Global Warming Solutions essays

Global Warming Solutions essays Since the mid nineteen sixties, environmentalism has exploded as a movement. Many environmentalists view modern industrial society as unsustainable and the way that western society functions as damaging the earth's natural biosphere and cycles. There is a growing body of evidence to support the belief that our consumer culture and industrial processes are in fact destroying the delicate balance and complex interrelationships that nature has forged and upon which we still rely. The biggest worry of most 'green' groups at present is the well documented 'global warming' effect in which it is believed the earth's average temperature is rising, causing sea levels to rise (more to do with thermal expansion of water than ice cap melting), destruction of natural habitats and most worryingly to humans; climate change. However it would be ignorant to believe that the earth has always been as it is now, indeed rapid climate change is a natural phenomenon which has occurred countless times in the earths history; ice ages and warm periods mark definite periods in earths living history, a period of extreme warmth for example marked the Cretaceous Tertiary era boundary where over 90% of the land species of the earth became extinct allowi ng mammals to become the dominant class of species. Ice age and periods of warmth are common and a feuture of a dynamic planet. Despite this, geology and anthropology have discovered fresh evidence that suggests this latest climate change event may be different. Only in times of extreme volcanic activity or celestial change has a climate change period been so quick in taking effect, and this present one is accompanied by neither. Evidence to suggest that it is indeed human activity which is causing environmental disaster is growing. Statistical and historical evidence suggests there is a direct link between the actions of humans and environmental destruction. Although conclusive proof can easily be found for aci...

Johnny Tremain Essays - Johnny Tremain, 2nd Millennium, Time

Johnny Tremain Essays - Johnny Tremain, 2nd Millennium, Time Johnny Tremain Johnny Tremain takes place in pre-Revolutionary Boston. Johnny Tremain is boy who is proudtoo proud. His pride made him overconfident. He pretty much planned all of his life while he was young; he would be a silversmith and marry Cilla. His mother dies when he is fourteen years old. Before his mother died, he was apprenticed to a silversmith named Mr. Lapham. When his mother died, she gave him a silver cup that showed that he was a member of the Lyte family. The cup signifies that he is related to the famous merchant Lyte who was very rich. One Sunday, in order to get a silver basin for Mr. John Hancock done on time, Johnny broke the Sabbath and cast a silver pitcher. Dove, who is very unintelligent and jealous of Johnny gave him a cracked crucible and it spilled all over the stove top and Johnny went to get it but it burned his hand. Mr. Lapham sent out for a midwife to come and fix his hand because they didnt want to get caught working on the Sabbath by a doctor. She wrapped it up together and it crippled and stuck together which meant he couldn't work as a silversmith anymore. Johnnys master, Mr. Lapham, said that he would always have a home there. Soon Mr. Lapham was getting impatient and Johnny knew that he needed to get a job. So Johnny went out to find a job. He had a rough time finding a job because nobody wanted a so-called crippled boy who supposedly couldn't do anything. After searching and searching for a new job, he was offered a job by a boy named Rab who was about his age to deliver the Boston Observer, which was a town newspaper. Johnny became a messenger for the Sons of Liberty, a group of patriots that includes Sam Adams, Paul Revere, and John Hancock. Johnny wanted to get to Lexington, so he made himself look like a soldier and tore open his shirt and smeared mud and blood on his face and body. He successfully slipped past the soldiers and got to Lexington. When he got there, he saw Pumpkin and gave him some clothes to escape and Pumpkin gave Johnny his uniform and a gun. Johnny dressed up and got to Dr. Warren. Dr. Warren fixed his crippled hand by cutting the skin. Johnny later finds out that Rab had been killed in the war. Dr. Warren tried to save him but could not because he had been fatally wounded.

Fashion and Gender Essay Example | Topics and Well Written Essays - 2000 words

Fashion and Gender - Essay Example The essay "Fashion and Gender" examines how the concept of fashion is connected with the idea of gender. The analysis of the issue will be performed from three different perspectives.To begin with, it may be particularly suitable to explain the exceptional role of gender when it comes to examining the role of fashion on the social environment. Thus, it is thought that â€Å"becoming visibly gender involves engagement with complicated, shifting coding system of colours, fabrics, trims, forms, shapes, and patterns and other body fashionings†. This means that fashion might be seen as a platform which allows people to adopt particular roles that are conditioned by their gender and finish their socialization. In other words, the concept in question implies that there is strict division between the genders. The importance of behaviour. Another point that should be mentioned with regard of the way fashion shapes identity of a person is the way people behave while wearing clothes. For example, when a man is dressed in a suit he is likely to be more polite and less aggressive since this kind of clothes is associated with formal events that require people to be on their best behaviour. On the other hand, if a person did not dress formally enough to a special occasion, this might be perceived as extremely rude. Nevertheless, in daily life people wear relatively similar clothes so there is another factor that truly makes difference in this case. The researchers argue that â€Å"it’s not about circumstances so much.

Purhsing Paper Can Be Fun Essay Example for Free

Purhsing Paper Can Be Fun Essay Question: What Performance problems is the captain trying to correct. Ans: 1 Poor Reporting Performance among the employees. Question: Use the MARS model of individual behavior and performance to diagnose the possible causes of the unacceptable behavior. Ans: 2 Possible causes for the unacceptable behavior is as follows: MARS Model: There are four main factors that directly influence an employee’s voluntary behavior and resulting performance. Employee Motivation: There was no clear motivation for employees to do their job perfectly as required. Motivation does not mean only financial motivation; people are motivated not only with money but also with an appreciation by the leaders of the company is enough to motivate them and pump in the force required to do the job with intensity. Captain must have set some goals which on achieving, the employees get recognition through an appreciation letter at least from the higher ranked personnel in the organization, keeping in mind that he was under the budget crunch which limited him in motivating employees by rewarding them financially. Ability: Analyzing the employees based on their capabilities was one of the cause. You will find some people whose interest is in doing the office work, captain should have recognize the skills and knowledge and segregate the work within depending on their capabilities. Coaching was also missing by the captain. Role Perceptions: They were aware about the consequences for inadequately doing the reporting as they were having issues when the case reached the court. Captain should have given them priorities from their various responsibilities by explaining them that the what matters is the quality of the work and not quantity. This would have helped them to improve. Situational Factors: As captain explained they set-up the team competitions based on the excellence of the reports, but the leaders were not committed and none of them were receiving any type of rewards for winning the competition. Leadership is responsible for the well-being of the employee in the company so they need to be committed. Question: Has the captain considered all the possible solutions to the problem? IF not what else might be done? Ans: NO What else can be done is as follows: 1. Task related trainings should be provided to strengthen the capabilities of the employees. 2. Improved Employee Engagement should be done, by recognizing the best employees, rewarding them which will boost their moral and they will feel that they are an integral part of the team. He can set-up a mechanism, like Employee of the Month Award and can display it in the office. 3. Coaching is also an important aspect of the leader, as a leader he should coach his team as and when required.

Management Respiratory Distress Syndrome Infants Health And Social Care Essay

Management Respiratory Distress Syndrome Infants Health And Social Care Essay Respiratory distress syndrome (RDS) is one of the most common consequences of prematurity and a leading cause of neonatal mortality and morbidity as a result of immature lungs. RDS particularly affects neonates born before 32 weeks of gestational age but is also recognised in babies with delayed lung maturation of different aetiology i.e. maternal diabetes. Since its initial recognition there have been vast advances in understating the pathology and management of this complex syndrome. However, in order to understand the pathology behind RDS it is imperative to obtain a good foundation of normal lung maturation and physiological changes that occur in the respiratory system during the transition from fetal to neonatal life. Physiological Development and Function of the lungs During intrauterine growth, fetal lung development begins as early as 3 weeks and progresses until 2-3 years. Conventionally it is divided into 5 stages; embryonic, pseudoglandular, canalicular, saccular and finally alveolar1 (Table 1). During the embryonic stage, the lungs develop from the fetal ectoderm to form the trachea, the main bronchi, the five lobes of the lung and the major blood vessels that connect the fetal lungs to the heart; the pulmonary arteries. This is followed by the pseudo glandular stage which results in the formation of the terminal bronchioles and associated primitive alveoli. These then further divide in the Canalicular stage to form the primary alveoli and subsequently the alveolar capillary barrier. This stage also comprises the differentiation of Type 1 and 2 pneumocytes which will later go on to produce surfactant. Thus babies born after 24 weeks, have a chance of survival as the platform for basic gas exchange has begun to develop. During the saccular st age there is further differentiation of type 1 and type 2 pneumocytes and the walls of the airways, in particular the alveoli, thin to enlarge the surface area present for gaseous exchange. This is followed by the alveolar stage which occurs through the transition form fetal to neonatal life up until 2-3 years. The hallmark of this stage is alveolar formation and multiplication to augment the surface area available for gas exchange to meet the increasing respiratory demands as the infant grows. Stage Time period Structural Development Embryonic 0-7 weeks Trachea, main bronchi and five lobes of the lungs develop from the fetal ectoderm. Pulmonary arteries form and connect to heart. Pseudoglandular 7-17 weeks Formation of terminal bronchioles and alveoli Canalicular 17-27 weeks Formation of alveoli-capillary barrier and differentiation of type I and II pneumocytes Saccular 28-36 weeks Walls of airway thin for efficacious gas exchange Alveolar 36 weeks -2 years Alveolar multiplication Table 1: Stages of Lung Development Once the pulmonary epithelium develops, it begins to secret fluid into fetal lungs, the volume and rate of which is imperative for normal lung growth. Another important factor essential for normal lung development and function is the production of surfactant. At about 24 weeks of gestation the enzymes and lamellar bodies required for surfactant production and storage begin to appear 3. Thus a normal fetus age is not ready to be delivered at this stage due to surfactant deficiency. As type II pneumocytes mature between 32-36 weeks, surfactant production increases and it is stored in the lamellar bodies of these cells. Surfactant is a complex mixture of phospholipids, neutral lipids and proteins 1, 4 that has a fundamental role in maintaining the alveolar-capillary interface and reducing surface tension. It is secreted as a thin film at the liquid-air barriers to facilitate alveolar expansion and prevent end-expiratory collapse of small alveoli, especially at low alveolar volumes. A key event in the development of the lungs is the establishment of spontaneous breathing post-delivery. Prior to delivery the fetal lungs decrease lung fluid production and as the lungs mature there is simultaneous maturation of the lung lymphatic system. During labour the mechanical compression of the fetal chest forces about 1/3 of this lung fluid thus preparing the fetus for spontaneous ventilation. This will require several stimuli; including hypoxia, hypercrabia and acidosis as a results of labour5 and hypothermia and tactile stimulation. Furthermore the stress of labour stimulates chemo-receptors in the fetal aorta and carotids to trigger the respiratory centre in the medulla to commence breathing. As the fetus emerges from the birthing canal, the fetal chest re-expands creating negative airway pressure which subsequently draws air into the lungs. This again forces the lung fluid out of the alveoli and allows for adequate lung expansion. As the newborn cries there is further e xpansion and lung aeration generating positive intrathoracic pressure which maintains alveolar patency and forces any remaining fluid into the lymphatic circulation. As the neonate adapts to extra-uterine life, the normal muscles of respiration work to maintain breathing (Figure 1). In order to inhale, the diaphragm and external intercostals muscles contract to increase the size of the thorax. This generates negative air pressure in the pleura and lowers the air pressure in the lungs so that the gradient between atmospheric air and alveolar air causes air to enter into the lung of the neonate. As the neonate inhales, the elastic recoil force of the lung increases. Once inspiration ceases, the elastic recoil force of the lung causes expiration. The diaphragm and external intercostals muscles relax, the thorax returns to its pre-inspiratory volume resulting in an increase in intra-thoracic pressure. This pressure is now greater than atmospheric pressure and air moves out of the lungs producing exhalation. Figure 1: The Mechanics of breathing6 For most neonates, this transition from fetal to extra-uterine life is uneventful and completed during the first 24 hours of life. The neonate is able to establish good lung function, maintain cardiac output and thermoregulate. However, for a certain population of neonates, usually those that are born early and thus called preterm, this transition is less smooth and it is these babies that will require the support and care of the whole paediatric department. Respiratory Distress Syndrome Respiratory distress syndrome (RDS) is the most prevalent disorder of prematurity and despite a better understanding of its aetiology and pathology, RDS still accounts for significant neonatal mortality and morbidity. The incidence RDS is inversely proportional to gestational age2 such that it decreases with advancing gestational age, from about 60-80% in babies born at 26-28 weeks, to about 15-30% in babies born at 32-36 weeks 1. Risk factors for developing RDS are summarised in Table 2 and include maternal illness, complications during pregnancy and labour and neonatal complications Table 2: Risk Factors for RDS1 Respiratory distress presents early in post-natal life particularly during the phase of transition from fetal to extra-uterine life. These babies will present with signs of grunting, cyanosis, nasal flaring, intercostal and subcostal recession, increased respiratory effort, and less commonly apnoeic episodes and circulatory failure. The severity of symptoms experienced are related to the pathology of disease and it is important to identify babies at greatest risk and commence management early in order to prevent respiratory complications such as chronic lung disease (previously called bronchopulmonary dysplasia), pulmonary hypertension and in adverse cases respiratory failure and even death. Identifying normal transition and respiratory distress is largely based on evaluating the risk factors for RDS, assessing the severity of symptoms and close neonatal observation if in doubt. Babies that are born close to term or those via caesarean section may display a difficult albeit a normal transition. These babies present with transient tachypnoea of the newborn in the first few hours with respiratory rates of about 100 breaths per minute and increased oxygen requirements. Symptoms are short lived, self limiting in most cases and usually relived by oxygen. Neonates who suffer from RDS will present with worsening symptoms of longer duration, respiratory rates of 120 and increased respiratory effort with a longer requirement for oxygen. Recovery if plausible usually begins after 72 hours and is associated with decreased oxygen requirements and better functional residual capacity. Pathophysiology of Respiratory Distress Syndrome Since its initial recognition, more than 30-40 years ago, much has been elucidated about the pathophysiology of this complex syndrome. In the premature neonate, the structurally immature and surfactant deficient lung is unable to maintain the basic lung mechanics required for adequate ventilation. As aforementioned lung mechanics rely on surfactant production, alveolar multiplication and maturity for effective gas exchange, chest wall elasticity and a functionally developed diaphragm. It is therefore evident that premature neonate who lack surfactant and have structurally immature lungs will develop RDS, atelectasis and abnormal lung function. In these neonates the essential first breaths are followed by a secondary pathological cascade characterised by tissue damage, protein leakage into the alveolar space and inflammation, which may resolve or progress to BDP or chronic lung disease of prematurity (CLD)7. In neonates with RDS, end-expiration results in the collapse of alveoli due to surfactant deficiency and a subsequent reduction in the functional residual capacity (FRC). The FRC is the volume available for gaseous exchange i.e the volume of gas left in the lungs after exhalation. It is determined by an intricate balance between the collapsing and expanding forces of the chest wall and lungs7. An ideal FRC enables the best possible lung mechanics, efficient ventilation and gaseous exchange. As the FRC is reduced at end-expiration due to alveolar collapse due to high surface tension, the pressure that will be required to re-inflate the already immature lungs is increased. This in turn increases the respiratory effort needed for adequate gas exchange which presents clinically as increased respiratory rate and subcostal/intercostal recession. Moreover reaching an optimal FRC may be further impeded by both surfactant deficiency and by the preterm infants impaired ability to clear fetal lung fluid. Radiographically a chest x-ray will show the characteristic ground-glass appearance with diminished lung volumes and the cardinal features of respiratory stress, tachypnoea, nasal flaring, intercostals recession, subcostal recession, increased breathing effort and grunting will begin to manifest early on. Despite this effort to breathe, alveolar ventilation remains poor. As these areas are receiving an adequate blood supply this produces a ventilation/perfusion mismatch resulting in right to left intrapulmonary shunting1. The lungs are unable to maintain good gas exchange and blood oxygen saturation and the level of carbon dioxide begins to increase resulting in respiratory acidosis, hypoxaemia and hypercarbia. The neonate further struggles to breath and attempts to generate higher negative pleural pressures to ventilate the lungs. The ensuing acidosis further diminishes surfactant production and neonates deteriorate rapidly as blood oxygen saturations plummet. The natural progression of the disease if left untreated will lead to pulmonary oedema, right-sided heart-failure and ultimately the most devastating outcome, neonatal death. Therefore the management of these neonates requires an aggressive multi-disciplinary team approach based on the pathology of these aforementioned homeostatic mechanisms. Alongside this the basic principles of neonatology; thermoregulation, nutritional support, efficacious cardiovascular support and infection control, are all fundamental in achieving the best therapeutic goal. Ultimately the aim is to provide adequate ventilatory support, allow the lungs to heal, impede further pulmonary injury, correct hypoxaemia and acidosis and above all to keep the neonate alive. Management of RDS As aforementioned the aim of treatment is to promote lung healing and reduce further pulmonary insults. We have already established that with increasing gestational age, particularly post-32 weeks, the infant will require less aid to help it cope with the transition from fetal to neonatal life. However, before 32-weeks there is an increased propensity to develop RDS and as the neonate is unable to cope, some form of respiratory support is required. Over the past 40 years there have been numerous management therapies including ventilatory support, surfactant therapy, nitric oxide therapy and supportive therapeutics strategies amongst others. The mainstay of treatment today remains supportive and involves the use of antenatal steroids, surfactant replacement therapy, continuous positive airway pressure and mechanical ventilation, which all aim to address the pulmonary insufficiency that manifest in these individuals Antenatal Glucocorticoids Glucocorticoid receptors are expressed in the fetal lung at early gestation and as the fetus grows stimulate surfactant production post-32 weeks. Alongside receptor expression there is an increase in fetal cortisol levels at late gestation9, which coincides with lung maturation, type II pneumocyte differentiation, surfactant synthesis as well as alveolar thinning. If birth occurs before this increase in serum cortisol, the pulmonary system has not matured adequately and therefore there is an increased propensity to develop RDS. Thus a single dose of glucocorticoids such as dexamethasone or betamethasone in the antenatal period promotes lung maturation. One of the first published reviews that showed the efficacy of antenatal steroids in preterm labour was produced by Crowley in 19958. Crowley showed that steroids given in preterm labour were effective in preventing RDS and improving neonatal mortality rates. Since then several randomised controlled clinical trials have evaluated the efficacy of steroids in reducing RDS. A recent Cochrane review of 21 trials assessed the effects of antenatal corticosteroids, given to women expected to go into preterm labour, on fetal/neonatal mortality and morbidity8. The authors concluded that a single dose of antenatal steroids promoted fetal lung maturation thereby reducing the risk of RDS and the need for assisted respiratory management. The mechanisms by which glucocorticoids are thought to exert their efficacy are described below. Firstly, glucocorticoids stimulate phospholipid production. Phospholipids are a major component of endogenous surfactant and as a result augment surfactant synthesis in the biochemically immature and surfactant deficient lung 9, although the exact mechanisms by which this occurs remains to be elucidated. Secondly glucocorticoids enhance lung maturation and development. As aforementioned, in order to produce surfactant, fetal lungs must produce type II pneumocytes which will then generate lamellar bodies in which surfactant is stored. Glucocorticoids enhance this process, promoting pulmonary epithelial cell maturity and differentiation into type II pneumocytes9. Furthermore glucocorticoids cause a decrease in pulmonary interstitial tissue thereby decreasing alveolar wall thickness. A thin alveolar wall thickness facilitates efficacious gaseous exchange and will therefore assist ventilation and oxygenation of the neonate once born thus decreasing the chances of developing RDS. Another known benefit of antenatal glucocorticoids is found in reducing oxidative stress on the immature lung and prevention of pulmonary oedema9. This accumulative evidence suggests that glucocorticoids are essential for normal pulmonary development and giving a single dose to mothers at risk of preterm birth may substantially decrease the chances of the infant developing RDS. Surfactant Therapy As discussed before, endogenous surfactant has a fundamental role in maintaining the alveolar-capillary interface in order to prevent end-expiratory alveolar collapse. This is achieved by thin spread of surfactant around the alveoli which ultimately acts to reduce surface tension. The most important component of surfactant which achieves this fundamental function is a phospholipid called dipalmitoylated phopshatidylcholine (DPPC)11. DPPC also stabilises the alveoli at end expiration, further preventing alveolar collapse. Alongside DPPC the synergistic actions of surfactant proteins (SP) SP-B and SP-C also lower surface tension11. Thus a deficiency in surfactant will cause alveolar collapse, decrease pulmonary compliance, increased pulmonary vascular resistance and produce ventilation-perfusion mismatch. Hence the aim of exogenous surfactant therapy is to reverse this pathological cascade and ultimately prevent alveolar collapse thereby limiting pulmonary damage and improving ventilat ion. Since the first clinical trial assessing the use of surfactant in managing neonatal RDS by Fujiwara in the 1980s10, our understanding of the composition, structure and function of surfactant has progressed vastly. In this uncontrolled trial the chest x-rays of 10 babies diagnosed with RDS, both clinically and radiologically, showed significant improvement after exogenous modified bovine surfactant was administered with a decreased requirement for ventilation. Since then several randomised controlled trials12 have shown that surfactant therapy, alongside antenatal steroids and ventilation continues to improve neonatal morbidity and mortality. Both natural (derived from an animal source) and synthetic (manufactured chemically) surfactants are available to use in managing RDS. Meta-analysis of trials comparing the two types of surfactant have shown that natural surfactants show a more rapid response in improved lung compliance and oxygenation12 thereby reducing neonatal mortality. Furthermore natural surfactants are less sensitive to inhibition by accumulative products of lung injury such as serum proteins. Surfactants need direct delivery to lungs and usually require intubation with short periods of assisted ventilation. Traditionally two therapeutic approaches have been established in managing RDs with surfactant. The first adopts the use of surfactant prophylactically, with surfactant given immediately after birth to enable the neonate to cope with extra-uterine life. The obvious benefit of this approach is that surfactant is administered to the baby before severe RDS develops resulting in long-term pulmonary sequelae for the neonate. However this technique is invasive, as surfactant administration requires endotracheal intubation, it is expensive and furthermore it may result in the unnecessary treatment of neonates. Moreover poor intubation with failed attempts and prolonged apnoeic episodes may further damage the lungs resulting in CLD. Despite this, there is a strong body of evidence for prophylactic use of surfactant and current guidelines state that all preterm babies born befo re 27 weeks of gestation, who have not been given antenatal steroids should be intubated and given surfactant at birth7. The second therapeutic approach evaluates the role of surfactant in rescue treatment used in neonates with an established diagnosis of RDS requiring ventilation and oxygen. The advantages of rescue treatment include that it is reserved for neonates in whom RDS is confirmed and it may decrease the morbidity associated with unnecessary intubation. The obvious disadvantage is that delay in surfactant delivery may allow for irreversible lung injury to develop with decreased efficacy of surfactant administration12. Several studies have aimed to clarify the issue between prophylactic and rescue surfactant treatment. A randomised trial by Rojas et al. showed the benefits of surfactant delivery within 1h of birth in neonates born between 27-31 weeks14 with an established diagnosis of RDS who were treated with continuous positive airway pressure soon after birth. 279 infants were randomly assigned either to the treatment group (intubation, very early surfactant, extubation, and nasal continuous positive airway pressure) or the control group (nasal continuous airway pressure alone). The results of this study demonstrated that infants in the treatment group i.e. those treated with surfactant, showed a decreased need for mechanical ventilation with a decrease in the incidence of CLD and pneumothoraces. Neonatal mortality rates were similar between both groups. A meta-analysis by Soll and Morley compared the effects of prophylactic surfactant to surfactant treatment of established respiratory distress syndrome (i.e. rescue treatment) in preterm infants33. The authors analysed eight studies comparing the use of prophylactic and rescue surfactant treatment and concluded that the majority of the evidence demonstrated a decrease in the incidence of RDS when surfactant was given prophylactically. Moreover the meta-analysis showed that infants treated with prophylactic surfactant had a better clinical outcome with a reported decrease in the risk of pneumothorax, pulmonary interstitial emphysema, CLD and mortality33. As a result of such studies most neonatal units continue to practice delivery of surfactant prophylactically in preterm babies at high risk of RDS. However, some literature still debates whether there are any real advantages of prophylactic surfactant over rescue treatment. What is evident is that surfactant therapy should play a fundamental role in the management of RDS. Future trials will need to further assess the indications for surfactant therapy in treating neonatal RDS and perhaps in the management of other pulmonary insufficiency disorders that affect the neonate. Although much remains to be elucidated about the complex pulmonary surfactant system, since its introduction 25 years ago, surfactant therapy has been at the forefront of reducing RDS and its role in decreasing neonatal mortality and morbidity cannot be disputed. Mechanical ventilation Mechanical ventilations is one of the cornerstones of neonatal intensive care units and regardless of the modality used, the primary function is to maintain adequate oxygenation and ventilation. The goals of mechanical ventilation are: to establish efficacious gaseous exchange to limit pulmonary insult and CLD to reduce the respiratory effort and work of breathing of the patient To achieve these basic goals several techniques, devices and therapeutic options are available to the neonatologist that can be either invasive or non-invasive. Continuous Positive Airway Pressure The use of CPAP; continuous positive airway pressure, in the treatment of RDS was first described in the 1970s and has since been identified as a important management strategy. CPAP applies positive end expiratory pressure (PEEP) to the alveoli throughout inspiration and expiration so that the alveoli remain inflated thereby preventing collapse. The pressure required to re-inflate the lungs is reduced as partially inflated alveoli are easily to inflate than completely collapsed ones. Animal studies with premature lambs have shown the benefits of nasal CPAP over mechanical ventilation. CPAP acts to lower the markers for CLD for example granulocytes, and markers of white cell activation, increases the amount of surfactant available, improves oxygenation and lastly corrects ventilation/perfusion mismatching2, 15. Moreover CPAP produces a more regulated pattern of breathing in neonates by stabilising the chest wall and reducing thoracic distortion16. Like surfactant therapy there are two ways in which CPAP can be administered. The first method, InSUrE: intubation, surfactant and extubation, adopts a brief intubation to administer surfactant and extubation to CPAP approach and the second is the Columbia method in which babies are started on CPAP in the delivery room and are only mechanically ventilated, and intubated if the need for surfactant is established. Several studies have shown the benefit of the first approach. A study by Verder et al. randomised 68 neonates with moderate to severe RDS; 35 infants were randomised to surfactant therapy following a short period of intubation and then extubation to CPAP and 33 neonates were randomised to nasal CPAP alone. The results of this study showed that infants in the earlier group had a reduced need for ventilation; 21% in comparison to 63% in the second group16,17. Another similar trial by Haberman et al. assessed the use of surfactant with early extuabtion to CPAP and subsequently the results showed a decreased need and duration for mechanical ventilation12. Furthermore a recent Cochrane review of six studies using the InSuRE method showed that neonates with RDS treated with early surfactant therapy followed by nasal CPAP, were less likely to need mechanical ventilation and develop air leaks in comparison to neonates that were treated with the Columbia approach (i.e. early CPAP therapy foll owed by surfactant if needed)17, 18. A more recent review by the same authors further confirmed the findings of the initial review and the relative risk for developing CLD was 0.51 (95% CI 0.26-0.99) with early surfactant treatment and nasal CPAP when comparing the two methods18. The Columbia method requires the stabilisation of neonates with CPAP in the delivery room with intubation and surfactant therapy used as necessitated. This approach was adopted when retrospectives studies done by Avery et al. and later Van Marter et al. evaluated the clinical outcomes in multiple neonatal units across the US2. In both cases a lower incidence of CLD was observed in the Columbia University Hospital which adopted CPAP as a primary treatment strategy as opposed to intubation and mechanical ventilation like other units. Leading on from this Ammari et al.. evaluated the Columbia method recently. The outcomes of 261 neonates with birth weight So far the evidence base for the Columbia method has been derived from retrospective cohort studies with a lacking in RCTS and therefore a lack of stronger evidence. One RCT that had aimed to evaluate the Columbia method was the recent COIN trial by Morley. This study evaluated whether the incidence of death or BPD would be reduced by CPAP rather than intubation and ventilation shortly after birth13. 610 neonates born between 25-28 weeks were randomised to CPAP or intubation and ventilation at 5minutes after birth and surfactant was administered at the neonatologists discretion. The results of the study demonstrated that at 28 days of gestation, infants in the CPAP group had a decreased need for supplemental oxygen and fewer deaths2,13. However worrying results from this study were that approximately 46% of babies in the CPAP group went onto require intubation and had a higher rate of pneumothoraces13. There are few randomised control trials assessing the benefit of CPAP alone in managing RDS and the results of the Columbia Hospital study have been irreproducible in other centres. The mainstream use of CPAP for managing RDS remains to start CPAP in the delivery room, after intubation for surfactant treatment. There is not enough evidence to show that CPAP alone can prevent RDS and associated complications in comparison with invasive ventilation. The evidence does suggest that there is a decrease in complications with surfactant therapy and CPAP but the relationship with CLD is less transparent. At present there are two RCTs ongoing that may provide further insight into the role of CPAP in RDS when complete. The first trial is the SUPPORT study, which is randomising infants between 24-27 weeks to CPAP beginning in the delivery room with stringent criteria for subsequent intubation, or intubation with surfactant treatment within 1 h of birth with continuing mechanical ventilation2. The second is the trial by the Vermont-Oxford Network in which infants born at 26-29 weeks gestation will be randomised after 6 days into one of three groups; (1) intubation, early prophylactic surfactant, and subsequent stabilisation on mechanical ventilation; (2) intubation, early prophylactic surfactant, and rapid extubation to CPAP; and lastly (3) early stabilisation with nasal CPAP, with selective intubation and surfactant administration according to clinical guidelines2. The immediate management of the RDS neonate with CPAP remains controversial and maybe the results of these ongoing RCTS wil l provide invaluable answers to the many uncertainties surrounding this device. Nasal intermittent positive pressure ventilation Another relatively recent development in non-invasive ventilation that has evolved from NICU ventilator machines and CPAP devices is the use of NIPPV for managing RDS. Sometimes called BiPAP (for bi-level positive airway pressure), this form of non-invasive ventilation is able to provide two levels of airway pressure, without the need for intubation. BiPAP maintains positive pressure throughout respiration but with a slightly higher pressure during inspiration. By doing so BiPAP/NIPPV is able to assist neonatal breathing by: reducing the work of breathing improving tidal volume increasing blood oxygen saturation and increasing removal of CO2 thereby limiting hypoxaemia and respiratory acidosis. As the neonate inhales, the NIPPV device generates a positive pressure thereby assisting the neonates spontaneous breath and providing ventilatory support. This is at a slightly higher positive pressure. As the neonate begins to exhale, the pressure drops, but a positive airway pressure remains in the lungs to prevent alveolar collapse and thus increase gaseous exchange. NIPPV may be a potential beneficial treatment for the management of babies with RDS and has been used in NICUs since the 1980s. Recently multiple studies have aimed to evaluate the efficacy of NIPPV in stabilising neonates. A randomised controlled prospective study by Kulgeman et al.. found that NIPPV was more successful than NCPAP in the initial treatment of RDs in preterm infants19. Kulgeman and his colleagues randomised infants A further study by Sai and colleagues also established the advantages of NIPPV over CPAP in managing RDs and reducing the need for mechanical ventilation and intubation in preterm infants. In their study 76 neonates between 28-34 weeks gestation with RDs at 6h of birth were randomised either to early NIPPV (37 neonates) or early CPAP (39 neonates) after surfactant use20. Firstly they documented that the failure rate with NIPPV was less in comparison to the CPAP group (p

How to Brief a Case Using the “IRAC” Method

Located in an upscale neighborhood, then perhaps it could argue that its failure to provide security patrols is reasonable. If the business is located in a crime-ridden area, When briefing a case, your goal is to reduce the information from the case into a format that will provide you with a helpful reference in class and for review.Most importantly, by â€Å"briefing† a case, you will grasp the problem the court faced (the issue); the relevant law the court used to solve it (the rule); how the court applied the rule to the facts (the application or â€Å"analysis†); and the outcome (the conclusion). You will then be ready to not only discuss the case, but to compare and contrast it to other cases involving a similar issue.Before attempting to â€Å"brief† a case, read the case at least once. Follow the â€Å"IRAC† method in briefing cases: Facts*Write a brief summary of the facts as the court found them to be. Eliminate facts that are not relevant to the court’s analysis. For example, a business’s street address is probably not relevant to the court’s decision of the issue of whether the business that sold a defective product is liable for the resulting injuries to the plaintiff. However, suppose a customer who was assaulted as she left its store is suing the business.The customer claims that her injuries were the reasonably foreseeable result of the business’s failure to provide security patrols. If the business is then perhaps the customer is right. Instead of including the street address in the case brief, you may want to simply describe the type of neighborhood in which it is located. (Note: the time of day would be another relevant factor in this case, among others).Procedural History*What court authored the opinion: The United States Supreme Court? The California Court of Appeal? The Ninth Circuit Court of Appeals? (Hint: Check under the title of the case: The Court and year of the decision will be given). If a trial court issued the decision, is it based on a trial, or motion for summary judgment, etc.? If an appellate court issued the decision, how did the lower courts decide the case?IssueWhat is the question presented to the court? Usually, only one issue will be discussed, but sometimes there will be more. What are the parties fighting about, and what are they asking the court to decide? For example, in the case of the assaulted customer, the issue for a trial court to decide might be whether the business had a duty to the customer to provide security patrols.The answer to the question will help to ultimately determine * This applies to case briefs only, and not exams. Use the IRAC method in answering exams: Issue/Rule/Analysis/Conclusion. whether the business is liable for negligently failing to provide security patrols: whether the defendant owed plaintiff a duty of care, and what that duty of care is, are key issues in negligence claims.Rule(s):Determine what the relev ant rules of law are that the court uses to make its decision. These rules will be identified and discussed by the court. For example, in the case of the assaulted customer, the relevant rule of law is that a property owner’s duty to prevent harm to invitees is determined by balancing the foreseeability of the harm against the burden of preventive measures.There may be more than one relevant rule of law to a case: for example, in a negligence case in which the defendant argues that the plaintiff assumed the risk of harm, the relevant rules of law could be the elements of negligence, and the definition of â€Å"assumption of risk† as a defense. Don’t just simply list the cause of action, such as â€Å"negligence† as a rule of law: What rule must the court apply to the facts to determine the outcome?Application/Analysis:This may be the most important portion of the brief. The court will have examined the facts in light of the rule, and probably considered a ll â€Å"sides† and arguments presented to it. How courts apply the rule to the facts and analyze the case must be understood in order to properly predict outcomes in future cases involving the same issue. What does the court consider to be a relevant fact given the rule of law?How does the court interpret the rule: for example, does the court consider monetary costs of providing security patrols in weighing the burden of preventive measures? Does the court imply that if a business is in a dangerous area, then it should be willing to bear a higher cost for security? Resist the temptation to merely repeat what the court said in analyzing the facts: what does it mean to you? Summarize the court’s rationale in your own words. If you encounter a word that you do not know, use a dictionary to find its meaning.ConclusionWhat was the final outcome of the case? In one or two sentences, state the court’s ultimate finding. For example, the business did not owe the assault ed customer a duty to provide security patrols.

Is Everything Already Determined by Fate or God or Is There Room for Human Freedom?

Is Everything Already Determined by Fate or God or Is There Room for Human Freedom? Do we as human beings have free will or does fate or God determine everything? The human life is lived in constant interaction with a complex of forces, energies, experiences, and events. Those are so varied that it is impossible or difficult to break it down to either or a duality of free will or fate. There is a pattern of what we have done, experienced, or are a part of. Yet, we are aware that there is a greater being, one that can be called divine.In that awareness, that of the divine presence, there is always a choice and possibility to create a new self in the image of God. In the book â€Å"God and the World†, an expression in Arabic Maktub was brought up which means, â€Å"it is written†. The question that was asked to Cardinal Ratzinger was whether or not God shows us the way we have to go so that we only have to recognize what is designated for us. His reply was that in Islam i t is addressed that everything is predestined and that we in a way live in a ready-woven web. That belief is contrary to Christianity because it always considers the freedom factor.In other words, on one hand, God embraces everything; he is aware of everything and guides the course of history. However, he has so arranged it that freedom has a fit in it. (58) In my understanding, Cardinal Ratzinger’s thoughts are as follow. Destiny is not predetermined. God has given you the choice to choose the right or wrong and also your destiny. If you do what God has commanded you to do, you escape hell and destruction. When you obey God’s commands, God saves your life and gives you eternal life after the physical death of your body.Christians pray because they’re told to. God is all knowing so he does know what we want and we still pray because it shows God that we recognize him as God and that we care enough to talk to him and keep in mind. In the article â€Å"Does doubt belong in faith†, there is a passage that states â€Å"just as we have already recognized that the believer does not live immune to doubt but is always threatened by the plunge into the void, so now we can discern the entangled nature of human destinies and say that the nonbeliever does not lead a sealed-off, self-sufficient life either. This part stood out to me because we often think of great faith as something that happens naturally so that we can be used for a miracle or healing. However, the greatest faith of all, and the most effective, is to live day-by-day trusting God. The type of trust that will make us look at every problem as an opportunity to see his work in our life. I think that a person’s faith is not complete unless he knows that whatever occurs could not have missed him, and whatever misses him could not have happened him. Everything is subject to the will of God all things were created with predestination.God knew all the disasters and troubles that happen on earth, or happen to an individual, or to his wealth or family, before they happened. No matter what disasters happen to a person, it is good for him, whether he realizes that or not, because God does not command anything that is not good for us. Once a person knows that all tragedies happen by the will of God, he has to believe and submit and be patient. The position of patience in relation to this aspect of faith, in particular, is like that of the head in relation to the body. Patience is a virtuous attribute with good consequences.Those who are patient will have an unlimited reward. Believing that God predestines everything that happens will teach a person to be modest and humble. This is so because everything that he does is by the willpower of God so if he succeeds he knows that he helped him in doing it; he doesn't succeed because he is intelligent or because he is rich or because he deserves it, and, likewise, a person isn't poor because he is stupid. This stops pr ide and arrogance from sneaking to his heart because he knows that God can afflict him with harm and deprive him from the rewards he brags about.In my opinion, believing in predestination doesn't make a person grieve about anything because he doesn't say things that reflect unhappiness like â€Å"if I did such and such then such and such would have happened†. Also, he doesn't worry too much about the future because he believes that everything is already written. What he would worry about is his actions and doing well. In the bible, and according to the bible a world that believes in a predestined fatalist environment is not correct. Although, we all are predestined, God has a plan for us all.He doesn't want to force us to do anything. We have always had free will. Without free will, what is the point? That is slightly different in Islam because as Muslims, the belief is that everyone's fate, and destiny is known, and written by God. It’s acknowledged that if someone st arts out poor and ends up rich, it's not because that person earned it out of hard work, it's because God wrote his fate as starting as poor, and ending up rich. Does Doubt Belong to Faith? October 2, 2007 Edward T. Oakes, S. J.

The Real Possibilities of Cloning essays

The Real Possibilities of Cloning essays On February 22, 1999 news was announced that Dolly the lamb was the first successful animal cloned. Unlike the other cloning experiments done over the past 15 years, this was the first successful clone made with an adult cell. The cell was used to activate and program the egg from which Dolly grew. Past clones involved using the cell from a fertilized embryo in the early stages of development. As news of Ian Willmut's cloned lamb got out across the globe, many people feared what they thought could possibly never come true. With the technology to clone identical animals, can humans be cloned too? Since then topic of discussion throughout the scientific world has centered on the cloning of humans. Recently, The University of Texas lab cloned the first headless creatures, headless mice. Since then, headless tadpoles have also been born at The University of Blath. This discovery is even more chilling because it opens up the door to headless humans, for purposes such as organ banks. Headless human production could also be used as a means for testing out new treatments for diseases such as cancer. Controversy is coming up more often considering the morals and ethics of cloning. Is headless cloning opening the gate to human immortality? Is a headless clone ever a living creature? Many people are beginning to wonder if cloning will be beneficial to our country. The cloning of animals as well as human cloning could prove very beneficial to our nation. For instance, cloning research would be very beneficial to improving the vitro fertilization process. Vitro fertilization is when a woman's egg is removed from her uterus, fertilized by a sperm donation, and replaced back in the uterus. John Robertson, an authority on reproductive technology and the law at the University of Texas School of Law says, "Even if they only produced three or four embryos, it could greatly improve the odds that it will work (Robertson, 3)." This c...

Creating a Vehicle Using Green Technology Essays

Creating a Vehicle Using Green Technology Essays Creating a Vehicle Using Green Technology Essay Creating a Vehicle Using Green Technology Essay Solar Vehicle EGR 100 12/3/2013 Introduction Living on Michigan States campus, one is constantly reminded to Be Spartan Green, whether it is turning off the lights or taking a shorter shower, Spartans are always striving to b e the most eco friendly students that any university could have. The problem at hand is to create a v ehicle using only green technology, such as solar panels, and have this car race up a ramp as fast as possible, with a shorter time being ideal. There are many requirements for this project, first of them being that the team itself eeds to be qualified to tackle such a task. With two members majoring in mechanical engineerin g, two members majoring in computer science, and one in biosystems engineering, the team has a wi de range of engineers that all pose a special skill that will aid in the creation of this solar car. An other requirement for this project is materials. Some needed are solar panels, which are provided, whee Is, gears, axles and some form of a structure. Each week the group needs to collaborate on new ideas an d be willing to share their opinions. A major constraint for this project would be time management. With so many different schedules it can be difficult to find the time to meet with the entire group at once. Each week group members would meet up to accomplish their goal. From starting out with prototypes and ending with a finished project. The desired end result will be a solar c ar that is light, efficient, and able to use its energy source in a way that will help it go as fast as possi ble up the ramp. Methods There are many different possible designs that would have fit within the constraints o f this roject. The designs that were created initially were later discarded after realizing th at transporting a load was no longer a requirement. This meant that the solar car would only need to go as fast as possible. This could be accomplished by either reducing weight or increasing power. Reducing weight was ultimately the key factor to the design decided upon. Many different designs we re thought through all with pros and cons that eventually led to the final design. The first alternative design was relatively similar to the primary design in that it had f our wheels, he motor on the front end of the car, and the solar panel placed on top, but it did no t incorporate any space to carry a load. The second alternative design for the solar car only had three wheels as to minimize weight. The axle of the third wheel would be connected to the axle of the fr ont two wheels by rubber bands so that the motor would still power the third wheel. Both of the design s were to be built upon a base constructed of 4 small long blocks of wood. These designs were created knowing that there would be future improvement. A basis was needed to start of the design proce The design of the prototype is roughly the same as the alternative design. It consists ofa simple structure and base that act as a housing for the parts of the motor and the solar pan el. The design is aimed to use the least amount of parts as possible so that the vehicle will be lightwei ght yet sturdy. The motor and solar panels are at opposite ends to balance the car. There is a spot to ad d a load if necessary. The power is being sent to the rear wheels via a rubber band and gears. This prototype was not functional because of various reasons. One of the reasons was because it was to bulky and heavy for the motor to move the vehicle. The elasticity in the rubber band caused the whee Is to have a hard time turning. It was decided that gears would work better because they are not goin g to have any elasticity damping the power of the motor. The final design was decided upon because it was lightweight and proved to be the most cost effective of all the designs. The base of the car is in a triangle shape that has a slit in the top of the triangle. The slit is big enough so that the back wheel can fit inside of it without touc hing the sides. On

Rotanas expansion Case Study Example | Topics and Well Written Essays - 750 words

Rotanas expansion - Case Study Example Rotana through the management expects to raise the standards of the hotel industry, which is only majorly realizable with clear goals. Performance in terms of the achievement of measured growth and expansion realization through the Middle East is also likely to improve due to well-set goals. Goals also support the controlling function in planning, as progress can be assessed and corrective action taken. When a company is able to meet its goals, motivation levels go up an as a result increased output is realizable (Forsyth 123). From the case study, Rotana’s stated goals are simple, clear, flexible and achievable given the growth realization so far both in the ME and North Africa. In addition, they are measurable, well written, in terms of outcomes and they are communicated to all the necessary members of the organization (http://www.rotana.com). â€Å"This is Rotana† in Rotana Hotels website, tell us much about the Vision, Values, and expansion plan. According to the Vi sion which is, â€Å"To be the Leading Hospitality Management Company recognized for its unique blend of world-class standards with genuine hospitality and for its truly treasured experiences provided for guests, colleagues and owners.† It is Culminated with a Brand promise revolving around their treasure for time, adaptability to treasured time and how such a time recognizes the past while reflecting on the presents into a promising future. Based on this it is prudent to say that Rotana adheres to its values and based on its Vision it has the potential of achieving its expansion plan to 100 hotels in the next three years (http://www.rotana.com). The case study reiterates the fact that planning is a procedure where an organization sets goals like the ones set by Rotana Hotels. After this, they then formulate a strategy on how such goals and targets are to be met. Ultimately developing an inclusive plan to integrate and coordinate work activities. According to the case study, I am able to learn that planning provides direction while reducing the level of uncertainty in organizational goals achievement. According to the case study, we are able to see that Rotana Hotels are able to grow by 70 branches and across regions that is in North Africa and ME (http://www.rotana.com). In attaining these, the Hotel was able to minimize wastage with well-set standards for control (Forsyth 207). Case study 2 Air Arabia seems to exploiting the Low cost strategy aimed at quality service provision to its clients while maximizing the profitability from its operations. The company claims to be the one that offers comfort, reliability, and value for customer’s money. In its low cost strategy, it has placed measures to reduce training, maintenance, and multi-cabins cost. Coupled with this is the high turn around costs to save on airport expenses. Airport, expenses are also reduced by flying to secondary less congested airports. Apart from the optional paid for in fligh t food and beverage the airline exploits for cheaper advertising through the internet hence saving on costs. The main advantage of this airline is the location, which allows it to access several locations worldwide hence wide client base (http://www.airarabia.com). SWOT analysis is quite useful for Air Arabia given its focus on its growth plans. This is because the SWOT would enable the stakeholders to quickly understand the company while recognizing its potential partnerships and suppliers. This is because SWOT analysis is a crucial resource for industry executives and anyone with an interest in gaining a better understanding of a company’s business (http://www.airarabia.com). Furthermore, the company will be bale to gain insight into the market place and better

Relevance of Clinical Care in Nursing Research Paper

Relevance of Clinical Care in Nursing - Research Paper Example The basic idea is to get involved in community services without expecting any reward. The idea is to serve the community and people by taking care of their needs. Extracurricular activities include taking time out of the normal routine and devoting much of time in community services to learn ways of serving others in a compassionate manner. This also requires leadership attributes as dealing with people and serving them comes under little guidance and individuals needs to decide the mode of interaction, behaviour and mannerism often requiring a participating and compassionate approach. Moreover, students are guided by people having prior experience in serving the community and thus there is ample scope to learn from the leaders to become leaders. The most significant experience can be of realising the fact that serving others offers great happiness that is unmatchable. The very idea of bringing smiles over the faces of others can be considered as the most significant experience and a chievement. Achievements show dedication and reward but in my case; being compassionate and dedicated reaped all achievements along with offering rewards in the form of priceless smiles and gratitude. I personally believe that nothing can beat this particular experience in terms of contentment. At times, serving the community exposes oneself to learn and the elements of risk are quite negligible. From an early age, I was fascinated to see doctors and their approach while serving others by curing them and bringing smiles on their faces. This created a profound impression over my mind along with making me think that serving the community and people is the real bliss. As a community care extender, my role will be to act as a volunteer in any hospital. This will help me in learning the intricacies of people and service management. With the primary goal of becoming a nurse, the role of community care extender will help in having a profound idea over how things are managed in hospital and how patients are managed and cared. As an intern, I will be receiving training in patient care that will be further utilised in my professional career. Overall, it can be said that the role of clinical care extender will assist me in meeting my career goals along with offering me a chance to evaluate my skills and attributes in a clear and precise manner. The core value of an internship is to follow the goals and objectives of the organisation along with devoting oneself in a selfless manner. The prime objective is to take care of patients along with learning new things by being active and zealous. At the same time, it is important to be honest, transparent and ethical in approach while initiating and completing tasks and responsibilities. Being an intern, it is very much evident that one has to assist the organisation in accomplishing its goals and objectives. In hospitals, it is important to have a compassionate and ethical approach in order to serve people and their needs. If I get selected as an intern, I will be ethical and honest in my approach. In last few years, I have learnt that ethics, honesty and transparency show the character of an individual and speak on his behalf. I will carry forward with this mindset along with embracing the legacy and objectives of the organisation to empower myself as a human being.