Engineering Environmental Sustainability- Take Home FINAL EXAM Assignment

Engineering Environmental Sustainability- Take Home FINAL EXAM - Assignment Example been subjected to uniform surcharge of 50kPa applied on the surface of soil deposit, which was later removed causing both the sand and clay layers in the current states to be over consolidated. For a 15-m- long, 500-mm drilled shaft and a geometrically identical closed-end steel pipe pile, calculate (a) the shaft capacity due to the clay layer ( divide the clay into ten sub layers of equal thickness in your calculations), (b) The shaft capacity due to the sand layer, (c) the total shaft capacity, (d) the ultimate base capacity, (e)the ultimate load capacity of the pile, (f) the allowable load based on a suitable factor of safety (without consideration of the strength of the pile cross-section), and (g) the allowable load if the compressive strength of the concrete is 15 MPa. Let us first divide the clay layer into 10 sub layers. The current vertical effective stress at each layer and past maximum vertical effective stress for each sub layer can be calculated from given data. The allowable axial load for the drilled shaft from geotechnical consideration is less than the allowable structural load, so, integrity of the cross section is not a concern. Therefore, the final allowable load of drilled shaft is obtained as We can now calculate the fundamental soil properties (undrained shear strength for clay and relative density for the sand layers.) Let us first calculate undrained shear strength of the clay layers. Following

IP1 ECON Essay Example | Topics and Well Written Essays - 750 words

IP1 ECON - Essay Example The price could fall as the A-phone is trying to clear the stock of the current models while developing new models to compete with the promegranate. The curve is likely to move to the left due to a fall in demand. If there is an increase of the price of A-phone due to a flaw found in the promegranate, demand is likely to fall if there are other competitors, but if there is little or no competition, the demand is going to rise (Bernanke and Abel, 2000). The movement is going to move according to the change in demand. If there is a new type of walkie-talkie that has unlimited range, and is basically free, demand for the A-phone is likely to fall. The rate in the fall in demand will depend on how many unique features the A-phone has. There is large number of people interested in the unique features such as cameras, and mp3 players. The price must fall in order to attract buyers even when the walkie-talkie is free, therefore, the curve will shift to the left due to the fall in demand. If it is discovered that there are health concerns when using cell phones, there is will be a drastic fall in the demand and price, since few people w ill be willing to use the phone. In this case, the curve is likely to move to the left due to the fall in demand. If there is a baby boom, there will be an increase in customers and therefore demand is likely to increase, and the price is also going to increase. In this case, the curve is going to shift to the right. If the price of the A-Phone and the Pomegranate both go up, demand is likely to remain the same, however, if the other brands in the market do not raise their prices, the demand may fall. The graph is likely to remain the same if the demand remains the same. If the market price of cell phones goes up, the demand will go down. The supply will outweigh the demand. Therefore there will be excessive supply in the market. If it becomes more expensive to

Explain the role of the judiciary in developing common law. Does this Essay

Explain the role of the judiciary in developing common law. Does this role assist with law making Explain the law making proces - Essay Example Customs were codified in the period of William the conqueror and this is said to be the basis of common law. With time, the king’s courts started to be used as a forum for dispute resolution of individuals, thus making it the common law and was subsequently said to be distinct from customs. However, the judges of that based their decisions on the customs and when a situation arose where no custom could be found new laws were formed. The procedure used at that point in time was by way of issuance of a writ, however, problems arose, as writs were fixed and only Parliament could approve a new writ, for a problem, which did not come under the existing writs. This caused a lot of problems thereby creating a rigid legal system and in lieu of this a practice of petitioning to the king was developed whereby individual cases were dealt with by the Chancellor. In turn a Court of Chancery was established whereby a new rule of ‘equity’ was established, which was contrary to t he common law of the ordinary courts. 1 The Court of Chancery was effective in respect of rectifying injustices but the existence of a parallel system was a problem, one of the problems being the existence of two separate procedures and was bought to an end by the Judicature act 1873-1875 whereby a unified system was established. 2 Thus the important aspect of the English Legal System has been its development by way of precedents, which the courts followed by way of the hierarchy of the courts. Furthermore, the fact that the House of Lords did not till 1966 have the power to overrule its own decision has also played an important role in this respect. The hierarchy of the courts has played an important part in respect of development of the common law and therefore the doctrine of binding precedent has led to such development. 3 The decisions of the judges are based upon the ratio decidendi and obiter dictum. The ratio of a judgment is the binding decision and the reasons for deciding , however, obiter dicta are the things that have been said by the way.4 The advantages of the hierarchy of the courts and judicial precedent is the consistency of decisions, certainty of decisions, efficiency of time and last but not the least flexibility of judges to mould common law.5 The disadvantages can be uncertainty by stare decisis, fixity by way of unjust precedent and unconstitutionality in respect of separation of powers.6 Thus the judges have played an important role in respect of developing the common law as can be seen by the historical developments. The judges now also play an important role by way of statutory interpretation. The next issue that would be looked into is the law making process of the Westminster Parliament and whether or not it’s effective. The Houses of Parliament are House of Commons and House of Lords. The laws of Parliament also known as Acts of Parliament are also called statutes or legislation. These acts can originate via party manifestos ; national emergency, crisis or new development; Royal Commissions; the Law Commission; or Private Members’ Bills.7 There are different types of Bills and these can be classified as Private Bills; Private Members’ Bills; or Public Bills. Public Bills are the common form of bills introduction of which is usually done by a Government minister. This is the most common type of Bill. Public Bills deals with matters which affects the public generally. As far as Private Members’

Issues, Challenges and Strategies in Successful Implementation of an Essay

Issues, Challenges and Strategies in Successful Implementation of an HRIS Project - Essay Example This article presents a critical analysis of the need for HRIS, features required in HRIS, design & acquisition issues, cost benefits, implementation issues and acceptance issues. Gardner and Lepak et al. (2003) presented that the new role of HR professionals is more of "strategic partners to the business" whereby they are expected to understand the business objectives of the organization and align the HR practices with the business goals defined to fulfil the objectives. Hence the business objectives expand into the HR objectives & related goals that are essentially defined to enhance employee contribution by providing them essential guidance, resources & support and to manage essential transformations & changes required in maintaining the fundamental culture of the organization. The authors argue that IT systems act as the catalyst for human resources professionals in achieving HR goals. Enterprise Resource Planning systems integrate various functional (departmental) information systems across the company such that the information from all departments can be integrated and organized for unified MIS reporting to the senior management enabling them to take quick & effective decisions (Gupta & Kohli. 2006). Human Resources is one of the key departments of an organization and hence HRIS need to be an integral part of ERP. The key result areas for all employees are defined by their respective functional managers but closely monitored by the HR function by virtue of key performance indicators. Kaplan and Norton (1996) developed the balanced scorecard system that helps organizations to design & implement a performance measurement system in such a way that individual performance measures can be tangibly mapped with organizational performance. The author hereby argues that such an integrated framework requires the performance management system to be an integral part of the E RP such that performance appraisal cycles can be carried out by respective supervisors of the employees but human resources function can closely monitor the KPI metrics and map with other soft aspects of the individual in terms of punctuality, knowledge & skill enhancement, trainings, additional certifications achieved, etc. The integrated information of functional KPIs and soft aspects can help the HR function to assess the overall performance of the employees and identify employee development needs as well as take decisions on promotions, increments, rewards & recognitions. 3.0 Requirement Analysis for an

Video game genres Essay Example for Free

Video game genres Essay Today, video games have become the most popular means of entertainment throughout our world. More than three-quarters of American youths have video-game consoles, and on a typical day at least 40 percent play a video game. Moreover, recently there has been a wide range of studies by professors throughout the world all focusing on the idea of whether or not video games are causing the youth to become a more illogical violent society in the future. Moreover, some people believe they are just a waste of precious time. However, they have been proven by many scholars that they are not only the best means of entertainment, but also one of the best sources of learning and improving brain performance and strategies, speed of alertness and decision making, and problem solving skills. Coming up with good strategies can be very handy for our lives whether it be in business, learning, teaching, etc. Nowadays video games have been proved to make people smarter towards creative strategy thinking. For example, it has been stated that â€Å"While there are many games that place a premium on strategy, most set an overall goal and give the gamer numerous ways in which he or she can achieve that goal. † Vila, Monica. 7 Reasons Why Your Son Should Play Video Games. http://www. babble. com/. N. p. , 04 Feb 2013. Web. 4 Nov. 2013. Video games teach kids to think objectively about both the games themselves and their own performance. In addition, players also get instant feedback on their decisions and quickly learn their own strengths and weaknesses through try and error since they get unlimited lives in a video game. Video games have a great effect on the youth regarding decision making. Some researchers compared action video-gamers and non-gamers with a series of simple decision-making experiments. Gamers devoted at least five hours weekly in the year before the experiment to playing action video games, such as Grand Theft Auto: San Andreas and Halo 2. They presented volunteers with arrays of dots, asked them to identify which way the dots were moving, and varied the number of dots moving in the same direction to make the task easier or harder. Video games get kids to think. There are dozens of video games that are specifically geared towards learning, but even the most basic shooter game teaches kids to think logically and quickly process large amounts of data. Rather than passively absorbing content from, say, a TV show, a video game requires the player’s constant input to tell the story. Moreover, well known sources such as the video games CQ research proved this characteristic about video gaming â€Å"Games stress taking your knowledge and applying it. That’s pretty crucial in the modern world,† says University of Wisconsin Professor of Reading James Gee. † Glazer, Sarah. Video Games. Congressional Quarterly, 2006. 939. Print. Indeed, the argument that video and computer games are superior to school in helping children learn as gaining currency in academic circles. Claimed benefits include improved problem-solving, mastery of scientific investigation and the ability to apply information learned to real-life situations. In conclusion, as you have seen, there is more than just killing and violence in video games. Our future children should be more exposed to video games not only for ways of entertainment, but also for the sake of improving their intelligence whether it be in creating new strategies, enhancing problem solving skills, or even allowing them to make better life decisions.

Anaemia During Pregnancy: Case Study

Anaemia During Pregnancy: Case Study ANAEMIA DURING PREGNANCY The wonder and joy ofpregnancyis matched by the bodys ability to adapt to looking after the growing baby. In addition to the mothers physiologic needs, there is the additional need to provide the building blocks for optimal growth of the baby. All this construction requires energy and oxygen as the fuel that helps drive the engine. Oxygen in the air that we breathe is delivered to the cells of the body by haemoglobin, a protein molecule found in red blood cells. When the blood lacks level of healthy red blood cells or haemoglobin it leads to a condition called anaemia. The main part of red blood cells is haemoglobin that binds to oxygen. If red blood cells is too few or the haemoglobin is abnormal or low , the cells in the body will not get enough oxygen. The body goes through significant changes when a woman is pregnant. Anaemia is a common disorder in pregnancy, which affect 20 to 60% of the pregnant women. About 20 to 30% of blood increases in the body, which increases the supply of iron and vitamins which are required in the production of haemoglobin. Most of the mothers lack adequate amount of iron during the second and third trimester of pregnancy. A mild anaemia is normal during pregnancy due to increase in the blood volume, but however a severe anaemia can put the baby at high risk of iron deficiency later in infancy. There are different types of anaemia that can develop during pregnancy such as fotal-deficiency anaemia vitamin B12, deficiency anaemia and iron deficiency anaemia. According to Cashion Alden, Perry (2009) In pregnancy, ladies need extra folate to make the red blood cells to transport oxygen to tissues throughout the body. Folate deficiency can directly contribute to certain types of birth defects. Folate-deficiency anaemia, folate which is also called folic acid, is a type of vitamin which is needed for the body to produce new cells, including healthy red blood cells. Iron-deficiency anaemia is when the body does not have enough iron to produce adequate amounts of haemoglobin, and is the most common cause of anaemia in pregnancy. To form healthy red blood cells the body needs vitamin B12 from her diet, the body would not be able to produce enough healthy red blood cells. Ladies who do not eat meat, poultry, dairy products, and eggs have a risk of vitamin B12 deficiency, which can lead to birth defects. Severe or anaemia which is untreated can lead to preterm or low-birth-weight baby, postpartum depression, baby with a serious birth defect of spine or brain, prenatal mortality or maternal death. . Some of the symptoms of anaemia during pregnancy are pale skin, lips and nail, feeling tired or weak, dizziness, shortness of breath, and rapid heartbeat. Antenatal care refers to care given to a pregnant woman from the time of conception is confirmed until the beginning of labor. Risk factors for anaemia in pregnancy can be woman pregnant with more than one child, two pregnancies close together, vomiting a lot because of morning sickness, teenager who is pregnant, not eating enough foods that are rich in iron and heavy periods before became pregnant In nursing process Assessment is the first stage in which nurse carries out a complete and holistic nursing assessment. Normal ward routine of nursing care procedures in antenatal unit at booking and important nursing focus areas is followed. Antenatal booking appointment, which provides the midwife with the valuable background information. The subjective and objective data is collected. The purpose of the visit is to bring together the woman to the maternity service. The information is shared between the mother and the midwife in- order to discuss, plan and implement care for duration of the pregnancy, the birth and postnatal period. During my attachment in antenatal clinic a mother came in for antenatal booking. Collecting her personal history, she is Mrs X, Indian married female. Her date of birth is 22th January, and is now 23 years old. , she is a high school graduate, is able to read and write and follow instructions, able to maintain eye to eye contact and is married to a 25 years old taxi driver named Mr Y. She is staying with her husband, his parents, two brother’s and a sister. They live in a wooden house near the copra mill. The mother is from Waibula but lives with relatives in Namara. Her emergency contacts were of her husband xxxxxxx and cousin sister xxxxxxx. Her family history, Mrs X mother is diabetic and her sister had twins. Mothers medical history was occasionally complains of migraine, and heavy menstrual bleeding. The husband and his elder brother are driving taxi and also they do a casual job in the timber mill. Mrs last normal menstrual period was on 25th of September 2012, her expec ted date of delivery is on the 7th of January 2013. She missed her period for two months. There was no gynaecological history present. Starting with her examinations, the height is 6 feet and 4 inches (1.65m) and is 66 kilograms. The urine test was normal, blood pressure was 80/40mmHg, temperature of 37.5 °C,pulse rate: 114 bpm, respiratory rate: 28 bpm skin: (+) pallor, (-) jaundice, (-) cyanosis, head:, EENT: pale palpebral conjunctiva, negative cervical lymp adenpathy chest, lungs: symmetrical chest expansion, (-) retractions heart: adynamic precordium, tachycardia, (-) thrills, (-) murmur abdomen: globular, soft, normal and active bowel sounds, non-tender extremities: pale nail beds, cold upper and lower extremities (-) cyanosis, weak peripheral pulsesneurological: No found neurological deficits rectal exam: No haemorrhoids, no fissures, no masses, palpated, no tenderness, intact rectal vault, good sphincter tone. In the blood test, the full blood count was done and was low an d proven to be anaemic. In order to ensure that the outcome of the pregnancy is the best for mother and baby, a routine is undertaken which is embraced by the term â€Å" antenatal care†. Fraser and Copper (2009) stated â€Å" the aims of antenatal care is to monitor the progress of pregnancy to .maternal and fetal health, developing a partnership with the woman, providing a holistic approach to the woman’s care that meets her individual needs, promoting an awareness of her public health issues for the woman and her family, exchanging information with the woman and her family, enabling them to make informed choices about pregnancy and birth, being an advocate for the woman and her family during her pregnancy, supporting her right to choose care appropriate for her own needs and those of her family, recognizing complications of pregnancy and appropriately referring woman to the obstetric team or relevant health professionals or other organizations, facilitating the wom an and her family in preparing to meet the demands of birth, making a birth plan, facilitating the woman to make an informed choice about methods of feeding and giving appropriate and sensitive advice to support her decision and offering parenthood education within a planned programme or an individual basis†.(P.g 265). During booking the mothers blood was sent in the laboratory for tests. The haemoglobin level 12g/dL or if it is the haematocrit less than 30% in a pregnant woman. Then it proves that the woman is anaemic. Mrs X haemoglobin level was 8.7g/dL and hemocrit was 25% , so it proved that she is anaemic. It is the risk to the mother and the fetus., So the nursing problem was diagnosed to Mrs X that she was suffering from Iron Deficiency Anaemia. Fraser et al. (2009) stated â€Å" iron deficiency anaemia is the most common hematologic disorder in pregnancy, it affects approximately 15% to 25% of pregnant woman, depending on the ethnic and socioeconomic groups being studied†.(P.g 872). After the diagnosis of iron deficiency anaemia Mrs X was referred to the doctor. The body produces more blood to support the growth of the body. The existence of a hematologic abnormally increases the pregnant women’s risk for developing more complication such as infection or preterm delivery If the mother not getting enough iron or certain other nutrients, the body might not be able to produce the amount of red blood cells it needs to make this additional blood. Taylor, Lillies, Lemone Lynn (2011) stated â€Å" carbohydrates, protein and fats are potential sources of energy for the body†.(P.g 1158). Mrs X presented with symptoms of pale skin, lips and nails, feeling tired or weak, dizziness, shortness of breath, rapid heart rate and trouble concentrating. It is very important to assess the wellbeing of the fetus. This was done by checking the fetal movement and listening to the fetal heart sound using a fetal cardio graph machine. The bloods were performed to see the changes that may indicate worsening of anaemia. The nurses has its own independent role scope of practice to ensure that the mother and fetus are healthy. The nurses role in managing the pregnant woman in this case of Mrs X are as follows. Nurses can be councillor, collaborator and advocator. The role of the nurse at first step will be taking or monitoring vital signs of the mother and thefetal heart rate. To assess the fetal heart rate, fetal heart sound and fetal kick count was monitored. Urine check is another important role of nurse in monitoring an anaemic mother. The mother will be asked to bring along a urine sample for glucose and protein level. In early pregnancy if protein level will be high it can be sign of problems including urinary tract infection, a kidney disorder , high blood pressure or diabetes. If in later pregnancy protein of high level is found is sign of pre-eclampsia. Taking of height and weight measurements is another role of a nurse, also to work out body mass index. Potter, Perry, Stockert Hill (2013) st ated â€Å" body mass index (BMI) measures weight corrected for height and serves as an alternative to traditional height-weight relationships†.(P.g 56). Since the nurse knows the diagnosis of Mrs Mrs Xshe can advise on what kind of foods to consume .She was advised to take foods that are rich in iron examples are red meat, egg yolks, dark leafy vegetables, dried fruit, iron-enriched cereals, grains, chicken giblets, beans, lentils, and liver. Establishment of quiet and peaceful environment to promote rest. During her hospitalization Mrs X was served with full diet. The nurse also taught to the woman on correct positioning while resting.The nurses also did health education with the husband on health. Nurses need to follow the physicians orders in giving the prescribed medications on time.They also advised on personal hygiene. In antenatal care the nurse needs to collaborate with other health care professionals, such as dietician, the obstetric, doctor, haematologists and physiotherapist. To enablepeople to make informed and practical choices about food and lifestyle in health and disease, the role of a dietician comes in, dietetics is the interpretation and communication of nutrition science. The role of a dietician was to prepare a food guideline for Mrs X. Obstetric team works with patients who are wanting to become to become pregnant, is pregnant or have recently delivered. The obstetricnurse have plenty roles in managing an anaemic mother. Mrs Narayan was admitted, reviewed, history taken, vaginal examination, fetal heart tones, and duration and intensity of contractions was done by an obstetric nurse. Paediatrician doctoradvised on healthy and successful delivery of Mrs Narayan, also advised on diet and medication compliance. Paediatrician doctor also took blood and urine test. The roleof midwife is to provide pregnancy care to woman during pregnancy and during birth. The midwife took Mrs X medical history and explained in detail the limitations and risks associated with pregnancy while being anaemic. The midwifealso checked urine for protein and heart beats for the developing baby. Health education was also provided by the midwife. The doctor was also responsible to prescribe medications, examination and to consider delivery if the condition of mother gets worse and fetus gets distressed. The physiotherapist taught Mrs X on exercise that was helpful to her. There are rationales behind the nurses independent roles in ensuring the well-being of the mother and the fetus. As stated earlier monitoring of vital signs, it is very important because to see if Mrs X condition is stable or not. Also same for the fetal heart rate and fetal sounds to see if everything is normal or not. Monitoring fetal heart rate and fetal sound to ensure that the fetus is not distressed. Urine checkis also important factor, it is done by the nurses to see if the glucose and protein level is normal or requires attention. Taking of height and weight is also important to see if mother is healthy and gaining weight since she is pregnant.Also to calculate the body mass index of the mother. The nurse providing health education on her diet, encouraging her to take iron rich foods to prevent or stop Mrs X from getting anaemic. The nurse administers medication as prescribed by the doctors to make Mrs X to improve on her health.Personal hygiene is really important because th e way mother keeps her self affects or reflects the fetus as well. There are rationales behind the professionals collaborative roles in establishing or giving quality care to the pregnant mother. Taking of history from the mother is to know whether she had any past medical problems, such as gynaecological issues or any surgeries that can hinder her present pregnancy. Doctors or paediatricians take samples of blood to see if mother is seriously anaemic or requires attention, or to see if there could be any complications.The rationale of doctors doing vaginal examination is to see cervical dilation or any complications which can arise. Counselling by the doctors of having proper diet or dieticians, to improve the condition of the mother and avoiding complications. Obstetric team was to ensure that if emergency develops there could be urgent need to conduct delivery in caesarean section, because they have knowledge on when and how to conduct delivery in emergency situation. Doctors presenting medication to increase iron level in the blood. Physiotherap ist needed to educate mother on exercise to help her in delivery. During the end of the antenatal clinic, the strengths and weakness of Mrs X was found and identified, it was recorded in evaluation. Mrs X was adjusted to what the plan was ruled out for her. Her strengths were that she followed her diet to what the dieticians planned for her. The health education was really effective to her and her husband supported on her diet and growing fetus. The family support was also there and she was in happy environment, free of fear and anxiety. Mrs X also took her tablets on time and gained weight. Another blood test was done and was found out that her haemoglobin level was normal. The benefitsof maternal iron supplementation on these outcomes are unclear, even for woman who develop anaemia during pregnancy. There is vivid evidence that maternal iron deficiencyanaemia increases the risk of preterm delivery and low birth weight. Iron supplementsimprove the iron status of the mother during pregnancy and during the postpartum period, even in woman who enter pregnancy with reasonable iron stores. Through my point of view, the mass of evidence supports the practice of routine iron supplementation during pregnancy, even though iron is most common and important for woman who have anaemia. ( Approx: 2443 words.) Reference Potter, P, A., Perry, A, G., Stockert, P, A., Hill, A, M. (2013). Fundamentals Of Nursing (8th ed.). United States Of America: Mosby. Fraser, D, M., Copper, M, A. (2009). Myles: Textbook for midwives (15th ed.). Edinburgh: Churchill Livingstone. Lowdermilk, D, L., Perry, S, E., Cashion, K., Alden, K, R. (2012). Maternity Women’s Health Care ( 10th ed.). United States Of America: Mosby. Taylor, C, R., Lillis, C., Lemone, P., Lynn, P. (2011). Fundammentals Of Nursing: The art and science of nursing care (7th ed.). Philadelphia: Lippincott. Reeder, S, J., Martin, L, L., Martin, L, L. (1997). Maternity Nursing: Family, newborns, and women’s health care (18th ed.). Philadelphia: Lippincott. 1

Treatment Of Cirrhosis Of The Liver Nursing Essay

Treatment Of Cirrhosis Of The Liver Nursing Essay Jo is a 23-year-old undergraduate student. She is very sociable and admits to enjoying a drink fairly frequently. Six months ago she got involved in a scuffle while out and ended up in her local AE department. While there she had a blood test which showed abnormal liver function. Follow up tests revealed she had cirrhosis but with only a small part of the liver affected at present. Consequently, Jo has been advised to quit drinking completely and has been referred to her local community alcohol team. However, she has not attended any sessions with them. She did go to one session with the AA which she found out about on the Web but did not return as she felt the people attending were so unlike her Im not an alcoholic. Recently, Jo has been to see her GP and said that, as her condition is so mild, and is not causing her any problems at present, she doesnt see why she should totally give up drinking. She claims to have reduced her drinking slightly going out only 4 nights a week and reducing the alcohol she drinks at home, and believes that this is enough. She admits to not telling any of her family or friends about her diagnosis. Her GP has now referred her to her local psychology service to see if you can make her see sense. How might a health psychologist go about helping Jo? Issues Jo has been diagnosed with having cirrhosis of the liver and has been advised by her GP to stop drinking alcohol. During early stages of cirrhosis there can be very few symptoms (Wright, 2009), and Jo does not seem to have experienced any physical aggravation that would indicate problems with her liver function. Therefore her diagnosis initially seemed inconceivable for Jo to comprehend. After a chronic disease is diagnosed, patients can be in a state of crisis and psychological disequilibrium (Taylor, 2006). Moos and Schaefer (1984, cited in Bennet, 2000) suggested that following a diagnosis of a chronic illness an individual can feel that their future plans, social identity and support network is threatened. She has decided not to tell her friends or family, and is avoiding the implication of her health through denial (Taylor, 2006) until she is more accustomed to the diagnosis. After prolonged inflammation of the liver due to excessive alcohol abuse Jo has cirrhosis on the liver. This is when normal healthy liver cells are damaged and replaced by scar tissue, reducing the number of cells remaining to perform its many important functions (Wright, 2009). Cirrhosis is the final stage of alcoholic liver disease, which is an incurable, progressive and potentially fatal (Wright, 2009). Alcoholic cirrhosis is a multi-factorial disease and is not only a result of high dependency to alcohol (alcoholism) (Addolorato et al, 2009; Day, 2009). Research have found a low dependency of alcohol in patients with cirrhosis (Smith, 2006 cited in Addolorato et al, 2009), and it is known that gender, genetic and nutritional factors can influence the disease progression to cirrhosis (Addolorato et al, 2009). Therefore alcoholic cirrhosis could develop in susceptible individuals whose life style of heavy alcohol abuse has predisposed them to their illness. Jos dependency to alcoho l will be established and considered throughout her treatment process, as this could affect the length and stringency of the treatment approach to achieve the best response (Kadden, 1998). Due to the progressive nature of liver cirrhosis in is imperative that Jo eliminates her alcohol intake, as this would worsen her condition (Wright, 2009). The ability to maintain abstinence from alcohol requires a change in lifestyle, accepting the responsibility of ones actions and being aware of the consequences of drinking behaviour (Farid, Clark Williams, 1997). Once Jo establishes this belief and takes responsibility that her behaviour influences her health, she will hold an internal locus of control (Farid et al, 1997). However currently believing that she has reduced her alcohol consumption to an adequate level, and doesnt believe her behaviour has an influence on her health status, she currently ender an external locus of control. Without acknowledgment of this link to her health, Jo might lack the motivation to stop drinking (Farid et al,1997). To alter and educate Jos current beliefs the information and advice given will need to match the appropriateness for her needs (Br unt, 1993). After her diagnosis Jo could be feeling a great deal of anxiety, fear and uncertainty (Berry, 2003), which would make the processing of advice and treatment information difficult. There is a danger that the individual can be left uneducated, which then adversely affects her coping methods and adherence to treatment (Silverman, 2005). Careful consideration must be made to their treatment of individuals who suffer from alcohol related illness as they tend to differ in their ability to function due to depression (Bianchi et al, 2005), raised anxiety (Bolden, 2009; Kim et al, 2005) and fatigue (Blackburn et al, 2007; Sogolow et al, 2007). There are also multiple psychological factors that contribute to this difference such as elevated levels of stress, inadequate coping mechanisms and reinforcement of alcohol use from other drinkers (Bolden, 2009; Bianchi, 2005; Constant, 2005). Psychological support could help Jo overcome any avoidant coping style and associated psychological distress p reventing adverse response to illness (Taylor, 2006). As this could have a detrimental effect on the progression of liver disease (Jin-Cai Xu-Ru, 2002) and act as a predictor for depression (Bianchi, 2005). Majority of the side effects for cirrhosis are treatable with adequate medical management of the patients affected by alcoholic cirrhosis (Addolorato, 2009). Despite damage to the liver, the liver can still perform some of its functions. Jo currently only has a small part of her liver affected and complete abstinence of alcohol is the only way to prevent further damage that could lead to the gradual recovery of liver function (Addolorato, 2009). However it is likely that end-stage liver failure will result in the patient being assessed for a liver transplant (Georgiou, 2003). Therefore, it is imperative that Jo has documented evidence of the length of time she has been abstinence from alcohol, has sound psychological wellbeing and a strong support network, imperative whilst on the waiting list for a replacement liver (Georgiou, 2003; Pereia, 2000) all in which are considered to reduce the risk of relapse both before and after the liver transplantation. A health psychologist can help Jo to employ effective strategies into different aspects of her life to prevent further alcoholic liver damage. Her current psychological wellbeing will be considered as she is adapting to various lifestyle changes, and therefore psychological intervention will help avoid or reduce psychological suffering (Blackburn, 2007; Kim, 2005). A health psychologist will educate Jo to tackle her current beliefs and develop effective coping mechanisms (Taylor, 2006). Having a wider support network would greatly benefit her treatment process (Georgiou, 2003), which would require her to involve family and friends for extra social support. Together with suitable nutritional advice (Merli et al, 2009) and exercise programme (Petrides et al, 1997) could reduce the effect of liver cirrhosis and could lead to the gradual recovery of liver function. Intervention From the start of the intervention it is important that Jo feels like she is being treated like an individual and that her health psychologist understands the impact of having diagnosed with liver cirrhosis will have on her life (Kadden, 1995), and that they may feel that their identity will be defined by their disability (Charmaz, 1995). A good patient-doctor relationship is important for the adherence and success of the intervention (Kadden, 1995). To establish a good rapport Jos health psychologist must display empathy and belief with good interpersonal skills (Kadden, 1996). He or she must be familiar with the material and function as an active teacher to import the skills successfully (Kadden, 1995). To further strengthen a positive patient-doctor relationship Jo must be encouraged to be involved in the decision-making of her treatment, as this could increase the likelihood of Jo being motivated to comply (Longabaugh, 1999). Jo will complete a Patient Knowledge Questionnaire (PKQ) to assess the knowledge of her disease, and also a CAGE screening test for alcohol dependence (Kadden, 1995), which will set a guide line for the health psychologist of the problems being addressed. Her current beliefs and perceptions of how her illness will affect her life can be further be explored by using open-ended questions (Kadden, 1995). Together with constant emotional support (Kadden, 1995) would improve her psychological wellbeing. Once Jos beliefs have been established, meaningful information can be given and educational programs can be incorporated. Jo requires learning necessary skills to change her problem behaviour, for this reason the information should be given alongside cognitive behavioural therapy (CBT), which views alcohol abuse as a learned behaviour which can be reversed (Lonabaugh Morgenstern, 1999). Jo will need to be aware that any negative feelings towards the diagnosis are normal and reassured that following the intervention she will learn adequate coping skills that will help her take control of her illness (Taylor, 2006). The first part will gain acceptance of the purpose, content and plan of the therapy. Information will be presented about the severity of her liver disease, and abstinence of alcohol clearly identified as the desired goal. The patient should elect a person (family member, friend) willing to act as a source of support. A motivational interviewing style should be used to throughout to promote self-efficiency and better understanding in a nonthreatening fashion (Georgiou et al, 2003). Secondly it is important to identify and develop sufficient coping skills and plan how they can occupy their time with social activities that do not involve alcohol. Potential high-risk situations for drinking will have been identified, and the third part of the therapy would req uire the individual to identify how they will avoid and cope with relapse. Jos psychologist should use the PKQ and CAGE results as a guideline to predict the length and stringency of the treatment (3-12 weeks), depending on level of alcohol dependence (Kadden, 1995), which should be constantly reviewed. Jo has shown positive response to cope with her diagnosis by looking for support on the internet. This provides support for the CBT approach as the success of this therapy will require active participation from the patient (Kadden, 1995). Jo did not enjoy the AA meeting she attended, and may have had difficulty comprehending their belief that an individual is unable to alter their drinking behaviour without the aid of religious intervention (Longabaugh Morgenstern, 1999). This would provide further support for the CBT approach having an underlying assumption that it is within the individuals power to change (Longabough Morgenstern, 1999). Attendances to alternative support group will be encouraged as researches have associated this with positive drinking o utcomes (Longabough, 1999). Jo might benefit from a group who share the underlying assumption that alcohol is learned maladaptive behaviour that they can change (SMART cited in Longabough, 1999). Total alcohol abstinence represents the most effective strategy for alcoholic patients affected by cirrhosis (Tilg Day, 2007 cited in Addolorato, 2009). Even low doses of daily alcohol intake are associated with increased risk of cirrhosis. Continuing alcohol abuse can lead to compilations such as hepatocellular carcinoma (Addolorato, 2009). Consequently, achieving total alcohol abstinence should be the main aim in the management of Jos liver cirrhosis. This could become complex if Jo is diagnosed with alcohol dependence (Sussman, 2004). Medical recommendations and/or brief interventions may not be sufficient to achieve and maintain alcohol abstinence when a diagnosis of dependence is present. There may be a need to add pharmacological approaches, like naltrexone, acamproste and bacolfen which have been shown to reduce alcohol craving and intake (Addolorato, 2009), to prevent relapse and further damaging Jos liver. Malnutrition is frequently present in cirrhotic patients, and considered to be a predictive factor for increased morbidity and mortality (Merli et al, 2009). Exercise and nutritional intervention could improve and prevent inter-related conditions such as obesity, diabetes and insulin resistance (Catalano, 2008), which may worsen her condition. Good nutrition has been shown to improve liver regeneration, recommending an intake of about 2000 calories per day to correct deficiencies and promote hepatic repair (Addolorato, 2009). It is generally assumed that patients with chronic liver disease should be encouraged to engage in exercise, as this will maintain or improve their physical well-being. This could have beneficial effects on body composition, muscle strength (Andersen et al, 1998) and glucose tolerance (Petrides, 1996) and may reduce symptoms of depression (Rot et al, 2009) and fatigue (Blackburn, 2007; Sogolow, 2008). However strenuous exercise is not recommended as this might i ncrease risk of internal bleeding (Petrides, 1996). There arent many researches available on the long-term functional outcome of nutritional and physical well being, however malnutrition (Merli, 2009), depression (Bianchi, 2005) and fatigue (Blackburn, 2007) have been shown to increases complications in liver disease. In conclusion forming a good report with the health professional throughout the sessions will promote the underlying success of the intervention. Jos determinants and high risk situations that are likely to lead to alcohol will be assessed. It is important to incorporate healthy interests to her lifestyle and involve her friends and family throughout the cognitive behavioural treatment, where Jo will learn the necessary coping-skills to unlearn old habits associated with alcohol abuse. She should receive psychological support counselling for a long as required and be encouraged to maintain nutritional and physical well-being, which will overall reduce disability and psychological distress.