Red Pandas Essay Example

Red Pandas Paper RED. PANDAS Hello, boys and girls my name is Kira, and today Ill tell you about one of our greatest discoveries When most people see the word panda, they think of the Big, furry, black-and-white Giant Panda. But the Lesser-known Red Panda, three times smaller, is also in Danger. Today classified as vulnerable, its status could Quickly change to endangered. The red panda is a living fossil. It has no close surviving relatives, and most resembles raccoons and skunks, not giant pandas. The red Pandas live in the eastern Himalayas and southwestern China. They primarily eat bamboo leaves and berries and Blossoms. Red Pandas mostly stay to themselves except During mating time that is during the day time. After about 134 days the red pandas give birth to one-four young. After Birth the red pandas mother cleans her cubs and recognizes Its by smell. Baby red pandas reach adult size about twelve Months. The babies are born in small holes in the trees. If The red pandas den is discovered more than once by a Human the mother eats her cubs. Their claws are partially Retractable. They have an extended bone which is like a thumb. Red pandas live up to twelve fourteen years. Over the winter they lose 15% f body weight. We will write a custom essay sample on Red Pandas specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Red Pandas specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Red Pandas specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Like the giant pandas it has a false thumb. That is an extension of the wrist bone. The red panda is slightly larger than a domestic cat. It has reddish-brown fur, a long, shaggy tail and a waddling due to its shorter legs. The red panda is the only living species of the genus Ailurus and the Family Ailuridae. Its also in the bear families and also not closely related to the giant pandas. The red pandas have excellent camouflage against its habitat of moss- and Lichen- covered trees. The Snow leopards and wild dogs are the predators. The red pandas are most active during the ay. Also the sad part about it that they only 2500 pandas left in the world. They are primarily hunt down the red panda because they use the fur to make hats and Jackets. That led their extinction for over years. FUN FACTS white pandas. They usually like to live alone, then in groups. Also red panda use their tongues to detect smell. Therefore, thats todays lesson before you take a break kids i need to ask everyone a question. What choice will you make when you leave here today? Will you help the Red Pandas, or will you go about your normal routine? By: Kira Checkley

Cancer - Smart Custom Writing Samples

Cancer - Smart Custom Writing Insanity DefenseExecutive summary The insanity plea should be eliminated for assisting criminals get away with murder as well as other serious felonies. Clever defendants have abused the very essence of the plea, thereby securing refuge from criminal punishment. Problems associated with the use of this plea include: difficulties in determining mental illness, differing opinions from psychiatrists concerning the sanity of the same subject, use of money to compromise psychiatrist’s conclusion in favor of the defendant, long time involved in the examination of one subject by psychiatrists thereby resulting to a delayed justice, artificial and crazy behavior by the subject during examination so as to influence the outcome of the examination, lack of scientific as well as an in-depth brain test to diagnose the patient, high cost when a forensic psychologist is involved, and lack of a trustworthy criteria for discharging such subjects from hospital.    Introduction Insanity defense is a strategy applied in law courts by mentally ill defendants to avoid being punished for crimes they committed on the assumption that they were incapable of distinguishing right from wrong at the time the crime was committed. They choose to do this so that instead of being granted jail term, they are given a psychiatric treatment. This concept dates back to the twelfth century although it has undergone some evolution. The original version of the plea didn’t intend to have the defendant found no guilty on the bases of inability to distinguish wrong from right but intended to have the defendant awarded a pardon or a way of mitigating the sentence. Its only in the nineteenth century that the argument of having the defendant acquitted on this basis arose. This paper will discuss the risks that come with the use of the plea and why it should be abolished. This plea has been widely abused by criminals to procure acquittal and that’s why its of interest to m e. Objectives The research seeks to identify the risks involved in the use of the insanity plea in the judicial system. Research methodology To achieve the desired research objectives, both primary and secondary sources of information were made use of. The primary sources included questionnaires given to professionals in the legal fraternity quite conversant with the concept and historians who are well versed with the genesis of the concept. The secondary source of information was basically library research targeting books and articles touching on the subject. Main body Continued use of this plea is the surest way to make the world itself insane and unpredictable. Imagine a suicide bomber who is caught on the verge of detonating the bomb and when taken to court, invokes this plea to procure acquittal (Pasewark 100). One major problem with insanity plea is the difficult involved in determining mental illness. What the proponents of this concept fail to realize is that, there is a big difference between insanity and mental illness (Pasewark 101). As a matter of fact, only some few mental illness constitute insanity. Insanity on the other hand is comprised of not only mental illnesses, but mental deficiencies as well. The two words are actually used in different disciplines of knowledge and it would therefore be wrong to equate them. Insanity is used in the legal arena and is therefore not a medical word. Problems therefore arise as experts try to apply a medical theory to a legal matter (Pasewark 104). Differing opinions from the psychiatric community as far as the sanity of one individual is concerned further subjects the concept to gross abuses (Manchester 112). Furthermore, the world is slowly giving in to corruption as a way of life and therefore the psychiatrists can be compromised to say that the defendant is insane. Money or lack of it can therefore play a very crucial role in the success or failure of an insanity defense. The determination of insanity is the preserve of court psychiatrists (Manchester 115). It’s important to realize that this determination can take dozens of sessions and even fail to come to a solid end as far as the mental condition of the defendant is concerned. This therefore ends up having a serious impact on the trial as well as its outcome. This results to big files of undecided cases and this waters down the credibility of the judicial system (Manchester 116). The determination largely involves behavior study. A defendant equipped with this kn owledge can decide to behave artificially so as to influence the outcome of the examination. This compromises the accuracy of the examination . No body puts the accuracy issue in a better word frame than Thomas Sowell in his book titled Insanity defense published in the year 1994, â€Å" psychiatrists and psychologists are often put in the same position as economists who are asked to predict things that no one is capable of predicting. Those with the honesty and realism to say they can’t do it are likely to be brushed aside†¦Ã¢â‚¬  (Sowell 10). Psychiatrists also have a tendency of identifying with people in their social as well as economic class (Fass 125) . This is the lot they are likely to describe better. If the case is involving a defendant in a different social and economic class as the psychiatrist, then the psychiatrist is very likely to be oblivious of the defendant’s problems. This means that the jury handling the case would base its verdict on a poorly researched conclusion. Sowell, 1984 gives a case that illustrates this behavior of psychiatrists. A forensic psychologist is quoted as saying â€Å" I hate to say this, but I don’t like to work with poor people†¦Ã¢â‚¬ ¦..They are talking about stuff that doesn’t interest me† ( Sowell 325). The fact that psychiatrists are also not required by the court to accompany their conclusion with some scientific backing makes the concept vulnerable to even more abuses. They do not even carry out an in-depth brain test to diagnose the patient. Psychiatrists arrive at their verdict via mere observance of the subject and then deciding based on their beliefs (Fass 126). If the case requires the services of forensic psychologists who are paid professionals, then accessibility problems set in especially if the defendant cannot afford the charges required (Fass 127). The concept is clearly a loophole used by defendants who conspire with rogue psychiatrists to get away with felonies and murder (Bonnie 85). A case in point that clearly illustrates this is the acquittal of the gentleman who attempted to assassinate President Rogan Reagan. This attempt was carried out in the full glare of the public and was captured in cameras. Hinckley earned an acquittal despite the evidence connecting him with the felony (Bonnie 87). This attempt brought up unprecedented public outcry. Psychiatrists involved in the case concluded that he made the attempt in an effort to impress Jodie Foster, an actress he had become obsessed with. The decision of the psychiatrists was based on observance as well as the upbringing of the suspect as opposed to scientific proves which would be more accurate and reliable (Bonnie 88). The fact that somebody for instance , masturbated for several years as an adolescence cannot be used to justify a felony of this degree. After a person is awarded acquittal courtesy of this plea, the law requires that such a person is taken to a mental institution where he/she is supposed to stay until a doctor proves that the person is no longer dangerous and therefore can coexist with others in the society (Manchester 121). A lawyer is also required to accent to this. The procedure of determining this is as untrustworthy and compromised as that of determining the insanity itself. For instance, Sowell, 1994 gives a case of one man by the name Kemper, E . E who earned acquittal after murdering his grant parents. This acquittal was based on the insanity plea. This man was therefore send to an hospital in accordance with the law. He spend about five years in the hospital after which he was dismissed after convincing psychiatrists and the judge that he was now cured and could coexist with others in the society. He did this by giving rational answers to the psychological test he was subjected to. Three years later, he fou nd himself behind bars again for killing eight women one of them being his mother. This casts a lot of doubt on the criteria used to discharge such subjects from hospital. This plea should therefore be abolished in favor of the â€Å" guilty but mentally ill â€Å" concept. In this case, the defendant would first be taken to hospital for psychotherapy and then once he/she is mentally fit, serve the remainder of the sentence in jail (Sowell 20) . Conclusion The paper has discussed the reasons as to why insanity plea should be eliminated from our judicial system. They have included: difficulties in determining mental illness, differing opinions from psychiatrists concerning the sanity of the same subject, use of money to compromise psychiatrist’s conclusion in favor of the defendant, long time involved in the examination of one subject by psychiatrists thereby resulting to a delayed justice, artificial and crazy behavior by the subject during examination so as to influence the outcome of the examination, lack of scientific as well as an in-depth brain test to diagnose the patient, high cost when a forensic psychologist is involved, and lack of a trustworthy criteria for discharging such subjects from hospital.    Works cited    Bonnie, R etal. â€Å"Decision Making in Criminal Defense: An Empirical Study of Insanity Pleas and the Impact of Doubted Client Competence† , Journal of Criminal Law and Criminology, Vol. 87, 1996. Fass, M. â€Å" A forensic Psychology Exercise: Role Playing and the Insanity Defense†, Teaching of Psychology, Vol. 26, 1999. Manchester, J. â€Å"Beyond Accommodation: Reconstructing the Insanity Defense to Provide an Adequate Remedy for Postpartum Psychotic Women†. Journal of Criminal Law and Criminology, Vol. 93, 2003. Pasewark, A. A Review of Research on the Insanity Defense. Annals of the Academy of Political and Social Science. London: Oxford University Press, 1986 pp 100-104 Sowell, T. Insanity defense . London: Oxford University Press, 1994

Phase 1 Discussion Board 12 Assignment Example | Topics and Well Written Essays - 750 words

Phase 1 Discussion Board 12 - Assignment Example not be satisfied by the reasoning provided and therefore for them it is essential to list down the factors, rank them according to priority and then explain the reasoning behind it. Before setting up a plant for carrying out the manufacturing operations it is important for Autoedge to understand the supply and demand of the raw material in that area. Autoedge before setting up a manufacturing plant must analyze the demand of the product in that area and figure out whether or not it will be easily for the firm to procure raw material for making the product. Autoedge before carrying its manufacturing operation must also keep in mind that the product they are manufacturing must not fall short as per the demand of their customers and vice versa. It must also research about the brands of automobile that are preferred in those areas. The company cannot succeed in the long run if it does conducted effective research before establishing its manufacturing plant (World Trade Organization, 2013). As the economies become more integrated as Autoedge offers services throughout the globe, therefore the political and economic risk associated with its locations increases. Autoedge while selecting the location for its manufacturing operations must consider the areas that are more politically stable, or are not impacted by unstable government or as a result of terrorism. The areas that are not politically stable affect not only the businesses in those areas but also the consumers and national economies depending on the nature of the product or service being offered by the firm. The GDP of any country is considered an important factor for the location of a manufacturing plant. The amount and number of products being manufactured in a particular country attracts businesses. Businesses usually prefer setting up their plants in country with high GDP in order to maximize their profits. The country that has a flourishing economy usually serves as a profitable location for almost any

John bull's other island Essay Example | Topics and Well Written Essays - 1000 words

John bull's other island - Essay Example al observer of ‘Irishness’ and his love-hate relationship with the English middle-class are played out by his two principal characters, Broadbent, a middle-class Englishman with a ‘colonial’ mind-set and the expatriate Irishman Doyle, who has no illusions about the Ireland of the early 20th century. A foil for the protagonists is added with the one-time priest Keagan, who is appalled by the impending land re-possessions. Regardless, Shaw has him acknowledge that maybe British efficiency may be better than ‘patriotic fools’. Shaw was somewhat dismayed by his critics failure to understand the character of Keegan, when he said â€Å"I shown the Irish saint shuddering at the humor of the Irish blackguard--only to find †¦ the average critic thought the blackguard very funny and the saint very impractical† (Shorter qtd. in Henderson 619). When the play was first performed, praise was copious - Edward VI was said to have laughed so much, his chair broke – but so was criticism, with Chesterton accusing Shaw of ‘being liable to fits of admiration for the British’, although condemning them elsewhere (Auden in Kronenberger 619) There had been other criticism and in response, Shaw allowed himself to be interviewed by The Tatler, stating that far from being frivolous, he had been deadly serious, showing †¦the Englishman to the Irishman and the Irishman to the Englishman, the Protestant to the Catholic and the Catholic to the Protestant†¦ taken that panacea for all the misery and unrest of Ireland (the Land Purchase Bill) †¦ and †¦ shown at one stroke its idiocy, its shallowness, its cowardice, its utter and foredoomed futility. (Shorter in Henderson 619). The reception of the treatment of the latter was even more mixed, which can only makes sense in the light of British ignorance of the Ireland of the early 20th century, with its large families, ‘progressively pauperized by primogeniture’, and its absentee landlords

Civil Law Rights Case Study Example | Topics and Well Written Essays - 2000 words

Civil Law Rights - Case Study Example if date is not mentioned then it is considered that in 7 working days consumer be liable to make payments for specific advertisement and finished the transaction by the date you have agreed with the person providing the service, or within a logical time if you haven't fixed a specific date This case entitle to 'Consumer Sale law' that center on the legal and self regulatory controls on the advertising of consumer goods and services - the law of consumer advertising that is the major provisions of the Trade Descriptions Act 1968. It also entitles to 'Control of Misleading Advertising Regulations 1988', Part III Consumer Protection Act 1987. Liability of sellers and manufacturers if the products sold are not satisfactory or are unsafe - the implied terms in the Sale of Goods Act 1979 (as amended) and related legislation, the manufacturers liability for defective products - Part I Consumer Protection Act 1987 and the general duty to supply safe products under both domestic and EC law with particular emphasis on the toy industry. Legal liability in respect of consumer services with particular emphasis on the travel industry. ... Legal liability in respect of consumer services with particular emphasis on the travel industry. The Consumer and the Internet - the course will examine the regulation of e-commerce in relation to business to consumer advertising and sale of goods and services on the Internet. http://www.law.cf.ac.uk/course/ug/modules.html According to these laws, all buyers are entitled to remedies under the legislation although consumers are entitled to a better range of remedies. Consumers are defined as people who are buying for rationales not linked to their trade, business or profession. A consumer's rights concerning the sale and supply of goods cannot be reduced in any means by a term in the agreement. Limitations might be probable in business- to-business contracts but any restriction is matter to the necessities of the Unfair Contract Terms Act 1977. Throughout the United Kingdom, nevertheless, a trader and a customer can concur that these rights do not be valid to a particular transaction for the condition of a service or must only be appropriate to a limited extent. Any such exclusion or restraint will however be issue to the provision of the Unfair Contract Terms Act 1977. Now we will discuss Rajeev's case. He requests a black leather jacket and accompanies his form with a cheque for 700 in payment of the price. As he received his jacket, he discovered from a label inside the jacket was made in Vietnam. Whereas, Pavarotti Fashions Ltd mail order catalogue in which it was mentioned that all Exclusive items of the highest quality using only natural fabrics hand-made in the European community. This is the pure case of consumer misleading

Wound care essentials summative assignment

Wound care essentials summative assignment Module Code: Wound Care Essentials Section 1. Search strategy Describe the strategy you used to retrieve the right resources to help you write your assignment. You must include the key words you used, the sources of your literature, the years searched and the type of literature you were looking for. Harvard (2007) stated that a well-structured literature search is an effective way to get reliable evidence on the topic being searched. The intended sources that will be use are healthcare databases, systematic review libraries and specialist organisations. In searching, keywords were created using Boolean logics AND, OR, NOT and phrases with quotations. The following are the list of keywords: Foot ulcer* CINAHL- retrieved 1842 records -COCHRANE lib retrieved 3 records PubMed retrieved- 1770 records diabetic foot ulcer* CINAHL- retrieved 844 records COCHRANE 2 records Cochrane reviews PubMed 46 records diabetes mellitus* CINAHL 54940 records PubMed 32863 records COCHRANE 0 record diabetic neuropathy* CINAHL 1003 records PubMed 802 records COCHRANE 0 IJDDC 76 records assessment tool* AND diabetic foot ulcer* CINAHL 24 results PubMed 2 results COCHRANE 0 International Journal of Diabetes in Developing Countries 0 manage* AND diabetic foot ulcer* CINAHL 216 results PubMed 24 results COCHRANE 0 IJJDC 0 manage* OR intervention* AND diabetic foot ulcer* CINAHL 224573 results PubMed 24 results COCHRANE 1131 results IJJDC 0 prevalence AND diabetic foot ulcer*- CINAHL 64 results PubMed 9 records COCHRANE 0 record IJJDC 11 records treatment* OR intervention* AND diabetic foot ulcer* CINAHL 316806 PubMed 33 records COCHRANE 39911 records IJDDC 5 records cost* AND diabetic foot ulcer* CINAHL 97 records PubMed 4 records COCHRANE 0 evidence base* AND diabetic foot ulcer* CINAHL 73 records PubMed 1 record COCHRANE 0 care guideline* AND diabetic foot ulcer* CINAHL- 3 records COCHRANE 0 PubMed 0 Eligible studies were identified by searching the Cochrane Library (November 8, 2010), Cochrane Wound group (2000 to November 1st week 2010), PubMed (2000 to November 1st week 2010), EBSCO CINAHL plus (2000 to November 2nd week 2010). Furthermore, reliable websites and links were used also such as www.intute.ac.uk, www.boperis.ac.uk, www.dh.gov.uk, www.library.nhs.uk, Wound Care Alliance, World Wide Wounds Electronic Journal, the Tissue Viability Society, and the International Journal of Diabetes in Developing Countries or www.ijddc.com. Peer reviewed and published journals were used which are reliable and reviewed by other authors. There was no restriction on language of publications. All publications were no more than 10 years old. Section 2. Wound aetiology Select a common wound type (e.g. diabetic foot ulceration, pressure ulcer, leg ulcer, fungating wound, dehisced surgical wound), which you have cared for in your role as a qualified nurse. It may help to reflect on a patient you have cared for with this type of wound. Using contemporary literature to support your work, discuss: What your chosen wound type is How this type of wound develops (including contributory factors) How this type of wound is recognised (common characteristics) Who it affects Prevalence in UK and home country Approximate word count: 800 _______________________________________________________________________________ Your answer here: One of the common types of wounds is diabetic foot ulcer. International Working Group on the Diabetic Foot (2010) defined diabetic foot ulcer in their research system as a full-thickness penetration of the dermis of the foot in a person with diabetes. According to Jeffocoate and Harding (2003) diabetic foot ulceration is a common complication of diabetes and it is disabling and frequently leads to leg amputation. It usually occurs as a result of neuropathic, vascular changes of a diabetic foot, foot deformities, plantar callus and smoking (NICE, 2010). Even though the cause of diabetic peripheral neuropathy is uncertain, it is known that the nerve function of a diabetic patient degenerates in response to metabolic changes, pressure and ischaemia (Alexander, Fawcett Runciman, 2000). On the other hand, the presence of high sugar level in the blood such as sorbitol can cause osmotic swelling and subsequent damage to the nerve cell, increase the risk of vascular disease and can also give rise to neuropathy and increase the risk of infection (Falanga, 2005; Watkins, 2000). Pendsey (2010) stated that the neuropathy in diabetic patients is manifested in the motor, autonomic and sensory components of the nervous system. In motor neuropathy, the innervations of the intrinsic foot muscles are damaged that leads to an imbalance between flexion and extension of the diabetic foot. It also affects the muscles required for normal foot movement altering the distribution of forces during walking. This creates anatomic foot deformities that make abnormal bony prominences and pressure points and causing skin reactive callus at the sites of abnormal load. It then gradually causes skin breakdown and ulceration (Pendsey, 2003). In sensory neuropathy, it affects the peripheral sensation, subsequently loss of sensation that makes the patient unable to feel trauma to their lower extremities. Patient will also feel heaviness, insensitivity to heat, cold and pressure. It is estimated that 45-60% of all diabetic ulcerations are due sensory neuropathy (Frykberg, Zgonis, Armstrong et al., 2006). According to Alexander et al (2000) when mechanical forces continue to be applied on the affected area, it leads to inflammation, abscess formation and, eventually, ulceration. This is also the reason many wounds go unnoticed and get worse progressively since the affected area is continuously subjected to repetitive pressure and shear forces from ambulation and weight bearing without noticing it. In autonomic neuropathy the peripheral nerve function is affected, which controls the distribution of blood through arteriolar vessels. One of the signs and symptoms is decreased perspiration in the lower extremities which make the skin becomes dry and increasingly prone to fissures (Alexander et al. 2000). Moreover, poor blood supply to the foot or ischaemia is another significant risk factor for diabetic foot ulceration, which according to Frykberg et al. (2006) it often occurs in combination with loss of sensation and the researchers also said that an estimated 45% of diabetic ulcers are due to ischaemia and neuropathy. Diabetic foot ulcer is commonly found in areas where the abnormal pressure distribution arises from disordered foot architecture. It is usually located on hallux, first metatarsal and fifth metatarsal heads, and under the heel (Grey, Enoch Harding, 2006). The precipitating causes of foot ulceration and infection are friction in ill fitting or new shoes, untreated or self treated callus, foot injuries, burns, corn plaster, nail infections and heel friction in patients confined to bed (Watkins, 2003). According to International Working Group on the Diabetic Foot (IWGDF) diabetes is global epidemic with devastating human, social and economic consequences. The disease claims many lives and places a severe burden on healthcare systems and economies everywhere, with the heaviest burden falling on low and middle income countries such as Philippines. It is estimated that 250 million people worldwide have diabetes, equating roughly 6% of the adult population with the age group 20-79 years. The number is expected to reach about 380 million by 2025, representing 7.1% of the adult population. This is due to the current lifestyles which is lack of exercise and not having a proper diet. A survey conducted by Morgan, Currie, Smithers, Butler and Peters (2000) revealed that foot problems occur in nearly 20% of diabetic patients. Two-thirds of lower extremity amputations are performed in diabetic patients alone, and a majority of these are preceded by a foot ulcer. Nwabudike and Ionescu-Tirgoviste (2008) set out a study to identify the clinical parameters associated with foot ulceration in diabetic patients. The study suggested that older age diabetic patient poses the risk of developing foot ulcer because of decreased ability to self care, including personal daily foot examinations. This is also a result of poor vision and impaired mobility which also predispose patients to trauma. The study also shows that most patients with ulcer were type 2 diabetic patients and this correlates with the age of the patient group. The average duration of diabetes the patients have was of 11.5 years. It is twice more common in males may be due to the active nature of the activities th at men are engaged compared to women, increasing the likelihood they may suffer from trauma. In Nwabudike (2008) research, it also showed that lack of awareness of the disease process and personal care increasing the likelihood that the ulcers may degenerate and leads to gangrene and amputation. Section 3. Wound Assessment Identify features of your chosen wound aetiology (wound type) that are commonly identified during the assessment process. Now select one of these features and critically discuss different ways of assessing this problem. You must link your discussion to the contemporary wound care literature. Here is a list of wound features commonly identified during assessment: Odour Exudate Infection Wound bed tissue e.g. slough, necrotic tissue Your discussion must make clear which aspect of wound assessment you have chosen and include an exploration of the different options available for measuring, describing and documenting it. Approximate word count: 500 Your answer here: Accurate wound assessment is essential for the appropriate and realistic planning of goals and interventions for patients with wounds (Collier, 2003). Diabetic foot wound has two classifications, the neuropathic foot ulcer and neuroischemic foot ulcer. Differentiating between these entities is essential because their complications are different and they require different therapeutic strategies (Pendsey, 2007). Neuropathic wound has no sensation and foot is warm to touch with intact pulses. The ulcerations are usually located on tips of toes and plantar surfaces under metatarsal heads. It also shows oedema, local necrosis and sepsis. On the other hand, ischaemic ulcer is painful upon rest and usually diminished sensation over period of time. Moreover, the foot is not warm to touch and has no pulse. The ulcerations are often located on margins of foot especially on the medial surface of the first metatarsophalangeal joint and over the lateral aspect of the fifth metatarsophalangeal joint. They also develop on the tips of the toes and heels. Signs of sepsis, necrosis or gangrene are also noted. An established clinical tool TIME which is adapted from Watret (2005) is being used for assessing the wound bed. The acronym stands for tissue, infection, moisture balance and advancing or undermining epithelium. Necrotic tissue, slough and eschar are non-viable tissues that can be found on diabetic ulcer that needs to be removed through debridement while the presence of epithelial tissue and granulation tissue in the wound suggests healing. The unhealthy granulation tissue often dark in colour and frequently bleeds on contact are signs of infection. Moisture in the wound bed needs to be assessed too. Moist is known to stimulate healing by promoting granulation and encouraging debridement, nevertheless, moisture balance should be maintained to prevent the wound from becoming too dry and too moist which could delay wound healing. In addition the wound edges and environment will be assessed for migrating epithelial cells which is a good sign of healing or maceration which suggest poor care. Infection is a major factor that affects the time healing of all wounds. Jeffcoate and Harding (2003) said that infection can cause substantial deterioration and delay wound healing. Infection is an invasion and growth of pathogenic microorganisms in the body. Diabetic foot infection is divided in three categories: superficial and local, soft tissue and spreading or cellulitis, and osteomyelitis (Jeffcoate Harding, 2003). The classic signs of infection are: heat, redness, swelling and pain. Other signs such as increase exudates, delayed healing, odour, and abnormal granulating tissue are also suggesting infection (Grey et al, 2006). Cutting et al (2005) and Edmonds (2005) used a checklist for identifying infection in diabetic foot ulcers. In the checklist, there are four areas; under it are the signs and a box opposite to it to check if certain signs are present. Clinical signs of infection: Cellulitis- acute inflammation of tissue lymphangitis phlegmon- purulent exudate pus/abscess crepitus in the joint erythema increase in exudates volume localised pain malodour probes to bone. Systematic signs of infection: Nausea Fatigue Vomiting Fever chills Probe to bone test: bone palpated no bone involvement Wound culture: wound swab required wound biopsy required. Furthermore, the wound infection continuum of Gary, White, Cooper and Kingsleys (2005; 2010) is also use to measure the extinct of infection. It is also a useful adjunct in identification of treatment objectives. The scoring is from 3-0; score of 3 means spreasing infection and 0 is colonised. Moreover, Gray et al (2010) also have the wound exudates continuum; it identifies presence of infection since excessive exudates suggest infections. Section 4. Wound Management Using the same wound feature that you identified in Section 3; critically discuss the different ways there are of managing this problem. Your discussion must include: The different types of wound care dressings, products and treatments that could be used to manage this problem Other appropriate/related aspects of patient care such as nutrition and positioning How the patient experience can be improved Now select one of your identified dressings and answer the questions in the product information table below: Product information table Name of dressing (the company name) AQUACEL Ag Hydrofiber (Convatec, Hull, UK) Category of dressing (the generic name) Hydrofiber Wound Dressing with Ionic Silver Indications for use Use on acute and chorin wounds, including burns, surgical wounds, diabetic foot ulcers, pressure ulcers, and leg ulcers Contra-indications Aquacel Ag Hydrofiber should not be used on individuals who are sensitive to or who have had an allergic reaction to the dressing and its components such as Na Carboymethylcellolose and silver. Its not compatible with oil-based products, such as petrolatum jelly. Sizes available 2x 2, 4x4.7, 6x6, 8x12, 75x18, 39x18 Adhesive or non-adhesive? Non-adhesive dressing Secondary dressing needed required Moisture retentive dressing such as DuoDERM Extra Thin or Versiva Approximate word count: 1000 Your answer here: Management of diabetic foot ulcers are removal of callus, eradication of infection, and reduction of weight bearing forces, often requiring bed rest with the foot raised (Alexander, Fawcett Runciman, 2000). A large proportion of patients with diabetic foot ulceration will develop infection, including osteomyelitis or bone infection and gangrene (OMeara et al, 2006; McIntosh, 2007). An infected diabetic ulcer needs immediate medical attention. Jude (2007) stated that infection is a major factor that delays wound healing of a diabetic ulcer. It may be necessary to undertake surgical debridement and drainage of pus. Then a wound swab will be taken from the floor of the ulcer after the callus has been removed. A culture of the excised tissue may provide more accurate information (Watkins, 2003). This will help identify the infective microorganisms and the appropriate antibiotic therapy to be given (Alexander et al., 2000). According to Watkins (2003) patients with superficial ulcer infection can be treated with oral antibiotics such as amoxicillin, flucloxacillin and metronidazole. Since the most likely organisms to infect superficial ulcer are staphylococci, streptococci, and sometimes anaerobes. For patients with deep infections should be hospitalised and started on broad-sprectrum antibiotics. Surgical debridement should then be carried out, which should include all the devitalised tissues, sloughed tendons, and infected bones. Jude (2007) said that diabetic foot ulcers generally have multiple organisms isolated from within the wound and methicillin-resistant Staphylococcus aureus (MRSA) is an important vancomycin and teicoplanin can be given to patients infected with MRSA. Anyhow, linezolid can be an alternative which can be administered orally. Furthermore, various topical antimicrobials, antiseptics, and antibiotics have been used also in treating infected diabetic foot ulcer. Topical antibiotics like neomycin, bacitracin, neomycin, gentamycin, polymyxin B, mupiricin, fusidic acid, and topical antiseptics are also used in infected foot ulcers. Although antiseptics and antibiotics are widely used, there is insufficient evidence for their use in diabetic foot ulcers (Jude, 2007). Lipsky, Holroyd Zasloff (2008) studies showed that pexiganan cream can be used as an effective alternative to oral antibiotic therapy in treating mildly infected diabetic foot ulcer and might decrease the risk of selecting antimicrobial-resistant bacteria. Dressings also play an important role in managing infected diabetic foot ulcers. There are various dressings available in the market nowadays. The selection of a dressing will depend on the condition of the ulcer. Most infected diabetic foot ulcers produce copious amount of exudates and pus. Dressings are used to control exudates, maintain a moist wound healing environment and eradicated the microorganisms that cause infection. The appropriate dressings for infected wounds with exudates are foam, alginates, hydrofiber, and hydrocolloids that are combined with silver ion. Silver has been shown to have bactericidal properties and has been used in wounds as an antimicrobial for more than century. It acts by impairing the bacterial electron transport system and some of its DNA function. It kills the microbes on contact through multiple mechanism of action, such as inhibiting cellular respiration, denaturing nucleic acids, and altering cellular membrane permeability. Nowadays, Silver ions have been incorporated in hydrofiber, foam, hydrocolloid, and alginate dressings (Bergin Wraight, 2006). Concreet Foam dressings with silver can be used during inflammatory phase following debridement and desloughing. It also kills microorganisms on the wounds. It is very absorbent that can be left undisturbed for 3-4 days. However, it can cause a drying effect on the wound if there are too little exudates. Hydrofiber dressings such as Aquacel Ag absorb the exudates, protecting the edges of the wounds from maceration at the same time kills the bacteria in the wound. Alginate dressings is use as a primary dressing and for packing wound, it is good for deeply ulcerated wound with high exudates. Another dressing is hydrocolloid; it is best use on wounds with granulating and epithelialising wounds that with low to moderate amounts of exudates. The primary dressings therefore should be either foam-based such as Contreet foam (Coloplast;Humlebaek, Denmark) or hydrofiber AQAg (Aquacel Ag; Convatec, Chester,UK), both of which will absorb the exudates. A moisture retentive dressing can be used as a secondary dressing such as DuoDERM Extra Thin or Versiva. One advantage with the hydrofiber dressing is its capacity to hold wound exudates and microorganisms within its fibres where the bacteria are then eradicated by the ionic silver (Jude, 2007). In addition, the used of hydrofiber dressing in exudating wounds has been proven with research. Jude also implied to improved outcomes in infected diabetic foot ulcers and ulcers that are colonised, one should consider silver dressings as an essential adjunct to wound care to improve its wound bed and to facilitate healing. Studies also revealed that patients treated with AQAg primary dressing showed improved healing and more overall ulcer improvement with less deterioration in the ulcer. Once the acute situation has resolved it will be necessary to ensure redistribution of the weight-bearing forces on the vulnerable foot by the use of specially constructed shoes or moulded insoles. Application of a total contact plaster cast, lightweight scotch cast boot, or air cast boots may help healing. These conform to the contours of the foot, thereby reducing shear forces on the plantar surface. Great care must be taken, especially with the fitting of plasters, to prevent chafing and subsequent ulcer formation elsewhere on the foot or ankle (Watkins, 2003). If recurrence of neurophatic ulceration is to be avoided, regular follow-up by a chiropodist will be required. An ongoing podiatry to remove excess callus and provide nail care regular assessment, look for active lesions and treat immediately, detect and manage deformities, callus, skin cracks, and discoloration, simple sensory test, examine pulses such as dorsalis pedis and posterior tibial, assess ankle reflex and assess other sensory modalities (Alexander, Fawcett Runciman, 2000). The patients experience will be improved by having a highly structured care. The patients infected ulcer shows healing improvement and prevent from amputation. Understanding the diabetic foot, the proper examination of the patients feet, investigations to classify the foot ulcers, and proper management techniques using a team approach, along with preventive steps, will go a long way in limb salvage and prevention of foot amputation (Pendsey, 2010). Section 5. Evidence based guidance Identify a contemporary source of evidence based guidance (i.e. a clinical guideline) which could be used as a basis for providing a high standard of care to patients with this type of wound. Critically discuss how the guidance given in this document might influence your nursing practice including whether you believe there are any omissions or recommendations made that would be difficult to manage in your own clinical setting (Phillipines). You must clearly state the full reference of your chosen guideline document and link your work to other healthcare literature where appropriate. Approximate word count: 500 Your answer here:

Teaching Philosophy :: Free Essays Online

Teaching Philosophy My teaching philosophy is that teachers need to relate the concepts that students learn to the world around them. Students attend an educational institution to prepare for future employment and to enter the real world. The basic skills that are needed to survive in society are taught in the classroom like reading and writing, but students must also be taught that the concepts that they are learning in the classroom will prepare them for the rest of their lives. The concepts that a student is learning must affect his or her life directly. To be more specific, students should be able to feel as if the subject matter that he or she is learning is somehow related to them and has an affect on the world that they live in. Students need to be able to relate to their school work to supplement further engagement. The more that a student feels they can relate to a specific subject, the stronger the possibility that the student will continue to be eager to learn the subject. For example, in an English classroom, students should be able to see themselves in an aspect of the literature they are reading. A group of seventh graders may have a hard time relating to a book about someone who is 5 years younger then them, but they may be eager to find similarities between themselves and a character that just happens to be of the same age. Showing your students that you care about their world allows your students to see that you care about them. If a teacher cares enough to relate the subject matter to a situation that may be occurring in his or her student’s lives, then the student will appreciate it. It motivates a student to excel and makes the teacher seem more approachable to the students. For example, the teacher should chose