Movie Analysis The Movie Parenthood - 856 Words

Those Blinded by the Limelight As a youthful child, I was prone to think that my family had to be the only one with obstacles, although, this changed dramatically after I watched the movie Parenthood. Because they are amazing at withholding his or her family problems, or at least they think they are, people put up a barrier to the outside world trying to show everyone how they are impeccable. The movie Parenthood really opens up our minds and proves to the frauds that faking perfection in life is not necessary. Besides, you cannot pick your family. They are your personal burden, and different personalities handle this responsibility individually. One of the terrific ways I became linked with this story is by seeing the similarities between Larry and my dad’s brother, Alan. By being adored by his father, Larry, in the movie Parenthood, dodged many self-destructive issues. He was the families pride and joy; always helping them shine in the limelight and proving over and over that Frank and his wife did a wonderful job raising him. This invoked them to be blinded by the truth. Larry was not who they thought he was. Similarly, my uncle was raised in the spotlight. As the star football player, the All-State singer, the student council president, and homecoming king, Alan had managed to accomplish it all. On the surface the average person would be in awe; confused and amazed by the fact that one man could be so talented and popular. As he matured, he had a revelation:Show MoreRelatedAnalysis of the Movie Parenthood705 Words   |  3 PagesThe movie Parenthood cover’s many of the topics we have discussed this s emester in class. But it obviously focused very strongly on parenting and marriage. During the course of the movie we see the four Buckman children’s very different style of parenting. Although all four were raised by the same parents the culture of their individual families are all look very different. Gil Buckman felt abandoned and ignored by his father and therefore responded, with his wife Karen, by being a very active andRead MoreMovie Analysis : Parenthood 861 Words   |  4 PagesIn the movie Parenthood it is about just what you may think, family. In every one there are complications to maintaining a stable, happy home. There are times where you may think that you have lost control of your relationship and your own life. In this film, that is what it showcases. Reality. Life. Not everything is going to go the way you planned, thus causing you to think your whole world is coming down on you. The main points the director emphasized that caught my attention in this movi e wereRead MoreUnderstanding Anxiety: Critical Analysis of a Central Character in the Movie, Parenthood1746 Words   |  7 Pagesindividuals experience a more chronic, constant state of anxiety in response to a wide variety of stimuli, whereas others have more infrequent bouts that tend to vary in both frequency and length. Utilizing the character of Kevin Buckman in the film Parenthood, the author examines the young boy’s pervasive sense of anxiety and the ways in which it manifests. Throughout the essay, the author highlights critical factors contributing to Kevin’s anxiety in order to more fully understand the behavior andRead MoreIpad623 Words   |  3 PagesMovie Analysis Journal Entry Parenthood the movie is filled with interpersonal communication in many different ways, from relationships, to labels, internal obstacles, and even direct definition. The movie showed many ways of interpersonal communication because of all the different people with in the family. Because of how many people where in the family, they’re where many different situations between different characters that related to the book. Gill and Patty’s son Kevin seemed a littleRead MoreParenthood Film Family Analysis Paper Essay1257 Words   |  6 PagesParenthood Film Family Analysis Paper Introduction The Parenthood film depicts average family that are changing life course which is the building block of many families. We have the father and mother with marital disfigurations of attachments, and lack of attachment between themselves and the relationships involving their four adult children and grandchildren. Furthermore, in this paper a description of accepting the shift generational roles and Structural Theory is analyzed and discussed in anRead MoreFilm Review Of Twilight 988 Words   |  4 PagesFilm Analysis of Twilight This report is a presentation of an evaluation of the first Twilight film, Twilight, which came out in 2008. This film depicts many family concepts, values, and relationships that were covered in the textbook, Public and Private Families: An Introduction, seventh edition, written by Andrew J. Cherlin. The main purpose of this film analysis is to address the different types of relationships, family values, and family concepts in this film. In this film there are multipleRead MoreSex, Young Adults, and The Media Essay616 Words   |  3 Pagesjust entertains us for hours on end. The media rarely has a positive influence, as it does not put sexual health messages in it’s television shows, movies, music lyrics, and magazines. The article Boys Will Be Boys and Girls Better Be Prepared: An Analysis of the Rare Sexual Health Messages in Young Adolescents’ Media examines and critiques four different vehicles of media. The study, that took place in the year 2000, chose to look at television shows, movies, magazines, and music as the four differentRead MoreAliens Gender Roles : Enchaned By Cyborgs1587 Words   |  7 Pagesthe mother figure of Newt. Newt actually refers to ripley (ellen) as mommy for the first time. There can be absolutely no plagiarism in this. This will be submitted to Safe Assign. This paper is mostly your close reading or film scene analysis interpretation.For example evidence in a particular scene you analyze relates to Cameron s reverse gender roles in the film. You can use an outside source but it should mostly be your interpretation and citing specific film scenes. A range (90-100):Read MoreKnocked Up Textual Analysis1885 Words   |  8 PagesAurora O’Bryan Prof. Kaufman 11/6/2007 Textual Analysis Knocked Up Intended for the enjoyment of the present-day youth generation, the 2007 comedy film Knocked Up deals with more than just comedic issues. Technically introduced as a romantic comedy, this film serves more to its comedic orientation. With awkward romance and stoner mannerisms, the laughs are plentiful for the intentional audience of Knocked Up. However, as the audience is served its fill of laughter, issues are presented that rarelyRead MoreAutism Spectrum Disorders And Its Effects3072 Words   |  13 Pagesshow Parenthood and the well-renowned film Rain Man. Because ASDs are becoming a more central issue in today’s society, I would like to explore the ways in which such media representations contribute to the layperson s understanding of these disorders within a social and cultural context. I will analyze the extent to which media representations contribute to a divide between society’s perception of these disorders and the reality of various types of ASDs. Using both Rain Man and Parenthood, I will

Causes of Unrest in the Middle East Essay - 1145 Words

The Causes of Unrest in the Middle East The causes of unrest in the Middle East are historical, religious, economic and geo-political. Ancient history and ancient civilizations can serve as a framework for understanding some of the existing enmity. For example, the Persians (Iranians) and the Babylonians (Iraqis) have been fighting for more than 3,000 years. However, the current unrest in the Middle East is the result of Western ethno-centrism and colonialism (covert and overt), combined with religious and sectarian conflicts. The impact of Western (Europe and the USA.) interference in the Middle East cannot be overstated. Indeed, the term â€Å"Middle East† is an artificial term that has no meaning except in the context of its†¦show more content†¦Each time a country tried to become a democracy, the implied threat of the possibility of oil being withheld from the military machines of the Western powers led to the destruction of the democratic elements and to the installation of kings and dictators tha t served the interests of Great Britain, France and the USA. Iran is an example of the destruction of democracy to preserve the supply of oil to the West. Iran, which was a functioning democracy during the early-1950s, attempted to nationalize their oil industry. The word â€Å"nationalization† has a negative connotation, but actually means using a nation’s resources for the nation rather than for the benefit of a colonial or external power. Great Britain, with the support of the US and other Western nations, embargoed Iranian oil exports causing great damage to the Iranian people and economy, but failed to break the will and spirit of the Iranians (Bostock). Eventually, the CIA engineered a coup which overthrew Mossadegh, the elected prime minister of Iran, and installed Shah Reza Pahlavi, one of the most vile, cruel and inhumane dictators of the modern era (Bostock). In 1978 the Shah was overthrown by Islamists, who are in power today as a result of the excesses of the Shah, and who are now attempting to develop nuclear we apons to prevent the USA from overthrowing them (Bostock). We call it terror; they call it self-preservation. Add-in the US support forShow MoreRelatedEssay about Increasing Oil and Gasoline Prices 1030 Words   |  5 PagesThis leads to a particular, why is the price of oil and gasoline increasing at such a rapid rate? 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Mearsheimer, a professor of Political Science and the co-director of the Pro gram on International Security Policy at the University of Chicago and StephenRead MoreUs Support And Agendas Within The Middle East1396 Words   |  6 PagesUS support and agendas within the Middle East have been extremely complicated in the last century. Starting with the backing of the Shah of Iran in the early 1950s to the present-day conflict in Syria, there appears to be no decision without adverse secondary and tertiary effects. Since the Persian Gulf War, US policy has been fully supportive of the Arabs and Turks while limiting official support for the Kurds in Turkey, Iraq, and Syria. Nevertheless, unofficially, the US has fully supportedRead MoreThe Arab Spring Revolution is a Failure1303 Words   |  6 Pagesâ€Å"Bombing in Libya kills 20 in the proximity of a ration distribution unit†. 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The â€Å"War on terror† was the ideal scheme since Islam was branded as the enemy, and 9/11, it couldn’t have been more convenientRead MoreHuman Rights are a Source of Conflict in the World Essay854 Words   |  4 PagesIn the present day global atmosphere it is understood that human rights are a source of conflict. It is understood that the policy of non- intervention in states causes problems in retrospect to colonialism, and in addition to understanding that human rights are a source of conflict as they impede upon the rights of women and undermine a large proportion of the worlds population causing conflict between genders and in the state itself. In supplementation to this, human rights and state security comeRead MoreThe Middle East Essay1021 Words   |  5 PagesThe middle east is a land stained with the blood of innocence and plagued with instability. Most history books will claim that the instability has been growing since the late 1970’s and some state its stemmed from bad blood between tribes that has been cultivating for thousands of years. But could the foundations on which the house of history stands be built upon grains of sand? Have western nations played a larger part in the rapid growth of conflict in the middle east? â€Å"Christianity and western

Nursing Care Plan free essay sample

While various mechanisms may cause TBI, the most common causes include motor vehicle accidents (eg, collisions between vehicles, pedestrians struck by motor vehicles, bicycle accidents), falls, assaults, sports-related injuries, and penetrating trauma. Motor vehicle accidents account for almost half of the TBIs in the United States, and in suburban/rural settings, they account for most TBIs. In cities with populations greater than 100,000, assaults, falls, and penetrating trauma are more common etiologies of head injury. The male-to-female ratio for TBI is nearly 2:1, and TBI is much more common in persons younger than 35 years. Diagnostic Procedures: The physical examination and the history of the exact details of the injury are the first steps in caring for a patient with head injury. The patients past medical history and medication usage will also be important factors in deciding the next steps. Plain skull X-rays are rarely done for the evaluation of head injury. It is more important to assess brain function than to look at the bones that surround the brain. Plain X-ray films may be considered in infants to look for a fracture, depending upon the clinical situation. Computerized tomography (CT) scan of the head allows the brain to be imaged and examined for bleeding and swelling in the brain. It can also evaluate bony injuries to the skull and look for bleeding in the sinuses of the face associated with basilar skull fractures. CT does not assess brain function, and patients suffering axonal shear injury may be comatose with a normal CT scan of the head. Numerous guidelines exist to give direction as to when a CT should be completed in patients who present awake after sustaining a minor head injury. The Ottawa CT head rules apply to patients age 2 to 65. High Risk †¢Glasgow Coma Scale less than 15, two hours after injury ? †¢Suspect open or depressed skull fracture ? †¢Sign of basilar skull fracture ? †¢Vomiting more than once ? †¢Older than 65 years of age Medium Risk †¢Amnesia before impact greater than 30 minutes? †¢Dangerous mechanism of injury Signs, Symptoms, and Course of the Disease/Disorder: It is important to remember that a head injury can have different symptoms and signs, ranging from a patient experiencing no initial symptoms to coma. A high index of suspicion that a head injury may exist is important, depending upon the mechanism of injury and the initial symptoms displayed by the patient. Being unconscious, even for a short period of time is not normal. Prolonged confusion, seizures, and multiple episodes of vomiting should be signs that prompt medical attention is needed. In some situations, concussion-type symptoms can be missed. Patients may experience difficulty concentrating, increased mood swings, lethargy or aggression, and altered sleep habits among other symptoms. Medical evaluation is always wise even well after the injury has occurred. Treatment and Prognosis: The treatment of head injury may be divided into the treatment of closed head injury and the treatment of penetrating head injury. While significant overlap exists between the treatments of these 2 types of injury, some important differences are discussed. Closed head injury treatment is divided further into the treatment of mild, moderate, and severe head injuries. Mild head injury Most head injuries are mild head injuries. Most people presenting with mild head injuries will not have any progression of their head injury; however, up to 3% of mild head injuries progress to more serious injuries. Mild head injuries may be separated into low-risk and moderate-risk groups. Patients with mild-to-moderate headaches, dizziness, and nausea are considered to have low-risk injuries. Many of these patients require only minimal observation after they are assessed carefully, and many do not require radiographic evaluation. These patients may be discharged if a reliable individual can monitor them. Patients who are discharged after mild head injury should be given an instruction sheet for head injury care. The sheet should explain that the person with the head injury should be awakened every 2 hours and assessed neurologically. Caregivers should be instructed to seek medical attention if patients develop severe headaches, persistent nausea and vomiting, seizures, confusion or unusual behavior, or watery discharge from either the nose or the ear. Patients with mild head injuries typically have concussions. A concussion is defined as physiologic injury to the brain without any evidence of structural alteration. Concussions are graded on a scale of I-V. A grade I concussion is one in which a person is confused temporarily but does not display any memory changes. In a grade II concussion, brief disorientation and anterograde amnesia of less than 5 minutes duration are present. In a grade III concussion, retrograde amnesia and loss of consciousness for less than 5 minutes are present, in addition to the 2 criteria for a grade II concussion. Grade IV and grade V concussions are similar to a grade III, except that in a grade IV concussion, the duration of loss of consciousness is 5-10 minutes, and in a grade V concussion, the loss of consciousness is longer than 10 minutes. As many as 30% of patients who experience a concussion develop postconcussive syndrome (PCS). PCS consists of a persistence of any combination of the following after a head injury: headache, nausea, emesis, memory loss, dizziness, diplopia, blurred vision, emotional lability, or sleep disturbances. Fixed neurologic deficits are not part of PCS, and any patient with a fixed deficit requires careful evaluation. PCS usually lasts 2-4 months. Typically, the symptoms peak 4-6 weeks following the injury. On occasion, the symptoms of PCS last for a year or longer. Approximately 20% of adults with PCS will not have returned to full-time work 1 year after the initial injury, and some are disabled permanently by PCS. PCS tends to be more severe in children than in adults. When PCS is severe or persistent, a multidisciplinary approach to treatment may be necessary. This includes social services, mental health services, occupational therapy, and pharmaceutical therapy. After a mild head injury, those displaying persistent emesis, severe headache, anterograde amnesia, loss of consciousness, or signs of intoxication by drugs or alcohol are considered to have a moderate-risk head injury. These patients should be evaluated with a head CT scan. Patients with moderate-risk mild head injuries can be discharged if their CT scan findings reveal no pathology, their intoxication is cleared, and they have been observed for at least 8 hours. Moderate and severe head injury The treatment of moderate and severe head injuries begins with initial cardiopulmonary stabilization by ATLS guidelines. The initial resuscitation of a patient with a head injury is of critical importance to prevent hypoxia and hypotension. In the Traumatic Coma Data Bank study, patients with head injury who presented to the hospital with hypotension had twice the mortality rate of patients who did not present with hypotension. The combination of hypoxia and hypotension resulted in a mortality rate 2. 5 times greater than if neither of these factors was present. Once a patient has been stabilized from the cardiopulmonary standpoint, evaluation of their neurologic status may begin. The initial GCS score provides a classification system for patients with head injuries but does not substitute for a neurologic examination. After assessment of the coma score, a neurologic examination should be performed. If a patient has received muscle relaxants, the only neurologic response that may be evaluated is the pupillary response. After a thorough neurologic assessment has been performed, a CT scan of the head is obtained. The results of the CT scan help determine the next step. If a surgical lesion is present, arrangements are made for immediate transport to the operating room. Fewer than 10% of patients with TBI have an initial surgical lesion. Although no strict guidelines exist for defining surgical lesions in persons with head injury, most neurosurgeons consider any of the following to represent indications for surgery in patients with head injuries: extra-axial hematoma with midline shift greater than 5 mm, intra-axial hematoma with volume greater than 30 mL, an open kull fracture, or a depressed skull fracture with more than 1 cm of inward displacement. In addition, any temporal or cerebellar hematoma that is larger than 3 cm in diameter is considered a high-risk hematoma because these regions of the brain are smaller and do not tolerate additional mass as well as the frontal, parietal, and occipital lobes. These high-risk temporal and cerebellar hematomas are usually evacuated immediately If no surgical lesion is present on the CT scan image, or following surgery if one is present, treatment of the head injury begins. The first phase of treatment is to institute general measures. Once appropriate fluid resuscitation has been completed and the volume status is determined to be normal, intravenous fluids are administered to maintain the patient in a state of euvolemia or mild hypervolemia. A previous tenet of head injury treatment was fluid restriction, which was believed to limit the development of cerebral edema and increased ICP. Fluid restriction decreases intravascular volume and, therefore, decreases cardiac output. A decrease in cardiac output often results in decreased cerebral flow, which results in decreased brain perfusion and may cause an increase in cerebral edema and ICP. Thus, fluid restriction is contraindicated in patients with TBI. Another supportive measure used to treat patients with head injuries is elevation of the head. When the head of the bed is elevated to 20-30 °, the venous outflow from the brain is improved, thus helping to reduce ICP. If a patient is hypovolemic, elevation of the head may cause a drop in cardiac output and CBF; therefore, the head of the bed is not elevated in hypovolemic patients. In addition, the head should not be elevated (1) in patients in whom a spine injury is a possibility or (2) until an unstable spine has been stabilized. Sedation is often necessary in patients with traumatic injury. Some patients with moderate head injuries have significant agitation and require sedation. In addition, patients with multisystem trauma often have painful systemic injuries that require pain medication, and many intubated patients require sedation. Short-acting sedatives and analgesics should be used to accomplish proper sedation without eliminating the ability to perform periodic neurologic assessments. This requires careful titration of medication doses and periodic weaning or withholding of sedation to allow periodic neurologic assessment. Intravenous lidocaine administered along with rapid sequence induction before endotracheal intubation is not associated with significant hemodynamic changes in traumatic brain injury patients. [9] The use of anticonvulsants in patients with TBI is a controversial issue. No evidence exists that the use of anticonvulsants decreases the incidence of late-onset seizures in patients with either closed head injury or TBI. Temkin et al demonstrated that the routine use of Dilantin in the first week following TBI decreases the incidence of early-onset (within 7 d of injury) seizures but does not change the incidence of late-onset seizures. [10] In addition, the prevention of early posttraumatic seizures does not improve the outcome following TBI. Therefore, the prophylactic use of anticonvulsants is not recommended for more than 7 days following TBI and is considered optional in the first week following TBI. After instituting general supportive measures, the issue of ICP monitoring is addressed. ICP monitoring has consistently been shown to improve outcome in patients with head injuries. ICP monitoring is indicated for any patient with a GCS score less than 9, any patient with a head injury who requires prolonged deep sedation or pharmacologic relaxants for a systemic condition, or any patient with an acute head injury who is undergoing extended general anesthesia for a nonneurosurgical procedure. ICP monitoring involves placement of an invasive probe to measure the ICP. Unfortunately, noninvasive means of monitoring ICP do not exist, although they are under development. ICP may be monitored by means of an intraparenchymal monitor, an intraventricular monitor (ventriculostomy), or an epidural monitor. These devices measure ICP by fluid manometry, strain-gauge technology, or fiberoptic technology. Intraparenchymal ICP monitors are devices that are placed into the brain parenchyma to measure ICP by means of fiberoptic, strain-gauge, or other technologies. The intraparenchymal monitors are very accurate; however, they do not allow for drainage of CSF. Epidural devices measure ICP via a strain-gauge device placed through the skull into the epidural space. This is an older form of ICP measurement and is rarely used today because the other technologies available are more accurate and more reliable. A ventriculostomy is a catheter placed through a small twist drill hole into the lateral ventricle. The ICP is measured by transducing the pressure in a fluid column. Ventriculostomies allow for drainage of CSF, which can be effective in decreasing the ICP. A risk of symptomatic hemorrhage exists with entriculostomy placement, and Bauer et al report from a retrospective study that an international normalized ratio (INR) of 1. 2-1. 6 is an acceptable range for emergent ventriculostomy placement in patients with TBI. [11] Once an ICP monitor has been placed, ICP is monitored continuously. No absolute value of ICP exists for which treatment is implemented automatically. In adults, the reference range of ICP is 0-15 mm Hg. The normal ICP wavef orm is a triphasic wave, in which the first peak is the largest peak and the second and third peaks are progressively smaller. When intracranial compliance is abnormal, the second and third peaks are usually larger than the first peak. In addition, when intracranial compliance is abnormal and ICP is elevated, pathologic waves may appear. Lundberg described 3 types of abnormal ICP waves, A, B, and C waves. [12] Lundberg A waves, known as plateau waves, have a duration of 5-20 minutes and an amplitude of 50 mm Hg over the baseline ICP. After an episode of A waves dissipates, the ICP is reset to a baseline level that is higher than when the waves began. Lundberg A waves are a sign of severely compromised intracranial compliance. The rapid increase in ICP caused by these waves can result in a significant decrease in CPP and may lead to herniation. Lundberg B waves have a duration of less than 2 minutes, and they have an amplitude of 10-20 mm Hg above the baseline ICP. B waves are also related to abnormal intracranial compliance. Because of their smaller amplitude and shorter duration, B waves are not as deleterious as A waves. C waves, known as Hering-Traube waves, are low-amplitude waves that may be superimposed on other waves. They may be related to increased ICP; however, C waves can also occur in the setting of normal ICP and compliance. When treating elevated ICP, remember that the goal of treatment is to optimize conditions within the brain to prevent secondary injury and to allow the brain to recover from the initial insult. Maintaining ICP within the reference range is part of an approach designed to optimize both CBF and the metabolic state of the brain. Treatment of elevated ICP is a complex process that should be tailored to each particular patients situation and should not be approached in a cookbook manner. Many potential interventions are used to lower ICP, and each of these is designed to improve intracranial compliance, which results in improved CBF and decreased ICP. Acute treatment of increased intracranial pressure The Monro-Kellie doctrine provides the framework for understanding and organizing the various treatments of elevated ICP. In patients with head injuries, the total intracranial volume is composed of the total volume of the brain, the CSF, intravascular blood volume, and any intracranial mass lesions. The volume of one of these components must be reduced to improve intracranial compliance and to decrease ICP. The discussion of the different treatments of elevated ICP is organized according to which component of intracranial volume they affect. The first component of total intracranial volume to consider is the blood component. This includes all intravascular blood, both venous and arterial, and comprises approximately 10% of total intracranial volume. Elevation of the head increases venous outflow and decreases the volume of venous blood within the brain. This results in a small improvement in intracranial compliance and, therefore, has only a modest effect on ICP. The second component of intracranial vascular volume is the arterial blood volume. Hypocapnia is capable of reducing cerebral blood flow 4% for each mm Hg change in PaCO2. The control mechanism is probably extravascular pH changes in fluid bathing cerebral resistor vessels, which alter smooth muscle intracellular calcium concentrations. This may be reduced by mild-to-moderate hyperventilation, in which the PCO2 is reduced to 30-35 mm Hg. This decrease in PCO2 causes vasoconstriction at the level of the arteriole, which decreases blood volume enough to reduce ICP. The effects of hyperventilation have a duration of action of approximately 48-72 hours, at which point the brain resets to the reduced level of PCO2. This is an important point because once hyperventilation is used, the PCO2 should not be returned to normal rapidly. This may cause rebound vasodilatation, which can result in increased ICP. Below a PaCO2 of 25-30 Torr, CBF falls much less rapidly, presumably because of severe enough vasoconstriction to induce hypoxemia in brain tissues, limiting oxygen delivery. PaCO2 tensions less than 25 Torr are sufficient to change brain metabolism into anaerobic, which increases acidosis. Low arterial O2 tensions influence CBF but to a lesser degree than PaCO2. No measurable changes in CBF occur during hypoxemia until the PaO2 drops below 50 Torr, at which time CBF gradually increases. In addition to reducing CBF, the resultant respiratory alkalosis may reverse local tissue acidosis, which develops in cerebral edema, benefiting cellular respiration and restoring autoregulation. Within 48-72 hours, renal mechanisms for handling bicarbonate excretion compensate for altered PaCO2 tensions, thereby normalizing cerebral pH and returning CBF to baseline values. There are 3 paradoxes to hyperventilation therapy for the control of ICP. †¢Since cerebral vasospasm is a serious concern in subarachnoid hemorrhage (SAH), attempts to create further vessel constriction by hyperventilation in order to decrease concomitant cerebral edema are rarely indicated unless the amount of edema is clinically emergent. †¢Vessels in the damaged area of the brain have lost their autoregulatory control. While unaffected brain regions would vasoconstrict normally to the stimulus of decreased PaCO2, damaged areas might vasodilate in response to diminished cerebral blood flow. This can create a â€Å"reverse steal† phenomenon, where blood and nutrients are diverted away from â€Å"normal† areas of the brain and into â€Å"damaged† areas. This diversion would feed the increased metabolic requirement of damaged tissues, but the sum total effect may cause more harm to the rest of the brain. In addition, the increased hydrostatic pressure combined with the capillary permeability damage might, in some cases, paradoxically increase ICP in damaged areas. †¢Sudden increases in PaCO2, as a result of ventilator changes, often result in dramatic increases in CBF, and rapid deteriorations in the patient’s condition. During hyperventilation, the cerebral bicarbonate level gradually adjusts to offset the lower level of CO2, maintaining normal pH. If the pCO2 is allowed to rise suddenly, the excess CO2 rapidly crosses the blood-brain barrier, but the bicarbonate level in the brain increases much less rapidly. The result is cerebral acidosis, with attendant cerebral vascular dilatation, increased cerebral blood volume, and elevated ICP, usually resistant to further hyperventilation. Unfortunately, little objective evidence exists that treatment by hypocapnia has significantly improved mortality or survival. At best, it seems to be a temporary stop-gap measure until some other curative measure, such as surgery, might be attempted. Patients with the most prompt response to hyperventilation generally have the best prognosis for recovery. No evidence exists that hyperventilation therapy produces benefit in hypoxemic-anoxic encephalopathy. CSF represents the third component of total intracranial volume and accounts for 2-3% of total intracranial volume. In adults, total CSF production is approximately 20 mL/h or 500 mL/d. In many patients with TBI who have elevated ICP, a ventriculostomy may be placed and CSF may be drained. Removal of small amounts of CSF hourly can result in improvements in compliance that result in significant improvements in ICP. The fourth and largest component of total intracranial volume is the brain or tissue component, which comprises 85-90% of the total intracranial volume. When significant brain edema is present, it causes an increase in the tissue component of the total intracranial volume and results in decreased compliance and increased ICP. Treatments of elevated ICP that reduce total brain volume include diuretics, perfusion augmentation (CPP strategies), metabolic suppression, and decompressive procedures. Diuresis and brain edema Diuretics are powerful in their ability to decrease brain volume and, therefore, to decrease ICP. Mannitol, an osmotic diuretic, is the most common diuretic used. Mannitol is a sugar alcohol that draws water out from the brain into the intravascular compartment. It has a rapid onset of action and a duration of action of 2-8 hours. Mannitol is usually administered as a bolus because it is much more effective when given in intermittent boluses than when used as a continuous infusion. The standard dose ranges from 0. 25-1 g/kg, administered every 4-6 hours. Because mannitol causes significant diuresis, electrolytes and serum osmolality must be monitored carefully during its use. In addition, careful attention must be given to providing sufficient hydration to maintain euvolemia. The limit for mannitol is 4 g/kg/d. At daily doses higher than this, mannitol can cause renal toxicity. Mannitol should not be given if the patients serum sodium level is greater than 145 or serum osmolality is greater than 315 mOsm. Other diuretics that sometimes are used in patients with TBI include furosemide, glycerol, and urea. Mannitol is preferred over furosemide because it tends to cause less severe electrolyte imbalances than a loop diuretic. Interestingly, mannitol and furosemide have a synergistic effect when combined; however, this combination tends to cause severe electrolyte disturbances. Urea and glycerol have also been used as osmotic diuretics. Both of these compounds are smaller molecules than mannitol and, as a result, tend to equilibrate within the brain sooner than mannitol; therefore, they have a shorter duration of action than mannitol. Urea has the additional problem that it can cause severe skin sloughing if it infiltrates into the skin. Hypertonic saline (3%) has generated some interest in the treatment of intracranial hypertension secondary to brain edema because it is thought to be less disruptive to fluid and electrolyte balance than other diuretic agents. Boluses of mannitol can generate a dramatic diuresis, resulting in rapid intravascular depletion and potential kidney damage. Mannitol can cause as much as 1500 cc of fluid to diurese in the space of 2 hours, as intravascular fluid depletion occurs, hematocrit can rise, blood viscosity can increase, and cloning is enhanced. This makes the area of brain irritation much more amenable to stroke. Saline 3% or 7. 5% administered in continuous infusion generates a more predictable and gentle osmotic flow of brain intracellular water into the interstitial space. The maximum effect occurs after the end of infusion and is visible over 4 hours. Hypertonic saline hydroxyethyl starch (HS-HES) seems to effectively lower ICP but does not increase CPP as much as does mannitol. Therapeutically, the limits of serum sodium and osmolality are in the range of 155-320. More research is needed to elucidate the exact method of action of hypertonic saline and the contraindications. Other supportive treatments While awaiting possible operative therapy, other supportive treatments are as follows: †¢Early extraventricular drainage of CSF is sometimes of value in controlling brain edema if there is a suspicion that the ventricles will progressively diminish in size because edema cannot be cannulated from a burr hole. †¢Coughing and straining increase venous pressure, restricting drainage and backing up blood into the head, thereby increasing ICP. Neuromuscular paralysis may decrease ICP by preventing sudden changes related to coughing or straining and by promoting systemic venous pooling that increases venous drainage from the head. Any other restrictions to jugular blood drainage, such as a kinked neck from positioning in bed, increase ICP by retarding jugular drainage, transmitting pressure back into the brain. †¢Trying to differentiate a drug-induced coma from an increased ICP–induced coma with a trial of naloxone (Narcan) is contraindicated, as it invariably induces agitation if the stupor is narcotic induced. Agitation increases catecholamine response, increases cardiac output, and increases blood flow to the head, thereby increasing hydrostatic pressure and ICP. Decreased serum protein (albumin) from malnutrition causes a decreased serum osmolality compared to the osmolality in the surrounding tissues. This allows intravascular water to flow along the increased osmotic gradient into the tissues, increasing edema. Hyperalimentation should be initiated as soon as possible if the course is likely to be protracted. †¢Boutique intravenous stabilizing cocktails have been said to maintain homeost asis of intravascular and extravascular fluid compartments, avoiding rapid fluid shifts that might adversely affect cerebral metabolism and edema. Composed of an albumin, bicarbonate, and Lasix solution, the albumin increases intravascular colloid content, resisting fluid flow into the brain substance, the bicarbonate buffers pH changes, and the Lasix tends to promote a stable, consistent urine output, resisting intravascular fluid changes from renal compensations. This may be useful in diffuse brain edema to protect against further damage from vascular compartment shifts, but body physiology probably adapts to it rapidly, thereby limiting its effect. These cocktails have not been proven to be effective as a treatment of SAH since they tend to promote diuresis and intravascular depletion. †¢Use of positive end-expiratory pressure (PEEP) for mechanical ventilation is controversial in TBI patients with acute lung injury/acute respiratory distress syndrome. Zhang et al found that PEEP can have a varied impact on blood, intracranial, and cerebral perfusion pressure in patients with cerebral injury. When applying this technique, mean arterial and intracranial pressure monitoring appears beneficial. [13] Management of cerebral perfusion pressure CPP management involves artificially elevating the blood pressure to increase the MAP and the CPP. Because autoregulation is impaired in the injured brain, pressure-passive CBF develops within these injured areas. As a result, these injured areas of the brain often have insufficient blood flow, and tissue acidosis and lactate accumulation occur. This causes vasodilation, which increases cerebral edema and ICP. When the CPP is raised to greater than 65-70 mm Hg, the ICP is often lowered because increased blood flow to injured areas of the brain decreases the tissue acidosis. This often results in a significant decrease in ICP. Metabolic therapies are designed to decrease the cerebral metabolic rate, which decreases ICP. Metabolic therapies are powerful means of reducing ICP, but they are reserved for situations in which other therapies have failed to control ICP. This is because metabolic therapies have diffuse systemic effects and often result in severe adverse effects, including hypotension, immunosuppression, coagulopathies, arrhythmias, and myocardial suppression. Metabolic suppression may be achieved through drug therapies or induced hypothermia. Barbiturates are the most common class of drugs used to suppress cerebral metabolism. Barbiturate coma is typically induced with pentobarbital. A loading dose of 10 mg/kg is administered over 30 minutes, and then 5 mg/kg/h is administered for 3 hours. A maintenance infusion of 1-2 mg/kg/h is begun after loading is completed. The infusion is titrated to provide burst suppression on continuous electroencephalogram monitoring and a serum level of 3-4 mg/dL. Typically, the barbiturate infusion is continued for 48 hours, and then the patient is weaned off the barbiturates. If the ICP again escapes control, the patient may be reloaded with pentobarbital and weaned again in several days. Hypothermia may also be used to suppress cerebral metabolism. The use of mild hypothermia involves decreasing the core temperature to 34-35 °C for 24-48 hours and then slowly rewarming the patient over 2-3 days. Patients with hypothermia are also at risk for hypotension and systemic infections. Another treatment that may be used in patients with TBI with refractory ICP elevation is decompressive craniectomy. In this surgical procedure, a large section of the skull is removed and the dura is expanded. This increases the total intracranial volume and, therefore, decreases ICP. Which patients benefit from decompressive craniectomy has not been established. Some believe that patients with refractory ICP elevation who have diffuse injury but do not have significant contusions or infarctions will benefit from decompressive craniectomy. Management of elevated ICP involves using a combination of treatments. Each patient represents a slightly different set of circumstances, and treatment must be tailored to each patient. Although no rigid protocols have been established for the treatment of head injury, many published algorithms provide treatment schemas. The American Association of Neurologic Surgeons published a comprehensive evidence-based review of the treatment of TBI, called the Guidelines for the Management of Severe Head Injury. In these guidelines, 3 different categories of treatments, standards, guidelines, and options are outlined. Standards are the accepted principles of management that reflect a high degree of clinical certainty. Guidelines are a particular strategy or a range of management options that reflect a high degree of clinical certainty. Options are strategies for patient management for which clinical certainty is unclear. Prognosis: The outcome of TBI is related to the initial level of injury. While the initial GCS score provides a description of the initial neurologic condition, it does not correlate tightly with outcome. Various methods have been used in an attempt to predict the outcome of TBI, and these are beyond the scope of this discussion. However, one simplified model uses 3 factors, that is, age, motor score of the GCS, and pupillary response (ie, normal, unilateral unresponsive pupil, bilateral unresponsive pupils), to provide a probability of outcome.

Ways of selecting romantic par Essay Example For Students

Ways of selecting romantic par Essay Ways of selecting romantic partnersThere has always been a belief that men and women differ in their ways of selecting romantic partners in terms of characteristics in their mates. For example, men have always been perceived to place more importance in size of breasts in women. Likewise, women have been perceived to place more importance on height of the men they are interested in and their build. This study is to find out whether these social stigmas are true in a typical large college campus dealing with subjects that are around the age of 18~19 years. Surveys were used to have the subjects rate the importance of characteristics of men and women that are typically looked at when either sex are looking for romantic partners. We will write a custom essay on Ways of selecting romantic par specifically for you for only $16.38 $13.9/page Order now The research in question is, †Gender Differences in Selecting Romantic Partners.† There were previous researches and surveys done on this subject. There are five such studies that best relate to the research topic. The first appeared in Sex Roles. The article was titled â€Å"Sex Differences in Factors of Romantic Attraction.† The second appeared in Psychological Reports and was titled, â€Å"Men’s Preferences in Romantic Partners: Obesity vs. Addiction.† The third appeared in College Student Journal and was titled, â€Å"College Students’ Homogamous Preferences for a Date and Mate. † The fourth appeared in Sex Roles titled, â€Å"Pursuit of Nontraditional Occupations: Fear of Success or Fear of Not Being Chosen?† The last article appeared in Psychological Bulletin titled, â€Å"Gender Differences in Mate Selection Preferences: A Test of the Parental Investment Model.† The first article, â€Å"Sex Differences in Factors of Romantic Attraction† was written by Jeffrey S. Nevid. His studies method included an anonymous survey in a college classroom consisting of only heterosexual males and females around the age of 19 to 22 years. The author wanted to see if the popular belief of males placing such physical aspects such as breast size and buttocks size influenced their choice of romantic and sexual partners. He also included females in his studies. In his survey, many physical attributes were presented and the numbers showed that when choosing sexual partners, both men choosing romantic partners, personal characteristics were given more importance than physical. The second article, â€Å"Men’s Preferences in Romantic Partners: Obesity vs. Addiction† was written by Sarah Sitton and Sharon Blanghard. The studies conducted by the two women were done using classified ads. The study was done to compare how many men would chose a recovering controlled substance addict to an obese woman. The result showed that while both attributes were considered very negative characteristics in which many men would avoid in their mate, the recovering addicts received more responses that those of the obese women. However, the men who responded to the addict ads were also admittedly recovering from substance abuse while the obese women in turn received responses from other obese men. In conclusion, men and women tend to seek out mates who are similar in characteristics (Walster, Aronson, Abrahams, and Rottman (1966)) and social desirability. The third article titled,†College Students’ Homogamous Preferences For a Date and Mate† was written by David Knox, Marty Zusman, and Wandy Nieves. A large group of graduate students in a south-eastern university reported the degree to which they preferred selecting a dating and marriage partner who was similar to them in each of ten background characteristics. The results in this study indicated females preferred to date a man who was similar to them in education and occupation and preferred to marry a man who had these similarities as well as religious values, and desire for children. Only men emphasized physical appearances in both dating and marital partners. Both sexes believed that homogamy is with happy and lasting relationships. The fourth article titled, â€Å"Pursuit of Nontraditional Occupations: Fear of Success or Fear of Not Being Chosen?† was written by Karen S. .u79f8b385529a168ec4606f482a1db2df , .u79f8b385529a168ec4606f482a1db2df .postImageUrl , .u79f8b385529a168ec4606f482a1db2df .centered-text-area { min-height: 80px; position: relative; } .u79f8b385529a168ec4606f482a1db2df , .u79f8b385529a168ec4606f482a1db2df:hover , .u79f8b385529a168ec4606f482a1db2df:visited , .u79f8b385529a168ec4606f482a1db2df:active { border:0!important; } .u79f8b385529a168ec4606f482a1db2df .clearfix:after { content: ""; display: table; clear: both; } .u79f8b385529a168ec4606f482a1db2df { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u79f8b385529a168ec4606f482a1db2df:active , .u79f8b385529a168ec4606f482a1db2df:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u79f8b385529a168ec4606f482a1db2df .centered-text-area { width: 100%; position: relative ; } .u79f8b385529a168ec4606f482a1db2df .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u79f8b385529a168ec4606f482a1db2df .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u79f8b385529a168ec4606f482a1db2df .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u79f8b385529a168ec4606f482a1db2df:hover .ctaButton { background-color: #34495E!important; } .u79f8b385529a168ec4606f482a1db2df .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u79f8b385529a168ec4606f482a1db2df .u79f8b385529a168ec4606f482a1db2df-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u79f8b385529a168ec4606f482a1db2df:after { content: ""; display: block; clear: both; } READ: Global terrorism Essay Pfost and Maria Fiore. To determine whether fear of success reflects realistic expectations of the negative consequences id deviance rather than a motive, reactions to â€Å"gender inappropriate† .