Great Gatsby Ch 7 Summary Essays - The Great Gatsby,

Great Gatsby Ch 7 Summary The Great Gatsby Chapter 7 Summary Chapter 7 was another important chapter in this book, it started off with Gatsby deciding to call off his parties, which he had held primarily to lure Daisy. He has also fired his servants to prevent gossip, and replaced them with connections of Meyer Wolfsheim. On the hottest day of the summer, Nick drives to East Egg for lunch at Tom and Daisy's house. When the nurse brings in Tom and Daisy's baby girl, Gatsby is stunned. During the awkward afternoon, Gatsby and Daisy cannot hide their love for one another, and Tom finally notices their situation. After finally realizing the situation, Tom agrees with Daisy's suggestion that they should all go to New York together. Nick rides with Jordan and Tom in Gatsby's car; Gatsby and Daisy ride together in Tom's car. Stopping for gas at Wilson's garage, Nick, Tom, and Jordan learn that Wilson has discovered his wife's affair and plans to move her to the West. Nick perceives that Tom and Wilson are in the same position. Tom begins his confrontation with Gatsby by mocking his habit and the fact that he claimed he went to Oxford. Tom asks Gatsby about his intentions with Daisy, and Gatsby replies that Daisy loves him, not Tom. Tom claims that he and Daisy have a history that Gatsby could not possibly understand. He then accuses Gatsby of running a bootlegging operation. Daisy, who began the afternoon in love with Gatsby, feels herself moving closer and closer to Tom as she watches the confrontation. Tom realizes he has won, and sends Daisy back to Long Island with Gatsby to prove Gatsby's inability to hurt him. As the confrontation ends, Nick realizes that today is his thirtieth birthday. Back at Tom's house, Nick waits outside, and finds Gatsby hiding in the bushes. Gatsby says he waited to make sure Tom would not hurt Daisy. He tells Nick that Daisy was driving when the car struck Myrtle, but that he, Gatsby, will take the blame. Still worried about Daisy, Gatsby sends Nick to check on her. Nick finds Tom and Daisy eating cold fried chicken and talking. They have put aside their differences, and Nick leaves Gatsby standing alone in the moonlight. Book Reports

Biography of Maslow and Start of his Career

Biography of Maslow and Start of his Career Abraham Maslow was born in 1908, in Brooklyn, New York. His parents were Jews who had immigrated into America from Russia. They wanted their children to achieve the best in the new world hence they pushed Maslow to succeed in school. Consequently, Maslow found solace only in books after developing loneliness as he grew up.Advertising We will write a custom research paper sample on Biography of Maslow and Start of his Career specifically for you for only $16.05 $11/page Learn More He first studied law at the City College of New York (CCNY) in a bid to satisfy his parents. He moved to Cornell after the first three semesters and then returned to CCNY. He got married to his first cousin, Bertha Goodman, despite the fact that his parents had opposed his marriage to Bertha. Maslow and Bertha got two daughters and then moved to Wisconsin for Abraham to enroll at the University of Wisconsin. While there, he gained interest in psychology as his academic work started to improve suddenly . Abraham took some time to interact with Harlow, who was credited for his studies on attachment behavior and experiments with the rhesus monkeys. He continued with his education until he received a PhD in 1934. One year after he had graduated, Maslow went back to New York to work with E.L Thorndike at Columbia where his interest to research on human sexuality continued to grow. While he taught full time at Brooklyn College, his interaction with Europeans who immigrated into the US became significant. Some of the people he interacted with included Fromm, alder, Horney and other Freudian and Gestalt psychologists. Between 1951- 1969, he was the chairman of psychology department at Brandeis. While at Brandeis, Abraham met Kurt Goldstein, author of ‘The Organism,’ who had introduced the idea of self-actualization in his book. This marked the period Abraham began his advocacy for humanistic psychology, which was very important to him. In the 1940s, Maslo w came up with one of the most remarkable hierarchies in his career, that of inborn needs. He was a professor at Brooklyn College and his goal was to understand and give explanations to the things that motivated human beings. He did this by combining approaches that existed such as behaviorist, Freudian, cognitive and gestalt approaches to make one theory. He argued that the individual approaches were comprised of reasonable points only that they did not include personality in its broader view. Maslow formulated a theory that argued that the motivation behind the actions of human beings was their needs, which he represented in the form of a five-level pyramid. The most important physiological needs were at the bottom of the pyramid while advanced psychological needs appeared as the pyramid progressively went higher. Maslow invented another field of study at the height of the Second World War, which involved the study of high-achieving individuals who were emotionally healthy. He lat er referred to them as self-actualizing individuals. He started by analyzing the characteristics of his mentors and the results of his investigations excited him.Advertising Looking for research paper on biography? Let's see if we can help you! Get your first paper with 15% OFF Learn More He recorded in his diary that his thoughts on the self-actualizing man were not of ordinary men who had certain things added, but ordinary men who had lost nothing. He described average men as human beings whose powers were inhibited and dampened. Maslow conducted interviews on individuals who had achieved a lot of things and was surprised to find out that most of them had reached the peak of their lives. They had experienced instances of great fulfillment and joy. In addition, their psychological health increased their happy moments. Most of the individuals he interviewed did not share in conventional religion. The language they used to describe their happiness peaks was vi rtually mystical and was mostly associated with feelings of success and family relations. Maslow published his famous book, Motivation and Personality in 1954. It was a comprehensive synthesis of the many years he had spent advancing theories about the nature of human beings, something that had earned him international recognition. He was very optimistic about human nature and this stirred a lot of interest in the field. He used his position as the head of psychology department at Brandeis University to bring humanistic thinkers such as Victor Frankl and Suzuki to the university to give lectures. Maslow’s career continued to grow significantly in the 1960s when employers wanted to get his advice on how to motivate their workers. The approach he used on employee engagement had a significant impact on regions where new concepts were being introduced. Maslow increased the popularity of the term synergy in a bid to explain work teams where the whole was important than all its par ts. He argued that it was possible to increase the productivity and innovative capacity of employees if they were urged to fully use their strengths through challenging and exciting tasks . In 1967, Maslow suffered a serious heart attack which forced him to relocate to San Francisco Bay together with his wife Bertha because the climate was milder. Although his health continued to deteriorate, his passion for writing, teaching, consulting and interest in human potential never declined. After his death in 1970, his ideas continued to inspire many people around the world. Maslow’s Pyramid of Human Needs In his earlier studies of monkeys, Maslow had discovered that the degree of importance of human needs varied. For example, if a people were hungry and thirsty at the same time, they tried to quench their thirst first. It was possible for an individual to miss food for several days. Thirst was therefore considered more serious than hunger. Likewise, if a person was thirsty then go t choked such that he could not breathe, the need to breathe became important than the need to quench thirst .Advertising We will write a custom research paper sample on Biography of Maslow and Start of his Career specifically for you for only $16.05 $11/page Learn More Using this idea that some needs were more urgent than others, Maslow came up with the famous hierarchy of needs. Apart from the basic needs such as food, air, water and sex, Maslow expanded the category of needs and included physiological needs, esteem needs, need for love and belonging, safety and security needs and self-actualization needs. Physiological Needs These included needs for oxygen, protein, water, protein, salt, calcium and other minerals and vitamins. They also included the need to have a balanced PH and temperature. Physiological needs also comprised of the needs to rest, be active, eliminate wastes such (CO2, swear, urine) and to avoid pain. Maslow categorized such needs as i ndividual ones whose absence caused individuals to look for them. Safety and Security Needs This second level of needs came in when the physiological needs were adequately taken care of. After these needs were fulfilled, the interest of people was to look for security and protection. Physiological needs were no longer important since the focus shifted to the need for safety and security. The evident of these needs was the desire for individuals to feel safe in their neighborhoods and also have financial security in their places of work. Love and Belonging Needs After physiological and safety needs were fulfilled, the third level started to emerge. Individuals started to feel the need to have friends, children, and affectionate relationships in general. They became increasingly vulnerable to social anxieties and loneliness. The evidence of the needs for love and belonging was the desire of human beings to have families and be recognized by the community members as part of the communi ty. Esteem Needs After the first three levels were filled up, individuals began to look for self-esteem. Maslow identified a lower and a higher version of esteem needs. The lower version comprised of the needs for respect of others, status, fame, glory, attention, recognition and dignity. The higher version was characterized by self-respect needs and a feeling that they were competent, confident, free and that they had achieved. This constituted the higher version which was different from needs such as respect for other individuals. When human beings acquired self-respect, it was not easily lost. The negative side of these needs was seen through inferiority complex and sel-esteem. Maslow reckoned with the proposal made by Adler that these needs formed the basis of psychological problems. In developed countries, majority of the people did not strife to fulfill safety and physiological needs. More often, they had love and a sense of belonging. What proved difficult for them to get was some little respect.Advertising Looking for research paper on biography? Let's see if we can help you! Get your first paper with 15% OFF Learn More Maslow referred to the preceding four levels as deficit or D-needs. If individuals lacked something i.e. deficit, they felt the need. But if their needs were completely fulfilled they did not have the feelings of need. This meant that they were no longer motivated to fulfill the needs because they were already fulfilled . Maslow made reference to homeostasis in a bid to explain the four levels. Homeostasis is a principle of operation used by the furnace thermostat. It switches the heat on and off depending on whether it is cold or hot. In the same manner, Maslow explained that when the body lacked a particular substance, it developed hunger for the substance. When it got enough supply of the substance, the hunger disappeared. The homeostatic principle was extended to needs such as belonging, safety and esteem. He argued that the needs were essentially survival needs which were built in human beings genetically. Maslow argued that the development of human beings generally took place in stages which were represented by the various levels. As newborns, people focused on physiological needs. After sometime, their focus was shifted to the need to be safe and secure. Soon after, they started to look for attention and affection. Later, they began to look for self esteem. When people were exposed to stressful situations or life was difficult for them, they changed to needs that were lower in the hierarchy. When individuals lost their jobs, they usually sought little attention. When people had problems in their families and their family members left them, love became their most important need during such moments. Maslow added that the same things occurred to the society. When the society suddenly got into problems, people started to look for a strong leader to lead the society and take things to their normal course. When they did not have food, their needs were more basic because food was a basic need . Maslow pointed out that sometimes human beings were required to ex plain their life philosophies. This involved asking them what their ideal world or life would be like. If people went through serious problems during their development such as extreme insecurity, death or separation of family members and neglect, it was possible for to fixate on such needs throughout their lives. This was how Maslow understood neurosis. For instance, he pointed out that people who experienced separation of their parents wee likely to feel insecure even when they got married. They were constantly afraid of being left because they felt that they were not good enough for their partners. Maslow and the Concept of Self-actualization The level of self-actualization in the hierarchy of needs invented by Maslow was a bit different. He used different terms to make reference to this level. For example, it was referred to as growth motivation instead of deficit motivation and he also named it self actualization. The needs at this level did not require homeostasis or balance. I ndividuals continued to feel them once they were engaged and were likely to become stronger once they were fed. Individuals were characterized by a continuous urge to fulfill potentials and become all that they could become. The needs basically involved individuals becoming the best they could become hence acquiring the feeling of self-actualized individuals (Franken, 2001). For this level to be attained, Maslow argued that it was important for the lower needs to be fulfilled first. If individuals struggled for food, they had to get food first, if they felt unloved and insecure, they had to look for love and security first. He pointed out that with the difficulties that existed in the world, only a small percentage of people attained self actualization. This argument raised a pertinent question of what Maslow really meant by self-actualization. In order to answer the question, he described people he considered to have attained self- actualization through a method he referred to as b iographical analysis. Maslow started by sampling a group of historical people he knew well and people he thought fulfilled the requirements of self-actualized people. Some of the people in the group were Abraham Lincoln, William James, and Eleanor Roosevelt among others. He then carefully studied the biographies of these individuals, their acts and writings and derived qualities that seemingly defined them. These were qualities that were not possessed by the rest of the common people. The individuals were reality centered which meant that they were able to differentiate fake and dishonest things from the ones that were genuine and honest. They were problem centered to mean that they looked at difficulties and problems of life that needed solutions not as troubles that required people to give up on them. They perceived means and ends in their unique way because according to them, the saying that the end justified the means was not always applicable. According to them, the means could be ends themselves to imply that the journey was more crucial than the ends. Self-actualized individuals also related with other individuals in different ways. First, they did not like company since they were happy when they stayed alone. However, they preferred deeper personal relations with selected friends as opposed to shallow relations with a large number of people. They were independent from physical and social needs and were not vulnerable to social pressure due to their nonconformist nature. To some extent, they also had mild humor since they did not want to appear humorous or crack jokes to other people. Maslow pointed out that self-actualizers had a quality he called acceptance of self and others. They accepted people the way they were instead of trying to change them to be the way they thought they were supposed to be. They directed the same acceptance towards themselves since they did not struggle to change their negative qualities. This quality enabled them to achieve spontaneity and simplicity since they did not portray themselves as different people. They always remained themselves. Further, these self- actualized individuals were respectful and had humility towards other people. Maslow described this quality as possession of democratic values which implied that they were not against individual and ethnic varieties but instead treasured them. Again, Maslow called this human kinship which was characterized by strong ethics . Moreover, this group of people was characterized by an ability to discern wonder in ordinary things, a quality Maslow referred to as freshness of appreciation. This enabled them to be creative, original and inventive. Finally, they exhibited a higher degree of peak experiences in comparison with the average people. Peak experiences were experiences that took individuals out of themselves and made them feel very tiny. Such experiences were sought after by many people because they influenced them positively. According to Maslo w, individuals who had attained self actualization were not perfect because he identified various flaws in their characters. First, he found out that they experienced moments of guilt and were anxious at other moments although their guilt was a bit realistic. Some of them exhibited signs of absentmindedness and were extremely kind. Others were characterized by unpredictable ruthlessness moments and loss of humor. The strongest qualities Maslow discovered of the self actualized individuals were that they had natural values which flowed from their personalities effortlessly. They also rose above certain societal dynamics that were deemed undeniable by other individuals. These included differences such as the ones that existed between masculine and feminine or selfish and generous (Daniel, 2001). Discussion of Maslow’s Work The contribution made by Maslow in personality theories was very significant. In the 1960s to be particular, people had lost faith in the mechanistic message s from the physiological and behaviorist psychologists. They were in search of meaning and purpose in their lives. They possibly looked for higher and mystical levels of meaning. Maslow was among the scholars who tried tirelessly to find the relevance of psychology among human beings and expounded on personality. During the same time, another movement was in place. Some of the things that inspired this movement were the same things that had turned Maslow off. They included computers and information processing, and the rationalistic theories such as the cognitive development theory developed by Jean Piaget and Linguistics by Noam Chomsky. This took root as the cognitive movement in psychology. Criticism of Maslow’s Work Although Maslow made significant contributions in the field of psychology, his work was not without criticism. The most common criticism was in relation to the methodology he used to conduct his study. It was argued that Maslow picked a few individuals he consi dered to have attained self-actualization then read about them and came up with conclusions regarding what self-actualization was. This was not credible science to most people. However, he knew this in his study and hoped that others would take over what he had started and expand his work. People were curious that Maslow who founded American Humanism had begun his career in the field of behaviorism with a strong inclination to physiology. He was not indeed a believer in science and often biology formed the basis of his ideas. The other reason why the work of Maslow was criticized was that he complicated the concept of self-actualization so much. Self-actualization had been described by Kurt and Carl Rodgers as what every living creature did including growing and fulfilling its biological destiny. Maslow limited this definition into something that was achieved by only two percent of the living things. The argument by Rodgers that babies were an apt example of self-actualization was r efuted by Maslow by saying that children rarely attained self-actualization . Maslow argued that individuals fulfilled their lower needs before they attained self- actualization. This was questioned because there were many examples of individuals who had achieved self-actualization yet their low level needs had not been fulfilled. Many known people had experienced poverty, depression, bad upbringing and other traumatizing experiences as they grew up. It was questionable if all these individuals never portrayed some form of self actualization. References Boeree, G. (2006). Abraham Maslow: 1908-1970. Web. Carducci, B. (2009). The Psychology of Personality:Viewpoints, Research, and Applications. New York: Wiley-Blackwell. Daniel, M. (2001).Maslows Concept of Self-actualization. Web. Engler, B. (2008). Personality Theories: An Introduction. Washington: Cengage Learning. Ewen, R. (2003). An introduction to theories of personality. New Jersey: Routledge. Franken, R. (2001).Human Motivatio n. Pacific Grove, CA: Brooks/Cole. Goble, F. (2004). The Third Force: The Psychology of Abraham Maslow. New York: Maurice Bassett. Hoffman, E. (2011). The Life and Legacy of Abraham Maslow. Web. Huitt, W. (2007). Maslows hierarchy of needs. Educational Psychology Interactive. Valdosta. Web. Schultz, D., Ellen, S. (2011). A History of Modern Psychology. New York: Cengage Learning.

Plato Euthyphro, Aristotle, Hobbes, Hume, Kant Assignment

Plato Euthyphro, Aristotle, Hobbes, Hume, Kant - Assignment Example 3. Socrates explains that the reactions or effects of things are different, as an action loved is said to be loved because someone is loving it. When someone does not love the action then it is not an action loved anymore. 1. Aristotle claims that we gain virtues by adaptation, and this I believe is true. I believe that humans are not naturally good or evil, we just absorb whatever it is that we are socially exposed to. As we mature, we learn to question things so we begin to choose for ourselves which are virtuous deeds and which are not, in our own perception. 2. I agree that there is no fixity with matters concerned with conduct and what’s good for us. As we mature, we, as humans learn how to preserve ourselves by accepting and rejecting beliefs that are beneficial for us. 3. Aristotle explains that virtuous men are only the ones capable of doing virtuous acts. I believe that virtuous men are more important than performing virtuous acts since it is a given that virtuous men will do virtuous acts but those who do virtuous acts may also do non-virtuous acts. 4. I find the premise rather contradictory. Aristotle states that the mean is between extremes but he says that there are some things that are wrong in all circumstances, such as adultery or stealing. According to Aristotle himself, we only adapt to our social environment, that’s how we learn virtues. One’s wrong may be one’s right and the differences in the opinion clouds the premise that some actions is always wrong. So then, wrong actions become wrong only because the social environment rejects the behavior. 1. Hobbes claims that men can be equal when a weaker man conspires with other weaker men or use machineries or such to fight a stronger man, whether it is physical or mental strength. And I agree with this since there are instances, like in wars

Questionnaire or Interview on Effects of Substance Abuse on Prisoners Assignment

Questionnaire or Interview on Effects of Substance Abuse on Prisoners in Austin, Texas - Assignment Example In doing this, the study focuses on establishing the reasons for the prevalence of substance abuse in Austin prisons as everything has its own cause. This is what will be used to determine the negative impacts on prisoners despite the existence of rehabilitation and treatment centers to take care of drug users. The questionnaire addresses all issues related to the effects of drug abuse on prisoners in Austin. Introduction Substance or drug abuse is a pattern of harmful and injurious use of drugs for purposes of altering one’s mood. According to Chang (2010), substance abuse refers to the consumption of illicit drugs for purposes that are meant to interfere with the normal mental condition of a person. Substance abuse is prevalent among many prisons in the modern world. There has been an increase in the rates of substance abuse in Austin prisons (Texas Statistical Report, 2012). This has been due to the fact that many prisoners want to forget their situation of being locked up in an institution with no freedom of movement. They, however, do not consider the long-term effects that substance abuse imposes on their lives as they are only focused on the short-term impacts, which in this case, is the altering of the normal condition. They do not consider the health and economic challenges that they incur later as a result of substance abuse. These conditions alter their social way of lives in one way or the other. Objectives of the study Specific objective I. To establish the effects of substance abuse on prisoners in Austin, Texas Other objectives I. To determine the prevalence of drug abuse in Austin prisons II. To determine the challenges faced by relatives of drug abusers in Austin Hypothesis I. Ho: there is no relationship between a weak criminal justice system and prevalence of substance use in prisons. H1: there is a relationship between a weak criminal justice system and prevalence of substance use in prisons. II. H: drug-related offenses influence dru g abuse in Austin prisons H1: drug-related offenses do not influence drug abuse in Austin prisons III. Ho: there is no relationship between negative effects on substance abusers and challenges to relatives of substance abusers H1: there is a relationship between negative effects on substance abusers and challenges to relatives of substance abusers A Questionnaire on Effects of substance abuse on prisoners in Austin, Texas SECTION A Personal Details 1. What is your name? (Optional) 2. What is your age? A. Below 18 years B. 18-30 years C. 31-40 years D. 41-50 E. Above 50 3. What is your education level? A. Primary B. Secondary C. Tertiary D. None 4. What is your religion? 5. What was the reason for your incarceration? Explain Possible answers to this question could be drug-related offenses or other offenses that may lead to incarceration. Jennifer et al. (2012), notes that drug abuse is implicated in three kinds of offenses related to drug. That is offenses related directly to drug ab use such as theft to get money for drugs, offenses defined by drug sale or possession, and offences related to a way of life that disposes an individual (substance abuser) to engage in unlawful activities. This may take the form of associating with other lawbreakers or with illegitimate markets. Therefore, most of the responses from interviewees on this question could be that they were imprisoned because of directly drug-related directly offenses.

A critical assessment of the marketing challenges facing an Essay

A critical assessment of the marketing challenges facing an organisation of your choice and recommendations for the development of Competitive Advantage - Essay Example A close analysis of other companies that have survive during harsh market periods will help point out possible opportunities that Ryanair mas use to escape the looming threat. The research will end with workable recommendations that will provide strategies for Ryanair to survive within the market. In the 21st century business environment, companies have to stay on the alert in terms of aligning their business strategy with the ever-changing business environment. Particularly, the international airlines market has become sensitive with rapid changes in the economic structure, increase in competition and government regulation (Cento, 2009). Ryanair, one of the low-cost international airline operators in Europe, has faced a number of challenges while operating in the dynamic market. The purpose of this essay is to make an analysis of the competitive ability of the company, point out specific problems and develop strategic adaptations for the company. Marketing analysis is concerned with the ability of a company within a specific industry to position itself as a top service provider. Hubbard, Rice, & Beamish (2008, p.69) defined industry as, a group of organizations or business units producing close substitutes. â€Å"Market† is a word which use very closely to â€Å"Industry.† Perhaps the most frequent word use as a substitute to â€Å"industry.† However, â€Å"market† defined as a group of consumers with similar needs. (Hubbard, Rice, & Beamish, 2008, p. 97). Evidently, each organization has operates within a particular industry and has a specific target market. Within an industry, organizations compete as a way of appealing to their target customer to purchase their service and products. On the other hand, the customers choose organizations that best suit their needs and purchase from organizations that best satisfy their tastes and

Case Study Abdominal Aortic Aneurysm Health And Social Care Essay

Case Study Abdominal Aortic Aneurysm Health And Social Care Essay A 72 year old male patient, smoker and family history of AAA, was referred by his GP to x-ray department. With clinical indication of fall at stairs 2 weeks ago and pain in lower back and right hip, to have an x-ray of lumbar spine and pelvis. After justifying the request card and check his details, they did AP and Lateral of his lumbar an AP examination of pelvis. And they send him back to have a result by his GP after 10 days. Radiologist reported on his x-rays and sends it back to the GP. There was an evaluation of the classification in the abdomen and suspected abdominal aortic aneurysm. So GP asked him to attend the surgery to discuss the x-ray result, and request an ultrasound of abdomen to have a better result and rough indication of the internal diameter and accurate assessment .Gp asked him to wait until he received appointment letter from hospital. After 4 weeks he had his appointment. Clinical indication was classification on lumbar x-ray, query abdominal aneurysm. Before he goes to do the screening he was fast for eight hours because food and liquid in the stomach and urine in the bladder can make it difficult to a get clear picture of the aorta for the ultrasound technician. He changed into a gown. Radiologist asked him to lie on his back and then he applied small amount of cold gel in his abdomen because the air between the skin and aorta will help to reduce by using the gel, by pressing the transducer against the skin over the abdomen. Radiologist monitored blood flow through the abdominal aorta to check for an aneurysm (Myo clinical staff 2010 and NHS website 2010). After procedure he discussed the result with patient. And reported the scan to his GP. The evaluation of ultrasound scan was an abdominal aortic aneurysm which was 4.5 cm. Heart was in normal size. No evidence of any significant mediastinal mass or lymph node enlargement. Kidneys were in normal sizes. The routine measurements and protocol are: Longitudinally, will examine the aorta from diaphragm to bifurcation, and will Document the length of the aneurysm and measure the anteroposterior (AP) diameter from outer wall to outer wall, and also will examine the iliac arteries to the iliac bifurcation and measure aneurysm from outer wall to outer wall. Transversically will Document the maximum diameter of the aorta at the diaphragm, superior mesenteric artery (SMA), and distally, and Measure AP and transverse diameters from outer wall to outer wall, also will Visualize the iliac arteries and measure aneurysms (Vikram and Deborah 2004). GP reoffered him to vascular surgeon, after 3 weeks he met the surgeon, He reviewed his medical history and discussed the x-ray and ultrasound result with him And rerecommend him watchful waiting, it means that the if aneurysm was smaller than 2 inches (5 centimetres) in diameter, it is not serious enough to require surgery. In this case, his doctor will check his condition every six months using additional ultrasound exams or other imaging tests until aneurysm reaches to 5.5cm (Medline Plus 2004). He also asked him to quit smoking, because Smokers are approximately 5times as likely as non-smokers to develop AAA (Hafez 2008). Six month after In Dec 2007 he received his second appointment for scan of his abdomen. He attends his appointment with same procedure. There was a small amount of increase in his aneurysm. Therefore report was send to Gp. Evaluation was 4.7cm aortic aneurysm. In April 2008 he had another scan with aneurysm with 5.2cm aneurysm. He could not stop smoking, but his GP strongly advised him to stop smoking. In March 2009, it was 5.6cm aneurysm and if the abdominal aortic aneurysm expands by more than 0.6 to 0.8cm per year, repair is usually recommended (Robert et al 2008). http://www.e-radiography.net/radrep/Vascular/Vascular_AAA_US_55mm/Vascular_AAA_US_55_long.jpg Radiological Report : US Abdominal Aorta : The maximum A.P. internal diameter of the abdominal aorta is 5.6 cms. Mural thrombus reduces the internal diameter to 2.0cms (x-ray 2000).   Vascular surgeon discussed with patient that he need a surgery as soon as possible, also explained the existence of two possible methods of repair and to outline the major risks and benefits of each. The traditional (open) surgical approach involves direct exposure of the aneurysm followed by replacing the aneurismal part of the aorta with a synthetic graft. Endovascular aneurysm repair (EVAR) is a more modern and less invasive technique which is becoming widely used (Hafez 2008). Patient preffered to have EVAR operation, but everybody is not suitable for EVAR, because of the shape of their aneurysm. So he was asked to have a CT angiogram to check if he is suitable for EVAR, otherwise he should have open surgery (NICE 2006). Surgeon request CT angiogram for him with clinical indication of EVAR 5.6cm in ultrasound scan. The week after he had a CT angiogram aorta. The technologist asked him if he has allergy to any contrast media, then positioned him on the CT examination table, lying flat on his back. He inserted an intravenous (IV) line into a small vein in his arm. A small dose of contrast material injected through the IV to determine how long it takes to reach the area under study. Week after the surgeon received the report from Radiologist. Evaluation of CT scan was a 6.2cm infrarenal AAA with a satisfactory neck and good potential common iliac landing zones suitable for EVAR ( Bhattacharya ). He asked to attend a pre-operative assessment clinic to meet his surgeon and other members of clinical team. They took his medical history and carried out a physical examination. The surgical team carried out a number of tests to make sure that he is healthy enough to have an anaesthetic and surgery. The tests were included: Arterial Blood Gas (ABG) levels, to monitor oxygenation, ventilation, and acid base status. Complete blood count to monitor Red blood cell, White blood cell(WBC), and platelet counts altered haemoglobin levels and hematocrit reflect any blood loss and the oxygen carrying ability of the blood. An elevated WBC count reflects an inflammatory response. Serum electrolyte panel-monitors fluid ,electrolyte, and acid base status Serum creatinine and blood urea nitrogen (BUN) levels, to monitor renal function. Blood coagulation studies to monitor clotting. Urinalysis to monitor renal status including secretion and concentration Blood crossmatching necessary for blood replacement Electrocardiography (ECG) may reveal cardiac changes associated with ischemia Chest X-ray may reveal abnormalities of the chest, heart and lungs (Holloway 2004). his RWS was 4.6 M/mcL, WBC: 6 K/mm^, haemoglobin levels: 11 g/dL, Hematocrit 44%, Blood urea nitrogen 13 mg/dL, Bilirubin, direct 0.2 mg/dL, Bilirubin, total 0.2 mg, Creatinine 0.8 mg/dL,( GAIL  HOOD 2007). The surgical team gave him advice about what he can do to prepare for surgery, and they also asked him about his home circumstances so that his discharge from hospital can be planned. If he still smoker, he strongly advised to stop smoking as soon as surgery is required. Research has found that people who stop smoking for at least two months before having surgery are four times less likely to experience complications following surgery compared with those who smoke. He already stopped smoking. Surgeon discussed him what will happen before, during and after his procedure, and any pain he might have. On admission day which was the week after, he was seen by one of the junior doctors who was obtained a detailed medical history and did a full physical examination. Blood tests were repeated and any pending investigations (for example heart scan) performed. One of the more senior doctors took through the consent form which you was required to sign before they can proceed with surgery. He was fasting from midnight before the procedure. Nursing care was focused on restoring and maintaining hemodynamic stability. Administer supplemental oxygen, monitor the patients cardiovascular status, insert two large-bore I.V. devices, and fluid resuscitate with 0.9% sodium chloride or lactated Ringers solution if hes hypotensive (Raymond 2006). He was taken to the theatre complex in his bed, In the anaesthetic room. the anaesthetist gave him an epidural and involves a needle puncture into his back. He also had a tube in his bladder, so that they could monitor the function of his kidneys; a tube in his hand, so that they could monitor his blood pressure. Then he transferred to the recovery area in the theatre complex, where he was taken care of by one of the recovery nurses pending transfer to the High Dependency Unit or the Vascular Ward. All the above mentioned tubes stayed in till the next morning, when all the tubes are removed and was encouraged to start walking and moving around. They gave him aspirin and cholesterol-lowering medication. He strongly advised to stay on these for life to reduce the risk of developing heart problems or having a stroke as he grow older. During his hospital stay, he was getting a mini-injection of heparin (Fragmin). This will thin his blood and prevent him from getting clots whilst he is in hospital (Inglott 2007). So surgeon start elective surgery to repair an aorta. He made small cut in his groin and passed up a catather inside an artery in his leg until it reached the area of the aneurysm. A compressed stent graft was fed to the site of the aneurysm. The procedure was guided using intensifier x-ray machine and radiographer took images step by step. The stent graft is made of a tube supported by a metal mesh. The stent graft was placed across the aneurysm. The stent kept the aorta open and aneurysm was protected from further pressure. The stent graft is slowly released from the delivery system into the aorta. As the stent graft is released, it was expanded to its proper size so that it snugly fits into aorta both above and below the aneurysm The guide wire is then removed from the Body. The stent graft remained inside the aorta permanently. Imaging procedures was Performed to check whether the stent graft is properly placed. the cut was closed with stitches and a dressing was placed over the stitches. (Bupas Health Information Team 2010). After the procedure, his breathing tube removed and he was taken to the intensive care unit for recovery. He received fluids and nutrition through his IV. The catheter in his bladder was remained in place for several days. The hospital stay was 5 days. During this time he was encouraged to get up and out of bed. Complete recovery was 3 months. In order to detect any complication he had need to follow-up carefully, particularly in the early stages. CT angiography was performed at day 2 after placement. No evidence of endoleak was detected during arterial phase scanning or after a 2-min delay. The patient was discharged without complication.Follow-up CT angiography was performed at 1 month and five month. Then every year after that, to make sure there are not any problems. Discussion: Aorta is the main blood vessel in body. This carries blood from heart to the rest of the body. The part of the aorta in the abdomen is called the abdominal aorta. It supplies blood to the stomach, pelvis and legs. An aneurysm is a weak area in a blood vessel. If a blood vessel weakens, it starts to bloat like a balloon and becomes unusually big. If an aneurysm forms on the abdominal aorta and grows too big, the aorta might tear or rupture (Upchurch and Schaub April 1, 2006, Heather 2008). The most common of these aneurysms known as abdominal aortic aneurysms AAA, is below the origin of the arteries to the kidneys. A more anatomically correct description would be infrarenal aortic aneurysms. In men, the maximum normal aortic diameter at this level should not exceed 2.5 cm. An aorta that is 3 cm or more in diameter at this level qualifies as being aneurismal. The prevalence of AAA varies according to ethnicity, age and gender. Men are six times more likely to be affected by this condition. At the age of 65 years, 3% of men will have an AAA. The popularity then increases with age to reach nearly 8% at the age of 80. AAAs represents nearly 98% of aneurysms of the whole aorta (Hafez 2008). The rate of growth and the risk of rupture increase exponentially with the diameter of the aneurysm, with a watershed level for serious risk at about 5.5cm. Therefore until the patient is gravely ill from other causes, any aneurysm wider than 5.5 cm should be operated upon electively (Raymond 2006 and Dillon et al 2010).Abdominal aortic aneurysm is usually asymptomatic .smoking and high blood pressure, are most important risk factors (patient booklet 2009 and Hafez 2008) About 80% of patients who present with a ruptured abdominal aortic aneurysm have no previous diagnosis. When rupture occurs, mortality is very high (Scot et al 2008 and Philip et al 2009).February On physical examination, AAAs with 3 to 3.9 cm range are palpable 29% of the time, compared with those with an AAA more than 5 cm. which can be palpated 76% of the time (Gilbert et al 2008). The symptoms associated with AAAs are: blurred abdominal or back pain, abdominal pulsatile and abdominal mass may be present in obese patients, Palpation of aneurysm may be difficult Early satiety, nausea or vomiting may occur due to duodenal compression. Ruptured or leaking aneurysms may present with severe back, abdominal, or flank pain that may radiate to the groin Hypertension or tachycardia Syncope Abdominal mass on exam Signs of retroperitoneal hematoma (Scott et al 2004 and Rosalyn 2006 and Louise and Anderson 2001). Compared with open surgery, EVAR has lower operative mortality, lower morbidity, and shorter length of hospital stay and greater likelihood of discharge to home than open surgery (Schermerhorn 2009) CT is the next step to help determine which treatment should be used (endovascular or open surgery) .Serial CT scans can be used to visualise the proximal neck (the transition between the normal and aneurysmal aorta), the extension to the iliac arteries, and the patency of the visceral arteries. They can also measure the thickness of the mural thrombus. With three-dimensional imaging, helical CT and CT angiography can provide additional anatomical details, especially useful if endovascular procedure is considered.( Akalihasan et al 2011and Macari et al 2001) Informed consent for any AAA repair must include accurate information about the reason for recommending surgery (i.e. the risk of aneurysm rupture without surgery), the reason for recommending either open or endovascular surgery and about the likely outcomes. Warn about the site and size of the surgical scar, about wound infection and incisional hernia formation, about deep venous thrombosis and particularly about sexual dysfunction which, it appears, may be equally common after open and endovascular repair (Brian 2008). If the patient is hypertensive, administer beta-blockers and nitroprusside as ordered. Manage pain with morphine sulfate or hydromorphone to keep him comfortable and to combat pain-induced increases in BP, heart rate, and oxygen demand (GAIL  HOOD 2007). Gilbert R. Upchurch, Jr, MD; Christopher Longo, MD; John E. Rectenwald, MD,March 2008 Volume 63. Number 3 Geriatrics) Upchurch, Jr. G.R. (M.D.) and Schaub, T.A. (M.D.) (April 1, 2006) Abdominal Aortic Aneurysm American Family Physician online. Available from: http://www.aafp.org/afp/20060401/1198.html [Accessed 16/2/2011] Heather, B. P. ( 2008 ) Abdominal aortic aneurysms, screening and the law AvMA Medical Legal Journal,Volume 14 Number 2 online. Available from: Myo clinical staff,June 23, 2010, © 1998-2010 Abdominal ultrasound Mayo Foundation for Medical Education and Research (MFMER).online, available at: http://www.mayoclinic.com/health/abdominal-ultrasoundWhat you can expect/,MY00076/DSECTION=what-you-can-expect[accessed 23/1/2011] http://www.ruh.nhs.uk/patients/services/vascular/documents/Endovascular_Aneurysm_Repair_Patient_Information.pdf, accessed 21st DEC 2010 Ultrasound secrets,  By Vikram Dogra, Deborah J. Rubens,2004 ,Philadelphia,Pensilvania Abdominal aortic aneurysm. MedlinePlus Medical Encyclopedia. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000162.htm. Accessed September 12, 2004 Abdominal aortic aneurysm disease: health risks,management and screening Hany Hafez Clinical Risk 2008; 14: 208-210 DOI: 10.1258/cr.2008.080076 what is ct angiography aorta of abdominal aortic aneurysm Stoeltings anesthesia and co-existing disease Robert K. Stoelting, Roberta L. Hines, Katherine E. Marschall 2008 676 pages Abdominal aortic aneurysm disease: health risks,,management and screening,Hany Hafez Clinical Risk 2008; 14: 208-210 DOI: 10.1258/cr.2008.080076 (http://www.healthcarerepublic.com/news/766641/ Abdominal aortic aneurysm is the cause of more than 6,000 deaths per year. By Mr Vish Bhattacharya) h ttp://www.radiologyinfo.org/en/info.cfm?pg=angioct (http://www.healthcarerepublic.com/news/766641/ Abdominal aortic aneurysm is the cause of more than 6,000 deaths per year. By Mr Vish Bhattacharya) Medical-surgical care planning,  By Nancy Meyer Holloway, 2004, Lippincott William Wilkins http://www.nhs.uk/Conditions/repairofabdominalaneurysm/Pages/Preparation.aspx http://www.stent-graft.com/id11.html,  Dr Ferdinand Inglott, consultant Vascular and Endovascular Surgeon at the Manchester Royal Infirmary,2007 Bupas Health Information Team, July 2010. Endovascular aneurysm repair (EVAR),online at: http://www.bupa.co.uk/healthinformation/directory/e/endovascular-repair, [accessed 16/2/2011]. (General surgical operations Page 432 Raymond Maurice Kirk 2006 723 pages Preview) Hany Hafez,2008, Abdominal aortic aneurysm disease: health risks, management and screening, Clinical Risk, Volume 14 Number 6 General surgical operations Raymond Maurice Kirk 2006 Page 432,Churchill Livingstone Elsevier Endovascular treatment for ruptured abdominal aortic aneurysm,Dillon M, Cardwell C, Blair PH, Ellis P, Kee F, Harkin DW,The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 12, Copyright  © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. PATIENT INFORMATION BOOKLET ,Endovascular Stent Grafts:A treatment for Abdominal Aortic Aneurysms,2009 Medtronic, Inc. All Rights Reserved. Printed in USA. UC200805202aEN 4/09  ©2009 American Medical Association. All rights reserved. (Reprinted) JAMA, November 11, 2009-Vol 302, No. 18 Abdominal aortic aneurysm disease: health risks,management and screening Hany Hafez Clinical Risk 2008; 14: 208-210 DOI: 10.1258/cr.2008.080076 Scott Davarn, MD Rob Reardon, MD Scott Joing, MD Academic Emergency MedicineVolume 14, Issue 4, Article first published online: 28 JUN 2008 http://onlinelibrary.wiley.com/doi/10.1197/j.aem.2007.01.001/pdf Philip E. Baker Kumar V. Ramnarine,2009, Development and Application of an Experimental Abdominal Aortic Aneurysm Model, Ultrasound 2009;17(1):30-34 _ British Medical Ultrasound Society 2009 University Hospitals of Leicester NHS Trust, Department of Medical Physics, Leicester Royal Infirmary, Leicester LE1 5WW, UKULTRASOUND N February 2009 N Volume 17 N Number 1 URASOUND N February 2009 N Volume 17 N Number 1 ).- Abdominal aortic aneurysm Gilbert R. Upchurch, Jr, MD; Christopher Longo, MD; John E. Rectenwald, MD, March 2008 Volume 63. Number 3 Geriatrics Screening programmes ,Abdominal Aortic Aneurysm , © NHS Abdominal Aortic Aneurysm Screening Programme 2010 Produced by COI for the NHS ,401590/C 1p December 2010, http://aaa.screening.nhs.uk/ Baker L;  Anderson E, 2010 May; Abdominal aortic aneurysm: simple screening could save lives, Primary care nurse practitioner, Generations Family Health Center, Norwich, CT, American Journal for Nurse Practitioners (AM J NURSE PRACT), 2010 May; 14(5): 29-34 (27 ref), journal article pictorial, tables/charts. In a Page Surgery  By Scott Kahan, John J. Raves,2004,Lippincott Williams Wilkins,Philadelphia Rosalyn Gendreau , 2006, Is it a kidney stone or abdominal aortic aneurysm? : 22-4 (journal article pictorial) Louise A. Anderson, MS, RN,2001, Abdominal Aortic Aneurysm,,THE JOURNAL OF CARDIOVASCULAR NURSING/,Article 1 5/21/01 11:11 PM Page 1, J Cardiovasc Nurs 2001;15(4):1-14, © 2001 Aspen Publishers, Inc Marc Schermerhorn, MD, Discussant ©2009 American Medical Association. All rights reserved. (Reprinted) JAMA, November 11, 2009-Vol 302, No. 18 online available at http://jama.ama-assn.org/content/302/18/2015.full.pdf+html, [accessed 14/2/2011]. Royal United Hospital Bath, NHS, Endovascular Aneurysm Repair Patient Information, http://www.ruh.nhs.uk/patients/services/vascular/documents/Endovascular_Aneurysm_Repair_Patient_Information.pdf, accessed 21st DEC 2010 NICE 2006 Abdominal aortic aneurysm ,N Sakalihasan, R Limet, O D Defawe,2011 at http://www.surgical-tutor.org.uk/default-home.htm?specialities/general/aaa.htm~right Michael Macari, MD, Gary M. Israel, MD,Phillip Berman, BA, Maria Lisi, BA, Anuj J. Tolia, BA, Mark Adelman, MD, Alec J. Megibow, MD, MPH, August 2001 Infrarenal Abdominal Aortic, Aneurysms at Multi-Detector, Row CT Angiography: Intravascular Enhancement without a Timing Acquisition1,520 z Radiology Macari et al, Volume 220 z Number 2 Abdominal aortic aneurysms, screening and the law ,Brian P Heather, AvMA Medical Legal Journal, 2008 Volume 14 Number 2 at http://cr.rsmjournals.com/content/vol14/issue2/ http://www.nursingcenter.com/prodev/ce_article.asp?tid=693846 (How to protect a patient with aortic aneurysm GAIL  HOOD  IRWIN RN, CEN, BSN   Nursing2007 ,February 2007   ,Volume 37  Number 2,Pages  36  

Asserting Masculinity in the Cultural Context of Camp :: Sociology Essays Research Papers

Asserting Masculinity in the Cultural Context of Camp Summer camp is an important annual experience in many children’s lives. Some kids choose to continue with camp long past their camper years and become counselors. A program, the Camper in Leadership Training (CILT) program, exists within the camp structure as a leadership program designed to educate kids, aged fifteen through seventeen, on how to become effective counselors. Each session typically concludes with a closing campfire, which the male CILTs extinguish after the females have left by urinating on the embers. This folk ritual, affectionately known to the CILTs as â€Å"pissing out the fire,† is employed by the male CILT folk group as a strategy that allows them to reassert power, to reaffirm the solidarity of the all-male group, and to regain their masculinity, which has been altered within the camp environment, before leaving the shelter of that environment. During this transitional period, the CILTs anticipate returning to the larger social world and are soci alizing themselves accordingly. These kids’ experiences with gender identity at camp mirror Barrie Thorne’s point that gender is socially constructed and highly contextual (Thorne 10). This folk ritual allows these boys to regain their gender identity, the identity largely accepted by the outside culture, as they prepare to re-enter mainstream society. The program is an emotionally challenging one: apart from teaching the foundations of counseling skills, the CILT directors encourage an opening of one’s true self that often involves breaking down the gender fronts kids bring with them. Thorne argues that â€Å"boys’ social relations tend to be overtly hierarchical and competitive† (92). The program does not encourage this type of social interaction. Rather, the program chooses to emphasize the emotions in personal relationships and self-disclosure typical of girls’ social relationships (94). After two weeks of learning, sharing, and growing within the camp context, the males’ social relations operate similarly to the females’ because there is no threat of being socially outcast for adopting the behavior values of the other gender. That is to say, the males have become bicultural along gender lines. Just as teasing (as Thorne points out) dissuades cross-gender interaction, social pressu re outside camp plays a similar role in limiting males’ expression of things seen as feminine, such as sharing feelings (54). For an age group faced with many social anxieties, extinguishing the fire at the end of the session is an essential tool of anticipatory socialization used to recreate the male gender identity necessary for acceptance in the outside male social world.