The Moonstone Essay -- essays research papers fc

Alexandra Lloyd What role did 19th Century popular serial novels such as Wilkie Collins’ The Moonstone play in British understandings of India? When Wilkie Collins first wrote The Moonstone in 1868, it was not published in the form available today, but was published in instalments in a popular Victorian magazine, All the Year Round. Upon its first publication it was eagerly read by the general British public, for its readership not only included the ruling and upper classes, but the cost and availability meant that a copy would have a wide circulation amongst all members of a household. The tale’s images and ideas of India thus reached many social groups in British culture. To Wilkie Collins, the gem, part of whose history we follow in The Moonstone, the novel of the same name, is the signifier of all things that humanity strives for, material and spiritual. He begins the novel by demonstrating that the history of the Moonstone gem is a history of thefts. In having his initial narrator state "that crime brings its own fatality with it" (p.6 Ch. IV of the prologue), Collins underscores the fact that nemesis attends every worldly expropriator of the Moonstone, which to its temporary European possessors is a bauble and a commodity but which to its faithful guardians, the Brahmins, is a sacred artefact beyond price. The Moonstone is never really English or England's, for the novel begins with an account of its various thefts. It opens in India with Rachel Verinder’s Uncle Herncastle's purloining the gem in battle (the opening lines are specifically "written in India"(p.1)) and closes with Murthwaite, the famed fictional explorer's, account (dated 1850) of the restoration of the gleaming "yellow Diamond"(p.466) to the forehead of the Hindu deity of the Moon "after the lapse of eight centuries"(p.466, "The Statement of Mr. Murthwaite"). The date of Murthwaite's account of the restoration of the diamond may be ironic, for in 1850 a Sikh maharajah, exiled from Indian after the Anglo-Sikh War of 1848-9, presented a gem, which is thought to be the ... ...l conciliation and transcendent faith if India were to arise from bloody, mutually destructive, strife and take her rightful place in the society of nations. Today, Collins's The Moonstone may be viewed not as a response to a national insurgency and/or European determination to keep the native in his place, but rather as a love story between two people who only come to see each other for what they are after misjudgements, misunderstandings, accidental and intended deceptions, and considerable self-sacrifice. Bibliography Page references to passages from The Moonstone come from the Oxford University Press, 1999 edition of the novel. Collins, Wilkie. The Moonstone. Oxford, Oxford University Press, 1999. Sutherland, John. â€Å"Introduction and A Note on the Composition† Wilkie Collins’ The Moonstone. Oxford, Oxford University Press, 1999. Stewart, J. I. M. â€Å"A Note on Sources.† Wilkie Collins' The Moonstone. Harmondsworth, Penguin, 1966, rpt. 1973. Pp. 527-8. Fraser, Antonia, ed. The Lives of the Kings and Queens of England. New York, Alfred A. Knopf, 1975. Peters, Catherine. The King of the Inventors: A Life of Wilkie Collins. London, Minerva, 1991.

School Life: What I Learned

As I look back, there are multiple reason I am who I am today, but when I think about it changing to a public school my junior year really had a huge impact on my life and who I am today. It has made me independent and trust of myself, become more involved in school and learned how to balance my time. Also, switch schools, I have experienced a huge diversity of people. My first two years of high school, I attended St.Pius X, there I had gone to school ith all the same people I had known my whole life. Pius was a very small school and very easy to adapt to. After my sophomore year, I just knew something wasn’t right with me. I felt very sheltered and I felt like I wasn’t my own person, I felt myself being like everyone else. Knowing myself and what I wanted in life, I knew St. Pius was no longer the school for me. My Junior year, I switched to North Kansas City, knowing few people going in. Going through something like that, I had no friends and no one to trust myself.I had no fear going in. Being able to start completely over with no friends and no one to trust or go to I developed so much confidence in myself and knew I would adapt quickly. Still to this day, even with the close relationships I have made with people, I am still very independent. I make sure no matter what goes on in my life to take care of all of my responsibilities and this quality will come in handy in college with everything I will experience and will continue to stay successful. To help myself adapt to the change, I became as involved as I possibly could.I joined clubs, did volunteer work and also played three sports all while maintaining a job. Being this involved I was nervous I would become overwhelmed and thought it would be easy to loose my focus with academics but I knew that I couldn’t let that happen. My grades really improved and I was able to manage all of my activities and always get my school work done. This will definitely benefit me in college because I k now that I will be as involved as possible and that i will still maintain the motivation to get ll my work done and take care of every single of my responsibilities I develop in college. North Kansas City is not only a bigger school that I am used to, but also a very diverse school. We represent people from about thirty six different countries. I have developed close relationships with people from places I have never even heard of. At North Kansas City high school there are so many opportunities, every individual person seems like they have found comfort there. I know I have found many things to be involved in.When I get in college I know there will be people all over the world and for most it will be a huge culture shock. Being surrounded by people with different backgrounds and all walks of life and my experience with going to one of the most diverse schools in the country will help me understand people and where they are all coming from. As much as I miss my old friends and old l ife, in the end I am so happy with the change. The self trusting, time management skills and experience to a very diverse school is what is best for me in the future, not only in college but in my career after college as well.

Physiology Dissertations - Third Stage Labour - Free Essay Example

Sample details Pages: 31 Words: 9412 Downloads: 2 Date added: 2017/06/26 Category Statistics Essay Did you like this example? Introduction Don’t waste time! Our writers will create an original "Physiology Dissertations Third Stage Labour" essay for you Create order This dissertation is primarily concerned with the arguments that are currently active in relation to the benefits and disadvantages of having either an active or passive third stage of labour. We shall examine this issue from several angles including the currently accepted medical opinions as expressed in the peer reviewed press, the perspective of various opinions expressed by women in labour and theevidence base to support these opinions. It is a generally accepted truism that if there is controversy surrounding a subject, then this implies that there is not a sufficiently strong evidence base to settle the argument one way or the other. (De Martino B et al. 2006). In the case of this particular subject, this is possibly not true, as the evidence base is quite robust (and we shall examine this in due course). Midwifery deals with situations that are steeped in layers of strongly felt emotion, and this has a great tendency to colour rational argument. Blind belief in one area often appears to stem from total disbelief in another (Baines D. 2001) and in consideration of some of the literature in this area this would certainly appear to be true. Let us try to examine the basic facts of the arguments together with the evidence base that supports them. In the civilised world it is estimated that approximately 515,000 currently die annually from problems directly related to pregnancy. (extrapolated from Hill K et al. 2001). The largest single category of such deaths occur within 4 hrs. of delivery, most commonly from post partum haemorrhage and its complications (AbouZahr C 1998), the most common factor in such cases being uterine atony. (Ripley D L 1999). Depending on the area of the world (as this tends to determine the standard of care and resources available), post partum haemorrhage deaths constitutes between 10-60% of all maternal deaths (AbouZahr C 1998). Statistically, the majority of such maternal deaths occur in the developing countries where women may receive inappropriate, unskilled or inadequate care during labour or the post partum period. (PATH 2001). In developed countries the vast majority of these deaths could be (and largely are) avoided with effective obstetric intervention. (WHO 1994). One of the central argumen ts that we shall deploy in favour of the active management of the third stage of labour is the fact that relying on the identification of risk factors for women at risk of haemorrhage does not appear to decrease the overall figures for post partum haemorrhage morbidity or mortality as more than 70% of such cases of post partum haemorrhage occur in women with no identifiable risk factors. (Atkins S 1994). Prendiville, in his recently published Cochrane review (Prendiville W J et al. 2000) states that: where maternal mortality from haemorrhage is high, evidence-based practices that reduce haemorrhage incidence, such as active management of the third stage of labour, should always be followed It is hard to rationally counter such an argument, particularly in view of the strength of the evidence base presented in the review, although we shall finish this dissertation with a discussion of a paper by Stevenson which attempts to provide a rational counter argument in this area. It could be argued that the management of the third stage of labour, as far as formal teaching and published literature is concerned, is eclipsed by the other two stages (Baskett T F 1999). Cunningham agrees with this viewpoint with the observation that a current standard textbook of obstetrics (unnamed) devotes only 4 of its 1,500 pages to the third stage of labour but a huge amount more to the complications that can arise directly after the delivery of the baby (Cunningham, 2001). Donald makes the comment This indeed is the unforgiving stage of labour, and in it there lurks more unheralded treachery than in both the other stages combined. The normal case can, within a minute, become abnormal and successful delivery can turn swiftly to disaster. (Donald, 1979). chapter 1:define third stage of labour, The definition of the third stage of labour varies between authorities in terms of wording, but in functional terms there is general agreement that it is the part of labour that starts directly after the birth of the baby and concludes with the successful delivery of the placenta and the foetal membranes. Functionally, it is during the third stage of labour that the myometrium contracts dramatically and causes the placenta to separate from the uterine wall and then subsequently expelled from the uterine cavity. This stage can be managed actively or observed passively. Practically, it is the speed with which this stage is accomplished which effectively dictates the volume of blood that is eventually lost. It follows that if anything interferes with this process then the risk of increased blood loss gets greater. If the uterus becomes atonic, the placenta does not separate efficiently and the blood vessels that had formally supplied it are not actively constricted. (Chamberlain G et al. 1999). We shall discuss this process in greater detail shortly. Proponents of passive management of the third stage of labour rely on the normal physiological processes to shut down the bleeding from the placental site and to expel the placenta. Those who favour active management use three elements of management. One is the use of an ecbolic drug given in the minute after delivery of the baby and before the placenta is delivered. The second element is early clamping and cutting of the cord and the third is the use of controlled cord traction to facilitate the delivery of the placenta. We shall discuss each of these elements in greater detail in due course. The rationale behind active management of the third stage of labour is basically that by speeding up the natural delivery of the placenta, one can allow the uterus to contract more efficiently thereby reducing the total blood loss and minimising the risk of post partum haemorrhage. (ODriscoll K 1994) discuss optimal practice, Let us start our consideration of optimal practice with a critical analysis of the paper by Cherine (Cherine M et al. 2004) which takes a collective overview of the literature on the subject. The authors point to the fact that there have been a number of large scale randomised controlled studies which have compared the outcomes of labours which have been either actively or passively managed. One of the biggest difficulties that they experienced was the inconsistency of terminology on the subject, as a number of healthcare professionals had reported management as passive when there had been elements of active management such as controlled cord traction and early cord clamping. As an overview, they were able to conclude that actively managed women had a lower prevalence of post partum haemorrhage, a shorter third stage of labour, reduced post partum anaemia, less need for blood transfusion or therapeutic oxytocics (Prendiville W J et al. 2001). Other factors derived from the paper include the observation that the administration of oxytocin before delivery of the placenta (rather than afterwards), was shown to decrease the overall incidence of post partum haemorrhage, the overall amount of blood loss, the need for additional uterotonic drugs, the need for blood transfusions when compared to deliveries with similar duration of the third stage of labour as a control. In addition to all of this they noted that there was no increased incidence of the condition of retained placenta. (Elbourne D R et al. 2001). The evidence base for these comments is both robust and strong. On the face of it, there seems therefore little to recommend the adoption of passive manage ment of the third stage of labour. Earlier we noted the difficulties in definition of active management of the third stage of labour. In consideration of any individual paper where interpretation of the figures are required, great care must therefore be taken in assessing exactly what is being measured and compared. Cherine points to the fact that some respondents categorised their management as passive management of the third stage of labour when, in reality they had used some aspect of active management. They may not have used ecbolic drugs (this was found to be the case in 19% of the deliveries considered). This point is worth considering further as oxytocin was given to 98% of the 148 women in the trial who received ecbolic. In terms of optimum management 34% received the ecbolic at the appropriate time (as specified in the management protocols as being before the delivery of the placenta and within one minute of the delivery of the baby). For the remaining 66%, it was given incorrectly, either after the delivery of the placenta or, in one case, later than one minute after the delivery of the baby. Further analysis of the practices reported that where uterotonic drugs were given, cord traction was not done in 49%, and early cord clamping not done in 7% of the deliveries observed where the optimum active management of the third stage of labour protocols were not followed. From an analytical point of view, we should cite the evidence base to suggest the degree to which these two practices are associated with morbidity. Walter P et al. 1999 state that their analysis of their data shows that early cord clamping and controlled cord traction are shown to be associated with a shorter third stage and lower mean blood loss, whereas Mitchelle (G G et al. 2005) found them to be associated with a lower incidence of retained placenta. Other considerations relating to the practice of early cord clamping are that it reduces the degree of mother to baby blood transfusion. It is clear that giving uterotonic drugs without early clamping will cause the myometrium to contract and physically squeeze the placenta, thereby accelerating the both the speed and the total quantity of the transfusion. This has the effect of upsetting the physiological balance of the blood volume between baby and placenta, and can cause a number of undesirable effects in the baby including an increased tendency to jaundice. (Rogers J et al. 1998) The major features that are commonly accepted as being characteristic of active management and passive management of the third stage of labour are set out below. Physiological Versus Active Management . . Physiological Management Active Management Uterotonic None or after placenta delivered With delivery of anterior shoulder or baby Uterus Assessment of size and tone Assessment of size and tone Cord traction None Application of controlled cord traction* when uterus contracted Cord clamping Variable Early (After Smith J R et al. 1999) physiology of third stage The physiology of the third stage can only be realistically considered in relation to some of the elements which occur in the preceding months of pregnancy. The first significant consideration are the changes in haemodynamics as the pregnancy progresses. The maternal blood volume increases by a factor of about 50% (from about 4 litres to about 6litres). (Abouzahr C 1998) This is due to a disproportionate increase in the plasma volume over the RBC volume which is seen clinically with a physiological fall in both Hb and Heamatocrit values. Supplemental iron can reduce this fall particularly if the woman concerned has poor iron reserves or was anaemic before the pregnancy began. The evolutionary physiology behind this change revolves around the fact that the placenta (or more accurately the utero-placental unit) has low resistance perfusion demands which are better served by a high circulating blood volume and it also provides a buffer for the inevitable blood loss that occurs at the time of delivery. (Dansereau J et al. 1999). The high progesterone levels encountered in pregnancy are also relevant insofar as they tend to reduce the general vascular tone thereby increase venous pooling. This, in turn, reduces the venous return to the heart and this would (if not compensated for by the increased blood volume) lead to hypotension which would contribute to reductions in levels of foetal oxygenation. (Baskett T F 1999). Coincident and concurrent with these heamodynamic changes are a number of physiological changes in the coagulation system. There is seen to be a sharp increase in the quantity of most of the clotting factors in the blood and a functional decrease in the fibrinolytic activity. (Carroli G et al. 2002). Platelet levels are observed to fall. This is thought to be due to a combination of factors. Haemodilution is one and a low level increase in platelet utilisation is also thought to be relevant. The overall functioning of the platelet system is rarely affected. All of these changes are mediated by the dramatic increase in the levels of circulating oestrogen. The relevance of these considerations is clear when we consider that one of the main hazards facing the mother during the third stage of labour is that of haemorrhage. (Soltani H et al. 2005) and the changes in the haemodynamics are largely germinal to this fact. The other major factor in our considerations is the efficiency of the haemostasis produced by the uterine contraction in the third stage of labour. The prime agent in the immediate control of blood loss after separation of the placenta, is uterine contraction which can exert a physical pressure on the arterioles to reduce immediate blood loss. Clot formation and the resultant fibrin deposition, although they occur rapidly, only become functional after the coagulation cascade has triggered off and progressed. Once operative however, this secondary mechanism becomes dominant in securing haemostasis in the days following delivery. (Sleep, 1993). The uterus both grows and enlarges as pregnancy progresses under the primary influence of oestrogen. The organ itself changes from a non-gravid weight of about 70g and cavity volume of about 10 ml. to a fully gravid weight of about 1.1 kg. and a cavity capacity of about 5 litres. This growth, together with the subsequent growth of the feto-placental unit is fed by the increased blood volume and blood flow through the uterus which, at term, is estimated to be about 5-800 ml/min or approximately 10-15% of the total cardiac output (Thilaganathan B et al. 1993). It can therefore be appreciated why haemorrhage is a significant potential danger in the third stage of labour with potentially 15% of the cardiac output being directed towards a raw placental bed. The physiology of the third stage of labour also involves the mechanism of placental expulsion. After the baby has been delivered, the uterus continues to contract rhythmically and this reduction in size causes a shear line to form at the utero-placental junction. This is thought to be mainly a physical phenomenon as the uterus is capable of contraction, whereas the placenta (being devoid of muscular tissue) is not. We should note the characteristic of the myometrium which is unique in the animal kingdom, and this is the ability of the myometrial fibres to maintain its shortened length after each contraction and then to be able to contract further with subsequent contractions. This characteristic results in a progressive and (normally) fairy rapid reduction in the overall surface area of the placental site. (Sanborn B M et al. 1998) In the words of Rogers (J et al. 1998), by this mechanism the placenta is undermined, detached, and propelled into the lower uterine segment. Other physiological mechanisms also come into play in this stage of labour. Placental separation also occurs by virtue of the physical separation engendered by the formation of a sub-placental haematoma. This is brought about by the dual mechanisms of venous occlusion and vascular rupture of the arterioles and capillaries in the placental bed and is secondary to the uterine contractions (Sharma J B et al. 2005). The physiology of the normal control of this phenomenon is both unique and complex. The structure of the uterine side of the placental bed is a latticework of arterioles that spiral around and inbetween the meshwork of interlacing and interlocking myometrial fibrils. As the myometrial fibres progressively shorten, they effectively actively constrict the arterioles by kinking them . Baskett (T F 1999) refers to this action and structure as the living ligatures and physiologic sutures of the uterus. These dramatic effects are triggered and mediated by a number of mechanisms. The actual definitive trigger for labour is still a matter of active debate, but we can observe that the myometrium becomes significantly more sensitive to oxytocin towards the end of the pregnancy and the amounts of oxytocin produced by the posterior pituitary glad increase dramatically just before the onset of labour. (GÃÆ'Â ¼lmezoglu A M et al. 2001) It is known that the F-series, and some other) prostaglandins are equally active and may have a role to play in the genesis of labour. (Gulmezoglu A M et al. 2004) From an interventional point of view, we note that a number of synthetic ergot alkaloids are also capable of causing sustained uterine contractions. (Elbourne D R et al. 2002) chapter 2 discuss active management, criteria, implications for mother and fetus. This dissertation is asking us to consider the essential differences between active management and passive management of the third stage of labour. In this segment we shall discuss the principles of active management and contrast them with the principles of passive management. Those clinicians who practice the passive management of the third stage of labour put forward arguments that mothers have been giving birth without the assistance of the trained healthcare professionals for millennia and, to a degree, the human body is the product of evolutionary forces which have focussed upon the perpetuation of the species as their prime driving force. Whilst accepting that both of these concepts are manifestly true, such arguments do not take account of the natural wastage that drives such evolutionary adaptations. In human terms such natural wastage is simply not ethically or morally acceptable in modern society. (Sugarman J et al. 2001) There may be some validity in the arguments that natural processes will achieve normal separation and delivery of the placenta and may lead to fewer complications and if the patient should suffer from post partum haemorrhage then there are techniques, medications and equipment that can be utilised to contain and control the clinical situation. Additional arguments are invoked that controlled cord traction can increase the risk of uterine inversion and ecbolic drugs can increase the risks of other complications such as retained placenta and difficulties in delivering an undiagnosed twin. (El-Refaey H et al. 2003) The proponents of active management counter these arguments by suggesting that the use of ecbolic agents reduces the risks of post partum haemorrhage, faster separation of the placenta, reduction of maternal blood loss. Inversion of the uterus can be avoided by using only gentle controlled cord traction when the uterus is well contracted together with the controlling of the uterus by the Brandt-Andrews manoeuvre. The arguments relating to the undiagnosed second twin are loosing ground as this eventuality is becoming progressively more rare. The advent of ultrasound together with the advent of protocols which call for the mandatory examination of the uterus after the birth and before the administration of the ecbolic agent effectively minimise this possibility. (Prendiville, 2002). If we consider the works of Prendiville (referred to above) we note the meta-analyses done of the various trials on the comparison of active management against the passive management of the third stage of labour and find that active management consistently leads to several benefits when compared to passive management. The most significant of which are set out below. Benefits of Active Management Versus Physiological Management Outcome Control Rate, % Relative Risk 95% CI* NNT 95% CI PPH 500 mL 14 0.38 0.32-0.46 12 10-14 PPH 1000 mL 2.6 0.33 0.21-0.51 55 42-91 Hemoglobin 9 g/dL 6.1 0.4 0.29-0.55 27 20-40 Blood transfusion 2.3 0.44 0.22-0.53 67 48-111 Therapeutic uterotonics 17 0.2 0.17-0.25 7 6-8 *95% confidence interval Number needed to treat (After Prendiville, 2002). The statistics obtained make interesting consideration. In these figures we can deduce that for every 12 patients receiving active management (rather than passive management) one post partum haemorrhage is avoided and further extrapolation suggests that for every 67 patients managed actively one blood transfusion is avoided. With regard to the assertions relating to problems with a retained placenta, there was no evidence to support it, indeed the figures showed that there was no increase in the incidence of retained placenta. Equally it was noted that the third stage of labour was significantly shorter in the actively managed group. In terms of significance for the mother there were negative findings in relation to active management and these included a higher incidence of raised blood pressure post delivery (the criteria used being 100 mm Hg). Higher incidences of reported nausea and vomiting were also found although these were apparently related to the use of ergot ecbolic and not with oxytocin. This is possibly a reflection of the fact that ergot acts on all smooth muscle (including the gut) whereas the oxytocin derivatives act only on uterine muscle. (Dansereau, 1999). None of the trials included in the meta-analysis reported and incidence of either uterine inversions or undiagnosed second twins. Critical analysis of these findings would have to consider that one would have to envisage truly enormous study cohorts in order to obtain statistical significance with these very rare events. (Concato, J et al. 2000) With specific regard to the mother and baby we note some authors recommend the use of early suckling as nipple stimulation is thought to increase uterine contractions and thereby reduce the likelihood of post partum haemorrhage. Studies have shown that this does not appear to be the case (Bullough, 1989), although the authors suggest that it should still be recommended as it promotes both bonding and breastfeeding. The most important element of active management of the third stage of labour is the administration of an ecbolic agent directly after the delivery of the anterior shoulder or within a minute of the complete delivery of the baby. The significance of the anterior shoulder delivery is that if the ecbolic is given prior to delivery of the anterior shoulder then there is a significantly increased risk of shoulder dystocia which, with a strongly contracting uterus, can be technically very difficult to reduce and will have significant detrimental effects on the baby by reducing its oxygen supply from the placenta still further. The fundal height should be assessed immediately after delivery to exclude the possibility of an undiagnosed second twin. (Sandler L C et al. 2000) There are a number of different (but widely accepted) protocols for ecbolic administration. Commonly, 10 IU of oxytocin is given intramuscularly or occasionally a 5 IU IV bolus. Ergot compounds should be avoided in patients who have raised blood pressure, migraine and Raynauds phenomenon. (Pierre, 1992). The issue of early clamping of the cord is complex and, of the three components of the active management of the third stage of labour this, arguably, gives rise to the least demonstrable benefits in terms of the evidence base in the literature. We have already discussed the increased incidence of postnatal jaundice in the newborn infant if cord clamping is delayed but this has to be offset against both the occasional need for the invoking of prompt resuscitation measures (i.e. cord around the neck) or the reduction in the incidence of childhood anaemia and higher iron stores (Gupta, 2002). In a very recent paper, Mercer also points to the lower rates of neonatal intraventricular haemorrhage although it has to be said that the evidence base is less secure in this area. (Mercer J S et al. 2006) Other foetal issues are seldom encountered in this regard except for the comparatively rare occurrence when some form of dystocia occurs and the infant had to be manipulated and represented (viz. the Zavanelli procedure). If the cord has already been divided then this effectively deprives the infant of any possibility of placental support while the manoeuvre is being carried out with consequences that clearly could be fatal. (Thornton J G et al. 1999) In the recent past, the emergence of the practice of harvesting foetal stem cells from the cord blood may also have an influence on the timing of the clamping but this should not interfere with issues relating to the clinical management of the third stage. (Lavender T et al. 2006) There are some references in the literature to the practice of allowing the placenta to exsanguinate after clamping of the distal portion as some authorities suggest that this may aid in both separation (Soltani H et al. 2005) and delivery (Sharma J P et al. 2005). of the placenta. It has to be noted that such references are limited in their value to the evidence base and perhaps it would be wiser to consider this point unproven. We have searched the literature for trials that consider the effect of controlled cord traction without the administration of embolic drugs. The only published trial on the issue suggested that controlled cord traction, when used alone to deliver the placenta, had no positive effect on the incidence of post partum haemorrhage (Jackson, 2001). The same author also considered the results of the administration of ecbolic agents directly after placental delivery and found that the results (in terms of post partum haemorrhage at least), were similar to those obtained with ecbolics given with the anterior shoulder delivery, although an earlier trial (Zamora, 1999) showed that active management (as above) did result in a statistically significant reduction in the incidence of post partum haemorrhage when compared to controlled cord traction and ecbolics at the time of placental delivery. In this segment we should also consider the situation where the atonic uterus (in passive management of the third stage of labour) can result in the placenta becoming detached but remaining at the level of the internal os. This can be clinically manifest by a lengthening of the cord but no subsequent delivery of the placenta. In these circumstances the placental site can continue to bleed and the uterus can fill with blood, which distends the uterus and thereby increases the tendency for the placental site to bleed further. This clearly has very significant implications for the mother. (Neilson J et al. 2003) There are other issues which impact on the foetal and maternal wellbeing in this stage of the delivery but these are generally not a feature issues relating to the active or passive management of the third stage of labour and therefore will not be considered further. There are a number of other factors which can influence the progress of the third stage of labour and these can be iatrogenic. Concurrent administration of some drugs can affect the physiology of the body in such a way as to change the way it responds to normal physiological processes. On a first principles basis, one could suggest that, from what we have already discussed, any agent that causes relaxation of the myometrium or a reduction in uterine tone could potentially interfere with the efficient contraction of the uterine musculature in the third stage and thereby potentially increase the incidence of post partum haemorrhage. Beta-agonists (the sympathomimetic group) work by relaxing smooth muscle via the beta-2 pathway. The commonest of these is salbutamol. When given in its usual form of an inhaler for asthma, the blood levels are very small indeed and therefore scarcely clinically significant but higher doses may well exert a negative effect in this respect. (Steer P et al. 1999) The NSAIA group have two potential modes of action that can interfere with the third stage. Firstly they have an action on the platelet function and can impair the clotting process which potentially could interfere with the bodys ability to achieve haemostasis after placental delivery. (Li D-K et al. 2003) Secondly their main mode of therapeutic action is via the prostaglandin pathway (inhibitory action) and, as such they are often used for the treatment of both uterine cramping, dysmenorrhoea and post delivery afterpains. (Nielsen G L et al. 2001) They achieve their effect by reducing the ability of the myometrium to contract and, as such, clearly are contraindicated when strong uterine contractions are required, both in the immediate post partum period and if any degree of post partum haemorrhage has occurred. Other commonly used medications can also interfere with the ability of the myometrium to contract. The calcium antagonist group (e.g. nifedipine) are able to do this (Pittrof R et al. 1996) and therefore are changed for an alternative medication if their cardiovascular effects need to be maintained. (Khan R K et al. 1998) We should also note that some anaesthetic agents can inhibit myometrium contractility. Although they are usually of rapid onset of action, and therefore rapid elimination from the body, they may still be clinically significant if given at the time of childbirth for some form of operative vaginal delivery. (GÃÆ'Â ¼lmezoglu A et al. 2003) relevant legal and ethical issues related to topic and midwife, Many of the legal and ethical issues in this area revolve around issues of consent, which we shall discuss in detail shortly, and competence. Professional competence is an area which is difficult to define and is evolving as the status of the midwife, together with the technical expectations expected of her, increase with the advance of technology. In general terms the areas of professional competence are defined in both legal and ethical terms. These two areas commonly overlap but they do differ in a number of ways. The ethical duty of non-malificence is essentially an obligation not to do harm to the patient. The legal consideration of this point is rather broader insofar as the law requires that not only do you (as a midwife) have to ensure that you do no harm to the patient but that you also have a duty to ensure that no harm comes to the patient by other means. This essentially means that the healthcare professionals concerned must speak out if they are aware of the possibility of potential harm to the patient. (Halpern S D 2005) In the context of this dissertation we could cite the hypothetical example of an obstetrician who was practicing passive management of the third stage of labour in direct conflict with the evidence base in the area. This would require a professional midwife to voice her concerns on the matter and she would be held legally liable if she simply acquiesced in silence. (Dimond. B. 2001). Another example (and supported by legal precedent would be the liability of a midwife who did not speak as the patients advocate if the obstetrician was incapacitated by illness or (for example) alcohol. (Re C 1994) In broad terms, the issues enshrined in the area of professional competence are encapsulated in the Bolam Principle. (Hunt T 1994). This states that a healthcare professional should not be held as negligent if he or she acts in accordance with the practice accepted at the time by a reasonable body of medical opinion. in effect, this principle is saying that it is neither reasonable nor practical to expect every professional to achieve expert status in every field of their clinical practice. When acting in a clinical sphere, the healthcare professional should effectively go to lengths that another reasonable practitioner would go to then they would not be considered negligent. (Clarke J E et al 1997). This principle effectively allows common sense to prevail. It is of particular importance in the next section where we shall consider issues of informed consent. A balance must be drawn between what is possible and what is necessary. There is no merit in covering ones self by explaining all possible eventualities to a patient if the net result is that the patient is going to be unrealistically terrified of the potential hazards of a procedure. We shall discuss this in detail shortly. We can conclude this section on negligence with the overview that it has been accepted that if a healthcare professional can point to or cite evidence that has been published in a reputable peer reviewed journal with a secure evidence base, then it is unlikely to be successfully challenged. The greater the evidence base for a specific course of action, the less likely it is that it can be disputed. (Hewison, A. 2004) informed choice and informed consent, Healthcare professionals in general, and midwives in particular, are constantly confronted with the issue of consent. Some situations are tacitly taken for granted simply because there is a general understanding that if the patient allows contact, such as having their face washed, then there is the implication of consent. At the other end of the clinical spectrum, if a patient needs a LSCS and has arrived in the anaesthetic room, they are not realistically in a position to leave if they so choose. Given these circumstances it is vital that the patient has been in a position to have given informed consent which means that it should have been carefully and considerately explained to them beforehand. Consent is the difference between therapy and assault (Veitch RM 2002). This comment is essentially at the forefront of our considerations here. Even in antiquity there was general agreement that consent was necessary. There are surviving texts from the days of Hippocrates which suggest that although the healthcare professionals of the day had an obligation to do their best for the patient there was no formal obligation on the part of the patient to have to accept what was advised. In reality, we can reflect on the fact that many of the treatments of those days were clearly gross and the issue of consent would actually have been less of a matter of contention simply by virtue of the fact that the patient would clearly have had to have made up their mind to accept the treatment if they turned up to see the physician at all. (Carrick P 2000). The realities of today mean that there are a great many more subtleties to consider and we now have the benefit and guidance of the advice given by the Good Practice in Consent Initiative Group which was a direct result of the requirements of the NHS Plan that proper consent must be sought from all NHS patients and research subjects. (DOH 2000). It was set up under the auspices of the National Institute for Clinical Excellence which noted an area of ambiguity in current practice and felt that definitive guidance was needed. (Brechin A et al 2000). Their advice is considered to be perhaps currently the definitive guide on the subject. (Say R E et al 2003). The group use the term proper consent which is not just casual phrase but does have a very precise definition. We note that the definition however, is different in ethical and legal contexts. The ethical connotation is that the adult is always considered to be competent to give proper consent unless it is proved to be not the case. (Kuhse Singer 2001). The legal connotation was summed up by Lord Donaldson (Donaldson 1993) who ruled that The test that they should apply is Can this patient understand and weigh up the information needed to make this decision? (DOH 2000). If they can, then the clinician has judged them to be competent and the consent is Proper. In the converse case then clearly it is not. The whole area of childbirth is one which is invested with a high emotional content. It is therefore incumbent on the midwife (and all healthcare professionals) that they should not let their own personal values influence the decision that the patient eventually makes. (Mason T et al. 2003). If the patient should make a decision that appears to be completely out of character or irrational, one should not immediately assume that they are incompetent. it is actually probably more rational to conclude that they may not have clearly understood the explanations given to them by the professionals and as Mezirow comments, it may also therefore be a consequence of the fact that inadequate opportunity has been given for the patient to reflect, consider and to ask questions. (Mezirow, J 1991). The issue of competence is complicated further with the recognition of the fact that the legal definition of being competent to give consent is not necessarily universal. Winter (R et al. 1999) gives the example of a patient who can be judged competent to decide whether they have a flu vaccination or nor yet may not be competent to make a complex decision relating to investment strategy. Problems arise not so often in the every-day circumstances of professional practice, but at the margins where situations are encountered which are perhaps not met very often. The midwife may find herself in a situation where the patient cannot, either by virtue of sudden emergency of perhaps being under the influence of sedation or anaesthetic, give competent informed consent. The question then arises as to who is able to give consent for any particular procedure? It is a common situation for relatives to be present and they may wish to give consent on behalf of their relative. Both the Good Practice in Consent Initiative and the professional guidelines on the subject drawn up by the Royal College of Midwives give unequivocal guidance on the subject. Both these authorities concur with the ruling by Lord Donaldson (Donaldson 1993) who ruled that if a patient is considered incompetent to give consent, for any reason at all, then others cannot give that consent for them. It is entirely appropriate for the clinician to listen to the points of view of all interested parties and may appropriately ask them to sign a form stating that this is their opinion or that they are happy with a proposed procedure, but they cannot give vicarious consent for that procedure on behalf of the patient. In short, the responsibility lies with the clinician involved to make a considered judgement on what they consider the patient would have said when they were competen t and the responsibility for that decision is theirs. This is clearly a decision that has to take into consideration issues that have a range and scope that is far wider than simply the clinical issues to be considered. Douglas sums up the situation by commenting that the clinician must try to come to an opinion as to just how it would be thought likely that the patient would have reacted in the circumstances. (Douglas C 2002) One other area of clinical importance where the law gives clear guidance, is the area where the patient has given instructions or perhaps expressed a wish as to how they wised to be treated in any specific situation even though they may not be able to give that opinion at the time in question and the clinician must abide by these wishes in the absence of any other factors. (Sugarman J Sulmasy 2001) The ethical debate about a patients choice revolves around the issue of autonomy. (Coulter A. 2002). Healthcare professionals have to allow the individual patient the right, Gillon would suggest the responsibility, (Gillon R 1997) of each patient to determine how they wish to advance their own welfare. The key issue in this regard is enunciated by Dimond (B 1999) who we cite verbatim: In the context of medical consent, this right and responsibility is exercised by freely and voluntarily consenting or refusing to consent to recommended procedures or treatments when in possession of a sufficient knowledge of the benefits .. and risks involved. It is this last phrase which encapsulates the difficulty in this area. How does a healthcare professional ensure that a patient has sufficient knowledge to make the decision they are being asked to make without either frightening them inordinately with excesses of information or attempting to sway or influence their decision by making a conscious decision to restrict the amount of information given. To illustrate this with an example. If a patient decides that they do not want to have ecbolic drugs the healthcare professional is faced with a dilemma. If they know that the evidence base is considerably in favour of the use of such drugs, to what extent should they invade the potential autonomy of the patient in seeking to persuade them to change their mind to what may be seen as a more rational choice? Yura helps us with an analytical assessment of this point. (Yura H et al. 1998). The authors suggest that the judgement as to whether the patient is making a proper decision should be based on consideration of four criteria, namely: 1) Adequate disclosure of information 2) Patient freedom of choice 3) Patient comprehension of information 4) Patient capacity for decision-making If these criteria are met then one must assume that the decision is proper and should not seek to change it further. Yura then goes on to suggest that if these criteria are all met then one can also say that three further necessary requirements for proper consent are also met. 1) That the individuals decision is voluntary 2) That this decision is made with an appropriate understanding of the circumstances 3) That the patients choice is deliberate insofar as the patient has carefully considered all of the expected benefits, burdens and risks and reasonable alternatives. If we look at the current recommendations of the Royal College of Midwives advice on the subject, we can point to the fact that they currently require four specific areas to be addressed. They clearly cannot determine to what depth these areas have to be covered, as this has to be left to the professional judgement of the individual clinician involved. They suggest that if: 1) Diagnosis 2) Nature and purpose of treatment 3) Risks of treatment 4) Treatment alternatives. (cited in Hogston, R et al 2002). have all been covered, then the consent process can be considered proper and adequate These arguments can be encapsulated in a comment by Lewars who, although he was actually writing about consent in the area of radiographic imaging, finds that his comments are equally valid in this respect. The thrust of this discussion, in essence, revolves around the fact that a consenting competent adult has the right to either agree or disagree with any form of treatment or investigation and that there is no compulsion or necessity for them to justify that decision to anyone else. The problem for the profession is just how to quantify and to educate the patient sufficiently for that consent to be valid. (Lewars M 2004) implications for future practice, Putting all of these considerations together, we approached this topic with an open and enquiring mind. It is clearly important, when trying to come to a decision on issues such as these to try to embrace the principles of evidence based practice. In each area of clinical activity, the conscientious practitioner should endeavour to assimilate their own personal evidence base. This should ideally be done by a personal and critical assessment of the available literature. (Taylor. B. J 2000). We note that simply by reading the literature one is not likely to come to a rational conclusion as some papers (particularly the older ones) are little more than an exposition of the personal opinions of experienced clinicians. Although this may have some value, it is graded at Level IV in the scale of evidence Classification of evidence levels Ia Evidence obtained from meta-analysis of randomised controlled trials. Ib Evidence obtained from at least one randomised controlled trial. IIa Evidence obtained from at least one well-designed controlled study without randomisation. IIb Evidence obtained from at least one other type of well-designed quasi-experimental study. III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies. IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities. ( After Tanenbaum S. 1999) Of far greater gravity and legitimate weight are the papers which are categorised as Level I (a + b) which are derived from meta-analyses or properly conducted randomised controlled trials. In researching this discussion we have tried to restrict the papers presented in support of the arguments discussed to be at least Level IIb and above. This helps to give legitimacy to the arguments put forward. There appears to be little doubt, from the evidence presented here, that the passive management of the third stage of labour does appear to have a number of rational arguments to support it and there are demonstrable benefits to be obtained from such passive management. We can cite the absence of the side effects of some of the ecbolic drugs as a simple example. If the drugs are not given then the patient will not experience the possible side effects such as nausea, headache and hypertension to name but a few. The corollary of this line of action is that, in sparing the patient such possible side effects it would appear that they are also spared the protective and beneficial aspects of such drugs. We have set out unassailable evidence that the use of ecbolic drugs reduces the number of post partum haemorrhages and therefore the associated morbidity (and mortality) that goes with it. Proponents of passive management of the third stage point to drawbacks with the use of ecbolics (as indeed do some of the balanced papers that discuss active management of the third stage). There is no doubt that if used unwisely or inappropriately, there are drawbacks to their use. The issue of the undiagnosed twin is frequently cited as a possible contraindication. In real terms however, in the developed countries, such eventualities are extremely rare, as the advent of commonplace ultrasound investigations of pregnancy has made the diagnosis of multiple pregnancy comparatively easy. The significance for future practice would appear to be that there is little evidence to support the overall efficacy of passive management of the third stage of labour. As a concluding comment we will consider the article by Stevenson (Stevenson J 2005) which makes comment on the Bristol third stage trial. It makes interesting reading as a commentary on the presentation of the trial. We have not included it in the main body of discussion as it cannot be considered a balanced argument being essentially the opinions of the writer Stevenson opens his paper with the comments: But the trial, based on false premises, is completely misleading, and numerous criteria are mistaken, misunderstood or misinterpreted. The reason that we have included this in the consideration of the overall issue is his premise about the trial structure in which he comments: The obvious alternative to active management is passive management, to see whether a womans body can cope without assistance; that should settle the matter conclusively. Here is a very common blunder in logic: to go from the sublime to the ridiculous, to justify one inordinate extreme by ridiculing the opposite inordinate extreme. The thrust of Stevensons logic is clear and he effectively and coherently argues for a middle course of partial management and active intervention only when needed. The difficulty with this course is that it is dependent on both circumstance and individual clinician preference, and as such, it is virtually impossible to construct a protocol for a controlled trial. The corollary of this is that, although Mr Stevenson can freely express his opinions it is unlikely that there will ever be a randomised controlled trial which will allow him to assemble a secure evidence base for his assertions. Sadly, after a careful and erudite exposition of his argument, Stevenson rather diminishes the validity of his paper by ending with the unflattering comment: The statistician, nowadays retitled epidemiologist, without noticing the abysmal flaws in the structure of this trial, has dressed it in jargon, giving it an air of respectability and credibility. Debate and disagreement is healthy and will promote further research. There is no doubt that further research is needed in this area. 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Lumbiganon 2003 A multicentre randomised trial of the management of the third stage of labour. The Lancet, Volume 358, Issue 9283, Pages 689-695 Gulmezoglu A M, Forna F, Villar J, Hofmeyr G J : 2004 Prostaglandins for prevention of postpartum haemorrhage (Cochrane Review). In: The Cochrane Library, Issue 1. Oxford, UK: Macmillan 2004. Gupta R, Ramji S: 2002 Effect of delayed cord clamping on iron stores in infants born to anemic mothers: a randomized controlled trial. Indian Pediatr 2002 Feb ; 39 (2) : 130-5 Halpern S D 2005 Towards evidence based bioethics BMJ, Oct 2005 ; 331 : 901 903 ; Hewison, A. 2004 Management for Nurses and Health Professionals: Theory into practice. Blackwell Science : Oxford. 2004 Hill K, AbouZahr C, Wardlaw T. 2001 Estimates of maternal mortality for 1995. Bull World Health Organ. 2001 ; 79 : 182-93. Hogston, R. Simpson, P. M. 2002 Foundations in nursing practice 2nd Edition, London: Palgrave Macmillian. 2002 Hunt T 1994 Ethical issues in Nursing London: Routledge 1994 Jackson K W Jr, Allbert J R, Schemmer G K, et al: 2001 A randomized controlled trial comparing oxytocin administration before and after placental delivery in the prevention of postpartum haemorrhage. Am J Obstet Gynecol 2001 Oct ; 185 (4) : 873-7 Khan R N, SK Smith, and ML Ashford 1998 Contribution of calcium-sensitive potassium channels to NS1619-induced relaxation in human pregnant myometrium Hum. Reprod., Jan 1998 ; 13 : 208 213 Kuhse Singer 2001 A companion to bioethics ISBN: 063123019X Pub Date 05 July 2001 Lavender T, Z. Alfirevic, and S. Walkinshaw 2006 Effect of Different Partogram Action Lines on Birth Outcomes: A Randomized Controlled Trial Obstet. Gynecol., August 1, 2006 ; 108 (2) : 295 302. Lewars M. 2004 Sustainability of medical imaging. To obtain informed consent from everyone is impossible [letter]. 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Dn Dna And Dna - 1683 Words

Question 1 a) DNA replication is the process in which a cell passes this DNA sequence onto other cells when it divides which is known as mitosis as it must duplicate its genome so each new cell has a copy. This occurs during interphase. During DNA replication the enzyme DNA helicase are important as they separate double-stranded DNA into single strands allowing each strand to be copied. DNA polymerase are another important enzyme that starts attaching new complementary nucleotides to these templates. It is done according to the base pairing rules, A=T, C=G, G=C and T=A. Once the new nucleotides are attached, two new sister DNA strands are formed same as the original strand. The result is two identical strands, each of which is half new. b) mRNA is a translation of DNA into a convertible protein substituting T with U. The template strand shown is the 1st step of transcription and it is transcribed to: GTA GAT TGG GGT CTC CTC. Each of the codons codes for a particular amino acid. For example, each codon is a triplet and codes for one amino acid. In the strand shown it separates it into triplets that will reveal codon and amino acid number. For example, CAT CTA ACC CCA GAG GAG = 6 amino acids. c) Sickle cell anaemia – GTA GAT TGG GGT CAC CTC Normal haemoglobin – GTA GAT TGG GGT CTC CTC While comparing the difference between the normal and sickle cell strands, it was identified that in the sickle cell there is a coding error. As the transcription error causes the personShow MoreRelatedDn Dna And Dna1128 Words   |  5 PagesQuestion 1 To clone complementary DNA (cDNA), it is necessary to obtain a library including the sequence of interest. Then the clones that are of interest are isolated and tested to ensure they are the right clones. cDNA is then synthesized through reverse transcription by the reverse transcriptase enzyme which yields a complementary DNA from the RNA. The cDNA is incorporated into a vector to allow for manipulation. 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Deoxyribonucleic acid or DNA carries almost all the genetic information of living things on Earth and is the molecular blue print for all known life (note: some viruses uses Ribonucleic acid RNA instead). The DNA is a linear sequence that exists in a complex structure that comprises two long stretches of nucleotides, which are twisted into a double helix. Each nucleotideRead MoreHuman Genetics 34 Points Total Essay1780 Words   |  8 Pagesmutations resulting in a morphological lighter skin tone. DNA Polymorphism for African Population DNA Polymorphism for European Population 5. Calculate the dN/dS ratio for MC1R in each human population (How does this compare with Rana et al’s South Asian data?). What does this suggest about the pattern of selection (if any) at this locus? (3 points) NOTE: dN/dS is the same as Ka/Ks Under polymorphism and divergence statistics the dN/dS ratio is 0.595 in the African comparison and 0.564 inRead MoreBlaine Kitchenware Case Essay3133 Words   |  13 Pages.tsoc noitargetni dna nwod- etirw yrotnevni ,elpmaxe rof ,tol a IKB tsoc evah sn oi tisiuqca esehT .htworg gniyortsed-eulav ni tsevni lliw yeht dna ,eerf si latipac taht kniht dluow tnemeganam ehT .noitacollasim latipac f o sksir gib eb lliw ereht ,hsac sulprus fo tol a sah ynapm oc eht fI – ksiR tnem tsevnieR .sreyub laitnetop cinagro fo daetsni seinapm oc llams f o sn oi tisiuqca m orf semoc htworg tnecer lla ,IKB roF .stcejorp ot laed retteb a noi tisiuqca eht gnikam ,n oillim 927 $ ot n oillim

We Need More Engagement Around Here - 765 Words

The Problem The employee motivation and engagement in the company is poor. Lots of workers are easygoing and apathetic. Only few of the employees give effort in their job. They also say that they were not able to learn and grow in the past year. Many employees say that they are satisfied with their salary and benefits however, only few of them are willing to stay in the company for at least three years. They are not motivated and showed no interest which leads to poor performance of their job. This could worsen if no proper actions would be taken. Areas to consider The company has both strengths and weaknesses; some of their strength is the following: †¢ The employees know what they are expected at work. The†¦show more content†¦Recognition is such a potentially powerful motivator. This could be done by giving recognition to the most industrious employee of every month, and selecting one most industrious employee for the year. Rewards can be a simple gift certificate or a custom-made plaque of recognition. Alternative 3: Teambuilding Another action would be to set up teambuilding activities to increase teamwork. Team building is pursued via a variety of practices, and can range from simple bonding exercises to complex simulations and multi-day team building retreats designed to develop a team. Team building is an important factor in any environment, it aims to bring out the best in a team to ensure self development, positive communication, leadership skills and the ability to work closely together as a team to solve problem. Teambuilding could also improve the individual relationship between employees. This alternative can be the preliminary action to take. Alternative 4: Learning environment The last but not the least action to take is to provide a learning environment for employees. The workplace must be a place for growth and learning. Management must extent efforts to enable employee to learn. This could take place by providing feedback on their work, supervising and reviewing the work done, and identifying areas to improve on. It is also important toShow MoreRelatedWe Need More Engagement Around Here1067 Words   |  5 PagesA Case Analysis on the Case Problem: We Need More Engagement Around Here Problem How should the management motivate the employees to facilitate them in fully engaging in work activities? Areas of Consideration 1. Employees’ Personalities and Demographic Status The management must recognize the personality, ethical, generational, and social status differences among their employees. This is to acknowledge the fact the different people require different motivation approaches. Thus, theseRead MoreProcedures For Assess Workforce Engagement Essay1472 Words   |  6 PagesA. Procedures to Assess Workforce Engagement There are several procedures in which workforce engagement can be assessed. The first method of assessment used by our educational institution that I will discuss in this section, is formal teacher observations and informal walk-throughs performed several times throughout the week. This assessment of workforce engagement is aligned with the state teacher observation tool and rubric in determining the level of effectiveness of each educator. AnotherRead MoreWhy Ai And Robots Start Engagement Marketing1634 Words   |  7 PagesWhy AI and Robots Continue to Rise in Engagement Marketing The rise of robots and AI in engagement marketing is fueled by several factors. The introduction of Apple’s Siri and Microsoft’s Cortana proves that artificial intelligence can provide a possible point of contact when reaching out to customers. Here are some of the reasons why AI and robots are here to stay and why we will see more of them in the future: Robots and AI are reliable and consistent Humans are prone to making mistakes. This isRead MorePresident Obama s Last State Of The Union Address912 Words   |  4 PagesDemocrats hold more dear than Republicans. Governor Nikki Haley of South Carolina gave the Republican response and that speech, although critical of the President’s approach, echoed many of his values, while still emphasizing values that Republicans hold more dear than Democrats. According to the Trends in American Values 1987-2012 survey from the Pew Research Center, Americans on both sides of the political aisle are concerned about the following issues: 1. Political engagement 2. GovernmentRead Morejack carter case study Essay1261 Words   |  6 Pagesno more than a high school education (often less) , and the market for them is very competitive. All these people are usually paid around $15.00 per hour, and they change job frequently. Turnover in their stores (as in the stores of many of their competitors) often approaches 400% Question 1. 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AtRead MoreCurriculum Guides for Academic Interventions Essay999 Words   |  4 PagesStrategies used: Student Engagement amp; Peer-Assisted Learning (Center for Innovations in Education, 2006) Educational Purpose: Student Engagement: To keep the student actively engaged will keep them away from having time to behave inappropriately (CISE, 2006). . It will also keep them from wanting to veer away from the educational activity. The key word here is actively. The goal or objective here is to engage the student actively, meaning we aren’t just keeping him/her busy, we are talking to themRead MoreHow Employee Strengths Improves Your Organization860 Words   |  4 PagesHow utilizing employee strengths improves your organization We live in a world where classification is king (there are literally hundreds of shades of blue). It’s understandable as it’s the primary way we humans learn about ourselves and the people and things around us. 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Rising Sea Level Essay Example For Students

Rising Sea Level Essay Rising Sea LevelRising sea levels have been disturbing geographers and geologists forsome time now. Scientists are constantly trying to prevent the effectsrising waters are causing, which mainly includes beach and island erosion. So far, their attempts with man-made development on beaches along the easterncoast of America have only made things worse. Up and down the U.S. coast, public money is subsidizing private propertyon islands made of sand, the stuff on which, as the Bible says, only foolsbuild (Ackerman 7). In recent years there has been a trend towards livingon the barrier islands of Americas Atlantic Coast. High rise condominiums,numerous shops, and several businesses have been built to sustain largepopulations on these islands and continue to be built. As a result, thisvital chain of islands that lies between the ocean and the mainland areat risk. While interfering with the natural configuration of these islands, humanconstruction has advanced the rate of beach erosion, thus leaving the mainlandwith no barriers during times of high surf. This effect has also led tocostly, unnatural ways to preserve the barrier islands. Saving these islandsin their natural state by curbing human encroachment will both protectmainland populations from high surf and save a considerable amount of federalmoney. The barrier islands are a chain of islands, stretching from NewYork to southern Texas, that have served as a critical barrier from theAtlantic Ocean for well over the past 4,500 years (Ackerman 23). These islands however are not as stable as those who live on them wouldlike it to be. Beaches, and in fact whole islands, are constantly erodedas they are subjected to varying winds, currents and changing sea levels. Along Floridas East Coast, roughly 368 miles, the average shoreline changeis retreating 22cm per year. Under natural conditions, native vegetationand shifting sands constantly replace or withhold sand on the islands (16). Unfortunately for the inhabitants of the barrier islands, this is a geologicalbehavior which can only continue if the islands remain in a natural state. In recent years humans on these shorelines and islands have been respondingto the naturally changing conditions, through the use of man made structuressuch as seawalls, groins, and sand replenishment, in an effort to savebeachfront property from erosion. Obstructing the natural shifts of the islands, says Orrin Pilkey ofDuke University who has studied these islands for thirty years, will causethem to, be lost forever (16-17). Attempting to hold beaches in placewith the use of seawalls, groins, and sand replenishment may seem likea good solution in theory, but in practice they probe ineffective. Oneof the most common methods of attempting to hold barrier island beachesin place is through the use of sea walls, which are costly and ineffective. Seawalls are typically cement walls constructed parallel to the seashorein an effort to block waves from coming over the beach and into property. However, seawalls tend to withhold sand behind the wall during times ofhigh surf and the natural tendency of the beach to respond to waves isdisturbed (Kaufman 207). The structures commonly fail from undermining or erosion by waves breakingover their tops. Under normal conditions sand would be spread out by outgoingcurrents, which in turn would lower the slope of the beach and cause thewaves to break gradually. With seawalls in place, sand remains stationarywhile waves erode the beach as wave energy is deflected against sand notprotected by the seawall (208). In addition to advancing the erosion rateof the sand and inhibiting the beaches natural tendencies, seawalls havebecome quite costly to maintain. For example, in New York $120 millionwas paid by the federal government to sustain and replenish seawall installationsas of 1996, and repairs continue to be made (Dixon 231). Clearly, thismethod is both costly and ineffective. Another commonly used method ofstopping erosion is the placement of groins, which are also ineffective. .u36cc8f02e246052aade49e159c675e91 , .u36cc8f02e246052aade49e159c675e91 .postImageUrl , .u36cc8f02e246052aade49e159c675e91 .centered-text-area { min-height: 80px; position: relative; } .u36cc8f02e246052aade49e159c675e91 , .u36cc8f02e246052aade49e159c675e91:hover , .u36cc8f02e246052aade49e159c675e91:visited , .u36cc8f02e246052aade49e159c675e91:active { border:0!important; } .u36cc8f02e246052aade49e159c675e91 .clearfix:after { content: ""; display: table; clear: both; } .u36cc8f02e246052aade49e159c675e91 { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u36cc8f02e246052aade49e159c675e91:active , .u36cc8f02e246052aade49e159c675e91:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u36cc8f02e246052aade49e159c675e91 .centered-text-area { width: 100%; position: relative ; } .u36cc8f02e246052aade49e159c675e91 .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u36cc8f02e246052aade49e159c675e91 .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u36cc8f02e246052aade49e159c675e91 .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u36cc8f02e246052aade49e159c675e91:hover .ctaButton { background-color: #34495E!important; } .u36cc8f02e246052aade49e159c675e91 .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u36cc8f02e246052aade49e159c675e91 .u36cc8f02e246052aade49e159c675e91-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u36cc8f02e246052aade49e159c675e91:after { content: ""; display: block; clear: both; } READ: Pearl Harbor - The United States Should Have Antic EssayGroins are pilings of rocks that extend into the ocean and perpendicularto the shore. Like seawalls, the primary purpose of a groin is to trapsand, but in longshore currents rather than sand deposits already on thebeach. Contrary to their intended purpose, these structures trap sand on theside facing a longshore current and leave the opposite side without sand(Kaufman 207). Over time, the side not facing longshore currents erodesand the initial problem reoccurs. Once again, after the unsuccessful useof groins, money and resources must be spent to restore the beach. A recentmethod of stopping erosion, and perhaps the most expensive, is that ofsand replenishment. Sand replenishment uses dredging techniques to pipesand from offshore deposits to the beach in an attempt to replace sand. This operation is also costly and the sand is usually lost in a major storm. Renourished beaches have a shorter life due to compaction and sea bottomimbalance differences. One example of its cost is that of Sea Bright beachwhere, at one million dollars a square mile; their beach was replenished(Ackerman 29). The total cost of this operation, which lasted between 1994 and 1996,was $36 million (29). These are just a few of the myriad of inadequateattempts to stop seashore erosion. Not only do these human obstructionsto the natural course of nature cause an accelerated erosion, millionsof government dollars are being lost in the process of attempting to savebeach front property from natural erosion. There are over 90 Federal navigationprojects and 21 Federal shore protection projects in Florida alone. Theseprojects have an annual maintenance cost of $32 million. Stephen Leatherman,head of the Coastal Research laboratory at the University of Maryland,suggests that, In nourishment projects locals pitch in about5 percent, state and county tax payers pay about 30 percent, and the federalgovernment pays the rest (Ackerman 30). Apparently, at the cost of theAmerican government, large sums of money are being spent on these futileefforts to stop natural occurrences. Recently in the past few years, anew attribute has been looked at. A bulge formed by Ice Age glaciers isslowly settling, while the mid-Atlantic coast is falling. In many places,the sea is taking back the land at the rate of about an inch every 25 years. Originally, scientists pondered why the sea level was rising fasterbetween Florida and New York than farther north. They hypothesized thatit must have been a shift in the Gulf Stream, but this new research showingthe fall of the land proved them wrong. Regardless, sea levels continueto rise and scientists are running out of ideas to prevent this from happening. Global sea level has risen 4 to 10 inches during the past 100 years becauseof global warming. By year 2050, a 16-inch sea-level rise is projected. Consequences of a higher sea-level to our coastal areas have not only includederosion, but some believe other effects it will have will include: tourism,the availability of drinking water, and damage from storms. The only effectivesolution that seems practical at the moment, without risking such largesums of money, is that human occupations of these islands become restricted. In most cases, people probably come to the seashore for recreation andrarely for necessity. Why not just live minutes away on the mainland andavoid having millions of dollars being spent on keeping beachfront propertyfrom washing away? This way federal money currently being spent on coastalprojects, such as seawalls, groins and sand replenishment, can be allocatedto more pressing problems of our nation. Until another economical solution,which does not contribute to the problem of erosion, is possible peopleshould minimize residential development on the barrier islands before boththe beaches and money wash away. .u63398d287d8307d142d1aaca76c8bf3b , .u63398d287d8307d142d1aaca76c8bf3b .postImageUrl , .u63398d287d8307d142d1aaca76c8bf3b .centered-text-area { min-height: 80px; position: relative; } .u63398d287d8307d142d1aaca76c8bf3b , .u63398d287d8307d142d1aaca76c8bf3b:hover , .u63398d287d8307d142d1aaca76c8bf3b:visited , .u63398d287d8307d142d1aaca76c8bf3b:active { border:0!important; } .u63398d287d8307d142d1aaca76c8bf3b .clearfix:after { content: ""; display: table; clear: both; } .u63398d287d8307d142d1aaca76c8bf3b { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u63398d287d8307d142d1aaca76c8bf3b:active , .u63398d287d8307d142d1aaca76c8bf3b:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u63398d287d8307d142d1aaca76c8bf3b .centered-text-area { width: 100%; position: relative ; } .u63398d287d8307d142d1aaca76c8bf3b .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u63398d287d8307d142d1aaca76c8bf3b .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u63398d287d8307d142d1aaca76c8bf3b .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u63398d287d8307d142d1aaca76c8bf3b:hover .ctaButton { background-color: #34495E!important; } .u63398d287d8307d142d1aaca76c8bf3b .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u63398d287d8307d142d1aaca76c8bf3b .u63398d287d8307d142d1aaca76c8bf3b-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u63398d287d8307d142d1aaca76c8bf3b:after { content: ""; display: block; clear: both; } READ: Hitler And Stalin EssayBibliography Ackerman, Jennifer. Islands at the Edge. National Geographic. August, 1997:2-31. Dean, G. Robert M.D. Review of Long-Term ShorelineChanges in Florida Online. AOL. http://bigfoot.wes.army.mil/6727.htmlDixon, Katherine L., and Orrin H. Pilkey. The Corps and the shore. Washington,D.C: Island Press, 1996. Head, M. Clarence and Marcus, B. Robert. The Faceof Florida. Kendall/Hunt Publishing Company 1998:144-147 Kaufman, Wallace,and Orrin H. Pilkey. The beaches are moving: the drowning of Americasshoreline. New York: Anchor Press, 1979.

Sir Isaac Newton Essays (1212 words) - Classical Mechanics

Sir Isaac Newton Topics in Geometry A Research Project Presented To The Department Of Mathematics Of Thomas Edison High School In Partial Fulfillment Of The Course In Geometry Sir Isaac Newton was born on January 4, 1643, in Woolsthorpe, near Grantham in Lincolnshire. He went to Grantham grammar school. When he was young, he was interested in mechanical devices than in studying. His youth inventions included, a water clock and a sundial. Isaac's father had died when he was three years old and left the family with little money. His widowed spouse soon remarried, leaving Isaac in the of his grandmother. She had three more children and widowed a second time. Since Isaac paid little attention to the family farm because he spent so much time reading, he was sent back to grammar school in Grantham. Later, in the summer of 1661, he went to Trinity College, at the University of Cambridge. He learned of the scientific revolution that had been going on in Europe through the work of Galileo, Nicolaus Copernicus, Johannes Kepler, and Ren? Descartes. Newton received his bachelor's degree in 1665. Two years later after avoiding the plague, Newton return to Trinity College where he was elected to a fellowship in 1667. Newton received his master's degree in 1668. Newton retracted much of the established curriculum of the university to pursue his interest such as mathematics and natural philosophy. Continuing entirely on his own, he analyzed recent developments in mathematics and natural philosophy. Eventually, he made discoveries that played an important part in his career in science. He became Professor of Mathematics at Cambridge in 1669. He lectured once a week on Geometry, astronomy, optics, arithmetic, or other mathematical subjects. Three years later he invented the reflecting telescope. In 1687 he published his work, ?Principia'(Mathematical Principles of Natural Philosophy), setting forward the theory of gravity. In 1696 Newton was named warden of the mint where at that time a complete recoinage and standardization of coins were taking place. When the project was finished in 1699, he was made master of the mint. He was elected president of the Royal Society in 1703 and was knighted in 1705. Newton also engaged in a vicious argument with Leibniz over the priority of the invention of calculus. The effects of the quarrel inevitably lend to his death. Newton died in London on March 20, 1727, and was honored with a burial. Accomplishments One of Isaac Newton greatest achievement was the three laws of motion. Despite these three laws, they are not related to things such as air resistance or other kinds of friction. Newton's first law states that any body moving uniformly in a straight line of in a state of rest will remain in uniform motion in a straight line or in a state of rest unless it is acted upon by some outside force. This means when in motion you will remain in motion or if in a state of rest you remain at rest unless you are move by something. When kept in motion when in motion or at rest, it is called inertia. Whenever in motion, both acceleration and deceleration require subduing the inertia of an object. Newton's second law of motion states what happens when a force is applied to a moving body. The change in motion depends on the force on the object. It also depends on the size of the force and the mass of the object. The greater the force, the greater the acceleration and the greater the mass of the object, the smaller the acceleration. Acceleration or deceleration of an object depends on the direction of the force. The effects of two or more forces moving on the path of an object are determined by means of vectors. A vector is the of force and direction in which it moves. Forces acting on a single point are called concurrent forces. Suppose a rowboat is being pulled forward along a shore of a lake by someone. At the sametime, someone else in the rowboat uses an oar to push the boat away from the shore. This is an example of concurrent forces. Newton's third law of motion states that for every action there is an equal and opposite reaction. This is a perfect example