Collaborative Health- LIfelong Learning Coursework

Shared Health-LIfelong Learning - Coursework Example They incorporate gatherings, gatherings, courses, in-administration preparing and adjusts. These instruction techniques utilize pedantic strategies which are successful at bestowing new information. Nonstop deep rooted learning is significant for various reasons. Initially, it contributes towards an incredible discussion. It is incredible to have a discussion with somebody who is educated on occasions. Deep rooted students are better at holding their own discussions. They for the most part have all the more intriguing themes and things to discuss (Alson, 2013). Besides, the world is dynamic and continues evolving. Deep rooted learning is imperative to stay aware of the changing requests of the world. In addition, long lasting learning is basic to empower one build up their capacities (Alson, 2013). Each individual is brought into the world with common capacities and abilities yet it doesn't imply that they ace these gifts the first occasion when they attempt them. Long lasting learning builds up these aptitudes subsequently filling in as a job in advancing self-improvement. At long last, deep rooted learning helps in opening one’s psyche. One can see an issue in a more extensive point of view because of their training. Staring at the TV, perusing, just as holding discussions teaches individuals about different perspectives. It might change one’s brain or may not yet comprehends that there is more than one side to each issue (Alson, 2013). All in all, the significance of long lasting learning ought to be a focus on all wellbeing experts. It can help them in different manners including self-awareness, improving their incorporation in the general public and empowering them to adjust to the changing requests of the world. Proceeding with training partners need to get, worth, and bolster contemporary standards of deep rooted

Richard Iii and Looking for Richard

Setting brings about authentic and topical information around a specific point in artistic work. Each content advances esteems import. For indiv. What's more, gatherings. RIII Wanted to demonstrate authenticity of Queen E’s rule-’validity of her case to throne’ â€Divine right Context: Relatively tranquil, S makes R a fallen angel and usurper to legitimize Eliz. Guarantee to seat. Individuals knew about RIII& Tudor’s oust of Platagenets, along these lines play is sensation of genuine occasions. Crowd identified with the qualities in the play-divine right, treatment and spot of ladies, good&evil, religion.Nobles talked in Iambic P, while hirelings talked in harsh writing, this was genuine, in this manner sounded good to the crowd, everybody adored the theater. â€Å"An genuine story speeds best, being evidently told† LFR develops from this, both show the inherent connections among settings and pieces of writings. Ruler Richard III and Looki ng For Richard straightforwardly identify with chronicled and social settings individually, social attracting on historical’s challenge to the setting in which it was written.Shakespeare’s play was created in a troublesome time of political and strict adherence. Shakespeare’s depiction of Richard centers around his underhanded and Machiavellian nature. Machiavelli’s The Prince encourages that a proficient ruler should plan to accomplish power at any expense. Richard is a Machiavel; he considers himself a villain, ‘Thus like the conventional Vice, Iniquity, I admonish two implications in single word. ’ LFR ‘While some key qualities are investigated, many are remarkable t the 1990’s’ The film and it’s quickness and availability had supplanted theater, coming about in film.Ap’s discernment was that social and cultural snags kept US from coming to acknowledge Shakespeare. Researchers have caused S to appear to be too troublesome entertainers have impression that they can’t proceed just as their Eng. Partners. AP’s juxtaposition of the two writings and their settings gave political experiences into both timespans, and the imperious/just social orders. Basic impressions of philosophies. He introduced totalitarian nature of Eliz. society and questions whether Shak. could be democratized. Qualities are realism and economism.

Nature vs. Nurture Genes or Environment

Nature vs. Nurture Genes or Environment Theories Print The Age Old Debate of Nature vs. Nurture By Kendra Cherry facebook twitter Kendra Cherry, MS, is an author, educational consultant, and speaker focused on helping students learn about psychology. Learn about our editorial policy Kendra Cherry Medically reviewed by Medically reviewed by Steven Gans, MD on August 28, 2017 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on July 01, 2019 Verywell / Joshua Seong More in Theories Behavioral Psychology Cognitive Psychology Developmental Psychology Personality Psychology Social Psychology Biological Psychology Psychosocial Psychology The nature versus nurture debate is one of the oldest philosophical issues within psychology. So what exactly is it all about? Nature refers to all of the genes and hereditary factors that influence who we areâ€"from our physical appearance to our personality characteristics.Nurture refers to all the environmental variables that impact who we are, including our early childhood experiences, how we were raised, our social relationships, and our surrounding culture. Even today, different branches of psychology often take a one versus the other approach. For example, biological psychology tends to stress the importance of genetics and biological influences. Behaviorism, on the other hand, focuses on the impact that the environment has on behavior. In the past, debates over the relative contributions of nature versus nurture often took a very one-sided approach, with one side arguing that nature played the most important role and the other side suggesting that it was nurture that was the most significant. Today, most experts recognize that both factors play a critical role.?? Not only that, but they also realize that nature and nurture interact in important ways all throughout life. A Closer Look at the Nature vs. Nurture Debate Do genetic or environmental factors have a greater influence on your behavior? Do inherited traits or life experiences play a greater role in shaping your personality? The nature versus nurture debate is one of the oldest issues in psychology. The debate centers on the relative contributions of genetic inheritance and environmental factors to human development. Some philosophers such as Plato and Descartes suggested that certain things are inborn, or that they occur naturally regardless of environmental influences. Nativists take the position that all or most behaviors and characteristics are the results of inheritance. Advocates of this point of view believe that all of our characteristics and behaviors are the result of evolution. Genetic traits handed down from parents influence the individual differences that make each person unique. Other well-known thinkers such as John Locke believed in what is known as tabula rasa, which suggests that the mind begins as a blank slate. According to this notion, everything that we are and all of our knowledge is determined by our experience. Empiricists take the position that all or most behaviors and characteristics result from learning. Behaviorism is a good example of a theory rooted in empiricism. The behaviorists believe that all actions and behaviors are the results of conditioning. Theorists such as John B. Watson believed that people could be trained to do and become anything, regardless of their genetic background. Examples of Nature vs.  Nurture For example, when a person achieves tremendous academic success, did they do so because they are genetically predisposed to be successful or is it a result of an enriched environment? If a man abuses his wife and kids, is it because he was born with violent tendencies or is it something he learned by observing his own parents behavior? A few examples of biologically determined characteristics (nature) include certain genetic diseases, eye color, hair color, and skin color. Other things like life expectancy and height have a strong biological component, but they are also influenced by environmental factors and lifestyle. An example of a nativist theory within psychology is Chomskys concept of a language acquisition device (or LAD).?? ?According to this theory, all children are born with an instinctive mental capacity that allows them to both learn and produce language. Some characteristics are tied to environmental influences. How a person behaves can be linked to influences such as parenting styles and learned experiences. For example, a child might learn through observation and reinforcement to say please and thank you. Another child might learn to behave aggressively by observing older children engage in violent behavior on the playground. One example of an empiricist theory within psychology is Albert Banduras social learning theory. According to the theory, people learn by observing the behavior of others. In his famous Bobo doll experiment, Bandura demonstrated that children could learn aggressive behaviors simply by observing another person acting aggressively. Even today, research in psychology often tends to emphasize one influence over the other. In biopsychology, for example, researchers conduct studies exploring how neurotransmitters influence behavior, which emphasizes the nature side of the debate. In social psychology, researchers might conduct studies looking at how things such as peer pressure and social media influence behaviors, stressing the importance of nurture. How Nature and Nurture Interact What researchers do know is that the interaction between heredity and environment is often the most important factor of all. Kevin Davies of PBSs Nova described one fascinating example of this phenomenon. Perfect pitch is the ability to detect the pitch of a musical tone without any reference. Researchers have found that this ability tends to run in families and believe that it might be tied to a single gene. However, theyve also discovered that possessing the gene alone is not enough to develop this ability. Instead, musical training during early childhood is necessary to allow this inherited ability to manifest itself.?? Height is another example of a trait that is influenced by nature and nurture interaction. A child might come from a family where everyone is tall, and he may have inherited these genes for height. However, if he grows up in a deprived environment where he does not receive proper nourishment, he might never attain the height he might have had he grown up in a healthier environment. Contemporary Views of Nature vs.  Nurture Throughout the history of psychology, however, this debate has continued to stir up controversy. Eugenics, for example, was a movement heavily influenced by the nativist approach. Psychologist Francis Galton, a cousin of the naturalist Charles Darwin, coined both the terms nature versus nurture and eugenics  and believed that intelligence was the result of genetics. Galton believed that intelligent individuals should be encouraged to marry and have many children, while less intelligent individuals should be discouraged from reproducing. Today, the majority of experts believe that both nature and nurture influence behavior and development. However, the issue still rages on in many areas such as in the debate on the origins of homosexuality and influences on intelligence. While few people take the extreme nativist or radical empiricist approach, researchers and experts still debate the degree to which biology and environment influence behavior. Increasingly, people are beginning to realize that asking how much heredity or environment influence a particular trait is not the right approach. The reality is that there is not a  simple way to disentangle the multitude of forces that exist. These influences include genetic factors that interact with one another, environmental factors that interact such as social experiences and overall culture, as well as how both hereditary and environmental influences intermingle. Instead, many researchers today are interested in seeing how genes modulate environmental influences and vice versa.

Human Reproductive Cloning Is Immoral And Unnatural

Amber Cady Human Reproductive Cloning is Immoral and Unnatural Westmoreland County Community College Introduction In some ways, the never-ending scientific possibilities of our time have continued to exceed our expectations. Within the 20th century there has been new medical research on stem cell research, and we have successfully completed organ transplants—more recently face and skin transplants. Without progressions like this from science, many would not be alive today. But when does science take it too far? Is there a moral reason to continue†¦or a stopping point? If so, who determines where to draw the line? Science has already made it possible to clone an animal (Solter). Now, the idea of cloning humans is within our†¦show more content†¦Another argument has individual worth. Would someone who was born naturally going to be less valuable than a person who was cloned without any defects or flaws? Of course, many ethical concerns have been connected with or lead to other concerns. For instance, the cloning debate relates to the â€Å"designer baby† debate, where p arents choose certain physical features for their child. This could lead to a domination of the cloned versus those born naturally. It is important to note that this is not a logical fallacy of â€Å"slippery slope.† Again, within our last century, medical history has shown how left unchecked, power can result in unethical experiments . One of the most important arguments against cloning has been the probability of the outcome. In past animal cloning attempts, it has been significantly shown that things do not turn out as planned. There have been both unknowns and unknown unknowns that are simply unpredictable as technology has demonstrated. Animals that have been cloned have suffered multiple birth defects, deformities, and ultimately, death (can you cite a source?). There has been inadequate success of cloning animals to ensure that it is entirely safe to perform on humans without a negative or unwanted outcome (cite). This same result could be that we are potentially leftShow MoreRelatedCloning : A Debate Of Morals And Human Rights862 Words   |  4 Pagesadvances that survives today, the dispute of cloning is ever existent as a debate of morals and human rights. People are asking if we have the right to clone humans and other animals. Cloning, the process of taking a cell from one organism, taking a donor womb cell from another organism of the same species, inserting the original cell in the donor cell, and placing the newly developed embryo inside a surrogate mother. This is an inhumane desecration of human rights and an obscene act against the naturalRead MoreThe Cloning Of Cloning For Medical Services1586 Words   |  7 PagesThe Ethicality of Cloning Cloning the latest process that could change the way we look at our environment, and the step to take us to lose what makes us unique and unparalleled. Cloning is the process of producing a genetically identical individual to the original. There are three types of cloning: gene cloning, reproductive cloning and therapeutic cloning. The disadvantages of cloning is that there had been many attempts at cloning and the results have been numerous deformations and abnormalitiesRead MoreCloning Is Ethically Immoral And Should Never Be Done Essay1924 Words   |  8 PagesReproductive human cloning is a form of asexual reproduction done in a lab, not by a sperm fertilizing an egg. This issue has been a hot topic for the past decade after Dolly the sheep was cloning in Scotland. Dolly was the first cloned mammal, whose very existence created much heat in the general public (Hansen, pg. 235, in Vaughn). Many people believe that cloning is ethically immoral and should never be done, but others think that scientific advances can greatly cure diseases. What is human cloningRead MoreThe Ethics of Cloning Essays2173 Words   |  9 Pagescould be produced (Cloning Fact Sheet, 1). This process is called cloning, and essentially it takes from one’s own genetic makeup to produce an exact replica. These exact replicas, known as clones, can benefit our society in many different ways; however, these benefits are not without great controversy and concerns. Proponents of cloning suggest that through cloning, humans can experience a greater quality of life with fewer health concerns including hunger and reproduction. Cloning consist of threeRead More Advantages of Cloning in Humans and Animals Essay1401 Words   |  6 PagesAdvantages of Cloning in Humans and Animals Cloning has existed for ages as a form of reproduction in nature. Now humans have harnessed the power to clone at will. This evokes an argument between those that support and those that do not support cloning. Among the population, there are fewer supporters than opponents. It might just be a gut reaction of humans to fear and suspect new technology, or it could be a well-founded fear. In the animal world, cloning could be used to save endangered speciesRead MoreThe Ethics of Cloning Essay example1453 Words   |  6 PagesThe Ethics of Cloning On February 27, 1997, it was reported that scientists produced the first clone of an adult sheep, attracting international attention and raising questions on the morality of cloning. Within days, the public had called for ethics inquires and new laws banning cloning. Issues are now raised over the potentially destructive side of this scientific frontier. Many people are morally opposed to the possible consequences of women being able to give birth to themselves, or scientistsRead More The Ethical and Theological Implications of Human Cloning Essay4880 Words   |  20 PagesThe Ethical and Theological Implications of Human Cloning Introduction Advances in science and technology have often caused revolutionary changes in the way society views the world. When computers were first invented, they were used to calculate ballistics tables; today they perform a myriad of functions unimagined at their conception. Space travel changed the way mankind viewed itself in terms of a larger context, the universe. In 1978, the first test tube baby was born in England makingRead More The Pursuit of Genetic Engineering Essay4075 Words   |  17 Pagesadvances in genetic engineering and cloning. These medical innovations have the potential to revolutionize our lives in numerous ways. However, the fear of controversy and the fear of the â€Å"new† could hinder and possibly halt any progress that we are capable of making. There are concerns that society should carefully consider. It is important, though, to thoroughly research and examine a topic in order to understand why there should be no fear caused by cloning and genetic en gineering one must knowRead MoreThe Ethical Debate Concerning Cloning Essay6336 Words   |  26 PagesConcerning Cloning In the year that has elapsed since the announcement of Dollys birth, there has been much discussion of the ethical implications of cloning humans. Although the simple use of the word clone may have negative connotations, many people have resigned themselves to the idea of cloning cows that produce more milk or using a cloned mouse for use in controlled experimentation. However, the idea of cloning humansRead MoreEffects of GMOS3836 Words   |  16 Pagestechnology which carries out the manipulation of genes. Production of Human Insulin: Patients suffering from diabetes are not capable of producing enough insulin. So, there arises a need for such people to obtain insulin from external sources. With the help of genetic engineering, human genes can be transferred into other mammals for the production of insulin. The mammals like sheep and goat are used as medium with human genes playing the role of software or the brain containing necessary

Aids the Silent Killer - 758 Words

AIDS: The Silent Killer Introduction AIDS is one of the most commonly known sexually transmitted diseases. The last stages of HIV, Human Immunodeficiency Virus, are what we know as AIDS, Acquired Immunodeficiency Syndrome. HIV is similar to other viruses like the flu or common cold except the human immune system cannot destroy the virus. The virus can hide in the cells of the body for long periods of time and attacks important parts of the immune system like T-cells or CD4 cells. Once HIV destroys a lot of CD4 cells the human body can no longer fight against infections and diseases. AIDS is diagnosed when the body cannot fight against disease and the patient has one or more specific opportunistic infections (OIs), different types of†¦show more content†¦In 1982, scientists discovered that AIDS remains a sexually transmitted disease. Not until 1984 did researchers conclude that AIDS is caused by HIV. 12 Although HIV has become somewhat maintainable, during the early years of the AIDs virus a vaccine seemed i mpossible, and with almost 30 years since the virus first budded its head there is still no vaccine.13 As I said earlier HIV is a virus, specifically a retrovirus. Retroviruses contain RNA for their genetic material, but once someone is infected the virus uses an enzyme called transcriptase to turn RNA into DNA.14 The virus then continues to replicate itself.15 People usually do not realize they have HIV because it is a lentivirus and there is usually a long period of time between the time of infection and the sign of serious symptoms.16 Animals have similar versions of HIV that have made good but not perfect models of how HIV works.17 HIV replicates at impeccable speeds creating billions of new HIV viruses to infect the body every day.18 The virus is able to mutate and evolve which makes it that much harder to defeat the virus.19 The CD4 cells and T cells are destroyed daily by HIV which eventually causes the immune system to regenerate or defeat infections.20 HIV is able to hide i n the cytoplasm of the cell that it infects or makes its way into the cell’s chromosomes.21 The virus does this to hide from the immune system so it will not be destroyed.22 Some drugs have been found toShow MoreRelatedHypertension : A Common Disease893 Words   |  4 PagesHypertension is a common disease that many people have heard about, but many do not understand. This â€Å"silent killer† has many causes, as well as signs, symptoms; however, there are ways to avoid it. This paper will explain hypertension in detail, including how to prevent it and how to live life to the fullest while having hypertension. Hypertension, is also known as high blood pressure (HBP). It is a common disease which mainly affects people over the age of 60. Hypertension is caused by increasedRead MoreThe Effects Of Hiv On A Healthy Lifestyle1553 Words   |  7 PagesHIV virus was in their body, they can go to a HIV medical care and receive â€Å"antiretroviral† therapy (HIV/AIDS, 2014). This means the person would receive several antiretroviral medicines that would slow down the rate of the HIV cells(HIV/AIDS, 2014). This means this will slow down how fast the HIV cells take and replace the immune cells in one’s body. This helps reduce the risk of having AIDS (the final stage of HIV). However, these medications and treatments can be expensive. Aguirre (2012) statedRead MoreAnalysis Of The Movie From The Dawn Of Film 1567 Words   |  7 Pagesreally in charge, the government and policing system that oversees the city, or the people that give it its substance. The search is on for a serial kil ler that targets young girls in a small town in Germany and it seems that the citizens are more engaged in the hunt than the police. A small tell tale sign drops hints to the audience on who the killer is. Theaters around the world begin to set up sound systems in the mid 1920s, so it is at this point where filmmakers utilize sound in their story tellingRead MorePulmonary Tuberculosis (TB) Infection1307 Words   |  5 Pagesestablishes itself in the lungs where it is called Pulmonary TB. Researchers have calculated that in 2012, 8.6 million people fell ill with TB and 1.3 million died from TB. â€Å"Tuberculosis is second only to HIV as the greatest killer worldwide due to a single infectious agent†. HIV/AIDS is the leading cause of tuberculosis cases around the world. Overall, one-third of the worlds population is currently infected with the TB bacillus. Etiology The infectiousRead MoreThe Population Of Interest Used By Charles Georges County Maryland1669 Words   |  7 Pagesblood pressure is known to have increased risk of stroke and heart disease (Sowers, Epstein, Frohlich, 2001). Hypertension in African American population is considered to be highest across the globe as compared to white population. It is a silent killer as it causes permanent damage to heart (World Health Organization, 2015). Obesity significantly contributes to hypertension in all populations. It is more prevalent in Hispanics and African American specifically in women in comparison to whiteRead MoreHuman Immunodeficiency Virus ( Hiv ) And Herpes Simplex Virus930 Words   |  4 PagesIn present day society, a silent pandemic affects countless humans. These diseases are known as sexually transmitted diseases (STDs). STDs typically spread without warning and once the diseases are contracted, it is impossible to eliminate even with assistance from advance modern medici ne. In particular, human immunodeficiency virus (HIV) and herpes simplex virus (HSV) are notorious for their capability to end a person’s way of life. These viral maladies are noted for their differences concerningRead MoreInjectable Drug Abuse1488 Words   |  6 Pagesthe menace of injectable drug abuse. Present Scenario Presently the region is infamous as a place with rampant use of drugs, high number of HIV/AIDS. According to the UNAIDS 2008 report, around 2.4 million Indians are currently HIV infected. Two lakh of whom are injecting drugs users (IDUs) and 50800 are from NE India. NACO revealed that 20% cases of HIV/AIDS epidemic here is spread by IDUs thorough contaminated needle. Analysis of state wise scenario reveals the alarming increase of drug users (DrugRead MoreA Child s Silent Killer1266 Words   |  6 Pages A Child’s Silent Killer A serious life threatening condition is sweeping over the U.S. today. This ailment can cause numerous types of cancer and is drastically increasing in incidence. The individuals affected are our children and adolescents. No this â€Å"disease† is not untreatable, it is not contagious and there is no chemo involved yet it continues to grow. Why? When asked to present a problem and a solution, what bigger a problem and easier a solution than the underrated concern of childhoodRead MoreEssay Poverty: A Silent Killer1050 Words   |  5 Pagessuch as tuberculosis and malaria. 2 The other killer disease associated with poverty is AIDS. 3 The need to earn more money often results in having more kids but with a lack of education about safe sex practices, sexually transmitted diseases run rampant in poverty stricken areas. When the parents contract HIV, HIV is passed to their newborns and the cycle continues resulting in a recursive cycle of death by AIDS. The reality is poverty is a silent killer that is ignored by most but by opening our eyesRead MoreA Comparison Of Aids And Ebola Essay1376 Words   |  6 PagesA comparison of AIDS and Ebola Doctors, as well as medical researchers, have often stated that there exist similarities as well as difference between HIV Aids and Ebola. The most notable similarity is that the two are viral conditions. Consequently, they can be compared based on characteristics common to viral diseases. The two spread through contract with body fluids of infected persons. Ebola and HIV are incurable illnesses that result in widespread stigma. However, both differ greatly despite

Salvation Free Essays

Initial thesis statement: Is salvation â€Å"by faith alone† (according to Luther) or must there be a â€Å"cooperation of faith and works† in salvation (according to the Roman Catholic tradition)? My initial answer to this question before I began this study was that of the Roman Catholic tradition, one must have the combination of both faith and works. Although faith plays a big part of salvation, I tend to believe without both works and faith you may not receive it. 2) First view: Salvation is â€Å"by faith alone† is held to be true by many people. We will write a custom essay sample on Salvation or any similar topic only for you Order Now Perhaps the most popular figure from the European Reformation, Martin Luther, noted for his doctrine of justification by faith alone was one who believed that only faith was needed for salvation, and he also held true that God provided everything that is necessary for justification. In 1528 Luther spoke out about salvation saying, â€Å"This faith alone, when based upon the sure promises of God, must save us; as our text clearly explains. And in the light of it all, they must become fools who have taught us other ways to become godly. †¦ Man may forever do as he will, he can never enter heaven unless God takes the first step with his Word, which offers him divine grace and enlightens his heart so as to get upon the right way. † Another important person who was on the side of salvation through faith alone is Paul. He uses a passage from Ephesians to support of his idea. â€Å"For it is by grace you have been saved through faith-and this is not from yourself, it is the gift of God-not by works, so that no one can boast. † He puts the emphasis on the fact that salvation is by faith alone.Paul later goes on to say â€Å"For we are God’s handiwork, created in Christ Jesus to do good works, which God prepared in advance for us to do. † That being said, we as humans are created to do good works, but reach salvation through faith alone. Yet another passage suggesting that we must only have faith is â€Å"For God so loved the world, that he gave his only begotten Son, that whosoever believeth in him should not perish, but have everlasting life. † 3) Opposing view: In contrast to Luther’s view, the Roman Catholic view states that salvation is by a â€Å"cooperation of faith and works. James 2:17-18: In the same way, faith by itself, if it is not accompanied by action, is dead. But someone will say, â€Å"You have faith; I have deeds. † Show me your faith without deeds, and I will show you my faith by my deeds. This creates a big contradictory in the bible. Although some may say deeds are not needed, in this very passage we are told without them our justification ceases to exist. One verse that simply breaks down and gives a great example of salvation through faith and works is James 2:20-26 that states: â€Å"20 You foolish person, do you want evidence that faith without deeds is useless?Was not our father Abraham considered righteous for what he did when he offered his son Isaac on the altar? 22 You see that his faith and his actions were working together, and his faith was made complete by what he did. 23 And the scripture was fulfilled that says, â€Å"Abraham believed God, and it was credited to him as righteousness,† and he was called God’s friend. 24 You see that a person is considered righteous by what they do and not by faith alone. 25 In the same way, was not even Rahab the prostitute considered righteous for what she did when she gave lodging to the spies and sent them off in a different direction? 6 As the body without the spirit is dead, so faith without deeds is dead. † In this passage are two great examples of two differen t people that receive salvation through both their work and faith in God. They didn’t know exactly what was going to happen when they listened to the word of God and did as he told them, but through faith in him they were able to do so and reach justification. They had never seen God but were put in the position to decide whether or not he existed. 4) â€Å"Critical Realist†: With respect to this doctrine I agree with the Roman Catholic tradition that salvation must have a cooperation of faith and works.The reason I still hold this to be true is that throughout the bible and other readings the support behind the idea of works and faith both being crucial to receiving salvation is much stronger than those of Luther. Luther made some great points that through faith, works is automatically going to be inclusive. He also made the point that God makes the first step to giving you all the things necessary to obtain salvation. However, I believe that if someone is faithful in the lord God and wants to be welcome to salvation, then in the rocess of life the works will come naturally to that person. On the other hand if someone is said to be faithful in God and do something harmful or bad to another person, then that so-called faithful person has gone against his/her faith in doing so causing them to fade away from salvation. I have learned from Luther’s view that there are many supportive articles and passages. I have also learned that there are great ideas in both of these arguments, however when it comes down to choosing one of the following the Roman Catholic tradition.My initial has not been strengthened nor weakened after doing the research and studying both sides. Both sides hold a firm argument, but the Roman Catholic view just seemed to catch my attention more. 5) Final Thesis Statement: This doctrine helps answering the initial question by giving information about both of the opinions and going into detailed arguments. I would say that the answer to the initial question is the to obtain salvation, one must have a combination of faith and works.Work Cited â€Å"On Faith amp; Coming to Christ, by Martin Luther. † lt;http://homepage. mac. om/shanerosenthal/reformationink/mlonfaith. htmgt;. McGrath, Alister E. Historical Theology: an Introduction to the History of Christian Thought. Oxford: Blackwell, 1998. Print. Ankerberg, John, and John Weldon. Protestants amp; Catholics: Do They Now Agree? Eugene, OR: Harvest House, 1995. Print. ——————————————– [ 1 ]. McGrath, Alister E. Historical Theology: an Introduction to the History of Christian Thought. Oxford: Blackwell, 1998. Print. [ 2 ]. â€Å"On Faith Coming to Christ, by Martin Luther. † . [ 3 ]. Ephesians 2:8-9 [ 4 ]. Ephesians 2:10 How to cite Salvation, Papers Salvation Free Essays A. Name the central character, protagonist – The main character is Langston Huges. (The author) B. We will write a custom essay sample on Salvation or any similar topic only for you Order Now Describe his/her key qualities or personality traits (complicated, stereotype, unique, round, flat, etc. ): Langston Huges is seemed as he’s full of integrity, honest to himself, sensitive, and observant. C. Who is another important character in the story, an antagonist? – Other important characters mentioned in this story are the Aunt, his friend Westley, and the pastor. II. Setting or time and place: Identify where and when the story takes place – The place is at bible church when Huges was 13 years old. III. Plot: A. What structure or design does the sequence of events follow: chronological, spatial, or order of importance? – The structure that is used in this story is chronological. A. Discuss the opening, rising action, climax (twist, surprise, turning point, and unexpected development), resolution and the denouement – The story started out in church and Huges was put into a special meeting to be seen by Jesus. You were told you were saved when you saw a light and before you knew it all the kids except Huges and Westley were remaining not being able to see the light. Westley got tired and pretended to be saved and Huges remained there for a while until he made a decision to be like Westley and got up to be pretended to be saved. Climax: When he cries late at night in bed. IV. Conflict/resolution (individual vs. individual; individual vs. society; individual vs. nature; individual vs. self? ): Huges is dealing with society so it would be individual vs society. A. What major problem is the main character faced with? Huges was attempting to be seen by Jesus and was trying to wait for a light to be saved. He’s taking things too literally. B. How does the main character attempt to solve this major problem? Langston Huges gets up and says he saw a light from Jesus. He tries to solve it by making confessions. V. Point of view: (First person, third person observer, third person omniscient? )- First person VI. Message or lesson: Can you think of appropriate expressions, proverbs or maxims that capsulate the main lesson? (Stand your ground): When you want to introduce an abstract subject to a child, you have to approach it easy and not so literal. VII. Theme: controlling or main idea: (brevity of life, loneliness, human suffering as a result of world conflicts, etc. The theme is about religion. (Religious experience as related by a child) How to cite Salvation, Papers

The European court of Justice Essay Example

The European court of Justice Paper This essay will argue how the conduct of the European Court of Justice (ECJ) supports the neo-functionalist theory of European integration. It will also show how the counter-argument of intergovernmentalism, whilst having some merits, does not explain the ECJs development as well as neo-functionalism. The principle-supervisor-agent (P-S-A) model will also be touched upon briefly. The ECJ was created under the same Treaty as the European Coal and Steel Community (ECSC) in 1951. The Treaty was signed by six states: Belgium, France, Germany, Italy, Luxembourg and the Netherlands. 1 Following the horrors of the two world wars, the ECSC was created in order to make it much more difficult for the two main protagonists, France and Germany, to begin any further wars. It was necessary for the ECSC to be scrutinised by an overriding Court to ensure that agreements were carried out. It was due to the failure of the League of Nations to monitor the rearmament of Germany during the interwar years, whilst her European neighbours were decommissioning their weapons en masse, which allowed the Second World War to be responsible for so much bloodshed. 2 The ECJ was set up as an independent judiciary to oversee the continued economic integration of the Member States (MS). Its role has since expanded into other areas, a subject which will be returned to later in this essay. The ECJ is limited in its function both politically and legally by MS shown by its more cautious approach taken during recent years. 3 The integration of Europe is described as being divided into three pillars. The first pillar is involved with economic integration and it is this pillar with which the ECJ is primarily concerned. We will write a custom essay sample on The European court of Justice specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on The European court of Justice specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on The European court of Justice specifically for you FOR ONLY $16.38 $13.9/page Hire Writer The second pillar is the formulation of a Common Foreign and Security Policy (CFSP) and thirdly, a Justice and Home Affairs (JHA) policy. These last two pillars were created within the Maastricht Treaty of 1992, broadening the scope of assimilation. The European Union was established to supersede the European Economic Community (EEC). The Treaty of Amsterdam gave more powers to the ECJ in particular with regards to the third pillar. The Court of First Instance (CFI) commenced operations in 1989 following the Single European Act (SEA) of 1986. At first the CFI was attached to the ECJ but later became a court in its own right. Following the Treaty of Nice amendments in 2004, the ECJ transferred jurisdiction of certain direct actions brought by MS against Community institutions over to the CFI and in addition cases brought by natural and legal persons (legal entities such as companies) are also dealt with there. In addition, the CFI examines appeals against decisions made by the European Civil Service Tribunal. 4 The ECJ is comprised of 25 judges, one from each MS. There are also eight Advocates-General (AGs), who give opinions on cases which have a great bearing on the final result. 5 The ECJs jurisdiction covers direct actions and references for preliminary rulings. The two main types of direct actions are infringement proceedings against MS under Article 169 (non-compliance/implementation of Community law) and judicial review (the ECJ scrutinizes new legislation to make sure it is lawful and not contradictory to existing laws). MS and private parties can also seek annulment of Community laws under Article 173. The ECJ also takes cases referred by national courts regarding Community law under Article 177, who make a ruling before passing their decisions back to the MS. The ECJ is therefore interlocutory in this capacity. The national courts are under no obligation to accept the ECJs rulings, but if they do, are bound by the Courts decision. 6 The theory of neo-functionalism was first published by Ernst Haas (1924-2003) in 1958. The trend during these post-war years was for grand theorizing and this theory did explain the technical spillover and loyalty transfer hoped for by the integrationists. The concept remained popular throughout the 1960s but waned substantially during the 1970s due to European stagnation. However, the idea has since been revived from the 1990s until the present day due to a surge in both the widening and deepening of the European Union. There are three main areas to the neo-functionalist theory, which will form the basis of this essay. Firstly, spillover. This is the idea that integration in one area will necessitate co-operation in a new area and so on. This can be in both technical arenas as well as political. Secondly, the involvement and upgrading of interest groups and loyalties to the supranational level. With the national level becoming increasingly less important, political actors will progressively start to think more at the European level. And finally, importance is attached to the role played by the elites, at both the national and the supranational level. 7 The theory of intergovernmentalism differs in its approach to the neo-functionalist theory by its belief in the dominance of the state. The theory asserts that the EU is not a supranational authority but that the MS are only involved in the EU in order to pursue their national interests. Where the actors have common goals, the European countries will join together in pursuit of these goals, these being primarily economic advancement. Interestingly, this is what neo-functionalists refer to as political spillover. Intergovernmentalists argue that EU integration is a zero-sum game and that policy areas will not touch issues of national sovereignty. However, it is clear in the case of the ECJ in particular, that national sovereignty has been surpassed on a mass scale by Community laws. It is more a theory of international relations rather than of a supranational system and is an idea based on realism. 8 Haas predicted that supranational authority would surpass the national. Political integration is the process whereby political actors in several distinct national settings are persuaded to shift their loyalties, expectations and political activities toward a new centre, whose institutions possess or demand jurisdiction over the pre-existing national states. The end result of a process of political integration is a new political community, superimposed over the pre-existing ones. 9 This has been seen in the areas of supremacy and direct effect. In 1963 in Van Gend en Loos vs. Nederlandse Administratie the Court ruled that the Treaties conferred both obligations and rights to individuals, national and Community institutions and that these rights and obligations must be upheld by national courts. This has since been known as the principle of direct effect. In 1964 in the Costa vs. ENEL case, it was decided that where Community and national laws clashed, that Community laws could not be overruled. This is known as the principle of supremacy. 10 These two main principles form the basis of the spillover theory and can no longer be separated. 11 As nations have progressively lost sovereignty over their laws,12 this is a concrete example of neo-functionalism in action. In the Francovich case of 1991 it was decided that MS would have to apply Community laws and that failure to do so would result in them having to undergo sanctions. 13 This case began the principle of state liability. National courts were now obliged to order MS to give compensation to individuals or other legal persons provided the case met the following three criteria: (1) the directive confers rights on individuals, (2) the contents of those rights are apparent from the directive, and (3) there is a causal link between the states failure to implement the directive and the loss suffered. In the adjoining cases, Brasserie du Pi cheur and Factortame III, the Court increased their original ruling to include all cases of breach by all governmental departments, whether administrative, political or judicial.

Multiple Sclerosis essays

Multiple Sclerosis essays Multiple sclerosis (MS) is a major health issue facing society today. It has affected more than 2.5 million people worldwide, including 400,000 Americans. MS is a serious chronic disease of the white matter of the central nervous system (CNS) that can render a person disabled. It usually starts between the ages of 20 and 40 years with an average onset of around 30. MS is proven to affect more women than men. Multiple sclerosis is thought to be an autoimmune disease. In MS, genetic factors and environmental factors are thought to be causes of the disease, such as, infections. MS is more common in colder climates, suggesting that geography may somehow influence a persons chance of developing it. The health profession that may be able to assist with this health issue is physical therapy to help with tightness, pain, and weakness in the muscles and joints. Physical therapy cannot cure the primary symptoms of MS, but the therapy can enable the patient to compensate for the changes brought about by this disease. The therapy can also be very helpful at lessening and even stopping the secondary symptoms. Treatments in physical therapy often can be completed in one to three office visits. The first appointment includes an evaluation and recommendations for exercises. The following appointments check the patients progress and review and expand their home program. Often, MS is active on the nerve fibers that control muscle movement. Many people with MS lose muscular strength in the arms and legs as the disease progresses. The loss can range from reduced dexterity to paralysis of an arm or leg (www.nmss.org). This is where I feel like physical therapy plays a vital role because it gives the patients hope and courage to go on with their every day lives. I feel that physical therapy will be very helpful because it would keep the patients muscles loose and able to have some range of motion. Without movem ...

The Many French Expressions With Avoir (to Have)

The Many French Expressions With Avoir (to Have) The French verb avoir (to have) is one of the most useful, flexible, and basic verbs in the French language, which probably explains its propensity to pop up in a slew of idiomatic expressions. French idiomatic expressions using avoir take you on a tour of the human condition, from feeling blue to feeling great, having charm to having the giggles, being right to being wrong. Expressions That Use Avoir Here are a few of the many expressions that use avoir. avoir ___ ans  Ã‚  to be ___ years oldavoir    infinitive to have to do somethingavoir beau infinitive despite doing, however much (one) doesavoir besoin de   to needavoir chaud   to be hotavoir confiance en   to trustavoir de la chance   to be luckyavoir du charme   to have charmavoir du chien (informal) to be attractive, have a certain somethingavoir du pain sur la planche (informal) to have a lot to do, have a lot on ones plateavoir du pot (informal) to be luckyavoir envie de   to wantavoir faim   to be hungryavoir froid   to be coldavoir honte de   to be ashamed of/aboutavoir horreur de   to detest/loatheavoir lair (de)  Ã‚  to look (like)avoir la frite  Ã‚  to feel greatavoir la gueule de bois  Ã‚  to have a hangover, to be hungoveravoir la patate   to feel greatavoir le beurre et largent du beurre  Ã‚  to have ones cake and eat it tooavoir le cafard (informal) to feel low / blue / down in the dumpsavoir lesprit de lescalier  Ã‚  to be unable to think of witty comebacks in time avoir le fou rire   to have the gigglesavoir le mal de mer   to be seasickavoir les chevilles qui enflent (informal) to be full of oneselfavoir lhabitude de   to be used to, in the habit ofavoir lheure   to have (know) the timeavoir lieu   to take placeavoir lintention de   to intend / plan toavoir mal la tà ªte, aux yeux, lestomac   to have a headache, a stomachache, eye painavoir mal au cÅ“ur   to be sick to ones stomachavoir peur de   to be afraidavoir raison   to be rightavoir soif   to be thirstyavoir sommeil   to be sleepyavoir tort   to be wrongavoir un chat dans la gorge  Ã‚  to have a frog in ones throatavoir un cheveu (sur la langue) (informal) to lispavoir un petit creux (informal) to be a little hungry / peckishavoir un poil dans la main (informal) to be lazyavoir un trou (de mà ©moire)   to have a memory loss, to have ones mind go blankavoir une dent contre quelquun (informal) to hold a grudge against someoneavoir une faim de lou p (informal) to be ravenous, famished chacun a son goà »t  Ã‚  to each his ownen avoir (familiar) to have gutsen avoir ras le bol (informal)   to be fed upil y a   noun there is, there are ___il y a period of time ___ agonavoir qu infinitive to just / only have to do somethingQuand les poules auront des dents  !  Ã‚  When pigs fly!Un tiens vaut mieux que deux tu lauras.  Ã‚  A bird in the hand is worth two in the bush.vendre la peau de lours (avant de lavoir tuà ©)  Ã‚  to count ones chickens (before theyre hatched)

Changing Roles of Women over Time Research Paper - 1

Changing Roles of Women over Time - Research Paper Example The overall impact of the research will be recollected in the conclusion. Works cited page would be added to a last page of the document. Women in present times are free and happy as compared to the women in last century or before. Over the centuries, women have been thought of a lesser creature, always under subjugation by males in the form of father, brother, husband or boyfriend. After living for centuries under the domination of men, women even tend to forget they were free. This situation started changing over last century especially in Europe and America where women started achieving more freedom. In the nineteenth century and before, women had a very less breathing space and rights. Many families and especially women were raised to behave in a certain way. It was almost a law and the way of being. Women were not given freedom since the beginning of time mainly on the pretext of being physically weak. Women were able to attend schools not very far back in time. Along the year's women rights have grown from very few to too many by now. The women had been suppressed based on self-defense, economic well being, empl oyment, sex, harassment, family, abortion and many more reasons. The movement for women’s rights arose in the early 19th century as an offshoot of abolitionism, the anti-slavery movement that declared each human being to be a self-owner. As with other abolitionists, the early feminists were individualists who drew inspiration from the Declaration of Independence and its principles of individual rights and responsibility. â€Å"The first women’s Rights convention was held in 1848 at Seneca Falls, New York. Elizabeth Cady Stanton gave a speech about the Declaration of Sentiments. During this speech, she declared that men and women are created equal. This is truly considered the beginning of the women’s movement† (Women and freedom).

Hewlett packered Strategic Choices mgt 499 Essay

Hewlett packered Strategic Choices mgt 499 - Essay Example This report aims at understanding and analysing what changes Hurd has made to organisation and how it fits in with his vision for the company (HP, 2008). When Hurd was elected as the CEO of the Hewlett Packard, he also brought about a new vision for the company. He did not concentrate on the competition that the company faces. Hurd has a strong belief which he said out in one of the meeting, where he mentioned that it is important to understand how long it might take for a company to ensure the work is done. He has always believed that HP has a very high potential to improve a lot and that a few changes will help the company grow to higher levels of success. This he has been able to achieve and show in the results. Once Mark was appointed it was within five months that the company started showing improvements. He emphasised on the no ‘Drama’ nonsense and it was felt through out the organisation. Hurd brought in a strict environment of ‘No – nonsense’ which has created a strong impact over the entire organisation. Hurd has shown the importance he gives to the company performance and has been a person who believes in numbers, spreadsheets and mainly execution. He has proved in his traits that he would not tolerate any nonsense and did not believe in pitching high visions for the company. Hurd has during the first five months of his tenure tried to calm things down in the company. The company has had an idea where the company has some earthshaking event once every 15 minutes. Hurd has tried to ensure this is firstly settled as it is not clear where this idea has been developed from. Hurd believes in executing and does not bother about what is being spoken or said. Hurd has worked really hard to ensure there is complete accountability for every employee within the organisation. Hurd emphasised that the company is in no way the same old pre – Fiorina HP. Hurd as mentioned earlier is very results

Study on the use of reflection in nursing

Study on the use of reflection in nursing In recent years, reflection has undoubtedly become an important concept in nursing, stimulating debate and influencing nursing practice and education around the world. Much has been written about the theory of reflection, the majority of which has been applied to the educational setting (Price 2004). However, the process of reflecting has been described as a transferable skill which may be incorporated into clinical practice, enabling practitioners to better understand themselves and others, and solve problems (Mantzoukas Jasper 2004). Indeed, the capability to reflect consciously upon ones professional practice is generally considered important for the development of education and, hence, for clinical expertise (Mamede Schmidt 2004). Reid (1993) defines reflection as a process of reviewing an experience of practice in order to describe, analyse, evaluate and so inform learning about practice (Reid 1993, p. 305). The nursing profession seems to advocate the need for nurses to be educated and practice in ways that develop their critical thinking, autonomy and sensitivity to others (Reed Ground 1997). Bulman (2004) contends that reflective practice may provide a means of achieving this. Within an intensive care setting, some evidence exists to suggest a strong relationship between lived experience and learning, with most critical care practitioners learning from previous experience (Hendricks et al 1996). More recently, reflection has been closely associated with the concepts of critical thinking and deconstruction. It is argued that a combination of these principles create a retrospective and prospective dimension, giving the practitioner the ability to deconstruct events, to reason the origins of situations, and to consider what has gone before and what may happen yet (Rolfe 2005). In order to be effective in practice there is a requirement to be purposeful and goal directed. It is suggested therefore that reflection cannot just be concerned with understanding, but must also focus on locating practice within its social structures, and on changing practice (Bolton 2001). This suggests that a structured approach to reflection is of benefit to the practitioner. Indeed the use of a model or framework of reflection is advocated as a tool which can aid and facilitate the practitioner in reflection, promoting a process of continuous development (Bulman 2004). Reflection is seen as a dynamic process and not a static one (Duke 2004), and thus the use of a framework which adopts a cyclic approach to reflective practice seems appropriate. One such framework is Gibbs (1988) Reflective Cycle, which is adapted form a framework of experiential learning, and uses a series of questions to guide, and provide structure for the practitioner when reflecting on an experience. Gibbs (1988) highlights 6 important areas of consideration when reflecting on a specific situation, encouraging the practitioner to consider what happened, why it happened and what could be done differently in the future. The 6 components of the Reflective Cycle are outlined below: Description What happened? Feelings What were you thinking and feeling? Evaluation What was good and bad about the situation? Analysis What sense can you make of the situation? Conclusion What else could you have done? Action Plan If the situation arose again, what would you do? It is clear that the idea of reflective practice has come to have a considerable impact on the nursing profession. This paper will focus on 2 clinical scenarios occurring within an intensive care setting. The issues raised will be discussed within the context of Gibbs (1988) Reflective Cycle. The aim in doing so is to highlight the benefits of a structured reflective process, and to identify ways in which clinical practice may be improved in the future. Scenario 1 Description The first scenario concerns the care of an elderly, critically ill patient, who was being treated in a surgical intensive care unit. At the time of this scenario the patient had been in intensive care for almost 3 weeks, having been admitted with respiratory failure requiring intubation, and displaying clinical symptoms consistent with sepsis. The patient had many other underlying medical problems, was morbidly obese, and despite antibiotic therapy was requiring high levels of inotropic and ventilatory support. Despite the patients symptoms, no definite source of sepsis had been identified. The above patient was being cared for by the author on a 12 hour day shift and at the morning ward round it was noted that the patients condition had deteriorated significantly over the previous 2 days, with increased inotrope dependence and worsening renal function. With few treatment options left to try, the consultant anaesthetist decided that the patient should have a CT scan to identify or rule out an abdominal problem as a source of the sepsis. The patient was reviewed by a consultant surgeon who felt that in view of the patients co-morbidity, surgery of any kind would not be appropriate, despite potential positive findings on CT. Knowing that a CT scan had been carried out 1 week previously with no significant findings, the author raised concerns about the benefit of such a procedure, and suggested that at the very least the patients family should be informed or consulted about the planned investigation. The patients son had been spoken to the previous day and informed that the prognosis was very poor. Withdrawal of treatment had been mentioned as a possibility in the event of no improvement in the patients condition. The son however was not informed about the scan which went ahead the same day. Transferring the patient to the radiology department for scan proved difficult. The patient was sedated for transfer resulting in a need for increased inotropes due to further hypotension caused by the sedation. The patients large size also created a problem in finding an appropriate transfer trolley to take the patients weight. Again the author voiced concerns, stating that perhaps transfer was inadvisable in view of the patients unstable cardiovascular status. The anaesthetist decided that we should proceed with the scan. The patient remained unstable throughout the transfer, requiring a further increase in inotropes on arrival at scan. Whilst on the CT table, the patient became dangerously hypotensive and bradycardic, and it seemed that cardiac arrest was imminent. Adrenaline boluses were administered, and large fluid boluses of gelofusine were also given. In view of this, the CT scan was abandoned midway, and the patient was quickly transferred back to ICU. Further adrenaline boluses were needed during transfer. On arrival back to ICU, the author was met by the patients son, who was not aware that the patient was being scanned. He was made aware of the patients poor condition. Back in ICU it was decided that further resuscitation was not appropriate. The son was present when the patient died a few minutes later. Feelings On the day these events took place, the predominant thoughts and feelings of the author were ones of guilt and inadequacy. Having considered the multiple health problems faced by the patient at this time, the author felt that the process of transferring the patient to CT scan and carrying out the scan itself may cause the patient stress, discomfort and potential danger, and ultimately be of little or no benefit. During the transfer and scanning process, the author became increasingly anxious about the immediate safety of the patient, and the potential for deterioration in the patients condition. When the patient became dangerously bradycardic and hypotensive, the authors thoughts were concentrated on trying to prevent cardiac arrest. On returning to ICU and meeting the patients son, it seemed that neither the dignity of the patient or the concerns of the family had been respected. The author felt an inadequacy and felt that the interests of the patient had not been properly advocated. The patient passed away in a distressing and undignified manner, and the son did not have the opportunity to spend personal time with the patient prior to this happening. The author felt guilty, as it seemed that the CT scan should not have happened and that the undignified circumstances surrounding the patients death need not have occurred. Evaluation Looking back on the events of scenario 1, it seems that there were both positive and negative aspects to the experience. During transfer to CT scan and the emergency situation which followed, the author felt that there was good teamwork between the different professionals involved in the care of the patient. Because of this, prompt action was taken, preventing cardiac arrest. However, it seems that this situation may have been avoided, which in turn raises many questions relating to the care of the patient. Ethically, one must question how appropriate it was to scan a severely septic, unstable patient, especially when corrective treatments would have been inappropriate in the event of an abnormality being discovered. Should the author have advocated the interests of the patient and family more forcefully? Was there a lack of communication and consensus between the critical care team? The events of this incident culminated in a clinical emergency situation which led to the patients death. Thus, the author feels that the patients clinical condition and the ethical issues and dilemmas surrounding the patients care must be examined and discussed, in the hope that lessons can be learned through the reflective process. Analysis Sepsis Most illness and death in patients in intensive care is caused by the consequences of sepsis and systemic inflammation. Indeed, sepsis affects 18 million people worldwide each year (Slade et al 2003), with severe sepsis remaining the highest cause of death in patients admitted to non-coronary intensive care units (Edbrooke et al 1999). Sepsis is a complex condition that results from an infectious process, and is the bodys response to infection. It involves systemic inflammatory and cellular events that result in altered circulation and coagulation, endothelial dysfunction, and impaired tissue perfusion (Kleinpell 2004). Dellinger et al (2004) define sepsis as the systemic response to infection manifested by 2 or more of the following: High or low temperature (>38 °C or Heart rate > 90 beats per minute Respiratory rate > 20 breaths per minute or PaCO2 High or low white blood cell count (> 12,000 or In severe sepsis impaired tissue perfusion along with micro vascular coagulation can lead to multiple organ system dysfunction, which is a major cause of sepsis-related mortality (Robson Newell 2005). While all organs are prone to failure in sepsis, pulmonary, cardiovascular, and renal dysfunction occur most commonly (Hotchkiss Karl 2003). When multiple organ system dysfunction occurs, Dolan (2003) promotes evidence-based sepsis treatment whereby patients should receive targeted organ support. This includes mechanical ventilation, renal replacement therapy, fluids, vasopressor or inotropic administration, and blood product administration, to maximize perfusion and oxygenation. In recent years new therapies have emerged which have been shown, in some cases, to increase the chance of survival from severe sepsis. Recombinant human activated protein C has been shown to have anti-inflammatory, anti-thrombotic and pro-fibrinolytic properties (Dolan 2003). In a randomised controlled trial, Bernard et al (2001) found a significant reduction in the mortality of septic patients who had been treated with activated protein C. The National Institute for clinical excellence (2004) now recommends this treatment for adult patients who have severe sepsis resulting in multiple organ failure, and who are being provided with optimal ICU support. Steroids, the use of which in ICU has long been debated, have also been shown, in low doses, to reduce the risk of death in some patients in septic shock (Annane 2000). Despite the development of specific treatments to interrupt or control the inflammatory and procoagulant process associated with sepsis, its management remains a major challenge in healthcare (Kleinpell 2004). The patient in scenario 1 was clearly in a state of severe sepsis, with respiratory, cardiac and renal failure, and receiving some of the supportive treatments mentioned above. Indeed it seems that the severity of this condition should not have been underestimated. In view of this, the ethical issues surrounding the decision to take this patient to CT scan must now be considered. Ethical Dilemmas and Consensus Ethical issues have emerged in recent years as a major component of health care for critically ill patients (Friedman 2001). Thus, caring for these patients in an intensive care setting necessitates that difficult ethical problems must be faced and resolved (Fisher 2004). Traditionally, much of the literature in biomedical ethics comes from theoretical perspectives that include principled ethics, caring ethics and virtue ethics (Bunch 2002). Although these perspectives provide an ethical awareness, which can be helpful, they do not of necessity give much direction for clinical practice. Melia (2001) supports this notion, suggesting that many discussions of ethical issues in health care are presented from a moral philosophical viewpoint, which as a consequence leaves out the clinical and social context in which decisions are taken and carried through. Beauchamp Childress (1994) identify 5 principles pertinent to decision making in intensive care. These are: salvageability, life preservation, non-maleficence, beneficence, and justice. Ethical dilemmas occur when two or more of the above principles come into conflict. The principles of beneficence (doing good), non-maleficence (doing no harm) and justice (fair treatment) are well established within the field of bioethics. Within a critical care context however, the dilemma between salvageability and life preservation becomes an important focus for health care professionals. Indeed, Prien Van Aken (1999) raise the question of whether all medical means to preserve life have to be employed under all circumstances, or are there situations in which we should not do everything that it is possible to do. This question becomes particularly relevant when a patients condition does not improve but rather deteriorates progressively. Curtin (2005) suggests that at some point in the course of t reatment, the line between treating a curable disease and protracting an unpreventable death can be crossed. In such incidences Prien Van Aken (1999) identify a transitional zone between the attempt to treat the patient, and the prolongation of dying, in which a conflict between the principles of life preservation and non-maleficence develops. These concepts seem particularly relevant to scenario 1 where the interests of the patient may have been neglected in favour of further attempts to treat the patients condition. This, in turn created a conflict between the principles of salvageability and life preservation. The decision to perform a CT scan on a patient with such cardiovascular instability and a very poor prognosis, meant that the patient was subjected to dangers and harms when there were few, if any benefits to justify this. Hence, the conflict between the ethical principles was not resolved, and the professional duty of non-maleficence toward the patient was not respected. Such conflicts and dilemmas in intensive care can be made all the harder by the availability of advanced technologies. Callahan (2003) writes that one of the most seductive powers of medical technology is to confuse the use of technology with a respect for the sanctity of life. In addition, Fisher (2004) contends that it has become all too easy to think that if one respects the value of life, and technology has the power to extend life, then a failure to use it is a failure to respect that value. This is particularly true of diagnostic technologies (such as CT scanning) which must be used with caution, especially in cases where the diagnostic information will make little or no difference to the treatment of the patient, but can create or heighten anxiety and discomfort for the patient (Callahan 2003). Medical technology is a two-edged sword, capable of saving and improving life but also of ending and harming life (Curtin 2005). Good critical care medicine carries the responsibility o f preserving life, on the one hand, and making possible a peaceful death, on the other. Callahan (2003) concludes by warning that any automatic bias in favour of using technology will threaten that latter possibility. Consensus between members of the intensive care team is also highlighted as an important issue in ethical decision making. Effective communication and collaboration among medical and nursing staff are essential for high quality health care (Woodrow 2000). Collaboration can be seen as working together, sharing responsibility for solving problems, and making decisions to formulate and execute plans for patient care (Gedney 2000 p.41). In intensive care units where ethical problems are faced frequently, care has to be a team effort (Fisher 2004). In a qualitative study, Melia (2001) found that there was a strong desire within the intensive care team that ethical and moral consensus should be achieved in the interests of good patient care, even though it was recognised that there is no legal requirement for nurses to agree with ICU decisions. Cobaoglu Algier (2004) however, found that the same ethical dilemma was perceived differently by medics and nurses with the differences being related to the hospitals hierarchical structure and the traditional distinctions between the two professions. Similarly, it has been observed that differences between doctors and nurses in ethical dilemmas were a function of the professional role played by each, rather than differences in ethical reasoning or moral motivation (Oberle Hughes 2001). It seems therefore that while the medical and nursing professions share the same aims for patient outcomes, the ideas surrounding how these outcomes should be achieved may differ (Fisher 2004). These differences have contributed to the development of the concept of the nurse as patient advocate, which sees advocacy as a fundamental and integral role in the caring relationship, and not simply as a single component of care (Snowball 1996). The role of the nurse advocate should be that of mediator and facilitator, negotiating between the different health and illness perspectives of patient, doctor, and other health care professionals on the patients behalf (Mallik 1998). Empirical evidence is sparse and philosophical arguments seem to predominate in the field of patient advocacy. There is some evidence to suggest that nurse advocacy has had beneficial outcomes for the patient and family in critical care areas (Washington 2001). Hewitt (2002) however found that humanistic arguments that promote advocacy as a moral imperative are compelling. Benner (1984) writes of advocacy within the context of being with a patient in such a way that acknowledges your shared humanity, which is the base of nursing as a caring practice (Benner 1984, p. 28). It has been argued that advocacy, at least in a philosophical sense, is the foundation of nursing itself and as such should be regarded as an issue of great importance by all practitioners (Snowball 1996). Conclusion It can be concluded that sepsis in a critical care environment is a complex condition with a high mortality rate, requiring highly specialised treatments. As such, the ethical issues and dilemmas faced by health care staff caring for a septic patient can be both complex and far reaching. It must be noted, that there can be no general solutions for such ethical conflicts; each clinical case must be evaluated individually with all its associated circumstances. A study of ethical principles would suggest that it is important that the benefits of a specific treatment or procedure are established prior to implementation, and that these benefits outweigh any potential harms or risks to the patient. The ultimate decision maker in the scenario under discussion was the consultant anaesthetist, who should have provided a clearer rationale for performing a CT scan on such an unstable patient. As the nurse caring for the patient, the author recognises that the final decision regarding treatment rested with the anaesthetist. However, the author could have challenged the anaesthetists decision further, advocating the patients interests, with the aim of reaching a moral consensus within the team. Perhaps then the outcome would have been more favourable for all concerned. Action Plan By reflecting on this scenario, the author has gained an understanding of sepsis and the potential ethical problems which may be encountered when caring for a septic or critically ill patient. As a result, the author feels more confident to challenge those decisions made relating to treatment, which do not seem to be in the best interest of the patient, or which have the potential to cause more harm than good. The author now has a greater understanding of the professional responsibility to advocate on a patients behalf, with the aim of safeguarding against possible dangers. It is hoped that this will result in improved outcomes for patients in the authors care. Scenario 2 Description This incident occurred in a surgical intensive care unit while the author was looking after a ventilated patient who had undergone a laparotomy and right sided hemi-colectomy 2 days previously. Around 10.30am the patient was reviewed by medical staff and was found to be awake and alert with good arterial blood gases, and requiring minimal ventilatory support. In view of this, it was decided that the patients support should be reduced further, and providing this reduction was tolerated, that the patient should be extubated later in the morning. In the intensive care unit in which the author works an intensive insulin infusion protocol is used (see Appendix A). This is a research based protocol which aims to normalize blood glucose levels and thus improve clinical outcomes for critically ill patients. All patients on this protocol require either to be absorbing enteral feed at à ¢Ã¢â‚¬ °Ã‚ ¥30ml/hr, on TPN or on 5% dextrose at 100ml/hr (Appendix A, note 2). The patient involved in this incident was receiving enteral feed via a naso-gastric tube, and was on an insulin infusion which was running at 4 U/hr. When it was decided that the patient was to be extubated, the author stopped the enteral feed as a precaution, to prevent possible aspiration during or after extubation. The author however did not stop the insulin infusion which breached the protocol guidelines. About 12 noon the patients blood gases showed that the reduction in support had been tolerated, and so the patient was extubated. Shortly after this the author was asked to go for lunch break and so passed on to a colleague that the patient had recently been extubated but was managing well on face mask oxygen. Returning from lunch 45 minutes later, the author found the patient to be disorientated and slightly confused. With good oxygen saturations, the author doubted that the confusion had resulted from hypoxia or worsening blood gases. The author then realised that the insulin infusion had not been stopped with the enteral feed earlier. A check of the patients blood glucose level showed that it was 1.2mmol/L. The author immediately stopped the insulin infusion, administered 20mls of 50% dextrose intravenously, as per protocol, and recommenced the enteral feed. Twenty minutes later, the patients blood glucose level had risen to 3.7mmol/L. The patient continued on the insulin protocol maintaining blood glucose levels within an adequate range. There were no lasting adverse effects resulting from the hypoglycaemic episode. Feelings When it was realised that the insulin infusion had not been stopped, the author felt a sense of panic, anticipating correctly that the patients blood glucose level would be dangerously low. Thoughts then became concentrated on raising the blood glucose level, to ensure that no further harm would come to the patient as a result of the authors mistake. Following the incident, when the patients glucose levels had risen, feelings of guilt were prominent. At this point the author realised how much worse the outcome could have been for the patient. The author felt incompetent, knowing that the patient could have been much more severely affected, or could even have died as the result of such a simple mistake. Evaluation The events of scenario 2 highlight the fact that clinical errors, while easily made, can have potentially disastrous consequences. This is especially true of those errors which involve the administration of drugs intravenously. In the interest of patient safety, it is important that all such errors are avoided. The clinical error outlined above could easily have been avoided. It seems that there was not sufficient awareness, on the authors part, of the insulin infusion protocol and the guidelines concerning the administration of insulin. As a result, the insulin protocol was not adhered to. The following analysis therefore will focus on the importance of insulin therapy in critical care areas, and will consider the safety issues surrounding intravenous drug administration. Analysis Blood Glucose Control in Intensive Care It is well documented that critically ill patients who require prolonged intensive care treatment are at high risk of multiple organ failure and death (Diringer 2005). Extensive research over the last decade has focused on strategies to prevent or reverse multiple organ failure, only a few of which have revealed positive results. One of these strategies is tight blood glucose control with insulin (Khoury et al 2004). It is well known that any type of acute illness or injury results in insulin resistance, glucose intolerance and hyperglycaemia, a constellation which has been termed the diabetes of stress (McCowen et al 2001). In critically ill patients, the severity of this condition has been shown to reflect the risk of death (Laird et al 2004). Much has been learned recently about the negative prognostic effects of hyperglycemia in critically ill patients. Hyperglycaemia adversely affects fluid balance, predisposition to infection, morbidity following acute cardiovascular events, and can increase the risk of renal failure, neuropathy and mortality in ICU patients (DiNardo et al 2004). Research suggests that there are distinct benefits of insulin therapy in improving clinical outcomes. Such benefits have been seen in patients following acute myocardial infarction, and in the healing of sternal wounds in patients who have had cardiac surgery (Malmberg 1997; Furnary et al 1999). More recently Van den Berghe et al (2001) conducted a large, randomized, controlled study involving adults admitted to a surgical intensive care unit who were receiving mechanical ventilation. The study demonstrated that normalisation of blood glucose levels using an intensive insulin infusion protocol improved clinical outcomes in critically ill patients. In particular, intensive insulin therapy was shown to reduce ICU mortality by 42%, and significantly reduce the incidences of septicaemia, acute renal failure, prolonged ventilatory support, and critical illness polyneuropathy. The length of stay in intensive care was also significantly shorter for patients on the protocol. It is unclear as to why improved glycaemic control has been associated with improved outcomes in several clinical settings. Coursin and Murray (2003) have summarized several leading hypotheses including maintenance of macrophage and neutrophil function, enhancement of erythropoiesis, and the direct anabolic effect of insulin on respiratory muscles. The potential anti-inflammatory effects of insulin have also been evaluated (Das 2001). There is also uncertainty over whether it is the actual insulin dose received per se, or the degree of normoglycaemia achieved that is responsible for the beneficial effects of intensive glycaemic management. Van den Berghe (2003) analysed the data derived from their 2001 study and have concluded that the degree of glycaemic control, rather the quantity of insulin administered was associated with the decrease in mortality and organ system dysfunction. In a follow up to Van den Berghe et als 2001 study, Langouche et al (2005) found that a significant part of the improved patient outcomes were explained by the effects of intensive insulin on vascular endothelium. The vascular endothelium controls vasomotor tone and micro-vascular flow, and regulates trafficking of nutrients and several biologically active molecules (Aird 2003). Langouche et al (2005) conclude that maintaining normoglycaemia with intensive insulin therapy during critical illness protects the vascular endothelium and thereby contributes to the prevention of organ failure and death. Whatever the reasons for improved patient outcomes, the study by Van den Burghe et al (2001) has prompted much research in this field, all of which has yielded similar results. In a similar study, Krinsley (2004) found that the use of an insulin protocol resulted in significantly improved glycaemic control and was associated with decreased mortality, organ dysfunction, and length of stay in the ICU in a heterogeneous population of critically ill adult patients. Thus it seems that with the strength of the emerging data in support of a more intensive approach to glycaemic management, insulin infusions are being utilised with increasing frequency, and are considered by many to be the standard of care for critically ill patients (DiNardo et al 2004). It is important to note that a well recognised risk of intensive glucose management is hypoglycaemia. Indeed Goldberg et al (2004) emphasise that in the ICU setting where patients often cannot report or respond to symptoms, the potential for hypoglycaemia is of particular concern. The events of scenario 2 highlight the authors error in the administration of insulin resulting in hypoglycaemia. For this reason some issues surrounding intravenous drug therapy will now be discussed. Intravenous Drug Therapy There is an increasing recognition that medication errors are causing a substantial global public health problem. Many of these errors result in harm to patients and increased costs to health providers (Wheeler Wheeler 2005). In the intensive care unit, patients commonly receive multiple drug therapies that are prescribed either for prophylactic indications or for treatment of established disease (Dougherty 2002). Practitioners caring for these patients find themselves in the challenging position of having to monitor these therapies, with the goal of maximizing a beneficial therapeutic response, as well as minimizing the occurrence of any adverse drug-related outcome (Cuddy 2000). The Nursing and Midwifery Council (NMC) (2004) identifies the preparation and administration of medicines as an important aspect of professional practice, stressing that it is not merely a mechanistic task performed in strict compliance with a written prescription, but rather a task that requires thought and professional judgement. Heatlie (2003) found that the introduction of new insulin protocols and regimes could give rise to problems, espe

Argumentative Essay Against Euthanasia Essay

Introduction Euthanasia is the practice of deliberately killing a person to spare him or her from having to deal with more pain and suffering. This is always a controversial issue because of the moral and ethical components that are involved. This paper will discuss the arguments against euthanasia. Discussion Euthanasia is clearly against the Hippocratic Oath that all doctors have to fulfil. This oath basically states that doctors must never be involved in the killing of people because after all, they have been trained to ensure that people are able to recover from their diseases and injuries. Doctors are the ones whom people entrust their lives whenever there is something wrong with their health. Thus, it is the responsibility of the doctors to always do the best they can to help people live and enjoy their lives (Cavan 48). If their patients die under their supervision, the doctors can accept this for as long as they know and can prove that they really did their best and exhausted all possibilities to ensure the survival of the patients. There are just certain instances where the disease or the injury of the patients has become so serious that it is already difficult to treat and make the patients recover. In these cases, it is unfair to blame the doctors for the death of the patients. The Hippocratic Oath helps the doctors to realize how important their responsibilities are to the people in terms of their health. This oath also provides an assurance to the people that they can trust their doctors and be assured that they will do whatever is necessary to help them deal with their health problems. If euthanasia becomes legalized, then the effectiveness of the Hippocratic Oath will be negated and the doctors can have the option of immediately resorting to euthanasia especially in difficult cases instead of trying their best until the very end. Another argument against euthanasia is that it is essentially homicide because the doctors will kill the patient even if it has been approved by the patient himself or the family of the patient. Euthanasia is not that different from murder because they both involve killing a person. The only difference is that in euthanasia, there is mercy and consent involved while in murder there is none (Tulloch 82). If murder is prohibited by law because people take matters into their own hands and kill others, then euthanasia should also be banned because doctors take matters into their own hands and kill their patients even if there is consent from the patients and their families or relatives. Lastly, the continued improvements and innovations in the field of medicine and health care make euthanasia illogical to be implemented as an option. The reason why medical experts continue to work hard to come up with improved medical technologies, medicines and treatment methods is that they want to make sure that the sick people are able to recover faster and healthy people become even healthier. All of these efforts are being done to make the society become more productive due to the presence of healthy and strong people (McDougall 26). Thus, doctors will not have an excuse for not doing their best for their patients as they already have access to the best medical technologies, medicines and treatment methods that will prevent them from having to resort to euthanasia as the only option. Conclusion There is no doubt that euthanasia needs to be banned as based on the three arguments discussed above, it does not deserve a place in human society. Doctors must never give up on their patients no matter how hopeless the situation might be. They must exhaust all options to give their patients a fighting chance to survive and

Henry The V ( Twelfth ) - 2085 Words

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Why Trade Is Good Or Bad - 982 Words

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