Sample Guide Sketchup Free Essays

1-Close ALL Applications and go disconnected 2-Open GoogleSketchUpProMEN. DMG and Install (This is adaptation 8. 0, in Trial mode, downloaded legitimately from the Sketchup site †May 2011) 3-Once Installed, however not Opened: A-Goto HD/Applications/Google Sketchup 8/SketchUp B-Right-click Sketchup and select †Show Package Contents C-Goto Contents/MacOS/D-Replace the SketchUp record with Sketchup from the Cracks organizer 4-Do a similar method on both LayOut and Style_Builder †Right snap, Show Package Contents, goto Contents/MacOS and supplant the particular documents with the Cracked adaptations. We will compose a custom paper test on Test Guide Sketchup or on the other hand any comparable subject just for you Request Now †Making sure you are still disconnected, open Sketchup and keep a note of the specific Time you opened it! A-Goto SketchUp/File/Preferences/General and un-tick Automatically Check for refreshes. 6-Close Sketchup will have now made shrouded documents for which it relies upon to lapse the Trial. For the accompanying you should show concealed records in Finder. On the off chance that you don’t realize how to do that, best do your own examination. 7-With shrouded records appeared in Finder: A-Goto HD/Library/Application Support/ In Finder, request the records segment by Date Modified, you should locate a concealed document looking something like this . hkzftzgrc It might have an alternate variety of lettering however in the event that it was Modified a similar time you ran Sketchup, at that point that’s the document you need to Lock. (Select the document, Press Command-I, and tick the Lock box) B-Goto HD/(your username)/Here again you should locate another concealed record looking like . hkzftmgrc . Ensuring it was made a similar time you opened Sketchup, lock this one as well. †Extra safety measures †it’s been proposed to bolt †HD/(your username)/Preferences/com. google. sketchuppro8. plist †however this will likewise bolt ALL your preset alternatives inside Sketchup. I’m not certain this is essential. Additionally a document to Lock might be made here †HD/(your username)/Caches/com. google. sketchuppro8/Cache. db †yet it was not created on my establishment And It wouldn’t hurt either to un-tick ‘Check For Updates’ in LayOut and Style_Builder That’s it, trust it works for you, Enjoy! Step by step instructions to refer to Sample Guide Sketchup, Papers

Oh yeah Essay Example For Students

Gracious better believe it Essay David OcampoHonor English IV2/21/02The Use of Sound in Shakespeares Sonnetsby Barbara Herrnstein Smith This article contends that Shakespeares utilization of the meter, or general structure of sounds, in his verse is as huge to his style as his illustrations, non-literal language, and pictures. Shakespeare utilized created methods, in any case, he executed them all the more adequately. Shakespeare had the option to execute the rhyming to sound common, like regular discourse, as opposed to fake and mechanical, as it normally sounds. Shakespeare was likewise ready to control words to make melodic sounds with blends and redundancies of vowel and consonant sounds. The article expresses that Shakespeare had the option to ace the melodic possibilities of the language. This was flawlessly executed through his utilization of complex circulations of phonetic components, and working with the inside beat, creating the genuine congruity of very much tuned sounds. Additionally, Shakespeare had the option to control the versifying meter to sound like common discourse. Conventional versifying meter verse tends to sound fake and mechanical. Be that as it may, Shakespeare was capable enough to overwhelm the methods of English verse and, in this way, had the option to keep away from the contorted characteristic accentuation of discourse and sidestepped the mechanical normality of pounding in such verse. TIPS FOR WRITING YOUR REPORT?Plan the report. Select a thought or theme for your report. Assemble data for your report. Distinguish the data you need to remember for your report. Recollect you ought to have in any event three different ways to help the fundamental thought of your report. Incorporate subtleties and explicit data that will assist you with coming to your meaningful conclusion. Compose a draft. Audit what you have composed. Give perusing the report a shot uproarious. It can assist you with getting botches. Check spelling and accentuation. Each sentence should start with a capital letter and end with a period, question mark, or shout mark. Make the last report. ?Include intrigue. Use diagrams and outlines to represent a thought. Incorporate an image, photograph, drawing, or guide. Discover a citation, and use it to come to your meaningful conclusion. ?Make the most of each word. Pick words your peruser will comprehend. Recollect you need to impart your plan to the individual perusing your report. Stay away from clichs. Utilize a thesaurus to supplant exhausted words and find better approaches to communicate your thoughts. Words/Pages : 359/24

An Overview of Emotionally Focused Couples Therapy

An Overview of Emotionally Focused Couples Therapy More in Relationships Spouses & Partners Marital Problems LGBTQ Violence and Abuse Emotionally Focused Therapy (EFT) is a short-term (eight to 20 sessions) and structured approach to couples therapy developed by Drs. Sue Johnson and Les Greenberg in the 1980s. It is grounded in research while focusing on negative communication patterns  and love as an attachment bond.?? Attachment Theory Attachment between people typically provides a safe haven: a retreat from the world and a way to obtain comfort, security and a buffer against stress. Attachment also offers a secure base, allowing you to feel safe while you explore the world and learn new information.  Its formation begins in childhood with a primary caretaker, such as a parent.?? Those early,  established patterns carry through to adulthood. An unavailable caretaker creates distress in a baby akin to an unavailable partner creating distress in an adult.  Attachment theory provides the emotionally-focused therapist with a road  map to the drama of distress, emotions, and needs between partners.   Grounded in Science According to the website dedicated to EFT, a substantial body of research outlining the effectiveness of this treatment exists.?? It is now considered one of the most (if not the most) empirically validated forms of couples therapy. Research studies have found that 70-75% of couples undergoing EFT successfully move from distress to recovery, and approximately 90% show significant improvements.  This recovery is also quite stable and lasting, with little evidence of relapse back into distress. EFT is being used with many different kinds of couples in private practice, university training centers, and hospital clinics.  It is also quite useful with various cultural groups throughout the world. The distressed couples who may benefit from EFT include those where one or both partners suffer from depression, addiction, post-traumatic stress disorders, and chronic illness, among other disorders.  EFT has proven to be a powerful approach for couples dealing with infidelity or other more traumatic incidents, both current and past. Neuroscience also intersects attachment theory and EFT. More recently produced  MRI studies  demonstrate the significance of secure attachment.?? Our attachments are potent, and our brains code them as “safety.” According to an  article on EFT in  Social Work Today, any perceived distance or separation in our close relationships is interpreted as danger.?? Losing the connection to a loved one threatens our sense of security. Primal fear ensues and sets off an alarm in part of our brain called the amygdala, also known as the fear center. Once the amygdala is activated, it triggers our  fight-or-flight response. When incoming information is familiar, the amygdala is calm. However, as soon as the amygdala encounters threatening or unfamiliar information, it increases the brain’s anxiety level and focuses the mind’s attention on the immediate situation. People go into a self-preservation mode, often doing what they did to survive or cope in childhood. This is the reason we are triggered as adults in our romantic relationships, in the same repeating (and unhealthy) patterns from our formative years.  EFT can help to unwind these automatic, counter-productive reactions. Fostering Healthy Dependency EFT provides a language for healthy dependency between partners and looks at key moves and moments that define an adult love relationship. The primary goal of  the model is to expand and re-organize the emotional responses of the couple. New sequences of bonding interactions occur and replace old, negative patterns such as “pursue-withdraw” or “criticize-defend.”?? These new, positive cycles then become self-reinforcing and create permanent change. The relationship becomes a haven and a healing environment for both partners. Creating a Secure Bond The process reduces couples’ conflict while creating a more secure emotional bond.  Couples learn to express deep, underlying emotions from a place of vulnerability and ask for their needs to be met.  Partners begin to view undesirable behaviors (i.e., shutting down or angry escalations) as “protests of disconnection.” Couples learn to be emotionally available, empathetic and engaged with each other, strengthening the attachment bond and safe haven between them.   EFT has many strengths as a therapeutic model.  First, it is supported by extensive research.?? Second, it is collaborative and respectful of clients. It shifts blame for the couples problems to the negative patterns between them, instead of the couples themselves (or the partners). Finally, the change process has been mapped into a clearly defined process consisting of nine steps and three change events that help guide the therapist and track progress. If you are looking for help with a distressed relationship, an EFT trained therapist would be a wise choice. There are also several books that might be of interest. Emotionally Focused Couple Therapy For Dummies by Brent Bradley and Jamies Furrow,  Hold Me Tight: Seven Conversations for a Lifetime of Love by Sue Johnson, or An Emotionally Focused Workbook for Couples: The Two of Us by Veronica Kallos-Lilly and Jennifer Fitzgeralds are all good places to start. The Best Online Marriage Counseling Programs

Evaluation Of A Research On Formative Feedback - 888 Words

3. Reviews/Commentaries Shute,V. (2008). Focus on formative feedback. Review of Educational Research, 78(1), 153-189. Shute conducts an extensive literature review of the research on formative feedback because despite extensive investigation, the author proposes, is still misunderstood due to conflicting findings and inconsistent pattern results. The focus of this review is that feedback must be â€Å"delivered correctly† to be effective. Therefore, Shute offers a twofold proposal: to understand the features, functions, and interactions of feedback in relation to learning and to use the findings to create guidelines for generating effective formative feedback. The focus of this study is primarily on performing tasks and the identified issues are several. Correct delivery of feedback is defined and guidelines are proposed since most research on this subject concludes that feedback can enhance learning considerably if delivered correctly. The interaction of task and student characteristics is investigated to address the major gaps in understanding that still exist, inclusively, instructional context in the efficiency of feedback. The author defines formative feedback (FF) as information intended to change a student’s thinking or behavior to improve learning. It ought to be specific, helpful, timely, and not judgmental. Types of FF are: confirmation of a correct answer, clarification of the accurate response, clues, and work examples. Previous research by Swam (1983) found thatShow MoreRelatedElements Of Formative Assessment987 Words   |  4 PagesWhat is formative assessment? Formative assessment seems to stand in contradiction to traditional modes of summative assessment in schools. Michael Scriven first introduced the term ‘formative evaluation’ in 1967, but Benjamin Bloom elaborated upon its distinction from summative assessment: ‘Quite in contrast is the use of formative evaluation to provide feedback and correctives at each stage in the teaching-learning process. By formative evaluation we mean evaluation by brief tests used byRead MoreError Types For Corrective Feedback1512 Words   |  7 PagesError types for corrective feedback. Research on the error types that need corrective feedback has reported mixed findings, indicating that while corrective feedback influenced the improvement of linguistic knowledge, its effects depended on the types of errors. Ferris (2006) categorized errors into five major groups (verb errors, noun errors, article errors, lexical errors, and sentence errors) and reported that students who received feedback only reduced the incidents of verb errors. Van BeuningenRead MoreAdvantages And Disadvantages Of Technology Based Assessment758 Words   |  4 Pagesensuing newsletter will discuss the positive including negative incommodity toward of technology based assessments such as formative assessments, criterion based assessments, curriculum based measurements. Additionally, present a summary regarding which technology examination I perceive are beneficial concerning student literacy. Current Technology Based Assessment Formative assessment is an examination regarding literacy. Therefore, measures student’s achievement in distinctive areas before educatorsRead MoreThe Professional Development Of A Teacher1631 Words   |  7 Pagesimportance of evaluation which is one of the four key aspects I have chosen to discuss. I believe that evaluation is an extremely important aspect in relation to the professional development of a teacher. Two common types of evaluation which are carried out are peer evaluation and self evaluation. Firstly, peer evaluation allows the opportunity for teachers to receive constructive feedback and criticism in order to aid and improve the effectiveness of their teaching. Often peer evaluation is carriedRead MoreThe Summative And Formative Models Of Evaluation And Their Organizational Convenient Application777 Words   |  4 Pagesis to discuss the summative and formative models of evaluation and their organizational convenient application. Reference from mission statement program descriptions from the previous module assignment would be utilized as an example in this paper. The paper will furnish the research based description of the purposes, members of the audience, information types, and sources of the collection of data which suits summative and formative models of the program evaluation. The paper will also identify andRead MoreThe Role Of Peer Assessment On The Classroom1496 Words   |  6 Pagespeers.’ A deeper definition comes from Black Wiliam (2001, p.2); â€Å"An assessment activity can help learning if it provides information to be used as feedback, by teachers, and by their [students] in assessing themselves and each other, to modify the teaching and learning activities in which they are engaged. Such assessment becomes ‘formative assessment’ when the evidence is actually used to adapt the teaching work to meet learning needs.† As aforementioned, peer-assessment is closely associatedRead MoreInstructional Research Project : Teaching Reading Comprehension Skills to Third Grade Students1266 Words   |  6 PagesThe goal of this project was to test a unit of instruction designed to teach 3rd grade students comprehension strategies to help them become better readers. The formative evaluation investigated whether the unit was effective at teaching ten comprehension related objectives and identified areas for improvement in the unit. Evaluation Methodology Subject Matter Expert (SME) Phase. The subject matter expert read and evaluated the unit using a checklist of characteristics, and then shared her thoughtsRead MorePtlls Unit 71446 Words   |  6 Pagesstandards. Formative Assessments (quizzes and practical tests) are used to strengthen memory recall by practice and to promote confidence in one’s knowledge. In the learning process we are trying to transfer knowledge and skills to a persons’ memory so that they become competent to perform a task. During that process people might fail to pay attention, fail to grasp everything taught or simply forget things even though they once knew it. Most learning environments use simple Formative questions asRead MoreEffectiveness Of An Observed Structured Clinical Examination1554 Words   |  7 Pagestheir ability of breaking bad news to patients and family, setting effective and practical goals of care with the patient, and assessing a patient’s mental status. Focus grou ps were also used to gain learner perspective on the training and provide feedback on what could be improved in the training sessions. Sample Procedure The targeted population was a nonrandom selection of twelve learners across the medical field that would be dealing with palliative care chosen on a volunteer basis. Within theRead MoreConsumer Behavior Research: Student Preparatory Attire Case Study1095 Words   |  4 Pagesassumptions from a research perspective are that direct contact with consumers in a manner in which they can touch, feel, look, smell and interact with a potential set of new products would provide greater efficacy to product development. Our assumptions are that emotions, opinions, and soft logic are the driving force within this consumer universe. The product being evaluated is a new clothing line for students called Student Preparatory Attire (SPA) program. The research question being asked

Deontology and Utilitarianism Essay - 1340 Words

Describe the main principles of the two normative ethical theories of deontology and utilitarianism. Compare and contrast the two theories, bringing out any problems or limitations you see in each. INTRODUCTION:- Bioethicists ask these questions in the context of modern medicine and draw on a plurality of traditions, both secular and religious, to help society understand and keep pace with how advances in science and medical technology can change the way we experience the meaning of health and illness and, ultimately, the way we lve. Bioethics is multidisciplinary. It blends law, philosophy, insights from the humanities and medicine to bear on the the complex interaction of human life, science, and technology. Although its†¦show more content†¦Kant believes that all people come to moral conclusions about right and wrong based on rational thought. Deontological moral systems are characterized by a focus upon adherence to independent moral rules or duties. To make the correct moral choices, we have to understand what our moral duties are and what correct rules exist to regulate those duties. When we follow our duty, we are behaving morally. When we fail to follow our duty, we are behaving immorally. Deontological moral systems typically stress the reasons why certain actions are performed. Simply following the correct moral rules is often not sufficient; instead, we have to have the correct motivations. This might allow a person to not be considered immoral even though they have broken a moral rule, but only so long as they were motivated to adhere to some correct moral duty. Nevertheless, a correct motivation alone is never a justification for an action in a deontological moral system and cannot be used as a basis for describing an action as morally correct. It is also not enough to simply believe that something is the correct duty to follow. Duties and obligations must be determined objectively and absolutely, not subjectively. There is no room in deon tological systems of subjective feelings; on the contrary, most adherents condemn subjectivism and relativism in all their forms. Perhaps the most significant thing to understand about deontological moral systems isShow MoreRelatedUtilitarianism And Deontology1059 Words   |  5 PagesUtilitarianism and Deontology are challenged in Watchmen, Adrian and Rorschach are both opposites of each other, as you can see during the film. Killing millions of innocents to save billions and maintain peace, while Rorschach believes in punishing the bad NOT the innocent. The Watchmen contains lots of violence regarding the usage of Utilitarianism and Deontology. Rorschach uses his strict rule of being moral. He will not and never change the way he views the city he lives in. He will always doRead MoreThe Between Utilitarianism And Deontology1345 Words   |  6 Pagesof Deontology, along with Jeremy Bentham and James Mills, the founders of Utilitarianism, all attempted to answer this question. Be ntham and Mills’ Utilitarianism stresses maximizing pleasure and happiness in the world over pain and unhappiness. In contrast, Kant’s Deontology focuses on honoring duties and obligations. A moral action must be â€Å"considered right and good by most people† (Merriam-Webster). The way Kant proposes that one achieves happiness is overall superior to Utilitarianism becauseRead MoreThe Ethics, Utilitarianism And Deontology1891 Words   |  8 PagesIn this assignment I am going to using my class notes and hand outs to describe what ethics, utilitarianism and deontology is. I will then be explaining the arguments between organ donation and transplantation. Lastly I will be identifying the rights of individual patients the responsibilities they have. 1.1 Ethics are moral principles that affect how people make decisions and live their lives. Ethics focuses on what is the good for individuals and society. Ethics are involved in how to live a goodRead MoreCompare and Contrast Utilitarianism and Deontology622 Words   |  3 PagesCompare and contrast utilitarianism and deontology. Utilitarianism is the principle that the correct form of action be taken to benefit the greatest number of people. Deontology is defined as the area of ethics involving the responsibility, moral duty and commitment. Both utilitarianism and deontology deal with the ethics and consequences of one’s actions and behavior despite the outcome. To contrast utilitarianism and deontology, utilitarianism summarized is making the right decision followedRead MoreArgument For Criticizing Utilitarianism And Deontology1138 Words   |  5 PagesBenny Mutoni Ethics Society Instructor: Joseph John Argument for criticizing utilitarianism and deontology In this paper, I will discuss various ethical courses of action during ethical dilemmas. I will be examining how utilitarians and deontologists use different approaches to solve ethical dilemmas, by citing the text â€Å"Doing Ethics: Moral Reasoning and Contemporary Issues† and views of philosophers such as John Stuart Mill, Immanuel Kant and Jeremy Bentham. Using these, I will develop an argumentRead MoreEthical Dilemmas Of Utilitarianism And Deontology1368 Words   |  6 PagesAndrew Sponsler 11/4/15 Ethics Considering Ethical Dilemmas through Utilitarianism and Deontology Kant’s theory of deontology and Mill’s theory of utilitarianism provide starkly different approaches to assigning moral value to ethical dilemmas, two modern dilemmas being commercial surrogacy and physician-assisted suicide. This essay will expound upon the process of deciding moral value within each ethical theory and then apply this decision process to the two ethical dilemmas. Arguments will beRead MoreUtilitarianism And Deontology And The Trolley Problem1483 Words   |  6 Pagesconsequences, based on what is right and wrong. In this paper I will be assessing the Trolley Problem in relation to Utilitarianism and Deontology and will conclude which theory is the best way to behave given the situation. In the first paragraph, I will begin by discussing the Trolley Problem followed by the next paragraph’s which will explaining how Utilitarianism and Deontology would approach the situation. Furthermore, I will be discussing which theory I believe is right in re gards to the bestRead MoreUtilitarianism, Deontology, And Virtue Ethics835 Words   |  4 Pageswas merely to determine what is right and wrong in certain situations. Although, after learning about Utilitarianism, Deontology, and Virtue Ethics, I have realized that certain characteristics of each play a role in determining what ethics truly are. Utilitarianism characterizes the definition of ethics, by making all choices have the greatest positive impact, while minimizing the risk. Deontology on the other hand would rather we not get involved because there is never a justifiable means to an endRead MoreThe Ethical Theories Of Deontology And Utilitarianism1414 Words   |  6 Pagesso how the ethical theories of Deontology and Utilitarianism plays a part and how the ethical perspective Emotivism also plays a part. Theories and Perspective Deontology is the reason for which the act is done and the rule according to which one chooses to act (Mosser, 2013). It doesn’t deny that the acts that we do have consequences (Mosser, 2013). It insists that those roles should not play a part in our moral evaluation of such acts (Mosser, 2013). Utilitarianism is a natural way to see whetherRead MoreUtilitarianism, Deontology, And Virtue Ethics1586 Words   |  7 Pagesunacceptable by our society because many United States organizations are starting to work together to stop these intolerable acts to end the suffering and pain. Ethical theories are categorized into three groups: utilitarianism, deontology, and virtue ethics (Mosser, 2013). Utilitarianism is a system of ethical choices according to the rightness or wrongness of an action that should be judged by its consequences (Mosser, 2013). This type of philosophy suggests that an action is morally right if its

Apes Chapter 3 Questions Free Essays

Chapter 3 Reading Questions: 1. Core Case Study: â€Å"Have you thanked your insects today? †- Explain why insects are significant. Many of the earth’s plant species depend upon insects to pollinate them. We will write a custom essay sample on Apes Chapter 3 Questions or any similar topic only for you Order Now Carnivorous insects, such as the praying mantis, control the ‘pest’ insect population. 2. What percentage of the species on this planet consists of insects? Animals? Plants? 53% are insects; 20% are other animals; 18% are plants. 3. Give three examples of how we benefit from microbes. Soil bacteria convert nitrogen gas into usable forms for plants; they decompose wastes into nutrients we use; they help produce various foods such as bread, cheese, wine, beer, and tofu. 4. What percentage of the biomass on this planet accounts for microbes? 90% of earth’s living mass. 5. Define the four spheres of the earth. The atmosphere is the thin membrane of air around the planet. The troposphere is the air layer about 11 miles above sea level. The stratosphere lies above the troposphere between 11-30 miles; it filters out the sun’s harmful radiation. The hydrosphere consists of earth’s water, found in liquid water, ice, and water vapor. The lithosphere is the crust and upper mantle of the earth’s soil. It contains nonrenewable fossil fuels, minerals, and soil, and renewable soil chemicals needed for plant life. The biosphere includes most of the hydrosphere, parts of the lower atmosphere and upper lithosphere. All parts of the biosphere are interconnected. 6. Describe the three interconnected factors that life depends on. The flow of high-quality energy; the cycling of matter or nutrients; gravity. 7. Describe what happens to all of the solar radiation that reaches the earth. Solar energy flowing through the biosphere warms the atmosphere, evaporates and recycles water, generates winds, and supports photosynthetic life. 8. Is the greenhouse effect a positive or negative issue for life on earth? Explain why. It is a positive effect because without it, the earth would be too cold to support most forms of life. 9. Explain the following terms: abiotic, biotic, range of tolerance. Abiotic consists of non-living components such as water, air, nutrients, and solar energy. Biotic consists of biological components such as producers, consumers, and decomposers. Each population in an ecosystem has a range of tolerance to variations in its physical and chemical environment. 10. Explain how limiting factors can control population size. Too much or too little of any abiotic factor can limit or prevent growth of a population, even if all other factors are at or near the optimum range of tolerance. 11. What factors usually limit terrestrial populations? On land, precipitation and soil nutrients are often limiting factors. 2. What factors usually limit aquatic populations? In water, temperature, sunlight, nutrient availability, dissolved oxygen content, and salinity are limiting factors. 13. What is the overall chemical reaction for photosynthesis? 6CO2 + 6H2O (+ light energy) C6H12O6 + 6O2. 14. What is the overall chemical reaction for respiration? C6H12O6 + 6O2 — 6CO2 + 6H2O + 36 ATP 15. Why are decomposers so significant to an ecosystem? They recycle the nutrients that make life possible throughout the ecosystem. 16. Why is biodiversity one of our most important renewable resources? Biodiversity provides us with natural resources, natural services, pleasure, and keeps the balance of the food web. 17. Describe 4 key components of biodiversity. Functional diversity includes the biological and chemical processes such as energy flow and matter recycling needed for the survival of species, communities, and ecosystems. Ecological diversity includes the variety of terrestrial and aquatic ecosystems found in an area or on the earth. Species diversity includes the number of species present in different habitats. Genetic diversity includes the variety of genetic material within a species or population. 18. What are the five major causes of species decline? Habitat destruction and degradation, invasive species, pollution, and human population growth. 19. Summarize two approaches to sustaining biodiversity. The ecosystem approach protects populations of species in their natural habitat by preserving sufficient areas of habitats in different biomes and aquatic systems. The species approach protects species from premature extinction by indentifying endangered species and protecting their critical habitats. 20. What trophic level do decomposers consume from? Decomposers process detritus from all trophic levels. 21. What form of energy is transferred from one organism to another? Stored energy in the tissues of the organism. 22. Why would the earth be able to support more people if we ate at a lower trophic level? The energy intake would be higher because there is less loss of energy. 23. Why are there rarely more than 4 or 5 trophic levels within an ecosystem? Because the food web would not be able to sustain that great of an energy loss in successively higher levels. 24. What is the significance of net primary productivity? NPP measures how fast producers can provide the food needed by other organisms in an ecosystem. 25. What might happen to us and to other consumer species as the human population grows over the next 40-50 years and per capita consumption of resources such as food, timber, and grassland rises sharply? What are the three ways to prevent this from happening? We will end up pushing other species to extinction and reduce the biodiversity in earth. To prevent this, we can prevent population growth, find renewable energy sources, and consume food locally and at a lower trophic level. 26. Consider the diagram on page 67 (figure 3-22). Explain why desertification is so significant of an issue and relate that to the significance of net primary productivity. Dry land ecosystems are already such fragile ecosystems, and many of these delicate ecosystems have the most net productivity. 7. Describe the four types of soil horizons. The surface litter layer (O horizon) is the top layer and consists of freshly fallen undecomposed or partially decomposed leaves, twigs, crop wastes, animals waste, fungi, and other organic material. It is normally brown or black. The topsoil layer (A horizon) is a porous mixture of the partially decomposed bodies of dead plants and animals, called the humus and inorg anic materials such as clay, silt, and sand. The B and C horizons (subsoil and parent material) contain most of a soils inorganic material and lies on bedrock. 8. How does color relate to the quality of the topsoil? The color of the topsoil suggests how useful a soil is for growing crops. Dark brown or black soil is rich in organic matter and nitrogen. Gray, bright yellow or red topsoils are the opposite. 29. What are the significant properties of soil? Soil texture: particle size of components. 30. How do humans impact the hydrological cycle? We alter the water cycle by withdrawing large amounts freshwater, clearing vegetation, and eroding soils, polluting surface and underground water, and contributing to climate change. 1. Be able to diagram the entire Carbon cycle. See below 32. What is the significance of burning fossil fuels on the C cycle? Adds more carbon to the air. 33. How are Carbon and Nitrogen used by living organisms? Carbon and nitrogen make up organisms and are used in respiration by them. 34. What two natural processes convert nitrogen gas in the air to a usable form? Nitrogen fixation, Nitrification. 35. How is the C N Cycle affected by humans? We add large amounts of nitric oxide in the air and we add fertilizers to the water and soils. How to cite Apes Chapter 3 Questions, Essay examples

Research critique in ventilator associated pneumonea free essay sample

Ventilator-associated pneumonia (VAP), defined as pneumonia occurring 48 72 hours after endotracheal intubation, is the most common and fatal nosocomial infection of intensive care. Risk factors include both impaired host immunity and the introduction of an endotracheal tube, which contributes to the development of VAP in the critically ill patient. VAP is associated with increased mortality and morbidity, increased duration of mechanical ventilation, prolonged intensive care unit and hospital stay, and increased cost of hospitalisation. Both the Centers for Disease Control Guidelines and Pugin’s Clinical Pulmonary Infection Score (CPIS) criteria note that diagnosing VAP requires a combination of clinical signs, impaired gas exchange, radiological changes and positive microscopy to differentiate an episode of VAP from mere colonisation. In a resource-strapped environment, semi-quantitative analysis of specimens obtained utilising a non-invasive sampling technique is an acceptable option. Specific guidelines have been developed to both prevent VAP and treat it appropriately as soon as possible. We will write a custom essay sample on Research critique in ventilator associated pneumonea or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page The guidelines provide targeted strategies, while additional management of VAP includes the provision of essential care, psychosocial support, ventilatory support, enteral feeding and relevant medication including deep-vein thrombosis prophylaxis, and the prevention of complications. The Care Bundle approach offers an interventional tool to implement strategies specifically directed to the prevention of VAP and the facilitation of a team approach to improving its clinical management. The evidence available presents a strong argument to consider a team approach to reducing the incidence of VAP in our own critical care units. Ventilator-associated pneumonia (VAP), defined as pneumonia occurring 48 72 hours after endotracheal intubation, remains the most common and fatal nosocomial intensive care unit (ICU) infection among mechanically ventilated patients. 1-3 Each episode of VAP results in extended ICU and hospital stay and increased cost of treatment per patient. VAP is not particularly selective, and any patient mechanically ventilated for 48 hours is at risk of developing an episode. Patients (adults, children and neonates) who are critically ill and cannot maintain their own respiratory function adequately, or have a compromised airway, require an artificial airway to provide ventilatory support and for clearance of secretions. The indications for endotracheal intubation to facilitate mechanical ventilation to provide adequate oxygenation and respiratory support may be either pulmonary or non-pulmonary, and therefore include trauma, surgical (emergency or elective), and medical Prevention. indd 44 patients. The consequences of VAP warrant efforts to implement prevention strategies and manage each episode effectively. Ventilator-associated pneumonia Definition Pneumonia is defined as inflammation of the lung parenchyma caused by infection. 3 VAP is defined as pneumonia occurring 48 72 hours after endotracheal intubation. 3 VAP is therefore also a nosocomial infection, i. e. an infection that develops 48 hours after a patient has been admitted to a hospital or health care facility. 4 The current classification scheme for pneumonia as outlined by the American Thoracic Society Guidelines for the Management of Adults with Pneumonia refers to nosocomial pneumonia as hospitalacquired pneumonia (HAP), which includes both 11/16/09 9:05:29 AM VAP and health care-associated pneumonia (HCAP). 3 Both are clinically and microbiologically distinct from community-acquired pneumonia (CAP). VAP is further defined as early-onset VAP (occurring 38 °C with no other recognised cause) †¢ Leucopenia (240 or ARDS †¢ ? 240 and no evidence of ARDS 0 2 Pulmonary radiograph †¢ No infiltrate †¢ Diffuse (or patchy) infiltrates †¢ Localised infiltrate 0 1 2 Tracheal secretions Score* †¢ 500 band forms November 2009, Vol. 25, No. 2 0 1 2 0 1 2 Culture of tracheal aspirate (semi-quantitative: 0 1 2 or 3+) †¢ Pathogenic bacteria cultured, minimal or no growth †¢ Pathogenic bacteria cultured, moderate or more growth M †¢ oderate or greater growth of pathogenic bacteria consistent with that seen on original Gram stain Total score of 6 points suggests VAP 47 0 1 2 Total *Score calculated by quantifying amount of tracheal secretions on a subjective 0 4 scale multiple times per day, then summing all the patient’s scores for the day. Management and treatment Given the risk, incidence, increased costs and attributable mortality, measures should be employed to prevent VAP where possible. This is particularly relevant in developing countries, where VAP poses the greatest risk to patients, with the incidence measured at 41% and the crude mortality rate at 44. 9%. 14 Antibiotic therapy remains the mainstay of treating VAP and should be initiated as soon as possible once the patient has been admitted, the clinical diagnosis suspected and the required specimens collected. The choice of antibiotic/s is determined by individual patient risk factors, the institutional pathogens and specific antibiograms. 3 The process should be according to protocol and usually involves initiating empiric broad-spectrum cover in the critically ill patient, which is adjusted and preferably de-escalated once the causative pathogen has been adequately identified and the appropriate sensitivity tests performed. Inadequate or delayed initial antimicrobial Prevention. indd 47 therapy has been associated with increased mortality,15 and should therefore be specifically targeted in the institutional protocol. Critically ill patients require intravenous antibiotics. Eight days of antibiotic therapy has been proven to be effective in treating most cases of VAP, with cases caused by a non-fermenting Gram-negative bacillus such as Pseudomonas or Acinetobacter being exceptions and requiring longer duration of therapy. 3,16 A number of evidence-based guidelines have been developed in recent years to direct clinical practice in an attempt to improve patient care, and in particular care of the critically ill. Specific guidelines have been developed to both prevent VAP and treat it appropriately as soon as possible. 17-21 The guidelines provide targeted strategies, while additional management of VAP includes the provision of essential care, psychosocial support, ventilatory support, enteral feeding, relevant medication including deepvein thrombosis prophylaxis, and the prevention of 11/16/09 9:05:30 AM November 2009, Vol. 25, No. 2 SAJCC complications. A website titled VAPAWAY is dedicated to research and the prevention of VAP, and provides access to relevant information at www. vapaway. com. 22 The Institute for Healthcare Improvement (IHI) in the USA has developed the Ventilator Care Bundle to address VAP as part of their Preventing Harm to 5 Million Lives Camapaign. 23 48 Care of the ventilated patient Strategies to prevent VAP: Recommendations3,17 VAP is preventable, and certain practices have been demonstrated to reduce its incidence and its associated burden of illness. 17 Prevention of VAP is possible through the use of evidence-based strategies intended to minimise endotracheal intubation, the duration of mechanical ventilation, and the risk of aspiration of oropharyngeal pathogens. 3 Modifiable risk factors require understanding and practical implementation. The vast amount of research findings are often overwhelming and conflicting. Having the data synthesised into evidence-based clinical practice guidelines (CPGs) by a credible group of multidisciplinary critical care clinicians (such as the Canadian Critical Care Society and Canadian Clinical Trials Group) improves the accessibility of reliable evidence for application in clinical practice. Guidelines can improve the processes, outcomes and costs of critical care. 17 Successful implementation requires a team approach that embraces an active strategy to improve patient care, participation by all team members, periodic review of guidelines and a continuous process to effect change in behaviour where required. Implementing clinical practice guidelines The IHI in the US recognised a need to reduce preventable errors after the release of the Institute of Medicine’s 1999 report on health care-related errors. 29 The 100,000 Lives Campaign launched by the IHI in 2004 generated an unprecedented commitment to change and collaboration across the US health care industry, led to the launch of a similar programme in the UK, viz. the Saving Lives Campaign,30 and led to the expansion of the IHI programme to become the Protecting 5 Million Lives from Harm Campaign in 2006. 23 The campaign is a national effort targeted at reducing preventable deaths in US hospitals, and protecting patients from harmful events that often have lasting effects. Medical harm is defined as ‘unintended physical injury resulting from or contributed to by medical care (including the absence of indicated medical treatment), that requires additional monitoring, treatment or hospitalization, or that results in death. Such injury is considered harm whether or not it is considered preventable, resulted from a medical error, or occurred within a hospital. ’24 The initiative has led to new standards of care being developed and the implementation of relevant research findings at the bedside. The Ventilator Care Bundle The Ventilator Care Bundle is one of the six key programmes of the original campaign and consists of ‘a series of (evidence-based) interventions related to ventilator care, that when implemented together, will achieve significantly better outcomes than when implemented individually’. 31 The key components of the Ventilator Care Bundle are: The following recommendations (Tables III and IV) are a summary of the recommendations of some of the more recent literature, including the updated (2008) CPGs of the Canadian Group17 and the recommendations of Pieracci and Barie. 3 †¢ Elevation of the head of the bed (30 45o)32 Note: The use of nebulised endotracheal tobramycin and the intratracheal instillation of tobramycin are not recommended for the prevention of VAP,18 but may be useful in treating tracheobronchitis. †¢ eep-vein thrombosis prophylaxis. 35 D The application of a clinical guideline for the treatment of VAP was found to increase the initial administration of adequate antimicrobial treatment and decrease the overall duration of antibiotic treatment. 19 In addition, routine ventilator-associated pneumonia prevention measures were applied, including semi-recumbent body position, discontinuation of mechanical ventilation using a medical intensive care unit specific weaning protocol, avoidance of gastric distension by monitoring residual volumes following feedings, and routine inspection of ventilator circuits to remove condensate. 19 Prevention. indd 48 †¢ aily ‘sedation vacations’ and assessment of D readiness to extubate33 †¢ eptic ulcer disease prophylaxis34 (for high-risk P patients only) Additional protocols could include: †¢ A structured oral care protocol28 †¢ A patient mobility component †¢ Weaning protocols. Resources are available to facilitate the implementation process. 31 These include: †¢ Daily goal worksheets †¢ Checklists †¢ Audit tools. Impact of a protocol to prevent VAP The Canadian Critical Care Trials Group suggests that ‘Although scientific advances have the potential to improve the outcomes of critically ill patients 11/16/09 9:05:30 AM Table III. Strategies to prevent VAP SAJCC November 2009, Vol. 25, No. 2 Physical strategies †¢ trict infection control, including hand hygiene with alcohol-based hand disinfectants, gowning and gloving S minimises person-to-person transmission of pathogens3 †¢ Adequate ICU staffing24 †¢ Minimise endotracheal intubation where possible3 17 †¢ Orotracheal route preferred to nasotracheal route 3 †¢ Maintenance of orotracheal cuff pressure 20cm H2O (but 72 hours) †¢ se of a closed endotracheal suctioning system for safety considerations only (decrease transmission of U infection-resistant organisms) does not prevent VAP21, 26, 27 17 †¢ Closed endotracheal suctioning system changed between patients, or as clinically indicated 3 †¢ Minimise the duration of mechanical ventilation †¢ Daily interruption of sedation †¢ Standardised weaning protocols 17, 21 †¢ Circuit changes only if the circuit becomes soiled or damaged, and between patients †¢ hanging of heat-moisture exchangers (HMEs) every 5 7 days or as clinically indicated (clogged with C secretions) if in use17 21 †¢ Use of water bath humidification or a heated humidifier is acceptable †¢ Bacterial filters are only indicated for use in patients with infectious diseases such as TB †¢ Consider non-invasive ventilation if possible3 †¢ Consider rotating beds, if available (kinetic bed therapy)17 †¢ emi-recumbent positioning (30? 45? head up) is protective, especially during enteral feeding (prevent S gastro-oesophageal reflux and aspiration)3, 17 †¢ egin enteral feeding slowly, especially during the 48 hours after initiating mechanical ventilation, to B minimise gastric reflux and potential aspiration risk3 †¢ The gastric route for feeding is recommended (post-pyloric route not superior)3 †¢ Oral care28 49 Pharmacological strategies †¢ ropharyngeal decontamination with a topical antiseptic such as chlorhexidine has been proven to be O beneficial17 †¢ Oral decontamination with povidone-iodine oral antiseptic only in patients with severe head injuries †¢ imit stress ulcer prophylaxis to high-risk patients (avoid antacids and histamine type 2 antagonists, L sulcralfate and proton pump inhibitors (PPIs) preferable)3 †¢ Limit red blood cell transfusions in trauma and the critically ill3 †¢ Targeted antibiotic administration strategies such as de-escalation and antibiotic rotation or ‘cycling’3 Note: Selective decontamination of the digestive tract (SDD) with topical or systemic antibiotics or antiseptics has not been shown to provide benefit outside of the Netherlands, may increase the incidence of MDR infections, and is therefore not recommended for general use. 3 Strategies that have not proved beneficial include:17 †¢ A systematic search for prevention of sinusitis (unless patient is intubated via the nasotracheal route) †¢ Prone positioning †¢ Prophylactic antibiotics (aerolised, nasal or intravenous) †¢ Aerolised antibiotics †¢ Intranasal mupirocin †¢ Topical antibiotics †¢ Post-pyloric feeding Educational strategies †¢ Staff education programmes3 Prevention. indd 49 11/16/09 9:05:31 AM Table IV. Diagnosis and treatment of VAP: Recommendations18 November 2009, Vol. 25, No. 2 SAJCC Diagnosis †¢ on-invasive techniques, viz. endotracheal aspirates with non-quantitative cultures, are recommended for the N diagnosis of VAP in immunocompetent patients as the initial diagnostic strategy2,6,12,18 50 Treatment Initial treatment: E †¢ mpiric antimicrobial therapy v. delayed culture-directed therapy where there is a clinical suspicion of VAP3,15,18 †¢ ppropriate spectrum mono-therapy for empiric therapy of VAP (single agent for each potential A pathogen)3,18 †¢ Choice of antibiotics based on patient factors and local resistance patterns3,18 Duration of treatment †¢ Maximum of 8 days’ antibiotic therapy in patients who received adequate initial antibiotic therapy16,18 †¢ onger duration of antibiotic therapy for cases of VAP caused by a non-fermenting Gram-negative bacillus L such as Pseudomonas or Acinetobacter, viz. 14 -15 days16 †¢ Antibiotic discontinuation strategy based on clinical criteria for the treatment of suspected VAP3,18 †¢ De-escalation of antibiotic therapy to culture-directed sensitive therapy3,18 who are at risk or who have VAP, the translation of research knowledge on effective strategies to prevent, diagnose, and treat VAP is not uniformly applied in practice in the intensive care unit. Knowledge about VAP may be used more effectively at the bedside by a systematic process of knowledge translation through implementation of clinical practice guidelines. ’36 Clinical practice guidelines aim to improve the quality of care, to decrease costs, and to reduce inappropriate variation in decision making in the critical care setting. 37 While there is some agreement regarding the evidence and the recommended strategies, implementation of guidelines remains a challenge in practice. In a study conducted in 2002 to establish why physicians do not follow guidelines, Rello et al. 37 found that non-adherence to guidelines for preventing VAP was common, and largely uninfluenced by the degree of evidence. The most common reasons identified were disagreement with interpretation of clinical trials, unavailability of resources and costs. 37 Implementation A team approach is essential for the successful implementation of a quality improvement initiative. The support of medical directors, nursing managers, administrators and ancillary services such as the laboratory, together with staff involvement, are key factors to success. The initiative requires a champion that will drive the process, written guidelines, userfriendly tools and regular feedback regarding the process, as well as ongoing review of the programme. Key elements are functional communication systems, accountability and continuous education of all staff. The Canadian Critical Care Trials Group promotes the concept of ‘a systematic process of knowledge translation that incorporates knowledge about clinical preferences and behaviour change theory – this Prevention. indd 50 process is defined as one that uses evidence-based clinical practice guidelines (CPGs) and includes a guideline implementation strategy that addresses understood barriers to clinician’s adherence to guidelines, and capitalizes on the facilitators’. 36 Guideline implementation strategies36 A combination of the following is required: †¢ Educational material, meetings and outreach visits †¢ Reminders †¢ Opinion leaders †¢ Computerised decision support systems †¢ Audit and feedback. The strategies need to be specifically suited to the complex and dynamic ICU environment, the multidisciplinary team, the organisational climate and culture of the ICU. Sinuff et al. found that ‘a coherent ICU team with common patient care goals and agreement with the purpose and goals of a guideline may facilitate guideline adherence’. 36 Behaviour change theory can provide a framework within which to initiate the change process. Critical components include effective leadership, a collaborative team, continued education programme, an effective communication system and an audit-feedback system. Conclusion Significant improvements in quality indicators and patient outcomes have been reported by hospitals that have embraced the bundle approach and implemented the ventilator care bundle in particular. Cruden et al. 38 found that the systematic and methodical implementation of the ventilator care bundle interventions over a 1-year period in a UK hospital