The Travesty of the Holocaust Essay Example for Free

Literacy Assignment Example | Topics and Well Written Essays - 1500 words

Proficiency - Assignment Example Where understudies are probably going to profit by these abilities as it improves their general proficiency and assist them with having better quality f instruction, educators are additionally required to create them, as they are basic for giving quality training and furthermore upgrade their presentation levels. Notwithstanding that, the extent of creating proficiency and numeracy in grown-ups has additionally expanded which will in general carry greater obligation to teachers. One of the significant territories encompassing poor education abilities is failure to comprehend the content being perused. Where perusing itself is an essential aptitude that is being created from the commencement of instruction, capacity to pick up information on setting in numerous edges is fairly hard to create. This issue is additionally joined by failure to perform scholarly research and furthermore sift through applicable sources to create vital comprehension. The issue further improves because of quality of various and non-solid information accessible on web and obsolete library assets. Likewise, capacity to recognize insightful and scholastically significant sources to help training has a basic incentive for present day understudies. Last component of this issue is to convey the information recorded as a hard copy. This abilities required improvement of sound language just as broad jargon. With constrained perusing being performed and lesser consideration given this region, understudies think that its hard to convey what they know well which influences their evaluations as well as their self-assurance. Another element of the issue being examined is to have appropriate information on numerical information and applicable scientific ideas. The issue increments when there are word issues as deriving importance out of composed content and changing over it into numeric information and further applying fitting strategies and methods implied for critical thinking. Subsequently, so as to create numeric aptitudes, it is basic that an understudy can determine right

Aromatherapy Massage Benefits and Precautions

Aromatherapy Massage Benefits and Precautions February 03, 2020  Hero Images/Getty Images More in Self-Improvement Holistic Health Happiness Meditation Stress Management Spirituality Inspiration Brain Health Technology Relationships In This Article Table of Contents Expand Overview Benefits What to Expect Precautions Aromatherapy massage is Swedish massage therapy using massage oil or lotion that contains essential oils (highly concentrated plant oils). During an aromatherapy massage, you inhale these essential oil molecules or absorb them through your skin. They are thought to promote beneficial changes in your mind and body by affecting the limbic system, a region of the brain known to be involved in emotion. Why Do People Get Aromatherapy Massage? Each essential oil used in aromatherapy is said to have different properties. For example, some calm and make you feel relaxed  while others energize. Here are some widely used essential oils and their purported properties:Calming:  chamomile, lavender, and geranium oilUplifting:  ylang-ylang, clary sage, rose, and neroli oilEnergizing: rosemary oilDecongesting: eucalyptus, pine, and  tea tree oil Since aromatherapy massage techniques are often the same as those used in Swedish massage (the most common type of massage in the US), people often get it for sore back, neck, and/or shoulder muscles or to ease stress. Use of therapeutic essential oils in massage is being explored for the following conditions: AnxietyDementia symptomsDepressionInsomniaMenstrual painSupportive care for people with conditions such as cancer Benefits Aromatherapy massage appears to reduce the pain and discomfort of menstrual cramps, a 2015 study from the Journal of Obstetrics and Gynaecology  suggests. Participants did a self-massage with rose essential oil, an unscented almond oil, or no oil on the first day of menstruation for two menstrual cycles. By the second cycle, aromatherapy massage reduced the severity of pain compared to massage therapy with almond oil or no oil.?? Massage with aromatherapy may also ease menopausal symptoms. In a 2012 study published in Menopause, researchers compared 30-minute aromatherapy massage (twice a week for four weeks) to massage with plain oil or no treatment and found that both massage and aromatherapy massage were effective in reducing menopausal symptoms (with aromatherapy massage being more effective than massage only).?? Other research suggests that aromatherapy massage may not relieve symptoms in people with cancer. A review published in the Cochrane Database of Systematic Reviews in 2016, analyzed previously published studies and concluded that this review demonstrated no differences in effects of massage on depression, mood disturbance, psychological distress, nausea, fatigue, physical symptom distress, or quality of life when compared with no massage.?? When comparing aromatherapy massage with no massage, they found that there was some indication of benefit in the aromatherapy-massage group but this benefit is unlikely to translate into clinical benefit.?? What to Expect During an Aromatherapy Massage Although you can find aromatherapy massage at almost every massage clinic or spa, the style of treatment, degree of customization, and the quality of essential oils varies widely. Many massage therapists have one or more premixed blends and will select the blend based on your health concerns. A massage for relaxation and stress relief would likely include lavender essential oil, while an uplifting massage may include rosemary essential oil. Your therapist may involve you in the selection process by asking you to smell various blends. Some massage therapists may add essential oils to massage oil immediately before each massage based on your unique condition or health goals. The quality of the essential oils varies widely. Essential oils are different from oils made with synthetic scents which dont have therapeutic effects. Massage therapists who are highly knowledgeable about aromatherapy tend to use quality essential oils in their massage oils. Once the massage oil is selected, the therapist leaves the room so you can disrobe and lie on the massage table. You will usually be asked to lie face down under a sheet. When the massage therapist begins the massage, you may notice the subtle aroma of essential oils. After the massage, the massage therapist may suggest a blend that you can use at home in between massage treatments. Tips to Make the Most of Your Massage: Avoid eating a meal right before a massage.If its your first time at the clinic or spa, arrive early so you can complete the necessary forms. Otherwise, you may want to give yourself some time to rest and relax before starting the massage. Precautions A licensed massage therapist should take your health history before the massage. Essential oils may cause an allergic skin reaction. Essential oils are highly potent and can be absorbed through the skin, so its important to avoid excessive use of aromatherapy oils and to only use oils that have been properly diluted by a carrier oil. If youre sensitive to scents, aromatherapy may not be right for you. If you are pregnant or breastfeeding, check with your doctor to see if this type of massage is safe for you. If it is, your doctor may also be able to recommend a licensed massage therapist who is certified in pregnancy massage. Massage shouldnt be done directly over bruises, skin rashes, inflamed or weak skin, unhealed wounds, tumors, abdominal hernia, or fractures. If a massage is painful, tell your massage therapist immediately. If you have a health condition, you should consult your doctor before getting an aromatherapy massage. People with certain conditions, such as cancer, may need to avoid essential oils and/or massage at certain times during their treatment or avoid it altogether.?? Final Thoughts Aromatherapy with essential oil-scented massage oils and lotions may help to ease stress and anxiety. If youre considering trying aromatherapy massage, its a good idea to talk with your healthcare provider first to discuss whether its appropriate for you.

Characteristics of Adults and Young People as Learners

The Characteristics of adults and young people as learners In this article we will consider the characteristics of young people and adults as learners. We will touch on the three main theories of teaching, identify and expand on three factors that have been identified as motivating adult learners and which the savvy teacher can use to increase the motivation of the learner. We will briefly consider five barriers that can affect a learner’s participation and or learning, looking at three of them in more detail together with some apt and practical support strategies to assist the learner and finally consider and outline the differences between pedagogical and andragogical models of learning. Three main theories of teaching A)†¦show more content†¦Ã¯Æ'Ëœ Accessibility. The college / centre should ensure that staff receive training to be conversant with problems faced by learners with Basic skills needs, Make use of Outreach classes to negate travel difficulties for the learner, make provision for trained staff to be available to assist at enrolment, and courses should be Publicised widely to increase awareness of availability and options . ïÆ'Ëœ Personal attitudes. The provider should take into account the learner’s experience, and actively stress strengths not weaknesses, manage and present the work in bite-sized chunks, and foster student involvement through the provision of regular reviews of performance, targets should be set through negotiation and agreed, make use of existing interests for student motivation, Staff should be generous in praise and accept and work at the learners pace. The learner should be encouraged to accept ownership of their own learning. Differences between pedagogical and andragogical models of learning Much study has been made of the two models of learning. a) Pedagogy has been defined as the art and science of educating children within a teacher focused environment of education. The teacher makes decisions as to what, when and how a lesson will be learnt. This system is driven purely by the teacher and their goals andShow MoreRelatedEssay about New Learning Strategies for Generation X1630 Words   |  7 Pageswhich the learning characteristics of the young adults classified as Generation X reflect the need for the new teaching and learning strategies promoted by cognitive scientists, such as learning in context, cooperative learning, and real-world application of knowledge. The Life Experience Gap The gap between Generation X and earlier generations represents much more than age and technological differences. It reflects the effects of a changing society on a generation. Young adults born between 1961Read MoreThe Human Being And Universe Diversified And Unique From Other Animals845 Words   |  4 PagesIn general, people are the most intelligent specie in the universe as they have the abilities to understand the symbolic interaction and the differences that make them unfamiliar with others. Simply speaking, children are inherited the similarities from their parents such as blood type, physical characteristics, and personality. However, they are not completely and totally inherited everything from their parents. A young teenager may develop any kind of identifying characteristics that he is taughtRead MoreHealth, Safety, And Welfare1515 Words   |  7 Pagessafety, and welfare is of paramount concern in all assessments as without this the learner is at an unfair disadvantage. To counteract this I’m proactive at promoting and enforcing safeguarding procedures. I have a duty and responsibility to provide a service to my learners and staff that protects them from harm. The ‘Safeguarding Vulnerable Groups Act 2006†² asks Assessors to protect those under 18 and all vulnerable adults (those in community care, with mental or other disability, age, or illness andRead MoreA Short Note On L1 And L2 Development1652 Words   |  7 Pages L1 Learners in the native language environment, people in this environment are native speakers. For acquisition of L1, child learners have no pressure and competition. They do not worry about the level of mother tongue reached, because they are native speakers. In contrast, most of L2 learners rarely in such language environment, they are often in a highly competitive, stressful learning environment. They are learning another language in the first language environment. Moreover, L2 learners studyRead MoreDifferences Between L2 And L2 Development1681 Words   |  7 Pages L1 Learners in the native language environment, people in this environment are native speakers. For acquisition of L1, child learners have no pressure and competition. They do not worry about the level of mother tongue reached, because they are native speakers. In contrast, most of L2 learners rarely in such language environment, they are often in a highly competitive, stressful learning environment. They are learning another language in the first language environment. Moreover, L2 learners studyRead MoreOutline Policy And Regulatory Frame Work Essay1021 Words   |  5 Pagesachieve make a positive contribution Achieve economic well-being. Education and skills act(2008) proposed to increase participation in learning, for young people and adult. It put in place a right for adults to basic and intermediate skill, giving adults a possibility to get the abilities they need. Equality Act (2010) The protected characteristics: Age Disability Gender reassignment Marriage and civil partnership Race Religion or belief Sex Sexual orientation Disability Discrimination ActRead MoreCase Study : Making Their Own Way By Marcia B. Baxter Magolda1643 Words   |  7 Pageschoosing this article is the fact that being a young adult who had just started university myself I can relate to this chapter and have already experienced some of the study findings. I also find it very interesting how education, experiences gained in young adult days and the process of ‘growing up’ develops people into who they become for the rest of their lives. Text summary Baxter Magolda is a well-regarded professor who studied how young people develop upon completing college up into their thirtiesRead MoreThe Alternative Learning System1623 Words   |  7 Pagesto basic education, and the DepEd is mandated to provide this service to all Filipinos. In the 80’s, the global community launched a campaign called Education for All (EFA) that aimed to eradicate illiteracy and promote functional literacy for all people of the world. Our nation was a signatory to this and as such, committed to providing education for all Filipinos ALTERNATIVE LEARNING SYSTEM → is a parallel learning system that provides a viable alternative to the existing formal education. It encompassesRead MoreRelationship Between The Client s And Educator s Perception Essay1371 Words   |  6 Pageslearning environment. Building a trusting nurse-client relationship is very important in promoting health education to any age group. Child Learner Children learn throughout their lives as they grow from birth to adulthood. For effective client education, a nurse need to understand the growth and development of the children, which includes biological characteristics, psychosocial stages, and developmental tasks. It is also important for the nurse to know how children learn at different stages of theirRead MoreFactors Affecting Teaching And Leadership Essay1728 Words   |  7 Pageslearning of children and young people and evaluate the importance of individual differences in this scenario. For proceeding with this study on the mentioned topic, we started by understanding the various theories of psychology of education and learning. We then moved onto understand the application and adaptation of these theories and evaluating the success and failure thereby aiding us to identify how individual differences affect teaching and learning of young people and children. As we go on

Lee Harvey Oswald and the Assassination of JFK - 1453 Words

Lee Harvey Oswald and the Assassination of JFK A- Plan Of Investigation This investigation will answer the question: To what extent did Lee Harvey Oswald’s history predispose him to kill John F. Kennedy? To determine the extent to which childhood and previous jobs influenced Oswald to assassinate the President, the scope of the investigation will focus on Lee Harvey Oswald and his relationships with political groups. It will also examine Oswald’s youth and the actions of previous life events. Only secondary sources about the assassination will be used in this examination. B- Summary Of Evidence Born October 18, 1939, Lee Harvey Oswald was born, just two months after the death of his father (Waggoner 27). His youth was spent†¦show more content†¦In Reclaiming History: The Assassination of President John F. Kennedy, the purpose of the reading is to present evidence surrounding the JFK assassination because it has been taken over by conspiracy theories which will continue unless someone makes the facts of the situation known, in which case Bugliosi did so in that the conspiracy thoughts can be put to rest. This book’s limitations include the fact that since there is mention about conspiracy and some analytical thought in addition to the cold, hard facts, one must be careful to pull out only the facts, so that they themselves can analyze the presented information. The origin of James McKinley’s book was written just a little more than ten years after JFK’s assassination. It is a book compiled of the accounts of 12 famous political figures in American History. In Assassination in America, the purpose of the reading is to examine the complex circumstances surrounding the assassination by recreating the background and drama encompassing the murder. The value of Assassination in America is that it was written just ten years after Kennedy’s assassination, so one is able to recall details more precisely, giving a more accurate account than a book written fifty years after the event. The limitations of McKinley’s book include the fact that his book not only includes details about Kennedy’s assassination, but also the accounts of other well-known assassinations in our history.Show MoreRelatedThe Assassination Of Jfk By Lee Harvey Oswald3669 Words   |  15 PagesThe shot seen across the country. The assassination of JFK still stands today as one of the most shocking events in American history. Its had a larger impact because of the fact that it was on national television and because of its graphic nature. Since we will never know the true motive of Lee Harvey Oswald, the only thing that we could do is make our own assumptions. That is what we’ve done, which have only made things more difficult for us to grasp and have created more conspiracy theories. IRead MoreA Brief Look at John F. Kennedy835 Words   |  4 Pageswas cut short by a belligerent man. John F. Kennedy or JFK would grow to become one of the United States’s smartest and youngest Presidents in history. Unfortunately for JFK his life and term as President was cut short after being assassinated by Lee Harvey Oswald. Although JFK did not serve a full term as President he affected our nation in many positive ways and was on the best presidents we ever had. John Fitzgerald Kennedy also known as â€Å"JFK† because of his initials was the 35th President of theRead MoreNoah Cooper. Mrs. Sites. English 10A. 15 April 2017. Lee1749 Words   |  7 PagesApril 2017 Lee Harvey Oswald: The Sole Assassin? The public must be satisfied that Oswald was the assassin; that he did not have confederates who are still at large; and that evidence was such that he would have been convicted at trial. Unfortunately the facts on Oswald seem about too pat- too obvious (Marxist, Cuba, Russian wife, etc.) The Dallas police have put out statements on the Communist conspiracy theory and it was they who were in charge when he was shot and thus silenced (â€Å"The JFK Assassination†Read MoreTo Kill A Kennedy954 Words   |  4 Pagesbeing â€Å"A person who is easily manipulated or victimized : pushover,† (www.merriam-webster.com). This is what Lee Harvey Oswald claimed he was when the Dallas Police Department arrested him on November 22, 1963 for suddenly assassinating President John Fitzgerald Kennedy. Today, the vast majority of Americans believe Oswald’s words, claiming that there was more behind the tragic assassination than the United States government once portrayed. Many hav e disregarded everything the government had told theRead MoreThe Assassination Of Jfk Assassination Theory1385 Words   |  6 Pagesessay is the JFK assassination theory. I would like to research this because I have seen documents and videos online and on television about the conspiracy but I have not done full research into it to see the facts. With the presidents of the United States they are able to make or break the country with their decisions, with that JFK was assassinated due to that and other reasons. I will be going into this research thinking that there is a conspiracy behind the assassination of JFK that it wasn tRead MoreAssassination Of Jfk s Assassination1140 Words   |  5 Pageslater, he was assassinated. The assassin, Lee Harvey Oswald was arrested 70 minutes after the assassination. There have been numerous debates over the last 55 years regarding this incident. Many people claim there is a conspiracy behind the case, allowing various conspiracy theories to emer ge over the years. One specific theory is about how the mafia was involved with JFK’s assassination. In 1963, the USA Presidential elections were approaching and so JFK and his wife Jacqueline travelled to DallasRead MoreJfk And The President Jfk1368 Words   |  6 PagesJohn Fitzgerald Kennedy (JFK) was assassinated in Dallas Texas. The nation and the whole world was shocked in that day. In fact, president JFK was preparing for his next combine in Texas, he took a road trip by a motorcade with his wife Jacqueline Kennedy, Governor John Connally, and his wife Nellie. The road trip went through Dealey Plaza in downtown Dallas towards the trade mart, where the president was scheduled to give a speech there. The road that the president JFK was traveling on by his motorcadeRead MoreMystery of Who Killed John F Kennedy1483 Words   |  6 PagesDue to the vast speculations of the assassination of John F. Kennedy on November 22, 1963 in Dallas, Texas the mystery of what really happened still lies amongst us today. From theory to theory there is no telling what the true motive in killing the President really was. Among the various theories are those that involve the Chicago mafia, Lee Harvey Oswald attempting the murder by himself, and the left and right wing factions of the U.S. government. After several investigations, there is no realRead MoreThe Assassination Of John F. Kennedy1500 Words   |  6 PagesThere is a lot of speculation about what really took place in the assassination of John F. Kennedy. Many people believe that Lee Harvey Oswald worked alone, but there are many people across the nation who think differently. Many theories can both support and disprove that Lee Harvey Oswald worked as a lone wolf in the assassination of John F. Kennedy. The official report by the government in the JFK assassination was that Lee Harvey Oswald worked alone on the twenty-third of November in 1963. The dayRead MoreAssassination of John F Kennedy1119 Words   |  5 Pageshe was abruptly struck by two penetrating bullets in the upper back and head. Our 35th President of the United States of America had been fatally assassinated by Lee Harvey Oswald, a sniper from the sixth floor of the Texas School Book Depository Building. However, did Lee Harvey Oswald, a crazy lunatic act alone in the assassination of President Kennedy. Both first – hand knowledge and visual evidence allows people to re – examine the events of this day and prove that there were other gunmen

Community Levels Of Physical Activity Health And Social Care Essay Free Essays

string(78) " the load of chronic disease on the ague sector and public services \( 8 \) \." NHS Western Cheshire Primary Care Trust ( PCT ) is the administration that commissions wellness services for the population of Western Cheshire ensuring that services run into local demands. The trust leads the local NHS ( infirmaries, general practicians, tooth doctors, oculists and community staff ) and works in partnership with other administrations, such as local governments and both public and voluntary sector administrations, to better the wellness and well-being of occupants ( 3 ) . Within the PCT the Public Health Department is headed by the Director of Public Health, a joint assignment between the PCT and the local authorization. We will write a custom essay sample on Community Levels Of Physical Activity Health And Social Care Essay or any similar topic only for you Order Now The section ‘s function within the PCT is to enable and back up the PCT and its spouses to better the wellness of the population and cut down wellness inequalities that exist in Western Cheshire. The section has a duty for wellness protection, instruction and betterment in the part, including proviso for immunization and showing services and exigency planning for epidemics, e.g. swine grippe. The section is responsible for development and bringing of wellness schemes, based upon local demands, to implement both national and regional policy. Within the section the Specialist Health Improvement Team has a duty for the commissioning and bringing of wellness instruction and betterment services, e.g. smoking surcease and weight direction, based upon national, regional and local policies, schemes and needs appraisals. For the intent of this paper Western Cheshire is assumed to hold a population of 150,000 with a mix of societal category, cultural and age groups mirroring the national norm. This paper proposes a two twelvemonth evidence-based scheme to increase degrees of exercising in the population. There are five attacks to wellness publicity ; Medical or Preventive ; Behaviour Change ; Educational ; Empowerment ; and Social Change, and, it might be said that, for wellness publicity to be genuinely effectual it should use aspects of each of these attacks ( 6 ) . Although possibly one or two attacks would look to be most suited to specific schemes or intercessions, for illustration behaviors alteration might be an appropriate attack for increasing degrees of physical activity but, in truth, will probably be doomed to failure without at least some part from most, if non all, other attacks. Therefore this scheme proposes a holistic methodological analysis, including actions embracing all five of th ese attacks. Evidence Base Physical inaction is a important, independent hazard factor for a scope of chronic wellness conditions impacting society today ( 7 ) and there is a compelling instance for implanting the publicity of physical activity in the NHS to procure the future wellness of the state ( 8 ) . In fact it has been said that if a drug or intervention was developed that had the possible to forestall as many wellness conditions as physical activity ( see fig. 1 ) it would be proclaimed a ‘miracle remedy ‘ or ‘wonder drug ‘ ( 7 ) . But physical inaction besides has far-reaching deductions for the wider populace sector, such as societal attention. For illustration: of grownups aged over 65, 12 % are unable to walk outside on their ain, and 9 % can non pull off stepss unaided ( 2 ) Figure 1. The impact of physical activity on many chronic wellness conditions Evidence shows that an active life style: has a significant impact on the hazard of major non-communicable disease, including coronary bosom disease, high blood pressure and some malignant neoplastic diseases ( 2 ) can cut down the hazard of shot, and modify cardiovascular disease hazard factors such as high blood force per unit area and high cholesterin ( 2 ) protects against malignant neoplastic diseases of the colon, chest ( post-maturity ) and endometrium ( 5 ) reduces the hazard of and helps pull off musculo-skeletal wellness conditions, including osteoporosis and degenerative arthritis ( 2 ) reduces the hazard of depression and promotes many other positive mental wellness benefits, including cut downing anxiousness ; bettering self-pride ; and assist cut down physiological reactions to emphasize ( 2 ) has been found to be as effectual in the intervention of mental sick wellness as anti-depressant drugs and psychotherapeutics ( 9, 10 ) supports weight direction – ensuing in modest weight loss of around 0.5-1kg per month ( 2 ) by the age of 70, 25 % of adult females and 7 % of work forces have deficient leg strength to acquire out of a chair without utilizing their weaponries ( 2 ) . Physical activity is portion of the solution to back uping the publicity of independent life in older grownups, thereby cut downing the cost of societal attention. Fallss are a prima cause of inadvertent decease of older people and fractured hips, as a consequence of falls, cost the NHS and societal services ?1.8 billion each twelvemonth in England ( 11 ) . Physical activity, peculiarly preparation to better strength, balance and coordination, can be extremely effectual in cut downing the incidence of falls ( 2 ) . Regular exercising has besides been shown to protect against the oncoming of depressive symptoms and anxiousness ( 12 ) . In mid-life and older grownups, physical activity can decelerate or forestall age-related cognitive diminution, and is associated with a lower hazard of developing dementedness ( 13 ) . Despite the multiple wellness additions associated with a physically active life style, merely 40 % of grownup work forces and 28 % of big adult females meet the Chief Medical Officers ( CMO ) recommendations for wellness ( 14 ) , nevertheless, the existent challenge is that 75 % of work forces and 67 % of adult females believe that they are active plenty ( 15 ) . There is a acknowledgment across the NHS that active life styles are now an intrinsic portion of twenty-first century health care and that advancing active life styles is a simple reply to many of the wellness challenges confronting our state today ( 8 ) . The load of sick wellness from inaction is clear and the statistics farther highlight the potency for important decreases in morbidity and mortality, which could be achieved if we consistently and actively promote engagement in physical activity through the NHS ( 8 ) . Equally good as holding the potency to better the wellness of the state, advancing physical activity could besides salvage the NHS money, cut downing the load of chronic disease on the ague sector and public services ( 8 ) . You read "Community Levels Of Physical Activity Health And Social Care Essay" in category "Essay examples" Using Primary Care to advance physical activity can assist the NHS move towards lower costs, more efficient and effectual services in prima ry attention and cut down the demand for, and costs of, acute attention ( 7 ) . Investing in the bar docket by implanting the publicity of physical activity in NHS services has the ability to significantly cut down the fiscal load of inaction on the economic system. Allender et Al. ( 16 ) estimated that for merely five conditions, post-menopausal chest malignant neoplastic disease, lower GI malignant neoplastic disease, cerebrovascular disease, cardiovascular disease and type 2 diabetes, in one twelvemonth entirely, the load of physical inaction: caused over 35,000 deceases ; caused 3.1 % of morbidity and mortality in the UK added over ?1.8 billion to the direct wellness cost load on the NHS. For a pattern population of 10,000 the cost of these five conditions attributable to physical inaction norms ?50,000 per twelvemonth ( 17 ) . Adding indirect costs to the wider economic system, such as working yearss lost due to sickness and premature mortality, produces a entire measure associating to physical inaction that may be every bit high as ?8.3 billion every twelvemonth ( 17 ) . Scheme The long term purpose of wellness publicity is to cut down morbidity and premature mortality ( 18 ) , to accomplish this intercessions are likely to be targeted towards whole populations or high hazard groups, with three degrees of bar ; Primary, aimed at forestalling the oncoming of disease ; Secondary, aimed at forestalling the patterned advance of disease ; and Tertiary, aimed at cut downing farther disablement or helping rehabilitation ( 18 ) . A cardinal purpose of this scheme is to aim intercessions at pre-school and school age kids, promoting them to be active in line with current recommendations. This will hold two effects ; foremost, by promoting kids to be more active, will be good in cut downing the prevalence of inaction related conditions in the hereafter ; and secondly, will assist to develop a civilization of taking regular physical activity. It has been shown that sedentary behaviors track from adolescence into maturity ( 19 ) and, although grounds is limited, it is believed that active kids are more likely to stay active into maturity ( 20 ) , besides when kids are taught appropriate wellness behaviors early, these are more likely to go accustomed and go on into maturity ( 21 ) . To accomplish this we must work closely with kids ‘s Centres, to guarantee that active drama forms a regular portion of their activities, and schools to guarantee that regular physical activity is incorporated into their course o f study, including activities which are non traditionally seen as school athleticss, which will besides promote the ‘Not Sporty ‘ kid to take part, activities such as Dance and Cheerleading, for illustration, have been shown to increase engagement in school based activity ( 22 ) . It is good that the National authorities have reviewed their support for the School Sports Partnership programme, which has done much to promote and advance activity in schools across the part, and we will go on to buttonhole, both locally and nationally, through Public Health England, for continued support for this programme and other programmes which will better entree to feature and activities within our schools. Many kids and immature people say that they would prefer to walk or rhythm to school ( 23 ) , and we will work with Local Education Authorities ( LEA ) and Local Governments to assist and back up schools to develop and advance active conveyance programs for both staff and students, including walking coachs, peculiarly for primary school students, which have been shown to be effectual in increasing degrees of physical activity in primary school kids ( 24 ) . But holding active conveyance programs is non sufficient to guarantee increased activity among staff and students, we besides need to guarantee the handiness of safe paths to schools, unafraid storage for rhythms and accoutrements etc. within schools and the support of parents to promote their kids to utilize active conveyance methods to acquire to and from school. To this terminal we will work with and buttonhole the Local Authority to guarantee that active conveyance is the easier pick for people to do and the LEA to guarantee s chools have the resources to supply secure storage installations. Persons diagnosed with many medical conditions may profit from increasing the sum of physical activity they do in order to forestall the patterned advance of their status. Working closely with GP ‘s these persons will be referred into activities which will assist forestall or cut down the patterned advance of their status. In many instances a first measure will be to supply information, particular to their status, about the principle for going more active and the hazards associated with non making so. As many of these people are likely to populate in countries of want ( 25, 26 ) the accent will be on advancing no-cost/low-cost activities, such as walking and cycling, which have been shown to be an appropriate method of advancing physical activity ( 1 ) . Walk is besides a suited activity for older people, every bit good as the physical benefits of improved or maintained musculus strength, joint mobility and proprioception, which can cut down falls in older grownups ( 2 ) , walk ing, peculiarly in a group, such as on a wellness walk, besides offers benefits which contribute to the societal and psychological wellbeing of persons ( 27 ) . We already have a web of wellness walks across the part, through the ‘Walking for Health ‘ programme and a figure of local groups presently provide a scope of cycling activities, including adaptative cycling, community rhythm drives and rhythm tuition. These activities will supply the back bone of our scheme but we need to guarantee they are accessible to people that need them. We will confer with with patient and support groups to guarantee that activities provided are activities of pick and are at a clip and topographic point where they can be accessed by the mark population. Many people with bing medical conditions require entree to specialised exercising proviso, aimed at cut downing farther disablement or helping rehabilitation ( 18 ) . We will look to use our bing exercising referral programme, working with qualified physical therapists and exercising professionals, from both the populace and private sectors, guaranting that patients are guided into suited activities and supported in their attempts to go more active. Activities will necessitate to be suited for Phase IV cardiac rehabilitation and/or rehabilitation from musculoskeletal hurt, among other conditions. Many of these activities already exist, through the public, private and voluntary sectors, and we will go on to work closely with suppliers to guarantee activities are suited for the referral programme, i.e. run by suitably qualified teachers and hazard assessed. Harmonizing to the 2006 Health Survey for England ( 14 ) one in four people said they would be far more active if they were advised to be so by a wellness professional. Therefore, based on the recommendations of NICE counsel ( 1 ) we will work closely with GP patterns to supply brief intercessions, based upon the â€Å" Lets Get Moving † ( LGM ) programme, for patients to assist promote them to be more physically active. This programme has been tried and tested in a figure of GP patterns in London and has been found to supply a cost effectual scheme for increasing population degrees of physical activity ( 4 ) . However, such work will be dependant on the suppliers of the brief intercession being able to signpost patients onto suited activities that they would wish to, or are willing to seek. The Change 4 Life web site has an activity hunt tool which is appropriate for this intent, although a elaborate function exercising will be required before manus, to guarantee as broad a s cope of local activities is included in the database and that information is current and correct. Although instruction entirely is improbable to hold a positive consequence on wellness behaviors, coupled with other attacks can take to the desired results. Evidence shows that old media runs to advance physical activity have been successful in raising consciousness and cognition, but non of increasing activity degrees ( 28, 29 ) , nevertheless, instruction is likely to play a cardinal function in the initial phases of many wellness publicity programmes ( 30 ) . Using societal selling techniques has been shown to be an effectual method of making difficult to make groups ( 31 ) , but instruction runs should be based upon positive messages, such as improved functional capacity or improved sleep forms, for illustration, instead than negative messages or panic tactics, which have been shown to be uneffective in arousing wellness behavior alteration ( 32 ) . The Change 4 Life programme is a national run, launched in 2009, which aims to assist persons and households to â€Å" eat good, travel more and unrecorded thirster † . We will seek to construct on the work that this programme has done, and continues to make, in advancing the benefits of an active life style. In add-on we will include physical activity information and the Change 4 Life activity hunt tool on the PCT web site and will promote our spouses, local authorization every bit good as other public, private and voluntary sector suppliers to make the same. Many administrations, such as the British Heart Foundation and Cancer UK, for illustration, bring forth a broad scope of literature on the benefits of physical activity in relation to specific wellness conditions and there is no purpose to re-invent the wheel. We do, nevertheless need to do certain that this information is made more widely available. We will therefore work closely with the local authorization libraries service, GP ‘s, tooth doctors, pharmaceuticss and supermarkets etc. to guarantee that these stuffs are available in the topographic points that people attend. We will besides set up a figure of awareness raising events across the part, supplying information and advice for the populace. These events will be specifically targeted in countries of greatest demand, i.e. countries of high want or countries where there is grounds of low consumption of physical activity, and will be held in topographic points where people congregate, i.e. supermarkets, station office, ca fe or public house for illustration. We will besides transport out media runs in partnership with local suppliers to advance specific activities at times of increased national involvement, associating into the 2012 Olympic Legacy programme, for illustration, or to bind in with other promotional events and national runs, such as National Walk 4 Life Day or National Older Person ‘s Day. Although there is limited grounds of wellness benefits of community engagement, it is suggested that persons have a better opportunity of accomplishing their ends if they participate with other people who are affected by, or portion, the same, or similar, fortunes ( 33 ) . There is good grounds to demo that authorization has the possible to bring forth improved wellness impacts, peculiarly when aiming specific community groups, such as adult females and people from deprived communities ( 34 ) . At the bosom of authorization is the construct that people can be equipped with the cognition, assurance and accomplishments to do a difference in their communities ( 35 ) . Involving members of the populace in back uping others within their ain communities to do positive wellness alterations in their lives is based on a sound apprehension of the value of life experience and community support systems that can be within vicinities ( 36, 37 ) . We will enroll people from different strands of the community and specific mark groups to go community Healthy Activity Champions. These persons will have preparation, support and counsel enabling them to transport out voluntary activities in their ain communities. However, engagement in physical activity within communities, particularly those in disadvantaged countries, is likely to be mostly dependent on the handiness and propinquity of installations and safe environments ( 38 ) . Having easy entree to safe community countries, such as resort areas or playing Fieldss, and doing local vicinities safe for out-of-door activity has a major consequence on bettering activity wonts, peculiarly among deprived populations, who by and large report lower degrees of physical activity ( 38 ) . Therefore we will work with bing community groups, particularly those in disadvantaged countries, to assist them convey about the alterations they want to see in their communities, assisting to pull support for local undertakings etc. In this we will wor k as a facilitator, non taking but back uping the community, supplying counsel and advice, as needed or requested, to enable them to accomplish their ain results, instead than those placed upon them by outside bureaus. Although, over recent old ages, there have been several authorities policies, schemes and studies either entirely aimed at, or at least integrating physical activity counsel and policy to some grade ( 7, 8, 17 ) , even the latest public wellness white paper ( 39 ) includes mention to the consequence physical activity can hold on the wellness of the state. We will go on to buttonhole, both locally, regionally and nationally, through the new Public Health England construction, for a wider consideration of physical activity in all authorities policies and schemes. We see a peculiar accent of this attack in buttonholing local authorities around the cardinal countries of local conveyance policy, to do active conveyance the easier pick, for both wellness and environmental sustainability. We will work closely with be aftering sections to guarantee that new developments incorporate programs to include safe countries for out-of-door activities and to travel off from the â€Å" No Ball Games † civilization that has developed in this state towards a civilization where we promote and encourage regular activity for all people, from cradle to sculpt. Costing Figure 2. Premises made in the preparation of declarative costing. Based on the NICE counsel ( 1 ) and the LGM feasibleness survey ( 4 ) , the undermentioned premises underlie this declarative costing. aˆ? Workforce cost premises: PCT Staff – ?25 per hr. ( Assume 20 proceedingss per patient ) aˆ? Training ; 6 PCT Staff for 3 hours ( module 1 ) – ?450.00 commissioning external preparation to present Module 2 preparation to 6 ( soap. 12 ) PCT staff – approx. ?2,500 ongoing pattern support – approx. ?200 per GP Practice per twelvemonth. aˆ? Premises ; Appraisal and brief intercession takes 15 to 20 proceedingss. Support activity following brief intercession and follow-up costs, ?5 per patient project intercession. The mean QALY gained per referral is 0.17 ( 1 ) ; ensuing from approx. 6 % of patients referred for interview accomplishing an addition in the figure of moderate activity Sessionss. Much of the work outlined by this scheme is already taking topographic point, although more attempt is needed to guarantee the success of this scheme. They key cost involved with this scheme will be for the puting up of the LGM programme and the rating procedure and declarative costs for this are given here. Areas where the PCT can anticipate to incur direct costs for puting up LGM are detailed in the programme commissioning usher ( 8 ) . Although, at this phase, elaborate costing has non been carried out for this programme, the Department of Health has provided an analysis of declarative costs ( 8 ) . However it should be noted that this economic analysis is intended to be declarative merely and will change harmonizing to the bringing methodological analysis chosen and the figure and features of the pati ents targeted ( see fig. 2 for premises made ) . Indicative set up costs Cost of staff preparation: ?3,000 Selling and Promotion: ?1,000 Staff costs involved with execution: ?5,000 Entire estimated set up costs: ?9,000 Indicative operating costs ( based upon 500 patients per pattern per twelvemonth ) Practice staff enrolling patients, finishing GPPAQ and mentioning for brief intercession ( Assuming ?5 per patient ) ?2,500 Brief intercession carried out by PCT staff ( Assuming 20 infinitesimal audience and ?25 per hr staff cost ) ?4,167 Assuming 80 % of patients undertake the intercession ( 400 patients ) Cost of support activity following brief intercession and followup ( based on ?5.00 per patient ) ?2,000 Entire cost per pattern for 1 twelvemonth ?8667 On this footing, with 15 patterns, each averaging 10,000 patients, covering the PCT country the entire jutting one-year costs are: – Year one ( including set-up costs ) ?139,005 Year two ( including 5 % cost addition ) ?136,505 Entire cost for two old ages ?275,510 The cost of rating for this scheme has yet to be finalised, nevertheless counsel suggests that around 10 % of the programme cost should be allocated to the rating procedure. Therefore leting between ?25,000 and ?30,000 would be appropriate for this scheme, giving a entire programme cost of around ?300,000. Based on NICE counsel ( 1 ) the estimated cost per QALY saved is ?295, good below the suggested threshold of ?30,000 per QALY ( 8 ) . Evaluation Measuring wellness publicity is non straightforward because it normally involves changing activities, long term aims and several spouses ( 18 ) . Health publicity argues for a holistic appraising attack, embracing qualitative research methodological analysiss, taking history of the changing contextual characteristics of many programmes ( 18 ) . The RE-AIM ( range, effectivity, acceptance, execution, care ) model ( 40 ) was developed to heighten the impact of wellness publicity intercessions by measuring the dimensions considered most relevant to real-world execution, such as the capacity to make underserved populations and to be adopted within diverse scenes ( 41 ) . The theoretical account was intended to steer planning and rating of evidence-based intercessions ( 42, 43 ) that address the different degrees of the socio-ecological theoretical account, such as those that target single wellness behavior alteration by increasing intrapersonal, organizational, and community resource sup port ( 44 ) ( see figure 3 for typical research inquiries ) . It has been used to measure a scope of wellness behavior alteration programmes, including physical activity, dietetic behavior, and smoke ( 45-47 ) . It is hence believed that this will be an ideal rating model for this scheme. Figure 3. RE-AIM Dimensions and Template Questions for Evaluating Health Education and Health Behaviour Research RE-AIM Dimension Questions Range ( Individual Level ) What per centum of potentially eligible participants a ) were excluded, B ) took portion and degree Celsius ) how representative were they? Efficacy or Effectiveness ( Individual Level ) What impact did the intercession have on a ) all participants who began the plan ; b ) on procedure intermediate and primary results ; and c ) on both positive and negative ( unintended ) , outcomes including quality of life? Adoption ( Puting Level ) What per centum of scenes and intercession agents within these scenes ( e.g. , schools/educators, medical offices/physicians ) a ) were excluded, B ) participated and degree Celsiuss ) how representative were they? Execution ( Setting/agent Level ) To what extent were the assorted intercession constituents delivered as intended ( in the protocol ) , particularly when conducted by different ( non-research ) staff members in applied scenes? Care ( Individual Level ) What were the long-run effects ( lower limit of 6-12 months following intercession ) ? B ) What was the abrasion rate ; were drop-outs representative ; and how did abrasion impact decisions about effectivity? Care ( Puting Level ) a ) To what extent were different intercession constituents continued or institutionalised? B ) How was the original plan modified? Beginning: www.re-aim.org It is import that rating of programmes, such as this, is built in from the beginning so that all involved know and acknowledge the end products and results that they are working toward ( 43 ) . We are presently working closely with local academic establishments to develop this rating procedure based upon the RE-AIM model. Decision It is widely accepted that physical inaction is a major subscriber to the load of ill-health that we face nationally today and that advancing and promoting an active life style is a simple, yet effectual, manner of cut downing this load for future coevalss. A behaviour alteration attack is likely to be most appropriate to increase population degrees of physical activity, and hence this is the chief attack used in this scheme. However, it must be recognised that a one size fits all scheme is improbable to be successful, hence, we have proposed a holistic attack to advancing active life styles. It should besides be recognised that many of the wellness results from schemes such as this are long term and are non likely to be realised within the life-time of the scheme. Therefore a robust rating model must be employed from the beginning so that advancement can be measured against programme end products, which grounds has shown to be effectual in accomplishing the anticipate wellness results. The RE-AIM model has been successfully used in assorted scenes, against a scope of behaviour alteration enterprises, including physical activity, hence it is ideal to be used for this scheme. Although this scheme is aimed at bettering the wellness of the population of Western Cheshire through increased activity degrees, if it is to be successful it will necessitate a conjunct attempt from the whole Public Health Department, from the Director of Public Health down, to guarantee that the scheme is accepted by all spouse administrations, both locally and nationally, peculiarly local and national authorities, to guarantee that physical activity is embedded in all policy, non merely regarded as a wellness or sport/community issue. Part 2. Behaviour Change The behavior alteration attack is popular in wellness publicity because it places wellness as the belongings of the person and assumes that people can do existent betterments to their wellness by taking to do appropriate life styles alterations ( 18 ) . Although behaviour alteration programmes tend to be an expert led, exceed down attack ( 18 ) , this scheme proposes a client led, bottom up attack. The programme is based on the healthcare professional supplying a brief intercession with persons, identified as person who would profit from increased activity. The procedure of behavior alteration is simply facilitated by the healthcare professional, through the proviso of appropriate information and advice particular to the person in the initial phase of the procedure. Then steering and back uping them, utilizing motivational interviewing techniques, instead than taking, through the behaviour alteration procedure. Critical to the bringing of these brief intercessions is the manner they are implemented. Nice counsel on behavior alteration intercessions delivered to persons recommends that practicians select intercessions that will actuate and back up patients to believe about the effects of their current behavior, see the positive effects of altering and program for alteration in little stairss ( 48 ) . NICE Public Health Guidance ( 1 ) recommends ; â€Å" Primary attention practicians should take the chance, whenever possible, to place inactive grownups and rede them to take for 30 proceedingss of moderate activity on 5 yearss of the hebdomad ( or more ) . They should utilize their opinion to find when this would be inappropriate ( for illustration, because of medical conditions or personal fortunes ) . They should utilize a validated tool, such as the Department of Health ‘s general practician physical activity questionnaire ( GPPAQ ) , to place inactive persons. When supplying physical activity advice, primary attention practicians should take into history the person ‘s demands, penchants and fortunes. They should hold ends with them. They should besides supply written information about the benefits of activity and the local chances to be active. They should follow them up at appropriate intervals over a 3 to 6 month period. † Brief intercessions have become the intercession of pick for many wellness publicity runs ( 18 ) and are by and large based upon the transtheoretical, or phases of alteration, theoretical account of behavioral alteration and, on occasion, the theory of self-government ( 49 ) . The transtheoretical theoretical account was foremost proposed by Prochaska and DiClemente in 1982 ( 50 ) , taking history of concepts from several theories from the field of psychological science, such as the theory of reasoned action ( 51 ) , and theory of planned behavior ( 52 ) . Sniehotta suggests that while these theories advanced apprehension of motive with respect to behaviour alteration they made small part to the scientific discipline of behavior alteration because they did non include a agencies for altering behavior or did non account for non-motivational behavior alteration techniques ( 53 ) . The construct of phases of alteration emerged during research into the procedures that persons use to alte r their troubled behavior ( 50 ) but the theoretical account has since been successfully used for many wellness behaviors change intercessions, including smoke ( 54, 55 ) , intoxicant ( 56, 57 ) , dietetic ( 58 ) , every bit good as physical activity ( 49 ) . A recent reappraisal indicated that motivational interviewing, based upon a ‘stages of alteration ‘ theoretical account, efficaciously helps clients to positively alter their behavior and exceeded results of advice merely intercessions in 80 % of the surveies included in the reappraisal ( 59 ) . The writers of the reappraisal farther suggest that, although some alterations may non be clinically important, it was of import to maintain in head that the procedure is based upon doing the patients cognizant of the potency for behavior alteration ensuing in improved wellness results and that the little alterations made within the period of survey may besides be of long term involvement if they mark the beginning of a long term procedure of alteration for the person ( 59 ) . The Lets Get Moving attack is a behaviour alteration intercession that has been designed to supply a systematic attack to placing and back uping grownups who are non run intoing the current recommendations for physical activity to go more active ( 8 ) . The attack is based upon NICE Public Health Guidance ( 1 ) , which endorses the usage of brief intercessions for physical activity publicity in primary attention as being both clinically and be effectual in the long term. The programme draws upon motivational questioning techniques to foreground the wellness benefits of physical activity, working through cardinal behaviors alteration phases and reasoning with a clear physical activity end, which is set by the person, and the designation of suited local chances to be active, including exercising referral, if appropriate ( 8 ) . Motivational interviewing is a patient centred attack, which fits in with the current authorities mantra â€Å" No determination about me, without me † . The procedure aims to arouse and beef up an persons intrinsic motive to alter lifestyle behaviors ( 8 ) and has been used by a assortment of health care professionals, across a scope of primary attention scenes, to present improved wellness results ( 60 ) . The active constituents of motivational interviewing are increasing preparedness to alter, utilizing empathetic listening techniques, increasing self-efficacy and increasing the sensed disagreement between existent and ideal behavior ( 61 ) . A recent reappraisal has shown that motivational interviewing in primary attention can hold a positive consequence on a scope of wellness behaviors, including diet and physical activity ( 62 ) . The construct of motivational questioning evolved from the experience of handling alcohol addiction, and was foremost described by Miller in 1983 ( 63 ) . This basic experience was developed into a coherent theory, and a elaborate description of the clinical process was provided by Miller and Rollnick ( 64 ) , who defined motivational interviewing as a ‘directive, client centred counselling manner for arousing behaviour alteration by assisting clients to research and decide ambivalency ‘ . The schemes of motivational interviewing are more persuasive than coercive, more supportive than argumentative, and the overall end is to increase the client ‘s intrinsic motive so that alteration arises from within instead than being imposed from without ( 65 ) . The motivational interviewing manner is a collaborative method utilizing distinguishable rules and techniques, while utilizing client centred techniques to construct trust and cut down opposition, the supplier focuses di rectively on increasing preparedness for alteration ( 61 ) . Reappraisals of physical activity intercessions have identified the scene of general pattern as a potentially effectual scene for population degree of physical activity publicity schemes ( 66, 67 ) . A written prescription is a familiar manner for patients to have advice from their GP, normally in the signifier of medicine ( 68 ) , and research has shown that supplying patients with a written prescription to take more exercising has been effectual, at least in the short term ( 6 to 10 hebdomads ) ( 69-71 ) . However grounds suggests that long term attachment to exert programmes may necessitate multiple contacts with the wellness professional and that GP ‘s, in peculiar, have expressed concern about deficiency of clip, assurance or skill to present separately tailored exercising advice ( 68 ) . It is suggested that one manner of get the better ofing these barriers is for other allied wellness professionals to supply the brief intercession following designation of suited campaign ers by the GP or pattern nurse ( 66, 69, 72 ) utilizing a validated tool, such as GPPAQ, to measure current activity degrees ( 1 ) . This is the attack proposed in this scheme, using allied wellness workers, such as wellness trainers, for illustration, appropriately trained to present the initial brief intercession and motivational interview audiences, following on from the referral by the healthcare professional, either at the GP pattern or in a separate location. Promoting physical activity in primary attention is recognised as an of import and potentially effectual attack for increasing population degrees of physical activity ( 1, 73, 74 ) . With assorted attacks being tried over recent old ages, including giving advice or guidance ( 75, 76 ) , supplying written resources ( advice brochures etc. ) ( 71 ) and exercise referral programmes ( 1, 77 ) . There is an increasing sum of grounds for the impact of wellness professionals promoting physical activity within primary attention ( 78 ) . A recent Australian survey suggests that merely three to five proceedingss of brief advice from a General Practitioner, supported with appropriate written stuffs, could take to an addition in the proportion of patients run intoing recommended degrees of physical activity 24 hebdomads after the intercession ( 68 ) . Similarly a survey on the effects of three brief intercession and reding attacks conducted by pattern nurses on patients with hazard factors assoc iating to cardiovascular disease besides showed a important addition in reported activity degrees four months after the intercession ( 75 ) . In 2009 the Department for Health launched the ‘Be Active, Be Healthy ‘ policy which proposed the phased airing of the ‘Lets Get Traveling ‘ programme, and the new authorities public wellness white paper ( 39 ) endorses the programme within the new public wellness construction. Decision Behaviour alteration intercessions are by and large seen as one of the most appropriate attack to increasing population degrees of physical activity and, among these, brief intercessions appear to be a popular pick among wellness publicity staff. Evidence suggests that the add-on of motivational interview techniques to the intercession has served to increase the effectivity of these intercessions in a assortment of wellness publicity scenes. The usage of the ‘Lets Get Traveling ‘ protocol for increasing activity degrees has been tried and tested and found to be both clinically and be effectual in a primary attention scene and is hence seen to be an appropriate attack to utilize for this scheme. This attack was endorsed by the old Labour authorities and this support has been re-iterated by the current Lib Dem/Conservative alliance authorities in the latest public wellness white paper and back uping paperss. 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The warm air of spring blows through my hair, reminding me that summer is drawing nearer. I feel the branch beneath my feet begin to sway in the breeze. I toss my pen and paper to the ground below and lie back against the sturdy trunk. I am suspended high above the ground, held up by only a wooden support. Here, the world is mine to control. I have no cares, no stress, and no worries. In my tree, I am free to think and feel without fear of being judged. Here, I think about life, loss, and love. Mostly, though, I think about the loss of my mom. I was only 14 years old, a high school freshman, when my mom passed away. There was no warning, no time to â€Å"prepare,† and shock was my only emotion. I had plenty of family and friends, but at this moment, I felt completely alone. We will write a custom essay sample on My Sanctuary or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page I went through all of the so-called stages of grief, in no particular order and some more than others. I met with a counselor twice, spent days in the school counselor’s office, and held late-night crying sessions by phone with close friends. Though no one completely understood, I did have those who were willing to listen. Various people told me I should find my own way to cope with this sudden loss. So I did just that. I read books about death, dying, and grief, known as â€Å"biblio-therapy.† I talked to friends, teachers, and anyone willing to listen. I even spoke to my Sociology class and managed to inspire a few classmates to share their own experiences. Though being with other people helped, the best method of â€Å"dealing† was simply being alone. I needed a sanctuary, and I found one right in my own front yard. My tree, which until recently I had been unable to climb, turned into a haven. Within its branches, I became shielded from not only the weather but the troubles of life. I was not hiding from life, but letting my problems sift through the leaves like beams of sunlight. I dealt with them one at a time, at my own pace, with no fear of ridicule. Over the next three years, I started to become more comfortable with my unique situation. I talked less and started listening more. I became a counselor for my friends, helping with their problems and offering a shoulder to cry on. As much as I helped them, they helped me even more. I realized I could turn my tragic experience into something positive. It was during this time that I decided to become a social worker so I can help others as they have helped me. As I watch the sunset through the branches, the sky looks even more brilliant from here, more vivid somehow. As the air becomes chilled by the darkening sky, I know it is time to leave for the night. I climb down slowly, savoring the feel of the rough bark against my palms. I make my way inside and settle into my bed, staring out the window. There, I see my tree, standing tall, proud, and ready for anything. I guess you could say the same about me.