Mirror, Mirror on the Wall free essay sample

Mirror , Mirror on the WallWhen you wake up from a nights sleep first thing most people do is go to the bathroom. A lot of people miss a key an element in that process which is looking in the mirror. Some people look in the mirror before they do anything else. But what do you really see when you look in the mirror? Some see the makeup they didnt wash off from the night before. Others see acne that they struggle with daily. And its a group of people that see a stranger in the reflection of the mirror. That stranger is the body that is reflecting but the true person is in the inside that they hold true to their hearts. Gender identity is something that has been a difficult journey for at least 1 million people in the United States according to the CDC ( https://www.cdc.gov/hiv/group/gender/transgender/index.html) . It must be a struggle to feel like you are going against everything that you were taught, and every society has deemed correct. But for some people in this country thats how they live their life every day. I would like to highlight what science deems as true, what society compounds and call true with science backing them up, and shine the light on a special case that contradicts the former.Gender identity is a persons concept of him or herself whether male or female, this can be either the same as their biological gender or it could be different (Schwartz, 2008). Most of the people out there are satisfied at being the gender they were born, though some may feel that they should be the opposite sex. This a simple explanation of what the Nature influence comes from. What you are born with and as should be who you are. And in most cases that is true. Someones gender as opposed to their sex is mainly a social construction and their own thoughts and feelings about their gender have a great impact on the development of their own identity. We as women biologically give birth to children and society gives us the fitting title of mother. This title has an influence on how women are defined in society, including their role in as well (Ohle, 2006). This thought creates the link between the belief that sex is associated with biology and a man or womens gender identity in any society is determined socially and psychologically which includes historically and culturally (Ohle, 2006). In the determination of gender identity, social and cultural perceptions of what is considered masculine and feminine traits along with roles are major players in determining what is right.With that being said, its believed that gender isnt a nature thing it is a nurture thing. Something that is learned from the environment and culture that you are exposed to (Ohle,2006). After the baby is born and doctors say whether its a girl or a boy, parents begin to raise the baby as such based on the gender or sex of the child. Which is also known as core gender identity (Dreger, 2009). Research has been collected and its been found that core gender identity takes place by age two or three, in some cases the child may be as old as five before the core gender identity is complete. But it is also believed that the parents have the power over this the gender role decision. A parents influence make up the largest contributing factor in determining environmental influences (Dreger, 2009). The same research has proven that behavioral changes happen when parents of either sex interact with different genders (Dreger, 2009). Some examples of this are that girls are cuddled more often, and boys are encouraged to play more assertively. Sooner or later the concept of his or her gender develops (Ghosh, 2009). Parents can often become overly worried about certain behaviors, but this tends to only confuse the child even more. Which is quite common and sad because the societal push of what a girl or boy should do or how they should act is not always the right example. Its ok for boys to cry and its ok for girls to play football if that is what they want to do and its not impeding on their development as a person.Now lets get back to the science aspect and start from the beginning. Every fetus begins life as a female because of the X chromosome coming from the mother; this is the only chromosome active for the first few weeks of gestation. At the eighth week the fetus takes a chromosome from the father who can be either an X or a Y (Wickens, 2005). If the fetus takes an X chromosome it will stay a female, but if it takes a Y chromosome it begins making testosterone and other male hormones and will begin to develop as a male. These different hormones work in the brain to create the male sex organs and genitalia (Wickens, 2005). What I just described is something we learn a little about in high school biology and in more depth in an embryology or other higher-level college course. It sounds cut and dry so why cant it be just that simple. This is how the saying, Men determine what the childs sex will be got established. Because of the second chromosome coming from them. But there are some situations during gestation a fetuss brain produces male hormones but the fetus still becomes a female. Other times the fetus does not produce enough testosterone for the fetus to become completely male. This is known as hermaphroditism (Ghosh, 2009). Society today calls this intersex. And these cases are few and far in between now but because it has happened and still can happen some parents now are going towards not labeling their child until they reach puberty and then allows them to determine who they want to be regardless of how they were born according to science.The special case I was referring to in the beginning is one about a lady that grew up in the deep south in the late 60s early 70s. She was born and raised up to be a healthy young woman. Everything that society said she should have to be the regular little girl was given. Baby dolls, dresses, lace socks (very southern tradition), and tea parties. Around 10 years old she felt like something wasnt right. She understood that she was a girl, but she didnt think it matched with her spirit. After a while she didnt act the rest of the girls including her sisters which became a problem in some cases. She wanted to hang with the boys more and venture off in what they were interested in. Her family around her just labeled it as her being a tomboy but she knew it was much more.She never had a boyfriend and wasnt interested in one. And once she got in high school her mother had to basically threaten her to put on anything feminine. By the time she reached her senior year she finally accepted the fact that not only was she attracted to females but that she didnt identify with females. She truly felt like she was a man trapped in a womans body. She was afraid to tell her family because of what the backlash could be and didnt want to risk the aftermath. So, after she graduated she left home for a summer trip and never came back. Through out her life she has evolved into the person she is today and from choice in clothes to a voluntary hysterectomy which is an extreme step she does it try to find piece in herself. The person I speak of is my mother. She has always maintained that the only reason that I am on this earth is because she was raped, and no one believed she was pregnant because of the fact everyone knowing that she didnt like guys in that way. So once everyone found out the truth of her pregnancy it was to late for her to have an abortion. At that time, she was very sad and mad because she didnt want any kids which is why Im the only child. But nonetheless she cherishes me like Im not human.As I listened to her story when I got older and was able to comprehend it was to clear to me that the sex you are at birth can possibly be different than your gender. Even though society has combined to two there is evidence that can very well contradict the status quo. Gender identity shouldnt have to be synonymous to the sex youre born with. And that doesnt make either wrong or less than the other. Once youre born it takes both nature and nurture to mold you into who end up being. So, if when you look in the mirror and see something different than what science says is ok nothing is wrong with that. And a perfect example of that is the younger children in my family who has only seen my mother as a male call her Uncle Jack instead of Auntie Jackie and she answers like its second nature. The mirror on the wall can be tricky but it will tell you what you see and what other people see. Sometimes it may be the same answer and other times it may be different.ReferencesSelf Identity, Vol. 7 Issue 1, p34-53, 20p, 1 Chart; DOI: 10. 1080/15298860600980185 Dreger, A. (2009).Gender Identity Disorder in Childhood: Inconclusive Advice to Parents. The Hastings Center Report, 39(1). 26-9. From: ProQuest database. Ghosh, S. MD (2009).Sexuality, Gender Identity. From: http://emedicine.medscape.com/article/917990-overview Ohle, A. (2006).The Effects of Culture on Gender Identity. From: http://ematusov.soe.udel.edufinal.paper.pub/_pwfsfp/000000a8.htm Schwartz, N. (2008)Sexual differentiation of the human brain in relation to gender identity and sexual orientation. Functional Neurology, 24(1), 17-28. From: ProQuest database. Wickens, A. P. (2005).Jackqueline Eppss recalls her childhood and early adulthood with a short account of present day- 1969-1990, 2001- present

Examining The Effects Of Having An Abortion Theology Religion Essay Example

Examining The Effects Of Having An Abortion Theology Religion Essay Example Examining The Effects Of Having An Abortion Theology Religion Essay Examining The Effects Of Having An Abortion Theology Religion Essay but overall the rates are increasing, which is a bad mark, because it shows that although engineering has increased and there are now other methods of abortion, people are disregarding the fact that abortion is slaying. Statisticss on abortion in South Africa: 85A 000 Abortions taking topographic point annually 500 Women dice every twelvemonth because they use the pill incorrect/ misuse it 425 adult females die due to illegal abortion 42 00 to 167A 000 illegal abortions are done every twelvemonth in South Africa and there is nil we can make about it. There is a jurisprudence that states the demands, but it is hard to implement when you do nt cognize about the backstreet abortions 50 % of all gestations end up in a abortion More than 500A 000 adult females have had an abortion since the jurisprudence has been implemented in 1996 The Numberss are striking sky high, in Limpopo the Numberss increased from 533 to about 4864 in 2006 24 % of abortions performed in South Africa are done within the 2nd trimester of the gestation and this is unsafe to the adult female s wellness and worse for the unborn babe. There are about 350 installations that perform abortion, but in 2007 merely 60 % of these medical clinics ( infirmaries ) were working/functioning. Many times we wonder why adult females prefer abortions over alternate methods, and most of the clip we think the ground is colza, good there stats say something else. Why are abortions performed? 1 % because of colza or sexual maltreatment 1 % because the kid will hold abnormalcies 3 % choose abortion because the adult female s wellness is at hazard 91 % prefer abortion as a method of birth control. These are the other grounds why adult females chose abortion: 25 % want to prorogue holding a kid 8 % do nt desire more kids than the already have 21,3 % of adult female ca nt afford a babe at that phase 11 % think or believe it will interrupt their job/education 14 % of the clip the spouse does nt desire the babe 12 % are excessively immature or any other expostulation 2 % choose abortion for another ground Teenage Pregnancy stats in South Africa: 66A 000 misss we re reported being pregnant in 2002, and that was their alibi for non go toing school The adolescent gestation rate rose to 86A 000 in 2004, and these misss still blamed their gestation on non go toing an educational installation More than a 1/3 of the babes that are born in South Africa have female parents that are 19 old ages of age or younger. One in every three misss has already had a babe by the clip they reach age 20 There is one instance where 71 % of the misss in a high school ion Soweto fell pregnant ( one the outskirts of Johannesburg ) 12 % of sexually active adolescents ( age 12-14 ) have neer used protection during sexual intercourse State Adolescent birth rate per 1000 adult females 15-19 A Israel 17 A Iceland 19 A Croatia 19 A United Kingdom 20 A Hungary 21 A Bosnia and Herzegovina 23 A Slovakia 24 A Estonia 26 A New Zealand 27 A Belarus 27 A Russia 30 A Georgia 33 A Macedonia 34 A Armenia 34 A Romania 37 A Ukraine 38 A Saudi Arabia 38 A Bulgaria 41 A Chile 44 A Brazil 45 A United States 53 A Indonesia 55 A Mexico 64 A South Africa 66 A India 73 A Nigeria 103 A Niger 233 This tabular array shows how the adolescent gestation rate is spread across the universe. South Africa with a population of about 49.3 million ( 66 adult females in every 1000, between the ages of 15 and 19, autumn pregnant ) , has some of the highest Numberss, compared to Russia who has 141 million people, but merely 30 out of 1000 autumn pregnant. Teenage gestation depends on a figure of things: Fortunes ( whether you are exposed to sexual maltreatment, poorness etc ) Location ( high offense and colza countries will increase figure of gestations ) Education ( if the adolescents are informed about the effects of abortion and whether or non they had Sex Ed ) Contraceptives ( do they hold entree to the protection necessary ) Culture ( in many civilizations it is required for the miss to get married at the age of 14 or 15 ) I think that many uneducated adolescents abort the kid because that is the easiest manner out and a speedy hole . Here are some facts that are against abortion and that show what truly happens when you have an abortion There are many complications for the female parent even if the process is legal. ( Whether it is emotional, physical or even religious, the female parent will endure in legion ways ) Physical effects that the female parent might endure from Psychological effects that the female parent might hold: Death Compunction and guilt Asepsis Suicide efforts Miscarriages in the hereafter Lower self-pride ( weakness and bereavement ) Menstrual jobs Might experience more choler which can take t kid maltreatment Infections Hate for those with a connexion to it Bleeding and a batch of hurting Ca nt forgive yourself Breast malignant neoplastic disease No more an involvement in sex 7. What are the general sentiments sing abortion: ( friends/family ) ( see interviews attached ) Number of ballots Abortion is a touchy topic and non many people are familiar with what precisely abortion entails. Many have a certain position because they have been raised in such a mode, but in the terminal it is your ain pick. I decided to interview five of my household members, and seek to analyze what they know and think about the construct abortion . I interviewed my cousins ( age 15 and 21 ) , my parents ( age 47-50 ) , my Aunt ( age 44 ) and my grandmother ( age 62 ) , merely so that I have a wide overview of the different age groups and what they conceive as slaying and when they think life starts. It was interesting to see that many of them thought that abortion was slaying, but yet they believe the adult female has the right to kill the babe. That was seen in the younger age groups and the inquiries asked to the older interviewees showed that they really thought about it and found it hard to do a determination. They believe abortion is slaying and so merely God decides when to take and give life. Our organic structure is merely borrowed to us here on Earth, so why do we have the right to make up ones mind what happens to the babe turning inside this borrowed organic structure? There were assorted feelings when it came to the inquiry about a rape-victim, since the babe being formed inside of your uterus, was nt done out of an act of love, but instead fury and force. Although God has a program for us all and everything that happens to us has a greater intent in the terminal, we do nt needfully see the bigger image at that place and so. We merely see the hatred and unhappiness, but in order for us to be free, we need to forgive the individual so that your life can be filled with copiousness. My household s ideas on the subject abortion are really broad, since none of them have of all time been in the state of affairs where they needed to take action ; but if I look at the inquiries asked and what the 5 interviewees answered, I would state that there is decidedly a negative intension to the word abortion , slaying and ferociousness, all Acts of the Apostless that are most surely non from God. The common feeling is that abortion should be eliminated ( particularly all the barbarous methods of abortion ) and instead think of alternate ways. Rescue those being led off to decease, hold back those astonishing towards slaughter. Proverbs 24:11 8. What professional organisations can advice you on abortion? They defend the defenceless Their purposes are: The protects human life and besides promote the value and being of a life They try to raise the rights of kids They help and back up pregnant female parents ( start of gestation up until existent birth ) Birth Right provides the loving option to abortion Another Organization that can help is the Birth right unit that is situated in Johannesburg and Durban This organisation will assist you if you are pregnant, scared, if you do nt desire to confront the universe and you merely necessitate person to listen. They help by: Giving you a anon. gestation trial Provide information on shelter places Give you apparels Make sure you have the necessary medical, legal and acceptance information When you find yourself on the out of boundss, we re here to assist. This non-profit organisation: Supply support to female parent s that have premature births and that have trouble or any complications during their gestation The intervene with the needful medical intervention, instruction Most significantly they provide a loving bosom and support Africa Cares for Life This Christian organisation provides you with all the necessary information if you find yourself in a crisis gestation. The provide preparation, resources ( medical, nutrient, apparels etc ) And Conferences with the needed advice and support 9. What support system is in topographic point in your school? To the Glory of God Doxa Deo College, a Christian school and college with the right values and ends set in topographic point. In Doxa we have a passion for God I which we strive to link to God on a hebdomadal base in congratulations and worship. A passion for people and service ; we learn to appreciate each other s uniqueness and at the same clip larn what it is to function those around you. A passion for unity, everything we do in Doxa is based on the illustration Jesus set for us. Passion for Tshwane and states is a manner of learning us how to make out and take duty for the demands around us. Passion for leading and growing ; at our school there are many chances to show and better out leading accomplishments, but even more we are able to turn, spiritually and emotionally. We see the dream God has for us. Even though we are a Christian school there are many things we to hold to confront, even the instance of abortion. About a twelvemonth ago, we had a state of affairs in our school, where a miss fell pregnant and chose to abort. The school handled it in a professional mode and supported the miss, her household and her category friends. The school announced what had happened so that no rumor could distribute. The miss was sent place for a few hebdomads in order to retrieve and after that she returned to school to happen the loving support of the school. Doxa will neer project anyone out because of their wickednesss, since it is non our topographic point to reprobate, but merely God. As a household of Christ Doxa s support system is non merely organize direction and managers, but instead the support from God that is worked through his adherents. 10. Decision: Abortion is slaying! This is my decision- abortion is slaying a incapacitated kid and to me personally, I believe that God did non mean for this to go on. In one physical cell, there is already life. It is the beginning of life and it remains the same through all the phases of development ( from inside the female parent s uterus to outside ) Seven yearss after the adult female has missed her catamenial rhythm, the babe s bosom has already started pumping blood through the premature vass. Life has already been initiated by: the breath of life ( Genesis2: 7 ) and so it will go on, until the last breath is given-you dice. God says that at a clip we will hold to stand up for our religion even if it means you might decease, but Christians have to take a stance for what we all SAY we believe. In America, Obama is a broad in many state of affairss, one of them being abortion. He approves the method of Partial birth control and he even said yes to kill a babe that has survived, but suffered an abortion. Abortion is a personal determination non a legal argument so why are we reasoning about whether abortion is acceptable or non. We are seeking to warrant the universe s actions by doing it legal, good that is non true in the eyes of the Lord. Merely He can give and take life and if you choose to travel against His ways, you will one twenty-four hours hold to stand before the King of Kings and warrant your actions of slaying one of His creative activities. Our Father is a God of grace, but God did nt mean for us to slay something that He gave as a gift. The Lord will bless you for your determinations and good plants, but he will besides keep you accountable for your wickednesss. Even though we might be right now ; here on Earth with the Government in charge and as our justice, we will one twenty-four hours bare the effects of our actions when we arrive in Eden and have to confront the true, all-powerful judge-GodaˆÂ ¦ Pregnancy is a gift of God, to be able to transport a kid inside a adult female is a miracle and God planned life in this manner. By aborting you are slaying, which is wickedness. Number 35: 33 Do non foul the land where you are. Bloodshed pollutes the land, and expiation can non be made for the land on which blood has been shed, except by the blood of the 1 who shed it. Abortion is legal in the universe s eyes, but non in God s. Although slaying is incorrect in the eyes of the Lord and besides the Government ( since you can be sent to imprison for slaying, but so what about abortion? ) the universe still chooses the easy manner out-terminate the pregnancy-abortion. It is now your ain determination that will do the difference, live with the babe God has made inside of you, or foul the land with the blood of guiltless babes. I say NO to abortion! God says that to slay is sin and besides sex before matrimony is sin. If you abstain from sex before matrimony you would nt necessitate to hold to abort and you will be populating the manner God has proposed for us to populate. So why would we wish to follow the footfalls of America where 1.6 million unborn babes are murdered every twelvemonth? Rather have the babe and live up to your moral criterions and happen an alternate method, by giving the babe up for acceptance or traveling to a installation where they can back up you and your babe. If I fell pregnant, I would NOT abort, I will populate with the kid God has given me and I know that God will travel with me and be my pillar of strength when I need Him, God says: Trust in the LORD with all your bosom and thin non on your ain apprehension. Proverbs 3:5 And that is precisely what I will make ; I wo nt tilt on my ain apprehension, something that the universe should make every bit good. Mother Theresas: I ever say one thing. If a female parent can kill her ain kid, so what is left of the West to be destroyed? It is hard to explicate, but it is merely that. Everyone has the right to life, even an unborn childaˆÂ ¦ 11. Glossary Forcepss: An instrument used to pull out or pull strings something. Almost like a brace of tongs, used by a sawbones Ultrasound: This is really high frequence moving ridges that are excessively high for the human ear to hear. The sound moving ridges can resile of tissue and so an image is formed ( echogram ) during an ultrasound for a pregnant adult female Legislation: A proposed jurisprudence, the act of jurisprudence devising Fluctuates: Something ( whether Numberss, the conditions or certain forms ) change invariably. It goes up and down Asepsis: If the adult female is sterile, non able to gestate a kid Broad: open-minded, free thought, even if it means traveling against the will of God

Analysis of theoretical explanations of the relationship between Essay

Analysis of theoretical explanations of the relationship between technology and society - Essay Example 2.1 Technological determinism is a reductionist theory which holds the assumption that a society’s technology plays a crucial role in driving the development of its social structure as well as the cultural values (McLoughlin 1999, 32). The social structures evolve as a result of adapting to the technological change. The theory also suggests that technology moves on its own course which is normally independent of the human direction. It is therefore regarded to as an autonomous system which ultimately permeates all other sub systems of a society. Technological determinism contributes to the conclusion that emergence of automated technology inevitably raises the level of skill as well as the autonomy of the work force. According to Webster (2002, 34), technological determinism is also a clear explanation of the relationship between technology and society which asserts that technology plays an important role in determining the social existence within a society. In most instances technological changes act as catalysts for societal change. The changes are either seen as literally outside the context of the society or metaphorically outside the society. In addition, the technological developments take place as a result of natural logic which is not socially or culturally determined. As a result, the developments enact change and social adaptation (McLouglin 1999, 39). 2.3 The reason as to why I think they are perfect examples is due to the impact they have on the society and their autonomy nature. Bearing in mind that technological determinism refers to technology as an autonomous system, the quotes support the idea behind that. For example, robots are slowly being assimilated into the systems of our homes and lives whereby they will play a central role later in the century just like both the internet and combustion do now. In reference to technological determinism, the revolution of

Using examples of your choice critically examine how ideas about the Essay

Using examples of your choice critically examine how ideas about the nation or national identity have become an important part of contemporary culture and socie - Essay Example Britons constructed their identity in opposition to an â€Å"other†: Catholic France. Gender roles were central to this moderate Protestant national identity. By looking at eighteenth-century British writers such as Sir Walter Scott and by analyzing William Hogarths prints, it was clear how British identity was constructed as strong and â€Å"masculine† while â€Å"others† especially the French, were described as weak and â€Å"feminine† (Taylor, 2000: 63). National Identity as a Part of Contemporary Culture and Society: The diversity, the multitudinous cultural effects and the flexible symbols of the national produce an enormous cultural resource that is a seething mass of cultural elements. Culture, according to this conception, is constantly in the process of developing, of emerging out of the dynamism of popular culture and everyday life whereby people make and remake connections between the local and the national, between the national and the global, between the everyday and the extraordinary. However well established and institutionalised nations may become, they remain elusive, perpetually open to context, to elaboration and to imaginative reconstruction (Edensor, 2002: vi). There are several routes towards expressing identity that exist within this matrix, some branches of which wither, are renewed, and multiple connections which exist between cultural spheres according to Edensor (2002: 1) emerge. Despite the globalisation of economies, cultures and social processes, the scalar model of identity is believed to be primarily anchored in national space. Partly, then, the space in which culture and everyday life operates is indisputably the nation which is a social and cultural construct. Edensor: (2002: 3) states that the position of the state towards already existing cultures is complex, for certain cultures may be eradicated (especially in the case of ethnic or

Decision Paper Case Study Example | Topics and Well Written Essays - 2000 words

Decision Paper - Case Study Example Presently, the school has two payment models, which are the fixed tuition fee system and the after care school payment. In both instances, there are variations with how much parents would pay; especially with the after care fee. With the tuition fee, the difference in amount of money to pay comes in as a result of existing discount systems for parents who qualify and fall within discount criteria. With the after school system, the difference comes in how many hours a student would be engaged in the system. This means that the billing system is complicated because of the differences. However, the billing system is typically manual whereby parents have to make payments directly to the vice principal and in her office. One other situation that creates a bit of difficulty with the present billing and information system; apart from its manual nature is that the payment procedure allows for two modes of payments, which are paying in bulk and paying in installment. Generally, this involves high cost and time for the vice principal in keeping records of various times of billing that payments are made. But for the inability of the information system to handle complex processes including the billing system of the school, the school would have grown beyond its present grade 3 level. The fact of the case is that because the information system is highly manual and complicated, the administrative term of the school hardly have any extra time to undertake administration programs that are centered on growth and expansion. If the principals and administrative term had for the past twenty (20) years dealt with something more advanced and modern, they would have spent less time managing the billing system of the school such that they could have concentrated their time on publishing for the physical expansion of the school. Diagrammatically, the billing and information system uses Microsoft Excel software that contain the following data about students and payments. Student Name Pa rent Name discount on fixed fees Monthly fixed tuition fee Monthly fixed after-care fee Discounted fixed fees Monthly â€Å"drop-in† fees Total monthly fee Payment received Amount paid to date Amount outstanding Business Process Improvement The shortcoming of the old system is its manual nature, which makes working on the billing system cumbersome, difficult and time consuming. It was indeed based on these shortcoming and weaknesses that the new information and billing system was designed. The new billing system embraces and encompasses the new approach to technological development because it has its entire operational component rooted in technological operations. This is to say that there is virtually no need and use of manual manipulations to get the new system to run or start and complete a billing process. The new billing system is typically an online process that gives parents the pleasure of making payments from the comfort of their homes and offices. This means that th ere is a major advantage whereby the need to walk distances from people’s home to the school to make payment has been eliminated. The role of the vice principal to spend almost three quarters of her duties and time in the school overseeing the payment of fees will also stop. This means that there is going to be more time for the school to concentrate on its new expansion

Hypertension Case Study Nursing

Hypertension Case Study Nursing 1) CASE SUMMARY Mr. MS is a 58-year-old Malay male who was previously diagnosed with hypertension, gout and triple vessel ischemic heart disease. He first presented with chest pain in March 2010 where he was diagnosed with ischemic heart disease. He was unable to complete an exercise stress test and an angiogram done in Hospital Sultanah Aminah found him to have triple vessel disease. He was told angioplasty was not possible due to the severity of the blocks and was counseled for CABG but he was not keen. Meanwhile, he has had angina attacks 2 to 3 times per week every week since his initial diagnosis for the last 3 months, usually relieved by sublingual GTN and was currently admitted for the 4th time for chest pain not relieved by GTN. ECG done 2 hours after onset of chest pain showed ST depression of 2mm at leads I, aVL, V3 V6 and left axis deviation with no Q waves. Trop T was positive (2.75 ng/ml) at 4 hours after onset and other cardiac enzymes were also raised significantly. He was diagnosed with NSTEMI and treated with aspirin 300mg, IV morphine 2.5 mg, sublingual GTN 3 tablets and subcutaneous clexane 60mg BD for 3 days as well as continuing his current medication regime of simvastatin, metoprolol, cardiprin, ISDN, amlodipine and GTN. Following admission, he was well in the ward with no recurrence of chest pain and did not develop any new complaints. He was discharged after 3 days of inpatient treatment with instructions to attend his follow-up appointment at the cardio clinic in HSAJB on the 16th of June 2010 to make an appointment for surgery. Following this episode of chest pain, which he says is the worst so far, he is now quite keen for CABG. PATIENTS DETAILS I/C NUMBER: 510831015263 AGE: 58 SEX: Male DATE OF ADMISSION: 3/6/2010 R/N: 1348445 2) CLINICAL HISTORY Chief Complaint Chest pain for 1 day. History of Present Illness Mr. MS is a 58-year-old Malay male who was previously diagnosed with gout, hypertension and ischemic heart disease with triple vessel disease. He was awoken from sleep at about 10pm due to a central chest pain of sudden onset. He described the character of the pain as crushing in nature and radiated to his neck. This episode of chest pain was the most severe since he was first diagnosed with ischemic heart disease. The pain was associated with profuse sweating, body weakness and was not relieved by rest. However, it was relieved by sublingual GTN, of which he has a supply of. His discomfort was made worst by exertion so he lay in bed to recover. Despite this, he had another episode of chest pain 30 minutes later. He took the sublingual GTN again but this time, the pain did not resolve. He was then brought to the emergency department of Hospital Batu Pahat by his son. This is Mr. MSs fourth admission for chest pain since March 2010. Since his diagnosis of ischemic heart disease in March, he has experience angina attacks two to three times per week, especially on exertion such as when straining while passing motion. During these attacks, he uses sublingual GTN to relieve his symptoms and normally feels much better after that. He only comes to the hospital when GTN does not work to relieve his symptoms. Systemic Review Mr. MS does not experience symptoms such as palpitations, dizziness, headache, nausea, vomiting, orthopnoea, paroxysmal nocturnal dyspnoea, epigastric pain, shortness of breath, fever, and had no syncopal episodes. He also does not have loss of appetite or loss of weight. Bowel and urinary habits are normal. His sleep has not been affected until this current episode whereby he was awoken by the chest pain. Past Medical History Mr. MS was diagnosed with hypertension 6 years ago when he had an episode of headache. He has been on medication since and was on regular follow-up with KK Rengit. He was diagnosed with gout 5 years ago when he had a left big toe swelling which resolved after some medication. He is not on long term medication for gout. Mr. MS was admitted for the first time 5 years ago in 2005 when he had bilateral renal calculi. He was subsequently referred to Hospital Sultanah Aminah for further management of this problem and it has since resolved and does not have follow-up anymore. Mr. MS was diagnosed with ischemic heart disease in March 2010 when he presented with chest pain for the first time. Following his recovery, he underwent a stress test in Hospital Batu Pahat but according to him, was unable to complete the procedure due to chest discomfort. He was referred to the cardiology unit in Hospital Sultanah Aminah for further management where an angiogram was performed and he was told to have triple vessel disease. He was also told that angioplasty was not possible due to the severity of the blocks. He was recommended to have Coronary Artery Bypass Grafting (CABG) but as of yet, no appointment has been made as he was still unsure of going through with the procedure. Following this episode of chest pain, Mr. MS has decided that going for the CABG is the only thing that will keep him alive. His current medications include: Tab Simvastatin 20mg OD Tab Metoprolol 75mg BD Tab Cardiprin 100mg OD Tab Isosorbide Dinitrate (ISDN) 5mg TDS Tab Amlodipine 10mg OD Sublingual Glyceryl Trinitrate (GTN) PRN He is compliant to his medication regime. Mr. MS is not known to have diabetes or hyperlipidemia. He also does not have any known food or drug allergies. Family History Mr. MS is the 3rd of 9 siblings. His father had hypertension and passed away a long time ago due to unknown causes. His mother and other siblings are healthy. None of them have hypertension, diabetes, ischemic heart disease or malignancy. Social History He lives in a kampung in Rengit with his wife and 5 children. Mr. MS does not smoke nor consume alcohol. He works in a palm oil plantation. The distance from his house to Hospital Batu Pahat is about half an hour. On further enquiry, Mr. MS says that the cost of the CABG is about RM1000, which he can afford. 3) FINDINGS ON CLINICAL EXAMINATION (Mr. MS was examined by me 9 hours after onset of chest pain) Mr. MS was alert, conscious, and communicative. He was not in obvious pain or respiratory distress. He was lying down comfortably on his bed. There were no tendon xanthomata, xanthelasma, pallor, corneal arcus or pedal edema. His JVP was not raised. His clinical parameters are: Blood Pressure : 158/94 mmHg Heart Rate : 94 beats per minute. Regular rhythm Respiratory Rate : 20 breaths per minute Temperature : 37Â °C SpO2 : 97% under room air On examination of the precordium, the apex beat was located at the 5th intercostal space on the midclavicular line and was normal in character. Parasternal heave was not felt and there were no thrills. First and second heart sounds were heard. There were no murmurs or added heart sounds. On examination of the chest, there was no deformity and chest expansion was equal on both sides. Percussion and tactile vocal fremitus was normal and equal on both sides. On auscultation, vesicular breath sounds were heard throughout all lung fields with good air entry. There was no wheezing or crepitations heard. On examination of the abdomen, it was soft and non-tender. There were no masses felt. Bowel sounds were heard and normal. 4) PROVISIONAL AND DIFFERENTIAL DIAGNOSES WITH REASONING Provisional Diagnosis Acute myocardial infarction with underlying triple vessel ischemic heart disease and hypertension With a history of diagnosed triple vessel ischemic heart disease with multiple episodes of angina attacks since the initial diagnosis, it is highly likely that Mr. MS is presenting with an acute coronary event and this should be a priority until proven otherwise. This is evidenced by the presentation of central, crushing chest pain of sudden onset that radiated to the neck and associated with profuse sweating and body weakness which is classical of a myocardial infarction. Mr. MS will require immediate investigations such as an electrocardiogram and cardiac enzymes to differentiate the acute coronary syndromes so that the appropriate management may be instituted for him e.g. if he has an ST-segment elevation myocardial infarction (STEMI), he will require myocardium-saving thrombolytic therapy to disrupt the ischemic event. As Mr. MS did not present with features such as acute shortness of breath, loss of consciousness and severe palpitations, it seems that he does not have complicati ons of acute myocardial infarction but these developments should be watched out for throughout his admission as complications may arise later. Differential Diagnosis Pulmonary embolism Pulmonary embolism is a possibility that can be considered when a patient presents with an acute chest pain that is accompanied by shortness of breath, hemoptysis, tachypnea, fever and even cyanosis and collapse in severe cases. Furthermore, the chest pain is of a pleuritic nature, of which it is worsened on breathing, and a pleural rub can be heard on auscultation of the chest. However, Mr. MS did not present in such a way. At the same time, Mr. MS did not have risk factors such as a deep vein thrombosis, prolonged immobilization or recent surgery. It is still highly likely that Mr. MS has suffered an acute myocardial infarction, and an ECG would help to differentiate between the two as pulmonary embolism might show the classic S1Q3T3 pattern of right axis deviation or right bundle branch block. Either way, the diagnosis should be made quickly so treatment may be instituted before his condition becomes worse or complications develop. Aortic dissection Aortic dissection presents as an acute onset chest pain that is tearing in nature, and often radiates to the back. It is often confused with myocardial infarction due to its presentation but differences include the lack of profuse sweating, signs of heart pump dysfunction and a normal ECG. Risk factors are usually uncontrolled hypertension, connective tissue disorders or chest trauma. Mr. MS has hypertension, but is under control, and does not have the other risk factors. A diagnosis of myocardial infarction should be the priority as thrombolytic therapy is vital, but if there is any reason to doubt that diagnosis, then further investigations should be performed. 5) IDENTIFY AND PRIORITISE THE PROBLEMS 1. Acute chest pain Mr. MS has acute chest pain with features very suggestive of a classical picture of myocardial infarction as he presents with crushing central chest pain that radiates to the neck and associated with profuse sweating and weakness. Given that he is known to have triple vessel ischemic heart disease and that he has suffered many angina attacks since his initial diagnosis, it is highly likely that he is having an acute myocardial infarction. Without further a due, he needs an electrocardiogram (ECG) and cardiac enzymes tested to distinguish between the different acute coronary syndromes so that the appropriate treatment protocols may be initiated for him as soon as possible to disrupt the ongoing ischemia. As Mr. MS is having severe chest pain that may overstimulate his sympathetic system and cause further ischemia, he will require immediate supportive therapy such as effective pain medication and oxygen therapy. 2. Triple vessel ischemic heart disease awaiting CABG Mr. MS was diagnosed with triple vessel ischemic heart disease when he first presented with chest pain in March 2010 and has since experienced many episodes of angina. Given his diagnosis and disease pattern, he is at a very high risk of developing a severe acute coronary event that may prove fatal if the infarction is too extensive or if complications develop. As percutaneous revascularization with a stent or balloon was not possible for him, he will require a CABG to both relieve his symptoms and reduce his mortality risks in the long term. He was unsure of going ahead with the operation previously, therefore no appointment date was given for surgery. However, now that he has changed his mind, every effort should be made by both the doctors in charge of him here in Hospital Batu Pahat and in the cardiology unit of Hospital Sultanah Aminah to arrange for his surgery as soon as possible, given the circumstances of his condition. 3. Compliance to medication Mr. MS is on several medications for his triple vessel ischemic heart disease and will require revascularization surgery soon in order to decrease his mortality risks. However, waiting for a CABG in the government setting may take some time, even under dire circumstances due to the nature of the system. Therefore, it is extremely crucial that Mr. MS is compliant to his medication regime while awaiting a CABG to prevent another episode of infarction. He should be counseled to fully understand this and the situation of his ischemic heart disease. It is also the responsibility of his doctors to ensure that he is taking the right combination of medications with the aim to prevent another acute cardiac event. Meanwhile, a sufficient supply of sublingual GTN should be provided for Mr. MS in cases of angina attacks at home. He should come to the hospital immediately if GTN fails to relieve his symptoms. 4. Regular screening for comorbid diseases Mr. MS has not been diagnosed with diabetes or hyperlipidemia previously but these diseases are strong risk factors for the long term implications of his ischemic heart disease. Therefore, Mr. MS should be screened regularly e.g. twice yearly during his follow-up appointments. Early detection of diabetes is necessary so that treatment can start as soon as detected in order to prevent his ischemic heart disease from becoming worst than it already is. As for his lipid control, if his lipid profile is found to be outside the normal limits, the dosage of his medication can be increased as necessary. Following his CABG, he will need to maintain a healthy lifestyle of a good, well-balanced, low-salt and low-fat diet and regular exercise within his limits. 6) PLAN OF INVESTIGATION, JUSTIFICATIONS FOR THE SELECTION OF TESTS OR PROCEDURES, AND INTERPRETATION OF RESULTS 1. Electrocardiogram (ECG) To look for any changes that may indicate an ongoing ischemic event, such as ST elevation or depression and T wave inversion in order to support the diagnosis of an acute myocardial infarction so appropriate treatment can be started. Differentiation of ST segment elevation or depression is also crucial in initiating treatment as thrombolytic therapy is only indicated for ST-elevation myocardial infarction. Results: ECG on admission (2 hours after onset) shows sinus rhythm with ST depression at leads I, aVL, V3 V6 with left axis deviation. T wave was present and normal. Interpretation: The ST depression in the leads above indicate an ischemic event at the anterolateral sections of the heart. The lack of ST elevation concludes a diagnosis of either unstable angina or NSTEMI, depending on the levels of cardiac enzymes. There is no sign of old infarction. 2. Cardiac Enzymes To look for elevated levels of cardiac enzymes such as troponin T, creatinine kinase (CK), lactate dehydrogenase (LDH) and aspartate transaminase (AST) that will indicate myocardium ischemia and necrosis. If elevated, a diagnosis of NSTEMI can be made in accordance with the ECG changes. However, cardiac enzymes when done too early after onset may not show any rise in levels 1. This does not mean that necrosis has not taken place and the test should be repeated once more at 6 hours after onset 1. Results: Troponin T (4 hours after onset) 2.75ng/ml ↑ (12 hours after onset) (60 hours after onset) Normal Range (U/L) CK 997 ↑ 263 ↑

Planning for a Terrorist Emergency :: essays research papers

Preparing for a disaster at American Universities and Colleges has changed dramatically. Prior to September 11th higher education institutions merely planned for natural disasters. American soil in no longer as safe as it once was. In addition to preparing for tornados, preparing for hurricanes, preparing for earthquakes, and preparing for fires there is need to prepare for a terrorist attack. A natural disaster is an event of nature that takes human lives or destroys property. In contrast, a terrorist attack is a man-made event that takes human lives and destroys property. Terrorist attacks appear in many forms biological terrorism, chemical terrorism, explosive terrorism, nuclear terrorism, and radiation terrorism. Data gathered from FEMA confirmed that the majority of terrorist attacks were explosive. In 2002 there were a total of 199 international terrorist attacks against buildings. Out the 199, 70% of the attacks were bombings (Brown & Lowe 1-16). Since actions taken to plan for explosive attacks are similar to preparing and planning for other types of attacks, explosive attack recommendations and supplies would be sufficient to handle such emergencies. Knoy Hall on the well-regarded campus of Purdue University is emergency planning for a terrorist attack. There are many variable involved that make emergency planning for an explosive attack difficult, including the number of individuals in or around the targeted structure and the tactics used by terrorists to implement an explosive attack. The different approaches to planning will be discussed in depth later in the report. Following the implementation of the recommendations in this report Knoy Hall will be prepared for an explosive attack. Brief Overview Research by U.S. Home Land Security and FEMA has revealed that it’s possible to implement an effective plan for a terrorist based emergency. Several avenues were researched to better prepare for the emergency. The course of action that is selected must be well thought out. Instead of preparing the entire campus, the emergency plan is for the school of technology building, Knoy Hall. There are a large number of students, a large number of Purdue faculty members, and a large number of staff that utilize Knoy Hall. Campus police and fire department may not have ample supplies to handle a large scaled attack. Therefore a number of tasks have to be completed to prepare Knoy Hall for a terrorist attack. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Supplies must be purchased and stored. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  A storage facility for emergency items must be purchased and constructed. Planning for a Terrorist Emergency :: essays research papers Preparing for a disaster at American Universities and Colleges has changed dramatically. Prior to September 11th higher education institutions merely planned for natural disasters. American soil in no longer as safe as it once was. In addition to preparing for tornados, preparing for hurricanes, preparing for earthquakes, and preparing for fires there is need to prepare for a terrorist attack. A natural disaster is an event of nature that takes human lives or destroys property. In contrast, a terrorist attack is a man-made event that takes human lives and destroys property. Terrorist attacks appear in many forms biological terrorism, chemical terrorism, explosive terrorism, nuclear terrorism, and radiation terrorism. Data gathered from FEMA confirmed that the majority of terrorist attacks were explosive. In 2002 there were a total of 199 international terrorist attacks against buildings. Out the 199, 70% of the attacks were bombings (Brown & Lowe 1-16). Since actions taken to plan for explosive attacks are similar to preparing and planning for other types of attacks, explosive attack recommendations and supplies would be sufficient to handle such emergencies. Knoy Hall on the well-regarded campus of Purdue University is emergency planning for a terrorist attack. There are many variable involved that make emergency planning for an explosive attack difficult, including the number of individuals in or around the targeted structure and the tactics used by terrorists to implement an explosive attack. The different approaches to planning will be discussed in depth later in the report. Following the implementation of the recommendations in this report Knoy Hall will be prepared for an explosive attack. Brief Overview Research by U.S. Home Land Security and FEMA has revealed that it’s possible to implement an effective plan for a terrorist based emergency. Several avenues were researched to better prepare for the emergency. The course of action that is selected must be well thought out. Instead of preparing the entire campus, the emergency plan is for the school of technology building, Knoy Hall. There are a large number of students, a large number of Purdue faculty members, and a large number of staff that utilize Knoy Hall. Campus police and fire department may not have ample supplies to handle a large scaled attack. Therefore a number of tasks have to be completed to prepare Knoy Hall for a terrorist attack. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Supplies must be purchased and stored. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  A storage facility for emergency items must be purchased and constructed.