Quiz review free essay sample

Top of Form Although most slaves came to the colonies before 1776, the majority of other types of labor came to North America voluntarily. True False Question 2 10 / 10 points The middle Atlantic colonies were more popular than New England as destinations for immigrants before 1770 because of their more liberal religious attitudes and the availability of land. True False Question 3 10 / 10 points The legal transfer of chattels supports economic growth. True False Question 4 10 / 10 points Slaves were only used in Southern agriculture. True False Question 5 0 / 10 points At one time, people living in the U. S. were imprisoned or fined for not having legitimate work. True False Question 6 0 / 10 points Robert Higgs and Louis Stettler (1970) find evidence to suggest that colonial couples married at a younger age than those in Europe, thus explaining the relatively high birth rates in colonial America. True False Question 7 10 / 10 points The majority of blacks were shipped from West Africa, but some also came from Madagascar and Zanzibar. We will write a custom essay sample on Quiz review or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page True False Question 8 10 / 10 points On the eve of the American Revolution, the majority of colonists were naturally born in the colonies rather than immigrants from elsewhere. True False Question 9 0 / 10 points Regional specialization did not emerge in the colonies due to the small size of the cities and towns. True False Question 10 10 / 10 points New England possessed a comparative advantage in producing cotton. Producers in this region produced cotton at the lowest possible opportunity cost in colonial America. True False Attempt Score: 70 / 100 70 % Overall Grade (highest attempt): 70 / 100 70 % Bottom of Form Close Top of Form The â€Å"Walker thesis,† that falling birth rates among native-born Americans was due to immigration, is reinforced by the view that immigrants were a direct capital transfer from Europe to America. True False Question 2 10 / 10 points In the case of Commonwealth v. Hunt (1842), the Massachusetts Court held that labor unions are not necessarily illegal. They may stop work and boycott products without committing unlawful acts. True False Question 3 10 / 10 points In the eighteenth century, the rise of manufacturing in New England helped the region attract more settlers than the other regions of the English colonies. True False Question 4 10 / 10 points Population growth in the early nineteenth century was slow due to the lack of immigration. True False Question 5 10 / 10 points The two main sources of U. S. population increase between Independence and the Civil War were natural increases in population and immigration. True False Question 6 10 / 10 points At the start of the Civil War, the population in the U. S. was about half that of the United Kingdom. True False Question 7 10 / 10 points In order to explain the relative sizes of families in urban versus rural environments, some economists viewed children as investment or durable consumptions goods, respectively. True False Question 8 10 / 10 points By the start of the Civil War, the value of woman’s labor was, on average, equal to that of an adult male due to technological advancements. True False Question 9 0 / 10 points Immigrants were valued as a vital source of labor and, consequently, they were greeted with open arms after the 1830s. True False Question 10 10 / 10 points Rural families were larger in size, on average, than urban families during the antebellum period. Some argue that the relatively high rate of return on a child born on a farm partly explains why. Children born on farms could be considered investments goods—â€Å"goods† used to produce something else. True False Attempt Score: 90 / 100 90 % Overall Grade (highest attempt): 90 / 100 90 % Bottom of Form Close Top of Form The early U. S. canals and railroads were built by private enterprise without the aid of governments. True False Question 2 10 / 10 points Most canals were economic failures. True False Question 3 10 / 10 points Railroad competition was the primary cause of canal failures. True False Question 4 10 / 10 points Productivity, or output per labor hour, rises as transportation costs fall. True False Question 5 10 / 10 points The Gallatin Plan (1808) was not passed because some individuals questioned its constitutionality. True False Question 6 10 / 10 points Internal improvements are important to a developing and growing economy. True False Question 7 10 / 10 points As the transportation system developed in the U. S. , urbanization occurred. True False Question 8 10 / 10 points Railroads attracted funds from foreign investors. True False Question 9 10 / 10 points Contrary to many researchers’ views, Hurst (1969) claims the government needed private investors to fund internal improvements. True False Question 10 10 / 10 points Commercialization, market growth and factories emerged in rural areas. True False Attempt Score: 100 / 100 100 % Overall Grade (highest attempt): 100 / 100 100 % Bottom of Form Close Top of Form Skilled labor commanded a higher wage than unskilled labor in both the U. S. and Europe between 1789 and 1860. However, skilled wages in the U. S. were higher, on average. A higher land to labor ratio in the U. S. can explain the higher wage rates of skilled workers in the U. S. True False Question 2 0 / 10 points Ames and Rosenberg (1963) argue that demand for manufactured goods in the U. S. tended to be utilitarian in nature rather than â€Å"high quality,† and this encouraged development of mass production methods. True False Question 3 0 / 10 points North’s (1955) theory of economic location is that of â€Å"balanced growth†Ã¢â‚¬â€many industries in each region must advance at about the same time in order for economic growth to occur. True False Question 4 10 / 10 points Early industrialization was characterized by labor-saving technology, and this caused U. S. wages to be lower in the manufacturing industry than would otherwise have been the case. True False Question 5 10 / 10 points American manufacturers rapidly dropped waterwheels when the steam engine was introduced. True False Question 6 10 / 10 points The U. S. lowered tariffs in the 1850s because of a budget surplus. True False Question 7 10 / 10 points Tariffs provide domestic producers with incentives to be inefficient and operate on the basis of comparative disadvantage. True False Question 8 10 / 10 points One of the main production advantages of the steam engine was the flexibility of its location. True False Question 9 10 / 10 points Hughes and Cain (2011) effectively argue that advancements in power technology helped open new opportunities for the strategic placement of cities and big factories. True False Question 10 0 / 10 points During the antebellum period, U. S. consumers increased their demand for mass-produced, standardized and simple goods. True False Attempt Score: 70 / 100 70 % Overall Grade (highest attempt): 70 / 100 70 % Bottom of Form Close Test 1 answers Attempt 1 Written: Feb 17, 2014 2:11 PM Feb 17, 2014 4:39 PM Submission View released: Jul 2, 2013 4:00 AM Question 1 2. 5 / 2. 5 points Although most slaves came to the colonies before 1776, the majority of other types of labor came to North America voluntarily. True False Question 2 2. 5 / 2. 5 points Indentured servants were white colonists who sold themselves into slavery when their farms in America failed. True False Question 3 2. 5 / 2. 5 points Mercantilism followed feudalism. Unlike feudalism, mercantilism did not support any form of a strong central government or system of nation states. True False Question 4 2. 5 / 2. 5 points Secure rights to land provided colonists with incentive to use the land productively, conserve it and invest in it. True False Question 5 0 / 2. 5 points Growth in real output per person occurred, on average, in colonial America. This growth translated into a great improvement in the quality of life for all citizens. True False Question 6 2. 5 / 2. 5 points Animal skins, livestock, tobacco, teeth and rocks have historically served as a medium of exchange, unit of account, store of value and method of deferred payment. True False Question 7 2. 5 / 2. 5 points Paper money helped colonists pay soldiers for services provided when specie was not available. This money was fiat money; it did not possess specie backing. True False Question 8 2. 5 / 2. 5 points By the end of the colonial period, the Middle Colonies’ population gained over New England but the Southern population continued to dominate. True False Question 9 2. 5 / 2. 5 points Of the 1790 colonist population, over 80 percent was of European origin while about 20 percent was of African origin. True False Question 10 2. 5 / 2. 5 points During the period in which the Navigation Acts guided colonial trade, international trade was safe and many countries fairly engaged in commercial trade. True False Question 11 2. 5 / 2. 5 points Southern plantation owners benefited from British policies on tobacco production in the United Kingdom. True False Question 12 0 / 2. 5 points English mercantilism recognized the law of comparative advantage, thus permitting individuals to specialize in producing those goods and services which they could produce at relatively low opportunity costs and trading those items for those which they could not. True False Question 13 2. 5 / 2. 5 points On the eve of the American Revolution, most colonials produced agricultural goods. The war boosted profits for many farmers. True False Question 14 2. 5 / 2. 5 points Thomas Jefferson supported the Land Ordinances of 1785 and 1787. True False Question 15 2. 5 / 2. 5 points Fifty-five delegates from seven states convened at the first Constitutional Convention (1787) to determine whether the central government of the new, independent country should modify its rules and regulations to permit more or less state sovereignty. True False Question 16 2. 5 / 2. 5 points Charles Beard (1935) argued that the economic self-interest of businessmen, merchants, manufacturers, bankers and investors led them to convene at the Constitutional Convention in the late 1770s. They believed that creating a new, or at least modified, system of laws would help them advance the projects in which they were interested at minimal cost. True False Question 17 2. 5 / 2. 5 points Thomas Jefferson strongly influenced the passing of the Land Ordinances of 1785 and 1787. A close study of those ordinances suggests that Jefferson believed in the importance of securing the private rights of individuals to buy, sell and derive income from their land. True False Question 18 2. 5 / 2. 5 points The Charles River Bridge v. Warren Bridge (1837) decision established that a state could incorporate competing franchises, effectively overturning the old idea that a corporate charter implied a grant of monopoly. True False Question 19 0 / 2. 5 points The right to grant charters to incorporated firms is reserved to the federal government, according to the Constitution. True False Question 20 2. 5 / 2. 5 points The fee simple form of land ownership in the United States was of English origin. True False Question 21 2. 5 / 2. 5 points The rights of state and local government to regulate, license and control businesses were taken away after the American Revolution. True False Question 22 2. 5 / 2. 5 points As an economy grows and develops, the police powers of the government with respect to controlling, regulating and inspecting businesses and their output become increasingly more costly to uphold and protect. True False Question 23 2. 5 / 2. 5 points The equal wealth and income distribution in the U. S. during its antebellum period can be clearly linked to its system of private property rights over land and minerals. True False Question 24 2. 5 / 2. 5 points Prior to the Civil War (1861–1865) American capitalism was free from government influence and controls. The government only served as the protector of private property rights and the provider of national defense. True False Question 25 2. 5 / 2. 5 points The evidence shows that the domestic and world markets for American cotton contributed to the spread of slavery into new lands. True False Question 26 2. 5 / 2. 5 points The steel plow and horse-drawn reaper increased labor productivity on all farms, small and large. True False Question 27 2. 5 / 2. 5 points Operation on the basis of comparative advantage led to the regional specialization of the use of slaves in the North. True False Question 28 0 / 2. 5 points By 1860, over one-half of all Southern farms utilized slave labor. True False Question 29 2. 5 / 2. 5 points Rising agricultural prices and opportunities to own land provided people with incentives to migrate to the trans-Appalachian states. True False Question 30 2. 5 / 2. 5 points Until 1860, the domestic and international demand for cotton provided motive to expand slavery. True False Question 31 2. 5 / 2. 5 points Fogel and Engerman (1974) argue that slavery was economically viable until 1860. True False Question 32 2. 5 / 2. 5 points Slaver owners were optimistic about the economic future of slavery on the eve of the Civil War. True False Question 33 2. 5 / 2. 5 points A fundamental criticism of Time on the Cross is that economics cannot be used to simply compare the welfare of the slaves to their free, white counterparts. True False Question 34 2. 5 / 2. 5 points Rational slave owners had economic incentive to adequately clothe, feed and care for their slaves. True False Question 35 0 / 2. 5 points Most surveyed economists support Fogel and Engerman’s (1974) position that plantation owners were largely rational and treated slaves in their best profit interest. True False Question 36 0 / 2. 5 points On the eve of the Civil War, cotton was the major crop in the Old South. True False Question 37 2. 5 / 2. 5 points The comparative advantage of the South was in small farms producing for the local market. plantation agriculture producing for export. manufacturing. shipbuilding and trades related to shipbuilding. Question 38 2. 5 / 2. 5 points What were the two main sources of population increases during the antebellum period? a significant increase in the number of indentured servants and slaves immigration and a natural increase in population government policies providing incentive to procreate and advanced pre-natal care longer life expectancies and high infant mortality rates Question 39 2. 5 / 2. 5 points Funding for canals came from which of the following sources? Private investments and tolls Taxes Borrowing on government credit All of the above Question 40 2. 5 / 2. 5 points For the period we are studying (1789–1860), the United States was a high tariff, protectionist nation. derived the vast majority of federal revenues from the tariff. was divided on the question of the tariff, with the South generally in opposition to it. was characterized by all of t

Weapons of World War One essays

Weapons of World War One essays Thru 1914 and 1919 World War One was the largest and most important current event happening and during the war technology increased tremendously, but most of the innovations were directed towards weapons and harmful objects of war, such as; rifles and pistols, machine gas, and grenades these three objects of war were examples of technology that changed for the time or were invented. These three things will be discussed and analyzed throughout my paper and proven to be powerful and meaningful in this war. Rifles and pistols like in every other war they were in existence were a large and significant part of this one too. They were more accurate and powerful thus allowing the men to hit a target from further away with a better chance of hitting where they aimed. Almost all infantry and officers in World War One carried a rifle, pistol or both. They were the most common weapon. Nearly all infantrymen in the First World War used bolt action rifles. This type of rifle had been invented by a Scottish immigrant to the United States, James Paris Lee. The bolt is the device that closes the breech of the barrel. The bolt-action rifle had a metal box, which cartridges were placed on top of a spring. As the bolt was opened, the spring forced the cartridges up against a stop; the bolt pushed the top cartridge into the chamber as it closed. After firing, the opening of the bolt extracted the empty cartridge case, and the return stroke loaded a fresh round. The more popular of the rifles used by each country is listed as follows. The Lee-Enfield was the main rifle used by the British Army during the war. Other popular bolt action rifles included the Mauser Gewehr (Germany), Lebel (France), Mannlicher-Carcano (Italy), Springfield (United States), Moisin-Nagant (Russia), Mannlicher M95 (Austria) and Arisaka (Japan). Although pistols were common for all infantry and officers not all men carried them they were not as accurate or ...

Leadeship Styes and Ethics for Law Enforcement Administrators Research Paper

Leadeship Styes and Ethics for Law Enforcement Administrators - Research Paper Example Leaders in the law enforcement agencies should themselves exercise high ethical standards which would then influence the followers to follow suit. The issue of ethical leadership has never been so relevant in law enforcing than it is today given the current issues of corruption, racial discrimination, violence and brutality and other escalating criminal activities. Given this chaotic nature of our streets, it is possible that law enforcers feel only connected to their ethical and professional obligations in theory, but on the ground, such ethics is thrown through the window due to the unpredictable and complex situations. This is where ethical leadership comes in to constantly offer training and guidance to the followers and encourage them always to remain within the boundaries of ethical standards and professional code of conduct governing the service. Leadership is an appreciated topic in all types of organizations, both private and public and is considered an essential component in the steering of organizational goals and objectives. Law enforcement agencies have also endeavored to institute effective leaders within its ranks due to the realization that quality leadership directly affects the quality of performance. Leadership can be taken to mean the process where a person or groups of persons selects, trains, and influences one or more followers to appreciate and agree to what needs to be done to realize the mission and objectives of the organization (Lussier & Achua, 2012). This, as Lussier & Achua (2012) notes, can be achieved by such leaders through humbly conveying a prophetic vision for the future of an organization in a manner that respects and identifiable with the beliefs and values of the followers. According to Lussier & Achua (2012), leadership has several key components which include: Leadership is a process that t akes

Breast Cancer Occurring during Pregnancy Research Paper

Breast Cancer Occurring during Pregnancy - Research Paper Example Women have a 12.67 % of developing breast cancer during their lifetime. ( National Cancer Institute’s Surveillance, Epidemiology, and End Results Program Cancer Statistics Review rates from 2001 to 2003.) According to Loibl S, von Minckwitz G, Gwyn K, et al. (2006) the condition will occur in one in 3000 pregnancies. Despite this, there have been few recent studies on the subject, especially those seeking to look for the histopathologic and immunohistochemical features which are combined in breast carcinomas in these patients, possibly because of the comparative rarity of the condition. Pregnancy-associated breast cancer (PABC), often referred to as gestational breast cancer; can be defined as any cancer of the breast diagnosed during pregnancy and up to one year postpartum including lactation (Molchovsky & Madarnas, 2008). However, there is considerable variation among authors, with defined postpartum periods ranging from 6 months to 2 years. (Psyrri & Burtness, 2005). Another idea is that PABC can be defined as occurring during pregnancy and until lactation ceases. PABC is the second most common malignancy in women, after cervical carcinoma, and occurs in 1 in 3000 pregnancies (Pavilidis & Pentharoudakis, 2005). A mother is already facing the huge changes that come with a new child and when breast cancer is diagnosed concurrently with pregnancy and lactation this becomes a very challenging situation for the patient, physically but also psychologically and socially, as well as her family, physicians, and other health care providers. Treatment options, either local or systemic, are limited by concerns about possibly harming the fetus, and are also conditioned by the gestational length of the pregnancy.

Assessment of Pressure Ulcers and Reliability of Risk Assessment Tools

Assessment of Pressure Ulcers and Reliability of Risk Assessment Tools The purpose of this assignment, is to identify a patient, under the care of the district nursing team, with a Grade 1 pressure ulcer, to their sacral area. To begin with, it will give a brief overview of the patient and their clinical history. Throughout the assignment the patient will be referred to as Mrs A, in order to protect the patients identity and maintain confidentiality, in accordance with the guidelines set out by the Nursing and Midwifery Council (NMC 2008). A brief description of a Grade 1 pressure ulcer will be given, along with a description of the steps taken in assessing the wound, using The Waterlow Scale (1985). This assignment will discuss the literature review that was carried out, along with other methods of research used, to gather vital information on wound care , such as the different classifications of wounds and the different risk assessment tools available. This assignment, will include brief overviews, of some the other commonly used pressure ulcer risk a ssessment tools, that are put to use by practitioners and how they compare to the Waterlow Scale. This assignment will also seek to highlight the importance of using a combination of clinical judgement, by carefully monitoring the patients physical and psychological conditions, alongside the at risk score calculated from the Waterlow Scale, in order to deliver holistic care to the patient. Mrs A is a 84 year old lady who has been referred to the district nurses by her General Practitioner, as he has concerns regarding her pressure areas . Following a recent fall she lost her confidence and is now house bound. She now spends more time in her chair as she has become nervous when mobilising around the house and in her garden. She has a history of high blood pressure and occasional angina for which she currently takes Nicorandil 30mg b.d. as prescribed by her General Practitioner , Nicorandil has been recognised as an aetiological aspect of non healing ulcers and wounds (Watson, 2002), this has to be taken into consideration during the assessment and throughout the management of her wound. Mrs A has no history of previous falls or problems with her balance. She has always been a confident and independent lady, with no current issues surrounding continence or diet. She has always enjoyed a large network of friends who visit her regularly. It is recommended by National Inst itute for Health and Clinical Excellence (NICE) that patients should receive an Initial assessment (within the first 6 hours of inpatient care) and ongoing risk assessments and so referrals of this nature are seen on the day, if it is received if not within 24 hrs. In order to establish Mrs As current risk of developing a pressure area, an assessment must take place. An initial holistic assessment, looking at all contributing factors such as mobility, continence and nutrition will provide a baseline that will identify her level of risk as well as identifying any existing pressure damage. A pressure ulcer is defined as, a localised injury to the skin and / or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. A number of contributing, or confounding factors, are also associated with pressure ulcers. According to the European Pressure Ulcer Advisory Panel (EPUAP 2009). Mrs A is more vulnerable to pressure damage, as her skin has become more fragile and thinner with age (NICE 2005). There are risk factors associated to the integrity of the patients skin and also to the patients general health. Skin that is already damaged, has a higher incidence of developing a pressure ulcer, than that of healthy skin. Skin that becomes too dry, or is more moist due to possible incontinence, is also at higher risk of developing a pressure ulcer than healthy skin. An elderly persons skin is at increased risk, because it is more fragile and thinner than the skin of a younger person. Boore et al (1987) identified the following principles in caring for the skin to prevent pressure damage, skin should be kept clean and dry and not left to remain wet. The skin should also not be left to dry out to prevent any accidental damage . Due to Mrs A spending more time sitting in her chair, she has become at a higher risk of developing a pressure sore, as she is less mobile. The reason being It becomes difficult for the blood to circulate causing a lack of oxygen and nutrients to the tissue cells. Furthermore, the lymphatic system also begins to suffer and becomes unable, to properly remove waste products. If the pressure continues to increase and is not relieved by equipment or movement. The cells can begin to die, leaving an area of dead tissue resulting in pressure damage. Nelson et al (2009) states, pressure ulcers can cause patients functional limitations, emotional distress, and pain for persons affected. The development of pressure ulcers, in various healthcare settings, is often seen as a reflection of the quality of care which is being provided (Nakrem 2009). Pressure ulcer prevention is very important in everyday clinical practise, as pressure ulcer treatment is expensive and factors such as legal issues have become more important. EPAUP (2009) have recommended strategies, which include frequent repositioning the use of special support surfaces, o r providing nutritional support to be included in the prevention. In order to gather evidence based research, to support my assignment. I undertook a literature review of the Waterlow Scale and Classifications of Grade 1 pressure sores. The databases used were the Culmulative Index to Nursing and Allied Health Literature (CINAHL) and OpenAthens. I used a variety of search terms including pressure sores, Grade 1 classification, Waterlow Scale, and How pressure sore risk assessment tools compare. Throughout the literature review the information was gathered from sources using a date range between the years of 2000 2011, although some references were found from sources of information that are from a much later date. This method of research ensured a plethora of articles and guidelines were collated and analysed. The trust guidelines in wound care were used, to show how we implement theory into practise in the community, using the wound care formulary. There was a vast amount of information available, as pressure area care is such a broad subject. The search criteria had to be narrowed down, in some cases to ensure the information gathered was relevant and not beyond the scope of the assignment. The evidence used throughout this assignment, is based on guidelines and recommendations given by NICE (2001), EPUAP (2001) and articles sourced from The Journal of Community Nursing (JCN). This was the most accurate information and guidance on pressure ulcer classifications and assessment although, some articles may not have been the most recent. The assessment tool used throughout my area of work, is the Waterlow Scale. The Waterlow Scale was developed by Judy Waterlow in 1985, while working as a clinical nurse teacher. It was originally designed for use by her student and is used to measure a patients risk of developing a pressure sore. It can also be used as a guide, for the ordering of effective pressure relieving equipment. All National Health Service (NHS) trusts have their own pressure ulcer prevention policy, or guidelines and practitioners are expected to use the risk assessment tool, specified in their trusts policy. NICE (2003), guidance states, that all trusts should have a pressure ulcer policy, which should include a pressure ulcer risk assessment tool. However, it reminds practitioners that the use of risk assessment tools, should be thought of as an aid to the clinical judgement of the practitioner. The use of the Waterlow tool enables, the nurse to assess each patient according to their individual risk of dev eloping pressure sores (Pancorbo-Hidalgo et al 2006). The scale illustrates a risk assessment scoring system and on the reverse side, provides information and guidance on wound assessment, dressings and preventative aids. There is information regarding pressure relieving equipment surrounding, the three levels of risk highlighted on the scale, and also provides guidance, concerning the nursing care given to patients. Although the Waterlow score is used in the community setting, when calculating the risk assessment score, it is vital that the nurse is aware of the difference in environment the tool was originally developed for. The tool uses a combination of core and external risk factors that contribute to the development of pressure ulcers. These are used to determine the risk level for an individual patient. The fundamental factors include disease, medication, malnourishment, age, dehydration / fluid status, lack of mobility, incontinence, skin condition and weight. The external factors, which refer to external influences which can cause skin distortion, include pressure, shearing forces, friction, and moisture. There is also a special risk section of the tool, which can be used if the patient is on certain medication or recently had surgery. This contributes to a holistic assessment of a patient and enables the practitioner to provide the most effective care and appropriate pressure relieving equipment. The score is calculated, by counting the scores given in each category, which apply to your patients current condition. Once these have been added up, you will have your at risk score. This will then ind icate the steps that need to be taken, in order to provide the appropriate level of care to the patient. Identification of a patients risk of developing a pressure sore is often considered the most important stage in pressure sore prevention (Davis 1994). During the assessment a skin inspection takes place of the most vulnerable areas of risk, typically these are heels, sacrum and parts of the body, where sheer or friction could take place. Elbows, shoulders, back of head and toes are also considered to be more vulnerable areas (NICE 2001). When using the Waterlow tool to assess Mrs As pressure risk, I found she had a score of 9. According to the Waterlow scoring system she is not considered as being at risk as her score is less than 10. As I had identified in my assessment, she had a score of 2, for her skin condition due to Grade 1 pressure ulcer to her sacrum. I felt it necessary, to highlight her as being at risk. A grade 1 pressure ulcer on her sacral area, maybe due to her recent loss of confidence and reduced mobility which has left Mrs A spending more time in her chair. Pressure ulcers are assessed and graded, according to the degree of damage to the tissue. The National Pressure Ulcer Advisory Panel (NPUAP), classifies pressure ulcers based on the depth of the wound. There are four classifications (Category/Stage I through IV) of pressure damage. In addition to these, two other categories have been defined, unstageable pressure ulcers and deep tissue injury (EPUAP, 2009) Grade 1 pressure damage is defined, as a non-blanchable erythema of intact skin. Indicators can be, discolouration of the skin, warmth, oedema, induration or hardness, particularly in people with darker pigmentation (EPUAP, 2003). It is believed by some practitioners, that blanching erythema indicates Grade 1 pressure damage (Hitch 1995) although others suggest that, Grade 1 pressure damage is present, when there is non-blanching erythema (Maklebust and Margolis, 1995; Yarkony et al, 1990). The majority of practitioners, agree that temperature and colour play an important role, in identifying grade 1 pressure ulcers (EPUAP, 1999) and erythema, is a factor in alm ost all classifications (Lyder, 1991). The pressure damage usually occurs, over boney prominences (Barton and Barton 1981). The skin in a Grade 1 pressure ulcer, is not broken, but it requires protection and monitoring. At this stage, it will not be known how deep the pressure damage is, regular monitoring and assessment is essential. The pressure ulcer may fade, but if the damage is deeper than the superficial layers of the skin, this wound could eventually develop into a much deeper pressure ulcer over, the following days or weeks. A Grade 1 pressure ulcer, is classed as a wound and so I have commenced a wound care plan and also a pressure area care plan. I will also ensure, Mrs A has regular pressure area checks in order to prevent the area breaking down. The pressure area checks will take place weekly until the pressure relieving equipment arrives, this will then be reduced to 3 monthly checks. Dressings can be applied to a Grade 1 pressure ulcer. They should be simple and offer some level of protection. Also, to prevent any further skin damage a film dressing is often used, or a hydrocolloid to protect the wound area (EPAUP, 2009) . These dressings will assist in reducing further friction, or shearing, if these factors are involved. It is considered the best way to treat a wound, is to prevent it from ever occurring. Removing the existing external pressure, reducing any moisture, which can occur if the patient is incontinent and employing pressure relief devices, may contribute to wound healing. Along with adequate nutrition, hydration and addressing any underlying medical conditions. The advice given to practitioners, on the reverse of the Waterlow tool is to provide a 100mm foam cushion, if a patients risk score is above 10. As Mrs A has an at risk score of 9, with a Grade 1 pressure sore evident, I feel it appropriate to provide the pressure relieving mattress and cushion to prevent any further pressure damage developing. All individuals, assessed as being vulnerable to pressure ulcers should, as a minimum provision, be placed on a high specification foam mattress with pressure relieving properties (NICE, 2001). As I am providing a cushion and a mattress, it is not felt necessary to apply a dressing at this point. However, the area will need regular monitoring, as at this stage it is unknown how deep the pressure damage is. If proactive care is given in the prevention and treatment of pressure ulcers, with the use of risk assessments and providing pressure relieving resources, the pressure area may resolve. Pressure ulcers can be costly for the NHS, debilitating and painful for the patient. With basic and effective nursing care offered to the patients, this can often be the key to success. Bliss (2000) suggests that the majority of Grade I ulcers heal, or resolve without breaking down if pressure relief is put into place immediately. However, experiences in a clinical settings supports observations, that non-blanching erythema can often result in irreversible damage (James, 1998; Dailey, 1992). McGough (1999) during a literature search, highlighted 40 pressure ulcer risk assessment tools, but not all have be considered suitable, or reliable for all clinical environments. As there are many different patient groups this often results in a wide spectrum of different patient needs. The three most commonly used tools in the United Kingdom (U.K.) are, The Norton scale, The Braden Scale and The Waterlow Scale. The first pressure ulcer risk assessment tool was the Norton scale. It was devised by Doreen Norton in 1962. The tool was used for estimating a patients risk for developing pressure ulcers by giving the patient a rating from 1 to 4 on five different factors. A patients with a score of 14 or more, was identified as being at high risk. Initially, this tool was aimed at elderly patients and there is little evidence from research gathered over the years, to support its use outside of an elderly care setting. Due to increased research over the years, concerning the identification and risk of developing pressure ulcers, a modified version of the Norton scale was created in 1987. The Braden Scale was created in the mid 1980s, in America and based on a conceptual schema of aetiological factors. Tissue tolerance and pressure where identified, as being significant factors in pressure ulcer development. However, the validity of the Braden Scale is not considered to be high in all clinical areas (Capobianco and McDonald, 1996). However, EPAUP (2003) state The Braden Risk Assessment Scale is considered by many, to be the most valid and reliable scoring system for a wide age range of patients. The Waterlow Scale, first devised in 1987, identifies more risk factors than the Braden and the Norton Scale. However, even though it is used widely across the U.K., it has still be criticised for its ability to over predict risk and ultimately result in the misuse of resources (Edwards 1995; McGough, 1999). Although there are various tools, which have been developed to identify a patients individual risk, of developing pressure sores. The majority of scales have been developed, based on ad hoc opinions, of the importance of possible risk factors, according to the Effective Healthcare Bulletins (EHCB, 1995). Franks et al, 2003; Nixon and Mc Gough, 2001, challenged the predictive validity of these tools, suggesting they may over predict the risk, cause expensive cost implications, as preventative equipment is put in place, when it may not always be necessary. Or they may under predict risk, so a patient maybe assessed as not being at high risk, develops a pressure ulcer. Although the Waterlow scoring system, now includes more objective measurements such as Body Mass Index (BMI) and weight loss after a recent update. It is still unknown, due to no published information, whether the reliability of the waterlow tool, has improved since the changes that took place. It has been recognised, as a fundamental flaw of these tools and due to this clinical judgement, must always be taken into consideration alongside the results that have been measure, from the use of the risk assessment. This is clearly recognised by NICE, as they advise their use as an aide-mà ©moire (2001). The aim of Pressure ulcer risk assessment tools, is to measure and quantify pressure ulcer risk. To determine the quality of these measurements the evaluation of validity and reliability would usually take place. The validity and reliability limitations, of pressure ulcer risk tools are widely acknowledged. To overcome these problems, the solution that is recommended is to combine the scores of pressure ulcer risk tools, with clinical judgment (EPAUP 2009). This recommendation, which is often seen in the literature, unfortunately is inconsistent as Papanikolaou et al (2007) states: If pressure ulcer risk assessment tools have such limitations, what contribution can they make to our confidence in clinical judgment, other than prompting us about the items, which should be considered when making such judgments?. Investigations of the validity and reliability, of pressure ulcer risk tools are important, in evaluating the quality, but they are not sufficient to judge their clinical value. In the research of pressure ulcer tools, there have been few attempts made to compare, the different pressure ulcer risk assessment strategies. Referring to literature until 2003, Pancorbo Hidalgo et al (2006) identified three studies, investigating the Norton scale compared to clinical judgment and the impact on pressure ulcer incidence. From these studies, it was concluded that there was no evidence, that the risk of pressure ulcer incidence was reduced by the use of the risk assessment tools. The Cochrane review (2008), set out to determine, whether the use of pressure ulcer risk assessment , in all health care settings , reduced the incidence of pressure ulcers. As no studies met the criteria, the authors have been unable to answer the review question. At present there is only weak evidence to support the validity, of pressure ulcer risk assessment scale tools and obtained scores contain varying amounts of measurement error. To improve our clinical practise, it is suggested that although tools such as the Waterlow Scale are used to distinguish a patients pressure ulcer risk, other investigations and tests, may need to be carried out to ensure a effective assessment is taking place. Practitioners may consider, various blood tests and more in depth history taking, including previous pressure damage and medications. Patients lifestyle and diet should also be taken into consideration and where appropriate, a nutritional assessment should be done if recent weight loss, or reduced appetite is evident. Nutritional assessment and screening tools are being used more readily and appear to be becoming more relevant in managing patients who are at risk of or have a pressure ulcer. The assessment tools should be reliable and valid, and as discussed previously with other risk assessment tools they should not replace clinical judgement. However, the use of nutritional assessment tools can help to bring the nutritional status of the patient to the attention of the practitioner, they should then consider nutrition when assessing the patients vulnerability to pressure ulcer development. The nutritional status of the patient should be updated and re-assessed at regular intervals following a assessment plan which is individual to the patient and includes an evaluation date. The condition of the individual will then allow the practitioner to decide how frequent the assessments will occur. The EPUAP (2003) recommends that as a minimum, assessment of nutritional status should include regu lar weighing of patients, skin assessment, documentation of food and fluid intake. As Mrs A currently has a balanced diet, it is not felt necessary to undertake, a nutritional assessment at this point. Her weight can be updated on each review visit, to assess any weight loss during each visit. If there is any deterioration in her condition, an assessment can be done when required. Continence should also be taken into consideration and where necessary a continence assessment should take place. Incontinence and pressure ulcers are common and often occur together. Patients who are incontinent are generally more likely to have difficulties with their mobility and elderly, both of which have a strong association with the development of pressure ulcers (Lyder, 2003).   The education of staff, surrounding pressure ulcer management and prevention, is also very important. NICE (2001) suggest, that all health care professionals, should receive relevant training and education, in pressure ulcer risk assessment and prevention. The information, skills and knowledge, gained from these training sessions, should then be cascaded down, to other members of the team. The training and education sessions, which are provided by the trust, are expected to cover a number of topics. These should include, risk factors for pressure ulcer development, skin assessment, and the selection of pressure equipment. Staff are also updated on policies, guidelines and the latest patient educational information (NICE 2001). Education of the patient, carers and family, is essential in order to achieve optimum pressure area care. Mrs A is encouraged to mobilise regularly, in order to relieve the pressure as a Grade 1 pressure sore has been identified, she is at a significant risk of developing a more severe ulcer. Interventions to prevent deterioration, are crucial at this point. It is thought, that this could prevent the pressure sore from developing into a Grade 2 or worse. NICE (2001) have suggested, that individuals vulnerable to or at elevated risk of developing pressure ulcers, who are able and willing, should be informed and educated about the risk assessment and resulting prevention strategies. NICE have devised a booklet for patients and relatives, called Pressure Ulcers Prevention and Treatment (NICE Clinical Guidance 29), which gives information and guidance on the treatment of pressure ulcers. It encourages patients to check their skin and change their position regularly. As a part of good practise, this booklet is given to Mrs A at the time of assessment, in order for her to develop some understanding of her pressure sore. This booklet is also given to the care givers or relatives so they can also gain understanding, regarding the care and prevention, of her pressure ulcer. An essential part of nursing documentation, is care planning. It demonstrates the care, that the individual patient requires and can be used to include patients and carers or relatives in the patients care. Involvement of the patient and their relative, or carer is advisable, as this could be invaluable, to the nurse planning the patients care. The National Health Service Modernisation Agency (NHSMA 2005) states clearly that person centred care is vital and that care planning involves negotiation, discussion and shared decision making, between the nurse and the patient. There were a number of improvements that I feel could have been made to the holistic care of Mrs A. I feel that one of the fundamental factors that needed to be considered , were the social needs of the patient. As I feel they are a large contributing factor, towards why the patient may have developed her pressure sore. The patient was previously known to be a very sociable lady, who gradually lost her confidence, resulting in her not leaving the house. There are various schemes and services available, which are provided by the local council or volunteer services, to enable the elderly or people unable to get around. For example, an option which could of been suggested to Mrs A are services such as Ring and Ride, or Werneth Communicare. Using these services or being involved in these types of schemes, may have empowered Mrs A to leave the house on a more regular basis. This would enable her to build up the confidence, she lost following her fall. This would have also lead to positive impact on the patients psychological care, as Mrs A would have been able to overcome her fears of leaving the house, enabling her to see friends and gain communications lost. As previously mentioned in this assignment, although Mrs A had a score of 9, which is not considered an at risk score. I still felt it necessary to act on this score, even though the wound was a not considered to be critical. If it is felt the patient is at a higher risk than that shown on the assessment tool, the practitioner should use their clinical judgement, to make crucial care decisions. It should also be considered, by the practitioner that risk assessment tools such as The Waterlow scale, may not have been developed, for their area of practise. Throughout the duration of Mrs As wound healing process, a holistic assessment of her pressure areas and general health assessment were carried and all relevant factors, were taken into consideration. The assessment tool used to assess her pressure areas, is th e most common tool used currently in practise and the tool recommended by the Trust. To conclude, there is evidence to prove that pressure ulcer risk assessment tools are useful, when used as a guide for the procurement of equipment. However, they cannot be relied upon solely to provide holistic care to a patient. It has been highlighted, that to ensure a holistic assessment of patients, it is necessary to complete a variety of assessments, to create a complete picture. Although The Waterlow scale covers a number of factors that need to be considered, throughout the assessment, it has become evident that the at risk score, can often be over or under scored depending on the practitioner. Clinical judgement has proved to be, a very important aspect of pressure ulcer prevention and treatment. The education of the patient, carer and relatives has also been highlighted, as an important aspect of care. Empowering the patient with information regarding their illness, may decrease the healing time and help prevent has further issues.

SURREALISM AND T.S. ELIOT :: essays research papers

Surrealism is a dangerous word to use about the poet, playwright and critic T.S. Eliot, and certainly with his first major work, "The Love Song of J. Alfred Prufrock ". Eliot wrote the poem, after all, years before Andre Breton and his compatriots began defining and practicing "surrealism" proper. Andre Breton published his first "Manifesto of Surrealism" in 1924, seven years after Eliot's publication of "The Love Song of J. Alfred Prufrock". It was this manifesto which defined the movement in philosophical and psychological terms. Moreover, Eliot would later show indifference, incomprehension and at times hostility toward surrealism and its precursor Dada. Eliot's favourites among his French contemporaries weren't surrealists, but were rather the figures of St. John Perse and Paul Verlaine, among others. This does not mean Eliot had nothing in common with surrealist poetry, but the facts that both Eliot and the Surrealists owed much to Charles Baudelaire's can perhaps best explain any similarity "strangely evocative explorations of the symbolic suggestions of objects and images." Its unusual, sometimes startling juxtapositions often characterize surrealism, by which it tries to transcend logic and habitual thinking, to reveal deeper levels of meaning and of unconscious associations. Although scholars might not classify Eliot as a Surrealist, the surreal landscape, defined as "an attempt to express the workings of the subconscious mind by images without order, as in a dream " is exemplified in "The Love Song of J. Alfred Prufrock." "Prufrock presents a symbolic landscape where the meaning emerges from the mutual interaction of the images, and that meaning is enlarged by echoes, often heroic," of other writers. The juxtapositions mentioned earlier are evident even at the poem's opening, which begins on a rather sombre note, with a nightmarish passage from Dante's Inferno. The main character, Guido de Montefeltro, confesses his sins to Dante, assuming that "none has ever returned alive from this depth"; this "depth" being Hell. As the reader has never experienced death and the passage through the Underworld, he must rely on his own imagination (and/or subconscious) to place a proper reference onto this cryptic opening. Images of a landscape of fire and brimstone come to mind as do images of the two characters sharing a surprisingly casual conversation amid the chaos and the flame. The nightmarish theme continues as the reader explores the wet, cold and hostile streets of the city, a city which seems to many readers to be on the verge of reality, without ever crossing the line.

Funeral Cosmetic Surgery

Cynthia Grosse,Kunkel English 11 Beauty is your funeral Cosmetic surgery is defined as, â€Å"surgery performed to improve the appearance, rather than for medical reasons† (Collins English Dictionary). Cosmetic surgery is a dangerous procedure because some people acquire lifelong scars not only that, death could be in the equation. On the other hand, many women get cosmetic surgery due to physical deformation or certain birth defects in efforts to cover up their embarrassing scars.Even though some cosmetic surgery can be beneficial, the fact that death could be involved, is it worth it? Cosmetic surgery should be illegal because the number of death and deformation in the person’s character are too great to risk any possible enhancements. We should not be allowed to get plastic surgery, implants, and liposuction because these things cause a person to become sick and then eventually die. Therefore we should warn the person about the harm of cosmetic surgery is. According to Dr.Darshan Shah, a Mayo Clinic-trained board certified surgeon, â€Å"Cosmetic Surgery itself actually carries very minimal risk if you put yourself in the hands of a qualified, certified cosmetic surgery specialist – someone who has trained and devoted [his or his] career to the misrepresentation and inexperience of certain surgeons†. (California Health and Beauty) This article is saying that people are dying because there not looking up facts and information about the surgeon, but how much is of this idea is true?I believe no matter who performs the surgery; it’s always dangerous and has many life threatening consequences. Whether or not the surgeon is ‘’good’’ or ‘’bad’’ the procedures should not be done and are unethical. First of all, cosmetic surgery costs a great deal of money. Breast augmentations are 3,797$, Tummy Tucks are,332$, Butt Lifts are $7,904, Collagen Injections are $673 and Eyelid surge ry is $2,912, To me no amount of money is worth risking your life for. Not only that, I believe that people are beautiful the way they are, and that they don’t need surgery to boost their self esteem.Individuals seek to conform to the social norm, and it’s apparent that they will go to any cost to make that happen. When comes to unethical issues such as transgender cosmetic surgery, no it should not be allowed. In Fact, when they get these procedures they can die from anesthesia. In conclusion, when come to cosmetic surgery its dangerous overall even though you’re getting medical reasons or even though you get Butt Lift or Tummy Tuck or Collagen injection , Overall cosmetic surgery is a dangerous ,harmful procedure that should be banned.