Randolph-Macon College Essay

I have learned a lot about this college, from my brother attending there for four year. There are many different characteristics that draw me to Randolph-Macon. Football is a plus because I know all the coaches, the characteristics are location, academic, small classes, teacher communication and small liberal arts college, and I believe they will help me succeed in my nest four years. These characteristics can be narrowed to ways that will advance my academic future. One of the characteristics in a college that I am looking for is the actual location. Ashland Virginia is a good small town that would be a good fit to live in for four years. Another reason that, I am looking to go to this college is because my Aunt and Uncle live right near the campus, I can go visit them any time I would like to. The campus is close to a few big cities which I like about it, it is near Richmond, Washington D. C and Norfolk. The school is only a short drive away from Roanoke. Personally, I am not looking for a big college to go too. I like Randolph-Macon because it is a small school with less than 1,200 students. The atmosphere on the campus is beautiful, I love walking through the campus when I visited my brother up there. Also, the reconstruction they are doing is going to be really nice. I have been told from a lot of people that have gone there, that there is a great bond between your classmates. Going to a small college like Randolph-Macon has its advantages that big colleges do not have. Randolph-Macon is a small liberal arts college; it has a wide range of classes that you can choose from. It ranges from guitar class to biology class it all matters what you want to learn. They have a business major that I am interested in. Having a business major, with a background of many other subjects will help me in the long run. Liberal arts will be an exciting challenge. Going Back to Randolph-Macon being that it is a small college it has its advantages. One major advantage that it has is small classes. Having small classes give teachers time to meet one on one with you. Also teachers go more into depth on subjects and always change in class. There are less than 20 people in each of your classes. The academics are nationally known, which is a huge plus. You defiantly get a good degree by going there. The academics part is a major reason why I am applying to this school so I can expand my knowledge with a good degree and get a job after I am done with college. Having small classes allows you to meet your teachers personally and develop communication. The teachers check attendance every day, which helps kids go to class. They have office hours that will work with their student’s schedules. The teacher will get know to know you on a first name bases which is very good in college. I think having big classes is a disadvantage to small classes because the teachers don’t care about you as much. Small classes will aid me because I will get help with classes and learn better. Randolph-Macon has its advantages and I have learned a lot about the from visiting my brother, these advantages are academics, teacher communication, small classes, small liberal arts college. Also knowing someone that went the school there helps me out a lot. The football program is a plus. These characteristics are very important in my decision. This is why I love Randolph-Macon College.

Ketone reduction

IntroductionKetone reduction is one of the fundamental reactions in organic synthesis and this results to the formation of the corresponding alcohol as the final product. In synthetic organic chemistry carbonyl reduction is an important process leading to a wide variety of reducing being realized. Several of these reducing agents can be used to reduce all carbonyl groups, but one class of compounds only react with hydride donors. Taking for example lithium aluminum hydride reduces in most occasion’s ketone, esters and aldehydes.Experiment 5B:The experiment was performed using the right procedures that was provided and the instructions followed to the latter and in this case sodiumborohydride was used as the reducing agent, the protocol followed came from a laboratory manual or primary literature. It is said in theory that the four hydrides in sodium borohydride are always in place to reduce a molecule of ketone, this suggests that one mole of sodium borohydride reduces four mo les of ketone. Sodium borohydride in this experiment was used to reduce 4-t-butylcyclohexanone which has a large sized t-butyl group making it to exist in an almost exclusive chair conformation one of its kind.Post-Lab assignment1. a)   The Lewis structure of a hydride ion is as shown;H- (hydride) Lewis structure and the (electron dot diagram) [H]+ or H+b)   This is because the carbonyl carbon has two delocalized electrons thus tends to   display high affinity for the four hydride ions (H-) off the Sodium borohydride which is highly neucleophilic2)  Ã‚   The mechanism involved the highly nucleophilic borohydride attacking at both the endo and the exo sides leading to the formation of both cis and trans isomers.4.   This was possible since the addition of dilute hydrochloric acid led to the formation of water molecule leading to neutralization of the excess reducing agent.5.   Percentage Yield = ratio of products to reactants multiplied by 100 percent6.  Ã‚   a) The mel ting point of the major product was rather low than the literature value melting point range.b)   This is so inorder to accommodate any experimental mistakes that might have occurred during the performance of the experiment also we can say that the presence and positioning of the t-butyl group contributed a great deal to the melting range of the product.7.  Ã‚   a)   There is absorbtion in IR at wave number 1710 cm-18.   The reaction forms two products since there is nucleophilic attack at both endo and exo sides of the main reactant 4-t-butylcyclohexanone, and the product structures are below,  Ã‚  t.-Bu  Ã‚  OH  Ã‚   cis-4-t-butylcyclohexanol      Or  OH   Ã‚  t-Bu   trans-4-butylcyclohexanol the main product.a) The Newman projection for the cis-isomer b) The Newman projection for the trans-isomerc)   Using the integrated values the ratio of cis/trans being the products can be calculated using the complex signals, one centered at 4.05 and the other near 3 .5 thus the areas under these complex signals are 0.85:3.66 or 1:4.3.References1.   University of West Florida, NMR Analysis of 4-t-Butylcyclohexanols

Submarine Escape Procedures

Michael Menor Professor Cady English 151 25 February 2013 Submarine Escape Procedures There are many catastrophes that can affect the operation of a submarine; fire and flooding can crimple a submarine completely if either is not resolved quickly. Submariners are trained to combat all forms of fire and flooding in different scenarios that are closely monitored in Submarine School. As a last resort, sailors are also trained in submarine escape in the very rare occasion that they must escape from the ship.Submarine escape is only effective at depths less than 600 feet; escape any greater depth would be impossible. Michael Menor deployed with two nuclear fast-attack submarines; the USS Santa Fe and the USS Albuquerque; during his four and a half year enlistment in the United States Navy. He is well versed in submarine escape and hopes that this will give you an understanding on how to escape from the depths of the sea. Every ship is equipped with two escape trunks, or hatches as some ma y call it; one forward and aft, both of which have similar dimensions and operation procedures.Each trunk is able to hold two escape personnel. The Submarine Escape Immersion Equipment; also known as a SEIE Suit; is a last resort option if a Deep Submergence Rescue Vehicle, or DSRV is unable to save personnel from a disabled submarine. The suit is a single piece construction capable of controlling pressure to prevent decompression sickness, or â€Å"the bends†, which is a side effect of rapidly ascending from ocean depths. Each suit is also equipped with a life boat that is contained within a pouch attached to the left hip.Familiarity with the escape hatch valves is not required; all operations are handled by personnel from within the ship. For the purposes of this procedure we will call these personnel â€Å"Supervisors,† since they are usually experienced supervisory personnel with the knowledge of operating the escape hatch. Depending on where the casualty, is you w ill always want to choose the escape trunk that is not in the affected compartment. Whether it is flooding in the forward compartment; your escape will be in the aft escape trunk in the Engine Room. The same pplies to a casualty in the aft compartment; your escape will be via the forward escape trunk. During this procedure you will be performing all actions from within the forward escape trunk. On the rare occasion that submarine personnel are not able to stop flooding in the engine room that leaves the ship sinking into the depths, and laid to rest on a sea shelf 500 feet below the surface. You will then need to don a SEIE suit by placing both feet into the suit and taking the zipper, which is placed on the outer side of the left leg and pulling this up until it is at your belly button.As you would put on a coat; place both arms into each sleeve equipped with rubber gloves and flip the hood onto your head. You must then pull on the zipper, which continues upwards centered on your c hest, and up to the hood. One common issue that can occur is the zipper getting stuck, or feeling as if it will not budge—remember that it was designed to keep water out of the suit—if this happens you will need to request the assistance of someone else.Now that you have the suit on you will need to make your way to the escape hatch ladder and climb into the 6 foot cylindrical space, which is only designed to hold two escape personnel; the two of you will be standing directly across from each other with your backs against the bulkhead. There is a charging hose attached to the left arm of your suit, attach this hose to the charging manifold on the bulkhead (wall) located to your left; the charging hose will inflate your suit to create a bubble barrier between you and the outside pressures of the ocean.Remember this is your source of oxygen, so continuing to keep the charging hose connected during your time in the escape hatch is crucial. As your suits are being charged please keep your feet away from the lower hatch as the Supervisors begin close and seal it. Once it is confirmed sealed a rush of water will begin to flood the hatch. Due to the buoyancy of your inflated suit you will begin to float; do not let this happen. To prevent this there is a handle to your right that you will be able to use to maintain your grip and keep you anchored safely.Supervisors will then pressurize the hatch to match the outside pressure outside of the hull. The first person that entered hatch will be the first one to escape; once the hatch is clear the second person will wait 30 seconds and follow to prevent getting entangled with one another. Since you are the lucky one to enter first, you will get to escape first. Supervisors will open the upper hatch; continue to maintain your grip until the upper hatch has reached its fully opened and locked position. Supervisors will use a wrench or hammer to knock on the lower hatch three times.This will give you the signal t hat the upper hatch is clear and you can escape. Release your grip from both the handle and the charging manifold. Allow the suit to take over as its positive buoyancy lifts you out of the hatch and upwards to the surface. The suit is designed to maintain proper atmospheric pressure for your safety during the ascent; as you will be traveling about 30 feet per second. Upon reaching the surface ensure that you are floating on your back, while in this position you need to reach into the pouch on your left hip and remove the life raft; pull on the yellow handle and allow the raft to self-inflate.Once inflated pull yourself onto the raft; during this time you can unzip the hood of your suit. The raft comes equipped with a drogue, water desalination kit, and equipment such as smoke signals, and flares to assist with your rescue. Congratulations on your successful escape; now you will wait for rescue personnel to find you and the others from your ship. At the surface it is highly recommend ed to regroup with other personnel from the ship and tie your rafts together. This will create a larger object for rescuers to spot during their search.

Karl Marx Essay Example | Topics and Well Written Essays - 500 words

Karl Marx - Essay Example In the capitalist economy, Marx maintained that the worker was isolated from their labor, the product of their labor, and the conditions of their labor; that this isolation made it impossible for the worker to utilize their natural productive capacity. Marx particularly questions features of the capitalist economy such as the class system and currency. He maintains that history is the product of an ongoing struggle between masters and slaves; carried on between the bourgeois and the workers during the lifetime of Marx. Similarly, Marx identifies money as a force destructive to the worker's innate capacity. Both money and class hinder the ability of the worker to realize their full potential. According to Marx, the class struggle was destructive to production because one class always exploited the other and opposed their interests. In many respects, Marx considered that the struggle between classes created the alienation of the worker from his work. By being subjected to the rule of a master class, the worker is alienated from his work because he does not benefit directly from it. The worker is isolated from the product of his labor by the sense that his work is for someone else's benefit. Marx considered money to have a similar effect, if a more dramatic.

The Decline of the Educational System in Harlem, NY Essay

The Decline of the Educational System in Harlem, NY - Essay Example The Jim Crow legislation, which was rampant in the South, widened the education gap between the blacks and the whites, which had adverse effects to the education system. The public education system did not serve the needs of the blacks adequately which worsened the problems experienced by the blacks (West 287). For example, the schools in the South Carolina became more overcrowded, the teachers were not paid well, and many of the teachers were not qualified. In addition, possessing education in the South did not guarantee the blacks with jobs and was difficult to gain high school status and earn respect for the knowledge gained in the education system. The emergence of trade schools provided the blacks with the training in fields such as millinery and sewing. Other schools, which underwent the renaissance time include the Bronx Community Chatter School, Fausset Districts Schools and Queen Metro High School. Harlem Renaissance came into the end in the 1930s as the Harlem artists and i ntellectuals drifted to other opportunities (Coy 124). Because of the prevalence of the racial segregation against the African American students, the Harlem students could not access the education they needed in order to have a substantial participation in the country affairs. In Harlem schools, the students performed dismally due to the low educational standards in schools. The government did little on the provision of the necessary infrastructure to facilitate the learning process (West 287). The education system denied the Harlem students to join decent jobs, participation in the nation’s economic and political affairs, and fight for a fair society. The education system in Harlem is often one, which does not provide students with adequate knowledge as resources in these schools are scarce compared to the students on other regions. The inadequate resources have made the students to score poorly. Consequently, the Harlem schools always post low grades during the internal exa ms and the national exams. The students often score poorly in mathematics and science subjects. For example, the score in mathematics is as low as below 30%. This has been linked to poor infrastructure, and inadequate staff because of understaffing by the government, as the priority of teacher allocation by the government is not in Harlem schools. The rate of drop out in the Harlem schools is high as 26.3% of the total number of the students drops out during their high and lower schools levels. The number of students who proceed to the tertiary level is extremely small. On average, 8% of the total students who started in lower classes join colleges and universities and are because high rate drop out the educational process (West 287). The teacher training is still poor and most of the teachers in the Harlem schools are untrained, thus making them inefficient in presenting the content to learners, thus low performance. The principle of the District-bargained contracts with the teache r unions has led to decrease in employment and sustaining highly motivated teachers. The high rate drop out has also affected the number of students who graduate from the colleges ad the universities. This means that the students of the African American in Harlem schools ar

Management accounting for Sustainable Development Essay

Management accounting for Sustainable Development - Essay Example In the fifties, the concept of growth came as an unexplored horizon in Economics. However when this theory failed to reconstruct the world under the Marshall plan, then economists like Arrow brought a new concept popularly identified as development. Development differs from growth in the way that growth only considers the economic variables of human life while development is more interested in socio economic factors. The concept of development seems to be more justified than growth particularly improving the third world countries. However, whether development can be sustained or not, considering the limited amount of resources in the world, remained unanswered till 1987. Again, development suffers not only from the resource constraint but human life is constantly leaving some permanent marks through some irreversible changes, which also constraints development. The concept of sustainable development put its first step in the human mindset through Brundtland report named as â€Å"Our Common Future† (1987). Under sustainable development the needs of the present generation gets satisfied without compromising the future generation’s ability to satisfy their requirements. Sustainable development can be called as a culmination of the decision making process towards sustainability with the internalization of environmental costs. With this cost concept comes the most important and touchy factor known as ‘pricing of environmental goods’.

Obesity in Kuwait Research Paper Example | Topics and Well Written Essays - 750 words

Obesity in Kuwait - Research Paper Example Data taken on the temporal changes in BMI and prevalence of obesity are even more so (Al†Asi). Women in Kuwaiti have been exposed to extreme physical as well as social variations in society in the past few years, and there has not been any study of this nature that has been carried out on them (Al†Asi). The main aim of this study is to respectively explore temporal changes in mean prevalence of obesity and BMI between the two independent samples of 1171 and1705 women of Kuwait between the ages of 18 years and older that were studied in1980-1981 and 1993-1994 (Al-Mahroos). 3- In Kuwaiti, white rice is the staple food both in the past and currently. It is believed that people in Kuwait take white rice once or twice in a day mostly for lunch and at times for dinner too (El-Bayoumy). Though there is no data on the average consumption of rice, data on the population consumption of the intake of rice is not available, data suggests that 17%of total energy available is consumed from white rice (El-Bayoumy) 1- There were two independent studies that were used to analyze and compare the temporal changes in the prevalence of obesity and BMI among the women in Kuwaiti BMI (Al-Awadi).The first study was a national study of 1171 women which was completed in 1980-1981 as it dealt mainly with the â€Å"Nutrition Status Assessment of Adults.† The second study to be carried out was a cross-sectional study of 1705 women which was completed in 1993-1994 and it was based on assessing the prevalence of obesity among Kuwaitis (Al-Awadi). The sample carried out between 1980-1981 sample of 1171 women was gotten from 17 randomly selected primary health care from the clinics situated in all of Kuwaiti five regions and sampling was taken randomly in accordance to the Kuwaiti’s population sex ratio (El-Bayoumy). The samples were divided among the clinics and the division was defined proportionally by the size of the area that was reserved by each of

Criminal Liability Coursework Example | Topics and Well Written Essays - 1500 words

Criminal Liability - Coursework Example The paper tells that criminal law is a body of statutes and rules that deals with crimes and their punishment; the law defines conduct that is prohibited because it can harm, endanger or threaten the welfare and safety of the public. Fitzerald is aged 13 years and is engaging in behaviours that can threaten public safety; he threw stones at passing car and it hit Gordon’s car and severely injured Gordon. In the second instance, he threw a stone at Dan but missed him and hit John instead. In advising Fitzerald, I will tell him the following legal facts relating to his behaviour; one, under UK law, age 13 years (his age) is under the age of criminal responsibility. Therefore, his behaviour should not be based on the assumption that because he considers himself a child he cannot be found guilty of a crime. As a matter of fact, within England and Wales, a child over the age of 10 years is considered to be responsible for crime as a result of their actions and should face legal con sequences if found guilty. Children below the age of ten years are considered doli incapax and are therefore not capable of forming criminal intent. The law assumes that children under the age of 10 years do not adequately understand differences between right and wrong acts and cannot be responsible for their actions. But children over 10 years are assumed to understand this difference just like adults and can be tried for their actions which may be deemed to amount to a crime. In addition, I will advise Fitzerald on what constitutes a crime according to the law. Glazebrook (2011, p. 49) explains that a person can be found guilty of a crime if it can be proven that that person had intended to commit the act before. Secondly, a crime can be committed through reckless actions of a person; that is, a person not caring about the consequences of his or her actions. Therefore, in Fitzerald situation it is clear that he can be accused from the two perspectives of what constitute a crime. F or example, in the first instance where he was throwing stones at passing cars, it can be said he did that with an intention to harm motorists or he was simply reckless and did care about the consequences of his actions. In the second instance, he had intention to hit Dan but he missed and hit John instead. In both instances, his actions can cause harm to the public and threatens public safety as well. Without doubt his actions which can be supported by substantial evidence in the court of law can result to him being charged and convicted. I will let him know what will inform the decision to convict him in court; one of the major reasons will be retribution which will make him ‘suffer’ in some way as a punishment of harming and making others suffer due to his actions (Mitchell and Farrar, 2008, p. 70). The second reason for his punishment will be rehabilitation. Law Library of Congress (2011) notes that the main aim of punishing criminal offenders especially children is to transform them into members of society who are valuable and can coexist peacefully with others. I will tell him that rehabilitation will aim at preventing future offense through convincing him that his conduct was wrong. Thus, in the light of the legal facts that I will have given to him, I will advise him to desist from such acts in the future to avoid being arrested. Instead, he should divert his time and energy to more constructive activities such as reading. Q2: A’s Criminal Liability and B’s Possible Legal Position Considering the circumstances surrounding the incident involving person A and B, A is not criminally liable for his actions because the intent to cause

Term paper 1 for an Academic writing class (Advantages Of Using Robots

1 for an Academic writing class (Advantages Of Using Robots In Future) - Term Paper Example There is however various factors that are considered while assigning activities to robots. First, it’s important to identify the activities that the elderly experience difficulty in handling. The robots are also developed considering their tasks so as to determine their physical abilities for example some robots are developed with ambulation ability to support in physical movement while others are developed with social communication ability to support in house hold tasks that require communication. Robots are used to assist in human activities due to several reasons such as improving the job quality, to avoid long repetitive jobs that tend to be boring or to perform tasks that could be dangerous to human beings (Richardson, 2007). Robots are also advantageous as they can work for many hours without complaining and they are not affected by factors like sickness as in human beings (Saeed, 2010). The robots are therefore used in the home environment to assist the elderly in diffi cult tasks that they may not manage to handle by themselves such as health, self maintenance and maintaining their independence. Some of the maintenance activities the robots could assist the elderly with include feeding, grooming, dressing bathing, preparing food, laundry, medication and transportation among others. They also have played a major role in enhancing medical administration on the adults by reminding them to take their medications and ensuring they take the right quantities at the right time. Additionally, robots are used in the medical field where they are able to perform operations as well as surgeries in cases where precision and delicacy are required. Robots are most commonly used in heart surgeries without having to open the patient’s chest. They are also useful in performing diagnosis and restoring the good health of the patient through close monitoring. Research has proved that robots are capable of performing safer and secure surgeries as compared to huma n beings because they can easily make small cuts in the organ tissues (Bond, 2009). This, therefore, ensures that the patients are more comfortable and at eas. The robots also enhance more accurate and safer diagnosis as compared to human beings. Human beings can easily make errors while performing the diagnosis and issuing medication due to various problems (Michler, 2003). The robots that perform diagnosis on patients perform the tests just the same way as the doctors or nurses. The activities the robots undertake in diagnosis include sample collection and scan performance among others. The use of robots also helps reduce errors and malpractices likely to occur as a result of diagnosis report delivery. Robots also play a vital role in rehabilitating accident victims by restoring the functioning of organs such as their hands and legs through therapy (Saeed, 2010). As part of therapy, the robots also help the patients keep fit by monitoring their weights through physical exercise su ch as walking and ensuring they take healthy meals. They also help in closely monitoring the progress of the patients as they recover from the injuries as well as enhancing effective administration of the hospitals. The robots therefore play a very role in the medical field and should as a result be widely implemented in other medical activities. Robots are also used as tools of education in both secondary and university levels where they perform the same

Paleontology and molecular biology Essay Example | Topics and Well Written Essays - 500 words

Paleontology and molecular biology - Essay Example It is in this regard that fossils must be cited in providing the present generation a unique opportunity to know evolutionary history and help scientists or interested groups in preserving some combinations of primitive and discovered characteristics of living things that are non-existence in extant taxa. Fossils, therefore, are very critical in documenting the character transformation sequences over a long period of time that cannot be achieved in modern times by the lone use of molecular data. The integration of fossil and molecular data has been well established in the book of Neil Shubin â€Å"Your Inner Fish: A Journey into the 3.5-Billion-Year History of the Human Body.† It all started with the discovery in 2004 by Shubin, Ted Daeschler, and Dr. Farish A. Jenkins, Jr. in the Arctic of the fossil of a fish, which they named Tiktaalik. The emergence of Tiktaalik fossil from the rock was a beautiful intermediate between fish and land-living animals (Shubin 22). Tiktaalik has a shoulder, elbow, and wrist composed of the same bones as an upper arm, forearm, and wrist in a human (39). Tiktaalik was just the beginning of the evolution of creatures living in water to land-living animals. It was just the tip of the iceberg, so to speak. With fossils, experiments cannot be done to reach a conclusion. Enter the role of the genes. To understand the difference of each cell in the body, it is imperative to understand the genetic switches that control the activity of genes in each cell and tissue (46). Experiments can be performed wherein the genes can be manipulated to see how bodies actually change in response to different conditions or stimuli (47). The discovery of the zone of polarizing activity (ZPA) in the 50s and 60s by biologists Edgar Zwilling and John Saunders (49) and the Sonic hedgehog in the 90s by Cliff Tabin, Andy MacMahon and Phil Ingham (52) contributed to the role of genes in the evolutionary development. ZPA was responsible for the

A poetic form for philosophical contemplation Essay Example for Free

A poetic form for philosophical contemplation Essay ‘The Ode is used as a poetic form for philosophical contemplation. ’ Compare two odes by Keats in the light of this observation Ode on a Grecian Urn and Ode to a Nightingale were written in May 1819, a time in Keats’ life which he devoted entirely to poetry. Both of these poems contemplate the poet’s approaching death, using stimuli of what is on the face of a Grecian vase and the song of a nightingale. There are differences and similarities between the two poems, and both will be looked at in the essay. Both of the above poems are odes. An ode is a form of poetry about emotion. First used by the Romans and Greeks, the form was revived in England in the 17th century. The form was popular among the English Romantic poets. A typical verse of an ode consists of a quatrain with a rhyme structure of ABAB and a sestet with a rhyme structure of CDECDE. However, Keats tended to be more liberal with his rhyme structures in his odes. Keats was born in 1795 and was the last born of the English romantic poets He became interested in poetry through his secondary school headmaster, who introduced him to Renaissance poetry and so the ode. Both of his parents died before he turned fifteen, so he became familiar with loss at an early age. His most famous sets of poems were his odes and these were written as Keats’ tuberculosis worsened in 1819. He died in 1821. There are two main themes in Keats’ odes: beauty and death. It is obvious beauty is looked at intently in Ode on a Grecian Urn, as the urn seems to tell the poet in the second to last line: ‘â€Å"Beauty is truth, truth beauty,†Ã¢â‚¬â„¢. Keats firstly tries to tell the reader what the urn’s figures think of beauty. They see happiness in beauty, as they are in ‘wild ecstasy’ to be with ‘fair’ women and listen to ‘pipes and timbrels’. Because they will be youthful forever, Keats tells them this is ‘all ye need to know’, as ignorance is bliss. Beauty is also looked at in Ode to a Nightingale The nightingale is similar to the urn’s individuals, because it is able is to ‘quite forget’ the horror of old age and can forever fly free above ‘hungry generations’ of people. Unlike the Urn, its ‘plaintive anthem fades’ without actually helping the author in any way.

A Thief of Time Essay Example for Free

A Thief of Time Essay In Tony Hillermans’ story, â€Å"A Thief of Time† (Hillerman, 2002) the author tells about murder and vanishings of people as Navaho detectives, Lieutenant Joe Leaphorn and Officer Jim Chee search for answers as to why, on the Indian grounds, that people are vanishing and why a well-known anthropologist is missing. Fear encompasses the tale of the ancient Indian grounds where detectives take center stage in looking for clues in the buried ruins that has caused so much confusion. When the backhoe is missing, this mysterious event sets Jim Chee in motion as he tries to uncover what really happened and he won’t stop until he finds the reason. His partner in this bizarre mystery is still coping with the loss of his spouse. Joe Leaphorn just wants to complete one more detective job before retirement. The younger officer; Chee isn’t ready for any type of quitting. Chee is excited about the fact that he may uncover something that includes not only the theft of the backhoe, but he is serious about uncovering the reason that two men have disappeared. Native Americans remain mysterious but the author tries to bring to life, what their true objectives are in this story. The Navaho detectives demonstrate their deep desire to do what is right in this story and offer us a good look into the lives of the Navaho Indian culture. The rummaging through the Indian grounds, unearths many various descriptions of what it’s like to live as a Navaho Indian and as these charming detectives did deep into the ground as they search for missing bodies and mechanical equipment, they discover a mystery that is worth looking into. Reference Page Hillerman, Tony. (2002) A Thief of Time. Harper Collins.

Management of Shoulder Dystocia: A Reflective Essay

Management of Shoulder Dystocia: A Reflective Essay Title: A reflective essay on how you would manage a shoulder dystocia as an obstetric emergency in a stand alone midwife led unit.   Undergraduate Degree Level Essay 1,000 Words Essay The condition of shoulder dystocia is diagnosed when the delivery of the foetal head is prevented by the impaction of one of the foetal shoulders within the mother’s pelvis. Simple head traction or episiotomy alone will not resolve the condition Shoulder dystocia is a complication of labour which is notoriously difficult to manage. It has a high complication rate and an increased rate of mortality. A number of studies have highlighted the fact that management is not always optimal. (Crofts, et al. 2006). Two UK studies produced similar findings that avoidable factors were identifiable in 66% of the perinatal deaths associated with shoulder dystocia. The definition of â€Å"avoidable factors† being a different management would have produced a better outcome. This malpresentation occurs in about 2% of vaginal deliveries and common associated morbidities include permanent brachial plexus injury, fracture of the clavicle, foetal haematoma and hypoxic brain injury. (Draycott, et al. 2008). Because the majority of cases of shoulder dystocia occur in the absence of predictable risk factors, all healthcare professionals in charge of a delivery should have an optimal plan to resolve shoulder dystocia in the safest way possible in any given circumstance. Management The management of shoulder dystocia is a subject that has acquired a large literature in its own right. It is therefore not appropriate to discuss it in great detail. Many of the studies done on the subject have identified a number of â€Å"critical tasks† in the delivery process. These include recognizing shoulder dystocia, asking for additional help, calling for paediatricians to be attend the delivery, applying gentle downward traction on the fetal head, placing the patient in McRoberts position, and applying appropriate suprapubic pressure. (Deering, et al. 2005) A number of mechanisms have been advised in the literature and these include rotational manoeuvre (Rubins or Woodscrew), episiotomy, delivery of the posterior arm, fracture of clavicle, symphysiotomy, all-fours manoeuvre, a cephalic replacement (Zavenelli) manoeuvre if other manoeuvres were not successful. (Crofts et al. 2008) Predisposing factors. Shoulder dystocia appears to occur in cases where there are no discernable predisposing factors however, there are some conditions that appear to make it more likely. The strongest single predictor appears to be foetal macrosomia. A number of authorities have suggested that maternal obesity is an association of the condition, but the meticulous study by Robinson showed conclusively that it was only obesity in diabetic mothers (that was associated with macrosomia) that had a high incidence of shoulder dystocia. Other causes of obesity did not have this association. (Robinson, et al. 2003) Gonen was able to report that a critical weight appeared to be 4,500 g with 33% of infants over this weight having shoulder dystocia and only 2% who were under it. (Gonen, et al. 1996) Birth position There appears to be considerable controversy regarding the ideal birth position. The McRoberts position (with maternal hips in flexion), combined with suprapubic pressure, has been reported as resolving 50% of identified cases of shoulder dystocia (German, et al. 1997). It is thought to achieve its effect through a rotation of the symphysis pubis and flattening of the sacrum. This, together with fundal pressure, is believed to reduce the possibility of the anterior shoulder being impacted under the symphysis pubis. There are some reports of the possibility of increased maternal morbidity (Heath, et al. 1999) and lack of effect (Beall, et al. 2003) Reflection. On a personal note, I have reflected on my own practice in dealing with cases of shoulder dystocia. As a result of researching this essay I have resolved to further explore the evidence base for dealing with the situation, because critical analysis of some of the papers read have challenged some of the ideas that I had previously believed to be true. In particular, I note papers which have analysed the behaviour of the responsible clinician in cases of shoulder dystocia and have been concerned about the frequent lack of paediatric back up. This has been identified as a failure on the part of the lead clinician, who is often so engrossed in the management of the condition that back up is simply overlooked. I have personally experienced cases where this has occurred and believe that a high degree of assertiveness is required if I see that it has been overlooked in the future. References Beall M H, Spong C Y, Ross M G (2003) A Randomized Controlled Trial of Prophylactic Maneuvers to Reduce Head-to-Body Delivery Time in Patients at Risk for Shoulder Dystocia. Obstetrics Gynecology 2003; 102: 31 35 Crofts J F, Bartlett C, Ellis D, Hunt L P, Fox R, Draycott T J (2006) Training for Shoulder Dystocia : A Trial of Simulation Using Low-Fidelity and High-Fidelity Mannequins : Obstetrics Gynecology 2006; 108 : 1477 1485 Crofts J F, Bartlett C, Ellis D, Winter C, Donald F, Hunt L P, Draycott T J (2008) Patient-actor perception of care: a comparison of obstetric emergency training using manikins and patient-actors. Qual. Saf. Health Care, February 1, 2008; 17 (1): 20 24. Deering S, Satin A J (2005) Evaluation of Residents Delivery Notes After a Simulated Shoulder Dystocia. Obstet. Gynecol., February 1, 2005; 105 (2): 448 449. Draycott T J, Crofts J F, Ash J P, Wilson L V, Yard E, Sibanda T, Whitelaw A. (2008) Improving Neonatal Outcome Through Practical Shoulder Dystocia Training. Obstet. Gynecol., July 1, 2008; 112 (1): 14 20. German R B, Goodwin T M, Souter I, Neumann K, Ouzounian J G, Paul R H. The McRoberts’ maneuver for the alleviation of shoulder dystocia: How successful is it? Am J Obstet Gynecol 1997; 176 : 656 – 61. Gonen R, Spiegel D, Abend M. Is macrosomia predictable and are shoulder dystocia and birth trauma preventable? Obstet Gynecol 1996; 88 : 526 – 9. Heath L T, Gherman R B. Symphyseal separation, sacroiliac joint dislocation and transient lateral femoral cutaneous neuropathy associated with McRoberts’ maneuver. J Reprod Med 1999; 44 : 902 – 4 Robinson H, Tkatch S, Mayes D C, Bott N, Okun N. (2003) Is Maternal Obesity a Predictor of Shoulder Dystocia? Obstetrics Gynecology 2003; 101 : 24 27 ############################################################### 12.8.08 Word count 1,060 PDG Different Medicinal Plants: Use Of Different Medicinal Plants: Use Of MEDICINAL PLANTS This section consist a list of sub-groups that gives information about Introduction, Importance, Systems of medicine, Utilization of medicinal plants. Introduction to Medicinal plants: About 250,000 higher plant species on earth, more than 80,000 species are reported to have at least some medicinal value and around 5000 species have specific therapeutic value. Herbs are staging a comeback and herbal renaissance is happening all over the globe. The herbal products today symbolize safety in compare to the synthetics that are considered as unsafe to human and environment. Even though herbs had been priced for their medicinal, flavoring and aromatic qualities for centuries, the synthetic products of the modern age surpassed their importance, for a while. However, the blind dependence on synthetics is over and people are returning to the herbals with hope of safety and security. Over three-quarters of the world population relies mainly on plants and plant extracts for health care. More than 30% of the entire plant species were used for medicinal purposes. (Joy, P.P., 2001) Herbals in world market: It is estimated that world market for plant derived drugs may account for about Rs.2, 00,000 crores. Presently, Indian contribution is less than Rs.2000 crores. The annual production of medicinal and aromatic plants raw material is worth about Rs.200 crores. This is likely to reach US $5 trillion by 2050. It has been estimated that in developed countries such as United States, plant drugs constitute as much as 25% of the total drugs, while in fast developing countries such as China and India, the contribution is as much as 80%. Thus, the economic importance of medicinal plants is much more to countries such as India than to rest of the world. (Joy, P.P., 2001) Biodiversity of herbals in India: India is one of the worlds 12 biodiversity centers with the presence of over 45000 different plant species. Indias diversity is UN compared due to the presence of 16 different agro-climatic zones, 10 vegetation zones, 25 biotic provinces and 426 biomes (habitats of specific species). Among these, about 15000-20000 plants have good medicinal value. However, only 7000-7500 species are used for their medicinal values by traditional communities. In India, drugs of plant origin have been used in traditional systems of medicines such as Unani and Ayurveda since ancient times. The Ayurveda system of medicine uses about 700 species, Unani 700, Siddha 600, Amchi 600 and modern medicine around 30 species. About 8,000 herbal remedies have been included in Ayurveda. The Rig-Veda (5000 BC) has recorded 67 medicinal plants, Yajurveda 81 species, Atharvaveda (4500-2500 BC) 290 species, Charak Samhita (700 BC) and Sushrut Samhita (200 BC) had described properties and uses of 1100 and 1270 species respectively, in compounding of drugs and these are still used in the classical formulations, in the Ayurvedic system of medicine. (Joy, P.P., 2001) Sources of medicinal drugs: The drugs are derived either from the whole plant or from different organs, like leaves, stem, bark, root, flower, seed, etc. Some drugs are prepared from excretory plant product such as gum, resins and latex. Plants, especially used in Ayurveda can provide biologically active molecules and lead structures for the development of modified derivatives with enhanced activity and /or reduced toxicity. Some important chemical intermediates needed for manufacturing the modern drugs are also obtained from plants (Eg. ÃŽÂ ²-ionone).The forest in India is the principal(diosgenin, solasodine) repository of large number of medicinal and aromatic plants, which are largely collected as raw materials for manufacture of drugs and perfumery products. The small fraction of flowering plants that have so far been investigated have yielded about 120 therapeutic agents of known structure from about 90 species of plants. Some of the useful plant drugs include vinblastine, vincristine, taxol, podophyllo toxin, camptothecin, digitoxigenin, gitoxigenin, digoxigenin, tubocurarine, morphine, codeine, aspirin, atropine, pilocarpine, capscicine, allicin, curcumin, artemisinin and ephedrine among others. (Joy, P.P., 2001) History of herbal medicine: Ayurveda, Siddha, Unani and Folk (tribal) medicines are the major systems of indigenous medicines. Among these systems, Ayurveda is most developed and widely practiced in India. Ayurveda dating back to 1500-800 BC has been an integral part of Indian culture. The term comes from the Sanskrit root Au (life) and Veda (knowledge). As the name implies it is not only the science of treatment of the ill but covers the whole gamut of happy human life involving the physical, metaphysical and the spiritual aspects. Ayurveda is gaining prominence as the natural system of health care all over the world. Today this system of medicine is being practiced in countries like Nepal, Bhutan, Sri Lanka, Bangladesh and Pakistan, while the traditional system of medicine in the other countries like Tibet, Mongolia and Thailand appear to be derived from Ayurveda. Phytomedicines are also being used increasingly in Western Europe. Recently the US Government has established the Office of Alternative Medicine at the National Institute of Health at Bethesda and its support to alternative medicine includes basic and applied research in traditional systems of medicines such as Chinese, Ayurvedic. (Joy, P.P., 2001) Disadvantages: A major lacuna in Ayurveda is the lack of drug standardization, information and quality control. Most of the Ayurvedic medicines are in the form of crude extracts which are a mixture of several ingredients and the active principles when isolated individually fail to give desired activity. This implies that the activity of the extract is the synergistic effect of its various components. About 121 (45 tropical and 76 subtropical) major plant drugs have been identified for which no synthetic one is currently available. The scientific study of traditional medicines, derivation of drugs through bio prospecting and systematic conservation of the concerned medicinal plants is of great importance. Unfortunately, much of the ancient knowledge and many valuable plants are being lost at an alarming rate. Red Data Book of India has 427 entries of endangered species of which 28 are considered extinct, 124 endangered, 81 vulnerable, 100 rare and 34 insufficiently known species (Thomas, 1997).There are basically two scientific techniques of conservation of genetic diversity of these plants. They are the in situ and ex situ method of conservation. (Joy, P.P., 2001) In Situ conservation of medicinal plants: It is only in nature that plant diversity at the genetic, species and eco-system level can be conserved on long-term basis. (www.ggssc.net) It is necessary to conserve in distinct, representative bio geographic zones inter and intra specific genetic variation. Ex situ conservation of medicinal plants: A. Ethno-medicinal plant gardens: Creation of a network of regional and sub-regional ethno-medicinal plant gardens which should contain accessions of all the medicinal plants known to the various ethnic communities in different regions of India. This chain of gardens will act as regional repositories of our cultural and ethno medicinal history and embody the living traditions of our societys knowledge of medicinal plants. (www.ggssc.net) Current status: There are estimated to be around 50 such gardens in the country ranging from acre to 40 acres some of them were set up by an All India Health Network (AHN). More recently a network of 15 such gardens has been set up in 3 states of South India with the initiative of FRLHT. One of the gardens is located in TBGRI, (Tropical botanical garden research institute) Palode at Thiruvananthapuram. B. Gene banks: In India there is a large number of medicinal plant species are under various degrees of threat. The precautionary principles would suggest that an immediate and country-wide exercise be taken up to deposit seeds of wild medicinal plants with a first priority to known Red listed species and endemic species. Current status: The department of bio-technology, Government of India has recently taken the initiative to establish 3 gene banks in the country. One is with ICAR at the NBPGR (National Bureau of plant genetic Resources) Campus, the second is with CIMAPs, (Central Institute of Medicinal and Aromatic plants) Luck now and the third with TBFRI in Thiruvananthapuram. C. Nursery network: The most urgent and primary task in order to ensure immediate availability of plants and planting materials to various user groups is to promote a nationwide network of medicinal plant nurseries, which will multiply all the regional specific plants that are used in the current practice of traditional medicine. These nurseries should become the primary sources of supply of plants and seed material that can be subsequently multiplied by the various users. Current status: Planting material for 40 odd species of medicinal and aromatic plants is reportedly available in the ICAR and CSIR (CIMAP) network. In South India FRLHT (Foundation for Rural Revitalization of Local Health Tradition) has recently set up a network of 55 supply nurseries. D. Cultivation of medicinal plants: Figures projecting demand and trade in medicinal plant species globally indicate a step upward trend in the near future. One estimate puts the figure of world trade in medicinal plants and related products at US $ 5 trillion by A.D. 2050 (world bank report , 1996).The demand so far has been met mainly from wild sources. This cant go on for much longer; policy intervention is urgently needed to encourage and facilitate investments into commercial cultivation of medicinal plants. (Joy, P.P., 2001) Cultivation of medicinal plants is inversely linked to prevalence of easy and cheap collection from the wild, lack of regulation in trade, cornering of the profits from wild collection by a vast network of traders and middlemen and absence of industrys interest in providing buy-back guarantees to growers. Current status: In the Govt. sector agro-technology of 40 odd species has been developed by ICAR Agricultural University System and CSIR (CIMAOs RRL, Jammu and Jorhat). In recent years industries like Dabur, Zandu, Indian Herbs, Arya Vaidya Shala, and Arya Vaidya Pharmacy and others have made some symbolic efforts to initiate cultivation. Since1984 NABARD (National Bank of Agricultural and Rural Development) has formulated schemes for financing cultivation and processing of medicinal plants. E. Community based enterprises: The income generated by the traditional medicine industry benefits small section of the society. A strong case exists for promotion of community level enterprises for value addition to medicinal plants through simple, on site techniques like drying, cleaning, crushing, powdering, grading, packaging etc. This will also increase the stake of rural communities in conservation and change the skewed nature of income distribution of the industry. Current status: Three community based enterprises are known in south India, one in Gandhi gram Trust, (Dindigul), Premade development Society (Peer made) Kerala and the third by VGKK in B.R.Hills, Mysore. Importance of Herbal Medicines: Herbal medicines are prepared from a variety of plant material such as leaves, stems, roots, bark, etc. They usually contain many biologically active ingredients and are used primarily for treating mild or chronic ailments. (www.ggssc.net) Herbal remedies can also be purchased in the form of pills, capsules or powders, or in more concentrated liquid forms called extracts and tinctures. They can apply topically in creams or ointments, soaked into cloths and used as compresses, or applied directly to the skin as poultices. A combination therapy integrating ayurveda and allopathy whereby the side effects and undesirable reactions could be controlled can be thought of. Studies can show that the toxic effects of radiations and chemotherapy in cancer treatment could be reduced by Ayurvedic medications and similarly surgical wound healing could be accelerated by Ayurvedic medicines. Modern science and technology have an essential role to play in the process. Systems of Medicine: There are mainly 3 systems of medicine practiced in the world today. They are, Modern System of medicine or Allopathy: This system was developed in the Western countries. In this system drugs (tablets, capsules, injections, tonics etc.) are manufactured using synthetic chemicals and / or chemicals derived from natural products like plants, animals, minerals etc. This system also uses modern equipment for diagnosis, analysis, surgery etc. Medicines or drugs of this system is often criticized for its treatment of the symptoms rather than the cause of the disease, harmful side effects of certain drugs and for being out of reach of common / poor people due to the high cost of drugs and treatment. This system is used in all the countries of the world today. (www.ggssc.net) Alternative Medicine or Traditional System: Different countries of the world developed independently their own traditional systems of medicine using locally available materials like minerals and products of plants and animals. (www.ggssc.net) The World Health Organization (WHO) is giving importance to these alternate medicine systems to provide Primary Health Care to millions of people in the developing countries. Development of herbal medicine: China developed the Chinese system of medicine, which is practiced in China, Singapore, Taiwan, Japan and other countries. In India, Ayurveda (developed in North India), Siddha (developed in Tamil Nadu) and Nagarjuna (developed in Andhra Pradesh) systems of medicine were developed. Ayurveda is practiced in Sri Lanka, Pakistan and Bangladesh also. Herbo-mineral is another traditional system used in India and other neighbouring countries. Drugs (balms, oils, pills, tonics, paste etc) are manufactured and marketed in these systems. (Joy, P.P., 2001) Advantages of traditional medicine: Traditional systems of medicine continue to be widely practiced on many accounts. Population rise, inadequate supply of drugs, prohibitive cost of treatments, side effects of several allopathic drugs and development of resistance to currently used drugs for infectious diseases have led to increased emphasis on the use of plant materials as a source of medicines for a wide variety of human ailments. Folk Medicine or tribal medicine: The medicinal systems followed by various tribals of different countries are popularly known as folk or tribal medicine. In the system, the medicine man or the doctor of the tribe who has the knowledge of treating diseases, keeps this knowledge as a closely guarded secret and passes it to the next generation by word of mouth. No written texts on these systems are available and different tribes follow different time tested methods. The treatment is often associated with lengthy and mystic rituals, in addition to prescription of drugs (decoctions, pastes, powders, oils, ashed materials etc.). Generally speaking, folk medicine can also be regarded as a traditional system of medicine. The basic aim of all the above systems of medicine is to alleviate the sufferings of human beings and their domesticated animals. (www.ggssc.net) Other Systems of medicine: Yoga, Acupressure, Acupuncture, Reiki, Magneto therapy, Pyramid therapy, Flower therapy, Homeopathy, Nature Cure or Naturopathy etc. are some of the other systems of medicine practiced in different parts of the world today. Utilization of Herbal Plants: The utility of medicinal plants has four major segments they are, Medicinal plants utilized in indigenous or traditional systems of medicines (ISM) Ayurveda, Siddha, Unani and Homeopathy systems of medicines , OTC (over the country, non-prescription) items / products involving plant parts, extracts galenicals etc. , Essential oils , Phyto pharmaceuticals or plants used in modern systems of medicine. (www.ggssc.net) Medicinal plants used in Traditional Systems of Medicine: As its name implies, it is the part of tradition of each country which employs practices that have been handed down from generation to generation. An important feature of traditional therapy is the preference of practitioner for compound prescriptions over single substance/drug as it is being held that some constituents are effective only in the presence of others. This renders assessment of efficacy and eventually identification of active principles as required in international standards much difficult than for simple preparation. In India, earlier the medicines used in indigenous systems of medicines were generally prepared by the practicing physicians by themselves, but now this practice has been largely replaced by the establishment of organized indigenous drug industries. It is estimated that at present there are more than 1, 00,000 licensed registered practitioners of Ayurveda, Siddha, Unani medicine or Homeopathy. In fact reliable data on availability in different regions of country as well as supply and demand of medicinal plants used in production of indigenous medicines are not available. (www.ggssc.net) Plants-parts, extracts and galenicals of medicinal herbs: The direct utilization of plant material is not only a feature of ISM in the developing world but also in developed countries like USA, UK, Germany etc., the various herbal formulations are sold on health food shops. Preparation of decoctions, tinctures, galenicals and total extracts of plants also form a part of many pharmacopoeias of the world. The current trend of medicinal plants based drug industry is to procedure standard extracts of plants as raw material. (www.ggssc.net) Essential Oils from herbal plants: The essential oil industry was traditionally a cottage industry in India. Since 1947, a number of industrial companies have been established for large scale production of essential oils, oleoresins and perfumes. The essential oil from plants includes Ajowan oil, Eucalyptus oil, Geranium oil, Lavender oil, Palmarosa oil, Patchouli oil, Rose oil, Sandalwood oil, Turpentine oil and Vetiver oil. Phyto-pharmaceuticals of medicinal plants: During the past decades, bulk production of plant based drugs has become an important segment of Indian pharmaceutical industry. Some of the Phyto-pharmaceuticals which are produced in India at present include Morphine, codeine, papaverine (Papaver somniferum), quinine, quinidine, cinchonine and cinchonidine (Cinchona sp., C.calisaya, C. Hyoscine, hyoscyamine (Hyocyamus Niger and H. muticus), colchicine (Gloriosa superbad, Colchicum luteum and Iphigenia stellata), cephaeline and emetin (Cephalis ipacacuanha), sennosides A B (Cassia angustifolia and C. acutifolia), reserpine, rescinnamine, ajmalicine and ajmaline (Rauvolfia serpentina); vinblastine and vincristine, ajmalicine (raubacine) (Catharanthus roseus); guggul lipid (Commiphora wightii); taxol (Taxus baccata); artemisinin (Artemisai annua) etc. (www.ggssc.net) CLASSIFICATION OF HERBAL PLANTS: They are classified according to the part used, habit, habitat, therapeutic value etc, besides the usual botanical classification.Based on Therapeutic value they are classified as follows. Anti malarial : Cinchona officinalis, Artemisia annua ,Anticancer : Catharanthus roseus, Taxus baccata ,Antiulcer : Azadirachta indica, Glycyrrhiza glabra , Antidiabetic : Catharanthus roseus, Momordica charantia , Anticholesterol : Allium sativum Anti inflammatory : Curcuma domestica, Desmodium gangeticum , Antiviral : Acacia catechu Antibacterial : Plumbago indica , Antifungal : Allium sativum , Antiprotozoal : Ailanthus sp., Cephaelis ipacacuanha , Antidiarrhoeal : Psidium guava, Curcuma domestica , Hypotensive : Coleus forskohlii, Alium sativum , Tranquilizing : Rauvolfia serpentina , Anaesthetic : Erythroxylum coca , Spasmolytic : Atropa belladona, Hyoscyamus niger , Diuretic : Phyllanthus niruri, Centella asiatica , Astringent : Piper betel, Abrus precatorius Anthelmentic : Quisqualis indica, Punica granatum , Cardio tonic : Digitalis sp., Thevetia sp. Antiallergic : Nandina domestica, Scutellaria baicalensis ,Hepatoprotective : Silybum marianum, Andrographis paniculata. (Joy, P.P., 2001) Safety of medicinal plants: The safety and effectiveness of alternative medicines have not be been scientifically proven and remains largely unknown. A number of herbs are thought to be likely to cause adverse effects. Furthermore, adulteration, inappropriate formulation, or lack of understanding of plant and drug interactions have led to adverse reactions that are sometimes life threatening or lethal. Proper double-blind clinical trials are needed to determine the safety and efficacy of each plant before they can be recommended for medical use. Although many consumers believe that herbal medicines are safe because they are natural, herbal medicines may interact with synthetic drugs causing toxicity to the patient, may have contamination that is a safety consideration, and herbal medicines, without proven efficacy, may be used to replace medicines that have a proven efficacy. (Joy, P.P., 2001) Eg: Ephedra has been known to have numerous side effects, including severe skin reactions, irritability, nervousness, dizziness, trembling, headache, insomnia, profuse perspiration, dehydration, itchy scalp and skin, vomiting, hyperthermia, irregular heartbeat, seizures, heart attack, stroke, or death. Poisonous plants which have limited medicinal effects are often not sold in material doses in the United States or are available only to trained practitioners, these include: Aconite, Arnica, Belladonna, Bryonia, Datura, Gelsemium, Henbane, Male Fern Phytolacca, Podophyllum andVeratrum. Furthermore, herbs such as Lobelia, Ephedra and Eonymus that cause nausea, sweating, and vomiting, have been traditionally prized for this action. Plants such as Comfrey and Petasites have specific toxicity due to hepatotoxic pyrrolizidine alkaloid content. There are other plant medicines which require caution or can interact with other medications, including St. Johns wort and grapefruit. (Phytotherapy , www.wikipedia.com) INTRODUCTION TO DIABETES MELLITUS In recent years, developed nations have witnessed an explosive increase in the prevalence of diabetes mellitus (DM) predominantly related to lifestyle changes and the resulting surge in obesity. The metabolic consequences of prolonged hyperglycemia and dyslipidemia, including accelerated atherosclerosis, chronic kidney disease, and blindness, pose an enormous burden on patients with diabetes mellitus and on the public health system. (Goodman Gilmans, 2006) In 1869, a German medical student, Paul Langerhans, noted that the pancreas contains two distinct groups of cells the acinar cells, which secrete digestive enzymes, and cells that are clustered in islands, or islets, which he suggested, served a second function. Direct evidence for this function came in 1889, when Minkowski and von Mering showed that pancreatectomized dogs exhibit a syndrome similar to diabetes mellitus in humans (Goodman Gilmans,2006) In the early 1900s, Gurg Zuelzer, an internist in Berlin, attempted to treat a dying diabetic patient with extracts of pancreas. Although the patient improved temporarily, he sank back into a coma and died when the supply of extract was exhausted. E.L. Scott, a student at the University of Chicago, made another early attempt to isolate an active principle in 1911. Using alcoholic extracts of the pancreas Scott treated several diabetic dogs with encouraging results; however, he lacked clear measures of control of blood glucose concentrations, Between 1916 and 1920, the Romanian physiologist Nicolas Paulesco found that injections of pancreatic extracts reduced urinary sugar and ketones in diabetic dogs. Although he published the results of his experiments, their significance was fully appreciated only years later. (Goodman Gilmans, 2006) Banting assumed that the islets secreted insulin but that the hormone was destroyed by proteolytic digestion prior to or during extraction. Together with Charles Best, he attempted to overcome the problem by ligating the pancreatic ducts. The acinar tissue degenerated, leaving the islets undisturbed; the remaining tissue then was extracted with ethanol and acid. Banting and Best thus obtained a pancreatic extract that decreased the concentration of blood glucose in diabetic dogs. (Goodman Gilmans, 2006) Insulin was purified and crystallized by Abel within a few years of its discovery. Sanger established the amino acid sequence of insulin in 1960, the protein was synthesized in 1963, and Hodgkin and coworkers elucidated insulins three-dimensional structure in 1972. Insulin was the hormone for which Yalow and Berson first developed the radioimmunoassay (Goodman Gilmans, 2006) Insulin regulation is achieved by the coordinated interplay of various nutrients, gastrointestinal hormones, pancreatic hormones, and autonomic neurotransmitters. Glucose, amino acids, fatty acids, and ketone bodies promote the secretion of insulin. The islets of Langerhans are richly innervated by both adrenergic and cholinergic nerves. Stimulation of a2 adrenergic receptors inhibits insulin secretion, whereas b2 adrenergic receptor agonists and vagal nerve stimulation enhance release. In general, any condition that activates the sympathetic branch of the autonomic nervous system (such as hypoxia, hypoglycemia, exercise, hypothermia, surgery, or severe burns) suppresses the secretion of insulin by stimulation of ÃŽÂ ±2-adrenergic receptors. Predictably, ÃŽÂ ±2 adrenergic receptor antagonists increase basal concentrations of insulin in plasma, and ÃŽÂ ²2 adrenergic receptor antagonists decrease them. The sugar is more effective in provoking insulin secretion when taken orall y than when administered intravenously because the ingestion of glucose (or food) induces the release of gastrointestinal hormones and stimulates vagal activity. Several gastrointestinal hormones promote the secretion of insulin. The most potent of these are gastrointestinal inhibitory peptide (GIP) and glucagon like peptide 1 (GLP-1). Insulin release also is stimulated by gastrin, secretin, Cholecystokinin, vasoactive intestinal peptide, gastrin-releasing peptide, and Enteroglucagon. (Goodman Gilmans, 2006) Distribution: Insulin circulates in blood as the free monomer, and its volume of distribution approximates the volume of extracellular fluid. Under fasting conditions, the pancreas secretes about 40 mg (1 unit) of insulin per hour into the portal vein to achieve a concentration of insulin in portal blood of 2 to 4 ng/ml (50 to 100 minutes/ml) and in the peripheral circulation of 0.5 ng/ml (12 minutes/ml) or about 0.1 nM. After ingestion of a meal, there is a rapid rise in the concentration of insulin in portal blood, followed by a parallel but smaller rise in the peripheral circulation. (Goodman Gilmans, 2006) Half Life: The half-life of insulin in plasma is about 5 to 6 minutes in normal subjects and patients with uncomplicated diabetes. This value may be increased in diabetics who develop anti-insulin antibodies. (Goodman Gilmans, 2006) Metabolism: Degradation of insulin occurs primarily in liver, kidney, and muscle. About 50% of the insulin that reaches the liver via the portal vein is destroyed and never reaches the general circulation. Insulin is filtered by the renal glomeruli and is reabsorbed by the tubules, which also degrade it. Severe impairment of renal function appears to affect the rate of disappearance of circulating insulin to a greater extent than does hepatic disease. Peripheral tissues such as fat also inactivate insulin, but this is of less significance quantitatively. The important target tissues for regulation of glucose homeostasis by insulin are liver, muscle, and fat, but insulin exerts potent regulatory effects on other cell types as well. Insulin is the primary hormone responsible for controlling the uptake, use, and storage of cellular nutrients. (Goodman Gilmans, 2006) DIABETES MELLITUS: Diabetes mellitus (DM) consists of a group of syndromes characterized by hyperglycemia; altered metabolism of lipids, carbohydrates, and proteins; and an increased risk of complications from vascular disease. Most patients can be classified clinically as having either type 1 or type 2 DM. Criteria for the diagnosis of DM have been proposed by several medical organizations. The American Diabetes Association (ADA) criteria include symptoms of DM (e.g., polyuria, polydipsia, and unexplained weight loss) and a random plasma glucose concentration of greater than 200 mg/dl (11.1 mM), a fasting plasma glucose concentration of greater than 126 ml/dl (7 mM), or a plasma glucose concentration of greater than 200 mg/dl (11 mM) 2 hours after the ingestion of an oral glucose load In the United States, about 5% to 10% of all diabetic patients have type 1 DM, with an incidence of 18 per 100,000 inhabitants per year. A similar incidence is found in the United Kingdom. The incidence of type 1 DM in Europe varies with latitude. The highest rates occur in northern Europe (Finland, 43 per 100,000) and the lowest in the south (France and Italy, 8 per 100,000). The one exception to this rule is the small island of Sardinia, close to Italy, which has an incidence of 30 per 100,000. However, even the relatively low incidence rates of type 1 DM in southern Europe are far higher than the rates in Japan (1 per 100,000 inhabitants). There are more than 125 million persons with diabetes in the world today, and by 2010, this number is expected to approach 220 million. (Goodman Gilmans, 2006) Both type 1 and type 2 DM are increasing in frequency. The reason for the increase of type 1 DM is not known. The genetic basis for type 2 DM cannot change in such a short time; thus other contributing factors, including increasing age, obesity, sedentary lifestyle, and low birth weight, must account for this dramatic increase. In addition, type 2 DM is being diagnosed with remarkable frequency in preadolescents and adolescents. Up to 45% of newly diagnosed children and adolescents have type 2 DM. There are genetic and environmental components that affect the risk of developing either type 1 or type 2 DM Types: Diabetes can be divided into two groups based on their requirements for insulin includes, (Pharmainfo.net) Type I: Insulin- dependent diabetes mellitus [IDDM] Type II: Non- insulin dependent diabetes [NIDDM] Type I: Insulin dependent diabetes mellitus: A burst of insulin secretion normally occurs after ingestion of a meal in response to transient increase in the levels of circulating glucose and amino acids. In the post operative period, low, basal levels of circulating insulin are maintained through beta cell secretion. However type one diabetic has virtually no functional beta cells. Treatment: Type I diabetic must rely on exogenous (injected) insulin in order to control hyperglycemia, maintain acceptable levels of Glycosylated hemoglobin (HbA1C) and avoid ketoacidosis. The goal in administering insulin to type I diabetic is to maintain blood glucose concentrations as close to normal as possible and

Proposal For Reparations Of African Americans Essay -- essays research

Proposal for Reparations of African Americans Due to the fact that many African-Americans cannot trace their genealogy back more than three generations, It would be extremely difficult to distinguish between those who are descended from Freemen and those descended from Slaves. Therefore, although it should have some impact on reparations, we must take into account those who cannot trace their genealogy( approximately 3/4th of African- Americans). We also must remember that in essence, no African-Americans were completely free. Many blacks, Freeman and Slaves alike were lynched, falsely imprisoned, raped, murdered, and subject to sub-human treatment. It is almost impossible to estimate the economic hardship caused by slavery and the aftermath that followed. To this day the African-American family still suffers from the aftermath of slavery. We see it in the form of Poverty, under-education, Discrimination, and Black on Black crime. Consider that Blacks are seriously under-represented in many of our nations top fields. Less than .05 percent of African-Americans are CEO's in corporate America. Blacks are also a rarity in Law, Medicine, and higher education, What follows is my estimation of the reparations needed. 1st generation descendant of slave: 500,000 of Freeman: 350,000 2nd generation descendant of slave: 350,000 of Freeman: 225,000 3rd generation descendant of slave: 225,000 of Freeman: 180,000 4th generation descendant of slave : 180,000 of Freem...

Enhancing Parental Participation within the NICU :: Health, Family Center Care

Family centred care (FCC) encompasses the concept of parental participation in their infants care (Franck and Callery 2004). It aims to place the needs of the infant in the context of the family (Saunders et al 2003). FCC is adopted within many neonatal units and is considered the gold standard of care aiming to underpin and guide neonatal care towards the partnership between health professionals and parents (Hutchfield 1999). Subsequent to the interruption of the bonding process between infant and family when a baby is admitted to the Neonatal Intensive Care Unit (NICU) it is suggested that the NICU provides an ideal opportunity for FCC practice (Allerman Beck et al 2009) as nurses and parents are compelled to develop an effective relationship in order to satisfy the infants care needs (Reis et al 2009). However a study by Higman & Shaw (2008) found that it appears to be more difficult to achieve on the neonatal unit as FCC is reliant on the family’s relationship with the chi ld. In order to deliver effective FCC neonatal nurses need an understanding of parents needs and how to address them. Mundy (2010) in a study researching the assessment of family needs in neonatal Intensive Care Units found that assumptions of parent’s needs were often made by healthcare professional’s resulting in unfounded and inappropriate conclusions. The importance of treating each family as individual is paramount when assessing how best to involve parents in the care of their infants (Higman & Shaw 2008). Review of the literature shows a lack of research into these assessments and highlights that enhancing family centred care requires appropriate assessments of family needs and the incorporation of this into individualised plans of care. A study into nurse’s perceptions about the delivery of FCC by Higman and Shaw (2010) supports this view, throughout the study it is apparent that although nurses realise the importance of FCC it is not always consistent within their own practice. Peterson et al (2004) suggests reasons for these inconsistencies could be the deficiency of adequate training and, the stress implementing FCC can impose on nursing staff due to an already demanding workload, potentially creating negative attitudes towards the relevance and practicalities of its delivery. The consensus view of FCC is positive although limitations to its execution are manifested throughout the literature. Staff shortages are suggested to hinder the performance of FCC within the clinical area, creating time constraints with nurses having very little opportunity to build good relationships with the families (Higman and Shaw 2008).

Drivers Essay -- essays research papers

Drivers   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Trying to sort out what type of driver a person might be is an extremely challenging task. In a person’s own mind, they think they are the aggressive type of driver, or the cautious type, but no one will ever admit that they are the “I got my license in a cracker jacks box driver';. The only fact that is certain about a person is they are never always aggressive or cautious while they drive. A person’s driving type varies from time, place, and, the most important reason, their attitudes affect one’s driving style.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  The roads today are filled with all types of drivers, but one of the worst drivers is the hot shot or aggressive drivers. All the time, day after day, people encounter these maniacs, who drive like they think they are invincible. The short period of time that I have been driving, I have encountered some crazy drivers. The first hotshot driver I saw, was actually two teens who were drag racing down the streets going ninety mph or faster. While they were racing, one of the two cars was actually driving on the opposite lane. Other experiences I have encountered were a high performance bike that was weaving in and out of cars just because he didn’t want to stop. This biker was going real fast for what he was doing he reminded me of a cop chasing a robber movie of just how fast the bike was ...

Moving to United States

Moving to United States The most memorable event in my life was when we moved out from Russia to a country that changes lives and is known as a dream land called the United States of America. When we sat on the airplane that was going toward the United States in August of 2004, we knew our lives are going to be changed in the way we always wanted them to. After twelve years of not going to school and being discriminated by Russian citizens, this moving to a new country was the most amazing, not just in my life generally, but for my entire family as well.The war started in Kabul, Afghanistan in July of 1994; moving to Russia was the only choice for my family to be safe even though we knew we would face a lot of difficulties. I was only four years old when my father and my mother took me the youngest in the family at that time, three of my brothers, and two of my sisters to Moscow, Russia. On our way to the train that was going toward Russia, we lost my fourteen year old brother.This a ccident almost stopped us from moving out from the country, but my father made the right choice either to look for his lost son or lose all of us, so we had to move on. When we finally arrived to Moscow, Russia in August of 1994, we did not have any money or a place to stay. My father remembered that he had a friend who had been living in Russia for twenty years already; maybe he could help us out for now to find a place to stay. He called him within three hours of our presence to Moscow and asked him if he could come and help us out.After an hour, he arrived, and he took us to his house and he was very happy of meeting my father after twenty years. We stayed at his house for three months. Four months later my father borrowed some money from his friend, and we opened our small business where we were selling leather jackets just to make some kind of money to eat and pay the rent. Nine months later, my father tried to take us to school, but they did not accept us because we did not ha ve any documentation that would allow us to go to school because we were illegal in the country.It was very hard and difficult for our father to see us not going to school and not getting the education that we needed for our futures; we even barely could go outside because of the citizens of that country would discriminate you and judge you by your skin color. One day my father went to the immigration center in Moscow and asked them if we could apply for citizenship or some kind of documentation that would allow his children to go to school. The Russian immigration center denied the request at the time because of some private reason that they did not want to tell my father.Five years passed and we still could not go to public schools or be legal in the country. My father tried it again and the Russian immigration center gives us the documentation that would allow us to live in the country but it did not allow us to go to school. Then one morning my older brother talked to my father, and he claimed that he does not want to live in Russia anymore without education and that he wants to move to Holland with his friends. My father was very upset and at the same time lost that he is right for how long are we going to be living like this.After three years of my brothers moving to Holland, my father decides to move to Sweden because that was the only country at that time that would accept immigrants and give them the right documentation to live in the country. It was very difficult for him to leave us in the country where the danger was around us every day, but he knew he must do something for his children to be able to go to school and live like the normal children do. In August of 1999 he arrived in Sweden, and the Swedish immigration center gave him temporary documentation to live in the country legally until they decide if he is eligible for citizenship.Very excited and happy our father called us and told us that he got the documentation to be legal in the country of Sweden. When we heard that, we thought we going to move to Sweden very soon and that we going to be together, but the Swedish immigration center asked us to wait a couple of years then we might move in. We waited two years and nothing happened, our father was very sad and confused about what he could do now. At the same time, he knew there was nothing he could do; it was all up to the immigration center of Sweden to decide our future.Then one day, it was our Holliday called Eid, my mother had her friend with her children over at our house to have a dinner with us, and she told her that they are about to move to United States the next month. My mother was very happy and excited for her friend and asked her how she did it. My mother told her that my fathers had been in Sweden for five years now and still nothing was happening. My mother’s friend told her she needed to apply at the United States immigration center that was located in Moscow and try to see if we would get acc epted.Then the next day January of 2004 my mother and I went to the United States immigration center, and we applied for the permanent residence ship to any state. After two months, we received a call from the United States immigration center that we are scheduled for an interview; we all were very excited and happy that we might move to United States, to a country that is known as the dream land and freedom. When we give our interview the person who was interviewing us asked us why we wanted to go to the United States.The answer was very simple to all of my family; it was education, freedom from being discriminated because of your skin color, and just to live in peace. After our interview, he told us, â€Å"I will see you guys in America† That moment was one of the best moments in my live and I do not think I could ever forget it. We all cried, and he told us it will take three months for them to do our paper work. When we received our plane tickets to New York, we were amaz ed and very excited about moving to a country where we never imagined moving in to. It was Sunday morning when we arrived in New York City International Airport.It was very hard for us to believe that this was really happening to us we were in America, a place where no one hates you, a place where they will allow you to go to school, and you can be who you are. Our lives changed after arriving in San Diego California, good things started to happen in with us. When we arrived here, there was a very kind gentleman at the airport who met us. He introduced himself as our case worker. We did not know what a case worker really meant, but what we did know that he was the only person who could help us.That very kind gentleman who was our case worker took us to school and got us an apartment. Two years later we found our brother after thirteen years who got lost at the time of our moving from Afghanistan. People have been saying that the United States of America can change people’s li ves, and they were right. It changed our lives, and it is a great country where everything is possible if you try. My entire family and I always had hope in our hearts; we knew nothing can be done if you do not try and if you do not have hope for a better future.

Ernest Hemingway Essay

Ernest Miller Hemingway was considered one of the great American authors of the 20th century. Hemingway’s unique style of writing set him apart from other authors of this time and of today. He influenced many generations of authors with his style of using powerful, precise words. He used few adjectives, simple verbs, and short sentences in his works. Hemingway believed that his writing should be based on knowledge that he had acquired on a particular subject through his own personal life. In a passage from Hemingway’s Death in the Afternoon, he wrote â€Å"If a writer of prose knows enough about what he is writing about he may omit things he knows and the reader, if the writer is writing truly enough, will have a feeling of those things as strongly as though the writer had stated them. † This is in fact why Hemingway wrote most of his novels and stories in the first person point of view. Hemingway was also known for the dialogue he wrote between his characters. This allowed the reader to see his character’s emotions and inner thoughts. Ernest Hemingway’s style challenged readers to look below the surface for the meaning of his words. This was known as the â€Å"Iceberg Theory† because the tip of an iceberg is the only visible portion above the sea while the largest part is far below the sea. The â€Å"Hemingway hero†, a male character who faces violence and destruction with courage, and the â€Å"Hemingway code†, unemotional behavior in difficult and dangerous situations, were also trademarks of Hemingway’s style. To better understand Ernest Hemingway as an author, one must first look at Hemingway as a person. Ernest Hemingway was born in 1899 in Illinois. As a young boy, Hemingway enjoyed hunting and fishing at the family cabin in rural Michigan. These outings allowed him to gain appreciation for Mother Nature, and to look for adventure in many parts of the world. This love of the outdoors was reflected in many of his writings, such as The Green Hills of Africa published in 1935. During Hemingway’s high school years, he was editor of the school newspaper. This was the beginning of his writing career. Shortly after graduation, Hemingway went into battle during World War I, where he was an ambulance driver. He became injured and returned to Illinois where he landed a job with the Toronto Star. He became a war correspondent, moved to Paris, and got the opportunity to interview many European political leaders, such as Mussolini. These two events influenced Hemingway to write his first best-seller, A Farewell to Arms, in 1929. Hemingway’s job, a reporter and journalist, required him to write short and to-the-point articles, which was how he wrote as an author. In 1929, this style of writing led Hemingway to write and publish his first work, Three Stories and Ten Poems. Hemingway the author was born. Ernest Hemingway was married four times. The first two marriages failed because Hemingway was unhappy, the third failed because his wife was unhappy, and the fourth continued until the end of Hemingway’s life. Hemingway never had a female as the main character in his works. In 1939, Hemingway’s father committed suicide after battling high blood pressure and diabetes for many years. The painful experience of his father’s death influenced the novel, For Whom the Bell Tolls. Hemingway moved to Cuba in 1945 where he wrote The Old Man and the Sea, a novel about an old fisherman who battled a giant marlin and the sea. This novel won Hemingway a Pulitzer Prize. In 1954, this novel also won Ernest Hemingway the Nobel Prize for Literature. He could not attend the ceremonies because of injuries he received in a near fatal plane crash. Hemingway was forced to move back to the United States in 1960 because of the communist movement led by Fidel Castro. Hemingway’s health began to deteriate. His injuries from the plane crash prevented him from enjoying his love for the outdoors and his love for writing. Hemingway sank into a state of depression and shot himself, just as his father had done some years earlier. Hemingway had several unfinished works, such as The Garden of Eden and A Moveable Feast, which were published to satisfy the reading public who longed for more of his great style of writing. â€Å"Hills Like White Elephants† and â€Å"A Clean Well-Lighted Place† were two short stories written by Ernest Hemingway during his career as an author. They both show Hemingway’s ability to entertain the reader with his short, simple well-known style, along with a bit of Hemingway’s personal beliefs and life. They are short on words, as a journalist would write, but not on the themes, that Hemingway the author wanted to convey to the reader. â€Å"Hills Like White Elephants† was a story about a girl and an American male who were discussing the fate of their unborn child. The story took place in a bar or cafe in Spain. Hemingway made the reader look for the true meaning of the story starting with the title by using symbolism. The story had nothing to do with â€Å"hills† or â€Å"white elephants†, but Hemingway’s choice of words and his use of dialogue between the two people soon guided the reader to realize that the title represented the real problem being dealt with by the girl and the American. The â€Å"hills† represented the two choices, or decisions, the girl had to make, either keep the baby alive in her womb or have an abortion. The â€Å"hills† might also have represented the difficulties of relationships. One hill is described as â€Å"fields of grain and trees†, or fertile, while the other is described as â€Å"having no shade and no trees†, or barren. The â€Å"white elephant† symbolized the mystery of what life had to offer, or something that nobody wanted–the baby. The dialogue used between the girl and the American showed the reader that the relationship was strained, â€Å"Just because you say I wouldn’t have doesn’t prove anything. â€Å"The American also tried to get the girl to see things his way by saying that the abortion he wanted her to have â€Å"is perfectly simple. † The story was typical of Hemingway’s â€Å"Iceberg Theory†. There was more going on in the story than just a conversation at a bar. The story was also a bit different from most of Hemingway’s other works. He seemed to have made the girl more superior than the male, more like a â€Å"Hemingway hero†, and also allowed her to display the â€Å"Hemingway code†, † I feel fine. â€Å", even though she was faced with a big decision in her life-one that could change it no matter what she chose. â€Å"A Clean Well-Lighted Place† was a story about an old man, a young waiter, and an old waiter. This story also took place in a bar in some Spanish speaking country. The story dealt with the light inside the cafe and the darkness inside the old man. The cafe was a place the old man could escape the darkness, boredom, and nothingness-the† Nada†, of his life. It is well lit and represented a place the old man could seek comfort. Hemingway used this character to demonstrate that â€Å"darkness†, or death, awaits us all. Again, He used dialogue to let the reader see how the characters emotionally felt. The young waiter was aggravated by the old man’s presence and said, â€Å"I wish he would go home. † Hemingway did not give the characters in this short story names because that was not necessary information for the reader. The reader only needed to feel the ideas in the story, Hemingway believed that it was not his name that was important but his words in his works. His concise wording gave the reader a chance to see his characters personalities. The young waiter stated that â€Å"An old man is a nasty thing. † which showed the reader that he had very little respect for the aging. During Hemingway’s final years, he resembled the old man in the cafe. Both were depressed and Hemingway wrote that he â€Å"tried to commit suicide†. The only difference between them was the old man did not succeed and Hemingway did. This story was also typical of his â€Å"Iceberg Theory†. There was much more going on in the bar than just people drinking. The old man also demonstrated the â€Å"Hemingway hero† and the â€Å"Hemingway code†. He faced death with courage and tried to show little or no emotion about his life ending. Many criticized Ernest Hemingway for his personal and sometimes less than perfect lifestyle, but very few critics can find fault in his literary works. They are works of a brilliant author who was very skilled at what he loved to do—write. According to the July 7, 1999 issue of Time Magazine, Ernest Hemingway deserved the Nobel Prize for Literature and â€Å"the trumpets of fame† that went with this prestigious honor. He received this award for his best selling novel, The Old Man and the Sea. â€Å"He broke the bounds of American writing, enriched U. S. Literature ?. and showed new ways to new generations of writers. † He was only one of five other American born writers to receive this honor. It also stated that Hemingway wrote this novel â€Å"over 200 times† before he felt it was ready for publication and that perhaps he was his own â€Å"best critic†. The words Hemingway wrote were described as â€Å"?. an organic being of their own. Every syllable counts toward a stimulating, entrancing experience of magic† and â€Å"fibrous and athletic, colloquial and fresh, hard and clean†. Ernest Hemingway was referred to as â€Å"an artist and brilliant with whatever words he chose to paint with. † Ernest Hemingway was a very interesting person and an enriching author. I enjoyed reading and studying the two short stories, â€Å"Hills Like White Elephants† and â€Å"A Clean Well-Lighted Place†. His style of using dialogue, symbolism, and concise wording made these works a challenge? but a challenge I liked. Hemingway worked timelessly to perfect his writing so that it could be appreciated by readers of all ages? even those of us who thought literature was not for them. Bibliography â€Å"Ernest (Miller) Hemingway. † DISCovering Authors. Online Edition. Gale, 2003. Student Resource Center. Thomson Gale. 12 April 2007< http://galenet. galegroup. com/servlet/SRC> Hunt, Douglas. The Riverside Anthology of Literature. Dallas: Houghton Mifflin Company, 1991. Kramer, Victor A. â€Å"Hemingway, Ernest. † World Book Online Reference Center. 2007. 12 April 2007. Kunitz, Stanley J. Twentieth Century Authors. New York: The H. W. Wilson Company, 1955. Segall, Mary T. Portals. Philadelphia: Harcourt Brace College, 1999.

Planning and Budgeting Essay

â€Å"Planning and budgeting are the two key major roles in the financial functioning of a healthcare organization. Planning covers the entire process and procedures of preparing the organization for their future financial goals. Budgeting include all of the detailed plans, which are expressed in dollar terms and they tell how the organizations resources will be obtained and used during a specific time period† (Gapenski, p. 253 & 259). In this paper there will be a brief discussion of what Ben Massell Dental Clinic, should take into consideration, when making pricing and service decisions. As well this paper will also cover the overall planning process and the components of their financial plan. Also this paper will briefly discuss how time analysis may help Bill Massell Dentistry to make sound management decisions. And lastly there will be a recommended major investment and a likely determination of how Ben Massell should address any financial risk and required returns. â€Å"In 1912 a philanthropist by the name of Morris Hirsch established the Morris Hirsch clinic with a goal in mind, which was to provide an out-patient medical service to those within the community, who weren’t able to afford proper medical care. Years later in 1929 a dental clinic was soon added. Then, in 1956 Dr. Irving M. Goldstein a dentist and former chief of staff of the Morris Hirsch clinic, he and his brother Dr. Marvin Goldstein decided to relocate their establishment to Pryor St, located in downtown Atlanta. They sought after one of Atlanta’s most premier builders and developer who had his eyes on the exact same building that the Goldstein brothers had chosen† (Massell, 2012, para. 1). The clinic resided in its new location for the next three years, and then in 1959 urban renewal and eminent domain laws, made it possible for the clinic to relocate once again. Soon, Ben Massell with the help of the Jewish Federation of Greater Atlanta was able to obtain a secure home on for his clinic located on 7th St in the Midtown area of Atlanta. And from that point on the clinic has remained there for the past 49 years. In honoring Ben Massell’s involvement, assistance and his financial generosity with the clinic it was then named, the Ben Massell Dental clinic (Massell, 2012, para. 2). When making pricing decisions, the managers of Ben Massell Dentistry Clinic, need to determine whether or not if their services are not only affordable, but are beneficial to the clients they serve. The managers of the Ben Massell Dental Clinic, also need to determine whether or not if they’re offering a substantial amount of volume discounts to clients and payer groups, and they need to determine exactly how large of a discount should be given to all of their clients. When making service decisions since the managers are not the ones who set the prices for the services, they have to decide whether or not that the payment is sufficient to assume the risks associated with providing services to the covered or non-covered population. The Planning Process is where the financial plans and budgets are developed for an organization to reach its financial goal. The process includes, value statement which describes the things the company values the most, mission statement describes the overall purpose for the existence of the company, and vision statement defines the company’s goals. Since, The Ben Massell Dental Clinic is a non-profit organization, their overall planning process consist of providing clients with the most advanced dental care. They describe themselves as the only resource for comprehensive and quality dental care at no cost to those in need of dental care. They offer a variety of services with the help of 140 volunteer dentists to better serve individuals who do not have access to proper dental services. Also The Ben Massell Dental Clinic is in partnership with, St. Joseph’s Mercy Care Services. With this partnership it allows clients to receive a general health screening for various health conditions. Along with the help of The Georgia Lion’s Lighthouse, clients are also able to receive a free exam and eyewear if needed. In order for clients to qualify for dental service without payment, they must meet certain guidelines. These guidelines include the following: new clients must live in one of the 13 major counties, Butts, Cherokee, Clayton, Cobb, Coweta, DeKalb, Douglas, Fayette, Fulton, Gwinnett, Henry, Paulding and Rockdale. Other qualifications include: showing proof of residence for the last six months, having no insurance or dental coverage and having a household income that falls below 125% of the current poverty level. The chart below gives us an exact example of a client’s eligibility. The components of the Ben Massell Dental Clinic financial plan arrive from the donations of major funding organizations in which some they have partnered with and other businesses that surrounds the Atlanta area. Also donations can be accepted directly from their website from those individuals of the community, who have a desire to take part in helping others to get the proper dental needed. These include, â€Å"The Jewish Federation of Greater Atlanta, which provided 14 percent of the clinics budget for the fiscal year of 2009-2010, United Way of Metropolitan Atlanta provided 6 percent through the support of United way employees, other organizations such as, the Google grants program assisted in the advertisement of the Ben Massell Dental Clinic website and the Grants to Greens Foundation contributed towards the materials in reconstructing, the building using recycled materials that are energy savers and cost efficient† (Jewish Family & Career Services [JF&CS], 2012, para. , 2, 3, 4). Time value analysis is the use of time value of money techniques to value future cash flows. â€Å"The reason why time analysis is so important in healthcare is because current amount of made being made is worth more than future dollars. By using this method this gives the dental clinic an opportunity to accept 25 new clients per week and 100 new clients within a months’ tim e. Using the time lines method allows the clinic to keep track of 5 new clients per day during a five day work week. It also helps managers to keep track of payments from other organizations and makes it easier to administer their services to everyone with ease of access, which will allow the operation to flow evenly without hassle. An example of this would be, when new clients are referred over to their clinic, they can easily keep track of what organization has sent the client and who’s responsible for assisting in making the payments for particular procedures administered to the clients. Adding an additional certified dentist could be a possible major investment for the Ben Massell Dental Clinic, even though they offer a large amount volunteer dentist, they only spend half a day’s time within the office. So by adding an additional certified dentist to the organization, this could not only lessen the wait time for clients, but it would also bring in additional revenues, grants and other sources of income to assist the clinic in progressing towards a better financial goal. The average salary of a dentist in Atlanta Georgia is $108, 00. 0 per year (â€Å"Dentist Salary,† 2012, para. 2). Which, can be considered as the net present value, the pertinent financial ratios consists of those organizations making payments for clients that, they refer to the clinic and the break even analysis would be the clinic meeting 25 patients per week on a weekly basis, 100 new clients a month and 1,200 new clients a year to cover the salary of the new dentist that may be add ed to the organization. Financial risk and required returns are two very important factors in healthcare financial management. Financial risk is defined as the risk an investor takes when investing in something and the expected return on that investment is much less than expected. Required returns are defined as the expected outcome on an investment made by an investor whether it is higher or lessor. In order for managers at The Ben Massell Dental Clinic to address financial risk and required returns, managers first need to look at their current financial status and the amount of new clients being referred over to them on a daily weekly to monthly basis. Depending upon the current numbers of incoming new client and their current financial status, managers can then make their decision on whether or not if hiring another dentist would be a great idea for the clinic. In conclusion planning and budgeting covers the entire process of preparing a business for the future. Since it is so important to the success of any organization, especially in healthcare many managers of an healthcare organization have a tendency to spend a great deal of time focusing on the overall planning process in order to keep the business in a successful financial state.