The use of spinal immobilisation in the prehospital environment An Essay

The use of spinal immobilisation in the prehospital environment An investigative study - Essay Example Findings such as continuous oozing, subcutaneous emphysema and especially expanding haematoma were initially missed. Current literature does not directly address the indications, benefit and risk concerning so-called immobilization for penetrating neck injuries. This is true for both journals and major trauma textbooks. Most authors simply recommend that all patients with such injuries should be immobilized, or merely state that such is the practice in their emergency department and pre-hospital trauma care. Even the manual of the ATLS does not make a distinction between blunt and penetrating neck trauma, generally stating that "any patient with a suspected spine injury must be immobilized above and below the suspected injury site until injury has been excluded by roentgenograms". In addition it stresses that "cervical spine injury requires continuous immobilization of the entire patient with a semi-rigid cervical collar, backboard, tape and straps before and during transfer to a definite-care facility". (Sauerland, 2004) In depth analysis of the text following these statements reveals that the au thor is referring only to casualties from blunt injury! Although there is no proven benefit of spin... Immobilization has been demonstrated to cause back and head pain, resulting in an increased number of radiographs required to clear the spine in the emergency department (ED). Rigid spine immobilization can also cause pressure-related tissue breakdown, restrict respirations, and, if used aggressively, actually cause spinal cord injury. (Jones, 2004) Importance of Spinal Immobilization ED studies have confirmed the ability of clinical criteria to reliably determine the need for spine radiographs, although the majority of these have addressed only the cervical spine. Stevens reported that only a small number of patients with cervical spine injury escaped capture using clinical clearance criteria in the ED. Although the ED use of clinical spine clearance protocols has been reported, the validity of using a similar protocol in the EMS setting has not been fully addressed. The goal of prehospital management of SCI is to reduce neurological deficit and to prevent any additional loss of neurological function. (March, 2002) Therefore, prehospital management at the scene should include a rapid primary evaluation of the patient, resuscitation of vital functions (airway, breathing, circulation; the "ABCs"), a more detailed secondary assessment, and finally definitive care (including transport and admission to a trauma centre). Moreover, after arrival at the scene, it is impo rtant to "read" the scene and to appreciate the mechanism of injury in order to identify the potential for SCI. Prehospital management in general and the management of the airway and ventilation in particular should include immobilisation of the spine in suspicious cases to reduce the risk of a secondary SCI. (Hoffman, 2000) Cardiovascular

AQA AS Philosophy Reason and Experience Key Points Essay Example for Free

AQA AS Philosophy Reason and Experience Key Points Essay †¢There are different types of knowledge: acquaintance, ability and propositional knowledge. Theories of knowledge discussed here are about propositional knowledge. †¢Knowledge is not the same as belief. Beliefs can be mistaken, but no-one can know what is false. †¢Knowledge is not the same as true belief, either. True beliefs may not be justified, but can be believed without evidence. To be knowledge, a belief must be justified. †¢Rationalism claims that we can have synthetic a priori knowledge of how things are outside the mind. †¢Empiricism denies this. It claims that all a priori knowledge is only of analytic propositions. Do all ideas derive from sense experience? †¢Locke argues that the mind at birth is a ‘tabula rasa’ – there are no innate ideas, which Locke defines as ideas present in the mind from birth. †¢Locke argues that there is no truth that everyone, including idiots and children, assents to – so no truth is innate. †¢Rationalists define innate ideas as ideas (concepts or propositions) whose content can’t be gained from experience, but which are triggered by experience. †¢Locke and Hume argue that all concepts are derived from sense experience, from impressions of sensation or reflection. †¢They claim that simple concepts are copies of impressions; complex concepts are created out of simple concepts by combining and abstracting them. †¢One argument for innate concepts is to challenge the empiricist to show how a particular complex or abstract concepts, for example, a physical object, is supposed to be derived from experience. If it cannot be, and it is used by children, then this is a reason to think it is innate. Are all claims about what exists ultimately grounded in and justified by sense experience? †¢Hume argues that all a priori knowledge is of relations of ideas, and so analytic. All knowledge of synthetic propositions, matters of fact, is a posteriori. It depends either on present experience or causal inference, which relies on past experience. †¢Our knowledge of matters of fact that relies on induction can only be probably – never proven. †¢Some rationalists, for example, Descartes, try to show that we can use a priori intuition and deductive argument to demonstrate what exists. †¢The core of the idea of rational intuition is that you can ‘see’ the truth of a claim just by thinking about it. †¢Descartes argues that sense experience on its own cannot establish what exists – how can we know that all sense experience is not a deception cause by an evil demon? †¢He argues that he cannot doubt his own existence, and that the mind can exist without the body. †¢Descartes argues for the existence of the physical world by first arguing for the existence of God. From God not being a deceiver, it follow that our sense experience in general can’t be completely mistaken – so they physical world exists. Conceptual schemes and their philosophical implications †¢Thinkers who defend the idea of conceptual schemes often argue that there are two distinguishable elements to our experience – the data of the sense, and then the interpretation of these data by a set of concepts. †¢Some argue that human beings have formulated different conceptual scheme which are not translatable into each other. From the same sense experience, they form different views of the world. †¢Because we must use concepts to formulate truths, we can argue that truths are relative to conceptual schemes. Or more accurately, some truths can only be stated in certain conceptual schemes and not others, and there is no one conceptual scheme which we can use to state all truths. Do all ideas derive from sense experience? II †¢One objection to the empiricist theory of the origin of concepts is that there are some complex concepts, for example, knowledge and beauty that cannot be analysed in terms of simpler concepts. †¢A second objection is that some simple ideas, for example, a particular shade of blue, don’t have to be derived from sense impressions. Empiricists can respond in two ways: all ideas could be derived from sense experience’ or some ideas are exceptions to the rule that all ideas are derived from sense experience, but these exceptions are derived from ideas that are derived from sense experience. †¢Another objection is that it is not possible to derive any concepts from experience, because in order to form concepts, we must make judgements of similarity and difference to classify experiences. But we can only make these judgements if we already have the concepts. †¢Defenders of innate ideas maintain that we innately have very specific capacities for forming particular ideas, and these ideas count as innate. †¢Suggestions for the origin of innate ideas include evolution, God, and a previous existence. Are all claims about what exists ultimately grounded in and justified by sense experience? II †¢Rationalists claim that we have synthetic a priori knowledge either innately or through rational intuition †¢Plato argues that many particular objects can have the same property, for example, beauty. These properties can exist independently of the particular objects, as shown by the fact that is we destroy all beautiful things, we haven’t destroyed beauty. These properties are instances of the Forms. †¢Plato argues that innate concepts are our knowledge of the Forms, from a previous existence. Unless we had such innate memories, we wouldn’t be able to classify experience using concepts. †¢Descartes argues that he cannot doubt his existence. We can object that he cannot know he exists; only that thoughts exist. †¢Descartes also argues that the mind can exist without the body. We can object that just because he can conceive that this is possible doesn’t show that this is possible. †¢Both these arguments and the objections use a priori reasoning. Hume objects that a priori reasoning can only establish analytic truths. †¢Nietzsche argues that reasoning is not, in fact, something independent that reveals the truth, but is grounded on assumptions about value. Metaphysical theories are the result of attempts to defend a particular way of understanding the world, one that rests on the false assumption that good and bad are opposites. †¢The verification principle claims that a statement only has meaning if it is either analytic or empirically verifiable. However, the principle itself is neither analytic nor empirically verifiable. †¢Rationalists argue that mathematics is an example of synthetic a priori knowledge. Empiricists argue that mathematics is analytic. Is certainty confined to introspection and the tautological? †¢Descartes argues that what we can doubt is not certain enough to be knowledge. However, we can argue that certainty and justification are not the same thing, and that while knowledge needs to be justified, we need an argument to show that it must be certain. †¢Certainty can refer to a subjective feeling, to a proposition being necessarily true or to the impossibility of doubting a proposition. †¢Empiricists claim that analytic truth is the only kind of necessary truth. Rationalists argue that there are synthetic a priori truths that are also necessary. †¢A necessary truth is certain. Claims about mental state, based on introspection, may also be certain for the person whose mental states they are. †¢Whether any other claims are certain depend on whether there are necessary synthetic a priori truths. Conceptual schemes and their philosophical implications II †¢Kant argues that experience is of objects, and asks how it is possible for experience to be intelligible in this way, not a confused buzz. †¢He answers that what makes experience possible are certain concepts, which he calls categories. These categories together express the ‘pure thought of an object’. †¢One such category is causality. This enables us to distinguish the temporal order of our perceptions from the temporal order of objects. †¢Kant argues that to talk of concepts interpreting sensation is misleading. Our sensory experience is always already conceptualised as experience of objects. †¢Two implications of Kant’s theory are that the structure of the everyday world of objects is defined by our a priori concepts; and that we cannot know anything about how reality is completely independent of how we think of it.

The Seven Habits Of Highly Effective People English Language Essay

The Seven Habits Of Highly Effective People English Language Essay In todays competitive world, looking for your next advantage is an ongoing exercise that requires a commitment to continuous improvement, reflection and a candid belief that the process of learning never ends. Some say that the day that you stop learning, is the day that you stop living and so comes one of the great minds on personal development, Dr. Stephen R. Convey author of the critically acclaimed book The 7 Habits of Highly Effective People to assist with that process. Before our analysis of 7 Habits, I will provide some information and background on the author, Covey. Covey is the author of several books including the international best seller, 7 Habits, a book named the #1 Most Influential Business Book of the Twentieth Century and one of the top-ten most influential management books every. The book has been sold more than 15 million copies in thirty-eight languages throughout the world. Dr. Covey holds a M.B.A from Harvard University and a doctorate from Brigham Young Univer sity, where he was a professor of organizational behavior and business management.  [1]  With such esteemed credentials, the book 7 Habits presents a holistic, integrated, principle-centered approach for solving personal and professional problems. In his writings, Dr. Covey defines a step-by-step framework for living and working based on fundamental principles that provide the reader with the wisdom and power that change reveals and creates.  [2]  The book is divided into four primary sections, first principles, Private Victory, Public Victory and Renewal, through which revealing seven effective habits that one should pursue if they are to be effective in their professional and personal lives in bring about change. The following analytical essay seeks to describe each of these seven effective habits and analyze each of them would apply in ones life, be it professional or personal. In his first chapters, Dr. Covey seeks to set out the fundamental framework for all other Habits are based on, Principles. These habits represent the internalization of correct principles upon which enduring happiness and success are based.  [3]  Covey establishes the need to create a paradigm shift that involves changing the way we view the world. The events may be completely identical, however, the manner in which we view and interpret them need to be altered in order to make a problem situation into an opportunity i.e. make lemons into lemonade. This very same concept was demonstrated while attending a new release film, featuring Aaron Eckhart and Jennifer Aniston titled Love Happens. In the film Eckhart, an author of a book on self motivation, takes a group of readers down into the streets of Seattle into the middle of a busy intersection, stopping traffic and then asking the group of people to describe what they see in an effort to demonstrate an important point. Traffic! No ise! Honking! Cursing! Anger! Frustration! Concrete buildings, shouted the people from the group as they stood blocking busy downtown traffic. Eckhart, then took the group of people back into the hotel up to the rooftop and once again asked the same question, Now describe what you see, asked Eckhart. Sunshine, rivers, horizon, open roads, HOPE!. Eckhart went on to describe the very concept that Covey describes as he opens the papers to his book on 7 Habits a shift in paradigm, changing your view of the world and good things will follow. What you are seeing is the same (i.e. the city) but seen from different perspectives (i.e. street vs. rooftop) and consequently they offer a different feeling and outlook on life. The first step in 7 Habits begins with the author moving the reader to shift our perspective. An additional example of this is illustrated by Convey by presenting two photos (one of an old lady and one of a young woman) combined into one where the viewer, since they were e xposed to one or the another of the pictures only sees the original picture that they were exposed. In his writing, 7 Habits explores a principle-centered, character-based, inside-out approach to personal and interpersonal effectiveness. Inside-out means to start first with self; even more fundamentally, to start with the most inside part of self with your paradigms, your character, and your motives.  [4]   I know of no more encouraging fact than the unquestionable ability of man to elevate his life conscious endeavor, Henry David Thoreau. The chapter on Habit 1 describes principles of personal vision and the paradigm of Being Proactive. The Habit of Being Proactive is described as achievable through first learning to control our language and avoiding the use of reactive phrases. Lets compare and contrast reactive and proactive phrases: theres nothing I can do versus lets look at our alternatives, I have to do that versus I will choose an appropriate response. The next mechanism under Habit 1 is being aware of the Circle of Concern/Influence. This concept is best explained using the illustration below: Circle of Influence Proactive people focus their efforts in the Circle of Influence. They work on the things that they can do something about. The nature of their energy is positive, enlarging and magnifying, causing their circle of influence to increase. Reactive people, on the other hand, focus on the Circle of Concern. They focus on the weakness of other people, they problems in the environment, and circumstances over which they have no control. Their focus results in blaming and accusing attitudes, reactive language, and increased feeling of victimization. Focusing on this, will result in Circle of Influence to shrink.  [5]  Building on the vision of self-fulfilling prophecy, leveraging the power of positive thinking, combined with control over our language to help yield positive results, with the opposite also being true, negative thoughts will result in the same. We control our happiness, since it starts and ends with the state of mind and in a position of power or influence, one can only be e ffective if he/she makes strides to radiate this energy. What lies behind us and what lies before us are tiny matters compared to what lies within us, Oliver Wendell Holmes. Under Principles of Personal Leadership, Covey introduces Habit 2: Begin with the End in Mind. This Habit describes the idea of a paradigm built on four primary factors, power, security, wisdom and finally, guidance. There are several others including money, family, work, etc but I will chose to focus of the first four. The four factors are described to be interdependent and when present together, harmonized and enlivened by each other, they create the great force of a noble personality, a balanced character, a beautifully integrated individual. The location of these factors on the continuum, the resulting degree of their integration, harmony, and balance, and their positive impact on every aspect of your life is a function of your centre, the basic paradigms at your very core. Things which matter most must never be at the mercy of things which matter least, Goethe. Habit 3 develops the Time Management Matrix, through a habit titled Put First Things, First. The idea behind this habit is primarily, prioritizing based on whether the task is important versus not important and urgent versus not urgent. Being a person of influence and being effective in life is based on your ability to operate effectively with finite resources. There is never enough time to do get it all done. But making the best with what you have and focusing on the important and urgent matters will lead to effective leadership. The next set of Habits revolves around securing the Public Victory and migrating from Independence to Interdependence. This migration involves moving the interests of the many into a cohesive set of values, concepts and vision. As summarized by Samuel Johnson, the paradigms of interdependence are best noted through the following quote: There can be no friendship without confidence and no confidence without integrity. Within his discussions on paradigms of interdependence, Convey wrestles with several philosophies related to building cohesion with individuals and describes the Emotional Bank Account, a concept that notes relationships require that one make frequent deposits through courtesy, kindness and keeping commitments. These deposits, are needed in the journey to effectively mobilizing individuals and creating interdependencies in relationships. What makes you effective as an individual, is not necessarily true as a leader leadership is not management and it is important to dis tinguish between them. As a leader, responsible for the vision of a group, it is needed that you have the support of your team and draw on the reserves (withdrawals) from the emotional bank account in order to maximizing the return of your planned assignment and/or project. We have committed he Golden Rule to memory; let us now commit it to life, Edwin Markham. Habit 4 Think Win/Win is an eye-opening concept that looks to build synergies between individuals by teaching one to change their frame of mind and heart to constantly look for mutual benefit in all human interactions. This means that agreements or solutions are mutually beneficial, mutually satisfying. With a Win/Win solution, all parties feel good about the decision and feel committed to the action plan.  [6]  The paradigms of interaction through Win/Win are divided into six sections in order to assist an individual avoid the traps: Win/Win, Win/Lose, Lose/Win, Lose/Lose, Win and finally Win/Win or No Deal. The specifics of each individual paradigm are a bit too detailed and perhaps out of scope, however, I conclude analysis of this concept with an observation that each person must work hard to understand the interest of all parties if they are to arrive at resolutions that secure longevity in commitment to the cause, project, relation and so forth. Representing each parties interests when arriving at resolutions, serves to ensure that the diversity of concept allows for the needed commitment to ensure that the initiative is seen through. Win/win as described by Covey is not a personality technique. It is a total paradigm of human interaction. It comes from a character of integrity and maturity. It grows out of high-trust relationships, embodied in agreements that effectively clarify and manage expectations as well as accomplishment. It thrives through supportive systems built on culminating and supportive environment built to last with humility and self determination. The heart has its reasons which reason knows not of, Pascal. In the chapter of Principles of Empathic Communication, Covey simply breaks down the process of effective communication into the most basic definition which is listening for the purpose of understanding. This effort, described in Habit 5 as Seek First to Understand, then to be Understood works to explain to the reader that effective people listen more than talk. Hence humans were created with two ears and only one mouth, right? Covey sets out the principles and defines under the act of ignoring, pretending, selective, attentive and finally empathetic. Under each of these definitions of listening the ultimate goal is to first set out understand what the other partys main idea and decode it using effective methods of using probing questions, being empathetic to the other persons position and them moving into seeking to be understood. A common trap everyone is victim of. No one wants to be misunderstood, may it be cultural or language, non-verbal distractions effecting the transmission of ones message the goal and failure are closely linked to the receivers ability to properly listen to what and how the message is being delivered. As a receiver, be the first to lead by working hard to understand the ultimate goal of what is being said, then recapping what is being said to provide the sender with a certain level of comfort, then set out to deliver your message. Sometimes when I consider what tremendous consequences come from little thingsà ¢Ã¢â€š ¬Ã‚ ¦I am tempted to thinkà ¢Ã¢â€š ¬Ã‚ ¦there are no little things, Bruce Barton. The 6th and the third in the process of transferring from Independence to Interdependence, Convey introduces the Habit of Synergizing. Synergy is a natural part of nature. Our ecosystem is built on the synergies between environment, the elements, its inhabitants, all working in tandem to support the renewal and progression of the natural world. Family life provides many opportunities to observe synergy and to practice it, says Covey in his chapter of Principles of Creative Cooperation. The very way a man and a woman bring a child into the world is synergistic. The essence of synergy is to value differences to respect them, to build on strengths, to compensate for weaknesses. The differences between the genders in this example, support the concept of strength in diversity through synergizing since each one person nu rtures a self-esteem and self worth that creates an opportunity for each to mature into independence and gradually move into interdependence.  [7]  Synergizing requires a high level of trust and cooperation to mobilize effectively. It is a natural being of the highest complexity that comes from creating an environment conducive to a network connected with the raw emotions of human trust, cooperation, belonging, all combined together to make for a sustainable goal of achieving a common objective. There is no real excellence in this entire world which can be separated from the right living, David Starr Jordon. The 7th and final Habit, is Sharpen the Saw, the very idea that we began with continuous improvement and self reflection. Though we may think weve mastered the 6 Habits to effective people, we must remained honest in knowing that we will always need to look back and reconsider how were interpreting the world in order to continue to progress effectively. This is the commitment is to preserve and enhance the greatest asset you have you.  [8]  This is represented by renewing the four dimensions of your nature physical, spiritual, mental and social/emotional. The four dimensions of yourself are the elements that form and sharpen your character and well being. Mental Dimension, like your physical being, requires exercise and proper nutrition in the form of literature, writing, strategic thinking and formulating ideas through the written word. Social/Emotional Dimension is gratified through giving back to society in service, charity, being empathetic to those in need and giving back in one form or another. Spiritual Dimension is belief in an absolute truth that formulates the greater purpose in this life. This is fundamental trust and belief in a greater Being that helps to make sense of what cannot be logically explain of life events. The Physical Dimension is the primal need to preserve your physical well being through exercise, proper nutrition and a sound outlet to overcome and manage the stress of life. Seven Habits. Neatly organized in three hundred and seven two pages, supported with examples and personal insights by one of the most acclaimed business academics of the modern age. Where does the thesis of 7 Habits of Highly Effective People stand in my mind after reviewing it in thorough detail? Simply, I agree. Covey is not the first or the last to write a self help book, looking to organize the soft elements of life into nice boxes and short lists that people are can follow to find the great answer to lifes struggle. But 7 Habits isnt just about cute habits organized in boxes. It starts with building on a fundamental concept etched with something everyone needs to be successful in their affairs personal principles. Covey never looks to advocate the laundry list of principles that one should follow to govern their decision matrix. The underlying principles must be based on ones own personal values. Each individual has a value set based on the elements that their life has exposed them to. Regardless of your personal faith, gender, even professional or academic background the principles and Habits outlined by Covey transcend to provide the reader with a scripture and guide that they can use to be more effective in their life, both professionally and academically. No one will ever define the formula of life, but we can train ourselves to understand the decision making paradigms to help make more consistent choices that mobilize first ourselves as individuals, then those interdependent organizations seeking unity and synergy towards that shared objective. 7 Habits is not a self help book, its a book of self reflection to help oneself achieve what they are destined to become. Starting with understanding our personal values, Covey moves the reader through Private Victory: Dependence to Independence by mastering Being Proactive, Beginning with the End in Mind and Putting Fist Things first. Public Victory: Independence to Interdependence by mastering think Win/Win, Synergize, Seek First to Understand, then Be Understood. And that invaluable commitment to continuous improvement and preserving your essential being with Sharpen the Saw. Is 7 Habits the best book I have ever read? Not really. Does it present ideas never considered? No. Then, what makes it great? The unity, simplicity and trust in you as a reader to find the answer within yourself. It takes a wise person, one with an MBA from Harvard perhaps, to understand that you cannot possibly write a book that would transcend 30-some languages and millions of copies with a message that would be applicable to all. It is the courage to provide a framework tailored to personal and individual values that allows everyone to consider this a guiding light to greater prosperity.

Cystic Fibrosis Essay -- Biology Genetic Defect

CF is caused by an inherited recessive genetic defect that is most prevalent in the white population. About 1 in 23 people in the United States carry at least one defective gene, making it the most common genetic defect of its severity. CF patients suffer from chronic lung problems and digestive disorders caused by a cellular defect in the transport of chloride ion. The problem in chloride handling results in loss of chloride in sweat which, in fact, is the basis for the clinical diagnosis of CF. As a consequence of the lesion in chloride transport patients' lungs become covered with sticky mucus which is difficult to remove and can promote infection by bacteria. Many people with CF require frequent hospitalizations and continuous usage of antibiotics, enzyme supplements, and other medications. In the past, the life expectancy of people with CF used to only be 8 years. However, with today's many medical advances, the average life expectancy is just under 30 years and is continuing to increase. Common cystic fibrosis symptoms involve: high amounts of salt (sodium and chloride) and potassium in sweat constant coughing and wheezing large amounts of mucus in the lungs recurring pneumonia failure to gain weight frequent, greasy, bulky, and strong-smelling bowel movements through the small intestine enlargement of fingertips and toes due to insufficient amount of oxygen in these areas Males with CF are sterile, and women who have CF can have problems with their menstrual cycles and becoming pregnant. CF slows down sexual development but brings no adverse effect upon it. Cystic Fibrosis: Fact or Fiction? "Woe to that child which when kissed on the forehead tastes salty. He is... ...olyte composition affects bacterial survival which provides an explanation for why CF airways are not maintained as a sterile environment. The data speculates that the bactericidal factor produced by airway epithelia may be a defensin-like molecule because it has characteristics of such factors. The results presented in the paper also link the molecular defect in CFTR Cl channels to the pathogenesis of CF lung disease. Most importantly the data suggests new approaches for therapy such as measurements of salt concentration and bactericidal activity may be clinically relevant assays for determining the effectiveness of potential therapeutic interventions. The data also raises the possibility that new interventions designed to correct the abnormally high salt concentration in CF fluid could be of benefit in treating or preventing airway infections in people with CF.

In The Fruit at the Bottom of the Bowl by Ray Bradbury and The Tell :: English Literature

In The Fruit at the Bottom of the Bowl by Ray Bradbury and The Tell Tale Heart by Edgar Allen Poe both authors have to convince the reader that the main character is mad. How do they do that? Which portrayal is more effective? Why? This essay will explore which madman is portrayed the best. Both stories deal with an obsession and a madness of some sort. In ' The Fruit at the Bottom of the Bowl' by Ray Bradbury the main character is William Action who frantically cleans trying to cover up the murder. Not knowing he is going mad. In ' The Tell Tale Heart' the man has an obsession with his masters eye, which drives him mad but he does not believe himself that he is mad. In 'The Tell Tale Heart' the characters motive is his masters "vulture's eye" which is shown by saying " I think it was his eye! Yes, it was this! Also when he says " One of his eyes resembled that of a vulture. In 'The Fruit at the Bottom of the Bowl" the characters motive is that his wife is having an affair this is shown by the character saying, " Where's my wife, Huxley? " and " I need one. I can't believe Lily's gone that she-". The first characters motive suggests madness because why would you want to kill a man just because of his eye. The second one stands to reason because if you find out your wife was having an affair the first thing you would want to do is kill the other person In ' The Tell Tale Heart' the narration is first person, so that the readers can put themselves there, the character addresses them directly, It also give you an insight into the characters most inner thoughts and feelings. In ' Fruit at the Bottom of the Bowl ' the narration is third person with stream of consciousness. This allows you to feel as thought you are watching the events unfold and that you become omnipotent. The narration method of ' The Tell Tale Heart' is more effective and convinces the reader of the main characters madness because you can tell the characters most inner thoughts and feelings as he addresses you unlike ' Fruit at the Bottom of the Bowl ' which only shows you the actions and doesn't give you an insight to his mental well being. In 'Fruit at the Bottom of the Bowl ' the characters attitude to the dead body and crime is one of calmness, although he was still conscious that his actions could be traced via his fingertips on the

Withdrawing Forces from Vietnam Essay -- Vietnam War American History

Withdrawing Forces from Vietnam â€Å"I’ve always said, if you don’t go in to win, don’t go in at all†¦Either you conduct the conflict with all the assets the United States has at its disposal to bring about a quick and successful outcome or you stay out.† -Alexander M. Haig JR. The War That Couldn’t Be Won! By withdrawing its forces from Vietnam in 1973 did the United States admit defeat? This is an argument that historians and observers have been having for years. Before answering that question however, we must first understand if we ever really had a chance to win the war. The circumstances leading up to the war were pretty much out of the United States control with an obligation to our French allies. With threats of communism taking over Vietnam, many felt that our presence was needed to avoid Ho Chi Mihn’s control. With all of the excitement, many important factors were overlooked such as did the United States have enough troops to fight this war, what type of retaliation the Vietnamese would use, and were we ready to fight a sixteen year war? The United States strongly underestimated the power and desire that the North Vietnamese had to gain control and preserve communism. It was thought that the US presence in Vietnam was required to contain the communist influence from living up to the expectations of the Domino Theory. The Domino Theory resulted from the Cold War and stated that if one country was to fall under the communist regime, soon neighboring countries would fall. At the time France was fighting to gain back control of Vietnam as it was beginning to feel resistance from small guerrilla groups known as the Viet Kong, so America saw it as its duty to help out their French allies by giving money and supplying weapons. America believed this was necessary in order to help the French keep control of Vietnam and never fall to Communism. These small Communist guerrilla groups were funded by other Communist powers such as China and Russia. If the whole of Vietnam fell to communist rule this could have had an impact on the rest of the world and show that a Communist regime holds more power than the United States Democracy, thus slowly turning the rest of the world communist. This was just the beginning of the part the US played in Vietnam. Gradually they got dragged further and further into the war and sud... ...m was not even really supported by the Vietnamese people. How could the United States expect to win a war when nobody wanted the government they had set up? South Vietnamese guerillas began to work with the North Vietnamese soldiers to defeat the American supported government and to unify Vietnam. The United States basically turned the Vietnamese that were earlier on their side against them. They became angry that so many of their civilians were being injured and killed and did not want the government set up by the United States to stay in place. With even more Vietnamese people against the United States, there was no way that they were going to be able to win this war. In 1975 many tired troops finally came home from Vietnam, defeated. Their efforts did not end communism and left countless numbers of Americans and Vietnamese people dead. The United States weak strategies, the public’s anti-war attitude, and the Vietnamese’s opposition to the government the United States had set up all contributed to the United State’s defeat in Vietnam. The most tragic part about the Vietnam War was that it took about sixteen years to lose a war that from the beginning we were not going to win.

History of Healthcare and Economics

This paper will discuss the history and evolution of healthcare economics and healthcare funding timelines. In the 21st Century healthcare has proven to be one the largest industries world. The healthcare industry has changed dramatically in the last hundred years. As changes and progression are examined, it becomes clearer that healthcare and the economy it has created, is an important part of American life. The way the funds flow in the healthcare system allows financial managers to track the money through the health care system. The initial flow of funds has drastically changed throughout the years. The economics of healthcare, â€Å"the study of how scarce resources are allocated among alternative uses for the care of sickness and the promotion, maintenance and improvement of health, including the study of how healthcare and health-related services, their costs and benefits, and health itself are distributed among individuals and groups in society†, according to The journal of Mental Health Policy and Economy (2006). There are records as early as the turn of twentieth century that show that healthcare providers charged for services including surgeries such as tumor removal, appendectomies and gynecological operations. Services may have been exchanged for items such as livestock, food items, or cotton. The patient or his or her family may have exchanged services for patient care. No form of health care insurance was available; prices were not set by any organization or person. Physicians of the early twentieth century were tradesmen and essentially businessman. Patients paid the full price for the medical services offered by the physician. According to PBS (n. d. ), in the 1910’s some reformers argue that there should be some sort of health insurance. Although the idea seemed to have some support, many physicians and other interest groups did not approve. War World One took place in 1917 and for the moment healthcare reform was put on the back burner. The lack of technology and inadequate health centers raise the amount of cost needed for medical care. The current economic and war state of the country took priority over healthcare reform. General Motors offers life insurance for 180,000 workers through Metropolitan Life. The same time doctors’ wages increased. During the Great Depression, it became apparent that there should be some sort of benefits for individuals as they reached retirement age. Instead of health insurance, the Social Security Act was passed. During the Roosevelt Administration, many reformers pushed for health insurance again, but conflicts within the country once again pushed for health care insurance. Blue Cross started offering private insurance for hospital care in many states even though it was considered a bad idea by many insurance professionals. The timeline from the PBS (n. d. ), website in the 1940’s a radical reformation took place. War World Two wages were capped and controlled on American employers. Companies began offering health benefits to compete with other employers. This idea has sparked the employer-based system that is used by employers today. A Universal Healthcare plan is introduced by President Truman, but is never used. The American Medical Association (AMA) believes the plan is Communist in nature. As the Korean War approached, healthcare reform was once again a low priority. The government established a policy that would make the federal government responsible for sick poor. Many people in 1950’s can no longer afford health care insurance, especially those who do not work. The price of hospital care doubled. President Johnson signs Medicare and Medicaid into law. During the 60’s, more than 700 insurance companies are selling health insurance. During the 1980’s Medicare begins charging insurance by the diagnosis and not the treatment of the patient. Technology, vaccinations, medications, and a rise in hospital expenses raise healthcare costs tremendously. Medicare’s high expenditure rates and rapid inflation of the economy also affected the higher cost of healthcare. Health care has seen many changes over the past years, but all the changes have created the health care system and the economics of the system to this point. As the gross domestic product (GDP) , which is the total market of healthcare, started to increase annually, the private sectors of healthcare, government controlled entities, and insurance companies profit and change policies, which in turn increases the (GDP). An increase in population, aging population and communicable diseases such as Hepatitis, HIV, AIDS, and Tuberculosis has increased the cost of health care even in recent years. Small deductibles, low copayments, and employer-based healthcare insurance have molded the idea in many patients’ minds that the patient should use medical services often to â€Å"get what they pay for. † This has created an imbalance of supply and demand. There are numerous reports that there is a shortage of providers. Rapid training of Physician Assistants and Nurse Practitioners are being educated and trained to help fill the gap of the numerous amounts of patients that need medical attention. The elasticity in health care has forced changes to be made in healthcare billing and insurance. The increased amounts of patients that need medical attention have increased the amount of providers needed. The increased costs of healthcare, technology, research, drugs, and lack of funds available for Medicare have forced a price increase for patients. Many employers find it more difficult to provide costly insurance to employees. Elasticity of services might normally demand a decrease in price, but prices have been inelastic in nature. Elasticity can also have a direct impact on when the government intervenes to set a fair price for services according to Tutor2U (2006). The insurance companies play a huge role in determining the amount of money that is needed for medical care. Supply and demand differ so greatly in the health care community than any other service or industry, making supply and demand a very different story than simply buying milk or a computer. Macroeconomics is the branch of economics that deals with the economy as a whole, such as unemployment rates, deflation and inflation. Microeconomics deals with the insurance companies and other health care related aspects that are affected by the economy fall into a more specific category known as microeconomics. As the whole economy changes, families, patients and individuals must choose to make decisions based on the economy. Healthcare decisions within communities and household are examples of microeconomics. As advances in healthcare are introduced, government regulations are introduced and the economy faces multiple challenges in the future, healthcare will likely see more changes to come.