Demographic Profile Of The Respondents Accounting Essay

In this chapter, consequence is obtained through the informations aggregation method from 300 questionnaires. The informations obtained from questionnaires are analyzed and computed by utilizing the Statistical Package societal Science ( SPSS ) package. Tables and charts will be exhibited to show the consequences in an apprehensible mode. This chapter started off with the descriptive analysis of the respondent demographic profile and cardinal inclinations measuring of concepts. Next, scale measuring is to supply the consequences of dependability trial. This is followed by the illative analysis with the Pearson correlativity coefficient analysis and multiple additive arrested development analysis. Last is to reason this chapter.4.1 Descriptive Analysis4.1.1 Demographic Profile of the RespondentsTable 4.1: Gender of RespondentsGenderFrequency Percentage Valid Percentage Accumulative Percentage Valid Male 105 51.7 51.7 51.7 Female 98 48.3 48.3 100.0 Entire 203 100.0 100.0 Beginning: Developed for the research In the Table 4.1 above, it showed the frequence and per centum of gender of 203 respondents. There were a sum of 105 male respondents ( 51.7 % ) and a sum of 98 female respondents ( 48.3 % ) . Table 4.2: The Age Group of RespondentsAgeFrequency Percentage Valid Percentage Accumulative Percentage Valid Under 21 old ages 5 2.5 2.5 2.5 21-30 old ages 67 33.0 33.0 35.5 31-40 old ages 54 26.6 26.6 62.1 41-50 old ages 31 15.3 15.3 77.3 51 old ages & A ; above 46 22.7 22.7 100.0 Entire 203 100.0 100.0 Beginning: Developed for the research Table 4.2 presented the frequence and per centum of the age group of respondents. 5 respondents ( 2.5 % ) were under 21 old ages old, 67 respondents ( 33.0 % ) were 21 to 30 old ages old, 54 respondents ( 26.6 % ) were 31 to 40 old ages old, 31 respondents ( 15.3 % ) were 41 to 50 old ages old and 46 respondents ( 22.7 % ) were 51 old ages old and above. Table 4.3: The Marital Status of RespondentsMarital StatusFrequency Percentage Valid Percentage Accumulative Percentage Valid Single 73 36.0 36.0 36.0 Married 130 64.0 64.0 100.0 Entire 203 100.0 100.0 Beginning: Developed for the research The Table 4.3 indicated the frequence and per centum of the matrimonial position of respondents. The bulk of the respondents were married which represented 64.0 % that is about 130 people out of 203 respondents. Meanwhile, 73 respondents ( 36.0 % ) were still individual. Table 4.4: The Education Level of RespondentsEducation DegreeFrequency Percentage Valid Percentage Accumulative Percentage Valid Primary instruction 8 3.9 3.9 3.9 Secondary instruction 77 37.9 37.9 41.9 Certificate / Diploma 80 39.4 39.4 81.3 Bachelor ‘s grade 33 16.3 16.3 97.5 Master ‘s grade 5 2.5 2.5 100.0 Entire 203 100.0 100.0 Beginning: Developed for the research From the Table 4.4, it showed the frequence and per centum of the instruction degree of respondents. From the information above, bulk of 80 respondents held a certification or sheepskin ( 39.4 % ) . The 2nd and 3rd largest groups were 77 respondents who had completed the secondary instruction ( 37.9 % ) and 33 respondents who held a unmarried man grade ( 16.3 % ) . Last, the respondents who had completed the primary instruction and which is a maestro grade holders were 8 people ( 3.9 % ) and 5 people ( 2.5 % ) severally. Table 4.5: The Working Period of RespondentsWorking Time periodFrequency Percentage Valid Percentage Accumulative Percentage Valid Less than 1 twelvemonth 23 11.3 11.3 11.3 1-5 old ages 63 31.0 31.0 42.4 6-10 old ages 48 23.6 23.6 66.0 11-15 old ages 25 12.3 12.3 78.3 16-20 old ages 19 9.4 9.4 87.7 Above 20 old ages 25 12.3 12.3 100.0 Entire 203 100.0 100.0 Beginning: Developed for the research The Table 4.5 represented the frequence and per centum of the on the job period of respondents. The respondents were divided into six classs. 23 respondents worked as an insurance agent for less than one twelvemonth ( 11.3 % ) , 63 respondents worked for 1 to 5 old ages ( 31.0 % ) , 48 respondents worked for 6 to 10 old ages ( 23.6 % ) , 25 respondents worked for 11 to 15 old ages ( 12.3 % ) , 19 respondents worked for 16 to 20 old ages ( 9.4 % ) and 25 respondents worked as an insurance agent above 20 old ages ( 12.3 % ) .4.1.2 Cardinal Tendencies Measurement of Constructs4.1.2.1 Commission PayTable 4.6: Cardinal Inclinations Measurement for Commission Pay No. Statement Mean Standard Deviation CP1 I think the committee wage is a really of import incentive for me. 4.3448 0.75078 CP2 I am motivated by committee wage to seek my best attempts in work. 4.2562 0.73350 CP3 My occupation public presentation determine the extra committee wage when achieve higher mark. 4.2808 0.81141 CP4 I will retain the occupation because I am satisfied with the committee wage. 4.0985 0.85025 CP5 I work hard is to acquire a better committee wage in this occupation. 4.3005 0.78561 Beginning: Developed for the research Table 4.6 illustrated the cardinal inclinations measurings of committee wage. Mentioning to the tabular array above, most respondents agreed to the CP1 with average value of 4.3448. The 2nd highest was CP5 with average value of 4.3005. The 3rd and 4th highest were CP3 and CP2 which had the average value of 4.2808 and 4.2562 severally. The lowest average value was CP4 which was 4.0985. From the tabular array above, CP4 had highest standard divergence value which was 0.85025. The 2nd and 3rd highest standard divergence value was CP3 and CP5 which had 0.81141 and 0.78561 severally. The 4th highest standard divergence was CP1 with the value of 0.75078. The lowest standard divergence value was 0.73350 by CP2.4.1.2.2 Job SecurityTable 4.7: Cardinal Inclinations Measurement for Job Security No. Statement Mean Standard Deviation JSM1 I think occupation security is another of import incentive for me. 4.1232 0.68188 JSM2 I am motivated by the good occupation security in current occupation. 3.9852 0.74779 JSM3 I feel my current occupation is unafraid, dependable and lasting. 3.9951 0.82951 JSM4 My occupation public presentation is influenced by the occupation security. 4.0000 0.79603 JSM5 I work hard is because I ‘m afraid to loss this stable occupation. 3.7143 1.00845 Beginning: Developed for the research The Table 4.7 illustrated the cardinal inclinations measurings of occupation security. The consequence from the tabular array above, JSM1 had the highest average value of 4.1232. The 2nd highest average value was JSM4 which was 4.000. The 3rd highest was JSM3 with the average value of 3.9951 which was followed by JSM2 which had a average value of 3.9852. The JSM5 had the lowest average value of 3.7143. Harmonizing to the Table 4.7, the JSM5 had the highest standard divergence value of 1.00845. The 2nd highest standard divergence value was JSM3 which was 0.82951. The 3rd highest was JSM4 with the standard divergence value of 0.79603 which was followed by JSM2 which had a standard divergence value of 0.74779. The lowest standard divergence value was JSM1 which was merely 0.68188.4.2.2.3 Opportunities for Advancement and DevelopmentTable 4.8: Cardinal Inclinations Measurement for Opportunities for Advancement and Development No. Statement Mean Standard Deviation AD1 I think the chances for promotion and development is another of import incentive for me. 4.1034 0.79238 AD2 I am motivated by chances for promotion and development in current occupation. 4.0443 0.75321 AD3 I have more chances for promotion and development in current occupation if I retain the occupation for longer period of clip. 4.0936 0.78734 AD4 I have more chances to direct for preparation, learn accomplishment and developing myself in current occupation. 4.1084 0.81330 AD5 I work hard is to acquire more chances for promotion and development in this occupation. 4.1675 0.74563 Beginning: Developed for the research Table 4.8 illustrated the cardinal inclinations measurings of chances for promotion and development. In the term of average value, AD5 had the highest mean of 4.1675. Second, it is followed by AD4 of 4.1084, AD1 of 4.1034 and AD3 of 4.0936. The AD2 had the lowest average value of 4.0443. From the Table 4.8, the AD4 had the highest standard divergence value of 0.81330. Second, it is followed by AD1 with the standard divergence value of 0.79238, AD3 with the standard divergence value of 0.78734 and AD2 with the standard divergence value of 0.75321. The lowest standard divergence value was 0.74563 by AD5.4.2.2.4 Work ItselfTable 4.9: Cardinal Inclinations Measurement for Work Itself No. Statement Mean Standard Deviation W1 I have more independent when I ‘m working. 4.1724 0.78654 W2 I have more assurance to accomplish the mark of the occupation. 4.2217 0.75461 W3 I am willing to work hard with current occupation. 4.2069 0.72886 W4 I am non willing to alter another occupation even if I get other occupation in elsewhere. 3.8227 0.98909 W5 I think my ability can execute good in current occupation. 4.1527 0.75211 W6 I am proud to work with current occupation. 4.2020 0.77944 Beginning: Developed for the research The Table 4.9 above, it illustrated the cardinal inclinations measurings of work itself. Based on the tabular array, W2 had the highest average value of 4.2217. The 2nd highest was W3 that had 4.2069 of average value. The 3rd highest was the W6 that had 4.2020 of mean value which was followed by, the W1 and W5 which had the average value of 4.1724 and 4.1527 severally. The W4 had the lowest average value was 3.8227. In the tabular array above, the highest standard divergence value was 0.98909 by the W4. The 2nd highest standard divergence value was W1 which was 0.78654. The 3rd highest standard divergence value was the W6 that had 0.77944 which was followed by, the W2 and W5 which had the standard divergence value of 0.75461 and 0.75211 severally. The lowest standard divergence value was W3 which was 0.72886.4.2.2.5 Job SatisfactionTable 4.10: Cardinal Inclinations Measurement for Job Satisfaction No. Statement Mean Standard Deviation JS1 In general I am satisfied with my occupation. 4.1330 0.74265 JS2 I am satisfied with the flexibleness of the on the job hours in current occupation. 4.3054 0.68601 JS3 I am satisfied with the committee wage strategy in current occupation. 4.0394 0.78250 JS4 I will retain the occupation because I am satisfied with the occupation security. 4.0148 0.74779 JS5 I am satisfied with the accomplishment in current occupation. 4.0591 0.78125 JS6 I am happy with the manner my co-workers and higher-ups treat me. 4.0936 0.79982 JS7 I am truly enjoyed with my occupation. 4.2266 0.81925 Beginning: Developed for the research Harmonizing to Table 4.10, it illustrated the cardinal inclinations measurings of occupation satisfaction. Based on the tabular array, most respondents agreed to the JS2 with average value of 4.3054. The 2nd highest was JS7 that had 4.2266 of average value. The 3rd and 4th highest average value was JS1 and JS6 which is 4.1330 and 4.0936 severally. The 5th highest was JS5 with the average value of 4.0591 which was followed by JS3 which had a average value of 4.0394. The lowest average value was the JS4 which was merely 4.0148. In the term of standard divergence value, JS7 had the highest standard divergence of 0.81925. Following, it is followed by JS6 of 0.79982, JS3 of 0.78250, JS5 of 0.78125 and JS4 of 0.74779. The two lowest standard divergence values were JS1 of 0.74265 and JS2 of 0.68601.4.2 Scale Measurement4.2.1 Internal Reliability TestTable 4.11: Reliability Statistic Variable Cronbach ‘s Alpha N of Items CP 0.881 5 JSM 0.805 5 Ad 0.911 5 Tungsten 0.899 6 Joule 0.901 7 Beginning: Developed for the research The dependability trial is test the consistence and truth of the IVs and DV which the credence degree of cronbach ‘s alpha more than 0.70. Based on the Table 4.11, the highest cronbach ‘s alpha is chances for promotion and development standing at 0.911. The 2nd highest is occupation satisfaction which the cronbach ‘s alpha is 0.901 followed by committee wage and work itself which the cronbach ‘s alpha are 0.899 and 0.881. The lowest cronbach ‘s alpha is occupation security standing at 0.805. From the consequence, overall the cronbach ‘s alpha for all variable are more than 0.70. Therefore, the questionnaire in this research is dependability and consistence.4.2.2 Normality TestThe trial of normalcy, histogram with normal curve, P-P secret plan and spread secret plan diagram are being used to demo the normal distribution of informations. Table 4.12: Trials of Normality Kolmogorov-Smirnova Shapiro-Wilk Statistic df Sig. Statistic df Sig. Standardized Residual .055 203 .200* .988 203 .091 a. Lilliefors Significance Correction * . This is a lower edge of the true significance. Beginning: Developed for the research This research uses 203 study questionnaires which the sample size is more than 100. Therefore, Kolmogorov-Smirnov ‘s trial is usage for proving the normalcy as it is used to analyze larger sample size ( n & gt ; 100 ) . Based on the Table 4.12, the important value of Kolmogorov-Smirnov ‘s trial is equal to 0.200, which is more than 0.05. Thence, as the normalcy premise is achieved, the informations can be assumed to be usually distributed. Besides, based on the Appendix D, the histogram with normal distribution curve of trade name trueness demoing a sensible bell-shaped and therefore the informations can be assumed to be usually distributed. In add-on, from the Appendix E, the normal chance secret plan of trade name prevarications near to the fanciful heterosexual line which is lifting from the lower-left corner to the upper right corner and demo a upward incline of the graph. This can connote that the informations can be assumed to be usually distributed.4.2.3 Multicollinearty TestBased on the Table 4.14, the correlativity coefficient between IVs were 0.581 for CP and JSM, 0.496 for CP and AD, 0.528 for CP and W, 0.604 for JSM and AD, 0.612 for JSM and W, and 0.657 for AD and W. Therefore, these correlativity coefficients are high between IVs but there is no multicollinearity job since they are all less than 0.8 in this research ( Field, 2005 ) . Furthermore, harmonizing to Table 4.13 the tolerance and VIF value for CP ( 0.606 1.650 ) , JSM ( 0.493 2.029 ) , AD ( .497 2.013 ) and W ( .478 2.094 ) are more than 0.1 and less than 10 severally in the multicollinearity statistics. Hence, multicollinearity job do non show in this research ( Hair et al. , 1992 ) . Table 4.13: Multicollinearity Model Collinearity Statisticss Tolerance VIF CP_Average .606 1.650 JSM_Average .493 2.029 AD_Average .497 2.013 W_Average .478 2.094 Beginning: Developed for the research4.3 Inferential Analysis4.3.1 Pearson ‘s Correlation AnalysisTable 4.14: Pearson ‘s Correlation Analysis CP JSM Ad Tungsten Joule Commsion Pay ( CP ) 1 Job Security ( JSM ) .581** 1 Opportunities for Advancement and Development ( AD ) .496** .604** 1 Work Itself ( W ) .528** .612** .657** 1 Job Satisfaction ( JS ) .557** .659** .674** .836** 1 ** . Correlation is important at the 0.01 degree ( 2-tailed ) . Beginning: Developed for the research By implementing Pearson Correlation Coefficient, Table 4.14 illustrates the consequences of the correlativity analysis of the four independent variables ( CP, JSM, AD and W ) and one dependant variable ( JS ) . The consequence from Table 4.14 shows that p-value of committee wage is 0.000 which is less than the significance value 0.01 degree ( 2-tailed ) and the R value is 0.557. Therefore, the analysis consequence concludes that committee wage is moderate positive correlated with occupation satisfaction. For occupation security variable, the p-value is 0.000 which is lower than the significance value 0.01 degree ( 2-tailed ) and the R value is 0.659 which indicates there is moderate positive relationship between occupation security and occupation satisfaction. In the Table 4.14, the p-value of chances for promotion and development is 0.000 ( P & lt ; 0.01 ) and the R value is 0.674. Hence, the chance for promotion and development is moderate positive correlated with occupation satisfaction. As shown in the Table 4.14, the p-value of work itself is 0.00 which is lower than the significance value 0.01 degree ( 2-tailed ) and the R value is 0.836. As a consequence, the work itself has high positive relationship with occupation satisfaction.4.3.2 Multiple Regression AnalysisTable 4.15: Multiple Regression Analysis Independent Variables Unstandardized Coefficients Standardized Coefficients t-value Sig. Bacillus Beta Changeless .350 2.069 .040 Commission Pay .069 .074 1.610 .109 Job Security .158 .160 3.154 .002 Opportunities for Advancement and Development .130 .143 2.834 .005 Work Itself .562 .605 11.724 .000 R2 .748 Adjusted R2 .743 F 147.264** Beginning: Developed for the research From table 4.15 above, shows that the correlativity coefficient, R= 0.864, means that there is a positive correlativity between the four independent variables and dependent variable. The value of R Square is 0.748 which indicates that 74.8 % of the discrepancy in the dependant variable ( occupation satisfaction ) is explained by the 4 independent variables ( committee wage, occupation security, chances for promotion and development, and work itself ) . However, it is still leaves 25.2 % of occupation satisfaction is explained by other factors in this survey. Furthermore, harmonizing to table above, p-value ( Sig. 0.000 ) is less than alpha value 0.05, therefore, the F- statistic which equals to 147.204 is important. That mean this theoretical account is a good form for the relation between the residuary and forecasters. Therefore, the independent variables ( committee wage, occupation security, chances for promotion and development, and work itself ) are significantly explicating the discrepancy in the occupation satisfaction among insurance agents. Since the p-value is less than 0.05 and is in the cull part which H0 is rejected. Harmonizing to Table 4.15, occupation security ( p=0.002 ) , chances for promotion and development ( p= 0.005 ) , work itself ( p & lt ; 0.001 ) are important to foretell the dependant variable ( occupation satisfaction ) in this survey because their p-values ( Sig. ) are less than alpha value 0.05. From the multiple arrested development analysis, occupation security, chances for promotion and development and work itself are the of import motive factors that affect the occupation satisfaction among insurance agents in Malaysia. Among these IVs, work itself is the strongest determiner. However, the independent variable ( committee wage ) is non significantly foretelling the dependant variable ( occupation satisfaction ) . This is because committee wage ( p=0.109 ) is more than the alpha value 0.05. Therefore, a multiple additive arrested development is formed by utilizing the information from the column headed â€Å" B † shown in the tabular array 4.15 above. The arrested development equation is as below: Job satisfaction = 0.350 + 0.069 committee wage + 0.158 occupation security + 0.130 chances for promotion and development + 0.562 work itself4.4 DecisionThree independent variables ( occupation security, chances for promotion and development and work itself ) for this research are found to hold important relationship with the independent variable ( occupation satisfaction ) . However, the independent variable ( committee wage ) is non important relationship with the dependant variable ( occupation satisfaction ) . Consequences of the analysis and back uping grounds for the consequences are being discussed in the undermentioned chapter.

Nurse Management

Our services are provided to those who have a private insurance, Medicare, Medicaid, or have the ability to pay for themselves. No individuals in need of our help will be denied, because of their inability to pay. I believe that management currently employs an instrumental leadership method. The instrumental leadership method has a category that includes the strategic leadership method. According to Rowel (2014), strategic leadership â€Å"influences organizational performance indirectly through actions and sections taken by the leader and his or her follower. Essentially it a follow the leader method, that seems to have taken on quite well with the majority. Our unit leader does not lead vocally, but through her actions. She works hard and which set the bar and example for the remainder of staff to follow. I believe that one of our biggest problems is the lack of accountability from some staff member. It is unfortunately really tough for some people to own up to their own mistakes, which would ultimately help the staff as a whole cause it is something that we all learn from.Our duty is to provide our patients with a multi-disciplinary team throughout their tenure with us, with the hopes of helping them reach a maximum level of dependability. This way they can gradually ease back into society. Ideally, the typical patient to nurse ratio is six to one. I reiterate the fact that is ideally, as with most nurses, in most facilities, we are normally understaffed. So that patient to nurse ratio can sometime reach to ten to one. Which in behavioral health, can be extremely dangerous.Many of our patients are very unstable individuals, and require extra care and supervision. Imagine having multiple patients needing that same care and supervision, at the same time. I simple solution would like for this, is for us to monitor our admissions. Take in account how many nurses are on staff, before admitting several patients at one time. Nurse Management Our services are provided to those who have a private insurance, Medicare, Medicaid, or have the ability to pay for themselves. No individuals in need of our help will be denied, because of their inability to pay. I believe that management currently employs an instrumental leadership method. The instrumental leadership method has a category that includes the strategic leadership method. According to Rowel (2014), strategic leadership â€Å"influences organizational performance indirectly through actions and sections taken by the leader and his or her follower. Essentially it a follow the leader method, that seems to have taken on quite well with the majority. Our unit leader does not lead vocally, but through her actions. She works hard and which set the bar and example for the remainder of staff to follow. I believe that one of our biggest problems is the lack of accountability from some staff member. It is unfortunately really tough for some people to own up to their own mistakes, which would ultimately help the staff as a whole cause it is something that we all learn from.Our duty is to provide our patients with a multi-disciplinary team throughout their tenure with us, with the hopes of helping them reach a maximum level of dependability. This way they can gradually ease back into society. Ideally, the typical patient to nurse ratio is six to one. I reiterate the fact that is ideally, as with most nurses, in most facilities, we are normally understaffed. So that patient to nurse ratio can sometime reach to ten to one. Which in behavioral health, can be extremely dangerous.Many of our patients are very unstable individuals, and require extra care and supervision. Imagine having multiple patients needing that same care and supervision, at the same time. I simple solution would like for this, is for us to monitor our admissions. Take in account how many nurses are on staff, before admitting several patients at one time.

Compare and contrast the distinguishing features of episode 2 of the mini series Changi and The Shoehorn Sonata

Gordon's Will is the 2nd episode of a six part series called Changi. The story is of one mans struggle to overcome and survive life in a POW camp. Gordon uses flash backs to reconstruct the past for the audience. Gordon (in the present time) has suffered a stroke and is having major medical and family troubles. Most of the show is shot in the POW camp where the secret nine live, a group of Gordon's friends that are also being held captive and that have formed an unbreakable and special bond. Midway through the show Gordon is asked to salute lieutenant Aso. When Gordon refuses, Aso commands Gordon to stand on a box until he is ready to salute, Gordon still refuses and stands on the box for three days, this is an example of Gordon's will to survive Changi with respect. There are many influential characters in Changi. ‘The Secret nine' are a ‘band of brothers' who without each other could not have emotionally survived the Changi POW camp. Gordon is the most influential character in the show, being that this episode is based on his time in the camp and life after it. Changi needed to use alot of dialogue because it is a television program. Australian slang such as ‘G, day', ‘bloody hell', ‘Japs' and ‘stick ya bib in' is used regularly throughout the show. Japanese is used throughout Changi wich gives the show a sence of urgency and helps to establish the setting. In the opening title you hear soothing/melodic music with a sudden burst of screaming, crying and wailing, this is symbolic of the pain and suffering Gordon (and other POW captives) had top survive. Changi is set around Gordon (an old man in the present and a young man in flashbacks). In the present Gordon is a lonely, old and sick man. In the Flashbacks Gordon was strong, stubborn, and willing to do anything in order to survive. The literal setting is a Japanese POW camp and a hospital, both places are symbolic of death. Many different camera techniques are used to develop the theme in Changi. Extreme close ups are used mainly in Changi to show fear and desperation on a characters face. In the second half of the show an extreme close up is used, it focuses on sweat that is dropping from Gordon's head when he is standing on the box, this was to show Gordon's determination to survive. On the Road to Gundagai is used as a theme song for the ‘secret 9'. Music was a coping mechanism for Gordon and his fellow prisoners so as to survive imprisonment with a stable mind. On the road to Gundagai was used because a lot of Australian people know and recognise that song. Both Changi and the Shoehorn Sonata have many similarities and many differences. In regards to the plot the Shoehorn Sonata and Changi are both about WW2 and being captured in a POW but are from two different perspective's (women's and men's). In regards to the characters in the texts both texts showed the main characters in the past and the present. In regards to the dialogue both texts use Japanese to give the show or play a sence of urgency and to define the setting clearly. IN regards to the setting both texts are very different; one is set in a hospital and the POW camp and the other is set in a television studio and a hotel. In regards to photography both texts use images to provoke the audience into feeling for the characters. Being a television series Changi has used photography every second of the show but being a play photography was used sparingly, but was still present. In regards to music/songs The Shoehorn Sonata used songs with lyrics that were symbolic of survival and Changi used a popular Australian song to symbolise ‘the secret 9's'will to survive. This essay has shown the distinguishing features of episode 2 of the mini series Changi and The Shoehorn Sonata, it then compared and contrasted them. Both texts dealt with a common theme of survival.

The Manhattan Project Research Paper Example | Topics and Well Written Essays - 1250 words

The Manhattan Project - Research Paper Example (Hewlett, 1962) The overall cost of $2 billion USD requiring over 130,000 people on thirty sites in three different countries would pay for a military, political, and cultural transformation that would define the nightmares of the age to come. The initial weapon itself, the fission warhead functioned exclusively through the splitting of radioactive, fissile uranium, creating a chain-reaction that leads to the splitting of additional atoms of fissile uranium for a release of energy thousands of times greater that anything which could be achieved using the trinitrotoluene (TNT) high-explosives that were prevalent early in the war. Specifically, the type of uranium used was the isotope (U-235), the difficulty in the procurement and purification of this precise form was the reason why 130,000 people were required. The Gun method requires one plug or bullet of fissionable uranium fired at a larger mass of uranium; critical mass is achieved when the two collide. Implosion requires surrounding the fissionable mass with high-explosive shaped charges that detonate inwards, compressing the mass and resulting in a chain-reaction. It is possible to combine one or more of these systems for daisy-chain successive detonations, creating weapons of compounded magnitude beyond the immediate purposes of a military campaign. (Life, Editors 1961) Such a threat no doubt adding radioactive fuel to the fires of nuclear hysteria that gripped the nation in the subsequent decade. The most immediate consequences of the Manhattan Project led to Japan being the only nation that sustained nuclear attack in time of war. Germanys surrender in the Spring on 1945 prevented them from being a threat in time for the first Little-Boy to be constructed. It is known, however that the Nazi did succeed in acquiring supplies of heavy water, containing the deuterium that would have aided

Knowledge can be gained from books and scientific observation. What Essay

Knowledge can be gained from books and scientific observation. What are some other important sources of knowledge andd why are they valuable - Essay Example The people from whom we learn something from are normally designated as authority. Apart from family, other common authority figures are celebrities. There is a lot of information that you can learn from authorities. However, this does not mean that they are always right. You can use rationalization to come up with many amazing facts. This is to say that when you are presented with a fact, you can deduce something else from it. For example, if all cats have hair and Baggs is a cat. Then Baggs has got hair. When using deductions to learn something new, the original two statements have to be true. However, deduction and rationality has its own downsides which can be referred to as logical fallacies. An example of a fallacy is as follows: All cats have got hair. Baggs has got hair. Therefore, Baggs is a cat. The third statement is a fallacy in itself and it can apply in any complex situation. That is why there is need to be extra careful when deducing facts. If you do not have information at hand about something, it is better not to deduce anything as doing so might lead to problems and misinformation. Intuition is one of the natural reactions that are very hard to understand, but it is one of the most accurate sources of information. Insight is the knowledge you have about something and it can be learned from books, scientific observation or experience. In most cases, intuition and insight go hand in hand. Intuition and instinct are somehow interlinked. Intuition is a like a small voice that tells you what to do and instinct is the action that results from the intuitive feeling. If you have some insight into something, then you will intuitively react to it the right way. For instance, you will know to slap at a mosquito when it bites you. This intuitive action is as a result of the insight you have about mosquitoes. Relying on intuition alone to come up with solutions to tough

Hypotheses, Causal Model, and Operationalization Form Essay

Hypotheses, Causal Model, and Operationalization Form - Essay Example Thus, anyone who eats a balanced diet or eats well will have to live longer than those who do not. C) Draw a causal model of your hypotheses—using textboxes, arrows, and proper notation. If you do not already know how to create textboxes, or resize textboxes, or draw and move arrow, or align plusses and minuses along the lines, or make all of the lines and arrows black— this is when to learn. In terms of layout and formatting, your model ought to look like those in the samples and exercises from class. (Simply bump it all to the next page if you need additional space.) 5. Where You Have Access to Data for Your Time Period and Cases to Actually Measure the Variable as Operationalized Above (NOT ‘hope’ to find and have access to, or ‘might’ find and have access to, or ‘will start to look for’ or anything other than KNOW where the needed info/data is and KNOW you have access to it.) The variables will be measured using the most appropriate methods for each of them. Since they have a direct influence on the findings, the choice of the variable will have to be made after considering its effectiveness. For instance, while dealing with eating habits as one of the variables in the research, the researcher will have to conduct a thorough survey to ensure that the most appropriate and proportionate population sample is studied and analyzed. This will help in ensuring that the research is accurate and valid to be relied

Does Third Cinema Still Exist or Has Already Died Essay

Does Third Cinema Still Exist or Has Already Died - Essay Example The term ‘Third Cinema’ was coined by in the 1960s by two filmmakers from Argentina: Fernando Solanas and Octavio Getino. In 1968, after jointly directing a film: La Hora de los Hornos (Hour of the Furnaces), Solanas and Getino wrote their manifesto known as hacia un tercer cine (towards a third cinema). There the authors had identified three categories of cinema: the First, the Second and the Third World Cinema. The Third Cinema is a form of opposition to the film making institutions of the dominating nations of the world. For this reason, it has also been described as ‘militant cinema’. The Third Cinema is defined by its director’s conception of the world. It is not determined by the genre of the film or any particular political viewpoint expressed by the cinema. This kind of cinema first flourished in the 1960s. This was precisely the time when many colonized countries were rising in protest in the form of their National Liberalization Struggle aga inst their western colonial powers. During this period, a group of film makers from the third world countries started making a new king of cinema. These were dynamic and politically stimulating films that represented the way of life and the political resistance in these less developed nations. Though these films were made on a variety of different themes, they were very different from contemporary western cinema. The directors of the Third Cinema wanted to provide expressions to the dissatisfied citizens of the third world countries who were already voicing their opinions on the economic and political exploitations of the western powers. Third Cinema provided the platform where people were allowed to argue, struggle and make experimental films which were a contrast to the usual entertaining cinema that was popular around the world. Solanos and Getino in their manifesto (1969) stated: â€Å"In the dependent countries, third cinema is a cinema of decolonization, which expresses the w ill to national liberation, anti-mythic, anti-racist, anti-bourgeois and popular†.              Ã‚  

Cultural diversity research paper Essay Example | Topics and Well Written Essays - 2000 words

Cultural diversity research paper - Essay Example This has resulted mainly due to a lot of pressure under exerted by the human rights activist under the Howard Government in the past decade. The multicultural policy also results due to general repercussion against liberal social movements surrounding groups such as the native people, feminist, ecologists and trade unionist over the decades. Due to such advocacy, the Australian environment has witnessed a shift of governance and policy conceptualization from quasi-pluralist model of ethnic governance to civic nationalist steered by the leadership of Howard government. Australia Multicultural Population Australia has a unique population in that 25% of them were born oversees and 43% of the national population are either born oversees or have one parent born oversees making it a country of multicultural population (Skywirk, 2013). In addition, this has been witnessed since 1945 due to the planned immigration programs, which have resulted into 6million people coming to Australia from ov er 150 countries in the globe (Skwirk, 2013). People wishing to migrate to Australia will not be denied entry based on race, ethnicity, religion or gender since selection of immigrants has been non-discriminatory over the years (Dunn & Forrest, 2006). This diversity in Majority of the Australia Immigrants are from the U.K, which represent over a million immigrants since 1970s to date. The immigration program of Australia and the multicultural policy is accommodative since it also tolerates the religious diversity by allowing populations from diverse religious backgrounds. In addition, the religious diverse groups are represented by the people from turkey, Lebanon and India who are equally welcomed in Australia. By 1980s, the Australian population was so diverse that it contained people from Vietnam, Philippines, Hong Kong, Malaysia, Cambodia and china, both in significant numbers making it a country of all races (Australia Government, 2013). The official language in Australia is Eng lish but there are over 200 languages from different communities including the 48 languages from the indigenous people hence about 16% speak other languages other than English. The Asian countries form the largest chunk of Australian immigrants representing 7% of the Australian overall population (Skwirk, 2013). Most of these are Chinese and Vietnamese representing the fifth and the fourth largest population in Australia respectively. By 1901, the Immigration Restriction Act restricted most of the early immigrant groups leading to fewer populations of immigrants during that period and this was before the realization that immigration is crucial for the social and the economic future of Australia. Australian multicultural policy principles (Australian Government, 2013) Principle 1: Due to the diversity of the Australian population in terms of both ethnicity/race and religion, it makes it a multicultural nation with more vibrant and creative ideologies, which helps in nation building. An enduring theme of Australian multicultural policy is that everyone belongs and enjoys all the benefits that come with the rich diversity. Moreover, the Austrians celebrate the diversity and recognize that the expression of diversity is embedded within their

The Genocide in Syria Essay Example | Topics and Well Written Essays - 1250 words

The Genocide in Syria - Essay Example The categorization of the group and the various individuals in that group is usually seen to defined by the perpetrators of the action. Perhaps the most distinctive contribution of this definition as proposed by chalk and Jonassohn is the description that the particular victim group and its various members are actually defined by the perpetrators. This aspect of the definition allows for the emphasizing that the perpetrators fundamentally work primarily according to their own individual and often fantastical, ideas of perceived enemy groups (30). The widely accepted definition as formulated by the UN terms genocide as being actions that are seen to be committed with the prime intent of attempting to destroy, the whole or specific parts of a national, ethnic, religious or racial group (Melson 23). The Origin of the Syrian Situation The Syrian civil war that has now turned into a genocide is seen to have initially grown out of a popular uprising against the current reigning al-Assad re gime. The uprising which began in March 2011 was part of the series of Arab Spring uprisings which were experienced in some regions of the Middle East having been inspired by the early 2011 fall of the repressive Tunisian regime. Among the key factors that resulted in causing the initial series of protests in Syria include widespread anger over the huge unemployment rates, state corruption, the numerous decades of dictatorship and state violence. By using a brutal response against the initial peaceful protests, the regime’s security forces were seen to inadvertently trigger a full-scale civil war that has now degenerated into a genocide. Despite experiencing some periodical ascents and descents, the current raging war in Syria is seen to have been continuously raging for a time period of over two years. Massive deaths (genocide) as a result of the Conflict According to the latest UN estimates, an approximated 5,000 Syrians are currently dying each month primarily as a result of the civil war and nearly 100,000 Sunnis are now estimated to have been destroyed by the reigning Assad regime since the advent of the war. Of note is that, there happens to be no magic number of actual deaths that can be used to categorize genocide. The ongoing genocide can only be identified by the act itself which is seen to have taken the form of deliberate and widespread destruction of extensively large numbers of non-combatant Sunni civilians (Carey 2013). As opposed to there being peaceful marches by Syrian citizens on the streets advocating for their freedom demands, the streets of Syria are now seen to primarily be peopled by a number of uncontrolled armed groups as well as the regime’s military powers. This has resulted in destruction levels in the country reaching a hitherto unprecedented level. CBC News (2013) reports that the an estimated over two million Syrian have reportedly fled the country with 1.93 million being registered as refugees and an additional 17 4,000 waiting for their refugee registration as at Sept 2013. The number of displaced persons inside the country is constantly on the increase and various aid agencies reported an estimated over four

From the Perspective of the Priest Child Abuser Essay Example for Free

From the Perspective of the Priest Child Abuser Essay The article â€Å"A Priest Child Abuser Speaks† from the book Slayer of the Soul was contributed by a priest who wishes to remain anonymous. He is a self-confessed child abuser during his priesthood, and by writing this, he wishes to share his experiences and his gradual climb back into society. He also believes that writing this article would provide a lesson for both the victimizers and their victims, and hopes that the victimizers would avoid committing such hideous wrongs towards their victims. In the article, the priest shares his journey of self-realization as he slowly vaporized the demon that was poisoning his soul and coercing him to do such crimes against children. The priest recalls that he was convicted for abusing children — sexually, psychologically, and emotionally — in the 1980s, and sentenced to 14 months in a minimum security facility. He believes that he was lucky, knowing that a similar child-abusing priest was sentenced for 20 years of hard labor. The priest mentions that life was tough for him both inside and outside of prison. He felt that a lot of people resented him for what he did to children, and believed that what happened was just a lie, no matter how true it was. Some officers, notably a lieutenant who hated him, bullied and toyed with him. Other prisoners were disgusted at his presence, refused to befriend him, or intimidated him often. For his size, he thought that he would not stand a chance, and he saw that avoiding conflict was the best solution. However, not all of these people resented him or was afraid of him. He recalls making some friends while in prison, ranging from guards to cell mates. They supported him and were sympathetic of him, especially at the time when the lieutenants abusive nature went a bit overboard. While in prison, he fought for the system to give him therapy for the â€Å"sickness† he believes that he was carrying. He won that appeal, and the court sent him to therapy twice a week. The Sex and Love Addicts Anonymous (SLAA) provided the opportunity for him to realize the root from which this sickness stemmed. While trying to heal himself, he also experienced rejection from close friends and acquaintances. Life was certainly difficult for him who was branded as a â€Å"child abuser,† which is why he wanted to reform himself in order to reenter society. During his SLAA therapies, he recalled his childhood which was filled with fear, anxiety, misfortune, and harassment. It was at that time when he idolized his parish scoutmaster and weirdly fell in love with him, prompting him into having a sexual relationship with him. It was a very traumatic experience that he knew he had to pull out from. He deducted that this might be the root of his â€Å"sickness† all along, as it was reinforced by an authority figure that it was â€Å"okay† to do it. He was also searching for a father figure, since his real father abandoned him and his family, and his mother declared him as the head of the household. When he entered the parish, he wished to help the children who had no father figure and had an emotionally miserable life. Things boiled over, and pretty soon, he was sexually involved with these young boys. One boy told his parents, and this made him realize his mistake. He mustered the strength to tell their parents that they need immediate therapy, but was arrested in the process when one therapist told the police about him. When he finally got out of prison, he wanted to mend the ties with his family and clear things up with them. However, they failed to â€Å"hear him out,† which was the reason that drove him into an unstable state in the first place. He confronted his scoutmaster and felt betrayed by his insights on the issue involving child abuse, telling him that it was wrong while he was regretting the fact that he believed in his scoutmaster. The damage has been done to him, and he believes that he needs to accept the consequences of his actions and just move on. He mentions that it left a black hole in his life, upon which he was initially placing things to fill that void. However, he realized that it was not the right course of action as he was building his life around that hole, completely avoiding it. Thus, he wished to enter the ministry again in order to help others that are trapped in the same dark cell in which he broke out from, although not completely. The priest mentions that gradually, he was able to recover his life and reform himself into the person that everyone knew before the incident. He was also able to reenter society as himself once again. Hence, he wishes to share his experiences to the world through this article in order to let people know that victims could become victimizers themselves one day, if they are not treated immediately. References A priest child abuser speaks. (1990). In S. J. Rossetti (Ed. ), Slayer of the Soul: Child Abuse and the Catholic Church (pp. 99-111). Mystic, CT: Twenty-Third Publications.

Water Content Or Moisture Content Environmental Sciences Essay

Water Content Or Moisture Content Environmental Sciences Essay Water content  or  moisture content  is the quantity of  water  contained in a material, such as  soil  (called  soil moisture),  rock,  ceramics, fruit, or  wood. Water content is used in a wide range of scientific and technical areas, and is expressed as a ratio, which can range from 0 (completely dry) to the value of the materials  porosity  at saturation. It can be given on a volumetric or mass (gravimetric) basis. The water content of a material is used in expressing the phase relationships of air, water, and solids in a given volume of material. In fine-grained (cohesive) soils, the consistency of a given soil type depends on its water content. The water content of a soil, along with its liquid and plastic limits as determined by Test Method  D4318, is used to express   its relative consistency or liquidity index. The quality of the result produced by this standard is dependent on the competence of the personnel performing it, and the suitability of the equipment and facilities used. Agencies that meet the criteria of Practice  D3740  are generally considered capable of competent and objective testing/sampling/inspection/etc. Users of this standard are cautioned that compliance with Practice  D3740  does not in itself ensure reliable results. The mass of water used in the above expression is the mass of free pore water only. Hence for moisture content determination the soil samples are dried to the temperature at which only pore water is evaporated. This temperature was standardized 105 C to 110 C. Soils having gypsum are dried at 60C to 80 C. The quantity of soil sample needed for the determination of moisture content depends on the gradation and the maximum size of particles. Following quantities are recommended. Soil Max quantity used (gm) Coarse gravel 1000 to 2000 Fine gravel 300 to 500 Coarse sand 200 Medium sand 50 Fine sand 25 Silt and clays 10 to 25 Moisture content affection : Always the amount of moisture contents affects the soil strongly by different issues , and this is the dramatically classifications of the different amounts of the moisture content in the soil : The soil is called ( brittle solid ) when its in a dry state or have a very little amount of moisture content inside the soil , and it will be hard and brittle as a result of that , though it breaks before it will deform ( hard candy ). The soil is described as ( semi-solid ) when its have a little amount of moisture content in it , thatà ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢s not able to cancel the solidity in the soil because of the little amount of it in the soil , and the behavior of the soil will be between the brittle and ductile state , and though it deforms permanently but with cracks ( like stiff cheese ). The soil described also as ( plastic ) when it have a noticed amount of moisture content which have an appearance affect in the soil , when the amount of the water content is nor little neither much in the soil , and the behavior of the soil in the state will noticed directly while catching the samlple of the soil by hand , it will have a very ductile , malleable behavior , thatà ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢s will deform without cracking ( like play-doh ). The soil in the last case , is the ( liquid ) soil which will have for sure a big amount of moisture content inside it , it we can notice that easily by slight moving or even by the naked eye , which will be like a thick or thin viscous fluid or like a soup. Actually always there is a limits between each state of the moisture content for the soil , and these limits called the consistency or atterberg limits of the soil , and to talk more briefly about the ( Atterberg Limits ) : The  Atterberg limits  are a basic measure of the nature of a fine-grained  soil. Depending on the  water content  of the soil, it may appear in four states: solid, semi-solid, plastic and liquid. In each state the consistency and behavior of a soil is different and thus so are its engineering properties. Thus, the boundary between each state can be defined based on a change in the soils behavior. The Atterberg limits can be used to distinguish between  silt  and  clay, and it can distinguish between different types of silts and clays. These limits were created by  Albert Atterberg, a  Swedishchemist.[1]  They were later refined by  Arthur Casagrande. These distinctions in soil are used in picking the soils to build structures on top. Soils when wet retain water and expand in volume. The amount of expansion is related to the ability of the soil to take in water and its structural  make up  (the type of atoms present). These tests are mainly used on clayey or silty soils since these are the soils that expand and shrink due to moisture content. Clays and silts react with the water and thus change sizes and have varying shear strengths. Thus these tests are used widely in the preliminary stages of building any structure to ensure that the soil will have the correct amount of  shear strength  and not too much change in volume as it expands and shrinks with different moisture contents, aand here is the informations about the three atterberg limits , shrinkage , plastic and liquid limit : Shrinkage limit The shrinkage limit (SL) is the water content where further loss of moisture will not result in any more volume reduction.[2]  The test to determine the shrinkage limit is  ASTM International  D4943. The shrinkage limit is much less commonly used than the liquid and plastic limits. [edit]Plastic limit The plastic limit is determined by rolling out a thread of the fine portion of a soil on a flat, non-porous surface. The procedure is defined in ASTM Standard D 4318. If the soil is plastic, this thread will retain its shape down to a very narrow diameter. The sample can then be remoulded and the test repeated. As the moisture content falls due to evaporation, the thread will begin to break apart at larger diameters. The plastic limit is defined as the moisture content where the thread breaks apart at a diameter of 3 mm (about 1/8). A soil is considered non-plastic if a thread cannot be rolled out down to 3mm at any moisture. [edit]Liquid limit The liquid limit (LL) is the water content at which a soil changes from plastic to liquid behavior. The original liquid limit test of Atterbergs involved mixing a pat of clay in a round-bottomed porcelain bowl of 10-12cm diameter. A groove was cut through the pat of clay with a spatula, and the bowl was then struck many times against the palm of one hand. Casagrande subsequently standardized the apparatus and the procedures to make the measurement more repeatable. Soil is placed into the metal cup portion of the device and a groove is made down its center with a standardized tool of 13.5 millimetres (0.53  in) width. The cup is repeatedly dropped 10mm onto a hard rubber base at a rate of 120 blows per minute, during which the groove closes up gradually as a result of the impact. The number of blows for the groove to close is recorded. The moisture content at which it takes 25 drops of the cup to cause the groove to close over a distance of 13.5 millimetres (0.53  in) is defined as the liquid limit. The test is normally run at several moisture contents, and the moisture content which requires 25 blows to close the groove is interpolated from the test results. The Liquid Limit test is defined by ASTM standard test method D 4318.[3]  The test method also allows running the test at one moisture content where 20 to 30 blows are requi red to close the groove; then a correction factor is applied to obtain the liquid limit from the moisture content..[4] The following is when you should record the N in number of blows needed to close this 1/2-inch gap: The materials needed to do a Liquid limit test are as follows Casagrande cup (liquid limit device) Grooving tool Soil pat before test Soil pat after test Another method for measuring the liquid limit is the  fall cone test. It is based on the measurement of penetration into the soil of a standardized cone of specific mass. Although the Casagrande test is widely used across North America, the  fall cone test  is much more prevalent in Europe due to being less dependant on the operator in determining the Liquid Limit. http://upload.wikimedia.org/wikipedia/commons/thumb/1/16/Atterberg_limits_02.JPG/220px-Atterberg_limits_02.JPG http://upload.wikimedia.org/wikipedia/commons/thumb/2/24/Casagrande_2.JPG/220px-Casagrande_2.JPG [edit]Importance of Liquid Limit test The importance of the liquid limit test is to classify soils. Different soils have varying liquid limits. Also to find the plasticity index of a soil you need to know the liquid limit and the plastic limit. [edit]Derived limits The values of these limits are used in a number of ways. There is also a close relationship between the limits and properties of a soil such as compressibility, permeability, and strength. This is thought to be very useful because as limit determination is relatively simple, it is more difficult to determine these other properties. Thus the Atterberg limits are not only used to identify the soils classification, but it allows for the use of empirical correlations for some other engineering properties. [edit]Plasticity index The plasticity index (PI) is a measure of the plasticity of a soil. The plasticity index is the size of the range of water contents where the soil exhibits plastic properties. The PI is the difference between the liquid limit and the plastic limit (PI = LL-PL). Soils with a high PI tend to be clay, those with a lower PI tend to be silt, and those with a PI of 0 (non-plastic) tend to have little or no silt or clay. PI and their meanings 0 Nonplastic (1-5)- Slightly plastic (5-10) Low plasticity (10-20)- Medium plasticity (20-40)- High plasticity >40 Very high plasticity [edit]Liquidity index The liquidity index (LI) is used for scaling the natural water content of a soil sample to the limits. It can be calculated as a ratio of difference between natural water content, plastic limit, and liquid limit: LI=(W-PL)/(LL-PL) where W is the natural water content. The effects of the water content on the strength of saturated remolded soils can be quantified by the use of the liquidity index, LI: When the LI is 1, remolded soil is at the liquid limit and it has an undrained shear strength of about 2 kPa. When the soil is at the plastic limit, the LI is 0 and the undrained shear strength is about 200 kPa.[4][11] [edit]Activity The activity (A) of a soil is the PI divided by the percent of clay-sized particles (less than 2 ÃŽÂ ¼m) present. Different types of clays have different specific surface areas which controls how much wetting is required to move a soil from one phase to another such as across the liquid limit or the plastic limit. From the activity, one can predict the dominant clay type present in a soil sample. High activity signifies large volume change when wetted and large shrinkage when dried. Soils with high activity are very reactive chemically. Normally the activity of clay is between 0.75 and 1.25, and in this range clay is called normal. It is assumed that the plasticity index is approximately equal to the clay fraction (A = 1). When A is less than 0.75, it is considered inactive. When it is greater than 1.25, it is considered active. After briefly explaining the the differences between the amounts of moisture content in the soil , we should explain a vey important issue , which is the methods of affection of the moisture content in the soil which is : Strength decreases as water content increases. à ´Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â€š ¬Ã… ¡Ãƒ ¢Ã¢â€š ¬Ã… ¾ Soils swell-up when water content increases. à ´Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â€š ¬Ã… ¡Ãƒ ¢Ã¢â€š ¬Ã… ¾ Fine-grained soils at very high water content possess properties similar to liquids. à ´Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â€š ¬Ã… ¡Ãƒ ¢Ã¢â€š ¬Ã… ¾ As the water content is reduced, the volume of the soil decreases and the soils become plastic. à ´Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â€š ¬Ã… ¡Ãƒ ¢Ã¢â€š ¬Ã… ¾ If the water content is further reduced, the soil becomes semi-solid when the volume does not change. And to talk more about the affection of the moisture aontent in the soil , this is a general affection of the moisture content in the soil at nature : The effect of increasing soil  moisture content  on soil temperature, soil reflectance and soil heat storage is studied in this work. The results show that an increase in  moisture content  decreases the soil temperature differences between day-time and night-time, which provides protection to the plant root system against sharp and sudden changes of soil temperature. It is also found that the solar energy absorption increases as the  moisture content  increases, which results in a higher heat storage capacity at higher  moisture content. Finally, plant growth rate and yield increased due to the modification of plant climate at higher moisture content Water content is an important property of soils, in ¯uencing soil solution chemistry and nutrient uptake by plants.Morphology and other speci ®c properties of the root, nutrient concentration in the soil solution, the mobility of nutrients in the soil, and supply from solid phases, aÃÆ' ¯Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬ect nutrient uptake (Nye and Tinker, 1977; Barber, 1995). Consequently, there are consistent diÃÆ' ¯Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬erences in concen- trations of elements near the rhizoplane at a range of soil water contents (Dunham and Nye, 1976). Soil chemical properties may exert a profound in ¯uence on growth and performance of plants (Grime and Curtis, 1976), and soil concentrations of several elements may be closely related to oristic composition (Tyler, 1996a). Under  ®eld conditions, soil moisture  ¯uctuates with temperature and rainfall. By changing soil solution chemistry, moisture  ¯uctuations could regulate the availability of nutrients, and the  ®eld distributi on of plant species. Water has a very different thermal conductivity than most soil particles and air (the thermal properties of the soil are determined by these three). The thermal conductivity of water is much greater than that of air, so the higher the soil moisture content the greater the thermal conductivity.  The greater the soil moisture content, the more the soil thermal conductivity is like that of water. Therefore, a saturated soil has a conductivity near that of water.  However, just because the soil moisture content is high, doesnt mean that the soil will warm up faster in the Sun than a dry soil. Evaporation of the water will remove much of the Suns energy before the soil will have a chance to warm.  Therefore, dry soils do warm up faster from sunlight and cool faster at night. This is assuming that there isnt a vegetation cover over the soil. Most wet soils evaporate the water, keeping the soil from warming as fast during the day, and cool more slowly at night because of their greater heat capacity (because of the higher water content).   Moisture content phase diagrame : this is a rough photo about the general form of the phase diagram of the soil , that we use always for calculation done for moisture contents and all other issues in the soil : http://upload.wikimedia.org/wikipedia/commons/thumb/5/54/Soil-phase-diagram.svg/300px-Soil-phase-diagram.svg.png Weight Components: à ´Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â€š ¬Ã… ¡Ãƒ ¢Ã¢â€š ¬Ã… ¾ Weight of Solids = Ws à ´Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â€š ¬Ã… ¡Ãƒ ¢Ã¢â€š ¬Ã… ¾ Weight of Water = Ww à ´Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â€š ¬Ã… ¡Ãƒ ¢Ã¢â€š ¬Ã… ¾ Weight of Air ~ 0 Volume Components: à ´Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â€š ¬Ã… ¡Ãƒ ¢Ã¢â€š ¬Ã… ¾ Volume of Solids = Vs à ´Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â€š ¬Ã… ¡Ãƒ ¢Ã¢â€š ¬Ã… ¾ Volume of Water = Vw à ´Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â€š ¬Ã… ¡Ãƒ ¢Ã¢â€š ¬Ã… ¾ Volume of Air = Va à ´Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â€š ¬Ã… ¡Ãƒ ¢Ã¢â€š ¬Ã… ¾ Volume of Voids = Va + Vw = Vv Weight-Volume Relationships : à ´Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â€š ¬Ã… ¡Ãƒ ¢Ã¢â€š ¬Ã‚   Steps to develop the weight-volume relationship à ´Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â€š ¬Ã… ¡Ãƒ ¢Ã¢â€š ¬Ã… ¾ Separate the three phases à ´Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â€š ¬Ã… ¡Ãƒ ¢Ã¢â€š ¬Ã… ¾ The total volume of a soil à ´Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â€š ¬Ã… ¡Ãƒ ¢Ã¢â€š ¬Ã… ¾ Assuming the weight of air (Wa) to be negligible, the total weight is then given as V = Vs + Vv = Vs + Vw + Va W =Ws +Ww Objectives Practical Applications This is some properties that we could conclude the state of it in the soil from knowing the amount of moisture content in the soil : à ¢Ã¢â‚¬Å¡Ã‚ ¬ Storability of the soil à ¢Ã¢â‚¬Å¡Ã‚ ¬ Agglomeration in the case of powders à ¢Ã¢â‚¬Å¡Ã‚ ¬ Microbiolgical stability à ¢Ã¢â‚¬Å¡Ã‚ ¬ Flow properties, viscosity à ¢Ã¢â‚¬Å¡Ã‚ ¬ Dry substance content à ¢Ã¢â‚¬Å¡Ã‚ ¬ Concentration or purity à ¢Ã¢â‚¬Å¡Ã‚ ¬ Commercial grade (compliance with quality agreements) à ¢Ã¢â‚¬Å¡Ã‚ ¬ Nutritional value of the product à ¢Ã¢â‚¬Å¡Ã‚ ¬ Legal conformity (statutory regulations governing food) Objectives : To learn the procedures of finding moisture content in the soil , and the variety in methods using to determine the moisture content. To determine the quantity of moisture content in the soil by good , accurate , safe , sheep way. To learn the differences in affection on the soil due to different amounts of moisture content in the soil To know the performance of the soil due to different amounts of moisture contents. To know how to use geotechnical laboratory tools, Such as the oven , balance , soil containers and all other different tools To know the importance of this experiment in the field work and how it affects the type and method of foundations must put upon different types of structures. Practical Applications : Moisture content plays an important role in understanding the behavior of fine grained soils. It is the moisture content which changes the soils from liquid state to plastic and solid states. Its value controls the shear strength and compressibility of soils. Compaction of soils in the field is also controlled by the quantity of water present. Densities of soils are directly influenced by its value and are used in calculating the Stability of slopes, bearing capacity of soils-foundation system, earth pressure behind the retaining walls and pressure due to overburden. The knowledge of determining the moisture content is helpful in many of the laboratory tests such as Atterbergà ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢s limits, shears strength compaction and consolidation. This experiment may be performed by two different methods. Geotechnical Engineering- I A. Oven drying method B. Torsion balance moisture content Actully we use the moisture content experiment mainly for getting the amount of water content inside the soil to be able to make the classification needs in the field for this soil ,and though to know how could we use this soil and where it could work and the amount of compaction needs of the soil containing a different amounts of water contents , to get the last conclusion from this important experiment , which is that the moisture content determination in the in situ in all field project is from the most important things that getting me ready to know the method of foundation thatà ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢s need above this soil to build on it at the end , stable , strong and good structure on it . In biological applications there can also be a distinction between physisorbed water and free water à ¢Ã¢â‚¬Å¡Ã‚ ¬ the physisorbed water being that closely associated with and relatively difficult to remove from a biological material. The method used to determine water content may affect whether water present in this form is accounted for. For a better indication of free and bound water, the  water activity  of a material should be considered. Water molecules may also be present in materials closely associated with individual molecules, as water of crystallization, or as water molecules which are static components of protein structure. In conclusion , Knowing the amount of moisture content of a substance helps determining if the soil is suitable for a specific use. Such like:- To know if the soil can hold structure safely for long time safely and serviceability or not. To be able and ready for the design of the foundation of any type of the structures. Determining and controlling the moisture in substances is unique and necessary for many products, and the process borders between art and science , in many and variable sides of the life and nature knowing how the Soil water regulates soil temperature by different amounts and shape of moisture content. Soil water serves as a solvent and carrier of food nutrients for plant growth. Tools , equipments and specimens Equipments that we have use in the laboratory for the moisture content determination experiment : Soil container : Ità ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢s a container which is ceramic containers of various shapes on light wood background Stock Photo 8282849 used to put different types of soil inside it or a combined types with others in the same container , and we have used it in this experiment to put a random type of fine-grained soil inside it and mix it with to determine the wight of it , and actually Soil container there are many sizes of the soil container upon to the quantity of soil need to put it in the container. IMG_0212.JPG SpatulaSpatula : it is an aluminum thin tool use to put soil by it in the soil container and for mixing the soil and water with each other in the soil container and also ità ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢s used for transfering soil from container and put it into heat resistance pot which is made of steel. IMG_0209.JPG Steel ContainerSteel Container : it is a container made of steel that have a heat resistance quality , which used to put the moist (wet) sample of soil inside it , to put the moist sample then inside the oven to dry the sample of the soil. Digital Balance : is the instrument use to weigh the different things , that not have an enormous weights , and it used in this experiment to weigh the soil container alone once , and to weight the soil container with soil inside it then. Digital Balance http://www.supplierlist.com/photo_images/167132/Vacuum_Drying_Oven.jpg Oven DryOven Dry : it is an apparatus used to heat the specimens needs to heat in the laboratories , and it was used in this experiment to dry the moist sample of soil. moist soil sample : the wet soil > Dry soil sample : the dry soil sample before putting in the oven sample after putting in the ovenIMG_0209.JPGIMG_0211.JPG Moist Soil Sample Dry soil sample Background Based on the literature review, the feasibility of using microwave oven to determine moisture content of soils is well demonstrated. In addition to the GS, there is an available international standard test method (ASTM D4643) for such determination. This method includes requirements to control the power ratings of microwave ovens and the period of drying procedure. Therefore, the possibility of overheating of a soil sample can be greatly reduced. In addition, the soil sample is required to be carefully mixed after each time of ovens heating for a certain period in order to prevent non-uniform heating of the sample. And in this experiment we going to compute the moisture content using this test method method be determine the weight of the soil before and after the dry process by the laboratory oven dry ,and then compute by a dramatically series of calculations the amount of moisture content in that sample of soil given in the laboratory. Procedures According to ASTM 2216, the dry and clean container should be weighted using balance and its mass recorded. A representative sample should be selected . The moist representative sample should be placed in the container. The lid should be secured in its position. The mass of the container with the sample should be taken and recorded. The lid should be removed and specimen should be placed in the oven. The sample should be dried in the oven at. The container should be removed from the oven when the sample reach a constant weight which means all the water has been evaporated. The specimen should be weighted and recorded. The moisture content then calculated by a series of calculations , and below in the next paragraph , all of the data and calculations is explained preefly by a list of numbers. Work Sheet DETERMINATION OF WATER (MOISTURE) à ¢Ã¢â‚¬Å¡Ã‚ ¬ CONTENT Lab. Humidity : 57% Lab. Temperature : 20.5 0C Moist Fine Grained Sample Of Soil Testing Stander ASTM : D2216-92 Moisture Condition : Moisture Added Type Of Oven : Convection Oven Method Of Drying : Continuous Heating Mass Of Moist Sample = 20 g Soil Passing 4.75 mm. (No.4) Sieve = 100% Soil Passing 37.5 mm. Sieve =100% B3 6 OBSERVATIONS Sample No. Container No. 9.5 g Mass Of Container 29.5 g Mass Of Wet Soil + Container 28.0 g Mass Of Dry Soil + Container CALCULATIONS 1.5 g Mass Of Water 18.5 g Mass Of Dry Soil 8.1% % Water Content Formulas Calculation Formulas: 1) Mass of water = (Mass of wet soil + container ) à ¢Ã¢â‚¬Å¡Ã‚ ¬ (Mass of dry soil + container) Mw = Mcws à ¢Ã¢â‚¬Å¡Ã‚ ¬ Mcs 2) Mass of dry soil = (Mass of dry soil + container ) à ¢Ã¢â‚¬Å¡Ã‚ ¬ (Mass of container ) Ms = Mcs à ¢Ã¢â‚¬Å¡Ã‚ ¬ Mc 3) water content = (Mass of water)/(Mass of dry soil) *100 w = Mw / Ms *100 Calculation: 1) Mass of water = 29.5 à ¢Ã¢â‚¬Å¡Ã‚ ¬ 28.0 = 1.5 (g) 2) Mass of soil = 28.0 à ¢Ã¢â‚¬Å¡Ã‚ ¬ 9.5 = 18.5 (g) 3) Water content = 1.5/18.5 * 100 = 8.1% Discussion The  measurement  of  moisture  content is a lab or a  procedure  used  to measure  the  amount of  moisture  or water that is embedded in a certain content in the soil , actually , the intended purpose for this lab or  procedure  once again as stated before is  to measure  the amount of  moisture  in a content. Times  in construction  we often need soil that must be suitable for building. In some cases  the soil  there and depending on where the land is located,  the soil  may not hold  foundation of  a building well.  In order for us to find out if  the soil  is durable enough to hold the  foundation of  a building we might have  to measure  the  moisture  of the content. When the percent of water is found we can than choose of  the soil  is suitable enough for the  foundation of  the building. actully the most important thing we have concluded from the experiment of determining the moisture content in the soil , is to know how much amount of compaction needs for this soil under the foundation to held the structure safely. Actully all foundations (including abutment) surfaces shall be shaped one horizontal to one vertical or flatter except as otherwise specified.And after stripping (due to stripping specification), the foundation shall be loosened thoroughly by scarifying or plowing to a minimum depth of six inches. The foundation shall then be compacted to the density and moisture requirements specified for the fill Areas that are too low after stripping and shaping must be filled to base grade with compacted fill equal to that used in other parts of the project, and eventhough the moisture content determination is from the most important tests that is from the basics we need in the Geo-technichal engineering, and later on in the foundation design. Conclusion The result of water content we get in the experiment after quit dry of the sample in the oven dry was 8.1% which is not acceptable to be able for building over it. Ità ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢s quite high for fine grain. This means ità ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢s not safe to build a structure, because the maximum allowable water content for grain is 1 %. Also this experiment is very important in Civil Engineering. Before construction ità ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢s very obligatory to know the water content of the soil. If the water content is very high and construction is done, that might cause damage to structure which will appear later. Actully , for each type of soil has its own capacity to keep the structure safe. For example, If the sample is coarse the maximum allowable water content is 6%. While for fine its 1% , so the last result we get from the determination of the moisture contents in this soil is that , with this high amount of moisture content we can not use this soid for the construction purposes , and if we try to do , it will cause a big proplems and damage in the building later in the future and will neve ever by safety to use it in the civil society. Type of errors Personal errors:- Personal errors such as mistakes in reading from the balance , or mistakes done by wrong transferring data to the data sheet ,also the delaying of time taking out sample from oven it can cause error. Instrumental errors:- Errors might occur in digital balance due to the amount of accuracy of the digital balance. The reading also will change because of air condition. To eliminate such type of errors the reading should be taken several times. Environmental errors:- Moisture in lab and air of air condition can cause errors in readings , and though will not give us the absolute amount of moisture content , and the temperature in the laboratory affecting the sample of soil and instruments in the lab , all of these invironmental factors could give us wrong readings in the esperiment.

Study on the use of reflection in nursing

Study on the use of reflection in nursing In recent years, reflection has undoubtedly become an important concept in nursing, stimulating debate and influencing nursing practice and education around the world. Much has been written about the theory of reflection, the majority of which has been applied to the educational setting (Price 2004). However, the process of reflecting has been described as a transferable skill which may be incorporated into clinical practice, enabling practitioners to better understand themselves and others, and solve problems (Mantzoukas Jasper 2004). Indeed, the capability to reflect consciously upon ones professional practice is generally considered important for the development of education and, hence, for clinical expertise (Mamede Schmidt 2004). Reid (1993) defines reflection as a process of reviewing an experience of practice in order to describe, analyse, evaluate and so inform learning about practice (Reid 1993, p. 305). The nursing profession seems to advocate the need for nurses to be educated and practice in ways that develop their critical thinking, autonomy and sensitivity to others (Reed Ground 1997). Bulman (2004) contends that reflective practice may provide a means of achieving this. Within an intensive care setting, some evidence exists to suggest a strong relationship between lived experience and learning, with most critical care practitioners learning from previous experience (Hendricks et al 1996). More recently, reflection has been closely associated with the concepts of critical thinking and deconstruction. It is argued that a combination of these principles create a retrospective and prospective dimension, giving the practitioner the ability to deconstruct events, to reason the origins of situations, and to consider what has gone before and what may happen yet (Rolfe 2005). In order to be effective in practice there is a requirement to be purposeful and goal directed. It is suggested therefore that reflection cannot just be concerned with understanding, but must also focus on locating practice within its social structures, and on changing practice (Bolton 2001). This suggests that a structured approach to reflection is of benefit to the practitioner. Indeed the use of a model or framework of reflection is advocated as a tool which can aid and facilitate the practitioner in reflection, promoting a process of continuous development (Bulman 2004). Reflection is seen as a dynamic process and not a static one (Duke 2004), and thus the use of a framework which adopts a cyclic approach to reflective practice seems appropriate. One such framework is Gibbs (1988) Reflective Cycle, which is adapted form a framework of experiential learning, and uses a series of questions to guide, and provide structure for the practitioner when reflecting on an experience. Gibbs (1988) highlights 6 important areas of consideration when reflecting on a specific situation, encouraging the practitioner to consider what happened, why it happened and what could be done differently in the future. The 6 components of the Reflective Cycle are outlined below: Description What happened? Feelings What were you thinking and feeling? Evaluation What was good and bad about the situation? Analysis What sense can you make of the situation? Conclusion What else could you have done? Action Plan If the situation arose again, what would you do? It is clear that the idea of reflective practice has come to have a considerable impact on the nursing profession. This paper will focus on 2 clinical scenarios occurring within an intensive care setting. The issues raised will be discussed within the context of Gibbs (1988) Reflective Cycle. The aim in doing so is to highlight the benefits of a structured reflective process, and to identify ways in which clinical practice may be improved in the future. Scenario 1 Description The first scenario concerns the care of an elderly, critically ill patient, who was being treated in a surgical intensive care unit. At the time of this scenario the patient had been in intensive care for almost 3 weeks, having been admitted with respiratory failure requiring intubation, and displaying clinical symptoms consistent with sepsis. The patient had many other underlying medical problems, was morbidly obese, and despite antibiotic therapy was requiring high levels of inotropic and ventilatory support. Despite the patients symptoms, no definite source of sepsis had been identified. The above patient was being cared for by the author on a 12 hour day shift and at the morning ward round it was noted that the patients condition had deteriorated significantly over the previous 2 days, with increased inotrope dependence and worsening renal function. With few treatment options left to try, the consultant anaesthetist decided that the patient should have a CT scan to identify or rule out an abdominal problem as a source of the sepsis. The patient was reviewed by a consultant surgeon who felt that in view of the patients co-morbidity, surgery of any kind would not be appropriate, despite potential positive findings on CT. Knowing that a CT scan had been carried out 1 week previously with no significant findings, the author raised concerns about the benefit of such a procedure, and suggested that at the very least the patients family should be informed or consulted about the planned investigation. The patients son had been spoken to the previous day and informed that the prognosis was very poor. Withdrawal of treatment had been mentioned as a possibility in the event of no improvement in the patients condition. The son however was not informed about the scan which went ahead the same day. Transferring the patient to the radiology department for scan proved difficult. The patient was sedated for transfer resulting in a need for increased inotropes due to further hypotension caused by the sedation. The patients large size also created a problem in finding an appropriate transfer trolley to take the patients weight. Again the author voiced concerns, stating that perhaps transfer was inadvisable in view of the patients unstable cardiovascular status. The anaesthetist decided that we should proceed with the scan. The patient remained unstable throughout the transfer, requiring a further increase in inotropes on arrival at scan. Whilst on the CT table, the patient became dangerously hypotensive and bradycardic, and it seemed that cardiac arrest was imminent. Adrenaline boluses were administered, and large fluid boluses of gelofusine were also given. In view of this, the CT scan was abandoned midway, and the patient was quickly transferred back to ICU. Further adrenaline boluses were needed during transfer. On arrival back to ICU, the author was met by the patients son, who was not aware that the patient was being scanned. He was made aware of the patients poor condition. Back in ICU it was decided that further resuscitation was not appropriate. The son was present when the patient died a few minutes later. Feelings On the day these events took place, the predominant thoughts and feelings of the author were ones of guilt and inadequacy. Having considered the multiple health problems faced by the patient at this time, the author felt that the process of transferring the patient to CT scan and carrying out the scan itself may cause the patient stress, discomfort and potential danger, and ultimately be of little or no benefit. During the transfer and scanning process, the author became increasingly anxious about the immediate safety of the patient, and the potential for deterioration in the patients condition. When the patient became dangerously bradycardic and hypotensive, the authors thoughts were concentrated on trying to prevent cardiac arrest. On returning to ICU and meeting the patients son, it seemed that neither the dignity of the patient or the concerns of the family had been respected. The author felt an inadequacy and felt that the interests of the patient had not been properly advocated. The patient passed away in a distressing and undignified manner, and the son did not have the opportunity to spend personal time with the patient prior to this happening. The author felt guilty, as it seemed that the CT scan should not have happened and that the undignified circumstances surrounding the patients death need not have occurred. Evaluation Looking back on the events of scenario 1, it seems that there were both positive and negative aspects to the experience. During transfer to CT scan and the emergency situation which followed, the author felt that there was good teamwork between the different professionals involved in the care of the patient. Because of this, prompt action was taken, preventing cardiac arrest. However, it seems that this situation may have been avoided, which in turn raises many questions relating to the care of the patient. Ethically, one must question how appropriate it was to scan a severely septic, unstable patient, especially when corrective treatments would have been inappropriate in the event of an abnormality being discovered. Should the author have advocated the interests of the patient and family more forcefully? Was there a lack of communication and consensus between the critical care team? The events of this incident culminated in a clinical emergency situation which led to the patients death. Thus, the author feels that the patients clinical condition and the ethical issues and dilemmas surrounding the patients care must be examined and discussed, in the hope that lessons can be learned through the reflective process. Analysis Sepsis Most illness and death in patients in intensive care is caused by the consequences of sepsis and systemic inflammation. Indeed, sepsis affects 18 million people worldwide each year (Slade et al 2003), with severe sepsis remaining the highest cause of death in patients admitted to non-coronary intensive care units (Edbrooke et al 1999). Sepsis is a complex condition that results from an infectious process, and is the bodys response to infection. It involves systemic inflammatory and cellular events that result in altered circulation and coagulation, endothelial dysfunction, and impaired tissue perfusion (Kleinpell 2004). Dellinger et al (2004) define sepsis as the systemic response to infection manifested by 2 or more of the following: High or low temperature (>38 °C or Heart rate > 90 beats per minute Respiratory rate > 20 breaths per minute or PaCO2 High or low white blood cell count (> 12,000 or In severe sepsis impaired tissue perfusion along with micro vascular coagulation can lead to multiple organ system dysfunction, which is a major cause of sepsis-related mortality (Robson Newell 2005). While all organs are prone to failure in sepsis, pulmonary, cardiovascular, and renal dysfunction occur most commonly (Hotchkiss Karl 2003). When multiple organ system dysfunction occurs, Dolan (2003) promotes evidence-based sepsis treatment whereby patients should receive targeted organ support. This includes mechanical ventilation, renal replacement therapy, fluids, vasopressor or inotropic administration, and blood product administration, to maximize perfusion and oxygenation. In recent years new therapies have emerged which have been shown, in some cases, to increase the chance of survival from severe sepsis. Recombinant human activated protein C has been shown to have anti-inflammatory, anti-thrombotic and pro-fibrinolytic properties (Dolan 2003). In a randomised controlled trial, Bernard et al (2001) found a significant reduction in the mortality of septic patients who had been treated with activated protein C. The National Institute for clinical excellence (2004) now recommends this treatment for adult patients who have severe sepsis resulting in multiple organ failure, and who are being provided with optimal ICU support. Steroids, the use of which in ICU has long been debated, have also been shown, in low doses, to reduce the risk of death in some patients in septic shock (Annane 2000). Despite the development of specific treatments to interrupt or control the inflammatory and procoagulant process associated with sepsis, its management remains a major challenge in healthcare (Kleinpell 2004). The patient in scenario 1 was clearly in a state of severe sepsis, with respiratory, cardiac and renal failure, and receiving some of the supportive treatments mentioned above. Indeed it seems that the severity of this condition should not have been underestimated. In view of this, the ethical issues surrounding the decision to take this patient to CT scan must now be considered. Ethical Dilemmas and Consensus Ethical issues have emerged in recent years as a major component of health care for critically ill patients (Friedman 2001). Thus, caring for these patients in an intensive care setting necessitates that difficult ethical problems must be faced and resolved (Fisher 2004). Traditionally, much of the literature in biomedical ethics comes from theoretical perspectives that include principled ethics, caring ethics and virtue ethics (Bunch 2002). Although these perspectives provide an ethical awareness, which can be helpful, they do not of necessity give much direction for clinical practice. Melia (2001) supports this notion, suggesting that many discussions of ethical issues in health care are presented from a moral philosophical viewpoint, which as a consequence leaves out the clinical and social context in which decisions are taken and carried through. Beauchamp Childress (1994) identify 5 principles pertinent to decision making in intensive care. These are: salvageability, life preservation, non-maleficence, beneficence, and justice. Ethical dilemmas occur when two or more of the above principles come into conflict. The principles of beneficence (doing good), non-maleficence (doing no harm) and justice (fair treatment) are well established within the field of bioethics. Within a critical care context however, the dilemma between salvageability and life preservation becomes an important focus for health care professionals. Indeed, Prien Van Aken (1999) raise the question of whether all medical means to preserve life have to be employed under all circumstances, or are there situations in which we should not do everything that it is possible to do. This question becomes particularly relevant when a patients condition does not improve but rather deteriorates progressively. Curtin (2005) suggests that at some point in the course of t reatment, the line between treating a curable disease and protracting an unpreventable death can be crossed. In such incidences Prien Van Aken (1999) identify a transitional zone between the attempt to treat the patient, and the prolongation of dying, in which a conflict between the principles of life preservation and non-maleficence develops. These concepts seem particularly relevant to scenario 1 where the interests of the patient may have been neglected in favour of further attempts to treat the patients condition. This, in turn created a conflict between the principles of salvageability and life preservation. The decision to perform a CT scan on a patient with such cardiovascular instability and a very poor prognosis, meant that the patient was subjected to dangers and harms when there were few, if any benefits to justify this. Hence, the conflict between the ethical principles was not resolved, and the professional duty of non-maleficence toward the patient was not respected. Such conflicts and dilemmas in intensive care can be made all the harder by the availability of advanced technologies. Callahan (2003) writes that one of the most seductive powers of medical technology is to confuse the use of technology with a respect for the sanctity of life. In addition, Fisher (2004) contends that it has become all too easy to think that if one respects the value of life, and technology has the power to extend life, then a failure to use it is a failure to respect that value. This is particularly true of diagnostic technologies (such as CT scanning) which must be used with caution, especially in cases where the diagnostic information will make little or no difference to the treatment of the patient, but can create or heighten anxiety and discomfort for the patient (Callahan 2003). Medical technology is a two-edged sword, capable of saving and improving life but also of ending and harming life (Curtin 2005). Good critical care medicine carries the responsibility o f preserving life, on the one hand, and making possible a peaceful death, on the other. Callahan (2003) concludes by warning that any automatic bias in favour of using technology will threaten that latter possibility. Consensus between members of the intensive care team is also highlighted as an important issue in ethical decision making. Effective communication and collaboration among medical and nursing staff are essential for high quality health care (Woodrow 2000). Collaboration can be seen as working together, sharing responsibility for solving problems, and making decisions to formulate and execute plans for patient care (Gedney 2000 p.41). In intensive care units where ethical problems are faced frequently, care has to be a team effort (Fisher 2004). In a qualitative study, Melia (2001) found that there was a strong desire within the intensive care team that ethical and moral consensus should be achieved in the interests of good patient care, even though it was recognised that there is no legal requirement for nurses to agree with ICU decisions. Cobaoglu Algier (2004) however, found that the same ethical dilemma was perceived differently by medics and nurses with the differences being related to the hospitals hierarchical structure and the traditional distinctions between the two professions. Similarly, it has been observed that differences between doctors and nurses in ethical dilemmas were a function of the professional role played by each, rather than differences in ethical reasoning or moral motivation (Oberle Hughes 2001). It seems therefore that while the medical and nursing professions share the same aims for patient outcomes, the ideas surrounding how these outcomes should be achieved may differ (Fisher 2004). These differences have contributed to the development of the concept of the nurse as patient advocate, which sees advocacy as a fundamental and integral role in the caring relationship, and not simply as a single component of care (Snowball 1996). The role of the nurse advocate should be that of mediator and facilitator, negotiating between the different health and illness perspectives of patient, doctor, and other health care professionals on the patients behalf (Mallik 1998). Empirical evidence is sparse and philosophical arguments seem to predominate in the field of patient advocacy. There is some evidence to suggest that nurse advocacy has had beneficial outcomes for the patient and family in critical care areas (Washington 2001). Hewitt (2002) however found that humanistic arguments that promote advocacy as a moral imperative are compelling. Benner (1984) writes of advocacy within the context of being with a patient in such a way that acknowledges your shared humanity, which is the base of nursing as a caring practice (Benner 1984, p. 28). It has been argued that advocacy, at least in a philosophical sense, is the foundation of nursing itself and as such should be regarded as an issue of great importance by all practitioners (Snowball 1996). Conclusion It can be concluded that sepsis in a critical care environment is a complex condition with a high mortality rate, requiring highly specialised treatments. As such, the ethical issues and dilemmas faced by health care staff caring for a septic patient can be both complex and far reaching. It must be noted, that there can be no general solutions for such ethical conflicts; each clinical case must be evaluated individually with all its associated circumstances. A study of ethical principles would suggest that it is important that the benefits of a specific treatment or procedure are established prior to implementation, and that these benefits outweigh any potential harms or risks to the patient. The ultimate decision maker in the scenario under discussion was the consultant anaesthetist, who should have provided a clearer rationale for performing a CT scan on such an unstable patient. As the nurse caring for the patient, the author recognises that the final decision regarding treatment rested with the anaesthetist. However, the author could have challenged the anaesthetists decision further, advocating the patients interests, with the aim of reaching a moral consensus within the team. Perhaps then the outcome would have been more favourable for all concerned. Action Plan By reflecting on this scenario, the author has gained an understanding of sepsis and the potential ethical problems which may be encountered when caring for a septic or critically ill patient. As a result, the author feels more confident to challenge those decisions made relating to treatment, which do not seem to be in the best interest of the patient, or which have the potential to cause more harm than good. The author now has a greater understanding of the professional responsibility to advocate on a patients behalf, with the aim of safeguarding against possible dangers. It is hoped that this will result in improved outcomes for patients in the authors care. Scenario 2 Description This incident occurred in a surgical intensive care unit while the author was looking after a ventilated patient who had undergone a laparotomy and right sided hemi-colectomy 2 days previously. Around 10.30am the patient was reviewed by medical staff and was found to be awake and alert with good arterial blood gases, and requiring minimal ventilatory support. In view of this, it was decided that the patients support should be reduced further, and providing this reduction was tolerated, that the patient should be extubated later in the morning. In the intensive care unit in which the author works an intensive insulin infusion protocol is used (see Appendix A). This is a research based protocol which aims to normalize blood glucose levels and thus improve clinical outcomes for critically ill patients. All patients on this protocol require either to be absorbing enteral feed at à ¢Ã¢â‚¬ °Ã‚ ¥30ml/hr, on TPN or on 5% dextrose at 100ml/hr (Appendix A, note 2). The patient involved in this incident was receiving enteral feed via a naso-gastric tube, and was on an insulin infusion which was running at 4 U/hr. When it was decided that the patient was to be extubated, the author stopped the enteral feed as a precaution, to prevent possible aspiration during or after extubation. The author however did not stop the insulin infusion which breached the protocol guidelines. About 12 noon the patients blood gases showed that the reduction in support had been tolerated, and so the patient was extubated. Shortly after this the author was asked to go for lunch break and so passed on to a colleague that the patient had recently been extubated but was managing well on face mask oxygen. Returning from lunch 45 minutes later, the author found the patient to be disorientated and slightly confused. With good oxygen saturations, the author doubted that the confusion had resulted from hypoxia or worsening blood gases. The author then realised that the insulin infusion had not been stopped with the enteral feed earlier. A check of the patients blood glucose level showed that it was 1.2mmol/L. The author immediately stopped the insulin infusion, administered 20mls of 50% dextrose intravenously, as per protocol, and recommenced the enteral feed. Twenty minutes later, the patients blood glucose level had risen to 3.7mmol/L. The patient continued on the insulin protocol maintaining blood glucose levels within an adequate range. There were no lasting adverse effects resulting from the hypoglycaemic episode. Feelings When it was realised that the insulin infusion had not been stopped, the author felt a sense of panic, anticipating correctly that the patients blood glucose level would be dangerously low. Thoughts then became concentrated on raising the blood glucose level, to ensure that no further harm would come to the patient as a result of the authors mistake. Following the incident, when the patients glucose levels had risen, feelings of guilt were prominent. At this point the author realised how much worse the outcome could have been for the patient. The author felt incompetent, knowing that the patient could have been much more severely affected, or could even have died as the result of such a simple mistake. Evaluation The events of scenario 2 highlight the fact that clinical errors, while easily made, can have potentially disastrous consequences. This is especially true of those errors which involve the administration of drugs intravenously. In the interest of patient safety, it is important that all such errors are avoided. The clinical error outlined above could easily have been avoided. It seems that there was not sufficient awareness, on the authors part, of the insulin infusion protocol and the guidelines concerning the administration of insulin. As a result, the insulin protocol was not adhered to. The following analysis therefore will focus on the importance of insulin therapy in critical care areas, and will consider the safety issues surrounding intravenous drug administration. Analysis Blood Glucose Control in Intensive Care It is well documented that critically ill patients who require prolonged intensive care treatment are at high risk of multiple organ failure and death (Diringer 2005). Extensive research over the last decade has focused on strategies to prevent or reverse multiple organ failure, only a few of which have revealed positive results. One of these strategies is tight blood glucose control with insulin (Khoury et al 2004). It is well known that any type of acute illness or injury results in insulin resistance, glucose intolerance and hyperglycaemia, a constellation which has been termed the diabetes of stress (McCowen et al 2001). In critically ill patients, the severity of this condition has been shown to reflect the risk of death (Laird et al 2004). Much has been learned recently about the negative prognostic effects of hyperglycemia in critically ill patients. Hyperglycaemia adversely affects fluid balance, predisposition to infection, morbidity following acute cardiovascular events, and can increase the risk of renal failure, neuropathy and mortality in ICU patients (DiNardo et al 2004). Research suggests that there are distinct benefits of insulin therapy in improving clinical outcomes. Such benefits have been seen in patients following acute myocardial infarction, and in the healing of sternal wounds in patients who have had cardiac surgery (Malmberg 1997; Furnary et al 1999). More recently Van den Berghe et al (2001) conducted a large, randomized, controlled study involving adults admitted to a surgical intensive care unit who were receiving mechanical ventilation. The study demonstrated that normalisation of blood glucose levels using an intensive insulin infusion protocol improved clinical outcomes in critically ill patients. In particular, intensive insulin therapy was shown to reduce ICU mortality by 42%, and significantly reduce the incidences of septicaemia, acute renal failure, prolonged ventilatory support, and critical illness polyneuropathy. The length of stay in intensive care was also significantly shorter for patients on the protocol. It is unclear as to why improved glycaemic control has been associated with improved outcomes in several clinical settings. Coursin and Murray (2003) have summarized several leading hypotheses including maintenance of macrophage and neutrophil function, enhancement of erythropoiesis, and the direct anabolic effect of insulin on respiratory muscles. The potential anti-inflammatory effects of insulin have also been evaluated (Das 2001). There is also uncertainty over whether it is the actual insulin dose received per se, or the degree of normoglycaemia achieved that is responsible for the beneficial effects of intensive glycaemic management. Van den Berghe (2003) analysed the data derived from their 2001 study and have concluded that the degree of glycaemic control, rather the quantity of insulin administered was associated with the decrease in mortality and organ system dysfunction. In a follow up to Van den Berghe et als 2001 study, Langouche et al (2005) found that a significant part of the improved patient outcomes were explained by the effects of intensive insulin on vascular endothelium. The vascular endothelium controls vasomotor tone and micro-vascular flow, and regulates trafficking of nutrients and several biologically active molecules (Aird 2003). Langouche et al (2005) conclude that maintaining normoglycaemia with intensive insulin therapy during critical illness protects the vascular endothelium and thereby contributes to the prevention of organ failure and death. Whatever the reasons for improved patient outcomes, the study by Van den Burghe et al (2001) has prompted much research in this field, all of which has yielded similar results. In a similar study, Krinsley (2004) found that the use of an insulin protocol resulted in significantly improved glycaemic control and was associated with decreased mortality, organ dysfunction, and length of stay in the ICU in a heterogeneous population of critically ill adult patients. Thus it seems that with the strength of the emerging data in support of a more intensive approach to glycaemic management, insulin infusions are being utilised with increasing frequency, and are considered by many to be the standard of care for critically ill patients (DiNardo et al 2004). It is important to note that a well recognised risk of intensive glucose management is hypoglycaemia. Indeed Goldberg et al (2004) emphasise that in the ICU setting where patients often cannot report or respond to symptoms, the potential for hypoglycaemia is of particular concern. The events of scenario 2 highlight the authors error in the administration of insulin resulting in hypoglycaemia. For this reason some issues surrounding intravenous drug therapy will now be discussed. Intravenous Drug Therapy There is an increasing recognition that medication errors are causing a substantial global public health problem. Many of these errors result in harm to patients and increased costs to health providers (Wheeler Wheeler 2005). In the intensive care unit, patients commonly receive multiple drug therapies that are prescribed either for prophylactic indications or for treatment of established disease (Dougherty 2002). Practitioners caring for these patients find themselves in the challenging position of having to monitor these therapies, with the goal of maximizing a beneficial therapeutic response, as well as minimizing the occurrence of any adverse drug-related outcome (Cuddy 2000). The Nursing and Midwifery Council (NMC) (2004) identifies the preparation and administration of medicines as an important aspect of professional practice, stressing that it is not merely a mechanistic task performed in strict compliance with a written prescription, but rather a task that requires thought and professional judgement. Heatlie (2003) found that the introduction of new insulin protocols and regimes could give rise to problems, espe