Pregnancy with Gestational Diabetes Essay

Gestational diabetes is a condition characterized by high blood sugar (glucose) levels that is first recognized during pregnancy. The condition occurs in approximately 4% of all pregnancies. What Causes Gestational Diabetes in Pregnancy Almost all women have some degree of impaired glucose intolerance as a result of hormonal changes that occur during pregnancy. That means that their blood sugar may be higher than normal, but not high enough to have diabetes. During the later part of pregnancy (the third trimester), these hormonal changes place pregnant woman at risk for gestational diabetes. During pregnancy, increased levels of certain hormones made in the placenta (the organ that connects the baby by the umbilical cord to the uterus) help shift nutrients from the mother to the developing fetus. Other hormones are produced by the placenta to help prevent the mother from developing low blood sugar. They work by resisting the actions of insulin. Over the course of the pregnancy, these hormones lead to progressive impaired glucose intolerance (higher blood sugar levels). To try to decrease blood sugar levels, the body makes more insulin to get glucose into cells to be used for energy. Usually the mother’s pancreas is able to produce more insulin (about three times the normal amount) to overcome the effect of the pregnancy hormones on blood sugar levels. If, however, the pancreas cannot produce enough insulin to overcome the effect of the increased hormones during pregnancy, blood sugar levels will rise, resulting in gestational diabetes. Complications of Gestational Diabetes Diabetes can affect the developing fetus throughout the pregnancy. In early pregnancy, a mother’s diabetes can result in birth defects and an increased rate of miscarriage. Many of the birth defects that occur affect major organs such as the brain and heart. During the second and third trimester, a mother’s diabetes can lead to over-nutrition and excess growth of the baby. Having a large baby increases risks during labor and delivery. For example, large babies often require caesarean deliveries and if he or she is delivered vaginally, they are at increased risk for trauma to their shoulder. In addition, when fetal over-nutrition occurs and hyperinsulinemia  results, the baby’s blood sugar can drop very low after birth, since it won’t be receiving the high blood sugar from the mother. However, with proper treatment, you can deliver a healthy baby despite having diabetes. Risks for Gestational Diabetes: The following factors increase the risk of developing gestational diabetes during pregnancy Being overweight prior to becoming pregnant (if you are 20% or more over your ideal body weight) Being a member of a high risk ethnic group (Hispanic, Black, Native American, or Asian) Having sugar in your urine Impaired glucose tolerance or impaired fasting glucose (blood sugar levels are high, but not high enough to be diabetes) Family history of diabetes (if your parents or siblings have diabetes Previously giving birth to a baby over 9 pounds Previously giving birth to a stillborn baby Having gestational diabetes with a previous pregnancy Having too much amniotic fluid (a condition called polyhydramnios) Many women who develop gestational diabetes have no known risk factors. Gestational Diabetes Diagnosed: High risk women should be screened for gestational diabetes as early as possible during their pregnancies. All other women will be screened between the 24th and 28th week of pregnancy. To screen for gestational diabetes, you will take a test called the oral glucose tolerance test. This test involves quickly drinking a sweetened liquid, which contains 50g of sugar. The body absorbs this sugar rapidly, causing blood sugar levels to rise within 30-60 minutes. A blood sample will be taken from a vein in your arm 1 hour after drinking the solution. The blood test measures how the sugar solution was metabolized (processed by the body). A blood sugar level greater than or equal to 140mg/dL is recognized as abnormal. If your results are abnormal based on the oral glucose tolerance test, another test will be given after fasting for several hours. In women at high risk of developing gestational diabetes, a normal screening test result is followed up with another screening test at 24-28 weeks f or confirmation of the diagnosis. Gestational diabetes is managed by: Monitoring blood sugar levels four times per day before breakfast and 2 hours after meals. Monitoring blood sugar before all meals may also become necessary. Monitoring urine for ketones, an acid that indicates your diabetes is not under control. Following specific dietary guidelines as instructed by your doctor. You’ll be asked to distribute your calories evenly throughout the day. Exercising after obtaining your health care provider’s permission. Monitoring weight gain. Taking insulin, if necessary. Insulin is currently the only diabetes medication used during pregnancy. Controlling high blood pressure. Monitor Sugar Levels Testing your blood sugar at certain times of the day will help determine if your exercise and eating patterns are keeping your blood sugar levels in control, or if you need extra insulin to protect your developing baby. Your health care provider will ask you to maintain a daily food record and ask you to record your home sugar levels. Testing your blood sugar involves pricking your finger with a lancet device (a small, sharp needle), putting a drop of blood on a test strip, using a blood sugar meter to display your results, recording the results in a log book, and then disposing the lancet and strips properly (in a â€Å"sharps† container or a hard plastic container, such as a laundry detergent bottle). Bring your blood sugar readings with you to your medical appointments so your health care provider can evaluate how well your blood sugar levels are controlled and determine if changes need to be made to your treatment plan. Your health care provider will show you how to use a glucose meter. He or she can also tell you where to get a meter. You may be able to borrow it from your hospital, as many hospitals have loaner meter programs for women with gestational diabetes. The goal of monitoring is to keep your blood sugar as close to normal as possible. The ranges include Time of TestTarget Blood Sugar Reading Before breakfastplasma below 105; whole blood below 95 2 Hours After Mealsplasma below 130; whole blood below 120 Insulin treatment is started if above levels are not maintained. Insulin for  Gestational Diabetes Based on your blood sugar monitoring results, your health care provider will tell you if you need to take insulin in the form of injections during pregnancy. Insulin is a hormone that controls blood sugar. If insulin is prescribed for you, you may be taught how to perform the insulin injection procedure. As your pregnancy progresses, the placenta will make more pregnancy hormones and larger doses of insulin may be needed to control your blood sugar. Your health care provider will adjust your insulin dosage based on your blood sugar log. When using insulin, a â€Å"low blood glucose reaction,† or hypoglycemia can occur if you do not eat enough food, skip a meal, do not eat at the right time of day, or if you exercise more than usual. Symptoms of hypoglycemia include Confusion, Dizziness, Feeling shaky, Headaches, Sudden hunger, Sweating, Weakness Hypoglycemia is a serious problem that needs to be treated right away. If you think you are having a low blood sugar reaction, check your blood sugar. If your blood sugar is less than 60 mg/dL (milligrams per deciliter), eat a sugar-containing food, such as 1/2 cup of orange or apple juice; 1 cup of skim milk; 4-6 pieces of hard candy (not sugar-free); 1/2 cup regular soft drink; or 1 tablespoon of honey, brown sugar, or corn syrup. Fifteen minutes after eating one of the foods listed above, check your blood sugar. If it is still less than 60 mg/dL, eat another one of the food choices above. If it is more than 45 minutes until your next meal, eat a bread and protein source to prevent another reaction. Record all low blood sugar reactions in your log book, including the date, time of day the reaction occurred and how you treated it. Diet Change with Gestational Diabetes If you have gestational diabetes, follow these eating tips: Eat three small meals and two or three snacks at regular times every day. Do not skip meals or snacks. Carbohydrates should be 40%-45% of the total calories with breakfast and a bedtime snack containing 15-30 grams of carbohydrates. If you have morning sickness, eat 1-2 servings of crackers, cereal, or pretzels before getting out of bed. Eat small, frequent meals  throughout the day and avoid fatty, fried, and greasy foods. If you take insulin and have morning sickness, make sure you know how to treat low blood sugar. Choose foods high in fiber such as whole-grain breads, cereals, pasta, rice, fruits, and vegetables. All pregnant women should eat 20-35 grams of fiber a day. Fats should be less than 40% of calories with less than 10% consumed being from saturated fats. Drink at least 8 cups (or 64 ounces) of liquids per day. Make sure you are getting enough vitamins and minerals in your daily diet. Ask your health care provider about taking a prenatal vitamin and mineral supplement to meet the nutritional needs of your pregnancy. Regular exercise during pregnancy can improve your posture and decrease some common discomforts such as backaches and fatigue. Being fit during pregnancy means safe, mild to moderate exercise at least three times a week. But, regardless of gestational diabetes, every pregnant woman should consult with her health care provider before beginning an exercise program. He or she can give you personal exercise guidelines, based on your medical history. Since both insulin and exercise lower blood sugar, you should follow these additional exercise guidelines to avoid a low blood glucose reaction: Always carry some form of sugar with you when exercising, such as glucose tablets or hard candy. Eat one serving of fruit or the equivalent of 15 grams of carbohydrate for most activities lasting 30 minutes. If you exercise right after a meal, eat this snack after exercise. If you exercise 2 hours or more after a meal, eat the snack before exercise. Pregnancy Weight Gain The recommended amount of weight gain during pregnancy depends on your pre-pregnancy weight, whether there is more than one fetus, and the trimester. Typically more weight gain is expected during the second and third trimester and recommended intakes of calories should increase at that time. Gaining the right amount of weight during pregnancy by eating a healthy, balanced diet is a good sign that your baby is getting all the nutrients he or she needs and is growing at a healthy rate. It is not necessary to â€Å"eat for two† during pregnancy. It’s true that you need extra calories from nutrient-rich foods to help your baby grow, but you generally  need to consume only 200 to 300 more calories per day than you did before you became pregnant to meet the needs of your growing baby. Ask your health care provider how much weight you should gain during pregnancy. A woman of average weight before pregnancy can expect to gain 25 to 35 pounds during pregnancy. You may need to gain more or less weight, depending on what your doctor recommends. In general, you should gain about 2-4 pounds during your first 3 months of pregnancy and 1 pound a week for the remainder of your pregnancy. Where the weight goes Baby8 pounds Placenta2-3 pounds Amniotic fluid2-3 pounds Breast tissue2-3 pounds Blood supply4 pounds Fat stores for delivery and breastfeeding5-9 pounds Uterus increase2-5 pounds Total25 to 35 pounds Baby After Delivery Your baby’s blood sugar level will be tested immediately after birth. If the blood sugar is low, he or she will be given sugar water to drink or by an intravenous tube in the vein. Your baby may be sent to a special care nursery for observation during the first few hours after birth to make sure he or she doesn’t have a low blood glucose reaction. If you had gestational diabetes, there is an increased risk that your newborn will develop jaundice. Jaundice is a yellow discoloration of the skin that occurs when bilirubin is present in the baby’s blood. Bilirubin is a pigment that causes jaundice and is released when extra red blood cells build up in the blood and can’t be processed fast enough. Jaundice goes away rapidly with treatment that often involves exposing your baby to special lights to get rid of the pigment. Gestational diabetes does increase the risk that your child will have diabetes in the future. Usually with gestational diabetes, blood sugar levels return to normal about 6 weeks after childbirth because the placenta, which was producing the extra hormones that caused insulin  resistance, is gone. Your doctor will check your blood sugar levels after your baby is born to make sure your blood sugar level has returned to normal. Some doctors recommend an oral glucose tolerance test 6-8 weeks after delivery to check for diabetes. You should also be screened for diabetes in the future. Women who have had gestational diabetes have a 60% increased risk of developing type 2 diabetes later-in-life. By maintaining an ideal body weight, following a healthy diet, and exercising, you will be able to reduce your risk of developing type 2 diabetes. In addition, women who have gestational diabetes during one pregnancy have a 40%-50% chance of developing diabetes in the next pregnancy. If you had gestational diabetes during one pregnancy and are planning to get pregnant again, talk to your health care provider first so you can make the necessary lifestyle changes before your next pregnancy. Get tips on eating right with Diabetes by consulting with a dietician or your primary care physician. Sources American Diabetes Association: â€Å"Gestational Diabetes.† Diabetes Care 2008 Agency for Healthcare Research and Quality: â€Å"Gestational Diabetes: A Guide for Pregnant Women.† August 2009 American College of Nurse Midwives: â€Å"Gestational Diabetes.† JMWH org. 135 2006

Human Resource Function Essay

How important is it for the organization to determine the effectiveness of the Human Resource Function? Why? The role of human resource management has evolved from merely handling administrative matters to being heavily involved in the company’s strategic planning. This is because more and more companies have recognised the key role that a skilled and competent workforce plays in creating, sustaining, and even increasing value for the organisation. Human resource management is embedded in every phase of an employee’s life cycle in the company, starting with recruitment. It is important for a company to hire new employees who will be able to address its business needs, are qualified, competent and motivated, and most importantly, whose values and principles are aligned with those of the company. It is also the role of the Human Resource (HR) department to market the company as the company of choice, especially for fresh university graduates, in order to get the best talents available. Another critical area of human resource management is talent retention. Sustaining the employee’s interest and promoting loyalty among the workforce can be achieved through a number of ways such as ensuring a healthy and safe working environment, providing competitive compensation packages and benefits, and rewarding outstanding employees who have significantly contributed to the attainment of the company’s goals. The idea is to ensure that the employees are generally happy with their work so that this will reflect on their performance. In addition, the HR department ensures that there are enough programs available to the employees for their training, development and upskilling needs. During and even after retirement, human resource management should also be present to ascertain that employees are satisfied and protected as they leave the organisation. Apart from looking after employees’ welfare throughout their stay in the company, the HR department handles a number of important functions such as internal communications, performance evaluation of employees, and managing an employee’s career development path. More importantly, though, human resource management ensures that the company abides by all national, and sometimes even international, labor laws and regulations. Measuring HR Effectiveness Gone are the days when companies simply believed that HR practices are working; they now want hard facts and quantifiable results to determine if HR is adding value to the organisation. However, measuring the effectiveness of a company’s human resources management should not be limited to its â€Å"people functions†; instead, it should also measure how HR best practices contribute to the attainment of the company’s business goals. In addition, the evaluation of HR’s effectiveness should strike a balance between cost (employee-related expenditures, both direct and indirect) and benefits or impacts on three levels – internal (employees themselves), external (customers, clients and other stakeholders) and business (financial outcomes). Metrics for determining the value of HR internally include manpower productivity which for a water company, for instance, can be expressed as staff per 1,000 connections; periodic performance ratings based on agreed targets and deliverables; turnover rate by age, rank and gender; compensation level against industry standards; training hours per person per year; number of employees who received awards and recognitions for the year; number of labor cases filed by union members; as well as health and safety indicators such as fatalities rate, injury rate, occupational diseases rate, lost day rate and absentee rate. A company can likewise establish the effectiveness of its HR practices by getting feedback from its stakeholders. This is particularly useful for organisations in the service industry. Customer / client satisfaction surveys can help determine how well (or poorly) the existing talent pool is equipped to carry out the company’s services, and how effective they are in addressing customer / client concerns. Results of such surveys will allow the company to evaluate the skills gaps, and consequently, the training and development requirements of its employees. Finally, financial information like revenue, market share, net income, and share price can broadly determine how strong the workforce is from top management down to skilled workers and rank-and-file staff. This is because all companies rely on their people to develop, implement and monitor business functions that should lead to the growth and profitability of the organisation. Importance of Determining HR Effectiveness As we have seen, HR serves as the guardians of employees who, in turn, are the cornerstone of any successful and stable organisation. This means that HR plays a critical role in ensuring the existence of a competent talent pool at any given time that can drive the company to attain its business goals. It is, therefore, important for a company to determine the effectiveness and efficiency of its HR functions. By measuring the level and magnitude of impact of its human resources management, a company may be able to establish whether it is putting in the right amount of investment through the right employee programs and for the right talents. Obviously, a company would not want to overspend on HR programs or processes that do not yield significant impacts or do not add value to the organisation. In addition, when good and comprehensive HR metrics or key performance indicators are in place, a company will be able to adopt a more targeted approach to people development. For instance, if after the annual performance appraisal the company finds out that most of its employees are poor in customer service, then it can develop a training module on customer interaction, negotiation and communication. Similarly, if employee assessment results show that some senior managers are not effective in their posts, then the company can make the necessary adjustments by moving these employees to another unit where their expertise will be maximised, and finding the most qualified talent to take their place. Evaluating the level of success of its HR department will also send a positive signal to employees especially when the company asks for their opinion. It will make them feel that the company is really committed to safeguard their welfare while working for the company and to hone their skills to become well-rounded professionals. More importantly, measuring the effectiveness of its HR programs and processes will allow the company to understand the kind of employees it has – whether highly skilled, average performers or mostly staff workers – and this will serve as an input to its strategic planning. Say, for example, the company wants to acquire a rival company or buy out a firm that went bankrupt, it will be able to clearly see if it has the needed talents to do so, or if they have available talents who can be seconded to the new subsidiary.

Case Analysis for Nursing Ethics Paper Essay

Overview A forty-eight year old female patient was brought into the emergency department with petechiae/purpura distributed over her skin. Her husband reported that she started to bleed from her nostrils and mouth. She suddenly appeared to have had what seemed to be unexplained bruises on her body and was semi comatose. In a state of panic, her husband brought her to the emergency department. With a heart rate of 180, her blood pressure was 60/24 and she was going into endotoxic shock. She received emergency care that made her stable enough to be transferred to the ICU where she became conscious and able to communicate. The medical team explained the seriousness of her condition and their plans for her treatment but she declined their proposal for further care and complained about inadequate insurance coverage for that hospital. She further professed her faith in God for divine healing. The medical team was then faced with offering this patient treatment regardless of her ability to pay to av oid the imminent danger of her leaving the hospital at that time. Medical Indications This forty eight year old female patient, who had no medical history in this hospital was diagnosed with Disseminated Intravascular Coagulation (DIC). DIC is a rare, life-threatening condition that prevents normal blood clotting in an individual. A treatment refusal or decline may hasten the disease process resulting in excessive clotting (thrombosis) or bleeding (hemorrhage) throughout the body leading to shock, organ failure or even death. Prognosis varies depending on the underlying disorder and the extent of clotting. Regardless of the cause, the prognosis is often poor, with 10-50% of patients dying. The goal of treatment is to stop bleeding and prevent death. According to WebMD (2007), in DIC, the body’s natural ability to regulate clotting does not function properly. This causes the platelets to clump and clog small blood vessels throughout the body. This excessive clotting damages organs, destroys blood cells, and depletes the supply of platelets and other clotting factors so that the blood is no longer able to clot normally. This often causes widespread bleeding, both internally and externally, a condition that can be reversed if treatment is carried out  promptly. Current indication for treatment include interventions such as transfusion of blood cells and other blood products to replace what has been lost through bleeding. Numerous tests to establish the probable cause of this condition have to be done because it is usually a first symptom of a disease such as cancer or it could be triggered by another major health problem. Patient Preferences The patient is informed of the benefits of follow up interventions after emergency care as well as the likelihood of losing functions of major organs and even death without following interventions being implemented. The principle of autonomy comes to play since it is her right to choose where, when and how she gets her health care. Based on the medical report and her personal reasons for deciding to leave the hospital against medical advice, there seems to be no evidence that she is mentally incapable. There is also no justification in disregarding her requests nevertheless, it is doubtful if she actually understands and appreciates the situation. Her preferences were to be signed AMA (against medical advice) so she can find cheaper, alternative care. Her husband, who was present with her, tried to convince her to accept the teams’ proposal but she insisted that she could not afford it. In my opinion, the patient decision was as a result of her ignorance of what choices was av ailable to her. Quality of life The quality of life for this patient is severely compromised because of the symptoms associated with this diagnosis (bleeding, syncope, weakness, shortness of breath, etc). As stated earlier, DIC could be as a result of an underlying disease such as cancer. If so, chemotherapy and radiation could help alleviate symptoms and give her a vibrant life expectancy. Also, there is the possibility that she would experience tremendous medical progress with treatment if her diagnosis has to do with platelet malfunction. However, we cannot tell, since she turned down any advice by the team to carry out blood tests. Without immediate treatment, she runs the risk of damage to major organs of her body, which could eventually lead to death. Time is of essence here because the longer she delays intervention, the more likely she has irrevocable damage that might negatively alter her previous  quality of life. Ethical issues that would arise with this patient is the emergency care she got, it got her stable enough to where she could refuse treatment. An assumption that we could make about receiving that care is, ‘what if she got into a DIC coma and had to be on a ventilator?’. She would have been unconscious and would probably not be able to debate whether she receives care or not. Contextual features Without casting aspersions, the reason, obvious to me, for refusal of care is financial. The patient talked about shopping for cheaper healthcare. This is a patient born to American missionaries in Brazil. As an American citizen, she took up the calling of her parents and was also a missonary in Brazil for most of her life. She married a man from England who is unaware of how the American system works. Her reason is justified because she probably had little to no social security and with her sojourn in Brazil, we can say that she has been accultured. Therefore her outlook and way of thinking would affect her decision about healthcare in America. Another contextual feature is that of religion and faith, the patient said that her faith in God would heal her but failed to see that this might be why she was at the hospital at that time. It is difficult to attribute her decision solely to faith or finance alone but one thing that stands out is the fact her husband tried to convince her otherwise. Still, she kept saying this was what she wanted. Her husband seemed helpless as he tried to communicate with the team however the patient kept saying that this was about her not him. My patient’s lack of insurance, her job as a missionary and her inability to pay acts as a bias that would prejudice the providers’ evaluation of her quality of life. Analysis The goal of medicine involves promoting health, curing disease, optimizing quality of life, preventing untimely death, improving function (maleficence), educating and counseling, avoiding harm (non-maleficence) and assisting in a peaceful death. The ethical dilemma is deciding to let her go based on her wishes (autonomy) versus doing what seems to be the overall right thing (paternalism), which is giving her treatment (beneficence), thus preventing harm (non-maleficence). The maleficent nature of medicine propels the team to convince the patient of what they think would restore her  health. In a bid to ‘do good(maleficence), she got emergency care that made her stable enough to communicate and state her wishes. Apart from maleficence and non-maleficence there are multiple ethical issues embedded in this case; the medical team is faced with honoring this patient’s autonomy and letting her go when they know she could be dead in a few hours without treatment. Nevertheless the patient is exercising her autonomy at her own detriment because she and her husband got adequate disclosure communicated clearly by the healthcare team about the reasons for treatment and the benefits & burdens related to her decision. The team’s scope of disclosure covered her current medical state, the possible interventions to improve prognosis and their recommendation based on clinical judgement. In addition, they are faced with medically determining her decisional capacity because of the possibility that her mental state might be affected by the pathology and her inability to afford care. If proven to be incompetent, then interventions are carried out regardless of what she wants. Hence, the medical team will deliberately override this patient’s autonomy because of their perceived notion of beneficence (paternalism). As medical practitioners, the team weighs the consequence (utilitarianism) of letting her go. To them, the action that would produce the best overall result is to go ahead and give her treatment. The ethical theory of deontology gives the team, the moral duty and obligation to do good and prevent harm. Compassion and sympathy (Ethics of care) also play a big role here, consider a patient who had committed her life to helping others, yet in her time of need could not get reciprocity. These emotions should play a major role in how the team decides to proceed. The nurse involved with this patient has an obligation to get to know this patient so that she can effectively advocate for her. Inasmuch as I know she has the right to refuse treatment, I strongly believe that her refusal is based on the insubstantiality of information and her lack of knowledge of what is accessible to her. Recommendation I recommend that the patient’s autonomy be empowered not overpowered by giving her information on what is available to her. An advocate (her nurse, case manager or social worker) should be assigned to her. In addition, the Chaplain should be invited to offer spiritual counseling. Asking the right questions, getting to understand her fears and giving her hope. Many  hospitals and clinics have patient navigators that can help determine financial aid for patients who cannot afford care or who do not have Medicaid/insurance. The team should encourage the patient that at this point money is of no consequence, her life and health come first in other words everything will be done to get her aid. I also recommend that the team critically asseses the decision-making capacity of the patient since it determines whether a patient’s health care decisions will be sought and accepted. Furthermore the patient should also be educated on and encouraged to put in place advanced directives to promote her autonomy and avoid a situation where there is no one to decide in case she is incapacitated. Justification In my opinion, Individuals respond favorably to people, things, beliefs and circumstances that hold significance, value and passion for them. Pesut’s (2009) article, confirms that incorporating spirituality into care where appropriate, has the potential to maximize health care quality. For this to be effective, the healthcare team has to look at the patient holistically, they have to put into consideration her profession of faith and how getting the chaplain involved will convince her that the medical team does not just want her money rather they value her worth. Subsequently, paternalism as a recommendation seems to be arbitrary and counteracts the autonomy of the patient, yet Whitney and McCullough (2007) in their article Physicians Silent Decisions: Because Patient Autonomy Does not Always Come First, give support to selective paternalism. They argue that Patients’ values and preferences play varying roles in medical decisions (Whitney et al. 2004). Indeed my patient’s refusal to accept care was not because she wanted to die but because her values of faith and her preference to spend within her means trumped getting the immediate intervention. Suffice to say that culture can be considered in this case because it influences values and preferences. My patient’s background was Brazilian, this is a country where there is little trust for the healthcare system. Hospitals and clinics are more interested in how much money they can make. So, Individuals that reside there, do not have routine checkup, they often wait till they are about to die before they go to a physician. And in this time they are constantly visiting places of worship in belief that they would be miraculously healed. As a result, my  patient probably had many symptoms over a period of time but did not go to the hospital, incidentally when she was brought in, it was a matter of life and death. With the team’s knowledge of her diagnosis and its pro gnosis, my patient’s preference became largely irrelevant. Yet, the physicians wanted to respect her autonomy and her sense of dignity by maintaining her part in the decision-making. As medical practitioners we uphold the goals of shared decision-making and of empowering patients to make important choices. However, these objectives provide important insights, not universal answers. In medicine, as elsewhere, individual choice, however highly we value it, must compete with individual welfare and with constraints of time and money hence the decisive factor will depend on the particular situation at hand. (Whitney and McCullough 2007 p. 37). Next, they explained that decision-making, whether silent or spoken by the physician must be understood in terms of the clinical encounter. In fact the overriding of her autonomy was for her own good. My rationale for encouraging advanced directives especially if she is deemed competent at the moment is, in the event that she can no longer make a decision in the future, something and someone will be in place to help. It will help to guide future clinical decisions and promote confidence in the decision of the surrogate she choos es. According to Lynch, Mathes and Sawicki (2008), patients are in the best position to make choices for themselves, or at least a position that is superior to that held by any other party. Therefore, patient directives must be enforced, though not through the mechanism of strict liability. (p. 158). Therefore, a decision written and signed by the patient legally would prevail, in the event that she becomes incapacitated and cannot decide she would already have that in place. Medical practitioners are encouraged to inform all patients’ about the importance of advance directives because it removes the burden of dealing with what the patients would have wanted. In summary, the discussion and justification of proceeding with medical intervention yet disregarding the patient’s decision, proves that autonomy can be respectfully countered. This is congruent in continuing with medicine’s obligation to ‘do no harm’, ‘do good’ and serve in the best i nterest of the patient. Evaluation The desired outcome was that this patient receives the care and intervention  that she needed in time to prevent gross damage to her body thus altering her quality of life. With the input of the chaplain, her husband, the advocate and careful communication with this patient, the patient admits that she wanted the best care. She accepts the offer for financial assistance and receives the appropriate intervention. The nurse and medical personnel express satisfaction in saving her life (maleficent), Her husband is elated and he also signs an advanced directive for himself. It seemed difficult to convince the patient at first but once the suggestion for financial aid and the Chaplain was received, the patient complied with all other recommendations. References Lynch, H. F., Mathes, M., Sawicki, N.N., (2008). Compliance With Advance Directives: Wrongful Living And Tort Law Incentives. The Journal Of Legal Medicine, 29:133–178. Retrieved from http://www.ncbi.nlm.nih.gov.proxy.medlib.iupui.edu/pubmed/18569439 Pesut, B. (2009). Incorporating patients’ spirituality into care using Gadow’s ethical framework. Nurs Ethics. 2009 Jul;16(4):418-28.Retrieved from http://nej.sagepub.com.proxy.medlib.iupui.edu/content/16/4/418.long WebMD, (2007). Retrieved November 26, 2012, from http://www.webmd.com/a-to-z-guides/disseminated-intravascular-coagulation-dic-topic-overview Whitney, S. N., McCullough, B. L. (2007). Physicians’ Silent Decisions: Because Patient Autonomy Does Not Always Come First. The American Journal of Bioethics, 7(7): 33–38, 2007. Retrieved from http://mcr.sagepub.com.proxy.medlib.iupui.edu/content/early/2012/10/31/1077558712461952.long

Make any topic pls Essay Example | Topics and Well Written Essays - 250 words

Make any topic pls - Essay Example In this post modern time, when one is showing his discomfort in news of Taliban’s imposed restrictions on girls in Afghanistan, no one expects even something least to happen in a country like US, a proclaimed leader of democracy. Despite of difference in gender, the uniqueness stands above. We all are born as human beings notwithstanding the sex. The difference is for the totality of human being. It should not be a measure in rewarding rights. The qualities of both male and fair sex may vary but none stands ahead. Both are the best in their own. The women in this egalitarian period of time have come up to forefront standing along with their male counterparts in almost all the fields. They have shared better parts in most adventurous and risky situations from combat war field to a journey to the space. Nothing holds the modern girl from involving into what a decade back thought to be unattainable by fair sex. A fair number of countries came up with a decision to include women in the armed forces across the world. And given the chances, they have proved their ability to achieve nothing lesser to their male counterparts could

Hammurabi's Code - An Overview Essay Example | Topics and Well Written Essays - 1000 words

Hammurabi's Code - An Overview - Essay Example Various parts of the law were written in systematic way so that reading of the Code by the people was easily understandable and people could derive what was expected of them from the written laws. The code was inscribed upon a black stone monument, eight feet high, and clearly meant to be erected for reading by his people. This famous stone-carving was found in the year 1901, not in Babylon, but in a city of the Persian mountains, as some later victor must have taken it in victory. The code starts and finishes with calls to the gods. It shows how regard for gods was mandatory before reading a law code although the prayers were mainly curses for non-abiders of the law (Horne, 1915). The code commands in lucid and sure strokes the making of society. The judge who commits mistakes in a law case is to be ousted from his position and rank forever, and heavily penalized. The falsified witness is to be beheaded. In fact, all the serious crimes are awarded death. For instance, if a man const ructs a house poorly, and the structure comes down and kills the owner, the builder is to be beheaded. If the owner's son is killed, then the builder's son would be beheaded. The Hebrews imbibed from here the law of "an eye for an eye.† These serious retributive punishments do not count excuses or clarifications, but only of the truth--with one noticeable exception. An offender was permitted to drown himself into "the river," the Euphrates. Clearly, people were not familiar with swimming; if the waves brought the culprit to the river banks alive he was pronounced not-guilty, if he could not swim back he was declared guilty. It shows Hammurabi’s belief in the justice of the reigning gods, although a bit childishly, it was implanted in the minds of people (Horne, 1915). There are thousands of rulings of the ancient times based on Babylonian laws, the so-called "contracts," including a vast range of deeds, conveyances, bonds, receipts, accounts and, most critical of all, t he actual legal verdicts awarded by the judges in the law courts. It helped in conserving the so-called "Sumerian Family Laws† (Johns, 1911). One can not find any symptoms of tribal tradition from the law of the Code. It is a ruler’s law; similar to self-help, bloody fights, marriage by seizure is missing; though family unity, district duty, and difficult times – these ancient traits are visible. The king is a kind-hearted ruler who can be available to all his people, he is equally capable and ready to safeguard the oppressed against the noblest oppressor. The royalty can excuse such a high profile culprit only if there is no resentment among the people for the oppressor. The judges are regularly observed and appeal is permitted. There are feudal holdings, masters of the levy, and police. There exists a postal system. There is free movement by people from Babylon to the coast of the Mediterranean. Women hold a rank of respect and reverence in the Hammurabi code ( Johns, 1911). The Code did not just personify the customs of that time or safeguard ancient law. The law-abiding citizens and litigation had a record of centuries in the temple stores in each city, huge enough, of past decisions and copies of judicial awards, getting mixed with the city traditions. The ever-prevailing habit of writing and practice of written deeds even more

EMC Certification For Laser Printer Essay Example | Topics and Well Written Essays - 2000 words

EMC Certification For Laser Printer - Essay Example esent satisfactory evidence from tests about their equipment complying with the requirements of the European Union EMC Directive display the CE mark on their equipment. The European Union will not permit sale or import of non-compliant equipment in the European Union and attempts to circumvent this requirement carry fines and terms of imprisonment for those involved. Thus, it is important for all those who want to sell laser printers or other similar equipment in the European Union to understand the process for issuing a declaration of compliance with European Union EMC Directive for a product. This brief report presents a discussion about fulfilling the requirements for declaring a product as EMC compliant to display the CE mark on the product. In the present age of ubiquitous computing, widespread use of electronic circuits of all kind for computation, communication and automation in close proximity to each other has meant that it is now necessary to ensure that devices containing various circuits do not affect each other adversely (Ott, 2009, Pp. 1 – 10). Electronic equipment, including equipment for interfacing with computers, must now operate in the real world environment without generating electromagnetic noise to pollute the radio frequency spectrum to affect adversely other devices or malfunctioning due to the affects of radio frequency interference from devices. The electromagnetic interference phenomenon has become a serious issue for design engineers and this issue is likely to become more serious as the proliferation of devices for various uses increases. Williams (2007, Pp. 1 – 2) states that electromagnetic interference can cause safety critical control systems to malfunction and this is the reas on why portable electronic devices, such as mobile phones, are not permitted to be used on board aircrafts. In addition, high levels of electromagnetic energy can potentially cause harm to human health (Williams, 2007, Pp. 21). In view of the threat from

How the deficits of the 1980's contributed to the prosperity of the Term Paper

How the deficits of the 1980's contributed to the prosperity of the 1990's - Term Paper Example These are: (1) to reduce the growth of government spending, (2) to reduce the marginal tax rates on income from both labor and capital, (3) to reduce regulation, and (4) to reduce inflation by controlling the growth of the money supply† (Niskanen, â€Å"Encyclopedia†). These changes reduced taxes for most wage earners, and most of the poor were actually exempted from taxes. Reagan also eliminated price controls on oil and natural gas, long distance telephone service, and ocean shipping. As reported by the Joint Economic Committee in April of 2000, Reagan’s polices resulted in the largest peacetime economic boom in American history. It also resulted to 35 million jobs for many Americans. The committee reports, â€Å"[i]n 1981, newly elected President Ronald Reagan refocused fiscal policy on the long run†¦these were fundamental changes that proved the foundation for the Great Expansion that began in December 1982† (Sperry, â€Å"Issues†). At the b eginning of the 1990s when Reagan’s tax rate cuts were set in place, tax payers who earned more were taxed more, and those who earned less were taxed less. This gave a chance for those in the lower rungs of the economic ladder to recover from their difficult economic situation. The reductions in income tax for those who had lower income were so dramatic because President Reagan doubled the personal exemption; he also increased the standard deduction, and he tripled the earned income tax credit. Earned income tax credit gave net cash to single-parent families with children at the lowest income levels. Reagan’s economic policies practically took from the rich and took less from the poor, and this gave the lower income group in American society a chance to recover and improve their lives. The eventual manifestations of improved life were later seen in the 1990s. The stimulants for growth in the 1990s can be traced back to the economic measures and policies which were implemented during the

Food Quality and Safty Case Study Example | Topics and Well Written Essays - 1000 words

Food Quality and Safty - Case Study Example Manufactures should embrace certain systems that ensure the integrity of the food in terms of health and quality. In order to do this they need to follow certain safety and quality assurance systems, which have been developed to safeguard the food quality. Some of them are obligatory while others are voluntary the obligatory ones are known as safety assurance systems. The difference between mandatory and voluntary systems is based on good Hygiene practices GHP as well as good manufacturing practices GMP (Sikora and Stranda 2005, p.85). Good hygiene practices systems will ensure the firms production process adheres to the highest standards of cleanness and food such as meat would never be exposed to contaminants or foreign particles such as plaster since it would be thoroughly examined before being released into the market. The law does not require the other quality management systems although desirable to consumers and society such as having quality assurance control points, which are put in place strategically with the view of eliminating hazard (Sikora and Stranda 2005, p.85). Quality control points allow the manufactures to check the products in stages, for instance, in bread production; the manufactures can check the dough after it has been through the oven for soot burnt parts. If this were to be done at every stage of production, the hazards would be considerably reduced as well as the margin for error in the final product. Hazard analysis and critical control points(HACCP) is considered to be the most important method of controlling safety hazards in food and drugs, its effectiveness is enhanced by the fact that, instead of inspecting the finished product, HACCP identifies the physical, chemical, and allergic hazards in the food during the production process, as such it is considered a preventive method. It can be applied in any

Critical literature review Assignment Example | Topics and Well Written Essays - 2000 words

Critical literature review - Assignment Example In contrast, some of the scholars have shown that performance management involves the scope for stereotyping and many other errors very frequently (Griffin and Moorhead, 2009). Therefore, it cannot be considered as a key constituent of organizational growth and development. In this paper, various aspects of performance appraisal will be critically analysed from the researchers’ point of view. Eminent researchers Melnyk, Bititci, Platts, Tobias and Andersen (2014) have identified the concept of performance management as a research paradox. According to them, though the system provides a critical and constructive assessment of employee functions in the organization, comparative assessment of employees in turn results in demotivation and deterioration of performance of some of the employees within the same organization. Therefore, performance management creates a paradoxical situation in the organization. Conversely, Armstrong and Taylor (2014) have shown that effective performance management enables the managers of an organization to review the performances of all individual employees and accordingly plan requirement for training and skill development, determine the performance gap and infuse visibility and accountability among the employees. Therefore, according to them, performance management tends to enhance organizational efficiency. Performance management can be explained through two contrasting theoretical perspectives such as Universalistic perspective and Contingency perspective. As defined by Hamid (2013) the universalistic approach establishes a direct relationship between management of human resource of an organization and performance of the employees. Hamid (2013) also stated that the universalistic approach of Human Resource Management (HRM) is based on the core idea of best practices of HRM. The approach is

MIS in business Essay Example | Topics and Well Written Essays - 1000 words

MIS in business - Essay Example MIS is part of the IT spectrum which deals with people, information, technology and business. MIS can be a key aspect in the decision making and the task analysis of the company which is dealing with technology and business. Now let's move our discussion to Information Systems and types of Information System. An Information System can be defined as a collection of hardware, software, people and data and which are integrated to generate information which caters the need of various organizations and which support various day-to-day activities. Information can be classified as two sections: internal information systems and external information systems. Internal information systems as the name imply deals with information pertaining to the details of the company. It talks about how the internal data of the company regarding various activities can be managed and manipulated. And further it talks about how it affects the state of the business details of the economy of the company. The major point is that the external information systems talks about the concept of Business to Business Solutions (B2B) An external system can work well if it follows work flow steps for a process to operate at B2B level. A company should receive and validate the request message which is destined for an external IS to fetch business data. It should select as particular IS and based on it should run orders, manage interactions with external IS. Thus this way company stands at better position to handle the information and as such can place itself in a better strategic position in the market. Thus Internal & External Information Systems are very essential for the up gradation of the information level of a department in a business organization. Now that we know about Information Systems, Lets move ahead by discussion managing information through information management. Information management can be defined as handling or managing of the information which has been gathered from various sources in order to optimize the accessibility of the information which is used by the various departments of the organization. One of the major advantages of using Information system for management as tool is that it is very effective and efficient and thus these factors propel the growth of the company in a positive manner. One major limitation of information management is that the amount of information present and usage of tools and techniques to manage information has lead to the problem of information overflow and thus it makes us understand that we need to adopt effective strategies in order to overcome the limitation. In general whenever we talk about the information systems and its types, we come across five different types of IS. They are: Office Automation System: Office Automation System or OAS helps the people working in the office workspace to process personal and organizational data, create documents and perform calculations in an effective manner. They are useful because they increase the productivity of the whole system. The subparts of OAS are communication systems and groupware systems. Example for OAS could be a word processing software, spreadsheets etc. Departmental Systems: As the name implies Departmental Systems deals with individual departments present in an organization. These could be Manufacturing and production systems, Sales and

What is steven pinker's response to media critics who are concerned Essay

What is steven pinker's response to media critics who are concerned about the harmful effects of consuming electronic media do you agree with his argument why or why not - Essay Example Currently, since many have accused new media for lowering intelligence, the level of since should then be reducing. On the contrary, the quality of science has been increasing because scientists are making use of new media. Similarly, he argues that other activities related t the human mind such as philosophy and cultural criticisms continue to flourish. Pinker further responds to the critics of new media by pointing out that experience does not necessarily shape the brain because the brain itself is not â€Å"a blob of clay.1† The brain does not necessarily copy the qualities of whatever it consumes, and therefore the effects of new media will not be as huge as implied by many. Instead of bemoaning technology, Pinker suggests that people should look for ways of exercising self control when using these new media. This will help encourage intellectual growth. Having read the article by Pinker, I agree with his arguments relating to the new media technologies. First, new media technologies have helped increase intellectual depth by allowing for multiple approaches to teaching and learning. This exposes individuals to various forms of information from a variety of sources, which makes people smart. As a student, I have benefited from these new technologies and this has greatly enhanced my knowledge in various fields. For instance, through these technologies, I am able to supplement class material with online materials obtained through search engines such as Google. As noted by Pinker, these technologies help us search and retrieve information online using tools such as social media and e-books. As knowledge continues to increase, there is the need to have tools that help in the effective retrieval, processing and storing of such information. Pinker rightfully argues that our brain power does not increase with increasing knowledge, and ther efore such tools come in handy. By sitting behind a computer for instance, one is able to obtain vast volumes of information

Democratic legislatures Essay Example for Free

Democratic legislatures Essay The Republican party is unreservedly for sound money. It is unalterably opposed to every effort to debase our currency or disturb our credit. It resumed specie payments in 1879, and since then it has made and kept every dollar as good as gold. This it will continue to do, maintaining all the money of the United States, whether gold, silver or paper, at par with the best money of the world and up to the standard of the most enlightened governments. Towards the middle of the week the group of gentlemen participating in these conferences was increased by several accessions from the number of Mr. McKinleys friends in other states, among whom may be mentioned Mr. Henry C. Payne, William R. Merriam and Melville E. Stone. After his arrival Mr. Henry C. Payne became particularly active in getting the conference together and in having the platform typewritten anew, after every change, and in having copies supplied to each participant. On Friday morning Mr. H. H. Kohlsaat of Chicago joined the conference, having come over from Chicago in response to a telegram particularly for that purpose. Mr. Kohlsaats relation to the whole matter was peculiar. The next step for Mr. Hanna and his assistants was to secure some strong endorsements by the State Conventions. Ohio was already in line, having endorsed McKinley for the nomination in the State Convention of 1895. The Convention of 1896 met at Columbus on March 10. Mr. Foraker, who had recently been elected United States Senator, made a lengthy speech, as temporary chairman, enumerating the many reasons why McKinley should receive the united, hearty, cordial, enthusiastic, and unqualified support of Ohio. The platform contained a ringing endorsement, which was greeted with a volley of cheers, and a resolution was adopted instructing the delegates-at-large to vote and work for his nomination. A telegram was received from the Kansas Convention assuring their support of McKinley, to which Ohio replied with enthusiasm. Wisconsin followed nine days later, and then came Oregon, Nebraska, North Dakota, and even Vermont. Indiana fell into line at an early date. Charles W. Fairbanks, who was to preside as temporary chairman of the convention, called upon General Harrison early in the year, and said to him frankly, If you, General, wish to be a candidate, I shall help you. If not, I am for Major McKinley. Harrison replied that he had wanted the nomination in 1892 and desired to succeed himself, but after four years of Democratic administration the thought of reorganizing the Government was intolerable. He added with twinkling eye, Your friend Cleveland is making my administration luminous. Indiana soon after declared for McKinley. McKinley wanted to retain the systems mobility and diversity, to let men fulfill their talents. He championed tariff protection specifically and the Republican party generally because he rightly understood that both promoted national interests. Naturally and honestly echoing the rhetoric of responsible individualism, he did not seek to advance at societys expense. The belief that material security fostered social responsibility might be as idealistic as facile self-sacrifice based on mans alleged innate goodness and rationality, but it at least accepted limitations in democratic politics, and the understandable reluctance of men to abandon old ideals. Some Republicans, and many Democrats, represented only business interests, but McKinleys background, personality, and constituency opened his mind to change and moderation. As a congressman, he favored civil service reform, federal protection of voting rights, and workable business regulation, reflecting the needs and aspirations of an expanding middle and working class. Like Mark Hanna, he had many friends in organized labor, and protection heightened his appeal in shops and factories. He visited the mines, warehouses, forges, and plants in his district, and got a warm welcome from most workers. His uncertain district, which Democratic legislatures regularly gerrymandered, was a blessing in disguise. He never had the luxury of safety. In American politics, a safe constituency was the kiss of death, since it isolated leaders from change and new demands. McKinleys whole congressional career sharpened his talents for compromise. In his own time, he was a liberal Republican, as many followers who later became reformers readily attested. I always felt that McKinley represented the newer view, Robert La Follette recalled. Of course, McKinley was a high protectionist, but on the great new questions as they arose he was generally on the side of the public and against private interests. By 1896, the Ohioan well represented the elements that could give the GOP a long lease on life.

Coincidence Counting With NAI Scintillation Detectors

Coincidence Counting With NAI Scintillation Detectors ABSTRACT Coincidence counting is a technique employed in nuclear medicine for PET imaging. This technique utilizes a positron emitting radionuclide that is injected into patients to track biochemical and physiological processes. The positron annihilates with an electron and emit two 0.511MeV gamma rays which are detected simultaneously by two scintillation detectors. In the experiment, two gamma ray sources, 60Co and 22Na were used with a NaI scintillation counter. A single channel analyzer (SCA) was used to count the number of voltage pulses whose height fell within the gate width. The absolute efficiency and intrinsic efficiency was obtained as a function of distance. Real and random coincidences were determined from the spectrum obtained with varying gate width and gate delay for each source. The optimum gate width obtained was 5 µsec for both sources with gate delays of 1.2 µsec and 0.2 µsec for 22Na and 60Co respectively. The real coincidences for 22Na and 60Co were found to be 200 .1  ± 2.3 and 76.5  ± 1.7 respectively. The random coincidences obtained were 25.1  ± 3.4 and 13.4  ± 2.6 for 22Na and 60Co respectively. This was determined by using the LINEST function. The percentage thus of random to real coincidences obtained in this experiment was 12.54  ± 1.85 % and 17.52  ± 3.81 % for 22Na and 60Co respectively. It was deduced that the uncertainty in determining a random coincidence was higher in 60Co than in 22Na. the magnitude of the uncertainty is as a result of fluctuations in the instrumentation. Hence the Na system is more efficient for coincidence counting and so it is useful in the PET system. INTRODUCTION Coincident counting is a radiological measuring technique that is utilised in the nuclear medicine in the PET scan whereby two photons emitted from an event are detected simultaneously by a ring of detectors. Sodium Fluoride (F18-NaF) is the positron-emitting radionuclide employed in PET for bone imaging [1]. Upon decay, the positron are emitted which travels for a short distance and under Compton’s scattering thereby loosing most of its energy. It then undergoes annihilation with an electron and emit two high energy 0.511MeV photons. The 0.511MeV photons are emitted 180 degrees apart and interact with the PET detector rings at opposite sites. [2] The detectors are made up of scintillation crystals coupled with photomultiplier tubes powered by a high voltage which produces a pulse with a height proportional to the gamma-ray energy. A SCA counts the number of voltage pulses whose height falls within a predetermined window of photon energies. Coincidence measurement is utilised when a single detector cannot produce all the information expected, as gamma rays are randomly produced, hence the need to set several detectors. Real coincidences occur when two photons are emitted in coincidence from the same annihilation event and are detected simultaneously within a certain time frame set by the gate width. Random coincidences occur when two photons emitted from different events are detected simultaneously within the time frame of the gate width. [3] The gate width determines the time window within which the simultaneous emission of the gammas are detected. The optimum gate width therefore will ensure that the maximum number of real coincidences are detected to minimise the events of random coincidences. In the ideal situation when the gate width is zero the real coincidences can be observed, and with an increase in gate width the random coincidences can be observed. In the PET scan, this will ensure efficiency of the coincidence system. The need for the gate delay is to enable the second pulse to be detected within the time frame of the gate width and this is usually a minute time frame. It takes into account the minute fluctuations that occur at time of pulses. By alternating the gate delay and gate width, the rate of coincidence can be determined. In this experiment the two sources used were 60Co and 22Na. 60Co emit two gamma rays upon beta decay at energies 1.3325Mev and 1.1732MeV with 60Ni daughter nuclide. The 22Na undergoes a beta decay and electron capture decay with the emission of a 1.275MeV gamma photons and two 0.511Mev upon interactions with the detector material. The positron from the beta decay of 22Na annihilates an electron of the detector and emit the two gammas at 0.511Mev energies at 1800. The coincidence counting system records just a certain portion of events depending on the solid angle as a function of distance. Coincidence counting as a function of distance is maximum in the middle and zero at the edge [4]. The photons can undergo several interactions in the detector before they are detected and that render the detector inefficient and so there is the need for its efficiency to be determined. The efficiency can be classed into two as absolute and intrinsic efficiencies and they are defined as Absolute efficiency ÃŽ µabs = Number of pulses recorded [3] Number of radiation quanta emitted by source Intrinsic efficiency ÃŽ µint = Number of pulses recorded [3] Number of radiation quanta incident on detector These efficiencies are related by ÃŽ µint = ÃŽ µabs * (4à ¯Ã¢â€š ¬Ã¢â‚¬  /à ¢Ã¢â‚¬Å¾Ã‚ ¦) [3] where à ¢Ã¢â‚¬Å¾Ã‚ ¦ is the solid angle of the between source and detector. The solid angle is dependent on the distance between source and detector (d) and the radius of the detector (r) and it is determined by the this equation, à ¢Ã¢â‚¬Å¾Ã‚ ¦ = 2à ¯Ã¢â€š ¬Ã¢â‚¬   1 d [3] √d2 + r2 To determine the efficiency of the coincidence system, the absolute efficiency for real and random coincidences were also determined for both sources based on the equations below. ÃŽ µabs for real coincidences for 22Na = ÃŽ µabs * ÃŽ µint ÃŽ µabs for random coincidences for 22Na = (ÃŽ µabs)2 * Activity * Intensity * Time ÃŽ µabs for real coincidences for 60Co = ÃŽ µabs * ÃŽ µabs ÃŽ µabs for random coincidences for 60Co = (ÃŽ µabs)2 * Activity * Intensity * Time METHOD Two NaI detectors coupled with photomultipliers with high voltages and preamplifiers were used for this experiment. The inputs were connected to spectroscopic and SCA amplifiers. Detector 1 was first corrected for background by counting for 5 minutes. The 22Na gamma ray source was varied with distance and the absolute efficiency of the detector was determined as a result. Detector 2 was introduced and set at a distance of 10cm apart from Detector 1. 22Na was positioned in the middle and the counting was set to 5 minutes. The gate width and gate delay were varied and their spectrum observed. The experiment was repeated for the second gamma ray source, 60Co. The optimum gate delay was determined and varied with the gate width to obtain the optimum gate width. A linear graph of count rate against gate width was obtained that showed the real and random coincidences based on the slope gradient obtained. The percentage ratio of the random to real coincidences were determined and the uncertainty associated with the experiment was also determined. RESULTS/DISCUSSION The background spectrum was corrected in the count reading for both sources. The background radiation is as a result of scattered radiation associated with the experiment. The absolute efficiency of the detector was determined for both sources as shown in Figure 1 and Figure 2 and Table 1a 1b and Table 2a 2b for 22Na and 60Co respectively. The absolute efficiency was obtained using the formula Absolute efficiency = Sum of count Intensity x Activity Figure 1: Absolute efficiency as a function of the distance between the 22Na source and detector Figure 2: Absolute efficiency as a function of distance between the 60Co source and detector The 22Na revealed a gradual decrease in efficiency with increasing distance, whereas 60Co revealed a rapid drop in efficiency as a function of distance. 60Co revealed lower absolute efficiencies since the measure of the number of pulses obtained by the 60Co was less than the number of photons emitted by the gamma ray source. This could have been due to Compton scattering reducing the number of photons actually detected as a pulse. The 22Na however revealed quite high absolute efficiencies and so can be confirmed that the detector was efficient in detecting the 22Na than the 60Co. The intrinsic efficiency was determined using the equation below. ÃŽ µint = ÃŽ µabs * (4à ¯Ã¢â€š ¬Ã¢â‚¬  /à ¢Ã¢â‚¬Å¾Ã‚ ¦) The solid angle was determined for the detector when the distance between both detectors was varied between 5cm to 20cm and the radius of the detector was measured as 10cm. This is shown in Tables 3 and 4 and Figures 3 and 4 for 22Na and 60Co respectively. Figure 3: Intrinsic efficiency as a function of distance between the 22Na source and detector Figure 4: Intrinsic efficiency as a function of distance between the 60Co source and detector The intrinsic efficiency for 60Co was lower than 22Na. It can be deduced that the number of 60Co photons incident on the detector was more than the number of pulses recorded. Hence signifying that the detector was not efficient in detecting the 60Co. The 22Na however displayed high intrinsic efficiency almost approximating the maximum value for intrinsic efficiency. The intrinsic efficiency were found to be fluctuating with the highest being 0.9898 and 0.3872 with a solid angle of 1.3029 at 13cm distance from detector for 22Na and 60Co respectively. This is as result of the detector’s geometry detecting the photons at different solid angles. The solid angle determines how much of the photons can be detected as a function of distance. The overlap of the error bars signifies the uniformity of the errors. The probability of a 0.511MeV gamma travelling in the direction of the detector and being absorbed by it, will imply that the second 0.511MeV will also travel in the correct direction. Both detectors detecting the two 0.511MeV gammas can be determined to yield the absolute efficiency for real coincidences. This can be deduced from the notion that photons travelling in the right direction will be absorbed in the right direction by both detectors. The results of absolute efficiencies for real and random coincidences for 22Na and 60Co is shown in Table 5 6 and Figure 5, 6, 7 8. The efficiencies for both sources decreased with distance and it was lower for 60Co. The absolute efficiency for random coincidences was however for both sources than the absolute efficiency for real coincidences. It can thus be inferred that the absolute efficiencies for real coincidences for both 22Na and 60Co yields less probability of detection of real coincidence with 60Co as compared to the 22Na. The abso lute efficiencies for random coincidences was however comparable for both sources as the probability of detecting the second event within the gate width is possible for both sources. Figure 5: Absolute efficiency for real coincidences as a function of distance for 22Na Figure 6: Absolute efficiency for random coincidences as a function of distance for 22Na Figure 7: Absolute efficiency for real coincidences as a function of distance for 60Co Figure 8: Absolute efficiency for random coincidences as a function of distance for 60Co The gate delay was varied with gate width to obtain the optimum values of delay and width. The optimum gate delay was obtained as 1.2 µsec and 0.2 µsec for both 22Na and 60Co respectively and was used for the experiment. A linear graph of count rate as a function of gate width was obtained and a fixed gate width was obtained as shown in Figure 5 and 6 and table 7 and 8 Figure 5: A linear graph of count rate as a function of gate width applying a 1.2 µsec gate delay for 22Na Figure 6: A linear graph of count rate as a function of gate width by applying a 0.2 µsec gate delay for 60Co Real coincidences occur on the intercept of the linear slope gradient, whereas random coincidences can be found with the slope. For 22Na the optimum gate width obtained was 5 µsec. The graph of count rate as a function of gate width yielded a slope gradient of y = 5.019x + 200.15. By applying the optimum gate width and correcting for the gate delay, the real and random coincidences were determined using the LINEST function. The real coincidences was found to be 200  ± 2.3 whereas the random coincidences was found to be 25.1  ± 3.4. The percentage thus of random to real coincidences obtained in this experiment was 12.54  ± 1.85 %. This gives the value of pure coincidences that are not dependent on gate width. For 60Co, the optimum gate width was 5 µsec. The graph of count rate as a function of gate width yielded a slope gradient of y = 2.6801x + 76.483. When the optimum gate width was applied whilst correcting for the minute gate delay, the real and random coincidences were determined using the LINEST function. The real coincidences was found to be 76.5  ± 1.7 whereas the random coincidences was found to be 13.4  ± 2.6. The percentage of random to real coincidences obtained in this experiment was 17.52  ± 3.81 %. The above results was compared with the measured values obtained from the graph. The intercept gave the real coincidences as 200.15 and 76.48 for 22Na and 60Co respectively. The point of data convergence on the straight line gave the optimum gate width and the count equivalent was found as 225.28 and 90.02 for 22Na and 60Co respectively. The difference between this value and the real coincidences yielded the random coincidences as 25.13 and 13.56 in 22Na and 60Co respectively. Hence the percentage ratio of the random and real coincidences was obtained as 12.49% and 17.73%. This is equivalent to the values obtained from the calculated coincidences with the differences being due to uncertainties. The uncertainties with this experiment were with the NaI detector which contributed to scatter around the cover. The count rates resulted in some uncertainties as well and has been sown in table 8 for both detectors. The solid angle presented an uncertainty as the measurements for the detector could incur a large margin of errors. From all the results synthesized for both sources it could be gathered that the 22Na was an efficient source for coincidence counting compared to the 60Co. This is as a result of the geometry of the detectors as the Co system does not show a coincidence system and so there is more likelihood of a random coincidence than a real coincidence as compared to the Na system. This concludes that the 22Na will be efficient in a PET system, hence the reason for positron emitting radioisotopes being used in the PET system to ensure the maximum number of coincidences are being detected CONCLUSION The experiment was performed to examine the coincidence counting in two gamma ray sources and to determine the real and random coincidences as a function of gate width. The optimum gate width obtained was 5 µsec for both sources with gate delays of 1.2 µsec and 0.2 µsec for 22Na and 60Co respectively. The real coincidences for 22Na and 60Co were found to be 200.1  ± 2.3 and 76.5  ± 1.7 respectively. The random coincidences obtained were 25.1  ± 3.4 and 13.4  ± 2.6 for 22Na and 60Co respectively. This was determined by using the LINEST function. The measured count rates was also determined from the graph and resulted in real coincidences for 22Na and 60Co respectively as 200.15 and 76. 48 and random coincidences of 25.13 and 13.56. The percentage thus of random to real coincidences obtained in this experiment was 12.54  ± 1.85 % and 17.52  ± 3.81 % for 22Na and 60Co respectively. This gave the quality of the uncertainty in the coincidence system. It was deduced that the uncertainties in determining a random was higher in 60Co than in 22Na hence the Na system is more efficient for coincidence counting and very useful in the PET system. REFERENCES [1] The detection of bone metastases in patients with high-risk prostate cancer:99mTc-MDP planar bone scintigraphy, single- and multi-field-of-view SPECT,18F-fluoride PET, and18F-fluoride PET/CT.Even-Sapir et al, J Nucl Med(2006)47:287–97 [2] The Physics of Medical Imaging, ed. S. Webb. IoP publishing [3] Radiation and Detection Measurement, Glen N Knoll, 3rd Edition [4] Coincidence Counting, E. K. A. Advanced Physics Laboratory, Physics 3081, 4051 APPENDIXES Table 1a: Counts rate as a function of distance between source and detector for 22Na Table 1b: Absolute efficiency as a function of distance between source and detector for 22Na Table 2a: Counts rate as a function of distance between source and detector for 60Co Table 2b: Absolute efficiency as a function of distance between source and detector for 60Co Table 3: Intrinsic efficiency as a function of distance between source and detector of 22Na Table 4: Intrinsic efficiency as a function of distance between source and detector for 60Co Table 5: ÃŽ µabs for real and random coincidences as a function of distance for 22Na Distance(cm) ÃŽ µabs à ¢Ã¢â‚¬Å¾Ã‚ ¦ 4à ¯Ã¢â€š ¬Ã¢â‚¬   ÃŽ µint ÃŽ µabs for real coincidences ÃŽ µabs for random coincidences 5 0.09940 3.473 12.57 0.35967 0.0994 48.7255 10 0.05091 1.8403 12.57 0.347637 0.0509 12.8015 13 0.04015 1.3029

Stress In The Medical Field Psychology Essay

Stress In The Medical Field Psychology Essay Problems of stress in various professions have attracted the attention of psychologists of different directions for a long time. A big majority of classical studies have shown that prolonged stress exposure leads to such adverse effects as the decrease in overall mental stability of the organism, the emergence of dissatisfaction of its activities, the tendency to reject assignments in situations of increased requirements, setbacks and defeats. Analysis of the factors that cause similar symptoms in different activities shows that there is a number of professions in which a person begins to feel self emotionally drained by the internal need for continuous contact with other people. It is a well-known fact that the medical profession like any other is related to interpersonal interaction, so timely diagnosis and correction of such violations are highly relevant to doctors and nurses. Thus, we are going to discuss stress in the medical field combining its impact on professional doctors a ctivities and personal lives. First of all, the interest in occupational stress in doctors is provoked by general trend towards the humanization of modern science, which is reflected in a wide variety of industries from the theory of management teams, to the fundamental philosophical epistemology and methodology of science. One manifestation of this trend is attracting the attention of researchers to the subject of professional activity, in particular the effect of chosen occupation on the nature and character of the person. Another reason for interest in this problem is the tightening of requirements for the professionals of different profiles and requirements tempo and rhythm of a modern lifestyle. The requirements for representatives of the so-called helping professions need additional attention, because their psycho-physiological state directly influences the effectiveness of their professional activities, whose importance in contemporary society can hardly be overestimated. In particular, studying of this problem in the annex to the medical staff is the question of extremely high importance, because exactly a human life is often the possible price of any mistake in their activities. Thus, the group of observation is doctors who provide mental, urgent, or palliative care and doctors in hospices. In psychology under the term stress we should understand the mental stress that occurs in humans under the influence of complicated, difficult, unfortunate circumstances of activities and daily life, or in special, extreme situations. As the stressors (the factors leading to the rise of human stress in short-term, and to the development of severe, long-lasting experiences) can be adverse physical effects of environmental emergencies, physical and psychological trauma, etc. Mental stress that arises under the influence of stressors may be a useful adaptive significance, mobilizing people to overcome difficulties. This phenomenon, for example, is well known to athletes or actors, prestarting excitement which serves as a setting for the upcoming activities. However, if stress is too high because of the intensity of exposure or its unexpectedness, human resources may be insufficient to cope with stress, and it begins to have a destructive effect on the person until the appearance of physiological disorders and complete disorganization of human life. Observing stress factors among doctors in hospices we see that exactly among people of this occupation the problem of occupational stress acutely announced itself at the present time, because in the modern post-industrial society, peoples attitude to work is changing at a pace that does not come across any previous generation. In developed countries, especially today, when the economic crisis continues, workers are increasingly losing confidence in the stability of their own social and material status, warranty in the workplace, and material well-being. Competition for the prestigious and highly paid job is rather high nowadays. On the one hand, parallel processes are taking a narrow specialization in the profession, and on the other hand the globalization of related industries is popular. Demand of the labor market is changing rapidly and facing some difficulties, one can not fully realize the accumulated energy due to physiological stress. As a result this energy begins to destroy human character and soul. In this case, instead of completely normal stress reactions the organism begins to literally tear apart the mechanisms of distress, when the energy can not be realized in constructive activities. As a consequence, a mental, emotional stress associated with stress in the workplace increases. People find in their behavior symptoms of revealed anxiety, depression, emotional burnout syndrome, psychosomatic disorders and other malfunctions. It leads to growing dependence on psychoactive substances, including alcohol, tranquilizers and other psychotropic substances. Thus, the data presented in Dollard, Winefield Winefield work shows that 81,4 % of examined doctors, 85,9% of nurses and 79,8% of medical students use alcohol. Also 33,3% of surveyed students regularly drink beer and other alcoholic drinks. (Dollard, Winefield Winefield, 2003). Thinking about the future of medical students and according to Levey we see that medical students are inundated with stress from the start of their medical training as they attempt to adjust to lifestyle changes and increasing hassles incurred by the demands of medical education. Characteristics commonly associated with medical training and identified as situational or professional stressors include: variable hour shifts, sleep deprivation, cumbersome administrative responsibilities, poor administrative support, and curriculum overload (Levey, 2001). Dollard, Winefield Winefield stated that Additional characteristics are: perceived lack of professional knowledge and skills, health care policy changes, difficult patients, patient care, life and death situations, and unexpected shill in academic performance. Further stressors mentioned in the literature include family responsibilities, incurring financial debt, decreased chances for social, leisure, or physical activities, decreased s upport network due to relocation, cultural and minority issues, and inadequate coping skills (Dollard, Winefield Winefield, 2003). The interest for the topic of stress in the medical field was provoked by Wicks words who wrote in the foreword for his own book, describing the appearance of stress and hardships of medical profession, the following: Who among us has not identified with the young leukemia patient who is refractory to treatment and scared to death, or the midcareer professional deeply unresponsive and too young to have had this massive stroke, or parents trying to absorb into their consciousness the sudden accidental death of a child? Instead of the afflicteds Why me? the caregivers frightened imponderable becomes Why not me? What roll of the dice, what act of fate, what divine intervention preserves me from any one of these circumstances? What makes it possible for physicians and nurses to confront these patients and circumstances day after day with caring and therapeutic resolve and to walk the balance beam between the paralyzing fear of their own mortality and the numbness of emotional disengageme nt or indifference? And while the hospital environment is the epicenter of personal exposure, the reminders are distributed ones day from office visits with patients to telephone calls with distraught family members. In each encounter, we see ourselves separated from our patients circumstances by the luck of the draw but believe at a subconscious level that we are somehow protected. Its like wearing a Red Cross arm badge in the battlefield. (Wicks, 2006) This phrase deeply impacts on people who work in the medical field and we can say with confidence that the structure of clinical manifestations of occupational stress among specialists of the helping professions (so-called emotional burnout) includes different features that bring together this phenomenon with the number of traditional mental (such as asthenic neurosis), and psychosomatic disorders. This state of affairs suggests the presence of etiopathogenetic structure of occupational stress in psychological level, playing almost the leading role in the origin and development of this phenomenon. WHO European Ministerial Conference (2005) noted that the stress associated with work, is an important issue for about one-third of workers in the European Union. The cost of solving problems related to mental health in this context includes in average 3-4% of gross national income of developed countries (Wicks, 2006). Observing literature about stress in medical field it was found that among physicians (as it was mentioned above the focus group for this project is doctors in hospices) as among other health professionals, there is a higher incidence of mental disorders compared with the averages in the population, and it is generally considered that it is connected with the peculiarities of the medical profession. In 1997, one of the issues of the journal Advances in Psychiatric Treatment was devoted to the overall theme of mental disorders among physicians with an emphasis on phenomenology and treatment. Interviewing Dr. Thomas, who is the doctor in hospice it was found that stress greatly influences not only professional life, but also personal life of any doctor. Dr. Thomas stated that often the patients life depends on the timely receipt of adequate medical care for high-quality rendering of which the doctor of hospice requires self-discipline, high level of concentration and clarity of action. The need for rapid decision-making under tough time constraints and information leads to long-term emotional suspense and, as a consequence, the development of stress. Dr. Thomas also mentioned during the interview that among health care workers professionals who are most distinguished by a heightened sense of responsibility, willingness to always come to the aid for the patient, the desire to be important, the desire to provide psychological support, a high degree of moral duty to the patient and the desire to conform to certain ethical-deontological requirements, experiences about their professional competence are in the group of risk for the stress development. While making the research of stress in the medical field it was found that according to British researchers as it was stated by Levey, in 41% of the cases among general practitioners high levels of anxiety are revealed, and clinically evident depression is present in 26% of cases. (Levey, 2001). The third part of doctors use medication for correction of emotional stress, and the amount of alcohol use exceeds the average level. According to Wicks stress is provoked by three types of factors in the big majority of cases (Wicks, 2006). In such situation personal role and organizational factors have the leading place in the medical field. Personal factor. It describes burning doctors as sympathetic, humane, gentle, fond, idealists, people-oriented, and at the dame time unstable, introverted, obsessed by fixed ideas, fiery and easily identifying themselves personalities. Role factor. The relationship between the role conflict, role ambiguity and emotional burnout was observed many decades ago. Wicks stated that employment in the case of a clear division of responsibility limit the development of stress in the medical field (Wicks, 2006). Moreover, doctors who feel fuzzy or uneven distribution of responsibility for their professional actions, understand that this factor increases sharply, even at much lower workload. Organizational factor. The main organizational factors that contribute to stress burnout include: high workload, lack or absence of social support from colleagues and management, insufficient remuneration for work, a high degree of uncertainty in assessing the work performed; inability to influence decision-making process; ambiguous requirements for the work; the constant risk of penalties, monotonous and unpromising activities, the need to outwardly show emotion, that is not conform to reality, lack of holidays, vacations and interests outside of the own medical profession. It is also necessary to mention that among the other important factors in the development of stress are the destabilizing organization of activities and unfavorable psychological atmosphere in the team. Making the accent on the development of stress among doctors of hospice we should mention that high medical pressure, twenty-four-hour regimen with the mandatory duty, the expectation of complications in the condition of patients require a high functional activity of the organism and can be qualified as the leading professional pathogenic factors. In addition, an aggravating effect on the health of workers has the contact with dying patients when the health worker does not see the positive results of the own efforts to save the patient and often feels his own weakness. As a result there can be mentioned developing brain disorders in the form of neurosis, hypertension, stenocardia, ulcers of the gastrointestinal tract and other health problems. It is obvious that professional activities often have an adverse impact on individuals that leads to depression. The greater medical workload lead to the fact that health care worker experiences less pleasure from the process of his own work. Exceeding regulatory number of patients, a large amount of clerical work-design, low technical equipment of the workplace and the permanent shortage of drugs also contribute to the manifestations of fatigue and nervousness. From the ergonomic factors doctors in the hospice often observe eye strain, overload of the musculoskeletal system. Thinking about the way how stress in the medical field relates to culture it is possible to say that the recent radical changes in society have an additional psychological burden on the medical staff, since society needs the higher quality workers in a much shorter time since economic restrictions are providing health services. Innovation activities of health care institutions is focused on the practical use of scientific and technical results and intellectual capacity to expand the range of services, methods for their production, to improve quality of care and meet patients needs for high quality medical services, and ultimately to optimize the level of health among population. The most part of health professionals who work in an innovative environment, have long working hours, overtime, associated with combining positions or additional training workload (training, development of new methods of diagnosis and treatment). Intensification of professional activities affects the health, helping to increase the level of overall incidence and prevalence of chronic diseases. In addition to the above observed facts Dr. Thomas stated that people working in health care facilities are often subjected to considerable personal stress They have problems in the private life because they cannot show their feelings to other people and have the predominant feature of the medical profession to deny the problems related to personal health. Due to the research work in the medical field we can state that among doctors in hospice there is a widespread idea that the stress at work is like a failure and doctors own weakness. Thats why stress calls denials based on the feeling of guilt and leads to the fact that doctors have many difficulties in admitting of the existence of these problems, respectively, it is difficult to share and solve them timely. Thinking about the negative impact of stress on the work of any doctor we should pay the specific attention to the fact that development of this state contributes to certain personality traits a high level of emotional lability (neuroticism), high self control, especially when expressing negative emotions with the desire to suppress them, the rationalization of the motives of personal behavior, a tendency to increased anxiety and depressive reactions associated with unattainability of internal standard and blocking negative emotions, rigid personality structure. The paradox is that the ability of health care workers to deny their own negative emotions can sometimes be a power in their hands, but often it becomes their weakness. Therefore it is useful to remember that we are always a part of our problem, or part of their solutions is always in our mind. Thus, the fieldwork shows that the syndrome of burnout is accompanied by the daily, routine professional work, often requiring from physicians a sufficiently intense, not spontaneous, unimportantly conflict, but for different reasons emotionally intense communication with patients, and therefore it is not associated with its extreme conditions. So, it becomes clear why frequency and intensity of this syndrome are much higher among oncologists and doctors in hospice than among surgeons or traumatologists. It is impossible to leave without attention the fact that the restriction of the possibility of using existing personal potential, the monotony of work, a high degree of uncertainty in the assessment of the work, dissatisfaction with social status are noted among the characteristics of communicative professions that have a significant impact on the development of stress. And only after the above numerated factors physicians emphasized that they considered low pay and poor working conditions as stress factors, considering them important, but not leading, as it often seems to be the sources of occupational stress in health care workers. Conformity / fail capabilities of professional in the medical field and social conditions of his activities lie in the focus of the problem of occupational stress. Therefore, this issue was explored in complex of specialist communication profession and its social environment. Emotional infectiousness burnout syndrome, which also emphasizes its social nature plays also an important role in the discussion of the information in this project. In conclusion, stress in the medical field and occupational stress in its wide sense are not the problem of difficult people, but the problem of difficult (unsolved) cases in the relationship and structure of interpersonal relations, fuzzy symbols of social roles and responsibilities, lack of emotional support from counterparts and leaders.

The Civil Reserve Air Fleet :: essays research papers

Abstract The Civil Reserve Air Fleet is a partnership between the Department of Defense and commercial airlines where the airlines contractually commit a portion of their aircraft and crews to be used by the Department in the event of any level of military conflict. These aircraft can be â€Å"called up† and required to respond quickly to provide airlift support to the Department of Defense. There are minimum required levels of participation in order for the airlines to be eligible, and in turn they receive peace time business including passenger and cargo movement approximately in proportion to their commitment level. The program is divided into three segments which include varying amounts and sizes of aircraft that serve specific purposes. There are also three levels of activation depending on the severity of the conflict, which also require different amounts and sizes of aircraft. This program has been in place for nearly 53 years, and has become an essential partnership required fo r an effective United States military. The following pages are an investigation various aspects of the Civil Reserve Air Fleet such as its purpose, history, and effectiveness. The Civil Reserve Air Fleet   Ã‚  Ã‚  Ã‚  Ã‚  The Civil Reserve Air Fleet (CRAF) is a network of select aircraft from several commercial airlines that are all committed in various amounts to the Department of Defense (DoD) to provide airlift resources when the capability of U.S. military aircraft is exceeded. This system is designed so that these carriers can provide military cargo movement and troop transportation to anywhere in the world on short notice in the event of a military conflict. In order for airlines to join the CRAF, they must commit at least 30 percent of their long-range passenger fleet and 15 percent of their long-range cargo planes (Fact Sheet, 2004). These aircraft must also be U.S. registered, capable of over water operations, and have at least four complete crews assigned for each aircraft (Fact Sheet, 2004). Airlines that participate in CRAF have provided vital support to our military since the Korean War (Graham, David, 2003). The Persian Gulf War was the first official activation of th e CRAF, where two thirds of the troops and one quarter of the air cargo was moved by commercial airplanes (Graham, 2003). Though not officially activated, the CRAF is currently supporting Operation Iraqi Freedom, providing nearly double the amount of aircraft that the DoD has estimated for its most demanding war strategies. This paper will provide a brief explanation of the purpose of the CRAF, its history, the effectiveness of the program, and a quick look towards the future of the CRAF.

Willian Faulkner :: essays research papers

William Cuthbert Faulkner was born on September 25, 1897, in New Albany, Mississippi, the first of four sons born to Murry and Maud Butler Faulkner. He was named after his great-grandfather, William Clark Faulkner, the â€Å"Old Colonel,† who had been killed eight years earlier in a duel with his former business partner in the streets of Ripley, Mississippi. A lawyer, politician, planter, businessman, Civil War colonel, railroad financier, and finally a best-selling writer (of the novel The White Rose of Memphis), the Old Colonel, even in death, loomed as a larger-than-life model of personal and professional success for his male descendants. A few days before William’s fifth birthday, the Faulkner’s moved to Oxford, Mississippi, at the urging of Murry’s father, John Wesley Thompson Faulkner. Called the â€Å"Young Colonel† out of homage to his father rather than to actual military service, the younger Falkner had abruptly decided to sell the railro ad begun by his father. Disappointed that he would not inherit the railroad, Murry took a series of jobs in Oxford, most of them with the help of his father. The elder Faulkner, meanwhile, founded the First National Bank of Oxford in 1910 with $30,000 in capital. William demonstrated artistic talent at a young age, drawing and writing poetry, but around the sixth grade he began to grow increasingly bored with his studies. His earliest literary efforts were romantic, conscientiously modeled on English poets such as Burns, Thomson, Housman, and Swinburne. While still in his youth, he also made the acquaintance of two individuals who would play an important role in his future: a childhood sweetheart, Estelle Oldham, and a literary mentor, Phil Stone. Estelle was a popular, vivacious girl in Oxford with an active social life that included dances and parties. Despite her romance with William, she dated other boys, one of whom was Cornell Franklin, an Ole Miss law student who proposed marriage. She lightheartedly accepted, apparently believing his request insincere since he was going to Hawaii to establish a law practice. When he sent her an engagement ring several months later, however, her parents thought Franklin would be a fine husband for their daughter, and she found herself unable to escape the circumstances. She and Franklin were married in Oxford on April 18, 1918. William’s other close acquaintance from this period arose from their mutual interest in poetry. When Stone read the young poet’s work, he immediately recognized William’s talent and set out to give Faulkner encouragement, advice, and models for study.