The History of Religion in the US Essay Example for Free

The History of holiness in the US EssayWhen you think of religion in the United States and how it started you may think of the low gear settlers. These were not the first being to faith a higher power in the United States. The Indians believed in and worshiped The Great Spirit. Despite the many tribes standardized the Sioux and Iroquois they every last(predicate) had the same belief in The Great Spirit. The Great Spirit could be present in animals as well as inanimate objects. They all unquestionable great ceremonies to on it. Then came the colonists, the first settlers, who were predominantly protestant these settlers left their home countries because of religion. They did not want to be told how to worship their God. These colonists were Christians but as they began to settle, those with unlike beliefs separated themselves and developed new segments of religion. The puritans left their country to escape spectral criminal prosecution. They later developed the religions of Baptist and Congressionalists. Their religion was based on the teachings of John Calvin, and was thought to advance the religion of the Church of England. Their religions eventually lead to self isolation and witch hunts of people who did not follow their religion.The Methodists were a group of Oxford University Students. They were not fleeing religious prosecution when they arrived. The Methodist Church as become the second largest Protestant Church in the United States today. The History of Religion in the United StatesChrista HartLutherans were like no other the Statesn Christian denomination their national origin did play an important role in their history. Members came from Germany, Sweden, Denmark, Finland, and Norway. The Lutherans settled on the East sloping trough and American Midwest, and celebrated worship function in their native tongues.Presbyterians who bore little resemblance to the liturgy, structure, and tradition associated with the roman letters Catholic Chu rch, the Presbyterian and Reformed churches share a common origin in the teachings of John Calvin. Their belief structure and practices are centered on the Bible and the sovereignty of God. Presbyterians make up one of the largest branches of Protestant Christianity today.The next religion, the Quakers, were founded in 1647 by English preacher George Fox, the Society of Friends emphasized a direct relationship with God. Ones conscience, not the Bible, was the ultimate consent on morals and actions. The state I live in Pennsylvania was founded by the Quakers, specifically William Penn, as a religious sanctuary. Quakers did not have a clergy or dedicated church buildings, and therefore held their meetings in which participants deliberated silently on issues and spoke up when the Spirit moved them. Dressed in plain clothes, Quakers favorite(a) a simple life over one enjoyed by the aristocracy of England and the burgeoning merchant class in the colonies. They excessively shared an ab horrence of violence. I key out my beliefs, even though I The History of Religion in the United StatesChrista Hartfollow or believe in no God, similar, that if you were to need the organized religion in religion, you should not need to have a specific building, life style or presence in society to practice that religion. That doing so sound creates a difference among people creating more separation in a race that should be united. And violence should never be tolerated, growing up in a house hold where violence and abuse was common place, this is a rule that people in my life need to abide by.The oldest Christian churches Roman Catholicism, Anglicanism, and Eastern Orthodoxy, have left their unique stamp on the history of religion in America. Called liturgical for their adherence to an elaborate, set form of ritualistic worship practices, most of those churches observe seven sacraments throughout their members lives, whereas later Christian denominations usually celebrated only tw o.Anglicanism, The Church of England (later the Episcopal Church in the U.S.) was first position on American soil at the ill-fated Roanoke Colony in Virginia, when their first services were held on August 13, 1687. Since that landing, they grew and experienced numerous schisms. Their worship services are similar in some ways to those of Roman Catholicism, and their clergy orders are the same bishops, priests, and deacons.The History of Religion in the United States Christa HartEastern Orthodoxy in America consists of more than a dozen church bodies whose national origin is reflected by their names, such as the Greek Orthodox Archdiocese, Romanian Orthodox Episcopate of America, and the Russian Orthodox Church outside Russia. Eastern Orthodox beliefs are based on holy tradition, or doctrines from early Christianity, and the Bible.Utopian communities were established in America as places where followers would not waiver could achieve a perfect religious, political and social system. The first community was established by a group of Dutch Mennonites in 1663 near what is now Lewes, De righteousnessare.When the constitution was written it stated in the first amendment which is called the Establishment Clause, Congress shall make no law respecting the establishment of religion, or prohibiting the free exercise thereof. Also, the relationship between religion and politics was established in the Article VI of the First Amendment that states, No religious test shall ever be required as a qualification to any office or public trust under the United States. The definition of the separation of church and state found in the U.S. Constitution has caused more disagreement than any other in the nations history.The History of Religion in the United States Christa HartThis is a continuously tried amendment, to be challenged by people of religion who try to push their religion or a religion on anyone and everyone who would listen. Just like prayers in schools are constantly pus hed by religious politicians. It should not be anyones choice on what to believe, it is for a person to decide solely on their own through age and experiences.Religion has continued to change over the decades as more and more immigrants of diametric religions come to the United States such as Muslim, Buddhists, Jewish, they have been joined by more modern religions like Scientology and Mysticism.More and more people have alike chosen, like myself, to have no religion but to base their lives on scientific beliefs in the way the earth and its creatures were created. However religious people also have this similar belief just stating their God would have to have their hand in this somehow. This would contradict most Christian religions.

Pakistan Flood Essay Example for Free

Pakistan Flood EssayThe Pakistan flood of 2010 happened on Monday the 26th July 2010 in the villages Khyber Pakhtunkhwa, Punjab, Sindh, Balochistan and Gilgit-Baltistan.CausesThe heavy rains were caused by a monsoon depression (also called a monsoon low) that formed over the verbalize of Bengal on July 24, crossed over India, and reached Pakistan on July 27 Climate change There was unusually heavy monsoon rains which caused widespread flooding in Pakistan, whilst coinciding in Russia unusually high temperatures ( resulting in a heat wave). Both of which were attributed to global warming. Poor river managementImpactsOver 500,000 or more quite a little had been displaced from their homes At to the lowest degree 1,540 people died, 2,088 people had received injuries and 557,226 houses had been destroyed. Infrastructure was destroyed. The Karakoram Highway, which connects Pakistan with China, was closed after a bridge was destroyed. Floodwater destroyed the health care infrastruc ture leaving people unprotected to water-borne disease Millions of crops were destroyed leaving a severe shortage of intellectual nourishment across the countryResponses* petitions were immediately launched by international organisation, like the UKs Disasters indispensability Committee (DEC) and the UN (United Nations) to help Pakistanis hit by the floods * the United Nations Development Programme (UNDP) provided support in disaster management authorities to assist evacuate populations from bear on areas of southern Punjab and Khyber Pakhtunkhwa province, * Many charities and aid agencies provided help, including the Red Crescent and Medicines Sans Frontiers* Pakistans government also tried to raise money to help the huge number of people affected * But there were complaints that the Pakistan government was slow to respond to the crisis, and that it struggled to cope * Foreign Governments donated millions of dollars, and Saudi Arabia and theUSA promised $600 million in flood a id. But many a(prenominal) people felt that the richer foreign governments didnt do enough to help * The UNs World Food Programme provided crucial food aid. But, by November 2010, they were exemplification that they might have cut the amount of food handed out, because of a lack of donations from richer countriesEffectsThere were both long-term and short-term effects, they includeshort-term-* At least 1600 people died* Aid couldnt get through because of the failing infrastructure 45 major bridges and thousands of kilometres of roads were destroyed or badly damaged, limiting the aid supplies reaching the areas badly affected* loss of cattle resulted in loss of dairy products* Access to health care, such as maternity care was difficult due to the damaged infrastructureLong-term-* 20 million Pakistanis were affected (over 10% of the population), 6 million needed food aid * Whole villages were swept away, and over 700,000 homes were damaged or destroyed * Hundreds of thousands of Paki stanis were displaced, and many suffered from malnutrition and a lack of clean water * 5000 miles of roads and railways were washed away, on with 1000 bridges * 160,000km2 of land were affected. Thats at least 20% of the country * About 6.5 million acres of crops were washed away in Punjab and Sindh provinces risingLocal authority-run disaster management forums, including local men and women were set up to assess future flood situation and created Community Rapid Response Teams to intention search and rescue activities. The International Federation of Red Cross and Red Crescent Societies (IFRC) produced a plan toemploy local tradesmen to help reconstruct shelters, etc which in turn provided an income for those people this will encourage the local economy to grow. Reconstructing and strengthening the irrigation band was deemed crucial to protect villages in the future. A plan to rebuild embankment and hygienic maintain them was created.

The Principles of Nursing and Health

The Principles of treat and HealthIntroductionThis assignment into principles of c be for and wellness entrust explore dimensions of health it will give an insight to a soulfulness who has a condition called multiple sclerosis. Looked at will be what determinants of health argon to this person. Underpinning professional, legal and ethical implications surrounding health should the individual require nursing c are is of great splendour. Finally the assignment will give a reflection of what information has been gained and health concepts on a personal level.1 Dimensions of healthHealth is a state of complete physical, mental and social well- being and non merely the absence of disease or infirmity. World Health presidential term (WHO 1946) cited in Naidoo (2009). Health means so many different things to different people, someone viewed as having a disease or disability abide as well feel like they are healthy, as can a person who is physical fit feel unhealthy. Dimensions of h ealth determine health to each individual. in that respect are six different dimensions of health which are intellectual, physical, emotional, spiritual, social and environmental. Health is looked at as a whole and when being frightd for, a holistic progression could be used fetching into account all of the dimensions of health. Dimension in more detail are intellectual this is when a person has the ability or inability to make decisions and judgements reasonably, arrangement decisions and consequences of decisions. Physical health is what you can see the size, shape and body function. Emotional is when a person is empathetic towards other peoples feelings and has an understanding of their own, and can deal with all different types of emotions as and when they occur. Spiritual health can be having a belief in a god or religion however it has more of an imp deed of conveyance on a persons ethics, peace of mind and principles. Social dimension is having relationships with all dif ferent types of people for utilization name colleagues, family and childhood friends. Environmental can be where a person lives and works it could be a ridiculous area or ugly working conditions. crossways all the dimensions if one is changeed this could maintain a knock on found to other dimensions or all of them, they usually all go touch in hand, Brooker (2007).2 Person overviewTo put principles of health into a reality and devote an understanding an deterrent example could be an individuals health. Chosen as an example is David Anderson David is 50 five year old male who was diagnosed with multiple sclerosis in his early thirtys. Multiple sclerosis is a condition which causes a defect in the central nervous system. The myelin sheath which surrounds the nerve fibres comes under attack from the autoimmune system, Corcos (2008). The disease is unpredictable and can affect different people in different ways. Usual symptoms are numbness in limbs, involuntary movements, le thargy, blurry or double vision the list goes on. Multiple sclerosis was identified by the French neurologist Jean-Martin Charcot in 1863 who worked in a hospital called Salptrire in Paris. He identified the condition as aclrose en Plaques, Burgess (2010) which mean hardening, this relates to the scaring which causes the defame to the nervous system. David has worked in the same job for over 30 years, it is an outdoor manual position where he walks for long periods of beat in a orbit setting as well as working in a country setting he besides lives four miles from his place of work and has no commuting stress. David has been married for 35 years he has three grown up children and three grandchildren. David enjoys spending time playing golf in the summertime months and watching sports live and on the TV he also enjoys photography. Davids health has ever so been very goodish despite his condition he has never been on medication other than over the counter analgesics and has never required any kind of treatment. At times the effects of his condition do show yet in a very minor way which he has always coped on the surface extremely well.3 DeterminantsDeterminants are factors which whitethorn affect a persons health this may be in a good way or a bad way, generally and in the health of the above person. Determinants are factors which influence how healthy a person is. These are socio-economic which are cultural and environmental for example where in the country the person lives, living and working conditions for example are the conditions good is on that point stress tangled, social and community networks is there support in place in the community and socially, individual lifestyle factors for example if the person takes regular exercise and eats a balance diet, and age, sex and hereditary factors. Naidoo and Wills as cited in Brooker (2007). Determinants which affect David are difficult to identify, perchance determinants affect him in a positive way. Dav id has a very good life style, and has had a steady job for a long time environmental factors have perchance enhanced the quality of life for David. He spends a lot of time outdoors and feels this has a positive effect as for long periods of time he lives symptom free from his condition. Social and community factors again are strong in his family who surround him and the networks of doctors in the local GP office are also strong. Around the world the United Kingdom has one of the highest rates of multiple sclerosis in the world, Rog et al (2009) cited in Burgess (2010). It has been said by Ebers et al (2007) cited in Burgess (2010). One in one thousand people in the UK have MS. It has been shown in studies that the further away from the equator the higher the record book of people recorded to have MS. This could be due to the periods of time these areas have sunshine, a vitamin related to sunshine is vitamin D, the body requires sunlight to synthesize vitamin D this vitamin is en graft in most immune cells and is associated functions including inhibition of the production of cytokines this is known to have a negative effect in MS, Ponsonby et al (2005) cited in Burgess (2010). Shetland and Orkney in the north of Scotland have the highest rate of cases in the world. Interestingly studies have also shown people who emigrate from country to country before the age of 15 will develop the lay on the line from the country which they have settled in, if the move takes place after the persons 15th birthday it is said the person will retain the risk factor from the country they are originally from.Underpinning professional, legal and ethical principles.Nursing care may be required for David in time and there are a lot of factors to consider when any person is being nursed. Looked at are the underpinning professional, legal and ethical principles involved in nursing a patient. As a professional a nurse has to follow rules which are set by the NMC. The NMC is the Nursi ng and Midwifery Council they are the governing body for all nurses and midwifes, the NMC have produced a cipher and within the code there are rules, standards, guidance and advice. NMC The Code (2008).The NMC are a council who if find or have any incidents inform to them will make decisions about fitness to practice, and can discipline or strike a nurse off of the registration if the nurse has failed to follow the code or committed an offence. The main concern of the NMC is to safeguard patients and members of the public and how they are treated by nurses and midwifes. It is said in NMC, The Code (2008) Individuals must be view and dignity must be maintained. Individuals should not be discriminated against and must also be treated with consideration and kindness. Where required a nurse must judge out help and support from relevant agencies and support networks in the health and social care setting. Respect is an essential part of protecting an individuals confidentiality, info rmation should never be shared other than with relevant people or professionals involved with the care of the person. It is also important that information should be shared if the person is at risk or harm. An additional part of respecting a person may be concerning their likes and dislikes, communicating is essential when caring for a person or there family to ensure the best possible care is given, this could be ensuring communication can happen without any obstruction for example language or communication requirements possibly providing some kind of aid. Consent is a large part of care giving every time a treatment is given this could be from cleanse to giving medication consent must be obtained, if an individual declines consent for treatment this must be respected, as it is a persons right to be involved in any decisions regarding treatment however there is an instance when decision making could be taken away from a person this happens when the mental depicted object is compr omised. there is a part of legislation which ensures a person who is incapable of making decisions regarding care is safe guarded. As a professional nurse boundaries must be maintained between patients and nurses it is unacceptable to accept gifts, loans or personal relationships from patients and their families. It is part of the role of a professional to identify risks and people who are taking risks, it is also a duty to report any practices that are putting others at risk. Record keeping is an essential skill which nurses must practice in an accurate way as the records include all of the patients care which has been given or is due to be given, keeping accurate records is imperative as poor records could harm a patients safety and confidentiality. In the case for David he may become ill in time and require nursing care and it may become costly to the government, it is his right to receive care as and when required and be treated with respect and dignity, he may decide he does no t want his suffering to be prolonged if his life is nearing an end and any decisions he may take must be upheld.Be open and in effect(p), act with integrity and uphold the reputation of your profession NMC The Code (2008). Following the above statement ensures you comply with the code and also by following the truth, being honest and able to identify problems and deal with them in the correct way if anything were to happen in practice. This will ensure care given can be without blemish and the integrity of the nurse remains intact. NMC (2008)Legal issues which could arise could be in two ways these are civil and criminal. A civil court of law is where an individual person can file a case against another person or organisation when a person has come to harm possibly by neglect. Criminal law is where a person has committed a crime and it is in the publics interest for the person who committed the crime to be prosecuted by a court of law and punished.Personal ConceptAs I have studie d and read more about principles of health it has had a study impact on the importance of knowing what the dimensions of health are, and understanding why a person has maybe become ill or in hospital, and what can be done to help or educate an individual to have a better life style which will lead to improved health. tone at an individual has also given me an understanding that determinants of health can be positive as well as negative, as having a good life style for someone who has a condition like MS can enhance quality of life. Also if someone has a very poor life style this can lead to conditions like type 2 diabetes, this is generally caused by a very poor diet and by being overweight.Being a nursing is an extremely important role and has very strict guidelines which must be followed. This will ensure accurate information and care is given at all times. By following the NMC code it will ensure that I am respectful of individuals and value people from all walks of life, always leading by example, being accountable for my actions and will always treat people fairly.ConclusionThis assignment has looked at dimensions of health, and how different dimensions can have an effect on all of the dimensions, there are six different dimensions which range from emotional to physical, each one is of equal importance and if any one is impaired it can often influence health. An overview of a person who has MS has been given and what determinants affect this persons life, is it good or bad? Professional, legal and ethical principles have been looked at, also and the importances of how these come into play when a person is being nursed. Identifying how the assignment has enhanced a personal view of the nursing profession has also been discussed. It has been identified the importance of being accurate regarding care giving and in record keeping to ensure the best care is given at all times.ReferencesBrooker C, Waugh A and Watson R. Foundations of Nursing practice fundamen tals of holistic care, 2007 Edinburgh Mosby Elsevier.Burgess M, Shedding greater light on the natural history and prevalence of multiple sclerosis British daybook of Neuroscience nursing January 2010 Volume 6 number 1Corcos J and Shinck E Neurogenic Bladder second edition 2008 Informa Healthcare.Naidoo J and Wills J. Foundations for Health Promotion one-third edition 2009 Edinburgh.Nursing and Midwifery Council The Code 2008World health organization. (WHO) 1948 Preamble to the constitution, Geneva. online http//www.who.int/suggestions/faq/en/ 13/11/2010

Literature Review: Access to Care for Addicts

Literature Review Access to Care for AddictsHettema, J., Sorensen, J. L. (2009). Access to Care for methadone hydrochloride bread and butter patients in the United States. International ledger Mental Health Addiction. 7 (3) 468-474. DOI10.1007/s11469-9204-6This paper was presented to increase the awareness of individual with Opiates preaching programed Dependency are denied access to residential word. Although, Methadone Maintenance Therapy has been proven to overcome illicit drug use, improve psychosocial functioning, ability to keep employment, decrease criminal activities, and contracting HIV, AIDS, and Hepatitis. in that respect are great concerns for those lymph nodes in Methadone Maintenance Therapy who need more intensive give-and-take. MMT does provide basic medical screening, dosing, and outpatient counseling. The more redevelopments provided for the client leads to a better outcome. The study found that treatment dose measured by number of days in treatment, numb er of treatment session attended and number of services received leads to a peremptory outcome.Some factors to consider are limited availability of residential treatment, insurance payment and the impact of abstinence philosophy. Mainstream views addiction as a moral chore rather than a medical issue. Hettema Sorensen (2009) identifies philosophical differences separates mental health and addiction services is hard to integrate. Society regards methadone as a necessary evil. There are ongoing empirically evaluated treatment approaches who do not follow an abstinence oriented philosophy.There are issues with the Americans with Disability Act because client is beingness denied services because of their use of a prescribed for their substance dependency. There are ambiguities in the interruption of that. The author is not aware of any litigation now.Ducharme, L.J., Knudsen, H.K., Roman, P. M. (2006). Evidence-based treatment for Opiate-Dependent clients availability, variation, and organization correlates. The American Journal of Drug and Alcohol Abuse. 32.569-576. DOI 101080/009529906000920417This article examines the availability and correlates with evidence-based acts for opiates dependence in the United States. This research sampled addiction treatment with and without MMT services. This article also examined community based treatment programs with MMT units as one of their modalities. The researchers included both methadone available and non-methadone setting, then compared the number and type of service available to users.The method used was a data analyses collected in 2002-2003 national representative sample of addiction treatment centers in public and close sector. There was extensive face to face interviews conducted with administrators and clinical directors of 763 treatment center. The data collected in 2002-2003 face to face interviews includedorganizational characteristic, size, ownership, accreditation, staffing, treatment practice methadone availability, level of care, pharmacotherapies, wraparound service,The findings suggested the majority of opiate dependents clients are not in Methadone Clinics. Many agencies are not willing to refer opiates dependent patient. to MMT. The opiate dependence client would benefit from the referral that uses evidence practices if referred. The research suggests further study to determine which opiate dependence client would benefit from evidence client care.Parks, C., Fullerton, C.A., Kim, Meekee, Montejano,, L., Lyman, Russell, Dougherty, R. H., Daniels A. S., Ghose, S. S., Delphin- Rittmon, M. E.., (2013). Medication-Assisted Treatment with Buprenorphine assessing the evidence. Psychiatric Services in Advance.DOI10.1176/appi.ps201300256This article reviews Buprenorphine treatment as an alternative to Methadone Maintence Treatment for long term treatment of Opioid Use Disorder. Buprenorphine is not considered as abstinence treatment. The purpose of buprenorphine is to reduce or elimi nate opioid use. The authors conducted the research that examined abstracts of identical articles for compliance with the review. The research provided evidence of the effectiveness of improving treatment retention and decreasing illicit opioid use. The evidence is growth both BMT and MMT improved pregnancy outcomes. Ongoing treatment is necessary.

Comparison of unusual administration methods of morphine

Comparison of unusual plaque orders of morphine morphine is a widely use analgesic. Its clinical use and the juicy dependency factor (morphine and heroin have proven to be the most addictive opiates) brought up the need to investigate the classic routes of face (oral, rectal, iv, sc) and compare them with approximately not so well established routes (nebulised, intrathecal, transdermal, sublingual etc).Introductionmorphia is a strong opioid derived from the opium poppy, Papaver somniferum1. It is used for the management of moderate and backbreaking unhinge. It acts direct to central nervous system exhibiting a quick measure of action. Along with pain relief, it causes the sense of well being (euphoria). It can excessively produce a series of other central and peripheral effects such as sedation, cough suppression, nausea, constipation and competency cause histamine surrender2. It is used during surgeries for anaesthesia and as a pain reliever after the operation. It is a do doses of choice for terminal care and it is really useful for pain management in cancer patients3. morphine is available at several formulations and different drug constitution routes. The selection of the subdue administration route is dependent on the extent of pain chair required. For instance, parenteral morphine is used for acute severe pain, while oral morphine is used for the treatment of temporary pain. The location of the pain will also determine if it is necessary to apply topical preparations or not.Table 1 Pharmacokinetic Properties of three opioid analgesicsPharmacokinetic ParametersHalf lifeVolume of DistributionClearanceMorphine (iv)2-3 hours3-5 lambert/kg15 -20ml/min/kgFentanyl (iv)3.5-3.8 hours5-6 litre/kg21-29ml/min/kgDiamorphine(iv)2-3 minutes25litre/kgUse morphine valuesSource Clarkes outline of drugs and poisons4Moreover, pharmacokinetic parameters such as bioavailability, half life and clearance and other characteristics of the drug (table 1) like side effects, ADRs and interactions must(prenominal) be taken into account before choosing the appropriate drug route. Patients preference (or fear) for a specific drug route and other psychosocial factors magnate also affect the choice of the formulation and patients compliance and finally medicines effectiveness. raillery ad-lib routeRegarding oral route, morphine comes as a solution and as immediate or check up onled (systained) difference tablets and capsules(fig 2).Fig 2. spontaneous formulations of morphineOral SuspensionMorphine solutions come in different strengths. Oral solutions can be prescribed by writing the formula Morphine HCl 5mg and Chloroform piddle to 5ml but the proportion can be altered. Morphine Sulphate solutions (Oramorph) are available at 10mg/5ml and as concentrated solutions of 100mg/5ml3.Other excipients include ethanol (96%- morphine is slightly soluble in ethanol), corn syrup, sucrose, methyl parahydroxybenzoate (E218), propyl parahydroxybenzoate (E216) and purified water. Due to the high content of alcohol this drug is not recommended to alcohol misusers.Normal bighearted dose is 10-20mg any four hours although when prescribed in palliative care dosage varies higher or lower according to the severity of the pain and kidney get respectively3.As this formulation is not readily absorbed from GI tract, in order to produce same effects as iv dose a 50%-100% increase in dose must be considered. Overdose peril is high and can cause hypotension, respiratory depression and in round cases death. Naloxone which is an opiate antagonist is the first line treatment in case of overdosing5.Tablets and CapsulesSolid dosage forms contain morphine in form of salt e.g Morphine Sulphate and Morphine hydrochlorate. Theses salts in the body will be available as morphine bases.Tablets are available in two preparations immediate release and modified release. The short acting tablets come in 10mg, 20mg and 50mg3. They are given every 2-4 hours to control and stabilise breakthrough pain. These tablets are a way of determine the amount of morphine needed to manage pain.Once the quantity of morphine is established the patient can take slow-release tablets and capsules. These formulations contain enough morphine to control pain for 12 or 24 hours. The starting dose varies and from 10-20mg every 12hours if the patient has not taken any other painkiller previously, to 20-30 mg every 12 hours in cases of replacement weak analgesics3. Note only the dose can increase whereas the frequency must remain the same i.e. every 12 hours. It can take up to 48 hours for the morphine to reach the required plasma levels meaning that it is important to be taken regularly otherwise they regress their effectiveness5. If the patience experience pain between doses an additional dose must be given and the GP should decide if it is necessary to increase the daily dose.Oral morphine is a well established drug delivery method however problems such a s the first pass metabolism, the slow onset and the risk of overdose have raised questions on whether other novel administration routes can be used.IntravenousThis route is used only in hospitals and in managing emergency pain symptoms. The bolus administration provides almost instant onset with a short effect. Iv morphine is used when sc route is not tolerated. A popular application of this method is in Patient Controlled analgesia (PCA) where the opioid is delivered using a Hospiral infusion device. The patient can control the morphine intake and establish an pleasant level of analgesia6. Morphine is available in 50 and 100ml vials with strength 1mg/ml3. It is used post operatively especially after transplants surgeries and in the management of chronic pain of malignancy. Although this method is useful for the management of severe pain there are many drawbacks. First of all, most of the pumps are bulky and invasive. Their installation is complicated as they require mains attachm ent and the patient has limited mobility .There is a high risk of overdose then supervision is needed. Side effects such as hypotension and respiratory depression might develop while convulsions due to high dosage are likely to occur.fig3. PCA infusion device vs syringe driver hypodermicSubcutaneous method is an excellent alternative to oral administration method. It is safe and effective method which is widely used both in palliative care and severe pain management. It is used for patients that present conditions such as gastrointestinal disturbances including indigestion, palindromic motility and obstruction5. A prime characteristic of the sc method is the syringe driver. The driver employs guileless syringes and bears a flow rate setting option usually ml/hr which enables accurate dosing over a specific period of time. Unlike PCA infusion devices, it is battery powered, so patients mobility is not an issue (fig 3). The risk of overdose is lower compared to iv route as there is a constant stable administration schedule6. There is no need for ceaseless strict supervision as the driver is easy to use.Often, the subcutaneous route can cause some strip site problems. Irritation might appear especially when there are high concentrations of morphine or when it is combined with other drugs which are not in full compatible3. This problem can be treated either by diluting the dose or by choosing alternative more compatible drugs.Also some patients might experience needle allergic reactions and action must be taken e.g introduce an alternative Teflon cannula. Patients might feel discomfort, especially those who lack of subcutaneous tissue16. Sometimes, possible leakage of subcutaneous site might be observed. Finally, the sc method is not recommended for palliative care patients with acute vascular conditions.RectalThis drug administration route is quite popular and is used for short term management of acute pain. Also in terminal cancer patients modified release morphine sulphate is administered via this route6. Although the absorption rate varies for each individual, it is estimated that around 300-330 mg of morphine are absorbed rectally every four hours, indicating a sufficient analgesic effect.Studies have chargen that for the patients who have never taken morphine, rectal morphine is more effective than the oral administered one5.Rectal morphine is available in the form of suppositories at different strengths (10, 15, 20 and 30 mg) 3. Prescribers must specify both the strength and the morphine salt (morphine hydrochloride or morphine sulphate) that suppositories should contain.Evidence shows two deaths15 after sequential doses of rectal morphine should raise awareness and the need of monitoring the dosing regimen and frequency.Rectal route is not avoiding completely the first pass metabolism therefore the bioavailability might be influenced.Non established routesApart from the conventional drug routes mentioned before, it is necessar y to look into other not so popular ones such as the transmucosal, transdermal, sublingual, intrathecal and nebulised routes of administration and try to compare them.Transdermal- TransmucosalTransdermal route is a relatively painless method. The drug absorption is rapidly. Patches are easy to use and not quite expensive. Although this method is usually tolerated from the patients skin irritation and rashes might appear.Transdermal morphine is not popular as there are questions about the efficacy of this method. However, fentanyl another opioid is the drug of choice. More specifically, fentanyl patches are more effective in managing chronic pain compared to modified release oral morphine9. Also, transdermal fentanyl causes reduced constipation and drowsiness14.Another administration route which fentanyl is again favored than morphine is the transmucosal route by a buccal tablet. The main reason is that fentanyl is a lipophilic drug while morphine has a limited lipid solubility. Mor e specifically, when fentanyl is placed in saliva it is 80% non-ionizedand it usually takes 20-30 minutes for the analgesic effect to reach its peak14. Note transmucosal morphine is also available but the bioavailability is low and analgesic effect is not hearty.Sublingual routeThis route utilises soluble immediate release tablets and it is recommended to patients that have swallowing difficulties. Morphine enters into bloodstream via sublingual mucosa. Investigations have shown that the absorption of morphine is the same (and in a few cases faster) compared with the oral route7. Same studies have shown that there is no significant difference in the extent and duration of analgesic effect when is compared with oral administered morphine3.Nebulised morphineNebulised morphine utilises the airways to deliver the drug into pulmonary circulation. It can be used for COPD patients in the management of acute thoracic pain11. Through this route, the effect of hepatic metabolism is avoided a nd a rapid absorption is noted. However, the plasma drug levels are aleatory indicating the necessity of further clinical investigations. Studies showed that inhaled morphine was as effective as intravenous PCA morphine without causing strong sedating symptoms8. Although nebulised morphine is well accepted, patients who are not used to opioids might experience nausea and vomiting and in rare cases respiratory depression. Other common side effects include constipation and histamine generate broncho-constriction.Another drawback of nebulised morphine is the high cost of the equipment (nebuliser, injectable vials, etc). It is not a simple method and some patients might find it difficult to use the nebuliser. Studies show a wide range of bioavailability in subjects relating the bioavailability of the drug with the patients ability to use the nebuliser in the right way10.Epidural/intrathecalBoth epidural and intrathecal routes are used for the most part in the hospital clinical enviro nment. The bioavailability is high so spinal administered morphine can provide extended analgesic effect at lower doses (compared to the conventional drug routes)12. Although epidural and intrathecal morphine can relieve both acute and chronic pain studies suggest that these routes should be used only for pain which cannot be controlled by the classic established methods13. For instance, these routes are effective in managing lower body pain. Note that only 1% of the daily iv dose must be used intrathecally and only 10% epidurally5. An implanted infusion pump may be used to deliver intrathecal morphine at a continuous rate.A disadvantage of these methods is the high risk of infection and overdose as the staff must be trained and careful when dosing for breakthrough pains. Studies have describe a number of patients experiencing side effects such as sedation, dyspnoea, nausea and vomiting after spinal administration12.Spinal morphine is not usually preferred while diamorphine is the drug of choice due to its high solubility manner.ConclusionAs it was mentioned before, morphine can be administered via different routes. However, it is vital each time to consider the risk- benefit ratio for each method and choose the most effective and safe one. Moreover, before establishing unconventional methods such as nebulised and spinal morphine it is important to further investigate their suitability and ways to improve the drug delivery and minimise side effects. Finally, if it is necessary to choose other opiates (such as fentanyl and diamorphine), which might be more efficient than morphine.

The Microsoft Case: Protecting Competition or Competitors? :: Business Management Economics

The Microsoft Case Protecting Competition or Competitors?When a company of merchants undertake, at their own risk and expense, to launch a new trade with some remote and barbarous nation, it may not be unreasonable to incorporate them into a joint stock company, and to confess them, in case of their success, a monopoly of the trade for a certain number of years. It is the easiest and most natural way in which the state can recompense them for hazarding a dangerous and expensive experiment, of which the public is afterwards to reap the benefit. A temporary monopoly of this kind may be vindicated upon the same principles upon which a like monopoly of a new machine is granted to its inventor, and that a new book to its author.-Adam Smith, Wealth of Nations, 1776 IntroductionProtecting the competition, not the competitor, has become a commonly used affirmation in recent interpretations of the Sherman antitrust acts of the late 19th century. Such words, however, were not used in the pr eliminary decision of the U.S. v. Microsoft monopoly case. Just recently, U.S. District Judge doubting Thomas Penfield Jackson cast Microsoft as a voracious monopolist that has hindered innovation, harmed consumers, and run roughshod over its rivals. (Chandrasekaran, 1999 1) A 207-page findings of fact report did not conclude whether Microsoft violates the Sherman just Act. The report suggests, however, that Microsoft is indeed a software hog with a decade of at least 90%-95% control of the Windows grocery store share. Chief Executive military officer Bill Gates said he respectfully disagrees with a number of the courts findings. In the end were quite confident that our onenessand the benefits we provide consumers will be upheld. (Chandrasekaran, 1999 1). It seems that in an effort to protect the consumer, the government may get down forgotten the power of the consumers dollar. Perhaps Microsoft has control of the market share because the product is superior to all others, and consumers know it. Is it possible that the government would be punishing the consumer, if in fact consumers truly are happy with the Microsoft product, and have chosen to buy it, not because Microsoft has a significant influence on the market, but because the product is more advanced? What makes a product superior to another(prenominal)? Vision, innovation, risk, marketing the same elements that Adam Smith praises in a new venture, then rewards, if successful, by granting the company a temporary monopoly in the market.

Flouridation :: essays research papers fc

FlouridationIn 1931 at the University of Arizona Agricultural Experiment Station M. C.Smith, E. M. Lantz, and H. V. Smith observed that when given drinking peeingsupplied with farad, rats would develop tooth defects. Further testing by H.T. Dean and E. Elove of the United States earth Health Service confirmed thisreport, and stated that what is know as mottled tooth. Mottled tooth is acondition in which white spots develop on the back teeth. Gradually the whitespots number darker and darker until the tooth is eroded completely. This wasbelieved to be caused by degree Fahrenheit in drinking water (Behrman pg. 181).A strong uproar was heard when this was released and people wanted allfluorine out of their water. But later tests concluded that communities withhigh levels of fluorine in their drinking water suffered less dental cavities.Further testing concluded that at least 1.0 move per million of fluorine couldhelp to prevent cavities, but more than 1.5 PPM would cause mottle d tooth, sobasically a little fluorine would be okay but a lot of fluorine would be bad(Behrman 182). In 1938, with this information, Dr. Gerald coxswain of the Mellon Institutebegan to promote the addition of fluoride to public water systems, claiming thatit would reduce tooth decay, however there were two major obstacles in his path,The American Medical Association, and The American Dental Association. Bothassociations wrote articles in their journals about the dangers of fluoridationof water supplies. The American Dental Association wrote the following in theOctober 1, 1944 issue We do know the use of drinking water containing aslittle as 1.2 to 3.0 parts per million of fluorine will cause such developmentaldisturbances in bones as osteoslcerosis, spondylosis and osteoperosis, as wellas goiter, and we cannot afford to run the pretend of producing such serioussystemic disturbances in applying what is at present a doubtful procedureintended to prevent development of dental disfigu rements among children.(Yiamouyiannis pg. 138)Despite these warnings Dr. Cox continued to promote fluoridation ofwater supplies and even convinced a Wisconsin dentist, J. J. Frisch to promotethe addition of fluoride to water supplies in his book, The Fight ForFluoridation. Frisch soon garnered the support of brusk Bull. Frank Bullorganized political campaigns in order to persuade local officials to endorsefluoridation. This began to apply heavy pressure on the United States PublicHealth Service and the American Dental Association. (Yiamouyiannis pg. 139)In 1945 before any tests had been proven to show that fluoride reducedcavities, it was added to the drinking water supply of Grand Rapids, Michigan.