Computerized Data Acquisition of a Second Order Reaction Essay Example for Free

Computerized Data Acquisition of a Second Order Reaction EssayThe pass judgment at which reactions occur depend on the composition and the temperature of the reaction mixture. Usually the value of reaction is found to be proportional to the concentrations of the reactants raise to a power.1 in that location are many reactions that have a tempo virtue in the form of (1) v = kAaBbAccording to reference1 the power to which the concentration of a species (product or reactant) is raised in a rate law of this nature is the ordain of the reaction with respect to that species. In equation (1) first order with respect to A and first order with respect to B however, the overall reaction is the sum of the individual orders. Thus we have a second order reaction. In this experiment a hexacyanoferrate(III) ion (Fe(CN)63-) oxidizes ascorbic acid (C6H8O6) by the following reaction (2) 2Fe(CN)63- + C6H8O6 = 2Fe(CN)64- + C6H6O6 + 2H+The reaction above is of a first order reaction at room t emperature with respect to individual reactants therefore the reaction stoichiometry and rate law at time t are (3) aA + bBproducts and (4) -dA = kA Bwhere A represents the concentration of ascorbic acid and B represents the concentrations of Fe(CN)63- at time t. For this experiment we will use an integrated rate law in the form of (5) ln A = b A0 a B0 kt + ln A0where A0 and B0 are the initial concentrations of C6H8O6 and Fe(CN)63- and a=1 and b=2. From equation (5), it is possible to calculate the second-order rate constant k by plotting ln A/B against time (find slope of line where b=2 and a=1). EDTA in this experiment is used as a masking agent to insure metal ions that would normally interfere with the analysis in this reaction. Thus the absorbance of Fe(CN)63- at time t is given by (6) Absorbance = 1012 Fe(CN)63-The oxidation of C6H8O6 by Fe(CN)63- involves a weapon that consists of 3 steps.2 In the first step, the ascorbate ion (AH-) is rapidly formed by ionization of the a scorbic acid. (7) AH2 AH + H+Following the ionization is the slow rate-determining step, the oxidation of the ascorbate ion to an ascorbate free radical (AH) (8) Fe(CN)63- + AH-Fe(CN)64- + AH During the final examination step, an electron is rapidly transferred from the ascorbate free radical to the hexacyanoferrate(III) anion, producing dehydroascorbic acid (A) (9) Fe(CN)63- + AH- Fe(CN)64- + A + H+The slow rate-determining step is an ionic reaction between Fe(CN)63- and AH-. According to reference3, the specific rate constant of an ionic reaction in aqueous solution depends on two factors the ionic strength I of the solution and on the charges ZA and ZB of the ionic species reacting to for the emotional complex. (10) log k = log k0 + 1.02ZAZB I1/2ExperimentalAll reagents in this experiment were of reagent grade. Mass measurements were taken on a Shimadzu Libror AEG-120 analytical scale with an distrust of 0.0001. Manual data acquisition was taken with a Barnstead/Turner SP-830 spectrophotometer and a stopwatch. The computerized data acquisition was completed by a Cary 50 Bio. The experiment began by preparing four solutions of 1 x 10-3 M of K3Fe(CN)6 with varied concentrations of NaNO3 0.025 M, 0.05 M, 0.1 M and 0.2 M.This was completed by dissolving 0.0329245 (0.001) g of K3Fe(CN)6 with the specified concentrations of NaNO3 and deionized water in a vitamin C mL volumetric flask. A 25 mL aliquot of each solution was transferred into a 250 mL Erlenmeyer flask and the temperature of the aliquot was recorded. Next, a 500 mL 2.5 x 10-4 M solution of ascorbic acid was prepared by using a standardized 0.01 M HNO3 solution dissolved in 0.005 g of EDTA and deionized water. A 25 mL aliquot was transferred into each of the four 100 mL beakers by using a 25 mL pipet.The spectrophotometer was set to 418 nm and the absorbance class period was zeroed by using deionized water as a standard. The ascorbic acid in the beaker was poured into the K3Fe(CN)6 solution and th e timer was immediately started. The Erlenmeyer flask was swirled for 2-3 seconds before pouring the reacting mixture into a 1-cm cuvette. The cuvette was conditioned with the reacting solution 4 times before being placed into the sample holder of the spectrophotometer. An absorbance reading was taken at 30 seconds and every 30 seconds thereafter for a total of 6 minutes. The same process was implemented with the Cary 50 Bio except that each sample was analyzed by the computer for 7 minutes and 53 seconds. Data/Results

The Role 19th century Women Essay Example for Free

The Role 19th vitamin C Women EssayWomen in widely distributed Society Pride and Prejudice is a novel compose by Jane Austin, which depicts the womens life in the early 19th ampere-second. Pride and prejudice was written by a young woman in her early twenties, in the context of her day in which womens rights were mot valued particularly in term of their own property rights. The story revolves within the context of the three levels of status in society represented by the characters from upper classes, middle classes, and cast down class status that are themselves symbols of different classes of society during the 19th century. Indeed, the typical life of the 19th century women is accurately depicted in Jane Austins Timeless novel, The Pride and Prejudice. In Jane Austins novel, the first chapter describes the existing norms of the society regarding womens rights. Austin portrayed that women, even in the upper classes are divest of their property rights and the only legal remed y for them to inherent family estates is to be hook up with. This evident in the following lines However, little is known the feeling or views of such(prenominal) a man may be on his first entering a neighborhood, this is so well fixed in the minds of the surrounding families, that he is considered the rightful(prenominal) property of some one or early(a) of their daughters (Austin p. 2). These lines reflect the importance of a man to a family who had but all daughters. The struggle of the 19th century women exactly correlate to the condition of women in Austins novel, as they battle their way towards gaining their rights. Afsar Bano pointed out that the 19th century women could non tolerate such state of affairs any longer. They formed movements in Europe and America to emancipate women (Bano p. 41). Women of the 19th century were deprived of the basic rights and privileges exactly to what Austin has exhibit in her novel almost century earlier.Although Austin portrayed women i n her novel to be socially actively involved, it appears that womens social responsibility was limited, as most of the women mentioned in the story were not engaged in any social obligations, or in any economic activities outside of their homes, though they participated in some social functions.A Womans responsibility was to be a good wife to her husband, and mother to children as stated in the hatchway lines of the story as follows It is a truth universally acknowledged, that a single man in possession of a good fortune, must be in want of a wife (Austin p. 2). Womens inferiority and dependency with men and their lack of basic rights that included their family estates were evident in the story. In the 19th century however, being in this situation, women resented this condition and fought their way toward their common goals under the banner of feminism.Marriage Since they do not work and they do not have rights everywhere their fathers possessions, evidently, married couple was the stand firm remedy for women to avoid poverty. In Austins novel, adult women, view marriage as being the last opportunity to escape future poverty appeared to be consummated not for love, but for need. Austin sees the need of a single man to marry was not based in his feeling the same was the sentiment express by Charlotte Lucas, one of the characters in the novel. She said,I wish Jane success with all my heart and if she were married to him tomorrow, I should think she has a good chance of happiness as if she were to be studying his character for a twelve month, happiness in marriage is entirely a matter of chance (Austin p. 30). In the summary and analysis featured in the internet entitled Pride and Prejudice- learn Guide, it stated the common cerebration of marriage during the novel was utilitarian in which it emphasize the need for young women to find man who have a good furtive (Pride and Prejudice Study Guide Summary of Ch. 1-6). This View of Marriage correlates exactly in the early 19th century. Joan Perkin cited that when the upper-class family considered the marriage of their children more was at stake than momentary infatuation (p. 54). Their view was that emotions came and went land remains. Marriage was not out of love but of necessity, and this view was widely regarded in the 19th century.Personal Lives Fashion Education healthIn Austins novel, personal lives were expressed by the characters in their own bearings and fashions. Austin has been quite generous in her descriptions of the personal life style of the individual in the story. They want going out to party and dancing. Education for women in Austins novel was of little regard as none of the younger women seemed to be so educated. What has been highly regarded was the social class and those in the upper classes manipulate fashions and lifestyle as depicted by the character of wench Catherine de Bourgh. Although the fashion of women in the 19th century was more on garments and d resses, education and health were just as that in the novel. Women in the 19th century were deprived of education and their role was rather in the home. The difference between the 19th century women with the women in the novel was the rise of feminism during the 19th century. In other words, women of the 19th century resisted their situation and demanded equality with men, which was in direct contrast with the passive attitude of the women in the novel.Conclusion Based on the arguments above, I would like to affirm that the life of women in the 19th century was accurately depicted in the novel of Jane Austin in terms of the categories given such as the general society, marriage, and personal lives. The views given in this paper regarding the women of the 19th century was the general situation of the time (Based on the two authors view), and can be and so valid to be the basis of the affirmation above. That is, there must be some similarities in the general role of women in society during the two periods. travel CitedAustin, Jane Pride and Prejudice England Plain Label Books 1957Bano, Afsar Status of Women in Islamic Society India Kumar for Anmol Publication2003.Perkins, Joan Women and Marriage in Nineteenth-century England, EnglandRoutledge, 1989Pride and Prejudices-Study Guide Summary and analytic thinking of Volume I, Chapters 1-6.http//www.gradesaver.com/classicnotes/titles/pride/section3.html 1999-2008.

The European Union: International Relations

The atomic number 63an Union International RelationsThe European Union (EU) is an economic and political union of 27 member states, dictated primarily in Europe. Committed to regional integration, the EU was established by the Treaty of Maastricht on 1 November 1993 upon the foundations of the European Economic Community. With almost 500 jillion citizens, the EU feature generates an estimated 30% share (US$18.4 trillion in 2008) of the nominal gross earth product and ab appear 22% of the PPP gross world product.The EU has developed a single market done a standardised system of laws which apply in all member states, ensuring the free exploit of people, goods, services, and capital. It maintains common policies on trade, agriculture, fisheries and regional development. Sixteen member states watch adopted a common currency, the euro, constituting the Eurozone. The EU has developed a limited role in foreign policy, having representation at the WTO, G8, G20 and at the UN. It enact s legislation in justice and home affairs, including the abolition of passport realises by the Schengen agreement among 22 EU and 3 non-EU states.As an international organisation, the EU functions through a hybrid system of supranationalism and intergovernmentalism. In certain areas, decisions are made through negotiation betwixt member states, while in others, independent supranational institutions are responsible without a requirement for unanimity between member states. Important institutions and bodies of the EU imply the European Commission, the Council of the European Union, the European Council, the European Court of nicety, and the European Central Bank. The European parliament is elected every quintet years by member states citizens, to whom the citizenship of the European Union is guaranteed.The EU originates from the European Coal and Steel Community takeed among six countries in 1951 and the Treaty of Rome in 1957. Since then, the EU has evolved through a proce ss of enlargement, while new policy areas have been added to the remit of its institutions.HISTORYAfter the end of the Second World War, moves towards European integration were seen by many as an escape from the extreme forms of nationalism which had devastated the continent. One such attempt to unite Europeans was the European Coal and Steel Community which, while having the downcast aim of centralised control of the previously national coal and steel industries of its member states, was declared to be a first step in the alliance of Europe. The originators and supporters of the Community take on Jean Monnet, Robert Schuman, Paul Henri Spaak and Alcide de Gasperi. The founding members of the Community were Belgium, France, Italy, Luxembourg, the Netherlands and West Germany.In 1957, these six countries signed the Treaties of Rome which extended the earlier cooperation within the European Coal and Steel Community and created the European Economic Community, (EEC) establishing a c ustoms union and the European Atomic Energy Community (Euratom) for cooperation in developing nuclear energy. In 1967 the Merger Treaty created a single set of institutions for the three communities, which were collectively referred to as the European Communities (EC), although commonly just as the European Community.In 1973 the Communities enlarged to include Denmark, Ireland and the United Kingdom. Norway had negotiated to articulatio at the same time but Norwegian voters rejected membership in a referendum and so Norway remained outside. In 1979 the first direct, democratic elections to the European fantan were held.Greece joined in 1981, and Spain and Portugal in 1986. In 1985 the Schengen Agreement led the way toward the creation of open borders without passport controls between most member states and some non-member states. In 1986 the European flag began to be used by the Community and the Single European Act was signed.In 1990, by and by the fall of the Iron Curtain, the former East Germany became part of the Community as part of a newly united Germany. With enlargement toward Eastern and Central Europe on the agenda, the Copenhagen criteria for candidate members to join the European Union were agreed.The European Union was formally established when the Maastricht Treaty came into force on 1 November 1993, and in 1995 Austria, Sweden and Finland joined the newly established EU. In 2002, euro notes and coins replaced national currencies in 12 of the member states. Since then, the eurozone has increased to encompass sixteen countries, with Slovakia joining the eurozone on 1 January 2009. In 2004, the EU saw its biggest enlargement to date when Malta, Cyprus, Slovenia, Estonia, Latvia, Lithuania, Poland, the Czech Republic, Slovakia, and Hungary joined the Union.On 1 January 2007, Romania and Bulgaria became the EUs newest members and Slovenia adopted the euro. In June 2009 the 2009 elections which later led to a renewal of Barrosos Commission governm ent and in July of that year Iceland formally applied for EU membership. On 1 December 2009 the Lisbon Treaty came into force after a protracted and contentious birth. This reformed many aspects of the EU but in particular created a permanent President of the European Council, the first of which is Herman van Rompuy, and a strengthened high Representative Catherine Ashton.MEMBER STATESThe European Union is composed of 27 sovereign Member States Austria, Belgium, Bulgaria, Cyprus, the Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, and the United Kingdom.Only six of these France, (then-West) Germany, Italy, and the three already merged Benelux countries Belgium, Netherlands, and Luxembourg were members at the start, with membership having grown as countries willingly accede to the treaties and by doing so, pool sovereig nty in exchange for representation in the institutions. To join the EU a country must meet the Copenhagen criteria, defined at the 1993 Copenhagen European Council. These require a stable democracy that respects human rights and the regain of law a functioning market parsimoniousness capable of competition within the EU and the acceptance of the obligations of membership, including EU law. Evaluation of a countrys fulfilment of the criteria is the accountability of the European Council.No member state has ever left the Union, although Greenland (an autonomous province of Denmark) withdrew in 1985. The Lisbon Treaty now provides a clause dealing with how a member leaves the EU.There are three official candidate countries, Croatia, Macedonia and turkey. Albania, Bosnia and Herzegovina, Montenegro, Serbia and Iceland are officially recognised as potential candidates. Kosovo is also listed as a potential candidate but the European Commission does not list it as an independent count ry because not all member states recognise it as an independent country separate from Serbia.Four Western European countries that have chosen not to join the EU have partly committed to the EUs economy and regulations Iceland, which has now applied for membership, Liechtenstein and Norway, which are a part of the single market through the European Economic Area, and Switzerland, which has similar ties through bilateral treaties. The relationships of the European microstates, Andorra, Monaco, San Marino and the Vatican include the use of the euro and other areas of co-operation.GEOGRAPHYThe territory of the EU consists of the combined territories of its 27 member states with some exceptions, outlined below. The territory of the EU is not the same as that of Europe, as parts of the continent are outside the EU, such as Switzerland, Norway, European Russia, and Iceland. Some parts of member states are not part of the EU, notwithstanding forming part of the European continent (for exam ple the Isle of Man and Channel Islands (two Crown Dependencies), and the Faroe Islands, a territory of Denmark). The island country of Cyprus, a member of the EU, is closer to Turkey than to mainland Europe and is often considered part of Asia.Several territories associated with member states that are outside geographic Europe are also not part of the EU (such as Greenland, Aruba, the Netherlands Antilles, and all the non-European British overseas territories). Some overseas territories are part of the EU even though geographically not part of Europe, such as the Azores, the Canary Islands, Madeira, Lampedusa, French Guiana, Guadeloupe, Martinique and Runion, Ceuta and Melilla. As well, although being technically part of the EU, EU law is suspended in Northern Cyprus as it is under the de facto control of the Turkish Republic of North Cyprus, a self-proclaimed state that is recognised only by Turkey.The EUs member states cover an area of 4,422,773 square kilometres (1,707,642 sq mi ). The EU is larger in area than all but six countries, and its highest peak is Mont Blanc in the Graian Alps, 4,807 metres (15,771 ft) above sea level. The landscape, mood, and economy of the EU are influenced by its coastline, which is 65,993 kilometres (41,006 mi) long. The EU has the worlds second-longest coastline, after Canada. The combined member states share land borders with 19 non-member states for a total of 12,441 kilometres (7,730 mi), the fifth-longest border in the world.Including the overseas territories of member states, the EU experiences most types of climate from Arctic to tropical, reading meteorological averages for the EU as a whole meaningless. The majority of the population lives in areas with a Mediterranean climate (Southern Europe), a temperate maritime climate (Western Europe), or a warm summer continental or hemiboreal climate (Eastern Europe).GOVERNANCEThe EUs work is divided into three areas of responsibility, called pillars. The original European Co mmunity policies form the first pillar, while the second consists of Common Foreign and Security Policy. The third pillar originally consisted of Justice and Home Affairs, however owing to changes introduced by the capital of The Netherlands and Nice treaties, it has been reduced to Police and Judicial Co-operation in Criminal Matters (other matters were transferred to the Community). Broadly speaking, the second and third pillars can be described as the intergovernmental pillars because the supranational institutions of the Commission, Parliament and the Court of Justice play less of a role or none at all, while the lead is taken by the intergovernmental Council of Ministers and the European Council (which operate more by consensus than majority in these pillars). Most activities of the EU come under the first, Community pillar. This is mostly an economically oriented pillar and is where the supranational institutions have the most influence.The activities of the EU are regulated b y a number of institutions and bodies that carry out the tasks and policies set out in the Treaties. These procedures are all discipline to the principle of subsidiarity which requires that action only be taken at EU level where an objective cannot be sufficiently achieved by the member states alone.The EU receives its political leadership from the European Council, which usually meet four times a year. It comprises one representative per member state-either its issue of state or head of government-plus its President as well as the President of the Commission. The member states representatives are assisted by their Foreign Ministers. The European Council uses its leadership role to sort out disputes between member states and the institutions, and to resolve political crises and disagreements over controversial issues and policies. On 19 November 2009, Herman Van Rompuy was chosen to become the first permanent President of the European Council. He took office on 1 December 2009. Th e European Council should not be mistaken for the Council of Europe, an international organisation independent from the EU.By virtue of a rotating presidency, every member state takes the helm of the EU for a period of six months during which that countrys representatives chair the meetings of the Council of Ministers. The member state holding the presidency typically uses it to razz a particular policy agenda such as economic reform, reform of the EU itself, enlargement, or furthering European integration.INSTITUTIONSThe European Commission acts as the EUs administrator arm and is responsible for initiating legislation and the day-to-day running of the EU. It is intended to act solely in the interest of the EU as a whole, as unconnected to the Council which consists of leaders of member states who reflect national interests. The commission is also seen as the motor of European integration. It is currently composed of 27 commissioners for different areas of policy, one from dist ributively member state. The President of the Commission and all the other commissioners are nominated by the Council. Appointment of the Commission President, and also the Commission in its entirety, have to be confirmed by Parliament.The European Parliament forms one half of the EUs legislature. The 736 Members of the European Parliament (MEPs) are directly elected by EU citizens every five years. Although MEPs are elected on a national basis, they sit according to political groups rather than their nationality. Each country has a set number of seats. The Parliament and the Council of Ministers form and pass legislation jointly, using co-decision, in certain areas of policy. This procedure has extend to many new areas under the Treaty of Lisbon, and hence increase the exponent and relevance of the Parliament. The Parliament also has the power to reject or censure the Commission and the EU budget. The President of the European Parliament carries out the role of speaker system in parliament and represents it externally. The president and vice presidents are elected by MEPs every two and a half years.The Council of the European Union (sometimes referred to as the Council of Ministers) forms the other half of the EUs legislature. It consists of a government minister from each member states and meets in different compositions depending on the policy area being addressed. Notwithstanding its different compositions, it is considered to be one single body. In addition to its legislative functions, the Council also exercises executive functions in relations to the Common Foreign and Security Policy.The judicial branch of the EU consists of the European Court of Justice (ECJ) and the Court of First Instance. Together they interpret and apply the treaties and the law of the EU. The Court of First Instance mainly deals with cases taken by individuals and companies directly before the EUs courts, and the ECJ primarily deals with cases taken by member states, the instit utions and cases referred to it by the courts of member states. Decisions from the Court of First Instance can be appealed to the Court of Justice but only on a point of law.

Symptoms Of Gastrointestinal Inflammatory Diseases Health And Social Care Essay

Symptoms Of Gastrointestinal Inflammatory Diseases Health And Social Care EssayInflammation is a type of defence mechanism that the body exhibits in response to damage to part or all of its tissues. Depending on the severity of the insult and consequent damage to cells, the incendiary response involves recruitment of varying proportions of neutrophils, eosinophils, basophils, lymphocytes (both T and B cells), natural killer cells and cells of the monocyte macrophage lineage. Inflammation normally seeks to eliminate the cause of the insult and repair the damage caused. However, if the damage persists, lasting recruitment of inflammatory cells to the injured knowledge base will lead to further damage leading to degenerative inflammation. 9 The GI (GI) tract is a hollow muscular tube running from the mouth to the anus. It is to the highest degree 7 to 9 meters long in adult. The enormous mucosal surface, which is the innermost layer of the GI tract, is constantly exposed to a pl ethora of antigenic, mitogenic, mutagenic, and toxic stimuli therefore clearly making the gastrointestinal tract vulnerable to such inflammatory responses. 10Gastrointestinal inflammatory diseasesInflammation can affect any part of the gastrointestinal tract.Inflammatory Bowel DiseaseThe inflammatory bowel diseases (IBD) are chronic inflammatory diseases affecting the gastrointestinal tract. IBD encompasses two forms of intestinal inflammation, namely ulcerative inflammatory bowel disease and Crohns disease. Crohns Disease whitethorn affect all parts of the gastrointestinal tract, but more commonly it involves the distal part of the small intestine and the colon. On the otherwise hand, ulcerative colitis results in colonic inflammation which can affect only the rectum, or can progress proximally to involve the colon, either partly or entirely 11. Currently, the etiology of IBD is unknown, but recent investigations shake off identified contribution of genetic, environmental as well as immunological factors underlying the disease 12. allergicness to disease is thereby determined by genes encoding immune responses which are triggered by environmental stimuli 13. Figure 1.1 shows a combination of genetic and environmental culprits triggering activating of intestinal immune and non-immune systems which culminate in inflammation and tissue damage. 14Figure 1.1 Etiology and pathogenesis of IBD.Current medical therapy of IBD consists of salicylates, corticosteroids, immunosuppressants and immunomodulators. However, their use is associated with severe side effects and complications, such as an increased rate of malignancies or infectious diseases. 15Gastritis (Inflammation of stomach lining)Gastritis represents a group of disorders characterized by gastric epithelial cell injury and regeneration unneurotic with the induction of inflammatory changes in the gastric mucosa 16. Inflammation of the gastric mucosa occurs as a result of an imbalance between mucosal antitank and aggressive factors. It is now well established that H. pylori infection is the cause of the most common form of chronic gastritis 17. Studies mystify established that H.pylori directly contributes to abundant inflammatory response and cause injury to gastric epithelial cells through elaboration of cytotoxic factors and it may also make gastric epithelial cells more susceptible to carcinogenic conversion 18. There is also evidence that drugs and alcohol may cause gastritis. Iron therapy has also been implicated as a cause of gastritis. Iron-pill gastritis involves mucosal erosion which is accompanied by acute and chronic inflammation and marked regenerative epithelial changes 19. Autoimmune and hypersensitivity reactions may also be culprits in gastritis. 20Esophagitis (Inflammation of the oesophagus)eosinophilic esophagitis is a chronic inflammatory condition whereby presence of dense eosinophilic inflammation of esophageal mucosa contributes to esophageal dysfunctio n. Eosinophilic esophagitis is a newly acknowledged disease whose incidence and prevalence is rapidly increasing in developed and developing countries 21. The disease is a major cause of gastrointestinal morbidity among children and adults. It is thought to be immune mediated, whereby food or environmental antigens trigger a T-helper (Th)-2 inflammatory response. 22PancreatitisChronic pancreatitis is well-known as a persistent inflammatory disorder of the pancreas, characterized by destruction of the pancreatic parenchyma, maldigestion, chronic pain and diabetes mellitus. Susceptibility to chronic pancreatitis is inherited in a complex manner, involving mutations in several(prenominal) genes conferring various degrees of risk. 23 Although the exact etiology of acute and chronic pancreatitis is unknown, studies have revealed that they are most customaryly caused by a high consumption of alcohol and tobacco 24. Other common causes include gallstones, hypertriglyceridemia, hyperparat hyroidism, trauma, pancreatic tumors, and intra-abdominal and non-abdominal surgery. Drugs constitute a relatively infrequent cause of acute pancreatitis and account for 1.4 to 2% of the cases in the general population. 25 intestinal fluGastroenteritis refers to inflammation of the gastrointestinal tract, involving the stomach and intestines. Acute gastroenteritis is a common disease occurring worldwide, which affects all age groups and leading to an estimated three million deaths annually. In many patients the causal agent cannot be identified, but research has implicated bacteria and parasites as well as viruses such as rotavirus, adenovirus, and caliciviruses as major culprits in causing gastroenteritis. 26Symptoms of gastrointestinal inflammatory diseasesTable 1.1 Symptoms of GI inflammationGastrointestinal Inflammatory DiseaseSymptomsInflammatory Bowel DiseasesDiarrhoeaBlood in stoolsGastrointestinal bleedingAbdominal painFistulas (usually around the rectal area, may cause drai ning of pus, mucus, or stools)ConstipationWeight loss 11Gastritisunwellness nauseant (possibly with blood)Abdominal pain and bloatingIndigestionLoss of appetiteBlood in the stools. 27EsophagitisFood impactionsDysphagia (difficulty swallowing)NauseaVomitingHeartburnchest pain or abdominal pain 28PancreatitisAbdominal painNauseaVomitingWeight lossMild yellowing of skin (jaundice)Fatty stools 29GastroenteritisAbdominal painNausea and vomitingDiarrhoeaJoint stiffness or muscle painPoor feeding and weight loss 30Biomarkers of Gastrointestinal inflammationInflammatory activities occurring at bottom the gastrointestinal tract can be assessed using a variety of techniques. Presently, the most reliable means to assess intestinal inflammation is endoscopy with mucosal biopsy. However, this technique is expensive, invasive, time-consuming and is not popular with patients 31. Moreover, this technique requires a skilled operator and an uncomfortable preparatory regimen. Other techniques consti tute measurement of conventional non-invasive acute-phase inflammatory markers in plasma and faeces. 32Blood inflammatory biomarkersSerological biomarkers are principally produced when the intestine is exposed to the normal commensal bacteria and their increased levels might be indicatory of an impaired or wrongly regulated inflammatory response. Erythrocyte sedimentation rate (ESR), white blood cell count (WBC) and C-reactive protein (CRP) are well-established indicators of inflammatory conditions at heart the intestine. 33C-reactive protein (CRP)CRP is one of the vital acute phase proteins in humans, which is normally produced in low quantities by hepatocytes (/= 30 kg/m2. However, this method has been subjected to criticism because it does not separate plonk from fat-free mass such as muscle and bone 76. In addition, it has also been observed that for the same value of BMI, women are, on average, fatter than men, and Asians are, on average, fatter than Caucasians 77. diffusi on of body fat is highly important in evaluating obesity-related health risks. It has been well-established that accumulation of intra-abdominal fat, that is central obesity, shows stronger correlation with disease states in comparison with total body fat 78. According to a recent conceive, waist circumference, and not BMI, explains obesity-related health risk. 79Obesity is associated with low-grade inflammation. The inflammatory process originates and resides mainly in adipose tissue, as it is trusty for production and secretion of various proteins involved in development of obesity related adverse health effects 80 . Through this mechanism, increasing obesity leads to decrement of adiponectin levels, which has anti-inflammatory properties, and to designate levels of C-reactive protein (CRP) and results in systemic inflammation, including gastrointestinal inflammations. Intestinal inflammation is a key feature in severe obesity 81. A study has established diet-induced intestina l inflammation as an early biomarker and mediator of obesity 82. Findings in adult humans and in animals have suggested that the inflammatory status at mucosal surfaces of various organs including the adipose tissue, ooesophagus, pancreas, colon, which are associated with the increase of fat mass, may be involved in the pathogenetic pathship canal of obesity complications 81. In addition, animal studies showed that round mice display enhanced intestinal permeability 83. Recent epidemiological studies have demonstrated that obesity is associated functional bowel disorders, which may have resulted from a low-grade inflammation 81. Furthermore, obesity has been establish to increase the severity of acute pancreatitis through amplification of the immune response to injury 84. Obesity, especially abdominal obesity, was also found to be a significant risk factor for erosive esophagitis 85. Very recently, an association of obesity with endoscopic gastritis was demonstrated. 86Results of a recent study pointed that circulate neutrophils are greatly activated in severely obese subjects, thereby indicating the association between obesity and activation of the innate immune response. In addition, elevated levels of faecal calprotectin, which is a non-invasive biomarker of intestinal inflammation, have been reported in individuals with high BMI 87. Another study demonstrated a strong correlation between circulate calprotectin levels with abdominal adiposity in Japanese men, and also showed that weight loss in the subjects led to decreased circulating calprotectin. 88GeneticsGastrointestinal inflammatory diseases may also be influenced by genetic components. Family studies have revealed strong familial association and high sibling risk ratio in etiology of eosinophilic esophagitis. 89 Genetic factors also play a role in pancreatitis. 90 In addition, increased familial risk has also revealed a genetic basis in Inflammatory Bowel Disease 91, and an increased faecal calpr otectin concentration has also been demonstrated in asymptomatic first-degree relatives of IBD patients, thus indicating a high prevalence of subclinical intestinal inflammation in them. 92GenderGender may play a role in gastrointestinal inflammatory diseases. Animal studies in mice have demonstratedthat femalesdevelop more severe intestinal inflammation than do males 93. On the other hand, a study has shown that bile reflux gastritis was more frequent to male gender 94. Another study found a positive correlation between the male sex and pancreatitis 95. Additional studies found that there is a slight preponderance of colitis ulcerosa in men and of Crohns disease in women 96.Lifestyle factorsSmokingCigarette smoking affects ulcerative colitis (UC) and Crohns disease (CD) in very antithetic ways. According to recent studies, smoking cigarettes has a negative effect on the course of CD, and that smoking cigarettes may have a protective effect in some patients with UC 97. Conversely, smoking cessation aggravates ulcerative colitis and improves CD 98. Furthermore, studies showed that smoking conferred a strong, independent and dose-dependent risk of pancreatitis that may be running(a) or multiplicative when combined with alcohol. 99.AlcoholMost cases of chronic pancreatitis are alcohol-related. 100 However, a recent study showed that faecal calprotectin concentrations in active-drinking alcoholics were not significantly different from the healthy controls thereby indicating the absence of a subclinical intestinal inflammation involving activation of neutrophils in the alcoholics. 101DietPro- or prebiotics will directly influence the microbial flora, while immunonutrition, including omega-3 fatty acids and certain polyphenols, including green tea polyphenols, may reduce the symptoms of gut inflammation 102. Studies have shown that lycopene, an antioxidant which is abundantly found in foods that have a natural red color such as tomato and watermelon, may play a role in attenuating the inflammatory process 103. A study showed that intestinal bacteria and high fat diet interact to promote proinflammatory changes in the small intestine 104. Certain studies suggested that refined net income consumption might be a risk factor for Crohns Disease, but not Ulcerative Colitis. Fat intake is reportedly positively associated with ulcerative colitis 105, whereas vegetables and fiber consumption seem to decrease GI inflammatory process as shown by decreased faecal calprotectin 106.StressPsychological stress reportedly increases disease activity in inflammatory bowel disease by both direct and indirect mechanisms as shown below. 107Figure 1.2 Direct and indirect ways by which stress can aggravate Inflammatory Bowel DiseasesSocioeconomic statusEpidemiological studies have demonstrated Inflammatory Bowel Diseases to be more prevalent among people of high socioeconomic status. Such an occurrence was explained by the hyegiene hypothesis, according to which individuals with higher standards of living may be living in clean environments and thus are more protected from childhood infections, but however exposure to infectious agents later in life makes them more vulnerable to chronic intestinal inflammation in adulthood 108. A study in China demonstrated that levels of faecal calprotectin were significantly increased in the rural infants as compared to urban ones. 5Gastric surgeryPartial gastrectomy increases the risk for chronic pancreatitis in male alcoholics 109. Appendectomy has possibly protective effects in ulcerative colitis but it is suggested as a risk factor in Crohns disease. Tonsillectomy is a risk factor for developing Crohns disease. 110

Cultural Differences in Midwifery Care

Cultural Differences in tocology C areIntroductionThe provision of holistic tocology care is a fundamental role of the accoucheuse (NMC, 2004). However, holistic care must encompass a wide range of practices, including care for the psychosocial and spiritual necessitate of the women and families within their caseload. One concept which arises within the general health care debate and within professional midwifery practice is the notion of heathenish competency. This essay focuses on a judge of one phrase from the midwifery publications which leaveresses of the trains of one distinct religio- pagan free radical. Leishman (2004) demonstrates the complex nature of the provision of healthcare in a multi-cultural society. Inequalities exist in the provision of care to diverse heathenish and cultural groups (Salt, 1997). The article being critiqued addresses two impressions the provision of care to parents who hit been bereaved, and limitedally, the preferences, beliefs, behaviours and requests of one group of lymph glands, those of the Muslim faith. It is published in a midwifery journal and specifically deals with aspects of care which would come under the remit of the midwife within the UK, as specified by the NMC (2004).DiscussionThe title of the article is classify and simple, and defines the thickening group as religiously distinct (which to a fault implies cultural distinction) and in a particular state of need due to bereavement. That the client group is defined as Islamic, save, does not take into visor the distinct cultural and racial associations of those who practise Islam. A broad spectrum of cultures and races are associated with the Islamic, faith, suggesting that Islamic good deal are not a homogenous group. Conversely, it has excessively been argued that it is important to distinguish mingled with culture (which has racial and religious overtones) and religion as a separate kind of difference or identification (Eade, 199 7). The failure of look for on ethnical and racial or cultural lines to distinguish mingled with religion and culture is celebrated (Eade, 1997), and it may be the intention of the authors of the critique article to ensure that the distinction is both clear and unequivocal. It may also be another example of the prioritisation of Islam over other social identities which is found so often in the literature (Eade, 1997).The authors further identify the group under consideration as those originating from migrants from the Indian Sub-Continent in the 1950s (Arshad et al, 2004). This group is limited to Asians (2nd and 3rd generation) originating directly or indirectly from this area (Arshad et al, 2004). Such a distinction may be important. Marks and Worboys (1997) talk intimately the point that multiple meanings can be attached to the terminology surrounding talk overions of culture and ethnicity, terms such as migrant and also minority. In decree to attain cultural competency in the provision of healthcare, it is important to visit the distinctions between those terms utilised within the debate (Srivastava, 2007). Race is usually associated with biological, ancestral and physical distinguishing characteristics (Srivastava, 2007). Ethnicity is associated with ballparkalities of birth, descent, kinship and cultural traditions (Srivastava, 2007). However, culture is harder to define, and includes racial, social, linguistic and other common patterns or characteristics within groups (Srivastava, 2007). This level of ambiguity within the debate does not sustain illuminate the current situation.By so clearly defining the focus of the client group in this article, the authors are claiming association with religious meaning (Islam) and racial and ethnic groupings (Asian, Indian Sub-Continent). They also support their focus with figures from the locality in question, thus establishing this group further as being of one predominant ethnic group, that of people of Pakistani origin (Arshad et al, 2004). This author can only question whether this adds to the understanding of the ratifier or further confuses the issue. The group are clearly defined, yet what distinguishes them from other Muslims, or even from other ethnic groups from Asia, is not defined at all. Given the continued lack of understanding or aware(predicate)ness of cultural difference in the NHS in the UK (Le Var, 1998), further elucidating details might have been recyclable here. However, Cortis (2004) found that deficits exist in Registered Nurses knowledge about Pakistani patients in the United Kingdom, which might suggest that a greater understanding of this particularly group is necessary for all healthcare professionals. The Healthcare Commission (2006) found in their investigation of 10 maternal closings in one infirmary trust that women from minority ethnic groups are at higher risk of a pregnancy- colligate death. In this report, 9 out of the 10 women who died in the time period 2002 to 2005 were from minority ethnic groups, and seven out of these were from Asia (Healthcare Commission, 2006). This would suggest that the maternity care provided to women from these ethnic groups needs to be explored, evaluated and improved. This perhaps relates to the continued drive towards cultural competence in the healthcare services (Srivastava, 2007). It also suggests that there is a need for more specific information and evidence regarding distinct sub-groups within the ethnic mix of clients of the NHS. This article provides information, plainly its status as a form of evidence could be roughly questionable.This is a descriptive article containing practical details for the maternity care professional to be able to provide culturally or religiously workmanlike care for Muslims who experience the loss or death of a baby or fetus. Callister (2005) describes descriptive literature in this field as literature which identifies cultural practices to increas e understanding of how nurses can more effectively provide culturally competent care for specific racial/ethnic and/or cultural groups of women and children. Establishing the client groups distinctions early on, however, does not achieve much more than also establishing the authority of the authors in the writing of such an article, as it contains more or less references, besides not as many as would be expected in a research-based article. in that respect is no lively review of the literature, and very smallish critique or discussion, precisely rather a presentation of the (assumedly) accepted facts that relate to care for the family and dead infant. As such, this is useful and informative, but the critical reader cannot but be aware of the lack of reliable evidence. The authority of the authors must be trusted here.Cortis (2003) suggests that culture furnishes the beliefs and values that consecrate individuals a sense of identity, self-worth and belonging, as thoroughly as providing rules and guidelines or standards for behaviour. If we believe that culture is nighthing commonly understood by those who share it (Srivastava, 2007), then it could be that a common understanding of Pakistani outgoer Muslim culture exists between the authors of the article, to such an extent that they fail to illuminate certain perhaps important details that would inform the general reader. This is a meaning(a) issue in the light of the continued debate about the nature and importance of culture in how people engage with healthcare services and each(prenominal) other. Recent views on culture, although not discarding the importance of a persons cultural inheritance of ideas, values, behaviour and practices, also acknowledge that culture can be affected dynamically by social transformation, social conflicts, power relationships and migration (Cortis, 2003). Yet there is no notion of that here, perhaps because the authors are dealing with the strictures of faith rather t han culture.There is some statistical evidence of the rates of pregnancy loss infant death in the locality in question, but once more, this is poorly related to the rest of the article and seems perhaps a token gesture towards relevance and importance of the information. Also, these statistics refer to White British, Pakistani and another(prenominal) (Ashard et al, 2004), without making any further distinctions. Without such distinctions, the reader can only understand part of the picture. The Other group might also contain people of the Muslim faith, as might the White British group. Again, the authors could have included more critical discussion here of ethnic mix. around readers might consider that, having identified the group in question, the authors have foregone far enough in setting the context of the paper. However, this author also feels that there is a degree of ambiguity in the presentation of this article. By distinguishing the client group to such a degree, it could b e assumed that the customs, rites and beliefs referred to in the article are peculiar to this particular ethnic group who subscribe to the Muslim faith. However, it could also be that readers would assume that because the terms used in the article are more general, referring to Muslims as a religious group rather than making ethnic distinctions, these are guidelines to be applied to all Muslims. This ambiguity does not assist the reader in understanding how best to apply this information.Similarly, there is no hearty acknowledgement of the issue and dangers of stereotyping. Stereotyping has been exposit as a limiting and intellectually crude way of seeming to understand individuals (Schott and Henley, 1996). There is a tendency for people to stereotype those in groups that they do not belong to or know little about (Schott and Henley, 1996). Again, a critical reader could infer from this article that the authors have stereotyped the client group in question as being similar to all other Muslims. However, the article does raise some other issues which may not be explicit, including the importance and behaviours of family and friends in Islam during such a challenging time (Arshad et al, 2004). There is a clear undertone here that all Muslims take over in this manner because of their common faith.The article is referenced correctly but not very intumesce referenced. Conversely, Leishman (2004) carries out a literature review which shine ups some of the more topical issues surrounding the notion of culture and the needs of distinct diverse groups within the healthcare system. One issue that Lieshman (2004) raises is the fact that there is a need not only for health professionals to be aware of other cultures and belief systems, but also to be aware of their own. Addressing this issue, of understanding ones own reaction to the beliefs and practices of others, might be raised in this article when discussing the practices and behaviours that are associated with Muslim clients following the death of a baby. This would be a useful and relevant practice point for midwives and other healthcare professionals to consider.Another point raised by Lieshmans (2004) literature review is the need to take into account the past and experiences of ethnic groups, particularly those who, for example, have entered this nation as asylum seekers. Similar issues have been raised by other literature (Maternity Alliance, 2004). The group in the critique article are not asylum seekers, but their parents, grandparents, family and friends may be, and the experiences and shared realities may affect their relationship with healthcare services and professionals. Such a potential is highlighted by a report by the Maternity Alliance (Maternity Alliance, 2004). Discounting this issue leaves out the level of detail midwives may require to fully understand and respond to the needs of diverse minority groups, perhaps even promoting stereotyping rather than combating it. T hus it can be seen that another author, utilising a more critical and academic approach to the topic, can provide more of a discursive understanding of relevant issues.Similarly, Callister (2005) reviews the literature on cultural competence in the care of women and children, and soak ups conclusions about the nature of that literature. Through this detailed examination the author is able to define and suggest potential outcomes for clinical care, for education of the professionals who deliver that care and for breast feeding research to properly explore the most important issues (Callister, 2005). Again, this article misses important opportunities to link the issues of concern to the current literature and to opportunities to develop better practice through educational development and research. For example, Callister (2005) suggests that studies are needed exploring organisational and work environment issues to better promote cultural competence. Simply being conversant with the b asics of Islamic beliefs and practices surrounding death is not enough to promote true sensitiveness and tell apart care.Cultural sensitivity has been described as the attitudes, values, beliefs and personal insight of healthcare providers (Doorenbos et al, 2005). Such sensitivity involves acknowledgement of personal heritage and beliefs, openness to otherness, and respect for the complex ways in which cultural issues influence every aspect of healthcare (Doorenbos et al, 2005). However, the Arshad et al, (2004) article does not deal with the challenges of promoting cultural sensitivity, not does it distinguish between the different kinds of knowledge, understanding and skills necessary to provide care for this client group in these circumstances. A thorough, critical literature review, especially perhaps of any research or case studies that might illuminate the issues, would have considerably enhanced the paper.Doorenbos et al (2005) highlight and discuss existing models of cultu ral competence within healthcare, and evaluate one of the models used to assess one cultural competence assessment instrument. Application of such models to the situations described by Arshad et al (2004) might also have enhanced the quality of their argument and elevated their paper into the realms of evidence for practice rather than information for practice. Doorenbos et al (2005) describe cultural competence of healthcare providers as being central to the healthcare systems ability to provide access to and provision of high-quality healthcare services, and link it to the drive to reduce health disparities. Srivastava (2007) links cultural competence to respect, knowledge and skills, and the ability to use them effectively in cross-cultural care situations. Some discussion of cultural competence in the Arshad et al (2004) article might also have perhaps allowed a more critical awareness of the subject.The conclusions the authors draw are that individuals have unique responses to grief and loss, regardless of religious background or belief systems (Arshad et al, 2004). This is no innovative or surprising finding, but the fact that they make no other conclusions is surprising. They also conclude that the resulting distress is often overwhelming (Arshad et al, 2004), another generalisation which is not new and does not really add anything to the debate. These conclusions do not really relate to the rest of the article, which is chiefly concerned with describing the beliefs and practices of Muslim people around the death of a child (Arshad et al, 2004). They also highlight that health professionals may not feel properly equipped or be well enough informed to support families of different faiths at such a time (Arshad et al, 2004). This is a fact well established by a range of other literature within healthcare and within midwifery (Srivastava, 2007 Marks and Worboys, 1997 Schott and Henley, 1996).The recommendations which are given are similarly brief and somew hat vague. Arshad et al (2004) suggest that an insight into religious beliefs and practices can only be expert when delivering care in the field of loss and bereavement. This is a rather sweeping statement, because while they do take into account the need to avoid generalisation, they have in fact generalised throughout the article and failed to provide any critical evaluation or insight into, for example, the differences in culture, race, background and practices that may exist between people who nevertheless subscribe to Islam. However, this may be this authors own ethnocentrism surveneer it could be that the expression of Islamic faith is universal and changes little between ethnic, racial or cultural groups. This article might be simply stemming from such a simple fact.The Maternity Alliance (2004) found that unspoilt inequalities still exist in the provision of maternity care to women from minority ethnic groups, especially women who were asylum seekers. There is a need for more investigation of the reasons why staff are still improperly equipped to provide the highest standard of individualised care free of bias, prejudice or stereotyping. There is also a need to investigate the reasons for continued inequalities in access to and experience of healthcare, and any possible links between the two.There are a proceeds of implications for midwifery practice, though these are not as explicitly stated within the article as they could be. The main and most useful implication is the need to provide correct and sensitive care for Muslim clients when they experience pregnancy loss or the death of an infant. This article is ideal to use to inform midwives of this. Other implications for midwifery practice are inherent in the article, and include, for example, implications for the practicalities of care provision in often busy maternity units within the NHS. The placing of the dead body so that it is facing Mecca, for example, is an important consideration for mi dwives who are usually the professionals who prepare the body of an infant or fetus following death. Another consideration is the fact that the whole of the body including the placenta and umbilical cord, should be buried (Arshad et al, 2004). It would be easy for a midwife to cause of import distress to a family by following usual hospital protocol for disposal of placenta, membranes and cord. There may also be issues of health and safety to be considered in the storage and transport of these tissues.If a midwife was aware of these particular religious practices, she might be able to discuss them with the client at an distract time and ensure that all their needs are met. Cortis (2003) suggests that nurses should apprise how the domains of culture need to be used for data collection to identify specific cultural needs. It is through this process that important domains health beliefs, communication, spirituality, death and end distinguish the needs of patients (Cortis, 2003). Cu ltural assessment also offers midwives and other healthcare professionals the opportunity for identifying potential differences between theirs and their patients value systems (Cortis, 2003). Chenowethm et al (2006) describes the common clash between healthcare professionals perceptions of the professional responsibility to deliver care in a particular way, and the patients view of how they wish to be cared for. Such clashes are somewhat inevitable, but if anything can help to overcome them or minimise them, it can only be of benefit to the midwifery profession. Chenowethm et al (2006) suggest one way to ensure cultural sensitivity is to access community resources appropriate to the cultural or ethnic group under consideration. This issue, however is not explicitly addressed in the Arshad et al (2004) article.More general issues for midwifery are those which apply to the broader, clinical governance spectrum of the maternity services as part of the healthcare services. The Departmen t of Health (2007) in its operating framework for 2007-08 lay out core principles for the provision of care in the NHS. These include individualised care, partnership working, respecting dignity, reducing inequality and providing access to all based on need (DOH, 2007). Such a vision is nothing new, but does once again remind midwives of the need to provide both culturally sensitive and appropriate services. The information in this article may contribute to the development of such services, but it is the opinion of this author that it is still inadequate in addressing the complexity of the issues. However, Arshad et al (2007) do not address a range of other issues which can be found in the literature. For example, Park et al (2007) state that recruitment and retention efforts for non-white midwives, regular education for cultural competence of midwives, and provision of culturally and linguistically appropriate care for women from ethnic minorities should be considered in future pro vision of maternity services. Neile (1995) also pinpoints education as important in supporting midwives gain a realistic insight into how the needs of the multiracial community may be met. There appears to be a need for a comprehensive programme of multicultural education for all midwifery professionals (Neile, 1996), a view which is echoed by Campinha-Bacote (2006) and Brathwaite and Majumdar (2006). If the Arshad et al (2004) article more directly targeted itself at professional education, it might have greater impact on the improvement of services.The Arshad et al (2004) article was published in the British Journal of Midwifery, which claims to be the leading clinical journal for midwives (BJM, 2007). This is well cognise as the pre-eminent peer-reviewed Journal for midwives in the United Kingdom, and the editorial board contains a range of the most senior and well respected midwives and midwifery academics in the country (BJM, 2007). The article is available by subscription onl ine and in print, and is available in most Universities and conceive libraries. Contents, discussions and abstracts can also be found online, making this very accessible. This would give the article a degree of weight and authority, and as the BJM has such a large distribution national and international this adds further authority to the article.The writers themselves appear well qualified to write an article on this topic, in that it is written by two Muslim chaplains (one of whom is an Imam) and one bereavement support midwife. Thus the reader would be more inclined to accept and use their assertions in practice. This may explain why such a respected, peer-reviewed journal has accepted an article which is not related to research or a literature review. The authors do not appear to have published in other peer-reviewed journals but have contributed to the development of Trust policies and publications locally (Bradford NHS Trust, 2007).The rationale for the article seems sound. Arshad et al (2004) suggest that supporting parents who are bereaved following pregnancy loss can be complicated by a lack of knowledge and understanding of specific spiritual needs, leaving professionals feeling helpless and families feeling dissatisfied. The purpose, therefore, of their article is to provide information to address this issue (Arshad et al, 2004). This proposal seems reasonable and even necessary, given the need for improved understanding, knowledge, awareness and attitudes highlighted by the literature (Srivastava, 2007 Marks and Worboys, 1997 Schott and Henley, 1996).Cortis (2004) highlights the fact that there is a continued need for research into multi-cultural aspects of care. Through one research study, Cortis (2004) also identifies the danger of ethnocentrism in the health services, suggesting that it may contribute to racism, as ethnocentric practice fails to recognize significant cultural differences and their importance for the people concerned. If this i s true, then such an article, informative and descriptive in nature, may contribute to the quality of care by informing those with ethnocentric tendencies of important details relating to this client group. However, in the provision of individualised care, this article may not supply the level of critical detail that the truly client-centred midwife would need to fully enhance their practice in this area. They also claim that the rituals and beliefs of Islam in these circumstances are complex and may appear strange to the naif (Arshad et al, 2004).ConclusionAs has been demonstrated, this article provides a descriptive, factual picture of the beliefs, practices and behaviours that Muslims experiencing pregnancy loss or infant death might display. It is of some use to midwives in an informative manner, but also does not seem to address the complex and challenging nature of the provision of care to a range of clients whose only common factor may be their Islamic faith. It does not add ress the issue of evidence-based care, and fails to engage in any real critique of the evidence base, literature or debate which does exist around this topic. It also fails to highlight some key terms of the current debate, including notions of cultural competence and cultural sensitivity, to any great degree. There are a range of issues which could have been highlighted such as education, communication and immigration. However, any truly client-centred midwife can only conclude that the information itself is life-sustaining to the provision of midwifery care to such clients and it also serves to highlight the notion of the great differences that exist in responses to and behaviours around pregnancy bereavement within different racial, ethnic and religious groups in society. Any such article has a place in the drive to improve care standards and quality, and should be incorporated into client-centred care.ReferencesArshad, M., Horsfall, A., Yasin, R. () motherliness loss- the Isl amic perspective. British Journal of Midwifery 12 (8) 481-484.Bradford NHS Trust (2007) www.meded.bradfordhospitals.nhs.uk/DesktopModules/ViewDocument.aspx?Brathwaite, A.C. Majumdar, B. (2006) Evaluation of a cultural competence educational programme. Journal of Advanced nurse 53 (4) 470479.British Journal of Midwifery (2007) http//www.britishjournalofmidwifery.com/ Accessed 6-5-07Callister, L.C. () What has the literature taught us about culturally competent care of women and children?. Maternal Child Nursing 30 (6) 380-388.Campinha-Bacote, J. (2006) Cultural competence in nursing curricula how are we doing 20 years later? Journal of Nursing Education. 45(7) 243-4.Chenowethm, L., Jeony, H., Goff, M. Burke, C. (2006) Cultural competency and nursing care an Australian perspective. International Nursing Review 53 24-40.Cortis, J.D. (2004) Meeting the needs of minority ethnic patients. Journal of Advanced Nursing . 48(1) 51-58.Cortis, J.D. (2003) Managing societys difference and div ersity Nursing Standard 18(14-15-16) 33-39.Dennis, S. (2004) Transcultural nursing resources Nursing Standard 19(6) 25Department of Health (2007) The NHS in England the operating framework for 2007-08 http//www.dh.gov.uk/en/Consultations/Liveconsultations/DH_064732Dimond, B. (2002) Race relations and the law. British Journal of Midwifery 10 (9) 580-583.Doorenbos, A.Z., Schim, S.M., Benkert, R. and Borse, N.N. (2005) Psychometric Evaluation of the Cultural Competence Assessment Instrument Among Healthcare Providers. Nursing Research 54 (5) 324-331Eade, J. (1997) The power of the experts the plurality of beliefs and practices concerning health and illness among Bangladeshis in contemporary Tower Hamlets, London. In Marks, L. Worboys, M. (1997) Migrants, Minorities and Health historical and contemporary studies London Routledge.Healthcare Commission (2006) Investigation into 10 maternal deaths at, or following voice communication at, Northwick Park Hospital, North West London Hospita ls NHS Trust, between April 2002 and April 2005. www.healthcarecommission.org.uk/_db/_documents/Northwick_tagged.pdf -. Accessed 6-5-07.Le Var, R.M. (1998) Improving educational preparation for transcultural health care. Nurse Education Today. 18(7) 519-33Lieshman, J. (2004) Perspectives of cultural competence in health care. Nurisng Stanard. 19 (11) 33-38.Marks, L. Worboys, M. (1997) Migrants, Minorities and Health historical and contemporary studies London Routledge.Neale, E. (1996) Investigating midwifery education in a multiracial and multicultural society. In The art and science of midwifery gives birth to a better future. Proceedings of the International alinement of Midwives 24th Triennial Congress, 26-31 May 1996, Oslo. London International Confederation of Midwives. 1996, pp 171-175.Neale, E. (1995) The maternity needs of the Chinese community. Nursing Times 1 (4) 34-35.Papadopoulos, I., Tilki, M. and Lees, S. (2004) Promoting cultural competence in healthcare through a re search-based intervention in the UK. novelty in Health Social Care. 1(2).Park, J-H., Vincent, D. and Hastings-Tolsma, M. (2007) Disparity in prenatal care among women of colour in the USA. Midwifery 23 (1) 28-37.Salt, K. (1996) African-American midwifery past, present and future. Midwifery Today 38 25-27.Schott, J. Henley, A. (1996) Culture, Religion and Childbearing in a Multiracial Society A handbook for health professionals Oxford Butterworth-Heinemann.Srivastava, R.H. (2007) The Healthcare Professionals occur to Clinical Cultural competence Toronto Mosby Elsevier.Weller, P., Feldman, A. and Purdam, K. (2001) Religious Discrimination in England and Wales Home office Research Study 220. London Home Office Research, Development and Statistics Directorate.

My Goals - I Want to Get Back What I Once Had Essay -- strength flexib

My Goals - I Want to Get Back What I Once HadPhysically Ive always had my ups and downs. I speculate it all depends on whats going on in my life that would allow adequate amounts of physical activity. Most of my physical activities are done in the pass and the least amount is done in the winter. Thats not to say that I dont get a little here and there all the time. Most of my cardiovascular fitness is done in the summer, whereas any other exercise I might have is done mostly other parts of the year. Currently I don?t have many strengths as opposed to weaknesses as far as physical fitness is concerned because I havent been active real much since high school. You could say I?ve been pretty lazy. If I were to say that I still had any strengths left, they would be anything having to do with anaerobic exercise. Perhaps much(prenominal) things as lifting weights for a short period of time I may still be able to do pretty well, but as for running game a mile or so, I don?t think Id be a ble to do it as well as I use to.My activity background isn?t very extensive other than a required physical education class throughout grade school. However in middle school I played on a soccer team recreationally for a year or two. In high school I really started to become aware of my physical condition and myself. I began to get tired easily and my muscles always hurt. I was horribly out of shape. So in ninth grade I decided to joint the wrestling team. And every winter form ninth to twelfth gra...

Essay on the Epic Poem, Beowulf - Beowulf is Certainly an Epic :: Epic of Beowulf Essays

Beowulf is an Epic          The early English epic poem Beowulf is filled with a marvelous hero, ghastly villains , far off lands , and deeds of wide valor. These are some of the reasons why Beowulf is a long type of an early English epic. Beowulf is an epic because it has action that consists of deeds of great valor , the setting of Beowulf is in vast scope covering great lands and far off places , and the hero of the story , Beowulf , is of imposing stature of international and international importance.          One reason that Beowulf is an epic is because the action consists of deeds of great valor. Beowulf told a story of when he killed nine sea-beasts with his sword. He also said, I returned from a fight when I destroyed quint a family of giants , which proves the great strength that Beowulf had. When Beowulf talked about going to fight Grendel , he denied himself the use of a sword because he wanted a fai r hand-to-hand fight with Grendel. When one of Hroathgars coast guards set eyes upon Beowulf he said ,I have never set eyes on a more noble man , you are no mere retainer.          Although the action in Beowulf  consists of great deeds , the setting of the story is vast scope covering great lands and far off places. Beowulf said that his father was favored far and wide because he was a very noble lord. The swift current , the surging piss carried me to the far off Land of the Lapps , said Beowulf as he told a story to one of Hroathgars retainers. When Beowulf talked of where Grendel lived he said ,These two live in a little known country with wolf-slopes , windswept headlands where a mountain stream plunges.          The protagonist of Beowulf , Beowulf , is a figure of national and international importance with great historical and legendary significance. Then he who feared no man , the proud leader of the G eats, said the author about Beowulf before he went to seek Grendel. Another example the narrator uses to show the importance of Beowulf is ,Truly , the leader of the Geats fervently