Thursday, October 31, 2019

Choosing a Small Business Computer Assignment Example | Topics and Well Written Essays - 1000 words

Choosing a Small Business Computer - Assignment Example One of the first considerations is compatibility. The small office PC needs to able to access and run the bulk of the programs available. This will mandate that the computer will be able to run programs that are written for Microsoft Windows. While moving to specialized platforms such as Linux or UNIX may provide greater security, the widespread application of Windows will have a greater benefit. Having decided on a Windows operating system, the next consideration is hardware. With a real estate business, there will be applications that will require multiple images of houses that will consume a large amount of disk space. Most desktop computers are available with a 320 Gbyte hard drive for less that $1000. They also have 2GB main memory and ample video memory to reproduce photo quality images without loss of speed. For a Dell computer model 1501 Inspiron with a 2.2 GHz Intel processor the price will be about $900 (Inspiron 1501 details, 2007). Hewlett Packard makes a similar computer, HP Compaq 5750, with slightly less storage (250 GByte) and an AMD processor for $920 (HP United States, 2007). However, the Dell comes with a 20-inch flat screen monitor that is an extra cost with the HP. All other things, such as brand and warranty, are equal and the selection would be the Dell. With a real estate business, there will be situations where you may need to go to a client's home or office. These scenarios will require you to take your computer with you which will necessitate using a laptop. A Dell laptop Insperon 1720 has all the features of the desktop (with a slightly reduced processor speed of 1.56 GHz) and sells for $1049 (Inspiron 1702/1721 Notebook, 2007). This has a WI FI card for wireless connection to the Internet. HP sells a similar laptop that has slightly less storage and a smaller screen for $949(HP Pavilion tx1000z series, 2007). Both have a long-term service contract available. The additional storage and the larger screen makes the Dell the better buy. With a real estate business there will be a lot of printing and document processing. One of the key concerns will be laser or inkjet For the real estate office it would be recommended to have a multi-function printer that prints, copies, and faxes. This will be a laser device that is black and white. The office will also need to do photo quality printing of homes and rooms that is best done by an inkjet printer. The real estate office will have to have 2 separate printers. However, with the wide choices available today, the cost is minimal in comparison to the features received. Do not purchase an all in one inkjet because the cost of printing the day to day documents would be unreasonable. Laser printers print and scan documents for about 2 cents a copy compared to 10 cents a copy for inkjet. The main consideration for a laser printer is features and cost. A few major companies manufacture most laser printers so quality is generally the same no matter who has put their name on it. Obviously we would expect better customer service from Hewlett Packard than we would from Podunk Printers, but the printer may in fact be the same hardware. Don't spend a lot of money on a laser printer. The HP 6310 will service all your office needs at only $132.00. For the office you will also need a high resolution color printer for photo quality work. These printers are inexpensive, but must be dedicated to printing photos. The ink cartridges are

Tuesday, October 29, 2019

English Poetry and of Mice and Men Exam Practice Essay Example for Free

English Poetry and of Mice and Men Exam Practice Essay what to look for in poetry †¢tone †¢pace †¢mood/atmoshere †¢themes/ideas †¢imagery †¢techniques, why woman work and overheard in country Sligo differences- ââ€" ªwoman work-very busy mood and atmosphere-because of the rhyme! reflects everything she has to do ââ€" ªOverhead-calmer, more relaxed, slow pace!-reflects here quite country irish life. the women themselves are different, one busy one maybe too similarity- †¢neither women feel like they have a lot to call their own †¢woman work talks about she can only call nature her own-star shine, moon glow/your all that i can call my own †¢overheard-says how she wanted her name in a book or on Angelou-implies stage, didnt get what she wanted i ought to feel happy-implies she should but doesnt †¢both spend their time doing house work The poem, Woman Work by Maya Angelou shows how busy life can be for a black woman in southern american, and the general mood is very busy, with the use of rhyming giving it a quick pace, reflecting on her life. It also highlights how she doesnt feel like she has a lot to a call her own in life, implying everything she does is not for self. The poem, Overhear in County Sligo shows the life a married woman in rural Ireland and the poem has a much calmer mood and slower pace reflecting the quiet she lives. It talks about dreams that the woman once had, and how maybe shes not as happy with her lot in life. I find my face in the glass/I ought to feel Im a happy woman this stands out to me in this poem as I think it provokes very strong emotions and empathy towards the woman, by showing how unhappy and unfulfilled she feels. One of the main differences between these two poems is the pace and mood. Woman Work has a much a quicker pass and busier mood whereas Overheard in County Sligo is much slower and more relaxed. In Woman Work Angelou uses short lines and a rhyme, to give the poem a quick pass. Reflecting on how busy life may be for the woman. Angelou writes, Ive got the children to tend / the clothes to mend. These lines are quite short, and the pace implies that the woman has to do all the work and has a lot of responsibilities. The use of the word tend also makes looking after the children sound like a very tedious thing and almost chore like, implying that she feels she many other and maybe more important things to be doing. In Overheard in Country Sligo the mood is much calmer and the slower pace gives a relaxing mood. Clarke writes, with a field of cows and a yard of hens this line, like the majority in the poem is quite longs and has a slow pace when reading, this may have been done to reflect t he womans lifestyle, and the poets use of describing the countryside makes life seem very calm and idyllic, almost as If the woman doesnt have a lot she has to rush for. One the main similarities in the poems is the impression that neither women have much that they feel they can call their own. In Woman Work, Angelou writes, star shine, moon glow/your all that I can call my own this shows that she doesnt feel that she has much she can call here own, implying that all the work she dos is not for herself, but for others. The uses of the words shine and glow to describe nature, implies that natures is possibly the one calm and beautiful thing in here life. In Overheard in Country Sligo, Clarke writes, or have my name printed in a book/to see my thoughts on printed page this implies that the woman had bigger dreams than of getting married and I think the use of the phrase my name printed shows that she wanted to have something that belonged to her and that showed everything she thought or did. I also think the fact that she states I married a man from County Roscommon shows that she may feel little belongs to here or has her name on, and that maybe she f eels that shes living a life for here husband and not for her self. Another similarity in the poems is that both women spend their time doing house work and chores. In Woman Work, Angelou lists off everything the she has to do with her day. Angelou writes, the floor to mop/the food to shop this makes her work seem very tedious and mundane and Clarke gives the similar impression about work in Overheard in County Sligo, when she writes and polish the lustre and brass,/to order and dust the tumbled rooms. She makes does not make work sound very interesting or something that she enjoys. However a subtle difference between the two is that Clarke makes the womans work seem very monotonous or as if she has to force herself to it, whereas in Woman Work, work seem to be very hectic and rushed. Valentine by carol ann Duffy and †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ by w h Auden plan- †¢valentine- its very personal shes writing it to her lover, shown by using i and you- personal pronouns †¢funeral blue- it seems more like hes declaring his feeling, attitude, instead of referring to the dead lover thus effects the mood. †¢valentine- onion represents love but also link s to the future, time continues †¢funeral- wants time to end, no future †¢love stays with you, nothings the same when it ends Valentine by Carol Ann Duffy is about giving an onion as a gift on valentines day, to represent love, the poet is tired of meaning less clichà © gifts and whats to give something truthful and poetic instead. She talks about every thing that the onion represents and what love entails, and the overall mood is very personal and uplifting, as if she was directly addressing a lover. Funeral blues is about life now that a lover is dead, and how its so difficult to understand how things can go on in life, but the fact that he uses a rhyme lighten the pace and shows that for others life will go on as normal. This poem seems more like the poet making a statement and has a very powerful, but sad mood as you realise how deviating a lose it is to the poet. One of the main differences between the poems is the tone and mood that they sets. Valentine, is very personal, it implies through the use of the personal pronouns, you and i that its supposed to have a more personal and intimate feel. Duffy shows this when she writes, I give you an onion./its fierce kiss will stay on your lips,/possessive and faithful, she uses very powerful words such as fierce and possessive which create a more passionate and powerful mood, giving a reader a string sense of her love for this person. Funeral blues however has a different tone and mood, it seems a lot less intimate ad personal but more like the poet trying to declare their pain to everyone, instead of referring to the lover in a personal way, he uses 3rd person as if hes telling others, not speaking to the dead lover. Auden shows this when he writes he was my north, my south, my east, my west,. This line is very strong and again reflects the sense of declaration that i think sets the mood throughout the poem, and the use of he makes it feels like a statement that everyone should here, which differs to the personal account given by Duffy. Another difference in the poem is the theme. Valentine talks about promise and future, where as in Funeral Blues it seems like the poets cant believe there is a future and that life can still go on. Duffy shows this theme of future in several different ways, one being when she writes Its platinum loops shrink to a wedding-ring, this line implies that she can imagine future with her lover, and the phrase, if you like implies that they can make what they want of life, and that again theres a future. Contrastingly in funeral blues Auden implies that he can no longer see a future know that hes alone, and nothing is worth while, this is show mainly in the final stanza,pour away the ocean, and sweep up the wood. implying that everything seems pointless in life and he can no longer appreciate the beauty in the world. One similarity between the poems is the idea that love is every powerful and stays with you no matter how it ends. Duffy shows this in Valentine in the final stanza, when she uses the strength of an onions smell as a metaphor for love staying with you, Its scent will cling to your fingers. The use of the word cling in this line is very powerful and helps to show the level in which love stays with you, implying its hold over a person is very strong. Auden shows love in a similar light in Funeral Blues, he writes, for nothing now can ever come to any good implying that love has changed everything, the way he perceives things and does things, showing like in Valentine the power love has over a person. Look closely at the text, what does it real about georges character, how does he behave and speak? plan- †¢george, it shows hes aware of the prejudice towards Lennie-feels the need to lie about why they travel together. †¢gets angry with Lennie, makes his life more difficult, doesnt always appreciate or is aware of the trouble george goes to. †¢hes quite quick and sharp, he responds well to question, knows the right things to say The extract reveals quite a lot about Georges character. It shows that George as quite a sharp and intelligent character, who seems to be able to say the right things. Steinbeck shows this when he write, george broke in loudly. oh! I aint saying hes bright. He aint. but hes a god damn good worker. This implies that george is very quick and sharp, hes very aware of the right things to say. The fact that Steinbeck also uses quite sharp short sentences here when Georges is speaking helps to show Georges thought proses and you can see him thinking about the thing the boss night want to hear. The extract also reveals that Georges character is very aware of the prejudice towards Lennie, and wants to do what he can protect Lennie as well as ensure them a job. He does this by not allowing Lennie to talk, and explaining why he may not come across as smart because he got kicked in the head by a horse when he was kid. This also implies that george doesnt share everyone elses prejudice towards m ental disabilities, or at least not Lennies. In the extract Steinbeck also represents george as having a short temper at times, especially regarding Lennie. Steinbeck shows this when he writes be a damn good thing if you was, george said viciously save everybody a hell of a lot o trouble. this gives the impression that George finds moving around with Lennie very frustrating, maybe because he knows that Lennie is always aware appreciates everything george does, and hes knows how much easier things would be if Lennie wasnt there. the use of the word viciously reveals a lot about Georges character and shows that he is capable of being quite vastly and powerful when he losses his temper. How the Steinbeck present slims character in the extract? Plan- †¢made to seem very friendly ad welcoming-his tone was friendly, it invited confidence without demanding it. †¢deep, wise, understanding, smart-his slow speech had overtones of not thought, but of understanding beyond thought — not like other ranch workers †¢impressive, strong. — He was the prince of the ranch, capable of driving, ten, sixteen even twenty mules with a single line. — Just the length of Stienbecks destruction makes him seem more impressive. †¢authoritative-all talk stopped when spoke. his authority was so great his word was taken on any subject. be it police or love in extract Steinbeck presents slim as being very different to your typical ranch worker at the time and shows many aspects of slims character. one being that he seem very strong and impressive, Steinbeck shows this when he writes, he was the price of the ranch, capable of driving, ten, sixteen even twenty mules with a single line this show how strong he is but steinboks use of increase figures makes him seem more impressive and as if hes strength has no end. the length in which steinbok writes about slim also emphasise how impressive a character he is. In the extract Steinbeck also presents slim as being a very deep, understanding and smart character. Steinbeck writes, his slow speech had overtones not of thought but of understanding beyond though. This implies that slims is a very deep character, whos understanding is far beyond that of other ranch workers. slim is also made to seem very authoritative in this extract. one of the ways in which steinbok shows this is when he writes h is tone was friendly, it invited confidence without demanding it. this shows slims character as being very friendly, but also as very reasonable and welcoming. the use of the word confidence also highlights that slims a character who is able to better others and confident that jet simp;y being around him enables others to be more open and confident. Finally Steinbeck shows slims slim authority. He does this when he writes, all talk stopped when he spoke. His authority was so great his word would be taken on any subject wether it be politics or love this quote highlights every aspect of slims character and the way people view him, it reinforces the fact that he is wise and knowledgeable ,as well as showing his power and straight over others. How does Steinbeck create mood and atmosphere in the extract? plan- †¢peaceful and innocent, sets the mood through describing cureless wife †¢quite, time stops Steinbeck creates mood and atmosphere in the extract through describing how quiet it is in barn. He describes how things change, and the way he looks at light gives a very calm and almost magical atmosphere. the sun streaks were high on the wall by now, and light was growing soft the makes everything seem very bright and the uses of the word soft creates a magical and beautiful atmosphere which helps to reflect upon how Curleys wife is portrayed know she is dead. Steinbeck also creates mood in the extract with the line and sound and movement stopped for much, much more that a moment, the reinforces the magical and peaceful atmosphere in this scene, and the use of the word stop makes the reader themselves pause and think about for a moment, creating a very deep and more effective mood. Steinbeck also creates mood in this extract through his description of Cruleys wife, and the meanness and the planning and the discontent and ache for attention were all gone from her face. this line m akes the reader feel a sense of the pain she felt when she was a live, but by referring to her pain Steinbeck also creates a stronger sense of freedom and relief now that see has died. the phrases gone from her face, also allows the reader to picture the scene and what she might look like creating a more real atmosphere. what to include- †¢context- the time †¢themes †¢tracking †¢what happens †¢quotes †¢conclusion For which character do you have the most sympathy for? Show how Steinbecks presentation of your character creates sympathy. plan- ââ€" ªcurelys wife ââ€" ªprejudice- i cant tai to know body but curly, jailbait, tart ââ€" ªloneliness-think i dont like to talk to nobody ever once in a while ââ€" ªunhappy marriage think Im gonna stay in that 2 by 4 house and listen to how curley gonna lead with his left ââ€" ªamerican dream-i could have been in the pitchers, failed know shes with curley ââ€" ªsymplahy in beauty in death, reveals hr pain ââ€" ªthe way she confided in lennie i dont like curley he aint a nice fella i have the most sympathy for curleys wife in the novel as i think that she has had a lot of disappointment and hardship in her life. one way in which stienbeck creates sympathy for her character is through showing her loneliness and how unhappy she is in her marriage. she does not seem happy or in love with curley, or the new life she has to lead to on the ranch, and her marriage is the main reason shes so lonely, it has meant shes isolated on the ranch, think Im gonna stay in that 2 by 4 house and listen to how cureless gonna lead with his left. and the fact that she doesnt seem to anything common with curley and hes quite self pbsored means she doesnt feel happy. and when she confides in lennie by saying i dont like curley, he aint a nice fella it generates sympathy by showing how unhappy she is about her life, and the fact that she says he aint a nice fella almost makes her appear trapped. the way she is treated by the other ranch workers also generates sympathy, as it makes her s eem very unwanted, as most of the ranch workers judge her harshly, and shes accused of being a tart and jailbait. the ranch workers attitudes towards her also shows the prejudice women faced at the time, and the fact that shes is a married women means no one should be talking to her, and shes expected to stay in the house and conform to society in the 1930s. one of the main ways in which Steinbeck creates sympathy for her character is through the way she is presented in death. he describes her as young and pretty, and the emphases he puts upon how all the plottig and meanness left her, and she looked so a peace, made all the pain shed felt in life very real. her american dream also generates sympathy, as it shows the hard ship and disappointment shes had to face in a life, but the she also deep down thinks she might get there some day. it shows the sort of life she desired and in a way that might have made her new life on the ranch harder to face. How does John Steinbeck presentation of George throughout the novel affect your feelings towards him? In this essay I will explore the presentation of George throughout the novel. One of the ways in which Steinbeck presents George is as a caring man. This is largely show through his parental attitude towards Lennie. He is shown to care about out Lennie and tries to keep him out of trouble even though he does not actually have any obligation to. This is shown during the first chapter when we see George take a lot of responsibility for Lennie, carrying his things â€Å"think I’d let you carry your own work card† and generally looking after him . This factor affected my feelings towards George, especially as during the time it was not normal for one man to care so much for another, especially ranch workers, as shown when slim finds out they travel together, â€Å"I never seen one guy care so much for another†. However George is shown to lose his temper with Lennie on several occasion, an example being in the first chapter when Lennie asks for ketchup, â€Å"you alw ays want what I ain’t got†, showing how difficult life can be for George traveling with him. This generates some sympathy towards George for me as it again shows how he puts up with Lennie because he loves him, even though he knows how different his life could be if he travelled alone. George’s attitude towards the American affected my feelings towards his character as well, especially as we saw it develop throughout the novel, and there are three main points that show how he feels towards the American dream. The first being when he is telling the story of their farm to Lennie, he interrupts himself and says â€Å"I ain’t got time for no more†, I think this shows that sometimes he gets caught up in this story, showing how much he longs for it but that deep downs knows how near impossible it is to achieve. The second point that I think is key to Georges attitude towards the American dream is when candy offers to give them the money. We see how excited George is when he says â€Å"we’ll do her†, this point affected my feelings towards him as it shows how much he wants the dream and gave me a sense of Georges happiness. I think that the main point regarding George’s attitude towards the dream was after candy had shown George Curley’s wife’s body, it’s during this scene we see how the dream was always really something for him and Lennie, and if he can’t do it worth Lennie it seems he doesn’t want to do it at all. All of these points really impacted my feeling towards as it generates a lot of emotions such as joy and sympathy towards George. How is the relationship between Curley and his wife important to the novel as a whole? plan- †¢shows that during the time relationships werent always based on love †¢prejudice- Curley doesnt let his wife talk to others †¢loneliness-shows that even though your wit someone you can still be lonely- happiness †¢their relationship is not close, this causes cureless wife to stray to talk to others, talk to Lennie Loneliness is at the heart of the novel, to what extent do you agree with this? Show how Steinbeck presents the theme of friendship in of mice and men? plan- †¢presents it as rare- ranch workers, time †¢presents it as brief and fragile †¢presents it through candy and dog †¢lennie and george †¢maybe look at slim being v. understanding and friendly and curly not trusting new people. Steinbeck presents the theme of friendship is several different easy throughout the novel. Steinbeck presents friendship as rare throughout the novel, during the 1930s male friendship between ranch workers was very rare, one point when this is show is when the ranch boss say i never seen one guy take so much trouble for another, implying that friendship between men is a very rare thing, and that workers may prefer to to keep to themselves. the rarity of lennie and georges friendship is also shown through several statements implying that they can not just be friends, for example when george and lennie meet curley as well as the boss they are questioned about the motives of their friendship. as well as presenting friendship as rare, Steinbeck also presents it as fragile, as we see the two major friendships end, candy and when his dog is shoot and lennie and george, when george kills lennie. The characters are powerless do you agree i do not agree all the characters are completely powerless, how ever in some ways the majority of them are for- Lennie †¢stronge †¢cant control him self, relies on others, mental illness. -Curleys wife †¢prejudice, Curley controls her -slim †¢powerful

Sunday, October 27, 2019

Management Of Chronic Pain Nursing Essay

Management Of Chronic Pain Nursing Essay This project is a complete illustration of pain and how treated by understanding how its work, references can be visited for more detailed information or contact me. Chronic pain is defined as a painful condition that lasts longer than 3 months. Chronic pain can also be defined as pain that persists beyond the reasonable time for an injury to heal or a month beyond the usual course of an acute disease. There are four basic types of chronic pain: (1) pain persisting beyond the normal healing time for a disease or injury, (2) pain related to a chronic degenerative disease or persistent neurologic condition, (3) cancer-related pain, (4) pain that emerges or persists without an identifiable cause. Chronic pain differs from acute pain in its function. Acute pain is an essential biologic signal to warn the individual to stop a potentially injurious activity or to prompt one to seek medical care. Chronic pain serves no obvious biologic function. Chronic pain patients presenting to the emergency department (ED) have not been well studied, despite their apparent numbers. Complete eradication of pain is not a reasonable end point in most cases. Rather, the goal of therapy is pain reduction and return to functional status. Chronic pain syndromes discussed in this paper include myofascial headaches, transformed migraine headaches, fibromyalgia, myofascial chest pain, back pain, complex regional pain types I and II, post-therapeutic neuralgia, and phantom limb pain. Drug-seeking patients are also covered. EPIDEMIOLOGY Chronic pain affects about a third of the population at least once during a patients lifetime, at a cost of-80 to 90 billion dollars in health care payments and lawsuit settlements annually. Chronic pain is also common in those who do not seek medical attention. Despite similar subjective pain, those who seek medical attention are less physically active, experience more social alienation and more psychological distress than those who do not seek medical attention. The causes of chronic pain are more complex than the causes of acute pain. Chronic pain may be caused by (1) a chronic pathologic process in the musculoskeletal or vascular system, (2) a chronic pathologic process in one of the organ systems, (3) a prolonged dysfunction in the peripheral or central nervous system, or (4) a psychological or environmental disorder. In contrast, acute pain may be influenced by, but is not primarily caused by, a psychological or continuous environmental disorder. A detailed listing of all the epidemiologic factors of the various chronic pain syndromes is beyond the scope of this paper. However, in general, patients who attribute their pain to a specific traumatic event experience more emotional distress, more life interference, and more severe pain than those with other causes. PATHOPHYSIOLOGY The pathophysiology of chronic pain can be divided into three basic types. Nociceptive pain is associated with ongoing tissue damage. Neuropathic pain is associated with nervous system dysfunction in the absence of ongoing tissue damage. Finally, psychogenic pain has no identifiable cause.3 Many chronic pain states begin with an episode of nociceptive pain and then continue with neuropathic or psychogenic pain. For example, an acute injury with fracture involves nociceptive pain, but an associated nerve injury may lead to neuropathic pain. Chronic disability may lead to psychogenic pain. Nociceptive pain results from the stimulation of nicotinic receptors in tissues or organs by noxious mechanical, thermal, or chemical stimuli. Chemical mediators of inflammation such as bradykinins and prostaglandins are essential elements in the pathophysiology of nociceptive pain. Examples of chronic nociceptive pain include cancer pain and pain due to chronic pancreatitis. Patients with nociceptiv e pain usually respond well to centrally acting analgesics. Neuropathic pain is caused by disease of the central or peripheral nervous system. Examples of neuropathic pain include complex regional pain type II (causalgia), post-therapeutic neuralgia, and phantom limb pain. Neuropathic pain responds poorly to common analgesics, including narcotics. Psychogenic pain is a diagnosis of exclusion and can be difficult to establish in the ED. Patients with psychogenic pain believe their pain is physical and tend to strongly reject the concept that it is psychological. CLINICAL FEATURES To better define the psychology of chronic pain, psychiatrists have divided patients characteristics into two groups.4 The first group has normal psychological function at baseline. However, continued pain and its effects, such as inability to work or altered body image, result in psychological dysfunction. The second group has primary psychopathology that predates the onset of chronic pain. Hypochondriacally, hysterical, pain-prone, and depressive personalities are included in this group. The following set of historical inquiries may prove helpful in the ED. The patients should be asked to describe the nature of the current pain, initiating and exacerbating or relieving factors. Other useful information includes determination of the chronic nature of their pain, quantification of similar episodes, and sources and modes of treatment, including medications and dosages for physician-prescribed, over-the-counter, or alternative medications. Outcomes of previous therapeutic efforts and the effect of the condition on the patients functional status are also important. Addiction to drugs or alcohol or experience with detoxification programs should also be noted. Finally, a review of systems should be done to rule out any other conditions. Substance abuse is a frequent problem in chronic pain patients. Patients referred to chronic pain clinics meet Diagnostic and Statistical Manual of Mental Disorders, third revised edition (DSM III-R) criteria for active substance abuse disorders in 12 to 24 percent of cases, while 9 percent meet criteria for remission diagnosis. Drug detoxification is often the first step of the therapeutic plan for new patients referred to a pain clinic. Objective findings of acute pain include tachycardia, hypertension, diaphoresis, and muscle spasms on stimulation. Objective evidence of chronic pain includes muscle atrophy in the distribution of pain due to disuse, skin temperature changes due to the effects of the sympathetic nervous system after disuse or secondary to nerve injury, and trigger points, which are focal points of muscle tenderness and tension. However, these findings do not have to be present for the pain to be factual. BACK PAIN   Ã‚  Ã‚   Risk factors for chronic back pain following an acute episode include male gender, advanced age, evidence of nonorganic disease, leg pain, prolonged initial episode, and significant disability at onset. Chronic back pain symptoms and causes can be divided into myofascial or muscular, articular, and neurogenic types. Myofascial back pain is characterized by constant dull and occasional shooting pain that does not follow a classic nerve distribution. Pain may or may not be exacerbated by movement. Usually trigger points can be found at the site of greatest pain, and muscle atrophy is not found. Range of motion of the involved muscle is reduced, but there is no actual muscle weakness. Previous recommendations for bed rest in the treatment of back pain have proven counterproductive. Exercise programs have been found to be helpful in chronic low back pain. Articular back pain is characterized by constant or sharp pain that is exacerbated by movement and associated with local muscle spasm. Myofascial and articular back pain may be indistinguishable from each other except by advanced imaging techniques beyond the usual scope of practice in the ED. Neurogenic back pain is classically characterized by constant or intermittent pain that is burning, shooting, or aching. The pain is usually more severe in the leg than in the back and follows a dermatome. Muscle atrophy as well as reflex changes can be seen over time. DIAGNOSIS The most important task of the emergency physician is to distinguish chronic pain from an exacerbation that heralds a life- or limb-threatening condition. A complete history and physical examination should either confirm the chronic condition or point to the need for further evaluation when unexpected signs or symptoms are elicited. An electrocardiogram (ECG) may be needed in some cases of chronic myofascial chest pain to help differentiate it from acute ischemic chest pain. Because chronic pain patients may be frequent visitors to the ED, the entire staff may prejudge their complaint as chronic or factitious. Physicians should insist that routine procedures be followed, including a full triage assessment and a complete set of vital signs. Rarely is a provisional diagnosis of a chronic pain condition made for the first time in the ED. The exception is a form of post-nerve-injury pain, complex regional pain. The sharp pain from acute injuries, including fractures, rarely continues beyond 2 weeks duration. Pain in an injured body part beyond this period should alert the clinician to the possibility of nerve injury, and proper treatment, discussed below, should be instituted. Definitive diagnostic testing of chronic pain conditions is difficult, requires expert opinion, and often expensive procedures such as magnetic resonance imaging (MRI), computed tomography (CT), and thermography. Therefore, referral back to the primary source of care and eventual specialist referral are warranted to confirm the diagnosis. TREATMENT Emergency physicians must avoid labeling patients with pain as either drug seekers or legitimate patients deserving narcotics for pain relief. With these labels, emergency physicians may exacerbate the problem and promote the learned pain response, where patients believe that they must come to the ED for pain relief. Chronic pain patients often request narcotics, although the lure of going to the ED can be just as strong without receiving narcotics. Any drug that alters sensorium can exacerbate the learned pain response. The external rewards of visiting the ED for medication or evaluation are many: attention and comforting from family and nursing staff, status as a special patient who must go the ED for pain control, avoiding responsibilities at work and at home, potential money if litigation is involved, and potential income if a disability claim is pending. Treatment with opiates frequently contributes to the psychopathologic aspects of the disease. Chronic pain and disability lead to distress and increased stress in the life of the patient. The potentiated psychological stress heightens physiologic arousal, which increases pain sensations. Elevated pain sensations exacerbate the patients disability. Opiate use only temporarily relieves the pain sensations, but the side effects frequently increase the disability associated with chronic pain, therefore exacerbating the psychological stress and the syndrome. Furthermore, a new problem is created as the patient becomes preoccupied with seeking pain relief from opiates. Another essential consideration is that many types of chronic pain are poorly controlled by opiates, and yet the side effects remain. It is interesting to note that the presence of objective evidence of pain does little to influence a physicians administration of narcotics. Physicians opiate-prescribing habits are most commo nly prompted by observed pain behaviors, such as facial grimacing, audible expressions of distress, or patients avoidance of activity regardless of the physical findings. With the exception of cancer-related pain, the use of opioids in the treatment of chronic pain is controversial. Many pain specialists feel that they should not be used. There are two essential points that affect the use of opioids in the ED on which there is agreement: (1) opioids should only be used in chronic pain if they enhance function at home and at work, and (2) a single practitioner should be the sole prescriber of narcotics or should be aware of their administration by others. Finally, a previous narcotic addiction is a relative contraindication to the use of opioids in chronic pain. In contrast to the concerns listed above, narcotics are both recommended and effective treatment for cancer pain. Long-acting narcotics such as methadone or transdermal fentanyl may be more effective than the short-acting agents. . The medications listed under Primary ED Treatment are familiar to emergency physicians. While NSAIDs are most helpful in conditions where there is ongoing tissue injury, such as chronic inflammatory arthritis or cancer-related nerve or bone damage, they are also helpful in many cases of chronic pain where no evidence of tissue damage or inflammation is evident. Non-steroidal anti-inflammatory drugs have been shown to be more helpful in acute than in chronic pain. However, the need for long-standing treatment of chronic pain conditions may limit the safety of the NSAIDs. Standard dosing procedures may be followed except in the elderly: Antidepressants and, most commonly, the tricyclic antidepressant drugs, are the most frequently used drugs for the management of chronic pain. Often, effective pain control can be achieved at doses lower than typically required for relief of depression. Tricyclic antidepressants appears to enhance endogenous pain inhibitory mechanisms. When antidepressants are prescribed in the ED, a follow-up plan should be in place. Discussion with a pain specialist is often beneficial. The most common drug and dose is amitriptyline 10 to 25 mg, 2 h prior to bedtime. Anticonvulsants are used for several pain disorders, especially neuropathic pain. Anticonvulsants prevent bursts of action potentials, which may prevent the severe lancinating pain of certain neuropathic syndromes. Carbamazepine (start 100 to 200 mg/d), valproic acid (start 15 mg/kg/d divided), and clonazepam (start 0.5 mg/d) are the most frequently used. Muscle relaxants, such as cyclobenzaprine 10 mg every 8 h, have been useful for chronic pain patients. Their sedating effects may limit their success. Tramadol is an atypical centrally active analgesic. It has less respiratory depression, less tolerance, and less abuse potential than do opiates. Tramadol has been used with success in patients with fibromyalgia, migraine headaches, low back pain, and neuropathic pain. The dose of tramadol is 50 to 100 mg every 4 to 6 h by mouth. Chronic Pain in the Elderly Elderly patients frequently complain of chronic pain. Unfortunately, many of the commonly used medications for pain have higher complication rates in the elderly. In particular, the non-steroidal anti-inflammatory drugs (NSAIDs) are associated with higher rates of gastrointestinal bleeding and renal disease in the elderly. Opioids also may cause debilitating sedation and/or constipation in the elderly; however, opioids may have less debilitating side effects than NSAIDs. Doses of many agents should be reduced when treating the elderly, to avoid side effects, and it is essential that a follow-up plan be in place at the time of discharge. There is a perception that the elderly are under medicated for pain control. While this may be true, the elderly do not seem to be under medicated more than other age groups. Conclusion In the end you can notice that pain can affect any one at any age, and its management is not easy as anyone think, especially in chronic moderate to severe pain. The variety of drugs that synthesized for this purpose are too much now, but no class of these drugs can cure the different causes of pain, and scientists now a days improving the activity of these drugs. In fact the now by the end of 2009 working on new formulation that is said to cure pain caused by inflammation. Thus aspirin will only be used for its anticoagulant and antipyretic activities, but not for anti-inflammatory action, this will reduce the toxicity cases caused by the aspirin over doses if it is used as anti-inflammatory or pain relief agent. Most important is that people with pain must ask doctor to find the cause of pain, so he/she can give the right medication and cure any type of inflammation or cancer if there is any early before the exacerbating of the current case, then it will be too late to try to cure the advanced disease and death may occur in most of the cases, so be careful any small pain can be the start for any kind of disease starting from stress ending with fatal cancer.

Friday, October 25, 2019

Neo-Nazis Essay -- essays research papers

Today there are many active hate groups in the United States such as the Ku Klux Klan, Neo-Nazi, Skinheads, Christian identity, and the Black Separatists. These hate groups like the Ku Klux Klan, which is one of America’s oldest and more feared, use violence and move above the law to promote their causes. Another example is a group called Christian Identity, who promotes a religion that is mainly racist and anti-Semitic. Another group are the Black Separatist groups, they are organizations whose basically are all based on hatred. We know alot about these groups because of the Intelligence Project these are citizen’s reports, law enforcement agencies, field sources and news reports that make us aware of the racism. Many people know how these groups act and think and most of the American people agree that these hate groups are immoral and should not be allowed to exist neither in the United States nor on the rest of the world.   Ã‚  Ã‚  Ã‚  Ã‚  All the hate groups know that they can only flourish if they continue to recruit new members. Three of the most obvious similarities among hate groups members are their sex, male; their race, Caucasian; and their age, 35 years old or younger. Many people think that the reason young people are willing to join hate groups in high school and in college is that they are uncertain about their own futures. People believe that young people who join hate groups are people with the least education and the least hope for the future in...

Thursday, October 24, 2019

My First day at sixth-form

I was sixteen and I had to make that same difficult question that everyone had to ask themselves at my age, ‘what am I going to do after I got my results from my GCSEs?' The day before I got my results I decided to go to Westwood ST Thomas sixth-form in stead of college. I have been at Westwood School for three years so I thought it would be easier to go somewhere that I knew and where they knew me. GCSE results day arrived; I took that short five minute walk for the last time of being a school girl. I got the magic envelope and opened it. I needed five C's or above to do the a-levels courses as planned. I took one look at the paper and my excitement turned into disappointment. I only got four C's. After talking to a careers adviser I decided what I should do. I had chosen to under-go a one year business course that would give me enough GCSEs that I needed. I went away that day feeling very low and disheartened that all my efforts didn't payoff. I felt like a year of my life was being taken away from me. 7AM, Monday morning, my alarm was beeping in my ear, Beep, Beep, beep. I rolled over and turned it off. I unwillingly thought ‘the first day of Sixth-form of what will be of a long year'. I was dragging my feet up the steep hill. A walk which was five minutes seemed like an hour. As I approached the school hill my heart was thumping in my chest. I told myself not to be so stupid. I had been at the school for three years but this time I was a student. As I walked through the gates nothing had changed! The old falling apart bike sheds which faced the gates were still there. I could see the three main blocks, where the specialist classes were held. Yep! The same old gloomy school. I got to where my tutor room was and sat down at an empty seat. I slowly one by one studied the people who are already settled in their seats. I didn't recognise anybody. They must be from different schools. I then studied the room, a big white board in the centre of the longest wall and around the other walls are notice boards with nothing on then. Surrounding the tables in the middle of the room are very old computers lined up against the wall. The decoration was an old off-white colour with paint starting to chip off the walls. The appearance and feeling was an old and depressing. I heard a familiar voice outside the room. It was my friend Amy. She walked in to the room and took her seat next to mine. I felt much relived that someone was in the group that I already knew. My new tutor and key teacher for the year, Mr Kendal, walked in to the room and sat down behind his big desk. He introduced himself then made each of us in turn introduce ourselves to the group. I am not the person for speaking in front of a group and felt my self go very red with embarrassment when it got to my turn. He gave us our student planner and the timetable; he went over some things that we were to do that year in the course. The time drove by so quickly. I looked at the clock and it was break time already. I had the chance to meet up with old friends and talk about what we did over the summer. When break time ended we all went back to our tutor rooms. This time I didn't know whether the sun was shinning through a different window, but I was starting to feel a bit more comfortable about the situation the room felt brighter, and a little more inviting. We had the tour of the school which lasted thirty minutes, and then we were allowed to go home. The walk home seemed like the old five minutes walk down the hill. I was feeling emotionally happy and pleased with the first day. (And it wasn't the fact it only lasted half a day). When I got home I told mum all about the day. I couldn't wait till bed time as I was exited about going back again the next day. (Even though it was an whole school assembly to meet the new Head Teacher). As I went to sleep that night I was still very happy, I thought, this year was not going to be as bad after all.

Wednesday, October 23, 2019

Cloud Computing Technology Essay

INTRODUCTION Cloud computing is Internet (â€Å"cloud†) based on development and use of computer technology (â€Å"computing†).It is a style of computing in which dynamically scalable and often virtualised resources are provided as a service over the internet.Users need not have knowledge of, expertise in, or control over the technology infrastructure â€Å"in the cloud† that supports them. The concept incorporates infrastructure as a service (IaaS), platform as a service (PaaS) and software as a service (SaaS) as well as Web 2.0 and other recent (ca. 2007-2009) technology trends which have the common theme of reliance on the Internet for satisfying the computing needs of the users. Examples of SaaS vendors include Salesforce.com and Google Apps which provide common business applications online that are accessed from a web browser, while the software and data are stored on the servers. A cloud is a pool of virtualized computer resources. A cloud can: 1.Host a variety of different workloads, including batch-style back-end jobs and interactive, user- facing applications. 2.Allow workloads to be deployed and scaled-out quickly through the rapid provisioning of virtual machines or physical machines. 3.Support redundant, self-recovering,highly scalable programming models that allow workloads to recover from many unavoidable hardware/software failures. 4.Monitor resource use in real time to enable rebalancing of allocations when needed. Fig 1.1: Overview of cloud computing HISTORY The underlying concept dates back to 1960 when John McCarthy opined that â€Å"computation may someday be organized as a public utility†; indeed it shares characteristics with service bureaus which date back to the 1960s.The term cloud had already come into commercial use in the early 1990s to refer to large ATM networks.By the turn of the 21st century,the term â€Å"cloud computing† had started to appear, although most of the focus at this time was on Software as a service (SaaS). In 1999, Salesforce.com was established by Marc Benioff, Parker Harris,and his fellows.They applied many technologies of consumer web sites like Google and Yahoo! to business applications. IBM extended these concepts in 2001,as detailed in the Autonomic Computing Manifesto-which described advanced automation techniques such as self-monitoring, self-healing, self-configuring, and self-optimizing in the management of complex IT systems with heterogeneous storage, servers, applications, networks, security mechanisms, and other system elements that can be virtualized across an enterprise. Amazon.com played a key role in the development of cloud computing by modernizing their data centres after the dot-com bubble and, having found that the new cloud architecture resulted in significant internal efficiency improvements,providing access to their systems by way of Amazon Web Services in 2002 on a utility computing basis. 2007 saw increased activity,with Google,IBM and a number of universities embarking on a large scale cloud computing research project, around the time the term started gaining popularity in the mainstream press. WORKING OF CLOUD COMPUTING Fig 1.2: Working of cloud computing In cloud computing you only need to load one application.This application would allow workers to log into a Web-based service which hosts all the programs the user would need for his or her job. Remote machines owned by another company would run everything from e-mail to word processing to complex data analysis programs.It’s called cloud computing, and it could change the entire computer industry. In a cloud computing system, there’s a significant workload shift.Local computers no longer have to do all the heavy lifting when it comes to running applications.The network of computers that make up the cloud handles them instead. Hardware and software demands on the user’s side decrease.The only thing the user’s computer needs to be able to run is the cloud computing system’s interface software, which can be as simple as a Web browser, and the cloud’s network takes care of the rest. CLOUD ARCHITECTURE Cloud architecture,the systems architecture of the software systems involved in the delivery of cloud computing, comprises hardware and software designed by a cloud architect who typically works for a cloud integrator. It typically involves multiple cloud components communicating with each other over application programming interfaces, usually web services. Cloud architecture extends to the client, where web browsers and/or software applications access cloud applications. Cloud storage architecture is loosely coupled, where metadata operations are centralized enabling the data nodes to scale into the hundreds, each independently delivering data to applications or users. Fig 1.3: Cloud architecture COMPONENTS 1. APPLICATION A cloud application leverages the Cloud in software architecture,often eliminating the need to install and run the application on the customer’s own computer,thus alleviating the burden of software maintenance, ongoing operation, and support. 2. CLOUD CLIENTS A cloud client consists of computer hardware and/or computer software which relies on the cloud for application delivery, or which is specifically designed for delivery of cloud services and which, in either case, is essentially useless without it. For example:Mobile ,Thin client ,Thick client / Web browser . 3. CLOUD INFRASTRUCTURE Cloud infrastructure,such as Infrastructure as a service,is the delivery of computer infrastructure, typically a platform virtualization environment,as a service.For example:grid computing ,Management , Compute ,Platform. 4. CLOUD PLATFORMS A cloud platform,such as Paas, the delivery of a computing platform,and/or solution saas,facilitates deployment of applications without the cost and complexity of buying and managing the underlying hardware and software layers. 5. CLOUD SERVICES A cloud service includes â€Å"products, services and solutions that are delivered and consumed in real-time over the Internet†.For example Web Services (â€Å"software system[s] designed to support interoperable machine-to-machine interaction over a network†) which may be accessed by other cloud computing components, software, e.g., Software plus services, or end users directly. 6. CLOUD STORAGE Cloud storage involves the delivery of data storage as a service, including database-like services, often billed on a utility computing basis, e.g., per gigabyte per month. For example Database ,Network attached storage ,Web service . TYPES OF CLOUDS 1. PUBLIC CLOUD Public cloud or external cloud describes cloud computing in the traditional mainstream sense, whereby resources are dynamically provisioned on a fine-grained, self-service basis over the Internet, via web applications/web services, from an off-site third-party provider who shares resources and bills on a fine-grained utility computing basis. 2. HYBRID CLOUD A hybrid cloud environment consisting of multiple internal and/or external providers â€Å"will be typical for most enterprises†. 3. PRIVATE CLOUD Private cloud and internal cloud are neologisms that some vendors have recently used to describe offerings that emulate cloud computing on private networks.These (typically virtualisation automation) products claim to â€Å"deliver some benefits of cloud computing without the pitfalls†, capitalising on data security, corporate governance, and reliability concerns. They have been criticised on the basis that users â€Å"still have to buy, build, and manage them† and as such do not benefit from lower up-front capital costs and less hands-on management ,essentially â€Å"[lacking] the economic model that makes cloud computing such an intriguing concept†.While an analyst predicted in 2008 that private cloud networks would be the future of corporate IT, there is some contention as to whether they are a reality even within the same firm. ROLES PLAYED IN CLOUD COMPUTING 1. CLOUD COMPUTING PROVIDERS A cloud computing provider or cloud computing service provider owns and operates live cloud computing systems to deliver service to third parties.Usually this requires significant resources and expertise in building and managing next-generation data centers.Some organisations realise a subset of the benefits of cloud computing by becoming â€Å"internal† cloud providers and servicing themselves, although they do not benefit from the same economies of scale and still have to engineer for peak loads. The barrier to entry is also significantly higher with capital expenditure required and billing and management creates some overhead.Nonetheless, significant operational efficiency and agility advantages can be realised, even by small organisations, and server consolidation and virtualization rollouts are already well underway.Amazon.com was the first such provider,modernising its data centers which,like most computer networks, were using as little as 10% of its capacity at any one time just to leave room for occasional spikes. This allowed small, fast-moving groups to add new features faster and easier, and they went on to open it up to outsiders as Amazon Web Services in 2002 on a utility computing basis. Players in the cloud computing service provision game include the likes of Amazon, Google, Hewlett Packard, IBM, Intel, Microsoft, Salesforce, SAP and Yahoo! 2. USER A user is a consumer of cloud computing.The privacy of users in cloud computing has become of increasing concern.The rights of users are also an issue, which is being addressed via a community effort to create a bill of rights. 3. VENDOR A vendor sells products and services that facilitate the delivery, adoption and use of cloud computing.For example:Computer hardware,Storage,infrastructure,Computer software,Operating systems ,Platform virtualization. APPLICATIONS OF CLOUD COMPUTING 1.EASY ACCESS TO DATA Clients would be able to access their applications and data from anywhere at any time.They could access the cloud computing system using any computer linked to the internet. 2. REDUCTION OF COSTS It could bring hardware costs down.Cloud computing systems would reduce the need for advanced hardware on the client side.You wouldn’t need to buy the fastest computer with the most memory, because the cloud system would take care of those needs for you. Instead, you could buy an inexpensive computer terminal, enough processing power to run the middleware necessary to connect to the cloud system. 3. CONVENIENCE Corporations that rely on computers have to make sure they have the right software in place to achieve goals. Cloud computing systems give these organizations company-wide access to computer applications.Instead, the company could pay a metered fee to a cloud computing company. 4. EASY STORAGE Servers and digital storage devices take up space. Some companies rent physical space to store servers and databases because they don’t have it available on site. Cloud computing gives these companies the option of storing data on someone else’s hardware, removing the need for physical space on the front end. 5. NO TECHNICAL SUPPORT RECQUIRED Corporations might save money on IT support. Streamlined hardware would, in theory, have fewer problems than a network of heterogeneous machines and operating systems. 6. SOLUTION TO COMPLEX PROBLEMS If the cloud computing system’s back end is a grid computing system, then the client could take advantage of the entire network’s processing power. CLOUD COMPUTING SERVICES 1. AMAZON WEB SERVICES The Amazon development model involves building Zen virtual machine images that are run in the cloud by EC2. That means you build your own Linux/Unix or Windows operating system image and upload it to be run in EC2. AWS has many pre-configured images that you can start with and customize to your needs. There are web service APIs (via WSDL) for the additional support services like S3, SimpleDB, and SQS. Because you are building self-contained OS images, you are responsible for your own development and deployment tools. AWS is the most mature of the CC options. Applications that require the processing of huge amounts of data can make effective you of the AWS on-demand EC2 instances which are managed by Hadoop. 2. GOOGLE AppEngine GAE allows you to run Python/Django web applications in the cloud.Google provides a set of development tools for this purpose. i.e. You can develop your application within the GAE run-time environment on our local system and deploy it after it’s been debugged and working the way you want it. Google provides entity-based SQL-like (GQL) back-end data storage on their scalable infrastructure (BigTable) that will support very large data sets. Integration with Google Accounts allows for simplified user authentication. 3. MICROSOFT WINDOWS AZURE Azure is essentially a Windows OS running in the cloud.You are effectively uploading and running your ASP.NET (IIS7) or .NET (3.5) application. Microsoft provides tight integration of Azure development directly into Visual Studio 2008. For enterprise Microsoft developers the .NET Services and SQL Data Services (SDS) will make Azure a very attractive option. The Live Framework provides a resource model that includes access to the Microsoft Live Mesh services. CHARACTERSTICS 1.COST Pricing is based on usage-based options and minimal or no IT skills are required for implementation. 2.DEVICE AND LOCATION INDEPENDENCE It enable users to access systems using a web browser regardless of their location or what device they are using, e.g. PC, mobile 3.MULTI-TENANCY This enables sharing of resources and costs among a large pool of users. 4.RELIABILITY This is suitable for business continuity and disaster recovery. 5.SCALABILITY Dynamic (â€Å"on-demand†) provisioning of resources without users having to engineer for peak loads 6.SECURITY It improves due to centralization of data,increased security-focused resources. 7.SUSTANIBILITY This comes through improved resource utilisation, more efficient systems. ADVANTAGES OF CLOUD COMPUTING 1. Ability to scale to meet changing user demands quickly 2. Pay by use. 3. Task oriented 4. Virtually no maintainence due to dynamic infrastructure software. 5. Application and operating system independent. 6. Easy to develop your own web-based applications that run in the cloud. 7. Location of infrastructure in areas with lower costs of real estate and electricity. 8. Sharing of peak-load capacity among a large pool of users ,improving overall utilization. 9. Separation of application code from physical resources. 10. Not having to purchase assets for one time or infrequent computing tasks. 11. Ability to use external assets to handle peak loads. DRAWBACKS OF CLOUD COMPUTING 1. Often limited or no technical support available. 2. Canned solutions such may not be full-featured or too task oriented. 3. When there are technical issues,you may lose access to your data or application. 4. No control. 5. You must have an internet connection. 6. If the company hosting the application goes out of business,you may lose access to your data or application permanently. REFERENCES 1. http://en.wikipedia.org/wiki/Cloud_computing 2. http://communication.howstuffworks.com/cloud-computing1.htm 3. http://communication.howstuffworks.com/cloud-computing2.htm 4. http://en.wikipedia.org/wiki/Cloud_computing_user 5. http://communication.howstuffworks.com/cloud-computing.htm 6. http://communication.howstuffworks.com/cloud-computing.htm/printable 7. http://cloudcadet.com/what-is-cloud-computing/ 8. http://askville.amazon.com/advantages-disadvantages-Web-based-Cloud-Computing- Wave/AnswerViewer.do?requestId=16202235