Helicopter Emergency Medical Service

Helicopter Emergency Medical Service Air medical transport has only been used for the past 70 years. The first true air ambulance flight was during the Great War. A Serbian officer was transported from the battlefield to the hospital by plane. Air ambulance was being tested by different military organizations during the First World War. Schaefer Air services was the first United States air ambulance service, created in 1947. The Korean War was the big turning point for EMS helicopters. In 1950, the military was given authorization to use helicopters for medical purposes.These helicopters were used to evacuate injured patients from the battlefield during combat. The small helicopters were equipped with basket stretchers that were attached to the landing gear. The patients were transported outside of the aircraft, which did not allow for medical during transport. From January 1951 to January 1953 more than 17,000 patients were removed from the battlefield and transported to the hospita l by helicopter. The use of medical helicopter transport significantly decreased the causality/death rate among the people in combat.World War II death/causality rate was 4. 5 deaths per 100 casualties, whereas, the Korean War death/casualty rate was 2. 5 deaths per 100 casualties. The Vietnam War introduced to idea of patients receiving medical care during air transport. The Bell UH-1 also known as the Huey was the frost helicopter that was large enough to carry the patient and medical staff inside the aircraft. The state of Maryland started the nation’s first combined emergency service helicopter program, in 1969. This program was put into place by the Maryland State Police and the University of Maryland.The program joined together the state police, rescue and HEMS (helicopter emergency medical service). In 1972, St. Anthony Central Hospital in Denver Colorado was the first hospital to have civilian hospital-based helicopter transport. This hospital-based helicopter transpo rt system is still in use today and is now intergrated with Denver EMS. The attributes of helicopter transport are speed, accessibility, specialized personnel and technology. Modern medical helicopters are capable of sustain speeds in excess of 150mph. This allows for patients to be transported to a specialized care center much faster than ground transport.Using a helicopter allows for emergency medical personnel to access patients in places ground crews cannot go. A helicopter can take off and land in a vertical motion. Emergency medical helicopters are staffed with highly trained and skilled staff. EMS helicopters are equipped with highly sophisticated medical technology and can reach people across a wide geographical area. When considering the use of the EMS helicopter you should take all these attributes into consideration. If these attributes are not important, then the use of an expensive EMS helicopter should not be used.Air medical transport can pose its own stressors to pat ients, medical staff and medical equipment. These stressors are more predominant in fixed-wing operations rather than helicopter transport. Hypoxemia is the biggest threat to people who fly. However helicopters no dot exceed 1000 feet above sea level. Patients being transported by helicopter are at no significant risk of hypoxemia secondary to decreased ambient pressure. Acceleration of the aircraft is another factor that can stress the patient. Helicopter acceleration force is not that much different than that of ground transport.Acceleration is more significant in fixed-wing aircraft. Noise is a major issue when it comes to helicopter transport. The noise inside the helicopter causes problems for the medical staff. The noise may hinder the medical staff from hearing lung sounds. The staff must use headphones and an intercom system to communicate. Vibration of the aircraft is another problem for the patient and staff. The vibrations can cause fatigue and discomfort to the patient. Vibration can also cause monitoring errors and equipment malfunction. Air medical transport has a few cons but when life is on the line these issues seem minor.Each helicopter has its own transport team. The transport team may consist of a pilot, registered nurse or paramedic, and can include EMT’s and EMT-I’s. Some flight crews include a physician. Physicians on fight crews have posed a lot of controversy as to whether a physician as a crew member improves the outcome of the patient. Each crew member must undergo many education courses as well as hands on training before being employed by HEMS. Safety is the most important aspect to HEMS. Emergency medical helicopters have an alarming history of crashes.The National Transportation Safety Board conducted a study to determine the major causes of helicopter crashes. Important areas of flight risk are the pilots, the mechanics of the aircraft, crew training, maintenance, weather conditions, time of day, and landing sites. The study showed that poor weather conditions posed the greatest risk for helicopter crashes. Since, the study many improvements have been made to improve the crash rate. It has been said that the sole decision is set on the pilot as to whether it is safe enough to take the flight or not.The pilot must consider the weather conditions, aircraft maintainence, and crew readiness. Medical personnel cannot make the decision to take the call. Medical personnel should not tell the pilot the nature of the call, because this may deter the pilot’s judgment. Currently the Federal Aviation Administration is looking to make changes in the safety procedures of HEMS. Air medical transport is generally used in for two reasons, rescue and inter-hospital transfer. Helicopter transport is very expensive and is potentially dangerous.Rescue helicopters are dispatched by emergency personnel at the scene. The helicopter reports to the scene of the accident or illness. When should a EMS helicopter be dispatched? EMS helicopter should only be called out when speed, accessibility, specialized equipment and personnel are all needed to save life or limb. Inter-hospital air medical transport is generally used to transfer critically ill patients to another hospital that suites the needs of the patient. There are two types of landing sites for EMS helicopters. One type is the controlled site. The controlled site located at hospitals.These landing sites are constructed to safely accomindate the aircraft. The second type of landing site is the uncontrolled landing site. The uncontrolled landing site is landing at the scene of an accident. The landing site is selected by the ground EMS. The pilot looks at the site and determines if it is safe to land or not. Ground EMS are trained on how to chose, and mark a landing site. Ground EMS personnel are also trained on how to behave around the aircraft. When a patient is going to be transported by air the ground EMS must prepare the patient f or transport.The EMS ground crew should have the patient stabilized as much as possible before transport. Another way ground EMS can prepare the patient is to intubate a patient that has a high potential for loss of airway. Good communication is the biggest factor in a successful transport. Ground EMS typically has radio communication with the helicopter. The communication between the two should be maintained until after the helicopter takes off. Maintaining good communication allows the flight crew to inform ground EMS of any major, unexpected patient complications or malfunctions of the aircraft.EMS helicopters must have well trained, diverse flight crews. These crew members must be able to perform their duties on the scene of an accident and while in flight. The crew members are trained to handle many different types of patients such as drowning, burns, spinal cord injuries, heart attacks, pediatric and neonatal patients. The flight nurse is responsible for the patient assessment , and interventions before loading the patient on the aircraft. The flight nurse must know how to use all the equipment and know all the safety guidelines pertaining to the aircraft.There are many different requirements to becoming a flight paramedic. A person who wants to become a flight paramedic must be able to work in chaotic situations. Becoming a flight paramedic involves a lot of hard work and dedication. The person who wants to become a paramedic must have at least one year EMT experience and many different certifications such as: CPR, Basic Life Support (BLS), Basic Pediatric Life Support (BPLS), Basic Trauma Life Support (BTLS), Neo Natal Life Support (NALS), Advanced Cardiac Life Support (ACLS), and Pediatric Advanced Life Support (PALS).In order to become a flight paramedic this person would have to have at least 5 years critical care experience in a high volume progressive EMS system. Becoming a flight paramedic is no easy task.References Formm, Jr. Robert E. â€Å"Air medical transport†. Journal of Family Practice. March 1993. http://www. findarticals. com/p/articles. html . 1 Oct. 2010. Kreisher, Otto. â€Å"The Rise of the Helicopter During the Korean War†. Aviation History Magazine. History. net Jan 2007. http://www. historynet. com/the-rise-of-the -helicopter-during-the-korean-war. htm. 1 Oct. 010 Federal Aviation Administration. â€Å"Helicopter Emergency Medical Service Safety. †8 June 2010. http://www. faa. gov/news/fact_sheets/news_story. cfm? newsID+6763. 1 Oct. 2010. Lenworth M. Jacobs, MD, MPH, FACS, and Bennet, Barbra, RN, MPH. â€Å"The Critical Care Helicopter System in Trauma. † Hartford Conneticut.. http://www. ncbi. nlm. nih. gov/pmc/articles/PMC/articles. 1 Oct. 2010 Gentile. Rosanne. â€Å"How to Become a Flight Paramedic: Required Qualifications and Education. † Associated Content. 18 August 2008. http://associatedcontent. com. 1 Oct. 2010

Malaysian Economics

2 – CAUSES OF INEQUALITY OF INCOME DISTRIBUTION 2. 1 Differences in education During the British rule, each ethnic group also generally experienced different education systems. Most Malays were educated in the government school system located in the rural areas that used the Malay language as the medium of instruction. The Chinese on the other hand sent their children to the Chinese medium schools, which mere established by Chinese voluntary associations.Nevertheless , the elite segment of each ethnic group generally sent their children to the English medium schools located in the urban areas, where the quality of education was far better than the rural Malay-medium school. Furthermore, most secondary and tertiary education was available in the urban areas with English as the medium of instruction. Those who were educated at the English medium schools tended to gain positions in the civil service, commerce, business, and professions. Since most of the Malays were educated in t he rural Malay medium schools, this indirectly limited their upward social mobility. . 2 Differences in skills Since Malay only received the education from government school in rural areas, the skills were limited. Lack of skills and knowledge were the factors of unemployed. This will worsened the situation of poverty and income disparities between the ethnic groups. Sectoral employment of Bumiputera and non-Bumiputera (%) in peninsular Malaysia, 1970. Sector| Bumiputera| Non-Bumiputera| Primary| 67. 6| 32. 4| Secondary| 30. 8| 69. 2| Tertiary| 37. 9| 62. 1| Notes: Primary (agriculture)Secondary (mining, manufacturing, construction, utilities, and transport) Tertiary (wholesale and retail trade, finance, government, and other services) 3. 3 Differences in access to capital A majority of non-malays are usually found to be living in the southern and western states of Malaysia , such as Pulau Penang and Kedah. These states form modern urban sectors and also modern rural sectors which a re playing the important roles in the economic activities. On the other hand, the Malays lived in the northern states of Malaysia, and they are indeed in the traditional rural sector.This imbalanced development had result the imbalance capital gain among the ethnic groups. Wealth Decomposition by Asset Classes in 2007 Asset Classes| Bumiputera| Chinese| Indian| Savings| 567| 2 795| 1 026| Investment Assets| 1 853| 4 629| 2 058| Financial Assets| 2 419| 7 423| 3 083| Real Estate| 70 453| 120 903| 84 146| Wealth| 72 873| 128 326| 87 229| 3. 4 Differences in unemployment pattern The supply of skilled manpower in their own field is the main problem in employment restructuring. Despite the limited success of bumiputera students, the presence of skilled and qualified bumiputera workers and professionals are inadequate.A few factors that contribute to this problem are such like limited accessibility to modern educational facilities and quality educational or even low family income. Bumiput era are mainly attracted to the public sector and lately the bumiputera states the record for having the highest employment rate among malay university graduates. Although the manufacturing sectors display a tremendously high rate or malay labor force, most of them are employed in the lower level or non-manegerial level of occupations.

Barn Burning An Endless Circle Essay Research

Barn Burning: An Endless Circle Essay, Research Paper Barn Burning: An Endless Circle William Faulkner? s short narrative? Barn Burning? is the narrative of a southern adult male forced into a function by society. ? Barn Burning? takes topographic point in the station Civil War South where a mans topographic point in society is derived by their actions during the war. Ab Snopse, a adult male who served both the North and the South, is plagued with his non-allegiance and failure to accept authorization. When Ab comes into struggle with his employer, he finds himself taking control from the authorization figure, and returning back to his materialistic ways. Having no commitment, Ab makes the move from assisting manus to the enemy by firing down barns. Along with many of Faulkner? s short narratives, ? Barn Burning? is set in the fanciful Mississippi county of Yoknapatawpha. During the Restoration of the South, the clip period following the Civil War, the lone thing that kept the South alive and running where the memories of fallen heroes and the belief that the South would someday recover the position that it had one time held. Families like the Sartorises and the de Spains were glorified and praised for awards that their household members had achieved during conflict. The award that households like these were granted placed them in public offices, and gave them chances to thrive where others could merely woolgather approximately. This same award seemed to transport on to those who shared the names of the great war heroes. ? ? Hey? , the Justice said. ? Talk louder. Colonel Sartoris? I reckon anybody named for Colonel Sartoris in this county can? t aid but state the truth, can they? ? ? ( Kennedy 163 ) . On the other manus, the Snopses are viewed as dishonourable. During the war, Ab Snopse was considered a soldier of fortune for functioning both sides of Thursday e manner. ? †¦nights passed during those four old ages in the forests concealing from all work forces, blue and grey, with his strings of Equus caballuss ( captured Equus caballuss, he called them ) ? ( 165 ) . Ab stole Equus caballuss from the North and the South, to gain a life. He was even shot by a Confederate soldier, ? His male parent turned, and he followed the stiff black coat, the stringy figure walking a small stiffly from where a Confederate provost? s adult male? s musket ball had taken him in the heel on a stolen Equus caballus 30 old ages ago†¦ ? ( 164 ) . Actions like these caused the community to look down upon the Snopses, which in bend caused Ab to raise retaliation upon his antagonists. When Ab comes into struggle with an employer, he reverts to his old Civil War ways of non commitment to profit himself. Mayor de Spain accuses Ab of deliberately destructing his carpet. After Ab? s efforts to repair the carpet fail, de Spain charges him 20 bushels of maize for the amendss. Ab, experiencing that 20 bushels are excessively steep a monetary value for the amendss, takes de Spain to tribunal and sues him. The Justice of the Peace lowers the mulct for the amendss, but Ab is still non satisfied. Feeling unjustly punished, Ab does the lone thing that he knows, he burns down de Spains barn, and is shot and killed in the procedure. Ab has neer held an commitment to any adult male or thing. His life is one of self-preservation. During the war he worked for both sides without commitment, bound merely by who was paying. In life after the war he has non changed one spot. He travels from farm to farm, sharecropping to supply for his household. When he feels force per unit area from an authorization he takes the power off from them by firing what they own. His commitment to an employer lasts merely every bit long as he retains the power. Once that is gone, he merely takes it back by force, and moves on.

Waste Disposal Practices Essay Example | Topics and Well Written Essays - 2250 words

Waste Disposal Practices - Essay Example Waste management is an area that directly affects most businesses and is highly legislated by laws that can be difficult to apply and interpret. The price of waste disposal has increased significantly. The present study will evaluate the current waste disposal practices through analyzing the waste hierarchy i.e. 3 R's (Recycling, Re-use, and Reduction). In the process of evaluation of different models of EMS i.e. ISO 14001, ACRON (BS 8555), Environmental Management and Audit System (EMAS), the study will evaluate the different systems and try to conclude the best-fit system for the company through which waste management could be done. The present study use both qualitative and quantitative methodologies e.g. interviewing the key informants, questionnaire survey and evaluation through quantitative analysis. Rationale of study: Sustainability has become a broad church in which the congregation ranges form governments to multinational corporations from non-governmental organizations to medium-sized and small companies and from aid charities to private individuals. At a corporate level, even the smallest business is touched by issues such as environmental regulations, standardization and business standards, occupational health and safety, traffic congestion, land and energy use, waste management and corporate social responsibility. Business needs to be more aware of how its actions impact on the environment and human health. Importantly for businesses, risk is determined by several factors, not just the intrinsic hazards of an activity or plant. This is where environmental management systems and procedures can reduce the risk of environmental accidents. We believe that a well-planned and well-implemented environmental management system (EMS) will help to improve the management of environm ental risks from the activity. The effectiveness of organizations EMS's or procedures will be part of our assessment for judging what does and does not constitute 'real' risk. By identifying, managing and implementing responsible environmental practice, it makes good business sense and is synonymous with a well-managed organization. Background: Every business creates waste, but many businesses have demonstrated that huge savings can be made by managing it better. Good EMS practices are also important to make sure to keep with in the law, which is changing rapidly. Many

Cynthia Cooper and WorldCom Essay Example | Topics and Well Written Essays - 1500 words

Cynthia Cooper and WorldCom - Essay Example This expose elucidates on the appropriate decision that Cynthia should take to deal with this issue. From the onset, it is crucial to point out that the right decision for Cynthia would be reporting these fraudulent acts to her superiors without making the information public. In order to make her case strong, Cynthia should use the findings from the additional investigations she carried out in order to ensure that the exposure has enough merit. However, it is crucial for her to seek another job before taking any action since the decision taken might leave her jobless. Any decision that one might take in such a situation has various implications. One such implication would be on the families affected by the whistle blowing in case of termination of careers and effectively the source of livelihood. Cynthia Hooper is no exceptional and has to consider her career and family and the careers of other employees, something I would do in her shoes. According to Sissela Bok, â€Å"Would-be whistleblowers confront the conflict inherent in all dissent: between conforming and sticking their ne cks out. The more repressive the authority they challenge, the greater the personal risk they take in speaking out† (as cited in Donaldson & Werhane, 2007). In this regard, there is a big risk of one’s livelihood and that of the family and the career of the whistleblower in case the superiors view such acts as dissent. Donaldson and Werhane (2007) further support this idea by stating that, â€Å"When audiences are not free to receive or to act on the information-when censorship or fear of retribution stifles response-then the message rebounds to injure the whistleblower.† The most important reason for reporting the extra findings indicate that Cynthia is showing responsibility by indicating the extra steps taken towards unearthing the truth. When making this decision however, it is crucial for her to remember that she may face accusations

W2 BA541 Disc Identifying Customers Essay Example | Topics and Well Written Essays - 250 words

W2 BA541 Disc Identifying Customers - Essay Example As such, the organization could be interpreted as more market-driven, rather than customer-oriented (Peppers & Rogers, 2010). In contrast, Johnson and Johnson’s credo is simply stated as â€Å"the values that guide our decision making are spelled out in Our Credo. Put simply, Our Credo challenges us to put the needs and well-being of the people we serve first† (Johnson and Johnson, 2014). Obviously, this organization is customer-driven. The effect is therefore manifested in terms of one’s trust and commitment to patronize the products of Johnson and Johnson’s more through being ensured that they put me first in their commitment of service. As such, even though these organizations are considered large in scale and their volume of customers (according to products and geographic location), both Unilever and Johnson and Johnson could manage their data according to products and even, geographic location across different countries; yet, much market research could have been undertaken by Johnson and Johnson to ensure that the needs, drives, and demands of the customers are taken into consideration during product development, launching, marketing, and sustaining continued patronage, in a longer time

Womens Leisure Essay Example | Topics and Well Written Essays - 750 words

Womens Leisure - Essay Example However, derby is popularly known as a type of rough contact sport. This is the reason why both male and female players may allow themselves some form of violence, roughness or even cheating strategies if they believe they have to win. At my school, athletes are perceived as physically healthy individuals and ones who are popular among members of the opposite sex. Moreover, the girls’ and boys’ athletic programs are usually perceived as a way for athletes to improve not only their physical health but also their self-esteem and popularity. Personally, I watch men’s professional sports more than women’s, especially basketball as NBA is more exciting to me than WNBA. It is hard to say why but as a man who is into basketball myself, I would usually prefer watching men play sports than women do it. Perhaps, it is the relatively higher level of aggression in men’s professional sports that makes them widely watched compared to women’s. Nevertheless, occasionally I am amazed whenever I see a woman doing a man’s job, especially when professional female athletes get to be really rough on the field, in the court or in the ring. Sports are basically all about competition, and so people are expecting a good and rough fight. This is akin to something that will maintain the adrenalin rush. This is also the same feeling the Romans perhaps once had while watching gladiators kill each other at the bottom of the Colosseum more than two thousand years ago. When it comes to the movie Whip It, Bliss seems to show doubt about trying out for the derby team because she herself is an indecisive woman with no idea about what the future would bring her. Moreover, she does not believe her mother Brooke would be proud of her if she played derby. Brooke wants her to be a beauty contestant like her in the past. Moreover, Bliss may be hesitant at attempting to do derby. This is because she knew that in order to be a professional derby player, on e has to be extra tough although one is female. She may have observed this since the first time she saw the Hurl Scouts and Holly Rollers played. Bliss and Brooke are very different from each other when it comes to leisure and recreation. Brooke likes shopping and is into beauty contests and other activities that bring out the refined woman in her. She views herself as usually right in her decisions, opinions and perspectives. Nevertheless, she shows her humility and love as a mother. This is evident when she tells Bliss that the latter need not join the Blue Bonnet pageant if she is only doing it for her mother. On the other hand, Bliss is into professional derby, men like Oliver, and something that will bring out the best in her. Bliss’ desire to bring out the best in her somehow translates as a desire to join the hurl Scouts and defeat the Holy Rollers. Little does she know that it is one way for her to prove her own worth to herself. In the process, she also indirectly pr oves to her mother that she can make decisions of her own. Nevertheless, at several instances in the movie, Bliss does not feel that she is making the right decisions. Thus, compared to her mother, who is righteous most of the time, Bliss shows some indecisiveness. Furthermore, perhaps this is the same way Bliss views herself at the beginning of the movie – a young woman with no direction. This view, however, changes in the end as her mother accepts her decision to be on the professional derby team. This is also the point where Bliss realizes her calling (Barrymore). The way I see it, Brooke is just the strict, conservative mother that mothers are supposed to be. On the other hand, Bliss is the picture of an ordinary girl who defies her own parents’

The theme of the short story Young Goodman Brown by Nathaniel Essay

The theme of the short story Young Goodman Brown by Nathaniel Hawthorne - Essay Example Usually, this kind of negative response did have a deadly result on the disrespected woman. It has been noted that the stories that were penned down before 1842 had a female character that was destroyed only by accident and not by intention alone. The story has shown the transformation of a man from his normal state to that of an abnormal one where he abandoned meeting with anyone and then in the end coming back to his life and restoring normal relationships with all that were important to him and more than that, his wife. A number of authors have made note of the fact that Browns departure from faith and reliance was not an act on purpose since Brown actually planned on returning to her after the forest trip. But there is a belief that the very act of the man leaving the woman shows the males indifference to the security related with their females. Thus it is viewed as the women are in reality viewed as somewhat a kind of sexual beings and men as sexually frozen pieces. The mans lack of sexual desire is what has been truly killing the woman of late and it basically allows for the man to continue living in a hollow life. This is true that this does not necessarily mean the real nature of women but about the way in which men imagine of them. Hawthornes men are obsessed with females but the only way they can make any connection with women is through fantasy or by performing some fantasy-related activities that are not considered appropriate by the female populace. The family ties play a huge role here as husband and wife are considered as the two wheels of a car, the car being the home in this point. These two have to gel together emotionally as well as physically in order to make their individual lives easy and the people who are attached with them within the household. Family ties definitely help the Young Goodman Brown as the writer has suggested that in the long run, it is the family which plays its due

Progressive Era through the Great Depression Essay - 1

Progressive Era through the Great Depression - Essay Example senators (Anderson, 2006). The nation struggled with difficulties because of industrialization and development, in the period of Progressive Era (1900–1920). City and middle-class reform crusade reinforced the administration having a superior role in managing such matters as the control of large trade and the well-being of the community. Several of its attainments were created on struggles of previous restructuring activities. For instance, the federal income tax policy and the direct election of senators were a part of the Mainstream package, and Ban on liquor production and its use. The program had received support from both Democrats and Republicans. Theodore Roosevelt became US President in 1901 even though he was the youngest one to hold the Presidential office. He had substantial political knowledge and served in various high level offices. During his administration from 1901 to 1909, 44 antitrust activities were filed counter to the nations major companies, comprising the Northern Securities Company. However, the principle of the presidents approach was that he noted among ‘good’ and ‘bad’ trusts and sturdily chosen to control companies for the wellbeing of people rather than causing damage them. The procedure of rebating was removed through the ‘Elkins Act’ (1903), and the ‘Hepburn Act’ (1906) permitted the Interstate Commerce Commission (ICC) to set maximum railroad charges. Americans expressed the fear that meat infected or covered in rat stools was treated and sold to the public. Senate responded to the disclosures by passing the ‘Pure Food and Drug Act’ (1906) that banned the production, sale, or carriage of food or drugs in interstate trade that had been infected. President Roosevelt vigorously endorsed the preservation of the nations natural resources. Roosevelt’s government set aside

High Cholesterol Essay Example for Free

High Cholesterol Essay Everybody worries about their health right? Nowadays people really don’t care too much and only do the bare minimum to get through their life. Most people just eat what they want, and make a bunch of decisions that will only destroy your body slowly. There are many diseases out there and you can never be too safe, because your health is what keeps you going with your life. Many diseases out there people don’t even know about. Well this disease I am about to discuss can affect your health like you wouldn’t believe. This disease can be very dangerous for the human body if not properly taken care of. This disease is called â€Å"High Cholesterol†. First off, what is Cholesterol? Well â€Å"Cholesterol is a sticky, waxy, fatty substance found naturally throughout your body.†1 Cholesterol is a very important substance to maintain. Doing so will prevent a lot of diseases that can cause even more damage to your body. That’s why watching what you eat can play a huge factor in your life when it comes to health. Now I will explain to you why it is important to manage your cholesterol. Why is Important to manage your cholesterol? If the cholesterol reaches an excessive amount, it can stick to the hearts artery walls. So much so that it can block and narrow them, this is known as plaque buildup. Over a period of time if the plaque builds up at a high rate, it can lead to a much more dangerous thing called atherosclerosis which is determined to be a hardening of the arteries. People don’t realize how serious it is to watch your cholesterol. Having High Cholesterol, it can cause a serious risk for heart disease. High cholesterol is in your body, and the more it increase 9which comes with age) the more it can cause a serious disease. The thing about High Cholesterol is when you have it; you will not even know it. If you continue to consume a lot of fatty foods, or being overweight from eating too much food altogether, or even if you have a family history of such disease, you must make sure you watch your cholesterol level at all times. Did you know that if you have a bit too much cholesterol in your blood, it can cause cardiovascular disease? Well â€Å"Cardiovascular disease is the No. 1 cause of death in the United States. 2,200 Americans die of cardiovascular disease each day, an average of one death every 39 seconds.†2 After reading that statement, doesn’t it make you wonder how you can treat it? Because I am sure that scares you just like it scares me. There are many things that can cause your cholesterol level to skyrocket, so the best thing to do is learn how to prevent this from even happening. It is important to have a daily diet, watching what you eat can prevent your cholesterol level to rise. Eating healthy food such as vegetable, meats, etc†¦always make sure you stay away from fatty foods. When having a good diet, it helps you maintain your weight, which being overweight can also cause high cholesterol. Being physically fit is also another good way to maintain high cholesterol. Not only do you want to watch what you eat, you also need to make sure you exercise. Exercising is by far the healthiest to do for your body. There are many different exercises that are good for your health. Some of these exercises are running, stretching, walking, jump rope, anything to keep your blood flowing in your body so that your cholesterol level stays normal. Another major product which can affect your cholesterol is tobacco. Tobacco which not only causes high cholesterol problems, it causes death by other diseases. Staying away from tobacco is very important. Even inhaling second hand smoke is bad for you. Quitting cigarettes should be a must, especially if you’re trying to maintain good health, and lower your cholesterol level. Every 7 seconds, someone is dying from the use of tobacco products. Treating high cholesterol is basically maintaining good health. Always make sure you see your doctor at least once a month, if not twice a year. Have him check for any problems when it comes to high cholesterol. It’s really something knowing that everything we do in life can affect us as a person, especially our bodies which keeps us alive and living our lives. So always make sure you maintain good health, and watch your cholesterol level so we can stay alive and live life because life is to short. Works Cited 1. What Is High Cholesterol? EverydayHealth.com. N.p., n.d. Web. 03 Oct. 2012. http://www.everydayhealth.com/heart-disease/cholesterol/understanding/ind

Día De Los Muertos: The Day of the Dead

DÃ ­a De Los Muertos: The Day of the Dead The Day of the Dead, or all souls day, is the official Catholic holiday following All Saints Day. The date of the DÃ ­a de los Muertos, is November 2nd. The date of this event is typically attributed to St. Odilio, an abbot of Cluny, France. St. Odilio wished to offer special prayer and singing to the Office of the Dead. The day was created in honor of those who died. During this time, there are three Requiem Masses, said to assist the soul of the deceased from Purgatory to Heaven. The modern view of death is attributed to the Aztec, as they themselves celebrated. They believed that after death, a person would rise though nine levels of, in order to reach their destination, Mictlan, the place of the dead. It was also believed that at birth, the destination of the person would be decided, and would not take into consideration how that person lived their life. It was also believed that the fashion in which one died would determine the region of their destination one would inhabbit. When the person arrived at the destination, one would either linger, awaiting movement to the next destination, or would transform. In the Aztec calender, two months are devoted to honoring the deceased. The ninth month was dedicated to deceased infants. The tenth month was dedicated the deceased adults. During the Spanish Inquisition of 1521, indigenous beliefs were fused with those of the Catholic church. As a celebration adapted by many Catholic nations globally, the central idea remains the same. If a person dies after living a humane life, he or she goes to Purgatory, also known as Hell (commonly known by this term for its slang uses.) After paying for their sins, by being cleansed in the Purgatorial flames, that person goes to the afterlife. If a person did not live a humane life, he or she would spend eternity suffering in the Purgatorial flames. It was believed however that the family of the deceased would assist the person in leaving Purgatory, by praying. During the DÃ ­a de los Muertos, family of the deceased often attends services, as well as creates an alter in their home. The typical the alter in the familys home is adorned with marigolds, the official flower of the dead, as well as a candle for each of the deceased. Incense is often used in conjunction to these items. Also, as part of the ofrenda, or offering, food is often prepared. The dead are believed to spiritually partake from the food, and the living later consume the food. In some countries, it is also common to view the play Don Juan Tenorio. Another common item is the sugar skull, as well as cardboard caskets with a skeleton which jumps out, and also masks, which are believed to show an expression which one cannot show normally. During the celebration of the dead, calaveras are published. These calaveras are similar to obituaries, except for those prominent in government or society, the person is often alive. The calaveras are published often in local newspapers in a versus style. They often will describe the character of the person, and what he or she has done for the comunity. One of the most popular pieces of the celebration are sugar skulls. The origin of these pieces are unknown, but it is often suggested, that they date back many centuries. The origin for the giving of the sugar skull, is believed that in ancient times, the human skull would be given as a commemorative. As this tradition grew, this became obsolete, as well as extremely unhygienic and grizzly. The sugar skull is believed to have been an alternative to this, having, in plain form, the rough shape and color of the human skull. In conclusion, the day of the dead brings forth a celebration in reflectance toward the dead. While the celebration is not performed in mass in non Hispanic nations, it is officially recognized by the Catholic church, which is responsible for a vast portion of religion globally. The celebration has been performed for many centuries, but is not commonly celebrated in counties from non Hispanic decent, such as most of Europe, and most of North America, with the exception of Mexico. Due to its vast importance in Hispanic nations, the celebration has carried out since 1521, and will most likely continue on past the lives of many generations to come. Bibliograpy http://spanish.about.com/gi/o.htm?zi=1/XJzTi=1sdn=spanishcdn=educationtm=159gps=343_145_1436_727f=00su=p897.6.336.ip_tt=2bt=1bts=0zu=http%3A//www.nacnet.org/assunta/dead.htm http://spanish.about.com/cs/culture/a/dayofdead.htm

Flowers from the Storm Essay -- Literary Analysis, Jane Eyre

Romancing the Gothic Romance novels come in many different styles with a variety of subgenres, themes, and character blueprints. Jane Eyre and Flowers from the Storm are no different. Both Jane Eyre and Flowers from the Storm are romance novels, with Jane Eyre continuing early nineteenth century Romantic period traditions as well as a novel with a romantic relationship between two characters. Flowers from the Storm is a historical romance which is patterned after Bronte’s Jane Eyre. Laura Kinsale, author of Flowers, has won a variety awards for her writing, including the 1996 RRA-L Romance award for best all-time favorite romance for Flowers; Bronte’s Jane Eyre came in second. Jane Eyre, a novel by Charlotte Bronte, is a gothic romance about a plain governess and a dark hero who eventually fall in love with one another. Likewise Kinsale’s, Flowers from the Storm, delivers the same generic conventions with a religious, plain, young woman and a misunderstood hero, who come together to develop a lasting romance. Charlotte Bronte first published Jane Eyre in 1847, under the pseudonym Currer Bell, a novel which has since become a success by earning its way into the literary canon. Bronte was born in 1816 in Yorkshire England and studied at the Clergy Daughters' School. After leaving school she became ever more interested in writing and reading Byron, after whom she later fashioned Rochester. Joyce Carol Oates relays, â€Å"for Jane Eyre, whatever its kinship to eighteenth-century Gothic and however melodramatic certain of its episode [†¦], is nonetheless a work of stubbornly idiosyncratic intelligence.† (7) With the publication of Jane Eyre, Charlotte Bronte earned the respect of every generation that followed. Laura Kinsale, ... ...le for historical fictions and furthered the love of the style for many writers and readers alike. The romantic period is over. Yet the writers and characters who flourished in the period are still around in the homes and minds of many aspiring writers. Of course Charlotte Bronte and her peers are important to novels like Flowers and others like it. They are the blueprints for not only the way many authors write, but the way the readers expect the stories to unfold. They are the reason for the memory of the Romantic and gothic and their influence is the reason why so many choose to write the style. Forgetting which novel holds the most value, one must remember that literature doesn’t just refer to what’s in the literary canon; it also refers to what’s on the bookshelves in the homes across this country, because today, Jane Eyre is almost as popular as Flowers.

Faulkners Light in August - Point of View :: Light August Essays

Light in August - Point of View    Most of Light in August's story is told by a third-person narrator. In some third-person novels the narrator is omniscient (all-knowing) and objective. In others he takes the point of view of the central character. In Light in August the narrator is often objective, as, for example, when reporting dialogue. But what is unusual about this novel is the way in which the narrator's point of view shifts frequently from one character to another. And even when reporting from the point of view of one character alone, the narrator sometimes stays on the surface of that character's speech and thoughts, while at other times he has access to memories so deep the character himself may not be consciously aware of them.    The difference between this shifting point of view and the point of view of an omniscient narrator is important. For example, you first hear of Joe Christmas from Byron's point of view. Byron seems a sympathetic character, so you tend to accept what he says. Later you see Joe Christmas from his own point of view but without access to his deepest thoughts and feelings. When (in Chapter 6) the narrator finally dives into Joe's buried memories, you get a completely different picture of him. But in Chapter 19 you see his final escape and murder from the point of view of Percy Grimm. One of Faulkner's purposes in this approach is to contrast public images with private realities. The Joe Christmas that the town of Jefferson knows is different from the Joe Christmas seen from within, and Faulkner's shifting point of view keeps you aware of that and other such contrasts.    Occasionally one of Light in August's characters tells his story in the first person, for example, the furniture dealer in Chapter 21.

Los Clorofluorocarbonados (CFCs) :: Ensayos Reportes Escolares

Los Clorofluorocarbonados (CFCs) Los Clorofluorocarbonados (CFC) y sus derivados tienen como fuentes principales algunos productos industriales, y los à ³xidos de nitrà ³geno, que se producen por multitud de causas, principalmente por la quema de combustibles fà ³siles y la utilizacià ³n de fertilizantes quà ­micos. La produccià ³n de cloro-fluoro-carbonos [CFCs] contribuye con aproximadamente el 14% del efecto invernadero. Los CFCs son sustancias quà ­micas sintà ©ticas, formadas por cloro, flà ºor y carbono. Las molà ©culas de CFC tienen una larga vida activa. El CFC-1 1 es activo durante unos 65 aà ±os y el CFC-12 durante unos 110 arios. Cada molà ©cula de CFC-11 y de CFC-12 contribuye 3.500 y 7.300 veces mà ¡s, respectivamente, al efecto invernadero que cada molà ©cula de C02. Los CFCs tambià ©n destruyen la capa de ozono en la estratosfera, causando que una mayor proporcià ³n de rayos ultravioleta alcance la superficie de la tierra. Una mayor incidencia de rayos ultravioleta tendrà ­a importantes efectos tanto en la agricultura como en la salud humana. E1 cà ¡ncer en la piel, los problemas oculares, y las afecciones al sistema inmunolà ³gico, son las amenazas mà ¡s inminentes sobre la salud de la poblacià ³n humana. Podrà ­an tambià ©n presentarse efectos adversos sobre las algas y el plancton, bases de la cadena alimentaria en el mar CONTAMINACIÓN ATMOSFÉRICA > Eliminacià ³n de los CFC de los inhaladores - dosificadores 1) OBJETIVO Elaborar una estrategia comunitaria para la eliminacià ³n de los clorofluorocarbonos (CFC) de los inhaladores - dosificadores. 2) MEDIDA DE LA COMUNIDAD Comunicacià ³n de la Comisià ³n al Parlamento Europeo y al Consejo de 23 de octubre de 1998: Eliminacià ³n progresiva de los CFC de los inhaladores - dosificadores. 3) CONTENIDO Los CFC forman parte de las sustancias que debilitan la capa de ozono y cuya produccià ³n y consumo se prohibieron en la Comunidad en 1995. No obstante, siguen utilizà ¡ndose en los inhaladores - dosificadores destinados al tratamiento del asma y de las bronconeumopatà ­as crà ³nicas obstructivas (BPCO) en virtud de las excepciones previstas en el Protocolo de Montreal y en el Reglamento (CE) n º 3093/94 para sus usos esenciales. En la decisià ³n IX/19 del Protocolo de Montreal, la Comunidad Europea y las demà ¡s Partes del Protocolo acordaron presentar, antes del 31 de enero de 1999, una estrategia de transicià ³n para la eliminacià ³n de los CFC de los inhaladores - dosificadores. La Comisià ³n cumple con tal compromiso mediante la adopcià ³n de esta Comunicacià ³n, que recomienda medidas que deberà ­an adoptar los Estados miembros para facilitar la transicià ³n hacia tratamientos del asma sin CFC preservando la salud y la seguridad de los pacientes.

Dealing with a Difficult Patient

Regardless of what professional field you are working in these tips could be helpful to you; because any job you get you will always be around other people so you should know how to control a bad situation. The physicians say that 15% of their encounters with patients are rated as difficult. When dealing with a â€Å"difficult† patient you must recognize the signs of anger, know what you should do so the situation doesn’t escalate, and get down to the root of the problem with the patient.The first step in dealing with an angry patient is recognizing the signs of anger, knowing the physical, verbal, and characteristics of a patient who is more likely to have an outburst. Clenching fists, fidgeting, breathing rapidly, tense posture, and tightening of the jaw are some of the easiest physical signs to look for. If you recognize these signs try to get to the root of the problem before things escalate to the verbal clues. Verbal signs may be raising his voice, yelling, saying mean or rude things to you; try to stay calm and not yell back let him vent his anger then try to resolve the situation.Patients that have problems with depression, anxiety, go into defense mode, being resistant with you, or their attitude may change from being happy and talkative to being quiet and short; these are the patients to watch for. Anger problems, stress, or anxiety can cause someone to be edgy when they get bad news or news that they do not agree with. Always remember, â€Å"Some people don’t like not having control over a situation. † (Forest, 2012) When someone is having health problems or they get bad news from the doctor they are more likely to get angry, although you cannot control what happens with your health; you can control how to handle it.There are many things that could cause a patient to get angry such as diagnosis, treatment, or even personal problems in the past or the present. A patient’s diagnosis can cause them to lose control if t hey hear they may lose their mobility, their symptoms have gotten worse, or losing their independence. Nobody wants to hear they are sick or that bad things could happen and when they do hear those things its triggers a negative emotion in them.Issues with their treatments may also be a trigger for anger if their treatment isn’t working how they think it should, the doctor changes their treatment, or they want to start treatment immediately but physically it isn’t possible; patients want things done how they want them and if it’s not done in that way it can erupt into a verbal altercation. Personal issues such as being abused as a child, growing up in a dysfunctional family, or losing someone close to them to an illness can cause people not to trust doctors and nurses.Personality disorders, strong emotions, having extreme behavior, or returning frequently with troubling problems are also signs that they could be a â€Å"difficult† patient. You have to rec ognize the signs of things that could trigger someone to get angry and prepare yourself in case things do get out of hand in those situations. As a professional in the medical field you must learn how to correctly deal with a situation if it gets out of hand, you have to listen, know how to handle your own temper, and learn the correct things to say so you don’t make the situation escalate even further.You have to listen to their words to try to get down to the root of the problem and don’t interrupt or ignore what they are saying. Ask them what they think will help fix the problem. (HPSC, 2012) Asking their solution shows that you care what they are saying so that’s a good way to go about calming them down. To ensure that the encounter isn’t going to escalate never show your angry, keep your hands down at your sides, keep some distance, maintain eye contact, and always be professional; the moment you lose control they will realize it.When you’re t alking to them m ake sure he knows that you understand by saying something like â€Å"I understand you concerns but.. ,† also call him by name it shows respect. Another thing you can do is explain his treatment in detail so you know he understands the problem and maybe that will even give him his solution. You can try to control the outcome of the situation by your actions and words; you just have to learn the correct way of going about it.While working in an office setting you will encounter patients that don’t agree with what you may say or do; but you have to learn how to manage the situation in a professional manner, without letting your anger get involved. You have to be the stronger person and say sir what can I do to make this experience better for you? You have to talk calmly and know the correct words to say to make sure the conflict can be resolved. If you have too many issues you may have to call in someone else to intervene; which in some cases is the smart thing to do.

Face Recognition Technology Essay

Facial recognition technology refers to a computer driven application that automatically identifies an individual from his or her digital image by a comparison of particular facial features in a facial database and in a live image (Vacca, 2007: 95).   The technology creates a template of people’s facial configurations, such as the lengths of their noses, and the angles of their jaws.   It thereby functions like the other biometric technologies (e.g. iris scanning) that use biological features for the purposes of recognition. According to Visionics, a manufacturer of face recognition technology, the technology is capable of finding human faces â€Å"anywhere in the field of view and at any distance, and it can continuously track them and crop them out of the scene, matching the face against a watch list (Kautzer, 2002).† Undoubtedly, these features of face recognition technology make it an attractive option for law enforcement agencies – always trying to catch criminals and keep an eye on suspects.   But, is there more to face recognition technology than meets the eye? Description and Uses of Facial Recognition Technology It is natural brain technology that allows humans to recognize fellow human beings.   According to Bruce & Young (1986) there are â€Å"face recognition units† in the brains of human beings (361).   Face recognition involves matching â€Å"the products of structural encoding,† that is, facial features that are spotted by the eye with â€Å"previously stored structural codes (Bruce & Young: 361).†Ã‚   Vacca writes that there are three areas of the face that are â€Å"primary targets† in face recognition because they do not typically change (95). These parts of the face include upper sections of a person’s eye sockets, the part of the face surrounding one’s cheekbones, and the sides of the human mouth.   Regardless of whether the human brain also considers these parts of the face most crucial to facial recognition, Vacca explains three different techniques used in man-made face recognition technology, namely, eigenface systems, eigenfeature systems, and thermal imaging.   Eigenface image systems capture facial images and change them to â€Å"light and dark areas (Vacca: 95).† In eigenfeature systems, certain features of the face, for example, the eyes and the mouth, are picked out and distances are measured between these features.   Thermal imaging systems, on the other hand, take thermal images of the human face, focusing on the pattern of blood vessels (Vacca). Even though iris scanning and other kinds of biometric technologies are known to be far more accurate than face recognition technology, it is believed that the latter would be more widely accepted because it is least intrusive.   This technology does not require users to push, click, or insert anything into the system, despite the fact that it takes many experts to create eigenface, eigenfeature or thermal imaging systems.   Moreover, companies using the face recognition technology do not require the installation of anything except a new software application. The cameras already in place as well as pictures of their employees on file are enough for companies that use this technology.   Hence, face recognition technology is cheaper for organizations than iris scanning, for instance, which requires reading setups.   According to Frances Zelazney, who works as the director of corporate communication at Visionics – a leading developer of biometrics – yet another advantage of facial recognition technology as compared to other biometric technologies is that â€Å"facial recognition provides for inherent human backup because we naturally recognize one another†¦ If the system goes down, someone can pull out an ID with a picture as backup, something you can’t do with fingerprint devices (Rutherford, 2001).† Unsurprisingly, facial recognition technology is known as the fastest growing biometric technology in our day.   Law enforcement agencies and the military have been successfully using the technology for many years without the public being aware of it.   In the year 1988, the Los Angeles County Sheriff’s Department (Lakewood Division) began using composite sketches of suspects, as well as video images, in order to conduct searches on a database of digital facial shots. The department also has a photo database of sex offenders and plans to find suspects on this database.   Then there is the Gang Reporting Evaluation Tracking system that can be searched with the use of photos of suspects in order for law enforcement to circumvent false identification cards as well as information that has been presented by gang members (Jarvis). Other applications of face recognition technology in the area of criminal investigation include the Integrated Law Enforcement Face-Identification System which incorporates a unique three dimensional composite technology to identify angled-view face shots more easily.   The system is meant to be very helpful in the correct identification of uncooperative suspects in addition to subjects that have been caught from a distance using video surveillance cameras. Furthermore, Britain is known to use at least two hundred thousand video cameras for surveillance.   Many of these cameras are being installed with the facial recognition technology today.   Typically these systems use computers to monitor cameras that are looking for recognized criminals.   As soon as the system is seen to identify a known criminal, the police are called (Jarvis). There are numerous United States embassies around the world that are already using the face recognition technology to keep criminals from entering the country.   The Israel-Palestine border control is similarly using the technology to reduce crime across the border (Jarvis). IQ Biometrix, established in 2001, was a company providing help to thousands of law enforcement agencies around the world with the FACES â„ ¢, a groundbreaking software tool allowing users to create and recreate billions of face shots, as well as encode, catalogue and transmit them.   The technology incorporated a facial composite tool that the FBI and the CIA also used.   The United States Department of Defense, the U.S. Navy, and various local as well as state police agencies had similarly opted for this groundbreaking system of facial recognition (â€Å"IQ Biometrix,† 2004). Given the importance of putting a name to a face in law enforcement, whether it is to solve crimes, protect the public, or to ensure security in jails, face recognition technology is proving itself to be of tremendous value.   Sheriff Everett Rice with the Pinellas County Sheriff’s Office in Florida employs the Viisage face recognition technology to â€Å"positively identify and verify individuals (â€Å"Facial Recognition in Action,† 2007).†Ã‚   Some of these individuals have been recently arrested while others are about to be released.   The face recognition technology is also of use with people that visit the courthouse.   So far, application of the technology has been successful, and users of the technology believe that it would have a greater impact on crime control in the years to come (â€Å"Facial Recognition in Action†).   The following is a detailed account of the case being considered: Over time, the Pinellas County Sheriff’s Office, like other law enforcement agencies, found itself faced with cumbersome booking, release and criminal investigation processes.   A prominent problem was a lack of timely information, which often allowed suspects to get away with providing false identification, hampering law enforcement or sidetracking investigations.   However the sheriff’s office found facial recognition to be an invaluable tool in providing quick and accurate identity information.   Facial recognition technology has allowed the sheriff’s office to quickly access important identity information and retrieve records, thus allowing officers to correctly identify even uncooperative suspects and to conduct more efficient investigations. In 2000, the Pinellas County Sheriff’s Office received a grant from the Office of Community Oriented Policing Services (COPS) at the U.S. Department of Justice.   The goal of the funding was to demonstrate the use of facial recognition technology for Florida law enforcement. Under the leadership of Lt. James Main acting as project director, the sheriff’s office decided to look beyond the traditional investigative uses of face recognition and to focus on how the quick, non-intrusive technology could be used to enhance operations at the jail. By initially focusing on the booking facility where mugshot images are collected, Main believed he could create processing efficiencies by using the existing images to build a facial recognition database.   The database would then serve as the foundation for identity solutions within Pinellas County, and throughout the state (â€Å"Facial Recognition in Action†). Application of face recognition technology by the Pinellas County Sheriff’s Office is a model for other agencies involved in criminal investigation.   The Pinellas County Sheriff’s Office has applied the new technology in other ways as well.   As an example, the Sheriff’s Office has expanded use of the technology to its patrol cars to allow street deputies to identify those individuals that have been stopped and are unable to produce identification.   There are workstations in the Pinellas Country where investigators may use face recognition technology to compare images that have been acquired in investigations. This system allows for search of at least two million images within ten seconds.   What is more, this browser based system is available in the cars of deputies that patrol the streets of the Pinellas County (â€Å"Facial Recognition in Action†).   Report on the use of face recognition technology for law enforcement in the Pinellas County continues thus: As envisioned by the Department of Justice grant, the Pinellas County Sheriff’s Office has partnered with other state and local agencies in Florida to maximize the effectiveness of the system.   Agencies participating in the project include the Florida Department of Corrections, the Florida Department of Law Enforcement (FDLE), seven Florida Regional Terrorism Task Forces, the Hillsborough County Sheriff’s Office, the Orange County Sheriff’s Office and Miami-Dade, Broward, Leon and Duval counties.

Hospital Emergency Room Overload Essay

As the name implies, the purpose of hospital emergency rooms is to provide quick and expert medical treatment for urgent and life threatening medical problems. The truth of the matter is that patients seek the ER for a variety of illnesses and injuries. They can range from catastrophic to as minor as a young child running his/her first fever. The downfall to this is that those patients who are truly not suffering from life threatening situations are taking away from those that are. Overcrowding results in longer waiting times to see a physician. Overcrowding also may contribute to decreased protection of a person’s privacy and confidentiality and impaired patient evaluation and treatment. According to an article written by Julie Rovner, she states that, â€Å"97% of ER doctors also said they treat patients daily who have private insurance and primary care doctors, but whose primary care doctors sent them to the emergency room for care due to the patient needing care when the doctor’s office was closed† (Rovner, 2011). Overcrowding has also been linked to more deaths in the emergency room than in the past. One reason is hospitals having to close their doors and rerouting ambulances to other hospitals because their ER is full. Nevertheless, there may be solutions to this ever growing problem. Hospitals can take cost-saving measures to help alleviate the overcrowding issue. They can move stable and non-emergency care patients to less expensive settings such as an observation area or walk-in center staffed by nurses. Creating more after hours urgent care centers where patients can be seen for non-urgent or life or death situations. Providing appropriate clinic facilities and care for patients without insurance. Providing physicians with incentives for accepting Medicare and Medicaid new patients will also alleviate the overcrowding issue. Even though any of these measures could help with overcrowding, and with the Affordable Health Care Act being deemed constitutional, providers don’t see overcrowding in the ER slowing down. Due to the constraints of the U.S. health care system, ER care for patientswith non-urgent conditions will continue and probably increase with the onset of the new health care reform. ACEP President David Seaberg said in a statement in July 2012 that, â€Å"Increasing the number of patients on Medicaid without an equivalent increase in the number of physicians willing to take that insurance will surely increase the flood of patients into our nation’s ERs. Coverage does not equal access† (Cheung-Larivee, 2012). In conclusion, a number of different solutions need to be considered and applied. Solving the ER problem is going to involve healthcare workers, business leaders, politicians and the public. References Cheung-Larivee, K. (2012, July 6). Health Reform Ruling won’t Solve Emergency Room Overcrowding. Retrieved September 15, 2013, from Fierce Health Care: http://www.fiercehealthcare.com/story/health-reform-ruling-wont-solve-emergency-room-overcrowding/2012-07-06 Rovner, J. (2011, April 28). ER Doctors Say Health Law Will Make ER Crowding Worse. Retrieved September 14, 2013, from Health News from NPR: http://www.npr.org/blogs/health/2011/04/28/135800784/emergency-room-doctors-say-health-law-will-make-er-crowding-worse

Business Ethical Problem

From September 2010 to May 2011 I interned with the Health Care Administration under the direction of the Executive Nursing Administrator at a hospital facility with nationally integrated service networks. I was told at the time of my hire that I would be privy to all conferences which took place with administrative officers; and that information discussed would be strictly confidential. During the course of my internship there were conferences held with administration and other â€Å"agents† at least once a week. I attended 2 meetings during my internship— neither of them eventful—and was conveniently given my supervisor’s work to complete while she attended the aforementioned conferences. Unknown to me at the time, the facility was under investigation due to complaints filed with the Attorney General from clients, client’s families and medical staff; including nurses and medical doctors. I learned quite recently that special federal investigators had been carrying out an official examination of the hospital since August 2010; concerning quality control issues, adherence to hospital policy and procedures; and other legal matters, including but not limited to: †¢Embezzlement of grants/misappropriation of funds †¢Understaffing Personnel employed in management positions where they were neither qualified, certified nor did they have prior experience in regard to the units they managed †¢Clients being admitted to psychiatric units without a 2 PC order †¢No PRN Protocol in place and agitated clients were admitted to units causing injury to self, other workers and clients. †¢Patient neglect and injuries due to accidents One day I was instructed by the Executive Nursing Administrator (ENA) to prepare 2 spreadsheets: One was a patient satisfaction survey and the second was a unit complaint survey which was to include in the questionnaire specific areas of complaint. I prepared the surveys and since I was given no direction, I researched what questions to ask; and (with SUNY’s documented approval); I utilized my university’s survey program. I prepared the surveys and they were approved by administration (hospital director, medical director and the ENA. I was then instructed to conduct the two survey interviews, which took place from September 2010 to March 2011. Ethical Problems I Faced: At the time of my internship the Unit Complaint Survey I constructed contained the name of the complainant, person’s title and 7areas of complaint; each complaint involved a different area of concern and was to count as a total number of complaints in that particular area; (i. e. : understaffing, p atient injuries/accidents, lack of prompt medical attention; admission documents incomplete, missing or not signed by the admitting physician, medication errors, etc. When Administration (who had previously approved the survey) reviewed the results of the questionnaire and observed that almost all of the units had more than 20 complaints a week, the ENA requested me to adjust the number of complaints to one per person if he/she had filed complaints in several areas of concern. In addition, I was to modify the number of complaints per Unit in regard to specific areas of concern to and combine the figures to reflect 1 complaint in that area. In other words, if 10 units had the same complaint regarding patient injury, the10 complaints would be combined on the survey and count as 1 instance of patient injury. After I completed my internship, the administrative nursing assistant called on behalf of the ENA (who took credit for creating the survey) to request that I come in and train health administrative personnel on how to use the programs I created; and to instruct them on recreating new spreadsheets with the template I had designed for the surveys utilizing SUNY’s survey/software program.

Sustainability in emerging economies - Simplified business plan (topic Essay

Sustainability in emerging economies - Simplified business plan (topic of your choice ) - Essay Example o work with Kenya locals to construct greenhouses that would ensure the country produce food that is sustainable to its population so that hunger can be averted. Attention is drawn to the fact that this country majorly depend on agricultural products as their basic point of the economy. Agriculture is the backbone of their survivals since it is the source of their daily food and comprise almost of 75% of their exports that earn foreign exchange that enables them to balance the trade deficits. But as studies shows, there has been a decline in a significant production. This significant decline is due to climate change and global warming. The two has led to extreme temperatures and excess heat that are unfavorable for food production. (Pearce, Barbier & Markandya (2013) shows that the production of food in these societies has an annual decreased from of up to 10% in the last decade. On the other hand, research by Barrett, Ilbery, Brown and Binns, (1999), shows that exports from these countries have fallen by 20% and the trend is likely to continue if not addressed. Thus, due to these demanding issues, the corporation has identified greenhouse c onstruction in these societies as the primary remedy for the situation. The establishment of the greenhouse will make the locals produce more than enough for their consumption against the extreme weather conditions. Hence, food security is ensured that will lower the poverty index to reduce by a greater percentage. Furthermore, production is expected to be in excess that can be used for exchange for other products from various societies. Hence, the balance of trade will be manageable that enhances growth in the economy creating sustainable development. The world institutions have proposed various heads that encourage the corporation to participate in the project developments. A report from World Bank shows that climate change is destroying the events gains that have been achieved over times hence companies and governments

Edward Estlin Cummings Research Paper Example | Topics and Well Written Essays - 1500 words

Edward Estlin Cummings - Research Paper Example He was named after his father although he was called by his middle name by the family. His father was a successful man as once he was a professor of Sociology and political science at the Harvard University before proceeding to become a renowned minister of a church located in Boston. This gave Cummings the opportunity in education and development as compared to other children because his father knew the value of education, therefore, doing all he could to provide the opportunity to his children. Cummings spent most of his time with his mother Rebecca s and sister, Elizabeth as they were the ones closets to him. This was when his destiny in poetry was predicted because he did a lot of writing as directed by his mother. In addition, he started writing poems under the watchful of his mother who directed on him on things to do and things not to do. He was a smart boy, and his mother encouraged him to write more poetry everyday. His home environment encouraged his poetic attitude as he h ad the opportunity to be affiliated with philosophers like William James and Josiah Royce who were family friends. Cummings went a head with his education and graduated from the Harvard University in 1915 with a certificate. Cummings from an early age studied Latin and Greek, and this explains his affinity for later works like XAIPE which is a Greek word meaning â€Å"Rejoice†, â€Å"Anthropos† a Greek word meaning â€Å"human† and â€Å"Puella Mea† a latin word â€Å"my girl†. ... This was when he started active participation into his life long career of writing and composing poems. Later life (Biography) Cummings attended Harvard University where he got a B.A. degree in 1915 and proceeded to obtain his Masters for English and Classical studies in 1916. Cummings labored on the newspaper of the school alongside Dos Passos and S. Foster Damon who were fellow Havard Aesthetes. During his final year at Havard University, the influence of writers such as Gertrude Stein and Ezra Pound was so great. He graduated magna cum laude in the year 1916, delivering a commencement address that was controversial entitled â€Å"The New Art†. This is the speech that gave him the first taste of notoriety since he was able to give a false impression that Amy Lowel, the well-liked imagist poet whom he so admired was â€Å"abnormal†. These chastised Cummings in the newspapers. He turned to poetry as he was ostracized because of his intellect. On September 21, 1917, he a nd his friend William Slater Brown got arrested as they were suspected of espionage. They both expressed anti-war views openly, and Cummings specifically talked of his lack of hatred towards the Germans. They were detained in a military detention camp where they languished for three and half years. He was released from the camp on December 19, 1917 due to much intervention from his father who was politically connected. He returned to United States in the year 1918. Later he was taken into the army where he served at the 73rd Infantry Division at the Camp Devens, Massachusetts until 1918 November. In 1921, he returned to Paris where he remained there for two years. He later moved on to take his new job in New York City where his role was to write

Research Methods Assignment Example | Topics and Well Written Essays - 500 words - 2

Research Methods - Assignment Example The research is divided into various topics that clearly explain each theme that the research is based on. Firstly, it focuses on various causes of absenteeism in schools. In this the roles of parents, teachers and the community at large of ensuring that students are always in schools are analyzed. Secondly, the article gives a connection between the absenteeism and exam failure. In this case, the essay explains in depth how school work accumulated up to a level that the student can no longer catch up with other students. Lastly, the study highlights the kind of life that the student lives once they clear school. In this case, the essay demonstrates how the student fails to fit well into the community. According to the research, the student will end being not very useful to the society should measures to restore them are not considered. The intention of this study was to probe the effect of constant communication on the general performance of online modules. The article makes an argument around the worth of effective communication in online units and the rationale of the achievement a scholar experiences when they succeed in an online course. The purpose the research is to find justification, to some aforementioned interests. Accordingly, the researcher was conducted in eight week through the analysis of students of an online module. This investigation incorporated the following strategy to observe classroom activity and online communication amongst student’s geographical location, maturity and cultural diversity are the most imperative fundamental dynamics. Additionally, the considerable statistics gathered by Mouffe, (2013) in their study describe the prospective consequences of failures and success was predictable. The research paper is divided into two parts; the first part investigates extent of the relationship between tutors and online students. In this the paper finds out various channels and

International business management Essay Example | Topics and Well Written Essays - 2500 words

International business management - Essay Example . For executives and entrepreneurs, the significance appears remarkably apparent: markets are rapidly being borderless; schemes that fail to recognize the integration of the global market place are shortsighted and misguided (Root, 1994, p. 27). Firms that maneuver in international marketplaces require to come up with the most critical resolutions while selecting the most appropriate method of entrance into a country. Arguably, Westhead et al (2002, p. 123) notes that organizations must decide on the most fitting entry strategy in order to optimize on resources. Globalization, as described by Wood and Robertson (2004, p. 143), facilitates and necessitates businesses to move to other international markets. However, before deciding on the entry mode, it is essential to understand the country’s economic, social and political institutions. ... 24-26). There exist diverse strategies of entry into an overseas market. Every strategy has its own disadvantages and advantages. Nonetheless, each company and organization selects a suitable mode of entry depending on the company background, temperament of the company, tactical aims over and above the resources available. In numerous instances, while deciding on the appropriate mode of entry a company experiences many problems and challenges such as environmental, safety, packaging, patents, labeling, copyrights and trademarks (Cateora & Graham, 2002, p. 124). This paper delineates the most appropriate foreign entry strategy for Coffee product. In addition, it attempts to clarify issues arising in the international market selection for the product. Entry Mode Root (1994) describes a market entry strategy as the planned method of delivering and distributing goods and services to a target market (p. 24). A market entry strategy maps out how an organization sells, delivers and distribu te its products in a foreign country. Westhead et al (2002, p. 65) notes that when an organization chooses to explore an international market, the selection of the most appropriate strategy is resolved by the company’s development stratagem. The chief objective of each firm is to institute itself in the international marketplace (Cateora & Graham, 2002, p. 134). For this reason, Westhead et al (2002, p. 145) notes that the procedure of deciding on the most appropriate entry mode necessitates instituting an effectual international promotion stratagem to point out the international chances, discover reserves and potentialities and make use of nucleus capabilities to adopt the international stratagems. The resolution on how to penetrate an overseas market has momentous effect on

Analysis of Strategic Risks in South Africa Essay

Analysis of Strategic Risks in South Africa - Essay Example This essay is one of the best examples of analysis of different specific kind of risks in political, social and economic environment of South Africa, that greatly influence a company operation. It critically looks at the political, economic, financial and social Risks and gives insights into how a corporation should position itself in order to gain the best of results in South Africa. Political risk refers to risks relating to the governance and control of the various peoples in a given nation. The inherent political risks in South Africa have to do with the nature of social exclusion practiced in the country for a long time. However, power is in the hand of a popular the Black African majority government. The constitution gives a lot of room for strikes, trade unionism and demonstrations, which reignites the strategy used by the Congress and the people power that comes with the current government. This means that a corporation entering the market needs to understand its microcosmic position and make adjustments to meet these elements of favoritism, nationalism, mass action and corruption. There is also economic risks that are connected with the high cost of doing business in South Africa and other factors like the entry of Chinese businesses who have control of affairs. There are also financial risks relating to credit risk and money transfer issues. Managing across culures is quite difficult. However, the cultural risk in South Africa is increased by the fact that the cultural diversity is huge. ... The World Cup brought South Africa surpluses in its balance of trade in the past year and increased its GDP its previous years’ data. With the weakening US Dollar, a business that seeks to operate in South Africa will find it relatively more expensive to trade in South Africa that it would in other parts of the world. Unemployment Unemployment rates in South Africa currently stand at 25.3% and this is blamed on the people’s demands for high wages and better working conditions than other parts of the world (SouthAfrica.Info, 2011). This therefore presents a labor risk to the nation. This is because these conditions show that clearly, labor is expensive in the country. This therefore means that any business that seeks to open up a branch in this country needs to be willing to pay more for labor. International Trade International trade in South Africa is increasingly becoming skewed in favor of the Brazil, India, China and Russia and nations like China in particular has a lot of control in the affairs of South Africa (SouthAfrica.Info, 2011). This therefore means that any company from a country not in this category risks losing out to the competition posed by these nations that are favoured by international treaty in South Africa. This therefore makes it more prudent for a corporation to consider other international expansion options that makes good use of outsourcing to remain competitive and acquire a favorable image in the South African market. Financial Risks General Financial Risks The World Bank gives South Africa 68% for credit worthiness indicating that although it is a low risk country to do business in there is still some risk to do business there (Adar, 2008) The Currency Risks South Africa’s Rand is quite stable

Your interest in Security Management Research Paper

Your interest in Security Management - Research Paper Example Firms use security management procedures and processes like categorization of information, assessment of risks in order to identify threats, rating the susceptibility of systems and categorizing assets in order to come up with effective controls. In security management, the prevention of loss emphasizes on the critical assets of the organization and the manner which they are to be safeguarded. One of the essential parts of the prevention of loss is assessment of the possible threats to effectively achieving the company’s goal. This is supposed to include the possible opportunities which further the goals, balance the possibilities and determine the effects while implementing measures that will minimize or complete eliminate the threats. Security risk management is the area of the management of security that I am most interested in, and it applies the ideologies of risk management in managing threats to security. It entails the identification of threats, assessment of the effectiveness of the controls that are already in existence to deal with the threats, determination of the ramifications of the risk, ranking the risks through rating their probabilities and effects, classification of the form of risk as well as suitable responses to the risks (Sennewald,

Final Business Model and Strategic Plan Essay Example | Topics and Well Written Essays - 1000 words - 1

Final Business Model and Strategic Plan - Essay Example The new product division will analyze the potential market for their products. They will use the available budget to conduct research that will provide insights about the competition in the markets and what the competitors are doing to win customers. In addition, the new product division will use the information received to build a strong company brand presence. Moreover the brand owners who include the brand manager and marketing manager will gather information about the prospective customers. They will conduct online surveys as well as group and personal interviews to find out about customers views and preferences, goals economic and financial status. Moreover, they will liaise with the IT department to come up with a website that will be sued to market the new product. The website will inform customers on the benefits of the product, the places where to purchase the product as well as the prices and discounts that will be provided for the product. In addition, clients can post the ir comments, recommendations as well as the challenges they have faced while using the product. Moreover some of the marketing promotions that will be used will include above the line and below the promotion. This includes the posters, newsletters, billboards, coverage on radio and television. The new product division will mostly use above the line advertisement for the purpose of reaching a massive group of people. The new product division will have an effective communication plan that will ensure effective communication both internally and externally. The new product division plans to have access to the agenda of the critical meetings by involving the senior executives to deliver on the presentations in regards to the new product division to get insights and feedback from them. The new product division also plans to have proper management by planning campaigns and tracking results and success. This will include monitoring performance of the new product

The power of language Essay Example for Free

The power of language Essay Although Susanne Langer did a study on humans and animals to show signs vs. symbols in understanding language, Helen Keller and Malcolm X took different paths on discovering the power of language. Langer brings up how there is a difference between symbols and signs, which most people consider them one in the same. For Keller she was deaf and blind from the age of 19 months, where she had difficulty learning how to communicate and understand language. In Malcolm X’s case, he was a street hustler who didn’t get proper education and was frustrated when he couldn’t get his point across through his letters he wrote. In â€Å"Language and thought† it was said, â€Å"A sign is anything that announces the existence or the imminence of some event, the presence of a thing or a person, or a change in the state of affairs† (Langer, Pg. 28). Where both humans and animals use signs all the time. For both of us sounds, smells, and motions could be signs of food, danger, the presence of others around us, or of a storm approaching. For animals they use signs for defense, to call out for others, signs of feelings or intentions to be reckoned with or just to let them in. Humans use signs way more than animals in their everyday life. We answer calls, read other peoples expressions, watch the sky or animals for coming storms, cross streets when there’s a walk man, or wait when it says, stop at red lights and go at green. â€Å"In every case a sign is closely bound up with something to be noted or expected in experience† (Langer, Pg. 28). â€Å"A symbol differs from a sign in that it does not announce the presence of the object, the being, condition, or whatnot, which is its meaning, but merely brings this thing to mind. † (Langer, Pg. 28). The difference between sign and symbol is that a sign generates us â€Å"to think or act in the face of the thing signified†, and a symbol is people’s concept of the thing symbolized. There are many things that are considered symbols, including words, pictures and memories. For example a heart is a symbol of love and a picture of a smiley face is a symbol of happiness. There are symbols everywhere with great significance or little value. But, according to Langer â€Å"The essence of language is symbolic, not signific. † (Langer, Pg. 31) Since Helen Keller was deaf and blind from a very young age, she didn’t know how to communicate her wants, needs and connect with the people around her. So finally at the age of seven her parents reached out to a teacher familiar with teaching the blind and deaf. Her teachers name was Miss Sullivan who taught her how to communicate by writing the words in Helens hand and letting her feel or touch the object to grasp exactly what it was. It started of with small inanimate objects like doll, hat and cup. Each time they would progress to more difficult words like sit, stand, walk and water. They went from words to sentences to trying to figure out how to explain the word love. Once she understood miss Sullivan’s definition of love, Keller â€Å"felt that there were invisible lines stretched between her spirit and the spirits of others† (Keller Pg. 68) She came to the realization that the deaf and blind have a more difficult time acquiring the amenities of conversation, which she accepts and understands. Malcolm X grew up in the hustler kind of environment, where he never had a good education and didn’t have to really communicate properly. Soon after Malcolm got arrested for burglary and was in jail, he became obsessed with the written word and books. He would send letters to people he had known in the hustling world, the mayor of Boston, the Governor of Massachusetts and harry S. Truman. Not one of them would write back, which made Malcolm more and more frustrated. He started off trying to read books to gain knowledge but it was useless because Malcolm didn’t understand most of the words in the books. So he decided the best thing was for him to read a dictionary, to study and learn more adequate words to add to his vocabulary. It started by copying and handwriting every word into his tablet, with every punctuation mark. After he wrote the words he would read them over and over, aloud and wake up thinking about those words. This continued until Malcolm copied the whole dictionary and knew almost every word he could. When he was done he picked up a book and could now understand what it was about. Malcolm said â€Å"I never had been so truly free in my life† (Malcolm Pg. 64). From signs and symbols having different meanings in life to finding enlightenment through a dictionary. All three of these authors have come a long way on their paths of discovering and understanding the power of language and communication. With curiosity, research, self-determination, persistence and keeping an open mind, the world of language can be explored to great measures into understanding its meaning and value.

Chem Notes Igcse Essay Example for Free

Chem Notes Igcse Essay Giant Covalent Structures There are 2 examples of Giant covalent structures: Diamond Graphite They are both  allotropes  of carbon, meaning they are  both different  types of the physical  form of Carbon. Diamond Structure: Giant covalent  lattice  of carbon atoms. Each Carbon atom is bonded to 4 others which tetrahedrally surround the atom. They have a  high melting point  as a large amount of heat energy is needed to break their bonds. They are  unable  to conduct electricity as they have no free mobile  electrons to carry the current. Diamond is very  hard  as there are many bonds within the substance. It is the hardest natural substance and is often used in drilling. Graphite Structure: Arranged in  layers  of atoms. Each carbon atom is joined to 3 others, leaving one outer shell electron on each carbon is free to move and able to cary the current. Therefore, they are able to conduct electricity. Graphite also has a high melting point for the same reasons as diamond. However, it is not hard like diamond but in fact very soft. There are weak forces between  the  layers of atoms. They  are able to slide over each other and therefore able to act as a lubricant. Covalent Bonding Definition:  When an atom shares one or more pairs of electrons between atoms to obtain the electronic configuration of a noble gas. Covalent bonds appear in  non-metals  and create  molecules. They can even appear in atoms of the same element,  H2. Molecule:  Two or more atoms  chemically  bonded together. The covalently bonded atoms are held together by  strong attraction  between the  bonding pair of electrons  and the  nuclei  of the atoms. Covalent bonds can be classified into  two  groups:  simple molecular  structures   giant covalent  structures Simple molecular Structures: They have low melting/boiling points due  to the fact that  there  are  weak  intermolecular forces of attraction. Although, they do have strong covalent bonds. Therefore, they need less heat energy to overcome and break the weak bonds. Some substances  sumblime  under heating. i. e. They turn directly into a gas from a solid. Giant molecular Structures:  See post on giant Molecular structures , Ionic Bonding Definition:  The transfer of one or more electrons between 1 atom to another Why? To obtain the electronic configuration of a noble gas. This  is because noble gases are inert/very unreactive. If an atom  loses  an electron then the atom will form a  positive  ion. This is because there are now more protons than electrons in the atom. If an atom  gains  an electron, the atom forms a  negative  ion as there are now more electrons than protons in the atom. The  charge  of an ion is related to where the element’s position is in the periodic table.

Surgical Treatment Method of Isthmic Spondylolisthesis

Surgical Treatment Method of Isthmic Spondylolisthesis Comparison of Two and Three Vertebral Segment Posterolateral Fusion in the Treatment of Isthmic Spondylolisthesis Serkan BILGIC, Omer ERSEN, Tolga EGE, Kenan KOCA, Selahattin OZYUREK, Safak EKINCI, Erbil OGUZ, Ali SEHIRLIOGLU ABSTRACT Background Optimal surgical treatment method of isthmic spondylolisthesis remains unclear. Complications can be invited while saving a segment for lumbar motion. Objective The aim of this retrospective study was to determine the effect of the number of fusion levels on the clinical results of adult isthmic spondylolisthesis patients who had undergone posterior instrumentation and PLF. Patients and Methods This retrospective study comprised 37 (20 male, 17 female) patients with isthmic spondylolisthesis who had undergone posterior instrumentation and PLF (Postero-lateral fusion) between January 2005 and May 2011. Pre and post-operative radiological evaluation was made by anteroposterior, lateral, oblique and lateral flexion-extension x-rays. Preoperative spondylolisthesis slippage grading was evaluated according to the Meyerding classification from the preoperative radiographs. Results The mean age of the patients was 36.4 ± 9.2 years and the mean follow-up period was 34.3 months. Two-level fusion was applied to 22 patients and single-level fusion was applied to 15 patients. Decompression was performed on 7 patients in the two-level fusion group and on 6 patients in the single-level fusion group. There were no neurological complication after surgery in either group. No union complications were seen in the two-level PLF group but in the single-level PLF group, screw loosening occurred in 3 patients and screw breakage in 1 due to the pseudoarthrosis. These four patients were revised with two-level PLF. Conclusions This study has demonstrated that two-level posterior instrumentation and PLF with local bone grafts and DBM have significantly better clinical and radiological results than single-level surgery. To avoid potential complications of PLIF, two-level PLF can be an alternative treatment option. Key words:Istmic spondylolisthesis, Posterior lumbar interbody fusion, Fixation Background Lumbar spondylolisthesis is present in about 5% to 6% of the population with various etiopathogenesis. Due to its variant pathological anatomy, the radiological appearance, age and clinical aspect of the patients are different on diagnosis. It generally starts as spondylolysis, a bilateral pars fatigue fracture and becomes spondylolisthesis with a slip of a vertebra over the adjacent one. As the slip increases, disc degeneration and pain starts (1-3). Although conservative treatment is the first treatment option, surgery for symptomatic spondylolisthesis in adults has been found to have better clinical results than conservative treatment choices (3, 4). However, it remains unclear which surgical strategy should be adopted, as there is limited scientific evidence on which to base an optimal treatment method. Discussions on spondylolisthesis treatment have generally focussed on reduction, fusion levels, graft choices, and surgical techniques (5-7). One of the most preferred surgical treatment options for spondylolisthesis is posterior transpedicular instrumentation of the relevant segments and posterolateral fusion (PLF) (5, 7). However, it is still a matter of controversy in literature as to how many levels should be fused and instrumented. Objectives The aim of this retrospective study was to determine the effect of the number of fusion levels on the clinical results of adult isthmic spondylolisthesis patients who had undergone posterior instrumentation and PLF. Materials and Methods This retrospective study comprised 37 (20 male, 17 female) patients with isthmic spondylolisthesis who had undergone posterior instrumentation and PLF between January 2005 and May 2011. Patients with spondylolisthesis other than Type 2 according to the Wiltse classification were excluded from the study. Pre and post-operative radiological evaluation was made by anteroposterior, lateral, oblique and lateral flexion-extension x-rays. Preoperative spondylolisthesis slippage grading was evaluated according to the Meyerding classification from the preoperative radiographs. The decompression decision was made preoperatively according to magnetic resonance imaging (MRI) and patients preoperative neurological evaluation. Preoperative and postoperative neurological status, duration of surgery, number of fused and instrumented levels, total blood loss and complications were evaluated from the clinical database. For clinical evaluation of surgical outcomes, the Oswestry Disability Index (ODI) a nd Visual Analog Scale (VAS) applied at the final follow-up were used. 3.1 Surgical procedure: Exposure was obtained from the spinous processes to the transverse processes bilaterally throughout segments planned for fusion. Under fluoroscopic control, 6.5 mm pedicle screws were placed by free-hand technique. No reduction manoeuvre was used. Decompression of the segments, which had been determined by preoperative MRI and clinical examination was performed for the patients with neurological deficit. In all cases PLF was performed. In the area planned for fusion, the spinous processes were resected, peeled off from soft tissues and used for grafting with demineralized bone matrix. Patients were mobilized with a soft brace on the first postoperative day and the brace was continued for 3 months. (Figure 1, 2) 3.2 Statistical analysis We used the SPSS software package (version 15.0, SPSS, Chicago, IL) and expressed categorical variables as percentages and continuous variables as mean ± standard deviation (SD) or median (quartiles). Kolmogorov-Smirnov test was used to evaluate whether the distribution of continuous variables was normal. For parameters that showed normal distribution we used the paired sample t test and for parameters that did not show normal distribution the Mann-Whitney U-test was used. Chi-square test was used to analyze categorical variables. Statistical significance was set at p Results All patients had a history of at least 3 months of lumbar pain due to the spondylolisthesis, which had proved to be resistant to conservative treatment. The mean age of the patients was 36.4 ± 9.2 years and the mean follow-up period was 34.3 months. Low-grade isthmic spondylolisthesis was present at L5-S1 level in 23 patients, at L4-5 level in 13 patients and at L3-4 level in 1 patient. Two-level fusion was applied to 22 patients and single-level fusion was applied to 15 patients. Decompression was performed on 7 patients in the two-level fusion group and on 6 patients in the single-level fusion group. There were no neurological complications after surgery in either group. Mean duration of surgery for single-level and two-level surgery was 160 minutes and 190 minutes (160-240), and average blood loss was 285 ml and 390 ml respectively. There were no differences between the two groups in terms of demographic properties (Table 1). One of the patients in the two-level PLF group had superficial infection and was treated with debridement and antibiotheraphy. No union complications were seen in the two-level PLF group but in the single-level PLF group, screw loosening occurred in 3 patients and screw breakage in 1 due to the pseudoarthrosis. These four patients were revised with two-level PLF. (Figure 3) ODI scores from the final follow-up were 12.2 ±6.2 in the single-level PLF group, and 9.2  ± 6.4 in the two-level PLF group (p=0,035). VAS scores were 3.2 ±1.7 in the single-level PLF group and 2.9 ±1.6 in the two-level PLF group (p=0.043). The ODI and VAS scores of the patients revised with two- level PLF were excluded from the clinical evaluation. Discussion Lumbar spondylolysthesis has several etiopathogenetic factors as was shown by Marchetti and Bartolozzi giving rise to variations in pathological anatomy, radiological findings, age and clinical symptoms of the patients on diagnosis. When conservative treatment options fail, surgery becomes the next step. Although there have been a large number of studies on spondylolisthesis, there is no clear evidence for a single superior treatment option. Anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF) and PLF with/without instrumentation are the most widely accepted surgical methods. Whilst PLF with instrumentation is the most preferred treatment for most authors, there is no scientific evidence showing that PLF is disadvantageous compared to PLIF or circumferential fusion (8-11) even though the major theoretical advantage of PLIF and circumferential fusion seems to have resulted in improved outcomes compared with PLF. Ekman et al (12) found that the type of fusi on, whether PLIF or PLF, did not affect the outcome of surgical treatment of adult isthmic spondylolisthesis over a two year follow-up period. Furthermore, PLIF is a more invasive, technically more difficult method requiring a longer operative time, which may result in increased blood loss and higher complication rates (12, 13). Similarly, Kim et al. could not demonstrate any difference between ALIF and PLF with instrumentation (11). Although circumferential fusion was reported as significantly better than PLF at 6 months and 1 year in a study by Swan, no difference was determined at two years (14). In a systematic review of 29 high quality studies, Jacobs and al. found no difference between different fusion techniques (15). In the current study the treatment choice was PLF with instrumentation which is a relatively easy method with a shorter operating time and lower blood loss compared to other techniques in literature. When performing PLF, slip reduction can be achieved during the same procedure. The advantages of slip reduction include improved spine biomechanics, better nerve root decompression and a better opportunity for fusion by relieving tension and shear forces (5). Although the major disadvantage of slip reduction is increased risk of neurological injury, there have been numerous studies evaluating slip reduction for adult low grade spondylolisthesis (14, 16-18). In the current study, slip reduction was not performed to avoid the possibility of potential neurological damage and as all the cases had low grade isthmic spondylolisthesis. To protect one more mobile segment, some authors have preferred single-level postero-lateral instrumentation and fusion instead of two-level (6, 13, 15). However, there is no scientific proof to help determine the number of fusion levels and this decision is based on the surgeon’s empirical experience. In a prospective study by Inage et al, two-level fusion with local bone grafts was shown to cause increased pseudoarthrosis (6). Similarly in a study by Deguchi et al, single-level fusions showed an 82% fusion rate, and two-level fusions, a 74% rate radiologically (19). Higher fusion rates in the two-level fusion group were achieved with rigid spinal implants. The clinical success of that study correlated with the radiological fusion rates. Contrary to the information in literature, local bone grafts mixed with demineralized bone matrix (DBM) were used in the current study to achieve union for both groups and no union problem was seen in the two-level fusion group. Pseudoarthros is was observed in four cases in the one -level fusion group. Although some authors have reported incongruity between the clinical results of spondylolisthesis patients and union rates, VAS and ODI are the most reliable clinical tests to evaluate spondylolythesis (9, 10, 20). The results of the current study reveal that two-level posterior instrumentation with PLF has better results than single-level surgery according to VAS and ODI. This study has some limitations. Firstly, the retrospective design did not allow for uniformity of the groups. The number of patients was also limited to achieve generalized results. Although the pedicle screws were all 6.5 mm in size, they were not all from the same manufacturer, so implant problems were disregarded. In conclusion, this study has demonstrated that two-level posterior instrumentation and PLF with local bone grafts and DBM have significantly better clinical and radiological results than single-level surgery. To avoid potential complications of PLIF, two-level PLF can be an alternative treatment option. References 1.Floman Y. Progression of lumbosacral isthmic spondylolisthesis in adults. Spine. 2000;25(3):342-7. 2.Fredrickson BE, Baker D, McHolick WJ, Yuan HA, Lubicky JP. The natural history of spondylolysis and spondylolisthesis. The Journal of bone and joint surgery American volume. 1984;66(5):699-707. 3.Osterman K, Schlenzka D, Poussa M, Seitsalo S, Virta L. 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A prospective study comparing decompression with decompression and intertransverse process arthrodesis. The Journal of bone and joint surgery American volume. 1991;73(6):802-8. 11.Kim NH, Lee JW. Anterior interbody fusion versus posterolateral fusion with transpedicular fixation for isthmic spondylolisthesis in adults. A comparison of clinical results. Spine. 1999;24(8):812-6; discussion 7. 12.Ekman P, Moller H, Tullberg T, Neumann P, Hedlund R. Posterior lumbar interbody fusion versus posterolateral fusion in adult isthmic spondylolisthesis. Spine. 2007;32(20):2178-83. 13.Madan S, Boeree NR. Outcome of posterior lumbar interbody fusion versus posterolateral fusion for spondylolytic spondylolisthesis. Spine. 2002;27(14):1536-42. 14.Swan J, Hurwitz E, Malek F, van den Haak E, Cheng I, Alamin T, et al. 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Single-level instrumented posterolateral fusion of the lumbar spine with a local bone graft versus an iliac crest bone graft: a prospective, randomized study with a 2-year follow-up. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2011;20(4):635-9. Tables Table 1. Paramaters of groups during surgery 1