Contrast in Conrads Heart of Darkness Essay Example for Free

Contrast in Conrads Heart of Darkness Essay Conrad uses contrast in his novel â€Å"Heart of Darkness†. Conrad would use contrast to convey meaning in his writing. Not only did contrast help convey meaning, but he also used it to show feelings. Of the many contrast in â€Å"Heart of Darkness† the difference of light and dark and the difference between the Thames River and the Congo River are the most obvious. The biggest contrast in â€Å"Heart of Darkness† is the difference between light and dark. London represents the light. London is in civilization, and if London represents the light, then civilization also has a big thing to do with light. The light represents everything that everyone has learned in their life, whether it was through experiences or through other peoples mistakes. On the other side there is the darkness. Africa is the main representation of darkness. Africa was uncivilized territory that everyone wanted to explore, but the darkness frightened people. Everything that happened in the darkness, â€Å"cannibals† and â€Å"savages† prowled the darkness, awaiting travelers. Africa is the heart of darkness. The contrast of the Thames River and the Congo River is also big in the story. The Thames is characterized as calm. Like the light the Thames represents good. The light from London makes sure the river is seen and nothing is cryptic about the river. On the other hand, the Congo is a dark, cryptic river. It is a place of evil. The contrast of these two rivers is the difference between the good and the evil, and light and dark. The Thames is peaceful and tranquil; it symbolizes light and civilization. The Congo is wild and barbaric; it symbolizes the dark and everything uncivilized and frightening.

Case Study On A Patient With Oesophagitis Nursing Essay

Case Study On A Patient With Oesophagitis Nursing Essay The patient was a female, age 89, with a BMI of 15.4 kg/m2 (underweight). Her presenting complaint was nausea and vomiting, bringing up coffee ground vomit, fatigue and loss of appetite since two days ago. Her past medical history included atrial fibrillation, paranoid psychosis and iron deficiency anaemia. She also had a cholestectomy done in year 2000. She was single and lived alone; she neither smoked nor drank. There was no relevant family history recorded for her case. On admission she was taking medication stated in Table 1 below. She was known to be allergic to ciprofloxacin. Table 1 Repeat medication taken on admission Drug Dose Digoxin 125 Â µg once daily Lisinopril 2.5 mg once in the morning Furosemide 40 mg once daily Clopidrogel 75 mg once daily Quetiapine fumarate 125 mg twice daily Tramadol hydrochloride 100 mg twice daily Codeine phosphate 60 mg one to be taken as required Paracetamol 500 mg four times daily Folic acid 5 mg once daily Ferrous fumarate 322 mg twice daily (Last prescription dated three months ago) Clinical data and diagnosis On admission, her temperature was 36.4Â °C, pulse was 83 beats per minute, and her blood pressure was 124/46 mmHg. Her Abbreviated Mental Test (AMT) score was 7 out of 10, indicating mild confusion. A full blood count, renal function test, liver function test, and an electrocardiogram (ECG) were carried out. Her liver function test came back normal. The ECG showed some ST depression, but the patient denied any chest discomfort. Her haemoglobin levels were low at 9 g/dl (11.5-16.5 g/dl), while platelets were low at 108109/l 150-400109/l). her plasma urea was elevated at 38.2 mmol/l (2.5-7.5 mmol/l), and her creatinine was 273 Â µmol/l (50-80 Â µmol/l for female). Her creatinine clearance was calculated to be 8.1 ml/min, which indicated severe renal impairment. The diagnosis was acute renal failure, and gastritis or peptic ulcer disease. Clinical progress On day 1, patient was dehydrated and had some upper abdominal discomfort (Dyspepsia). The plan was to stop tramadol, clopidogrel, lisinopril and furosemide, due to the coffee ground vomit and acute renal failure. Two units of RCC (Red cell concentrate) and IV fluids were given. A urinary catheter was used to monitor urine output. Patient was continued on ferrous fumarate and given gaviscon 10mls. Quetiapine fumarate was not given as it was not available. On day 3, patient was paranoid; as quetiapine fumarate was still not available, haloperidol 1 mg was given as an intramuscular injection according to the hospital guidelines. Her haemoglobin levels were back to normal (12 g/dl) and her creatinine clearance improved to 33.3 ml/min; measurements were taken again because the values were so different. The catheter was taken out, but she was to receive subcutaneous fluids hourly. Patient was passing black stools. She was given Peptac 10mls for abdominal discomfort and was scheduled for an endoscopy the next day. Quetiapine fumarate was given on day 4 and patient was taken off haloperidol. On day 6, the patients confusion was thought to be influenced by digoxin; levels were checked and found to be 1.1 Â µg/l (0.5-2.0 Â µg/l); however dose of digoxin was decreased to 62.5 Â µg. a rectum examination was conducted to make sure patient was not bleeding from the lower gastrointestinal tract. The gastroscopy report came back stating patient had grade D oesophagitis (Reflux oesophagitis), that is an extenxive mucosal breaks engaging at least 75% of oesophageal circumference. She was also found to have a large chronic duodenal ulcer, non-bleeding with visible vessels. The plan was to start the patient on IV proton-pump inhibitor (PPI, pantoprazole 8 mg/hr) for 72 hours, oral omeprazole 20 mg daily, and eradicate H. pylori if infection was present (CLO test). On day 9, the CLO test came back negative. Patient was taken off IV PPI and put onto oral PPI (Omeprazole 40 mg daily). A repeat endoscopy was scheduled for the week after. Disease Overview Prevalence Oesophagitis is the inflammation of the lining of the oesophagus, usually caused by irritation due to stomach acid reflux.1,2 It is included under the boarder term of gastro-oesophageal reflux disease (GORD), which also includes endoscopy-negative reflux disease.3 In the UK, there is a 28.7% prevalence of GORD, and the risk is found to increase with age, especially for those over 40 years of age. There is an estimated of over 50% of GORD patients between 45 and 60 years of age.4 About 25 to 40% of people with GORD are found to have oesophagitis on endoscopy.5 Pathophysiology, risk and diagnosis Acid reflux can occur because of incompetence of the lower oesophageal sphincter, a transient complete relaxation resulting from a failed swallow, that is, a swallow without the usual peristalsis wave (Found in 65% of patients). It can also be caused by a transient increase in intra-abdominal pressure (17% of patients), or a spontaneous free reflux due to the lower oesophageal sphincter having a low resting pressure (18% of patients).6 Possible risk factors for GORD are pregnancy, excess alcohol consumption, smoking and hiatus hernia. Obesity is thought to be a risk factor, as well as certain foods like onions, citrus fruits and coffee. Drugs that are thought to relax the lower oesophageal sphincter like calcium channel blockers are thought to play a role in promoting GORD. There is however very limited evidence to support these claims.4,5 It is now thought that more than 50% of GORD risk is genetic, as it is found that a first degree relative of a person with GORD is four times more at risk of getting the disease.4 Diagnosis of GORD is based mainly on the patients symptoms, predominantly acid regurgitation or heartburn.7 An endoscopy is usually the main diagnostic procedure done to confirm GORD. Pharmacological treatments and mechanisms of action The main drug used for this disease is a proton-pump inhibitor (PPI). PPIs are one of the most prescribed drugs for the treatment of acid-peptic diseases, including GORD and peptic ulcer disease.8,9 They are substituted 2-pyridyl methysulfinyl benzimidazoles, with pKa around 4, and have a very short plasma half life of one to two hours. They are weak bases that are lipophilic, which allows them to cross the membranes of the parietal cells easily. Once inside the parietal cells, where the pH value is less than 4, they protonate into the activated tetracyclic sulphenamide form of the drug and accumulate inside the cells. Here they form covalent bonds with the cysteine residues in the hydrogen/potassium adenosine triphosphatase (H+/K+ ATPase) enzymes, forming disulphide bonds, inhibiting the acid secretion activity of the pump irreversibly. Due to the covalent bonds, their duration of action exceeds their plasma half life. To resume acid production, the parietal cells must then generate , or activate, new proton pumps.8,9 Examples of PPIs are omeprazole, lansoprazole, pantoprazole, and rabeprazole, the last of which has a pKa of 5, and is activated at a broader range of pH compared to the other three, leading to a higher acid-suppression activity. The common side-effects of PPIs are nausea, diarrhoea, abdominal pain and headache. Diarrhea seems to occur because of a change in the gut flora brought about by the PPI, and appears to be age-related.8 PPIs, especially omeprazole, are known to alter the activity of cytochrome P in the liver, an important consideration for patients taking drugs with narrow therapeutic windows like warfarin and phenytoin. They also cause a prominent gastric pH increase, and are able to inhibit or decrease the absorption of weak bases that require acid for absorption, like iron salts, griseofulvin, and vitamin B12.8 Other drugs that may be used in this case are H2 receptor antagonists, which inhibit the secretion of acid by stopping histamine from binding to the H2 receptors on the parietal cells; and prokinetic drugs, usual examples like cisapride, metoclopramide and domperidone, which work by increasing the pressure of the lower oesophageal sphincter, and accelerating gastric emptying.10 Evidence for treatment of the condition The National Institute for Health and Clinical Excellence (NICE) guidelines state that, for the management of oesophagitis on endoscopy, patients are to be given full dose PPI for one to two months. If there is a response to the treatment, low dose PPI is given, probably on an as required basis. If there is no response, the dose of PPI is doubled for another month, before switching to low dose PPI. If there is no response to the doubled dose of PPI, treatment is then switched to a histamine H2 receptor antagonist or a prokinetic.11 Klinkenberg-Knol EC et al1 compared the effects of omeprazole and ranitidine in a randomised, double-blind, endoscopically-controlled trial done on patients with reflux oesophagitis. Omeprazole was given at a dose of 60 mg daily while ranitidine was given at 150 mg twice daily. The symptoms were evaluated before starting the trial, and at the second, fourth and eighth week. Endoscopy was done at the start of the trial, and repeated during week 4, with another after 8 weeks if there was an absence of healing at week 4. For patients taking omeprazole, 19 out of 25 patients improved from Grade 2 or 3 (erosions or ulcerations) to Grade 0 or 1 (erythema and friability)12 after 4 weeks; while for patients taking ranitidine 7 out of 26 showed similar improvement (P = 0.002). At week 8, corresponding improvement was shown in 22 out of 25 for the omeprazole group, and 10 out of 26 for the ranitidine group (P = 0.001). Omeprazole showed a significantly higher healing rate, which was reflected in a better improvement of reflux symptoms as well. Patients receiving omeprazole experienced a more profound and faster relief of heartburn, which was the most common symptom complained by the patients (P = 0.0001). After 2 weeks, 92% (23 out of 25 patients) of patients receiving omeprazole reported that their reflux symptoms were either gone or had improved, while only 65 % (17 out of 26) of the ranitidine group reported the same (P = 0.01). This study however, only showed the superiority of omeprazole over ranitidine in the short term treatment of reflux oesophagitis. Further studies were needed to evaluate the effects of omeprazole in long term management and at a lower dose. Havelund T et al12 performed a double blind study on patients with Grade 1, 2 and 3 reflux oesophagitis. Patients were allocated randomly in this study to a treatment with omeprazole (40 mg once daily), and ranitidine (150 twice daily), for a period of 12 weeks. It was found that patients treated with omeprazole had a faster response to the treatment than those taking ranitidine (P < 0.0001). For the omeprazole group, healing rates were reported at 4, 8 and 12 weeks to be 90%, 100% and 100% respectively for those with Grade 1 reflux oesophagitis. For Grade 2 and 3, corresponding healing rates were 70%, 85% amd 91%. While for the ranitidine group, healing rates were 55%, 79% and 88% for Grade 1, and 26%, 44% and 54% for Grade 2 and 3. This pointed to a superiority of omeprazole at a lower dose (40 mg) over ranitidine. Sandmark S et al13 did a similar study, but with an omeprazole dose of 20 mg daily. Healing of oesophagitis was targeted in this study to be a complete healing of all ul cerative and erosive lesions in the oesophagus. At 4 weeks, healing rates were shown to be 67% in the patients taking omeprazole and 31% in those taking ranitidine (P < 0.0001). Corresponding healing rates were 85% (Omeprazole group) and 50% (Ranitidine group) after 8 weeks (P < 0.0001). This was also reflected in a more profound and faster- improvement in reflux symptoms in the patients taking omeprazole (51% by the end of the first week compared to 27% for patients taking ranitidine). Robinson M et al14 conducted a study to compare, in patients with erosive oesophagitis the efficacy and tolerability of omeprazole at a dose of 20 mg daily to ranitidine at a dose of 150 mg twice daily together with a prokinetic drug metoclopramide at a dose of 10 mg four times daily. It was found that healing rates for omeprazole were significantly greater than that for ranitidine in combination with metoclopramide. Omeprazole also provided a more profound relief for patients with reflux symptoms. More side effects and treatment-related withdrawals were found among the patients allocated the ranitidine-metoclopramide combination. Omeprazole was thus found to be more effective and better tolerated. Iskedjian M and Einarson TR conducted a meta-analysis15 of the three drugs cisapride, omeprazole and ranitidine for GORD treatment. At 12 weeks, 95% of patients were cured in the omeprazole group (40 mg daily), 81% in the ranitidine group (600 mg daily), and approximately 60% in the cisapr ide group (40 mg daily). In mild GORD, healing rate was 56% for cisapride versus 38% for ranitidine, while healing rates for cisapride and omeprazole showed no significant difference. In severe GORD, the healing rate for cisapride was only a half of that of omeprazole (43% versus 87%), while showing no significant difference when compared to that of ranitidine (50%). Thus it was concluded that omeprazole is favoured for treating severe GORD, while cisapride may be that of mild GORD. Vigneri S et al16 compared 5 maintenance therapies after an initial treatment of omeprazole 40 mg daily for 1 to 2 months, and healing was confirmed by endoscopy. Patients were then randomly assigned 12 months of treatment in the 5 following groups: cisapride (10 mg three times daily), ranitidine (150 mg three times daily), omeprazole (20 mg daily), ranitidine and cisapride, or omeprazole and cisapride. At 12 months 54% of the cisapride group, 49% of the ranitidine group, 80% of the omeprazole group, 66% of the ranitidine-cisapride group, and 89% of the omeprazole-cisapride group were found to be in remission at 12 months of maintenance therapy. Omeprazole showed a significantly better efficacy than cisapride (P = 0.02), and ranitidine (P = 0.003). Ranitidine-cisapride combination therapy was found to show a more profound improvement than ranitidine alone (P = 0.05). Omeprazole-cisapride combination therapy showed better efficacy than cisapride (P = 0.003), ranitidine (P < 0.001), an d also ranitidine and cisapride combination therapy (P = 0.03). Omeprazole as monotherapy or in combination with cisapride is found to be more effective for maintenance therapy of reflux oesophagitis, compared to ranitidine or cisapride alone. Omeprazole in combination with cisapride shows more efficacy than ranitidine and cisapride. The effects of newer PPIs lansoprazole (30 mg daily), rabeprazole (20 mg daily) and pantoprazole (40 mg daily) were compared with that of omeprazole (20 mg daily), ranitidine (300mg daily) and placebo in randomised clinical trials brought together by Caro JJ et al.17 The healing rate ratios noted for the newer PPIs as well as omeprazole were as follow: lansoprazole 1.62; rabeprazole 1.36; pantoprazole 1.60; and omeprazole 1.58. There was a greater decrease in the heartburn symptoms in patients taking PPIs than those taking ranitidine (P < 0.002), as well as in the healing of ulcers (P < 0.05), and relapse (P < 0,01). Compared to placebo, the PPIs obtained a much more profound relief of reflux symptoms (P < 0.01), healing of ulcers (P < 0.001) and relapse (P < 0.006). From this study, it was found that there is not much difference between the newer PPIs and omeprazole when it comes to relief of reflux symptoms, ulcer healing and rate of relapse, while all PPIs are better than ranitidi ne and of course, placebo in terms of treatment for erosive oesophagitis. Kahrilas PJ et al18 compared esomeprazole and omeprazole efficacies in reflux oesophagitis patients. It was found that more patients (P < 0.05) on esomeprazole 40 mg and esmoprazole 20 mg were healed after 8 weeks of treatment compared to omeprazole (94.1% and 89.9% compared to 86.9%). Adverse effects were common in both treatments. Esomeprazole was found to have a greater efficacy compared to omeprazole in reflux oesophagitis and both have a similar tolerability profile. Rohss K et al19 showed that esomeprazole at 40 mg daily had better acid control than omeprazole 40 mg daily. Since maintenance of intragastric pH > 4 is important for the effective management of GORD, the mean percentage of a 24 hour period with intragastric pH > 4 was taken as an indication of the efficacy of the treatments. Measurements were taken on day 1 and day 5, and on both days esomeprazole showed a greater mean percentage (P < 0.001) at 48.6% and 68.4% versus 40.6% and 62.0% for omeprazole. Wahlqvist P et al20 compared,from the perspective of the National Health Service (NHS),the cost effectiveness of the actue treatment of esomeprazole (40 mg daily) with omeprazole (20 mg daily) in reflux oesophagitis patients.It was estimated that, taking into consideration of the healing probabilities over 8 weeks, treatment with esomeprazole saves up toa total of 1290 pounds compared to treatment with omeprazole. Esomeprazole was found to provide a greater effectiveness at a lower cost. This is reflected in another study conducted by Plumb JM and Edwards SJ,21 which found that esomeprazole is cost effective in comparison to all other PPIs for the treatment of reflux oesophagitis. Conclusion The treatment given to this patient was appropriate in terms of the algorithms stated in the NICE guidelines; she was started on a full dose PPI after eosophagitis was confirmed on the endoscopy. As stated above, PPIs are proven to have superior effects in comparison with histamine H2 receptor antagonists and prokinetic drugs, both providing relief of reflux symptoms but not healing the oesophagitis itself.10 Among all the PPIs currently available, esomeprazole, the S-isomer of omeprazole, has been found to show more improvement than all other PPIs. Current studies have shown that the treatment of reflux oesophagitis with esomeprazole is more cost effective than treatments using any other PPI, providing a greater healing rate at a lower cost. Thus it might be in the interest of the NHS to treat this patient with esomeprazole than omeprazole. (2271 words)

History of Foreign and Security Policy

History of Foreign and Security Policy Defining Foreign and Security Policy from the Cold War to Present Today’s increasingly globalised community has seen more diplomatic and social evolution in the past half-century than the civilized world has seen in recent memory. The advent of multinational trade and military alliances such as the North Atlantic Trade Organization has increasingly intertwined security policies with foreign policies, which in turn entail more than just military alliances. Foreign subsidies by way of fiscal aid grants and weapons contracts warrant the need for nations to adopt solid, transparent foreign and security policies as the traditional global threat of warfare changes. The most notable examples for security and foreign policies as well as the need for a national and supranational governmental monitor are the United States and the European Union. The aforementioned two bodies share between them diplomatic ties to most every member of the international community. The onus of foreign and security policies becomes more apparent through examination of dipl omatically fragile and militarily-temperamental regions such as the Middle East, whose international agreements and regional alliances are the basis for subsequent American and EU policy, without which allies and trade partners would find little benefit from trade and security agreements. Foreign policy amounts to little more than a series of political guidelines and rules of engagement by which any country implementing it best gains at a certain point in time. Foreign policies are known to change radically from one year to the next; the Cold War is perhaps the greatest testament to the temporal nature of international relations and foreign policy. Robert John Myers notes in his US Foreign Policy in the Twenty-first Century how quickly Western countries changed their approach to the Soviet Union. Prior to 1945 â€Å"during the savage struggle of World War II, the primacy of the wisdom of political realism seemed to have been learned† by the Allies, who interlocked â€Å"inte rest, power, and morality in the councils of the principal Allied power†[1]; the USSR at the time was an indispensable ally against Germany and Japan. Much to the chagrin of their current political detractors, the Soviets were perhaps the most powerful ally America had in the war against the Axis powers, with borders spanning the heart of the Nazi regime and maritime waters bordering the Imperial Japanese. Foreign policy then had nothing to do with the civil liberties, democracy, and freedom of the press so touted today in the same countries that huddled together in opposition to Moscow during the Cold War. Prior to the partition of Germany at the close of the war, it was easily recognizable that â€Å"wartime cooperation to defeat the Axis was clearly important† and Allied foreign policy toward its Soviet contingent was one of camaraderie and mutual interdependence[2]. Once the war ended, however, the close ties between the powers dissipated and politically malignant a ntipathy filled the void. With a barely nascent United Nations absent as policy moderator, the US and the USSR led a series of proxy wars starting with â€Å"the attack by North Korea on South Korea on 25 June 1950,† marking â€Å"the limited cooperation [and mediation] that came to be expected from the UN in the security field†[3]. International mediation, which should have taken place given the alliance that transpired between the US, USSR, and Europe during WWII was all but gone in the years of reconstruction and the escalation of the Cold War. There are two points of speculation given the rise of the Cold War: the first is that the United Nations failed as an international mediator, and the second is that the United Nations was obsolete, serving only to keep other countries out of the periphery of the Soviet-American struggle for dominance. The difference between foreign and security policy during the Cold War was elementary. The American foreign policy toward the Soviet Union was one of mutual trade and sales, the development of which was speculated by many to be a financial insurance policy; if the two superpowers intertwined economically, the idea of armed struggle would be so financially devastating that neither side would be willing to continue along the path to war. American security policy was markedly different given the proxy wars fought in Korea, Vietnam, and the Middle East. Foreign policy essentially existed in the case of the Cold War to ensure that security policy would never be employed. The Cold War was a fascinating case of how foreign policy and security policy could run completely contrarian to each other. Any two given nations can foster amicable foreign policies in their approach to each other independent of a covertly hostile security policy as evidenced by the oft-shifting approach of successive American administrations to the Soviet behemoth. Jimmy Carter, for example, â€Å"forbade grain sales to the Soviet Union following the nation’s invasion of Afghanistan in 1979,† while â€Å"Ronald Reagan made the unpopular embargo an issue in the 1980 elections, reversing the policy after his election†[4]. The Reagan policy shift did not predicate a change in security policy, as the administration continued its support of Afghan mujahideen forces through arms sales and finance while continuing its agricultural trade with Moscow. It is now well-known that the UN was inconsequential in international mediation throughout the Cold War. This is not to say that an international or supranational regulatory body is not needed; in the case of the US and USSR, the absent (and perhaps powerless) UN was perceived as such because their collective power was dwarfed by the two superpowers. With no military or financial incentive, the question of the relevance of a supranational regulatory body in foreign and security policy is moot. Even today, American foreign policies often contravene UN resolutions with little or no repercussion due to the immense economic, political, and military might of Washington. While the Cold War ended relatively peacefully without UN intervention, the concept of an international body was not scorned by the US, which partnered with various countries to create the North Atlantic Trade Organization (NATO). It should be noted, however, that the US was an open advocate of NATO for the very reason tha t the UN was not potent enough a body to act on American will or on behalf of American aspirations. International mediation in this sense is needed for the monitoring of foreign and security policy; whether or not mediation will be effective in both sectors is quite another issue. Foreign policy can be monitored, policed, and even dictated by a supranational body as evidenced in the partition of Germany and the formation of the Eastern Bloc post-WWII. Security policy, however, is a point of major contention with any nation faced with the prospect of supranational control. Any nation with major investment (diplomatic or financial) abroad would be reluctant to cede jurisdiction of its own soldiers and sovereignty to an outside body, especially one such as the UN whose member list consists of nations antagonistic to one another. The irony here is that a multi-national group could have foreign and security policy power over a nation whose security policy is antagonistic to one or more members of the same international group. Israel, for example, would embark on an unprecedented leap of faith if it allowed the UN and its Arab members to mediate its security policy, all despite the fact that from the first years of its inception (1948-1967) the Jewish state relied o n the UN to justify its existence to the international community. The multi-faceted Arab-Israeli conflict is just one example of how unchecked world superpowers exerted their influence unchecked by the vigil of an international body. Prior to the fall of the Soviet Union, foreign policy was a much simpler venture as the world found itself functioning under the umbrella of just two superpowers, led by and acting under the auspices of either Washington or Moscow. The fall of Communism left a vacuum in the Middle East, as the now-extinct USSR had no allegiances to the Middle East in which it fought a series of proxy wars and conflicts with the United States. What transpired following the end of Moscow’s reign as a world superpower was the creation of several diplomatically independent states in the Middle East. Where Moscow once supported Syria, Egypt, and Iraq while arming said nations’ leaders, they found themselves increasingly dependent on other sources for trade and international subsidy such as the EU and the United States. The foreign policy then drove the security policy, baited by American and EU sponsorship acting independently of the UN. Today, Egypt, once the sworn enemy of Israel (whose cl osest international ally is Washington), receives America’s second-largest international aid package. This of course is contingent upon the maintenance of a lasting peace as well as other conditions detailed in the Camp David Accords of 1978. The UN and the EU’s parts in the conflict were minimal, as security policies of the two comprised of a minimal militaristic component and a far larger foreign policy component. Pinar Bilgin observes in Regional Security in the Middle East how the fragile Mediterranean â€Å"as an alternative spatial representation began to take shape from the 1970s onward largely in line with the development and changing security conception and practices of the European Union,† a group whose policies toward the region â€Å"have been shaped around three major concerns: energy security (understood as the sustained flow of oil and natural gas at reasonable prices); regional stability (understood as domestic stability especially in countries in geographically North Africa); and the cessation of the Israel/Palestine conflict†[5]. Unlike the US and USSR, whose motives will be examined later, the EU was interested solely in the protection of their economic preservation and the prevention of any armed conflict from spilling into their geographic vicinity. In addition to the Arab-Israeli crisis, EU Member States such as Italy, France, and Spain faced growing resentment in the Maghreb (Arab North Africa) as a corollary of imperial European rule. The EU’s policies were hence different from â€Å"non-EU actors [who] encouraged and supported the search for security within a Euro-Mediterranean framework†; the EU has almost â€Å"single-handedly sought to construct a Euro-Mediterranean Region to meet its own domestic economic, societal, and, to a much lesser extent, military security interests†[6]. The American and Soviet interest in the region was also one of economic, political, and security nature, bu t on a much larger scale. Buzan and Waever note in their Regions and Powers: The Structure of International Security how: â€Å"The United States and the Soviet Union were latecomers as major players in Middle Eastern regional security, though the former had long-standing oil interests there. The two superpowers were drawn into a pattern of regional turbulence that was already strongly active. Their interest in the region was heightened by the fact that, like Europe, the Middle East sat on the boundary between the spheres of communism and ‘free’ worlds. Stalin’s aggressive policy after 1945 had pushed Turkey and Iran into the arms of the West. Turkey became a member of NATO, and was thus fixed into the main European front of the Cold War. Until the Islamic Revolution in 1979, Iran fell increasingly under American sway, not only through corporate oil interests, but also as part of the loose alliance arrangements that connected American containment clients in Turkey, Iran, and Pakistan. To counter this US success right on its borders, the Soviet Union tried to play in the Arab world b ehind this front line, by establishing political and military links to the radical regimes and movements that sprang up in the Middle East during the 1950s and 1960s (Syria, PLO, Iraq, Egypt, Libya, Algeria, Yemen)†[7] The entire Middle East, ranging from Egypt to Iran, became what Buzan and Waever describe as a â€Å"third front in the Cold War, after Europe and Asia, and its oil resources tied it powerfully into the global economy†[8]. The Camp David Accords were especially important; while Israeli security policies remained virtually unchanged (the Israeli-Egyptian peace is frequently described as â€Å"cool† in comparison to Israeli-Turkish relations), their foreign policies shifted. The two acted under the auspices of the United States, signalling a significant achievement in the Cold War. Though the â€Å"crosscutting complexities of internal alignments in the Middle East† make it â€Å"difficult to trace a clear Cold War pattern of great power intervention,† the small gains and losses in war and political action were of huge consequence. With the 1978 signing of the Camp David Accords, the United States shifted its foreign policy in the Arab world successfully, sp litting allegiances in the Middle East to one drawn along Arab lines to one drawn along foreign policy lines. With Turkey and Iran (at least until Tehran’s 1979 Islamic Revolution) securely in the American camp, the Middle East was thus left only with Syria and Iraq in alliance with the USSR. Conflict in the Middle East was hence capitalized upon by the United States by way of foreign policy, which existed independently of the nations’ security policies. Foreign policies always shift more easily than security policies, as the former serve the interest of a nation’s economy and the latter are charged with the military protection of a nation’s sovereignty, diplomatic or otherwise. As evidenced by the Cold War, American policies in Iraq alone have shifted dramatically. Prior to 1979, for example, American foreign and security policies were in place to secure its interests (Saudi Arabia and Israel) from Baghdad. From 1979 to 1991, American foreign policies toward Iraq remained the same, but its security policies shifted to accommodate Iraqi military suppression of post-revolutionary Iran. From 1991 to 2003, both foreign and security policies shifted to those of aggression and financial seclusion. It should be noted that until 1991, these foreign policy shifts were executed at the whim of three American presidents. Iran followed the same path, with pre-1979 Tehran under Reza Shah Pahlavi serving as a vital blockage to Soviet expansionism. Following the Islamic Revolution of 1979, security policy was hostile toward and sought to exclude Tehran by funding Saddam Hussein. Foreign policy changed during the Contra Scandal, wherein American military leaders sold Tehran various munitions and weapons in direct subterfuge of Washington’s official military support of Baghdad; weapons were sold to a lesser evil (Iran) in order to fund covert operations in support of Nicaraguan right-wing guerrillas. Managua’s leftist-government was thought to be the latest expansion of Soviet influence and was hence a closer threat in physical proximity than the rise of the radical Islamic government of Tehran which was equally opposed to the Soviets at the time. All this transpired, again, without minimal monitoring by an international body. The greatest irony of the aforementioned events, however, is the perception of their respective successes and failures. America succeeded without international intervention in the pacification and dismantlement of the Soviet Union; however, today’s chaotic Middle East was a corollary, including the 9/11 attacks that changed forever the security and foreign policies of the United States. The current wars waged by America and what allies remain are again largely conducted without the support or monitoring by the UN or any other international body, and it remains to be seen how the future will unfold. BIBLIOGRAPHY Bilgin, Pinar. (2005) Regional Security in the Middle East: A Critical Perspective.London: Taylor Francis Routledge. Buzan, Barry and Ole Waever. (2003) Regions and Powers: The Structure ofInternational Security. Cambridge: Cambridge U P. Myers, Robert John. (1999) US Foreign Policy in the Twenty-first Century: TheRelevance of Realism. Baton Rouge: Louisiana State U P. Wilson, Ernest J. (2004) Diversity and US Foreign Policy: A Reader. New York:Taylor Francis Routledge. 1 Footnotes [1] Myers 1999, p. 98 [2] Ibid [3] Myers 1999, p. 98 [4] Wilson 2004, p. 127 [5] Bilgin 2005, p. 140 [6] Bilgin 2005, p. 140 [7] Buzan and Waever 2003, p. 198 [8] Buzan and Waever 2003, p. 197

The Bully Essay -- essays research papers

The Bully Violence in schools is an ongoing problem. Students verbally and mentally abuse each other on a daily basis. Verbal abuse is the most precedent. These students are usually titled as bully’s or having aggressive behavior. Girls have a tendency to indirectly bully, and boys have a tendency to physically bully other students. Bullying is a misbehavior that has to be resolved by looking at what is causing the behavior. It is not something that can be tolerated in schools, and classrooms. Bullying or aggressive behavior can be defined in many ways. The child pushes people around, may threaten other students, and can have a bad temper. Usually the student is extremely negative. Bullies perceive everyone is against them. They demean others and humiliate them in public eyes. They look for trouble and their parents may promote their behavior, including fighting. The teachers find that the students talk back to them, and these types of students often have learning disabilities. They are also usually loners with few friends, and if they have friends their the leader of the pack.   Ã‚  Ã‚  Ã‚  Ã‚  Bullying or aggressive behavior has many effects on the school-learning environment. Students are frightened by misbehaving bullies so it creates a situation were fear is present in the classroom. It is not fair that children feel uncomfortable, and confrontations occur. Class time is wasted, the learning stops, and class discussions or lectures are interrupted; bad e...

Comparing Jane Eyre and Wide Sargasso Sea Essay -- comparison compare

Comparing Jane Eyre and Wide Sargasso Sea Jean Rhys obviously had Charlotte Bronte's Jane Eyre in mind while writing Wide Sargasso Sea. Each novel contains events that echo other events or themes in the other. The destruction of Coulibri at the beginning of Wide Sargasso Sea reminds the reader of the fire at Thornfield towards the end of Jane Eyre. While each scene refers to events in its own book and clarifies events in its companion, one cannot conclude that Rhys simply reconstructed Thornfield's fall in Coulibri's. Though they exhibit some similarities, to directly compare these two scenes without considering their impact on the novels as whole works would be ridiculous. Each scene's main importance, and contribution to the overall intertextual meaning, lies elsewhere in the two works, not simply within the confines of the scenes themselves. The similarities between the two fire scenes might lead one to suspect that they are in some way parallel, yet their differences discount this oversimplified view. Both fires are set by arsonists described as insane. Bronte's Bertha is "the mad lady, who was as cunning as a witch" (Bronte 435). Rhys's Antoinette recalls "a horrible noise sprang up" from the attacking freedmen, "like animals howling, but worse" (Rhys 38). This madness, however, serves different purposes for each scene. Bronte uses madness to further degrade Bertha to the level of bestiality and insanity, a theme which she develops from the very moment the character is introduced until her fiery death in the destruction of Thornfield. By reducing Bertha to a single dimension, Bronte uses Bertha not as a character but as a tool with which to manipulate the flow of the plot. Rhys, however, uses madness toward a diffe... ...cott. "Fire and Eyre: Charlotte Bronte's War of Earthly Elements." The Brontes: A Collection of Critical Essays. Ed. Ian Gregor. Englewood Cliffs, NJ: Prentice Hall, 1970. 110-36. Macpherson, Pat. Reflecting on Jane Eyre. London: Routledge, 1989. McLaughlin, M.B. "Past or Future Mindscapes: Pictures in Jane Eyre." Victorian Newsletter 41 (1972): 22-24. Rhys, Jean. Wide Sargasso Sea. London: Penguin, 1968. Sarvan, Charles.  ¡Ã‚ §Flight, Entrapment, and Madness in Jean Rhys ¡Ã‚ ¦ Wide Sargasso Sea. ¡Ã‚ ¨ The International Fiction Review. Vol 26.1&2:1999:82-96. Solomon, Eric. "Jane Eyre: Fire and Water." College English 25 (1964): 215-217. Staley, F. Thomas. "Jean Rhys." Dictionary of Literary Biography, British Novelists, 1890 -1929: Modernists. Detroit: Gale, 1985. Wyndham, F. Introduction. Wide Sargasso Sea. By Jean Rhys. London: Penguin, 1996. 1-15.

Health promotion Essay

Health promotion is the art and science for helping people develop of their preferences between optimal health and their major passions. What motivate people to achieve optimal health, and what supporting then in lifestyle changing to movie forward to the optimal health. I strongly believe that optimal health is emotional balance, physical, spiritual, intellectual, and social health. Changing of lifestyle based on combination of increase motivation, learning experiences, build skills and creation of different opportunities that give us access to environment that provide positive health practice like the best choice. Moreover, health promotion is amount of information for individuals, communities, and family education. Health promotion is promotion of healthy lifestyle and healthy ideas and help people to achieved their best status of health. According to the definition of Health Promotion motivate people to take control over to improve their health. For health promotion we need to have support such as: create supportive environment for health and develop personal skills. Health promotion is the most important part of nursing care. Nurse plays important role in public health promoting. Focus for health promotion for nurses more point of disease prevention and changing lifestyle of individuals and their behavior. Moreover, that main purpose of health promotion in nursing is educate people and encourage them respect their health. Nursing role as health promoters is very complex, because of multi-disciplinary experience and knowledge of health promotion in nursing practice. Main idea of health promotion developed to improve community based practice according to the health policies. My idea is that healthcare professionals guide other people to the right health decisions. Nurses make people re-evaluate their health ideas and moreover we help not just for individual, we help even families, organizations, and communities. Nurses proved models toward health promotion and appraise how effective is evidence-based practice for the future researches. How are nursing roles and responsibilities evolving in health promotion? Nursing of public health practice is focused on population and  required a lot of different knowledge, skills and competencies. Nurse must have unique knowledge by focusing working in the community participation in health promotion and prevention. Nursing Role in primary care very important and can redesign of the primary nursing care system when patient is the center of the medical facility. All nursing field working for patient`s care such as: communication with the patients, visit patients at the home for their daily care. Many resources used for public health nursing practice and centered on improving health of population by prevention methods. Moreover, nurses are advocates and planning for the patients by multi level view of health. We know what our patients needs because we are at bedside and in the community. We take care of patients every day and every hour because nursing is 24 hour care. Nurses improve the health outcome for everybody in the community by applying their clinical skills and experience in health care. Health promotion is focusing on removing bad influences on health to developing healthy environment and supporting individuals and communities to take control and charge of their own health. Moreover, health promotion build on health education and help people prevent many illnesses and injuries by supporting right healthy behavior. Programs for health promotions include intervention such as lifestyle changing, smoking cessation and primary method of prevention. Unfortunately, people rarely change their behavior that’s why implementation methods must be started in community as a first step for global changes. Local health promotion will bring to the people right set of priorities which can support to promote health. Health Promotion has three levels: primary prevention, secondary prevention and tertiary prevention. The major one is to protect people from experiencing an injury and protect people from developing a disease. For example: education about quit smoking, the importance of exercise regularly, good nutrition , dangers of alcohol and other drugs. Regular screening tests to monitor risk for illness. Secondary prevention is intervention after disease or risk factor have already diagnosed. The goal is to catch disease in slow face or in earliest stage. As educators we have to tell people to take daily low dose of aspirin as a prevention of stroke or heart attack. We can recommend regular screening tests and exams in people who have risk  factors for diseases. Tertiary prevention more about helping people take care of long-term health problems such as diabetes, cancer, and heart attack. For example rehabilitation programs for stroke, support group chronic pain management programs for the patients. I am nurse in Rehabilitation Center and Long –term facility. I have seen every day how rehabilitation program help people to manage their new lifestyle and how to fight with their illnesses. Else in our facility we have support groups. People can discuss to each other about their health problems, their prognosis and future expectations. Moreover in that group people share with their own experiences and can provide right and helpful information for the patient who just was diagnosed and have a long way ahead to accept that new role in family and community. For a lot of health problems primary, secondary and tertiary interventions combination is necessary to achieve a right level of protection and prevention. For ideal world Primary prevention is the best but unfortunately in our modern busy world not all of us follow the best way. The main role here play limit of knowledge about causes of some particular injury or diseases. Although, primary and secondary prevention are clear in areas as heart disease and cancer, may be not that much useful for musculoskeletal illness. In that case prefer to have primary prevention then secondary and tertiary. I am wound care nurse in long term facility and I believing that primary prevention for pressure ulcers is the best way to promote health for all patients. Bed sores are not a disease process and preventive method must be on the first place. Elderly population has higher risk factors to have bed sores because of age, fragile skin, complicated disease, chronic disease. Prevention is the best way to keep such patients in a good level of health. Many resources now available to prevent pressure ulcers in the long-term facilities: Air mattresses, turning and reposition every two hours and as needed, incontinence care every two hours and as needed, skin barrier, Moreover, physical and occupation therapy intervention: schedule patients for out of bed daily, special cushion to prevent pressure ulcer from prolong sitting. All of that can promote health to geriatric population and make their lives longer and more comfortable. Else, in wound care preventive measures less cost than treatment. Money that is saved on treatment can be good resources for future researches of wound care field. Wound Care still needs new researches to promote healing. The  main reason of prevention in wound healing is sepsis which can lead to death of the patient. We have to take care about our patients and the best care is prevention method. By that we can save people lives and make them feel better and more comfortable in their diseases and injuries. Art of science of Health Promotion Conference  Michael P. O’Donnell (2009) Definition of Health Promotion 2.0: Embracing Passion, Enhancing Motivation, Recognizing Dynamic Balance, and Creating Opportunities. American Journal of Health Promotion: September/October 2009, Vol. 24, No. 1, pp. iv-iv. International Journal of Healthcare Management. Apr2014, Vol. 7 Issue 1, p53-59. 7p. DOI: 10.1179/2047971913Y.0000000058. , Database: Business Source Complete ASCs for the promotion of the wound healing of radiation ulcers via angiogenesis. †¦.. J Plast Reconstr Aesthet Surg 2010 JOURNAL OF WOUND CARE SORBION SUPPLEMENT 2010. http://www.jcn.co.uk/key-topics/wound-care/

Economics and Environmental Hazards Essay

In the 21st century, global warming, littering, waste, and temperature rises have been the subject of focus for many scientists. While examining the many causes of global warming, scientists found fossil fuel emissions and CO2 emissions to be a major cause. Although Earth is known as the Blue Planet for its vast water sources, much of that water is saltwater. Only 3% of the Earth is fresh water, and 70% of that is in glacial ice, unreachable by most. Thus, only 0. 5% of the Earth is made of usable freshwater. This limited amount of water is unsuitable for the world’s expanding population. Much of this water, however, can be easily conserved by switching from bottled water to tap water. Through using tap water and conserving plastic, we can save 27 times the amount of water we currently are saving, and use water sources wisely so as to not run out. Literature Review In the 1930s, the subjects of global warming, water, and lack of resources for fossil fuels became concern for Americans. The New York Times ran their first global warming article in 1929, when it first was considered a myth. Now that global warming has become a major concern for people, we realize how much we have wasted nature’s resources- especially water. Although 75% percent of the Earth is made up of water, less than 1% is drinkable and accessible by people. Countless blogs, websites, newspapers, and academic journals, such as the Journal of Dental Association (2003) and BioMed Central (2009), describe how our thoughtless actions have led to water depletion. Through processing, we waste 26 liters of water to get 1 liter of bottled water. The bottles are made in China using crude oil and transported thousands of miles on oil-eating machines, causing the ozone layer to melt. There are now seldom disputes to the existence of ozone depletion, and media uses print and internet to support the cutting down on bottled water. Bottled Water: Economics and Environmental Hazards. Thousands of years ago, water was a gift from the gods, to be saved and cherished. It allowed ancient civilizations to grow into structured societies, and gave people the ability to survive on domesticating animals and growing plants. Today, in the modern world, water is often taken for granted, and has become a daily thing of our lives. We see water fountains everywhere, and bottled water can be purchased in bulk. However, at the current rate we are using water, freshwater amounts are likely to decimate. This gift from the gods has brought environmental harm to the world and wasted the money of thousands of people. Thus, in order to protect the environment and save our own money, we must make good choices and switch from excessively using bottled water to using tap water. One of the top reasons people often buy bottled water is because of the convenience it provides (Ferrier, 2001, pp. 118-119). Easy life is what the entire economy runs on, as we have seen from the declining economy. As income lessens, people are reverting back to an older lifestyle of doing things themselves instead of purchasing services and goods. While bottled water may taste better because of chemicals that companies add in, it also costs significantly more. A New York Times reporter calculated that eight glasses of New York City tap water were about 49 cents a year, but 8 glasses of bottled water would be 2,900 times more expensive- as much as $1,400 per year. Because water is something that every household needs, it is reasonable to conclude that by switching to bottled water, families could cut their water expenses in half (Helm, 2008) and America as a whole could save. The high costs of purchasing bottled water are often due to the processing that bottled water must go through and the costs of shipping and plastic. Instead of drinking water from a local river or other water source, people choose to drink water shipped from Fiji, where extra charge is added for shipping. The plastic that is used to make the bottle also adds charge. A replacement for this kind of convenience is drinking from the bottles and then continuously refilling them to save your money and the environment. According to the Container Recycling Institute, 85% of water bottles in the United States end up in landfills (cited in Aslam, 2006). Unfortunately, plastic takes up to 1,000 years to decompose and the fuel emissions that delivery trucks emanate destroy the ozone layer. Even more smog and smoke is given off by the manufacturing plant, contributing to global warming, evaporation of our current freshwater supply, and melting/mixing of glacial freshwater and ocean water. About 70% of freshwater is in glacial ice, and as a result of temperatures rising, the freshwater melts, mixing in with saltwater and becoming undrinkable until further chemical processing. Another common myth about bottled water is that it is healthier. A study conducted by University of Birmingham researchers found that â€Å"†¦The majority of participants believed that bottled water has some health benefits but that they were not necessarily significant or superior to the benefits provided by tap water† (BioMed Central, 2009). The participants, users of the university’s sports center, stated that the health benefits of bottled water were negligible, and it was taste and convenience that truly motivated them to buy bottled water. Some research even suggests the opposite- that bottled water is less beneficial to health than tap water. While communities actively add in fluoride – a cavity fighter- to the water supply, the majority of bottled water contains little to no fluoride (Rugg-Gunn, 2003). Many large water companies currently undergo processes such as distillation and/or osmosis – both remove all fluoride from the water (American Dental Association, 2003). Since we now know that bottled water is not healthier than other water sources, we must reflect again on the numerous drawbacks of bottled water. Landfills continue to grow and grow, leading to larger emissions of ozone-depleting gases (Sarma, 2002). Birds and other small animals choke on plastic, mistaking it for food, and also die as a result. The ecosystem is dying as a result. The world works as a whole, a cycle, a circle. The consequences of our actions will always come back to bite us, or in the case of water, our posterity when they have low water supply. Conserving water today will benefit people later. In addition, as we become closer and closer to high UV radiation exposure and losing our ozone layer, scientists are frantically trying to build labs, gather money, and conduct extensive research about how to conserve the environment and water. By not procrastinating, and saving plastic and water resources now, we will save great amounts of money. The exotic island of Fiji is known for its pure, fresh, crisp water, even to Americans who live thousands of miles away. A 16 ounce bottle of Fiji water currently costs from $1. 50 to $2. 50. At a rate like that, when we are at the edge of the Great Lakes and other vast water sources, but purchase water from the other side of the world, our money is being sold away to foreign countries. Most of 2. 7 million tons of plastic used for bottling and packaging come from China (Aslam, 2006). The result is a national economic breakdown, not only in the water industry, but in all industries, since people cannot cut down on the amount of water they need to drink. It takes 63 million gallons of oil per year to manufacture water bottles (Niman, 2007). That is not only more water than Fijians themselves drink that we are buying, but also 63 million extra gallons of oil and plastic that we toss away. Ironically, one third of Fijians are in destitution and lack the amount of water they need. Because one liter of bottled water uses 26 liters of water, one kilogram of fossil fuel, and one pound of CO2 (Thangham, 2007), little is left for the Fijians in destitute. This is true for not only Fiji waters, but all waters in the world. In 2007, Fiji, one of the world’s most popular drinking water sources, became the first bottled water company to release its carbon footprint -85,396 metric tons of CO2eq (Corporate Social Responsibility, 2008). Imagine the carbon footprint total for the world, or even the United States. Perhaps American water companies have not released their carbon footprints because of how overwhelmingly large they are. If we could cut down on how much bottled and imported water we drank, we could preserve a large amount of water for the future.