The Sonnet Essay Example | Topics and Well Written Essays - 1000 words

The Sonnet - Essay Example . A line of poetry that repeatedly uses an unstressed syllable followed by a stressed syllable is called an iambic line. (Harrison, 68) The basic form of traditional Italian sonnets was different from the English or Shakespearean sonnet. â€Å"The Italian sonnet has two parts: an eight-line stanza called an octave and a six-line stanza called a sestet.† (Elizabeth and Hamilton, 263) However, its British originators introduced other elements related to human lives as well, and this required the traditional form of the sonnet to evolve accordingly. Consequently, the form of the sonnet changed to interweave multiple themes, for instance, in Sonnet 18, the principal themes are: beauty, life, death and eternity; while each theme is dealt in distinct quartos in a different way. This Sonnet like other Shakespearean sonnets has 14 lines in iambic pentameter, which are divided into three quatrains, followed by a couplet. The different parts of Sonnet 18 cater to different stages of the development and transition of thought or the central idea of the poem. In the first quarto of Sonnet 18, the poet introduces an object of comparison ‘summer’s day’ with his beloved’s beauty and analyzes different perspectives of this comparison. The use of comparatives like ‘more lovely and more temperate’ (2) and superlatives like ‘too short’ (4) enhance the comparison between the beauty of the poet’s beloved and the summer’s day. Hence, a summer’s day acts as a stimulant for the poet that becomes so inspired by its beauty that he deems it fit to be compared with his beloved’s beauty. However, once he begins to compare their beauties, he realizes that his beloved exalts in so many ways. The idea continues to develop in the second quarto where the emphasis switches from beauty to glory of a summer’s day. According to the poet, some days might be brighter than others,

Lynching Essay Example | Topics and Well Written Essays - 750 words

Lynching - Essay Example And on that same day, residents claim that one of the thieves was captured and was set on fire resulting to the act of public lynching. Residents did this brutal act of public lynching because police didn’t give them enough protection and that the residents claimed justice into their own hands. Residents claim that the police in their community are corrupt and would not protect them if there was no corresponding amount of money involved. The residents protested and didn’t report to their work the following day. They have invited the police in their town to have a meeting and to settle the issue between the police and the community. During the meeting the residents demanded that the police protection in their community should be improved, that the stolen goods should be returned to its owners once the thief that was set on fire discharges out of the hospital, that the police stationed in their community are changed and that the robbers named â€Å"banda† will be e victed in Villa Pagador. After the burning on one of the robbers, the residents were labeled by the police and the media as savages. The residents had a furious reaction to this because they were the ones who were robbed and that they only took justice in their own hands because there was no way they could depend on the police as stated above, and now they are the ones being projected as dreadful people. Residents claim that the police in their community are being paid by the â€Å"banda† to give way on the robbery operations, that’s why the residents wanted to change the set of police in their community. These are the driving forces that lie behind the quest for visibility on the part of Villa Pagador residents. The residents in Villa Pagador are trying to achieve legitimate police protection and to change their image as savages. That’s why they showed there way of protesting through public lynching

Superior Grain Inc Essay Example | Topics and Well Written Essays - 2000 words

Superior Grain Inc - Essay Example describe the assumptions and methods used (3 pts) Somewhat describes assumptions and methods used (7 pts) Substantially describes assumptions and methods used (8 pts) Effectively describes assumptions and methods used (10 pts) Calculate statistics using a spreadsheet Does not calculate appropriate statistics using a spreadsheet and/or does not provide evidence of calculations (0 pt) Calculates appropriate statistics using a spreadsheet (most answers are not correct) (13 pts) Calculates appropriate statistics using a spreadsheet (not all answers are correct) (21 pts) Calculates appropriate statistics using a spreadsheet (most answers are correct) (25 pts) Effectively calculates statistics using a spreadsheet (almost all answers are correct) (30 pts) Explain implications of output of statistical analysis Does not explain implications of output of statistical analysis (0 pt) Partially explains implications of output of statistical analysis (3pts) Somewhat explains implications of output of statistical analysis (7 pts) Substantially explains implications of output of statistical analysis (8 pts) Effectively explains implications of output of statistical analysis (10 pts) . . . continued . . . TITLE OF RUBRIC: Case Analysis, cont. (Page 2 of 2) Course: QNT 5040 LEARNING OUTCOME/S: (see syllabus) Date: 02.15. 2013 PURPOSE: To facilitate effective decision making under uncertain conditions by quantifying risk. Name of Student: Kelly Espinosa, Diana De Castro, Elsa Santos, Marie Jean, Lesan Thomas, Courtney Waite VALIDITY: Best practices in Monte Carlo simulation. Name of Faculty: Nova Southeastern University COMPANION DOCUMENTS: Assignment and format instructions, Case Earning maximum points in each box in ‘PROFICIENT’ column and / or points in columns to the right of... Based on the analysis of the historical data and projected data for the upcoming year, it would be a mistake for Superior Grain to rely on the volume of shipments allotted from the Polish contract to cover the costs of building the third wharf with the expectation of 20% profit. It is apparent from the statistics that the addition of the third wharf would decrease the demurrage charge; however, there is a negative net present value (NPV) that indicates the company should not build the third wharf. Even though, there is a negative NPV for the company, according to our five-year analysis, Superior Grain Elevator could still consider building the third wharf. Because of the 3 factors detailed below, Superior Grain Manager, Mike Armstrong, needs to consider building the third wharf. By building the third wharf the waiting time will be dramatically decreased, and customer satisfaction will also increase. After the contract is over the number of ships will go back to 115 with the savings o f more than $100,000 per year. There is always a possibility within the next 2 years for the company to get a new contract which it will be prepared to handle. Therefore by building the third wharf the company will be able to benefit from it.

Lynching Essay Example | Topics and Well Written Essays - 750 words

Lynching - Essay Example And on that same day, residents claim that one of the thieves was captured and was set on fire resulting to the act of public lynching. Residents did this brutal act of public lynching because police didn’t give them enough protection and that the residents claimed justice into their own hands. Residents claim that the police in their community are corrupt and would not protect them if there was no corresponding amount of money involved. The residents protested and didn’t report to their work the following day. They have invited the police in their town to have a meeting and to settle the issue between the police and the community. During the meeting the residents demanded that the police protection in their community should be improved, that the stolen goods should be returned to its owners once the thief that was set on fire discharges out of the hospital, that the police stationed in their community are changed and that the robbers named â€Å"banda† will be e victed in Villa Pagador. After the burning on one of the robbers, the residents were labeled by the police and the media as savages. The residents had a furious reaction to this because they were the ones who were robbed and that they only took justice in their own hands because there was no way they could depend on the police as stated above, and now they are the ones being projected as dreadful people. Residents claim that the police in their community are being paid by the â€Å"banda† to give way on the robbery operations, that’s why the residents wanted to change the set of police in their community. These are the driving forces that lie behind the quest for visibility on the part of Villa Pagador residents. The residents in Villa Pagador are trying to achieve legitimate police protection and to change their image as savages. That’s why they showed there way of protesting through public lynching

Culture and Healthcare in America Essay Example | Topics and Well Written Essays - 500 words

Culture and Healthcare in America - Essay Example According to Loraine Magda (2007) "From academia to the applied sciences, medicine, law and politics, Western society operates from a paradigm firmly based on materialism with grave skepticism, and unless proven true by science, becomes relegated to the wasteland of wishful thinking." Most scientists believe that science starts with basic questions and as they try to answer, and develops the answers, it leads to further questions. When students are taught on this basic belief they ignore the interplay of science with society, and such training tends to obscure connection between science and society. Thomas Kuhn says "to acquire the status of a paradigm, a scientific achievement must offer sufficiently convincing resolutions of previously recognized problemsmust also have enough unresolved problems to provide the puzzles for subsequent research practice within the research tradition it comes to define" (Marshall1998).

Management Of Minor Injuries

Management Of Minor Injuries Introduction: As part of this minor injuries course we have been asked to provide a 3000 word assignment utilising a case method as means of researching a patient scenario we experienced during clinical practise. Case study method enables a researcher to investigate an individual and evaluate these findings and relate this evidence to clinical practice ( REFERENCE 1) Case studies are also often subjective and based around a personal experience or memorable patient (REFERENCE 2), whilst identified by (REFERENCE 3) that these case studies do not provide a great amount of empirical and statistical evidence, (REFERENCE 4) highlights that case study methods stimulate critical thinking and help practitioners apply theory to clinical practice. For this case study I have chosen a patient who I treated for an Achilles tendon rupture. This assignment will aim to document the assessment of a patient in the acute stage of injury discuss the initial management of the injury discuss the treatment plans available conclude how this case study has impacted on my clinical practise The Achilles tendon is given its name by Greek hero Achilles as the largest and strongest tendon within the human body, Patel and Haddad (2006). It connects the calf muscle (gastrocnemius) to the heel bone (calcaneus) and is located below the skin at the back of the ankle.(reference needed) As the calf muscle contracts it provides it enables the foot to be pointed downwards (plantarflexion) It is this action that enables us to walk, run, jump and to stand on our toes.(reference needed) Despite great forces applied through this tendon it is vulnerable due to its limited blood supply, the least vascularised area being 2 to 6 cm above the calcaneum. This diminished blood supply predisposes this region to chronic tendonitis and potential rupture. (reference 5) Kerr (2005) suggests three main attributing factors are leading to an increase in rupture. Increased sedentary lifestyle Rising popularity of recreational sports especially in older men An increasing proportion of people are overweight 75% of Achilles injuries occur during sporting activities, and research indicates this is occurring with patients who describe themselves as novice or beginners (Josza et al, 1989). As ENPs it is important that we are able to differentiate between an acute tendon injury and other complaints i.e. gastrocnemius tears in order to treat, advice and refer appropriately. Misdiagnosis or delay in treatment can lead to gait dysfunction and chronic pain. The following case study is a true event of a patient I assessed during my clinical placement. To maintain the patients confidentiality he will be referred to as Mr Smith. CASE STUDY: 68 year old retired gentleman, no drug allergies, no significant past or ongoing medical problems. Mr Smith attended the emergency department at 10.00 and was booked in with a limb problem. I greeted Mr Smith, explained my role as a training Emergency Nurse Practitioner (ENP) and gained consent for his assessment. Mr Smith had been out dancing the previous night and thought he had been kicked in the back of his right lower leg. Since, he had described difficulty walking and not been able to bend his foot as normal. Despite walking tentatively Mr Smith manoeuvred himself onto the examination couch. From his facial expression he appeared comfortable and his pain had been reduced having taken his own paracetamol and ibuprofen. The worst pain had been last night and the patient described an ache this morning. Further analgesia was offered but declined by the patient. Physical examination: This was broken down into 5 key areas described by Guly (2002) Look (inspection) Feel (palpation) Movement Specialist tests Function During our course we have assessed neurovascular function as a separate examination. This will be assessed between movement and specialist tests. Look: Mr Smith was examined in a private cubicle. His trousers removed in order to expose both lower limbs for comparison. Mr Smith had no wounds, no obvious deformity, no erythema /cellulites and no bruising noted. There was noticeable swelling around the base of the calf in the soleus region on the medial aspect of the limb. Both limbs were of equal colour and warmth. No surgical scarring was observed on either limb. Feel: Palpation of lower leg then took place. In accordance with Gully (2002) this should take place from the joint above to the joint below. Palpation started from the knee joint downwards. From the examination of the knee joint no pain over bony land marks was elicited by the patient. The palpation moved distal towards the ankle, no bony tenderness was identified. The ankle was examined for bony tenderness. No tenderness was found at the posterior edge or tip of both the medial and lateral maleolus, the base of the 5th metatarsal or the navicular bone. Using Ottawa ankle rules (Hopkins, 2010) there was no indication to xray the ankle. Mr Smith was then asked to go into the prone position, this enabled a good comparative view of both limbs mainly the gastrocnemius muscles and the Achilles tendons. The gastrocnemius muscle was then palpated; although uncomfortable towards the distal muscle a specific tender point was not identified. The Achilles tendon was then palpated; this gave a specific origin for the pain. There was also bogginess (palpable step) in the lower third of the Achilles. Although a step was palpable Kerr (2005) indentified that not all ruptures have a palpable step, the cause of this unknown. Movement: Ankle movements were examined both active and passive. Mr Smith had good active dorsi flexion and normal plantar flexion of both ankles. However when examined with passive resistance there was a marked deficit on his right ankle. Sterling (2001) highlighted that even though normal range of motion is witnessed during active movement it is essential passive movement is carried out, and assumptions should not be made to the integrity of the Achilles tendon. Both medial and lateral ligaments were stressed with no laxity and good end feel. Finally an anterior draw test was performed, the ankle was stable. Neurovascular status: Mr Smith had normal sensation of his first web space, dorsum of foot and anterior and lateral aspect of lower leg. Mr Smith was able to dorsiflex and had normal toe plantar mechanism. Pedal pulse was also present. Specialist tests: Mr Smith was then asked to kneel onto the trolley and support himself using the wall. A Thompson- Simmons (calf squeeze) test was then performed. At this time Mr Smith had no plantar flexion movement. Johnson and Morelli (2001) details this is highly suggestive of a ruptured Achilles tendon. Prior to undertaking this assignment I was not aware of any other specialist tests other than ultrasound. These shall be discussed later. Function: Guly (2002) states the examination of a joint should include its functionality. Mr Smith was then asked to perform a calf heel raise (stand on tip-toes). He was unable to perform this task. Sterling et al (2001) summarised that a patient whose other plantar flexors are still functioning will not be able to perform this task if their Achilles is ruptured. Treatment: Mr Smith was diagnosed and treated as an Achilles tendon rupture. He was placed in an equinas cast and was given crutches to mobilise with, which he did very well. A referral was then made to our fracture clinic where he would be followed up with the orthopaedic team. Take home analgesia was offered but declined by the patient. Mr Smith asked about the long term plan of action, would he need surgery to repair his tendon. I answered honestly and stated I didnt know but endeavoured to find out from one of my colleagues. It was this lack of follow on care knowledge that has been one of the focuses for this case study. Having an extended knowledge base would further enable a holistic approach to care not only in the acute care environment but to also provide accurate information about the care the patient should expect to receive. This sharing of knowledge will hopefully enable the patient to make an informed choice about how they would like to proceed. The follow on from acut e injury to referral to fracture clinic is currently within 3 days. The patient will be presented if suitable with two options; surgical repair or conservative management. From reviewing the literature contributing towards this assignment it is clear the orthopaedic world is divided over these two strategies of care. However the common goal summarised by Patel and Haddad (2006) is a restoration of the normal length and tension of the Achilles tendon, allowing patients to regain their functional and desired level of activity. Fotiadis et al (2007) supports this and further discusses the importance of restoring length as this will preserve strength of the gastrocnemius and the soleus muscles, again improving functionality. Surgical repair: the procedure involves making a longitudinal incision on the medial aspect of the Achilles tendon. Normally the incision is between 8 and 10cm, the ends of the tendon are then sewn together using non-absorbable suture. Two types of stitch are favoured, Krackow or Bunnell. (see appendix A) Kerr (2005) highlights the advantages of surgical repair as Increased strength Reduced calf atrophy Less likely hood of re-rupture Faster return to sporting activities. However with any invasive procedure there will be a risk off Deep wound infection Deep vein thrombosis Delayed wound healing Scar adhesions Hyperesthesia or numbness of the skin After surgery the limb is immobilised with an equinas plaster or brace for between 6 to 8 weeks followed by physiotherapy. Non Surgical Management: Johnson and Morelli (2001) outlines that conservative management involves the patient being placed initially in an equinas cast. The immobilisation of the ankle plantar flexed between 40ÂÂ ° and 60ÂÂ ° enables the tendon to be stress free promoting the unification of the partial tear or rupture tendon. Having discussed the current treatment guidelines with my orthopaedic colleagues at the hospital the patient would be expected to return to fracture twice over a 6 week period. This would be to have a new POP each time and gradually have the degree of plantar flexion increased. The patient would remain on crutches, non weight bearing on the affected limb, to reduce the potential stress placed on the tendon. Having presented the case study and outlined initial management and expected follow up care, I would now like to introduce new methods of assessing for Achilles tendon rupture as stated on page 3. Matles Test: The patient is laid in the prone position with knees flexed at 90ÂÂ °. Both feet and ankles are observed for plantar flexion. The diagram below indicates the there is an increase in dorsi-flexion on the injured limb (right) Source: foot and ankle hyperbook (2011) The OBrien test: the patient lies in the prone position knees flexed at 90ÂÂ °. A small gauge needle is then inserted 10cm form the superior border of the calcaneus into the Achilles tendon. Passive dorsiflexion and plantar flexion movements are applied; absence of movement indicates a potential rupture. The Copeland test: the patient is laid in prone position with knees flexed at 90ÂÂ °. A sphygmomanometer is placed around the bulk of the calf and the pressure raised to 100mmHg with the ankle plantar flexed. When the ankle is dorsiflexed, in a non- injured Achilles tendon, pressure increases to 140mmHg. Where the Achilles is ruptured the pressure remains the same (Sterling et al, 2000). Other specialist diagnostic procedures can be performed i.e. ultrasound or MRI. These have been highlighted by Patel and Haddad (2006) as more accurate at detecting partial tears. Ultrasound is operator dependent and requires an experienced technician and radiologist and MRI carries a high cost and limited clinical value of what has already been diagnosed clinically. Differential diagnosis: During the initial history taking it is paramount an accurate detail history is taken leading up to the events. Majewski et al(2008) outlines 44% of Achilles injuries are misdiagnosed as ankle sprains or gastrocnemius injuries and advocates the use of the two specialists test previously identified; the calf squeeze test and the Maltes test. Majewski et al (2008) concludes along with proficient palpation of the Achilles tendon two positive tests is good evidence of a rupture. However reinforces the need for sonography (ultra-sound) to differentiate between partial and full tears. As ENPs we are usually the first clinician patients see with an acute injury. We have a vital role in demonstrating accurate history taking, assessment, treatment and referral to the appropriate speciality. Despite the patient having an injury it is important that we can provide the patient with accurate education and health promotion advice. It is recognised within our department that weekends have a high increase is sporting injuries who attend the emergency department. The main sports are rugby league and football. We have a great opportunity to impart knowledge to patients with injuries in order to hopefully reduce the incidence of new or re-occurring injury. In relation to Achilles injury or Achilles tendonitis Walker (2005) promotes warm up techniques, the benefits include: Increased blood flow to working muscles Increased range of movements Improved speed of contraction Increased temperature and hence increased elasticity Improved oxygen saturation As previously identified there is reduced vascularisation to part of the tendon, Henry et al (1986) concludes that warming up increases the flexibility of the joint involved and best results occur from static stretching. Another important factor to advice patients about is footwear. If possible hard backs of shoes should be padded as identified by Milroy (1994) these areas nudge the Achilles, often at the site of injury and wherever possible heels should be slightly raised to shorten the Achilles resulting in less injury from sudden lengthening. It is this information that I will be now documenting i.e. did they warm up prior to exercise and also conveying this to patients in order to reduce further injuries. Conclusion: As identified there is an increase in Achilles tendon rupture injuries hence more people will be attending the Emergency Department through direct referral from General practitioners and Walk in Centres/ Minor injuries units or from self presentation. From reviewing literature it is evident there is a significant number of misdiagnosis occurring around the area of injured Achilles tendons. Despite Mr Smiths diagnosis seeming straightforward I now have a greater appreciation of differential diagnosis and the effects misdiagnosis or delay in treatment can have on the short an

Caring for Older People Essay -- Health Care, Diseases, Dementia

Caring for older people highlights many special and difficult issues for nurses and carers, such as separation, illness, loneliness, death and how to provide continued care (Morrissey et al, 1997). This essay discusses the strategies of care delivered for an older person with dementia during my recent clinical placement. Discussions will focus on normal ageing process taking into account the relevant biological, sociological and physiological perspectives and the impact this had on this individual’s life experience. Ropers’ model is used as a frame work in which cae is delivered. Other related issues to be considered include the role of informal carers and the impact this had on him. Confidentiality is maintained in conjunction with NMC 2010 code of conduct. Thus a pseudonym (Scot) is adopted where the client’s name is mentioned. Scot is a 70 year old man with a long term history of psychosis. Recently he had been diagnosed with dementia. He had been well managed on quiatiapin until he had stopped taking the medication and his psychosis had worsened. And due to his decline in his mental state, he has also been refusing access to his carer (his wife) and was at risk of self neglect. Dementia is a disorder manifested by multiple cognitive defects, such as impaired memory, aphasia, apraxia and a disturbance in occupational or social functioning, Howcroft (2004). Disturbances in executive functioning are also seen in the loss of the ability to think abstractly, having difficulty performing tasks and the avoidance of situations, which involves processing information. Scot suffers from Alzheimer’s disease, a type of dementia, which affects the brain cells and brain nerve transmitters, which carry instructions around the brain. The b... ...is condition and how she can reduce the feelings of anxiety, tension and loss of control that has resulted from the impact of Scots deterioration. By the end of my placement, evaluations showed that although there have not been significant changes in Scots mental and physical state, it is also imperative to note that he has been supported and maintained well to carry some of the daily activities of living. Whilst Scots care plan continued to be reviewed, there is also an ongoing support and educational programmes for his wife, which will enable her to effectively care for Scot. Having gained experience working with older people, I have understood that whenever you care for a person especially the older person, one must take a holistic view of the person’s physiological and psychological and social circumstance in order to provide effective and continuous care.