Robert Frost Takes Our Imaginations To A Journey Through Wintertime Wi

Robert Frost takes our imaginations to a journey through wintertime with his two poems Desert Places and Stopping by Woods on a Snowy Evening. Frost comes from a New England background and these two poems reflect the beautiful scenery that is present in that part of the country. Even though these poems both have winter settings they contain very different tones. One has a feeling of depressing loneliness and the other a feeling of welcome solitude. They show how the same setting can have totally different impacts on a person depending on their mindset at the time. These poems are both made up of simple stanzas and diction but they are not simple poems. In the poem Desert Places the speaker is a man who is traveling through the countryside on a beautiful winter evening. He is completely surrounded with feelings of loneliness. The speaker views a snow covered field as a deserted place. A blanker whiteness of benighted snow/ With no expression, nothing to express. Whiteness and blanknes s are two key ideas in this poem. The white symbolizes open and empty spaces. The snow is a white blanket that covers up everything living. The blankness symbolizes the emptiness that the speaker feels. To him there is nothing else around except for the unfeeling snow and his lonely thoughts. The speaker in this poem is jealous of the woods. The woods around it have it - it is theirs. The woods symbolizes people and society. They have something that belongs to them, something to feel a part of. The woods has its place in nature and it is also a part of a bigger picture. The speaker is so alone inside that he feels that he is not a part of anything. Nature has a way of bringing all of her parts together to act as one. Even the animals are a part of this wintery scene. All animals are smothered in their lairs,/ I am too absent-spirited to count. The snow throws its blanket of whiteness over everything and to him it is a feeling of numbness. The loneliness includes me unawares. The spe aker has lost his enthusiasm for life. He can not express his feelings easily because of this feeling of numbness. The speaker is also in denial about feeling alone. He is at a stage where he just does not care about too much and he is feeling a bit paranoid. They cannot scare me with their empty space. He is saying who cares how I feel, I do not need anyone else. I have in me so much nearer home/ To scare myself with my own desert places. The speaker was starting to realize that he had shut himself off to the world. He recognized that this winter place was like his life. He had let depression and loneliness creep into his life and totally take over like the snow had crept up on the plain and silently covered it. If he continues to let these feelings run his life, eventually everything would be snuffed out much like the snow does to nature. Stopping by Woods on a Snowy Evening is a much happier and more upbeat poem than Desert Places. This poem is about stopping to enjoy life or as the cliche goes, stopping to smell the roses. But I have promises to keep,/ and miles to go before I sleep. The speaker in this poem was a very busy man who always had obligations to fulfill and places to go. A feeling of regret is present. The man would like to stay and enjoy this private nature scene longer but he knows that he has other things to do. Again, Frost gives us a beautiful nature scene but this time we enjoy welcome solitude. The woods are lovely, dark and deep. This poem expresses the joy of nature. The speaker seems concerned about what the rest of society would think about him just stopping in the middle of nowhere for no apparent reason. His horse represents society. My little horse must think it queer/ To stop without a farmhouse near. He admits that just stopping does seem odd. He is also somewhat concerned about the man

French and Spanish Influance essays

French and Spanish Influance essays The French and Spanish responded differently to the culture and economy of the Native Americans. Even though both countries traveled to the New World for riches, their ways of obtaining the riches could not have been more different. The Spanish decided to conquer and enslave the Indians. The French traded peacefully with the Indians and changed both the Indian culture and their own culture to gain confidence with the Indians. The type of Spaniard, which arrived on the New World before 1750, was either a monk or a conquistador. The job of the conquistadors was to capture Indian cities and then loot them of all their riches. After the capturing and looting of cities, the conquistadors would usually enslave all the surviving Indian people to earn money for the conquistador. The Spanish government did not mind this because they got one fifth of all the profits of these settlements known as The Royal Fifth. Because of the lack of Spanish women, the conquistadors intermarried with the Indians creating a new race called Mestizos. In Spain, being a Mestizo or having Native American blood in your veins was looked down upon. The social hierarchy consisted of pure blood Spanish being at the top and pure Native Americans being at the bottom. This created a natural block against any people with Native American blood holding a high position in Spain, which was probably one of the main reasons Indian slavery was never put into question by the Spaniards. The monks of Spain were no better then the conquistadors. The monks only goal was to convert the Native Americans to Catholicism. These servants of God destroyed the Indian temples and built churches where they once lay. No part of Indian culture was allowed to be retained by the Native Americans. The effect of this was the Indians did not accept Catholicism but they also lost ties to their own culture. The French had a more peaceful approach to the Indians. The f...

La-Z-Boy Incorporated India and Philippines Subsidiaries Essay

La-Z-Boy Incorporated India and Philippines Subsidiaries - Essay Example The company’s economic outlook is expected to increase in FY2012. Globalization has made La-Z-Boy’s transition in India seamless. India’s sophisticated banking system attracts profitable organizations like La-Z-Boy towards India. La-Z-Boy has strengthened India’s economy by employing local workforce. La-Z-Boy’s business in India can be more beneficial with due assistance of the Association of Furniture Manufactures and Traders (AFMT). In order to escape risks while working in India, it is recommendable for La-Z-Boy to be well-aware of the various languages, business etiquettes, norms and religious values in India. Mumbai is the most suitable city for La-Z-Boy to establish business in India because of its cultural richness, population and good environment. USA and Philippines are trading partners and USA is a very strong financial provider of Philippines. Since Philippines resembles USA in culture, La-Z-Boy’s working style is consistent with t he indigenous culture of Philippines, though the organization may have to tackle the risk of investment in

Job Statement Personal Example | Topics and Well Written Essays - 500 words

Job - Personal Statement Example Part of my current role as Support Assistant is to prepare learning material for these children, according to their abilities. I have also regularly worked with a private speech and language therapist, and have found this experience both useful and satisfying. Apart from this, I have liased with two outreach teachers from special schools in the borough, to make provisions for two autistic children I currently support. At Uphall, having worked in the nursery and foundation stages, I have had exposure to existing practice and procedure. My NVQ 2 and my Diploma in Social Work have helped in this. Besides, my BA (Hon) degree in primary education has enabled me to acquire in-depth knowledge of childhood studies and the connected policy aspect, ranging from the Discrimination Act to Every Child Matters and the S.E.N code of practice. My strengths in the curriculum are in Maths and I.C.T activities as well as in other languages.

Chronic Kidney Disease: Pathology and Biochemistry

Chronic Kidney Disease: Pathology and Biochemistry The kidneys are a pair of organs that function to removing metabolic wastes like urea, carbon dioxide, salts, and chemicals from the blood and excreting these wastes as urine. Kidneys also regulate the concentration of body fluids and electrolyte concentrations, arterial pressure, secretion/excretion of hormones and acid-base balance of body fluids (Guyton Hall, 2005). The main functional filtering unit of the kidney is the nephron. At least 800 thousand nephrons are in one kidney. The initial filtering unit in the nephron is the glomerulus, and the filtrates coming from the glomerulus are formed into urine as it passes the other components in the nephron. Diseases in the kidney cause a significant number of deaths and disabilities worldwide (Coresh, et al., 2007). Acute renal failure is manifested by the kidneys abruptly stopping, although the chance exists that the kidneys could recover, while in chronic kidney disease there is a progressive decline in the function of the nephrons. More specifically, chronic kidney disease is defined as damaged or decreased kidney function measured by a decrease in the glomerular filtration rate (GFR) for a period or three or more months (Levey, et al., 2003). Initial damage to the nephron results in compensatory responses of the remaining nephrons allowing for the continuation of clearance of blood solutes. The compensatory action of the nephrons during early damage is thought to be a major cause of renal damage, because during compensation the glomerular capillary pressure is increased so much that damages are incurred leading to lesions in the glomeruli (Arora Verelli, 2010). Chronic kidney disea se is also caused by hypertension, diabetes, disorders in blood vessels and glomeruli, infections, immune system disorders, congenital disorders, and urinary tract obstructions (Guyton Hall, 2005). Clinical symptoms for chronic kidney disease are not evident until the number of functional nephrons decreases by 70-75% (Guyton Hall, 2005). The progressive deterioration in kidney function could ultimately lead to end-stage renal disease where the patient must undergo dialysis to remove wastes from the blood, or transplanted with a new kidney. Chronic kidney disease has 5 stages based on the GFR (National Kidney Foundation, 2002). Patients with the stage 1-3 of the disease do not show symptoms. At stage 4-5 electrolyte balance and endocrine disorders become evident. It is believed that the uremic disorders observed at stage 5 are due to the accumulation of toxins (Arora Verelli, 2010). Increased retention of potassium (hyperkalemia) occurs due to inability of the kidneys to excrete potassium. Metabolic acidosis results from the inability of the kidneys to produce enough ammonia necessary to react with the endogenous acid and produce ammonium. Phosphates, sulphates, and other organic anions accumulate, causing large anion gaps. Metabolic acidosis increases protein degradation and amino acid oxidation, and reduces albumin synthesis, resulting in protein-energy malnutrition, decreased body mass, and increased muscle weakness. Acidosis also interferes with Vitamin D metabolism and mineral imbalance resulting in renal osteodys trophy or renal bone disease. Renal bone disease can be averted with timely dietary measures and medications like phosphate binders and calcitriol (Renal Resource Center, 2007). Skeletal and extraskeletal complications result from the progression of renal bone disease. In chronic kidney disease, renal bone disease is categorized into four general types: (1) low turnover disease or defective mineralization; (2) high turnover bone disease brought about by high levels of the parathyroid hormone (PTH) levels; (3) beta-2-microglobulin associated bone disease; and (4) mixture of the 3 diseases (Arora Verelli, 2010). Diagnosis and management of chronic kidney disease Chronic kidney disease is diagnosed by laboratory tests on urine and serum. Serum creatinine as an estimate of glomerular filtration rate, albumin-creatinine ratio in the urine, and examination of urine sediment and dipstick test for erythrocytes and leukocytes are recommended (Levey, et al., 2003). Image analysis by ultrasound can be performed for patients with symptoms of stones, infection, obstruction of the urinary tract and having a family medical history of polycystic kidney disease. Serum electrolytes should be measured on patients who are hypertensive, diabetic, and those who have been exposed to drug toxicity. Other tests include urinary concentration or dilution, and acidification for selected patients who present symptoms of polyuria, metabolic acidosis, metabolic alkalosis, hypo- and hyperkalemia (very high levels of potassium). Kidney function is assessed by analyzing serum creatinine along with a blood urea nitrogen test (Lab Tests Online, 2009). Creatinine clearance is an indication of the efficiency of the kidneys in filtering small molecules out of the blood. A traditional and principal marker of kidney damage is persistent or recurring proteinuria (Kean Eknoyan, 1999). Proteins are large molecules, and therefore they cannot pass the membranes of the glomeruli into the urine. Glomeruli, being negatively charged, also repel proteins. Size and charge barriers do not allow the passage of proteins into urine, unless the glomeruli are damaged (Proteinuria and microalbuminuria, 2007). Proteins can be measured using reagent strip tests for point of care detection and laboratory tests, including immunoassays (Carter, Tomson, Stevens, Lamb, 2006). When the protein level is more than 3500 milligrams, extensive glomeruli damage has already occurred. An albumin (or protein)-creatinine ratio higher than 30 mg albumin/g creatinine, is abnormal since the cut-off points are greater than 17 mg/g in males and more than 25 mg/g in females (Warram, Gearin, Laffel, Krolewski, 1996; (Jacobs, Murtaugh, Steffes, Yu, Roseman, Goetz, 2002). Glomerular filtration rate (GFR) is currently the best test for detecting kidney disorders. GFR is estimated using a formula that uses serum creatinine value, and gender, age and weight of individual. The GFR has been recommended to be the main criterion in classifying kidney disease. Five stages of chronic kidney diseases have been identified based on the glomerular filtration rate (GFR) (National Kidney Foundation, 2002). Kidney damage has been proposed with normal or increased GFR of > 90 mL/min per 1.73 m2, while kidneys have already failed when the GFR greatly decreased at Indications of chronic kidney disease are varied and diverse. Increase or decrease in levels of important electrolytes phosphate, potassium and calcium. Other indications are metabolic acidosis, pericarditis, malnutrition, neuropathies and cardiovascular complications (Shlipak, et al., 2005; Tonelli, et al., 2006). The treatment of chronic kidney disease depends on the stage of the disease and should focus on several important factors (Arora Verelli, 2010). The primary objective is to delay and halt the progression of the disease by treating the known underlying condition (e.g. hypertension, diabetes). Systolic blood pressure, hyperlipidemia, and glycemic levels must be controlled, and use of angiotensin receptor blockers is recommended. Pathologic symptoms should be treated as follows: anemia with erythropoietin; high phosphate levels with dietary means for binding and restricting phosphate binders; low calcium levels with supplements and hyperparathyroidism with vitamin D analogs or calcitriol (Arora Verelli, 2010). For uremic manifestations, dialysis and transplantation are recommended depending on the stage of the diseases, and the indications. Timely planning for renal transplantation is also necessary in order to prepare the patient. Reflection on module Chronic kidney disease is prevalent worldwide, with millions of people affected. The review conducted here shows that the disease has been well characterized with respect to the point-of- care and clinical tests for diagnosis. Chronic kidney disease affects the accumulation of ions in the blood therefore leading to a multitude of adverse conditions. The US National Kidney Foundation has spearheaded efforts to standardize and systematize the different stages, diagnostic approaches and treatment modalities. Apparently, chronic kidney disease results from other disorders. Therefore it can be prevented and corrected by first preventing and curing the underlying cause. This makes the nature of the disease complicated, and solutions are also complex. What is clear is that kidney disease is mostly a result of lifestyle, since most underlying causes like diabetes, cardiovascular disease, and hyperlipidemia are mostly due to lifestyles. A limitation in the publications that were reviewed was the lack of clear recommendations on how the onset of chronic kidney disease can be prevented, and what specific medications can lead to repair of the glomeruli and the nephrons after damage has occurred. Clearly, a patient with chronic kidney disease is saddled with the knowledge that a complete cure is not possible; and it only takes a matter of time for one to have the end-stage renal disease. The challenge for the medical community is to come up with a clear preventive strategy against kidney disease, and to have other long-term options aside from dialysis or organ transplantation.

MAR project team Essay

Strength Integrated Health consists a number of hospitals. Has an internal technology department – MIS. Has a large number of staff MAR project team is well rounded with technology. The institutions of Integrated Health are well known by the people in Tempe, Arizona. A non-profit organization, which means all the earned money minus the salary and daily operational costs of the institution, can be used for development. Weaknesses Utilizes manual processing of information. Low investment on automation. Chief Information Officer doesn’t have technical background. Some Directors doesn’t support automation and would rather have the traditional process. A large number of staff doesn’t agree with the change. Due to manual filings, specialists reported that patients endorsed to them doesn’t have files 30% of the time. Doesn’t have a change management process. MIS Staff are underestimated and their relevance is not clear to the whole organization Opportunities Lower of costs by investing on computerizing MAR. Can attract partnerships with insurance companies as they are becoming a trend. By investing in computerized MAR, less information would be missing or incorrect If medical tests would not be repeated unnecessarily, then operational costs can be lessen. Computer management of patient medication profiles offers the opportunity to enhance communication between pharmacists and nurses decrease medication errors and delays in delivery of therapy. enhance medication delivery accuracy and timeliness Threats If the computerized MAR is not implemented, insurance companies would not want to partner with Integrated Health. Increasing incorrect medical profiles of patients. If the computerized MAR is implemented, There will be dependence on its automation in the future and when it fails, operations will stop. Cost for further upgrades to fix bugs and improve services will be considered.

Disc Arthroplasty Essay

Degenerative disc disease have been a problem for many people as this disease brings about low back pain that seems to paralyze the working force,   the middle adulthood population (Smeltzer, 2004). Not only does it bring impaired quality of life to those who suffer from it, but Arvind Kulkarni adds large health care expenses to the list of problems brought about by this disease as seen in his article entitled Prosthetic Lumbar disc replacement for degenerative disc disease. Spinal fusion, which is the medical management for degenerative disc disease, has been criticized by several doctors in the practice due to its untoward effects in the patient’s overall recovery and lifetime improvement. Specialist in the field, Christoph Siepe, identified these unpleasant effects as accelerated adjacent system degeneration, pseudarthrosis, spinal canal stenosis, and donor site morbidity. Adjacent segment degeneration, as mentioned by Peter Ullrich in his article entitled Fusion versus Artificial Disc Arthroplasty for Lumbar Degenerative Disc Disease, stated that this is the major complication of spinal fusion and the reason why most surgeons want this procedure replaced. Adjacent segment degeneration or ASD happens when mechanical stress is transferred to the adjacent segment, also mentioned by Peter Ullrich. But research showed that this procedure can be modified to show more positive results. An anterior lumbar interbody fusion showed a low occurrence of revision surgery needed, which meant low frequency of adjacent segment degeneration, all pointed out in Mr. Ullrich’s paper.   However, to achieve this outcome, Mr. Ullrich declared that there should be an improvement in patient selection and in the procedure. The patients should be those patients having degenerative disc disease in their 5th lumbar to 1st sacral segment, because there is minimal motion at this level. By doing so, he states that fusing these segments do not change the patient’s mobility as much.   But not all are satisfied of this result. Doctors and specialists are continuously making efforts to totally changing the primary medical management for degenerative disc diseases. Studies have been conducted, and several replacement procedures were approved by the FDA. Peter Ullrich stated in his paper that the total disk replacement procedure was approved for medical use by the FDA in the year 2004 using the Charite artificial disc but for only one level of the spinal vertebrae, being the L4 – L5 or the L5 – S1. This is not the first time that a total or partial disc replacement was done. The history of this procedure was mentioned in an article in a website by Spine-Health that disc nucleus replacement was done first in 1955 by David Cleveland by injecting methyl-acrylic. Ever since then, there have two other FDA approved products aside from the Charite, the website Spine-Health states that the Prodisc was approved on August 2006 and the Kineflex lumbar on June 2005.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   A total disc replacement is being described by Jose Reyna in his article, Advances in Artificial Disc Technology, as being composed of two pieces of plates made of metal that has teeth to be able to attach itself to the end plates of the vertebral bones above and below it. This means that the particular intervertebral disc that is causing pain has to be removed and replaced by an artificial disc. Several artificial discs have been developed by various manufacturers in the country and they only differ in design and composition. The Charite, as mentioned earlier, is made up of a unique sliding core with two metal alloy end plates. The Prodisc being based on spherical articulations is made up of cobalt chromium molybdenum alloy as stated in the website Spine-Health. Inventors Qi-Bin Bao and Paul Higham developed a hydrogel prosthetic nucleus made up of PVA powder and a solvent mixed together, as seen on the article, Hydrogel intervertebral disc nucleus with diminished lateral bulging. The total disc replacement procedure has its advantages and disadvantages. Even after some models being approved by the FDA, it is still being assessed thoroughly by specialists in the field. Charles Rosen and Douglas Kiester report poor results and complications in the total disc replacement procedure. As it was mentioned in their study, this procedure causes fractures, severe pain, dislocations, extrusion of the implant, facet joint degeneration, and unexplained radiculopathy. They attribute these substandard results to the fact that the center of rotation of segmented motion is erroneous. Jose Reyna Jr. also mentions several disadvantages of the procedure in his study, stating that the anterior approach to the surgery can cause injury to the aorta and the common iliac vessels, can cause retrograde ejaculation in men by injuring the superior hypogastric plexus, hemorrhage can result from the retroperitoneal approach, and infection can occur. However, he also stated some advantages, as this procedure is said to maintain range of motion in majority of the patients as a long-term outcome. There are still a lot of studies to be conducted, and patients to be experimented on. A three year study conducted by Christoph Siepe et al., entitled Clinical Results of Total Lumbar Disc Replacement With ProDisc II: Three-Year Results for Different Indications, intended to assess total disc replacement outcome in patients who actually underwent the operation. Their results showed that not all degenerative disc diseases can be treated with this medical management. The best outcome was seen in patients exhibiting degenerative disc disease condition plus soft disc herniation or nucleus pulposus prolapse. Outcome was measured against the patient’s improvement from their preoperative levels. There were inferior results from the patients who had bisegmental damages, and a higher complication rate. Also it was mentioned that the younger patients, more specifically those aged below forty exhibited better outcome than those older than forty. Technology like this is still being developed, studied and modified as we speak. What is important is that there are people out there who care and who try to make a difference, whether it is by inventing, criticizing or being the experimental person wherein these new devices will be made a reality. References Charles Rosen, Douglas Kiester, Thay Q. Lee: The Potential Biomechanical Etiology for Lumbar Disc Replacement Failures: Review of 24 Patients and the Rationale for Revision . The Internet Journal of Minimally Invasive Spinal Technology. 2007. Volume 1 Number 2. Medscape. (2002). Advance in Artificial Disc Technology. Retrieved January 22, 2008 from http://www.medscape.com/viewarticle/445057 Medscape. (2002). Clinical Results of Total Lumbar Disc Replacement With ProDisc II: Three-Year Results for Different Indications. Retrieved January 22, 2008 from http://www.medscape.com/viewarticle/542479 Neurology India. (2005). Prosthetic Lumbar disc replacement for degenerative disc disease. Retrieved January 22, 2008 from http://www.neurologyindia.com/article.asp?issn=0028-3886;year=2005;volume=53;issue=4;spage=499;epage=505;aulast=Kulkarni Neurospine. (no indicated year). Fusion versus Artificial Disc Arthroplasty for Lumbar Degenerative Disc Disease. Retrieved January 22, 2008 from http://www.neurospinewi.com/newsletters/fusionvsartificial.html Patent Storm. (1996). Hydrogel intervertebral disc nucleus with diminished lateral bulging. Retrieved January 22, 2008 from http://www.patentstorm.us/patents/5534028-fulltext.html Smeltzer, S. and Bare, B. (2004). Medical-Surgical Nursing. Philadelphia: Lippincott Williams & Wilkins. Spine-Health. (1997-2007). Lumbar artificial disc surgery for chronic back pain. Retrieved January 22, 2008 from http://www.spine-health.com/research/discupdate/artificial/artificial01.html