“Hard Lives” in College

Justifying â€Å"Hard Lives† in College In the article â€Å"The Myth of Inferiority†, the author, Allan Culpepper, talks about people’s point of views about community college students. Unlike most universities or colleges, community college students are older, first generation students, work multiple jobs, and/or have to take care of dependents. Financial stability is the main issue community college students face. Yes, they do have â€Å"hard lives†, but does that justify for excessive absences, rewrite opportunities, and late papers? Hard lives† do not justify excessive absences; however, they do justify rewrite opportunities and late papers. â€Å"Hard lives† do not justify excessive absences simply because they will get too far behind and miss an excessive amount of notes. Along with Mr. Culpepper, â€Å"I have also found students who manage to complete a full load of classes successfully while working three jobs, caring for elderly, and coping with chronic illness†¦Ã¢â‚¬  (330). As in most universities or colleges, these students are already given a certain amount of days for absences.In most cases, six absences are allowed for the semester which is two and half weeks of class. If the students save these absences for emergencies, six absences are more than enough for one semester. Rewrite opportunities are justifiable for students having â€Å"hard lives†. Unlike students who have plenty of time to write papers, some students have long, late work hours. Therefore, these students are not capable of writing their papers to their full potential. Another reason it is justifiable is because some of them have dependents they need to take care of.This makes it hard to find time throughout the day to write their papers. Then again, Mr. Culpepper said, â€Å"many students choose community college for a variety of good reasons such as cost†¦ and flexible schedule† (330). With flexible schedule they do not have an excuse. Bringing in late papers is justifiable for students with â€Å"hard lives† to some extent. Unless students plan to be â€Å"sick†, they never know when they are going to actually be ill. Also, most community students have multiple jobs working many late hours.Since financial stability is their number one priority, they may need to work a double on school days; especially if they are low on financial income. This means they would not be able to go to class and turn in their papers on time. Under these circumstances, there should be an excuse to turn in late papers. â€Å"Student will be students, wherever they are. † (303). However, there should be a limit on the number of late papers you are able to turn in and the consequence of point deduction after so many days.There should be no excuse for excessive absences; however, there should be reasonable understanding for certain situations that are justifiable for rewrite opportunities and late papers. Agreeing with Mr. Culpepper, community college students should receive the same expectations as universities and private colleges. Mr. Culpepper said it best, â€Å"I have learned to maintain a high standard, expect students to meet them, and do whatever I can to help students meet those expectations† (331).Works Cited Culpepper, T. Allen. â€Å"The Myth of Inferiority. † The Norton Mix. Ed. Judy Sieg. New York: Norton, 2012. 327-332.

Social class is linked to educational achievement

It has been suggested that societal category is linked to educational accomplishment. The lower the socio-economic position of a household, so it is said, follows a form of low educational accomplishment. Conversely, kids from so called, center and upper category households in general tend to be higher winners academically than their on the job category equals, and are more likely to go to university. Research suggests that kids with parents in extremely paid professions are more likely to obtain higher classs in their GCSEs, take A degrees and so go on onto university than kids with parents in low paid manual employment. Therefore, it could be argued that a kids ability to go socially nomadic remains inactive, as it is likely that they will go on along the way of their parents. ( REFERENCE ) The research undertaken for this undertaking seeks to find if the same applies to maturate pupils either go toing Bath Spa University or maturate alumnuss known to the research workers. The research will try to look into whether or non there is any correlativity between parental societal category and that of the mature pupils and graduates educational accomplishments. The research will besides research the impression of societal mobility and seek to detect if the topics of the survey believe that they have or will, accomplish societal mobility due to their educational accomplishments. The consequences of this survey, if the result is favorable, could perchance assist to promote other mature pupils from lower socio-economic backgrounds into higher instruction. However, if the consequences seem to hold with old research, which argues that lower income households feel that the costs outweigh the benefits of higher instruction, and hence would non see university, so the research may hold an inauspicious affect and merely reenforce the fact that people feel that a university instruction is merely for the wealthy. The consequences of the survey could enable universities to nail jobs mature pupils face, which could enable them to explicate schemes to promote pupils from lower socio-economic backgrounds to use for a topographic point at university. However the consequences could reenforce the generalization or old research which suggests that kids from working category households are less likely to travel to university and hence deter people from even trying to travel through the application procedure. ( mention ) The consequences could besides assist to detect replies to go on the procedure of shuting the spread between societal category and educational accomplishment. However, if the findings suggests the opposite to already published research, eg, if our findings argue that societal category has no bearing on the educational accomplishment of the topics of the survey, so inquiries would necessitate to be asked as to why our survey appears to differ from the norm. ( mention ) Hypothesis. Does societal category affect educational accomplishment? This research will try to set up a nexus between societal category and educational accomplishment. As already stated in the debut, research ( current and historical ) suggests that low socio-economic position constantly leads to low educational accomplishment. The undermentioned research is intended to look into whether this generalized impression is true of the topics who volunteered to be interviewed for this undertaking. The variables to be measured will be that of ; the societal category of the topics parents and the educational accomplishments of the topic. Following on from this the research will besides try to set up whether or non the single topics have, or expect to accomplish, societal mobility due to their educational accomplishments. Literature reappraisal There are many pieces of research which have attempted to reply the inquiry ‘does societal category affect educational accomplishment ‘ . Assorted theories have been introduced as to the grounds why kids from lower societal categories appear to make less good academically than their more advantaged equals and as to why at that place seems to be a big spread in the consumption of university topographic points from people from low socio-economic backgrounds. Connor et Al ( 2001 ) found that there was a continuing and â€Å" long standing form of societal exclusion † of lower category groups in higher instruction. Their research suggests that there are legion factors which lead to the under-representation of the lower categories, including ; household background and support, and fiscal considerations. They besides make the interesting point that over the last 50 old ages statute law has been put in topographic point to guarantee that educational patterned advance is based on ability instead than wealth. However, their research seems to propose that the statute law has non been successful in accomplishing its purposes. Research conducted by Goldthorpe ( 1996 ) agrees with the findings of Connor et Al. goldthorpe provinces that the differences between societal category and educational attainment have changed really small since the beginning of the 1900 ‘s. It is suggested that kids from lower category households have remained more likely to go forth the instruction system once they have finished their compulsory instruction than their more financially advantaged equals. This could be due to the fact that parents with a higher economic position appear in general to put a higher value on instruction than the parents of kids from the lower categories. It has been suggested that the lower categories place more value on vocational and on the occupation developing instead than higher instruction. There has been research such as that by bowles and gintis ( 1976 ) that suggests that instruction is a signifier of ‘cultural reproduction ‘ . They argue that the dominant or higher categories use their power to guarantee ‘social structural reproduction ‘ . Therefore, it is suggested that societal control is maintained by the educational system by working category inequality. In practise schools would non lawfully be allowed to consciously discriminate against kids from lower societal categories. However, there may be unconscious favoritism. For illustration, kids are praised and given inducements such as certifications for stand outing in the schoolroom. Yet the kids more likely to stand out are those from more advantaged households who are able to afford the excess resources such as excursions and books. Following on from this, Goodwin and le expansive ( 1987 ) suggest that those households in greatest demand are non the mark of educational subsidies. They a rgue that province support for instruction by and large merely helps the more financially advantaged households maintain their ability to come in higher instruction. However, although it could be argued that statute law, schools and support are all colored towards households of higher socio-economic position, Gambetta ( 1987 ) suggests that a kids ability to come in higher instruction is all due to their parents. Gambetta found that the picks parents made comparative to their kids ability was based on their perceived societal category. Therefore working category households were less ambitious with respects to their kids instruction than those of higher socio-economic position. As the above research suggests that societal category affects educational accomplishment in kids, it so has to be asked ‘does the same apply to adults? ‘ A study on higher instruction and societal category ( Bolton 2010 ) shows historical informations refering how societal category affected university engagement in the early twentieth century. The information shows that the per centum of entrants with male parents who have a manual business, and hence considered working category, were as follows ; 1928-1947 23 % 1955 25 % 1961 25 % As the authorities have introduced statute law to assist shut the spread between societal category and entryway to higher instruction at that place should perchance be additions in these Numberss in more recent times. However, informations from UCAS shows that in 2001 the Numberss were much the same as those shown supra. In 2001 merely 27 % of entrants were from a working category background. However, the study concluded that ; ‘since the mid 2000 ‘s ; immature people from disadvantaged countries are well more likely to come in higher instruction ‘ ( Bolton 2010 ) . However, a research paper entitled ‘ Social Class and Higher Education ‘ ( Connor et al 2001 ) commissioned by the Department for Education and Skills ( DfES ) suggests that there are many factors every bit good as societal category that affect possible pupils determinations to come in into higher instruction. The research workers province that ; â€Å" pupils from lower societal category backgrounds take into history a wider scope of issues than their opposite numbers in higher societal category groups when taking the determination to come in higher instruction † . The countries of concern for those from a working category background included the fiscal facet, nevertheless, they besides raised issues such as experiencing unable to get by with the work load, the application procedure and personal issues such as working during term clip and besides set uping child care. However, the chief issue does look to be that of a fiscal nature. Those from the lower classed either would instead get down paid employment every bit shortly as possible after go forthing mandatory instruction or they feel that the cost of analyzing at university outweighs the benefits. Despite the chief findings of this study being reasonably negative towards higher edication by the lower categories there were some positive facets. The participants of the survey from the lower categories who had decided to come in university did so with the belief that the makings that they would finally derive would intend that their calling preospects and future gaining possible were raised well. The little graduated table research undertaking which follows is slackly based on old research into societal category and higher instruction. If the published research is right so we should happen that societal category does in fact affect educational accomplishments in grownups. If our research corresponds with others, so we should happen that merely about 25 % of our participants who are from working category backgrounds have entered into higher instruction. Methodology. The focal point of this survey was to find whether or non socio-economic position had any impact on educational accomplishment. A series of inquiries were devised to be delivered in either a face to confront interview or by manner of an electronic mail questionnaire, depending on which was more practical, due to distance and clip restraints. Those topics who were asked to answer via electronic mail were asked to react in every bit much item as possible instead than merely yes or no replies. The purpose of the inquiries asked was to find the effects of the topics parents societal category and educational accomplishment on that of their kids. The initial inquiries asked were general inquiries to find the age, sex and location of the interviewee. This was followed by a set of inquiries to set up parental educational accomplishment and societal category. The inquiries besides attempted to set up whether or non their parents attitude towards instruction had any impact on the topics educational picks. The concluding set of inquiries sought to detect the educational accomplishments of the topic and their current or future socio-economic position. aˆÂ ¦aˆÂ ¦aˆÂ ¦aˆÂ ¦.of the topics are undergraduates and aˆÂ ¦aˆÂ ¦aˆÂ ¦aˆÂ ¦ aˆÂ ¦aˆÂ ¦aˆÂ ¦aˆÂ ¦of the questionnaires were completed by manner of face to confront interviews. Another aˆÂ ¦aˆÂ ¦aˆÂ ¦aˆÂ ¦aˆÂ ¦.were conducted via electronic mail questionnaire. The interviews and questionnaires took about 10 proceedingss to finish. All of the persons who were asked to react did so. The determination to utilize interviews and questionnaires was taken because we felt that we could acquire a more unequivocal reply to our hypothesis this manner instead than a simple questionnaire that merely needed yes and no replies. However, there are restrictions when utilizing this method for research. Some of the inquiries which were asked were unfastened to sentiment and besides self-perception. Some of the information was besides 2nd manus as we had asked for information about parents. Once once more, this may non be entirely dependable as the topics were non asked for unequivocal cogent evidence of either their parents, or their ain educational accomplishment or societal position. Therefore, the research is based on the premise that the topics were true in the answering of the inquiries. There are other restrictions. The research was really little graduated table and therefore it could be argued that the sample of topics is non representative of the general population of under alumnuss and alumnuss in the United Kingdom. However, as a usher it could take to similar inquiries being asked on a larger graduated table to enable the theory that societal category does or does non hold an consequence on educational accomplishment, depending on the findings of this research, to be proved or disproved. With respects to the ethical considerations of this research, those who participated were ensured namelessness at all times. No names have been used in the write up of the research and merely the general location and age of the particiants have been documented. All participants were made aware of the grounds for the research and how the information they gave would be used. They were besides informed that a transcript of the finished research undertaking would be made available to them for their blessing, if they so requested, before it would be handed into the university. They were besides made aware that they could retreat their part at any clip before the entry day of the month.Findingss and decisionThe chief intent of our research undertaking was to find whether or non a on the job category background created a barrier to higher instruction for grownups in the same manner as antecedently mentioned research suggests it has on kids. The research argues that kids of mandatory school age are at a disadvantage educationally if they are from low income households and we wanted to look into as to whether or non this translated into maturity. Our findings seem to propose that low socio economic position does non restrict the opportunities of grownups come ining into higher instruction. Seven out of the 12 subjects interviewed categorised themselves as coming from a working category background and six of them had either gained grades or were analyzing for a grade at the present clip. This translates to about 86 % of people from lower category background come ining into higher instruction, whereas old research has stated that the norm is about 25 % . However the contradiction is likely due to the little graduated table of the undertaking which was undertaken. The other five participants considered themselves to be from a in-between category background and all five had enetered into higher instruction. Therefore, our little graduated table research undertaking seems to propose that there is no disadvantage in a individuals ability to derive makings from university or other higher instruction constitutions based soley on their on the job category background. It could be said that it is an persons ain motive and aspirations, or deficiency of both, that has the most impact on their educational accomplishment, instead than their on the job category background. One of the topics interviewed declared that her parents had ; â€Å" influenced me to travel out and accomplish what I want careless of category, money or background † . Bing at university as a mature pupil I felt that the result of our research would in fact find that category did non find educational accomplishment. However, it is a really little graduated table undertaking and could non be perceived to be dependable informations which reflects the educational accomplishments based on category for the state as a whole. The information could be seen as colored and undependable as eleven out the 12 subjects interviewed had been, or were presently at, university. Those interviewed were besides known to the research workers. If there had been a wholly random sample of topics from a shopping promenade for illustration at that place would hold perchance been a really different result. I feel that to do the research valid and dependable it would necessitate to be done on a much larger graduated table. The topics interviewed should be selected at random throughout the united land to enable a broad assortment of people and therefore a varied choice of repli es, which would perchance in bend produce more valid and dependable informations which would more likely correspond to old research in the same field.

Venipuncture Case Study Example | Topics and Well Written Essays - 1000 words

Venipuncture - Case Study Example This case study focuses on venipuncture. A number of aspects emanate from this nurse’s experience. It is a good practice to talk to a patient and offer the assurance regarding the medical procedure. No evidence of this is present in the situation. Additionally, nurses ought to position the patient’s arm in the most favorable position. In venipuncture, this is supposed to be a straight line. Once again, it appears that the nurse skipped this step. A limit exists on the number of attempts that a nurse can perform on a patient. If two attempts have failed, one is meant to consult a senior practitioner for assistance. This nurse tried to do everything on her own. Caregivers need to exercise judgment when selecting the suitable vein for blood collection. It is likely that this professional did not choose the best vein to carry out the draw. She did not wait for the vein to become visible as this hampers success of the procedure. The pressure with which she inserted the needl e could also have caused the problem. This paper declares that nurses must eliminate risks that stem from the environment. They must adhere to preset standards that govern the procedures they are performing. The competency statement also states that infection control must be kept at a minimum. Nurses must use ergonomics into to protect patients and themselves from injury. Safety should be top in their priority list, and this should involve adherence to legislative procedures. The caregiver ought to provide comfort to the patient by adjusting external parameters to meet these needs. This objective must be maintained throughout the therapeutic intervention. In this case, the nurse was meant to administer a procedure in a safe and secure manner, but she fell short. According to the competency statement, the nurse is supposed to adjust medical procedures in response to a patient’s comfort requirements. Clearly, this nurse did not abide by such a principle. Furthermore, she was meant to prioritize the patient’s safety. Making four attempts in venipuncture is dangerous to a patient’s safety. It could cause health complications like tendon, nerve or arterial injury (Adams & Elliot, 2006). The gentleman may have encountered some bruising. It might even lead to excessive bleeding, fainting and even spark of an allergic reaction (Walther-Wenke, 2008). Competency statement 9.5 also states that the nurse must adhere to the principles of ergonomics in order to minimize injury. These standards were compromised in the case. Several ergonomic principles could have been ignored such as the grip of the need, the angle in which the needle was administered as well as the depth to which the nurse inserted the needle (Scales, 2008). The subject in this case study is in need of a development program for venipuncture. Therefore, the

Equity and the Law of Trusts Essay Example | Topics and Well Written Essays - 1500 words

Equity and the Law of Trusts - Essay Example It seems apparent that the coming of age for equity and trust laws were indeed based upon medieval cultures and moral judgments of the day, as the Chancellor of medieval times was in fact based on religious right and not trained in legal matters. One of the major problems of the day was the fact that disputes were not settled within the courts but rather on a county by county diversity which usually involved whatever each of the districts followed as part of their own judicial accounting. By 1529, a properly trained lawyer took the appointment of Chancellor and thus a new era was cemented with respect to proper documents being recorded and kept which would ultimately lead to many important doctrines to be formed outlining equity laws. "In modern practice, perhaps the most important distinction between law and equity is the set of remedies each offers." (Wikipedia: Equity) Resulting from this modernization of a medieval practice, it would be fair to state that through the development of equity laws since the medieval times is defined only by what the rewards would normally reap for judgments. During earlier times, payment would have been comparative to the time and era. For instance, in modern times, it would lean more towards the monetary rewards and not so much in material value. Differences between Equity and Trust Laws To understand how the laws of equity were derived from trust laws of the English court system, it is important to define each. "Equity is the name given to the portion of the legal system, in countries following the English common law tradition that resolves disputes between persons by resorting to principles of conscience, fairness and justness. Equity comes into play typically when none of the parties to the dispute has done anything against the law, but their rights or claims are in conflict." (Wikipedia: Equity) Trust laws were derived from this definition of equity system of law governance and is described as In common law legal systems, a trust is a relationship in which a person or entity (the trustee) holds legal title to certain property (the trust property or trust corpus), but is bound by a fiduciary duty to exercise that legal control for the benefit of one or more individuals or organizations (the beneficiary), who hold "beneficial" or "equitable" title. The trust is governed by the terms of the (usually) written trust agreement and local law. The entity (one or more individuals, a partnership, or a corporation) that creates the trust is called variously the trustor, settlor, grantor, donor, or creator. This dual title (legal versus equitable) is frequently called "split title." The "title split" of trust law may be generalized colloquially as follows: legal title involves control, management, and possession, while equitable (beneficial) title involves "benefit," "enjoyment," and "use." (Wikipedia: Trust (Law) USA) There is an important distinction with respect to how equity law and trust law are governed and does date back to the early history of English law with respect to h

Grief and Life Essay Example | Topics and Well Written Essays - 1000 words

Grief and Life - Essay Example At first she thought that the feeling of meaninglessness and the feeling of grief are very different from each other. But she realizes, after being a mother and a wife, and after losing someone she dearly loves, that what she felt as a child was very similar from the grief that struck her as an adult. This essay talks about the journey of Didion through grief, particularly how she describes her experience with grief in terms of the feeling of meaninglessness that plagued her throughout her young life. Didion explains how different our notion of ‘grief’ is from what it really is in real life. She explains how our expectations of grief are too ‘simple’ or ‘easy’. We know that we will lose someone we love. We expect to go through definite changes, and ‘heal’ immediately. We expect that we should be strong during this very tough time (Worden, 40). Didion explains such in the following manner: â€Å"In the version of grief we imagine, the model will be ‘healing’. A certain forward movement will prevail† (Didion, 392). We think that the normal course of grief is toward ‘healing’ or ultimate ‘acceptance’ of a loss of a loved one. That we do not have to exert too much effort in moving on because everything will resolve by itself. She adds that â€Å"we imaging that the moment to most severely test us will be the funeral, after which this hypothetical healing will take place† (Didion, 392). She mentions ‘hypothetical’ to emphasize the fact that this belief is somewhat flawed. However, based on her experience with grief, it is an emotion that does not subside easily; it is an emotion that is very difficult, sometimes impossible, to deal with. As Didion says, â€Å"We have no way of knowing†¦Ã¢â‚¬  Grief is something that is uncertain; something that is unimaginable (Didion, 392). Grief is a feeling of

Essential data Essay Example | Topics and Well Written Essays - 2500 words

Essential data - Essay Example annual sales of SVL 12†, 15† and 19† flat screens of computers, the chart shows that the annual sale of Type C screens that are 19† are greater than sales of type B and type a it is obviously because the 19† screens are expensive than 12† and 15†. The correlation is one of the most common and most useful statistics. A correlation r is a single value that explains the degree of relationship among two variables. Correlation value r will always be between -1.0 and +1.0, if the correlation is negative, we have a negative relationship; if its positive, the relationship is positive. Here we have the correlation value r = -0.786 and the scatter plot shows a negative association between distance of SVL outlet and the Total sales in SVL outlets, it means the sales in SVL outlets that are near to high streets is more than in those outlets that are far from the high street. The correlation value r = 0.772 and the scatter plot shows a positive association between average monthly advertising expenditure and the Total sales in SVL outlets, it means the sales in SVL outlets increases with the expenditure on advertising. Regression investigates the dependence of one variable conventionally called the dependent variable on one or more variables called independent variable and provide an equation to be used for estimating or predicting the average value of the dependent variable from the known values of independent variable. Where, Y is the predictor, X is the predictor, â€Å"a† is the value of Y when X equals zero and is called Y-intercept, and â€Å"b† indicates the changes in Y for a unit change in X and is called the slope of the line and â€Å"e† is an error term having a normal distribution with mean of zero and standard deviation ÏÆ' (Fisher, 1922). We estimate â€Å"a† by â€Å"a†, â€Å"b† by â€Å"b† and â€Å"ÏÆ'† by â€Å"s†. The fitted equation is then: If we have P-value < ï  ¡ then we have to reject our hypothesis, from ANOVA table of regional location and

The Problem-Solution Speech Essay Example | Topics and Well Written Essays - 500 words

The Problem-Solution Speech - Essay Example It is true that beauty lies in the eyes of the beholder but then again beauty is also dependent heavily on the person who is being looked at – as to how he or she presents his or her own self towards the appreciating individual (Author Unknown, 2011). Beauty surely is skin deep as the world has come to this notion after much thought and consideration. The problem here is how beauty has gained so much significance that it is seen as the most aspired characteristic of the personality that one talks about (Czarniawska, 2011). The problem thus seems to bother the best of us, and even you and me, which is nothing but a quagmire for all and sundry. Similarly, facial looks and sexiness of the body does not actually count towards what we know as beauty. My dear ladies and gentlemen I need to tell you that beauty is more within than being outside. It is comprised of thinking ideologies than facial cuts and dimples. This is indeed true because beauty within any person is difficult to judge since it is hidden deep down inside. I believe that beauty could be judged by this person’s actions, behaviors and talks (Holbrook, 2005). He or she could be written off as an ugly person if he or she does not know how to talk to people, how to interact with them and how to be considerate towards their issues. The solution is that beauty is just present because the beholder believes it so. There would be no beauty if he knows that the face of the body cuts are for a certain period of time, and would vanish away quickly. Ladies and gentlemen, I would like to suggest that beauty must not be looked inside people with an exterior eye alone. It needs to be based on past events, present understanding of matters and how things would shape up within the future. Beauty comprises of all these tangents to be called as beauty in essence (Anastasia, 2010). I would like to end my speech by making a point here. Beauty of face and body could vanish with

Critique of the play How I Learned to Drive by Paula Vogel Essay

Critique of the play How I Learned to Drive by Paula Vogel - Essay Example This expresses much more broadly Bits character: When she is drunk, she is cynical but also deeply afraid; her childhood experiences, the warnings her parents gave her, ring out through her at a highly internalized level. This helps inform us how they will interact when it comes to the more serious issue of Uncle Peck. This line, uttered by the Teenage Greek Chorus, says that Bits father is ruled by his stomach and his superiors in life. This is a critical expression of how the play and the people within it tend to view men, and will help to give an understanding of the developments of the plot. This quote is literally Bit telling her friend that sex is painful, especially before marriage. But it is also a sign into how Bit, thanks to her uncles treatment of her, views sex. She has been molested, and she realizes the degree of the trauma to her. It is similar to another quote, Quote #4, which shows that Bit thinks that men are monsters that cannot control their urges. Quote 4: â€Å"Lucy, you’d better not be filling Mama’s head with sex! Every time you and Mary come over and start in about sex, when I ask a simple question like, â€Å"What time is dinner going to be ready?† Mama snaps my head off!† This quote has Bit literally asking someone not to talk with sex to her mother. But the quote is showing two things about Bits psychology. First: She views sex as something beyond the purview of control, something that people are just forced into by their urges (and, in her case, others). Second: It demonstrates that she has to talk about sex enough to irritate her mother, which is caused by her

Theatrical Show Essay Example | Topics and Well Written Essays - 1000 words

Theatrical Show - Essay Example I suppose that every viewer watching a play compares his experiences to the experience on the stage and associates himself with one of the principal heroes. That is why for most viewers, as I realized after the play, the idea of being abandoned in teenage age was unbearable. It was depressing for me as well because I recalled instantly how poorly protected and developed I was at thirteen and even sixteen and how my personality lacked coherence and stamina. They say, that teenage years are the hardest for parents and while watching kids who grow up without parents I felt admiration and some kind of jealousy (that I can regard as a compliment to the believable portraits created o the stage). On the one hand, it is a great challenge; on the other hand it is such an exciting experience for children. I guess that if people are formed in such circumstances they can become truly self-sufficient people. That is what we see in the â€Å"Edith Can Shoot Things and Hit Them† : the proces s of personalities development. It is really hard to capture this elusive moment but it seems to me that the actors of this play coped with their task. Edith is by all means a central figure in the play because she is the youngest. This girl is a real tomboy who possesses so many different kinds of weapon that a professional soldier could be surprised. A rifle and a bow with arrows serve her as a symbolic protection from the problems of the outside world she cannot solve due to her age. Being only twelve, the period when other girls just start walk farther from their houses, Edith has to protect her little family from inadequacy and careless parents. I was touched to see a girl so strong as a character and so delicate as a human being inside, and her skills with a rifle served as a good metaphor to me. The actress managed to feel how a little human can hide her fear of insecurity under a mask of bravado and indifference. I suppose that the actress was

Capitalism is destroying the planet Essay Example | Topics and Well Written Essays - 1000 words

Capitalism is destroying the planet - Essay Example Therefore, in line of with endeavors of capitalists to maximize their profits by intensive and extensive exploration of the natural environment, this paper shows that capitalists’ production is the root cause of environmental pollution that is posing serious dangers to survival of biodiversity, which for this case includes humanity. The driving force of capitalism has remained to be profit maximization. Serving social demands such as food, shelter, clothing and social amenities is just but a by the way. In their primary bid to maximize profits, in which none of them can shy away from being part and parcel, capitalists are driven to further accumulate wealth in any means that would give them a comparative advantage over competitors. Since their production is limited to exploring natural environment for their gains, hundreds of thousands of industries have been established. Examples include food processing, motor vehicle, and utilities that generate energy that is the driving fo rce of any economy (Sweezy 2). A capitalistic set-up is very vibrant in the sense that it has several players each pursuing their own economic goals. Such a place is characterized by closely packed business entities each engaged in some economic activity. For instance, in producing goods and services for the masses, the number of factories that have been established are increasingly occupying more space on the surface of the earth. This has the implication that more fossil fuels is being consumed to keep these factories running. Understandably, these fuels, example of which include coal, produces carbon (IV) oxide that leads to global warming. In another scenario, capitalism has encouraged unsustainable economic competition for different players in the market. For example, in the process of maximizing profits in the fish industry, capitalists have built up large fishing vessels that process fish immediately they are fished. This has the implication that the rate at which fish are be ing processed is faster that even the rate of their reproduction. The same case applies to forested areas where trees are being fell rapidly than they are planted. The unsustainable utilization of natural resources is what has raised eyebrows regarding the negative effects of capitalism. The wide spread destruction of the world’s tree population for the use of manufacturing goods for large scale corporations is just the tip of the iceberg. We have developed a culture that is largely in an â€Å"amnesic† state if you will. We are taught to consume and build a relationship with these products to where they are accepted in every part of our lives. These same products are increasing the CO2 emissions in the earth’s atmosphere to a recent all-time high of 400.03 ppm. This large increase is due to multiple things including globalized use of fossil fuels and the industrialization of production (Kempf 4). Capitalism has significantly increased the exploration of natural resources which in time increases manufacturing. This domino effect ends with increase in Carbon (IV) Oxide concentration which destroys the ozone layer by causing global warming. Increased temperature have caused melting of the ice carps thus increasing the water levels in the seas and oceans. In the event of a natural disaster such as tsunami, for example the one that hit the coastline of Indonesia in 2004, the effects are

Kotters Leading Change Essay Example for Free

Kotters Leading Change Essay John P. Kotter is an American educator and author. He earned a Bachelor of Science in electrical engineering and computer science in 1968 from Harvard University, a Master of Science from MIT in 1970, and a Doctor of Business Administration from the Harvard Business School in 1972. He joined the Harvard Business School in 1972 and is currently the Konosuke Matsushita Professor of Leadership, Emeritus, at Harvard Business School. He is cofounder of Kotter International, a leadership organization that helps Global 5000 company leaders accelerate the implementation of their change strategies in a complex environment. He has authored eighteen books including twelve best sellers. This book was written in the mid-1990s when the leadership meta-discipline of change was receiving significant attention both in academia and business. Summary of Concepts The primary thesis of Leading Change is that for organizations to be successful in a significantly changing environment they need to identify where and how top performers derail during the change process, and they need to follow an 8-step process to manage significant change to achieve transformational results. The work begins by showing how the rate of change in the business environment is significant and increasing. This is due to several forces outside an organization including increased competition, globalization, technology improvements, and social trends. The author asserts that organizations have not operated well in this rapidly changing environment as many of their structures, systems, methods, and culture have been more of a drag on change rather than a facilitator of change. Based on the author’s experience, some of the â€Å"common errors† organizations make include allowing too much complacency, not adequately leveraging effective leadership and vision, not sustaining momentum, and not incorporating a culture of change. The work outlines the eight stages that significant change initiatives should proceed through to address these common errors. Stage 1 establishes a sense of urgency by providing more information to more people more often and encourages a willingness to deal honestly with this feedback. Establishing the right sponsorship for change is Stage 2 and includes forming executive teams or coalitions that are key decision-makers, influencers, and resource owners. Stages 3 – 5 leverage leadership best practices (as compared to management practices) with an emphasis on developing a clear and compelling vision, clearly communicating that vision, and engaging employees throughout the organization through increased delegation and responsible risk taking. Stages 6 – 7 maintain change momentum by delivering and celebrating short-term wins and by consolidating those wins into clear results. Stage 8 incorporates these chan ge best practices into the corporate culture to facilitate on-going change. The work concludes with an emphasis on developing leaders through a culture of life-long learning and leadership development. Critical Evaluation Kotter’s purpose is to present a practical approach for organizations to use to implement significant change programs. This approach intends to address the author’s assumption that businesses have not performed well based on common errors such as complacency, unclear vision, lack of change momentum, and lack of a culture of change. The strength of the 8-step change process is that it is easy to understand and implement. Another strength is that the differences between management practices and leadership practices are clearly delineated. It strongly emphasizes the point that successful change initiatives need to be leadership driven. The 8-step process outlines how to leverage these leadership practices. The work falls short in a number of areas. First, and through the author’s own declaration, there is no attempt to cite other sources as evidence to bolster his conclusions. The work is based on the author’s experience and writings. There is no research pre sented that supports the efficacy of the 8-step change process. Second, the change process is presented sequentially making it an oversimplification. Although the author briefly acknowledges that many of the stages are concurrent, there is no advice on how to manage multiple, concurrent stages. Third, the work links the eight common errors to the eight change stages, but the logic that links these is not always very compelling. For example, error #2, fail to create a guiding coalition is answered by Stage 2, create a guiding coalition. It would have been more persuasive to say that individuals have neither the time nor the expertise to absorb rapid significant change and that a coalition of sponsors could leverage their relative strengths. Finally, the work falls short in addressing organizational culture change. The author suggests in Stage 8 that the culture needs to be adapted. Although culture is defined and its benefits are extolled, there are no real insights or methods offere d. Overall, the author does achieve the goal of laying out a practical and implementable change process for organizations to leverage in their change journeys. All business executives considering significant change programs should read Leading Change.

Diet and Digestion as Factors for Large Size in Sauropods

Diet and Digestion as Factors for Large Size in Sauropods Dinosaurs have captured the imagination since the very first fossils were discovered. The mystical creatures in many ancient cultures may be attributed to fossils weathering out of the earth. Nearly every culture had some form of dragon in their mythology, a uniformity best explained by fossilized dinosaurs. Some scientists believe the fossils of ceratopsians are the source of the mythological griffin. Part of the fascination with dinosaurs is their size. With few animals reaching such massive proportions, the creatures that produced single bones as tall as a human must have seemed other worldly to ancient peoples. They still draw fascination today; their features so different from anything living. As more and more fossils are found, explanations and extrapolations of the features, size, and behavior become more comprehensive. The unknown element of dinosaur life allows for wild projections and suppositions, and the drama of discovery and scientific discourse and hypothesis disproval continue to draw the interest of people. As more is discovered, more questions are raised. One field of questions pertain to sauropod size. Sauropods are distinct in their absolutely massive bodies. Far larger than anything known by living humans, they are fascinating to consider. Trying to imagine their size is in some ways like trying to imagine the vastness of space. Without actually standing next to a mounted skeleton, there is no living reference to fix the size of sauropods in the imagination. Some estimates place the largest sauropods at 80,000kg, or 170,000 lbs. Conservative estimates suggest weights of 40,000-50,000 kg. Sauropod height is in some specimens 60 feet, about 3 times the height of a two-story house. Some sauropods were a third of a football field in length! Such sizes are nearly unfathomable, raising the question of how they got to be so massive and how their bodies functioned. Modern herbivores are often much bigger than carnivores, because in general, their e nergy expenditure is less and the biomass of their food source is higher. The huge size of sauropods is definitely tied to their diet, and it is likely that their food source and digestive mechanisms were a major factor in their growth to such massive sizes. The food available to sauropods was not very nutritive. Before the evolution and diversification of angiosperms 125 million years ago, herbivorous animals had to rely mainly on gymnosperms and ferns. The best measure of plant nutritional value is in the concentration of nitrogen and nonstructural carbohydrates like sugars. Protein levels largely correspond to the nitrogen levels in leaves. Because non-angiosperm plants dont have the xylem transport network that evolved, there is less nutrient flow, and therefore less nitrogen concentration. Ferns, cycads, and conifers, some of the main plant types available to the sauropod dinosaurs, were low in nutrition, and gymnosperms had secondary chemical defenses that made them unpleasant to eat and harder to digest (Midgley, 2005). A study by Zvereva and Kozlov (2006) found that the nitrogen concentration in gymnosperms drops in environments with elevated temperature and CO2 concentration, compared to the modern environment. Sugar levels tend ed to stay the same. The toughness of leaves increases when CO2 levels are higher. The carbon-nitrogen ratio is significantly increased by elevated CO2. It is well-known that the environmental conditions during the age of dinosaurs was both higher in temperature and higher in CO2 concentration. This would have produced plant material significantly less nutritious than the plant matter today. The lesser food quality supports the evolution of large sauropod dinosaurs, as the Jarman-Bell Principle states that larger species can feed on diets of lesser quality food, evidenced by the relatively large size of modern grazing mammals (Clauss, et. al., 2009). The physiology of the dinosaurs shows evidence of partitioning. Some sauropods, such as diplodocids, were low browsers, who were unlikely to life their heads higher than a couple meters (Stevens and Parrish, 1999). This separated their food source from the mid to high browsers, limiting their available food source in some ways, yet also preventing competition amongst sauropod species. The lower plant quality requires that herbivorous animals consume more material in order to meet their nutritional and energy needs. Given the quality of available plants, extended digestion would have been required. Of several methods to process plant material, sauropods digestion was extremely fermentation heavy. They had very little oral processing. Their teeth were either broad and leaf like, with serrations in the crown, or later more narrow and peg like. In most sauropods, teeth were present in the front part of the mouth but not the back. The body plan in the early Mesozoic seems to have been to maximize food intake through teeth adapted for cropping, stripping, and pulling plant material but with little oral processing. There is some evidence in the tooth replacement rate and wear that teeth farther back in the mouths of sauropods were not used in oral processing or food acquisition, but rather served the purpose of cheeks, to keep the food in the mouth (Schwarz, et. al., 2015). Prosauropods had some check development, but in the sauropod line, cheeks were lost early (Chure, et. al., 2010). There have been no teeth found in association with sauropods that had a large horizontal surface, indicative of use for chewing (Christiansen, 1999). The heads of sauropods were extremely small compared to their body size. Any dental batteries or cheeks would have increased the head mass and likely made it prohibitively heavy, especially at the end of a long neck. Christiansen also noted that the muzzle width in sauropod dinosaurs is proportionally wider than the width in herbivorous animals. This enables sauropods to intake more food per bite, increasing their intake rate. With relatively poor food nutrient quality, sauropods would need to consume a great amount of food to meet their daily needs. The length of the neck adds length to the digestive envelope, another way to maximize food consumption. The lack of oral processing, wide muzzle, and long neck work in conjunction to increase the consumption capability or sauropods, increasing their ability to meet their dietary needs and shortening thei r feeding time. With such high consumption and such little processing, digestion would be almost entirely focused in the gut. The particle size would be very large, making digesta harder to break down, and the longer it takes to digest. There has been some debate about the presence of gastroliths and a gastric mill in sauropod dinosaurs. Gastric mills certainly would help break down the plant material into smaller particle sizes and speed the digestion process. Unfortunately, the fossil record seems to rule out the presence of a gastric mill for most sauropod dinosaurs. Wings and Sander (2007) tested the hypothesis of sauropod gastroliths by testing gastrolith usage in farm ostriches. They found that rose quartz, which has the same properties as the white vein quartz found in association with sauropods, last the longest. Using granite cubes, they found that the general shape of the stone stays the same. They also found that the gastric milling process quickly roughens the face of the stone. None of the stones that he used in his test retained a shine, unlike those suspected to be sauropod gastroliths. He also found that gastroliths are about 1% of the total body mass. According to them, the largest mass of gastroliths found in association with a sauropod is 15kg, much lower than 1% of the estimated sauropod body mass. Gastroliths likely scale with body mass simply because organ size roughly scales with body mass. The stomachs of sauropods could have been proportionally smaller than expected, although it is unlikely with the amount of food that they are estimated to have consumed. Using projections from living herbivores, it is estimated that the large sauropods would consume several hundred kilograms worth of food (Englemann, et. al., 2004). This estimate accounts for the proportional decrease in required food consumption for successively larger and larger organisms. In another study focusing on the distribution of gastrolith stones amongst sauropod remains, it was found that gastroliths were found with about 4% of sauropod fossils. There are some species of sauropod that have strong evidence of gastric mills, but they are not widespread enough (Wings, 2014). With little to no processing of plant material, and with no evidence of any other break down processes, sauropods must have heavily relied on fermentation to digest their food. The relatively low density of nutrients in the gymnosperms at the time already required longer fermentation times. In order to achieve longer fermentation time, the gut size needs to increase, or the amount of food eaten needs to decrease. As the food particles must have been large, the time taken for fermentation would need to be even longer. With no internal soft tissues preserved in the fossil record, it is hard to determine where fermentation took place in the gut. Fermentation demands a large digestive tract. Larger intestines allow for longer digesta retention, pulling more nutrients from the food. The large torsos of s auropods could certainly fit and extensive gut. Estimates based on living animals gives a digesta retention time between 8 and 16 days. Galapagos turtles, which do not chew their food, retain theirs for 11 days (Franz, et. al., 2009). Sauropod dinosaurs could have evolved to be so large because those individuals with larger guts had better survival chances than those who had smaller guts. As stated previously, the amount of food needed in relation to the body mass would likely have been much lower than other, smaller herbivorous organisms. As sauropods heads were evolved to take in the maximum amount of food, the intake of food would likely not have consumed most of the sauropods time. This time advantage would have been especially needed in semiarid environments, like the Jurassic area preserved in the Morrison formation. Although there is lush vegetation in the Morrison fossil record, it is not widespread instead found in clusters. The Morrison Formation suggests that the environm ent during the time of sauropods was savannah-like. The dense vegetation found was likely due to seasonal rains, or centered around areas of water, such as lakes or streams. The vegetation likely moved, growing in different areas depending on rainfall (Englemann, et. al., 2004). Large herbivores would need to follow the seasonal changes, and migrate in search of new food sources. The size of the sauropods and the advantages of that size would have been a major edge in a semi-arid environment. Such sizes would have also made locomotion more efficient. Longer strides afforded by the overall large body size decreases the amount of energy per unit of distance. This, too, increases the ability of sauropods to migrate in search of food. Sauropod reliance on fermentation was so great that their methane production has been linked to the warm climate of the Mesozoic era (Wilkinson, et. al., 2012). Assuming a more reptilian metabolism, one paper puts the global biomass of large sauropods at 2 00,000 kg/km2. Their total estimated annual methane emission is about 520 million tons. For comparison, modern day ruminants produce about 50-100 million tons of atmospheric methane, and the total modern day global emissions are about 500-600 million tons a year. The author notes that their estimate could have been overstated by a factor of two, but also understated by the same amount, depending on assumed metabolic function and density of sauropods. Sauropods large sizes and reliance on fermentation to digest food was a major influence on their environment, and created a positive feedback loop, where the temperature increase would push nutritive values of plants lower. Massive sauropod bodies were well adapted to their environment and digestion. Of course, such large sizes bring their own challenges. The most debated question is whether or not dinosaurs were endothermic or ectothermic, and whether endothermy was even possible in mega dinosaurs like the sauropods. At body masses estimated between 20,000 kg and 80,000 kg, overheating would have been a huge problem in large sauropod dinosaurs. While it is unknown if they had special soft tissue adaptations in order to combat their size, it is speculated that their long necks and tails may have helped them keep cool by increasing surface area without adding too much internal volume (Eagle, et. al., 2011). The accelerated growth capable in endothermic animals is a major factor in favor of sauropod endothermy. Sauropods grew several size magnitudes, from hatchlings estimated to be about 10kg, to the hulking adult dinosaurs, in only a few decades (Sander Clauss, 2008). But does the size of adult sauropods rule out endothermic metabolisms? According to Eagle and others (2011), endo thermy was not impossible in large sauropods. In lower temperatures, more 13C-18O clumps form, which are preserved in the fossil record. The analysis of these clumps is not dependent on knowing the oxygen isotope composition of the surrounding water. These clumps can be observed in the tooth bioapatite of dinosaurs. The accuracy of this method is 1 °C, with precision within 1 °-2 °C. The accuracy of this method comes from tests of modern taxa, in which the isotopic temperature agrees with the expected temperature of the organisms. Eagle found the average body temperature of Brachiosaurus to be 38.2 °C  ± 1 °C and the temperature of Camarasaurus to be 35.7 °C  ±1.3 °C including a sample from a different fossil site. These temperatures are within the range of modern mammals, and lower than the body temperatures of many birds, which can be greater than 40 °C. Eagle does note that the temperature reflects the temperature of tooth formation, which may differ from the main body temperature. Body temperature is a product of metabolism, size, environmental temperature, and any special adaptations for the regulation of heat. The temperatures given for these sauropods is close to the temperatures estimated by earlier research done by Gillooly (2006). Such temperatures in such large animals suggests that they were either ectothermic, had low basal metabolic rates, or had some special methods of heat dissipation. Some researchers suggest that large sauropods were fermentative endotherms (Mackie, 2002). Because sauropods needed a lot of energy to reach their adult size in such little time, it is likely that they were endotherms who underwent some sort of change at maturation that prevented overheating as an adult. Metabolic changes through development is not unusual, so it is very possible that it also occurred in sauropods. They could have shifted from a higher metabolic endothermy during their rapid growth phase, to a lesser metabolic homeot hermy supported by the fermentation heat output from their fully formed guts. Other evidence in support of endothermic sauropods are growth lines, or the lack there of, in sauropod bones (Kohler, et. al., 2012). Lines of arrested growth are normally associated with ectotherms, which have periods of rapid growth interspersed with periods of slow growth. These lines are found in mammals as well, and in the majority of dinosaurs. The pattern the lines leave are not found in sauropod bones. This suggests unbroken, stead growth rates, highly unlikely in ectotherms. The evidence suggests endothermy in sauropods, even in large ones. Because endothermy requires more energy to maintain, sauropods would have had to consume a massive amount of food, unless they had a low basal metabolism. Hippopotami, while mammals and clearly not the size of sauropods, have particularly long retention times because they have low food intake and enormous gut capacity. Their required energy for maintenance is r emarkably low. This strategy is common in non-ruminant foregut fermentators and some small hindgut fermentators (Clauss, et. al., 2009). The metabolic process of sauropods is linked to their energetic needs and dietary restrictions. In some research, one of the byproducts of fermentation, heat, supports the endothermic theory, and endothermy in sauropods as juveniles helps explain how they managed to reach their massive adult size. The herbivorous, fermentative nature of sauropods is not an obstacle in understanding their ability to function at such large sizes. Sauropods likely evolved to be large because of the abundance of plant materials, especially after many herbivores died out during both the Permian extinction, but also the Triassic-Jurassic extinction. Their adaptations allowed them to widely diversify and fill the newly opened ecological niches. Some have speculated that their large body size was driven by predation, as larger bodies, especially the size of sauropods, were a natural defense (Sander, et. al., 2011). Given the evidence, it is more likely that immunity to predation was a lucky side effect of size, not the driving factor. It seems more likely that the resource opportunities of plants drove the initial adaptation, especially with the diverse nature of sauropods and their apparent partitioning, than protection. The size of sauropods is inextricably linked to their diet and digestive methods. Much of the discussion of sauropod feeding is based on conjecture is based on living animals, that are obviously very different from sauropods. As there is are no known records of internal tissues, it is hard to know anything about how sauropods functioned internally beyond comparing them to existing behaviors and traits in todays animals. Even though todays herbivores are different than sauropods, patterns of herbivory are similar in very different taxa. The circumstantial evidence offered by analysis of modern organisms still enables scientists to attempt to fit sauropods within the known herbivorous patterns, with allowances for the unknowns. Perhaps this analysis is just another element of the imaginative aspect of dinosaur life. Until more evidence is found, I believe that the evolution of the massive sauropods was in large part due to their diet and digestion. The nutrition offered by gymnosperms demanded higher levels of processing. The minimal oral digestion evidenced by small heads and non-chewing teeth led to greater digesta retention times in the gut. A greater gut size would have sped fermentation, compensating for the large particle size of the plant material and its low nutrient density. There is some evidence for resource partition amongst sauropods, both between different species and within the same species. Different tooth structure and browsing levels are some adaptations driven by available resources. The other benefits of the large body size of sauropods, in my opinion, do not seem likely to be as important in size evolution as the plants and their digestion. When the sauropods appeared, they filled an ecological niche left by previous extinctions, and quickly diversified, creating a hugely successful group of organisms, both in overall diversity, but also in longevity. Works Cited Christiansen, Per, 1999, On the Head Size of Sauropodomorph Dinosaurs: Implications for Ecology and Physiology. Historical Biology, v. 13, iss. 4, p. 269-297. Chure, D., Britt, B. B., Whitlock, J. A., Wilson, J. A., 2010, First complete sauropod dinosaur skull from the Cretaceous of the Americas and the evolution of sauropod dentition. Naturwissenschaften, v. 97, iss. 4, p. 379-391. Eagle, R. A., Tà ¼tken, T., Martin, T. S., Tripati., A. K., Fricke, H. C., Connely, M., Cifelli, R. L., Eiler, J. M., 2011, Dinosaur Body Temperatures Determined from Isotopic (13C- 18O) Ordering in Fossil Biominerals. Science, v. 333, n. 6041, p. 443-445. Englemann, G. F., Chure, D. J., Fiorillo, A. R., 2004, The implications of a dry climate for the paleoecology of the fauna of the Upper Jurassic Morrison Formation. Sedimentary Geology, v. 167, iss. 3-4, p. 397-308. Franz, R., Hummel, J., Kienzle, E., Kà ¶lle, P., Gunga, H., Clauss, M., 2009, Allometry of visceral organs in living amniotes and its implications for sauropod dinosaurs. Proceedings of the Royal Society B, v. 276, iss. 1662, p. 1731-1736. Gillooly, J. F., Allen, A. P., Charnov, E. L., 2006, Dinosaur Fossils Predict Body Temperatures. PLoS Biology, v. 4, iss. 8, p. 1467. Kohler, M., Marà ­n-Moratalla, N., Jordana, X., Aanes, R., 2012, Seasonal bone growth and physiology in endotherms shed light on dinosaur physiology. Nature, v. 487, iss. 7407, p. 358-361. Mackie, Roderick I., 2002, Mutualistic Fermentative Digestion in the Gastrointestinal Tract: Diversity and Evolution. Integrative and Comparative Biology, v. 42, n. 2, p. 319-326. Midgley, J. J., 2005, Why Dont Leaf-Eating Animals Prevent the Formation of Vegetation? Relative vs Absolute Dietary Requirements. The New Phytologist, v. 168, n. 2, p. 271- 273. Sander, P. Martin Martin Clauss, 2008, Sauropod Gigantism. Science, v. 322, n. 5899, p. 200- 201. Sander, P. M., Christian, A., Clauss, M., Fechner, R., Gee, C. T., Griebeler, E., Gunga, H., Hummel, J., Mallison, H., Perry, S. F., Preuschoft, H., Rauhut, O. W. M., Remes, K., Tà ¼tken, T., Wings, O., Witzel, U., 2011, Biology of the sauropod dinosaurs: the evolution of gigantism. Biological Reviews, v. 86, p. 117-155. Schwarz, D., Kosch, J. C. D., Fritsch G., Hildebrandt, 2015, Dentition and Tooth Replacement of Dicraeosaurus hansemanni (Dinosauria, Sauropoda, Diplodocoidea) from the Tendaguru Formation of Tanzania. Journal of Vertebrate Paleontology, v. 36. Stevens, Kent A. J. Michael Parrish, 1999, Neck Posture and Feeding Habits of Two Jurassic Sauropod Dinosaurs. Science, v. 284, n. 5415, p. 798-800. Wilkinson, D. M., Nisbet, E. G., Ruxton, G. D., 2012, Could methane produced by sauropod dinosaurs have helped drive Mesozoic climate warmth?. Current Biology, v. 22, iss. 9, p. R292-R293. Wings, O., 2015, The rarity of gastroliths in sauropod dinosaurs a case study in the Late Jurassic Morrison Formation, western USA. Fossil Record, v. 18, iss. 1, p. 1-16. Wings, Oliver P. Martin Sander, 2007, No gastric mill in sauropod dinosaurs: new evidence from analysis of gastrolith mass and function in ostriches. Proceedings of the Royal Society B, v. 274, iss. 1610, p. 635-640. Zvereva, E. L. M. V. Kozlov, 2006, Consequences of simultaneous elevation of carbon dioxide and temperature for plant-herbivore interactions: a metaanalysis. Global Change Biology, v. 12, iss. 1, p. 27-41.

Case Summary Hypertension In Pregnancy Health And Social Care Essay

Case Summary Hypertension In Pregnancy Health And Social Care Essay Mdm. SM is a 30-year-old Malay female of gravida 5 parity 3+1 who is at 37 weeks and 5 days of gestation. She was diagnosed to have hypertension in pregnancy during antenatal routine follow-up in Klinik Kesihatan Simpang Renggam at 36 weeks and preeclampsia (blood pressure 160/100mmHg, urine dipstick albumin 1+) 3 days before admission. She was admitted to Hospital Kluang and started on Tab. Methyldopa 250mg TDS. She was advised for induction of labour in view of preeclampsia at term and she requested to be transferred to Hospital Batu Pahat (HBP). She did not have any signs and symptoms suggestive of severe preeclampsia or labour. During admission to HBP, tablet prostin 1.5mg was inserted into the posterior fornix twice to induce labour but there was no change in cervical os and symptoms of labour. Decision was made to try artifical rupture of membranes. However, following the procedure, internal monitoring detected fetal distress and as spontaneous delivery was not imminent, Mdm. S M was agreeable for emergency lower section caesarean section under general anaesthesia. A healthy infant boy was delivered (weight 2.9kg, Apgar score 91105) and there were no intra or post-operative complications. Following the surgery, both mother and infant were well in the ward. Mdm. SM was ambulating and tolerating orally and by the 2nd post-op day, both had passed urine and motion. Wound inspection on day 2 showed clean, non-gaping wound. As she was well, decision was made to discharge her and she was given appointment to review her blood pressure and operative wound at the postnatal clinic at KKSR. On discharge, her blood pressure was 140/70mmHg (without medication) and urine dipstick albumin was trace. Analgesia given on discharge were mefenemic acid and paracetamol. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology PATIENTS DETAILS I/C NUMBER: 800318015794 AGE: 30 SEX: Female DATE OF ADMISSION: 20/6/2010 R/N: 1358593 2) CLINICAL HISTORY Chief Complaint Elevated blood pressure detected in pregnancy at 36 weeks of gestation. History of Present Illness Mdm. SM is a 30-year-old Malay female of gravida 5 parity 3+1 who is currently at 37 weeks and 5 days of gestation. She was referred to Hospital Kluang from Klinik Kesihatan Simpang Renggam (KKSR) for elevated blood pressure detected on routine antenatal follow-up and subsequently transferred to Hospital Batu Pahat (HBP) for induction of labour in view of her development of high blood pressure in pregnancy. Her elevated blood pressure was first detected during her routine antenatal follow-up at Klinik Kesihatan Simpang Renggam 10 days before admission to HBP. During this visit, her blood pressure was recorded as 150/90mmHg and she also complained of slight bilateral swelling of her feet but otherwise had no other complaints. The feet swelling resolved after 3 days. Throughout the next 7 days, she went to KKSR every alternate day for monitoring and 3 days before admission to HBP, her blood pressure was noted to be 160/100mmHg with presence of albumin 1+ on urine dipstick that was prev iously not present. She was immediately given tablet labetolol 100mg and admitted to Hospital Kluang where she was subsequently started on tablet methyldopa 250mg 8-hourly. Three days after admission to Hospital Kluang, she was advised by the doctor to undergo induction of labour and she thus requested to be transferred to HBP so her family members in Batu Pahat could take care of her. During the course of these events, she did not experience shortness of breath, headache, blurring of vision, epigastric pain, seizures, abdominal pain, vaginal bleeding, nausea, vomiting, palpitations, or recurrence of the foot swelling. At time of admission, she did not experience contraction pain, show, leaking of liquor. Fetal movements were good. Systemic Review Mdm. SM did not have fever. Her appetite was good and her urinary and bowel habits were normal. Her sleep was unaffected. Antenatal History This was an unplanned but wanted pregnancy. Mdm. SM realized she was pregnant when she missed her period, of which the last was 28/12/09. She bought a pregnancy test kit and it tested positive. She subsequently did her booking at KKSR at 7 weeks of period of amenorrhoea. At booking, her blood pressure was 120/80mmHg, hemoglobin 13.4g/dL, sugar undetected, and urine albumin negative. Infective screening was negative and blood type O positive. Her expected due date was given as 14/8/10. During follow-up 1 month later, she had her first ultrasound scan which found her uterus to be larger than dates. Her due date was revised to 6/7/10. Modified glucose tolerance test done twice during pregnancy were negative. She experienced morning sickness and vomiting during the first 3 months of pregnancy but it was not severe and she could cope without medication. Throughout the pregnancy, she was diagnosed to have urinary tract infection twice and was treated with antibiotics. A further 3 ultrasoun d scans were done and all were normal. She was also compliant to the supplements given throughout pregnancy. There were no other problems during the antenatal follow-up until the detection of elevated blood pressure 10 days before admission to HBP. Past Obstetric History This is her fifth pregnancy and her last childbirth was in 2008. She has 3 children, 2 boys and a girl, of whom all were born via vaginal delivery at postdate after induction of labour. Birth weights ranged from 2.7 to 3.0kg, all are healthy with no complications and were breastfed. However, during her 3rd pregnancy, she suffered a miscarriage during the 12th week and dilatation and curettage was performed during that admission. Gynae Menstrual History Mdm. SM achieved menarche at the age of 12. Her menstrual cycles have always been regular with 28 days per cycle and 5 to 7 days of flow. She does not experience menorrhagia or dysmenorrhoea. She has never had a cervical smear done and has never used oral contraceptive pills. She has not required medical attention for any gynaecological problem. Past Medical History Mdm. SM has never been diagnosed with any chronic disease such as diabetes, hypertension, and asthma before. She has also never been admitted for non-pregnancy related reasons. She also does not have any known food or drug allergies. Family History Mdm. SM is the eldest of three siblings. Her youngest sister also had gestational hypertension. Her father has hypertension and her mother had diabetes, but passed away 2 years ago due to tuberculosis. All family members have been screened and all tested negative for tuberculosis. Social History Mdm. SM is now a housewife. She formerly worked in a factory but decided against returning to work following her last pregnancy in 2008 for her childrens benefit. She is a non-smoker and does not consume alcohol. Her husband is a short-haul lorry driver and smokes, but only outside their home. They live slightly off Kluang, and it takes them slightly over an hour to reach HBP, and 15 minutes to reach KKSR. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 3) FINDINGS ON CLINICAL EXAMINATION (Mdm. SM was examined by me on the 2nd day of admission) Mdm. SM was alert, conscious and cooperative. She was not in any pain or distress. She was sitting comfortably on her bed. On examination, there was no pallor, jaundice or pedal edema. Her reflexes were not brisk. Her clinical parameters are: Blood Pressure : 124/80 mmHg Heart Rate : 95 beats per minute. Regular rhythm Respiratory Rate : 20 breaths per minute Temperature : 37 °C Examination of the cardiovascular system, respiratory system, fundus, thyroid and breasts were normal. On examination of the abdomen, it was distended with gravid uterus as evidenced by linea nigra, and striae albicans. There was no striae gravidarum, scars, or pulsations noted. On palpations, the abdomen was soft and non-tender, uterus non-irritable, and fetal parts felt. The symphysio-fundal height was 36cm, which corresponds to dates. On examination, this is a singleton fetus at longitudinal lie with cephalic presentation, with the fetal back on the maternal left. The fetal head was four fifths palpable. Estimated fetal weight is 2.8 to 3.0kg. Liquor is adequate. Fetal heart was heard and the rate was 142 beats per minute. Vaginal examination (by medical officer on admission) revealed no perineal, vulval or vaginal abnormalities. Cervical os was 1 cm with cervix tubular, soft and axial, station high and membrane intact. Bishops score was 3/10. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 4) PROVISIONAL AND DIFFERENTIAL DIAGNOSES WITH REASONING Provisional Diagnosis Preeclampsia in pregnancy Mdm. SM developed new onset elevated blood pressure of 160/100mmHg at 36 weeks of gestation and urine dipstick albumin of 1+ (300mg/L). This fits the minimum requirement of preeclampsia among the hypertensive diseases in pregnancy. However, Mdm. SM did not experience any symptoms to suggest a severe preeclampsia or impending eclampsia such as headache, visual disturbances, epigastric pain, vomiting, liver tenderness. The urine dipstick for albumin is not the best way to detect proteinuria required for the diagnosis of preeclampsia 3 and is usually only used for screening, but as the blood pressure and urine albumin were persistently elevated, it is better to err on the side of caution and treat Mdm. SM as such since patients with relatively mild preeclampsia can rapidly progress into severe disease 1. Following the repeated positive detection of urine albumin of only 1+, more definitive tests should be performed to better quantify her proteinuria 2,3. Differential Diagnosis Pregnancy-induced hypertension, late onset As Mdm. SM has been compliant to her antenatal follow-ups and did not have elevated blood pressure detected at any time before 36 weeks of gestation, it is likely that she has developed the onset of a hypertensive disease in pregnancy and it appears to be of late onset as it developed only after 32 weeks gestation. However, as subsequent visits showed urine dipstick albumin of 1+, indicating the onset of proteinuria (although poor predictive value and not as significant as 2+) 3, it might prove wiser to be more vigilant and assume that Mdm. SM does indeed have preeclampsia as it would be foolish to dismiss these warning features despite the fact that she does not demonstrate any suggestive symptoms because it is possible that even patients with no prodromal signs may suddenly progress into eclampsia 1,3. Essential hypertension in pregnancy with superimposed preeclampsia Another possibility that we may entertain is that Mdm. SM has had previously undiagnosed essential hypertension with currently superimposed preeclampsia. However, this seems rather unlikely. Firstly, Mdm. SM is young at the age of 30 and unlikely to suffer from essential hypertension as this disease common presents after the age of 40. Secondly, at no time throughout antenatal follow-up did she have elevated blood pressure recorded before that particular visit at 36 weeks of gestation. However, following delivery of her infant, she should have her blood pressure rechecked during postnatal follow-up care at 6 to 12 weeks post-delivery. If her blood pressure if still elevated at that time, then it will be more likely that she has essential hypertension. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 5) IDENTIFY AND PRIORITISE THE PROBLEMS 1. Elevated blood pressure and its implications in pregnancy Mdm. SM has newly discovered elevated blood pressure at 36 weeks of gestation. This is considered late onset but is not uncommon, and gives rise to a spectrum of hypertensive disorders in pregnancy. While it seems that at first she has gestational hypertension, the mildest of the disease spectrum, she demonstrated proteinuria on her subsequent antenatal visit, therefore concluding that she has preeclampsia. Hypertensive disorders in pregnancy have the potential to put both mother and infant at increased risk of mortality. Its complications are elaborated below. During admission, Mdm. SM should be monitored for any change in her condition as she may quickly progress into severe disease states and this would require urgent intervention, the most definitive being the delivery of the infant. Ward management includes close observation of both mother and infant, and medication to control the elevated blood pressure. 2. Induction of labour in view of preeclampsia at term Termination of the pregnancy is the only definitive sure for preeclampsia. On presentation, Mdm. SM has features categorized as mild preeclampsia. Normally, severe preeclampsia would dictate the need for antihypertensive and anticonvulsive therapy followed by subsequent delivery and symptoms such as headache, epigastric pain, and visual disturbances may indicate this. The fetal age is usually an important deciding factor when it comes to inducing labour as the treatment goals seek the best outcome for both mother and infant. As Mdm. SM is already at term and there have been no issues previously detected regarding the health of her fetus, it should be safe to proceed with induction of labour. There is also no reason to prolong the pregnancy as the risk of eclampsia increases. If for any reason an obstetric reason arises e.g. fetal distress, delivery should proceed via caesaren section. 3. Impending eclampsia and other potential complications Warning signs and symptoms of impending eclampsia or severe preeclampsia include headache, visual disturbances, epigastric pain, reduced urine output, edema and ultimately, convulsions. These symptoms should be recognized early so the necessary intervention can take place. Seizures increase the risk of maternal and perinatal morbidity and mortality rates. Some maternal complications are placenta abruption, neurological deficits, aspiration pneumonia, pulmonary edema, cardiopulmonary arrest, and acute renal failure. Other major complications that may occur as a result of severe preeclampsia are HELLP syndrome, pulmonary embolism and stroke. Fetal complications include growth restriction, fetal distress, and death. 4. Risk of post-partum eclampsia It is possible for eclampsia to occur in the postpartum period especially when the patient has reached term. In such cases, up to 44% of eclampsia occurs postpartum 3. As the risk is quite high, Mdm. SM should continue to be monitored in the ward for the development of any signs and symptoms. As she is comfortable and relatively symptom free while in the ward, it appears unlikely that she may worsen into an eclamptic state but the risk should not be afforded. As there are no guidelines to suggest an optimum postpartum inward observation period, it would depend on her clinical situation during the subsequent days following her delivery. 5. Hypertension in pregnancy and its long term implications As Mdm. SM has developed preeclampsia during this pregnancy, she is at increased risk to develop hypertensive or metabolic complications in future pregnancies. The risk of recurrence is generally higher in earlier onset preeclampsia. At the same time, she should be evaluated in the postpartum period for the possibility of essential hypertension at the 6 week postnatal review. Also, women with preeclampsia are at an increased risk for developing hypertension, diabetes, hyperlipidemia, chronic renal disease, stroke and ischemic heart disease. Mdm. SM should be made aware of all these implications and should be educated on how she can prevent these via the modification of her lifestyle. She should also be advised to attend preconceptual counseling in the event of a future pregnancy and to come early for booking. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 6) PLAN OF INVESTIGATION, JUSTIFICATIONS FOR THE SELECTION OF TESTS OR PROCEDURES, AND INTERPRETATION OF RESULTS 1. Urine Dipstick for Albumin To look for the presence of albumin in the urine firstly, to confirm proteinuria, and secondly, to evaluate the severity of the preeclampsia. Urine dipstick for albumin should be repeated daily in the ward. Also, if in doubt, further investigation to quantify proteinuria can be done e.g. urine protein/creatinine spot test 2,3. Results: Urine dipstick albumin on admission was trace. Results at KKSR showed 1+. Interpretation: This result could be due to the fact that the blood pressure has lowered as Mdm. SM has been started on methyldopa and her blood pressure is under control. This does not mean that she no longer has preeclampsia. She should be checked daily for any changes in both blood pressure and proteinuria. 2. Full Blood Count To look for anemia which may require correction, haemoconcentration which may indicate severe preeclampsia 1, and platelet levels as HELLP syndrome is a complication that may arise in preeclampsia. This may also serve as baseline in case operative procedures are required. Result: TWBC 12.0 x109/L à ¢Ã¢â‚¬  Ã¢â‚¬Ëœ (neutrophils 8.20, lymphocytes 2.70) Hemoglobin 10.7 g/dL à ¢Ã¢â‚¬  Ã¢â‚¬Å" Hematocrit 32.3% à ¢Ã¢â‚¬  Ã¢â‚¬Å" Platelets 354 x 109/L Interpretation: The total white cell count is slightly raised, but this is to be expected in pregnancy. The hemoglobin is slightly low but this is also expected in pregnancy and should be monitored especially if the patient requires surgery or experiences anemic symptoms. There is no haemoconcentration and the platelets are normal. 3. Prothrombin Time, INR, Activated Partial Thromboplastin Time (PT/INR/APTT) To obtain a baseline of the coagulation profile in case operative procedures are required and also to look for potential coagulopathy as it is a possible complication of preeclampsia. Result: PT 12.3s INR 1.05 APTT 39.6s Interpretation: PT/INR/APTT is within normal range. Coagulopathy appears unlikely in Mdm. SM given that her platelets are also normal and her preeclampsia is not severe. 4. Renal Profile To assess renal functions to look for elevation of creatinine as that would indicate severe preeclampsia and also to detect acute renal failure which is associated with increased risk of HELLP syndrome, placenta abruption and postpartum hemorrhage 1. Result: Urea 1.3mmol/L Sodium 140mmol/L Potassium 3.7mmol/L Creatinine 51 µmol/L Interpretation: Mdm. SM renal profile is normal and creatinine is not elevated, adding to the indicators that her preeclampsia is of the mild category. Low urea levels and good urine output also rules out acute renal failure. 5. Liver Functions Test To assess liver functions and its components such as liver enzymes and bilirubin which would be raised in severe preeclampsia or HELLP syndrome in which there is hemolytic anemia and elevated liver enzymes. Result: Total protein 73g/L Albumin 33g/L Globulin 40g/L Total bilirubin 0.5mg/ml Direct bilirubin 0.2mg/ml Indirect bilirubin 0.3mg/ml ALP 121U/L à ¢Ã¢â‚¬  Ã¢â‚¬Ëœ ALT 7 U/L GGT 7 U/L Interpretation: Liver enzymes (ALT) and bilirubin levels are not elevated, indicating a mild preeclampsia and no biochemical evidence of HELLP syndrome. The ALP is slightly elevated, but this could be due to compression of the gravid uterus on the hepatobiliary tree. 6. Serum Uric Acid Elevated serum uric acid is an early biochemical sign of preeclampsia 1 and may help to predict maternal complications in preeclampsia 4. Results: Serum uric acid 103 µmol/L à ¢Ã¢â‚¬  Ã¢â‚¬Å" Interpretation: Serum uric acid levels are not elevated and are in fact, slightly lowered. This result indicates low likelihood of severe preeclampsia or maternal complications. 7. Serum Lactate Dehydrogenase To check for elevated levels which should indicate hemolytic anemia, a component of HELLP syndrome. Results: Not done during this admission. 8. Cardiotocograph (CTG) Done on admission as a baseline for fetal monitoring. Results: Baseline fetal heart rate was 130 beats per minute, baseline variability was 5 10, accelerations present with no decelerations. Interpretation: CTG is reactive with no signs of any fetal compromise. CTG should be repeated following each procedure e.g. prostin insertion, AROM or if fetal compromise is suspected. 9. Transabdominal Ultrasonography This should be done to confirm fetal age, as confirmation of fetal age is important when it comes to deciding whether or not to induce labour in preeclampsia. Also to check for fetal well-being and growth restriction, but these requires repeated scans and plotting of growth chart over a period of time. Result: No ultrasonography was done during this admission. The last scan was done in Hospital Kluang before patient was transferred to HBP. The last scan reports fetal age corresponding to dates, AFI of 9, and no abnormalities detected with no mention of other findings. Interpretaion: As fetal age is corresponding to dates and there is no suggestion of fetal compromise or restriction, it is safe to proceed with induction of labour. 10. Urinalysis (UFEME) To check the levels of proteinuria which may be more quantitative than urine dipstick. Results: Leukocytes, nitrite, protein, glucose, ketone, urobilinogen, and bilirubin were not detected. Interpretation: No proteinuria was detected. This could mean that the patient does not have preeclampsia but rather gestational hypertension, or it could be undetected as the blood pressure has also become well controlled with medication. However, no risks should be taken and Mdm. SM should be closely observed in the ward. Either way, induction of labour and delivery would still be ideal for her as she has already reached term. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 7) WORKING DIAGNOSIS AND PLAN OF MANAGEMENT ON ADMISSION Working Diagnosis Induction of labour at term in view of mild preeclampsia in pregnancy Comment: As Mdm. SM has elevated blood pressure and urine dipstick albumin 1+ but has no physical or biochemical features suggestive of severe preeclampsia, the working diagnosis is mild preeclampsia. However, she should be monitored closely in the ward for any symptoms indicative of disease progression. As she has reach term, it would also be wise to induce labour in her, especially given her history of postdates as delivery would be the only definitive management in such cases. Plan of management on admission Continue T. Methyldopa 250mg 8-hourly Daily urine albumin dipstick Vital signs monitoring 4-hourly Baseline cardiotocograph on admission Fetal kick charting and Labour progress charting To notify immediately if spontaneous rupture of membranes To notify immediately if strong contractions commence Encourage orally For induction of labour with T. Prostin 1.5mg as Bishops score unfavourable To notify immediately if any symptoms occur STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 8) SUMMARY OF INPATIENT PROGRESS (INCLUDING MAJOR EVENTS, CHANGE OF DIAGNOSIS OR MANAGEMENT AND OUTCOMES) Throughout the first two days of admission, Mdm. SM was comfortable in the ward with no development of any symptoms of severe preeclampsia, eclampsia, or labour. Her vital signs were stable with blood pressure ranging 122-138/70-84. On the morning of the 2nd day, tablet prostin 1.5mg was inserted into her posterior fornix under aseptic technique. Cardiotocograph was reactive and vaginal examination 6 hours post-insertion showed cervical os 3cm, cervix 2cm, soft and axial, and high station. Therefore, a 2nd tablet of prostin was inserted on the morning of the 3rd day. Once again, post-insertion cardiotocograph was reactive and vaginal examination 6 hours later showed no changes to before. Mdm. SM still did not experience any signs and symptoms of labour. She also did not have any symptoms indicating progression of her preeclampsia. On the morning of the 4th day, it was decided that Mdm. SM should undergo artifical rupture of membranes (AROM) rather than have a 3rd prostin tablet inser ted. Cardiotocograph monitoring had been difficult so decision was made to insert fetal scalp electrode at the same time for internal monitoring. Following the AROM, internal monitoring revealed a drop of fetal heart rate from 130 to 100 beats per minute with no accelerations. Cervical os was still 3cm with no symptoms of labour. Decision was made to proceed with emergency lower section caesarean section (ELSCS) under general anaesthesia and Mdm. SM gave her consent. Via ELSCS, a healthy baby boy was delivered weighing 2.9kg with Apgar score of 91105. There were no intra or post-operative complications. Post-operative medications given include IV ampicillin 500mg QID, subcutaneous heparin 5000 units BD, IV pitocin 40 units QID, IM pethidine 50mg PRN, Tab. paracetamol 1g QID and Tab. Mefenemic acid 500mg TDS. Throughout the next 2 days, Mdm. SM was comfortable in the ward and had mild operative site pain with no other symptoms and vital signs were stable. All medications except analg esia were stopped. She was ambulating well, tolerating orally and had passed urine and motion by the 5th day. As for the baby, breastfeeding had commenced and he had also passed urine and motion. The uterus was well contracted at 22 weeks size and dressing was not soaked. Inspection of the wound on the 6th day revealed a clean and non-gaping wound. She was counseled on contraception and indicated a preference for intrauterine contraceptive device. As she was well, she was discharged with appointment to return to postnatal clinic at KKSR to review her blood pressure and operative wound in 1 weeks time. On discharge, her blood pressure was 140/70mmHg and urine dipstick albumin was trace. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 9) DISCHARGE PLAN, COUNSELLING AND MOCK PRESCRIPTION Discharge Plan Tab. Mefenemic acid 500mg TDS PRN Tab. Paracetamol 1g QID PRN Follow-up appointment at Klinik Kesihatan Simpang Renggam (KKSR) Postnatal clinic in 1 week to review blood pressure and operative wound. Follow-up appointment at KKSR in 6 weeks for review, cervical smear, and contraception. Counseling Advised to return immediately to the hospital if Mdm. SM has problems with the caesarean wound e.g. pain, discharge or if she develops any new or worrying symptoms. Advised on the need to be compliant to postnatal follow-up to review Mdm. SMs condition. Advised for cervical smear during postnatal follow-up as previously never done. Counseling regarding breastfeeding and contraception. Explain about the nature of pregnancy-related hypertensive disorders and its long term implications. Advised to attend antenatal clinic for preconceptual counseling if future pregnancy is desired, or to come for booking immediately once discovered to be pregnant. Advised to observe a healthy lifestyle in order to prevent development of conditions such as hypertension and diabetes. Mock Prescription Tab. Paracetamol 1g QID PRN x 1/52 Tab. Mefenemic acid 500mg TDS x 1/52 STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 10) REFERRAL LETTER (IF APPLICABLE) Medical Officer, Postnatal Clinic, Klinik Kesihatan Simpang Renggam, 86200, Simpang Renggam. 20th June 2010 Mdm. SM (IC.800318015794) Date of admission: 20th June 2010, Date of discharge: 25th June 2010 Problem: Late onset hypertensive disease in pregnancy Dear medical officer, Mdm. SM is a 30-year-old Malay lady of parity 4+1 who was diagnosed to have preeclampsia at 36 weeks of gestation during routine antenatal follow-up at your centre. During admission to our ward, she underwent induction of labour with tablet prostin and artificial rupture of membranes. However, fetal distress developed, picked up on internal monitoring and Mdm. SM underwent emergency lower section caesarean section under general anaesthesia. She delivered a healthy baby boy (2.9kg, Apgar 91105) with no complications intra- and post-operatively. We are discharging her into your care. Please review her blood pressure as scheduled and also offer contraception and cervical smear as previously never done. She has indicated preference for intrauterine contraceptive device. Do not hesitate to contact us immediately should the need arise. Thank you very much for your attention. Yours sincerely, Paul Kong Fu-Xiang (Final year medical student, IMU), Department of Obstetrics Gynaecology, Hospital Batu Pahat. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 11) LEARNING ISSUES IN THE 8 IMU OUTCOMES 1. Disease prevention and health promotion Hypertensive disorders in pregnancy are one of the most common antenatal problems and eclampsia is a major source of maternal mortality. What are the ways in which some element of prevention can be instituted or to decrease the severity of preeclampsia? There haven been certain strategies touted to prevent or modify the severity of preeclampsia. These are categorized as dietary supplements, antihypertensive medications, antioxidants, and antithrombotic agents 5. As low salt diet is one of the recommended dietary changes for hypertensive patients, De Snoo et al 1 was one of the earliest researchers to study the effects of low salt diet in preventing preeclampsia but this practice was discarded as it yielded no significant change. Knuist et al performed a randomized controlled trial in 1998 and they reported that despite helping control blood pressure in non-pregnant individuals, a sodium-restricted diet was ineffective in 361 women in terms of prevention of preeclampsia 6. The dietary supplementation of calcium of at least 1 gram per day is recommended as class I-A evidence 2. Several studies showed that women with low calcium diets were at significantly increased risk of gestational hypertension 7,8,9. Levine et al performed a large , randomized-controlled trial and they found that there was no significant difference in outcome with calcium supplements versus placebos 10. This suggests that unless a pregnant woman has a low calcium intake, calcium supplements may have no added benefit 5. With regards to fish oil supplements and its cardioprotective fatty a

Nightmares :: essays research papers

Nightmares   Ã‚  Ã‚  Ã‚  Ã‚  Usually when you end up drifting off to sleep, you fall into a deep sleep and begin to experience a so called dream.† However, most children, and even some adults, experience some even more terrifying so called dreams. These dreams are called nightmares. Nightmares have been occurring in people’s sleep for hundreds of years. People have been interested in them for centuries and they have quite an interesting past to them. People used to believe that the dream anxiety attack was caused by a demon pressing up against a person’s chest during their sleep. They were even considered as a form of black magic, evil affiliation, and even sometimes possession. The sleep cycle comes in a multi-stage cycle. All in all there are five cycles. The first four of the stages is where there is non-rapid eye movement (NREM). As the fifth stage occurs, that is where rapid eyes moment (REM) happens. Nightmares almost always occur in the second half of a persons sleep and it is always followed with an awakening of the individual even if the person doesn’t remember waking up during the night. Nine times out of ten, when people’s brain can’t handle what is going on during the rapid eye movement stage, they wake up very panically and are also very aware of their surroundings. Nightmares are mostly referred to as being a younger persons trouble but you will find that a lot of adults have the problem of nightmares also. The children’s nightmare is very different than the adult’s because the adult’s nightmare is based on the persons fears such as being chased or attacked. The children’s nightmare is more of a fantasy nightmare. Anyone that has a high fever before they go to bed is more likely to suffer from a nightmare. Rapid eye movement will usually wake a person up if they can sense that something bad is going to happen. Most of the time when one has a nightmare, will wake up right before some really bad will happen. the most popular nightmare is when you are actually falling from something that is very high up in the air. It always ends by you waking up right before you are about to hit the ground. It is been proved that no matter how many nightmares that one person will have, not one single nightmare will be exactly the same as any of the others.