Augustine's Contribution to Epistemology Essay Example | Topics and Well Written Essays - 1500 words

Augustine's Contribution to Epistemology - Essay Example Augustine deems the course by which the psyche progresses from the fixation with the object towards deliberation that of the divine as a constitutive part of the cleansing and refinement that is salvation, and as arising in the two-natured Christ, through partaking in Christ’s body.1 Augustine devoted his life to the fundamental quest for truth.2 The epistemological groundwork of his hermeneutic is originated in this expedition for truth.3 Augustine recognizes that Scripture will be understood by a man who possesses an intellectual core. Every human spirit comprehends through the means of enlightenment by a heavenly luminosity. Some men are bestowed with the grace of seeing ideas more clearly while others less clearly. Hence, in the usual course of events, the human intellect does see the divine facts moderately, not immediately in his life.4 The very character of substance hinders the human psyche from the absolute wisdom of the understandable. Augustine adopted the doctrine dated back from the time of the philosophers, Aristotle and Plato, that certain factors thwarts the soul in his search for truth and knowledge. In reference to the bible, Augustine supposes that matter deters the exact forethought for veracity. Moreover, he believes that being endowed with the birthright of original sin from Adam and Eve hinders humans to be guided by the divine light, which, in turn, will help them clearly perceive reality. Original sin darkens the path of human intellect towards certainty. Augustine believes that the corruptible body impedes the quest for knowledge and the main vice that dominates the soul is pride.5 Humility, through the Incarnation and the words of the Holy Scripture, heals pride. The Incarnation facilitates the dialogue between humans and God. Philosophical and biblical reasons predominate Augustine’s speculations of his works. However, the human psyche does not perceive truth directly. Augustine gave emphasis that the human inability to see the truth precisely in his life renders God and truth ineffable; hence, his theology accentuated that God is known better by not knowing him.6 Furthermore, celestial origin is beyond description and human words are simply unsuccessful in clearly describing it. Men utilize remarks, unsuitable they may be, just to say something rather than nothing.7 Moreover, Augustine highlights that such events can never be known.8 Beliefs an individual has known cannot be modified by a more complex fact unless that individual views that reality with his own eyes. Thus, faith continues an individual’s pursuit for wisdom. This insinuation of reliance is astonishing for Christians since their religion is rooted in a variety of historical occurrences. Now and then, some people believed that Augustine’s great contribution to epistemology is to rescue the cognitive status of belief.9 Although substandard to wisdom, it is nevertheless essential to human life in general, but especially i n religion.10 For the reason that Christianity is founded on the works of authors from long ago that individuals in this present time barely even know, what they only did was to believe in what they have written. Augustine associates ontology to epistemology for the reason that teaching and learning are spliced into being.11 For instance, language is often already a part of being, and such it is inseparable to its mnemonic function—teaching and learning.12 Thus, in Augustine’

Marketing and consumption Essay Example | Topics and Well Written Essays - 1250 words

Marketing and consumption - Essay Example 2012). This study will extensively expound on the marketing event that took place on September 10th 2013 by Apple Inc where it launched the lower-cost iPhone 5C which is ‘The most colorful iPhone Yet’ and the iPhone 5S which is dubbed as ‘The Most Forward-Thinking Smartphone in the World’ (CBCnews 2013). Apple Inc is one of the most famous information technology companies, and it is a multinational corporation whose headquarters are based in America, California. Apple Inc is a world renowned for its high-quality products, and it is involved in the sale, development and design of personal computers, computer software and consumer electronics. Apple’s popular hardware products include the iPod music player, the iPad tablet computer, the Mac computers and the iPhone Smartphone (Chazin 2013). September 10th 2013 was a very special day for the Apple Inc company since it was launching two phones that have never been seen in the world ever. iPhone 5C is a lo wer-cost iPhone since Apple has been known to produce very expensive products due to its market niche as well as a good reputation that has lasted many years since the creation of the company in 1976. Thus, its products have been known to be very expensive as compared to similar products that try to rival Apple’s products (Apple 2013). Not only is the iPhone 5C lower in cost but also the most colorful iPhone to be manufactured in the world. ... It is the first Smartphone with 64-bit technology that provides blazing-fast performance, especially when editing photos, launching apps or when playing graphic-intensive games. The iPhone 5s delivers desktop class architecture on the palm of the customer’s hand (iPhone(a) 2013). My selection is relevant to marketing since Apple Inc is a world-renowned company and, therefore, any marketing launch that it organizes has to be covered by all the media in the world due to its attraction of many customers. The chosen marketing event for this study is an excellent example of marketing since there are various lessons that can be learnt from the event. It is paramount to note that Apple had already conducted a marketing awareness program that it will be launching the two phones and there was a humongous response worldwide from many people who wanted to purchase the iPhones firsthand (AppleEvents 2013). The marketing event had attracted very prominent people from all corners of the wor ld since they wanted to know what other new-product Apple had created. It is worth noting that Apple Inc has a long history with its co-founder, the late Steve Jobs and therefore, after his demise, many people thought that the company would not survive in business for long. Therefore, this marketing event was an attraction since people wanted to get a grip of the two new products (TheGuardian 2013). The marketing event was conducted in a very organized and colorful manner that was valuable to any person with a passion for marketing since there were numerous concepts that could be learnt. From the invitation cards to the colorful event, all aspects had what an excellent marketing event should endeavor to practice (Apple 2013). The

Should American Gun Laws Be Reformed Essay Example for Free

Should American Gun Laws Be Reformed Essay America is under ever mounting pressure to reform its gun laws. Overall, 337,960 gun related crimes and 31,000 firearms deaths a year results in America having the highest rate of firearm crime and death in the western world. America’s gun violence is so remarkably high for such a wealthy nation. Continuous mass shootings in schools and workplaces, most recent of which was the Sandy Hook school shooting on December 14 2012, means there is constant political debate over if/how the government should tackle gun violence. Many argue that there should be tighter checks on people purchasing guns, while the NRA and gun advocates claim that the Second Amendment guarantees each citizen an absolute right to â€Å"bear arms†. Aims 1. I aim to find out what the current law is on carrying a firearm in the USA. 2. I aim to compare gun laws and gun crime in the USA to countries with similar levels of gun ownership. 3. I aim to discuss if there are effective ways to reduce gun violence in the USA whilst retaining the right to bear arms. USA gun laws The Second Amendment is the part of the US Bill of Rights that protects the right of US citizens to keep and bear arms, it reads: â€Å"A well-regulated militia, being necessary to the security of a free state, the right of the people to keep and bear arms, shall not be infringed. (1791) Gun laws vary in the USA between different states. Stricter states like California require a Handgun Safety Certificate for handgun purchases, obtained by passing a written test; and short-barrelled shotguns and rifles are prohibited. By contrast, states like Arizona let any adult who is not a prohibited possessor openly carry a loaded firearm. â€Å"Self-defence† is a legitimate reason to carry a gun in public nationwide. All states have gun laws that are more relaxed than British law. Comparing Countries The US has the highest rates of gun ownership in the world, 88. 8 guns per 100 people (2007). The number two country, Yemen, has significantly fewer guns with 54. 8 guns per 100 people. This shows how separated the US is from the rest of the world in terms of gun ownership. It also makes it hard to directly compare the USA to a country with similar gun ownership rates. Finland compared to the USA Finland has the 4th highest firearm ownership worldwide; 45. 3 guns per 100 people, with only Switzerland (45. 7), Yemen (54. 8) and America (88. 8) with higher rates of gun ownership. However, where Finland differentiates itself from America (and Yemen) is that it has comparatively low levels of gun crimes and deaths. The small arms survey (2007) shows that 60% of murders in the USA are gun-related whilst in Finland only 19. % of murders involve a gun. Last year alone America suffered seven mass shootings; Finland, just one. Gun ownership in Finland is much more regulated than it is in the US. Firearms can only be obtained with an acquisition license, which can be applied for from the local police. Guns must be stored in a locked space or otherwise with vital parts removed and separated. They may be carried only when they are transported from their place of st orage to the place of use (eg: shooting range). Aside from police and military personnel, only security guards with closely defined working conditions, special training and a permit are allowed to carry a loaded gun in public places. Self-defence is not a valid reason to own a gun. The firearms certificate may be cancelled if a person has committed any crimes. Physical and mental problems or reckless behaviour are also valid grounds for cancelling the certificate. A major question is whether gun-control laws reduce crime. It would seem that Finland shows this to be true. Tighter gun control seemingly drastically reduces gun crime. Are restrictive gun laws the reason that Finland has a much lower rate of gun crime than the USA? Or are there other major factors? Israel compared to the USA Although Israel has seemingly very tight laws on firearm ownership, it is a country that is very heavily armed due to compulsory military service and armed security guards in every school and most workplaces; yet they rarely use their guns to shoot each other. Many men and women openly carry firearms while carrying out day-to-day activities in Israel, but non-political mass killings there are unheard of. In Israel guns for personal use are theoretically hard to legally obtain. Assault rifles are banned, registration is necessary, and a whole system of checks and requirements are in place to keep weapons out of the wrong hands. Yet, gaps in the system and non-thorough checks make it easy for nearly anyone to come up with a legal excuse to own a gun (even though not many do). Despite being in a constant cold war, only 58 Israelis were murdered by guns last year, compared with 10,728 Americans. Israel hasn’t even got a high percentage of gun related murders; 11. 7%. Lower than both Finland and the USA. This can’t be down to heavy gun restriction, because Israel is a country where everyone; not only knows how to use a gun effectively due to compulsory, excessive military training, but, every single citizen has almost immediate direct access to a gun. Surely, any Israeli intending to murder someone, would instinctively choose a gun as their weapon? So, why is it that, in one of the only countries in the world that makes it compulsory for every eighteen year old to spend 3 years learning how to shoot to kill, we see some of the lowest levels of gun crime worldwide? In Israel, guns are not toys to be used as displays, or for threatening suspicious people walking down the street. They are necessary security measures against terrorism for the public’s safety. When everyone has a gun, guns are no longer seen as talismans for the weak, frightened, and unstable, seeking a sense of security, but as killing machines that are to be handled with the utmost caution and care, used solely for serious protection. Can the USA reduce gun violence? Israel is a prime example of a society that has a large amount of armed civilians in public places, yet almost no gun crime. This is a direct result of its gun culture. Its attitude towards guns and the knowledge every adult holds; how to handle and use a gun correctly, translates to a very responsible society. A similar model can be seen in Finland. Responsible gun carrying adults, with appropriate knowledge, who understand the uses and dangers or guns, result in low levels of gun crime and a safer society. Similar attitudes towards guns can also be seen in Switzerland (also with compulsory military service. ), Sweden and Norway all of which are in the top 12 countries for gun ownership yet all have far lower rates of gun crime than the USA. Changing gun culture in the US would be a realistic place to start trying to reduce violence, even though it may be costly. This would be a legitimate and possibly more effective alternative to heavily decreasing the number of guns in public ownership. Conclusion To be sure, shooting rampages have occurred in the past years in Germany, Norway, Finland, Canada, Australia and the United Kingdom, but nowhere as costly or numerous as in the USA. This is largely down to America’s gun culture which needs to be changed if America wants to end mass shootings and decrease its gun crime. Following Israel’s example and educating gun owners about their rights and responsibilities, so as to create a culture of sensible and mindful gun ownership. If the US government were to spend money educating gun owners about the uses and dangers of guns (which they already do with gun carrying police officers), they would start to create a more stable society. America’s gun culture is what needs to change, not its ownership rates, if people want to own firearms and the government permits it; it’s the government’s responsibility to make sure the owner is capable of handling a gun safely, so that they don’t infringe on others citizen’s life. This solution would not mean a drastic reduction of citizens owning guns. Rather, it would encourage them to use them safely, with caution and respect. This has the direct intention of reducing accidental injuries and crime alike. Gun ownership isn’t the problem. People aiming guns at each other is. Guns don’t kill people, people kill people. America needs to change to attitudes of its people fast, before more of them die.

Modern society and causes of social change

Modern society and causes of social change If the human balance of nature is essentially a matter of matching persons with activities, anything that disturbs that balance leads to social change- (Bryant Peck, 2007; 449) In a continuously developing world particularly with reference to the current global ideal of what we now call a modernised society, the concept of social change may be identified as the influence perpetuating the pandemic. Social change in this instance is described as the adjustment in the basic structures of a social group or society (Giddens, 2006). According to Giddens (2006) social change is an ever-present phenomenon in social life, but has become especially intense in the modern era due to efforts to restore social balance. Hence, the outcomes of these efforts of social change may be reflected in a positive or negative light. In essence if social change is the perpetuating factor of a developing society, then the trigger of its influence must come from some sort of threatening social event. These events may vary in form. Natural disasters are thus recognised as not only an environmental, yet a societal event as well that poses a threat for social change, arising from the soci al consequences that they bring about. This essay will therefore aim to discuss the impact of social change on the environment and describe the social consequences of natural disasters, with reference to case studies to provide evidence. The onset of social change as mentioned above is triggered by social events. Subsequently those socially threatening events are triggered by the victims themselves. In this case human beings are not only the victims yet also the perpetrators of critical social events which predispose social change. There are many elements and dimensions that need to be considered when addressing the intricate concept of social change. The first is that social change has consistent characteristics (Macionis, 1996). In this sense according to Macionis (1996) the first characteristic is that social change happens everywhere, though differs from place to place. For example the United States would experience faster change due to its advanced technology in comparison to a third world country that does not have these advances. Another characteristic is that social change is sometimes intentional but often unplanned (Macionis, 1996). In this context one would draw attention to technological developments and the levels of advantages and disadvantages. For example in the transportation industry, the invention of the airplane was developed in order to increase trade and speed travel. Though, when it was developed it was probably not realised how this invention would affect societies and families in the future. Accordingly, we now suffer with the devastating consequences of global warming of which the advances in transportation have contributed. In addition social change also generates controversy (Macionis, 1996). In this case the conflict theory is reflected whereby social change emerges due to conflict amongst race, class, religion etc. Karl Marx in particular believed that class conflict sparked change and the conflict theory draws on the works of his communism approach reflected in his perspective of the class system. Lastly, some social changes matter more than others do (Macionis, 1996). For example the invention of computers was more important than the invention of cabbage patch dolls (Macionis, 1996). The causes of social change arise in cultural, conflict, political, economic, environmental and ideational contexts. Yet, combined the causes form the globalisation pandemic. Globalisation may be describe as the process of increasing the connectivity and interdependence of the worlds markets and businesses (DFAIT, 2002). The ever-increasing interdependencies among nations in resource exploitation, production (including out-sourcing) and marketing and the need to remove obstructions to this interdependency are driving forces behind the rush for globalisation (Rahman, 2002). These interdependencies cause a need to develop and, in marketing terms, this need becomes a demand thus as the demand increases so does the production. Consequently as the production increases the advances in the particular products increase to ensure better quality and so the process continues. This has continued to the point where we now have genetically modified foods to feed a growing population and the process of cloning. It is these particular advances that are now the reasons for many of the environmental problems that have occurred recently. Hence, the point made on the notion that social change forms part of a cycle. According to (Rahman, 2002) these global forces have produced rapid social change which is often marked by more inter and intra-regional disparity, environmental and ecological crisis, social disintegration, conflict and violence. Local population growth and natural disasters further aggravate the magnitude of human hardship (Rahman, 2002). This hardship occurs due to the use and limited availability of the resources which is usually used to generate the products that globalization exploits. These hardships arise because humans, like all organisms on Earth, interact with both the biotic (living) and abiotic (non-living) factors in their environment (Richmond, 2002). This interaction has devastating effects on the environment. As Richmond (2002) explains, environmental degradation happens when a potentially renewable resource (one of the biotic or abiotic factors humans need and use such as soil, grassland, forest, wildlife or fuel) is extracted at a rate faster than the resource can be replaced, and thus becomes depleted. According to Richmond (2002) if the rate of use of the resource remains high, the resource can become non-renewable on a human time scale or even become non-existent. Evidence occurring throughout the twentieth century shows that agriculturally productive land has been extensively modified to make it even more productive (Richmond, 2002). This includes the widespread use during the twentieth century of chemical fertilizers (often produced from oil) pesticides, and extensive irrigation (Richmond, 2002). As Richmond (2002) emphasises to supply the needs of extensive irrigation, surface water has been diverted and many wells have been drilled seeking more subsurface water. At the same time that industrial agriculture was growing, agriculturally productive land was being lost to urban development and industry (Richmond, 2002). In the twenty first century, competition for remaining land and water resources is expected to continue to increase (Richmond, 2002). These particular problems are contributory causes of globalisation and can lead to natural hazards. Natural hazards, which is defined as a threat of a dangerous magnitude of a natural process, have the potential to cause a number of primary and secondary phenomena (Chen, 2005). According to Chen (2005) primary phenomena are the natural hazards themselves this includes tropical cyclones, floods, storms, droughts and earthquakes. The secondary phenomena comprises of the vulnerabilities of the elements at risk such as populations, infrastructure, economic, political and social activities, which make them more susceptible to being harmed or damaged by a hazard event (Chen, 2005). The secondary cause results from the dependency of the primary. For example the devastating and seemingly arbitrary nature of disasters such as Hurricane Katrina can reinforce the popular notion that such events are random in their social dimensions. There are many aspects of social dimensions that get affected and these occur abruptly due to the unpremeditated impact of natural disasters. In the case study based on Hurricane Katrina, among New Orleanians who were employed at the time of the storm, only a quarter reported having the same job one month later, compared with over two-thirds of respondents from outside the city (Elliot Pais, 2006). This shows that the natural disaster brought about unemployment which is considered a social issue. Based on the same study by Elliot Pais (2006) it was concluded that when such disasters do occur, individuals understandably become stressed. The results of the Hurricane Katrina Case study also show that for all three indicators of stress (current, short-term, and long-term) proved to be remarkably consistent (Elliot Pais, 2006). They show that race, not class, had a strong influence on post-disaster stress associated with Hurricane Katrina, with blacks generally reporting higher stress levels than whites, all else being equal (Elliot Pais, 2006). Moreover, this racial difference increased further into the future when respondents are asked to look five years ahead (Elliot Pais, 2006). For example, the average black-white differential in stress was greater when respondents are asked to look five years ahead than when they were asked to look only a few months ahead (Elliot Pais, 2006). This provides evidence that natural disasters have social impacts yet is not the driving force behind political change. Instead the politics and ethical issues arise from the mind-sets of the victims themselves arising from the current social systems implemented prior to the disaster. The very same study proved that when these disasters occur, individuals are intensely personally affected and prior research suggests that this stress tends to be higher in technological disasters than in natural disasters (Erikson, 1994; Freudenberg, 1997; Norris et al., 2001). This pattern is pertinent to Hurricane Katrina because many observers now view events within the City of New Orleans as primarily a technological disaster (levee failure) and events outside the city as primarily a natural disaster (wind, rain, and storm-surge destruction) (Elliot Pais, 2006). This proves the correlation between man made global advances and natural disasters. In another study conducted in Ethiopia on the effect of the severe prolonged Ethiopian drought of 1998-2000 presents a second kind of disaster experiment (Carter, Little, Mogues, Negatu, 2007). Direct destruction of assets was modest, but the income losses of repeated crop failures in some locations forced households to choose between preserving assets, or selling them to maintain current consumption and health v(Carter et al, 2007). This particular example suggests that natural disasters puts its victims into a life threatening position of decision yet that decision is forced upon by a global economy. Hence, in order for survival individuals are forced to resort to modern consumptions and become part of the modern economic system. This occurs due to the premise that most land is owned by those who have the most wealth and power. Individuals who are in poverty are therefore unable to build their villages on these lands, though those who have some kind of wealth have an advantage to rebuilding a living. In the case of the recent earthquake in Haiti crisis, political instability and violence seem to have intensified over the last two decades (Daumerie, 2010). While the influence of population on political stability and security is certainly not a simple cause-and-effect relationship, a very youthful age structure can potentially exacerbate the development challenges faced by a nation and, in turn, accentuate political instability (Daumerie, 2010). In Haiti, 15 to 29 year-olds comprise 50 percent of the population, and entering the labour market proves very challenging for them (Daumerie, 2010). As Daumerie (2010) suggests between 45 and 55 percent of youth in their twenties are either unemployed or inactive. Girls perform hard, unpaid work in the household and in some cases engage in paid sexual activity (Daumerie, 2010). As noted by Steve Laguerre of Catholic Relief Services, We have a lot of cross-generational sex between young girls and older men who can provide for them. (Daumerie, 2010;2). According to Daumerie (2010) young boys substitute this by engaging in illegal activities, which in the data are reported as inactivity. Eighty percent of violent crimes in the Caribbean are committed by men, the majority of whom are under age 35 (Daumerie, 2010). The case of Haiti reveals political, economical and social issues that have arisen from the natural disaster. The victims in poverty are forced to resort to desperate measures and the youth is devastatingly affected by this. According to Daumerie (2010) in the capital Port-au Prince, dozens of gangs wander the slums and kill, steal or beat with freedom, while controlling different parts of the city. For a population of less than ten million (half of them children), surveys report 209,000 small arms and light weapons distributed among a horde of armed groups, including criminal and youth gangs, resistance fronts, death squads, prison escapees, political groups, self-defence militias, private security companies and children (Daumerie, 2010). With a succession of military officials rising to power in recent years, international aid was largely suspended and the Haitian army was left with little capital to reimburse its soldiers, who began to use their weapons against citizens for their own gains (Daumerie, 2010). Later, the drug trafficking trade also contributed to the proliferation of violence as Haiti was used by the Colombian cartel as a trans-shipment point for cocaine (Daumerie, 2010). Armed criminal group violence has intensified radically since the last military overthrow in 1994 and have become more brutal since 2000 (Daumerie, 2010). One can elicit that the use of weaponry and violence poses disastrous effects on the physical environment. According to Enzler (2006) the use of weapons, the destruction of structures and oil fields, fires, military transport movements and chemical spraying are all examples of the destroying impact war may have on the environment. Air, water and soil are polluted, man and animal are killed, and numerous health affects occur among those still living (Enzler, 2009). The use of warfare thus contributes to the damaging effects of global warming experienced all over the world today. Hence the notion that the victims impose harm on the environment. In conclusion humans are continuously faced with social change due to the fact that they are continuously changing their way of life. By continuously changing the way of life by modernized means we are changing the life of the living environment itself. The globalisation pandemic is evidence of this. As we continuously develop these advances in production and ways of living we are destroying the balance of nature. When this balance is disrupted natural disasters occur and hence social change emerges. This brings about a cycle where human action and nature are dependent upon one another. Social change in its current state needs to be directed in a positive light where balance is restored. Perhaps this balance will only be renowned when human action is directed toward positive outcomes.

Effect of Spontaneous Breathing Trial (SBT) Duration

Effect of Spontaneous Breathing Trial (SBT) Duration Effect of Spontaneous Breathing Trial (SBT) Duration on the Clinical Outcomes of Mechanically Ventilated Patients Admittted at Medical Intensive Care Units of a Tertiary Government Hospital In Davao City INTRODUCTION Background of the Study: Mechanical ventilation (MV) is primarily used to support patients whose respiratory function is compromised due to a variety of reasons. However, several studies have shown that prolonged MV among intensive care patients is associated with adverse clinical outcomes. Thus, MV should be discontinued promptly as soon as patients are capable of breathing spontaneously. Furthermore, patients who are dependent on MV stay longer in the intensive care unit, requiring dedicated care and frequent monitoring. The inadequate number of intensive care unit beds necessitates maximizing the use of limited resources in delivering essential care to critically ill patients. Discontinuing mechanical ventilation in a well-timed and safe manner should lead to desirable outcomes for both patients and clinicians. Hence, strategies that assist in early withdrawal of patients from mechanical ventilation should be investigated. The process of liberating from mechanical support is known as weaning. In most studies, it was noted that nearly half of the total duration of mechanical ventilation is spent in the weaning process. Each day, a set of weaning predictors is tested and patients who meet the criteria proceeded to a spontaneous breathing trial (SBT). Several researches set the SBT at 120 minutes. The American Thoracic Society guidelines recommend SBT for 30 minutes to no longer than 120 minutes. In our institution, current practice involves an overnight duration of SBT. The optimal duration of SBT, however, is not known. The long duration of SBT requires close monitoring of a critically ill patient, which is challenging for the limited number of intensive care unit staff. Hence, this study will investigate the hypothesis that short (30 minutes), intermediate (120 minutes) and long (overnight) duration of SBT have similar clinical outcomes. Review of Related Literature: Mechanical ventilatory support is used when spontaneous ventilation is insufficient for the sustenance of life. The word supportis emphasized in this context since mechanical ventilation is not a cure for the underlying disease, but it is at best a type of support, offering rest to the patient while the disease processes are treated. A study by Esteban et al showed that half of the intensive care units in North America had at least 40% of adult patients receiving mechanical ventilation. This data is similar to that of a prospective study involving 20 countries in 2004, where it was reported that 33% of patients required mechanical ventilation. Invasive mechanical ventilation is a risky, uncomfortable, and costly procedure that should only be utilized when indicated. Major indications for mechanical ventilation are: (1) partial pressure of oxygen in arterial blood (PaO2) cannot be maintained above 50 mm Hg despite high levels of delivered oxygen; (2) partial pressure of carbon dioxide in arterial blood rises above 50 mm Hg; (3) ventilation becomes inefficient and/or exhausted; (4) airway protection. According to Esteban et al (2002), the most common causes for mechanical ventilation were acute respiratory failure in the postoperative period (20.8%), pneumonia (13.9%), congestive heart failure (10.4%), sepsis (8.8%), trauma (7.9%), and acute respiratory distress syndrome (4.5%). The goal of mechanical ventilation is to improve ventilation, oxygenation, and lung mechanics. However, as is the case with other medical therapies, the benefit of mechanical ventilation comes at a price. An Indian study revealed that 55 of the 100 mechanically ventilated patients admitted at a university hospital developed complications as follows: nosocomial pneumonia (29%), gastrointestinal hemorrhage (11%), airway complications, (10%), cardiovascular complications (8%), equipment failure (7%), and barotrauma (2%). The most common complication is ventilator-associated pneumonia (VAP) which occurs 48 to 72 hours or thereafter following endotracheal intubation. The incidence of VAP ranges from 9 to 27%, with mortality rate of between 33 to 50 %. A local private tertiary institution reports a lower incidence of VAP at 7.6%.In this institution, a total of 621 adult patients were intubated from September to December 2014. Of these patients, 13.3% developed ventilator-associated pneumon ia. Numerous studies report that weaning from mechanical ventilation after the underlying reason of respiratory failure has been resolved, account for more than half the total duration of mechanical ventilation. In some trials, however, weaning comprise only 40% of the whole duration of mechanical ventilation. Nevertheless, the duration of weaning is an important component that needs close attention. In a study by Coplin et al higher mortality, more cases of pneumonia and longer hospital admission was reported in patients who underwent more than 48 hours delay of liberation from mechanical ventilation. Hence, physicians should be encouraged to minimize the duration of weaning. Researchers have long recognized the complications of mechanical ventilation. They have proposed multiple techniques to facilitate the transition to spontaneous ventilation. Successful weaning from MV at any time was reported to be associated with a higher survival rate. Generally, weaning has two components. The first component is a list of â€Å"readiness to wean† criteria based on clinical factors that help decide if a patient is ready to breathe spontaneously. Ely and colleagues developed a scoring system wherein all five criteria should be met to pass the screening test. The criteria are as follows: the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2) had to exceed 200; the PEEP should not exceed 5 cm H20; there had to be an adequate cough during suctioning; the ratio of the respiratory frequency to the tidal volume should be less than 105 breaths per minute per liter; and no infusions of vasopressor agents or sedatives. The second component is the spontaneous breathing trial (SBT), a period of unassisted breathing during which the patient is observed for signs of respiratory failure. Several studies have investigated the methodology for weaning. The commonly used techniques are T-piece, synchronized intermittent mandatory ventilation (SIMV), or Pressure Support Ventilation (PSV). The traditional mode of weaning is the T-piece weaning, which involves attaching the endotracheal tube to a T-piece such that one of the two remaining limbs of the T is connected to a humidifier, which supplies humidified oxygen while the third limb is left open to allow for exhalation. The primary disadvantage of this method of weaning is that apnea, low VE and airway pressure alarms are disabled, and close visual monitoring is required. However, this type of weaning provides an estimation of post-extubation breathing, resulting in rapid recognition of patients who are able to tolerate weaning. One of the potential areas of study is improving processes that shorten the spontaneous breathing trial. Three previous studies conducted in years 1999, 2002 and 2003 demonstrate the equivalence of 30 minutes and 120 minutes SBT using both T-piece and PSV protocols. Based on these trials, Macintyre (2012) recommended that an SBT should be at least 30 min but no longer than 120 min to allow proper assessment of ventilator discontinuation Similarly, White reported that the length of an SBT should be approximately 30 minutes to 120 minutes. However, an overnight duration of SBT has been in practice in this institution for many years due to limited data on the success rate of extubation using a shorter SBT duration. After the patient is able to sustain spontaneous breathing, the next step is to ascertain whether the patient can tolerate extubation. This is an important decision, as both delayed and failed extubation are associated with prolonged ventilation and mortality. Several factors may predict extubation failure after a successful SBT. The decision to extubate patients is largely based on the ability to clear secretions and protect the airway. A weak cough and moderate volume of secretions are also associated with extubation failure. Some studies suggest that a Glasgow coma score of ≠¤ 8-10 is correlated with extubation failure since increased risk of aspiration occurs in patients with reduced level of consciousness. Other characteristics recognized as risk factors for extubation failure are: older age, severity of illness on ICU admission, prolonged duration of ventilation prior to extubation, and continuous sedation

Miscellaneous Critics on Waiting for Godot :: Waiting Godot Essays

Nothingness â€Å"Accordingly, any interpretation that purports to know who Godot is (or is not), whether he exists whether he will ever come, whether he has ever come, or even whether he may have come without being recognized (or possibly in disguise) is, if not demonstrably wrong, at least not demonstrably right† (Hutchings 27). â€Å"Although works of the theater of the absurd, particularly Beckett’s, are often comical, their underlying premises are wholly serious: the epistemological principle of uncertainty and the inability in the modern age to find a coherent system of meaning, order, or purpose by which to understand our existence and by which to live† (Hutchings 28). Godot’s characters do not despair in the face of their situation, and this â€Å"perseverance remains constant throughout a body of work that, in the words of the citation awarding Beckett the Nobel Prize for Literature in 1969 had ‘transmuted the destitution of modern man into his exaltation’ (qtd. in Bair 606)† (Hutchings 30). â€Å"Many relate the play to existentialism†¦:God is dead, life is absurd, existence precedes essence, ennui is endemic to the human condition†¦In many ways, such a reading is an evasion of the play’s complexity, a way of putting to rest the uncertainty of one’s response to it† (Collins 33). The reader, like modern man, must not give into â€Å"the arrogant presumption of certitude or the debilitating despair of skepticism,† but instead must â€Å"live in uncertainty, poised, by the conditions of our humanity and of the world in which we live, between certitude and skepticism, between presumption and despair â€Å"(Collins 36). Tragicomedy is life enhancing because it tries to â€Å"remind the audience of the real need to face existence ‘knowing the worst,’ which ultimately is liberation, with courage and humility of not taking oneself or one’s own pain too seriously, and to bear all life’s mysteries and uncertainties; and thus to make the most of what we have rather than to hanker after illusory certainties and rewards† (Esslin, Theater 47). â€Å"Act II. The next day. But is it really the next day? Or after? Or before?† (Esslin, Presence 109). Many details point out the absence of (meaninglessness of) traditional time, which is just one of many ways that the play resists interpretation and meaning: â€Å"People misunderstand it on all sides, just as everyone does his own sorrow. Explanations flow in from all quarters, each more pointless than the last† (Esslin, Presence 110). Some of the many attempts to impose meaning on the play include

Assassination of John Fitzgerald Kemmedy :: John Fitzgerald Kennedy

Assassination of JFK On Friday, November 22nd 1963 at 12:30 P.M. the 35th president of the United States of America, John Fitzgerald Kennedy assassinated while he rode in an open limousine though the streets of Dallas. This event, which abruptly and severely altered the course of history, has created more controversy than any other single event. Some haunting questions still remain. "Who did it?" "Why did they do it?" "How was it done?" "Was there a cover up" The official answers complied by the Warren Commission have never satisfied the majority of the world's population. In this following essay I will try to show who was responsible for the assassination of John F. Kennedy. I believe the only way to prove that there was a cover up, is to firstly prove that Lee Harvey Oswald is not the killer. The Warren Commission consisting of "various outstanding citizens" was created to "ascertain, evaluate and report upon the facts relating to the assassination ... and the subsequent violent death of the man charged with the assassination Lee Harvey Oswald. The purpose of the Commission was to examine the evidence developed by the Federal Bureau of Investigation and any additional evidence that may hereafter come to light ... to make such further investigation, as the Commission finds desirable. In less than one week they found that a 'lone nut' killed JKF. At no time did the Warren Commission seem to consider the basic legal rights of Oswald - innocence until proven guilty, the right to legal representation, or the right to cross-examine witnesses and evidence against him. There is no way that Lee Harvey Oswald was the lone assassin. Firstly the paraffin test of Oswald's hands and his right cheek conducted on November 23, 1963, has been positive for his hands but negative for his cheek. Generally, this is evidence in Oswald's favor, but the Commission asserted that the test "is completely unreliable in determining either whether a person has recently fired a weapon or whether he has not." Nobody saw Oswald on the 6th floor window after 11:55 on November 22nd. 90 seconds after the assassination, Roy Truly and Police officer M. L. Baker saw Oswald on the second floor. Oswald had to take the stairs down. But he had just 90 seconds to hide the rifle in the opposite corner of the sixth floor, run downstairs 4 floors passing Victoria Adams who never saw him and reach the second floor where he was encountered to be "calm and collected". The Warren Commission claimed that Oswald fired three shots Assassination of John Fitzgerald Kemmedy :: John Fitzgerald Kennedy Assassination of JFK On Friday, November 22nd 1963 at 12:30 P.M. the 35th president of the United States of America, John Fitzgerald Kennedy assassinated while he rode in an open limousine though the streets of Dallas. This event, which abruptly and severely altered the course of history, has created more controversy than any other single event. Some haunting questions still remain. "Who did it?" "Why did they do it?" "How was it done?" "Was there a cover up" The official answers complied by the Warren Commission have never satisfied the majority of the world's population. In this following essay I will try to show who was responsible for the assassination of John F. Kennedy. I believe the only way to prove that there was a cover up, is to firstly prove that Lee Harvey Oswald is not the killer. The Warren Commission consisting of "various outstanding citizens" was created to "ascertain, evaluate and report upon the facts relating to the assassination ... and the subsequent violent death of the man charged with the assassination Lee Harvey Oswald. The purpose of the Commission was to examine the evidence developed by the Federal Bureau of Investigation and any additional evidence that may hereafter come to light ... to make such further investigation, as the Commission finds desirable. In less than one week they found that a 'lone nut' killed JKF. At no time did the Warren Commission seem to consider the basic legal rights of Oswald - innocence until proven guilty, the right to legal representation, or the right to cross-examine witnesses and evidence against him. There is no way that Lee Harvey Oswald was the lone assassin. Firstly the paraffin test of Oswald's hands and his right cheek conducted on November 23, 1963, has been positive for his hands but negative for his cheek. Generally, this is evidence in Oswald's favor, but the Commission asserted that the test "is completely unreliable in determining either whether a person has recently fired a weapon or whether he has not." Nobody saw Oswald on the 6th floor window after 11:55 on November 22nd. 90 seconds after the assassination, Roy Truly and Police officer M. L. Baker saw Oswald on the second floor. Oswald had to take the stairs down. But he had just 90 seconds to hide the rifle in the opposite corner of the sixth floor, run downstairs 4 floors passing Victoria Adams who never saw him and reach the second floor where he was encountered to be "calm and collected". The Warren Commission claimed that Oswald fired three shots