Tiny Influences free essay sample

â€Å"Please, can we have a story?† â€Å"Okay, but only one because it’s bed time.† Two heads scramble for a place on my lap as if it’s stadium seating. Their freshly-shampooed heads dampen my shirt with a unique, fruity fragrance. As I turn the book pages, I hear a crisp rustle that comforts me more than any other sound. While Kyle and Marissa are lost in the magic of the story, I am drawn back in time to when their adventure began. I remember traveling through the NICU thinking how polished, clean, and organized it was compared to the rest of the hospital. My shoes squeaked across the linoleum. The tang of antibacterial soap lingered down the hall. A steady thrum†¦thrum†¦thrum of monitors came from every direction and fluorescent lights quivered in never-ending rows. Pushing through the maze of incubators, I saw the crowd of white coats before I heard the alien cries. We will write a custom essay sample on Tiny Influences or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page When I first laid my eyes upon my brother and sister, they were tiny, red, squealing bodies in a sea of frantic doctors. Fear grasped my heart at the sight of the twins, for they appeared inhuman. Fused eyes greeted me like a newborn kitten’s. I gaped. I boggled. Their size was minute. One pound 13 ounces and one pound 15 ounces are just numbers until they are associated with living†¦breathing†¦beings. All I got was a glance, until the doctors dragged us away because we had not washed our hands. We were oblivious to the immense danger of germs in premature lives. Retreating into our hospital room, we gathered around a bed with tear-streamed faces. I felt like I’d swallowed a boulder. In need of an activity, I scrunched the worn bedspread between my palms. Since we were situated roundabout, I searched my family’s faces. No one seemed to know where to look. Each of us had the same question. â€Å"How could children so delicate possibly survive?† We said a heart-felt prayer that our new family members would make it. I knew at that moment that it was out of our hands. Over the course of three months, Kyle and Marissa kept fighting despite all the odds. To this end, morphine administration was essential just to touch their bodies. A micro-ventilator kept them alive, providing every morsel of oxygen for them. Also, the twins each underwent thoracic heart surgery in their first week of life. They suffered through numerous blood transfusions and spinal taps. Pneumonia infected their feeble bodies four times altogether. Being able to suck wasn’t instinctive. All in all, they had to be trained to do most everything I was born knowing how to do, but they succeeded and came home. When I supported their fragile heads for the first time, I experienced terrifying rapture. It was so strange to hold faces I had gazed at for months but had never been able to touch. I could not fathom that Kyle and Marissa were real. Peering into pairs of blue eyes, I thought of what they had endured to be nestled in my arms. Coming home, however, did not make them normal twins. On the contrary, they needed constant attention. Exposure to any bacteria could easily have killed them; consequently, they barely left our house for a year. Hence, our family became the hermit crabs on the block. Surgical masks became regular attire in our home, and oxygen tanks were a fundamental appliance. Neither flu shots nor friends coming over with a cold were negotiable. In short, Kyle and Marissa took up an ample portion of my life. As I finish the storybook, I examine Kyle and Marissa’s captivated faces and I realize that the twins have no memory of the experiences I cannot forget. Their lives are not about what they conquered in the past but about what they confront each day. Recently, a lady commented to me, â€Å"You are so good with those kids.† In contrast, I believe they have been â€Å"so good to me.† Caring for them has taught me more than I could ever hope to give in return.

Joy Harjo - Feminist, Indigenous Poet and Activist

Joy Harjo - Feminist, Indigenous Poet and Activist Born: May 9, 1951, Tulsa, OklahomaOccupation: Poet, Musician, Performer, ActivistKnown for: Feminism and American Indian activism, particularly through artistic expression Joy Harjo has been a significant voice in the rejuvenation of indigenous culture. As a poet and musician, she was influenced by the activism of the American Indian Movement (AIM) during the 1970s. Joy Harjos poetry and music often speak of individual womens experiences while examining larger cultural concerns and Native American  traditions. Heritage Joy Harjo was born in Oklahoma in 1951 and is a member of the Mvskoke, or Creek, Nation. She is of part Creek and part Cherokee descent, and her ancestors include a long line of tribal leaders. She took the last name Harjo from her maternal grandmother. Artistic Beginnings Joy Harjo attended the Institute of American Indian Arts high school in Santa Fe, New Mexico. She performed in an indigenous drama troupe and studied painting. Although one of her early band teachers did not allow her to play the saxophone because she was a girl, she picked it up later in life and now performs music solo and with a band. Joy Harjo had her first child at age 17 and worked odd jobs as a single mother to support her children. She then enrolled in the University of New Mexico and received her bachelors degree in 1976. She received her MFA from the prestigious Iowa Writers Workshop. Joy Harjo began writing poetry in New Mexico, inspired by the American Indian activist movement. She is recognized for her poetic subject matter that includes feminism and Indian justice. Books of Poetry Joy Harjo has called poetry the most distilled language. Like many other feminist poets writing in the 1970s, she experimented with language, ​form and structure. She uses her poetry and voice as part of her responsibility to her tribe, to women, and to all people. Joy Harjos poetic works include: The Last Song (1975), her first chapbook, a small collection of poems in which she began questioning oppression, including the colonization of Native land. What Moon Drove Me To This? (1979), Joy Harjos first full-length collection of poetry. She Had Some Horses (1983), considered one of her classics it explores the oppression of women, but also their spiritual lives and triumphant awakenings. In Mad Love and War (1990), an examination of both personal relationships and societal struggles of Native Americans. The Woman Who Fell From the Sky(1994), which won the Oklahoma Book Award in Poetry. How We Became Human: New and Selected Poems 1975-2001, a collection that looks back over her three-decade career as a poet. The poetry of Joy Harjo is rich with ​imagery, symbols, and landscapes. What do the horses mean? is one of her readers most frequently asked questions. In reference to meaning, she writes, Like most poets I dont really know what my poems or the stuff of my poetry means exactly. Other Work Joy Harjo was an editor of the anthology Reinventing the Enemys Language: Contemporary Native American Womens Writings of North America. It contains poetry, memoir, and prayer by Native women from more than fifty nations. Joy Harjo is also a musician; she sings and plays the saxophone and other instruments, including flute, ukulele, and percussion. She has released music and spoken word CDs. She has performed as a solo artist and with bands such as Poetic Justice. Joy Harjo sees music and poetry as growing together, although she was a published poet before she publicly performed music. She has questioned why the academic community would want to confine poetry to the page when most poetry in the world is sung. Joy Harjo continues to write and perform in festivals and theaters. She has won the Lifetime Achievement Award from the Native Writers Circle of the Americas and the William Carlos Williams award from the Poetry Society of America, among other prizes and fellowships. She has taught as a lecturer and professor at multiple universities throughout the Southwest United States.

The musculoskeletal System - A Case Study - Short Answers Essay

The musculoskeletal System - A Case Study - Short Answers - Essay Example The wounds can be open or closed. Open wounds are common because the shaft of the tibia is just below the skin and subcutaneous tissue and is not covered with much soft tissue. Most of the tibial shaft fractures are associated with fibular fractures too. In Julia, the fracture occurred due to high speed accident. The fibula was however not involved and the wound was closed. The main sources of pain in Julia are the site of fracture, skin and subcutaneous tissue and the muscles surrounding the tibia. Fracture induces significant amount of inflammation and release of inflammatory mediators with cause pain, swelling, warmth and redness. During fracture, hematoma may be formed which can also cause pain (Rosenberg, 2007). Inflammatory cells, phagocytes and fibroblasts have a major role in the healing process of the fracture. Fracture causes formation of hematoma and a blood clot gets formed between the broken fragments of the fracture. After the initial few days following fracture, blood vessels grow within the clot. These blood vessels allow accumulation of phagocytes to the area which help in the removal of dead tissue. The blood vessels also cause pouring in of fibroblasts which multiply in the walls of the blood vessels and produce collagen fibres. These fibres replace the blood clot. The fibroblasts also lay down bone matrix or calcium hydroxyapatite which helps in the transformation of collagen to bone (Rosenberg, 2007). Factors which promote wound healing in Julia are immobilization, good nutrition, young age and absence of infection (Rosenberg, 2007; Konowalchuk, 2005 and Norvell, 2009). Immobilization is very essential to promote fracture healing. This is because, any movement of the fragments of the fracture hinder the process of healing. Movement disturbs the formation of clot and invasion of blood vessels within the clot. Decrease in the formation of blood vessels prevents invasion of fibroblasts essential for deposition of collagen and bone

Consumer Borrowing Essay Example | Topics and Well Written Essays - 500 words

Consumer Borrowing - Essay Example On the other hand, there are users whose spending needs exceed their current income levels so they have a deficit. Therefore, they require additional funds to make up the difference. These funds can be trasferred from suppliers to demanders of money in two ways. First is through Financial institutions that are of two types including depository insitutions such as commercial banks, saving and credit unions (also known as financial intermediaries) and non-depository instituions such as life insurance companies, pension funds and finance companies. Depository institutions especially banks accept deposits from savers (lenders) of money that they can withdraw on demand. They pool customer deposits and use these funds to make loans or investments to demanders or borrowers of money (consumers and businesses). These institutions make money because of interests rate that they charge from demanders, which is higher than what they to pay to savers or depositors of money. On the other hand, non-depositry institutions such as insurance companies accept business risks of their customers in return for a series of payments called premiums. They then invest their excessive funds after meeting their operating expenses (insurance claims, salaries etc). Finance companies offer short-term loans to borrowers. They usually sell securities or borrow funds from commercial banks therefore they tend to charge higher interest rates as compared to banks. Second is through financial markets where people and organizations wanting to borrow money are brought together with those having surplus funds. Financial markets are primarily divided into primary and secondary markets. Primary market are those in which corporations raise funds by issuing new securities. In Secondary markets, on the other hand, previously issued securities such as mortgages, bonds and stocks are traded among investors. Stock exchanges are perhaps the best example of these type of markets.

Should overseas aid be used for climate change adaptation Essay

Should overseas aid be used for climate change adaptation - Essay Example Hence successful adaptation is often executed with the help of overseas aid. This paper aims to critically analyze this subject while identifying that either overseas aid should be used for climate change adaptation of not. Description In order to study the relationship between overseas aid and climate change adaptation it is important to first analyze various factors associated with general foreign aid. The concept of overseas aid revolves around the basis principle of helping poor nations and the under developed countries. For instance, Australia is one of the major contributors of overseas aid. It mostly sends monetary help to Indonesia and some parts of South Asia and Middle East (Overseas Aid, 2013). United Kingdom is also working to increase the climate adaptability through undertaking significant measures in the developing countries (Impact of UK Overseas Aid on Environmental Protection and Climate Change Adaptation and Mitigation, 2011). In addition to this one of the United States’ overseas aid programs is particularly associated with climate change adaptation. This program critically assesses the climate change taking place all over the world including the increasing risks, susceptibility and various opportunities for improvements (Agency Climate Change Adaptation Plan, 2013). Research indicates that the climate changes occur as per the regional conditions. Therefore with time the rise in sea level will impact the populated coastal areas while turning them in to uninhabitable place. Today very few people are affected by the floods, heat waves, storms, etc. but in future millions of people are expected to get influenced by these natural disasters. Moreover, the agricultural productivity will decrease while on the other hand sea food would also be destroyed due to increased acidification by 2050 (Climate Change and Development, 2012). Following figure further explains this situation: These climate changes will also influence the developed countri es including USA, Australia, etc. but the most severe impacts are expected to be seen in the developing countries. This will subsequently affect the global political, social and economic conditions. Moreover, food would not be available for poor while rich will have to avail it against huge cost (Climate Change and Development, 2012). If no action is taken to control climate change then the greenhouse gases are expected to continuously weaken the natural environment (Mendelsohn, 2000, p.583). This signifies that an extensive climate change adaptation plan is required so as to meet the future challenges. However, the adaptation plan cannot be made successful with national or even regional resources and therefore overseas aid has become a necessary element in this regard (Climate Change and Development, 2012). Overseas aid should be used for climate change adaptation due to the following reasons (Climate Change and Development, 2012): Foreign investments will reduce the negative impac ts of climate change will increasing the resources necessary for life. Countries which are still going through the process of developing transportation and energy infrastructures can actually use overseas aid to accelerate their development procedure. Speedy development will subsequently increase employment opportunities while giving way to tackle the drastic climate changes. Climate risk reduction programming could be initiated in poor countries. Significant anticipations can be made regarding draught

Health Promotion in Adult Nursing: Adult Asthma Case Study

Health Promotion in Adult Nursing: Adult Asthma Case Study This essay will address how to help a 20 year old asthma sufferer bring to an end his recurrent admissions to hospital because of acute exacerbations in his asthma. Asthma is a common and chronic inflammatory disorder of the airways, associated with marked health and economic consequences. It is estimated that approximately 5.2 million people in the United Kingdom (UK) suffer from asthma, making the condition the most common long term illness in this country. Asthma accounts for 1,400 deaths per annum, with a third of these being among individuals under 65 years of age. Similarly, asthma also accounts for about 69,000 hospital admissions a year. It is estimated that more than half of the 5.2 million people with asthma in the UK do not have adequate symptom control. While 500,000 of these have asthma that is difficult to control with available medication, and are thought to be resistant to corticosteroids, asthma is not well controlled in approximately 2.1 million people for reasons s uch as non-concordance with medication (Asthma UK, 2004, pp3-7). As already mentioned asthma is a long-term chronic condition (LTC) and although chronic illness is not a newly-recognised phenomenon, the incidence and prevalence has significantly increased over the second half of the 20th century and continues to rise in the 21st century (Howie, 2005, p318). This is not least because of the aging population and advances in medical science diminishing the impact of infectious diseases. In addition, the emergence of unhealthy lifestyles is arguably the trigger for many non-communicable diseases such as chronic heart disease, type 2 diabetes mellitus, and chronic obstructive pulmonary disease to which asthma has similar pathophysiology. (Nissinen et al, 2001, p963). It is estimated that in the UK over 17.5 million people are affected by a LTC and 8.8 million have long term illness that severely limits their day to day ability to cope. It is proposed that those aged over 65 affected by a LTC are more likely to have multiple long term conditions, which makes care particularly complex. Debatably, unhealthy lifestyles and an aging population are the reasons for the high prevalence of LTCs contributing towards the large financial costs in caring for these patients who occupy up to 42 percent of all acute hospital bed days (Department of Health (DH), 2005b, p10). Arguably, these issues indicate that these patients are not receiving the care in ways that meet their needs or the needs of the health system. It is proposed that this is why management of LTCs is of specific importance to current Government health strategies. To this effect, numerous policy documents have been published that define the present philosophies for the management of LTCs. One particular policy; The National Service Framework (NSF) for Long Term Conditions was published by the DH in March 2005 (DH, 2005b, p24). The NSF predominantly concentrates on individuals’ with long-term neurological conditions. However, it is anticipated that to a great extent the guidance presented could be relevant to all long-term conditions. The document has outlined 11 â€Å"quality requirements† and among others there are various ones that are particularly pertinent to Steven Williams’s case. These include the provision of person-centred care and choice, the offering of information and support for the safe and effective use of medicines, the supporting of self care and the consideration of health promotion needs. It is suggested that in order to meet Steven’s needs he will require support and education so that he can make informed choices. Metcalf (2005, p60) suggests that informed choice for those with LTCs is the key to success and a means of examining issues pertaining to non-concordance, risk taking behaviours and patient choice. As already mentioned, Steven began to smoke when he started attending university. Cigarette smoking is implicated as a health-risk behaviour and there is evidence to suggest that active smoking in adults with asthma increases asthma severity. A study by Siroux et al, (2000, p470) on the relationships of active smoking to asthma and asthma severity, found that current smokers with asthma had more asthma symptoms, more frequent asthma attacks (≠¥ 1 attack per day) and scored higher on the asthma severity scores, compared to those asthma sufferers who had never smoked and ex-smokers. Other trigger factors that can exacerbate asthma symptoms include house dust mites, pet allergens, pollen, moulds and fungal spores, certain drugs such as asprin and beta blockers, occupational triggers and viral respiratory tract infections (Roberts, 2002, p46). Arguably, in Steven’s case, alongside his lack of concordance with his asthma medication, it is suggested that his smoking habit is a key factor in his acute asthma exacerbations. Therefore, it is proposed that Steven needs help with smoking cessation and education on the side effects and concordance of his medication. Numerous approaches are presently being utilised for smoking cessation. These approaches incorporate pharmacological methods, such as nicotine replacement therapy or antidepressants, hypnotherapy, and exercise supported interventions. Behavioural approaches include stage based interventions, which mainly use the transtheoretical model (Prochaska, DiClemente Norcross, 1992, p1102-14) and this model divides people into five different stages. These are the precontemplation, contemplation, preparation, action, and maintenance stages. The justification behind â€Å"staging† people, as such, is to fit the therapy to a person’s need at his or her particular point in the change process. Succession through the stages is in order, although relapses to previous stages can happen. The model also recognises 10 processes of change, the theory being that the effectiveness of the different processes of change will vary according to the patient’s stage. Arguably, however, this h as not repeatedly been defended in empirical research (Sutton, 2000, p31). It is proposed that it would be necessary for health professionals to recognise precisely an individual’s stage of change, or readiness to change. This is so that an intervention based on â€Å"stage specific processes† of change can be employed. It is important that the stage of change is re-evaluated regularly, and that the intervention should reflect changes in the individual’s willingness to change. These elements of the intervention can be continual until the person accomplishes and sustains the change in behaviour. In this way, stage based interventions develop and adjust in answer to the individual’s progression through the stages of change. Therefore it is debated that stage based models recommend that interventions that take into account the existing stage of the individual will be much more successful and efficient than one size fits all interventions (Prochaska, DiClemente Norcross, 1992, p1103). Having said this however, the stages of change t heory does not take into account any outside influences that might have an impact on a person’s ability to change. It is proposed that Steven recognises that he has a problem and has asked for help. Therefore, it is suggested that this places him in the contemplation stage. It is suggested therefore, that Steven needs to be given help and advice that will lead him to the preparation for action stage. In doing this, debatably, it will be necessary for Steven to assess his feelings regarding his smoking behaviour. It is important therefore that health professionals who are using behavioural change models for smoking cessation are thoroughly trained in the procedure or at least are aware of the availability of a smoking cessation nurse. Ethically, it is argued that health professionals have a duty of care to help patients like Steven live healthier lifestyles. However, ethically Steven has the right to autonomy in his lifestyle choices (Tschudin, 2003, p151). It is proposed that inhaled corticosteroids are still the most effective preventer drug for attaining treatment objectives (British Thoracic Society, Scottish Intercollegiate Guidelines Network (BTS, SIGN, 2004, Chapter 4, p2). Steven has voiced concerns about the effects of steroids and this has stopped him taking his preventative inhaler. Similarly, he only uses his reliever inhaler when he becomes extremely wheezy. This is in accordance with Bender’s (2002, p554) suggestion that one of the reasons people do not take their medication is because they are worried about side effects. It is argued that this could be because their initial concerns might have not been fully addressed by health professionals (Carter et al, 2003, p27). It is proposed that nurses are ideally placed to educate patients on the benefits of medication concordance. It is important that a nurse thoroughly explains the necessity of the treatment and any subsequent side effects. Inhaled corticosteroids are t he main preventative treatment for asthma sufferers. When taken twice daily at a low dose, corticosteroids are highly effective in reducing asthmatic symptoms, improving lung function, and reducing cellular inflammation. Systemic effects are rare on a low dose and most asthma patients are extremely well controlled on a low dose inhaler. Adverse local effects can include dysphonia and oral candidiasis. These symptoms can be relieved by either gargling or rinsing the mouth with water after inhalation (Roberts, 2002, p48). It is proposed that if Steven regularly takes his preventative inhaler then his asthma will be better controlled and he is much less likely to need systemic corticosteroids that can have adverse side effects such as weight gain and thinning of the skin when taken long-term. The NSF quality requirements of person-centred care and choice, and the offering of advice on the use of medication are relevant to the case mentioned, as is the consideration of health promotion needs. The patient will require help in giving up smoking as this is a major factor contributing to his repeat admissions to hospital. Help in the correct use of his medication is also required if he is to remain free from episodes of acute asthma. Nurses caring for patients like Steven will need to know what help is available with smoking cessation and the various options that can be offered to individuals who want to cease smoking. The Prochaska and DiClemente model of behaviour change is commonly used in smoking cessation; however, its effectiveness is questionable. References Asthma UK (2004) Where do we stand, http://www.asthma.org.uk/how_we_help/publishing_reports/index.html (last accessed: June 25th 2007) Bender BG (2002) Overcoming barriers to nonadherence in asthma treatment, Journal of Allergy and Clinical Immunology, 109 Supplement 6, S554-559 British Thoracic Society, Scottish Intercollegiate Guidelines Network (BTS, SIGN) (2004) British Guideline on the Management of Asthma: A National Clinical Guideline, revised edition, Edinburgh, http://www.sign.ac.uk/guidelines/published/support/guideline63/download.html, chapter4, (last accessed: June 26th 2007) Carter S, Taylor D Levenson R (2003) A Question of Choice: Compliance in Medicine Taking, Medicines Partnership, London Department of Health (2005b) The National Service Framework for Long-term Conditions, http://www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Longtermconditions/index.htm (last accessed: June 25th 2007) Howie K (2005) Long-term conditions, Practice Nursing, 16, 7, 318 Metcalf J (2005) The management of patients with long-term conditions, Nursing Standard, 19, 45, 53-60 Nissinen A, Berrios X Puska P (2001) Community-based noncommunicable disease intervention: lessons from developed countries for developing ones, Bulletin of the World Health Organisation, 79, 963-970, http://www.who.int/bulletin/archives/79(10)963.pdf (last accessed: June 25th 2007) Prochaska JO, DiClemente CC Norcross JC (1992) In search of how people change: Applications to addictive behaviors, American Psychologist, 47, 1102-14 Roberts J (2002) The management of poorly controlled asthma, Nursing Standard, 16, 21, 45-51 Tschudin V (2003) Ethics in Nursing: The Caring Relationship, Third edition, Butterworth Heinemann, London Siroux V, Pin I, Oryszczyn MP, Le Moual N, Kauffmann F (2000) Relationships of active smoking to asthma and asthma severity in the EGEA study, European Respiratory Journal, 15, 3, 470–477 Sutton S (2000) A critical review of the transtheoretical model applied to smoking cessation. In: Norman P, Abraham C, Conner M, eds. Understanding and changing health behaviour: from health beliefs to self-regulation. Amsterdam: Harwood Academic Press

Use of Aphorisms in Steinbecks The Winter of Our Discontent :: essays research papers

In John Steinbeck’s classic novel The Winter of Our Discontent, one can find many general truths and principles, also known as aphorisms. Ethan Allen Hawley, the main character, seems to gift the reader with another aphorism at the turn of every page, but some of these sayings may be considered more remarkable than others. One of the more noteworthy aphorisms is a statement made by Ethan at the end of chapter 6: â€Å"To be alive at all is to have scars†.   Ã‚  Ã‚  Ã‚  Ã‚  While this may not be the theme that Steinbeck concentrates on the most, it is surely one of the most important. Ethan is the most prominent example of this, as he has suffered many misfortunes in his life. Every other mature character in the book also carries these emotional scars; scars on one’s morality, character, and soul. Perhaps what the author was trying to convey is that from the moment one is born, one knows pain and suffering. However, many of these wounds heal with time, and become the scars of the past. Ethan compares the scars that his lack of morality will bring to the scars that his failure has produced, but the truth is that these are not scars at all, but injuries that time will not heal, and conscience will only make worse. His wounds will never mend, they will weigh down on him until drastic measures must be taken to escape the constant reminders of what he has done. Ethan considers and then nearly commits suicide, but he realizes that n o matter what he has done, his daughter needs him above anything else. So he must go on living, scar after scar becoming layers upon layers of discontent on his heart.   Ã‚  Ã‚  Ã‚  Ã‚  Every human being on earth accumulates scars of this nature. From errors made in the past come forth blemishes on the soul that serve as permanent reminders of one’s mistakes, and the scars provide maps to roads not to be taken again.