How Nothings Changed and Two Scavengers deal with social injustices Essay Example for Free

How Nothings Changed and dickens Scavengers deal with fond in unspoiledices EssayBoth Nothings Changed and Two Scavengers deal with social injustices, however, there are few sorry differences between them.Nothings Changed is set in Cape Town, Africa and focuses on the requisition of black and white concourse, after an a crashheid was made. It is an autobiographical poem by Tatumkhulu Afrika.The poem is about how territorial dominion Six used to be a place for blacks and whites to live together. But when that changed, Tatumkhulu left in anger (and prison). Now he has returned to his old home after many geezerhood and has discovered that the segregation has gotten wider and worse. The social injustice in the poem is the black and white segregation. On the other hand, Two Scavengers deals with the social segregation between the classes in America. At a set of traffic lights, early in the morning (9am), a food waste truck has stopped next to a couple in a Mercedes. The gar bage manpower hence ponder on the class system and how they are less respected by hatful like this couple.They wonder if theyd ever be seen as equals as they wonder if the democracy of America really works. The social injustice in the poem is the panache the different classes are each treated differently. The first stanza of Nothings Changed is setting the scene as the generator walks towards his old home. We can tell that the area is now a wasteland by what the writer treads over (like the cans and weeds) on his walk back home. We can tell hes angry from how his old home has turned out from when he says, The hot, white, inwards turning anger of my eyes, as he get laids he has returned home.Although all of the stanzas use commas a lot, the morsel stanza uses and after each comma. I obtain that the commas are used to in order to add more expression as you read, and as you pause at each comma, you wonder whats coming next, thus creating distrust even though, in my opinion, th e poem is not that exciting or interesting enough for it to have any use. On the other hand, the ands that are used passim the second stanza, instead picks up the pace as we experience what he is deprivation through at the alike time that he is going through his feeling, since the poem is wrote in first person, as if he is actually reliving these memories, make us feel more emotional and connected to the writer.In the stern stanza, there is only one line, but one that I feel is a very important line for comparing the poems.No sign says it is but we know where we belong.This line shows us that although no one is saying that whites are treated better (new restaurant) than blacks (working mans caf), this line shows us that the blacks know that the segregation is still there.The writer says of how his, manpower burn for a stone, a bomb, to shiver down the glass of the whites only restaurant. We know that this is the same reason why the writer was sent. to prison all those years a go, but we are unsure whether this is that memory he is reliving or if he is speaking of the present day.The next and final sentence of the poem has the writer com manpowerting that, Nothings Changed. This, Id like to believe, tells us that, either way, the writer is willing to risk prison (or worse?) in order to vent his anger at the segregation.The first stanza of Two Scavengers sets the scene by introducing us to the personas and telling us what they are doing.The garbage truck is described as bright yellow while the garbage men are described wearing red plastic blazers, both of which would stand out anywhere in San Francisco at nine in the morning. I feel that this tells us that no matter how hard the government major power try to hide the garbage men, they are going to get noticed at some point.The writer says of the garbage men, one on each side hanging on, in reference to where they are on the garbage truck (back stoop).This makes me think that the writer is trying to make out that the men are struggling to hold on to this job, even though it is such a looked down upon job.The writer then says that the 2 garbage men are looking down into an elegant open Mercedes with an elegant couple in it. In that section, the writer has took the literal message of looking down but we also think of the figurative meaning and then are meant to wonder if the garbage men are in concomitant better people than the couple and so their position should be swapped.From the fact we know that the couple are heading to his architects moodyice while the garbage men are on their journey home, shows us that the couple and garbage men are like night and day, both there, but never at the same time. This emphasizes the segregation between the different classes.In the second stanza, the writer describes the older of the two garbage men as some gargoyle Quasimodo, Quasimodo be the title character of The Hunchback of Notre Dame, the main theme of the book being the cruelty of socia l injustice.Quasimodo led a tragic life, being kind and loving despite his ugliness. However, he dies of a broken heart. Quasimodo means almost end or half made.From this, I believe that the writer is backing up my point about the garbage men perhaps being better people than the couple and that what we are seeing of the garbage men is only the tip (no pun intended) of the iceberg.In the second stanza, the writer describes the older of the two garbage men as some gargoyle Quasimodo, Quasimodo being the title character of The Hunchback of Notre Dame, the main theme of the book being the cruelty of social injustice.Quasimodo led a tragic life, being kind and loving despite his ugliness. However, he dies of a broken heart. Quasimodo means almost finished or half made.From this, I believe that the writer is backing up my point about the garbage men perhaps being better people than the couple and that what we are seeing of the garbage men is only the tip (no pun intended) of the iceberg. The last stanza is made almost entirely of a metaphor, one part of which grabs my attention because it is an oxymoron, the part being small gulf.The metaphor describes how even though there is not much of a gap between the two vehicles, making it easy for one person to climb into the other vehicle, theyll never be able to do so because of the class system and how, because of it, they are always going to be looked down upon.Of course, the two poems are similar in the way that they both deal with social injustices (Class system and Segregation), but, in the same way, different because the two place settings (San Francisco and Cape Town) are so far apart.In Nothings Changed, as previously mentioned, the writer uses a lot of commas to slow down the pace in order, I believe, to add suspense.On the other hand, the writer of Two Scavengers doesnt use any punctuation, instead stopping the line whenever he wants the reader to stop and let what theyve just read sink in.Because of the punctuat ion, the structure of Nothings Changed looks less pre-prepared and more straight from the heart, as the plot would suggest.However, Two Scavengers is neater in its construction, despite the lack of punctuation, thus giving off the opposite feel to Nothings Changed.After studying both poems, although I feel that I wouldnt need to, its obvious to me that Nothings Changed shows far more anger, raw as it might be, than Two Scavengers.The reasons for this being that in Nothings Changed, there is a constant reminder of how angry the writer is as he walks around his old home, in the end, of course, neediness he had a bomb to blow up a whites only restaurant.But, in Two Scavengers, the two garbage men look at the social injustice in hope rather than anger, as seen by when they wonder if theyd ever be able to reach in to the Mercedes and start a practice conversation with the couple, like old friends.

A Deeper Perspective on Executive Power Essay Example for Free

A Deeper Perspective on Executive strength EssayExecutive Power is often and briefly defined as the power to enforce and administer the laws. It is usually bestowed upon the President or Head of a country. In the exercise of this power, the person who has such power assumes a wad of authority and the corresponding big and deep responsibility, thus making him the most influential person in the land he governs. The exercise of an Executive Power through the Presidents own will is sometimes referred as the discretionary power which is undoubtedly constitutional. But the exercise of such will moreover no power is considered unconstitutional. Will but no power pertains to actions or instances that the executive department may exercise on their discretion but is in violation of a certain provision in the constitution.See more The stages of consumer buying decision process essay In the case of Clinton v city of New York, the acts of Clinton canceling 4722(c) of the Balanced Budget A ct and 968 of the Taxpayer Relief Act by virtue of an Act, was held unconstitutional and in violation of Article I, 7. Clinton acted beyond his discretionary powers. He acted with his own will in canceling the above-mentioned provisions but he has no power to do such.To wit the court, that the Act that procures the discretionary powers of Clinton to cancel the repugn provisions mentioned, impermissibly disrupts the balance of powers among the three branches of the government which are clearly categorized and distinguished under separation of powers. Moreover, the Acts procedures are non authorized by the Constitution. If this Act were to be considered as valid, it would authorize the President to create a law whose text was not voted on by each House or presented to the President for signature which would clearly be a violation of the process in passing a new law provided for in the constitution. (Clinton v City of New York, 1998)ReferencesClinton, President of the United States, , et al. v City of New York et al. June 25, 1998. Supreme Court Collection. Cornell University LawSchool. Retrieved from supct.law.cornell.edu.

COPD Case Study Assignment

COPD Case Study Assignment1) CASE SUMMARYMr TLT is a 58 year darkened taxi driver who was admitted to Hospital Batu Pahat due to newly diagnosed degenerative obstructive pulmonary put onion.He has had hypertension for the ago one year and is taking T Amlodipine 5mg od. He is also a chronic smoker for the rareen 40 years who smokes about 20 sticks of cigarettes a day.Mr TLT takeed with shortness of breathing place which progressively change magnitude in severity for the past 4 days. The shortness of breath was associated with a suspire. in that location was also cough with take of mucoid flatness. The dyspnoea occurred after an successiveness of upper respiratory share infection.Mr TLT has been having intermittent chronic cough associtaed with mucoid sputum for the past 3 years. He has also been having persistent pulselessness for the past 1 year especi whollyy on crusade. He has not sought interposition prior to this admission.On physical examination, Mr TLT was tacypnoiec with a respiratory ramble of 28 breaths per minute. at that place was no cyanosis. Repiratory system examination showed white plague of accesory go acrosss as tumesce as increased anterior posterior diameter of the chest and reduced cricosternal distance. On auscultation, vesicular alive was perceive with generalised rhonchi and coarse early inspiratory crepitations at the lower zone of both lungs. The cardiovascular system examination was normal. on that point were no opposite abnormalities on physical examination.Investigations make include chest plain radiograph which showed a hyperinflated chest, tubular heart and absence of vascular markings at the peripheries. The ECG showed sinus rhythm with low voltage. No P pulmonale indicative of right atiral hypertrophy seen.A working diagnosis of acute exacerbation of chronic obstructive airway disease due to upper respiratory tract infection was made.Mr TLT was given over nebulization of ipratropium platitude, sa lbutamol and normal saline for 2 times. His symptoms improved after cosmos given the nebulization. He was discharged after three days when the dyspnoea had resolved. He was given metered dose inhaler of Ipratropium Bromide 40microgrammes tds and MDI salbutamol 200microgrammes PRN. He was given an designation to assess his symptoms at the outpatient discussion section in one month time. student forebode Tan Hai Liang ID NO M0409146NAME OF SUPERVISOR Prof Khin gyration familiar medicatePATIENTS DETAILSI/C digit 510912-01-6343 AGE 58SEX Male DATE OF ADMISSION 2 June 2009R/N NUMBER 11434512) CLINICAL HISTORYChief complaintMr TLT is a 58 year old taxi driver who familiarizeed with shortness of breath for the past four days. bill of present illnessMr TLT is a chronic smoker for the past 40 years who has been have about twenty sticks of cigarettes a day. He had been diagnosed with hypertension for the past one year and is currently on T Amlodipine 5 mg od.Mr TLT has been h aving intermittent chronic cough for the past 3 years. The cough is productive at times. The sputum produced is mucoid in character and about one tablespoonful in amount. There is no birth in the sputum. It is also not foul-smelling. Mr TLT accordingly proceeded to have shortness of breath for the past one year. The dyspnoea is persistently present and described as requiring increased effort to breathe. It is worse on exertion and Mr TLT experinces reduced effort tolerance. He is now able to climb one and a half flights of stairs before becoming breathless. He has not consulted whatever doctors for these symptoms prior to admission.Mr TLT then substantial symptoms of upper respiratory tract infection such as rhinorrhea and sore throat one week prior to admission. He had fever of 38 degress celcius at that time which resolved with paracetamol. He also had a productive cough with mucoid sputum at this time. Mr TLT then developed increase shortness of breath 4 days prior to admissi on. The shortness of breath worsened over the 4 days and was associated with noisy breathing. He was breathless even at rest but was still able to speak in sentences. There was also an increase in cough as well as occupation of sputum. The sputum was mucoid and non purulent. He also did not notice both blueness around his lips or at his fingers.Systemic redirect examination There was no loss of appetite or loss of weight. He had mild ankle oedema but no other signs of heart harm such as orthopnoea or paroxysmal nocturnal dyspnoea.Past medical historyMr TLT has not had any hospital admissions prior to this. He was diagnosed with hypertension brave year as an incidental finding during a visit to the kilinik kesihatan for an upper respiratory tract infection. He is currently taking tablet Amlodipine 5 mg once workaday.Family historyMr TLT is the eldest of 5 siblings. There is a strong family history of hypertension in that his mother as well as 2 other siblings are also hyperten sive. There is no family history of asthma, diabetes or ischaemic heart disease.Social historyMr TLT exampled to work as a taxi driver but has stopped working full time 2 years ago. He still occasionally drives his taxi but spends more than time at home with his family. He is a chronic smoker for the past 40 years and smokes about 20 sticks of cigarrettes a day. He drinks alcohol with his friends on weekends. He drinks one to two bottles of beer each time. scholarly person NAME Tan Hai Liang ID NO M0409146NAME OF SUPERVISOR Prof Khin ROTATION intrinsic Medicine____________________________________________________________________________3) FINDINGS ON CLINICAL EXAMINATIONOn general examination, Mr TLT was well nourished and alert but was tachypnoiec. He was able to speak in sentences but in that location was use of his accessory muscularitys. There was no clubbing or cyanosis seen. There was also no peripheral oedema, pallor or jaundice.Vital signsPulse rate 72 beats per minute , regular with good volume. No bounding pulse.Respiratory rate 28 breaths per minute neckcloth pressure 129/73Temperature 37 degrees CelsiusSpO2 95% at a lower place nasal prong oxygen 3 litres per minuteExamination of the respiratory systemOn control of the hands, there was no peripheral cyanosis or flapping tremors seen. There was also no clubbing, muscle wasting or palmar erythema seen. There was presence of nicotine stains. The jugular venous pressure is mildly elevated at 3.5 cm above the sternal angle. On palpation of the trachea, the trachea is central but the cricosternal distance is 2 fingers which is reduced. The apex beat could not be palpated.On inspection of the chest, there is an increased anterior posterior diameter giving rise to a barrel shaped chest. The chest moves equally with respiration and there is use of accessory mucles with intercostal, subcostal and suprasternal retraction. There are no chest wall deformities. On palpation, chest expansion is reduced on both sides. Tactile fremitus is equal on both sides. On percussion, there is hyperresonance over both lungs with loss of liver and cardiac dullness. On auscultation vesicular breathing is heard. There is generalised expiratory rhonchi. There is also fine early inspiratory crepitations heard at the lower zones of both lungs.Examination of the cardiovascular systemThe apex beat could not be palpated. There were no parasternal heaves or thrills palpable. On auscultation, normal first and second heart sounds were heard. There was mild bilateral pitting oedema.Examination of the abdomenOn inspection, the abdomen is flat and moves with respiration. There was no guarding or tenderness. The liver and spleen were not palpable. There was no organomegaly.Examination of the neurological system was normal.STUDENT NAME Tan Hai Liang ID NO M0409146NAME OF SUPERVISOR Prof Khin ROTATION Internal Medicine4) PROVISIONAL AND DIFFERENTIAL DIAGNOSES WITH REASONINGProvisional diagnosis needlelike exacerb ation of newly diagnosed chronic obstructive airway disease due to upper respiratory tract infection.Evidence forPatients with chronic obstructive airway disease (COPD) usually present with a persistent dyspnoea and reduced effort tolerance which was present in the history given by Mr TLT. He is also at increased risk of developing COPD due to exposure to associated risk factors such as tobacco smoke. He has been a chronic smoker for the past 40 years. There is also the presence of chronic cough occasionally associated with mucoid sputum which set ahead suggests COPD. Physical findings of a hyperinflated chest and vesicular breathing with generalised expiratory rhonchi also point to an obstructive airway disease.During this admission Mr TLT had increasing severity of shortness of breath even at rest. This was associated with a wheeze that was described as noisy breathing. Sudden worsening of symptoms suggest an episode of acute exacerbation. The history of upper respiratory tract i nfection symptoms suggest that it was the knowledgeableness for this episode of exacerbation.Differential diagnosis1) Congestive cardiac blow.Mr TLT may have developed congestive cardiac failure as a primary item or as a complication of chronic lung disease. There is history of reduced effort tolerance. Patients with congestive cardiac failure may also present with a wheeze and sudden increase in dyspnoea. Physical examination of fine crepitations at both bases of the lungs may also indicate congestive cardiac failure. There is also evidence of mildly raised JVP as well as mild pittint ankle oedema.Evidence againstThere is no history of any cause of heart failure such as ischaemic heart disease or cardiac valve defect. Mr TLTs previous records during follow-up show well controlled blood pressure.Additional investigations need to be carried out in couch to rule out this condition. A chest plain radiograph may be through in order to look for evidence of heart failure such as cardi omegaly. An ECG may be done to look for right atrial hypertrophy. An echocardiogram should also be completeed in order to assess the function of the ventricles.2) BronchiectasisPatients with bronchiectasis have a history of chronic cough as well as production of copious amounts of sputum. They may also have persistent shortness of breath, reduced effort tolerance and wheeze.Evidence againstThe sputum produced by Mr TLT is mucoid in nature and not purulent which is typical in bronchiectasis. It is also not copious and foul smelling in nature. On physical examination, coarse crepitations would be heard in bronchiectasis as opposed to the fine crepitations heard in Mr TLT. There is also no evidence of clubbing.Chest plain radiograph should be done in order to look for thickened bronchial walls or cystic shadows.STUDENT NAME Tan Hai Liang ID NO M0409146NAME OF SUPERVISOR Prof Khin ROTATION Internal Medicine5) IDENTIFY AND PRIORITISE THE PROBLEMS1. Shortness of breath and reduced effort toleranceMr TLTs chief complaint is shortness of breath. This may be attributed to the increase in number of goblet cells and later on fibrosis of the bronchial walls causing airway obstruction seen in chronic obstructive airway disease. The shortness of breath may be partially relieved with the use of nebulization of ipratropium bromide, salbutamol and normal saline or with the use of metered dose inhalers. Chest physiotherapy may also be useful.Mr TLT also has had reduced effort tolerance and persistent dyspnoea for the past a year. As such he may require the use of ipratropium bromide in a metered dose inhaler upon discharge in order to feel less breathless due to the bronchodilator effect of the ipratropium bromide.2. Upper respiratory tract infectionMr TLT may require antibiotics as he still has symptoms of upper respiratory tract infection such as sore throat. Furthermore patients who present with an acute exacerbation are at greater risk of having a bacterial infection. This is because of the depressed immune state that the patient is in as a result of the acute illness as well as due to any steroids that would be given as part of the guidance plan. The suppressness of economic consumption of antibiotics in chronic obstructive airway disease leave alone be further discussed below.3. Adequate inhaler techniqueMr TLT would need to be taught about the ameliorate technique to be use when using metered dose inhalers. He would probably require daily use of ipratropium bromide metered dose inhalers to reduce his breathlessness. In the casing that he is unable to learn proper technique, he may be encouraged to buy an aerochamber.4. Smoking expirationMr TLT should be counseled on bullet bound as it has been proven that smoking cessation would alter the agate line of progression in COPD and is associated with lower all-cause fatality rate. He should be counseled on the various options of smoking cessation which will be discussed further below.STUDENT NAME Tan Hai Liang ID NO M0409146NAME OF SUPERVISOR Prof Khin ROTATION Internal Medicine6) PLAN OF INVESTIGATION, JUSTIFICATIONS FOR THE pickax OF TESTS OR PROCEDURES, AND INTERPRETATION OF RESULTS1) Full Blood CountJustification In order to view the total white guess as well as the differential count to see if there is an infection which has caused this episode of exacerbation. There may also be secondary polycythemia if the patient has chronic pulmonary hypertension.Results etiolate cell count 7.91 X 109/LRed blood cell 4.48 X 1012/LHaemoglobin 133.00 g/dlHaematocrit 42.00 ratio crocked cell volume 93.80 fLMean cell haemoglobin 29.70 pgMean cell haemoglobin conc. 317.00 g/lPlatelets 141.00 X 109/LDifferential countNeutrophils 60.10% 4.76 X 109/LLymphocytes 25.30% 2.00 X 109/LMonocytes 13.80% 1.09 X 109/LEosinophils 0.50% 0.04 X 109/LBasophils 0.30% 0.02 X 109/LInterpretation This is a normal full blood count result with normal total white count as well as normal hae moglobin levels.2) Plain chest radiographJustification do in order to look for evidence of chronic obstructive airway disease such as hyperinflated chest or evidence of congestive cardiac failure such as cardiomegaly and prominent upper lobe vessels.Results Hyperinflation of the chest with the 7th anterior rib crossing the diaphragm. No other abnormalities seen.Interpretation Hyperinflation of the lung field is consistent with the provisional diagnosis of chronic obstructive airway disease.3) Sputum FEME, culture and sensitivity (not done)Justification In order to look for any bacteria which may have been the cause of the exacerbation . If there any organism cultured, proper antibiotics can be given based on the sensitivity test.4) arterial blood gas (not done)Justification May be necessary in atrocious cases of breathlessness to look for respiratory failure and associated changes in blood pH.5) Blood urea serum electrolytes and creatinineJustification To look for renal impairment which may be present due to Mr TLT having hypertension. Renal impairment may also affect the dosage and type of antibiotics used.ResultsUrea 3.7mmol/LSodium 135 mmol/LPotassium 3.7 mmol/LCreatinine 65 umol/LInterpretation Normal result. There is no renal impairment6) ElectrocardiogramJustification To look for evidence of right ventricular hypertrophy or right atrial hypertrophy which may be seen in chronic lung disease.Results ECG with sinus rhythm. There is no P pulmonale seen. There is low voltage seen. No ischaemic changes seen. No left ventricular hypertrophy.Interpretation Normal ECG with low voltage is seen in a hyperinflated chest such as in patients with COPDSTUDENT NAME Tan Hai Liang ID NO M0409146NAME OF SUPERVISOR Prof Khin ROTATION Internal Medicine7) WORKING diagnosis AND PLAN OF MANAGEMENT ON ADMISSIONWorking diagnosis incisive exacerbation of chronic obstructive airway disease due to upper respiratory tract infectionMy proposed plan of guidance is as followsAcu te management1. Provide supplemental oxygen via nasal prong 3L/min and maintain SpO2 above 90%. Arterial blood gas should be done in order to ensure adequate oxygenation without carbon dioxide retention of acidosis.2. Close monitoring of critical signs and SpO2 hourly until the patients breathlessness improves. Nursing staff to inform if patient deteriorates such as increased respiratory rate or drop in oxygen saturation below 92%.3. Give nebulization of Ipratropium BromideSalbutamolNormal Saline in ratio of 221 every four hours until breathlessness decreases.4. Oral prednisolone 40mg once daily for 10 days5. Postural drainage and chest physiotherapy may be performed.6. Oral antibiotics such as T. Cefuroxime may be given. This was not given in this patient with further discussion below.Long term management1. MDI ipratropium bromide 40 microgrammes tds2. MDI salbutamol 200 microgrammes PRN3. commission on proper inhaler technique.4. Couseling on smoking cessation.STUDENT NAME Tan Hai Liang ID NO M0409146NAME OF SUPERVISOR Prof Khin ROTATION Internal Medicine8) SUMMARY OF INPATIENT PROGRESS (INCLUDING MAJOR EVENTS, CHANGE OF DIAGNOSIS OR MANAGEMENT AND OUTCOMES)Mr TLT was warded for a total of 3 days. His breathlessness improved after nebulization with ipratropium bromide, salbutamol and normal saline for one day. He no longer needful nebulization after one day. Mr TLT was also able to ambulate without feeling breathless. He was able to eat and to sleep well without macrocosm bothered by the dyspnoea. His vital signs were also normal and his respiratory rate improved to about 20 breaths per minute. There was still some ronchi heard on auscultation but it was much reduced. He was afebrile during his stay.Mr TLT was discharged after 3 days of admission and educated on chronic obstructive airway disease. He was also counseled on the richness of smoking cessation. He was given an appointment with the medical outpatient department in one month time in order to review his symptoms after being given MDI ipratropium bromide. He was told to return to the hospital if he had similar episodes.STUDENT NAME Tan Hai Liang ID NO M0409146NAME OF SUPERVISOR Prof Khin ROTATION Internal Medicine9) DISCHARGE PLAN, COUNSELLING AND MOCK PRESCRIPTIONDischarge Plan1. Medicationsi. MDI Salbutamol 200g PRNii. MDI Ipratropium Bromide 40g TDSiii. T. Amlodipine 5mg once dailyiv. T. Prednisolone 20mg od for 7 days.2. Counseling on COPD and use of metered dose inhalerMr TLT should be taught about the correct technique in using a metered dose inhaler. The technique should then be assessed before discharge. In the event that Mr TLT is unable to coordinate well, he may be advised to purchase an aerochamber.3. Counseling on smoking cessationThe approach to counseling a patient on smoking cessation as well as various options will be further discussed below.4. Education on the symptoms of an acute exacerbation and advise to return to the hospital if there is development of those symptoms.5. For follow-up at the medical outpatient department for review of symptoms while on MDI ipratropium bromide. He should also be taught about pulmonary rehabilitation. A spirometry appointment may also be made.STUDENT NAME Tan Hai Liang ID NO M0409146NAME OF SUPERVISOR Prof Khin ROTATION Internal Medicine10) REFERRAL LETTER (MANDATORY)Dr Tan Hai LiangMedical Department,Hospital Batu PahatFamily physician,Klinik Kesihatan Batu Pahat,83000 Batu Pahat, 10 June 2009Dear esteemed colleague,Patients name Teo Lai ThingPatients I/c number 510912-01-6343Problem Chronic Obstructive Airway disease convey you for seeing this 58 year old gentleman who is hypertensive for the past 1 year currently on T. Amlodipine 5mg once daily.He presented to Hospital Batu Pahat with shortness of breath for 4 days that was increasing in severity. A diagnosis of chronic obstructive airway disease was made. He was discharged uneventfully on the third day of admission with the pursuit medicatio n MDI Salbutamol 200g PRN, MDI Ipratropium Bromide 40g TDS and T. Amlodipine 5mg once daily.Mr Teo has been a chronic smoker for the past 40 years and smokes up to 20 sticks of cigarettes a day. We have counselled him about the benefits of smoking cessation while in the ward. He is currently considering it and would like to learn more about the various options of smoking cessation.Kindly assess the patients keenness for smoking cessation as well as provide him with additional information on the options available to quit smoking.Thank you.Sincerely____________(Tan Hai Liang)Medical Department Hospital Batu PahatSTUDENT NAME Tan Hai Liang ID NO M0409146NAME OF SUPERVISOR Prof Khin ROTATION Internal Medicine11) instruction ISSUES IN THE 8 IMU OUTCOMES1) Communication skillsWhat are the benefits of smoking cessation in COPD patients and how should counseling be done?Counseling for smoking cessation should play a pregnant role in the holistic management of a patient with chronic obstru ctive airway disease. This is because studies have shown that smoking cessation changes the clinical course of COPD by preserving lung function. One study of patients reviewed at 14.5 years after stopping smoking showed that smoking cessation treatment showed 18% reduction in all-cause mortality compared with usual care without smoking cessation intervention. Patients who had stopped smoking had lower rates of death due of coronary heart disease , cerebrovascular disease, lung cancer, and other respiratory disease as compared with those assigned to usual care who continue to smoke. 1Fig. 4. Effect of smoking cessation on mortality cause at 14.5 years in the Lung Health Study.(A) Comparison of smoking cessation intervention with usual care. (B) Comparison according to smoking status.I therefore looked up for counseling methods for smoking cessation. The American College of Chest Physicians recommend that physicians should be the first line in introducing smoking cessation. 2 There a re 5 As that a doctor should perform for a patient who is a smoker Ask about tobacco use at every visit Advise tobacco users to quit prize the willingness to attempt quitting Assist the patient with methods for quitting Arrange for follow-up contact via phone or face to faceIf the patient is not yet willing to quit, there are 5 Rs which should be identified together by the patient and the doctor Relevance of quitting for the patient Risks of illness related to continued tobacco use Rewerds/benefits of smoking cessation Roadblocks for quitting, internal and external Repetition of the motivation intervention at each encounterThere are two means of intervention in smoking cessation namely pharmacological and behavioural. The pharmacological means include nicotine replacement therapy or buproprion. Behavioural interventions include counseling programs that teach problem-solving skills and set up groups. 3In conclusion, I learned that doctors have an important role in actively encourag ing patients who smoke to stop as there are umteen proven benefits of smoking cessation. The steps discussed above on techniques in the counseling of patients would be helpful to me in the future.2) Professionalism, ethics and personal developmentShould antibiotics be given for episodes of exacerbation of chronic obstructive airway disease?Mr TLT was not given antibiotics during this episode of exacerbation. Certain quarters support the use of prophylactic antibiotics in all exacerbations due to the knowledge that most exacerbations are caused by the common organisms of Streptococcus pneumoniae (S. pneumoniae), Haemophilus influenzae (H. influenzae), Pseudomonas aeruginosa (P. aeruginosa) and Moraxella catarrhalis (M. catarrhalis).Sputum culture may not be useful as even in the clinical stable state, some patients have sputum positive for bacteria. As such a broad spectrum antibiotic is usually used to cover different bacteria. til now, is this use of antibiotics justified in that do patients benefit from it or is the overjudicious use of antibiotics merely promoting antibiotic resistant bacteria?Current world(prenominal) initiative for chronic Lung Disease guidelines 4 recommend that antibiotics should be given ini) patients with exacerbations of COPD and the three cardinal symptoms of increaseddyspnoea, increased sputum volume and increased sputum purulence.ii) patients with exacerbation of COPD with two of the cardinal symptoms if increasedpurulence of sputum is one of the two symptomsiii) patients with severe exacerbations of COPD that requires mechanical ventilationA meta-analysis by Ram et al 5 of 11 placebo controlled RCTs with 917 patients attempted to analyse the value of antibiotics in the management of acute COPD exacerbations. The results show that there is a decrease in short-term mortality, treatment failure and sputum purulence with antibiotic therapy compared to placebo. The authors concluded that antibiotics therapy is appropriate in exacer bations of COPD associated with increased cough and sputum purulence. They further install that antibiotics have the greatest effect for patients with severe exacerbations who are admitted to the hospital. They were unable to comment on exacerbations with non-purulent sputum, what antibiotics were the best to be used and also the duration of therapy due to the lack of RCTs done on these aspects.In conclusion, it was appropriate that Mr TLT was not given antibiotics as he did not have the cardinal signs as mentioned by the GOLD guidelines and further supported by the systemic review.3) self-importance directed life long learningWhat are extrapulmonary manifestations of COPD and what are its therapeutic implications?Chronic obstructive lung disease has long been known as a situate pulmonary disorder. However new evidence have shown that COPD may be a systemic disease that involves pathology in several extra-pulmonary systems.An article by Remels et al 6 summarized the extrapulmonary manifestations as well as its implications on the holistic management of chronic obstructive airway disease. The article showed that there is skeletal muscle dysfunction as well as systemic hullabaloo in chronic obstructive airway disease.There is loss of muscle vision associated with impaired protein metabolism. The loss of muscle mass which is called sarcopenia may progress to cachexia. Studies have also shown that there is increased apoptosis of muscle cells at the cellular level. Independent of the loss of muscle mass is the reduced muscle courage. This finding has been attributed to abnormalities in mitochondria or to hypoxia. These findings have significant implications on management of a COPD patient which will be discussed below.Systemic inflammation is also seen in patients with COPD. This is evidenced by elevated levels of the proinflammatory cytokines such as tumor necrosis factor-alpha (TNF-a), interleukin-6, interleukin-8, and TNF-a receptors. The origin of the syst emic inflammation is thought to be independent of the pulmonary manifestation of COPD. One postulation is the increase systemic inflammatory mediators such as neutrophils and lymphocytes in the circulation of patients with COPD. Another proposed mechanism is increased cytokine production due to chronic hypoxia.The therapeutic implications of these findings is that muscle atrophy should be prevented by resistance exercise as well as combined strength and endurance exercise. Current Malaysian guidelines on the management of COPD 7 recommend pulmonary resistance including lower and upper limb exercises as well as inspiratory muscle training. This concurs with a Cochrane metaanalysis by Lacasse et al 8 which strongly support respiratory at least four weeks of exercise training as part of the of management for patients with COPD. The authors found that there was clinically and statistically significant improvements in quality of life as measured by dyspnea, fatigue and emotional function .4. Critical thinking and questionWhat is the efficacy of systemic corticosteroids for acute exacerbations of chronic obstructive airway disese?The use of systemic oral or intravenous corticosteroids is recommended by GOLD guidelines in the management of acute exacerbations of chronic obstructive airway disease. However the patient, Mr TLT was not given any systemic corticosteroids. This could be because he merely had a mild exacerbation.I therefore looked up a Cochrane metaanalysis on the use of systemic corticosteroids for acute exacerbations of chronic obstructive airway disease 9. The authors reviewed randomized controlled trials comparing parenteral or oral corticosteroids with placebo for the treatment of exacerbation of COPD. The primary outcomes measured were treatment failure (hospital readmission, return to emergency department), relapse and mortality.The authors reviewed 11 studies involving 1081 participants. The results show a statistically significant difference betwe en placebo and use of corticosteoids. There was less treatment failure in patients given corticosteroids. Relapse within 30 days were also reduced. However there was no statistically significant reduction in mortality.As such the authors concluded that administration of oral or parenteral corticosteroids in the treatment of acute exacerbations of COPD reduces the likelihood of treatment failure. This is associated with early and continuing improvement during treatment with corticosteroids in lung function, breathlessness and blood gases and with a shorter hospital stay. This in turn has a positve impact on the economic cost of treating exacerbations, with fewer follow-up visits and hospital admissions. The authors also found that although there is an increased incidence of corticosteroid side effectuate such as fluid retention, hypertension and adrenal suppression, the effects are unlikely to persist after treatment ceases.EVIDENCE BASED MEDICINE WORKSHEET FOR refresh OF THERAPY S TUDIESASKING QUESTIONPatient (P) Patients who present with stable COPDIntervention (I) Oral corticosteroidsComparison (C) PlaceboOutcome (O) Effects on health statusACCESSING EVIDENCE THE bet PATHHow was the article identified The Cochrane LibrarySearch keywords corticosteroids, stable COPDCitation Walters JAE,Walters EH,Wood-Baker R.Oral corticosteroids for stable chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2005, Issue 3.1. Is

Occupational Hazards among Sanitary Staff in Hospital

occupational Hazards among Sanitary Staff in HospitalOccupational Hazards among Sanitary Staff Working at Tertiary Cargon Hospitals of KarachiAbstractImproper dissolution focusing increases the risk of occupational hazard among staff working in hospital. The aim of this cross-sectional hit the books was to identify awareness and practices associated with occupational hazards among the sanitary staff working at tertiary shell out hospitals. The study was conducted at 2 government hospitals in Karachi, from October 2012 to January 2013. An anonymous, self-descriptive questionnaire was employ to collect data. Among 106 participants, only 39% (n=41) received training on managing uncivilized waste. Moreover, only 51% (n=54) were able to differentiate between perilous and non-hazardous waste. more or less, 69% (n=73) respondents had homework of Personal Protective Equipment (PPE) whereas only 36% (n=38) were compliant with it. Two third of the participants reported that they ha ve en supposeered injury from hospital waste. Fishers Exact political campaign revealed that workout of PPE is associated with education, own, training and awareness. The study revealed great need of awareness about health hazards among sanitary staff working at hospitals along with provision of facilities.Keywords Occupational Hazards, Personal Protective Equipment, Waste Man get along withment, Sanitary Staff.Hospital waste serves to be the most hazardous waste material which apprise lead to life laborious infectious diseases. Poor and improper handling of waste increases the risk of exposure to pathogenic organisms.1 Waste material generated from hospitals are considered as hazardous hence, it needs to be treated cautiously.2In developing countries, there is scarce awareness and knowledge about proper management of hospital waste.3 All staff working at hospital is prone to acquire infections. However, sanitary staffs are at greater risk.4 A number of diseases can be transmit ted via contact with hazardous hospital waste including Acquired Immunodeficiency Syndrome (AIDS), hepatitis B, and hepatitis C.5 Therefore, training of sanitary staff working at healthcare facilities is essential.4All healthcare facilities needs to prepare their own policies to ensure proper management of hospital waste and provision of staff safety.6 Appropriate management of hospital waste is based upon hospital administration, policies, finance, staff training, and active participation of staff.7 The staff creditworthy for handling hospital waste needs to be provided with every essential PPE.8 This study focuses on awareness of occupational hazards among sanitary staff working at government hospitals in Karachi.The study was conducted at two tertiary care government hospitals of Karachi from October 2012 till January 2013. It was a cross sectional survey conducted on 106 participants that had granted consent and who had minimum of 3 months of experience. The survey was conduct ed by dint of a structured questionnaire and data was analyzed through SPSS.Among 106 participants 71% (n=75) were male and 29% (n=31) were females. Mean age of participants was 40.23 (+ 9.5 SD). As displayed in Table 1, among all participants 62% had work experience of more than 5 years. Majority (n=36, 34%) of the participants had received secondary education. Participants who had done mean(a) (n=23, 22%) were working as shift supervisors. Job responsibility of participants included dusting and cleaning wards (n=41, 39%), collection of hospital waste (n=32, 30%), segregation of hospital waste (n=18, 17%), and disposal of waste material (n=15, 14%).Table 1Demographic Profile of Study Participants152532342423362341321815142430322322342239301714During job tenure, only 41 (39%) staff received formal training on handling hospital waste and preventing health hazards by following standard precautions. However, 54 (51%) of the respondents were aware about hazardous and non-hazardous was te products. Among all participants, only 19 (18%) underwent medical revue and 67 (63%) of them received Hepatitis-B vaccination. However, among recipients of Hepatitis-B vaccine, only 37 (35%) received complete vaccination i.e. all 3 doses of Hepatitis-B.On inquiring about availability of PPE, 73 (69%) responded that PPE are provided by hospital whereas, only 38 (36%) of the respondents were using PPE. Among all participants, 87 (82%) were compliant with hand washing.With regard to separate collection of hazardous waste from non-hazardous waste, 47 (44%) of the respondents said that they collect waste separately. However, only 21 (20%) of the participants reported that they carry hazardous and non-hazardous waste separately. Majority (n=88, 83%) were using open containers for carrying waste material.Around 69 (65%) of the participants responded that they have encountered injury from hospital waste. Among them, 2 (2%) encountered needle stick injury, 30 (28%) experienced sharp inju ries, 24 (23%) came in contact with blood and consistence fluids, and 14 (13%) got other types of injury. Only 18 (17%) of the participants didnt experienced any illness, however 21 (20%) experienced gastrointestinal tract problems, 28 (27%) suffered from respiratory disorders, 14 (13%) got eye infections, 11 (10%) came in contact with skin diseases, and 14 (13%) encountered blood borne diseases.With regard to compliance of using standard precaution 34 (32%) of the participants always use gloves, only 7.5% of the participants always use apron, and 31 (29%) always use masks.The Fishers Exact test revealed a significant association between experience and use of PPE (P=0.027). Similarly, highly significant association has been identified between training and compliance with use of PPE (PPPP=0.078), was found to be insignificant (see Table 2).Table 2Association between Compliance with Use of PPE and Demographic Characteristics* Significant** Fishers Exact Test applied due to low cell c ountGeneration of waste at hospitals demands for it proper disposal to avoid hazardous consequences associated with it. It is the prime responsibility of hospital to maintain clean and healthy environment to veer infections associated with hospital wastes.6 Therefore, it is essential to provide discriminate training to ensure staff safety.9 In current study, less than fractional of the respondents received training and around half of the respondents displayed awareness about hazardous waste material. The study also displayed an association between training as well as awareness about hazardous waste with compliance to PPE use. Similarly, available evidences in the field also suggests that training of staff along with regular follow-ups can foster compliance with appropriate waste management practices.10 Available literature also suggests that for appropriate management of hospital waste and safety of hospital staff, constant training programs needs to be organized.8 current study revealed that only 18% of the sanitary staff went through medical inspection and around 35% of the staff received complete doses of hepatitis B vaccination. In contrast, previous study on sanitary staff working in tertiary care hospital of Rawalpindi reported that none of the sanitary staff went through medical checkup or received any vaccination before or during job tenure.4The findings of current study revealed that availability of PPE was inadequate. However, it is essential to provide continuous supply of PPE and to bring change in attitude of staff towards use of PPE. The efforts of providing training, creating awareness, and providing personal protective equipment impart not be of worth if staff will not comply with the appropriate waste handling and management strategies. Our study also demonstrated that only one third of the respondents were using available PPE. However, non-compliance with appropriate management of hospital waste makes sanitary staff prone to infections.1 0Hence, efforts need to be made for providing training and creating awareness among sanitary staff for handling hazardous hospital waste. Moreover, organization should develop relevant policies and protocols to ensure appropriate handling and disposal of hospital waste. Organizations should also take initiatives for conducting medical inspection and vaccinating all hospital staff including sanitary staff. Availability of PPE should be adequate and staff needs to be encouraged to use PPE. Evidence based interventional research can be conducted to ensure appropriate handling of hazardous hospital waste for preventing sanitary staff from infectious diseases.ReferencesHossain MS, Santhanam A, Nik Norulaini NA, Omar AK. Clinical solid waste management practices and its electric shock on human health and environment-A review. Waste Manag 2011 317546.Ross DE. Safeguarding public health, the core reason for solid waste management. Waste Manag Res 2011 2977980.Janjua NZ, Khan MI, Mahmood B. nifty injuries and their determinants among health care workers at first-level care facilities in Sindh Province, Pakistan. Trop Med Int Health 2010 15124451.Ahmed I, Farooq U, Rabia M, Naheed A, Maryum A, Asia A. Awareness among sanitary workers regarding their job A survey at tertiary care hospital. Medical Forum Monthly A Journal for all Specialties. Retrieved from http//www.medforum.pk/index.php?option=com_contentview=articleid=467awareness-among-sanitary-workers-regarding-their-job-a-survey-at-tertiary-care-hospital.Hayashi Y. Proper disposal of medical wastes infection prevention and waste management at Hiroshima city, Asa Hospital. Rinsho Byori, 2000 (Suppl 112)26-31.Hashmi SK, Shahab S. Hospital and biomedical waste management. In Iliyas M, Editor, Community medicine and public health. 4th ed. Karachi Time Publishers, 2003, pp. 426-37.Yadav M. Hospital waste-A Major Problem. Hospital Today 2011 8 276-282.Pandit NB, Mehta HK, Kartha GP, Choudhary SK. commission of biomedi cal waste Awareness and practices in a district of Gujarat. Indian J Public Health 2005 49245-7.Al-Khatib IA, Al-Qaroot YS, Ali-Shtayeh MS. Management of healthcare waste in circumstances of limited resources a case study in the hospitals of Nablus city, Palestine. Waste Manag Res 2009 2730512.Ikram A, Hussain Shah SI, Naseem S, Absar SF, Ullah S, Ambreen T, et al. Status of hospital infection control measures at 7 major tertiary care hospitals of northern punjab. J Coll Physicians Surg Pak 2010 2026670.

Impacts of Green Energy Production on Ireland

Impacts of Green Energy Production on IrelandAn Evaluation of the Impacts of Green Energy Production on the Flora and Fauna of IrelandIntroductionGreen force production has significantly increased in recent years. Its rise is primarily due to environmental concerns and the vital need to find alternative pushing sources as fossil fuels supplies decline. In monetary value of the environment, the use of renewable qualification in order to alleviate the effect of global warming is supported internationally. (Warren, et al., 2005) There ar several sources of renewable readiness used in Ireland today, these include wind power, solar, hydroelectric might and biomass etc.Global Policy and legislation In 1992, at the Earth summit in Rio, many nations joined an international accord, which was known as the United Nations Framework Convention on Climate Change (UNFCCC) (United Nations, 2017). This treaty was put into effect in 1994 and its main aim was to fight the challenges of climate change. In order to achieve this, they bring forwardd constituent states to keep their greenhouse vocalisationicle accelerator emissions at a steady state. (United Nations, 2017). This treaty was accompanied by the Kyoto Protocol which was more than successful as it committed developing countries to reduce their emissions by introducing legitimately binding reduction bearings. (United Nations, 2017)EU policy and legislationIn 1997, the EUs renewable energy policy came ab break through with the implementation of the White Paper which was called Energy for the futurity renewable sources of energy (atomic number 63an Commission , 2011). This paper gave details of how gross energy manipulation in terms of renewable energy take to increase from 6% to 12% by 2010 (European Commission , 2011). Then in 2008 the Commission proposed an ambitious Climate Change and Energy Package. The European Union accepted this package in December of 2008. This energy package stated that European Union segment States must achieve the following targets20% decrease in greenhouse gunslinger emissions by 2020 in comparison to the 1990 levels.20% increase in the use of renewables.20% increase in energy capacity.(European Commission , 2011)All EU Member States were required to draw up National Renewable Energy Action Plans (NREAPs) as part of the Renewable Energy Directive (European Commission , 2011). These NREAPs outlined the focussing in which each Member State aimed to go steady their approved share of the everywhereall target of a 20% increase of renewables in energy consumption by 2020. Additionally, the NREAP must also describe the steps that will be taken to improve and grow the use of renewable energy. Examples of this include improving conditions to take more access to electricity gird lines as considerably as having less administrative barriers. (European Commission , 2011).Irelands Policy and LegislationIrelands renewable energy policy and legislation is entir ely based on the context of European legal responsibilities. Our policies and legislations are specified in legion(predicate) Directives and Regulations, as well as in many international and national targets (Dineen, et al., 2015). In terms of the NREAP, Ireland submitted its final intend to the European Commission at the end June in 2010. We submitted our initial progress typography in the January of 2012 followed by the second report two years later in February 2014 (Dineen, et al., 2015). There are many schemes that are carried out nationally to meet the EUs 2020 targets.Irelands Strategy for Renewable Energy 2012 2020, proposed an ambitious statement which stated that Ireland could become a world-wide leader in the research and progress of renewable energy and former(a) associated technologies (Dineen, et al., 2015). Irelands strategy for renewable energy recognises five goals, some of which include an increase in both onshore and offshore wind the construction of a sustaina ble bioenergy sector and building robust and efficient electricity networks etc. (Dineen, et al., 2015).Under the European Union Directive 2012 on energy efficiency all member states, including Ireland must redeem a NREAP. The European Energy Directive placed energy efficiency at the forefront of the EU Energy 2020 strategy. It became a part of the law in Ireland through the SI 426 of 2014 and SI 131 of 2014 (Dineen, et al., 2015). The directive is aimed at keeping energy use from economic growth separate as well as setting out a mutual model of measures to meet the European Unions 20% target in energy efficiency by 2020 (Dineen, et al., 2015).It is prerequi set that all member states submit three National Energy Efficiency Action Plans to the European Commission over a seven-year period. The action plans should detail the measures think to meet the 20-20 targets (Dineen, et al., 2015). Irelands initial National Energy Efficiency Action Plan was available in May 2009. It reitera ted the target which was originally included in 2007 in the White Paper on energy efficiency. This target aimed to save approximately 20% of the average primary energy used from a period of 2001 2005, with this target being reached by 2020 (Dineen, et al., 2015).In terms of Irelands legislation on the protection of vegetation and fauna, the protection of biodiversity on an international front comes from the Convention on biological Diversity (CBD), in the form of an extensive strategy towards sustainable development. The CBD has three main aims which includeTo conserve biodiversity.To sustainably use the components of biodiversity.To share the benefits that come from the use of hereditary resources in a just and impartial way.(A, et al., 2005)Irelands main policy to protect the flora and fauna is included in the National biodiversity plan Actions for Biodiversity. This action plan outlines how Ireland plans to conserve and protect its biodiversity. This policy is supported by the following legislationBirds Directive 1979Habitats Directive 1992 (Natura 2000 sites)Wildlife Act 1976, plus amendment Act 2000Irish Flora surety Order 2015(Scheer, et al., 2016)DiscussionCurrently there are numerous different types of renewable energy available in Ireland, which include wind power, solar, hydroelectric energy and biomass etc. This section is going to focus on just wind and hydroelectric energy. sprain Power background drift power began to draw touch just after the oil shocks in the 1970s and it only started to grow during the 1990s (Warren, et al., 2005). Today, wind energy is at the forefront in terms of renewable energy as it has emerged as one of the cleanest, safest and cheapest sources of energy. Since the 90s the content of wind generating energy has been doubling approximately every three years and the production costs pass on been decreasing thus making it a favourable source of energy. In Ireland, the first operational windfarm came about in 1992 and as of 2015 there were 228 operational windfarms extradite across 27 counties (Irish Wind Energy Association, 2017). These windfarms are producing a wind capacity of 3025 megawatts. It is estimated that the value of 1MW can provide energy for approximately 650 homes, therefore the capacity of 3025MW is providing enough energy for 1.97 million homes in Ireland (Irish Wind Energy Association, 2017). However, for these windfarms to be effective it is vital that they are located in open, exposed areas where wind facilitate is high. Thus, the uplands, coastal and offshore areas are generally proposed (Drewitt Langsto, 2006).ImpactsFrom a report carried out by BirdLife (BirdLife Europe , 2011), wind power energy was classified as a medium risk technology, therefore meaning that it can have veto impacts i.e. habitat disturbance especially in terms of sensitive species. However, if the correct framework policies are in place and if they are strategically organised then they can be develope d without any negative impacts (BirdLife Europe , 2011). Areas such as the uplands, coastal and offshore are important habitats for migratory, breeding and wintering birds and therefore their habitats may be affected by the development of windfarms. However, the impact of wind farms on bird populations can vary and depend on different aspects including the habitats that are affected, the species that are present, the topography of the adjacent land and finally the biogeographic range of a species (Drewitt Langsto, 2006).At numerous poorly sited wind farms (specifically at offshore sites) collision mortality has had a significant effect on population level (BirdLife Europe , 2011).In addition, more indirect effects such as access to remote areas i.e. tracks may lead to an increased level of disturbance or an increased risk of predation. cumulative mortality may contribute to the decline in more susceptible species due to opposite environmental or anthropogenic pressures (BirdLife Europe , 2011). Thus, impacts that are site specific in addition to effects on the local wildlife populations are in fact relevant apprehensions if windfarms are not developed properly. To mitigate the effects of developing windfarms there are two directives under EU environmental legislation that are directly applicable to the development of wind farms. These directives include sea Directive (Strategic environmental Assessments)EIA Directive (Environmental Impact Assessments)(European Commission , 2011)Strategic Environmental Assessments (SEAs) are assessments that authorities use to improve spatial plans for various infrastructure needs such as energy installations (BirdLife Europe , 2011). These assessments include the process of analysing as well as allowing the publics input to combine the analysis of environmental protection into plans and to encourage sustainability through investment programmes (BirdLife Europe , 2011). Furthermore, Environmental Impact Assessments (EIAs) a re carried out by developers with the aim of avoiding, reducing and mitigating the impacts of projects. They then consider their findings in the planning decisions (BirdLife Europe , 2011)Hydroelectricity backgroundHydroelectricity is another major source of renewable energy and it is made from the movement of body of water. It is currently the worlds most extensively used source of renewable energy (O Rourke, et al., 2009). Three different categories of hydroelectric plants occur which includeImpoundment - most prevalent and known kind of hydroelectric plant. It uses a dam to keep the water in a reservoir and a turbine releases the water, therefore generating electricity.Diversion the water is diverted/transferred from the river over a canal which turns the turbine.Pumped storage water is pump from a low reservoir into a higher reservoir when the electricity demand is low. Thus, electricity is generated when the electricity demand is high and the water is released. (O Rourke, et al., 2009)In terms of Ireland, hydroelectric energy is our second greatest source of renewable energy, just behind wind. The development of this energy will increase with more focus on the smaller scale hydroelectricity plants. Currently the ESB oversee the larger-scale plants and they have stated that these plants supply approximately 6% of our electricity (O Rourke, et al., 2009).ImpactsHydroelectric plants can have numerous negative impacts on both the land and in terms of wildlife. Firstly, hydroelectricity plants can have a significant effect on aquatic ecosystems. For example, fish and several other species can be wounded or killed by the turbine blades, however there has been numerous mitigation methods to minimize these impacts e.g. fish ladders and in-take screens (UCS, 2017). As mentioned above the most leafy vegetable types of hydroelectric power plants use a dam and a reservoir and they generally can hinder the migration patterns of fish, thus affecting their populatio n. These plants can also have an impact on the flow of the river and on the water temperature i.e. the temperature not being consistent. These changes can have a significant effect on the native flora and fauna in the river and on the land (Environment and Ecology , 2017). Wildlife impacts can also occur within the dammed reservoir in addition to downstream from the plant. Water from a reservoir is generally more stationary compared to normal river water (UCS, 2017). As a result, it would be expected for the reservoir to have a higher aggregate of sediment and nutrients, which in turn would promote a surplus amount of algae and other aquatic weeds (UCS, 2017). This then allows the weeds to crowd out additional flora and fauna that exist in the river. (UCS, 2017).ConclusionIrelands Current StateIreland has made significant progress towards achieving the energy efficiency and renewable energy targets. From a report carried out by SEAI (Scheer, et al., 2016) in 2016 they stated that t o date Ireland has done the followingIn terms of our energy efficiency target, Ireland has energy efficiency savings relating to about half of the countrys 2020 energy efficiency target (Scheer, et al., 2016).In terms of meeting our 2020 renewable energy target, we are also just over half way with 8.6% of our gross final consumption coming from renewables in 2014 (Scheer, et al., 2016).This has been achieved due to more than 40,000 homes and more than 550 businesses using some form of renewable energy. In terms of heat, 6.6% of the national 12% heat target has been achieved by end 2014 (Scheer, et al., 2016).Additionally, since 2003 around 190 wind farms, linked across 24 counties, have been developed. This compares to 2,375 MW of renewable electricity capacity.In total, over 6 million tonnes of CO2 emissions have been avoided each year through using energy efficient and renewable energy technologies (Scheer, et al., 2016).In terms of wind power energy, with careful development they can prove to be successful as they dont produce greenhouse gas emissions, pollutants, outflowing or waste. In addition, its a natural source of energy.Hydroelectricity also has potential as a source of energy, as stated above it currentlyprovides approximately 6% of our electricity. However, Ireland is limited to a small number of large-scale of hydro sites for the generation of power. (O Rourke, et al., 2009).ReferencesA, Z., C, M. D, B., 2005. The Convention on Biodiversity and Its Potential Implications for the Agricultural Sector in Europe, s.l. Institute for European Environmental Policy (IEEP) .BirdLife Europe , 2011. Meeting europes renewable energy targets in harmony with nature , Sandy, U.K The RSPB.Dineen, D. D., Howley, M. Holland, M., 2015. Renewable Energy in Ireland 2013, s.l. SEAI.Drewitt, A. L. Langsto, R. H., 2006. Assessing the impacts of wind farms on birds. International journal of Avian science , 148(S1), pp. 29-42.Environment and Ecology , 2017. Hydropower and the Environment. Online Available at http//environment-ecology.com/energy-and-environment/100-hydropower-and-the-environment.htmlAccessed 30 January 2017.European Commission , 2011. Wind Energy developments and natura 2000, Luxembourg European Union.Irish Wind Energy Association , 2017. Irish Wind Energy Association Environmental Impacts. Online Available at http//www.iwea.com/environmentalimpactsAccessed 30 January 2017.Irish Wind Energy Association, 2017. Irish Wind Energy Association. Online Available at http//www.iwea.com/index.cfm/page/windenergyfaqs?q19Accessed 28 January 2017.O Rourke, F., Boyle, F. Reynolds, A., 2009. Renewable energy sources and technologies applicable to Ireland. Renewable and sustainable energy reviews , Volume 13, pp. 1975-1984.Scheer, J., Clancy, M. Gaffney, F., 2016. Irelands Energy Targets, Progress, pipe dream Impacts, s.l. SEAI Energy.UCS, 2017. Environmental Impacts of Hydroelectric Power. Online Available at http//www.ucsusa.org/clean_en ergy/our-energy-choices/renewable-energy/environmental-impacts-hydroelectric-power.html.WI-UvfmLTIUAccessed 30 January 2017.United Nations, 2017. The UN and climate change. Online Available at http//www.un.org/climatechange/towards-a-climate-agreement/Accessed 10 February 2017.Warren, C. R., Lumsden, C., ODowd, S. Birnie, R. V., 2005. Green On Green Public Perceptions of. diary of Environmental Planning and Management, Volume 48, pp. 853-875.

William Shakespeares Antony and Cleopatra Essay -- Shakespeare Antony

William Shakespeares Antony and CleopatraShakespeares Antony and Cleopatra is aptly named, not just because the wanton away centers around these two characters, but in like manner because it encompasses the consorts fixation on the lovers oppositional relationship. On the surface level, Antony embodies the Roman ideals of a good, noble man, while Cleopatra represents the hyper-sexualized, dangerous Eastern woman. However, upon further examination some(prenominal) Antony and Cleopatra display complicated internal conflicts that effectively reverse these polar positions repeatedly throughout the play. In this way, the opposition between Antony and Cleopatra that exists on a simple, interpersonal level is echoed by more complicated, internal conflicts within each of these characters on a deeper, more individual level. The tension between the title characters creates the love that draws them together at the same time as it drives them further apart, thus establishing yet another layer of antagonistic relationships within the play. The importance of these oppositional relationships is underlined most starkly in defend II.2. In particular Enobarbus speech describing Cleopatras beauty functions as one of the greatest statements of the plays conflicting themes. This speech reflects the antagonistic nature of the plays central relationships through the invocation of equivalent antagonistic relationships between the violent descriptors used to depict Cleopatra. Throughout the play, Shakespeare establishes a love-hate relationship between Antony and Cleopatra. In doing so, there are times when the lovers are characterized as stark opposites of each other as well as instances where these characterizations are reversed. The Romans, represented b... ...defining Antony and Cleopatras every bit oppositional relationship. The battles within her reflect Antonys personal struggles, as well as the great wars within their relationship. Thus, the dualities wi thin Enobarbus speech reflect the oppositional relationships both(prenominal) within the play as a whole and within the greater context of Act II.ii. Antony and Cleopatra struggle to define themselves on intra- and inter-personal levels as well as within the greater societal sphere. Ultimately, they can never fully resolve the polar oppositions that exist both within and between them. This results in the physical and emotional violence that is both reflected and predicted in Enobarbus speech.Work CitedBeggared. Oxford English Dictionary. http//dictionary.oed.com/ Accessed 10/17/05Shakespeare, William. Antony and Cleopatra. New York Penguin Books, 1999.

Emptiness in The Hollow Men Essay -- Hollow Men Essays

Emptiness in The Hollow Men After Eliot had published The shove along Land, he felt as though he had not been able to fully convey the sense of desperation and emptiness in that work. Beginning with Doriss Dream Songs and Eyes I Last Saw in Tears, he explored these themes, eventually uniting all such poems in The Hollow Men. The end yield is a work that, unlike The Waste Land and its ultimate chance for redemption, has only the indelible emptiness of the hollow workforce as its conclusion. The hollow men are those who, in life, did not act on their beliefs they resisted any action at all, and as a result stagnate eternally in the Shadow, a land in between heaven and hell, completely isolated from both. Eliots allusions give a familiar literary and popular basis to the setting, while the symbols and melodic progression convey the futility and spiritual brokenness of the men. The poems initial epigraph, Mistah Kurtz-- He dead is the first of many allusions to Conrads novel, Heart of Darkness. Eliot uses the references to draw the readers attention to the moral situation of Kurtz and the others who have crossed/ With direct eyes, to deaths other Kingdom. These men and Kurtz defined themselves through their actions, whether or not they were good. In Baudelaires words, So far as we are human, what we do must be either evil or good so far as we do evil or good, we are human and it is better, in a paradoxical way, to do evil than to do nothing at least, we exist (Drew 94). An entire description of the condition of the hollow men, this quote has also been used in criticism of Heart of Darkness. Thus the (spiritual) stagnation of the tumid river and those who wait beside it is contrasted with the dynamici... ...ubmission to a valet de chambre that ends not with a bang but a whimper. Works Cited Brady, Ann Patrick. Lyricism in the Poetry of T.S. Eliot. London Kennikat Press, 1978. Drew, Elizabeth. T.S. Eliot The Design of His Poetry. New York Charles Scribners Sons, 1949. Headings, Philip R.. T.S. Eliot, Revised Edition. capital of Massachusetts Twayne Publishers, 1982. Moody, A. David. The Cambridge Companion to T.S. Eliot. Cambridge University of Cambridge Press, 1994. Moody, A. David. T.S. Eliot, Poet. Cambridge University of Cambridge Press, 1994. Raine, Craig. The Awful Daring of T.S. Eliot. The Guardian. 21. August 19, 1988. Roessel, David. Guy Fawkes Day and the Versailles Peace in The Hollow Men. English Language Notes, Sept. 1990. 52-58. Vol. 28. Williamson, George. A Readers Guide to T.S. Eliot. New York Octagon Books, 1974.