Gun Control Essays (1285 words) - Gun Politics In The United States

Gun Control Gun Control Gun control is an action of the government that is supposed to reduce crime. Congress has passed many laws on this subject and there really has not been an effect. Gun control has been a controversial issue for years, but the citizens of the United States have a right to own guns and the Constitution states that. On the government's path to control guns they created the Brady Act. Handgun Control Incorporated is the major organization for lobbying, and introducing legislation on gun control. It is headed by Sarah Brady, wife of former White House Press Secretary James Brady. James Brady was shot during an attempt on President Reagan's life in 1981. Sarah is the one responsible for introducing this bill. This bill was supposed to stop criminals from obtaining guns. If an individual wants a firearm bad enough, chances are they will get one (Brennen and Polsby). All it does Is prevent honest people from being able to purchase guns. The person purchasing the gun has to wait for two week while the government performs a background check. The problem with this is it stops the average citizen from purchasing a gun on the whim, while it protects the common criminal. What if a burglar enters a house with full intention to maim or kill? The innocent victim can not get a gun to protect his family because he was arrested seven years ago for drunk driving (Larson). According to the General Accounting Office, in the first seventeen months of the law's existence only seven criminals were convicted for attempting to buy a handgun. Banning more and more guns may reduce gun violence, but it will not eliminate guns from society and will only lead to more and bigger problems. While continuing to take more freedom away from the American people. Gun control laws do not prevent little kids from using guns and harming people. Violent video games help children with their marksmanship and to get over their fear of shooting someone. Parents of three slain girls in the Heath School shootings are going after the manufacturers. They feel that violent video games are partially responsible for their children's death. They claim that the video game taught the shooter how to be an excellent marksman. The boy had never used a gun, but was skilled enough to hit eight moving targets in only eight shots (Prichard). Another fact that backs up the parent's belief is that of military training. Each year billions of dollars are spent to train police and the military how to shoot. Video simulation is the best way to help overcome the natural resistance that most people have about shooting someone. Studies show that people are extraordinary susceptible to programming. One main difference between military training and video games is that military instructions are constantly pausing the action and where the video game is in constant action (Blakemore). There is no direct relationship between the number of guns and the amount of crime in the United States. Between 1973 and 1992, the rate of gun ownership increased by forty-five percent while the homicide rate during that period fell by nearly ten percent. Even with the increasing number of guns in society the homicide rate decreased, highlighting that guns are not the root of the problem, people are. Guns do not kill people, people kill people. Guns do not work as self-protection against criminals. Guns are just as valuable to civilians as they are to police officers. As many as sixty-five lives are protected by guns for every life lost to a gun. Every year potential victims kill between two thousand and three thousand criminals, and wound an additional nine thousand to seventeen thousand. Private citizens mistakenly kill innocent people only thirty times a year, compared to about three hundred and ten mistaken killings by police. Criminals succeed in taking a gun away from an armed victim less than one percent of the time. Gun control laws are needed to prevent the purchase of saturday night specials and assault weapons. Criminals generally prefer larger caliber and more expensive handguns (Brennen and Polsby). President Clinton proposed a restriction on armor piercing ammo. However, the FBI reported that sixty-eight percent of officers killed were not wearing a vest. Of those killed wearing a vest ninety-five percent were shot in unprotected areas. Many people like to use guns for recreation use. The NRA, National Rifle Association, even has its own hunting magazines. These magazines are

Free Essays on Market Researcher

The writer as Market Researcher Interviewing Techniques  · Protect genuine interest do not get defensive with interviewee  · Phrase questions in such a way that the users do not know how you want them to reply Some examples of an out line to follow if you are asking about a specific manual are:  · How frequently do you use this manual  · Under what circumstances do you use it  · When did you last use it  · What tasks are you doing when you use it  · How do you use it? Do you sit down and read it, or do you refer to it while you are doing something else?  · How would you rate it (excellent, Good, fair, poor, awful)  · What do you like best about it?  · What would you change about it?  · Do you have marginal notations in it?  · Who else uses the manual?  · Do you know what they use it for? Some examples of questions to ask about a set of manuals for a product are:  · How easy was it to find the information you wanted? Did you 1. Always find the right manual right away 2. Sometimes try another manual before the right one 3. Almost always try the wrong manual first 4. Hunt through several manuals to find the information 5. Mostly find it.  · When you had the right manual, how easy was it to find information in it? 1. Very easy 2. Pretty easy 3. Took more that three tires 4. Had to leaf through looking 5. Never found it  · Were the titles of the manual 1. Very descriptive 2. Descriptive 3. All right 4. Not very descriptive 5. Not at all descriptive Surveying the audience  · To find out the whole customer group you must prepare questionnaires and surveys representative customers  · A sample of people can include customers chosen at random or it can be representative customers  · Surveys can be done by mail, by telephone or in person  · Mail surveys is the most convenient but the least reliable and the least likely to get responses  · Telephone surveys have a much higher response rat... Free Essays on Market Researcher Free Essays on Market Researcher The writer as Market Researcher Interviewing Techniques  · Protect genuine interest do not get defensive with interviewee  · Phrase questions in such a way that the users do not know how you want them to reply Some examples of an out line to follow if you are asking about a specific manual are:  · How frequently do you use this manual  · Under what circumstances do you use it  · When did you last use it  · What tasks are you doing when you use it  · How do you use it? Do you sit down and read it, or do you refer to it while you are doing something else?  · How would you rate it (excellent, Good, fair, poor, awful)  · What do you like best about it?  · What would you change about it?  · Do you have marginal notations in it?  · Who else uses the manual?  · Do you know what they use it for? Some examples of questions to ask about a set of manuals for a product are:  · How easy was it to find the information you wanted? Did you 1. Always find the right manual right away 2. Sometimes try another manual before the right one 3. Almost always try the wrong manual first 4. Hunt through several manuals to find the information 5. Mostly find it.  · When you had the right manual, how easy was it to find information in it? 1. Very easy 2. Pretty easy 3. Took more that three tires 4. Had to leaf through looking 5. Never found it  · Were the titles of the manual 1. Very descriptive 2. Descriptive 3. All right 4. Not very descriptive 5. Not at all descriptive Surveying the audience  · To find out the whole customer group you must prepare questionnaires and surveys representative customers  · A sample of people can include customers chosen at random or it can be representative customers  · Surveys can be done by mail, by telephone or in person  · Mail surveys is the most convenient but the least reliable and the least likely to get responses  · Telephone surveys have a much higher response rat...

Catcher in the Rye Essay Example | Topics and Well Written Essays - 500 words - 2

Catcher in the Rye - Essay Example He allowed Holden to use a lot jargon or street lingo to give an uncanny realism to the novel. The novel seems to have an overwhelming sense of doom and gloom. The character of Holden Caulfield wants to get out of his familiar surroundings because he was not satisfied. In a sense, he seems to be going somewhere else but with no definite direction or destination. Holden feels an unsettled spirit, he wants to go from here to there and is always in the habit of saying goodbye to someone or someplace he had been to before. His restless spirit wants to be always on the go but he lacks a certain motivation, like he is lost to the world. â€Å" . . . I mean Ive left schools and places I didnt even know I was leaving them. I hate that. I dont care if its a sad good-by or a bad good-by, but when I leave a place I like to know Im leaving it. If you dont, you feel even worse.† This line sets the tone for the rest of a story that is one of unmitigated ennui. Boredom, restlessness, insecurity and emptiness had pervaded the novel all throughout except when Holden is with children whom he is fond of. â€Å"I dont even know what I was running for – I guess I just felt like it.† With this line, it is quite obvious that Holden wants to get away from something but he just cannot put his finger on it or what he was running away from. Perhaps he was running away from himself as he is mostly disgusted with the ways things are in his life, especially with the death of brother Allie to sickness (leukemia). He is merely ambivalent with anything and everything, from his own father, himself and also with the whole world itself. Holden had been traumatized by this death but he does not even know it or will admit to it (Bloom 8); he is haunted by it. In a sense, Holden wants to disappear from this world, perhaps to stop his worrying. He is always worried, â€Å"when I really worry about

Bipolar and Personality Disorders & Dehydration and Diarrhea Research Paper

Bipolar and Personality Disorders & Dehydration and Diarrhea - Research Paper Example This concern is due to the vulnerability these disorders pose (Lesley, 2009). Symptoms Varied research indicates that close to 20% percent of patients with Borderline Personality Disorder might have experienced Bipolar Disorder at certain intervals (Goodwin, 2009). Like Borderline Personality Disorder on the instability of temper as well as the reluctant effect noted on the conduct of a patient can be found on Bipolar Disorder through inconsistent character of temperamental. Most cases of Borderline Personality Disorder and Bipolar Disorder portend incidents of Manic and Hypomanic states. This causes a person to feel very animated and superior or in circumstances of mania the affected person might feel very low and depressed during the episode. Relative NANDA research reports provided that at least 10% of persons affected by other psychological disorders indicated to have bipolar disorder concurrently (Lesley, 2009). For instance, persons suffering from BPD experience grave degrees o f irritability and varied emotions while those affected with Bipolar Disorder exhibit impulsiveness. However, this evidence might not be accurate according to other results and therefore requires that substantial facts be provided in future (Lesley, 2009). Pharmacological intervention Evidence indicates that environmental aspects have significant roles in the development and course of Borderline Personality Disorder and Bipolar Disorder. Defectiveness in the structure and or performance in certain brain circuits could be a cause Borderline Personality Disorders and Bipolar Disorder (Lesley, 2009). National Depressive and Manic Depressive Association (MD MDA) argue that persons experiencing Borderline Personality Disorder Bipolar Disorder exhibit worry and confusion episodes. Such episodes might magnify the sate of Borderline Personality Disorder and Bipolar Disorder based on the pattern and length of episodes experienced. For example, aggravation of both ailments might occur in case s where the episode frequency is longer in duration (Lesley, 2009). Treatment A condition of Borderline Personality Disorder and Bipolar Disorder are easily treatable due to major advances in contemporary medicine (Lesley, 2009). Applying benefit versus risk for treatment plans. Lithium drug has been identified and certified as an effective medicine that would help patients Borderline Personality Disorder and Bipolar Disorder to overcome their conditions. Experts argue that this drug basically has the capacity to regulate mood disorder caused by frequent episodes. However, there are those who observe that 40% of people who use do not get cured of Borderline Personality Disorder and Bipolar Disorder. It is claimed that the drug causes grave side-effects that can damage the ability of its users to cope up with pain (Ketter, 2010). Anticonvulsant medicines are best applicable to people who are not contented with the use of Lithium as medication of Borderline Personality Disorder and Bi polar Disorder. Conditions of extreme Mania from the two are treatable by neuropeltic medications (Goodwin, 2009). There is an option of administering Benzodiazpenes neuroleptics. This drug has a lower damaging side effect for patients of Borderline Personality Disorder and Bipolar Disorder. Teaching patient Interrelations of Borderline Personality Disorder and Bipolar Disorder patient require attention from psychoeducational that

Self-evaluation (Telecommuting will be the new way that jobs are Essay

Self-evaluation (Telecommuting will be the new way that jobs are performed in the next ten years. Introduction ) - Essay Example This can act as detrimental to a section of people are not well educated or skilled to perform any other kind of jobs. (Piskurich, 2008, p.27) Another argument presented by this paper is that telecommuting can provide an employee the added advantage of selecting his/her own working environment and this can have both economic and social benefits. However, there is also a down side because it becomes the responsibility of the employee to pay the bills of electricity and heat of his own working environment and in most companies the employees are not reimbursed for these aspects. (Piskurich, 2008, p.22) The paper puts forward a third argument that telecommuting provides the employee the advantage of working from home. This can help the employee to spend more time with the family thus promoting family values and developing stronger family relations. However, this can be disadvantageous for the supervisors whose primary responsibility is to monitor the efficiency and productivity of their supervisees. The supervisors do not feel comfortable because they cannot physically see their supervisees on daily basis. If the supervision is done badly then telecommuting can further reduce its effectiveness, however it can increase supervision that is done well. There is also the problem of jealousy from colleagues as many people feel that telecommuters do not work in all working hours at home. There may be others who cannot take up telecommuting because of their nature of work. All these can arouse jealousy from colleagues. This working from home facility can have an added disadvantage for thos e companies which regularly face crisis as it causes lack of flexibility. In case of emergency when holding a meeting is required it becomes extremely difficult to bring all the employees together if majority of them work from home. Therefore telecommuting as a way of job is

Minimizing Cost of Volatile Inhalational Anesthetics

Minimizing Cost of Volatile Inhalational Anesthetics P The population that will be examined are male and female patients with a physical status (PS) of I-II requiring general anesthesia for surgery, ages 20-40. I The intervention being introduced is utilizing Sevoflurane (UltaneÂÂ ®) as the inhaled anesthetic for surgeries requiring general anesthesia lasting less than one hour. C The comparison group will be those utilizing Desflurane (SupraneÂÂ ®) as the inhaled anesthetic for surgeries requiring general anesthesia lasting less than one hour. O The use of Sevoflurane for surgery cases requiring general anesthesia for less than one hour will save money for the anesthesia department rather than using Desflurane. PICO Question: Will the use of Sevoflurane rather than Desflurane in surgeries requiring general anesthesia lasting less than one hour save money for the anesthesia department? Abstract Inhalation anesthetics are used millions of times every single day in surgeries requiring general anesthesia all over the world. Cost containment is anesthesia is no longer an option, it is an absolute necessity. Anesthetic drugs account for up to 6 percent of total hospital pharmacy costs and inhalation agents comprise over twenty percent of that as a whole. One of the areas most amenable to cost reduction in the anesthesia department budget is the use and choice of inhalational anesthetic. A quantitative quasi-experimental controlled trial was developed to determine if money could be saved in the anesthesia department by utilizing Sevoflurane as the inhalational anesthetic for surgeries requiring general anesthesia less than one hour rather than Desflurane. The study chose males and females, ages twenty to forty, requiring general anesthesia at a mid-sized, urban, teaching hospital in South-Western Pennsylvania. Prices of anesthetic agents were gathered from the same facility and c alculated to determine the total cost savings that would ensue with the use of the interventional inhalation agent rather than that used by the control group. The use of Sevoflurane for two-thirds of the cases which Desflurane was used saved the institution over twenty thousand dollars. Key Words: Inhalational Anesthetics, Pharmacoeconomics, Desflurane, Sevoflurane, Anesthesia Introduction Research Problem: The cost of health services and technologies continue to increase exponentially while resources are finite. Developing effective strategies to minimize costs without compromising patient safety and quality of care are the most difficult challenges medical professionals experience.13 Inhalational anesthetics comprise twenty percent of the drug expenses in anesthesia departments. The cost of inhalational anesthetics depend on their potency, which is their minimum alveolar concentration (MAC), the minimum amount of inhalational anesthetic needed in the lungs to facilitate the absence of movement to noxious stimuli, the fresh gas flows (FGF) used to deliver the anesthetic gas, the amount of anesthetic vapor released by each milliliter of liquid, and the price of the inhalational anesthetics themselves.2,16 Inhalational anesthetics are used when general anesthesia is needed for surgery and patients do not have diseases or conditions which would preclude them from being able to utilize them (e.g. those who have malignant hyperthermia). The anesthesia provider decides which inhalational anesthetic is best for a given patient, based on their history and needs for the surgery. The problem exists when providers just use whichever anesthetic is most easily accessible at that time without minding any consideration as to the cost of the particular gas and the level of FGF they are using, which is purely a waste of money as the patient will lose heat and humidity, waste high levels of inhaled anesthetic, and demise cost containment for the anesthesia department. Statement of Purpose The purpose of this research study is to determine whether the implementation of Sevoflurane as the choice inhalation anesthetic for surgery requiring general anesthesia for procedures lasting less than one hour rather than using Desflurane will provide cost containment for the anesthesia department. Objectives/Aims The objective of this study is to provide an avenue of cost containment for the anesthesia department of a mid-sized, urban, teaching hospital and overall savings for the medical health system. This will allot more money in the department budget to be spent on technological advances, and equipment used to better develop opportunities for patient safety, the ultimate goal of all medical professionals. Review of Literature: Many studies explore different methods of cost containment in the anesthesia department. Almost all of the studies exclusively develop the notion of cost savings related to the fresh gas flows used to deliver inhalation anesthetics. Cost containment requires primarily a decrease in FGFs, but it may also be influenced by a rational use of the available halogenated agents.3 With the advances in technology and the ultra-modern anesthesia machines available, anesthesia providers should feel safe in using minimal FGFs to deliver anesthesia that would not harm their patients in any way.3 Anesthetists can directly influence healthcare costs through the patterns in which they practice, which includes reducing the FGFs chosen during inhalational anesthesia, which will directly affect the amount of inhaled anesthetic delivered to the patient and ultimately the costs which are attributable to inhaled anesthetics.10,15 Depending on breathing systems used, which are mostly semi-open today, up to ninety percent of the anesthetic gases delivered escapes into the atmosphere completely unused. By using low-flow anesthesia, most of the patients air they exhale is recycled and then returned to the patients lungs after the carbon dioxide from the exhaled air has been absorbed.15 There are also advantages of using low-flow anesthesia such as conserving the patients heat and humidity, making it less of a need to warm the patient externally, which will cut down costs on heating blankets and the like, as well as maximized the rebreathing of the exhaled anesthetic, which will cut down on the amount of gas vented into the environment,6 but there are cautions that anesthesia providers must take when using low FGFs, as titration in inhalation anesthetic is not as easily predicted. Product labeling for Sevoflurane does include a warning that patient exposure should not exceed two hours using FGF rates greater than one and less than two liters per minute.7 Also, it is not recommended at all to maintain FGFs less than one when using Sevoflurane as the patients inhalational anesthetic of choice. These recommendations are to minimize the risk of exposure of the patient to compound A which in laboratory animals, has been shown to be linked to nephrotoxicity. There are no minimum flow rate designations that exist for Desflurane.7,8 Isoflurane is less expensive than Sevoflurane and Desflurane at equal dose and the same FGFs.7 When comparing Sevoflurane with Desflurane as they are being used for surgeries lasting less than two hours, there was a ninety percent decrement time for Sevoflurane which approached the short duration of anesthesia matching that of Desflurane. However, when the duration of anesthesia increased over two hours, Sevofluranes ninety percent decrement time approached that of Isoflurane.7 The cost of inhaled anesthetic agent can be estimated by using an equation that provides the cost of anesthetic per MAC hour: Cost per MAC hour ($) = [(Conc.)(FGF rate)(Duration)(MW)(Cost per mL)] / [(2412)(D)]6 The cost of one milliliter of Isoflurane is twenty-three cents, Sevoflurane is forty-one cents, and Desflurane is eighty-three cents. Regardless of the fast onset and emergence Desflurane offers, the cost of administering Desflurane is greater than the cost of Sevoflurane at any FGF rate.10,11 The cost of inhaled anesthetic agent can be estimated by calculating the cost per MAC hour, which is the administration of inhaled anesthetic agent at 1 MAC for a one hour time interval. The cost can be calculated using the concentration percent on the anesthetic dial of gas delivered, the FGF rate chosen, the duration of the anesthetic (sixty minutes in this case), the molecular weight of the anesthetic agent (MW in grams), cost per mL of liquid agent (in dollars), a factor accounting for the molar volume of a gas at twenty-one degrees Celsius (a constant of two thousand four-hundred twelve), and the density of the agent (D in grams/mL). Cost per MAC hour ($) = [(Conc.)(FGF rate)(Duration)(MW)(Cost per mL)] / [(2412)(D)]6 The cost per MAC hour can be seen in Table 2. Desflurane is associated with a shorter recovery as is Sevoflurane, but the differences between the two in terms of patient discharge cannot be consistently shown in research studies.13 Gupta evaluated n=246 patients for recovery time after undergoing surgeries less than two hours with either Sevoflurane or Desflurane. Patients given Desflurane were able to open their eyes sixty seconds before those who received Sevoflurane, P When comparing Sevoflurane and Isoflurane for patients who are undergoing surgery for more than two hours, Gupta evaluated n=634 patients. The patients who underwent Sevoflurane were able to open their eyes sooner, P Savings of more than one hundred thousand dollars resulted from the change of using Desflurane to using Sevoflurane in the operating rooms at Montefiore Medical Center in the Bronx, New York. Traynor noted that three bottles of Desflurane are needed to maintain a level of anesthesia equal to that of one bottle of Sevoflurane, making this agent much less expensive for the hospital to utilize, with no difference in patient discharge times. Reviews of Literature indicated that patients who received Desflurane could be extubated in the operating room about two minutes sooner than the patients who received Sevoflurane; an advantage seen meaningless in the large scale of the operating room sequences.9,15 Methodology The research design chosen was a quasi-experimental study. It involved the use of an experimental group and a control group. It is important to mention that the control group was compiled from hospital anesthesia records. The study did not involve randomization as a medical facilitys computer database cannot throughput this information. Permission from a mid-sized, Southwestern Pennsylvania teaching hospital was granted and all information gathered from the facility involved no patient identifiers, including gender or age. The hospitals Institutional Review Board (IRB) was provided all details of the research study and deemed the research experiment to be exempt and permission was granted to start the study without any changes in the studys design. General anesthesia data spreadsheets were gathered from the hospital exemplifying a patient anesthesia case total for the month of July, 2012. From this information, it was determined there were a total of n0=1,459 general anesthesia cases and after careful analysis, it was found that n1=500 cases lasted less than one hour and n2=959 cases lasted equal to or more than one hour in length from the beginning of anesthesia delivery to the end of the surgical procedure, as seen in Chart 1 in Appendix A. The Southwestern Pennsylvania hospital was asked to provide their costs for Desflurane, Sevoflurane, and Isoflurane inhalation anesthetics. These prices can be seen in Table 1 of Appendix A. Utilizing the equation to calculate the amount of inhaled anesthetic used during a general surgical case in a sixty minute time duration, MAC hour costs could be calculated as seen in Table 3. The pharmacy was also asked to provide how many bottles of inhalational anesthetic are bought and used annually in their operating rooms. These results are seen in Chart 2 and calculated annual costs of the anesthetics are shown in Chart 3 in Appendix C The experimental group for the research procedure involved men and women, ages twenty to forty, with PS scores of I and II, who were undergoing general anesthesia for surgery cases lasting less than one hour. These patients were administered Sevoflurane as their inhalational anesthetic during surgery at a FGF rate of 2 liters per minute (LPM). To be sure all patients were given the same standard induction regimen, all drug doses were based on current body weight calculations. Propofol, a sedative hypnotic was given at 2 milligrams per kilogram (mg/kg). Fentanyl, an opioid analgesic was given at 5 micrograms per kilogram (mcg/kg). Midazolam, a benzodiazepine sedative was given at a standard dose of 2mg/kg. Lidocaine, a class 2 anti-arrhythmic agent was given at 1.5 mg/kg. All patients participating in the study were given their induction medications at these doses provided. In the preoperative area, all patients were given the right to participate or not participate in the research experiment as they were provided a letter of informed consent, which described completely that they would be treated no differently than any other patient and they were voluntarily consenting to participate in a research study as an individual, and in no way obligated to participate if they were unwilling to do so. Those who were not involved in the experimentation are those patients who were unwilling to consent to participate in the experiment as an individual. Those with malignant hyperthermia were excluded from the study as they could not receive volatile inhalational anesthetics. Patients who required additional narcotic for pain during surgery were excused from participation. Those with chronic kidney disease or kidney failure were also not involved in the experiment as Sevoflurane, the experimental variable could lead to kidney complications. Participants who only were given inhalational anesthetic for painful stimulation during intravenous sedation were also excluded from participation in this study. It was important to determine which inhalational anesthetic was favored most by anesthesia providers at the Southwestern Pennsylvania hospital between Sevoflurane and Desflurane for general anesthesia cases lasting less than one hour. Surveys were sent out to all members of the anesthesia team as titled Survey 1 in Appendix D. Ethics/Professionalism Ethical considerations were regarded during the completion of the study from start to finish. All information gathered from a Southwestern Pennsylvania hospital was kept in confidence and destroyed at the finish of the study by professional paper shredding services. Participant names, ages, race, nationality, and medical histories were not gathered from the hospital and were blinded from the investigator, owing to complete confidence of all those who participated during a twelve month interval. Results Results are pending until the quasi-experimental research study is completed. Discussion Volatile inhalational anesthetics account for twenty percent of pharmacy costs in the anesthesia department.10,16 By using a pharmacoeconomic model, it can be seen that careful choice of anesthetic for patients can represent a large cost containment for the anesthesia department in the hospital, without compromising patient care. All patients need to be considered a new case and may not fit into the pharmacoeconomic model because of family histories (e.g. malignant hyperthermia). However, when possible, using Sevoflurane for the choice inhalation anesthetic for general surgery cases rather than Desflurane for those lasting less than one hour can result in large cost savings for the anesthesia department. Over twenty thousand dollars could be saved if the Southwestern Pennsylvania hospital would utilize Sevoflurane over Desflurane for two-thirds of their total surgeries requiring general anesthesia for less than one hour. It is important to mention that as a professional anesthesia student, FGF commonly observed with Sevoflurane are 2 LPM and FGF with Desflurane commonly observed are 2 LPM. The nephrogenicity associated with Sevoflurane is not commonly observed when this amount of FGFs are used.7 With the use of 1 LPM FGF when using Desflurane, as there is no minimum FGF required to avoid physiological aberrance, 17,19 there is also a great cost savings maintained for the anesthesia department. Limitations There are limitations in any study when research is conducted and from this study, results are limited to a single institution and this limits its external validity as a result. Randomization was not included in this research study as a convenience sample population was used at one hospital location. The study was not extremely descriptive as patients with higher PS scores were not studied in this particular research project. This study is also missing research on older age groups, as participants age twenty to forty were included only. As all of these limitations can be seen in the experimental study, the results from this research study cannot be imposed on larger populations and therefore generalizability is poor. Future research can make these findings representable and provide for better generalization. Future Recommendations for Research In future research, randomization should be used when developing research as this will strengthen the results. Larger sample populations should be used in defined, smaller age variances to be able to impose the results on a specific group of patients. Defined surgeries should be used in sample populations to show stronger significance when looking at varied surgical procedures their results. With the inclusion of the above criteria, the research study would be experimental rather than quasi-experimental, and results could be superimposed onto given populations with much stronger data observance. Dissemination This research project will appear in the May, 2013 edition of Anesthesia and Analgesia in its entirety with all results included. There will also be one hour lectures provided on these research findings at the University of Pittsburgh at Greensburg, Robert Morris University, and St. Vincent College, times and final adjusted locations are to be announced via bulletins, which be hung in the cafeterias of each of these locations. Conclusion Inhalational anesthetics represent a significant cost for pharmaceutical costs in the anesthesia department. It is important for professional anesthesia providers to deliver cost-effective, safe anesthesia care to patients in surgery. When analyzing surgical procedures requiring general anesthesia for less than one hour, the use of Sevoflurane rather than Desflurane as the choice inhalation anesthetic in surgery can provide the anesthesia department an avenue of cost savings without compromising patient care. When Desflurane must be used for patients who cannot be administered Sevoflurane, it is important to keep in mind there is no recommendation for FGF rates, and cost savings can also be preserved by utilizing low FGFs when using Desflurane. References Weinberg L, Story D, Nam J, McNicol L. (2010). Pharmacoeconomics of volatile inhalational anaesthetic agents: an 11-year retrospective analysis. Anaesthesia and Intensive Care, 38(5), 849-854. Lockwood GC White DC (2001). Measuring the costs of inhaled anesthetics. British Journal of Anesthesia, 87(4), 559-563. Odin I, Feiss P. (2005). Low flow and economics of inhalational anaesthesia. Best Practice Research Clinical Anaesthesiology, 19(3), 399-413. Strum EM, Szenohradszki J, Kaufman W, Anthone GJ, Manz IL, Lumb PD (2004). Emergence and Recovery Characteristics of Desflurane Versus Sevoflurane in Morbidly Obese Adult Surgical Patients: A Prospective, Randomized Study. Anesthesia and Analgesia, 99, 1848-1853. Boldt J, Suttner S. (2000). Low-Flow Anesthesia: Does it have Potential Pharmacoeconomic Consequences? Pharmacoeconomics, 17(6), 585-590. Golembiewski J. (2010). Economic Considerations In the Use of Inhaled Anesthetic Agents. American Journal of Health-System Pharmacy, 67(4), 9-12. Meyer T. (2010). Managing inhaled anesthesia: Challenges from a health-system pharmacists perspective. American Journal of Health-System Pharmacy, 67(4), 4-8. Boldt J, Juan N, Kumle B, Heck M, Mund K. (1998). Economic Considerations of the Use of New Anesthetics: A comparison of Propofol, Sevoflurane, Desflurane, and Isoflurane. Anesthesia and Analgesia, 86, 504-509. Agoliati A, Dexter F, Lok J, et al. (2010). Meta-Analysis of Average and Variability of Time to Extubation Comparing Isoflurane with Desflurane or Isoflurane with Sevoflurane. Anesthesia and Analgesia, 110(5), 1433-1439. Dolk A, Cannerfelt R, Anderson RE, Jakobsson JP. (2002). Inhalation anesthesia is cost-effective for ambulatory surgery: a clinical comparison with propofol during elective knee arthroscopy. European Journal of Anesthesiology, 19(2), 88-92. Chernin EL (2004). Pharmacoeconomics of inhaled anesthetic agents: Considerations for the pharmacist. American Journal of Health-System Pharmacy, 61(4), 18-22. Beaussier M, Deriaz H, Abdelahim Z. (1998). Comparative effects of desflurane and isoflurane on recovery after long lasting anaesthesia. Canadian Journal of Anaesthesia, 45(5), 429-434. White PF. (2010). Facilitating Recovery from Anesthesia: Assessing the Costs and Benefits of Anesthetic Drugs. Anesthesia and Analgesia, 110(2), 273-275. Gupta A, Stierer T, Zuckerman R, Sakima N, Parker S, Fleisher LA (2004). Comparison of Recovery Profile After Ambulatory Anesthesia with Propofol, Isoflurane, Sevoflurane and Desflurane: A Systematic Review. Anesthesia and Analgesia, 98, 632-641. Traynor K. (2009). Inhaled anesthetics present cost-saving opportunity. American Journal of Health-System Pharmacy, 66(7), 606-607. Kapur P. (1994). Pharmacy Acquisition Costs: Responsible Choices Versus Overutilization of Costly Pharmaceuticals. Anesthesia and Analgesia, 78, 617-618. Dexter F, Bayman EO, Epstein RH (2010). Statistical Modeling of Average and Variability of Time to Extubation for Meta-Analysis Comparing Desflurane to Sevoflurane. Anesthesia and Analgesia, 110(2), 570-580. Southwestern Pennsylvania Hospital. (2012). Annual Anesthesia Data Tracking Information. Accessed 08/30/2012 with Permission from Corporate Department. Southwestern Pennsylvania Hospital. (2012). Pharmacy Records. Accessed 08/30/2012 with Permission from Corporate Department. Appendix A Table 1: Cost of Inhalational Anesthetic per a Southwestern Pennsylvania Hospital Pharmacy Records Inhalational Anesthetic Cost Per Bottle ($) Total Volume in Bottle (mL) Cost per mL of Liquid ($) Sevoflurane (Ultane) 100.82 250 0.40 Isoflurane (Forane) 9.73 100 0.09 Desflurane (Suprane) 136.37 240 0.56 Reference 19. Table 3: Calculated MAC Hour Inhalation Anesthetic Cost at a Southwestern Pennsylvania Hospital FGF Rate (L/Min) Isoflurane ($) Desflurane ($) Sevoflurane ($) 1 0.31 9.68 2.71 2 0.62 19.36 5.43 3 0.93 29.04 8.14 All estimated costs are based on duration of 60 minutes and the formula proposed by Golembiewski. Isoflurane calculations are based on concentration of 1.15%, MW of 184g, cost per mL=$0.09 and D of 1.49 g/mL Desflurane calculations are based on concentration of 6%, MW of 168g, cost per mL=$0.56, and D of 1.45g/mL Sevoflurane calculations are based on concentration of 2.0%, MW of 201g, cost per mL=$0.40, and D of 1.51g/mL Appendix B Chart 1: Total Anesthesia Cases in July, 2012: Time Intervals from a Southwestern Pennsylvania Hospital Reference 18. Table 2: Estimated Cost per MAC Hour ($) of Inhaled Anesthetic Gases: Based on FGF Rates FGF Rate (L/Min) Isoflurane ($) Desflurane ($) Sevoflurane ($) 1 0.5 12.9 6.0 2 1.0 25.9 12.1 3 1.5 38.8 18.1 All estimated costs are based on duration of 60 minutes and the formula proposed by Golembiewski. Isoflurane calculations are based on concentration of 1.15%, MW of 184g, cost per mL=$0.15 and D of 1.49 g/mL Desflurane calculations are based on concentration of 6%, MW of 168g, cost per mL=$0.96, and D of 1.45g/mL Sevoflurane calculations are based on concentration of 2.0%, MW of 201g, cost per mL=$0.90, and D of 1.51g/mL Reference 7. Appendix C Chart 2: Number of Bottles of Inhalational Anesthetic Used Annually at a Southwestern Pennsylvania Hospital Reference 19. Chart 3: Annual Expenditure on Inhalational Anesthetics at a Southwestern Pennsylvania Hospital

Social Promotion or Retention: The Only choices for failing students? E

Social Promotion or Retention: The Only choices for failing students? How to help students who fail, or students who do not achieve up to a certain academic standard, is an issue that probably goes back to the beginning of levels of school for students to progress through. In the U.S. it goes back to the 1840’s where age-graded schools began. In those times children who did not meet a certain standard were retained, or they repeated that grade. Rates of grade retention are difficult to trace in the past as well as currently. In some of these illustrative examples, a state could reduce retention by half in thirty years. However, different states had different retention rates. In 1909 one Massachusetts school district had a 7.5% retention rate while a Tennessee had a 75.8%. â€Å"In the 1930’s educators recognized that grade repetition might endanger student’s social and emotional development, which gave rise to the practice of social promotion. As a result of this policy, students were passed on to the next grade even if they were not ready for the work.† (Alkin, 1114) Both social promotion and retention intend to rectify the problem of failing students. However, does either of these two methods succeed? If they do not then what does? Retention is the process of keeping students at the grade they fail. However, according to Donald R. Moore, the executive director of Designs for Change, a Chicago non-profit group that strives to improve schools, â€Å"It’s a politically popular initiative, but it harms kids in the long term.† (Gewertz, 1, 13 2002) talking about repeating the same grade. Holding students back a grade without changing the instructional strategies is ineffective. Much evidence suggests that the achievement of retained stud... ... likely to fail and help them before it can happen. (Riley, 1999), (Oakes, 1999). Mr. Franczyk, a principal in Chicago, where social promotion has ceased says, â€Å"Retention itself does not benefit anyone. But early intervention does, I see it every year.† Evidence for early intervention working is overwhelming. As Alexander, Entwisle, and Dauber put it, the answer to social promotion and retention is intervention policies that ensure that resources are brought to bear to promote successful student learning, especially for those children at risk of failure. (Alexander, 1994) This policy should lower failing rates and help students gain the mastery over the studied material it also shows them that they do not have little worth and that much is expected from them. This policy change address why students fail and changes in those areas are necessary for them to succeed.

Life in Ireland & Typhoid Fever Essay

During the 1930s in Ireland, the majority of the people lived in the countryside. There were several late marriages and high birth-rates in the rural areas of Ireland at this time. Numerous people from Ireland were immigrating to England because of overcrowding and poor economic conditions. Ireland was also fighting an economic war with Britain at this time. Some popular forms of entertainment in Ireland were cinema, cross-road dancing, and sports. 2.There are several similarities to the poem about the highwayman and the story of Patricia and Frankie. In â€Å"The Highwayman† Bess, the landlord’s daughter was not allowed to talk to the highway man because of her father. This is similar to â€Å"Typhoid Fever† because Frank and Patricia were not allowed to talk to each other because the nuns and nurses wouldn’t allow it because of their diseases. Another similarity is that Bess dies in â€Å"The Highwayman† and Patricia dies in â€Å"Typhoid Fever†. It also seemed as if Frank was falling in love with Patricia, like how the thief had fallen in love with Bess. In â€Å"Typhoid Fever† Frank stated, â€Å"I’d love to do that myself, come by moonlight for Patricia in the next room not giving a hoot though hell should bar the way.† My inference of this line was that Frank felt that his relationship with Patricia was similar to the thief’s relationship with Bess. 3.Frank McCourt was able to re-create the voice of a 10-year-old boy in â€Å"Typhoid Fever† because the events described in â€Å"Typhoid Fever† were of his own. â€Å"Typhoid Fever† came from a memoir Frank had written, which was called Angela’s Ashes. A memoir is a biography or an account of historical events, especially one written from personal knowledge. I also think Frank McCourt was able to re-create the voice of a 10-year-old boy because of how he had the main character act and talk. For example, when Patricia asks how old he is and appears disappointed when he says ten, Frank says, â€Å"But I’ll be eleven in August, next month.† Usually children want to be perceived as older. So when you ask a child how old they are, they usually are very exact, saying the year and month. Another example form the story is how Frank reacts when Patricia mimics the nun. In the story it says, â€Å"Then Patricia whispers, Give thanks, Francis, give thanks, and say your rosary,  Francis and I laugh so hard a nurse runs in to see if I’m all right.† If an adult had heard Patricia mimic the nun they would be able to control their laughter enough so that the nurse would not have heard anything.

The Evolutionary Arms Race - Natural Selection

The Evolutionary Arms Race - Natural Selection Species, in order to evolve, must accumulate adaptations that are favorable for the environment in which they live. These preferred traits are what make an individual more fit and able to live long enough to reproduce. Since ​natural selection chooses these favorable characteristics, they get passed down to the next generation. Other individuals that do not exhibit those traits die out and, eventually, their genes are no longer available in the gene pool. As these species evolve, other species that are in close symbiotic relationships with those species must also evolve. This is called co-evolution and it is often compared to an evolutionary form of an arms race. As one species evolves, the other species it interacts with must also evolve or they may go extinct. Symmetrical Arms Race In the case of a symmetrical arms race in evolution, the co-evolving species are changing in the same way. Usually, a symmetrical arms race is a result of competition over a resource in an area that is limited. For example, the roots of some plants will grow deeper than others to obtain water. As the water level goes down, only the plants with the longer roots will survive. Plants with shorter roots will be forced to adapt by growing longer roots, or they will die. The competing plants will keep evolving longer and longer roots, trying to outperform each other and get the water. Asymmetrical Arms Race As the name implies, an asymmetrical arms race will result in the species to adapt in different ways. This type of evolutionary arms race still results in the co-evolution of the species. Most asymmetrical arms races come from a predator-prey relationship of some sort. For instance, in the predator-prey relationship of lions and zebras, the result is an asymmetrical arms race. The zebras become faster and stronger to escape the lions. That means the lions need to become stealthier and better hunters in order to keep eating zebras. The two species are not evolving the same types of traits, but if one evolves, it creates the need in the other species to also evolve in order to survive. Evolutionary Arms Races and Disease Humans are not immune to the evolutionary arms race. In fact, the human species is accumulating adaptations constantly to fight disease. The host-parasite relationship is a good example of an evolutionary arms race that can include humans. As parasites invade the human body, the human immune system will kick in to try to eliminate the parasite. Therefore, the parasite must have a good defense mechanism to be able to stay in the human without being killed off or expelled. As the parasite adapts and evolves, the human immune system must adapt and evolve as well. Similarly, the phenomenon of antibiotic resistance in bacteria is also a type of evolutionary arms race. Doctors often prescribe antibiotics for patients that have a bacterial infection in hopes that the antibiotics will stimulate the immune system and kill off the disease-causing pathogen. Over time and repeated uses of antibiotics, only bacteria that have evolved to be immune to the antibiotics will survive and the antibiotics will no longer be effective in killing off the bacteria. At that point, another treatment will be necessary and force the human to either co-evolve to fight off the stronger bacteria, or find a new cure to which the bacteria are not immune. This is the reason why it is important for doctors not to overprescribe antibiotics every time a patient is sick.

Narcissistic Personality Disorder essays

Narcissistic Personality Disorder essays Few people associate narcissism with Narcissus, the mythical character in antiquity who drowned because he was so fond of looking at his image reflected in the water of a pool, fell in and drowned. Fewer still might associate narcissism, which has become a popular term for anyone who is self-involved (the quintessential Valley Girl of a generation ago, and, arguably, Friends on TV of the current one) to an overwhelming extent. And still fewer might associate narcissism with heinous criminal acts. Yet, all of these associations are arguably true, particularly the last. Worse, still, it is resistant to treatment. "Narcissistic personality disorder (NPD) is a common and often disabling syndrome. Although persons with narcissistic personality disorder are often difficult to treat, certain psycho therapeutic strategies have been identified which can lead to effective interventions with these clients," according to Schwartz and Farrell and Edson, on the other hand, seem to believe narcissism is a psychopathology that is genetic, and, as such, is not much likely to be affected by any treatments currently available. Farrell and Edson (2003) note that "Hare (1993) suggests that psychopathy emerges from a complex and poorly understood interplay of biological and social factors. Additional studies support and extend this research, indicating that psychopaths' brains are different from those of normal people (Patrick, 1994 and Doren, 1987)." Stawar (1997) wondered, "Do some individuals have the ability to manipulate certain others into committing horrendous acts of violence and mayhem' What parameters might define such an antisocial personality disorder by proxy, and what are the underlying dimensions and dynamics'" This possibility will be further examined later in this paper. However, few would argue that "Narcissistic Personality Disorder (NPD) is essentially characteri...

OUTLINE ON ARAB AMERICANS AND JEWISH AMERICANS Assignment

OUTLINE ON ARAB AMERICANS AND JEWISH AMERICANS - Assignment Example migrating to the United States during the 19th century because of two major reasons that I have identified (Caught in the Crossfire: Arab Americans | PBS, n.d.). First of all, like all the other ethnic groups that went to the United States, Arab Americans came seeking for better opportunities. This was caused because of the wars and economic hardships in some Arab countries specifically two major crippling blows: the opening of the Suez Canal that slanted world traffic from Syria to Egypt that made other competitors in the silk industry have easy access in competing with the Lebanese silk industry; and when the Lebanese vineyards were invaded by phylloxera. iii.Another reason for Arab American’s emigration would be personal advancement. This is especially because they were experiencing religious persecutions, and the lack of political and civil freedom because of the oppressive Ottoman regime (NITLE Arab World Project, n.d.). ii. To be able to escape persecution. They first arrived in New Amsterdam, a Dutch-owned colony then without any Jewish community. At first, they were refused admission because they were seen to be the blasphemers of Christ until they were able to prove that they are loyal and economically productive residents that they were welcomed to live and work in New Amsterdam (The Jewish Americans. Jewish Life in America | PBS. n.d.). For Arab Americans, they established the American- Arab Anti-Discrimination Committee which is responsible for defending rights of people of Arab descent and promote their cultural heritage even when they are in a foreign country (About Us - American-Arab Anti-Discrimination Committee. n.d.). Aside from that, the Arab American Institute, which is a non-profit organization, was created to encourage the direct participation of Arab Americans in political and civic life in the United States (About the Institute | The Arab American Institute. n.d.). For the Jewish Americans, the â€Å"Jewish American Heritage Month† now

Principles of Finance in General Motors and Honda Motors Assignment

Principles of Finance in General Motors and Honda Motors - Assignment Example General Motors is an American Auto-maker which recently filed its bankruptcy due to its unstable financial condition. General Motors was among the top auto-makers of America, but due to issues like the hike in the prices of the commodities such as raw materials and labor, government pressure towards the production of fuel-efficient cars, critical issues of corporate governance, etc, the company filed its bankruptcy in the court of Manhattan. Honda Motor Corp. from Japan is considered the fifth largest motorcycle manufacturer and auto-maker in the world. The company has a sustainable financial condition because it has posted a profit of? 234.4 billion, which is about US$2.7 billion in its first quarter of 2011. Moreover, the company has also posted a profit of? 135.92 billion in quarter 2. Honda has a huge market share in the Asian markets. Analysis of the Financial Statements As we can see in Appendix 1(a), that General Motors has to face a gross loss of US$ 8,791,000, in 2009. In 20 10, and 2011, the gross profit was US$ 16,554,000, and US$ 19, 047,000 respectively. This indicates an improvement in the financial condition since 2009. However, the net income has reduced from 2009 to 2010 and 2011. In 2009, the net income was US$ 104,821,000, in 2010 it was US$ 6,172,000 and in 2011, US$ 9,190,000. So this signifies that the operating expenses have increased in 2010 and 2011 than 2009. That is why even after having a considerable increase in revenue, the net income of the company was decreasing. In Appendix 1(b), we can see that the total assets of the company have increased in 2011 to US$ 144,603,000 from US$ 136,295,000. The assets have remained almost constant over the years, with a consistent increase in current assets. This means the company maintained its liquid assets over the period of 2009-11. The long-term debt of the company has increased considerably from US$ 5,562,000 to US$ 10,551,000 in 2012. The balance sheet for all the three years of the company shows a negative net tangible asset balance. In Appendix 2(a), the income statement reveals that the revenue of Honda Motor Corp has decreased in 2011 to US$ 96,581,000 than its previous year, 2010, which was US$ 107,829,000. The gross profit figure also reflects the revenue different in 2011 and 2010. The net income has also decreased to US$ 2,570,000, which was US$ 6,444,000 in 2010 and US$ 2,872,000 in 2009. So 2011 had to bear a considerable amount of loss. The company does not have a negative income figure, but the profit had reduced a lot. Considering Appendix 2(b), the total assets which include the current or liquid assets remains consistent all throughout 2009-11. Long term debts of the company have not increased much as it was US$ 24,754,000 in 2009, US$ 24,653,000 in 2010 and, US$ 27,158,000 in 2011. The net tangible assets show a positive balance, which reveals a balanced financial status of the company.