Saturday, December 28, 2019
The Problem of Vouchers and School Choice Essay - 1125 Words
The Problem of School Choice Is it right to force students to attend the schools prescribed for them by geography? Is it fair to deny students who live in poorer neighborhoods the chance to go to better schools with better facilities, better teachers and safer conditions? Should we allow our tax revenues to leave our school districts for greener pastures? Should we permit schools poor in both resources and performance to wither on the vine, an acceptable casualty of competition? Because of dissatisfaction with many public schools, particularly those in large urban settings, a movement to allow students to choose alternatives to their assigned schools has sprung up in various parts of the country and abroad. Proponentsâ⬠¦show more contentâ⬠¦As our populace ages, especially in small, old towns, more and more voters begrudge spending on schools, students and teachers. School board candidates, knowing who votes, campaign as taxpayer advocates much more often than they run as student advocates. The voters want to pay as little as possible and get acceptable results. For many of them, acceptable results means graduating most of their students with as few problems as possible. Innovation is seen as an expensive, unproven luxury that taxpayers on fixed incomes cannot afford. Buildings are maintained at the lowest possible functional level; aesthetic improvements rank very low in budget priorities. In inner city schools, a smaller proportion of the cost of educating students comes from local tax revenues; more comes from state sources. If theres one iron-clad truth its that, as much as taxpayers dislike paying taxes to support their local schools, they hate their tax dollars going to schools outside their community even more. So the impoverished schools are unlikely to receive funds to help them do the things that make schools attractive to both students and teachers: upgrade the physical plant, provide technology advances and offer amenities (seen as luxuries by taxpayers) that make people want to spend time in school. Ugly buildings get uglier, outdated curricula is perpetuated, and schools in poor neighborhoodsShow MoreRelated School Vouchers The Wrong Choice Essay1473 Words à |à 6 PagesSchool Vouchers: The Wrong Choice Susie is a young girl who lives in Florida. Since kindergarten, she has attended a nearby private school. Her parents willingly pay her tuition, even though doing so forces them to cut other corners. They do not mind these sacrifices, since they know that their daughter is getting the best education they can give her. Jesse lives downtown, in the inner city. She attends the local public school and struggles through her classes. Her mother would likeRead MoreEssay about Our Nation Needs Vouchers and School Choice674 Words à |à 3 PagesThe Nation Needs School Vouchers à Lets face it - public schools are failing. SAT scores have steadily declined since 1960. Results from other tests of public high school seniors conducted by independent research groups show a serious decline in the quality of public education over the last several decades. A national voucher system would be a good start at restoring competition and parental choice in education. à Accompanying the steady decline in the quality of education has beenRead More School Vouchers Essay1739 Words à |à 7 Pagesthe issue of school vouchers. The two sides have remained deeply entrenched in their rival positions concerning this issue. Some wonder about the practicality of using the vouchers, while others wonder if it is defeating the purpose of the educational system. Educational vouchers can be very beneficial for both the student and even the school districts involved in the program. Many people do not realize the benefits of this program. Educational vouchers are something that many school districts needRead MoreEducation in America1590 Words à |à 7 PagesEducation in America: Failing Schools Education in America is one of the most important issues that face our nation. If the education in America is not thought of one of most serious issues we face, our nation as a whole will fall. There are many debates and they seemly extend to all walks of life. The debates range from the decline in education, school vouchers, and the no child left behind law. As a nation, the United States is ranked above others. We must search for that solutionRead MoreVouchers In Texas Essay1499 Words à |à 6 PagesSchool Choice and Vouchers in Texas When people think of Texas many might think of a rich and flourishing economy. With that thriving economy in mind, people may associate a great over all public school system in place. Unfortunately for Texans this not the case. In a 2016 report Texas ranks 43rd among the other states national k-12 education rankings (Fechter 2016). The determination of the ranking included 3 variables, chance for success, school finance, and K-12 achievement (Fechter 2016). TheRead More Cultural Diversity Essay1637 Words à |à 7 Pagesprivate school systems. She suggested students achieve greater results in an environment in which competition and different religious and cultural backgrounds exist. (Rees 93). Although students may have a different religion, culture, race and socio-economic level, they all deserve an equally outstanding education. There is a national attempt to give parents the option of a public or a private education for their youngsters. There is also such a thing as a Voucher Sy stem. In PUBLIC SCHOOLS, PRIVATERead MoreEssay about Vouchers and School Choice - Vouchers are Not the Solution1296 Words à |à 6 PagesSchool Vouchers: Not the Solution à à As standardized test scores continue to plummet and our nation falls farther behind such industrial rivals as Germany, England, Australia and Japan in comparable education, parents are questioning the current system of education. After being kicked around the national agenda for decades, the school voucher issue is finally being emphasized in several state legislatures, as well as in Congress. In the website titled Vouchers: No, but...Taxpayer Help toRead MoreThe Chilean Ministry Of Education986 Words à |à 4 Pagescontrol of local schools to municipal governments, who were now in charge of everything except for the national curriculum, including negotiating individual contracts with teachers (Schiefel 6). Furthermore, Pinochet established ââ¬Å"a voucher-type government subsidy available for use in both private and public municipal schools, which are distributed in numbers directly proportional to the size of a schools enrollmentâ⬠(ââ¬Å"The Failingsâ⬠). As a r esult, when students changed schools, so did their moneyRead MoreHow Privatization of Education May Be Possible1360 Words à |à 5 Pagescritique of education funding and the notion of privatization of education. The Voucher System It seems to me that one of the best ways of privatization would be to adopt the voucher system. Louisiana just started doing that with promising results. The voucher system asserts that every individual has the right to an education of his or her choice and the government has no right to compel him to attend a certain school... The way that this can be practically implemented is by following LouisianasRead MoreAmerican Schools Are Failing For Minority Students1025 Words à |à 5 PagesThe idea that American schools are failing is not a new one, but it is an idea that is extremely widespread. There are constant news reports claiming that our schools are worse than ever and Congress has passed extensive legislation such as No Child Left behind in an attempt to fix the American educational system. Some people believe that American schools are not completely failing, but only failing for minority students. Reforms like mandatory busing, vouchers, charter schools, accountability, and
Thursday, December 19, 2019
Snapshot Isolation And There Validation Steps For Update...
TERM REPROT SNAPSHOT ISOLATION Abstract: This paper mainly describes about the snapshot isolation and there validation steps for update transactions and serializability issues of snapshot isolation. To maintain more than one version of a data items it can possible to permit a single transaction to read an existing version of a data item rather than the more update version created by an uncommitted transaction or by a transaction that ought to come later in serialization order. To obtain this there are different types of multi-version concurrency control techniques one of those techniques which widely used in the real world is snapshot isolation. It has been used by major database management system to obtain high throughput. It also provides better performance than the serialzability so itââ¬â¢s gained wide acceptance in commercial and open source systems such as Oracle, SQL, PostgreSQL, Interbase, Firebird. Introduction: Snapshot isolation is a multi-version concurrency control that is very popular and intensely utilized. The snapshot isolation technique was first introduced by the critique of ANSI isolation levels in a paper in 1995. The work on multi-version concurrency control which derived snapshot isolation. Multi-version concurrency is nothing but every transaction is conceded consistent views of the data from the transaction begin and the database will use the existing version of the data to guarantee isolation level is achieved without locking the data. According to
Wednesday, December 11, 2019
Hepatitis The Liver Disease Essay Research Paper free essay sample
Hepatitis, The Liver Disease Essay, Research Paper Hepatitis, the Liver DiseaseWhat is Hepatitis? Hepatitis in simple words, is an redness of the liver. Different things cause the different types of hepatitis, but they all produce redness of the liver. Viral hepatitis refers to several common contagious diseases caused by viruses that attack the liver. The most of import types of viral hepatitis are hepatitis A, hepatitis B, and hepatitis C. Newly discovered signifiers of viral hepatitis besides include hepatitis D, E, and G. Toxic agents, that is drugs or chemicals, can do non-viral signifiers of hepatitis, intoxicant, or auto-immune procedures. Another signifier of hepatitis is toxic hepatitis. Viruss or liver harm due to toxic substances can do toxic hepatitis. Toxic hepatitis is a impairment of the liver cells caused by chemicals, intoxicant, drugs, and industrial compounds. Alcohol maltreatment is a common cause of toxic liver harm. Study of hepatitis is still under manner, but every bit far as we are concerned we will merely ta ke a close expression at three types of Hepatitis in this study: hepatitis A, hepatitis B, hepatitis C. HEPATITIS AHepatitis A is a liver disease caused by the hepatitis A virus. Hepatitis A can impact anyone. In the United States, hepatitis A can happen in state of affairss runing from stray instances of disease to widespread epidemics. Good personal hygiene and proper sanitation can assist forestall hepatitis A. Vaccines are besides available for long-run bar of hepatitis A virus infection in individuals of two old ages of age and older. Immune globulin is available for short-run bar of hepatitis A virus infection in all ages.Persons with hepatitis A virus infection may non hold any marks or symptoms of the disease. Older individuals are more likely to hold symptoms than kids are. If symptoms are present, they normally occur suddenly and may include febrility, fatigue, and loss of appetency, sickness, abdominal uncomfortableness, dark piss, and icterus, yellowing of the tegument and eyes. Symptoms normally last less than 2 months ; a few individuals are sick for every bit long as 6 m onths. The mean incubation period for hepatitis A is 28 yearss ( scope: 15-50 yearss ) . Hepatitis A virus is spread from individual to individual by seting something in the oral cavity that has been contaminated with the stool of a individual with hepatitis A. This type of transmittal is called # 8220 ; fecal-oral. # 8221 ; For this ground, the virus is more easy spread in countries where there are hapless healthful conditions or where good personal hygiene is non observed. Most infections result from contact with a family member or sex spouse who has hepatitis A. Casual contact, as in the usual office, mill, or school scene, does non distribute the virus.Hepatitis a is diagnosed through a blood trial, utilizing IgM anti-HAV, immune globulin that is hostile to the Hepatitis A virus. Children with hepatitis A normally have no symptoms. Adults may go rather sick all of a sudden, sing icterus, weariness, sickness, purging, abdominal hurting, dark urine/light stools, and fever. The i ncubation period norms 30 yearss, nevertheless, an septic person can convey the virus to others every bit early as two hebdomads before symptoms appear and one hebdomad after. Symptoms will vanish over a six-month period until complete recovery occurs. Nevertheless complications may happen if no actions are taken, these include fulminant hepatitis or backsliding of the disease.In the conflict against hepatitis and in an attempt to forestall its spread two merchandises are available. A virus infection: immune globulin and hepatitis A vaccine.+ Immune globulin is a readying of antibodies that can be given before exposure for short-run protection against hepatitis A and for individuals who have already been exposed to hepatitis A virus. Immune globulin must be given within 2 hebdomads after exposure to hepatitis A virus for maximal protection.+ Hepatitis A vaccinum has been licensed in the United States for usage in people # 8217 ; 2 old ages of age and older. The vaccinum is recommen ded ( before exposure to hepatitis A virus ) for individuals who are more likely to acquire hepatitis A virus infection or are more likely to acquire earnestly ill if they do acquire hepatitis A. The vaccinums presently licensed in the United States are HAVRIX manufactured by SmithKline Beecham Biologicals, and VAQTA, which is manufactured by Merck A ; Co. , Inc.Often people wonder if such type of vaccinums and bar techniques are safe and their side effects. Well so far hepatitis A vaccinum has had an first-class safety profile. No serious inauspicious events have been attributed definitively to hepatitis A vaccinum. Tenderness at the injection site is the most often reported side consequence. Immune globulin is besides determined really safe. No case of transmittal of HIV or other viruses has been observed with the usage of immune globulin administered by the intra-muscular path. Immune globulin can be administered during gestation and breast-feeding. It should be noted though tha t protection against hepatitis A merely begins four hebdomads after the first dosage of hepatitis A vaccine.HEPATITIS BHepatitis B is besides a serious disease caused by a virus that attacks the liver. The virus, which is called hepatitis B virus ( HBV ) , can do womb-to-tomb infection, cirrhosis ( marking ) of the liver, liver malignant neoplastic disease, liver failure, and decease. Hepatitis B vaccinum is available for all age groups to forestall hepatitis B virus infection. Hepatitis B can impact anyone. Each twelvemonth in the United States, more than 200,000 people of all ages get hepatitis B and near to 5,000 dice of illness caused by HBV. If you have had other signifiers of hepatitis, you can still acquire hepatitis B. One out of 20 people in the United States will acquire hepatitis B some clip during their lives. Your hazard is higher if you: + Have sex with person infected with HBV + Have sex with more than one spouse + Live in the same house with person who has lifelong H BV infection + Have a occupation that involves contact with human blood + Shoot drugs + Are a patient or work in a place for the developmentally handicapped + Have hemophilia + Travel to countries where hepatitis B is common Your hazard is besides higher if your parents were born in Southeast Asia, Africa, the Amazon Basin in South America, the Pacific Islands, and the Middle East. You besides get hepatitis B by direct contact with the blood or organic structure fluids of an septic individual ; for illustration, you can go infected by holding sex or sharing acerate leafs with an septic individual. Even babes get the disease, a babe can acquire hepatitis B from an septic female parent during childbearing. Hepatitis B is non spread through nutrient or H2O or by insouciant contact. If you have the hepatitis virus, HBV, in your blood you can give hepatitis B to your babe. Babies who get HBV at birth may hold the virus for the remainder of their lives, can distribute the disease and can acquire cirrhosis of the liver or liver cancer.Sometimes, people who are infected with HBV neer recover to the full from the infection ; they carry the virus and can infect others for the remainder of their lives. In the United States, about one million people carry HBV. You may hold hepatitis B, and be distributing the disease and non cognize it ; sometimes a individual with HBV infection has no symptoms at all. The lone manner to cognize if you are presently infected with HBV or if you are a bearer of the virus is to hold a specific blood trial for HBV. The trial will non demo positive during the incubation period ( 45 to 60 yearss, mean 120 yearss ) .If you have symptoms + Your eyes or tegument may turn yellow + You may lose your appetency + You may hold sickness. emesis, febrility, tummy or joint hurting + You may experience highly tired and non be able to work for hebdomads or months There is no remedy for hepatitis B ; this is why bar is so of import. Hepatitis B vaccinum is t he best protection against HBV. Three doses are needed for complete protection. All pregnant adult females should be tested for HBV early in their gestation. If the blood trial is positive, the babe should have vaccinum along with another shooting. Hepati Ti B immune globulin, called H-BIG, at birth. The vaccinum series should be completed during the first 6 months of life. Therefore who should be vaccinated against hepatitis B? + All babes, at birth should be + All kids 11-12 old ages of age who have non been vaccinated + Persons of any age whose behaviour puts them at high hazard for HBV infection+ Persons whose occupations expose them to human bloodPeople who have non cleared HBV from their blood within 6 months are considered to be inveterate infected and are called hepatitis B bearers. There are about 1 million individuals inveterate infected with HBV in the U.S. at the present clip. While there is no intervention for ague hepatitis B, there are two sanctioned interventions for chronic hepatitis B: interferon alfa-2b and 3TC. Lone patients with active HBV reproduction are candidates.HEPATITIS CHepatitis C ( HCV ) is a signifier of hepatitis caused by an RNA virus. HCV histories for the bulk of the hepatitis instances antecedently referred to as non-A, non-B hepatitis. The hepatitis C virus was first identified and described in 1989, and in 1990 a h epatitis C antibody trial ( anti-HCV ) became commercially available to assist place persons exposed to HCV. Presently, there are 175 million people worldwide who are infected with the Hepatitis C virus, 4+ million of those are in the United States. For every one individual that is infected with the AIDS virus, there are more than four septic with Hepatitis C. The CDC estimates that there are up to 230,000 new hepatitis C infections in the U.S. every twelvemonth. In mid-1995 the hepatitis C virus was seen for the first clip of all time by scientists with the assistance of an negatron microscope. It is a additive single-strand RNA ( ribonucleic acid ) virus 40-50 nano-meters in size. It is covered with a lipid envelope and is encased with glycoprotein polymers. Unlike hepatitis A which is caused by faecal taint of nutrient and H2O ; or hepatitis B which is spread through contact with septic blood or other organic structure fluids ; hepatitis C is spread by direct contact with the blo od of an septic individual. Prior to the find of the virus, it was known that some agent caused hepatitis or redness of the liver in people who had been given blood, and it was known that the agent could be transmitted to patients and to experimental animate beings in blood. Before the virus was identified, this signifier of hepatitis was called not A non B hepatitis because the viruses doing hepatitis A and hepatitis B were already identified and could be tested for. Patients with hepatitis following exposure to blood that had negative trials for hepatitis A and for hepatitis B were said to hold non-A non-B hepatitis. It is now known that the bulk of these patients were infected with the virus identified and named hepatitis C virus or HCV for short. As trials for this virus have improved over the old ages since 1989, more and more people who have hepatitis which could non be diagnosed with truth are now being right diagnosed as infected with the hepatitis C.Not excessively long ago , the CDC, Center for Disease, control has release standards that lets you know of the hazard you run of holding this disease. You may be at hazard for hepatitis C if you: + Were notified that you received blood from a giver who subsequently tested positive for hepatitis C. + Have of all time injected illegal drugs, even if you experimented a few times many old ages ago + Received a blood transfusion or solid organ graft before July, 1992 + Received a blood merchandise for coagulating jobs produced before 1987 + Have of all time been on long-run kidney dialysis + Have grounds of liver disease ( CDC Homepage hypertext transfer protocol: //www.cdc.gov ) HCV is spread chiefly by direct contact with human blood. For illustration, you may hold gotten infected with HCV if: + You of all time injected street drugs, as the acerate leafs and/or other drug # 8220 ; works # 8221 ; used to fix or shoot the drug ( s ) may hold had person else # 8217 ; s blood that contained HCV on them. + You received blood, blood merchandises, or solid variety meats from a giver whose blood contained HCV. + You were of all time on long-run kidney dialysis as you may hold unwittingly shared supplies/equipment that had person else # 8217 ; s blood on them. + You were of all time a health care worker and had frequent contact with blood on the occupation, particularly inadvertent needle sticks. + Your female parent had hepatitis C at the clip she gave birth to you. During the birth her blood may hold gotten into your organic structure. + You of all time had sex with a individual infected with HCV. + You lived with person who was infected with HCV and shared points such as razors or toothbrushes that might hold had his/her blood on them.Current surveies indicate that most ( 80 % ) people infected with hepatitis C will develop a chronic province of infection. About 30 % those with chronic infection will travel on to develop cirrhosis of the liver. The disease appears to come on easy, symptom s frequently do non look for 10 or twenty years.The overall badness of chronic hepatitis C is controversial. There is no inquiry that HCV can take to cirrhosis and primary hepatocellular carcinoma ( HCC ) and that end-stage chronic hepatitis C is now the taking indicant for liver transplantation.Avoidance of spread of this virus is an of import public wellness issue. The current limited information suggest that sexual transmittal is highly rare, but it is surely prudent to rede any sexual spouses of any infection that you know you have. Although the hazard of transmittal of hepatitis C by unprotected intercourse, that is without the usage of rubbers, is far less than the hazard of conveying many other infections including hepatitis B, people with multiple sexual spouses should ever pattern safe sex. Unlike hepatitis B, which is about wholly preventable with everyday usage of the really effectual vaccinum available for that disease, at this clip there is no vaccinum available which i s capable of protecting anyone from hepatitis C infection. The development of an effectual vaccinum against hepatitis C is a end of research workers, but advancement has been slow in this.Currently, there are three types of interferon and a combination of interferon and Virazole used to handle hepatitis C. Selection of patients for intervention may be determined by biochemical, virologic, and when necessary, liver biopsy findings, instead than presence or absence of symptoms. Interferon must be given by injection, and has a figure of side effects including flu-like symptoms: concerns, fever, weariness, loss of appetency, sickness, purging, depression and cutting of hair. It may besides interfere with the production of white blood cells and thrombocytes by dejecting the bone marrow. Periodic blood trials are required to supervise blood cells and thrombocytes. Ribavirin can do sudden, terrible anaemia and birth defects so adult females should avoid gestation while taking it and for 6 months following intervention. The badness and type of side effects differ for each person. Treatment of kids with HCV is under investigation.Currently, about one half of all liver grafts in the U.S. are performed for end-stage hepatitis C. However, re-infection of the transplanted liver by HCV occurs at a high rate. Fortunately, this infrequently requires a 2nd graft. What is the most effectual therapy for the hepatitis patients? By analyzing the immune response to the hepatitis viruses, scientists hope to place the mechanisms that lead to patient recovery and remedy. Medical research workers are hopeful that anti-viral drug intervention, immune stimulators, and cistron therapy will take to the obliteration of the hepatitis viruses. Mentions 1. H.W. Reesink, Hepatitis C virus, Basel ; New York: Karger, c19982. Hepatitis Foundation International online, hypertext transfer protocol: //www.hepfi.org/3. Tong MJ, Reikes AR, Clinical results associated with hepatitis C, New Engl Journal of Med. 19954. The Hepatitis Information Network, hypertext transfer protocol: //www.hepnet.com/5. The centre for Disease Control, hypertext transfer protocol: //www.cdc.gov/6. The National Center for Infectious Disease, hypertext transfer protocol: //www.cdc.gov/ncidod/
Wednesday, December 4, 2019
Rational Argument Security and Current Issues in Airport
Question: Describe the Rational argument Security and Current issues in airport? Answer: Introduction Air voyage is a snappy and invaluable methodology to accomplish an end of the line. Despite the way that various wayfarers may challenge of skipped flight tickets, setbacks in the midst of the events, and the amount of cartable sacks they are permitted to bring onto the plane, air escapade is a key piece of smart transport. One key piece of terminal system is security system. Today, security is a noteworthy need that air terminals must give totally. Due to the late adversary strikes on Sept 11, 2001, plane terminals nearby avionics courses require their customers to feel safe. An eagerness for air terminal security took me to the Tallahassee Local Airport. Beside the event surge, the workplace is not an involved position. I land there on a Weekend evening around one week after the adversary strikes. Found in an immeasurable rectangle-shaped making, there is not a lot of development proceeding outside of international terminal. One or two people glide about out of international terminal walking towards the vehicle auto parking space and yellow taxi line one piece of the making. No control point of view vehicle halting is permitted and there are cops circulated before the making to confirm that guests stick to this rule (FAA Advises Air Travelers on Airport, 2001). Current issues I get into terminal and seat myself before the course of action surfaces. I foresee that the workers will be comprehensive while asking the general security concerns. Has your stuff been in your proprietorship at all times? Has anyone accommodated you anything or requested you to bring on or take a gander at any things for them? These are basic concerns to ask, in light of the fact that a system used by terrorists is to cover an effect inside an oblivious particular's stuff. An exchange method is to give something, maybe a toy or toy to some individual who is going to board an air transport. That guiltless giving off an impression of being thing may truly be an effect or some distinctive perilous device (howstuffworks.com, 2001). With cops wandering all through terminal I would incline toward not to look conspicuous. I endeavour to show up as if other individuals who are with seeing tolerantly holding up to see relatives parts. I imagine that if individuals know you are checking them they put on an outer surface. By barring myself, I am prepared for overview the adventurers compare with the wellbeing focused contrivances without changing their timetable with my vicinity. As I sit in the annoying seats, I watch that there are generally few voyagers weighing in. The game plan surfaces have emerge or two individuals working. In the meantime, inside a half-hour more individuals begin to take a gander at in. I look at the encounters of the travellers searching for any indication of anxiety or instability. There is none. Everyone is proceeding with their standard lifestyle. These calm displays that voyagers have driven me to research more into whether they are incorporated about preparatory contrivances. The game plan guests let you know to the explorers about engaging emerge bear on every individual and tension the likelihood of fascinating request by security before getting on the flying machine. As demonstrated by the Government Aircraft Management, tourists must be arranged to present a real picture recognition card with their getting on goes. The guests similarly depict that without an answer no one can viably encounter the accompanying reason for confirmation, the steel sensors. Any person who comes to overall terminal to draw near relatives will need to defer on the other side. The adventurers stick to these solicitations and there are no disputes or concerns. Rationale Since security is a noteworthy sensitivity to voyagers and avionics courses, I explored the record and propelled course of action. I expected to know which one was gotten more and if one kind of game plan was more secure than the other course of action. Adventurers' fly immeasurable miles consistently and unfortunately now and again they use passes fabricated from stole plan stock-the file whereupon an answer is conveyed. The Airlines Reporting Corporation (ARC), the best supplier of airfare stock universally and the crucial supplier for U. S. wander powers, confirm that frustrations from stole plan stock are kind of immaterial, charging the multibillion-dollar air wander industry simply several million money yearly. Regardless, travel affiliations thing, varying that the burglaries of plan stock cost immeasurable money yearly. Curve communicates that stole plan stock is less hurting with the use of cutting edge passes. The constant improve in automated ticketing, according to various air wander forces, will diminish the necessity for airfare stock and in this way may over the long haul lessen plan stock robbery. Various powers furthermore note that the steady improve in mechanized ticketing may soon centre the issue because, with file passes, wander affiliations and other plan suppliers will have less need to hold extensive heaps of airfare stock. This decreases the chance for possible theft (United States. General Accounting Office. , 2001). Integration Regardless of the way that the wandering open did not give off an impression of being at danger from terrorists or unlawful untouchables who could use passes from stole game plan stock, air travel fragments at the time considered that unmindful adventurers obtained and used pretty much all these passes. Forces weight that terrorists are unlikely to intentionally use passes from stole stock because doing so will likely grow their probability of recognition. Likewise, they point out that sorted out foe classes have agreeable plans and access to defiled individual recognition to purchase true blue passes. Notwithstanding the way that the electronic plan is highlighted to be more secure and more even minded, I did experience an issue in the midst of a trip over the U. S. Declares. My returning outing from the state of Utah to California did not contain the comfort and protection of the propelled game plan. As I reviewed in before I sheets the flying machine the course of action authority couldn't find my name in the machine. In the wake of rehashing tries to find my name the course of action master found that my answer had been unequivocal under the name of a mate who wandered with me. After we reviewed our totes we started to the leaving checkpoint to get a report game plan. The game plan master at the checkpoint passed us our passes barely looking at our driver's licenses. As I dissected the course of action I watched that she provided for me the erroneous game plan. The course of action had the erroneous name on it and I had revealed her my permit. Regardless of the way that using t he electronic course of action actuated issues I accuse the plan guests for being imprudent. Conclusion The association in the middle of voyagers and air terminal protection has made an alternate relationship. Security and wellbeing measure is the most basic on both the voyager and air journey mind. Aeronautics courses, for instance, Delta surrenders and advancing bits of knowledge as for flight tickets and the efforts to establish safety that it is getting to check the certification of its adventurers. Explorers can look upward this unpretentious components on the Internet. Aeronautics courses and the Government Aircraft Management locales furthermore give this organization. On the off chance that strikes happen before long there may be a colossal loss of air voyage, and air wander pay may persevere altogether more than they did in the midst of the month of September (Delta.com, 2001). Plane terminal preparatory contrivances may change far and wide, yet as an America and in light of the late strikes turning around air wander, I do have issues in the matter of whether preparatory characteristics are totally required in the United Declares. I acknowledge that the America game plan of air terminal protection should recognize the tight exercises that other air terminals complete. Concerning the Tallahassee Local Airport, it has finished getting extra exercises to secure their flying transports and voyager certification (Lovasz, 2001). To confirm voyagers that it is secured to fly, judicious characteristics should keep be tight and fairly required. As people endeavour to proceed with their lives there will constantly be instability concerning whether the air wander they are going on is secured. In case preparatory idiosyncrasies stay compelling, it will send the affirmation that voyagers have lost in air wander. References 1. Delta.com. (2001, October 11). Delta Reports September Traffic. Retrieved from Delta.com: tacindex.jsp?file=SeptTraffic.htmltactype=Currenttacitem=Releasetitle=Delta%20R2. FAA Advises Air Travelers on Airport. (2001, October 14). Airline Security Measures. Retrieved from Federal Aviation Administration Public Affairs: https://www.faa.gov/apa/update.htm3. howstuffworks.com. (2001, September 27). How Airport Security Works. Retrieved from How Stuff Works: https://www.howstuffworks.com/airport-security.htm.4. Lovasz, M. (2001). Personal Interview. 5. United States. General Accounting Office. . (2001). Report to the Chairman, Subcommittee on Aviation, Committee on Transportation and Infrastructure, House of Representatives: Issues Associated with of Theft of Stock Used to Create Airline Tickets. Washington: GAO. Appendix: Argument Map
Thursday, November 28, 2019
Homosexuality Essays (2572 words) - Sexual Orientation,
Homosexuality Homosexuality- The Major Cause of Homosexuality The origins of human sexuality and homosexuality in particular have puzzled philosophers, theologians and ordinary people for thousands of years. In scatter cultures, homosexuals have been regarded as a normal part of life, however, same sex attraction to most cultures have been treated as an unforgivable sin or a terrible crime. Many psychologists and psychiatrist had attempted to ?treat and counsel? the homosexuals. In our social norm, male attracts to female and female attracts to male. To everyone this is a natural and biological urge. However, there is a significant minority who attracts to their own sex. It's about five percent of the population in the world. There are many opposing viewpoints of whether it derives from variation in our genes or our physiology, from the intricacies of our personal history or from convergence of these? Is it for that matter a choice rather than a compulsion? Chances are no one factor or study can alone explicate and clarify the human sexual orie ntation. However, there are evidences that prove being gay is not a choice. The nature of homosexuality primarily comes from one's biological sexual orientation and the environment is just a source to bring forth or repress the behavior Many researchers and scientists have long search for the distinguishable brain structures, the biochemistry in the human brains to differentiate the differences to classify between the two obvious sexes we now have in our society, male and female. Such sex differentiation of the brain's structure is called sexual dimorphism. . (LeVay/ Hamer 22) The first significant observation of sexual dimorphism performed in an animal laboratory. Roger A. Gorski, a professor at University of California, Los Angeles, conducted an experiment on rats. In 1978, Gorski examined the rat's hypothalamus, a region at the base of its brain that is involved in instinctive behaviors and regulation of metabolism. He discovered there is a group on front of the hypothalamus is several times larger in millimeter of the male rats compared to the female rats. The cell group is very small but it could be easily observed on a stained slice when being viewed under a microscope. More interestingly, Gorski's finding applied to the sexual orientation between males and females. That particular group of cell is known as the medial preoptic are has been involved in the sexual behaviors typically displayed in males. For instance, if there is a male rat has a injury medial preoptic area, he apparently couldn't indifferent to sex with another female. From the study o f Gorski and his co-workers, we now know the androgen is the typical male hormone and the estrogen is the female hormone played a major role in bring about dimorphism during the fetus development. (LeVay/Hamer 23) Another finding also involved with Gorski and his colleagues at U.C.L.A, especially with his student, Dr. Laura S. Allen. They also found the dimorphic structure in the human brain. A cell group named INAH3, shorten for the third interstitial nucleus of the anterior hypothalamus, in the medial preoptic region of the hypothalamus is about three times larger in men that in women. (LeVay/Hamer 23) Animal studies make available a good deal of evidence for biological basis of disease, but in this case, sexual orientation. Through a careful exploitation of hormone level on rats, Gorski as been able to produce male rodents that demonstrate feminine behavior and injected into the female fetus that develop with the male fetus and it appear to be masculine because of the male testosterone. They also look and act more like males. In addition, they are less attractive to male mice (Gorman 60) Related to Gorski and Allen's study, Simon LeVay, a British biologist and neurologist at San Diego Salk Institute, who is also gay, performed another study for Biological Studies, in 1990. LeVay decided to check whether INAH3 or some other cell group in the medial preoptic area varies in size with sexual orientation as well as with sex. LeVay conducted an experiment on the hypothalamus in autopsy specimens from nineteen homosexual men, all of whom died of AIDS and sixteen heterosexual men, six of whom had also died of complication of AIDS. After encoding the specimens to eliminate all the bias that could
Sunday, November 24, 2019
The Difference Between Restrictive and Nonrestrictive Clauses
The Difference Between Restrictive and Nonrestrictive Clauses The Difference Between Restrictive and Nonrestrictive Clauses The Difference Between Restrictive and Nonrestrictive Clauses By Mark Nichol An essential, or restrictive, clause is a part of a sentence that provides integral context for the reader. A nonessential, or nonrestrictive, clause is parenthetical, presenting additional information that is not necessary for reader comprehension. Writers are, with increasing frequency, neglecting to appreciate the distinction, thereby undermining the effectiveness of the language they use. The following sentences illustrate how this carelessness (or ignorance) adversely affects meaning. Discussion and revision of each sentence responds to the fact that each of the following sentences erroneously treats optional material as required content. 1. Phyllis Schlafly, the conservative political activist who devoted much of her energy in the 1970s to stopping the passage of the Equal Rights Amendment that would have banned discrimination on the basis of sex in the United States, has died. The phrase ââ¬Å"The Equal Rights Amendment that would have banned discrimination . . .â⬠implies that more than one such amendment was proposed and that this one in particular, and no others, was intended to ban the specified discrimination. However, ââ¬Å"would have banned . . . United Statesâ⬠is helpful but nonessential information about the one and only amendment, and that phrase should be included parenthetically: ââ¬Å"Phyllis Schlafly, the conservative political activist who devoted much of her energy in the 1970s to stopping the passage of the Equal Rights Amendment, which would have banned discrimination on the basis of sex in the United States, has died.â⬠2. Smith was referring to the Columbian mammoth which roamed the continent of North America before migrating to the Channel Islands. The sentence seems to imply that more than one species of Columbian mammoth existed, and that the one in question was native to North America but ended up on adjacent islands (with which substituting for the preferred pronoun that). However, the phrase ââ¬Å"which roamed the continent of North America before migrating to the Channel Islandsâ⬠is additional information attached to the main clause, ââ¬Å"Smith was referring to the Columbian mammoth,â⬠so it should be set off with a comma: ââ¬Å"Smith was referring to the Columbian mammoth, which roamed the continent of North America before migrating to the Channel Islands.â⬠3. The two dwarf planets are in the asteroid belt thatââ¬â¢s littered with rocky debris from the formation of the sun and planets some 4.5 billion years ago. The implication here is that more than one asteroid belt exists, and the one under discussion is littered with the described rocky debris; one or more others, presumably, has no such detritus. But the part of the sentence that follows ââ¬Å"asteroid beltâ⬠is nonessential information that should be appended to the main clause parenthetically, with a comma separating the two sentence segments: ââ¬Å"The two dwarf planets are in the asteroid belt, which is littered with rocky debris from the formation of the sun and planets some 4.5 billion years ago.â⬠Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Grammar category, check our popular posts, or choose a related post below:50 Incorrect Pronunciations That You Should AvoidCapitalization Rules for the Names of Games90 Verbs Starting with ââ¬Å"Ex-ââ¬
Thursday, November 21, 2019
Ashes by Edvard Munch and Abstractoin by Juan Gris Essay
Ashes by Edvard Munch and Abstractoin by Juan Gris - Essay Example The mural print is a depiction of a man and a woman in a forest that is dusky. The atmosphere in the picture is relatively gloomy filled with both hopelessness and despair. The trees and the existence of a man and a woman can be interpreted to be a form of a romantic adventure. However, the adventure may have been crippled by a misfortune. The woman has her hands on her red, long hair while standing at the center of the picture. The frowned face is filled with desolation and despair while the direction of her eyes is towards the audience (viewer). Apparently, she is regretting something. On the other hand, the man has his hand on his head while sitting on the left corner of the picture. The tone of his face is apparently not only sickly but also green. In fact, the man appears to be so hopeless that his pace canââ¬â¢t face the viewer. The dress that the woman has on her is white and it is half unbuttoned. Inside the white dress, one can glimpse at the red undergarment . The colors depicted in Munchââ¬â¢s work can be interpreted in several ways. According to my interpretation, white is used to represent innocence of the woman in question while the red one can be a symbol of either love or passion or even romance. As for black, which is normally associated with negativity, symbolizes either death or sorrow. The green painting on the manââ¬â¢s face expresses a disturbed state of the mind and a sad mood. Interestingly, a clear look at the picture using high definition quality glasses indicates that there is lack.
Wednesday, November 20, 2019
Individual - Videoconference Assignment Example | Topics and Well Written Essays - 1250 words
Individual - Videoconference - Assignment Example The manager should be able to define the project success standards by identifying the various stakeholders involved which include those that are directly affected by the project, persons who sponsor the project implementation and the society at large (Journal, 2013). This will aid the business to upsurge its market share, meet the customer targets by attaining specific standards, the firm will also be able to increase its revenues since they can achieve the target sales while maintaining the customer satisfaction and keeping up with the industry and state standards. However the problem exist since some goals will be given more priority than others as there will be a trade-off of the choices. But the business goal must be decided since it is only rational to determine direct issues that will affect sales and improve revenue. Second, project manager should allow degree of freedom, project animators and decide on the restraints. Constraints are the limited resource available while the motivators are those factors that initiates a faster result of the project and freedom allows for adjustments during the project cycle (Charrel & Galarreta, 2007). This factor is advantageous to the companyââ¬â¢s projects to be stretchy so that it can be successful. None the less, allowing too much flexibility may lead to wide deviations from the project objectives and should only be allowed at minimum levels. This factor has the rationale that if one direction is bound to fail, the manager can find other alternatives to remedy the situations while maintaining the project desires. Third, the manager should set achievable goals and avoid impossibilities. This is done by negotiations by consumers, managers of the organizations and all the staff members involved on the realistic targets to work on while keeping a good demand and forecast predictions about the future (Kerzner & Learning, 2013). This will enable the company to solve problems
Sunday, November 17, 2019
Relational Leadership qualities of Colin Powell and how he represented Essay
Relational Leadership qualities of Colin Powell and how he represented them - Essay Example Colin L. Powell was born in Harlem in 1937 and was the son of Jamaican immigrants who were very much involved in his education and personal achievement .Colin manifested both these qualities of a bright young man and a high achiever throughout his academic career. He was well aware of his humble beginnings and he makes some interesting reflections about that in his biographical accounts. "In the preface to his autobiography, My American Journey, Powell describes himself as "a black kid of no early promise from an immigrant family of limited means." The audiences who pay dearly to hear Powell speak these days understandably believe that the man who rose from such unpromising beginnings to become one of the most admired public figures in the world must have grasped the secrets of leadership early on. He clung to them dearly as he became the youngest general in the Army, then found his way to the seventh floor of the State Department. "When I go out and speak," says Powell, "I don't talk about the chairmanship and all that stuff. I talk about being a young second lieutenant at Fort Benning, Ga. Most of what I learned about leadership I learned in my first two months there."1 Colin Powell with his vision of success and promoting the ri... In the year 1986 he left Washington to serve as commander of the Fifth Corps in Germany and when he returned he became the Assistant to the President for National Security Affairs in Reagan's era. His excellent leadership qualities his 1991 service as Chairman of the Joint Chiefs of Staff made him a figure of national importancee during the successful Operation Desert Shield and Desert Storm conducted to to expel the Iraqi army from Kuwait.He declined the opportunity to run for president in the year 1996. and has focused his efforts on his organisation ,America's Promise,since then which is an organization dedicated to creating opportunities for today's young people.This shows how his leadership has been instrumental in encouraging the youth population and also in paving the way for inspired young people. Powell's leadership His political views have been moderate and he has earned great respect with the American people as an inspiration towards all.As has been pointed out in the book "Exploring Leadership"he inspires people with his actions like a good leader should. Serving as the Secretary of State in the Bush administration, Powell was popularly perceived as moderate. Powell's great asset was his tremendous popularity among the American people. He has played a pivotal role after September 11,in the management of America's relationships with other nations in order to secure a stable coalition in the War on Terrorism.He has been a tactful leader and has paved the way for more moderate views amongst the Bush administration.He refused to go to the Iraq War unless the international community supported this decision and continued to be the saner voice
Friday, November 15, 2019
A Five Forces Analysis Of Air Arabia Tourism Essay
A Five Forces Analysis Of Air Arabia Tourism Essay According to this model any business has 4 stages during its life cycle. These stages are: Introduction, Growth, Maturity, and Decline. In the introduction phase a company just starts offering its new product or services in the market. At this stage the company might the only one in the market or its services or products might be completely new. In the stage of growth the company has to make huge investments for the marketing and research and development of the product so that the product can grow competitive in the market. The stage of maturity the curve of the industry life cycle becomes flatter and the rate of growth slows down. There are very few firms in this stage where the business giant has a little competition from the new comers in the industry. At last the decline phase of the life cycle is nearly inevitable if there are no regular improvements are done in the product or service. In this phase the sales decline at a very pace. Every company, industry or business goes throu gh all these stages in their life cycle but there are very few companies which have seen the maturity phase. Air Arabia is one of those companies of the UAE which is in the stage of maturity. The company is considered to be in the stage of maturity as it fulfils all the requirements to be in the stage. Air Arabia is the largest aviation company that offers the lowest flying cost. The strategy of cost minimizing and branding by increasing the number of flights is to gain sustainable competitive advantage in the industry and competitive edge over the new entrant competitors. Being in the phase of maturity of the industry life cycle the company Air Arabia must stick to its low cost carrier services and focused on the current business model. Air Arabia has captured most of the business hubs of the Middle East and North Africa region which has a potential developing market and prospective growth for the aviation industry and LCCs. The business strategy of the company should not be only s triving for cutting down the operational cost to provide low price carrier but to provide service which is more scheduled, convenient, more destinations it covers, and performs in time. Analysis of the Air Arabia based on Michael Porters five Competitive Forces: Threat of New Entrants The entry of new company in the industry influences the competition scenario in the industry. The aviation industry has a high potential of profits so it may attract competitors in the market. These new entrants might be threat for the Air Arabia aviation company which is the leader in the LCCs. These threats might be in terms of better services, lower cost of product and services. Air Arabia is a well established, profitable and most successful company in the industry so it would be difficult for the new entry to sustain in the market. The barrier of entry in the industry is also very high because of the huge cost of establishing the business. The business needs millions of millions dollars to be invested to establish a company. The cost of an aircraft is around $ 2 billions and to compete with the Air Arabia the competitors has to run the airline at low cost and offering better customer services. Air Arabia has a brand name and customer loyalty in the business which gives it compet itive advantage over the new entrants in the industry. Bargaining Power of Suppliers Every industry and business needs raw material to manufacture their final product or service and this raw material is made available by the suppliers. These suppliers can influence the profit involved in the industry by varying the cost or quality of the raw material. Thus the relations with between the manufacturer and suppliers become important for the industry. The airline industry has very specific suppliers for the business. One is the aircraft manufacturing companies like Boeing and Airbus and fuel suppliers. Because of scarcity of the suppliers of aircrafts and limited production of units the suppliers can control the prices and bargaining power will be higher with them. The fuel suppliers also control the cost of the tickets of airlines. This force is a threat for the Air India as the suppliers has more power then the company. Bargaining Power of Buyers This force is stronger in the airline industry in the Middle East and North Africa region. The buyers have higher power of bargaining for low cost, and better services. The situation is because of the large number of options available to the passengers and the number of passengers travelling in the LCCs is very high which will affect the business on a very large scale. Because of the availability of several options of low cost airlines and the facility of internet booking of air tickets the customers have many flexible options available. So to weaken this force of buyers the company ha to maintain the quality of services and the cost of the services should be kept minimum in the industry. Otherwise this force will also act as a threat for the company. Threat of a Substitute Products or Services Substitutes for the airline industry are trains or driving cars but availability and feasibility of these substitutes varies from region to region. Cars and trains might be substitute for the regional and local flights but they cannot replace international low cost flights. So the power of this force also differs in regions like in Europe where travelling with trains is easier and cheaper the threat will be higher but in UAE where the train facility is not good and because of the hot and dry climate travelling with cars is also not possible flights are the best option as it is more convenient and time saving. So the power of force will be weak there and opportunities of business will be higher. Rivalry among existing firms In the aviation the competition level is very high between various airline companies. In the Middle East and North Africa region there are many international airlines in the industry. All these companies are attracting customers by providing best customer services, best aircrafts and lowest price in the industry. But the Air Arabia has been established in the region for the past many years and holding the position of leader in the LCC airlines. Business-Level Strategy The differentiation strategy requires the development and improvement in the quality of product or services. These products are offered to customers with better and unique characteristics which are completely different and advanced from the competitors. The uniqueness in the services will add a value to them and this value may be charged as a premium price of the service by the company. Air Arabia has been the leader f the LCCs for the past three years. Now the company can use is brand value to cover up the extra cost of the exclusive services by the customers. The unique attributes of the services provided by Air Arabia will be able to charge some extra dollars from the customers if the suppliers increase the cost of their products. The current business strategy of Air Arabia is cost focused; it provides services at the minimum cost possible in the industry and is leading the LCC industry for the past 3 years. The company should now add some value to its services. These value added services may be better customer service, rapid innovation and advanced technology. But if the company will practice this new business strategy along with its brand image then the threats and weaknesses can be overcome. To be successful with the differentiation strategy of business an organization might have certain strengths: Use of best and advanced scientific and technological concepts. Expert and competent work force for developing value added products or services. Sales team should be skilled enough to spread the advanced features and usability of the product. Brand image and reputation to improve quality and advancements. Value in the service and product can be created by implementing following steps in the business: Lowering Buyers Costs Improved quality will minimize the chances of problems in the services and thus the cost of buyer will also get reduced. Raising Buyers Performance The main objective of increasing the quality of services is to entertain the customers with better services and let them enjoy the service. Sustainability The uniqueness and reputation of the products will create barriers and high switching cost. Risks of Using a Differentiation Strategy Risks involved in using differentiation strategy in the airline industry are high. Competitors of Air Arabia can start imitating its business model or tastes and requirements of customers might change very frequently which might loose the value the service so the service will need changes accordingly. Functional-Level Strategies Internal analysis Business Model Mission, Vision, Values, and Goal Air Arabia is the leading firm in the field of low cost carriers with the mission of revolutionizing the air travel in the Middle East and North African region. The approach of the company will be novel and innovative which will offer services satisfying to the full value of money of customers. To achieve the mission of the company it will use low fare operations to grow the profitability of the organization. The teams of the Air Arabia will be highly motivated for customer satisfaction which will showcase the highest standards of operations and will manage the operational cost of the company. The vision of Air Arabia is To be one of the worlds leading Budget Airlines with respect to: Profitability and Margin Innovation Reputation Operational Excellence Air Arabia shows its loyalty to its passengers by offering them the minimum rates and best combination of rates and services which will attract them to travel with Air Arabia more frequently. The organization commits to its shareholders the highest and most secure return on their money. The company with its value Pay Less, Fly More offers safe, reliable and comfortable air travel throughout its network more often. The company always looks forward to meet the requirements and expectations of its valued customers by offering various value added services and offers. The company always invites the suggestions and feedbacks from the customers in order to improve its services and offerings. The journey with Air Arabia should be a wonderful experience is the main point of dedication of the company. Conclusion The Air Arabia must adopt generic business strategy of differentiation in addition to its current cost focused strategy. This mix of business strategies will gain competitive advantage over its competitors to the company. The better quality of services will make it the best company in the airline business. Air Arabias AcelAero was the multifunctional reservation system. It has offered and software solution enterprise: airline for better operational services. The company offers flights to more than 65 destinations around the world. Air Arabia understands the value of money of the customers and provides services that are compatible to the price customers have paid. All these are the uniqueness and advantages of the company in comparison to other airlines. Air Arabia will gain competitive advantages by focusing on other market segments. Like providing cargo services to Aramex, partnering with Dubai bank and Dubai Islamic Bank for the online payment facility, offering various gifts and v ouchers on the annual celebrations of the company. All these steps of the company are aimed to improve the brand name and corporate image of the company, regionally or internationally. These value added services of the company will help in increasing the number of customers and number of repeat customers who were once satisfied with the services of Air Arabia. The Air Arabia airlines company is in the maturity stage of the business life cycle so it will have to face strong competition with the competing airlines companies. To gain competitive edge over its competitors each company will be using offensive business strategies rather than defensive one to remain competitive in the market. The research and analysis of internal and external factors affecting the position of company in the airlines industry proposes following recommendations: The cost of operations of Air Arabia is increasing because of increasing fuel prices and giant investments in aircrafts and its services. The company must minimize the operational costs by improving operations in the business, particularly improvement in maintenance process, aircraft utilization, and effective scheduling of flights. Labor cost can also be reduced by using technology in various distribution processes. Although Air Arabia has threats of the high class airlines which provides high level of services to the passengers, the company is a leader in the low cost airlines. So cost of tickets can be increased up to a certain extent in order to improve the quality of services and add some value to those services. Air Arabia can remain competitive in the market because it is the leader of the LCCs and charges of other high class airlines are too much for a normal non business class customer. By extending the roots of the business in such a manner the company can grow its market s hare in the business class customers too. Air Arabia has routes in more than65 destination all over the world but as the UAE is a main attraction of global tourism so the routes of the airlines should be increased. The company should join some global alliances in order to widen the range of price and service offered by the airlines.
Tuesday, November 12, 2019
Grenada :: essays research papers
For a country as powerful as the United States, there comes a responsibility to protect its allies, neighbors, and supremely itself. However, there are times when this sense of responsibility misleads the U.S. into using force that is excessive or unnecessary. We are walking a fine line of political laissez-faire and obligation to intervene, but add the element of a à ¡Ã °Lyndon Johnsonà ¡Ã ¯s obsessive fear of the spread of Castro-style communismà ¡Ã ± (Musicant 363), and consequently, we will find ourselves resurrecting gun boat diplomacy and the Monroe Doctrine. Although under the veil of ensuring safety to our citizens, the invasion of Grenada is an example of where we overstepped our legal bounds, fabricated justifications and reacted without preparation, inconsiderate of the criticism which was definite to follow. à à à à à A main concern of the United States was its 1,000 citizens on the island. Of these citizens, 600 were medical students at St. George University. Because of the political turmoil, the U.S. stated to its public that the students and citizens on Grenada were in danger. President Reagan also stated to the press that there was no way for our citizens to get off the island. However, the State Department had issued a formal note to Grenada asking about the safety of its citizen, to which the minister of external affairs replied, à ¡Ã ° The interest of the United States citizens are in no way threatened by the present situation ... which the Ministry hastens to point out is a purely internal affairà ¡Ã ±(Musicant 374). The Chancellor of the school, Charles Modica, was announcing that the students were in no danger, and that the school was expected to continue to have good relations with the à ¡Ã °Governmentà ¡Ã ± (Weinberger 108). This display of good will coincid ed with the report Margaret Thatcher, Britianà ¡Ã ¯s Prime Minister, received from the Deputy High Commissioner in Bridgetown, Barbados, who had visited Grenada, that the British citizens were safe and that the new regime was cooperating in making arrangement for those who wished to leave(Thatcher 330). The same cooperation was being offer to the U.S., contradicting the Presidentà ¡Ã ¯s statement, which was made long after notification from Grenada that Americans were free to leave on regular or charter flights. Also clearly in contradiction was Lieutenant Colonel Oliver North report to the press stating that the airports were open for two hour even the day before the invasion (Speakes 161-162). There was no evidence that the student or citizens were in any danger, except during the invasion.
Sunday, November 10, 2019
Driving Force of Globalisation Essay
An NIC stands for a Newly Industrialised Country. It is a term used to describe a country that has moved away from an agriculture-based economy and into a more industrialised, urban economy. These countries have a high growth rate. Current NICs include China, India, Brazil, Malaysia, Mexico, South Africa, Philippines, Thailand and Turkey. The average growth rate between these countries is approximately 7.64% compared to the world average of 3.7% (2011). The average Gross Domestic Product (GDP) per capita for these NICs is US$10,769 compared to the world average GDP per capita of US$12,000. GDP is a useful indicator of development and a great measure for comparing differences between countries, therefore allowing a clear differentiation between countries that are Highly Industrialised Countries (HICs), Newly Industrialised Countries (NICs) or Low Industrialised Countries (LICs). The Human Development Index (HDI) is another strong indicator of development, it includes a combination of statistics: life expectancy, education and income. The average HDI of these NICs is approximately 0.6874. The world average HDI is 0.862. India is now an NIC, as the IT services boom has transformed the countryââ¬â¢s economy, which is now growing at more than 9% per year, the same rate as China. Indiaââ¬â¢s HIC is 0.547(2011 estimate). Since China opened up its markets to the West in the 1980s, the city of Shanghai has transformed into a booming metropolis consisting of about 21 million people. Shanghai accounts for 30% of Chinaââ¬â¢s foreign exports and attracts 25% of all foreign investment into the country. The GDP of Shanghai alone is US450 billion! Chinaââ¬â¢s HDI is 0.867 (2011 estimate). Globalisation is the stage of processes and impacts that occur at a global scale, usually economic systems, but it can include physical systems (global warming) and socio-cultural systems (fashion, music, film industry). Globalisation can be measured using the Globalisation Index, which tracks and assess changes in the 4 key components of global integration. Another measure of globalisation is the KOF Index of Globalisation. This calculates the overall index of globalisation and sub-indices referring to actual economic flows, economic restrictions, data on information flows, data on personal contact and data on cultural proximity. NICs have been and continue to be the driving force of globalisation. Manufacturing tends to occur mainly in industrialised countries. Globally, manufacturing output continues to increase and most manufacturing still occurs in industrialised countries. Although relative contribution of manufacturing to most industrialised countries economies has declined, manufacturing remains fundamental to all economies. Many of the new industrialised countries are dramatically increasing their manufacturing output, by establishing their unique multi-nationals and implement manufacturing plants in developed countries. An example of a country doing this is South Korea. NICs have a variety of advantages over fully developed countries, as they are able to benefit from cheap labour costs, lower business taxes, cheaper land and fewer environmental controls. Multi-nationals are hugely responsible for a large majority of the rise in globalisation, for example; the introduction of Trans-national companies (TNCs). These multi-nationals have huge benefits, i.e. they have generated millions of new jobs in NICs, however; they have also lead to social, political and economic problems within a country, as well as between countries. For example, Uganda, a very poor country with a GDP per capita of just $1,300 (2011), has been forced to lower its prices of exporting coffee, which is what its economy relies on. Coffee prices have fallen by 70% since 1997, costing exporters in developing countries $8 billion in lost foreign-exchange earnings. This divides the gap between the rich and the poor, as the richer countries will benefit from trading, while the poorer countries, such as Uganda, will loose out in gaining money on exports, therefore making them poorer. TNCs dominate industrial production including manufacturing and services, therefore further dividing the gap between the rich and the poor, and being the main leader of globalisation as a consequence. TNCs work to meet the demand for its good from HICs. For example, Toyota, like many other TNCs undertakes much of its manufacturing in LICs in order to meet the high and constant demand from HICs. Manufacturing in LICs is preferred as it provides these large companies with cheap labour. Toyota was recorded as the fifth largest TNC in 2010. It has 51 overseas manufacturing companies in 26 countries and regions, it has Design and Research and Development centres in the USA, Japan, Belgium, the UK, France, Thailand and Australia, and its headquarters are in Japan. Globalisation inevitably increases pressure to liberalise trade and to eliminate tariffs and non-trade barriers. Liberalisation of trade within OPEC clearly resulted in China (an NIC) for example, gaining a comparative advantage over the US (MIC) in the manufacture of machinery products. Globalisation has also been a resulting factor for the dramatic increase in technology. Bangalore, in the Silicon Valley of India is experiencing a remarkable IT boom, that is transforming the prospects of Indiaââ¬â¢s economy. The internet is the fastest growing tool of communications. It took just 4 years for the internet to reach 50 million years, in contrast to the 38 years it took for radio and 13 years for television. However, the bulk of internet traffic is between and within North America, Western Europe and, to a limited extent, East Asia i.e. HICs and NICs. In Asia, Japan accounts for the major share of internet traffic, which is the reason for why this country has become an NIC, where as most other countries in Asia are LICs. A number of charismatic new Indian companies are now challenging the multinationals for global leadership in this area, including TCS (TATA Consultancy Services), Infosys and WIPRO (the current global leader in technology). The IT services boom has helped to transform the Indian economy, which is now growing at more than 9% a year, comparable to China. The new-found affluence of the young workers in the IT sector has led to a change in attitudes to wealth and consumption in the country. More and more young people are increasingly being able to afford such luxuries, for example cars and home ownership. On the other hand, NICs are not necessarily the driving force to globalisation. The reason for this is that these countries have only been able to develop due to the richer western countries. These MICs have the money to buy up land in poorer countries, as part of land colonization in order to meet the demand of these MICs. Many of the new industrializing countries (NICs) are dramatically increasing their manufacturing output, however this is only as a result of industrialised countries becoming established in the NICS. The core periphery is a theory to explain the process by which some countries become wealthy and others become poor, subsequently increasing the divide between them. The patterns of trade that emerges from the 1500s onwards created a wealthy ââ¬Ëcoreââ¬â¢ of European countries. The nations who supply these rich European countries remained poor and on the edge, known as the periphery. The Global core regions include North America, Europe and Japan. This core owns and consumes 80% of global goods and services, earns the highest incomes, makes most decisions about the global economy, e.g. what goods are produced, and provides most global investment. Therefore, richer countries control trade, and so have control of LICs to meet their large demand, subsequently being the driving force of globalisation. Trade has been the engine of globalisation, with world wide trade in manufactures goods increasing more than 100 times (from $9.5 billion to $12 trillion) in the last 50 years. This has outpaced the overall growth of the global economy. Since 1960, increased trade has been made easier by international agreements to lower tariff and non-tariff barriers on export of manufactured goods, especially to rich countries. Those countries which have managed to increase their role in the world trading system (through implementing TNCs) by targeting exports to rich countries ââ¬â such as Japan, Korea and now China. All these countries have seen a dramatic increase in their standard of living. In conclusion, I strongly believe that NICs have been the driving force to globalisation. Moving to a more industrialised, urban economy will help any country to perform better in the global market, helping it to gain a higher growth rate and GDP. Having a higher HDI in a country will also help those countries to receive higher standards of living and an enhanced quality of life. Globalisation occurs as factor of change to economic, physical and socio-cultural systems, which all have large global influences. HICs have therefore, increasingly been the cause for globalisation, as they develop from an agriculture-based economy into an industrialised, urban economy.
Friday, November 8, 2019
Government Regulation of Psychology Profession
Government Regulation of Psychology Profession Introduction The legal aspect of professional psychology concerns itself with adherence to law and ethics governing the profession in areas relating to treatment of mental patients and subjects in empirical research. Government regulation of psychology profession is mostly done through formulation of relevant laws and creation of means of understanding the legal issues and questions in the field of professional psychology.Advertising We will write a custom research paper sample on Government Regulation of Psychology Profession specifically for you for only $16.05 $11/page Learn More The professional practice of psychology has become increasingly complex in modern society which has resulted in renewed attention on issues regarding its legality and ethics. Ethics refer to the rules and guidelines that govern the conduct of psychology professionals. These are clearly outlined in the American Psychology Associationââ¬â¢s ethics code which provide the standard s of professional conduct that psychologists are expected to adhere to when dealing with clients. On the other hand, law refers to a body of rules that govern the affairs of a specific community. While the ethics code has the force of law in situations where it is used as a licensing regulation, its violation does not necessarily imply violation of law. Legal Issues Relating To Informed Consent and Refusal The principle of informed consent dictates that participants in any form of psychology research and therapy should be adequately informed in an easy to understand language, of all the significant factors that could affect their willingness to participate in such processes (Rivera, 2010). The patients have a right to be informed about the possible physical and emotional risks associated with the treatment process and the psychologist should also inform them of alternative forms of treatment and their effects in order for patients to be able to make informed decisions. In the event where the patient is unable to understand the medical procedure consequently hindering his ability to make a decision, the professional psychologist should look for an experienced attorney in the health care field who should make the decision on behalf of the patient.Advertising Looking for research paper on psychology? Let's see if we can help you! Get your first paper with 15% OFF Learn More In absence of such a person, the doctor is under obligation to look for another authorized practitioner with whom they make appropriate decision of behalf of the client. The basis of legal doctrines of informed consensus lies in the ability of adult patients of sound mind to make decisions regarding the doctorââ¬â¢s proposed medical procedure in self determination (Rivera, 2010). Psychologist and their clients engage in an extensive discussion regarding the medical procedure which serves to inform the patient of the possible risks and benefits associated with the pro cedures. In addition, the law requires such professionals to take rational steps to converse with patients in situations where there exists a communication barrier so that they are able to give an informed consent regarding their treatment. The right to give an informed consent also creates a provision for refusal rights. Patients and clients have a right to turn down any form of treatment regardless of its necessity upon which the professional psychologist should initiate further discussions. The patient may choose to reject the medication due to lack of trust, fear, depression, religious views among other factors and the practitioner should not use coercive means to convince the patient to agree to undergo treatment. Legal Issues in Assessment, Testing, And Diagnosis in Professional Psychology Psychological testing has continued to be a major mode of professional inquiry and is most commonly used in psychological research to measure varying constructs. Through psychometrics, profe ssional psychologists analyze samples of the subjectââ¬â¢s behavior in order to assess their functioning. Often, concerns have been raised over ethical and legal issues regarding human treatment during the process of psychological assessment and testing. Consequently, facilities that conduct psychological testing are regulated through institutional review boards which govern the way subjects are treated during such processes.Advertising We will write a custom research paper sample on Government Regulation of Psychology Profession specifically for you for only $16.05 $11/page Learn More Through psychological assessment, psychologists engage in comprehensive and in-depth analysis of the subjects in order to come up with a diagnosis. Psychologists are under obligation to effectively communicate the results of the assessment to the client using clear and easy to understand language. If the practitioner does not present the results in person, it should be agr eed upon prior the assessment and he should ensure that the person delivering the information does so in a clear and competent manner. The security of results and client diagnosis should also be ensured and availability of the results should be limited to the client and the referral source unless otherwise indicated by the client. Legal issues relating to testing, assessment and diagnosis further seek to address the test bias associated with the process. Systematic error in measurement may occur in certain incidences due to existence of biasness towards minority groups especially in intelligence tests, psychopathology, and academic potential tests. In response to this, proposals to outlaw some of the psychological tests and develop more appropriate psychological assessment have been put forward. The law further requires that subjects in psychological research be treated in a humane way. Subjects in research should be reasonably and adequately compensated for their time and should be protected against stigmatization and discrimination. The United States congress has passed a number of influential legislative acts that relates to testing and assessment such as the civil rights Act, Americans with disability Act, and truth in testing law among other legislation. Importance of Maintaining Confidentiality in the Therapeutic Relationship Professional psychologists are obligated to ensure that the clientââ¬â¢s right to privacy is maintained through maintenance of confidentiality. It is regarded as a fundamental component of therapeutic relationships since it promotes trust between the practitioner and the client consequently facilitating positive outcomes.Advertising Looking for research paper on psychology? Let's see if we can help you! Get your first paper with 15% OFF Learn More The utilitarianism perspective argues that if confidentiality is not maintained, patients may fail to disclose all the relevant information which would prove damaging to the healing process (Anonymous, 2008). The deontology perspective argues that the role of maintaining client confidentiality is a universal moral obligation that therapists should seek to maintain (Anonymous, 2008). The relationship between the patient and therapist is based on the expectation that any form of information that the client reveals is going to be kept confidential failure to which results in undermining the universal moral obligation. Maintaining a clientââ¬â¢s confidentiality is viewed as respect to the individualââ¬â¢s autonomy which enables him or her to have control over issues relating to own life such as the right to keep private information and make independent decisions regarding oneââ¬â¢s health. There exist ethical and legal provisions that regulate confidentiality in therapeutic rel ationships. Failure to adhere to these regulations may lead to punitive measures which negatively impact on the practitionerââ¬â¢s career. However, various bodies have acknowledged that confidentiality cannot be absolute. For instance, The Australian Medical Association code of ethics, 2004 creates a provision for exceptions in maintaining confidentiality for cases where there is a serious risk to the patient or other people (Anonymous, 2008). Various legislations have also been enacted to deal with confidentiality issues which create provisions which render therapists liable in case of breach of confidentiality. Influence of Legislation on Professional Psychology Professional psychology practice in modern world is heavily influenced by various government legislations. Countries have formulated psychology profession acts which aim at regulating the activities carried out by psychology professionals. The acts often outline the qualifications of psychologist practitioners and dicta tes that such practitionersââ¬â¢ posses a valid license in order to establish their own practice. This serves to protect mental patients from unqualified practitioners who may be out to exploit them rather than providing them with the necessary treatment that they require. In United States, a number of legislations have been enacted which directly or indirectly affect the profession of psychology. Most of these acts are established by the federal government hence vary from one state to another. In most states, there exist specific laws that outline the educational requirement for such professionals. In the state of Virginia, practitioners should hold a doctorate degree in a psychology profession program from a recognized University and should be accredited by the American Psychology Association. This serves to ensure that the licensed psychologists are adequately trained and skilled to deal with the patientââ¬â¢s problems. The law further governs the profession of psychology t hrough control of bodies which deal with issuance of license and have the ability to revoke such licensees upon failure by practitioner to adhere to rules and regulations governing the profession. In order to ensure that they remain in operation, professional psychologists adhere to the legal and ethical standards while dealing with clients. This ensures that the clientââ¬â¢s rights are upheld during the process of treatment which also plays an important role in the recovery process. Persons licensed by boards are also subject to other disciplinary actions upon failure to comply with the legal standards of the profession. A client who feels that his rights have been violated against during the course of treatment may sue the practitioner in a court of law for damages. Role of Competence in Professional Psychology The nature of work in professional psychology requires competent practitioners who are capable of dealing with diverse issues facing human mental health. This has led to shift within the profession towards emphasis on acquisition and maintenance of competence. This is achieved through development of educational programs that aim at producing competence and establishment of bodies that award credentials and certify practitioners as competent. Embracing a culture of confidence within the psychology profession promotes learning and innovation where practitioners can develop new and more effective means of dealing with psychological problems. Ensuring competence among professional psychologists protects the patients from unqualified practitioners and serves to promote effective service provision in the health sector. Conclusion Legal aspects of psychology play a key role in regulating the practice of professional psychology in society. It is especially important since it serves to protect the psychological ill from selfish drives of incompetent practitioners. The legal aspects seek to address issues regarding confidentiality of patientââ¬â¢s informa tion and protection of patients during the treatment period. Legal legislations relating to such issues serve to protect patients undergoing treatment and subjects in psychological research against exploitation and inhumane treatment. The law has therefore played an important role in regulation of the client therapy relationship which has boosted patientsââ¬â¢ confidence encouraging them to seek help for various mental problems. Reference List Anonymous, (2008). Confidentiality in Therapeutic Relationships: The Need to Develop Comprehensive Guidelines for Mental Health Professionals. Web. Rivera, R. (2010). Legal Aspects of Professional Psychology. Web.
Wednesday, November 6, 2019
Enteral and Parenteral Nutrition Essays
Enteral and Parenteral Nutrition Essays Enteral and Parenteral Nutrition Essay Enteral and Parenteral Nutrition Essay Which critically ill patients should receive TPN? Prof R D Griffiths in conjunction with Fresenius-Kabi Why are these guidelines required? In the critical care setting, nutritional support influences the outcome for critically ill patients. This guideline seeks to outline the important role of parenteral nutrition in the critically ill patient. Enteral and parenteral nutrition The enteral route for nutrition delivery is preferred where it can be safely delivered in the absence of gastrointestinal intolerance. For a small proportion of patients enteral feeding is not possible but in addition for a larger proportion of patients research consistently shows that enteral nutrition does not always cover the total nutritional needs of intensive care unit patients. There has been a reluctance to use parenteral nutrition (PN) or to supplement enteral (EN) or oral nutrition with parenteral nutrition (PN) for the perceived risk that to do so increases the infection and mortality risk. Systematic review evidence acquired from studies in the critically ill shows that while there may be an increased risk of infection there is no added mortality risk [ 1 ]. Parenteral nutrition has changed considerably over the last forty years and many of the complications were a feature of historical PN practice associated with its inappropriate use, unbalanced formulations and liberal overfeeding. Even the risk of infection may be more related to the underlying patient disease and indication for PN rather than modern PN formulations and delivery in ICU. Malnourishment It has been estimated that around 40% of all patients in hospital are undernourished and this is associated with further complications. Acute critically ill patients lose on average approximately 5-10% of skeletal muscle mass per week during their ICU stay [ 3 ]. Complications such as septicaemia in these patients are to a large extent caused by malnutrition and impaired immunological function [ 2 ]. Complications versus choice of nutrition route When correctly applied, the complications of PN are less likely to result in death compared with those of EN. Recent studies conclude that PN compared with early EN is risk-neutral overall [ 3 ]. It is reassuring that in critically ill patients, when used with EN in the ICU as a supplement, PN has been confirmed to be risk-neutral or may even offer benefits. However from current data it is not possible to justify the extra cost of supplemental PN when started concurrently with EN at the start of an ICU admission [ 1 ] but more importantly there are no studies where it has been started in the more appropriate situation after EN has been shown to fail in already malnourished ICU patients. It has been demonstrated that nutritional goals were reached in 22% of ICU patients fed via EN compared with 75% with PN [ 2 ]. It must be remembered that under nutrition is a debt that must eventually be repaid and this is also worse if it is compounded! The ACCEPT study showed that survival from intensive care was improved when an evidence based guideline for nutrition was followed and more nutrition delivered more consistently. This was achieved by earlier introduction and more complete enteral nutrition delivery without any decline in the use of PN alone or in supplementation. Using the guidelines These guidelines have been developed using a step-by-step approach as follows: Step 1ASSESSMENTDoes the patient require nutritional support? Step 2ADMINISTRATIONWhich route(s) should be used? Step 3ACHIEVEMENT (REVIEW)Are nutrition goals being met? Step 1 Nutritional Risk Screening (adapted from NRS 2002 ESPEN) Does this patient require nutritional support? Initial screening of patients is recommended in these guidelines but it is assumed that ALL patients fulfill the criteria for requiring a final screening assessment which follows. The adaptation assumes an affirmative answer to the question ââ¬Å"Is the patient severely ill? (e. g. in intensive care) Impaired nutritional statusSeverity of disease (increase in requirements) Score 0Normal nutritional statusScore 0Normal nutritional requirements Score 1 Wt loss 5% in 3 months or foodScore 1Hip fracture. Chronic patients in (Mild)intake below 50-75% of normal particular acute complications of requirements in preceding weekcirrhosis, COPD. Chronic diabetes haemodialysis, oncology. Score 2Wt loss 5% in 2 months or BMIScore 2Major abdominal surgery, stroke, (Moderate)18. -20. 5 + impaired general condition orsevere pneumonia, haematologic food intake 25-60% of normal requirement malignancy. in preceding week. Score 3Wt loss 15% in 3 months or BMI Score 3Head injury, Bone marrow transplant (Severe)18. 5 + impaired general condition orIntensive Care Patients (APACHE 10) food intake 0-25% of normal requirement in preceding week SCORE+ SCORE= TOTAL SCORE AGE ADJUSTMENT (IF PATIENT ? 70 YRS ADD 1 TO TOTAL SCORE)= TAAS SCORE INTERPRETATION SCORE ? 3The patient is nutritionally at risk and a nutritional plan should be initiated. SCORE 3Weekly re-screening of the patient. If the patient is scheduled for a major operation a preventative nutrition plan should be considered to avoid associated risk status. Step 2Administration route(s) Nutritional support does influence the outcome of critically ill patients and evidence suggests that the consistent achievement of nutritional goals is important and this should if feasible be through the enteral route [ 7 ]. Evidence suggests that for most patients this is just as effectively and safely delivered through a naso-gastric tube compared to tubes sited after the stomach [ 1 ]. It must be recognized that problems do occur with all forms of enteral delivery and that delivery is more often attained by the parenteral route3 and this is apparent in critically ill patients where enteral nutrition is inappropriate, contraindicated or has failed. Parenteral nutrition should be used when the GI tract is not functional or cannot be accessed or when the patientââ¬â¢s nutrient needs are greater than those which can be met through the GI tract. However it should not be commenced in the non-malnourished as a supplement until approaches to enteral delivery have been optimized [ 1 ]. Assess the integrity and function of the bowel using the following prompts: IF THE ANSWER IS ââ¬Å"NOâ⬠TO EITHER QUESTION ââ¬â TIME TO CONSIDER PN Is the digestive tract functioning? Is the patient well nourished and recovery of gut function expected within 3 days? IF THE ANSWER IS ââ¬Å"YESâ⬠TO EITHER QUESTION ââ¬â TIME TO CONSIDER PN While using an enteral feeding protocol does the presence of excess gastric aspirates (e. g. persistently 150mls after measures to improve gastric emptying) lead to reduced enteral intake. Does the nutrition equirements of the disease or injury exceed that which can be delivered safely via the enteral route? Some patients with an intact GI tract do not tolerate enteral feeds or do not receive sufficient intake enterally or orally to meet their energy and protein requirements. The reasons for poor gastric emptying should be considered. Simple measures such as turning to the right side or reducing opiate intake may be tried along w ith short trials of either Metoclopramide or Erythromycin if other causes have been excluded. However gastrointestinal intolerance is an important and worrying sign and is associated with increased pneumonia and risk of death independently of illness severity . The supine posture is also associated with increased risk of aspiration pneumonia and if patients cannot be nursed in the semi-erect position parenteral nutrition may be a safer option whether it is used as a supplement or as the sole source of nutrition in these patients [ 6 ]. Choice of feed and amounts In the critical care setting estimation or measurement of precise requirements is fraught with error. A target of 25 kcal/kg/day for the first week is acceptable. Protein intake is the central component as this cannot be stored metabolically. Most evidence supports 1. 5 gm/kg/day as a reasonable target. Requirements change during an illness and generally increase in the second week and when patients become more active. Simple methods using patient size bands based upon accessible measures of body size (height or weight) should be used to calculate target amounts. More sophisticated individual patient calculations have not been shown to be any more accurate. Polymeric complete enteral feeds should be used for most patients and infused continuously. Evidence for the use of specific formulations is lacking, except that the immunonutrition cocktails that contain extra arginine should NOT be given [ 1 ] outside of the peri-operative setting where evidence exists. An all-in-one complete balanced parenteral formulation should be used and evidence based recommendations suggests where practical these should contain glutamine [ 1 ]. They should be delivered continuously through a dedicated lumen that should not be used for any other access. Some of the energy should come from lipid sources but there is paucity of evidence to suggest any particular lipid formulations although this may change as more advanced formulations come on the market. Caution should be applied when other lipid containing infusions are also in use (e. g. propofol). Lipid infusion is safe at rates up to 1. 5 gm/kg/day, and glucose should be given at 3-4 gm/kg/day. Use simple standardized regimens for most patients. Within ICU acute electrolyte management (e. g. potassium and phosphate) is more readily managed by separate infusions if safe systems exist. Patients on renal support will have increased nutritional losses so maintain on full feeding. Important when using either EN or PN Nutrition should be commenced at reduced rates especially in the malnourished until metabolic tolerance established. Increase to full target over a 3 day period and monitor for re-feeding syndrome. It is possible to overfeed with PN but unless glucose intake exceeds 4-5 gm/kg/day hyperglycaemia indicates peripheral insulin resistance and the need for additional insulin and not reduction in feed volume. Step 3 Are nutrition goals being achieved? Set targets and check nutrition intake daily and act upon the findings. It is recommended that calorie (and nitrogen) intake is calculated daily in addition to the fluid balance. Has the patient received the amount of nutrition prescribed over previous days? Nutritional support, once instigated, should be monitored to confirm the safety of treatment. The following guide illustrates the type of monitoring required. The tests required will depend upon duration and method of feeding. The frequency of testing will vary depending on the illness severity. Fluid balance and calorie intake and if possible weight. Urea and electrolytes daily (watch K+ as feeds may have only a modest K+ content) Blood glucose monitored frequently and preferably as part of a tight glycaemic control. Phosphate (This should be monitored closely especially when starting feeds in the malnourished) Plasma lipid clearance or triglycerides Full blood count Liver function tests, Calcium Magnesium Calculation or measurement of nitrogen balance is not reliable in the routine setting. Nutrition support algorithm summary ASSESS Is nutritional support required? 40% of patients admitted to hospital are undernourished REASSESS Supplemental PN? ADMINISTER Which route? Is enteral feeding practical and safe? If not consider PN ACHIEVE and REVIEW Are you satisfying the nutrient needs of the patient? N Y WEANING STRATEGY If on EN can oral intake be started? If on PN can EN be started?
Subscribe to:
Posts (Atom)