IAS 40 Investment Property Essay Example | Topics and Well Written Essays - 2000 words

IAS 40 Investment Property - Essay Example There has been a widely held debate in terms of a need to classify a property as an investment property or a property which is in use by the owner. International Financial Reporting Standards (IFRS) provides a clear cut difference between the property which is intended to be held as investment and the property to be held for the purpose of use other than any investment purpose (Deloitte, 2012). On the other hand, if Generally Accepted Accounting Principles are taken into consideration, then there cannot be found any difference between the two as such. However IFRS has recognized the need for providing specific guidance especially for the property which is to be held by the owner for the purpose of investment (Deloitte, 2012).This article aims to study the various impacts of IAS 40 â€Å"Investment Property† with respect to different elements. The paper is structured in such a manner that first section highlights the overview of IAS 40 in which a brief history, definition, obje ctive and scope of Investment Property is briefly discussed. Second part of this article outlines at the accounting treatment of Investment Property such recognition, measurement and disclosure requirements are explained in detail. Next section provides a brief comparison of IFRS and GAAP in respect of Investment Property followed by a section which illustrates an example reproduced from the annual report of a publicly listed company. Discussion and conclusion of IAS 40 will summarize this article.

Cross cultural awareness Essay Example | Topics and Well Written Essays - 4500 words

Cross cultural awareness - Essay Example Stereotypes are simplified and standardized conceptions about groups of people or individuals (Hurst, 2007). These stereotypes are used as mental shortcuts by people when they are dealing with people about whom they know little personally (Hurst, 2007). For example, there are stereotypes about Blacks, Latinos, Older Workers, Female Workers, Arabs and Asians among scores of others. When interacting with a person from any of these stereotypical groups, it becomes easier to think of them as having the specific characteristics that are associated with the group. For example, two African persons – though they may be coming from countries as diverse as America and Egypt, might be considered to be both aggressive, good in sports and bad in academics etc. as these attributes come with the stereotype of ‘Black’ person. Stereotypes are not all bad as they may actually help you in making quicker decisions as they provide an easy way to understand behaviors (Ewen and Ewen, 2006). For example, in the case of Germany, the people can be expected to desire more efficiency in overall hotel operations while in the case of Japan, the hotel guests may require more expression of courtesy from the staff. Having this knowledge from the typical stereotypes, the hotel can tailor its package accordingly to provide the best service delivery as desired by different people. Stereotypes can also help in understanding the differences in a non-complex manner and thus enable better decision making (Ewen and Ewen, 2006). For example, in the hotel context, stereotypes can help in serving the people belonging to different groups better. It may be useful to know what people from different regions prefer in terms of dà ©cor, food or service, and this knowledge can be derived from stereotypes. Next benefit of stereotyping is that it provides us with a mental file or a mental background in the context of which we can make sense of

Radiographic Quality of Root Canal Treatments

Radiographic Quality of Root Canal Treatments Title: Radiographic quality of root canal treatments performed by undergraduate dental students Authors: Masoud Saatchi1, Golshan Mohammadi2, Armita Vali Sichani3 Dental Research Center, Department of Endodontics, School of Dentistry, Isfahan University of Medical Sciences. Isfahan, Iran. School of Dentistry, Isfahan University of Medical Sciences. Isfahan, Iran. Department of Endodontics, School of Dentistry, Isfahan University of Medical Sciences. Isfahan, Iran. Summary: The aim of the present study was to evaluate the quality of root canal treatments performed by students of Isfahan University School of Dentistry between 2013 and 2015. Periapical radiographs from 784 root treated teeth including 1674 root canals were randomly selected and evaluated in terms of quality of root fillings (length and density of root fillings) and procedural errors (ledge, foramen perforation, root perforation, and fractured instrument). Descriptive statistics and chi square test were used for evaluation of the data (P Key words: dentistry, procedural errors, radiography, root canal treatment, undergraduate student Introduction Root canal treatment (RCT) is an important part of comprehensive dental care (1). High prevalence of apical periodontitis in endodontically treated teeth, as reported by epidemiological studies (2-4), reveals that outcome of RCT in many populations is poor, which as a health care problem can elicit medical, economical and ethical consequences (1). Outcome of primary endodontic treatment is reported to be associated with many factors (5). One of these factors is technical quality of RCT that is usually evaluated using radiographic method (3, 6). Its shown that the length of the root filling, relative to the radiographic apex, significantly affects the treatment outcomes (7). In addition, root fillings with an adequate density are strongly associated with a lower risk of periapical disease (8). Also, procedural errors such as ledges, zip and elbow formations, fractured instruments and perforations may accrue during the RCT. These errors may result in compromised cleaning and shaping, leakage through root filling or infection of the periradicular tissues and can jeopardize the endodontic outcomes (9). Recent studies accomplished in various population groups, show that undesirable quality is a common finding in RCTs performed by dentists and undergraduate dental students (Table 1). Therefore a worldwide enhancement in the quality of RCT is required (2) that could be achieved by means of education. Studies concerning quality of RCT are needed in order to appraise the efficiency of dental training, highlight the weaknesses and help with the planning for dental education. Thus, the aim of the present study was to evaluate quality of root canal treatments (quality of root fillings and incidence of procedural errors) performed by students of Isfahan University School of Dentistry between 2013 and 2015. Materials and methods In this cross-sectional study, a random sample of 1200 cases were selected from the records of patients who had received RCT by undergraduate students at School of Dentistry, Isfahan University of Medical Sciences, Iran, during 2013-2015. Records with missing or unreadable radiographs due to improper imaging or processing technique, or those with radiographs that didnt show the entire length of the root canals and 2mm of periapical area, were excluded. Finally, 784 treated teeth including 1674 canals were evaluated. The RCTs were accomplished by fourth, fifth and sixth year undergraduate dental students according to the fallowing protocol: after taking medical and dental history and diagnosis of palp and periapical disease, local anesthesia was injected and the access cavity was prepared. An aseptic technique with rubber dam isolation was applied and working length was determined using periapical radiographs. Canals were prepared using step back technique by means of stainless steel k-files of 0.02 taper (Dentsply, Tusla, USA or Mani, Tochigi, Japan). In some case Gates-Glidden drills (Mani, Tochigi, Japan) were used for preparation of coronal third of the canals. Canals were irrigated by 2.5% sodium hypochlorite. Obturations were carried out using lateral compaction technique with gutta-percha cones (Ariadent, Tehran, Iran) and a ZOE based sealer. Teeth were temporarily restored and referred for permanent restorations. For root canal treatment of each tooth, 4 periapical radiographs (preoperati ve, working length determination, master cone and postoperative) were taken by the bisecting-angle method using De Gotzen dental radiography machine (De Gotzen, Roma, Italy) and E speed size 2 intraoral films (Primax, Berlin, Germany). Developing solutions (Champion, Tehran, Iran) were used to possess the radiographs in a time-temperature technique. Endodontist academic stuff supervised all the treatment steps. Average academic stuff: student ratio has been 1: 6 at the time of the study. In order to evaluate the quality of each RCT, at least 3 radiographs including preoperative, working length determination and postoperative, were examined. Evaluations were made in a dark room under even illumination and 3x magnification. Radiographs were mounted in a cardboard slit to exclude the extraneous lights. Measurements were done using a transparent ruler of 0.5 mm accuracy. In cases that the radiographic images were taken with an alternation in horizontal angulation, it was supposed that they were exposed with a mesial angulation. Two individual investigators (GM and AV) securitized the radiographs of each record. The results were compared and in case of disagreement a third investigator (MS) was asked to examine the records, and a final agreement was achieved. Before the study, investigators were calibrated and Inter-examination agreement was determined by evaluating 30 radiographic records that werent included in the study. For establishing intra-examiner agreement, each investigator re-evaluated the same radiographs after 2 weeks. Evaluation of quality of RCTs was accomplished by examining radiographic quality of root fillings and detection of the procedural errors. Root canal was considered as the unit of evaluation. Quality of root filling in each canal was categorized as acceptable and unacceptable based on the following criteria: Acceptable root filling: root filling ending 0-2 mm from radiographic apex without any visible voids in the filling mass or between the filling mass and root canal walls. Unacceptable root filling: Overfilling: root filling that extends beyond radiographic apex. Undrefilling: root filling ending shorter than 2 mm from the radiographic apex. Inadequate density: root fillings with visible voids in the filling mass or between the filling mass and root canal walls. The criteria for the detection of procedural errors in this study, were as follows: A ledge was identified if the root filling in the final radiograph did not follow the curvature of the main canal path in working-length radiograph. Root perforations (including furcation perforation, strip perforation and lateral perforations of the root) were detected when extrusion of the filling materials was identified in any area of the root except the apical foramen. Foramen perforation was diagnosed when the apical termination of the filled canal appeared as an elliptical shape transported to the outer wall. Fractured instruments: was detected by observing a part of instrument in the root canal or in periarticular area in the final radiograph. Statistical analysis Data were analyzed using SPSS software version 21 (SPSS Inc., Chicago, USA). Descriptive analyzes were used for expressing frequency of radiographic criteria of quality of RCTs. Pearsons chi square test was used to compare the results among tooth types and locations and also academic year of students. P-values Results From 1200 collected records of endodontically treated teeth, 416 cases (34.7%) were excluded and 734 teeth including 1674 root canals were evaluated. 52% of treated root canals were in maxilla and 48% were in mandible. Canals of molar teeth comprised the most frequent treated root canals (68%), followed by canals of premolars (22%) and anterior teeth (10%) . 6th   year students performed RCTs on 49% of root canals. 5th and 4th year students treated 32% and 19% of root canals, respectively. Anterior teeth and premolars constituted the teeth treated by 4th year students while 5th and 6th year students treated premolars and molars (Table 2). Technical quality of root fillings According to length and density, acceptable fillings was found in 54.1% of root canals. From treated maxillary root canals, 56.2% and from treated mandibular root canals, 51.9% were acceptable. Rate of acceptable root fillings wasnt significantly different between the two arches (P=0.072). Among tooth types, canals of molar teeth exhibited lower ratio of acceptable root fillings (51.3%) compared to premolars (61.3%) (P=0.001). Rate of acceptable fillings in anterior teeth (57.7%) wasnt significantly different from molars (P=0.430) and premolars (P=0.128). Inadequate density, overfilling and underfilling was found in 34.6%, 11% and 8.3% of root canals, respectively. In both arches inadequate density consisted the most common cause for unacceptable fillings. In maxilla overfilling consisted the second frequent cause for unacceptable fillings, followed by under filling, However, underfilling was the second common cause of unacceptable fillings in mandible and overfilling was the least f requent cause (Table 3). From the root canals treated by 5th year students 46.1% had acceptable fillings which is significantly lower than canals treated by 4th year students (55.6%) (P=0.007) and 6th year students (58.8%) (Pth and 6th year students (P=0.339) (Table 4). Procedural errors: Procedural errors were found in 18.6% of root treated canals. Incidence of procedural errors between 5th year students (22.2%) and 6th year students (19%) wasnt significantly different (P=0.149). Students of 4th year had created less procedural errors (11.6%) than students of 5th year (Pth year (P=0.003). Ledge was the most frequent procedural error and was identified in 12.5% of root treated canals. Foramen perforation, root perforation and fractured instrument were detected in 2%, 2.4% and 2% of canals, respectively (Table 5). Incidence of procedural errors wasnt significantly different in canals of anterior teeth (12.3%) and premolars (9.5%) (P=0.341). These errors were significantly more frequent in canals of molars (22.5%) than anterior teeth (P=0.003) and premolars (P The k-value for inter-examiner agreement was 0.87 for detection of acceptable root fillings and 0.81 for identification of RCTs without procedural errors. For intra-examiner agreement k-values for detection of acceptable root fillings and identification of RCTs without procedural errors were 0.93 and 0.87 for first and 0.84 and 0.81 for second investigator, respectively. Discussion This study was designed to evaluate the quality of root canal treatments accomplished by undergraduate dental students at School of Dentistry, Isfahan University of Medical Sciences. Periapical radiographs taken during the RCT procedures were used for this investigation. Root fillings were considered acceptable if terminated 0-2 mm from radiographic apex and had no voids. This criteria is extensively documented to be associated with improved periapical health (4, 5, 8). In order to limit inter-examiner and intra-examiner erraticism, the radiographic criteria were strictly defined and two investigators were calibrated before the study. Its reported that great variations could exist between investigators regarding assessment of technical quality of RCT (22). In the present study, the k-value of 0.87 for detection of acceptable root fillings and 0.81 for identification of RCTs without procedural errors, exhibit good agreement between the investigators. Also values for intra-examiner agreement were found to be greater than 0.81, which shows reliability of each investigator. Acceptable root fillings according to length and density was found in 54.1% of investigated canals. Comparing this result to the findings of others is rather difficult due to differences in level of practitioners (undergraduate students, general practitioners, and endodontists), techniques and materials used for preparation and obturation of the canal and also evaluation criteria used to assess the quality of RCT. For example, in the study of Bierenkrant et al. (18) who investigated root canals treated by endodontists, 91% of root fillings had adequate quality which is greater than the present study and other studies investigating quality of RCT performed by undergraduate students and general practitioners (Table 2). Among the studies concerning quality of RCT performed by undergraduate students, frequency of acceptable fillings in the current study is comparable to the findings of Eleftheriadis Lambrianidis (14) (55.3%) and Khabbaz et al. (19) (54.8%). In the study of Er et al. (15 ), 33% of root fillings were acceptable which is less than the present study; thought, they used different evaluation criteria. Lynch and Burke (16) reported adequate fillings in 63% of RCTs, which is higher than the present study, however they only evaluated single rooted teeth. In the present study, inadequate density was the most common cause for unqualified root fillings. This is consistent with the findings of Balto et al. (20). Its believed that lateral condensation technique with gutta percha, could create voids in canals with insufficient flaring (14). No significant difference was found between quality of maxillary and mandibular root fillings. Also adequate root fillings in molars were less than premolars. This result was consistent with findings of Er et al. (15) and Khabbaz et al. (19) who report a lower quality of root fillings in molar teeth. This could be explained by posterior position and complex anatomy of these teeth. Students of 5th year had performed more unacceptable root fillings than 4th and 6th year students. This could be explained considering the fact that at Isfahan University School of Dentistry, first clinical encounter of undergraduate students with molar teeth, is at their 5th year of study. Iatrogenic errors were detected in 18.6% of root canals. These errors are more frequent in molar teeth. Balto et al. (20) and Khabbaz et al. (19) also reported a high prevalence procedural errors in molar teeth. The reason for this, could be explained by curved and narrow canals of molar teeth, which makes them challenging for undergraduate students. Furthermore, 5th and 6th year students had created more procedural errors than 4th year students. This is because 4th year students only perform RCTs on anterior teeth and premolars which are less challenging than molar teeth. In this study, ledge was found to be the most frequent procedural error and was detected in 12.5% of root canals. This finding is similar to incidence of ledged root canals in the study of Khabbaz et al. (19) and is less than study of Eleftheriadis Lambrianidis (14). Its shown that stainless steel hand files used by unexperienced undergraduate students could increase the incidence of ledge and other procedural errors (14). Radiographic images cannot illustrate all iatrogenic errors. For instance, over instrumentation which drives pulpal fragments and microorganisms beyond the apex into the periapical tissues, can only be radiographically diagnosed when it is followed by extrusion of filling material from the apex. The use of bisecting-angle technique for taking periapical radiographs, results in less accuracy in recognition of canal length, comparing to the parallel technique (23). It has also been shown that using only one orthoradial radiographic image for assessing the adaptation of the filling material to the root canal walls, isnt reliable. This adaptation has to be further investigated with at least one extra radiography of distal or mesial angulation in order to obtain more realistic estimate of density of root filling (24). Although radiographic quality of RCT is a significant determinant in predicting outcomes of primary endodontic treatment, the radiographic images can not reflect the general quality of treatment. Application of the antiseptic and aseptic techniques, material used and microbial circumstance of the canal are the predicting factors which are not investigated in radiographic studies. At Isfahan University School of Dentistry, Step-back preparation and cold lateral condensation techniques are being taught to the undergraduate dental student. Most universities teach these standard techniques to their students. Its shown that using rotary Ni-Ti instruments provide better canal shaping, reduce the procedural errors and are being taught in undergraduate curriculum in some dental schools (17). In many studied insufficient time allocated to clinical and preclinical training, the academic stuff: student ratio and evaluation methods are stated as reasons for low quality of RCTs in university clinics (14, 19, 20). Isfahan University School of Dentistry uses endodontic specialists and 3rd year post graduate students as training stuff. Also academic curriculum have been recently revised to increase preclinical training. Nevertheless, enhancing the time allocated to clinical training and increasing stuff: student ratio could lead to improvements in quality of RCTs performed by undergraduate students. In conclusion, findings of this study shows that 54.1% of root fillings performed by undergraduate students of Isfahan University School of Dentistry were acceptable. Thus, there a necessity to revise the educational programs in Endodontics in order to improve quality of root canal treatments. References: 1.Boucher Y, Matossian L, Rilliard F, Machtou P. Radiographic evaluation of the prevalence and technical quality of root canal treatment in a French subpopulation. Int Endod J. 2002;35(3):229-38. 2.Asgary S, Shadman B, Ghalamkarpour Z, Shahravan A, Ghoddusi J, Bagherpour A, et al. Periapical Status and Quality of Root canal Fillings and Coronal Restorations in Iranian Population. Iran Endod J. 2010;5(2):74-82. 3.Moreno JO, Alves FR, Goncalves LS, Martinez AM, Rocas IN, Siqueira JF, Jr. Periradicular status and quality of root canal fillings and coronal restorations in an urban Colombian population. J Endod. 2013;39(5):600-4. 4.Pak JG, Fayazi S, White SN. Prevalence of periapical radiolucency and root canal treatment: a systematic review of cross-sectional studies. J Endod. 2012;38(9):1170-6. 5.Ng YL, Mann V, Rahbaran S, Lewsey J, Gulabivala K. Outcome of primary root canal treatment: systematic review of the literature-Part 2. Influence of clinical factors. Int Endod J. 2008;41(1):6-31. 6.Craveiro MA, Fontana CE, de Martin AS, Bueno CE. Influence of coronal restoration and root canal filling quality on periapical status: clinical and radiographic evaluation. J Endod. 2015;41(6):836-40. 7.Sjà ¶gren U, Hà ¤gglund B, Sundqvist G, Wing K. Factors affecting the long-term results of endodontic treatment. J Endod. 1990;16(10):498-504. 8.Chugal NM, Clive JM, Spangberg LS. Endodontic infection: some biologic and treatment factors associated with outcome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96(1):81-90. 9.Peters OA. Current challenges and concepts in the preparation of root canal systems: a review. J Endod. 2004;30(8):559-67. 10.Hayes SJ, Gibson M, Hammond M, Bryant ST, Dummer PM. An audit of root canal treatment performed by undergraduate students. Int Endod J. 2001;34(7):501-5. 11.Dugas NN, Lawrence HP, Teplitsky PE, Pharoah MJ, Friedman S. Periapical health and treatment quality assessment of root-filled teeth in two Canadian populations. Int Endod J. 2003;36(3):181-92. 12.Barrieshi-Nusair KM, Al-Omari MA, Al-Hiyasat AS. Radiographic technical quality of root canal treatment performed by dental students at the Dental Teaching Center in Jordan. J Dent. 2004;32(4):301-7. 13.Segura-Egea JJ, Jimenez-Pinzon A, Poyato-Ferrera M, Velasco-Ortega E, Rios-Santos JV. Periapical status and quality of root fillings and coronal restorations in an adult Spanish population. Int Endod J. 2004;37(8):525-30. 14.Eleftheriadis GI, Lambrianidis TP. Technical quality of root canal treatment and detection of iatrogenic errors in an undergraduate dental clinic. Int Endod J. 2005;38(10):725-34. 15.Er O, Sagsen B, Maden M, Cinar S, Kahraman Y. Radiographic technical quality of root fillings performed by dental students in Turkey. Int Endod J. 2006;39(11):867-72. 16.Lynch CD, Burke FM. Quality of root canal fillings performed by undergraduate dental students on single-rooted teeth. Eur J Dent Educ. 2006;10(2):67-72. 17.Moussaà ¢Ã¢â€š ¬Ã‚ Badran S, Roy B, Bessart du Parc A, Bruyant M, Lefevre B, Maurin J. Technical quality of root fillings performed by dental students at the dental teaching centre in Reims, France. Int Endod J. 2008;41(8):679-84. 18.Bierenkrant DE, Parashos P, Messer HH. The technical quality of nonsurgical root canal treatment performed by a selected cohort of Australian endodontists. Int Endod J. 2008;41(7):561-70. 19.Khabbaz MG, Protogerou E, Douka E. Radiographic quality of root fillings performed by undergraduate students. Int Endod J. 2010;43(6):499-508. 20.Balto H, Al Khalifah S, Al Mugairin S, Al Deeb M, Al-Madi E. Technical quality of root fillings performed by undergraduate students in Saudi Arabia. Int Endod J. 2010;43(4):292-300. 21.Yavari H, Samiei M, Shahi S, Borna Z, Abdollahi AA, Ghiasvand N, et al. Radiographic evaluation of root canal fillings accomplished by undergraduate dental students. Iran Endod J. 2015;10(2):127-30. 22.Lambrianidis T. Observer variations in radiographic evaluation of endodontic therapy. Endod Dent Traumatol. 1985;1(6):235-41. 23.Forsberg J. Estimation of the root filling length with the paralleling and bisecting-angle techniques performed by undergraduate students. Int Endod J. 1987;20(6):282-6. 24.Eckerbom M, Magnusson T. Evaluation of technical quality of endodontic treatmentreliability of intraoral radiographs. Endod Dent Traumatol. 1997;13(6):259-64.

Rosa Parks :: essays research papers

Rosa Parks Rosa parks was born on February 4,1913, in Tuskegee, Alabama. She was a civil rights leader. She attended Alabama State College, worked as a seamstress and as a housekeeper. Her father, James McCauley, was a carpenter, and her mother, Leona (Edward's) McCauley was a teacher. Rosa P. had one younger brother named, Sylvester. Her family lived in Tuskegee. When Rosa was two years-old her parents split up and she, her mother, and her brother moved to her grandparents farm in Nearby Pine Level, Alabama. Her grandparents were one of the few black families who owned their own land, rather than work for someone else. Although they were poor, they were able to raise enough food for all. During the first half of this century for all blacks living in America skin color affected every part of their lives. The South in particular was very racist. Slavery had been abolished only by some fifty years earlier, and blacks were still hated and were feared by whites because of skin color. Jim Crow had a law "separate but equal." The Supreme Court ruled in 1896, that equal protection could not mean separate but equal facilities. Blacks were made to feel inferior to whites in every way. They were restricted in their choices of housing and jobs, were forced to attend segregated schools, and were prohibited from using many restaurants, movie theaters. Rosa Parks said, years later, "Whites would accuse you of causing trouble when all of you were doing was acting like a normal human being, instead of crining. You didn't have to wait for a lynching. You died each time you found yourself face to face with this kind of discrimination." Rosa Parks didn't like attending a poor, one-room school, with few books or supplies, not being able to stop on her way home from school to get a soda or a candybar. She hated how they were parts for blacks like restaurants, trains, and bus and even being forced to give up her seat for a white person. Rosa's mother, Leona McCau ley, worked as a teacher, and the whole family knew the value of education. Rosa attended the local black elementary school, where her mother was the only teacher. When she graduated, the family worked hard to save enough money to send her to a private school for black girls. At the age of 11 she began to attend Montgomery Industrial School for Girls.

Hamlet on Film: An Alternative Medium Essay

Hardliners and literary purists of Shakespeare’s works might find it hard to engage in the entertaining yet profound modern adaptation of Hamlet. Michael Almereyda’s re-interpretation of Hamlet set in modern times has met mix criticisms one of disdain and the other filled with delight. There have been many attempts to make Shakespeare’s Hamlet relevant to today’s fast-paced and commercially driven society. Still the rest falter while a rare few have managed to shine to perfection even if the snotty will most likely pick on the apparent anachronism and lack of literary value. Yet Almereyda’s adaptation of Shakespeare’s Hamlet to film is able to transcend the fixation for the original and provide something that young audiences and readers alike can enjoy. Shakespeare’s Hamlet has attained universal familiarity. It follows a plot that even the uninitiated can relate to. It is a story about a person who, after finding out that his mother has married another (who turns out later to be the murderer of the father) just after the wake of the of his father, suffers an episode of mad rampage and revenge. The madness that Hamlet suffers is a tale that is almost impossible to portray without the aid of poetic words and lyrics. This is probably why any attempt at projecting the complicated character and his vices in the big screen would most likely fail. His madness is simply beyond the reach of any cinematic magic. What is required is a clever play of words and the appropriate use of imagery and not a series of images that fails to deliver what is hidden and subtle. Notwithstanding this major obstacle, Almereyda’s manner of telling the story in the same archaic English language but with liberal changes in setting, actors and overall plot has overcome the hurdle of making Shakespearean plays relevant. The fact that the plot was revamped to include radical technological advancements such as the advent of wireless telecommunications and the dominant presence of corporations is something that borders on incredible insensitivity to the original Hamlet to pure genius. At first glance, it is difficult to connect the past with the future. Other adaptations strive to stay true to the script as well as the contextual background in translating the words of Shakespeare to moving images. However, Almereyda’s version, if it can be called as such, revolutionizes the way Shakespeare and his works are interpreted on the silver screen. For instance, kings were replaced by corporate big-heads and CEO’s and Hamlet—a medieval figure has been transformed to a person who embodies with utmost accuracy late-teenage angst with certain qualities that not only keeps in line with how Hamlet was then but also takes on other unique attributes such being pensive and reserved. Ambitious as it is difficult, the modern version of Hamlet is in many ways a success than a failure. Ethan Hawke’s portrayal of Hamlet maybe a little too wide of the mark in certain scenes where it is obvious that the recitation of Shakespeare’s famous lines appear forced and contrived. But where it matters the most, especially the famous Hamlet soliloquy where he ponders on the several layers of life and living comes out as both contemporary and faithful to the original. For instance, the scene in the video store is telling of how much the film has integrated old English to modern life. Ethan Hawke, who plays Hamlet, utters the famous monologue with consistency and resolve. At first, the words come out too slow and too artificial as if Shakespeare’s words suddenly turned violent and meaningless with Ethan Hawke’s voice. But after several moments of dramatic pauses and carefully timed emphasis on certain words, the teenage-angst driven speech becomes a beautiful and deliberate as if the character is both alike and different to Hamlet. Perhaps this is because the lines are inherently profound and no matter who says it and in whatever manner the lines will never be less good than it is. Yet it is clear, that the portrayal is more than sufficient to pass the standards that Shakespeare, if alive today, would likely approve. In other words, the scene where Ethan Hawke performs the famous lines is a gamble by the director, which gamble has paid off. For one, despite the initial problems with connecting the old times with the new inasmuch as the film is merely a rehash of an old play, the monologue has turned from ancient to modern. Thanks to the controlled way in which Ethan Hawke has delivered the lines, it becomes easy for the modern audience to appreciate the lines as if they were reading the original. Another notable feature of the scene is the fact that it is set in video rental store. This is significant because it is generally assumed that when Hamlet said these words he was alone and in a dark place. In the scene however, the place was well lighted and the actor although technically alone was surrounded by shelves of consumer-friendly products i. e. movies and blockbusters, which if interpreted in the modern sense would probably paint a picture of a world overwhelmed by the omnipresence of consumers and products. In other words, the scene was shown in a way that touches base with the reality of the corporate world as juxtaposed to the dark and brooding environment when Hamlet felt the need to question life and his desire to live. The changes in some of the lines are also a contentious issue when watching the film after having read the original. While it is admirable that the screenwriter has decided to edit a few words out in order to make some of the lines easy to the ears of the moviegoer, the fact that some of the words were taken out and replaced with a â€Å"re-interpretation† if not an abbreviation of complex thoughts puts a huge crevice from the original work from the adaptation. One such instance is the scene where Hamlet slowly dies as he utters his final words. The original version has a measured cadence to the words but the film turns this rhythm into short phrases that notwithstanding the close similarity to the original fails to capture the original scene when Hamlet dies. These departures from the original are probably a necessary evil in order to produce and make a film of such scale and ambition. It would not be surprising that to transform a Shakespearean ballad into a modern version would require some tweaking in order to present the story to the audience that does not only overwhelm them with details and the subtlety of the original but manages to thresh out the beauty of the play without being too cerebral. In the same vein, the film is successful as a modern adaptation of Hamlet precisely because the world wherein the story is set is almost similar. While the Prince of Denmark had his grand stature and his privileged position as a respected intellectual in Shakespeare’s Hamlet, so did the Hamlet in Almereyda’s film. The rest of the characters also jive with, or at least stay parallel to, the original. They appear and play the roles in the film almost exactly as how one would imagine the characters while reading the play. Indeed, the visual advantages of film are play a major role in making the film a success as compared to the flat and limited stage acting. It is a fact that the plays of Shakespeare were performed on stage with real actors very much like films of today are dominated by actors and actresses. However, it is entirely different when the medium involves the big screen, closed-up images, camera angles and the freedom to shoot scenes in whatever form and location. The limitations of staging Hamlet on a closed-in theatrical platform are overcome by the power of the film to zoom in and out of key locations. In addition, not only are the locations more versatile and limitless, comparatively, but the facial expressions and the movements of the actors and actresses become magnified for the audience to hear and see with incomparable precision and detail. Ultimately, these main visual and auditory advantage help make the modern adaptation a faithful re-production of Hamlet and an exquisitely wrought and clever modern portrayal of timeless and iconic characters playing out a famous story of revenge, betrayal and redemption. Works Cited Hamlet. Dir. Michael Almereyda. Perf. Ethan Hawke, Julia Stiles, Bill Murray, Kyle MacLachlan, Diane Venora, and Sam Shepard. Miramax, 2000. Film.

Person Centered Care

If you would like to contribute to the art and science section contact: Gwen Clarke, art and science editor, Nursing Standard, The Heights, 59-65 Lowlands Road, Harrow-on-the-Hill, Middlesex HA1 3AW. email: gwen. [email  protected] co. uk Person-centred care: Principle of Nursing Practice D Manley K et al (2011) Person-centred care: Principle of Nursing Practice D. Nursing Standard. 25, 31, 35-37. Date of acceptance: February 7 2011. SummaryThis is the fifth article in a nine-part series describing the Principles of Nursing Practice developed by the Royal College of Nursing (RCN) in collaboration with patient and service organisations, the Department of Health, the Nursing and Midwifery Council, nurses and other healthcare professionals. This article discusses Principle D, the provision of person-centred care. Authors Kim Manley, at the time of writing, lead, Quality, Standards and Innovation Unit, Learning & Development Institute, RCN, London; Val Hills, learning and development a dviser, RCN, Yorkshire and the Humber; and Sheila Marriot, regional director, RCN, East Midlands.Email: kim. [email  protected] ac. uk Keywords Nurse-patient relations, person-centred care, Principles of Nursing Practice These keywords are based on subject headings from the British Nursing Index. For author and research article guidelines visit the Nursing Standard home page at www. nursing-standard. co. uk. For related articles visit our online archive and search using the keywords.THE FOURTH Principle of Nursing Practice, Principle D, reads: ‘Nurses and nursing staff provide and promote care that puts people at the centre, involves patients, service users, their families and their carers in decisions, and helps them make informed choices about their treatment and care. ’ The provision of care that is experienced as right by the person receiving it is at the core of nursing practice. Principle D sets out to endorse and expand on this point, which is often summarised as providing person-centred care – a philosophy that centres care on the person and not only their healthcare needs.The King’s Fund uses the term NURSING STANDARD ‘the person in the patient’ to convey the same point (Goodrich and Cornwall 2008). There is a consensus that person-centred care equates with quality care (Innes et al 2006, Royal College of Nursing (RCN) 2009), although the service users involved in developing the Principles indicated that they wanted to receive person-centred, and safe and effective care. Such inter-related care is based on best evidence, which is blended with the needs of the individual within specific contexts.Healthcare teams, healthcare provider organisations and governments often articulate an intention to deliver person-centred care. However, achieving it is often challenging and difficult to sustain. Achieving person-centred care consistently requires specific knowledge, skills and ways of working, a shared philosophy th at is practised by the nursing team, an effective workplace culture and organisational support. While all members of the nursing team endeavour to provide person-centred care, some nurses have more transient contacts with patients and those important to them.Examples include staff working in operating departments, general practice or outpatients. The challenges in these situations include skill in developing rapid rapport and ensuring that communication systems respect the essence of the person and protect his or her safety in a way that maintains person-centred values and continuity of care. Person-centred care can be recognised by an active observer or the person experiencing care. The following might be experienced or observed: 4 A focus on getting to know the patient as a person, his or her values, beliefs and aspirations, health and social care needs and preferences. Enabling the patient to make decisions based on informed choices about what options and april 6 :: vol 25 no 31 :: 2011 35 art & science principles series: 5 assistance are available, therefore promoting his or her independence and autonomy. 4 Shared decision making between patients and healthcare teams, rather than control being exerted over the patient. Enabling choice of specific care and services to meet the patient’s health and social care needs and preferences. 4 Providing information that is tailored to each person to assist him or her in making decisions based on the best evidence available.Assisting patients to interpret technical information, evidence and complex concepts and helping them to understand their options and consequences of this, while accessing support from other health and social care experts. 4 Supporting the person to assert his or her choices. If the individual is unable to do this for him or herself, then the nursing team or an appointed formal advocate would present and pursue the person’s stated wishes. 4 Ongoing evaluation to ascertain that care an d services continue to be appropriate for each person. This involves encouraging, listening to and acting on feedback from patients and service users. Other attributes of the nursing team include being professionally competent and committed to work, and demonstrating clear values and beliefs (McCormack and McCance 2010). In addition, nurses should be able to use different processes in the development of person-centred care: working with patients’ values and beliefs, engaging patients and mental health service users, having a sympathetic presence, sharing decision making and accommodating patients’ physical needs (McCormack and McCance 2010). People from minority ethnic groups often experience barriers to person-centred care.There is a need to understand the way in which different minority groups within local populations access information and how different cultural understandings, languages and communication styles influence perceptions of personalised care (Innes et a l 2006). A shared philosophy For person-centred care to achieve its full potential, the approach needs to be practised by the entire nursing team. This requires a shared philosophy and ways of working that prioritise person-centred behaviour, not only with patients and those that are important to them, but also within the team.The wellbeing of staff and the way in which they are supported also needs to be person-centred as staff wellbeing positively affects the care environment for staff and patients. For a shared philosophy to be realised in practice, person-centred systems and an effective workplace culture need to be in place (Manley et al 2007, McCormack et al 2008). Such systems focus not only on structures and processes, but also on the behaviours necessary to provide person-centred care. An effective workplace culture has a common vision through which values are implemented in practice and experienced by patients, service users and staff.This culture demonstrates adaptability and responsiveness in service provision, is driven by the needs of users and has systems that sustain person-centred values. Clinical leadership is pivotal in promoting effective cultures. This is achieved through modelling person-centred values, developing and implementing systems that sustain these values, encouraging behavioural patterns that support giving and receiving feedback, implementing learning from systematic evaluations of person-centred care and involving patients in decision making (Manley et al 2007).To determine whether person-centred care is being delivered or how it can be improved, workplaces need to use measures or methods that enable systematic evaluation to take place. These should be embedded within patients’ electronic NURSING STANDARD Knowledge, skills and ways of working Each member of the nursing team is expected to provide person-centred care, although the required knowledge, skills and competences may come from the wider nursing and healthcare t eam. Principle A, through its focus on dignity, respect, compassion and human rights, is the essential basis for providing person-centred care (Jackson and Irwin 2011).However, other qualities, such as the ability to develop good relationships are required: ‘The relationship between the service user and front line worker is pivotal to the experience of good quality/person-centred care/ support’ (Innes et al 2006). Developing good relationships with patients and colleagues requires team members to be self-aware and have well-developed communication and interpersonal skills. These skills enable the nursing team to get to know the person as an individual and enable other interdisciplinary team members to recognise these insights through effective documentation and working relationships.Getting to know the patient is a requirement for nursing expertise, but is also dependent on the way that care is organised (Hardy et al 2009). 36 april 6 :: vol 25 no 31 :: 2011 records to reduce the burden of data collection and analysis. The Person-centred Nursing Framework (McCormack and McCance 2010) identifies a number of outcomes that may inform these measures, including satisfaction with care, involvement in care, feeling of wellbeing and creating a therapeutic environment. The RCN (2011) recognises that different measures may already be in place to support evaluation of person-centred care.It is encouraging teams and organisations to submit their measures to the RCN for endorsement. The measures should meet certain criteria, for example they should be evidence-based, take into account stakeholder and other perspectives, and be practicable. Endorsed measures can be shared with others through the RCN website. Organisational support Innes et al (2006) made the point that organisations have an important role to play in enabling person-centred care through the promotion of user-led services. This can be achieved through overcoming bureaucratic structures such as in creased management and budget-led services.It is important that management provides support to the front line nursing team in its day-to-day work and recognises the importance of nurse-patient relationships to this endeavour. This support may be, for example, through initiatives that release time to care through lean methodology (a quality improvement approach that focuses on making processes more efficient and reducing waste) (Wilson 2010), and practice development methodologies associated with person-centred cultures (McCormack et al 2008). access clinic; service-users are seen weekly for a brief intervention (10-15 minutes).Service-users appreciate this alternative to the usual one-hour appointment every two weeks and find the approach less threatening. The clinic is run by a nurse prescriber who is able to titrate medication against need or therapeutic benefit while delivering high quality psychosocial interventions in a brief intervention format. The clinic is supported by a se rvice user representative. This representative gives confidence to service-users who may be lacking belief in their ability to achieve lifelong abstinence and provides service users with an introduction to other community based self-help support networks.After service users have engaged with the service through the quick access clinic, they progress to an appropriate level of key working intervention to meet their more complex needs. This initiative illustrates a number of elements of Principle D, including the use of a formal advocate service, drawing on a service representative, who supports the patient in his or her choices as well as helping him or her to assert his or her wishes. The approach provides a flexible service whereby clinical interventions are provided by a nurse practitioner, and complex needs are assessed quickly.The service user and the nursing team work in partnership to decide when the patient is ready to embark on the next level of interventions required to mee t the patient’s complex needs. Conclusion Principle D emphasises the centrality of the patient to his or her care. It requires skill from each member of the nursing team. The potential contribution of each member to person-centred care will be enhanced if everyone in the team is using the same approach. Such an approach requires a workplace culture where person-centred values are realised, reviewed and reflected on in relation to the experiences of both patients and staff NSCase study A good example of patient-centred care is illustrated by an initiative from a specialist drug and alcohol service at Avon and Wiltshire Mental Health Partnership NHS Trust. The nursing team treats drug users for an initial 12 weeks in a quick References Goodrich J, Cornwall J (2008) Seeing The Person in The Patient: The Point of Care Review Paper. The King’s Fund, London. Hardy S, Titchen A, McCormack B, Manley K (Eds) (2009) Revealing Nursing Expertise Through Practitioner Inquiry. Wiley -Blackwell, Oxford. Innes A, Macpherson S, McCabe L (2006) Promoting Person-centred Care at the Front Line. Joseph Rowntree Foundation,York. Jackson A, Irwin W (2011) Dignity, humanity and equality: Principles of Nursing Practice A. Nursing Standard. 25, 28, 35-37. Manley K, Sanders K, Cardiff S, Davren M, Garbarino L (2007) Effective workplace culture: a concept analysis. Royal College of Nursing Workplace Resources for Practice Development. RCN, London, 6-10. McCormack B, Manley K, Walsh K (2008) Person-centred systems and processes. In Manley K, McCormack B, Wilson V (Eds) International Practice Development in Nursing and Healthcare. Wiley-Blackwell, Oxford, 17-41. McCormack B, McCance T (2010) Person-centred Nursing: Theory and Practice.Wiley-Blackwell, Oxford. Royal College of Nursing (2009) Measuring for Quality in Health and Social Care: An RCN Position Statement. http://tinyurl. com/ 6c6s3gd (Last accessed: March 16 2011. ) Royal College of Nursing (2011) Principles of Nursi ng Practice: Principles and Measures Consultation. Summary Report for Nurse Leaders. http://tinyurl. com/5wdsr56 (Last accessed: March 16 2011. ) Wilson G (2010) Implementation of Releasing Time to Care: the Productive Ward. Journal of Nursing Management. 17, 5, 647-654. NURSING STANDARD april 6 :: vol 25 no 31 :: 2011 37