Motion and grauity Research Paper Example | Topics and Well Written Essays - 500 words

Motion and grauity - Research Paper Example ys, â€Å"An object in motion tends to stay in motion, and an object at rest tends to stay at rest, unless the object is acted upon by an outside force† (Croce, pp. 38). From this explanation, it is an understanding that a body remains in motion unless some other force stops it down. From this definition, this other force can be either friction or gravity, and thus, understanding of motion itself is an efficient way of understanding the force of gravity. The second law says, â€Å"Acceleration of an object is dependent upon two variables - the net force acting upon the object and the mass of the object† (Quah, pp. 57). This law explains that mass and force are the two indicators that decide the rate with which the body slows or accelerates. Thirdly, Newton stated, â€Å"Every action has an equal and opposite reaction† (Quah, pp. 57). In this regard, these three laws of motion are the best ways of defining and understanding motion. Specifically, from these understandings, motion is any change that occurs in the location or place of a body with regard to time and space. In addition, it is an observation that in physics, scientists always define and explain motion with respect to different references, such as friction, gravity, time, velocity, etc. However, without gravity, there can be no definition of motion. In particular, gravity is the most fundamental concept of nature that allows objects and bodies with any mass to interact, and more specifically, attract each other (Garnow, pp. 23-25). In addition, gravity enables the objects and bodies with masses to acquire weight that results in their falling on the ground. In this regard, gravity or gravitation is the basic force that keeps existence of sun, earth, moon, etc in the universe in balanced manner, whereas, its absence would have caused irregularity in orbits of the universe. Therefore, gravity is the fundamental force that directs and manages motion of bodies and objects in the time and space (Garnow, pp.

Buddhism Research Paper Example | Topics and Well Written Essays - 1250 words - 2

Buddhism - Research Paper Example This essay explores the Buddhism. The highlighting point was not to pray but to have control on one's mind. In this regard, it was more regarded as world philosophy rather than as religion. But with passing time, it obtained the character of a religion inclusive of rituals and dogmas. (Keown, p. 23 ) The life history of Gautama Buddha was full of events. The most effective institution that Lord Buddha recognized during his life span was the monastic order called Sangha into which all men were permitted to go in irrespective of their social order. The members of this monastic order, Sangha, were called as Bhikkus which meant beggars, who had to have a very tough life, without having any kind of desires. The daily needs of the Bhikkus were very limited, they get only that much which is necessary for one to survive physically. Their only belongings were an entreating bowl, loin cloth of yellow color, one walking stick, when and wherever if necessary and one pair of beach sandals for the ones who need the most. They had to maintain themselves by the alms they received but were prohibited from explicitly pleading for alms. If the alms were given willingly then they need to get accepted and if not given willingly the Bhikkus need to shift their focus onto the next address. Thus it turn ed out to be a little clergy, but which was nothing like its Hindu matching part which was not based upon social group and was tilted towards the activities of the missionary rather than focusing on the presentation and maintenance of rituals. (Smith and Novak, pp. 40-45; Keown, pp. 23 ) During the lifetime of Lord Buddha, the beginning of Buddhism from other types of devotion which made up Hinduism was more or less complete. This took the outline of non-acknowledgment of any embodied Gods or Goddesses, spirits or evil spirits and the near lack of rites and rituals, denial of the class system and the powerful disciple act of monks which consisted representation of societal service with the aim of mitigation of human pain. Another noteworthy feature was that in initial stages, all supporters of Lord Buddha were enrolled as the members of Sangha and therefore it was entirely a religion of the disciples. (Smith and Novak, pp. 40-45; Keown, pp. 25-30 ) From its beginning, Buddhism has a cknowledged royal benefaction. In the entire lifetime of Lord Buddha, Ajatashatru was the ruler of one of the most powerful kingdom of North India called Magadha where Buddhism was patronized and after few years where Lord Buddha attained Nirvana (the Salvation), the foremost religious committee of Buddhists was being held at Rajagriha, which was, at that point, the capital of Magadha, ruled by Ajatashatru. Such councils were the point to formulate and revise Buddhist religious policy which was

Arguments Against Nuclear Weapons

Arguments Against Nuclear Weapons Nuclear weapons. Without a doubt, the deadliest form of weapon man has ever invented, capable of killing millions of people and annihilating entire cities. They are inhumane weapons that carry catastrophic effects when used which are present for many years after the explosion. Despite this, there are thousands of nuclear weapons in possession of several nations around the world. Even if these weapons of mass destruction were never actually used for the purpose of causing harm, their very existence still carries significant consequences. I firmly believe that the only way to bring an end to the needlessly harmful effects that such weapons carry is a ban on both their use and possession or at least a reduction in countries nuclear arsenal and in this essay I will be explaining why. Obviously, one of the main arguments against the possession and use of nuclear weapons is their devastating effect on both the people and the environment. So far, the only use of nuclear weapons for the purpose of warfare was the USAs use of atomic bombs in Japan during the events of World War 2. These bombs were relatively small compared to the weapons possessed by some nations today, but their use still had catastrophic effects. After the bomb ironically named Little Boy was dropped on Hiroshima, 5 square miles of the city was destroyed, 70,000 80,000 people were immediately and mercilessly killed by the blast. Others died either from the collapsing buildings or from the intense radiation exposure. The suffering did not end there, the increased radiation levels in the area caused a massive increase in the cancer occurrences in people and birth deformities. The environment was also inevitably affected; the radioactive fallout caused plants and wildlife to be affected. While this ma y seem bad, the technological advances in society today has spawned even more destructive and dangerous nuclear weapons that, if used would have effects far worse than what was seen during World War 2. In addition, some scientists hypothesise that a small scale nuclear war between India and Pakistan would result in megatons of black carbon being released into the atmosphere, causing what scientists call a Nuclear Winter. This would lead to global temperatures falling and we would receive 9% less rain every year. This would ultimately cause crop failure worldwide and an estimated 2 billion people would starve. Chemical reactions would also occur in the atmosphere which would thin the Earths ozone layer, which protects us from the suns ultraviolet rays. In a couple of years after the nuclear exchange, the ozone layer would be approximately 20 to 25 percent thinner. The decreased protection from UV radiation from the sun would lead to an increased occurrence of skin cancer in people and a further amount of crop failure. Furthermore, possessing and maintaining nuclear weapons is also very costly, the scientists have high salaries and the materials are expensive. The weapons need to be continuously maintained and money also needs to be spent on waste management. The UK spends an enormous  £2 billion each year on running and maintaining Trident (the UKs nuclear weapon arsenal). That is around the amount spent on the NHS each week. There are also discussions on whether the Trident submarines should be replaced. This would cost around  £100 billion. That is a massive amount of money which could be much better spent on essential services such as healthcare and education. This is especially important considering the financial crisis that the NHS is in which may force them to abandon free healthcare for the public unless they get more funding. Needless to say, this would have a very undesirable effect on the public. One of the most popular arguments for the possession of nuclear weapons is that they are very useful as deterrents and help to maintain peace between nations. In order for the idea of nuclear deterrence to be effective, we must assume that all nation leaders think the best interest of the people of their country. However, it is well known that some nations do not play by this very delicate ruleset. These include terrorist organisations. This is a gamble on millions of human lives that is not worth taking. Because most nuclear threats come from dictatorships and terrorist organisations instead of genuine governments, it would be morally wrong to cold-bloodedly kill tens of thousands of civilians because of the actions of a select few. There is also the risk of accidental firings because of mistakes, errors in calculations or moments of panic. The fact that just one single mistake or irrational decision can take the lives of millions of people is yet another reason why it is wrong for anyone to possess such weaponry. The possession of nuclear weapons also brings about the risk of loss or theft. With the growing nuclear arsenal of nations such as Russia, other nations may find it necessary to upgrade their nuclear arsenal to counteract the possible threat. An increased number of nuclear weapons means a greater risk of them being stolen, lost or even worse, detonated. This issue is becoming increasingly more important with the new president of the United States Donald Trump wanting his countrys nuclear arsenal to be above all else. This nuclear superiority the US desires will surely increase the tension between nations and amplify the risk of a nuclear attack or accident. In conclusion, the possession of nuclear weapons will continue to bring its vast array of disadvantages, whether that be the catastrophic effects that a nuclear weapon explosion could bring. Using valuable money that could be much better spent elsewhere such as in healthcare or education. Or by being the cause of many conflicts and suffering across the world. As long as nations possess nuclear weaponry, they will most likely be used again, either on purpose or by accident. The only way to prevent this would be for nuclear weapons to follow the same fate as chemical and biological weapons and receive a worldwide ban on both their possession and use.

Adoration of the Magi by di Nardo :: Iconographical Analysis Art Artwork

Iconographical Analysis: di Nardo, â€Å"Adoration of the Magi† The painting â€Å"Adoration of the Magi† by di Nardo portrays the three Magi approaching the baby Jesus and the Virgin Mary. However, there is much more to it than just this familiar scene from Judeo-Christian lore. When approaching this painting in order to analyze it iconographically, it is necessary to first look at all aspects of the form. If this aspect is ignored, it provides for an incomplete analysis of the painting. Once this is looked at, the iconography of the painting becomes much clearer, and it is easier to compare the painting to the actual biblical text from which it was derived (Gospel of St. Matthew 2:1 – 2:12). When approaching the painting the first thing I noticed was the odd perspective. There are several vanishing points. Also, all of the figures seem to be placed on one plane. Because of this, the two figures that represent Jesus and Mary seem to be hovering weirdly above the ground. This, I believe, draws the viewer’s attention to these two figures, since they are the main focus of the painting. Due to the influence of my culture, I recognized the figures as Jesus and Mary immediately. However, despite this, there are a few indicators as to who the people represented in the painting are. When viewing the painting, it is obvious that the figures of mother and child are the main point because the gazes of all of the people in the represented center on the child, including the mother’s. Also, the weird hovering effect also directs the viewer’s attention to these two figures. Both Mary and Jesus have halos, but this is not necessarily a distinguishing factor seeing as how there are also four other figures in the painting that have halos. However, the halo that surrounds the head of the baby Jesus has a slightly different pattern than those that the other figures possess. This lets you know that for whatever reason, this child is set apart from all other figures in the painting. So, even if the viewer is of another culture or religion and doesn’t see the significance of the female in the picture being clothed in blue and red, or the significance of the â€Å"blessing† position in which the baby is holding his hand, he can see that for some reason, this child is being distinguished from all other people in the painting.

Cream Cracker Under The Settee

The name of the play that we are studying is ‘Cream Cracker under the Settee'. This play was written in 1987 by a middle aged Alan Bennett who was born in Leeds in 1934. He grew up through the Second World War and in his play he writes about how views on life have changed over the years. The play is part of the ‘Talking Heads' series of plays in the 1980's. ‘Cream Cracker' is a dramatic monologue in which Doris, a 75 year old â€Å"lady of leisure†, speaks throughout. Doris is played by Dame Thora Hird who has just recently passed away. The play explores the changes within society from when Alan Bennett was a child, through the sixties and to the 1987. In the 1960's, the younger generations were getting most of the love and care from the family but the elderly were beginning to be seen as a hindrance. The play also explored how people had changed with the feeling that it was necessary to lock their doors and to be very secure rather than leaving the door open like they did in the ‘olden days'. Doris' personality changes throughout the play, as in the beginning, Doris wants to be independent but Zulema, Doris' care worker, has forbid her from doing any housework. This enrages Doris as she believes Zulema doesn't clean her house properly as she says â€Å"Zulema doesn't dust. She half dusts†. This is pointing out that Doris is quite fussy with the help that she receives from Zulema and doesn't seem to be grateful for any of it. There is proof that Doris is correct about the way Zulema dusts when she finds an old cream cracker under the settee. Doris intends on keeping the cream cracker to send off to social services to show that Zulema doesn't dust her house. This shows that Doris is quite spiteful. Later on in the play, Doris seems to be quite dull but she also recites quite a few conversations that her late husband Wilfred and she had. An example of which is when she spoke about the garden and that Wilfred wanted to have a bush but Doris wanted concrete. Wilfred argued about it having non character but Doris wanted it because of the hygiene. This shows that Doris is quite obsessive about hygiene and now she has to try and keep her house tidy otherwise she believes she will be put in Stafford House, an elderly home, but in fact, it is the other way round. By cleaning Doris is putting herself at more risk of being put in Stafford house as she is not very good on her feet and suffers from dizzy spells and has a pacemaker. This will make the audience feel sorry for her and will make them hope that she doesn't fall or be moved to Stafford House. The way in which Doris speaks makes her seem very realistic and can help people in the audience relate to her in many ways e.g. you could relate to someone you know such as an elderly relative when she's breathless. This makes it feel as if you know Doris more than you actually do and makes her seem like a real person who would be very easy to like. She also brings up past conversations she has been a part of as I mentioned before which help the audience to become more interested in the play as they are finding out what Doris is like and what kind of things she chatted about with her husband. Doris' life story is quite a moving, involving and very emotional journey. Alan Bennett makes the story very interesting and even more involving by making the actress look directly into the camera and making her seem like she's upset and choking through her sentences. She tells the audience about the way that, when Wilfred and she were younger, they were trying for a baby and when they were having the baby, it was a still birth. The midwife then wrapped the baby boy, who Doris wanted to call John, in newspaper and Doris was horrified by this. She saw this action as saying that the baby was dirty and that it was worthless. By the time Doris had awoken, the baby had gone. This makes this part of the play very sad and distressing. There are many unseen characters in this play which Doris interprets in her own special way. She mimics a lot of the characters, especially Zulema, and she is also talks quite sarcastically about Zulema in the way she talks to her. You see this when Zulema says about Doris being unable to run around with the Ewbank and all Doris says in reply is â€Å"Yes, Zulema.† This would make the audience feel sorry for Doris but in the same way happy that she isn't going to let Zulema boss her around. Another character that is introduced by Doris is Wilfred. We first hear of Wilfred when Doris knocks the photo of the two of them from the mantel piece when she attempts to dust and falls off the buffet. This would make the audience gasp in shock and feel sympathetic for her when she says â€Å"we're cracked Wilfred†, which means she is referring to her leg as she may have broken it and that their marriage is cracked. There are a few other characters used in the play such as the little boy who pees in the garden, which shows how disrespectful young children are nowadays, the neighbours whose leaves blow onto Doris' garden and the policeman who comes to check on her at the end of the play. These characters are all well timed to come into the play as it breaks the scenes up nicely and is like a chapter in the story being broken by turning the page. If Alan Bennett hadn't put these breaks in the play could have become a bit boring. Alan Bennett uses his genius and past experiences to make the play realistic by making Doris very able to relate to. A lot of old people from the same era as Doris are very reluctant to change like when Doris is in her own home and Zulema mentions Stafford House, she becomes all defensive and wary of what might happen next. This will create a lot of interest as people may be threatening their elderly relatives with being placed in a home if they cannot cope on their own and then the people will be able to see how it could be affecting them.

A Report into Racism Essay

It is important to carry out this investigation because in the long term children who are in our care at the moment will be the next generation of adults who will run the country one day. By teaching children values and respect at a young age, society will be fairer to everyone. It is crucial to learn about anti-discrimination practice as it may affect children’s development, for example a child that experiences racial discrimination may lack confidence throughout their lives. Racism occurs at times when people do not understand cultures and traditions that are different to the ones they follow themselves. These thoughts and ideas are usually passed on from parents and carers to a child from a young age and stay with them as they grow up so that they form stereotypical views. Research by Milner (1983) shows that â€Å"children as young as 3 years attach value to skin colour, with both black and white children perceiving white as superior to black. † This supports the theory that children can absorb messages about racial stereotyping from a very young age. By undertaking this investigation I will become an efficient diploma childcare and education worker in how to avoid discrimination in a setting and reinforce my knowledge on best practice. I will observe the influence of resources in promoting anti-racism within the day nursery. I will learn more about children’s rights, the law that protects them from racism and where I stand in the eye of the law. In the future my knowledge from this study will raise my awareness of racism and prevent it occurring – after all, prevention is better than cure. Discrimination is the ability to identify differences between individuals or groups, then to deny one individual or group favour of another. From a health and care point of view this means denying access to services and preventing equal opportunities. A definition of racism by Meggitt et al. (2000) states: â€Å"Racism is the belief that some ‘races’ are superior to others based on the false idea that different physical characteristics (i. e. skin colour) or ethnic background make some people better than others. † Racial discrimination can occur to anyone, at any time in their lives, at any age from babies to the elderly. Be so affected by stereotyping that events become a self-fulfilling prophecy, for example, if a black child is told that black people are destined to be lower classed and not achieve well then the child behaves accordingly with expectations. Review of Literature Stephen Lawrence was brutally murdered aged 18 years on April 22nd 1993. He was waiting with his friend Duwayne Brooks for a bus home at 22. 30. Stephen walked into the centre of the road to see if a bus was coming and his friend called out to him. A group of 5 or 6 white youths across the other side of the road called out ‘what, what nigger? ‘ and they all approached Stephen and stabbed him twice, once in the chest and once in the arm. Both these wounds severed arteries and he would have died instantly if he had not been so physically fit and ran 100 yards before he fell to his death. Stephen Lawrence’s unprovoked attack was solely motivated by racism. Nobody to this day has been convicted of this appalling crime. The police have been criticised for taking prolonging the investigation. No other witnesses have come forward to identify the killers apart from Brooks even after the huge publicity of the murder. Three of the prime suspects were taken to trial in 1996, however the prosecution failed due to lack of sustainable evidence and they can never be tried again in the present law. Two other suspects were released in 1995 and there is no chance of them being prosecuted with existing evidence. This shows that the police force involved needed to work harder at the time to ensure that the murderers were jailed when they were trailed. The police force must work harder in the future to prevent any further racial violence cases reaching the same conclusion as the Stephen Lawrence Inquiry. Also, legislation and laws will have to be looked at very carefully to avoid the same issues raised. The government think that from this case new regulations will be made: â€Å"†¦ we do believe that the debate about policing and racism has been transformed by this Inquiry†¦ † Damilola Taylor was killed among the tower blocks of a run down estate in Peckham whilst returning home from an after-school computer class. He was attacked by a group of Afro-Caribbean boys who stabbed him in the leg and then forced a marble down his throat to keep him from shouting for help. The police were criticised again for their handling of the case. More than 120 officers worked on the case at an estimated i 2. 5 million, however at the trial the main witness was found to be a liar and dismissed; and the two of the four defendants were released by the judge.

How to write winning proposals - Emphasis

How to write winning proposals How to write winning proposals Rob Ashton explains how developing your writing skills can help you to win sales. Whether you love them or hate them, you can’t deny that reality TV shows such as The X-Factor provide contestants with honest feedback about their performances. After the tone-deaf wannabes are swiftly weeded out, the ones with raw talent are prodded and guided by Simon et al before being transformed into marketable acts. But when it comes to your sales proposals, the only critics you have are your prospects. There’s usually no training ground before you’re let loose on your public. So if they like what you have to offer, the chances are you’ll get a sale. If they’re uncertain, they may well give you little idea of where you went right or wrong. Imagine that you meet a client and build a good relationship before promising to email over a proposal later in the week. But by the time it comes to putting pen to paper, you’ve forgotten the conversation and struggle to get back into the groove. Instead, you simply send out a standard proposal that leaves the prospect cold and you without a sale. In this case, the client gives some helpful feedback, but it skirts around the real issue. You don’t get the witty one liner that says: ‘great in person, but sounded like a robot on paper’. Most salespeople haven’t been taught how to develop a fresh, personable writing style. But proficient sales writing is a skill that can be learnt. And once you have, your proposals can act as a ‘silent sales force’ that is out there winning business for you while you’re busy pursuing other opportunities. So, become your own judge by learning and applying some simple tips and techniques to your written work. Switch off your computer We tend to live in the virtual world of our computer screens. But at the beginning of the writing process, it’s helpful to get away from the screen and use a pencil and paper to gather your thoughts. So before you type a word, ask yourself the following six questions: What is the proposal about? Who will read it? How much do they already know about the subject? What do they absolutely need to know? How important is the subject to them? How interested are they in the subject (which is not necessarily the same thing)? Doing this allows you to home in on the main ideas and messages you want to communicate. Keep asking yourself: What do you really want to say? Then jot down all the ideas that are essential and important to your proposal. Build a persuasive structure Next, focus your proposal by using the Four Ps technique, which stands for: position (where they are now), problem (why they can’t stay there), possibilities (where they could go) and proposal (where they should go). This approach turns conventional wisdom on its head and is surprisingly effective. It allows you to begin with the client’s situation and needs, and to recommend solutions, while building your credibility in the process. Only then do you write about your pedigree – by which point you’ll just be confirming what they’ve already concluded. Get personal One of the best ways to show your personality through writing is to use words such as ‘we’, ‘us’ and ‘our’. These words help to connect you to your readers. Similarly choose the active voice to make your sentences livelier. For instance, you can write ‘I [or we] guarantee that you’ll notice a difference in three days,’ rather than ‘a difference has been guaranteed within three days.’ Short and sweet Finally, no-one wants to wade through the sales equivalent of War and Peace. Keep sentences to a maximum of 15-20 words and edit ruthlessly until you have a compelling document that begs to be read. Mastering these skills will help you to tailor your writing so that it meets the needs of each particular client. Don’t worry if you don’t hit gold on your first go. For every one-hit wonder in the record business, there are those who’ve created a long, successful career by making constant adjustments to their performance, until they develop that certain something that sets them apart from the rest. For proposal-writing training, see our course for teams and our course for individuals.

Skin and Foot Assessment of a diabetic mellitus patient The WritePass Journal

Skin and Foot Assessment of a diabetic mellitus patient Introduction Skin and Foot Assessment of a diabetic mellitus patient IntroductionCase scenarioNeurologic system Skin assessmentThe outcome of having foot assessmentOutcome of musculoskeletal systeOutcome of neurologic assessmentOutcome of peripheral vascular assessmentOutcome of skin assessmentConclusionReferenceRelated Introduction In this article, we will discuss a case scenario related to diabetic mellitus patient. After understanding the case, we will state what is our main concern in this scenario and why will we focus on this aspect rather other aspect. Also we will introduce some tools to do an assessment in order to predict the outcome. If we understand the possible outcome, we may anticipate the outcome of this patient and understand the possible worse situation too. In this scenario, foot assessment will be focused on. Case scenario Ms Wong, 47 years old woman who was a housewife, arrived at hospital due to get dizzy, fatigue and fall in the floor at home with little bleeding. After she arrived at emergency department, nurse discovered she got a wound in the left heel but she didn’t feel pain, nurses suspected she got the wound during she fell in the floor. Her vital sign was normal; body temperature was37.5C, pulse 70/min, blood pressure 126/80 mmHg, respiration 18/min. After having a blood glucose test, we knew that she was suffering from hypoglycemia and her blood glucose index was 2 mmol/d. As nurse provided glucose water and wound dressing to her, she recovered and transferred to ward for continuing observation. Her past history was that she was suffering diabetic mellitus for 7 years and having regular oral diabetic mellitus medication without daily blood glucose test by herself and her BMI was over 25, she was overweighed. Her parents had diabetic mellitus too but they passed away. After tackling her emergency problem which is lower blood glucose level, we will focus on the further investigation in order to find out the reason why she don’t get any feeling of her wound as well as to investigate how the sensation change and what is the possible outcome so as to give some recommendations to her and prevent the serious consequences. As early detection and treatment of diabetic foot complication could reduce the prevalence of negative outcome. (Prakash, 2011) In the following part, we will focus on the foot assessment. For foot assessment Foot assessments include the following aspects such as demographics, musculoskeletal system, neurologic system, peripheral vascular system and skin. Assessments will though inspection, palpation, sensation and using tools so as to obtain the result. For demographics To obtain data from interview, it includes regarding type of diabetes, gender, any smoking habit, presence of hypertension, retinopathy, nephropathy and suitability of footwear. (Thompson, Nester, Stuart Wiles, 2004) For musculoskeletal system Assessment includes postures, gait, strength, flexibility, endurance and range of motion. It includes evaluation for any deformity because imbalance of foot muscles frequently. (Khanolkar, Bain Stephens, 2008) Other muscles problems like claw toes, hammer toes, heel spurs, calluses, cracks and corns. (Chan, Yeung, Chow, Ko, Cockram Chan, 2005) The website shows how to have the musculoskeletal assessment to the patient. (BJSM, 2008) Inspection and palpation can be applied into this assessment, note the size and contour of the joint which is including knee and ankle, inspect the skin and tissue of the foot for color, swelling and any masses, any lesion or deformity, pay attention of the skin integrity. Palpation is including skin for temperature, muscles, bony articulations and area of joint capsule, notice any heat, tenderness, swelling. The most important is to palpate radial and brachial pulse. If the peripheral pulse is weak, we need to have a further assessment. Neurologic system Assessment should include asking neuropathic symptoms such as burning, tingling, numbness and nocturnal leg pains. Assessment related to sensory assessment, pressure assessment, and vibration sensation too. For sensation Pinprick sensation test is used to test pain. Lightly apply the sharp point or dull end to the foot skin randomly, unpredictable order and ask the patient to say sharp or dull depending on the sensation felt. If the result of pinprick sensation test is abnormal, temperature sensation test will be applied. Fill two test tubes, one with hot water and one with cold water and apply the bottom ends to the patient’s skin randomly and ask them to say which temperature is felt. Another method to test sensation is light touch. Apply a wisp of cotton to the skin, stretch a cotton ball to make a long end and brush it over the skin in a random order and irregular intervals and ask the patient to say yes when touch is felt. (Jarvis, 2004) Pressure sensation is usually assessed by using the10gnylon Semmes-Weinstein monofilament. (Khanolkar, Bain Stephens, 2008) For vibration Tuning fork can be used to test vibrations over bony prominences. Strike the tuning fork on the heel of your hand and hold the base on a bony surface of the fingers and great toe and ask the patient to indicate when the vibration starts and stops. If no vibrations are felt, move proximally and test ulnar processes and ankles, patellae. Also compare the vibration of both sides. (Jarvis, 2004) For peripheral vascular system The Doppler ultrasonic stethoscope is a device to detect a weak peripheral pulse and to measure a low blood pressure or blood pressure in a lower extremity. The Doppler stethoscope magnifies pulsatile sounds from the heart and blood vessels. Place a drop of coupling gel on the end of the handheld transducer. Place the transducer over a pulse site, swiveled at a 45-degree angle. Apply very light pressure and locate the pulse site by the swishing, whooshing sound. (Jarvis, 2004) Nurses should apply both Doppler ultrasonic stethoscope and ankle-brachial index. The Ankle-brachial Index is to apply a regular arm blood pressure cuff above the ankle and determine the systolic pressure in either the posterior tibial or dorsalis pedis artery. Then divide that figure by the systolic pressure of the brachial artery. The normal ankle pressure is slightly greater than or equal to the brachial pressure. However, the ankle-brachial index may be less reliable because of calcification which makes their arteries non-compressible and may give a falsely high measurement. (Jarvis, 2004) Skin assessment If patient have wound or skin impair, nurses should do wound assessment to record the size and the characteristic such as redness, edema, pain and heat. It is used to follow the wound healing progress. If necessary, nurses may have a bacteria test to confirm either the wound have microbe or not. (Worley, 2006) The outcome of having foot assessment The assessment findings can be used to indicate or predict the problems of their diabetic foot. The most positive outcome is no diagnostic findings. It is including integrated skin with normal sensation. However, other possible findings are neuropathy, ischemia, ulceration, infection and necrosis. The most serious alive consequence is amputation. Outcome of musculoskeletal syste The possible finding of musculoskeletal system is foot deformity. Deformity should be recognized early and accommodated in properly fitting shoes before ulceration occurs. If nurses assess the footwear, the chance of foot deformity will be reduced. Deformities include the Charcot foot which refers to bone and joint destruction that occurs in the neuropathic foot. Early diagnosis is important to prevent severe deformity. The foot presents with unilateral erythema, warmth and edema. (Edmonds, 2008) Outcome of neurologic assessment The outcome of neurologic assessment is either absent of sensory neuropathy or not. If patient loss of sensory neuropathy, they cannot sense pain or pressure and has a lack of identity with their feet. Also, motor neuropathy where muscular loss results in the clawed toes, high arch, foot drop and an absent ankle reflex. Due to absence of sweat and sebum production of autonomic neuropathy, the skin is dry and inelastic. In addition, pressure sensation test can be further confirmed their pain sensation is true or not. If patient can feel the pressure from the filament, the protective pain sensation is present. It is important to avoid areas of callus when carrying out this procedure as applying the filament to a plaque of callus may lead to a false diagnosis of neuropathy being recorded. (American Diabetes Association, 2010) Outcome of peripheral vascular assessment The outcome of Doppler ultrasonic stethoscope is to indicate the presence of peripheral vascular disease though listen the pulse qualities. The normal range of ankle-brachial index is 1.0 to 1.2. If the ankle-brachial index is of 90% or less, it indicates the presence of peripheral vascular disease. If the index is 0.9 to 0.7, it indicates a mild claudication, 0.7 to 0.4 indicates moderate to severe claudication, and 0.4-0.3 indicates severe claudication usually with rest pain except in the presence of diabetic neuropathy. The most serious outcome of this assessment is the index less than 0.3; it is diagnosing ischemia with impending loss of tissue. (Jarvis, 2004) Ischemia or peripheral arterial occlusive disease is the possible outcome too. It eventually will reduce in arterial perfusion severely and result in vascular compromise of the skin, often precipitated by a major trauma. Also ischemia is always associated with neuropathy. (Wilson, 2003) Infection process is the main reason for major amputation following ulceration. It can complicate the neuropathic and the neuro-ischemia foot ulcer. As infection originate from skin trauma or ulceration, often spreading to soft tissue then bone. Associated with neuropathy or ischemia, mean infection is often missed because of an absence of pain or loss of ability to mount an inflammatory response. Also there is no increase in temperature, white blood cell count and C reactive protein. (Wilson, 2003) Outcome of skin assessment The most positive skin assessment outcome is integrated skin and no wound. However, if diabetic patient have wound, healing is usually protracted. It is because patients with neuropathy continually traumatize their foot wounds by walking freely upon them. It is difficult to tell patient to take rest when they don’t feel pain during walking. Also patients with ischemia cannot mount an adequate inflammatory response to fight infection and achieve healing. Another reason is related to the healing process. Macrophages and neutrophils are important agents in wound healing, particularly at the inflammatory stage which is fundamental to all ensuing stages. However, the above function of diabetic is impaired. Thus the wound will hard to heal. If the wound decay, it will become foot ulceration. (Bentley Foster, 2007) Necrosis is a grave implication that diagnosis necrotic foot, threatening the loss of the lumbs, and is caused by infection or ischemia or both. It is classified as either wet or dry, each with its specific management. If it is in the neuropathic foot, necrosis is invariably wet initially and is nearly always due to a septic arteritis secondary to soft tissue infection complicating a digital or metatarsal ulcer. The arterial lumen is often occluded by a septic thrombus. Both wet and dry necrosis can occur in the neuroischemic foot. The common cause of a black toe is again septic arteritis, exacerbated by large vessel disease in the leg. Dry necrosis can also develop in the neuroischemic foot and is secondary to a severe reduction in arterial perfusion. (Edmonds, 2008) For Amputation The combined impact of neuropathy, ischemia and infection are so great that is amputation. It is preceded by foot ulceration and infection. It is because diabetic related to an artery disease which reduces blood flow to the feet. If the blood flow reduces, the healing process will be slowly. Even with preventative care and prompt treatment of infection and complications, there are instances when amputation is necessary to remove infected tissue in order to save a limb or even save a life. (Wilson, 2003) If missing the above assessment, nurses cannot diagnosis the problem of this patient. The most serious consequence will be happened. Conclusion Diabetic foot assessment indicates lots of different outcomes. Patient with diabetic should not look down upon their wound; it will be have a serious consequence which is amputation. In order to have a quality of life, an impaired skin’ diabetic patient must need the further foot assessment so as to prevent the negative outcome. Reference American Diabetes Association. (2010). Foot Complications. Retrieved Mar 23, 2011, from http:// www.diabetes.org/living-with-diabetes/complications/foot- complications.html Bentley, J., Foster, Ali. (2007). Multidisciplinary management of the diabetic foot ulcer. Wound Care, S6, S8, S10, S12. BJSM. (2008). Knee Exam (5 of 27): Neurovascular evaluation: supine. Retrieved Mar 23, 2011, from youtube.com/user/BJSMVideos#p/u/38/xe W7dwcBZCI Chan, C. N. J., Yeung, T. F. V., Chow, C. C., Ko, T. C. G., Cockram, C. S., Chan, N. N. (2005). A manual for management of diabetes mellitus a Hong Kong Chinese perspective (revised ed.). Hong Kong: TheChineseUniversity ofHong Kong. Edmonds, M. (2008). A natural history and framework for managing diabetic foot ulcers. British Journal of Nursing, 17(11), S20, S22, S24, S25-S29. Jarvis, C. (2004). Physical Examination Health Assessment (4th ed.).Philadelphia:Elsevier Khanolkar, M. P., Bain, S. C., Stephens, J. W. (2008). The diabetic foot. Q J Med, 101, 685-695. Prakash, S. (2011). Early Screening to Cure from Type 2 Diabetes. Retrieved March 23, 2011, from http://topnews.us/content/237118-early-screening-cure-type-2 -diabetes Thompson, L., Nester, C., Stuart, L., Wiles, P. (2004). Interclinician variation in diabetes foot assessment- a national lottery?. Diabetic Medicine, 22, 196-199. Wilson, D. J. (2003). Amputation and the diabetic foot: learning from a case study. Wound Care, S18, S20, S22, S24. Worley, C. A. (2006). Neuropathic Ulcers: Diabetes and Wounds, PartI.Etiology and Assessment. Dermatology Nursing, 18(1), 52-53.

Conjugate Base - Chemistry Definitions Terms

Conjugate Base - Chemistry Definitions Terms Conjugate Base Definition The Bronsted-Lowry acid-base theory includes the concepts of conjugate acids and conjugate bases. When an acid dissociates into its ions in water, it loses a hydrogen ion. The species that is formed is the acids conjugate base. A more general definition is that a conjugate base is the base member, X-, of a pair of compounds that transform into each other by gaining or losing a proton. The conjugate base is able to gain or absorb a proton in a chemical reaction. The conjugate acid donates the proton or hydrogen in the reaction. In an acid-base reaction, the chemical reaction is: Acid Base â‡Å' Conjugate Base Conjugate Acid Key Takeaways: Conjugate Base Conjugate acids and bases are part of the Bronsted-Lowry theory of acids and bases.According to this theory, the species that donates a hydrogen cation or proton in a reaction is a conjugate acid, while the remaining portion or the one that accepts a proton or hydrogen is the conjugate base.The conjugate base may be recognized as an anion. Conjugate Base Examples The  general chemical reaction between a conjugate acid and a conjugate base is: HX H2O ↔ X− H3O In an acid-base reaction, you can recognize the conjugate base because it is an anion. For hydrochloric acid (HCl), this reaction becomes: HCl H2O ↔ Cl− H3O Here, the chloride anion, Cl−, is the conjugate base. Sulfuric acid, H2SO4 forms two conjugate bases as hydrogen ions are successively removed from the acid: HSO4- and SO42-.

MANAGEMENT FOR CLINICIANS Essay Example | Topics and Well Written Essays - 1250 words

MANAGEMENT FOR CLINICIANS - Essay Example asks that the healthcare industry re-align itself in such a way as to provide a team that is multi-disciplinary and works together for the good of the patient, that care become more patient centered, and an effort to determine how to use clinical support staff in such a way as to reduce the pressure on the healthcare professionals that are already overwhelmed (Garling report, 2008). This paper will discuss recommendations made by the commission and how shared patient centered care teams can provide much needed care. The patient provider relationship has been changing for some time and with new initiatives will continue to change. Today healthcare is electronic and highly regulated and healthcare workers are faced with increased amounts of accountability in their practice. Consumers are more interested in becoming part of their own healthcare and are reasonably able to contribute when that option is available (Smith, & Barefiled, 2007),. The shortage of professionals in healthcare is not expected to get better anytime soon and may, in fact, get worse. Every possibility of expanding the methods we presently use in supporting those professionals becomes important. This is the time for true patient centered care. This is a growing trend and empowers healthcare consumers and their families with the adaption of patient centered initiatives. Caring Together has determined to create a focus on the patient. In doing that, they have set a goal to make healthcare more efficient as well as more sustainable. They have clearly stated that â€Å"everything must be about the patient.† (Caring Together, pg. 5). This has not been true in the last few years as the amount of paperwork grows and the supervision of support staff has waned. Now, however, is the time to move forward and solve these problems for the betterment of patient care. According to Smith and Barefield (2007), there are seven aspects of patient centered care. Those include, respect for patient’s values,

Capital investment appraisal within an organisation looks at the Essay

Capital investment appraisal within an organisation looks at the acquisition of fixed assets so as to generate wealth for the organisation - Essay Example Capital investment appraisal, which is also called capital budgeting, is the process to use funds to acquire operational assets (Khamees et al. 2010). These investment decisions obtain their guidance and source from the outcomes or results, which are provided by the source of capital investment appraisal. If the outcomes of capital investment appraisal are positive and encouraging, and these outcomes show that a particular investment, if taken, would bring wealth and additional inflows to the organisation, then investment or fund managers do not delay or waste a single minute to give a green signal for the investment project. Additionally, that investment project must ensure that after a certain number of years, the investment project would bring some additional inflows which would be more than the initial cost invested into that investment project. Four investment techniques are the different methods: Payback period, discounted payback period, net present value (NPV) and internal ra te of return (IRR). These four investment techniques are the basic tools used by the investment managers to carry out the process of investment appraisal. Each investment technique is different and is used differently by the fund or investment managers. Payback period is simply takes into account the number of years. Payback period informs that how many years a particular investment project would take to recover the initial cost of investment. The discounted payback period is a bit different to payback period. The discounted payback period uses a firm’s cost of capital for the purpose of evaluating the expected future cash flows from an investment project.... The discounted payback period uses a firm’s cost of capital for the purpose of evaluating the expected future cash flows from an investment project. In the discounted payback period, without using the cost of capital, the application of discounted payback period would not be possible and applicable for the purpose of conducting an investment appraisal. Net present value (NPV) is considered to be a more effective and reliable investment appraisal tool in comparison with other tools of investment appraisal. The main reason for its more recognition and more application among the different fund and investment managers is that net present value heavily relies on the technique of time-value of money concepts. The internal rate of return (IRR) is a discount rate. This discount rate is used by many fund and investment managers for the purpose of evaluating the future cash inflows. The only and most important function of the internal rate of return is to give a figure of cost of capita l; and this figure is used and applied on the different available cash flows to determine their present value. Capital Investment Appraisal For the financial and investment managers, the activity of capital investment appraisal brings a huge amount of responsibility for them. The capital investment appraisal requires purchasing a long term asset with a life of many years. This means, in case that fixed asset is purchased, the company becomes locked in for the duration of the asset’s life. Also, since the purchase of a fixed asset would directly increase the current level of business operations, and the contribution of the fixed asset would also increase in the activities of sales, costs and so on, it becomes necessary for the investment and fund

HEALTH PROGRAM EVALUATION (Impact Evaluation and Accountability CASE Research Paper

HEALTH PROGRAM EVALUATION (Impact Evaluation and Accountability CASE 4) - Research Paper Example GAO supports the senate in curbing errors of federal processes in healthcare through reporting on the progress of health standards. Furthermore, it enhances performance analysis in policies and drawing choices for senate objectives, auditing operations of the organization to conclude whether state funds are subject to appropriate organization. Indeed, it equally looks into improper and unlawful allegations and issues legitimate verdicts like information about agency rules. Most of GAO’s responsibilities in the State healthcare programs base on organizational planning objective one, which is offering well timed and excellence services to U.S senate. It also ensures that the State government handles current issues for their well-being and financial safety of American people. For example, FY2007, GAO delivered information which helped in coming up with ways of solving problems that were disabling the provision of services to the injured veterans and soldiers (Dodaro, 2010). The organizations well-known products comprises of lawful choices and views, reports, special publications and testimonies. In addition, the GAO suggests solutions to problems that evident in government programs; they detect long-term developments and raise concerns on the fiscal status of the state. Among its latest distinctive report is the 21st period challenge, which was about reexamining Federal government base. The report’s aim was to assist the U.S in the review and deliberation of State spending and tax programs in healthcare spending. GAO also analyses and monitors the changes involved in lasting fiscal outlook, consequences of healthcare and demographic costs and other fiscal commitments in the state (Dodaro, 2010). Evaluation process exudes various challenges. Apart from timeliness, quality and relevance that evaluation entails, the main challenge is in conveying of evaluation outcomes to audiences participating in

The Titanic OR The Love Canal OR BP Deepwater Horizon Spill OR Essay

The Titanic OR The Love Canal OR BP Deepwater Horizon Spill OR Fukushima Reactor Meltdown OR Wikileaks(Julian Assange) - Essay Example This implies that, what is more important to consider for an individual is the fact that she or he as a person is responsible and independently acting, and conscious being (existence) rather than the labels, stereotypes, definitions, roles, and other preconceived categories fitting the individual (essence) (Thomas 23). Basically, what this means is that the actual life of a person is what constitutes his or her true essence instead of other arbitrarily attributable essence used by other people to define her or him. Therefore, going by existentialism, a human being, through his or her own consciousness creates his or her own values which determine a meaning to his or her life. Though existentialism has its strong point, other approaches refute it. Generally, existentialism approach can offer practical and useful solutions to psychological problems, it overemphasizes three different themes namely: meaningless, isolation and death. Proponents of these approach then place (Thomas 42). Ex istentialism alongside the ethics arising out of it can be such an attractive package. The fact that in existentialism one can create his or her actions, shows that this approach can give a person a good moral base line. However, it does not imply that it necessarily does that, as it has an assortment of belief and tenets but fails to involve detailed code of ethics (Warnock 46). Each individual is left to work the issue of ethics himself or herself but within the tenets of existential through system. This gives an individual a lot of latitude to decide what is wrong and right. However, it is worth noting that some individuals may reach a spurious notion of what is right and wrong. This is one of the key weaknesses of this ethics. The second weakness is that existentialism ethics is tied up with other systems (Thomas 43). This way, it can lead those who adhere to it into wrongheaded decisions. Existential principles are entwined with established, detailed, and complex ethical system s (Thomas 25). The third weakness is that existentialism is hard to be interpreted by many people. The result of which is that few people end up using its principles as their ethical guidelines The Love Canal is the Niagara Falls chemical disaster (Brook 3). This town was not arguably known for what it was designed for â€Å"love† but for being the largest chemical disaster in North America. As existentialism will have it, William T. Love had envisioned creating a town near Niagara Falls, which will run off hydroelectricity. His plan was that the hydropower would be supplied to this town by running these canal from the upper Niagara Rivers to the lower part of this river (Brook 5). Mr. Love’s plan was to turn this canal into a shipping route with a model city, which surrounded the canal. However, this did not happen. This is because the â€Å"Panic of 1893† caused the financiers of the project to pull out their money. Mr. Love went broke which meant the end of t hese project (Brook 8). The aftermath of Mr. Love’

Reflective analysis case studies Essay Example | Topics and Well Written Essays - 2250 words

Reflective analysis case studies - Essay Example On the night in question, as a site manager, I was dealing with admissions and bed allocations. A colleague who was working opposite was the first responder that night. She received a call from the Critical Care Unit (CCU) at 2300 hours; the CCU nurses narrated that a female patient was having ongoing chest pains following the use of the commode; nurses also reported changes in the patient’s ECG reading; the CCU nurses also reported that the patient was given a glyceryl trinitrate (GTN) spray. My colleague and I already met the patient the previous night at the Emergency Medical Care (EMC) unit when she was admitted for shortness of breath (SOB), palpitations, and was having pleural effusions drained. Before we left for the ward, we fast beeped the doctor about the patient. We knew from the patient’s admission that she was 64 years old and had a Coronary Artery Bypass Graft (CABG) and an Aortic Valve Replacement (AVR) surgery 13 days prior to her admission. When we got to the CCU, the patient was extremely anxious and frightened; was very short of breath; was having chest pains; and was speaking in short sentences. The patient was also not sweating. The CCU nurses already put her on 15L Oxygen non-rebreath mask. I immediately made my A to G assessment while my friend helped to calm and reassure the patient. The doctor arrived a few minutes after we did and he saw the patient briefly, auscultated her chest, and went to the nurses’ station to write down his orders on the patient’s chart. I went to the nurses’ station to confer with the doctor about his initial findings and his orders. The doctor ordered Digoxin 500 mcg to be given immediately to the patient; he also ordered an increase in the treatment dose of clexane to 90 mg. He also ordered another 12 lead ECG to be done on the patient in 2 hours time; another dose of Digoxin in 6 hours time; IV

Chaucer writes a 'feminine kind of romance' ( Burrow). Discuss with Essay

Chaucer writes a 'feminine kind of romance' ( Burrow). Discuss with reference to 3 canterbury tales - Essay Example n the battles and events of the past, such as the battles of Troy, the conquests of Alexander the Great or the chivalric traditions rising out of the Arthurian legend. Among these stories, the primary focus was typically placed upon the action of the story, the battles and the skirmishes that occurred between characters, and the aftermath of such behavior, such as the winning of the lady, the acquisition of worldly fame or the re-enforcement of nobility. However, not all stories followed this basic formula, especially as the written tradition began to grow through the 14th century. As writers began to experiment with various means of recording the stories that had been passed down through the oral tradition as well as working to develop stories of their own, new modes of expression began to emerge. For example, Colin Burrow assertively states that Chaucer wrote a feminine kind of romance. What is a feminine kind of romance and how does this apply to Chaucer? To answer these questions , the following paper will first define the characteristics of the kind of ‘feminine’ romance Burrow was discussing and then analyze three of Chaucer’s Canterbury Tales – the Wife of Bath, the Prioress and the Knight’s Tale – to determine whether this description applies. The concept of the feminine romance has a great deal to do with the underlying structural format of the novel, particularly as it relates to the issues surrounding gender and the differences between the various ways in which the genders relate to others. For example, studies continue to show even today that women place greater emphasis upon the concept of relationships while men place more emphasis upon action.2 It should not be surprising, therefore, to discover that feminine romances, as such, are primarily concerned with the relationships of characters rather than the actions they undertake. This includes a certain focus upon the emotional lives of the characters as opposed to their physical

Reflective analysis case studies Essay Example | Topics and Well Written Essays - 2250 words

Reflective analysis case studies - Essay Example On the night in question, as a site manager, I was dealing with admissions and bed allocations. A colleague who was working opposite was the first responder that night. She received a call from the Critical Care Unit (CCU) at 2300 hours; the CCU nurses narrated that a female patient was having ongoing chest pains following the use of the commode; nurses also reported changes in the patient’s ECG reading; the CCU nurses also reported that the patient was given a glyceryl trinitrate (GTN) spray. My colleague and I already met the patient the previous night at the Emergency Medical Care (EMC) unit when she was admitted for shortness of breath (SOB), palpitations, and was having pleural effusions drained. Before we left for the ward, we fast beeped the doctor about the patient. We knew from the patient’s admission that she was 64 years old and had a Coronary Artery Bypass Graft (CABG) and an Aortic Valve Replacement (AVR) surgery 13 days prior to her admission. When we got to the CCU, the patient was extremely anxious and frightened; was very short of breath; was having chest pains; and was speaking in short sentences. The patient was also not sweating. The CCU nurses already put her on 15L Oxygen non-rebreath mask. I immediately made my A to G assessment while my friend helped to calm and reassure the patient. The doctor arrived a few minutes after we did and he saw the patient briefly, auscultated her chest, and went to the nurses’ station to write down his orders on the patient’s chart. I went to the nurses’ station to confer with the doctor about his initial findings and his orders. The doctor ordered Digoxin 500 mcg to be given immediately to the patient; he also ordered an increase in the treatment dose of clexane to 90 mg. He also ordered another 12 lead ECG to be done on the patient in 2 hours time; another dose of Digoxin in 6 hours time; IV

Awakenings Project Essay Example for Free

Awakenings Project Essay The abuses at Bainbridge Hospital reflected a broken system at that time. Any person who was deemed untreatable was put into a â€Å"garden†- where people were treated like flowers that were simply â€Å"watered† and â€Å"fed† every day. The attitude of the people who worked at the institution was of people who had accepted the system’s failures as a way of life; they did not strive for change, they simply â€Å"went with the flow. † Dr. Sayer introduces a number of attitudes that can be seen in modern care facilities. For example, his unfailing persistence in not giving up on patients who he believed had a chance at life. These patients had been immobile for decades, with countless people telling him that they would never get better. By believing in their cognizance and their persistent awareness of their surroundings, Dr. Sayer creates the hospital environment of today, punctuated with the idea that all patients should have the chance to have the best chance in life. He never gave up hope. However, Dr. Sayer also faced many different obstacles in attempting to treat his patients. For example, he needed to first overcome the mockery of his fellow coworkers. The doctors and nurses who worked with him did not understand his desires to pursue what seemed like a meaningless waste of time. However, in doing so, he gave life back to people who would have otherwise been trapped forever, in a state of permanent limbo. Later, he also faced the crisis of dosage with his â€Å"patient zero†, Leonard. Would he cross the line and illegally dose Leonard without the consent of the pharmacist? In doing so, he achieved success. However, he had to do so by compromising the laws set by society. Moreover, he had to muster funding for the drug for all the patients that had been affected at the institution. He could have given up after the head of the hospital told him that it was simply too much money, but he persisted in his efforts and was rewarded with enough funding for every patient’s awakening. I agree with the approach Dr. Sayer took because he was a pioneer during his time. Could he have otherwise succeeded in the revival of the patients that had been afflicted with the mysterious illness? His practices, although at times showing his own sense of morality and disregard for the accepted, would later become what is widely believed to be the basis of hospitals today. He took an interest in finding out the truth and never stopped believing.

Pulmonary Edema Lungs

Pulmonary Edema Lungs Outline of pulmonary edema: Pulmonary edema is the inflammation of the lungs that occurs due to the excessive accumulation of fluids in the lungs (alveoli) which results in poor exchange of gases which can cause dyspnea and finally respiratory and cardiac failure. Symptoms: The common symptoms of pulmonary edema include Dyspnea i.e. difficulty in breathing, shortness of breath, noisy and labored respirations rales, blood in cough, restlessness, anxiety, palor (paleness of skin). Diagnosis: It can be diagnosed by physical examination and knowing the patients medical history. By checking the wheezing sounds that are whistling or musical sound that can be heard without a stethoscope and inspiratory crackling sound that can be heard at the end of deep breath with the help of stethoscope and the characteristic third sound of the heart which can be seen in the cases of cardiogenic pulmonary edema patients. Apart from those general blood tests like liver enzymes, electrolytes, complete blood count etc. is done than a final confirmation is made by the X-ray of the lungs. Pulmonary Edema is a disease that affects the heart finally and begins in the lungs. Due to the inadequate pumping of the left ventricle, fluid accumulates in the spaces outside the blood vessels in the tissues of the lungs. It leads to a complication of heart disorders, sometimes acting as the first sign of coronary heart disease, and most commonly associated with congestive heart failure. It can be chronic or develop suddenly and quickly become life threatening. As large amounts of fluid suddenly shift from the pulmonary blood vessels to the lungs then pulmonary edema becomes life-threatening. When the heart begins to fail, the veins going through the lungs build up pressure and in turn the lungs pressure begins to rise which results in the building up of fluid being pushed into the alveoli. This fluid interrupts our normal oxygen flow through the lungs. Results and symptoms of pulmonary edema: Pulmonary edema occurs due to excessive accumulation of fluids and foam into the alveoli of the lungs when the pulmonary blood vessels are engorged. It can often be associated with congestive heart failure. It begins primarily with the building up of fluids in the microscopic alveoli of the lungs causing poor respiratory exchange resulting in Dyspnea with noisy and labored respirations. Rales which are powdery or gravelly sounds can be heard with stethoscope and some patients even cough up blood-tinged sputum. It occurs when the heart becomes damaged or weakened; as a result unable to pump blood to all the parts of the body, typically beginning with the left heart failure as a consequence of the damaged left ventricle which leads to backing up of the blood first in the pulmonary vessels and finally in systemic vessels. As a consequence blood fluids are forced into the body tissues due to increased pressure in the vessels causing a swelling known as edema. If it occurs in the alveoli of the lungs it is termed as pulmonary edema. Finally it can lead to congestive heart failure. Shortness of breath; Difficulty in breathing: Diseases like pulmonary edema leads to shortness of breath or difficulty in breathing which is known as Dyspnea which occurs due to poor respiratory exchange in the lungs. It causes labored and noisy respirations often associated with powdery or gravely sounds known as rales when checked with the stethoscope. Dyspnea is not a primary illness but a condition brought about by a number of medical, traumatic and environmental causes. It can be related to Lung diseases, heart conditions, allergic reactions, CO poisoning, etc. In most cases it occurs when a disease has caused some kind of direct interference with either the flow of air into and out of the lungs or with the exchange of gases within the lungs. In typical dyspnea, as in the case of asthma the problem causing interference originates in the lungs itself. Dyspnea can be classified into acute dyspnea with sudden onset can be caused by anaphylactic shock, cardiac arrhythmias trauma, etc. and chronic dyspnea which can be caused by Asthma, Bronchitis, COPD, Neuromuscular disorders, etc. Air hunger or feeling of drowning, Grunting of gurgling sounds with breathing, Wheezing As a sign of congestive heart failure the patient would wish to remain in a seated or semi-reclined position which allows less labored respiration. The patient should be kept calm to conserve body heat. These oxygen hungry patients will accept oxygen therapy without difficulty. In severe lung diseases like an Asthma attack, the small bronchioles becomes narrower due to the contraction of the smooth muscles that make up the airway apart from the overproduction of thick mucus leading to the restriction of airflow. The airflow is restricted in mainly in one direction such as, during inhalation, the expansion of lungs exerts an outward force resulting in the increase in the diameter of the airway, allowing air to flow into the lungs. During exhalation the opposite occurs resulting in the trapping of the stale air into the lungs which requires forceful exhalation of air by the patient, producing the characteristic wheezing sound associated with asthma. Wheezing sounds are whistling or musical sounds that can be heard without a stethoscope. Gurgling is caused often due to a foreign object, or blood and other fluids in the trachea. It is believed that cardiac murmurs are associated with the possibility of heart failure which is not correct as in about 50 % of the heart failure cases there is no murmur observed. Still a cardiologist should take note seriously if any murmur is present in the patient. In the diagnosis of heart failure Gallop rhythm (one can imagine the sounds of hooves of horse smoothly running at full speed) is very typical and significant. SOB with lying down, you may need to sleep with you head propped: The affects of the body position of a person sometimes gives an idea about the underlying disorder causing dyspnea. For example in platypnea, that is dyspnea while sitting gives indications of a liver disease. The worse type of Dyspnea is when the patient is lying down and suffering from shortness of breath, which is associated with heart disease or paralysis of the diaphragm. It is called as orthopnea. Another type of dyspnea is PND (Paroxysmal nocturnal dyspnea) which occurs during sleep forcing the patient to wake up gasping for breath; usually relieving the patient if he / she sit up or stands. It may indicate the dysfunctioning of the left ventricle of the heart, narrowing of the mitral valve or hypertension. If a patient is suffering from orthopnea he sleeps with the head propped up. Cough: It is an annoying symptom which can occur as a result of many causes such as pulmonary edema, tuberculosis, Bronchitis, Asthma, etc. Anxiety: Factors like excessive worry, nervousness, instability, nausea, etc. are the major symptoms of anxiety. Restlessness: It can be caused by a number of factors such as anxiety, nervousness, insomnia, hyperactivity, etc. Excessive sweating: Sweating is due to the presence of sweat glands under our skin, which is controlled by the sympathetic nervous system of our body and whenever our body temperature rises sweating is stimulated. Thus, it controls the body temperature. Emotional stress also stimulates sweating. Palor or pale coloration or cyanosis of the parts will also take place during any respiratory or cardiac attack. Sympathetic over stimulation leads to symptoms like palor, sweating, and tachycardia during heart failure. Additional symptoms with progression of the disease: Nasal flaring: It is an indication of breathing difficulty caused by the enlargement of the nostril opening during breathing; as a result the total airway resistance is reduced. Inability to speak: The patient may not be able to speak due to pulmonary obstruction or cardiac failure. Decrease in levels of awareness: the level of awareness or consciousness of the patient will also go down during any respiratory or cardiac attack.

Technologys Impact on the Upper Mississippi River Essay -- Enviroment

Technology's Impact on the Upper Mississippi River Since the days of Lewis and Clark men have dreamed of harnessing the "Father of Waters" in the interests of commerce and development. The long struggle which ensued required incredible ingenuity and determination on the part of engineers as well as enormous capital investment. The Mississippi River Commission, established in 1897, was the first federal program designed specifically to meet these requirements, and early systems, instituted by the Army Corps of Engineers, saw much success. Technological advancements in the fields of transportation, flood control, and natural resource management were needed and, eventually, emerged to provide the level of control possible today. This report will discuss the technological transformation of the upper Mississippi river and the motivation behind it from the middle 1800's. Economics, in the form of cheap transportation, have been the impetus behind most of the development along the Upper Mississippi. In the early 1800's, transportation was limited to keelboats (large rafts made of roughcut lumber) which floated downstream with the current where they changed their cargo and then were poled or warped (pulled from shore with a rope) back upstream. With the development of the steamboat the arduous journey up and down the river, taking up to nine months by keelboat, became a much more reliable route for transporting both products and people. In the late 1800's, the invention of the internal combustion engine led to the powerful towboats seen on the Mississippi today. Towboats move 70 to 85 million tons of cargo annually between Minneapolis and the Missouri River [http://www.emtc.nbs.gov]. Underscoring the economic importance of such ... ...ing fascinating about science, one gets such wholesale returns of conjecture out of such trifling investments of fact." References: Mairson, Alan, "The Great Flood of '93," National Geographic, vol. 185 (January 1994),pp. 42-81. National Biological Service, Department of the Interior, "Environmental Management Technical Center," http://www.emtc.nbs.gov (1996). Twain, Mark, Life on the Mississippi (New York, New York: Harper & Row, Publishers, 1917). Upper Mississippi River Basin Coordinating Committee, Upper Mississippi River Comprehensive Basin Study, vol. 1 and 5 (1972) U.S. Army Corps of Engineers, "Upper Mississippi River--Illinois Waterway System Navigation Study," http://www.usace.army.mil/ncd (1996). U.S. Geological Survey EROS Data Center, "Upper Mississippi River Basin Flooding," http://edcwww.cr.usgs.gov/doc/edchome/sast (1996). Technology's Impact on the Upper Mississippi River Essay -- Enviroment Technology's Impact on the Upper Mississippi River Since the days of Lewis and Clark men have dreamed of harnessing the "Father of Waters" in the interests of commerce and development. The long struggle which ensued required incredible ingenuity and determination on the part of engineers as well as enormous capital investment. The Mississippi River Commission, established in 1897, was the first federal program designed specifically to meet these requirements, and early systems, instituted by the Army Corps of Engineers, saw much success. Technological advancements in the fields of transportation, flood control, and natural resource management were needed and, eventually, emerged to provide the level of control possible today. This report will discuss the technological transformation of the upper Mississippi river and the motivation behind it from the middle 1800's. Economics, in the form of cheap transportation, have been the impetus behind most of the development along the Upper Mississippi. In the early 1800's, transportation was limited to keelboats (large rafts made of roughcut lumber) which floated downstream with the current where they changed their cargo and then were poled or warped (pulled from shore with a rope) back upstream. With the development of the steamboat the arduous journey up and down the river, taking up to nine months by keelboat, became a much more reliable route for transporting both products and people. In the late 1800's, the invention of the internal combustion engine led to the powerful towboats seen on the Mississippi today. Towboats move 70 to 85 million tons of cargo annually between Minneapolis and the Missouri River [http://www.emtc.nbs.gov]. Underscoring the economic importance of such ... ...ing fascinating about science, one gets such wholesale returns of conjecture out of such trifling investments of fact." References: Mairson, Alan, "The Great Flood of '93," National Geographic, vol. 185 (January 1994),pp. 42-81. National Biological Service, Department of the Interior, "Environmental Management Technical Center," http://www.emtc.nbs.gov (1996). Twain, Mark, Life on the Mississippi (New York, New York: Harper & Row, Publishers, 1917). Upper Mississippi River Basin Coordinating Committee, Upper Mississippi River Comprehensive Basin Study, vol. 1 and 5 (1972) U.S. Army Corps of Engineers, "Upper Mississippi River--Illinois Waterway System Navigation Study," http://www.usace.army.mil/ncd (1996). U.S. Geological Survey EROS Data Center, "Upper Mississippi River Basin Flooding," http://edcwww.cr.usgs.gov/doc/edchome/sast (1996).

Earnest Hemingway Essay -- essays research papers fc

Earnest Hemingway As one of the 20th century's most important and influential writers. His writings drew heavily on his own experiences for his writing. His writing reflected his trouble with relating to women and his tendency to treat them as objects, as he had four marriages and countless affairs, highlighting his theme of alienation and disconnection. Now here is why he is what he is by writing about what he was. Ernest Miller Hemingway was born on July 21, 1899, in Oak Park, Illinois, to Dr. Clarence Hemingway and Grace Hall Hemingway. Oak Park was a mainly Protestant, upper middle-class suburb of Chicago that Hemingway would later refer to as a â€Å"town of wide lawns and narrow minds" (Gerogiannis 188). The second among six children, Ernest spent the first two years of his life dressed as a girl by his mother. She called him â€Å"Ernestine† and fantasized that he was the twin of his older sister, as she dressed them both in matching dresses and gave them similar hairstyles (Rozkis 233) As he grew older, however, his father stepped in and insisted that Ernest be â€Å"raised like a man,† teaching Ernest how to behave and introducing him at a young age to hunting, fishing, and boxing, all activities in which he would stay interested for the rest of his life (Gerogiannis) It is perhaps this early start at questioning his manliness and his father’s attempts to drive any femininity out of him that instilled his characteristic obsession with proving his masculinity throughout his life. Schlusemeyer 2 Hemingway received his schooling in the Oak Park public school system. In high school he was mediocre at sports, joining the football, swimming, basketball, and water polo teams and serving as the track team manager (Nelson 5). He began his journalistic career writing for the school paper, the Trapeze, where he wrote his first articles and often humorous pieces in the style of Ring Lardner, a popular satirist of the time. After graduating in the spring of 1917, against the wishes of his parents, he forwent college and took a job as a cub reporter for the Kansas City Star. It is here that the seeds of his unmistakable staccato writing style were planted as he followed the rules of the Star’s stylebook exactly. â€Å"Use short sentences,† it said. â€Å"Use shor... ...Modified August, 1999. Viewed April 20, 2005. http://www.ernest.hemingway.com Ernest Hemingway in Oak Park, Illinois Last Modified 2004. Viewed April 21, 2005. http://www.ehfop.org Gerogiannis, Nicholas. "Ernest Hemingway." Dictionary of Literary Biography: American Authors in Paris. Vol. 4. Detroit: Gale, 1982. 187-211. Meyers, Jeffrey. Hemingway: A Biography. New York: Harper & Row, 1985. Nelson, Raymond S. Ernest Hemingway: Life, Work, and Criticism. Fredericton, N.B., Canada: York Press, 1984. Picturing Hemingway: A Writer in His Time Last Modified January, 1998. Viewed April 21, 2005. http://www.npg.si.edu/exh/hemingway/index.htm Rozkis, Laurie E. Macho, Macho Man: Ernest Hemingway. New York: Pearson Press, 1999. The Ernest Hemingway Home & Museum Last Modified 2002. Viewed April 20, 2005. http://www.hemingwayhome.com Timeless Hemingway. Last Modified January, 2005. Viewed April 20, 2005. http://www.timelesshemingway.com

Major Historical Developments of the Early Renaissance

According to Perry in his book, during the Middle Ages people praised the greatness of God.   They saw preparation for heaven as the most important reason for life.   The beginning of the change from the medieval outlook to a modern one is called the Renaissance, or rebirth.   It was the time of gradual change, not a sharp break in the Middle Ages.   They continued to believe in the teachings of the Church.   But to their religious beliefs they added many worldly interests and activities. During the Medieval Europe, we can say that the Church plays an important role in the society, particularly the Christian belief.   It is said that it was the foundation of medieval civilization.   It gives form, direction and unity in the society.   The people believe that the path to heaven is through the church. The church was the center of life among medieval people.   It was used as a community center.   The church services were part of medieval people’s daily lives.   The priests also play as the teacher among villagers.   They taught them the sacraments and teachings of the church.   They provided services among the villagers like mass, provided care for the needy and sick, and taught children Latin.   The Monks and Nuns were the finest examples of the Christian way of life according to the people during this period. One contribution to civilizations of the Middle Ages was that the convents and monasteries during this time established hospitals and provided shelter for travelers.   It is also consider as the center of learning.   They converted pagans to Christianity.   Mendicants were visible in towns and even on open roads. They preach and they meet their needs by begging.   Among those mendicants were Franciscans, Poor Clares and the Dominicans.   The Dominicans main goal was not only to preach but also to convert every individual. The Church during this time insisted that people should obey the rules and doctrines of the Church in order to reached heaven. They tried to persuade heretics to return to the fold.   If that failed, it would threaten them with excommunication.   An excommunicated person would be expelled from the church and denied the sacraments.   In the Age of Faith no punishment could be worse than this one. Renaissance Renaissance is the term used during the beginning of change from the medieval outlook to a modern one; it also means rebirth.   It was also the time of gradual change.   Renaissance people during this time were neither nonbelievers nor heretics.   They still believe in the teachings of the church.   But as time goes by, changes have brought to their beliefs that affect their activities and worldly interests.   Renaissance does not only bring some changes in the beliefs of the people.   Humanism is one example of this.   There are individuals who were known as humanists. The first great humanist of the Renaissance was Francesco Petrarch.   He collected ancient Latin and Greek manuscripts and imitated the style of Great Roman poets.   He explored and sought his innermost feelings.  Desiderius Erasmus, a gentle Dutchman was one of the respected Christian humanists.   He was interested in studying human behavior.   He wanted people to be kind and reasonable.   He was consider as a Christian humanist because he spread the new learning and sought a deeper and purer religious devotion. There were medieval artists that were known during this time like Raphael, Michael Angelo Buonarotti, and Leonardo da Vinci.   They express their feelings through paintings.   Their work of art focuses on religion.   Among their work of art were Madonna by Raphael; the paintings of Michael Angelo in the ceiling of the Sistine Chapel; and even Mona Lisa of Leonardo da Vinci.   All of this was reflections of the Christian religion.  Like the Renaissance, the Reformation plays a big role during this time.   Reformation was the time when many Christians left the Catholic Church. There are people that led to this reformation. One is John Wycliffe, he was from England who questions the basic teaching of the church – – that people can reached heaven through the Church.   Another reformist was John Huss of Bohemia who was influenced by Wycliffe.   He challenged the authority of the Pope, denounced the wealth of the clergy and called the deepening of spiritual feeling.   The third reformist was Martin Luther, who was a German Monk who believes that people could reach God by Faith alone. He also nailed on the door of Wittenberg his Ninety-Nine Theses which denounces the indulgences of the Church. As a whole I can say that reformation plays a big role in the changes that occur to the religious beliefs of the people.   It divided the unity of faith among westerners from Catholicism emerge Protestantism.   The Reformation also helps to develop modern economics attitudes.   The secular attitude of the Renaissance contributed in the politics and the economic life of people in the society. Reference: Unfinished Journey: A World History. 1983. Marvin Perry. Houghton Mifflin Company. Boston, Massachusetts. ISBN: 971-11-0125-4      

Factors Affecting Climate

Factors Affecting Climate There are many different factors that affect climate around the world. The most important factors are:- †¢Distance From The Sea †¢Ocean Currents †¢Direction of Prevailing Winds †¢Relief †¢Proximity To The Equator †¢The El Nino Phenomenon †¢Recently, it has been accepted that human activity is also affecting climate. Distance From The Sea (Continentality) The sea affects the climate of a place. Coastal areas are cooler and wetter than inland areas. Clouds form when warm air from inland areas meets cool air from the sea. The centre of continents are subject to a large range of temperatures.In the summer, temperatures can bevery hot and dry as moisture from the sea evaporates before it reaches the centre of the continent. Ocean Currents The Ocean Currents of the World http://www. itl. net cean currents can increase or reduce temperatures. The diagram to the left shows the ocean currents of the world. The main ocean current tha t affects the UK is the Gulf Stream. Can you see where the gulf stream is? The Gulf Stream is a warm ocean current in the North Atlantic flowing from the Gulf of Mexico, northeast along the U. S coast, and from there to the British Isles.The Gulf of Mexico has higher air temperatures than Britain as it's closer to the equator. This means that the air coming from the Gulf of Mexico to Britain is also warm. However, the air is also quite moist as it travels over the Atlantic ocean. This is one reason why Britain often receives wet weather. The Gulf Stream keeps the west coast of Europe free from ice in the winter and, in the summer warmer than other places of a similar latitude. The chart below was the first chart drawn of the Gulf Stream. It was drawn by Benjamin Franklin in 1770.The Gulf Stream – As Drawn By Benjamin Franklin http://www. cnmoc. navy. mil. educate Direction of Prevailing Winds Winds that blow from the sea often bring rain to the coast and dry weather to inland areas. Winds that blow to Britain from warm inland areas such as Africa will be warm and dry. Winds that blow to Britain from inland areas such as the Netherlands will be cold and dry in winter. Britains prevailing winds come from a south westerly direction over the Atlantic. The winds are cool in the summer and mild in the winter. Relief Climate can be affected by mountains.Mountains receive more rainfall than low lying areas because the temperature on top of mountains is lower than the temperature at sea level. That is why you often see snow on the top of mountains all year round. The higher the place is above sea level the colder it will be. This happens because as altitude increases, air becomes thinner and is less able to absorb and retain heat. Proximity To The Equator The proximity to the equator affects the climate of a place. The equator receives the more sunlight than anywhere else on earth. This is due to its position in relation to the sun (see right).The diagram shows that the equator is hotter because the sun has less area to heat. It is cooler at the north and south poles as the sun has more area to heat up. It is cooler as the heat is spread over a wider area. The Earth's Position in Relation to the Sun http://www. itl. net El Nino El Nino, which affects wind and rainfall patterns, has been blamed for droughts and floods in countries around the Pacific Rim. El Nino refers to the irregular warming of surface water in the Pacific. The warmer water pumps energy and moisture into the atmosphere, altering global wind and rainfall patterns.The phenomenon has caused tornadoes in Florida, smog in Indonesia, and forest fires in Brazil (see below) Devastation Caused by a El Nino-generated tornado in Florida http://news. bbc. co. uk Smog In Indonesia http://news. bbc. co. uk El Nino Causes Forest Fires in Brazil http://news. bbc. co. uk Human Influence The factors above affect the climate naturally. However, we cannot forget the influence of humans on ou r climate. We have been affecting the climate since we appeared on this earth millions of years ago. In those times, the affect on the climate was small.Trees were cut down to provide wood for fires. Trees take in carbon dioxide and produce oxygen. A reduction in trees will therefore have increased the amount of carbon dioxide in the atmosphere. The Industrial Revolution, starting at the end of the 19th Century, has had a huge effect on climate. The invention of the motor engine and the increased burning of fossil fuels have increased the amount of carbon dioxide in the atmosphere. The number of trees being cut down has also increased, meaning that the extra carbon dioxide produced cannot be changed into oxygen.

Clinical Experience of Student Essay

My learning throughout the first year has been helped by an unerring optimism in the value of nursing, and an appreciation that each and every daily interaction augments my experience. This enthusiasm, however, has caused an inhibitory effect on my self-directed researching, and created conflict in some placement areas. While developing my role as a nurse, my activities as a person at home and beyond have diminished, as I attempt to adjust to the demands of both domains (Spouse 2003:109). I resent distracting influences, and frequently domestic pressures restrain my desired pace to accumulate factual knowledge. As described by Palmer et al. (1994:40), my learning can oscillate between two extremes, â€Å"all or nothing†. Spouse (2003) depicts the student nurses’ need to develop multi-tasking skills emotionally, mentally and physically as they are caught between the cultures of clinical areas, peer-driven University life and home. The conflicts arising from these settings create a disharmony, which I believe for some, may undermine nursing as a career choice. The competence of a future nurse is evaluated by evidence-based documents, instructors, mentors assignment and examination results and is based on a continuum of regular assessments. The learning experience of a student nurse remarkably influences own practice in clinical areas, as well as the performance level of the student in academic matters. First timers in clinical rotation engage themselves in the initial stage of familiarizing and accustoming one’s self to the practice becomes crucial. This is the point when printed theories in books and hand outs are recalled nd reshuffled in the mind in order to carry out the best intervention suited for a particular situation. It was never easy for the a novice student nurse to be assigned in the OB ward or in the emergency room without sufficient knowledge about postpartum care or familiarity with the basic instrument used in minor surgeries. Also, inadequate and ineffective education influences the manner that one gains necessary principles and skills needed in actual and assisted delivery cases. This has affected the coping strategies of the trainees to different problems arising in the clinical settings. In reality, some just performed as assistants instead of handling actual deliveries—this is also dependent to the hospital protocols—and some were just given free cases. This fact has urged others’ curiosity to get a hasty view of the first learning experiences of the other nursing students who are also in the same level. Some people ought to assess the level of students’ adjustment with the respect to different conflicts they have encountered so that appropriate improvements in nursing education programs will be obtained. The trend to commit oneself to healthcare field has not yet wiped out especially in nursing profession. Students seem to be devotedly engaging themselves into this line as seen with continuous enrollment of freshmen students and transferees, may it be influenced by financial demands, personal preferences, or just by current blooms. The Professional Regulation Commission reported that the country has an oversupply of 400,000 licensed nurses (Porcalla, 2008). With this fact that there are still thousands of nursing graduates in the country who are either unemployed or working as call center agents, clerks, salesladies or salesmen, discouragement in the part of the fresh high school graduates is still invincible. Though many say that those temporary jobs are just their means of earning money while waiting for the board examination, individual encounters prove that a significant percentage of those graduates would just end up working in the same condition; others fortunately have passed the board and served as volunteer nurses to gain experience during the initial years of the profession; and some might have dealt with hard life or just settled down rearing families. For so many reasons, nursing career—for some—terminates there, which should not be. Why is it that even universities have started to limit accepting nursing enrollees due to overpopulation of out-of-work nursing graduates, the government’s need for ideal healthcare system is still unmet? The answer would be—it is a matter of competition! In the Filipino context, it goes, â€Å"Matira ang matibay. † As with the student admission criteria of one hundred eleven medical schools in the United States, education programs and requirements filter nursing students meticulously (Reynolds, W. Scott, P. A. ,& Austin W. , 2000). Spouse (2003:42) depicts the student nurses’ need to develop multi-tasking skills emotionally, mentally, and physically as they are caught between the cultures of clinical areas, peer driven university life and home. The conflicts arising from these settings create a disharmony, which Greenwood (2003) believes for some, may undermine nursing as a career choice. Aside from it, it is not new to hear stories about taking the course with the dictate of the mother in exchange for the big Dollar sign neither a complaint for expensive matriculations and a shelf of three-kilogram-books. According to Rep. Satur Ocampo, â€Å"Low and inappropriate budget of DOH for 2009 now pegged at 28. 9 billion still does not address the problem of the exodus of nurses in the country†(Porcalla, 2008). It is one of the major sicknesses of the country’s healthcare system which puts down the field. But with the growing population and high expectancies of quality care and competence, nurses should be skillful in integrating theoretical frameworks, as well as nursing philosophy, into real life situations so that high quality care can be delivered and optimal health will be met and promoted. Nursing is an art, an art of caring. Nurses are much involved in lots of health teachings and interventions; and are expected to portray a variety of roles. Be it as an educator, communicator, caregiver, counselor, advocate or as a leader, a nurse should possess a well-defined body of knowledge and expertise in the field especially on actual scenarios (Kozier et. al. ,2008). Student nurses may be perceived as trainees, yet it is far apart from that thought. It is incorporating oneself to and embracing the vocation of helping and providing care in order for mastery and dedication to be more likely. The developmental educative process in nursing is a sophisticated and complex combination of scientific, logical, humanitarian, communicative, experiences and psychomotor skills, designed to consolidate abilities to produce â€Å"knowledgeable doers† (Greenwood 2003, Sajiwandani 2000, Slevin 1992, Cheung 1992). Nursing students at this point of time should be cautious whether they have delivered or could deliver appropriate care. They have to be very vigilant because they deal with a lot of toxic things every single day (Tacdol, 2008). It is not anymore in a classroom setting, it is more of real life situations. When at the area, there is no room for mistakes. No more dummies. No more trials. The reflective process enables the students to gain a sense of proportion. While researched academic study underpins practice, there are frequently qualifications made by nursing staff about ward performed procedures, stating â€Å"real-life† situations employ differing methods to those taught in the class room. These instances challenge student’s assumptions and provide impetus for further clinical reflective investigation (Spouse 2003, cited by Greenwood 2003). They also serve to demonstrate the existence of multiple methods of care delivery, attuning them to motives and perspectives of other practitioners in the healthcare team, indicating that others have legitimate reasoning (Palmer et. al 1994 cited by Greenwood, 2003) The performance of students in the clinical area is greatly affected by difficulties they encounter especially in their first clinical duty. Factors include relationship with clinical instructors, misunderstandings arising from group works, hospital policies and requirements, alterations in contingencies when handling patients and so on. As new members of the healthcare team, adjustment to different stressors seems to be crucial. It is an undeniable fact that problems with the clinical instructor top all. Many claim that superiors sometimes do not provide favorable atmosphere for learning. Using negative reinforcement is one of the examples. Others found this as beneficial since it helps the students to ask questions, enhances perception, and inhibits recurring of errors. But many negate this assertion. Embarrassment, comparison to other schools, and stickling behavior of the superior notably outweigh the benefits it should have made. Although many have agreed that the student nurses are very effective in delivering their duties and responsibilities in the clinical areas, there should still be improvement in the learning scheme of the education provider because there is no room for mistakes in the medical profession because it deals with a very fragile thing-life- and a single mistake may cause an enormous damage which is death. The students must be prepared and trained well before their exposure in the clinical areas so as not to commit error (Babula et. al. , 2006). Group conflicts such as lack of teamwork have something to do in accomplishing case studies. Hospital policies and protocols may at times become annoying and confusing. Different shifts and location of clinical duties tend to be the second in the list. Personal moods and anxieties affect functioning of the whole personality which may result to unproductive planning and ineffective nursing interventions (Abaravar et. al. , 2006). Moreover, unexpected problems arising when handling patients are to be aided with harmonious interaction between the instructor and the students while correction and giving of remedies are done (Amania et. al. , 2008). The identification of these common conflicts that are actually the factors which affect the level of performance of nursing students in clinical duties extensively bring up good adaptation behaviors and ease up finding solutions to the mentioned conflicts. Because of the continuous efforts made by some concerned people behind the nursing education? students, educators, and also the registered nurses in the profession? improvements in nursing curriculum has been made. Though distinction between the old and new curriculum of the program have been clearly identified, effectiveness of each are still debated and talked about more often. For nursing education and nursing career does not end in passing all the academic subjects and completion of the PRC forms, one has to subject himself in difficult situations when nursing judgment becomes a necessity. As nursing student begins on the path of career, he or she finds new opportunities unfolding as from within which brighten the path ahead. The kaleidoscope image used on the cover of the 7th edition of Fundamentals of Nursing by Kozier and Erb is an everchanging piece of art with its colors, light and form. As it turns, it represents new opportunities for beautiful new designs. Seeking light and reflections to form new shapes allows one to open one’s mind to all possibilities a kaleidoscope has to offer (Kozier et. al. ,2007). Same with the field of nursing, there are many areas that a nursing student may have never imagined at the beginning of his or her journey. As nursing students open their minds and eyes to these wonderful chances, a good experience they had gained when they were still first timers would be a pertinent tool and inspiration in attuning upcoming difficulties and developing passion in the career. These would let them not to desist from this world of struggles. Conclusion A qualified nursing practitioner is a professionally trained integrated member of the health-care team. This professional education should be life-long, beginning with three years pre-registration factual knowledge and skill acquisition. As previously described there is a symbiotic relationship between nursing’s craft and nursing wisdom, and they are required in practice simultaneously. Despite the apparent impression given by traditional methods of education that these categories exist seperately, for nursing they are fluidly cohesive, one informing the other, through reflective analysis (Watts 1992:). The elements experienced by nursing students during their training are bonded internally together to authenticate their practice, by unleashing possibilities inherent in the situation between patient and the therapeutic self (Kirby and Slevin 1992). The following guidelines are intended to promote improvements in the student’s learning experience. Qualified staffs that direct pace and direction of study need to encourage students in imaginative and innovative ways to prepare them for adoption of new concepts and the flood of changes and that they will need to make in all aspects of their life. Support such as this will guide them through the vulnerable initial stages of their steep learning curve of level one, as echoed by the dissonance described in the first paragraph of the essay. Guidelines I would like to see better preparation of mentors by lecturer-practitioners within clinical placements, in order to foster environments of positive, constructively planned activities. From this, students can gain insight to challenge their assumptions and lay-view of nursing. In this respect, I would like those in the clinical settings to be encouraging students rather than attempting to degrade their efforts by dismissing their academic research based interest in the subject of nursing. I would like access to professional teaching staff in-college at all times, especially immediately prior to and post placement. I hope for tutor liaison with mentors more regularly within the clinical settings, serving to remind mentoring nurses that their duty to support students is real, and linked with Higher Education Establishments. I would like to see in-college mentors giving better, basic and consistent guidance while initially developing the concepts of critical reflective consciousness and the production of an evidence-base of knowledge thus strengthening the intellectual and practical growth of students.