‘Poetry Teaches Us About Life and the World Around Us Free Essays

‘Poetry shows us life and our general surroundings. ’ The two sonnets â€Å"Martin and the Hand Grenade† by John Foulcher and â€Å"Beach Burial† by Kenneth Slessor both talk about various parts of war and war times showing us life and our general surroundings. â€Å"Martin and the hand grenade† investigates the idea that man has a violet streak which can prompt demolition, Foulcher portrays numerous parts of war, for example, the psychological effects just as some physical effects and parts of the projectile. We will compose a custom paper test on ‘Poetry Teaches Us About Life and the World Around Us or on the other hand any comparable subject just for you Request Now Accentuating the distinction in how grown-ups and kids decipher fighting. Sea shore Burial† is an account of the poet’s misery for the mariners who kicked the bucket on an incredible land and ocean fight in the North African battle during WWII. On another level, it records the fight that we as a whole battle, paying little heed to race or political or strict conviction, participated in the regular front of mankind against death. The sonnet â€Å"Martin and the Hand Grenade â€Å"is dependent on an individual encounter that Foulcher had while instructing at a young men school in one of his history exercises, depicting that grown-ups and youngsters have an alternate perspective on war and brutality. Foulcher makes a striking picture of the occurrence in our psyches and permits us to imagine ourselves watching the hand projectile through the allegory â€Å"With his father’s somber aptitude, Martin pushes out the terminating pin†. Martin’s father is explicitly alluded to as having â€Å"bleak skill† that had once shown him how to work the projectile. Foulcher utilized this descriptive word as a powerful method of passing on his own demeanor to war and brutality, depicting his own insight as â€Å"bleak† demonstrating his negative disposition to the savagery and devastation the Grenade causes. As Martin shows the projectile, the class â€Å"pause for history† emblematically indicating how children’s comprehension and enthusiasm for the war and numerous different parts of our general surroundings can be upgraded through truly observing or grasping a curio. The understudies pose inquiries, Martin allegorically states, â€Å"No-it had constrained, power: ten yards, at that point the spread, turned out to be too free to even think about catching a man’s mortality†, representing the capacity of explosives and the savage fatalities brought about by wars. In like manner â€Å"Beach Burial† by Kenneth Slessor, portray parts of war however this season of the more graphical and visual real factors. A stun picture is made through exemplification â€Å"The guards of dead mariners come; around evening time they influence and meander in the waters far under† empowering the peruser to accentuation with the fighters that passed on at war. As verse permits us to create more prominent bits of knowledge and find out about our general surroundings, â€Å"Beach Burial† successfully depicts the genuine and real happenings of war or the outcome of war. To cull them from the shallows and cover them in tunnels, Someone, possesses energy for this it seems†, allegorically speaks to how an individual, out of a sign of regard is covering the dead bodies. Emotively language further permits the peruser to find out about the world and feel for the individuals who encountered the war, â€Å"And each cross, the determined stake of ti dewood, Bears the last signature of men†. â€Å"Martin and the Hand Grenade† concentrates more on the projectile and ‘painting a picture’ of the explosive and the class, permitting the peruser to decipher the sonnet and imagine angles identified with the war and the world all in all. Though â€Å"Beach Burial† centers around the happenings of war, yet on installing a solid picture of war in the perusers mind, permitting them to comprehend and feel the pity expected by the sonnet. As the two sonnets have an alternate method of passing on war, they despite everything show the peruser life and assist them with understanding the world they are living in. â€Å"Beach Burial† delineates numerous visual parts of the war, not at all like â€Å"Martin and the Hand Grenade† which centers around how Australian life has been impacted enormously; intellectually, sincerely and truly by a few parts of the war. Step by step instructions to refer to ‘Poetry Teaches Us About Life and the World Around Us, Essays

International Business Profile of two countries (South Korean, and Essay

Universal Business Profile of two nations (South Korean, and Japan) - Essay Example Schoenbaum (26-27) puts it that each nation has an alternate business profile with data running on the subjects of prompt business significance. The above investigation examinations the worldwide business profile for Japan, South Korea and Singapore. It additionally shows their FDI profile and how the nations can manage the global interest for business. Japan global business profile Japan is situated in the eastern Asia which is at the Island between North Pacific Ocean and the East Sea or the Sea of Japan. The capital city is Tokyo and the complete populace is around 127 million as at 2004. The Japan ethnic network is comprised of 99 percent of Japanese and the 1 percent incorporates others, for example, Korean, Chinese, Filipino, Brazilian and different minorities Chew (2008). The religions incorporate that of Shinto and Buddhist which is around 85 percent. The Japan language is said to have started from the Altaic dialects, for example, Turkish and it is perceived to be near the K orean language. The economy of Japan is positioned as the second after USA. Japan is the biggest production of machine instruments and the main vehicle fabricate. It is likewise well known in steelmaking and this assembling and administration industry has added to the development of Japan’s GDP. ... As indicated by Hoe (2010) Japan’s culture incorporate concealing any hint of failure which is the business culture. They likewise accept that turning a customer’s demand adds up to humiliation. Japan’s business profile includes concordance which is the controlling way of thinking for their business settings. The training framework additionally demands relationship and individual poise. The Japanese comprehend it is hard for outsiders to work there as they don't anticipate that outsiders should be familiar with the way of life and language. They thusly work together basing on close to home connections. Correspondence is through welcome or occasional cards and universal merchants ought to guarantee they react as this holds an individual to be of high regard. Japan outside exchange association gives productive data including different offices and focuses, residential just as worldwide administrations for speculations. This incorporates monetary, showcase reports an d overviews (Chew 2008). South Korean universal business profile South Korea is situated in the Eastern Asia which is the fringe of East Sea and Yellow Sea. The capital city is Seoul and the populace is around 48 million as at 2004 enumeration. The ethnicity is comprised of homogeneous individuals. Their religion is involved 26 percent of Christians, 27 percent of Buddhist, 46 percent of individuals with no association and others. The Koreans communicate in one language and offer a particular physical trademark which makes them not quite the same as others in Asia, for example, Chinese and Japanese. South Korea is more affected by Confucian qualities that pervade all working life angles which incorporate administration frameworks or relational relations (Dennis 2003). As indicated by Denoon and Hudson (22-23) the Confucian morals significantly

Is it Possible for ADHD to Develop in Adulthood

Is it Possible for ADHD to Develop in Adulthood ADHD Adult ADD/ADHD Print Is it Possible to Develop ADHD in Adulthood? By Keath Low Keath Low, MA, is a therapist and clinical scientist with the Carolina Institute for Developmental Disabilities at the University of North Carolina. She specializes in treatment of ADD/ADHD. Learn about our editorial policy Keath Low Medically reviewed by Medically reviewed by Daniel B. Block, MD on January 29, 2020 twitter linkedin Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Medical Review Board Daniel B. Block, MD on January 29, 2020 ADHD Overview Symptoms Causes Diagnosis Treatment Living With In Children Hero Images / Getty Images How can an adult who feels newly scattered, inattentive, restless, or overwhelmed know if attention deficit hyperactivity disorder (ADHD) is to blame? This is a particularly challenging question for adults who dont feel they exhibited symptoms when they were younger as, most often, ADHD gets diagnosed in childhood. Does this mean theyve developed ADHD as an adult, was it missed when they were a kid, or is something else at play? With this overview, learn more about what ADHD is, the onset and progression of the disorder, and what it means to develop ADHD-like symptoms later in life. What Is ADHD? ADHD is a neurodevelopmental disorder that develops in childhood. Key symptoms of the condition may include lack of focus, difficulty controlling impulses, challenges with organization, struggles with paying attention, and/or hyperactivity. The exact cause of ADHD is unknown but many medical studies have shown a strong genetic component and pinpoint developmental impairment of the brains executive function as a key component. As such, the condition tends to run in families. Environmental factors and homelife may worsen (or improve) symptoms but do not cause ADHD. Instead, it is thought to be a purely brain-based disorder. There is no cure for ADHD but treatments, including medications, behavioral therapy, and other supports, can help a great deal. While some grow out of ADHD, most do not. A minority see their symptoms lessen as they get older. According to the ADHD advocacy and support group Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), 11% of school children have ADHD and the disorder continues into adulthood 75% of the time. For the majority, ADHD is a lifelong condition. An Overview of Living With ADHD Can You Get ADHD as an Adult? The short answer is, no, adults dont suddenly get ADHD. In order to meet the criteria for an ADHD diagnosis, several symptoms that cause impairment must be present in childhood. Specifically, signs of ADHD need to be evident before age 12.  This means, technically, ADHD does not develop in adulthood. In other words, if you have ADHD as an adult, you also had it as a child. Conversely, if you definitely did not present with these symptoms as a child, then your current symptoms may be the result of something else, such as depression, anxiety, or another mood disorder. However, ADHD is sometimes hard to diagnose, as symptoms can present quite differently from person to person and it is diagnosed largely through observation rather than with more concrete means, such as a blood test or other physical markers. As an adult seeking diagnosis, its possible that no one knew to look for ADHD, and you might have had it all along. ADHD symptoms can also manifest in different  ways as a person ages. For example, in younger children, hyperactivity may present as an inability to sit still, while adults may simply seem restless. Additionally, some people with ADHD find ways of coping that can mask their symptoms, such as using a fidget, using organizational supports, incorporating lots of physical activity into their schedules, or consuming a lot of caffeine, which acts similarly (although to a lesser degree) to prescribed stimulant medications, such as Adderall (amphetamine and dextroamphetamine). As a result, someone may not be diagnosed with the disorder until later in life. How Symptoms of ADHD Change Over Time Symptoms of ADHD may emerge as early as the preschool years, particularly if a child displays the hyperactive and impulsive type of symptoms. These behaviors tend to get noticed earlier simply because they tend to be more disruptive. Signs of inattention can easily be missed, however, as these children may be quietly unfocused or able to do well without having to pay close attention. Symptoms of inattention tend to become more noticeable when a child gets older, particularly after entering grade school, which requires increasing demands for sustained focus. While very young children are encouraged to move around in the classroom setting and learn through physical activity and play, older children are expected to sit still, listen attentively, maintain ever-greater self-control, and respond quickly to questions posed by the teacher. Adolescence can bring on a whole new set of challenges as teenagers become more and more responsible for self-management while expectations, responsibilities, and academic and social pressures increase. Often ADHD symptoms become more pronounced when teens are expected to organize their own time, plan ahead to complete ever-larger projects and tasks, and think carefully about potentially risky behavior. Issues such as impulsivity, lack of attention, and poor self-esteem can result in more obviously negative outcomes, including drug use, teen pregnancy, and reckless driving. In adulthood, some people notice a lessening of symptoms, while others still experience them to a similar degree. However, often the symptoms of ADHD in adults look less like the kid who seems driven by a motor and more like a person who is forgetful, restless, easily distracted, and/or overly reactive to frustration. Similar treatment options, including medication and behavioral therapy, are available for adults and offer good results for many with ADHD. The key is to make sure you are accurately diagnosed by consulting a doctor with experience treating patients with ADHD. A Word From Verywell If you suddenly experience  symptoms in adulthood that seem similar to ADHD but you have never experienced  before, its unlikely that ADHD is the issue. Be sure to talk with your doctor about your concerns about memory, inattention, or other troublesome symptoms. There are certain conditions of adulthood that can look a bit like ADHD, including depression, anxiety, sleep difficulties, and even menopause. Once you have an accurate diagnosis, youll likely feel better knowing what is really going on and can then put your energy into pursuing effective treatment options. Strategies for Living Well With ADHD

U.s. Federal Acquisition Regulation - 1243 Words

A contract has been awarded under competitive negotiated procedures and an unsuccessful offeror wanted to know why they were not the winner. The Federal Acquisition Regulation (FAR) provides an approach to this issue by offering an organized correspondence with the unsuccessful offeror and the government. An unsuccessful offeror may submit a request to the contracting officer for clarification on why they did not win the award. This request is called a debriefing. The debriefing provides feedback from the government on the unsuccessful offeror’s proposal explaining the process in depth as to why they were not selected. Only certain information is shared and will vary depending on whether the debriefing is conducted prior to or after†¦show more content†¦(FAR 15.505) Submitting a timely request for a Preaward Debriefing is essential if the offeror wants to make certain that the debriefing will take place. If an offeror submits a request for a debriefing within the three day window, the Government should conduct the debriefing within five days after an offeror’s request. When the offeror delivers a timely request for a debriefing, the Government must propose a scheduled debriefing date in writing and have the offeror acknowledge the requested debriefing date immediately. If the debriefing date is unavailable for the offeror and they request a later time, the original debriefing date must be acknowledged by the offeror in writing and the request for a later date, such as after the award is announced. In the delayed Pre-award Debriefing (after award), it must include all of the information normally provided in the second type of debriefing, a Postaward Debriefing. (Marine Corps Specific). Postaward Debriefings are conducted after notification of award and the offeror’s request for the Postaward Debriefing must be received by the Government within three days after the date on which the offeror received notification of the contract award. It is ideal for the debriefing to occur within five days after receipt of the written request, including offerors who requested the delayed Preaward Debriefing. A Postaward Debriefing may also be conducted orally, in writing,Show MoreRelatedA Discussion Of Administrative Law Essay1181 Words   |  5 PagesA Discussion of Administrative Law Congress and the state legislature pass laws that align to the U.S. Constitution. However, the laws enacted are general provisions that do not explain how they should be utilized. Consequently, federal, state, and local agencies must define the policies and regulations of the statutes. The rules and regulations established by the agency are known as administrative laws (Walsh, Maniotis, Kemerer, 2014). Educators must follow the laws passed by the state legislatureRead MoreImplementing Integrated Product And Process Development1547 Words   |  7 Pagesconcurrent engineering, and total quality management. In the early 1980s, U.S. industry used the concept of integrated design as a way to improve global competitiveness. Industry s implementation of IPPD expanded concurrent engineering concepts to include all disciplines, not just technical, associated with the design, development, manufacture, distribution, support, and management of products and services. Diverse segments of U.S. industry have successfully implemented this concept to become recognizedRead MoreTranslating the Federal Acquisition Regulation Clause1048 Words   |  4 PagesTitle Date The Federal Acquisition Regulation (FAR) is the chief body of rules in the Federal Acquisition Regulation System used by the United States government. 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The purpose of the RFC was to try to help businesses no matter what size large and small by providing federal funds. In 1942, Congress created the Smaller War Plants Corporation (SWPC) to help small businesses during World War II. Funds were provided for financial institutions to help give credit to struggling small business owners. When the war endedRead MoreHistory Of The Small Business Program1500 Words   |  6 PagesSmall Business Program In 1932, President Hoover tried to mitigate the Great Depression by creating The Reconstruction Finance Corporation (RFC). The purpose of the RFC was to try to help businesses no matter what size large and small by providing federal funds. In 1942, Congress created the Smaller War Plants Corporation (SWPC) to help small businesses during World War II. Funds were provided to financial institutions to help give credit to struggling small business owners. 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The increased regulatory burden is playing a toll on community financial institutions who cannot keep up with the overhead cost it takes to meet the new regulations. It is frustrating community

Summary Love Is Never Silent Essay - 650 Words

In the 1985 movie â€Å"Love is Never Silent† it is set during the great depression and follows the Ryder family, Abel and Janice two deaf parents of two hearing children Margaret and Bradley. Abel works for a newspaper company on the printing press, Janice is a seamstress. The parents rely on the oldest child Margaret as their link to the hearing world by being their voice. In the beginning tragedy hits the family as the Ryder’s youngest child Bradley falls from their second story apartment and dies. Now that Margaret is the only hearing child she feels obligated to always be available for her parents when they need her. When she goes with her parents to a Mortuary she has to help them purchase a wood box instead of a coffin for her brother†¦show more content†¦William joins the military and while he’s gone Margaret invites William’s mother Mrs. Anglin and brother Marshall to her parents’ house for dinner, which doesn’t go well beca use Mr. and Mrs. Ryder refuse to sign in an even more awkward silence. William comes back injured but not crippled and they live with her parents until he’s accepted into college. Margaret’s parents are sad to see her go but as soon as they can they go see her and it was unannounced. Margaret’s parents are very upset to see the place where she’s living and go to sign how upset they are that William hasn’t provided better for their daughter. Her parents never visit her again. The next time Margaret sees her parents is when she’s very pregnant to let them know that they’ll be grandparents. Lastly William and Margaret move into better housing where they will raise their child till William graduates from college. Margaret and William invite everyone to their baby shower after the birth of their son and her parents show up after everyone has gone. Margaret is upstairs with her son and William answers the door and her parents surprise her. When they see each other all the turmoil between them is gone and they enjoy each other’s company. The movie ends with Janice’s retirement party where Abel, Margaret, William and their son go and Janice’s signs a speech that MargaretShow MoreRelatedThe Hermits1206 Words   |  5 Pageswas also there sailing to visit the holy shrines. Then they saw a group of people gathered together. One merchant said to the Bishop that the fisherman is telling them about the hermits who lived in an island nearby the sea. Before the fisherman never had a chance to see the three hermits, until last summer, he saw them by himself. He said to the bishop that one of the three hermit’s looks tiny, bent, but he keeps smiling. Another, a little taller, also old, in a torn coat, but he is a powerfulRead MoreLiterary Analysis Of Ethan Frome1739 Words   |  7 Pagesgoing to perpetually attempt to demonstrate his love to Mattie Silver, as well try to make her like him. Furthermo re, as a result of Ethan’s strong obsession to be with Mattie, I can elicit that Ethan is going to incorrectly assume and interpret Mattie gestures, due to his obsession and will not be thinking clearly about her actions. Which, is evident in the passage being he took incorrect ideas into his brain, by seeing Mattie with Denis Eady. (96) Summary Previously, before the passage, Ethan FromeRead MoreRachel Louise Carson and the Environmental Movement Essay1361 Words   |  6 Pagesadoration of the ocean and nature. She made the decision to pursue her lifelong love of the ocean and became a Marine Biology student at the Pennsylvania College for Women, where she graduated in 1929. But it was not until the 1940’s when Carson was working as a scientist and editor for the U.S. Fish and Wildlife Service’s Fisheries Bureau, that her passion and literary work would take her to a level of popularity she had never known before. By 1958, Carson had become very popular as a writer and environmentalistRead MoreAnalysis Of Editha By William Dean Howells And The Yellow Wallpaper1070 Words   |  5 Pagesgender rule for most men and women were enforcing it. In the story, Editha make it a point to George that she cannot love him unless he was in the war and didn’t really care to hear his point for not wanting to join th e war. The main point of realism the author, William Dean Howells, showed was the effect that war had on society during the 19th century during which many would call the love and marriage era. The Yellow Wallpaper is another piece of evidence that I have found to depict â€Å"Realism.† TheRead MoreVultures Comparison with What Were They Like801 Words   |  4 Pagescommandant, but rather explores whether there is hope because there is love everywhere, or whether there is despair, because even though love is there, evil is still always present. However, in WWTL, Levertov is obviously focusing on the effects of the evil of people rather than questioning the nature of evil itself in people. To begin with, Achebe relies heavily on juxtaposition and contrast to represent the co-existence of love and evil in people. The ‘commandant’ is described as having ‘human roastRead MoreArt Form for the Digital Age864 Words   |  4 PagesArt Form For The Digital Age Summary â€Å"Art Form For The Digital Age,† by Henry Jenkins is about gaming expanding and how its being considered a digital art. The growing game industry is said to be the most growing form of art in the economy today. The gaming industry has grown tremendously in the past century. It went from silent pong games to intense story plot and mind blowing real life graphics like Final Fantasy. Games are becoming more and more realistic, characters can talk, andRead MoreAnalysis of the Green Mile Essay1007 Words   |  5 PagesProfessor Janet Ward English 110 November 3, 2011 Summary of the Novel, â€Å"The Green Mile† A summary of any novel by Stephen King has to include a small biography of the horror novelist, himself. Publishing this novel in 1996 as a serial novel, with the first edition actually coming out as one of six small paperbacks that were eventually made into one novel. Stephen King is well known for his horror novels, therefore, this summary of the novel â€Å"The Green Mile† shows this book set in theRead More The Book of the Duchess, the Parliament of Fowls, and the House of Fame1628 Words   |  7 Pagesevident. There are three major themes intertwined within the three works, which Chaucer has added to the Dream Vision genre. The first work, possibly written from 1368-1372, the Book of the Duchess begins with the love-sick narrator finally falling asleep as he reads the sad love story of Seys and Alcyone (originally written by Ovid). He dreams that he is in bed early in the morning, then out hunting in the forest. He follows a dog down a path and finds a knight dressed in black who laments theRead MoreEssay on Ode on a Grecian Urn by John Keats1525 Words   |  7 PagesOde on a Grecian Urn by John Keats Summary In the first stanza, the speaker, standing before an ancient Grecian urn, addresses the urn, preoccupied with its depiction of pictures frozen in time. It is the still unravishd bride of quietness, the foster-child of silence and slow time. He also describes the urn as a historian, which can tell a story. He wonders about the figures on the side of the urn, and asks what legend they depict, and where they are fromRead MoreAnalysis of a Walk to Remember1696 Words   |  7 PagesIntroduction/ Writing Style: The author of A Walk to Remember is Nicholas Sparks. He was born on December 31,1965. According to Wikipedia he is an internationally best selling American author. He writes novels with themes that include Christianity, love, tragedy, and fate. He is currently the author of 12 published novels; including: Message in a Bottle, A Walk to Remember, and The Notebook. He lives in New Bern, North Carolina with his wife Catherine and their five children. I believe his purpose

Redemption Review. “I Found That The Negroes Who Had Been

Redemption Review â€Å"I found that the negroes who had been declared free by the United States were not free, in fact that they were living under a code that made them worse than slaves; and I found that it was necessary, as commanding officer, to protect them, and I did† (pg. 55). Those are the words of Governor Adelbert Ames, a former general of the Union army, turned senator and later becoming the governor of Mississippi. Ames was advocate in ensuring that negroes receive the rights that they were promised. Nicholas Lemann uncovered some of the forgotten truths of racism in this novel, starting with displaying the importance that Ames played in the deep south during the post war and reconstruction period. Adelbert Ames married Blanche†¦show more content†¦Ames saw it as a tactical move maneuver to keep elite power, rather than a genuine change of mind. Negro voter gave Ames his victory over Alcorn, by a margin of thirty thousand voters. In Vicksburg, Mississippi, on July 4th, a celebration for Negro Republicans, when a group of whites with guns turned up and began shooting. Peter Crosby, a thirty-year-old black veteran and the county sheriff of Vicksburg, held the most important position in local government warned Ames of the counties unstable conditions. According to the author, these were Crosby’s words, â€Å"There is a great excitement among the colored people and seems to be a settled determination among reckless, desperate white men to repeat ‘Meridian’† (pg. 71). The whites began an up rise against the negroes of Vicksburg county. After getting word of the unfortunate events that had occurred, Ames returned to Jackson, Mississippi, where he was met by refugees from Vicksburg. He immediately sent Grant a telegram requesting federal troops. There were several out breaks of White Liners attacking’s in Mississippi, an account recorded from a Silver Creek, Mississippi, reported to President Grant, â€Å"Thae tak up the Corlded Peapel and Haung them†¦We are Prass so We can’t stand it. If the law woant pertect ous we don’t what to do† (pg 77). White Line organizations was to reestablish the Democratic Party and their means was violent disruption to organize politicsShow MoreRelatedHarriet Beecher Stowe s Uncle Tom s Cabin3362 Words   |  14 Pagesbe compliant to their masters and focus their attention into being devout Christians. Stowe portrays this stance through Tom who knows that through a peaceful submission to his masters and an unbreakable faith, he will ultimately achieve eternal freedom in heaven. However, I would argue that when we look at the sentimental affect that some of her characters, such as Tom, had on the readers of the time; it is easy to see how they were successful in promoting the abolitionist message despite the presenceRead MoreWomen as Commodity8915 Words   |  36 PagesWOMEN AS COMMODITY Women As Commodity Since ancient times, There people who are being sold just like a mere things sold in a market to be slaves, pimp, and its quiet alarming that even naive child is a victim of this kind of discursive life. Women have been also analyzed to be part of those bundles of things paraded, bidded for, sold, and traded off despite the fact that women are making huge contributions for the development of their countries in different aspects today, still women are beingRead MoreWomen as Commodity8899 Words   |  36 PagesWOMEN AS COMMODITY Women As Commodity Since ancient times, There people who are being sold just like a mere things sold in a market to be slaves, pimp, and its quiet alarming that even naive child is a victim of this kind of discursive life. Women have been also analyzed to be part of those bundles of things paraded, bidded for, sold, and traded off despite the fact that women are making huge contributions for the development of their countries in different aspects today, still women are

Critical Evaluation Report Quantitative Study †Free Samples

Question: Discuss about the Critical Evaluation Report Quantitative Study. Answer: Introduction Critical appraisal of a journal involves evaluating the research article systematically to determine its trust-worthiness, appropriateness and relevance to a particular context (Polit, 2016). Southern-Australian University has given various models for research critiquing as CASP (Critical-appraisal skill program), PEDro scale (Physiotherapy-evidence database), CONSORT, JADAD score, etc. The journal of Annals of Emergency-Medicine is an international journal that is published by the American-college of emergency physicians to improve the quality of medical-care.Annals are the largest circulating peer-reviewed journal in emergency- medicine with more than 33,000 subscribers. It has the highest impact-factor of 5.008 and is also cited longer than other emergency- medicine journals for 9.6 years as compared to 5.1 years of circulation of the competitor journal (Callaham, 2017).These informations about Annals motivate me to use this research in my practice confidently and provide quality- care. The authors Bugden, Scott, Clark, Johnstone and Shean are experts in the emergency-medicine field. The first four authors are from the Centre of applied health-economics, Menzies Health-institute (Queensland) of Griffith University. They are experienced in the NHMRC centre for research with excellence in nursing field and they have experience in Centre for health-practice innovations of Queensland. This study was conducted in Caboolture community hospital, Queensland at the north of Brisbane with 52,000 ED cases annually. The authors contributions motivates me to use the given research findings confidently in my practice to reduce the peripheral-intravenous catheter failure. Abstract The title is highly clear and congruent with the text. They have stated the objectives as to evaluate whether the failure of peripheral-intravenous (IV) catheters could be minimised by the skin-glue application with standard securement which is clear, specific and achievable. They have stated the aims/hypothesis as whether the failure rate of peripheral-IV catheters could be reduced by the skin-glue application and standardized securement and research design as single-site, 2-arm, non-blind, randomized-controlled trial and the samples of 360 adults with peripheral-IV catheter. They have given about the control (standard-securement) and experimental group (skin-glue with standard-securement) with study-instruments for primary outcomes (within 48 hours) and secondary outcomes (occlusion, site-infection, phlebitis/ dislodgement). They have given the findings based on the objectives with conclusions. Structuring the Study They have demonstrated their motivation for this study through an elaborate review of literature. According to the study, peripheral-IV catheters are inserted in nearly 80% of the hospitalized patients, with majority of the insertions in ED (Limm, 2013). Among which 33%- 69% of IV-devices fails prematurely due to infections, occlusions, phlebitis and/or dislodgement (Marsh, 2015a). This failure occurs mostly due to the improper fixation of peripheral-IV catheters in patients skin. Additionally, there is no clear evidence to show the best methods to secure peripheral-IV catheters. A newer method to improve the fixation of peripheral-IV catheter by using skin-glue (cyanoacrylate) at the insertion-site is employed in this study. Marsh (2015b) has stated the PIVC inserted in wards showed a reduction in failure-rate. The literatures quoted were current, relevant and comprehensive with correct reference citations. They could have included more evidences to describe about the failure rate o f skin-glue and the effect of skin-glue in reducing occlusion, phlebitis and dislodgement as like infection. There are no studies to compare skin-glue method with current best comparators to generalize the results. They have conducted a single insertion-site, two-armed RCT in 360 adults with 380 peripheral-IV catheters in ED and were randomized by Randomizers for clinical-trial software in 1:1 ratio; without blocking/stratifying to both standard-securement and skin-glue group. The skin-glue patients received one drop of cyanoacrylate-glue at the insertion-site and below the catheters hub. The standard care was carried-out based on Queensland- Departmental guidelines (2015) and measured the primary and secondary outcomes. They have stated the hypothesis as the skin-glue application on the insertion-site of peripheral-IV catheters in ED would minimize the failure rate at 48 hours which is a scientific hypothesis that explains the expected relationship between variables (Polit, 2016). They have not given hypothesis for secondary outcomes. The hypothesis indicates that the researchers are interested in testing the relationships of application of skin-glue with catheter failure rate. Sample The sample was adequately described. In this study, the samples were selected by 1 of 3 research nurses (trained ED) in ED for 16 hours/day for a period of 7 days/week. They have selected patients those who requires hospital admission and are 18 or more years of age with patent peripheral-IV catheter inserted in upper-limb with intact skin and that is inserted by an ED nurse/physician and those gave written- informed consent. They have determined a sample size of 174 in each of two groups as standard care and skin-glue group. They have selected only the samples having one peripheral- IV catheter and have confirmed the peripheral- IV catheters patency by flushing 10-mL of 0.9% saline into it. They have excluded patients who are known case of allergic to skin glue or standard securement material, presence of infection, phlebitis or thrombosis near the catheter, agitated patients, non-English samples without interpreter. Data collection The researchers have collected base- line demographic details as well as confounder (possible) details at the time of enrollment by using structured questionnaires with components as age, gender, intake of medications, number of PIVCs, insertion site, right or left upper- limb, professional who has inserted, PIVC gauge and hours from insertion to intervention and follow-up. The primary outcomes were measured in-person through direct visualization (for hospitalized patients) or through telephonic conversation (for discharged patients) at 48 hrs or more (Rickard, 2012, Webster, 2010). The authors have collected data for secondary outcomes through direct observation, chart- review as well as standardized client questionnaire. The data was collected by one of the three research nurses. The data are not described adequately. They have not mentioned the method of measuring study variables but they have described only the variables. For ex: they have described that they are measuring phlebi tis but the method of measuring phlebitis (scores or rating scales) are not described. The authors have measured the data for primary outcomes through the demographic and confounder details in both standard-securement and skin-glue group and for secondary outcomes as infection, occlusions, dislodgment and phlebitis through direct observation, reviewing the clients medical charts and standardized clients questionnaire. The authors have not clearly explained about the origin of measurement instruments. They have just mentioned about the references from Rickard (2012) which suggests that they could have taken this reference as their guide and could have prepared the self-structured measurement instruments. They have not adequately described about their measurement instruments for both primary and secondary outcomes. The authors have only described about the questionnaire for measurement, but the method of measurement was not given. They have not validated the data collection instrument s. The reliability of the measurement instruments were not assessed and reported. Ethical issues were not discussed except issues of follow-up. Data analysis The follow- up was complete enough to take the findings credible. Even the lower rate of follow-up loss (2.8% /PIVC and 0.83%/sample) that is similar in both the groups was managed by omitting the particular patients and only the patients with complete data were taken for analyses. They have not blinded the patients and staffs as it was impossible due to the subtle- color and appearance of skin- glue present at the time of intervention with follow-up. The research nurses were also not masked as they should allocate samples to skin- glue group and determine the integrity of intervention. There are significant differences (10%) (95% CI:18% to 2% with p=.02) between the failure rate of peripheral- IV catheter in skin- glue group and standard group. Significant reduction (7%) in dislodgement (95% confidence- interval: 13% to 0% with p=.04) was noted in skin- glue group. Phlebitis occlusion rates were also low in skin- glue but not statistically- significant. No infections are reported i n both groups. The statistics used is inferential statistics which is used to draw inferences from given data to general conditions in which both p-values with point-estimation (CI) were used in this study (Polit, 2016, Newcombe, 2012). The statistical analysis of primary outcomes suggests that peripheral- IV catheter failure was lower in the skin- glue group as compared to standard- group at a confidence interval of 95% at p.05 showing that there is a significant difference between both the groups and hence the statistical hypothesis is accepted (Polit, 2016). The analysis of secondary outcomes suggests that the difference between dislodgement of skin- glue group and standard- care group was statistically significant at a CI- 95% between 13% to 0% that showing increased significance difference between them p=.04 (p.05). The difference between phlebitis in both groups is less with confidence- interval of 95% between 5 to 3% and occlusion with CI 95% of 8 to 4% shows that they are st atistically significant. No evidence of infection in both groups (0%). Findings The findings of the study were expected. Enough information was presented to judge the results based on the objectives set by the researchers and have clearly and completely stated the results. The findings shows that the failure rate of PIVC was 10% lower in patients with skin-glue (17%) as compared to that of the standard group (27%) (Confidence interval 95%:18% to 2%; p=.02) and the secondary outcome of PIVC failure due to dislodgement was noted to be 7% less in the skin- glue group (7.0%) than standard group (14%) (CI 95%:13% to 0%). The failure rate of PIVC due to phlebitis as well as occlusion were found to be lowered in skin-glue group than standard group but were not statistically- significant. There are no infections in both the group. They stated that using IV lines with skin-glue are 5 times harder to fail. The individual patient analysis in standard (n=179) versus skin-glue group (n=170) shows that the PIVC failure rate was 52 and 31 and secondary failure rate was 51 and 28 respectively. The study was limited to only a particular area with local people-mix. They have not included the sclerotic drugs, anti-coagulants, potential confounders (no. of PIVC access, dwelling time) to generalize the results. The measurement of patient through telephones (n=209), might alter the results but the discharged samples were able to report complication (Rickard, 2012). PIVC failure tends to increase with dwelling time, which is not measured (Wallis, 2014). They suggested that they may proceed with cost-benefit analysis in the future, if financial needs are met. The researchers have mentioned the implications as use of skin-glue has reduced PIVC failure significantly (28%) and are simple and rapid method to carry-out in ED. There are no sufficient informations in this report to permit for replicating study. Conclusion The authors have concluded that the application of skin- glue in the PIVC insertion site along with the standardized care given by Queensland- Department of Health may minimize the rate of failure of peripheral- IV catheter in adult emergency department patients who are admitted in the hospital. The apparent reduction in the PIVC failure rate can benefit the patients by promoting comfort with outcomes and reduction of hospital admissions and costs that are caused due to complications. In 2016, Budgen found that the use of skin- glue that is made up of cyanoacrylates could make the peripheral- IV catheter lines harder and hence un-intentional removal and infection rate is reduced (HospiMedica, 2016). These findings suggest that use of skin- glue in PIVC will indirectly avoid interruption to therapy as well as prevent unnecessary anxiety and discomforts in re-inserting PIVC. Systemic sepsis that occurs in 0.1% of PIVC failure patients could also be prevented by this method (Stuart, 201 3). Relevance to nursing practice The nurses as the care takers should provide a quality nursing care to all the people at all the settings. The modern nurses have to be expertise in all the aspects of nursing care. The nurses should strive to conduct research and develop more evidences so as to enhance the nursing care by providing evidence based care to the patients. The most important role of the nurses involves preventing illness, protecting health as well as promoting health (ICN, 2010, ANA, 2010). As nurses form the primary care- giver in the emergency department of all the hospitals, they have to be expertise in various care modalities including care of peripheral- venous catheters and protect it from its premature failure and dislodgement of the catheter, infection at the catheter insertion skin site and occlusions of catheter due to blood clot or phlebitis (Rebelem, 2016). Most of the patients admitted in the emergency department of hospitals are started with peripheral IV catheter line to start infusion and medicines so as to save the life of the patient among which 33% - 69% of IV- devices fails causing discomfort to the patients. The major predisposing factor to premature device failure involves the improper fixation of the peripheral- IV catheter to the limb of patient leading to not only dislodgement but also micro-motion resulting in irritation of vein leading to phlebitis and occlusion causing entry of micro- organisms from skin into the catheter entry- site leading to severe infection (Marsh, 2015a). This form of peripheral- IV catheter failure occurs mostly after 48 hours of insertion which implies that improvement has to be made for securement in this timeframe. Hence, nurses should secure the peripheral- IV catheter with some securement especially cyanoacrylates skin- glue near the catheter insertion site to create adherence of catheter with the patients skin so as to avoid premature failure. The nurses should conduct further research to use skin- glue to prevent failures in larger population to generalize the results. The CDC guidelines (2011) has designated that replacing intravenous catheters forms an unresolved care issue that indicates need for further research (OGrady, 2011). Peripheral- IV catheter failure causes disruption in therapies of patients such as hydration therapy, antibiotic and analgesic therapy resulting in the deterioration of patients heath adversely and interrupting the treatment process. This also indirectly burdens the patients and their family members by increasing the cost, producing anxiety with discomfort of re-inserting the catheter again and again (Aymes, 2016). Hence, nurses have to increase her expertise to secure the IV line safely so as to protect the patients values and protect their lives. Further, it increases the costs of the health- care system of a country that includes increased nursing staff time in patients care, increased consumables, extended length of hospital stay with increased adverse- event managements. Even, a smaller reduction in the catheter- device failure will definitely transform in-to a larger improvements in patients care, health- outcomes and flow of health and treatment costs. Thus, by practicing skin- glue securing in patients with peripheral- IV catheter, the nurses will definitely improve the patients values and prevent subsequent morbidity, mortality, as well as reduces hospital charges (Stuart, 2013). References ANA. (2010). What is nursing?. Retrieved from https://www.nursingworld.org/Especially ForYou/StudentNurses/ What is nursingaspx Aymes, S. (2016). Skin Glue Reduces IV Failure Rate in the Emergency Department. Retrieved from https://www.acepnow.com/skin-glue-reduces-iv-failure-rate-in-the-emergency-department/ Callaham, M. L. (2017). Annals of Emergency Medicine: Official Journal of theAmerican College of Emergency Physicians. Retrieved from https://www.journals.elsevier.com/annals-of-emergency-medicine HospiMedica. (2016). IV Drip Failure Reduced by Skin Glue Application. Retrieved from https://www.hospimedica.com/critical-care/articles/294767305/iv-drip-failure-reduced-by-skin-glue-application.html ICN (2010). The ICN definition of Nursing. Retrieved fromvhttps://www.ich.in/definition.htm Limm, E.I et al. (2013). Half of all peripheral intravenous lines in an Australian tertiary emergency department are unused: pain with no gain?: Ann Emerg Med. 62:521-525. Marsh, N et al. (2015a). Devices and dressings to secure peripheral venous catheters to prevent complications [review]: Cochrane Database Syst Rev. 6:CD011070. Marsh, N et al. (2015b). Securement methods for peripheral venous catheters to prevent failure: a randomized controlled pilot trial: J Vasc Access.16:237-244. Newcombe, R.G. (2012). Confidence Intervals for Proportions and Related Measures of Effect Size. Retrieved from https://books.google.co.in/books?isbn=1439812780 OGrady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011; 52: e16293. Polit, D.F Beck, C.T. (2016). Nursing Research: Generating and assessing evidence for nursing practice. Lippincott Williams Wilkins: New Delhi. Queensland Government Department of Health. (2015). Centre for Healthcare Related Infection Surveillance and Prevention, Queensland Government Department of Health, Australia: Peripheral intravenous catheter (PIVC) guideline. Retrieved from https://www.health.qld.gov.au/publications/clinical-practice/guidelines-procedures/diseases-infection/governance/icare-pivc-guideline.pdf. Rebelem. (2016). Should We Use Skin Glue to Secure Peripheral IVs: R.E.B.E.L. EM. Retrieved from https://rebelem.com/should-we-use-skin-glue-to-secure-peripheral-ivs/ Rickard, C.M et al. (2012). Routine versus clinically indicated replacement of peripheral intravenous catheters: a randomized controlled equivalence trial: Lancet. 380:1066-1074 Stuart, R.L et al. (2013). Peripheral intravenous catheterassociated Staphylococcus aureus bacteraemia: more than 5 years of prospective data from two tertiary health services: Med J Aust. 198:551-553. University of South Australia. (n. d.). Critical Appraisal Tools. Retrieved from https://www.unisa.edu.au/Research/Sansom-Institute-for-Health-Research/Research/Allied-Health-Evidence/Resources/CAT/#Randomised Wallis, M.C et al. (2014). Risk factors for peripheral intravenous catheter failure: a multivariate analysis of data from a randomized controlled trial: Infect Control Hosp Epidemiol.35: 63-68. Webster, J et al. (2010). Clinically-indicated replacement versus routine replacement of peripheral venous catheters: Cochrane Database Syst Rev. 3: CD007798.