Strategic Plan of my current employer Essay Example | Topics and Well Written Essays - 1250 words

Strategic Plan of my current employer - Essay Example Internal environmental factors affecting an organization’s performance include strengths and weaknesses. Externally, opportunities and threats influence an organizations’ performance among industry competitors. Inefficiency in the planning process is dangerous to the survival of an organization. Mistakes by the management while lying down the strategic plan management consequentially lead to failure and loss of business to competitors. In the extreme, an organization faces liquidation (Bo?hm, 2009). To achieve is purpose of â€Å"to develop a self-actualized scholar, who possesses a knowledgeable and discerning mind, thrives in service to others, and is prepared for college,† Paulo Freire Charter School must effectively manage its internal and external environments effectively and efficiently. Internal factors adequately affect the strengths and weaknesses of an organization. The management of any organization needs to plan for the purpose of hedging against any form of internal problems. Resources and human capital are essential elements in the internal factors management. Availability of raw materials, financial capital for investment and labour to work in the various departments are the internal factors affecting the performance of an organization. To achieve organizational goals, adequacy of resources is essential. Internal factors make both the organizational strengths and weaknesses. ... Long-term finances are essential in financing long-term operations of the school. Inadequate finances for an organization are its weakness, while adequate finances are its strength. Purchase of machinery, hiring of workers, and expansion of a classes and addition of courses offered by the school are the major uses of long-term funds in the school. Strategic budgeting process by an organization ensures proper allocation of resources according to the requirements of the organization. Poor budgeting of organizational funds potentially leads to financial problems to the school. Prioritizing needs with reference to the organizational needs and requirements will help the organization from getting into financial problems. Bo?hm (2009) points out that as strength, adequate finances greases the various wheels used by the management to achieve the school’s purpose. However, this could also form part of its weaknesses. Inadequate funds, misappropriation of the school’s income and poor liquidity position are a weakness that can lead to poor results, and thus the school losses business to its competitors. Human capital is responsible for the achievement of organizational goals and objectives (Bruce, 2006). To achieve its goal the school needs human resources, and these need care and profession in their handling. Investing in human resources of the organization increases the organization quality of services. At the same time, the organization achieves its goals, reaches its vision and lives up to its mission statement. Proper motivational strategies to the teachers increase their output. According to Frey (2002), there is more to motivation than offering good salaries to the employees. Although

The Poetry of WWI Essay Example for Free

The Poetry of WWI Essay My study aims to cover the key points of the poetry written during and about the first world war and the various factors which may have influenced it. We will start with Drummer Hodge which was written during the Boer war by a writer named Thomas Hardy. The poem offers an unusual view of war which isnt often seen elsewhere. Drummer Hodge by Thomas Hardy The poem is an existentialist paradox Hodge was an unimportant figure in a major war and is representative of the thousands of casualties of the battle. The poem begins ambiguously. They could refer to either friend or foe. Their identity is not as important as their attitude towards Hodge. Hodge is thrown into a pit just as found, without a coffin and presumably without a service. His homely Northern breast and brain suggests Hodge was a simple, modest sort, but a valuable human nonetheless. Unlike the other poems, Drummer Hodge is very structured and never changes its six-line 1-2-1-2-1-2 form as opposed to Brookes and Owens use of octaves and sestets. Hardy uses Roman numerals to separate each stanza and to provide a classical feel to the poem. The mood of the piece is somewhat sympathetic towards the subject. Hodge could be anybody but is used as an example of the unfairness of war. In the second part of the poem, Hodge is referred to as being fresh like a child to young to die. Hardy constantly emphasizes Hodges foreignness and he makes it clear that Hodge was a complete stranger to the southern surroundings in which he fell. Words such as ..foreign constellations and that unknown plain are used to portray the fact. In Brooks and Owens sonnets, death is focused on and referred to throughout as glorious, brave and heroic while in Drummer Hodge, a death is portrayed as, sudden, unexpected, and ultimately unfair and inglorious similar to the surprise death of Brooke himself. In June 1914, Austria, Serbia, Russia, Germany, America and several other countries plunged into world war, engulfing Europe in one of modern historys bloodiest and most catastrophic conflicts. In fact, it is said to be the landmark and the beginning of modern history, it had a profound impact on the remainder of the century. Before this great war began, it was received in Europe with much enthusiasm, not since repeated. The public were led to believe it would be over by Christmas and would put an end to all wars. As we know, that was not the case. On the favorable side, the war did give birth to a whole new genre of poetry, led mainly by Rupert Brooke, but also many others. The patriotism expressed in these pieces was printed regularly in newspapers so anyone not yet in battle would rush off to become a soldier and get their name in the memorials. It kept the soldiers going and maintained their will to fight and die for their country. Many soldiers saw it as their duty to sacrifice themselves in the name of their homeland and any form of death in war was regarded as heroic and glorious. In the latter years of the war, the poetry became harder, more realistic and perhaps discouraging to aspiring soldiers as Owen, Rosenberg and Sassoon took over from Brooke and therefore it was not received with equal enthusiasm. However, Brookes war sonnets are still read out in church memorials today, the soldier in particular. Born the son of a schoolmaster in Rugby on August 3rd 1887, Rupert Chawner Brooke went on to become one of the most famous poets of the first world war, due largely to the success of his poem the soldier that expressed the patriotic feelings of a generation at the time of his death. However this was only one of his hundreds of poems written over the course of his life-time, many dealing with subjects other than war. Rupert was educated at Rugby, before moving on to study at Kings College, Cambridge. He was a good student and athlete and proved an extremely popular young man. In 1909 he moved to Granchester where he lived with his friends and wrote many of his non-war poems. In spring, became a member of the Fabian Society. He spent the spring of 1911 in Munich studying German where he met and fell in love with Flemish sculptress Elizabeth Van Rysselberg. When he returned to Granchester in May 1911, he began to work for his Fellowship at Kings. At the same time, despite the demands of his academic career, he completed his first volume of poetry, which he entitled Poems 1911. This was published in early December, and produced a small profit within a few weeks. In the next twenty years it ran to 37 editions, totalling around 100,000 copies. In 1913, Rupert was finally awarded a Fellowship at Kings. On 15th September 1914, he applied for a commission in The Royal Naval Division. Rupert Brooke actually saw little combat during the war. It was during this period that he wrote his most famous poetry. He wrote a set of five sonnets which rewarded him in instant fame after the soldier was quoted in a sermon in St. Pauls church, London. He took part in an expedition to Antwerp but while sailing for the Dardanelles, he was bitten on the upper lip by a poisonous mosquito. He soon fell ill and at 4:46pm on the 23rd April 1915, the day of Shakespeare and St George he died aboard a hospital ship in the Aegan of blood poisoning. His companions buried him in an olive grove on the Greek island of Skyros. We buried him in the same evening in an olive-grove where he had sat with us on Tuesday one of the loveliest places on this earth, with grey green olives round him, one weeping above his head; the ground covered with flowering sage, bluish-grey, and smelling more delicious than any flower I know .. We lined his grave with all the flowers we could find, and after the last post the little lamp-lit procession went once again down the narrow path to the sea. A Brief Summary of Brookes five war sonnets I. PEACE In the first of the five war sonnets from which Brooke gained the majority of his fame, the word war is not mentioned even once. Instead, Brooke talks about the release from pain, grief and a world grown old and cold and weary which is death. Death is personified as the key to cleaner life and the poem is begun by the thanking of God who has wakened us from sleep. The sestet speaks further about the privilege of death and finally obtained peace which our previous world failed to offer. The worst friend and enemy is but Death. II. SAFETY In the second chapter of Brookes plea for death, he explores the idea of war being safe safe from survival in this case. Who is so safe as we? III. THE DEAD It was poems like this which was used in newspapers in order to encourage young men to go to war and die, with the image in their minds that if they did so, they would become richer souls and labeled as heroic. Brooke speaks of the privilage of death which is introduced in the first sonnet and further magnifies its magnificence and Honour. dying has made us rarer gifts than gold. The poet compares the death of a soldier to the inferior ending met with old age by those living a life of safety and absent usefulness outside of war. that unhoped serene that men call age The sestet mentions the gain of Nobleness, Holiness and love lacked so long which comes hand in hand with an honourable death. IV. THE DEAD Similar to Hardys Drummer Hodge, the fourth in Brookes five sonnets talks about what has been lost with death. As in Drummer Hodge, the poem mentions how the dead had known joy, love, sorrow, kindness, emotion all of which is ended by death. However, unlike Hardys sympathetic approach to the matter, Brooke inserts his traditional, patriotic conclusions. a white, Unbroken glory V. THE SOLDIER The last of the five is of course the most widely known and anthologized of Brookes work, in fact it wouldnt be unfair to say that it is one of Englands most famous pieces of literature. It was this poem that triggered off instant fame for the poet and inspired many others. Brooke begins the poem with If I should die, think only this of me: which sets the tone for the rest of the poem to follow. The octave speaks of how an English corpse, fallen in a foreign field will leave a superior presence in the air and earth to the non English soil which occupied the space beforehand. The soil becomes a body of England and breathes fresh English air, blest by the suns of home. In the sestet, Brooke becomes a pulse in the eternal mind and his heart will be in peace in an English heaven. Despite the poems obvious politically unacceptable flaws (suns of home, an English heaven, richer dust in a foreign field etc), it is clear that it was the mood and tone of the piece which appealed to many rather than its words. Laurence Binyon Binyon was born in 1869 and died age 74 in 1943. Like Brooke, he is best remembered for one poem in particular, his being for the fallen. Unlike Brooke, Binyon was not actually a soldier in the war, but rather an orderly working for the Red Cross. For the Fallen by Laurence Binyon The word They which appears twelve times in the poem refers to the soldiers fallen in battle to which the poem is dedicated. The first stanza begins by speaking of England and They as one. England is personified as mother to them, With proud thanksgiving, a mother for her childrenFlesh of her flesh they were, sprit of her spirit, The whole piece is presented in a funeral-style tone, in fact the poem was probably used for exactly that. Solemn the drums thrill, A glory which shines upon our tears, We will remember them. The fifth stanza sounds similar to Hardys Drummer Hodge and Brookes IV. The dead in terms of mood and sympathy, yet more in the style of Brooke rather than Hardy in that they died for a reason for their country. The last stanzas tell how They are to England as stars are to the night, Moving in marches upon the heavenly plainstarry in the time of our darkness. After 1915, the war poetry began to change. Tones became harsher and more realistic as the death count rose and the war dragged on. After living through the horror of the trenches, the soldiers lost the enthusiasm with which they came to battle and the war only got worse as opposed to its Christmas end originally expected. The best known poet of this period is Wilfred Owen (1893 1918), famously quoted as claiming My subject is warthe horror and the pityThe poetry is in the pity. And indeed it was. Owens works are quite unlike any other, patriotism replaced by pity. He came to war with a smile on his face, as Brooke and all the other soldiers had done, but after the traumatizing experiences of fighting in the trenches and after witnessing more than one too many unneccacary deaths, his enthusiasm was turned to anger and would later be reflected in his poetry. From 1917 to 1918, Owen was sent home for a year to recover from concussion where he met Siegfred Sassoon who also had signific ant influence on his works. His most popular poem is Anthem for Doomed Youth. Anthem for Doomed Youth His disgust and pity towards the unreasonable loss of lives is expressed without hesitation as the poem begins and throughout the Octave. He begins by rhetorically asking the reader, What passing-bells for these who die as cattle?. Passing bells are tolled at funerals in churches to mark the passing on to heaven and the neutralizing of the soul which is spoke of in the sestet of Brookes The Soldier. The question takes an important turn before it finishes, turning the mind away from church and into war where these (his comrades) die as cattle and from here until the sestet, his pity is demonstrated. He proceeds to answer his semi-sarcastic question with Only the monstrous anger of the guns, Only the stuttering rifles rapid rattle. These, the subject of the poem die to the sound of guns, the noise of war and are left respectlessly in the dirt to deteriorate rather than a ceremony and burial one would usually hope for. His expression, die as cattle applies the fact that they were mass slaughtered, killed inhumanly. The sound of the rifles is all that Can patter out their hasty orisons, meaning that the prayers of their somewhat undesirable funerals are in the form of rapid gunfire. Again comparing their deaths to the out of war funerals, the wailing shells are given the role of the mourning choirs. The Sestet makes a sudden change in setting, taking the reader back to the homes of their families and the tone changes from harsh and anger driven to a sudden quietness, carefully contrasting the two settings, yet the sadness is still very much apparent. What candles may be held to speed them all?, he asks in a second opening question. Once again, the candles refer to the candles lit in the church ceremonies in which their souls are speeded off to heaven. Not in the hands of boys, being the boys who carried the candles at the funeral, but in their eyes which talks of the glitter of tears in their comrades eyes who are also referred to as boys (the idea being that that is exactly what they were, hence Doomed Youth) Shall shine the holy glimmers of good-byes. In the last line a drawing down of blinds is the blinds which are drawn as funeral prosessions are passed by houses, where the blinds or shutters are closed as a mark of respect for the dead. Here however, the whole world draws its blinds for them at each dusk. The poem may be easily comparable to The Soldier given that they were both written during the first world war, they are of similar structure and length and both were written by young men who both died during that war. However, being that Anthem for Doomed Youth was written later on in the war, and Brooke died before experiencing the horrors of the trenches, both poets have approached the subject with a different tone, Brooke seeing the war from an entire different angle from Owen who witnessed the aftermath and the wars many casualties.

Case Summary Hypertension In Pregnancy Health And Social Care Essay

Case Summary Hypertension In Pregnancy Health And Social Care Essay Mdm. SM is a 30-year-old Malay female of gravida 5 parity 3+1 who is at 37 weeks and 5 days of gestation. She was diagnosed to have hypertension in pregnancy during antenatal routine follow-up in Klinik Kesihatan Simpang Renggam at 36 weeks and preeclampsia (blood pressure 160/100mmHg, urine dipstick albumin 1+) 3 days before admission. She was admitted to Hospital Kluang and started on Tab. Methyldopa 250mg TDS. She was advised for induction of labour in view of preeclampsia at term and she requested to be transferred to Hospital Batu Pahat (HBP). She did not have any signs and symptoms suggestive of severe preeclampsia or labour. During admission to HBP, tablet prostin 1.5mg was inserted into the posterior fornix twice to induce labour but there was no change in cervical os and symptoms of labour. Decision was made to try artifical rupture of membranes. However, following the procedure, internal monitoring detected fetal distress and as spontaneous delivery was not imminent, Mdm. S M was agreeable for emergency lower section caesarean section under general anaesthesia. A healthy infant boy was delivered (weight 2.9kg, Apgar score 91105) and there were no intra or post-operative complications. Following the surgery, both mother and infant were well in the ward. Mdm. SM was ambulating and tolerating orally and by the 2nd post-op day, both had passed urine and motion. Wound inspection on day 2 showed clean, non-gaping wound. As she was well, decision was made to discharge her and she was given appointment to review her blood pressure and operative wound at the postnatal clinic at KKSR. On discharge, her blood pressure was 140/70mmHg (without medication) and urine dipstick albumin was trace. Analgesia given on discharge were mefenemic acid and paracetamol. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology PATIENTS DETAILS I/C NUMBER: 800318015794 AGE: 30 SEX: Female DATE OF ADMISSION: 20/6/2010 R/N: 1358593 2) CLINICAL HISTORY Chief Complaint Elevated blood pressure detected in pregnancy at 36 weeks of gestation. History of Present Illness Mdm. SM is a 30-year-old Malay female of gravida 5 parity 3+1 who is currently at 37 weeks and 5 days of gestation. She was referred to Hospital Kluang from Klinik Kesihatan Simpang Renggam (KKSR) for elevated blood pressure detected on routine antenatal follow-up and subsequently transferred to Hospital Batu Pahat (HBP) for induction of labour in view of her development of high blood pressure in pregnancy. Her elevated blood pressure was first detected during her routine antenatal follow-up at Klinik Kesihatan Simpang Renggam 10 days before admission to HBP. During this visit, her blood pressure was recorded as 150/90mmHg and she also complained of slight bilateral swelling of her feet but otherwise had no other complaints. The feet swelling resolved after 3 days. Throughout the next 7 days, she went to KKSR every alternate day for monitoring and 3 days before admission to HBP, her blood pressure was noted to be 160/100mmHg with presence of albumin 1+ on urine dipstick that was prev iously not present. She was immediately given tablet labetolol 100mg and admitted to Hospital Kluang where she was subsequently started on tablet methyldopa 250mg 8-hourly. Three days after admission to Hospital Kluang, she was advised by the doctor to undergo induction of labour and she thus requested to be transferred to HBP so her family members in Batu Pahat could take care of her. During the course of these events, she did not experience shortness of breath, headache, blurring of vision, epigastric pain, seizures, abdominal pain, vaginal bleeding, nausea, vomiting, palpitations, or recurrence of the foot swelling. At time of admission, she did not experience contraction pain, show, leaking of liquor. Fetal movements were good. Systemic Review Mdm. SM did not have fever. Her appetite was good and her urinary and bowel habits were normal. Her sleep was unaffected. Antenatal History This was an unplanned but wanted pregnancy. Mdm. SM realized she was pregnant when she missed her period, of which the last was 28/12/09. She bought a pregnancy test kit and it tested positive. She subsequently did her booking at KKSR at 7 weeks of period of amenorrhoea. At booking, her blood pressure was 120/80mmHg, hemoglobin 13.4g/dL, sugar undetected, and urine albumin negative. Infective screening was negative and blood type O positive. Her expected due date was given as 14/8/10. During follow-up 1 month later, she had her first ultrasound scan which found her uterus to be larger than dates. Her due date was revised to 6/7/10. Modified glucose tolerance test done twice during pregnancy were negative. She experienced morning sickness and vomiting during the first 3 months of pregnancy but it was not severe and she could cope without medication. Throughout the pregnancy, she was diagnosed to have urinary tract infection twice and was treated with antibiotics. A further 3 ultrasoun d scans were done and all were normal. She was also compliant to the supplements given throughout pregnancy. There were no other problems during the antenatal follow-up until the detection of elevated blood pressure 10 days before admission to HBP. Past Obstetric History This is her fifth pregnancy and her last childbirth was in 2008. She has 3 children, 2 boys and a girl, of whom all were born via vaginal delivery at postdate after induction of labour. Birth weights ranged from 2.7 to 3.0kg, all are healthy with no complications and were breastfed. However, during her 3rd pregnancy, she suffered a miscarriage during the 12th week and dilatation and curettage was performed during that admission. Gynae Menstrual History Mdm. SM achieved menarche at the age of 12. Her menstrual cycles have always been regular with 28 days per cycle and 5 to 7 days of flow. She does not experience menorrhagia or dysmenorrhoea. She has never had a cervical smear done and has never used oral contraceptive pills. She has not required medical attention for any gynaecological problem. Past Medical History Mdm. SM has never been diagnosed with any chronic disease such as diabetes, hypertension, and asthma before. She has also never been admitted for non-pregnancy related reasons. She also does not have any known food or drug allergies. Family History Mdm. SM is the eldest of three siblings. Her youngest sister also had gestational hypertension. Her father has hypertension and her mother had diabetes, but passed away 2 years ago due to tuberculosis. All family members have been screened and all tested negative for tuberculosis. Social History Mdm. SM is now a housewife. She formerly worked in a factory but decided against returning to work following her last pregnancy in 2008 for her childrens benefit. She is a non-smoker and does not consume alcohol. Her husband is a short-haul lorry driver and smokes, but only outside their home. They live slightly off Kluang, and it takes them slightly over an hour to reach HBP, and 15 minutes to reach KKSR. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 3) FINDINGS ON CLINICAL EXAMINATION (Mdm. SM was examined by me on the 2nd day of admission) Mdm. SM was alert, conscious and cooperative. She was not in any pain or distress. She was sitting comfortably on her bed. On examination, there was no pallor, jaundice or pedal edema. Her reflexes were not brisk. Her clinical parameters are: Blood Pressure : 124/80 mmHg Heart Rate : 95 beats per minute. Regular rhythm Respiratory Rate : 20 breaths per minute Temperature : 37 °C Examination of the cardiovascular system, respiratory system, fundus, thyroid and breasts were normal. On examination of the abdomen, it was distended with gravid uterus as evidenced by linea nigra, and striae albicans. There was no striae gravidarum, scars, or pulsations noted. On palpations, the abdomen was soft and non-tender, uterus non-irritable, and fetal parts felt. The symphysio-fundal height was 36cm, which corresponds to dates. On examination, this is a singleton fetus at longitudinal lie with cephalic presentation, with the fetal back on the maternal left. The fetal head was four fifths palpable. Estimated fetal weight is 2.8 to 3.0kg. Liquor is adequate. Fetal heart was heard and the rate was 142 beats per minute. Vaginal examination (by medical officer on admission) revealed no perineal, vulval or vaginal abnormalities. Cervical os was 1 cm with cervix tubular, soft and axial, station high and membrane intact. Bishops score was 3/10. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 4) PROVISIONAL AND DIFFERENTIAL DIAGNOSES WITH REASONING Provisional Diagnosis Preeclampsia in pregnancy Mdm. SM developed new onset elevated blood pressure of 160/100mmHg at 36 weeks of gestation and urine dipstick albumin of 1+ (300mg/L). This fits the minimum requirement of preeclampsia among the hypertensive diseases in pregnancy. However, Mdm. SM did not experience any symptoms to suggest a severe preeclampsia or impending eclampsia such as headache, visual disturbances, epigastric pain, vomiting, liver tenderness. The urine dipstick for albumin is not the best way to detect proteinuria required for the diagnosis of preeclampsia 3 and is usually only used for screening, but as the blood pressure and urine albumin were persistently elevated, it is better to err on the side of caution and treat Mdm. SM as such since patients with relatively mild preeclampsia can rapidly progress into severe disease 1. Following the repeated positive detection of urine albumin of only 1+, more definitive tests should be performed to better quantify her proteinuria 2,3. Differential Diagnosis Pregnancy-induced hypertension, late onset As Mdm. SM has been compliant to her antenatal follow-ups and did not have elevated blood pressure detected at any time before 36 weeks of gestation, it is likely that she has developed the onset of a hypertensive disease in pregnancy and it appears to be of late onset as it developed only after 32 weeks gestation. However, as subsequent visits showed urine dipstick albumin of 1+, indicating the onset of proteinuria (although poor predictive value and not as significant as 2+) 3, it might prove wiser to be more vigilant and assume that Mdm. SM does indeed have preeclampsia as it would be foolish to dismiss these warning features despite the fact that she does not demonstrate any suggestive symptoms because it is possible that even patients with no prodromal signs may suddenly progress into eclampsia 1,3. Essential hypertension in pregnancy with superimposed preeclampsia Another possibility that we may entertain is that Mdm. SM has had previously undiagnosed essential hypertension with currently superimposed preeclampsia. However, this seems rather unlikely. Firstly, Mdm. SM is young at the age of 30 and unlikely to suffer from essential hypertension as this disease common presents after the age of 40. Secondly, at no time throughout antenatal follow-up did she have elevated blood pressure recorded before that particular visit at 36 weeks of gestation. However, following delivery of her infant, she should have her blood pressure rechecked during postnatal follow-up care at 6 to 12 weeks post-delivery. If her blood pressure if still elevated at that time, then it will be more likely that she has essential hypertension. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 5) IDENTIFY AND PRIORITISE THE PROBLEMS 1. Elevated blood pressure and its implications in pregnancy Mdm. SM has newly discovered elevated blood pressure at 36 weeks of gestation. This is considered late onset but is not uncommon, and gives rise to a spectrum of hypertensive disorders in pregnancy. While it seems that at first she has gestational hypertension, the mildest of the disease spectrum, she demonstrated proteinuria on her subsequent antenatal visit, therefore concluding that she has preeclampsia. Hypertensive disorders in pregnancy have the potential to put both mother and infant at increased risk of mortality. Its complications are elaborated below. During admission, Mdm. SM should be monitored for any change in her condition as she may quickly progress into severe disease states and this would require urgent intervention, the most definitive being the delivery of the infant. Ward management includes close observation of both mother and infant, and medication to control the elevated blood pressure. 2. Induction of labour in view of preeclampsia at term Termination of the pregnancy is the only definitive sure for preeclampsia. On presentation, Mdm. SM has features categorized as mild preeclampsia. Normally, severe preeclampsia would dictate the need for antihypertensive and anticonvulsive therapy followed by subsequent delivery and symptoms such as headache, epigastric pain, and visual disturbances may indicate this. The fetal age is usually an important deciding factor when it comes to inducing labour as the treatment goals seek the best outcome for both mother and infant. As Mdm. SM is already at term and there have been no issues previously detected regarding the health of her fetus, it should be safe to proceed with induction of labour. There is also no reason to prolong the pregnancy as the risk of eclampsia increases. If for any reason an obstetric reason arises e.g. fetal distress, delivery should proceed via caesaren section. 3. Impending eclampsia and other potential complications Warning signs and symptoms of impending eclampsia or severe preeclampsia include headache, visual disturbances, epigastric pain, reduced urine output, edema and ultimately, convulsions. These symptoms should be recognized early so the necessary intervention can take place. Seizures increase the risk of maternal and perinatal morbidity and mortality rates. Some maternal complications are placenta abruption, neurological deficits, aspiration pneumonia, pulmonary edema, cardiopulmonary arrest, and acute renal failure. Other major complications that may occur as a result of severe preeclampsia are HELLP syndrome, pulmonary embolism and stroke. Fetal complications include growth restriction, fetal distress, and death. 4. Risk of post-partum eclampsia It is possible for eclampsia to occur in the postpartum period especially when the patient has reached term. In such cases, up to 44% of eclampsia occurs postpartum 3. As the risk is quite high, Mdm. SM should continue to be monitored in the ward for the development of any signs and symptoms. As she is comfortable and relatively symptom free while in the ward, it appears unlikely that she may worsen into an eclamptic state but the risk should not be afforded. As there are no guidelines to suggest an optimum postpartum inward observation period, it would depend on her clinical situation during the subsequent days following her delivery. 5. Hypertension in pregnancy and its long term implications As Mdm. SM has developed preeclampsia during this pregnancy, she is at increased risk to develop hypertensive or metabolic complications in future pregnancies. The risk of recurrence is generally higher in earlier onset preeclampsia. At the same time, she should be evaluated in the postpartum period for the possibility of essential hypertension at the 6 week postnatal review. Also, women with preeclampsia are at an increased risk for developing hypertension, diabetes, hyperlipidemia, chronic renal disease, stroke and ischemic heart disease. Mdm. SM should be made aware of all these implications and should be educated on how she can prevent these via the modification of her lifestyle. She should also be advised to attend preconceptual counseling in the event of a future pregnancy and to come early for booking. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 6) PLAN OF INVESTIGATION, JUSTIFICATIONS FOR THE SELECTION OF TESTS OR PROCEDURES, AND INTERPRETATION OF RESULTS 1. Urine Dipstick for Albumin To look for the presence of albumin in the urine firstly, to confirm proteinuria, and secondly, to evaluate the severity of the preeclampsia. Urine dipstick for albumin should be repeated daily in the ward. Also, if in doubt, further investigation to quantify proteinuria can be done e.g. urine protein/creatinine spot test 2,3. Results: Urine dipstick albumin on admission was trace. Results at KKSR showed 1+. Interpretation: This result could be due to the fact that the blood pressure has lowered as Mdm. SM has been started on methyldopa and her blood pressure is under control. This does not mean that she no longer has preeclampsia. She should be checked daily for any changes in both blood pressure and proteinuria. 2. Full Blood Count To look for anemia which may require correction, haemoconcentration which may indicate severe preeclampsia 1, and platelet levels as HELLP syndrome is a complication that may arise in preeclampsia. This may also serve as baseline in case operative procedures are required. Result: TWBC 12.0 x109/L à ¢Ã¢â‚¬  Ã¢â‚¬Ëœ (neutrophils 8.20, lymphocytes 2.70) Hemoglobin 10.7 g/dL à ¢Ã¢â‚¬  Ã¢â‚¬Å" Hematocrit 32.3% à ¢Ã¢â‚¬  Ã¢â‚¬Å" Platelets 354 x 109/L Interpretation: The total white cell count is slightly raised, but this is to be expected in pregnancy. The hemoglobin is slightly low but this is also expected in pregnancy and should be monitored especially if the patient requires surgery or experiences anemic symptoms. There is no haemoconcentration and the platelets are normal. 3. Prothrombin Time, INR, Activated Partial Thromboplastin Time (PT/INR/APTT) To obtain a baseline of the coagulation profile in case operative procedures are required and also to look for potential coagulopathy as it is a possible complication of preeclampsia. Result: PT 12.3s INR 1.05 APTT 39.6s Interpretation: PT/INR/APTT is within normal range. Coagulopathy appears unlikely in Mdm. SM given that her platelets are also normal and her preeclampsia is not severe. 4. Renal Profile To assess renal functions to look for elevation of creatinine as that would indicate severe preeclampsia and also to detect acute renal failure which is associated with increased risk of HELLP syndrome, placenta abruption and postpartum hemorrhage 1. Result: Urea 1.3mmol/L Sodium 140mmol/L Potassium 3.7mmol/L Creatinine 51 µmol/L Interpretation: Mdm. SM renal profile is normal and creatinine is not elevated, adding to the indicators that her preeclampsia is of the mild category. Low urea levels and good urine output also rules out acute renal failure. 5. Liver Functions Test To assess liver functions and its components such as liver enzymes and bilirubin which would be raised in severe preeclampsia or HELLP syndrome in which there is hemolytic anemia and elevated liver enzymes. Result: Total protein 73g/L Albumin 33g/L Globulin 40g/L Total bilirubin 0.5mg/ml Direct bilirubin 0.2mg/ml Indirect bilirubin 0.3mg/ml ALP 121U/L à ¢Ã¢â‚¬  Ã¢â‚¬Ëœ ALT 7 U/L GGT 7 U/L Interpretation: Liver enzymes (ALT) and bilirubin levels are not elevated, indicating a mild preeclampsia and no biochemical evidence of HELLP syndrome. The ALP is slightly elevated, but this could be due to compression of the gravid uterus on the hepatobiliary tree. 6. Serum Uric Acid Elevated serum uric acid is an early biochemical sign of preeclampsia 1 and may help to predict maternal complications in preeclampsia 4. Results: Serum uric acid 103 µmol/L à ¢Ã¢â‚¬  Ã¢â‚¬Å" Interpretation: Serum uric acid levels are not elevated and are in fact, slightly lowered. This result indicates low likelihood of severe preeclampsia or maternal complications. 7. Serum Lactate Dehydrogenase To check for elevated levels which should indicate hemolytic anemia, a component of HELLP syndrome. Results: Not done during this admission. 8. Cardiotocograph (CTG) Done on admission as a baseline for fetal monitoring. Results: Baseline fetal heart rate was 130 beats per minute, baseline variability was 5 10, accelerations present with no decelerations. Interpretation: CTG is reactive with no signs of any fetal compromise. CTG should be repeated following each procedure e.g. prostin insertion, AROM or if fetal compromise is suspected. 9. Transabdominal Ultrasonography This should be done to confirm fetal age, as confirmation of fetal age is important when it comes to deciding whether or not to induce labour in preeclampsia. Also to check for fetal well-being and growth restriction, but these requires repeated scans and plotting of growth chart over a period of time. Result: No ultrasonography was done during this admission. The last scan was done in Hospital Kluang before patient was transferred to HBP. The last scan reports fetal age corresponding to dates, AFI of 9, and no abnormalities detected with no mention of other findings. Interpretaion: As fetal age is corresponding to dates and there is no suggestion of fetal compromise or restriction, it is safe to proceed with induction of labour. 10. Urinalysis (UFEME) To check the levels of proteinuria which may be more quantitative than urine dipstick. Results: Leukocytes, nitrite, protein, glucose, ketone, urobilinogen, and bilirubin were not detected. Interpretation: No proteinuria was detected. This could mean that the patient does not have preeclampsia but rather gestational hypertension, or it could be undetected as the blood pressure has also become well controlled with medication. However, no risks should be taken and Mdm. SM should be closely observed in the ward. Either way, induction of labour and delivery would still be ideal for her as she has already reached term. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 7) WORKING DIAGNOSIS AND PLAN OF MANAGEMENT ON ADMISSION Working Diagnosis Induction of labour at term in view of mild preeclampsia in pregnancy Comment: As Mdm. SM has elevated blood pressure and urine dipstick albumin 1+ but has no physical or biochemical features suggestive of severe preeclampsia, the working diagnosis is mild preeclampsia. However, she should be monitored closely in the ward for any symptoms indicative of disease progression. As she has reach term, it would also be wise to induce labour in her, especially given her history of postdates as delivery would be the only definitive management in such cases. Plan of management on admission Continue T. Methyldopa 250mg 8-hourly Daily urine albumin dipstick Vital signs monitoring 4-hourly Baseline cardiotocograph on admission Fetal kick charting and Labour progress charting To notify immediately if spontaneous rupture of membranes To notify immediately if strong contractions commence Encourage orally For induction of labour with T. Prostin 1.5mg as Bishops score unfavourable To notify immediately if any symptoms occur STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 8) SUMMARY OF INPATIENT PROGRESS (INCLUDING MAJOR EVENTS, CHANGE OF DIAGNOSIS OR MANAGEMENT AND OUTCOMES) Throughout the first two days of admission, Mdm. SM was comfortable in the ward with no development of any symptoms of severe preeclampsia, eclampsia, or labour. Her vital signs were stable with blood pressure ranging 122-138/70-84. On the morning of the 2nd day, tablet prostin 1.5mg was inserted into her posterior fornix under aseptic technique. Cardiotocograph was reactive and vaginal examination 6 hours post-insertion showed cervical os 3cm, cervix 2cm, soft and axial, and high station. Therefore, a 2nd tablet of prostin was inserted on the morning of the 3rd day. Once again, post-insertion cardiotocograph was reactive and vaginal examination 6 hours later showed no changes to before. Mdm. SM still did not experience any signs and symptoms of labour. She also did not have any symptoms indicating progression of her preeclampsia. On the morning of the 4th day, it was decided that Mdm. SM should undergo artifical rupture of membranes (AROM) rather than have a 3rd prostin tablet inser ted. Cardiotocograph monitoring had been difficult so decision was made to insert fetal scalp electrode at the same time for internal monitoring. Following the AROM, internal monitoring revealed a drop of fetal heart rate from 130 to 100 beats per minute with no accelerations. Cervical os was still 3cm with no symptoms of labour. Decision was made to proceed with emergency lower section caesarean section (ELSCS) under general anaesthesia and Mdm. SM gave her consent. Via ELSCS, a healthy baby boy was delivered weighing 2.9kg with Apgar score of 91105. There were no intra or post-operative complications. Post-operative medications given include IV ampicillin 500mg QID, subcutaneous heparin 5000 units BD, IV pitocin 40 units QID, IM pethidine 50mg PRN, Tab. paracetamol 1g QID and Tab. Mefenemic acid 500mg TDS. Throughout the next 2 days, Mdm. SM was comfortable in the ward and had mild operative site pain with no other symptoms and vital signs were stable. All medications except analg esia were stopped. She was ambulating well, tolerating orally and had passed urine and motion by the 5th day. As for the baby, breastfeeding had commenced and he had also passed urine and motion. The uterus was well contracted at 22 weeks size and dressing was not soaked. Inspection of the wound on the 6th day revealed a clean and non-gaping wound. She was counseled on contraception and indicated a preference for intrauterine contraceptive device. As she was well, she was discharged with appointment to return to postnatal clinic at KKSR to review her blood pressure and operative wound in 1 weeks time. On discharge, her blood pressure was 140/70mmHg and urine dipstick albumin was trace. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 9) DISCHARGE PLAN, COUNSELLING AND MOCK PRESCRIPTION Discharge Plan Tab. Mefenemic acid 500mg TDS PRN Tab. Paracetamol 1g QID PRN Follow-up appointment at Klinik Kesihatan Simpang Renggam (KKSR) Postnatal clinic in 1 week to review blood pressure and operative wound. Follow-up appointment at KKSR in 6 weeks for review, cervical smear, and contraception. Counseling Advised to return immediately to the hospital if Mdm. SM has problems with the caesarean wound e.g. pain, discharge or if she develops any new or worrying symptoms. Advised on the need to be compliant to postnatal follow-up to review Mdm. SMs condition. Advised for cervical smear during postnatal follow-up as previously never done. Counseling regarding breastfeeding and contraception. Explain about the nature of pregnancy-related hypertensive disorders and its long term implications. Advised to attend antenatal clinic for preconceptual counseling if future pregnancy is desired, or to come for booking immediately once discovered to be pregnant. Advised to observe a healthy lifestyle in order to prevent development of conditions such as hypertension and diabetes. Mock Prescription Tab. Paracetamol 1g QID PRN x 1/52 Tab. Mefenemic acid 500mg TDS x 1/52 STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 10) REFERRAL LETTER (IF APPLICABLE) Medical Officer, Postnatal Clinic, Klinik Kesihatan Simpang Renggam, 86200, Simpang Renggam. 20th June 2010 Mdm. SM (IC.800318015794) Date of admission: 20th June 2010, Date of discharge: 25th June 2010 Problem: Late onset hypertensive disease in pregnancy Dear medical officer, Mdm. SM is a 30-year-old Malay lady of parity 4+1 who was diagnosed to have preeclampsia at 36 weeks of gestation during routine antenatal follow-up at your centre. During admission to our ward, she underwent induction of labour with tablet prostin and artificial rupture of membranes. However, fetal distress developed, picked up on internal monitoring and Mdm. SM underwent emergency lower section caesarean section under general anaesthesia. She delivered a healthy baby boy (2.9kg, Apgar 91105) with no complications intra- and post-operatively. We are discharging her into your care. Please review her blood pressure as scheduled and also offer contraception and cervical smear as previously never done. She has indicated preference for intrauterine contraceptive device. Do not hesitate to contact us immediately should the need arise. Thank you very much for your attention. Yours sincerely, Paul Kong Fu-Xiang (Final year medical student, IMU), Department of Obstetrics Gynaecology, Hospital Batu Pahat. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 11) LEARNING ISSUES IN THE 8 IMU OUTCOMES 1. Disease prevention and health promotion Hypertensive disorders in pregnancy are one of the most common antenatal problems and eclampsia is a major source of maternal mortality. What are the ways in which some element of prevention can be instituted or to decrease the severity of preeclampsia? There haven been certain strategies touted to prevent or modify the severity of preeclampsia. These are categorized as dietary supplements, antihypertensive medications, antioxidants, and antithrombotic agents 5. As low salt diet is one of the recommended dietary changes for hypertensive patients, De Snoo et al 1 was one of the earliest researchers to study the effects of low salt diet in preventing preeclampsia but this practice was discarded as it yielded no significant change. Knuist et al performed a randomized controlled trial in 1998 and they reported that despite helping control blood pressure in non-pregnant individuals, a sodium-restricted diet was ineffective in 361 women in terms of prevention of preeclampsia 6. The dietary supplementation of calcium of at least 1 gram per day is recommended as class I-A evidence 2. Several studies showed that women with low calcium diets were at significantly increased risk of gestational hypertension 7,8,9. Levine et al performed a large , randomized-controlled trial and they found that there was no significant difference in outcome with calcium supplements versus placebos 10. This suggests that unless a pregnant woman has a low calcium intake, calcium supplements may have no added benefit 5. With regards to fish oil supplements and its cardioprotective fatty a

An Analysis Of Hemingways Hills Like White Elephants Essay -- Hills Li

In Hemingway’s â€Å"Hills Like White Elephants† I found many layers of symbolism, and a fascinating psychological underplay afoot between his two characters. It begins with the girl’s comment about a line of white hills seen in the distance, which she compares to white elephants. The man responds with the comment â€Å"I’ve never seen one.† The symbolism of a white elephant is widely known as something very large or apparent that no one wishes to acknowledge or speak of in American society. It is an interesting opening to a very strained conversation concerning an apparent pregnancy, and the man’s wish to terminate it. The couple’s careful avoidance of actually naming the problem, or the proposed solution, suggests the situation in which a mate, reluctant to assume responsibility, or unprepared for the task of parenthood, is lobbying to prevent it.   Ã‚  Ã‚  Ã‚  Ã‚  In her next comment, â€Å"No, you wouldn’t have.† the girl returns a very passive aggressive riposte, perhaps suggesting that the man cannot, or will not, recognize an unpleasant issue. His defensive reaction to her response suggests that she is correct. She then changes the subject casually, as though retreating from his irritation. He plays along with it in a placatory manner, seemingly eager to avoid an escalation of the tension that obviously exists between them. Clearly, the woman in this story is reluctant to abort her pregnancy, while the man is strongly committed to making it happen. After he orders them...

Socio Economic Effects Of Stroke Health And Social Care Essay

In most of the developed states, cerebrovascular accident or shot is a common cause of decease and disablement. Stroke ranks 3rd as a cause of decease after bosom disease and malignant neoplastic disease in U.S.A and U.K. The one-year economic disbursal due to cerebrovascular accident has been estimated to transcend 7 billion dollars in U.S.A. Prevalence rates reported for cerebrovascular accident universe broad vary between 500 to 800 per 1,00,000 population. ( Nolen,2008 ) Stroke is the 3rd prima cause of decease in the United States. It accounts for about 1,64,000 mortalities yearly. An estimated 5,50,000 people experience stroke each twelvemonth. Stroke is besides a chief cause of grownup disablement. In United States more than 4 million shot subsisters are populating with changing grade of disablement. Stroke is socio economically really important in older people. Harmonizing to WHO, shot was the 2nd commonest cause of world-wide mortality in 1990 and the 3rd commonest cause of mortality in more developed states ; it was besides the ground for about 4A ·4 million deceases worldwide. In 1999, the figure of deceases due to stroke ailing 5A ·54 million worldwide, and two-thirds of these occurred in less developed states. Stroke was found to be a major cause of long-run disablement and, has potentially tremendous emotional and socioeconomic effects for patients, their households, and wellness services. The case-fatality rate due to stroke varies from 11.7 % to 32.4 % . An estimated 15 million people worldwide survived minor shot each twelvemonth and about 4,800,000 in the USA, in which 50 % of instances each twelvemonth are in adult females. ( Health Statistics for US,2002 ) The incidence of shot in the U.S has declined, but there is no diminution in the badness. Harmonizing to background information it is a taking neurological cause of long term disablement. ( Davidson,2008 ) . Annually an estimated 50,000 individuals in Canada suffer from shot. There is 5.4 million persons who have a history of shot and up to 3,00,000 shot subsisters in Canada. Each twelvemonth about 16,000 dice from shot in Canada. ( Hock ‘s article, 2003 ) The prevalence of shot varies. Over the last 30 old ages at that place has been a definite addition in the prevalence and incidence of shot in India ( The Hindu, March 2008 ) The prevalence of shot in India scopes from 40 to 270 per 100 000 population. Approximately 12 % of all shots occur in the population of greater than 40 old ages of age. Major hazard factors are high blood pressure, hyperglycaemia, baccy usage, and low haemoglobin degrees. In major infirmaries 2 per centum of infirmary enrollments, 1.5 per centum of medical enrollments and 9 to 30 per centum of neurological admittances histories for stroke.The National Commission on Macroeconomics and Health has pointed out that instances of shot would increase from 1,081,480 in 2000 to 1,667,372 in 2015. The ICMR survey on Burden of Disease ( 2005 ) has found that there has been an addition in the figure of shot instances in India during the last one and a half decennaries by 17.5 % . There was besides an addition in mortality rate by 7.8 % Dr. Ashok cites that statistically India may be seeing every bit many as 200 shots for every 100,000 cross subdivision of the population. Dr. RK Srivastava ( 2008 ) estimated that 3 million adult females and 2.5 million work forces worldwide dice from shot every twelvemonth, and in developed states it is the 3rd commonest cause of decease. In China it is the taking cause of long term disablement since about two-thirds of patients require rehabilitation. Almost 10 % of shot patients recovered wholly, 25 % showed minor damage, 40 % had moderate to severe damages that required particular attention. Dr. D Nagaraj ( 2007 ) discussed on the quickly increasing shot load due to altering population with increasing life anticipation. There is a broad fluctuation in the incidence ( 13-105/100,000 ) , prevalence ( 52-842/100,000 ) of shot across the state and in the past decennaries. Case human death ranges from 11.7 % -32 % .The ischaemic shots account for 70 % to 80 % . The surveies nevertheless, have reported a higher per centum of haemorrhagic shots. The individual most of import hazard factor is found to be high blood pressure.The prevalence of smoking baccy varies from 28 % to 50 % in different surveies and of intoxicant usage ranged from 1.5 % to 47 % . Hypercoagulopathies accounted for 6 % of shot, hyperhomocysteinemia was recorded to be high in 40 % of storke clients. 57 % of diability have been recorded in most surveies. Shymal K. Das and Tapas K. Banerjee ( 2003 ) conducted a population based survey on shot in Kolkata to happen out the prevalence, incidence and instance human death hazards. The findings shows that, the prevalence and incidence rates of shot in this survey are similar to or higher than many surveies conducted in western states. The entire instance human death rates in India is among the highest class of shot human death in the universe. In 2006,105 instances were detected in 6 months in Tamil Nadu, among which 36 % were of age less than 40yrs,39 % were of 40-60yrs of age. The survey shows that 26 % of clients had a old history of shot. 8 out of 11 screened for homocysteinemia. Epidemiologic surveies on shot published on equal reviewed diaries during the past 10 old ages were identified utilizing MEDLINE and pubmed hunts and were reviewed utilizing the construction of WHO ‘s shot compound Infobase. Harmonizing to WHO, the figure of stroke events is proposed to increase from 1.1 million per twelvemonth in 2000 to more than 1.5 million per twelvemonth in 2025. ( World Health Organisation 2007 ) In 2005, estimations indicated that 58 million people died, in which chronic diseases accounted for 35 million deceases ( 60 % ) . Cardiovascular diseases, chiefly bosom disease and shot caused 17A ·5 million deceases Stroke is the 2nd prima individual cause of decease, with 5A ·8 million fatal instances per twelvemonth, 40 % of which are in people of age less than 70 old ages. About 15 million new instances occur every twelvemonth, and about 55 million people have experienced shot in the yesteryear, either with or without residuary disability.By 2025, four out of five shot events will happen in people populating in these parts. ( International Stroke Surveillance, 2005 ) Around half of shot subsisters suffer with important disablement. Physiotherapy will help in recovering every bit much motion and map as possible. Neurological shot physical therapy helps to better balance and walking, increases ability to execute simple to complex undertakings, cut down cramp, hurting and stiffness. It besides helps to increase strength, to retain normal forms of motion, additions affected appendages map and increases energy degree. ( Samuel.J et.al,2008 ) The research workers besides observed that most of the patients were dependent in run intoing the ego attention activities. Nurses are frequently in the forepart of stroke instruction. Health instruction is a critical measure in accomplishing conformity. Patients understanding may find the ultimate success of the rehabilitation and better the ability.Since shot with unilateral paralysis is a major job, the ego attention abilities of a patient should be identified and should be taught to be independent in run intoing their ain demands. The research worker from her short period of clinical experience has observed that most of the shot patients have unequal cognition sing causes, direction and bar. Therefore people should be encouraged to cognize about these facets. Sing the big figure of patients admitted in the infirmary, the research worker is of the sentiment that the wellness instruction booklet needs to be prepared which will assist the patients to acquire cognition on cause, direction, bar and to better their ego attention ability.STATEMENT OF THE PROBLEMâ€Å" A survey to measure the cognition and to place the ego attention abilities of shot patients in Senthil Multi Speciality Hospital, Erode, Tamil Nadu † .OBJECTIVES OF THE STUDYTo measure the cognition of patients sing shot. To place the ego attention abilities of shot patients. To happen out the relationship between cognition and self attention abilities of shot patients. To find the association of cognition and self attention abilities with selected socio demographic variables of shot patients. To fix a wellness instruction booklet on shot.OPERATIONAL DEFINITIONSAppraisalIt refers to statistical measuring of cognition of patients about shotKNOWLEDGEIt refers to patients awareness sing significance, causes, hazard factors, marks and symptoms, diagnostic steps, direction and bar of secondary shot onslaught.StrokeIt refers to a neurologic alterations caused by an break in the blood supply to a portion of the encephalon.HemiplegiaIt refers to neurological shortage in which there is functional disablement of one side of the organic structure.DesignationIt refers to a action or procedure of finding the ego attention abilities of shot patients.SELF CARE ABILITIESIt refers to those activities that the patient is able to execute independently.PatientsIt refers to clients admitted with shot and receiving intervention for more than 3 hebdomads.HEALTH EDUCATION PAMPHLETIt refers to information in a written signifier sing definition, causes, hazard factors, clinical manifestations, hosp ital direction and place attention direction of shot.PremisePatients will hold unequal cognition sing shot. Patients who had stroke face assorted self attention shortage in their recovery period.RestrictionStudy was limited to stroke patients with unilateral paralysis who are admitted for more than 3 hebdomads in one peculiar infirmary, so the findings can non be generalized. Patients who are in the age group of 35-65 old ages. Study was limited merely to 40 patients. Study was limited to those who are willing to take part in the survey.CONCEPTUAL FRAMEWORKA conceptual model is a set of constructs and propositions that spell out the relationship between them. The overall intent is to do scientific findings meaningful and generalisable. Concepts are the mental images of phenomena and are the edifice blocks of the survey. Polit and Hungler ( 1999 ) states that the conceptual model is an interconnected construct of abstractions that are assembled together in some strategy by their relevancy to a common thing. This is a device that helps to excite research and the extension of cognition by supplying both way and drift. The present survey is aimed at measuring the ego attention ability and cognition of shot patients in Senthil Multi Speciality Hospital, Erode. The conceptual model selected for the survey is based on Orem ‘s self attention shortage theory ( 1985 ) . Orem defined self attention as learned, end oriented activity directed toward the ego in the involvement of keeping life, wellness development and good being.Major CONCEPTS AND DEFINITIONSOrem labels her ego attention theory of nursing as a general theory composed of three related constructs.THE CONCEPT OF SELF CAREDescribes and explains self attention. What the client should execute to keep hygiene. In this survey it is the ego attention activities performed by the client like bathing, dressing, combing, eating, ambulation, lavatory usage and placement.THE CONCEPT OF SELF CARE DEFICITDescribes and explains why people can be helped through nursing.In this survey it is the province in which the client is non able to execute the ego attention activities ( bathing, dressing, eating, ambulation, intestine and bladder control ) or the dependence degree that require aid in run i ntoing the ends.THE CONCEPT OF Nursing SYSTEMIt is a uninterrupted series or actions that are directed to run into individual ‘s curative ego attention demand. There are three types of nursing system:WHOLLY COMPENSATORY SYSTEMIf the client is unable to execute actions, the system is entirely compensatory that is the nurse performs all actions. In this survey, it refers to the to the full dependent shot clients or those requires assistance to execute their activities of day-to-day life like bathing, dressing, combing, eating, vesica and intestine control, ambulation and placement.PARTIALLY COMPENSATORY SYSTEMIf the nurse and patient portion the duty, the system is partly compensatory. In this survey, it refers to the partly independent and partly dependent shot clients those who requires moderate aid by the important others or nurse in executing the activities of day-to-day life like feeding, bathing, ambulation, placement.SUPPORTIVE EDUCATIVE SYSTEMWhen a patient provides all self care necessitating motions and lone instruction is required as a grid to activity so it is supportive educative system. In this survey, it refers to the to the fu ll independent shot clients, those who are able to make the ego attention activities and requires wellness instruction sing bar of accidents, safe bed to chair and chair to bed transportation techniques, importance of early rehabilitation to better the societal activities and steps to forestall the secondary shot onslaught.SELF CARE AGENCYIt is the person ‘s ability to execute self care activities. It consists of two agencies.sSELF CARE AGENT:The individual who provides the ego attention. In this survey, the ego attention agent is client ‘s with shot.DEPENDENT CARE AGENT:The individual other than the person who provides attention. In this survey, the dependant attention agent is the research worker, who assesses the cognition sing significance, hazard factors, causes, marks and symptoms, direction and bar of secondary shot onslaught.THERAPEUTIC SELF CARE DEMAND:Curative ego attention demand is the summing up of ego attention actions to be performed for some continuance o f clip and in some location to run into self care necessities particularized for a individual.In this survey, it refers to the impart cognition sing significance, causes, hazard factors, marks and symptoms, direction and bar of secondary shot onslaught and do the patient to execute self attention sing personal lavatory, eating, lavatory usage, vesica and intestine control, ambulation. This chapter dealt with the debut, demand for the survey, statement of the job, aim of the survey, operational definitions, premises, restriction and conceptual model.

Family Life Cycle Theory Essay

State the three developmental tasks outlined in the family life cycle theory. Discuss 2 factors examined in this unit that affect the completion of each developmental task. Include examples. (300 – 400 words) The family life cycle describes early adulthood as a stage in which individuals are launched from their families of origin. Parents and children must separate from one another so that young adults can accept emotional responsibility for themselves. The three developmental tasks must be mastered to allow the family life cycle theory to occur. The first developmental task outlines that young adults must form an identity separate from that of the family or origin. This process is known as individualization. The second developmental task declares that young adults must develop new intimate relationships with peers outside of the family to provide the social and emotional support they need. The third developmental task indicates that young adults must make their first tentative commitment to a career or workplace role. These developmental tasks enable young adults to be self-sufficient adults. The parents and child relationship must change in order to be less hierarchical so that a young adult can accept responsibilities for making decisions. Parents must be tolerant of difference of opinions as young adults make occupational choices. They must all accept that their child is forming new intimate relationships. There are several factors in this unit that affect the completion of each developmental task. In the first task, development involves change in response to crisis so the family can move on to a different, not necessarily better stage. In the movie Step Brothers, both Dale and Brennan (the step-brothers), realize they caused the separation of their parents. They are forced to put matters into their own hands and move out. This proves to be a critical moment in both their lives. Dale and Brennan need to sort out emotionally what they will take along from the family or origin, what they will leave behind, and what they will create for themselves. In the second tasks, an important factor is that development involves seeking new relationships with people who will soon become a permanent fixture in your life. For example, referring to same movie, once Dale and Brennan had left the home, they both seek to develop new relationships. Dale discovers an intimate relationship with Brennan’s brother’s wife. Brennan tries forming an intimate relationship with his counselor as well as a better relationship with his new acquired brother.

How to Make a Rainbow Rose (and How It Works)

How to Make a Rainbow Rose (and How It Works) Have you seen a rainbow rose? Its a real rose, grown to produce petals in rainbow colors. The colors are so vivid, you may think pictures of the roses are digitally enhanced, but the flowers really are that bright! So, you may be wondering how the colors are made and whether the rose bushes that produce these flowers always bloom in vibrant colors. Heres how it works and how you can make a rainbow rose yourself. How Real Rainbow Roses Work The rainbow rose was developed by  Peter van de Werken, the owner of a Dutch flower company. While special roses are used, the plants are not bred to produce the rich colors. Actually, the rose bush would ordinarily produce white roses, but the stems of the flowers are injected over time with dyes so that petals form in bright single colors. If the flower isnt treated as it is growing, the blooms are white, not ​rainbow. While the rainbow is a special version of the technique, other color patterns are also possible. Its not a science trick you can achieve quite so well with your home rose bush, at least not without a lot of experimentation and expense, because most pigment molecules are either too large to migrate into the petals or else too toxic for the rose to flower. Special proprietary organic dyes said to be made from plant extracts are used to color the roses. Making Rainbow Roses at Home While you cant duplicate the exact effect, you can get a lighter version of a rainbow using a white rose and food coloring.  The rainbow effect is much easier to achieve with white or light-colored flowers that arent as woody as a rose. Good examples to try at home include carnations and daisies. If it has to be a rose, you can do the same project, but expect it to take longer. Start with a white rose. Its best if it is a rosebud because the effect relies on capillary action, transpiration, and diffusion in the flower, which takes some time.Trim the stem of the rose so that it is not extremely long. It takes more time for color to travel up a longer stem.Carefully split the base of the stem into three sections. Make the cuts lengthwise up the stem 1-3 inches. Why three sections? The cut stem is fragile and likely to break if you cut it into more parts. You can use color science to achieve the full rainbow using three colors - red, blue, yellow or yellow, cyan, magenta - depending what dyes you have available.Carefully bend the cut sections slightly away from each other. Now, one way to apply the dyes would be to bend the stems into three contains (e.g., shot glasses), each containing a single color of dye and a bit of water, but this is hard to accomplish without breaking the stems. An easier method is to use 3 small plastic baggies, 3 rubber bands, and o ne tall glass to hold the flower upright. Into each bag, add a small amount of water and several (10-20) drops of one color of dye. Ease a section of the stem into the bag so that it is immersed in the dyed water, and secure the bag around the stem with a rubber band. Repeat the process with the other two bags and colors. Stand the flower in a glass. Check to make sure each stem section is immersed in the liquid since the flower needs water to live.You may start to see color in the petals as quickly as half an hour, but expect to let the rose soak up dye overnight or possibly for a couple of days. The petals will be the three colors, plus the mixed colors, for petals receiving water from two parts of the stem at once. This way, youll get the whole rainbow.Once the flower is colored, you can trim off the cut section of stem and keep it in fresh water or a homemade flower food solution. Helpful Tips Flowers take up warm water more quickly than cold water.Keep the rose away from light and heat, since these can cause it to wilt and die too quickly.If you want to try injecting flowers with natural colors, learn about natural pigments you can use.

Supply Chain Management Essay

Supply Chain Management Essay Supply Chain Management Essay Introduction Majors in supply chain management focuses on processes of excellence for the organization. Supply chain management focuses of the flow of information, services and goods that target at delivering maximum value to the organization’s customers. Supply management has the responsibility of supplying services and goods that the organization deals with to the customers. They also manage the transformation and conversion processes that target at converting input to output. Supply chain management functions within the scope of organizing, planning and controlling the flow of bought materials within the organization. The Majors gives close attention to the analysis and selection of vendors, price determination and value analysis. Supply chain Majors also have the responsibility of disposing surplus and scrap materials. It places emphasis on the efficient application and usage of transportation by the management of business within the framework of logistics. Supply chain manages resourc es, procurement, fabrication, production, storage and production. It consists of interconnected components, which are required for the transformation of ideas to delivered services and products. Through execution, Exel operated most part of the supply chain. These traditional activities lowered the costs of storing and moving products and improving the speed of delivery for HM. However, this represents a minute portion of the capabilities of the firm. Using the execution strategy, supply chain did not manage costs and opportunities available to customers. This included opportunities in the matching of supplies and demands. This is where the firm could manage the highest payoff. The planning function of supply chain has the potentials of enabling the firm attain its allocation and purchasing functions. Planning also ensures that the firm has better execution capabilities. Planning eliminates instances of the â€Å"just in case† behaviors that occur in ordering extra inventory. Planning has the potentials of ensuring that the firm’s shipments reach the customers on time. Planning confers deeper knowledge of supply chain, which would result to enormous savings. For instance, the lack of knowledge resulting from failures in execution would strain the firm in realizing the advantages of cost savings arising from consolidated trucks. Planning eliminates risks because of the expansion of the relationship between customers and the firm. Planning enables the exchange of greater stakes in the activities of the firm and its performance. Technology firms have approached Exel for a portion of its financial planning in order to increase their share of savings. Planning increases the confidence of the firm, which enables it exceed expectations. A clear understanding of the strategy will enable the firm move swiftly with its planning strategy. One of the executives at Exel noted that he needed to present a case for moving towards planning strategies for its supply chain. The ability of the execution team to execute the plans developed by the firm plays an enormous role in ensuring that the firm continuously develops creative planning strategies. Execution ensures the firm can lower the cost of storage and transportation and deliver products to customers effectively. The firm should become aware of the potentials of adding operations to its expertise, and to the customer is a planning function. The ability of ensuring smooth planning in allocation and purchasing requires the execution team performs effectively and understands its role. Planning and execution should be carried out jointly to ensure that nothing goes wrong in the supply chain. Professional essay writers at company can provide you with a high-quality custom essay on Supply Chain Management written from scratch!

Exam Questions - Employee Relations Coursework Example | Topics and Well Written Essays - 750 words

Exam Questions - Employee Relations - Coursework Example Collective bargaining refers to the participation of trade unions, free market sympathizers and employee representatives in determining and setting up of employee’s pay. Such practices are meant to ensure that when setting up the pays, the rights of the employees are taken care of. Since 1879, the trend in the collective bargaining has been moving from the decentralized collective bargain. Unitarism is a theory of autonomy that is characterized by minimal external influence in the decision making process. In this approach, there is very little involvement of the employees in the decision making. Unitarism is autocratic in nature. Pluralism on the other hand refers to a theory where there is very high level of trade union membership and involvement of employees in decision making. In this approach, the trade unions are clearly recognized to have a very legitimate role employee matters and how the employees and employer relate. Employee Relation in the United Kingdom as well as in the entire Europe has changed over the years. This has been in terms of the health and safety issues, collectivism and participation. United Kingdom has also witnessed the emergence of the freedom of association together with equal treatment frameworks that are all meant to ensure that employee rights are maintained. The state plays a central role in ER in almost all the countries including the United Kingdom. This is in terms of the polices as well as the legislations that are put in place by the state to ensure that the ER practices in a country does not exploit or deny the parties involved their rights. The state passes legislations and policies that are related to employee exploitation, exclusion and integration. Over the years, the trade unions in the United Kingdom and in Europe as a whole have reinvented and remodeled themselves to be able to respond to the ER needs that continue to

Persuasive speech; How violent video game affect children Essay

Persuasive speech; How violent video game affect children - Essay Example The increasing trend of using technology and gadgets is reducing the degree of outdoor activities for children. This results in increased durations of indoor activities that mainly constitute of watching TV and playing video games. According to Reinberg, US kids spend around 8 hours watching TV and playing video games every day. The modern video games have alarming levels of aggression and violence in them since they are mainly based on warfare or combat themes. Anderson stated that many scenario based games revolve around the killing of innocent characters with guns, knives, fighting etc. Exposure to such level of violence and aggression for elongated durations affects the players on a short term, as well as a long term basis. Kooijmans stated that violent games cause an increase in destructive cognitions and negative arousals. He also stated that violent video games induce hostile attitudes and beliefs among the users on a long term basis. The high quality of graphics and animation make the scenarios look genuine and give the perception of a real life. Anderson stated that experience of such real life violent situations makes the individuals insensitive to other people’s suffering and pains since they view such details on a daily basis in the form of animated characters. Benedetti pointed out that the increase of violence in video games is having another severe effect on the new generation; shootouts in schools. There have been numerous instances where students have opened fire at their fellow students and caused massacres. Examples of such incidents include Colorado shootout in 1999, Viginia Tech School shootout in 2007 etc. Layton stated that the shooters in the Colorado shootout were excessive players of ‘Doom’, ‘Mortal Kombat’ and ‘Wolf 3D’. These games were considered to be popular and common violent games of that era. Layton also

System Feedback Loops Essay Example | Topics and Well Written Essays - 1250 words

System Feedback Loops - Essay Example The archetypes identified here are reinforcing loop and balancing loop. The Balancing Loop attempts to move some current state to a desired or reference state though some Action (Bellinger, 2004). A Gap is produced when the desired state interacts with the current state. When the gap is larger, it means the influence is stronger and produces Action which then causes current state to move towards desired state. According to Bellinger (2004), this is done until the Gap is reduced to zero where there is no more influence toward Action. A Reinforcing Loop is a structure which feeds on itself to produce growth or decline (Bellinger, 2004). State 1 either increases or decreases which influences State 2 to move in the same direction. This structure produces growth or decline, hence, it is reinforcing it. Learning Organizations for NutriSystem The increasing demand for healthy diet in U.S. has an impact in weight loss market. NutriSystem has been a leading provider of weight management. Usin g the system feedback loops, events can be affected by determining the patterns observed in behaviors and desired outcomes. These feedback loops illustrate the interactions between events or states. Based on the example of diabetes cases, many people are diagnosed with diabetes and NutriSystem is aiming at promoting health for diabetics. Sytems Feedback Loops 2 Figure 1 - Reinforcing Loop In this diagram, it shows one example of the relationship between diagnosis for diabetes and the number of potential diabetic customers. The more people who are diagnosed with diabetes, the greater the number of potential diabetic customers are for NutriSystem. In other words, the potential diabetic customers increase when more people are likely to be diagnosed with diabetes. The potential diabetic customers can be predicted because the likelihood of people having diabetes is evident. Getting a diagnosis for individuals is likely to be an outcome of predicted potential diabetic customers who are at high risk due to factors such as pregnancy, pre-diabetes conditions, or trends in sugar intake. In 2011, statistics from National Diabetes Fact Sheet show that there are about 25.8 million or 8.3% of U.S. population that have diabetes. There are 18.8 million people diagnosed with diabetes, 7.0 million who are undiagnosed, and 79 million who have pre-diabetes. There are millions of new cases of diabetes every year (American Diabetes Association, 1995-2011). This System Feedback Loops 3 was become an opportunity for NutriSystem to serve diabetics as they have formed a strategic alliance with American Diabetes Association to promote weight loss for people with Type 2 diabetes. A view of benefits of health and nutrition using NutriSystem can be depicted in the following diagram: Figure 2 – Reinforcing Loop NutriSystem offers over 100 food items designed to combine â€Å"good† carbohydrates, proteins and fats (Pechman, 2011) in addition to glycemic index (GI) prepared meal s for diabetics. They provide customers with home delivery meal program that includes balanced, pre-prepared, and portion-controlled meals. (Pechman, 2011). Demand for products such as that of NutriSystem has increased with the growth of obesity epidemic. System Feedback Loops 4 To make a profit, NutriSystem must target potential customers by using new and improved marketing strategies

Stroke Rehabilitation Essay Example | Topics and Well Written Essays - 2000 words

Stroke Rehabilitation - Essay Example Lack of physical activities, has also been found to affect the recovery process of most patients with strokes. The essay will focus on the importance of activities in the recovery of stroke patients. This will be based on scientific studies that indicate the importance of physical exercises (American Association of Cardiovascular and Pulmonary Rehabilitation, 2004). The current studies have mentioned that inactivity and sedentary lifestyles to be common in patients with stroke. This has been associated with the physical deconditioning, a situation that many patients in critical conditions cannot be evade. The physical inactivity can be attributed to age differences, especially in many patients who are above the age of 60. It is also common in patients with negative attitudes and perception about the recovery programs. Patients, who believe that they will recover and become independent, are more likely to participate in physical activities. They respond well to the medical treatment. Several researches also find a correlation between motor coordination and the increased sensitivity of the str oke-impaired limbs with exercises. As a physiotherapist, I have been able to discover the importance of physical activities. I have found that patients who are positive and regularly participate in physical exercise are more likely to respond to drugs. The patients are able to improve their self-esteem and are very positive in life. Only a few patients who have been constantly taking part in physical activities that been diagnosed with the co-occurring ailments. Further, none of the case of recurrent of stroke has been reported. On the contrary, I have had about four patients being diagnosed with hypertension and diabetes mellitus due to inactivity. These patients have refused to continue with the physical exercise program I have made. Hence, my interactions with the patients prove that indeed the physical exercises play an imperative role. As such, I advocate for

Lack of communication on relationships Essay Example | Topics and Well Written Essays - 250 words

Lack of communication on relationships - Essay Example However, this practice leads me to exhaustion and I slowly started to dislike the place. It could have been over easily, however, lack of communication on my behalf led me to a point where I considered quitting that job. Also, once while working there, I started noticing that my manager had started being a bit rude and strict to me. And although, he didn’t use to say much, it led to start of a rumor that I was going to be fired. That not only made me uneasy emotionally, but also affected my motivation at work. However, sometime later it became clear that his behavior was due to his personal problem and not due to my work. Lack of communication often leads to a conflict or in other cases worsening of a conflicting situation (Conflict Research Consortium). It is important to communicate in order to prevent conflict and maintain a clean and clear environment all

Moral luck Essay Example | Topics and Well Written Essays - 1250 words

Moral luck - Essay Example Concepcion (2002) describes the "standard view of responsibility" whereby "it is unjust to hold a person morally responsible for that which she did not control. Agents deserve to be morally appraised or held liable only for that which they controlled" (455). The problem this poses is that at some level it can always be argued that a situation was outside of a person's control. There will invariably be some uncontrollable factor that, when joining the confluence of other factors over which a person did have control, it can be argued was the cause of any given scenario. For example, if a person driving a vehicle strikes a child who suddenly runs into the road, it might be argued that the person could have been paying closer attention and thereby braked sooner, or should have been driving more slowly. On the other hand it could be argued that a reasonable person under the circumstances could not have predicted the child running into the road, and therefore this was just bad luck and the driver should not be held responsible. This epitomizes the concept of moral luck. To what extend does a random, uncontrollable occurrence relieve a person of moral responsibility for a harm done Concepcion goes on to argue that accepting the standard view of responsibility "is tantamount t... never morally responsible, show that luck is not ubiquitous or at least that ubiquitous luck is not moral, or show that ascriptions of responsibility can retain justice despite the omnipresence of luck" (455). The implication is that it does not make sense to avoid assigning responsibility simply because luck played a role in the moral dilemma, since luck will virtually always be a factor to some degree. This would logically mean that nobody is ever morally responsible for anything. Paradox of Moral Luck and Moral Responsibility The paradox, as Thomas Nagel (1979) describes it, is that individual moral responsibility is possible even though luck is ubiquitous. We hold a person responsible for actions taken within a scenario he/she did not bring about. It is possible for a person to be morally blameworthy even though the bulk of the circumstances bringing about a scenario were entirely outside of that person's control. Degrees of control are virtually irrelevant, as proximate causation of uncontrollable variables fails to offer any relief from a person's moral responsibility for actions taken within any given situation. Consider the case of a soldier who voluntarily enlists in the U.S. Marine Corps in the hopes of being deployed in Iraq to fight in the war on terror. This person, after months of grueling patrols in Baghdad watching his fellow marines get killed by improvised explosive devices, decides to take revenge by entering the nearest civilian residence and shooting up the women and children inside. Then consider the kid who had his sights set on college but was instead drafted into the U.S. Army during the Vietnam War and becomes so worn down by the war and numbed to killing that he partakes in a massacre of civilians at Mai Lai. The former soldier chose to

Stroke Rehabilitation Essay Example | Topics and Well Written Essays - 2000 words

Stroke Rehabilitation - Essay Example Lack of physical activities, has also been found to affect the recovery process of most patients with strokes. The essay will focus on the importance of activities in the recovery of stroke patients. This will be based on scientific studies that indicate the importance of physical exercises (American Association of Cardiovascular and Pulmonary Rehabilitation, 2004). The current studies have mentioned that inactivity and sedentary lifestyles to be common in patients with stroke. This has been associated with the physical deconditioning, a situation that many patients in critical conditions cannot be evade. The physical inactivity can be attributed to age differences, especially in many patients who are above the age of 60. It is also common in patients with negative attitudes and perception about the recovery programs. Patients, who believe that they will recover and become independent, are more likely to participate in physical activities. They respond well to the medical treatment. Several researches also find a correlation between motor coordination and the increased sensitivity of the str oke-impaired limbs with exercises. As a physiotherapist, I have been able to discover the importance of physical activities. I have found that patients who are positive and regularly participate in physical exercise are more likely to respond to drugs. The patients are able to improve their self-esteem and are very positive in life. Only a few patients who have been constantly taking part in physical activities that been diagnosed with the co-occurring ailments. Further, none of the case of recurrent of stroke has been reported. On the contrary, I have had about four patients being diagnosed with hypertension and diabetes mellitus due to inactivity. These patients have refused to continue with the physical exercise program I have made. Hence, my interactions with the patients prove that indeed the physical exercises play an imperative role. As such, I advocate for

Moral luck Essay Example | Topics and Well Written Essays - 1250 words

Moral luck - Essay Example Concepcion (2002) describes the "standard view of responsibility" whereby "it is unjust to hold a person morally responsible for that which she did not control. Agents deserve to be morally appraised or held liable only for that which they controlled" (455). The problem this poses is that at some level it can always be argued that a situation was outside of a person's control. There will invariably be some uncontrollable factor that, when joining the confluence of other factors over which a person did have control, it can be argued was the cause of any given scenario. For example, if a person driving a vehicle strikes a child who suddenly runs into the road, it might be argued that the person could have been paying closer attention and thereby braked sooner, or should have been driving more slowly. On the other hand it could be argued that a reasonable person under the circumstances could not have predicted the child running into the road, and therefore this was just bad luck and the driver should not be held responsible. This epitomizes the concept of moral luck. To what extend does a random, uncontrollable occurrence relieve a person of moral responsibility for a harm done Concepcion goes on to argue that accepting the standard view of responsibility "is tantamount t... never morally responsible, show that luck is not ubiquitous or at least that ubiquitous luck is not moral, or show that ascriptions of responsibility can retain justice despite the omnipresence of luck" (455). The implication is that it does not make sense to avoid assigning responsibility simply because luck played a role in the moral dilemma, since luck will virtually always be a factor to some degree. This would logically mean that nobody is ever morally responsible for anything. Paradox of Moral Luck and Moral Responsibility The paradox, as Thomas Nagel (1979) describes it, is that individual moral responsibility is possible even though luck is ubiquitous. We hold a person responsible for actions taken within a scenario he/she did not bring about. It is possible for a person to be morally blameworthy even though the bulk of the circumstances bringing about a scenario were entirely outside of that person's control. Degrees of control are virtually irrelevant, as proximate causation of uncontrollable variables fails to offer any relief from a person's moral responsibility for actions taken within any given situation. Consider the case of a soldier who voluntarily enlists in the U.S. Marine Corps in the hopes of being deployed in Iraq to fight in the war on terror. This person, after months of grueling patrols in Baghdad watching his fellow marines get killed by improvised explosive devices, decides to take revenge by entering the nearest civilian residence and shooting up the women and children inside. Then consider the kid who had his sights set on college but was instead drafted into the U.S. Army during the Vietnam War and becomes so worn down by the war and numbed to killing that he partakes in a massacre of civilians at Mai Lai. The former soldier chose to

Vancouver-Hollywood North vs the Loss of Canadian Identity Essay Example for Free

Vancouver-Hollywood North vs the Loss of Canadian Identity Essay Introduction: 1 Vancouver is being called â€Å"North Hollywood† because a vast of film producers decide to set up their shooting places at BC, Canada. Vancouver is deserved to be rewarded as this special title because it’s unique beauty of the diverse sceneries and the sophisticated filming technologies. These inputs have already attracted by Hollywood and lead the U.S. film industry entry into making the huge quantity of runaway production era. The 2001 Report concluded that the 1998 Canadian production incentive programs were very successful in attracting production from the U. S.A(StephenM.Katz, 2006, p.1). question has been brought into the public attention and this paper will mainly focus on: why does Canada not encourage their own domestic film industry, but would rather give foreign film industry tax incentives. Additionally, due to the growing number of American movies crushed into the Canadian entertainment market, this paper will also discuss both the positive and negative effects emerged under this issue. The tax incentive given by the Canadian government cannot be denied for one of the reason to turn BC as well known asNorth Hollywood: â€Å" Foreign production companies will see the Production Services Tax Credit jump to 25%, with an unchanged 6% bonus for work done outside the Vancouver area.†(BC Announce 35% Film Incentive Credit, 2008). Actually, not only BC is doing such things but also New Zealand. Newman illustrates The film and television production industry is significant in both New Zealand and British Columbia. Governments in both localities provide substantial support for the industry through government agencies and tax  incentives.(Newman.D,2005,abstract).Currently, BC is directly toward into a service-oriented country by providing the U.S. big financial profits. This strategy seems to become a really effective approach to enlarge their awareness toward the global without promoting their own film industry but rather borrowing their beauty to U.S. Takaki and Shoot explains that some of the U.S. Film associations like SAG (Screen Actors Guide) and FTAC (Television Actions Committee) already had an unpleasant attitude toward the Canadian federal governments tax incentive legislation (Takaki,MillieShoot, FilmTelevision,2001). They are not encourage the U.S. film industry to do the runaway productions in order to persist the U.S. rights and promoting their own movie domestically. Currently, there are a lot of such top-grossing movies include:X men, Silent Hill, Mean girls,etc(Chris Hamilton, 2008) . Apparently, there are both advantages and disadvantages behind the runaway production for both U.S. and Canada. Take the employment issue as instance:the loss of the job opportunities would be one of the serious concern towards the Americas because the film producer would prefer to hire the local employers rather than bring the workers all the way to B.C. This is aiming of saving appropriation expenditure. Many people like Pendarkur M hold the belief of: â€Å"creating employment is more important than fighting for better wages and working conditions†(Pendarkur, 1998). Basically, this idea is fairly straight forward which stand for its way much better to  have a job rather than getting a better wages and working conditions provided by their boss. In this way, the employment is seen as the priority of one country. Nevertheless, we still cannot deny the advantages and disadvantages it brought to BC and U.S. The optimistic effects might probably cause a decrease unemployed rate for the Canadians. In another words, more Canadians would find a job under the help of the U.S. film industry.On the other hand, there would be a high unemployed rate for the Americans. Other than the job opportunities we get, Vancouver is successfully known as North Hollywood currently and it helps to promote Canadians film industry. After that, it widen the opportunities for the TV producer to do the movies and help to  expose the beauty of diverse BC sceneries to the whole world. Eventually, he ended up with the solution that:† This type of thinking has resulted from the weakened position of Canadian and international unions, which has placed them in a struggle for survival and left them unprepared to negotiate with the powerful and expanding entertainment industry†(Pendarkur, 1998). After getting the great job opportunities, BC is actually facing a further serious problem which is the lack of capability to get rid of the domination of U.S. and build their own entertainment industry. The longer period people adopted into something, the harder for them to leave it behind and build a new industry. Actually, there is a far long period when the U.S. Corporation first started dominated some of the Canadian entertainment market. According to Pendarur M: 4 Paramount Famous-Lasky, the leading vertically integrated firm in the United States, dominated the Canadian feature film market through its subsidiary, Fomous Players Canadian Corporation,(Pendakur, M. 1990). The Canadians were influenced and dominated by the U.S. Industry for such a long period already. This situation lead the Canadian get more adopted to U.S. Entertainment world rather than building up their own film industry. This lead to the consideration of the loss of local audiences once the government decide to promote their local film market. Moreover, audience fragmentation is another concerns about why Canadian not encourage making its own movies.If people randomly walk into a cinema, it is obviously to find out the U.S. movies took over a great percentage of movie products on the Canadian cinema. Also, it gets a fairly good feedback among the audiences which makes the Canadian cinema become prosperous. In order to let it remain the same situation and let it survive, the Canadian film industry realize to spend more time and attract more foreign powerful film-making countries is significant rather than creating their own domestic film. Through David Skinners research., he claimed that:these definitions are all based on a concern that the dominant corporate media do not adequately represent the interests of all members of society(David, 2010, p.221). These definitions on the above quote are actually stand for the idea of  Ã¢â‚¬Å"alternative media† . The dominant corporate media cannot be fully satisfied by one hundred percent of the audiences because different people from the various social status have their own interests. To be  more specific, even though the Canadian government invest expenditure to promote the real Canadian movie,the audience fragmentation still exists. To consider this issue in a further financial perspectives, it better and easier to support the U.S. runaway productions in order to keep the Canadian cinema industry alive and have a large number of audiences really buy the tickets. Moreover, a more serious situation would happen derived from the previous sequences. The dominant corporate might only provide the pastime for those of them who have the ability to access media. Nevertheless, the rest of them might remain the same living style as what they were before because they dont have the capability to access them like some remote areas. The new technologys exist give people a new sight to understand the world. The powerful invention of these new media going to influence how we think and how we behave. After that, it causes the huge gaps between the one who can get into the cinema and who are not capable to use that. Its hard for a whole nation to unite together and figure out what their real interests are. The Canadian government provide the tax incentives undoubtedly created benefits for both of them financially but seems ignore the further concern of creating a â€Å"real Canada† consists of it’s real identity. What kind of movie we watch has a direct impact to shape Canadian itself. Specifically, someone who makes the film affect what kind of messages they get. It impacts the Canadian identity in several various aspects. Particularly, there is not  doubt that Canada and U.S. overlap a lot of similarities like the languages. However, there is one significant factor cannot be denied on this context which is the â€Å"unique identity†. The Canadians do have its own unique identity including the enthusiasm to the national hockey, the still existing of First Nation’s unsophisticated lifestyle and other factors make Canada become a unique nation and really help the Canadians to define who they are. Along with the tendency of growing proportion U.S. film start to shoot  movies in Canada, the Canada seems have less time to promote their own film. Some of the U.S. identities are being shown during the films and this is going to directly injected into Canadians mind. Consequently, they would not be able to have a strong nationality traits. In conclusion, this paper mainly explored the reasons for the Canadian government intentionally turn Vancouver into north Hollywood instead of investing the film producer to shoot the real domestic movie with real local identity in it. Also, this paper looked at the profits and drawbacks from both U.S. film associations perspective and Canadian governments point of view. Next, it emphasis the significant role of one countrys entertainment industry. The film industry has no longer simplly provide an entertainment way for people to have a pastime but it become a nations symbol and reflected the countrys real identity. The elements being made during the scenes potentially injected into audiences mind and they behave toward the invisible messages being created by the film. As time passes, it definitely  going to influence how Canadian behave and how they communicate between each other. This paper concluded that the creation of one countrys identity is far more significant compared with governments financial concern. References David, Skinner. (2010) â€Å"Minding the Growing Gaps: alternative media in Canada† In Leslie R.S(ed.) Mediascapes. Nelson College Indigenous Press. Famous Movies Filmed in Canada | Cinemaroll. (n.d.). Cinemaroll | film making, from the viewers perspective. Retrieved March 24, 2011, from http://cinemaroll.com/cinemarolling/famous-movies-filmed-in-canada/ Newman, D. (2005). Regions And Runways: Film Assistance In New Zealand British Columbia, 1990-2005. Media International Australia Incorporating Culture Policy, (117), 11-30. Retrieved from EBSCOhost. Pendakur, M. M., Sussman, G. G., Lent, J. A. (1998). Hollywood north: film and TV production in Canada. In , Global Productions: Labor in the Making of the Information Society (pp. 213-238). Retrieved from EBSCOhost. Pendakur, M. (1990). Canadian Dreams American Control: The Political Economy of the Canadian Film Industry. Retrieved from EBSCOhost. 9 Stephen M. K. (2006). The Global Success of Production Tax Incentives and the Migration of Feature Film Production From The U.S. to the World Year 2005 Production Report[Adobe Digital Editions version]. Takaki, MillieShoot,( 12/14/2001). Dispute Heats Up Over Runaway Tariff Proposal. Film Television Literature Index with Full Text (Vol. 42, Issue 50) Vancouver Film. Net: BC Announces 35% Film Incentive Credit. (n.d.). Vancouver Film. Net. Retrieved March 24, 2011, from http://www.vancouverfilm.net/2008/01/bc-plans-35-film-tax-credit.html