US Representative Congressman Ander Carson

Ander Carson has been in the U.S. congress for a few years, but after beginning as a Democratic Committee Person in the year 2000, he has been featured in several committee assignments (William par 1).Advertising We will write a custom report sample on US Representative: Congressman Ander Carson specifically for you for only $16.05 $11/page Learn More Some of these assignments are generally the government funded ventures which made it possible for Indiana to continue receiving funds from President Barack Obama’s administration. Recently, he challenged the congress by proposing for a new Grant Program that would enable the low-income families to â€Å"†¦access the locally grown food and vegetables† (House Government par.1). He has considered it to be a benefit for Americans in terms of health and access to food throughout the year. While in Miami, 2011, Ander accused the members of the Tea Party that they wanted to hang him on a tree an d bring Jim Crow back instead. This happened when the Congressional Black Caucus’ members was visiting 5 cities in the month of August (Calvin par.8). In February 2011, despite a majority supporting the Bill, Ander Carson voted against the Rooney Amendment 13 to H.R 1 Bill that advocated for the environmental protection of Florida environment from the high levels of phosphorus and neurotoxin chemicals which contaminated its waters (Calvin par.9). In April 2012, Ander successfully passed a bill to protect the small businesses due to the income tax deduction (Danson par. 4).Advertising Looking for report on government? Let's see if we can help you! Get your first paper with 15% OFF Learn More This bill proposed a 20% deduction of tax for all employees considered to employ less than 500 employees in the business. In fact, many small businesses would benefit from the assignment committees of the government funds. Ander’s views Madrassa as the ideal education system for America, especially if it follows the Islamic model. He is a Muslim and has seen how such a system works, and considers it to have a multiple of benefits if well-employed (Schultz par.5). Most of the schools using the Madrassa Education System within the U.S are funded by Muslims. Commentary In fact, it has been reported that Anderson was the one who gathered various reporters and spoke many lies about the Tea Party though that was a wrong decision (Sherman par. 4). It was a betrayal of his colleagues and considered to be so bad that it even appeared in the Sunday Talk show as well as in the headlines just before the Obama Care Vote. I do respect Ander Carson, but I do not agree with some of his commentaries on his fellow colleagues, especially those made at the Tea Party. He owes an apology to all the frontline fighters for civil rights for making insults to them (Paul par. 3). Those comments were thoughtless and unnecessary. This shows that he can never be trusted by hi s colleagues who closely work with him.Advertising We will write a custom report sample on US Representative: Congressman Ander Carson specifically for you for only $16.05 $11/page Learn More As a matter of fact, there is no single leader from the Tea Party who has advocated for neither the return of the Jim Crow Legislation nor the lynching of blacks. Over the years, Carson has been very active in passing many bills in the U.S. Congress that have helped many Americans. I do agree with his view of the low income families earning a living by growing vegetables and other agricultural commodities. These foods are natural and, therefore, do not interfere with the health of the consumers. It will help many Americans live healthier than they did before. Most Americans have overweight complications and other diseases associated with the chemicals found in the fast food. Therefore, the Grant Program will be supported by many due to the many benefits associated with it. Carson should have supported the Rooney Amendment 13 Bill at the Congress as a person who has been in the frontline for the improvement of lives of Americans. The environment should be kept clean just like he is now proposing for the consumption of the natural foods. Despite the fact that he had voted against the bill, it was passed after majority of the members had supported it (Danson par.6). The bill for deduction of income tax for the small businesses is a good idea as it motivates many small businesspeople to continue employing the Americans since they have enough funds left to pay them well.Advertising Looking for report on government? Let's see if we can help you! Get your first paper with 15% OFF Learn More The only problem is that 500 employees are too many to be considered a small business. The limit should be reduced to around 300 employees. I think there are many issues likely to be encountered if Carson continues proposing for the Muslim model of the Madrassa Education System (Jason par.7). This is a very sensitive issue, and it appears that he has some interests of religion which may go well only with Muslims but not for the Christians. He should be careful in his commentary not to have a bad reaction from the Christians in America. Despite the negative sides of Carson, he has successfully assisted many Americans, which is a good thing, by protecting the Wall Street Consumers while serving in the Capital Markets Authority Committee. Carson has done well in his term at the Congress. Works Cited Benson, Jason. Video: Rep Andre Carson Thinks American Schools Should Be Modeled after Madrassas. 2012. Web. Calvin, Andre. Rep. Carson’s Liberal Action Score: 58. 2012. Web. Danson, James. HR 9 – Income Tax Deduction for Small Businesses – Key Vote. 2012. Web. Felix, William. â€Å"Andre Carson U.S. Representative.† Washington Post, 2008. Web. House Government. â€Å"Congressman Carson Seeks to Expand Year-round Access to Healthy Food for Low-Income Families.† House government Online. 2012. Web. Ogden, Paul. â€Å"Congressman Andre Carson Insults History, Makes Light of Lynchings and Jim Crow Experienced by African-Americans.† Ogden on Politics. 2011. Web. Schultz, Denis. Muslim Congressman Andre Carson’s Modest Proposal: Remake American Education System with Madrassas. 2012. Web. Sherman, Jake. Andre Carson: Tea Party Wants Blacks ‘hanging on a tree‘. 2011. Web. This report on US Representative: Congressman Ander Carson was written and submitted by user Bennett Carver to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

Is Act 5 a fitting end to the play Hamlet Essays

Is Act 5 a fitting end to the play Hamlet Essays Is Act 5 a fitting end to the play Hamlet Paper Is Act 5 a fitting end to the play Hamlet Paper Essay Topic: Hamlet Hamlet is one of Shakespeares later plays, written in the early 17th Century. However, it is set in a 13th Century Danish Court with Hamlet, the eponymous hero, as Prince. The play Hamlet falls into the literary genre of a tragedy. Traditionally, the tale of a tragedy begins with a hero (in this case Hamlet) who, due to unfortunate circumstances, proceeds upon his/her downfall through the play and is usually slain during the closing stages. Shakespeare follows this pattern meticulously, although more specifically than tragedy, he chooses to pursue the style of Senecan Tragedy. The Senecan Tragedy originated from the Roman philosopher and poet, Seneca, who lived in the first century AD. A Senecan Tragedy contains several distinct factors, such as violence and the use of the supernatural. Shakespeare includes these elements in his play to give Hamlet some kind of familiar, sustained theme for his audience. The most prominent Senecan aspect included, is the structure of vengeance. Both Shakespeare and Senecas plays are divided into five acts. Each act contains its own distinct theme. The first act introduces the appeal for vengeance-more specifically the ghost of Hamlets father. By the end of the act Hamlet appears to be accepting the role of the avenger: O cursed spite, that ever I was born to set it rite! (I-v-190) The second act in Senecan Drama revolved around the expectation of the avenger planning his revenge. Comparatively in Hamlet, Act 2 is the period in which the Prince conjures the idea of using a play within a play (another Senecan aspect) to uncover Claudius thoughts and hence enforce his opinion of whether to proceed or not. The act ends with Hamlets soliloquy, the culmination of which is the rhyming couplet (used by Shakespeare to emphasise his point): The plays the thing/ In which Ill catch the conscience of the King (II-ii-600). The play begins to gather its constructive momentum during Act 3. This is when Hamlet uses his mousetrap (the play). He notices the Kings response and consequently believes in the ghost: O good Horatio, Ill take the ghosts word for a thousand pounds (III-ii-290) He almost acts upon his beliefs but decides the time is not right. Hamlet then confronts his mother in the privacy of her bedchamber, but notices that someone is spying upon them. He has no idea who this intruder may be but irrationally stabs through a curtain, killing the father of Laertes, Polonius. Shakespeare includes this section of the play in Act 3 because it acts as a pre-cursor of things to come in the penultimate and final acts. Act 4 is often used as an interval or a break from the theme of vengeance. Revenge is prevented in this act of Hamlet, as the Protagonist is sent to England to be killed. This helps build up the suspense and therefore adds to the drama of Act 5. Hamlet however, escapes and arrives back in Denmark by the end of the act, now having made a final decision. Act 5 is the infamous climax of Hamlet. In the first scene, Hamlet begins conversing with a sexton in the graveyard. The graveyard is used because firstly, it helps give a powerful motif of mortality, which contributes to the tension within the audience, and secondly because this specific location is a prevailing indication of mortality. This motif is furthermore enforced by Shakespeares selective use of language, which is crucial to portray emotions that are beginning to emerge as the play Hamlet moves towards its climax. The quotation: Why may not that be the skull of a lawyer? Where be his quiddities now (v-i-95) is a good example of this. As the scene develops, the audience discovers that the gravedigger does not realise who Hamlet is and therefore talks to him about Hamlet. This incident is a display of dramatic irony; one example of the Elizabethan humour employed by Shakespeare in Act 5. Equivocation and wordplay, also between the gravedigger and Hamlet, is another style, and there are others. Humour is used in the play Hamlet to create dramatic texture. It lightens the atmosphere of the play and the minds of the audience, therefore providing a starker contrast with the bitterness soon to follow. When the funeral procession enters, Hamlet discovers that the grave is being dug for Ophelia, who has committed suicide. This is the first instance of death in Act 5 and Shakespeare is, in some ways, creating the path towards the climax of his play through the death of Ophelia. The Prince then proceeds with his declaration of intent: It is I, Hamlet the Dane (v-i-250). Through this declaration, Shakespeare informs the audience that Hamlet is finally becoming the avenger by adopting the title of his late father, the King. Laertes then declares Hamlet culpable for the death of his father and sister. Shakespeare uses this emergence of antagonism as another pre-cursor of things to come, thus developing his audiences anticipation. They are parted and Hamlet leaves after declaring his love for Ophelia: I loved Ophelia, forty thousand brothers could not with all their quantity of love (v-i-265). This dialogue shows how each avenger is trying to prove superior to the other. The final scene is the climax of the play. It begins with Hamlet and Horatio being informed that the King has arranged a duel between Hamlet and Laertes. Hamlet agrees, believing that fate will take its toll. This scene acts as a catharsis; resolving the various tensions that Shakespeare has created throughout his play Hamlet. The first to be resolved is between Hamlet and Laertes. Laertes wounds Hamlet with his poisoned rapier. Hamlet then stabs and kills his opponent, ending the rivalry between the two. The second tension to be resolved is that between Hamlet and his mother-who drinks a poisoned drink that was meant for her son. The tension between the Prince and his mother revolved around the marriage of the Queen to the dead Kings brother. She admits guilt: Thou turnst my eyes into my very soul, And there I see such black and grained spots (iii-iv-100) but takes little action. This is why Shakespeare chooses to end her life. Hamlet finds the King responsible for his mothers death and in his rage slays his stepfather. This is the third and major tension that is resolved. Finally, to conclude the play, Hamlet dies. Revenge has been completed: Now cracks a noble heart. Good night sweet prince/And flights of angels sing thee to thy rest! I believe that Act 5 is most certainly a fitting end to the play, Hamlet. The act (in particular the last scene) is both exciting and resolving. The vast amounts of tension and/or suspense that commence from the beginning of the play and persist until the end keep the audience interested and alert throughout. Shakespeares culmination of events along with the denouement in Act 5 manages to resolve the many antagonisms and tensions created between the main characters earlier in the play through the duel scene. Additionally, he ends Hamlet with the arrival of a new monarch, Prince Fortinbras, which restores the harmony within the state of Denmark. This restoration leaves the audience with a feeling of completion, as a worthy end to a play should. Finally, Act 5 is a fitting end to the play because of the bloodthirsty conclusion that helps to fulfil the aspects of Senecan Drama, along with the structure of revenge through the quintet of acts. So, in conclusion, I believe that Shakespeare has designed a very fitting end to his revenge tragedy, Hamlet.

It is essay about an event i have visited ( you have to chose the

It is about an event i have visited ( you have to chose the right topic for it - Essay Example The Ham was in the form of a long gown, a collar, and a wraps the right lapel over the left. During lunch hour, we ate delicious triangle shaped rice dumplings made from rice with fillings of nuts, dates, and beans. The staple food for Chinese is rice that helps in the economic growth of the society. I could not help but notice the American culture. The clothing style depends on the status an individual has in the society, occupation, climate, and religion. One of my American friend mentioned that their fashion is greatly influenced by the media and celebrities. She was dressed in cowboy hats and boots and a pair of jeans made her look fabulous. The Americans mostly eat junk food like the hamburgers, hotdogs, cheese, macaroni, and potato chips. In addition, they also eat dried meat as snacks. The amazing European food was distinct from the other foods. I was lucky to taste the Gelato that was sweet and tasty. The Europeans argued that the Gelato was different from ice cream. The gelato has more sugar, softer and creamier compared to ice cream. The European foods have different categories ranging from cereals, meat, fats, and sugar. The Europeans wear upscale and classy clothes. Their fashion entails clean and elegant simple lines that perfectly fit. They prefer wearing different set of colors in different seasons. I was able to interact with the African students and their foods and attire were completely different from the others. Their foods are rich in fiber and often organic. The most interesting meal was the ugali. It is prepared by mixing water and corn to form stiff porridge. It is served with stew and vegetables. Most of the African countries weave clothes from cotton that is grown locally. They also use the dyeing techniques like tie and die. Most of these clothes have a head wrap that is tied around the head and matches the African attire. The Indian Sari is the most common dress in India. Their way of dressing is marked with religion and

Evaluate Auditing Processes Essay Example | Topics and Well Written Essays - 1000 words

Evaluate Auditing Processes - Essay Example The essay will also evaluate the various accounting processes that are being adopted by the federal government in a succinct manner. It is evident that there lay certain specific criteria, which need to be adhered while complying with a standard auditing process. This aspect is also evident in the case of auditing a town or a city. The audit, which has been conducted for the Town of Maywood can be evaluated based on the requirements of GAAS. Theoretically, GAAS is a particular framework, which provides a set of guidelines to be followed by auditors for ensuring accuracy, reliability as well as fairness in the auditing process. The audit conducted for the Town of Maywood was executed with proper observations of the activities performed by the people who were involved with the preparation of its financial statements. It can be affirmed that this particular auditing procedure adhered to the guidelines of GAAS (Kinney Jr, 1986). Notably, the audit report also presented the reason for not considering the financial reports of other towns with which Maywood is associated. This particular aspect also shows compliance of the audit report with the GAAS framework (Public Company Accounting Oversight Board, 2014). Through analyzing the audit report, it can be determined that the audit conducted for the Town of Maywood is in alignment with most of the requirements of the GAAS framework and very little has been omitted or not complied with the same. Prior to the preparation of an audit report, individuals interested both in public administration as well as working as accountants for governmental units must possess an in-depth knowledge about the objectives along with the standards to be followed while preparing an audit report. This may be owing to the reason that the effectiveness of public administration is directly relevant with appropriate

Collapse Essay Example | Topics and Well Written Essays - 1000 words

Collapse - Essay Example The paper will conclude with a critical evaluation f Diamond’s book and summarization of the main points discussed in the whole paper. The author has succeeded in bringing out his message in the book. He has discussed the reasons as to why many societies collapsed especially in the 13th and 14th centuries. Some of the reasons as t why the societies collapsed include outbreak of deadly disease (Bubonic Plague), changes in climatic seasons, and war. Due to the above factors, many people in the societies lost their lives and this led to the reduction of people in the society. There is also the discussion of how the societies were able to recover from the loss. For one, there was strengthening of the army which enabled strong defense against the members of the society. There was cultural survival whereby the culture of the Mongols was dropped and the societies embraced the Chinese cultural traditions. There was multiplication of population due to increase of birth rates. This made the society to replace the people who were lost during the war. According to Diamond, societies collapsed mainly in the fourteenth century due to the outbreak bubonic plague. Since the societies were crowded, the disease widely spread and caused lot of deaths to the people. The outbreak continued up to seventh century whereby by then it had claimed a lot of lives. The disease had spread and had covered most parts of Asia, Europe some parts of north Africa (Diamond 2011 , p. 350). In 1340s, merchants from Mongols and other travelers assisted in the spread of the plague along all the trade routes that were used by the Chinese people. By the year 1348, the disease had spread throughout the Mediterranean basin and most parts of Western Europe. The other reason for the collapse according to Diamond was the changes in climatic seasons whereby in 1300 B.C there was a continued cool season for five years. This made famine to ravage the

Hydration Management in Acute Stroke Patients

Hydration Management in Acute Stroke Patients Introduction Stroke is a global public health concern with many sufferers presenting with varying levels of confusion (Oh and Seo 2007). Management of hydration in acute stroke patients is not standardised and variations in practice can be very wide between different continents. The sheer number of possible comorbidities and the relative ease with which hydration can trigger concomitant problems can lead to increasing incidence and prevalence of long-term patient care resulting from inadequate hydration management. Optimum hydration assessment and management are key clinical activities; however, inadequate hydration controls by health professionals persist (Oh and Seo 2007). Research shows that to guide fluid management to desired levels, a regular assessment of the volume status has to be made Scope This literature review is based on works that are found on Medical Literature Analysis and Retrieval System Online (MEDLINE), the Cumulative Index to Nursing and Allied Health literature (CINAHL), Cochrane, Department of Health (DoH), National Institute of Clinical Excellence (NICE), National Medical Council (NMC), World Health Organisation (WHO), Wiley Interscience and CKS databases that relate to hydration in stroke patients and nursing awareness of hydration in stroke patients. There is wide literature on different aspects of stroke and many authors have studied the effects of hydration in stroke patients. This review looks at literature that discusses management of hydration and/or the impacts of variations in hydration management on acute stroke patients outcomes like method of feeding, time- compliance in taking readings or measurements, legal issues and ethical issues. Relevance to clinical practice This literature review looks at relevant studies by experts that are found on credible databases. The purposes of the expert studies are reviewed and analysed to inform better understanding of current nursing practice in hydrating acute stroke patients. Several studies on hydration highlight specific difficulties relating to the assessment and management of hydration in acute stroke patients. There are differences between the management and the assessment of hydration in different hospitals and these complicate improving awareness of managing hydration for nurses in practice. If optimum hydration is directly linked to improved outcomes in acute stroke patients, research will be required to identify and overcome barriers to effective hydration management, including the development of specific tools (and knowledge base) to facilitate interventions that promote optimum hydration in seeking improved outcomes in acute stroke patients. Methods of search and documentation n on-line literature search of MEDLINE, CINAHL, COCHRANE, DOH, NICE, NMC, WHO and CKS from 1999 to May 2009 failed to identify enough relevant articles on hydration in stroke patients. Other sources were then reviewed for available literature on medical journals including the BMJ and American Family Physician. For the on-line computer-based literature searches, the following keywords were used: stroke, fluid balance, hydration, cerebrovascular accident (CVA), dehydration, stroke outcome, cerebrovascular disorders, medical management, artificial nutrition and hydration, dysphagia, dysphasia, pyrexia, acute brain infarction, enteral tube feeding, fluid and electrolyte balance, neurology, withholding treatment, pathophysiology and nurses and hydration Hydration and hydration management in acute stroke patients This literature review looks at one of the issues encountered globally in the treatment of acute stroke patients optimum hydration. It takes a particular look at the nursing awareness, measurement, assessment, methods of intervention and the legal issues associated with hydration in acute stroke patients. Stroke is a debilitating condition and can be caused by an ischaemic event or a subarachnoid/intracerebral bleeding. Stroke patients usually present in hospital with co-morbidities (Oh and Seo 2007). Variations exist in stroke fatalities across geographical regions even within the same continent. Studies by Bhalla et al (2003) across four European centres (London, Dijon, Erlangen and Warsaw) have shown significant variation (after adjusting for case mix) in stroke case fatality, in incontinence, dysphasia, dysphagia, conscious level, pyrexia, hyperglycaemia and comorbidity. There were also significant intervention differences between centres in intravenous fluid use, enteral feedin g, initiation of new antihypertensive therapy and insulin therapy, with the London centre having the lowest uptake of interventions. In another European BIOMED Programme, significant variations in case fatality for stroke between European centres (after adjustment for stroke severity) were observed, with the United Kingdom (UK) centres having the highest case fatality and the lowest levels of independence (Wolfe et al., 1999). There were lower intervention rates in the UK centre to correct abnormal physiological parameters in the acute phase which may reflect a difference in philosophy of acute medical supportive care compared with other European countries (Wolfe et al., 2001). Awareness of optimal hydration balance and assessment of the patients hydration condition (in the care of acute stroke patients) is a fundamental part of critical care nursing and optimising the hemodynamic situation can be seen as a team-effort. One of the important factors determining quality of the circula tion is the amount of circulating blood (Hoff et al 2008). Following a stroke, patients may have swallowing impairment and other changes of the gastro-intestinal (GI) tract that could affect nutritional and hydration status and that lead to aspiration pneumonia (Schaller et al 2006). Such changes affect the ability of the acute stroke patient to lead a normal nutritional life. Although the Schaller et al (2006) work did not show a direct link between hydration and other comorbidities, they agree that impaired hydrational status is associated with reduced functional improvement, increased complication rates, and prolonged hospital stays. Hydration and hydration status Hydration balance is a measure of the bodys ability to manage fluids and electrolytes. In order to identify the urgency of interventions, nursing staff should characterize an individuals fluid and electrolyte imbalance as mild, moderate, or severe based on pertinent information including lab tests and other relevant criteria. It is important to recognize that the main electrolyte in extracellular fluid (ECF) is sodium and that of intracellular fluid (ICF) is potassium (Edwards, 2001). Toto (1998) pointed out that large increases or decreases in fluid volume can cause infarct, coma and confusion. This knowledge becomes significant in maintaining cerebral blood flow and in preventing secondary brain insult after an acute stroke. In a complication, respiratory or metabolic acidosis will promote the movement of potassium from the ICF and give rise to high serum potassium levels, which may affect cardiac function (Edwards, 2001). This phenomenon can be seen in many traumatic insults to th e brain. A basic knowledge of this physiology in addition to the homeostatic mechanisms for fluid and electrolyte balance is a vital foundation for nursing practice, and essential to the nurses role in hydration management. Cook et al (2005) highlighted the significance of fluids and hydration in the neuroscience patient and in Cook et al (2004) they highlighted that an understanding of the physiological mechanisms that surround stroke is important for nurses to monitor and treat such patients. Kelly et al (2004) in their study of dehydration and venous thromboembolism (VTE) after acute stroke believed dehydration after acute ischaemic stroke (AIS) is strongly independently associated with VTE, reinforcing the importance of maintaining adequate hydration in these patients. Their study of hydration over a 9-day period showed indication that dehydration was largely hospital acquired and that the association was causal. Although the possibility that VTE was already present at entry to hospital cannot be discounted, tests have shown that VTE is rarely present before the second day post stroke, and then it becomes increasingly prevalent over the next few days. This could be for one of many reasons including poor communication between patient and hospital staff, change of environment for the patient and the physiological impacts of stroke Hydration balance and nutritional/electrolyte balance The differences in how hydration is assessed in different hospitals have been subject of study for some time. The significance of fluid electrolyte homeostasis becomes very relevant in trauma and shock situations such as subarachnoid haemorrhage where an inflammatory response is triggered which causes a significant change in capillary membrane permeability in a short period of time. In such situations, water, electrolytes and albumin move into the interstitial space to permit the site of injury to receive the required factors (third space shift) (Edwards, 2001). A number of physiological mechanisms are required to maintain homeostasis of hydration status, all of which inform proactive nursing assessment, intervention and evaluation. Those with trauma to the nervous system are vulnerable to disruption to the homeostasis of fluid and electrolyte balance (Cook 2005). Older adults may have a poorer capacity to adapt to shifts in acute fluid balance, leading to the possibility of cardiac and renal functions being impaired and, as a result, a lower glomerular filtration rate (Sheppard, 2001). Managing the fluid balance of the stroke patient by intake and output measures needs to be exercised cautiously because even though the patients fluid volume may not have changed, his/her circulatory volume may be significantly lower in instances of major trauma (Edwards, 2001) Good hydration has been shown to reduce the risk of urolithiasis (category Ib evidence) (see Appendix 2), constipation, exercise asthma, hypertonic dehydration in the infant, and hyperglycemia in diabetic ketoacidosis (all category IIb evidence), and is associated with a reduction in urinary tract infections (UTIs), hypertension, fatal coronary heart disease, venous thromboembolism, and cerebral infarct Complications of measurement/control Naso-gastric v PEG, enteral v parentera Patient history taking on presenting in the hospital differs from hospital to hospital. History taking should include assessment of fluid intake and loss, baseline hydrational status, skin turgor, heart rate, blood pressure and urinary output. Normal fluid intake for the average adult is approximately 2-2.5 litres, obtained from food, fluids or metabolic by-products (Edwards, 2001). Methods of measurement are not standardised across hospital settings with Wise et al (2000) showing that faecal fluid losses are often neglected in daily fluid balance charts with the possibility of inaccurate hydration assessment. Fluid assessment must include estimating, as accurately as possible, the quantity of fluid taken in. It must take into consideration the entire processes by which water, potassium and sodium are obtained. Measurements are often mainly focused on the extremes of hydration (optimal hydration and extreme dehydration) and this should not be the case. Assessment of hydrational statu s and need is continuous and begins somewhere along a continuum of severe hypovolaemia/ dehydration to severe hypervolaemia/ overhydration. In looking at dehydration, not only extreme dehydration should be noted. Manz and Wentz (2005) highlight that there is increasing evidence mild dehydration may also account for many morbidities and play a role in various other morbidities. The way in which stroke is managed acutely, such as measures maintaining physiological homeostasis may also vary between different populations (Bhalla et al 2003). The physiological indicators of acute deficits in fluid balance may be masked in individuals where compensatory mechanisms are intact. A history of acute events, mainly from baseline documentation and history taking, may enable better identification of such imbalances (Sheppard, 2001). Fluid and electrolyte homeostasis is brought about by the interaction between the renal, pulmonary, neuroendocrine, integumentary and gastrointestinal systems (Edward s, 2001). According to (Cook 2005), fluid and electrolyte management is a fundamental aspect of the role of the neuroscience nurse. Artificial feeding and fluids are the options for a patient who has an advanced, life-threatening illness and is dying. The patient, family members and doctor can talk about these options and the benefits and risks (Ackermann 2000). Hydration and electrolyte status are crucial mediators to the extent of the neuro-hormonal response to trauma. Edwards (1998, 2001) highlighted that homeostasis is maintained by a constant movement of water, sodium and potassium between intra- and extracellular compartments. While the movement of water and electrolytes between the cellular compartments is highly significant, it is important to recognize that in acute and chronic illness intracellular fluid (ICF) is reduced and extracellular fluid (ECF) increased almost to the extreme (Edwards, 2001). This is highly relevant for cerebral metabolism, because transport of oxyge n, glucose, proteins and other products for cellular metabolism—and their by-products—may be severely impaired. Stroke may affect ones level of alertness, perception of thirst, ability to access liquids, and ability to swallow them when offered. Stroke victims with such impairments may be at increased risk for diuretic-induced dehydration (Churchill et al 2004). Managing hydration balance is of crucial importance and the mechanisms for the adequate monitoring and controls need to be in place. Nursing management questions in the assessment of hydration in acute stroke patients should include whether use of intravenous fluids during the first week of stroke was recorded. Questions should also include whether the patient was fed orally, by nasogastric tube, through percutaneous gastrostomy tube, by intravenous methods or not at all? The fact that these questions can be raised enforces the need for adequate documentation and recording of acute stroke patient records. Bhall a et al (2002) says that the use of artificial ventilatory support with intubation or nasal intermittent positive pressure ventilation should be documented as well as the use of supplemental oxygen given through nasal catheters or masks. Enteral tube feeding is a vital means of feeding and balancing hydration levels in patients with stroke. There are no set standards for hospitals in the UK and hospitals have recorded much variation between them in the timing of the start of enteral tube feeding and whether a nasogastric or percutaneous endoscopic gastrostomy (PEG) tube is used (Ebrahim and Redfern 1999). Some clinicians delay tube feeding for 2 weeks or more, and although early nutrition is unlikely to be harmful, whether any nutritional benefits offset the difficulties and complications of initiating and maintaining early enteral tube feeding is unclear. If the timing or route of enteral tube feeding does affect outcome, the present variation in practice means that large numbers o f patients are being denied best treatment. Whether enteral tube feeding via PEG rather than nastrogastric tube or early initiation of enteral tube feeding improve outcomes was tested in the FOOD trials and no evidence of significant benefit from PEG rather than nasogastric tube feeding was found. Neither was any hazard from early tube feeding found (The FOOD collaboration 2003). The explanation for any difference between PEG and nasogastric groups is not clear, but one factor might be the effect of a long-term PEG tube on dependency since more patients in the PEG group were still receiving such tube feeding than in the nasogastric group at follow-up (The FOOD collaboration 2003). The survivors in the PEG group were also more likely to be living in institutions and had lower quality of life. Another intriguing finding was the excess of pressure sores in the PEG group, raising the possibility that those with such tubes might move less or be nursed differently. Weaknesses in this test results include insufficient statistical power to exclude more modest differences between groups; no information about the proportion of eligible patients enrolled in each centre; our use of an informal (although reliable and highly predictive) assessment of nutritional status; absence of precise monitoring of patients daily intake of nutrients (rather than fluids); absence of on-site source data verification or collection of information on changing nutritional status (e.g. in-hospital weights); possible bias due to masking of secondary outcome measures. Although compliance was not 100%, this fact results from the inevitable difficulties of adhering to rigid schedules when patients conditions change. Difficulties with nasogastric feeding in stroke patients (who are often confused and uncooperative) have led to increasing use of PEG tubes at an early stage. Enthusiasm for this method has been encouraged by the results of a trial that reported much lower case fatality rates in patien ts fed via PEG (13%) rather than nasogastric tube (57%) (The FOOD trial collaboration 2003). Due to significant alterations in fluid balance after enteral tube-feeding in patients, close attention to the recording of fluid balance such as intake/output measurements, body weights and simple bedside assessments is needed to detect fluid imbalances and other serious complications at an early stage (Oh and Seo 2007). One explanation for the varying and inconsistent readings in fluid hydration between enteral and PEG might b Stroke patients and the impacts of stroke on life Difficulty with swallowing is a common problem in acute stroke patients, and can lead to aspiration pneumonia, dehydration, and exacerbation of any existing malnutrition (Finestone and Greene-Finestone 2003). In Oh and Seo (2007) the authors set out to examine the fluid and electrolyte complications after enteral tube feeding in acute brain infarction patients. The background is that inconsistencies in the results of the water and electrolyte complications associated with enteral tube feeding are partly because of uncontrolled disease-related variables. The implication is that these variables were not adequately managed. Stroke patients very often present with dysphagia and this is very commonly dehydration associated with undernutrition (The Food Trial 2005). Up to half of stroke patients in hospital have dysphagia, which precludes safe oral nutrition for the first few days and can persist for long periods (Mann et al 1999). Although a 50% prevalence can be considered to be high, th e nutritional/fluid status of a stroke patient can rapidly deteriorate in hospital. The difficulty in feeding stroke patients with dysphagia coupled with the discomfort associated with stroke can exacerbate undernutrition and/or dehydration. Studies show that undernutrition shortly after admission is independently associated with increased case fatality and poor functional status at 6 months (The FOOD trial collaboration 2003). The current financial burden of efficiency savings and reduced budgets in the NHS hospitals results in reduced staff numbers so that patients can not be attended to on a one-on-one basis so that ensuring appropriate hydration levels is done by periodic but regular monitoring of charts. An option for the future in this area may be to involve the patients family members in hydration monitoring and provide them with appropriate training if evidence can show that being around loved ones improves outcomes and early warnings. In acute stroke, artificial nutrition t hrough an enteral route is needed because of dysphagia and since oral feeding is unsafe in some dysphagic patients, enteral nutrition is often administered as nasogastric or percutaneous endoscopic gastrostomy (PEG) tube feeding (Finestone and Greene-Finestone 2003). Naso-gastric tube feeding (a prevalent enteral method) has been reported to improve clinical outcomes more than the parenteral route in brain-injured patients (Rhoney et al 2002). Oh and Seo (2007) in their study used 85 subjects, but their work was limited by the fact that it was performed retrospectively and some of the subjects records were incomplete. Also, because the patients in the study were from one hospital it is not conclusively known whether the results can be generalised to the whole population./p> Legal and other aspects Japanese physicians attitudes towards artificial nutrition and hydration (ANH) as a life-sustaining treatment (LST) were examined to find out if they withhold or withdraw the LST when treating older adults with stroke-caused profound impairment with no hope for recovery. The study findings show that the informants held different views towards LST because most doctors considered ANH to be indispensable and ANH is automatically provided to patients (Aita and Kai 2006). With the advancement of medical technology, decisions to withhold or withdraw LST are among the most difficult to make for health professionals (British Medical Association 2001). Physicians caring for stroke patients often encounter comatose or semi-comatose patients with severe stroke for whom it is difficult to determine whether or not to continue care (Asplund and Britton, 1989). By administering LST, some patients in this patients group, whose bodily functions other than brain function could remain stable, could pot entially survive for months or years without achieving awareness or being able to interact with others (Aita et al 2008). Certain Japanese physicians have criticized the current efforts regarding life prolonging as Aita et al (2008) states: Prolonging the process of dying like this constitutes the violation of dignity and human rights. The life-prolongation only serves hospital operators who want to make profits by keeping hospital beds occupied. They also said this practice impacted the carers and that some nurses also feel emptiness toward the manipulative life-prolongation when taking care of these elderly patients. In the West, some countries have worked out nation-wide guidelines related to withholding or withdrawing LST that say stroke-caused profound impairment with no hope for recovery is a potential reason to withhold or withdraw LST (British Medical Association, 2001). Ackermann (2000) believes withholding and withdrawing therapy challenge family physicians to be excellent communicators with patients and families and recommends that family physicians should continue to be strong advocates for dying patients. Sprung et al (2003) highlighted differences between withholding and withdrawing therapy showing that withdrawal of therapy is followed by a nearer and more rapid death than withholding therapy, and that physicians and nurses were more inclined towards withholding rather than withdrawing therapy. Food and water are considered symbols of caring (Ackermann, 2000), therefore, it may be natural for physicians to give a special status to ANH as food and water. Whether to withdraw ANH from a patient in persistent vegetative state has also drawn substantial media attention in the U.S. (Casarett et al., 2005; Ganzini, 2006). The findings of the study also suggest that the physicians double standard is partly based on their subjective judgment whether the treatment is ordinary or extraordinary. However, the standard of ordinary/extraordinary care has long been criticized as too vague to guide decision-makers in the U.S. (Beauchamp and Childress, 2001). It is believed the current legal framework has also inappropriately led some physicians to simply continue care regardless of the patients conditions, thus resulting in putting an unnecessary burden on patients. The physicians subjective interpretation of the current legal framework may lead to decisions not to initiate mechanical ventilation in some older adults for fear of facing a situation in which physicians cannot withdraw it at a later stage Conclusion Hypovolemia and hypervolemia occurred frequently after acute stroke but were often not recognized as such by nurses. The nurses predictions of current volume status do not seem sufficiently reliable to serve as a basis for therapeutic decisions. More advanced techniques for bedside assessment of volume status may be indicated for optimizing volume status in patients with acute stroke (Hoff et al 2004). Whereas studies have looked at the optimal method of improving hydration, whether correcting dehydration in stroke improves outcome is not very clear. Given the complexity of the cell death cascade following brain ischemia, novel approaches and combination therapy are inevitable for victims of stroke (Fisher and Brott 2003). The review indicates that standards vary from country to country in the legal framework for withdrawing and withholding hydration and nutrition during end stage care.

HIV and Its Coreceptors Outline Essay -- Biology AIDS

What is HIV? The Human Immune System * In order to understand HIV, one must understand the human immune system. The first line of defense is a person’s skin, mucous membranes, and other secretions which prevent pathogens from ever entering your body. Pathogens are considered things your body does not want, for example bacteria and viruses. * The second line of defense includes nonspecific mechanisms which attempt to contain the spread of pathogens throughout one’s body. The second line of defense relies heavily on the use of white blood cells, which ingest invading organisms. About 5% of white blood cells are made of monocytes, which develop into macrophages. The role of these macrophages is vital to the human immune system, as they are able to engulf pathogens without having to self destruct. * The body’s third line of defense is a highly specific means of distinguishing â€Å"self† from â€Å"non-self† and destroying all â€Å"non-self†. All of one person’s cells are marked with a unique set of proteins which label them as â€Å"self†. Certain cells in the body are capable of recognizing every antigen (molecules belonging to viruses/bacteria) that may enter one’s body over a lifetime. These cells include macrophages, T-Cells, B Cells, and interior thymus cells. These cells rely on Helper T-Cells to alert them of antigens in the body, thus creating an immune response. Once recognized, Killer T-Cells actively destroy pathogens and even the body’s own cells if that have been invaded by a pathogen. How HIV attacks the Body * As commonly known, HIV cannot penetrate your immune systems first line of defense. You cannot contract HIV by breathing bad air or by holding the hand of somebody who is HIV positive. You have to wo... ... lymphocytes. Phipps and Branch observed Fyn Kinase activity in patients with and without HIV. Those with HIV contained high Fyn Kinase activity and low levels of Fyn protein. They also found that Fyn Kinase activity increases within 30 minutes of infection of the CD4+ T cells. This new-found information revolutionized the way testing for HIV occurs. References: Alkhatib, G. et al, "CC CKR5: A RANTES, MIP-alpha, MIP-1 beta Receptor as a Fusion Cofactor for macrophage-tropic HIV-1." Science 272, 1955 (1996). Grimes, W., R. Hallick, M. Hewlett, J. Aronson, and B. Fishel. Biology 181 Laboratory Manual 2002. Hayden-McNeil Publishing, Inc. Moore, J.P. "Co-receptors: Implications for HIV Pathogenesis and Therapy." Science 276, 51, 1997. Purves, W., D. Sadava, G. Orians, and H. Heller. Life: The Science of Biology , Sixth Edition 2001. Sinauer Associates, Inc.