Steroids Research Paper Example | Topics and Well Written Essays - 1250 words - 1

Steroids - Research Paper Example Recently, steroids have been in discussion with the media. In addition, many sports related persons are heard or seen on media charged with the steroid abuse. However, steroids are comprised of several different names for example stackers, pumpers, gym candy, weight trainers, roids, gear, Arnolds (Lau ) and the most popular one is juice (Freedman 64). In recent years steroids are being used in the treatment of many diseases like asthma, lack of proper growth, cancer, osteoporosis and other skin related disease (Freedman 64). They are defined as a â€Å"class of lipids having a particular molecular ring structure called the cyclopentanoperhydro-phenanthrene ring system. Steroids differ from one another in the structure of various side chains and additional rings. Steroids are common in both plants and animals. In humans, steroids are secreted by the ovaries and testes, the adrenal cortex† ("Steroids." 1-1). Moreover, the chemical substances that are produced in the human body in order to control the metabolism are known as hormones. The hormones act as a courier that controls the actions of the body by sending messages to the body tissues (LeVert 96). Similarly, steroids are also like hormones, they are substances prepared in the laboratory and are known as synthetic steroids that are used for the treatment of medical issues (Freedman 64). The hormones in males for example testosterones are responsible for the improvement of male distinctiveness such as facial hairs, intensifying male voices or bu lky muscles. Males produce large amount of testosterone that helps in enhancement of male features. Anabolic steroids are also derived from male sex hormones testosterones. In addition, steroids are used by many health professionals for the treatment of several diseases but these steroids can be availed only by the medical prescription (Freedman 64). These are the natural steroids produced in the human body by a gland known as the adrenal cortex.

Narrative Experience Essay Example for Free

Narrative Experience Essay Being a foreign student whose first language is Chinese, I had a hard time pushing myself into the world of English. I started to learn English at age six, which is rather a young age for Chinese to study a second language. At that time, English only meant the alphabet to me. I felt quite easy playing with my 24 friends all day long. However, I planned to escape from the English world when I met grammar, vocabulary and sentence structures. I tried my best to memorize the grammars, to use the various different kinds of vocabularies. Nevertheless, what I wrote still looked boring; lacked content and theme. It was just like having all the right pieces for a puzzle called English Composition, but the process was so hard that I did not know where to put each of them to get the final picture. Like a baby who falls via learning how to walk, I totally had no idea how to walk on a road called academic writing. To be specific, I â€Å"fell† every time I wrote argumentative essay. Last year, as a foreign student who wanted to study abroad, I need to attend a language test called TOEFL. Writing an argumentative essay is a part of the test. An argumentative essay should consist of a mean topic and several logical theses to support the mean theme. I memorized this instruction but felt rather confusing. I had no problem clarifying which sentence should be the topic but was bad at giving detailed arguments. When I did a simulative test for the first time, I was required to write my opinions about homeschooling. Suddenly plenty of stories about homeschooling came up to my minds. â€Å"Well, it is just like a piece of cake since I can use the story from Helen Keller, Edison and etc.! † I told myself while writing down four stories about homeschooling. However, I only got 10 out of 30 for my first try. I was shocked by the comment, â€Å"Lacking clear theses to develop the topic. Although there are several beautiful sentence structures, there is no connection between each sentence. † said by the English teacher. To be honest, I am also bad at writing compositions in my mother tongue, Chinese. Not being logical is a problem existing both in my Chinese and English composition. It is a problem about my way of thinking indeed. I could hardly find a proper way to learn how to writing an argumentative essay and I paused around the starting point. In order to understand how to write English compositions and get a better score, I took a summer course for preparing for the TOEFL test. It was when I met my god of logic, who totally changed my attitude towards English composition. He is my writing teacher Brian. Brian never used a textbook, what he need was just a marker and a blackboard. His syllabus was never about what we would learn each day but full of topics. I still remember he wrote â€Å"automobile† on the blackboard for the first class. â€Å"Trust me; we can finish a 1000-word essay about this topic within the next 2 hours. † Then he said. â€Å"One thousand?! † I repeated. At that time, I thought he was bragging because it was just the first composition class. And based on my understanding, we were supposed to study some words and sentence structures which can be used as templates rather than looking at a topic. Hence, I turned to be curious about what he was going to say next. I had a strange feeling that I would gain something special from him. â€Å"What will people usually think of when talking about automobile? † He continued without pausing, â€Å"The history of automobile. † †The concept of automobile,† students replied. â€Å"Then, let us Google a definition for automobile to start this topic,† he opened the monitor and typed the word while speaking. The prior choice was the definition from Wikipedia, â€Å"An automobile is a wheeled motor vehicle used for transporting passengers, which also carries its own engine or motor. † He used it as the first sentence. He went on capturing another sentence illustrating the history of automobile just from the same page. â€Å"Ok, since automobile has such a long history as we can see from the second sentence, what can you think of after it? † â€Å"It must have brought lots of changes to the daily life of our people! † I replied naturally, â€Å"Bravo! So girl, give me some more details that you can think of,† He moved to my front and start to ask me constantly. Well, we can travel to some place we have never been to and we can start off whenever we want! † â€Å"Give me an example! † While I was telling him the story after my father bought his first car, he turned back to the blackboard and wrote down what I had just said. I started to be much interested in what he would ask next since this was definitely a new teaching method to me. Brian interacted with us during the whole two hours. Dramatically, we really finished a 1000-word draft at the end. I totally could not believe it and continued looking at the blackboard filling with all the sentences we came up with during the two hours. They are just the stories and ideas from our brains. In my view, they are just what we would say when chatting with others. Brian used a magic rope to tie them up and change them into a composition! â€Å"Being logical is not that hard. The only thing we need to do is connecting your sentences while spreading out your topic. Every time you wrote down a sentence, ask yourself, ’what do I think of it,’ ‘what should I write next. ’† Brian said at the end of the class. I used to be busy searching for fancy but meaningless words or skillful but useless phrases without knowing why I use it. Hence, my essay had no logic and no content. It is just a bunch of irrelevant sentences. Just like a chic lady without a clear face. Brian used simple questions to lead my logic and develop the theme of the essay naturally. Every sentence in the draft suddenly made sense to me. I had no problem understanding the connection between two sentences and why we need to give examples for explaining the benefits of automobile. The method of inquiry lifts me to another level of understanding what literacy is. At first, I though literacy was just about different types of writing formats, like narratives, argument essays, poetry, etc.. But I deny them all now. In my point of view, making sense is the priority. If a passage lacks logic, we can learn nothing from it although we read numerous difficult sentences. Since then, no matter what kind of essay I am required to write, I start from the words and sentences which make sense to me. Then I follow the instruction to modify them. Yes, I see my door to the world of English. I want to end my literary experience with an interesting story happened last week, my brother Dill asked me to help him with his TOEFL composition. As I was reading his draft, all the old memories of my learning process just came back. This time, I had a clear purpose. While modifying each thesis and point arguing about what the mobile has brought to our daily life, I just used what my teacher, Brian told me to do. I know I should ask myself the connection between each sentence from the beginning. My brother started his essay with a story about his first cellphone. But I think it would be clearer if he pointed out his theme first and use this story as an argument example. Although it has been a year since I took the TOEFL course, this method for literary writing is just like what I just learnt yesterday. Writing an argumentative essay does not seem to be a barrier to me anymore.

Client Based Care Case Study: Elderly with Diabetes

Client Based Care Case Study: Elderly with Diabetes 215479 Client Based Care Study Introduction In this essay, the author will explore the care of a single patient, encountered in clinical practice, examining the impact on quality of care, and on the health and wellbeing of the individual, of key aspects of care. Case studies allow nurses to reflect on practice, examine critical elements of case and of clinical decisions made and actions taken, and to examine areas of care in more detail. This essay will explore the care of one patient, who shall be called Molly, an older, community dwelling adult with Type 2 diabetes, who was admitted to a medical admissions ward having been found unconscious at her home by neighbours. The essay will examine the aspects of her care that relate to the management of her condition, the assessment and management of her social, care and personal needs, and the planning of her future care and support needs. Reference will be made to governmental guidelines and policies, and to interprofessional working as a fundamental component of meeting patient needs in this case. Discussion Diabetes is a chronic disease which is known to impact significantly on the health, wellbeing and prosperity of individuals, of families, and of society as a whole[1]. More than 1.4 million in the UK are affected by diabetes[2]. Because of the great impact that this disease has on public health and on the use of NHS and social care resources and services, the Department of Health has published a National Service Framework for diabetes, which not only sets standards for management and diagnosis of the disease, but outlines best practice in the light of the latest available evidence on the condition[3]. There are two types of diabetes, Type 1 and Type 2, both of which are signified by a persistent high level of circulating blood glucose, due to a lack of insulin or a significantly impaired response to insulin, or to a combination of both factors[4]. Type 1 diabetes is due to the insulin-producing cells in the pancreas, called the Beta Cells, located in the Islets of Langerhans, failing to produce insulin, because the body’s own immune system has destroyed them[5]. Type 2 diabetes is usually caused by a reduced amount of insulin production by these cells, and by a degree of insulin resistance within the body, wherein the body’s metabolic responses to insulin are not as sensitive[6]. Type 2 Diabetes is the condition which Molly, the patient in this case study, has been affected by. Molly is a 66 year old woman who has had Type 2 diabetes for 17 years. She is treated by twice daily insulin, and, living independently still in her own home, she is visited once weekly by a district nurse to monitor her glycaemic control and check her insulin stocks and her general wellbeing. Molly has a BMI of 35, and also has a history of hypertension which is controlled by medication. She has her blood pressure checked weekly as well. Molly lives alone, never having married, and has no children. She has an active social life, attending a local book group, taking part in a local history and re-enactment society, and volunteering at a community library. She is known by the district nurses to be competent in administering her own insulin and measuring her own blood sugar, but she does not always adhere to her regimen and her recommended diet, because it can interfere with her social life. Molly was found unconscious by one of her neighbours at 9 pm, and the ambulance was called. Paramedics attending were told of her history by her neighbour, who waited with her, and suspected either Diabetic Ketoacidosis or hypoglycaemia. Diabetic ketoacidosis is a condition which can be life-threatening, and is usually due to a lack of insulin, which means that the cells of the body are unable to use glucose for energy, and so instead convert fat reserves to energy, which can produce ketone bodies which can adversely affect brain function[7],[8]. Hypoglycaemia can be caused by an overdose of insulin, or inadequate carbohydrate intake in a person who is taking insulin, or by the patient taking too much exercise, thus using up glucose, or by a combination of these Paramedics found her blood sugar to be 1.1 mmols, and administered glucagon to reverse the hypoglycaemia. She recovered consciousness quickly once her blood sugar improved, but was also given facial oxygen, and had full observations taken. Molly remained confused after insulin administration. She was taken to the medical admissions unit for a full assessment and, if necessary, in-patient admission and review of her diabetes. According to emergency care principles for the diabetic patient, the priorities are to save the patient’s life, alleviate their symptoms, prevent long-term complications of the disease and their current risk factors, and then to implement care that will help to reduce risk factors for their health, such as hypertension obesity, smoking, and hyperlipidemia, along with providing ongoing education and support for self-management of their condition[9]. In Molly’s case, the team evaluated her condition, because although the initial diagnosis was hypoglycaemia, suggested by her self-reported history of missing meals that day and being very busy, the differential diagnosis was diabetic ketoacidosis, which can be precipitated by physical or biological stress, including changes in endocrine function or other diseases, such as myocardial infarction[10]. Molly is pale as well, a finding suggestive of hypoglycaemia, along with her elevated blood pressure and dilated pupils[11]. As Molly was conscious, her Glasgow Coma Score was 13, and she had responded well to glucagon, according to established diabetic protocols, she needed to be stabilised and undergo a range of investigations to determine any other disease or factors precipitating her condition[12]. Blood pressure, temperature, pulse and respiration rate were monitored recorded via continuous telemetry, and an ECG was carried out, which ruled out myocardial infarction. Molly had blood sent for Full Blood Count, Liver Function Tests, Urea and Electrolytes and Glucose, as well as insulin levels, prothrombin time, clotting factors[13]. Prothrombin Time and Clotting Factors may also be tested, due to the risk of disseminated intravascular coagulation. Bloods were also sent to test HbA1c; Fructosamine; Urinary albumin excretion; Creatinine / urea; Proteinurea; and Plasma lipid profile[14]. Urine was dipped with reagent strips to test for glucose, protein (suggestive of kidney problems) and ketones. Because of her presentation, Molly was put on a continuous IV infusion of insulin, titrated hourly using a syringe driver against blood glucose, with an infusion of 5% glucose running in a different IV port. IV fluid therapy, and fluid balance, were also monitored closely[15]. Diabetes can cause kidney damage and impaired urinary function, so monitoring kidney function was an important part of care[16]. Once Molly was stabilised, ongoing care related to supporting her health and wellbeing, and minimising complications of her diabetes, became an important part of care. Diabetes is a significant public health issue, because it is not only associated with the ‘social’ disease of obesity, but also because as a disorder it is associated with a number of serious health implications[17]. These complications include macrovascular complications, including atherosclerosis and cardiovascular disease[18], [19], [20]; diabetic retinopathy and sight loss due to vascular damage which weakens the walls of the blood vessels in the eyes, causing microaneurysms and leakage of protein into the retina, vascular damage and scar tissue [21], peripheral neuropathy, peripheral vascular disease and gastrointestinal dysfunction, gomerular damage, and kidney failure[22]. The impact of this disease on public health relates to the fact that many people of working age are diabetic, and because the co ndition is chronic as well as serious, with acute exacerbations and so many complications, it presents a serious drain on health and social care resources. Therefore, it is imperative that individuals with diabetes are identified as early as possible, and are educated and supported in good self-management, and provided with ongoing care to maintain good glycaemic control[23]. Molly’s status as an older adult is also a public health issue, because older adults constitute the largest patient group in the UK, and the ones which consume the biggest proportion of healthcare services[24]. However, it was also important to avoid stereotyping Molly as an older person, and making assumptions about her needs and her health. Although she was obese and hypertensive, and had Type 2 diabetes, she was very active and had a very important social life, and was usually independent and self-caring. It was important to consider the social support that she had, and to ensure that she was aware of any services or support she might be able to access if she felt it necessary. However, some members of the multidisciplinary team, in particular, some of the medical staff, did appear to act in a way that suggested they were stereotyping Molly based on these factors (age, weight, health) and were discussing her case without really making clear reference to her as a whole perso n. This leads on to the need to evaluate the multidisciplinary input in Molly’s case, and the quality of the interprofessional working that took place, which is discussed below. As can be seen from the list above, diabetes can affect the individual and the body in complex ways, and so requires an holistic approach to care[25]. Care should also be based on evidence based, collaboratively agreed care pathways[26], as suggested by the NSF for diabetes[27]. Molly may need a comprehensive review of her management and her lifestyle, the patterns of care and the ongoing monitoring of her condition[28]. The National Institute for Clinical Excellence recommends a patient-centred approach to ongoing patient education and management, and also suggests a number of options for patients who might require different forms of insulin administration, such as continuous sub-cutaneous insulin[29], [30]. This, however, was not suitable for Molly, because it is usually for people with Type 1 diabetes. Health promotion and education is an important part of Molly’s care at this point, which is related to the fact that her current hospital admission is due to mismanagement of her condition herself. It was important to determine what factors about her lifestyle and behaviours had led to the lapse and the serious hypoglycaemia. Ongoing care, health promotion and education involved multi-professional collaboration and integration of care into a complex, detailed care plan. The aim was to provide Molly with the information, support and guidance that would allow her to view her diabetes management as a means of achieving a better quality of life, rather than viewing her diabetes as something which interfered with her quality of life. It was also important to view Molly in terms of supporting her to continue with her normal social activities. Research shows that making changes in lifestyle, and providing good, effective health education, helps to contribute to reducing rates of diab etic complications[31]. However, the kind of health education and support used is important, because different approaches have different levels of effectiveness. Some research examines the differences between health education that tries to persuade patients to be compliant with regimes and activities designed by health professionals, approaches which are usually generic, and health education that is client-centred[32]. Client centred approaches are usually more effective, as they are individualised. Research shows very clearly that patients with diabetes need to understand their disease fully, and be supported and empowered to make the lifestyle and behavioural changes that will enhance their wellbeing whilst enabling them to control their condition[33]. In this case, a diabetic nurse specialist was involved with Molly’s case, and a plan for health education and support drawn up, with clear guidelines and a tailored plan for managing her social life around her diabetes. Diabetes UK recommends a struc tured, tailored education programme for people with the condition[34]. Interprofessional and multidisciplinary working is a fundamental component of care for a patient with diabetes like Molly[35]. This means that diabetic patients should experience seamless care, addressing all needs, with access to all the professionals necessary to support her care[36]. Specialist involvement, including diabetic nurse specialists, was a feature of this care, and helped with a client centred focus[37]. The literature suggests that it is important for a lead professional to take charge[38], but in Molly’s case, her lead nurse was not present for the majority of her inpatient stay, and there was a lack of effective coordination of the complex number of professionals involved. In relation to multidisciplinary, interprofessional working Molly was referred to ophthalmic services for a check-up, to ensure that there was no diabetic retinopathy or glaucoma. She was referred to a dietician to support her in managing her dietary intake. She was also referred to a social worker. Diabetic specialist doctors were involved, and a report was sent to the diabetic nurse at her local surgery, as well as to her GP. Molly ended up staying in hospital, however, on a medical ward, for two weeks, even though her condition was stabilised rapidly, and she experienced no further complications. In this case, interprofessional working was not effective, because although the said referrals were made, or were recorded to have been made, Molly was not seen by the dietician or a social worker for over a week, and only when she began to threaten to take a discharge against medical advice did the dietician and social worker arrive and get involved. The doctors in charge of Mollyâ€℠¢s case however appeared to make judgements about plans for discharge and ongoing care without involving the nursing team and without considering some aspects of her social situation and Molly’s own preferences and wishes. It is apparent, from this case, that while Molly’s immediate medical needs were met, the interprofessional working element of her ongoing care failed in some way. There are a complex range of professionals and support workers who provide healthcare[39]. Because of this complexity, interprofessional education has become part of healthcare education programmes[40]. Interprofessional working is supposed to help with the provision of true patient-centred care, and the highest quality of care[41]. However, experience in this case, and some of the literature, cites ongoing problems with interprofessional working in a number of contexts. Some of this is to do with the professional boundaries and hegemonies which persist in healthcare professions, which continue to be defended rigorously by each profession[42]. Some literature shows that elitism, professional isolationism and professional defensiveness can have negative effects on health professionals themselves as well as on the qual ity of care delivery[43]. Yet there is ample government guidance, particularly from the Department of Health, which aims to improve service provision, and the NSF for Older People[44], identifies the most important elements of care and service provision which must be improved upon. Standard 2 of the NSF, ‘Person-Centred Care’, requires that health and care services are designed around the needs of the older patient (and their carers)[45]. However, this kind of needs-based care then demands . â€Å"an integrated approach to service provision†¦ regardless of professional or organisational boundaries, [which is] delivered by clinical governance, underpinned by professional self regulation and lifelong learning† .†[46] In Molly’s case, the fundamental role of the nurse in providing leadership and coordination for her care was not acknowledged or supported. Some researchers suggest that this can be due to medical hegemony[47]. Current approaches to offsetting such ingrained hierarchical thinking are very much focused on initial education of healthcare professionals, overcoming historical professional boundaries[48], [49], [50]. The research shows that there is a difference between multiprofessional working, which does not transcend the traditional hierarchies and boundaries , and inter-professional working, which is built on the desire to share care, support each other, and value each others’ expertise[51]. Government drivers continue to underpin strategies for better, ‘joined up working.’[52],[53]. The failures which occurred in Molly’s care were clearly linked to poor communication between the healthcare professionals, a lack of joined up working, and a lack of recognition, perhaps, of the importance of the social aspects of Molly’s case, and the health-education aspects, based on her individual needs. On reflection, the author believes that had there been better, collaborative working, then none of these needs would have been overlooked and they would have been dealt with more speedily. But another aspect of her care that could be improved upon was related to her own involvement in her case. Molly was not fully involved in her case discussions and in the medical decisions made about her care. While this can be a product of the medical hegemony mentioned before[54], it constitutes a serious oversight and is not in line with governmental guidance[55]. Research shows that the patient voice is the most important one in terms of collaborative care planning and manage ment[56]. Conclusion This case study has identified the case of Molly (a pseudonym), an older patient with Type 2 diabetes who received good quality clinical care in meeting her acute care needs and managing her medical condition and its potential consequences, but for whom interprofessional working failed in relation to ongoing care and multi-discinplinary involvement. Diabetes is a significant public health issue, and a range of governmental guidance and research evidence informs care for patients with the condition. The public health issues surround the serious morbidity and mortality associated with diabetes, and the fact that good management and glycaemic control can minimise these complications. In this case, the patient’s needs were prioritised medically, but interprofessional communication broke down. While the appropriate referrals were made, proper joined up working did not take place. Similarly, Molly was not fully involved in her case, and should have been. Diabetes is a serious, chronic condition, and one which requires patient-centred assessment, identification of needs, and management. All those involved should adhere to the available guidelines and commit to effective interprofessional working. References Allen, D., Lyne, P. Griffiths, L. (2002) Studying complex caring interfaces: key issues arising from a study of multi-agency rehabilitative care for people who have suffered a stroke. Journal of Clinical Nursing 11 297-305. Anthony, S., Odgers, T. Kelly, W. (2004) Health promotion and health education about diabetes mellitus. Journal of the Royal Society for the Promotion of Health. 124 (2) 70-3 Banks, s. Janke, K. (1998) Developing and implementing interprofessional learning in a faculty of health professions. Journal of Allied Health. 27 (3) 132-136. Billingsley, R. Lang, L. (2002) The case for interprofessional learning in health and social care. MCC Building Knowledge for integrated care 10 (4) 31-34. Bloomgarden, Z.T. (2006) Cardiovascular Disease Diabetes Care 20 (5) 1160-1166. Collis, S. (2005) Diabetes care by non-specialists must take a holistic approach. Nursing Standard 19 (31) 28. Colyer, H.M. (2004) The construction and development of health professions: where will it end? Journal of Advanced Nursing 48 (4) 406-412. Coombs, M. Ersser, S.J. (2004) Medical hegemony in decision-making – a barrier to interdisciplinary working in intensive care? Journal of Advanced Nursing 46 (3) 245-252. Department of Health, (2001) National Service Framework for Older People. Available from www.dh.gov.uk/publications accessed 5-1-09. Department of Health (2002) National Service Framework for Diabetes Available from www.doh.gov.uk Accessed 5-1-09. Department of Health, (2006) A New Ambition for Old Age: next steps in implementing the national service framework for older people. Available from www.dh.gov.uk/publications accessed 5-1-09.. Department of Health, (2007) Creating an Interprofessional Workforce: An Education and Training Framework for Health and Social Care. Available from www.CIPW.org.uk accessed 5-1-09.. Diabetes UK (2006) POSITION STATEMENT Structured Education for people with diabetes www.diabetes.org.uk/good_practice/education/recommend accessed 6-1-09.. Edge, J.A., Swift, P.G.F., Anderson, W. Turner, B. (2005) Diabetes services in the UK: fourth national survey: are we meeting NSF standards and NICE guidelines? Archives of Disease in Childhood 90 1005-1009. Funnell, M.M. (2004) Patient Empowerment Critical Care Nursing Quarterly 27 (2) 201-204. Gordon, F. Ward, K. (2005) Making it real: interprofessional teaching strategies in practice. Journal of Integrated Care 13 (5) 42-47. Greenwood, R., Shaw, K. Winocour, P. (2005) Diabetes and the Quality and Outcomes Framework British Medical Journal 331 1340. Guthrie, R.A. Guthrie, D.W. (2004) Pathophysiology of Diabetes Mellitus. Critical Care Nursing Quarterly 27 (2) 113-125. Hankin, L. (2005) Diabetic Emergencies Nursing Standard 19 (52) 67. Hartley, H. (2002) The system of alignments challenging physician professional dominance: an elaborated theory of countervailing powers. Sociology of Health and Illness 24 (2) 178-207. Hilton, L. Digner, M. (2006) Developing a pathway of preoperative assessment and care planning for people with diabetes. Journal of Diabetes Nursing. 10(3) 89-94. Howe, A. (2006) Can the patient be on our team? An operational approach to patient involvement in interprofessional approaches to safe care. Journal of Interprofessional care 20 (5) 527-534. Keene, J., Swift, L., Bailey, S. Janacek, G. (2001) Shared patients: multiple health and social care contact. Health and Social Care in the Community 9 (4) 205-214. Keen, H. (2005) Diabetes and the quality and outcomes framework. British Medical Journal 331 1339 Kenny, G. (2002) Interprofessional working: opportunities and challenges. Nursing Standard 17 (6) 33-35. Kesby, S.G. (2002) Nursing care and collaborative practice Journal of Clinical Nursing 11 357-366. Krentz, A. (Ed). (2004) Emergencies in Diabetes : Diagnosis, Management and Prevention. USA: John Wiley Sons. Masterson, A. (2002) Cross-boundary working: a macro-political analysis of the impact on professional roles. Journal of Clinical Nursing 11 331-339. NICE (2003) Guidance on the use of patient-education models for diabetes www.nice.org.uk accessed 6-1-09. OBrien, S.V. Hardy, K.J. (2003) Developing and implementing diabetes care pathways. Journal of Diabetes Nursing. 7 (2) 53-6 OBrien, S., Michaels, S., Marsh, J. Hardy, K.(2004) The impact of an inpatient diabetes care pathway. Journal of Diabetes Nursing. 8(7) 253-6. O’Neill, A.E. Miranda, D. (2006) The right tools can help critical care nurses save more lives. Critical Care Nursing Quarterly 29 (4) 275-281. Pollard, K.C., Miers, M.E. Gilchrist, M. (2004) Collaborative learning for collaborative working? Initial findings from a longitudinal study of health and social care students. Health and Social Care in the Community 12 (4) 346-358. Pollom, R.K. Pollom, R.D. (2004) Utilization of a multidisciplinary team for inpatient diabetes care. Critical Care Nursing Quarterly 27 (2) 185-188. Price, B. (2006) Exploring person-centred care. Nursing Standard 20 (50) 49-56. Reinauer, H. (2002) Laboratory Diagnosis and Monitoring of Diabetes Mellitus. Geneva: World Health Organization. Robinson, F. (2006) Community programmes promote healthier living. Practice Nurse. 10 32 (8) 11, 13. Scott, A (2006) Leadership in diabetes nursing: Where is it? Journal of Diabetes Nursing 10(9) 324 Skinner, T.C., Cradocl, S., Arundel, F. Graham, W. (2003) Four theories and a philosophy: self-management education for individuals newly diagnosed with Type 2 diabetes. Diabetes Spectrum 16 (2) 75-80. Snow, T. (2006) A breath of fresh care in diabetes Nursing Standard 20 (37) 14-15. Soedmah-Muthu, S.S., Fuller, J.H., Mulner, H.E. et al (2006) High risk of cardiovascular disease in patients with type 1 Diabetes in the UK. Diabetes Care 20 (4) 798-804. Stanley, D., Reed, J. Brown, S. (1999) Older people, care management and interprofessional practice. Journal of Interprofessional Care 13 (3) 229-237. Suman, S. Lockington, T. (2003) Generic care pathways for acute geriatric care and rehabilitation as a tool for care management, discharge planning and continuous clinical audit. Journal of Integrated Care Pathways 7 (2) 75-79. Turina, M., Christ-Crain, M. Polk, H.C. (2006) Diabetes and Hyperglycaemia: strict glycaemic control. Critical Care Medicine 34 (9) 291-300. Watkins, P.J. (2003) ABC of Diabetes (Fifth edition). London: BMJ Publishing Group. 1 Footnotes [1] Department of Health (2002) [2] Hilton, L. Digner, M. (2006) p 89. [3] Department of Health (2002). [4] Department of Health (2002). [5] Watkins, P.J. (2003). [6] Watkins (ibid) [7] DoH (ibid) [8] Hankin, L.(2005) p 67. [9] Watkins (ibid). [10] Turina, M., Christ-Crain, M. Polk, H.C. (2006) p 291. [11] Guthrie, R.A. Guthrie, D.W. (2004) p 113. [12] Edge, J.A., Swift, P.G.F., Anderson, W. Turner, B. (2005) p 10005. [13] Hankin (ibid) [14] Reinauer, H. (2002) [15] Guthrie (ibid) [16] Guthrie (ibid) [17] DoH (2002); Department of Health, (2001). [18] Guthrie (ibid) [19] Bloomgarden, Z.T. (2006) [20] Soedmah-Muthu, S.S., Fuller, J.H., Mulner, H.E. et al (2006) [21] Guthrie (ibid) [22] DoH (2002). [23] DoH (2002) [24] Department of Health, (2001) [25] Collis, S. (2005) [26] Pollom, R.K. Pollom, R.D. (2004) [27] OBrien, S.V. Hardy, K.J. (2003) [28] Snow, T. (2006) [29] NICE (2003) [30] Diabetes UK (2006) [31] Anthony, S., Odgers, T. Kelly, W. (2004) [32] Skinner, T.C., Cradocl, S., Arundel, F. Graham, W. (2003) [33] Antony (ibid) [34] Diabetes UK (2006) [35] DoH (2002) [36] Keene, J., Swift, L., Bailey, S. Janacek, G. (2001) [37] Keen, H. (2005) [38] Scott, A (2006) [39] Masterson, A. (2002) [40] Pollard, K.C., Miers, M.E. Gilchrist, M. (2004) [41] Kenny, G. (2002) [42] Colyer, H.M. (2004) [43] Price (ibid)

Literature - Postmodernism, Economic Domination, and the Function of Art :: Literature Essays Literary Criticism

Postmodernism: Economic Domination and the Function of Art    Does aesthetic creativity relate to or influence reality? Does art possess the capacity to heal society? These questions seem implicit to Walker Percy's understanding of literature and art in general. Literature is a thought-involved process concerned with communication; it selves as a moral guidepost to commend society as well as correct it. Literature represents and describes; it presents readers with a method of articulating and resolving problems in society.         Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   "So it is clear that redescribing a world is the   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   necessary first step towards changing it" (Rushdie   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   18).       Art, in one sense, creates its own political agenda. Percy pursues his diagnostic theory of literature having reckoned with the basic relationship between language and life. Percy seems to answer the initial two questions posed with a resounding yes.      Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The issue of art's impact upon a society is not quite so easily resolved, however. Not every person writes or thinks about art with the same set of assumptions. In order to strike at the heart of the question "what is the purpose of art?" we must first identify, understand and appreciate certain fundamental assumptions inquiries, mediating contexts, surrounding the political nature of art and the role of the artist in authentic creativity. I would like to frame my discussion within the apparent struggle between two ideological contexts: modernism and postmodernism. Using Percy's diagnostic theory of literature to facilitate the discussion, we can examine how modem and postmodern assumptions attempt to shape the purpose of aesthetic creativity.      Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Percy's approach to art is inherently modern. He is concerned with unity and truth and achieving them through the creative process. Modernism claims to Speak to some form of ideological absolute, a universal quality. All things ultimately move to reveal a unified whole, a universe bathed in Truth. Reason is the primary tool of the modernist. It is privileged above all other human faculties. Reason allows humanity to possess knowledge, to know, to assimilate, to unify. Truth and knowledge are hopelessly intertwined. The search for knowledge is thus the search for truth as well. Percy mirrors this modern reverence for the power of human thought, when he claims that literature is essentially cognitive. Art is an expansion and extension of the mind. Art is thus actively involved in the search for Truth.

Hydrogen Fuel Cell Research Paper

An arising problem in today’s world is the destruction of the ozone layer because of the emissions and harmful gases that vehicles are giving off. Forget ethanol or biodiesel. The next big thing in automotive fuel may very well be hydrogen. Automakers rapidly are closing in on making hydrogen fuel cell vehicles an everyday fact of life, with several test models set to debut over the next few years. Hydrogen fuel cells to power vehicles are desirable, experts say, because hydrogen is a renewable fuel that can be used to create electricity to run cars. A chemical reaction between oxygen and hydrogen produces the electric power, and when pure hydrogen is used, the only emission from the tailpipe is harmless water vapor. Many people are asking, â€Å"Why fuel cells? † The gasoline engine in a conventional car is less than 20% efficient in converting the chemical energy in gasoline into power that moves the vehicle, under normal driving conditions. Hydrogen fuel cell vehicles, which use electric motors, are much more energy efficient and use 40-60 percent of membrane to the other side of the cell, the stream of negatively-charged electrons follows an external circuit to the cathode. You can read also Thin Film Solar Cell This flow of electrons is electricity that can be used to do work, such as power a motor. On the other side of the cell, oxygen gas, typically drawn from the outside air, flows through channels to the cathode. When the electrons return from doing work, they react with oxygen and the hydrogen protons (which have moved through the membrane) at the cathode to form water. This union is an exothermic reaction, generating heat that can be used outside the fuel cell. The future of hydrogen fuel-cell vehicles depends on advances in four areas: the hydrogen source, the distribution infrastructure, the on-board fuel tank and the on-board fuel cell. Hydrogen must be made from carbon-free renewable sources before fuel-cell vehicles can make a dent in the climate problem. One idea is to make the hydrogen by splitting water using electricity from wind farms, or solar panels. Once the hydrogen is made, it must be distributed via special pipelines and tankers to an extensive network of hydrogen refueling stations, which have yet to be created yet. Once in the tank, fuel cell vehicles must store enough hydrogen to go several hundred kilometers between refueling stops. Liquid hydrogen requires insulated tanks at -253*C. so most companies have chosen to compress the hydrogen inside high-strength carbon fiber tanks. The purpose of the fuel cell is to convert hydrogen to electric power. The challenge is to make it light, cheap, robust and durable — yet powerful enough to run the engine, lights and air conditioning. Hydrogen fuel cells, while about twice as efficient as internal-combustion engines using gas, cost nearly 100 times as much per unit of power produced, critics note. And hydrogen is explosive. It ignites at a wider range of concentrations than natural gas and requires less energy to ignite, Michael D. Amiridis, chair of the chemical engineering department at the University of South Carolina, told the Web site and gas-electric hybrid cars advocate hybridcars. com. â€Å"It’s scary – you cannot see the flame,† Amiridis said. Still, automakers are pushing ahead. â€Å"What we can do from our side is to show that technology is mainly feasible, and we have many corporate projects in this area,† said BMW’s corporate communications manager Andreas Klugescheid. It’s North America Engineering and Emission Test Center in California, for example, has been testing two BMW Hydrogen 7 prototypes that run on both hydrogen and gasoline, using a dual-fuel engine and two separate fuel tanks. With the push of a button on its steering wheel, the Hydrogen 7 can run on either hydrogen or gasoline. It can go 125 miles on its hydrogen mode and 300 on its gasoline mode, thus limiting the possibility that its driver might be stranded, given that there’s only one hydrogen filling station in California, near Los Angeles. Along with the hydrogen fuel cells' high efficiency (from 40-70%), the possibility of utilizing both heat and electricity from them will make a significant contribution to reducing atmospheric emissions. For example, a fuel cell operating at 60% efficiency would emit 35-60% less CO2 at the fossil fuel stage and 80% less from hydrogen. Both GM and Honda are hoping to bypass concerns about the lack and cost of developing hydrogen filling stations by creating home hydrogen refueling devices that would allow cars to be refilled overnight in garages. Much of the push for hydrogen fuel-cell vehicles is aimed at putting the public at ease through demonstration models and projects Energy sources of the future will have to be cleaner and more efficient than current sources – fuel cells fulfill these requirements. Several challenges remain before we will see wide-spread commercialization, mainly because of restrictions with size, cost, reliability and safety, but an environmentally-friendly source of power is definitely on its way.

Free Essays on Revelation

â€Å"Revelations† by Flannery O’Conner is the story of Ruby Turpin’s journey towards the revelation depicting the reality she had not come to grips with. The main character, Mrs. Turpin, doesn’t think twice before judging people, yet, when she herself is judged she is astounded and stunned. â€Å"I haven’t done anything to you. [Girl who judged Turpin].† (396), Mrs. Turpin thinks to herself, without realizing that she too judges before the victims get a chance to prove themselves. Then, when the hired help tells her that nothing bad has happened, you just had a little fall, it almost satires the fact that Turpin thought she had taken a fall comparative to an over exaggerated plummet towards death. The comment’s suggestive language, implies that the incident was not a â€Å"bad† thing but a vital revelation. The character Turpin’s life is run solely by her own ego. In fact, her hobby is to classify others according to her standards of acceptability; placing them in her foreseen categories. Turpin clings to her good works and her social class as a insignia of her merit; separating herself as a dignified being from blacks, poor white trash, freaks, and lunatics. When the tables turn, and Mrs. Turpin becomes the subject of judgment, she is thrown from her perch of judgment, and placed in a vulnerable position. The fat girl with acne, that had been idly sitting beside Mrs. Turpin in the doctor’s waiting room, seemed to have had enough of Mrs. Turpin’s attitude. She violently threw her book at Mrs. Turpin, and then attempts to strangle the life out of her as well. Then the girl looked directly into the eyes of Mrs. Turpin and said, â€Å"Go back to hell where you came from, you old wart hog†(402). Mrs. Turpin is horrified by this comment, and can’t seem to get it off her mind. She feels as if the comment was a blow to her very being; turning her life completely upside down. When she tells her awful story to the black hire... Free Essays on Revelation Free Essays on Revelation â€Å"Revelations† by Flannery O’Conner is the story of Ruby Turpin’s journey towards the revelation depicting the reality she had not come to grips with. The main character, Mrs. Turpin, doesn’t think twice before judging people, yet, when she herself is judged she is astounded and stunned. â€Å"I haven’t done anything to you. [Girl who judged Turpin].† (396), Mrs. Turpin thinks to herself, without realizing that she too judges before the victims get a chance to prove themselves. Then, when the hired help tells her that nothing bad has happened, you just had a little fall, it almost satires the fact that Turpin thought she had taken a fall comparative to an over exaggerated plummet towards death. The comment’s suggestive language, implies that the incident was not a â€Å"bad† thing but a vital revelation. The character Turpin’s life is run solely by her own ego. In fact, her hobby is to classify others according to her standards of acceptability; placing them in her foreseen categories. Turpin clings to her good works and her social class as a insignia of her merit; separating herself as a dignified being from blacks, poor white trash, freaks, and lunatics. When the tables turn, and Mrs. Turpin becomes the subject of judgment, she is thrown from her perch of judgment, and placed in a vulnerable position. The fat girl with acne, that had been idly sitting beside Mrs. Turpin in the doctor’s waiting room, seemed to have had enough of Mrs. Turpin’s attitude. She violently threw her book at Mrs. Turpin, and then attempts to strangle the life out of her as well. Then the girl looked directly into the eyes of Mrs. Turpin and said, â€Å"Go back to hell where you came from, you old wart hog†(402). Mrs. Turpin is horrified by this comment, and can’t seem to get it off her mind. She feels as if the comment was a blow to her very being; turning her life completely upside down. When she tells her awful story to the black hire...