Precede Proceed Model Essay Example | Topics and Well Written Essays - 1250 words

Precede Proceed Model - Essay Example As per the research conducted by Stanford University Medical Center (2003), South Asian Indian Women are more prone to heart diseases and diabetes compared to other women of the world. The primary reason behind this is their reluctance to the insulin resistance syndrome that causes high blood pressure, cholesterol and diabetes. There is no doubt that diet plays an important role in controlling diabetes but reluctance towards insulin is one of the major problems that often aggravate the problem. Thus, it is important for health planners, policy makers and evaluators to design an effective and efficient health program pertaining to the diabetes control among South Asian Indian Women. The role of health care institutes and communities is of great importance in creating awareness along with changing the health care systems and patterns along with educating women suffering from diabetes. There is a need of global initiative and a systematic utilization of the health framework to attain he alth objectives. It is important to incorporate Precede Proceed Model’s elements while designing an effective framework for controlling diabetes along with keeping a tab on related diseases. ... There has been a dramatic increase in the prevalence of Diabetes in South Asian Indian Women living in different parts of the world. The primary reason behind this is low physical activities and high fat diet. There is no denying that genetics play an important role in determining a disease but apart from it, health initiatives and perceptions also play a deciding role. It is important to create local level awareness among these women along with guiding them in an informative and logical manner on the use and importance of insulin. An initiative needs to be taken by creating health care communities bringing changes along with managing and guiding people suffering from diabetes (Gielen, McDonald, Bone, (2008). This would help in addressing the problem in a systematic manner offering great results and solutions. Precede Proceed Model Lawrence Green (1976) stated that Precede Proceed Model is a framework that helps and guides health planners, policy makers and evaluators to assess a hea lth problem along with designing an effective health programs. It includes enhancing of health and quality life by designing and implementing effective health initiatives and programs. This model requires active participation of targeted audience in order to understand problems and issues pertaining to a specific disease. This model states that health problems are influenced by both environmental and personal factors and need to be analyzed well. In this discussion, the basic health problem to be assessed and analyzed is diabetes and community based health solutions would be designed based on Precede Proceed Model. This would help in achieving the proposed objective of the discussion in a desired and systematic manner. Description of the Model The

Democratization efforts in the Gulf Essay Example | Topics and Well Written Essays - 250 words

Democratization efforts in the Gulf - Essay Example However, more still needs to be done to ensure that the democratization process is effective. There is a need to establish reforms in the judiciary and allowing the civil society to perform their oversight duties. The limits of educational policy as an engine of social change and economic uplifting can be discussed from a number of perspectives. The Middle East education is inherently based on the religious teachings of Islam2. Anything contrary to this form of education is disregarded. The Middle East does not have educational policies that bring about social change in the region. Education is centred on religion, and this, hinders other tenets of education to be wished away as they are regarded as tools that undermine the Islamic faith3. It is important to note that certain elements of the education system in the Middle East are relevant to the needs of the people only to some

William Wordsworth’s Use of Nature Essay Example for Free

William Wordsworth’s Use of Nature Essay William Wordsworth sought to find universal truths, rather than individual ones. They challenged their readers to look at nature not with a sense of fear or apathy, but as an equal. Poets urged people to see that nature and man are one, and therefore, by experiencing nature, one can experience life more fully. To do so, people must first have an authentic experience, keeping an open mind, free from rational thought. Imagination must take over from there, providing one with not only a sense of resolution, but also independence. Although some experiences may make one sadder, it also makes one wiser in knowing the truth, and living through the experience. Wordsworth and the other Romantic poets strayed away from the common Neoclassical thought that poetrys main goal was to teach, in that he believed poetrys main goal was for pleasure. Out of teaching, comes pleasure in the learning. Lyrical poetry, a passionate speaking from the heart, was created as a result. The works of Wordsworth justify his experience as an early child who undergone hardship in life by losing early his beloved parents and leaving with him his neurotic sister Dorothy. (Online Literature) The magnificent landscape deeply affected Wordsworths imagination and gave him a love of nature. (Read Print Online). Nature deserves to be love and praise by addressing these to all his work. This can be proven in his following works: First, Wandered Lonely as a Cloud is Wordsworths interpretation of an experience that his sister, Dorothy, had. Second, Strange Fits of Passion Have I known is a realization and visualization of fear in losing Lucy. Third, The Prelude is full of his memories, youthful adventure and nature that mold him spiritually and feel free. There are lots of ballads written by William Wordsworth that illustrate the love and use nature based on his experienced. This research explores only these three works. Wandered Lonely as a Cloud First, Wandered Lonely as a Cloud is Wordsworths interpretation of an experience that his sister, Dorothy, had. Dorothy Wordsworth says in her journals that the day to which the poem refers to was full of furious winds and heavy rain, in which they tried to run away from. This running away symbolizes Wordsworth takes his sisters experience and gains his own; one of beauty and understanding versus his sisters running away. To him, and other lyrical poets, in order for man to grow and mature, he/she must face nature. When this balance is gained, the poet has been successful. Man in general running away from nature. (Applebee, Arthur N. , et al. , 2000). The poem lonely as a Cloud begins with the evidence of an error, resolves the problem, and shows at the end a proof of authenticity. Love is created, and therefore, the poet can never hate or destroy nature. The poem subjected a person to restrictions and classifications that society has placed on a certain ways of life. It also shows the feeling of Wordsworth in loving human and nature. It tells the pleasure from being in solitude. When in solitude and tranquility, the rational mind is stopped so that unregulated emotion can begin. I Wandered Lonely as a Cloud, Wordsworth presents a picturesque natural setting that not only delights the mind’s eye of the speaker, but the reader as well. First, he describes the daffodils as â€Å"golden,† (Davies, Hunter, 1980) instantly giving them aesthetic value. Then he uses personification to add to the beauty of the scene by characterizing the daffodils as â€Å"dancing in the breeze. † A simile adds to the effect of the natural setting by comparing the natural daffodil garden to another beautiful natural panorama: â€Å"Continuous as the stars that shine/ and twinkle on the Milky Way/ they stretched in never-ending line. † Hyperbole emphasizes the magnitude of the scene. â€Å"Ten thousand saw I at a glance. † Wordsworth continues by juxtaposing the daffodils with the waves that crash in the sea beside them. Even the waves cannot compare in beauty, he says. Later, while lying on his couch, the daffodils give the speaker a feeling of â€Å"bliss,† accentuating the Romantic tenet that humans can find true beauty and joy in nature. Strange Fits of Passion Have I known revised and analyzed by Sarena Cha

Workload Management in Mental Healthcare

Workload Management in Mental Healthcare Workload Management / Transition to Practice (Mental Health) Prescribed Evidence General Introduction The clinical setting I have chosen for the workload management is Connolly Norman House Mental Health Clinic. For my seven week placement in this clinic I was working with the CMHNs from the Mater Sector Community Services. The aims of the Mater Sector Team continuously focused on providing the highest standard of care to each patient while working in partnership with the service user and its family and respect the person’s individuality. The Mater Sector Team consisted of two consultant psychiatrists, two medical registrars, five CMHNs, one social worker, one clinical psychologist and one administrative secretary. Other services which were linked to the clinic included the main hospital, the day hospital, day centres and numerous other support services. Each CMHN had assigned a number of service users for which she has designated responsibility. Each patient’s care was planned in collaboration with them and the amount of input provided to each patient depended on how unwell somebody was and how much input was necessary was decided by the CMHN. In order to identify the care needs of service users, the Bio-Psycho-Social Nursing Assessment is used in the particular clinical setting chosen for this assignment. This model is recovery oriented and involves service user’s opinions on what is needed in order to improve their recovery journey. The main goal of this assessment framework is to empower the service user re-gaining a life, which includes responsibility, choice, risk taking, hope and social inclusion. The Quality Framework for Mental Health Services in Ireland (Mental Health Commission 2007) was the philosophical framework which guided my delivery of nursing care. The framework promotes a user centred, recovery focused approach. It aims to empower users of the service while also emphasising the person’s journey towards recovery. This framework is very broad and enabling as it applies to all services equally regardless whether care is being delivered in an in-patient setting, in the community or in the home. Client Work For the duration of my seven week placement in this clinic I was delegated a caseload of five patients but for this assignment I will focus only on three patients because of the word count limit. The patients to be taken onto my caseload were selected by my preceptor and the other CMHNs. John is a 76 year old man with a history of depressive disorder and anxiety. John lives alone and socially isolates himself. He is divorced for many years. He has two sons but has contact with only one of them who visits him regularly. His physical health is not very good as he has a history of diverticular disease which causes him abdominal and stomach pain. At the moment, objectively John does not display any symptoms of depression or anxiety and subjectively John reported â€Å"I am feeling ok now.† John’s main issue at the moment is that he continues to be socially isolated and remains unmotivated to go out for walks or to attend any of the groups in the Day Care Centres. When I met John for the first time I informed him what my role is and together we devised a care plan for him in order to reduce his social isolation and to remain well in mental and physical health. The first plan devised was in relation with his daily routine. I explained to him that incorporatin g short walks in his daily routine will benefit his physical and mental health. I also explained to John that social interaction is very important in reducing and preventing the symptoms of depression. John also agreed for me to refer him to â€Å"Befriending† services with a view to reduce his social isolation as they can make available one-to-one companionship once a week. John also agreed for me to visit him once a week and to go out for short walks. For the first two weeks John denied going out for walks together with me as we planned previously. He was displaying lack of motivation and he would find different reasons to avoid going out. As a former psychiatric nurse, John would always like to talk to me about his career and the hospital he was working with. As he was still living nearby his previous workplace, on my third visit I asked John if he would like to show me around the grounds next to the hospital where he used to work. John was very happy about this and agreed to go for a walk. For the next few weeks John appeared to be more motivated to go out for walks while me accompanying him and reported that he really enjoys the walks. Because John has a history of non-compliance with medication, on each of my home visits to him I ensured that he was taking his medication as prescribed and checked his dosset box. At the end of my placement John informed me that he is socialising more with his friends and agreed to continue to go out for walks few times a week. Sarah is a 44 year old lady with a diagnosis of chronic paranoid schizophrenia with prominent negative symptoms. Sarah has two sisters and one brother who died two years ago. She is living with her parents and they look after her at home. Sarah has major difficulties in attending self-care and ADL’s in general. She has a lack of daily routine spending much of her time in bed. She has isolated herself from the outside world since her early teenage years. Sarah has also difficulty in retaining information and is unable to travel on her own around town because of her lack of awareness regarding directions and safety. Because of this, her parents fear of her welfare or becoming lost. Since Sarah’s medication was changed to Clozapine, she has been more interactive with others and increasingly initiating conversation. She has also expressed an interest to attend the art and music therapy group in a Day Centre. I worked closely with Sarah and together we devised a care plan wi th a view to improve her self-care and to have more structure throughout the day. She also agreed for me to accompany her to the Day Centre in order to attend the art and music groups. This would improve her social activity outside of home and her independence by improving her directions skills to and from the Day Centre. Next, we formulated a plan to be followed every day and that consist of her to have a shower in the morning, helping her mum to prepare the meals for the day and going out for walks daily accompanied by one of her parents. While I accompanied Sarah to the Day Centre I used picture and monument identification folder to identify what bus to get and what stop to wait at. I also allowed Sarah to lead the way with minimal assistance. At the end of my placement Sarah had more structure to her day and her mum informed me that she could see a real improvement in Sarah’s behaviour while attending her activities of daily living. Sarah’s interaction with other p eople in the day centre also improved and she reported that she really enjoys the groups. She was still unsure of bus route numbers but she was able to lead the way from the bus stop to her house. Sarah and her family were delighted of her improvements. Mary is a 77 year old lady with a long history of paranoid schizophrenia. Mary has one daughter and after the separation from her husband, she lived with her mother who would look after her and her daughter. Since her mother died twenty years ago Mary lives on her own but her daughter and her sister visit her regularly. At the moment Mary’s mental state is stable and she complies with the medication prescribed. However, Mary feels that her memory is poor and she is worried about not being able to manage paying the bills. After I had been introduced to Mary, together we devised a care plan in order to reduce her anxiety in relation of not being able to remember things and to reduce her worries regarding bills. Mary agreed to use a notebook to write down what she needs to remember. I also encouraged her to attend for an assessment with psychiatry of old age and she agreed for me to talk with one of the doctors in the clinic about this. Mary also agreed for me to complete a budge t plan form for her and to send it to†¦.I also encouraged her to pay the bills weekly until this would come into effect. Furthermore, I advised Mary to have more social outlets by attending day services or community social services. Mary agreed with this and asked me to refer her to one of the day centres. At the end of my work with Mary she informed me that using the notebook helped her significantly about recalling things she has to do and that she is using it very often. I also informed Mary that I was in contact with one of the charity organisations and they agreed to help her pay the bills until she could use the budget plan and she was very happy with this. Mary continues to attend a day centre once a week and she finds it very enjoyable. Mary was pleased with the help she received from me as she informed me and I advised her to contact the CMHN if she has concerns regarding her mental health and for support. Management Tasks During my placement, I carried out numerous administrative and management tasks, including: answering the phone and taking messages for other members of the team, carrying forward patient’s appointments for their depot injections and ordering from the pharmacy if necessary. I would also take part in organising and filing medical and nursing notes. Seeing that there was an administrative secretary in the clinic she carried out many of the administrative tasks. Workload Management For this assignment I am going to describe a typical working day within Mater Services Team in the clinic of Connolly Norman House. The day usually commences at 9:00hrs and ends at 17:00hrs. After arriving I informed my preceptor that I have to carry out two home visits to two of the patients in the morning. At 9:30hrs I left the clinic to visit one of my patients. I arrived at my patient’s house at 9:45. I accompanied my patient for a walk and to the local coffee shop for a cup of tea. After we returned to my patient’s house I completed a nursing assessment with him. I left the patient’s house at 11:00hrs. I walked to visit my next patient. I arrived at her house at 11:15. After I have talked with my patient about how she feels and about her concerns I went back to the clinic. I arrived at the clinic at 12:15hrs. I recorded in the patients nursing notes regarding the home visits. I also did a handover to my preceptor about the two patients. While in the office, I had to answer the phone and record a few messages in the message book. I also had to make a referral for one of the patients to one of the support services for people with mental illness. After I completed the referral, I went for my lunch break from 13:00hr to 13:45hrs. In the afternoon from 14:00hrs to 17:00hrs patients are expected to attend the clinic in order to receive their depot injection and to attend their appointment with the doctor. At 1:45 I went to the clinical room to prepare the trolley for the depot injections. The clinic lasted from 14:00hrs until 16:30hrs. During this time I had to administer depot injections under the supervision of staff nurse and afterwards I sign the patient’s kardex and get it co-signed by the nurse who supervised me. I then ensured to follow up the depot book and document when his/her depot is next due and I informed the patient when they are due to return again and provide them with an appointment card. I also had to check each pat ient’s vital signs and weight as part of a physical screening evaluation programme. At one point I had to link with the secretary as I couldn’t find one of the patient’s kardex but she couldn’t find it either. Therefore I had to ask the doctor to re-write a new kardex in order for the patient to receive her depot injection. While in the clinic I also had to take two phone messages and pass them on to one of the CMHN. At 16:30hrs I went for a hand over from the doctors working within our catchment area. The handover was regarding new referred patients to the services and lasted for 30 minutes. I had to record all the information from the doctors with regards new patients referred to the services. I finished work at 17:00hrs. Conclusion After completing this placement I feel I have gained a lot of experience in working in the community. By having my own caseload it encouraged me to use my own initiative and whenever I felt in a challenging position I always asked for guidance from my preceptor or other staff nurse. My preceptor and the other CMHNs supported and guided me throughout my seven weeks placement.

Because I could Not Stop for Death by Emily Dickinson Essay -- Becaus

Emily Dickinson was born in Amherst, Massachusetts, on December 10, 1830. Except for a few months of travel, she remained in Amherst until her death. Dickinson began, in her twenties, a gradual retreat into the confines of the homestead, the house in which she was born, until for the last fifteen years of her life she didn't leave its grounds and saw no one but her brother and sister. As her withdrawal intensified, Emily's principal method of communication was through her letters. Emily Dickinson died on May 15, 1886 after an illness. ( Harold Bloom 11 - 13) Modern readers are apt to comment upon the frequency with which Dickinson returns to this subject of death. (Wolff, Cynthia, G. 749) "Because I could Not Stop For Death" was written in about 1863 (Kennedy 740) The poem is comprised of six stanzas of four lines each. The poem is long and aligned to the left. The rhyme scheme is ABCB in its first and last two stanzas; however, stanza three and four has different rhyme schemes as stanza three is read ABBC and stanza four is read ABCD. She frequently applies the use of personal pronouns; for example, in the first stanza of the poem, she uses the pronouns "I", "He", "Ourselves". In the second stanza she uses the pronouns "We", "He", "I". In the third stanza she uses the pronoun "We", in three out the four lines composing the stanza. As Harold Bloom, editor of "Bloom's Major Poets ' Emily Dickinson' " says,† When Dickinson declares her "I," these instants become our own" (Bloom 38) The use of pronouns in the poem makes us, as the readers, get involved so deeply into the poem so that we get to feel the protagonist of the poem which is of course the speaker. Most stanzas are composed of a two -beat line but the majority is three b... ...re is a paradise waiting for us. Works Cited Dickinson, Emily. "Because I could Not Stop For Death." Literature: An Introduction to Fiction, Poetry, and Drama. 4th Compact Ed. XJ Kennedy and Dana Gioia . NY: Longman, 2005 Wolff, Cynthia, G. "Dickinson And Death." Literature: An Introduction to Fiction, Poetry, and Drama. 4th Compact Ed. XJ Kennedy and Dana Gioia . NY: Longman, 2005 Bloom, Harold. "Biography of Emily Dickinson." Bloom's Major Poets. Edited And With An Introduction By Harold Bloom: Emily Dickinson. Comprehensive Research And Study Guide. Harold Bloom. Broomall, PA: Chelsea House Publishers, 1999 Tate, Allen. "Allen Tate On Emily Dickinson." Bloom's Major Poets. Edited And With An Introduction By Harold Bloom: Emily Dickinson. Comprehensive Research And Study Guide. Harold Bloom. Broomall, PA: Chelsea House Publishers, 1999

Analysis of Flea by John Donne :: essays research papers

The Flea The narrator in The Flea is a youthful man trying to convince a young woman to give her virginity to him. He tries to do this by comparing their relationship to a flea that is in the room. The flea bites them both and Donne explains to her that this is symbolic of both of their worlds combining into one. He says that the flea is now the realm of love, lust, and marriage. At first this poem seems to be just about love, commitment from a male to a female, who says no his lustful desires. However, a deeper look than just the superficial reveals that the male in this poem is actually revealing a valid point to his lady: that the loss of innocence, such as her virginity, does not constitute a loss of her honor. At first, this poem seems to be simply about a young, sexually hungry man who is trying to convince a girl to give into his sexual wishes. She denies the ?wanna be? lover because she believes that the act of intercourse before marriage is a dishonorable sin in the eyes of the church. The lady ends up killing the flea and symbolically killing the false world the man had constructed in the flea. She then says that neither of them are any worse by killing the flea, which the male agrees with. The man concludes his point by granting that the death of the flea does not really have any consequences, just like her fears to loose her respectability and honor. His main point in all his talk about the flea is to show her that her honor will not be ruined if she yields to him. John Donne?s poem connects flesh and spirit, worldly and religious ideas in a fascinating way between seemingly unrelated topics. He compares sexual intercourse to a bite of a flea and says that now their blood has mixed inside the flea. He also compares the inside of the tiny flea to the entire world, including the couple.

New York and Nebraska

In this world no two places can be considered to be same. All the places have a certain amount of distinctness, a certain flavor and a very dominant persona. If we consider two places, New York and Nebraska, there are a lot of similarities and contrasts, as they are the states of a same country, i.e. United States of America. Both the states have discrete histories but have common grounds on the basis of European Settlers. Nebraska became officially part of United States of America only in 1812 after Missouri Treaty bill.   New York on the other hand was dominant by the point of British and it was an important place in terms of the revolution for Independence.Comparisons between New York and NebraskaNew York and Nebraska are both large states of America and have lot of importance to the country. Both the states being large on their own are blessed on natural terms. On the whole the two states have similarities on the basis of its large parks and greenery. Also both the states are b lessed with the amount of voluminous rivers flowing through them. Nebraska and New York have a very good base in agriculture and have large share of their economy dependent on agricultural products. On a religious point of view too, both the states comprising have similarities in terms that both have a maximum population of Christians than any other religions. The states also are very rich in its heritage and culture and the no. of museums both have are outstanding, as both the states have a view of protecting and highlighting their culture.Contrasts between New York and NebraskaFirstly the climate of both the states is very different, and their discreetness is so high that the state of Nebraska has in fact two climates in its region. The state is grossly divided between a humid climate and a steppe climate. Also the effect of Global warming though being everywhere in the world is marginally higher in Nebraska compared to New York. This is assessed by the following:‘Nebraska i s home to an incredible diversity of native wildlife species, including 346 birds, 83 mammals, 87fish, 47 reptiles and 13 amphibians. Rising temperatures in the state will likely change the makeup of entire ecosystems, forcing wildlife to shift their ranges or adapt. Global warming could contribute to a 20-50 percent decline in forested area, particularly in eastern Nebraska, where grasslands and savanna could replace forests and woodlands’.(Courtesy: Myra Wilensky, â€Å"Global warming and Nebraska†. Retrieved on May 4, 2008 from http://www.nwf.org/globalwarming/pdfs/Nebraska.pdf#search=%22%22global%20warming%22%2C%20Nebraska%22)Both the states have a massive difference in the terms of economy as the state of New York is one of the key finance providers of the nation compared to Nebraska. One of the major contrasting feature of the two states politically is Nebraska is a religious Republican follower while the state of New York is avidly a Democratic supporter.Conclus ionBoth the states have their own theories of running the economy and are well blessed with flora and fauna. The comparison between the two states assesses the fact that how much ever two places might be distinct or similar, both of them are unique in their own way.Reference:1)  Ã‚  Ã‚  Ã‚  Ã‚   Myra Wilensky, â€Å"Global warming and Nebraska†. http://www.nwf.org/globalwarming/pdfs/Nebraska.pdf#search=%22%22global%20warming%22%2C%20Nebraska%22 New York and Nebraska In this world no two places can be considered to be same. All the places have a certain amount of distinctness, a certain flavor and a very dominant persona. If we consider two places, New York and Nebraska, there are a lot of similarities and contrasts, as they are the states of a same country, i.e. United States of America. Both the states have discrete histories but have common grounds on the basis of European Settlers. Nebraska became officially part of United States of America only in 1812 after Missouri Treaty bill.   New York on the other hand was dominant by the point of British and it was an important place in terms of the revolution for Independence.Comparisons between New York and NebraskaNew York and Nebraska are both large states of America and have lot of importance to the country. Both the states being large on their own are blessed on natural terms. On the whole the two states have similarities on the basis of its large parks and greenery. Also both the states are b lessed with the amount of voluminous rivers flowing through them. Nebraska and New York have a very good base in agriculture and have large share of their economy dependent on agricultural products. On a religious point of view too, both the states comprising have similarities in terms that both have a maximum population of Christians than any other religions. The states also are very rich in its heritage and culture and the no. of museums both have are outstanding, as both the states have a view of protecting and highlighting their culture.Contrasts between New York and NebraskaFirstly the climate of both the states is very different, and their discreetness is so high that the state of Nebraska has in fact two climates in its region. The state is grossly divided between a humid climate and a steppe climate. Also the effect of Global warming though being everywhere in the world is marginally higher in Nebraska compared to New York. This is assessed by the following:‘Nebraska i s home to an incredible diversity of native wildlife species, including 346 birds, 83 mammals, 87fish, 47 reptiles and 13 amphibians. Rising temperatures in the state will likely change the makeup of entire ecosystems, forcing wildlife to shift their ranges or adapt. Global warming could contribute to a 20-50 percent decline in forested area, particularly in eastern Nebraska, where grasslands and savanna could replace forests and woodlands’.(Courtesy: Myra Wilensky, â€Å"Global warming and Nebraska†. Retrieved on May 4, 2008 from http://www.nwf.org/globalwarming/pdfs/Nebraska.pdf#search=%22%22global%20warming%22%2C%20Nebraska%22)Both the states have a massive difference in the terms of economy as the state of New York is one of the key finance providers of the nation compared to Nebraska. One of the major contrasting feature of the two states politically is Nebraska is a religious Republican follower while the state of New York is avidly a Democratic supporter.Conclus ionBoth the states have their own theories of running the economy and are well blessed with flora and fauna. The comparison between the two states assesses the fact that how much ever two places might be distinct or similar, both of them are unique in their own way.Reference:1)  Ã‚  Ã‚  Ã‚  Ã‚   Myra Wilensky, â€Å"Global warming and Nebraska†. http://www.nwf.org/globalwarming/pdfs/Nebraska.pdf#search=%22%22global%20warming%22%2C%20Nebraska%22