Origins for the Treatment for Tuberculosis Essay -- Biology Medical Bi

Origins for the Treatment for Tuberculosis Abstract Tuberculosis, also known as Mycobacterium tuberculosis, is a deadly bacterium that invades the respiratory system. This bacterium spreads rapidly from person to person by a simple cough or sneeze. Treatment for tuberculosis has changed over the years. In the beginning the most common form of treatment was the sanatorium, where patients infected with Tuberculosis were kept in an isolated environment. Now a days the treatment is straightforward and the patient is put on two standard antibiotics, isoniazid and rifampicin. These drugs are very effective at fighting tuberculosis, but recently a new strand has been developed, multi-drug resistant tuberculosis. This paper outlines the various treatments for tuberculosis from the beginning of the 16th century to the present and the changes that have occurred in the bacteria. Tuberculosis, often called TB, has been recognized as a dangerous illness for quite sometime. Although its incidence has greatly declined during most of the last century, there has been a significant increase over the last twenty years. The recent incidence rate has been relatively high among the homeless in inner city areas and among those infected with the AIDS virus. TB also remains a severe health issue for infants and the elderly. While the disease continues to be a source of concern among the more populated and less hygienic areas in Asia, it is also prevalent in certain areas of this country where it has been linked with the arrival of refugees from Asia and Central America. Tuberculosis is primarily a bacterial infection of the respiratory system. If bacteria, viruses, or fungi enter the lungs and become established there, they could cause several dise... ...he benefits that medical technology has brought to society over centuries as well as an awareness that the fight against bacteria is by no means over. The recognition that there are several forms of drug-resistant bacteria today should propel future generations to rededicate efforts to eradicate them. Further research and observations should be made in order to help suppress deadly strands of tuberculosis. TB Treatment 6 References: Carlomagno, Cathy. (April 2005). 100 years of Progress in Tuberculosis Treatment. www.medicalnewstoday.com/medicalnews.htm Davies, Peter. March 1999. Multi Drug Resistant Tuberculosis "http://www.priory.com/cmol/TBMultid.htm" Larson, David. (1996). Mayo Clinic Family Health Book. New York: William Morrow & Company. Padilla, M. (2005). Tuberculosis. Encarta. 7-27-05: http://encarta.msn.com/encyclopedia_761576449/tuberculosis/html.

Analysis of Dis Poetry by Benjamin Zephaniah Download this essay Print Save Essay

In ‘Dis Poetry’, Zephaniah portrays many ideas about his opinion on poetry, and he also portrays his personal experience with poetry, and how poetry affects him as a person. Through his poem, he aims to break many of the stereotypes surrounding poetry, and how it should be something that is accessible to all, rather than just the elite or well-read One of the main ideas that Zephaniah portrays in this poem is that poem is all about ‘freedom of expression’, and that it is meant for everyone. He initially writes how ‘dis poetry is not Party Political’, which could be used to suggest that poetry is not meant to affect the real world, and should be taken too seriously, but is instead simply something that everyone can enjoy. The fact that he writes ‘I’ve tried Shakespeare, but dis is de stuff I like’ goes to show how people should not be confined to specific types of poetry, or forced to respect poetry from history, but instead that everyone should be allowed to enjoy whatever form of poetry pleases them. Zephaniah also writes how ‘dis poetry is fer de wise an foolish’, which further illustrates his point that poetry should be accessible to all. He also writes how ‘anybody can do it fe free’ and that ‘dis poetry is fe yu an me’, further showcasing his views on how poetry should be widespread and accessible. He ends the poem with the phrase ‘It goes to yu WID LUV. This shows how Zephaniah believes uses this poem as a message, and the full stop after LUV could be used to emphasise this ‘LUV’, and show Zephaniah’s affection behind the message. Because Zephaniah believed in the need for multicultural acceptance, this poem could be used as a message to portray how everyone should be allowed to enjoy whatever poetry they like, not depending on their background, and this ‘LUV’ possibly is used to show Zephaniah’s love to these other cultures. Zephaniah also suggests that, in his opinion, poetry does not necessarily need to have any sort of structure or seriousness. He states how it is ‘not designed fe dose who are critical’, which is used to show that the poetry should just be accepted as it is instead of being over analysed and scrutinised. In addition, he states how ‘no big words [are] involved’ and that ‘pages of written words’ are ‘not needed’, showing that he believes that poetry is all about the meaning behind the words, as well as the ‘riddim’ rather than how it is presented or structured, and the fact that there are ‘no big words’ shows how poetry should be accessible to everyone, not just those who are well-read. Furthermore, the great use of enjambment in this poem, as well as the sections where it breaks out of structure during the ‘chant’, showcases Zephaniah’s beliefs that a strict structure is not required, and the fact that the message of the poem is still very evident shows how a poem does not need ‘long words’ and a ‘structure’ to convey a strong message. Zephaniah also portrays the way in which poetry is a way of life. He writes how it ‘is wid me when I gu to me bed’ and how ‘It gets into me dreadlocks’, showing how his life essentially revolves around poetry. Furthermore, he writes how ‘if I hav a problem de riddim gets it solved’, which shows how important poetry is to him, and how it plays an important role in his life. He also writes how he ‘chants in de morning, in de night and in de darkness’, suggesting that poetry is a part of his life throughout the entire day. The change in structure and rhyme during this part of the poem could also possibly be symbolic of how poetry takes over his mind and behaviour, and how this is essentially a ‘stream of consciousness’. This is further compounded upon through the way in which he states ‘when I am talking to meself in poetry I talk, showing how poetry is now part of his mind. However, alternatively, it could also be used negatively, and that Zephaniah’s emphasis on poetry has resulted in a change of his personality. Overall, Zephaniah uses this poem to some what break the stereotypes about poetry, that it is only meant for those who are wise, well-read and analytical, by instead portraying how it should be accessible to all, and it is unnecessary for poetry to be so serious.

A Frugal Life

Thesis: Three extreme types of penny-pinchers are the frequent couponer, the frugal shopper, and the freegan. Do you have more the month left after all your money is gone? For most people shopping is an ingrained and unavoidable way of life. We work, we spend, we trash and we buy again. It's a cycle that seems all but impossible avoid in today’s society. TS: For decades, shoppers clipped coupons from newspaper circulars and magazines Using coupons is one way that the frequent couponer tries to get more for their money.PS:There are many online sites that you can go to and clip and print free coupons. Coupon. com is just one of the many online companies that offer free printable coupons and digital mobile coupons. SSCouponing gradually declined as grocers started loyalty-card programs that compensated repeat shoppers with discounts. But during the recession in the past few years, the number of coupons redeemed rose 27%, from 2. 6 billion to 3. 3 billion in 2008, says Inmar Inc. , a coupon-processing agency. SS:It was estimated by Coupons. om that approximately half of the redeemed coupons in the United States originated from weekly supplements in Sunday papers. PS: Sunday newspapers have traditionally been the dominant distribution method for coupons. It was estimated by Coupons. com that approximately half of the redeemed coupons in the United States originated from weekly supplements in Sunday papers. SS:It is always a good idea to match coupons with a stores sale prices. This way the couponers can get more bang for their buck. SS:The frequent couponers also will go to the stores that double the manufacture coupon up to 50 cents off.Another good practice is to use one coupon multiple times usually up to four items on one coupon. SSSherri Jones of Calvert City, Ky. , says,† I try not to abuse these discounts. Recently, Ms. Jones, 36, took 50-cent coupons for meat seasonings to a number of supermarkets that were doubling the coupons' value. Because t he seasonings were already on sale for $1 each, Ms. Jones got them for nothing. CS:This practice will save a little money at stores. A little here and a little there will add up to big savings over time. TS: Frugal living is a little more intense way of watching where dollars go.PS:A frugal person will never pay retail prices on absolutely anything. They will always shop around for best deals either by looking through clearance bins or by looking through thrift shops. SS:Living a frugal life calls for a lifestyle change and a conscious awareness of spending and saving. Living on a tight budget and listening for â€Å"Old Abe to scream† is not for the faint of heart. SS: Extreme Couponing is a thrilling sport that combines savvy shopping skills with couponing in an attempt to buy to most groceries as possible while spending as little money as possible.PS:Another way the frugal person will save their hard earned money is to make and use homemade products like laundry detergent, and household cleaners. It does require certain know-how to make items for the home. SS:Frugal living is a great way to be easier on the environment by reusing as many things as possible. If someone needed a vase for flowers, which their kids picked from the neighbor’s yard, they could use a glass jar for the vase. SS:It does require certain know-how to make items for the home CS:it hobby time consumingTS:The word freegan is a combination of â€Å"free† — as in it is free because you found it in a dumpster — and â€Å"vegan,† Vegans are people who avoid products from animal sources or products tested on animals. Not all freegans are strict vegetarians. Although some would rather eat found meat; dairy and eggs than let good food and items go to waste. The freegan attempts to spend as little money as possible by scavenging instead of buying products. Freegans rescue furniture, clothes, household items and even food thrown away by others. PS:They rep air what they already own.By fixing what is broken, freegans reduce the need to buy another product. Freegans often darn their socks, or only buy secondhand clothing to reduce the consumerism. They also find brand new clothing behind stores in the trashcans. SS:They often barter their services for an item that they want or need. Just like Jim, who needed a tune-up on his lawnmower and asked the local lawnmower repair shop owner if he could trade mowing the shops grass for a month in return for his tune-up. The shop owner agreed. No money ever exchanged hands. SS:Freegans believe that housing is a right, not a privilege.They are mad that people freeze to death out on the streets while landlords, banks, and cities keep buildings boarded up and vacant. Freegan squatters are people who live in abandoned buildings, rent-free. PS: Freegans or â€Å"dumpster divers† believe that one man’s trash is another man’s treasure. SS:Most freegans practice urban foraging in larg e cities, such as New York City, with its density and wealth, where there is good food and it is plentiful. Freegans look for food in trash bins behind large restaurants, grocery stores, even schools.Dedicated freegans usually establish a routine by going to a set of dumpsters they visit weekly or even daily. Many learn when trash goes out and when dumpsters are unattended SS:Stores throw out large amounts of visually damaged goods like bruised fruit or crushed boxes. They also discard products that have reached their sell-by-date. Although sell-by dates provide a general idea of when food will go bad, they are not safety dates. Trash from grocery stores and restaurants is also different from that of the average residential trash because stores usually bag discarded food separately from other trash.CS: Although freeganism likely has roots in the hobo subculture from the Great Depression. It's not too surprising that people would eventually find a way to forage as a way of personal s ubsistence. Freeganism has spread around the world. They sometimes eat community dinners also known as potlucks made from scavenged food. As long as there is edible food and usable products in the trash, people will be there to pick up the waste. Extreme Couponing is an extreme sport that combines savvy shopping skills with couponing in an attempt to save as much money as possible while accumulating the most groceries.The grocery coupons you need are out there, you just need to connect with people who have them. Here are some Extreme Couponing techniques to help you save money: 1. Clip ALL the coupons from your weekly circulars and Sunday newspaper. It’s always a good policy to clip all coupons because an item may go on sale in the future and you can trade your coupons with other couponers for the ones you do want. 2. Study the weekly supermarket sales and compare this to your coupon inventory. 3. Know your supermarket’s coupon policy: a. Are expired coupons accepted? b. Can you use 10 coupons for 10 of the same items? . Can you stack a manufacturer coupon with a store coupon? d. Are there double and triple coupon days? e. Does your store accept competitor’s coupons? f. How are coupon overages applied to the final bill? These are the most frequently used techniques for reducing a grocery bill significantly and how some shoppers are even entitled to cash! Since supermarket policies are constantly changing, call before you shop and ask the questions above. Make sure you write down the name of the person at the supermarket who gave you the information. 4. The local Sunday newspaper is an excellent source for grocery coupons.Do not pay for electronic coupons. There are many websites that you can clip and print coupons for free. Janis an extreme couponer says that she uses a 3 ring binder with baseball card protector pockets and made dividers for approximately 35 categories. She buys multiple papers and hits up the local recycle bins to look fo r more circulars. She also exchanges with her mother and daughter. Janis said, â€Å"We all don’t use the same products. Therefore, it works well for us to trade coupons. † For decades, shoppers clipped coupons from newspaper circulars, magazines and coupon booklets.Couponing gradually declined as grocers launched loyalty-card programs that rewarded repeat shoppers with discounts. But amid the recession in the past few years, the number of coupons redeemed rose 27%, to 3. 3 billion from 2. 6 billion in 2008, says Inmar Inc. , a coupon-processing agent. The year-over-year percentage increase was the largest since Inmar started tracking the statistic more than 20 years ago. Fueling the increase isn't the general populace but heavy coupon users, people who redeem 104 or more coupons over six months, according to an August report by The Nielsen Co.These users tend to be females under the age of 54 with college degrees and household incomes above $70,000, Nielsen says. Hotc ouponworld. com, which has seen its membership grow to 200,000 from 80,000 in the past year, targets couponers who think â€Å"there's an economic value in buying all your peanut butter for the year in one week in September,† says site founder Julie Parrish, 35, of West Linn, Ore. Two years ago, she bought 50 18-ounce jars of Skippy creamy peanut butter for 17 cents each; last September, she paid 35 cents each. At retail, they cost around $3. 9. Ms. Smith, the Charleston woman whose closet doubles as a pantry, says she disliked grocery shopping until she got laid off last year from her clerical job and, to economize, turned to couponing Web sites. On two recent trips to her local supermarket, she says she paid $5 for $78 worth of items, and $2 for $40 worth of goods. Some supermarkets recently told analysts that shoppers with an eye for discounts were executing these coupons deals with surgical precision. Carrie Petersen of Columbia, Md. , says she tries not to abuse discount s. Recently, Ms.Petersen, 38, took 50-cent coupons for meat seasonings to a number of supermarkets that were doubling the coupons' value. Because the seasonings were already on sale for $1 each, Ms. Petersen got them for nothing. Extreme Couponing is an extreme sport that combines savvy shopping skills with couponing in an attempt to save as much money as possible while accumulating the most groceries. The grocery coupons you need are out there, you just need to connect with people who have them. Here are some Extreme Couponing techniques to help you save money: 5.Clip ALL the coupons from your weekly circulars and Sunday newspaper. It’s always a good policy to clip all coupons because an item may go on sale in the future and you can trade your coupons with other couponers for the ones you do want. 6. Study the weekly supermarket sales and compare this to your coupon inventory. 7. Know your supermarket’s coupon policy: g. Are expired coupons accepted? h. Can you use 10 coupons for 10 of the same items? i. Can you stack a manufacturer coupon with a store coupon? j. Are there double and triple coupon days? . Does your store accept competitor’s coupons? l. How are coupon overages applied to the final bill? These are the most frequently used techniques for reducing a grocery bill significantly and how some shoppers are even entitled to cash! Since supermarket policies are constantly changing, call before you shop and ask the questions above. Make sure you write down the name of the person at the supermarket who gave you the information. 8. The local Sunday newspaper is an excellent source for grocery coupons. Do not pay for electronic coupons.There are many websites that you can clip and print coupons for free. Janis an extreme couponer says that she uses a 3 ring binder with baseball card protector pockets and made dividers for approximately 35 categories. She buys multiple papers and hits up the local recycle bins to look for more circulars. She also exchanges with her mother and daughter. We all don’t use the same products. For decades, shoppers clipped coupons from newspaper circulars, magazines and coupon booklets. Couponing gradually declined as grocers launched loyalty-card programs that rewarded repeat shoppers with discounts.But amid the recession in the past few years, the number of coupons redeemed rose 27%, to 3. 3 billion from 2. 6 billion in 2008, says Inmar Inc. , a coupon-processing agent. The year-over-year percentage increase was the largest since Inmar started tracking the statistic more than 20 years ago. Fueling the increase isn't the general populace but heavy coupon users, people who redeem 104 or more coupons over six months, according to an August report by The Nielsen Co. These users tend to be females under the age of 54 with college degrees and household incomes above $70,000, Nielsen says. Hotcouponworld. om, which has seen its membership grow to 200,000 from 80,000 in the past year, t argets couponers who think â€Å"there's an economic value in buying all your peanut butter for the year in one week in September,† says site founder Julie Parrish, 35, of West Linn, Ore. Two years ago, she bought 50 18-ounce jars of Skippy creamy peanut butter for 17 cents each; last September, she paid 35 cents each. At retail, they cost around $3. 59. Ms. Smith, the Charleston woman whose closet doubles as a pantry, says she disliked grocery shopping until she got laid off last year from her clerical job and, to economize, turned to couponing Web sites.On two recent trips to her local supermarket, she says she paid $5 for $78 worth of items, and $2 for $40 worth of goods. Some supermarkets recently told analysts that shoppers with an eye for discounts were executing these coupons deals with surgical precision. Carrie Petersen of Columbia, Md. , says she tries not to abuse discounts. Recently, Ms. Petersen, 38, took 50-cent coupons for meat seasonings to a number of superma rkets that were doubling the coupons' value. Because the seasonings were already on sale for $1 each, Ms. Petersen got them for nothing.

Developing practitioner The WritePass Journal

Developing practitioner Introduction Developing practitioner IntroductionReflection in nursingConclusion ReferencesRelated Introduction Reflection has increasingly become an essential element of nursing professionalism. However, the term ‘reflection’ is not clearly defined in the literature and most definitions could be described as complex or vague (Atkins and Murphy 1993). Williams and Lowes (2001) define reflection as; ‘.a way of exploring and evaluating previous experiences and appreciating their value on personal practice and self.’ (pg. 1) Reflection is important to student nurses as it enables us to look at ourselves and our practice objectively. However, Mackintosh (1998), as well as other authors, are dubious that reflection can do all that it claims to do. What is agreed by nursing writers is that we can grow and mature as both a professional and a person by integrating our theory and knowledge into practice. The process of reflection can help move us from a student, to a nurse, and later to a competent and expert practitioner (Benner 1984). As nurses we should have the competencies to identify and respond to issues and make decisions that are informed and based on knowledge. All healthcare professionals make daily decisions that have ethical implications. Ethics for student nurses can be challenging as many of these decisions are emotive and students find these feelings hard to dismiss and difficult to rationalise (Clarke 2003). In their study, Ellis and Hartley (2001) found that student nurses expressed concerns over ethical problems and their ability to deal effectively with them. With the focus on a legal and ethical issue which I encountered whilst on clinical placement, I will reflect upon and critically analyse the issues raised in the incident using a recognised model of reflection. The model which I have chosen for this purpose is Borton’s Reflective Framework (1970, in Jasper 2003) which is increasingly being used by healthcare professionals as an approach for reflection. Jasper (2003) describes Borton’s model as simple and pragmatic, which meets the needs of practitioners to describe, make sense of and respond to situations. Howev er, the model has been criticised and Rolfe et al (2001) suggest it does not include the finer details of reflection and offers no prompts as to how reflection is to be conducted within each stage of the process. Even so, Rolfe et al (2001) do state that in comparison to Gibbs’s (1988, in Jasper 2003) and Johns (1998, in Johns 2005) models of reflection, it can be seen that the activity of reflection leads to action being taken in Borton’s framework, rather than just proposed, therefore moving from the realms of ‘maybe’ back into the reality of practice. The simplicity of the model and the proposal of action being taken in future situations prompted me to consider this model for this assignment purpose. Also, when reviewing the literature around reflective models, I found evidence by Burrows (1995) to suggest that nursing students under the age of 25 do not have the cognitive abilities and experience to reflect and alter their practice. Bulman and Schutz ( 2004) reiterate this perspective by implying that less mature students are more inclined to use more descriptive models such as Gibbs rather than more advanced, as these may not be of any use to them. As I would consider myself a mature student and want to develop my knowledge beyond that of a novice practitioner, taking into account the simple structure of the model as discussed, I feel that Borton’s Reflective Framework (1970) is an appropriate choice to use as a guide to my reflective account. The incident I have identified to reflect upon involves the refusal of further treatment by a patient who is terminally ill. With a view to gaining new knowledge, insights and to further develop as a nurse practitioner, I will reflect upon the ethical and legal issues that arose from this encounter. These include autonomy, beneficence, capacity and informed consent, as well as my own feelings and preconceptions. I will maintain confidentiality throughout this assignment by changing the names of those persons involved incompliance with the Nursing Midwifery Council (NMC) ‘Code’ (2008). Reflection in nursing Reflection is not just about adding to our knowledge; it is about challenging the concepts and theories as we try to make sense of that knowledge (Burton 2000). Kim (1999) argues that constructing knowledge from clinical practice is not enough and that nurses must also reflect on how that knowledge can lead to intentions to act. Several authors distinguish a gap between theory and practice in nursing (Conway 1994; Lauder 1994) and suggest that reflective practice may be the process with which to alleviate this. However, these authors do not support their claims with any evidence and are only offering opinion. The question still remains as to whether reflective practice produces better patient care as intended as there is very little research evidence on the benefits of reflective practice in nursing (Hargreaves 1997). Burton (2000) further reiterates this point by recognising that reflection relies entirely on information from patients and claims to be to their benefit, but is resear ched solely in the terms of the effects on practitioners. Reflective practice is also a fundamental concept of nurse education, with students encouraged to challenge their clinical practice and widen their knowledge base. However, Mackintosh (1998) stated that; ‘The implementation of reflection for students is as uncertain as its definition, with no guidelines or uniform method of application available.’(pg. 7) This criticism is evident in more recent literature, with Ireland (2008) and Hong and Chew (2008) both recognising that there are no definite guidelines on how to structure reflective practice in education. Writing reflective journals is one way reflective practice is encouraged in education as it allows students privacy and also to look back at previous entries to see how they have developed as nurse practitioners. However, Hargreaves (1997) suggests that reflective journals can be repetitive and time consuming, leading to boredom for the student. Hargreaves (1997) also proposes that when students are required to reflect in groups, this can lead to low self esteem as there is a lack of privacy. Also, when reflecting-on-action for assessment purposes, students may feel anxious about writing open and honest accounts in case of bad marks, leading to them writing what they think others want to hear and not the truth (Teekman 2000). When reflecting-on-action for this assignment purpose, I have been aware of these issues and this has encouraged me to reflect a true account of the incident, regardless of how difficult I may have found it to expose myself in such a way. Ethical issues relating to confidentiality also arise when reflecting, both for the person writing them and for the patient, as writing ‘stories’ about them without their consent can been seen as bad practice. However, Hargreaves (1997) argues that nurses have always ‘used’ patients and it is these experiences with patients that shape practice and it can be proposed that if a patient’s case is discussed but she has no knowledge then it can cause no harm and may actually benefit the patient directly or indirectly (Hargreaves 1997). Despite these criticisms, as opposed to giving care uncritically, reflection allows nurses to examine, question and learn from their experience and Andrews et al. (1998) recognise a danger of nursing care becoming ritualistic if it is not challenged. Using the three basic starting points in Borton’s Reflective Framework (1970) as a guide to the structure of my account, I am now going to reflect on the ethical and legal issue which I encountered recently whilst on clinical placement. What? It is important to recognise before recounting the incident, that as well as students being inclined to alter the scenario when reflecting-on-action as acknowledged, hindsight bias (Jones 1995) is also a concept by which a person’s recollection of events is influenced once they know the final outcome of the situation. Factors involved in hindsight bias are the desire to appear correct, maintain self esteem and to enhance feelings of competence (Jones 1995). Also stressful situations can affect attention and Saylor (1990) concluded in his study on recall, that for novice nurses and students in difficult interpersonal situations, such as topics on death, these are likely to cause stress resulting in less important issues being remembered. I had been involved in Mrs Jones’s care for a number of weeks and I was aware that she had returned from theatre the day before where she was to have had a secondary tumour removed. I was also aware, as was she, that she was terminally ill. I was in the room with Mrs Jones and her husband and we were chatting as I did her clinical observations. She was telling me that she was not afraid of dying and that she had been very lucky and had had a wonderful life. I felt very saddened by this and can clearly remember thinking to myself that I must remember what they told us in University about communicating with the dying patient, as I didn’t know what I was going to say once she finished speaking. In the end I decided that it was best if I say nothing rather than saying something inappropriate. This made me feel guilty at my own incompetence. The consultant then entered the room with my mentor and I asked my mentor if I should leave, but Mrs Jones insisted that I stay. The consultant then told Mrs Jones that they had been unable to remove the tumour. Mrs Jones nodded at this and said that she thought that would be the case. I suddenly felt out of my depth and wished I could just leave the room. The consultant continued by saying that he could offer Mrs Jones radiotherapy to try and shrink the tumour and prolong her life. He told her the side effects of the treatment, the frequency and also that it would not cure her, only ‘give her more time’. Mrs Jones stated that she did not want any more radiotherapy and just wanted to be pain free. I felt quite upset at this point and was trying not to make eye contact with anyone else in the room as I knew I would probably cry. The consultant continued by saying that although radiotherapy had side effects, it could add months to her life, and that there were options avai lable to help counter the side effects and that it might be worth considering. I remember thinking that Mrs Jones will probably decide on the radiotherapy if the doctor says it is the best thing to do, I couldn’t make sense of why she wouldn’t. Mrs Jones stated again that she did not want any further treatment, that she had discussed it with her family and that all she wanted was for her kids to see that she was happy, pain free and peaceful. Mrs Jones’ husband was crying at this point but told the consultant that they had talked about it and that he respected his wife’s decision and they would now like some time alone. At that the consultant, myself and my mentor left the room. The incident played on my mind immediately afterwards and although I wanted to talk with someone about it, I knew if I opened my mouth to speak I would cry so I busied myself with other things. So What? I had nursed Mrs Jones for a number of weeks and felt personally affected by her prognosis and her refusal of treatment to prolong her life. Mrs Jones was the same age as my own mother and had similar family dynamics to myself. I felt guilty that I could not offer some sort of comforting response when talking with her and during her interaction with the consultant. The feeling of guilt elevated as I felt inadequate to respond in what I felt was an appropriate manner. A study carried out by Kelly (1991) found that feelings of guilt are evident in students and appear more frequently as students gain experience. These findings are similar to those of Smith (1998) who concludes that guilt feelings in students are associated with a perceived inadequacy of personal responses and ethical dilemmas. The more experience gained, the more students felt fearful and guilty as they worry about what will be expected of them. I can relate to this evidence having worked in the health care setting for a number of years prior to starting my nurse training and now being in my second year, I have high expectations of myself and my practice. I feel that if I don’t match up to these expectations, and what I believe other people expect from me, I am letting myself and others down. Smith (1998) recognises that students develop coping mechanisms such as detachment and adopt these when they are in situations that are difficult for them. I tried to detach myself from the situation by not making eye contact or speaking as I felt out of my depth within the situation. Although detachment can be seen as a threat to the nurse-patient relationship, Smith (1998) concluded that some degree of detachment is necessary for students to maintain the ability to function and prevent breakdown. I adopted this coping mechanism to prevent myself from crying and upsetting the situation further, which appears to support the findings proposed by Smith. However in a study carried out by Kralik et al (1997) on patient’s experiences in hospital, the participants stated that, when cared for by nurses who appeared detached, it was a negative experience and they felt vulnerable and insecure. I am aware that if I allow detachment to become embedded within my future practice it may aff ect my ability to offer compassionate care to patients. Although I was aware of the knowledge around communication with the terminally ill, I was unable to reflect-in-action and apply this knowledge to practice. Schon (1983) describes reflection-in-action as the way that nurses think and theorise about practice whilst they are doing it. This is seen as an automatic activity that occurs subconsciously in practice. According to Street (1992), students experience difficulty connecting theory with the realities of practice. However, Street does suggest that there are indications that students are able to integrate theory gained in the classroom with practice, but at first it is deliberate and conscious. This evidence suggests that reflection-in-action is developed through experience. I felt upset that Mrs Jones did not want any further treatment and I kept thinking that if it was my own mother I would want her to stay alive as long as possible. I may have felt like this as I did not want to experience the grief that comes with death, which appears now to be a selfish act. The refusal of treatment with a view to end of life can sometimes be associated with voluntary euthanasia. This term involves the deliberate intervention or omission with the intent of ending an individual’s life at their request (Saunders and Chaloner 2007). Despite a Bill passing before parliament on assisted dying or assisted suicide, existing laws remain unchanged and euthanasia of any sort is illegal in the UK. However a person’s right to refuse treatment is legal in the UK and is supported in the NMC ‘Code’ (2008) which states; ‘You must respect and support peoples rights to accept or decline treatment and care’. Although the consultant was persistent in his offer of further treatment, he did not at any time disregard Mrs Jones’s decision to refuse treatment. UK law goes to great lengths to protect a person of full age and capacity from interference with personal liberty. In the case of Sidaway v Bethlem Royal Hospital (1985) it wa s stated that; ‘a capable adult has an absolute right to refuse to consent to medical treatment for any reason, rational or irrational, or for no reason at all, even where that decision may lead to their own death.’ (Lord Scarman 1985 pg. 3) This absolute right has been upheld in more recent cases such as Re T (adult: refusal of medical treatment) (1997) and Re B (adult: refusal of medical treatment) (2002). The courts also recognise that in law there is a distinction between letting die (refusal of treatment) and killing a person (euthanasia), even though this is not accepted by some philosophers (Dimond 2005). Saunders and Chaloner (2007) question whether there is a moral distinction between withholding life sustaining treatment at the patients request and actively taking steps to end the patient’s life at their request. However, a concept that is shared amongst UK law, literature and philosophers is the respect for a person’s autonomy. This makes me consider whether the consultant, despite his persistence, did not disregard Mrs Jones’s decision as he was respecting her right to be autonomous. Buka (2008) proposes that to be autonomous means to be able to choose for oneself and involves individuals being able to formulate and determine the course of their own life. Autonomy consists of values and beliefs that are unique to the individual and that change with circumstances, so what Mrs Jones considered to be of value to her prior to her illness could well have changed at the time of the incident. Also what Mrs Jones believed to be of value to her could very well be different to what I would consider to be of importance. Begley (2008) acknowledges that dying well involves living well until the end of life and living well throughout the dying process depends on the responses of each unique person to the conditions in which they find themselves. Mrs Jones spoke about wanting her kids to see she was happy, pain free and peaceful, which appeared to me to be her main priority. Mrs Jones also spoke about how she was not afraid to die and that she had had a wonderful life. In their study of patients with incurable cancer, Voogt et al. (2005) found that while approximately a third of the participants strove for length of life, a third wanted quality of life. Mrs Jones’s values and beliefs may have been intertwined with an autonomous decision to die with dignity. Radley and Payne (2009) suggest that when people refuse treatment later on they want to spend quality time with their family without the side effects of treatment. Tingle and Cribb (2007) also recognise that although medicine can now provide the means of staving off death, the cost to the individual may be too high. Some may not want to spend their last days or weeks attached to tubes and drips. Tingle and Cribb further reiterate their point by proposing that it needs to be recognised that even if the pain of those who are terminally ill can be controlled, what they may fear the most is the technology that potentially leads to a loss of self-respect and self esteem. The concept of dying with dig nity is supported in UK law, and Article 3 of the Human Rights Act (1998) states that ‘no-one shall be subjected to torture or inhuman or degrading treatment or punishment’, an article which can be used to support cases of withdrawal of treatment. An autonomous person is also defined by Beauchamp and Childress (2001) as an individual who has the capacity to make decisions for themselves, as well as being competent to evaluate and deliberate information in order to reflect their own life plan. Capacity in the law is defined as the ability to understand information and make a balanced decision (Griffith 2007). Capacity is a fundamental component of autonomy and the Mental Capacity Act’s (2005) starting point is the presumption that a person has the capacity to make decisions for themselves unless it can be shown that they are incapable. Mrs Jones had been involved in decisions to do with her care throughout her treatment and the consultant knew her well. However, Tingle and Cribb (2007) suggest that patients are not very good at saying when they don’t understand and Pellegrino (2004, in Harrison et al. 2008) found in his study that patients suffering from cancer are on a negative spiral of events which may diminish their clinical competence and result in feelings of ‘powerlessness’. This evidence could suggest that Mrs Jones may have felt that she did not have the power to not only make a competent decision, but to tell the consultant that she did not understand what he was saying. The decision of whether a person has capacity is to be made at the time of the decision making (MCA 2005) and Larcher (2005) acknowledges that clinical competence may fluctuate, depending on the circumstances and compounding factors such as pain. Mrs Jones had regular analgesia to control her pain and did not before, during or after the encounter make any complaints of discomfort. She had support from her husband and was familiar with her surroundings as well as the staff present in the room. All these factors indicate to me now that Mrs Jones had the capacity to evaluate and deliberate the information given to her and make a decision that reflected her own life plan. The main principle of the Mental Capacity Act (2005) stresses that a person’s right to autonomy must be respected and can be further supported by requiring steps to be taken to maximise decision making capacity. One of these steps is informed consent. The Mental Capacity Act (2005) states that information given must include the nature of the decision, the purpose for which it is needed and the likely effects of any decision made. The need to weigh the information as part of the process of making the decision has been described by the courts as; ‘The ability to weigh all relevant information in the balance as part of the process of making a decision and then use that information to arrive at a decision.’ (Re MB Caesarean section 1997, in Griffith 2007). The consultant gave Mrs Jones information about her prognosis and treatment in compliance with the Mental Capacity Act (2005) as well as other health care policies (DOH 2007; 2008). He disclosed the factual details such as the advantages and disadvantages of the treatment and the potential side effects of undertaking further radiotherapy. However questions still arise as to how much information needs to be disclosed to the patient before consent can truly be said to be informed. As a moral matter it has been suggested that you should disclose whatever information a reasonable person would want to know plus whatever further information the actual individual wants to know (Radley and Payne 2009). However, research carried out by Clarke (2003) does suggest that patients demonstrate poor levels of knowledge and comprehension, particularly where bad news has been given. When the consultant told Mrs Jones that they hadn’t been able to remove the tumour she had replied that she had t hought that might have been the case. This indicates to me that Mrs Jones had already taken the time to consider her options and the possibility that the tumour may not be removed, prior to the encounter with the consultant. Seymour (2001) proposes that the informed decision to refuse treatment may be about regaining control in a situation where there may be few desirable options. Radley and Payne (2009) suggest that the decision to refuse treatment, is not a rejection of medicine but a rejection of false hope or an acceptance of another sort of hope in which quality of life is preferred over quantity of life. Mrs Jones had undergone intensive treatment in the months leading up to this final prognosis and I now consider that the finality of this diagnosis may have given her not the opportunity to ‘give up’ but to spend quality time with her family without the side effects of a treatment which was not going to cure her. Therefore Mrs Jones was taking positive steps to safeguard the death she wanted. After Mrs Jones initially refused the treatment the consultant went on again to say that ‘it could add months to her life’. I thought at the time that Mrs Jones may take time to consider this again given that the consultant was to me the ‘expert’. From a medical viewpoint, death is seen as a failure, rather than as an important part of life (Smith 2000), so there may be a conflict when a patient chooses to make a decision that is likely to end in death. Physicians who are unable to keep patients alive may struggle to avoid experiencing an inevitable sense of failure (Clarke 2003) as it is widely accepted that medicine’s primary goal is to restore a person’s health (Heaney et al. 2007). By offering Mrs Jones a treatment to delay the inevitable the consultant was acting in a beneficent manner and tension can arise when beneficence and autonomy are in conflict. With advanced medicines today life can be sustained for longer periods, however Van Kle ffens et al (2004) found in their study that for the patients who refused the treatment, their decision was not based on the pros and cons of treatment from a medical perspective but a ‘circumstantial basis’. In a further study by Van Kleffens in 2005, the patients who decided not to accept further treatment said it was based on their own experiences, values and meanings in life. Voogt et al (2005) also proposed that physicians do not engage sufficiently with the world of the patient that extends outside of medicine. So although the consultant knew Mrs Jones well and had been involved in her care for many months, he had only been associated with her in the medical concept. Contemporary opinion suggests that where there is tension between autonomy and beneficence, autonomy should take precedence (Dimond 2005). Now What? Mrs Jones passed away how she wished, in hospital surrounded by her family. Consideration of the ethical and legal principles discussed required a depth of knowledge that I as a student did not hold for this particular situation which was to me personal, complex and difficult to define. From reflection on this incident I recognise now that I have gaps in interpreting theory into practice. Benner’s (1984) work proposes that nurses move from novice to expert as a result of both experiences and training. By analysing the situation with reference to theories and concepts, I have come to realise that only through experience, greater knowledge and confidence will these gaps begin to close. I now know that no one solution was correct nor was it incorrect. Nurses have a legal and moral duty to act in a beneficent way which at times may conflict with the autonomy of the patient. However, providing the patient is of age and has the capabilities to make informed and balanced decisions, in cases of conflict the law will favour autonomy over beneficence. I have come to appreciate that the patient is the only one who can decide what matters to them and what is good based on the information given and as a nurse I am in a position to recognise when patient autonomy is at risk of not being respected and help to restore it. This would then result in the principles of autonomy and beneficence working in partnership rather than in conflict, with the act of beneficence being the action that increases the autonomy of the patient. The process of reflection can bring up painful emotions again but if followed properly and supported appropriately, it can help the reflector to come to terms with their emotions and move on. I now know that the feelings I expressed were natural for a novice like me. Should this particular situation arise again I know I would be able to take this new knowledge with me but am unsure as to whether it would diminish my feelings of sadness, I am however confident that I could now put them to one side. Conclusion Reflection is an important aspect of nurse education and can assist student nurses in linking theory and practice and in developing self-awareness skills. Borton’s (1970 in Jasper 2003) reflective framework has assisted me in both reflecting on what was to me a difficult and personal experience and being able to structure an academic assignment based on it. Even though critics claim that Borton does not include the finer details of reflection or any guide as to how reflection is to be conducted within each stage of the process, I found that these omissions allowed me a wider scope and more freedom to analyse and challenge the situation and my own feelings. Had I used a model such as Gibbs (1988 in Jasper 2003), which consists of prompt questions, it may have restricted my reflection as I tried to answer the specific questions. I am aware of the negative elements of reflection but feel that by acknowledging these within my assignment I was able to conduct a reflection that was an honest and true account. The ethical and legal issues that arose in the incident were autonomy, beneficence, capacity and informed consent. All these issues are interlinked and have an impact on each other and I now understand that each must be considered both as individual components and together in order to gain an accurate perception of a situation and provide patient centred care. My professional knowledge and understanding of these issues and the importance of reflection in nursing has increased considerably by completing this reflective assignment. I understand that by reflecting on situations that occur within clinical practice I will gain new insights, knowledge and understanding therefore empowering me in my practice. This will enhance my nursing practice in future in variety of ways, in particular by assisting me in conti nuous professional development throughout my nursing career, as required by the NMC (2008). References ANDREWS, M.; GIDMAN, J., and HUMPHREYS, A., 1998. Reflection: does it enhance professional nursing practice? British Journal of Nursing 7, 413-417 ATKINS, S.; MURPHY, K., 1993. Reflection: a review of the literature. Journal of Advanced Nursing 18, 1188-1192 BEAUCHAMP, T.L.; CHILDRESS, J.F., 2001. Principles of Biomedical Ethics, 5th edition. Oxford: Oxford University Press BEGLEY, A.M., 2008. Guilty but Good: Defending voluntary active euthanasia from a virtue perspective. Nursing Ethics 15(4), 434-445 BENNER, P., 1984. From Novice to Expert. California: Addison-Wesley BORTON, T., 1970. Reach, Touch and Teach. London: Hodder Arnold cited in M. JASPER, 2003. Beginning Reflective Practice (Foundations in Nursing and Health Care). Cheltenham: Nelson Thomas LTD B, RE (adult: refusal of medical treatment).; 2002. 1 FLR 1090. Available from: bailii.org/ew/cases/EWHC/Fam/2002/429.html (Accessed 14th May 2011) BUKA, P., 2008. Patients’ Rights, Law and Ethics for Nurses: A practical guide. London: Hodder Arnold BULMAN, C.; SCHUTZ, S., 2004. Reflective Practice in Nursing, 3rd edition. Oxford: Blackwell Publishing LTD BURROWS, D., 1995. The nurse teacher’s role in the promotion of reflective practice. Nurse Education Today 15, 346-50 BURTON, A.J., 2000. Reflection: nursing’s practice and education panacea? Journal of Advanced Nursing 31(5) 1009-1017 CLARKE, J., 2003. Patient centred death. British Medical Journal 327, 174-175 CONWAY, J., 1994. Reflection, the art and science of nursing and the theory-practice gap. British Journal of Nursing 3, 114-118 DEPARTMENT OF HEALTH., 2007. Cancer reform strategy. London: Crown Publications DEPARTMENT OF HEALTH., 2008. End of life care strategy. London: Department of Health DIMOND, B., 2005. Legal Aspects of Nursing, 4th edition. London: Pearson Education Limited ELLIS, J.R.; HARTLEY, C.L., 2001. Nursing in today’s world: Challenges, Issues and Trends. Philadelphia: Lippincott GIBBS, G. (1988) Learning by Doing: A Guide to Teaching and Learning Methods. Oxford: Blackwell Publishing cited in M. JASPER, 2003. Beginning Reflective Practice (Foundations in Nursing and Health Care). Cheltenham: Nelson Thomas LTD GREAT BRITAIN. Human Rights Act 1998: Elizabeth ll. Chapter 42. 1998. London: The Stationery Office. Available from: legislation.gov.uk/ukpga/1998/42/contents (accessed on 14th May 2011) Great Britain. Mental Capacity Act 2005: Elizabeth II. Chapter 9. 2005 London: The Stationery Office. Available from: legislation.gov.uk/ukpga/2005/9/contents (Accessed on 15th May 2011) GRIFFITH, R., 2007. Making decisions for incapable adults 1: Capacity and best interest. British Journal of Community Nursing 11(3), 119-125 HARGREAVES, J., 1997. Using patients: exploring the ethical dimension of reflective practice in nurse education. Journal of Advanced Nursing 25, 223-228 HEANEY, M.; FOOT, C,. and FREEMAN, W., 2007. Ethical issues in withholding and withdrawing life-prolonging medical treatment in the IC U. Current Anaesthesia Critical Care 18, 5-6, 277-283 HONG, L.P.; CHEW, L., 2008. Reflective practice from the perspectives of the bachelor of nursing students in International Medical University (IMU). Singapore Nursing Journal 35(3), 5-6,8-10,12-15 JASPER, M., 2003. Beginning Reflective Practice (Foundations in Nursing and Health Care). Cheltenham: Nelson Thomas LTD JOHNS, C., 1998. Opening the Doors of Perception. Oxford: Blackwell Science cited in C. Johns and D. Freshwater, 2005 (eds), Transforming Nursing through Reflective Practice. Oxford: Blackwell Science JONES, P.R., 1995. Hindsight bias in reflective practice: An empirical investigation. Journal of Advanced Nursing 21, 783-788 KELLY, B., 1991. The professional values of English undergraduates. Journal of Advanced Nursing 16, 867-872 KIM, H.S., 1999. Critical Reflective inquiry for knowledge development in nursing practice. Journal of Advanced Nursing 29(5), 1205-12 KRALIK, D.; KOCH,T., and WOTTON K., 1997. Engagement and detachment: Understanding patients’ experiencing with nursing. Journal of Advanced Nursing 26(2), 399-407 LARCHER, V., 2005. Consent, competence and confidentiality. British Medical Journal 330, 7487, 353-356. LAUDER, W., 1994. Beyond reflection: practical wisdom and the practical syllogism. Nurse Education Today 14, 91-98 MACKINTOSH, C., 1998. Reflection: a flawed strategy for the nursing professional. Nurse Education Today 18, 553-7 MB, RE (Caesarean Section)., 1997. 2 F.L.R. 426 cited in R., Griffith., 2007. Making decisions for incapable adults 1: Capacity and best interest. British Journal of Community Nursing 11(3), 119-125 NURSING MIDWIFERY COUNCIL, 2008. The code: standards of conduct, performance and ethics for nurses and midwifes. London: NMC PELLEGRINO, E., 2004. Ethical considerations in head and neck cancer. California: Addison-Wesley cited in L, Harrison., R, Sessions., W, Hong., 2008 (eds). Head and Neck Cancer: A Multidisciplinary Approach, 2nd edition. Philadelphia: Lippincott Williams Wilkins RADLEY, A.; PAYNE, S.A., 2009. A sociological commentary on the refusal of treatment by patients with cancer. Mortality 14(4), 309-24 REID, B., 1993. ‘But we’re doing it already!’ Exploring a response to the concept of Reflective Practice in order to improve its facilitation. Nurse Education Today 13(4), 305-309 ROLFE, G.; FRESHWATER, D.; and JASPER, M., 2001. Critical Reflection for Nursing. Hampshire: Palgrave Macmillan SAUNDERS, K.; CHALONER, C., 2007. Voluntary euthanasia: ethical concepts and definitions. Nursing Standard 21(35) 41-44 SAYLOR, C.R., 1990. Reflection and professional education: art, science and competency. Nurse Educator 15(2), 8-11 SCHON, D., 1983. The Reflective Practitioner: How professionals think in action. London: Temple Smith SEYMOUR, J.R., 2001. Critical moments: death and dying in intensive care. Buckingham: Open University Press SIDAWAY V BETHLEM ROYAL HOSPITAL.; 1985. AC 871, 1985 1 All ER 643, 1985 2 WLR 480. Available from: bailii.org/uk/cases/UKHL/1985/1.html (Accessed 14th May 2011) SMITH, A., 1998. Learning about reflection. Journal of Advanced Nursing 28(4), 891-898 SMITH, R., 2000. A good death: an important aim for health services and for us all. British Medical Journal 320, 7228, 129-130 STREET, A.F., 1992. Inside nursing- A clinical ethnography of Clinical Nursing Practice. New York: Albany TEEKMAN, B., 2000. Exploring reflective thinking in nursing practice. Journal of Advanced Nursing 31(5), 1125-1135 TINGLE, J.; CRIBB, A., 2007. Nursing Law and Ethics, 3rd edition. Oxford: Blackwell Publishing LTD VAN KLEFFENS, T.; VAN BAARSEN, B., and VAN LEEUWEN, E., 2004. The medical practise of patient autonomy and cancer treatment refusals: a patients’ and physicians’ perspective. Social Science Medicine 58, 2325–2336 VAN KLEFFENS, T.; VAN LEEUWEN, E., 2005. Physicians’ evaluations of patients’ decisions to refuse oncological treatment. Journal of Medical Ethics 31, 131–136 VOOGT, E.; VAN DER HEIDE, A.; RIETJENS, J.A.C.; VAN LEEUWEN, A.F.; VISER, A.P.; VAN DER RIJT, C.C.D., 2005. Attitudes of patients with incurable cancer towards medical treatment in the last phase of life. Journal of Oncology 23, 2012-2019 WILLIAMS, G.R.; LOWES, L., 2001. Reflective practice. Reflection: Possible strategies to improve its use by qualified staff. British Journal of Nursing 10(22), 1482-8

Spaying and Neutering

Spaying and Neutering Spaying and Neutering Spaying and Neutering By Maeve Maddox A local public service announcement invites listeners to telephone for further information â€Å"about spay and neutering.† A Web search finds numerous examples of the verb spay joined with the participle form: This vet clinic in SW Portland offers low-cost spay and neutering for cats and dogs. Pet Spay and Neutering Program–Just Fix It [USDA] provides a list of programs in each state that provides low cost or free spay and neutering services for cats. Several institutions and organizations offer help for pet spay and neutering or low-cost service.   The present participle of the verb spay is spaying. The examples should read â€Å"spaying and neutering†: This vet clinic in SW Portland offers low-cost spaying and neutering for cats and dogs. Pet Spaying and Neutering Program–Just Fix It [USDA] provides a list of programs in each state that provides low cost or free spaying and neutering services for cats. Several institutions and organizations offer help for pet spaying and neutering or low-cost service.   An easy way to avoid misusing the word spay in announcements of this kind would be to use only the word neuter. Unlike spay, which refers to the removal of an animal’s ovaries, the word neuter can mean either â€Å"to castrate† or â€Å"to spay.†    The past and present participle forms of the verb spay are frequently mispronounced and misspelled: Incorrect: I got my cat spaded and she got [a] hernia from the stitches. Correct : I got my cat spayed and she got [a] hernia from the stitches. Incorrect: I am contemplating  spading  and declawing my kitten when she turns 6 months old.   Correct : I am contemplating  spaying and declawing my kitten when she turns 6 months old. The past tense forms of both verbs–neuter and spay–end in -ed: neutered and spayed. The words are pronounced [nyoo-terd] or [noo-terd]) and [spayd]. Speakers who mispronounce and misspell the word spayed as spaded are perhaps confused by the existence of the word spade [spayd], which functions as both noun and verb. The verb spade (to dig) has a past form in -ed: If you did not plow or  spade the  garden site in the fall, turn the  soil  in spring as soon as it is dry enough to work. The Alcotts thrived as Bronson  spaded the  earth for his acre of garden. An interesting etymological fact is that both words–spay and spade–derive from spatha, the Latin word for a broad-bladed sword. The verb spay entered English from French espeier, â€Å"to cut with a sword.† Its earliest meaning in English was â€Å"to kill a deer with a sword,† as in these directions in a 1425 hunting manual: â€Å"spay him [the deer] even behind the shoulder forward to the heart.† The same manual also uses spay to mean removing the ovaries of an animal. The word spay got its name from the cutting aspect of a sword, whereas the word spade got its name from a sword’s tapered shape. It may help to keep the words spay and spade apart by remembering that animals are spayed with delicate medical instruments having no resemblance to broad garden implements. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Expressions category, check our popular posts, or choose a related post below:100 Words for Facial ExpressionsHomonyms, Homophones, Homographs and HeteronymsPractice or Practise? Spaying and Neutering Spaying and Neutering Free Online Research Papers Rarely does one nod ones head in approval at the thought of surgically removing dogs or cats testicles. Removing the ovaries and uterus remains similarly unheralded except for when we clarify that we mean to chip away at the sexual organs of animals all for the sake of the expensive oriental rug that runs across the living room floor as luxuriously as a furry Fido or a purring Princess. Indeed in the back of our neighbors judgmental minds lurks the suspicion that we pet owners aim to spay our female animals or neuter our male creatures because of selfish human reasons. After all, not only may a female dog in heat ruin a rug, but also an intact dog is reportedly a threat to small children in the house. Granted, sparing one’s children is hardly deemed a selfish human desire, yet we still dismiss the fact that â€Å"the age of three is prime time for an intact male dog to be involved with a terrible tragedy, such as †¦ killing children† when we admit that â€Å"obviously, not all intact male dogs are aggressive child-killers† (Davis). In a fit of projection, we humans tend to personalize the medical matter of spaying and neutering, as if our own reproductive organs – let alone sex life and hunting skills – were on the line. But research shows that expert after expert believes that it is for the sake of the animal that we allow and perform these surgical procedures. Indeed, keeping an animal intact may be more selfish, for people who want to breed dogs or cats for show are typically those who oppose state-mandated neutering programs, which – together with educational programs- have been responsible for the fact that about 75 percent of d ogs and cats have been neutered or spayed (Woolf). With mostly competitive breeders and other extremists policing the privates of animals to keep them intact, a second look at the more humane reasons for these surgical procedures is certainly warranted. As the research shows, spaying and neutering are the single most effective methods of not only easing the strain on overpopulated shelters, but also for keeping cats and dogs healthy and safe. Overpopulation of cats and dogs lead to a burden on society. Animals reproduce at extremely high rates and may give birth to a large litter of newborns. Research Papers on Spaying and NeuteringGenetic EngineeringInfluences of Socio-Economic Status of Married MalesBook Review on The Autobiography of Malcolm XThe Spring and AutumnHip-Hop is ArtPersonal Experience with Teen PregnancyEffects of Television Violence on ChildrenCapital PunishmentResearch Process Part OneThe Effects of Illegal Immigration

Heat of Vaporization Example Problem

Heat of Vaporization Example Problem Heat of vaporization is the amount of heat energy required to change the state of a substance from a  liquid into  a vapor or gas. It is also known as enthalpy of vaporization, with units typically given in joules (J) or calories (cal). This example problem demonstrates how to calculate the amount of energy required to turn a sample of water to steam. Heat of Vaporization Problem What is the heat in joules required to convert 25 grams of water into steam? What is the heat in calories?Useful information: Heat of vaporization of water 2257 J/g 540 cal/g Note:  You wont be expected to know enthalpy or heat values; they will be given in a problem or can be looked up in a table. Solution You can solve this problem  using either joules or calories for heat. Part IUse the formula  q m ·ÃŽâ€Hvwhereq heat energym massΔHv heat of vaporizationq (25 g)x(2257 J/g)q 56425 JPart IIq m ·ÃŽâ€Hfq (25 g)x(540 cal/g)q 13500 cal Answer The amount of heat required to change 25 grams of water into steam is 56425 joules or 13500 calories. A related example illustrates how to calculate the energy when water changes from solid ice into steam.

The Sixties Cultural and Counter Cultural Movement Essay

The Sixties Cultural and Counter Cultural Movement - Essay Example The term was popularized by Theodore Roszak in his book The Making of a Counter Culture (published, in 1969), and remains with us today. Roszak was himself much influenced by Alan Watts, the Anglican priest with a deep interest in Asian thought and culture. Watts was hugely influential in the religious face of the 60s counter-culture. He Watts taught at the School of Asian Studies in San Francisco and was fascinated with Hinduism and especially Buddhism; and his many books, such as The Way of Zen (1957) and Psychotherapy East and West (1961), were widely available and read. Hehad been drawn to the Beat movement, which defiantly rejected organized religion as practiced in America at that time, and their appropriation of Asian thought is clearly seen in Jack Kerouac's autobiography, The Dharma Bums, dharma being a Hindu and Buddhist term for 'the teaching of right living.' Gary Snyder and Alan Ginsberg were other beat poets who came to California in the late fifties and became involved in Zen Buddhism as a result of Watt's teaching. The San Francisco's Zen Center was established in 1959 largely as a result of the influ ence of Watts' and a Japanese Buddhist scholar, Daisetz Suzuki, whose son later became the spiritual inspiration behind the growth of the center and the Zen community in the States. Watts used the term "cosmic consciousness" in his 1962 book, The Joyous Cosmology, to describe the high states of consciousness which a person can achieve with meditation and other spiritual practices. The term was eagerly taken up, but there is nothing new under the sun, and in this case, as Camille Paglia (2003) points out, Watts was simply recycling a term used by Richard Bucke in 1901, when he compared Asian and Western religious teachings by various leaders, including Buddha, Jesus, William Blake, and Walt Whitman, all of whom Bucke thought had attained spiritual enlightenment. The overlay of Eastern religions, Hinduism, and Buddhism, was accompanied by a deep and new interest in the beliefs and practices of the Native American religions. It was as if at least some of youth of western civilization had suddenly awakened from the dream of White supremacy. The University of California became the first in the nation to offer serious studies into the traditions of those that had been so brutally repressed over the previous century. The huge antiwar protests of 1967-1974 were always accompanied by huge masks, music and painted demonstrators reflecting the curious mixture revolutionary politics, ecstatic spiritual practices and free sex made possible by the newly developed contraceptive pill. The 60s counterculture was committed to political change, and to a truth about life outside religious and social institutions. The political movements of that era, of which the Vietnam War protests were only a part, had their roots in THE great liberation movement of the 60s, the civil rights movement, which was sparked by the Supreme Court's 1954 decision to declare segregation in public schools unconstitutional. The fact that ordained ministers like Martin Luther King,