Discuss Oedipus' tragic flaw and its ramifications Research Paper

Discuss Oedipus' tragic flaw and its ramifications - Research Paper Example To escape such a tragedy, he tied the infant’s ankles and commanded a shepherd to leave it to die at Mount Cithaeron. Taking pity on the innocent soul, the shepherd instead brought him to Polybus, king of Corinth and wife Merope. They raised the child as their own and called him Oedipus. Intrigued by questions about his true identity, and with his adopted parents standing firm on the deception that he is their own, Oedipus consulted the oracle of Apollo at Delphi. Oedipus was told that he is fated to take the life of his father and make a wife of his own mother. Horrified of what awaits him in what he thought was his birth land, Oedipus left Corinth, determined never to return. On his journey to Thebes, he came upon Laius and had him killed when a squabble over pride sets in, inadvertently fulfilling part of the prophecy. At the time, Thebes was in state of trepidation on account of a man-eating Sphinx, thus unable to pay enough attention to the death of its king. Oedipus, how ever, brought the Sphinx’s reign of terror to an end by answering its riddle about the phases of human life. Consequently, Oedipus was granted the right to the throne and the hand of Jacosta, widow to Laius and mother to Oedipus, in marriage. They had four children: two sons, Eteocles and Polynices, and two daughters, Antigone and Ismene. The attempt by Oedipus to break away from the fated catastrophe proved meaningless. As a consequence of the serious mischief he inflicted upon his parents, Oedipus was held responsible for a series of unfortunate events that tormented Oedipus himself, his family, and the whole of Thebes. It was such an irreparable damage that can be put right by neither repentance nor punishment. The Plague in Thebes The magnificent reign of Oedipus in the city of Thebes was brought to a standstill when once again a pestilence that spared not a single being came about. The soil from which the people cultivated their live stocks turned barren, and the robust greenery that supplied their daily bread stopped bearing fruits. Worst of all, the women complained of infertility—unable to bequeath their husbands successors to their homes and duties. This was conveyed to Oedipus in appalling agony by a priest of Zeus. â€Å"Meanwhile, the common folk, with wreathed boughs, a blight is in our harvest in the ear, a blight upon the grazing flocks and herds, a blight on wives in travail; and withal armed with his blazing torch the God of Plague hath swooped upon our city emptying the house of Cadmus, and the murky realm of Pluto is full fed with groans and tears† (Sophocles 3). It was revealed by the blind prophet Teiresias that the plague shall not be banished from Thebes until the death of king Lauis is given justice, and the perpetrator was thrown to perish into the fortress of Hades. Oblivious to the fact, Oedipus vowed to his subjects that he would stop at nothing to take vengeance on the man responsible. Typical for a man in his position, Oedipus demonstrated resoluteness to keep his word despite pleas by his wife to do otherwise. This, unfortunately, resulted in another tribulation that broke his heart and tore his soul into pieces. When her brother Creon came back from an inquest to give light to the tragedy that befell the late king, Jocasta had her suspicions

Target Research Paper Example | Topics and Well Written Essays - 2250 words

Target - Research Paper Example Product quality plays an important role in determination of performance of companies that gain success in the long term (Foss & Knudsen, 2003). In this paper, the issue of maintaining good quality of products by Target Corporation has been discussed as a method of defeating the company’s rivals (Ehmke, 2008). Customers prefer making purchases from Target stores since they get the appropriate products that they are searching for at the most reasonable prices (Nadia, 2001). The key strategies that have led this company up the success ladder are excellent marketing and advertising strategies, high brand value developed through strategic promotion of brand and intense product differentiation (Franco-Santos, et al., 2007). Being one of the top ranking companies in the US market, the company faces steep competition from other dominant firms in the market, such as, Wal-Mart, K-Mart and Costco. However, recently, the firm has been facing certain problems, such as high price of product s than market standards and very close substitutes of its products. The main issue faced by Target Corporation is that whether it should follow the strategy of maintaining high quality of its products. The two contesting arenas that arise in this regard are high quality and high price. Target is considering high quality for its products while it is out wedged by competitors that offer low priced products. This paper is dedicated to the discussion of bringing solution to this problem. Different possible solutions to this problem would be discussed. These solutions are provided after considering the current business environment in which the company operates. Although, all the possible solutions are proposed on the basis of the some analysis of the company situation and overall industry condition, these refer to diverse aspects. However, in order to gain advantage over its nearest rivals, the company would have to identify the loop holes in which it is directly lagging behind its compe titors. In this case, the problem is that the company is facing price war. Competitors, such as Wal-Mart, K-Mart and Costco, which are known across the globe for their low price items, are gaining edge over Target Corporation, since the prices charged by Target are higher than the products that they offer. In this case the company might aim at reducing cost so as offer the products at lowered prices. However, price wars can be sustained only up to a certain limit, beyond which prices cannot be reduced for maintaining profitable business. Hence, it would have to take some other option for maintaining its competitive position in the industry. These possible solutions are discussed in the next section. Possible solutions to the problem In the current business world, companies are concerned about the gaining an extra edge over other market players. An important aspect that helps in assessing the performance of a particular company in the market is the extent to which customers would be attracted more towards a particular brand than other brands available in the market. It is imperative for every business to develop a base of loyal customers that would increase over time (Smith & Wright, 2004). Niche markets are growing rapidly in the modern world and they are increasing awareness of customers about product features and characteristics of products that they

Growth Mindset Essay Example for Free

Growth Mindset Essay Asking Effective Questions Problem Solving Approach in mathematics classroom because it engages student in inquiry, prompting them to build on and improve their current knowledge as they â€Å"construct† explanations and help them solve tasks at hand. In a â€Å"Constructivist classroom† students are seen as the ones who are actively creating their own knowledge†. This is done through questioning to h I need respect, motivation, encouragement, determination, to have confidence in your students. 8 Tips for Effective Questioning 1. Anticipate Student Thinking (plan the possible questions to stimulate thinking and deepen student understanding 2. Link to Learning Goals 3. Pose open ended questions 0 help build students’ self-confidence, help them respond at their own stage of development and allow for differentiation Invitational stems that use plural forms and exploratory language invite reflection. Huinker and Freckman (2004, p. 256) suggest the following examples: As you think about Given what you know about In regard to the decisions you made From previous work with students When you think about..As you consider In what ways In your planning Take a minute. 4. Pose Questions that actually need to be answered 5. Incorporate verbs that elicit higher levels of Bloom’s Taxonomy Verbs such as connect, elaborate, evaluate and justify prompt students to communi- cate their thinking and understanding, to deepen their understanding and to extend their learning. Huinker and Freckman (2004, p. 256) provide a list of verbs that elicit specific cognitive processes to engage thinking: observe notice remember contrast interpret evaluate summarize visualize (â€Å"see†) differ distinguish decide identify compare predict explain conclude infer relate consider describe 6. Pose Questions that Open up conversations to include others. 7. Keep Questions Neutral 8. Provide Wait Time (use strategies such as turn and talk, think-pair-share and round robin to give students time to articulate and clarify their thinking Ms Hastings does use different Instructional Strategies. She builds strong relationships with her students, set high expectations for performance and has a good understanding of their needs to reach success in her classroom. Ms Hastings first has a strong belief in the â€Å"Growth Mindset† by setting high expectations and showing student they can learn as opposed to the belief of â€Å"either you are good at math or not†. Teacher shows students how they can succeed and achieve through â€Å"application and experience†. Their words and actions make it clear that the past does not dictate the future. If a teacher promotes the â€Å"growth mind-set†, they can focus students on â€Å"self-development, self-motivation and responsibility† and help them develop the mental determination to continue to improve. She clearly sets objectives and provides feedback to her students to help them progress. By reinforcing effort and providing recognition, students believe they can succeed. These strategies all provide students with the belief that they can positively affect their learning She also uses various strategies to promote thinking and learning in the classroom. She uses cooperative learning, uses effective questioning and graphic organizers. She uses team building exercises and forms a base group, in which they learn and work together for the semester. In reading the Capacity Building Monograph in â€Å"Asking Effective Questions in Mathematics† in showed how you can change Learning to becoming something you get for a short time to permananence and building a deeper understanding. In Ms. Hastings class, the 8 tips provided in this monograph are great strategies being used in Ms. Hastings class. One of the most important influences in student achievement is the relationship between teacher and students (Hattlie, 2009). By Ms. Hastings telling success stories this provides encouragement to her students. Ms. Hastings class is preparing her students with the skills of the â€Å"21st Century Learner†. She is doing this by helping her students set personal learning goals, self-assessment for understanding, therefore, making learning permanent, accessing tools and resources for enhancing their understanding and using their learning in rich meaningful tasks in real-world contexts. These students will learn problem-solving, critical thinking and using their prior knowledge and skills to apply them to new situations. Two challenges faced by adolescents is the belief they are not good at math, therefore, find it challenging and are less engaged in math class. The second challenge is to make math learning become permanent through student engagement. This means using Instructional Strategies to ensure students are engaged in their own learning and self-assessment. One of the challenges faced by adolescents is the belief they are â€Å"not good at math†. This may be imparted by their parents belief they were not good at mathematics and do not ask more from their children. There needs to be a shift from this belief from all adults involved. They must recognize and affirm the importance of mathematical literacy for all. In the Ministry’s Numeracy Report (2004), students need the â€Å"ability to deal with the  fundamental notions of number and change in order to make sense of mathematical information presented in everyday contexts† (Paulos, 1988, pg.). Mathematical literacy in important for both employment and post-secondary admissions. Therefore, as teachers, we need to take advantage of the abundant opportunities for fostering mathematical literacy across the curriculum. As with Ms. Hastings, has a strong belief in the â€Å"Growth Mindset† by setting high expectations and showing student they can learn as opposed to the belief of â€Å"either you are good at math or not†. Teacher shows students how they can succeed and achieve through â€Å"application and experience†. Their words and actions make it clear that the past does not dictate the future. If a teacher promotes the â€Å"growth mind-set†, they can focus students on â€Å"self-development, self-motivation and responsibility† and help them develop the mental determination to continue to improve. She clearly sets objectives and provides feedback to her students to help them progress. By reinforcing effort and providing recognition, students believe they can succeed. These strategies all provide students with the belief that they can positively affect their learning She also uses various strategies to promote thinking and learning in the classroom. She uses cooperative learning, uses effective questioning and graphic organizers. She uses teambuilding exercises and forms a base group, in which they learn and work together for the semester. The second challenge faced by adolescent if to ensure their learning has â€Å"permanence†. This is done through strong conceptual foundations in math and ample opportunities for students to demonstrate their knowledge. I also believe that as teachers we need to use effective instructional strategies to emphasize student ability to think, use problem-solving skills and build on prior knowledge. Ms. Hastings uses various strategies to promote thinking and learning in the classroom. She uses cooperative learning, uses effective questioning and graphic organizers. She uses team building exercises and forms a base group, in which they learn and work together for the semester. In reading the Capacity Building Monograph in â€Å"Asking Effective Questions in Mathematics† in showed how you can change Learning to becoming something you get for a short time to permanence and building a deeper understanding. In Ms. Hastings class, the 8 tips provided in this monograph are great strategies being used in Ms. Hastings class. One of the most important influences in student achievement is the relationship between teacher and students (Hattlie, 2009). By Ms. Hastings telling success stories this provides encouragement to her students. Ms. Hastings class is preparing her students with the skills of the â€Å"21st Century Learner†. She is doing this by helping her students set personal learning goals, self-assessment for understanding, therefore, making learning permanent, accessing tools and resources for enhancing their understanding and using their learning in rich meaningful tasks in real-world contexts. These students will learn problem-solving, critical thinking and using their prior knowledge and skills to apply them to new situations. To be able to prepare our students as 21st Century Learners, we need to increase our math competence through professional learning to be more effective. The Expert Panels Report on Student Success in Ontario Mathematical Literacy, Grades 7-12 (May 2004) looked at at-risk mathematical learners and came up with a number of themes: Effective teaching and learning begins with the needs to the adolescent learners and have a good understanding of their development stages Connect the learning in math to the lives of the students (having rich meaningful tasks that connect to real-life contexts) Ensuring they have a strong conceptual foundations to be able to apply their knowledge and continue their learning Instructional learning strategies empahisize problem solving and building and one’s own understandings To improve students’ performance, teachers need to link instruction more closely to assessment More professional learning opportunities for teachers to strengthen their competence in math Technology to support learning and have more accessibility to students who are struggling in math Also extra support for  Ã¢â‚¬Å"at risk† students to close the gap Strong leadership and strong planning to create an effective learning environment in which all the needs of the students are met and success is promoted. 2. Changing Climate – Transforming Classroom Culture Dan Myer Inquiry Based Learning Being interest in students thinking How my teachers see them in a sincere way and shed the idea of controlling the process Bring the student who are not strong in the foundations Gains in achievement – multimedia helped students who are identified at risk or LD Teach as we are taught, memorization, calculations, learning formulas, doing math and debrief M.J. Hobbs Senior P.S. –DI 7-8 Differentiated Instruction and problem solving by group readiness Individual Accountability in group work Create a positive work environment Group work looks like, sounds like anchor charts with clear understanding of expectations Participate in work that is engaging and challenging Centennial S.S. HPEDSB Differentiating Instruction Secondary Think-Pair-Share Mathematical Questions Justify using mathematical vocabulary Learning Centres give students choice, work collaboratively and related to hands on materials and manipulatives’ based on their strengths (observe the kids first to see how they are learning Use the entry point depending on their strengths and how they learn to work towards the curriculum expectations Use of different strategies and connect using different means to demonstrate their learning Data given for Problem Solving Exit cards to demonstrate learning in a differentiated environment to take responsibility on teaching the students how they learn DI planning for kids based on grouping on kids strengths and needs.

Acute Respiratory Distress Syndrome Health And Social Care Essay

Acute Respiratory Distress Syndrome Health And Social Care Essay Acute Respiratory Distress Syndrome (ARDS) is a serious respiratory condition of diffuse alveolar injury seen frequently in intensive care patients. It was first identified in 1967 by Ashbaugh, Bigelow, Petty and Levine as the acute onset of broad respiratory symptoms. This improved the clinical and pathological understanding of the condition. Small changes to therapeutic practice have developed, however despite these developments the morbidity and mortality in patients of all ages with ARDS remains significantly high (Fan, Needham, Stewart, 2005). This topic has been chosen by the author as they have a personal interest in this type of patient after having recently cared for a critically ill ARDS patient in their ICU (Intensive Care Unit). The author has previously been involved in caring for ARDS patients at their place of work and over that period has observed changing practices and treatment. A further knowledge and understanding of this complex patient is their motivation for this topic. A case study relating to a case of ARDS is attached as Appendix 1 and will be referred to throughout this assignment. The pathophysiology of this disease leading up to the presenting signs and symptoms of ARDS will be presented. Current literature and treatment trends will be discussed in conjunction with the medical and nursing practice observed within the ICU workplace. Treatment trends and recommended best practices will be identified and critically analysed. Recommendations will then be presented to encourage best practice within the ICU workplace. First described in 1967 by Ashbaugh and colleagues as Adult Acute Respiratory Distress Syndrome, ARDS patients continue to have a high rate of mortality and morbidity (Fan, Needham, Stewart, 2005). A definition was implemented in 1988 (MORE DETAILS>>>) and then a new simplified definition was recommended in 1994 by the American-European Consensus Conference (AECC) (Harman 2009). It acknowledged that the severity of lung injury varies, and it was a definition that was easy to apply in the clinical setting (Ware Matthay, 2000). The new definition involved changing the name from adult to acute respiratory distress syndrome as it was observed that the syndrome occurs in adults and children. The AECC definition states that the patient must have an acute condition, characterised by bilateral pulmonary infiltrates and severe hypoxaemia in the absence of evidence of cardiogenic pulmonary oedema. Hypoxaemia is calculated as a ratio of PaO2/FiO2. In ARDS the ratio is less than 200. Cardiogen ic pulmonary oedema is excluded either clinically or by pulmonary wedge pressure of less than 18mm Hg in patients with a Swan-Ganz catheter. Despite this official and accepted definition there is still argument over the ability to accurately define ARDS when it is a syndrome and not an illness and because of this the presentation and pathway of the disease varies between patients (Zambon Vincent, 2008). There has also been criticism over the simplicity of the AECC definition as it does not identify the underlying cause, nor does it require other systems affected to be assessed (Ware Matthay, 2000). The major benefit of the universally accepted definition has been the ability for hospitals and investigators to begin the advancement of clinical trials into treatment of this syndrome (Ware Matthay, 2000). In patients diagnosed with ARDS 80% can have the cause related to either direct or indirect injuries. Direct injuries include pneumonia, aspiration, lung contusion, fat embolism, near-drowning, inhalation injury, and reperfusion injury. While indirect injuries include non-pulmonary sepsis, multiple trauma, massive transfusion, pancreatitis and cardiopulmonary bypass (Berten Soni 2009). This insult to the respiratory system is reflected in a variety of pathophysiological presentations leading to the patients presenting signs and symptoms. There are 3 identified stages of ARDS. The acute or exudative phase is seen in days 1-7. The sub-acute or proliferative stage is seen from around day 7, and the chronic or fibrotic phase is generally seen around 2-3 weeks after the initial onset (Marshall, Bellingan, Laurent, 1998, Griffiths 2007). The exudative phase leads to the disruption of the normal alveoli-capillary barrier which therefore disrupts ventilation and oxygenation. Inflammation occurs in the lungs and the body releases cytokines and inflammatory mediators from the epithelial and endothelial cells. Other cells (neutrophils and T-lymphocytes) move into the lungs and causing alveolar damage. The inflammation causes endothelial dysfunction, and increases the permeability of this barrier which allows fluid to escape from the capillaries and limits the draining of fluid out from the lungs. Small vessel thrombosis occurs as a result of pulmonary capillary and endothelial swelling Cell debris plugs the alveolus lumen leading to pulmonary oedema increasing the thickness in the alveolar-capillary space. Surfactant supply depletes and production becomes inactivated. The exudative phase is seen in the ICU patient as increased shortness of breath, higher respiratory rate, productive cough, wet sounding chest, decreased oxygenation. These symptoms were all seen with the patient in Appendix A. The Proliferative Phase is and involves the initial stimulus causing the stimulation of the cascade effect. All ARDS patients will experience this stage. It leads to an increase in the permeability of the alveolar-capillary barrier leads to a rush of fluid into the alveoli. This injury allows pulmonary oedema to occur in patients with no known cardiogenic failure. This protein rich fluid engulfs the alveoli drawing in activated neutrophils and macrophages. This initiates the inflammatory cascade which releases interleukins, tumour necrosis factor and inflammatory mediators. Neutrophils release oxidants, leukotrienes and various proteases. The effect of this process is cell damage, with cell debris blocking alveolus lumen and the inactivation of surfactant. As a result platelets combine, a procoagulant cascade may arise. Surfactant inactivation, alveolar filling, cellular debris all lead to an increase in respiration rate. Surfactant loss causes alveolar collapse due to increased surface tension and causes a decreased closing lung volume. This leads to less than normal functional residual capacity causing increased respiratory rate and reduced lung compliance. The alteration in the harmony between alveoli and vascular ************************************************** The proliferative stage is generally seen after day 7. It involves the proliferation of fibroblasts, hyperplasia of pneumocytes and ongoing inflammation. The Fibrotic phase is seen 3 weeks after presentation and the patient is seen to have lung fibrosis, honeycombing and bronchiectesis. This leads to long-term chronic lung conditions. Clinical management of ARDS is focused on promptly and appropriately treating the underlying cause, supporting lung function and preventing complications related to the medical treatment and the disease process. No treatment is definitive, but early anticipation of complications can reduce the length of stay. Treatment is supportive As previously noted mortality rates have barely reduced over the years. There has been much research into new ventilation strategies along with pharmacological and non-pharmacological techniques. So far few have improved survival. The most important and practice changing study was in 2000 when The Acute Respiratory Syndrome Network did a large (861 patients) multi-centred randomised trial comparing traditional tidal volumes with lower tidal volumes. At the time patients were being ventilated with tidal volumes (VT) of 10-15ml per kilogram of body weight with plateau pressures of 50, to achieve normocarbia and pH. The study was abandoned early as there was seen to be a 22% decrease in mortality of those patients with the lower range of TV. The high peak pressure and the high tidal volumes were found to be causing shearing injuries to the lungs and also causing a higher mortality. This study revolutionalised ventilation strategies of ARDS patients and demonstrated that lung protection techniques could improve survival (Levy, 2004). It is now common practice worldwide to ventilate patients on tidal volumes of around 6ml/kg and as low as 4ml/kg and to allow permissive hypercarbia. I There continues to be research in to the benefit of PEEP in ARDS. There have been several studies conducted looking at the benefits but few have had conclusive results. Ashbaugh et al. (1967) identified patients that were mechanically ventilated with ARDS and had no PEEP became immediately severely hypoxaemic. Research has continued since then as to identify the optimal amount of PEEP. PEEP is important as it assists the severe ARDS patient by minimising alveolar collapse and improving gas exchange and lung compliance. Traditionally PEEP is set at 5-12cmH2O (Briel et al., 2010) but it is yet to be established what is the optimal level of PEEP ( Gattiononi, Caironi, 2008, Dellinger, Levy, Carlet et al, 2008). recent studies have been trying to identify if higher PEEP is better than lower, or traditional PEEPS. The problem has been what is low and what is high PEEP? A recent analysis by Briel et al. (2010) and supporting commentary by Rubenfeld (2010) has identified that the it has also been found that PEEP can be dangerous in but it is not established how much is enough PEEP. The author has identified medical and treatment seen within their place of work and will discuss this further. Oxygenation is optimised as seen in appendix A by Treatment includes optimising gas exchange by maintaining oxygenation, adequate tissue perfusion. Strict fluid balance. Ensuring nutritional requirements are met Before 1990 ARDS was reported to have a mortality rate of 40-70% in the US (there were few studies outside the USA initially) (Harman, 2009). Since then several studies have been done around the world. New research has found the rate of mortality has deceased marginally in some studies, but still not significantly. A couple of studies in the US and the UK in the 1990s have found mortality rates much lower in the 30-40% range (Davidson, Caldwell Curtis, 1999, Davey-Quinn, Gedney Whitely 1999). A 2002 Australian study identified mortality at 34% (Bersten, Edibam, Hunt, Moran, and the ANNZCCSCTG). A 2008 systematic analysis of ARDS statistics identified mortality still in the range of 15-61% in studies published after 2000 (Zambon Vincent, 2008). It must be acknowledged that some of this data was from studies with very small groups of patients in the trials. Despite this it still identifies a high rate of mortality and very little improvement in survival over the years. Improvements have been developed in the care due to ventilation strategies, improved intensive care better understanding and treatment of sepsis, recent changes in the application mechanical ventilation, better overall supportive care of critically ill patients Medical and nursing management within the authors One of the biggest developments in the treatment of ARDS was a study done in 2000 which challenged the traditional ventilation of high Treatment is supportive with the aim of maintaining adequate oxygenation to the tissues via APPENDIX 1 Mrs X is a 51 year old female who is normally fit and well. She has no past medical history. She does not take any regular medicines. She has no known allergies. She lives with her husband and 3 adult children and works full time. She returned from Melbourne 10 days prior to her presenting symptoms appearing. Mrs X has been unwell for 7 days with lethargy, myalgia, and a slight cough. She presents to her GP with a 72 hour of worsening headache, myalgia, and now a productive cough. Her GP prescribes antibiotics (Amoxycillin) and advises her to commence them the following day. The following day Mrs X is taken to the local tertiary hospital (A) by her husband with further worsening symptoms and now respiratory distress. Her respiratory rate is 30; her SpO2 is 93% on room air. She is tachycardic (110), afebrile, normotensive and her chest x-ray shows right middle and right lower lobe pneumonia, early basal consolidation, and a small left pleural effusion. Mrs X is admitted to the medical ward on CPAP Presents at tertiary hospital (A) with worsening symptoms. Respiratory Rate 30. CXR shows RML + RLL pneumonia, early basal consolidation, and small L) pleural effusion. Admitted to medical ward with CPAP, tiring over the evening with increasing PEEP and FiO2 requirements. Transferred to ICU on CPAP. Intubated at 2130hrs due to worsening condition and tiring. Continues to deteriorate over the next 12 hours, now with a vasopressor requirement. Referred to tertiary hospital (B) for transfer. Swabs and cultures taken for multiple bacteria and to identify the source of pneumonia. Broad spectrum antibiotic cover commenced. (Screening included H1N1, mycoplasma serology, and urinary legonella-all eventually coming back as negative). Managed in tertiary hospital (A) overnight with high PEEP (20) and Fio2 (90%) requirements. Spo2 and PaO2 remain low (85%/55). Recruitment manoeuvres attempted by consultant and found to bed unsuccessful. Bloods show early coagulopathy, thrombocytopenia. Worsening CXR: RUL, RML, RLL, LML, LLL consolidation. Discussion with family regarding possibility of ECMO in tertiary hospital (C) if continued deterioration. Tertiary hospital (B) arrives the following afternoon. Pt being managed prone. Unproned and transferred to Tertiary Hospital (B). Arterial blood gas on arrival= Managed in hospital (B) with high respiratory support. Peaking with Fio2 1.0 PEEP of 24. Aiming for Pao2 >60, SpO2 >88%. Condition further deteriorates on day 3 in hospital (B). Ventilation and oxygenation proving difficult. Any movement causing severe desaturation. Increasing PEEP (18) and decreasing FiO2 (0.6-0.7) found to be beneficial in this patient. ABG over the day Time FiO2 pH pCO2 pO2 0908 0.6 7.35 53.5 59.7 1452 0.7 7.36 52.4 60.5 2001 0.6 7.35 53.6 62.6 2300 0.7 7.38 49.7 55.0 Initial arterial blood gas shows Sedated on morphine and midazolam and propofol. Strict fluid balance. Commenced on regular IV steroids. IV frusemide. IV erythromycin and imipenem. FASTHUG principle applied. Enteral feeding recommenced Remained febrile despite antibiotic and line changes. Chest drain insertion on day 3 in hospital (B) Tracheostomy on day 9 as not respiratory or cardiovascularly stable enough earlier. Remained on a FiO2 of an average of 0.60 and PEEP of 16-20 for the first 12 days. De-sedated and a slow respiratory wean commenced on day 10. Patient continues to be critically ill and have slow respiratory wean on day 18 when she is transferred back to her domicile hospital (Hospital A) to continue recovery and weaning

Soviet Industrialization :: essays research papers fc

When one looks at the history of the USSR, one of the most important aspects to look at is the massive industrialization that took place under the Soviet regime. This industrialization, like so many other things, is a complicated issue, with many arguments circling around it. The process was marked both by tremendous progress and expansion, as well as gross inefficiency and waste.   Ã‚  Ã‚  Ã‚  Ã‚  To better understand the Soviet industrialization, it is necessary for us to briefly look at the history that preceded it. When the Bolsheviks came to power, they inherited a country with economic conditions that were far from favorable. It was a country devastated by World War I as well as the civil war that followed it. For all intents and purposes, one can say that the economy of the country was in ruins, and drastic steps were necessary in order to feed the hungry population, and for the country to survive.   Ã‚  Ã‚  Ã‚  Ã‚  To answer this problem, a New Economic Policy (NEP) was implemented. In essence, this policy went away from communist ideology to a large degree. It allowed farmers to go out and sell what they have produced, and brought in many elements of the free market. At the same time, the Soviet regime restored the industry which existed but was devastated by war.   Ã‚  Ã‚  Ã‚  Ã‚  To a large degree, this policy was successful. By 1920s, the USSR managed to reach industrial production levels of roughly 1913. (Suny 233) Furthermore, the population was no longer starving, and living conditions improved throughout the country. However, NEP also brought in several problems. One of them, in the eyes of the Soviet leadership, was that it naturally brought polarization into society, producing some rich and some poor peasants, whereas ideologically there were supposed to be no classes in the new society (Suny 171)   Ã‚  Ã‚  Ã‚  Ã‚  A more serious problem, however, was the fact that rapid industrial advance was incompatible with NEP. It was necessary to shift country’s resources from agriculture towards the production of heavy industry. Instead of producing consumption goods, it was necessary to produce capital goods. (Suny 234)   Ã‚  Ã‚  Ã‚  Ã‚  The peasants, however, had little incentive to sell their product, since there were few things of use that they could get in return (since the economy concentrated on production of capital goods instead of consumption goods). This, naturally, brought tension between the city which had to be fed, and the peasants who would not give up or sell their product, unless compelled to do so by the state.

Masculine Desires Expressed in Art and Media Essay -- Male Masculinity

Suppose the locks to a Starbuck’s Cafà © were slowing turning to seal the doors shut from any last customers. But before the latch could roll into the opposite lock, two strangers pulled open the door and made their way inside. A sight to have seen: James Bond and Keanu Reeves. They held each a large canvas and a sculpture, respectively. Both purchased their favorite coffee drinks at the local cafà ©. Having made an exception in not closing the shop at the normal time, the employee allowed the men to enjoy their beverages inside—in the comfort of the inexplicably soft couches. The gentlemen sat and conversed about their current lives. My question is: does the adolescent worker, who is still bewildered, share a singularity with the unexpected customers, as well as with the artworks in their possession? Regardless of the hypothetical, the answer is always the same: Yes. The fictitious heroes and brave men conceived by man bear the longings and passions of their creator. In fact, it is through them that man lives vicariously. However, prior to the births of legendary characters in motion pictures and comic books, there existed artworks that introduced the public to the deepest desires of man. They portrayed his universal image: a man that is â€Å"wild at heart†. What does the action sequence of The Matrix: Reloaded have in common with a sixteenth-century sculpture? Baccio Bandinelli’s Hercules and Cacus, exemplifies the first of three desires in man. According to the legend, Hercules went on a journey to complete his tenth labor, a task of retrieving the Cattle of Geryon. Cacus, â€Å"a fire-god†¦demoted to a fire-breathing giant†, stole the cattle from the unsuspecting Hercules and hid with them in a cave. The theft launched the enemies into ... ...expresses. The three desires of man are painted and sculpted in the magazines, books, television shows, and movies of today. Society suggests the ideals and universal image of man it wants to uphold; the media engraves the information into the stone tablets of its mind. Sure, I can appreciate the sculpture of Hercules and the painting of Christ, but only because I know that I can personally relate to the artworks. I want a battle to fight, an adventure to live, and a beauty to rescue. Works Cited Eldredge, John. Wild at Heart. Tennessee: Nelson Publishing, 2001 Gladwell, Malcolm. Blink. New York: Little, Brown and Company, 2005 â€Å"Hercules and Cacus† Wikipedia September 25, 2006 Gospel of John BibleGateway September 25, 2006 Masculine Desires Expressed in Art and Media Essay -- Male Masculinity Suppose the locks to a Starbuck’s Cafà © were slowing turning to seal the doors shut from any last customers. But before the latch could roll into the opposite lock, two strangers pulled open the door and made their way inside. A sight to have seen: James Bond and Keanu Reeves. They held each a large canvas and a sculpture, respectively. Both purchased their favorite coffee drinks at the local cafà ©. Having made an exception in not closing the shop at the normal time, the employee allowed the men to enjoy their beverages inside—in the comfort of the inexplicably soft couches. The gentlemen sat and conversed about their current lives. My question is: does the adolescent worker, who is still bewildered, share a singularity with the unexpected customers, as well as with the artworks in their possession? Regardless of the hypothetical, the answer is always the same: Yes. The fictitious heroes and brave men conceived by man bear the longings and passions of their creator. In fact, it is through them that man lives vicariously. However, prior to the births of legendary characters in motion pictures and comic books, there existed artworks that introduced the public to the deepest desires of man. They portrayed his universal image: a man that is â€Å"wild at heart†. What does the action sequence of The Matrix: Reloaded have in common with a sixteenth-century sculpture? Baccio Bandinelli’s Hercules and Cacus, exemplifies the first of three desires in man. According to the legend, Hercules went on a journey to complete his tenth labor, a task of retrieving the Cattle of Geryon. Cacus, â€Å"a fire-god†¦demoted to a fire-breathing giant†, stole the cattle from the unsuspecting Hercules and hid with them in a cave. The theft launched the enemies into ... ...expresses. The three desires of man are painted and sculpted in the magazines, books, television shows, and movies of today. Society suggests the ideals and universal image of man it wants to uphold; the media engraves the information into the stone tablets of its mind. Sure, I can appreciate the sculpture of Hercules and the painting of Christ, but only because I know that I can personally relate to the artworks. I want a battle to fight, an adventure to live, and a beauty to rescue. Works Cited Eldredge, John. Wild at Heart. Tennessee: Nelson Publishing, 2001 Gladwell, Malcolm. Blink. New York: Little, Brown and Company, 2005 â€Å"Hercules and Cacus† Wikipedia September 25, 2006 Gospel of John BibleGateway September 25, 2006

Changing the Scope of Practice for All Nurses

Changing The Scope Of Practice For All Nurses October 21, 2012 Changing The Scope Of Practice For All Nurses The Institute of Medicine and the Robert Wood Johnson Foundation has proposed many changes take place in the field of education for nurses to assist in the Affordable Care Act to be a full success in transforming health care.They have published the report â€Å"The Future of Nursing Leading Change Advancing Health† recommending that the scope of practice for all nurses which include the registered nurse, advance practice nurse, certified nurse anesthetist, and the certified nurse midwife to be able to practice at their education and skill level through continuing competencies. Now it is up to all nurses to decide if changing the scope of practice for nurses is a good or bad idea. This paper will show how changing the scope of practice will enable nurses to care for their patient more effectively.Nurses are going to have to step up to the plate, and show the whole world how important nursing is to providing health care to all people. And for the Affordable Care Act to truly change the health care system to better help the people and communities of the United States, the scope of practice for nurses will need to change to better meet the needs of the public. Education The Institute of Medicine report encourages nurses who graduate with an associate degree to continue on with their education to at least the baccalaureate level. Nurses at the baccalaureate level are then encouraged to continue on to the masters or doctorate degree.The different foundations and the federal government introducing funding opportunities and scholarships to students trying to find ways for schools and government to further nurse’s education to higher level to be more affordable (â€Å"The Future of Nursing† 2010. p. 177). It is important to stress the need to gain nurses with the knowledge to teach our future nurses. Nurses will also need to be involved in co ntinuing education and continued competencies. Where nurses stay up to date with current practice and can demonstrate knowledge and skill in the practice (â€Å"The Future of Nursing† 2010. . 202). Also, equipping nurses with the skills and knowledge to take care of patients of today, who have more comorbidities than ever before. Equipping nurses with the knowledge and skill to not only preform the competency but understand the how and why it works, which will be a key factor in transforming health care. One proposal is that â€Å"Interprofessional education of physicians, nurses, and other health professionals, as well as new methods of improving and demonstrating competency throughout one’s career†¦Ã¢â‚¬  (â€Å"The Future of Nursing† 2010. p. 165).This will allow better communication, collaboration, and respect between everyone involved in patient care. The Institute of Medicine also discusses different ways to make nurses continuing their education mo re affordable. Primary Care The way primary care nurses deliver care to patients will change if the report by the Institute of Medicine is adopted. Most of the changes will affect the advanced practice nurses, by allowing them to practice to their full potential of knowledge and skill level. They will be able to take care of patients without having to have a physician on the premises or overseeing their work at all times.The Institute of Medicine gives an example where in Philadelphia there is a nurse managed health care center. This center is run by Nurses, Nurse Practitioners, and Social Workers. Other health care professionals help when needed like nutritionists, physicians, and others when needed. Places like this would be able to serve areas where there is little to no physicians available to meet the health care needs of the people who live there. Leadership By reading the report, â€Å"The Future of Nursing Leading Change Advancing Health†, it describes how important n urses are becoming stronger leaders for the future advancement of nursing.With all the changes coming with the Affordable Care Act, this report recommends that nurses need to be playing a large contributing roll in the development of policies to maintain patient centered health care, making sure that health care is accessible to all, and is affordable. Stronger leadership skills can be developed through continued education. By nurses moving on to higher degree education, they are thus developing the leadership skills they will need to work more cohesively with others both in the health care field and out. Nurses need to be playing a role in all aspects of policy making.From working in the hospitals and communities as advocates for patients which is defined as â€Å"The nurse is demonstrating the value of other-centeredness to advance the health of an individual† (Creasia & Friberg, 2011, p. 80). Nurses will need to sit on boards both in the hospitals and in the public sector, legislating to political officials, and even possibly holding a political office themselves. It is going to take all nurses to make a change from nursing students to advance practice nurses, educators, and nursing organizations leadership (â€Å"The Future of Nursing† 2010. p. 221-251). Goals for PracticeFor the nursing scope of practice to change effectively, it will have to start in nursing school. Nursing students will need to start aiming toward a goal of higher education. Knowing they will need to be better prepared with the gained knowledge of continuing on to a baccalaureate, masters, or doctorate degree in nursing to be able to take care of the ever increasing health care needs. Nurses will need to maintain their knowledge and skill level for up to date practice through competency based learning throughout their career. They will need to be the future leaders in and out of the nursing profession.Each nurse knowing that nursing consists of many different aspects, maki ng sure to help in the advancement of all future nurses. Some nurses choose to go into the clinical field, community nursing, education, advanced practice, research, legislation, specialty associations, and many more to further nursing profession and health care. In conclusion, by changing the scope of practice for nurses, they will be able to deliver patient care that matches their knowledge and skill level. This will allow more health care professionals mainly nurses, to practice in areas that have lacked sufficient health care providers to meet the needs of the public.The public will benefit from having nurse practitioners available in rural, suburban, and urban areas where physicians are scarce. Thus the public will have access to affordable, high quality health care to all who are in need.References Creasia, J. , & Friberg, E. (2011). Conceptual Foundations the Bridge to Professional Nursing Practice. (5th ed. , p. 80). Retrieved from http://pageburstls. elsevier. com/books/978 -0-323-06869-7 The Future of Nursing Leading Change, Advancing Health (2010). Retrieved October 13, 2012, from http://www. iom. edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health. aspx.