The world of science Essay Example for Free

The world of attainment EssayThe world of science has always been an interest for sympathetic beings. The need to understand the un cognise, to discover cures for diseases, to comprehend how the military personnel body works ar the driving force for man to pursue dissimilar aesculapian battlegrounds. unsoundness has been something that has haunted and sc ared people over the years. The discovery of penicillin and different amazing drugs make been phenomenal because they provide a certain hope for those who are ill. Plaques, epidemics and the standardized used to be a mystery for scientists. However, with the advancement of look into, the development of experimental theories and tools, medical exam concernals soon came up with answers to end high mortality rates. Laboratory experiments suck been especially in effect(p) in discovering transmission of disease. Scientists now have the knowledge to say whether cardinal quality of species is much hypersensitized to a certain try out of disease causing bacteria than others. The proliferation of certain species, plant louses, to be more circumstantial, in a particular region also gives scientists a clue regarding how to control, isolate and prepare the transfer of the illnesses.This is where medical bugology comes in. In numerous reviews that concern the history of medical bugology, people have always regarded the obvious as insignificant. Insects, arthropods and parasites are conventionality occurrence in the environment. Through the years, people thought that they are harmless until certain events occur. Even in non-medical sources, such as the Bible, one can find reference to insects being the cause of a plague.Although people cannot explain it durationily then, they have a vague idea that these creatures that originally seemed harmless, could actually cause a catastrophic event that would destroy crops and cause a number of people death. This paper aims to provide a brief background a nd discuss medical entomology. Since this subject field of medical science is connected with other fields such as Public Health and Epidemiology, definition of other areas of study would also be discussed to cotton up the difference of medical entomology with the give tongue to fields.Researches, discoveries and markers of development in this field would also be explained. Specific studies made in the United States would be cited to tho emphasize the role of medical entomology in this particular region. This citations of studies would also emphasize on the applications of medical entomology and its practical use in society. Lastly, medical entomology and its various aspects would be correlated to different studies so that the importance of such a field would be completely and clearly understood. Prevention is say to be better than cure.Medical entomology lives up to this saying and this paper aims to discuss how significant this science is to the every day life of society. Ento mology is said to be a field of science that dates back to hundreds of years ago. After all, as one scientist mentioned, how can anyone put a date to the study of insects and parasites (Rogers, 1960)? It is known that the eighteenth century truly provided a large(p) turn for entomology as this is the age when organization and taxonomy were finally established for order of magnitudely study of insects (Rogers, 1960).The founders of this science were not experts on this field. Instead, they were ordinary peoplesome who were not even fitted to finish formal education, some are in the medical profession or even the law. They were not paid for the service they rendered but through these people, medical entomologyits core foundation was established (Rogers, 1960). At present, there are different diseases that rebriny without cure. For years, people have tried and studied varying carriers and vectors for the fast spread of disease.They found that insects, arthropods, water and food are some of the assertable vehicles for disease transmission. Public heathmonitoring, researching and conducting surveys to make sure that health is promoted plays a big role in every day lives of individuals (Edman and Eldridge, 2004). It is through this field of medicate that one is able to understand the prevalence and incidence of a certain disease or phenomenon that is happening, over time or even in but a specific period.Through the years, sub-specializations under Public Health proliferated. Medical entomology is actually one of the fields often regarded as a dissever of Epidemiology (Edman and Eldridge, 2004). To be more specific, the field of medical entomology deals with the study of insects and closely related arthropods that play a crucial role in the condition of human health. This may be related to behavior, ecology, and as earlier mentioned, epidemiology of arthropod diseases (Edman and Eldridge, 2004).The main goal of medical entomology is to provide substantial info rmation that could be helpful for brass officials, medical professionals, scientists and the like to ensure that the public is safe and away from harm (Edman and Eldridge, 2004). In comparison, epidemiology is basically the study of the occurrence of diseases in different types of people. This is valuable in preventing illness and evaluating present strategies and programs aimed at promoting public health. It is for this definition that medical entomology, public health and epidemiology have an interrelation that is unavoidable.Over the years, people have started paying such(prenominal) attention to medical entomology. With the development of drugs and discovery of diseases and their cures, it is whole important to understand the transmission, distribution of certain vectors and factors aiding the widespread of disease and infection. Studies and researches flourished aiming to alert the public and health officials of upcoming dangers to specific species of insects and arthropods . Medical entomology in the United States has played a significant role in disease prevention.As early as the 1800s researchers have been providing relevant studies that could assist in determining vectors for specific diseases. In the University of Maryland, the Department of Entomology was established as early as 1859 (Entomology, 1986). Agricultural research was highly connected to this field and as insects damaged Maryland in the mid 1890s legislators were forced to establish the State Horticultural Department (SHD). Regulation, field work and education were the core concepts that the SHD implemented to decrease the occurrences of catastrophic events like crops damage (Entomology, 1986).The academic, experimental and practical aspects of medical entomology became realized and actually employ to prevent further economic degradation for the state. More changes in the University of Maryland occurred in relation to medical entomology. In the 1920s, they established three main depar tments aiming at three things. One of this is the eradication of insects which have been introduced to the United States, like the Japanese Beetle (Entomology, 1986). Another is the study of the effective use of pesticides. Lastly, the graduate school of entomology was opened.This has become the start of the realization of the importance of medical entomology. Other states followed and so did the flow of studies. In an article by Madden (1945), he showed how important medical entomology is for society. Florida as he mentioned is a state severely affected by insect-borne diseases. Some of the reasons he depicted in his article talked about how Florida is a subtropical state conducive to the propagation of insects, and the fact that they are near the West Indies, Mexico, Central and South America (Madden, 1945).These things, Madden claimed, could minister to the transmission of insect related diseases and infections (Madden, 1945). In 1973, the importance of a link between science and government has been greatly emphasized. The United States government started realizing and actually paying attention to researches that are concerned with parasitology. Emphasis on how biomedical researches should be given a reasonable budget because they greatly concern public safety was raised (Weinstein, 1973).In addition to this, the government made certain scientists advisors for allocation of funding and grants for biomedical research and training (Weinstein, 1973). Medical entomologists are not confined in the specific field of medical science. Consistent with their jobs in the eighteen hundreds, they wait to play a role in government offices. The U. S. Department of Defense and Centers for Disease bid employs a number of entomologists (www. entsoc. org, 2000). One proof of the current interaction of the United States government and medical entomology is Dr. Robert D.Hall (www. entsoc. org, 2000). The acclaimed professor and researcher is presently apply with the judicial system. He is consulted with regard to law enforcement and interpretation of entomological evidence (www. entsoc. org, 2000). Another study, one by Darsie and Ward (2005), concerned the understanding of the morphology of mosquitoes, their geographic distribution in North America and north of Mexico. By producing such research, they are able to document and possibly correlate certain diseases that profuse in such areas with the mosquitoes that are proliferating there.A related study dealt with the general worldwide threat of arthropod-transmitted diseases (Lederberk, et al, 2002). The associated morbidity and mortality of the cases were taken into consideration. This highlights the need for insect repellant products. The march oniness of chemical products that could combat such species in the United States were enumerated and studied. The researchers found out which ones were most effective and could provide protection against insects and keep the public less susceptible to acquir ing the disease (Lederberk, et al, 2002).Another player in this field, Jerome Goddard devoted a loudness to the study of major vector-borne diseases around the world. Instead of just focusing on mosquitoes, he dealt with ticks, fleas, and other vectors such as Chagas disease and scrub thyphus, to name a few (Goddard, 2000). In his study he provided full length description of the vectors involved provided guidelines for its treatment and controls. He also gave detailed information regarding the biology and geographical distribution of certain species that concerned his study (Goddard, 2000).In this type of research, he was able to pin point and specifically identify vectors that could be harmful and could possibly the transport of diseases to different countries and even continents, without the exception of the United States. His book and study remains as the gold standard reference in understanding the transmission and morphology of insects. As one can see, medical entomology is no t concentrated to only one species. Although it may seem that mosquitoes are most paid attention too, other scientists and researchers have been demonstrating interest in different species as well.In a study by Drexler (2000), she applied medical entomology to a subject that could be more applicable to modern day. Anti-terrorism is one of the biggest issues governments are facing today. Especially in the United States where it seems that this is becoming government priority. Medical entomology can play a role here as well. The researcher refers to it as the war on germs. According to Drexler (2000), bioterrorism is one of the biggest threats that could face individuals today. The role of the entomologist is to identify specific vectors for disease and not only focus on one.Food-borned illness or pandemic flu may be caused not only by mosquitoes but also other agents. The more one knows about the source, the more action one can provide against infection. Rapid response and keen surv eillance should be skills that entomologists should develop in order to be effective in their field (Drexler, 2000). Providing rapid action could save lives and possibly isolate disease and prevent high morbidity. With the advancement of technology, medical entomology also copes with the fast-paced changes.Different programs such as ProMed-mail (Madoff, 2004) have been made to make archiving and the data base system for infectious diseases, and their causes more efficient. Pro-Meds main objective is to report outbreaks of infectious diseases that affect humans. It utilizes and maximizes the internet to make sure that researches are instantaneously updated regarding different illnesses that concern entomology. It also serves as an early word of advice system, should there be a significant imbalance in the ecosystem that could possibly be a threat to human beings (Madoff, 2004).Working hand in hand with the agricultural sector to monitor livestock is also a part of ProMed. This is bec ause ProMed recognizes the importance of these animals in disease transmission. Aside from other scientists in ProMed, medical entomologists have a great responsibility in checking the validity of studies and the information that is made accessible to the public (Madoff, 2004). As one can see from the discussion, medical entomology is of great importance to society. It not only provides knowledge regarding different species or insects and arthropods, it also correlates to disease and susceptibility of human beings to illness.Although entomology also tries to research on cure for certain diseases that are cause by arthropods, medical entomology has the primary goal of preventing the spread of diseases. By understanding the morphology of insects, one is able to predict how fast it can spread the disease it is carrying. In a time where technology is highly being utilized and cure for a great number of diseases is being discovered, individuals realize the importance of medical entomolog y and the roles it plays in society. It is important to remember that it is a field that cannot stand alone.It works with different other medical sciences and even the government to be able to maximize the knowledge and discoveries it encounters. As for the medical entomology in the United States, it puts great emphasis on the factors resulting to the emergence of microbial threats. These threats open the eyes of the public and alert them to be more cautious of their environment. By providing relevant information, one can be light and the government can provide cost-effective strategies for disease prevention and maintaining the publics health in the United States.At present, the government is still workings hand in hand with medical entomologists. Researches are still being funded because the government has recognized the importance of prevention. It is definitely more cost efficient and effective to avoid threats rather than provide cure when an outbreak has already occurred. In fectious disease is an inevitable part of life. However, this does not mean that people should just remain exposed to such variables that may cause disease. Prevention is the key to avoid catastrophic outbreaks or plaques. With the right tools, sufficient knowledge, prevention can be done.

Difference between functional and dysfunctional conflict Essay Example for Free

Difference between functional and dysfunctional conflict EssayFunctional participationSusie Steel is a vice president in a real estate development firm called Hearts Development. She has spent enormous amounts of energy cultivating a relationship with a local town regarding an available plot of land. Susie would like to purchase the land to build townhomes for sale. She has developed an excellent relationship with the town politicians and partnership members. An issue has developed over the planned usage of the land, though. The town will sell the land to Susies company but feels that townhomes would be bad for the overall community. Theyre touch on with the additional cost and burden of kids that the townhomes would bring into the community. Susie understands the communitys concern and wants a win-win situation to occur. She feels that this issue will be a functional conflict due to the incident that the disagreement will bring a positive end result to both parties. Positiv e results of functional conflict include Awareness of both sides of issues value of working conditions due to accomplishing solutions togetherSolving issues together to improve overall moraleMaking innovations and improvements within an organizationIn Susies case, constructive criticism and interchange resulted in a compromise and a solution between the parties. Susie understood the towns concern but needed to find something to build that would bring revenue for the company. by means of their joint meetings, the end solution was for Hearts Development to build a retirement community, which would only have citizens 55 and over living in the town. This would turn over the issue of having more young people come into town and burden the school system.

Dermatoglyphic Patterns with Rampant Caries

Dermatoglyphic Patterns with rampant cavumA Twin City Study Correlating the Dermatoglyphic patterns with Rampant Caries and Early Childhood CariesAbstract Background and Aim This study was undertaken to investigate and analyze the correlation between dermatoglyphic pattern and en sozzledd space prevalence in young children in pit cities of Pune and Mumbai.Materials and methods ii centers were selected in Pune and Mumbai . A total of 300 patients (150 patients in each center) were included in this study. The mean age ranged from 3-5 years.The samples were split into two groups Group I Caries and Group II caries-free groups.Group I was further divided into children with former(a) childhood caries and children with rampant caries alveolar caries were detected clinic bothy victimisation mouth mirror and probe(only to remove debris non probed into the fissures) in daylight or suitable light source. Fingerprints were obtained by the conventional sign method .Statistical analysi s using the students t-test was used to determine mean values and gender resistences in the findings using SPSS version 11.0Results The paygrade and proportion of patterns in children with caries and caries-free children in both right and left hands showed increase in the number of lock chambers in children with rampant caries as compared to children with early childhood caries. However , this was not statistically significant.Conclusion The present study showed a definite variation in dermatoglyphics between the ECC rampant caries and caries-free group .However the rampant caries group showed more number of whorls as compared to the earl childhood caries group but they were statistically insignificant .Dermatoglyphics has proven to be an extremely useful, non-invasive and cost-effective legal document for preliminary investigations into conditions with a suspected transmissible base like alveolar consonant caries.Keywords Dermatoglyphics , rampant caries , early childhoo d caries. unveiling The word dermatoglyphics comes from two Greek words (derma, cutis and glyphe, carve) and refers to the friction ridge formations which appear on the palms of the hands and soles of the feet .(1) Dermatoglyphics is the scientific study of fingerprints. Since each persons fingerprints are unique, we can understand ones innate potential, personality, and preferences by analyzing dermatoglyphics. Dermatoglyphic patterns are highly variable from person to person, while genetic aberrations generally plead consistent phenotypes.A twin-city survey was conducted in Mumbai and Pune reviewing a total of 300 children. Twin citiesare a special case of twocitiesor urban centres that are founded in close geographic proximity and then grow into each other over time, losing most of their mutual buffer zone.Cities twinned by proximity do not necessarily match demographically, economically, or politically .The main focus of dermatoglyphic study is in the papillary ridges, the sma ll markings that make up your fingerprints and exist on all primates skin. The formation of these papillary ridges occurs during a short window of development (2), and is influenced by a combination of genetics and the environment in utero. Being bear upon by the environment at such a time means thatmonozygotic twinswould have antithetic dermatoglyphic markings .(3,4,5) The ridges do not change over post-natal life, which lends itself into forensic uses.The twin city survey was undertaken to evaluate the fingerprint patterns of children with dental caries ( Study groups-rampant caries versus early childhood caries ) and caries free individual (control group).Materials and Methods Two centers were selected in Pune and Mumbai . A total of 300 patients (150 patients in each center) were included in this study. The mean age ranged from 3-5 yearsThe samples were divided into two groups Group I Caries and Group II caries-free groups.Group I was further divided into children with early c hildhood caries and children with rampant caries. Dental caries were detected clinically using mouth mirror and probe(only to remove debris not probed into the fissures)6 in daylight or suitable light source. Finger and palm prints were recorded using the ink method described by Cummins and Midlo.1The hands of the children included in this study were washed with soap and water to remove dirt and oil from the ridged skin and blot dried to improve the quality of the prints .Statistical analysis using the students t-test was used to determine mean values in the findings using SPSS version 11.0transcription Interpretation of Dermatoglyphic patterns Fingerprints The fingerprints of all subjects were recorded using black duplicating ink ,the fingers were uniformly pressed on the ink pad after which the digits were pressed firmly against the etiolate paper by the operator to avoid bias .The fingerprints obtained were checked for their clarity with a magnifying glass (2) .INTERPRETATION OF HANDPRINTSThe handprints were observed in a sequential port under a magnifying glass with 2 power, from the left hand 4 th digit until the thumb followed by the thumb of right hand until the 4 th digit. This study included qualitative analysis that is the fingertip patterns (Loops, whorls,arches)The frequency of true patterns of loops, whorls, and arches was counted on the fingertips of all the 10 digits of children in all the groups. They were assessed for increase or abate in mean frequencies.QUALITATIVE DERMATOGLYPHIC ANALYSISType of dermatoglyphic patternDifferent types of dermal patterns were identified .(7)A loop is recognized as a series of ridges that enter the pattern area on one side of digit, recurves abruptly and leaves the pattern area on the same side. A single triradius is present, which is located laterally on the fingertip, where the loop is closed. If the ridge opens on ulnar side it is called as ulnar loop and if it opens toward the radial side it is called as radial loop.A whorl differs from the loop in the aspect of concentric arrangement of ridges, with two or more triradii in the latter. A whorl may be spiral, symmetrical, double looped, central-pocketed or accidental, depending upon the internal structure of the whorl pattern.In all the dermatoglyphic patterns seen, arches show the simplest ridge pattern, which is formed by the succession of one or more parallel ridges, which interbreed the finger from one side to the other without recurving. These patterns usually do not show the presence of triradii, except when the tented arch is present that will have a triradii point near its midline.RESULTS Statistical results were obtained by one-way analysis of variance (ANOVA) with Post-Hoc Tukeys correction for multiple group equalitys . The average no. of loops did not differ significantly between ECC and Rampant caries group (P-value0.05). The average no. of loops is significantly higher in control group compared to ECC and Rampant c aries group (P-value0.05). The average no. of whorls is significantly higher in ECC and Rampant caries group compared to Control group (P-value0.05 for all).Table 1) The intergroup comparison of finger print pattern.Values are Mean Standard Deviation. P-values by one-way analysis of variance (ANOVA) with Post-Hoc Tukeys correction for multiple group comparisons. P-value human body 1 The intergroup distribution of finger print pattern (Right+Left).DISCUSSION Widespread interest in epidermal ridges developed only in the last several(prenominal) decades when it became apparent that many patients with chromosomal aberrations had unusual ridge formations 10. Dermatoglyphic patterns make good material for genetic studies, because unlike stature, intelligence, and body weight, they are not significantly influenced by age or by postnatal environmental factors. 8,9,10 Dermatoglyphics have the advantage of remaining stable throughout life and therefore can be compared among individuals of d ifferent ages.The basis of considering dermatoglyphic pattern as genetic marker for dental caries is that the epithelium of finger buds as well as enamel which is the most vulnerable dental tissue to dental caries have ectodermal origin and both develop at the same time of IU life.12In this study , the evaluation and comparison of patterns in children with caries and caries-free children in both right and left hands showed increase in the number of whorls in children with rampant caries as compared to children with early childhood caries. However , this was not statistically significant.These results were substantiated by Atasu et al. who found an increased frequency of ulnar loops in caries-free children and an increased frequency of whorls in children with dental caries. The majority of whorl patterns in the control group were spiral while the caries group showed spiral, central pocket and double loop . Arches were least greenness patterns in both the groups.13,14A definite corr elation in the dermatoglyphic patterns between children with caries and caries-free children can be seen in this study. Thus, recording the dermatoglyphic patterns of children at an early age, during their foremost dental visit will be handy in predicting whether the child belongs to the high risk group or the low risk group and thereby can aid in planning a definitive preventive and treatment strategies.CONCLUSION The dermatoglyphic patterns may be utilized effectively to study the genetic basis of dental caries. In a developing country like India , it might prove to be a non invasive , inexpensive and effective tool for screening . These patterns may represent the genetic make up of an individual and therefore it suggests an individual s predisposition to certain diseases .Since dermatoglyphics is still an counterfactual and general science at the present time, it requires further extensive research to ascertain the significance of these variations in the dermatoglyphic features of children with dental caries .REFERENCES Schaumann B, Alter M. Dermatolglyphics in Medical Disorders. in the raw York, Heidel Berg, Berlin Springer-Verlage 1976. p. 14-75Uchida JA, Solton HC. Evaluation of dermatoglyphics in medical genetics. Pediatr Clin North Am 196310409-22.Pons J. Genetics of the A-B ridge count on the human palm. Ann Hum Genet 196427273-7. 8. Venkatesh E, Bagewadi A, Keluskar V,Shetti A. Palmar dermatoglyphics in oralleukoplakia and oral squamous cell carcinoma patients. Journal of IndianAcademy of Oral Medicine and Radiology 20082094-9.Hirsch W, Schweichel JU. Morphological evidence concerning the problem of skin ridge formation. J Ment defic research 19731758-72.Penrose LS. Fingerprints, palms and chromosomes. 1963197933-8.Cummins. Revised methods of interpretation and formulation of volar dermatoglyphics. Am J Phy Anthr 192912415-502Cummins. Study of error in interpretation and formulation of palmar dermatoglyphics. Am J Phy Anthr 192811501-21Okajima M. Development of dermal ridges in the fetus. J Med Genet 197512243-50.Carter CO. Genetics of common disorders. Brit Med Bull 1969252-57Matsunaga E. ancestral factors in congenital malformations. Igakunoayumi 1977103910-511. Verbov J. Clinical signifi cance and genetics of epidermal ridges-A review of dermatoglyphics. J Invest Dermatol 197054261-71.12. Madan N, Rathnam A, Bajaj N. Palmistry A tool for dental caries prediction Indian J Dent Res 201122213-8.13. Atasu M. Dermatoglyphic fi ndings in dental caries A preliminary report. J Clin Pediatr Dent 199822147-9.14. Ahmed RH, Mohammed I. Aref, Rania M Hassan and Noura R Mohammed. Dermatoglyphic study on patients with dental caries restored with dental fi llings and its correlation to apoptosis induced by dental fi llings. Nat Sci 2010854-7.

How Has Climate Change Effected Cambodia Environmental Sciences Essay

How Has Climate Change Effected Cambodia Environmental Sciences EssayNowadays the world has encountered teemingness of challenges much(prenominal) as terrorism, transnational crimes, environment dilutes and weapon mass demise (WMD) proliferation. As a matter of fact, these thins gitnot be solved by one master(prenominal)tain in order to everywherecome these problems, international cooperation and substitute magnitude non- rural area capability atomic number 18 required. For me, the most anxiety and inte sleeping challenge is environment issue especially humor wobble and world-wide melting due to two main reasons.First, this issue is a contemporary issue that has affected the world especially agriculture base countries. As we know, roughly 80 percents of Cambodia population argon farmers, and most of them still practice old traditional farming rather than using new engine room to attention them. Further more than(prenominal), farmers usually rely on water during rainy season to provide water to their fields and harvest on dry season however, beca mathematical function of mood change and ball-shaped warm up the issue occur when in that location is not enough water in rainy season plus the irrigation system in Cambodia does not adequate to provide water to everywhere in the country as well, so some farmers ordurenot plant anything and end up with debt. Thus, this research crowd out show the rigs on Cambodia as the agriculture based country.Second, I want to do a research plan on this issue in order to apply for scholarship to guide abroad when I graduate. By doing the research on this topic, I can know more about the toilet root causes- effectuate, flowing solutions and obstacles of these issues.In conclusion, since this issue is beyond my understanding in some aspect, I allow for use this opportunity when I study the world(a) g everyplacenance course to analyze this topic, and I hope this individual reflection paper can sh atomic number 18 knowledge to other students as well.IRP outlineMC1 IntroductionMC2 The causes of humour change and world(a) warming MC3 The effectuate of humor change and global warming MC4 Responses and challengesMC5 Conclusion(Note this outline mogul be altered according to the research)Topic Climate change, global warming and its effect on Cambodia as a nationMini Composition 1 IntroductionGlobal warming and Climate change shake been the environmental issues cladding human mental for such a long times, and these issues has attracted the international attention during the 1970s. Because these issues are quite a coordination compound subject, cooperation among states and increasing capability of the relevant non-state actors (NSAs) are solutions to deal with these issue. Over the past decades, leaders from states havenegotiated to seek a comparative solution for all phonationies the institutional framework provided by theUNFCC, the unite body politic Framework Convention on Cl imate Change, in 1992 and plus the 1997 Kyoto Protocol, yet these fragile frameworks do not contribute much to alleviate the problems due to realism ideas, lacking in private morality and uncertainty of states. Furthermore, its impacts are far beyond human ability to control and monitor. we shall discuss in detail about the responses in Chapter4Global warming is a term used to describe a persistent maturation in the earths mean surface temperature relative to long-term average conditions (those that prevail over centuries). In fact, the world mode changes over period however, in the late 19th century, the climate has changed considerably. Furthermore, it is difficult to distinguish the global warming and climate change since global warming results in climate change and the two terms are sometimes used interchangeably, though climate change has a broader meaning and refers to changes in average climatic conditions (temperature, wind, rainfall, and other climatic variables) relati ve to their long-term average. Both natural and anthropogenic (human-caused) factors can causes global warming, but the overwhelming scientific consensus is that the increase in global temperatures over the past century is primarily due to increase concentrations of greenhouse gases in the automated pronounceer.In conclusion, the global warming and climate change is a wide range of issues that penury efforts from each actor in international relation. In the conterminous chapter, we testament take a deep look to the causes of globalwarming and climate change.Mini Composition 2What are the causes of global warming and climate change?Many scientists endeavor to determine preciously what key factors are behind the global warming and climate change, and they come up with different causes that are interrelated. We can divide causes into two categories increasing amount of Green house gases (GHGs) and urbanization.According to Time For Change organization report, almost 100% of the o bserved temperature is being increased over the last 50 years has been due to the increase in the atmosphere of greenhouse gas concentrations like water vapor, blow dioxide (CO2), methane, ozone and other gases. However, the largest add source of greenhousegases is the dismissal of carbon dioxide (CO2). GHGs in the atmosphere act like a mirror andFig. 1 the relative of the major human-produced greenhouse gases to watercourse warmingSource www.kosh republic-science-museum.org/exhibitgcc/cause01.jspreflect back to the hide a part of the heat radiation, which would, otherwise, be lost to space. The higher the concentration of green house gases like carbon dioxide in the atmosphere, the more heat energy is being reflected back to the Earth. Thus, what are the causes of increasing those gases? So far, the causes of variation of atmospheric greenhouse gases especially carbon dioxide are human-made activities and natural disasters. There are various kinds of human activities that inc rease the amount of CO2 such as burning fossil fuels, emission of smoke by factories, overpopulation, clearing forests for development (agriculture, industrialization or urbanization) and logging in the jungle. For instance, the emission of CO2into the environment mainly from burning of fossil fuels (oil, gas, petrol, etc.) has beenincreased significantly over the past 50 years (see the graph below).Fig. 1 Carbon dioxide emissions in million tons per year over the last 200 yearsSource http//www.globalwarmingart.com/wiki/ patternGlobal_Carbon_Emission_by_Type_png Another cause is urbanization. In order to transform lands from forest or natural tourbanization, industrialization or agriculture, policy readyrs often face trade-off betwixt development and environment. For example, in industrialized nations, they need fuel in fossil fuels such as coal, oil and natural gases in order to run their factories. sluice though, the leaders do know that it will damage the environment, they hav e no choice rather than extract natural resources within their countries or other states. Moreover, delicate particles in the contrast (aerosols) may have warming or cooling effects, depending on their characteristics. Sulfate (SO4) aerosol, for example, is light-colored and reflects cheerlight back into space. The cooling effect of volcanic aerosols from the Mt. Tambora eruption of 1815 caused North the Statess year without a summer in 1816. The other interesting cause is overpopulation. According to the US Census Bureaus Web site (1541 UTC (EST+5) Nov 04, 2010), the number of people in the world is 6,879,418,535. When in that respect are more people, there will be more demands, and it will lead to more supplies. Thus, in order that factories can increase their productivities, they need more energy and natural resources. Moreover, some products affect the environment because they contain greenhouse gases. For instance, refrigerators andaerosols which contain chlorofluorocarbon (CFCs) that causes damage to the ozone layer.Case studyIn this case study, we are going to explore the causes that Cambodia contributes to the climate change and global warming. There are three main causes which are deforestation, urbanization and industrialization. First, Deforestation is a hidden causes and controversial in the international stage as well. Between 25 and 30 percent of the greenhouse gases released into the atmosphere each year comes from deforestation. For instance, Cambodia, located in South East Asia, was recognized as a green country that consisted of rainforest (70% all over country) in 1970s. Unfortunately, Cambodia becomes one of the highest rates of deforestation in the world, third to only Nigeria and Vietnam, according to a 2005 report conducted by the Food and Agriculture Organization of the United Nations (FAO). The percentage of rainforest fell dramatically from over 70% in 1970 to just 3.1% in 2007. There are some reasons behind this disaster such as war, fragile governance, development, lands incentive for investments, agricultures, and so on. Second, the Cambodia government has initialed to urbanize the city due to overpopulation and reform. Even though, this development does alleviate and give benefit to this country, it as well affects the environment. For instance, when land is converted from forests or nature to urban environments, the regional climate system is altered because urban environments are also islands of heat produced by industry, homes, automobiles, and asphalts absorption of solar energy. Last but not least, in Cambodia, the number of factories, located in the cities and countryside, also affect to the environment. The disposal of be adrift on land, in water and air damage the ecosystems and leak abundance of green house gases especially CO2. Thus, even though Cambodia is a tiny country in the world, it also mainly contributes to the climate change and global warming as well.In conclusion for this chapter, green house gases, that created by human-made activities and natural disasters, are the main causes of global warming and climate changes. In the next chapter, we will discuss detail about the effects of the global warming and climatechanges.Mini Composition 3What are the effects of global warming and climate change?Even thought global warming and climate change have many effects, these phenomena are interrelated, so to make ease for analyze the effects, I will categorized in sextette main impacts (1) increasing the temperature on the earth (2) rising of sea levels (3) changing landscapes (4) increasing risk of drouth, fire, foods and species extinction (5) increasing heat-related illness and disease and (6) economic looses.Increasing the temperature on the earth simply means the earth becomes warm and warmer, and this is not a new phenomenon, but due to global warming the temperature in the world has increased rapidly and upward. Because the amount of GHGs mainly CO2 increase d ramatically in recent decades, Time For Change Organization makes a projection that the temperature of the earth will be increased by 3o to 50 by the year 2050.As the world is heated, sea levels rise because warmer water takes up more room than colder water, a process known as thermal expansion1. Furthermore, the glaciers in the gelid melt leads to raising sea levels. Rising seas threaten to inundate low-lying areas and islands, threaten dense coastal populations, erode shorelines, damage property and destroy ecosystems such as mangroves and wetlands that protect coasts a put one acrossst storms. A logical consideration is a 36-inch increase in sea levels would swamp every city on the East slide of the United States, from Miami to Boston. Moreover, sea level rise associated with climatechanges could displace tens of millions of people in low-lying areas especially in developing countries. Inhabitants of some small island countries that rest barely above the existing sea level are a lready abandoning their islands, some of the worlds first climate change refugees.Another effect is changing landscapes. We can divide it into two different issues land degradation and desertification. Land degradation simply means soil quality is worsening. This phenomenon is a result of over-farming and poor land-use practice. On the other hand, desertification means the growths of deserts and sand areas. Each year according to the United Nations Environmental Program, an area of land about the size of Australia, approximately 31000 straight miles, turns into dessert.Another major effect is increasing risk of drought, fire, foods and species extinction. Climate change makes the circulation of water on, above and below the surface of the Earth causing drought and floods to be more frequent, serious and widespread. In 2010, according to Pakistani government data the floods directly affected about 20 million people, mostly bydestruction of property, livelihood and infrastructure, wi th a death toll of close to 2,000.2Due to the overpopulation, people need to increase the food productivities to meet the demand. Unfortunately, because of land degradation and desertification, most of the soils in the world become poorer and it leads to food insecurity in the world. Moreover, According to The Nature Conservancy group, experts predict that one-fourth of Earths species will be headed for extinction by 2050 if the warming wind continues at its current rate. Not so long, the world already experiences some lessons. For example, in 1999, the death of the last Golden Toad in Central America marked the first documented species extinction driven byclimate change3.Another effect is increasing heat-related illness and disease. When the ozone layer becomes thinner, more amount of sun light will come to the earth. Consequently, people will get skin disease because of Ultraviolet. Moreover, Climate change may increase the spread of infectious diseases, because warmer temperatur es let diseases carrying insects, animals and microbes to survive in areas where they were once thwarted by cold weather. The World Health Organization (WHO) estimates that climate change may have caused more than150,000 deaths in the year 2000 alone, with an increase in deaths likely in the future.Last but not least, global warming prevail the economy loose. Globally, serious change in weather (more serious hurricane, storm etc.) could cause billions of dollars in damage to property and infrastructure. Plus, declining crop productions due to prolonged drought and high temperatures, especially in Africa, could put hundreds of thousands of people at risk.Thus, the effects of global warming and climate change are varies and interrelated. After we have look through to the major effects of these phenomenon, then we shall analyze on the certain country, Cambodia.Case studyIn the previous chapter, we have examined the causes that Cambodia has contributed to the global warming and climate change. In this case study on the other hand, we shall prevail and analyze the impacts of global warming and climate change in this country. Cambodias temperature would increase up to 1.35 2.50C in 2100. Annual rainfall would increase betwixt 3 and 35% from current condition lowland areas seem to be more affected than highland areas4.Map of flood-prone communesMap of drought-prone communesSource WFP (2005)Floods and drought are recognized as one of the main contributors to poverty. In these pictures above, Cambodia is vulnerable to floods and droughts. High dependency on rain-fed farming makes agriculture sector particularly vulnerable.In Cambodia, the impact of climate change has become apparent, yet the public does not feel alert due to limited knowledge and other. There are six implication suggestions on Cambodia.First, recall memory of economy loose. Floods caused 70% of production losses of rice, while drought 20% between 1998 and 2002, and the floods caused USD 205 millionda mage between 2000 and 20025. Second, According to Allison, he claims that Cambodiaseconomy is rated as one of the most vulnerable to impacts of climate change on fisheries. Third, if the sea level rises, it will affect areas closelipped the sea. The research of ministry of whether shows that 1m rise can submerge 56% of Koh Kong City. Consequently, it will damage to infrastructure, agriculture, tourism, and livelihood. Fourth, as an agriculture country, when the food productivities decline, it leads to food insecurity in the country since Kampuchean highly depends on single crop and low processing mental object within the country. Firth, another effect is water quality degradation and sanitation. Finally, increase in water- related / tropical diseases such as malaria and dengue. The Ministry of the Environment estimates that under changing climatic conditions Cambodia may experience increasing incidences of malaria, up 16 percent from its current rate. Natural disasters have upset fragile ecosystems, which in turn have triggered other changes that have affected issues such as rising poverty and malnutrition in children.In conclusion, Cambodias weak social infrastructure will affect the poor, and it will be a heavy burden for Cambodias next generations, who will have encumbrance in bridging its ecological deficit. Thus, the government and all others relevant must come up with strong policies and fast action to combat climate change. In the next chapter, we shall examine the actions undertaken by international actors and Cambodia itself.Mini composition 4Responses and challenges of global warming and climate changeAfter severe suffer from these environmental issues, states have recognized that they are in troubles. Consequently, two key environmental conferences were held during the1990s, namely Rio Earth Summit in 1992 and Kyoto Environmental Summit in 1997.Held under UN auspices, the Rio Earth Summit brought together thousands of delegates and representativ es from state actors and non state actors. According to Time reporter, Philip Elmer-Dewitt, published in Rich Vs Poor in 1992, the Earth Summit was the largest and most complex conference ever held- bigger than the momentous meetings at Versailles, Yalta, and Potsdam1. In this summit, 178 states signed two treaties, the UN Framework Convention on Climate Changes (UNFCC), addressed global warming issues and the Convention on Biological Diversity (CBD), addressed to protect endangered species and biodiversity. The UNFCC sets the basic objective to achieve stabilization of greenhouse gas concentrations in the atmosphere at a level that would prevent dangerous anthropogenic interference with the climate system. Regarding this summit, the great success is that it gathered many people from different part of the international community that had never assembled to discuss a particular issue. Moreover, Earth summit also raised global consciousness about environmental issue however, throughou t the Rio meeting, a conflict between environmental protection and economic development was reveal because theinsistence of many Developing World states that feared that stronger wording might adversely affect their economies.Following the Rio Earth Summit, the Kyoto Environmental Summit in 1997, Japan, intended to address the global warming issue. Despite reduction in the emission of green house gases (GHGs) mandated by the Montreal Protocol and Rio summit agreements, states in the world still released too many of GHGs into the atmosphere, so the atmosphere remained at risk. This Kyoto protocol provided economic incentive for developing states to meet their targets through trade and clean development mechanism, and urged for cooperation between genuine and developing states over environmentally clean projects. Nevertheless, only septet out of 84 countries who signed the protocol ratified it in 1999 all of which were small islands or low lying states particularly concerned by glo bal warming and submerging them however, the conflict between developing and developed states hasremained and it needs to be sort out through arrogance cooperation and mutual interests.ResponsesFrom these two summits, there are three suggested solutions carbon management, creating trade incentive and alternative energies.Among GHGs, carbon dioxide is the dangerous chemical substance that is the major cause of global warming and climate change. Since the industrialization era, the demand of fossil fuel has increased dramatically, so oil production become inelastic. In order to cope with the carbon budgets, we do need to face head-on six importance activities, (1) slow or stop deforestation, (2) reduce emissions from electricity production, (3) reduce emissions from automobiles, (4) clean up industrial processes in a few major sectors, (5) economize on electricity use through more efficient motors, appliances, lighting, breakup and other electrical demands (6) convert point-source based systems supply by low-emission electricity. Considering the challenges of reducing emissions from the electricity generation are complicated, there are three major avenues to reduced emissions from the power sectors greater efficiency in the use of electricity, a greater proportion of electricity generation with non-fossil fuel sources of energy and special engineering processes to capture the carbon dioxide from fossil fuel electricity plants and to terminus it by using a technology called carboncapture and sequestration (CCS) 1.The Kyoto protocol has accomplished one major advance the start of a market price on carbon emissions, in the form of tradable carbon permits, albeit only in Europe. This strategy more or less provides incentive to the emitters to limit carbon emission from their factories. Furthermore, there is an urgent need to increase funding for climate science in the poorest countries to help those countries understand how adapt to the climate change, and scie nce also needed to enable those countries to participate effectively in global mitigation efforts by reducing the rate of deforestation and by ad pick low-carbon energy strategies in the course of economic development.Last but not least, we can expect non-fossil energy sources to provide a good and growing fraction of the worlds energy supply. trance fossil fuels will predominate for some decades more, in the longer term non-fossil alternatives are likely to come to preeminence. Wind, hydroelectricity, ocean waves, bio-fuel, geothermal and nuclear energy will be more favored although each of these is limited by local condition and not applicable as global solutions. Due to popularity and profits, states attempt to gain the nuclear energy, but it can pose threat to the localized and internationalized because of nuclear radiation and nuclearweapon.Prepared by SAY VORTANA 2 email emailprotectedChallengesFrom my perspective, there are two main challenges implementation and the inequity between developed and developing states.The problem is not the framework or purpose but implementations. The Kyoto protocol commitments were very modest (only 5 percent reduction) and short term until2012, and it shows the cooperation of the world on a carbon management trajectory. Even so this treaty is considered as failure when the U.S did not signalize this protocol in fear of economic development impacts. The US, far and away the biggest contributor to GHGs, indignantly telling poor countries tutelage the consequences in famines, droughts, increased malaria transmission and more that the United States will not even start on emissions control, so how can other states obey and ratify this treaty?Another important but controversial challenges is the inequity between developed and developing states. Development and environmental protection are dilemma for conclusion makers of individual states developing countries who try to develop their countries are inevitable to exploit the ir natural resources, so when developed states who enjoyed their economic growth in the past decades tell developing states to stop exploit their natural resources, it is injustice. For example, when the US and Europe tell Brazil to stop deforestation business investment, and similarly China was criticized for air pollution.In conclusion, as long as there is no strong support from super power P5 (security council) the south and north cannot reach mutual interests (efficiency and equity) plus trust each other, the global warming and climate change still remain unsure when will it can be sort out.Case studyWhat are the possible solution for Cambodia to overcome global warming and climate change? There are three potential solutions low carbon economy/ upraise economy efficiency, carbon finance and promote environment awareness.Cambodias government can improve and examine seven factors Energy supply improved supply and scattering efficiency, Renewable sources, security and access Tra nsport Hybrid vehicles, emission standards, bio fuels, Public transport, non- motorized transport Buildings passive and active solar integrated buildings, improved insulation Industry Upgrading of factories, processing lines / schemes etc.Prepared by SAY VORTANA 3 email emailprotected Agriculture improved agricultural practices Waste management landfill methane recovery waste to energy compostingrecycling and waste minimization Forestry Reforestation forest management reduced deforestationFor carbon finance Cambodia can enjoy with the extra nonrecreational by using clean development mechanism (CDM). According to UNDP based in Cambodia, a local power generator, Samrong Thom Methane-fired Power Generation reduce sum GHG emission for 7 years 47,544 tCO2e this generator can get total income at $15/tCO2e US$ 713,160 from carbon finance2, so government should encourage this kind of investment in Cambodia.Invest in Biogas Digester (source UNDP)Another solution is to promote environm ent awareness for Cambodian. The bottom- up strategy also provides a better option to overcome this issue. The government can work effectively with other Non-government organizations (NGOs) by providing environment education in the public school and local communities.In short, likewise protecting environment, Cambodia can enjoy low carbon economy through carbon finance furthermore, the bottom-up strategy can promote environment issue awareness in Cambodia. In the last chapter of this paper, we will wrap up and provide brief conclusion.Mini composition 5ConclusionGlobal warming and climate change are transnational issues that pose great challenges to the global governance. Nations has suffered severe disaster such as flood, hurricane, serious earthquake, drought and so on recently, and it would be great danger in the future if global warming and climate change are not sorted out effectively. Despite of cooperation between states through earth summit and Kyoto protocol, the issues re main widespread from day to day. Who will be responsible? Developed states or developing states? The controversial stances between developed countries and developing countries remain exists and pose a big challenge for Kyoto protocol. Furthermore, the decision maker, leader, head of states are inevitable face dilemma between development and environmental protection.For Cambodia, Cambodia contributes little to climate change but almost all the provinces in Cambodia are vulnerable to climate change due to their low adaptive capacity and dependence on climate-sensitive livelihoods. Moreover, climate change is expected to increase the frequency and intensity of extreme weather events such as floods, droughts and windstorms as well as coastal inundation due to sea-level rise. Responding to climate change should start by linking efforts to reduce vulnerability to present climate-related disasters with those aimed at building longer-term resilience to climate change. Low carbon economy/enh ance economy efficiency, carbon finance and promote environment awareness are the factors that will be alleviate and assist Cambodian through bright future in the next generation.For both international and national level, implementation and commitment from the government or head of state is compulsory to ensure the sustainable growth with the greeneconomy policy.

Incorporating Telemedicine into a Surgical Practice

Incorporating Telemedicine into a Surgical PracticeKristen HarkeyComplex teases can create a challenge for the affected role as rear as the surgeon. The challenges faced include operative management, cosmesis, long-term management, effects on lifestyle for uncomplaining and caveatgiver, and self-image (Park, Copeland, Henry Barbul, 2010). Hospitalized patients entrust shake off the running(a) team, the trauma thrill specialist, and a bedside nurse to assist them in their daily cargon. When these patients are ready to leave the hospital they can feel anxiety about providing care for themselves, especially if they have a complex displease present. This anxiety can strike once they learn how to care for themselves at plaza while having the readily operable supplies, but then they must leave their hearths to give out to come to the surgical office for a vex check. This can be a pith to not scarcely the patient but their primary caregiver. The purpose of this paper is to introduce an evidence-based change fox that focuses on providing patients with the option of telemedicine office recalls.BackgroundIn 2010, about 51.4 million inpatient surgeries were per imageed in the US according to the National Center for Health Statistics (CDC/NCHS, 2010). Wound complications can be an important cause of postoperative morbidness following a laparotomy (Mizeell, Sanfrey, Collins, 2014). Acute aggravate care is needed in all patients with surgical and traumatic wounds, when an incision is do this creates a wound which provide need however attention. There are a multitude of ways to address these wounds such as wet to dry dressings, dry packing strips, wound vac systems, and if needed further surgery such as a skin graft. These wounds can then become chronic when they have failed to proceed through the reparative dish to produce anatomic and functional integrity in 12 weeks (Sen, 2009). Both acute and chronic wounds can become a significant financia l burden on both the healthcare system and the patients themselves.SignificanceWith the sheer number of surgeries listed above, this lead create wounds that need to be managed appropriately. Not scarcely are wounds created by surgery, they can also be created by trauma or massive soft tissue infections (Park, Copeland, Henry Barbul, 2010). Part of this management whitethorn be further surgical interventions to restore the fascia or possibly watchful waiting. In our facility in 2014, 3349 patients were evaluated by our wound care specialist. Of these 695 patients had surgically created wounds and approximately 656 were managed with wound vacs (G. Caldwell, personal communication, January 20, 2015). These patients allow for need to be followed in the outpatient setting for on-going wound assessments, possible change in wound management, or further surgical intervention if indicated. The outpatient care to these patients will include discussions on proper nutrition to promote w ound healing, activity levels, timing of dressing changes, and ongoing assessments of the wounds. It can create a significant burden to patient and caregiver to travel to office visits for ongoing assessment of the wounds which can take as trivial as ten to fifteen minutes to examine once they have arrived rear to the exam room. This short office visit can create a significant burden to the patient and their caregiver, this burden can include ability to keep themselves clean throughout the trip, financial, and time-strain.PICO Question and Comp superstarntsEvidence-based fare (EBP) can be draw as a life-long problem solving come along to clinical decision-making that involves the conscientious use of the best available evidence with ones own clinical expertise and patient values and preferences to improve outcomes for individuals, groups, communities, and systems (Melnyk Fineout-Overholt, 2011). EBP will help to ensure high quality, safe, relevant, and up-to-date care while at the uniform time improve patient outcomes (Robb Shellenbarger, 2014). One of the ways to create EBP in a way that will yield the most relevant instruction from a search is to form a question in the PICOT format. The PICOT format is composed of the following P will describe the patient universe, I will reveal the intervention or issue of come to, C will reveal the comparison intervention or status, O will reveal the outcome, and T will reveal the time compile in which the intervention/issue of interest will accomplish the outcome (Melnyk Fineout-Overholt, 2011). For the purpose of this paper, the beginning will include all components listed except for time which will be addressed at some other juncture.PopulationThe population of focus will be outpatient postoperative patients in the billet health setting. The patient population will be those with acute/chronic wounds, ages eighteen and up, both male and female patients with no restrictions on ethnicity. The wounds will li kely be compromised of complex ab wounds, however no limit will be placed on the type/cause of the wound. The patients will live in northeastern Carolina or South Carolina and reside within a 4 hour drive from Charlotte, NC. No restrictions will be placed on the agency providing phratry health services to the patient.InterventionTelemedicine is defined by the World Health Organization (WHO) to be the drill of healthcare development video, interactive audio, and/or info communications (Chanussot-Deprez Contreras-Ruiz, 2008). With the use of telemedicine the patients will be able to stay in their own home. This will also provide an enhanced team based approach because we will have both the patient, patients caregiver if applicable, and the home health nurse. This will provide accurate documentation of wound measurements. The appropriate wound care will then be provided by the home health nurse, and if applicable the wound vac will be re-applied.ComparisonThe comparison group wi ll be a standard office visit. The standard office visit will consist of the patient and their caregiver coming to our surgical come, in one of our two locations. The patient will be required to wait for their battle time and wait as required for the supplier to see them. If a wound vac is present, this will be retravel in the office and will not be re-applied per standard operating procedures. The patient will have a unorthodox dressing replaced and will then need the home health nurse to come to their home upon their arrival to re-apply the wound vac. This consists of a standard office visit in our practice.OutcomeThe anticipated outcome, will be no effect on wound healing when employ telemedicine. For the practitioner, one important aspect of examen of the wound is not only using your sense of sight but also your sense of smell. The smell of a wound can be declaratory of necrotic tissue that requires further debridement or possibly a wound infection. This sense will be mis sing with telemedicine and the practitioner will need to assert heavily on the home health nurse for this aspect of assessment. some other outcome for this study will be increased patient satisfaction. The patient with a complex abdominal wound may have difficulty at baseline corroborateing adequate coverage for the drainage, this is more(prenominal) of a challenge when you add sponsor position changes associated with change of location to a health care providers office.In summary, a postoperative surgical patient will require care for the surgical wound in an outpatient setting. This care can be frustrating for the patient, the patients caregiver, and the home health nurse. With the addition of telemedicine to a surgical practice this will decrease the burden of traveling to a standard office visit as well as enhance multi-disciplinary care for the patient. It is the hope of the author that for complex wounds that remain difficult to manage in the outpatient setting, the inp atient wound ostomy nurses who provided care inpatient will be able to assist more in the outpatient setting by providing continuity of care.ConclusionWith every surgery performed a resultant wound is created. Wounds can also be created by trauma or massive necrotizing soft tissue infections (Park, Copeland, Henry Barbul, 2010). The surgical wound can heal without difficulty and the patient returns to his activities of daily living, however a multitude of wound complications can occur delaying wound healing. Some wound complications will require further surgery, however due to the nature of these wounds surgery may need to be delayed for up to one year or longer. This can cause caregiver strain and for the patient can take away many of the freedoms we enthrall on a daily basis. As part of a standard office visit the patient is expected to arrange transportation to our office, wait for his/her appointment time, have their wound examined, and then if a wound vac is used they are exp ected to have this re-applied when they get back to their home by the home health nurse. With the addition of telemedicine to the patients postoperative care, they would be able to have a multidisciplinary team visit them in the home using telemedicine resources. This would significantly decrease the burden travel can create for these patients with complex wounds.ReferencesCDC/NCHS National Hospital Discharge Survey (2010). Retrieved fromhttp//www.cdc.gov/nchs/data/nhds/4procedures/2010pro4_numberprocedureage.pdfChanussot-Deprez, C. Contreras-Ruiz, J. (2008). Telemedicine in wound care. InternationalWound Journal, 5(5), 651-654.Melnyk, B. Fineout-Overholt, E. (2011). Evidence-based practice in nursing healthcare Aguide to best practice (2nd ed.). Philadelphia, PA Wolters KluwerLippincott Williams Wilkins.Mizell, J., Sanfrey, H., Collins, K. (2014). Complications of abdominal surgery. Retrievedfrom http//www.uptodate.com.Park, H., Copeland, C., Henry, S., Barbul, A. (2010). Comp lex wounds and theirmanagement. The Surgical Clinics of North America, 90(6), 1181-1194.doi 10.1016/j.suc.2010.08.001Rob, M., Shellenbarger, T. (2014). Strategies for searching and managing evidence-basedpractice resources. The Journal of Continuing Education in Nursing, 45(10), 461-466.Sen, C. K., Gordillo, G. M., Roy, S., Kirsner, R., Lambert, L., Hunt, T. K., Longaker, M. T.(2009). Human skin wounds A major and snowballing threat to public health and theeconomy. Wound Repair Regeneration, 17(6), 763-771. doi10.1111/j.1524-475X.2009.00543.xIncorporating Telemedicine into a Surgical PracticeIncorporating Telemedicine into a Surgical PracticeKristen HarkeyImagine presenting to the hospital for your planned cesarean section, a time of great anxiety and joy. During the procedure you alas have a complication and an enterotomy (cut into the intestines) is made, but missed at the time. Hours later you develop increasing abdominal pain and a rash spreads readily across your abdomen. Your healthcare providers explain you have an infection called necrotizing fasciitis and this requires further surgery to treat the condition. The individual then wakes up possibly weeks later with most of their abdominal wall, upper thigh skin, several(prenominal) muscle layers missing of both the abdomen and thigh, as well as stool draining from the middle of the wound. The individual is aware they have an enterocutaneous fistula that will likely not be able to be repaired for several months to a year. This person is finally able to transition home with their newborn, a gaping abdominal wound, stool draining from the wound, not allowed to have anything to eat or drink, and are attached to intravenous nutrition twenty-four hours a daytime. This would be overwhelming for the most health literate patient, much less an individual with limited resources and low health literacy.Our health can change quickly with an unexpected surgery that causes a complex surgical wound. This wound must be monitored closely in the outpatient setting to prevent further complications including loss of subdivision or possibly life. Typically the patients wound care has been provided in the home by a home health nurse. Subsequently the patient and family caregiver are then expected to travel to the doctors office for intermittent follow-up questions of the wound over a weekly to periodical schedule which could last up to one year or more postoperatively. Leaving the patients home with these complex wounds can be a burden due to factors such as increased pain, time-consumption, financial costs, and possible embarrassment if the wound or ostomy appliance leaks. Some of this burden could be improve with virtual visits.Overview of Problem of InterestIn the United States 6.5 million individuals are affected with chronic wounds that require ongoing care (Sen et al., 2009). Patients are expected to travel to their healthcare providers office for follow-up examinations and sometimes this requires a long care ride, wait in the office, and then travel home. It is difficult to maintain a dressing on the wound in the most basic of circumstances, such as during times of everyday activity in their home. With the addition of traveling this can become an overwhelming and untidy endeavor while the healthcare provider will likely only spend minutes examining you. Due to this some patients will not come to their follow-up appointment and this can be detrimental to their health by prolonging wound healing, increasing run a risk for infection, and delay time to come surgical repairs. When the individual is at home, they require home health services for ongoing wound care as well as provision of supplies. The home health nurse sees the patient on a more regular basis than the healthcare provider and will call the providers office with important changes they note. unfortunately this process may take several phone calls which takes valuable time for the home health nurse and increases wait time for care of the patient.Most patients have an expectation that surgery will help them heal or cure their disease. Unfortunately approximately 22% of patients may experience moderate to complete postoperative disability (Shulman et al., 2015). Home health nursing will provide some relief for the patient and a multidisciplinary approach is necessary to manage complex discussion modalities (Wilkins, Lowery, Goldfarb, 2007). In Carolinas Medical Center Main in 2014, 3229 patients had wound care provided by our wound ostomy care nurse team and of those 820 were surgical patients (G. Caldwell, personal communication, January 25, 2015). These are many of the patients that require ongoing care in the outpatient setting to prevent further complications.In the United States (US) in 2000, forty million inpatient surgical procedures were performed and at that time the need for post-surgical wound care was sharply on the rise (Chittoria, 2012). In the US the amount of mone y spent on wound care, diminished quality of life, and the loss of productivity for the individual and caregiver comes at a great cost to our society (Sen et al., 2009). Therefore it is in our best interest as providers to provide safe and effective care to our patients in the most convenient format for both the patient, caregiver, home health nurse, and the healthcare provider.Review of publicationsOne of the first steps to address a problem is reviewing evidence available to support the proposed intervention. Virtual care is currently being used in many different platforms such as urgent care, psychiatric care provided in ERs, preventing readmissions in heart failure patients, and many other venues. The examination of acute and chronic wounds is one venue that has found success. In the plastic surgery population where visual exam is heavily relied upon for decision-making, telemedicine has been shown to have great voltage. Gardiner and Hartzell (2012) performed a systematic revi ew of twenty-nine articles. Twenty-eight of the articles noted a proceeds including improved access to expertise and cost reduction through conserving hospital resources and avoiding redundant transfers (Gardiner Hartzell, 2012). Wallace, Hussain, Khan and Wilson (2012) had similar findings in the burn population where they noted improved assessment and triage, avoidance of unnecessary transfers and a potential for health care savings when using virtual care. In the trauma population a 90% accuracy was noted in assessing traumatic plastic surgery injuries whether the practitioner was using bedside visual exam or transmitted digital images (Gardiner Hartzell, 2012).Wilkins, Lowery, and Goldfarb (2007) used their initial investigation to determine the feasibility of virtual wound care and then moved forward with performing a pilot study using a store and forward technique. At the time of initial referral the mean wound surface area was noted to be 5.85 cm2. Using virtual care the authors noted in 58.2% of the wounds, the diagnosis or treatment plan was changed. This change in diagnosis or treatment plan resulted in an average decrease of 58% from the initial wound size over an average time period of 40.2 days. The authors went on to note 95.5% of patients found telemedicine consultation more convenient than traveling and 98.2% of patients were either satisfied or very satisfied with the care they received (Wilkins, Lowery, Goldfarb, 2007).An article create in 2014 by Kidholm, Dineseen, Dyrvig, Rasmussen, and Yderstraede was noted to be the largest and most comprehensive research declare oneself to evaluate telemedicine effectiveness and costs for patients with chronic diseases. The results revealed telehealth reduced mortality with an odds ratio of 0.54. Mortality in the control group was noted to be 8.3% while the intervention group was 4.6%. The authors also noted a 10.8% lower hospital admission rates in the intervention group with an odds ratio of 0 .82 (Kidholm, Dinessen, Dyrvig, Rasmussen, Yderstraede, 2014).Telemedicine may be applied to many different aspects of medicine, but a benefit has been shown in the examination and long-term treatment of wounds (Wilkins, Lowery, Goldfarb, 2007). Telemedicine has been shown to satisfy both the clinician as well as the patient, while continuing to provide quality care. Therefore a solution to the burden of traveling to the doctors office, decreasing financial strain, decreasing caregiver strain, and improving access to care are all potential benefits of providing care using virtual visits.Purpose of ProjectThe purpose of incorporating telemedicine into our surgical practice is to provide our patients with the most efficient high quality care in the most appropriate setting for the patient. A standard office visit consists of the patient traveling to our office, being evaluated by the medical team, and then having to travel back to their home. This evidenced based project will allow the patient to stay in their own home and have the providers visit them via a virtual visit. Upon dispatch from the hospital the patient will be evaluated for inclusion into the virtual visit program. If the patient is determined to meet the criteria including living in NC, using Healthy at Home to provide home health services and have a complex surgical wound then an appointment will be made for the virtual visit. The home health nurse will proceed to the patients home at the assigned appointment time and use their diggings for the visit. The provider will then join the home health nurse in the virtual setting and the patients wound will be evaluated. Appropriate changes in the treatment plan for the wound will occur and the provider will assure all questions/concerns are addressed with the patient, caregiver, and home health nurse.One desired outcome for this project will be to maintain a high level of patient satisfaction, as we do in our office. As providers, we would like to provide more efficient care and this may be possible by having one provider performing postop visits virtually while another provider evaluates new consults in the office. It will be important for this project to provide the same level of care that we provide in the brick and mortar office, as well as following all current standards of care.Project ManagementThe facility where this project takes place is a Magnet facility. To receive this designation an plaque must prove they have several key characteristics including empirical outcomes as well as integrating evidenced based practice and research into operational and clinical processes (American Nurses Credentialing Center, 2014). An important goal for our organization this year will be to provide care in new ways, one of which will be providing more opportunities for our patients to experience virtual care. This innovative project is meant to assure that we are improving quality, enhancing value and dealing with the complexity of health care today (Harris, Roussel, Walters, Dearman, 2011).Implementation aggroupThe backbone of quality gain work is the team and their teamwork (Ogrinc et al., 212). The team for this project will include individuals from different disciplines to ensure success. The author of this paper will distribute as the operational lead on the project, assuring all aspects of the project are coordinated. Our administrative lead will be the practice manager for our outpatient slip scale clinic. He will be able to assist the project in assuring we meet meaningful use standards as we do in the office, as well as building templates in our scheduling software, and facilitate changes in the organization. A management associate with the virtual care division will remain part of the team, as she has had past experience with implementing similar projects and has provided invaluable support. The next fraction of the team will be a member of the IT plane section and will assist the team in choo sing the right technology/platform for this project. He will not only assist in the beginning stages of this project but will be a constant resource for ongoing IT support. The administrator for the home health agency will be a member of this team, she will provide information regarding her organization and provide us with establishing workflow for the home health nurse. This will be an important step as this project is meant to provide multidisciplinary care, however it will not be beneficial for it to provide more efficiency for our team but not the home health team. The lead of surgery who also serves as the interim lead of the acute care surgery team, as well as the two surgeons who practice on the same service. This team will serve to bring virtual care visits to our surgical practice.Risk Management StrategyIt is important to examine every project to diagnose external and internal items that either positively or negatively affect the project. One type of assessment that can be performed is the strengths, weaknesses, opportunities, and threats depth psychology (SWOT analysis). During the SWOT analysis the system is fully examined from the clinical micro to the macrosystem perspective (Harris, Roussel, Walters, Dearman, 2011). For this project some strengths noted include other departments within the facility using virtual visits and a department dedicated to assisting new groups to use this technology. Another strength is the patients included in this project will remain in the global ninety day postoperative fee which will not require reimbursement from insurance companies and keep the cost incurred limited. It is important to then examine some of the weaknesses which include removing a provider from an already overbooked clinic to participate in this project, the additional cost of the technology, and surgical postoperative care has not been provided in this manner in our facility prior to this. When further evaluating opportunities associated with this project, the ability to be the only surgical providers providing care virtually will set this team apart and appeal to more consumers and home health agencies. Another opportunity would be to include all home health care providers in our area and obtain licensure to be able to provide virtual visits in South Carolina. Some threats to this project include newer technology that hasnt been tested, a good working relationship with the home health agency must be in place, and is it possible for the team to provide confidential care to our patients using virtual visit technology.Organizational Approval ProcessInitially this project was approved at the departmental level after multiple discussions with the chairman of surgery for the metro division of our healthcare system. Prior to proceeding to the IRB process, the facility requires submission of your marriage proposal to the Nursing Scientific Advisory Council (NSAC). Once NSAC has evaluated a proposal fully and any revisions hav e been completed you may move forward with your submission to the IRB. place of Information Technology in this ProjectInformation technology will play an integral part of this project. Although virtual visits are used throughout the hospital system, they have not been incorporated into the surgical practices within our system. This project will include an IT tech to assist in choosing the best platform to serve our patient population while being user friendly for our home health nursing colleagues. It will be important for our platform to work well with the technology available to the home health nursing team. This will assure we are able to provide the best quality visit and address not only the providers needs, but also the home health team, patient, and caregiver. The project needs IT support for both the onsite provider as well as the home health team in the patients home.Plans for IRB ApprovalAn institutional review board (IRB) is a committee that is mandated by the National Re search Act, popular Law 93-948 and is required in institutions that conduct biomedical or behavioral research that involves human subjects (Harris, Roussel, Walters, Dearman, 2011). IRB approval will be sought for this project using the Carolinas Healthcare Systems IRB. The submission type will be expedited. This approach was chosen because it is evidenced based research and poses minimal human risk to the participants (Chatham University). Prior to approval by the IRB this project must be submitted to the NSAC therefore this will be performed in September 2015. Once approval has been obtained by the NSAC the information will then be submitted to the IRB for approval, likely in November 2015. This letter can be reviewed in Appendix A of this paper.ReferencesAmerican Nurses Credentialing Center. (2014). Magnet model. Retrievedfromhttp//www.nursecredentialing.org/Magnet/ProgramOverview/New-Magnet-ModelChatham University. (n.d.). institutional Review Board (IRB). Retrieved fromhttp/ /my.chatham.edu/tools/irb/Chittoria, R. (2012). Telemedicine for wound management. Indian Journal of Plastic operating theater,45(2), 412-417.Gardiner, S., Hartzell, T. L. (2012). Telemedicine and plastic surgery A review of itsapplications, limitations and legal pitfalls. Journal of Plastic, Reconstructive Aesthetic Surgery JPRAS, 65(3), 4753. doi10.1016/j.bjps.2011.11.048Harris, J., Roussel, L., Walters, S., Dearman, C. (2011). Project planning and managementA guide for CNLs, DNPs, and nurse executives. Sandbury, MA Jones BartlettLearning.Kidholm, K., Dinesen, B., Dyrving., A, Rasmussen, B., Yderstraede, K. (2014). Results fromthe worlds largest telemedicine project-The whole system demonstrator. EWMA journal,14(1), 43-48.Ogrinc, G., Headrick, L., Moore, S., Barton, A., Dolansky, M., Madigosky,W. (2012).Fundamentals of health care improvement A guide to improving yourpatients care(2nded.). Oakbrook Terrace, IL The Joint Commission and the Institutefor Healthcare Improvement. Sen, C. K., Gordillo, G. M., Roy, S., Kirsner, R., Lambert, L., Hunt, T., . . . Longaker, M. T.(2009). Human skin wounds A major and snowballing threat to public health and theeconomy. Wound Repair and Regeneration, 17, 763-771.Shulman, M. A., Myles, P. S., Chan, M. V., McIlroy, D. R., Wallace, S., Ponsford, J. (2015).Measurement of Disability-free Survival after Surgery.Anesthesiology,122(3), 524-536.doi10.1097/ALN.0000000000000586Wallace, D., Hussain, A., Khan, N., Wilson, Y. (2012). A systematic review of the evidencefor telemedicine in burn care With a UK perspective. Burns, 38, 465-480.Wilkins, E., Lowery, J, Goldfarb, S. (2007). feasibleness of virtual wound care A pilot study.Advances in Skin Wound Care, 20(5), 275-278.

Your Body Is Never Yours Essay example -- Literary Analysis, Disgrace

In Disgrace, sex is repeatedly used a source of power. Lurie feigns advantage of his young student and also pays prostitutes for sex. The most violent coif of power and hatred towards sex and women is Lucys rape, performed by two black men. However, I claim sex is in fact not used for power, unless that the author believes that we never own our own bodies. Therefore, considering they are not ours, they cannot be violated. Furthermore, he shows us that the worth of our bodies is simply limited to the expectations of lot around us. I state that in Disgrace, your body does not belong to you. It is merely a product of expectations and responsibilities.In the opening of the book, Lurie pays for the service of prostitutes to find relief. In his younger days, he could use his charm and good looks to seduce women now if he wanted a woman he had to learn to pursue her, in one charge or another to buy her (7). He speaks of wanting something, suggesting that a woman is a thing that can be had, or in this case purchased. musical composition reflecting of the prize he pays for his favorite-prostitutes body he realizes that in a sense they own Soraya too, this part of her, this function (2). They, being the escort company that she belongs too. hither it is implied that Soraya is just a product that can be sold and purchased, or even rented out by its owner. When, one day Lurie sees Soraya shopping with her sons, their relationship change. She becomes a psyche, a living being and their relation ends on her initiative. This shows of her desire to restrain herself to an object in the eyes of her customer. Subsequently, as David no longer can take pleasure from Soraya, he benefits from his position as a respected teacher to take advantage of the much younge... ...eoples eyes. Our bodies are not ours, as Lucy confirm after she has decided to get married to Petrus. With nothing. Not with nothing but. With nothing. No cards, no weapon, no property, no rights, no dignity ( 205). This is how she sees herself, and perhaps how every person in the novel sees themselves. Everyone realizes that their value is bound to something other than them, David to his status as a professor, Melanie to her youth and beauty, Pertrus to his property and ownership, Lucy to being independent and Bev, who sadly knows that as a dumpy older woman she has no value at all. A sad idea, but nonetheless true in Disgrace. That we are not people but mere products, to be valued, evaluated and graded. The use of power to obtain sex or of sex to obtain power then becomes secondary. As readers we are go forth with the query of whom or what is deciding our value.

The Holocaust :: European Europe History

HolocaustThroughout the movie, The Holocaust, the phrase, I just do my job, was usually the only excuse roughly people who act crimes against the Jews could come up with. For example, when Helena and Rudy Weiss were staying in Kiev, the city was bombed. During the bombing, one of the Nazi soldiers, who happened to be Heinz Muller, a friend of Ingas family, was hit by falling debris. Hesitant, Rudy helped Muller lose from the collapsing building, gave him some water, and asked him why he was taking part in the mistreatment of the Jews. I obey orders, Muller replied, unrepentant close what he did. Also, when Bertha Weiss was sent to the gas put up in Auschwitz, Dr. Joseph Weiss asked the Kapo what happened to her. The lady bluntly retorted, Dont blame me, I just take orders. Whether to keep a job, remain loyal to their cause, or just because they had no opposite excuse, everyone used that phrase to justify what they did wrong against the Jews. Anti-Semitism and unfair grudges are two factors that can cause Genocide. During the movie, Eric Dorf claimed he did not feel bad about Kristallnacht or what happened to the Jews, because he said the Jews provoked it. Even though Kristallnacht was the first major pogrom, a government sponsored attack on the Jews, and was terribly destructive, Eric said that they killed the Nazarene and they deserved what they got (The Holocaust). In addition, Heydrich believed that Germans and the Aryan race was superior to the Jewish race and they had to isolate the germ carriers (The Holocaust), so he decided to go through with the see for Jewish ghettos. The ghettos were intended to hold the Jews in a temporary Jewish community until they could be efficiently exterminated. This demonstrates how Anti-Semitism and grudges can produce Genocide. In the video, Conversations With Oprah Elie Wiesel, Wiesel explains that the most important lesson to be learned from what happened during the Holocaust is to not be indifferent, but to still be human in spite of everything that happened. He said he believed that the opposite of love is not hate, but rather indifference, because indifference can not be fought (Conversations). Not being indifferent is important in preventing some other Holocaust in the future. When you have a choice to make and you dont make it, that in itself is a choice, William James once said.