Midevil Times Essays - Feudalism, Middle Ages, Social History

Midevil Times Highlights of the Medieval Times The Medieval period was a time of many great accomplishments. Even though kings struggled for land power(Holt, 186), and people struggled just to stay alive, it was a time that will always mark a spot in history. Of the Middle Ages there were three main topics; government, manor and town life, and the role of the church. All three of these influenced the medieval Times greatly. The government of the medieval times was based on a system called feudalism. This was a system of government was based on personal loyalties between lords and vassals. This system is different from modern governments, do to the fact that they are usually strong and centralized. The top person of feudalism was the lord. The lord had authority over everybody including the vassals. The vassals were people who owed loyalty to a lord. In feudalism, the status of knights was considered to be the lowest, however, to be a knight in armor was a great honor. Feudalism continued to gain power through out many countries during the medieval times. It lead to the success of many powerful monarchies. Eventually feudalism died out do to new ideas and stronger centralized governments began to take over. During the Middle Ages, all life was surrounded around the manor. The castle that was in the manor was made of stone and had a moat surrounding it. Although people would think that manor life would be great and pleasant, it was not always like that. Food scraps and other garbage was often just left on the floor. Arrows could be shot through the windows because they had no glass for windows. The peasants lived outside of the castle in little villages. Peasant families lived in small hut made of mud or wood with straw roofs (Holt, 195). These hut only had one room, therefore it made life very miserable for many people. A peasants day of life consisted of farming. Not only did they have to farm their land, but also had to farm the lords land also. Life in the medieval Times may seem to be very difficult, which it was, but it has changed our lives for the better. The center of medieval life was all about the church. During this time, the people believed that they could only be saved through the church. Eventually through out the years, other stuff came into their lives, and church was not a important. The people still remained loyal to their religion, but it no longer played as the center of their life. Finally, as the church role began to fade away, the time began to give away into a new age. During the Middle Ages, there were three main aspects, which were the government, the manor and town life, and the role of the church. All three of these things led to many achievements that will always mark a spot in history. Mythology

4 Top Secrets to Professional Success for Millennials

4 Top Secrets to Professional Success for Millennials Like the Baby Boomers before us, the Millennials are fast becoming a major force in the workplace. As we move onto career paths from school and internships, there are new challenges to the status quo. But how do we negotiate those- and more importantly, how do we help define what we want the workforce to be as we move forward? 1. Build Your Brand Like It’s Your Job.More than ever, social media is a factor in hiring. Keeping a close eye on what you put out there on Instagram, Vine, Twitter, etc. is an essential way to manage your professional image. Share content relevant to your field, and monitor who’s reposting and engaging you on that content. And for the goofy/personal stuff? Set up a private account that’s just for you and your social crew, and make sure it’s entirely separate from your â€Å"Janie Smith, Marketer Extraordinaire† profile.2. Think Outside the 9-to-5 Box.One of the defining moments for the Millennial generation of workers was the economy crash of 2008. Younger workers were often lost in the shuffle as jobs were cut all over the place. But that wasn’t necessarily doom- it was a wake-up call that maybe the standard 9-to-5 job isn’t the only way to go. Many people can make their career work as freelancers, part-time workers while pursuing other opportunities, teleworkers, and other nontraditional employees. Being flexible may be the best option for you.Also, don’t hesitate to use non-paid experience as a selling point on your resume. If you picked up stellar office communications during your internship, say so. If you developed rockstar time management skills during your volunteer gig, list it.3. Play the Long Game.Plan ahead. Retirement may be a long time away, but there’s an awful lot that can happen in the meantime. Be smart about financial planning, but also about whether you’ll want to have a family at some point, or start your own business. The earlier you get started f actoring long-term goals in to your plans, the easier it will be to actually set them in motion when the time comes.4. Think About More Than Money.A high-paying job in your chosen field is The Dream†¦ who doesn’t want that? But there may come a time when you need to consider whether other factors are just as important as the salary figure. Flexible work arrangements, vacation time, and the ability to travel may end up being just as golden to you as a slightly higher paycheck.   Definitely take your priorities into consideration during any hiring and negotiation process.As Millennials face a unique moment in their career paths, you should see it as a chance to take hold of the process and find ways to develop it (and yourself) into the professional world you’d like to see.

Manson Family Member Linda Kasabian

Manson Family Member Linda Kasabian Charles Manson made a poor call when he picked Linda Kasabian to join the group of killers who set out to kill everyone inside the homes of actress Sharon Tate and Leno and Rosemary LaBianca. Kasabian was there  but stood in horror as the screams of the victims broke the nights silence. She managed to escape from the Manson family and later turned states evidence during the Tate and LaBianca murder trials. It was her eye-witness testimony that sealed the convictions of those responsible for the brutal murders. The Early Days Linda Kasabian was born on June 21, 1949, in Biddeford, Maine. At age 16, she quit school, left home and headed out west in search for the meaning of life. While on the road, she lived in various hippie communes where she engaged in casual sex and drugs. By the age of 20, she was a two-time divorcee and had given birth to a baby girl. On July 4, 1969, pregnant with her second child, she visited Spahn Ranch and immediately joined Charles Manson and the Manson family. Helter Skelter On August 8, 1969, Kasabian, who had only been with the Manson family for four weeks, was selected by Manson to drive family members Tex Watson, Susan Atkins and Patricia Krenwinkel to 10050 Cielo Drive. The assignment for the night was to murder everyone inside the home. Manson believed that the massacre would kick start an apocalyptic race war that he had predicted and named Helter Skelter. It was the address of actor Sharon Tate and her husband, film director Roman Polanski.   The couple was renting the house and Sharon Tate, who was eight and a half months pregnant, invited Hollywood hairstylist, Jay Sebring,  coffee heiress Abigail Folger, and Polish actor Wojciech Frykowski, to stay as house guests while Polanski was away in London. 10050 Cielo Drive had previously been the home of record producer Terry Melcher, who Manson had tried to get a record contract with, but the deal never materialized. Angry that Melcher was putting him off, Manson when to his home to confront him, but Melcher had moved away and Manson was asked to leave the premises. Angry and rejected, the address became symbolic of all that Manson hated about the establishment. Butchered When the Manson family members arrived at the Tate home, Kasabian watched as the groups first victim, 18-year-old Steven Parent, was shot to death by Tex Watson. Parent had just graduated from high school and was trying to raise money for college. He was hoping to sell his radio to his friend William Garretson, who was the caretaker of the Tate home.  After visiting with Garretson, he  was on his way home and was driving up to the electric gates to leave the Tate home, just as the Manson group arrived. Watson knifed and shot him three times, killing him. Kasabian later  stood watch outside the Tate home and heard screams coming from inside. She watched in shock as some of the victims came running outside the home, soaked in blood and screaming for help, only to be caught and butchered on the front lawn by Tex Watson  and Susan Atkins. Kasabian tried to stop the massacre by telling the group that she heard noises, but her attempts failed and everyone inside the house, including eight-month pregnant Sharon Tate was viciously murdered. After the murders, Kasabian wiped off blood and fingerprints from the weapons used in the murders and dropped them into a ravine. The LaBianca Murders The next night Kasabian was ordered by Manson to go out again and later testified that she was too afraid to tell him no. This time the group included Manson, Watson, Atkins, Krenwinkel. Kasabian, Van Houten and Steve Grogan. The group drove to Leo and Rosemary LaBianca. First Manson and Tex went inside the LaBianca home and tied up the couple. He instructed Watson, Krenwinkel, and Van Houten to go inside and kill the couple. Manson, Kasabian, Atkins and Grogan drove away, and went hunting for another victim.   Manson wanted to find and murder an actor who was also one of Kasabians old boyfriends. She purposely pointed out the wrong apartment and the group, tired of driving around, gave up and returned to the ranch. Kasabian Escapes Spahn Ranch Two days after the LaBianca murders, Kasabian agreeing to run an errand for Manson, used the opportunity to flee from Spahn Ranch. To avoid suspicion she had to leave her daughter Tonya behind. Later  she located her daughter at a foster home where she was placed after the October police raid on Spahn Ranch. Kasabian Turns State Evidence Kasabian went to live with her mother in New Hampshire. A warrant for her arrest was issued on December 2, 1969, for her involvement in the Tate and LaBianca murders. She immediately turned herself over to the authorities and turned states evidence and was given immunity for her testimony. Her testimony was invaluable for the prosecution in the Tate-LaBianca murder trial. Co-defendants Charles Manson, Susan Atkins, Patricia Krenwinkel and Leslie Van Houten were found guilty largely based on Kasabians direct and honest testimony. After the trial, she returned to New Hampshire where she dealt with a lot of public scorn. She eventually changed her name and it has been rumored hat she moved to Washington State. See Also: The Manson Family Photo Album Source:Desert Shadows by Bob MurphyHelter Skelter by Vincent Bugliosi and Curt GentryThe Trial of Charles Manson by Bradley Steffens

Drugs used in ischemic heart disease and congestive heart failure Essay

Drugs used in ischemic heart disease and congestive heart failure - Essay Example Along with beta blockers, ACE inhibitors can also be used since they retard progression of coronary artery disease. These drugs act by inhibiting the activity of the enzyme which decreases the production of angiotensin II. They must be used in caution while using with other drugs because of their potential to increase potassium levels. Statins are used to control hypercholesterolemia. These include atorvastatin, simvastatin, pravastatin, lovastatin and fluvastatin. Their use leads to significant improvement in endothelium-dependent dilation of coronary and peripheral arteries in patients with hyperlipidemia. They also have the advantage of stabilizing atheromatous plaques in coronary arteries and may even contribute to regression of coronary atherosclerosis (Zevitz, 2006). The cornerstone of medical treatment in both patients with symptomatic and those with asymptomatic myocardial ischemia is antianginal medications. The drugs which fall in to this category include beta blockers, calcium channel blockers such as nifedipine, felodipine, and amlodipine, and nitrates. These drugs act by increasing blood supply into the coronary arteries. Long-acting nitrates are effective in the treatment of myocardial ischemia and are frequently used in combination with both beta-blockers and calcium channel antagonists. Short-acting nitroglycerin is the agent of choice in the treatment of acute symptomatic myocardial ischemia (Zevitz, 2006). The antiplatelet drugs which may be used are aspirin, clopidogrel, ticlopidine, or dipyridamole. Of these, aspirin is most effective in reducing risk for MI. These drugs act by decreasing platelet aggregation and inhibiting thrombus formation. They are effective in the arterial circulation, where anticoagulants have little effect. The goal of pharmacotherapy in CCF is to achieve a PCWP of 15-18 mm Hg and a cardiac index >2.2 L/min/m2, while maintaining adequate blood pressure and perfusion to

1111 Essay Example | Topics and Well Written Essays - 750 words

1111 - Essay Example In the study, directed by Susan D. Moeller, a professor of journalism as Maryland University, 200 students were asked to give up their electronic gadget for 24 hours. The students were unwilling to give up their electronic gadgets and they only did so unwillingly because they had to oblige to their teachers’ request. In the study, it was observed that most of the 200 students who took part in the study seemed traumatised by the experience of giving up their digital devices. In response to their experiences for the 24 hours that they remained without their digital gadgets, the students expressed various experiences about how they felt alienated and disconnected from the world or from their friends and relatives. This study showed that media influences people’s decisions in various ways. To begin with, in this study, it was found that the majority of American students are really addicted to media. This is because describing their feelings when they have to abstain from using media requires using the terms that are used to describe other forms of addictions; these terms include withdraw, frantic cravings, anxiety, jittery, crazy, miserable, and extremely antsy ( Maasik and Solomon, 2003 ). For this reason, therefore, media influences the decisions of people in a significant way through making people addicted to it. Once one is addicted to media, his/her decisions in life will be inclined or based on their objects of addiction, i.e. media. That is why we learn in this study the students who participated in this study unanimously expressed the view that they felt isolated from life when they abstained from using their digital gadgets. Secondly, we learn in this study that for the majority of the students who took part in the study, abstaining from using media meant losing their personal connections; for the students, electronic gadgets are their links to the world and abstaining from using digital gadgets, therefore,

Ancient democracy to present democracy Essay Example for Free

Ancient democracy to present democracy Essay The word democracy is derived from two Greek words, demos, which means people, and kratos, which means rule. Today the word has come to mean exactly that, ruled by the people. Many ancient political Greek philosophers would use the phrase the governors are to be governed which we can relate to today. Even though the Greeks notion of democracy is dramatically different from our current democracy, it has been one of the most influential philosophies that have shaped the political thought of the United States. Ironically the term democracy is the most used term to describe the American government even though it has little meaning in our government today. The Athenian government was the first democracy known to the world. Athens had a government where all of the citizens took part in the decision making. Thus, everyone who qualified as a citizen could participate and did not have to be an elected representative. For one to be considered a citizen they first had to be born in Athens and had to be free. Next, once turned eighteen years of age he had to have at least two years of military training then serve in the navy or army. After he has served he could then vote. After the age of thirty he could be considered for council. The women of Athens were also considered to be citizen however they did not posses any political power. The Athenian democracy had three main branches which were the assembly, the council, and the jurymen. The assembly had the reasonability of making the policies for Athens. The assembly could be considered the legislative branch and it was made of eligible Athenian citizens. The council enforced administrative matters and the policies. They were also in control of the military and finances. The council was made of five hundred citizens and could be considered the executive branch. The jury men had the important yet tedious job of resolving disputes of the people. There were six thousand jurymen to manage this job in the courts. The Greeks of Athens had no single head of the government and no political parties. The United States has some similarities with Athenian democracy but very few. There are three branches, the legislative, executive, and the judicial which  are similar to the three branches of Athenss government. The legislative branch is made of the Senate and the House of Representatives. They are in charge of making the laws of the states. The House of Representatives consists of a representative from each state. There is one representative from each district in the state. The district in each state depends on the population of the state. There are four hundred and thirty five members of the House. Each of them only serve for two years and then have to run for re-election. The Senate consists of one hundred members. Each state has two representatives in the Senate. The Senate has three times the amount of service time than the House. The Executive branch is the president and his cabinet. The president gets to appoint his cabinet which consists of several positions, the Secretary of State, Attorney General, National Security Advisor, and more. The judicial branch has nine justices as apposed to six thousand, one that serve as the Chief Justice. Once they are appointed by the president they serve for the rest of their lives. As you can see, the American democracy doesnt quite fit the Greeks definition of democracy. They have appointed officials that can dictate how the people live. The Greek democracy actually consisted of citizens that could participate in political issues without being elected or appointed.

Motherboard: The Soul of the Computer Essay -- Computing

â€Æ' I. Introduction â€Æ' II. Criteria in Choosing a Motherboard A. Form Factor This refers to the physical aspects of a motherboard. It simply categorizes motherboards into its general shape and size. Consequently, it would specify the type of power supply and case it can support. Standard form factors of IBM PC compatible industry, ensures interchangeability across generations of technology likewise with products of competing vendors. On the other hand, in enterprise computing, form factors ensure that server modules fit into existing rack mount systems. B. Chipset The chipset is a set of integrated microchips in the computer’s motherboard which is primarily intended to work with a particular group of microprocessors. It has an important job of determining the system’s performance, controlling the communication between the processor and external devices, handling a huge amount of data and directing data from the AGP bus which results to affecting the machine’s graphics performance. It is composed of two major microchips, the North Bridge which connects the CPU to the main memory and graphics controllers, and the South Bridge which manages the data to other integrated components and slower local buses like PCI (Peripheral Component Interconnect), ISA (Industry Standard Architecture). C. Expansion Slots/Ports Expansion slot is a type of port on the motherboard that allows the user to install additional features on the computer such as graphics performance enhancement and memory expansion. These slots offer computer flexibility and upgradability and permit devices such as network cards, sound cards, video cards, and modems to connect. D. Reputation This is merely a reflection of the company’s social status derived from th... ...ion: http://www.brighthub.com/computing/hardware/articles/69163.aspx. Marks in History: ASUS Motherboards. (n.a.). Retrieved August 07, 2010 from ASUSTeK Computer Inc.: http://www.asus.com/ contentpage.aspx?content_type=aboutasus&content_id=9. DFI. (2010). Retrieved August 07, 2010 from DFI - Wikipedia, the free encyclopedia: http://en.wikipedia.org/wiki/dfi. Computer form factor. (2010). Retrieved August 07, 2010 from Computer form factor - Wikipedia, the free encyclopedia: http://en.wikipedia.org/wiki/computer_form_factor. Kozierok, C. M. (2001). Motherboard Form Factors. Retrieved August 07, 2010 from PCGuide - Ref - Motherboard - Form Factors: http://www.pcguide.com/ref/mbsys/mobo/form.htm. Reputation. (2010). Retrieved August 07, 2010 from Reputation - Wikipedia, the free encyclopedia: http://en.wikipedia.org/wiki/reputation#reputation-based_decisions.

A Materialistic Society Essay

A happy life is more important than anything someone can buy in a store. It’s not a physical thing nor is it materialistic. Society has come to orbit around the quality of things they can buy to impress the neighbors and to show off how much money they have invested. They want the shinier, the bigger house, and the greener lawn. It doesn’t matter how expensive your car is or how big of a house you have. Material possessions are great for only so long, but nothing lasts forever. Society shouldn’t be focusing so much on materialistic things that can always be replaced, when memories are out there to be made. Today, life is being lived too fast. No one slows down to enjoy their life. We should all get off the train once in a while and experience things at our own pace. In today’s society, life is about how successful a person can be, how much money they can earn, and how much nice stuff they have. Society’s prime focus is mainly about materialism instead of the more important things in life such as family. According to New York Times there are statistics stating that â€Å"materialism is bad for you† In Lexington Massachusetts, a psychologist and couples therapist named Aline Zoldbrod says† A husband and wife no longer connect, they are so exhausted from the pursuit of nicer things ( a big house, private school for the kids, fancy cars) that they are time starved and depleted. Life is luxurious yet unsatisfying and simply no fun†. Now, children are starting school around three and four years old. People are even staying in school longer. Now instead of going to get a job, when a student graduates high school, they immediately go to college. After college, they go to work. At this job they will have a 401K and a pension plan. They will work at this job for over twenty years. During these twenty years, they will raise a family and put them through school. The cycle has begun again for another generation. While working this job, people in society are expected to support their family financially. Parents are too busy working to notice their child’s life is passing them by. It is understandable after all, with the cost of living increasing, parents have to work more hours to make ends meet. Everything a family is doing in today’s society is either to save money or to earn more money. For example, every store has some kind of sale going on at any given time to try and get more business so they can make more money. When did society start worrying more about their financial situation rather than the quality of their life? A person can have all the money in the world but that doesn’t mean they lead a happy and fulfilled life. Life shouldn’t be about having the best things possible, but rather having the best times possible. Life has become too rigid and too structured that no one even has time to sit back and relax. It’s important to make time for yourself and for your family because you can’t take back time you can only pass it. Everyone is constantly running and looking for ways to make their life easier and ways to make things faster so they can fit more things into their schedules. A persons life is so busy because of the almighty quest for more money. A happy life is more important than anything someone can buy in a store or online. Its not a physical thing nor is it materialistic. Its life and you only live once so you need to make the best of it, and enjoy the little things. If you just make a little less room for the materialistic things that can be easily replaced, and a little more room for memories that are out there to be made.

Analysis of Rudyard Kipling’s “The Bridegroom” Essay

During the First World War, death was a constant threat. Soldiers faced it every day in the trenches, and more succumbed to it. Rudyard Kipling’s Epitaphs of War represents the impact those deaths had across much of the world. â€Å"The Bridegroom† exposes the last thoughts of a dying soldier through an extended metaphor, personification and tone. First of all, the title and first stanza reveal that the speaker, a young soldier, is either dying or already dead. Traditionally, a bridegroom defines a man on his wedding day. In this poem, Kipling personifies the bride as death and therefore the title refers to a man on his last day. The speaker is a soldier fighting in the trenches, writing or at least speaking out to his wife back home. The first stanza initiates the apologetic and sorrowful tone that is used throughout the poem. The soldier asks his wife not to call him â€Å"false† as he rests in other arms. He apologizes to his beloved for abandoning her for a new mistress, death. The arms not only represent death’s embrace, but they also evoke falling to the weapons of the enemy in battle. The stanza also demonstrates that the couple’s marriage is recent as the speaker mentions his wife’s â€Å"scarce-known breast.† The second stanza clearly brings forward the poem’s theme. The soldier mentions his â€Å"more ancient bride,† death. She is qualified as ancient because she has always existed, not only with him but since the beginning of time. He also describes a cold embrace, the word cold working on several levels here. It refers to the deceased and his rigidity, but it also expresses his reluctance to follow death. By calling her â€Å"constant,† Kipling emphasizes the reality of death on the battlefield; she was faithful and always lurked over the soldier. The third stanza describes how the young man escaped from his â€Å"often set marriage† with death through unexplained miracles. We can suppose that he narrowly survived several life-threatening events, thereby cheating death,  which relates back to his â€Å"cheating† on his living marriage. His â€Å"new† marriage is now perceived as â€Å"consummate,† a term which is usually used for unions made complete through the sexual act. This union, however, refers to the soldier’s falling into death’s embrace, finally touching her after a long apprehension and ultimately lying in her bed, his grave. The term â€Å"consummate† can also represent perfection, which, in this marriage refers to the fact that it was meant to be. The last line reinforces the consummation by saying that the union â€Å"cannot be unmade.† Death cannot be unmade; it is a permanent state as the ideal marriage is, but it also returns to the metaphorical bed which will forever remain unmade. In the last stanza, the tone reaches a lull, yet is still filled with sorrow. The speaker urges his wife to â€Å"live,† to move on and allow life to â€Å"cure† her of the painful memory of him. Kipling uses a metaphor to treat memories as a painful disease that can only be cured by time. The soldier expresses fear of being forgotten with the word â€Å"almost.† He wants to be remembered although he mostly desires for his beloved to regain happiness. The final two lines return to a more somber tone as the soldier states he will have to endure the â€Å"immortality† of memories in death. In the end, we can feel the young man has a greater acceptance of his state as he begins using the pronoun â€Å"us† to qualify himself and death. The marriage, having been consummated, as previously stated, they are now one. Immortality is an evocative word, which fits perfectly into the general theme. The soldier is now immortal, fixed in time with his memories and never able to make new ones. The term also refers back to death, which is immortal in its own way. To conclude, Rudyard Kipling’s â€Å"The Bridegroom’ expresses the difficult process associated with death. The various metaphors and personification bring forward the themes in an apologetic, somber tone. The nameless soldier represents all young men who died young unfairly in the trenches, afraid of being disloyal to their countries.

Medicines management †an introduction to non-medical prescribing 2000 word case study The WritePass Journal

Medicines management – an introduction to non-medical prescribing 2000 word case study 1. INTRODUCTION Medicines management – an introduction to non-medical prescribing 2000 word case study 1. INTRODUCTION1.1 . MEDICINES MANAGEMENT1.2 . NON-MEDICAL PRESCRIBING1.3 . CASE STUDY2. PATIENT OVERVIEW3. DIAGNOSIS3.1 . DIAGNOSTIC TOOL3.2. TREATMENT RECCOMENDATIONS4. MEDICATION  4.1. GALANTAMINE4.2. MIRTAZAPINE4.3. LORAZEPAM5. LEGAL, ETHICAL AND PROFESSIONAL ISSUES5.1. ADHERENCE5.2. MENTAL CAPACITY5.3. ETHICAL CONCERNS6. REFERENCESRelated 1. INTRODUCTION 1.1 . MEDICINES MANAGEMENT Medicines management can be defined as; â€Å"†¦a system of processes and behaviours that determines how medicines are used by the NHS and patients.† (National prescribing centre,2002, P1). According to Dr Michael Dixon chair of the NHS alliance, Medicines management services are the processes for designing, implementing, delivering and monitoring patient-focused care, based on need, and include all aspects of supply and therapeutic use of medicines within healthcare settings. â€Å"Poor medicines management within organisations can lead to low public confidence in health services, unaddressed health needs and unsatisfactory patient outcomes and can lead to unscheduled emergency admissions or failure to maintain independence in the community leading to re-admission to hospital and other acute care settings. It can also lead to organisational issues such as, unmet targets, inappropriate allocation of resources, inefficient services, and risk.† (Calderdale pct, 2004) â€Å"Good medicines management means that patients receive better, safer and more convenient care. It leads to better use of professional time and enables practitioners to focus their skills where they are most appropriate. Effective medicines management also frees up resources which means that NHS money can be used where it is most effective. Good medicines management benefits everyone.† (npc.co.uk/mm/index.htm) 1.2 . NON-MEDICAL PRESCRIBING â€Å"Non-medical prescribing is prescribing by specially trained nurses, optometrists, pharmacists, physiotherapists, podiatrists and radiographers, working within their clinical competence as either independent or supplementary prescribers.† (npc.co.uk/prescribers/resources/NMP_QuickGuide.pdf) The Department of health recognised that non-medical prescribers are a large and growing workforce. They found that by the end of 2009 there were over 14,000 nurse prescribers, 1700 pharmacist and supplementary prescribers and many community nurse prescribers and allied health professional prescribers that had qualified to prescribe within their competence. (DOH, London, 2009). 1.3 . CASE STUDY This piece of work is a case study of a service user from the authors practise placement area at the time of writing. The case study incorporates three key elements within it; The service user Three medications prescribed to them The legal and professional issues surrounding the above The case study will look at these three elements in detail within the report. 2. PATIENT OVERVIEW (In order to uphold confidentiality, during this report the service user in question will be referred to as ‘Mary’. (NMC, Code, 2008) Mary is a seventy three year old lady who was admitted to the inpatient practise placement area on the 02/04/2011. Mary has a diagnosis of Alzheimers Dementia and was presenting with increased confusion and according to her care givers (Mary was a resident in a nursing home) had been showing signs of depression and aggression over the last few months culminating in a series of aggressive outbursts which ended in a serious attack on a member of her care home staff. The decision had been made that a hospital admission to the organic illness assessment ward (Older people’s services) was necessary to manage risk, assess the progression of Mary’s condition and reassess her package of care. Mary was initially resistant to all interventions from the ward team and displayed high levels of agitation and aggression. The consultant and nursing team felt that medication would play an important role in the management of Mary’s initial presentation. However Mary’s resis tance to any therapeutic interventions meant that alternative approaches were felt to be the only option at the start of treatment. John was also given a capacity assessment and found to lack capacity which allowed the ward staff to treat Mary effectively in her best interests. (For Mary’s pen story see appendix 1) 3. DIAGNOSIS Mary has a diagnosis of Alzheimers   Dementia. The Alzheimer’s society explain the term dementia describes a group of symptoms these include a decline in memory, reasoning and communication skills a gradual loss and decline in the skills needed to manage the individuals activities of daily living , confusion and a change in behaviour or personality. These symptoms are caused by the physical impact of disease or injury on the brain. There are a number of different conditions that lead to dementia including Alzheimers disease. (alzheimers.org.uk/site/scripts/documents_info.php?documentID=160) 3.1 . DIAGNOSTIC TOOL â€Å"Making a diagnosis of dementia is often difficult, particularly in the early stages The time it takes to make a diagnosis can vary. If scans and other investigations are required, it could be 4-12 weeks. If the person is in the early stages of dementia, a 6-12 month period of monitoring may be required before a diagnosis can be made.† (alzheimers.org.uk/site/scripts/documents_info.php?documentID=121) â€Å"The Mini Mental State Examination (MMSE) is the most commonly used test when a diagnosis of Dementia is being considered The MMSE is the test that the National Institute for Health and Clinical Excellence (NICE)  recommends for deciding whether a drug treatment for Alzheimers Disease should be prescribed.† (http://guidance.nice.org.uk/DT) However NICE do stress it should not be relied on as the only means of assessment alone as diagnosing dementia involves careful monitoring and assessment. 3.2. TREATMENT RECCOMENDATIONS â€Å"Treatment for Dementia should only be initiated and supervised by a specialist experienced in the management of Dementia.† (BNF, 2009, P280) 4. MEDICATION â€Å"Being prescribed a medicine is arguably the most frequent intervention in the NHS† (Shepherd, 2002). Mary’s medication was reviewed on admission to the inpatient ward due to her aggressive and volatile presentation. For the purpose of this report three of the medications Mary was prescribed will be discussed in detail.   4.1. GALANTAMINE â€Å"Acetylcholinerase inhibiting drugs are used in the treatment of Alzheimers disease, specifically for mild to moderate disease.† (BNF, 2009, P280) Galantamine is a medication used to treat moderate Alzheimers dementia disease. Alzheimers occurs as a result of atrophy of the cerebral cortex. The disease causes changes in central neurotransmitter function especially the cholinergic system. It is linked to a lack of sufficient acetycholine levels. Evidence also points to raised levels of glutamate (a neurotransmitter). Galantamine is one of the centrally acting inhibitor of acetylcholinerase. It is a reversible acetylcholinerase inhibitor medication which works by increasing levels of acetylcholinerase in the synaptic cleft of central nervous system neurons. Galantamine is used to ‘slow’ neuronal degeneration by impeding further atrophy of the cerebal cortex. Evidence for the drug relates to an individual’s cognitive enhancement, however there is no cure for Alzheimers dementia and so medication is purely palliative. (Aarbakke, J et al, 2006) Interactions of Galantamine from a patient safety perspective include:- Warfarin effects are enhanced. Antipsychotics and barbiturates effect is reduced (Johns dose of Zuclopenthixol increased to counteract this) Muscle relaxants effects are modified. Dosage of Galantamine must be carefully considered and the individual’s renal functioning and Creatinine levels must be checked prior to treatment. Side effects of Galantamine include:- Nausea Sleep disturbance Headache Dizziness Drowsiness and fatigue Depression (Treated with Mirtazapine in Mary’s case) (BNF, 2009, P281) Mary was prescribed Galantamine Hydrobromide (Reminyl XL) a prolonged release medication. The Scottish medical consortium state Reminyl XL is recommended for the treatment of moderate Alzheimers dementia and allows a reduction in dose frequency and is as cost effective as immediate release forms of Galantamine. (scottishmedicines.org.uk/files/reminyl_XL_Summary_Advice__FINAL__for_website.pdf) 4.2. MIRTAZAPINE Mirtazapine is a medication used to treat depression. Theories explain the cause of depression as a neurobiological change resulting in too little Noradrenaline and 5HT in some central nervous synapses. Mirtazapine is an Atypical antidepressant. It is a presynaptic alpha2 adrenoreceptor antagonist and increases central noradrenergic and serotonergic neurotransmission which then increases the release of noradrenaline. Mirtazapine has an antihistamine effect with sedative effects and so is beneficial to Mary due to her agitation and restless presentation. Mirtazapine is also suitable for older adults due to its anticholinergic effect. (Aarbakke, J et al, 2006) Interactions of Mirtazapine from a patient safety perspective include:- Alcohol – Sedation increased Warfarin – Enhances anticoagulant effect Anxiolytics and hypnotics – Sedation increased. Mary is also prescribed Lorazepam at present and this is monitored closely when given for over sedation. Withdrawl from Mirtazapine must be staggered due to side effects of withdrawing. (medicinenet.com/mirtazapine/article.htm) Dosage – Mary is on a titrating dose of Mirtazapine and so may be experiencing side effects which she is not used to and may cause her further distress. It was important that Mary be monitored closely and reassured during this time. Side effects of Mirtazapine include:- Increased appetite and weight gain (regular weight assessed and diet chart commenced) Oedema Sedation (Mary is monitored closely for over sedation due to her other medications sedative effects) Dizziness and headache Postural hypotension (Mary’s blood pressure is checked daily) â€Å"Mirtazapine causes few antimuscarinic effects and is therefore recommended over Trycyclic antidepressants† (BNF, 2009, P215). 4.3. LORAZEPAM Lorazepam is an Anxiolytic. Benzodiazepine anxiolytics are indicated for use short-term in anxiety states. However they are also used as an adjunctive therapy at the beginning of anti-depressant treatment to ease the initial worsening of symptoms, as in Mary’s case. Interactions of Lorazepam from a patient safety perspective:- Respiratory Depression- (Mary was monitored and physical obs taken post dose) Sleep apnoea syndrome (Mary was on arms length observation levels anyway) Severe hepatic impairment Myasthenia Gravis Side effects of Lorazepam include:- Drowsiness Lightheadedness Confusion Ataxia Headache Hypotension (Mary’s bp was taken on a daily basis) Confusion and Ataxia may be particularly apparent in elderly and should be closely monitored. (BNF, 2009,P189) 5. LEGAL, ETHICAL AND PROFESSIONAL ISSUES Therapeutic interventions which involve the prescribing and administration of medications have legal, professional and ethical implications. In Mary’s case these included the following issues. 5.1. ADHERENCE One of the problems with medication administration as part of planned care was Mary’s resistance to all interventions from the ward staff. â€Å"People with dementia often have problems taking prescribed medication. They may forget to take it without prompting or supervision, and can lack awareness of their health problems. Some believe they do not need medication as they think there is nothing wrong with them.† (Stapleton, L. 2010) Medication adherence can be improved by applying some simple measures:- Ensure patients know what drugs they are taking, why they are taking them, and when.   Also check that they are aware of any possible side effects, and what to do if they experience them. Check that all patients with dementia are able to take their medication safely by organising dosette systems, and ensure carers can help patients where necessary. Give all patients and their families’ information about how to contact the clinic nurse by providing verbal information and written leaflets. Ensure patients have a written treatment plan. (Stapleton, L. 2010) According to Cheesman (2006), adherence is an approach to achieving the best use of medication involving the sharing of information between healthcare professionals and patients. The prescriber can promote an effective therapeutic relationship by building a patient’s confidence in their ability to self-manage their condition. 5.2. MENTAL CAPACITY â€Å"The Mental Capacity Act 2005 provides a statutory framework to empower and protect people aged 16 and over who lack, or may lack, capacity to make certain decisions for themselves because of illness, a learning disability, or mental health problems. The act was fully implemented in October 2007 and applies in England and Wales. If someone is unable to make a decision for themselves at the material time because of an impairment of the mind, then that person can be said to lack the mental capacity to make that decision.† (Alzheimers society, 2011). According to the law, a person is defined as being unable to make decisions for themselves if they are not able to undertake at least one of the following: understand information given to them retain that information long enough to be able to make a decision weigh up the information available to make a decision communicate their decision by any possible means, including talking, using sign language, or even through simple muscle movements such as blinking an eye or squeezing a hand. (Rethink, 2010) Mary was found to lack capacity as she was unable to retain or weigh up the information given to him to make a decision. Mary lacked any insight into her recent worsening of symptoms, changes in behaviour and aggression. This is often the case with dementia disease. â€Å"The act encompasses five main principles: 1   A presumption of capacity − Every adult has the right to make their own decisions and must be assumed to have capacity to do so unless it is proved otherwise. 2   The right for individuals to be supported to make their own decisions − All reasonable help and support should be provided to make their own decisions. 3   It should not be assumed that someone lacks capacity simply because their decisions might seem unwise or eccentric. 4   If someone lacks capacity, anything done on their behalf must be done in their best interests. 5   If someone lacks capacity, before making a decision on their behalf, all alternatives must be considered and the option chosen should be the least restrictive of their basic rights and freedoms.† (Warren, L. 2010) â€Å"When considering a persons views and wishes it is important that they are given weight, and are carried out, unless the effects would be detrimental to that person.† (National archives, 2010) The multi-disciplinary team worked to all these principles in Mary’s case by:- 1. Presuming capacity by letting Mary make decisions until the capacity assessment had been done and a formal plan of care put in place. Mary was also supported to continue to make decisions on a daily basis which she was deemed to have capacity to make e.g. what to wear that day. 2. Support was provided in the form of an Independent mental health advocate (IMHA). 3. Mary was found to have capacity to make certain decisions even if they seemed strange to the ward staff. Staff supported her in this. 4. Mary had a best interest assessment and the findings were used to formulate a comprehensive care plan for Mary. 5. The MDT sought input from the deprivation of liberty safeguarding team (DOLS) around the intervention decisions with Mary to ensure they were applying the least restrictive care. 5.3. ETHICAL CONCERNS When working with people with dementia ethical practise should be considered as dementia is a long-term illness with no cure. Treatment is purely palliative and the evidence for the benefit versus drawbacks to treatment is not fully understood. (www.mind.org.uk) Foot Anstey solicitors explain that Advance directives and lasting power of attorneys put in place can ensure that the service user receives the treatment and care they want when they are no longer able to voice their requirements themselves. (www.repod.org.uk) Healthcare professionals must make the service user the centre of care decisions in the service user’s best interests to uphold ethical practise. 6. REFERENCES Aarbakke, J et al, (2006) Illustrated Pharmacology for nurses. Hooder Arnold, London. Alzheimers society (2011). Diagnosis and assessment. [Internet] Available from: alzheimers.org.uk/site/scripts/documents_info.php?documentID=260 [Accessed on 5/4/11] British National Formulary (March 2009) Galantamine, pg 281-282, BMJ and RPS, London. British National Formulary (March 2009) Mirtazapine, pg 215-216, BMJ and RPS, London. British National Formulary (March 2009) Lorazepam, pg 188, 190 BMJ and RPS, London. Calderdale pct, (2004) Improving health, improving lives: commissioning strategy for Calderdale. [Internet] Available from: calderdale.nhs.uk/fileadmin/files/Public_Information/Publications/Strategic_Plan_Appendix_1.pdf [Accessed on 6/4/11] Cheesman S (2006) Promoting concordance: the implications for prescribers.Nurse Prescribing; 4: 5 205-208. Dixon, M (2010) Modernising medicines management. A guide to achieving benefits for patients, professionals and the NHS, Executive summary. National prescribing centre, (2001) [Internet] Available from: npc.nhs.uk/developing_systems/intro/resources/library_good_practice_guide_mmmexecutive_summary_2002.pdf [Accessed on 10/4/11] Fittock, A. (2010) Non-medical prescribing by nurses. National prescribing centre [Internet] Available from: npc.co.uk/prescribers/resources/NMP_QuickGuide.pdf  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   [Accessed on 6/4/11] MedicineNet.com, Mirtazapine index. [Internet]   Available from: medicinenet.com/mirtazapine/article.htm [Accessed on 30/1/11] Modernising Medicines Management. A guide to achieving benefits for patients, professionals and the NHS. National Prescribing Centre, (2001). [Internet]   Available from: npci.org.uk/medicines_management/medicines/medicinesintro/library/5mg_intro_to_mm.php [Accessed on 6/4/11] The National Archives (2010) Mental Capacity Act, 2005. [Internet] Available from: legislation.gov.uk/ukpga/2005/9/part/1 [Accessed on 10/4/11] National prescribing centre (NHS) Medicines management [Internet]. Available from: npc.co.uk/mm/index.htm [Accessed on 9/4/11] Non-medical prescribing programme, (2009) DOH, London. [Internet] Available from: dh.gov.uk//TheNon-MedicalPrescribingProgramme/index.htm [Accessed on 5/4/11] Nursing and Midwifery Council. (2008). The code: Standards of conduct, performance and ethics for nurses and midwives. [Internet].   Available from: nmc-uk.org/Nurses-and-midwives/The-code/The-code-in-full/   [Accessed on 10/4/11] Rethink National Advice and Information Service. (2010). Mental Capacity Act 2005. [Internet] Available from: rethink.org/living_with_mental_illness/rights_and_laws/laws_you_need_to_know_about/mental_capacity_act.html [Accessed on 12/4/11] Scottish medicines consortium (2004) NHS Scotland, Treatment for Alzheimers dementia [Internet] Available from: scottishmedicines.org.uk/files/reminyl_XL_Summary_Advice__FINAL__for_website.pdf [Accessed on 13/4/11] Shepherd, M. (2002). Medicines. Nursing Times,   VOL: 98, ISSUE: 15, PAGE NO: 43 [Internet] Available from: nursingtimes.net/nursing-practice-clinical-research/medicines/206461.article [Accessed on 12/4/11] Stapleton, L (22 Nov, 2010) Can nurse prescribing improve medication concordance in people with dementia?. Nursing Times, 106:46 [Internet] Available from: nursingtimes.net/nursing-practice/clinical-specialisms/prescribing/can-nurse-prescribing-improve-medication-concordance-in-people-with-dementia/5022174.article [Accessed on 11/4/11] Warren, L (2010) Mental capacity Act, 2005 Factsheet. [Internet] Available from: alzheimers.org.uk/site/scripts/documents_info.php?documentID=354 [Accessed on 5/4/11]

A Research Study On Evolution And Evolution Essay -- Evolution, Creation

According to The Huffington Post, only 66% of adults in the U.S. believe in evolution and about half of the 66% believe that there was a divine being guiding evolution (Kaleem). A lot more people believe in creationism than expected. In order to know the full significance of this statistic, one must first know what it means. We have learned in school that evolution is thought to be a long-term, ongoing process by which single-celled organisms grew to be complicated organisms through natural selection. Natural selection occurs when organisms with the best traits survive to reproduce more, making those traits more common and effectively changing the species over time ("Natural Selection: Charles†¦Ã¢â‚¬ ). The rest of the 33% of adults in the previous statistic believe that humans have existed in their current form since the beginning (Kaleem). In other words, these remaining people are likely creationists. Generally, a creationist believes that a god or some divine power created the earth and the heavens out of nothing, through its own will. This creator will interact with his or her world as necessary (Ruse). Using this definition, Christians would be considered creationists. Now, when factoring in the amount of Christians in the United States, that 33% makes more sense. Naturally, these two ideas clash. Their very definitions negate the other’s. Evolutionists and creationists have an ongoing battle about which one is more valid due to the extensive amount of accreditation and history the ideas possess. The study and idea of evolution have been going on for a long time and there is a great deal of history behind the theory. An article reports that even before Charles Darwin, scientists and philosophers the possibility of an â€Å"intelligent being† (â€Å"Creationism Should Be†¦Ã¢â‚¬ ) Teaching evolution would also be bad for students, according to Christians. Some blame modern science for diluting the integrity of God and man. Fighting for creationism in schools is a righteous act in their minds and these creationists must do their best to bring Americans back to a God. (â€Å"Neither Creationism nor†¦Ã¢â‚¬ ). There are plenty of reasons why each theory should be taught in school. However, the question still stands of whether or not they should be. From a fair perspective, they should both be taught. However, from a legal standpoint, only evolution should be taught. Perhaps one day the United States will not have to worry about this issue. According to a study, the amount of non-religious youth and adults have been increasing for several generations and this trend will continue (Lipka).