competence are awareness, attitude, knowledge and skills. The nurse should be conscious of different people reaction to health care. They can educate the ethnic group about the importance of checking health care needs and taking regular treatment option. They should have the attitude to handle all kind of people as those w ith little or no knowledge of health care. If they know the cultural sense of individuals, they their nursing practice will be free of cultural bias. It will bring better outcome in health care. The problem of workforce supply can be handled by reduces by introducing more culturally competent workforce. More clinic should be opened in ethnic areas to give the ethnic group better access to health care facility (Phillips and Malone 2014). Reference List Brown, W., Bryson, L., Byles, J., Dobson, A., Manderson, L., Schofield, M. and Williams, G., 2010. Women's health Australia: establishment of the Australian longitudinal study on women's health.Journal of Women's Health,5(5), pp.467-472. Bungay, H., Jackson, J. and Lord, S., 2016. Exploring assistant practitioners views of their role and training.Nursing Standard,30(30), pp.46-52. Gulliver, A., Griffiths, K.M. and Christensen, H., 2010. Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review.BMC psychiatry,10(1), p.113. Lawrence, D., Hancock, K.J. and Kisely, S., 2013. The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers. Mohammed, S., Stevens, C.A., Ezeonwu, M. and Cooke, C.L., 2016. Social Justice, Nursing Advocacy, and Health Inequities: A Primary Health Care Perspective.Practicing Primary Health Care in Nursing: Caring for Populations. Owen, N., Healy, G.N., Matthews, C.E. and Dunstan, D.W., 2010. Too much sitting: the population-health science of sedentary behavior.Exercise and sport sciences reviews,38(3), p.105. Phillips, J.M. and Malone, B., 2014. Increasing racial/ethnic diversity in nursing to reduce health disparities and achieve health equity.Public Health Reports,129. Scannapieco, F.A. and Ho, A.W., 2001. Potential associations between chronic respiratory disease and periodontal disease: analysis of National Health and Nutrition Examination Survey III.Journal of periodontology,72(1), pp.50-56. Tremblay, M.S., Colley, R.C., Saunders, T.J., Healy, G.N. and Owen, N., 2010. Physiological and health implications of a sedentary lifestyle.Applied Physiology, Nutrition, and Metabolism,35(6), pp.725-740.efield, M.A., Loken, B. and Hornik, R.C., 2010. Use of mass media campaigns to change health behaviour.The Lancet,376(9748), pp.1261-1271.