Nursing Learning Experiences Coursework Example | Topics and Well Written Essays - 1250 words

Nursing Learning Experiences - Coursework Example The study analyses the nine essential aspects that outline the results expected of graduates of baccalaureate nursing. The essentials enhance a nurse graduate to work in diverse fields because they oblige an individual to integrate skills, knowledge and attitudes developed from the study in his or her daily activities. The nine essentials are the key to nursing activities; they involve learning and portraying knowledge and skills in all aspects of nursing. Through this essential, nurses learn that good cohesion between a nurse and the community is very essential in nursing profession. It enhances success in most of the activities involving patient care. According to â€Å"The Essentials of Baccalaureate Education for Professional Practice† (2008), liberal education constitute broad understanding of wide scope of science, cultures, social practices, and ability to implement the learnt elements in overcoming complex problems and challenges. From this, it is evident that nurses d o learn that having broad understanding of different cultures as well as social practices assist significantly in offering nursing care to patients from different backgrounds. It is also evident that broad understanding of science as well as arts enables a nurse to solve complex problems and challenges associated with nursing care. It is evident that broad understanding of cultures as well as social practices enables a nurse to advance his or her leadership skills through intermingling with people of different societies and cultural practices easily.

My Immigration Research Paper Essay Example for Free

My Immigration Research Paper Essay In this paper I will use the ethical theories of utilitarianism and deontology, as well as the perspective of ethical egoism, as they pertain to the issue of immigration. Living in a state bordering Mexico [New Mexico], this is indeed becoming a pressing issue as tens of thousands of illegal immigrants flood my state and neighboring states. This issue brings up many questions such as: 1 – What is our moral obligation to these immigrants? 2- What is our moral obligation to U. S. citizens that are affected by this influx? 3- Is it morally right for smugglers to profit from the pain of those seeking safety, security, and a better life? 4- Is it morally/ethically right for parents to subject their children to the long, lonely, dangerous journey to the United States. By applying the theories and perspective noted above, I will show that if this issue is not handled immediately, the consequences will be detrimental to both U.S. citizens and the immigrants as well. The desire of the immigrants to obtain a better life does not preclude them from following current laws and processes. While they act from a position of self -interest, their actions impact many others in the process. From October 2012 through September 2013, the Border Patrol has apprehended about 24,000 unaccompanied children at the border. Between October 2013 and the end of June 2014, the number rose to 57,000. It is estimated this number could reach 90,000 by the end of September 2014. Most are coming from El Salvador, Honduras, and Guatemala. Once the immigrants arrive in the United States, what is our moral obligation to them? Under current law, these children are placed under the custody of the Department of Health and Human Services which works to place them with family members in the U.S. while awaiting a court date. The influx has created the largest backlog in immigration courts. â€Å"In the first half of the year there were 366,724 pending cases. As of March the average wait time for  a case was 578 days, according to the Justice Department records.† Experience has shown many immigrants never show up to these hearings.† Deontology claims an act is to be evaluated in terms of its accordance with a set of rules. Consequently, it is clear that these immigrants have broken the immigration laws of the U.S. both in the way they entered the country and in their refusal to attend court hearings. Their flight to this country clearly is done for the person’s self- interest. They hope to flee the dangers and poverty of their home countries to seek a better life in the United States. However, does the actions of the immigrant outweigh the effect of this influx on the population of the United States? Once here, national, state, local and charitable organizations are being used to house, feed, provide medical care, and other assistance to these immigrants. Meanwhile, United States veterans, homeless, mentally ill, and the elderly go without needed services. Should our own citizens not be our main focus? In my state of New Mexico, one of the poorest in the nation, we are currently housing and processing hundreds, if not thousands of these immigrants. My town of Las Cruces has opened its churches to house and care for the immigrants, even though many of the children here do not have enough to eat or a proper living environment themselves. Once the immigrants arrive at our local shelter, they are given a cot, clean clothes, a shower, hot meals and health checks. After eating, they file into rooms to collect hygiene supplies, diapers, clothes, and suitcases. Children can choose one toy from a large box of donated stuffed animals. Down the hall, volunteers assist the immigrants to call their families across the country and book train, bus, and plane tickets, depending on how much the families can spare. With the system the church shelter has developed, most immigrants will be on their way to relatives within 2 days. President Obama is seeking billions of dollars to increase the number of facilities for these immigrants, to tighten border security, and expand the number of U.S. immigration judges. Should huge amounts of U.S. money be expended to deal with illegal activity or more properly used to alleviate problems of legal U.S. citizens? Governor Rick Perry of Texas has ordered the National Guard to help protect the border because of Congress’s inability to act on this issue. Again, this is taking resources that might be needed elsewhere. While most Americans understand and empathize with the reasons for this influx,  the cost to the American public is substantial. One of the less publicized sides of this immigration issue is the smuggler’s profiting from the distress/fear of others. The smugglers are referred to as ‘coyote’ smugglers. One smuggler described â€Å"shipments of thousands of dollars in human cargo from slums of Honduras and highlands of Guatemala to cities across the United States. It is business; sometimes business is very good.† The vast majority of immigrants who enter the U.S. illegally do so with the help of a network of smugglers. It is a high risk, high yield business estimated to generate $6.6 billion a year. The immigrants pay $4,000 to $10,000 each for this illegal journey. The smugglers in turn pay off government officials, gangs operating on trains, and drug cartels. The experts estimate a profit of $3,500- $4,000 per person if the journey goes as planned. The smugglers are profiting from the rising violence in gang-ridden cities of Central America. Many of the immigrants travel to the U.S. because they believe they will be allowed to stay. The U.S. generally releases children to parents, relatives, or family friends. Their cases take years to go through the immigration courts. This gives rise to rumors of a new law or amnesty for children. The coyote smugglers spread those rumors to drum up business. In a July 23, 2014 issue of the Las Cruces Sun-News it was reported that the Homeland Security Department arrested 192 people along the Mexico border in South Texas on immigration smuggling charges and seized more than $625,000. A crackdown called â€Å"Operation Coyote† took place over the last month, part of the 90 day effort to target smuggling groups. The White House stated that smugglers are exploiting U.S. policies and the crackdown was a message to the smugglers that â€Å"our borders are not open to illegal immigration.† Analyzing this issue from the perspective of ethical egoism, the immigrants and the smugglers are both looking out for themselves, one to seek freedom and a better life, the other to procure as much money as possible. From a deontology perspective, clearly both the immigrants and smugglers are not following the law. The immigrants are entering the U.S. illegally while the smugglers are giving payoffs to drug cartels, gangs, and government leaders. Finally from a utilitarian standpoint the course of action of both the illegal immigrants and the smugglers certainly does not maximize the greatest good for the greatest amount of people. The illegal immigrants may benefit in the short run, but  if eventually returned to their countries may indeed be subject to even greater hardship. The corruption supported/used by the smugglers does nothing to create a better life for the majority of people. And once again the financial and emotional effect on the U.S. is wide spread. Another question/ concern raised by this influx of mostly unaccompanied children is related to their safety, both in their home countries and related to their long journey to the United States. Homicide, extortion, rape, and gang recruitment have risen to epidemic levels in Guatemala, Honduras, and El Salvador. â€Å"Immigrants’ rights advocates in the U.S. say they are seeing more children from Central America who are not only fleeing gang recruitment and random violence, but who have been targeted themselves.† This violence is seen as the key reason for driving immigrants north. But let’s look at the very imminent danger of death these immigrants face by not only placing themselves in the hands of smugglers [whose only concern is money] and the desert journey they face. The smugglers receive money from the immigrants and their families [both in their home country and in the U.S.] This in turn places more of a financial burden on these families, while a successful outcome is not assured. Along the journey, these immigrants are still subjected to the threats of gangs, drug cartels, and corrupt government officials. They are subjected to the extreme heat of the desert with little food or water and often just the clothes on their backs. Recent news reports put a face to this crisis when Texas authorities identified a decomposed body found recently near the border with Mexico as that of an 11 year old Guatemalan boy, Gilberto Francisco Ramos Juarez. He was identified by calling a phone number etched into his belt buckle and by family members describing the clothes he was wearing when he left home. A recent interview of a rancher in Brownsville Texas reported him also finding a body on his ranch. He reports having to keep a constant vigil all day and night as illegal immigrants enter his land, approach his house and car, and seek aid. Hector Espinal, the Honduras spokesman for UNICEF, stated â€Å"The message is that governments should do what they need to do to stop the violent conditions that are making these children leave.† How to stop violence in Honduras is a subject of much debate. Two major gangs- The Mara Salvatrucha and Barrio 18, have grown into transnational criminal organizations. Drug cartels use Honduras as a point to move cocaine into the United States.  First Lady Garcia of Honduras says her country needs its own U.S. funded anticrime program similar to Plan Colombia or Mexico’s Merida Initiative to fight the gangs and cartels. Vice President Joe Biden recently visited Guatemala. To coincide with that trip, President Obama has pledged $93 million in new programs to reduce violence in Central America. This includes $40 million to reduce gang membership in Guatemala, $25 million to build 77 youth outreach centers in El Salvador and $18.5 million to build 77 outreach centers in Honduras. The White House is currently requesting approximately $3.7 billion in emergency funding with $300 million for international programs to aid Central America. However, the House Republicans recently passed legislation to address the crisis. The new $694 million version would send migrant youths back home without hearings, and contained a companion bill that could lead to deporting more than a half a million immigrants to whom the Obama administration granted temporary work permits. This companion bill could prevent more than 700,000 people who’ve already gotten work permits, from renewing them. Lawmakers objected to sending any more money to President Obama without a strong stance against the two-year-old deportation relief program that they blame for causing the current border crisis by creating the perception that once here, young migrants would be allowed to stay. The new GOP border bill adds $35 million more for the National Guard, reimbursing states for guard deployment. It would increase spending for overwhelmed border agencies, add more immigration judges and detention centers, and alter a 2008 anti-trafficking law. We can apply the theories of utilitarianism and deontology and the perspective of ethical egoism to the above question much in the same way as we did before. Once again the immigrants, but also the smugglers, are acting in their own self-interest. One wants freedom, the other seeks money. Both the illegal immigrants and the smugglers are breaking the law, both in their home countries as well as the United States. By focusing on their own interests, the illegal immigrants forget the bigger picture. Would it not benefit the greater number of people to focus on the root problems in Central America? No one doubts the dangerous conditions in these countries. However, other dangerous conditions face the immigrants on the journey to the United States. Is one danger greater than the other? If these immigrants indeed make it to the United States, most will be returned to their home countries  to be placed in the same conditions, disillusioned from the loss of their hopes and dreams. Only by a concerted effort to improve conditions in their home countries, can the greatest benefit result for the greatest number of people. The issue of immigration is perhaps one of the hottest issues facing our country today. As tens of thousands of illegal immigrants make their way into the U nited States, many moral and ethical issues arise. Do the individual rights of the immigrant to seek a better life, outweigh the negative effect their actions place on their own families as well as the citizens of the United States? Do the immigrants have a right to break laws, both in their home countries, as well as the United States, in order to obtain their dream? Is it the ethical/moral responsibility of the United States to care for the illegal immigrants once they arrive? And lastly, is it morally /ethically correct to send children from one dangerous situation into another one, rather than trying to fix the core issues precipitating their illegal journey to the United States? By applying the theories of utilitarianism and deontology, as well as the perspective of ethical egoism, I have attempted to answer these questions. Utilitarianism stresses the greatest good for the greatest amount of people. In the case of illegal immigration that would seem to be that more effort should be aimed at correcting the core issues in Central America. Deontology stresses evaluating an issue in terms of its accordance with a specified set of rules. Obviously, in the case of illegal immigration, the laws are not being followed. And lastly, ethical egoism argues that acts should be done out of a person’s own self –interest. Clearly, this is what drives the immigrants. But the impact in the long run, both to the immigrants, their families, and the citizens of the United States, may be too big a price to pay. References 1 Exporting Mayhem across the Border. [2014]. Bloomberg Businessweek, [4379], 10. [Permalink]:http://search.ebscohost.com.prox-library.ashford.edu/login.aspx?direct=truedb=bshAN=96077008site=eds-live 2 Grillo, Ioan [2014]. Honduran Children Deported From U.S. Back to World’s ‘Most Violent City. Time.Com, p1-1. 1p. [Permalink]:http://search.ebscohost.com.proxy-library.ashford.edu/login.aspx?direct=truedb=bshAN=97074587site=eds.-live. 3 LaFranchi, H. [2014July]. Border crisis: Kerry asks Central America to help combat ‘false information’. Christian Science Monitor. P.1. [Permalink]: http:// search.ebscohost.com.proxy-library.ashford.edu/login.aspx?direct=truedb=crhAN=96897036site=eds-live 4 Preston, Julia. The New York Times. U.S. looks to tide illegal border crossings-Biden goes to Central America to discourage illegal immigration- deportations of central americans will be accelerated. Accelerated by the Lexington- Herald [Ky.] [June 2014]. [Permalink]: http:// search.ebscohost.com.proxy-library.ashford.edu/login.aspx?direct=truedb=edsnbkAn=14E97D7C018E48F0site=eds-live 5 Schearer, M. [2014]. Obama in Political Bind over Unaccompanied Immigrant Minors. Time. Com, 1.[Permalink]: http:// search.ebscohost.com.proxy-library.ashford.edu/login.aspx?direct=truedb=bshAN=97059415site=eds-li ve 6 Micheal,Shear, W.[2014 July 10]. Obama seeks $4 b for border crisis- United States- Immigration- 150,000 children projected to flee Central America. The Sydney Morning Herald [Australia]. P 17. [Permalink]: http:// search.ebscohost.com.proxy-library.ashford.edu/login.aspx?direct=truedb=edsnbAN=14EF984EBA4C6788site=eds-live 7 E. Edurado Castillo and Christopher Sherman of the Associated Press. Migration spotlights Mexican ‘coyote’ smugglers retrieved from The Las Cruces Sun – News [2014 July 22]. 8 Christopher Sherman and Will Weissert of the Associated Press. Gov. Rick Perry will send National Guard to border. Retrieved from The Las Cruces Sun –News [2014 July 22]. 9 Kuhnman, Jim The Associated Press. How a flood of kids upended immigration debate. Retrieved from The Las Cruces Sun –News [2014 July 21]. 10 Anderson, Lindsey The Las Cruces Sun News. Cots, Clothes and Compassion [2014 July21]. 11 The Associated Press. Gov’t arrests 192 for smu ggling. Retrieved from The Las Cruces Sun –News [2014 July 23]. 12 Werner, Erica The Associated Press. Hose Oks border crisis bill. Retrieved from The Las Cruces Sun-News [2014 August 2].

Emotions Seen In of Mice And Men :: essays research papers

Emotions Seen in "Of Mice and Men" This essay will deal with the way emotions were used in the story of "Of Mice and Men". Not only friendship and loyalty between George and Lennie. Faith, hope, charity, love, hate, jealousy and indifference are among the other emotions that develops during the story between them and the other characters, and that shows us Steinbeck's way of character definition. In the beginning of the story, we think that everything between George and Lennie is a big friendship, but even them show other emotions during the story. Lennie shows his childish way of dealing with anything, desperation and fear when Crooks tease him, saying that George is hurt and is not coming back, and when he has the dreams of Aunt Clara and The Gigantic Rabbit. George shows indecision on how to deal with Lennie and when he's going to kill him. Both have a dream together. A faith in each other that make them think that they are different. They have a future. They have each other to look for them. When they arrive in the ranch we learn that the boss is a person that cares for people weaker than other. It's a kind of charity. When he thinks that Lennie is being sold, he goes to his side, try to help him. From Candy, we see love towards his dog that he had for so long and we see a guilty feeling for letting others execute him. Curly show hate and jealousy at the same time. Because he's not a big guy, he wants to fight all of them, and because he's always the winner (Just because he doesn't fight fairly), he is proud to tell everybody that he's the best. Slim is a man who shows a lot of emotions during the story. He shows us indifference to Curly and friendship towards Lennie, but when Lennie killed the woman, and George killed him, he's the only one who seems to know why he done that. Curly's wife shows us unhappiness with her marriage and with the way her life got into. Crooks has an important role in the story, showing us his feelings about prejudice and how he feels bad, because he is rejected by all.

Public Policing Versus Private Security Essay

When comparing private security to public law enforcement there are both many similarities and differences (COPS, 2012). Private security is paid by a private company or agency, whereas public policing is paid by government salaries and taxpayers (COPS, 2012). Public police officers have the authority to enforce laws and protect and serve society (COPS, 2012). Private security officers are paid to protect private property and personnel (COPS, 2012). Most of the duties that public policing and private security officers perform are similar (COPS, 2012). â€Å"Private security and public law enforcement share many of the same goals: preventing crime and disorder, identifying criminals, and ensuring the security of people and property† (COPS, 2012, P. 1). As there are two private security practitioners for every one sworn law enforcement officer, effective partnerships can act as a much needed force multiplier (COPS, 2012). The services that both officers perform are to achieve si milar goals, to prevent, and deter crimes (COPS, 2012). Public policing and private security officers serve as leaders while performing their duties (COPS, 2012). Public policing and private security officers have a positive impact on the criminal justice system (COPS, 2012). The impact that both of these companies have on the criminal justice system could be beneficial if both would team up, work together, and look toward the future (COPS, 2012). There are also several differences between public policing and private security (COPS, 2012).Even though both public policing and private security perform the same type of work, private security protects organizations and personnel (COPS, 2012). Public policing has the authority to enforce the laws and maintain order in society (COPS, 2012). Private security officers perform duties, where they protect, and deter crimes on private property (COPS, 2012). There are several distinct differences between public policing and private security (COPS, 2012). Public policing performs the following duties: maintains order, protects and serves the community, controls traffic, prevents crimes, and arrests offenders (COPS, 2012). Private security officers perform the following duties: serves as an escort, patrols business grounds and surrounding areas, such as parking lots, security guards, and transports valuables (COPS, 2012). Another difference between public policing and private security is  private security has the main concern of protecting corporate and personnel, although public policing has the main concern of public safety and seeking to enforce the laws of the criminal justice system (COPS, 2012). If a private security guard witnesses a crime outside their grounds or area of protection, it is their choice whether or not to engage in the situation (COPS, 2012). Another difference between public policing and private security is that public policing earns respect from the community, whereas private security does not earn that same r espect because they work for a company or an agency for profit (COPS, 2012). The community will have different views regarding private security because they do it for money (COPS, 2012). Public police officers do get paid but by the government, not a private organization (COPS, 2012). This brings questions about whether or not private security organizations are running their business with the right intentions in mind (COPS, 2012). Before the community will respect them they want to know money is not the main motivation (COPS, 2012). Both private security and public policing have several similarities and their duties overlap in several ways (COPS, 2012). Though still a minority, both of these agencies do employ women along with men (COPS, 2012). Both of these jobs use uniforms to show people who they are, deter crime, and show their authority (COPS, 2012). Both private security and public policing perform duties that uphold the law and keep the community and organizations crime-free (COPS, 2012). The leadership roles of both of the private and public sectors are fairly similar (COPS, 2012). They both have a paramilitary ranking system (COPS, 2012). Within the public policing ranking system there are officers, detectives, and sergeants (COPS, 2012). Each rank reports to the highest position with their rank (COPS, 2012). The officers report to the highest ranking officer within the government agency (COPS, 2012). Within the private sector, the positions are similar to public with a sergeant, corporal, and senior patrol officer (COPS, 2012). The company owner would be the highest rank within the private sector (COPS, 2012). Public policing and private security both play important roles in the criminal justice system (COPS, 2012). Both roles deter crime with their presence (COPS, 2012). Both roles can make an arrest, investigate crimes, and prevent crimes (COPS, 2012). Public policing and private security help keep members of the community safe (COPS, 2012). Another similarity of  public policing and private security is that both sectors need to have training (COPS, 2012). Depending on the duty, private security may not need as much training as public policing but both need training to perform their duties effectively (COPS, 2012). The different roles that public policing and private security play in the criminal justice system are both important (COPS, 2012).Public policing is bound by enforcing the laws and policies (COPS, 2012). Private security focuses more on keeping the company and personnel safe (COPS, 2012).Most private security is not bound by the same regulations that public police have to follow, such as reading an offender their Miranda Rights (COPS, 2012). There are three important elements that make up a comprehensive security plan, which are physical, personnel, and information security (COPS, 2012). The physical aspect of the security plan is building design, fences, locks, lighting, and alarm systems (COPS, 2012). Another aspect of physical security is security personnel (COPS, 2012). The physical aspect of the security plan may be the main focus on protecting and deterring crime (COPS, 2012). The personnel aspect of a security plan is protecting people within a company or organization and this comes from the presence of the security guard (COPS, 2012). Another aspect of personnel security is identification badges (COPS, 2012). Identification badges allow security officers to check the identity and the security clearance of individuals who come into the company (COPS, 2012). The information aspect of a comprehensive security plan has background checks (COPS, 2012). Another aspect of information security would be to put certain papers through a shredder and dispose important documents properly (COPS, 2012). One more aspect of information security would be to encrypt messages and codes (COPS, 2012). Encrypting files would provide security, so that no one would be able to access information (COPS, 2012). Public policing and private security of different similarities and differences; however, both have common goals in mind to protect and serve (COPS, 2012). Both of the goals of these agencies intertwine within each other (COPS, 2012). Both roles are important within the criminal justice system (COPS, 2012). Public policing has to abide by the laws and regulations that affect society that private security do not have to follow, such as reading a suspect their Miranda rights (COPS, 2012). The presence of private security helps provide services to the public police by handling small crimes, such as shoplifting,  security issues, business security, a nd surveillance (COPS, 2012). The service that private security provides frees up public police because in the past police officers had to respond to an abundance of calls (COPS, 2012). Private security does not protect society; their main focus is protecting companies and personnel (COPS, 2012).Public policing and private security need to work together as they head into the future to make society a safer place (COPS, 2012). However, the integrating of the public and private law enforcement needs to be a smooth transition. There are reservations about the integrations because of the main difference that comes to mind about the private sector is money. Regardless of anything, private security agencies are businesses making money. Usually, businesses are run in a manner so that they will make money. Law enforcement is a human services field, not a place to run as a business. Therefore, people will wonder if integration between the two sectors will change the focal point to a money-making business rather than a human services field. When money becomes the focal point of a human services field, things will be run differently and that may not be the best interest at heart for public policing. Privatizing everything would change the priorities, goals, and conditions of the entire justice system. References Private Security and Public Law enforcement. (2012). Retrieved from http://www.cops.usdoj.gov/Default.asp?Item=2034

Nitric Oxide Therapy in infants with pulmonary hypertension

The benefits of nitrogen oxide (NO) therapy as used in the treatment of infants with persistent pulmonary hypertension (PPHN) can be best appreciated if the reader is familiar with the pathophysiology of PPHN and the previous methods used in treating the disease. The function of NO has evolved in the minds of the scientific community from being a mere noxious gas emitted by vehicles to a wonder compound in the field of medicine. In the area of pulmonology, its vasodilatory effect in the blood vessels is now being used to assist PPHN patients in rerouting blood flow in infants whose blood circulation fails to shift from fetal to normal circulation.Such nature of the compound, being the main ingredient in NO therapy allows for a less invasive procedure which in effect reduces risks of complications during and after treatments, expected in previous treatment methods. This reduced risks account for the relatively more cost-effective character of NO therapy as a treatment method in PPHN p atients.There is not much use for the lungs during the fetal life. At such stage, the function of the lungs is carried out by the placenta through the umbilical cord. Fetal life is characterized by a high pulmonary vascular resistance (PVR) with pulmonary blood flow being restricted to a less than 10% lung-directed cardiac output. Blood vessels that connect the heart and the lungs are constricted, sending the circulating blood back to the heart through the ductus arteriosus, a blood vessel that functions only in fetuses. In other words, the lungs in the fetal stage are bypassed.At birth, when the lungs finally assume the function of gas exchange, the PVR decreases, allowing for an increase in pulmonary blood flow. The blood vessel that is previously constricted, favoring blood flow to the ductus arteriosus is now relaxed, simultaneously with the permanent closure of the ductus arteriosus. This happens as the lungs become ventilated and the alveolar oxygen tension is increased.Persis tent Pulmonary Hypertansion occurs when at birth, the lung circulation fails to achieve the normal drop in PVR, preventing the transition from fetal to newborn circulation. This failure results in the continuous functioning of the ductus arteriosus which impairs the flow of blood from the heart to the lungs and limits the amount of oxygen that can be picked up by the blood to be delivered to the different parts of the body. The blood that flows back to the heart remains in an unoxygenated state which could lead to the development of refractory hypoxemia, respiratory distress and acidosis.It is only in 1987 when nitric oxide (NO) was recognized as a key endothelial-derived vasodilator molecule. From then, research has been expanded to establish the role of NO throughout the body, and to discover its therapeutic potential.   To appreciate the effects of NO in alleviating pulmonary hypertension, it is important to gain understanding of its chemistry and mechanism of action.Nitric Oxi de is a gaseous compound that rapidly diffuses across membranes and has a single unpaired electron. This explains its high reactivity, especially to Hemoglobin (Hb) in the blood. This nature of the compound accounts for its noted biological significance. It has been discovered to function as stimulant in the release of hormones; as neurotransmitter; a significant participant in the magnification of synaptic actions and learning processes; and an inhibitor in platelet aggregation, which makes it a marvel in the field of cardiology. In the field of pulmonology, nitric oxide is valued for its vasodilatory effect in the blood vessels.This effect can be explained by the mechanism involving the compound's diffusion from the vascular endothelial cells to the subjacent smooth muscles of the pulmonary vessels. From here, NO activates the enzyme guanylate cyclase to change conformation to promote smooth muscle relaxation by converting GTP to cGMP.   This vasodilatory effect signals the mech anism to modulate blood flow and vascular tone.Given the mechanism of action, it is easy to surmise how NO can be utilized as a therapeutic agent in the management of blood-vessel-related diseases such as those related to the heart (hypertension), the reproductive system(erectile dysfunction) and in this case, the lungs (Persistent Pulmonary Hypertension in infants (PPHN)).Before NO, treatments used in infant PPHN are hyperventilation, continuous infusion of alkali, tube vasodilation and vasodilator drugs. A study on the effects of these various treatments was done by Ellington, Jr., et. al., (2001) showing no specific therapy clearly associated with the reduction in mortality in infants. In determining whether therapies were equivalent, the study showed that hyperventilation reduced the risk of extracorporeal membrane oxygenation (ECMO) with no oxygen increase at 28 days, while alkali infusion increased the use of ECMO as well as an increase in the use of oxygen at 28 days (Ellingt on, Jr., et. al., 2001). ECMO is a highly invasive procedure that requires major surgery, performed in serious cases of PPHN when patients fail to respond to treatments.It is only after post-lab studies were able to identify the role of NO-cGMP signaling in the regulation of lung circulation that NO therapy was developed for PPHN (Channick, R., et. al., 1994). Like previous treatment methods, NO therapy improves oxygenation as well as reduces the risk of ECMO in infants with PPHN (Oliveira, et. al., 2000). But because nitric oxide is capable of acting on its own upon inhalation to relax the blood vessels and improve circulation, it is considered as a less invasive procedure in the management of infants with PPHN compared to the previous treatments mentioned in the preceding paragraphs.The efficiency of the treatment procedure can be determined by observing its effect on the patient's ventilation and blood flow, which is a determinant of the efficiency of transpulmonary oxygenation a nd partial pressure of oxygen in the systemic arterial blood (Ichinose, et. al., 2004). NO therapy enhances the mechanism by which blood flow is redistributed toward regions in the lungs with better ventilation and higher intra-alveolar partial pressure of oxygen (Ichinose, et. al., 2004).Other treatments used in the management of PPHN such as tube ventilation, alkalosis and intravenous vasodilators were shown to be effective in ameliorating pulmonary hypertension in some infants, but in many instances, it does not, as ECMO almost always becomes a necessity in saving the life of the infants (Ichinose, et. al., 2004). A type of hyperventilation has been proven not to increase the risk of ECMO, but unlike NO-therapy (Ellington, Jr., et. al., 2001), it is invasive as to require a tube inserted inside the infant's trachea.In patients with moderate PPHN, there is an improvement in arterial p a O 2, reduced necessity of ventilator support and low risk of progression to severe PPHN (Sadiq, et. al., 2003) and this, without the risk of increasing the incidence of adverse outcomes when the age of 1 year is reached (Clark, et. al. 2003). Inhaled NO is able to rapidly increase the arterial oxygen tension and increase the blood flow in the lungs without causing systemic hypotension (Roberts, 1992; Kinsella, 1992). No apparent increase in morbidity has been shown after one year of treatment with NO (Aparna and Hoskote, 2008). For high-risk infants with PPHN, inhaled NO has been found to lessen the risk of pulmonary hypertensive crisis (PHTC) after congenital heart surgery (Miller, et. al. 2000).Studies on the role of NO in the management of PPHM show that while it is therapeutic, it also prevents the occurrence of chronic lung disease which affects morbidity. Vascular cell proliferation and pulmonary vascular disease have been shown to decrease with NO in the newborn (Roberts, et. al., 1995). In addition, while NO treatment can be more costly, it is the most cost-effective among other methods because of the reduced need for ECMO (Angus, et. al. 2003). For these reasons, it is understandable why NO therapy seems to have taken over in the area of PPHN treatment.ReferencesAngus DC, Clermont G, Watson RS, et al. (2003). Cost-effectiveness of inhaled nitric oxide in the treatment of neonatal respiratory failure in the United States. Pediatrics. 112, 1351–1360.Aparna U., Hoskote, MD., et. al. (2008). Airway function in infants treated with inhaled nitric oxide for persistent pulmonary hypertension. Pediatr Pulmonol. 43, 224-235.Channick R, Hoch R, Newhart J, et al. (1994). Improvement in pulmonary hypertension and hypoxemia during nitric oxide inhalation in a patient with end-stage pulmonary fibrosis. Am J Respir Crit Care Med. 149, 811-814Clark, RH., Huckaby, JL., et. al. (2003). Low-Dose Nitric Oxide Therapy for Persistent Pulmonary Hypertension: 1-Year Follow-up. Journal of Perinatology. 23, 300.  Ellington Jr, Marty, O'Reilly, et. al. (2001). C hild Health Status, Neurodevelopmental Outcome, and Parental Satisfaction in a Randomized, Controlled Trial of Nitric Oxide for Persistent Pulmonary Hypertension of the Newborn. Pediatrics,107.Ichinose F, Roberts JD, et.al. (2004). A Selective Pulmonary Vasodilator: Current Uses and Therapeutic Potential. Circulation. 109, 3106-3111. Kinsella JP, Neish SR, Shaffer E, et al. (1992). Low-dose inhalation nitric oxide in persistent pulmonary hypertension of the newborn. Lancet.   340, 819–820.Miller O, Tang SW, et. al. (2000) Inhaled nitric oxide and prevention of pulmonary hypertension after congenital heart surgery: A randomised double-blind study. The Lancet. 356: 9240, 1464.Oliveira cac, et. al. (2000). Inhaled Nitric oxide in the management of persistent pulmonary hypertension of the newborn: a meta-analysis. Rev. Hosp. Clin. Fac. Med. S., 55 (4): 145-154, 2000Roberts JD Jr, Polaner DM, Lang P, et al. (1992). Inhaled nitric oxide in persistent pulmonary hypertension of the newborn. Lancet. 340, 818–819.Roberts JD Jr, Roberts CT, Jones RC, et al. (1995). Continuous nitric oxide inhalation reduces pulmonary arterial structural changes, right ventricular hypertrophy, and growth retardation in the hypoxic newborn rat. Circ Res. 76, 215-222.  Sadiq HF, Mantych G, et. al. (2003). Inhaled Nitric Oxide in the Treatment of Moderate Persistent Pulmonary Hypertension of the Newborn: A Randomized Controlled, Multicenter Trial. Journal of Perinatology.   23, (2).98

Big Brother and Winston essays

Big Brother and Winston essays Freedom is a basic desire of human nature. Many novels are written about men who want freedom so much that they would die for it. However, many countries today are not free. For example, the war in Iraq is about trying to free people from oppression. Before the war, Iraq was like Big Brother and no one had any freedom. George Orwell wrote 1984 to show that governments that take freedom away from its citizens are evil. He used three characters to illustrate this evil: Parsons, Mr. Charrington, and OBrien. Parsons is a fat and obnoxious member of the Party. He works at the Ministry of Truth. His job is to conduct propaganda and historical revisionism. His wife is rather stupid and his children have no manners. They are also member of the Junior Spies who spy on adults (especially their parents) and report any disloyalty to the Party. Next, Mr. Carrington is an old man who runs a secondhand store in the prole district. He seems to be nice to Winston and Julia. He also seems to support Winstons rebellion against the Party. However, no one in Winstons world is who he seems to be. In reality Mr. Carrington is a member of the Thought Police. Winston even tried to catch the attention of the Thought Police by writing Big Brother is Watching You in his diary. Finally, the most evil character is OBrien. He is a member of the Inner Party, and he makes Winston believes that he is rebellious, too. The revolutionary group called the Brotherhood is what Winston wants to join, and he thinks OBrien can get him into it. Instead, OBrien abuses and brainwashes Winston and turns him into a loyal subject of Big Brother. In conclusion, Winstons downfall was mainly caused by his paranoia about the Party. However, the evil characters of Parsons, Mr. Charrington, and OBrien manipulate Winstons downfall. Freedom is something that Winston will never exper...

Tomorrow when the war began book review essays

Tomorrow when the war began book review essays The story starts when two teenagers, Ellie and Corrie, living in a country town decide to go bush for a few days. They werent allowed to go unless more people joined them, so they invite five more friends. Homer, Lee, Kevin, Robin and Fiona. They spend several days camping in a remote place that is called Hell. They return home after several days and find their pets either dieing or dead. They are then horrified to also discover their friends and family are missing. In search of other members of their town they head to the showground only to discover that their country has been invaded and their loved ones imprisoned. Seeking refuge they return to Hell and begin their struggle for survival. The story is told by Ellie, who decides to write it all down to leave a record of what happened in case they dont survive. It follows them as they set up a camp in Hell and then as the book progresses we learn more about each of the characters. While the book has received lots of praise and given Marsden a strong following of fans I found the book boring and I really didnt enjoy it. This was because the characters didnt appeal to me as they seemed unrealistic. I was unable to relate to them as I doubt that all of the teenagers would be as loyal, hardworking and able to come to grips with the though of the invasion so easily. They also display numerous amounts of quick thinking and the capability to think like soldiers even though they havent had any training. ...