Cherrie Morag Heroes And Saints Essay Example | Topics and Well Written Essays - 1250 words

Cherrie Morag Heroes And Saints - Essay Example Heroes and saints represent horrible epidemics of incurable diseases birth defects among other problems that a small farming town faced; this was caused by the spraying of a pesticide that resulted in a great suffering among the people. These Political injustices arose in the American system of governance. The play seeks to sound a message to the present people that they should not count on other people, to bring changes, but should demand the help. People must learn to come together, and fight for their basic rights. This can only be achieved if the oppressed come together, and in one voice demand, their rights and this will lead to the eventual attainment of happiness and liberty. The race takes precedence in the play, once one was recognized as a Latino he or, she was taken to have a sort of disability. Race and disability are both identities that are interstitial and simultaneous. In this play, Moraga makes use of disability as a metaphor and phenomenal frame for economic oppress ion, gender, and racial discrimination. Felipe Franco is a character used by Moraga in this play, the mother to Felipe worked in the fields poisoned by pesticides when she was pregnant, due to this Felipe was born with no limbs. Here, what is seen is the use of disability put forward in lived reality and used as a metaphor dissipating oppression. An environmental justice group identified race to be a very powerful factor when it comes to the public’s exposure to toxicity. Pesticides tend to focus on the female reproductive system resulting.

Macbeth Essay Example for Free

Macbeth Essay Macbeth is a play that is written by William Shakespeare, who is a famous poet and playwright. William Shakespeare’s play Macbeth is a tragedy. The earliest account of its performance was from 1606. Tragedies contain distressing events that involve the main character or characters. These types of plays usually contain the death of a liked character or the main character or characters. Macbeth’s genre is a tragedy due to some of its themes. One theme of the play that portraits a tragic event is the theme of ambition. This is where Macbeth gets the idea of being king, but for him to become king he kills multiple times by committing a murder himself or getting others to kill on his behalf, like with the killing of King Duncan, Banquo, Lady Macduff and her child, which are tragic events due to death. The other theme is prophecy where the supernatural exists with the three witches, who give the prophecy to Macbeth about him becoming king, and that’s where Macbeth’s ambition starts, which turns into evil and also leads to tragic events. There is also the theme of reality that shows a tragic event as this leads to the death of Macbeth. Due to his belief in his own invincibility and he is killed by Macduff. A Greek philosopher called Aristotle said that all tragedies must have these characteristics: a man of high social standing, experiences a downfall, because of the flaw it is revealed only as a result of a tragic action of the narrative. Macbeth fits Aristotle characteristics by its structure of the play. It fits the characteristics by this: rising action of exposition is the very begging at the play. The complication, which is the witches’ prophecy, that leads to the rising action of the murders of people in the play. The climax is when Macbeth is the king. The falling action followers by Macbeth kills more to retain his title of king and Lady Macbeth dies and the catastrophe which is where Macbeth gets killed due to his ambition turning evil, and the resolution which is where Malcolm becomes king. The structure fits Aristotle characteristics as Macbeth the man with high social standing, experiences a downfall, which is the climax of killing for his ambition, which then, leads to a result of tragic action of which Macbeth the main character is killed. In the play Macbeth, Shakespeare uses different types of language like verse, which is written as poetry. Most of it is blank verse and rhymed couplets. He also uses prose, which is everything that is not in poetry. In the play, Shakespeare uses a blank verse, which has ten syllables with five stresses in each line. Shakespeare uses rhymed couplets in Macbeth to let the audience know it’s the end of a scene due to the fact the theatres in the 16th and 17th century did not have curtains or lightening effects like ours today due to show the end of a scene. In Macbeth act 2 scene 3 Malcolm says at the end of the scene. â€Å"But shift away: theres warrant in that theft. Which steals itself, when theres no mercy left† Here is a rhyming couplet as the pairs of line rhyme by the words theft and left, by this rhyming couplet signals the audience and actors back then that it is the end of the scene. Macbeth also has prose language in the play. Shakespeare uses prose for those characters that have comic and low statuses, as the prose structure does not have a formal structure of poetry and it can mean many manners of ideas. In Macbeth prose is used when Lady Macbeth is sleep walking in Act 5 scene 1 when she says â€Å"Yet heres a spot. † The use of prose here shows Lady Macbeth is ill and going mad by her losing her high status as she speaks in prose which is normally used by low status characters. Macbeth also uses paradox in some of his lines like with the witches saying at start in scene 1 act 1, â€Å"Fair is foul, foul is fair†. This quote from Macbeth is where the witches are saying things are not what they seem, but Macbeth writes the line differently than that in paradox, which is when it contrasts itself. Therefore, it makes the line more interesting to listen to, and it get us the audience to think more what is being meant, as it can be very ambiguous. The meaning of this line is more embraced, as it does seem things are not what it seems when the line is paradox. In Macbeth there is a lot of imagery text like with metaphors, which are something, called something else like with this quote Angels are bright still, though the brightest fell: Though all things foul would wear the brows of grace†. This is when Malcolm describes Macbeth as a fallen angle, which implies Macbeth is perfect, and cannot do wrong and shows Malcolm thinks very highly of Macbeth. When Shakespeare uses metaphors it gives a great image to the audience, as you can see it gives us a better picture of what Malcolm feelings are of Macbeth. In Macbeth imagery text is used by similes as well, which is something is described as something else like here, â€Å"And on thy blade and dudgeon gouts of blood, which was not so before. This is where the floating danger which Macbeth see in front of him turn bloody and the simile describes the blade as â€Å"dudgeon gouts of blood† which says it has lots of blood on it. When Shakespeare uses similes it gives a powerful image of what something looks like as the blade give the image of loads of blood rather than just a bit. Also Shakespeare uses personification in Macbeth which is something is described as human like â€Å"Stones have been known to move, and trees to speak. Here the environment is being described like humans saying the stones move and the trees speak which is give a very unusual image to the audience but make them more engaged to watch and listen. Macbeth is a play that is loosely based on events in the past in the year of 1040-1057 in Scotland. The events are based on a real person called Macbeth, who ruled as king in Scotland in 1040-1057. He did overthrow the previous king Duncan. The real Lady Macbeth was a granddaughter of another king, who was actually murdered by king Duncan’s grandfather. Malcolm and Donald Bain were sons of King Duncan, with Malcolm becoming king after the death of Macbeth. You can see Shakespeare’s play had the similarities of the past with the some of the character names and their position like the real Macbeth became king after Duncan who died who was king previously, but the difference is that there was no murder of King Duncan in the past like there is in the play. But I think Shakespeare would have got the idea of murder of Duncan by the real Lady Macbeth’s grandfather who was killed by the real King Duncan’s grandfather. The audiences of 1606 who watched the play would have been shocked of the death of Macbeth in the play as they see him in war and succeeding, they see him being loyal to the king, and that he could have been seen as a hero. However, when he turns evil by killing for his ambition to come true he is seen as villain in some audiences eyes, but they also see him die. This would shock the audience as their hero turned into evil and died. This may make the audience think whom they can actually trust; especially the king would at that time have been King James, in case the same happened to him like King Duncan in the play. King James of Scotland would have seen Macbeth and I think his thoughts of the play may have shocked him. It would have shocked him as he would have empathised with king Duncan, and when he see him getting killed by what he had believed to have been a loyal friend, this would of worried him. King James would rethink his loyal friends, and would have been cautious in case a loyal friend would kill him as King Duncan was killed. The witches at the start of the play would have affected the audiences as in 1611; witchcraft was seen as real and very scary, so this would have attracted the audience’s attention and spooks them a bit. In England at 1563, there were laws placed against witchcraft by Queen Elizabeth. In 1603 queen Elizabeth died, and when the play was performed I think the first scene of the witches would have irritated some people due to the fact that it was disrespecting their previous queen Elizabeth’s law against witchcraft. I think some audiences may have thought Shakespeare was a witch of some sort, for writing witchcraft into his play Macbeth, which may lead to people to think his plays was good though witchcraft was being used to write them. I also think male audiences in 1606 would have been offended by Lady Macbeth overruling and controlling a man in the play which is Macbeth, when she orders him to kill King Duncan. In 1606 women were lower and that men were leaders and were not suppose to be controlled by women. But in the play it shows Lady Macbeth controlling Macbeth which I think may made male audiences angry, for seeing a women controlling a man. I think women audiences in 1606 would have been shocked by Lady Macbeth controlling of Macbeth, as this was not reality for them. I think this play may have offended women by the fact that Shakespeare’s character Macbeth did what a women told him to do and ended up being killed, which could imply the message do not listen to women as it turn out bad. Today’s audience of men or women would not be offended by the play of Macbeth and Lady Macbeth as there is equal rights today between both genders, and that women can tell a man what to do as this is reality these day. As well audiences today would not be spooked by the witchcraft scenes as people today do not believe in witchcraft due to science proving a most of it wrong. Nevertheless, I do think the death scene of killing of Macduff’s son would have offended both audiences. A scene of a child being killed is chilling for both audiences of today and in 1606. The first scene that I will analyse that guides the audience to a tragic event is the one which is Macbeth’s soliloquy, act 2 scene 1. In this scene Macbeth imagines a dagger floating towards Duncan’s chamber where he is sleeping. Macbeths talks to himself saying â€Å"is this a dagger, which I see before me? â€Å" Macbeth cannot believe what he is seeing and questions himself. Before this scene Lady Macbeth tells Macbeth to commit murder by killing the king Duncan. This scene results in the murder of king Duncan who was a noble, great king. The language in the quote asks a question with the question mark and the word â€Å"is†, Macbeth here is imagining a dagger, which the audience could not see due to no props, so with Macbeth questioning himself shows the audience that Macbeth is imagining something. The audience listening to Macbeth question himself would put them on edge, as they would see a person having a strange hallucination in front of their eyes. The question Macbeths asks is rhetorical, as he does not expect an answer as he talking to himself. With Shakespeare using a rhetorical question here I think it helps the audience understands Macbeth is seeing something in his imagination. If this scene was staged with Macbeth more in a panic, worried and scared rather than just confused when imagining the dagger, this would make audiences more disturbed I think, and would have caused them to share some of the emoion of macbeth. Macbeth‘s character could have even cried during this scene which would have shown more emotion of fear. The audience would perceive the character of macbeth as frighted and much more hesitant to commit murder and therefore would have felt sorry for him at one point. The second scene that i will analyse that guides the audience to a tragic event is the one which features the killing of Macduff‘s child, which is in Act 4 scene 2. Before this scene happens, you have Macbeth ordering for Lady Macduff and her child to be killed. At the end of the secne the son is killed, with murderers following Lady Macduff to kill her as well. The child says to his mother which is Lady Macduff â€Å"He has killed me, mother: Run away, I pray you! â€Å". Here the child is shouting to his mother to run, so she does not get killed. The language shakespeare uses here is quite emotive. For a start the boy is shouting as by the exclamation mark, this will get the auidence attention from watching the play as its more dramatic. Its also dramatic by the words â€Å"pray youâ€Å" as the boy is asking God for her safety. This makes the audience upset here becuase as the boy who is himself doomed, does not want his mother to die, which we know it is going to happen. Its quite emotive as the boy shows affection for his mother and not wanting her to be murdered, this give the audience strong feeling of sadness. The way this scene is staged is that Lady Macduff runs off set with the murderers following her. It would be much more upsetting for the auidence to watch her be killed in front of her son. Audiences watching this scene would now have seen macbeth as even more evil as they have now watched another murder which he ordered to be committed. The most chilling scene for myself would have been the murder of Lady Macduff and her child, as i think its upsetting for seeing a child being killed. I think that Macbeth is greedy and evil has he had his ambition come true for others missfortune which i think is greedy, and doing murder of a innocent child is just plain evil in my opion. Overall i think the play macbeth has a good, easy to follow story line.

Nursing Role in Elderly Person Discharge Planning

Nursing Role in Elderly Person Discharge Planning Title: Critically discuss the role of the nurse in the planning and implementation of safe discharge for the hospitalised elderly person. 1. define your understanding of discharge planning linking it to the ageing process and the reasons why older people are more susceptible to poor discharge planning. The NHS is effectively a rationed service with a finite limit on its resources. Coast points out that one of the major limiting factors which determines the overall ability of the NHS to deliver appropriate healthcare is the number of beds which are available at any given time (Coast et al. 1996) A direct consequence of this statement is the realisation that the availability of beds in the NHS as a whole is a reflection on the bed occupancy and also the efficiency with which potential patients can get into these beds. (Costain et al. 1992). It also directly follows that the efficiency with which patients can be safely discharged back into the community (or to other destinations) has a profound impact on the overall availability of beds for new patients. A patient’s discharge is ultimately dependent on an enormous number of interdependent variables, not the least of which are their physical, mental, emotional and financial state. (Gould et al. 1995). Clearly other factors such as their support networks and the availability of appropriate carers may play a critical role. If we accept that the elderly are more likely to be dependent as a demographic group, then it is clear that all of these issues must be addressed in a timely and positive fashion before a typical elderly patient can be safely discharged from hospital. If we accept that it is not ideal or practical for all of these factors to be assessed by one healthcare professional, then best practice would suggest that it is appropriate to assimilate information that is available from a number of different agencies in order to allow a proper evidence based decision to be made. (Sackett, 1996). Common clinical practice is to invoke the help of a multidisciplinary discharge team. In the context of this essay, we should note that the elderly may face a number of different discharge options and the multidisciplinary discharge team should ideally consider all of them as appropriate. We shall not discuss them all in detail here, but provide an overview of the most commonly utilised options. Victor Nazareth (et al 1994) point to the fact that multidisciplinary discharge planning may be subsumed by expediency in some cases where some immediately attractive schemes such as discharge to a nursing home may be employed as it requires only a modest investment of planning time but effectively shifts the patient sideways out of an acute hospital bed. Such options may appear to be attractive in the short term but the implications for the elderly patient and their family can be profound if they are not explored properly prior to discharge. (Stojcevic N et al. 1996) Some centres utilise the mechanism of nurse-led inpatient rehabilitation care for the elderly who no longer require medical attention, but this does not address the issue of releasing hospital beds. (Steiner 1997) The elderly, as a group, may frequently fall into a category where they are not quite well enough or independent enough to be discharged home but yet are not really ill enough to remain in hospital. (Closs et al. 1995). In these circumstances the multidisciplinary discharge team may consider the option of a Hospital at Home which acts effectively as a transition stage where help at an enhanced level can be provided in the short term which allows the elderly patient to be safely discharged from hospital thereby releasing the bed for another acutely ill patient and the original patient can recuperate in their own home until well. (Fulop et al. 1997) Martin points to the fact that, in order to be effective, a multidisciplinary discharge team needs to ensure that appropriate facilities are put in place in a timely fashion prior to patient discharge. (Martin et al 1994). Failure to do this will render the whole scheme less than optimally effective, as the patients may not get the full range of appropriate facilities, not derive appropriate benefit and this may culminate in premature or unnecessary readmission to hospital, which is effectively a waste of resources. (Pound et al. 1995) Richards (et al 1998) has provided an exemplary tour de force of the issue with a randomised controlled trial of a large cohort of patients. Their main outcome markers were, excess mortality, quality of life, cost and patient acceptability. (Coast et al. 1998) The paper is actually both long and detailed but the main findings were that all of the parameters that were measured (with one exception), showed no adverse effect of an early discharge. The differences were that there was a greater expression of patient satisfaction with the Hospital at Home scheme. (Wilson et al 1997) 2. Anatomy and physiology of the ageing process should be briefly explained. The anatomy and physiology of aging are two subjects which are specialties in themselves and we do not presume to attempt to cover them in any detail in this essay. Russell points out that older adults are not simply a more aged version of a younger adult, they have distinct metabolic and anatomical differences that alter (for example) their nutritional requirements. As humans age their variability in nutritional need becomes greater rather than narrower. (Russell R M 2000). This type of change can be demonstrated in the fact that the older adult generally maintains their ability to absorb macronutrients well into advanced years but they loose the ability to absorb a wide variety of micronutrients. (van Asselt D Z et al. 1998) Other areas where the aging adult is demonstrably different from the young adult is in the state of their DNA which undergoes progressive oxidation from free radicals throughout life. This has repercussions with regard to a number of disease processes such as diabetes mellitus and many types of cancer. (Gilchrest B A et al. 1997) There appears to be a pre-programmed reduction in mitochondria content of tissues as they age. This is manifest in a number of clinical ways. Reduced strength and energy together with muscle wasting are frequent accompaniments of advancing years and may be one of the most significant factors in the rehabilitation of the elderly person. (Navarro A et al. 2007) 3. In this assignment it is important to define and discuss your understanding of ageism and ageist attitudes in relation to appropriate discharge planning. There are many studies which explore the subject of ageism in clinical practice. They reveal a stereotypical belief that older people are â€Å"dull, disagreeable, inactive, and economically burdensome† (Spence D L et al. 1998 These attitudes are still encountered in some healthcare professionals who may categorise lives into discrete stages as a means of charting progress. The expression â€Å"Act your age† suggests that one has to comply with the cultural (rather than biological) expectations of a stage in life. These stages are commonly associated with economic power with the 40s and 50s usually being considered to be the pinnacle of life as such people tend to have good health and are most likely to have robust financial resources. (Schroots J J F 1998) Engendering positive feelings about older people will help to produce a climate of better care for the elderly. (Puckett J M et al. 1999) In terms of the multidisciplinary discharge team, one should clearly be aware of the fact that the elderly have different needs, requirements and abilities. The belief that this equates with a lesser status and a lower level of expectation should be actively challenged. There is no rational reason to expect an 80 yr old to be less entitled to dignity and a good quality of life than a 30 yr old. If we consider the Rudd study (Rudd et al 1997) we can point to a hard evidence base to support the concept that active multidisciplinary discharge planning can actually produce an improvement in the quality of life indicators for the elderly if ageist stereotypes are actively challenged. It is fair to observe that this particular study utilised a particularly wide-ranging and apparently forward thinking multidisciplinary discharge team, but the results achieved are impressive by any analysis. 4. Explore the role of the nurse in relation to multi disciplinary team working in planning safe discharge. By its very nature, the multidisciplinary discharge team is made up of members from a number of clinical disciplines. The role of the nurse is multifactorial. Very often the nurse is the lead organiser in the team. (Lindley et al 1995). In addition to this, the professional role of the nurse often will allow a special insight into the dynamics of the caring and support networks outside of the hospital environment. It is part of the professional nursing requirement that the nurse should also act as the patient advocate (in common with other clinical disciplines) and as such should speak up for the patient if she believes that a clinical or social need is being unfulfilled. (Roper et al. 1983) 5. consider the psychological psychosocial impact that appropriate discharge planning could have on the older person and their family. Because of the increased likelihood of physical frailty, secondary morbidity and financial insecurity in this demographic group, increased dependence is more likely to be found in the elderly. This dependence is almost certain to be increased in the short term in the immediate aftermath of a hospitalisation. This will inevitably have a significant impact on the psychological well-being of both the patient and their carers. Depression is commonly seen (but less commonly recognised) in the elderly as they may struggle to cope with the demands of daily living which are also likely to be more acute after as in-patient spell. (Roper et al. 1983). Anxiety is another commonly experienced entity in both the patient and their carers as, to a degree, if planning has not been adequately carried out or inadequately explained, they may be concerned about how they are going to manage. Intuitively one can suggest that both of these factors can be significantly reduced with appropriate pre-discharge planning and intervention. (Drummond et al. 1995). 6. Appraise strategies in health promotion and rehabilitation with regard to discharge planning that can assist the older person and their family. This is potentially a vast area as there are a great many papers which have looked at the efficacy of the multidisciplinary discharge team in the discharge planning process. As illustrative examples we can consider some of them. The Mahoney paper suggests that the basic minimum input for a multidisciplinary discharge team should be a nurse and an occupational therapist and that these core workers should have the ability and discretion to co-opt additional specialists such as physiotherapists, geriatricians, social workers and psychologists as they feel appropriate. (Mahoney et al 1965) Specific types of patient discharge may require specific modifications of the basic plan. Ball produced a tour de force in his paper on discharge of the elderly from a coronary care unit, (Ball et al. 2003) where patients were allowed to go home earlier than they might normally have been allowed home but with the proviso that specific teams of specialist nurses were available to reassess the patient in their own home and consider direct readmission if required. The team referred to in this study was comparatively unusual insofar as it was comprised six nursing staff but with different skills and experience and they referred the patients to other members of the team only if they felt that more expert input was required. Many papers consider the role of the occupational therapist as a specific and vital entity in the discharge planning process. Gilbertson (et al. 2000) considered the various impacts that each individual professional had on the overall effectiveness of the eventual discharge and came to the conclusion that the impact of the discharge process (as measured by the Barthel quality of life indicator) was influenced by the input of the occupational therapist more than by any other individual category of healthcare professional. In making this statement, we should note that the authors were conducting a study into the discharge of stroke patients and therefore their findings may not be completely generalsable across the entire spectrum of patient discharge. We should also note that these benefits, which were detailed at some length in the analysis section of the trial, were only demonstrable on a comparatively short term basis. Their six month follow up after discharge showed that the patients had returned to the pre-admission status of quality of life. This, in itself, should not be considered as a negative finding as ultimately, it is one of the purposes of hospital admission to try to maintain or improve a patient’s quality of life In passing, we should also note that the Logan study (Logan P A et al. 1997) produced a similar trial structure and concluded that the Social Worker had an equally important part to play in the successful discharge of the patient. 7. your discussions should address inter disciplinary practice, relevant research and government policies (including the national service framework for older people). Discussion There are a great many studies that have been consulted in preparation for this essay. An overview would suggest that it is best practice to carefully assess, consider and then implement an appropriate discharge package for each patient. This has the advantage of minimising physical, psychological and practical trauma for the patient and their carers but also, (as Hensher observes) it can reduce the incidence of readmission in the immediate post-discharge period. (Hensher N et al. 1999) The National Service Framework for the elderly makes a number of good practice recommendations together with targets and goals that have a specific impact on the whole of the discharge process. (Rouse et al. 2001). Arguably one of the most significant recommendations is the implementation of the multidisciplinary discharge team process although there is no specific recommendation as to how the team should be comprised. A number of papers have examined the impact of the various differential structures of the teams and have come to differing conclusions. We have cited some of these already but some, such as the huge STUC trial suggest that, in specific consideration of the elderly, the prime determinant of whether a patient was going to eventually cope at home or not was their ability to transfer â€Å"successfully and reliably† from chair to chair and to a large extent, this was dependent on the availability of physiotherapy input. (STUC 1997) To conclude, we should perhaps detail the structure and facilities of the â€Å"ideal† discharge team as outlined by the STUC authors. A hospital based outpatient clinic, geriatric day hospital, generic domicillary physiotherapy and speech and language therapy, hospital outpatient physiotherapy, and the usual community resources. The maximum level of home care available in the study area to all patients was three one hour visits daily by a home help for personal care, meals on wheels, and community nurse visits for specific tasks. In addition this paper also quotes details of the additional measures that were also available for the patients:- Patients randomised to the community therapy team remained in hospital until the required package of social services care could be organised and any home adaptations undertaken whereas a store of commodes, high chairs, and toilet frames was kept by the team to expedite discharge. The patients were assessed for rehabilitation needs before discharge in conjunction with the hospital based therapists to set initial objectives and to ensure continuity of care. After discharge, patients were given a planned course of domiciliary physiotherapy, occupational therapy, and speech therapy, with visits as frequently as considered appropriate (maximum one daily visit from each therapist). In addition to all this input, the paper comments that each patient was assessed by the team on a weekly basis for up to three months to ensure optimum utilisation of resources The team’s input base was detailed as:- i) Senior physiotherapist grade 1 with neurological training, ii) Senior occupational therapist grade 1, iii) Speech and language therapist, iv) Therapy aide. v) Nurse vi) Consultant physician To conclude, we can consider a very valid point made by Haines (T P et al. 2004) who suggests that if proper multidisciplinary assessments take place in admission units as well as prior to patient discharge, it is quite possible that some cases may not actually need hospital admission in the first instance. References Ball, Kirkby Williams, (20030 Effect of the critical care outreach team on patient survival to discharge from hospital and readmission to critical care: non-randomised population based study. BMJ 2003 ; 327 : 1014 (1 November), Closs S J, Stewart L S P, Brand E, Currie C T. (1995) A scheme of early supported discharge for elderly trauma patients the views of patients, carers and community staff. Br J Occup Ther 1995 ; 58 : 373 376. Coast J, Inglis A, Frankel S. (1996) Alternatives to hospital care: what are they and who should decide. BMJ 1996 ; 312 : 162 166 Costain D, Warner M, eds. (1992) From hospital to home care. London : Kings Fund, 1992. Drummond A E R, Walker M F. (1995) A randomised controlled trial of leisure rehabilitation. Clin Rehab 1995 ; 9 : 283 290. Fulop N J, Hood S, Parsons S. (1997) Does the National Health Service want hospital at home? J R Soc Med 1997 ; 90 : 212 215 Gilbertson, Peter Langhorne, Andrew Walker, Ann Allen, and Gordon D Murray (2000) Domiciliary occupational therapy for patients with stroke discharged from hospital: randomised controlled trial. BMJ, Mar 2000 ; 320 : 603 606 ; Gilchrest B A and VA Bohr (1997) Aging processes, DNA damage, and repair. The FASEB Journal, Vol 11, 322 330, 1997 Gould M M, Iliffe S. (1995) Hospital at home: a case study in service development. Br J Health Care Manage 1995 ; 1 : 809 812. Haines T P, Kim L Bennell, Richard H Osborne, and Keith D Hill (2004) Effectiveness of targeted falls prevention programme in subacute hospital setting: randomised controlled trial. BMJ, Mar 2004 ; 328 : 676 ; Hensher, N. Fulop, J. Coast, and E. Jefferys (1999) The hospital of the future: Better out than in? Alternatives to acute hospital care. BMJ, October 23, 1999 ; 319 (7217) : 1127 1130. Lindley R I, Amayo E O, Marshall J, Sandercock P A G, Dennis M, Warlow C P. (1995) Hospital services for patients with acute stroke in the United Kingdom: the Stroke Association survey of consultant opinion. Age Ageing 1995 ; 24 : 525 32. Logan P A, Gladman J R F, Lincoln N B. (1997) A randomised controlled trial of enhanced social service occupational therapy for stroke patients. Clin Rehab 1997 ; 11 : 107 113 Mahoney F I, Barthel D W. (1965) Functional evaluation: the Barthel index. Maryland State Med J 1965 ; 14 : 61 65. Martin F, Oyewole A, Maloney A. (1994) A randomised controlled trial of a high support hospital discharge team for elderly people. Age Ageing 1994 ; 23 : 228 34. Navarro A. Boveris A (2007) The mitochondrial energy transduction system and the aging process. Am J Physiol Cell Physiol 292 : C670 C686, 2007 Pound P, Bury M, Gompertz P, Ebrahim S. (1995) Stroke patients views on their admission to hospital. BMJ 1995 : 311 : 18 22. Puckett J M, Petty R E, Cacioppo J T, Fischer D L. (1999) The relative impact of age and attractiveness stereotypes on persuasion. J Gerontol. 1999 ; 38 : 340 343. Richards, Joanna Coast, David J Gunnell, Tim J Peters, John Pounsford, and Mary-Anne Darlow (1998) Randomised controlled trial comparing effectiveness and acceptability of an early discharge, hospital at home scheme with acute hospital care. BMJ, Jun 1998 ; 316 : 1796 – 1801 Roper Logan Tierney (1983) Using a model for nursing. Edinburgh : Churchill Livingstone 1983 Rouse, Jolley, and Read (2001) National service frameworks. BMJ, Dec 2001 ; 323 : 1429. Rudd, Charles D A Wolfe, Kate Tilling, and Roger Beech (1997) Randomised controlled trial to evaluate early discharge scheme for patients with stroke. BMJ, Oct 1997 ; 315 : 1039 – 1044 Russell R M (2000) The aging process as a modifier of metabolism. American Journal of Clinical Nutrition, Vol. 72, No. 2, 529S 532s, August 2000 Sackett, (1996). Doing the Right Thing Right: Is Evidence-Based Medicine the Answer? Ann Intern Med, Jul 1996 ; 127 : 91 94. Schroots J J F. (1998) On growing, formative change, and aging. In : Birren J E, Bengston V L, eds. Emergent Theories of Aging. New York, NY : Springer-Verlag; 1998. Spence D L, Feigenbaum E M, Fitzgerald F, Roth J. (1998) Medical student attitudes toward the geriatric patient. J Am Geriatr Soc. 1998 ;16 : 976 983. Steiner A.(1997) Intermediate care: a conceptual framework and review of the literature. London: Kings Fund, 1997. Stojcevic N, Wilkinson P, Wolfe C. (1996) Outcome measurement in stroke patients. In: Wolfe C, Rudd T, Beech R, eds. Stroke services and research. London: The Stroke Association, 1996. STUC (1997) Stroke Unit Trialists Collaboration. Collaborative systematic review of the randomised trials of organised inpatient (stroke unit) care after stroke. BMJ 1997 ; 314 : 1151 8. van Asselt D Z, de Groot L C, van Staveren W A, et al. (1998) Role of cobalamin intake and atrophic gastritis in mild cobalamin deficiency in older Dutch subjects. Am J Clin Nutr 1998 ; 68 : 328 – 34. Victor C, Nazareth B, Hudson M, Fulop N.(1994) The inappropriate use of acute hospital beds in an inner London District Health Authority. Health Trends 1994 ; 25 (3) : 94 97. Wilson A, Parker H, Wynn A, Jones J, Spiers N, Jagger C, et al. (1997) Hospital at home is as safe as hospital, cheaper, and patients like it more: early results from a randomised controlled trial. Society for Social Medicine abstracts. J Epidemiol Community Health 1997 ; 51 : 593.

Proposition 187: Dont Mess With Texas :: essays research papers

Proposition 187: Don't Mess With Texas In November of 1994, Californians passed the most controversial piece of state legislation this decade. Proposition 187 was designed to stem the flow of illegal aliens into California by withholding all non-emergency medical benefits from non-naturalized citizens. Latinos turned out in record numbers to voice their disapproval, and for good reason too. The health care resolutions of Proposition 187 were products of poor reason and unsound economic judgment. The resolutions did not get the state any closer to a balanced budget, and only served to worsen the health care outlook for the future of California. It is clear that Proposition 187 was a mistake, and should not be encouraged to be repeated in Texas. The most popular reason for passage, that supporters of Proposition 187 used, was the theory that a cut in illegal health services would save state taxpayers several million dollars a year. This argument only applies to states that have a personal income tax, often used to help fund health care for the state, and when the illegal immigrants avoid paying this tax. Texas does not have such a tax, so health care is funded by the taxes that everyone in the state pays. That means that illegal aliens are paying just as much as "real Americans" are in sales taxes, gas taxes, liquor taxes, and cigarette taxes. For example, illegal aliens in San Diego, California accounted for 26.6 million dollars in health care costs in 1994 (Serb 63). Not a single person would deny that this is a lot of money, and therefore would seem to be an excellent reason to cut funding right this minute. However, the logical person has to realize how important those same aliens are to filling the state's excise tax coffers each year. Excise taxes paid by ‘illegals' were accounting for up 60.5 million in state tax alone (63). In retrospect, it hardly seems right to say that illegal immigrants are not paying their fair tax share for their health needs. It also isn't fair that "U.S. businesses need Mexican workers for low-paying jobs, but don't want them to have access to heath care while they are here" (Hudson 37). Another economically based reason, that proponents of 187-like legislation have made, is that Texans will save money by denying non-emergency care to illegal aliens. Without close scrutiny, this seems to be a claim to make the pocket book happy. After all, we would still allow the ‘aliens' the right to life saving treatments, but we would also save a bundle by cutting the little visits to the doctor for fevers, colds, and sprained ankles.

Eth/125 Gender and Sex Worksheet

Associate Program Material Gender and Sex Worksheet Answer the following questions in 50 to 150 words each. Provide citations for all the sources you use. What is gender? What is sex in biological terms? Are gender and sex the same thing? Explain why or why not? According to  Ã¢â‚¬Å"Eldis†Ã‚  (2013),  Ã¢â‚¬Å"'Gender' refers to the socially constructed roles of and relations between men and women. , while ‘Sex' refers to biological characteristics which define humans as female or male. † (1) Gender and sex are similar but they are not the same thing.I say this because a person can have the sexual characteristics of a man but still have the gender of a woman e. g. transgender. According to  Lesbian & Gay Community Services Center, Inc. (2013),†Transgender,† at its most basic level, is a word that applies to someone who doesn't fit within society's standards of how a woman or a man is supposed to look or act e. g. â€Å"Transgender† may be used to describe someone who was assigned female at birth but later realizes that label doesn't accurately reflect who they feel they are inside.This person may now live life as a man, or may feel that their gender identity can't be truly summed up by either of the two options we're usually given (male or female). (1, 2) How do gender and sex contribute to the concepts and constructions of masculinity and femininity? According to  Planned Parenthood Federation of America Inc  Ã‚  (2013),   â€Å"Culture determines gender roles and what is masculine and feminine. What does it mean to be a woman or man? Whether we are women or men is not determined just by our sex organs. Our gender includes a complex mix of beliefs, behaviors, and characteristics.How do you act, talk, and behave like a woman or man? Are you feminine or masculine, both, or neither? These are questions that help us get to the core of our gender and gender identity. † Gender and sex does help with the construct ion of masculinity and femininity, but culture plays a huge role in determining your gender e. g. a boy that raised without a father figure and had more female role models might have more feminine traits. Do our concepts of gender and sex contribute to the ways we embrace gender and sex in diversity? Yes, our concepts of gender and sex contribute to the ways we embrace gender and sex in diversity.I say this because it is the norm to act like the sex or gender we or born into or raised up to be. People are afraid of things that are not consider the norm. Do our concepts of gender and sex contribute to our understanding of sexual orientation? Explain. Yes, of gender and sex contribute to our understanding of sexual orientation. I say this because what we understand gender and sex to be is what we use to create our beliefs of sexual orientation e. g. If we don’t believe that culture has anything to do with gender, and gender is what makes a person’s sexual orientation cle ar.Then we couldn’t possibly believe that a person could be â€Å"transgender†. Works cited Eldis. (2013). Retrieved from http://www. eldis. org/index. cfm? objectId=76FB2B59-BFA2-926C-DC2B394188B4DA92    Lesbian & Gay Community Services Center, Inc.. (2013). The Center. Retrieved from http://www. gaycenter. org/gip/transbasics/whatistrans Planned Parenthood Federation of America Inc. (2013). Planned Parenthood. Retrieved from http://www. plannedparenthood. org/health-topics/sexual-orientation-gender/gender-gender-identity-26530. htm Eth/125 Gender and Sex Worksheet Associate Program Material Gender and Sex Worksheet Answer the following questions in 50 to 150 words each. Provide citations for all the sources you use. What is gender? What is sex in biological terms? Are gender and sex the same thing? Explain why or why not? According to  Ã¢â‚¬Å"Eldis†Ã‚  (2013),  Ã¢â‚¬Å"'Gender' refers to the socially constructed roles of and relations between men and women. , while ‘Sex' refers to biological characteristics which define humans as female or male. † (1) Gender and sex are similar but they are not the same thing.I say this because a person can have the sexual characteristics of a man but still have the gender of a woman e. g. transgender. According to  Lesbian & Gay Community Services Center, Inc. (2013),†Transgender,† at its most basic level, is a word that applies to someone who doesn't fit within society's standards of how a woman or a man is supposed to look or act e. g. â€Å"Transgender† may be used to describe someone who was assigned female at birth but later realizes that label doesn't accurately reflect who they feel they are inside.This person may now live life as a man, or may feel that their gender identity can't be truly summed up by either of the two options we're usually given (male or female). (1, 2) How do gender and sex contribute to the concepts and constructions of masculinity and femininity? According to  Planned Parenthood Federation of America Inc  Ã‚  (2013),   â€Å"Culture determines gender roles and what is masculine and feminine. What does it mean to be a woman or man? Whether we are women or men is not determined just by our sex organs. Our gender includes a complex mix of beliefs, behaviors, and characteristics.How do you act, talk, and behave like a woman or man? Are you feminine or masculine, both, or neither? These are questions that help us get to the core of our gender and gender identity. † Gender and sex does help with the construct ion of masculinity and femininity, but culture plays a huge role in determining your gender e. g. a boy that raised without a father figure and had more female role models might have more feminine traits. Do our concepts of gender and sex contribute to the ways we embrace gender and sex in diversity? Yes, our concepts of gender and sex contribute to the ways we embrace gender and sex in diversity.I say this because it is the norm to act like the sex or gender we or born into or raised up to be. People are afraid of things that are not consider the norm. Do our concepts of gender and sex contribute to our understanding of sexual orientation? Explain. Yes, of gender and sex contribute to our understanding of sexual orientation. I say this because what we understand gender and sex to be is what we use to create our beliefs of sexual orientation e. g. If we don’t believe that culture has anything to do with gender, and gender is what makes a person’s sexual orientation cle ar.Then we couldn’t possibly believe that a person could be â€Å"transgender†. Works cited Eldis. (2013). Retrieved from http://www. eldis. org/index. cfm? objectId=76FB2B59-BFA2-926C-DC2B394188B4DA92    Lesbian & Gay Community Services Center, Inc.. (2013). The Center. Retrieved from http://www. gaycenter. org/gip/transbasics/whatistrans Planned Parenthood Federation of America Inc. (2013). Planned Parenthood. Retrieved from http://www. plannedparenthood. org/health-topics/sexual-orientation-gender/gender-gender-identity-26530. htm

How have the values of the boys changed by Chapter 10? Essay

In chapter 10 there is a shift of values form a democracy to a dictatorship. Following Jack’s rebellion most of the boys have left camp and joined forces with Jack, now known as ‘The Chief’, at Castle Rock. Since they first landed on the island as innocent school children a lot has changed, as many of the values which they once held are disregarded on account of them being stranded on the island. When Jack first arrived on the island he was the eldest and naturally assumed that it was his destiny to be in charge. As head choir boy, Jack has been set aside from the rest, â€Å"golden cap badge† and it is obvious that back home he was very important and was given the authority in terms of the choir. Due to the control he exerts we can understand that prior to landing on the island, Jack was a leader who ruled by fear. When they first meet the rest of the boys it takes the combined efforts of begging â€Å"But, Merridew. Please, Merridew †¦ can’t we?† and a boy fainting for him to consider the two groups merging. Here we can see Jack’s instant aversion to situations where he is not fully in charge. This means that often times he would prefer separatism, as we see when he distinguishes the Hunters, to co-habitation where making compromises and accept other people’s points of view. We know that Jack doesn’t like this because before he goes to form his own tribe he says † It’s time some people knew they’ve got to keep quiet and leave deciding things to the rest of us.† Jack was at first in agreement with the request for democracy but this was only because he was convinced that he would win the vote. When he realises that he has in fact lost out to Ralph he â€Å"blush[es] with mortification†. He is not sure whether to stay or go when he is offered charge of the Hunters. By taking over the hunters Jack tries to gain favour with the boys because he thinks that the boys will become dependent on him. However the longing for rescue and the fact that the tool for rescue is Ralph’s brainchild means that Ralph continued to have the upper hand on Jack. Despite this Jack still tries his best to prove himself to the boys. For example, at first like many of the boys on the island Jack is unable to kill however now, behind the mask, he kills to show his power and control over the lives of others. However William Golding makes the death of Simon strange, in that Jack does not take responsibility and is almost afraid of what he has become. â€Å"Roger gathered a handful of stones and began to throw them. Yet there was a space round Henry, perhaps six yards in diameter, into which he dare not throw. Here, invisible yet strong, was the taboo of the old life. Round the squatting child was the protection of parents and school and policemen and the law.† Roger is portrayed to be a very cruel character and this quotation shows the beginning if the boy’s falls into uncivilisation however at this early stage the boys still act in a civilised nature. However like many of the older boys Roger chooses to test the water and soon enough the urge to destroy overcomes him. Despite this Roger still feels restricted by â€Å"parents and school and policemen and the law†-the adults who make the rules and make sure they are followed. However before long, Roger and most of the other boys lose their respect for values and morals, and violence, torture, and murder break out as the savagery becomes the distinctive sway i n the group At first Ralph is esteemed and supports all the boys on the island due to the way that he has kept a level head despite being on tropical island. His strong-willed nature means that when others break down he is still solid. However with talks of beasts and mutiny Ralph becomes disgruntled and begins to think of home a lot. Towards the end of the book despite having the symbol of democracy, the conch he feels that that this is useless against Jack’s oppressive regime.

Congested Heart Failure Case Study Essay

History: Martha Wilmington, a 74-year-old woman with a history of rheumatic fever while in her twenties, presented to her physician with complaints of increasing shortness of breath (â€Å"dyspnea†) upon exertion. She also noted that the typical swelling she’s had in her ankles for years has started to get worse over the past two months, making it especially difficult to get her shoes on toward the end of the day. In the past week, she’s had a decreased appetite, some nausea and vomiting, and tenderness in the right upper quadrant of the abdomen. On physical examination, Martha’s jugular veins were noticeably distended. Auscultation of the heart revealed a low-pitched, rumbling systolic murmur, heard best over the left upper sternal border. In addition, she had an extra, â€Å"S3† heart sound. Using the internet, do any applicable searches to give a reasonable scientific explanation to the questions below. Understanding figure 20-13 in your textbook also may add some insight to these questions. You may find the following links useful to aid you answering these questions: Congested Heart Failure Paper ABC of Heart Failure What is causing this murmur? Perhaps there has been narrowing of Martha’s pulmonary semilunar valve which is located between the right ventricle and the pulmonary artery. The closing of this valve is heard best over the left upper sternal border. As stated above, this is where auscultation of the heart revealing a low-pitched, rumbling systolic murmur. A murmuring sound is heard due to the high resistance to blood being pumped through. 2) What is causing her â€Å"S3† heart sound? An S3 sound is an extra sound indicating abnormal blood pressure within the heart, namely against the ventricle walls during diastole (relaxation). Blood seems to be flowing too rapidly into the ventricles during diastole. She may have ventricular walls that have become hardened and thus not relaxing as needed in order to fill with ease. As the blood quickly flows in, it will hit the hardened walls, creating an extra sound. In congestive heart failure, preload and contractility are major factors in the improper functioning of the heart as a pump. 3) Is her history of rheumatic fever relevant to her current symptoms? Explain. Rheumatic fever caused by Group A Streptococcus bacteria may cause damage to heart tissues including valves. Overtime, congestive heart failure may have developed. However, the pulmonary semilunar valve seems to be the issue in this case study, whereas rheumatic fever normally affects left heart tissue. 4) A chest X-ray reveals a cardiac silhouette that is normal in diameter. Does this rule out a possible problem with Martha’s heart? Explain. No, a normal diameter of a cardiac silhouette does not rule out a problem with Martha’s heart. The heart adapts and will compensate for damage in order to still function optimally. The right ventricle, in this case, will become stronger in order to push the same amount of blood (stroke volume) through the narrowed pulmonary semi-lunar valve. This thickening doesn’t necessarily change the inner diameter. 5) You examine Martha’s abdomen and find that she has an enlarged liver (â€Å"hepatomegaly†) and a moderate degree of ascites (water in the peritoneal cavity). Explain these findings. The increased resistance of blood flow through the pulmonary semilunar valve from the right ventricle backs up the pressure of blood flowing into the right atrium. This back flow pressure builds up in the body as systemic pressure, increasing hydrostatic pressure which increases fluid build-up (ascites) in the peritoneal cavity and liver, enlarging the liver. 6) Examination of her ankles reveals significant â€Å"pitting edema.† Explain this finding. Fluid builds up in the interstitial space of her extremities (i.e. ankles) due to the changes in the hydrostatic pressure caused by the back-flow pressure originating in the heart. 7) She is advised to wear support stockings. Why would this help her? Support stockings could be used. I worked at a Med-Spa and the doctor would advise his patients to wear compression hoses after laser vein treatments if there were no other individual contraindications of use. Compression hoses prevent fluid from accumulating in surrounding tissues and interstitial spaces by directing excess fluid into other blood vessels and the lymphatic system. 8) Which term more accurately describes the stress placed upon Martha’s heart — increased pre-load or increased afterload? Increased after-load describes the stress placed upon Martha’s heart. Afterload is the pressure that the heart pumps blood against. There is increased pressure associated from left ventricular damage and narrowing of the semi-lunar valve in Martha’s diseased state, leading to the resistance of blood flow. 9) What is the general term describing Martha’s condition? Right-sided congestive heart failure is the general term for Martha’s condition. 10) How might Martha’s body compensate for the above condition? Martha’s sympathetic nervous system will begin to predominate, causing constriction of blood vessels so that important organs will regain necessary delivery of blood. Also, heart rate and stroke volume affect cardiac output. In Martha’s case, cardiac output is affected due to a decrease in stroke volume. Higher resistance to blood flow decreases the amount of blood pumped by her ventricles, so the heart compensates in order to function optimally. Increased contractibility or the increased rate at which her heart pumps is indicative of this compensation. 11) Martha is started on a medication called digoxin. Why was she given this medication, and how does it work? Digitoxin (digitalis) increases the strength and length ventricular contraction which slows heart rate by reducing sympathetic activity. Her right ventricle will then pump more efficiently. 12) 12. Two weeks after starting digoxin, Martha returns to the physician’s office for a follow-up visit. On physical examination, she still has significant hepatomegaly and pitting edema, and is significantly hypertensive (i.e. she has high blood pressure). Her physician prescribes a diuretic called furosemide (or â€Å"Lasix†). Why was she given this medication, and how does it work? Digitoxin is commonly given in conjunction with a diuretic. The use of a diuretic manages edema, a symptom of congestive heart failure. Increased urination will rid her body of excess ions, reducing the amount of fluid in the interstitial spaces.