Nitric oxide therapy

There is not much use for the lungs during the fetal life. At such stage, the function of the lungs is carried out by the placenta through the umbilical cord. Fetal life is characterized by a high pulmonary vascular resistance (PVR) with pulmonary blood flow being restricted to a less than 10% lung-directed cardiac output. Blood vessels that connect the heart and the lungs are constricted, sending the circulating blood back to the heart through the ductus arteriosus, a blood vessel that functions only in fetuses. In other words, the lungs in the fetal stage are bypassed.At birth, when the lungs finally assume the function of gas exchange, the PVR decreases, allowing for an increase in pulmonary blood flow. The blood vessel that is previously constricted, favoring blood flow to the ductus arteriosus is now relaxed, simultaneously with the permanent closure of the ductus arteriosus. This happens as the lungs become ventilated and the alveolar oxygen tension is increased.Persistent Pulm onary Hypertansion occurs when at birth, the lung circulation fails to achieve the normal drop in PVR, preventing the transition from fetal to newborn circulation. This failure results in the continuous functioning of the ductus arteriosus which impairs the flow of blood from the heart to the lungs and limits the amount of oxygen that can be picked up by the blood to be delivered to the different parts of the body. The blood that flows back to the heart remains in an unoxygenated state which could lead to the development of refractory hypoxemia, respiratory distress and acidosis.It is only in 1987 when nitric oxide (NO) was recognized as a key endothelial-derived vasodilator molecule. From then, research has been expanded to establish the role of NO throughout the body, and to discover its therapeutic potential.   To appreciate the effects of NO in alleviating pulmonary hypertension, it is important to gain understanding of its chemistry and mechanism of action.Nitric Oxide is a g aseous compound that rapidly diffuses across membranes and has a single unpaired electron. This explains its high reactivity, especially to Hemoglobin (Hb) in the blood. This nature of the compound accounts for its noted biological significance. It has been discovered to function as stimulant in the release of hormones; as neurotransmitter; a significant participant in the magnification of synaptic actions and learning processes; and an inhibitor in platelet aggregation, which makes it a marvel in the field of cardiology.In the field of pulmonology, nitric oxide is valued for its vasodilatory effect in the blood vessels. This effect can be explained by the mechanism involving the compound's diffusion from the vascular endothelial cells to the subjacent smooth muscles of the pulmonary vessels. From here, NO activates the enzyme guanylate cyclase to change conformation to promote smooth muscle relaxation by converting GTP to cGMP.   This vasodilatory effect signals the mechanism to modulate blood flow and vascular tone.Given the mechanism of action, it is easy to surmise how NO can be utilized as a therapeutic agent in the management of blood-vessel-related diseases such as those related to the heart (hypertension), the reproductive system(erectile dysfunction) and in this case, the lungs (Persistent Pulmonary Hypertension in infants (PPHN)).Before NO, treatments used in infant PPHN are hyperventilation, continuous infusion of alkali, tube vasodilation and vasodilator drugs. A study on the effects of these various treatments was done by Ellington, Jr., et. al., (2001) showing no specific therapy clearly associated with the reduction in mortality in infants. In determining whether therapies were equivalent, the study showed that hyperventilation reduced the risk of extracorporeal membrane oxygenation (ECMO) with no oxygen increase at 28 days, while alkali infusion increased the use of ECMO as well as an increase in the use of oxygen at 28 days (Ellington, Jr., et. al., 2001). ECMO is a highly invasive procedure that requires major surgery, performed in serious cases of PPHN when patients fail to respond to treatments.It is only after post-lab studies were able to identify the role of NO-cGMP signaling in the regulation of lung circulation that NO therapy was developed for PPHN (Channick, R., et. al., 1994). Like previous treatment methods, NO therapy improves oxygenation as well as reduces the risk of ECMO in infants with PPHN (Oliveira, et. al., 2000). But because nitric oxide is capable of acting on its own upon inhalation to relax the blood vessels and improve circulation, it is considered as a less invasive procedure in the management of infants with PPHN compared to the previous treatments mentioned in the preceding paragraphs.The efficiency of the treatment procedure can be determined by observing its effect on the patient's ventilation and blood flow, which is a determinant of the efficiency of transpulmonary oxygenation and partia l pressure of oxygen in the systemic arterial blood (Ichinose, et. al., 2004). NO therapy enhances the mechanism by which blood flow is redistributed toward regions in the lungs with better ventilation and higher intra-alveolar partial pressure of oxygen (Ichinose, et. al., 2004).Other treatments used in the management of PPHN such as tube ventilation, alkalosis and intravenous vasodilators were shown to be effective in ameliorating pulmonary hypertension in some infants, but in many instances, it does not, as ECMO almost always becomes a necessity in saving the life of the infants (Ichinose, et. al., 2004). A type of hyperventilation has been proven not to increase the risk of ECMO, but unlike NO-therapy (Ellington, Jr., et. al., 2001), it is invasive as to require a tube inserted inside the infant's trachea.In patients with moderate PPHN, there is an improvement in arterial p a O 2, reduced necessity of ventilator support and low risk of progression to severe PPHN (Sadiq, et. al., 2003) and this, without the risk of increasing the incidence of adverse outcomes when the age of 1 year is reached (Clark, et. al. 2003). Inhaled NO is able to rapidly increase the arterial oxygen tension and increase the blood flow in the lungs without causing systemic hypotension (Roberts, 1992; Kinsella, 1992). No apparent increase in morbidity has been shown after one year of treatment with NO (Aparna and Hoskote, 2008). For high-risk infants with PPHN, inhaled NO has been found to lessen the risk of pulmonary hypertensive crisis (PHTC) after congenital heart surgery (Miller, et. al. 2000).Studies on the role of NO in the management of PPHM show that while it is therapeutic, it also prevents the occurrence of chronic lung disease which affects morbidity. Vascular cell proliferation and pulmonary vascular disease have been shown to decrease with NO in the newborn (Roberts, et. al., 1995). In addition, while NO treatment can be more costly, it is the most cost-effective among oth er methods because of the reduced need for ECMO (Angus, et. al. 2003). For these reasons, it is understandable why NO therapy seems to have taken over in the area of PPHN treatment.ReferencesAngus DC, Clermont G, Watson RS, et al. (2003). Cost-effectiveness of inhaled nitric oxide in the treatment of neonatal respiratory failure in the United States. Pediatrics. 112, 1351–1360.Aparna U., Hoskote, MD., et. al. (2008). Airway function in infants treated with inhaled nitric oxide for persistent pulmonary hypertension. Pediatr Pulmonol. 43, 224-235.Channick R, Hoch R, Newhart J, et al. (1994). Improvement in pulmonary hypertension and hypoxemia during nitric oxide inhalation in a patient with end-stage pulmonary fibrosis. Am J Respir Crit Care Med. 149, 811-814Clark, RH., Huckaby, JL., et. al. (2003). Low-Dose Nitric Oxide Therapy for Persistent Pulmonary Hypertension: 1-Year Follow-up. Journal of Perinatology. 23, 300.Ellington Jr, Marty, O'Reilly, et. al. (2001). Child Health S tatus, Neurodevelopmental Outcome, and Parental Satisfaction in a Randomized, Controlled Trial of Nitric Oxide for Persistent Pulmonary Hypertension of the Newborn. Pediatrics,107.Ichinose F, Roberts JD, et.al. (2004). A Selective Pulmonary Vasodilator: Current Uses and Therapeutic Potential. Circulation. 109, 3106-3111. Kinsella JP, Neish SR, Shaffer E, et al. (1992). Low-dose inhalation nitric oxide in persistent pulmonary hypertension of the newborn. Lancet.   340, 819–820.Miller O, Tang SW, et. al. (2000) Inhaled nitric oxide and prevention of pulmonary hypertension after congenital heart surgery: A randomised double-blind study. The Lancet. 356: 9240, 1464.Oliveira cac, et. al. (2000). Inhaled Nitric oxide in the management of persistent pulmonary hypertension of the newborn: a meta-analysis. Rev. Hosp. Clin. Fac. Med. S., 55 (4): 145-154, 2000Roberts JD Jr, Polaner DM, Lang P, et al. (1992). Inhaled nitric oxide in persistent pulmonary hypertension of the newborn. Lan cet. 340, 818–819.Roberts JD Jr, Roberts CT, Jones RC, et al. (1995). Continuous nitric oxide inhalation reduces pulmonary arterial structural changes, right ventricular hypertrophy, and growth retardation in the hypoxic newborn rat. Circ Res. 76, 215-222.Sadiq HF, Mantych G, et. al. (2003). Inhaled Nitric Oxide in the Treatment of Moderate Persistent Pulmonary Hypertension of the Newborn: A Randomized Controlled, Multicenter Trial. Journal of Perinatology.   23, (2).98

Motivational Theorists Essay

Team work is majorly important when organising, setting up or running a business. If employees and employers can’t organise themselves it causes conflicted between each other and the business might be affected by this. This could be because of disagreements of a topic, for example choosing a name for a product. This could cause tension between employees and put pressure on the manager. Team work is when a group of people come together to either discus or develop ideas. The groups can either be informal or formal. The main differences between these groups are that formal groups are more main stream businesses, for example Microsoft. Whereas team groups that are informal could be based upon close friends that are going on a Duke of Edinburg walk. However, because there are different organisations that have either formal or informal teams, this makes different structures depending on the different organisations involved. Informal groups are formed because the people involved feel the need for either: †¢Social interaction (sport events, birthdays) †¢To discuss different aspects of their business and the management skills †¢To discuss ideas regarding interests such as sports One of the main aims of the informal groups is to improve social needs, this will create motivation for the employees because they will feel more secure at work and they will have better communication skills. Although these informal groups are not set up by the management, they still have motivation as a useful factor. However, the aims of a formal group are different, this is because they seem more sophisticated and organised. This is because they are often organised because the group want to commit to long term and short term goals, therefore they have to be more committed and serious. Some of the groups are formed because the employees are working with similar goals, including: †¢Members feel committed and have a sense of ownership and respect for each other, including their other talents †¢The members almost always have a clear idea of their goals and aims †¢The members are motivated and egger to improve their businesses and their skills The members of the formal groups are not randomly selected, they are assessed because they need to have the same commitment and social skills as the other members in order not to bring the group down and cause it to be less organised. Teams are formed in organisations to help develop ideas that could potentially improve businesses. If teams are made then that means that there are more ideas involved and the business will be open to more options rather than one person putting in their opinions that could be based around the same thing. Teams are also formed to improve the contact and communication skills around the work place; it helps employees feel more comfortable with their surroundings and improves motivation for the staff. Year 13 applied team The year 13 applied class has organised a group in order to keep the organisation under control and more formal. Having this group in applied will help the year 13’s to become closer as a community. It will also improve social skills to a high extent which will gain valuable skills in the future when dealing with clients and customers. It will improve social skills because the students will have first-hand experience on what it is like exchanging ideas with their peers and team leader. It will force the students to get along with each other despite any social issues which prepare them for a future in business, making each student more professional. Having to discuss their opinions will also widen the students mind into exploring the different techniques that different people choose which means they will become more educated rather than keeping with the same technique that a student would use if they were to be working alone. The main aims of the DBS applied are: Usually organisations have similar objectives and aims, this is because profit related organisations want to make a profit and they want to event to be a success. However the aims will adjust to fit the event, for example one of the aims of a team building event might be to improve staff morale, whereas the aim of a product launch may be to raise awareness of a new product and attract new buyers. Every organisation and event will have an aim, either to make profit, be successful or be organised. The main aims of the DBS talent show are: †¢Raise awareness of the applied team †¢Make a profit to give to a local charity †¢To provide an enjoyable event for all participants and audience †¢To improve the school profile amongst the community †¢To ensure a smooth running event It is highly important for the DBS applied 13’s to have appropriate and SMART aims and objectives, this is because they help structure and organise the event making the chances of success greater than if they didn’t have aims and objectives. Benefits and limitations of team work Advantages Working with other students and employees can have benefits as well as limitations. The advantages and disadvantages of teams also need to be considered before deciding to transition to teams. The following table of team advantages and disadvantages is an adaptation of work by Medsker and Campion (1992).* This list can also be used by existing teams to self-evaluate their efficacy. (source /www.hf.faa.gov/) Having teams in a business can enhance the amount of work that is being submitted by the employees, this means that the business will benefit because they will have more work completed by a shorted dead line which saves time and money for new projects. An example of this is giving out leaflets to promote a product. If 10 people distribute the leaflets then it will take up less time than if it were one person giving out the information. Not only do teams benefit business and organisations, it also benefits individuals. This is because it improves communication levels and boosts confidence because the team members are working together and discussing their ideas. These are some team advantages and explanations: Team advantages Explanations Team members have the opportunity to learn from each other. This gives the employees the opportunity to embrace new ideas from different people; it also gives the opportunity to people to express ideas which mean other people can gather different information from difference aspects of the topic which will widen their mind frame. It gives chance to others to communicate with others. This will give the team members confidence in the work place because they will have better communication skills amongst themselves which also means that in the future they will be more likely to be able to get along with others in team work and amongst office hours. New approaches to tasks may be discovered. For any team, this is a benefit because different areas are looked at from the business plan. Because different people are working in the team there are many different ideas and tactics used which means new skills will be learnt and appreciated. Teams membership can provide social facilitation and support for difficult tasks and situations. This means that each team member is supported by their team mates, not only does this give confidence but it allows the plan to almost become bullet proof because if one of the team members are failing at a task there will be others involved to help. Disadvantages Although teams give both businesses and individuals they also have some limitations that come with them. For organisations there might be conflict between the team members therefore some team members might leave the company completely which will cost the business money because they will have to recruit new staff and pay for training and hold meetings about the event/program they are organising. This can also effect the views that team members have of each other, for example the completion rates might become too high (many members want to take leadership or the team) which might cause conflict between friends and colleges. Below is a table of some limitations the team work brings into a working environment: Disadvantages Explanations Some individuals are not compatible with team work.some individuals see team work as demotivating because it doesn’t fit into the way that they work, this might cause confusion amongst these types of people and it might cause them to lag behind and become over loaded with work they have to complete, this could cause the team to slip and cause problems. Some members may experience less motivating jobs as part of a team.There is almost a hierarchy in a team for example, there is the team leader that has the most responsibilities in the team and then the work load becomes less. Some workers are highly motivated by heavy workloads and high responsibility (theory X and Y), if a team member who works like this has little responsibilities then they are likely to become demotivated. However it could become the opposite way and a work member could be pressured by the amount of work they have to complete and they might feel unappreciated and stressed which could cause the team to fall. Teams may be time-consuming due to need for coordination and consensus.This could cause conflict with the team member’s social life because of the workloads that they are being given. It is important for a business to allow their team members to have a good amount of social life in order for them to work to a high standard. If the workloads given are highly time consuming then it might take over time and run into the employees leisure time which will affect the levels of happiness and could cause them to become demotivated and their working levels will drop. Impact of leadership In every business and organisation there are different ways of leaderships. Leadership is the way that the managers and team leaders motivate and control their employees, without them then it workers would not know what to do and the businesses will lose money and staff rapidly because of the lack of motivation and skills their employees have. There are five main management styles in business are organisations, these are made up of: †¢Autocratic †¢Democratic †¢Laissez-faire †¢Proactive †¢Reactive Autocratic Each one of the above are differently structured in order to fit the employee’s needs. They all can be related to the theories of Maslow, Herzberg and McGregor. Autocratic style workers are clear on their tasks that they need to complete, however these workers need a controlling environment to become motivated the workers are not quite focused. The manager of an autocratic worker gives the employees a set of tasks to do and they expect the workers to do exactly what they are told and when they are told to do it. There is hardly no opportunity for the autocratic workers to give their opinions to the manager and there is no discussions about the tasks that they have been given, it is a very controlled environment. Autocratic workers can be related to the theory X and Y (however the autocratic workers are only applied to X not Y) An example of an autocratic management style could be a bakery store, as the business became more popular and the demands became higher, the manager decided to become more forceful with the employees to make sure deadlines were complete on time and there was no money lost. Because it was a small business with such high demands then the manager would decide that there would be no room for discussion on the tasks the manager gave them. There are some limitations of an autocratic ran business, autocrats could lead to little motivation. This is because the employees have no say in the business that they are working on which could make the employees feel like they have little importance in the they are working in and they could feel highly pressured into doing some things that they really disagree on. This gives a sense of poor ownership and commitment to the business. Another limitation could be that, if a business is at a peak season and the demands are higher than usual there will be more pressure put on the employees and the manager might find that it is hard to cut the deadlines back even shorter than usual because there is already so much work that are on strict deadlines. Being an autocratic manager could also affect the business over all, this is because new ideas that employees have would not get across to the manager which means new improvements that could enhance the businesses income will not be acted upon. Having an autocratic based business could give some benefits towards not only the staff but the customer’s and consumers. Some examples of organisations that benefit from an autocratic based business are: †¢The armed forces and the police †¢Medical areas like hospitals and sergeants †¢Fire fighters †¢Managers of internships These are all organisations that are almost always under pressure and have little time to discuss the different options available. For example, where there are health and safety issues going on, surgeons can’t afford to spend their time on consulting other people first, they must act fast. This works out well for them because this means that more lives are saved and the business profile is high and caries a good reputation. Managers of internships often use the autocratic way of managing staff because they are often inexperienced, shy and have little confidence. Having a forceful manager controlling them will allow the workers to because confident at work because they will be able to get on with their work. It will also prepare them for the future work because the manager will let them know what is expected from them in other business. One other thing is that the workers will have less time to communicate because the work levels and demands are high. This means less time for d istractions and more motivation for work. Democratic Democratic management is much more lenient than the autocratic style of management this is because the employees have a chance to get their opinions across. They also have an opinion on how the business is run. However, this doesn’t mean that their opinions will change the company or organisation. There are still similarities between democratic and autocratic leaders because there is still a leader that makes the overall decision despite what the employees say. The democratic leaders often set a date in which they take time to talk to all of the employees who have an input about the business; this could be a positive or negative approach. The reason why the manager carefully set a date for this is because it takes a lot of time and patience to listen and take in all the different opinions of people. It doesn’t just take time to listen and observe to the employees, it also takes careful analysing to decide to take action and change the businesses ways because of the empl oyees’ choice. This is also because the manager has to go through the different levels of the hierarchy, therefore this can become very time consuming. Another disadvantage of having a democratic manager is that there will always be either a winner or a loser in some sense. This is because the employees point either gets across and there are significant changes made in the business for the employees benefit, or the managers chooses not to change anything which leaves the employees feeling ignored and demotivated. This can give the employees low motivation because the employees who wanted a change in the work place would have worked relatively hard and spent time planning and prepping for the meeting and the employees would feel like they wasted their valuable time for no reason. However, having a democratic manager is not all negative, having this type of working area can mean the workers are highly motivated for the fact that they feel valued because the managers take part in what they think about the business, and their opinions. Where as if they are not listened to many of the workers would feel like they are just there to work and have little contribution to the company and have no control over anything. Another positive aspect of democratic workers is that when the managers do listen to them, and there is a change made the workers feel proud and they feel like they have made commitments to the work place. This also means that a good relationship is made between the manager and the employees. The employees have more respect for the manager because they took the time to listen to them; in return the employees are likely to work harder. An example of this is, when new initiatives are considered at recruitment consultancy, Longbridge international, they are discussed and agreed collectively, almost 89% of the staff believes they make a valuable contribution to the company and 88% feel that they have/make a difference. (source: applied business text book) This example supports the fact that the employees are motivated by a democratic leader because they are listened to and respected, rather than a manager that doesn’t let them have any control over the work area or themselves. Laissez-faire Laissez-faire management program is a hand off approach, this means that the employees are free to work as they like and they are not put under pressure by their managers like other motivation and management theories. The managers who work like this will potentially give the employees the materials they need to complete the tasks that have been set for them. Laissez-faire workers have their own goals and are self-motivated. However, these workers must be highly experienced and motivated and who have a need for achievement to work because there is no manager pressuring for work. If an inexperienced worker comes into an atmosphere like this it is highly likely that the company will suffer with poor communication and lack of work on deadlines. This could happen because employees are not used to have a very free environment and they might take advantage of this. This type of management styles is highly popular within more creative businesses, this is because they are allowed to make up d ifferent styles and work by themselves. Some examples of Laissez-faire companies could be: †¢Graphic designer †¢Magazine editor motivational theorists †¢Decorator The work that is more artistic and creative is supposed to reflect of the employee themselves therefore this is why Laissez-faire management style is better because they are allowed this freedom whereas in autocratic and democratic environments they are not which means every ones work will almost be the same. However, the businesses that recruit these types of workers need to carefully think about whom they choose, in interviews they will commonly ask questions relating to their work techniques and they will analyse if the workers can work freely and don’t rely on the managers for advice, help and pressure. By asking these questions they are saving money and time for the business. If they were to recruit a worker that is cauterised as an X theory worker then they will slack off and not complete work on time. An advantage of working like this is that most people don’t like having someone looking over their shoulder constantly, so a laissez-faire management style promotes trust in the workers. The workers also have a feel of importance at work because they aren’t constantly being looked after and they have control of their work life as well as their social and leisure time. Another advantage is that this kind of style is positive only in the case when the employees are very responsible and in case of creative jobs where a person is guided by his own aspirations. In these cases, less direction is required so this style can be good. However there are some limitations to have such a free flowing environment, these can be because an laissez-faire management style makes it easy for workers to do a substandard job or to slack off entirely, and it usually takes a very high-visibility problem to bring such workers to light. This style has more disadvantages because usually it is the result of the lack of interest of the leader that leads to his adopting this style. It proves poor management and makes the employees lose their sense of direction and focus. The disinterest of the management and leadership causes the employees to become less interested in their job and their dissatisfaction increases.

Indigenous Australian Health And Culture Health And Social Care Essay

The ‘Little Children are Sacred ‘ study was released in 2007 following a twelvemonth long enquiry into studies of sexual maltreatment in Aboriginal communities in the Northern Territory. The study made 97 recommendations to better the wellness and well-being of Autochthonal people. The federal and province authoritiess responded within 2 hebdomads with what became known as the Northern Territory Emergency Response ( NTER ) . In a rushed move that lacked lucidity of aims, research and mensurable marks or foresight to sustainability ( Edmund Rice Centre for Justice and Community Education -ERC 2008:1 ) . Autochthonal Culture is diverse and hard to specify as each community is characterised by its ain civilizations, history, political relations and demographics ( Council for Aboriginal Reconciliation ) . The Australian Governments ain reappraisal into the NTER, the NTER reappraisal ( 2008 ) measured it ‘s actions affected 45,500 Aboriginal people in over 500 communities, so it is inevitable a â€Å" one size fits all attack † ( ERC 2008 ) non be a sensible solution to the issues across the Northern Territory. â€Å" There is uncontentious support from the Autochthonal communities for a decrease in intoxicant related force, quality lodging, improved wellness and well-being, instruction and employment † ( NTER reappraisal, 2008 ) , nevertheless there is a sense of unfairness that Aboriginal people feel, being that their civilization is responsible instead than the actions of consecutive authoritiess failure to adequately supply sufficient substructure and resources. The Federal and State Governments acted on the substantiated grounds from the Small Children are Sacred study and there is no denial that action was required. The combined study from the Department of Health and Ageing and Australian Institute of Health and Welfare revealed a figure of wellness concerns ; 40 % of kids had untreated dental cavities, 38 % had perennial thorax infections, and 31 % skin conditions. Alarmingly, sing the high figure of infant deceases in Autochthonal people, 71 % of babies were found to be at hazard of Sudden Infant Death Syndrome due to bed sharing, exposure to tobacco fume and inappropriate bedclothes. Sadly though, due to the deficiency of grounds based wellness betterment schemes introduced during the intercession, long term heals ends are yet to be achieved ( Bacon, Nash, Fowler and Sorenson 2010 ) . The Government offers advancement studies on how they are shuting the spread but a comparing to the Small Children are Sacred study shows that small has really been achieved. Whilst they have appointed Dr Howard Bath as Children ‘s Commissioner ( recommendation 9 ) , the enterprises for kid protection are still either impermanent steps or waiting for funding allotment or legislative alterations. ( Northern Territory Government 2008:7 ) . Likewise, the pressing demand for better lodging and â€Å" critical mass building † ( Wild & A ; Anderson 2007 ) to alleviate overcrowding has amounted to 3 houses for autochthonal households and 19 places for Government employees ( recommendation 84 ) . Clearly this does non run into the demand identified and the $ 647 million allocat ed to remote lodging must be utilised as a affair of urgency ( Northern Territory Government 2008 p.17 ) . Australia is reportable to the International Covenant on economic, societal and cultural rights which states the ‘right of everyone to the enjoyment of the highest come-at-able criterion of physical and mental wellness ‘ ( Couzos and Theile, 2007 ) . Further more, the authorities is to supply ‘sufficient resources to guarantee wellness services are available, accessible, low-cost, acceptable and of good quality ‘ ( p.522 ) . It is unacceptable so that the authorities can non work out a wellness crisis impacting less than 3 % of its population ( Webb, 2010 ) . A Western Australian Inquiry from 2002 proved success from such intercessions comes from â€Å" culturally relevant plans, staffed and managed by their ain communities † ( Gordon, Hallahan & A ; Henry 2002:388 ) and deficient co-involvement reinforces the belief of authorities control over their lives and intensifying exposure and impotence. Legislation passed at the clip allowed for the remotion of the license system to, and compulsorily acquisition of, autochthonal land, enforced English speech production in category suites, removed the Community Development Employment System ( CDES ) , quarantined 50 % of public assistance payments and implemented compulsory wellness cheques for kids ( Creative Spirits 2010 ) . This was achieved without audience with the autochthonal communities and enforced with a ferociousness reminiscent to colonial times, distributing fright and favoritism. In the words of Aboriginal Elder Yingiya Guyula from Darwin, NT, â€Å" We urgently need the white governments, federal every bit good as Northern Territory, to come and speak to us at the community degree † . Possibly if this had been the instance the people involved may hold been more unfastened to communicating and action. The execution of public assistance quarantining causes shame and humiliation to all who are affected and is non a necessary step for most people. In fact, it causes more jobs as people now need to go long distances at a immense fiscal and clip load, to shop at major mercantile establishments alternatively of back uping local shops ( Eatock 2008:12 ) . The embarrassment of utilizing a centrelink rudimentss card reveals the shoppers income position and is evocative of the ration system from the clip of colony, â€Å" taking societal security policy backwards † ( Australian Council of Social Service ) . The issue of favoritism and the wide generalization that the hapless behavior of some are displayed by all is affecting. It is known that intoxicant is a conducive factor to criminal behaviors such as force, assault and disregard, nevertheless since autochthonal people are 12 % less likely to be regular consumers of intoxicant than not autochthonal people ( Gray & A ; Saggers 2002 :115 ) , the job can be more right attributed to the deficiency of resources and funding spent in the country of instruction, bar and rehabilitation. Couzos and Theile suggest that overall wellness coverage costs for autochthonal people are well less that all other Australian citizens, and in fact have a medicare outgo of merely over a 3rd of that for not autochthonal people ( 2007:522 ) . The Government could hold achieved so much more through common coaction. In their ain response in hind sight, it was identified that long term solutions could â€Å" merely be achieved through consistent battle and partnership between community and authorities † ( NTER reexamine 2008 ) . This sentiment was mirrored by Aboriginal and Torres Straight Islands Social Justice Commissioner Mick Gooda who believes community battle is cardinal to guaranting services are â€Å" delivered and developed suitably † and funding be targeted to greatest demands ( Human Rights Commission 2010 ) . Sing autochthonal people have a rate of morbidity of disease, and societal, educational and economic disadvantage at 3 times the rate of their non autochthonal opposite numbers ( Couzos & A ; Theile 2007:523 ) and because of the unjust distribution of primary wellness attention services and marginalization in rural and distant Australia, the biomedical attack to wellness is non culturally competent in these countries ( Langton cited in Gray & A ; Saggers 2002 ) nor does it cover the holistic model now favoured in order to embrace the dimensions of wellness that are experienced in Autochthonal people, that cover the single, households and whole communities ( Besserab 2000:85 ) . The response to the NTER has been widely and aloud voiced by community members, non for net income administrations, Aboriginal rights groups, wellness organic structures and authorities bureaus. The general reaction has been one of choler for the blazing Acts of the Apostless of favoritism and neglect for human rights. The senate standing commission on community personal businesss said the Government was evidently cognizant that the NTER was outside the jurisprudence or it would non hold suspended the Racial Discrimination Act and that as such the unity of citizenship was lost rendering autochthonal people â€Å" no longer equal before the jurisprudence † ( 2010 ) . Further more, Peter Robson claims the statute law that enabled the intercession was a signifier of â€Å" corporate penalty † ( Green Left Weekly 2008:13 ) for autochthonal people. It is apprehensible that feelings of eviction, choler and isolation would be heightened along with a sense of history repetition. The mandatory acquisition of land is a peculiarly sensitive country due to the battle to win back native rubric. Of importance though is the Rudd authorities ‘s agreement to interchange support for wellness, lodging and instruction in exchange for land ( ERC 2008:5 ) . This is evidently non the instance for other Australians and represents unjust trade patterns. Aboriginal Rights Coalitions called for an â€Å" immediate terminal to the prejudiced statute law † ( Robson 2008:13 ) . Amnesty International have reported on the lodgment by Aboriginal communities to the United Nations for pressing action for breach of rights to â€Å" audience, consent and engagement † ( 2009 ) believing Australia is non run intoing its duties under the International Convention on the Elimination of all Forms of Racial Discrimination. It is easy to look back and justice the action of the NTER, and if the administrative officials had merely taken the clip to be after before implementing their actions, better determinations may hold been made. Assessing old intercessions elsewhere is Australia for illustration may hold given them better thoughts on how to outdo do it work. An illustration of a good undertaking is the Looma Healthy Lifestyle undertaking intercession in Queensland ( Clapham, K, O'Dea, K, & A ; Chenhall, R 2007: 275-278 ) . Faced with epidemics of diabetes and bosom disease, clip was spent developing local people from the community to take messages into the schools to advance healthier life style and better nutrition to the younger coevalss, promoting athleticss and diversion, implementing breakfast plans and doing all public countries smoke free. The local store was taken over by autochthonal people, giving more control back to the people and the consequence was healthier nutrients such as fresh fruit and vegetable and better oils for sale. The intercession proved a success through records of lower cholesterin degrees, lower blood force per unit area and less incidence of bosom disease, although diabetes degrees remained unchanged in the short term. Although on a different graduated table to the NTER, this shows how coaction and instruction can accomplish more than hurried aggressive authorities controlled enterprises. There are other illustrations of community enterprises that have brought about alteration and hope across Australia every bit good as reappraisals of old intercessions that have been successful and non successful, and the NTER may hold had a different response if the grounds had been considered and managed before hotfooting in from a top heavy attack. The 1986 Ottawa Charter for Health Promotion ( WHO ) is an illustration of researched, proved grounds that societal attacks to intervention through community development, capacity edifice and authorization are a more humane and sustainable system for alteration. The inquiry of support is a ambitious issue. The first twelvemonth cost about $ 88 million ( ERC 2008:3 ) and what this money really achieved is problematic. In that first 12 months the incidence of substance maltreatment and baccy and debris nutrient ingestion increased and school attending remained inactive ( NTER Review 2008 ) . On top of this, no grounds of paedophile rings were found in the Northern Territory, and less than 1 % of kids examined were referred to child protective services. 40 % of the kids carried treatable diseases, all of which are normally associated with poorness ( Robson 2008:13 ) . One would believe that the graduated table of morbidities found during compulsory wellness cheques for auditory, dental and parasitic diseases for illustration would justify the pressing and unrestricted arrangement of primary wellness services such as child wellness nurses in all communities. Further more, if such services had been in topographic point antecedently the degree of disregard would non hold reached such critical degrees. Surely the fiscal cost of supplying wellness and societal services on a long term footing would hold outweighed the billion dollar disbursals that achieved little over an intense period. The Federal Governments ‘Stronger Families Fund ‘ in Western Australia was a committedness of $ 20 million over a 4 twelvemonth period and created a Centre for kids to travel for nutrient, instruction, diversion and wellness demands, and it was supported by the autochthonal community who were empowered and strengthened by the mending relationships procedure ( Gordon, Hallahan & A ; Henry 2002:402-403 ) . The Edmund Rice Centre ‘s ‘Grass roots ‘ plan trialled in Goodooga in NSW really required no support. The purpose was to convey the community together, increase instruction results for kids and base on balls on civilization and was based on conveying parents and grandparents into the schoolrooms to go through on their cognition and experience and giving control to the community ( ERC 2008:6 ) . The $ 800 million committed to community safety, reconstructing communities and undertaking kid maltreatment as promised by the Rudd Government in 2009 is now bei ng watched closely and critically ( FaHCSIA 2009 ) . Another scheme to come out of the ‘Little Children are Sacred ‘ study and has gained Autochthonal support and blessing from many in the legal sphere is offender rehabilitation ( Recommendations 36-40 & A ; 72 ) . In a move to recognize Aboriginal traditional jurisprudence, maintain households together and supply and ‘effective option to condemnable justness ‘ ( Gordon, Hallahan & A ; Henry 2002:394 ) , it has been recommended the authorities expression into condemning that â€Å" incorporates Aboriginal impressions of justness and rely less on tutelary sentencing † ( Wild & A ; Anderson 2007:25 ) . This would return culturally relevant intercessions and advance a regard the community. Family duties have strong bonds and since there is a loss of assurance in white adult males policy, better results may be resolved by seting the burden back to the autochthonal groups and make a mutual regard. Aboriginal Magistrate Pat O'Shane believes if wrongdoers partic ipate in plans to â€Å" construct self regard and mend their lives and relationships † ( Gordon, Hallahan & A ; Henry 2002:394 ) , happier healthier communities will eventuate. To the job now of sustainability: It can be seen that short term holes that lack the proper support and evidenced based pattern and neglect to turn to the â€Å" implicit in societal determiners † ( Clapham, K, O'Dea, K, & A ; Chenhall, R 2007:273 ) so length of service is hard to accomplish. Sustainability has been likened to ‘routinisation ‘ ( Clapham, K, O'Dea, K, & A ; Chenhall, R 2007:273 ) , and in that regard no profound outcomes can be expected in the immediate hereafter, nevertheless the alterations can get down to be made now and the rippling will hopefully be positive. Of class support, engagement, employment, intersectoral relationships and services may non stretch between election rhythms and it is up to each authorities to perpetrate to seeing these issues through until equality is achieved for all Australians. The NTER reappraisal recognises that â€Å" you can non drive alteration into a community on the dorsum of a truck † ( 2008:58 ) . The hope of class is that no irreparable harm has occurred since 2007 that may hold set rapprochement back for a farther 200 old ages. This fright was spoken by an Aboriginal senior from the Djirrikaymirr people, Dr Djuniyini Gondarra, who said â€Å" the intercession has failed to better wellness and had in fact, intensified depression and loss of hope among Aboriginal people. † It is tragic to believe we may be responsible for farther eviction and wellness diminution on an already delicate population when our occupation was to assist and foster them to get the better of the events of the yesteryear.

Philosophical Approach For Balancing Issues Term Paper

Philosophical Approach For Balancing Issues - Term Paper Example This essay seeks to answer the question: are there are ways of harmonizing the individual rights whereas defending the public at the same time. As a point of departure, majority argues on when individual rights have been violated, and on similarly complains are raised when protection of the public is contravened. The situation surrounding individual rights and its interconnectedness with the public fabric is a give and take. This implies that, people need to understand that, they will have to sacrifice some degree of privacy for the good of all the members of the society. Majority of people talk of rights without considering the wider perspective of the meaning of rights (Bjarnason & Carter, 2009). This kind of understanding has changed the society to a catered one, where people tend to think and believe that everything should be given to them and this contrasts, the fundamental aspect of seeking to balance the individual rights with the public interests. Numerous philosophers have a rgued the need for people to appreciate the fact that, the society is made of people who get affected by erroneous decisions made, without the consideration of balancing the individual desires, rights and the public interests. This study establishes that the declaration of independence was founded on three fundamental rights: right to life, rights to pursuit of happiness and right to liberty. It is explicitly understood that, the right to life defends the individual’s ability to handle all actions obligatory for the preservation and gratification of life (Bjarnason & Carter, 2009). On the other hand, the right to pursuit to happiness safeguards an individual’s capacity to live for own sake quite than for the societal sake. Equally, the right to liberty defends an individual’s capacity to reflect and act on his own decision. The question that emerges is â€Å"what if individual’s pursuit of these rights violates other people’s rights?† It is the government’s philosophy to safeguard the well-being of its entire populace. For the attainment of balance, a perfect situation may not be a favorable milieu (Snyder, Lopez & Pedrotti, 2011). The truth of the matter is that, individuals will be forced to give up on some rights to provide for a give and take milieu, which is favorable in balancing the societal and individual desires. It should be noted that, a balance should be compromised in order to create and sustain a peaceful coexistence in the society. A comparison of today’s world complexity and that of the declaration of independence makes it somehow difficult to create a fair environment, where societal needs do not conflict those of individuals. For instance, the issues of terrorism have advanced to become a global concern (Snyder, Lopez & Pedrotti, 2011). Terrorism has become a global threat to security. This starts at the individual point, spreads to a group of individuals, and finally to the society. Suc h complex issues affecting the security of all members soothe local and global society compels individuals to forego some critical privileges attributed to individuals’ rights to the governing authority to seek for equilibrium between the individual happiness and insecure society or a secure society and miserable individual lives. In some circumstances, governing authorities may be obligated to monitor phone calls and text messages such that, they can be able to trace terrorists. Despite infringing individual privacy rights, there should be no problem, because the overall intent of such kind of measures is to ensure a safe society for all. It should be understood that, such steps are undertaken as last resort in curbing such crimes. This is an example of equilibrium that should

Trade mark and Copy right Essay Example | Topics and Well Written Essays - 1000 words

Trade mark and Copy right - Essay Example Trade marks are registrable at state level and federal level in the U.S. Whenever any one wants to claim some thing as a trademark, he can use the words" TM" next to the trade mark to serve public or competitor as notice of his right over the same whether registered or not. Unregistered trademark is called common law trade mark giving right to the user who is manufacturer or seller by virtue of its use. If it is registered with the U.S. patent and Trademark Office, the symbol can be used beside the trademark and not while the application for trade mark reiteration is pending. Benefits of registering with federal agency are 1) it serves as a constructive notice throughout the country, 2) evidence that it is owned by the user, 3) invocation of federal courts jurisdictions, 4) it can be used for registration in foreign countries, and 5) if registration is field with U.S.customs which will be used for preventing entry of foreign goods infringing trademarks. (FindLaw) The legal basis of Tempur-Basic is that ComfortStep used by Real Man Boot Company is similar to their brand name 'Comfort-step' in their goods. Though it is not registered, they are alleged to be the first ever users of the said name. However close scrutiny of the names reveals that they are not similar. There is a hyphen between the word comfort and step in the claimant's trade mark where as there is no hyphen in the defendant's trade mark. More over goods are also not the same. Whereas the claimant is using it on casual wears, defendants are using it on work boots though both are foot wears. Position would be different had the claimant registered the trade mark stating that they are using in all their goods including boots. The right over the trade mark registered or not is perpetual. Hence claimant can not succeed in their claim. Question 2 A Describe the general duties of a director of a corporation, and the standards that a director is expected to meet in fulfilling those duties. Also describe what factors or interests you can consider in making decisions as a director. Originally, a director was expected to act only in the interest of share holders of the corporation. But of late, it is the acting in the best interest of the corporation that has to be taken into account before considering interest of the share holders. By virtue of section 302 A.251, subd 5, other stake holders' interests have also to be kept in mind by the director. The other stake holders are corporation's bankers, creditors, Government bodies, employees, and environment. The director should be loyal to the corporation by not competing with the corporation's business. Any thing that the director is accessible to in the affairs of the corporation should not be used by the director for self-serving personal enrichment. He is expected neither to use for personal gain nor disclose matters that are confidential to outsiders and rivals. The director must notify any conflicting interest he may be involved on which the company board must decide for the director to continue with or drop i t before taking director ship or before assuming any new role during his directorship. The director has the power to appoint or dismiss the CEO of the corporation and also decide his salaries. The director is responsible to declare dividends, work out strategies, and can restructure corporation's capital structure including class of share

Islamic Banking as a banking system that follows the ways of Islam Essay

Islamic Banking as a banking system that follows the ways of Islam - Essay Example As such, financial products are also designed according to such principles. Accumulating wealth is not against the law, but making money through unfair or fast means is not supported. Although Islamic banking is conservative in many ways, it is also safe. In Islamic banking, all transactions must be interest-free. There are several sets of rules for transactions, leasing, joint ventures, and partnerships. These laws are formulated with the Islamic religious sayings of the Quran and religious scholars in mind. In Islamic Banking, an Ijarah denotes the activity of leasing a property, is conducted by the bank. The bank takes possession of the property from its owner and leases it to a third party for rent; no interest is charged, as per the stated norms of Islamic banking. Even the maintenance cost is borne by the bank. The Islamic regulation is against making money through unfair means. For example, if the lessee pays a fine for late payment, the money goes to charity, not to the bank. Transactions in Islamic banking are considered Salam if the buyer pays the full amount to the seller. It is important that the buyer demonstrate that he is not in debt. Islamic banking offer many products that must be passed by the Shariah Supervisory Board. This board regulates and coordinates the operational activities of banking institutions functioning under Islamic banking rules (Hassan & Lewis, 2006, p. 1-4). Ijarah The term Ijarah refers to a lease, wage, or rent. It denotes the opportunity to use an asset or service at a predetermined price or wage. Under this type of contact, the bank makes the asset available to the customers by lending them for a fixed time period and at a fixed price or rent. Ijarah is derived from the word Al Ajr, which means compensation, substitutes, or counter value. It involves transferring the usufruct but not the ownership, of the asset. In Islamic banking, the bank and the customers are involved in the lending contract. The bank transfers the us ufruct to another person for a predefined period of time and consideration. Under Ijarah, the asset to be lent should be non-perishable and non-consumable. Any assets that do not follow the criteria cannot be treated as subjects for lending. Ijarah is used in two different kinds of situations: first, for providing services to other people in exchange for wages, and second, as hired services, where the employer is called 'musta jir' and the employee is called 'ajir'. The second situation deals with the lending of assets by banks to the third party in return for fixed rental charges from the party. Both types of Ijarah are formulated according to the laws of Islam. Ijarah is not only a mode of financing but also a medium for sales. This form of transaction is also followed in other, non-Islamic western countries (Ahmed, I. & Shabbir, n. d., p. 26). Ijarah wa Iktina In this type of lease, the leasor enters into an agreement with the lessee and agrees to buy the property after the compl etion of the leased period. The contract can be terminated even before the due date for the completion of the lease. The lessee can also buy the property before the date of commencement. The purchase price is determined by the market value of the asset. Ijarah Thumma Al-Bai This combines both the contracts that are Ijarah, meaning leasing and Bai, which means the purchase of the asset. Ij

Diet and Nutrition Essay Example | Topics and Well Written Essays - 1500 words

Diet and Nutrition - Essay Example This essay focuses on the role of health policies in Australia and how they are going about working towards achieving a healthier way of life for the community and what measures have been taken with regard to this particular health issue. What are the changes brought about in the general attitudes of the people Is the impact positive, negative or neutral What more can be done to make the system more efficient and universal These are a few questions this essay attempts to answer. The faced pace of life coupled with a sedentary lifestyle has brought along with it a myriad of diseases and health problems which were unknown to humankind a till a century ago. On one hand medical science has emerged victorious in fighting the battle against plague, small pox and to an extent polio as well but on the other hand humankind today has become more susceptible to diseases like diabetes, hypertension, obesity strokes, cancers and AIDS. The prevalence of these ailments is more in developed nations, which is a major cause of concern as they greatly affect a nations health care budget. It is of common knowledge that most of these diseases stem from poor dietary habits, lack of physical exercise although they are confounded by various other hereditary and psycho- social factors. Since it is a very vast area, the intensity and impact of is difficult to assess and control. It thus continues to eat into our society like an invisible malignancy. The National Aboriginal Community Controlled Health Organization states that: 'health is not just the physical well-being of an individual, but the social, emotional, and cultural well-being of the whole community in which each individual is able to achieve their full potential as a human being thereby bringing about the total well-being of their community'1 Keeping this statement in mind we shall discuss the negative impact and repercussions of improper diet and nutrition, which is currently a national health priority with the Australian Health Care System. Today's "yuppie lifestyle" has bred the demand of "instant and readymade". People do not have the time to assess their nutritional requirements and the exhaustive timings in the corporate world leave them with no energy for physical exercise. There is no fixed pattern for meals, meals are skipped many a times and whatever food is available is consumed without second thoughts. The easiest solution in this solution seems to be fast food or processed food, which is available off the racks. This results in excessive consumption of salt, trans- fats and sugars, which are all anti - health agents. Health status of an individual primarily depends upon the quantity and quality of the food consumed-the right type and amount of food is important in meeting the nutritional needs of the body and fighting chronic

Computer Virus Charges Sought Assignment Example | Topics and Well Written Essays - 250 words

Computer Virus Charges Sought - Assignment Example 3. The I Love You Virus, as one of the first major viruses since the internet exploded in the late 90s and early 2000s shook people’s faith in the internet as a secure place. It also taught users that they had to be very careful of attacks that take advantage of their emotional states (by encouraging them to click/download something in order to cause a virus on their computer), such as the â€Å"I love you† message or other questionable content.   4. Guzman did not face any direct punishment for his crimes. Though Pilipino authorities tried to charge with a variety of crimes from theft to criminal mischief, none of the charges landed because of lack of evidence and the fact that the Pilipino criminal justice system was simply not set up to deal with cyber attacks. His name, however, will forever be associated with this virus and he will have a hard time finding employment in the future (Landler). I think that this punishment might fit the crime – it’s impossible for someone to make reparations for billions of dollars worth of damages, and people need to take some responsibility for their own internet behavior. If Guzman didn’t do this, someone else would have.   

Film Essay Example | Topics and Well Written Essays - 250 words - 2

Film - Essay Example There are very rare politically charged films that are found today and the reason for that is because according to ‘USA today’ analysis, 26 movies that were released in the past 20 years and which had politically charged theme only four films did a business of over $100 million and nearly two-thirds did a business less than $50 million. But apart from these statistics, directors apart from Michael Moore are still trying for politically charged movies such as ‘Lions for lambs’, a Robert Redford’s movie which highlights the US involvement in Iraq and Afghanistan. Other example includes the movie of Jolie’s Bosnian, ‘In the land of blood and honey’ (DeBarros and Bowles). The genre of films that are politically charged other than the documentaries include a suspense drama ‘Betrayed’ and ‘The zookeeper’. The musical film includes ‘School daze’ and the epic include ‘Syriana’ which have a politically-charged themes. Recently there had been a fiction film on a politically charged theme, ‘Route Irish’ and ‘the day the Earth stood still’. These films cover the social issues as well as political issues (DeBarros and Bowles). The cultural and societal change has made a differentiation in the present world and the spirit of sixties. Recent films on politically charged theme prove that directors are still trying to come up with the films of every genre to highlight the political issues. DeBarros, A and S Bowles. "Movie fans vote no on politically-charged films." 11 July 2007. http://www.usatoday.com. 20 March 2012

Multinational businesses Essay Example | Topics and Well Written Essays - 2500 words

Multinational businesses - Essay Example (Veseth, 2010) This paper examines the phenomenon of globalization and analyzes the effect of the phenomenon by taking the example of a company (Coca-Cola). The paper is divided into sections on globalization and what it means as well as detailing the pros and cons of the process. Further, the issue of globalization in terms of whether it is consistent with economic theory is also examined. The other section is the case study of a company that has long been regarded as one of the prime beneficiaries of globalization and this section looks at the way in which globalization has benefited the company and the impact of the current recession on the prospects of the company. Globalization and the forces driving it There are many definitions of globalization depending on the way in which the phenomenon is viewed. For the purposes of this paper, it would suffice to state that globalization means the integration of markets across the world and the movement of people, goods and services across national boundaries. The phenomenon of globalization is closely tied with that of free trade and the theory of comparative advantage as proposed by one of the founding fathers of modern economics, David Ricardo. Whether the current practice of globalization is consistent with the economic theory would be examined in detail in the later paragraphs. (Bhagwati, 2004) If we examine the question as to what is globalization, we find that the term encompasses a broad range of activities that range from a) multinational companies seeking to setup operations in countries like China and India to take advantage of the lower costs of labour and the exchange rate differential that promotes exports from these countries to the Western world b) the free movement of people and ideas across countries in search of the best markets for their services because of the deregulation of the economies of the West as well as the East. (Friedman, 2005) The case for globalization seems pretty straightforward. I f a company enjoys substantial cost advantages in production because of wage and exchange rate differentials, then economic theory states that the company is better off producing in a country where the costs are low and selling in a country where the margins on its products are more. Hence, this simple notion of free trade theory underpins much of the discussion on globalization. Further, economists like Jagdish Bhagwati have shown that the countries like the United States gain in terms of having cheaper goods as well as outsourcing of jobs. The gains are in the nature of capital saved by relocating production and outsourcing functions that can be gainfully employed in the home countries for more productive purposes. The argument here is that the US gains in terms of moving up the value chain and investing in Research and Development while the activities at the bottom of the value chain like manufacturing can be done at lower costs. (Bhagwati, 2004) The case against globalization is that the process involves the movement of capital to the countries where costs are low and hence these countries build up huge reserves of foreign exchanges that lead to global imbalances in the way in which current account deficits in the US are

Comparing and contrasting between two poems Essay Example for Free

Comparing and contrasting between two poems Essay In this essay I am going to look at the differences and similarities between two cultural poems. I will look at the language used by the poets to describe the different cultures and I will also look at the imagery used to portray the cultures in the poems. The two poems I will be looking at is Island man by Grace Nichols and Blessing by Imtiaz Dharker The poem Island Man is about a Caribbean Island man who lives in London and still wakes up to the sound of the sea and the poem Blessing is about a third world country who have hardly any water and cant wait for the water pipe to burst so that they can have some more water for a while. Island Man is broken up into four stanzas with one line at the end on its own. The first stanza is where he is waking up after dreaming about the island and he is slowly coming back from his dream. In this stanza they have used a metaphor wombing, which is actually a made up word, however, this word makes you think that he could have possibly grown up here as the word gives the impression that he feels a sense of safety towards the island and so he could have grown up there. It also uses sibilance with the words Surf, steady and wakes. This creates a calm and gentle mood for the island where Island Man possibly grew up. The second Stanza is also about him waking up from his dream and coming back from the island in his head and also expands on the image created in the first stanza. The first line Wild seabirds gives you the feeling that on this island you are free and you can relax and have fun without being stressed out all the time. There is an adverb defiantly used on the third line to describe the sun Sun surfacing defiantly this is a lexical field, creating the image of independence or refusing to be organized. Also the word emerald has been used to describe the island, this suggests that the island is precious to him and that it has many vivid colours whish are really special to him. Then the last line of the second stanza is stood out from the rest of the poem groggily groggily is used to describe the him coming back from the island to the stress of everyday life, and it emphasises the way that he doesnt want to come back. The third and fourth stanzas are about him waking up from his dream about the island and realises that he is in London and not where he wants to be. Grey metallic soar and Dull, north circular roar are used to describe London as really dull and having a lack of colour, whereas the island appeared to be very colourful, for example Blue surf and sun surfacing defiantly and emerald island. Also in the third stanza the third line stands out from the rest of the poem Surge of wheels, this is describing the sharp sound of London compared to the soft and relaxing sounds of the island. In the fourth stanza, the first and second lines link back to the island muffling, muffling deadens the sharp sounds from earlier in the poem and his crumpled pillow waves, links to the sounds of the island, him thinking his pillow is the waves of the island. And finally the last line in the fourth stanza island man heaves himself which is followed by the last line Another London day, Contrasts with wakes up and shows how much he really is longing to be on that island instead of in London and how he has to pull himself away from his island and begin another London day. The poem Blessing starts with a similie which really emphasises the meaning of the poem the skin cracks like a pod. There is never enough water, onomatopoeia is also used with the word cracks to add emphasis to show how desperate these people are for water. Like Island Man the second stanza expands on the image created within the first two lines. The second line uses onomatopoeia twice, splash and echo. This makes you realise how precious the water is to the people in the poem, especially when it says how they imagine the echo of it in a tin mug on lines 3-6, this really shows there desperation and longing for something everyone else would take for granted. In the third stanza, various metaphors are used to add emphasis to the previous stanza and also create a new image of how they react when they receive more water than they normally have. They describe the water as silver crashing to the ground, this shows how important the water is to the people, especially when the water is described as silver. The people are described as a congregation to again add emphasis and show how much these people want the water and how desperate they are, this is shown again by using another metaphor on the very last line of the third stanza frantic hands, this again shows the desperate people trying to reach for the water. Finally, the fourth stanza describes how fantastic and amazing they find this water by using another metaphor to show how much they treasure the water as the blessing sings over their small bones, also in this final stanza it describes how poor they were and how little they had by saying that the children were naked and their small bones could mean that they are really weak as they dont have much to eat and obviously not enough to drink. Overall the two poems are fairly similar as they are both about people wanting things and longing for something that they dont have. For instance in Island Man he continuously dreams about the island where he possibly grew up and where he wants to be everyday instead of the dull and stressful life that he is currently living in London. Likewise in Blessing the people who live in the poor country have hardly any water and are longing for water. A phrase from each poem could possibly link this to each poem, for example in Island Man on the fourth line it says In his head and in Blessing on the third line it says Imagine. These phrases could indicate to the reader that both poems are about people wanting things that they cant have and are so desperate that they dream about them. However there are differences between the two poems, for instance in the way the poems are written, because Island man has no punctuation apart from a capital letter on the first and last line and also on the first line in the section of poem that starts to describe the city of London. This could be to distinguish between the two different places described in the poem and then the last line of the poem where it shows how he is feeling about waking up for another London day when he really doesnt want to. And also because in Blessing they are longing for something which they need to survive (water), whereas in Island Man he is desperate to go back to the island where he grew up and is precious to him however unlike the people in Blessing, he could actually live without the island, even though he may not want to, although you cant live without water.

Islamic Art and Architecture; Influence and Effects Essay Example for Free

Islamic Art and Architecture; Influence and Effects Essay Introduction During the reign of the Ottomans, Safavids, and Mughal rulers, architecture and art took on more meaning than it had in the past. The types of architecture and manuscript writing have had both symbolic significance and influence on the people of these empires. The architecture can be said to have had the greatest impact on the presence of power and devotion to Islamic arts of all of the empires, while manuscripts were held privately until trends influenced their spread over greater distances and people. The Ottomans, in their quest to expand their lands and influence, conquered Constantinople in 1453, which sparked a major period of construction in the new capital of the Ottoman Empire. This large building initiative took place in order to encourage a repopulating of Istanbul, as well as the revitalization of the economy in this declining city. The buildings and complexes the Ottomans built shed an interesting light on their concerns and ideals. For example, while the complexes were mainly built as places of worship, they took on other roles, such as, centers for education, commerce, and hospital care. One complex is clear in its intentions to the public, as can be seen by the endowment deed, which read â€Å" to elevate matters of religion and religious sciences in order to strengthen the mechanisms of worldly sovereignty and to reach happiness in the afterworld†, (Bloom Blair, 298). This combination of buildings in a complex format drew people from the old capital and cities of the empire, and generated revenue that amassed into fortunes for the rulers of the Ottoman Empire. The Ottomans, however, were not the only empire to enjoy great wealth and displays of that wealth. The Mughals, who descended from the same Turkish conquerors as the Ottomans, also enjoyed prosperity from great building projects. The architecture of the Mughals was able to change with great regularity during its time, due to the constant movement of the central government. The Mughals also benefited from a blend of styles and influences to create their palaces. The most famous example of Mughal architecture was the Taj Mahal, which was built in the memory of a deceased favorite wife. In the building of temples and tombs in Mughal history, it is quite common to find them built as reminders to the community of saints, heroes, or loved ones. It was  also common to find that they lacked as muc h fine detail as their neighbors to the west, but brought new styles to the architecture derived from the rich traditions of the people of India. Unlike the Ottomans and The Mughal, the Safavids were derived from the family lineage of Mohammed the prophet. Despite this difference, the Safavids built great temples and complexes for similar reasons. The Safavids built great complexes, and like the Ottomans, they moved their capital to a centralized location in order to centralize power, and increase commerce. The Safavids also shared another trait in building with the Ottomans. They both had a strong emphasis on education, and liked to keep a watchful eye over it. For this reason, religious complexes often included the highest forms of education for both the government and the religion of Islam. Though in competition for much of their histories, the Ottomans and Safavids adhered to many of the same architectural styles, with one major difference. Due to their difference in branches of Islam, the Safavids, unlike their Sunni neighbors the Ottomans, had little problem with diverging from traditional customs of avoiding the use of depictions of animals and people in their design. This proved to enhance the appearance of the buildings, but also give them a unique place in the history of Islamic buildings. Manuscripts, on the other hand, have a very different history than do the magnificent buildings of the Islamic world. In the Ottoman Empire, as was true of most of the Muslim world, the Koran was the most copied manuscript. Copies of the Koran were reproduced with astonishing art, but were usually given as gifts to other rulers. In this system, the common person was excluded from viewing the finest manuscripts. Common manuscripts were produced by artisans, but lacked the high quality of that of the royal courts. The Ottomans also used their talents to reproduce manuscripts that depicted great rulers and events in history, as well as topography paintings that displayed the prominence of conquest in the Ottomans daily life. Ottoman manuscripts were not as popular or unique as the ones created by the Safavids or Mughals, but they did posses superiority in the ar t of calligraphy. Manuscripts from the Safavid and Mughal empires possessed greater detail in art, but most of the calligraphers were not as skilled as those of the Ottoman Empire. Despite this lack of good calligraphy, the Safavids and Mughals were more skilled in art and design. Like the Ottomans, the Mughals and Safavid empires copied  the Koran at a high rate, but only the best works of art were given away as gifts. This lack of quality reproductions, which included not only writing, but also painting, led to the decline of the bound book. This decline led to the development of an industry of artisans creating single manuscripts. These manuscripts allowed for both artistic differences that were hard to avoid in large manuscripts, and it allowed more people to posses art. They were collected into books, but they had a greater impact on both the people of the Muslim world and the Europeans, who were exploring the area heavily in search of people to colonize. The arrival of the Europeans also led to a decline in the production of small manuscripts, due to the fact that the printing press and mass production of books were arriving in Europe. Conclusion Islamic art and architecture both had more than one use in Islamic life. The architecture reminded the people of saints, great rulers, martyrs, or beloved figures, as well as serving as a center for religion, education, commerce, and medicine. The art of the Islamic world was originally used to tell of battles, heroes, and most popularly recreate the Koran. Art also allowed for the growth of writing, painting, and the distribution of ideas over greater distances than the spoken word. Both Islamic art and architecture still hold as reminders to Muslims and the world that great rulers, conquerors, and artists have made a lasting impact on the region and its culture.

The Lung Chronic Disease Bronchopulmonary Dysplasia Nursing Essay

The Lung Chronic Disease Bronchopulmonary Dysplasia Nursing Essay Bronchopulmonary dysplasia or BPD is a form of chronic lung disease that develops in preterm neonates and is treated with oxygen and positive-pressure ventilation (PPV). In this paper I will discuss exactly what bronchopulmonary dysplasia is, its pathophysiology, the etiology, its clinical presentation, and any differential diagnosis of the disease. I will also present in my research the treatment and management for the disease, its prognosis, and the sequelae. Bronchopulmonary dysplasia formerly known as Chronic Lung Disease of Infancy is a chronic lung disorder that is more prevalent in children who were born prematurely with low birthweights, and whose lungs havent had the time to fully develop. White male infants seem to be at a greater risk for development, and genetics may contribute to some of these cases. It is also very common in those who have received prolonged mechanical ventilation to treat respiratory distress syndrome (RDS). It is ironic that the treatment for RDS is considered to be the prime cause of BPD. With the treatment of RDS the patient is treated with high pressures and high FiO2 over a period of time. Its the high pressures of oxygen delivery that can result in necrotizing bronchiolitis and alveolar septal injury; this action further compromises the oxygenation of blood. Bronchopulmonary dysplasia is characterized by inflammation and scarring in the lungs. The signs and symptoms to watch out for are the oxygen deman ds of the infant not decreasing as they should, in some cases even increasing. Fast breathing, a fast heart rate, flared nostrils, retractions, poor weight gain, and coarse crackles may be heard upon auscultation. The pathophysiology of BPD is linked to four factors. These factors are oxygen toxicity, barotrauma, the presence of a PDA (patent ductus arteriosus), and fluid overload. Exposure to high concentrations of oxygen can lead to edema and the thickening of the alveolar membrane. When you have prolonged exposure it causes the alveolar tissues to hemorrhage and become necrotic. As the disease progresses the interstitial spaces will become fibrotic. When the lung tries to heal itself, all of the new cells are damaged by the same factors as before, and it continues in a cycle. All of this can interfere with alveolarization and lead to alveolar simplification with a reduction in the surface area for gas exchange. Any damage to the lung during a critical stage of growth will result in significant pulmonary dysfunction. With patients who have left-to-right shunting through the PDA it is more likely that they develop pulmonary congestion and worsening compliance. With this problem the patient wi ll need higher ventilatory pressures and oxygen percentages to help with ventilation and oxygenation; therefore they have a higher risk of BPD. Bronchopulmonary dysplasia develops as a result of an infants lungs becoming irritated or inflamed. The lungs of premature infants are very fragile and arent fully developed, and therefore they can become easily irritated. Ventilators are used to help with the breathing by using pressure to blow air into the airways and lungs. However it is the pressures used that can irritate and harm a premature infants lungs, so they are used only when absolutely needed. Sometimes oxygen therapy is given to make sure that the infants brains, hearts, livers, and kidneys get enough oxygen to work properly. However in some cases high levels of oxygen can inflame the lining of the lungs and injure the airways, it can also slow lung development. Another cause is infections that can inflame the underdeveloped lungs of premature infants. With this problem it causes narrowing of the airways and makes it harder for infants to breathe. Lung infections can also increase the need for extra oxygen and breathin g support which in turn leads to the ventilation and extra oxygen requirements. There are some studies also show that heredity plays a role in causing BPD. Infants with bronchopulmonary dysplasia will have abnormal findings on physical exams, chestx-rays, pulmonary function testing, and histopathologic examinations. Initial findings observed shortly after birth are consistent with respiratory distress syndrome (RDS). Persistence of these abnormalities can be associated with an increased risk of bronchopulmonary dysplasia. Physical examination may reveal tachypnea, tachycardia, increased work of breathing, including retractions, nasal flaring, and grunting, as well as frequent desaturations and significant weight loss during the first 10 days of life. Infants with severe bronchopulmonary dysplasia are often extremely immature and had a very low birth weight. Their requirements for oxygen and ventilatory support often increase in the first 2 weeks of life. At weeks 2-4, oxygen supplementation, ventilator support, or both are often increased to maintain adequate ventilation and oxygenation. Dif DX Atelectasis refers to collapse of part of the lung. It may include a lung subsegment or the entire lung and is almost always a secondary phenomenon, with no sex or race proclivities; however, it may occur more frequently in younger children than in older children and adolescents. The direct morbidity from atelectasis is transient hypoxemia due to blood flowing through the lung, which does not have normal air flow. The blood does not pick up oxygen from the corresponding alveoli. This shunting results in transient hypoxemia. Hypertension Patent ductus arteriosus (PDA) is one of the more common congenital heart defects. The presentation widely varies. Depending on the size of the patent ductus arteriosus, the gestational age of the neonate, and the pulmonary vascular resistance, a premature neonate may develop life-threatening pulmonary overcirculation in the first few days of life. Conversely, an adult with a small patent ductus arteriosus may present with a newly discovered murmur well after adolescence. During fetal life, the ductus arteriosus is a normal structure that allows most of the blood leaving the right ventricle to bypass the pulmonary circulation and pass into the descending aorta. Typically, only about 10% of the right ventricular output passes through the pulmonary vascular bed. Pneumonia and other lower respiratory tract infections are the leading causes of death worldwide. Because pneumonia is common and is associated with significant morbidity and mortality, properly diagnosing pneumonia, correctly recognizing any complications or underlying conditions, and appropriately treating patients are important. Although in developed countries the diagnosis is usually made on the basis of radiographic findings, the World Health Organization (WHO) has defined pneumonia solely on the basis of clinical findings obtained by visual inspection and on timing of the respiratory rate. (See Clinical Presentation.) Pneumonia may originate in the lung or may be a focal complication of a contiguous or systemic inflammatory process. Abnormalities of airway patency as well as alveolar ventilation and perfusion occur frequently due to various mechanisms. These derangements often significantly alter gas exchange and dependent cellular metabolism in the many tissues and organs that determine survival and contribute to quality of life. Subglottic stenosis (SGS) is a narrowing of the subglottic airway (see image below), which is housed in the cricoid cartilage. The subglottic airway is the narrowest area of the airway because it is a complete, nonexpandable, and nonpliable ring, unlike the trachea, which has a posterior membranous section, and the larynx, which has a posterior muscular section. Tracheomalacia is a structural abnormality of the tracheal cartilage allowing collapse of its walls and airway obstruction. A deficiency and/or malformation of the supporting cartilage exists, with a decrease in the cartilage-to-muscle ratio. Immaturity of the tracheobronchial cartilage is thought to be the cause in type I, whereas degeneration of previously healthy cartilage is thought to produce other types. Inflammatory processes, extrinsic compression from vascular anomalies, or neoplasms may produce degeneration. Diffuse malacia of the airway of the congenital origin improves by age 6-12 months as the structural integrity of the trachea is restored gradually with resolution of the process. Treatment and management Treatment in the NICU is designed to limit stress on infants and meet their basic needs of warmth, nutrition, and protection. Once doctors diagnose BPD, some or all of the treatments used for RDS will continue in the NICU. Such treatment usually includes: Using radiant warmers or incubators to keep infants warm and reduce the chances of infection. Ongoing monitoring of blood pressure, heart rate, breathing, and temperature through sensors taped to the babies bodies. Using sensors on fingers or toes to check the amount of oxygen in the infants blood. Giving fluids and nutrients through needles or tubes inserted into the infants veins. This helps prevent malnutrition and promotes growth. Nutrition is critical to the growth and development of the lungs. Later, babies may be given breast milk or infant formula through feeding tubes that are passed through their noses or mouths and into their throats. Checking fluid intake to make sure that fluid doesnt build up i n the babies lungs. As their condition improves, babies who have BPD are weaned or taken off NCPAP or ventilators slowly, until they can breathe on their own. These infants will likely need to continue getting oxygen therapy for some time. If your infant has moderate to severe BPD, echocardiography may be done every few weeks to months to check his or her pulmonary artery pressure. If your child needs long-term support from a ventilator, he or she will likely have a tracheostomy (TRA-ke-OS-to-me). A tracheostomy is a surgically made hole that goes through the front of the neck and into the trachea (TRA-ke-ah), or windpipe. Your childs doctor will put the breathing tube from the ventilator through the hole. Using a tracheostomy instead of an endotracheal (en-do-TRA-ke-al) tube has several advantages. (An endotracheal tube is a breathing tube inserted through the nose or mouth and into the windpipe.) Long-term use of an endotracheal tube can damage the trachea. This damage may later r equire surgery to correct. A tracheostomy may allow your baby to interact more with you and the NICU staff, start talking, and develop other skills.While your baby is in the NICU, he or she also may need physical therapy. Physical therapy can help strengthen your childs muscles and clear mucus out of his or her lungs.Infants who have BPD can recover, but many spend several weeks or months in the hospital. This allows them to get the care they need. Before your baby goes home, its important for you to learn as much as you can about your childs condition and how its treated. Your baby may continue to have some breathing symptoms after he or she leaves the hospital. Your child will likely continue on all or some of the treatments that were started at the hospital, including:Medicines, such as bronchodilators, steroids, diuretics, and caffeine. Oxygen therapy and/or breathing support from NCPAP or a ventilator. Extra nutrition and calories, which may be given through a feeding tube. Pre ventive treatment with a medicine called palivizumab for severe respiratory syncytial virus (RSV). This common virus leads to mild, cold-like symptoms in adults and older, healthy children. However, in infants-especially those in high-risk groups-RSV can be more serious, leading to severe breathing problems. Your child also should have regular checkups with and timely vaccinations from a pediatrician. This is a doctor who specializes in treating children. If your child needs oxygen therapy or a ventilator at home, a pulmonary specialist may help with long-term medical care and make treatment recommendations. Mechanical ventilation In most cases of bronchopulmonary dysplasia (BPD), respiratory distress syndrome is diagnosed and treated. The mainstay for treating RDS has been surfactant replacement with oxygen supplementation, continuous positive airway pressure (CPAP), and mechanical ventilation. The treatment necessary to recruit alveoli and prevent atelectasis in the immature lung may cause lung injury and activate the inflammatory cascade. Trauma secondary to positive pressure ventilation (PPV) is generally referred to as barotrauma. With the recent focus on a ventilation strategy involving low versus high tidal volume, some investigators have adopted the term volutrauma. Volutrauma suggests the occurrence of lung injury secondary to excessive tidal volume from PPV. The severity of lung immaturity, the fetal milieu, and the effects of surfactant deficiency determine the need for PPV, surfactant supplementation, and resultant barotrauma or volutrauma. With severe lung immaturity, the total number of alveoli is reduced, increasing the positive pressure transmitted to distal terminal bronchioles. In the presence of surfactant deficiency, surface tension forces are increased. Some compliant alveoli may become hyperinflated, whereas other saccules with increased surface tension remain collapsed. With increasing PPV to recruit alveoli and improve gas exchange, the compliant terminal bronchiole and alveolar ducts may rupture, leaking air into the interstitium, with resultant pulmonary interstitial emphysema (PIE). The occurrence of PIE greatly increases the risk of bronchopulmonary dysplasia. Many modes of ventilation and many ventilator strategies have been studied to potentially reduce lung injury, such as synchronized intermittent mechanical ventilation (SIMV), high-frequency jet ventilation (HFJV), and high-frequency oscillatory ventilation (HFOV). Results have been mixed, although some theoretical benefits are associated with these alternative modes of ventilation. Although shorter duration of mechanical ventilation has been demonstrated in some trials of SIMV, most trials have not had a large enough sample size to demonstrate a reduction in bronchopulmonary dysplasia. Systematic reviews suggest that optimal use of conventional ventilation may be as effective as HFOV in improving pulmonary outcomes. Regardless of the high-frequency strategy used, avoidance of hypocarbia and optimization of alveolar recruitment may decrease the risk of bronchopulmonary dysplasia and associated of neurodevelopmental abnormalities. PPV with various forms of nasal CPAP has been reported to decrease injury to the developing lung and may reduce the development of bronchopulmonary dysplasia. In general, centers that use gentler ventilation with more CPAP and less intubation, surfactant, and indomethacin had the lowest rates of bronchopulmonary dysplasia. Oxygen and PPV frequently are life-saving in extremely preterm infants. However, early and aggressive CPAP may eliminate the need for PPV and exogenous surfactant or facilitate weaning from PPV. Some recommend brief periods of intubation primarily for the administration of exogenous surfactant quickly followed by extubation and nasal CPAP to minimize the need for prolonged PPV. This strategy may be most effective in infants without severe RDS, such as many infants with birth weights of 1000-1500 g. In infants who require oxygen and PPV, careful and meticulous treatment can minimize oxygen toxicity and lung injury. Optimal levels include a pH level of 7.2-7.3, a partial pressure of carbon dioxide (pCO2) of 45-55 mm Hg, and a partial pressure of oxygen (pO2) level of 50-70 mm Hg (with oxygen saturation at 87-92%). Assessment of blood gases requires arterial, venous, or capillary blood samples. As a result, indwelling arterial lines are often inserted early in the acute management of RDS. Samples obtained from these lines provide the most accurate information about pulmonary function. Arterial puncture may not provide completely accurate samples because of patient agitation and discomfort. Capillary blood gas results, if samples are properly obtained, may be correlated with arterial values; however, capillary samples may widely vary, and results for carbon dioxide are poorly correlated. Following trends in transcutaneous PO2 andP CO2 may reduce the need for frequent blood gas measurements. Weaning from mechanical ventilation and oxygen is often difficult in infants with moderate-to-severe bronchopulmonary dysplasia, and few criteria are defined to enhance the success of extubation. When tidal volumes are adequate and respiratory rates are low, a trial of extubation and nasal CPAP may be indicated. Atrophy and fatigue of the respiratory muscles may lead to atelectasis and extubation failure. A trial of endotracheal CPAP before extubation is controversial because of the increased work of breathing and airway resistance. Optimization of methylxanthines and diuretics and adequate nutrition may facilitate weaning the infant from mechanical ventilation. Meticulous primary nursing care is essential to ensure airway patency and facilitate extubation. Prolonged and repeated intubations, as well as mechanical ventilation, may be associated with severe upper airway abnormalities, such as vocal cord paralysis, subglottic stenosis, and laryngotracheomalacia. Bronchoscopic evaluation should be considered in infants with bronchopulmonary dysplasia in whom extubation is repeatedly unsuccessful. Surgical interventions (cricoid splitting, tracheostomy) to address severe structural abnormalities are used less frequently today than in the past. Oxygen therapy Oxygen can accept electrons in its outer ring to form free radicals. Oxygen free radicals can cause cell-membrane destruction, protein modification, and DNA abnormalities. Compared with fetuses, neonates live in a relatively oxygen-rich environment. Oxygen is ubiquitous and necessary for extrauterine survival. All mammals have antioxidant defenses to mitigate injury due to oxygen free radicals. However, neonates have a relative deficiency in antioxidant enzymes. The major antioxidant enzymes in humans are superoxide dismutase, glutathione peroxidase, and catalase. Activity of antioxidant enzymes tend to increase during the last trimester of pregnancy, similar to surfactant production, alveolarization, and development of the pulmonary vasculature. Increases in alveolar size and number, surfactant production, and antioxidant enzymes prepare the fetus for transition from a relatively hypoxic intrauterine environment to a relatively hyperoxic extrauterine environment. Preterm birth exposes the neonate to high oxygen concentrations, increasing the risk of injury due to oxygen free radical. Animal and human studies of supplemental superoxide dismutase and catalase supplementation have shown reduced cell damage, increased survival, and possible prevention of lung injury. Evidence of oxidation of lipids and proteins has been found in neonates who develop bronchopulmonary dysplasia. Supplementation with superoxide dismutase in ventilated preterm infants with RDS substantially reduced in readmissions compared with placebo-treated control subjects. Further trials are currently under way to examine the effects of supplementation with superoxide dismutase in preterm infants at high risk for bronchopulmonary dysplasia. Ideal oxygen saturation for term or preterm neonates of various gestational ages has not been definitively determined. In practice, many clinicians have adopted conservative oxygen saturation parameters (ie, 87-92%). A delicate balance to optimally promote neonatal pulmonary (alveolar and vascular) and retinal vascular homeostasis is noted. In the Supplemental Therapeutic Oxygen for Prethreshold Retinopathy of Prematurity (STOP-ROP) trial to reduce severe retinopathy of prematurity (ROP), oxygen saturations of more than 95% minimally affected retinopathy but increased the risk for pneumonia or bronchopulmonary dysplasia. The normal oxygen requirement of a preterm infant is unknown. Pulmonary hypertension and cor pulmonale may result from chronic hypoxia and lead to airway remodeling in infants with severe bronchopulmonary dysplasia. Oxygen is a potent pulmonary vasodilator that stimulates the production of nitric oxide (NO). NO causes smooth muscle cells to relax by activating cyclic guanosine monophosphate. Currently, pulse oximetry is the mainstay of noninvasive monitoring of oxygenation. Repeated episodes of desaturation and hypoxia may occur in infants with bronchopulmonary dysplasia receiving mechanical ventilation as a result of decreased respiratory drive, altered pulmonary mechanics, excessive stimulation, bronchospasm, and forced exhalation efforts. Forced exhalation efforts due to infant agitation may cause atelectasis and recurrent hypoxic episodes. Hyperoxia may overwhelm the neonates relatively deficient antioxidant defenses and worsen bronchopulmonary dysplasia. The patients oxygen requirements are frequently increased during stressful procedures and feedings. Some NICUs have adopted a conservative oxygen saturation policy of maintaining saturations of 88-94%. Caregivers are more likely to follow wide guidelines for ranges of oxygen saturation than narrow ones. Some infants, especially those living at high altitudes, may require oxygen therapy for many months. Transfusion of packed RBCs may increase oxygen-carrying capacity in preterm infants who have anemia (hematocrit The need for multiple transfusions and donor exposures can be minimized by using iron supplementation, a reduction in phlebotomy requirements, and by use of erythropoietin administration. Treatment of inflammation Elevated levels of interleukin-6 and placental growth factor in the umbilical venous blood of preterm neonates are associated with increased incidence of bronchopulmonary dysplasia. This inflammation likely affects alveolarization and vascularization of the pulmonary system of the second-trimester fetus. Fetal sheep exposed to inflammatory mediators or endotoxin develop inflammation and abnormal lung development. Activation of inflammatory mediators has been demonstrated in humans and animal models of acute lung injury. Activation of leukocytes after cell injury caused by oxygen free radicals, barotrauma, infection, and other stimuli may begin the process of destruction and abnormal lung repair that results in acute lung injury then bronchopulmonary dysplasia. Radiolabeled activated leukocytes have been recovered by means of bronchoalveolar lavage (BAL) in preterm neonates receiving oxygen and PPV. These leukocytes, as well as lipid byproducts of cell-membrane destruction, activate the inflammatory cascade and are metabolized to arachidonic acid and lysoplatelet factor. Lipoxygenase catabolizes arachidonic acid, resulting in the production of cytokines and leukotrienes. Cyclooxygenase may also metabolize these byproducts to produce thromboxane, prostaglandin, or prostacyclin. All of these substances have potent vasoactive and inflammatory properties. levels of these substances are elevated in the first days of life, as measured in tracheal aspirates of preterm infants who subsequently develop bronchopulmonary dysplasia. Metabolites of arachidonic acid, lysoplatelet factor, prostaglandin, and prostacyclin may cause vasodilatation, increase capillary permeability with subsequent albumin leakage, and inhibit surfactant function. This effects increase oxygenation and ventilation requirements and potentially increase rates of bronchopulmonary dysplasia Activation of transcription factors such as nuclear factor-kappa B in early postnatal life is associated with death or bronchopulmonary dysplasia. Collagenase and elastase are released from activated neutrophils. These enzymes may directly destroy lung tissue because hydroxyproline and elastin (breakdown products of collagen and elastin) have been recovered in the urine of preterm infants who develop bronchopulmonary dysplasia. Alpha1-proteinase inhibitor mitigates the action of elastases and is activated by oxygen free radicals. Increased activity and decreased function of alpha1-proteinase inhibitor may worsen lung injury in neonates. A decrease in bronchopulmonary dysplasia and in the need for continued ventilator support is found in neonates given supplemental alpha1-proteinase inhibitor. All of these findings suggest the fetal inflammatory response effects pulmonary development and substantially contributes to the development of bronchopulmonary dysplasia. The self-perpetuating cycle of lung injury is accentuated in the extremely preterm neonate with immature lungs. Management of infection Maternal cervical colonization and/or colonization in the neonate with Ureaplasma urealyticum has been implicated in the development of bronchopulmonary dysplasia. Viscardi and colleagues found that persistent lung infection with U urealyticum may contribute to chronic inflammation and early fibrosis in the preterm lung, leading to pathology consistent with clinically significant bronchopulmonary dysplasia.[13] Systematic reviews have concluded that infection with U urealyticum is associated with increased rates of bronchopulmonary dysplasia. Infection-either antenatal chorioamnionitis and funisitis or postnatal infection-may activate the inflammatory cascade and damage the preterm lung, resulting in bronchopulmonary dysplasia. In fact, any clinically significant episode of sepsis in the vulnerable preterm neonate greatly increases his or her risk of bronchopulmonary dysplasia, especially if the infection increases the babys requirement for oxygen and mechanical ventilation. Future management Future management of bronchopulmonary dysplasia will involve strategies that emphasize prevention. Because few accepted therapies currently prevent bronchopulmonary dysplasia, many therapeutic modalities (eg, mechanical ventilation, oxygen therapy, nutritional support, medication) are used to treat bronchopulmonary dysplasia. Practicing neonatologists have observed reduced severities of bronchopulmonary dysplasia in the postsurfactant era. Maintaining PPV and oxygen therapy for longer than 4 months and discharging patients to facilities for prolonged mechanical ventilation is now unusual. Medication Summary Many drug therapies are used to treat infants with severe bronchopulmonary dysplasia (BPD). The efficacy, exact mechanisms of action, and potential adverse effects of these drugs have not been definitively established. A study group from the NICHD and US Food and Drug Administration (FDA) reviewed many of the drugs used to prevent and treat bronchopulmonary dysplasia. Walsh and colleagues concluded that detailed analyses of many of these treatments, as well as long-term follow-up, are needed.[15] Vitamin A supplementation Seven trials of vitamin A supplementation in preterm neonates to prevent bronchopulmonary dysplasia were analyzed for the Cochrane Collaborative Neonatal review. Vitamin A supplementation reduced bronchopulmonary dysplasia and death at 36 weeks postmenstrual age. However, the need for frequent intramuscular injections in extremely premature infants has precluded widespread use of this therapy. Diuretics Furosemide (Lasix) is the treatment of choice for fluid overload in infants with bronchopulmonary dysplasia. It is a loop diuretic that improves clinical pulmonary status and function and decreases pulmonary vascular resistance. Daily or alternate-day furosemide therapy may facilitate weaning from positive pressure ventilation (PPV), oxygenation, or both. Adverse effects of long-term therapy are frequent and include hyponatremia, hypokalemia, contraction alkalosis, hypocalcemia, hypercalciuria, renal stones, nephrocalcinosis, and ototoxicity. Careful parenteral and enteral nutritional supplementation is required to maximize the benefits instead of exacerbating the adverse effects. In patients with mild hyponatremia or hypokalemia, supplementation with potassium chloride is favored over supplementation with sodium chloride. Thiazide diuretics plus aldosterone inhibitors (eg, spironolactone [Aldactone]) have also been used in infants with bronchopulmonary dysplasia. In several trials of infants with bronchopulmonary dysplasia, thiazide diuretics combined with spironolactone increased urine output with or without improvement in pulmonary mechanics. Hoffman et al reported that spironolactone did not reduce the need for supplemental electrolytes in preterm infants with bronchopulmonary dysplasia.[16] To the present authors knowledge, long-term studies to compare the efficacy of furosemide with those of thiazide and spironolactone therapy have not been performed. Bronchodilators Albuterol is a specific beta2-agonist used to treat bronchospasm in infants with bronchopulmonary dysplasia. Albuterol may improve lung compliance by decreasing airway resistance by relaxing smooth muscle cell. Changes in pulmonary mechanics may last as long as 4-6 hours. Adverse effects include increased blood pressure (BP) and heart rate. Ipratropium bromide is a muscarinic antagonist that is related to atropine; however, it may have bronchodilator effects more potent than those of albuterol. Improvements in pulmonary mechanics were demonstrated in patients with bronchopulmonary dysplasia after they received ipratropium bromide by inhalation. Combined therapy with albuterol and ipratropium bromide may be more effective than either agent alone. Few adverse effects are noted. Methylxanthines are used to increase respiratory drive, decrease apnea, and improve diaphragmatic contractility. These substances may also decrease pulmonary vascular resistance and increase lung compliance in infants with bronchopulmonary dysplasia, probably by directly causing smooth muscle to relax. Methylxanthines also have diuretic effects. All of these effects may increase success in weaning patients from mechanical ventilation. Synergy between theophylline and diuretics has been demonstrated. Theophylline has a half-life of 30-40 hours. It is metabolized primarily to caffeine in the liver and may result in adverse effects such as increase in heart rate, gastroesophageal reflux, agitation, and seizures. The half-life of caffeine is approximately 90-100 hours, and caffeine is excreted unchanged in the urine. Both agents are available in intravenous and enteral formulations. Caffeine has fewer adverse effects than theophylline. Schmidt and colleagues reported that the early use of caffeine to treat apnea of prematurity appeared to reduce ventilatory requirements and that it may decrease the incidence of bronchopulmonary dysplasia.[17] Corticosteroids Systemic and inhaled corticosteroids have been studied extensively in preterm infants to prevent and treat bronchopulmonary dysplasia. Dexamethasone is the primary systemic synthetic corticosteroid studied in preterm neonates. Dexamethasone has many pharmacologic benefits but clinically significant adverse effects. This drug stabilizes cell and lysosomal membranes, increases surfactant synthesis, increases serum vitamin A concentration, inhibits prostaglandin and leukotriene, decreases pulmonary edema (PE), breaks down granulocyte aggregates, and improves pulmonary microcirculation. Its adverse effects are hyperglycemia, hypertension, weight loss, GI bleeding or perforation, cerebral palsy, adrenal suppression, and death. Many researchers have evaluated the effects of early administration of dexamethasone to prevent bronchopulmonary dyspl