Ethical Dilemma Essay Example | Topics and Well Written Essays - 1000 words

Ethical Dilemma - Essay Example When the managers investigated the issue, they came to know that the software developer was not able to fulfill the requirements of the customer due to which he was delaying the issue. He tried to hide from the managers his poor skills in removing software errors. Later on, the company provided the customer with his desired software in just two days using another developer. The ethical issue in this example was that the developer tried to hide his inability in removing the errors by trying to delay the issue. The issue not only decreased the customer’s confidence in the company but also resulted in putting a spot on the company’s image. The developer could have tackled the situation in a much different way. He should have made the company aware of the real situation instead of being afraid of losing his job.  I believe that if an employee of a company behaves unethically, it puts an adverse impact on the overall image of the company. It not only results in the loss of customers’ confidence in the company’s products but also affects the image of the company. Therefore, employees should behave ethically in all situations because ethical behavior is the key to the resolution of complex issues.If I would be in the position of the software developer, I would handle the issue differently. I would not hide my disabilities on the cost of losing the customer’s confidence. First, I would collect detailed information to resolve the issue properly. I would come to the customer personally to know the concerns of the customer. 2 Next, I would determine the exact issue by analyzing the information obtained from the customer. I would consider the nature of my job responsibilities and my obligations to the company while determining the issue and my role in resolving the issue. Brown (2011) states, â€Å"Ethical issues that arise in the workplace should be carefully examined, and handled with care, as the determinations of these ethical issu es can lead to the growth or demise of a company†. 3 After determining the key ethical issue, I would identify the individuals who would be involved in the issue. In the above-mentioned case, I would carefully analyze the situation to identify the stakeholders and

Dickens’ Victorian Critique of Church and State Essay Example for Free

Dickens’ Victorian Critique of Church and State Essay There is not much question in a look at his career’s work, that Charles Dickens was by his nature a harsh social critic. He would often make his characters morally objectionable in order to demonstrate the ills of society and would take an especially great interest in showing the iniquities of Church and State. In the deeply unequal England of the Victorian era, Dickens felt that he saw a lot of suffering, a great many people in need and a visible disgust of the rich toward the poor. The fact that these conditions had associated so closely with the premise of God and Crown had drawn out in critics such as Dickens as sharp distaste for the British institution girding both. That is why so many of his works centered on the relationship of the rich and poor, separated as such by the unwelcome permeation of authority of the former over the latter. The labor conditions Dickens explores in Hard Times through such figures as Stephen are contrasted sharply by the life of decadence and sanctimony denoting the figure of Josiah Bounderby. Clearly the figure through who Dickens channels the greatest pitch of protest, there is a clear hostility toward the hypocrisy and meanness which allows Bounderby to prevail over the poor of Coketown with a divinely entitled and self-declared superiority. It is here that Dickens captures the Victorian era’s undercurrent of resentment of the exploitation of God and Church for the interests of rendering selective such universal entitlements as faith and justice. In Bounderby, we are given the opportunity to view the justice system in Dickens’ time as something principally founded on inequality, determining a process which is governed by an aristocratic jurisdiction over that which deemed righteous, just and moral. All of these concepts emerge in Bounderby, and especially in a notable encounter with Stephen, suggest the most demonstrably inappropriate misuse of religious principles. In Hard Times, published in 1854, Dickens shows that he is specifically interested in dealing with a current problem of labor abuse. He draws a deeply negative picture of the rationalist political movement with which Bounderby may be identified. This was a powerful movement at the time in England. Rationality was focused on facts, which Dickens believed were used to give strict control over education, values and even creativity. This would impact the making of religion and justice too. The chief characterization of Bounderby captures this points exceedingly well, remarking that â€Å"there was a moral infection of claptrap in him. Strangers, modest enough elsewhere, started up at dinners in Coketown, and boasted in quite a rampant way, of Bounderby. They made him out to be the Royal arms, the Union-Jack, Magna Charta, John Bull, Habeas Corpus, the Bill of Rights, an Englishman’s house is his castle, Church and State, and God Save the Queen, all put together. † (52) The declaration, clearly satirical in its delivery, is nonetheless a premise upon which we will find Bounderby behaving in the most repugnant of ways. When the aforementioned Stephen, an honest laborer detained in a marriage with an abusive and alcoholic wife, goes to Bounderby, the wealthy mill owner and a public judge, he is denied a request for divorce. Bounderby denies him because poor laborers like him are not expected to have the money to have a divorce. In the scene between Stephen and Bounderby, we can see how the justice system is deeply imbalanced, as are the attitudes of the people in the justice system. When Stephen argues that the legal system wouldn’t let him get a divorce was a ‘muddle,’ Bounderby disciplines him, â€Å"Don’t you talk nonsense, my good fellow,. . . about things you don’t understand; and don’t you call the Institutions of your country a muddle , or you’ll get yourself into a real muddle one of these find mornings. The institutional of your country are not your piece-work, and the only thing you have got to do, is, to mind your piece-work. You didn’t take your wife for fast and for loose; but for better for worse. If she has turned out worse—why, all we have got to say is, she might have turned out better† (Hard Times, 84) The response, which only makes Stephen more angry, shows how Dickens’ really likes to use the writing device of irony. As Bounderby and Mrs. Sparsit, who is a rich, high-class woman with a divorce, together call Stephen guilty of ‘impiety,’ we know that the two are having some sort of inappropriate relationship with one another. This casts a blaring spotlight on the hypocrisy at the root of his cruel religiosity. Bounderby takes on the mantle of Dickens’ twinned reproach for the system and church which had conspired to make England so deeply unequal a place. That God had come to overwhelm the senses of justice and humanism seems a clear justification to Dickens that the core morality of religion had by the Victorian age been exposed for the bastard-child of human conceit which it had come to embody. Indeed, in the above claim by Bounderby against Stephen, was can see that Dickens is be very sarcastic when he uses the word ‘impiety. ’ Particularly, the statement is delivered at the expense of a poor man, demonstrating a perceived relationship between righteousness and social class. The cruel and empowered judge would characterize himself as the man of God, so noted for his chosen rank and certainly not, from the reader’s (or Dickens’) perspective, because of his admirable moral disposition.. The outcome of Stephen’s visit to Bounderby and Sparsit is that his poor, labor-class status renders him morally, and thus legally, forbidden from divorce. A clear symptom of the Victorian era, we can see Dickens taking particular pains demonstrate that manner in which religion and justice had come to falsely associate. The vitriol which Bounderby aims at Stephen is powerfully representative of the purpose in this association, allowing the wealthy to prevail over fundamental personal institutions such as the faith, family and welfare of the poor. Works Cited Dickens, C. (1870). Hard Times. Barnes Noble Classics.

EHR Implementation and Effects on Nursing Essay -- medical records, he

EHR Implementation Background The implementation of electronic health records (EHR) continues to make an impact on nursing and patient care throughout the country. As a part of the American Recovery and Reinvestment Act of 2009, all public and private healthcare providers were required to implement electronic health records in their facilities by January 1, 2014. By demonstrating â€Å"meaningful use† of the electronic medical record, facilities are able to maintain Medicaid and Medicare reimbursement levels. Providers who show that they are meeting the â€Å"meaningful use† criteria during EHR use will receive an incentive payment from Medicare and Medicaid. â€Å"Meaningful use† is â€Å"using certified technology in EHR implementation to improve quality, safety, efficiency, and reduce health disparities; engage patients and families; improve care coordination; and maintain privacy and security of patient health information† (Centers for Medicare & Medicaid Services, 2013). The federal government has encouraged EHR use in hopes that it will significantly improve patient care. There is the intent that electronic health records will allow any provider access to important patient health information no matter where the patient is, while â€Å"creating a comprehensive national electronic health information network that leads to a reduction in the duplication of tests, an improvement in the cost-effectiveness of interventions, and the ability to compile a comprehensive patient history† (McBride, Delaney, Tietze, 2012). While the implementation of EHR’s has good intent, an important question is, â€Å"How are the implementation of EHRs having an effect on emergency nursing and patient care?† Benefits of EHR Use in the Emergency Department Nurses are... ...ers to consider long-term benefits. (2012). ED Management, 24(3). Guterl, G. (2012, April 2). Motivating Meaningful Use on ADVANCE for Nurses. Retrieved February 18, 2013, from http://nursing.advanceweb.com/Features/Articles/Motivating-Meaningful-Use.aspx Kutney-Lee, A. (2011). The effect of hospital electronic health record on. NCBI, 41(11). Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3236066/ McBride, S., Delaney, J., & Tietze, M. (2012). Health Information Technology and Nursing. American Journal of Nursing, 112(8). Retrieved from http://www.nursingcenter.com/lnc/pdf?AID=1402619&an=00152258-201301000-00010&Journal_ID=&Issue_ID= Meaningful Use - Centers for Medicare & Medicaid Services. (2013, December 6). Retrieved February 19, 2015, from http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html

Influence Change through Strategic Thinking Essay

Strategic Thinking can be defined as the learning process which entails many aspects of turning the innovative ideas into reality through team work, planning and organizing of resources. It includes the need to have problem solving abilities and critical analysis of situations. Strategic thinking can be used as a very effective tool to implement; manage and sustain the change in any organization and help organizations prosper under the scheme of change (Sanders, 1998). Why is Strategic thinking necessary? Strategic thinking when compared with strategic planning serves us with many differences. With an aerial view, both of ideas seem to be very similar, however, in actual organizational based scenarios, strategic thinking is quiet different from planning, and involves more rigorous activities. Strategic thinking only helps in shaping the future that is partial planning of the future. In the process, the ideas are not discreet and are interactive in nature. This helps to generate better outputs as the interaction gives other the chances to present their opinions. Strategic thinking provides lower level management to have their say in strategy making and development as it an interactive system of thinking. The involvement of the management at all levels is what gives it an edge over strategic planning. An organization is a system in which sub systems are present. These sub systems interact with each others and hence managers at all the levels come together to create a strategy viable for their organization. All the managers understand their positions and their roles in the organization know that they are correlated and are interdependent (Wootton & Horne, 2002). Strategic thinking has one important aspect i. e. , change. Change is inevitable when strategic thinking is in process. It is true that strategic thinking tackles the difficult part of implementing the change rather than sustaining and evaluating it. Change management is difficult and the toughest part of change management is implementing and managing change (Wootton & Horne, 2002). Strategic Thinking and Influencing Change However, strategic thinking assists in successful change implementation. Change management and transformation from one state to the other is involved with rigorous planning and with out planning, change management process would come out to be a failure. Hence, strategic thinks aids in making correct decisions as it an interactive system of thinking (Kotter, 1996). The important thing is to identify whether the change is at strategic, operational or functional level, and when change is identify, it must be made sure that in order to bring about the change a paradigm shift must come. The change that would come would bring a transformation current system and the way things are done in an organization. Innovative thinking and thinking that is out of the box clearly assists in planning and implementing a strategic change in an organization. Continuous improvements and evaluation is another critical success factor in implementing change with the aid of critical thinking. In order to bring about the change effectively, the mangers must challenge the current situation they are in. complacency should be avoided at all levels of change. All assumption must be confronted and must be checked against the current scenarios if they are applicable. All the assumptions must be checked against the evidences and must be characterized and prioritized (Kotter, 1996). The managers must make a clear distinction between their ends and the means they would achieve those ends. The ends must be clearly identified and the means and methods of achieving those ends must be done when ends are assessed and are understood. Change brings about resistance, and at this stage, managers must identify the means to handle the resistance and the consequences of the resistance (Kotter, 1996). All levels of the planning process must be utilized in strategic thinking when establishing change in any organization or at stage of organizational life. These levels are mega level, macro level and micro level. At all levels of organizational change and planning process a holistic approach should be employed and used. This would help the managers understand what change would consequently which part of the system and sub system. Interaction amongst those systems would clear away the hurdles that could come in the process of change, and better ideas come up to eradicate and overcome those barriers. Relationships should be established in strategic thinking to understand that the organization is not a stand alone entity but is well connected with the outside world (Sanders, 1998). Measurable objectives must be set so that they are evaluated at a later stage of change and when the change is needed to be sustained, the specific changes can be managed well if there is a slight disorder in them. Indistinguishable and ambiguous objectives should not be adhered to and should not be taken into account. Status quo must not be challenged but a change should be with in the status quo and achievable at all levels of the organization. The pros and cons must be measured. If the success of that particular change is made measurable then the failure and damages of that particular change should also be made measurable (Kotter, 1996). Ideal vision, even though difficult to achieve, always provides the possibilities that can be present to lead to that particular ideal vision. This is the basis of strategic thinking. Continuous improvement and incessant change is the key to organization’s success. Both amalgamated give a perfect strategy to come about a successful change action with minimized resistance and better results (Sanders, 1998).

Sepsis Systemic Immune Response Health And Social Care Essay

Sepsis is defined by the clinical marks and symptoms of a systemic immune response to infection. ( 1-2 ) Presently, sepsis on a world-wide degree creates a important degree of mortality ; and consequences in about one tierce of all Intensive Care admittances. ( 3-5 ) In Victoria entirely there are about 8500 admittances to Emergency Departments with patients enduring from sepsis ( 3 ) and this figure is increasing. Sepsis intervention can be initiated with a wide spectrum antibiotic, and so transferred onto a specific antibiotic regimen. Presently the degree of pre infirmary informations available on the direction of sepsis is really limited and the most advanced theoretical account has been initiated in the United Kingdom ; including a pre infirmary testing tool and so the infirmary direction known as the ‘Sepsis six ‘ . ( 6 ) Pre hospital direction can be utilised to the full potency of paramedics developing and cognition with the disposal of pre infirmary antibiotics ; nevertheless this is non without hazard. Possibly the opposition to manus over the authorization to paramedics in the United States is the impression of making a ace bug ; similar to Methicillin-resistant Staphylococcus aures. This paper proposes that the disposal of antibiotics in the pre hospital field does transport some hazard, but the research suggest that the benefits clearly outweigh these hazards. A new pre infirmary guideline must be created due to the sheer figure of Emergency Department admittances. The possible to do a important difference to a patient ‘s result is imperative.EpidemiologyIt has been extremely researched and reported across the universe that sepsis is a major cause of morbidity, mortality and topographic points an tremendous fiscal load on the several wellness system. ( 2, 5, 7 ) Statistics from Australia, United States and the United Kingdom are similar in nature and supply a wealth of information sing the epidemiology of sepsis. Sepsis in the Uni ted States has been recognised as a public wellness issue, ( 8 ) with surveies describing that there are 300 reported instances per 100,000 with about 40 % mortality. ( 5, 7-9 ) Severe sepsis in the United land histories for 27 % of Intensive Care Unit admittances ( 4 ) and this is comparable with 23.8 % of Intensive Care admittances in Victoria, Australia. ( 3 ) However it may be noted that this information is non really recent and that in the clip of survey the incidence was increasing by about 9 % per twelvemonth ; whilst besides describing a lessening in the figure of deceases associated with sepsis from about 45 % to 37.7 % . ( 5, 7, 9 ) Whilst many surveies report the figure of admittances, few report the age distribution of patients showing with sepsis. Sundararajan et. Al. high spot that the age distribution within their survey was bimodal which identified that the age brackets at the extremes of the spectrum were over represented ; with kids less than 1 and grownups in the 70-79 age bracket. ( 3 ) Upon farther probe into the types of causative pathology doing sepsis in these patients ; gram positive beings account for 28 % , gram negative for 20 % , fungous infections 2 % and other beings for 49 % . ( 3 ) These figures are comparable with a survey conducted by MacArthur et. Al. of about 2634 patients with about 30 % identified as gm positive and 26 % gram negative bacteriums. ( 10 )Pathophysiology and clinical characteristicsWhat is Sepsis?Sepsis is an infection induced syndrome and the clinical visual aspect in nature is the effects of cellular interactions between the host and invading pathogen. ( 2, 11-12 ) Sepsis may be initialised by drawn-out local redness to extinguish and unclutter the invading pathogen. The 2nd line of defense mechanism against occupying pathogens involves the production and activation of leucocytes at the local site of infection. ( 13-14 ) Throughout this stage, immune cells identify the pathogen through pattern acknowledgme nt protein receptors on the cells. ( 15 ) An illustration of one of these receptors are toll like receptors and these are among the acknowledgment receptors which have the ability to trip immune cells, bring oning the production of proinflammatory cytokines and chemokines by the stimulation with bacteriums and viral proteins ( depending on the infection ) . ( 15-16 ) The occupying pathogen may originate the complement tract of the immune system, leting leucocytes to phagocytose [ digest ] the pathogen. If the host fails to restrict the invading pathogen to a local country, the pathogen may occupy the blood stream. ( 16 ) If phagocytosis continues in the blood watercourse, toxic substances released by the pathogen may leak straight into the blood stream ; these include endotoxins released by gram negative bacteriums ( 17 ) and lipoteichoic acid and peptidoglycan released by gram positive bacteriums. ( 18 ) These byproducts of phagocytosis and decease of the cell may trip a systemic a ctivation of the complement system and excite the production of inflammatory cytokines. ( 19 ) Subsequently taking to an increased excessive and prolonged inflammatory response. ( 20 ) The consequence of this drawn-out response leads to Systemic Inflammatory Response Syndrome ( SIRS ) which is the consequence of either direct or indirectly through the production and activation of azotic oxide, oxidizers and proteolytic enzymes which is known to hold the possible to take to inflammation induced organ hurt. An illustration of this would be Acute Respiratory Distress Syndrome. ( 16, 20 ) SIRS is characterised by two or more of the undermentioned: organic structure temperature & gt ; 38A °C or & lt ; 36A °C, bosom rate & gt ; 90 beats per minute, respiratory rate & gt ; 20 per minute or arterial CO2 & gt ; 32mmhg or a demand for unreal airing, and white blood count greater than 12,000/mm3 or & lt ; 4000mm3 or & gt ; 10 % immature signifiers. ( 21 ) Sir can be besides initiated non m erely by infection, it may besides develop as a consequence of injury, ischaemic hurt or unfertile redness. ( 22 )What is terrible sepsis?If SIRS is left untreated, this response so cascades into what is known as terrible sepsis. Severe sepsis is defined as ‘sepsis associated with organ disfunction, hypoperfusion or hypotension responsive to fluid resuscitation ‘ . ( 23 ) This can come on to infected daze, which involves ‘persistent hypotension unresponsive to fluid disposal ‘ . ( 23 ) An illustration of terrible sepsis is called Multiple Organ Dysfunction Syndrome ( MODS ) . This occurs when the infection of the blood stream leads to progressive failure of two or more organ systems which result from a drawn-out and uncontrolled inflammatory response. This organ disfunction can take to possible organ failure and decease. ( 19 )Analyse grounds associating to the prehospital direction of sepsis to place hazards and benefits of paramedic-initiated antibiotic the rapy ;Sibley and Sibley ( 23 ) suggest that if Emergency Medical Services ( EMS ) or Paramedics have a patient enduring from suspected sepsis, that they must be managed with O therapy, good documented critical marks and IV entree to originate unstable resuscitation. ( 24 ) The end for EMS is to keep systolic blood force per unit area merely above 90mm Hg, with a Mean arterial force per unit area of 65mm Hg as any higher has the possible to decline cardiac end product, with inauspicious reactions. ( 24-26 ) Other surveies support the impression of keeping Mean arterial force per unit area at 65mm Hg as there is no clinical benefit to increasing this value higher. ( 27-28 ) Sibley and Sibley ( 23 ) contradict many other surveies which suggest that early empiric antibiotic intervention of patients suspected of holding sepsis is a standard pattern ; and the earlier intervention is initiated, the more positive the result. ( 2, 6, 8, 10, 16, 25, 29-30 ) Empirical antibiotic intervention is the usage of a wide spectrum antibiotic whilst curative intervention with antibiotics is the induction of antibiotic intervention after blood civilizations are taken and the specific pathogen is identified. ( 31 ) Whilst empirical antibiotic intervention in the direction of sepsis may be the initial drug of pick, it is in the patient ‘s best involvement that appropriate antibiotic therapy is continued within the infirmary. Appropriate antibiotic therapy is defined as â€Å" the usage of an antimicrobic agent that is right on the footing of all available clinical, pharmacological and microbiological grounds. † ( 32 ) With regard to the pre-hospital disposal of antibiotic therapy, a recent survey concluded that, if a patient is enduring infected daze, with each hr of hold in antibiotic disposal after the oncoming of hypotension was associated with an mean lessening in endurance of about 8 % . ( 33 ) However, a possible job with empirica l antibiotic intervention is that because sepsis is non the consequence of a individual pathogen, the usage of empirical antibiotics may non cover the pathogen doing the disease or unwellness. Broad spectrum antibiotics may ‘bide clip ‘ until blood civilizations and appropriate testing can be done within a infirmary scene. The current research suggests that the antibiotic choice used to handle conditions such as sepsis has a profound impact on patient results ( 34 ) and this is besides the instance with unequal antibiotic therapy, where the invading pathogen is non being efficaciously treated. ( 31 ) With respect to the empirical intervention, there are many different signifiers of pathogens that can do sepsis, including Staphylococcus aures, Streptococcus pneumoniae, Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. ( 10 ) With this in head, the aforesaid figures that approximately 28 % of infected patients are caused by a gm discoloration positive, and 20 % of patients are gram discoloration negative, and the remainder being about 52 % ( 3, 10 ) , the impression is that wide spectrum antibiotics may non cover these specific pathogens, hence rendering intervention useless. Potentially this could take to a negative or inauspicious result. An International Initiative, the ‘Surviving Sepsis Campaign ‘ ( 30, 35 ) and the Critical Care Community in the United Kingdom ( 6 ) ab initio concentrated on educating exigency section staff to advance the debut of direction of sepsis known as ‘Early Goal Directed Therapy ‘ . Upon reappraisal, hapless execution of this enterprise and resuscitation lead the instruction staff involved to a move to aim the staff working in countries outside of the exigency section, including the execution of an operationalised resuscitation direction program referred to as the ‘Sepsis Six ‘ . The ‘Sepsis Six ‘ involves the disposal of high flow O, blood civilizations, IV antibiotics, fluid resuscitation, step serum lactate and hemoglobin and the interpolation of a urinary catheter to mensurate urine end product. The ‘Sepsis Six ‘ can be implemented by hospital staff with different accomplishment sets in the first hr following the diagnosing of sepsis and can do a important part to diminishing mortality. ( 6 ) With regard to the principle of the ‘Sepsis Six ‘ Robson et. Al. proposes that constituents of this intervention can be initiated pre infirmary, and interestingly, the writers besides highlight that pre infirmary sepsis attention is unusual, but pre infirmary cardiac attention is common. The inquiry remains as to why that is. Given that all the literature available suggests that there is a important lessening in morbidity and mortality associated with early antibiotic intervention. Within Ambulance Victoria, the current direction for the intervention of terrible sepsis has non been established. Merely a guideline is specifically written for meningococcal blood poisoning which allows paramedics to administrate Ceftriaxone in the pre infirmary field in the suspected instance of meningococcal blood poisoning. ( 36 ) Walker ( 37 ) proposes that in the twelvemonth 2003, meningococcal disease affected about 500 Australians with about 100 of these instances showing in Victoria. It would look logical that an appropriate guideline is established for sepsis and terrible sepsis based on the available informations from Sundararajan et. Al. ( 3 ) which suggest within a 4 twelvemonth clip frame, about 34,000 admittances to hospital were identified as enduring from sepsis. However, it must be recognised that this lone histories for 1.1 % of the entire figure of admittances to Victorian exigency sections. ( 3 ) This is well more hospital admittances when compared with meningoc occal blood poisoning, with similar, if non more deathly effects. Possibly the idea of utilising empirical antibiotic therapy doing a ‘super bug ‘ with sepsis is debateable. Whilst many surveies report that Methicillin-resistant Staphylococcus aures is developed within the infirmary system ( 38 ) instead than the community based scene ; this attitude is altering with larger Numberss of community acquired Methicillin-resistant Staphylococcus aures being reported, ( 39 ) with an estimated 50 % of the population being a bearer of the bacteriums. ( 40 ) The concern of physicians and other wellness professionals to the idea of originating intervention with an empirical antibiotic may be a consequence of old traffics with Methicillin-resistant Staphylococcus aures. Methicillin-resistant Staphylococcus aures has evolved and mutated to be come ‘resistant ‘ over coevalss with different strains of antibiotic that were ab initio effectual at extinguishing the bacterial pathogen. ( 41 ) The idea that exposing such a wide spectrum antibi otic ; for illustration Rocephin, ( a Mefoxin antibiotic ) is that the exposure of a drug like this may potentially originate a familial mutant in potentially a broad spread of different strains of pathogens. Many surveies have investigated the usage of empirical antibiotics and besides the possibility of non merely one pathogen doing disease, hence developing an appropriate antibiotic government. This makes logical sense nevertheless, with consideration to the possible to do a familial mutant, exposing a pathogen to several antibiotics may hold the possible to bring forth a immune strain to non merely one antibiotic, but several. The surprising intelligence is that these surveies have proven to hold small or no excess consequence in cut downing mortality. ( 42-43 ) Walker ( 37 ) proposes that the disposal of pre infirmary antibiotics by paramedics does hold the potency for complications, including inauspicious reactions such as anaphylaxis and vasomotor prostration. However, the hazard of antibiotic disposal is no different to the disposal of any other drug, with possible side effects and inauspicious reactions specific to single patients.Synthesise recommendations for paramedic direction of sepsis based on available grounds.Pre infirmary informations available on the intervention and direction of infected patients are scarce. It is apparent that more research needs to be undertaken in order to right place infected patients and originate early intervention. However the inquiry remains as to whether informations will of all time be available due to the possible inauspicious reactions and the ethical quandary environing the prospective withholding of intervention to patients. The information that is available suggest that paramedics can do a diff erence in the possible results of these patients. A mortality rate of stopping point to 40 % is unacceptable. It is proposed that paramedics undertake a similar theoretical account to the ‘Sepsis Six ‘ with an available pre infirmary testing tool ; similar to what the United Kingdom propose. This involves the designation of systemic engagement of the immune system by using the categorization for SIRS ; whilst utilizing this in concurrence with history of a new infection. Taking both of these into consideration, relentless hypotension, low O impregnation and deficiency of urine end product classifies pre hospital patients as enduring from terrible sepsis. ( 6 ) Paramedics are an built-in portion of the wellness attention squad and within the United States they are being overlooked and possible accomplishments are being disregarded and this is still non understood when the literature suggest that early intervention does do a difference in results. With respect to the early disposal of antibiotics, non all patients will name at the oncoming of symptoms. Many will wait until the status is intolerable or they feel like they are deteriorating, therefore it is of import that empirical antibiotic therapy is undertaken at the earliest chance. From the available literature ; the United Kingdom ‘s theoretical account is the gilded criterion in footings of pre infirmary showing and direction of sepsis. Paramedics are extremely trained wellness professionals and are able to pull off infected patients consequently, and as antecedently mentioned, the sepsis six involves high flow O, blood civilizations, IV antibiotics, fluid resuscitation, measured serum lactate and hemoglobin and urinary catheter and step urine end product. This paper does non suggest that paramedics undertake all of the intervention outlined, but alternatively have the ability to originate O therapy, deliver endovenous fluid and antibiotics ; and potentially have the ability to take blood civilizations to manus over to the infirmary. However, it must be emphasised that excess on scene clip to finish these appraisals and intervention must be taken into consideration every bit good as how long till the nearest infirmary. Besides of import to observe that paramedics must advise a receiving infirmary so that the infirmary can suitably triage ( 44 ) and use the pre infirmary pickings of blood in the beginning of faster intervention and supply the ability to originate an appropriate antibiotic government. Possibly a reappraisal of the current guideline in Victoria is needed to widen the range of paramedic pattern to test for possible infected patients, as the literature suggest that this current proportion of patients are exponentionally increasing. However ; it may be easy to theorize alterations that need to be made to the system, and this will take clip and money. Walker ( 37 ) proposes from a direction position there are important costs associated with the antibiotics, preparation and appraisal and on-going replacing of antibiotics on all vehicles. Therefore it is imperative to go on research and hence implement a new guideline into ambulance pattern ; which will profit the wellness of all invested parties. The early acknowledgment and direction of sepsis has deductions on possible patient result. Sepsis has an highly high mortality associated with it and as mentioned antecedently the Oklahoman antibiotics can be administered ; the rapid lessening in patient morbidity and mortality. With regard to the high Numberss of presentations to Victorian exigency sections and intensive attention admittances ; this is mirrored throughout the universe. One of the of import points to understand that the admittances to intensive attention can be avoided if sepsis is recognised earlier and paramedics may hold a important impact on the acknowledgment and disposal of antibiotics, as infected patients have the possible to be really unwell. The fiscal load on the wellness system is tremendous with one survey theorizing that the United States approximate spend on sepsis entirely to be 16 billion dollars. ( 2, 7 ) Data is unavailable from Victoria and Australia ; nevertheless the costs associated with suppl ying antibiotics for the direction of sepsis will be less than handling in an Intensive Care Unit.DecisionOne of the chief repeating subjects throughout this paper is that sepsis and terrible sepsis have a high association with morbidity and mortality, even though the figure of presentations have increased. The point needs to be emphasised that current direction is non good plenty. The research within infirmaries is apparent, that early antibiotic intervention of patients enduring from sepsis has profound effects on endurance and recovery. Paramedics are potentially the first line of wellness attention workers exposed to patients enduring terrible sepsis and have the ability to move with wide spectrum antibiotics. Within Victoria, ambulances already carry Ceftriaxone ; an illustration of a wide spectrum antibiotic. A guideline particular to sepsis demands to be developed and implemented in the pre infirmary field, potentially on the footing of the United Kingdom ‘s theoretical account of recognizing terrible sepsis. The cost benefit analysis of implementing a new guideline, with the possible disposal of antibiotics to more patients would badly outweigh the costs associated with an admittance to an intensive attention installation. The impression of taking pre infirmary blood and advising a receiving infirmary of the possible infected patient may originate appropriate intervention faster. Paramedics have the ability to do a difference with this clip critical patient.

Use Magazine Vendor Websites to Find New Paying Markets

Use Magazine Vendor Websites to Find New Paying Markets We have all been there. We have poured over websites for writers, submission directories like Writers Market and WritersWeekly.com to find that next freelance opportunity. There are many magazines to write for, both online and off, especially now that the internet has blossomed and bloomed. The trouble comes in when writers try to find actual paying work. There’s a little-known source that many writers overlook: Magazine vendors. These are firms that sell magazines (usually at a discount) to the public. Most of them have large, detailed websites listing thousands of magazines, many of which you didn’t even know existed. And, most popular magazines pay writers respectable rates. The process is simple. Find a magazine on one of the vendor sites, use Google or another search engine to find the magazine’s website, and then find the masthead so you’ll know where, and to whom, to send your query. You’ll find writer’s guidelines posted on some of the websites as well. Some magazine sites list editorial email addresses, while others have forms you can use to submit to them online. For sites that have email addresses, you might want to create a spreadsheet, categorized Usually, the magazines that are in the best-seller category pay the highest. Here are three magazine vendors you can use to find new paying markets for your writing: Magazine Agent magazine-agent.com Magazine Agent has magazines listed Amazon Kindle Magazines https://www.amazon.com/Magazines-Journals-Kindle/b?ie=UTF8node=241646011 Amazon’s Kindle has boosted not only book buying, but magazine buying as well (electronic editions, of course). The magazine categories are in a linked list in the left-hand column. The information for each publication has the price, the publisher, and reviews. Naturally, the best place to find the highest paying magazines is in the best-sellers section, which is in a box on the right-hand side of the page. Find magazines you want to approach, find their websites, and then find the masthead. Magazines.com https://www.magazines.com This is similar to the sites above, and also has a link to their best-sellers at the top of the page. There you have it! A roundabout, yet solid way to find magazines that actually pay their writers. For some magazines, the hardest part will be locating the email addresses of the magazine editors but, with a bit of help from Google (or your favorite search engine) and a lot of patience you can have a large list of editors to query in the future.

Free Essays on Battle of Chancellorsville

The Battle of Chancellorsville took place from May 1, 1863 to May 4, 1863 after the Battle of Fredericksburg and is said to be one of General Robert E. Lee’s greatest accomplishments during the Civil War. General Lee wanted to take the to fight to the enemy’s territory in Pennsylvania, to break up and capture the coalfields, and to cut off the fuel supplies for the manufacturing establishments, railways, and steamships. At the beginning of 1863 he directed the topographical engineers to prepare a detailed map from the Potomac River to the Susquehanna River. This map ended up being used at the Battle of Gettysburg. After the battle of Fredericksburg and the failure of the Mud Campaign the Union army was demoralized. Desertions were frequent and insubordination was common practice throughout the ranks. To rectify this problem President Lincoln appointed Major General J. Hooker to replace Major General Burnside as the Commander of Union Army in the Potomac. He restored forces to about 134,000 soldiers. General Hooker wanted to start a campaign to take the fight to General Lee and start the campaign towards the end of April. General Hooker sent Major General Sedgwick across the Rappahannock River with three battalions, just below Fredericksburg. General Hooker with the Fourth Corps would march up north of the Rappahannock River concealed by the forest, and cross the river Germanna and Ely Fords near Chancellorsville. Then they marched on the road leading to Fredericksburg. General Hooker was hoping to come across General Lee’s rear flank and force him to retreat towards Richmond. Hooker was then planning on giving chase to the Confederate Army. On April 13, 1863, General Hooker started executing his plan by sending an advance cavalry lead by General Stoneman with 10,000 troops to cross the Rappahannock River at Kelly’s Ford. To attack his supply base and railroad deep behind Confederate Army lines at Gordonsvill... Free Essays on Battle of Chancellorsville Free Essays on Battle of Chancellorsville The Battle of Chancellorsville took place from May 1, 1863 to May 4, 1863 after the Battle of Fredericksburg and is said to be one of General Robert E. Lee’s greatest accomplishments during the Civil War. General Lee wanted to take the to fight to the enemy’s territory in Pennsylvania, to break up and capture the coalfields, and to cut off the fuel supplies for the manufacturing establishments, railways, and steamships. At the beginning of 1863 he directed the topographical engineers to prepare a detailed map from the Potomac River to the Susquehanna River. This map ended up being used at the Battle of Gettysburg. After the battle of Fredericksburg and the failure of the Mud Campaign the Union army was demoralized. Desertions were frequent and insubordination was common practice throughout the ranks. To rectify this problem President Lincoln appointed Major General J. Hooker to replace Major General Burnside as the Commander of Union Army in the Potomac. He restored forces to about 134,000 soldiers. General Hooker wanted to start a campaign to take the fight to General Lee and start the campaign towards the end of April. General Hooker sent Major General Sedgwick across the Rappahannock River with three battalions, just below Fredericksburg. General Hooker with the Fourth Corps would march up north of the Rappahannock River concealed by the forest, and cross the river Germanna and Ely Fords near Chancellorsville. Then they marched on the road leading to Fredericksburg. General Hooker was hoping to come across General Lee’s rear flank and force him to retreat towards Richmond. Hooker was then planning on giving chase to the Confederate Army. On April 13, 1863, General Hooker started executing his plan by sending an advance cavalry lead by General Stoneman with 10,000 troops to cross the Rappahannock River at Kelly’s Ford. To attack his supply base and railroad deep behind Confederate Army lines at Gordonsvill...

4 pieces of career advice no one will give you

4 pieces of career advice no one will give you You’ve heard all the classics before (including from us!): never stop revamping your resume. Practice your body language. Keep your network evergreen, because you never know when you’ll need it. These are all important and useful tips for anyone’s career, no matter what the industry. But if you’re just starting out, there are some more†¦off-the-record things that everyone learns the hard way, but people don’t really talk about. Let’s look at some of the things that happen to most of us, but aren’t necessarily in the career guides. 1. You’re going to fail (sometimes)That sounds super harsh and pessimistic, right? But it’s also true. You’re not gonna fail all the time, or most of the time- don’t worry. But sometimes, things will go badly, and you will run into the big â€Å"F.† It happens to all of us- the straight-A overachievers, the guy who doesn’t care, the seasoned professional. Sometim es things just aren’t going to go well. And while it can be upsetting, especially if it leads to negative feedback or professional consequences, you have to be able to absorb it, take what lessons you can, and move on. And when it happens, remember that you’re not alone, and that some of the most important lessons come from falling on your face once in a while.2. Set work-life boundaries earlyAt the start of any new job or career path, you want to set a great first impression. The one who starts early (or is impeccably on time every day), stays late, deftly responds to an after-hours email. Here’s the problem with that approach: it can turn into the status quo very quickly, as people start to expect that your hard-charging ways are just the way you operate and what they can expect from you. This is not to say you should slack off, or try to set expectations low. Rather, make sure you’re staking out personal boundaries and that you have personal outlets th at balance out the job. If you don’t have a workout routine, or de-stressing activity, or something that keeps you happy and fulfilled outside of work, that’s a fast-track to burnout.3. Don’t take everything so seriouslyYes, your career is important. Yes, you should be a strong advocate for yourself and not take crap from anyone. But if you’ve got your Game Face on all the time at work, you run the risk of alienating coworkers, bosses, anyone on the receiving end of your â€Å"don’t mess with me† vibe. Being flexible (and willing to take a step back and chill out) when necessary will help you keep a kind of equilibrium at work.4. It’s okay to have imposter syndromeYou’ve probably heard about â€Å"imposter syndrome,† where people feel like they’re inadequate at their jobs and that everyone else is on the cusp of figuring out that they don’t belong there. Turns out, a little insecurity can go a long way towa rd helping your career. If you feel an overwhelming sense of inferiority, that could mean that you need more training or guidance. But if you feel more like you could take that feeling and direct it into professional development, or working more efficiently, then it can be a boon to your career.No matter who you are, no matter what job you do, the most important career advice of all is â€Å"don’t worry.† As long as you’re working hard to improve yourself at every step of your career, you don’t always have to worry about whether you’re following the proper advice- it just has to be proper for you and your goals.

Head Start Program Introduction Essay Example | Topics and Well Written Essays - 500 words

Head Start Program Introduction - Essay Example Once approved the organizations will receive funding for 5 years to plan and conduct Early Head Start for children from birth till three years old focusing on developing a strong parental bond, empowering parents and developing building blocks for early learning success and Head Start programs focusing on reading and math skills for children 5 years and younger. Head Start Programs are regulated and their performances reviewed annually by the US Department of Health and Human Services/ Administration for Children and Families to ensure that the organizations are performing to the outlined standards. In addition, Head Start does more than just provide a platform for our children’s didactic learning success. Head Start also funds research for building strong healthy families and marriages. Children being raised in a single parent home does not condemn a child to academic failure, however studies show studies that children of divorce experience more behavioral problems, earned lower grades (Cherlin, 1981) and twice as likely to not graduate from high school than their peers who benefit from living with parents who did not divorce. (Zill, 1993) With marriages of the children of divorced parents at a much higher rate of divorce than the marriages of children from intact families, the cycle of potential low academic success and the poverty often associated with individuals not graduating from high school will likely continue. Nevertheless, the effectiveness of the program is quite controversial. Will studies do show that participants are happy and well, there is no significant evidence showing that they are any better off than regular public school students (Klein 2011). Economic issues also plague the program. The national deficit, already crowed schools, and inefficient schooling sites limit the program’s effectiveness. For example, the state

Learning Points Assignment Example | Topics and Well Written Essays - 750 words

Learning Points - Assignment Example This collectively places the medical practitioner in the best position to note the possible kinds of infections, there causes, and how best to handle it or them. The main purpose for a diagnosis- according to Neal-Boylan (2011) the primary intention for effective diagnosis and treatment of any illness inclusive of the cardio-infections is to decrease the risk factors, which play a part in the progression of the cardiovascular disease as well as heart failure. For this case, the diagnosis is important because it helps the medical professionals and the patients reduce the fear for the reoccurrence of angina, control of diabetes, reduction of blood pressure, and engagement in physical activities among them weight loss. Need for conservation treatment- as per the document by Deming & Riddick-Grisham (2011), conservation treatment is one among the best strategies of disease infection. It includes undertaking all the precautionary medical measures on the verge to ensure a comprehensive treatment of an infection, for this case, angina. Some of the pivotal schemes of conservation treatment for this case include checking of blood sugar four times a day, taking all the medications as prescribed by specialists, and seeking for immediate medical attention in case any reactions occur. Other additional conservation treatment for this case are keeping records of blood sugar, body weight, and blood pressure and presenting them to the concerned practitioners in the consecutive visits of the medical facility. With reference to Bailey & Trybulski (2012), there are a number of prominent features of patient education for clinical case including what they need to avoid and what they ought to embrace in attempts to speed up the healing or treatment process. Some of the main features of patient education for this case include: Embrace the appropriate eating habits, that is as per the

Certain groups in society are more crime prone than others. Critically Essay

Certain groups in society are more crime prone than others. Critically discuss how social inequality might contribute to crime amongst these populations - Essay Example Social inequality should obviously contribute to the crime ranking. However, it is important to understand in what way it affects the society and groups. There exist two major approaches to the reasons making people commit a crime. Both of them are based on the concept of human nature. We all are supposed to be born with ‘inherent potentials and abilities’ that ‘interact with environmental influences to produce behaviour, some of which is considered criminal’ (Wiebe 2004). Why do some people violate the norms and laws of the society? What is more responsible for the anti-social behaviour – external, objective circumstances or our in-born inclinations? The XIX-XX centuries are notable for paying extreme attention to environment as the major shaper of an individual’s behaviour, sometimes even ignoring predispositions. These views must have spread due to socialists’ ideology. Radical environmentalism treats human nature as one consisting of "vague and consequently plastic predispositions" that constitute "the indeterminate material that the social factor melds and forms" (Durkheim, 1895/1962, pp. 105-106, In Wiebe 2004). Another radical wing of scientists keeps to the theories based on classical view of human nature, concepts developed by Hobbes and his contemporaries. The human is seen as a creature seeking ‘immediate gratification of selfish desires’ ready to ‘commit crimes in pursuit of this gratification’, which occurs ‘at the expense of the legitimate rights of others, undermining group interests’. In order to defend its interests the group may either teach its members self-control or simply limit opportunities to satisfy impulses (In Wiebe 2004). Besides, these two theories, there exist a variety of others. Strain theory teaches that people commit crime when they are blocked from their legitimate opportunities to attain the desirable goals, which are determined by the dominant culture.

Homework25 Coursework Example | Topics and Well Written Essays - 250 words

Homework25 - Coursework Example The German aggression threatened every nation in Europe such as France, but the British vowed not to let German undermine its sovereignty (Roark 6). In its annexation, German invaded Poland and America feared that if British were left alone to fight against German, it might suffer so much because it did not have enough resources to go to war. Therefore, the U.S reversed its neutrality policy and allowed its allies to buy supplies and ammunition to fight off German aggression. The war had dire consequences for women and family. The husband left their families to the battle ground thus making their families vulnerable of the challenges in the society, to struggle for food, shelter and education. Moreover, it is the American citizen who bore the greatest burden because resources that were diverted to the war were meant to help in the development of the domestic economy. In addition, the attack by Japan on Pearl Harbour made mothers lost their husbands and sons who were the bread winner of their

The US Liberal Criminological Tradition Critical Analysis Essay

The US Liberal Criminological Tradition Critical Analysis - Essay Example There are clear statistics that show that some ethnic minorities are more likely to be associated with crime and the punitive system within both the US1 and the UK2. There is further evidence that this may be a result of ethnic discrimination and social stratification3, leading some scholars and supporters of liberal criminology to suggest that there is racial bias within the criminal justice system. There are those that go further and suggest that the punitive system does not represent what could be seen as a ‘true definition of criminality’ but rather a skewed view based on these ethnic and economic differences that evidence themselves in the statistics. This liberal criminology has become somewhat of a tradition, particularly in the US4, meaning that it has influences on criminological research in the UK and further afield. Whilst the aim to find a definition of true crime free from the effects of social and political order is perhaps noble, it can be difficult for sc holars to move away from the shadow that the US liberal criminological tradition has cast. ... This will provide insight into crime politics and how criminological traditions and research find themselves part of the legal landscape, and the effects that this type of background can have on contemporary research and attitudes within the field. The US Liberal Criminological Tradition To fully understand the nature of the question, it is perhaps prudent to examine the US liberal criminological tradition in more detail. Liberal criminology can be said to be the ‘perennial search for a measure of actual or real criminality’5. This search is deemed necessary partly because of the thought that crime figures (and the resultant research) often fails to account for crimes that have gone unreported or criminals that have not been prosecuted or otherwise recorded by the punitive system6. Liberal criminologists often go so far as to suggest that this way of analysing crime means that it is not true scientific research as it does not represent the scientific method7. The purpose of finding this true definition of criminality is to reduce the effects of political and socioeconomic factors on the justice system8. It has also been suggested that liberal criminologists ‘tend to share the hope that once real crime has been isolated and measured, its causes can be identified and solutions devised’9. Evidently, it is incredibly difficult to separate a justice system which relies on human judgement from political and socioeconomic factors present within the culture. Liberal criminology acknowledges this factor, but insists that much of the data provided on crime and criminals is false; ‘they reflect the bias inherent in an economically, ethnically, and racially stratified society’10. The argument here is perhaps

Homework25 Coursework Example | Topics and Well Written Essays - 250 words

Homework25 - Coursework Example The German aggression threatened every nation in Europe such as France, but the British vowed not to let German undermine its sovereignty (Roark 6). In its annexation, German invaded Poland and America feared that if British were left alone to fight against German, it might suffer so much because it did not have enough resources to go to war. Therefore, the U.S reversed its neutrality policy and allowed its allies to buy supplies and ammunition to fight off German aggression. The war had dire consequences for women and family. The husband left their families to the battle ground thus making their families vulnerable of the challenges in the society, to struggle for food, shelter and education. Moreover, it is the American citizen who bore the greatest burden because resources that were diverted to the war were meant to help in the development of the domestic economy. In addition, the attack by Japan on Pearl Harbour made mothers lost their husbands and sons who were the bread winner of their

Working with and leading people Essay Example | Topics and Well Written Essays - 1500 words - 2

Working with and leading people - Essay Example His recruits learnt to support each other during difficult times; it was a lesson on showing concern for one’s teammate. This is a depiction of the principle stage of Tuckman’s Teamwork Theory which discusses the formulation of the team. This is a stage where each individual is trying to find his/her role in the team, they are sizing each other up and there are cases of doubt to one’s purpose (Tuckman Bruce, 1965) Oliver tasked the recruits with challenging assignments like working night shifts at the bakery. Knowing the difficulty level of his challenge, he appeared for some of the shifts and he worked alongside his recruits. At the end of the training they were expected to work together as a team in a commercial kitchen, they therefore had to develop a sense of devotion towards each other. To foster this devotion, Oliver took his recruits for camping activities and later on he tested them by taking them through a simulation test. They were tasked with the duty of preparing meals for fifty clients. The purpose of the simulation was to see how they worked under pressure. This was in line with Tuckman’s second stage theory which is the Storming. At this level they have started seeing themselves as a team however, this stage is characterized by confrontations and various levels of conflict. This is expected due to the pressure put on them by Oliver. As per the expectations, some of them crumbled when the scene got chaotic. This was however, part of the team building process. At the end of the training, the recruits were assured of a job working for Oliver. They therefore had an end in mind. This sense of purpose according to Dr. Belbin, M. 2014 is the motivator for teamwork. Oliver demonstrated participative leadership when he engaged with his recruits in their daily tasks, when he helped them solve problems that occurred at the ground level. His hands on approach was in line with the Participative Leadership Theory which

Catcher in the Rye Essay Example for Free

Catcher in the Rye Essay The story takes place in Manhattan and is about a young boy named Holden Caulfield, it is about the learning experience that takes place and how an immature child tried to come to terms with multiple problems. In J. D. Salinger’s bildungsroman, Catcher in the Rye, Salinger utilizes the symbols, the red hunting hat; Allie’s catching mitt, and the ducks in central park to portray the theme that it is impossible to preserve natural innocence. Salinger utilizes the symbol of the red hunting hat to portray Holden’s loss of innocence and travel into adulthood. Firstly, when Holden is first mentioning the hat, â€Å"It only cost me a buck. I wore it, I swung the old peak way round to the back-very corny, I’ll admit but I liked it that way. † (17) Holden is talking about how he bought the hat and just wears it to express his own personality and recognizes that he likes to wear it in different ways. When he is explaining why he purchased the hat, he is trying to make people understand, he is constantly looking for acceptance from his peers and others, yet at the same time he tries to push people away by wearing the hat. This helps show that Holden is on his path to trying to figure out how he can stop the inevitable loss of innocence. Secondly, while walking down the street in the cold Manhattan weather, â€Å"My ears were nice and warm, though. That hat I bought had earlaps in it. And I put them on-I didn’t give a damn how I looked. Nobody was around anyway. † (53) As Holden is walking down the street, all he cares about is what he is feeling at that moment, just trying to stay warm and comfortable not caring about what others think. One can infer here that Holden doesn’t care too much about what others think, while this could be a facade to what he really feels inside, he tries to portray himself not caring about what others think and just wants to be happy. This continues to portray his path down the loss of innocence because as he starts to realize other people’s thoughts matter, he understands that he must give a little for the acceptance of others. Finally, towards the end of the novel when Holden angers Phoebe, â€Å"She wouldn’t answer me. All she did was, she took off my red hunting hat-the one I gave her- and practically chucked it right in my face. Then she turned her back on me again. It nearly killed me. † (207) Phoebe is angered by Holden’s immaturity and his lack of caring for others and crushes Holden’s last spirits toward innocence. With ties to the last person in the world crumbling, Holden begins to finally question his stance on life and must decide whether or not he is going to try and salvage the last relationship or completely isolate himself. Holden realizes that by his sisters actions and her disregard of the hunting hat, that he must grow up and this starts a chain reaction within him that could be a cause of his breakdown but it is unknown, Holden finally comes to terms with this loss of innocence and realizes that there is nothing that he can do to stop it. Allie’s catching mitt is also used in the portrayal of the loss of innocence in Holden and the characters around him. We are first shown the mitt when Holden is doing the composition on the catchers Mitt, â€Å" He had poems written all over the fingers and the pocket and everywhere†¦he wrote them on it so that he’d have something to read when he was in the field and nobody was up to bat. He’s dead now. † (39) This is the first time the reader sees Holden tear up and let some of his emotions get the best of him, he is talking of his dead brother Allie who meant a lot to him. One can infer that this was one of the more important relationships that Holden had and the loss of this relationship causes Holden to feel a series of symptoms and change the way he interacts with people. With the death of his brother Allie, Holden experiences for the first time, the lost of a loved one, one of the few people that he makes attachments with and this causes him to try and preserve the innocence within other children and even adults that he meets on his journey. The next time we see the glove, Holden is recollecting his past memories of Jane, â€Å"She was the only one, outside my family, that I ever showed Allie’s baseball mitt too, with all the poems written on it. † (77) Jane was another person who Holden allowed himself to get close to; he shows this by showing Jane his brother’s mitt. Holden is trying to get Jane close to him so that he can have someone in his life that is pure and cares about him, by showing her the mitt; he is revealing a part of him that no one outside of his family knows about. He sees the innocence in Jane and wants to try and preserve it; he wants to get close to Jane to keep her out of the adult world and not allow her to be corrupted by the world around her. The final time the glove is mentioned, Holden is having a flashback on when D. B. ants to prove a point, â€Å"â€Å"He made Allie go get his baseball mitt and then asked him who was the best war poet, Rupert Brooke or Emily Dickenson. Allie said Emily Dickenson† (140) This is one of the only times we see Allie alive and the whole family, besides Phoebe, together. Allie’s innocence is portrayed through the glove, when D. B. asks him which WWII author was better, one that was in the war or one that never saw a day in the war, Allie answers with the latter. This can be int erpreted as Allie seeing how the other author was not corrupted in the war and her work was more pure.

Complications of Exodontia

Complications of Exodontia Introduction: Patients visit the dental clinic for a routine or planned visit for treatment, conditions related to the oral cavity or due to pain. Even with the invention of advanced dental techniques in restoration of teeth, extraction is one of the most routinely carried out dental procedure (El-Kenawy and Ahmed, 2015). Exodontia can be defined as Painless removal of the whole tooth or tooth roots with minimal trauma to the investing tissues, so the wound heals un-eventfully (Datarkar and Datarkar, 2007). Dental extraction procedures require a good understanding of anatomical structures along with adequate armamentarium and good technique. Successful treatment depends on good diagnosis, planning, appropriate surgical technique and well monitored post operative period. Even though it is a straight forward procedure, there is a possibility of complications during various stages of exodontia and the surgeon should be able to cope with it (Louis, 2015). Complications are unforeseen events that tend to increase the morbidity, above what would be expected from a particular operative procedure under normal circumstances (Venkateshwar, et.al, 2011). They are rare and can arise due to a wide variety of factors. This report covers systemic and local complications for: Pre-operative Peri-operative Post-operative Discussion: Pre-operative complication and management Pre-operative Systemic complications: Pre-operative evaluation of the patients in-depth history (medical, dental or social) past and present and physical examination is crucial (Thakur, et.al, 2014). The patient should be asked about their chief complaint and history of present illness describing onset, quality, intensity, duration, location, radiation, exacerbating or relieving factors, medications (prescribed or over the counter) being taken including any allergies and the type of allergic response. A note of patients family history might reveal inherited illnesses such as haemophilia. Patients social support system should also be noted along with habits such as alcohol/drug intake and tobacco use. A ROS should be completed and it might reveal undiagnosed medical conditions. Questionnaires are used for this purpose (Appendix 1). The common medical conditions and their management are discussed below: Cardiorespiratory: Angina, myocardial infarction, hypertension and asthma are most common. Symptoms are crushing chest pain, dyspnoea, oedema and palpitations. Patients will have difficulty in going up more than 20 stairs, also there is cough and wheeze. Minor treatment can be performed in case of stable angina, but elective dental care deferred in unstable or recent angina. The risk of MI in higher within the first 6 months of prior MI and are classified as ASA class IV and high risk procedures deferred. Elective dental care can be normally performed safely in asymptomatic patients with more than 12 months MI. Premedication is administered to patients having BP value between 160-190/95-110 mmHg (oral or inhalation sedation). There is no proof of cardiac risk reducing even in case of delaying surgery in patients who have BP higher than 180/110 mmHg (Andersson et al, 2010). Bleeding disorders: Questions should be asked about bleeding or bruising and family history. (Minimum platelet count for surgery 100,000 per micro litre). 5% tranexamic acid mouth wash given and patient on anticoagulants should have INR Endocrine disorders: Diabetes (Morning appointment 1- 1.5 hrs after breakfast, this avoids hypoglycaemic reaction), hyperthyroidism, hypothyroidism. Epileptic seizures: Type, frequency, precipitating factors. Allergies: Including local anaesthetics, antibiotics, analgesics, dental materials. Use of anticoagulants: INR of 2.0-3.5 is the safe range for performing simple exodontia procedures. The range is reduced to 1.6-1.9 for complicated procedures. Bisphosphonates, Gastrointestinal disorders, Liver disorders and jaundice, Infections- HIV, hepatitis, syphilis or gonorrhoea, Pregnancy, Radiotherapy also need to be monitored as they could lead to complications. In all the above disorders the anxiety control protocol should be followed and pre-operative medications given if required. Physiological examination is also carried out to confirm dental or medical conditions along with the vital signs (Appendix 2). ASA classification for minimum pre-operative requirement is a protocol to be followed (Appendix 3). Pre-operative local complications: Pain: It can be odontogenic or non-odontogenic. Patient should be asked questions as explained in HOPI (2.1.1). It is treated based on WHO classification (AppendixÂÂ   4) Infection: It can be a localised abscess or can spread into spaces (submandibular, sublingual or maxillary) adjoining the tooth causing severe complications as well as affect the use of anaesthetics during surgery. It is treated with the use of antibiotics (Yousuf, et.al, 2016). Peri-operative complications and their management: 2.2.1 Peri-operative Systemic complications: The following are the most commonly encountered conditions in dental practise (0.7 cases per dentist per year, Girdler, 1999).ÂÂ   In the event of an attack, stay calm, stop dental treatment, make the environment safe, make patient sit upright in most cases, monitor vital signs, check for AVPU (Appendix 5) in conscious patient and follow ABCDE (Appendix 6) approach in unconscious patients (Scully,2014). In non-responding patients always call 999 and initiate CPR (Appendix 7). Emergency drugs and equipment list (Resuscitation council UK, 2013; Joshi Acharya, 2016) (Appendix 8). Asthma: Few activations of patients own salbutamol inhaler (100 mcg/actuation) or 10 activations using large volume spacer device, repeated every 10 mins and oxygen (15 litres/min). Anaphylaxis: Give oxygen (15 litres/min), i.m adrenaline (anterolateral aspect of the middle third of vastus lateralis) in a dose 0.5 mL injection of 1:1000, repeated at 5 minute gap after monitoring vital signs. Paediatric dose given (Appendix 9). Angina: 2 GTN sprays (400 mcg/actuation) sublingually, oxygen (15 litres/min). Patient does not recover in 3 minutes treat for MI. MI: Call 999 immediately, sublingual GTN if not already given, single dose aspirin (300mg) orally to be chewed, oxygen (15litres/min). Epileptic seizures: Do not attempt to restrain movement, give oxygen (15litres/min), single dose of 10mg midazolam buccally. Hypoglycaemia: Conscious patient give oral glucose, repeated in 10 minutes. Unconscious patient give glucagon i.m route (1mg adults, 0.5mg children Syncope: The patient should be laid flat immediately and legs elevated, give oxygen (15litres/min). Choking: Allow patient to cough vigorously, remove any visible foreign bodies, give 5 sharp back blows and if there is no dislodgement of the foreign body 5 abdominal thrusts are delivered (Heimlich) (AppendixÂÂ   10). 2.2.2 Peri-operative Local complications: These can be prevented by proper treatment planning, use of good surgical knowledge and technique. Pre-operative X-rays will help the dentist to locate any abnormalities in relation to the tooth and position of anatomical structures. Patient past dental history and blood test reports checked (Appendix 11). The experience of the surgeon plays a very important role in preventing these complications and effectively managing them. Soft tissue injuries: Due to improper manoeuvring or slippage of instruments. Common areas injured are lips, cheeks, palate, floor of mouth, tongue. Management: Good flap reflection and luxation of tooth ensuring proper grip of instrument and soft tissue protection using thumb and forefinger of free hand. Small injuries need no treatment. In extensive injuries bleeding needs to be controlled and wound sutured. Tooth root fracture: Common event due to extensive caries, large restoration and endodontically treated tooth. Root tip fractures are common in posterior multirooted teeth. These are caused due to improper luxation and use of excessive forces using forceps. Management: If root fracture is noted, irrigate socket thoroughly and directly visualise root. If root tip ( Crown fracture or luxation of adjacent tooth: Crown fracture (extensive caries or large restoration) and luxation of adjacent tooth occur when large amount of force is applied to extract a tooth using the adjacent tooth as fulcrum. Management: Avulsed tooth repositioned and stabilised using splints for atleast 3-4 weeks. If there is any pain after this period the tooth needs to be restored with root canal treatment. Haemorrhage: Frequently occurs in most dental surgical procedures. It is mainly due to the trauma to the blood vessels or disorders of blood coagulation. Management: Control bleeding and attempt to find the origin. Haemostasis obtained by Compression, Cellulose (Surgicel), Haemostatic Collagen (CollaPlug, CollaTape), Bone wax, 5% Tranexamic acid mouth wash, sutures and Electrocautery (Bagheri, et.al, 2016). Maxilla: Fracture of maxillary tuberosity: may create problem for denture retension and is because of extraction of the maxillary posterior teeth (bone weakened by maxillary sinus pneumatising into alveolar process), ankylosis of the tooth or decreased resistance of bone and poor technique (Von and Lozanoff,2017). Management: If periosteum is not detached from the fractured segment, the bone is repositioned, tissue approximated, sutured and extraction rescheduled after 2 months. If bone segment completely reflected from tissues, tooth is first extracted, bone smoothened and wound sutured. Antibiotics with broad spectrum are prescribed. Displacement of tooth into maxillary sinus: Occurs when trying to luxate impacted maxillary third molar. Management: Make the patient sit in upright position and take radiograph. If tooth is visible it can be removed by forcing positive pressure through sinus by closing nostril and exhaling. If this fails tooth can be removed by trephination using Caldwell-Luc (Appendix 12) or Lindorf approach (Boucree, et.al, 2015) Oroantral communication: Due to extraction of maxillary posterior teeth. It is confirmed from bubbling of blood from post extraction site when patient tries to breathe out while nostrils are pinched (Valslava test). Management: small sized communication treated by filling alveolus with collagen and suturing using figure of 8 method. If tissues dont approximate, portion of bone is removed to facilitate buccal and palatal tissue approximation. Large communications are treated using pedicle mucoperiosteal flaps. Antibiotics prescribed if tooth was infected along with nasal decongestants. Mandible: Fracture of mandible: associated with extraction of impacted third molars, due to excessive force applied by elevators or forceps, large pathologic lesions. Management: If there is any fracture while extraction, tooth removal needs to be completed to prevent infection of the fracture line. Afterwards, case on case basis jaw segment stabilisation can be achieved by either intermaxillary fixation or rigid internal fixation for a period of upto 6 weeks. Administration of broad spectrum antibiotics is necessary. Dislocation of TMJ: Due to lengthy procedure on patients with TMJ disorders. There is mandibular deviation in the direction of the healthy side in unilateral dislocation, but there is prognathic movement of the mandible in bilateral dislocation. There is also restriction in mandibular movement and patients exhibit open bite. To prevent such problems mandible must be firmly supported in exodontia procedures. Management: Thumbs placed on occlusal surfaces of teeth, the body of the mandible on both sides are supported by the other fingers. Thumbs are used to exert a downward pressure and at the same time the other fingers are used to push the mandible upwards and posteriorly, until condyle moves in its original position. Post-operative complication management: Post operative Local complication: Immediate- haemorrhage (2.2.2 d) Delayed- Haemorrhage (2.2.2 d) Swelling and pain (2.1.2) Alveolar osteitis: Noticed couple of days after extraction due to blood clot disintegration resulting in necrosis in bone surface of the socket (Tong, et.al, 2014). Management: Gentle irrigation of the wound area with saline and application of medicated packing to the area, e.g. eugenol dressings, and aggressive use of oral analgesics (Akinbami and Godspower, 2014). Late- Nerve injury: Inferior alveolar, mental, and lingual nerves. Nerve trauma may cause sensory disturbances (anesthesia, hypesthesia, paresthesia, dysesthesia) resulting in resulting in burning sensation, tingling, biting of tongue and lips, abnormal chewing. Nerve damage can be due to neurapraxia, axonotmesis, and neurotmesis. Management: Usually palliative, painful situations require analgesics; also attempt is made to restore sensation using vitamin B complex. Often, the injured nerve segment needs to be replaced by using graft or suturing has to be performed on severed segments. Trismus: Masticatory muscle spasm causes restriction in mouth opening, normally with third molar extraction. Management: Heat therapy, muscle relaxant medication, administration of analgesics, anti-inflammatory and physiotherapy lasting few minutes every 4 hours. Osteonecrosis: Can be due to MRONJ, 60% of patients had bone necrosis at extraction site. (Mansoor,2015; Heufelder,2014 ). Management: Antibiotics prescribed to control infection. In advanced cases surgical removal of the necrotic bone is advised. Also microbial rinse along with daily irrigation can be done. Exposed bone can also be covered using a removable appliance. Post Operative systemic complications are mainly related to haemolytic and haemorrhagic diseases and can be managed by using methods previously. Conclusion: Exodontia is a simple procedure, practice of which inevitably can lead to complications from time to time. The complications arising due to these procedures can vary from a simple (dry socket) to the more complicated ones like everlasting nerve damage and displacement of tooth into maxillary sinus. There is a saying prevention is better than cure which is always best applied when trying to prevent the occurrence of these complications (Oliver, 2014).ÂÂ   The surgeon should always be sure of patients past and present medical and dental history, make appropriate pre-operative tests and x-rays and formulate a treatment plan that is best for the patient. Abbreviations: ABCDE Airway, breathing, circulation, disability, exposure ASA American Society of Anesthesiologists AVPU Alert, voice, pain, unresponsive CPR Cardiopulmonary resuscitation GTN Glyceryl trinitrate HOPI History of present illness i.m Intramuscular INR International normalised ratio MI Myocardial infarction MRONJ Medication-related osteonecrosis of jaws ROS Review of systems TMJ Temperomandibular joint WHO World health organisation References: Akinbami, B.O. and Godspower, T., 2014. Dry Socket: incidence, clinical features, and predisposing factors. International journal of dentistry, 2014. Bagheri, S.C., Bohluli, B. and Meyer, R.A., 2016. Oral surgery complications. Avoiding and Treating Dental Complications: Best Practices in Dentistry, p.103. Boucree II, T.S. and Garri, J.I., 2015. Dental Extractions. In Ferraros Fundamentals of Maxillofacial Surgery (pp. 429-442). Springer New York. Crispian Scully, 2014, medical problems in dentistry, Elsevier. Datarkar, A.N. and Datarkar, A.N., 2007. Exodontia Practice. Jaypee Brothers Publishers. Fragiskos D. Fragiskos , 2007, oral surgery, Springer. Grandini, S.A., Barros, V.M., Salata, L.A., Rosa, A.L. and Soares, U.N., 1993. Complications in exodontia-Accidental dislodgment to adjacent anatomical areas. Braz Dent J, 3, p.103. Heufelder M, 2014, Principles of oral surgery for prevention of bisphosphonate-related osteonecrosis of the jaw, Oral and Maxillofacial Surgery, Volume 117, Issue 6, June 2014, Pages e429-e435. Joshi, S. and Acharya, S., 2016. Medical Emergencies in Dental Practice-A Nepalese study. Orthodontic Journal of Nepal, 5(2), pp.33-37. Lars Andersson et al, 2010, Oral and maxillofacial surgery, Wiley-Blackwell Louis, P.J., 2015. Complications of Dentoalveolar Surgery. Manual of Minor Oral Surgery for the General Dentist, p.265. Mansoor, J., 2015. Pre-and postoperative management techniques. Before and after. Part 1: medical morbidities. British dental journal, 218(5), pp.273-278. Mohamed H. El-Kenawy, Wael Moohamed Said Ahmed, 2015- comparison between physics and conventional forceps in simple dental extraction. Oliver, R., 2014. Prevention and management of oral surgery complications in general dental practice. British dental journal, 216(5), pp.263-264. Renton, T., Woolcombe, S., Taylor, T. and Hill, C.M., 2013. Oral surgery: part 1. Introduction and the management of the medically compromised patient. British dental journal, 215(5), pp.213-223. Resuscitation council UK, 2013, medical emergencies and resuscitation, www.resus.org.uk Thakur, A.R., Babshet, M., Amur, S. and Naikmasur, V.G., 2014. Medical screening of dental patients: 16-year experience in a referral dental hospital. Journal of Medicine and the Person, 12(2), pp.76-83. Tong, D.C., Al-Hassiny, H.H., Ain, A.B. and Broadbent, J.M., 2014. Post-operative complications following dental extractions at the School of Dentistry, University of Otago. New Zealand Dental Journal, 110(2). Venkateshwar, G.P., Padhye, M.N., Khosla, A.R. and Kakkar, S.T., 2011. Complications of exodontia: a retrospective study. Indian journal of dental research, 22(5), p.633. von Arx, T. and Lozanoff, S., 2017. Posterior Maxilla. In Clinical Oral Anatomy (pp. 133-162). Springer International Publishing. Yousuf, W., Khan, M., Mehdi, H. and Mateen, S., 2016. Necessity of Antibiotics following Simple Exodontia. Scientifica, 2016. Appendix: 1 pocketdentistry.com Appendix: 2 pocketdentistry.com Appendix: 3 anesthesiallc.com Appendix: 4 img.medscape.com Appendix: 5 pocketdentistry.com Appendix: 6 pocketdentistry.com Appendix: 7 Appendix:8 resus.org.u Appendix: 9 allergy.org Appendix: 10 4.bp.blogspot.com Appendix: 11 cllhealed.files.wordpress.com Appendix: 12 image.slidesharecdn.com

Comparing the Use of Light and Dark by Melville, Poe, and Hawthorne Ess

Use of Darkness and Light by Melville, Poe, and Hawthorne Melville, Poe, and Hawthorne all tend to focus on the darker side of humanity in their writings. In order to allow their readers to better understand their opinions, they often resort to using symbolism. Many times, those symbols take the form of darkness and light appearing throughout the story at appropriate times. A reader might wonder how light functions in the stories, and what it urges the reader to consider. If we look carefully at these appearances of light, or more likely the absence of it, we can gain some insight into what these "subversive romantics" consider to be the truth of humanity. Hawthorne uses this technique to its fullest; however, it is also very obvious in the stories of Poe and Melville. All of these authors have something to say about what they perceive as the breakdown of man and society - and they often clue us in by using differing degrees of light. The presence of darkness and light is probably the most apparent in Hawthorne's pieces, and "Young Goodman Brown" is an excellent example. The story starts off as Young Goodman Brown begins his trip into the forest, away from his wife, Faith. The first presence of light is in the first sentence: "Young Goodman Brown came forth at sunset ...." Now, there is light in the sun, but the significance lies in the fact that the sun is setting. The brightness in life - that is, the goodness of humanity that once existed, is now being taken over by the darkness. YGB then departs down a "dreary road, darkened by all the gloomiest trees of the forest." There is no mistaking this for anything but a symbol. YGB, representing all man, is going down a "narrow path" leading into one of the darkest and sca... ...aking of humanity): "this black conceit pervades him, through and through. You may be witched by his sunlight,--transported by the bright gildings in the skies he builds over you;--but there is the blackness of darkness beyond; and even his bright gildings but fringe, and play upon the edges of thunder-clouds." Â   Works Cited: Adler, Joyce. "Benito Cereno: Slavery and Violence in the Americas." Critical Essays in Herman Melville's Benito Cereno; Burkholder, Robert E., ed. Macmillan Publishing Co., NY, 1992. Gargano, James. "Art and Irony in William Wilson." New Approaches to Poe; Benton, Richard P., ed., 1970. Levin, Harry. The Power of Blackness. New York, 1967. Melville, Herman. "Hawthorne and His Mosses." From The Literary World, August 17 and 24, 1850. Accessed at: http://eldred.ne.mediaone.net/nh/hahm.html on May 1, 2000. Â  

Deception Point Page 13

The President didn't blame them. His staff had worked grueling hours to support him in the upcoming election, and now, all of a sudden, it seemed the President was fumbling the ball. Soon they will understand, Herney told himself. Soon I'll be the hero again. He regretted having to keep his staff in the dark for so long, but secrecy was absolutely critical. And when it came to keeping secrets, the White House was known as the leakiest ship in Washington. Herney arrived in the waiting room outside the Oval Office and gave his secretary a cheery wave. â€Å"You look nice this morning, Dolores.† â€Å"You too, sir,† she said, eyeing his casual attire with unveiled disapproval. Herney lowered his voice. â€Å"I'd like you to organize a meeting for me.† â€Å"With whom, sir?† â€Å"The entire White House staff.† His secretary glanced up. â€Å"Your entire staff, sir? All 145 of them?† â€Å"Exactly.† She looked uneasy. â€Å"Okay. Shall I set it up in†¦ the Briefing Room?† Herney shook his head. â€Å"No. Let's set it up in my office.† Now she stared. â€Å"You want to see your entire staff inside the Oval Office?† â€Å"Exactly.† â€Å"All at once, sir?† â€Å"Why not? Set it up for four P.M.† The secretary nodded as though humoring a mental patient. â€Å"Very well, sir. And the meeting is regarding†¦?† â€Å"I have an important announcement to make to the American people tonight. I want my staff to hear it first.† A sudden dejected look swept across his secretary's face, almost as if she had secretly been dreading this moment. She lowered her voice. â€Å"Sir, are you pulling out of the race?† Herney burst out laughing. â€Å"Hell no, Dolores! I'm gearing up to fight!† She looked doubtful. The media reports had all been saying President Herney was throwing the election. He gave her a reassuring wink. â€Å"Dolores, you've done a terrific job for me these past few years, and you'll do a terrific job for me for another four. We're keeping the White House. I swear it.† His secretary looked like she wanted to believe it. â€Å"Very well, sir. I'll alert the staff. Four P.M.† As Zach Herney entered the Oval Office, he couldn't help but smile at the image of his entire staff crammed into the deceptively small chamber. Although this great office had enjoyed many nicknames over the years – the Loo, Dick's Den, the Clinton Bedroom-Herney's favorite was â€Å"the Lobster Trap.† It seemed most fitting. Each time a newcomer entered the Oval Office, disorientation set in immediately. The symmetry of the room, the gently curving walls, the discreetly disguised doorways in and out, all gave visitors the dizzying sense they'd been blindfolded and spun around. Often, after a meeting in the Oval Office, a visiting dignitary would stand up, shake hands with the President, and march straight into a storage closet. Depending on how the meeting had gone, Herney would either stop the guest in time or watch in amusement as the visitor embarrassed himself. Herney had always believed the most dominating aspect of the Oval Office was the colorful American eagle emblazoned on the room's oval carpet. The eagle's left talon clutched an olive branch and his right a bundle of arrows. Few outsiders knew that during times of peace, the eagle faced left-toward the olive branch. But in times of war, the eagle mysteriously faced right-toward the arrows. The mechanism behind this little parlor trick was the source of quiet speculation among White House staff because it was traditionally known only by the President and the head of housekeeping. The truth behind the enigmatic eagle, Herney had found to be disappointingly mundane. A storage room in the basement contained the second oval carpet, and housekeeping simply swapped the carpets in the dead of night. Now, as Herney gazed down at the peaceful, left-gazing eagle, he smiled to think that perhaps he should swap carpets in honor of the little war he was about to launch against Senator Sedgewick Sexton. 15 The U.S. Delta Force is the sole fighting squad whose actions are granted complete presidential immunity from the law. Presidential Decision Directive 25 (PDD 25) grants Delta Force soldiers â€Å"freedom from all legal accountability,† including exception from the 1876 Posse Comitatus Act, a statute imposing criminal penalties for anyone using the military for personal gain, domestic law enforcement, or unsanctioned covert operations. Delta Force members are handpicked from the Combat Applications Group (CAG), a classified organization within the Special Operations Command in Fort Bragg, North Carolina. Delta Force soldiers are trained killers-experts in SWAT operations, rescuing hostages, surprise raids, and elimination of covert enemy forces. Because Delta Force missions usually involve high levels of secrecy, the traditional multitiered chain of command is often circumvented in favor of â€Å"monocaput† management-a single controller who holds authority to control the unit as he or she sees fit. The controller tends to be a military or government powerbroker with sufficient rank or influence to run the mission. Regardless of the identity of their controller, Delta Force missions are classified at the highest level, and once a mission is completed, Delta Force soldiers never speak of it again-not to one another, and not to their commanding officers within Special Ops. Fly. Fight. Forget. The Delta team currently stationed above the Eighty-second Parallel was doing no flying or fighting. They were simply watching. Delta-One had to admit that this had been a most unusual mission so far, but he had learned long ago never to be surprised by what he was asked to do. In the past five years he had been involved in Middle East hostage rescues, tracking and exterminating terrorist cells working inside the United States, and even the discreet elimination of several dangerous men and women around the globe. Just last month his Delta team had used a flying microbot to induce a lethal heart attack in a particularly malicious South American drug lord. Using a microbot equipped with a hairline titanium needle containing a potent vasoconstrictor, Delta-Two had flown the device into the man's house through an open second-story window, found the man's bedroom, and then pricked him on the shoulder while he was sleeping. The microbot was back out the window and â€Å"feet dry† before the man woke up with chest pain. The Delta team was already flying home by the time its victim's wife was calling the paramedics. No breaking and entering. Death by natural causes. It had been a thing of beauty. More recently, another microbot stationed inside a prominent senator's office to monitor his personal meetings had captured images of a lurid sexual encounter. The Delta team jokingly referred to that mission as â€Å"insertion behind enemy lines.† Now, after being trapped on surveillance duty inside this tent for the last ten days, Delta-One was ready for this mission to be over. Remain in hiding. Monitor the structure-inside and out. Report to your controller any unexpected developments. Delta-One had been trained never to feel any emotion regarding his assignments. This mission, however, had certainly raised his heart rate when he and his team were first briefed. The briefing had been â€Å"faceless†-every phase explained via secure electronic channels. Delta-One had never met the controller responsible for this mission. Delta-One was preparing a dehydrated protein meal when his watch beeped in unison with the others. Within seconds the CrypTalk communications device beside him blinked on alert. He stopped what he was doing and picked up the handheld communicator. The other two men watched in silence.

7c’s of Written Communication

7 C’s off effective communication (with respect to written communication): Written communication  occupies an important position in the communication sphere, so written communication has to pay adequate attention on certain principles of necessity. The essentials of every written communication are principles of unity, coherence and emphasis. These principles along with other essentials of effective communication, like language, planning and organization make the written communication effective. Clarity:  The writing should be correctly planned and expressed in a logical way,and the writer should make sure that the ideas flow smoothly from beginning to end. The message must be so clear that even the dullest man in the world should readily understand it. The communicator must be very clear about all the aspects of the idea in his mind and about the purpose for which it is to be communicated. Next to it, he must be clear about the selection, suitability and usage of the mediu m. The signals of the encoded message must be carefully composed of and transmitted well.Clarity of written language is the first and foremost emphasis one should seek in writing. So clarity of language is a form of courtesy. Clarity, therefore, can be achieved in writing by taking pains by writing to serve the purpose rather than to impress readers. Understanding the subject bring about clarity in the writing. Don’t jump about from one part of the writing to another and then back to the first aspect. This is confusing for you and the reader. Deal with each aspect separately and clearly.Clear description brings about the script alive, takes readers to where you have been and evokes atmosphere. It can bring flavor in the most arid and dry news story and make the difference between a report that satisfies and one that does not. * Completeness:  It is an essential factor for effective communication. A message must be organized appropriately in the sense that it must include al l the important ideals and its details. The contents of the message must be checked in order to verify that there is no omission of the relevant details.An incomplete message can do little to convey the information and to persuade the receiver. All the aspects of the message must be grouped and brought together in logical sequence to prepare meaningful thought units. The communicator effort can be more fruitful and effective if the receiver easily reacts to the sender’s message. The incomplete messages may create doubts in the receiver’s mind. The receiver of the incomplete message feels angry, confused and irritated by it. Effective writing communication implies a condition of being complete and clear.The principles of unity or completeness apply at three levels; one, the individual sentences must be unified. Two, individual paragraphs must be unified and three the totality of the script must be unified. The first principle states that each simple sentence must contai n a single idea clearly expressed. All sentences relating to a particular matter constitute a unified individual paragraph. Each paragraph in a section forms a unit of thought. All units of thoughts structurally constitute the message of entire communication or a unified message.Each unified individual sentence conveys only one central idea. It must be direct, simple, brief, clear and vigorous. Too much use of buts, ands, pomposity and technical jargon must be avoided. Prompt and adequate attention of the reader is the essence of purposeful communication. Completeness in writing is achieved through orderly arrangement of ideas flowing into other ideas and progressing into conclusion. An incomplete writing leads to side tracking, misunderstanding, seeking clarifications and explanation etc. thus, the writer must consider the receiver’s capabilities to understand. Coherence:  Coherency is equally essential for good written communication. Clear communication in simple sentence s helps the reader to understand. Facts and figures must be stated plainly and in an intelligent manner. Relation and clarity are the two important aspects of coherence. Coherence means, tying together of several ideas, under one main topic in any paragraph. Smooth flow, lucidity and transition aspects should be given effect to and there should not be any scope for the reader to misinterpret, mis-read or mis- spell the message.Coherence is given to a larger paragraph or section of a message and leads to purposeful communication where the writer is well received, read, understood and acted upon by the reader. * Conciseness:  Conciseness is an important factor in effective communication. It means saying all that needs to be said and no more. The aimless verbiage, unnecessary details and heavy paragraphs make our communication ridiculous and ineffective. We must omit those words and sentences from our message, which are not likely to bring about results.The message, which can be expr essed in fewer words, is more impressive and effective than the same message expressed in a number of words. The communicator must organize his message in such a way that every word in it is meaningful and of interest to the receiver. Even a single word or a sentence, which does not contribute to accomplish the purpose of the communication, should be carefully omitted. Conciseness refers to thoughts expressed in the fewest words consistent with writing. It is achieved in writing in definite style and use of precise words.Unnecessary superlatives, exaggeration and indirect beginning should be avoided. Care should be taken to use adjectives judiciously, avoiding irrelevant details, unnecessary expression and mumbling sentences. Avoid vague judgmental descriptions and be precise and clear. * Credibility:  A good writing is always forceful and direct and has the power and capacity to produce a reaction or desired effect. Clarity in writing brings about credibility because it ensures t hat others understand the message easily and quickly. A clear and direct approach in writing makes it possible to achieve the principle of credibility in your writing.Other essentials of writing like correctness and completeness add to the strength of credibility in the writing. * Correctness:  Without correctness, readers may refuse your write up. Communication must be correct in tone and style of expression, spelling, grammar, format, contents, statistical information; stress-unstressed, etc. there should not be any inaccurate statements in the message. Efforts must be made to avoid errors in spellings, punctuations, etc. the incorrect written documents lower the readers’ confidence in the writer.In the same way, the incorrect statements and other miscellaneous errors of the speaker lower the listeners’ confidence in him and it may tarnish his image and reliability too. When communication receiver finds one error he suspects that there can also be other errors in t he message. Therefore, he starts searching for other mistakes automatically. The subject matter of communication must be correct or accurate. The manner in which the message is transmitted must be absolutely correct. Accuracy in writing can be achieved by careful checking and editing.Correctness demands accurate figures, because decisions may go wrong if wrong figures are given. Over writings, erasures, strikeovers, wrong spellings, faulty grammar, poor sentence construction etc may distract the readers and lead to misunderstanding. Written communication clearly means making others to understand. Therefore, it is essential that the sender should verify the correctness of the information before transmitting it to the receiver. And before accepting the information for important decision-making, the receiver should clarify his doubts regarding the accuracy and correctness of the message.Continuity:  As far as possible the writer should avoid jargon. Jargon is a language that is speci al to science, commerce, technology, trade and profession. In writing, the jargon should not be incorporated as this could make the writing confusing and unclear. Brevity or use of fewer words brings about continuity and grace in your writing. The effect of good writing depends on its style and continuity of subject till the conclusion. If one takes care to be precise, correct and clear in writing and if the continuity is maintained throughout writing, the desired effect from the reader is achieved.