What Is An American Essays (556 words) - , Term Papers

What Is An American ?What is an American The attributes of the regular American has changed radically consistently. We have changed from multiple points of view from when we formally got free in 1776 to the here and now in 2001. A portion of the transformation we have experienced as a nation have been to improve things, others for the most exceedingly terrible. In the twentieth and now the twenty-first hundreds of years, the American culture has grown up with new thoughts on life and new innovation that has become a piece of life. The Modern American can be depicted as somebody who is persevering, independent, and electronically progressed. Ladies used to remain at home and deal with the house while their spouses worked. Presently ladies are working in indistinguishable fields from men, even in high glory occupations, for example, specialists, attorneys, and leaders of notable organizations. The present American makes their cash by buckling down. The common American specialist begins at the base and buckles down get to the top. All over, individuals are utilizing gadgets, for example, mobile phones, 2-way pagers, PCs, different gadgets that were not accessible previously and have now become a significant mostly American's live. Americans have been baffling in the course of recent years or thereabouts. Issues have heightened in sedate use, abhor violations, and other negative activities, for example, high school pregnancy. Ruler 2 There have been a few upgrades in the province of Americans like the decreased pace of smoking and crimes. It is imperative to advance in the battling of medication use, despise wrongdoings, just as our different issues to improve the present society. The activities of Americans presently will influence the general public later on, regardless of whether it is one year from now or one quite a while from now, which makes it critical to pick what is best for the country. Being an American, I have a portion of the qualities that the Modern American have. I am diligent employee, holding a requesting after school occupation and staying aware of my investigations simultaneously. I am a piece of the electronic rage that has assumed control over the world inside the most recent ten years. My convictions are that hardware are the way to accomplishment later on so I wish to keep myself educated in this viewpoint. Alongside a significant number of my kindred young people, I am free. I can think, act, and settle on significant choices all alone without the assistance of somebody revealing to me how to carry on with my life. I don't accept that I am a piece of our general public's concern, however that I am a piece of its answer. It is significant for each American to show high characteristics on the grounds that a chain is just as solid as its most fragile connection. For this situation it implies that our general public can just flourish with the aggregate as sistance of the entirety of its individuals. Present day Americans have more noteworthy, progressively troublesome issues to manage each day. It has gotten progressively mind boggling to experience existence without hitting a couple of knocks in transit. As the country develops more established, it must be kept up that we were given our opportunity however not to the degree of manhandling it. Present day Americans must endeavor to improve society and to make the United States a superior spot to live now, and later on. American History

Leadership And Management In Public Relations Management Essay

Initiative And Management In Public Relations Management Essay The workmanship and sociology of examining patterns, foreseeing their outcomes, guiding authoritative pioneers and actualizing arranged projects of activity, which will serve both the association and the open intrigue. (Asch and Solomon 1946) Advertising point principally to give a correspondence between an association and its clients. It is one of the most significant business works with respect to any association. It is basic to ceaselessly check its notoriety in the market that it provides food. Additionally, with the current atmosphere of worldwide expansions that greater part of the cutting edge organizations practice, it is basic that the association keeps contact with what it needs to depict to the shoppers so desires from the association is moreover. Open Relation is utilized to manufacture affinity withâ employees, clients, speculators, voters or the general public. Almost any association that entertains itself with being depicted in the open condition utilizes some degree of advertising. Open connection isn't constrained to just expanding mindfulness about an association. It manages other complex elements of checking and observing the responses of its activities( Ahluwalia et al 2000). This delineates what the association reflects to its market subsequently helping in choosing the following game-plan as and when required. Exposure is one of the significant apparatuses for Public relations. Most; if not all, PR crusades contribute vigorously for exposure. Exposure includes spreading of data for an item, individual, administration, cause or association to increase open mindfulness. Exposure helps in successful PR arranging and is one of the most popular strategies embraced by any PR for an association. In present occasions, experts generally use innovation as their principle instrument to get over their messages to target crowds (Collins et al, 1975). Customarily, probably the most seasoned apparatus utilized by advertising experts is a press/media unit. It is normally an assortment of limited time materials with the end goal of dissemination. These give data about an occasion, association, business, or even an individual. Data likewise incorporates, reality sheets, official statements (or media discharges), media alarms, handouts, pamphlets, photos with subtitles, duplicates of any media clasps, and social mediums. As of late, most associations may have a site with a connection which normally refreshes the message that is required to be imparted with the end goal of correspondence. Online form of such news is one of the fundamentals that is received as of late. Other broadly utilized apparatuses incorporate leaflets, pamphlets and yearly reports. (Basuroy et al 2003) In the ongoing occasions, innovative employments of informal organizations, writes, and even web radio advertising experts encourage to straightforwardly send messages through their separate mediums. Techniques are utilized to discover the response of the crowd in the present market. Asking into the positive interests of the intended interest groups broadly incorporate the utilization of reviews, leading examination or even center gatherings. Different strategies are attempted to draw in target crowds by utilizing the data assembled. This is then guided as a message to them utilizing instruments, for example, social or other famous mediums.'(Burrough and Bryan,2006) Progressively, organizations are using intuitive person to person communication choices, for example, media sites, Twitter and Facebook, as devices in advancement for the PR battles. This can be credited to the way that not at all like the conventional instruments, online life outlets empower the association to take part in two-manner correspondence, and get moderately speedier criticisms thus effectively supporting in settling on precise choices. Complementary nature of interchanges Separated from Effective Public Relations by Cutlip(2010) The above figure represents, correspondence is a complementary procedure of trading signs to educate, teach, or convince, in view of shared implications and molded by the communicators relationship and the social setting. (Godes, 2004) NEGATIVE PUBLIC RELATIONS: Negative Public connection happens under conditions and circumstance when the message sent across to general society by the association is seen not rational to what it depicts. It might be communicated as that procedure which compromises the notoriety and corporate personality of an association because of unrealistic activities that prompts far-fetched circumstances and conditions. (Eliasberg et al 1997) Be that as it may, this marvel can be either deliberate i:e. (by an outside source, for example, a contender) or accidental (insufficient research of a normal response or poor inner correspondences ). (Hueng et al,1982) Attributable to the idea of this report, the scientist has decided to consider just the ominous advertising for this investigation and accordingly Black advertising will just be referenced once. From that point, steps to manage horrible advertising will be incorporated for additional piece of this work. Deliberate Negative Public Relations It demonstrates in setting to frequencies which are conveyed about by outsider source with aim to discolor the notoriety of a focused on association, these sort of purposeful negative PR systems are otherwise called Black Public Relations (James and Caryn 2006). It includes gathering data utilizing significant level of mechanical undercover work and serious knowledge to reveal the focused on organization privileged insights that are troublesome to the associations partners (Hueng et al,1982). The main target of such practices is to deliberately upset the channels and messages of correspondence between the association and its investors. This sort of negative open connection is a dishonest business practice yet it is been generally utilized against business rivals. (Grossmen et al1984) Unexpected Negative PR/Unfavorable Public relations. This is an event under conditions when an association is confronting an open test to its notoriety. For the most part these difficulties may come in the accompanying structures:- An examination from an administration organization. A criminal charge. A media request. An investors claim An infringement of ecological guidelines At long last an infringement in various different situations including the legal,â ethical and/orâ financial factors (Godes et al 2004). The above are difficulties that an association faces which may prompt an ominous Public relations circumstance for an association. Be that as it may, the greater part of them can be contained very quickly whenever took care of with direness. For the most part, wellspring of a negative Public connection is conceived out of botched emergencies circumstance in an association. Emergency correspondence is of most extreme significance to contain any such far-fetched conditions. In the event that productively took care of, emergency correspondence can turn into the best guard against any issue transforming into a completely blow fiasco. An outline to clarify the above can be found on account of Johnson. In 1982, after cyanide was found in certain containers of a JJ item Tylenol, J and J quickly declared a review of an expected supply of around a hundred million available for use in its residential market of the United States and other remote market (Berger,2005). This choice of Johnson, to collaborate completely with the media, earned it heaps of gestures of recognition for its business guideline of being socially dependable. The resultant was that the organization got extra positive press inclusion when it in this way presented its new alter safe bundling. Likewise In March 2005, a lady bit into a finger while eating bean stew at Wendys. Wendys reacted speedily and shut down that area. This was trailed via cautiously disposing of the various bean stew that was dated as the disputable stock. The area was revived simply after a careful examination of the remainder of the stocks.This emergency could have harmed Wendys picture, however inferable from it reacting appropriately and fittingly, next to no harm was seen to their picture (Berger,2005). These are two of the couple of models which show proficient emergency the executives techniques in spite of not being in charge the negative PR at the underlying phases of the emergency. Johnson had the option to increase positive exposure for the brief dynamic and was in this way ready to contain the circumstance before it left extent. Then again, numerous different associations have indicated need dealing with an emergency circumstance and have languished over the equivalent. Source Perrier is a case of such an association, that couldn't defeat negative exposure when its top administration showed poor emergency the board. Hints of benzene were found in the companys filtered water in 1990, anyway the organization guaranteed the open that it was just contained to bottles in North America. During a similar time, researchers discovered hints of benzene in its filtered water which was being sold in Europe. This time, the administration accused it upon a polluted separating framework a consoled that it was being handled with most extreme desperation. Never the less, media had then inspected the brands water from all its predominant market and found that the circumstance had been persevering for a more drawn out timeframe and that the benzene bound item had been selling all around the globe. The media addressed Perriers respectability and worry for open wellbeing, and the organization lost its prevailing situation in the commercial center; it has been not able t o revamp its notoriety (Bogart and Dave 2001). The accessible writing on the wellspring of negative PR isn't lucidly indisputable as various scientists have distinction in the degree and width with respect to their view about the reasons for unavoidable PR. Lerbinger (1997), properties two causes i:e. the board disappointment and ecological powers. He classifies the two into eight classifications of emergency circumstances which are as per the following: Normal for instance Asian Tsunami which influenced everything the same I:

Columbia University to open Center for Veteran Transition and Integration COLUMBIA UNIVERSITY - SIPA Admissions Blog

Columbia University to open Center for Veteran Transition and Integration COLUMBIA UNIVERSITY - SIPA Admissions Blog Earlier this month, Columbia University announced the creation of a new Center for Veteran Transition and Integration that will provide innovative educational programming and support for veterans making the transition to two- and four-year colleges, graduate and professional schools, civilian life, and the workforce. Major Michael Abrams, a veteran of the war in Afghanistan and a current Marine Corps Reservist, as well as the founder of FourBlock, a program to prepare veterans for business careers, will lead the center as its executive director. Beth Morgan, former executive director of Service to School and director of higher education initiatives for the Marine Corps, joins the center as director of higher education transition and partnerships. The Center for Veterans will open in the fall of 2017. Columbia’s long-standing commitment to veterans can be traced back to 1947, when the School of General Studies was founded to integrate into the University community thousands of returning military veterans seeking education after World War II through the first GI Bill. Today more than 650 veterans are enrolled at Columbia, most of them supported by the Post-9/11 GI Bill and the Yellow Ribbon Program. The University has enrolled more student-veterans than all other Ivy League schools combined, while maintaining a graduation rate above 90 percent and a record of job and graduate school placement that equals Columbia’s non-veteran graduates. Highlighting this success, this year’s valedictorian at the School of General Studies is Colin Valentini, a Marine Corps veteran who came to Columbia to study applied mathematics. Columbia’s successful efforts in helping military service members make the transition to a rigorous academic environment has prompted interest from other universities, employers, government agencies, and veteran-support organizations across the country that would like to replicate its veteran support model. The new veterans center will draw on Columbia’s expertise in curriculum development, instructional technology, and support services in facilitating veterans’ success in an academic setting. In collaboration with a network of public and private partners, the center will provide access to world-class technology and technical support. It will serve military service members at all levels, enlisted and officers, as well as active-duty military personnel preparing for transition, veterans already in higher education, and veterans in the workforce, providing them with the best-in-class resources that they need to ensure their continued academic and professional development. The experience and expertise that Abrams and Morgan bring to this endeavor will be integral in achieving the Center’s vision. Read more about the Center at Columbia News.

Domestic Violence The Horrific Effects Of Abuse

DOMESTIC VIOLENCE: The Horrifying Effects of Abuse â€Å"To those who abuse: the sin yours, the crime is yours, and the shame is yours. To those who protect the perpetrators: blaming the victims only masks the evil within, making you as guilty as those who abuse. Stand up for the innocent or go down with the rest†¦Ã¢â‚¬  These are the words of an individual who sees too clearly the injustice which comes with domestic violence toward women. The United States government estimates one in every four women will experience domestic violence in her lifetime. Domestic abuse remains a significant social problem in many towns, cities and neighborhoods and though the victims involved may often remain silent, its emotional, psychological and physical effects still linger on. Domestic violence defined by law according The United States Department of Justice is â€Å"†¦a pattern of abusive behavior in any relationship that is used by one partner to gain or maintain power and control over another intimate partner.† The harrowing details of many stories narrated by women nation-wide will continue to place domestic violence in the societal spotlight. It is considered a national crime; however, there are many who still debate its exaggeration and the justice that it should accompany. The traditional theories of justice are contradictorily blind to the injustice women face on a daily basis. Many philosophers, traditionalists and post-modernists maintain the notion that a woman’s role is mostly in her privateShow MoreRelatedThe Effects Of Intimate Partner Violence On Children Essay811 Words   |  4 Pages The effects of intimate partner violence are attenuating and extend far beyond physical scarring. The abuse of woman and children has been researched extensively by Rachel Pain (2014, p. 536) as acts of â€Å"terrorism within the home†. If we are to compare the experience of women and children living in violent homes and the act of ‘terrorism’ itself we get a corresponding experience (Pain, 2014, p. 546). The construction of fear, the loss of identity, the ongoing distress of constantly feeling unsafeRead MoreChild Abuse Is The Most Important Part Of Today s Society1302 Words   |  6 Pagesparenting involves the use of excessive violence as a form of punishment. Children are placed in a horrific situation through abuse instigated by their parents that damages the child physically and psychologically. Children everywhere are being abused by their parents whether it be physical or emotional abuse. In order to help prevent child abuse, one must first understand some of the reasons that parents abuse their children. There is no excuse to abuse one’s child and there have been many studiesRead MoreDomestic Violence And Its Effects On Society869 Words   |  4 Pageswith a neglectful nature and/or an imbalance of neurotransmitters can impact an individual’s development and overall self-image. Equally, an individual’s experience with domestic violence and its horrific ramifications can also impact a person’s psychological, emotional, physical, and social growth. Domestic Violence Domestic violence, is a virulent calamity that has woven its way into our society for thousands of years. It is not biased to a particular race, group, or culture. Grievously, it has anRead MoreThe Masked Women1130 Words   |  5 PagesThe Masked Women Females’ ages 18 to 24 and 25 to 34 generally experienced the highest rates of intimate partner violence (â€Å"Statistics†). People so young are being brought into horrible situations that can cause emotional, mental and physical harm that has long lasting effects on them. The ad â€Å"It Rarely Stops† by The National Domestic Hotline was posted on YouTube in September 2015. In this ad, a young women is gazing into her bathroom mirror (the camera) with a sorrowful look on her face. SheRead MoreDomestic Violence s Impact On A Person1429 Words   |  6 PagesDomestic Violence s Impact Upon A Person Not all people think about domestic violence but for a large amount of people it is an everyday hell. Most people have the privilege of going about their day carefree of who they will see at a time during that day, while others are fearful of seeing one or more people throughout their day. Domestic violence also know as partner abuse is a series of abusive patterns that are between two people, most commonly spouses. Emotional abuse, physical abuse, and sexualRead MoreDomestic Violence And Its Effects On Society1649 Words   |  7 PagesIn America most cases of Domestic Violence are never actually reported, many times these cases go unheard and the victims suffer in silence. The worn out cries of a battered woman as she lays on the ground clutching herself and begging her significant other to just stop. The bruises and cuts that remain unreported due to the victim claiming they accidentally fell yet again. The abusers tend to make the victim almost entirely dependable on them. An a buser will do this to gain control and to createRead MoreAnimal Cruelty And Domestic Violence Essay1159 Words   |  5 PagesWhile there is a common belief that Animal Cruelty and Domestic Violence are two separate issues, but, upon closer investigation proves there is a prominent correlation between the two. Despite the whether you believe animals and humans should be given equivalent attention remains a debated subject. Many people would answer that they should, as both human animals and nonhuman animals share many characteristics in the sense that they are both sentient living beings; both can feel pain, experienceRead MoreThe Effects Of Violence On Domestic Violence1380 Words   |  6 Pagesobject to violence, because when it appears to do good, the good is only temporary; the evil it does is permanent†, quoted by Mahatma Gandhi. Violence is defined as an unjust or unwarranted exertion of power or force to intentionally injure, damage, or destroy something or someone. Amongst the various types of violence, there is one in particular that has been causing an ongoing debate within societies across the world; this certain type of violence is known as domestic violence. Domestic violence, alsoRead MoreThe Effects Of Domestic Violence On Domestic Abuse1340 Words   |  6 Pages1301 Lacina-Taylor 2 December 2014 Stop The Abuse Underreported and underestimated, domestic abuse rips families apart every single day. Domestic violence comes in mainly five different forms, physical, sexual, psychological, emotional, and economic. This violence ruins families, demoralizes the victims, and the public downplays the household terrorism that goes on every day. Generally thought of as taboo, the public belittles and humorizes domestic abuse as a way to deal with it, that avoidance mustRead MoreThe Correlation Between Domestic Violence And Post Traumatic Stress Disorder1182 Words   |  5 PagesThe Correlation Between Domestic Violence and Post-Traumatic Stress Disorder Domestic violence is a horrific circumstance that is an ongoing issue to the public health of the world. Affecting the lives of millions annually by psychologically crippling the minds of the affected through chronic exposure to abuse. According to the National Coalition Against Domestic Violence (2014), 1.3 million women are subjected to this devastating situation. â€Å"No such global estimate was applicable for men† (Trevillion

The Significance of Act 3 Scene 3 of William Shakespeares...

The Significance of Act 3 Scene 3 of William Shakespeares Othello Othello was written by Shakespeare around 1602 and was set 35 years previously to that time (around 1571) during the Elizabethan era. Shakespeare got the idea for the play from the Italian Novella Gli Hecatommithi and only changed minor details slightly. He kept the same plot but some of the characters and themes in the play were very different. The play itself is a tragedy and includes the things that Aristotle defined as what a tragedy should include. Firstly, a protagonist, this is Othello. He is the protagonist as the play shows the story of his fall from a place of eminence as is required in all tragedies according to†¦show more content†¦His manipulation leads to the deaths of Desdemona and Othello. In the play there is physical movement of the characters from Venice to Cyprus, which helps towards the insecurities of Othello developing further. Venice was where the love between Desdemona and Othello developed and therefore gives the relationship a sense of security. In Venice any problems there is order and control and any problems are dealt with swiftly and even though Othello is still an outsider he is valuable to them. However, the move to Cyprus makes Othello vulnerable in that he is no longer valued and is being moved away from what he knows - into the unknown, which makes it easier for Iago to play on Othellos insecurities as they are more susceptible to attack. Before they move there is a storm, which relates to the turbulence to Othellos life that will be brought with the move. The scene I am focusing on is Act 3 Scene 3; this is the longest and most dramatic scene in the play. It is the climatic turning point of the play and is significant in that it is the first time Iago really begins to take hold of Othello, to manipulate him and make him lose his trust in Cassio and Desdemona. A key event in this scene is when Iago says Ha! I like not that As this is the beginning of Iagos manipulation over Othello making Othello curious as to whatShow MoreRelatedOthello: The Tragedy of an Aristotelian Tragic Hero Essay1531 Words   |  7 PagesShakespeares play, â€Å"Othello, the Moor of Venice,† is a powerful example of a tragedy and it’s main character, Othello, is an excellent illustration of what Aristotle constitutes as a tragic hero. The play imitates life through basic human emotions such as jealousy and rage. In addition, Othello is far from being a perfect character - another quality that meets Aristotles requirements. Othello also matches Aristotles ideas of tragic hero because our Othello realizes the error of his ways, causingRead MoreThe Tragedy Of Othello The Moor Of Venice Essay1743 Words   |  7 Pages ‘Without setting, characters are simply there, in a vacuum, with no reason to act and most importantly, no reason to care.’ The setting gives place for a narrative to begin and evolve from, without a strong setting some texts may be difficult to interpret without extra contextual and historical knowledge of the time period of which it was written. Shakespeare’s The Tragedy of Othello the Moor of Venice written 1603 was set in Italy, in the Venetian Republic . This setting was gaining popularityRead MoreThe Symbolism Of Othello By William Shakespeare958 Words   |  4 Pagesme and I will treasure it as long as I live. In William Shakespeare’s play, Othello, the symbolism of Desdemona’s handkerchief is central to the play’s tragic dà ©nouement. The handkerchief serves a very important role in shaping the story to the way it is, it ultimately becomes the reason for Othello’s brutal murder of his wife, Desdemona. In addition, the handker chief is shown as a symbol of â€Å"different things from various events in this play† (Othello). In the first, it is shown as a symbol of Othello’sRead MoreOthello, By William Shakespeare1218 Words   |  5 PagesIn a historical time period where emphasis was shifting from religion to race and ethnicity, key indicators of differences that perpetuated into racial prejudice and racial ideologies are evident in Othello by William Shakespeare. Although racism was not fully formed at this moment in history, Othello can be interpreted as a representation and an exploration of this shift in ideology. In the past, before this change toward racial differences, religion was the major segretory factor in signifyingRead MoreThe Importance of Act 3 Scene 3 to William Shakespeares Othello1463 Words   |  6 PagesThe Importance of Act 3 Scene 3 to William Shakespeares Othello In this essay I am going to investigate the importance and effectiveness of Act 3 scene 3 considering its significance in terms of plot, characters and theme and its dramatic power. Throughout this scene there are striking examples of the main themes of the play, one of these being appearance and reality. Iago fools everyone in the play into believing hes honest. No one even suspects him of treacheryRead MoreThe Significance of Death and Sex to William Shakespeare1482 Words   |  6 PagesThe Significance of Death and Sex to William Shakespeare In this essay, I will consider Death and Sin in Shakespearean drama and I would like to look at three of Shakespeares tragic plays: Hamlet, Othello and King Lear. Shakespeare uses many themes in all his play that attract audiences throughout history. The things he wrote about are as relevant now as they were in his time. Death and Sin were issues that are always around. In his plays, Shakespeare could comment on these things andRead More Iago in William Shakespeares Othello Essay2704 Words   |  11 PagesIago in William Shakespeares Othello Unequivocally, Iago plays an important and major function in the tragedy of Othello. By the end of the play, Iago has been directly responsible for the deaths of Roderigo, Emilia and the protagonist and his love. Iagos importance to the play is revealed by his contribution to the plot and his significance relative to other characters. Iagos function, which invariably adds to the importance he has on the play, is to lead to the downfall of Othello thereforeRead More The Significance of the Players in Hamlet Essay899 Words   |  4 PagesThe Significance of the Players in Hamlet      Ã‚   Most characters in Hamlet present themselves as something other than themselves or how as we, the audience, or another character thinks they should appear.   Two of the main characters in this play, Hamlet and King Claudius, are constantly acting as something other than their true nature.  Ã‚  Ã‚   Ironically, the characters that invoke changes in Hamlet and King Claudius to reveal their real personalities are the players, merely actors themselves, notRead MoreCompare Relationships Between Romeo and Juliet and Between Desdemona and Othello 1931 Words   |  8 PagesIn Two of Shakespeare’s most noted plays Romeo and Juliet and Othello Shakespeare explores the essence of tragedy. How regardless of what measures they take my the nature of the play both relationships are doomed before they flourish, The extent in witch obsession clouds the minds of the luckless heroes and by what extent the women seem to be more in control of the men than the other way round. In the plays ‘Romeo and Juliet’ and ‘Othello’ by William Shakespeare, Shakespeare uses the concept ofRead MoreWilliam Shakespeares As You Like It As a Study of Perception and Misperception2315 Words   |  10 PagesWilliam Shakespeares As You Like It As a Study of Perception and Misperception The concepts of perception and misperception are common themes in many of Shakespeares plays and can be found in his comedies, tragedies and histories alike. Shakespeare explores these often-parallel elements through several different forms in his work, such as disguise, mistaken identity and blindness, and events caused by these can lead to amusing, confusing or sometimes tragic consequences

Literature Search Free Essays

Grap, Mary. ,Munro, Cindy. , Hummel, Russel. We will write a custom essay sample on Literature Search or any similar topic only for you Order Now , Jessica. , Elswick, and Sessler Curtis. 2005. Effect of Backrest Elevation on the Development of Ventilator-Associated Pneumonia. AACN. Retrieved from ajcc. aacnjournals. org on March 3, 2012. Abstract †¢ Background Ventilator-associated pneumonia is a common complication of mechanical ventilation. Backrest position and time spent supine are critical risk factors for aspiration, increasing the risk for pneumonia. Empirical evidence of the effect of backrest positions on the incidence of ventilator-associated pneumonia, especially during mechanical ventilation over time, is limited. Objective To describe the relationship between backrest elevation and development of ventilator-associated pneumonia. †¢ Methods : It is a nonexperimental, longitudinal, descriptive design was used. The Clinical Pulmonary Infection Score was used to determine ventilator-associated pneumonia. Backrest elevation was measured continuously with a transducer system. Data were obtained from laborato ry results and medical records from the start of mechanical ventilation up to 7 days. †¢ Results Sixty-six subjects were monitored (276 patient days). Mean backrest elevation for the entire study period was 21. 7 °. Backrest elevations were less than 30 ° 72% of the time and less than 10 ° 39% of the time. The mean Clinical Pulmonary Infection Score increased but not significantly, and backrest elevation had no direct effect on mean scores. A model for predicting the Clinical Pulmonary Infection Score at day 4 included baseline score, percentage of time spent at less than 30 ° on study day 1, and score on the Acute Physiology and Chronic Health Evaluation II, explaining 81% of the variability (F=7. 1, P=. 003). Literature Search 3 †¢ Conclusions Subjects spent the majority of the time at backrest elevations less than 30 °. Only the combination of early, low backrest elevation and severity of illness affected the incidence of ventilator-associated pneumonia. Amelia Ross. (2006). The impact of an evidence-based practice education program on the role of oral care in the prevention of ventilator-associated pneumonia. Ret rieved from, www. elsevierhealth. com/journals/iccn. on March 2, 2012. Abstract BACKGROUND: Despite strong evidence in the literature on the role of oral care in the prevention of ventilator-associated pneumonia (VAP), nurses continue to view oral care as a comfort measure with low priority and utilize foam swabs rather than toothbrushes. Although an evidence-based oral care protocol existed and best-practice oral care tools were available, the VAP rates had not significantly decreased even though nurses reported providing oral care. OBJECTIVES: The aim of the study was to determine if an evidence-based practice (EBP) educational program would improve the quality of oral care delivered to mechanically ventilated patients; thereby, reducing the VAP rate. RESULTS: Improvement in oral health was demonstrated by a decrease in median scores on the Oral Assessment Guide (pre (11. 0), post (9. 0)). A t-test analysis revealed a statistically significant difference (p=0. 0002). The frequency of oral care documentation also improved as demonstrated by a positive shift to the more frequent timeframes. The VAP rates have decreased by 50% following the EBP education Literature Search 4 ntervention. CONCLUSIONS: The implementation of an EBP educational program focused on patient outcome rather than a task to be performed improved the quality of oral care delivered by the nursing staff. Carolyn L. , Cason, Tracy, Tyner. , Sue, Saunders, Lisa, Broom. , 2007. Nurses Implementation of Guidelines for Ventilator-Associated Pneumonia from the Ce nters for Disease Control and Prevention. AACN. Retrieved from ajcc. aacnjournals. org on March 1, 2012. Abstract †¢ Background Ventilator-associated pneumonia accounts for 47% of infections in patients in intensive care units. Adherence to the best nursing practices recommended in the 2003 guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention should reduce the risk of ventilator-associated pneumonia. †¢ Objective To evaluate the extent to which nurses working in intensive care units implement best practices when managing adult patients receiving mechanical ventilation. †¢ Methods Nurses attending education seminars in the United States completed a 29-item questionnaire about the type and frequency of care provided. †¢ Results Twelve hundred nurses completed the questionnaire. Most (82%) reported compliance with hand-washing guidelines, 75% reported wearing gloves, half reported elevating the head of the bed, a third reported performing subglottic suctioning, and half reported having an oral care protocol in their hospital. Nurses in hospitals with an oral care protocol reported better compliance with hand washing and maintaining head-of-bed elevation, were more likely to regularly provide oral care, and were more familiar with rates of ventilator-associated pneumonia and the organisms involved than were nurses working in hospitals without such protocols. Literature Search5 †¢ Conclusions The guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention are not consistently or uniformly implemented. Practices of nurses employed in hospitals with oral care protocols are more often congruent with the guidelines than are practices of nurses employed in hospitals without such protocols. Significant reductions in rates of ventilator-associated pneumonia may be achieved by broader implementation of oral care protocols. Grap, Mary. ,Munro, Cindy. , Hummel, Russel. , Jessica. Elswick, and Sessler Curtis. 2005. Effect of Backrest Elevation on the Development of Ventilator-Associated Pneumonia. AACN. Retrieved from ajcc. aacnjournals. org on March 3, 2012. Abstract †¢ Background Ventilator-associated pneumonia is a common complication of mechanical ventilation. Backrest position and time spent supine are critical risk factors for aspiration, increasing the risk for pneumonia. Empi rical evidence of the effect of backrest positions on the incidence of ventilator-associated pneumonia, especially during mechanical ventilation over time, is limited. Objective To describe the relationship between backrest elevation and development of ventilator-associated pneumonia. †¢ Methods : It is a nonexperimental, longitudinal, descriptive design was used. The Clinical Pulmonary Infection Score was used to determine ventilator-associated pneumonia. Backrest elevation was measured continuously with a transducer system. Data were obtained from laboratory results and medical records from the start of mechanical ventilation up to 7 days. †¢ Results Sixty-six subjects were monitored (276 patient days). Mean backrest elevation for the entire study period was 21. 7 °. Backrest elevations were less than 30 ° 72% of the time and less than 10 ° 39% of the time. The mean Clinical Pulmonary Infection Score increased but not significantly, and backrest elevation had no direct effect on mean scores. A model for predicting the Clinical Pulmonary Infection Score at day 4 included baseline score, percentage of time spent at less than 30 ° on study day 1, and score on the Acute Physiology and Chronic Health Evaluation II, explaining 81% of the variability (F=7. 1, P=. 003). Literature Search 3 †¢ Conclusions Subjects spent the majority of the time at backrest elevations less than 30 °. Only the combination of early, low backrest elevation and severity of illness affected the incidence of ventilator-associated pneumonia. Amelia Ross. (2006). The impact of an evidence-based practice education program on the role of oral care in the prevention of ventilator-associated pneumonia. Ret rieved from, www. elsevierhealth. com/journals/iccn. on March 2, 2012. Abstract BACKGROUND: Despite strong evidence in the literature on the role of oral care in the prevention of ventilator-associated pneumonia (VAP), nurses continue to view oral care as a comfort measure with low priority and utilize foam swabs rather than toothbrushes. Although an evidence-based oral care protocol existed and best-practice oral care tools were available, the VAP rates had not significantly decreased even though nurses reported providing oral care. OBJECTIVES: The aim of the study was to determine if an evidence-based practice (EBP) educational program would improve the quality of oral care delivered to mechanically ventilated patients; thereby, reducing the VAP rate. RESULTS: Improvement in oral health was demonstrated by a decrease in median scores on the Oral Assessment Guide (pre (11. 0), post (9. 0)). A t-test analysis revealed a statistically significant difference (p=0. 0002). The frequency of oral care documentation also improved as demonstrated by a positive shift to the more frequent timeframes. The VAP rates have decreased by 50% following the EBP education Literature Search 4 ntervention. CONCLUSIONS: The implementation of an EBP educational program focused on patient outcome rather than a task to be performed improved the quality of oral care delivered by the nursing staff. Carolyn L. , Cason, Tracy, Tyner. , Sue, Saunders, Lisa, Broom. , 2007. Nurses Implementation of Guidelines for Ventilator-Associated Pneumonia from the Ce nters for Disease Control and Prevention. AACN. Retrieved from ajcc. aacnjournals. org on March 1, 2012. Abstract †¢ Background Ventilator-associated pneumonia accounts for 47% of infections in patients in intensive care units. Adherence to the best nursing practices recommended in the 2003 guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention should reduce the risk of ventilator-associated pneumonia. †¢ Objective To evaluate the extent to which nurses working in intensive care units implement best practices when managing adult patients receiving mechanical ventilation. †¢ Methods Nurses attending education seminars in the United States completed a 29-item questionnaire about the type and frequency of care provided. †¢ Results Twelve hundred nurses completed the questionnaire. Most (82%) reported compliance with hand-washing guidelines, 75% reported wearing gloves, half reported elevating the head of the bed, a third reported performing subglottic suctioning, and half reported having an oral care protocol in their hospital. Nurses in hospitals with an oral care protocol reported better compliance with hand washing and maintaining head-of-bed elevation, were more likely to regularly provide oral care, and were more familiar with rates of ventilator-associated pneumonia and the organisms involved than were nurses working in hospitals without such protocols. Literature Search5 †¢ Conclusions The guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention are not consistently or uniformly implemented. Practices of nurses employed in hospitals with oral care protocols are more often congruent with the guidelines than are practices of nurses employed in hospitals without such protocols. Significant reductions in rates of ventilator-associated pneumonia may be achieved by broader implementation of oral care protocols. How to cite Literature Search, Essay examples

Restoration of Euglycemia After Duodenal Bypass Surgery

Questions: 1. What is the most commonly used restrictive bariatric procedure worldwide?2. What is the difference between Roux-en-Y gastric bypass and sleeve gastrotectomy?3. Why the secretion of gut hormone in adjustable gastric banding (AGB) is mainly considered to be due to weight loss?4. What is the possible role for GLP-1 in bariatric surgery?5. Which experiments support the hypothesis that GLP-1 is directly involved in improvement of glycemia in gastric bypass in animal and humans?6. Explain why reduction in ghrelin secretion in bariatric surgery would be beneficial on glucose homeostasis?7. Explain why improvement seen in diabetes in some type of bariatric surgery is independent of weight loss?8. What did you find most interesting or difficult? Answers: 1. The most commonly used restrictive bariatric procedure worldwide is adjustable gastric banding (AGB). 2. In the Roux-en-Y gastric bypass (RYGB) surgery a major part of the stomach, duodenum and 40 cm of the jejunum are bypassed whereas the sleeve gastrotectomy involves the removal of 75% of the stomach, thr removed part includes the hormone secreting gastric fundus.3. The gastrointestinal tract remains intact as a result of the AGB surgery and continues to secrete gut hormones. However, the reduced intake capacity of the diabetic patient causes weight loss and leads to better glucose homeostasis and the improved glucose levels are independent of change in gut hormone secretion levels.4. The secretion of GLP-1 which is low in obese patients shoots up by six times after bariatric surgery. An incretin hormone, GLP-1 signals satiety and stimulates secretion of insulin. It suppresses glucagon secretion and retards gastric emptying. The increased levels of GLP-1 therefore improve glucos e homeostasis in patients who have undergone bariatric surgery. However, the levels of GLP-1 are not raised in adjustable banding surgery as opposed to bariatric procedures which involve removal of parts of the GI tract.5. A set of experiments performed on rats and humans supports the hypothesis that GLP-1 is directly involved in improvement of glucose homeostasis in gastric bypass treated subjects.Exendin 9 - 39 amide (Ex-9) has been used to study the physiological activity of GLP-1. Ex-9 is known to block GLP-1 activity by binding to its receptors. GLP-1 action causing release of post prandial insulin gets blocked without any impact on other hormones required for insulin secretion. Diabetic rats that were treated with a duodenal-jejunal bypass (an RYGB-like surgical procedure) exhibited improved glucose homeostasis in comparison with sham-operated rats.Ex-9 has been used in humans to check whether high secretion of insulin in RYGB treated patients can be attributed to GLP-1 induced secretion of insulin from beta cells causing post-surgical hypoglycemia. Administration of Ex-9 resulted in a 33% fall in insulin secretion.6. The removal of gastric fundus during bariatric surgery causes reduction in ghrelin secretion. This hormone is known to stimulate appetite. It inhibits insulin secretion through a mechanism yet to be clearly understood. Ghrelin suppresses adiponectin a hormone that plays a role in insulin sensitization and causes stimulation of counter regulatory hormones. Ghrelin secretion is affected by the vagus nerve which is severed during bariatric procedures on purpose. The secretion of ghrelin continues after the procedure during which the vagus nerve remains intact.7. Improvement in glucose homeostasis has been seen in diabetics who have been treated with bariatric surgery irrespective of weight loss. The sudden rise in GLP-1 post bariatric procedures that reduce ghrelin secretion leads to greater satiety and insulin secretion. The duodenal bypass may cause higher levels of gut hormones to be released which directly improve insulin sensitivity.Secretion of diabetogenic gut secretions is reduced. Alterations in bile acids and gut microflora can improve glucose homeostasis.8. The role of GLP-1 in achieving glucose homeostasis in patients treated with bariatric surgery is the most interesting and that bypass surgeries may be bypassed in future. References: Jiao, J., Bae, E. J., Bandopadhyay, G., Oliver, J., Marathe, C., Chen, M., Hsu, J.-Y., Chen, Y., Tian, H., Olefsky, J. M., and Saberi, M. (2013). Restoration of euglycemia after duodenal bypass surgery is reliant on central and peripheral inputs in Zucker fa/fa rats. Diabetes. 62: 1074-83.Vetter, M. L., Ritter, S., Wadden, T. A., and Sarwer, D. B. (2012). Comparison of bariatric surgical procedures for diabetes remission: efficiency and mechanisms. Diabetes Spectrum. 25(4):200-10. Doi:10.2337/diaspect.25.4.200.