Nick Djokovic Essay Example for Free

Nick Djokovic Essay In today’s world, there are many sport figures one can look up to. We have chosen the best of the best in the tennis world, Novak Djokovic. Djokovic is a Serbian professional tennis player who is currently ranked world number 1 by the Association of Tennis Professionals. Despite being the underdog during his early years as a professional tennis player, he is now the best professional tennis player overtaking the previous king of tennis Rafael Nadal. Ever since the age of four, he has been interested in tennis. Unlike most children his age, it was not a fleeting interest. He was determined to achieve his dream of becoming the best tennis player in the world. With his steadfast dream, he has won six Grand Slam titles and has brought him to where he is now. This report will cover Djokovic’s personality, values and attitude, motivation and leadership skills that had helped him to achieve his dream. The points highlighted are also the main reason he is worth following as an influential leader. 2.0 Personality The big five model of personality consists of extraversion, neuroticism, agreeableness, conscientiousness and openness to experience. Djokovic can be seen as a person that is highly extrovert as he is fun-loving, expressive and sociable. During his comeback as the winner in the Australian Open, he was so overjoyed that he threw his racket, wristbands and his shirt to his fans (AOL News, 2011). Djokovic is also socially attached to his fans that he created an application known as ‘Nole4You’ that focuses on a direct coverage of Djokovic’s real time games (New Newsworthy, 2012a). On the other hand, Djokovic is low on the neurotism category as he is much balanced and emotionally stable. According to Suttles (2013), Djokovic was â€Å"gracious in defeat† as every defeat he channels it back into better concentration for the next match. Next, Djokovic is rather high on the agreeableness meter as he shows a great deal of care towards others through his charities. Djokovic created the Novak Djokovic Foundation which supports young children from disadvantaged communities especially in native Serbia (New Newsworthy, 2012b). Besides that, he was also elected as the ambassador of The United Nations Children’s Fund (UNICEF) in Serbia as he was utterly concern in the welfare of the people in his hometown as well as the importance in early childhood education in Native Serbia (Look To The Stars, 2011). He was also keen in participating in fights for the betterment of society such as the fight against acquired immunodeficiency syndrome (AIDS) which required him to use the Head Red special edition bag collection from Head to the French Open Grand Slam (Look To The Stars, 2013a). Djokovic is also high in conscientiousness as he is responsible for his career and he is well organized after his achievement in the Australian Open. Although being reckless in his previous season, he is where he is now due to his hard work in perfecting his service techniques and getting his diet right (Carter, 2011). According to Djokovic in an interview, he wants to be consistent in his games and to do this, he has to stay fit and take care of his health and physical condition (The National, 2011). Lastly, Djokovic is very open to new experience. One afternoon in year 2010, Djokovic received a phone call from Dr. Igor Cetojevic who said that his fatigue in the 2010 Aussie Open was due to his diet that consists of glutens that caused an accumulation of toxins in his large intestines. Djokovic listened to his advice to practice a gluten-free diet as well as to build him up spiritually. Besides that, Djokovic also took risk to change his serve technique as advised by Marian Vajda. As a result of Djokovic’s openness, he no longer suffers from fatigues and he felt much happier and balanced. In addition, a change in his serve technique enabled him to defeat the former world number one five times consecutively and brought him to the top of the tennis world (Saslow, 2012). 3.0 Values and Attitude As a well-known figure in the world of tennis, Djokovic has certain values that enable him to enjoy the success that he has today. According to George and Jones (2012, p.93), values are defined as personal convictions about what one should strive for in life and how one should behave. Values are further divided into two categories; work values and ethical values. In terms of work values, there are intrinsic and extrinsic work values. In definition, intrinsic work values are values that are related to the nature of the work itself. Some examples of intrinsic work values that are prominent in Djokovic’s work are the ability to make important contributions to the public, the interesting work and the challenging work that can be done. Firstly, in terms of the ability to make important contributions to the public, Djokovic is well known for his philanthropic work. Due to this status as the highest ranked tennis player, he is very well-connected and is able to influence his fans over his beliefs. From this, he has helped to raise awareness for AIDS, human trafficking, poverty, human rights, women’s rights, children’s rights and many more (Look To The Stars, 2013b). Aside from that, his ability to make important contributions to the public and society is further supported by his status as the ambassador of UNICEF in Serbia. Aside from him advertising his beliefs on social media such as Facebook, Twitter and his video blog, UNICEF has also advertised their cause through Djokovic because of his popularity among the younger generation (UNICEF, 2011). Although generating a high pay from his career, he did not choose this career lifestyle because of it. He started playing tennis at the age of four and played professionally when he was 16 years old. This is due to his passion and interest in tennis. He has trained and played in every single tennis tournament to gain the experience he needed. Even though he has been injured quite a number of times in terms of ankle and knee injuries, that has never stopped him from pursuing his dream of being the best tennis player (Mitchell, 2013). However challenging his work may be, Djokovic never gave up. He continuously pursues his dream of being the best. After relentless practice and competitions, he finally replaced Roger Federer as the top ranked tennis player in the world. This attitude of his is admirable and serves as a constant reminder to his fans that nothing is impossible. On the other hand, extrinsic values are values that are related to the consequences of work. One of the more prominent extrinsic values is the high salary. Not only does he get paid for playing tennis, he gets paid through his endorsements deals with well-known companies such as UNIQLO, Fitline and Telekom Srbjia (Badenhausen, 2011). His salary also includes appearance fees, exhibitions and prize money. Besides that, his career as a tennis player provides him with many job benefits. One of the many is fame. Unlike most athletes, Djokovic enjoys being in the limelight and often shares news and funny anecdotes of his life with his fans. Next, his job provides very flexible working hours. He practices his tennis with his coaches at any time he wants. Due to his flexible working hours, he gets to spend more time with his family and to indulge in vacations as well as hobbies. According to George and Jones (2012, p.97), work attitude is defined as the collection of feelings, beliefs and thoughts about how to behave in one’s job and organisation. Although similar to values, work attitudes are more specific and are not as constant as values as work attitudes change over time. In 2008, although he was winning tournaments, Djokovic hired a new fitness coach in hopes that it will help boost his performance. After the change, he was able to defeat the two reigning champions in the tennis world, namely, Roger Federer and Rafael Nadal. His attitude changed once a new factor was introduced into his life (ESPN, 2010). 4.0 Motivational Theories Everyone in the world possesses a particular set of skills that they are good at in their lives. People who managed to realize their potential often harness that skill and sharpen it to become a much better person. During those times, motivation towards that ability drives them to keep pushing forward in harnessing those skills. Many professional sportsmen and sportswomen started training during childhood. Motivation is what has kept them and pushed them into training harder every day until they finally achieve their goal. According to George and Jones (2012, p. 183), there are three elements of work motivation; direction of behavior, level of effort and level of persistence. Novak Djokovic, world’s best tennis player, possessed all these three elements. For example, although his family had economic problems in Serbia, he still chose to fly to Germany to train despite only being 12 years old. Even as a child, he loved tennis with a passion. He once skipped afternoon classes in school just so he could attend tennis training with his coach (PRPepper Production, 2012). His passion, effort and persistence during training are boundless. His motivation was driven because he loved tennis rather than his parents forcing the sport on him. 4.1 Maslow’s Hierarchy of Needs Djokovic’s efforts and achievements relate a lot to Maslow’s Hierarchy of Needs. Maslow’s Hierarchy of Needs consists of five different types of needs from the lowest to the highest; physiological, safety, belongingness, esteems and self-actualization needs (George and Jones, 2012, p. 187). The two needs most emphasized by Djokovic are the esteem needs and self-actualization needs. Right from the beginning, Djokovic was always focused and determined to be the best in the tennis world, which directly means beating the best players in the world such as Roger Federer, Andy Murray, Tommy Haas and Rafael Nadal. Esteem needs emphasizes on an individual being recognized and respected by others (George and Jones, 2012, p.187). Djokovic strived hard during his early years under the guidance of Nikola Pilic. At the age of 16, he was awarded the champion of â€Å"La Boule†. This event leads to the start of his professional career (PRPepper Prodcutions, 2012). However, he did not stop that as he was motivated aim higher. This further explains Maslow’s self-actualization need theory, which is defined as â€Å"needs to realize one’s full potential as a human being†. Djokovic trained hard every day motivated by one goal; to be the best tennis player in the world. Due to him having a high self-actualisation, Djokovic obtained the title of being the best tennis player in the ATP rankings in 2012 after obtaining a 43% winning rate in 2011. Today, Djokovic is further motivated by his lost to Rafeal Nadal in the 2013 French Open. Instead of giving up, Djokovic evaluates his loss as a sense of motivation to train harder in order to win the next tournament, Wimbledon (Gajaria, 2013).

Impact of Drinking Whilst Pregnant

Impact of Drinking Whilst Pregnant Samantha McKenna To what extent does drinking alcohol while pregnant affect the life of an unborn child? â€Å"In Australia, alcohol is responsible for a considerable burden of death, disease and injury† (Alcohol guidelines: reducing the health risks, 2015). â€Å"The Australian Institute of Health and Welfare report that 38% of Australian women consume 3 or more drinks per day† (Pyettfor, 2007). Thorough research has shown that there are many biological impacts on the fetus caused by alcohol consumption during pregnancy, which result in further impacts placed upon them as they go through life. Consuming any sort of alcohol while pregnant, including beer, wine and spirits, are all linked to the cause of Fetal Alcohol Spectrum Disorder (FASD) (Womens and Childrens Health Network, 2014). Biological impacts Alcohol affects a fetus as the harmful substances can pass the placental barrier. This can occur very quickly because a fetus is nourished by the mother’s bloodstream, which results in the baby having the same alcohol blood levels as the mother (British Columbia Ministry of Education, 2010). Prenatal Alcohol exposure can affect the way a baby develops during all stages of the pregnancy, which can lead to biological anomalies for the child which effects are continuous (British Columbia Ministry of Education, 2010). Abnormalities in the fetus can include problems in the central nervous system, growth deficiency and abnormal facial characteristics, all as a result of alcohol consumption during pregnancy (Webb, 1991). This is because the development of the baby’s cells and organs can be disturbed. In particular, growth and development of the head are a common result of FASD. A person with FASD can have a smooth philtrum (no groove between upper lip and nose), a thin upper l ip and a small eye opening (Telethon Kids, 2011). An interview conducted with a midwife who wishes to remain anonymous has seen the effects of FASD firsthand, also supports this theory regarding the facial features of a person with FASD (Anonymous, 2015). There is also mild to severe brain developmental delays due to abnormalities in the brain cells (Jean, 2012). The cells are affected because â€Å"alcohol is so small in size so it can enter the developing cells and change the growth and migration of the cells, which reduces the number of pathways or connectors and alter the neurochemistry of the cells† (National Organisation for Fetal Alcohol Spectrum Disorder, 2013). This can produce permanent brain damage. The damage caused by the alcohol exposure results in problems with storing and retrieving information, problem solving, focus and verbal memory, due to the brains corpus callosum being damaged (Robinson, 2013). Issues from the brains cerebellum being damaged also create problems with controlling movements, maintaining balance and fine motor skills (National Organisation for Fetal Alcohol Spectrum Disorder, 2013). There are also possible heart damages (which are particular in the ventricular septum), low birth weight, geni tal defects, kidney problems and cerebral palsy. As well as limb anomalies such as curved little fingers, extra fingers or toes, or additional creases in hand (Telethon Kids, 2011). Some babies who are exposed to very high levels of alcohol as a fetus can possibly die due to the prenatal exposure (Womens and Childrens Health Network, 2014). â€Å"Data suggests that for every 10g of alcohol taken in daily during pregnancy the risk of developmental anomalies rises by 1.7% and fetal growth is reduced by 1% â€Å" (Cornwell, 1993). Although there is no safe amount of alcohol to drink, the more consumed the higher the risk will be any of the above effects impacting the child. Figure 1 shows how the damages to the brain compare to a brain with no prenatal alcohol damage. This shows the extent of how much damage occurs to the brain from alcohol consumption and how evident it is when compared to a brain not exposed to alcohol. Figure 1- brain scans showing the difference between two 6 week old babies brains. (FASlink, 2014). Social and behavioural impacts As stated above the consumption of alcohol while pregnant results in many biological impacts on the fetus; however, this also results in a range of social and behavioural issues on a child with FASD. As a consequence from the biological damages, this can result in the child’s difficulty in planning, setting goals, being on time and complying with legal obligations. Other complications can possibly include; issues at school, multiple foster care placements, reduced self esteem and depression, inappropriate sexual behaviour, inability to live independently, unemployment, poverty (Telethon Kids, 2011). â€Å"Often people who are born with FASD will show no outward signs and they may be misjudged for inappropriate actions, which can then be interpreted as bad behaviour† (Provicial Outreach Program for Fetal Alcohol Spectrum Disorder, 2013), whilst the real cause is the unfortunate brain damage. FASD children, or adults, have ‘challenging behaviour’s’; as their actions seem impulsive, defiant or poorly thought out, and it is evident they struggle socially as they have difficulty making friends (FASD Characteristics across the Lifespan). People with FASD struggle linking their actions to possible outcomes, predicting outcomes, generalizing information, staying still, paying attention, have poor memory and language, and uneven maturation (Telethon Institute for Child Health Research, 2009). All of these conditions may not be noticed or observable as a baby and â€Å"only noticed when the child reaches school age, where the child’s behaviour and learning difficulties are problematic† (Pyettfor, 2007). Professor Elliot, the Professor of Pediatrics and Child Health at the University of Sydney supports these findings as she states â€Å"At the end of the day these children have problems with learning, behaviour and developmental growth†. Sue Miers also supports this theory as she says her daughter who has FASD â€Å" could not learn from her mistakes†. Her daughter is now 30 and still requires ongoing support (Jean, 2012). According to the Australian Journal of Advanced nursing, â€Å"pregnant women who are know to use illicit drugs face consequences that can include sometimes removal of children following birth† (Miles). This shows how alcohol consumption during pregnancy can have a great impact on the child, not only biologically, but also socially due to behavioural characteristics that last throughout their whole life. Prevalence of disorders Many surveys have been completed within Australia to measure the prevalence of disorders of FASD and the percentage of women who drink alcohol while pregnant. â€Å"A 2014 Australian survey estimates of people with FASD arrays from 0.006 to 0.068 per 1,000 live births† (Callinan, 2014). Another survey found that 81% of the participants of the survey reported to drinking alcohol during pregnancy, and 0.2% of the sample drank more than 20 units of alcohol a week. As well as 71% of the sample reporting 0 to 5 units per week (Callinan, 2014). Studies also show that younger women are more likely to stop drinking alcohol when they are aware of their pregnancy but are more likely to drink prior to their knowledge of the pregnancy (Breen, 2013). Another survey conducted by researchers found that 37.6% of the 1,633 women surveyed had consumed alcohol while pregnant during 2003-2004 (Callinan, 2014). This research also shows that younger women haven been exposed to different and more information on the pressures of drinking while pregnant than older women, resulting in a lower prevalence of alcohol consumption during pregnancy by younger women. A respondent by an individual who participated a survey produced for this research supports this theory. Respondent 9 wrote about being pregnant 39 years ago and how people were unaware of the dangers of drinking alcohol during pregnancy during that time, as she is currently 69 years old, â€Å"there were no warnings that come to mind about â€Å"drinking alcohol† while pregnant† (FASD community survey, respondent 9, 2015). The graph pasted below (figure 2) also presents the decrease in women’s alcohol consumption from 2001 to 2007. In 2001 44% of the surveyed women drank whilst pregnant, in 2004 33% reported drinking, and in 2007 only 25% of the women reported alcohol consumption while pregnant. It also shows in 2010 49% of the women drank prior to their knowledge of pregnancy, but only 20% of the women drank once they were aware of there pregnancy (Callinan, 2014). (Callinan, 2014). Strategies implemented to reduce disorders As there is no cure for FASD, many prevention strategies are put into place in order to reduce the risk and prevalence of FASD and to stop women from drinking alcohol at risky levels during pregnancy, as well as plans to help the children affected by prenatal alcohol exposure. The Australian Government as well as local communities have implemented strategies to reduce the impact of FASD. The Government scheme was introduced in 2013, which will last to 2017. The aim of this plan is stated below: Enhancing efforts to prevent FASD Secondary prevention targeting women with alcohol dependency Diagnosis and management Targeted measures supporting prevention and management of FASD within Indigenous communities and families in areas of social disadvantage National coordination, research and workforce support (Australian Department of Health, 2014). Australian institutes have also produced prevention advertisements in order to educate the community and publicize the effects of FASD, as seen below (figure 3). Figure 3: (FASD prevention, 2010) In 2007, The Marulu strategy has also been implemented into the community of Fitzroy, WA, which has high rates of alcohol use. The Marulu strategy tactics are; prevention through education, diagnosis, treatment, and support (Variety Charity, 2003). The Anyinginyi Health Aboriginal Corporation created the Fetal Alcohol Spectrum Disorder Project in 2011. This projects aim is to raise awareness, educate, prevent and support children with FASD (National Organisation for Fetal Alcohol Spectrum Disorder). Even though government strategies are implemented, these local projects are also essential for rural areas to become educated in the problem. Opinions of drinking alcohol while pregnant on mothers within society A survey conducted for the purpose of this research uncovered the opinion that women in Kensington Park, Adelaide, have on drinking alcohol while pregnant. The survey was completed by mothers in the community, due to the respondents needing to be women who have had children. Although, it was difficult to receive a large quantity of replies. 16 replies were collected and the context in each were of great standard, providing a strong understanding on their opinions of drinking alcohol whilst pregnant and the knowledge they obtained regarding this issue. Out of the 16 replies, 75% of respondents believed that no alcohol was an appropriate amount to be consumed during pregnancy, as they understood the possible risks (FASD community Survey, 2015). The other 25% stated they understood the risks but believe a small amount of alcohol during pregnancy was fine to consume (FASD community survey, 2015) (see appendix for further evidence). Keeping in mind if this survey were to be conducted in a different suburb (e.g. with a lower socio-economic status) the results may vary. To conclude, there is much scientific research and evidence to support the negative outcomes of drinking throughout pregnancy as it has a potentially detrimental effect on the life of an unborn child. As addressed above, the biological impacts such as cell migration that effects the overall development of the child’s brain and significantly affects the life of the child. Facial anomalies are also evident with prenatal alcohol exposure. The potential significant brain damage is the cause of unintentional negative social and behavioural effects on the child that affects them for their whole life. The statistics which state the prevalence of disorders and women who drink alcohol during pregnancy supports, along with the opinions women have towards drinking alcohol, supports how damaging this condition can have on the community and child as it’s a serious disorder which is not publicized to the community as often as it should. As stated above, a mother drinking alcohol whil e pregnant has a very large effect on the life of the child exposed physically, biologically, socially and behaviourally. Reference List Secondary sources- Alcohol guidelines: reducing the health risks. (2015, March 24). (A. Government, Producer) Retrieved April 10, 2015, from National Health and Medical Research: http://nhmrc.gov.au/health-topics/alcohol-guidelines Australian Department of Health. (2014). Responding to the impact of Fetal Alcohol Spectrum Disorders in Australia. Retrieved March 28, 2015, from Australian Government Department of Health: http://www.health.gov.au/internet/main/publishing.nsf/Content/0FD6C7C289CD31C9CA257BF0001F96BD/$File/FASD%20-%20Commonwealth%20Action%20Plan%20MAY%202014%20(D14-1125690).pdf Breen, D. L. (2013). Its time to have the conversation: Understanding the treatment needs of women who are pregnant and alcohol dependent. NSW, Australia: University of New South Wales. British Columbia Ministry of Education. (2010). Alcohol effects on the developing brain. Retrieved Feburary 25, 2015, from FASDoutreach: http://www.fasdoutreach.ca/elearning/understanding-fasd/alcohol-effects-developing-brain Callinan, S. (2014, March 17). Trends in alcohol consumption during pregnancy in Australia 2001-2010. Cornwell, A. (1993). Drugs, Alcohol and Mental Health (Vol. 2). Cambridge, Great Britain: Cambridge University Press. FASD Characteristics across the Lifespan. (n.d.). Retrieved April 2, 2015, from nofasd Australia: www.nofasd.org.au/_/FASD_-_Characteristics_across_the_Lifespan FASD prevention. (2010, October 1). Wallet Card: Say No to Alcohol When You Are Pregnant. Retrieved April 1, 2015, from Girls, Women, Alcohol and Pregnancy: https://fasdprevention.wordpress.com/2010/10/01/wallet-card-say-no-to-alcohol-when-you-are-pregnant/ FASlink. (2014). Fetal Alcohol Spectrum Disorders. Retrieved March 31, 2015, from FASlink: http://www.faslink.org/fasmain.htm Jean, P. (2012, September 12). Alcohol in pregnancy warnings. Canberra times . Miles, M. Challenges for midwives: pregnant women and illicit drug use (Vol. 1). Adelaide, SA, Australia: Australian Journal of advanced nursing. National Organisation for Fetal Alcohol Spectrum Disorder. (n.d.). Current FASD projects. Retrieved March 25, 2015, from National Organisation for Fetal Alcohol Spectrum Disorder: http://www.nofasd.org.au/research-library/current-fasd-projects National Organisation for Fetal Alcohol Spectrum Disorder. (2013). What is FASD? Retrieved March 25, 2015, from National Organisation for Fetal Alcohol Spectrum Disorders Australia: http://nofasd.org.au/resources/what-is-fasd-1 Provicial Outreach Program for Fetal Alcohol Spectrum Disorder. (2013). What is FASD? Retrieved March 3, 2014, from Provicial Outreach Program for Fetal ALcohol Spectrum Disorder: https://www.fasdoutreach.ca/elearning/understanding-fasd/what-is-fasd Pyettfor, P. (2007). Fetal Alcohol Syndrome: A literature review for the Healthy pregnancies, Healthy Babies for Koor Communities Project. Melbourne, VIC, Australia: State of VIctoria . Robinson, M. (2013). How the first 9 months shape the rest of our lives. Australian Psychologist , 239-245. Telethon Institute for Child Health Research. (2009). Alcohol and Pregnancy and Fetal Alcohol Spectrum Disorder: A resource for Health Professionals (Vol. 1). Perth, WA, Australia: Telethon Institute for Child Health Research. Telethon Kids. (2011). Alcohol, Pregnancy, FASD. Retrieved March 31, 2015, from Fetal Alcohol Spectrum Disorders: http://alcoholpregnancy.telethonkids.org.au/understanding-fasd/what-is-fasd/ Variety Charity. (2003). Supporting the Marulu Strategy . Retrieved March 25, 2015, from Youtube: https://www.youtube.com/watch?v=cegTvwWJjpY#action=share> Webb, I. (1991). Alcohol. Essex, Englans: Hodder Wayland. Womens and Childrens Health Network. (2014). Pregnancy and Alcohol- risks and effects on the developing baby. Retrieved March 31, 2015, from Womens and Childrens Health Network: http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?p=114np=122id=1950 Primary sources Anonymous midwife. (2015, March 20). FASD interview. (S. McKenna, Interviewer) Adelaide, SA, Australia. FASD Community Survey, 2015. Appendix Some of the replies to â€Å"What is your personal opinion on drinking alcohol while pregnant? Do you think it’s acceptable to an extent? Why?† (FASD community survey, respondent 14, 9, 13, 4, 2015)

Incorporating Telemedicine into a Surgical Practice

Incorporating Telemedicine into a Surgical Practice Kristen Harkey Complex wounds can create a challenge for the patient as well as the surgeon. The challenges faced include operative management, cosmesis, long-term management, effects on lifestyle for patient and caregiver, and self-image (Park, Copeland, Henry Barbul, 2010). Hospitalized patients will have the surgical team, the wound care specialist, and a bedside nurse to assist them in their daily care. When these patients are ready to leave the hospital they can feel anxiety about providing care for themselves, especially if they have a complex wound present. This anxiety can decrease once they learn how to care for themselves at home while having the readily available supplies, but then they must leave their homes to travel to come to the surgical office for a wound check. This can be a burden to not only the patient but their primary caregiver. The purpose of this paper is to introduce an evidence-based change project that focuses on providing patients with the option of telemedicine office visits. Background In 2010, approximately 51.4 million inpatient surgeries were performed in the US according to the National Center for Health Statistics (CDC/NCHS, 2010). Wound complications can be an important cause of postoperative morbidity following a laparotomy (Mizeell, Sanfrey, Collins, 2014). Acute wound care is needed in all patients with surgical and traumatic wounds, when an incision is made this creates a wound which will need further attention. There are a multitude of ways to address these wounds such as wet to dry dressings, dry packing strips, wound vac systems, and if needed further surgery such as a skin graft. These wounds can then become chronic when they have failed to proceed through the reparative process to produce anatomic and functional integrity in 12 weeks (Sen, 2009). Both acute and chronic wounds can become a significant financial burden on both the healthcare system and the patient’s themselves. Significance With the sheer number of surgeries listed above, this will create wounds that need to be managed appropriately. Not only are wounds created by surgery, they can also be created by trauma or massive soft tissue infections (Park, Copeland, Henry Barbul, 2010). Part of this management may be further surgical interventions to restore the fascia or possibly watchful waiting. In our facility in 2014, 3349 patients were evaluated by our wound care specialist. Of these 695 patients had surgically created wounds and approximately 656 were managed with wound vacs (G. Caldwell, personal communication, January 20, 2015). These patients will need to be followed in the outpatient setting for ongoing wound assessments, possible change in wound management, or further surgical intervention if indicated. The outpatient care to these patients will include discussions on proper nutrition to promote wound healing, activity levels, timing of dressing changes, and ongoing assessments of the wounds. It can create a significant burden to patient and caregiver to travel to office visits for ongoing assessment of the wounds which can take as little as ten to fifteen minutes to examine once they have arrived back to the exam room. This short office visit can create a significant burden to the patient and their caregiver, this burden can include ability to keep themselves clean throughout the trip, financial, and time-strain. PICO Question and Components Evidence-based practice (EBP) can be described as a â€Å"life-long problem solving approach to clinical decision-making that involves the conscientious use of the best available evidence with one’s own clinical expertise and patient values and preferences to improve outcomes for individuals, groups, communities, and systems† (Melnyk Fineout-Overholt, 2011). EBP will help to ensure high quality, safe, relevant, and up-to-date care while at the same time improving patient outcomes (Robb Shellenbarger, 2014). One of the ways to create EBP in a way that will yield the most relevant information from a search is to form a question in the PICOT format. The PICOT format is composed of the following: â€Å"P† will describe the patient population, â€Å"I† will reveal the intervention or issue of interest, â€Å"C† will reveal the comparison intervention or status, â€Å"O† will reveal the outcome, and â€Å"T† will reveal the time frame in w hich the intervention/issue of interest will accomplish the outcome (Melnyk Fineout-Overholt, 2011). For the purpose of this paper, the author will include all components listed except for time which will be addressed at another juncture. Population The population of focus will be outpatient postoperative patients in the home health setting. The patient population will be those with acute/chronic wounds, ages eighteen and up, both male and female patients with no restrictions on ethnicity. The wounds will likely be compromised of complex abdominal wounds, however no limit will be placed on the type/cause of the wound. The patient’s will live in North Carolina or South Carolina and reside within a 4 hour drive from Charlotte, NC. No restrictions will be placed on the agency providing home health services to the patient. Intervention Telemedicine is defined by the World Health Organization (WHO) to be the practice of healthcare using video, interactive audio, and/or data communications (Chanussot-Deprez Contreras-Ruiz, 2008). With the use of telemedicine the patients will be able to stay in their own home. This will also provide an enhanced team based approach because we will have both the patient, patient’s caregiver if applicable, and the home health nurse. This will provide accurate documentation of wound measurements. The appropriate wound care will then be provided by the home health nurse, and if applicable the wound vac will be re-applied. Comparison The comparison group will be a standard office visit. The standard office visit will consist of the patient and their caregiver coming to our surgical practice, in one of our two locations. The patient will be required to wait for their appointment time and wait as required for the provider to see them. If a wound vac is present, this will be removed in the office and will not be re-applied per standard operating procedures. The patient will have a temporary dressing replaced and will then need the home health nurse to come to their home upon their arrival to re-apply the wound vac. This consists of a standard office visit in our practice. Outcome The anticipated outcome, will be no effect on wound healing when using telemedicine. For the practitioner, one important aspect of examination of the wound is not only using your sense of sight but also your sense of smell. The smell of a wound can be indicative of necrotic tissue that requires further debridement or possibly a wound infection. This sense will be missing with telemedicine and the practitioner will need to rely heavily on the home health nurse for this aspect of assessment. Another outcome for this study will be increased patient satisfaction. The patient with a complex abdominal wound may have difficulty at baseline maintaining adequate coverage for the drainage, this is more of a challenge when you add frequent position changes associated with traveling to a health care provider’s office. In summary, a postoperative surgical patient will require care for the surgical wound in an outpatient setting. This care can be frustrating for the patient, the patient’s caregiver, and the home health nurse. With the addition of telemedicine to a surgical practice this will decrease the burden of traveling to a standard office visit as well as enhance multi-disciplinary care for the patient. It is the hope of the author that for complex wounds that remain difficult to manage in the outpatient setting, the inpatient wound ostomy nurses who provided care inpatient will be able to assist more in the outpatient setting by providing continuity of care. Conclusion With every surgery performed a resultant wound is created. Wounds can also be created by trauma or massive necrotizing soft tissue infections (Park, Copeland, Henry Barbul, 2010). The surgical wound can heal without difficulty and the patient returns to his activities of daily living, however a multitude of wound complications can occur delaying wound healing. Some wound complications will require further surgery, however due to the nature of these wounds surgery may need to be delayed for up to one year or longer. This can cause caregiver strain and for the patient can take away many of the freedoms we enjoy on a daily basis. As part of a standard office visit the patient is expected to arrange transportation to our office, wait for his/her appointment time, have their wound examined, and then if a wound vac is used they are expected to have this re-applied when they get back to their home by the home health nurse. With the addition of telemedicine to the patient’s postopera tive care, they would be able to have a multidisciplinary team visit them in the home using telemedicine resources. This would significantly decrease the burden travel can create for these patients with complex wounds. References CDC/NCHS National Hospital Discharge Survey (2010). Retrieved from  http://www.cdc.gov/nchs/data/nhds/4procedures/2010pro4_numberprocedureage.pdf Chanussot-Deprez, C. Contreras-Ruiz, J. (2008). Telemedicine in wound care. International  Wound Journal, 5(5), 651-654. Melnyk, B. Fineout-Overholt, E. (2011). Evidence-based practice in nursing healthcare: A  guide to best practice (2nd ed.). Philadelphia, PA: Wolters Kluwer|Lippincott Williams   Wilkins. Mizell, J., Sanfrey, H., Collins, K. (2014). Complications of abdominal surgery. Retrieved  from http://www.uptodate.com. Park, H., Copeland, C., Henry, S., Barbul, A. (2010). Complex wounds and their  management. The Surgical Clinics of North America, 90(6), 1181-1194.  doi: 10.1016/j.suc.2010.08.001 Rob, M., Shellenbarger, T. (2014). Strategies for searching and managing evidence-based  practice resources. The Journal of Continuing Education in Nursing, 45(10), 461-466. Sen, C. K., Gordillo, G. M., Roy, S., Kirsner, R., Lambert, L., Hunt, T. K., Longaker, M. T.  (2009). Human skin wounds: A major and snowballing threat to public health and the  economy. Wound Repair Regeneration, 17(6), 763-771. doi:10.1111/j.1524-475X.2009.00543.x Incorporating Telemedicine into a Surgical Practice Incorporating Telemedicine into a Surgical Practice Kristen Harkey Imagine presenting to the hospital for your planned cesarean section, a time of great anxiety and joy. During the procedure you unfortunately have a complication and an enterotomy (cut into the intestines) is made, but missed at the time. Hours later you develop increasing abdominal pain and a rash spreads quickly across your abdomen. Your healthcare providers explain you have an infection called necrotizing fasciitis and this requires further surgery to treat the condition. The individual then wakes up possibly weeks later with most of their abdominal wall, upper thigh skin, some muscle layers missing of both the abdomen and thigh, as well as stool draining from the middle of the wound. The individual is informed they have an enterocutaneous fistula that will likely not be able to be repaired for several months to a year. This person is finally able to transition home with their newborn, a gaping abdominal wound, stool draining from the wound, not allowed to have anything to eat or drink, and are attached to intravenous nutrition twenty-four hours a day. This would be overwhelming for the most health literate patient, much less an individual with limited resources and low health literacy. Our health can change quickly with an unexpected surgery that causes a complex surgical wound. This wound must be monitored closely in the outpatient setting to prevent further complications including loss of limb or possibly life. Typically the patient’s wound care has been provided in the home by a home health nurse. Subsequently the patient and family caregiver are then expected to travel to the doctor’s office for intermittent follow-up examinations of the wound over a weekly to monthly schedule which could last up to one year or more postoperatively. Leaving the patient’s home with these complex wounds can be a burden due to factors such as increased pain, time-consumption, financial costs, and possible embarrassment if the wound or ostomy appliance leaks. Some of this burden could be relieved with virtual visits. Overview of Problem of Interest In the United States 6.5 million individuals are affected with chronic wounds that require ongoing care (Sen et al., 2009). Patients are expected to travel to their healthcare provider’s office for follow-up examinations and sometimes this requires a long care ride, wait in the office, and then travel home. It is difficult to maintain a dressing on the wound in the most basic of circumstances, such as during times of everyday activity in their home. With the addition of traveling this can become an overwhelming and untidy endeavor while the healthcare provider will likely only spend minutes examining you. Due to this some patients will not come to their follow-up appointment and this can be detrimental to their health by prolonging wound healing, increasing risk for infection, and delay future surgical repairs. When the individual is at home, they require home health services for ongoing wound care as well as provision of supplies. The home health nurse sees the patient on a m ore regular basis than the healthcare provider and will call the providers’ office with important changes they note. Unfortunately this process may take several phone calls which takes valuable time for the home health nurse and increases wait time for care of the patient. Most patients have an expectation that surgery will help them heal or cure their disease. Unfortunately approximately 22% of patients may experience moderate to complete postoperative disability (Shulman et al., 2015). Home health nursing will provide some relief for the patient and a multidisciplinary approach is necessary to manage complex treatment modalities (Wilkins, Lowery, Goldfarb, 2007). In Carolinas Medical Center Main in 2014, 3229 patients had wound care provided by our wound ostomy care nurse team and of those 820 were surgical patients (G. Caldwell, personal communication, January 25, 2015). These are many of the patients that require ongoing care in the outpatient setting to prevent further complications. In the United States (US) in 2000, forty million inpatient surgical procedures were performed and at that time the need for post-surgical wound care was sharply on the rise (Chittoria, 2012). In the US the amount of money spent on wound care, diminished quality of life, and the loss of productivity for the individual and caregiver comes at a great cost to our society (Sen et al., 2009). Therefore it is in our best interest as providers to provide safe and effective care to our patients in the most convenient format for both the patient, caregiver, home health nurse, and the healthcare provider. Review of Literature One of the first steps to address a problem is reviewing evidence available to support the proposed intervention. Virtual care is currently being used in many different platforms such as urgent care, psychiatric care provided in ER’s, preventing readmissions in heart failure patients, and many other venues. The examination of acute and chronic wounds is one venue that has found success. In the plastic surgery population where visual exam is heavily relied upon for decision-making, telemedicine has been shown to have great potential. Gardiner and Hartzell (2012) performed a systematic review of twenty-nine articles. Twenty-eight of the articles noted a benefit including improved access to expertise and cost reduction through conserving hospital resources and avoiding unnecessary transfers (Gardiner Hartzell, 2012). Wallace, Hussain, Khan and Wilson (2012) had similar findings in the burn population where they noted improved assessment and triage, avoidance of unnecessary trans fers and a potential for health care savings when using virtual care. In the trauma population a 90% accuracy was noted in assessing traumatic plastic surgery injuries whether the practitioner was using bedside visual exam or transmitted digital images (Gardiner Hartzell, 2012). Wilkins, Lowery, and Goldfarb (2007) used their initial investigation to determine the feasibility of virtual wound care and then moved forward with performing a pilot study using a store and forward technique. At the time of initial referral the mean wound surface area was noted to be 5.85 cm2. Using virtual care the authors noted in 58.2% of the wounds, the diagnosis or treatment plan was changed. This change in diagnosis or treatment plan resulted in an average decrease of 58% from the initial wound size over an average time period of 40.2 days. The authors went on to note 95.5% of patients found telemedicine consultation more convenient than traveling and 98.2% of patients were either satisfied or very satisfied with the care they received (Wilkins, Lowery, Goldfarb, 2007). An article published in 2014 by Kidholm, Dineseen, Dyrvig, Rasmussen, and Yderstraede was noted to be the largest and most comprehensive research project to evaluate telemedicine effectiveness and costs for patients with chronic diseases. The results revealed telehealth reduced mortality with an odds ratio of 0.54. Mortality in the control group was noted to be 8.3% while the intervention group was 4.6%. The authors also noted a 10.8% lower hospital admission rates in the intervention group with an odds ratio of 0.82 (Kidholm, Dinessen, Dyrvig, Rasmussen, Yderstraede, 2014). Telemedicine may be applied to many different aspects of medicine, but a benefit has been shown in the examination and long-term treatment of wounds (Wilkins, Lowery, Goldfarb, 2007). Telemedicine has been shown to satisfy both the clinician as well as the patient, while continuing to provide quality care. Therefore a solution to the burden of traveling to the doctor’s office, decreasing financial strain, decreasing caregiver strain, and improving access to care are all potential benefits of providing care using virtual visits. Purpose of Project The purpose of incorporating telemedicine into our surgical practice is to provide our patients with the most efficient high quality care in the most appropriate setting for the patient. A standard office visit consists of the patient traveling to our office, being evaluated by the medical team, and then having to travel back to their home. This evidenced based project will allow the patient to stay in their own home and have the providers visit them via a virtual visit. Upon discharge from the hospital the patient will be evaluated for inclusion into the virtual visit program. If the patient is determined to meet the criteria including living in NC, using Healthy at Home to provide home health services and have a complex surgical wound; then an appointment will be made for the virtual visit. The home health nurse will proceed to the patient’s home at the assigned appointment time and use their tablet for the visit. The provider will then join the home health nurse in the virt ual setting and the patient’s wound will be evaluated. Appropriate changes in the treatment plan for the wound will occur and the provider will assure all questions/concerns are addressed with the patient, caregiver, and home health nurse. One desired outcome for this project will be to maintain a high level of patient satisfaction, as we do in our office. As providers, we would like to provide more efficient care and this may be possible by having one provider performing postop visits virtually while another provider evaluates new consults in the office. It will be important for this project to provide the same level of care that we provide in the brick and mortar office, as well as following all current standards of care. Project Management The facility where this project takes place is a Magnet facility. To receive this designation an organization must prove they have several key characteristics including empirical outcomes as well as integrating evidenced based practice and research into operational and clinical processes (American Nurses Credentialing Center, 2014). An important goal for our organization this year will be to provide care in new ways, one of which will be providing more opportunities for our patients to experience virtual care. This innovative project is meant to assure that we are improving quality, enhancing value and dealing with the complexity of health care today (Harris, Roussel, Walters, Dearman, 2011). Implementation Team The backbone of quality improvement work is the team and their teamwork (Ogrinc et al., 212). The team for this project will include individuals from different disciplines to ensure success. The author of this paper will serve as the operational lead on the project, assuring all aspects of the project are coordinated. Our administrative lead will be the practice manager for our outpatient sliding scale clinic. He will be able to assist the project in assuring we meet meaningful use standards as we do in the office, as well as building templates in our scheduling software, and facilitate changes in the organization. A management associate with the virtual care division will remain part of the team, as she has had past experience with implementing similar projects and has provided invaluable support. The next member of the team will be a member of the IT department and will assist the team in choosing the right technology/platform for this project. He will not only assist in the beginn ing stages of this project but will be a constant resource for ongoing IT support. The administrator for the home health agency will be a member of this team, she will provide information regarding her organization and provide us with establishing workflow for the home health nurse. This will be an important step as this project is meant to provide multidisciplinary care, however it will not be beneficial for it to provide more efficiency for our team but not the home health team. The chairman of surgery who also serves as the interim lead of the acute care surgery team, as well as the two surgeons who practice on the same service. This team will serve to bring virtual care visits to our surgical practice. Risk Management Strategy It is important to examine every project to identify external and internal items that either positively or negatively affect the project. One type of assessment that can be performed is the strengths, weaknesses, opportunities, and threats analysis (SWOT analysis). During the SWOT analysis the system is fully examined from the clinical micro to the macrosystem perspective (Harris, Roussel, Walters, Dearman, 2011). For this project some strengths noted include other departments within the facility using virtual visits and a department dedicated to assisting new groups to use this technology. Another strength is the patients included in this project will remain in the global ninety day postoperative fee which will not require reimbursement from insurance companies and keep the cost incurred limited. It is important to then examine some of the weaknesses which include removing a provider from an already overbooked clinic to participate in this project, the additional cost of the techno logy, and surgical postoperative care has not been provided in this manner in our facility prior to this. When further evaluating opportunities associated with this project, the ability to be the only surgical providers providing care virtually will set this team apart and appeal to more consumers and home health agencies. Another opportunity would be to include all home health care providers in our area and obtain licensure to be able to provide virtual visits in South Carolina. Some threats to this project include newer technology that hasn’t been tested, a good working relationship with the home health agency must be in place, and is it possible for the team to provide confidential care to our patients using virtual visit technology. Organizational Approval Process Initially this project was approved at the departmental level after multiple discussions with the chairman of surgery for the metro division of our healthcare system. Prior to proceeding to the IRB process, the facility requires submission of your proposal to the Nursing Scientific Advisory Council (NSAC). Once NSAC has evaluated a proposal fully and any revisions have been completed you may move forward with your submission to the IRB. Role of Information Technology in this Project Information technology will play an integral part of this project. Although virtual visits are used throughout the hospital system, they have not been incorporated into the surgical practices within our system. This project will include an IT tech to assist in choosing the best platform to serve our patient population while being user friendly for our home health nursing colleagues. It will be important for our platform to work well with the technology available to the home health nursing team. This will assure we are able to provide the best quality visit and address not only the provider’s needs, but also the home health team, patient, and caregiver. The project needs IT support for both the onsite provider as well as the home health team in the patient’s home. Plans for IRB Approval An institutional review board (IRB) is a committee that is mandated by the National Research Act, Public Law 93-948 and is required in institutions that conduct biomedical or behavioral research that involves human subjects (Harris, Roussel, Walters, Dearman, 2011). IRB approval will be sought for this project using the Carolinas Healthcare System’s IRB. The submission type will be expedited. This approach was chosen because it is evidenced based research and poses minimal human risk to the participants (Chatham University). Prior to approval by the IRB this project must be submitted to the NSAC therefore this will be performed in September 2015. Once approval has been obtained by the NSAC the information will then be submitted to the IRB for approval, likely in November 2015. This letter can be reviewed in Appendix A of this paper. References American Nurses Credentialing Center. (2014). Magnet model. Retrieved  fromhttp://www.nursecredentialing.org/Magnet/ProgramOverview/New-Magnet-Model Chatham University. (n.d.). Institutional Review Board (IRB). Retrieved from  http://my.chatham.edu/tools/irb/ Chittoria, R. (2012). Telemedicine for wound management. Indian Journal of Plastic Surgery,  45(2), 412-417. Gardiner, S., Hartzell, T. L. (2012). Telemedicine and plastic surgery: A review of its  applications, limitations and legal pitfalls. Journal of Plastic, Reconstructive   Aesthetic Surgery: JPRAS, 65(3), 47–53. doi:10.1016/j.bjps.2011.11.048 Harris, J., Roussel, L., Walters, S., Dearman, C. (2011). Project planning and management:  A guide for CNLs, DNPs, and nurse executives. Sandbury, MA: Jones Bartlett  Learning. Kidholm, K., Dinesen, B., Dyrving., A, Rasmussen, B., Yderstraede, K. (2014). Results from  the worlds largest telemedicine project-The whole system demonstrator. EWMA journal,  14(1), 43-48. Ogrinc, G., Headrick, L., Moore, S., Barton, A., Dolansky, M., Madigosky,  W. (2012).Fundamentals of health care improvement: A guide to improving your  patients’ care(2nded.). Oakbrook Terrace, IL: The Joint Commission and the Institute  for Healthcare Improvement. Sen, C. K., Gordillo, G. M., Roy, S., Kirsner, R., Lambert, L., Hunt, T., . . . Longaker, M. T.  (2009). Human skin wounds: A major and snowballing threat to public health and the  economy. Wound Repair and Regeneration, 17, 763-771. Shulman, M. A., Myles, P. S., Chan, M. V., McIlroy, D. R., Wallace, S., Ponsford, J. (2015).  Measurement of Disability-free Survival after Surgery.Anesthesiology,122(3), 524-536.  doi:10.1097/ALN.0000000000000586 Wallace, D., Hussain, A., Khan, N., Wilson, Y. (2012). A systematic review of the evidence  for telemedicine in burn care: With a UK perspective. Burns, 38, 465-480. Wilkins, E., Lowery, J, Goldfarb, S. (2007). Feasibility of virtual wound care: A pilot study.  Advances in Skin Wound Care, 20(5), 275-278.

First Persian Gulf War: 1990-1991 Essay -- history

First Persian Gulf War: 1990-1991 The First Persian Gulf War between 1990 and 1991 was the most militarily efficient campaign in US history where comparatively few lives were lost. This war accomplished many goals, including that it secured the economic advantages for the â€Å"Western World†. It encouraged a free flow of natural resources, established the value of air power and superiority, and verified that a free alliance for justice will prevail over armed aggression. In the end, the United State’s goals were accomplished: Kuwait was liberated from Saddam and peace settled into the Middle East (Rayment). The Soviet Union attacked Afghanistan on December 27, 1979. This posed a threat on the United States because of their oil ties in this area. On January 23, 1980 President Jimmy Carter responded with a statement called the Carter Doctrine. In this, Carter stated that, â€Å"An attempt by any outside force to gain control of the Persian Gulf region will be regarded as an assault on the vital interests of the United States of America, and such an assault will be repelled by any means necessary, including military force.† (Richie, 25). Ten years later, United States officials were reminded of the Doctrine as signs of an Iraqi invasion of Kuwait by Saddam Hussein began to appear. With a portion of the world’s oil of eleven percent, this invasion would add another nine percent. Not only was this dangerous but if Iraq continued a southern advance, he would gain the oil of Saudi Arabia. Saddam could possibly control forty-six percent of the world’s oil supply and manipulate the global economy (Richie, 25). On July 17, 1990, photos from a KH-11 spy satellite showed that Iraqi military equipment was being positioned near the Kuwait border .General Colin Powell was not concerned with this advancement because the lineup did not include necessary equipment such as fuel trucks and artillery that would be needed for an invasion. Powell believed that this was just a practice exercise or a bluff because Saddam had been pressing Kuwait to lower the oil production in order to keep the prices high (Richie, 26). Kuwait was a small country that had once been part of the Ottoman Empire like Iraq. Then Kuwait had become a British Protectorate from which it had been granted its independence. Its borders had been set in a subjective manner causing it to be difficult to de... ...s pride, and possibly his life. Saddam and his troops were not the only ones to have made faults (Marshel). Had the United States carried out their task, Saddam would not have repressed his own people, violated peace agreements and worked on weapons of mass destruction (Rayment). The United States was able to keep Saddam from succeeding in his attempt to conquer the Middle East eight years ago, but they stopped when they should have pursued the most (Marshel). Without the errors that both sides had made, the present day world would have been affected in a completely different way. Works Cited Allen, Thomas B., et al. War in the Gulf. Atlanta, Georgia: Turner Pub., 1991. Bush, George. â€Å"Persian Gulf War.† Annals of American History. 3 Mar. 2004 "Desert Storm 1: 1990-1991." Gulf War. 2003. 3 Mar. 2004 . Lee, Roger A. â€Å"The Persian Gulf War (1990-1991).† The History Guy. 14 Aug. 2001. 3 Mar. 2004 Marshel, Jim. "Mistakes of the Gulf War." Unpublished essay, 13 Mar. 1998. 3 Mar. 2004 . Rayment, W. J. The Gulf War. 2004. 3 Mar. 2004 . Richie, Jason. â€Å"Persian Gulf War, 1991.† Iraq and the Fall of Saddam Hussein. Minneapolis, Minnesota: Oliver Press, 2003.

Physiological Effects of Ventolin :: essays research papers

Physiological Effects of Ventolin Ventolin is a brand name of the drug albuterol sulfate HFA, and its generic name is adrenergic bronchodilator. It is mostly taken as an inhalator, but can also be taken as tablets or syrup. It treats the symptoms of bronchospasms. Bronchospasm is an abnormal contraction of the smooth muscle of the bronchi, narrowing and obstructing the respiratory airway, resulting in coughs, wheezing or difficulty in breathing. The chief cause of this condition is asthma, although it may also be caused by respiratory infection, chronic lung disease or an allergic reaction to chemicals. The mucosa lining of the trachea may become irritated and inflamed, which secretes mucus, causing it to be caught in the bronchi and triggers coughing. On the handouts, there are three different pictures of the inside of the trachea, showing the difference between a normal healthy trachea, and inflamed one and another with a mucus plug from the left main bronchus. These pictures were taken from the internet, with the address on the handout. A Ventolin inhalator is breathed in through the mouth to open up the bronchial tubes of the lungs. It relaxes the smooth muscles of all the airways, from the trachea to the terminal bronchioles. Ventolin also clears the mucus in the bronchi, making it easier for patients to breathe and reduces coughing. For Ventolin to work optimally, situations that may trigger an asthma attack must be avoided. These situations include exercising in cold, dry air; smoking; breathing in dust; and exposure to allergens such as pet fur or pollens. Relating to the case study, a few of these may apply to the patient, such as exercising in the cold morning air and perhaps breathing in dust and allergens such as pollens or maybe from the eucalyptus in the Blue Mountains might have had an effect on his condition. There are two forms of bronchodilators, a short acting and a long acting form. Short acting relieves or stops asthma symptoms and is very helpful during an attack. They are also called ‘rescue’ medications because they are best for treating sudden or severe asthma symptoms. Long acting bronchodilators are used to control asthma, they take longer to work but they also last longer, up to 12 hours, whereas a short acting would only last for about 4-5 hours. Ventolin is a short acting form, it is the recommended medication to use 15-20 mins before exercising.

Bioterrorism and Plague Essay -- Biological Terrorism Terrorist Homela

Bioterrorism and Plague Plague, also known as Yesirnia pestis, has wreaked havoc since the first documented outbreak in the 6th century, along with changing the course of history. Although bubonic plague is the most common form of plague, pneumonic plague is the more fatal form of the bacteria. It is the only form that has been successfully aerosolized by man and has the potential of taking down a mass of people in days. If used as a bioweapon, it would cause major damage. This paper is designed to inform you of the history, the facts, and the precautions needed to prevent a bioterrorist attack. In 1970, The World Health Organization estimated that 50 kg, or 110 lb, of Y. pestis sprayed over a city would infect 150,000 individuals and kill about 40,000 (Grey, p.218). Throughout history, there have been plague epidemics that have killed thousands of people. From the Athenian plague starting in 430 B.C. to the famous Black Death in 1346, people from all over the world have been caught in chaos with insufficient treatments and no reliable way of preventing this horrible disease from spreading. Today, vast medical advancements have yielded successful treatments for the plague, but people are still highly susceptible to widespread disaster if a bioterrorist attack does manage to occur. In 430-26 B.C. during the Peloponnesian War, which was fought between Sparta and Athens, overcrowded conditions in the cities allowed plague to spread quickly. It claimed tens of thousands of victims including Pericles, the former leader of Athens. We know of this outbreak because of the last remaining source: Thucydides in his History of the Peloponnesian War (Smith, p. 1). Having been through the plague himself, Thucydides described the symptoms w... ...5. Arizona Dept. of Health Services. 8 July 2005 â€Å"FAQ About Plague.† 2005 CDC. 5 April 2005. www.bt.cdc.gov/agent/plague/faq.asp Med TV. â€Å"Bubonic Plague Symptoms.† 2006. MED TV. 11 Oct. 2006. www.plague.emedtv.com/bubonic-plague-symptoms.html Henderson, Donald; Inglesby, Thomas and O’Toole, Tara. Bioterrorism. Chicago: American Medical Association, 2002. Inglesby, Thomas and Dennis, Davis. â€Å"Plague as a Biological Weapon.† Medical and Public Health Management. 2000. JAMA. 3 May 2000. http://jama.ama-assn.org/cgi/content/full/283/17/228/ â€Å"Natural History.† Plague. 2005. CDC. 30 March 2005. http://cdc.gov/ncidod/dvbid/plague/history.htm#100 Mayoclinic. â€Å"Plague.† Health Library. 1998-2008. Mayo Clinic. 1 Sept. 2006. www.cnn.com/HEALTH/library/DS/OQ493.html Grey, Michael and Spaeth, Kenneth. â€Å"Plague.† The Bioterrorism Sourcebook. The McGraw-Hill Companies: US. 2006.

Mrs.Daas

Interpreter of Maladies Good Evening, My name is Trisha Hariramani. A student of The Cathedral Vidya School Lonavala Batch IBDP1 doing my English SL in the A1 course shall be presenting my individual oral presentation on the Character of Mrs. Das in the short story of The Interpreter of Maladies. The collection of stories deals with the everyday lives of Indians abroad (mostly Bengali immigrants), as they go out into the New World with their Indian Diasporas at hand. Jhumpa Lahiri tells us tales of complicated marital relationship, infidelity and the powers of survival.Her short stories, Interpreter of maladies, the blessed house, Mrs. sen, and the treatment of Bibi haldar, are exclusively about women perceived through the eyes of a third person. Each of these female characters has the common motif of exclusion and to a certain extent the pursuit for fulfilment. I am going to be solely focusing on Mrs Das’s character, her traits and personality. In this story of cultural shock , the opening sentences which describes a bitter quarrel between Mrs.Das and her husband over who would take their daughter, Tina, to the bathroom, convey to the reader that not only does she have constrained marriage but also that her children are an obligation to her. Jhumpa Lahiri expands on this initial impression of disgust and depicts Mrs. Das to be self engrossed. She is portrayed to be indifferent to her surroundings. For instance when the men at the tea stall try and tease or entice her by singing Hindi love songs she doesn’t pay any mind at all. Her lack of understanding of the language reveals her cultural obliviousness. To add to this prevalent obliviousness the author describes Mrs.Das’s physical appearance and sense of clothing intently. By doing so she evokes Mrs. Das’s American background and upbringing. â€Å"Her hair was shorn a little longer than her husband’s† as opposed to the long black hair of a stereotypical Indian woman, th is indicates that she is modern and doesn’t have a traditional Indian mindset. Lahiri explicitly portrays the ignorance of Indians abroad towards their homeland as well as the negligence of their cultural values. Jhumpa Lahiri could probably relate or has observed this because she was born and raised outside of India.Instances such as the little boys’ amusement towards the picture of â€Å"the elephant god† commonly known as Ganpati, who is one of the deities best-known and widely worshipped in India depicts how unaccustomed the Das’s were to their Hindu faith. Another example is when Mr. Das inquires about his wife to Tina and refers to Mrs. Das by her first name , this is a confined to be disrespectful in India. The Das’s were evidently tourists in their own country and hadn’t maintained their Indian Diasporas; these close observations are made through the eyes of Mr.Kapasi, their tour guide. Mr. Kapasi empathises with Mrs. Das and easily identifies symptoms of the couples strained marriage. Every relationship goes through hardships but theirs was prolonged, and this played like a broken record in Minas’ mind. She was convinced that she had fallen out of love with her childhood sweetheart and it dawned on her that she may have missed out on what life had to offer. She reflected her life day in a day out eventually falling out of love with life as well. Mrs. Das was gravely depressed. We could relate her eating habit with this). She believed that her husband didn’t suspect or sense their strained marriage but I reckon he did, he just refused to acknowledge or accept the fact.Their marital problems are revealed through their constant bickering, frustrated tones, the indifference towards one another as well as the protracted silences. More than that is their total disregard for each other’s opinion. For instance, Mrs. Das had thought Mr. Kapasi second job to be romantic. â€Å"Mr. das craned to loo k at her. â€Å"What’s so romantic about it? His tone was vexing. The essence of her maternity is alas implicit. There are several instances where she displays an unruly temperament as a mother. For example; Not holding Tina’s hand as they walked to the restroom, nor did she call on the carpet when Tina fiddled with the lock of the car door. While applying nail polish her daughter’s immaterial demand to have some put on her as well was turned down. â€Å"Leave me alone,† she said turning her body slightly. â€Å"You’re making me mess up. † Once again expressing her selfish demeanour.Indirectly implying to the reader to the reader that a bottle of nail paint was more important to this woman than the one she so lovingly conceived her daughter Tina , how the value of love is lost to the realms of a materialistic object which in reality is unimportant, valueless and temporary. In strong comparison, Mr. Das was more of a father figure. He made a n effort to mind the children and answer their dewy-eyed queries. â€Å"What’s Dallas? † Tina asked. â€Å"It went off the air,† Mr. Das explained. â€Å"It’s a television show. † This shows us that Mr. Das doesn’t ignore his children and that he disciplines them when needed. Don’t touch it† Mr. Das warned Ronny. He could see that the little boy was fascinated by the goat and was tempted to go play with it. Unfortunately, when the child rushed over to play with the goat he just frowned and didn’t intervene. Mr. Kapasi finds it hard to believe that the Das’s were regularly responsible for anything other than themselves. This is subjective because this may be strange to someone who has been brought up in India but to an American it could be completely normal. In the story, Lahiri distinctly puts it across to the reader that they weren’t ready to take on the role of parents, and that they were too young.Mrs. Da s sounds more like a teenager being dragged for a family vacation by her parents. Rather than a mature parent aware of her responsibilities. She came out of hiding behind her dark brown sunglasses only when Mr. Kapasi revealed his second job as an interpreter. The attention that Mr. Kapasi received intoxicated him and made him delirious. Little did he know that her sudden interest in him wasn’t genuine and that she had an ulterior motive . Her intentions, which were to relieve herself of her burdensome secret, were blatantly put across when the two were left alone in the car. Mr.Kapasi reads Mrs. Das like an open book at this point. She confesses to him her adultery, and justifies her doings. Her overwhelmed youth being taken from her, having no one to confide in after a bad day, loneliness, this gives me a sense of why she behaved the way she did and had her unconventional feelings to throw everything away. She was expecting a remedy for the way she had felt, unfortunately M r. Kapasi had failed to meet her expectations, she also felt insulted by what he had to say to her. This is depicted by the glare that she gives him. She then turns her back to him and gets out of the car. Is is really pain you feel, Mrs Das, or is it guilt? †Mr. Kapasi certainly hadn’t provided her with a remedy for her ail, but he got to the heart of the matter. After all he was only an Interpreter of Maladies. I found Mrs. Das’s character particularly appealing because of how the story manifested her selfish and egotistical behaviour. Until the very end of the story the reasons for her bad behaviour is a mystery to the reader. As one reads on you are able to empathize with her as she justifies her behaviour and expresses her agony and frustration that she has been suppressing for over a decade. I’d like to end with a quote;