Tuesday, September 17, 2019
Abstract Postoperative Pulmonary complications (PPC) such as atelectasis, impaired gas exchange, pneumonia and acute respiratory failure (ARF) are not uncommon in patients undergoing major surgery and are a leading cause of increased patient morbidity, mortality and increased length of hospital stay (Yoder, Sharma, Hollingsworth, Talavera, & Rice, 2013). Healthcare professionals are now expected to give patients verifiably effective treatments by implementing current evidence based practice (EBP). In order to do so, interventions to prevent PPCs must be investigated. The aim of this study was to evaluate the effectiveness of adding incentive spirometry (IS) to traditional postoperative chest physiotherapy (CPT) and respiratory care. Eighty patients between 30 and 50 year old who had undergone surgery participated in the study. Patients were divided into two groups: the intervention group where IS was used in addition to the traditional CPT, and the control group which included only traditiona l CPT. The results obtained in the investigation indicated that there were significant differences between both groups at the end of the study in terms of PPCs and hospital length of stay (LOS). Conclusion: Addition of IS to postoperative care helped in controlling PPCs. Keywords: postoperative pulmonary complication, incentive spirometer, chest physiotherapy, length of Stay Research Question In postsurgical patients, how does using incentive spirometer, compared to not using incentive spirometer, affect incidence of PPCs and hospital LOS? Hypothesis Because the risk for developing PPCs is not well studied specific numbers of occurrences are difficult to predict. However, it was hypothesized that patients who incorporated IS as part of their postoperative care would have a clinically significant decrease in the occurrence of PPCs and hospital LOS compared to those who did not incorporate IS into their postoperative care. Data Collection A quasi-experimental control trial was conducted from February 1, 2014 to May 31, 2014. The lead researcher, Adrienne Hinson, collected the data personally. During the four month study, eighty patients ranging in age from 30 to 50 years old who were undergoing surgery where the abdomen or chest was opened were selected randomly from the General Surgery Department at McLeod Regional Medical Center in Florence, SC. On sampling days, patients meeting the criteria were numbered chronologically based on their surgery time. For eighty consecutive business days, one of the patients was chosen randomly using a random numbers table created on Microsoft Excel. Patients who had recently been diagnosed with or treated for acute pulmonary complications, those who could not be instructed or supervised to assure appropriate use of the IS, and patients whose cooperation or comprehension was lacking were excluded from the study. All appropriate procedures were used to safeguard the rights of study participants. The study was externally reviewed by the hospitalÃ¢â¬â¢s institutional review board before data collection began. Patients received verbal and written explanations of the study purpose and data collection procedures and after indicating willingness to participate in the study, voluntary informed consent was obtained (See Appendix A). Information included within the informed consent included participant status; participants were told which postoperative activities were routine, and which activities were being evaluated. Participants were informed that the data collected about them would be used for research purposes. The overall goals of the research, to evaluate to addition of IS to postoperative care, was described to patients. Participants were informed about which types of data would be collected, what procedures they would undergo, and how they were selected. The time frame of the commitment was defined as beginning on post-op day one and lasting until their follow upÃ visit after discharge. Information regarding funding was available to participants. All participants were educated on potential risks and benefits of participation. Finally, patients were assured that their privacy would be protected at all times and that they would be allowed to withdraw from the study at any point during their hospital stay (Polit & Beck, 2012). The patients were deliberately placed into one of two experimental groups. Deliberate placement reduces confounding by ensuring the two groups were comparable when age, sex, smoking history, type of surgery and post-operative analgesia were compared. The control group consisted of 40 patients who underwent routine chest physiotherapy (CPT) postoperatively, as recommended by the Clinical Practice Guidelines set forth by The Agency for Healthcare Research Quality (2011). A physiotherapist supervised and assisted the treatment twice a day in the first two postoperative days and once a day from the third to the tenth days. During any session, the patients performed three to five deep breaths interspersed with periods of quiet breathing followed by two or three coughs or huffs with support from a pillow at least 10 times over a 15 minutes period. Additional techniques such as positioning and chest wall percussion were applied if breathing and coughing exercises alone were not effective in clearing excessive or retained pulmonary secretions. Patients were instructed to perform coughing and deep breathing exercises independently every hour while awake. The treatment group consisted of the remaining 40 patients who also followed the same Clinical Practice Guidelines but also received breathing exercise training with IS (Voldyne Volumetric manufactured by Sherwood Medical Company U.S.A.) In addition to the routine chest physiotherapy up to the tenth postoperative day. Application of breathing training with incentive spirometry was applied for five minutes, five times a day (El-Marakby et al., 2013). Monitoring began immediately postoperatively and continued until discharge. Hospital LOS was documented for each patient, along with whether or not the patient developed a PPC within 10 days of surgery. The researcher rounded on each hospitalized patient daily to ensure compliance and to update discharges and PPC diagnoses. In order to determine LOS, participant observation was used as a tool to collect data. LOS was calculated by subtracting day of admission from day of discharge. Date of admission was the date of surgery for all participants. Date of discharge was determinedÃ by the surgical teams, who were blinded to the study and therefore measures are not likely to be influenced by reactivity (Polit & Beck, 2012). PPCs were defined as any pulmonary abnormality that produced identifiable disease or dysfunction, was clinically significant, and adversely affected the postoperative clinical course (Hayden, Mayer, & Stoller, 1995). Patients were monitored daily for 10 days for the diagnosis of a PPC. Given this definition, PPCs documented included atelectasis, pneumonia, acute respiratory failure, and exacerbation of COPD. Along with physical assessment and past history, biophysiological measures were used as data collection tools to aid in the diagnosis of PPCs (See Appendix C). Equipment and lab analysis were readily available and tests for biophysiological measures were completed by the appropriate staff at McLeod Regional Medical Center. Ordering tests and the interpretation of results was fulfilled solely by the healthcare providers as deemed necessary. The researchers were not responsible for diagnosing PPCs, but rather the observation and recording of data. Biophysiological measures for diagnosing acute respiratory failure include a low level of oxygen; a pulse oximetry falling below 80% saturation on room air or when arterial blood gas shows PaO2.
Monday, September 16, 2019
Marriage is a part of life that most people look forward to. Once people get married their whole life is devoted to each other. Married couples are supposed to work through their problems and support each other. In William ShakespeareÃ¢â¬â¢s play Othello, he suggests otherwise. Both Desdemona and Emilia were killed by their husbands. The only girl left at the end of the play is Bianca, a prostitute. Marriage, while generally a positive concept, is fatal and dangerous in William ShakespeareÃ¢â¬â¢s play Othello. Both Desdemona and Othello were happy with their marriage until Iago purposely sabotaged it. He convinced Othello that Desdemona was cuckolding him. When Othello believed IagoÃ¢â¬â¢s lies and decided to kill Desdemona it showed how he had immediately lost all trust in Desdemona and that Iago must be right. Othello and DesdemonaÃ¢â¬â¢s love was based on trust, which made their marriage successful in the beginning. The marriage started to fall apart once Othello stopped trusting Desdemona. Desdemona did nothing wrong and trusted Othello when he did not trust her. Shakespeare is suggesting that even if you do nothing wrong in a marriage that it will eventually fall apart. Iago She did deceive her father, marrying you; [Ã¢â¬ ¦] Othello And so she did. (3. 3. 18) When Iago is trying to convince Othello that Desdemona is unfaithful, he suggests that if a woman will disobey her father then she is likely to cheat on her husband. Othello agrees with him when in reality DesdemonaÃ¢â¬â¢s decision to go against her father and marry Othello shows loyalty to Othello. She never talks badly about him, even when he is abusing and accusing her of not being loyal to him. Shakespeare suggests that if jealousy enters your marriage it will completely take over any trust the relationship once had. Jealousy was powerful enough to break apart a strong marriage, like Desdemona and OthelloÃ¢â¬â¢s. Iago and EmiliaÃ¢â¬â¢s marriage consists of Emilia being blinded by her love, ultimately leading to her murder. Emilia trusted Iago because she loved him so much even though he was using her and lying to her. She was too oblivious to see the reality that her husband was the one sabotaging Othello. Iago used his own wife to get the handkerchief for him. When Iago asked her to get it for him, she did not even know the purpose for it, but got it for him anyway. Emilia could not stand to face the fact that her own husband was dishonest. I am glad I have found this napkin. This was her first remembrance from the Moor. My wayward husband hath a hundred times Wooed me to steal it, but she so loves the token, (3. 3. 334) This quotation shows how Emilia is not suspicious that Iago is using her and sabotaging Othello and DesdemonaÃ¢â¬â¢s marriage. She refers to the hankercheif as a Ã¢â¬Å"napkin,Ã¢â¬ which shows how unimportant it seems to her. When she finally steals it she does not do it for her benefit, she does it so Iago will be happy. She is so blinded by love that she even says how Desdemona loves it, but she does not care as long as she pleases Iago. After she was a good wife, he betrays her and kills her for talking too much. Emilia was happy with her marriage, knew someone was lying to Othello, but did not know that it was her own husband. Shakespeare is suggesting that if you have a marriage that you think is perfect then it might not actually be as perfect as you thought. At the end of the play, only one woman stays alive, Bianca, the prostitute. She has sexual relations with Cassio, but is not married to him. Shakespeare is inferring that Bianca not having a husband is what kept her safe. Cassio gave Bianca the handkerchief and it makes her feel important to him even though it is just a small present that he found. O Cassio, whence came this? This is some token from a newer friend: To the felt absence now I feel a cause: IsnÃ¢â¬â¢t come to this? Well, well. (3. 4. 205) This quotation proves that they are not married and it does not seem like they will get married for the future. Bianca is shocked when Cassio gives her the handkerchief. Also, Cassio does not know anything about the handkerchief, so he just sees something belonging to a woman around his house and decides to give it to her to be kind. Shakespeare thought oppositely compared to most of our society today. For most people now marriage is a very exciting part of life that many people look forward to and celevbrate. To Shakespeare, marriage was dark and dangerous, not a happy event. Shakespeare didn't think that love was strong enough to over come a man's jealousy, greediness, and a woman's ignorance.
Sunday, September 15, 2019
Rashel froze. Her sword remained in the air, poised over the vampire's heart. Ã¢â¬Å"Well, what are you waiting for?Ã¢â¬ the vampire said. Ã¢â¬Å"Go on and do it.Ã¢â¬ Rashel didn't know what she was waiting for. The vampire was in a position to block her sword with his wooden handcuffs, but he didn't do any such thing. She could tell by his body language that he wasn't going to, either. Instead he just lay there, looking up at her with eyes that were as dark and empty as the depths of space. His hair was tousled on his forehead and his mouth was a bleak line. He didn't seem afraid. He just went on staring with those fathomless eyes. All right, Rashel thought. Do it. Even the leech is telling you to. Do it fast-now. But instead she found herself pivoting and stepping slowly away from him. Ã¢â¬Å"Sorry,Ã¢â¬ she said out loud. Ã¢â¬Å"I don't take orders from parasites.Ã¢â¬ She kept her sword at the ready in case he made any sudden moves. But all he did was glance down at the wooden handcuffs, wiggle his wrists in them, and then lie back. Ã¢â¬Å"I see,Ã¢â¬ he said with a strange smile. Ã¢â¬Å"So it's torture this time, right? Well, that should be amusing for you.Ã¢â¬ Stake him, dummy, came the little voice in Rashel's head. Don't talk to him. It's dangerous to get in a conversation with his kind. But she couldn't refocus herself. In a minute, she told the voice. First I have to get my own control back. She knelt in her ready-for-action crouch and picked up the flashlight, turning it full on his face. He blinked and looked away, squinting. There. Now she could see him, but he couldn't see her. Vampire eyes were hypersensitive to light. And even if he did manage to get a glimpse of her, she was wearing her scarf. She had all the advantages, and it made her feel more in command of the situation. Ã¢â¬Å"Why would you think we want to torture you?Ã¢â¬ she said. He smiled at the ceiling, not trying to look at her. Ã¢â¬Å"Because I'm still alive.Ã¢â¬ He raised the handcuffs. Ã¢â¬Å"And aren't these traditional? A few vampires from the south shore have turned up mutilated with stocks like these on. It seemed to have been done for fun.Ã¢â¬ Smile. Vicky's work, Rashel thought. She wished he would stop smiling. It was such a disturbing smile, beautiful and a little mad. Ã¢â¬Å"Unless,Ã¢â¬ the vampire was going on, Ã¢â¬Å"it's information you want.Ã¢â¬ Rashel snorted. Ã¢â¬Å"Would I be likely to get information from you if I did want it?Ã¢â¬ Ã¢â¬Å"Well.Ã¢â¬ Smile. Ã¢â¬Å"Not likely.Ã¢â¬ Ã¢â¬Å"I didn't think so,Ã¢â¬ Rashel said dryly. He laughed out loud. Oh, God, Rashel thought. Stake him. She didn't know what was wrong with her. Okay, he was charming-in a weird way. But she'd known other charming vampires-smooth, practiced flatterers who tried to sweet-talk or cajole their way out of being staked. Some had tried to seduce her. Almost all had tried mind control. It was only because Rashel had the will to resist telepathy that she was alive today. But this vampire wasn't doing any of the ordinary things-and when he laughed, it made Rashers heart thump oddly. His whole face changed when he laughed. A sort of light shone in it. Girl, you are in trouble. Kill him quick. Ã¢â¬Å"Look,Ã¢â¬ she said, and she was surprised to find her voice a little shaky. Ã¢â¬Å"This isn't personal. And you probably don't care, but I'm not the one who was going to torture you. This is business, and it's what I have to do.Ã¢â¬ She took a deep breath and reached for the sword by her knee. He turned his face to the light. He wasn't smiling now and there was no amusement in his voice when he said, Ã¢â¬Å"I understand. You've gotÃ¢â¬ ¦ honor.Ã¢â¬ Looking back at the ceiling, he added, Ã¢â¬Å"And you're right, this is the way it always has to end when our two races meet. It's kill or be killed. The law of nature.Ã¢â¬ He was speaking to her as one warrior to another. Suddenly Rashel felt something she'd never felt for a vampire before. Respect. A strange wish that they weren't on opposite sides in this war. A regret that they could never be anything but deadly enemies. He's somebody I could talk to, she thought. An odd loneliness had taken hold of her. She hadn't realized she cared about having anyone to talk to. She found herself saying awkwardly, Ã¢â¬Å"Is there anybody you want notified-afterward? I mean, do you have any family? I could make sure the news gets around, so they'd know what had happened to you.Ã¢â¬ She didn't expect him to actually give her any names. That would be crazy. In this game knowledge was power, with each side trying to find out who the players on the other side were. If you could identify someone as a vampire-or a vampire hunter-you knew who to kill. It was Batman and Catwoman all over. The important thing was to preserve your secret identity. But this vampire, who was obviously a lunatic, said thoughtfully, Ã¢â¬Å"Well, you could send a note to my adopted father. He's Hunter Redfern. Sorry I can't give you an address, but he should be somewhere down east.Ã¢â¬ Another smile. Ã¢â¬Å"I forgot to tell you my name. It's Quinn.Ã¢â¬ Rashel felt as if she'd been hit with an oak club. Quinn. One of the most dangerous vampires in all the Night World. Maybe the most dangerous of the made vampires, the ones who'd started out human. She knew him by reputation-every vampire hunter did. He was supposed to be a deadly fighter and a brilliant strategist; clever, resourcefulÃ¢â¬ ¦ and cold as ice. He despised humans, held them in utter contempt. He wanted the Night World to wipe them out, except for a few to be used for food. I was wrong, Rashel thought dazedly. I should have let Vicky torture him. I'm sure he deserves it, if any of them do. God only knows what he's done in his time. Quinn had turned his head toward her again, looking straight into the flashlight even though it must be hurting his eyes. Ã¢â¬Å"So you see, you'd better kill me fast,Ã¢â¬ he said in a voice soft as snow falling. Ã¢â¬Å"Because that's certainly what I'm going to do to you if I get loose.Ã¢â¬ Rashel gave a strained laugh. Ã¢â¬Å"Am I supposed to be scared?Ã¢â¬ Ã¢â¬Å"Only if you have the brains to know who I am.Ã¢â¬ Now he sounded tired and scornful. Ã¢â¬Å"Which obviously you don't.Ã¢â¬ Ã¢â¬Å"Well, let me see. I seem to remember something about the RedfernsÃ¢â¬ ¦. Aren't they the family who controls the vampire part of the Night World Council? The most important family of all the lamia, the born vampires. Descended directly from Maya, the legendary first vampire. And Hunter Redfern is their leader, the upholder of Night World law, the one who colonized America with vampires back in the sixteen hundreds. Tell me if I'm getting any of this wrong.Ã¢â¬ He gave her a cold glance. Ã¢â¬Å"You see, we have our sources. And I seem to remember them mentioning your name, too. You were made a vampire by HunterÃ¢â¬ ¦ and since his own children were all daughters, you're also his heir.Ã¢â¬ Quinn laughed sourly. Ã¢â¬Å"Yes, well, that's an on-again, off-again thing. You might say I have a love-hate relationship with the Redferns. We spend most of the time wishing each other at the bottom of the Atlantic.Ã¢â¬ Ã¢â¬Å"Teh, vampire family infighting,Ã¢â¬ Rashel said. Ã¢â¬Å"Why is it always so hard to get along with your folks?Ã¢â¬ Despite her light words, she had to focus to keep control of her breathing. It wasn't fear. She truly wasn't scared of him. It was something like confusion. Clearly, she should be killing him at this moment instead of chatting with him. She couldn't understand why she wasn't doing it. The only excuse she had was that it seemed to make him even more confused and angry than it did her. Ã¢â¬Å"I don't think you've heard enough about me,Ã¢â¬ he said, showing his teeth. Ã¢â¬Å"I'm your worst nightmare, human. I even shock other vampires. Like old HunterÃ¢â¬ ¦ he has certain ideas about propriety. How you kill, and who. If he knew some of the things I do, he'd fall down dead himself.Ã¢â¬ Good old Hunter, Rashel thought. The stiff moral patriarch of the Redfern clan, still caught up in the seventeenth century. He might be a vampire, but he was definitely a New Englander. Ã¢â¬Å"Maybe I should find a way to tell him,Ã¢â¬ she said whimsically. Quinn gave her another cold look, this time tempered with respect. Ã¢â¬Å"If I thought you could find him, I'd worry.Ã¢â¬ Rashel was suddenly struck by something. Ã¢â¬Å"You know, I don't think I've ever heard anyone say your first name. I mean, I presume you have one.Ã¢â¬ He blinked. Then, as if he were surprised himself, he said, Ã¢â¬Å"John.Ã¢â¬ Ã¢â¬Å"John Quinn. John.Ã¢â¬ Ã¢â¬Å"I didn't invite you to call me it.Ã¢â¬ Ã¢â¬Å"All right, whatever.Ã¢â¬ She said it absently, deep in thought. John Quinn. Such a normal name, a Boston name. The name of a real person. It made her think of him as a person, instead of as Quinn the dreadful. Ã¢â¬Å"Look,Ã¢â¬ Rashel said, and then she asked him something she'd never asked a Night Person before. She said, Ã¢â¬Å"Did you want Hunter Redfern to make you a vampire?Ã¢â¬ There was a long pause. Then Quinn said expressionlessly, Ã¢â¬Å"As a matter of fact, I wanted to kill him for it.Ã¢â¬ Ã¢â¬Å"I see.Ã¢â¬ I'd want to do the same, Rashel thought. She didn't mean to ask any more questions, but she found herself saying, Ã¢â¬Å"Then why did he do it? I mean, why pick you?Ã¢â¬ Another pause. Just when she was sure he wouldn't answer, he said, Ã¢â¬Å"I was-I wanted to marry one of his daughters. Her name was Dove.Ã¢â¬ Ã¢â¬Å"You wanted to marry a vampire?Ã¢â¬ Ã¢â¬Å"I didn't know she was a vampire!Ã¢â¬ This time Quinn's voice was quick and impatient. Ã¢â¬Å"Hunter Redfern was accepted in Charlestown. Granted, a few people said his wife had been a witch, but in those days people said that if you smiled in church.Ã¢â¬ Ã¢â¬Å"So he just lived there and nobody knew,Ã¢â¬ Rashel said. Ã¢â¬Å"Most people accepted him.Ã¢â¬ A faint mocking smile curved Quinn's lips. Ã¢â¬Å"My own father accepted him, and he was the minister.Ã¢â¬ Despite herself, Rashel was fascinated. Ã¢â¬Å"And you had to be a vampire to marry her? Dove, I mean.Ã¢â¬ Ã¢â¬Å"I didn't get to marry her,Ã¢â¬ Quinn said tonelessly. He seemed as surprised as she was that he was telling her these things. But he went on, seeming to speak almost to himself. Ã¢â¬Å"Hunter wanted me to marry one of his other daughters. I said I'd rather marry a pig. Garnet-that's the oldest-was about as interesting as a stick of wood. And Lily, the middle one, was evil. I could see that in her eyes. I only wanted Dove.Ã¢â¬ Ã¢â¬Å"And you told him that?Ã¢â¬ Ã¢â¬Å"Of course. He agreed to it finally-and then he told me his family's secret. Well.Ã¢â¬ Quinn laughed bitterly. Ã¢â¬Å"He didn't tell me, actually. It was more of a demonstration. When I woke up, I was dead and a vampire. It was quite an experience.Ã¢â¬ Rashel opened her mouth and then shut it again, trying to imagine the horror of it. Finally she just said, Ã¢â¬Å"I bet.Ã¢â¬ They sat for a moment in silence. Rashel had never felt soÃ¢â¬ ¦ close to a vampire. Instead of disgust and hatred, she felt pity. Ã¢â¬Å"But what happened to Dove?Ã¢â¬ Quinn seemed to tense all over. Ã¢â¬Å"She died,Ã¢â¬ he said nastily. It was clear that his confidences were over. Ã¢â¬Å"How?Ã¢â¬ Ã¢â¬Å"None of your business!Ã¢â¬ Rashel tilted her head and looked at him soberly. Ã¢â¬Å"How, John Quinn? You know, there are some things you really ought to tell other people. It might help.Ã¢â¬ Ã¢â¬Å"I don't need a damn psychoanalyst,Ã¢â¬ he spat. He was furious now, and there was a dark light in his eyes that ought to have frightened Rashel. He looked as wild as she felt sometimes, when she didn't care who she hurt. She wasn't frightened. She was strangely calm, the kind of calm she felt when her breathing exercises made her feel one with the earth and absolutely sure of her path. Ã¢â¬Å"Look, Quinn-Ã¢â¬Å" Ã¢â¬Å"I really think you'd better kill me now,Ã¢â¬ he said tightly. Ã¢â¬Å"Unless you're too stupid or too scared. This wood won't hold forever, you know. And when I get out, I'm going to use that sword on you.Ã¢â¬ Startled, Rashel looked down at Vicky's handcuffs. They were bent. Not the oak, of course-it was the metal hinges that were coming apart. Soon he'd have enough room to slip them off. He was very strong, even for a vampire. And then, with the same odd calm, she realized what she was going to do. Ã¢â¬Å"Yes, that's a good idea,Ã¢â¬ she said. Ã¢â¬Å"Keep bending them. I can say that's how you got out.Ã¢â¬ Ã¢â¬Å"What are you talking about?Ã¢â¬ Rashel got up and searched for a steel knife to cut the cords on his feet. Ã¢â¬Å"I'm letting you go, John Quinn,Ã¢â¬ she said. He paused in his wrenching of the handcuffs. Ã¢â¬Å"You're insane,Ã¢â¬ he said, as if he'd just discovered this. Ã¢â¬Å"You may be right.Ã¢â¬ Rashel found the knife and slit through the bast cords. He gave the handcuffs a twist. Ã¢â¬Å"If,Ã¢â¬ he said deliberately, Ã¢â¬Å"you think that because I was a human once, I have any pity on them, you are very, very wrong. I hate humans more than I hate the Redferns.Ã¢â¬ Ã¢â¬Å"Why?Ã¢â¬ He bared his teeth. Ã¢â¬Å"No, thank you. I don't have to explain anything to you. Just take my word for it.Ã¢â¬ She believed him. He looked as angry and as dangerous as an animal in a trap. Ã¢â¬Å"All right,Ã¢â¬ she said, stepping back and putting her hand on the hilt of her bokken. Ã¢â¬Å"Take your best shot. But remember, I beat you once. I was the one who knocked you out.Ã¢â¬ He blinked. Then he shook his head in disbelief. Ã¢â¬Å"You little idiot,Ã¢â¬ he said. Ã¢â¬Å"I wasn't paying attention. I thought you were another of those jerks falling over their own feet. And I wasn't even fighting them seriously.Ã¢â¬ He sat up in one fluid motion that showed the strength he had, and the control of his own body. Ã¢â¬Å"You don't have a chance,Ã¢â¬ he said softly, turning those dark eyes on her. Now that he wasn't looking into the flashlight, his pupils were huge. Ã¢â¬Å"You're dead already.Ã¢â¬ Rashel had a sinking feeling that was telling her the same thing. Ã¢â¬Å"I'm faster than any human,Ã¢â¬ the soft voice went on. Ã¢â¬Å"I'm stronger than any human. I can see better in the dark. And I'm much, much nastier.Ã¢â¬ Panic exploded inside Rashel. All at once, she believed him absolutely. She couldn't seem to get her breath, and a void had opened in her stomach. She lost any vestige of her previous calm. He's right-you were an idiot, she told herself wildly. You had every chance to stop him and you blew it. And why? Because you were sorry for him? Sorry for a deranged monster who's going to tear you limb from limb now? Anyone as stupid as that deserves what they get. She felt as if she were falling, unable to get hold of anythingÃ¢â¬ ¦. And then suddenly she did seem to catch something. Something that she clung to desperately, trying to resist the fear that wanted to suck her into darkness. You couldn't have done anything else. It was the little voice in her mind, being helpful for once. And, strangely, Rashel knew it was true. She couldn't have killed him when he was tied up and helpless, not without becoming a monster herself. And after hearing his story, she couldn't have ignored the pity she felt. I'm probably going to die now, she thought. And I'm still scared. But I'd do it over again. It was right. She hung on to that as she let the last seconds tick away, the last window of opportunity to stake him while the cuffs still held. She knew they were ticking away, and she knew Quinn knew. Ã¢â¬Å"What a shame to rip your throat out,Ã¢â¬ he said. Rashel held her ground. Quinn gave the handcuffs a final wrench, and the metal hinges squealed. Then the stocks clattered onto the concrete and he stood up, free. Rashel couldn't see his face anymore; it was above the reach of the flashlight. Ã¢â¬Å"Well,Ã¢â¬ he said evenly. Rashel whispered, Ã¢â¬Å"Well.Ã¢â¬ They stood facing each other. Rashel was waiting for the tiny involuntary body movements that would give away which direction he was going to lunge. But he was more still than any enemy she'd ever seen. He kept his tension inside, ready to explode only when he directed it. His control seemed to be complete. He's got zanshin, she thought. Ã¢â¬Å"You're very good,Ã¢â¬ she said softly. Ã¢â¬Å"Thanks. So are you.Ã¢â¬ Ã¢â¬Å"Thanks.Ã¢â¬ Ã¢â¬Å"But it isn't going to matter in the end.Ã¢â¬ Rashel started to say, Ã¢â¬Å"We'll seeÃ¢â¬ -and he lunged. She had an instant's warning. A barely perceptible movement of his leg told her he was going to spring to his right, her left. Her body reacted without her direction, moving smoothlyÃ¢â¬ ¦ and she didn't realize until she was doing it that she wasn't using the sword. She had stepped forward, inside his attack, and deflected it with a mirror palm block, striking the inner side of his arm with her left arm. Hitting the nerves to try and numb the limb. But not cutting him. She realized with a dizzy sense of horror that she didn't want to use the sword on him. Ã¢â¬Å"You are going to die, idiot,Ã¢â¬ he told her, and for an instant she wasn't sure if it was him saying it or the voice in her head. She tried to push him away. All she could think was that she needed time, time to get her survival reflexes back. She shoved at himÃ¢â¬âand then her bare hand brushed his, and something happened that was completely beyond her experience.
Saturday, September 14, 2019
Racial discrimination and social inequality is a worldwide social illness. This especially happens in highly developed countries that have capabilities of granting the needs of numerous immigrants from other countries. However, the provision of being highly developed is also a way by which countries become highly diverse in population and culture. Mainly, this is also the reason why there exists too much discrimination in the said type of societies. In this regard, the American society is among the focus of the discussion of such issues. To be able to understand the impact of the said issue towards the society, two major public policies shall be examined in support of the said issue. The policies to be tackled in this paper would be pertaining to the Criminal Justice Policy and Immigration Naturalization Policy. Using the events that govern the said policies, this paper shall introduce the issues that govern the race and ethnicity issues of the American government and politics. Leon E. WynterÃ¢â¬â¢s Ã¢â¬Å"Transracial America SellsÃ¢â¬ shows how the black-Americans already lead the entertainment industry. As he usually talks about the Ã¢â¬Å"browning of mainstream commercial cultureÃ¢â¬ in most of his compositions, Wynter points out how the radical shift in the place of race and ethnicity in American commercial culture since the late 1970Ã¢â¬â¢s really affects the preferences of people in the marketplace. He also adds on his essay how nonwhite Americans are giving so much profit to the entertainment industry. He says Ã¢â¬Å"color has been weaving through music, sports, television, news media and literature in a bold band that had never been seen beforeÃ¢â¬ . True, even the different expressions such as Ã¢â¬Å"WassupÃ¢â¬ which came from the black-American culture is already widely accepted. Meanwhile, Langston HughesÃ¢â¬â¢ Ã¢â¬Å"Let America be America againÃ¢â¬ talks about the long-lost dream of the American race. A unified country giving everyone a chance to live in a rather easy life through laboring everyone especially those who are in dire need of employment. In his poem, he points out how much the land of America really belongs to those who plow it such as the farmers, to those who cultivates its culture and resources, to those who really serve their country to the hardest yet best way they could. Contrary to WynterÃ¢â¬â¢s composition, Hughes sees the marketplace to be a place of greed widely using people for its own profit and gains. To Hughes, this kind of false equality is rather a hindrance to the true essence of the American dream. As obviously seen, both of the writers likes to show how possible it really is to attain the American aim of being unified as one country. One believes in what is obviously seen in the society specially on the marketplace where both white and nonwhite Americans gain the fame and thus influence the greater crowd of a mixed culture and depict a unified America, while the other strongly suggests on putting the lesser fortunate into employment and letting them gain from what they have earned since the land belongs to them. Consequently, WynterÃ¢â¬â¢s vision of the dream of equality is far more obvious than that of HughesÃ¢â¬â¢. WynterÃ¢â¬â¢s idea is more practical and thus more appealing to almost everyone in the entire globe. Even other countries actually see the reality of what Wynter says Ã¢â¬Å"transracial sellsÃ¢â¬ . Surely, many will agree that the mixed culture of the white and non-white Americans is widely spreading in the whole world through media and entertainment. Since technology has already evolved so much, the unification of different races is easier attained through the use of the entertainment industry and commerce. As a fact, a bigger percentage of the world population is highly influenced with what they see on TV or n the Internet which commerce usually uses as a medium of selling itÃ¢â¬â¢s products. HughesÃ¢â¬â¢ poem on the other hand is also acceptable although itÃ¢â¬â¢s a bit of the less truth that is actually happening right now. We are actually leaving in a world where oppression is really rampant and the fact that it happens to those who are less fortunate, his vision of the American dream is somewhat hard to fulfill. Sad but true, we are actually living in a society where the fittest in the group survives. It is also convincing when Hughes pointed out how greed affects the marketplace so much, that sometimes the equality that the entertainment industry shows is rather false since its only driven by profit-oriented goals of commerce and yet it doesnÃ¢â¬â¢t care so much on the needs and interests of the greater number of the lower members of its community who give it the chance of existing. After all, there would be no such kind of commercial success without the existence of those who patronage its product, the people who have lesser opportunity in the marketplace. But even though he had such a good view on how the American dream could be fulfilled, he still lacked the practical way on looking on what has already been done to meet that certain American goal. As clearly mentioned in the evidences above, at some point, racism and ethnic discrimination may still be a main problem that the American Government should face. However, with the policies created by the political parties of the country especially regarding the immigration and criminal justice systems of the country, it could be seen how the community has been faring on the said issue so far. As mentioned by Patterson in Ã¢â¬Å"The Ordeal of IntegrationÃ¢â¬ , Ã¢â¬Å"the large and continuous growing number of ethnic groups having a middle class life in America proves that the social policies of the country concerning ethnic groups are applied strongly and are re3ceiving fine resultsÃ¢â¬ . Hence, the statement, which was made by Higham earlier, has been proven true and shown as a resolvable matter in the American society. Yes, the political balance of the country towards its views of the social minorities would continuously be improved and regulated.
Friday, September 13, 2019
Managing Change - Research Proposal Example A successful management of change process leads to implement the procedural changes in a sustainable manner so that the organization can enjoy the long enduring benefits arising out of such changes (Hernes, Hendrup and SchÃ ¤ffnerc, 2015). In this paper, research will be done on change management of a renowned global fast food restaurant, Burger King. Theories of cultural changes and adaptation versus standardization will be analysed in order to establish the research agenda. Since its inception, the company has gone through several transformations in terms of management changes and changes in the production and operational process, as a result of external environmental changes. The Florida based company has gone through substantial changes since it has decided to expand its business in the Gulf Region. The research paper will concentrate on how the management has been able to manage the changes exclusively in Gulf region over a period of time. Organizational change is a critical aspect for every organization operating in global business framework. According to Hoenen and Kostova (2014), as the Gulf region is still in a state of pursuing its socio-economic and political reforms and accordingly changing the rules and legislations from time to time, it has become necessary for all the multinational companies operating in this region to change their business process and align their operations with the transforming regulations in this region. Schmid and Kotulla (2011) are on the opinion that when a multinational company decides to expand business in a new region on the globe, the management has to decide for every aspects of business starting from source of raw material, production and distribution process to supply chain and marketing strategies. Therefore, depending on the availability of resources and other facilities they should decide whether the company will standardize their existing
Thursday, September 12, 2019
History, Stalin and the first Five-Year Plan - Essay Example The method dealt here is to access and analyze the discussed sources, learning through the sources the viewpoint held by the authors and discussing their utility in providing knowledge about the plan while at the same time critically analyzing the plan itself. Joseph Stalin, Soviet Communist leader, became famous for his Ã¢â¬ËflawsÃ¢â¬â¢ as much as for his Ã¢â¬Ëambitious industrial driveÃ¢â¬â¢. Both the characteristics are contradictory as are the views that various people hold about him. As the USSR went through turmoil after WWI and the civil war StalinÃ¢â¬â¢s Five Year Plan ostensibly set out to provide greater strength to USSR in order to keep the Western Capitalist influences at bay. Through the evidence suggested, it however becomes clear that the results of five-year plan were more a Ã¢â¬ËfantasyÃ¢â¬â¢ than Ã¢â¬ËrealityÃ¢â¬â¢. However, disregarding the plan as complete failure would be a failure on our part to access the plan completely. The plan was implemented with the single objective in mind, that of technically advancing the USSR in order to cut down its dependence on western countries and to provide a means for working class people to believe in the socialist system. The plan was a success in that while the capitalist countries were suffering the effects of the great depression and, mass unemployment, the USSR was going through a rapid change in terms of its industry and agriculture. It is important to note that USSR implemented its plan without the help of foreign investments. There were huge investments in heavy industry as well as light industry. The development programs included the tractor plants of Kharkov and Stalingrad, the AMO 1automobile factory in Moscow, the automobile plant in Nizhni-Novgorod, the Dnieprostroi hydroelectric project, the mammoth steel plants at Magnitogorsk and Kuznetsk, the network of machine shops, and chemical plants in the Urals. The face of Moscow changed in a short span with new buildings, schools, hospitals
Wednesday, September 11, 2019
M7a2 - research methods - Essay Example This includes all researchers associated with University Institutional Review Board Handbook in conformity with the set of laws developed by the University Institutional Review Board Handbook. By not getting well-versed consent from the board, Ann will not be following the guidelines developed by the board. Even though she believes she is not interfering with participants, it is important to inform the board so that they conduct their investigations (Institutional Review Board Handbook, 2011). According to the code of federal regulations, participants are humans whom the researcher carrying out research obtains information, through involvement or contact with the person. Therefore, these individuals are known as participants. So, the other main purpose of University Institutional Review Board Handbook is to make sure that the risks to participants are reduced (Institutional Review Board Handbook, 2011). This is illustrates indispensable condition for guarantee. The perseverance of when the study participant is at possibility of being at risk is substance of using an ordinary sense and good professional opinion as it relates to the state of affairs of the research achievement (Corey, Corey & Callanan, 2007). The board will cautiously weigh the comparative risks and remuneration of the investigation measures as they communicate to the study participants. Therefore, researchers are not justified in not obtaining informed consent from the board (Corey, Corey & Callanan, 2007). AnnÃ¢â¬â¢s description described above does not meet the Universitys informed consent criteria. This is because she fails to follow the direct procedure developed by the university board. Ann should inform the board about the participants. She should ensure that the participants in the study are fully aware of the risks and that individuals may withdraw from the study at any time without any form of penalty. Ann should also be