Video games kill Essay Example for Free

Video games kill Essay Video games have become very popular among many age groups especially teenagers. Its common for teenagers to spend hours playing video games, particularly games with violence, sex, and criminal behavior. This is a huge concern for many parents. One parent says, My kid is so lazy, all he does is play video games in the basement! I dont know what to do. Susan, another parent says, Its frustrating when my son plays video games when its a beautiful day out. I dont get it! Many parents tend to believe video games are a waste of time, antisocial, and believe their child will become violent. But most young people, especially teen boys describe video games as fun, exciting, and another way to spend time with friends. An interesting fact parents should know is video game violence can increase aggression in only some individuals, depending on their personalities. Research by Patrick Markey, PhD, sampled 118 teenagers and participants played a violent or a non-violent video game and then hostility levels were tested. Teenagers who were highly neurotic, less agreeable and less conscientious, are more likely to be affected by violent video games. Participants who didnt have these personality traits were not affected or only slightly affected. Surprisingly, research has also found violent content isnt the main draw for the younger audience. Boys especially, surround friendships around video games and are more interested in playing to compete and win. It can be similar to rough-housing play boys engage in as part of normal development. Its another outlet for competition, status or to establish a hierarchy in the group (Olson CK. Childrens Motivations for Video Game Play in the Context of Normal Development). One teen, Alastair says, Its exciting, its like playing football, a way to bond. Another teen, Mike C. said, Some of my favorite high school memories were on xbox live. Its an easy way to connect with friends. Teenage boys want to compete with one another but it doesnt necessarily mean that because a kid plays a violent video game theyre immediately going to go out and beat somebody up, says Dr. David Walsh, president National Institute on Media and the Family. Researchers at Mass General Hospital Center for Mental Health and Media, discovered teenagers who play violent video and computer games use it as a way to cope with feelings, such as aggression, frustration, and stress. Many other scientists and psychologists also think video games can make your child smart, teaching high level thinking skills such as multitasking, quick thinking, working cooperatively, memory and self-confidence. Playing a video game is similar to working through a science problem. Like students in a laboratory, gamers must come up with a hypothesis, says James Paul Gee, Professor of Education at the University of Wisconsin-Madison. For example, players in some games constantly try out combinations of weapons and powers to defeat an enemy. If one does not work, they change hypothesis and try the next one. Video games are goal-driven experiences, which are fundamental to learning. With a combination of concentration and rewarding surges, video games exercise and build muscle for the brain caused from neurotransmitters such as dopamine. Dopamine is a chemical released when we encounter something pleasurable, like when someone surprisingly finds a $20 dollar bill in their pocket. A teenager beating a level or using their favorite weapon to beat the enemy will release pleasurable feelings. Dopamine is very important for learning behavior and motivation for activities in our lives. This is a main reason teenagers love to play video games. But too much dopamine can become addicting. Parents should know the difference between a teen having fun and passing time opposed to being addicted to video games. Some signs of addiction are losing track of time, not eating and becoming irritable. One way to avoid video game addiction is teaching your children how to develop a balanced lifestyle. Also, create dialogue with your teen about the content of the video game. Showing interest in what your teen enjoys can open the door to a better relationship, improved communication and trust. If youre still frustrated with your teen, create an agreement about what you want changed. An agreement can be written or verbally explained about what is expected when it comes to chores, school, video games, or other responsibilities. If the teen, or even the parent breaks the agreement, both can talk about what happened or changes needed. Remember, be non-judgmental, acknowledge feelings, and listen when talking with your teen. Another form of effective communication is the use of I statements. It should replace the opposing You statements which implies judgment and blame, saying theyre at fault for playing video games. For example, a parent telling their teenager, You spend so much time playing video games, is not as effective as I am interested in knowing why playing video games are fun for you? Also, telling your teen what to do or how to feel will most likely upset them, making them feel controlled. Its best to be patient, manage anxiety and exemplify good behavior by showing them how to balance activities and express feelings. In addition, exposing your child to different activities can be very beneficial. Taking a trip to an art exhibit or sporting event can help teenagers discover new interests and learn other ways to be engaged. To sum up video game violence, one person who I think says it best is renowned comic-book author, Gerard Jones. He says, When we try to protect our children from their own feelings and fantasies, we shelter them not against violence but against power and selfhood. See more at: http://www. strugglingteens. com/artman/publish/DoVideoGamesKillES_130114. shtml#sthash. wtWmToi9. dpuf.

Microbial Analysis of Soil Essay Example for Free

Microbial Analysis of Soil Essay Abstract: soil samples were collected fortnightly from area near Dahisar River, A river in suburb of Mumbai. laboratory analysis started from July 2010 to September 2010. Total bacterial and fungal count were estimated by standard spread plate isolation. Isolated bacteria were subject to colony characterization and were estimated by their morphological and biochemical characters. As being a monsoon the occurrence of variation of different species were high. The microorganisms isolated from the soil were of staphylococcus strain and were gram positive, aerobic, coccus shaped bacteria. The fungal species were also identified, of which Aspergillus and Penicillium were dominant, followed by mucur, as sub dominant .This project aims to find out the water and soil quality of River and as it is flowing through an industrial area, to find out if it is getting affected by the Industrial pollutants. Introduction: Soil is the region on the earth’s crust where geology and biology meet, the land surface that provides a home to plant animal and microbial life (Pelczar et al., 1993). Soil teems with microscopic life (bacteria, fungi, algae, protozoa and viruses) as well as macroscopic life such as earthworms, nematodes, mites, and insects, and also the root systems of plants. The numbers and kinds of micro- organisms present in soil depend on many environmental factors: amount and type of nutrients available, available moisture, degree of aeration, pH, temperature etc (Prescott et al., 1999). Soil bacteria and fungi play pivotal roles in various biochemical cycles and are responsible for the recycling of organic compounds (Wall and Virginia, 1999). Soil microorganisms also influence above- ground ecosystems by contributing to plant nutrition, plant health, soil structure and soil fertility (O’Donnell et al., 2001). Soil is generally a favorable habitat for the proliferation of microorganisms, with micro colonies, developing around soil particles. Numbers of micro organism . In soil habitats normally are much higher than those in fresh water or marine habitats (Atals and Bartha, 1998). Bacteria make up the most abundant group of micro- organisms in the soil (3.0 x 106 – 5.0 x 108) per gram of soil, followed by the actinomycetes (1.0 x 106 – 2.0 x 107), fungi (5.0 x 103 – 9.0 x 106), yeast (I.0 x 103 – 1.0 x 106), algae and protozoa (1.0 x 103- 5.0 x 105) and nematodes (50 – 200) counts per gram of soil are wide differences in the relative proportions of individual bacteria genera found in particular soils (Atals and Bartha, 1998). Soil fungi may occur as free-living organisms or in mycorrhizal association with plant roots. Fungi are found primarily in the top 10 cm of the soil and are rarely found below 30 cm. They are most abundant in well-aerated and acidic soils (Domsch et al., 1980). Most fungi in soil are opportunistic (zymogenous). They grow and carry out active metabolism when conditions are favorable which implies adequate moisture, adequate aeration and relatively high concentrations of utilizable substrates (Postage, 1994; Miyanoto et al., 2002). In this research we isolate culturable heterotrophic bacteria and fungi from different top soil samples MATERIALS AND METHODS Laboratory analysis Preparation of materials The materials needed for this experiment include; glass wares (conical flasks, bijou bottles, pipettes, petri-dishes) and they were washed with detergents. These glass wares were rinsed thoroughly with clean distilled portable water and left to air dry before sterilizing them in the autoclave at 15ââ€" ¦C for 1 hour. Also, the laboratory cabinets on which the work would be carried out was swabbed with cotton wool soaked in methylated spirit to sterilize it before any microbiological analysis was carried out to avoid the growth and isolation of other organisms not present in the samples. After sterilization, the plates were allowed to cool to about 45 degrees before they were used. Microbiological evaluation Ten (10) grams of the soil sample for microbiological evaluation was weighed into 9ml of sterile water. Preparation of serial dilution goes thus: 1ml of the original stocks solution was poured into 9ml sterile distilled water and mixed thoroughly to give 10-2 of the original sample and this was done for each sample and the bottles labeled according to date of collection Isolation and Enumeration of Micro-organisms. 1gram of the samples was homogenized in 9mls of distilled water to obtain a ratio of 1:9 and the second diluted of each sample was plated using the pour plate technique. Sterile molten nutrient agar (NA), potato dextrose agar (PDA), macconky’s agar,(MA) manitol salt agar (MSA) and deoxycholate astrate agar (DCA) were used{the potato dextrose agar (PDA) was acidified). These agars were then added and left to solidify undisturbed. These plates were incubated 37oC for 24hours (incubation was aerobic) and the procedure was repeated using 10-2 finally the number of colonies per plates were counted and recorded. The acidified PDA was incubated at 25C for 3-7 days for microbial growth. Total Bacterial counts (Cfu/g) The total bacteria count for each sample was determined with the pour plate techniques using nutrient agar. The plates were incubated between 24hours at 370C and all colonies appearing on the end of the incubation period were counted using digital unlimited colony counter and the counts were expressed in colony forming unit per gram {CFU/g} of the sample. Colonies of bacteria developing on the plates were observed, isolated and reisolated on a fresh media until pure culture was obtained. Preparation of Pure Culture It is necessary to isolate organisms in pure culture before studying and identifying them because a pure culture originates from one cell. Characteristics colonies from the original culture on the plates were picked with a sterile wire loop (using surface streaking method) and this loop was used to make streak of the colony on the surface of newly prepared sterile agar plates of NA,MA MSA. These streak will space out the inoculants and discrete colony of a particular specie of organism and then incubated at 35-37oC for 24hours to enhance microbial growth. Distinct colonies were re-inoculated on another fresh agar plates in order to obtain a pure culture. The isolates were picked with sterile loop and streaked into prepared agar slants, labeled and incubated for growth after which they were kept in the refrigerator for future use and identification. Identification of Isolates These isolated bacteria were identified using both morphological culture characteristics (i.e. the color, shape, elevation, capacity, consistency, edge) and biochemical test (i.e. citrate, oxidase, indole, sugar fermentation, test etc.)and the bacteria were identified based on the results obtained from the above mentioned biochemical characterization results and the procedures include. Grams Staining Techniques A drop of distilled water was placed on a clean glass slide. The inoculating wire loop was sterilized by flaming until it was red hot (this is to prevent the invasion of unwanted micro- organisms that might be inhabiting the wire loop) in the blue flame of a Bunsen burner. The loop was allowed to cool and the small portion of each colony of microorganisms to be gram stained was picked and smeared in the drop of water (distilled) on the glass slide and then spread into a thin smear along the slide. The smear was air dried and passed through the blue flame. The smear was stained with 1%crystal violet and left for 1minutes (60secs) and then washed with running distilled water it was then stained again with Lugols iodine for another 60secs and also washed with running distilled water. The slide was decolorized rapidly with 75% alcohol in order to present the organism from having the color of the primary reagent and it was washed immediately with distilled water. The slide finally was flooded with a counter stain safranine (a secondary stain) for 60secons and also washed off with distilled water and allow to air dry. The slide was covered with a cover slide and observed under the microscope using oil immersion x 100 objective lens with immersion oil. The gram reaction of the isolated arrangement and the shape of the cell were observed and recorded. Gram positive (+ve) bacterial were characterized by a purple color (i.e. the primary stain) while the gram negative (-ve) bacteria were characterized by red color (i.e. the secondary stain) .This procedure is actually used to ascertain the component of each organisms cell wall. Motility Motility was determined by hanging drop techniques. Using loop, a little part of the colony of the organisms were grown in peptone water for 18hours and then placed in the grease free slide and covered with a Vaseline bound cover slip and then observed under x100 objective lens. A motile organism is then seen moving in the drop of liquid. Identification Of Mold Isolates Mold isolated was identified using cultural and morphological characteristics and according to (Fawole and Oso, 2001), microscopic observation was carried out using lacto phenol blue stain. Procedure for Mold Staining A drop of lacto phenol blue stain was dropped on a clean grease free sterilized glass slide and after this a sterile inoculating wire loop was used to pick the mycelium unto the glass slide from the mold culture .The mycelium was spread evenly on the slide. Teasing was carried out to separate the mycelium in order to get a homogenous mixture and the mixture was then covered with cover slips gently and then allowed to stay for some seconds before observing under x40 under the microscope. The microscope examination of actively growing mold was on the basis of structures bearing spores, presence or absence of septate. BIOCHEMICAL TESTS Catalase Test Catalase test demonstrates the presence of catalase enzyme by aerobic microorganisms. Catalase is an enzyme that catalysis the release of oxygen from hydrogen peroxide (H2O2). To test for catalase, a drop of 3% hydrogen peroxide solution was added to a slide and the organism to be tested for catalase production is brought in contact with the hydrogen peroxide. The production of gas bubbles however indicates a positive reaction and this shows that catalase enzyme is produced.(FawoleOso, 2001) Oxidase test This was carried out by placing a clean filter paper on the working bench or petri dishes and 2-3 drops of freshly prepared oxidase reagent was added to the isolate using a sterile inoculating wire loop. After this, a few quantity of oxidase reagent was added and a purple coloration was observed within 10-15minutes which indicated that the organisms is oxidase positive and according to Olutiola et al, 1991, a positive reaction is dependent on the presence of cytochrome. This test is also useful for the separation of Neisseria in mixed culture and in differentiating Pseudomonas from enteric bacteria. Indole test Olutiola et al, 1991, describes the test as one which is important in the differentiation of colonies and it depends on the production of indole from tryptophan by the organism. An inoculating loop was used to inoculate the organism into a test tube containing decarboxylase medium becomes violet. An uninoculated test tube serves as a control (i.e. remained yellow) Sugar fermentation test The ability of the isolates to utilize certain sugar as energy source was tested. If the organism does ferment a particular sugar, acid will be produced and gas may be produced or not. Acid production is indicated by color change of the medium from red to yellow and acid presence could also be detectable with a ph. indicator in the medium while the production of gas is indicated by a void produced in a Durham tube. The fermentation medium was prepared by 0.1g of sodium chloride and 0.1g of fermentable sugar (glucose) in 10ml of distilled water. An amount of 9ml of the medium was pipette into a test tube containing Durham’s tubes in replicates. 5ml of phenol red indicator was immediately discharged into the test tubes. The test tubes containing medium were sterilized in an autoclave at 121 o for 15minutes.After sterilization, each isolate were incubated in glucose Medium. An uninoculated test tube was also incubated for glucose to serve as a control. The test was also carried out using maltose, lactose, galactose, manitol, sucrose, fructose and mannose.(Olutiolaet al., 1991) Discussion: The abundance of bacteria and fungi in this study were typical of environment with high species richness and functional diversity. Despite the fact that it is possible that a number of bacteria and fungi may be missed in this study, the isolates could be readily assigned dominant (e.g. Bacillus sp, Aspergillus sp) or transient/succession roles in the isolation of organisms form different seasons, which form the basis of this study. In additions to the implications of the determination of the number of microorganisms during soil sampling, one should consider the qualitative aspect of the preservation of important species and groups of microorganisms and of the changes in these biochemical characteristics resulting from the variations in these counts. Although the results of this study would not be considered to be exhaustive, as it was done within the limits of facilities available in the laboratory, an insight into the population dynamics and distribution of culturable aerobic bacteria and fungi diversity has been elucidated. This is without prejudice to the possible influence which a substantial proportion of bacteria and fungi that are not culturable in vitro could have on the overall picture of event. It would require more modern technology (nuclei acid probes) to obtain such detailed overview of microbial diversity. This should be a subject of extension of this investigation in future. Conclusion Through this project, if emphasis is made on public health, the observation and findings show striking predominance of Salmonella typhi. And E.coli. E.coli being an enterobacter cause dysentery and S.typhi poses a great risk of typhoid. Health inspector and municipal authorities should look into this matter for further investigation and if possible improvement Acknowledgement Investigators are grateful to the Principal Management of S.V.K.M’s Mithibai College for constant encouragement support. And head of department of zoology Prof. V.V. Dalvie for providing me opportunities and Prof. Radhika D’souza, under whose guidance the project was successfully completed References 1 .Atals RM, Bartha R (1998). Microbial Ecology: Fundamentals and Applications. 4th Edition. Benjamin Cummings Publishing Company Inc. Addison Wesley Longman Inc. pp. 300 – 350. 2. Miyanoto T, Igaraslic T, Takahashi K (2002). Lignin–degradation ability of litter decomposing basidomycetes from picea forest of Hokkaida Myco.sci. (41): 105 – 110. 3. Domsch KH, Gaws W, Anderson TH (1980). Compendium of soil fungi 4. O’ Donnell AG, Seasman M, Macrae A, Waite I, Davies JT (2001). Plants and Fertilizers as drivers of change in microbial community structure and function in soil. Plant Soil (232): 135 – 145. 5. Pelczar MJ, Chan ECS, krieg NR (1993). Microbiology: Concept and Application International edition McGraw-Hill, USA. Pp 281-324. 6. Wall DH, Virginia RA (1999). Controls on soil biodiversity insights from extreme environments. Appl. Soil Ecol. (13): 137–150. 7. Fawole and Oso, 2001

Wound care essentials summative assignment

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

Creation and Evolution: An Eternal Debate Essay -- essays research pap

Creation and Evolution: An Eternal Debate   Ã‚  Ã‚  Ã‚  Ã‚  Many people have tried to reconcile the differences between creationism and Darwinism but few have succeeded. Any religious debate is seen as a very sensitive subject and the discussion about the foundations of certain religions generally becomes difficult. Darwinism, in relation to religious beliefs can become controversial; some say they can coexist and some say they cannot. Darwinism was not intended to be anti-religious, but religious activist have criticized the belief since On The Origin of Species was published in 1859. Common ground between the two subjects is a very rough place, but it can be achieved. Reconciliation between the subjects has been achieved but few are standing by it because even the compromise is controversial.   Ã‚  Ã‚  Ã‚  Ã‚  The beliefs of Charles Robert Darwin, as shown in his book On the Origin of Species, are controversial religiously and have been debated since its’ publication. Darwin writes â€Å"I see no good reason why the views given in this volume should shock the religious feelings of any one† (Darwin 329). This was not how religious activists saw the book; they attacked Darwin’s beliefs and stated it is in opposition of some religious beliefs. Darwinism is based on the basic belief of ‘natural selection’ and ‘survival of the fittest’. These are not separate thoughts when it comes right down to it. According to Darwin, the idea of ‘natural selection’ states that animals adapt slowly in accordance to their environment, and their DNA adjusts throughout generations. At first glance, this seems like a logical, non-controversial topic, but Creationist believe that â€Å"†¦all species were created by God and had not changed biologically† (Hirschberg 321). This is where the conflict comes in to play. Darwin believes that genes can mutate and change over generations to better adapt to environment. This belief has since been overturned by modern evolutionists. Hirschberg put it this way: â€Å"Today, evolutionists believe that mutations in genes produce the variations that natural forces select for survival. And, indeed, geneticists have traced ancestral relationships among species from the presence of similar molecular structures and DNA patterns† (Hirschberg 321). Instead of only bettering the species, the DNA shifts and the stronger of the species ... ...; there are others that rebel against the compromise. Overall not many have gotten very far in the compromise process and it does not seem promising. Works Cited Berra, Tim M. Evolution and the Myth of Creationism: A Basic Guide to the Facts in the Evolution Debate. Stanford, California. Stanford University Press. 1990. Darwin, Robert Charles. Past to Present: Ideas That Changed Our World. Ed. Stuart and   Ã‚  Ã‚  Ã‚  Ã‚  Terry Hirschberg. Upper Saddle River, NJ: Prentice Hall, 2003. Davis, Edward B. â€Å"The Christian Century†. Chicago. Jul 15 – Jul 22. 1998. Vol 115,   Ã‚  Ã‚  Ã‚  Ã‚  Iss. 20; pg. 678. Hirschberg, Stuart and Terry, ed. Past to Present: Ideas That Changed Our World.   Ã‚  Ã‚  Ã‚  Ã‚  Upper Saddle River, New Jersey: Prentice Hall. 2003. Holy Bible: New Living Translation. Tyndale House Publishers, Inc. Wheaton, Illinois. Housley, Kathleen. â€Å"The Christian Century†. Chicago. Jun 19- Jun 26, 2002. Vol. 119,   Ã‚  Ã‚  Ã‚  Ã‚  Iss. 13; pg. 39. Pope, Stephen J. â€Å"The Christian Century†. Chicago. Jul 13, 2004. Vol. 121, Iss. 14;   Ã‚  Ã‚  Ã‚  Ã‚  pg. 38.

I Am Tolstoy, But Not A Tolstoyian :: essays research papers

In 1828, somewhere in the countryside north of Moscow, Leo Tolstoy was born into the Russian nobility. Count Tolstoy, although acquainted with the finer things that life had to offer, new that the Romantic view of the world was false early in his life. His mother left this world when he was two, and his father undoubtedly told horrific stories of the chaotic Napoleonic Wars. This, coupled with the consecutive deaths of not only his father, but his favorite aunts and grandmother, all before his twenty-first birthday, a three year stint in the military during the Crimean war, and the works of masters such as Rousseau, Voltaire, Hegel, Darwin, Dickens, Gogol, and the New Testament contributed to the literary genius which is Tolstoy. As a realist, Tolstoy was committed to truthfully representing reality in literature. As a founder of a socio-religious movement, aptly named Tolstoyism, his goal was to enlighten the masses. The Death of Ivan Ilyich is a prime example of the merger of these two ideals. At first glance this is a simple tale of a "most simple and most ordinary and therefore most terrible" man’s life and death (1208). But upon closer scrutiny, we see that this is a stylized account of the Count’s own life. Much like Ivan, the Count married a younger wife, not so much out of love, as out of convenience. After a few years of marital bliss, problems arose. Both men tried to separate home and work, with the disastrous results of neglecting their wives. Although ideally matched socially, these two couple’s argued about everything from work and politics, to the children not eating their food fast, or slow enough. When Ivan dies, his wife wraps up his affairs, as best she can. Tolstoy, however, made out his will well before his death in 1910, and interestingly enough, leaves his wife of over 50 years relatively little of his possessions. Another similarity between the Count and the Judge is their deaths. Ivan’s "floating kidney," or "appendicitis," depending on the doctor, caused him great pain and discomfort for the last couple years of his life. Towards the end, he refused to see any doctors, and finally had a revelation. Tolstoy died the death of an eighty-two year old

Native Americans vs. European Colonists Essay -- religious beliefs, e

The European colonists and the Native Americans of North America had very different views on nearly everything they encountered in their lives. Living in vastly different cultures lead both groups to have two extremely different outlooks on four main topics; religious beliefs, the environment, social relations, and slavery, differences which the colonists used to their advantage when conquering the peoples of the New World. The colonists, by saying that the Native Americans were primitive and savage because of their differing and seemingly illogical attitudes, were able to do things that they could never have done to people they believed to be equals. Whether this was a conscious or subconscious method on the part of the Europeans remains hotly debated, but the fact remains that by pointing out the differences of the two main cultures as a negative denoting European superiority, the colonists were able to take the Native American lands and goods without much remorse. When this country began, there were few European colonists with the modern perspective of tolerance towards different cultures. Hardly anyone sought to learn about the Indian culture, very few adopted it as their own, and the majorities were often fearful and anxious toward their new neighbors. These four main differences in religious beliefs, the environment, social relations, and slavery, were what sparked the ill treatment towards the Native Americans, an atrocious treatment that would continue for the next three hundred years in America. Religious beliefs were very important to the first European Colonists who came to America. In Europe during the 1600’s, religion was something that decided a lot of things in a person’s life; what part o... ...iogrosso "The Joy of Sects" and Books on Spirituality and World Religion, Religion Discussion Weblog, Editorial Consultation, Spiritual Direction. Web. 4 Mar. 2011. . Popick, Jacqui. "Native American Women, Past, Present and Future." Lethbridge Undergraduate Research Journal 1.1 (2006). Web. 3 Mar. 2011. . Pritzker, Barry. A Native American Encyclopedia: History, Culture, and Peoples. Oxford: Oxford UP, 2000. Print. Roe, Melissa A. "Indentured Servants." EH.Net | Economic History Services. Lafayette College. Web. 4 Mar. 2011. . Taylor, Alan. American Colonies: The Settling of North America. London: Penguin, 2002. Print. Wiesner, Merry E. An Age of Voyages, 1350-1600. New York: Oxford UP, 2005. Print.

Bend it like Beckham Essay

All cultures have different ways of showing respect and how there life is. In Bend it Like Beckham director Gurinder Chadha shows us the Indian life with the character Jessminda. Jessminda’s dreams are more important than her culture so she does not want to be the typical traditional Indian girl her parents want her to be; it sets the tone of depressed, troubled, and motivated. Jessminda changes throughout the story. At first she is really depressed because she wants to play soccer but her parents won’t let her. The reason why they won’t let her is because her culture is against her playing a boy sport that shows body parts her culture is against showing. The author shows us the tone of depressed by having Jessminda act sad and rude towards her parents. Also he shows the tone of depressed by having calm sentimental music playing. For example, ff she follows her culture her parents will be happy and she will have to give up scholarships that she could have. If she plays soccer her parents will be mad at her but she will get what she’s been wanting. Then her best friend, Jules stops talking to her because she sees Jess kiss there soccer coach, Joe. The reason her friend got mad is because Jess knew Jules and there soccer coach. The author uses this fight with her friend to show more depression that Jessminda is going through. He shows by putting them together and have them argue and he angles the camera close up to show their emotions as there talking. Culture is a big part of our lives but do we always follow it or would we rather follow our dreams? Jess starts to become daring which makes her start getting in trouble. She does what she has to just so she can play in soccer games. For example her parents and sister leave but she acts like she is sick so she doesn’t have to go with them but once they leave she goes to play in a soccer game but her dad had to go back to the house and finds out that she isn’t home. He then goes to where her game is and watches her play. Her parent’s hate that she wants to play soccer but her dad sees how much she likes it but she’s sneaking out to go play. By the author putting in this scene, he is showing that sometimes people have to do what they need to just to get what they want. He shows us the process of Jessminda lying to her parents and going and playing the game. This shows that she is a troubled girl who will show how much she likes something that means something to her. Everyone has those moments when we have to sneak away to do something that we really want to do. In addition another example of her being troubled is when she starts falling in love with their coach. She knows her culture only allows Indian woman to date Indian boys that the family accepts. Her falling for Joe is risking her life and his. The author shows us being troubled by having them two alone, dark nights so they fall in love. She does spend a lot of time with Joe but only because he is her soccer coach. Everyone has moments when we do things that changes us as a person. Jess becomes motivated to playing soccer. If it wasn’t for her coach she would of quit right in the beginning when her parents told her she couldn’t play. The problem is if she doesn’t play she won’t get the scholarships she can get and she won’t go on to college. So her coach talks to her and tells her if she just plays this championship game she will have a scholarship because they will be out there watching how they play. The author uses this to show that there are chances out there. Another problem is that her sister’s wedding lands on the day of the championship game, and her parents will not let her miss her sister’s wedding. She is sad that she can’t go but until her dad sees that she is talking to the guy her parents want her to marry and he sees what’s going on. They then tell her dad that the championship game is going on and she’s missing it so he tells them to go. This example shows confident by Chadha having her dad give her a chance to play. She then goes to the game and gets more motivated that when she gets there Jules is happy to see her so they could play together. She then played and ended up making the winning goal. After the game the person who was watching them to see if they can get there scholarships went up to them and offered them there scholarships. While he is watching them play Chadha keeps having the camera go to him to show how he reacts to good or bad plays. The camera angles help shows motivation and confidence by they keeps repeating his reaction. Chadha has good parts and bad parts to get us thinking. If it wasn’t for her coach Joe she would have given up her dream to respect her culture but now she has a scholarship that leads her to a better successful life. Cultures are what people believe in and that they follow but sometimes there’s a negative side in our culture that cannot always be followed. Everyone changes as a person good or bad and have different types of attitudes towards what he or she wants or has. Jessmindas dreams were more important to her that she went against her culture but her dad accepted it.