Nursing Placement for Ischemic Heart Disease- myassignmenthelp

Question: Discuss about theNursing Placement for Ischemic Heart Disease. Answer: Introduction The purpose of the paper is to gain a deep insight regarding the importance of pathophysiology, pharmacology, assessment of the diseases that are manifested by the patient in the given case study. In the given case study, the patient named Jackson Roland was admitted to Hampstead hospital as he fell in the aged care and got injured sustaining cervical spine. The actual patient name has been used in here. As he has no one to look after him, he has permanently stayed in aged care. Jack had a past medical history of Diabetes Mellitus (DM) type 1, hypertension, Ischemic Heart Disease (IHD), atonic bladder (SPC), Peripheral vascular disease(PVD). A catheter that is inserted surgically through the lower part of the abdomen directly into the bladder is known as suprapubic catheter or SPC. He also underwent bilateral transmetatarsal amputation, carpal tunnel surgery and CABG* 2 8 stunt 2008. As he is suffering from severe sensorimotor polyneuropathy due to diabetic neuropathy, there is risk for fall due to decreased sensation and lack of muscle coordination and control. Due to high blood sugar level, the nerves are damaged and can lead to neuropathy enhancing the risk for fall (Vinik et al. 2015). This condition is a diabetic complication and mostly occurs when diabetes remain undiagnosed or not well controlled. This could be the reason for Jacks fall and his need for admission at the hospital. For the access to Jacks information, informed consent is required from him or his caregiver at the aged care. The confidentiality is important while getting access to his personal information like past medical history, current medications, past surgeries and in getting previous medical records (Keast 2016, pp.20). Patient confidentiality has been maintained in here. The main risk for Jack after admission is the moderate or severe brain injury that could be associated with the sustained cervical spine injury (Theologis et al. 2014, pp.356-361). Therefore, there is a requirement of diagnosis and management of cervical spine trauma and assessment of diabetes and hypertension being the major concern and SPC supra pubic catheterisation due to atonic bladder. Pathophysiology As mentioned above, the medical history of Jack revealed that he is suffering from DM type 1, IHD, PVD, hypertension, atonic bladder (SPC) and severe sensorimotor polyneuropathy. Diabetes and hypertension are the major concern that could have manifested the signs and symptoms in Jack and made him prone to fall. Type 1 DM or juvenile diabetes is a condition when the body does not produce insulin that is important to break down the starches and sugars for energy generation (American Diabetes Association 2015). The pathophysiology of DM type 1 is the destruction of beta cells that secrete insulin from the islets of Langerhans in the pancreas (Jennings 2015). There is decline in beta cell mass that in turn decreases the insulin secretion until there is no adequate insulin to maintain the normal blood sugar levels where autoimmunity is the major DM type 1 pathophysiology (American Diabetes Association 2015). There is sensory neuropathy caused by segmental demyelination and axonal degeneration that is manifested in Jack making him prone to fall due to sustained hyperglycaemic condition. A patient having chronically elevated glucose level is exposed to damage to the longest nerves in their bodies that convey sensory information from the feet and toes to the spinal cord. The loss of muscle tone and sensation are worst felt at the ankles and feet. This makes it difficult for the patient to walk or stand up. This is more prominent at old age. The condition brought about by neuropathy is one of the major reasons that people with diabetes have such a high risk for falls (Atkinson, Eisenbarth and Michels 2014, pp.69-82). Pathophysiology of hypertension is multi-factorial and complex where kidney acts as the major target organ and contributing factor. Arterial hypertension is the persistent systemic blood elevation where the cardiac output is elevated or systemic vascular resistance increase. There is a strong link between hypertension and diabetic neuropathy where hypertension acts as the independent risk factor as RBCs and Na/K ATPase decrease. An alteration in the microcirculation plays an important role in this regard. Hypertension leads to up-regulation of matrix metalloproteinase (MMP) expression at the sites of myelin thinning at sensory nerve fibers. This potentially worsens comorbid diabetes (Visser et al. 2014). This could be the pathophysiology of hypertension in Jack with diabetes, both being intertwined conditions sharing significant overlap in the manifestation of the underlying risks (Burnier and Wuerzner 2015, pp.655-683). There are macrovascular complications associated with longstanding hypertension or diabetes which includes IHD (Ischemic Heart Disease) and PHD (American Diabetes Association 2015). Microvascular complications include sensorimotor polyneuropathy that is witnessed in Jack on admission. IHD is a condition in which there is narrowing or blockage of the blood vessels that affects the blood supply to the heart. This occurs due to cholesterol deposition on the walls of the vessels reducing the nutrient and oxygen supply to the heart muscles that is essential for the proper functioning of the heart. Therefore, this condition occurs when some part of the heart is deprived of the oxygen and blood supply that can lead to heart attack (Shepard et al. 2015, pp.455-456). In the given case study, Jack is suffering from DM type 1 that is the major risk factor for the disease. Hypertension also acts as a risk factor for the development of IHD and with time, the disease progresses. The longstanding high glucose levels damages arteries that make them hard and stiff. There is building up of fatty materials on the walls of these vessels blocking the blood flow to brain and heart that can lead to stroke (Shepard et al. 2015, pp.455-456). PVD is also caused due to diabetes and hypertension, being the primary factor for the development of the disease. There is slow narrowing or blocking of the blood vessels that can also cause spasms. PHD is a progressive circulation disorder that also involves blood vessels outside heart like arteries, lymphatic vessels or veins. These vessels supplying blood to brain, legs are also constricted and results in improper functioning. PHD most commonly affects feet and legs where there is decrease in the inner size of vessels and eventually blocks the major arteries (Mascarenhas et al. 2014, pp.149-166). Postural hypotension (PH) is the one of the signs associated with Jacks fall, which he sustained at home and it could be a risk for him as he suffers from type I Diabetes Mellitus. PH is defined as fall in the systolic blood pressure 20mm Hg or a fall in the diastolic blood pressure 10mm Hg, following 3 minutes of continuous standing. It is associated with sympathetic autonomic dysfunction in patients suffering from diabetes mellitus (Bharucha et al. 2013, pp.330-339). It can cause renal failure and even sudden death. It is caused as a result of poor diabetic control and ageing. Diabetes is linked to PH as autonomic neuropathy and inappropriate usage of antihypertensive medications can give rise to sudden drops in the blood pressure, thereby resulting in falls as a result of syncope or fainting (Hjortkjr et al. 2016, p.e012307). Under normal conditions, when an individual changes to a standing position from a sitting position, the brain sends signals to the blood vessels of the leg s to undergo constriction reflexively and in an instant manner. This prevents blood to accumulate in the leg, preventing blood and oxygen deprivation to the brain. However, in patients with diabetes mellitus, the nerves involved in signalling send poor signals to the leg blood vessels and thereby results in fall in blood pressure. This is a sign of sympathetic neuropathy and results in PH. However, anti-hypertensives like diuretics and alpha-1-antagonists like terazosin and prazosin can also cause postural hypotension. Individuals with diabetes are also at an increased risk of sustaining dehydration. High blood glucose levels in can lead to decrease in water content of the body resulting in dehydration. One of the symptoms of severe dehydration is fall in blood pressure, which can cause fainting in individuals. The patient was suffering from diabetes mellitus, so one of the reasons for his fall could be dehydration. Apart from diabetes, peripheral neuropathy can also cause postural hypotension (Canal et al. 2013). The peripheral nervous system helps to connect the central nervous system with the rest of the body like arms, legs, internal organs, mouth, among others. In peripheral neuropathy the nerves associated with the connections and the necessary signalling undergoes malfunction. These malfunctions are caused as a result of damage to these nerves. One of the symptoms associated with peripheral neuropathy is a drop in blood pressure, which can result in fainting. Nerve damage in peripheral neuropathy is mainly caused by diabetes (Metzler et al. 2013, pp.2212-2219; Tsantoulas et al. 2017, p. eaam6072). The condition of atonic bladder is also linked with poorly controlled or long-standing diabetic condition. This condition is a urologic complication of diabetes referred as bladder dysfunction. There are complaints of urge incontinence to decreased bladder or overactive bladder and overflow incontinence. This is a condition faced by the patient as he had undergone supra pubic catheterisation. Neurological destruction is linked to the development of atonic bladder. Destruction of damaging of the nerves that are responsible for bladder control are associated with atonic bladder condition. This may result in obstructive urinary bladder, underactive or overactive urinary bladder. This is caused as a result of the alterations in the physiology of the detrusor muscles, neuronal impairment and urothelial dysfunction. This is the reason SPC supra pubic catheterisation was being administered in Jack. This could be a reason for dehydration in Jack leading to postural hypotension and risk for f alls. An overactive bladder can cause the frequent release of urine from the body and if this fluid is not replaced, it results in dehydration (Chu, Tsai and Hwang 2016, p.S66; Ay et al. 2013, p. E135 ). The resulting neuropathic condition that is witnessed in Jack in sensorimotor polyneuropathy, where he has lost the ability to feel or move due to nerve damage. Polyneuropathy is defined as the systemic or body wide condition where the nerves are damaged in different parts of body like nerve fibres, nerve cells and nerve coverings (Taveggia et al. 2014, pp.242-252). Sensorimotor polyneuropathy can cause damage in nerve cells, axons and the myelin sheaths. This damage takes place in the covering of the nerve cells that makes nerve signals to become slow or stop working. One of the causes of sensorimotor polyneuropathy is diabetes. Transmetatarsal amputation (TMA) is performed to preserve limb viability and is used to treat patients with diabetic neuropathy among other medical conditions. TMA is done in cases of forefoot ulcerations and gangrene complicated due to the presence of diabetes mellitus. The patient had also undergone carpal tunnel surgery. This surgery relieves pressure fro m the median nerve, thereby preventing carpal tunnel syndromes. Carpal tunnel syndrome causes numbness, weakness and tingling sensations in the hand because of pressure building in the median nerve of the wrist. Diabetes is one of the causes of carpal tunnel syndrome. Reduction in heart rate variability (HRV) is generally associated with diabetic sensorimotor polyneuropathy. The patient had also undergone coronary artery bypass surgery (CABG) to improve his blood flow to the heart. Thus, the patient suffers from severe sensorimotor polyneuropathy, which has affected his limbs like forefoot and wrists. Moreover, his heart is also affected. From the above discussions regarding the pathophysiology of the conditions that are manifested in Jack, it is evident that diabetes and hypertension are the main reasons for the development and progression of these diseases. He developed postural hypotension as a result of his diabetes. He also suffered from sensorimotor polyneuropathy, which is associated with diabetes. For this reason, he had to undergo TMA to maintain his limb viability and also had to undergo carpal tunnel surgery to relieve pressure from the median nerves in his wrist. Another symptom of sensorimotor polyneuropathy is heart rate variability and as a result he had to undergo CBG. The cervical spine injury also exhibit complications like bladder dysfunction that leaves the detrusor muscles incapable of contraction and causes urine to flow back to the kidneys and so, SPC is being used that permit passive urine drainage at regular intervals for the prevention of bladder overfilling. The conditions are due to the com plications of long-standing diabetes or hypertension in Jack that was either undiagnosed or poorly managed. Therefore, the main concern for his care are the diabetes and hypertension conditions and the SPC supra pubic catheterisation due to atonic bladder. Pharmacology Jacks current medications include Navorapid, Lantus solo star pen, Amlodipine. The immediate concern is to manage his diabetes and blood pressure levels. He suffered a sustained cervical spine injury, but it is not possible to reverse the spinal cord damage. However, pharmacological medications could promote regeneration of nerve cell and improve the nerve functioning. Therefore, the pharmacological interventions in spinal cord injury treatment is focused on the prevention of further injury and empowering Jack to lead a productive and active life. The medication NovoRapid is used for the lowering of the blood sugar levels, as the pancreas cannot produce insulin to meet the requirements of the body (Wendt et al. 2017, p. 1932296817693254). The expected outcome of this medication is to lower the blood glucose levels as glucose cannot store or accumulated by the body for use. Novorapid stimulates the glucose uptake in fat and skeletal muscle, inhibits the production of hepatic glucose. This medication also inhibits proteolysis or lipolysis and enhances protein synthesis (Davisplus.fadavis.com, 2017). It has a rapid action and onset with shorter duration as compared to human insulin. It has a therapeutic effect of controlling hyperglycemia and so it can control the blood glucose levels of Jack, which were found to be high as he was suffering from type I diabetes mellitus, which results in inability of the body to produce insulin. The side effects of this drug include hypoglycemia in the endothelial cells and have local effects lik e swelling, erythema, pruritis and liposystrophy. It also has miscellaneous side effects include allergic reactions like anaphylaxis. The contraindications of this drug are in hypoglycemia, hypersensitivity or allergy and should be cautiously used in infection and stress. As Jack is suffering from type 1 diabetes, this drug must be used with longer-acting insulin that includes the precautions before using this drug for lowering the blood glucose levels. These precautions include inadequate dosing or treatment discontinuation. Inadequate or discontinuation of treatment can lead to diabetic ketoacidosis and hyperglycaemia. NovoRapid must not be injected if symptoms of hypoglycaemia develop. Dose adjustment is considered following blood glucose adjustment. Rapid onset of action of NovoRapid can be expected in the case of patients with concomitant diseases. Concomitant diseases increases patients requirements for insulin and as a result, the doses need to be changed. Insulin antibodies can form and insulin administration needs to be regulated in order to prevent hyper or hypoglycaemia. The nursing considerations include the proper administration of the drug and check for dose, type and expiration date. This drug should be administered by disposable external insulin pump and discarding of cartridges after 7 days. The infusion site should be changed every 48 hours and most importantly, insulin aspart should be administered along with a long-duration acting insulin due to Novorapids short duration of action (Jennings 2016, pp.132-23; Bowering et al. 2017, pp. 161770). The patient used a Lantus Solostar pen for insulin injection. Amlodipine is used to lower blood pressure and also helps to improve blood flow to the heart, in case of blocked arteries. Amlodipine is an antihypertensive and calcium channel blocker that inhibit the transportation of calcium into vascular and myocardial smooth muscle cells that result in inhibition of excitation-contraction coupling and contraction. It has a therapeutic effect of vasodilation that results in decreased blood pressure. This coronary vasodilatation result in decreased severity and frequency of angina attacks and also helps in the treatment of high blood pressure or hypertension. The patient in the case study is treated with Amlodipine for the treatment of hypertension. However, the side effects of this drug include fatigue, dizziness, angina, peripheral edema, hypotension, bradycardia, angina, palpitations and may cause flushing, nausea and gingival hyperplasia. This drug is contraindicated in low systolic BP below 90 mm Hg and hypersensitivity. This drug should be c autiously used in aortic stenosis, severe hepatic impairment and should be used with utmost precaution. Before administration, nurse should consider the dose, route of administration and expiry date and may be administered without regard to the meals (Higaki et al. 2017, p.251). Amlodipine can cause low blood pressure, which can result in dizziness and fainting. Thus, it is necessary to monitor the blood pressure before its administration. Lantus solostar pen or insulin glargine has therapeutic effect by lowering of the blood glucose levels through stimulation of glucose uptake in the fat and skeletal muscles. It inhibits the production of hepatic glucose and inhibition of lipolysis, proteolysis. It also enhances protein synthesis and control hyperglycemia. The adverse reactions of this drug are hypoglycemia, swelling, erythema, lipodystrophy and pruritis and can cause hypersensitivity including anaphylaxis. Before administration, the nurse should consider the dosage and administration of this drug as medication errors are common in insulin. Insulin syringes should be properly used and there should be no mixing of the drug with other insulin solutions. The drug should be administered subcutaneously once daily at the same time each day and should not be administered with insulin pumps or IV (Rosselli et al. 2015, p.251; Ranjan et al. 2016, p.410-418). Investigations The assessment of the vital signs and diagnostic tests or activities is important for the patient-center care and planning. The patient history, vital signs, laboratory tests and physical examination is important for the proper planning of care and disease management. Vital signs of a patient are important for the healthcare professionals to determine the treatment options and provide critical information to make the decisions for treatment and management. In the given case study, after admission to the hospital, Jack was diagnosed with type 1 DM, hypertension through the diagnostic testing of blood. He suffered a serious fall at his home as a result of postural hypotension, which indicates that he had these medical conditions prior to hospital admission but was diagnosed after admission. Everyday Jacjkson was monitored thrice daily to check his blood sugar level before administration of insulin. It is necessary to check blood glucose levels before insulin administration, since, insu lin administration following low blood glucose levels can give rise to serious health concerns and can also give rise to hypoglycaemia. Monitoring of blood glucose levels is essential to guide the therapy for diabetic patients. Patients with Type 1 diabetes are usually given 2 injections of two types of insulin per day. This generally progresses to 3-4 injections of different types of insulin. Types of insulin depends on blood glucose levels. Monitoring of blood glucose levels is essential in order to modulate the insulin dosage, activity and food consumption. The main reason for admission was fall, so X ray was done to look for any kind of injury that he has sustained after cervical spine injury. The patients past medical history revealed that he suffers from hypertension and diabetes. His blood pressure and blood glucose levels had to be monitored in the aged care, so that proper medications and nursing implementations were carried out to provide sufficient care to the patient. In the aged care, the patients blood pressure was checked regularly. This was because, he was suffering from hypertension, moreover, high blood glucose levels can also result in high blood pressure. Jack also suffered from heart problems and hypertension is a major risk factor for the development of ischemic heart disease. Therefore, it is necessary to monitor blood pressure, in order to prevent ischemic heart disease. Measurement of blood pressure is also needed in patients suffering from postural hypotension, which can increase the risk of falls. High blood pressure can also intensify the symptoms in patients suffering from angina, which in turn can increase the risk of heart attack. As Jack is hypertensive and sustained cervical spine injury, x-ray and ECG are important to assess his heart condition and any kind of internal injury after falling (Forbes and Watt 2015, pp.60). ECG can detect patterns in heart beats to monitor proper blood flow to the heart and necessary nursing care plan can be designed to prevent heart attack. Necessary care and monitoring is needed for patients with supra pubic catheterization. The bag should be present below the waist to prevent urine flow back to the bladder. It is also necessary to monitor whether the catheter is connected and to identify presence of kinks. It is also necessary to move the tubing in the absence of proper draining. In the nursing process, the physical assessment and medical history are important part of data collection for the individualized, patient-centered and holistic care. The medical history is the foundation of diagnosis and treatment as it helps in the identification of patient care needs. The investigations are the key component in the patient assessment that enables healthcare professionals to enable high quality of patient care by giving them a better understanding of the patients complexities, conditions and processes that are involved in the planning care and treatment (LeMone et al. 2015, pp.7-9). Immediate most urgent discharge issue After Jacks discharge from the hospital, it is necessary to hand over his necessary diet plan, nursing care and medications to the staff members in the aged care. It is necessary to monitor his blood pressure and blood glucose levels regularly to provide necessary care with respect to his medical condition. The rationale for choosing this issue is that as he is suffering from diabetic complications and sustained cervical injury, it is important to manage his diabetic or hypertensive condition and his compliance with medications. However, falls may not be an urgent issue but high blood pressure can affect his already deteriorating heart condition. For this, there is need for inclusion of other healthcare professionals who can promote his proper health and improve quality of life. Registered dietician, nurse educator, exercise physiologist and physiotherapists are required for Jack in keeping his diabetes and hypertension under control and compliance to medications. An exercise physiol ogist can inform patients about blood glucose and how to monitor it, so that proper medications can be taken. Moreover, they also provide information about eating strategies and exercises that would help to reduce body fat and high blood glucose levels. Nurse educator would help to educate Jack so that he can take control of his condition and coordinates treatment (American Diabetes Association 2015, pp.S4-S10). Registered dietician can educate and encourage him to follow his daily meal plan as a part of self-management at home and exercise physiologist would help him to develop appropriate exercise for maintaining his fitness level (American Diabetes Association, 2013, pp.S80-S85). Thus, a patient can carry out self -management at home, in the absence of others to take care of him. Reflection According to the Nursing and Midwifery Board in Australia (NMBA) under National Competency standards for the registered nurses, feedback is important as it provides support and reassurance (Birks et al. 2016, pp.522-543). It helps the nurses to become motivated and by taking an active participation in the feedback progress, they can better understand their nursing practice and work towards their professional development. Seeking feedback in nursing practice helps to improve the nursing care and participate in the quality improvement processes. Self-appraisal and constructive feedback enhance critical thinking while reflecting on their nursing practice and in achieving a benchmark in the professional nursing development. Feedback from colleagues helps nurses to critically reflect on their nursing practice and undertake self-regulation on a daily basis for the enhancement of professional development and in identifying the professional needs (Fisher, 2017, p.4). Feedback aids in contrib uting to the professional development as they actively take part in the professional nursing practice as it provides additional knowledge to the existing nursing practice for its enhancement. Feedback can be gained from patients, carers, doctors, colleagues, among others. It helps in communicating with the patients, care givers and relatives to provide highly enhanced care for the patients. It also helps to carry out self-assessment, which can essentially help in improving the nursing practices. These in turn helps in the continuation of the nurses professional development. The NMBA standards for nurses stresses on a variety of domains. These include collaborative and professional practice, provisions for care and reflective or analytical practice. Collaborations in professional practice is necessary to make improvements in the existing nursing practices. Moreover, reflection of ones practices are essential in order to analyse and self deduce the pros and cons associated with the pr actice to make improvements in the future in order to provide enhanced care to patients. Concisely, NMBA standards states that seeking feedback and using information from others by nurses helps in professional development and understanding on how to assess their nursing practice in variety of clinical settings. References American Diabetes Association, 2013. Executive summary: Standards of medical care in diabetes2013.Diabetes care,36(Supplement 1), pp.S4-S10. American Diabetes Association, 2015. 13. Diabetes Care in the Hospital, Nursing Home, and Skilled Nursing Facility.Diabetes Care,38(Supplement 1), pp.S80-S85. Atkinson, M.A., Eisenbarth, G.S. and Michels, A.W., 2014. Type 1 diabetes.The Lancet,383(9911), pp.69-82. Ay, A., Demir, A., Kismet, K., Emir, L. and Ertas, E., 2013. Idiopathic giant atonic bladder (6000 mL in volume) present for 15 years with no urinary symptoms.Canadian Urological Association Journal,7(1-2), p.E135. Bharucha, A.E., Batey-Schaefer, B., Cleary, P.A., Murray, J.A., Cowie, C., Lorenzi, G., Driscoll, M., Harth, J., Larkin, M., Christofi, M. and Bayless, M., 2015. Delayed gastric emptying is associated with early and long-term hyperglycemia in type 1 diabetes mellitus.Gastroenterology,149(2), pp.330-339. Birks, M., Davis, J., Smithson, J. and Cant, R., 2016. Registered nurse scope of practice in Australia: an integrative review of the literature.Contemporary nurse,52(5), pp.522-543. Bowering, K., Case, C., Harvey, J., Reeves, M., Sampson, M., Strzinek, R., Bretler, D.M., Bang, R.B. and Bode, B.W., 2017. Faster Aspart Versus Insulin Aspart As Part of a Basal-Bolus Regimen in Inadequately Controlled Type 2 Diabetes: The onset 2 Trial.Diabetes Care, p.dc161770. Burnier, M. and Wuerzner, G., 2015. Pathophysiology of Hypertension. InPathophysiology and Pharmacotherapy of Cardiovascular Disease(pp. 655-683). Springer International Publishing. Canal, N., Comi, G., Saibene, V., Musch, B. and Pozza, G., 2013, October. The relationship between peripheral and autonomic neuropathy in insulin dependent diabetes: a clinical and instrumental evaluation. InPeripheral Neuropathies: Proceedings of the International Symposium on Peripheral Neuropathies Held in Milan, Italy, on June 2628, 1978(Vol. 1, p. 247). Elsevier. Chu, Y.B., Tsai, T.F. and Hwang, T.I., 2016. Case report: A giant atonic bladder with more than 5000ml in volume.Urological Science,27(2), p.S66. Davisplus.fadavis.com (2017).Cite a Website - Cite This For Me. [online] Davisplus.fadavis.com. Available at: https://davisplus.fadavis.com/3976/meddeck/pdf/insulinaspart.pdf [Accessed 6 Nov. 2017]. De Visser, A., Hemming, A., Yang, C., Zaver, S., Dhaliwal, R., Jawed, Z. and Toth, C., 2014. The adjuvant effect of hypertension upon diabetic peripheral neuropathy in experimental type 2 diabetes.Neurobiology of disease,62, pp.18-30. Fisher, M., 2017. Professional standards for nursing practice: How do they shape contemporary rehabilitation nursing practice?.Journal of the Australasian Rehabilitation Nurses Association,20(1), p.4. Forbes, H. and Watt, E., 2015.Jarvis's Physical Examination and Health Assessment. Elsevier Health Sciences. Higaki, J., Komuro, I., Shiki, K., Lee, G., Taniguchi, A., Ikeda, H., Kuroki, D., Nishimura, S. and Ogihara, T., 2017. Effect of hydrochlorothiazide in addition to telmisartan/amlodipine combination for treating hypertensive patients uncontrolled with telmisartan/amlodipine: a randomized, double-blind study.Hypertension Research,40(3), p.251. Hjortkjr, H.., Jensen, T., Kofoed, K.F., Mogensen, U.M., Sigvardsen, P.E., Kber, L., Hilsted, K.L., Corinth, H., Theilade, S. and Hilsted, J., 2016. Nocturnal antihypertensive treatment in patients with type 1 diabetes with autonomic neuropathy and non-dipping: a randomised, placebo-controlled, double-blind cross-over trial.BMJ open,6(12), p.e012307. Jennings, P., 2016. Insulin aspart.Reactions,1598, pp.132-23. Keast, K. (2016). Taking enrolled nursing into a new era.Australian Nursing and Midwifery Journal,23(8), 20. LeMone, P., Burke, K., Dwyer, T., Levett-Jones, T., Moxham, L. and Reid-Searl, K., 2015.Medical-surgical nursing. Pearson Higher Education AU. Mascarenhas, J.V., Albayati, M.A., Shearman, C.P. and Jude, E.B., 2014. Peripheral arterial disease.Endocrinology and metabolism clinics of North America,43(1), pp.149-166. Metzler, M., Duerr, S., Granata, R., Krismer, F., Robertson, D. and Wenning, G.K., 2013. Neurogenic orthostatic hypotension: pathophysiology, evaluation, and management.Journal of neurology,260(9), pp.2212-2219. Ranjan, A., Schmidt, S., Madsbad, S., Holst, J.J. and Nrgaard, K., 2016. Effects of subcutaneous, low?dose glucagon on insulin?induced mild hypoglycaemia in patients with insulin pump treated type 1 diabetes.Diabetes, Obesity and Metabolism,18(4), pp.410-418. Rosselli, J.L., Archer, S.N., Lindley, N.K. and Butler, L.M., 2015. U300 Insulin Glargine: A Novel Basal Insulin for Type 1 and Type 2 Diabetes.Journal of Pharmacy Technology,31(5), pp.234-242. Shepard, D., VanderZanden, A., Moran, A., Naghavi, M., Murray, C. and Roth, G., 2015. Ischemic heart disease worldwide, 1990 to 2013.Circulation: Cardiovascular Quality and Outcomes,8(4), pp.455-456. Taveggia, G., Villafae, J.H., Vavassori, F., Lecchi, C., Borboni, A. and Negrini, S., 2014. Multimodal treatment of distal sensorimotor polyneuropathy in diabetic patients: a randomized clinical trial.Journal of manipulative and physiological therapeutics,37(4), pp.242-252. Theologis, A.A., Dionisio, R., Mackersie, R., McClellan, R.T. and Pekmezci, M., 2014. Cervical spine clearance protocols in level 1 trauma centers in the United States.Spine,39(5), pp.356-361. Tsantoulas, C., Lanez, S., Wong, S., Mehta, I., Vilar, B. and McNaughton, P.A., 2017. Hyperpolarization-activated cyclic nucleotidegated 2 (HCN2) ion channels drive pain in mouse models of diabetic neuropathy.Science Translational Medicine,9(409), p.eaam6072. Vinik, A.I., Vinik, E.J., Colberg, S.R. and Morrison, S., 2015. Falls risk in older adults with type 2 diabetes.Clinics in geriatric medicine,31(1), pp.89-99. Wendt, S.L., Ranjan, A., Mller, J.K., Schmidt, S., Knudsen, C.B., Holst, J.J., Madsbad, S., Madsen, H., Nrgaard, K. and Jrgensen, J.B., 2017. Cross-validation of a glucose-insulin-glucagon pharmacodynamics model for simulation using data from patients with type 1 diabetes.Journal of Diabetes Science and Technology, p.1932296817693254.

Economics of Contract Law

Question 1: If a contract is silent as to the sum to be paid by the employer to the contractor for the works, the law implies into the contract an obligation on the employer to pay a reasonable price for the works carried out. Drawing on examples from standard form contracts, highlight how express terms have been used to give effect to and/or modify the assessment of the reasonable price the law would, in the absence of express terms as to the sum payable, require the employer to pay. Question 2: It was in the nineteenth century first and foremost that a philosophy of freedom of contract was established. Embedded in this philosophy was not only the freedom to enter into and negotiate the terms of contract, but also the right of the parties to determine the levels of compensation payable in the event of a breach'. Evaluate the extent to which this approach is, today, reflected in the ability of a party to impose penalties on the other party in the event of a breach of contract. Question 3: Ethel, a property developer, decided to build a house (the house) for herself and her family. She wanted the house to be modern in design and built largely of reinforced concrete and glass. She also wanted the house to provide a place in which she could display her valuable collection of paintings throughout. The Dominant Cause Partnership (DCP) is a leading firm of architects that specialise in the construction of such dwellings. At a meeting with Ahmed, a senior partner in DCP, Ethel described the nature of her painting collection. She explained that her paintings would be damaged by sunlight and that, if she were to go ahead with the project, it was vitally important to her that the glass walls of the house should protect the paintings from sunlight. Ahmed assured her that modern glass-making technology would offer her paintings the protection needed. Ethel then entered into a contract with DCP for the design of the house. DCP produced a design, detailed drawings and technical specifications for the house. DCPs involvement in the project ended at that point and Ethel paid DCPs bill. She then took over the management of the construction of the house herself. Ethel ordered materials and engaged a building company, which constructed the house. Both the construction of the house and the materials ordered were in strict compliance with DCPs drawings and specifications. Once the glass had been fitted Ethel soon discovered that it possessed none of the light-protecting qualities required. Upon investigation, it was discovered that whilst the glass conformed to the specification ordered by Ethel and specified by DCP, DCPs specification for the glass was incorrect. It is estimated that the cost of replacing the glass will increase the building cost of the house from 1,000,000 to 1,500,000. The value of Ethels paintings is estimated at 750,000. 1.Advise Ethel on any claims that she may have against DCP in breach of contract. 2. Advise Ethel on the damages she may recover if she is successful; include in your advice the principles the court will use when deciding whether to award substantial damages in respect of breach of contract. Answers: 1: Contract means a lawfully enforceable agreement between at least two parties based upon some terms and conditions depending upon which the parties to the contract performs their obligation as to each other in relation to the terms of the contract (Meyer, 2010). The validity of a contract depends upon its essentials, these are mandatory for the purpose of constructing a valid legal contract. The essentials of a contract are as follows: 1. The parties to the contract must have attained the age of maturity at the time of entering into the contract.2. The free consent of the parties to the contract is mandatory for the purpose of forming a valid contract.3. The parties to the contract must be of sound mind and they are enough capable for understanding the terms and conditions as well as the consequences of the contract.4. The subject matter of the contract must not be illegal in nature and any terms or conditions of the contract must not contravene any provision of any law in force (Suez environment awarded contract in UAE, 2008).5. Another most important essential factor of a valid contract is consideration, without consideration no valid contract can be formed (Frey and Frey, 2001).Here, in the mentioned circumstances the sum which is to be paid by the employer to the contractor is not given but the obligation from the part of the contractor is implicated in an implied manner. But according to the provisions of the law of contracts in United Arab Emirates, any contract without consideration of either party is void and shall not have any legal enforceability as well as the binding force of law (Fattal and Schutz, 2008). Consideration is what a party to the contract receives in against of performing his part of obligation in the course of the contract. The consideration of a contract may be or may not be calculated in the economic form or any other kind. Consideration is a promise to do anything or to abstain from doing anything, which may or may not have any financial relation (Elliott and Quinn, 2007). For example if A and B enters into a contract and A says to be if B gives his pen to A, he will never talk to Bs wife C anymore. Here, As consideration is the pencil and Bs consideration is the promise made by A that he will never talk to Bs wife C. So it is not necessary that the consideration of a contract must be financial in nature, rather it is a promise to perform any particular act which may be in relation to the economic factor or may not. Without consideration if any contract is formed then that will be a void contract and if the consideration from either party is not mentioned properly then it would be difficult to determine the part of consideration in enforceability of the contract (Richards, 2006). In the famous case of Browning Vs Johnson, the Ld Court has observed that the forbearance of a lawful right of either party to the contract is a valid consideration for the other party of the contract subject to the consent of the parties. The court also held that a promise to surrender a lawful right from the part of either of the parties to the contract is a valid consideration for the other party to the contract. Subsequently, consideration need not to be adequate or parallel to the comparative value, but it is sufficient that either of the party to the contract made promise to do anything or abstain from doing anything against the performance of the other party in the course of the contract (Hillman, 1997).According to the Article 267 of the United Arab Emirates Civil Code independent annihilation of a contract cannot have any legal effect in the United Arab Emirates, however the observation of the Courts in United Arab Emirates demonstrate that the employer in construction cases be able to be permitted to unilaterally conclude a contract, subject to some exceptions. In a current Appeal judgment in a court with competent jurisdiction, it was observed that the grounds behind this exemption are that muqawala type of contracts often takes an extended period of time to conclude and situation may transform in the period connecting formation of contract and completion of the work of the contract. This exemption has its pedigree in Egyptian law (Bechor, 2007). In this case, the court observed that when a chief contractor provides notice of annihilation to the subcontractor, the contract of muqawala terminates and the chief contractor have to pay compensation the subcontractor for the expenditures incurred, any work previously performed and defeat of profit which is expected by the subcontractor to earn by taking responsibilities of the work (Company, 2015). The main reason behind the concept of reasonable price is that no one should be deprived of what he is entitled. If any party to the contract performs his part of obligation then he is entitled to get his consideration, in the mentioned circumstances in the question, the actual amount of consideration was not mentioned but there was something which could have been taken in account as consideration though it was not specific for that purpose the principal of reasonable price applies. In the case of Baird Textile Holdings Ltd v MS plc, it was observed by the Ld. Court that if the price is uncertain the terms of the contract then the either of the party give terminate the contract by serving a notice of termination but if either of the party has already performed his obligation then the other party have to perform his part of duty in the course of the contract, if it is uncertain then the principal of reasonable price may be applied (McKendrick, 2007). In the case of Scammell and Nephew Ltd v Ouston, it was held by the Ld. Court that if the actual quantity of consideration is not mentioned in the terms of the contract then it is not possible for the courts to determine the actual reasonable price in relation to the consideration as it depends upon various factors like market, conditions, quality of work and most importantly the kind of performance, whether it is performed in accordance with the terms of the contract or not (Christ water technology subsidiary awarded UAE contract, 2007). 2: In this regard it should be mentioned that in case of a breach of contract penalty was the only remedy in the nineteenth century, but in present scenario this concept has changed a lot. Nowadays, in case of a breach of contract by either party to the contract there are three possible way in relation to the remedy. These are, (i) Compensation or damages, (ii) Specific performance, and (iii) Injunction. As per the information provided in the context of the question a party to the contract was not only empowered to negotiate the terms of the contract but also impose penalties upon the other party in case of a breach of contract (Knight and Satchell, 2007). The level of penalty was also determined by the aggrieved party of the contract. But in present legal scenario things changed to a very far extend, now any person may enter into a valid contract subject to the competency of the person, may also negotiate the terms and conditions of the contract but if there is any breach of contract t hen the for the purpose of complying appropriate remedy the aggrieved party have to approach to the court of law with competent jurisdiction (Carter, 2012). Only the court of law has the power to impose penalty upon the other party to the contract or to give decree in favor of any other form of remedy which is available in the course of such breach of contract. Whether there is any scope for imposing penalty or not that also is determined by the concern court with competent jurisdiction. These issues are generally decided by the court depending upon various factors in accordance with the terms of the contract as well as the law of contract of the country. For example, if in case of breach of contract, where chances of specific performance is more possible than imposing penalty, then the court of law with competent jurisdiction may give a decree in favor of specific performance of the contract but if there is no scope for specific performance or if it is done it would not serve the l oss of the aggrieved party then the court may impose penalty upon the defendant. Here the aggrieved party is not authorized to take any action in relation to imposing penalty by himself; the court of law will award it, if the court thinks fit and proper. For illustration, A and B entered into a contract, where A has paid a sum of money to B and B was obliged to construct a building in the adjacent land of the house of A but B has not constructed the building, here the scope of specific performance is very much available, so B may be compelled to perform his duty unless he have to pay compensation along with the sum of money received in this regard, to A. From the nineteenth century till today, the concept of penalties in case of breach of contract has changed a lot. Now the term penalty has became more adequate in the legal field in the name of damages. The process of determining the penalty is also changed as per the development of the legal surroundings. Damages are determined by two forms which are; liquidated damages and un-liquidated damages. Liquidated damages is a form of damages where the actual loss suffered by the aggrieved party because of the breach of contract can be calculated and depending upon which penalty can be imposed, for example A and B entered into a contract, where A gave a sum of 1000 $ to B and asked to construct a building adjacent to the house of A, and also promised to pay the balance amount of money which is 1500$ after completing the construction, but after the construction has been complete, A refuses to pay the balance amount of money to B, here the loss suffered by B is specific and can be easily cal culated, so it falls within the within the purview of the concept of liquidated damages. But if in the same case the amount of money was not specified and the cost of construction made by B, was not recorded then it would not be possible for the court to determine the actual amount of loss suffered by B in this regard, so the court may impose a lump sum amount of damages in favor of B, this will fall under the concept un-liquidated damages as it was not able to calculate the actual amount of loss suffered by the aggrieved party (Cohen and McKendrick, 2005). In a famous English case ofHillas Co Ltd v Arcos Ltd, the house of lord observed that in breach of contract if the specification of the kind of breach and loss suffered by the aggrieved party is sufficient then the court of law may grant compensation upon the defendant in a specific way and the amount of compensation would be very much adequate in accordance with the breach as well as the terms and conditions of the contract. In the case of Carlton Communications and Granada Media plc v The Football League, the court of law with competent jurisdiction held that compensation is a right of the aggrieved party in case of a breach in course of a contract but if there is sufficient and justified ground of such breach of contract from the part of the defendant of suit then the amount of compensation may be waived and if it breach happened due to any natural disaster then neither of the parties to the contract shall be liable for any sought of penalty. In the case of Hadley v Baxendale, the court of law held that the aggrieved party to a breach of contract is entitled to get back the losses suffered due to the breach but any loss of anticipated income or gain is not permissible to be reimbursed from the defendant due to the breach of contract and the amount of damages shall be calculated depending upon the actual loss suffered by the aggrieved party (Grundmann, 2007). In the present legal scenario, the right of the aggrieved party has been changed to some extend especially as to rights in case of a breach of contract. Previously in the nineteenth century the parties to the contract has the right not only to enter into the contract and negotiate the terms of the contract but also to determine the level of compensation in case of the breach of contract (Fattal and Schutz, 2008). But in present legal scenario things have been changed, the court of law with competent jurisdiction has the authority to determine the level of compensation in case of a breach of contract (Beale and Tallon, 2002). Not only that whether there is any scope for the imposition of penalty is available or not or any other form of remedy is available to the aggrieved party or not, shall also determined by the court of law with competent jurisdiction. If the court of law things fit and proper then only the decree relating to the compensation shall be given and the form of damages shall also be determined by the court of law by applying its discretionary power (Fitzpatrick, 2004). In present society the scope of contract law has been noticeably increased in comparison to the nineteenth century, many cases are disposed depending upon the discretion of the court of law as every case is different every aspect is dissimilar and the region of contract law has been tremendously improved. In the case of Victoria Laundry (Windsor) Ltd v Newman Industries Ltd, the house of lord held that in case of a breach of contract the parties to the contract are at a liberty to solve the dispute by way of negotiating the terms of the contract or any other form of alternative dispute resolution but neither of the party has the right to impose the level of compensation upon the other party of the contract, if it does then it will not bear the binding force of law, for that purpose the aggrieved party have to approach the court of law with competent jurisdiction (Geest, 2011). From the above discussion it can be concluded that since the period of nineteenth century there has been a lot of changes arrived in scope of contract law. Many great judgments have been given by the court of law with competent jurisdiction and many great doctrines have been also evolved in relation to the concept of contract law and various contractual aspects. In spite of these alteration and changes the basic structure of the contract law remains the same as it was it the earlier period of time (Beale, 2010). In future it is very much possible that a lot more changes to the concept of agreements and contracts is going to be changed but the fundamental requirements and structure of the law of contract would be similar to that of it is in present (Stone and Cunnington, 2007). 3 (a): Under the mentioned circumstances, Ethel has the right to sue the Dominant Cause Partnership (DCP), as in the course of the contract formed between Ethel and the Dominant Cause Partnership, it was mentioned by Ethel that what kind of glasses she need for the purpose of protecting her paintings and she also talk about the nature of her painting and the kind of exhibition she would like to made. The representative of the company DCP assured Ethel that they will make the in such a manner that there shall be no scope for any damage to her painting by way of sunlight as they will specify superior quality of modern glasses which will offer her paintings a greater perspective as to protection from sunlight, but the company DCP has not complied their obligation in this regard as after constructing the house Ethel realize that the they specified was not up to the mark and it was not matching such quality as per the description made by the representative of DCP, they has prescribed some other kind of glass material dissimilar to her requirement and the term of the contract. For that purpose Ethel could have suffer from the loss of damage to her valuable paintings apart from that though the paintings has not been damaged yet before that it came to the knowledge of Ethel, but the DCP has violated the condition of the contract as well as Ethel have to bear the cost of change the fitted glass prescribed by the DCP. Hence, the liability lies upon the company that is Dominant Causes Partners. Because of their misconduct Ethel have to incur an additional expense for the purpose of changing the glass. So, Ethel has the right to reimburse all the expenditures in relation to change the wall glasses prescribed by the DCP. Though the cost of changing the glasses is higher than the actual cost of the paintings but in course of the contract there were nothing mentioned regarding the painting except the factors which may damage the painting and the protection of the painting that is the quality glasses for wall, which were the main subject matter of the breach of contract (Ellinghaus, 2007). For that purpose DCP have to bear the expenses in relation to change the wrong glasses which were fitted due to misconduct from the part of the DCP. If DCP have perfectly discharged his duty in the course of the contract in issue then Ethel would not have to change the glasses as well as the terms of the contract woul d not have been violated. In the case of Koufos v Czarnikow LtdorThe Heron II, it was observed by the Ld. Court that the plaintiff is entitled to get all the loss suffered due to the breach of contract or due to the negligence from the part of the defendant or due to any misconduct from the part of the defendant in the course of the contract, but loss of any anticipatory income is not permitted to be reimbursed by the plaintiff (Poole, 2006). 3 (b): Under the mentioned circumstances, Ethel is entitled to get compensation from the Dominant Causes Partners (DCP), as the company DCP has violated the right of Ethel in the course of the contract, not only that the company DCP has not performed their duty with due diligence in accordance with the terms of the contract for that reason Ethel not only have to incur the expenses for changing the glasses she has harassed, her legal right has been infringed and there was a possibility of causing damage to her painting. Because of that DCP is liable not only to pay the amount of loss in relation to change the glasses but also to pay damages in this regard. Generally in a situation like this the court awards liquidated damages as the cost of changing the glasses are estimated as well as if the painting would have been damaged the cost of which is also calculable, so, there is maximum possibility of awarding liquidated damages in this regard. In the case of Jackson v Royal Bank of Scotland, th e court of law with competent jurisdiction has observed that if the legal right of any party to a contract is violated in the course of the contract then the other party who is responsible for such violation is responsible to pay compensation to the aggrieved party of the contract in issue along with all the loss suffered by the aggrieved party (Kovac, 2011; Lexology.com, 2015). In the case of Williams v Roffey Bros, it was observed by the court of law, that in case of a breach of contact if the right of either of the party is infringed by the other party in relation to the contract then the aggrieved party is entitled to be compensated by the party to the contract who has infringed such right whether deliberately or not, but if the right has been infringed due to any natural consequences and the things were beyond control of the parties to the contract then neither of the party is liable for payment of any sought of damages (Williams v Roffey Bros, [1990]). In the mentioned case of Ethel, here the right of Ethel has been infringed by the Dominant Causing Partners, so it is not essential that whether it has been done intentionally or not, the main issue is that the right of Ethel has been infringed by the misconduct and improper discharge of duty from the part of the Dominant Causes Partners and there were no scope of natural disaster in such violation of ri ght (Stone, 2007; Baird, 2007). References Baird, D. (2007).Economics of contract law. Cheltenham, UK: Edward Elgar. Beale, H. (2010).Cases, materials and text on contract law. Oxford [England]: Hart Pub. Beale, H. and Tallon, D. (2002).Contract law. Oxford [England]: Hart Pub. Bechor, G. (2007).The Sanhuri Code, and the emergence of modern Arab civil law (1932 to 1949). Leiden: Brill. Carter, J. (2012).Carter's breach of contract. Oxford: Hart Pub. Christ water technology subsidiary awarded UAE contract. (2007).Membrane Technology, 2007(10), p.6. Cohen, N. and McKendrick, E. (2005).Comparative remedies for breach of contract. Oxford: Hart. Company, A. (2015).TERMINATING CONSTRUCTION CONTRACTS FOR CONVENIENCE IN THE UAE - Al Tamimi Company. [online] Tamimi.com. Available at: https://www.tamimi.com/en/magazine/law-update/section-5/september-3/terminating-construction-contracts-for-convenience-in-the-uae.html [Accessed 11 Mar. 2015]. Ellinghaus, M. (2007).Australian cases on contract. [Melbourne, Vic.?]: Code Press. Elliott, C. and Quinn, F. (2007).Contract law. Harlow: Pearson Longman. Fattal, R. and Schutz, R. (2008).La re siliation unilate rale du contrat. [S.l.]: [s.n.]. Fattal, R. and Schutz, R. (2008).La re siliation unilate rale du contrat. [S.l.]: [s.n.]. Fitzpatrick, A. (2004).The judicial system. Mankato, Minn.: Creative Education. Frey, M. and Frey, P. (2001).Essentials of contract law. Albany, NY: West/Thomson Learning. Geest, G. (2011).Contract law and economics. Cheltenham, UK: Edward Elgar. Grundmann, S. (2007). Regulating Breach of Contract The Right to Reject Performance by the Party in Breach.European Review of Contract Law, 3(2). Hillman, R. (1997).The richness of contract law. Dordrecht: Kluwer Academic Publishers. Knight, J. and Satchell, S. (2007).Forecasting volatility in the financial markets. Amsterdam: Butterworth-Heinemann. Kovac, M. (2011).Comparative contract law and economics. Cheltenham, UK: Edward Elgar. Lexology.com, (2015).Lexology. [online] Available at: https://www.lexology.com/ [Accessed 11 Mar. 2015]. McKendrick, E. (2007).Contract law. Basingstoke: Palgrave Macmillan. Meyer, L. (2010).Non-performance and remedies under international contract law principles and Indian contract law. Frankfurt am Main: P. Lang. Poole, J. (2006).Casebook on contract law. Oxford: Oxford University Press. Richards, P. (2006).Law of contract. Harlow, England: Pearson Longman. Stone, R. (2007).Contract law. Milton Park, Abingdon, UK: Routledge-Cavendish. Stone, R. and Cunnington, R. (2007).Text, cases and materials on contract law. London: Routledge-Cavendish. Suez environment awarded contract in UAE. (2008).Membrane Technology, 2008(1), pp.5-6. Williams v Roffey Bros[1990].

Rape and molestation an Example of the Topic Psychology Essays by

Rape and molestation There are different reasons that cause rape and violence in modern societies. Most of them lie in the belief that one has a right to control or punish someone, if he doesnt obey his rules or behavior habits. Thats why rape is considered to be an expression of iniquity in power relations between man and woman or homosexuals. The reason of the following inequality in power relationships cannot be generally considered to be the outcomes of the evolution or humans nature, but basically the societies that make woman a citizen of a second class. Need essay sample on "Rape and molestation" topic? We will write a custom essay sample specifically for you Proceed Our Customers Frequently Tell EssayLab professionals: Who wants to write essay for me? Specialists suggest: Professionals Are Creating Successful College Custom Essays! Best Essay Writing Service Reviews Buy Essay Online Cheap Best Essay Writing Service Good Essay Writing Company The problem of creating inequality and the social processes that follow social inequality are not have been studied deeply by the sociobiologists, and the best solution to the rape problem that they give is primary not to dress very attractively- and once again it looks like a method to control womans behavior. The understanding of the rape problem is very essential in our society and as the specialists say the main stress has to be made on changing the nature of relationships between men and women, whichs main task is to promote more equality between them two. Sociobiological explanation of rape is really nothing more than a science in the service of oppression. They point that men who are not successful in their life use rape to gain sexual access and compensate their stress as well as to show power. For the most of cases rape happens because as act of demonstration power not just the act of satisfying sexual desires and needs. Some sociolbiologists argue that men rape women to in order to pass their genes on the next generation. But still it makes a lot of questions, which Lisa Vevett covers in her article Why men rape? : For instance, if passing on their genes is the aim of rape, why do rapists attack the elderly, menopausal women and children? Why do men get raped? What of those women killed by rapists - they will never give birth. The researchers are incredibly ignorant about what happens during a rape. Some men do not ejaculate during rape and so do not deposit their semen inside the woman. This suggests that whatever is driving him to rape is not sexual arousal. Others ejaculate outside the woman. The claim that rapists are predominantly poor young men is also open to question. Certainly many young men convicted of rape are poor. Their convictions are more the result of their being unable to afford expensive lawyers who specialize in defending those accused of rape, than their greater. One of the rapists explained his personal reasons for such a behavior: "I was a comrade before. Then we were no longer given political tasks. Most of the tasks were given to senior people. I felt that we have been used by these senior comrades because I do not understand why they dumped us like this. Myself and six other guys decided to form our own organization that will keep these senior comrades busy all the time. We formed the South African Rapist Association (Sara). We rape women who need to be disciplined. They do not want to talk to most people. They think they know better than most of us and when we struggle, they do not want to join us" As the researches show there are lots of motives that result in raping and it creates definite and clear patterns of attacks. Every attack has its own patterns that depend on the motives of the rapist and the patterns of rape mainly include such kinds of rape as anger rape, power rape and sadistic rape. The article Patterns of Rape gives the full description of the most spread reasons for rape and gives the covering statistics to their distribution. Anger rape takes the second among the patterns of rape that happen nationwide (nearly 40 percent of all the cases). Anger rape is characterized by physical cruelty that is used by a rapist to Make his victim obey him. The offender experiences rage and anger and tries to express it on the victim in both ways physically and verbally during the act of attack. It can be expressed through his nasty and abusive manner of speaking. For such people anger rape is a means of offence, which they can commit against their victim. Those people cannot control themselves often when they experience anger and for them the weapon is sex and violence and the basic motive for such acts is revenge. The main purpose of the power rape is to gain control over the victim, not necessarily to make harm to the victim. The sexuality that a rapist feels is way to compensate his issues of mastery, control, strength and authority. Power rapists mostly give emphasis to verbal threats to the victim and just use the amount of power necessary to control the victim and to subdue the victim, not more. Its is considered that power rapes take the leading place in the statistics and cover nearly fifty five percent of all the cases countrywide. Power rapists have diverse fantasies about the sexual conquests and the rape itself. They mostly believe that their victim enjoys the rape even though that the victim can resists to have a sexual intercourse. It often happens that power rapists are convinced about the sexual pleasure got by their victims and can even ask their victims for a date later. Power rapists, are often sure about nothing wrong with their behavior, they may think it to be normal and as the result they can commit a number of rapes in a short period of time with different victims. The most rare type of rape and the one that will most likely cause death to victim is sadistic rape. Committing a sadistic rape, rapists get errection through brutal aggression, demonstration of anger and power to the victim. Sadistic rape is a result of 5 percent of all rapes countrywide. It often involves tortures and restrains and can even be some type of ritual or can have other violent and bizarre qualities. The injures that a rapist makes to victim are mainly focused on her sexual parts of the body, also rapists of this kind use foreign objects for penetration into victims body. The sadistic rapes are well planned and prepared. The rapist can have the idea of raping for quite a period of time making a full preparation for his future actions. The potential victims of the sadistic rape are often prostitutes as well as other women who dress very expressively. It often happens that victims do not survive after being raped and sometimes rapists get a further satisfaction by murdering the victim. Male rape has become of the urgent topic nowadays and it involves the events that happen not only prisons but in daily normal life as well: Many people believe that the majority of male rape occurs in prison; however, there is existing research which shatters this myth. A study of incarcerated and non-incarcerated male rape victims in Tennessee concluded that the similarities between these two groups would suggest that the sexual assault of men may not be due to conditions unique to a prison and that all men are potential victims (Lipscomb, Gary H. et al. (1992). "Male Victims of Sexual Assault." Journal of the American Medical Association, 267(22): 3064 - 3066.). Research indicates that the most common sites for male rape involving post-puberty victims are outdoors in remote areas and in automobiles (the latter usually involving hitchhikers). Boys in their early and mid-teens are more likely to be victimized than older males (studies indicate a median victim age of 17). The form of assault usually involves penetration of the victim anally and/or orally, rather than stimulation of the victim's penis. Gang rape is more common in cases involving male victims than those involving female victims. Also, multiple sexual acts are more likely to be demanded, weapons are more likely to be displayed and used, and physical injury is more likely to occur, with the injuries that do occur being more serious than with injured female rape victims. Besides rape violence that is usual among the adult, there exist a social problem of child molestation that is being widely discussed nowadays. Child molestation is a more serious problem from many perspectives than rape violence of adults. Because of the forming psychics of the child or a teenager molestation can result a deeper negative impact on his inner world and relations with the society than rape of an adult. An adult has more options to cope with any difficult situation, because of the previous life experience, while a child is not. The problems caused by rape and molestation in the younger age, can be the reasons of difficulties in sexual life in future and fear before the private relations, marriage and having children. Its a big trauma for childs personality, because nearly in all the cases the child keeps the truth about being molested inside of himself and very rare tells it to parents or other adults. Its basically because of the fears to be understood wrong, to be punished and judged. Its also believed that children who experience molestation are more likely to perceive sexual and private relations in abnormal form that can also cause psychological abnormalities and issues that will prevent a person from living a healthy and full life. It has been argued for a long time that homosexuals are more likely be involved in child molestation. But the statistics that is given by different sources is very controversial: Ann Landers says the statement "Homosexuals are more inclined to molest children sexually than heterosexuals" is false. The American Psychological Association has sponsored a work that asserts: "Recognized researchers in the field on child abuse... almost unanimously concur that homosexual people are actually less likely to approach children sexually." The report provided in the article Child Molestation and Homosexuality by Paul Cameron gives the following data: In 1983, a survey of the sexual experiences of 4,340 questioned adults from 5 different U.S. cities reported that about 3% of men and 7% of women had sexual contact with a man before they were 13 (i.e., 30% was homosexual). The survey of 3,132 adults, made in the year of 1983 in Los Angeles reported that 3.8% of men and 6.8% of women had been sexually assaulted while been kids. The survey reported that 93% of the assailants were male, and just 1% of girls had been assaulted by females. Also the report told that nearly 35% of the assaults were caused by homosexuals. The survey made Los Angeles Times in 1985 across the United States, quested nearly 2,700 adults about molestation cases that could take place in their life. Twenty seven percent of women and sixteen percent of man respectively said that they have been sexually molested. Since ninety three percent of boys and seven percent of girls were molested by the same sex adult molesters the survey calculated that 40 percent from the whole number of molestation cases was committed by homosexuals. In the recent survey made in the UK among the 15-19 year old teenagers, thirty five percent of boys and nine percent of girls confessed to have been bended for sexual contact by adult homosexuals, and two percent of boys and one percent of girls respectively, had sexual contact. The publication on the following theme made in 1980s also gave the evidence that from twenty five to forty percent of the cases of child molestation were homosexual acts. Besides the statistics of the molestation victims the article gives the following data about the number of homosexuals who admitted to have committed child molestation: The survey made in 1948 reported that thirty seven percent of gays and about two percent of lesbians agreed about having sexual contacts with teenagers who were under 17, and in addition twenty eight percent of gays and one percent of lesbians admitted that they had sex with underage partners while they themselves were eighteen or older. From the 565 gays, that answered to the survey made by Kinsey Institute in 1970 in San Francisco, 25 percent agreed to have sex with boys who were sixteen or younger when they themselves were older than twenty one. The Gay report gives nearly the same data: 23 percent of gays and 6 of lesbians had sexual relations with teens who were younger than sixteen. Susan Maree Jevons gives the following descriptions of the potential molester in her article Profile of a serial child molester: Child molester is more likely to: Have been abused as children themselves Be Sexually attracted to children (most can't or won't resist these urges) Find positions where children are available (leader of children's clubs, ministries, etc., coaches, camp counselors & chaperones, daycare centers, school positions, offers to babysit for friends & family, etc.) Seem to love children, children seem drawn to person Seek out women with children (or friends with children) Spend a lot of time with a child (not their own) Seem rigid, moral, a pillar of the community (too often accusations of abuse have not been believed because the person seemed to be too good, too outstanding to do such a thing Groom a child--create a special bond (this may involve giving child gifts, money, or even alcohol, or other 'forbidden' things that make it appear he is a special friend and creates atmosphere for secret keeping. Could also include playfully touching, tickling, etc., but moves toward inappropriate touch) Be an authoritarian or timid and unassertive Frequent places like video arcades Be addicted to child pornography Be uncomfortable in adult relationships (i.e., doesn't relate well, insecure) Have symptoms and after-effects of a survivor Deny or rationalize their behavior Be Manipulative Befriend single mothers in order to get to the children. They prey on the desperation of the woman who has no support system. They often sleep with the mother "Roughhouse" with children--tickling, slapping buttocks, etc.--and use this playful guise when they are in fact touching inappropriately Calling young teenage girls "sexy" or making other sexually suggestive comments ( available on web:http://www.suite101.com/article.cfm/child_abuse_and_recovery/33399) The basic problem of the modern society is that there is no obvious solution for the problem of rape cases. Rape and molestation cannot be totally prevented, but still much can be done to avoid some potential cases. As the psychologists tell woman have not to wear sexually attractive clothes, as well as to provoke men by their behavior. There is a lot that can be done to prevent child molestation. Basically the people who are involved in childcare and education have to be carefully examined by the psychologists and other specialists in order to reduce existing risks of molestation. Its important as well to include new trends in to education so that the children will be taught that its OK to talk about these issues with parents and/or school authorities. The best way to escape potential rape is to act reasonably to the situation and to never provoke violent behavior from the side of the potential rapist on purpose. Reference list: Vevett, Lisa Why men rape, Article Patterns of Rape, Article Male rape Information sheet, Rape Crisis center of Catawba county Sexual Molestation Causes, Consequences Protect Your Children from Molestation & Abduction, Article Jevons, Susan Maree Profile of a serial child molester, Article Basic Facts about Rape & Sexual Assault, Article, Georgia network to end sexual assault

Environmental Science Designing Cities for People by Lester Brown

Environmental Science Designing Cities for People by Lester Brown The Plan B given by Lester Brown reaches its climax in chapter six of the text entitled â€Å"Designing Cities for People’. In this chapter, Brown talks about the different alternatives that cities have adopted to make the environment safe and conducive for human existence. Most city designs done earlier on had adopted plans, which aimed at ensuring mobility by designing them to accommodate as many cars as possible. Advertising We will write a custom essay sample on Environmental Science: â€Å"Designing Cities for People† by Lester Brown specifically for you for only $16.05 $11/page Learn More These designs however come to fail considering the doubling fact of the ownership of cars each passing day as the population increases and the designs remaining as they are. The presence of the cars therefore contributes towards immobility rather than enhancing the expected mobility. The chapter â€Å"Designing Cities for People† explores the dif ferent alternatives employed by major city administrators to ensure that the decongestion of cities as well as the curbing of pollution and ultimately giving the health of the city residents a priority. The most innovative alternative as far as I am concerned is the use of bicycles as a means of enhancing mobility. Bicycles have helped decongest several cities considering that a number of bicycles can use a path or the space that only one vehicle can use. Another outstanding benefit of considering the bicycle as the most viable option in the quest for decongesting cities and making them conducive for human existence is that bicycles do not emit gases that can cause respiratory problems to people. To curb the obesity pandemic and the early onset of diabetes in countries such as the US, the people need to consider the biking option with seriousness since it provides a good way of exercising. The problem of settlements is another challenge that cities are facing more so those in deve loping countries. Considering that most people are leaving the rural areas in search of opportunities of good life in urban centers, the problem of rural-urban migration has greatly caught most city designers off guard. Most of the people who come to the cities do so based on economic constraints that force them to squat in risky areas such as riverbanks and steep slopes, a thing that makes it impossible for city planners to provide them with basic social amenities. The most viable solution to this problem that authorities in developing countries should adopt is a system whereby they encourage people to live in the rural areas by making their lives comfortable while there. Advertising Looking for essay on environmental studies? Let's see if we can help you! Get your first paper with 15% OFF Learn More Through making social amenities cheap and easy to access for the people as well as employment opportunities, the rates that people will move with to urban cent ers will definitely be low making it easy to deal with the problem of emerging shanties and slums. By adopting control measures such as those adopted by Enrique Peà ±alosa, the mayor of the city of Bogota, many problems that threaten the lives of innocent people in cities through pollution as well as the inconveniences caused by traffic jams can be completely dealt with. One important thing that this mayor stands out for is his insistence on the importance of parks in cities. As he says, these amenities â€Å"are important for the physical and emotional health of a city†. Many city planners are however failing to understand the magnitude of this statement in that many of them are changing the city parks into parking lots, interpreted as killing the cities emotionally as these places are important for they make the people who come to them and enjoy the tranquility feel equal as put forth by Peà ±alosa.

Article critique Example | Topics and Well Written Essays - 500 words - 5

Critique - Article Example The aim of this article is to highlight how the endoscopic method can help in identification and treatment of sub-gingival calculus. Although the endoscopic technique is viewed as an efficient device in periodontal disease, it has some shortcomings that cannot be ignored. For example, the results of Michaud et al. showed that the endoscope does not give any benefit in root planning and scaling procedures in tooth rootedness (Osborn et al., 2014). The technology of periodontal endoscopic has provided a solution to various problems associated with ordinary detection of calculus, and gives an option in the clinical setting. The technology enables the sub-gingival video image to be exhibited on a proximate detector. As stated by Osborn et al. (2014), the image can be magnified 24x to 48x their real size, relying on the position of the lens and the object under observation (p.230). The article demonstrates how the device can be used for a clear view of sub-gingival calculus. The research was a clinical experiment. It was conducted to compare results of periodontal with and without the help of periscope in patients with periodontitis sites. The statistics were analyzed in a descriptive way of standard and mean deviation. The results were scrutinized to permit differentiation of 11-12 ODU explorer calculus and periscope. The level of calculus was examined utilizing the Endoscopic Calculus Index that was developed by Checchi et al. (p.231). In order to preserve the similarity in calculus indices, the tactile calculus detection using 11-12ODU explorer, employed a revised version of the index. The patients were given two appointments; six and eight-week re-evaluation sessions. The findings proved that the periscope detected many sites that could not be revealed by the explorer. The results of endoscopic revealed a decrease in surface area of the calculus compared to tactile explorer alone. Moreover, the endoscope made it easier

Causes and Effects of Childhood Obesity Research Paper

Causes and Effects of Childhood Obesity - Research Paper Example According to the findings, obesity is impossible to hide and typically introduces a great deal of public humiliation every time the individual walks out the door. This element alone can cause lifelong severe psychological damage that significantly impacts the individual’s ability to live a happy, fulfilling life. However, the physical cost of being obese are much greater even than this. It is well-known that obesity can dramatically lower life expectancy at every age level. What might not be so well known is that there are at least 300,000 deaths in the United States every year that are the direct result of the person being obese. Even when life doesn’t seem threatened, people who are obese suffer a greater number of illnesses, have an earlier onset and more severe problems in their bones and joints and back region and are more lethargic than those who are not. Approaching epidemic proportions, identifying the causes and treatment of obesity is of utmost importance part icularly when working with children who have an entire lifetime ahead of them. Heredity significantly influences obesity. People who are genetically predisposed to being obese have a harder time trying to lose weight or to maintain the desired body mass. Children born into overweight families are often overweight even before they have the opportunity to try maintaining a healthy weight. Other contributing factors to the problem of obesity in children can include metabolic and socioeconomic circumstances, diseases, endocrine ailments, and medications Metabolism refers to how efficiently a person’s body burns up energy. Metabolic levels and hormonal balances differ widely from one person to another and both factor significantly in controlling weight.

Teaching Essays Curriculum Development Learning Styles

Teaching Essays Curriculum Development Learning Styles Focus on Curriculum Development Learning Styles Introduction: There are different learning styles that have developed with accompanying tests that helps individuals to understand their learning styles. A learning style is a method that is used to educate which is particular to a specific individual and which is assumed that if used by that individual, it will help them to learn their best. It has been described as that particular style that helps individuals to process the stimuli of their mind which helps them to understand what they are being taught. Though the concept of learning style is relatively young having gained ground in the 1970s, it has become an important process in the modern education especially on matters concerning how teachers use it in the curriculum and how it is used in the development of the curriculum. It has been found out that if teachers understand the learning styles of their pupil, they can help their students to adapt to the needs of their classroom work and hence make the process of learning interesting to them. Therefore it has been found quite important to integrate the various learning styles of students in the curriculum in order to ensure that the curriculum meets the needs of the various students who are taught using the same curriculum. (Wang and Nagy, 2007) This paper looks at different learning styles that have been identified. It will try to relate the learning styles with how they are being in the curriculum. Hence the focus will be on the learning styles and how the curriculum has been developed to cater for the needs of different learning styles. But first let us look at learning styles. Models and theories of learning styles There are more that 80 learning styles that have been proposed but all of them consist of some basic styles. There are three basic learning models that have been identified and that are used by learners. Let us look at these models. Visual learners This is a model where student learn through seeing. It is a method in which ideas, concepts, and other information are closely associated with the images that are represented in a graphical manner. The learner just need to see the body language of the teacher and the facial expression that the teacher in order to understand what they are teaching. This method is mostly used by those students who are able to concentrate for a long time and who prefer to sit in front of their classrooms in order to avoid any distraction to their visual aids. These students may think in pictures and at the same time learn form the visual displays like diagrams, overhead transparencies, videos, flip charts, and other materials which use visual aids to communicate. The learners are usually very much attentive during the classroom lessons and they take notes in order to absorb most of the information that is being given by the teacher. (Lawrence, 1999) Researches have found out that visual learning theory helps students to improve in many education areas including critical thinking where they are likely to link graphics with verbal and visual information and draw understanding from such a relationship, retention where these students are likely to remember most of the information which was visually or verbally represented, comprehension where student can understand new ideas and connect then to their previous experience or knowledge, and organization where the students can actually use diagrams in order to organize large amount of data in a way that it can be easily understood. The base of this learn style lies in the way a student can visualize the data and later interpret it and build literacy along that data. (Sather, 2007) Auditory Learning Style This is a style where students learn through listening. In this style, students learn through verbal lectures which include a variety of discussions, talking and listening. The student who uses this style may not strive to be in front of the classroom but they like staying at a distance where they can get most of what is happening. They are able to interpret the meaning of a speech through interpreting the underlying tone of teacher voice, pitch, speed and other nuances of speech. They may not concentrate on writing what is being said but they are very keen on listening what is being said. They don’t rush to take notes but they take time to write their notes. The learners also can benefit a lot from reading aloud texts and also use a tape recorder. This style is used by about 20 percent of the population. In most instances, when these students are learning, the read but they cannot understand if there is no sound in the background. Therefore most to them will be reading and at the same time listening to music or any other background noise. Some of the students have been found to read when there is noise in the background. These learners focus more on the sound that they are hearing that what they are learning. When they are spelling, they usually use sounds. In case they meet with individuals, they are likely to forget their faces but remember their names. These students also like to talk a lot. (Kolb, 2003) Tactile or Kinesthetic Learners These can be described as learners who learn by moving, doing or touching. They have been descried as learning best through a hands approach in which they actively explore the physical world around them. Although they may appear like restless students how finds it hard to sit still for long period, they use their restlessness in moving and touching to learns. In this regard, this learning style is said to take place when student carry out the physical learning activity instead of taking their time to listen or watch the demonstration of a learning activity. Student who use this learning styles have been said to the some of the natural discoverers learners as they are able to achieve most of their learning through practical applicability of the theories unlike having thought over something for along time and then initiating the concept. However there is not evidence that has been shown to support the efficacy of the kinesthetic theory of learning. Going by the above learning theories, the visual learners makes up to 30 percent of the population while the auditory learners are around 20 to 25 percent. There fore kinesthetic learners could make up majority of the population in this regard making up to about 45 percent of learners. Kinesthetic learners have been found to be more efficient in the other physical activities at school and in other areas of application. This analysis gives us the three major types of learning styles that are used. This shows diversity that exists in the student population and therefore there is need to understand this diversity in order to be an effective curriculum instructor. This indicates that though a teacher may be having student in the same class, they m ay be having diverse needs than the physical needs that the teacher can actually see in the students. Therefore as was said in the introduction, there is need for the teacher to have full knowledge of the diverse learning styles of each and every student in order to cater for their needs. Without such and understand of the learning styles of students, it would be hard for a teacher to identify students and classify them into their respective learning styles. This would help the teacher to serve them well. Let us now look at how the curriculum is developed in order to cater for the needs of these students. (Fang, 2002) Curriculum Development and Learning Styles Curriculum is used to support the effort of the teacher in education. A curriculum is just a set of program that gives detail on how students should be taught. It acts as guideline that is systematically made to allow learner to understand concepts it stages. It is an important tool not only to the teacher but also to the learners. Educators place so much emphasize on the design of the curriculum since it has impacts on the education of the students. Curriculum and instruction are some of the most important sectors in education. Hence we can say the curriculum is the base of any education process. (McCarthy, 2004) As we have said learning theories are very imprint in the education process. This is because they have an impact on the design of not only the curriculum but also instruction and assessment. Learning theories are considered when coming up with the process since they are important in supporting the education process. Learning theories are important in the curriculum since educator place a lot of emphases on the intuition, feeing, sensing, imagination and other aspects that are important in helping the student understand what they are being taught. In the curriculum learning styles are also important in analyze, reason and the problem solving process. In the instruction, learning theories have an impact in that teachers should come up with their own instruction methods which will help the students understand what they are being taught. Teachers should come up with instruction methods that caters for the needs of the students using the above four learning styles. This means that it will first take the teacher time to understand the kind of learners who are in the class and try to address their needs in the process of teaching. A teacher will use various experiences that have been gained over time. In addition a teacher will be expect to use reflections, conceptualization and experimentations in coming up with the best teaching method that will help the students understand. As instructors of the curriculum, teachers can introduce variety of experiment elements in the classrooms like sound, music, visuals, body movement, verbal lecturing and other methods which will cater for the needs of the students. For a teacher to know whether they are giving needed curriculum and instruction to the student, they are likely to assess the students. This is a part of the curriculum which shows the effective of the design and implementation of the curriculum. In this regard, teachers must understanding the needs and learning styles of different students in order to come up the proper assessment techniques. Because teachers cannot give different assessment tests to different students according to their learning style, they should therefore employ various techniques in the assessment that will help them to develop all the brains in their classroom. In their regard, the assessment tests should be balance such that it addresses all the needs of students without giving undue advantage to others. The curriculum is made up of the above mentioned three aspects. That means that there is the curriculum content, there must be defined was in which the curriculum shall be instructed to the students, and it must provide means of assessment for the contents of the curriculum. Therefore the provision of the curriculum must be based on the learning style as had been illustrate above. Consideration of the learning styles is very crucial in the learning environment since it dictates the way the curriculum is developed. In developing the curriculum, there must be effort to address the needs of each and every student. As we have seen from our analysis, the biggest percentage among the student population perhaps the kinesthetic learner who constitute about 45 percent of the population. Therefore the curriculum must take into consideration this proportion of the population in order to have relevant and effective contents. The content of the curriculum must give specific details which ensure that the deliver of the contents will have more practical work than theoretic work. This is in order to work with the percentage of the population that is high in the population. Unfortunately many curriculums that have been designed have not kept to the issue of learning theories in the population. This makes many of the curriculums unable to meet their expectation. The expectation of any curriculum is to impart knowledge to the students in the simplest manner possible. This will help them to gain knowledge easily. Therefore if the curriculum is to meet its goals, it must be designed in a way that it addressed the needs of each and every learner in the population. In this regard the curriculum may be having the contents that take care of the learners but the instructors may fail to implement these provisions. This makes learning ineffective and student underperforms. Conclusion As we have seen there are various learning styles that are used by students. These learning styles are important since they help each and every student to understand the contents of the curriculum in the simplest way possible. Teachers as the instructors of the curriculum must understand the learning style of their students in order to give them the best instructions that they need in their learning process. The design of the curriculum must also take care of the needs of each and every student. Therefore the curriculum should be developed in a way that its content, instruction and the assessment guides must give each and every student an advantage. This means that teachers as the instructors of the curriculum have a role to play to ensure that the needs of each and every student is met. Reference Fang, A. (2002). Utilization of learning styles in curriculum development. New York State Kolb, D. (2003). Experiential Learning: Experience as the Source of Learning and Development. New York: Wiley Lawrence, G. (1999). Practical Guide to Learning Styles; Oxford University McCarthy, B. (2004). Teaching to Learning Styles; London: Routledge Sather, A. (2007). The benefit of principals and teaching of supporting youth engagement in school; NASSP Bulletin December 2007 Wang, N. Nagy, J. (2007): The alternate route teacher transition to the class. NASSP Bulletin, March 2007