Whitmans Leaves of Grass and Song of Myself, and...

This semester I have learned valuable tools and techniques when it comes to writing and analyzing different types of literature. I will thoroughly explore what Whitman, Columbus and Smith meant in specific passages of a few of their literature works. Whitman’s free verse poems, â€Å"Leaves of Grass† and â€Å"Song of Myself†, seemed to be most appealing. I also found Christopher Columbus’s â€Å"Letter to Lluis de Santangel† and â€Å"Letter to Ferdinand and Isabella† to be quite intriguing about life back then. Even John Smith’s writings such as â€Å"The General Historie of Virginia† and â€Å"A Description of New England† enlightened me to what it was they saw when venturing out in the new world. Walt Whitman was an American poet whose free verse brought a new style and uniqueness to American poetry. â€Å"Free verse is poetry organized according to the cadences of speech and image patterns rather than according to a regular metrical scheme. The meter is irregular and its rhythms are based on patterned elements such as sounds, words, phrases, sentences, and paragraphs, rather than on the traditional units of metrical feet† (â€Å"Free Verse Encyclopedia† 1). You can see his free verse style through his literary works such as â€Å"Leaves of Grass† and â€Å"Song of Myself†. Whitman wrote broad stanzas and focused on the whole of America as his inspiration. His lines covered a wide range of topics and generated multiple points of view for the reader. He called his life’s work â€Å"Leaves of Grass†; stressing the

Claims of outstanding balance - Free Essay Example

Sample details Pages: 9 Words: 2690 Downloads: 9 Date added: 2017/06/26 Category Law Essay Type Argumentative essay Tags: Act Essay Did you like this example? We have been asked to advise Xana on the likelihood of her being able to bring a successful claim against Yvette under EC law to recover the outstanding balance of her account; namely, that proportion of the total fees payable required, under the Free Movement of Services Act 2008, as a contribution towards the quality audit which Xana is required to undergo in accordance with the provisions of that same Act. Central to this problem question is the Law of the European Union pertaining to the freedom to provide and receive services and also the freedom of establishment In order to provide a reasoned argument in response to this question it will be necessary to examine the provisions of Council Directive 2006/123/EC, which the Free Movement of Services Act 2008 purports to implement; Articles 43 to 55 of the Treaty of the European Union (1992), which provide (inter alia) the core governing principles on which restrictions to aforementioned freedoms are permiss ible under EC Law; and, the case law of the European Court of Justice, the decisions from which provide insight into how these principles are likely to be interpreted and applied, in order to determine whether or not: . Don’t waste time! Our writers will create an original "Claims of outstanding balance" essay for you Create order The tutorial services supplied to Yvette by Xana, on a distance-learning basis, are likely to be considered à ¢Ã¢â€š ¬Ã‹Å"servicesà ¢Ã¢â€š ¬Ã¢â€ž ¢ for the purposes of Articles 43 to 55 of the Treaty of the European Union and Council Directive 2006/123/EC; The à ¢Ã¢â€š ¬Ã‹Å"quality audità ¢Ã¢â€š ¬Ã¢â€ž ¢ restriction imposed on Xana by the Free Movement of Services Act 2008 is permissible under European law; and, The à ¢Ã¢â€š ¬Ã‹Å"contribution requirementà ¢Ã¢â€š ¬Ã¢â€ž ¢ imposed on Yvette by the Free Movement of Services Act 2008 is valid, taking into account the overriding objectives of Articles 43 to 55 of the Treaty of the European Union and Council Directive 2006/123/EC. In regard to whether or not the tutorial services supplied to Yvette by Xana, on a distance-learning basis, are likely to be considered à ¢Ã¢â€š ¬Ã‹Å"servicesà ¢Ã¢â€š ¬Ã¢â€ž ¢ for the purposes of Articles 43 to 55 of the Treaty of the European Union and Council Directive 2006/123/EC: For the purpose of the freedom to provide and receive services across the European Union, a à ¢Ã¢â€š ¬Ã‹Å"serviceà ¢Ã¢â€š ¬Ã¢â€ž ¢ is defined by Article 50 EC, which states: à ¢Ã¢â€š ¬Ã…“Services shall be considered to be à ¢Ã¢â€š ¬Ã‹Å"servicesà ¢Ã¢â€š ¬Ã¢â€ž ¢ within the meaning of this Treaty where they are normally provided for remuneration, insofar as they are not governed by the provisions relating to freedom of movement for goods, capital and persons.[1]à ¢Ã¢â€š ¬Ã‚  While it has been held by the European Court of Justice, in the case of Belgium v. Humbel[2], that the provision of education by the State does not fall within the scope of this definition, even where students are required to pay fees towards the operational costs of the institutions providing their education; in the present case, because the services provided by Xena are fully commercial and independent from the duties of the United Kingdom to provide subsidized education to its citizens, it is highly likely that the services in question would be deemed to fall within the scope of Article 50 EC. For the purposes of Council Directive 2006/123/EC, a à ¢Ã¢â€š ¬Ã‹Å"serviceà ¢Ã¢â€š ¬Ã¢â€ž ¢ is defined by Article 4(1) of the Directive as being, à ¢Ã¢â€š ¬Ã…“any self-employed economic activity[3], normally provided for remuneration, as referred to in Article 50 of the Treaty.[4]à ¢Ã¢â€š ¬Ã‚  Additionally, a list of activities which are expressly excluded from the scope of the Directive is provided by Article 2(2)(a)-(l) and Article 2(3) of the Directive, which includes such activities as private security services[5] and gambling activities[6]. Because the services provided by Xena to Yvette are o f an economic nature, being provided in return for valuable consideration, and are not of the kind excluded by Articles 2(2) and 2(3) of the Directive, we can conclude that it is likely that the services in question would be deemed to fall within the scope of Council Directive 2006/123/EC. One exception to these rules should be noted briefly: In the case of Grogan[7] it was held that the provision of financial information did not fall within the Treatyà ¢Ã¢â€š ¬Ã¢â€ž ¢s definition of a service, it rather representing a manifestation of freedom of expression. While it could be argued that Xenaà ¢Ã¢â€š ¬Ã¢â€ž ¢s primary business activity is supplying her clients with information, the reason that the Grogan decision can be distinguished from this present case is that, in Grogan, the information was being provided for free Xena charges for her information and offers it as part of a structured educational service. We can therefore conclude with some confidence that the service pr ovided to Yvette by Xena qualifies as a à ¢Ã¢â€š ¬Ã‹Å"serviceà ¢Ã¢â€š ¬Ã¢â€ž ¢ for the purposes of the European Treaty and also Council Directive 2006/123/EC. Bearing this conclusion in mind, we must now turn to consider whether or not the à ¢Ã¢â€š ¬Ã‹Å"quality audità ¢Ã¢â€š ¬Ã¢â€ž ¢ restriction imposed on Xana by the Free Movement of Services Act 2008 is permissible under European law: Of particular relevance to this enquiry is the freedom of establishment as provided by Article 43 EC[8]. This Treaty Article provides, inter alia, that: à ¢Ã¢â€š ¬Ã…“[R]estrictions on the freedom of establishment of nationals of a Member State in the territory of another Member State shall be prohibited.à ¢Ã¢â€š ¬Ã‚  Within the context, establishment includes the à ¢Ã¢â€š ¬Ã…“setting-up of agencies, branches or subsidiaries by nationals of any Member State established in the territory of any Member State,à ¢Ã¢â€š ¬Ã‚  and also, à ¢Ã¢â€š ¬Ã…“the right to take up and pursue activ ities as self-employed persons and to set up and manage undertakings, in particular companies or firms.[9]à ¢Ã¢â€š ¬Ã‚  While it is true that the à ¢Ã¢â€š ¬Ã‹Å"audit requirementà ¢Ã¢â€š ¬Ã¢â€ž ¢ does not prohibit establishment of English language service providers in the United Kingdom, the jurisprudence of the European Court of Justice has interpreted the freedom of establishment widely. In the Gebhard[10] case, the European Court of Justice provided four conditions which must be satisfied in order for a restrictive nation measure to be deemed valid at law: à ¢Ã¢â€š ¬Ã…“It follows from the Court s case-law that national measures liable to hinder or make less attractive the exercise of fundamental freedoms guaranteed by the Treaty must fulfil four conditions: they must be applied in a non-discriminatory manner; they must be justified by imperative requirements in the general interest; they must be suitable for securing the attainment of the objective which they pursue; and they must not go beyond what is necessary in order to attain it.[11]à ¢Ã¢â€š ¬Ã‚  This latter requirement of à ¢Ã¢â€š ¬Ã‹Å"necessityà ¢Ã¢â€š ¬Ã¢â€ž ¢ was provided in the earlier case of Kraus v Land Baden-Wuerttemberg[12] and is further supported by Council Directive 2006/123/EC: à ¢Ã¢â€š ¬Ã…“[N]o such authorisation scheme or restriction should discriminate on grounds of nationality. Further, the principles of necessity and proportionality[13] should always be respected.[14]à ¢Ã¢â€š ¬Ã‚  The questions which therefore fall for determination are as follows: Is the à ¢Ã¢â€š ¬Ã‹Å"quality audità ¢Ã¢â€š ¬Ã¢â€ž ¢ requirement imposed by the Free Movement of Services Act 2008 an imperative requirement in the general interest[15]? If so, is the à ¢Ã¢â€š ¬Ã‹Å"quality audità ¢Ã¢â€š ¬Ã¢â€ž ¢ requirement a suitable and proportionate way of achieving those objectives? And, If so, does the à ¢Ã¢â€š ¬Ã‹Å"quality audità ¢Ã¢â€š ¬Ã¢â€ž ¢ requirement go beyond what is necessary to achieve its legitimate objectives? In regard to (a); the justifications which have been proffered by the government of the United Kingdom for the imposition of the à ¢Ã¢â€š ¬Ã‹Å"quality audità ¢Ã¢â€š ¬Ã¢â€ž ¢ requirement are two-fold: First, that it promotes à ¢Ã¢â€š ¬Ã‹Å"the purity of the English languageà ¢Ã¢â€š ¬Ã¢â€ž ¢; and, second, that it à ¢Ã¢â€š ¬Ã‹Å"protect jobs in the UK further and higher education sectorà ¢Ã¢â€š ¬Ã¢â€ž ¢. In regard to the latter of these aims, because it is an economic aim, i.e. promoting employment for the benefit of the United Kingdomà ¢Ã¢â€š ¬Ã¢â€ž ¢s economy, the Courts are unlikely to consider this in the à ¢Ã¢â€š ¬Ã‹Å"general interestà ¢Ã¢â€š ¬Ã¢â€ž ¢ or a à ¢Ã¢â€š ¬Ã‹Å"legitimate public interestà ¢Ã¢â€š ¬Ã¢â€ž ¢[16]. This conclusion is further supported by the decision in the case of Finalarte Sociedade de ConstruÃÆ' §ÃƒÆ' £o Civil V Urlaubs und Lohnausgleichskasse der Bauwirtschaft[17]. In regard to the former aim: While it is true that one of the legitimate aims suggested by Council Directive 2006/123/EC is the objective of promoting higher quality in education[18], it is difficult to argue that the aim of à ¢Ã¢â€š ¬Ã‹Å"promoting purity of languageà ¢Ã¢â€š ¬Ã¢â€ž ¢ falls within this legitimate category, especially since the European Courts of Justice generally take an highly restrictive interpretation of à ¢Ã¢â€š ¬Ã‹Å"legitimate aims[19]à ¢Ã¢â€š ¬Ã¢â€ž ¢. If anything, this profferred justification fits more comfortably inside one of the cutural heads of public policy objectives, such as for the à ¢Ã¢â€š ¬Ã‹Å"promotion of the national language[20]à ¢Ã¢â€š ¬Ã¢â€ž ¢. However, even if this former aim is considered legitimate and in the general interest, it is not obvious that imposing a costly and rigid[21] à ¢Ã¢â€š ¬Ã‹Å"quality audità ¢Ã¢â€š ¬Ã¢â€ž ¢ is a proportionate way of achieving this objective, nor that it is necessary in order to achieve that objective. For example, Xena might already be in possession of a quality appr oval certification from her home State which would serve the purpose equally well. While this is mere speculation, it reveals one circumstance under which the à ¢Ã¢â€š ¬Ã‹Å"quality audità ¢Ã¢â€š ¬Ã¢â€ž ¢ imposed by the Free Movement of Services Act 2008 is a disproportionate and unnecessary requirement in light of the objective of promoting the national language. However, as per the decision in the case of Jean Thieffry v Conseil de lordre des avocats ÃÆ'   la cour de Paris[22], this argument will only defeat the UKà ¢Ã¢â€š ¬Ã¢â€ž ¢s claim (that the derogation for the freedom of establishment is justified) if it can be shown that there exist equivalent à ¢Ã¢â€š ¬Ã‹Å"qualificationsà ¢Ã¢â€š ¬Ã¢â€ž ¢ or audit certification processes in other Member States of Europe. If such equivalences exist, then the UKà ¢Ã¢â€š ¬Ã¢â€ž ¢s claim is more likely to be successful and the à ¢Ã¢â€š ¬Ã‹Å"quality audità ¢Ã¢â€š ¬Ã¢â€ž ¢ provision of the 2008 Act will likely be deemed valid. Converse ly, if it is held that equivalences do exist in other Member States, then I would argue that the Courts would not be satisfied that the à ¢Ã¢â€š ¬Ã‹Å"quality audità ¢Ã¢â€š ¬Ã¢â€ž ¢ requirement satisfies the test as set out in the Gebhard[23] case. One final point on this enquiry: We have not been provided with details of the enforcement mechanisms which have been adopted under the 2008 Act to compel business compliance; if this Act creates a criminal law offence for failing to undergo the à ¢Ã¢â€š ¬Ã‹Å"quality audità ¢Ã¢â€š ¬Ã¢â€ž ¢ process, which is quite possible, then the measure must be deemed contrary to the objectives of Council Directive 2006/123/EC which, at Article 1(5) states: à ¢Ã¢â€š ¬Ã…“Member States may not restrict the freedom to provide services by applying criminal law provisions which specifically regulate or affect access to or exercise of a service activity[24]à ¢Ã¢â€š ¬Ã‚  We are not in possession of the facts required to make any firm conclusion in this regard. In regard to the final enquiry of this paper; namely, whether or not the à ¢Ã¢â€š ¬Ã‹Å"contribution requirementà ¢Ã¢â€š ¬Ã¢â€ž ¢ imposed on Yvette by the Free Movement of Services Act 2008 is valid: Of particular relevance to this enquiry is Article 14(1) of Council Directive 2008/123/EC which provides that: à ¢Ã¢â€š ¬Ã…“Member States shall not make access to a service activity in their territory subject to compliance with discriminatory requirements based directly or indirectly on nationality[25]à ¢Ã¢â€š ¬Ã‚  Because only residents of the United Kingdom are subjected to this contributory surcharge, there is no doubt that this measure would be deemed discriminatory by the European Court of Justice. This is supported by the decision in the case of Van Binsbergen[26] in which it was held that measures discriminating on grounds of nationality (whether directly or indirectly) must be abolished in accordance with Article 49 of the European Treaties. While it could be argued that because the measure looks to country of residence rather than nationality, per se[27], that it does not discriminate on the basis of nationality. However, this argument is likely to fail as, in practice, this means that more UK nationals are likely to be affected negatively by the measure than non-UK nationals[28]. In conclusion, if Xena brought a claim against Yvette, Yvette would likely be successful in arguing that she should not have to pay the additional audit charge. Even if the Court do accept that the objectives of imposing this charge on Xena are legitimate, proportionate and necessary, the restriction to Yvettes freedom to access educational services has been compromised by a discriminatory measure; namely, the requirement that recipients of English language services in the United Kingdom must pay a surcharge to contribute to the costs of the audit process imposed under the Free Movement of Services Act 2008. References: Barnard, C. and J. Scott, à ¢Ã¢â€š ¬Ã‹Å"The Law of the Single European Marketà ¢Ã¢â€š ¬Ã¢â€ž ¢, Hart Publishing, Oxford and Portland, Oregon, 2002. Craig, P. and G. De BÃÆ' ºrca, à ¢Ã¢â€š ¬Ã‹Å"EU Law Text, Cases and Materialsà ¢Ã¢â€š ¬Ã¢â€ž ¢, Fourth Edition, Oxford University Press, Oxford, 2007 Foster, G. à ¢Ã¢â€š ¬Ã‹Å"Blackstoneà ¢Ã¢â€š ¬Ã¢â€ž ¢s Statutes EU Treaties Legislationà ¢Ã¢â€š ¬Ã¢â€ž ¢, Eighteenth Edition, Oxford, Oxford University Press, 2007 Tobler, C., à ¢Ã¢â€š ¬Ã‹Å"Indirect Discrimination: A Case Study Into the Development of the Legal Concept of Indirect Discrimination Under EC Lawà ¢Ã¢â€š ¬Ã¢â€ž ¢, Antwerpen à ¢Ã¢â€š ¬Ã¢â‚¬Å" Oxford, Intersentia, 2005. Footnotes [1] Article 50 of the EC Treaty [2] Belgium v Humbel (Case 263/86) [1988] ECR 5365 [3] Insight into when an activity will be considered à ¢Ã¢â€š ¬Ã‹Å"economicà ¢Ã¢â€š ¬Ã¢â€ž ¢ is provided by paragraph 17 of the text of the Directive which states: à ¢Ã¢â€š ¬Ã…“This Directive covers only services which are performed for an economic consideration. Services of general interest are not covered by the definition in Article 50 of the Treaty and therefore do not fall within the scope of this Directive.à ¢Ã¢â€š ¬Ã‚  [Council Directive 2006/123/EC, para.17] [4] Article 4(1) of Council Directive 2006/123/EC [5] Article 2(k) of Council Directive 2006/123/EC [6] Article 2(h) of Council Directive 2006/123/EC [7] The Society for the Protection of Unborn Children Ireland Ltd v Stephen Grogan and others (1990) Case C-159/90. [8] The reason that the freedom of establishment provisions of the European Treaty are relevant here rather than the freedom of services provisions is because the services being supplied by Xena are permanent, in that she plans to provide these educational services in the United Kingdom on a regular basis for a significant duration of time. This is very similar to the arrangement pursued by Mr. Gebhard in the Gebhard case: At paragraph 27 in this case it was held: à ¢Ã¢â€š ¬Ã…“However, that situation is to be distinguished from that of Mr Gebhard who, as a national of a Member State, pursues a professional activity on a stable and continuous basis in another Member State where he holds himself out from an established professional base to, amongst others, nationals of that State. Such a national comes under the provisions of the chapter relating to the right of establishment and not those of the chapter relating to services.à ¢Ã¢â€š ¬Ã‚  Gebhard v Consiglio dellà ¢Ã¢â€š ¬Ã¢â€ž ¢Ordine degli Avvocati e Procuratori di Milano [1995] Case C-55/94 ECR I-4165 at para. 27. [9] Article 43 EC [10] Gebhard v Consiglio dellà ¢ â‚ ¬Ã¢â€ž ¢Ordine degli Avvocati e Procuratori di Milano [1995] Case C-55/94 ECR I-4165 [11] Ibid, at para. 37 [12] Dieter Kraus v Land Baden-WÃÆ' ¼rttemberg (1992) Case C-19/92. [13] In regard to the applicability of the principle of proportionality to assessments of these kind, it was held, in the case of Bond van Adverteerders v Netherlands State [1988] Case 352/85 ECR 2085, that whenever a Member State seeks to rely upon a public policy justification for derogating from a freedom contained in the European Treaty, a proportionality assessment must be conducted when deciding upon the validity of that derogation. [14] Council Directive 2006/123/EC at para. 56. [15] The way that Craig and De Burca (2007) describe this requirement is as follows: à ¢Ã¢â€š ¬Ã…“[T]he restriction must be adopted in pursuit of a legitimate public interest, which is not incompatible with Community aims.à ¢Ã¢â€š ¬Ã‚  Craig and De Burca (2007) p827. [16] For example, see the case of SETTG V Ypourgos Ergasias [1991] Case C-350/89 ECR 1-2387, paras. 22-23 [17] Finalarte Sociedade de ConstruÃÆ' §ÃƒÆ' £o Civil V Urlaubs und Lohnausgleichskasse der Bauwirtschaft (1998) Case 71/98. [18] Para. 40 of Council Directive 2006/123/EC: à ¢Ã¢â€š ¬Ã…“[T]his Directive has been developed by the Court of Justice in its case law in relation to Articles 43 and 49 of the Treaty and may continue to evolve. The notion as recognised in the case law of the Court of Justice covers at least the following grounds: the need to ensure a high level of education.à ¢Ã¢â€š ¬Ã‚  [19] Barnard and Scott (2002) p9. For an example of a restrictive approach for permitting public policy derogations, see the case of Raymond Kohll v Union des caisses de maladie (1996) Case C-158/96. [20] Fn.12 [21] Rigid in that the audit must be conducted by a à ¢Ã¢â€š ¬Ã‹Å"designated auditorà ¢Ã¢â€š ¬Ã¢â€ž ¢ appointed from one of the Schools of Education of UK universities and colleges. [22] Jean Thieffry v Conseil de lordre des avocats ÃÆ'   la cour de Paris (1976) Case 71/76 [23] Fn. 10. [24] Article 1(5) of Council Directive 2006/123/EC. [25] Article 14(1) of Council Directive 2006/123/EC. [26] Van Binsbergen (1974) Case 33/74 [27] For example, Yvette is a Polish national being levied with the audit surcharge because she utilized the service while residing in the United Kingdom. [28] Jean Thieffry v Conseil de lordre des avocats ÃÆ'   la cour de Paris (1976) Case 71/76. For a detailed analysis of this argument, see Tobler (2005) p129.

Dissociative Identity Disorder ( Psychological Psychology...

Dissociative Identity Disorder (DID), previously known as Multiple Personality Disorder, is a disorder characterized by having multiple personality states. Within these altered states, a person with DID will have different personal and autobiographical characteristics which distinguish the different personality states from one another. According to Susan Nolen-Hoeksema (2014), DID is one of the most controversial disorders in clinical psychology. The reason for this is many people are critical of the validity of DID as an actual disorder. There have been cases where people would claim to have altered personalities, but were in fact malingering for attention or to avoid punishment for crimes. Also, many of the symptoms of DID overlap with the criteria associated with Schizophrenia (Hoeksema, 2014). Therefore, many psychiatrists today are reluctant to diagnose people with DID because they believe their symptoms could be attributed to another disorder, and many people are critical of DI D being an actual disorder is the first place. This reluctance and disapproving thought towards DID is what this paper will focus on. The aim of this paper is to prove DID is a legitimate disorder by showing the neuroanatomical and psychobiological differences between altered personality states in people diagnosed with DID. These show that there are biological differences which cannot be attributed to faking or malingering of symptoms and therefore prove DID to be a genuine, diagnosable disorder.Show MoreRelatedDissociative Disorders And The Most Controversial Disorders1055 Words   |  5 PagesMai Nguyen PSYC 1 Dec. 11, 2015 Dissociative Disorders Dissociative disorders are one of the most controversial disorders that exist. 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Pneumonia Manual of Infection Prevention and Control

Question: Discuss about thePneumonia for Manual of Infection Prevention and Control. Answer: Introduction Joice is a 76-year-old lady presenting with pneumonia. She has a previous medical history of osteoporosis and a surgical history of hysterectomy. She is allergic to sulphur, and she is currently she is on Atonel and ostelin vitamin D calcium medication. She has started manifesting signs of having a productive cough, expectorating yellow sputum, being febrile (39.2oC), feeling of coldness, and shortness of breath. These are typical symptoms of pneumonia which affect gaseous exchange in the lungs. The elevated temperature can be linked to an infection in the lungs due to a certain pathogen while the shortness of breath is due to hypoventilation in the lungs due to consolidation (White, Duncan Baumle, 2012). A productive cough is a sign of a bacterial infection which causes irritation of the mucosa within the tract hence production of secretions by the goblet cells.Nosocomial pneumonia is an infection that usually affects the lower respiratory tract. It occurs when the system is not i ncubated during the period of patient admission and typically manifests itself few days after hospitalization. Investigations should be done to rule out other diseases such as metastatic lung cancers and pneumonia of radiation origin. Sputum evaluation, complete cell count and bronchoscopy are the major tests done accurately to diagnose the condition Patients under ventilator machines are at risk of contracting the disease (Lippincott, 2012). The occurrence of the condition in the old lady can be linked to her advanced age because her immunity is compromised. Other risk factors for the condition are alcoholism habits, HIV infection, diabetes disease and heart failures. Anatomy and Physiology Exchange of gases in the body takes place in the lungs. The upper respiratory tract delivers air into the lungs during inhalation. Lungs are covered by a serous layer referred to as pleura which contains pleural fluid that aids in the smooth motion of the lungs during the process of breathing. Each lung is divided into lobes with several alveoli in them (Marieb, E. N., Hoehn Hutchinson, 2014)). The alveoli are arranged in clusters facilitating sufficient gaseous exchange. Several factors determine the movement of air in and out of the lungs which include resistance to air flow and compliance of the lungs. The alveoli are highly vascularized to ensure maximum diffusion of the respiratory gases. The alveolar-capillary membrane is very effective in a healthy individual during this process due to its large surface area and its thinness. In a healthy adult, the gases diffuse with no complication due to the concentration gradient created in the capillaries and alveoli. Blood flow through the capillaries is referred to as pulmonary perfusion (Marieb, Hoehn Hutchinson, 2014). Any deviation from the norm in the process is due to a respiratory disease or anomaly. Microbiology The laboratory results show an elevated number of white blood cells mainly neutrophils (8x109/L) which should ideally be 2.0x109/L. This is typical of pneumonia infection. The arterial pH (7.0u/l) is lower than the norm (7.35u/l-7.45u/l). This can be attributed to building up of high levels of carbon dioxide as a result of ineffective ventilation (Williams Hopper, 2012). The levels of calcium are compromised from the usual of 10.0mmol/L.This is due to the advanced age of the patient which causes a decrease in oestrogen levels in the body. Oestrogen is a crucial hormone in calcium synthesis in the body (Fox, 2014)). There is an elevated level of aspartate aminotransferase hormone (39u/l) which is more than the usual value of between 12u/l and 20u/l. This is due to the increase of liver function of detoxification of impurities that build up in the body. The common microorganisms for hospital-acquired pneumonia are s.aureus, p.aeruginosa and enterobacter (Imran, Amjad Haidri, 2016). I t is often associated positive blood cultures. Certain strains of the pathogens are resistant to antimicrobial drugs except for vancomycin (Lippincott, 2012). This can be linked to overuse or misuse of certain antimicrobial agents. A new pulmonary infiltrate on chest x-ray is common. A purulent sputum and bacteraemia are common in affected patients Pathophysiology Following exposure of the lungs to a pathogen during the process of inhalation, metastasis of infected haematogenous agents or aspiration, the lower respiratory system gets compromised. The process is aggravated by impaired host defences or the presence of a pre-existing highly virulent organism (Hart, Loeffler Kent, 2012). Some diseases such as lifestyle illnesses, comorbid conditions, metabolic syndrome and malnutrition put the patient at a greater risk of acquiring the condition. The patient presents with advanced fevers,tachycardia, and pleural effusions. The state alters natural ventilation and diffusion of gases within the lungs. A reaction which brings about inflammation takes place in the lungs resulting in the production of exudates which consequently impairs the normal exchange of gases (White, Duncan Baumle, 2012). Leucocytes then shift into the alveoli and occupy the air spaces. The ventilation is inhibited due to the increased secretions and oedema from the mucosa whic h causes occlusion within the bronchi. Patients with a pre-existing airway disease may suffer from bronchospasm due to hypoventilation, poor perfusion results. Blood traversing the pulmonary circulation end up not being oxygenated adequately (Hart, Loeffler Kent, 2012). This brings about the deficiency of arterial oxygen hence the reduced oxygen saturation in the body of the affected patient. Nursing Consideration for the Patient in Relation to Infection Control Strict adherence to aseptic technique by nurses and other health care providers during any invasive and non-invasive procedure is essential in order to prevent introduction of microorganisms into the body that may possibly cause nosocomial infection (Damani Damani, 2012). Therefore, proper sterilisation of any equipment that is to be used in any invasive procedure is crucial. Additionally, disinfection of the hospital environment using a proper disinfectant should be advocated for by the nurse to minimize the chances of microorganisms thriving within the patients environment (Moody, Septimus, Hickok, Huang, Platt, Gombosev, Terpstra, Perlin, 2013). Furthermore, health personnel should thoroughly sanitize their hands with an appropriate alcohol based hand rub before and after touching the patient, prior to eating, following visit to a washroom and when the hands are visibly dirty. Sneezing directly into the hands should be discourages, instead a cloth or tissue should be used (Kaye, 2016) in an effort to prevent contact transmission of microorganisms to the susceptible patient. On the other hand, administration of prophylactic antibiotics to the patient should be done to create unfavourable environment for thriving of microorganisms is recommended. The Problem of Ineffective Airway Clearance Related to Productive Sputum/Tracheobronchial Secretions Intervention and Rationale Getting rid of the secretion is a priority measure. This is because any secretion that is retained can consequently affect the efficiency of gaseous exchange besides slowing the recovery process. Intake of water is also necessary for thinning and loosening the secretions. This facilitates easy elimination. Alternatively, a facemask can be used to provide humidification in order to realize the same effect of thinning besides reducing tracheobronchial irritation. A reflexing technique can be employed to initiate coughing if voluntary coughing does not result in complete clearance of sputum .A simple way to of initiating a cough is by the use of an incentive spirometer (Lippincott, 2012). This is necessary for improving the patency of the airway. The patient should be positioned correctly and done unto a deep inspiratory manoeuvre and an explosive expiration. Chest percussion and postural drainage are beneficial in physiotherapy as it mobilises sputum thus easy elimination. During this procedure, the patient should assume a convenient position and put under a mechanical precursor or manual vibrator so as to drain the secretion contents efficiently. If the patient does not have the energy to cough, nasal tracheal suctioning is advised (Perry, Potter Ostendorf, 2016). Oxygen therapy should be administered until a satisfactory value (95percent) is achieved. This can be shown by the use of a pulse oximetry or analysis of the arterial blood gas. The Problem of a Risk for Deficient Fluid Volume Related to Fever and Dyspnoea The nurse should promote fluid intake. This is done by persuading the patient to take a lot of water. When the fluid in the body is deficient, the respiratory rate of the patient increases because of the increased workload brought about by the bodys compensatory mechanism to counter fever and laboured breathing (Williams Hopper, 2012). A high incidence of respiration leads to an increase in fluid loss from the body during the process of exhalation. This potentially leads to dehydration. Two litres of water per day is advised unless the patient has another condition which contraindicates this measure. Administration of antipyretics is beneficial in countering fever (Lippincott, 2012). Non-steroidal anti-inflammatory drugs such as ibuprofen and ketoprofen are recommended. Reduced episodes of fever lessen the amount of water lost from the body through sweating. The patient should be encouraged to assume a comfortable position such as the cardiac position in order to facilitate easy breathing. Heavy exercises should be discouraged until the bodys oxygen saturation is normal. This is due to the excessive need for oxygen by the body due to building up of carbon dioxide on exercising (Montravers, Harpan Guivarch, 2016). In conclusion, hospital pneumonia is a lower respiratory system infection that results due to several factors which include reduced immunity, old age and increased exposure to pathogens. For this case, the patient may have been exposed to the bacterial pathogens due to reduced immunity that is associated with old age. With effective monitoring and management nosocomial pneumonia can be treated with antimicrobial therapy. Recognition of the specific pathogen causing the illness is crucial in order to identify the drugs that are active against the bacteria instead of empirical therapy that exposes one to more drug side effects. Additionally, vital signs should be monitored as well as interventions offered to normalize any deviation from the normal ranges. Noting complications and adhering to the current therapeutic regimen is crucial in facilitating early recovery. Misuse of antibiotics should be discouraged as it may result in resistance. If the patients condition deteriorates a chang e of management or referral is advised. 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