Homeland Security Essay Example for Free

Homeland Security Essay Homeland Security is a cabinet level agency in the federal government. Its birth came after the terrorist attacks on September 11th, 2001. Its main goals were to deter terrorism on U. S. soil and the safety of the American infrastructure. It has been reported many times the trouble this department is having getting off the ground. â€Å"Hardly a day goes by without some fresh report on a contract gone bad, a new technology that does not work, a new Coast Guard cutter that is not seaworthy, or more cargo that slips through port without inspection† (Light, 2007). Every year new assessments of the department including Congress, the 9/11 Commission and the departments own inspector general gives it low grades for job satisfaction, management, and leadership. Just some of the problems it is having are high turnover, internal bureaucratic struggles and structural problems. So with all that said it is having problems reaching many of its outlined goals. It still needs funding, authority, better strategy for protecting American soil, personnel, better screening at airports for passengers and employees, and better technology to find weapons such as explosives. Improved intelligence capabilities are probably the most important. Border security issues were the founding fathers main focus when he was with the agency and I am in agreement. Securing our countries boarders on a daily basis is the Homeland security’s main concern. The military that has done that job up until now but with the world being global we need to separate the two and give each their own set of ground rules to operate at an optimum level. The merging of immigration and customs enforcement can only help in making this department function at a level the American public can be proud of with the goals of this office being completed (Magleby, O’Brien, Light, Peltason, Cronin, 2006). Even with all its imperfections I still believe that it is a needed department in our government. A somewhat more rigid department to handle military type action on homeland soil was needed and was realized on 9/11. We had been living in a glass house and it was just a matter of time. The partnership it is creating with state and local governments especially with intelligence from federal sources will build a safer America. After the disaster of Katrina in 2005 it was more obvious that this newly formed department would need some redesign in its structure. But I think with having Homeland Security it will help to build a better military. This would allow more forces to be deployed outside our borders when needed. I think now if Homeland Security had been up to par, would we still be in Iraq or would the troops the Republicans so desperately want to send be there and back by now? Reference: Light, P. (2007, Spring). The homeland security hash. Wilson Quarterly, 31(2). Magleby, D. B. , O’Brien, D. , Light, P. , Peltason, J. W. , Cronin, T. E. (2006). Government by the People: National, State, and Local 21st. Ed. New Jersey: Prentice Hall.

Sustainable Tourism in Developing Countries

Sustainable Tourism in Developing Countries To what extent can tourism be  sustainable in developing countries? Introduction Tourism Sustainability Conclusion References Introduction When one looks at monetary flows, along with the creation of jobs, the tourism sector represents one of the largest industries globally[1]. The preceding aspect is an important one, as tourism provides the opportunity for small and medium sized (5 through 500 employees) businesses to form, along with micro enterprises that typical consist of fewer than six people, and usually represent family operations[2]. These types of enterprises create employment opportunities, and in tourism, particularly in developing countries, the influx of tourist money provides openings for street vendors, cart food services, transport, and other self employment[3]. An example of the importance of micro enterprises and SME’s is provided in an International Finance Corporation report authored by Hallberg[4] that states these types of firms represent the majority of employment. She points out that in Ecuador firms with less than 50 employees represents 99 percent of all enterprises in that country, an d 55 percent of employment[5]. In the case of Bangladesh, enterprises with less than 100 employees represented 99 percent of all companies, employing 58 percent of all workers[6]. The preceding has been brought forth to provide the context for this examination in the extent that tourism can be sustainable in developing countries. The point being made is that the hard currency flows represent an economic benefit that is important not only in tourism monies spent, but also as a basis for foreign investment and the creation of opportunities for foreign businesses to set up operations, with tourism as the entree. The foregoing economic benefits represent a critical facet in approaching and understanding the importance of tourism to developing countries. The preceding importance also holds true for developed countries as well. The importance of tourism in developed countries is brought forth by the Assistant Secretary General of the World Tourism Organization, Geoffrey Lipman, who stated â€Å"Showing the full economic impact of the sector in the Index will enhance travel tourism’s relevance for policy-makers†¦The Index makes clear that, although industrialized states currently dominate, poorer countries have a massive potential to be the leading force in international tourism,[7]. The significance of mentioning this Report in the context of this examination is that it provides an analysis of key drivers regarding competitiveness, which are thirteen pillars, as represented by â€Å"1. policy rules and regulations, 2. environmental regulation, 3. safety and security, 4. health an d hygiene, 5. prioritisation of travel and tourism, 6. air transport infrastructure, 7. ground transport infrastructure, 8. tourism infrastructure, 9. information and communication technology (ICT) infrastructure, 10. price competitiveness, 11. human capital, 12. national tourism perception, and 13. natural and cultural resources[8]. The benefits to a country and its populace as a result of tourism can have long term implications economically, however, the foundations, as set forth by the foregoing pillars, indicates that attaining such a goal requires commitment and a national plan to achieve. Tourism Sustainability The preceding brought forth the complexities involved in conducting tourism, highlighting that it is not a segment that can be entered into lightly if long term and sustainable results are to be achieved. An example of the Index illustrates the foregoing: Chart 1 Travel and Tourism Competitiveness Index – Regulatory Framework Segments 1 through 5[9] Pillars 1. Policy 2. Environment 3. Safety 4. Health 5. Priority Rules Sustainability Security Hygiene TT Country Rank Score Rank Score Rank Score Rank Score Rank Score Albania 104 3.69 93 4.08 71 4.93 59 476 104 3.55 Argentina 91 3.95 107 3.94 98 4.45 40 5.62 70 4.23 Austria 22 5.04 53 4.63 21 5.85 37 5.72 32 4.92 Bangladesh 114 3.31 121 3.71 129 2.83 117 2.11 122 2.77 Bolivia 127 2.88 104 3.98 92 4.53 14 6.51 91 3.81 Botswana 74 4.13 68 4.42 50 5.26 97 3.24 82 3.95 U.K. 5 5.54 10 5.56 65 5.01 41 5.58 43 4.69 U.S. 19 5.22 100 4.02 119 3.75 44 5.50 21 5.26 Chart 2 Travel and Tourism Competitiveness Index – Regulatory Framework Segments 6 through 10[10] Pillars 6. Air 7. Ground 8. Tourism 9. ICT 10 Price Transport Transport Infrastructure Infrastructure Compettive Country Rank Score Rank Score Rank Score Rank Score Rank Score Albania 112 2.20 116 2.55 86 2.53 86 2.16 90 4.33 Argentina 67 2.94 90 3.05 53 3.91 54 3.03 41 4.94 Austria 29 4.25 10 6.03 1 7.00 20 4.88 104 4.17 Bangladesh 116 2.12 69 3.56 122 1.29 122 1.52 10 5.44 Bolivia 108 2.25 114 2.59 99 2.21 106 1.81 14 5.32 Botswana 77 2.72 72 3.50 78 2.80 92 2.05 6 5.49 U.K. 4 5.65 11 5.85 16 6.18 9 5.46 127 3.44 U.S. 2 6.34 19 5.45 6 6.74 13 5.23 105 4.18 Chart 3 Travel and Tourism Competitiveness Index – Regulatory Framework Segments 11 through 14[11] Pillars 11. Human 12. Affinity 13. Natural 14. Cultural Resources Resources Resources Country Rank Score Rank Score Rank Score Rank Score Albania 58 5.03 6 6.32 130 1.87 75 2.17 Argentina 60 5.01 74 4.69 12 5.01 41 3.29 Austria 19 5.62 23 5.45 37 4.00 11 5.59 Bangladesh 107 4.26 125 3.95 100 2.61 109 1.44 Bolivia 98 4.60 116 4.18 15 4.86 62 2.45 Botswana 124 3.36 58 4.85 31 4.20 113 1.37 U.K. 7 5.87 90 4.54 27 4.35 4 6.28 U.S. 5 5.91 114 4.29 2 6.04 7 5.83 The preceding Charts provide a summary look at the varied areas that a country needs to consider in order to make tourism work in the face of the high rate of competitiveness. It points out the comparative facets inherent in generating tourism as well as a basis for understanding areas of deficiency and potential strengths in crafting a plan for sustainability. In order to increase and build the tourism sector, the country, its business community as well as populace need to be able to contribute as well as participate in the process. Britton[12] helps us to understand that tourism entails â€Å"†¦travel flows; microscale spatial structure and land use of tourist places and facilities; economic, social, cultural, and environmental impacts of tourist activity; impacts of tourism in third world countries; geographic patterns of recreation and leisure pastimes; and the planning implications of all these topics† as vital areas. In order to arrive at the point of sustainability in tourism, third world countries have to have or be in the process of developing the underlying structures that create and generate attraction for potential visits, with the understanding that other locales are engaging in the same objectives[13]. Thus, sustainability means building upon what currently exists via definitive plans to maintain present levels, and of course enhance them in order to compete effectively. Richards and Hall[14] advise that sustainable tourism represents a broad range of issues, which the Travel and Tourism Competitiveness Index illustrated[15]. It, sustainable tourism, includes cultural facets, social accountability, environmental practices, economic considerations, quality of life, safety and security issues in terms of crime and policing. Universally, there is no agreed upon framework for sustainable tourism as the conditions, circumstances and allied facets for countries differ. However, sustainability in tourism is a real factor, one that demands the coordinated and concerned effort of the government, businesses and populace to work. In understanding the sustainability aspects and why such is important, one needs to be mindful of the economic ramifications that are the foundation for the importan ce attached to tourism by all countries, not just developing ones[16]. Tourism is an economic pursuit, and as such it aids a country, and more specifically city and or region to grow, improve and earn currency from travellers, investment, and new business openings[17]. The importance of tourism as an economic force is evidenced by the General Agreement on Trade in Services (GATS), which developed the first legally binding multilateral agreement that deals with trade in the tourism sector[18]. Its main provision sets forth the elimination of barriers to prevent foreign service providers and investors from participating in market access[19]. In order to make tourism sustainable, governmental policies, standards and practices need to ensure that there are a series of planned steps to enhance the efforts in the tourist sector, which unfortunately is not usually the case in developing countries[20]. Usually, in developing countries, efforts to promote tourism have been initiated and implemented by the private sector as well as in some cases citizen’s groups[21]. The foregoing represents a core issue in that these types of efforts are doomed to be short term actions based upon surges in popularity of an area generated by avant garde travellers that have discovered a quiet, generally unspoiled location, and other disjointed means that does not have an official plan behind it[22]. As shown by the Travel and Tourism Competitiveness Index[23], competition in the tourism segment is marked by a broad number of underlying foundations that require concerted efforts and involvement on the part of the aforementioned government, private business sector, and community. Obvious facets that require government participation on a defined level represent marketing and promotional activities through an official tourist agency, the long term and consistent development of infrastructure related areas such as airports, transport, roads, and other support factors[24]. The United Nations Commission on Sustainable Development[25] points to the importance of national, regional and local governments in planning for sustainable development as the â€Å"†¦providers of social services, builders of economic infrastructure, regulators of economic activity, and managers of the natural environment, local authorities have many direct instruments at their disposal to influence development†. The U.N. Commission on Sustainable Development[26] adds to the preceding by telling us that planned tourism activities are essential to ensure that the local communities have a level playing field in terms of inclusion and involvement concerning the economic wealth generated by tourist activities, along with planning to minimise environmental impacts, and improvement of the social welfare. Tourism is an industry that competes with like locations on the international stage, with many developing countries organised for this area in a concerned manner. To compete on this level, sustainable tourism must operate like a business. Place or destination marketing is a hallmark in the process, which Gold and Ward[27] advise â€Å"†¦ is defined as a process whereby local activities are related as closely as possible to the demands of the targeted customer †¦ (with the intention) to maximise the efficient social and economic functioning of the area concerned, in accordance with whatever wider goals have been established†. Each locale has to identify its special features and communicate the advantages that it has to prospective travelers through concerted efforts. Products and services offered by companies are geared toward the long term, noted by their comprehensive marketing, promotional and related plans to seek competitive advantages, and induce consumer trial[28]. To be effective over the long term, sustainable, destinations need to treat their locales in the same manner that companies do. Conclusion Sustainable tourism in developing countries represents an important economic aspect that can help to spur foreign investment in a broader sphere of industrial areas outside of tourism if conducted in a concerted manner. The importance of the preceding is that tourism is an important economic tool that can be utilised for broad range of areas that can benefit a developing country if its government has the vision, commitment and foresight to see the real world implications and demonstrated successes that tourism can bring. As pointed out, tourism represents a commitment to infrastructure, marketing, promotion, and the involvement of the private business sector along with the local communities that will be impacted to set the foundation for programs, facilities, business opportunities and commercial realisations that benefit the locale. Tourism is a means to change external opinions and perceptions of an area through internally directed programs such as place marketing. While some destinations may have been discovered by travellers or writers and became trendy ‘in spots’ that position will dwindle for the next ‘in spot’ unless the government takes notice and seizes the opportunity to make the location one that stays on the tourist radar. In other instances, locales can be put into the tourist arena as a result of their special circumstances and conditions, such as weather, beaches, lakes, snow, forests, wild animals, monuments and ancient cities, cultural festivals and the like , Whatever the nuance, the building of travel requires planned infrastructure to enhance the experience. Easy transport access, rent cars, power, Internet lines, police, etc. Sustainable tourism requires sustainable efforts in order to make it work. References Apostolopoulos, Y., Gayle, D. (2002) Island Tourism and Sustainable Development: Caribbean, Pacific, and Mediterranean Experiences. Praeger Publishers. Westport, CT, United States Beirman, D. (2003) Restoring Tourism Destinations in Crisis: A Strategic Marketing Approach. Allen Unwin. Crows Nest, New South Wales Britton, S. (1991) Tourism, capital and place: towards a critical geography of tourism. Vol. 9. No. 4. Environment and Planning Development Bull, A. (1995) The economics of travel and tourism. Longman Press. Melbourne, Australia Coleman, S., Crang, M. (2002) Tourism: Between Place and Performance. Berghahn Books. New York, New York, United States Duffy-Smith, M. (2003) The Ethics of Tourism Development. Routledge. London, United Kingdom Font, X., Bendell, J. (2002) Standards for Sustainable Tourism for the Purpose of Multilateral Trade Negotiations. World Tourism Organisation. Madrid, Spain Gold, J., Ward, S. (1994) Place Promotion: The Use of Publicity and Marketing to Sell Towns and Regions. John H. Wiley Sons. New York, New York, United States Hallberg, K. (2001) A Market-Oriented Strategy for Small and Medium Scale Enterprises- International Finance Corporation. Discussion Paper 40. Washington, D.C., United States Mahdi, A., Osman, M. (2000) An Assessment of the Effectiveness of Small and Micro-Enterprise Finance in Employment Creation. Retrieved on 6 January 2009 from http://www.iceg.org/NE/projects/labor/epicfinal.pdf Mowforth, M., Munt, I. (2003) Tourism Sustainability: Development and Tourism in the Third World. Routledge. London, United Kingdom Richards, G., Hall, D. (2000) Tourism and Sustainable Community Development. Routledge. London, United Kingdom Porter, M. (1980) Competitive Strategy: Techniques of Analysing Industries and Competitors. Free Press. New York, New York, United States The U.N. Commission on Sustainable Development (1999) Tourism and Sustainable Development: The Global Importance of Tourism. The U.N. Commission on Sustainable Development. New York, New York, United States UNCTAD (2002) Growing Micro and Small Enterprises in LDCs. UNCTAD, New York, United States United Nations Commission on Sustainable Development (1999) Tourism and Sustainable Development: Sustainable Tourism, A Local Authority Perspective. United Nations Commission on Sustainable Development, New York, New York, United States World Economic Forum (2007) The World Economic Forum’s First Ever Travel Tourism Competitiveness Report. 1 March 2007. Retrieved on 6 January 2009 from http://www.weforum.org/en/media/Latest Press Releases/Tourismpressrelease World Travel and Tourism Organisation (1999) The Global Importance of Tourism. Commission on Sustainable Development. World Travel and Tourism Organisation, New York, New York, United States 1 Footnotes [1] World Travel and Tourism Organisation (1999) The Global Importance of Tourism. Commission on Sustainable Development. World Travel and Tourism Organisation, New York, New York, United States [2] UNCTAD (2002) Growing Micro and Small Enterprises in LDCs. UNCTAD, New York, United States [3] Mahdi, A., Osman, M. (2000) An Assessment of the Effectiveness of Small and Micro-Enterprise Finance in Employment Creation. Retrieved on 6 January 2009 from http://www.iceg.org/NE/projects/labor/epicfinal.pdf [4] Hallberg, K. (2001) A Market-Oriented Strategy for Small and Medium Scale Enterprises- International Finance Corporation. Discussion Paper 40. Washington, D.C., United States [5] Ibid [6] Ibid [7] World Economic Forum (2007) The World Economic Forum’s First Ever Travel Tourism Competitiveness Report. 1 March 2007. Retrieved on 6 January 2009 from http://www.weforum.org/en/media/Latest Press Releases/Tourismpressrelease [8] Ibid [9] World Economic Forum (2007) The World Economic Forum’s First Ever Travel Tourism Competitiveness Report. 1 March 2007. Retrieved on 6 January 2009 from http://www.weforum.org/en/media/Latest Press Releases/Tourismpressrelease [10] World Economic Forum (2007) The World Economic Forum’s First Ever Travel Tourism Competitiveness Report. 1 March 2007. Retrieved on 6 January 2009 from http://www.weforum.org/en/media/Latest Press Releases/Tourismpressrelease [11] World Economic Forum (2007) The World Economic Forum’s First Ever Travel Tourism Competitiveness Report. 1 March 2007. Retrieved on 6 January 2009 from http://www.weforum.org/en/media/Latest Press Releases/Tourismpressrelease [12] Britton, S. (1991) Tourism, capital and place: towards a critical geography of tourism. Vol. 9. No. 4. Environment and Planning Development. p. 451 [13] Mowforth, M., Munt, I. (2003) Tourism Sustainability: Development and Tourism in the Third World. Routledge. London, United Kingdom. p. 6 [14] Richards, G., Hall, D. (2000) Tourism and Sustainable Community Development. Routledge. London, United Kingdom. P. 9 [15] World Travel and Tourism Organisation (1999) The Global Importance of Tourism. Commission on Sustainable Development. World Travel and Tourism Organisation, New York, New York, United States [16] Bull, A. (1995) The economics of travel and tourism. Longman Press. Melbourne, Australia. p. 23 [17] Apostolopoulos, Y., Gayle, D. (2002) Island Tourism and Sustainable Development: Caribbean, Pacific, and Mediterranean Experiences. Praeger Publishers. Westport, CT, United States. p. 11 [18] Font, X., Bendell, J. (2002) Standards for Sustainable Tourism for the Purpose of Multilateral Trade Negotiations. World Tourism Organisation. Madrid, Spain [19] Ibid [20] Duffy-Smith, M. (2003) The Ethics of Tourism Development. Routledge. London, United Kingdom. p. 9 [21] Beirman, D. (2003) Restoring Tourism Destinations in Crisis: A Strategic Marketing Approach. Allen Unwin. Crows Nest, New South Wales. p. 222 [22] Ibid [23] World Economic Forum (2007) The World Economic Forum’s First Ever Travel Tourism Competitiveness Report. 1 March 2007. Retrieved on 6 January 2009 from http://www.weforum.org/en/media/Latest Press Releases/Tourismpressrelease [24] Coleman, S., Crang, M. (2002) Tourism: Between Place and Performance. Berghahn Books. New York, New York, United States. p. 53 [25] United Nations Commission on Sustainable Development (1999) Tourism and Sustainable Development: Sustainable Tourism, A Local Authority Perspective. United Nations Commission on Sustainable Development, New York, New York, United States [26] The U.N. Commission on Sustainable Development (1999) Tourism and Sustainable Development: The Global Importance of Tourism. The U.N. Commission on Sustainable Development. New York, New York, United States [27] Gold, J., Ward, S. (1994) Place Promotion: The Use of Publicity and Marketing to Sell Towns and Regions. John H. Wiley Sons. New York, New York, United States. p. 41 [28] Porter, M. (1980) Competitive Strategy: Techniques of Analysing Industries and Competitors. Free Press. New York, New York, United States. pp. 34-36

Surgical Pain Relief: Multimodal Analgesia And Paracetamol

Surgical Pain Relief: Multimodal Analgesia And Paracetamol INTRODUCTION As a nurse on a surgical ward dealing with a diversity of operating procedures it is important to understand the effects of surgical pain, as pain intensity and control is an integral part of the nursing duties. Layzell (2008) argues that pain management for postoperative patients should be a priority for all healthcare professionals. Furthermore having a say in how medications are administered but not prescribing drugs also means that it is essential to have an understanding of pharmacology. This ensures that informed discussions can talk place with the medical officer when it is felt that pain relief for a patient requires review. Additionally this enables the right balance of pain relief to be administered to minimise distress for the patient throughout their surgical journey. According to Lucas (2008) the benefits and adverse effects of the different types of analgesia also need to be considered when treating postoperative pain. Pain is a complex phenomenon that is difficult to define. The most general definition used was published by the International Association For The Study Of Pain (IASP) in 1979 and refers to pain as an unpleasant, sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage (IASP  2010). Pain is also subjective and the intensity can only be experienced by the sufferer (Mann and Carr 2006). Neurophysiology there are three types of pain receptors communicating pain signals through nociceptors or pain fibres (Mann and Carr 2006). These receptors can be found in the skin, surfaces of the joints, periosteum (the specialised lining around the bone), arterial walls and certain structures in the skull, although the brain itself does not have any of these receptors (Mann and Carr 2006, p3). Each receptor reacts to a different stimulus. The mechanical receptor to touch, thermal to heat or cold and chemical to products present in the body that are released after trauma causing inflammation and increased sensitivity at the wound site (Mann and Carr 2006). The chemical receptors also react to chemicals introduced into the body (Mann and Carr 2006). The nociceptors are the sensory instruments that transmit pain signals through sensory nerve fibres to the dorsal horn of the spinal cord and into the brain (Mann and Carr 2006). There are three types of nerve fibres: A-delta responds to mechanical or thermal sensations, C fibres also known as polymodal because they respond to mechanical, thermal and chemical influences and Aà ¢Ã¢â€š ¬Ã¢â‚¬Ëœbeta fibres which occur in the skin, reacts to touch but does not transmit pain sensations (Mann and Carr 2006). Psychologically pain can induce fear, anxiety, anger, frustration and also a sense of helplessness may be experience from being unable to physically control the intensity of the pain being felt (Rothrock et. al. 2007). Physiologically pain can reduce the functions of the immune system whilst increasing the potential for wound and chest infections as well as impairing the wound healing processes (Middleton 2003, Pudner and Ramsden 2010). Pain also induces vomiting, increases the workload of the cardiovascular and gastrointestinal systems, decreases lung capacity and can also reduce physical mobility (Middleton 2003, Rothrock et. al. 2007). Traditionally following surgery, a single opioid drug such as morphine is used, depending on the type of surgery performed, for moderate to severe or acute pain (Shorten et. al. 2006). It is argued that patients who receive this monoà ¢Ã¢â€š ¬Ã¢â‚¬Ëœtherapy would prefer to be treated with non ­Ãƒ ¢Ã¢â€š ¬Ã¢â‚¬Ëœopioid remedies (Shorten et. al. 2006). According to Mann and Carr (2006) using the monoà ¢Ã¢â€š ¬Ã¢â‚¬Ëœtherapy method only targets one pain pathway and although morphine is considered the gold standard it tends to have many adverse effects. These include a 0.2% risk of respiratory depression, sedation, urinary retention, nausea and vomiting which affects around 30% of patients, itching or pruritus, hypotension or low blood pressure plus confusion and hallucinations in the elderly (Mann and Carr 2006, Rothrock et. al. 2007, Manley and Bellman 1999). Some of these side effects are controlled with antià ¢Ã¢â€š ¬Ã¢â‚¬Ëœemetics for sickness and antià ¢Ã¢â€š ¬Ã¢â‚¬Ëœhistamines for pruritus (Rothrock et. al. 2007). Combinational drug therapy began in the 1950s (Michielsen 2007). Since then there has been increasing developments in establishing opiate sparing analgesic regimes with fewer side effects for surgical pain (Shorten et. al. 2006). Painkillers such as paracetamol (acetaminophen) can be combined with drugs from the codeine group, tramadol and non-steroidal antià ¢Ã¢â€š ¬Ã¢â‚¬Ëœinflammatory drugs (NSAIDs) as part of a multimodal regime (Manley and Bellman 1999). This allows for lower doses of individual drugs to be given, reducing the severity of adverse events and targeting more than one pain pathway as each drug has a different mechanism of action (Shorten et. al. 2006). Paracetamol is a universal drug that is generally well tolerated but its mechanisms are not fully understood (Mann and Carr 2006). There are only mild to rare reported occurrences of side effects such as skin rashes and other allergic reactions (Manley and Bellman 1999). Paracetamol, a member of the non-opioid group is one of oldest known synthetic analgesic and antipyretic drugs (Manley and Bellman 1999, p470). Being also an antipyretic paracetamol has the ability to reduce fever temperature (Pudner and Ramsden 2010). It can be administered orally, rectally or intravenously in the form of a prodrug known as perfalgan or propacetamol (Manley and Bellman 1999, Royal Pharmaceutical Society of Great Britain 2007). Prodrugs are treatments that need to be broken down in the body before they become active (MedicineNet 2010). It is suggested that paracetamol should be used as part of a multimodal regime for surgical patients experiencing mild to moderate pain (Pudner and Ramsden 2010). Multimodal treatments involve combining drugs to form a compound in order to increase pain relief and reduce opioid adverse effect (Shorten et. al 2006, Manley and Bellman 1999, Pudner and Ramsden 2010). These combinational drugs are regulated by the Medicines and Healthcare Products Regulatory Agency (MHRA) and European Medicines Evaluation Agency (EMEA) and only a limited number has been approved (Shorten et. al 2006, Department of Health 2010). Pharmaceutical companies have also introduced several fixedà ¢Ã¢â€š ¬Ã¢â‚¬Ëœdoseà ¢Ã¢â€š ¬Ã¢â‚¬Ëœcombinations such as coà ¢Ã¢â€š ¬Ã¢â‚¬Ëœcodamol a combination of codeine phosphate, a weak opioid and paracetamol as well as coà ¢Ã¢â€š ¬Ã¢â‚¬Ëœdydramol a compound of dihydrocodeine and paracetamol (Shorten et. al 2006, p185). The main side effect of these codeine products is constipation, which can be remedied with a mild laxative (Manley and Bellman 1999). Tramadol, another weak opioid can also be combined with paracetamol (Manley and Bellman 1999). The side effects of tramadol include minimal respiratory depression, nausea, vomiting, dizziness, headache and sweating (Manley and Bellman 1999). Using this drug appears to defeat the object of reducing opiate contraindications but the combination is generally well tolerated and effective for moderate to severe pain (Shorten et. al. 2006). Rothrock et. al (2007) argues that combining NSAIDs with opioid drugs effectively reduces opioid usage by 20-40%. However increased postoperative bleeding and the chances of developing gastrointestinal ulcers cause NSAIDs to be used sparingly for surgical patients ((Rothrock et. al. 2007). The Human Rights Act 1998 states that ethically it is the duty of all healthcare staff to ensure that patients are protected from any form of torture, inhuman and degrading treatment and punishment (Office of Public Sector Information 1998, Article  3). Nurses are also responsible for their actions and as such must be able to justify decisions made or omissions which affect the wellà ¢Ã¢â€š ¬Ã¢â‚¬Ëœbeing of a patient (Nursing and Midwifery Council 2008). From a surgical nursing perspective this means it is imperative to ensure patients receive good pain management following their operation. However according to a recent study by Dolin, Cashman and Bland (2002) one in five patients still report severe postoperative pain. Manley and Bellman (1999) suggest patients commonly believe that pain is acceptable following surgery. While Pudner and Ramsden (2010) argue that postoperative pain should be controlled and patients should not expect or see pain as inevitable. This literature review aims to firstly evaluate current research and evidence in relation to the use of paracetamol as one part of a multimodal analgesia regime for surgical pain relief. Secondly to use the results to make recommendations for standardising multimodal pain control for postoperative patients and re-educate staff on the importance of effective pain management. METHODOLOGY Search Criteria For this literature review an advanced search was carried out over the internet. The health and medical sciences specific databases of Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Online (MEDLINE), Cochrane Library and Internurse.com were explored (Thomas 2000). CINAHL includes full text and is the most relevant source of information for nursing while MEDLINE focuses on life sciences and is produced by the National Library of Medicine (LoBiondo-Wood 2010, p68). The Cochrane Library holds a collection of systematic reviews and Internurse.com has journal articles written by nurses (LoBiondo-Wood 2010, p68). The Cochrane Library was used to determine if any critical reviews had previously been carried out on the subject of paracetamol being used as part of a multimodal regime for postoperative patients. Only 4 papers were found. Internurse.com was exploited for articles containing current knowledge on the use of multimodal therapy for surgical pa tients. These editorials were utilised within the introduction. The keywords or inclusion criteria for the literature search included paracetamol in the title while the words surgical and post operative were left optional to increase the depth of the search. Truncation or wildcards were employed to make the search more sensitive and specific to the topic being researched as follows: surgical surg* and post operative post op* (Gerrish, and Lacey 2006). The search mode was set to Boolean which defines the relationships between words or groups of words in a literature search (LoBiondo-Wood 2010). This process involved using the word AND before the truncated words surg* and post op*. The date time frame was also limited from 2000 to 2010 to ensure that the studies were up to date and relevant to present day policies and procedures for pain control (LoBiondo-Wood 2010). Restrictions were also placed to only include papers that were based on humans, research papers and in the English language. Humans were selected as experiments on animals due to their biological makeup was not considered to be relevant to controlling postoperative pain in human beings. As this is a literature review it was appropriate to only select research papers for analysis. Language was also deemed to be significant as finances and the time schedule to complete the review did not allow for interpretation of the papers from other Dialects. Expanders were included to find papers that had related words and for the search to be carried out within the full text of the articles. Review 8 papers resulted from the above search criteria. These were then screened using inclusion criteria, the titles and abstracts to determine their relevance to relieving surgical pain with multimodal analgesia therapy. The inclusion criteria was trials that included patients who had received paracetamol (acetaminophen) postoperatively, trials that included multimodal therapy, papers that were published within the last 10 years, subjects who were adults as my surgical setting only treats patients over the age of 18 and within a hospital environment. Exclusion criteria were trials that involved animals or children as discussed earlier. The types of interventions could include any routes for drug administration as paracetamol can be administered via intravenous, oral or rectal modes. One paper was excluded from the review at this point as it was a monoà ¢Ã¢â€š ¬Ã¢â‚¬Ëœtherapy trial for paracetamol. The remaining 7 papers met with the inclusion criteria and were scored for methodological quality using a critical appraisal skills programme (CASP) containing 10 questions {{488 Public Health Resource Unit (PHRU) 2007}}. The questions were answered yes, no or cant tell for each paper. Using a tool provides a way of systematically appraising what is published and filtering through papers to determine their relevance and accuracy {{427 Crookes, P. and Davies, S. 2004}}.

tragoed Elements of Tragedy in Oedipus the King (Oedipus Rex) :: Oedipus the King Oedipus Rex

Elements of Tragedy in Oedipus Rex It is not the tragic subject matter of the text that is of primary interest - but rather the manner in which the plot is developed. The story line progresses as if the reader is "unpeeling an onion." The tale of King Oedipus is well known. An enraged Oedipus unknowingly slays his father (Laiusq, King of Thebes) and supplants him as monarch and as husband to his own mother (Queen Jocasta). As each successive "layer of the onion" is unpeeled, Oedipus is brought a step closer to realizing the true nature of his actions. Foretold in prophecy and initiated by his anger, the downfall of Oedipus comes to fruition as all facts gradually come to light. This "enlightening" starts with the revelations of a blind prophet named Tiresias. Though sightless, Tiresias can "see" the truth. He argues with Oedipus "...you have your sight, and do not see... . Yea, you are ignorant... ."(Sophocles, 15). Understandably, Oedipus is enraged at the prophet's accusations and fatally insists on investigating the murder of King Laius. In Aristotle's Poetics, it is stated that a tragedy must be complete - having a beginning, middle and end. Of equal importance "...the sequence of events, according to the law of probability or necessity, will admit of a change from bad fortune to good or from good fortune to bad."(Aristotle, 15). The impetus for the downfall of Oedipus, "Known far and wide by name" (Sophocles, 1), is his anger. Enraged he slew King Laius and in anger he hastily pursued his own ruination. From the aforementioned recriminations of Tiresias to the conflict with his brother-in-law Creon (his ill temper again displayed - "Tempers such as yours most grievous to their own selves to bear,... .(Sophocles, 25); through the revealing exchanges with his wife/mother Jocasta and her slave (whose pity saved the infant Oedipus), damming insight grows in a logical sequence, all the while fueled by the Oedipal rage. Realizing the heinous nature of his actions, Oedipus blinds himself in a fit of anger and remorse - now, as Tiresias, he can see. In an age where popular entertainment is apparently guided by the maxim "more is better" (see the body count in any popular "action thriller") and "special effects" dominate,

Compare the relationships and emotions in the following poems; Home :: English Literature

Compare the relationships and emotions in the following poems; Home Burial, Long Distance and My Grandmother. I am going to compare the relationships and emotions in the following poems; â€Å"Home Burial, â€Å"Long Distance† and â€Å"My Grandmother†. In all three of these poems, there is a common theme. They are all to do with the breakdown in communication and relationships between family and have characters, which are dealing with grief. Each of the poems tackles these themes in different ways. The first poem† Home Burial† is a dramatic narrative poem in which we are presented with a couple whose marriage is in crisis, It explores how the different responses of a husband and a wife of the death of their child has had a damaging affect on their relationship. The poem â€Å"Long Distance† is written by a son reflecting on the experience of his fathers’ grief of the loss of his wife. In the final poem, the poet writes an account of the life and death of her grandmother and how she responds to it. The wife from â€Å"Home Burial† is stood upon the top of their stairs looking out at the mound under where her child is buried. â€Å"What is it you see? She in her place refused him any help.† This shows the inadequacy of communication between them, as struggles to find the reasons for her behaviour she won’t let him past her barrier, give him any help or any insight to her problem. It also displays that she feels as though he couldn’t possibly understand why she is so dull because she sees him as blind and unable to relate to what she is feeling. It also suggests a feeling of resentment towards her husband. â€Å"Her face changed from terrified to dull.† This leads us to believe that there is no spark of love between them anymore and that she has grown a sense of hatred towards him. Amy doesn’t want her husband to speak of the loss of his child because she believes that her husband doesn’t have any respect for their child as he dug the grave for it. â€Å"Can’t a man speak of his own child he’s lost?† â€Å"Not you!† I feel that the women has misunderstood the mans actions and that by burying his child is his way of steeping himself in his grief, of forcing it into his muscles of his arms and his back, of feeling the dirt on his clothes. She wants to get out of the house and to get out of having this conversation with him. This sort of situation has happened before as the man says,

Alone on a Mountaintop Summary Essay

In â€Å"Alone in a Mountaintop†, an excerpt from Lonesome Traveler (1960), Jack Kerouac describes his journey west as â€Å"a fire lookout†. Jack Kerouac stated that he was â€Å"tired† do city life and sought solitude, so†[he]applied† to be â€Å"a fire lookout† and went west (218). (218) Kerouac started his journey by driving towards the Cascades, followed by taking a â€Å"lift†, riding on a ferry, followed by a tugboat, and climbing with a horse and mule up the northern cascade mountain. He them noted how the further on he traveled the less â€Å"inhabitants† he noticed. After two days of waiting for Andy, the muleskinner, and Assistant Ranger Marty Gohlke, Jack describes how they took the tugboat up †Ross Lake† and started up the mountain with mules packed with enough supplies for sixty-three days and nights on Desolation mountain. Kerouac described how he reacted when they came upon what was to be his summer home and then noted how Andy and Marty helped him set up camp. He then settled into bed for the night. (222-223)  Kerouac noted that he was now alone, Andy and Marty left. He then spent the day cleaning and turned in early to be awoken to the sounds of nature. The job, as Kerouac noted, was to watch out for fires and he noted one storm. Jack felt sympathy for all of the smoke jumpers. He noted that most days were routine. He ate breakfast and radioed in. Kerouac would lay in the meadow and eat around noon, and by nightfall he had gathered his firewood to cook his supper. Kerouac noted that two months had passed. (223-224) Kerouac explained that he discussed that the journey to solitude does not matter where you are; but it’s in one’s mind. (227-228) Jack concluded by noting as he would lead a renewed life, and as he left his summer home he â€Å"turned and blessed† â€Å"the little pagoda on top† of Desolation Mountain which he had come to adore (228). (228)

Evacuation

Evacuations have become more common in today's world than many people realize. They are majorly the results of fires, floods or any calamity that occurs within our homes. Other storms like hurricanes upon their occurrence make mass-scale evacuation. Some occurrence takes place as a result of the activities done by man on land and some exist naturally. For example, transportation and industrial accidents that take place end up in releasing harmful substances at homes, places of work or along the water bodies, which make people to leave their homes and even places of work. However, the amount of time one leaves depends on the nature of the hazard. In case the event is in form of weather condition, you might have a day to ready. Some disasters do not give people time to pick their basic necessities and they end up vacating without any single asset. For this matter, planning ahead is very essential.An organized evacuation can result to either confusion, injury to the people vacating or damage of the property vacated. Therefore, when developing an emergency action plan, it is important to determine factors like the conditions under which evacuation would be necessary, evacuation procedures like routes and exits. Some important symbols also include fire, emergency and disaster planning diagrams, stairwell, security camera, sprinklers, and roof access, among many others. In this plinth, the paper aims at designing a well furnished evacuation plan with proper mapping, planning exit doors, and the plan for the disable. It will also pinpoint the importance of planning in advance for evacuation as well as stating some of the safety equipments and alarms. The safety equipment herein is good quality smoke detector, regular maintenance and the survival kits in case of emergency.Mapping Map is very instrumental in the design of evacuation plan. It provides instant clarity during the occurrence of the event. Some of the elements to consider include the basic layout of the property like the walls and the doors. This is very important because it help in showing the outside of the property for the people to go to in case of the emergency. The compass in the corner is also instrumental and it should indicate the direction of North with a capital letter â€Å"N.† The exit points like the doors should be left wide open most of the time for clear accessibility during exit. The marshal area, the point where the evacuees meet should be safe and a distance from the building site to provide enough protection from fie and any onsite peril like chemicals and explosive materials.Planning in Advance Apparently, planning in advance help in preventing most of the problems thereafter. Planning should start as far as the foundation of the building is laid. In planning, there should be a well stated chain of command, the person responsible for assessing the situation, the one in charge of high building, and even notifying the emergency services. It is important to plan and make everyone knows his or her role and be trained how to perform it. For instance, posting an evacuation plan on each floor, and identifying a trained personnel helps a lot in the getting people out in case of the disaster. The personnel ensure that everyone is accounted for and taken care of during the event. Planning for a visitor managing system also assist in the provision of a digital visitor log, this in return helps in account for any of the non-employee who might be present in the building during the occurrence.Planning Exit doors and Surveying the SiteSpecific evacuation procedures should be well planned and designed. Location of the emergency equipment like, routes, and exits like the doors, windows, should be marked and kept clear, open and safe all the time. They should be without any obstructions. In case of any building with interior spaces like the stairwells, painting should be done for clear visibility. Also, survey should be done in these places regularly to and reports made to the personnel responsible so that in case if damage, repair is made at an early stage. Evacuation plan suitable for disabled people Managers and the owners of institutions have the sole responsibility of providing the emergency facilities for people with disability. Disability like hearing, visually, speech, mentally should be taken care of. The elderly persons and children should also be considered in this case. A means of communication to people with hearing and seeing problems should be provided so that they are accommodated in case of the event. Color coding for the room identification should be simple and easy to identify for the disabled. Moreover, the employees should be taken to seminars and workshops and trained adequately on how to handle unexpected behavior as well as providing necessary assistant to people with such problems. Additionally, they should be made aware on how to handle mentally impaired persons and make good attempts to communicate with them efficiently, in a loving and caring manner.The Importance of Planning in Advance for EvacuationIt is important to understand that disasters are has to happen in every society. The response and recovery of the disaster starts and end at the local level and therefore it is important for the community to work together so as to prevent, avoid or control the occurrence of such phenomenon. Advance preparation ensures that most of the problems are controlled or saved. It is very important to alert the family members or the workers on how to respond to the cyclone watches and warnings for it helps them escape the danger within a short period of time. Children at the age of between nine and eleven when taught how to call police or fire department will help them save their lives in case they are alone in the house. Listening to instructions from the officials in various departments within the office helps one to prepare in advance to vacate the room when they inform you to do so. The fly away kits, which are the small bags or backpacks that contain family documents like the identification cards, the ATMs, credits cards should be kept in plastic bags to keep them dry most of the time. The kit helps in gathering most of the items like medicine, money and any important document before departure. Maintaining important credentials like the education, birth, marriage certificates, immunization records easily allow the foreign workers to grab their files quickly and plan for their travel back to their home countries or the adjacent states for safety.Testing the Escape Plan Plans must be checked, assessed and updated sporadically to ensure that they are up to date. Any contingency plan is better than failing to plan completely. It is important to test the workability of the plan to ascertain yourself that it is functional. Practicing the plan made underway will ensure that the problems and the weaknesses in the plans are identified at their primary stages and the corrective measure taken before everything goes a mess. Practicing also enables the planners to exactly know what they are required to do and where they should go at what particular time.Safety Equipment and AlarmNo one plans for an emergency or disaster, especially the ones that affects their lives. The truth is that the emergencies and disasters can strike anyone, anytime and anywhere and therefore preparing for them is very essential. One can be forced to vacate the house, work place or company at the time he or she least expected. In this precept, it is important to avail the safety equipment and alarms so that in case of any emergency, one is caught on the safe side. Good Quality Smoke Extinguishers and Fire Detectors Fire detector and smoke extinguishers is very appropriate and should be very effective. It must be able to sound a strong warning to all people within the premise in all circumstance. In as much as there are different types of fire alarms, one should consider the appropriate one for that risk assessment. Before installing the detector system, it is inherent to discuss with the local fire authority and advise accordingly. There are series of factors one should consider before installation. Ensure that the escape route is short, clear passageways to all the escape routes, the escape are kept free from any obstructions. It is very instrumental to install the emergency lighting system so as to provide enough light in the room in case of the event.Regular Maintenance Maintenance should be done regularly to ensure that the systems are in good conditions always. The personnel should do frequent check up on the workability in order to avoid the last minute rush. During assessment, the personnel may require that you provide portable multi-purpose fire extinguishers so that people on your premises can tackle a fire in its early stages. These fire extinguishers should be installed, tested and maintained in accordance with manufacturers' directives. In smaller business grounds, you may only need one or two transportable extinguishers. However, larger, big premises require a number of portable extinguishers, which are situated in suitable locations. Survival kits in case of Emergency The employees may need personal protective equipment to help them vacate the room in case of an emergency. Protective kits and equipment must be based on the likelihood of the hazard at work place and the ability of the workers to use them. Some of the safety kits in this case are the safety glasses, goggles or the face shields for protection, the chemical suits, gloves, hoods and boots for body protection against chemicals. It also important to have the hard hats and the safety shoes for head and foot protection. ConclusionIt is inherent to state that evacuation plan is very fundamental in our day to day life. It is not only used at home, but also in offices, big and small companies and any enterprise because a disaster is never planned for. It can occur to anyone, anywhere irrespective of the statues, social class, or the geographical locality. When planning for the evacuation plan, it is important to take care of all groups of people, the able and the disabled, the young and the old, and those living in low and high roofs. Also, it's important to take the preventive measure to avoid the occurrence of the event both at home and at work place, and in case it takes place there should be ways through which the victims find their ways out. Maintenance of the equipments used is very vital since it helps in ensuring that they are in good conditions always. They should also be tried always to ensure their workability and to avoid not only using them during crisis.