Ventilator associated pneumonia Essay Example | Topics and Well Written Essays - 750 words

Ventilator associated pneumonia - Essay Example This element decreases VAP by decreasing the risk of aspiration of gastrointestinal secretions and also oro-naso-pharyngeal secretions and also by improving ventilation of the patient through higher spontaneous tidal volumes when compared to supine position (Safer Healthcare Now, 2011). Hospitals in Canada can implement this component by implementation of a strategy that ensures head end elevation like documentation of the intervention in nursing flow charts at regular intervals, as a topic of discussion during multidisciplinary daily rounds and as documentation on goals sheet. A protractor must be brought into the ICU to demonstrate the nursing staff as to how 45 degrees elevation looks like. A piece of colored tape must be pasted on the wall behind the bed of the patient to ensure compliance during ventilator checks. Another implementation strategy would be to include a specification for monitoring of head of the bed by mechanical devices. An environment must be created where all h ealth professionals like orderlies and radiology technicians are encouraged to notify the nursing as to whether the head of the bed is elevated. ... The staff must be encouraged and motivated for compliance (Safer Healthcare Now, 2011). 2. Daily performance of readiness to extubate by interruption of sedation and spontaneous breathing trial This is done to decrease the duration of mechanical ventilation and also early extubation which decreases VAP. This also decreases exposure to ventilator-circuit endotracheal tube device (Safer Healthcare Now, 2011). This element can be implemented by introducing a process which temporarily interrupts sedation every day at an appropriate time, like before rounds, to reappraise the neurocognitive ability of the patient, to assume a breathing pattern that is viable and to ascertain needs for analgesia and sedation. Sedation scale must be used to prevent under-sedation. These must be standardized for all mechanically ventilated patients and both these strategies must be linked into the protocol of weaning process. Non-invasive ventilation can be used as a strategy to liberate patients from mechan ical ventilation. Compliance must be discussed every day during rounds and compliance must be used to motivate and encourage the staff (Safer Healthcare Now, 2011). 3. Use of oral tubes rather than nasal tubes for tracheal or stomach access. This reduces the risk of nosocomial sinusitis and thus decreases the risk of VAP (Safer Healthcare Now, 2011). This element can be incorporated in the hospitals by making orotracheal intubation the standard protocol for mechanical ventilation. In all patients receiving mechanical ventilation for more than 24 hours, orogastric tube must be placed for gastric decompression and feeding rather than nasogastric tube and this must also be included in the protocols in not only ICUs, but

Molly Dinton Essay Example for Free

Molly Dinton Essay I dont know where documentary is going, but at the moment it is fast becoming a soap opera in order to keep its place in the schedules Molly Dinton. Dinton believes that the documentary genre is changing in order to survive. This evolution of the genre could be justified, and enables the diverse genre to still be able to attain fixtures on the British television broadcasting stations. The statement of the documentary fast becoming a soap opera, can to some extent be supported. Currently on British television, there has been a swarm of reality TV programmes and Docu- soaps, which can be seen as a polluted hybrid of the documentary genre. These programmes are noted as successful in attracting an audience, therefore, the TV institutions are more likely to exploit these wining formulas of the genre and schedule the newer, more popular American format of documentary rather than the traditional documentary formula that aims to construct a social criticism and catalyse change, which often has a stigma of smelling of dust and boredom (Alberto Cavalcanti). Institutions are able to have a minimal risk of financial failure with docu- soaps and reality TV programmes, because as well having a high rating of audience consumption, the programmes are financially very cheap to produce. This is because the hybrid forms do not generally have professional actors but consist of real people. Also the programmes are often filmed in cheap locations over a relatively short period of time compared with Nick Broomfields Aileen- The Life and Death of a Serial Killer. In this recent documentary (2003) Broomfield worked in America for multiple months, which would have been extremely costly. Paul Hanmann, head of BBC Documentary features, says that a reality programme is three times cheaper as comparable light entertainment. Or take for example, Martin Bashirs The Michael Jackson Story, where by Bashir followed Michael Jackson from country to country over a period of a year, making a very costly production for ITV. In this investigative documentary, it too can also be noted as conforming to the new soap opera style of documentary, as Bashir chose to present to the nation the version that sensationalised the Jackson story in a negative light creating a spin off of conversation for a duration after. Bashir, like a soap opera director, chose to present the narrative version of the documentary that would create the most dramatic effect or shock for the audience. TV executives are more keen on scheduling the popular forms of the documentary genre and make the values of the programme centre on entertainment, as they feel entertainment is more appealing to the audience than a documentary that exits on a moral and ethical dimension. The intertextuality of the Docu- Soaps such as Vet School, The Cruise and Driving school, attract huge viewing ratings. For example Driving school had a 12. 5 million audience. The Docu- soap resembles the conventional fly on the wall antecedents, but like a Soap Opera, the genre prioritises audience entertainment over social commentary, and focuses on characters and their personalities, rather than on their social roles or professions. Characters are picked for their personalities, to ensure interesting viewing and strike a parallel with the Soap Operas, in that the characters are known on a first name basis to build up a relationship between audience and screen characters. Likewise, the episodes are strongly based on the drive of the narrative structure, to make more entertaining, simplistic and more story- like for the audience to follow and enjoy. Yet another demonstration of documentaries becoming a soap opera is with channel 4s Thatll teach them. In this series, teenagers of today were seemingly sent back in time to be educated in the 1950s. The programme is then followed up, several months later with, That taught em, making the series like a soap opera because the channel are adding to the original narrative, in order to get a greater knowledge of the teenagers. Reality TV combines the commercial success of tabloid content with a public service mode of address. The genre includes The Salon, Big Brother, Police Camera Action and Wife Swap, which are all hugely popular. Big Brother had a staggering 45, 000 people audition to be on the programme. These programmes are essentially very alike in comparison to Soap Operas. Often in reality TV, contrasting personalities are deliberately selected or an arisen conflict sensationalised; also many of the programmes are edited in order to capture comedy moments. Moreover in the Docu- Soap Driving School, there is evidence to suggest that many of the sequences, or body language/ facial expressions in the programme were faked in order to create further dramatic effect. Through sensationalising episodes, these programmes are able to compete with the story lines of many soaps, and attract viewers who enjoy much of the dramatisation that occurs in the soap operas. It also serves to entertain the audience. Reality TV is very much like many soaps. This is achieved by using editing. The Directors are able to create a persona or character of the participants, that the audience will either love or loathe, through selecting which footage to air and which to discard. With CCTV footage in Police Camera Action and 24/7 actuality footage of the constructed documentary, Big Brother, the audience is able to involve themselves in dramatic irony and acquire a greater knowledge of the characters and their situations, like we are also able to do through watching soaps. As McCann states it often turns us into Peeping Toms, which obviously appeals to a sector of society. There is however, evidence to suggest that many documentaries, which adopt the objective of catalysing change in the law or the dominant ideology and use film verite, are also still scheduled on British TV. For example, during November of each year, war documentaries will be broadcasted for Remembrance Day, and in the month of August, documentaries on Princess Diana and her death will be documented, to heighten the audiences level of awareness surrounding her suspicious death. These documentaries try to offer several new pieces of information discovered that are based on fact and not fiction. Experts, eyewitnesses, and official civil servants provide the evidence for the programme, giving it credibility. The documentary serves to criticise, the way in which the investigation was run, but also to cause the audience to change their previously held opinion on the subject, and to take on and believe the message given by the text. Occasionally other documentaries by famous documentarians are scheduled, such as Nick Broomfields Biggie and Tupac, (channel 4 2003), where Broomfield exposes the maze of obstacles and corruption complicating the investigation of the unsolved murders of the rap stars. Also, it is evident that many nature documentaries are shown on channel five, but not at peak times, which docu- soaps and reality TV are aired. In addition to this there is evidence to suggest that not all documentaries have to become soap operas in order to keep its place in the soap operas. This point can be clearly illustrated with the co- production by the BBC and Discovery Channel in their creation of Walking with Dinosaurs. The documentary achieved huge success and was stated as being the biggest thing on TV in 160 million years. With the aid of computer graphics, the programme portrayed to the audience at peak times of scheduling, a factual account of how dinosaurs lived, adapted into the different time periods, and eventually became extinct. There are also niche channels on Digital or Sky channels, such as Discovery, History, and the Learning channel, all of which schedule films solely from the documentary genre. These channels have high ratings and status, but are not available to everyone. In conclusion, I feel that Molly Dinton was justified in stating that the documentary is fast becoming a soap opera in order to keep its place in the schedules. This is mainly because the mass audience prefer docu- soaps and reality TV, which are closely related to soap operas. This is because these factions of the documentary genre entertain, and cause diversion and escapism for the audience, who are easily able to relax in their leisure time and watch the light- entertainment programmes. They are not presented with a programme that requires the mind to work too hard after a draining day. The broadcasting institutions generally broadcast, what is demanded from the public and what is financially better for their business, making the way clear for further reality shows that resemble the soaps to be produced. Perhaps the film verite documentaries are not as popular as the hybrid genres because in general they require a higher intellect/ socio- economic group to follow the programme or be interested in the issues investigated. This form of documentary perhaps has outlived its usefulness and no longer has a very clear significance. The vast docu- soaps and reality television programmes are scheduled at peak times, because they appeal to a wider audience where as the occasional documentary is scheduled mainly in the late eve. Therefore it is true that documentaries are fast becoming soap operas in order to survive.

Number of Folds in Paper: Thickness of Earth to Sun

Number of Folds in Paper: Thickness of Earth to Sun Calculating the number of folds and the hypothetical size of a piece of paper so that its thickness equates to the distance from the Earth to Saturn. As a physics student doing the option on astrophysics, I have become very interested in the immensity of the universe. I decided it would be intriguing to combine it with my personal hobby of doing origami which helps me to relieve stress. As a result, I investigated the amount of times a piece of paper would need to be folded in half so that its thickness achieves a length which equates to the distance from the Earth to Saturn. I have chosen the planet Saturn because it is one of the biggest planets that can be observed by the naked eye and I have been able to see it last summer from the top of a high hill in La Pedriza in the Guadarrama mountain range near my hometown (Collado Villalba, Madrid, Spain). Popular claims suggested that it is impossible to fold a piece of paper in half more than seven times no matter its size or thickness.   Previous mathematicians have worked out the number of folds required to reach the moon from the Earth which was worked out to be 42 folds[1] using a m thick paper. The size of the paper however, was not found. In theory, the average folds for a normal size A4 (m) paper is seven. This is an interesting topic because it is incredible how, by exponential growth, a miniature of m thick like a piece of paper can be folded in half to reach the distance of the planet Saturn. Britney Gallivan[2] was able to fold a piece of toilet paper of 1200 meters a number of 12 folds. She derived two mathematical expressions based on geometrical sequences, taking into consideration the amount of paper lost in every fold. These formulas make it possible to calculate the hypothetical length L and width W of a piece of paper that would be folded n times to equate the distance from the Earth to Saturn. Gallivan established some rules that would need to be followed when folding a sheet of paper in half:       A single rectangular sheet of paper of any size and uniform thickness can be used. The fold line has to be in the same direction each time. The folding process must not tear the paper. When folded in half, the portions of the inner layers which face one another must almost touch one another. The average thickness or structure of material of paper must remain unaffected by the folding process. A fold is considered complete if portions of all layers lie in one straight line. Hence, the length L of the paper influences the number of times it can be folded in half. Hypothesis The distance from the Earth to Saturn will be obtained by folding a piece of paper ≠¥50 times with a hypothetically large enough paper. This exploration used exponential growth and logarithms in order to find out the number of folds required to reach Saturn. Before any calculation was done, it was indispensable to collect all the data required for the investigation. All the values were used were in the international system of units (metres) and standard form in order to keep the exploration standardized. Taking into consideration the elliptical orbits of the planets, sometimes they are closer to Earth and sometimes they are further away. Therefore, the value used during this mathematical exploration was the mean value of when they are the furthest apart and the closest together. Astronomical units (AU) are the standard unit measure used when dealing with distances within the Solar System. 1 AU is equal to the distance from the Earth to the Sun which is equivalent tom. Distance from the Earth to Saturn when closer together 8.00 AU[3] Distance from the Earth to Saturn when further apart 11.0 AU3 Mean distance from the Earth to Saturn    AU   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   m The thickness of a normal A4 paper (0.210 297m) was calculated by taking a measurement of an office pack of 500 pages (80gsm) which was found to be about 0.05m. The thickness of each individual page is calculated by dividing the total thickness (0.05m) by the amount of sheets (500); giving a result of m. Whenever a paper is folded in half, the number of layers is doubled so the thickness increases by two. When there is only one layer of paper (not folded), its thickness is m. Once it is folded in half for the first time, its thickness will be multiplied by 2 hence, m Folding it one more time means multiplying it by two again, m Thus, an expression can be established, showing the exponential growth; The expression can be represented in a graph to illustrate graphically the exponential growth because of folding. Graph 1: From Graph 1, it is possible to visualise how, something that seems unrealistic like folding a sheet of paper to reach Saturn becomes possible. The graph also illustrates how rapidly exponential growth occurs. Since the expression needs to be equal to the distance from the Earth to Saturn to work out (the number of folds), an equation to find can be solved: Folds To find, the rules of logarithms were put in place due to the exponential nature of the equation. The answer has been rounded up to 54 because it is not possible to have a half fold. Gallivan derived the following formula for the minimum length of a piece of paper of thickness t to be folded n times in a single direction To prove this formula, it is neccesary to understand that after each fold, some part of the paper is lost and becomes a rounded edge. I folded an A4 sheet of paper seven times in order to illustrate this: As you can see from the picture, there is a rounded edge on the side which is paper being lost and is not contributing to the real thickness but just joining the layers. The curved portion becomes bigger in correlation with the number of folds and begins to take a greater area of the volume of the paper. At the first fold, a semicircle of radius t (thickness) is formed, which has a perimeter . Thus, units of the paper are being used in the fold.   A paper smaller than this cannot be folded since there is not enough paper to form the fold. After the fold, there is a two-layer sheet of paper with a thickness of 2t. Another fold results in folding the second layer over the first layer. The second layer has a radius of , so it uses units of paper. The total amount of paper used by the second fold, for both layers, is resulting in a four-layer piece of paper. The ith fold begings with layers, and folding the jth layer uses units of paper. Hence, the total length of paper used for the ith fold is given by Therefore, to obtain the total length of paper required for n number of folds, sum this over i from 1 to n, which gives Gallivans formula: The thickness can be substituted into t and the number of folds can be substituted into n which gives L to be equal to 1.70-1028m. The other expression proposed by Gallivan can be used to calculate the width of the paper. If the length lost in the radii of earlier folds is not considered, the length lost must be considered in the last fold. At the final fold n, the side of the square must be at least equal to the length lost in the final fold which is (amount of length lost in each fold. Taking into consideration that the total area of the sheet (area = nb of sheets in penultimate step area of square in penultimate step) is preserved, Gallivans equation can be derived: Again, the thickness and number of folds can be substituted and an answer for W can be found giving W to be 2.69-1020m. In conclusion, the initial hypothesis was right since the number of folds was 54 which is, indeed, greater than 50. The hypothetical paper that could, in theory, be folded 54 times so that its thickness equates the distance from the Earth to Saturn of m would be long and wide (taking into consideration that its thickness would bem). The dimensions of this paper would be bigger than the actual distance from the Earth to Saturn so, unfortunately, we do not have a paper that big that would allow us to reach to Saturn just by folding it in half. This mathematical exploration used logarithms to find out the number of folds needed to reach Saturn with a m thick paper. However, the dimensions of this sheet of paper would be too big and hence, impossible to find in the Earths surface. Nevertheless, the exploration could have looked at using a thinner piece of paper to see if its dimensions would have been smaller and perhaps, we would have been able to find it in the surface of the Earth and we would have been able to reach Saturn. References       Astronomy, S. (2012). How Far away is Saturn? [Online] Space.com. Available at: http://www.space.com/18477-how-far-away-is-saturn.html [Accessed 16 Jan. 2017]. IFLScience. (2016). Fold A Piece of Paper in Half 103 Times and It Will Be As Thick As the UNIVERSE. [Online] Available at: http://www.iflscience.com/space/fold-piece-paper-half-103-times-and-it-will-be-thick-universe/ [Accessed 16 Jan. 2017]. Pomonahistorical.org. (2002). Folding Paper in Half Twelve Times. [Online] Available at: http://pomonahistorical.org/12times.htm [Accessed 16 Jan. 2017]. [1] IFLScience. (2016). Fold A Piece of Paper in Half 103 Times and It Will Be As Thick As the UNIVERSE. [online] Available at: http://www.iflscience.com/space/fold-piece-paper-half-103-times-and-it-will-be-thick-universe/ [Accessed 16 Jan. 2017]. [2]Pomonahistorical.org. (2002). Folding Paper in Half Twelve Times. [online] Available at: http://pomonahistorical.org/12times.htm [Accessed 16 Jan. 2017]. [3] Astronomy, S. (2012). How Far away is Saturn? [online] Space.com. Available at: http://www.space.com/18477-how-far-away-is-saturn.html [Accessed 16 Jan. 2017].

The Lady in Black and the Lovers in The Awakening :: Chopin Awakening Essays

The Lady in Black and the Lovers in The Awakening Kate Chopin's The Awakening is a terrific read and I am hardly able to put it down! I am up to chapter XV and many of the characters are developing in very interesting ways. Edna is unfulfilled as a wife and mother even though she and her husband are financially well off. Her husband, Leonce Pontellier, is a good husband and father but he has only been paying attention to his own interests. At this point he is unaware of the fact that his wife's needs are not being met. Robert and the other characters are equally intriguing but something else has piqued my interest. Some of Chopin's characters are not fully developed. I know that these are important characters because they are representative of specific things; they are metaphoric characters. In particular, I've noticed the lovers and the lady in black. I'm fascinated by the fact that both the lovers and the lady in black are completely oblivious to the rest of the world. They are also in direct contrast with e ach another. For this week's reader response I am taking a different approach. Rather than analyzing the main characters, I will examine the lovers and the lady in black. The lady in black is first mentioned in Chapter I. Mr. Pontellier is surveying the cottages when he notices that a lady in black is walking demurely up and down, with her beads (468). In this example the rosary beads suggest that the lady in black is religious. I believe that this character is a symbol of religion. While everyone else is relaxing, she is busy praying. It is also worth noting that there are several passages which suggest that Edna is rebelling from her religious upbringing. For example, just after we meet the lovers, Edna shares a memory with Madame Ratignolle. She describes herself walking through a meadow as a young girl. She says, "Likely as not it was Sunday... and I was running away from prayers, from the Presbyterian service, read in a spirit of gloom by my father that chills me yet to think of it" (480). Similar to the description of her fathers service, the lady in black is serious and serene.

Ecstasy :: essays research papers

Ecstasy is a very popular designer drug. It is said to give complete euphoria for up to 6 hours. It came around in the 80’s and is becoming more popular now. It’s real name is MDMA (3,4-Methylenedioxy-N-Methylamphetamine). It is a dangerous high and is more popular with young people. In the following paragraphs are some information about the drug. Ecstasy is sold on the streets and is illegal as a schedule 1 drug, along with heroin and cocaine. It has many street names like beans, X, E, rolls, etc... Ecstasy can range anywhere from $5 to $25 and is usually a 100-150 mg pill. It’s known as the â€Å"love drug† because you are supposed to be very generous and friendly when on the drug. Effects generally happen within 20-40 minutes, when the user often experiences a brief "rush" of energy, usually described as mild but euphoric. After this rush, the high levels off to a peak which lasts 2-3 hours and is followed by a "coming down" sensation. MDMA exerts amphetamine-like effects which include dilated pupils, dry mouth and throat, tension in the lower jaw, grinding of the teeth, nystagmus (eye wiggles), sweating, or nausea and overall stimulation. These side effects are dose dependent and will vary depending on the health of the individual user. The following are some feelings or emotions the ecstasy user experiences: Entactogenesis ("touching within") This is a generalized feeling that all is right and good with the world. People on MDMA often describe feeling "at peace" or experiencing a generalized "happy" feeling. Also, common everyday things may seem to be abnormally beautiful or interesting. Empathogenesis Empathogenesis is a feeling of emotional closeness to others (and to one's self) coupled with a breakdown of personal communication barriers. People on MDMA report feeling much more at ease talking to others and that any hang-ups that one may have with regard to "opening up" to others may be reduced or even eliminated. An enhancement of the senses MDMA can significantly enhance (sometimes distort) the senses - touch, proprioception, vision, taste, smell. â€Å"Beaners† can sometimes be seen running their hands over differently textured objects repeatedly, tasting and smelling various foods/drinks. â€Å"Ecstasy. The perfect word. No other could have described what I was experiencing right then and there. Beyond words. The entire message was contained in a scream and the most intense smile my face had displayed in ages.

The Plague as a Metaphor in Shelleys The Last Man :: Shelley The Last Man

The Plague as a Metaphor in Shelley's The Last Man      Ã‚   The Last Man was Mary Shelley's most ambitious and experimental work. Necessitating that a plague, which decimates mankind, is justified in its pursuit, Mary Shelley creates a world where utopian ideals can cause the destruction of mankind, if they are not checked by moral and ethical standards. Published in 1826, the novel was widely pilloried by a public who found it's gloomy tone and high Romanticism to be 'out of touch' with a more progressive society. Mary Shelley's concept of humanity decimated by a deadly plague affronted progressive politicians as godless and as a result, the novel was banned in Austria and became more of an in topic at dinner parties than a book to be seriously read. Since its publication, Mary Shelley scholars have ignored The Last Man and concentrated on Frankenstein because of the novel's reflection of the influential Romantic circle of Lord Byron and Percy Shelley. It wasn't until the feminist movement of the 1970's that the novel underwent a re birth and became critically judged as a work far superior to Frankenstein. Written three years after the death of Percy Shelley, The Last Man is a reflection of the political influence of William Godwin and the Romantic ideals of Lord Byron and Percy Shelley. Despite her initial desire to dedicate the work to the ideology of these men, The Last Man serves as Mary Shelley's repudiation of the utopian ideal perpetuated by Godwin, Shelley and Lord Byron. The plague serves as a metaphor for the failure of the utopian ideal to support the traditional needs of the family. As a biographical and political novel, The Last Man is Mary Shelley's quest to understand her husband, father and Lord Byron's political ideals and their subsequent failure to support her and her children.    Mary Shelley led a most extraordinary life. As the daughter of the radical writers, Mary Wollstonecraft and William Godwin, it appeared to be Mary's destiny to earn a living through her writing. As she states in her 1831 preface to Frankenstein, "It is not singular that, as the daughter of two persons of distinguished literary celebrity, I should have very early in life thought of writing" (Hindle 5). After the death of Percy Shelley in 1822, Mary spent the next three years trying to atone for what she believed were her sins against Shelley.

Pre-Romanticism

The Romantic penned (1785-1830) Contrast with Neoclassicism The replacement of reason by the imagination The shift from a mimetic to an expressive orientation for poetry, and indeed all literature. Pre-romanticism & Romanticism This period marks the end of Augustan Age.The main themes of Augustan Age were: reason rationality no feelings typical conception of the high social class The American Revolution (1775-1783) where the declaration of independence stated that America was an independent nation. The Industrial Revolution (1750-1850)transformed Britain from agricultural to industrial country In rural communities the destruction of omen industry was accompanied by a rapid growth of the process of enclosing the old open-field and communally worked farms into privately owned agricultural holdings. The peasants deprived of their lands, were forced to go to work in factories Mechanization meant a new form of slavery The economic and social ills were clearly seen by the people, suffering was largely confined to the poor: the diseases of industrial towns, the misery of child labor, and the crowds of underpaid workers.The suffering of the new class, the proletariat, led o the first strikes The Great French Revolution (1789) which introduced the democratic ideals: Liberty, Equality and Fraternity for everybody Revolution in France took a violent course: the accession to power by Jacobin extremists; the â€Å"September Massacres† of the nobility in 1792 followed by execution of the royal family brought England into a war against France(1793) Revolutionary and Napoleonic period in France (1789-1815) Under the influence of the Revolution the Irish peasants plotted a rebellion against English landlords. It broke out in 1798 but was cruelly drowned in blood Ideals of the Romanticism As a consequence to the chaotic lifestyle they tried to find a shelter in nature The feelings are: sadness, melancholy and meditation Romanticism was a movement against the progress of b ourgeois civilization It was an effort to do away with the injustice, the exploitation of man by man. The poets of this period are called graveyard poets because the countryside became place of death and contemplation The romanticists made emotion, and not reason, the chief force of their works. This emotion found its expression chiefly in poetry