Enteral and Parenteral Nutrition Essay Example

Enteral and Parenteral Nutrition Essay Which critically ill patients should receive TPN? Prof R D Griffiths in conjunction with Fresenius-Kabi Why are these guidelines required? In the critical care setting, nutritional support influences the outcome for critically ill patients. This guideline seeks to outline the important role of parenteral nutrition in the critically ill patient. Enteral and parenteral nutrition The enteral route for nutrition delivery is preferred where it can be safely delivered in the absence of gastrointestinal intolerance. For a small proportion of patients enteral feeding is not possible but in addition for a larger proportion of patients research consistently shows that enteral nutrition does not always cover the total nutritional needs of intensive care unit patients. There has been a reluctance to use parenteral nutrition (PN) or to supplement enteral (EN) or oral nutrition with parenteral nutrition (PN) for the perceived risk that to do so increases the infection and mortality risk. Systematic review evidence acquired from studies in the critically ill shows that while there may be an increased risk of infection there is no added mortality risk [ 1 ]. Parenteral nutrition has changed considerably over the last forty years and many of the complications were a feature of historical PN practice associated with its inappropriate use, unbalanced formulations and liberal overfeeding. Even the risk of infection may be more related to the underlying patient disease and indication for PN rather than modern PN formulations and delivery in ICU. We will write a custom essay sample on Enteral and Parenteral Nutrition specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Enteral and Parenteral Nutrition specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Enteral and Parenteral Nutrition specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Malnourishment It has been estimated that around 40% of all patients in hospital are undernourished and this is associated with further complications. Acute critically ill patients lose on average approximately 5-10% of skeletal muscle mass per week during their ICU stay [ 3 ]. Complications such as septicaemia in these patients are to a large extent caused by malnutrition and impaired immunological function [ 2 ]. Complications versus choice of nutrition route When correctly applied, the complications of PN are less likely to result in death compared with those of EN. Recent studies conclude that PN compared with early EN is risk-neutral overall [ 3 ]. It is reassuring that in critically ill patients, when used with EN in the ICU as a supplement, PN has been confirmed to be risk-neutral or may even offer benefits. However from current data it is not possible to justify the extra cost of supplemental PN when started concurrently with EN at the start of an ICU admission [ 1 ] but more importantly there are no studies where it has been started in the more appropriate situation after EN has been shown to fail in already malnourished ICU patients. It has been demonstrated that nutritional goals were reached in 22% of ICU patients fed via EN compared with 75% with PN [ 2 ]. It must be remembered that under nutrition is a debt that must eventually be repaid and this is also worse if it is compounded! The ACCEPT study showed that survival from intensive care was improved when an evidence based guideline for nutrition was followed and more nutrition delivered more consistently. This was achieved by earlier introduction and more complete enteral nutrition delivery without any decline in the use of PN alone or in supplementation. Using the guidelines These guidelines have been developed using a step-by-step approach as follows: Step 1ASSESSMENTDoes the patient require nutritional support? Step 2ADMINISTRATIONWhich route(s) should be used? Step 3ACHIEVEMENT (REVIEW)Are nutrition goals being met? Step 1 Nutritional Risk Screening (adapted from NRS 2002 ESPEN) Does this patient require nutritional support? Initial screening of patients is recommended in these guidelines but it is assumed that ALL patients fulfill the criteria for requiring a final screening assessment which follows. The adaptation assumes an affirmative answer to the question â€Å"Is the patient severely ill? (e. g. in intensive care) Impaired nutritional statusSeverity of disease (increase in requirements) Score 0Normal nutritional statusScore 0Normal nutritional requirements Score 1 Wt loss 5% in 3 months or foodScore 1Hip fracture. Chronic patients in (Mild)intake below 50-75% of normal particular acute complications of requirements in preceding weekcirrhosis, COPD. Chronic diabetes haemodialysis, oncology. Score 2Wt loss 5% in 2 months or BMIScore 2Major abdominal surgery, stroke, (Moderate)18. -20. 5 + impaired general condition orsevere pneumonia, haematologic food intake 25-60% of normal requirement malignancy. in preceding week. Score 3Wt loss 15% in 3 months or BMI Score 3Head injury, Bone marrow transplant (Severe)18. 5 + impaired general condition orIntensive Care Patients (APACHE 10) food intake 0-25% of normal requirement in preceding week SCORE+ SCORE= TOTAL SCORE AGE ADJUSTMENT (IF PATIENT ? 70 YRS ADD 1 TO TOTAL SCORE)= TAAS SCORE INTERPRETATION SCORE ? 3The patient is nutritionally at risk and a nutritional plan should be initiated. SCORE 3Weekly re-screening of the patient. If the patient is scheduled for a major operation a preventative nutrition plan should be considered to avoid associated risk status. Step 2Administration route(s) Nutritional support does influence the outcome of critically ill patients and evidence suggests that the consistent achievement of nutritional goals is important and this should if feasible be through the enteral route [ 7 ]. Evidence suggests that for most patients this is just as effectively and safely delivered through a naso-gastric tube compared to tubes sited after the stomach [ 1 ]. It must be recognized that problems do occur with all forms of enteral delivery and that delivery is more often attained by the parenteral route3 and this is apparent in critically ill patients where enteral nutrition is inappropriate, contraindicated or has failed. Parenteral nutrition should be used when the GI tract is not functional or cannot be accessed or when the patient’s nutrient needs are greater than those which can be met through the GI tract. However it should not be commenced in the non-malnourished as a supplement until approaches to enteral delivery have been optimized [ 1 ]. Assess the integrity and function of the bowel using the following prompts: IF THE ANSWER IS â€Å"NO† TO EITHER QUESTION – TIME TO CONSIDER PN Is the digestive tract functioning? Is the patient well nourished and recovery of gut function expected within 3 days? IF THE ANSWER IS â€Å"YES† TO EITHER QUESTION – TIME TO CONSIDER PN While using an enteral feeding protocol does the presence of excess gastric aspirates (e. g. persistently 150mls after measures to improve gastric emptying) lead to reduced enteral intake. Does the nutrition equirements of the disease or injury exceed that which can be delivered safely via the enteral route? Some patients with an intact GI tract do not tolerate enteral feeds or do not receive sufficient intake enterally or orally to meet their energy and protein requirements. The reasons for poor gastric emptying should be considered. Simple measures such as turning to the right side or reducing opiate intake may be tried along w ith short trials of either Metoclopramide or Erythromycin if other causes have been excluded. However gastrointestinal intolerance is an important and worrying sign and is associated with increased pneumonia and risk of death independently of illness severity . The supine posture is also associated with increased risk of aspiration pneumonia and if patients cannot be nursed in the semi-erect position parenteral nutrition may be a safer option whether it is used as a supplement or as the sole source of nutrition in these patients [ 6 ]. Choice of feed and amounts In the critical care setting estimation or measurement of precise requirements is fraught with error. A target of 25 kcal/kg/day for the first week is acceptable. Protein intake is the central component as this cannot be stored metabolically. Most evidence supports 1. 5 gm/kg/day as a reasonable target. Requirements change during an illness and generally increase in the second week and when patients become more active. Simple methods using patient size bands based upon accessible measures of body size (height or weight) should be used to calculate target amounts. More sophisticated individual patient calculations have not been shown to be any more accurate. Polymeric complete enteral feeds should be used for most patients and infused continuously. Evidence for the use of specific formulations is lacking, except that the immunonutrition cocktails that contain extra arginine should NOT be given [ 1 ] outside of the peri-operative setting where evidence exists. An all-in-one complete balanced parenteral formulation should be used and evidence based recommendations suggests where practical these should contain glutamine [ 1 ]. They should be delivered continuously through a dedicated lumen that should not be used for any other access. Some of the energy should come from lipid sources but there is paucity of evidence to suggest any particular lipid formulations although this may change as more advanced formulations come on the market. Caution should be applied when other lipid containing infusions are also in use (e. g. propofol). Lipid infusion is safe at rates up to 1. 5 gm/kg/day, and glucose should be given at 3-4 gm/kg/day. Use simple standardized regimens for most patients. Within ICU acute electrolyte management (e. g. potassium and phosphate) is more readily managed by separate infusions if safe systems exist. Patients on renal support will have increased nutritional losses so maintain on full feeding. Important when using either EN or PN Nutrition should be commenced at reduced rates especially in the malnourished until metabolic tolerance established. Increase to full target over a 3 day period and monitor for re-feeding syndrome. It is possible to overfeed with PN but unless glucose intake exceeds 4-5 gm/kg/day hyperglycaemia indicates peripheral insulin resistance and the need for additional insulin and not reduction in feed volume. Step 3 Are nutrition goals being achieved? Set targets and check nutrition intake daily and act upon the findings. It is recommended that calorie (and nitrogen) intake is calculated daily in addition to the fluid balance. Has the patient received the amount of nutrition prescribed over previous days? Nutritional support, once instigated, should be monitored to confirm the safety of treatment. The following guide illustrates the type of monitoring required. The tests required will depend upon duration and method of feeding. The frequency of testing will vary depending on the illness severity. Fluid balance and calorie intake and if possible weight. Urea and electrolytes daily (watch K+ as feeds may have only a modest K+ content) Blood glucose monitored frequently and preferably as part of a tight glycaemic control. Phosphate (This should be monitored closely especially when starting feeds in the malnourished) Plasma lipid clearance or triglycerides Full blood count Liver function tests, Calcium Magnesium Calculation or measurement of nitrogen balance is not reliable in the routine setting. Nutrition support algorithm summary ASSESS Is nutritional support required? 40% of patients admitted to hospital are undernourished REASSESS Supplemental PN? ADMINISTER Which route? Is enteral feeding practical and safe? If not consider PN ACHIEVE and REVIEW Are you satisfying the nutrient needs of the patient? N Y WEANING STRATEGY If on EN can oral intake be started? If on PN can EN be started?

Vital Records of Birth, Marriage and Death in France

Vital Records of Birth, Marriage and Death in France Civil registration of births, deaths, and marriages in France began in 1792. Because these records cover the entire population, are easily accessible and indexed, and include people of all denominations, they are a vital resource for French genealogy research. The information presented varies by locality and time period but often includes the individuals date and place of birth and the names of the parents and/or spouse. One additional bonus of French civil records  is that birth records often include what is known as margin entries, handwritten notes made in the side margin, which can lead to additional records. From 1897, these margin entries will often include marriage information (date and location). Divorces are generally noted from 1939, deaths from 1945, and legal separations from 1958. The best part of French civil registration records, however, is that so many of them are now available online. Records of civil registration are typically held in registries in the local mairie (town hall), with copies deposited each year with the local magistrates court. Records over 100 years old are placed in the Archives Dà ©partementales (series E) and are available for public consultation. It is possible to obtain access to the more recent records, but they are not usually not available online due to privacy restrictions, and you will generally be required to prove, through the use of birth certificates, your direct descent from the person in question. Many Departmental Archives have placed portions of their holdings online, often beginning with the actes detat civils (civil records). Unfortunately, online access to the indexes and digital images has been restricted to events older than  120 years by the Commission nationale de linformatique et des libertà ©s (CNIL). How to Locate French Civil Registration Records Locate the Town/CommuneThe important first step is to identify and approximate date of a birth, marriage, or death, and the city or town in France in which it occurred. Generally knowing just the department or region of France is not enough, although there are some cases such as the Tables darrondissement de Versailles which indexes the actes dà ©tat civil across 114 communes (1843-1892) in the Yvelines department. Most civil registration records, however, are accessible only by knowing the town - unless, that is, you have the patience to wade page by page through the records of dozens if not hundreds of different communes. Identify the DepartmentOnce you have identified the town, the next step is to identify the department that now holds those records by locating the town (commune) on a map, or using an Internet search such as lutzelhouse department france.  In large cities, such as Nice or Paris, there may be many civil registration districts, so unless you can identify the approximate location within the city where they lived, you may have no choice but to browse through the records of multiple registration districts. With this information, next locate the online holdings of the Archives Dà ©partementales for your ancestors commune, by either consulting an online directory such as French Genealogy Records Online, or use your favorite search engine, to search for the name of the archives (e.g. bas rhin archives) plus etat civil. Tables Annuelles and Tables Dà ©cennalesIf the civil registers are available online through the departmental archives, there will generally be a function to search or browse to the correct commune. If the year of the event is known, then you can then browse directly to the register for that year, and then turn to the back of the register for the tables annuelles, an alphabetical listing of names and dates, organized by event type - birth (naissance), marriage (mariage), and death (dà ©cà ¨s), along with the entry number (not page number). If you are not sure of the exact year of the event, then look for a link to the Tables Dà ©cennales, often referred to as the TD. These ten-year indexes list all names in each event category alphabetically, or grouped by the first letter of the last name, and then chronologically by the date of the event. With the information from the tables dà ©cennales you can then access the register for that particular year and browse directly to the portion of the register for the event in question, and then chronologically to the date of the event. What to Expect Most French civil registers of birth, marriage, and death are written in French, though this doesnt present a great difficulty to non-French speaking researchers as the format is basically the same for most records. All you need to do is learn a few basic French words (e.g.  naissancebirth) and you can read pretty much any French civil register. This French Genealogical Word List includes most of the common genealogy terms in English, along with their French equivalents. The exception is the localities that at some point in history were under the control of a different government. In Alsace-Lorraine, for example, some civil registers are in German. In Nice and Corse, some are in Italian.

Benjamin Franklin Research Paper Example | Topics and Well Written Essays - 1000 words

Benjamin Franklin - Research Paper Example Firstly, it is important to understand how much Franklin embodies American ideals, especially modern American ideals – he probably helped shape them. Unlike most of the founding fathers, Franklin did not emerge from wealthy landed classes but rather had the working class background. His father was a simple candle maker, a working class but relatively successful profession, and his mother was only one generation removed from a history of indentured servitude He did not inherit a great deal of wealth, but rather had to work his own way to prominence, eventually becoming a successful newspaper editor in Philadelphia, and the president of Pennsylvania. America has long been proud of its lack of a monarchy or aristocracy, and many Americans value their independence and individuality and respect those who build their own legacies more than those who inherit them (Isaacson 2003). Benjamin Franklin is thus one of the founders of the American ideal of humanity, as he embodies this indi vidualist, self-made ideas exactly, unlike many of the other founding fathers who were born, quite literally to a silver spoon, plantations, and fields of slaves. I would argue that not only did he embody the American spirit, but the enormous respect for his intellect and nature helped shape the American identity, so it is not coincidental that he embodies it, as he helped to found it. Beyond embodying the American spirit, even the modern American spirit, very well, Franklin was also the true definition of a renaissance man. He is possibly most famous for his experimentation with the study of electricity, mythologized in the famous tale of the kite and the key (), and his eventual invention of the lightning rod. Beyond his scientific pursuits in that vein, he also invented many things that are still used to this day – he invented the odometer, to measure the distance a carriage had traveled, bifocal glasses, new types of stoves, and a glass armonica (Smith 2012). These inventions are impressive – people still wear bifocal glasses to this day, and the basic principles of his odometer are the same as those used in vehicles today. However, what is possibly most impressive about Franklin is that these inventions did not define his life, as they would of lesser men, but only served as a background to his most influential accomplishments: his role in the c reation and

Clay Shirky's Here Comes Everybody (2008) Term Paper

Clay Shirky's Here Comes Everybody (2008) - Term Paper Example As an example, many people are blogging about thousands of topics. Some of these blogs are personal and only go out to a few people (usually family and friends) while others are intended for a larger, more global audience. These blogs may have errors in them but they are being shared without filtering. Socially, the â€Å"publish than filter† approach is able to bring people together on a larger scale than previously available. People can learn about each other via several social networking sites and they can meet large groups of people via these sites. People are able to have conversations with perfect strangers about their ideas. Economically, many people have learned to master social business networking by sharing content on several social networking sites that include Twitter, LinkedIn, Facebook and YouTube. Each site has a different way of giving content but people are able to gain an understanding of the person behind the business as well as the business. Mass amateurism , according to Shirkey, refers to the idea that anyone can publish anything so â€Å"everyone is a media outlet†. This means that people do not have to have fancy degrees in journalism or be professional writers to be published on the Web. People are able to provide different viewpoints on a variety of topics and it does not matter who they are as a writer. Also, the individuals are able to publish more often and more regularly. One example that Shirky keeps exploring is the Blog. The blogs are written on many different topics and people can present their political views, share photos, or create videos and publish them all over the Internet with most of the tools to do these things provided for free. Another example that Shirky gives is the use of instant messaging and other chat programs that allow the individual to be in touch with a variety of people in real time. These types of media allow an individual to publish more than once, on a regular basis, and more is said than would be possible in print newspapers and magazines because of the standards of those newspapers and magazines. The advent of mass amateurism does not mean the end of professionalism; it just means another vehicle for information will be developed. There will always be people who want to read professional literature including magazines and newspapers like Time or The New York Times because they want to read good journalism. Open Source Software (OSS) is software that is provided free by a manufacturer that gives the same opportunity to the end users as commercial software. Linux is one good example because it is a group of software programs that many schools have used instead of Microsoft products. The reason OSS is popular is because there are no licensing agreements that must be updated yearly and schools can make as many copies as necessary; faculty and students can also copy this software to their home computers. Shirkey says that OSS is more an ecosystem that can tolerate mista kes easier than commercial software systems. Because Linux uses source codes and the company gives the codes to users, people can customize the software to meet the organizations’ needs. The history of OSS shows that it will not take over commercial software because it still has some challenges. Shirky continually showed how different types of OSS was used but how it was given as an alternative for organizations who did not have the money to

Persuasive speech evaluation Assignment Example | Topics and Well Written Essays - 250 words

Persuasive speech evaluation - Assignment Example Provided that he wants to correct his mistakes in the first place. Ms. Pisani was definitely an engaging speaker as she knows how to lighten a serious discussion with humor and anecdotes that allows the people to feel relaxed and understand the seriousness of the topic without being as serious as heart attack. What is amazing about the talk that Ms. Pisani gave is that the was able to combine both the informative and persuasive patterns of speech. She managed to stay on topic while persuading people to believe in her position about sex, drugs, and HIV. She was quite effective in delivering her speech because she actively engaged her audience by using slide presentations, props such as her public health glasses, and other gimmicks that worked in her favor. Most specially, the fact that she used lighthearted words in presenting her topic, made the people more interested in hearing what she had to say. The fact that the audience was laughing while she was talking shows hos successful her speech was. She was definitely able to relate with her audience because she spoke from personal experience and the experience of friends, even giving actual condoms away in order to deliver her message of safe sex. The audience positively responded to her by clapping and laughing along with

The Narrator In Raymond Carvers The Cathedral

The Narrator In Raymond Carvers The Cathedral Fiction writers use various ways in telling their story. One of such ways includes the establishment of the position through which the storyteller is to convey the plot. Raymond Carvers Cathedral is a perfect example of a story from a first person narrator. A first person narrator lacks a complete hold and knowledge of other characters and often gives incomplete information and perceptions about them. In the story, the use of first person narrator gives the story in the perspective of I. The anonymous character in Cathedral is revealed as having misconstrues and limitations in the story (Stern 50) His flaws are evident in the manner in which he interacts with other characters in the story. Nevertheless, the author gives the narrator an opportunity to grow and prove his stereotypes wrong. Confusion and ignorance are a great impediment for ones true focus in life. A slight moment with the truth can be a turning point in a persons life; giving an opportunity to remedy past mistakes and misconceptions. The narrator is presented as having various inadequacies and flaws which prevent him from getting a clear view of the world. Perhaps, the narrators prejudice against blind people reveals more about his character. The narrator clearly shows his uneasiness with the blind man visiting, And his being blind bothered me. My idea of blindness came from the movies. In the movies the bind moved slowly and never laughed (Carver 186). Apparently, the narrator foolishly searches for any reason to dismiss the blind man. For instance, the narrator says, Id always thought dark glasses were a must for the blind. à ¢Ã¢â€š ¬Ã‚ ¦.I remembered reading somewhere that the blind didnt smoke (Carver 190-191). The blind man is a friend of his wife and is paying the couple a visit. Evidently, the narrator is naÃÆ' ¯ve and ignorant about blind people. Through the reactions and actions of the narrator, we are able to infer some elements of his character flaws. For instance, it is undoubtedly true that the n arrator is overly insecure. As a man of the house, he is afraid that the feminine can take away his position. This is demonstrated symbolically through the use of the castle in the story (Bullock 343). The masculine castle of the narrator is demonstrated by the differentiation of whatever is inside and outside. As a male, the narrator must be able to not only prevent any form of external intrusion but also the threat of the feminine power he lives with. Surprisingly, the threat he faces is his own feminine nature. The narrator is devoid of self-awareness. His attitude towards Robert, the blind man and his wife depict a great deal of the narrators insensitivity. In fact, he betrays himself through his inarticulate manner of speech. A plethora of flaws can be drawn from the mannerisms shown by the narrator (Bugeja 80). The author applies the present situation of the narrator as well as the past experiences to paint a full picture about the life of the narrator. As a working person, there is nothing desirable about the narrators job. From the story, we gather information that the narrator is struggling with bad habits. In the past, the narrators wife is said to have attempted to commit suicide. She also has had a divorce and seemingly, her marriage to the narrator is definitely an unhappy one. Yet, the narrator does not seem to be there for her. The narrator is not only a drunkard but also a drug addict. He spends most of his time after work in his living room watching TV. Worse still, he does no t seem to have a flicker of enthusiasm about his marriage. In fact, he does not show signs of intimacy with anybody in his life. All these are signs of ignorance and insensitivity. The transformation of the narrator comes rather unexpectedly. From the beginning of the story, he can see Robert as a mere blind man. He resents him and dismisses him as useless and weak. In fact, the narrators stereotypical associations of the blind man are not different with that of a common person. However, a turning point comes in his life when he spends time with Robert. At first, the narrator feels rather awkward that his wife does not keep her guest comfortable. Robert, aware of the narrators weaknesses and his lonely life, endeavors to create a relationship with him. He takes advantage of the narrators TV viewing habits to dispel the stereotypes and misplaced perceptions of the narrator. Unknown to the narrator, Robert is possesses very string personality. Unlike the narrator, the blind man is self sufficient, confident, sensitive, perceptive, and self-assured as well as gregarious. Moreover, Robert is immensely knowledgeable; possessing a heightened capability and awareness. As it dawns on the narrator, disability is not inability. The narrator recognizes the humanity possessed by Robert in spite of his blindness. The growth of the narrator comes along with his revised perception and stereotypes about blind people. The use of the cathedral is significant in the story. It is used as an implied metaphor suggesting the isolation that the narrator faces as a masculine figure. The craving for the masculine narrator to maintain his power and ego seems as an imprisonment (Lacan 1280). After obtaining re-assurance from Robert, the narrator clearly changes his direction. The blind man does not meet the stereotypes possessed by the narrator about blind men. The moment he spends with Robert turns out to be his turning point. The TV program on cathedrals offers a chance for the narrator to come into self recognition, allying all previous fears about blindness. As the narrator draws the cathedral while his eyes are closed, he expresses the liberty he feels. He admits that I was in my house. I knew that. But I didnt feel like I was inside anything. This is certainly a transformation of the earlier masculinity held by the narrator. The symbolism in the use of cathedral is that when the narrator draws it, he i s designing a new masculinity different from that of the castle. The narrator escapes from his feeling of insecurity embracing a new dawn; a complete rebirth. The dependency of masculinity on others to achieve its full potential is depicted in the response given by Robert about cathedrals. Being blind, Robert describes a cathedral as he has just heard from the TV. According to the blind man, generations of the same families worked on a cathedralà ¢Ã¢â€š ¬Ã‚ ¦.. Men who their lifes work on themà ¢Ã¢â€š ¬Ã‚ ¦. never lived to see the completion of their work (Carver 190). In this, it is evident that that just like Robert is a crucial catalyst towards the development of the narrator, men are similar to cathedrals and have to have these supports. To help hold them up, so to speak. These supports are called buttresses (Carver 191). Men need support like the cathedrals for them to reach the up. According to the narrator, men built cathedrals during the olden days for them to be closer to God. The metaphor presented through the use of a religious building shows a need for design directed towards religious dimension. Although the dimension is not presented through doctrines, we can decipher it from the church wedding for the blind man and his wife (Bullock 345). Ignorance can pose a great danger in the life a person; particularly in their daily interactions with other people. Failure to adopt open mindedness and a free focus towards life can render an individual into imaginary blindness. Physical blindness does not mean mental blindness; a physically blind person can show a normal person with clear vision the way. Stereotypes are the dwelling places for confusion and ignorance; favoring the perpetuation of misplaced imaginations and beliefs.

Career in Accounting

Career in Accounting Tammy Doll Everest University Online September 2012 Career in Accounting I have always wanted a career in Accounting. I was always good in math and keeping things organized. Although it is not what my parents wanted for me. They wanted me to become a nurse. There are quite a few steps that I must take to become an accountant. Through minimal education requirements and continued education I will better myself and grow within my career. As an Accountant I would have a multitude of responsibilities depending on what field that I decided to go in.There are several fields I could go into, Auditing in which I would go into a business or to an individual and do a complete audit on their financial history. There is a Budget Analysis career option in which I would be responsible for the financial plans of a business. Another career field would be Management Accounting which is basically running a business, deciding when and where to spend the money. The career that I woul d like to have in the accounting field would be to become a Certified Public Accountant.A certified public accountant is responsible for preparing and auditing annual financial statements. I would also be responsible for completing tax returns for businesses and personal income taxes. (Accounting coach, 2004-2012) There are several things that I have to accomplish before I get my CPA. First I must get my Associates degree in accounting, which will allow me to get some experience. Then I will go for my bachelor’s degree. Just a bachelor’s degree in accounting is not enough to qualify for my CPA license. Accounting coach, 2004-2012) I would need to have 150 college credits and also pass an ethics exam in order to sit for the CPA exam. Different states have different requirements to maintain my CPA license, but generally I would have to take so many higher education credits per year to recertify. To get where I want to be there is a lot of steps that I must climb, I am up to the challenge. There is a wide range of opportunities for me, depending on the degree I obtain in Accounting.Just having an associate’s degree in accounting certifies me to be a bookkeeper or an accounting clerk. The salary I could expect to make is $18,000 to $40,000 per year. Going on with my dream and pursuing my bachelor’s degree and ultimately my CPA I could earn $40,000 to $80,000 per year depending on experience. (Accounting coach, 2004-2012) Accountants must be well organized and be knowledgeable of financial documents. They must also be trustworthy, honest, have strong communication skills and be very attentive to detail. (Ford) Smith, 2012). It is also very helpful that I am knowledgeable of using Excel and similar computer programs, because spreadsheets are the core of accounting organization. After completing this paper and doing extra research, I still want a career in Accounting. I have a lot of hard work ahead of me. Organization and math was always one of my stronger qualities. I am ready to better myself through further education and be the best that I can be in my career. ReferencesAccounting Coach. (2004-2012). CPA requirements, accounting jobs and opportunities. In Accounting Coach (Ed. ), Retrieved from http://www. Accountingcoach. com/careers/CPA-requirement. html Careers in business. In (1997). Careers in Accounting. Retrieved from http://www. Career-in- Accounting. com (Ford) Smith. (2012). Traits, skills, and personal characteristics for an accountant. In Retrieved from http://www. chron. com/traits-skills-personal-characteristics-accountants-9716. html

New Century Financial Corporation Essay

Summary: the mortgage mess happened in 2008 when there was a decreased homing price. However, their mortgage payment by homeowners were soon greater than the price of house. As a result, they forced the repurchase policy of many mortgage agreements, and let the subprime lenders to take over their houses. Subprime lender like New Century became the bankrupt because of the high lost associate with the mortgage cancelation. To maintain earning, the management modify the estimate of its reserve. However, KPGM, the auditor of the New Century is question of their work. KPMG lost its independence due to its afraid of lost business. 1.The advantages include better understanding of the industry, lower cost because of the reduced amount of work on evaluate the industry, gain great profit when the industry is going up, and early recognition of the industry trend because of the shared information from different companies. The disadvantages include risk of loss profit when the industry go down, create a mind set of doing audit that can be bias, 2.They need to ensure the information gathered by the prior team is properly communicated and understand by the take over team. As a result, it results in the saving of the time and effort of the take over team to spend. It also gave the new team a different point of view as well as better understanding of the company. on the other hand, they also need to ensure the work quality of the taker over team will not be reduced. 3.Significant deficiency: A significant deficiency is â€Å"a control deficiency, or combination of control deficiencies, that adversely affects the entity’s ability to initiate, authorize, record, process, or report financial data reliably in accordance with generally accepted accounting principles such that there is more than a remote likelihood that a misstatement of the entity’s financial statements that is more than inconsequential will not be prevented or detected.† Material weakness: A material weakness is â€Å"a significant deficiency, or combination of significant deficiencies, that results in more than a remote likelihood that a material misstatement of the financial statements will not be prevented or detected.† SAS 112 requires the auditor to communicate control deficiencies that are significant deficiencies or material weaknesses in internal control. Significant deficiencies or material weaknesses must be communicated in writing to management and those in charge of governance–for example, to the audit committee of the board–no later than 60 days following the report release date. Unqualified Opinion can be issued when internal control over financial reporting is effective: no material weaknesses in internal control over financial reporting exist as of the fiscal year-end assessment date. 4.The procedures to audit important â€Å"accounting estimates† include :considering the relevance, reliability, and sufficiency of the data and factors used by management, evaluating the reasonableness and consistency of the assumptions, and re-performing the calculations made by management. 5.The GAAS require an auditor to exercise due professional care, to adequately plan its audit, to sufficiently understand a business’s internal structure, and to obtain sufficient evidence to reach reasonable conclusions. KPMG allegedly failed to adhere to the GAAS by having an inexperienced audit team,; failed to challenge New Century management for unreasonable estimates; failed to test the repurchase reserve despite evidence of internal control weaknesses and apparently inaccurate estimates of outstanding repurchase requests; and failed to raise deficiencies and inaccuracies in New Century’s accounting practices or internal controls. 6. Although the investors are complaining that they should be liable for the lost because they did not actively participate in the mortgage market. It is true that they did nothing wrong, but they need to identify this risk when they invest. Investor does not have enough information about the market trend that should be provided. As a result, they invest the money base on the outdated information. There is no way for them to identify the threat of their investment. 7.1) auditor need to maintain independence from their work, lose of independence can lead to a bias conclusion, which cannot be trusted upon. KPMG’s afraid to lost New Century as a client lead them to issue a report in favor of the management. 2) do not employ inexperience auditor, especially when the company is in its hard time. Inexperience auditor will cause mistake of their work. Company in hard time have a incentive to make fraudulent statement, and inexperience auditor are not able to detect them. 3) be aware when the company going down. The management may try to management the earning in order to meet estimates.

Philosophy essays essays

Philosophy essays essays Due process of law is commonly defined as the right of every citizen against arbitrary action by national or state governments. This law was created to protect the personal liberty of every citizen. In court matters involving crime, the state is the party charging the individual with the crime. In often cases, this can be intimidating and imposing to the defendant. The requirements of due process are an attempt to lessen the intimidation and create a more equal environment for the individual and the state. Although this is the common definition of the due process, it has never been defined precisely by the Supreme Court. They have used this to mean, The gradual process of judicial inclusion and exclusion. The fourth, fifth, sixth, and eighth amendments provide for due process of law in several ways. The fourth amendment was designed to protect the people against improper searches and seizures, meaning searches and seizures without a warrant. It also insures that an arrest cannot be made without probable cause, which is to be determined at a later date by a judge or court. Also, it insures through the exclusionary rule that the court can exclude evidence obtained through an illegal search. The Fifth Amendment allows a person being accused of a crime to remain silent and not provide a statement to the police. It also provides all citizens the right to a grand jury. During an arrest or while on trial it gives the defendant the right to not incriminate themselves i.e. testify against themselves. This is also the same amendment that protects double jeopardy, which is being tried more than once for the same crime. The sixth amendment provides all accused persons to the right of co unsel i.e. a lawyer even if they were unable to afford it, one would be provided. They are also granted the right through this amendment to have witnesses questioned at their trial. Also in the sixt ...

The Importance of Being Earnest Research Paper Example

The Importance of Being Earnest Research Paper Example The Importance of Being Earnest Paper The Importance of Being Earnest Paper when Algernon asks why he has come to the town. This shows he is irresponsible because it shows he just wants to have fun and enjoy himself. This quote also shows he is wealthy and extravagant because he can obviously travel whenever he wants to and has the cash to do so. This links back to the point that he is irresponsible because if he had the sole responsibility of anything then he wouldnt just be able to travel for example if he worked then he would not just be able to leave his job. The word pleasure emphasises the point that the character Jack is wealthy, as he clearly has a luxurious lifestyle and the money to afford pleasure. The phrase what else should bring one anywhere? also suggests he is young and care free because he has no understanding that people might not travel for pleasure. He appears to be living in his own little world and has no idea that others struggle to find the money to survive and have to work very hard to do so. This is an important part of Oscar Wildes message that the rich were quite nai ve but I will discuss this further later. On the other hand this quote could show he was just spontaneous and always looking for an adventure. Instead of being frivolous he is just enjoying the money he has and making the most of his life. It would probably depend on the audiences views on money as to whether they saw Jack as overly extravagant or just spontaneous. The idea that he is irresponsible is actually not a true character trait, because actually Jack is quite devious, and does have responsibilities because he is a guardian in the country, where he is known as Jack, to Cecily his ward. The previous quote applies to this as well because doesnt want Algernon to find out he has responsibilities as he may come across as boring. While he is actually travelling to the town for pleasure, he tries to cover the fact he has a secret life in the country with what else should bring one anywhere? This acts as a cover because Jack knows that travelling isnt always about pleasure but he tries to fit in with Algernons profligate lifestyle. At many points in the play Jack says things that make the characters he is talking to believe he is someone he is not. This is usually due to the fact he is trying to cover up his lies. There are points when Jack is shown to be demanding. When he travels to the town, in act one, he says to Algernon I simply want my cigarette case back. This shows Jack to be demanding and perhaps impatient. The phrase simple want implies he is impatient as this is the way the line would be performed when on stage. I imagine that the line would be delivered in a snappy way, and Jack would probably look quite angry or uncomfortable. The line is short which would make the audience believe that Jack is short-tempered and the word want adds to this. His demand is polite yet the tone in the actors voice would give away that Jack was actually frustrated. In the conversation that is taking place, Algernon has read the inscription on the cigarette case, which makes it obvious that is belongs to Jack and is from Cecily. Algernon knows Jack as Ernest as this is what Jack calls himself in the town. Algy also knows the cigarette case belongs to Ernest so is confused by the inscription which goes against what he knows. The conversation arouses suspicion with Algy and so he starts questioning Jack (or Ernest as he is known to Algernon at this point). The quote links to this because instead of having a short-temper, he could have appeared impatient because he was anxious about being found out. The actor could show this by being fidgety and looking uncomfortable with the situation. This makes sense because Jack is happy with the way he has two lives, one in the town and one in the country and as no-body likes to be lied to, Algernon and Jack would probably wend up having a fight, and things would probably have to change or Algernon would want to meet Cecily and everything would get confusing, so Jack didnt want him to find out. If this is the case the word simply would be Jack trying to cover the fact he was really anxious to get his cigarette case back without Algy discovering the lies and him trying to sound as casual and calm as possible. Throughout the play, he is very cagey about the secrets and right up until the end, there are still things being discovered. Oscar Wilde sometimes gives the characters lines that just spark the idea with the audience that they are lying. At the beginning Jack says Eh? Shropshire? Yes of course! This gives the idea that Jack is lying about where he has been and where his house in the country it because he sounds confused. He is hesitant to begin with, like he is unsure of what he is talking about, even though, he should be sure. The question marks show the actor would go up at the end of the words, to make it clear it is a question. The actor would also probably have a confused face, while he thinks about what is being said. Jack after giving away slightly that he was lying tries to go back on himself, and cover it up by saying Yes, of course, as if he knew all along. This is a subtle effect used by Wilde, which just triggers the feeling he is being dishonest with the audience. From this point they are then more likely to pick up on other times when he is lying, which adds to both his character and the storyline. Narcissistic is a word that could be used to describe many of the characters but Jack definitely has this characteristic. Wilde makes all the characters self-centred and vain, which is a lot of the reason why the play is a comedy. It adds to the humour because they are only interested in their own lives, so end up clashing because they are unable to understand other people. Wilde shows Jack to have this trait with the line It is very painful for me to be forced to speak the truth. He doesnt realise how much his lying might upset people and hasnt thought about the consequences. All he wants is happiness for him and this links back to the point that he is demanding because he doesnt understand that others may have their own concerns. He has been lying but he doesnt think about how this will affect others just how painful it is for him. It sounds as if he doesnt realise that the lies may hurt others but he understands that it is wrong because he is embarrassed about having to tell them. He doesnt want to admit he has lied because he likes the situation he is in even though it is deceitful. At certain points he can be very hypocritical. He says to Algernon my dear fellow the sooner you give up this silly nonsense the better about his lying and having a double personality. This is hypocritical because Jack also has another personality and identity but this is what he is telling Algy off for! The fact he calls it silly nonsense shows that he recognises that what he is doing is a bit stupid and immature but this doesnt affect his actions because he is benefiting from having two identities because he can get out of things he doesnt want to do. Jack also appears to be romantic throughout the play. He loves Gwendolen and want impress both her and her mother; who wont let them marry. In the first act he appears very romantic when he admits his love to Gwendolen. The character has the line, I have never loved anyone in the world except you. He sounds very charming and this line is likely to surprise and impress Gwendolen. On stage this would probably be a very intense and emotional scene. Gwendolen and Jack are having this secret conversation while Lady Bracknell (Gwendolens mother), is in the other room, so it could be quite rushed or panicky. Later in act one he calls her My own darling which shows he is affectionate, but possible a bit possessive. The fact he calls her darling shows he is affectionate and adoring of her because it is a familiar pet-name. He says my own which is the part that makes him sound possessive because it sounds like she is a possession; an object rather than a woman. This could mean the character is controlling and maybe clingy. He wants other people to know Gwendolen is with him and it could be pride or it could be jealousy and control. Towards the end of the play, in act 3, Gwendolen says I am engaged to be married to Mr. Worthing. This quote makes Jack (Mr. Worthing) appears to be romantic because the couple have stayed together through the action in the play so far, even though they have had opposition. They are still serious about each other, and love each other even though their relationship was frowned upon and challenged by the highly respected Lady Bracknell. She was quite a fierce character so it makes it more likely that Jack and Gwendolen are truly in love, because they are in an unofficial and nonstandard relationship (because of the way they got together), and so should probably not be together but even with Lady Bracknell pressuring them to split up they havent. Their relationship is unusual because in that era, if you wanted to marry a woman you went to her parents first but Jack didnt do this, he went straight to Gwendolen, which must have angered Lady Bracknell as she would have felt protective towards Gwendolen. This proves Jack is romantic because he must have really loved Gwendolen, or at least really wanted to be with her because Lady Bracknell was very powerful and what he was doing, she disapproved of and could have probably done something about. However in the end Lady Bracknell does intervene, but Jack still protests by not allowing Cecily to marry Algernon, Lady Bracknells nephew. This shows a selfish side of Jack; he is stopping someone elses relationship because he cant have his own way. This links back to the idea that he was self centred because if he was selfless than he would let Cecily and Algernon be together because that would make them happy and even though he is upset, they could still continue their relationship, but they cant without his permission. I was in handbag. This is a quote that describes Jacks mysterious past, in which he was abandoned and found in a railway station. This has probably had an impact on his life and character and he may be so self-centred because he felt rejected and feels he deserves to be because his real parents didnt want him and so he gives himself the attention. On stage the conversation would probably be quite awkward because Lady Bracknell is questioning him and he is obviously embarrassed about his part and doesnt want it to come out. It remains quite mysterious (until the end) because he doesnt know who his parents are until it is revealed that his mother is Lady Bracknells sister. Jack is engaged to Gwendolen but that is just one relationship that he has. His best friend is called Algernon and actually turns out to be his brother! He lives in the town but travelled out to the country to find out about Jack. The two characters are in many ways very similar because they are both dishonest and irresponsible. This is shown when Jack says I could deny it if I liked, I could deny anything if I liked because he is implying that he is used to and good at lying and can get himself out of any situation. This is possible not the best thing to say in this situation as he has been found to be lying; by saying this he is implying that he lies all the time. This would only make the characters trust him less and wonder what else he has been lying about. He also sounds a bit cocky and again self-centred because he thinks he can do what he likes, without thinking and he can get away with it. This is a characteristic that he shares with Algy which is possibly why they get on so well. They are both Bunburyists which means they have created another identity to get them out of social meetings that they dont want to take part in! This shows they are both selfish and probably ungrateful because somebody has gone to the effort of inviting them to the event and then they pretend they are busy to get out of it. This is backed up by the quote you have invented a very useful younger brother in order that you may be able to come up to town as often as possible because it explains why Jack ahs created Earnest. Although they get on well on the whole, they sometimes have small disagreements over petty things. In act two they have a disagreement over muffins. How can you sit there, calmly eating muffins, when we are in this horrible trouble is a quote from this argument. They continue arguing over the muffins, but there is an underlying reason for this argument. They are both probably a bit annoyed and nervous as to what is going to happen next because both the women have just found out they are Bunburyists and have gone inside. This has left the men in bad moods and they need to take it out on someone so they have a go at each other over the first thing they can. Though the play is quite light-hearted being a comedy there is a serious message underneath. I believe one symbol of this is the food. It seems to be a key idea carried through the play: the cucumber sandwiches in the first act and muffins and cake and sugar in the second act. I think that the food and gluttony is a representation of other appetites and levels of indulgence. When Jack eats the bread and butter, that is meant for Gwendolen, enthusiastically it is humorous but also could show that he is assuming Gwendolen likes him, and also that he shouldnt like Gwendolen and is being greedy wit his women. This idea is intensified because Algy says you behave as if you were married to her already as if the bread and butter represented Gwendolen. This idea is also present when Cecily and Gwendolen meet in act two and Gwendolen claims Cake is rarely seen at the best houses nowadays. And sugar is not fashionable anymore because it shows Gwendolen is very fussy and very concerned about image and others opinions. This is the same when it comes to men because she was only marrying Jack because she thought his name was Earnest. Wilde uses theses symbols (like the food) and themes to get across his message. The main theme is marriage, both as part of the storyline and as an underlying opinion of Oscar Wilde and his opinions of the people of the era. It soon becomes clear that in the Victorian era money, social class and background are the important things for the upper class to find a partner. This is shown when Lady Bracknell is interviewing potential bachelors for Gwendolen How many bedrooms? . She is clearly thinking about the vale of the property and making sure Gwendolen will have a rich husband who will be able to support her financially. Cecily is very dreamy but Jack is the only one who is a true romantic and although he has fallen for a rich woman wouldnt necessarily want/need a rich woman. The fact that this is a play means that the audience would have to go to the theatre, probably meaning they are quite wealthy, and might not understand the jokes fully because it is about their lifestyle, so it could offend. I think for this reason Wilde made it a comedy so he didnt put people of too much by having a go in a light hearted way. Another message of the play is that all the characters are very similar. If you pick out any line, which doesnt contain a name then a lot of the time it is difficult to know which character said it. This could suggest that Wilde believed the upper class lacked character and individuality. Regularly in the play the characters (especially Gwendolen and her mother Lady Bracknell) appear to lack personality and just seem shallow and only concerned with money and what is fashionable. All the characters are well spoken, and often appear to be being polite well their motives are actually quite malicious. What the Victorians believed about morality is also a source for mock the Victorians for Wilde. Throughout the play there seems to be a set of unwritten moral rules that everyone should obey. For example when Jack finds out Algy has read his cigarette caser he says he thinks reading a private cigarette case is ungentlemanly. Wilde mocks this by making the characters take this to extreme lengths. The whole play is quite satirical and presents a moral paradox due to the fact the title is The Importance of Being Earnest, Earnestness is a quality of being serious and as none of the characters are meant to be this, its satire. What Wilde wants us to see as truly moral is really the opposite of earnestness: irreverence. The fact that the two main male characters lie throughout the play might also be a point that Wilde tries to get across. Both treat life as if it is just a game or a work of art that they can do what they like with. Algy although untruthful, only created Bunbury to travel different places however Jack takes it to another level, by taking on both identities, bothering with costumes when Ernest dies etc. Algy makes up stories that dont harm the others view on truth but Jack acts almost hypocritically. Overall, Jack didnt actually change that much over the course of the action. He starts lying and just lines from the end says it is a terrible thing for a man to find out suddenly that all his life he has been speaking nothing but the truth, so his views have not changed considerably. The plot has not changed his life a huge amount, especially not in a negative way that would prompt change. He has found out he has a brother, but it is his best friend anyway so even though it may change their relationship, its not negative. He temporarily split form Gwendolen but then they got back together so this is not negative and also Lady Bracknell has discovered Jack is her nephew so this is good. This means we will see no reason to change because everything is good and how he wants it to be. Wildes message is clear, and in general I would say he thought the upper class were shallow and self-centred!

Portrait of a Teacher Personal Statement Example | Topics and Well Written Essays - 750 words

Portrait of a Teacher - Personal Statement Example One particular past educator of mine singlehandedly embodied the teaching philosophy found within each â€Å"portrait of a teacher.† During my time spent in this classroom, I was able to feel a sense of belonging and purpose. Incorporating a student-centered instructional approach, as well as diverse assessment approaches, this particular educator fostered a learning environment where each and every student felt the driving purpose and moral of each lesson. Throughout the course of the year, the instructor cultivated learning through student interaction, as well as life-relevant lessons, which afforded each pupil a meaningful and unique learning experience. Although the educator incorporated the use of direct-instruction into the classroom setting, the majority of learning activities centered around student interaction and engagement, which allowed each student the opportunity to learn on their own, while the teacher played the role of the facilitator, rather than the dictator . Students in the classroom felt encouraged to think critically about a topic or lesson because they felt a connection to the instructor’s material, and no longer felt like an inanimate object in the classroom. The democratic feel to each classroom activity permitted students to express themselves through their artistic and personal strengths, and also led to peer interaction that was absent from most classroom settings. In contrary to this particular teacher, another instructor from my past lacked the fundamental qualities of an influential educator. Rather than promoting a democratic principal in the classroom setting, this particular teacher followed a more totalitarian approach to education. Thinking back to this classroom, I struggle to recall meaningful lessons or memorable moments. Instead, I can recall a sense of fear and anxiety, which ultimately restricted my ability to learn and develop as a student. The lack of peer interaction in the classroom, as well as the tea cher-centered instructional approaches, cultivated an inability to focus on the task at hand, and inevitably led to poor student retention and understanding. One specific instance I can recall from this learning environment, which illuminates this exact point, was during a test review lesson. During review, the teacher would simply instruct students, through direct instruction, of the material that would be covered on the future exam. Instead of utilizing a student-centered approach, which would have ultimately encouraged student interaction and promoted discussion on the topic of review, the teacher simply lectured on the main points of the test. I can still recall the feeling of being unattached to the curriculum, simply worrying about the results of the exam, rather than the process of learning or the enjoyment of being a student. Inevitably, this led to poor test results, as well as a lack of enthusiasm for education. As a future educator, my goal is to incorporate a sense of be longing and purpose within each and every student. From my experiences as a student, I can still recall the detrimental impact of feeling neglected or ostracized from the process of learning. Author, Robert Slavin, discusses the impact on learning when students are neglected within the learning process. Slavin writes, â€Å"

Analyzing Gender Differences in Spontaneous Speech Research Proposal

Analyzing Gender Differences in Spontaneous Speech - Research Proposal Example From the time they are born, baby girls are considered fragile and they are exposed to delicate language and handled very gently. Boys, on the other hand, are exposed to strong tones and power-filled language and are handled less gently as they are tossed in the air and held upright from a younger age to demonstrate their power and strength (Rasquinha & Mouly, 2005) This study attempts to investigate gender differences in choice of topics to talk about and linguistic differences in verbal expressions. Its significance lies in the fact that understanding gender differences and accepting them as natural to the person will help others understand where the speaker is coming from. To understand gender differences in communication better, it is important to actively analyze how men and women express themselves linguistically and explain the differences between the two if any. Background of the Research Problem Most miscommunication problems between men and women stem from the fact that they are wired differently. According to Rasquinha and Mouly (2005), women are more prone to communicating verbally with a language of connection and intimacy. This means that they use more of their emotions when speaking. On the other hand, men are more prone to communicating with a language of status and independence. This means they use more of their logical reasoning and less of their emotions. Sometimes, conflicts arise when issues pertaining to interpretations of certain topics and gender differences come into play.