Wednesday, November 27, 2019
Siege of Detroit - War of 1812
Siege of Detroit - War of 1812 Siege of Detroit - Conflict Dates: The Siege of Detroit took place August 15-16, 1812, during the War of 1812 (1812-1815). Armies Commanders at Detroit United States Brigadier General William Hull582 regulars, 1,600 militia Britain Major General Isaac BrockTecumseh330 regulars, 400 militia, 600 Native Americans Siege of Detroit - Background: As war clouds began to gather in the early months of 1812, President James Madison was encouraged by several of his key advisors, including Secretary of War William Eustis, to begin making preparations to defend the northwest frontier. Overseen by the Governor of the Michigan Territory, William Hull, the region possessed few regular troops to defend against a British invasion or attacks by Native American tribes in the area. Taking action, Madison directed that an army be formed and that it move to reinforce the key outpost of Fort Detroit. Siege of Detroit - Hull Takes Command: Though he initially refused, Hull was given command of this force with the rank of brigadier general. Traveling south, he arrived at Dayton, OH on May 25 to take command of three regiments of Ohio militia led by Colonels Lewis Cass, Duncan McArthur, and James Findlay. Slowly moving north, they were joined by Lieutenant Colonel James Millers 4th US Infantry at Urbana, OH. Moving across Black Swamp, he received a letter from Eustis on June 26. Carried by a courier and dated June 18, it implored Hull to reach Detroit as war was imminent. A second letter from Eustis, also dated June 18, informed the American commander that war had been declared. Sent by regular mail, this letter did not reach Hull until July 2. Frustrated by his slow progress, Hull reached the mouth of the Maumee River on July 1. Eager to speed the advance, he hired the schooner Cuyahoga and embarked his dispatches, personal correspondence, medical supplies, and sick. Unfortunately for Hull, the British in Upper Canada were aware that a state of war existed. As a result, Cuyahoga was captured off Fort Malden by HMS General Hunter the next day as it attempted to enter the Detroit River. Siege of Detroit - The American Offensive: Reaching Detroit on July 5, Hull was reinforced by around 140 Michigan militia bringing his total force to around 2,200 men. Though short on food, Hull was directed by Eustis to cross the river and move against Fort Malden and Amherstburg. Advancing on July 12, Hulls offensive was hampered by some of his militia who refused to serve outside of the United States. As a result, he halted on the east bank despite the fact that Colonel Henry Proctor, commanding at Fort Malden, had a garrison numbering only 300 regulars and 400 Native Americans. As Hull was taking tentative steps to invade Canada, a mixed force of Native Americans and Canadian fur traders surprised the American garrison at Fort Mackinac on July 17. Learning of this, Hull became increasing hesitant as he believed large numbers of Native American warriors would descend from the north. Though he had decided to attack Fort Malden on August 6, his resolve wavered and he ordered American forces back across the river two days later. He was further concerned about dwindling provisions as his supply lines south of Detroit were under attack by British and Native American forces. Siege of Detroit - The British Respond: While Hull spent the early days of August unsuccessfully attempting to re-open his supply lines, British reinforcements were reaching Fort Malden. Possessing naval control of Lake Erie, Major General Isaac Brock, the commander for Upper Canada, was able to shift troops west from the Niagara frontier. Arriving at Amherstburg on August 13, Brock met with the noted Shawnee leader Tecumseh and the two rapidly formed a strong rapport. Possessing around 730 regulars and militia as well as Tecumsehs 600 warriors, Brocks army remained smaller than his opponent. To offset this advantage, Brock combed through the captured documents and dispatches that had been taken aboard Cuyahoga as well as during engagements south of Detroit. Possessing a detailed understanding of the size and condition of Hulls army, Brock also learned that its morale was low and that Hull was deeply afraid of Native American attack. Playing on this fear, he drafted a letter requesting that no more Native Americans be sent to Amherstburg and stating that he had over 5,000 on hand. This letter was intentionally allowed to fall into American hands. Siege of Detroit - Guile Deception Win the Day: Shortly thereafter, Brock sent Hull a letter demanding his surrender and stating: The force at my disposal authorizes me to require of you the immediate surrender of Fort Detroit. It is far from my intention to join in a war of extermination, but you must be aware, that the numerous body of Indians who have attached themselves to my troops, will be beyond control the moment the contest commences†¦ Continuing the series of deceptions, Brock ordered extra uniforms belonging to 41st Regiment to be given to the militia to make his force appear to have more regulars. Other ruses were conducted to deceive the Americans as to the actual size of the British army. Soldiers were instructed to light individual campfires and several marches were conducted to make British force appear larger. These efforts worked to undermine Hulls already weakening confidence. On August 15, Brock commenced a bombardment of Fort Detroit from batteries on the east bank of the river. The next day, Brock and Tecumseh crossed the river with the intention of blocking the American supply lines and laying siege to the fort. Brock was forced to change these plans immediately as Hull had dispatched MacArthur and Cass with 400 men to re-open communications to the south. Rather than be caught between this force and the fort, Brock moved to assault Fort Detroit from the west. As his men moved, Tecumseh repeatedly marched his warriors through a gap in the forest as they emitted loud war cries. This movement led the Americans to believe that the number of warriors present was much higher than in actuality. As the British approached, a ball from one of the batteries hit the officers mess in Fort Detroit inflicting casualties. Already badly un-nerved by the situation and fearing a massacre at the hands of Tecumsehs men, Hull broke, and against the wishes of his officers, ordered a white flag hoisted and began surrender negotiations. Aftermath of the Siege of Detroit: In the Siege of Detroit, Hull lost seven killed and 2,493 captured. In capitulating, he also surrendered MacArthur and Cass men as well as an approaching supply train. While the militia were paroled and permitted to depart, the American regulars were taken to Quebec as prisoners. In the course of the action, Brocks command suffered two wounded. An embarrassing defeat, the loss of Detroit saw the situation in the Northwest radically transformed and quickly dashed American hopes of a triumphant march into Canada. Fort Detroit remained in British hands for over a year until being re-taken by Major General William Henry Harrison in the fall of 1813 following Commodore Oliver Hazard Perrys victory at the Battle of Lake Erie. Hailed as a hero, Brocks glory proved brief as he was killed at the Battle of Queenston Heights on October 13, 1812. Selected Sources History of War: Siege of DetroitWilliam HullThe Capture of Detroit
Saturday, November 23, 2019
Assisted Ventilation in Status Asthmaticus Essays
Assisted Ventilation in Status Asthmaticus Essays Assisted Ventilation in Status Asthmaticus Paper Assisted Ventilation in Status Asthmaticus Paper Assisted Ventilation in Status Asthmaticus Background When a patient is admitted in the Intensive Care Unit (ICU) with a diagnosis of status asthmaticus, it means that the asthma attack is extremely severe and critical. In this situation, the patient does not respond to high doses of steroids and inhaled bronchodilators. According to Groth, this resistance to medication is most likely the consequence of three things that make it extremely hard to get air in and lout of the lungs. These three factors are as follows:  ·Ã‚        Bronchospasm, which is a condition of an extreme spasm of the airways.  ·Ã‚        Edema, which is a condition when the lining of the airways is swelling.  ·Ã‚        Thick mucus secretions in the airways. Normally, when an individual breathe in, the airways are pulled open when the chest wall becomes larger; however, when the individual breathe out, the airways have a tendency to collapse, locking in air in the chest. However, when a person is an asthmatic, emptying the lungs takes a long time for the reason that the airways are restricted. An asthmatic person cannot totally empty the lungs prior to having to take one more breath. When a person is severely asthmatic, he/she experiences shorter breathing so he/she tries to breathe faster and he/she has little time to exhale. When this happens, the lungs keep hold of, or â€Å"trap,†lots of air, which is called hyperinflation or air-trapping. Moreover, this procedure makes it more difficult to take another breath in, and the breathing muscles have to try harder and make more effort to take in any air. Groth said that a young or if not a healthy asthmatic can more often than not surmount this complexity, but at the expense of a c onsiderable strain on the breathing muscles. Then, when this demand is continued for too long, for instance due to resistance to medicine, the asthmatic person’s breathing muscles can get exhausted and he/she will acquire respiratory failure. Furthermore, according to Corbridge and Hall (1995), status asthmaticus is a life threatening type of asthma described as a situation in which an increasingly worsening attack is impassive or not responsive to the customary proper treatment with adrenergic drugs and that causes pulmonary insufficiency. The most important mechanical occurrence in status asthmaticus is a progressive rise in airflow resistance. In addition, mucosal edema or inflammation and mucous plugging are the primary causes for the late recovery in status asthmaticus. Ibsen added that the combination of acidosis, hypercapia, and hypoxia together with the mechanical consequences of increased lung volumes might bring about or cardiovascular arrest or cardiovascular depression. Indications for ICU Admission            Schwarz and Lubinsky (1997) asserts that a person with status asthmaticus should be admitted to ICU when he/she feels the following:  ·Ã‚        Exhaustion  ·Ã‚        Altered sensorium  ·Ã‚        Presence of high-risk factors  ·Ã‚        Use of continuous inhaled beta-agonist therapy  ·Ã‚        Failure to improve in spite of adequate therapy  ·Ã‚        Increasing PCO2 ins spite of treatment  ·Ã‚        Markedly decreased air entry Due to difficulty in breathing, a person with status asthmaticus admitted in then ICU is ventilated through assisted or mechanical ventilation. Groth said that a mechanical ventilator takes over the function of breathing in the course of status asthmaticus; however, it does nothing to overturn airway inflammation or bronchospasm. The main function of a mechanical ventilator is to sustain breathing for the exhausted muscles until such a time when a variety of medications become helpful and effective. For a patient in the ICU to obtain mechanical ventilation, he/she needs an endotracheal tube, which is a plastic tube that is inserted by means of the nose or mouth into the windpipe or trachea and is linked to the ventilator. Moreover, the patient must likewise be sedated with an opioid-like morphine called fentanyl and medically paralyzed so as to let the ventilator function effectively and to make the patient comfortable. Mechanical Ventilation            If the patient has already undergone rapid extubation but still suffers difficulty of breathing, there is probably a failure in extubation. Werner (2001) says that extubation is a major complication of translaryngeal intubation, but its impact on mortality, duration of mechanical ventilation (MV), length of intensive care unit (ICU) and hospital stay, and need for ongoing hospital care has not been adequately defined.            Hence, in the case of extubation failure, the patient in the ICU should be intubated. Epstein et al., (2000) said that as many as 20% of extubated patients require reintubation (specifically extubation failure) within 72 hours of extubation, with the exact prevalence depending on numerous factors. The pathophysiologic basis of extubation failure is often different from the cause of weaning failure. Extubation failure substantially prolongs the duration of mechanical ventilation, intensive care unit stay, and hospital stay, and substantially increases hospital mortality. Therefore, prediction of extubation outcome and prevention of extubation failure may be critically important. Unfortunately, standard weaning tests have not proven sufficiently accurate in predicting extubation outcome. New semi-objective measurements of cough strength and secretion volume can help recognize patients at increased danger for extubation failure. It is signifi cant to observe that mortality increases with reintubation delay, which illustrates that clinical worsening might occur during the period without ventilatory support. As a result, better result possibly will come from rapid detection of patients at increased danger, followed by quick reinstitution of ventilatory support when extubation failure happens. Schwarz and Lubinsky (1997) also said that the patient in the ICU should be intubated and mechanically ventilated he/she suffers the following:  ·Ã‚        Diminishing level of consciousness  ·Ã‚        Significant hypoxemia that is poorly responsive or unresponsive to supplemental oxygen therapy alone  ·Ã‚        Apnea or respiratory arrest  ·Ã‚        Impending respiratory failure marked by significantly rising PCO2 with fatigue, decreased air movement, and altered level of consciousness The choice to intubate an asthmatic should be done with tremendous concern. According to Cox, Barker and Bohn (1991), positive pressure ventilation in an asthmatic person is made difficult by acute air trapping and airway obstruction that causes hyperinflated lungs, which might refuse to accept further inflation and puts the patient at high danger of barotrauma. As a result, mechanical ventilation must be carried out just in the face of constant deterioration regardless of maximal bronchodilatory therapy. Moreover, Werner (2001) agrees that the assessment and choice to intubate an asthmatic should not be taken without due consideration, and intubation must be prevented if possible. Tracheal intubation may aggravate bronchospasm (O’Rourke Crone, 1982) and positive pressure ventilation will significantly boost the danger of circulatory depression and barotraumas (Williams et al., 1992). According to Corbridge and Hall (1995), ventilator management can be challenging to a certain extent. For this reason, the following principles should be applied in taking care of a patient with status asthmaticus in the ICU:            1.Do not attempt to regulate or normalize the pCO2. Tolerate hypercapnia, and make use of pharmacologic buffering agents if needed to raise the pH to 7.2. How high a pCO2 you could do with to endure is determined by the pressures required to ventilate the patient.            2.Make an effort to keep plateau (alveolar) pressures 30-35 cm H20. Peak pressures might be higher than this because of increased airways resistance.            3.Small tidal volumes are typically required because of propensity and high resistance for air trapping. 5-7 cc/kg is a logical and practical place to begin.            4.Rate must be low and expiratory time long, inspiratory time somewhat short. The plan is to leave as much time as possible for expiration, without causing the inspiratory pressure to be extremely high since you are attempting to get the gas in over too short a period. Rates of 10-14 and I:E ratios of 1:4 to 1:6 are usual.            5. Pressure cycled or volume cycled ventilation can be employed. If employing volume-cycled ventilation, be certain to look at the pressures generated cautiously. If employing pressure cycled, the ventilator will typically not arrive at â€Å"plateau†or no flow, and you have to look at the volumes delivered. Regular reassessment is vital.            6.If you come across problem with oxygenation or just cannot move the chest, manually bag the patient and re-examine therapy and ventilator strategy.            7.Case series and some anecdotes show that there has been certain success with the use of pressure support ventilation in the sedated, but not paralysed, intubated asthmatic. Its regular use has not been subjected to controlled trials.            8.The patient should be well sedated and generally paralyzed during mechanical ventilation. Constant infusions or doses scheduled on a regular basis must be used.            9.Premedicate with lidocaine and extra sedation prior to suctioning to lessen the bronchoconstriction in reaction to stimulation.            10.Go on with insistent bronchodilator therapy-aerosols or MDIs, atrovent, intravenous terbutaline, and steroids. Take into account â€Å"kitchen sink†therapies like ketamine, magnesium, isoflurane, and helium. Respiratory Acidosis, Metabolic Acidosis and Permissive Hypercapnea as a Lung Protective Strategy According to (Rebuck and Read, 1971), the customary regulation that respiratory acidosis determines or affects intubation has become outdated. With the start of more insistent utilization of inhaled b-agonist therapy, 1% of asthmatic children confined in the hospital (Cox, Barker and Bohn, 1991) and around 5 to 10% of asthmatic patients confined in pediatric intensive care (Pirie et al., 1998) need intubation. Rebuck and Read (1971) maintains that asthma is a sickness of airway obstruction, specifically, increased airway resistance, causing persistence of the time constant or the time required for lung units to fill and empty. Hence, slow ventilator rates are typically required. Tuxen and Lane (1987) also claims that during high peak airway pressures, the rule of mechanical ventilation of patients with status asthmaticus is controlled hypoventilation, putting up with higher levels of PCO2 so as to peak inspiratory pressures and reduce tidal volume. The incidence of respiratory acidosis goes after that of hypercarbia (Nowak, 1983). In addition to acute airflow limitation, metabolic acidosis might also happen (McFadden and Lyons, 1968). Numerous instruments are possibly included. Then, according to Roncoroni et al. (1976), if cardiac output is compromised, hypoxia of the peripheral tissues might trigger lactic acidosis to build up or worsen. Furthermore, increased oxygen consumption by the respiratory muscles might be a factor as well. Also, it might likewise be generated with the aggressive administration of nonselective sympathomimetics (Appel et al, 1983). Darioli and Perret (1984) established the idea of controlled hypoventilation with lower-than-traditional respiratory rates and tidal volumes in asthmatic adult patients, and discovered a significantly reduced frequency of barotrauma and death measured up to to historical control subjects. Meanwhile, this idea has been broadly accepted and realized to develop outcomes in asthmatic adult patients. Moreover, this concept, which is called permissive hypercapnia has also been reported in asthmatic children patients. Dworkin and Kattan (1989) dispensed mechanical ventilation to 10 children with the purpose of keeping peak inspiratory pressure , 60 cm H2O and arterial pH . 7.10; Paco2 ranged from 40 to 90 mm Hg; then, they did not detect air leak following intubation, and all of the 10 children survived. In addition, Cox et al (1991) said that when asthmatic children being given mechanical ventilation with initial tidal volumes of 10 to 12 mL/kg at rates of 8 to 12 breaths/min, inspirat ory time was set at 1 to 1.5 s (considering an expiratory time of approximately 5 s), and tidal volumes were modified to keep peak inspiratory pressures at 45 cm H2O, just two postintubation pneumothoraces were observed, and all children survived without sequelae in spite of considerable hypercarbia throughout mechanical ventilation. Werner (2001) said that permissive hypercapnia could be endured provided that the patient continues to be sufficiently oxygenated. A longer I:E ratio, frequently more than 1:3-4, helps tolerate slow but total emptying of the lungs during exhalation, helping and assisting ventilation and preventing unnecessary further air-trapping (auto-PEEP). The utilization of positive end-expiratory pressure (PEEP) is contentious (Werner, 2001). A person with status asthmaticus in respiratory failure on mechanical ventilation frequently has a considerable amount of air trapping that causes intrinsic PEEP, which possibly will be worsened by means of continuing PEEP during exhalation. Nevertheless, a number of patients may perhaps gain by the addition of PEEP, maybe by way of preserving airway patency during exhalation. Therefore, in a patient in the ICU who continues to be refractory to the initial ventilatory settings with no or very low PEEP, carefully escalating the PEEP may possibly demonstrate to be beneficial. Werner (2001) added that customarily, slow controlled ventilation with heavy sedation and with or without muscle relaxation is the strategy employed to ventilate patients with status asthmaticus. However, warning is necessitated, because the use of muscle relaxants with high-dose steroids has been linked with the growth of prolonged paralysis. On the other hand, a number of practitioners give an account of ventilating children with status asthmaticus with pressure support alone, enabling the patient to set his or her own respiratory rate as identified by his or her own physiologic time stable at the same time helping ventilation by means of relieving the fatigue caused by considerable work of breathing. Noninvasive positive pressure ventilation (NPPV), for instance, continuous positive airway pressure (CPAP) or bimodal positive airway pressure (BiPAP) delivered by way of a facemask, has been utilized for support of status asthmaticus. NPPV has been demonstrated to splint the airways, letting better exhalation and emptying (Werner 2001). Tuxen and Lane (1987) asserted that patients necessitate monitoring and supportive measures during mechanical ventilation. They also said that patients might be uneasy and air hungry while ventilated with low respiratory rates, and hypercapnia as a result of an approach of controlled hypoventilation. Preferably, flow-volume loops should be monitored to determine if sufficient time is given for exhalation to evade breath stacking, which happens if the next breath is delivered prior to exhalation is finished. Moreover, monitoring auto–positive end-expiratory pressure (auto-PEEP) and exhaled tidal volume is vital as well. Pirie et al. (1998) said that electrolytes and fluids must be monitored. Prior to arrival in the hospital, children with status asthmaticus have frequently had reduced oral intake and might have been vomiting as a consequence of respiratory difficulty or adversative effects from their medications. This causes decreased intravascular volume status that might be potentiated by the outcomes of positive pressure ventilation. Furthermore, cardiac output might be reduced as a consequence of lessened preload that are caused by auto-PEEP and air trapping. This decreased cardiac output and intravascular volume might perhaps be complemented by metabolic acidosis. Intravascular fluid expansion is necessary to cure hypotension, hypoperfusion, or metabolic acidosis. Moreover, diastolic hypotension might irregularly develop from high doses of beta-agonists. A vasoconstrictor (specifically, phenylephrine or norepinephrine,) might be taken into account if considerable diastolic hypotension in the face of sufficient intravascular volume persists. Monitor serum electrolyte levels, as medications used to treat asthma can result in significant kaliuresis (Tuxen and Lane, 1987). Meanwhile, Nowak et al. (19833) said that placement of indwelling arterial catheters offers nonstop blood pressure monitoring in addition to arterial blood gas sampling. They also maintained that blood gases must be monitored to evaluate response or reaction to therapy in mechanically ventilated patients.            Meanwhile, mechanical ventilation utilizing unsuitable settings can generate acute inflammatory response in the lund and acute parenchymal lung injury. The related release of cytokines into alveoli and the systemic circulation (Ranieri et al., 1999) might be a factor to multiple organ dysfunction (Slutsky and Tremblay, 1998) and mortality in acute respiratory distress syndrome (ARDS). â€Å"Lung-protective†ventilation strategies try to evade these outcomes by means of restraining peak lung distension and evading end-expiratory collapse, tolerating the hypercapnia that frequently results; such strategies decreased mortality rate in ARDS in two randomized trials (Slutsky and Tremblay, 1998). Hypercapnia is normally considered as an adverse result of limiting alveolar stress, but in a series of studies, Laffey, Engelberts and Kavanagh (2000) have asked whether hypercapnic acidosis per se might be a factor to the advantages of lung-protective ventilation. They demonstrated that in isolated perfused rabbit lungs, respiratory acidosis protected the lung from ischemia–reperfusion injury, while respiratory alkalosis potentiated the damage. The protective result of respiratory acidosis was linked with inhibition of xanthine oxidase, and was prohibited by means of buffering the acidosis; specifically, the protection was because of the acidosis instead of hypercapnia.            Acidosis restrains the cytokine expression and respiratory burst in macrophages (Roncoroni et al., 1976). Then, Laffey, Engelberts and Kavanagh (2000) have talked about other studies recommending cytoprotection by hypercapnic acidosis. Hence, even though it appears that it is impossible that all of the evident advantage of lung protective ventilation is a direct result of hypercapnia, the hypothesis tackled by Laffey, Engelberts and Kavanagh (2000) is a significant and sensible one. If â€Å"lung-protective ventilation†in ARDS does decrease pulmonary and systemic inflammation, and possibly multiple organ dysfunction, hypercapnic acidosis as such could possibly be somewhat responsible, maybe by downregulating inflammatory cells, and perhaps other mechanisms in addition to inhibition of xanthine oxidase. Therapy and Care in the ICU ICU therapy begins in step-wise fashion and escalates to a â€Å"kitchen sink†approach. This is because there is fairly little data which points to one combination of therapies being superior to others, and because an asthmatic deteriorating despite â€Å"usual†therapy is in significant danger. Standard therapy includes steroids (solumedrol) and beta-agonists (intermittent aerosols, continuous aerosols, or intravenous terbutaline). â€Å"Adjunctive†therapy includes anticholinergic agents (Atrovent). Chest physiotherapy and/or IPV (intermittent percussive ventilation) may be helpful and/or necessary for some patients.â€Å"Kitchen sink†therapies include magnesium, helium, ketamine, antibiotics, inhalational anesthetics, aerosolized lasix.            Based on the literature of Groth, the patient in the ICU must be prescribed continuous nebulization of albuterol for the first eighteen hours after the patient’s admission to the Intensive Care Unit and then switch to intermittent albuterol every two hours. Inhaled ipratropium could also be added every 6 hours. Ipratropium is an anticholinergic bronchodilator, and reduces bronchoconstriction through a different means. Then the patient will continue to be treated with a high dose of intravenous corticosteroids. He/she will also be given antibiotics if he/she has a fever, a high white blood cell count, and increased cough and mucus indicating that he/she has an infection.            Groth also asserted that several of the treatments of last resort employed in status asthmaticus consist of giving general anesthesia with inhalational anesthetics, which are very effective and powerful bronchodilators. Nevertheless, the help of an anesthesiologist will be needed to give this kind of treatment. Intravenous anesthetics like ketamin, can be useful as well. Recommendations Sin Fai Lam, Mow and Chew (1992) said that a more open-minded use of the ICU for patients with severe asthma has formerly been promoted. Procrastination might bring about a respiratory arrest. The result is at all times worse following a respiratory arrest; Lee, Tan and Lim (1997) gave an account of a merely 50% survival from hypoxic brain damage following a respiratory arrest despite good intensive care treatment. It is not advantageous to wait until the patient is almost dilapidated from CO narcosis to take control of the airway. If active airway intervention is unavoidable, it is preferable to come up with this decision early instead of late. This means that it is better to be pro-active instead of procrastinating. Early endotracheal intubation and mechanical ventilation in the patient with life threatening asthma might be practical procedures that can save life and bring about good clinical outcome. Complete signs for intubation are cardiac and respiratory arrest or considerable alteration in mental state. At other instances, the decision made in the face of increasing exhaustion and progressive deterioration. Based on the various literature discussed in this paper, would like to see more patients who need ventilation be intubated electively instead of as a consequence of a cardiorespiratory arrest. Blood gas abnormalities by itself are not a sign to intubate the patient. Several patients with respiratory acidosis and hypercapnia will respond and react to treatment with bronchodilators and do not need mechanical ventilation. More significant is the development in clinical findings and in the arterial blood gases. Furthermore, procrastination in the instigation of mechanical ventilation when it is certainly necessary is connected to the fear of complications. Definitely, contemplation and reflection should at all times be provided to the possible dangers. Intubation in a dyspnoeic, relentless and anxious patient must be carried out by the most knowledgeable and skilled clinician available. A large endotracheal tube must be chosen because it helps suction and lessens airways resistance. Based on the literature, there are advantages of both oral and nasotracheal intubation, and sedative options in the preparation of the patient differ among people. When endotracheal intubation has been performed, the physician’s priority should be to take control with positive pressure ventilation. This will necessitate the utilization of sufficient sedation and typically paralysis with a muscle relaxant. Paralysis might regularly merely be necessary in the first stages of ventilation, and must be weaned off as soon as possible to lessen the danger of acute myopathy. Ventilation must primarily be in the CMV manner. Ventilatory settings should also be selected to evade extreme lung inflation. This approach will lessen the danger of systemic hypotension or pneumothorax. Lung inflation is lessened by means of permitting a sufficient time for exhalation (TE). Meanwhile, expiratory time may perhaps be prolonged by means of reducing minute ventilation (VE) by either minimizing inspiratory time (TI) or lowering respiratory rate RR or tidal volume (VT). Inspiratory time is lessened through increasing inspiratory flow rate and by means of employing a square flow wave form. Tidal volumes of 8-10 mls/kg with a respiratory rate of 10-14 and inspiratory flow rates of 60 L/min or higher are frequently appropriate (Sin Fai Lam, Mow and Chew, 1992). A suitable peak airway pressure of 50 mm H20 should be aimed for. Furthermore, controlled hypoventilation is a method employed to lessen the danger of hypotension and barotrauma. The goal is to guarantee sufficient oxygenation, stay away from extreme dynamic hyperinflation (DHI) and tolerate a degree of hypoventilation. It is completely tolerable to let the PCO 2to increase so as to evade DHI. One must not try to normalize the PCO2 to the detriment of DHI (Lee, Tan and Lim, 1997). Hypotension might be attributed to too much DHI. A short experiment of apnoea (30-45 seconds) is indicative, as blood pressure rises and venous return increases during the period of apnoea. If this does not occur, other causes of hypotension like fluid depletion, tension pneumothorax, unnecessary sedation or myocardial depression should be taken into account. Lastly, A number of studies have evidently revealed that mechanical ventilation saves lives in life-threatening asthma (Sin Fai Lam, Mow and Chew, 1992). With good ICU management, the period of required ventilation is short, complications can be kept to a minimum, and there is more often than not no problem in weaning the patient off the ventilator. Nevertheless, we should remember that ultimately, the therapy and remedy of acute life-threatening asthma does not merely begin 3 days prior to the attack, but much earlier, as most acute attacks are avoidable with the appropriate use of standard and regular prophylactic medication, the proper education of patients, the avoidance of trigger factors, the appropriate implementation of a co-management plan between the patient and his doctor, the objective measurement of the PEFR, and the accessibility to medical care in times of crisis.# References Appel D, et al. (1983). Lactic acidosis in severe asthma. American Journal of Medicine. Corbridge T, and J. Hall. (1995). The assessment and management of adults with status asthmaticus. American Journal of Respiratory Critical Care Med. Cox R, G. Barker, and D. Bohn. (1991). Efficacy, results, and complications of mechanical ventilation in children with status asthmaticus. Pediatric Pulmonology. Darioli R, and C. Perret. (1984). Mechanical controlled hypoventilation in status asthmaticus. American Review of Respiratory Disorder. Epstein, S. et al. (2000). Effect of Unplanned Extubation on Outcome of Mechanical Ventilation. American Journal of Respiratory Critical Care Med. Groth, M. Status Asthmaticus. Retrieved from http://denverpost.healthology.com Laffey J, D. Engelberts, and B. Kavanagh. (2000). Buffering hypercapnic acidosis worsens acute lung injury. American Journal of Respiratory Critical Care Med. Lee K, W. Tan, and T. Lim. (1997). Severe asthma. SMJ. McFadden E. Jr, and H. Lyons. (1968). Arterial-blood gas tension in asthma. N Engl J Med. Nowak R, et al. (1983). Arterial blood gases and pulmonary function testing in acute bronchial asthma: predicting patient outcomes. JAMA. O’Rourke P. and R. Crone. (1982). Halothane in status asthmaticus. Critical Care Med. Pirie J, et al. (1998). Changes in treatment and outcomes of children receiving care in the ICUs for severe acute asthma. Pediatric Emergency Care. Rebuck A, and J. Read. (1971). Assessment and management of severe asthma. American Journal Medicine. Roncoroni A, et al. (1976). Metabolic acidosis in status asthmaticus. Respiration (Herrlisheim). Ranieri V, et al. (1999). Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome. JAMA. Schwarz A, and P. Lubinsky. (1997). Acute severe asthma. In: Levin DL and Morriss FC, eds. Essentials of Pediatric Intensive Care. 2nd ed. Vol 1. Sin Fai Lam K, B. Mow, and L. Chew. (1992). The profile of ICU admissions for acute severe asthma in a general hospital. SMJ. Slutsky A, and L. Tremblay. (1998). Multiple system organ failure. Is mechanical ventilation a contributing factor? American Journal of Respiratory Critical Care Med. Tuxen D, and S. Lane. (1987). The effects of ventilatory pattern on hyperinflation, airway pressures, and circulation in mechanical ventilation of patients with severe airflow obstruction. American Review of Respiratory Disorder. Werner, H. (2001). Status Asthmaticus in Children : A Review. CHEST. Williams T. et al. (1992). Risk factors for morbidity in mechanically ventilated patients with acute severe asthma. American Review of Respiratory Disorder.
Thursday, November 21, 2019
The Transformation of the World By the Automobile Revolution Annotated Bibliography
The Transformation of the World By the Automobile Revolution - Annotated Bibliography Example The automobiles have made the economy as the core of the modern society. The cars have made the movement of goods and services from and to the market (Sutter, Driven Wild 09). In the offices, they make people are punctual. The automobiles take the perishable goods produced locally to the market (Raghnaill, 2014). This eliminates chances of getting losses. Secondly, automobiles have influenced the health of individuals in the society in cases of an emergency and non-emergency case to take the patients to the hospitals (McKinsey & Company, 2014). Today there are flying doctors without boundaries who spend most of their time in their offices waiting to utilize these vehicles to make the lives of the community better (Schensul, 2014). The automobiles have a unique way of bringing the people of the society together. With travelling over long distances made so easy and cheap, people can meet as if they live in the same village. Besides, today cars form part of entertainment in various form s. As a hobby, these people watch the rally games at their time of leisure making their life enjoyable. It is true that the impact of the automobile in the modern society is significant. It has brought about a better life and improved the quality of life. The automobiles role in the creation of economics autonomy is also marvelous. With the integration of the automobile to sport and health, it has also improved the quality of life. The automobile makes for almost all the aspect of the modern society.
Wednesday, November 20, 2019
The Social Contract Theory Essay Example | Topics and Well Written Essays - 1000 words
The Social Contract Theory - Essay Example The state was thus given the entire right to protect the rights of the individuals. However, in Hobbes’ case, it was the king that was the sovereign individual that would rule over the land and would have its command habitually obeyed by the people. In Locke’s case, however, people would have their own freedom because they would form a democratic polity by way of coming together. Governance in both cases is about controlling the nature of the state that prevailed at the time in order to bring about a sense of clarity and order in the way by which people lived. However, it must be understood that governing a state does not only involve controlling the bad aspects of the state. The state is formed by people because they require a singular authority to tell them how to behave in different situations. This might not necessarily only include the bad aspects because the state also controls the good nature of the human beings. Governance is thus about both because the state is the sovereign power that has a hold over the safety and security of its citizens. Since it is a sovereign authority or command of the sovereign, it is being obeyed by the people and thus it becomes the function of the state to ensure that whatever it is that people are obeying is for their betterment or societal welfare. Therefore, the state must have controlled power in order to protect the citizens because otherwise since it is a sovereign command, it might get overthrown as was seen in the French Revolution, when Rousseau stated his theory of the social contract.
Sunday, November 17, 2019
Slope-Intercept Formula to Determine the Annual Increase Essay Example for Free
Slope-Intercept Formula to Determine the Annual Increase Essay Select an inventory management problem that applies to your work or personal life. Prepare a project proposal in which you: †¢Describe the organization, the inventory problem it faces, and the expected benefits that are motivating the organization to implement a solution. †¢Convert time series data collected in Week Two to seasonal indices. You may choose to use the University of Phoenix Material: Summer Historical Inventory Data or University of Phoenix Material: Winter Historical Inventory Data if the data you collected is insufficient. †¢Use seasonal indices to analyze the inventory data. oUse the slope-intercept formula to determine the annual increase in inventory. oProvide monthly seasonal indices for the given data. oIdentify the busy months of year. oIdentify the slow months of year. †¢Construct a histogram of the inventory data using Microsoft ® Excel ®. †¢Forecast the future inventory costs using time value of money concepts. University of Phoenix Summer Historical Inventory Data The University of Phoenix Summer Historical Inventory Data is the source for developing Team B’s inventory management proposal. Annual trend lines were plotted in Microsoft Excel  © to display the inventory amounts for each year. The trend line in this case is positive, which indicates that the likelihood of inventory levels in the subsequent years will continue to rise without considering any additional factors that may influence the business. Factors to support the observation include economic instability from stock market volatility, a decline in consumer confidence, severe weather, and acts of terrorism. Table 1 shows the existing data and includes the fifth year projections. Figure 1 displays the trend line.
Friday, November 15, 2019
The Latest Advances In Drug Manipulations Of The Immune System Essays
INTRODUCTION In order to provide a detailed analysis of recent pharmacological developments involving the human immune system, it is firstly necessary to introduce the innate and adaptive immune responses . Immunosuppressants and immunomodulators will be differentiated between and a selection of new and often experimental drugs belonging to each category will be provided. Specific drugs will be described including the pharmacokinetics and pharmacodynamics involved with each type. The possible clinical uses will be alluded to along with details from recent research. INNATE IMMUNITY Innate immunity is the first line of defence and comprises physical (skin), biochemical (complement, lysozyme) and cellular (macrophages, neutrophils) mechanisms (Katzung, 1998). All these mechanisms are non-specific, anti-microbial agents which work in conjunction with adaptive immune responses to provide a more effective system (Downie et. al., 1995). ADAPTIVE IMMUNITY The adaptive immune system is split into two mechanisms: humoral immunity and cell-mediated immunity. A basic understanding of these concepts is necessary for the purpose of understanding the specific effects of different immunopharmacological agents. HUMORAL IMMUNITY Humoral or antibody-mediated immunity is associated with B-lymphocyte cells. Antigens are foreign molecules that initiate an immune response, they have inherent immunogenicity (Tortora & Grabowski, 1996). Upon contact with an antigen, B-cells divide to produce a clone of plasma cells capable of the production of antibodies. Antibodies are immunoglobulins, modified blood proteins with a specific action against antigens. Five main sub-types of immunoglobulins have been identified of which IgG is the most abundant in bodily fluids (Hopkins, 1995). Several cells are known to initiate the process of plasma cell differentiation and are known collectively as antigen presenting cells (APCs) (Waller & Renwick, 1994). Lymphokines The antigen on the surface of the APC triggers TH-cells to produce hormone-like lymphokines (Lessof, 1993). Lymphokines are cytokines, regulators of the immune reactions which are produced by lymphocytes. Examples of these chemicals include interleukins, interferon and tumour necrosis factors. Their action involves the regulation of the proliferation, differentiation and activity of leukocytes (Dale et. al., 1994). The na... ...nours/himmun.html">http://www.pharm.uwa.edu.au/aussie/honours/himmun.html Kahan, B. D. (1998) History of Immunosuppression AT <a href="http://surgery.uth.tmc.edu/organ_transplant/historyimmu.html">http://surgery.uth.tmc.edu/organ_transplant/historyimmu.html Nijkamp, F.P. & Parnham, M. J. (1999) Principles of Immunopharmacology AT <a href="http://www.springer_ny.com/catalog/np/mar99np/3-7643-5780-0.html">http://www.springer_ny.com/catalog/np/mar99np/3-7643-5780-0.html Schultze, J. & Johnson, P. (1999) A Stimulating New Target for Cancer Immunotherapy IN The Lancet vol. 354, Oct. 9, 1999, pp1225-1226 Stadtlander Drug Distribution Co. Inc. (1998) Investigational Immunosuppressants for Transplantation AT <a href="http://www.stadtlander.com/feature/immunosuppren.html">http://www.stadtlander.com/feature/immunosuppren.html Swope, V.B; Abel-Malek, Z; Kassem, L. M. & Nordlund, J.J. (1991) Interleukins 1 Alpha & 6 & Tumor Necrosis Factor-Alpha are Paracrine Inhibitors of Human Melanocyte Proliferation & Melanogenesis AT <a href="http://www.biosyna.com/patent.htm">http://www.biosyna.com/patent.htm
Tuesday, November 12, 2019
How Time is expressed in Bill Viola’s ‘Room for St John of the Cross Essay
This video and sound installation by Bill Viola, ‘Room for St John of the Cross’, speaks of the concept of time in a number of different ways. It consists of a black cubicle in the centre of a darkened space. A small window reveals the interior of the cell which is a softly lit space containing only a table with a pitcher, a water glass and a video monitor. Projected behind the cell is a moving image of mountains with storm clouds accompanied by the sounds of a storm. A voice whispers in Spanish some of St John’s poetry. St John, a poet and mystic was imprisoned for 9 months in 1577 in a cell so small he could not stand within it. During his imprisonment he wrote mystical poetry concerned with transcending events and barriers in search of the Son of God, poetry that has been handed down to us in the modern day, so his poetry could be said to transcend time. The cell a three dimensional object, represents the fourth dimension, that of time, 9 months of his life. This is the period a child spends in the womb, curled and unable to stand, before birth. The mountains would perhaps represent eternity as they are so unchanging. The moving clouds show that time is passing, but the storm may signify chaos of the earliest period of creation. The clouds could also represent an ability to rise above the events of each day – which included regular beatings. The water and the light within the cell could represent the eternal life giving power of God, which St John found each day. God moved upon the face of the waters freshly each day, creating order out of the chaos in which he found his life to be. In ‘The Dark Night’ which may be one of the poems composed during this period he wrote ’all things ceased; I went out from myself, leaving my cares. ’ (as translated by Kieran Kavanaugh and Otilio Rodriguez,) Despite severe oppression, deprivations and physical difficulties, he was in ecstasy and time was forgotten. Works Cited Electronic Sources Kavanaugh K, an d Rodriguez, O. ( translators) Carmelite. com Our Saints, The Collected Works of St John of the Cross http://www. carmelite. com/saints/john/works/cn_6. q` 6th February 2008 Room for St John of the Cross 1983 http://www. sfmoma. org/espace/viola/BV05. html 6th February 2008
Sunday, November 10, 2019
Macao Job Vacancy Issues in Hospitality Industry
Macao Job Vacancy Issues in Hospitality Industry Statistic Analysis Introduction This report analyses key factors which result in vacancy issue in Macao hospitality industry with supportive statistics and information basically from 2009 to 2011. Since 2009, the influx tourist flow keeps enlarging the tourism market. [18] In 2011 every Macao labour has received at least 80 tourists. (D1) The problem is that tourist growth rate (up to15. 1% in 2010 and down to 12. 2%) has far exceeded the number of labour growth rate (1. 5% in 2010, to 3. % in 2011) of Macao, and the difference keeps becoming larger during the last three years. (D5)So Macao labor market is obviously unable to feed the tourism industry employment gradually expanding need. [2] Job vacancy issues description In 2008 to 2010 periods, the total percentage of vacancy jobs has been growing with the total amount of job offered in hospitality industry from 7% to 8% in the total 50,271 offered jobs in 2010. According to the rese arch, the hospitality job vacancy problem mainly occurred on both management position (such as company leader and senior manager) and rank-and-file position.In the same period, management position vacancies drop from 3% in 2008 and ended up with 1% in all vacancy jobs). Rank-and-file position vacancies' occupation grew from 88. 2% in 2008 to 88. 5 %( 4,099 vacancies) in 2010 among all the job vacancies. Particularly, waiter/waitress, unskilled workers vacancies takes over 95% in the rank-and-file vacancies during the three years. Reasons for job vacancy issue analysis There are two reasons cause the management position vacancy. First, limited quality of labor market.Till 2011, there are 26% of the total Macao labors are holding a college or higher educational degree, this percentage would be 15. 8% if excluded imported workers apart. [3][4]Moreover, the language skills would bring the percentage even lower, as the most regular used language is Cantonese (83. 30%), and followed by Ma ndarin(5%), and English (2. 30%) respectively in 2011. Second, the lack of international exposure, makes Macao labors less competitive in the market, because of small amount of travels and business activities outside to western ountries. As for the rank-and-file job vacancy issue, mostly owes to: lower salary, lower status, and restricted labor importing policy. Low salary, especially for waiter/waitress, unskilled workers(around MOP6000), if compare with that(about MOP10,000) (D7)of rank-and-file positions in gaming industry which owns the similar job requirement; In Macau, there are common negative attitudes toward some rank-and-file jobs, because of social status concerns.Jobs like waiter/waitress, cleaning and house keeping, is always in need. Conclusion and Recommendations In conclusion, with the rapid development of tourism industry, issues like naturally lacking of human resource(267,200 local labours[10]), limited qualified manpower[14] and restricted labor importing policy, together will affect efficiency and effectiveness of the hospitality industry.In order to solve the job vacancy issues, government on the one hand, acts as a profound role in guaranteeing the benefit and priorities for local labors, in the short term; On the other hand government has being taken step improving the education system during the years, by subsidizing application for studying professional subjects and tertiary education, [13]in the long term.Recommendations for a company, such as arranging more practical training on management concepts and skills to develop local talents for senior positions; Language training to cater to international customers and management is also an alternative; Bring in certificate recognition system could be a good way to measure competence or set standard for employment, promotion and reward. Finally, it's also the individual responsibility to making full use of the resources offered by public and private organization, get to ready for the globa l competition. Reference: [1] 4 ? 2011 2] : http://news. china. com. cn/local/2012-03/29/content_25017774. htm [3] 1. 8? http://www. macaodaily. com/html/2012-04/24/content_692714. htm [4] 13/2010 http://bo. io. gov. mo/bo/i/2010/22/regadm13_cn. asp [5]2. 6 , , ,2011 [6] http://www. bizintelligenceonline. com/content/view/229/10/lang,/ [7] http://www. newmacau. org/cms/index. php? option=com_content&view=article&id=1290:2011-06-12-04-17-20&catid=9:2009-10-14-10-38-30&Itemid=23 [8] http://www. chengpou. om. mo/news/2011/12/9/19932. html [9] ,2009 http://www. al. gov. mo/diario/l03/cs1-4/2009-120%20%2801-05%29. pdf [10] , ,2011 [11] 14 15 http://www. gov. cn/jrzg/2007-09/12/content_746039. htm [12] – http://www. dsal. gov. mo/chinese/dfpcourse. htm [13]Government to create databank for securing young talent http://www. macaudailytimes. com. mo/macau/35383-Government-create-databank-for-securing-young-talent. html [14] http://www. macaodaily. com/html/2011-12/31/content_66071 5. htm [15] http://www. acaodaily. com/html/2011-12/20/content_657692. htm [16] http://www. macaodaily. com/html/2012-03/19/content_682512. htm [17]Macao workers happier, concerns lurking http://www. macaudailytimes. com. mo/macau/34953-Macau-workers-happier-concerns-lurking. html [18]Macau's GDP growth rate slows to 20. 7 pct in 2011 http://www. macaunews. com. mo/content/view/1667/53/lang,english/ [19] http://www. dsec. gov. mo/Statistic. aspx Diagram 1: 2008~2010 ( : ) | |2008? |2009? |2010? | | |2293. 3185 |2175. 214 |2496. 5411 | | |323. 4 |323. 9 |336. 3 | [pic] : ; Diagram 2: 2009~2010 ( : ) [pic] : -2010? 11 ; 2010~2011 ( : ) [pic] : -2011? 11 ; Diagram 3: 2009~2011 ( : ) |2009? | | |? 1? |? 2? |? 3? |? 4? | | |15176 |14250 |17272 |18222 | | 9216 |7027 |9331 |10325 | | |5960 |7223 |7941 |7897 | |2010? | | |? 1? |? 2? |? 3? |? 4? | | |14860 |29878 |44460 |45585 | | |8845 |12753 |14705 |13769 | | |6015 |17125 |29775 |31816 | |2011? | | |? 1? |? 2? |? 3? |? 4? | | 47404 |52525 |64091 |60961 | | |14199 |16912 |19554 |21278 | | |33205 |35613 |44537 |39683 | : ; Diagram 4: [pic] : ; Diagram 5: [pic] | |2009? |2010? |2011? | | |-1. 00% |1. 50% |3. 80% | | |-6. 20% |15. 10% |12. 20% | Diagram 6: 2008? ~2010 ( 😕 ) | |2008? 2009? |2010? | | |6617 |6490 |6470 | | |6468 |6340 |7850 | | |5619 |6080 |6100 | | |5633 |5820 |5830 | | |10045 |10580 |10730 | | |13974 |13360 |13710 | : ; Diagram 7: 2008? ~2010 pic] : ; Diagram 8: ( : ) [pic] : ; Diagram 9: | | (? ) | (? ) | (? ) | | |15. 7(5. 0%) |13. 9(4. 3%) |14. 8(4. 4%) | | |52. 3(16. 6%) |55. 8(17. 4%) |52. 5(15. 7%) | | |172. 6(54. 7%) |177. 6(55. 5%) |189. 8(56. 6%) | | |75. 2(23. 8%) |73. 0(22. 8%) |78. 3(23. %) | | |315. 8 |320. 2 |335. 4 | : ; Diagram 11: | | : | | : | : , | | : | : , , | | : | : | | : ? 4-5 3 , | | | : , ( ) | | | : | | | : | | : | : , | | : 18-45? | : , | | : | : , | | : | : , | | : ( ) | | | : , , | | : ;
Friday, November 8, 2019
Medicalization
Medicalization Medicalization is a process where problems affecting human beings are diagnosed medically and treated using medical prescriptions. Therefore medicalization of deviance involves introducing medical treatment to correct deviant behaviors. This however applies to certain behaviors that are nons of such behaviors include male chauvinism, obesity, racism, gambling, alcoholism, mental disorder, unattractiveness and sexual acts.Advertising We will write a custom critical writing sample on Medicalization specifically for you for only $16.05 $11/page Learn More According to medical terms deviance of whatever form is regarded as an illness. A definition for deviance can also be described using medical terms and a treatment for each of the deviant behavior can be prescribed in order to correct them. There are several human characteristics that do not just involve personal traits that are stigmatized in the society. Research in the field of medicine has been done on tre atment of such behavior. For instance there are sex drugs that are specifically used by people of women to treat medical conditions because they are more vulnerable to such conditions and the society has already labeled it that way. Women experience deviant behaviors such as depression more compared to men. Because of the fact that they are emotionally attached to things, they tend to express feeling candidly compared to men. As a result, there are certain behaviors which are common with women. Such behaviors can be subjected to medicalization. Treatment of depression is among the development of medicalization of deviant behaviors. Sadness, which can also translate to depression or stress, is generally considered a deviant behavior in the society and there are drugs that are specifically made for people undergoing sadness in their lives. Reproductive Technologies: Who can reproduce? According to chapter five of the book by bell hooks, it describes of how systems created in the socie ty perpetuate and reproduce oppression against the marginalized. This marginalized group includes women and people from small ethnic groups and races. Gender is an issue that has been discussed in public forums and solutions suggested towards solving the discrimination that is aimed towards women. Gender mainstreaming is one of the adopted suggestions to solving this problem whereby there is at least some representation of women in decision making. In the modern society, women need equality with men in education and other sectors of the society. These are the exact issues that she points out and critically analyzes in her book. The issue of gender mainstreaming where in each and every aspect of the society there is need for gender sensitivity in terms of representation.Advertising Looking for critical writing on gender studies? Let's see if we can help you! Get your first paper with 15% OFF Learn More Women involvement is linked to development and Hooks puts this point out clearly by saying that equality is for the benefit of the interest of both men and everyone in the society. A look at all the millennium development goals, gender issues has huge impact in achieving almost all of them. Equality in gender can also benefit society in the sense that the role that women play in the society and in the family is really important and needs to be appreciated. Take an example of a family in which the woman or the wife has a job and goes to work daily. This means that the overall income of that family will be much higher than when it is just the male providing for the family. The problem that arises with such a scenario is that career women are considered to neglect their family responsibilities and leaving their children under the care of baby sitters. This problem can easily be solved since the breed of women today like to multitask. They can easily take care of their children by sparing some time for them and balancing their time for both wo rk and home issues Denial of women’s voices Bell Hooks in her book perceives human nature as being rational. Human beings are also equal in thinking and no one should prevent another human being from taking part in reasoning. Women are always prevented by men from doing some virtuous activities that involves philosophical thinking and reasoning. Their minds are geared towards things that are vanity in nature. For instance they use their natural beauty to make the men like them without realizing that the beauty can easily disappear. The only thing that seems to last longer for the time period that we are alive is the ability of a human being to be rational. Hooks identifies some enlightening activities in which she believes that if only women could be educated in these activities, then they can begin to think as rational beings and participate in philosophical activities which she claims to be more virtuous Hooks is a product of enlightenment in the sense that she uses a rheto rical approach to enable the men to see a faulty side of women and use this knowledge to create equity in the society by treating women as equal rational beings. In her explanation, she criticizes the nature of women and most of her arguments are focused on women. But at the same time her arguments are expected to be read by men so that they can easily realize the benefits of creating equality in the society. The oppression that men have towards women is detrimental to both the interest of men and those of the society in general. For instance, if women continue to enjoy the power of beauty over men then this would make men susceptible to issues of lust and adultery.Advertising We will write a custom critical writing sample on Medicalization specifically for you for only $16.05 $11/page Learn More Embodied power and popular culture; how women are represented and the power of socialization She uses the term equality to express what is expected of the society as a whole in terms of relationships of gender. The society can achieve a state of equality by educating women on these key enlightenments that they are unaware of. The education according to Hooks is one that should emphasize on reasoning and philosophical activities and not issues to do with trying to impress people with their charm. Education that will enable the society to achieve equality is one that would make women to make rational judgment. This overrides the power of beauty that women enjoy over men. Nature has been used in the book to explain the natural state of men as rational beings and women as charming beings of which she argues otherwise about the state of women. She says that human beings in general are supposed to be equal for the interest of the society and the only way to achieve this is by making the women to reason. Virtue is the other enlightenment term that she uses in her work. This term is used to show that reasoning and rationality is of more importance to the society and to everyone at large. She says that rational activities such as philosophy are more virtuous than activities that only impress others. She also says that charm has very little effect to the men especially in marriage. It creates feelings of insufficiency in the women and they would start thinking of ways to please other men. Backlash against feminism; why is feminism a threat and to what? The rise of feminism brought a change in the minds of every one that women are no different than men. They deserve to be treated right with equal opportunities as men. This movement has bore substantive fruits to this moment. Gender is an issue that has been discussed in public forums and solutions suggested towards solving the discrimination that is aimed towards women. Gender mainstreaming is one of the adopted suggestions to solving this problem whereby there is at least some representation of women in decision making. The idea behind feminism is considered good for the present generation of women. However its extreme nature has come under serious and stern criticism in the recent past. Among the societies that do enjoy the extreme nature of feminism include religious institutions. Ideologies of feminism are completely against most religious principles. This makes feminism to be disregarded when viewed from a religious perspective. However, the common religious institutions such as Islam and Christianity have come to a compromise by regarding women as equal beings with equal ability as their male counterparts. Women being a weaker sex in the society for a long time now, have always been dominated by the men and sometime physically intimidated so that they do not come out of their cocoons.Advertising Looking for critical writing on gender studies? Let's see if we can help you! Get your first paper with 15% OFF Learn More The gendered and race symbol of nationalism, religion and war I have seen several women who have the moral strength to stand their ground whenever they experience harassment. When a man or a group of men decide to speak suggestively over their bodies or make sexual advancement to them, they confidently put them off and tell them to mind their manners. If women could display such confidence and courage, then they would help change the perception of men over women and create a dully mutual respect that is supposed to exist between men and women. Women rarely do such things to men even when they are rise to power. So it is obvious that they do not deserve to be treated that manner just as they would not treat others in that manner. On very many occasions women have the feeling that the men possess power and for them to survive then they have to submit to them. Ever since girls become young, they are brought up in a manner that they have to be good towards other. They are told to be ver y respectful and caring and treat other well. So whenever girls are in a situation where they have to be bad, they suffer the feeling of guilt. They fear being rejected because of the way they were brought up. When it comes to religion, women have different rights. Most religions deal with women in a wholesome way by looking at how a woman should relate with God, how she should relate with man as her natural spouse, and how she relates to herself as a human being who is part of the greater society. Religion agrees on the fact that a woman is a weaker gender in the society however there are differences in the way they both attend to the rights and needs of a woman. Women and globalization In traditional societies, women were highly involved in procurement of food and this contributed greatly to the status of women in the society. Even though their roles were limited to their physical abilities, the impact they had on the economy could be felt. They did not have to depend on men to su pport themselves. They had the ability of looking for food and finding it to feed their children and family. Women were stable on their own and this gave them a status in the society. In todays society, women who participate in food procurement are able to build their status. Introduction of waged labor, contributed a great deal towards the destruction of womens economic status. Men were favored in most of the labor jobs available to them because of their physical abilities. They could handle most of the work and were more effective compared to women. This left the women to be forced to remain at home and depend on the men. And currently womens economic status is still being marred by development projects even though the world at large is beginning to get sensitive on gender issues. In todays capitalist society, women are beginning to gain economic status and are making a lot of profit. But this is also causing tension and bringing conflict at homes since men are losing control and dominance, and most of them feel intimidated by the profits from womens work. Aging women In this age women are struggling to have their independence and be equal to the men. They are encouraged to venture in almost anything that men are doing. The image of success in a woman today is shown by the ability to balance several issues in their lives such as career, marriage and children. However other issues have arisen as women try to be successful in life by pursuing several things at a time. These issues include the manner in which children are growing up without values that are important for them and the society. As women grow old, they receive more power and respect from the society. Before such changes were witnessed, women, especially mother played the very important role of instilling these values to their children. The early stages of a child development is very important when at least the child is around the mother because it is at this age that it is possible to shape the min ds and ways of thinking of a child. Most children who are raised with their mothers and both parents end up developing good self esteem. They know very well that there is some stability at home and that whenever they want support and advice; they can get it right from their mothers or fathers. Children need to be assured that they loved and cared for in order for them to grow positively and it’s the mother who is at a better position to provide this security. This therefore means that mothers should stay at home at least for the early years of their children development. This paper intends to develop a profound argument that supports the idea that mothers should stay at home The waves of feminism; where we are at now Since the rise of feminism, a lot of women have come out to challenge the men in fields that were once believed to be male dominated. These fields included political leadership and leadership in general, some sporting activities, and occupations that deal with en gineering and sciences. The progress made so far is heading towards the right direction as policy makers are forced to include women in decision making process. The old tradition of not allowing girls to go to school is gradually changing though not at a desirable pace. The role that women play in the society and in the family is really important and needs to be appreciated. Take an example of a family in which the woman or the wife has a job and goes to work daily. This means that the overall income of that family will be much higher than when it is just the male providing for the family. The problem that arises with such a scenario is that career women are considered to neglect their family responsibilities and leaving their children under the care of baby sitters. This problem can easily be solved since the breed of women today is like to multitask. They can easily take care of their children by sparing some time for them and balancing their time for both work and home issues. Po litically they have more power and social rights and the women seems to be hopeless and restricted at home where they only engage themselves in child bearing and child rearing and work around the house such as cooking. Gender has also been linked to development. A look at all the millennium development goals, gender issues has huge impact in achieving almost all of them. For instance when the laws are discriminatory against women, then access to education is limited and hence it is going to be hard to achieve that goal. The majority of the underpaid workers constitute of women. Therefore this makes gender issues a priority consideration before thinking of these other goals of the MDG. The role of women in child rearing is important in achieving millennium development goal number 4 which touches on child mortality. Activism; kinds Gender mainstreaming is a positive response toward creating equal opportunities for women in the world. The requirements for gender mainstreaming include c alls for gender equality where there are equal relations between male and female in all walks of life. The areas where equity must exist include: politics, work place, sexuality and culture. In mainstreaming, there should also be inclusion of gender issues in to political agenda. Every policy made by policymakers must include equal representation of both sexes. For example in public appointments made a leader must meet a standard as stipulated by the law. Normally the ratio of male to female in public offices appointments should be 1 to 3, where 1 represents the female and 3 represents the male. Including female participants in decision making is also important. Women have to be represented equally in all institutions of decision making such as the congress, house of representative and parliaments. Also in state corporations and statutory bodies this needs to be reflected in the leadership and managements as it is the state to take first steps of responsibility towards gender sensit ivity. There is need for this culture and norm in institutions and organizations. Policies must be put into place to regulate private farms to adopt cooperation on gender issues in all the departments of the farms. There are nations that still struggle to see to it that women are equally represented in decision making, therefore these mainstreaming procedures and requirements are applicable in such countries. It is observed that in such countries there is usually some level of strict poverty meaning that gender inequality is actually linked to poverty. In most case of poverty stricken area, men have an upper hand in getting opportunities for income generation compared women. Hooks, Bell. Feminism is for everybody. New York: South End Press, 2000. Kimmel, Michael S and Amy Aronson. The gendered society reader. London: Oxford University Press, 2007.
Tuesday, November 5, 2019
Definition and Examples of Pathos in Rhetoric
Definition and Examples of Pathos in Rhetoric In classical rhetoric, pathos is the means of persuasion that appeals to the emotions of an audience. Adjective: pathetic. Also called pathetic proof and emotional argument.The most effective way to deliver a pathetic appeal, says W.J. Brandt, is to lower the level of abstraction of ones discourse. Feeling originates in experience, and the more concrete writing is, the more feeling is implicit in it (The Rhetoric of Argumentation). Pathos is one of the three kinds of artistic proof in Aristotles rhetorical theory. Etymology: From the Greek, experience, suffer Pronunciation: PAY-thos Examples and Observations Of the three appeals of logos, ethos, and pathos, it is the [last] that impels an audience to act. Emotions range from mild to intense; some, such as well-being, are gentle attitudes and outlooks, while others, such as sudden fury, are so intense that they overwhelm rational thought. Images are particularly effective in arousing emotions, whether those images are visual and direct as sensations, or cognitive and indirect as memory or imagination, and part of a rhetors task is to associate the subject with such images.(L. D. Greene, Pathos. Encyclopedia of Rhetoric. Oxford University Press, 2001)Most twenty-first-century direct mail solicitations for environmental groups invoke the pathetic appeal. The pathos exists in the emotional appeals to the receivers sense of compassion (for the dying animal species, deforestation, the shrinking of glaciers, and so on).(Stuart C. Brown and L.A. Coutant, Do the Right Thing. Renewing Rhetorics Relation to Composition, ed. by Shane Borrowman et al . Routledge, 2009) Cicero on the Power of Pathos[E]veryone must acknowledge that of all the resources of an orator far the greatest is his ability to inflame the minds of his hearers and to turn them in whatever direction the case demands. If the orator lacks that ability, he lacks the one thing most essential.(Cicero, Brutus 80.279, 46 B.C.)Quintilian on the Power of Pathos[T]he man who can carry the judge with him, and put him in whatever frame of mind he wishes, whose words move men to tears or anger, has always been a rare creature. Yet this is what dominates the courts, this is the eloquence that reigns supreme. . . . [W]here force has to be brought to bear on the judges feelings and their minds distracted from the truth, there the orators true work begins.(Quintilian, Institutio Oratoria, c. 95 A.D.)Augustine on the Power of PathosJust as the listener is to be delighted if he is to be retained as a listener, so also he is to be persuaded if he is to be moved to act. And just as he is delighted if you speak sweetly, so is he persuaded if he loves what you promise, fears what you threaten, hates what you condemn, embraces what you commend, sorrows at what you maintain to be sorrowful; rejoices when you announce something delightful, takes pity on those whom you place before him in speaking as being pitiful, flees those whom you, moving fear, warn are to be avoided; and is moved by whatever else may be done through grand eloquence toward moving the minds of listeners, not that they may know what is to be done, but that they may do what they already know should be done.(Augustine of Hippo, Book Four of On Christian Doctrine, 426) Playing on the Emotions[I]t is perilous to announce to an audience that we are going to play on the emotions. As soon as we appraise an audience of such an intention, we jeopardize, if we do not entirely destroy, the effectiveness of the emotional appeal. It is not so with appeals to the understanding.(Edward P.J. Corbett and Robert J. Connors, Classical Rhetoric for the Modern Student, 4th ed. Oxford University Press, 1999)All About the Children- It has become a verbal tic for politicians to say that everything they do is about the children. This rhetoric of pathos reflects the de-intellectualization of public life- the substitution of sentimentalism for reasoned persuasion. Bill Clinton carried this to comic lengths when, in his first State of the Union address, he noted that not a single Russian missile is pointed at the children of America.Those children-seeking missiles were diabolical.(George Will, Sleepwalking Toward DD-Day. Newsweek, October 1, 2007)- A brilliant young woman I know was asked once to support her argument in favor of social welfare. She named the most powerful source imaginable: the look in a mothers face when she cannot feed her children. Can you look that hungry child in the eyes? See the blood on his feet from working barefoot in the cotton fields. Or do you ask his baby sister with her belly swollen from hunger if she cares about her daddys work ethics?(Nate Parker as Henry Lowe in The Great Debaters, 2007) Stirred, Not ShakenHillary Clinton used a moment of brilliantly staged emotion to win the New Hampshire Democratic primary . . .. As she answered questions in a diner on the morning before the election, Mrs. Clintons voice began to waver and crack when she said: Its not easy. . . . This is very personal for me.Emotions can be an electoral trump card, especially if one can show them as Mrs. Clinton did, without tears. The key is to appear stirred without appearing weak.(Christopher Caldwell, Politics of the Personal. Financial Times, January 12, 2008)Winston Churchill: Never give in[T]his is the lesson: Never give in. Never give in. Never, never, never, never- in nothing, great or small, large or petty- never give in, except to convictions of honour and good sense. Never yield to force. Never yield to the apparently overwhelming might of the enemy. We stood all alone a year ago, and to many countries, it seemed that our account was closed, we were finished. All this tradition of ours, our songs, our School history, this part of the history of this country, were gone and finished and liquidated. Very different is the mood today. Britain, other nations thought, had drawn a sponge across her slate. But instead, our country stood in the gap. There was no flinching and no thought of giving in; and by what seemed almost a miracle to those outside these Islands, though we ourselves never doubted it, we now find ourselves in a position where I say that we can be sure that we have only to persevere to conquer.(Winston Churchill, To the Boys of Harrow School, October 29, 1941) Artful Persuasion: A Pathetic ParodyDuring the 1890s, the following genuine letter from a homesick schoolboy was reprinted in several magazines. A century later, British journalist Jeremy Paxman quoted it in his book The English: A Portrait of a People, where he observed that the letter is so perfect in its depictions of the horrors and so cunning in its attempts to extract sympathy before the appeal for cash that it reads like a parody.One suspects that it reads like a parody because thats exactly what it is.My Dear Ma- I wright to tell you I am very retched and my chilblains is worse again. I have not made any progress and do not think I shall. I am very sorry to be such an expence, but I do not think this schule is any good. One of the fellows has taken the crown of my best hat for a target, he has now borrowed my watch to make a water wheal with the works, but it wont act. Me and him have tried to put the works back, but we think some wheels are missing, as they wont fit. I hope Matildas cold is better. I am glad she is not at schule I think I have got consumption, the boys at this place are not gentlemanly, but of course you did not know this when you sent me here, I will try not to get bad habits. The trousers have worn out at the knees. I think the tailor must have cheated you, the buttons have come off and they are loose behind. I dont think the food is good, but I should not mind if I was stronger. The piece of meat I send you is off the beef we had on Sunday, but on other days it is more stringy. There are black beadles in the kitchen and sometimes they cook them in the dinner, which cant be wholesome when you are not strong.Dear Ma, I hope you and Pa are well and do not mind my being so uncomfortable because I do not think I shall last long. Please send me some more money as io 8d. If you cannot spare it I think I can borrow it of a boy who is going to leave at the half quarter and then he wont ask for it back again, but perhaps you wd. n ot like to be under an obligation to his parents as they are tradespeople. I think you deal at their shop. I did not mention it or I dare say they wd. have put it down in the bill.- Yr. loving but retched son(Switchmens Journal, December 1893; The Travelers Record, March 1894; The Collector, October 1897) An instructors first impulse might be to assign this letter as an editing exercise and be done with it. But lets consider some of the richer pedagogical opportunities here.For one thing, the letter is a smart example of pathos, one of the three categories of artistic proof discussed in Aristotles Rhetoric. Likewise, this homesick schoolboy has masterfully executed two of the more popular logical fallacies: ad misericordiam (an argument based on an exaggerated appeal to pity) and the appeal to force (a fallacy that relies on scare tactics to persuade an audience to take a particular course of action). In addition, the letter aptly illustrates the effective use of kairos- a classical term for saying the appropriate thing at the appropriate time.Soon Ill be asking my students to update the letter, retaining the same persuasive strategies while freshening the litany of horrors.(Grammar Composition Blog, August 28, 2012) The Lighter Side of Pathos: Pathetic Appeals in Monty Python Restaurant Manager: I want to apologize, humbly, deeply, and sincerely about the fork.Man: Oh please, its only a tiny bit. . . . I couldnt see it.Manager: Ah, youre good kind fine people for saying that, but I can see it. To me its like a mountain, a vast bowl of pus.Man: Its not as bad as that.Manager: It gets me here. I cant give you any excuses for itthere are no excuses. Ive been meaning to spend more time in the restaurant recently, but I havent been too well. . . . (emotionally) Things arent going very well back there. The poor cooks son has been put away again, and poor old Mrs. Dalrymple who does the washing up can hardly move her poor fingers, and then theres Gilbertos war woundbut theyre good people, and theyre kind people, and together we were beginning to get over this dark patch. . . . There was light at the end of the tunnel. . . . Now, this. Now, this.Man: Can I get you some water?Manager (in tears): Its the end of the road!(Eric Idle and Graham Chapman, episode three of Monty Pythons Flying Circus, 1969)
Sunday, November 3, 2019
Business Regulations and Practices Essay Example | Topics and Well Written Essays - 500 words - 1
Business Regulations and Practices - Essay Example In this case, Oya is the President of Paka Corp. to enter into binding agreements on behalf of Paka. However, the agreements must be related to the daily business operations. They should fall within the object clause of Paka Corp. An officer of the corporation does not have the capacity to bind the corporation in anything outside the normal business operations. It is a fact that a corporate officer lacks the capacity to bind the corporation in matters irrelevant to the business. Oya involved the company in a personal loan, which is irrelevant to the business. Paka Corp. is in the business of selling computer services and not in the business of consigning personal loans regardless of the person involved. The fact that Oya is the company President does not change the operating powers of the corporation as outlined in the objects clause. The action of Oya to consign the Paka Corp. for a loan is ultra vires, which makes the whole transaction void. A shareholder owns share(s) in a corporation. Shareholders are entitled to a given number of benefits. Every state has business laws that govern the relationship between shareholders and the corporation (Bruno and Ruggiero 10). In general, shareholders enjoy several rights that are not influenced by the corporation bylaws or charter. Lucia is entitled to all the general rights of shareholders. In most corporations, a single vote is equivalent to one share unless specified otherwise in the corporation laws (Bruno and Ruggiero 13). Based on this fact, Lucia has a voting right in the company. The voting rights of a shareholder are not determined by the number of shares that he or she owns in the corporation. The number of shares also affects the voting power attached to each shareholder. Shareholders with many shares possess strong voting powers. Lucia has the right to attend shareholder meetings
Friday, November 1, 2019
Nursing Essay Example | Topics and Well Written Essays - 750 words
Nursing - Essay Example These include denial, anger, bargaining, depression and acceptance. Over the years, statistics have proved that other situations of loss can cause people to undergo the aforementioned emotional stages. According to Kubler-Ross, the first stage implies dealing with grief of losing a loved one; this stage is denial. â€Å"It is a temporary defence and will soon be replaced with partial acceptance†(Kubler-Ross, 1969). Denial is a state of unbelief when one first hears the news of the fateful event or death. The person is in shock and wishes that this is only a dream or a passing wind. In the Bible, Job lost all his wealth when he was tested by the devil. In one single day, he lost his ten children, thousands of household animals including sheep, oxen, donkeys and camels. After receiving the news, Job fell down and worshiped God, which is a contrast to Kubler-Ross theory. Secondly, after acceptance, persons get angry and go out to seek reasons. Job got angry on hearing the news o f the loss; he tore his mantle and shaved his hair but did not express his anger to God. Additionally, he cursed the day he was born. However, he did not ask why all that was happening in his life but he reckoned that he came naked to the earth and he would leave the same way. Thirdly, Kubler-Ross observed that people get into bargaining with their maker or the universe about their loss. In contrast, Job accepted his maker’s wisdom and did not try to bargain. Fourthly, a person becomes withdrawn, gets into depression, and wonders whether life is still worth living. Likewise, Job felt helpless and his wife would tell him to curse God and die as a last resort. Lastly, Kubler-Ross observed that patients in terminal illness would eventually accept their fate and seek out a normal life again. Similarly, Job accepted the will of God and did not heed to his friends and his wife’s request to curse God. He received a double portion of his prior wealth. The stages of loss, as su ggested by Kubler-Ross, may not apply to Buddhism, which is a funerary religion. The Japanese poems dwell so much on death and eternity and regard it as a new way of looking at life or as a new enlightenment. Additionally, they believe in cycles of rebirth and wondering souls, which gives them an aspect of accepting loss as the will of their Nirvana. A strong relationship exists between joy and the above grieving models. Joy is a state of happiness contributed by good things of life. For instance health, not dying, love optimism, hope, and admiration. According to Kearney & Griffin, parents draw joy from talking about the success of their children as affectionate, beautiful, generous, or cheerful. Joy is the opposite of grief and does not exist in isolation of grief. Drawing two circles and naming one joy and the other grief, the place they meet at is a combination of both joy and grief (Kearney & Griffin, 2001). At one point, one is happy about their life and success but at the bac k of their mind, there is a possibility of death, sickness, or loss of job. Therefore, people interact with grief as much as they interact with joy in their daily lives. I concur with Kubler-Ross method of grieving. News of loss of a loved one or a terminal illness leaves devastating effect on ones life. However, each person takes a different turn on receiving such news. Some will go straight to acceptance; others follow the five steps, while some may remain in denial forever. According to Good Therapy website,
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