An Analysis of Grand Strategy :: essays research papers fc

An Analysis of Grand Strategy through the Lens of Neo-Security Complex Theory   Ã‚  Ã‚  Ã‚  Ã‚  Barry Buzan, Ole Waever, and Jaap de Wilde attempt to structure a fundamentally new approach to the study of security issues by attempting to incorporate traditional notions of security analysis into a broader understanding of international security that incorporates non-military threats. Their neo-security complex theory does provide substantive insight into how the process of securitizing issues occurs and how one can address non-military existential threats within a security studies framework; however, there are some substantive problems that require greater theoretical precision in order to prevent making the securitizing process they describe nothing more than a residual category. Ultimately, Buzan, Waever, and de Wilde need to incorporate both temporal elements as well as and probability into their approach in order to disaggregate existential threats. Without such modifications, the existential threat posed by an incoming nuclear or chemical warhead is equi valent to increased levels of radon in the home.   Ã‚  Ã‚  Ã‚  Ã‚  In order to show the virtues, flaws, and possible improvements that would allow neo-security complex theory to become a more powerful analytic tool in security studies it is first necessary to briefly explicate the core elements of the approach and show how it diverges from the traditional understanding of security studies. Then one must show how its application would provide substantive insight into particular security practices found in the literature, such as grand strategy. After doing so, we must address substantive problems generated from the application of the theory and then show how various improvements would strengthen the neo-security project.   Ã‚  Ã‚  Ã‚  Ã‚  The neo-security complex theory revolves around an attempt to expand the possibilities of what constitutes a security threat by conceptualizing it as meaning solely a threat to one’s physical existence. While recognizing that there are many threats and vulnerabilities that arise both within and outside military issues, Buzan, Waever, and de Wilde argue that including all such events would ultimately prove the traditionalists’ critique that expanding security beyond military issues inevitably leads to a lack of coherence. The way out of this conceptual morass is to distinguish between political issues and construct security as pertaining to â€Å"existential threats to a referent object by a securitizing actor who thereby generates endorsement of emergency measures beyond rules that would otherwise bind.†   Ã‚  Ã‚  Ã‚  Ã‚  Like neorealism, neo-security complex theory relies upon levels of analysis as a means to situate actors, issues that pose existential threats, and the interactions between them that constitute security. An Analysis of Grand Strategy :: essays research papers fc An Analysis of Grand Strategy through the Lens of Neo-Security Complex Theory   Ã‚  Ã‚  Ã‚  Ã‚  Barry Buzan, Ole Waever, and Jaap de Wilde attempt to structure a fundamentally new approach to the study of security issues by attempting to incorporate traditional notions of security analysis into a broader understanding of international security that incorporates non-military threats. Their neo-security complex theory does provide substantive insight into how the process of securitizing issues occurs and how one can address non-military existential threats within a security studies framework; however, there are some substantive problems that require greater theoretical precision in order to prevent making the securitizing process they describe nothing more than a residual category. Ultimately, Buzan, Waever, and de Wilde need to incorporate both temporal elements as well as and probability into their approach in order to disaggregate existential threats. Without such modifications, the existential threat posed by an incoming nuclear or chemical warhead is equi valent to increased levels of radon in the home.   Ã‚  Ã‚  Ã‚  Ã‚  In order to show the virtues, flaws, and possible improvements that would allow neo-security complex theory to become a more powerful analytic tool in security studies it is first necessary to briefly explicate the core elements of the approach and show how it diverges from the traditional understanding of security studies. Then one must show how its application would provide substantive insight into particular security practices found in the literature, such as grand strategy. After doing so, we must address substantive problems generated from the application of the theory and then show how various improvements would strengthen the neo-security project.   Ã‚  Ã‚  Ã‚  Ã‚  The neo-security complex theory revolves around an attempt to expand the possibilities of what constitutes a security threat by conceptualizing it as meaning solely a threat to one’s physical existence. While recognizing that there are many threats and vulnerabilities that arise both within and outside military issues, Buzan, Waever, and de Wilde argue that including all such events would ultimately prove the traditionalists’ critique that expanding security beyond military issues inevitably leads to a lack of coherence. The way out of this conceptual morass is to distinguish between political issues and construct security as pertaining to â€Å"existential threats to a referent object by a securitizing actor who thereby generates endorsement of emergency measures beyond rules that would otherwise bind.†   Ã‚  Ã‚  Ã‚  Ã‚  Like neorealism, neo-security complex theory relies upon levels of analysis as a means to situate actors, issues that pose existential threats, and the interactions between them that constitute security.

Concept Analysis on Self Perception Essay -- Psychology

This is a concept analysis on self-perception. Self-perception is non-discriminatory in that it crosses all socio-economic, religious and ethnic backgrounds. The effects of self-perception can be and usually are life altering. Self-perception can tear at the fabric of the victim's self-confidence, self-worth and trust in their perceptions when relating to life events, eventually causing a chasm or warped view of the inner self. The reason for examining self-perception relates to how it affects the healing process and the relationships with those providing care. Introduction Working in a healthcare system you encounter people from various ages and statuses. It has always been concerning to see how self-perception affects a person’s wellbeing. Understanding self-perception is to also understand how people change both internally and externally depending on the perception that they have of themselves and how professionals in the healthcare field can help to mend that self-perception. The long term effects of self-perception are both psychological and physiological and play a direct role in the healing process. Purpose The purpose of this concept analysis is to (1) understand self-perception (2) define and understand the critical attributes within the framework of nursing, philosophy, society and psychology (3) consider the long term effects of self-perception. To fully understand self-perception we must first understand how it is defined. The following definitions and explanations of the word ‘self-perception’ come from The American Heritage Dictionary of the English Language 5th Edition. Self-perception is defined as an awareness of the characteristics that constitute one’s self; self-knowledge. Self-Perception is ve... ...self running low on self-esteem. (1995, November-December). Psychology Today, 28(6) Retrieved from http://go.galegroup.com/ps/i.do?id=GALE%7CA17537882&v=2.1&u=tel_s_tsla&it=r&p=PPPC&sw=w Modell, Arnold H. (1924) The private self. Copyright 1993 by the president and fellows of Harvard College. Library of congress cataloging in publication data. Riding, Richard J. & Rayner, Stephen G. (Eds.). (2001). International Perspective on Individual Differences. Self Perception. Vol. 2 (2) Liberman, Matthew D., Pfeifer, Jennifer H. The self and social perception: Three kinds of questions in social cognitive neuroscience. Retrieved from http://www.scn.ucla.edu/pdf/chapter7.pdf Goodwin, Renee & Engstrom, Gunnar. (2002). Personality and the perception of health in the general population. Psychological Medicine, 32, pp 325-332 doi: 10.1017/S0033291701005104

Argumentative Paper: Legalizing Euthanasia -- Assisted Suicide

Most people do not like to talk or even think about death; much less the topic of ending one’s own life. However, for some, death is a desired alternative to living in agony. Euthanasia has been a topic of debate since antiquity, and both sides stand firm on their beliefs. The right to choose death is illegal in most countries. I believe in people’s freedom to do what they please with their own bodies. The basic right of liberty is what America was founded on. Euthanasia should be a legal option. It’s important to start by understanding the different types of euthanasia. Allowing someone to die is, â€Å"Forgoing or withdrawing medical treatment that offers no hope of benefit to the total well-being of the patient, or that imposes burdens disproportionate to the potential benefits, allows the patient to die† (Manning 2). Traditionally called passive euthanasia, allowing someone to die was redefined by and is acceptable in the Catholic Church. Active euthanasia, also known as physician-assisted suicide, is when someone other than the patient ends the life of the patient upon explicit request. I view active and passive euthanasia to be one in the same with one very real difference; allowing someone to die delays the inevitable and the patient is left to twist and turn for awhile longer. Peter Chesterfield comments, â€Å"A terminally ill, mentally competent patient like me should not be forced to suffer. This is as morally unacceptable as murder† (qtd. In Friedman 8). On the other hand, â€Å"The phrase ‘mercy killing’ refers to someone’s taking a direct action to terminate a patient’s life without the patient’s permission† (Thiroux and Krasemann 184). Mercy killing is the form of euthanasia that must be properly monitored and consist... ...ties Toward Physician- Assisted Death: An Exploratory Assessment of the Vulnerability Argument,† Journal of Disability Policy Studies, vol. 16, no. 1, Summer 2005. Print. Manning M.D., Michael. Euthanasia and Physician-Assisted Suicide: Killing or Caring? Mahwah: Paulist Press, 1998. Print. Nordqvist, Christian. "What Is Euthanasia." Medical News Today. MediLexicon International, 26 Sept. 2014. Web. 05 May 2015. . Sharma, Shweta. "Euthanasia: Debate Rekindled on Right to Die for the Terminally Ill." Health and Wellness Resource Center. Mel, 3 Aug. 2014. Web. 05 May 2015. Snyder, Carrie L. Euthanasia: Opposing Viewpoints. Farmington Hills: Bonnie Szumski, 2006. Print. Thiroux, Jacques P. and Kevin W. Krasseman. Ethics: Theory and Practice. Upper Saddle River: Prentice Hall, 2012. Print.

Family Health Essay

Diversity among individuals, as well as cultures, provides a challenge for nurses when it comes to delivering meaningful health promotion and illness prevention-based education. How do teaching principles, varied learning styles (for both nurses and patients), and teaching methodologies impact the approach to education? How do health care providers overcome differing points of view regarding health promotion and disease prevention? Provide an example. 1)We live in a very diverse nation and overcoming challenges related to cultural beliefs and preferences is a very common obstacle for health care workers today. In an article in The Online Journal of Issues in Nursing cultural diversity is defined as being more than just race, Health care workers must realize that addressing cultural diversity goes beyond knowing the values, beliefs, practices and customs of African Americans, Asians, Hispanics/Latinos, Native Americans/Alaskan Natives, and Pacific islanders. In addition to racial classification and national origin, there are many other faces of cultural diversity. Religious affiliation, language, physical size, gender, sexual orientation, age, disability (both physical and mental), political orientation, socio-economic status, occupational status and geographical location are but a few of the faces of diversity. (Camphina-Bacote, 2003) Health care workers have to diligently accommodate the many needs of all the individuals they encounter. These needs range from diverse deep cultural backgrounds, varying learning styles and learning preferences, and mixed opinions defining health and well being. Language barriers may also be a hardship for health care workers to overcome. An example of how health care workers can overcome differing points of view would be demonstrated in their ability to accommodate to the specific needs of the patient. For example a Hispanic patient who is a Jehovah’s Witness and only speaks Spanish has been ignoring abnormal signs and symptoms of rectal bleeding for several weeks. She comes into the hospital and is worked up and then diagnosed with colon cancer. The early treatment process  requires a colon resection. The risks are discussed with the patient and the risk of blood loss with the surgery is covered. During the operation the patient does experience some bleeding and has hemoglobin that drops down well below normal range to 5.3. In the Jehovah’s Witness culture they do not believe in accepting blood transfusions. After the procedure the pt. is transferred to the ICU. In the ICU the visiting hours are typically restricted to specific hours and this patients family does not understand and does not feel comf ortable leaving there loved one unattended. In the scenario described above there are several examples of possible obstacles that the health care worker must overcome. First would be the language barrier. The use of an interpreter service would be required to be certain that the patient has a concrete understanding of the diagnosis, the treatment, signs and symptoms of chemo and radiation, education for follow up treatment etc. The second obstacle to consider would be the religious belief and refusal of blood products. The risks associated with anemia and possibly educating the pt. and family about natural options available to try and raise hemoglobin nutritionally with iron and vitamin supplements. The third obstacle could be the cultural preferences of family dependency and honoring and providing care for elders. The new diagnosis of cancer is difficult and when you add complexities like language barriers and specific religious beliefs it can make the process even more complicated. Health care workers must be very agile in t heir abilities to create flexible learning environments for the many diverse encounters the will have. References: Camphina-Bacote, J. (2003). Many faces: Addressing diversity in health care. The Online Journal of Issues in Nursing, 8, retrieved from http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume82003/No1Jan2003/AddressingDiversityinHealthCare.aspx 2) Health practices and beliefs are diverse among all cultures in relation to health, illness, birth and death. What is equally true is that there is also diversity within the cultural group; therefore nurses must develop health  promotion and illness prevention-based education that is focused on the individual while taking into considering teaching and learning styles that are culturally relevant. Teaching and learning methodologies, principals, styles or approaches are perhaps the most challenging for nurses. Not only are nurses diverse in culture, sex, age, socioeconomic and religion, we are also part of a discipline that is diverse in practice. It is necessary to acknowledge our own beliefs, biases as it relates to other culture groups so that we don’t unintentionally create barriers to learning. Health care providers can overcome differing points of view regarding health promotion and disease prevention by creating a learning environment built on mutual trust, respect and acceptance. The goal is to provide education that is built upon the individual or group strengths that empower and engage the group/individual to be an active participant. It should encourage decision-making that positively affects lifestyle and health behavior changes. Through experience and education I have had the opportunity to see the diversity within the Hispanic culture. There are major differences with this group in terms of immigrants and acculturated Hispanics. One notable difference is in health care practices. Immigrants take on the traditional formal practices in regards to illness. They are more likely to practice home remedies recommended by a relative such as the use of herbs (yerbas), and healers (curandero), or seek a spiritual healer or religious leader for prayer before seeing a physician because the perception of illness is that it is an act of God for bad life or lifestyle. Therefore their life is in Gods hands. Acculturated Hispanics are more likely to adopt American health practices, depending on access and resources available in health care. However, in some cases a certain residual traditions and practices are seen even acculturated Hispanics. What one individual or cultural group perceives to be important or relevant may be insignificant to another. Reference Lipson, J. G., & Dibble, S. L. (Eds.). (2006). Providing Culturally Appropriate Health Care: Culture & Care 3) Low health literacy, cultural barriers, and limited English proficiency have been coined the â€Å"triple threat† to effective health communication by the Joint Commission. Nurses, who work with patients from increasingly diverse cultural groups, experience daily how these three threats offer a challenge to the effective provision of care at the system, provider and patient levels. Patients deserve culturally and linguistically competent healthcare. First and foremost nurses should continually develop their ability to practice cultural self-awareness so as to better recognize their own cultural and linguistic assumptions and biases. Because health literacy depends on cultural and linguistic factors, there is a need for patient assessment tools that can efficiently collect information on patient literacy, linguistic ability and cultural beliefs. So that providers rely on assessment tools, not on â€Å"gut feelings†. Nurses should make appropriate use of medical interpreters and cultural brokers. Medical interpreters should be cross-trained in cultural competence and health literacy, in addition to medical interpretation training. Understanding cultural differences enables nurses to use appropriate teaching such as oral patient education instead of pamphlets or written materials they may not understand. A teaching tool for ESL is Picture Stories for Adult ESL Health Literacy, which gives students and teachers a starting point for talking about complex healthcare problems and solutions. The assumption that patients understand â€Å"enough† is a common misconception in the operating room. Nurses are responsible for assessing the patients while  the surgeons and anesthesiologist often rely on the information in the chart. The patient is rarely able to verbalize or explain what the doctor is going to do. The Cyracom phone is a indispensable tool used in the operating room to assess and educate culturally diverse patients. We are the patient advocates and must be proactive in providing teaching and answering questions and making sure patients understand what is happening to them. Singleton, K., Krause, E., (Sept. 30, 2009) â€Å"Understanding Cultural and Linguistic Barriers to Health Literacy† OJIN: The Online Journal of Issues in Nursing. Vol. 14, No. 3, Manuscript 4 4) Culture refers to the learned, shared and transmitted knowledge of values, beliefs and ways of life of a particular group of people that generally pass on from generation to generation and it influence thinking, decisions, and actions in certain way and manners (Singleton & Krause, 2009). Culture and language affect how patients attain and apply skills in health care which makes patient education very difficult for nurses to achieve a better outcome for the patient. Nurses are in a position to make better connections between patient culture, language, and health literacy in order to improve health outcomes for culturally diverse patients. Nurses today are providing care, education and case management to an increasingly diverse patient population that is face with triad of cultural, linguistic, and health literacy barriers (Singleton & Krause, 2009). Patient education is essential in assisting patients to live with illness and to have improved health outcomes. Patient education is also one of the most satisfying aspects of care provided by professional nurses. To facilitate learning, nurses must apply effective patient teaching strategies. This process includes assessing and prioritizing learning needs, assessing learning styles, and implementing teaching strategies designed to address identified learning needs (Chang & Kelly, 2007). For example, a family friend had a baby three years ago; she lost a lot of  blood as a result of some complication during child birth. Her hemoglobin was 8gm/dl (Normal 12.1-15.1gm/dl) which was low compare to the normal. Doctor wants her to get blood transfusion which she and her immediate family did not want because of their cultural beliefs. The provider gave options on how she can increase her hemoglobin by eating food rich in iron and vitamin B; eat fruits and vegetables high in vitamin C, which will help her body to absorb iron and Iron supplement tablet. The first obstacle there was her cultural beliefs which the provider has to overcome by providing her with an alternative to increase her Iron level. Second obstacle was decision making. In different cultures, individual may look to the nuclear family, extended family, or family head to make decision. The decision for Iron supplement was a family decision due to their cultural beliefs. Furthermore, patients make decisions that are similar to their health beliefs systems to which their culture permit. If the provider does not subscribe to the same health belief system regarding disease etiology as does the patient, health directions may not be followed and conflict may arise between the patient and the provider. Hence, it is important that providers consider the patient’s beliefs when providing health education and interventions (Chang & Kelly, 2007). References: Chang, M., & Kelly, A. (2007). Patient Education: Addressing Cultural Diversity and Health Literacy Issues. 27(5), 411-417. Retrieved from http://www.medscape.com/viewarticle/564667 Singleton, K., & Krause, E. (2009). Understanding Cultural and Linguistic Barriers to Health Literacy. The Online Journal of Issues in Nursing, 4(3), Retrieved from http://www.nursingworld.org/mainmenucategories/anamarketplace/anaperiodicals/ojin/tableofcontents/vol142009/no3sept09/cultural-and-linguistic-barriers-.html

The Return: Shadow Souls Chapter 6

Elena was using all her considerable talents at negotiation to calm Matt down, encouraging him to order a second and third Belgian waffle; smiling at him across the table. But it wasn't much good. Matt was moving as if he were driven to rush, while at the same time he couldn't take his eyes off her. He's still imagining Damon swooping down and terrorizing some young girl, Elena thought helplessly. Damon wasn't there when they stepped out of the coffee shop. Elena saw the frown between Matt's eyebrows begin and had a brainstorm. â€Å"Why don't we take the Jag to a used-car dealership? If we're going to give up the Jaguar, I want your advice on what we get in return.† â€Å"Yeah, my advice on beat-up, falling-apart heaps has got to be the best,† Matt said, with a wry smile that said he knew Elena was managing him, but he didn't mind. The single car dealership in the town didn't look very promising. But even it was not as depressed-looking as the owner of the lot. Elena and Matt found him asleep inside a small office building with dirty windows. Matt tapped gently on the smudged window and eventually the man started, jerked up in his chair, and angrily waved them away. But Matt tapped again on the window when the man began to put his head down once more, and this time the man sat up very slowly, gave them a look of bitter despair, and came to the door. â€Å"What do you want?† he demanded. â€Å"A trade-in,† Matt said loudly before Elena could say it softly. â€Å"You teenagers have a car to trade,† the little man said darkly. â€Å"In all my twenty years owning this place – â€Å" â€Å"Look.† Matt stepped back to reveal the brilliant red Jag shining in the morning sun like a giant rose on wheels. â€Å"A brand-new Jaguar XZR. Zero to sixty in 3.7 seconds! A 550-horsepower supercharged AJ-V8 GEN III R engine with 6-speed ZF automatic transmission! Adaptive Dynamics and Active Differential for exceptional traction and handling! There is no car like the XZR!† Matt finished nose to nose with the little man, whose mouth had slowly come open as his eyes flickered between the car and the boy. â€Å"You want to trade that in for something on this lot?† he said, shocked into frank disbelief. â€Å"As if I'd have the cash to – waitaminute!† he interrupted himself. His eyes stopped flickering and became the eyes of a poker player. His shoulders came up, but his head didn't, giving him the appearance of a vulture. â€Å"Don't want it,† he said flatly and made as if to go back into the office. â€Å"What do you mean you don't want it? You were drooling over it a minute ago!† Matt shouted, but the man had stopped wincing. His expression didn't change. I should have done the talking, Elena thought. I wouldn't have gotten into a war from word one – but it's too late now. She tried to shut out the male voices and looked at the dilapidated cars on the lot, each with its own dusty little sign tucked into the windshield: 10 PERCENT OFF FOR XMAS! EASY CREDIT! CLEAN! GRANNY-OWNED SPECIAL! NO DOWN-PAYMENT! CHECK IT OUT! She was afraid she was going to burst into tears at any second. â€Å"No call for a car like that around here,† the owner was saying expressionlessly. â€Å"Who'd buy it?† â€Å"You're crazy! This car will bring customers flocking in. It's – it's advertising! Better than that purple hippo over there.† â€Å"Not a hippo. S'an elephant.† â€Å"Who can tell, with it half deflated like that?† With dignity, the owner stalked over to look at the Jag. â€Å"Not brand-new. S'got too many miles on it.† â€Å"It was bought only two weeks ago.† â€Å"So? In a few more weeks, Jaguar will be advertising next year's cars.† The owner waved a hand at Elena's giant rose of a vehicle. â€Å"Obsolete.† â€Å"Obsolete!† â€Å"Yeah. Big car like this, gas guzzler – â€Å" â€Å"It's more energy efficient than a hybrid – !† â€Å"You think people know that? They see it – â€Å" â€Å"Look, I could take this car anywhere else – â€Å" â€Å"Then take it. On my lot, here and now, that car is barely worth one car in exchange!† â€Å"Two cars.† The new voice came from directly behind Matt and Elena, but the car dealer's eyes widened as if he had just seen a ghost. Elena turned and met Damon's unfathomable black gaze. He had his Ray-Bans hooked over his T-shirt and was standing with his hands behind his back. He was looking hard at the car dealer. A few moments passed, and then†¦ â€Å"The†¦silver Prius in the back right corner. Under†¦under the awning,† the car dealer said slowly, and with a dazed expression – in answer to no question that had been asked aloud. â€Å"I'll†¦take you there,† he added in a voice to match his expression. â€Å"Take the keys with you. Let the boy test-drive it,† Damon ordered, and the owner fumbled to show a key ring at his belt, and then walked slowly away, staring at nothing. Elena turned to Damon. â€Å"One guess. You asked him which was the best car on his lot.† â€Å"Substitute ‘least disgusting' and you'd be closer,† Damon said. He flashed a brilliant smile at her for a tenth of a second, and then turned it off. â€Å"But, Damon, why two cars? I know it's more fair and all, but what are we going to do with the second car?† â€Å"Caravan,† Damon said. â€Å"Oh, no.† But even Elena could see the benefits of this – at least after they held a summit to decide on a rotation schedule between the cars for Elena. She sighed. â€Å"Well – if Matt agrees†¦Ã¢â‚¬  â€Å"Mutt will agree,† Damon said, looking very briefly – very briefly – as innocent as an angel. â€Å"What have you got behind your back?† Elena said, deciding not to pursue the question of what Damon intended to do to Matt. Damon smiled again, but this time it was an odd smile, just a quirk of one side of his mouth. His eyes said it was nothing much. But his right hand came out and it was holding the most beautiful rose Elena had ever seen in her life. It was the deepest red rose she had ever seen, yet there wasn't a hint of purple to it – it was just velvety burgundy, and open at exactly the moment of full bloom. It looked as if it would be plush to the touch, and its vivid green stem, with just a few delicate leaves here and there, was at least eighteen inches long and straight as a ruler. Elena resolutely put her own hands behind her back. Damon wasn't the sentimental type – even when he got on his â€Å"Princess of the Night† soapbox. The rose probably had something to do with their journey. â€Å"Don't you like it?† Damon said. Elena might be imagining it, but it almost sounded as if he were disappointed. â€Å"Of course I like it. What's it for?† Damon settled back. â€Å"It's for you, Princess,† he said, looking hurt. â€Å"Don't worry; I didn't steal it.† No – he wouldn't have stolen it. Elena knew exactly how he would have gotten the rose†¦but it was so pretty†¦. As she still made no move to take the rose, Damon lifted it and allowed the cool, silky-feeling petals to caress her cheek. It made her shiver. â€Å"Stop it, Damon,† she murmured, but she didn't seem to be able to step backward. He didn't stop. He used the cool, softly rustling petals to outline the other side of her face. Elena took a deep breath automatically, but what she smelled was not flowerlike at all. It was the smell of some dark, dark wine, something ancient and fragrant that had once made her drunk immediately. Drunk on Black Magic and on her own heady excitement†¦just to be with Damon. But that wasn't the real me, a small voice in her head protested. I love Stefan. Damon†¦I want†¦I want to†¦ â€Å"Do you want to know why I got this particular rose?† Damon was saying softly, his voice blending in with her memories. â€Å"I got it because of its name. It's a Black Magic rose.† â€Å"Yes,† Elena said simply. She'd known that before he said it. It was the only name that fit. Now Damon was giving her a rose kiss by swirling the blossom in a circle on her cheek and then applying pressure. The firmer petals in the middle pressed into her skin, while the outer petals just brushed it. Elena was feeling distinctly light-headed. The day was warm and humid already; how could the rose feel so cool? Now the outermost petals had moved to trace her lips, and she wanted to say no, but somehow the word wouldn't come. It was as if she had been transported back in time, back to the days when Damon had first appeared to her, had first claimed her for his own. When she had almost let him kiss her before she knew his name†¦. He hadn't changed his ideas since then. Vaguely, Elena remembered thinking something like that before. Damon changed other people while remaining unchanged himself. But I've changed, Elena thought, and suddenly there was quicksand under her feet. I've changed so much since then. Enough to see things in Damon I'd never imagined could be there. Not just the wild and angry dark parts, but the gentle parts. The honor and decency that were trapped like veins of gold inside that stone boulder in his mind. I have to help him, Elena thought. Somehow, I have to help him – and the little boy chained outside the boulder. These thoughts had trickled slowly through her mind while it seemed separated from her body. She was so involved with them, in fact, that she somehow lost track of her body, and only now did she realize how much closer Damon had gotten. Her back was against one of the sad, sagging cars. And Damon was speaking lightly, but with an undertone of seriousness. â€Å"A rose for a kiss, then?† he asked. â€Å"It is called Black Magic, and I did come by it honestly. Her name was†¦it was†¦Ã¢â‚¬  Damon stopped, and for a moment a look of intense bewilderment flashed across his face. Then he smiled, but it was the warrior's smile, the brilliant one he turned on and off almost before you were sure you had seen it. Elena sensed trouble. Sure, Damon still didn't remember Matt's name correctly, but she had never known him to forget a girl's name when he was really trying to remember. Especially within minutes of when he must have fed from that girl. Shinichi again? Elena wondered. Was he still taking Damon's memories – only the highlights, of course? The thrills, good or bad? Elena knew that Damon himself was thinking the same thing. His black eyes were smoldering. Damon was furious – but there was a certain vulnerability about his fury. Without thinking, Elena put her hands on Damon's forearms. She ignored the rose, even as he traced the curve of her cheekbone with it. She tried to speak steadily. â€Å"Damon, what are we going to do?† That was the scene that Matt walked in on. Ran in on, actually. He came weaving through a maze of cars, and dashed around a white SUV with one flat tire, shouting, â€Å"Hey, you guys, that Prius is†¦Ã¢â‚¬  And then he stopped dead. Elena knew what he was seeing: Damon caressing her with the rose, while she was practically embracing him. She let go of Damon's arms, but she couldn't back away from him because of the car behind her. â€Å"Matt – † Elena began, and then her voice trailed off. She had been about to say â€Å"This isn't what it looks like. We're not in the middle of a cuddle. I'm not really touching him.† But this was what it looked like. She cared about Damon; she had been trying to get through to him†¦. With a small shock, that thought repeated itself with the force of a shaft of sunlight shooting through an unprotected vampire's body. She cared about Damon. She really did. It was usually difficult being with him because they were alike in so many ways. Headstrong, each wanting their own way, passionate, impatient†¦ She and Damon were alike. Small shocks were going though Elena, and her entire body felt weak. She found herself glad to lean against the car behind her, even though it must be getting dust all over her clothes. I love Stefan, she thought almost hysterically. He's the only one I love. But I need Damon to get to him. And Damon may be falling to pieces in front of me. She was looking at Matt all the while, her eyes full of tears that would not fall. She blinked, but they stubbornly stayed on her lashes. â€Å"Matt†¦Ã¢â‚¬  she whispered. He said nothing. He didn't need to. It was all in his expression: astonishment turning to something Elena had never seen before, not when he was looking at her. It was a sort of alienation that shut her out completely, that severed any bonds between them. â€Å"Matt, no†¦Ã¢â‚¬  But it came out in a whisper. And then, to her astonishment, Damon spoke. â€Å"You do know it's all me, don't you? You can hardly blame a girl for trying to defend herself.† Elena looked at her hands, which were shaking now. Damon was going on, â€Å"You know it's all my fault. Elena would never – â€Å" That was when Elena realized. Damon was Influencing Matt. â€Å"No!† She took Damon off guard, grabbing him again, shaking him. â€Å"Don't do it! Not to Matt!† The black eyes that were turned on hers were definitely not those of a suitor. Damon had been interrupted in the use of his Power. If it had been anyone else, they would have ended as a small spot of grease on the ground. â€Å"I'm saving you,† Damon said coldly. â€Å"Are you refusing me?† Elena found herself wavering. Maybe, if it was only once, and only for Matt's benefit†¦ Something surged up inside her. It was all she could do not to let her aura escape completely. â€Å"Never try that on me again,† Elena said. Her voice was quiet but icy. â€Å"Don't you dare ever try to Influence me! And leave Matt alone!† Something like approval flickered in the endless darkness of Damon's gaze. It was gone before she could be sure she'd seen it. But when he spoke, he seemed less distant. â€Å"All right,† he said to Matt. â€Å"What's the game plan now? You name it.† Matt answered slowly, not looking at either of them. He was flushed but deadly calm. â€Å"I was going to say, that Prius isn't bad at all. And the dealer guy has another one. It's in okay condition. We could have two cars just alike.† â€Å"And then we could caravan and split up if someone was following us! They won't know which to follow.† Normally Elena would have thrown her arms around Matt at this point. But Matt was looking at his shoes, which was probably just as well really, since Damon had his eyes shut and was shaking his head slightly as if he couldn't believe something idiotic. That's right, Elena thought. It's my aura – or Damon's – that they're homing in on. We can't confuse them with identical cars unless we have identical auras, too. Which really meant that she should drive with Matt the whole way. But Damon would never accept that. And she needed Damon to get to her beloved, her one and only, her true mate: Stefan. â€Å"I'll take the ratty one,† Matt was saying, arranging it with Damon and ignoring her. â€Å"I'm used to ratty cars. I already arranged a deal with the guy. We should get going.† Still speaking only to Damon, he said, â€Å"You'll have to tell me where we're really going. We might get separated.† Damon was silent for a long moment. Then, brusquely, he said, â€Å"Sedona, Arizona, for a start.† Matt looked disgusted. â€Å"That place full of New Age lunatics? You're kidding.† â€Å"I said we'll start out from Sedona. It's complete wilderness – nothing but rock – all around it. You could get lost†¦very easily.† Damon flashed the brilliant smile and instantly turned it off. â€Å"We'll be at the Juniper Resort, off North Highway 89A,† he added smoothly. â€Å"I've got it,† Matt said. Elena could see no emotion in either his face or his expression, but his aura was seething red. â€Å"Now, Matt,† Elena began, â€Å"we should really meet every night, so if you just follow us – † She broke off with a sharply inhaled breath. Matt had already turned around. He didn't turn back when she spoke. He just kept going, without another word. Without a backward glance.

End Stage Dilated Cardiomyopathy CDCM Health And Social Care Essay

Approximately 3 million Americans suffer from end-stage DCM, and another 400,000 are diagnosed yearly [ 1 ] . Many of them suffer every twenty-four hours from bosom failure and every twelvemonth end-stage DCM is a lending factor in about a one-fourth million deceases [ 2 ] . As the population ages, the incidence of end-stage DCM is expected to increase greatly [ 3 ] . In congestive bosom failure ( CHF ) , antecedently normal bosom musculus becomes damaged, taking to a generalised weakening of the walls of the cardiac Chamberss [ 4 ] . To counterbalance for the weakening of their muscular walls, the cardiac Chamberss dilate in a procedure called â€Å" remodeling † [ 5 ] . The weakening and the dilation of the bosom musculus finally lead to bosom failure [ 6 ] . Dilated Cardiomyopathy [ 7 ] hypertext transfer protocol: //images.ddccdn.com/cg/images/en1294847.jpg Although in many instances no cause ( etiology ) is evident, end-stage DCM likely resulted from harm to the myocardium produced by a assortment of toxic, metabolic, or infective agents. It may besides be due to hempen alteration of the myocardium from old myocardial infarctions [ 8 ] . Patient forecast depends on the phase of the disease but is typically characterized by a high mortality rate. End-stage DCM will do decease due to progress, irreversible bosom failure and other jobs such as arrhythmias and stroke [ 9 ] . Other than bosom organ transplant, there are presently no healing intervention options for end-stage patients with this disease. However, other options such as Ventricular Assist Device ( VAD ) and Cardiac Resynchronization Therapy ( CRT ) can besides be applied. [ 10 ] hypertext transfer protocol: //www.scimitarequity.com/blog/wp-content/uploads/cli_v2-300Ãâ€"258.gifA Possible Solution – Heart Transplant[ 11 ] Heart graft is a surgical graft process performed on patients with end-stage bosom failure due to distend myocardiopathy or terrible coronary arteria disease. hypertext transfer protocol: //www.barnesjewish.org/upload/images/Transplant/Heart % 20Transplant/Conditions % 20Leading % 20to % 20Transplant-435.gif The most common process is to take a on the job bosom from a late deceased organ giver ( homograft ) and engraft it into the patient. The patient ‘s ain bosom may either be removed ( orthotopic process ) or, less normally, left in to back up the donor bosom ( heterotopic process ) . Orthotopic process of cardiac organ transplant. [ 12 ] How bosom is transplanted: [ 12 ] A midline scratch is made over the breastbone to open the chest pit to acquire to the bosom. The great vass of the bosom are attached to a heart-lung beltway machine that enables the organic structure to keep blood flow to the organic structure and encephalon. The unhealthy bosom is removed and a healthy donor bosom is so sutured into topographic point. The heart-lung beltway machine is removed and the new bosom is restarted. Heterotropic process of bosom graft. [ 13 ] The bosom is donated by person who has been declared brain-dead but remains on life support. The donor bosom must be matched every bit closely as possible to the patient ‘s tissue type to cut down rejection of the new bosom by the organic structure. Because giver Black Marias are in short supply, graft can merely be carried out after extended scrutiny and probe have been performed on both giver and patient to guarantee the best possible result for both sides is achieved and to minimise complications. The patients need to be chronic plenty to necessitate a new bosom, yet healthy plenty to have and last with it. [ 14 ] [ 15 ] hypertext transfer protocol: //a248.e.akamai.net/7/248/430/20080911223522/www.merckmedicus.com/ppdocs/us/common/cecils/b9781416028055500872/images/f001.jpgThe Risks of Heart TransplantDuring the first twelvemonth, 25 % of bosom graft receivers have marks of a possible rejection. The receiver ‘s immune system regards the new bosom as a â€Å" foreign organic structure † and attacks it. Therefore, the patient has to have life-long immunosuppressive drugs to stamp down the immune system from rejecting the giver ‘s bosom. Immunosuppressive drugs may weaken the patient ‘s immune system and cause infections, malignant neoplastic disease, diabetes melllitus, osteoporeosis every bit good as kidney disease. [ 16 ] Receiving bosom from a close comparative whose blood and tissue type match the patients can cut down the dose of immunosuppressive drugs as it can cut down rejection. Besides, failure of the donor bosom may besides go on over clip, due to the same grounds that caused the original bosom to neglect and if the patient ‘s organic structure rejects the donor bosom or if cardiac homograft vasculopathy develops. Patients who have a failed bosom graft can be considered for a retransplant. [ 17 ] Additionally, the patients might hold the hazard of geting infection during the graft. There is besides a perioperative mortality of anesthesia and surgery between 0.03 % and 0.05 % due to change by reversal reaction to medicines and take a breathing jobs. [ 18 ] However, in my sentiment, the minute chance of mortality for the hazard of anaethesia should non deter a patient from undergoing bosom graft.The Effectiveness of Heart TransplantA bosom graft can reconstruct the wellness and energy experienced prior to bosom failure. The bosom graft receivers are placed in the advantaged place of taking their former normal and active lives, with drawn-out life. [ 19 ] After bosom graft, patients receive a new functioning bosom and their organic structures regain the normal bosom ‘s map. Quality of life is normally good, particularly if the side effects of the immunosuppressant drugs can be kept to a lower limit. [ 20 ] I believe that bosom graft is appropriate in handling end-stage DCM as the new bosom is able to pump blood out of the bosom to provide O needed by respiring cells in the organic structure. So, the patients do non necessitate to necessitate bosom machines any longer. The success rate one twelvemonth after the graft is 85 % to 90 % in twelvemonth 2006. This survey besides shows that 75 % are alive after five old ages ; and between 50 % and 60 % are alive after 10 old ages. [ 20 ] The operative mortality rate is about 8 % for the first twelvemonth from twelvemonth 2000 to 2005, which are considered rather low. [ 20 ] Thus, I strongly agree that bosom graft is an effectual solution to end-stage DCM due to its high success rate and comparatively low mortality rate. hypertext transfer protocol: //www.elsevier.es/ficheros/images/255/255v57n12/origen/255v57n12-13069891fig10.jpg Above figure shows the actuarial endurance curve, with an ab initio crisp lessening over the first twelvemonth followed by a less pronounced diminution of about 2.2 % annually. [ 21 ]Economic and Ethical IssuesThe cost of bosom graft is really high. The estimated cost to transfer a bosom without complications is about between US $ 140,000 to US $ 150,000. [ 22 ] Estimated U.S. Average 2008 Freshman Billed Charges Per Transplant [ 22 ] 30 yearss pre-transplant Procurement Hospital graft admittance Doctor during graft 180 yearss post-transplant admittance Immunosuppressant Sum Long-run direction of bosom graft related to immunosuppression, complications, and psychosocial accommodations bring a big economic load for those from hapless households. This fiscal issue calls for authorities subsidies for those hapless patients. Heart graft should, as a affair of national policy, be considered a medically necessary portion of attention for patients with bosom failure. Thus, authorities should go on to give resources to this expensive and complex, but life-saving, engineering. However, some people argued that this significant sum of money should be spent on bettering the criterions of public wellness and life alternatively of developing bosom graft. Nevertheless, I think that these controversial voices can be compromised if the authorities gives a balanced allotment for investing in bosom graft and the societal public assistance of general community. [ 1154 words ] Ethically, bosom graft is objected by some people sing their spiritual and societal norm. In Japan, a dead individual with an uncomplete organic structure before entombment is considered a bad luck. Most household of the deceased have denied consent to the Black Marias due to non wishing the thought of surgery on the organic structure, non being certain if the patient would hold agreed and non holding as a household whether to travel in front. Although age and sex of the possible giver did non impact the determination, households of cultural minority givers were more likely to decline consent than those of white givers. [ 23 ] Thus, I think informed consent, non killing in recovering variety meats, regard for giver and household wants, and prohibition of active mercy killings are among the rules that are of import to this ethical foundation of bosom graft. Besides, more persons should voluntarily register as organ giver to avoid the job of household refusal. Although merchandising and purchasing of Black Marias can increase the supply of Black Marias, it is frequently being argued as Black Marias are being commercialized and this violates human self-respect. Besides, most of these Black Marias are obtained illicitly by improper people for the interest of doing money. In my sentiment, rigorous Torahs should be enacted and enforced to control illegal bosom graft market. Even though there are some ethical statements sing bosom graft, I think that these statements should non deter critical DCM patients from undergoing bosom graft as they can upgrade their life after the graft, following the presently increasing endurance rates.Alternate SolutionsVentricular Assist Device ( VAD )Figure A shows the location of the bosom and the typical equipment needed for an implantable LVAD. Figure B shows how the LVAD is connected to the bosom. [ 24 ] VAD is a mechanical circulatory device that is used to replace the map of a failing bosom and is intended for short term usage – for patients retrieving from bosom onslaughts or bosom surgery ) or long term usage – for patients enduring from congestive bosom failure, due to end-stage DCM. [ 25 ] VADs are designed to help either the right ( RVAD ) or left ( LVAD ) ventricle, or both at one time ( BiVAD ) . Which of these types is used depends chiefly on the implicit in bosom disease and the pneumonic arterial opposition that determines the burden on right ventricle. Long-run VADs are usually used as finish therapy and a span to recovery for DCM. [ 26 ] [ 27 ] Bar Graph: Treatment of End-Stage Heart Failure VAD is an effectual option in instance bosom graft could non be carried out due to inaccessibility of givers ‘ Black Marias or other factors. It is a more realistic solution to end-stage DCM as it helps the bosom to pump blood from the chief pumping chamber to the remainder of organic structure, while the patients are waiting for new bosom. In the last few old ages, VADs have improved significantly in footings of supplying endurance and quality of life among receivers. [ 28 ] Besides, VAD is instantly available, has planned intercession, accomplishable good degree of physical activity and possible recovery of native bosom. [ 29 ] However, the patient needs to be invariably depending on continually power-supplied device, and hazards including blood coagulums, hemorrhage, infection, and device malfunctions are involved with utilizing VAD. [ 30 ] When blood comes in contact with VAD, it tends to coagulate more. Blood coagulums can distrupt blood flow and may barricade blood vas taking to of import variety meats such as the encephalon, therefore doing serious complications such as shot or even decease. [ 30 ] The quotation mark above illustrates the hazards of VAD. This quotation mark, obtained from National Library of Medicine of United States through its website www.nlm.nih.gov/medlineplus/ency is considered really valid and dependable as it agrees with the information provided by the on-line encyclopaedia of A.D.A.M. , Inc. Accredited by American Accreditation HealthCare Commission or URAC, URAC ‘s accreditation plan is an independent audit to verify that A.D.A.M. follows strict criterions of quality and answerability. A.D.A.M. is among the first to accomplish this of import differentiation for on-line wellness information and services. A.D.A.M. Medical Review Board of Cardiology is headed by Marshall A. Corson, MD, Cardiology Section Chief Harborview Medical Center and Associate Professor of Medicine of University of Washington Medical School, Seattle, Washington. Besides, this article is invariably updated with the last update on 22nd May 2010. However, the hazard of blood curdling can be reduced by taking anti-coagulants for every bit long as the patient is implanted with VAD.Cardiac Resynchronization Therapy ( CRT )CRT is besides another signifier of therapy for CHF caused by end-stage DCM. It uses a specialised pacesetter to re-coordinate the action of the right and left ventricles in patients with bosom failure by pacing both ventricles at the same time. [ 31 ] When the work of the two ventricles is coordinated, the bosom ‘s efficiency additions, and the sum of work it takes for the bosom to pump blood is reduced. [ 32 ] T0 S: septate contraction oncoming ; T0 LW: sidelong wall contraction oncoming ; T0 A: vertex contraction oncoming ; T0 ANT: anterior contraction oncoming ; T0 INF: inferior contraction oncoming ; CRT: cardiac resynchronization therapy. This figure shows the times of oncoming of contraction in different walls. IN CHF patients, inferior-to-anterior activation sequence was ever with a bigger hold at baseline, which reduced after CRT. [ 34 ] CRT Device [ 33 ] hypertext transfer protocol: //www.mayoclinic.org/images/crt-2col.jpg hypertext transfer protocol: //www.ispub.com/ispub/ijc/volume_6_number_1_5/synchronization_parameters_and_perfusion_improvement_after_cardiac_resynchronization_therapy/perfusion-fig1.jpg Surveies with CRT have demonstrated its ability to better the symptoms, the exercising capacity, and the feeling of wellbeing of many patients with moderate to severe bosom failure. [ 35 ] Surveies have besides shown that CRT can better both the anatomy and map of the bosom – care to cut down the size of the dilated left ventricle, and hence bettering the left ventricularA expulsion fraction. Most significantly, CRT can better the endurance of patients with bosom failure. [ 35 ] This beginning, an article entitled â€Å" The consequence of cardiac resynchronization on morbidity and mortality in bosom failure † is written by voluntary scientists and health care professionals. The statements have a strict reappraisal and blessing procedure before being published. Many statements are written jointly with and reviewed by the American College of Cardiology and is published in extremely recognized diaries such as The New England Journal of Medicine. The grounds below from another beginning shows that the statements given from the article are true. CRT reduces hazard of all-cause mortality by 40 % , bosom failure ( HF ) due to DCM by 45 % and sudden decease by 46 % . [ 36 ] Degree centigrades: UsersafiqahDesktopallcausechrtext.jpg

Amy’s Bread Essay

Strengths: Amy’s entrepreneurial spirit; Toy Kim Dupree-excellent right-hand manager; Already has about 50 wholesale customers, plus 30 on a waiting list; Company is finally turning a profit; Positive work environment (5 day work week, better pay than competition, benefits package, 401(k) plan, employees allowed to speak freely, low turnover); Retail business allows for higher profit margins, and now represents 25% of Amy’s business; Good niche product mix-high quality bread products, micro-bakeries; Makes herself available to the press/public, leads to word of mouth advertising; Can now secure bank financing due to Amy’s proven track record; Wholesale business (representing 75% of the business) is more stable than retail business. Opportunities: Much higher profit margins in high-end breads (black olive, apple walnut rasin-$2.40 wholesale, $3.40 retail profit with the high-end breads vs. $1.71 wholesale, $2.60 retail without high-end breads); Retail business (currently 25% of business) allows for higher profit margins and payment is only in cash; Hiring another manager could allow Amy more time to run the company; Buying 31st street location would allow for production facility expansion and the ability to cater to customers currently on the waiting list; Leasing the 15th street location could allow both retail and production expansion. Weaknesses: Bakery industry is highly competitive with low wholesale profit margins; NYC locations are very expensive; Higher labor costs due to hand-production techniques (35% of CGS); Ingredient prices are volatile; Ingredients are more expensive than the competition’s; CGS is 65% of net sales; Competitors can enjoy better economies of scale due to automated production and cheaper ingredients; 75% of the business is through lower-profit wholesalers; Current production location is too small to meet growing demand. Threats: Dieting trends (i.e. Atkins diet) could affect consumer demand for bread. Mission: To produce high-quality, handmade breads for wholesale and retail customers through our retail locations and door-to-door deliveries. Objective: Amy’s Bread has seen steady growth over the last few years. This success has overextended both the employees and the warehouse space. Amy is looking to move operations to one of two locations: a building on 31st street, or one on 15th street. The 31st street location would allow Amy to expand her wholesale business and allow her to invest in a property instead of leasing. Amy should also look into adding a manager to allow her the time to focus on the overall business. Her most profitable bread lines are the high-priced breads, she should look into increasing the number of high-priced bread. Eventually, Amy should consider opening small retail locations in New York City.