Questions to answer on Management Essay Example | Topics and Well Written Essays - 3250 words

Questions to answer on Management - Essay Example The patent right enables an individual to own the idea or invention for substantial period of time so that it can be developed sufficiently into a real invention or business. Patent rights provide protection for the idea or invention from being copied or reproduced by others. Firstly, the idea or invention has to be explained in brief through an application made to the Government Patent Office by an agent or lawyer. This will be reviewed and approved if original and new. Once the first application is approved, a date will be given to the application during which he/she can work on the idea; this date is referred to as the ‘priority date.’ Once approved, a plan for its development must be prepared and produced to the patent office for further approval within 12 months. During this period, the inventor can advertise or publish the idea. After one year, the inventor needs to produce a detailed plan for its development, which is referred to as the ‘Final Specification. ’ If this idea is completely new and does not match with any of the other patents, then it is approved. If it finds any similarities with others, it is rejected. Rejection is accompanied with sufficient explanation. The applicant can also modify it in case it resembles any other idea. If the inventor fails to abide by the confidentiality of the idea or leaks the idea in some way, the patent will be subject to cancellation. Hence, confidentiality is very important during the period when first application is sent for approval. Secondly, if the idea or invention resembles or already exists in the market, then patent rights may be rejected. Patents applied in the United Kingdom are valid only within that country. To obtain patent protection in different countries, separate patents must be filed according to the respective country’s regulations. Obtaining international patents are very expensive. However, the International Convention on Patents provides a common priority da te for all patents during which ideation and development in different countries can be prepared. One common committee governing European patents is the European Patent Office (EPO), which provides patent protection in all European countries at the same time. Hence, patents issued by the EPO are enforceable by individual nations within the European Union and few other countries that come in the purview of EPO. Moreover, the patents issued by the EPO are governed by laws related to various international committees. Patents are divided mainly into 3 categories namely utility patents, design patents, and plant patents depending upon the idea or invention. In the engineering sector, utility and design patents are more common ones. National patents issued within European countries are governed by national legislation and could include aspects related to filing the patents, examination, scope of grants, invalidation, breach and revocation. Patents obtained on methods or ideas related to pr ocedures and certain products are not same in all countries. For instance, patents approved in the United States for certain products or procedures may not be approved in the United Kingdom and other countries. Under an employment agreement, ideally all inventions that are made during the employment and related to the job during working hours and with the use of official resources are owned by the employer. Therefore, if an employee invents something related to his/her job, then the rights to that invention are with the

Private School vs Public School Essay Example for Free

Private School vs Public School Essay Many public school facilities are impressive others are mediocre. The same is true of private schools. In the public school system, the twin engines of political support and economic revenue base are critical. In private schools the ability to attract endowments and other forms of financial support are just as critical. Private school facilities reflect the success of the schools development team and that of the school to continue to generate alumni support. Some private K-12 schools have facilities and amenities which surpass those found at many colleges and universities. Hotchkiss and Andover, for example, have libraries and athletic facilities on a par with those at Brown and Cornell. They also offer academic and sports programs which make full use of all those resources. It is hard to find comparable facilities in the public sector. They are few and far between. Public schools also reflect the economic realities of their location. Wealthy suburban schools will have more amenities than inner city schools as a rule. Think Greenwich, Connecticut versus Detroit, Michigan, for example. So, who has the edge? Lets call it a draw, all things considered. Class Size: According to the NCES report Private Schools: A Brief Portrait private schools win out on this issue. Why? Most private schools have small class sizes. One of the key points of private education is individual attention. You need student to teacher ratios of 15:1 or better to achieve that goal of individual attention. On the other hand a public system has to take almost anyone who lives within its boundaries. In public schools you will generally find much larger class sizes, sometimes exceeding 35-40 students in some inner city schools. At that point teaching rapidly degenerates into babysitting. Teaching: Public sector teachers are generally better paid. Naturally compensation varies widely depending on the local economic situation. Put another way, its cheaper living in Duluth, Minnesota than it is in San Francisco. Unfortunately low starting salaries and small annual salary increases result in low teacher retention in many public school districts. Public sector benefits have historically been excellent; however, health and pension costs have risen so dramatically since 2000 that public educators will be forced to pay or pay more for their benefits. Private school compensation tends to be somewhat lower than public. Again, much depends on the school and its financial resources. One private school benefit found especially in boarding schools is housing and meals. Private school pension schemes vary widely. Many schools use major pension providers such as TIAA-CREF Both public and private schools require their teachers to be credentialed. This usually means a degree and a teaching certificate. Private schools tend to hire teachers with advanced degrees in their subject over teachers who have an education degree. Put another way, a private school hiring a Spanish teacher will want that teacher to have a degree in Spanish language and literature as opposed to an education degree with a minor in Spanish. Budgets: Since local property taxes support the bulk of public education, the annual school budget exercise is a serious fiscal and political business. In poor communities or communities which have many voters living on fixed incomes, there is precious little room to respond to budget requests within the framework of projected tax revenue. Grants from foundations and the business community are essential to creative funding. Private schools on the other hand can raise tuition, and they also can raise significant amounts of money from a variety of development activities, including annual appeals, cultivation of alumni and alumnae, and solicitation of grants from foundations and corporations. The strong allegiance to private schools by their alumni makes the chances of fund-raising success a real possibility in most cases. Administrative Support: The bigger the bureaucracy, the harder it is to get decisions made at all, much less get them made quickly. The public education system is notorious for having antiquated work rules and bloated bureaucracies. This is as a result of union contracts and host of political considerations. Private schools on the other hand generally have a lean management structure. Every dollar spent has to come from operating income and endowment income. Those resources are finite. The other difference is that private schools rarely have teacher unions to deal with. Advantages and disadvantages: There are many advantages and disadvantages to both public and private schools. As a parent, both options must be explored and the choice must be based on what is right for each particular child. Public schools often have a larger variety of subjects available, especially when it comes to electives. However, what is learned is somewhat decided by the state because public schools need to do well on standardized testing. Private schools, on the other hand, whether parochial or private have much more freedom of choice in curriculum and can choose to make their own assessments. Because of the individualized instruction, private schools tend to do generally better on standardized testing, that is, if they choose to use it. Private schools, many times, have more demanding curricula and have a higher rate of students who go on to attend college. Public schools are larger and also have larger class sizes. Public schools also have larger student-teacher ratios. According to a web site called Public School Review, Private schools average 13 students per teacher, compared with an average of 16 students per teacher in public schools (public school review). However, public schools have certified teachers. Private schools typically have teachers who are not state-certified and who may not have expertise in their subject matter. The biggest difference between public and private schools probably is that public schools are required to educate all students. They cannot deny any student admission. On the other hand, private schools have complete control about which they accept and can kick students out much more easily. Public schools are funded by tax revenue whereas private schools are funded privately. That means private schools cost money to attend called tuition. Taxpayers pay for public schools so the payment is included in what people pay. However in private schools, the payment is upfront for students to attend. Overall, there is no one right answer for which kind of school a student attends-public or private. The decision must be made for each individual student as there are advantages and disadvantages of both. Comparisons: Private school can be more beneficial than going to a public school. Private schools focus on preparing students for the next level of education; public schools are focused on test preparations sessions. Choosing the right school system for your child has a repercussion towards their future education. In the public school system the classrooms are overcrowded with students. Each class has an average of 27 to 30 students to it, which can limit the ability of one on one interaction with the teacher. A lot of the bullying issues come from the unstructured dress codes. This can create social divide to the less fortunate kids that can’t afford all the name brand items. In public school teachers are quick to say your child needs to be on medication if they are high strung, without knowing what other forms of issues might be occurring in the home. When parents try to discipline their child at home the school seems to always try to step in. Some things should be up to the parents to handle without haven to worry about the school stepping in. In the private school system when a child enters the school for the first time he or she will start out with a minimal class size with no more than 20 students. This allows more one on one time with the teacher, it also opens up more time for activities. The private school has a very strictly enforced dress code to eliminate animosity between the students. The schools are very family oriented with parents and students being involved with school activities. Teachers and parents are held to higher standards from the private schools. Teachers are expected to continue to grow and parents are obligated to maintain discipline of their children even in their absence. The testing that takes place at private schools is called Terra Nova, and kids are tested two or three times a year. Conclusion So, who comes out on top? Public schools or private schools As you can see, there are no clear-cut answers or conclusions. Public schools have their advantages and disadvantages. Private schools offer an alternative. Which works best for you? Thats the real question which you have to answer.

Rebound Tenderness in Diagnosis of Appendicitis in Children

Rebound Tenderness in Diagnosis of Appendicitis in Children Abdominal pain is a common presentation within the accident and emergency department [A+E] and specialist nurses working in this environment need to be familiar and confident in dealing with this presentation (Hibberts and Bushell 2007, Pines, Pines, Hall, Hunter, Srinivasan and Ghaemmaghami 2005). Abdominal pain can be associated with a wide variety of surgical and nonsurgical conditions, with the most prevalent cause being acute appendicitis (Lin, Chen, Chung, Ho, and Lin, 2009). The diagnosis of appendicitis is formulated from subjective and objective data including a patients history, abdominal examination, laboratory investigations and signs and symptoms. This assignment will critically analyse the clinical skill of testing for rebound tenderness and its relevance to diagnosing appendicitis in children. The clinical diagnosis of acute appendicitis in children is difficult for many practitioners (Broek, Ende, Bijnen, Breslau and Alkmaar, 2004). Between the years 2008 and 2009 the number of patients presenting to A+E within the UK who were diagnosed with appendicitis was 44,244 (NHS Information Centre, 2009). This equates to almost 0.3% of all presentations in A+E over one year. Approximately 9,300 of this population were between the ages of 0 and 14 years old (NHS Information Centre, 2009). However up to 25% of these 9,300 children with suspected appendicitis have a normal appendix at operation (Smink, Finkelstein, Garcia-Pena, Shannon, Taylor, and Fishman, 2004). Furthermore, the 25% of paediatric negative appendectomies now result in considerable clinical and economic costs to the NHS (Koepsell, 2002). These substantial figures are one of the primary reasons for specifying this assignment on children. In addition, the scope of practice within A+E covers paediatrics for many adult q ualified nurses and adult trained nurse practitioners. It is therefore imperative that the knowledge base for all A+E staff encompasses paediatrics at an advanced level as well (Cleaver, 2003). The overall accuracy for the clinical examination in diagnosing acute appendicitis has been reported to be between 54% and 70% in children (Birkhahn, Briggs, Datillo, Van Deusen and Gaeta, 2006). In addition Whisker, Luke, Hendrickse, Bowley and Lander (2009) suggest that only 4% of children have a miss-diagnosis of appendicitis in specialist paediatric centres, compared to 20% in district general hospitals. Despite the uncertainty of the diagnosis and the cost of miss-diagnosis to the NHS, appendicitis requires urgent treatment (Williams, et al., 2009). This is due to the risk of perforation, which occurs in approximately one third of cases in children (Neilson, et al., 1990). Therefore the need for a good clinical assessment at first contact in A+E is needed to provide a correct management plan and reduce on costs for the NHS. An abdominal examination should be performed where possible in a warm, well lit room with the patient well-draped and relaxed (Bickley, 2009). Initially the practitioner should undertake inspection, auscultation and percussion of the whole nine sections of the abdomen (Lippincott Williams and Wilkins, 2008). The final aspect of the abdominal examination should be palpation as this has the potential to be the most painful (Allan, 2008). Palpation is a process which should always be commenced away from the site of pain, as this will allow the patient to gain some reassurance from the practitioner and help them to relax (Bickley, 2009, Hibberts and Bushell, 2007). The practitioner should utilise the palmer surfaces of the fingers to identify any abnormal signs (Bickley, 2009). More specific palpation techniques can help to diagnose appendicitis, such as rebound tenderness (Bickley, 2009). This is performed by pressing slowly and firmly to a specific area and then withdrawing them quickly (Bickley, 2009). Practitioners should observe the patient and ask if pain was worse on pressing or letting go (Hibberts and Bushell, 2007). However, Bickley (2009) suggests that if any of the previous examinations such as light or deep palpation are positive then this should not be undertaken as it will cause undue pain for the patient. The whole process of abdominal examination in children follows the same system as in adults. However, the causes of abdominal pain in children are often different, encompassing a broad range of acute and chronic diseases (Bickley, 2009). Therefore it maybe pertinent to suggest that more emphasis should be placed special techniques such as checking for rebound tenderness rather than abdominal palpation and testing for rebound. The initial discovery and accreditation of rebound tenderness (also known as Blumbergs sign) is credited to a German surgeon called Jacob Moritz Blumberg (1873 1955). Many articles make reference to Blumbergs sign; however there appears to be no relevant literature, research or evidence base to support this surgeon was the gentleman who discovered this sign (Mantzaris, Anastassopoulos, Adamopoulos and Gardikis, 2008). A study undertaken by (Williams, et al., 2009) showed that out of 98 children who had acute appendicitis 91% had right lower quadrant tenderness on palpation however only 30% had rebound tenderness. Another study by Lin, Chen, Chung, Ho, and Lin (2009) also suggested that 43.4% of the 53 children examined with appendicitis had rebound tenderness. So both these studies suggest that positive rebound tenderness is an indication of an acute appendicitis in children and therefore cannot be ruled out of an initial differential diagnosis. Golledge, Toms, Franklin, Scriven and Galland (1996) specifically evaluated the â€Å"cats eye symptom† (pain going over a bump in the road), the cough sign, right lower quadrant pain to percussion, rebound tenderness and guarding. The data from this evaluation suggested that rebound tenderness had a likelihood ratio of 7.4 compared to the other signs which had likelihood ratios of between 1.1 and 4.1. This data therefore suggests that rebound tenderness is a very useful sign in the diagnosis of acute appendicitis, but that the other signs and symptoms are not (Moyer, et al., 2001). Overall rebound tenderness is useful sign for diagnosing appendicitis when there is a high suspicion of appendicitis and is accompanied with other diagnostic indicators (Moyer, et al., 2001). Another presentation to be considered in relation to abdominal pain and rebound tenderness is the duration of the pain experienced by the child. A study undertaken by Oshea, Bishop, Alario and Cooper (1988) involved 246 children from 13 to 18 years old who presented to the emergency department with a history of less than one week of abdominal pain. Results showed that the likelihood ratio of pain was greater when the child had the pain for more than 12 hours (Likelihood ratio: 1.3) compared to less than 12 hours (Likelihood ratio: 0.64). Later in the study pain duration was evaluated at less than 24 hours and more than 24 hours, with their likelihood ratios being 0.83 and 1.2 respectively. When compared to Andersson, et al. (1999) study of 502 patients aged 10 to 86 the greatest likelihood ratio was 1.7 at 7-12 hours after onset of pain. Based on both studies it is very difficult to see how duration of pain can lead to the diagnosis of appendicitis. Therefore, practitioners must not allow the duration of pain to prevent any further investigation into the diagnosis (Moyer, et al., 2001). Another symptom which could possibly indicate the diagnosis of appendicitis is fever (Gwynn, 2001). Cardall, Glasser and Gusss (2004) study evaluated two hundred and ninety three people aged between 7 and 75 who presented to the emergency department with suspected appendicitis. Temperatures were classed at greater than 99oF or less than 99oF. The study showed that 27% of patients whos temperature was 99oF. When the results were analysed in terms of specific temperature intervals, the highest likelihood ratio (3.18) was found in patients with temperatures greater than 102  °F. However, Bergerons (2006) study on clinical judgement suggests there is no clinical value with temperature as there is minimal sensitivity and specificity in the diagnosis of appendicitis. Therefore, as with duration of pain duration and levels of WBCC, temperature as a single entity has little diagnostic utility in the diagnosis of appendicitis unless it is combined with other signs and symptoms such as rebou nd tenderness (Cardall, Glasser and Guss, 2004). For many years laboratory tests such as white blood cell count (WBCC) leukocytes and C-reactive protein (CRP) have been used to support a diagnosis, but the considerable overlap with other inflammatory conditions accounts for the low specificity and positive predictive value of these tests (Stefanutti, Ghirardo and Gamba, 2007). Recent studies on adult patients who present with clinical signs and symptoms indicating acute appendicitis, show that appendicitis can be excluded if both leukocyte count and C-reactive protein value are normal (Gronroos, 2001). However, Stefanutti, Ghirardo and Gamba, (2007) suggest that only a few studies have been reported in paediatric patients and the role of WBCC and CRP in excluding acute appendicitis in children has not been confirmed. According to Andersson et al. (1999) children who present with signs and symptoms of appendicitis such as rebound tenderness and have a WBCC of 15000 only moderately increases the estimated risk of appendicitis. This t herefore shows that only at the extremes of the WBCC does this diagnostic indicator appear useful (Moyer, et al., 2001). Therefore, contrary to adult patients, normal leukocyte count, WBCC and CRP value cannot effectively exclude acute appendicitis in children. Another usual predictor of appendicitis is vomiting (Bergeron, Richer, Gharib and Giard, 1999). The study by Andersson et al. (1999) calculated the likelihood ratio for appendicitis in a patient with vomiting compared to one with no vomiting to be 1.8. In addition Reynolds and Jaffe (1992) study suggests that a combination of four predictors including; vomiting right lower quadrant pain, abdominal tenderness, and abdominal guarding. More specifically 97% of the 377 children studied who were diagnosed with appendicitis had two or more of these predictors. Therefore, a patient who presents to A+E with less than two of the above predictors is quite unlikely to have appendicitis. Alvarado (1986) conducted a retrospective study of 305 patients hospitalised with abdominal pain suggestive of acute appendicitis. Signs, symptoms, and laboratory findings were analysed for specificity, sensitivity, predictive value, and joint probability.Their importance, according to their diagnostic weight, was determined as follows: localized tenderness in the right lower quadrant, leukocytosis, migration of pain, shift to the left, temperature elevation, nausea-vomiting, anorexia-acetone, and direct rebound pain (Alvarado, 1986). This scoring system shown below is deemed by many surgeons as an easy aid for supporting the diagnosis of acute appendicitis (Khan and Rehman, 2005). A study undertaken by Baidya, Rodrigues, Rao and Khan (2007) investigated the diagnostic accuracy of Alvarado scoring system. The results showed that a score of >7 for an appendicitis was 88.2% correct in diagnosis. However, the diagnostic accuracy of an Alvarado score Despite recent advances in knowledge and diagnostic investigations, a population-based analysis in the United States found that the incidence of unnecessary appendectomy has not changed (Flum, Morris and Koepsell, 2001). Therefore to increase diagnostic accuracy, new modalities such as ultrasound scans have been introduced (Broek, Ende, Bijnen, Breslau and Alkmaar, 2004). Kaneko and Tsuda (2004) conducted a 10-year study using ultrasound scans to diagnose appendicitis in children and are convinced that ultrasound scans can identify inflamed appendices with 100% sensitivity and can also determine the severity as well. However Smink, Finkelstein, Garcia-Pena, Shannon, Taylor and Fishman (2004) suggest that the use of ultrasound has not decreased negative appendectomies as similar negative rates were present over a decade ago. Therefore on the basis of the available evidence, patients presenting to A+E with a strong clinical case of appendicitis should be referred direct to the surgeon without an ultrasound. In addition to the use of ultrasound scanning the use of computed tomography (CT) has been recently studied and evaluated. There are currently two perspectives in the literature regarding the use of CT scan for the diagnosis of acute appendicitis: one supporting its routine use due to the decreased incidence of negative appendectomies, and the other one against its routine use due to the increased cost and delay in surgical management (Ceydel, Lavotshkin, Yu and Wise, 2006). In addition the benefits of imaging eliminating inpatient observation and unnecessary surgery must be weighed against the malignancy risk from radiation, as well as discomfort of rectal contrast administration (Smink, Finkelstein, Garcia-Pena, Shannon, Taylor and Fishman, 2004). Ceydel, Lavotshkin, Yu and Wises (2006) retrospective study showed that the negative appendectomy rate was much less in patients who had CT scans (7.6%) compared to the non CT scan group (24%). Therefore clinicians within A+E use their cl inical judgement and place emphasis on the importance of routine history and an accurate physical examination utilising CT scans for atypical cases of acute appendicitis (Gwynn, 2001). Currently within the A+E department there is no specific pathway or tool for ruling in acute appendicitis in paediatrics. In addition Birkhahn, Briggs, Datillo, Van Deusen and Gaeta (2006) suggest that no major medical association or professional organisation currently endorses a standardised pathway for the evaluation of patients with suspected appendicitis. With up to 25 % of children having negative appendectomies it is therefore of clinical and financial value to consider the use of a scoring system to admit or discharge children who present with a possible acute appendicitis. Current systems are in place for other potential conditions such as myocardial infarctions, pancreatitis and pneumonia. These other systems have been audited locally and nationally and are currently working well within the trust, therefore the plans to introduce the Alvarado scoring system will be put forward in the next review of clinical practice meeting between nursing and medical staff. To conclude, this assignment demonstrates that for an emergency department practitioner in a fast paced A+E setting, the accurate diagnosis of acute appendicitis remains a challenge for the paediatric age group. An accurate history and physical examination, which as highlighted can be challenge in younger patients plays an important role in the diagnosis of early acute appendicitis (Mallick, 2008). Physical clinical signs elicited upon examination provide the practitioner with a good insight to expected diagnosis. However, the usefulness of rebound tenderness as a single examination has minimal clinical value. The whole patient picture which encompasses an accurate history, clinical examination, laboratory investigations and possible diagnostic imaging is therefore vital to providing a correct diagnosis. The use of clinical scoring systems like the Alvarado score can be a cheap and quick tool to apply in emergency departments to rule in acute appendicitis. This scoring system includes many aspects such as clinical history, rebound tenderness and laboratory investigations. This allows for observation and critical re-evaluation of the evolving clinical picture. Its application improves the overall diagnostic accuracy and consequently reduces negative appendectomies (Khan and Rehman, 2005). In clinical cases where the practitioner is unsure if the actual diagnosis is acute appendicitis other diagnostic imaging studies such as ultrasound and CT may be undertaken. This must only then be considered once a thorough clinical examination has not provided any indication for acute appendicitis and the benefits out way the risks. References NHS Information Centre. (2009). Primary diagnosis: summary. Retrieved November 21, 2009, from Hospital Episode Online: http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937categoryID=202 Allan, B. (2008). History and examination (3rd ed.). Philadelphia: Mosby. Alvarado, A. (1986). A practical score for the early diagnosis of acute appendicitis. Annals of Emergency Medicine, 15 (5), 557-564. Andersson, R., Hugander, A., Ghazi, S., Ravn, H., Offenbartl, S., Nystrà ¶m, P., et al. (1999). Diagnostic value of disease history, clinical presentation, and inflammatory parameters of appendicitis. World Journal of Surgery, 23 (2), 133-40. Baidya, N., Rodrigues, G., Rao, A., Khan, S. (2007). Internet Scientific Publications. Retrieved December 22, 2009, from The Internet Journal of Surgery: http://www.ispub.com/journal/the_internet_journal_of_surgery/volume_9_number_1/article_printable/evaluation_of_alvarado_score_in_acute_appendicitis_a_prospective_study.html Bergeron, E. (2006). Clinical judgment remains of great value in the diagnosis of acute appendicitis. Canadian Journal of Surgery, 49 (2), 96-100. Bergeron, E., Richer, B., Gharib, R., Giard, A. (1999). Appendicitis is a place for clinical judgment. American Journal of Surgery, 177, 460 462. Bickley, L. (2009). Bates Guide to Physical Examination and History Taking (10th ed.). Philadelphia: Wolters Kluwer Health / Lippincott Williams and Wilkins. Birkhahn, R., Briggs, M., Datillo, P., Van Deusen, S., Gaeta, T. (2006). Classifying patients suspected of appendicitis with regard to likelihood. The American Journal of Surgery, 191, 497-502. Broek, W., Ende, E., Bijnen, A., Breslau, P., Alkmaar, D. (2004). Which children could benefit from additional diagnostic tools in cases of suspected appendicitis? Journal of Paediatric Surgery, 39 (4), 570-574. Cardall, T., Glasser, J., Guss, D. (2004). Clinical value of the total white blood cell count and temperature in the evaluation of patients with suspected appendicitis. Academic Emergency Medicine, 11 (10), 1021-1027. Ceydel, A., Lavotshkin, S., Yu, J., Wise, L. (2006). When should we order a CT scan and when should we rely on the results to diagnose an acute appendicitis? Current Surgery, 63 (6), 464-468. Cleaver, K. (2003). Developing expertise the contribution of paediatric accident and emergency nurses to the care of children, and the implications for their continuing professional development. Accident and Emergency Nursing, 11, 96 102. Flum, D., Morris, A., Koepsell, T. (2001). Has misdiagnosis of appendicitis decreased over time? A population-based analysis. Journal of the American Medical Association, 286, 1748-1753. Golledge, J., Toms, A., Franklin, I., Scriven, M., Galland, R. (1996). Assessment of peritonism in appendicitis. Annals of the Royal College of Surgeons England, 78, 11-14. Gronroos, J. (2001). Do normal leukocyte count and C-reactive protein value exclude acute appendicitis in children? Acute Paediatrics, 90, 649- 651. Gwynn, L. (2001). The diagnosis of acute appendicitis: Clinical assessment versus computed tomography evaluation. The Journal of Emergency Medicine, 21 (2), 119-123. Hibberts, F., Bushell, C. (2007). Physical assessment in gastroenterology abdominal examination. Gastrointestinal Nursing, 5 (7), 24 30. Kalan, M., Talbot, D., Cunliffe, W., Rich, A. (1994). Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis: a prospective study. Annals of the Royal College of Surgeons, 76, 418-419. Kaneko, K., Tsuda, M. (2004). Ultrasound-based decision making in the treatment of acute appendicitis in children. Journal of Paediatric Surgery, 39 (9), 1316-1320. Khan, I., Rehman, A. (2005). Application of Alvarado scoring system in diagnosis of acute appendicitis. Journal of Ayub Medical College Abbottabad Pakistan, 17 (3), 17-21. Koepsell, F. (2002). The clinical and economic correlates of misdiagnosed appendicitis: Nationwide analysis. Archives of Surgery, 137, 799-804. Lin, C., Chen, J., Chung, T., Ho, Y., Lin, W. (2009). Children presenting at the emergency department with right lower quadrant pain. Journal of Medical Science, 25, 1-9. Lippincott Williams and Wilkins. (2008). Assessment made incredibly easy Philadelphia: Wolters Kluwer Health / Lippincott Williams Wilkins. Malik, K., Khan, A., Waheed, I. (2000). Evaluation of the Alvarado score in diagnosis of acute appendicitis. Journal of College of Physicians and Surgeons Pakistan, 10, 392-394. Mallick, M. (2008). Appendicitis in pre-school children: A continuing clinical challenge: A retrospective study. International Journal of Surgery, 6, 371-373. Mantzaris, D., Anastassopoulos, G., Adamopoulos, A., Gardikis, S. (2008). A non-symbolic implementation of abdominal pain estimation in childhood. Information Sciences, 178, 3860-3866. Moyer, V., Elliott, E., Davis, R., Gilbert, R., Klassen, T., Logan, S., et al. (2001). Evidence Based Paediatrics and Child Health. London: BMJ Books. Neilson, I., Laberge, J., Nguyen, L., Moir, C., Doody, D., Sonnino, R., et al. (1990). Appendicitis in children: Current therapeutic recommendations. Journal of Paediatric Surgery, 25 (11), 1113-1116. Oshea, J., Bishop, M., Alario, A., Cooper, J. (1988). Diagnosing appendicitis in children with acute abdominal pain. Paediatric Emergency Care, 4, 172-176. Owe, T., Williams, H., Stiff, G., Jenkinson, L., Rees, B. (1992). Evaluation of the Alvarado score in acute appendicitis. Journal of the Royal Society of Medicine, 85, 87-88. Pines, J., Pines, L., Hall, A., Hunter, J., Srinivasan, R., Ghaemmaghami, C. (2005). The interrater variation of ED abdominal examination findings in patients with acute abdominal pain. American Journal of Emergency Medicine (23), 483-487. Rehman, I., Burki, T. (2003). Alvarado scoring system in the diagnosis of acute appendicitis in children. Journal of Medical Sciences, 11, 37-41. Reynolds, S., Jaffe, D. (1992). Diagnosing abdominal pain in a paediatric emergency department. Paediatric emergency care, 8, 126-128. Smink, D., Finkelstein, J., Garcia-Pena, B., Shannon, M., Taylor, G., Fishman, S. (2004). Diagnosis of acute appendicitis in children using a clinical practice guideline. Journal of Paediatric surgery, 39, 458-463. Stefanutti, G., Ghirardo, V., Gamba, P. (2007). Inflammatory markers for acute appendicitis in children: are they helpful? Journal of Paediatric Surgery, 42, 773-776. Whisker, L., Luke, D., Hendrickse, C., Bowley, D., Lander, A. (2009). Appendicitis in children: A comparative study between a specialist paediatric centre and a district general hospital. Journal of Paediatric Surgery, 44, 362-367. Williams, R., Blakely, M., Fischer, P., Streck, C., Dassinger, M., Gupta, H., et al. (2009). Diagnosing ruptured appendicitis preoperatively in paediatric patients. Journal of American College of Surgeons, 208 (5), 819 825.

Linus Pauling Essay -- Biography Linus Pauling Essays

Linus Pauling (1901-1994) A master and maker in many fields, Linus Pauling lived a very long and productive life spanning nearly the entire twentieth century. By the time he was in his twenties, he had made a name for himself as a scientist. After many significant contributions including his work on the nature of the chemical bond, he turned to chemical biology and is generally accepted as the founder of molecular biology. Later in his life he became very involved in issues of politics and peace for which he is somewhat less well known. In his later years, he became interested in health and medicine and specifically in the use of vitamin C to prevent ailments from the common cold to cancer. In Pauling’s own words he was â€Å"†¦a physicist with an interest in chemistry. [His] scientific work, however, has not been restricted to chemistry and physics, but has extended over X-ray crystallography, mineralogy, biochemistry, nuclear science, genetics, and molecular biology; also nutrition and various aspects of research in medicine, such as serology, immunology, and psychiatry† (Marinacci Ed., 1995, p. 26). Pauling received two Nobel Prizes acknowledging his contributions, one in Chemistry in 1954 and one for Peace in 1962. Gardner describes the creative individual as follows: â€Å"The creative individual is a person who regularly solves problems, fashions products, or defines new questions in a domain in a way that is initially considered novel but that ultimately becomes accepted in a particular cultural setting† (Gardner, 1993, p. 35). As I understand this, a creative individual is one who seeks out problems and states or solves them in a way that no one else has previously. Such inno... ...ive individuals. He also fits Gardner’s description of the Exemplary Creator fairly well. Linus Pauling was a creator with astounding intellectual abilities who was also active in many other areas as dictated by his interest and passion. His ideas and research into the nature of chemical bonds significantly changed the way that we understand the world. References Books: Gardner, H. (1993). Creating Minds. New York: Basic Books. Goertzel, T., & Goertzel, B. (1995). Linus Pauling. New York: Basic Books. Hargittai, I., & Hargittai, M. (2000). Conversations with Famous Chemists. London: Imperial College Press. Marinacci, B. (Ed.). (1995). Linus Pauling in His Own Words. New York: Simon & Schuster. Internet (photographs): http://www.wic.org/bio/lpauling.htm http://pauling.library.orst.edu/exhibit/index1.htm

gatdream F. Scott Fitzgerald’s The Great Gatsby - Just Dream It! :: Great Gatsby Essays

The Great Gatsby: Just Dream It! In Fitzgerald's The Great Gatsby, all the characters are, in one way or another, attempting to achieve a state of happiness in their lives. The main characters are divided into two groups: the rich upper class and the poorer lower class, which struggles to attain a higher position. Though the major players seek only to change their lives for the better, the American Dream is inevitably crushed beneath the harsh reality of life, leaving their lives without meaning or purpose. Tom and Daisy Buchanan, the rich socialite couple, seem to have everything they could possibly desire; however, though their lives are full of material possessions and worldly goods, they are unsatisfied and seek to change. Tom, the arrogant ex-football player, drifts on "forever seeking a little wistfully for the dramatic turbulence of some irrecoverable football game"(pg. 10) and reads "deep books with long words in them"(pg. 17) in order to have something to talk about. Though he appears happily married to Daisy, Tom has an affair with Myrtle Wilson and keeps an apartment with her in New York. Tom's basic nature of unrest prevents him from being satisfied with the life he leads, and so he creates another life for himself with Myrtle. Daisy Buchanan is an empty character, someone with hardly any convictions or desires. Even before her loyalty to either Tom or Gatsby is called into question, Daisy does nothing but sit around all day and wonder what to do with herself and her friend Jordan. She knows that Tom has a mistress on the side, yet she doesn't leave him even when she learns of Gatsby's love for her. Daisy makes her love to Gatsby apparent, yet cannot bring herself to tell Tom goodbye except when Gatsby forces her too. Even then, once Tom begs her to stay, even then Daisy ultimately leaves Gatsby for a life of comfort and security. The Buchanans are the ultimate examples of wealth and prosperity, and the American Dream. Yet their lives are empty, unfulfilled, and without purpose. Though Myrtle Wilson makes an attempt to escape her own class and pursue happiness with the richer set, her efforts ultimately produce no results and she dies. She is basically a victim of the group she wanted to join. Myrtle tries to join Tom's class by entering into an affair with him and taking on his way of living, but in doing so she becomes corrupt as if she were rich.

Oedipus is Deserving of his Suffering :: essays research papers

Question: Sir John Sheppard comments that Oedipus behaves normally, commits an error in ignorance and brings suffering upon himself. He declares that "Oedipus suffers not because of his guilt, but in spite of his goodness.† What is your opinion of this comment? I disagree with this statement. To a certain extend, I think Oedipus’s suffer is what he deserved. No one can be held fully responsible for actions committed under some kind of external constraint, and for the case of Oedipus, such constraint might be exerted by god. But it does not mean that Oedipus suffers not because of his guilt, but of his goodness, because Oedipus is responsible for those actions which are not performed under constraint. Oedipus has choices, but every time he chooses the wrong one even he knew that the one he chose will turn out to be bad. He still chooses this road to certain extend, is because of his arrogant pride. I think the events of the play are Oedipus fault. Oedipus makes important mistakes or errors in judgment that lead to this ending. His pride, blindness, and foolishness all play a part in the tragedy that befalls him. Oedipus's pride leads to the story's tragic ending. He is too proud to consider the words of the prophet Teiresias, choosing, instead to rely on his own investing powers. Teiresias warns him not to pry into these matters, but pride in his intelligence leads Oedipus to continue his search. Oedipus thinks he can change fate. He just tries to ignore it, because he counts on his own ability to root out the truth. Oedipus is a clever man, but he is blind to the truth and refuses to believe Teiresias's warnings. He suffers because of his hamartia. I t is this excessive pride fuels his own destruction. I would just say Oedipus is a tragic hero. Foolishly he leaves his home in Corinth without further investigating the oracle's words. à ¼ The vanity of Oedipus is latent when he travels, against warnings, to the oracle of Delphi. His inflated notions of his stature as ruler directly question the authority of the gods. He goes to the oracle then leaves without an answer. Finding out his true father is important because he has just been told he will kill his father. Oedipus is not intelligent about the way he conducts himself.

Extreme Sports Essay

The X Games is one of the more popular sporting events, where people gather to watch athletes compete in extreme sports. Some of these sports include skateboarding, mountain biking and motorcycle racing. The community around extreme sports can sometimes be seen as exclusive and particular when it comes to defining what an extreme sport is and who is a true extremist. Originally, I believe the extreme sport community created this division of athletics because they thought their sports did not fit in at a standard sporting event. Part of the reason some the extreme athletes participate in their sport is because they see it as a way of defying the boundaries of what is seen as a typical sport. Most extreme sports are about pushing limits. Extreme sports are not conventional in the sense that practicing isn’t really necessary, a coach isn’t necessary, and the sports are very individualistic. Some of the extreme sport athletes do it for the adrenaline rush. They do it purely for themselves. Their reasoning contrasts to some of the other sports where lots of practice and coaching is essential for success. A lot of the athletes that compete in non extreme sports are focused on getting sponsors or when you’re younger, getting recruited for college. For the extreme sport community this is considered to be feeding into the capitalist society/culture. Part of extreme sports is about taking risks and not having anything to fall back on. The X games have put a strain on the extreme sports community because some seem to think that the event has altered the true goal of the sport, which is to take risks and to go against the mainstream culture. Some people seem to believe that it has become like the other sporting events, in the sense that there are now big sponsors and judges. They argue that the extreme athletes are no longer taking risks because they want to make sure they can land the trick. The goal is no longer to try new tricks and push the bar, but its more about doing what you know will please the judges. This goes against what extremist originally wanted for the sport. It takes the risk  out of it and you no longer do it for yourself but for the judges. The fact that there are sponsors is also a cause for controversy because some people see it as the athletes being sellouts. For example, Tony Hawk is famous skate boarder. He has a lot of sponsors, video games, and ads. Some say he is no longer a true extremist because of it. At the same time, what makes the sports in the X games more extreme than say diving or gymnastics? Both sports are very individualistic and there is a lot of a risk, yet they are not seen as extreme sports. I think the extreme sports community has tried to make their community too exclusive and extreme sports benefit from the X games and the sponsors and judges it brings. The event does bring aspects that were not originally a part of the sport, but the extreme sports community will grow now. Extremist can still continue to push limits and do the sport for themselves despite what others may think.