On Dumpster Diving Essay

Quite by accident, I found the essay On Dumpster Diving by Lars Eighner on the pages of Seagull magazine. The first lines of it captured my interest considerably, for as I had never read about dumpster diving or scavenging before. On Dumpster Diving is a piece of large Eighner’s work called Travels with Lizbeth (1993), which was based on his own experience of homelessness. The author engages me by telling the origin and meaning of the term Dumpster Diver, presenting his survival guide with specified rules and regulations. Dumpster is a trademark of garbage loading onto trucks system. Dumpster diving involves persons voluntarily climbing into rubbish bins (dumpsters) to find valuables or simply useful items, including food and used clothing. Eighner writes that the life of a beggar traveling without any money opened his eyes to the fact that all those containers with waste are real â€Å"supermarkets† for the poor, and they are not only a source of survival, but also a d epositary of high-quality and diverse food. Anyhow, there is a risk in eating such findings. According to Eighner’s experience, taking food out of dumpsters should involve three simple principles: â€Å"using the senses and common sense to evaluate the condition of the found materials, knowing the Dumpsters of a given area and checking them regularly, and seeking always to answer the question, â€Å"Why was this discarded?† Narrator advises to avoid such foods as game, poultry, pork, and egg-based meals. Soft drinks testing should be based on their fizzing vigorously. Being a scavenger, one has to notice the least signs of visible contaminates. Notwithstanding the scavenger has no indemnity of self- intoxication. Later on Lars tells about â€Å"a predictable series of stages a person goes through in learning to scavenge,† in which disgust at the beginning gives way to indiscriminate acquiring of the things. The story also includes information about the â€Å"can-divers† and their way of diving featured as unethical and impudent. The plot of it is neither compound nor rich in events and characters. However, it is thought provoking. The author gives us detailed guidance how to survive being a dumpster diver. Reading the essay, I asked myself right along whether it was the only aim of Eighner to teach us those rules. As the story progressed, I picked up the writer’s conception gradually. His essay exemplifies the wasteful nature of American society and implies that it is the result of materialistic values but also ignorance and lack of understanding. People unreasonably throw out even food that is appropriate for using: â€Å"Students throw out many good things including food†¦the item was thrown out through carelessness, ignorance, or wastefulness.†(Eighner) The scavenger can acquire â€Å"boom boxes, candles, bedding, toilet paper, medicine, books, a typewriter, a virgin male love doll, change sometimes amounting to many dollars† in the dumpsters. I suppose the purpose of the article is also to show how immoral is to throw out good food and things, knowing that thousands are starving and suffering from poverty. However, exactly that garbage helps him to survive at difficult times. Eighner’s reasoning for why people are materialistic derives from the concept that they are lost and unsure of what they want. In a way, his short essay On Dumpster Diving, suggests to his readers that to achieve the state of satisfaction, they need to know what they want. He states, â€Å"Almost everything I have now has already been cast at least once, proving that what I own is valueless to someone.† The author himself collects only things that are of benefit to him and leaves the rest for the benefit of others. The article shows that the writer being homeless still keeps his intelligent, clever, and sentimental way of thinking. He emphasises the transience of material being and says, â€Å"Once I was the sort of person who invests material objects with sentimental value. Now I no longer have those things, but I have the sentiments yet.†(Eighner) I think, describing all the rules of dumpster diving Lars Eighner represents us the necessity of keeping the etiquette even in adversity. The breakers of that common law are the â€Å"can-divers.† They, as contrasted with the true scavengers, look only for the money there and mix the contents of the dumpster making it more difficult to find the truly good things, the author explains. The worst in can scroungers’ actions is their audacity to go through individual containers in front of peoples homes, something a true diver would never do. Doing that the can diver finds different prescriptions, diaries and things the owner throws out. It is clear that privacy disclosing would embarrass us. Eighner exclaims against private invasion, thus demonstrating his culture and humanism. The last paragraph where Lars compares himself to ultra-wealthy is the most interesting point of the essay, to my mind. The rich people can acquire anything they like and the money does not stand in the way of doing that. The dumpster diver gets the things from dumpsters free too. Author’s analysis is that the truly rich or the truly poor are those who do not want or need. In his comparison, Lars means that he and the super-rich do not need the items the rest of us do. He can just go out and find them. The narrator tries to show the positives of his profession, but does not overlook the negatives as well, following it with the words: â€Å"Dumpster diving has serious drawbacks as a way of life.† The main idea of Lars Eighner in his essay is to assure us that any hopeless situation has its way out. The life goes on even if you meet difficulties†¦ He calls us for keeping our cultural and ethical talents even when being in the lowest state of life. We may not forget that having materialistic values over moral ones destroys and vitiates us from inside. In the unique voice – dry, disciplined, poignant, comic- Eighner celebrates the triumph of the artistic spirit in the face of enormous adversity, thus, inspiring me for true respect.

Key Economic Indicators and Changes over time in Bangladesh

The ancient region that in 1000 B.C. was called the Vanga, or Banga, Kingdom is considered to be #8 among the poorest and most densely populated countries today. Bangladesh, an independent country with parliamentary democratic government at the head of the state, remains dependent on foreign investors, grant aids and loans from the World Bank, the Asian Development Bank, the U.S., Japan and some Western countries, and suffers from corruption, lack of reforms, weak infrastructure and unstable financial system.The economic exploitation of the East Bengal (contemporary Bangladesh) by the West Pakistan, contemporary Pakistan, has turned out to be the complete deficit for the first player and the surplus for the other one. Yet, the advantageous climate, fertile soil, abundance of water and population growth are still playing the essential role and bringing the balance in economic indicators: income and employment rates, productivity, import and export prices, inflation, balance of trade, balance of payments, etc.Till the 10th century the East Bengal was ruled by Buddhists. Since that time the power had been handing over to Hindu, then Islamic converts in 1576 and British India from 1757 till 1947. However, the foreign dominance has shifted to domestic one and for 24 years the historic region of Bengal was a part of Pakistan. Though, the most of Pakistani population were the residents of East Pakistan (contemporary Bangladesh), the West Pakistan was holding the control over politics and economics.Grace to Sheik Mujibur Rahman and other Bengali nationalists, the independent state of Bangladesh with the capital of the state – Dhaka, and Sheikh Mujibur, as its head, was proclaimed on March 26, 1971. However, 1 million Bengalis had to pay the price during the four-year civil war that followed the independence of Bengali nation. On February, 1974, Pakistan finally accepted their autonomy attempt and a slaughter of brave soldiers was compensated in an unexpected way .The greatest problem, which has affected the devastated economy in 1980s, was the population growth. According to the facts, provided by Heitzman, J., and Worden, R., the population of East Bengal in 1901 numbered 29 million people, of East Pakistan – 44 million in 1951, of Bangladesh – 71 million in 1974, 87 million in 1981 and 110 million in 1988 (1989). It was expected that Bangladesh will reach the mark of 140 million by 2000 and today it numbers 150 million people. Today, Bangladesh takes the first place in population among Asian countries, the third one in national debt and the lowest GDP growth – 4.5 percent (Vital Statistics, 2006).Though Bangladesh had such natural resources as natural gas, timber, coal and agricultural land, they could not cover the demand of the growing population, along with natural disasters, such as cyclones, tropical monsoons, droughts, tornadoes, tidal bores and floods; therefore, agriculture – the key economic factor â⠂¬â€œ was rising from ashes over and over again.So, the newly proclaimed government had to seek answers to the following issues:1) environmental – degradation and erosion of soil, deforestation, lack of lands for cultivation, shortages of water and its pollution, natural disasters;2) national – overpopulation, illiteracy, technological regress and diseases.The independence has also brought some economic concerns, which have to be solved with the help of brand new economic policies and planning. The government of Bangladesh had to manage over 300 industrial enterprises (90 percent out of all enterprises such like), which West Pakistani owners left after 1971. The grant aid and loan commitments to the developing economy at that time numbered $15 billion disbursed out of $22 billion planned. The UN Development Program, along with the World Bank, the Asian Development Bank and developed countries gave a hand to strengthen the new nation.In order to manage the economy, the government of Bangladesh had to develop new industrial capacities and rehabilitate the economy itself. The West Pakistani economic model turned out to be inefficient and has led to economic stagnation. In 1975, the government resolved to organize public corporations and gave a greater scope to private sector, which is still working on. The state-owned enterprises that were targeted at: sugar, cotton textiles, steel, fertilizer, chemicals, minerals, pharmaceuticals, food, forest, paper newsprint, cement, garments, tea processing, engineering and shipbuilding products have been privatized; while banking sector, jute, oil and gas production remained under the governmental control.Bangladeshi government endeavored to encourage private sector and investments, denationalize public industries, ease up the import system and reinstate budgetary regulation. Yet, the reforms, expected from an enhanced structural adjustment facility (ESAF), along with the International Monetary Fund (IMF), were affected by political confrontation in 1991-1993. That very year, Bangladesh received $3.3 billion in food and development assistance from the United States and was forgiven $293 million of national debt. The corruption level and political troubles cut the foreign investments in 2000-2001 and led to the economic regress.In 2003, after liberalization reform, the Poverty Reduction and Growth Facility (PRGF) $490-million plan for 3 years was approved by the IMF. Also, the World Bank has approved $536 million in interest-free loans. Other economic policies originated from the West Pakistani model and estimated the Annual Development Program, Poverty Reduction Strategies (PRSs) and the five-year plans for the economy.The first two waves of the Five-Year Plan failed to meet the objectives; but the last one, which lasted from 1985 to 1990: reduced poverty, â€Å"[brought] down the rate of population growth to 1.8 percent annually (present rate is 2.2 percent (Vital Statistics, 2006)), in crease[d] exports by 5.9 percent and  domestic savings by 10 percent, attain[ed] self- sufficiency in food production, [stated] GDP of 5.4 percent† (Heitzman, 1989). In its turn, the government of Bangladesh maintained institutions, responsible for implementation of economic policies and planning. The Planning Commission, the National Economic Council, the Executive Committee and the Project Evaluation Committee were and are still monitoring the reforms and progresses of economic policies and plans.According to the â€Å"Bangladesh† fact sheet, the key economic indicators between 2001 and 2006 are as follows: GDP showed a stable increase from $47.2 billion in 2001 to 63.0 billion in 2006, therefore, real GDP growth varied from 4.8 to 6.2 accordingly; GDP per capita have increased from $335 to $407; goods exports varied from 14.5 percent of GDP to 16.1 percent. The Central Bank of Bangladesh in its publication â€Å"Major Economic Indicators† provided the ample data on other economic indicators. Hereby, the Bangladeshi inflation rate increased from 1.5 % in 2001 to 6.94 % in 2007; balance of trade, 2007, amounts $-2,551 million, exports increased by $1519.05 to $9036.45 million (20.21 %) and import payments increased by $2172.8 to $12743.5 million (20.55%) in 2007.These promising facts show that foreign investments and loans, along with domestic policies, improved infrastructure and financial system, made economic reforms, and strengthened Bangladeshi positions on the global market. Yet, the growing number of labor force earns its livings from agriculture, while undeveloped industrial sector, inefficient power supplies and underdeveloped energy and gas resources hide the potential for economic growth, developed market, and the way out of poverty. The government of Bangladesh had turned its blind eye towards the economic perspectives of technological progress, the interrelationship between transportation and communication, and the core econ omic factor – industrialization in the very beginning of the new nation, so today it remains underdeveloped and holds the place of one of the poorest countries in the world.References:Central Bank of Bangladesh. (2007, May). Major Economic Indicators: Monthly Update.Department of Foreign Affairs and Trade. (2006, July). Bangladesh: The Economy FactHeitzman, J., Worden, R. (1989). Bangladesh: A Country Study. Washington: GPO for theLibrary of Congress.Virtual Bangladesh. (2006, August). Economy: Vital Statistics. Retrieved June 5, 2007, from Read also: Padma Bridge

Influence of Reference Groups Essay

When you think about reference groups, there are a number of perspectives that one has to consider. According to Hawkins (2010), a reference group is a group whose presumed perspectives or values are being used by an individual as the basis for his or her current behavior. Thus, a reference group is simply a group that an individual uses as a guide for behavior in a specific situation (p. 227). Groups may be classified according to a number of variables. Four criteria are particularly useful: membership, strength of social tie, type of contact, and attraction. Delta Sigma Theta Sorority, Inc. is a private, non-profit organization whose purpose is to provide assistance and support through established programs in local communities throughout the world. A sisterhood of more than 200,000 predominately Black college educated women, the Sorority currently has over 900 chapters located in the United States, England, Japan (Tokyo and Okinawa), Germany, the Virgin Islands, Bermuda, the Bahamas and the Republic of Korea. The Sorority was founded in 1913 by 22 students at Howard University. These young women wanted to use their collective strength to promote academic excellence; to provide scholarships; to provide support to the underserved; educate and stimulate participation in the establishment of positive public policy; and to highlight issues and provide solutions for problems in their communities (Delta Sigma Theta, 2010). Delta Sigma Theta’s website is about heritage. This site speaks volumes about how these women wanted to be a part of an organization that consists of excellence. These women have a lifetime membership within the sorority. The influence that this organization has, as well as the site, is remarkable. The information on this site will allow younger women that have the desire to go to college and be a part of an organization that helps one excel, not only in school, but also in the workforce as well. This site has all the criteria of a basic reference group. The social ties that this organization has within the world are by far the best for young women that are willing to be a part of change. People that have â€Å"made it† when it comes to financial stability may feel that they are affluent in the society. There are people that have made millions and they do stand alone when it comes to affording â€Å"the better things† in life. Bentley’s website is attractive because the vehicle shows class. The influence that this vehicle has on a person’s financial status is undoubtedly the car of all cars. A Bentley is unmistakable – all it takes is a glance at the twin headlights, matrix grille or the high waistline to know one. The paradox of the car is that although it is instantly recognizable, it takes time and effort to hand-build each one. That’s the assured Bentley hallmark. A hand-built car using the finest quality natural materials takes time. Yet, while others may do things ‘meticulously’ or ‘painstakingly’, Bentley has always been about passion. In fact, our entire reputation rests on the experienced skills and passion of our people, handed down through generations. Many of our people say that they work on each Bentley as if it were going to be their car. They want to get it right. It’s no wonder that every machinist who creates a set of upholstery signs the back of it with his or her initials (Bentley, 2010). Once again Bentley’s website is about class and luxury. This site tells a story about smoothness when it comes to highway. There is nothing like being comfortable while traveling on highway or down the street to the mailbox. People that are attractive to the glitz and glamour will definitely enjoy riding either in the backseat of a spacious vehicle or driving behind the wheel. The six-time success at Le Mans has made Bentley more than a car – it has come to stand for a way of doing things: with spirit, flair, courage, instinctive intelligence and teamwork. Endurance racing has always been a way for us to test, strengthen and improve the cars.

Icu Case Study

Case Study A 45 year old male was admitted to ICU following an exploratory laparotomy which showed a ruptured appendix and peritonitis. The procedure began as a laparoscopic cholecystectomy but the initial finding was pus throughout the peritoneal cavity and a normal gallbladder. An open exploratory laparotomy where a ruptured appendix was discovered which was removed and a washout was performed. The patient had a two day history of abdominal pain prior to his admission through A&E. He had no previous medical or surgical history. The patient smoked 20/day and drank alcohol at the weekends.Once admitted to ICU, he was intubated and ventilated on bilevel ventilation and sedated with propofol and fentanyl. In theatre he received two litres of hartmanns solution as a fluid load, however in ICU was commenced on maintenance of normal saline at 100mls/hr. Feeding was ruled out on admission as it was thought that the patient would have extubated the following day. However, the patient was in ICU six days prior to extubation, therefore TPN was commenced. Noradrenaline was used for a MAP above 70mmhg rather than a fluid load. The patients clinical scenario was more in depth as outlined above.However, these are outside the scope of this case study. The medical and nursing interventions discussed in this assignment is mechanical ventilation, total parental nutrition and vasopressors. Mechanical Ventilation Bilevel ventilation is a relatively new setting. (Mireles-Cabodevila et al, 2009) The ventilator maintains a high pressure setting for the bulk of the respiratory cycle, which is followed by a release of low pressure. (Mireles-Cabodevila et al, 2009) The release to a low PEEP is the expiration phase and aids the elimination of CO?.The release periods are kept short to prevent derecruitment of alveoli and encourage spontaneous breathing. (Mireles-Cabodevilla et al, 2009) The advantages of bilevel include an increase in mean alveolar pressure with recruitment, haemodynamic and ventilatory benefits and reduced sedation requirements. (Putensen et al, 2006) Analgesia and sedation is not only used for pain relief and anxiety but for mechanical ventilation comfort. (Putensen et al, 2006) This level can reduced to aim of a Riker of 4, which a co-operative, responsive patient. Putensen et al, 2006) This reduces the need for more vasopressors to maintain a stable cardiovascular system. (Putensen et al, 2006) When first admitted the patients ventilatory settings were: FiO2 0. 4 Rate 12 HiPeep 22 LoPEEP 5 PS 10 CXR showed bibasal atelectasis/consolidation ABG – pH 7. 43 paCO? 33 paO? 74 HCO? 23 BE -0. 5 The pH is within normal limits, on the lower end, i. e. between 7. 35 – 7. 45. Therefore it is normal/alkalotic. The paCO? indicates an alkalotic range. This is used to assess the effectiveness of ventilation. (Coggon, 2008) PaO? is 74, which is low as normal range is 80-110, which shows hypoxemia.PaO? is not interpreted in the patients acid-base status but indicates O? binding to haemoglobin. (Coggon, 2008) The HCO? is normal. The next step is to match the CO? , HCO? to the pH. The CO? and pH is on the alkalotic side of normal. Therefore it shows a respiratory disturbance. (Woodruff, 2009) The next step is to see if either compensation is occurring. To do this, the interpretor must look to see if either the CO? or HCO? go in the opposite direction of the pH. In which, in the ABG above, you can clearly see that it does although the HCO? is within normal range, which means no compensation is occurring. Woodruff, 2009) The full diagnosis is uncompensated respiratory alkalosis with hypoaxemia. The patient is more than likely hyperventilating with poor gas exchange in view of the CXR. In response to this ABG result ventilatory setting were changed to: FiO2 0. 4 Rate 8 HiPEEP 22 LoPEEP 8 PS 14 ABG post setting change – pH 7. 39 paO? 103 paCO? 36 HCO? 22 The rate was changed as the patient was blowing off too much CO? with the rate of 12 plus any spontaneous breaths he was doing. The patients chest was rotten with a productive secretions and bibasal consolidation at the bases, seen in a repeat CXR.Suctioning resulted in moderate to large amounts of white sputum. The patients wife stated that he had been suffering from a cold for one week prior to admission. Therefore an increase in PEEP (Hi and Lo) was required to recruit the alveoli and aid in good gas exchange. (Dellinger at al, 2007) It is recommended that positive end expiratory pressure is set to avoid extensive lung collapse on expiration. (Dellinger et al, 2007) Maintaining pressure and spontaneous breathing resulted in an increase in arterial oxygenation and helped prevent a deterioration in pulmonary gas exchange. Putensen et al 2006) Studies have been carried out to determine whether high PEEP increases patients outcomes. These include the ALVEOLI study and the Lung Open Ventilation (LOV). These studies do not show an improvement on mortalit y with the increase in PEEP however show a decrease in days on the ventilator. (Mercat et al 2008) The patients right side was worse than the left on the CXR and auscultation. Therefore he was being positioned right side up and his back on pressure area cares. Repositioning patients not only protects the patients skin but it also improves gas exchange and decrease the risk of ventilator acquired pneumonia. Deutschmann and Neligan, 2010) Positioning the patient with the good lung down may improve paO? and aid in the drainage of secretion. (Deutschmann and Neligan, 2010) Elevating the head of the bed also aids recruitment of alveoli at the bases and again decreases the risk of ventilator acquired pneumonia. (Deutschmann and Neligan, 2010) All of the above interventions by nursing and medical staff were to improve the patients outcome and aid extubation once the patients chest improved and any other factors affecting the patients ability to self-ventilate. Total Parenteral NutritionIt is seen as appropriate time-scale of 1 – 3 days that surgical patients commence normal diets. (Braga et al, 2009) As the patient was intubated and ventilated, no feeding was commenced until day three. The main goal of nutritional support is to avoid starvation in the aim to support post-operative recovery, and maintain the patients normal body functions. (Braga et al, 2009) Malnutrition decreases patients outcomes within the critical care setting. (Artinian et al, 2006) Total parenteral nutrition (TPN) was commenced at 40mls/hr as per the ICU Dr's orders.The dietician reviewed the patient and suggested the goal rate was 81mls/hr, which the feed was slowly increased to over two days. this is because of the risk of referring syndrome. Refeeding syndrome is ‘a syndrome consisting of metabolic disturbances that occur as a result of reinstitution of patients who have been starved or malnourished. ‘ (Shils et al, 2006) The medical and nursing team must keep a close eye on the patients bloods. Although this is standard practice with all patients in ICU. Refeeding syndrome can cause a multitude of complications including, neurological, pulmonary, cardiac and hematologic. Assiotisa and Elenin, 2010) The use of the dietician greatly reduces the risk of over-feeding. (Ziegler, 2009) However, the consensus is the patients are underfed as medical teams are conservative in their approach of prescribing rates. (Faisy et al, 2009) Although the dieticians are heavily involved in the ICU that the patient in this study is, recent studies have shown that this is a good standard of care, as this helps doctors and nurses focus on early nutrition prescribed at the correct rate. (Faisy et al, 2009) The most used formulae used to predict goal rate is 25/kcal/kg ideal body weight. Braga et al, 2009) However in intubated patients, there is a fluctuating in ‘resting energy expenditure' due to the use of sedatives, analgesics and vasopressors causing confusion ove r energy given and uptake. (Faisy et al, 2009) The bag of TPN the patient had is ?. This is appropriate as patients requiring TPN need a full range of vitamins and trace elements daily. (Braga et al, 2009) Enteral nutrition is widely used in ICU due to the increased risk of TPN induced catheter-related sepsis, cost and multi-organ failure. Faisy et al 2009) However, surgical patients are less likely to receive enteral nutrition compared to medical patients. (Elke et al, 2008) Previous studies investigating critical ill abdominal surgical patients suggested that early feeding is beneficial. (Artinian et al, 2006) Nevertheless, another report suggested it did more harm than good, resulting in an increase of infections. (Artinian et al, 2006) The current recommendations, is that patients whom are expected to commence a normal intake should be started on parenteral nutrition. Singer et al, 2009) The patient who was still sedated and ventilated at this stage falls under the recommendatio ns. His bowel sounds were scant and he did not have a bowel motion since admission. The surgeons were reluctant to commence feeding with the absence of bowel sounds. This is due to the fear of a paralytic ileum as peritonitis may cause this. (McClare et al, 2009) It is now acknowledged that gentle feeding may restore gut mobility and is recommended for early management. (McClare et al, 2009) The lack of sound evidence based practice results in a need for future studies on post-operative feeding. Lownfels, 2008) While the patient is on TPN, an insulin protocol in in place to monitor blood sugar levels second hourly and adjust insulin as required. There is a high risk of hyperglycaemia due to insulin resistance when the body is under increased stress. (Braga et al, 2009) Therefore close glucose control is of benefit to the patients outcome in the ICU setting, including fewer infectious episodes and lower mortality. (Braga et al, 2009) A central line or another type of central access i s recommended for the administration of TPN, as it can irate the veins in peripheral access. Singer et al, 2009) A study performed about the reliability of central venous lines and PICC lines came to the conclusion that the number of infections was the same, nevertheless, phlebitis and thrombus occurred more frequently in the PICC lines. (Singer et al, 2009) Feeding the patient is a complicated process and a close eye on the patient is needed is pick up on complications that may occur during the feeding regime. Once the patient was extubated. , he remained drowsy for a day and a half. Ammonia levels were done and these came back high. The TPN was stopped and the patient's mental status slowly improved.The patients LFT's were normal. Vasopressors The patient is also being treated for an abdominal infection and community acquired pneumonia. Septic shock is defined as an inflammatory response syndrome with a mean arterial pressure (MAP) of 70mmhg. Other factors affecting the cardiovasc ular system include sedatives. (Ray and McKeown, 2007) Therefore the systemic infection and sedatives are contributing to the patients low blood pressure. Vasopressors and intropes are used when volume replenishment is not able to adequately increase blood pressure or with this patient fluid resuscitation is not considered (as he already had 2000mls of luid intra-operatively). (Morrell et al, 2009) Sufficient fluid loading is recommended prior to vasopressor use to try and stabilise the patient with septic shock. (Dellinger et al, 2009) Vasopressor therapy is used to maintain tissue perfusion in the event of critical illness. (Dellinger et al, 2007) Perfusion is reliant on pressure and control of vascular beds are inevitably lost when mean arterial pressure falls below a certain point. (Dellinger et al, 2007) Within the unit the patients are treated with norepinephrine (noradrenaline), which is the drug of choice when treating shock induced hypotension.This is because norepinephrine is a potent drug and is very effective at treating hypotension compared to other drugs. (Dellinger et al, 2007) Norepinephrine is an ? -adrenergic agonist and has some ? -adrenergic effects. (Urden et al, 2006) Noradrenaline is naturally released by nerve cells, producing the fight or flight response within the body. (Urden et al, 2006) This would normally produce an increased heart rate, increased blood pressure, dilated pupils, dilate air passage in the lungs and narrowing of blood vessels in non-essential organs, which aids the body in coping under stressful situations. Urden et al, 2006) The alpha receptors are found in muscle tissue, therefore by stimulating these receptors, noradrenaline causes the muscles to contract resulting in narrowing of blood vessels. (Urden et al, 2006) This means that an increase in MAP and systemic vascular resistance with little alteration in heart rate and volume output. (Morrell et al, 2009) Intravenous infusions of noradrenaline at low doses has been reported to increase blood pressure, urinary output and creatinine clearance, resulting in an aid to overall decreasing vasopressor therapy. Morrell et al, 2009) However, as with most drugs, side-effects of high doses of vasopressors, which include headache, bradycardia, hypertension, and inadequate blood flow leading to low levels of oxygen in extremities. (MIMMS, 2011) Studies involving small doses of vasopressin show an improvement in blood pressure over a small period of time. (Russell et al, 2008) The titration of noradrenaline is the nurses responsibility once the doctors order the aim MAP. (Brown and Edwards, 2008) An important part of nursing care is comprehensively assessing the patient receiving vasopressors. Brown and Edwards, 2008) These must include, urinary output, consciousness (if able), colour, temperature, pulses of the extremities, heart rate, blood pressure, signs and symptoms of myocardial schema. (Brown and Edwards, 2008) Titration of the drug is based on current observations. An important aspect to consider when using vasopressors, is to treat the cause of the shock. (Dellinger et al, 2009) This aids in recovery the the decreasing usage of invasive procedures. The use of noradrenaline on the patients improves his oxygenation and outcomes through this acute illness.The main objective is to improve oxygenation and noradrenaline has an impact on oxygenation by increasing preload, leading to an increased cardiac output. It also has an impact on cardiac contractility, which increases the force ejection thus allowing the heart to over come any increase in afterload caused by the vasoconstriction. (Urden et al, 2006) The increase consumption of oxygen, oxygen consumption increases. (Brown and Edwards, 2008)This is due to the hypermetabolic rate the critical ill patient is under.Caring for critically ill patients requires an in-depth knowledge on bodily systems and functions. Within the ICU environment, hierarchy of nurses which range from junior to senior. This exists to aid growth within the junior members of staff, as continuing education is important. As the above case study shows, numerous problems need to be addressed throughout the care of the patient. As only three issues have been addressed, this only illustrates a small insight into the scope of care the patient received. References Mercat, A. t al, (2008) Positive End-Expiratory Pressure settings in Adults with Acute Lung Injury and Acute Respiratory Distress Syndrome: A Randomised Controlled Trial. JAMA, 6: 646-655 McClare, S. A. , et al (2009) Guidelines for the provision and assessment of nutrition support therapy in the adult critical ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition, JPEN, 33: 277-316 Lownfels, A. B. (2008) Recovery after abdominal surgery: Is enteral feeding preferable? A best evidence review. http://www. medscape. org/newarticale/568983 Shils, M.E. , et al (2006) Modern nutritio n in health and disease, 10th edition, Lippincott Williams and Wilkins, Baltimore Assiotisa, A. , Elenin, H. (2010) Implications of refeeding syndrome in post-operative total parenteral nutrition. http://www. grandrounds-e-med. com/articles/gr100013. htm Deutschmann, C. S. , Neligan, P. J. (2010) Evidence-Based Practice of Critical Care, Saunders, Philadelphia Coggon, J. (2008) Arterial blood gas analysis: Understanding ABG reports. Nursing Times; 104: 18, 28-29 Woodruff, D. (2009) 6 Easy Steps to ABG Analysis. http://www. Ed4nurses. com Faisy, C. et al (2009) Impact of energy deficit calculated by a predictive method on outcome in medical patients requiring prolonged acute mechanical ventilation, British Journal of Nutrition, 101, 1079-1087 Singer, P. , et al (2009) ESPEN Guidelines on Parenteral Nutrition: Intensive Care, Clinical Nutrition, 28, 387-400 Braga, M. , et al (2009) ESPEN Guidelines on Parenteral Nutrition: Surgery, Clinical Nutrition, 28, 378-386 Antinian, V. , et al (2006) Effects of early enteral feeding on the outcome of critically ill mechanically ventilated medical patients, CHEST, 129, 960-967 Elke, G. et al (2008) Current practice in nutritional support and its association with mortality in septic patients – Results from a national, prospective, multicenter study, Critical Care Medicine, 36, 1762-1767 Putensen, C. , et al (2006) The impact os spontaneous breathing during mechanical ventilation, Current Opinion in Critical Care, 12, 13-18 Mireles-Cabodevila, E. , et al (2009) Alternative modes of ventilation: A review for the hospitalise, Cleveland Clinic Journal of Medicine, 76, 417-430 Morrell, M. 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Hobbes and Absolute Sovereignty Essay Example | Topics and Well Written Essays - 2250 words

Hobbes and Absolute Sovereignty - Essay Example He criticised several fields and gave argumentative ideas including sovereign governments which this work will be based upon. Sovereign is a state of a people or societies where a group of people or a person has been designated the authority to govern. The sovereign body always has control in religion, finance and military of the society. In this set up, the magistrate does not pledge allegiance to any superior forces or power and he is according to the state orders supreme. The control in the three sections by someone who has not been designated as sovereign in the social sense may as well assume the position of sovereignty. As stated by Hobbes in Behemoth, he gives a difference between de jure and de facto sovereign. Hobbes, felt that naturally the society cannot be differentiated from state of nature which is always at war. This is a condition whereby people are being forced to be in contact without an authority that is superior. The presence of the sovereign was therefore meant t o prevent this state of commotion. The erected sovereign was to be given the subject’s rights and was expected create peace by all means. The idea of Hobbes was that sovereign which is absolute had limited power specifically by power which was assumed to be greater. This power outlined rights to be forfeited and duties of the sovereign. Hobbies argument was based on the fact that a government irrespective of the state was far much better than the State of Nature. This is because he thought that absolute sovereignty as a form of government was a measure to prevent the coming back of the State of Nature and it could easily make people live peacefully, due to lack of friction in the association with each other. Hobbes gives a clear conflict between two concepts: an effective sovereign, stable and the need of peace and the denial of the sovereign the advantages listed therein. Hobbes, opinion was as a result of the attitude he had towards the England government which resulted to the civil war. For example they thought that the state could be limited in its ability to raise taxes and at the same time have the government, the government power was to be reserved in a pre-eminent manner. Hobbes outstands to be an absolutist in the view that he gives no room for revolutionary change whatsoever ideologically on the ground. One can in a violent manner plan to dismiss or overthrow the sovereign with the aim of replacing it with one that is new or change the form state. For absolutism, this is sensible. States exist with the main agenda of preventing and solving misunderstandings, confusions and conflicts, these should be done not by violence but preferably by the state. This is because the state is more organised, there are procedures and rules of conflict resolution rather than spontaneous reaction of the violent groups or individuals. Hobbes expresses his clear stand on the governments theory in his Originator of science that is Politically Authentic, De Cive 164 7 where he argued that he had finally found out a mode of rationalising a roadmap into political characters and that a new mode of science had been created by him. Hobbes studied governments that were civil by paying more attention to its central unit of operation. He compared it to humans being both social and natural and thereafter gave an extensive evaluation their forms and generation. Hobbes reasoned that

Performance Management Essay Example | Topics and Well Written Essays - 2500 words

Performance Management - Essay Example Furthermore, it is often considered as the process where various resources of the organisation or any particular department are utilised efficiently in order to successfully attain the broad objectives of the organisation (Patterson & et. al., 2003). It has been noted from the provided case that Gearflex Co, a retail chain that deals with car accessories has grown to become the market leader in this particular sector in the recent times. However, it is believed that this leap of the company is relatively due to its effective decision making ability regarding the domain of performance management. One such decision can be attributed with the approach of the company to implement ‘Beyond Budgeting’ model in its operational activities. It is further observed that the operational director of the company is largely responsible for this change initiation related to the organisational strategy. This aspect has further influenced the management of the company to select the operati onal director to deliver a presentation in a particular conference that has the participation of managers from various retail sector of the world. Aim of the Report Contextually, the aim of this report presentation will be to demonstrate the scenarios which has influenced the operational department of Gearflex Co to select Beyond Budgeting’ model for their operation. These factors will include the potential problems associated with traditional budgeting techniques including several behavioural aspects as well as the benefits the organisation has gained by shifting to Beyond Budgeting’ model. Problems and Weaknesses in Traditional Budgeting Approach Over the years various forms of budgeting technique has been implemented by organisations in their operational purposes. Among those, the line-item budgeting or traditional budgeting is quite commonly applied budgeting model. This type of budgeting was devised with the intention to deal with the rising issues of organisation al setting including the area of purchasing, bidding, accounting as well as auditing among others. Over the years, this approach was seen to be extensively employed in organisational operation as a full time budgeting tool delivering potentially noteworthy results for the overall business. However, with the emergence of contemporary business environment, companies has started to realize the need of replacing traditional budgeting approach with a more flexible and efficient model. This is due to certain problems and weaknesses associated with traditional budgeting approach which are being highlighted subsequently (Cheong, 2013). There are several potential problems association with the aspect of traditional budgeting. First is the factor of time. Notably, traditional budgeting consumes a lot of time in its execution. Reportedly, companies in most of the scenarios take more than six months to execute traditional budgeting. This aspect hampers the efficiency of organisational operation . Furthermore, it has also been analysed that since traditional budgeting takes longer duration in its completion, organisations are also required to provide resources for a longer basis which further increase the cost of the company concerning

HR Strategy for HSBC Essay Example | Topics and Well Written Essays - 3000 words

HR Strategy for HSBC - Essay Example This paper aims to provide an overview of the business strategy of HSBC Holdings plc and to develop the HR strategy that will fit the new company’s strategy. HSBC retail banking segment targets premium market, focusing on customers with medium to high incomes. Thus, the company is capable to earn good profits and to minimize risks associated with high-risk borrowings (Uvais, 2015). Recently, the company has updated its business strategy aiming to be â€Å"where the growth is, connecting customers to opportunities† (Hsbc.com, 2015). HSBC introduced a two-part strategy comprised of the following two elements: (1) a network of businesses connecting the world, and (2) wealth management and retail with local scale (Hsbc.com, 2015). Therefore, on the one hand, the company aims to achieve global reach and develop its business operations in the international arena, achieving thus economies of scales, and on the other hand, it aims to capture opportunities in wealth management and retail markets with a focus made on growth markets (Hsbc.com, 2015). Strategically, the company aims to expand its business in Asia, North Africa, and the Middle East as the markets with huge potential. Currently, the HSBC is restructuring its operations worldwide and in the UK. The company aims to improve its profitability and to reduce costs. In order to achieve this goal, the management is planning to cut the number of jobs significantly in the UK and across the globe. According to the most recent information, the company has introduced a cost-cutting strategy whereas its management aims to cut costs by $4.5 billion ( £3 billion) to $5 billion ( £3.3 billion) a year by 2017 (ITV News, 2015). However, in order to dampen the overall effect of this cost-cutting strategy, the company also has a plan to create more than 2000 new positions (Uvais, 2015).