Spinal Immobilization free essay sample

These resources have been analysed and a conclusion drawn from them in regards to spinal immobilisation in the pre-hospital setting. Method: This assignment uses an evidence based approach; the author explores spinal injuries and the current management of them in the pre-hospital setting across a number of countries. The author relates current practice with recent literature and draws a final conclusion from the findings. Conclusion: Prehospital care for patients with acute traumatic spinal injuries requires great care to avoid secondary injury; recognition of otential injury is of great importance. Although injuries to the spinal cord occur in 2% of the patients that paramedics immobilize, pre-hospital management and treatment can play a significant role in the patient’s outcome. There is growing evidence that full body immobilization can be of more harm than good if not done correctly. Introduction Traumatic spinal cord injuries are severe, life threatening and life altering . Managing the risk of spinal cord injury in trauma patients is an understandable concern for medical professionals. We will write a custom essay sample on Spinal Immobilization or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Spinal immobilization is initiated on a regular basis in pre-hospital setting for patients at risk of a spinal cord injury. In the past immobilization has been thought to be a relatively harmless procedure. There is now, however, growing evidence that this approach can be harmful, pre-hospital spinal immobilization in trauma patients should be questioned and explored. There is a large amount of literature on pre-hospital immobilization; the purpose of this paper is to review the current literature and make a recommendation for New Zealand practice. This paper explores current pre-hospital management of spinal cord injuries, the literature around cervical spine immobilization and full body immobilization. Spinal cord injury Spinal cord injury is injury to the spine with any localised damage to the spinal cord or to the roots that lead to some functional loss, either loss of motor function (paralysis) or sensory loss (paresthesias). Spinal cord injuries are caused by the spine being forced beyond its normal range, injury can be caused by hyperflexion, hyperextension, rotation, compression, or penetrating injury of the spinal cord. The leading causes of injury to the spinal cord includes car accidents (40%), falls (21%), acts of violence (15%), sporting injury (13%) (Sanders, 2012) Spinal injuries may be classified into sprains, strains, fractures, dislocations and/or actual cord injuries. Spinal cord injuries are further classified as complete or incomplete and may be the result of pressure, contusion or laceration of the spinal cord (Marieb amp; Hoehn, 2010). It is very important for paramedics and emergency personal to know that pain from a spinal cord injury is not necessarily localized to the area of the injury. In 18% of cervical, 63% of thoracic and 9% of lumbar injuries, the pain is located elsewhere (Bernhard, Gries, Kremer, amp; Bottiger, 2005). Current Management Pre-hospital management of acute spinal cord injury is of critical importance, it has been estimated that 25% of spinal cord damage may occur or be aggravated after the initial event (Bernhard, Gries, Kremer, amp; Bottiger, 2005). Pre-hospital treatment of patients with a spinal cord injury involves recognition of patients at risk and appropriate immobilisation (Tintinalli, 2011). Spinal immobilization and spinal precautions are common practices in the pre-hospital setting of patients with trauma. Despite this practice, spinal cord injuries are rare, approximately 2%, and are often obvious at the scene. Several rules exist that are designed to help pre-hospital providers clinically clear the cervical spine this helps reduce the need for radiography and reduce adverse effects from spinal immobilization (Alejandro amp; Schiebel, 2006). The goal of pre-hospital management of spinal cord injuries is to reduce neurological deficit and to prevent any additional loss of neurological function. Therefore, prehospital management at the scene should include a rapid primary evaluation of the patient, resuscitation of vital functions (airway, breathing, and circulation), a more detailed secondary assessment, and finally transportation to definitive care. In addition, after arriving at the scene, it is important to evaluate the scene and to understand the mechanism of injury in order to identify the potential for spinal cord injuries (Bernhard, Gries, Kremer, amp; Bottiger, 2005). Currently in New Zealand according to St John (2011) clinical guidelines and Wellington free Ambulance (2011). If the patient has any of the following signs or symptoms they should have their cervical spine immobilised: 1. Tenderness at the posterior midline of the cervical spine or 2. Focal neurological deficit or 3. Decreased level of alertness or 4. Evidence of intoxication or 5. Clinically noticeable pain that may distract the patient from pain of a cervical spine injury. Australia’s Queensland Ambulance service has similar cervical immobilisation criteria to New Zealand, they use a clear flow chart to that is similar to the Canadian C-spine Rule but includes distracting injury and intoxication. Their other treatments focus on limiting neurological deficit and prevent secondary injury. This is achieved through appropriate spinal immobilisation, maintaining a high index of suspicion of spinal cord injury (Clinical pratice guidelines Trauma, 2011). Saskatchewan, Canada also use the Canadian C-Spine rule, this rule is only used if the patient is co-oprative and has a Glasco comoa scale (GCS) of 15. If the patient meets ther criteria for cervical spine immobilization they are also fully immobilised on a long spine board or scoop stretcher. Full immobilization includes the head, neck and spine; this is done to prevent any further injuries during transport. Canada also administers an anti-emetic (anti-nausea medication) to prevent any unwanted and preventable movement (Saskatchewan Emergency Treatment Protocol Manual, 2012). In the United States of America to determine whether it is appropriate to apply full spinal immobilization which can include rigid collar, backboard, three point restraining device and head immobilization device, in the prehospital setting the following is assesses. If any of the below findings are positive, full spinal immobilization is to be implemented (Emergency medical services pre-hospital treatment protocols, 2012). 1. Midline bony spinal tenderness to palpation 2. Physical findings with a neurologic deficit 3. Altered mental status to including substance abuse and loss of consciousness 4. The presence of additional painful or distracting injuries 5. The complaint of numbness 6. Language barrier i. e. patient not understanding the questions asked, dementia, speaks a different language, or mentally delayed 7. Pain in cervical region on movement 8. Children under the age of 12 9. Significant mechanism of injury or care provider judgment It appears that the United States of America fully immobilize the majority of suspected/ potential spinal cord injuries. Litigation associated with error in spinal management can be very costly, with the average payouts being $3 million per incident in the United States (Abram amp; Bulstrode, 2010). The Literature Cervical spine immobilization It is believed that movement of the non-immobilised patient with an unstable vertebral column injury places the spinal cord at risk of primary or worsening damage. There is a lot of evidence that cervical immobilisation can restrict movement, but evidence proving that cervical collard protect against secondary injury is lacking (Ramasamy, Midwinter, Mahoney, amp; Clasper, 2009). In prehospital care, paramedics are trained to immobilize all patients with possible spinal cord injury; in order to prevent additional neurologic injury. Many patients will be found to have no injury to the spine at all. Some will have an unstable fracture with an intact spinal cord; the goal is to prevent movement of the spine therefore preventing damage to the spinal cord. Others will unfortunately already have neurological disability on initial examination. In these patients, the goal is to prevent further cord injury (Peery, Bruice, amp; White, 2007). A number of risks may be associated with application of the cervical collar. If the jaw support of the collar clamps the teeth together, the airway may be compromised if the patient vomits. Cervical collars have also been found to place pressure on the neck this can cause an increase in intracranial pressure. Acute respiratory failure, hypoxia and hypoventilation have also been reporter (Bernhard, Gries, Kremer, amp; Bottiger, 2005; Hann, 2004; Abram amp; Bulstrode, 2010; Engsberg, et al. , 2013). A rise in intracrainal pressure (ICP) has been associated with a worse neurological outcome in patients suffering from a head injury. Cervical spine immobilisation has been foud to increase the ICP by approximatly 4. 5 mmHg. This is relevent because head injuries occur in an average of 34% of trauma patients (Abram amp; Bulstrode, 2010). Galim, et al. 2012) applied cervical spine imobilisation to nine fresh cadervers in order to assitaine weather or not collars exacerbate cervical spine injuries. X-ray’s were taken befor and after application of the collar. Galim found after the application of the collar there was a grossly abnormal seperation of the verterbra in all nine cadervers. The average seperation mesurement was 7. 33 mm (see figure 1). The collars did not cause the injury, but th is appears to promote seperation between vertebrea. This seperation sugests collars push the head away from the body, this causes stretching of the soft tissue including the spinal cord. Galin, et al recognises that the use of cadervers could repersent worst case scernario because of the difference in muscle tone in compard to an unconscious patine. The result of a randomized controlled trial on healthy volunteers has provided some useful insight into cervical spine immobilization and its effectiveness in trauma patients (Alejandro amp; Schiebel, 2006). Figure 1 Hann (2004) found that in general only 55% of patients will fit perfectly into cervical immobilization collars. The majority of patients will have an ill-fitting Collar. True cervical immobilization is likely to be unobtainable. Even a halo frame (which has mental pins that are screwed into the skull), allows a small amount of motion. However, the rigid cervical immobilization collar remains the best and most effective for the needs of the prehospital setting (Hostler, Colburn, amp; Seitz, 2009). Ideally, only patients with unstable spines would have a cervical collar applied. But these patients cannot be identified in the pre-hospital setting; determining spinal injury out of hospital is not easy nor is it accurate (Horodyski, DiPaola, Conrad, amp; Rechtine, 2011). In both Canada and Australia the Canadian C-Spine Rule is used to determine which patients could benefit from immobilisation (see figure 2). In one study on 8,283 patients who were assessed by emergency services and the Canadian C-Spine rule was applied. The paramedic’s received a short online tutorial on how the C-Spine rule worked. This study found that paramedics were able to apply this rule reliably, and did not miss any cervical spine injuries. The rule was found to be accurate; only 12 patients had clinically significant spinal cord injuries (Vaillancourt, et al. 2009). Figure 2 Full spinal immobilization There is growing questioning of the need to fully immobilise a patient, with many suggestions that immobilisation does not prevent additional spinal cord injuries, however it may in fact cause such injuries (Krell, et al. ,2006; Alejandro amp; Schiebel, 2006; Bernhard, Gries, Kremer, amp; Bottiger, 2005; Peery, Bruice, amp; White, 2007). The use of a spinal board is com mon in attempt to provide rigid spinal immobilization in the pre-hospital setting for trauma patients with potential spinal injuries. Nevertheless, the benefit of long backboards is largely unproven (Alejandro amp; Schiebel, 2006). A number of studies in the literature do present complications when poor standards of immobilisation are performed. Issues include occipital, lumbar and sacral pain development when padding is inadequate or absent, increased respiratory compromise with incorrect chest strapping, pressure sore development due to inadequate padding and spinal miss-alignment again are as a result of inappropriate/ inadequate padding. Perry, Brice amp; White (2007) found that if a patient is lying on a spinal board which is poorly trapped, it is likely the patient would move more during transport than if they were places on the stretcher. Inadequate pre-hospital spinal immobilization was found to occur on a regular basis; the main problem being straps had greater than four centimetres slack. Straps that have a four centimetres or greater slack cannot sufficiently immobilise a patient with a potential spinal injury. Abram amp; Bulstrode (2010) has noted that correct immobilisation of the cervical spine, with placing a patient on a backboard with the straps tightened correctly, that the patients respiratory function can be restricted by up to 15%. If the patients head is strapped in place but the body is poorly immobilized, this creates a situation where the body can pendulum at the neck. This situation is potentially more dangerous than not immobilising at all because it allows transport forces to move the weight of the body against an unstable spine (Peery, Bruice, amp; White, 2007). The general theory of spinal immobilisation is that movements would be reduced if neck protection is used along with a backboard to aid smooth extrication form a motor vehicle. Engsberg, et al (2013) found a significant decrease in movement (as opposed to full assistance i. e. spine board) when the patient exited the vehicle unassisted with a cervical collar in place to protect the neck. The results indicated that an unassisted cervical protected technique had significantly less range of motion than the unassisted unprotected and the fully assisted technique. In fact, with the addition of the cervical spine collar the level of protection was increased and range of motion was decreased in many instances (Engsberg, et al. , 2013). The use of backboards have been found to induce three to five as much movement than a scoop stretcher if the patient is on the ground (Krell, et al. , 2006). Abram amp; Bulstrode (2010) sugests that the risk of futher neurological injury due to inadiquate immobilisation may be overestermated. They back this statement up with a 5 year retrospective study. The neurological outcomes for patients where no routine pre-hospital immobilization was used were compared to trauma patients who received spinal immobilization. Two physicians acted independently, the patients were categorised into disabling r non-disabling. The trial found deterioration occurred less frequently and there was less over all neurological disability in the patients with no routine immobilization. It was suggested that, a large amount of force is required to damage the spine and injure the spinal cord; Abram amp; Bulstrode concluded that movement created during transport was unlikely to generate sufficient energy to res ult in additional injury. There were however weaknesses in this study. Patients who died at the scene or during transport were excluded. It was concluded that neurological deterioration in patients with spinal cord injury occurs in around 5% of patients even with good immobilization of the spine. Conclusion Immense care needs to be taken when providing medical care to an acutely injured patient with suspected spinal injury in the pre-hospital setting. Approximately 2% of all trauma patients will have sustained a spinal injury. Patients with acute traumatic spinal injury are at risk of neurologic deterioration which is thought to be due to secondary injury to the spinal cord. A potential cause of secondary injury is through unintentional manipulation of the spinal cord predominately in the setting of an unstable injury. Minimizing the chances of secondary injury can be challenging in the pre-hospital setting due to the location and accessibility of the patient, transport. Treatment that is initiated in the pre-hospital setting can lead to significant morbidity in other body areas, such as pressure areas, decreased respiratory effort. There is large variation in how care is administered in the pre-hospital setting from one country to another. There is a possibility that fill body immobilization may be contributing to mortality and morbidity in some patients, this warrants further investigation. The Canadian C-spine study showed that only 0. 14% of patients immobilized had clinically significant spinal cord injuries. New Zealand could improve their current practice by improving pre-hospital criteria to establish which patients really are at significant risk for needing spinal immobilization, this could reduce the number of patients exposed to the unnecessarily risks of spinal immobilization. Bibliography Abram, S. amp; Bulstrode, C. (2010). Routine spinal immobilization in trauma patients: What are the advantages and disadvantages. The Surgeon, 218-222. Ahn, H. , Singh, J. , Nathens, A. , MacDonald, R. D. , Travers, A. , Tallon, J. , . . . Yee, A. (2011, August). Pre-Hospital Care Management of a Potential Spinal Cord Injured Patient: A Systematic Review of the Literature and Evidence-Based Guidelines. Journal of Neurotrau ma, 8(28), 1341–1361. doi:10. 1089/neu. 2009. 1168 Ahn, H. , Singh, J. , Nathens, A. , MacDonald, R. D. , Travers, A. , Tallon, J. , . . . Yee, A. (2011, August). Pre-Hospital care management of a potential spinal cord injured patient: A systemic review of the literature and evidance-based guidelines. Journal of Neurolotrauma, 28, 1341-1361. doi:10. 1089/neu. 2009. 1168 Alejandro, A. , amp; Schiebel, N. (2006). Is routine spinal immobiilization an effective intervention for trauma patients? Emergency Medicine, 110-112. Bernhard, M. , Gries, A. , Kremer, P. , amp; Bottiger, B. (2005). Spinal cord injury Prehospital management. Resuscitation, 127-139. Clinical pratice guidelines Trauma. (2011, September). Retrieved from Queensland Ambulance Service: http://www. mbulance. qld. gov. au/medical/pdf/09_cpg_trauma. pdf Dunn, T. M. , Dalton, A. , Dorfman, T. , amp; Dunn, W. W. (2004). Are emergency medical technition-basics able to use a selective immobilization of the cervical spine protocol? Prehospital emergency care, 207-211. Emergency medical services pre-hospital treatment protocols. (2012, January 3). Retrieved from Commonwealth of Massachuse tts : http://www. mass. gov/eohhs/docs/dph/emergency-services/treatment-protocols-1001. pdf Engsberg, J. R. , Standeven, J. W. , Shurtleff, T. L. , Eggars, J. L. , Shafer, J. S. , amp; Naunheim, R. S. (2013). Cervical spine motion during extraction. The Journal of Emergency Medicine, Vol 44, 122-127. Galim, P. B. , Dreiangel, N. , Mattox, K. L. , Reitman, C. A. , Kalantar, S. B. , amp; Hipp, J. A. (2012). Extrication collars can result in abnormal seperation between vetebrae in the presence of a dissociative injury. The Journal of Trauma, 12-16. doi:10. 1097/TA. ob013e3181be785a Hann, A. (2004, August 20). A photographic guide to prehospital spinal care: Edition 5. Retrieved April 2, 2013, from Emergency technologies: http://www. neann. com/pdf/psc. pdf Horodyski, M. , DiPaola, C. P. , Conrad, B.

Free Essays on National Parks

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Health Management Plan for Smoker with Heart Disease

Health Management Plan for Smoker with Heart Disease Introduction Cigarette smoking is still the leading cause of preventable death in the developed world. In the UK it is estimated to cause serious illness in 4.5 million people and kills about 300,000 people each year. Frieden estimates that it kills 5 million people in the world annually. (Frieden et al. 2005) This essay will consider the management plan for an idealised patient who smokes and has recently been diagnosed with ischaemic heart disease. There is a great deal of evidence in the literature which links smoking with both increased incidence and increased morbidity and mortality in heart disease. (Molyneux et al. 2004). It follows therefore that every effort should be made to encourage a patient who smokes to quit at the first opportunity. There is some evidence to suggest that one of the optimum times to successfully persuade a patient to quit smoking is when they have had a smoking related health event. (Ferguson et al. 2003) In the context of this essay one can assume that, having just been diagnosed with some form of heart disease, this would be an optimum time to instigate such an intervention. Pathophysiology Cigarette smoking is known to be a major health hazard. It is significantly implicated in virtually all aspects of both cardiovascular morbidity and mortality. (Missel et al. 2008). In terms of pathophysiology, cigarette smoking has an effect on all phases of the atherosclerotic process from the earliest detectable signs of endothelial dysfunction to clinically significant thrombotic clinical events. There appears to be little difference in the implications of active or passive smoking as the effects appear to be largely dose (exposure) related. (Heiss et al. 2008). The mechanisms by which cigarette smoking exerts its pathological effects are complex, but it is known to increase inflammation, enhance the thrombotic processes and increases the oxidation of LDL cholesterol. Cigarette smoking increases the oxidative stress on the body. (OConnell et al. 2008). These smoking-specific effects are accumulative. And there is evidence to support the view that persuading a patient to reduce hi s intake is beneficial, even though this is clearly not as beneficial as complete cessation. (Wood-Baker 2002) Goals Any management plan should ideally have goals. This does not imply that they will all be achieved, but all of the processes identified and activities embarked on should have the ideal goal as their ultimate target. In this particular case, one can define several goals which will assist in the process of smoking cessation and management of their heart disease. A) To ensure that the patient understands their condition. B) Empowerment and education of the patient so that they can participate in their management plan with understanding and commitment C) To assist the patient in the medical treatment of the acute phase of their condition. D) To rehabilitate the patient after the acute stages are stabilised E) To engage with the patient’s carers (formal and informal) to optimise the patient’s return to health F) To assist the patient to quit smoking G) To support the patient as they negotiate their illness trajectory. Clearly there may well be other goals that could be considered and may arise in specific cases. This essay however, is dealing with the generalised patient. These goals are therefore designed to be applicable to the majority of cases of patients who smoke and have heart disease. Assessment The assessment of a patient begins at the first point of contact. Information can be gleaned from many sources and should be appropriate to the presenting condition. Assessment should be holistic and thorough. In this specific case, one should make particular enquiries relating to factors that are relevant to the patient’s lifestyle (relevance to their heart disease) and to their personal habits (relevance to their smoking pattern). One should pay particular attention to the factors that may make them wish to persist in their habit of smoking so that they can be specifically addressed when smoking cessation is discussed. Targeted interventions are more likely to be effective than blanket ones. (Rigotti et al. 2004). In consideration of their heart disease, one should make specific enquiries in relation to their eating and exercise habits as well as their willingness to participate in any proposed lifestyle change programme that may be suggested. Interventions and broad nursing strategies. Clearly the term â€Å"heart disease† covers a multitude of potential pathologies and it is not practical to consider specific interventions for all possibilities. In the context of this essay, one will consider broad strategies which are applicable to most situations. 1) Encourage compliance with drug regimens: Drugs are commonly prescribed in association with heart disease. They can be as part of a primary intervention such as controlling blood pressure (antihypertensives) or perhaps for improving cardiac output (digoxin) or for controlling secondary pathologies (viz. lipid lowering medication, diabetic treatment, anticoagulants). There is a case for using nicotine replacement medication. If this is the case then compliance with an appropriate dose and reducing regime will enhance the likelihood of success. (Parrott et al. 2004) The nurse can assist by encouraging the patient to comply with the regime. They may choose to do this by explaining to the patient why the various drugs are important and how they work or, if compliance is a persistent problem, by acting as the patient’s advocate and discussing with other healthcare professionals if alternative dosing regimes may assist compliance. 2) Facilitate recovery from the illness: This is a vast topic and will, to a large extent, be dependent on the disease process. Clearly the patient who has modest hypertension will require quite different input from the patient who has just sustained a major myocardial infarction. In the acutely debilitated patient, the nurse will need to play a more active and practical role than with the ambulant and largely well patient. Because of the emphasis of this essay on smoking cessation one can specifically include this as a major task in this area of the management plan. The specific details and treatment options will be discussed later. There is evidence that by assisting the patient to quit smoking, this will directly assist in the recovery process from the heart disease. (Siahpush et al. 2003) 3) Provide emotional support: This may be relevant in the patient who smokes primarily for reasons of anxiety or stress. Exploration of the causative factors is clearly relevant if any targeted approaches are going to be effective. If the heart disease is newly diagnosed, additional support may be required to help the patient adapt from a perceived wellness role to an illness role. (Roy. 1991). In this segment one should note that there is some suggestion that the anxiety sometimes caused by the process of smoking cessation can be counter-productive to the treatment of some forms of heart disease. There does not appear to be a strong evidence base to support this intuitive view however. (Sullivan et al. 2007) 4) Prevent the disease: It is known that patients who have smoked will always have a higher lifetime risk of disease than those who have never smoked. Absolute prevention is therefore not possible. Patients who smoke and are then persuaded to stop, can reduce their risks very considerably. It is known that patients who stop smoking will reduce their risks of myocardial infarction by 50% in the first year of smoking cessation. (Prescott et al. 1998) Expected outcome One can hope to assist the majority of patients to quit smoking. To a degree, one has to accept that there will always be a resistant nucleus of individuals who will (for whatever reason) simply not give up. It is not possible to predict, in advance of the intervention, which patients will be in the group that eventually relapses, therefore all patients should be helped equally aggressively. If one considers the results of the Hilleman trial, one is faced with the remarkable prospect that in a study of post CABG patients (who one might assume had the greatest incentive to quit smoking) a staggering 84% were back smoking within 10 weeks of the operation despite a huge input of anti smoking propaganda. (Hilleman et al. 2004) Patient empowerment and education A number of sources highlight patient empowerment and education as one of the prime predictors in a positive decision to quit smoking. (viz. Edwards 2004). If a patient understands the reasoning behind why they are being asked to undertake a health programme they are more likely to comply with it. Education is therefore one of the major factors in the various programmes designed to help patients give up smoking. Empowerment is another prime factor. Many studies have highlighted the need to stress self-belief in the patient and that the degree of self-belief equates strongly with a positive result. (viz. Miller et al. 2003) Smoking cessation A brief overview of the literature on smoking cessation will indicate that the subject is vast and that many different approaches have been tried with varying degrees of success. It is not appropriate to consider all of the various options, but this essay will cover those that appear to have the greatest reported degrees of success. Fung considered interventions that were suitable for hospitalised patients and of the four different regimes trialed, found that a regime which incorporated face-to-face counselling to identify risk factors for smoking Maintenance, individualising advice about quitting, involving patients in education measures (particularly exploration of the health effects and the benefits of quitting), was the most effective. (Fung et al. 2005). The authors also make the comment that the single most effective strategy was to get the smoker to adopt specific coping strategies such as disassociating the act of smoking from their normal daily routine and habits. They were asked not to smoke inside the home or inside the car, not to smoke with coffee or when reading or directly after a meal. Encouraging the family and friends to support them was the next most effective strategy. (Town et al. 2000) Many authorities advocate the use of nicotine replacement therapy (viz. Sullivan et al. 2007). Currently this is available in several presentations with the transdermal patches appearing to give the best rates of prolonged abstinence (about double that of placebo). Even the best results from trials however, do not give a success rate above 35% with the majority giving results in the region of about 20% abstinence at six months. (Hilleman et al. 2004) Follow up Because of the high relapse rate in smoking cessation programmes, follow up is an essential part of the management plan. The literature is full of various follow up strategies ranging from time intensive home follow ups to phone call contacts. It would appear that no one particular form of follow up is significantly more effective than any other. It has been found that any form of follow up is more effective than no follow up at all. Conclusions The evidence base to link cigarette smoking and heart disease is unchallengeable. Advising and helping a patient who has demonstrable heart disease to give up the habit is almost certainly going to have a beneficial effect on their long term health. In reaching this conclusion, one should not loose sight of the fact that there is a substantial failure rate. Any management plan to encourage the patient who smokes to quit, should make use of targeted interventions with follow up and consider using the approaches with optimum outcomes in order to achieve the best achievable response. References Edwards, R (2004) The problem of tobacco smoking. BMJ 328, 217 219 Ferguson, J A, Patten, C A, Schroeder, D R, et al (2003) : Predictors of 6-month tobacco abstinence among 1224 cigarette smokers treated for nicotine dependence. Addict Behav 2003; 28, 1203 1218 Frieden T R, Blakeman D E. (2005) The Dirty Dozen : 12 Myths That Undermine Tobacco Control. American Journal of Public Health . September 2005, Vol 95, No. 9 1500 1505 Fung P R, Snape-Jenkinson S L, Godfrey M T, Love K W, Zimmerman P V (2005) Effectiveness of Hospital-Based Smoking Cessation Chest. 2005; 128 : 216 223. Heiss C, N. Amabile, A. C. Lee, W. M. Real, S. F. Schick, D. Lao, M. L. Wong, S. Jahn, F. S. Angeli, P. Minasi, et al. (2008) Brief secondhand smoke exposure depresses endothelial progenitor cells activity and endothelial function : sustained vascular injury and blunted nitric oxide production. J. Am. Coll. Cardiol., May 6, 2008; 51 (18) : 1760 1771. Hilleman D E, Mohiuddin S M, Packard K A (2004) Comparison of Conservative and Aggressive Smoking Cessation Treatment Strategies Following Coronary Artery Bypass Graft Surgery. Chest. 2004; 125 : 435 438. Miller, M, Wood, L (2003) Effectiveness of smoking cessation interventions: review of evidence and implications for best practice in Australian health care settings. Aust N Z J Public Health 2003; 27 : 300 309 Missel E, G. S. Mintz, S. G. Carlier, J. Qian, S. Shan, C. Castellanos, R. Kaple, S. Biro, M. Fahy, J. W. Moses, et al. (2008) In vivo virtual histology intravascular ultrasound correlates of risk factors for sudden coronary death in men: results from the prospective, multi-centre virtual histology intravascular ultrasound registry Eur. Heart J., July 2, 2008; (2008) ehn 293 v1. Molyneux, A Nicotine replacement therapy. BMJ 2004; 328 : 454 456 OConnell E D, J. M Nolan, J. Stack, D. Greenberg, J. Kyle, L. Maddock, and S. Beatty (2008) Diet and risk factors for age-related maculopathy. Am. J. Clinical Nutrition, March 1, 2008; 87 (3) : 712 722. Parrott, S, Godfrey, C (2004) Economics of smoking cessation. BMJ 2004; 328 : 947 949 Prescott E, Hippe M, Schnohr P, Hein H O, Vestbo J. (1998) Smoking and risk of myocardial infarction in women and men : longitudinal population study. BMJ 1998; 316 : 1043 1047 Rigotti, N A, Munafo, M R, Murphy, M F G, et al (2004) Interventions for smoking cessation in hospitalised patients (Cochrane Review). The Cochrane Library. Issue 3, 2004 John Wiley Sons. Chichester, UK: Roy C (1991) An Adaption model (Notes on the Nursing theories Vol 3) OUP : London 1991 Siahpush, M, Borland, R, Scollo, M (2003) Factors associated with smoking cessation in a national sample of Australians. Nicotine Tob Res 2003; 5 : 597 602 Sullivan K M, Seed S E, DeBellis R J. (2007) State of the Art Reviews : Smoking Cessation. A Review of Treatment Considerations . American Journal of Lifestyle Medicine, Vol. 1, No. 3, 201 213 (2007) Town, G I, Fraser, P, Graham, S, et al (2000) Establishment of a smoking cessation programme in primary and secondary care in Canterbury. N Z Med J 2000; 113 : 117 119 Wood-Baker, R (2002) Outcome of a smoking cessation programme run in a routine hospital setting. Intern Med J 2002; 32 : 24 28 ########################################################### 3.8.08 Word count 2,503 PDG

The Role of Washington County, Ohio in the Success of the Underground R

The Role of Washington County, Ohio in the Success of the Underground Railroad Gone, gone, --sold and gone To the rice-swamps dank and lone, From Virginia's hills and waters, -- Woe is me, my stolen daughters!" (Whittier in Hamilton, pg. 105) Families torn apart, humans sold on auction blocks, using humans for animal labor. These tragedies along with the words of the Quaker poet John Whiittier are just the beginning when trying to explain the motivation for abolitionists helping to free slaves. The Underground Railroad was a path to safety and freedom for thousands of slaves before the Civil War. Escaping from the chains, confinement and abuse of slavery was no easy task and it took the cooperation of many people to make escape possible. The anti-slavery movement created this path to guide and protect escaped slaves on their way to Canada, the freedom land. Many slaves traveled through Ohio on their journey and were assisted by Ohio residents. My research paper will answer the question: What role did Washington County, Ohio, play in the success of the Underground Railroad? Limitations and Delimitations While there were many states, slaves and abolitionists involved in the Underground Railroad, certain restrictions must be placed on the research. The research in this paper will only cover four stations and their conductors from Washington County, Ohio. The paper will take you on a trip through this county from a slaves point of view. Although the history and origin of slavery will not be covered in this paper, the feelings and thoughts of the slaves on their journeys will be depicted. Fugitive slaves, or runaway slaves, were fleeing a life of hardship and confinement for a life of h... ...hat even bloodhounds will not scent out (Cosner, pg. 85). WORKS CITED Hamilton, Virginia. Many Thousand Gone . New York: Scholastic, Inc, 1993. Blockson, Charles L. The Underground Railroad . New York: Prentice Hall, 1982. Cosner, Sharon. The Underground Railroad . New York: Venture, 1991. DuBois, W.E.B. The Souls of Black Folk . New York: Penguin Books, 1989. Burke, Henry R. Journeys on the Underground Railroad . Marietta, OH: The Underground Railroad Research Center, 1995. Douglas, Fredrick. Narrative of the Life of Fredrick Douglas, An American Slave . New York: Penguin Classics, 1986. "Underground Railroad." World Book Encyclopedia . 1992 ed. "Underground Railroad." Encyclopedia Americana . 1972 ed. Burke, Henry R. Personal Interview. 22 October 1996. Burke, Henry R. E-mail to Author. 18 November 1996.

Psychodynamic approach Essay

P1 – Explain the principle psychological perspectives. M1 – Assess different psychological approaches to study. Sigmund Freud developed an approach which was the first psychological approach that elucidated behaviour. Freud discovered the psychoanalysis, which is a technique for curing mental illness and also a theory which explains human behaviour. Psychoanalysis is recognised as the talking cure. Normally, Freud would inspire his patients to talk freely (on his famous couch) concerning their symptoms and to explain precisely what was on their mind. He also states ‘The iceberg which has 3 levels known as the conscious mind, preconscious and unconscious mind. Freud compared himself to an archaeologist digging away layers of the human mind, and found three discrete parts of the mind. He was the earliest philosophers to get public awareness the concept that we are not conscious of all our features all the time. He proposed that what we are conscious of is represented on our conscious mind but that most of our memories, feelings and mind he named as ‘unconscious’. We don’t have access to the contents of our unconscious, but they occasionally ‘leak out’ in dreams and slips of the tongue. Freud’s first elucidated behaviour by his iceberg analogy. He suggested that the conscious mind was like the tip of an iceberg –merely a small part being accessible to consciousness. Part of the unconscious that we can easily access he named it the preconscious. This can be used in health and social care as health carers can identify what is happening in the client’s conscious mind and identify any faults there might be such as depression and schizophrenia and possibly phobias. Sigmund Freud proposed that we have inborn drives that stimulates our conducts in the form of the mind. These are known as the ego, superego and the id. The id occurs at birth and is the base of our unconscious inclination. It works on the gratification concept to get instant pleasure, so it prevents pain and therefore it is very egocentric. The id is the origin of a supernatural known as Libido. The superego  develops throughout the age of five years and entails principles and values. It is the child’s ego and moral sense which constructs the paragon of what the child wishes to be. Our ego is developed throughout our childhood and it enables the child to learn that getting instant gratification is not always feasible and that a lot of the time pain cannot be prevented The ego operates on the actuality principle because it decides what actions are most convenient and what to avoid from the id. It also tries to balance the requirements of the id and superego with the actualit y of life so we can do what normal individuals do by using the defence mechanisms. Depending on Sigmund our defence mechanisms are used in order to manage unconscious dispute amongst ego, superego and id. These disputes might be unconscious or conscious and the defence mechanisms work in an unconscious manner to wards of any disagreeable feelings and make things better for the person. There are four key defence systems that are used by the ego. An example is displacement. Displacement is when people’s emotional state towards the actual goal cannot be expressed and where accepting faults cause concern and worry that causes moods to be interchanged on to other objects. For instance an individual blaming their parents for their performance as of them not raising them properly instead of blaming their self. Denial is another ego defence mechanism that is where someone cannot accept a specific truth. Individuals might object to believe occurrence or acknowledge emotions as of worry and concern, thus specific awareness is not dealt with. For instance, someone who is unwell might reject to believe this. Repression†¯is another well-known defence mechanism. Repression acts to keep information out of†¯conscious†¯recognition. Though, these memories don’t just vanish; they endure to impact our behaviour. For example, a person who has repressed memories of abuse suffered as a child might later have troubles making relationships. The final ego defence mechanism is regression. This is where people act out behaviours from the†¯stage of psychosexual development†¯in which they are fixated. For instance, someone fixated at an earlier developmental stage may cry or sulk as of hearing dissatisfying news upon. Behaviours related to regression can differ significantly depending  upon which stage the individual is fixated at. Someone fixated at the†¯oral stage†¯may start eating or smoking immoderately or may become verbally violent. A fixation at the†¯anal stage†¯might result in immoderate tidiness or messiness. Sigmund also developed the psychosexual stages of development. He supposed that character is chiefly started throughout the age of five years because early experiences play a great role in the development of character and endure to impact behaviour in the future. He believed that our character develop in stages in which pleasure-seeking drives of the id commence to focus on erogenous places. The driving power behind our performance was elucidated by psychosexual energy known as the libido. Through completing the stages successfully the person can develop a good character. Though, if the stages are not completed appropriately and specific matters at the stage are not sorted out. Then, it results in fixation. Fixation is where there is a continuous focus on an earlier psychosexual stage as of unsorted dispute. The person will continue to be stuck at this stage if the dispute is not resolved. There are five stages to the psychosexual that Freud suggested. The first stage is the oral stage, at this stage the child is 0-1 years of age and the chief source of libido is the mouth. Here the child will relish consuming food along with placing objects into their mouth. The essential impact at this stage is the mother because the child will link the mother and food with love. If they are neglected from food or are fed involuntarily then it may well cause matters in the future. If a child is weaning from liquid to solid foods they need to learn to be patient for food to be cooked instead of having food instantly. The second stage is the anal stage. At this stage the child is one to three years of age and the child will feel a sense of pleasure in the anus. The child will feel gratification from expelling or holding in excrement. The essential effect at this stage is being taught on how to use the toilet. The child will learn when and where they are intended to release excrement which will prevent fixation. Added to that, the child  would be capable to sway their parents by their bowel movements, because their parent’s devotion and approbation depends on whether or not they release excrement when they ask to be able to go to the toilet. Though, being too stern on the child being permitted to toilet training could possibly lead to fixation, also because the child might develop to become anal impetuous. The third stage is the phallic stage where the child is three to five years of age. The key source of libido here is the child’s penis or vagina and pleasure is obtained from masturbation. At this stage the child will encounter Electra complex and associate with their mother if they are female, whereas if the child is a male they will encounter Oedipus complex where he will associate with his father. Through being affected by this information positively, the superego is developed and they include the morals of the self-same sex parent along with association of gender and sex duties. If they do not associate with the self-same sex parent then they will become fixated at this level and this could possibly lead to homosexuality. The fourth stage is the latency period. At this period the child is six years of age. The latent period is a time of investigation in which the sexual drive is still present, but it is directed into other areas like intellectual pursuits and social interactions. They have reached puberty and the key source of gratification is playing with peers of both sexes. During this stage the child is active with playing with their peers that not much befalls in terms of sexuality. If fixation befalls here the child will not feel content with members of the incompatible sex because they grow up and will find it to build heterosexual relationships. This stage is essential in the development of social and communication skills and self-confidence. The final stage is the genital stage which arises from puberty and the key source of libido/gratification here is having sexual intercourse with others. At this stage the persons interests and feelings towards others benefit will develop and they try to create a balance among their discrete lifestyles. If fixation has arose throughout any other stage, it will become  obvious at this psychosexual stage. Though, a different concept was suggested by Erik Erikson which approved with Freud’s theory to a degree. This was Erik Erikson’s psychosocial stages of development. He thought like Freud that everyone grows in stages, however these stages endure during our life and rather than having a greater focus on the lust for indulgence we must deem our need to be tolerated also. Erikson suggested eight psychosocial stages of development. Stage one is where the child is aged from zero to one years of age and the focal point is how the infant is raised. If they are raised in the right way, then they will form trust, but if the infant isn’t raised in the right way, then the infant will begin to not trust parents/guardians and their surroundings. Stage two is where the child is aged from one to three years of age and the focal point is being permitted to freedom. If this is done appropriately the child will develop some sort of autonomy. If they are continuously criticised the child will interrogate their own aptitude. Stage three is where the child is three to six years of age and begin to interact with the everyone. If the child is persuaded to endeavour different things and develop different skills and qualities, it will enable them to develop capabilities and self-assurance. However, if the child is continuously criticised and made culpable, then it will cause low confidence. Stage four is where the child is six to twelve years of age and focuses on the knowledge of how things operate. If the child begins to accomplish practical jobs they will form some kind of hard work however, if they are being pressured on specific tasks that they cannot accomplish will cause subservient and make them feel incapable. Stage five is where the person is twelve to eighteen years of age and the main focus at this stage is developing some sort of individuality by experimentation. Through being permitted to do the experiment, the child could then possibly develop a secure identity. However, not experimenting means they do not create a secure identity and causes misperception and negative identity. Stage six is where the person is aged eighteen to forty years of age and will focus on discovering new relationships to lead to long term commitments with each other. By creating these secure and committed relationships the sense of safety and be associated to devotion leads to a sense of love. Though,  through ignoring closeness and having phobia of commitment can cause the person to isolate them-selves and this little amount of love and could cause depression. Stage seven is where the person is aged forty to sixty five and the main focus is creating a career and having a family. Through having a career and giving back to society by parenting children and participating in community services, the person receives a sense of love and care. However, not getting participating with society could possibly cause a feeling of wasting life and being unfruitful. Stage eight is the final stage and here the person is over the age f sixty five. The person’s focal point at this stage is working less actively and intensely and think about their accomplishments during the course of their life. Through, performing this successfully, the person develops the merit of understanding that enables them to look back on their life with a feeling of accomplishment. This way the person is then able to can accept passing deprived of being afraid. Though, if the person has feelings of culpability about their life or has an insufficient achievement which will cause feelings of lead to feelings of desolation and frequently depression and as a result phobia of death. A benefit of the psychodynamic approach is that it is developed in stages. These stages make it easier to examine and give back up due to the fact that the stages are simple and easy to follow and acknowledge, therefore, making it easier to gather support for. On top of this, the stages developed by Erikson have more logic than Freud’s psychosexual stages because they make sense and are easy to acknowledge. This means that it can be easily implemented in health and social care practises. For instance in the counselling and treatment centre the health and social care workers are then able to use their insight of the eight stages of Erikson’s concept to detect why the person is feeling dejected has insufficient autonomy and tried to give most appropriate remedy. Though, some issues can be discovered with the psychodynamic approach. A problem is that the approach doesn’t use scientific methodology which means that it is based on opinions. This makes it hard to depend on the results because they are not a dependable source. This insufficient facts means the  approach is can be proven false. On top of this, a lot of the backing research originates from case studies. Though, these enable us to get in detailed information about one person. They might not be the most convenient when it comes to application to other people because the results can’t be generalised to the overall populace. A well-known case study that has been implement by Freud was the case of Little Hans, which was used as assistance for his psychodynamic approach. Little Hans had a fear of horses because he thought that they would hurt him or cause chaos. Little Han’s dad after being consulted by Freud, interpreted his fear through saying that the horses looked like his dad and that the phobia of being bitten signifies the fact that Little Hans was encountering the Oedipus complex and had a phobia of being castrated by his dad as of his feelings about his mum Little Han’s father and played a role his analyst and interpreted his sexual desires and associated these back to the Oedipus complex. Though, there are numerous factors to the Little Han’s case study that have been neglected. For instance, Little Han’s was more petrified of his mum because she threatened to cut off his penis because he was persistently fiddling with it. Also, after Freud spent some time with Little Han’s his parents split up. This means that Little Han’s phobia might be as of the reason that his parents ended their marriage and not be as of Oedipus complex. On top of this, his mum was also spiteful to her baby daughter, therefore it can possibly be that the ‘row’ he was scared of was the crying of his baby sister. Additionally, Freud analyse Little Han’s fear him-self. It was his dad who used Freud’s instructions in order to cure Little Han’s phobia. This means that, as his dad is not an expert analyst, he didn’t get the ideal remedy and the interpretations made might have possible been wrong, and so leading to inadequate remedies . This case study indicates that there are numerous different factors that Freud didn’t deem which could have been the motive of Little Han’s’ phobia. His phobia might have been better elucidated through operant conditioning. Little Han’s had witnessed a falling horse before, therefore, it might be that he related his fear at that instant with the falling horse and therefore develop the phobia.   However, Freud was capable to gather an adequate amount of data about Little Han’s which helped him in the explanation of his fear. However, his case studies are subject to partiality as most of his case studies focused on middle-class Victorian female, however some of his cases focused on males. This indicates that his results are sex bias and might not be relevant to the opposite sex. Also, his explanation are opinion based which means that they might vary to another psychoanalyst’s explanation. This could possible lead to issues to the welfare of the person who will not get remedies as of dissimilar information they are getting. Another problem with the psychodynamic approach is that the therapies people get entails time and dedication. This means that the client needs to be dedicated in the remedy in order for them to recover. Another therapy like medicine might possibly be quicker, however psychoanalysis has a more long term effect on the person. Where remedies can lead to deterioration, psychoanalysis will alter the client’s perception and lead to long term modifications. This is beneficial for the patient because at the therapy and counselling centre, they will be aware that the dedication and time will be useful, also will identify long term modification after some time.

Universe

For this week's essay it was asked of me to write about the ways in which life observed In nature can yield understanding In our own lives. From my own observation of nature I have learned that everyone has a role to play In life. No matter how small of a creature: there is something vital that it does for our existence. In the following paragraphs I will be explaining this a bit more into detail. To make my perspective a bit more clear I will be providing a few examples. For example ants, ants are such small creatures and without doing any research hind; what ecological importance does an ant have?Honestly I can't think of any Important roles an ant may have for our ecosystem so I did a bit of research. Ants turn and aerate the solo allowing water and oxygen to reach plant roots; they are also a very important part of the food web. Some species of ants eat termites: others are the actual meal for other animals such as frogs, bears, etc. Zebra mussels are small triangle shaped shells and are usually a brown color with stripes. In fresh water ecosystems they can act as filters for plankton, by clearing the eater sunlight can reach deeper Into the water; this lets more aquatic animals to grow.Although they do provide benefits to our ecosystem they can also be very damaging; they can clog pipes, they eat phytoplankton which leaves less food for fish and zooplankton. They tend to grow on manmade structures which affect the governments and business owners financial troubles. In my opinion difficulty plays an important role in our life; if we don't experience the bad things how will we know what the good things are? I think that the hardships e face not only help us realize the good things in life but also help us learn to appreciate them.In my experience the sports adage – No pain, no gain Is true. To me It means that nothing worthwhile Is ever going to be easy. Is the gain ever worth the pain? Yes, yes it is. For example, I am in a long distance relationship right now. My boyfriend currently resides in Colorado while I'm living in Arizona. It's definitely hard to be so far apart and not see each other that often and we both make sacrifices on each ends and it's a struggle sometimes but in the end it's Roth It.As far as what type of gain it has to be In order to be worthwhile Ill have to say that that's subjective to each person. In conclusion, from observing nature I have learned that even when it doesn't seem like we have a role to play we do have one. God has a plan for us and we should trust that, also even the smallest things can make a huge impact in our lives.

20 Informative Essay Topics Discuss Controversial Redistricting Issues with Ease!

20 Informative Essay Topics Discuss Controversial Redistricting Issues with Ease! Redistricting is a political topic which deals with the segmentation of large cities into smaller districts. As this is a research topic with a big spectrum, your course instructor might be tempted to assign it. If you have been asked to write a detailed paper or essay on this topic, you can go over to our 10 facts on redistricting for an informative essay and find a lot of details on the subject. However, if you are looking for direct topics which will make your research a lot easier and narrow, here are 20 you can pick out from for your essay. Here are 20 topics regarding redistricting for your informative essay: The General History of Redistricting Vs. Current Redistricting How The Baker Vs. Carr Trial Played Part in Contemporary Redistricting The Necessity of Redistricting The Logic Behind Its Concept Discuss The Origins of the â€Å"1-Person-Equals-1-Vote† Statement The Effects of Geographical Contiguity on Redistricting A Detailed Look at Partisan Gerrymandering Its Setbacks Bipartisan Gerrymandering Its Benefits What is Biased Redistricting? History of Litigations Against Biased Redistricting What Role Does Redistricting Play In Eliminating Incumbents? Reasons Why Richard Cranwell Didn’t Run for Re-Election after Redistricting How Minority Votes are Rendered Useless in Redistricting The Strategic Dilution of The Latino Community Votes in 2003 Adverse Effects of Redistricting on Small Communities Effects of Redistricting of Regions with Certain Predominant Ethnic Populations The 92’ Race Riots Their Adverse Effects on Koreatown How States Use Legislators for Redistricting Commissions Their Reliabilities on Redistricting Backup Commision Vs. Political Commission Independent Commission Its Role in Legislations You can elaborate on these topics extensively and if you are just getting started, look at our guide on how to write an informative essay on redistricting for tips and tricks. To assist and inspire you to write the best essay, here is an example of an informative and authoritative essay. Sample Informative Essay on the History of Redistricting Redistricting is an example of how the American democratic system handles equality. This political strategy is used to adjust the population of the country to districts. Redistricting has a huge impact on our daily lives and it is important that we study its topics in detail so we can make an informed decision for our communities. Federal, state and local legislatures are elected from districts and their size is usually the same as the entire jurisdiction. For example, if we talk about the members of a school board, they may be elected from the area of the same boundaries and not the overall district of the school that the board governs. However, a lot of times, the district lines subdivide territories. This results in one city or a state controlling multiple districts. When this happens, an entity is needed that can create a system to decide where the lines are. In the colonial times, constraints of a district were defined by borders of individuals or collection of towns and counties. Legislatures were formed by assigning a particular number of representatives to each district. The 1777 New York State’s constitution, which had assigned a total of 9 representatives to the city, is a good example of this. However, because the overall population had grown exponentially, the growth was not equal; while some towns and counties grew larger, others didn’t. Some jurisdictions didn’t update their systems and as a result, there was an imbalance between the number of representative and district lines. Districts that didn’t modify their borders and number of representatives presented various reasons. While some complained about conflicting policies, others failed to follow because of personal political interests. Some states blankly refused to redistrict, as in the case of the state of Tennessee. There was also a lack in equality with regards to the size of the district because the Los Angeles county was 400 times larger than the smallest district in California. Before the 60s, there was unjust manipulation of district borders to enforce a certain political impact. Unfair drawing of district lines helped incumbents increase their likelihood to gain points in electoral campaign. After the 60s, the rules changed due to a series of Supreme Court cases and it was firmly decided that no such biases would be tolerated. Redistricting became a constitutional right of a citizen and it was imperative for the population for each district to be equal. District boundaries were then regularly adjusted so new information about the population could be accounted for. Though this is a good example of a redistricting essay, you can produce an even better one if you put your mind to it. So instead of waiting for the deadline and writing a poorly researched essay, start right away and your instructor will soon begin singing your praise. References: U.S. Const. art. I,  §2, cl. 3. See, e.g., N.Y. Const. art. III,  § 4 (setting the size of the State Senate). Office of the Clerk, U.S. House of Representatives, Congressional Apportionment, at http://clerk.house.gov/art_history/house_history/congApp/. Act of Aug. 8, 1911, ch. 5, Pub. L. No. 62-5, 37 Stat. 13; Reapportionment Act of June 18, 1929, ch. 28, Pub. L. No. 71-13, 46 Stat. 21, 26–27. Hanh Quach Dena Bunis, All Bow to Redistrict Architect, Orange County Register, Aug. 26, 2001. The â€Å"hand,† at the eastern end of current district 11, excised a portion of what had been Cranwell’s district 14. Lindsey Nair, Redistricting Effectively Moves Cranwell, Roanoke Times, Apr. 24, 2001. See Ill. State Board of Elections, Search Vote Totals, at elections.il.gov/electioninformation/GetVoteTotals.aspx

Plagiarism Essay Example | Topics and Well Written Essays - 1250 words - 3

Plagiarism - Essay Example one else’s language, ideas, or other original (not common-knowledge) material without acknowledg ­ing its source (Council of Writing Program Administrators, 2003). Nelson and Stepchyshyn have defined plagiarism as the use or close imitation of the language and thoughts of another author and the representation of them as ones own original work (Stepchyshyn & Nelson, 2007). Plagiarism is not a new concept, passing off others’ writings and ideas as one’s own existed even before the internet came into existence. However, the easy access of a variety of materials has caused an increase in plagiarism and it has now become a great cause for concern for universities and academic institutions across the world. About two decades back, plagiarism did not have severe punishments or consequences. However, in today’s scenario plagiarism is very serious offence and can have numerous consequences that include expulsion from the academic institution or a job. Apart from that, the most serious consequence is that the loss of credibility of a writer. One key reason why students indulge in plagiarism could be lack of awareness. As Evan (2000) says, everyone seems to know that plagiarism is wrong, including those who commit the offence, but few know how to completely define it. Many students do not understand that even using their own previous works without citation is plagiarism. This increases the instances of unintentional or accidental plagiarism, where students are not aware of what qualifies as plagiarism. For some students, reproducing large chunks of others’ texts is a way of signalling they know of the existence of this information (Ryan, 2000). Therefore, it is clear that lack of proper awareness is one reason why there is an increase in plagiarism. Ensuring proper awareness and making the students familiar with the various aspects of plagiarism can make the students more conscious and thereby reducing the cases of unintentional plagiarism. Teaching appropriate

Spreading Democracy Essay Example | Topics and Well Written Essays - 750 words

Spreading Democracy - Essay Example This is not a situation that people and nations are likely to outgrow in the foreseeable future – perhaps not ever (Andersen, Seibert and Wagner). The end product of this mistrust that has grown over time has been the hostility leading from suspicion against the West. The reaction of the populations of the Middle East should however not be thought to always be at a consensus; far from it. There has been support by some regimes for the West which includes the United States seen as the â€Å"heir of the British imperialism† (Richman 3). The united states has been involved in the political situation in the Middle East since World War II in order to ensure that the oil rich fields stay within friendly arms and also in a bid to fending off competition especially from the then soviet union. It is this interests that have amassed a story of triumph and tragedy for the US in that region. The relationship with Iraq was born out of the desire to reign on the threat posed by Iran and this underwent a metamorphosis into a relationship jointly between Iran, Syria and the United States against Iraq in recent years. The action of President Bush to intervene in the Persian Gulf War with the aim of restoring the feudal monarch of Kuwait, which he viewed as the legitimate one, was not an abrupt decision. It had been the culmination of US foreign policy in the region for a long time that had spun for many administrations. It was as a deterioration of the relationship between the US and Iraq, which had started as far back as during the Baghdad pact that was aimed at making Iraq the capital of NATO which was a strategy against the soviets. The then government was overthrown by Abd al-Karim Qasim who accused it of being pro-Western. Qasim led the country from 1958 to 1963 when he was driven out in a coup by Abd al-Salam Arif who was said to have received help from the US Central Intelligence Agency (CIA). Earlier, in an attempt to overthrow Qasim, Saddam Hussein had be en involved in a failed coup in 1959, however, with the help of the CIA which had been accused of being his sympathizer, he overthrew the government of Arif in 1968 (Battle 2). This proves that the US has been involved in the political landscape of Iraq even before the advent of World War II. In 1979, when Saddam became prime minister, there was a concerted effort by him and his close family members in conjunction with people of his hometown to establish a dictatorship. Jimmy Carter, who was the president of the United States during the Iran-Iraq war, chose to be â€Å"neutral† when the war initially broke out (Lenczowski 8). Secretly though, the US was accused of aiding the Iraqis in a bid to undermining the rule of Ayatollah Khomeini in Iran. The tilt in the US policy of neutrality was born out of the hostage situation that occurred when Iran held 52 Americans. However, records show that the US was involved in funding Iraq through Saudi Arabia. The US was hoping that by pro pagating the war, the Iranians would eventually run out of supplies and would need spares. Here, they anticipated that the Iranian resolve would have been eroded and they could secure their hostages. The US did no however anticipate that the Iranians would turn to Vietnam where they themselves had left enough spares during their invasion there. The US deliberately exposed the weaknesses that the Iranians had in a bid to inciting the Iraqis into the war. This collaboration of the US with Iraq born out of the common enmity with Iran was aimed at serving the purpose of quelling the opposition that the Iranian administration had of the West and of retaining Iraq as a strategic partner in the continued inhabitation in the region. However, the US only looked at the areas that they were to gain, did not see the actions