What is meant by the term gothic Essay Example for Free

What is meant by the term gothic Essay Gothic literature, which is sometimes referred to as Gothic horror, is a genre that links horror and romance into one tale of ‘transgressing the boundaries’. Gothicism was unheard of until the late 1700’s, this movement into a new genre of literature. This was pioneered by the English author Horace Walpole, in his famous fictional book ‘The Castle of Otranto’, or as Walpole alternatively titled it ‘a Gothic story’. Horace Walpole himself had transgressed the boundaries slightly; by introducing this new style of writing he had added a whole new genre into literature. Walpole’s style of writing was unique and captivated the readers mind and imagination to let he or she share the act of transgression, or as Robert Kidd, a renowned critic put it, â€Å"The Gothic has somehow seduced the reader so that he or she is complicit in engaging in whatever he or she might encounter†. This is what kept Gothicism alive, the author’s ability to intrigue the reader and give them a thirst to read more gothic literature. The term Gothic has been viewed as very different things over time. Gothicism came about at a very tumultuous time, after the fall of the Roman Empire, a time of raw and uncontrolled exercise of physical power. The Goths were a barbaric tribe of murderers, rapists and thieves, later the term was known as ‘Medieval’. Nowadays the term Gothic is viewed very differently by modern society, when thought about now, one thinks of it as horror. It is in rock bands, the theatre, but mainly in the modern film industry. Gothicism has become somewhat of an obsession to modern film producers and leading film companies in recent years. This acceleration of Gothic themed films started in 1922 with the film ‘Nosferatu’; this was then followed by ‘Rebecca’ in 1940. And the list continues, Sleepy Hollow (1999), Corpse Bride (2005), Sweeney Todd (2007), and one of the more modern examples, the newer version of The Woman in Black (2012). This just highlights the extent of interest in modern society about modern Gothicism. The standard thought of somebody, when they are posed with the question ‘What do you understand about the term Gothic?’ would most likely be fairly predictable. The scene would be set in the heart of a dark, wet forest away from any normal civilisation. The building would be a dark and rundown old mansion in a large empty clearing with large empty  rooms and halls. Gargoyles would be clinging to the exterior of the building, and a decrepit, collapsed roof leaking and dripping in the driving rain. When the innocent traveller knocks on the door hoping to gain refuge and shelter from the storm, he is greeted by an emaciated, gangly butler who invites them in, as they fail to notice the menacing grin as they enter the dark, badly lit and claustrophobic corridor. The scene created is one of fear and horror which is typical of Gothicism. All these features are motifs in Gothic literature. These tools are what all authors of Gothic literature use without exception. This is for the simple reason that these tools are what keep the genre of Gothic literature alive. The author uses the reader’s natural, urge for adrenalin boost and thrill, through suspense and mystery to make the book successful. In almost every Gothic text, the reader is in a position of dramatic irony where he or she can see everything happening and unfolding, without the ability to stop it. Another one of the main reasons, as to why Gothic Literature is such a success is because; Gothic texts allow the reader to think the unthinkable, and to sublimate their innermost desires, psyche and their wildest imaginations. The reader is able to satisfy his or hers innermost desires through the pages of the book. The reader finds refuge through Gothic text. This is no exception with the authors. The author also wants to satisfy their imagination by creatively and articulately channelling their thoughts into a work of art. Robert Kidd writes in his ‘Transgressing the Boundaries’ article, â€Å"The power and passion of Gothic Literature seemed eminently suited to the iconoclasts who wished to challenge the status quo†. There were many famous writers like this, for example, Horace Walpole, Lewis, Godwin and of course Mary Shelley. The authors and readers of Gothic Literature share a very special connection. Both sides gain from books and share the same feelings as one writes and one reads the book, with both satisfying their imaginations. Mary Shelley’s ‘Frankenstein’ or ‘The Modern Prometheus’ is a known as a Gothic text. Although Frankenstein is indeed a gothic text, it does not include every element of Gothic text. However it is impossible to read the book without realising that there are a lot of Gothic techniques within. A major part of Gothic literature is mystery, and this is present from the very beginning of the book. We experience mystery firstly in the letters on  pp. 15-31. The reader at this stage does not know who is writing the letters (He is soon revealed as Robert Walton) and who the Mrs Saville he is writing to is. This is the first mystery; the next is why Robert Walton is writing in such a serious tone, â€Å"Rejoice to hear that no disaster has accompanied†. Already the reader is feeling a sense of danger and mysteriousness in the book. This is an exact example of the reader being driven to read further to satisfy their curiosity. Gothic Literature is not only about horror; romance also plays a very large part in it. And this is also present from the very beginning of the book. In the letters mentioned in the previous paragraph, as well as the mystery and danger sensed by the reader (â€Å"Rejoice to hear that no disaster has accompanied†.), the reader also senses the love between Robert Walton and his sister, Mrs Saville. There are of love and affection in every single letter without exception, for instance â€Å"Farewell, my dear, excellent Margaret.† And the list can continue with numerous examples. The various examples above that contribute to a Gothic text are not lone samples. These various themes and motifs continue throughout the text. Gothic text also has a reputation for not immediately beginning with horror and dark mystery; rather it begins with peace and harmony that gradually changes throughout the text, and again ‘Frankenstein’ is a testimony to this. When Victor completes his pride, his experiment, his son, his reaction is one of ecstasy, â€Å"Beautiful. Beautiful!† which quickly changes to one of disgust and abhorrence, with his words â€Å"the beauty of the dream vanished, and a breathless horror and disgust filled my heart.† This emotion of love changing to disgust is verification of Shelley’s efforts make ‘Frankenstein’ a Gothic text, as many texts do. Mary Shelley, in the book ‘Frankenstein’ or ‘The Modern Prometheus’, went to great lengths to make the book a Gothic text, and indeed it went on to become one of the most famous Gothic texts in history.

Effect of Substance Abuse on Child Upbringing

Effect of Substance Abuse on Child Upbringing Need for Treatment Women with children According to Miller (2001), the number of substance abuse treatment facilities for mothers with young children is very limited and therefore, implementation of local outpatient programs is very important to meet their specific treatment needs. Substance abuse treatment for single mothers is given a lower importance than the sufficient provision of their children in terms of safety and physical needs (Miller, 2001). Treatment of substance abuse and prevention of lifetime relapse requires various approaches (Miller, 2001). According to the Department of Health and Human Services (DHHS) (as cited in Miller, 2001), more than one-third of females who abused drug have undergone major depressive episodes and shown symptoms of mental health problems. Therefore, women who are abusing substance are more likely to experienced mental health problems as well. On the other hand, there is a high possibility that they will end up becoming the victims of domestic violence or experience partner violen ce (Miller, 2001). Substance Abuse and Mental Health Services Administration (SAMHSA) (as cited in Miller, 2001) stated that when problems regarding domestic violence failed to be addressed, it will interfere with the effectiveness of treatment and might lead to relapse. Moreover, the high rate of women involving in the legal system is also associated with substance abuse (Miller, 2001). Furthermore, women who are involved in substance abuse lack parenting skills, overreact with harsh discipline or neglecting their children due to their previous experience with same dysfunctional family patterns during their childhood years (Miller, 2001). By looking from the social learning perspective, this means that they are unaware that their children are seeing them as role model and might follow their footsteps in abusing substance. Need for treatment success In order to achieve successful participation in substance abuse treatment, the various needs of patients need to be known. Miller (2001) stated that mother with young children will only be able to focus on her addiction after basic needs such as food, shelter, and water of the family were addressed. Therefore, if any of the needs are affected, it may cause the mother to abandon the ongoing treatment. Besides that, in order for the treatment to be successful, clients must believe or have a positive perception towards the treatment that it will help them alleviate their addiction. Catalano, Ashery, Robertson, and Kumfer (as cited in Miller, 2001), found that including parenting program to clients in substance abuse treatment will significantly decrease the chances of relapse after treatment besides improving preservation because these clients believe that having good parenting skills is important. Miller (2001) pointed out several steps that can ensure a successful treatment program. One of it is to remove attendance barriers by permitting mothers to bring along their children to participate in the treatment program. Besides that, providing child care, training skills for children, and knowledge on substance abuse will make way for the identification of their emotional and behavioural problems. Likewise, providing parenting skills training and support services will help mothers with young children to increase their self-esteem. According to Miller (2001), he stated that funding basis is very important to develop and expand substance abuse treatment program in order to promote and nurture better stability in families by helping mothers to deal with their addiction while at the same time to become a better parent to the children. Amongst child welfare cases in which parents are having substance abuse is concomitant with increasing rates of child re-victimization, higher possibility of out-of-home placement, longer placement in care, and higher rates of child adoption and parental rights termination (Kaufman Oliveros, n.d.). Therefore, it is important to focus on several needs and factors besides addressing treatment barriers to ensure the success of treatment completion. One of the ways to ensure treatment completion is with the introduction of Family Treatment Drug Courts (FTDC). According to Kaufman and Oliveros (n.d.), several studies on FTDCs found that they are associated with a better substance abuse treatment initiation, lengthier stay in treatment, lesser days in out-of-home placement for children, higher frequency of family reunification, and higher chances of treatment completion. Kaufman and Oliveros (n.d.) continued to state that parents who attended FTDC and have completed the treatment quicker have almost 90 percent chance of reunification and have their children returned. A study found in the work of Kaufman and Oliveros (n.d.) suggested that it is important to work with extended family and natural supports to enhance permanency outcomes for children. Creating cross-system collaborations and placing a substance abuse specialist in child welfare institutions seems to be an effective strategy for increasing intake rates (Kaufman Oliveros, n.d.). Motivational Interviewing (MI), a person-centered and collaborative form of counselling that stimulates and reinforces motivation for change is an extremely effective approach to improve treatment initiation and completion as well increase treatment entry among substance abuser (Kaufman Oliveros, n.d.). Furthermore, substance abuse treatment initiation can be enhanced by outreach and engagement strategies (Kaufman Oliveros, n.d.). Outreach and engagement strategies are also effective at increasing substance abuse treatment completion rates when used with FTDC (Kaufman Oliveros, n.d.). On the other hand, today, FTDC and the newly developed home-based treatment intervention for substance abuse seem to be the most promising treatment program to improve treatment outcomes (Kaufman Oliveros, n.d.). Home-based substance abuse treatment program has an advantage of dealing with poverty related treatment barriers by bringing the program to those who cannot afford to access other substance abuse treatment programs. Treatment approaches that are delivered must not only emphasize on reducing the symptom but must also increase environmental stability and improve social functioning (Belcher, Briggs, Suarez, Titus, 2012). In order to achieve treatment success, structural resources that assist bonds among providers must be developed or enhanced to nurture more integrated service sectors (Belcher et al., 2012). Treatment services can only be fully integrated after changes are implemented across the whole system rather than within individual treatment programs (Belcher et al., 2012). Berlin (2002) stated four main common concerns that every treatment should have. The first concern is that treatment must be multi-dimensional and comprehensive by identifying numerous domains. Treatment must also include resources or access to services. Next, family therapy must be included to enhance communication among family members besides improving parental and guidance skills. The last concern is that after-care mu st be included in order to prevent relapse from occurring. Pressing Problems Parents who abuse substance are associated with the significant increase risk of child maltreatment and it is frequently under reported by child protective services (Bellettiere, Chuang, Cross, Wells, 2013). Family functioning and the well-being of children are also at risk when parents abuse drugs and alcohol (Bellettiere et al., 2013). Besides that, there is a high possibility that caregivers who abuse substance will engage health risk behaviours and mistreat the children in their care (Bellettiere et al., 2013). On the other hand, the children of parents who abuse alcohol and drugs will probably experience problems in terms of their emotion and behaviour as well as cultivate their own substance abuse in their later stage of adolescence and early adulthood (Bellettiere et al., 2013). A number of costly and alarming social problems can be associated directly to drug dependence. Recent studies estimated that the United States government has to spend around 67 billion dollars annually in crime, low productivity of work, foster care, and other social problems caused by drug dependence (Kleber, Lewis, McLellan, O’Brien, 2000). Volkow and colleagues (as cited in Kleber et al., 2000) found that the dopamine system of individuals who abstain from using cocaine was impaired three months after their last use. Other studies (as cited in Kleber et al., 2000) found that there was sustained variations in the stress response system after former substance users abstain from using opiate or cocaine. The response of encountering an individual or something that is earlier associated with drug use that might create conditioned physiological reactions and craving for the drug can combine to produce the feeling of loss of control (Kleber et al., 2000). The relapse frequencies which were reported to be very high are a clear sign of the negative reinforcement that alcohol and drugs have on people (Berlin, 2002). Alcohol causes more than 150,000 deaths each year and alcohol kills more Americans compared to other drugs other than tobacco which caused 440,000 deaths annually (Wu, 2005). Alcohol consumption has a negative effect on the central nervous system and brain that will cause those who consume alcohol to be aggressive and engage in risk taking behaviours (Wu, 2005). National Institute on Drug Abuse (as cited in Wu, 2005) stated that marijuana might induce impairment of short term memory, attention span, judgment skills, coordination and balance, learning skills, and other cognitive functions. The withdrawal symptoms of marijuana include irritability, restlessness, decreased appetite, insomnia, tremor, chills, and increased body temperature (Fisher Harrison, 2013). Besides that, cocaine will cause someone to have decreased appetite and sleep, increased heart rate, muscle spasms, and convulsions (Wu, 2005). The withdrawal symptoms of cocaine include intense drug craving, irritability, dep ression, anxiety, and lethargy (Fisher Harrison, 2013).

Physical therapy management to reduce post operative CABG

Physical therapy management to reduce post operative CABG Coronary Artery Bypass Graft surgery (CABG) is a medical procedure used in the treatment of coronary artery disease (CAD). CAD is a disease that causes narrowing of the coronary arteries (the blood vessels that supply oxygen and nutrients to the heart muscle) due to the accumulation of fatty deposits called plaques within the walls of the arteries. Investigations such as electrocardiogram, stress tests, cardiac catheterization, imaging tests such as chest x- rays, echocardiography, or computed tomography (CT), and blood tests to measure blood cholesterol, triglycerides, and other substances are used to diagnose CAD. The accretion of plaques over the years causes symptoms such as chest pain, fatigue, palpitations, and shortness of breath. Some patients with CAD may be symptom free in the early stages; the disease will progress until sufficient artery blockage exists to cause symptoms and discomfort. Blockage of the coronary arteries will cause the heart muscle to weaken due to inadequ ate blood supply, leading to a condition called ischemia. If the blood flow is not restored to the particular area of the heart muscle, the tissue dies, leading to myocardial infarction or heart attack. In order to restore blood supply and treat the narrowing of the arteries, the blocked portion of the artery is bypassed or rerouted with another piece of vessel, this is called CABG surgery1. Despite the many advances and development in anesthesia, surgical techniques, and postoperative care for CABG surgery, postoperative pulmonary complications (PPCs) retain a high postoperative morbidity and mortality rate 1. The risk of PPC has increased in CABG procedure due to two factors: intra-operative and external. The intra-operative factors are factors that are associated with the surgical procedure such as general anesthesia, surgical incision, type of graft, topical cooling for myocardial protection, and cardiopulmonary bypass2. General anesthesia increases the risk of PPC when the anesthetic component is administered to the patient while lying in supine position; it results in respiratory depression leading to a Ventilation-Perfusion (VQ) mismatch. In the surgical approach, the incision site in the upper thoracic area, which is a standard 20cm incision, decreases the preservation of pulmonary function. The type of graft used such as IMA increases the risk of attaining PPC. Topical cooling also used in CABG increases the incidence of phrenic nerve injury. Cardiopulmonary bypass which is unique to this surgery causes additional lung injury and longer pulmonary recovery, which occurs due to the acute systemic and pulmonary inflammatory response which is known as à ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒâ€¦Ã¢â‚¬Å"pump lung or à ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒâ€¦Ã¢â‚¬Å"post pump syndrome 2. External factors that could increase the risk of acquiring PPC are aging, the prevalence of surgical delay, increased sickness and complex health problems. The diagnosis of PPC, requires symptomatic pulmonary dysfunction symptoms such as increased work of breathing, shallow respiration, ineffective cough, and hypoxemia 2; in addition to clinical findings such as atelectasis, pleural effusion, pneumonia etc. The most frequent types of PPC associated with CABG are atelectasis which ranges from16.6% to 88%, phrenic nerve paralysis (30 % to 75%), and pleural effusion (27%-95%) 2. Acquiring PPC leads to the increased use of medical supplies and other health care expenses. Numerous interventions have been used to treat PPC but, due to variance in opinions, no resolution has been reached to which is the most effective and efficient intervention in treating PPC. To prevent postoperative complications such as PPC, less invasive techniques are applied by physical therapists. Physical therapists are responsible for the management and rehabilitation of the patient, which includes treating and educating the patient and helping them to attain the maximum function, and satisfying level of independence; this is achieved by decreasing the level of limitation and impairment. Physical therapy treatments include mobilization and airway clearance techniques, positioning, breathing exercises, coughing maneuvers, mobility and functional exercises. Physical therapy has been known to intervene in surgical procedures such as CABG, but most of the intervention used in patients reha bilitation is performed postoperatively. Recent studies have confirmed that post-operative patients, especially in CABG can improve as much as 50% 3 by introducing pre-operative physical therapy management. The preoperative management targets patients pre-surgically and directs its rehabilitating techniques towards the reduction of a possible PPC pre-operatively. Preoperative physical therapy management includes appropriate patient selection, preoperative PT assessment, patient education, and pre-operative physical therapy treatment (PPTT). These management protocols further enhance post-operative results by training patients on post-operative techniques. Thus pre- and post- operative physical therapy management is performed to reduce post-operative CABG pulmonary complications. Literature review Pre-operative Physical Therapy Treatment Preoperative management is an early involvement of physical therapy prior to surgery. It is a method used in prevention of patient deterioration by directing its efforts towards the patients respiratory and physical condition. Preoperative physical therapy management ensures that the patient is in the best respiratory and physical condition prior to surgery, to be able to have a rapid recovery. Preoperative management mainly focuses on appropriate patient selection, patient education, pre-operative assessment, and preoperative treatment. Appropriate patient selection Patients undergoing surgery have certain characteristics which can increase or alter the risk of any surgical complications especially in CABG. These characteristics affect the outcome of surgery, therefore leading to post operative complications. Suitable patient selection in preoperative rehab is important. This allows the physical therapists to categorize patients. Patients can either be classified as low risk or high risk patients. Classifying patients in such order ensures that each patient will obtain a tailored preoperative management program according to their condition and will receive maximum benefits from the program 4. The characteristics that alter the patients risks are pre-existing respiratory problems, obesity, age, smoking, patient motivation, and nutritional status 4. Pre-existing respiratory problems is of three factors infection, restrictive defects, and obstructive defects. Infection may affect both upper and lower respiratory tracts. If the upper respiratory tract is infected, it will cause increased mucus production. And if it infects the lower respiratory tract it may initiate impaired gas exchange leading to hypoxia secondary to pneumonia, resulting in exacerbation of infection. Restrictive defects include lung fibrosis, pulmonary oedema, and pleural effusion. The restrictive may reduce lung volume, resulting in an increase of airway resistance and closing of airways following anesthesia. Obstructive defects are also known as Chronic Obstructive Pulmonary Diseases (COPD). The occurrence of COPD in patients undergoing surgery will lead to an increase in the anesthesia dose due to bronchial hyperactivity. Obesity is another characteristic that can upgrade a patient into the higher risk group. Obesity is usually detected by using the Body Mass Index (BMI). According to Selsby and Jones 1993, increase in body mass may lead to reduced lung compliance by approximately one third; this is due to the additional weight on the chest wall. As a person ages the lung loses its elasticity in recoiling and the lung volume is reduced. During aging, respiration is reduced by weakening of the respiratory muscles and stiffening of the rib cage. Smoking is the major cause of greater ventilation/perfusion (V/Q) shunt, and impaired oxygenation during anesthesia. This is because smoking results in narrowing of the airways, excessive mucus secretion and decreased mucus clearance, and irritable airways. Patient motivation is the current mental or cognitive, and emotional state of the patient. Any disturbance in such states may result in decrease patient compliance and increases the duration of the patients recovery. Preoperative PT assessment Pre-operative assessment is a technique used to establish an outline of the patients current status, and form a baseline to assess the patients progress. The pre-operative assessment includes subjective and objective assessments. Subjective assessment is an interrogation procedure used by the physical therapist to obtain information to help with the preoperative treatment program. During the subjective assessment, open-ended questions 4 are used, which allows the patient to discuss their current problems. There are five main points that need to be clarified during this type of assessment; dyspnea, cough, secretion (sputum and haemoptysis), wheeze, and chest pain. During the objective assessment, the physical therapists use their own skill in examining the patient. The physical therapists examines by observation, palpation, percussion, and auscultation. Further details may be obtained by the use of tests such as spirometry arterial blood gases (ABGs), and chest radiographs 4. When assessment is completed, the physical therapist analyzes the information obtained and integrates it with their knowledge, resulting in a problem list. According to the problem list the physical therapists addresses these problems by setting specific, measurable, achievable, realistic, and time specific goals according to the problems obtained from examination. A well designed treatment plan is set to help resolve these problems. Patient Education Patient education plays an important role in rehabilitation. The patient is educated by the staff, which includes the surgeon, physical therapists and nurses. The patient is educated on preoperative and postoperative programs or protocols. During patient education, verbal and written information is given to patients. The role of the physiotherapist in patient education is to highlight and clarify the main points of the CABG procedure, allowing the patient to become familiar with the surgery. The physical therapist also explains the main effects of surgery on the respiratory function, location of the wound, and wires and monitors attached. The instructions given before the surgery puts the patient at ease and postoperatively accelerates the functional recovery of the patient. To reinforce the verbal information, leaflets and brochures are given to help the patient. Pre-operative Physical Therapy Treatment (PPTT) PPTT is directed towards maximizing pulmonary function 4 by the reduction of PPC and the use of non-invasive PT interventions. Since PPTT is a newly emerged, few studies are found that discuss the preoperative treatment of patients undergoing CABG procedures. Therefore no precise treatment techniques or protocols are followed during PPTT. Studies have suggested that the most common types of PPC that occur following CABG surgery are atelectasis, and pneumonia. Atelectasis which is an abnormal respiratory condition causes lung collapse, therefore leading to deprivation of gas exchange. It is caused by an obstruction of major airways and bronchioles. It is a complication that is frequently seen in post-operative period and is found in the basilar region in post CABG. To treat and prevent such condition deep breathing techniques and incentive Spirometry is used 5. Pneumonia is an infection or inflammation of the lungs. It can be caused by microorganisms such as bacteria, viruses, or fungi or by a potential complication such as pleural effusion. Pneumonia is treated by pharmaceutical agents, coughing techniques, and breathing exercises 5. It was found that both PPCs are caused by the patients inability to expectorate sputum and due to insufficient diaphragmatic breathing. Therefore the most appropriate way to treat such conditions is to rehabilitate patients preoperatively. PPTT treatments are of a large variety and no precise treatment has been advised solely for treatment. During my investigation I have came upon many techniques used. The most common treatment used within the PPTT is breathing exercises (BE), respiratory muscle devices, and sputum expectoration techniques. BE are several techniques used to help increase the muscle strength and increase air entry. It is performed by inflating and deflating the lungs. There are many types of BE some are pursed lip breathing (PLB), paced breathing, diaphragmatic breathing, segmental breathing, sustained maximal inspiration (SMI), and global lung expansion. Respiratory muscle devices are instruments used to help strengthen the surrounding breathing muscle by the use of resistance as shown with the inspiratory muscle trainers (IMT) and aids the patient in air entry by visual aid, as shown with the incentive spirometer (IS). The sputum expectoration techniques are tactics used to expel secretions from the lung. One of the most common techniques used nowadays is the secretion removal technique, this is a method used to remove mucus from the lung and helps in expectorating the sputum, it is known as postural drainage. This method can be applied according to area of secretion and can be modified according to the patients condition. Other supporting or assisting techniques is coughing and the Forced Expiratory technique. Coughing is used to help the patient to expectorate sputum. The PT can teach the patient the correct method and may support the patient incision or wound when coughing if needed, or assists the patient by applying force on the abdomen, increasing the abdominal pressure therefore giving extra force. FET is less forceful technique, it is similar to coughing, and the patient huffs instead of coughing. This method brings the mucus to the upper airways and is usually followed by coughing to expel sputum. An observational follow up study was performed by Isabel Yanez-Barage. The purpose of the study was to examine the use of preoperative respiratory physiotherapy, on the incidence of pulmonary complications in CABG surgery. Two groups of patients were involved in the study. The first group was the intervention group, whom received PPTT and the second group was the control group, who had no PPTT. The apparatuses used within the study included Incentive IS and, BE. Prior to their use, uses and importance of the apparatus was explained to the patients. The techniques that was used during the study, were ten deep BE, diaphragmatic breathing, thirty long expansion maneuvers, tactile stimulation, three stages of Sustained Maximum Inspiration (SMI), ten global lung expansion, secretion removal techniques, supported or assisted coughing. The above techniques were put in a program, and all exercises were performed in two sessions per day, while the SMI was performed six times per day, five set s with 30-60 seconds rest between each set. The results of the study showed that the presence of atelectasis occurred 48hours after surgery. The PPTT group had a 17.3% of atelectasis, while the non PPT group had 36.3%. The study also showed that a relationship existed between atelectasis and patient gender, and that 21.8% was found in females while 37.5% in males 3. Another study performed by Erik H. J. Hulzebos, focused on two primary outcomes. One was post operative complications, which is pneumonia. The second outcome measure is the post-operative pulmonary complications (PPC), which include the influences of morbidity and mortality rate, the length or duration of stay at hospital, and the overall resource utilization. The interventions used in this study included such as IMT and IS, while the techniques included are patient education in active cycle of breathing techniques and Forced Expiratory Techniques (FET). The program followed within the study was the use of FET and performing it on daily basis seven times per week for duration of two weeks before surgery, and the IMT was done for twenty minutes, six times per week without supervision and once per week with PT supervision. The result of the primary outcome measure is that18% (25 of 139) of the patients from the IMT group developed PPC, while patient 35% (48 of 137) of usual care group developed PPC. The incidence of pneumonia was less in the IMT group whom had 6.5% (9 of 139). While on the other hand the usual care group had a higher incidence which was 16.1% (22 of 137).The usual care group had also another complication, where 3 of the 22 patients developed respiratory failure and died after surgery as a result of cardiac failure, while none of the IMT patients died. The study concluded that preoperative physical therapy reduced PPC by 50%. The study suggests that no a single PT techniques or intervention is better than the other in preventing PPC. Pre-operative PT has increased inspiratory force, decreased the incidence of PPC and hospitalization, and reduced morbidity 1. . Post-operative Physical Therapy Management Post operative complications are common in patients undergoing cardiothoracic surgeries. According to Agnieszka Piwoda et al, the fundamentals to a properly designed and conducted cardiac surgery, is physical therapy management 6. To minimize postoperative complications, physical therapy management is introduced. Postoperative physical therapy (POPPT) starts the instant the patient is transferred from the operating room to the intensive care unit (ICU), which lasts 1 to 2 days and is continued in the ward from 2nd day till the date of discharge which is the 7th day 6. During the patients stay at the ICU postoperative, physical therapy rehab is aimed towards the reduction of airway obstruction, increasing and enhancing ventilation-perfusion matching, which is also known as gas exchange (VQ matching), restoring normal gasometrical values which when by doing so, the patient is prevented from re-intubation 6, decreasing ventilatory failure where the patient becomes dependent to the mechanical ventilator 3, and preventing thrombo-embolitic changes altogether leading to a decrease in ICU stay. The ward rehab starts when the patient gains early extubation; this allows the patient to regain contact with reality. During this period the physical therapist is able to eradicate secretion accumulation, and rapidly mobilize or ambulate the patient 6. Maintenance of permanent and intensive mobilization will improve cardiopulmonary tolerance, leading to an increase in physical endurance and patient independence, therefore reducing hospital stay 7. Most of the studies involving a majority of patients undergoing CABG are focused on reducing basilar atelectasis and pneumonia and hypoxemia 7 by applying specific post operative physical therapy objectives such as recruiting lung tissue from shunt to zone of low ventilation in relation to perfusion 8, increasing lung capacities especially FVC and FEV8, decreasing respiratory muscle dysfunction 3, increasing respiratory muscle function diaphragm 6, restoring thoracic breathing manoeuvres by strengthening postural and respiratory muscles, and endorsing effective breathing patterns by reducing the work of breathing 7. To achieve optimum results and regain the inclusive functional independency, POPPT management should include airway clearance techniques, early mobilization, bed mobility and positioning, breathing exercises (BE), and patient education. Specific post operative physical therapy techniques such as the use of intensive deep breathing exercises and devices such as IS, and IMT should be emphasized when rehabilitating post CABG patients. Prior to POPPT, an extensive patient evaluation similar to the preoperative assessment should be performed. When assessing the patient problems, goals should be set and are treated accordingly. Airway clearance techniques A manual or mechanical procedure that assists in clearance of secretion from the airways is known as Airway Clearance Techniques (ACT) 9. ACT is indicated for impaired mucociliary transport or an ineffective and unproductive cough. When choosing an ACT the patients pathophysiology, symptoms and medical status should be taken in consideration. The techniques included in ACT are Postural Drainage (PD), manual chest clearance, and coughing. PD is a technique that drains secretion by gravity assistance, and the use of more than one body position. There are 12 positions used during PD 9, in each position the segmental bronchus is drained perpendicular to the floor. These positions can be modified according to the patients medical status. The most affected segment should be prioritized. The patient is positioned using an adjustable bed, pillows or blanket rolls, and enough personnel to assist in moving the patient safely. PD is used for approximately 5-10 minutes solely and longer if tolerated 9. Manual chest clearance technique is the application of manual supplementary techniques such as vibration, percussion, and shaking to postural drainage positions 10. Coughing technique is a forceful airstream method used to remove secretions out through the trachea and to the mouth. Coughing technique is performed in four stages, and may be applied before, during and after PD and manual chest clearance techniques. In CABG patients, the coughing technique is supported using splinting. This is done is applying pressure to the incision site either by using a pillow or a belt. This techniques helps with decreasing the pain associated with the surgery. Early mobilization Early mobilization or ambulation is the method used to set patients in motion postoperatively by using the assistance of PT. The patient mobilization process is performed gradually and according to the patients tolerance. Mobilization starts by sitting the patient from supine to a long sitting position. Then when further stability is regained the patient is positioned on the edge of the bed. The patient is then progressed to standing, and later when the patient regains more stability, walking is initiated. Positioning Positioning is a therapeutic and ventilatory movement that is used to assist the patient in regular changing of position while in bed. It is essential in the patient early stages of recovery. Positioning allows the patient to progress from dependence to independence. The technique involves the selection of certain positions to assist the patient with efficient and diaphragmatic breathing patterns. The technique is indicated for patients with diaphragmatic weakness, patients unable to correctly use the diaphragm for efficient inspiration, or who have inhibition of diaphragm muscle due to pain 9. The training usually commences in the ICU. An example used by Sadowsky et al on positioning is the performance of ROM exercise with breathing. The exercise is performed by the patient inspiring air and accompanying it with shoulder flexion, abduction, external rotation, and eyes in an upward gaze. Then the patient exhales with shoulder extension, adduction, internal rotation and downward gaze. In addition to the exercise the patient is asked to tilt the pelvis posteriorly. This allows diaphragmatic breathing pattern and optimizes the length-tension relationship of the diaphragm 9. This technique progression should be applied to transfer, ambulation, and stair climbing. This technique is highly recommended for patient patients that underwent CABG since they are likely to have 90.7% of diaphragmatic elevation 11. Breathing exercises Breathing exercises are maneuvers used for patients with signs and symptoms of decreased strength or endurance of the diaphragm and intercostal muscles 9. There are many breathing exercises one of them is known as the Active Cycle of Breathing Technique (ACBT) 10. ACBT includes a group of breathing techniques such as breathing control, thoracic expansion exercises, and forced expiration technique. Other methods that assist BE are respiratory devices such as Inspiratory Muscle Trainers (IMT) and Incentive Spirometry (IS). Respiratory devices are mechanical equipments used in attempt to reduce postoperative pulmonary complications particularly atelectasis and pneumonia. BE and respiratory devices are suggested for patients at high risk of having atelectasis such as CABG patients, whom are for 24.7% of postoperative atelectasis 9, 11. A study performed by Elizabeth Westerdahl investigated the effect if deep breathing exercise on pulmonary function, atelectasis, and Arterial Blood Gases (ABGs) after CABG. The study was performed on two groups, the first group was the deep breathing group and the second was the control group. Both groups were approached similarly in assessment, positioning, and mobility once or twice daily during the first 4 postoperative days. Chest PT was done twice in the first 4 post-op days, the therapy includes early mobilization, instructions in coughing techniques, and daily active exercises of the shoulder girdle, upper back, and assistance to turn form side to side and get out of bed. The deep BE group received an extra program, performing breathing exercises every hour during the day for four postoperative days. The exercise used is, 30 slow deep breaths with PEP blow bottle device, a 50cm plastic tube in a bottle containing 10 cm of water. The exercise was performed sitting; it is 3 sets of 10 deep breathing exercises with 30-60 seconds pause between each set. If needed, patient coughs during the pause to mobilize secretion. The result of the study illustrate that atelectasis was found in large areas at basal level close to the diaphragm and minor at the upper level near the apex. There was a significant decrease in atelectasis in deep breathing group by one half compared to the control group, and the correlation between PaO2 and atelectasis was weak. Recruited lung tissue is most likely converted from shunt regions to zones with low ventilation in relation to perfusion. In conclusion, Patients who performed deep-breathing exercises had a significant smaller atelectasis, and less reduction in FVC and FEV on the 4th post-op day. 8 Patient education Patient education which is an integral part of the post-operative physical therapy management is applied similarly to the preoperative patient education program. When educating a patient in the post-operative period, the instructions given should highlight the thought of improving quality of life by emphasizing on points such as having healthy eating habits, ceasing smoking, achieving independence, and accentuating the benefits of rehab, and returning back to ADL. Patients should also improve their physical education by participating in other therapies that have been introduced such as tai chi, PNF, NDT Bobath and music therapy 6. Conclusion As PPC has been of great concern to health professionals, the reduction of complications that accompany major surgeries such as CABG is of an important development. The main objective in physical therapy with regard to CABG is to reduce PPC by intervening with less invasive protocols. The combination of both pre-operative and post-operative physical therapy management has had effective results in managing CABG patients. The reduction of PPC by the use of preoperative physical therapy management has led to many advantages. Some of them are significant reduction in mechanical ventilators duration therefore reducing the duration of ICU stay, reduced hospitalization, decreased morbidity and mortality rate, enhanced early functional recovery, improved lung function and gas exchange. Such accomplishments are significant, but more studies have to be performed to develop PPTT programs and provide a certain protocol The reduction of PPC by the use of postoperative physical therapy has lead to the best outcome of treatment. It has decreased complications associated with surgery and reduces PPC, allowing the patient to regain maximum physical condition, reducing ICU and hospital stay by achieving physical and functional independence therefore assisting the patient in regaining better-quality of life 5. The patient can further continue physical therapy at the cardiac facility to promote additional cardiopulmonary conditioning. In Kuwait, post-operative PT management is more widely-used than preoperative. During my investigation I found out that the chest hospital is aware of the preoperative management and is applying it, but in an informal way. I would like to call attention to the use of post-operative PT management in association with pre-operative physical therapy management to help the patient have a better surgical outcome, regain maximal independence and improve the quality of their life.

The Chicano Movement: Struggles, Goals, and Accomplishments Essay examp

In American history, civil rights movements have played a major role for many ethnics in the United States and have shape American society to what it is today. The impact of civil rights movements is tremendous and to an extent, they accomplish the objectives that the groups of people set out to achieve. The Mexican-American Civil Rights Movement, more commonly known as the Chicano Movement or El Movimiento, was one of the many movements in the United States that set out to obtain equality for Mexican-Americans (Herrera). At first, the movement had a weak start but eventually the movement gained momentum around the 1960’s (Herrera). Mexican-Americans, also known as Chicanos, began to organize in order to eliminate the social barriers that prevented them from progressing in American society (Bloom 47). Throughout the years of the Chicano Movement, Mexican-Americans had a â€Å"desire to integrate into the mainstream culture while preserving their own identity† (Bloom 47) . The Chicano Civil Rights Movement was a progressive era when Mexican-Americans had goals that they wanted to accomplish and sought reform in order to be accepted as a part of the United States. The Chicano Movement, like many other civil rights movements, gained motivation from the everyday struggles that the people had to endure in the United States due to society. Mexican-Americans, like many other ethnicities, were viewed as an inferior group compared to white Americans. Mexican-Americans sought to make a change with the Chicano Movement and â€Å"the energy generated by the movement focused national attention on the needs of Mexican-Americans† (Bloom 65). The Mexican-American Movement had four main issues that it aimed to resolve and they ranged from â€Å"restoration of la... ...tory: Postwar United States, 1946 to 1968, Revised Edition (Volume IX). New York: Facts On File, Inc., 2010. American History Online. Facts On File, Inc. Web. 12 February 2012. Tejada-Flores, Rick. "Fight in the Fields - CESAR CHAVEZ | PBS." PBS: Public Broadcasting Service. Web. 12 February 2012. Tenes, Angel. "SYLVIA MENDEZ GETS HIGHEST U.S. AWARD & HONOR."MENDEZ V. WESTMINSTER. 25 February 2011. Web. 10 March 2012. United States and Mexico. "Treaty of Guadalupe Hidalgo." From Treaties and Other Agreements of the United States of America, 1776-1949. Compiled by Charles I. Bevans. Washington, D.C.: Government Printing Office, 1968-76. American History Online. Facts On File, Inc. Web. 10 March 2012. Woo-Sam, Anne. "Mexican Americans and the Chicano Movement." Encyclopedia of American Social Movements. Sharpe Online Reference. 2012. n. pag. Web. 12 February 2012.

Granite :: essays research papers

Granite Vigorously wiping off the dead grass and dandelion petals from the rock, the girl’s hand brushed a jagged edge roughly. As she quickly drew her hand away for examination, she saw what her hand had lain upon. The right upper corner of the baby’s headstone was broken off. She took a moment to contemplate her blood expanding into the crevices and gullies of the edge’s gap. She scanned the knoll ahead and around it and spotted the chunk. She walked over and picked it up, her knuckles getting whiter every second as she clutched the severed edge firmer and firmer. Then she spotted the culprit. An old rusted mower and a tactless, overweight nimrod with gray hair crowning it. With a shot of adrenaline, she hurled the stone edge after the tractor. Had this man no respect for the souls he so violently cut over? The stone dropped ten feet short, and the man was oblivious to it. The girl, innocent and full of rage, dropped to her knees at her deceased brother’s headstone. The only way she’ll ever see him. Only one tear fell the whole night, though. She wasn’t as mad as she was blown away at the whole idea that, even though he was her older sibling, he’d always be preserved in time, like the granite above him, as a four-day-old infant. She considered this while shifting her vision to the huge slab of white stone near the left road. This was the children’s saint, with most of the children buried around it. When her family came to the grave when she was in grade school, she used to love to climb on the smooth stone and hear the sparrows in their tiny trees dotting the plateau of the dead. She shook this thought off with a cold shiver as the first droplets of a new rain fell tumbling on her jersey. Her eyes showed she was inattentive to it while she kneeled, slowly outlining the word "Joey" with her left pinky. She’d always regretted the fact that she never felt any real depression from his death, but how could she? She wasn’t even a twinkle in her parents’ eye when it happened.

Project Management Summary Essay

Strategic portfolio management plays an intricate part in project management. Through this paper, the reader will gain a stronger understanding of the relationship that strategic portfolio management plays in project management. Strategic Management Relation to Project Management Project management involves several parts, but the meaning must be understood first. â€Å"Project management is the planning, organizing, directing, and controlling of company resources for a relatively short-term objective that has been established to complete specific goals and objectives† (Kezner, 2013, p4). Knowing this allows the project manager to implement steps toward achievement of the defined goals and objectives. Part of these steps has to do with strategic management. Project management is strategically managed to advance the corporation’s organizational goals. Strategic management insures the right initiatives are pursued and supported with resources. Strategy today needs to align to a more fluid nature of business environments. It has to be flexible enough to adapt constantly to changing external and internal conditions. The relationship between strategic portfolio management and project management is a very important relationship. Strategic management compliments project management in that it attempts to ensure success by way of doing things at the most opportune time. If a company attempts something too early or too late then possible negative consequences may occur. Projects, within programs or portfolios, are a means of achieving organizational goals and objectives, often in the context of a strategic plan. Although a group of projects within a program can have discrete benefits, they can also contribute to the benefits of the program, to the objectives of the portfolio, and to the strategic plan of the organization. Conclusion As stated at the beginning of this paper â€Å"strategic portfolio management  plays an intricate part in project management†. The reader should now have a stronger understanding of the relationship that strategic portfolio management plays in project management. References Kerzner, Ph.D., H. (2013). Project Management: A Systems Approach to Planning, Scheduling, and Controlling (11th ed.). Retrieved from The University of Phoenix eBook Collection. Project Management Institute. (2013). A guide to the project management body of knowledge. (PMBOK guide). Newtown Square, Pa: Project Management Institute.

Future of Policing Proposal Essay

Policing is not just keeping the peace in today’s society. Police officers have several responsibilities and also new technology to learn. New technology helps law enforcement preform a better job in communication, crime solving, decreasing crime and making communities a better place to live for citizens and their families. Biometrics and GPS tracking are two useful technologies’ that have made the police able to catch criminals, and solve crimes quicker and more sufficient. Biometrics modalities used by law enforcement is fingerprints, DNA (Blood), and patterns of the voice and faces of victims. Then GPS Tracking helps law enforcement keep track of other police officers, or GPS can be used to tract a suspect if he or she is running away from the law. There are many vehicles that come standard with the GPS system that makes it easier for law enforcement to track a car if it has been stolen the owner. The future of the GPS tracking system may be identifying as leaving things like, the satellites, cameras, computers that will have been powerful, all in all just leaving all the â€Å"complicated† technology in the past. In today’s time you need three working satellites in order to get a good enough signal for your GPS, and even then you it might take a minute or two to get an accurate destined location. There are places all around the world where you cannot get any satellite signal, and even in big cities, it can become very difficult to get signal. â€Å"The world-first approach to visual navigation algorithms, which has been dubbed SeqSLAM (Sequence Simultaneous Localization and Mapping), uses local best match and sequence recognition components to lock in locations. SeqSLAM uses the assumption that you are already in a specific location and tests that assumption over and over  again. For example if I am in a kitchen in an office block, the algorithm makes the assumption I’m in the office block, looks around and identifies signs that match a kitchen. Then if I stepped out into the corridor it would test to see if the corridor matches the corridor in the existing data of the office block lay out. Said by Dr. Michael Milford from Queensland University of Technology (QUT). Biometrics is all the quantifiable biological or behavioral characteristics used for the identification and classification of individuals. Fingerprints are the most common biometric modality used by law enforcement, but there are others. These modalities include deoxyribonucleic acid (DNA), voice and facial patterns. Biometrics also consists of all the various technologies used to categorize and recognize human characteristics. Biometric fingerprint scanning works because fingerprints are unique to each individual. People are born with a pattern of ridges and valleys on their fingers. These patterns are created thru a number of genetic and environmental factors. As a unique marker, a skilled analyst or a fingerprint scanner can recognize the patterns and use it to identify the person the fingerprint belongs to. Biometric fingerprint authentication is used to securing access to information and technology. The fingerprint of an authorized user is scanned and kept on record. The user swipes its finger along the scanner and only those with the proper clearance is allowed to enter or have access to the information. The Federal Bureau of Investigation has a biometric system known as Integrated Automated Fingerprint Identification System (IAFIS). The system is a national fingerprint and criminal history catalog. The system is available to law enforcement officers from the local, state, and federal levels. It allows an agency to makes inquiries 24 hours a day, 365 days a year. IAFIS aids policing organizations in solving and preventing crimes and catching criminals before they break the law again. The system gives law enforcement access to its automatic fingerprint database, its considerable search capacity, electronic picture storage, and allows for the electronic exchange of fingerprints. The system contains the information on over 70  million criminal subjects in its master file along with the fingerprints of 73,000 known and suspected terrorists investigated by the United States and international law enforcement agencies. All biometric systems do have a potential weakness associated with it. Unlike passwords and pin codes which can be changed easily, fingerprints cannot be altered. Should the stored digital copy be stolen and used for fraudulent transactions, the user would have little recourse to fix the situation as they cannot change their prints. They would be unable to use any biometric fingerprint scanner in the future as there will always be doubts and concerns about the authenticity of their prints. Gun use and safety is an important issue around the world and especially in the United States. Mytec Technologies are working with American firearms manufacturer Smith & Wesson on a â€Å"smart gun.† The partnership is intended to create a gun that will prevent anyone other than authorized users from shooting the weapon. The focus of the joint venture is to build a programmable handgun which will prevent any accidental shootings. The system will use finger tip sensor on the handle of the gun that will â€Å"read† the fingerprint. It will then convert the fingerprint into a digital medium and compare the newly scanned fingerprint against the authorized directory stored inside the scanner. The weapon will unlock and can be fired if and only if a match is found. An issue yet to be remedied is the control of the user’s biometric data. A database of authorized users will need to be created and kept secured. Will a government agency have to be created to control of this data or will it be under the purview of the users? The second issue which has arisen is how many authorized fingerprints will be allowed per weapon? Should there be a limit or will it be at the owner’s discretion as to how many fingerprints are authorized? These issues must be solved before the technology is allowed to be sold to the public. Being efficient and effective is a must when it comes to policing this includes using any and all forms of modern technology. Relying on technology is a must especially when it comes to the need and the importance of vital information. Since this information can  have an extreme amount of influence on any given the circumstance, it is important that the information being provided is accurate. Biometrics and GPS Tracking are important forms of modern technology that help provide such information such as facial recognition and location of suspects at a very accurate rate. Without the use of modern technology to aid the police with the work they do, providing efficient and effective police work can prove difficult. References Federal Bureau of Investigation. (2014, May 08). Integrated Automated Fingerprint Identification System. Retrieved from http://www.fbi.gov/about-us/cjis/fingerprints_biometrics/iafis Fox News. (2001, January 25). Smart Gun, Smart Solution? Retrieved from http://www.foxnews.com/story/2001/01/25/smart-gun-smart-solution/ Global Security.org. (2011, July 13). Homeland Security Biometrics. Retrieved from http://www.globalsecurity.org/security/stsyems/biometrics.htm