The Influence of English on My Writing Skills Essay Example for Free

The Influence of English on My Writing Skills Essay I started learning English when I was 10. I found learning foreign language very entertaining, useful and, funny. In a very short time period I learned to speak English quite good and I was able to understand American movies without subtitles. As time was passing, my English was gradually improving and after couple of years I was able to speak it fluently. When it comes to writing, however, I was struggling from the very beginning. Even though I could speak English fluently, I never was really able to print my thoughts on piece of paper. When I was in high school, the English teacher thought that level of my English was among the highest in a class. However, she would never understand my poor performance on written tasks. She was very surprised that I can speak English so well, but still perform poor on essays. In the beginning, the professor though it is due my poor writing skills in general. But, on the other side, my essay grades in Bosnian very excellent, and Bosnian teacher would speak in superlatives about me. So one day, Ana, the English teacher gave me a very interesting task. She first told me to write an essay in Bosnian, and then to use a same topic, and write it in English. I did so, and difference was massive. The Bosnian essay was excellent, and essay written in English not even close as good. We finally found out what was the problem. Although, I was speaking English very well, the most of the words I knew came from different movies and TV shows. The English I was using was mostly made of slang words an terms. It was very good for easy conversation, but not that good for writing. This was a problem that I never completely solved. Despite my writing skills were improving all the time, my English essays were never that good and far away from those written in Bosnian. When it comes to writing the language barrier was insurmountable. The great ideas and thoughts were always coming to my mind, but I was never really able to write them down in English. However, I am pretty sure that I am not the only one with this problem. I think that there are many kids, especially in non-English speaking countries, which have same problems with overcoming language barrier. They all probably have great imagination and great ideas but cannot express them on piece of paper. Overcoming this language barrier was very tough task for me, and I have not finished it yet. Never less, I will keep trying and practicing until my English becomes as good as my Bosnian. I would strongly encourage all other internationals, with same problem, to keep trying and never give up. Because, one day, when we write an English essay and our teacher cannot tell that it’s written by an international; I will know that we made it!

The Respiratory System And Disease Health And Social Care Essay

The Respiratory System And Disease Health And Social Care Essay There are two lungs in the human chest; the right lung is composed of three incomplete divisions called lobes, and the left lung has two, leaving room for the heart. The right lung accounts for 55% of total gas volume and the left lung for 45%. Lung tissue is spongy due to very small (200 to 300  ¿Ã‚ ½ 10 ¿Ã‚ ½6 m diameter in normal lungs at rest) gas-filled cavities called alveoli, which are the ultimate structures for gas exchange. There are 250 million to 350 million alveoli in the adult lung, with a total alveolar surface area of 50 to 100 m2 depending on the degree of lung inflation (2). Conducting Airways Air is transported from the atmosphere to the alveoli beginning with the oral and nasal cavities, through the pharynx (in the throat), past the glottal opening, and into the trachea or windpipe. Conduction of air begins at the larynx, or voice box, at the entrance to the trachea, which is a fibromuscular tube 10 to 12 cm in length and 1.4 to 2.0 cm in diameter. At a location called the carina, the trachea terminates and divides into the left and right bronchi. Each bronchus has a discontinuous cartilaginous support in its wall. Muscle fibers capable of controlling airway diameter are incorporated into the walls of the bronchi, as well as in those of air passages closer to the alveoli. Smooth muscle is present throughout the respiratory bronchiolus and alveolar ducts but is absent in the last alveolar duct, which terminates in one to several alveoli. The alveolar walls are shared by other alveoli and are composed of highly pliable and collapsible squamous epithelium cells. The bronchi subdivide into subbronchi, which further subdivide into bronchioli, which further subdivide, and so on, until finally reaching the alveolar level. Each airway is considered to branch into two subairways. In the adult human there are considered to be 23 such branchings, or generations, beginning at the trachea and ending in the alveoli. Movement of gases in the respiratory airways occurs mainly by bulk flow (convection) throughout the region from the mouth to the nose to the fifteenth generation. Beyond the fifteenth generation, gas diffusion is relatively more important. With the low gas velocities that occur in diffusion, dimensions of the space over which diffusion occurs (alveolar space) must be small for adequate oxygen delivery into the walls; smaller alveoli are more efficient in the transfer of gas than are larger ones (2). Alveoli Alveoli are the structures through which gases diffuse to and from the body. To ensure gas exchange occurs efficiently, alveolar walls are extremely thin. For example, the total tissue thickness between the inside of the alveolus to pulmonary capillary blood plasma is only about 0.4  ¿Ã‚ ½ 10 ¿Ã‚ ½6 m. Consequently, the principal barrier to diffusion occurs at the plasma and red blood cell level, not at the alveolar membrane (2). Movement of Air In and Out of the Lungs and the Pressures That Cause the Movement Pleural Pressure Is the pressure of the fluid in the thin space between the lung pleura and the chest wall pleura. Alveolar pressure Is the pressure of the air inside the lung alveoli. To cause inward flow of air into the alveoli during inspiration, the pressure in the alveoli must fall to a value slightly below atmospheric pressure. Transpulmonary pressure It is the pressure difference between that in the alveoli and that on the outer surfaces of the lungs, and it is a measure of the elastic forces in the lungs that tend to collapse the lungs at each instant of espiration, called the recoil pressure. Compliance of the Lungs The extent to which the lungs will expand for each unit increase in transpulmonary pressure (if enough time is allowed to reach equilibrium) is called the lung compliance. The total compliance of both lungs together in the normal adult human being averages about 200 milliliters of air per centimeter of water transpulmonary pressure (3). Figure 2. Compliance diagram of lungs in a healthy person (3). Pathophysiology of Weaning Failure Reversible aetiologies for weaning failure can be categorized in: Respiratory load, cardiac load, neuromuscular competence, critical illness neuromuscular abnormalities (CIMMA), neuropsychological factors, and metabolic and endocrine disorders. Respiratory load The decision to attempt discontinuation of mechanical ventilation has largely been based on the clinician ¿Ã‚ ½s assessment that the patient is haemodynamically stable, awake, the disease process has been treated adequately and that indices of minimal ventilator dependency are present. The success of weaning will be dependent on the ability of the respiratory muscle pump to tolerate the load placed upon it. This respiratory load is a function of the resistance and compliance of the ventilator pump. Excess work of breathing (WOB) may be imposed by inappropriate ventilator settings resulting in ventilator dysynchrony (4). Reduced pulmonary compliance may be secondary to pneumonia, cardiogenic or noncardiogenic pulmonary oedema, pulmonary fibrosis, pulmonary haemorrhage or other diseases causing diffuse pulmonary infiltrates (5). Cardiac load Many patients have identified ischaemic heart disease, valvular heart disease, systolic or diastolic dysfunction prior to, or identified during, their critical illness. More subtle and less easily recognized are those patients with myocardial dysfunction, which is only apparent when exposed to the workload of weaning (5). Neuromuscular competence Liberation from mechanical ventilation requires the resumption of neuromuscular activity to overcome the impedance of the respiratory system, to meet metabolic demands and to maintain carbon dioxide homeostasis. This requires an adequate signal generation in the central nervous system, intact transmission to spinal respiratory motor neurons, respiratory muscles and neuromuscular junctions. Disruption of any portion of this transmission may contribute to weaning failure (5). Critical illness neuromuscular abnormalities CINMA are the most common peripheral neuromuscular disorders encountered in the ICU setting and usually involve both muscle and nerve (6). Psychological dysfunction Delirium, or acute brain dysfunction: Is a disturbance of the level of cognition and arousal and, in ICU patients, has been associated with many modifiable risk factors, including: use of psychoactive drugs; untreated pain; prolonged immobilisation; hypoxaemia; anaemia; sepsis; and sleep deprivation (7). Anxiety and depression: Many patients suffer significant anxiety during their ICU stay and the process of weaning from mechanical ventilation. These memories of distress may remain for years (8). Metabolic disturbances Hypophosphataemia, hypomagnesaemia and hypokalaemia all cause muscle weakness. Hypothyroidism and hypoadrenalism may also contribute to difficulty weaning (5). Nutrition Overweight: The mechanical effects of obesity with decreased respiratory compliance, high closing volume/functional residual capacity ratio and elevated WOB might be expected to impact on the duration of mechanical ventilation (5). Ventilator-induced diaphragm dysfunction and critical illness oxidative stress Ventilator-induced diaphragm dysfunction and critical illness oxidative stress is defined as loss of diaphragm force-generating capacity that is specifically related to use of controlled mechanical ventilation (9). Clinical Presentation of Patients Patients can be classified into three groups according to the difficulty and length of the weaning process. The simple weaning, group 1, includes patients who successfully pass the initial spontaneous breathing trial (SBT) and are successfully extubated on the first attempt. Group 2, difficult weaning, includes patients who require up to three SBT or as long as 7 days from the first SBT to achieve successful weaning. Group 3, prolonged weaning, includes patients who require more than three SBT or more than 7 days of weaning after the first SBT (5). Clinical Outcomes and Epidemiology There is much evidence that weaning tends to be delayed, exposing the patient to unnecessary discomfort and increased risk of complications (5). Time spent in the weaning process represents 40 ¿Ã‚ ½50% of the total duration of mechanical ventilation (10) (11). ESTEBAN et al. (10) demonstrated that mortality increases with increasing duration of mechanical ventilation, in part because of complications of prolonged mechanical ventilation, especially ventilator-associated pneumonia and airway trauma (12). The incidence of unplanned extubation ranges 0.3 ¿Ã‚ ½16%. In most cases (83%), the unplanned extubation is initiated by the patient, while 17% are accidental. Almost half of patients with self-extubation during the weaning period do not require reintubation, suggesting that many patients are maintained on mechanical ventilation longer than is necessary (5). Increase in the extubation delay between readiness day and effective extubation significantly increases mortality. In the study by COPLIN et al. (13), mortality was 12% if there was no delay in extubation and 27% when extubation was delayed. Failure of extubation is associated with high mortality rate, either by selecting for high-risk patients or by inducing deleterious effects such as aspiration, atelectasis and pneumonia (5). Rate of weaning failure after a single SBT is reported to be 26 ¿Ã‚ ½ 42%. Variation in the rate of weaning failure among studies is due to differences in the definition of weaning failure. VALLVERDU et al. (14) reported that weaning failure occurred in as many as 61% of COPD patients, in 41% of neurological patients and in 38% of hypoxaemic patients. Contradictory results exist regarding the rate of weaning success among neurological patients. The study by COPLIN et al. (13) demonstrated that 80% of patients with a Glasgow coma score of more than 8 and 91% of patients with a Glasgow coma score less than 4 were successfully extubated. In 2,486 patients from six studies, 524 patients failed SBT and 252 failed extubation after passing SBT, leading to a total weaning failure rate of 31.2% (5). The vast majority of patients who fail a SBT do so because of an imbalance between respiratory muscle capacity and the load placed on the respiratory system. High airway resistance and low respiratory system compliance contribute to the increased work of breathing necessary to breathe and can lead to unsuccessful liberation from mechanical ventilation (15). Economic Impact Mechanical ventilation is mostly used in the intensive care units (ICU) of hospitals. ICUs typically consume more than 20% of the financial resources of a hospital (16). A study that analyzed the incidence, cost, and payment of the Medicare intensive care unit use in the United States (US) reveled that mechanical ventilation costs a sum close to US$2,200 per day (17). One study shows that patients in the ICUs receiving prolonged mechanical ventilation represents 6% of all ventilated patients but consume 37% of intensive care unit (ICU) resources (18). Another study corroborates this numbers also showing that 5% to 10% of ICU patients require prolonged mechanical ventilation, and this patient group consumes more than or as much as 50% of ICU patient days and ICU resources. Prolonged ventilatory support and chronic ventilator dependency, both in the ICU and non-ICU settings, have a significant and growing impact on healthcare economics (19). Summary TREATMENT OPTIONS WEANING FAILURE Overview The process of initial weaning from the ventilator begins with an assessment regarding readiness for weaning. It is then followed by SBT as a diagnostic test to determine the possibility of a successful extubation. For the majority of patients, the entire weaning process involves confirmation that the patient is ready for extubation. Patients who meet the criteria in table 2 should be considered as being ready to wean from mechanical ventilation. These criteria are fundamental to estimate the likelihood of a successful SBT in order to avoid trials in patients with a high probability of failure (5). Table 2 Criteria for Assessing Readiness to Wean Clinical Assessment Adequate cough Absence of excessive tracheobronchial secretion Resolution of disease acute phase for which the patient was intubated Objective measurements Clinical stability Stable cardiovascular status (i.e. fC =140 beats*min-1, systolic BP 90 ¿Ã‚ ½160 mmHg, no or minimal vasopressors) Stable metabolic status Adequate oxygenation Sa,O2 >90% on =FI,O2 0.4 (or Pa,O2/FI,O2 =150 mmHg) PEEP =8 cmH2O Adequate pulmonary function f =35 breaths*min-1 PImax =-20 ¿Ã‚ ½ -25 cmH2O Ve < 10 l*min-1 P0.1/PImax < 0.3 VT >5 mL*kg-1 VC >10 mL*kg-1 f/VT 13 ml*breaths-1*min-1 No significant respiratory acidosis Adequate mentation No sedation or adequate mentation on sedation (or stable neurologic patient) Taken from (5) and (15). fC: cardiac frequency; BP: blood pressure; Sa,O2: arterial oxygen saturation; FI,O2: inspiratory oxygen fraction; Pa,O2: arterial oxygen tension; PEEP: positive end-expiratory pressure; f: respiratory frequency; PImax: maximal inspiratory pressure; VT: tidal volume; VC: vital capacity; CROP: integrative index of compliance. 1 mmHg=0.133 kPa. According to an expert panel, among these criteria only seven variables have some predictive potential: minute ventilation (VE), maximum inspiratory pressure (PImax), tidal volume (VT), breathing frequency (f), the ratio of breathing frequency to tidal volume (f/VT), P0.1/PImax (ratio of airway occlusion pressure 0.1 s after the onset of inspiratory effort to maximal inspiratory pressure), and CROP (integrative index of compliance, rate, oxygenation, and pressure) (20) . Minute Ventilation Minute ventilation is the total lung ventilation per minute, the product of tidal volume and respiration rate (21). It is measure by assessing the amount of gas expired by the patients lungs. Mathematicly, minute ventilation can be calculated after this formula: V_E=V_T ¿Ã‚ ½f It is reported that a VE less than 10 litres/minute is associated with weaning success (22). Other studies found that VE values more than 15-20 litres/minute are helpful in identifying if a patient is unlikely to be liberated from mechanical ventilation but lower values were not helpful in predicting successful liberation (15). A more recent study concluded that short VE recovery times (3-4 minutes) after a 2-hour SBT can help in determining respiratory reserve and predict the success of extubation (23). When mechanical ventilation takes place, this parameter is calculated monitoring flow and pressure by the ventilator in use itself or by an independent device attached to the airway circulation system such as the Respironics NM3 ¿Ã‚ ½ by Phillips Medical. Other ways to determine minute ventilation are by measuring the impedance across the thoracic cavity (24). This method though, is invasive and requires implanted electrodes. Maximal Inspiratory Pressure Maximal inspiration pressure is the maximum pressure within the alveoli of the lungs that occurs during a full inspiration (21). Is it commonly used to test respiratory muscle strength. On patients in the ICU or those not capable to cooperate, the PImax is measured by occluding the end of the endotracheal tube for a period of time close to 22 seconds with a one-way valve that only allows the patient to exhale. This configuration leads to increasing inspiratory effort measuring PImax towards the end of the occlusion period. However PImax is not enough to predict reliably the likeliness of successful weaning due to low specifity (15). The measurement of PImax can be performed by devices equipped with pressure sensors. Tidal Volume Tidal volume is the amount of air inhaled and exhaled during normal ventilation (21). Spontaneous tidal volumes greater than 5 ml/kg can predict weaning outcome (25). More recent studies found that a technique that measures the amount of regularity in a series analyzing approximate entropy of tidal volume and breathing frequency patterns is a useful indicator of reversibility of respiratory failure. A low approximate entropy that reflects regular tidal volume and respiratory frequency patterns is a good indicator of weaning success (26). Tidal volume can be measured using a pneumotachographic device. Breathing Frequency The degree of regularity in the pattern of the breathing frequency shown by approximate entropy rather than the absolute value of the breathing frequency is been proven to be useful in discriminating between weaning success and failure (26). The breathing rate or frequency is measured by counting the breathing cycles per a defined period of time. The Ratio of Breathing Frequency to Tidal Volume Yang and Tobin [18] then performed a prospective study of 100 medical patients receiving mechanical ventilation in the ICU in which they demonstrated that the ratio of frequency to tidal volume (rapid shallow breathing index (RSBI)) obtained during the first 1 minute of a T-piece trial and at a threshold value of =105 breaths/minute/l was a significantly better predictor of weaning outcomes However, there remains a principle shortcoming in the RSBI: it can produce excessive false positive predictions (that is, patients fail weaning outcome even when RSBI is =105 breaths/minute/l) [35-36] Also, the RSBI has less predictive power in the care of patients who need ventilatory support for more than 8 days and may be less useful in chronic obstructive pulmonary disease (COPD) and elderly patients [37-39]. The Ratio of Airway Occlusion Pressure to Maximal Inspiratory Pressure The airway occlusion pressure (P0.1) is the pressure measured at the airway opening 0.1 s after inspiring against an occluded airway [42]. The P0.1 is effort independent and correlates well with central respiratory drive. When combined with PImax, the P0.1/PImax ratio at a value of 13 ml/breaths/minute offers a reasonably accurate predictor of weaning mechanical ventilation outcome. In 81 COPD patients, Alvisi and colleagues [39] showed that a CROP index at a threshold value of >16 ml/breaths/minute is a good predictor of weaning outcome. However, one disadvantage of the CROP index is that it is somewhat cumbersome to use in the clinical setting as it requires measurements of many variables with the potential risk of errors in the measurement techniques or the measuring device, which can significantly affect the value of the CROP index. Clinical Treatment Profiles CONCLUSIONS AND RECOMMENDATIONS

Bobby Knight Essay -- Coach Coaching Bobby Knight Essays

Bobby Knight In the San Juan heat of 1984, coaching legend Bobby Knight became infamous for his assault on a Puerto Rican security guard over a practice time during the Olympic preliminaries (Biography 2). Headlines of one of the most famous college basketball coaches of all time haven’t come to an end since. The veteran coach from the state of Ohio has since thrown a chair across a gym floor, been video taped choking a player, and assaulted school employees and fellow students on the campus of Indiana. He has been in heated arguments with anyone from school presidents to the media after heart breaking losses. Scrutiny and controversy have followed Bobby Knight ever since he brought his disciplined style of basketball to the scene of college athletics. Love him or hate him, Bobby Knight is one of the most controversial and talked about coaches of all time. He steals the headlines and spotlight no matter where he is which leaves a fine line in public opinion. The criticism of Knight and actions were displayed very strongly by J.C. Watts in the Sporting News magazine. J.C. Watts is a well respected and known Republican Representative of the state of Oklahoma. He was an All-American college football player at the University of Oklahoma and has been around strong traditional athletic programs ever since his collegiate career (Watts 1). In his article My Turn which appeared in the January 12, 2004 edition of the Sporting News, Watts voices his opinion on Bobby Knight as an outsider looking in with strong incite. Watts, like many individuals, feel that the NCAA (National Collegiate Athletic Association) and the general public have seen enough antics from Bobby Knight. He believes the tirades and disruptions of coll... ...an most coaches could even dream of. The guy is a winner, competitor, disciplinarian, and most importantly a great individual. Oh, and he may just be the greatest college basketball coach of all-time! Works Cited Caldwell, Christopher. â€Å"Knight Falls.† National Review 9 Oct. 2000: 30. Ebsco Host. Academic Search Premier. Indiana University. 14 Apr 2004 . Watts, J.C. â€Å"Knight’s Act is Old, Even in a New Year.† The Sporting News 12 Jan 2004: 7. Lexis Nexis. Academic Search Premiere. 14 Apr 2004 . Outside the Lines. College Athletics. ESPN. Bristol, CN. 2001. Biography of Bobby Knight. 2000. A&E Biography., .

Epic of Beowulf Essay - The Value System in Beowulf :: Epic Beowulf essays

The Value System Revealed in Beowulf  Ã‚   Beowulf is a deeply serious commentary on human life with the main characters embodying a pronounced and coherent set of values. They are also the representatives of the outlined code for conduct and behaviour of those times. Honour, generosity and trust may seem to be the key words in the code. The protagonists reiterate in actions and words a belief in the importance of generosity of spirit and self awareness that make man a responsible member of the society. Beowulf secures the future of his thanes, in case of his death, not leaving them up to their own fate. He proves that in the warrior society, human relationships must be based on mutual respect and trust rather than subordination of one man to another. A warrior vowing loyalty to his lord becomes a voluntary companion more than his servant, taking pride defending him and fighting in battles. In return, he receives affectionate care and rich rewards - e.g. seen in Hrothgar’s attitude to Beowulf’s achievements. The relationship between the relatives is also a part of the outlined characteristics of conduct - if a person was killed, a relative was obliged to kill the slayer or execute the wergild (â€Å"manprice†), even if the killing was accidental. In fact, the money was less important than the actual carrying out of the kinsman’s duty. â€Å"It is better for a man to avenge his friend than to much mourn† – states Beowulf firmly, reiterating the weight attached to the moral responsibilities rather than attention drawn to the materialistic possessions. They were valued highly - the treasure gained in battles improved the well being but it was more of a common factor spiritually uniting the warriors and allowing them to fully realise their potentials. Still, family was the priority. King Hrethel (‘grandfather’ of Beowulf), however, may exemplify a clash in following the code and set values. One of his sons accidentally killed another; by code of kinship king Hrethel was forbidden to exact compensation from a kinsman, yet by the same code he was required to do one in order to avenge death. He was trapped in a situation without a moral way out and therefore Hrethel refused to face life any longer. Marriage also appears to be a part of the general code. It was a form of alliance between the fighting tribes e.

How did the Tsar survive the 1905 Revolution? Essay -- essays research

How did the Tsar survive the 1905 Revolution? Introduction Controversy surrounds whether or not the revolution was a â€Å"dress rehearsal† for the 1917 revolution or a missed opportunity for Tsar Nicholas II to consolidate a constitutional monarchy. This dissertation will focus on the survival of the Tsar, as it is ultimately an open question whether he would have saved the monarchy. The dissertation will also reveal that in the Tsar’s heart was more in reaction than reform. This coursework will show that part of the key to the monarchy’s survival was the division of the opponents of Tsarism. It took World War I to cause a major breakdown in relations that left the monarchy open to further revolution through total war. The 1905 revolution was the result of the Russo-Japanese war which broke out in 1904. The war saw military and naval defeats for the Russian forces. There were food shortages in cities and the Soviets (assemblies of workers and soldiers’ representatives) were formed in St. Petersburg and Moscow. The event which started the whole revolution in the Russian Empire was â€Å"Bloody Sunday†; the event of the massacre of armament workers by Cossacks in front of the Winter Palace at St. Petersburg. The leader, Father Gapon, wanted to present the Tsar a petition requesting an improvement of living conditions and more freedom of expression. Riots spread to Odessa, the Black Sea Port and to Moscow where the Soviets were formed and Trotsky became involved. The battleship Potemkin mutinied and tried to help the Odessa rebels. There was a film made by the director Eisenstein which implied that the 1905 rebellion gave the momentum to a new revolutionary movement. However, ultimately, the revolution of 1905 was suppressed in the short term. Summer brought mutinies from both the navy and army. The loss against Japan at Port Arthur and defeat at Tsushima far from strengthened the position of the Tsar’s government, in fact had weakened it. Autumn saw the transformation of industrial discontent give way to an all-out strike. It was then that the Soviets began to form-councils to demand improvements for the workers, led by Lev Trotsky. Disturbances and riots such as Bloody Sunday clearly proved to be a challenge to the Tsarist system. There are key factors which allowed the Tsar to survive. We can isolate three factors which enhanced the Tsar’s survival: the loyalty of... ...l and social grievances. Stolypin was dropped and he had been assassinated by 1911. The Duma was distrusted and total war after 1914 prepared the road of revolution by 1917. The Tsar survived the 1905 Russian Revolution by a combination of repression, economic reforms and tactics which divided the opposition. Bibliography Ascher, Abraham (1992) Second Edition: The Revolutions of 1905, Stanford University Press.   Ã‚  Ã‚  Ã‚  Ã‚   Bushnell, Albert (1985) Mutiny amid Repression: Russian Soldiers in the Revolution of 1905, Indiana University Press. Evans, David and Jenkins, Jane, (2001) Years of Russia and the USSR, 1851-1992, Hodder and Stoughton Educational. Karpovich, Michael (1960) Imperial Russia, Holt, Rhinehart and Winston Inc. Lynch, Michael (2000) Reactions and Revolutions: Russia 1881-1924, Hodder and Stoughton. Lynch, Michael (2000) â€Å"The Russian Revolution: Russia 1881-1924†, Hodder and Stoughton. Morris, Terry and Murphy, Derrick (2000)â€Å"Europe: 1870-1991† HarperCollins Educational Pipes, Richard (1990) The Russian Revolution 1899-1919, Alfred A. Knoph Inc., Pipes, Richard (1970) Struve: Liberal on the left, 1870-1905 Cambridge Massachusetts Press.

Disadvantages of Watching TV

We require some kind of etiquate to educate the human beings for watching TV execessively without getting the advantages of the same. We have lost all our old heritage to socialise the environment. Watching TV does not involve the person participation actively. In sub-conscious mind we just go on watching the subject without involving our active mind. We are also loosing the social activites as well as outdoor activities which gives boosting effect on human mind. We should generate awareness among the people about the disadvantage of watching the TV. Although this great invention of science has played major role in human life to give more comfort as well as information human requires for his development but in my view disadvantages has also played vital role to destroy of old age heritage which in fact scientifically proven that outdoor as social activites gives metal and physical satisfaction. As we are well our that our encestors have develop sense of visualizing the events happening at far distant places. This has happend because human has practiced his body in such a that they can see adn visualise the thing before the events take place. But TV may not give this opportunity to develope the human mind. Watching TV has become habbit and some time we do not prefer to visit relatives and friends house and also do not prefer to be visited by them. We would like to generate the awareness in the human being to visulaise this drawback in order to avoid untoward incident to happen in futre and repent on this activity at later date. We must develope and generate a group who can devote the time to make people aware about the outcome of this activity.

Ethics and Confidentiality Essay

In the nursing profession, keeping patient confidentiality is of the upmost concern. It is an important feature of the nurse -patient relationship and must be maintain as basis of providing care. Confidentiality is described as respecting other people’s secret and keeping security information gathered from individuals in the privileged circumstances of a professional relationship. (Lee and Godbold , 2012). The privacy act offer nurses some flexibility in using professional opinion regarding disclosure of information; however safe guards must be utilized (McGowan 2012). In the following paragraph, implications of breach of confidentiality and application of ethical principles and theories in decision-making in an ethical dilemma with reference to article by Nathanson , (2000)entitled â€Å" Betraying Trust or Providing Good Care? When is it Okay to Break Confidentiality?† will be addressed. Confidentiality is fundamental in the healthcare system. When Confidentiality is breeched, it may deter patients from seeking treatment for fear of disclosure of one’s personal information (Beech 2007). Confidentiality can result in legal and professional problems, distrust, disrespect, and feelings of betrayal and or poor compliance with treatment. The question then arises, when is it okay to breech confidentiality between a patient and the healthcare provider? Confidentiality may be breeched when harm is foreseen for the patient and the society at large. Mark Gowan (2012) suggests that â€Å"Nurses should be aware of some regulations regarding confidentiality as well as situations and when to use; and disclosure of Protected Health Information are permitted. (****). When faced with an ethical dilemma, all possible options should be explored in order to protect the patient’s right of confidentiality and autonomy. While maintaining confidentiality of patient, it is imperative to note that issues might arise that will necessitate the breach of confidentiality as seen in the case of Nurse Hathaway and the teenagers. Nurse Hardaway was involved in an ethical dilemma when two teenagers with serious diagnosis and demanding confidentiality approach her for care. The nurse was confronted with breaking or maintaining confidentiality and let harm come to the patient (Nathanson , 2000). Of either choices, the nurse may be liable for breach of patient confidentiality or neglect when poor decision is made, because the nurse is professionally and personally responsible for their actions. When faced with ethical dilemmas, applications of ethical principles and theories become necessary in making good decisions. It is vital that nurses are familiar with the principles, theories, standard of practice and code of professional ethics. The decision made by Nurse Hathaway to disclose the diagnosis to the teenager’s parents was viewed as the right decision given the circumstances. Failure of the nurse to disclose the diagnosis to the teenager’s parent would consequently jeopardize the health of the teenager. The ethical theory utilized in the scenario reflects Utilitarian and Deontology approach. A utilitarian approach requires identifying and choosing an alternative that would likely produce the most good for all involved (least harm). The positive outcome of breaching confidentiality outweighs the suffering and poor health status foreseen for the teenager. Nurse Hathaway also utilized the theory of Deontology, which focuses on doing ones duty as long as it is universally applied irrespective of the circumstances. Critical thinking and good decision making skill is vital In advocating for the patient; as it is the duty of the nurse to protect, promote, restore, and maintain the health of the individual and the community. The decision to disclose the teenager’s health information to the school authority was considered unethical. The poor judgment and action by the nurse resulted in humiliation and possible suicidal attempt by the teenager (Nathanson 2000). Ethically, this decision proved not to be in the best interest of the patient and defies the principles of nonmaleficence and beneficence. Both principles entail the duty to do good l and cause no harm. Confidentiality was breached because the situation did not require reporting to the school authorities. An alternative way of dealing with such ethical dilemmas would be for the school nurse to conduct health fairs on safe sex education and health practices among teenagers in the school and community. School nurses and authorities should also be notified of the prevalence of sexually transmitted diseases without identifying any particular student. In worst case scenario, the nurse should also consult with the facility or institutional ethical committee for directive. The ethics committee plays several key roles when it comes to making ethical decision because they are able to identifying whether or not an action is justifiable. One of the roles is to assist in revising and developing policies pertaining to clinical ethics ( DCD ETHICS committee). Collaboratively, the ethics committee together with their diverse experiences, educational back grounds, perspective and unique values would produce a well balanced discussion of alternatives (GCU). The ethics committee might also utilize a combination of the ethical principles and theories in making decision. Uustal’s model also assist in identify the following steps to be taken: identifying the problem, stating your values and ethical position related to the problem, considering factors related to the situation, generating alternatives related to the dilemma, categorizing the alternative, developing a plan of action, implementing the plan and evaluating the plan of action taken. The sole aim of the ethics committee is to advocate, protect and promote the right of the patient while making decisions that will benefit all. As in the previous scenario, the ethical committee if consulted would provide necessary guidance in the dissemination of the patient’s information, thereby eliminating the implication of breach of confidentiality. Confidentiality helps to foster a good nurse-patient relationship. However there are times when confidentiality conflicts with ones duty and values. The law of confidentiality is complex, and demands a balance between patient’s right and the nurse’s duties. When faced with an ethical dilemma there’s a need for proper integration of the ethical principles and theories in order to arrive at a descion that promotes and respects the patients autonomy. Nurses should be acquainted with their code of professional conduct and responsibilities frequently. Nurses should employ the use of the ethics committee found in most facilities as needed.