Colleges vs. Conservatories for Music Majors

Colleges vs. Conservatories for Music Majors When it comes to higher education, prospective music, and theater arts majors have three choices. They can attend a conservatory, try a university or small, private liberal arts college with a strong performing arts department - or opt for that happy medium, universities with conservatories. There are so many decisions and schedules to ponder when applying to college as a music or theater major, but this ones crucial. Here Are the Differences Some large universities, including UCLA and the University of Michigan, boast strong music departments and all the benefits and lifestyle choices a large university offer  Ã¢â‚¬â€œ football games, Greek life, dorms and a wide variety of academic courses. But music majors who dreamed of a math-free existence may be in for a rude surprise. Double check the general ed (or GE) requirements before holding that no-calculus celebration.By contrast, small college-level conservatories such as the Manhattan School of Music, Juilliard and the San Francisco Conservatory of Music focus exclusively on the arts. Everyone is a music or theater arts major, and competition, even after admission, tends to run high. In addition to music, theory and music history courses, students take humanities and writing classes. Some conservatories offer foreign language and/or music business courses, but you won’t find Anthro 101 here or sports (although some conservatories have arrangements with nearby un iversities – Manhattan School of Music students, for example, can take English at Barnard College across the street, and they can use the athletic facilities at Columbia). You won’t get the prototypical â€Å"college experience† here – no frats, no â€Å"Big Game.† And watch out for housing issues. Manhattan and Juilliard have dormitories, but Mannes’ housing is spread out over New York City, and the SF Conservatory has no dorms at all. Check out this list of the top 10 conservatories in the U.S. And finally, there is the conservatory within a major university option. The Thornton School at USC and the University of the Pacific, for example, have conservatories on campus, which give students both the intensity of the conservatory experience and that sense of â€Å"college life.† For some, it becomes a balancing act. Some students have trouble balancing their GE requirements with the considerable conservatory commitment, but it depends on the school and the individual. Visiting the schools and taking a look around are essential steps in making a decision. But start by doing some preliminary research online or at one of the performing arts college fairs hosted by the National Association of College Admissions Counselors at venues across the country. Check out the College Fair 101 survival tips before you go.

Your guide to saving for retirementÂÂ

Your guide to saving for retirement   Have you ever heard the phrase â€Å"It’s never too soon to start planning for the future†? It’s a good rule of thumb, especially when it comes to financial planning and saving for retirement. Sure, you may be at the very beginning of your career journey. You might feel as if it’s too soon for you to have to think about this subject, and that you have plenty of time to worry about planning for your retirement down the road. Still, it might be worth your time to reconsider when you should start. The truth is, most people put off saving for retirement way too long, and the end result is endless anxiety and fear that they’re ill-equipped to afford retirement. Unfortunately, in many cases, they may be correct.According to a recent Business Insider article, Americans just aren’t saving enough for retirement. Based on a study of over 5,000 individuals conducted by Merrill Lynch and Age Wave, one-third of all adults have zero retirement savings and 23% have less than $10,000 tucked away,  an insufficient sum to last through one’s retirement years- especially considering that advances in health care and elder care are making it easier to live longer lives. The article reports that the average American’s retirement goal is to have â€Å"security and the ability to live comfortably without fear of running out of money,† yet they are not doing the type of planning and saving required to make that a reality. Business Insider reports that the major reasons why so many folks struggle with retirement planning are as follows:Most people don’t have any financial role models.  Half of pre-retirees age 50 and older say they don’t have any positive role models when it comes to handling finances. Though some say they can turn to a parent or financial adviser for advice, 40% still don’t understand basic terms associated with retirement savings, such as IRA and 401(k).Most people consider money to o taboo to discuss openly.  Even in the era of Facebook oversharing, 57% of Americans still consider money a distinctly private matter. However, this mindset is shifting: In every category, millennials were more open to discussing taboo topics than people 50 and older.Financial decisions are second-guessed more than any other major life decision.  The study found that 39% of people think twice about money decisions more than anything else. Only 18% of people give pause to career-related choices above all else, and even fewer- a mere 15%- second-guess decisions about their health the most.You don’t have to have all of the retirement planning answers when you’re just starting out, especially since your financial needs, plans, and resources will likely evolve over time. That said, it is a good idea to start building responsible financial habits and behaviors early on and to always operate under the mindset that the money you earn is a valuable commodity and resource t hat you should treat responsibly. And above all- don’t forget that time tends to fly by faster than you think. Retirement isn’t quite as far off as it might seem.Consider taking advantage of the following strategies to help you jumpstart your retirement-saving planning.Get comfortable with saving.There’s an unfortunate tendency among young adults who are just starting out in their professional paths to treat each paycheck as a reservoir of disposable income, a specific amount of money that they have to spend until the next paycheck arrives. It’s a bad idea to get used to treating your income this way. But once it becomes a habit, it’s a tough one to break.Instead, try getting used to saving a percentage of your paycheck each week. 10% is a good place to start for most individuals. It’s okay to start small; the goal here is to get comfortable with the notion of saving. Try increasing the amount you save over time, or whenever your take home p ay increases. Do your best to avoid dipping into this growing pool of money for discretionary purposes. However, if you do hit an unexpected and unavoidable life expense, you’ll have this money to help see you through if needed.Explore workplace retirement savings options.The good news is that many companies offer retirement savings options as part of their employee benefit packages. Do you know what your options are? If not, spending some time researching your benefits or talking to an HR professional at your company is a wise investment. If your company offers a 401(k) savings plan, and any sort of fund matching benefit (even better), it’s certainly in your best interest to take advantage of the plan as soon as possible. Once you get through the initial paperwork to enroll, your contributions will be automatic- all you need to do is keep an eye on it periodically and make adjustments as needed. The value of your 401(k) will build over time, so it stands to reason tha t the earlier you start, the more money you’ll have saved for retirement down the road. Trust us, you’ll thank us later.Explore additional retirement savings options.Contributing to your company 401(k) is a great idea, but it’s often not enough- depending on your retirement needs, your plans should include some level of diversification. Although your may just be beginning to explore your retirement savings options, it’s never too early to get comfortable with the various investment vehicles available to you. These include stocks, bonds, mutual funds, and a Roth IRA account, in addition to your personal savings and 401(k). Once again, the key is diversification- spreading out your money in various areas in an effort to reduce your overall risk exposure in any one area.We recommend that you learn about how these investment tools work in general and how you can make them work for you as part of your long-term investment portfolio. There’s a wealth of research and information available online, and you may want to consult a financial professional to help you get started. As your savings grow, consider using one of these investment tools to allow your money to grow over time.Are you ready?Just thinking of retirement can be scary, let alone trying to figure out how to make it financially feasible. If you’re just getting started in your professional journey, the good news is that you do have some time to thoughtfully prepare for how to save for retirement- but the sooner you start, the better off you’ll ultimately be. Use the strategies presented here to help you kick start your retirement planning. Best of luck!

The Dimensions of Inter-Professional Practice Essay

The Dimensions of Inter-Professional Practice - Essay Example The role of inter professional practice protective meal times in UK hospitals The term protected mealtimes can be described to imply periods within the hospital setting when there are completely no urgent issues or activities at hand. During these times, patients are able to take their meals without interruption and staffs are readily available to offer help to those who need it. Research shows that patients whose mealtimes are protected eat more and are better nourished with improved chances of recovery. Protected meal times can influence achievement of benchmarks including conducive environment, assistance to eat and drink, obtaining food, and food presentation, monitoring, and eating to promote health. Older people admitted to hospital have malnutrition on arrival and most of them are at risk of becoming malnourished or their current nutritional state worsening in hospital, if precautions are not taken. Facilitation of protected meal times Inter-professional working team should fa cilitate implementation of protected mealtimes through the following ways. First, is by ensuring that patients are served with all the three basic meals of breakfast, lunch and dinner. They have to follow each mealtime with a one hour rest period for interaction with visitors, relatives and supporters. The team should also alter the drug delivery time so that patients are given food only after taking their meals and allowed to have enough rest. No other activity should be scheduled during mealtimes to ensure that all patients dedicate their time to meals and no other business. The team should plan to enhance service delivery by recommending a balanced diet and enhancing availability of patient assistants to offer services to patients who are not able to eat by themselves or in need varying assistance. The team should recommend that an audit be carried out after every two weeks to verify whether these rules and procedures of protected meal times are being followed (Rolfe, Freshwater & Jasper 2001). The following measures will be taken by our inter-professional team: There should be medical staff moving rounds, radiology focusing lunchtime slots on other areas, nurse routine- nurses want to get everything done, junior staff reluctant to challenge visitors and staff. The areas intended to put more emphasis include surgical areas, considering how protected mealtimes will interact with theatre lists, and wards which have greater impact on other departments like radiology. This should be followed by an audit to measure and review success in all these areas. There should be an arranged meeting with the hospital management to collaborate and ensure that the whole process is implemented. The unique role of the Inter-professional officials in the Inter-Professional Practice team is both individual and collective in that it takes one’s own conviction and commitment compounded by knowledge and professional experience to mould together with others like minded profes sional colleagues in order to achieve a set collective objective; which in our context is superior delivery of service in protected

The Battle of Little Big Horn Essay Example | Topics and Well Written Essays - 500 words

The Battle of Little Big Horn - Essay Example From this study it is clear that the Battle of Little Big Horn is characterized as a massacre war because of not only the processes of the war, but also the end result of that war. A massacre war is associated with mass killing of unarmed people. In tandem with this assertion, it is evidenced by Everett that the U.S. Calvary under the leadership of Lt. General George Custer was trapped by Indian forces and spread with arrows and bullets which killed them in less than an hour despite their use of horses’ bodies as a barricade. From the description of the war, it is apparent that Custer and his men did not fight back; they were killed mercilessly.This research highlights that  in the information provided by Derudio also supports the claim the Battle of Little Big Horn was a massacre war. According to Derudio, Custer divided the armies into three groups ignored the orders to wait, and decided to attack the Indians without realizing the number of Indian warriors numbered three t imes his army. The Cheyenne, Hunkpapa Sioux and Oglala Sioux enveloped Custer and his men then poured them with gunfire and arrows. The shooting horses and using their carcasses to form a wall provided insignificant protection against the bullets and arrows. Custer and his men were killed in what was referred in this account as â€Å"the worst American military disaster ever.†Ã‚  Calvary had killed. According to her, the Indian armies surrounded the Custer and killed every army.     

Hypoglycaemia in a Term Infant Form Diabetic Mother

Hypoglycaemia in a Term Infant Form Diabetic Mother Hypoglycaemia in a term infant form diabetic mother ASSIGNMENT TITLE: Critically analyse the care provided to an infant from a diabetic mother and family The following assignment will discuss the care of an infant within a special care baby unit, the care provided will be critically analysed and local, national guidelines and recent research associated with the care of the infant will be discussed. In order to ensure confidentiality and in accordance with Nursing and Midwifery Council (2015) the infant being discussed will be referred as Infant B. for the purposes of this assignment the nursing framework Casey, A. (1988), will be used. Casey model includes child, family, health, environment and nurse however to personalize the care provided the main focus within this assignment will be concerning blood glucose control though, temperature control, minimized pain, maintaining a safe environment, establishing feeds, communication and family centred care will be discussed as well in relation to blood glucose control. The rationale supporting the use of Casey model is said to focus on family centred care that is redefining the relationships in health care, increasing and becoming one of the main goals on the neonatal units across the world (Staniszewska et al., 2012). Casey, A. (1988) acknowledges the vital role of the parents and family and ensures the everyday care of the child through a partnership and negotiation between parents and family and the nurse (Casey and Mobbs, 1988; Patient- and Family-Centered Care and the Pediatricians Role, 2012). This assignment is focused on the care of infant B, born at term at 41 weeks and two days gestational age within an antenatal diagnosis of maternal diabetes mellitus type I with a birth weight of 3140 grams, over two consecutive night shifts. Admitted to special care with one day of life with diagnosis of hypoglycemia one of the most frequent causes of admission in this sector (NHS Improvement, 2016). The assessment of infant B. was performed at the moment of admission on the first day after transferred from post-natal unit as per Trust policy. An adequate assessment is a crucial component of nursing practice, mandatory for planning and provision of patient and family centred care (Staniszewska et al., 2012) fundamental for their professional accountability and responsibility RCN (2014.) IDM according with UNICEF (2013) are at risk and need to be correctly identified and managed appropriately. The definition of hypoglycemia in the newborn infant has remained controversial because of a lack of significant correlation among plasma glucose concentration, clinical signs, and long-term sequelae (WRIGHT and MARINELLI, 2014; Hay, et al 2009; UNICEF, 2013) Bulbul and Uslu (2016) concluded that there has been no substantial evidence-based progress in defining what constitutes clinically important neonatal hypoglycemia, particularly regarding how it relates to brain injury. However they consider clear the definition of transient and persistent hypoglycemia and their differences (Cornblath et al.,2000). Many authors have suggested a numeric definitions of hypoglycemia that are variable in postnatal age (Cornblath and Ichord, 2000; Harris at al, 2012; Hawdon 2013; Arya at al, 2013; Stomnaroska-Damcevski, 2015; Adamkin, 2016). The value 2.6mmol/l was adopted by many clinicians and by the Trust as well, however there is no scientific justification for this value (Wright and Marinelli, 2014). On admission infant B. presented with a low blood glucose level (BGL) of 1.3mmol/L, In order to increase blood glucose level, a peripheral venous line (PVL) was inserted in right foot as per Trust policy (2012) (NICE,2015), 10% Dextrose bolus administered, started intra venous fluids of 10% Dextrose and a nasogastric tube inserted. Blood glucose level checked 30mins after (NICE, 2015), level increased to 3.1 mmol/l. IV fluids started (60ml/kg/day) (NICE, 2015; BNF, 2015) and BGL checked 1-2 hours after. Frequency was based on infant B condition (Stomnaroska-Damcevski et al, 2015). Dextrose 10% is given to restore blood glucose levels and provide calories minimizing liver glycogen depletion (BNF, 2014). Administration of a 10%Dextrose is protocoled but this value, once more, it is not consensual in literature (BNF, 2010; Arya at al 2013; Adamkin, 2016). A bolus was given first, with higher concentration that infusion, to increase quicker the values and followed by the infusion to stabilize the levels (Adamkin, 2011). The goal is to achieve a blood glucose level of 2.6 to 9mmol/L (Rennie and Kendall, 2013). Frequent Dextrose bolus are not recommended (WHO, 1997) per risk of hyperosmolar cerebral oedema. A study developed by Heagarty (2016) showed significant benefits of oral dextrose gel as an option for treatment of symptomatic hypoglycemia. Shows that is most effective, well tolerated and reduce 50% the incidence of neonatal hypoglycemia in high risk infants, but just for newborn babies in postnatal unit, not indicated for NICU admissions due to severity conditions (BNF, 2015). Hawdon et al (1994) describe a persistent effect and side-effects, and high doses can stimulate insulin release, that can be a reason why oral glucose gel it is not used in NICU. Other option is glucose water however studies (Wight and Marinelli, 2014) indicate that has insufficient energy and lack of protein. At delivery, glucose supply from mother to the infant stops, and consequently glucose concentrations decrease rapidly, until a exogenous source of glucose is available, the infant depends on his hepatic glucose production to face metabolic needs and maintain the homeostasis during the first few days (Boissieu et al. 1995; de Rooy and Hawdon, 2002). The pediatric endocrine society considers the first 48h of a health newborn infant a normal period of transitional hypoglycemia (Cornblath and Ichord, 2000; Merenstein and Gardner, 2011). Low ketones levels, inappropriate preservation of glycogen, and low glucose levels, are characteristics of this period and may activate mechanisms for brain protection (Adamkin, 2016; Standley, et al, 2016). Acute neurophysiological changes occur when human neonates are low in BGL and the long-term significance of these acute changes is not clear (Cornblath and Ichord, 2000). The presence of risks factors, as an infant from a diabetic mother (Rennie and Roberton, 2013) predisposing an infant to hypoglycemia, and increase the risk of persistent hypoglycemia (Thornton et al., 2015). Highlighting the risk factors may determine an appropriate management and a proper planning since the delivery (Lang, 2014) and according with UNICEF (2013) IDM are at risk and need to be correctly identified and managed appropriately. Based on this we can consider infant B a high risk baby to develop hypoglycemia with risk for persistent hypoglycemia. As an IDM, infant B. developed in postnatal period a hypoglycemia episode, this can be considering a transitional hypoglycemia that is caused by hyperinsulinemia (Stanley at, 2015). A study developed by Isles, Dickson and Farquhar (1968) suggests IDM removes glucose quicker than babies from a non-diabetic mother, and that comes from the ability to produce more insulin based on memory of levels experienced in utero. Hyperinsulinism is the most common cause of increased utilization of glucose, and can be temporary, for example when the fetus has been in contact with a hyperglycemic environment by poorly controlled maternal diabetes, (Rennie and Roberton, 2013). In this stage is important to screen for transient and persistent hypoglycemia, the last one with high risk to develop permanent hypoglycemia and consequently induced brain injury (Adamkin, 2011). Neonatal hypoglycemia is commonly asymptomatic but non-specific and extremely variable signs can be presented (Merenstein and Gardner, 2011). In the Trust we apply N-PASS scale to assess pain, agitation and sedation (Hummel et al, 2004) Neurological manifestation as irritability, jitteriness, lethargy, seizure and cardiorespiratory manifestations like cyanosis, pallor, apnea, irregular respirations, tachypnea and cardiac arrest can be presented. Infant B on admission had an appropriate crying not irritable, appropriate behavior, relaxed facial expression, normal tone and with vital signs in normal range. N-PASS scale was applied every three hours when vital signs evaluated, on every procedure and every time that was appropriate. Hypoglycemia cannot be defined only based on single BGL, has to contextualize with infant and mother history (Cornblath and Ichord, 2000). A study developed by Eidelman and Samueloff (2002) associate directly physiopathology of an IDM with metabolic processes including fetal hyperglycemia and fetal hyperinsulinemia, this fetal hypermetabolic state promote somatic growth, obesity, and metabolic disturbance in short and long-term consequences. Diabetic control early in pregnancy is associated with normal neurodevelopment outcome, but according with Schwartz and Teramo, (2000), blood glucose control increases their importance during the pregnancy and especially during the labor and delivery. IDM according with WHO (1997) as high risk for hypoglycemia however, Hawdon (2015) and NICE (2015) says if prenatal and intrapartum are followed by a specialist and monitored this babies should be treated in a first approach as a low risk infant, and the baby can stay with the mother after birth to monitor BGL for 24h or 12h if stable (Adamkin, 2011). IDM is not an indication to be admitted in the neonatal unit. Managing a baby asymptomatic with confirmed hypoglycemia relies on continuing breastfeeding but now more frequently (Amended, 2015), feed 1-3ml/kg (up to 5ml/kg if needed) of expressed breastmilk (EBM) or substitute nutrition (formula, donor human milk) (NICE, 2013; Hegarty, 2016). Increasing frequency will provide more colostrum for the baby, will stimulate the breast to produce more milk, its a moment to practice skin-to-skin, provides a relaxing healthy moment for both encouraging bounding (Adamkin, 2016) Infant B. developed hypoglycemia in post-natal unit and formula milk was started, to receive proper neonatal care had to be separated from mom. This fact interfered with breastfeeding, production of breast milk and bonding between mother and newborn (Sparshott, M., 1997). Mother B didn ´t have any milk production and that was a trigger for a stressful situation. Assessment of knowledge of all situation was done; emotional support was given, educated and encouraged to continuing breastfeeding, explained importance of breastmilk. Colostrum is the first milk produced by a mother, as a high concentration of nutrient and sugar and ideal to help blood glucose level to reach acceptable values (Wight and Marinelli, 2014). Breastmilk is preferred to formula for association with increase of ketones production (Hawdon et al 1992) and lower blood glucose values in term babies fed with formula, related with insulinogenic effect of protein in formula (Lucas et al, 1981). In partnership with mother B. was planned to stop formula milk when possible and all the EBM expressed was given to infant B. Encourage skin-to-skin contact and unlimited access to breast. (Wight and Marinelli, 2014) It is extensively documented in the literature (Tessier, (1998); Almeida et al., 2010; Heidarzadeh et al., 2013; Blackman, 2013) that kangaroo care provides health benefits not only for the infant but also for parents. A study performed by Heidarzadeh et al. (2013) conclude 62.5% of the mothers that provide kangaroo care to their babies were discharged from the hospital exclusively breastfeeding their babies, comparing with 37.5% of the group that didnt provide kangaroo care. Almeida et al. (2010) in a similar study concludes 82% on discharge go home exclusive breastfeeding. Blackman in 2013 performed a study where one of the subjects evaluated was blood glucose level when provided kangaroo care and results were significantly higher comparing with infants that didnt rece ived. Tessier in 1998 cit by Poppy Steering Group (2009) conclude kangaroo care reduce maternal anxiety, and increase a mothers sense of competence and sensitivity towards her infant. After birth, one of the most important changes is related with metabolism energy and thermoregulation. Infant B. is a term baby however, is a newborn and the risk of disturbance of the thermoregulation is present (Arya at al 2013). A newborn after birth, loses heat immediately by evaporation, convection, conduction and radiation, dependent on the ambient air pressure, temperature and humidity and the temperature of surrounding surfaces (Waldron and Mackinnon, 2007) The newborn has an ability to control and balance temperature, glucose and oxygen perfusion constitute the energy triangle (Aylott, 2005) Variations in this gradual transition can result in disturbances of the neonate regulation such as neonatal hypoglycemia or hyperglycemia. Infant B. had initially presented with an axilla temperature of 37.1 °C, normothermic according with World Health Organization (2006), whilst nursed in an open cot. To prevent variations in temperature infant B. was dressed with a vest and Babygro, a hat and wrapped with a shawl and a light blanket on top NHS (2015) and nursed away from draughts and windows to reduce heat loss by convection (Vilinsky and Sheridan, 2014). Furthermore, care was taken to reduce over exposure of the infant due to procedures, as minimize handling and promoting kangaroo care. World Health Organization (1997) describes kangaroo care as a method to keep babies warm and improve the experience during painful procedures as heel pricks (Johnson, 2007). In order to avoid overheat, as Trust policy, temperature was monitored every three hours by use of a tempadot placed under the axilla for 3minutes and room temperature was set at 24-26 °C. It is essential that neonates are nursed within their neutral thermal environment, defined as a temperature where a baby with normal body temperature has a minimal metabolic rate and minimal oxygen consumption (Waldron and Mackinnon, 2007). Hypothermia can lead harmful effects as hypoglycemia, respiratory distress, hypoxia, metabolic acidosis and failure to gain weight (McCall et al, 2010). During this two night shift, Infant B. was able to maintain his temperature. Detect pain in a neonate it ´s a challenge for multiple factors, a complete and efficient evaluation results in an adequate plan of interventions. As referred previously, N-PASS scale it is adopted by the Trust as a tool to assess pain in neonates. Infant B is exposed to frequent acute pain for heel pricks for evaluation of BGG and cannula in left foot. On admission pain score 0 but during the procedures pain score 1 with consolable crying, tachypneic, tachycardic and clenched Non-nutritional sucking with and without sucrose, swaddling or facilitated tucking and kangaroo care are non-pharmacological techniques adopted to minimize pain to infant B. (2016). Non-nutritional sucking demonstrates to be effective to calm and decrease, particularly mild and moderate pain experienced by the neonate and behaviour responses to pain (Liaw et al., 2010). Baby regulates and organizes himself and relief pain through sucking with no nutritional intake objective. Sucrose effect is mediated by endogenous opioid pathways activated by sweet taste (Gibbins and Stevens, 2001). Beyond non-nutritional sucking, others interventions can be applied, and most of them in partnership with family and parents. Individualised developmental care to include family, explained how to reposition the baby in a comfortable way, swaddling and nesting, and during the procedure containment holding. Encourage parents to touch the neonate and talk with him. If the procedure allowed, do kangaroo care. Minimize painful procedures and clustering, discuss with parents schedules and develop a plan with team. Manipulate the environment decreasing noise and light (Sparshott, 1997). An approach based in recognition and appreciation of parents roles, siblings and other family member allow the nurse to recognise critical steps on the care pathway (Staniszewska et al., 2012) Maximising opportunities for communication with parents/ family increasing confidence in role as a parent and supporting parents-infant relationship. Within the special care unit family-centred care is essential as is advocated by the unit in which the care was being received. During this episode infant B. was placed in a normal cot, because he is a term infant and able to maintain his temperature. This fact allowed his mother as well to be more closed, with no physical barriers. The poppy Steering group (2009) indicate through the needs of parents with an infant requiring neonatal support, the findings show that parents need to have the opportunity to get to know their babies, emotional support, involvement in care and decision making and to establish effective communication with health care staff. When mother B. was able to attend the unit she appeared worried and anxious about not being with infant B. in port-natal ward. It was clear that she saw the change to a different place as a barrier. Explained that she can stay all day and night with infant B. only in handover time, she need to leave for 30 mins, was discussed the bette r time for cares and handling the baby for procedures. Infant B. father was not in the unit during the night, went home to rest, nursing staff were the only support available to her. A study developed by the poppy steering group (2009), showed evidence that improved communication and involvement in their baby ´s care promotes positive parent-child interaction and attachment. It is important for them to have the opportunity to spend time with their baby and know them in partnership with the nurse that is responsible to provide emotional support and provide involvement in care being open to discuss decisions to be made and stablishing effective communication. Mother B. referred that the possibility to do skin-to-skin when it is appropriate for her and for her baby, helped her to cope with sensation of losing control of her baby. Create opportunities for the mom to feel participative in the care, especially during feeding time, like helping with nasogastric feeding encourage bounding and promote attachment in situations of separation between mother and infant. (Bliss, 2011) In second night shift Infant B. remains on IV fluids, intravenous infusion rate was increased to 90ml/kg/day, as per Trust policy. Infant B was able to maintain blood glucose levels between 3.1-4.2mmol/L. Following Trust guidelines supported by NICE (2015), glucose measurements are now twice a day after two consecutive measurements above 2.6mmol/L if infant B developed symptoms of hypoglycemia frequency will be increased. Stablishing breastfeeding but followed by top up ´s through nasogastric tube (2mls every 2 hours) (Wight and Marinelli, 2014) given all EBM available and formula milk to achieve amount of milk that infant B needs. Intravenous fluids as decreased as feeds increased, titrating, to meet infant B intake requirements. Infant B was tolerating well his feeds, abdominal not distended and soft, minimal milky aspirates the plan is normalizing baby, decreasing amout of fluid given by intravenous line and increase feeds hoping baby can return to post-natal unit in the next day. Screening high risk babies is other controversial intervention. A utilization of a tool to screen universally IDM after birth will allow more accurate assessments. NICE, 2013 preconize a standard approach, considering IDM healthy babies until any underling condition appears. However Stomnaroska-Damcevski et al (2015) thinks that assessment is important and. Tools like CRIBS and SNAPPE both based in specific criteria but different between should be used. BGL checked by test-strips provides a estimative value, vary 0.5-1mmol/l (Hay et al, 2009) laboratory enzymatic methods is the most accurate method, but results not quick enough for rapid diagnosis, delaying potential interventions and treatment. A Test-strips is important but must be confirmed by a laboratory testing, however the treatment shouldnt be delayed in order to wait for the values, preventing neurologic damage. (Polin, Yoder and Burg, 2001, Adamkin, 2011) All literature consensual in therapeutic through IV dextrose bolus, and IV dextrose continuing infusion, increasing to 12.5% dextrose if values not stable (NICE,2013; Stomnaroska-Damcevski et al ;2015) but when start therapeutic interventions remains not clear. Need more research about oral glucose gel, and more studies about hypoglycaemia to try to understand values of reference and what is dangerous for infant. NICE, 2013, recommends an individualized approach to management with treatment personalized to the specific disorder, taking in mind patient safety and family preferences. Ungraded best practice statement. The available studies are inconclusive and ambivalent about the subject of hypoglycaemia. Primary studies about blood glucose levels are old, and that fact can compromised the conclusion of the case study for up to date resources. Flexibility of sources becomes easy to get lost in the main questions. A case study it ´s about a particular subject and become individualized losing the relevance. However the context of the phenomenon subject of study is explored in its context with is significance and understanding (Gerrish, K. and Lacey, 2006). This subject is something that we expect to see improving and more reflexion about practice. Diversity of literature helps contextualize diferent prespective through the time. Explain to women with insulin-treated pre-existing diabetes that they are at increased risk of hypoglycaemia in the postnatal period, especially when breastfeeding, and advise them to have a meal or snack available before or during feeds. [2008] To test BGL, in the Trust, it is used Bedside glucose reagent test strips, according with Akalay et al (2001) this are inexpensive and practical but are not with significant variance from true blood glucose levels, especially at low glucose concentrations. Ho et al (2004) preformed a study with five different glucometers, concluding that alone they are not sensitive enough to do a diagnose, just for initial assessment, advising a laboratory analysis to be more accurate. Tools para haver tools tinham de diferentes para cada grupo de risco (Harris, 2012) References AACN., NANN., AWHONN., and Watson, R. (2014). Certification and Core Review for Neonatal Intensive Care Nursing. 1st ed. Elsevier Health Sciences. Adamkin, D.H. (2016) Neonatal hypoglycemia, Seminars in Fetal and Neonatal Medicine, . doi: 10.1016/j.siny.2016.08.007 Adamkin, D.H. and Polin, R.A. (2016) Imperfect advice: Neonatal hypoglycemia, The Journal of Pediatrics, 176, pp. 195-196. doi: 10.1016/j.jpeds.2016.05.051 Al-Agha, R., Firth, R., Byrne, M., Murray, S., Daly, S., Foley, M., Smith, S. and Kinsley, B. (2011). Outcome of pregnancy in type 1 diabetes mellitus (T1DMP): results from combined diabetes-obstetrical clinics in Dublin in three university teaching hospitals (1995-2006). Irish Journal of Medical Science, 181(1), pp.105-109. American Academy of Pediatrics and College of Obstetrics and Gynecologists. Guidelines for Perinatal Care. Elk Grove Village, IL: American Academy of Pediatrics; 2012. Armentrout, D. and Caple, J. (1999). Newborn hypoglycemia. Journal of Pediatric Health Care, 13(1), pp.2-6. Arya, V., Senniappan, S., Guemes, M. and Hussain, K. (2013). Neonatal Hypoglycemia. The Indian Journal of Pediatrics, 81(1), pp.58-65. Aylott, M. (2006a) The Neonatal energy triangle part 1; Metabolic adaptation. Paediatric Nursing. 18, 6, 38-42 Casey, A., 1988. A partnership with child and family. Senior Nurse 8(4), 8-9 Cho, H.Y., Jung, I. and Kim, S.J. (2016) The association between maternal hyperglycemia and perinatal outcomes in gestational diabetes mellitus patients, Medicine, 95(36), p. e4712. doi: 10.1097/md.0000000000004712 Clinical Features of Neonates with Hyperinsulinism. (1999). New England Journal of Medicine, 341(9), pp.701-702. Corkin, D., Clarke, S. and Liggett, L. (2011). Care planning in children and young peoples nursing. 1st ed. Chichester, West Sussex, UK: Wiley-Blackwell. Cornblath M, Hawdon JM, Williams AF, Aynsley-Green A, Ward Platt MP, Schwartz R et al. (2000) Controversies regarding definition of neonatal hypoglycaemia: suggested operational thresholds. Pediatrics; 105: 1141-5. Cornblath, M. and Ichord, R. (2000). Hypoglycemia in the neonate. Seminars in Perinatology, 24(2), pp.136-149. Cornblath, M., Hawdon, J., Williams, A., Aynsley-Green, A., Ward-Platt, M., Schwartz, R. and Kalhan, S. (2000). Controversies Regarding Definition of Neonatal Hypoglycemia: Suggested Operational Thresholds. PEDIATRICS, 105(5), pp.1141-1145. de Boissieu, D., Rocchiccioli, F., Kalach, N. and Bougnà ¨res, P. (1995). Ketone Body Turnover at Term and in Premature Newborns in the First 2 Weeks after Birth. Neonatology, 67(2), pp.84-93. de Rooy, L. and Hawdon, J. (2002). Nutritional Factors That Affect the Postnatal Metabolic Adaptation of Full-Term Small- and Large-for-Gestational-Age Infants. PEDIATRICS, 109(3), pp.e42-e42. DePuy, A.M., Coassolo, K.M., Som, D.A. and Smulian, J.C. (2009) Neonatal hypoglycemia in term, nondiabetic pregnancies, American Journal of Obstetrics and Gynecology, 200(5), pp. e45-e51. doi: 10.1016/j.ajog.2008.10.015. Deshpande, S. and Ward Platt, M. (2005) The investigation and management of neonatal hypoglycaemia, Seminars in Fetal and Neonatal Medicine, 10(4), pp. 351-361. doi: 10.1016/j.siny.2005.04.002. Eidelman, A. and Samueloff, A. (2002). The pathophysiology of the fetus of the diabetic mother. Seminars in Perinatology, 26(3), pp.232-236. Feldman, A. and Brown, F. (2016). Management of Type 1 Diabetes in Pregnancy. Curr Diab Rep, 16(8). Gerrish, K. and Lacey, A. (2006). The research process in nursing. 1st ed. Oxford: Blackwell Pub. Gibbins, S. and Stevens, B. (2001). Mechanisms of Sucrose and Non-Nutritive Sucking in Procedural Pain Management in Infants. Pain Research and Management, 6(1), pp.21-28. Guthrie, R., Van Leeuwen, G., Glenn, L. and Jackson, R.L. (1968) The incidence of asymptomatic hypoglycemia in high-risk newborn infants, The Journal of Pediatrics, 72(4), pp. 582-583. doi: 10.1016/s0022-3476(68)80380-4 Hansmann, G. (2009). Neonatal emergencies. 1st ed. Cambridge: Cambridge University Press. Harris, D.L., Weston, P.J. and Harding, J.E. (2012) Incidence of neonatal hypoglycemia in babies identified as at risk, The Journal of Pediatrics, 161(5), pp. 787-791. doi: 10.1016/j.jpeds.2012.05.022. Hay, W., Raju, T., Higgins, R., Kalhan, S. and Devaskar, S. (2009). Knowledge Gaps and Research Needs for Understanding and Treating Neonatal Hypoglycemia: Workshop Report from Eunice Kennedy Shriver National Institute of Child Health and Human Development. The Journal of Pediatrics, 155(5), pp.612-617. Hillman, N., Kallapur, S. and Jobe, A. (2012). Physiology of Transition from Intrauterine to Extrauterine Life. Clinics in Perinatology, 39(4), pp.769-783. Isles, T., Dickson, M. and Farquhar, J. (1968). Glucose Tolerance and Plasma Insulin in Newborn Infants of Normal and Diabetic Mothers. Pediatric Research, 2(3), pp.198-208 Isles, T., Dickson, M. and Farquhar, J. (1968). Glucose Tolerance and Plasma Insulin in Newborn Infants of Normal and Diabetic Mothers. Pediatric Research, 2(3), pp.198-208. Jobe, A. (2015). Transitional neonatal hypoglycemia. The Journal of Pediatrics, 166(6), pp.1329-1332. Johnson AN. The maternal experience of kangaroo holding. J Obstet Gynecol Neonatal Nurs 2007;36(6):568-73. Lang, T. (2014). Neonatal hypoglycemia. Clinical Biochemistry, 47(9), pp.718-719. Liaw, J., Yang, L., Ti, Y., Blackburn, S., Chang, Y. and Sun, L. (2010). Non-nutritive sucking relieves pain for preterm infants during heel stick procedures in Taiwan. Journal of Clinical Nursing, 19(19-20), pp.2741-2751. Lula O.,Lubchenco, M.D, and Harry Bard, M.D (1971) Incidence of hypoglycemia in newborn infants classified by birth weight and gestational age. pediatrics, 47(5), 1971, pp.831-836. Lyon, A. (2004). Applied physiology: temperature control in the newborn infant. Current Paediatrics, 14(2), pp.137-144. Merenstein, G. and Gardner, S. (2011). Merenstein Gardners handbook of neonatal intensive care. 8st ed. St. Louis, Mo.: Mosby Elsevier. Patient- and Family-Centered Care and the Pediatricians Role. (2012). PEDIATRICS, 129(2), pp.394-404. Polin, R., Yoder, M. and Burg, F. (2001). Workbook in practical neonatology. 1st ed. Philadelphia: W.B. Saunders. Polit, D. and Beck, C. (2012). Nursing research. 1st ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams Wilkins. Postnatal Glucose Homeostasis in Late-Preterm and Term Infants. (2011). PEDIATRICS, 127(3), pp.575-579. Rennie, J. and Roberton, N. (2013). Rennie and Robertons textbook of neonatology. 5st ed. Edinburgh: Churchill Livingstone Elsevier. Rozance, P. and Hay, W. (2012). Neonatal Hypoglycemia-Answers, but More Questions. The Journal of Pediatrics, 161(5), pp.775-776. Schwartz, R. and Teramo, K. (2000). Effects of diabetic pregnancy on the fetus and newborn. Seminars in Perinatology, 24(2), pp.120-135. Sparshott, M. (1997). Pain, distress, and the newborn baby. 1st ed. Abingdon, Oxon, OX: Blackwell Science. Staniszewska, S., Brett, J., Redshaw, M., Hamilton, K., Newburn, M., Jones, N. and Taylor, L. (2012). The POPPY Study: Developing a Model of Family-Centred Care for Neonatal Units. Worldviews on Evidence-Based Nursing, 9(4), pp.243-255. Stanley, C., Rozance, P., Thornton, P., De Leon, D., Harris, D., Haymond, M., Hussain, K., Levitsky, L., Murad, M., Simmons, R., Sperling, M., Weinstein, D., White, N. and Wolfsdorf, J. (2015). Re-Evaluating Transitional Neonatal Hypoglycemia: Mechanism and Implications for Management. The Journal of Pediatrics, 166(6), pp.1520-1525.e1. Stomnaroska-Damcevski, O., Petkovska, E., Jancevska, S. and Danilovski, D. (2015). Neonatal Hypoglycemia: A Continuing Debate in Definition and Management. PRILOZI, 36(3). Strozik, K., Pieper, C. and Roller, J. (1997). Capillary refilling time in newborn babies: normal values. Archives of Disease in Childhood Fetal and Neonatal Edition, 76(3), pp.F193-F196. Thornton, P., Stanley, C., De Leon, D., Harris, D., Haymond, M., Hussain, K., Levitsky, L., Murad, M., Rozance, P., Simmons, R., Sperling, M., Weinstein, D., White, N. and Wolfsdorf, J. (2015). Recommendations from the Pediatric Endocrine Society for Evaluation and Management of Persistent Hypoglycemia in Neonates, Infants, and Children. The Journal of Pediatrics, 167(2), pp.238-245. Thureen, P. and Hay, W. (2006). Neonatal nutrition and metabolism. Cambridge, UK: New York. Wielandt, H, Schà ¸nemann-Rigel, H, Holst, C, Fenger-Grà ¸n, J 2015, High risk of neonatal complications in children of mothers with gestational diabetes mellitus in their first pregnancy, Danish Medical Journal, 62, 6, MEDLINE, EBSCOhost, viewed 9 October 2016.

Impact of Technology Essay

Information Tech has revolutionized the phase of business around the world. Local businesses have become international due to a simple website. I. T. has helped businesses in advertising. People who check their email may suddenly have a pop up at their page ends with sales up to 60% at JC Penny’s! I. T. has helped in customer service, huge corporations like Microsoft attend to customer needs through email and chat services. Networking internal and external in organizations has improved the working of businesses. Staffs and clients likewise can get in touch with the managers for feedback, progress reports and extensions. Communication has bloomed, two business organizations if they need to work together can easily do so. Hotmail, when merged with MSN was easy since the service was online. Business these days require a lot of planning, due to high tech organization systems on computers, planning can be done on an organized pattern, with schedule formats, grant charts etc. Huge databases can now be controlled and stored on network and back up drives. Accessibility of files also has become an easy task with series of password keys and shared folders. Cash transactions are easily made, delay in reduced hence giving liquidity to business. Businesses have been at the forefront of technology for ages. Whatever can speed production will draw in more business. As computers emerged in the 20th century, they promised a new age of information technology. But in order to reap the benefits, businesses needed to adapt and change their infrastructure. For example, American Airlines started using a computerized flight booking system, and Bank of America took on an automated check-processing system. Obviously, now, most business is conducted over personal computers or communication devices. Computers offer companies a way to organize dense databases, personal schedules and various other forms of essential information. As information travels faster and faster and more reliably, barriers of distance disappear, and businesses are realizing how easy it is to outsource jobs overseas. Outsourcing refers to the practice of hiring employees who work outside the company or remotely — and even halfway across the world. Companies can outsource duties such as computer programming and telephone customer service. They can even outsource fast-food restaurant service — don’t be surprised if you’re putting in your hamburger order with a fast-food employee working in a different country entirely. Outsourcing is a controversial practice, and many believe that U. S. companies who take part are hurting the job market in their own country. Nonetheless, from a business perspective, it seems like the wisest route, saving companies between 30 and 70 percent. Another technology that’s starting to revolutionize business is actually not very new — it’s just cheaper these days. Radio frequency identification (RFID) technology is infiltrating and changing business significantly in a few ways. Microchips that store information (such as a number equivalent of a barcode and even an up-to-date history of the chip’s travels) can be attached to product, and this helps companies keep track of their inventory. Some businesses have even begun to use RFID chip implants in humans to tighten security. An access control reader detects the chip’s signal and permits the employee access to the door. But many people are concerned about privacy issues if this were to become widespread practice. Handheld devices like Blackberries have become wildly popular for businesses because they let users check and send email from anywhere, and browse the Internet. Impact of Communication Technology on Life Think of the days when there were no computers and no modern means of transport. Human life was highly restricted due to the unavailability of technological applications. Daily life involved a lot of physical activity. Life of the common man was not as luxurious as that of modern times, but he was more active. Exercise was integrated into routine physical activities. It was contrary to the sedentary lifestyle of today, which leaves no time for exercise and fills days with inactivity and laze. Today we don’t want to, and thanks to technology, don’t even need to, walk, move around or exert physically to get things done. We have the world is at our fingertips. We think of technology as a boon to society. I am afraid; it’s not completely a boon. The Internet has bred many unethical practices like hacking, spamming and phishing. Internet crime is on the rise. The Internet, being an open platform lacks regulation. There is no regulation on the content displayed on websites. Internet gambling has become an addiction for many. Overexposure to the Internet has taken its toll. In this virtual world, you can be who you are not, you can be virtually living even after you die. Isn’t this weird? Children are spending all their time playing online and less or almost no time playing on the ground. Youngsters are spending most of their time social networking, missing on the joys of real social life. Think of the days when there were no online messengers, no emails and no cell phones. Indeed cellular technology made it possible for us to communicate over wireless media. Web communication facilities have worked wonders in speeding long-distance communication. On the other hand, they have deprived mankind of the warmth of personal contact. Emails replaced handwritten letters and communication lost its personal touch. With the means of communication so easily accessible, that magic in waiting to reach someone and the excitement that followed have vanished. Moreover, we have become excessively dependent on technology. Is so much of dependency good? Is it right to rely on machines to such an extent? Is it right to depend on computers rather than relying on human intellect? Computer technology and robotics are trying to substitute for human intellect. With the fast advancing technology, we have started harnessing artificial intelligence in many fields. Where is the digital divide going to take us? How is our ‘tomorrow’ going to be? ‘Machines replacing human beings’ does not portray a rosy picture, does it? It can lead to serious issues like unemployment and crime. An excessive use of machines in every field can result in an under-utilization of human brains. Over time, we may even lose our intellectual abilities. You know of the declining mathematical abilities in children due to use of calculators since school, don’t you? The impact of technology on society is deep. It is both positive and negative. Technology has largely influenced every aspect of living. It has made life easy, but so easy that it may lose its charm one day. One can cherish an accomplishment only if it comes after effort. But everything has become so easily available due to technology that it has lost its value. There is a certain kind of enjoyment in achieving things after striving for them. But with everything a few clicks away, there is no striving, there’s only striking. With the developments in technology, we may be able to enjoy all the pricey luxuries in life but at the cost of losing its priceless joys.

Police Corruption and Misconduct - 2992 Words

Police Corruption and Misconduct We all know that Police Officers and those involved in Law Enforcement are typically good people who we entrust to uphold our laws and rules in society. For them to be able to do their job however we grant them several privileges that that empower them more than the average citizen. Their status at times can make them appear above the law since they are the ones upholding and enforcing it and with all due respect I believe mostly of those individuals are responsible and respectable however as we know from history time to time such privileges an lead to corruption and the abuse of power which they are granted. The following CNN news article contains a hint of some of the corruption that can take place. Taking place in King City California a rural and agricultural area recently where 6 police officers along with the former chief of police were arrested for several charges including conspiracy. Accusations claimed that the arrested officers took advantag e of their powers and would impound the cars of local citizens typically those in the lower class and poor with the goal of those victims not being able to afford the impounding fees and then selling the vehicles to make a profit afterwards. The owner of a local towing company was also arrested being believed to be part of the corrupt officer’s conspiracy. Dean Flippo who is the District Attorney of Monterey County believed the conspiracy would take the following steps in order. First one ofShow MoreRelatedPolice Misconduct and Corruption2063 Words   |  9 PagesINTRODUCTION For as long as policing has existed in America, there has been misconduct and corruption associated with any given policing agency. Police officer malfeasance can range from minor cases of misconduct to the downright criminal acts that are considered to be corruption. 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