Care of Confused Client | Case Study

Care of Confused Client | Case Study CARE OF A CONFUSED CLIENT Customer PROFILE Human Immunodeficiency Virus (HIV) is an infection spread through body liquids and impacts cells of the resistant framework called CD4 cells or T cells. HIV devastates these cells lessening the body’s capacity to battle disease. At the point when this happens the HIV infection is then knows as (AIDS). At the point when a customer has AIDS they can have side effects, for example, neglect, disarray and trouble focusing. This happens when the HIV infection has contaminated the cerebrum causing a condition known as AIDS Dementia Complex (ADC). At the point when a customer presents with ADC as a medicinal services supplier the key parts of reviewing these customers care plans would have a solid accentuation on wellbeing. (Places for infection control and anticipation 2014) John not his genuine name for security reasons is a customer who as of late introduced to the office where I work with AIDS and has been giving indications of ADC which has made his home life extremely difficult to oversee and progressively perilous. The ADC has left John with scenes of disarray. As another customer I should initially assemble Johns care designs as they are essentially significant in deciding Johns care. These consideration designs additionally help the multidisciplinary group guarantee Johns mental and physical requirements are met. As a befuddled customer, John may do not have the ability to process the essential exercises of day by day living (ADL). In this manner as a medicinal services supplier I would likewise need to go about as a backer to guarantee his needs were met. This can be guaranteed on an everyday premise by picking up the regard of John and by including him and by picking up his assent on any choices concerning his consideration. This may incorporate actualizing all important consideration plans. John’s individual cleanliness is significant in advancing his positive mental self portrait. This can be accomplished by the accompanying advances: Continuously guarantee his hands are washed in the wake of toileting His face is washed every day He has normal showers or showers His teeth are brushed twice every day John might not have any desire to permit me to complete a portion of these obligations yet to facilitate the circumstance I may find a way to help in Johns care. Utilize lovely smelling cleanser, bubble shower or cleanser Play music that John likes Continuously clarify as you complete errands Be touchy to Johns state of mind Continuously check latrine to guarantee it is in working request and the washroom isn't excessively cold Enquire how John likes to have these assignments finished (ie shower or shower) Continuously let john help as much as possible Nourishment care is additionally significant on the grounds that the more beneficial John is genuinely the less befuddled he may turn into. This can be accomplished by guaranteeing John eats standard dinners. At times since John is confounded he will won't eat so it is significant the nutritionist is educated so as to give supplements which can substitute to strong nourishments. This is fundamentally significant as to coercively feed customers is exploitative so along these lines it would be increasingly helpful to energize supplement drinks. A urinary yield and defecation outline is likewise a basic piece of Johns care plan as it helps the multidisciplinary group direct John’s real capacities to keep him from getting stoppage or lack of hydration which would leave John who is befuddled progressively confounded. Some of the time John might not be able to control his own admission of solids or fluids (ie to an extreme or excessively little) so it is significant for a liquid and solids diagram to help balance his substantial needs. Falls chance appraisals ought to likewise be finished and placed practically speaking to guarantee Johns security when he is doing his essential exercises of day by day living. Continuously help John when he is going to washroom or moving starting with one zone then onto the next Guarantee washroom is away from mess when taking John to restroom for washing or toileting Expel all messiness from Johns bedside (ie guarantee all links are cleaned away and strolling outline if necessary is inside his span ) Guarantee John has appropriate footwear (ie great fitting with elastic bottoms to forestall slips) Guarantee all restroom fittings are steady and in great working request Appropriate handrails are set up to help Johns needs Strolling to and from restroom is without messiness Different concerns I may have for John is the danger of him building up a weight sore. Confounded/Immobile customers like John are progressively powerless to pressure wounds through poor sustenance admission and diminished versatility. Measures set up by the multidisciplinary group to forestall these wounds are pressure diminishing pads, sleeping cushions and standard checking, and turning of John as to help his flow. The Waterlow scale additionally assumes significant job in figuring out who is in danger of building up a weight sore. Every one of these measures set up will upgrade the physical prosperity of John anyway as human services bolster laborers we should give comprehensive consideration to John including his social and mental prosperity. One part of all encompassing consideration is guaranteeing John’s profound requirements are met. This may fluctuate from individual to individual and as a carer we should never be inclination towards a client’s individual conviction. John’s nobility is indispensably significant however this may need since he now and then gets befuddled subsequently I should go about as a promoter and guarantee his privileges and pride are met. Straightforward measures can incorporate creation sure protection is given when going to individual cleanliness needs. On occasion John may come up short on the capacity to have the option to stand securely. In this way a crane may must be utilized. This could be a terrifying encounter for John so as the carer it is indispensable to utilize great conveying abilities to console him of his wellbeing and pride by safeguarding the window ornament is drawn at these occasions. Customary checks of John to guarantee he remains appropriately dressed in order to forestall shame for him or his friends and family during visiting times. As John’s carer I would consistently clarify and include him in dynamic including his attire when dressing or the kind of food he wants to eat as not to as sume I could pick since he here and there gets befuddled. At the point when a customer has ADC the standard treatment is a medication mixed drink called profoundly dynamic antiretroviral treatment (HAART) which decreases the measure of HIV in the blood diminishing the harm to the mind. As a carer it is significant I screen the utilization of this drug as John would neglect to take it or take excessively. Other significant factors in rewarding an individual with ADC are to assist John with animating his psyche by rousing him with leisure activities that he is keen on. It is additionally imperative to guarantee the family remember John for get-togethers, for example, birthday events, weddings or any occasion for which he could go to interface. Communication, inspiration and different treatments that are for the most part useful in reorienting a befuddled client.(WebMD2014) On end by including John in dynamic and executing the significant consideration plans I the carer will guarantee comprehensive safe mind and enhance his capacity to recuperate or deal with his ailment. This is accomplished through acceptable correspondence trough the multidisciplinary group continually recalling that John and Johns family are the most significant factor of the group. List of sources Site pages Places for sickness control and counteraction (2014) what is hiv [online],available:http://www.cdc.gov/hiv/rudiments/whatishiv.html[12/12/2014]. Webmd(2014)hiv and dementia [online],available:http://www.webmd.com/hiv-helps/control/hiv-dementia[9/12/2014]. COARSE MATERIAL Innovative preparing (2013)†healthcare associate traineeship†,5n2770:care abilities, Dublin:solas. [Type text][Type text] Does Population Growth Pose Threats To Humanity? Does Population Growth Pose Threats To Humanity? Over the previous decades, populace development has developed essentially and the earths assets are not renewing quick enough to stay aware of the development rate. Increment in populace had squeezed the earths assets as they are being utilized more. Over the top populace has prompted clog, poor day to day environments, contamination, and general ecological corruption. Research Purpose The primary motivation behind this paper is to decide how populace development is influenced the manner in which we live, our condition and thus, the supportability of keeps an eye on exercises. for example will the impacts of these exercises affect the limit of the earth to support mankind? Technique for request The technique for request for this paper will be writing survey. Different written works by various writers will be utilized to decide if populace development poses a danger to mankind. Impediments of the investigation The examination was constrained with the impacts of populace development on humankind. Working definitions Mankind Refers to the human species Populace Number of species occupying a territory at a particular time Over populace Overpopulation alludes to the state where an animal categories possessing a territory put focus on the biological systems as the environments can not, at this point have the option to continue the populace Populace development Refers to the expansion in the number of inhabitants in a specific territory after some time. Ecological corruption Refers to the disintegration of the condition of nature because of keeps an eye on exercises. Extent of Inquiry This paper will cover works of different writers who have composed on populace development, over populace and the impacts of populace development on nature. Writing Review Impacts of populace development on nature Thomas Malthus contended that methods for resource influenced the expansion or diminishing of a populace. Malthus previously carried the populace issue to consideration; he raised the issue of food supplies and arithmetical proportions. As indicated by Malthus, while populace expanded geometrically, food assets would just increment mathematically. After some time, this hypothesis has demonstrated to be valid as in populace will in general increment if individuals have the methods for resource to keep up the populace. for example as people groups methods for means increment, they altogether increment in po

The Failure of Reconstruction Essay Example For Students

The Failure of Reconstruction Essay Remaking was a disappointment because of the sentiment on race. Prejudice had a major impact in the 1896 Plessey versus Furguson case. Reproduction started in 1865 and finished in 1877. Two objectives were to reconstruct the south and to change society. Recreation ought not be thought of as a poorly conceived notion. It was essentially difficult to simply change routes in the south with out utilizing a power. Dark codes sat idle however for the south yet put them in further isolation. The dark codes so anyone might hear a type of masked servitude. They gave blacks the option to claim land, and go to court; they still werent so anyone might hear to serve on a jury or out loud to cast a ballot. Over the long haul, dark codes simply made it simpler for the individuals of the south to proceed with their poor treatment towards blacks. We will compose a custom paper on The Failure of Reconstruction explicitly for you for just $16.38 $13.9/page Request now A positive advance came for recreation in 1868. That was the fourteenth amendment, that expressed that All people conceived or naturalized in the United States and of the express that they dwell (Thomas, 14) The revision likewise announced that no state could make or implement any law that limit the benefits of the residents of the United States. This revision is obviously government control over state power. This demonstration was passed by congress to ensure that legality of the social liberties acts (that made African Americans full resident and ensured cirten right of citizenship, that totally went operators anything that had to do with dark codes. With these new laws set up, Tourgee contended that the Louisiana law Separate however equivalent facilities for the white and shaded races on all traveler prepares inside that state, removed Plessey fourteenth amendment rights. The entry of the 1866 Civil Rights Acts and the fourteenth amendment denoted the advance toward racial recrea tion, which was dubious. (Thomas, 7) Right subsequent to following this constructive advance during reproduction, came another racial demonstration that denied the relationships among whites and individuals of different races. The trade off of 1877 shut down reproduction. Republican, Rutherford Hayes was chosen over Samuel Tiden, who was a democrat. The two gatherings made a dele with one another. The arrangement that they conceded to was to get the government troops out of the south. This left nothing to implement the fourteenth amendment. With the fourteenth amendment not being authorized, in principle, the south could return to treating slaves awful and proceed with bondage. Prejudice was so awful in the south, and in certain pieces of the north, that blacks started to feel like America was intended to be a white nation. DeBois alluded to this as a twofold cognizance (Thomas, 141) Blacks we being thought of by whites as fierce savages. Whites ridiculed every little thing about them from their looks right down to their characters. White force bunches like the KKK made it difficult for dark to fit in or go about there day by day lives, without being pestered. These are only a portion of the models how prejudice was unjustifiable and inconsistent to blacks. Toward the finish of remaking, prejudice proceeded as though it never applied. My inquiry is by what method would reconstruction be able to work when you have individuals like John Tyler Morgan that said subjugation was a custom and it was primitive not to take part in it.? (Thomas, 64) It is clear that he needed to keep the shading line and needed no part in helping the current issue. He believed that the answer for the issue was to send all the blacks back to Africa. (Thomas, 73) .u6e3c92956d5df4d4a2e564e74013c218 , .u6e3c92956d5df4d4a2e564e74013c218 .postImageUrl , .u6e3c92956d5df4d4a2e564e74013c218 .focused content zone { min-tallness: 80px; position: relative; } .u6e3c92956d5df4d4a2e564e74013c218 , .u6e3c92956d5df4d4a2e564e74013c218:hover , .u6e3c92956d5df4d4a2e564e74013c218:visited , .u6e3c92956d5df4d4a2e564e74013c218:active { border:0!important; } .u6e3c92956d5df4d4a2e564e74013c218 .clearfix:after { content: ; show: table; clear: both; } .u6e3c92956d5df4d4a2e564e74013c218 { show: square; change: foundation shading 250ms; webkit-progress: foundation shading 250ms; width: 100%; obscurity: 1; progress: darkness 250ms; webkit-progress: haziness 250ms; foundation shading: #95A5A6; } .u6e3c92956d5df4d4a2e564e74013c218:active , .u6e3c92956d5df4d4a2e564e74013c218:hover { mistiness: 1; progress: murkiness 250ms; webkit-change: darkness 250ms; foundation shading: #2C3E50; } .u6e3c92956d5df4d4a2e564e74013c218 .focused content region { width: 100%; position: relativ e; } .u6e3c92956d5df4d4a2e564e74013c218 .ctaText { outskirt base: 0 strong #fff; shading: #2980B9; text dimension: 16px; textual style weight: intense; edge: 0; cushioning: 0; content design: underline; } .u6e3c92956d5df4d4a2e564e74013c218 .postTitle { shading: #FFFFFF; text dimension: 16px; textual style weight: 600; edge: 0; cushioning: 0; width: 100%; } .u6e3c92956d5df4d4a2e564e74013c218 .ctaButton { foundation shading: #7F8C8D!important; shading: #2980B9; fringe: none; outskirt range: 3px; box-shadow: none; text dimension: 14px; text style weight: striking; line-stature: 26px; moz-outskirt span: 3px; content adjust: focus; content enrichment: none; content shadow: none; width: 80px; min-tallness: 80px; foundation: url(https://artscolumbia.org/wp-content/modules/intelly-related-posts/resources/pictures/straightforward arrow.png)no-rehash; position: supreme; right: 0; top: 0; } .u6e3c92956d5df4d4a2e564e74013c218:hover .ctaButton { foundation shading: #34495E!important; } .u6e3c929 56d5df4d4a2e564e74013c218 .focused content { show: table; stature: 80px; cushioning left: 18px; top: 0; } .u6e3c92956d5df4d4a2e564e74013c218-content { show: table-cell; edge: 0; cushioning: 0; cushioning right: 108px; position: relative; vertical-adjust: center; width: 100%; } .u6e3c92956d5df4d4a2e564e74013c218:after { content: ; show: square; clear: both; } READ: Pauls Letter To The Galatians EssayAnother individual that idea whites were the second rate race was Fredric Hoffman. He took estimation examinations of the skull, chest and lung imprisonment. He principle study was the lungs. He found that whites had far higher lung imprisonment, which in principle, made them less inclined to sickness, and in his eyes, the substandard race. Henry Field said blacks have not accomplished anything, and they are stuck in unremarkableness level of society. (Thomas, 102). Field denies social uniformity in the north, and admits to the shading line. He feels this is regular. The Plessey versus Furguson case on May 18, 1896 was about the territory of Louisiana that .

Reshaping Yourself During Break

Reshaping Yourself During Break Being surrounding by class, tests, quizzes, and all school-related material can ultimately leave one’s brain fried. Leaving campus for a long break, or even in high school for the 5 day weekend my old high school use to have, was an amazing time to release stress and spend time with the family. Even if I had work to do during the break, my friends would say “technically you’re not on a break,” but I honestly do not mind it because while I am typing this, I am in the comfort of my own room with my dog by my side. Students can either do two things while on break: relax or catch up on homework while relaxing at the same time. In my opinion, it is possible to do homework during a school break. You just have to find a sweet spot to concentrate and get work done. Luckily, I was able to accomplish that with some visits to my local Starbucks back at home with the company of my old best friend. Not only am I doing homework, but also reconnecting with someone who I haven’t talked to in ages. That being said, a coffee shop or community library will do wonders in regards to doing homework off-campus. Fall break, from my experience, can also be an opportunity to fix errors that have been occurring throughout the semester. In other words, play the catch-up game. It is a good time to do that since there are no classes to attend or meetings. One can easily set out a plan during the free time that the break offers. It might sound boresome for people, but I promise you it will take a good amount of weight off your shoulders once everything is clear and ready to go. This comes in handy since finals season is around the corner for most of us. If you end up spending a school break just relaxing and not opening your bookbag at all, that’s fine too! As long as you don’t have to worry about a ton of assignments once school starts again, you will be fine. However, I am not saying that I condone being lazy. Always get stuff done ahead of time so you won’t be panicking last time but sadly everyone does that. A single week might no seem like a lot, but it can help those that need it. It can open opportunities for people who want to progress with what they want to accomplish with what is left in the semester. Since my break is practically over at this point, it reminded me that it is important to check up on yourself. School is important, but do not overdo it. You are human that needs to rest! As a prospective student, you might be thinking “Well, I don’t really have to worry about this right now!” You’re right, but time does run fast nowadays. That being said, appreciate your breaks and make the most out of it before it is time to chase the bread again. Luis Class of 2021 I was born and raised in Cicero, Illinois. Although I entered Illinois as an English major, I trusted my gut and switched to Journalism. Coming to a big institution and being a first-generation student can feel like a handful. However, knowing your resources and getting out of your comfort zone can help in the long run.

Analysis Of Comprehensive And Abstinence Results - 2222 Words

Sex Education An Analysis of Comprehensive and Abstinence Results Sex education has always been a controversial topic, especially to the extent that it is taught to. Under the early years of the Reagan administration, the Adolescent Family Life Act was passed for abstinence-only education based on the presumption that talking about sex in school would promote sexual activities among teenagers. The two-point act was quietly passed in 1981, as it was not voted on by the House and was coded under Title XX of the Public Service Health Act. The first point was to provide at least two-thirds of funds to support pregnant teenagers, while the second point’s purpose was to use the remaining one-third or less to discourage sexual acts until marriage. Lawrence (2007) asserted that teenage pregnancy rates at the time of passing were rising, so the government wanted to stop everything all together. Since then, billions of dollars have been spent and more laws have been passed to promote abstinence-only education. Pregnancies, sexually transmitted diseases (STDs), and sexually transmitted infections (STIs) in the U.S. actually continued to rise, despite what was believed that the acts and funding could accomplish (p. 2). Though scientists and accredited researchers saw this coming, they continued with research to finalize conclusions with the majority hypothesis that comprehensive sex education would show the greatest improvement among teenage pregnancy. Comprehensive sex educationShow MoreRelatedImplementation of Comprehensive Sex Education in High School Essay1281 Words   |  6 PagesThis bill is established and designed to implement comprehensive sex education classes as a mandatory curriculum in high school of every state in the United States in order for every high school student to graduate. Section Two: Congress hereby finds and declares that the sex education curriculum has been wrongly denied of pursuing a thorough course in order for high schoolers to achieve a better understanding of anything sex related. Sex education, or sex ed, is an instructional course built toRead MoreAbstinence Only Programs For Public Schools1383 Words   |  6 Pagesadvocatesforyouth.org, â€Å"abstinence only education teaches students to abstain from sex prior to marriage.† These program has been proven to be ineffective. Abstinence only education is ineffective because it is not conducive in reducing teen pregnancy rates and sexually transmitted diseases rates. Abstinence only programs are less likely to teach students about birth control and contraception and how to access it. These programs has not been shown to reduce teen sexual activity. Abstinence only programs becameRead MoreShould Sex Education Be Taught?1553 Words   |  7 Pagesparents, educators, religious groups, and society. Some people believe in abstinence only curriculum while others believe a comprehensive curriculum is more effective. Values, beliefs, and funds can affect how students are being taught. It is important that we pick a curriculum that works best for the students. Sex education can vary in what they teach to the students about sexuality such as, contraceptives, STI/HIV, and abstinence. In different schools they are being taught different skills. AccordingRead MoreTypes Of Integrative Review784 Words   |  4 PagesMethods In order to locate the correct studies for this integrative review, the student referenced Holly (2014) in order to develop a search strategy encompassing (a) defined concepts; (b) theoretical review and comparison; (c) methodological issue analysis; (d) accentuated knowledge gaps; (e) trend identifiers; and (f) current practices. The search strategy was inclusive of a grey literature as well as a literature search related to specific databases, keywords, and years. The two databases usedRead MoreSex Education And The Early 19th Century1204 Words   |  5 Pagesresponsibilities, human sexual anatomy, sexual activity, sexual reproduction, age of consent, reproductive health, reproductive rights, safe sex, birth control, and abstinence. Sex education that covers all of these aspects is known as comprehensive sex education as opposed to the abstinence only education that only promotes abstinence. Common avenues for sex education are parents or caregivers, formal school programs, and public health campaigns. Traditionally, adolescents in many cultures wereRead MoreThe Importance Of Sex Education788 Words   |  4 Pagesnumber of participants will consist of three groups, all from the 2016-2017 school year. The first group did not participate in neither sex education program offered by the school, the second group participated in abstinence-only sex education, and the third group participated in a comprehensive sex education program. 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When tracking the history of sexual education in Texas, it is evident that there is an overwhelming amount of programs that encourage abstinence as the only method of contraception. Although Texas does not require sexual education to be taught, it does have limitations as to what can be taught. Legally, sexual education programs have to stress abstinence as the primary method of contraception. When taught, it is not legally required that medically accurate information about contraception beRead MoreThis Study Is Designed To Focus On The Effectiveness Of1305 Words   |  6 Pagesof which 11% have had four or more partners (Centers for Disease Control and Prevention, 2015). Currently the state of Texas does not mandate sex education as part of a school program, however when available, it must be age appropriate and stress abstinence only. The state law requirement is that when taught, the Texas Health and Safety Code  § 85.004 department shall develop model education programs to be available to educate the public about AIDS and HIV infection. The programs must be scientificallyRead MoreEssay on Abstinence-Only Sex Education does work.1332 Words   |  6 PagesAbstinence-only Sex Education does work. Teenage sexual activity has sparked an outcry within the nation. With such activity comes a high price. Studies have shown that there has been a significant rise in the number of children with sexually transmitted diseases (STDs), emotional and psychological problems, and out-of-wedlock childbearing. Sex has always been discussed publically by the media, television shows, music and occasionally by parents and teachers in educational context. Teens hear them

Should Poor Or Homeless Individuals Be Required Pay For...

Studies from various cities in the United States have revealed that there is an overall inadequacy of healthcare for low income, homeless, and uninsured individuals (Hwang et al., 2010). For many years the government has recognized the lack of care and have been struggling to enact a healthcare reform. Finally, in March 2010 the Affordable Care act was written into law (Hammer et al., 2010). There have been many debates on the pros and cons and how effective this act will be at achieving the goal. These debates raise the question, should poor or homeless individuals be required to pay for healthcare insurance? Experiencing poverty or homelessness presents unique barriers to all aspects of life, one being healthcare. Many of these individuals have heightened exposure to communicable diseases and parasites on a daily basis (Zlotnick et al., 2013). Healthcare needs within the population range from diseases such as hypertension, diabetes, cardiovascular disease, obstructive lung disease, HIV, cancer, liver or kidney disease, and chronic pain (Baggett et al., 2010). Another common occurrence within the population is substance abuse, mental illness, vision impairments, dental concerns and an increased mortality rate (Hwang et al., 2010). There are various reasons for why homeless or poor individuals have unmet health needs. It is likely that one may be unemployed or have a low income employer who does not offer health insurance benefits. Many individuals who have experiencedShow MoreRelatedThe Affordable Care Act Of The United States1616 Words   |  7 Pagesincome, homeless, and uninsured individuals (Hwang et al., 2010). The government has recognized the lack of healthcare for these individuals. For many years, politicians have been struggling to enact a healthcare reform. 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TOLAC vs. elective repeat cesarean delivery Free Essays

Any scar tissue is weaker than original tissue, but can usually carry the function of the organ. With past hysterectomy the uterus is weakened by the surgical cut; increasing the risk uterine rupture during labor (when the uterine muscles work hard to push the fetus though the birth canal). The consequences of such event can be catastrophic for both the mother and the baby; prompting obstetricians to recommending elective cesarean section to their patients. We will write a custom essay sample on TOLAC vs. elective repeat cesarean delivery or any similar topic only for you Order Now Cesarean section, even when scheduled ahead of time, is still a major abdominal surgery; putting patients at risk of complications such as lacerations of the intestines and bladder, infection, hemorrhage, development of DO and pulmonary embolism. Post surgical adhesions can result in bowel obstructions, infertility, organ displacements and pain. Through years of research, it has been proven that babies delivered via C-section are at increased risk for respiratory complications and NICE stays (Kamala, 2009). Mothers considering elective repeat cesarean should be aware that multiple scars on the uterus can complicate future pregnancies resulting in conditions such as placenta Prevail and placenta accurate. Multiple hysterectomies (cut though the uterus) increase the risk of necessary hysterectomy (removal of the organ) during or even after the surgery. Because the risks increase with each consequent cesarean, mothers delivering via this method should be educated about possible limit on the number of future pregnancies (London, 2011; AGOG, 2010) Despite the dangers associated with repeat cesarean, supporters of this method argue that the risks associated with elective surgical delivery are lower than those associated with emergency c-section following uterine rupture . Because of the restrictions on the TOTAL candidates as well as limited interventions augmenting delivery during TOTAL, for many mothers repeat cesarean is the only safe option of delivering her baby. TOTAL / ABACA In the late ass’s of last century an increasing number of cesarean deliveries prompt the National Institute of Health and American College of Obstetrics and Genealogy to encourage B providers to allow woman with prior Cesarean an option for vaginal earth. TOTAL has since become a popular choice; increasing in numbers up to mid ass’s; reaching 28% in 1996 ( AGOG, 2010). ) To some mothers natural delivery is a very important aspect of welcoming a baby to the world. Among the advantages of successful ABACA, shortened hospitals stay and greatly decreased recovery times often are important considerations for mothers who already have one or more children in the house. Natural offset of labor often is associated with developmental readiness of the fetus and results with lower NICE stays. Passing through the birth canal pushes he fluid out of the baby’s lungs easing the first breaths and decreasing respiratory distress. Natural labor stimulates production of colostrums and speeds up secretion of milk, allowing newborns a better nutritional start (London, et. All, 2011). Careful selection of candidates for TOTAL decrease the dangers associated with this option, but serious risks for both mother and baby remain. As Mentioned earlier uterine rupture is among the worse case scenarios, granting the need for emergency cesarean section. Health research established that the risk of uterine tear or rupture upends on the kind of incision(s) previously performed on the uterus. The classic hysterectomy is associated with the greatest risks of rupture during labor. This kind of incision was popular in the past and consisted of high vertical cut though the fibers of the upper part of the uterus. Low vertical hysterectomy is similar to classic incision, but take place in the lower non portion of the uterus, resulting in fewer risk of rupture during future labor, however because the incision cuts through the number of fibers in the uterus (vertical cut through the horizontally align smooth muscles of uterus) the risk is still greater than the low transverse incision. The latest one, being the safest and most commonly performed nowadays (certain situations however prompt the B provider to use vertical or other incisions of the uterus, those may include: emergency, multiple gestations, unfavorable position of the fetus). Because the superficial cut though the skin may not match the direction of the hysterectomy, adequate review of the patient documentation form the previous deliveries is necessary to assure patient’s safety during trial of labor. Vertical incisions almost always grant the patient the need for the repeat cesarean ( London, et all, 2011). Because of the real risk of uterine rupture, mothers attempting TOTAL should be closely monitored during labor; external monitors should be attached to continuously observe frequency of contractions and fetal heart rate. Rapid change in the fetal heart rate, combined with the loss of contraction on the monitor may be associated with the tear in the uterus. Certain medications and procedures may increase woman’s risk of uterine rupture: inducing labor with Piton or certain prostaglandin s among such actions therefore limiting Total’s to spontaneous offset of labor. Delivering the baby past its due date is associated with larger babies; increasing the strain on the weakened uterus. (Guise, et. Al, 2010) In addition to the presence of the favorable horizontal uterine incision, mothers should meet other recommended criteria to have the greatest chance of successful TOTAL: pelvis appropriate for delivery, body weight less than 200 lbs and favorable fetal position at the time of delivery along with lack of overall health conditions (diabetes, hypertension Just to name a few)(AGOG, 2010). It is thought that previous vaginal delivery (whether before the C-section or ABACA) greatly increases the chances for successful vaginal delivery, while lack of such experience may sway the providers away from TOTAL. A provider’s personal experience with TOTAL may also play a role when choices regarding delivery are discussed. CONCLUSION Despite the benefits of ABACA and the reduced medicals risks that have come with advancement in the field, ABACA deliveries are on the decline from their high. â€Å"[sic] however, medico-legal issues and concerns about the risk of uterine rupture have undistributed to a reversal in this trend† (Angstrom, 2011) and in 2006 only 8. 5% of woman successfully gave vaginal birth after previous c-section experience (AGOG, 2010). Nowadays less than 10% of mothers chooses TOTAL over elective cesarean, between 60 and 80% of them will successfully deliver their baby vaginally (ABACA). Despite great chances for successful outcomes of TOTAL many facilities and providers don’t offer their patients an option for TOTAL, pressing the expecting mothers for elective surgery. This may have been the result of earlier strict recommendations released by the AGOG in the ass’s which requiring facilities offering TOTAL to have ability of performing emergency cesarean sections on woman with failed TOTAL dames, 2010). Despite recent loosening of those strict requirements in August of 2010 many hospitals still offer repeat cesarean as the only option available. Attempting TOTAL in facilities that are not equipped for emergent situations seems very risky, as labor may quickly change its direction and put the mother and her baby at risk (situation that may arise during any labor). Additionally, attempting TOTAL at facilities that start offering it due to a change in recent recommendations seems also to favorable for the mother; as those facilities lack personnel trained and accustomed to the care of laboring woman with a history of cesarean. How to cite TOLAC vs. elective repeat cesarean delivery, Papers

Picture This A Warm, Sunny, November Day In Dallas, Texas. Everyone I

Picture this: a warm, sunny, November day in Dallas, Texas. Everyone in the town is excited because the president was making a stop there and a parade was to be held. The streets were packed as the limousine, carrying President Kennedy, his wife, Jackie, the governor, and his wife, passed by slowly. While the president waved to the crowd, everything seemed to be well and good. Now picture the same scene, a few minutes later: the crowd is in hysteria, no one knows what is going on, but the president has been shot. Nobody knew who did it, or why anyone would, since Kennedy was so well liked among the American public. To this day, the mystery of JFK's death is still unsolved, but the theories are still out there. I believe that Kennedy was shot from behind, and that the government played a part in the assassination. This theory can be supported in many ways. First of all, by looking at photographs and videos of the shooting, it is easily seen that after Kennedy was shot, his head was thrown in a backwards direction. The law of physics which states that every action is matched with an equal and opposite reaction proves that, for this to happen he had to of been shot from the rear. Also, after examining the two wounds in the back of JFK's head and neck, it was proven, through the autopsy, that they were entrance wounds, meaning that he had to have been shot from behind. While this is a common theory among the American public, the thought that the government was involved, is a not such common theory. There are many reasons why I happen to believe that the government played a part in Kennedy's assassination. For one, why would Kennedy be in an open convertible that was going at a very slow speed? Should he not have been in a concealed limousine, shielded by bullet-proof glass? Also, when the autopsy was performed, I would think to have the best, most experienced doctors assigned to examine Kennedy's body, instead, a newer, inexperienced doctor was given the case. Lastly, I do not understand why it has been so long, and the murderer still has not been found. The United States is supposed to be the most advanced country, economically and technologically, in the world, and we can not find out who killed one of our most beloved presidents? This just does not seem right. Overall, JFK was a very well liked man among the American public. Around the time of his murder, no one could understand why somebody would kill him. People, today, still do not understand why, and the mystery is still yet to be solved. Many theories out there, one of which has to be true. I believe that the government played a part in his assassination, however, the public may never know.

Top 10 Confused English Words [U-Z]

Top 10 Confused English Words [U-Z] Top 10 Confused English Words [U-Z] Top 10 Confused English Words [U-Z] By Maeve Maddox Having come to the end of the alphabet with my series of â€Å"words often confused with one another,† I find myself hard-pressed to come up with a final set of ten for the remaining letters, U-Z. I can’t think of any for U or Z, but here are some for V, W, and Y. 1. vane / vain / vein All three sound alike and speakers know what they mean when they say them. The confusion arises with the spellings. INCORRECT: A cupola sat astride the angled wedge of the rooftop, sporting a beautiful gold colored  weather vain. CORRECT: A cupola sat astride the angled wedge of the rooftop, sporting a beautiful gold colored  weather vane. INCORRECT: If we cut one of our vains what chance do we have to live? CORRECT: If we cut one of our veins what chance do we have to live? vane noun: a blade that rotates vain adjective: 1. hopeless: â€Å"She continues to harbor a vain desire to write a novel that will make her rich.† 2. having an excessively high opinion of ones own appearance, attainments, qualities, or possessions: â€Å"He is especially vain about his hair.† vein noun: the tubular vessels in which the blood is conveyed through the animal body. 2. venal / venial Neither word is common in ordinary speech. Catholics are familiar with the adjective venial in reference to a lesser kind of sin than a mortal sin. In a secular context, â€Å"a venial fault† is one that does not deserve severe censure. Venial (three syllables) is usually applied to a thing. The adjective venal (two syllables) applies to people as well as to things.    â€Å"As a politician in a venal age, he preserved his independence and purity.† â€Å"The venal man raised the price from  $13.50  a pill to  $750 overnight.† venial adjective: easily forgiven. venal adjective: corruptible; likely to accept bribes. 3. vicious / viscous Although pronounced differently, viscous [VIS-kus] is often misspelled as the more familiar word vicious [VIH-shus], with comical effect. INCORRECT: Polymer solutions are very vicious so need lots of solvent. CORRECT: Polymer solutions are very viscous so need lots of solvent. vicious adjective: cruel and mean. viscous adjective: thick and sticky. 4. wave / waive Both words are pronounced the same. wave verb: move back and forth. â€Å"The sign waved in the wind. waive verb: give up; not require. â€Å"Do you waive your right to an attorney?† The usual error is to leave the i out of waive. INCORRECT: Can a 21-year-old who waved his rights to appeal without knowing the law get another trial? CORRECT: Can a 21-year-old who waived his rights to appeal without knowing the law get another trial? 5. weather / whether Both words are pronounced the same by speakers who don’t distinguish between the sounds of w and wh. weather noun: condition of the atmosphere at a given place and time. â€Å"The weather outside is frightful.† Whether is a function word used as different parts of speech. One use is as a conjunction to introduce an alternative expressing doubt or choice. The usual spelling error is to spell whether as weather. INCORRECT: I am a grown-up and can make decisions  weather to marry  or  not. CORRECT: I am a grown-up and can make decisions  whether to marry  or  not. 6. wet / whet The h in whet is often omitted, perhaps because so many speakers pronounce wh as w. wet adjective: full of moisture. â€Å"The wet dog shook vigorously.† wet verb: to make wet. â€Å"The oboe player wets his reed before playing.† whet verb: to sharpen. â€Å"Here, whet your sword on this grindstone.† whet verb: to stimulate. â€Å"The scent of baking bread always whets my appetite.† INCORRECT: One day in Quebec  will wet your appetite for  a longer visit.   CORRECT: One day in Quebec  will whet your appetite for  a longer visit.   7. wreck / wreak Although pronounced differently, the words are frequently mixed up in writing. wreck /REK/ verb: to damage severely; to destroy. wreak /REEK/ verb: to cause damage. Wreak is an old word, used chiefly in the phrase â€Å"to wreak havoc.† â€Å"Patricia is no longer a hurricane, but it’s about to wreak havoc in Texas.† INCORRECT: A  tornado wrecked havoc  in the city in 1896 killing several hundred people. CORRECT: A  tornado wreaked havoc  in the city in 1896 killing several hundred people. 8. wreath / wreathe The error with these words is failure to recognize wreathe as a verb in which the th is voiced. wreath noun: [The th is unvoiced, its sound in thin.] a ring-shaped arrangement of leaves or flowers. â€Å"She hung a Christmas wreath on the door.† wreathe verb: [The th is voiced, its sound in then.] to surround or encircle. â€Å"Inside, she wreathed the mirrors with holly branches.† INCORRECT: Martha Stewart makes small arborvitae wreathes to accent the front door of her home. CORRECT: Martha Stewart makes small arborvitae wreaths to accent the front door of her home. The plural of the noun wreath is wreaths. The third person singular of the verb wreathe is wreathes. 9. yoke / yolk Both words are pronounced the same. Yoke is usually spelled correctly in the context of a contrivance used to hook two animals together, as in â€Å"a yoke of oxen.† It’s when yoke is used in the context of sewing that it is sometimes misspelled as yolk. And on cooking sites, sometimes yolk is misspelled as yoke. yoke noun: (sewing) part of a garment, made to fit the shoulders. yolk noun: The yellow internal part of an egg. INCORRECT: The Creek Line House: How to Separate Egg Whites from the Yokes CORRECT: The Creek Line House: How to Separate Egg Whites from the Yolks INCORRECT: How To Sew A Shirt Yolk CORRECT: How To Sew A Shirt Yoke 10. your / you’re The query â€Å"difference between your and you’re† brings up 323,000,000 Google hits when typed in the search box. Clearly, a great many English speakers remain uncertain as to the difference. Your is a possessive adjective. â€Å"Is that your dog?† Your is always followed by a noun. You’re is a contraction of the words â€Å"you are.† The apostrophe in you’re indicates that something is missing. The ’re stands for the verb are. The a of are is what is missing. You’re may be followed by a noun, an adjective, or the present participle of a verb. â€Å"You’re [you are] the best friend I ever had.† (noun) â€Å"You’re [you are] wrong about this matter.† (adjective) â€Å"You’re [you are] making a big mistake.† (present participle) People who have difficulty with these words can avoid problems by spelling out â€Å"you are.† If the result sounds stuffy in an informal context, the writer can replace â€Å"you are† with you’re in revision. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Misused Words category, check our popular posts, or choose a related post below:Using "a" and "an" Before WordsBest Websites to Learn EnglishUsing "zeitgeist" Coherently

Battle of Hobkirks Hill in the American Revolution

Battle of Hobkirk's Hill in the American Revolution Battle of Hobkirks Hill - Conflict Date: The Battle of Hobkirks Hill was fought April 25, 1781, during the American Revolution (1775-1783). Armies Commanders Americans Major General Nathanael Greene1,551 men British Lord Rawdon900 men Battle of Hobkirks Hill - Background: Having won a costly engagement against Major General Nathanael Greenes army at the Battle of Guilford Court House in March 1781, Lieutenant General Lord Charles Cornwallis paused to rest his weary men. Though he initially wished to pursue the retreating Americans, his supply situation would not allow for further campaigning in the region. As a result, Cornwallis elected to move towards the coast with the goal of reaching Wilmington, NC. Once there, his men could be re-provisioned by sea. Learning of Cornwallis actions, Greene cautiously followed the British east until April 8. Turning south, he then pressed into South Carolina with the goal of striking at British outposts in the interior and reclaiming area for the American cause. Hampered by a lack of food, Cornwallis let the Americans go and trusted that Lord Francis Rawdon, who commanded around 8,000 men in South Carolina and Georgia, could deal with the threat. Though Rawdon did lead a large force, the bulk of it consisted of Loyalist units which were scattered across the interior in small garrisons. The largest of these forces numbered 900 men and was based at his headquarters in Camden, SC. Crossing the border, Greene detached Lieutenant Colonel Henry Light Horse Harry Lee with orders to unite with Brigaider General Francis Marion for a combined attack on Fort Watson. This combined force succeeded in carrying the post on April 23. As Lee and Marion conducted their operation, Greene sought to strike at the heart of the British outpost line by attacking Camden. Moving quickly, he hoped to catch the garrison by surprise. Arriving near Camden on April 20, Greene was disappointed to find Rawdons men on alert and the towns defenses fully manned. Battle of Hobkirks Hill - Greenes Position: Lacking sufficient men to besiege Camden, Green retreated a short distance north and occupied a strong position on Hobkirks Hill, approximately three miles south of the Camden battlefield where Major General Horatio Gates had been defeated the previous year. It was Greenes hope that he could draw Rawdon out of the Camden defenses and defeat him in open battle. As Greene made his preparations, he dispatched Colonel Edward Carrington with most of the armys artillery to intercept a British column that was reportedly moving to reinforce Rawdon. When the enemy did not arrive, Carrington received orders to return to Hobkirks Hill on April 24. The next morning, an American deserter incorrectly informed Rawdon that Greene had no artillery. Battle of Hobkirks Hill - Rawdon Attacks: Responding to this information and concerned that Marion and Lee might reinforce Greene, Rawdon began making plans to attack the American army. Seeking the element of surprise, the British troops skirted west bank of Little Pine Tree Creek swamp and moved through wooded terrain to avoid being spotted. Around 10:00 AM, British forces encountered the American picket line. Led by Captain Robert Kirkwood, the American pickets put up stiff resistance and allowed Greene time to form for battle. Deploying his men to meet the threat, Greene placed Lieutenant Colonel Richard Campbells 2nd Virginia Regiment and Lieutenant Colonel Samuel Hawes 1st Virginia Regiment on the American right while Colonel John Gunbys 1st Maryland Regiment and Lieutenant Colonel Benjamin Fords 2nd Maryland Regiment formed the left. As these forces took position, Greene held the militia in reserve and instructed Lieutenant Colonel William Washington to take his command of 80 dragoons around the British right to attack their rear. Battle of Hobkirks Hill - The American Left Collapses: Moving forward on a narrow front, Rawdon overwhelmed the pickets and forced Kirkwoods men to fall back. Seeing the nature of the British attack, Greene sought to overlap Rawdons flanks with his larger force. To accomplish this, he directed the 2nd Virginia and 2nd Maryland to wheel inward to attack the British flanks while ordering the 1st Virginia and 1st Maryland to advance. Reacting to Greenes orders, Rawdon brought up the Volunteers of Ireland from his reserve to extend his lines. As the two sides neared, Captain William Beatty, commanding the right-most company of the 1st Maryland, fell dead. His loss caused confusion in the ranks and the regiments front began to break. Rather than press on, Gunby halted the regiment with the goal of reforming the line. This decision exposed the flanks of the 2nd Maryland and 1st Virginia. To make the situation on the American left worse, Ford soon fell mortally wounded. Seeing the Maryland troops in disarray, Rawdon pressed his attack and shattered the 1st Maryland. Under pressure and without its commander, the 2nd Maryland fired a volley or two and began falling back. On the American right, Campbells men began to fall apart leaving Hawes troops as the only intact American regiment on the field. Seeing that the battle was lost, Greene directed his remaining men to retreat north and ordered Hawes to cover the withdrawal. Circling around the enemy, Washingtons dragoons approached as the fighting was ending. Joining the battle, his horsemen briefly captured around 200 of Rawdons men before assisting in evacuating the American artillery. Battle of Hobkirks Hill - Aftermath: Departing the field, Greene moved his men north to the old Camden battlefield while Rawdon elected to fall back to his garrison. A bitter defeat for Greene as he had invited battle and been confident of victory, he briefly thought about abandoning his campaign in South Carolina. In the fighting at the Battle of Hobkirks Hill Green lost 19 killed, 113 wounded, 89 captured, and 50 missing while Rawdon sustained 39 killed, 210 wounded, and 12 missing. Over the next few weeks both commanders reassessed the strategic situation. While Greene elected to persevere with his operations, Rawdon saw that many of his outposts, including Camden, were becoming untenable. As a result, he began a systematic withdrawal from the interior which resulted in British troops being concentrated at Charleston and Savannah by August. The following month, Greene fought the Battle of Eutaw Springs which proved the last major engagement of the conflict in the South.

The Cultural Clash of a Wedding between a Catholic Priest and a Female Essay

The Cultural Clash of a Wedding between a Catholic Priest and a Female Buddhist - Essay Example Culture plays an important role in every society especially when it comes to religion and gender roles. This aspect has had a major impact on how various people from cultural backgrounds and different gender go about their duties within the society. Ingram states that some cultures and religious doctrines are to a certain degree non-conforming therefore, a major cultural clash can occur in the event of the interaction of the two religious setups that may profess extreme doctrines (6). This is especially so when it involves the incorporation of gender as each religious doctrine associate men and women with specific gender roles. The main aim of this essay is to discuss two distinct cultures and identify the cultural clash that may arise when a wedding between a female Buddhist and Catholic father take place. Religious and cultural doctrines under the Roman Catholic Church Believed to be the earliest Christian Church, the Catholic Church like any other Christian Church, believes in cre ation and life after death. The church practices a number of doctrines that place women at a certain level within the society. Worshipping I the dioceses and parishes, the Catholic hopefuls, men and women included, partake of the mass and to a certain degree, confine their religious teachings within the Bible. The worshippers believe in trinity and the resurrection of Jesus Christ and they confirm this by baptism and partaking of the Holy Sacrament. Most worshippers believe in religious symbols of Jesus and Mary as a way of connecting to God. When it comes to gender and sexuality issues, the Catholic Church is especially restrictive to women holding positions of power like the papacy and fatherhood. In addition, men who have devoted their lives to Christ ought not to marry (Ingram 22). Religious and cultural doctrines in Buddhism Unlike their Christian counterparts, the Buddhists believe in the Three Jewels, often referred to as the Three Refugees. The Buddha, the Four Noble Truths, and the Four Reminders, talk about human life and the essence of his existence although some of the details contained therein may significantly differ with Christian beliefs (Ingram 24). When it comes to gender roles, there is perception that women ought to be equal to men although there are certain discrepancies. The monks and nuns ordain the nuns while only the monks ordain themselves. According to the Buddhist philosophy, enlightenment of a person can elevate their social status irrespective of their gender, a perception that has infiltrated several Buddhist cultures through western modernization (Ingram 36). The clash between the Roman Catholic and the Buddhist culture Although there are some elements of resemblance between the Buddhist and Catholic belief systems, significant inconsistencies surface across the across the cultural divide of the two cultures. According to Ingram, certain similarities do exist especially pertaining to the exclusive importance accorded to life wit hout due regard to the specific gender. These include the right to life, refraining from sexual misconduct, practice of high morals, and the belief in a supernatural being, which has spiritual reign over all that inhabit the earth (26). However, there are notable differences between the two cultures that may lead to a scenario of a cultural clash, in case circumstances force the two cultures to interact (Ingram 32). The major one being that generally, Buddhists are polytheists while the Christian Catholics are monotheists. While Christians follow one Almighty God, most Buddhists have specific gods for certain incidences of life, for example the god of life, the god of marriage, and the god of the skies. Christians do believe in the good old story of creation of mankind and life after death while to the Buddhists, it is a bit twisted in that they do not regard the story of creation while at the same time ignoring what happens after life on earth as

Ethics, Gender and Family - Legalising Same-sex marriage for the Research Paper

Ethics, Gender and Family - Legalising Same-sex marriage for the benefit of children - Research Paper Example Different religions tend to have different point of views on same sex people; and the same could be said about the politicians also (Maylor and Blackmon, 2005, p. 209). Today same sex marriage is legally recognized in countries like Belgium, Argentina, Brazil, Canada, France, Denmark, etc. Another major issue that has evolved over the past few years along with same sex marriage has been the issue of partnership and adoption issues related to same sex marriage. There are people who believes that same sex marriage should be legalized mainly for the benefits of the children; however there are those who believe that same sex marriage is something which is not natural and it may not actually benefit the children. The present study has been conducted in lieu to understand the issues involved in the debate against and for same sex partnering by recognizing the attitudes, prejudice, stereotypes, myths involved in the lesbian and gay individuals in the role as parents. Hereby it is also needs to mentioned that secondary research has been used for the collection of secondary data, which has been used for the analysis to draw the final conclusions. A child is defined as an individual person below 18, except the national regulations and laws identify the age of majorities earlier. The controversy of same sex marriages is growing every day. Several options are rising with fear or courage. It is quite difficult to understand to find out the appropriate argument. Smart (1991) has argued that, psychoanalytical theories have labelled the homosexuality as the trait of deviant psychiatric. It is evident that, the attitude of human beings has changed in recent years (Staver, 2004). Still a prejudice element exists regarding the same sex parenting. It is assumed that, children may be flat with the confusion about gender. Moreover, in this case children may get confused over the sexual orientation and stigmatisation. In several countries, the identification of same sex couple is wel l established. Denmark is the first country who has introduced same sex union’s legal reorganization. By observing this, several other countries also have granted several legal rights to these kinds of same sex couples. Civil marriage rights are exist in eight jurisdictions, such as Spain, Belgium, Canada, Netherlands, California, Connecticut, Massachusetts and South Africa (Laycock, Picarello & Wilson, 2008). In these countries, there is no distinction between the heterosexual and same sex couples. In the year 2008, the parliament of Norway has adopted a marriage law considering the same sex couples (Wardle, 2003). In the year 2006, the supreme court of New Jersey has passed a law about the same sex couple. Moreover, the higher courts of New York City and Washington D.C. have defined the same sex marriage (Eskridge & Spedale, 2006). In the same year, the supreme court of New Jersey has announced that, the couples of same sex will enjoy the same social benefits similar to the couples of opposite sex. The same sex marriage was legalized in the year 2009 in the supreme court of Columbia, New Hampshire and Vermont. Moreover, the states of Washington and Maryland have legalized the same sex ma

Documentary photography

Documentary photography Intro Documentary photography is extended form — that is, a work composed of a sizeable number of images. Some relation to text is a given, even if its only minimal, as in the identification of subject, date, and location; the text may in fact be extensive. There is no external time limit implicit in this form; some documentary projects have stretched over decades. For this reason, the documentary photographer is likely to have the opportunity to refine the project, not only through the analysis of the work-in-progress at various stages but even by the reshooting of unsatisfactory segments of the work. The elaborate nature of such projects lends itself to subjects that are seen as enduring; for much the same reason, the final forms they assume tend to be durable: the book and the exhibition have to date functioned as the primary embodiments of documentary projects, though certain audio-visual formats are serving this purpose with increasing frequency. The expose, the compassion and outrage, of documentary fuelled by the dedication to reform has shaded over into combinations of exoticism, tourism, voyeurism, psychologism, and metaphysics, trophy hunting – and careerism. It is easy to understand why what has ceased to be news becomes testimonial to the bearer of the news. Documentary testifies, finally, to the bravery or (dare we name it?) the manipulativeness and savvy of the photographer, who entered a situation of physical danger, social restrictedness, human decay, or combinations of these and saved us the trouble. Or who, like the astronauts, entertained us by showing us the places we never hope to go. War photography, slum photography, â€Å"subculture† or cult photography, photography of the foreign poor, photography of â€Å"deviance.† As I see it, the intentions of a documentary photographer are to record some aspects of reality, by producing a depiction of what the photographer saw and which portends to represent that reality in as objective a manner as possible. I believe we have already discussed in all sorts of forums the fact that photography per se, is tantamount to manipulation. That the impact of the lens selected, the film chosen, and all the other technical variables leave ample room to question the so called faithful representation of reality. So let us not mull over this one endlessly, as I think it thins the debate rather enhances it. The journalist is not some copier machine that simply reproduces mindlessly what is placed on the platen in front of her. He weaves and puts together the information in order to insure that it accurately portrays the information presented in a decision making process that supports the story being presented. As I have come to understand it, it has mainly to do with past traditions and customs. It apparently flies in the face of reason, that if one would alter an image, it no longer could call itself a document. What is wrong in that analysis is that any and all alterations have been treated equal (they are all bad). We know for a fact that not all alterations have the same justifications behind them, that some alterations can even contribute to enhance the veracity of an image rather than the opposite. Furthermore, many of the fears related to the conceptual changes for photography have to do mainly with a loss of certainty of what the photograph actually is delivering, in so far as a document, with little debate about the veracity of the content of a given image. We are of course dealing here with the same sort of ethical debates around editing a story, be that with text or film, even sound tracks, something everyone has been discussing for a long time. For photography it is no different. Why should it be? Since the 1980s photojournalism has been at a crossroads. Digital technologies do impinge on the routines, rituals, traditions, and behaviors of photojournalists. Digital technologies do require a variety of skill-sets that could not have been imagined a half-century ago. The photojournalist of the future will understand the ethical responsibilities that come with electronic digital manipulation. The rise of documentary photography does not spring from fashion. Rather its rapid growth represents strong organic forces at work, strong creative impulses seeking an outlet suitable to the serious and tense spirit of our age. The proof that documentary photography is not a fad or a vogue lies in the history of other movements in photography. Against this pattern of sterility, of ideas which could not reproduce themselves, we have the new function (and evolving from it the new esthetic) of documentary photography, an application of photography direct and realistic, dedicated to the profound and sober chronicling of the external world. To Lewis Hine, who thirty-five years ago was making photographs of child labor in sweat shops and textile mills, the vague tenents of pictorialism or the even less useful purposes of the photogram or rayograph must be incomprehensible. To the hard-working photographers of the Farm Security Administration, the somewhat remote and abstruse manner of the spiritual heirs of the Photo-Secession may seem too refined. To such a photographer as Berenice Abbott, setting down the tangible visage of New York in precise detain and lineament, the sentimental fantasies of a Fassbinder must be well nigh incredible. We have all had a surfeit of pretty pictures, of romantic views of hilltop, seaside, rolling fields, skyscrapers seen askew, picturesque bits of life torn out of their sordid context. It is life that is exciting and important; and life whole and unretouched. By virtue of this new spirit of realism, photography looks now at the external world with new eyes, the eyes of scientific, uncompromising honesty. The camera eye cannot lie, is lightly said. On the contrary, the camera eye usually does nothing but lie. But the external world is those facts of decay and change, of social retrogression and injusticeas well as the wide miles of America and its vast mountain ranges. The external world, we may add, is the world of human beings; and, whether we see their faces or the works of their hands and the consequences, tragic or otherwise, of their social institutions, we look at the world with a new orientation, more concerned with what is outside than with the inner ebb and flow of consciousness. The fact is a thousand times more important than the photographer; his personality can be intruded only by the worst taste of exhibitionism; this at last is reality. Yet, also, by the imagination and intelligence he possesses and uses, the photographer controls the new esthetic, finds the significant truth and gives it significant form. Body A new generation of photographers has directed the documentary approach toward more personal end. Their aim has not been to reform life, but to know it. Their work betrays a sympathy — almost an affection — for the imperfections and frailties of society. They like the real world, in spite of its terrors, as the source of all wonder and fascination and value — no less precious for being irrational . . . . What they hold in common is the belief that the commonplace is really worth looking at, and the courage to look at it with a minimum of theorizing. Contemporary documentary practice by photographers such as Fazal Sheikh, Simon Norfolk, Luc Delahaye, Paul Graham, Martin Parr and Pedro Meyer examine the social world with a measured sense of contemplation, challenging the traditional conventions of documentary photography in revealing a vision and voice about the real world. As I see it, the intentions of a documentary photographer are to record some aspects of reality, by producing a depiction of what the photographer saw and which portends to represent that reality in as objective a manner as possible. If we can agree to that description, I can already see our critics pounding on their desks accompanied by some degree of glee on their faces, as they suggest that this is precisely the reason why there is no room for the computer to be used in recreating documentary images. That the impact of the lens selected, the film chosen, and all the other technical variables leave ample room to question the so called â€Å"faithful representation† of reality. So why are so many people up in arms about the idea that a photograph edited in the computer is not really a true documentary representation? As I have come to understand it, it has mainly to do with past traditions and customs. It has been widely commented that much of the important photojournalism of the last several years has been done by amateurs — London Underground bombing, Abu Ghraib prisoner abuse, coffins of American soldiers coming from Iraq, young woman being flogged in Afghanistan, etc. And now, of course, there are the many images from Iran by amateurs which become even more critical as professionals are banned from the country. Instead of a single iconic photograph we will often be looking at imagery made by people who, as amateurs, are not schooled in the history of photography–they will be making imagery for information, not to replicate or create new icons. As such, their imagery will probably often be both more original and more awkward, but it may also make it more difficult to find the telling metaphors. In this sense, the imagery will be more modest and probably more credible. The need for professional photo essayists with deep understandings of specific cultures, both insiders and foreigners, is more crucial than ever. Somehow they must be paid for their work, and equally important is to find places for them to publish. Like writers and editors, photojournalists are held to a standard of ethics. Each publication has a set of rules, sometimes written, sometimes unwritten, that governs what that publication considers to be a truthful and faithful representation of images to the public. These rules cover a wide range of topics such as how a photographer should act while taking pictures, what he or she can and cant photograph, and whether and how an image can be altered in the darkroom or on the computer. This ethical framework evolved over time, influenced by such things as technological capability and community values; and it is continually developing today. News images shape our culture in ways both profound and deep. These photos have woven themselves into the collective memory of a generation. There are some who would even say that the mounting weight of photographic evidence was the primary cause for public opinion to shift against the war in Vietnam, and hence effected an end to the war itself. As such, to borrow a phrase from pop culture, â€Å"With great power comes great responsibility.†1 Responsible photojournalism means adherence to a standard of ethics. Photographic and video images can reveal great truths, expose wrongdoing and neglect, inspire hope and understanding and connect people around the globe through the language of visual understanding. Photographs can also cause great harm if they are callously intrusive or are manipulated. Ethics is an inherently subjective field. In his seminal textbook, Photojournalism, the Professionals Approach, author and photojournalism professor Kenneth Kobrà © writes, â€Å"Photojournalism has no Bible, no rabbinical college, no Pope to define correct choices.†8 There is no sole arbiter of what is or isnt ethical, and even if there were, the line isnt always black and white. Most texts regarding ethics in photojournalism focus on the issue of what might be termed â€Å"photographic truth† whether a particular image accurately represents the subject or whether it misleads the viewer. The National Press Photographers Association Code of Ethics states that the â€Å"primary goal† of the photojournalist is the â€Å"faithful and comprehensive depiction of the subject at hand.† Additionally, photojournalistic ethics might encompass the choices an individual photographer makes while shooting. For example, should a war photographer put down his cameras in order to help an injured soldier? If someone asks that his or her photo not be taken, is it ethical to photograph that person anyway? If ethics in photojournalism is about being â€Å"faithful and comprehensive,† is intentionally underexposing or poorly focusing unethical? Some of these questions sit on the line between journalistic ethics and professionalism. Utilitarianism as a philosophy attempts to weigh positives and negatives of a situation, and maximize the good for the greatest number of people. For example, if gruesome photos of a car crash offend the victims families, but shock the community into driving safely, then by Utilitarianism the taking and publication of those photos is deemed to be ethical. Photographer-centric ethics have to do with photographers choices at the time news photos are captured up until the photos are handed off to an editor. Whether or not to pose a subject, the question regarding what to do with a wounded soldier in combat, and how a photographer treats an image in the darkroom (or in the computer) are all matters of photographer-centric ethics. The method used to reproduce photographs on the printing press was not perfected until the 1880s, and it was not widely adopted for several more years. The New York Times, for example, did not publish photos until 1896. Though The New York Times printed its first photographs in a Sunday Magazine in 1896, the newspaper was not without visual imagery before then. Advertisements in The Times throughout the 1880s feature drawings and etchings, and those tools were occasionally used for news purposes. Though photography was known to many people and gaining popularity as an art form at the time, newspapers lacked the technology (and therefore the ability) to include photographic images as part of their reportage. This, however, did not stop some newspapers from hiring photographers and making use of their images. Some period newspapers employed both graphic artists and news photographers. This process was used at many different newspapers from the late 1800s to the early 1900s. The hand-drawn images were popular with readers, and publishers were loathe to switch over to the newer photographic technology. That technology, the halftone process, employed a fine screen that converted an image to a series of dots. When, at last, newspapers and magazines were able to regularly feature photographic images, the photos themselves were almost as much of a story as the news itself. Newspapers throughout the early 20th century are rife with â€Å"worlds first photo of † images. Around the turn of the century, smaller and less complex photo equipment started to become available. Celluloid film, first used for photographic purposes in 1888, was rapidly replacing glass as the substrate for photographic chemicals. This, along with Kodaks famous â€Å"Box Brownie† camera allowed more people to start taking photographs of their own. Among the public, the spread of amateur photography sparked by George Eastmans Kodak and other small cameras and the invention of faster lenses, shutters, and film led to a taste for candid, often close-up images with a sense of immediacy and spontaneity: the posed group portrait was obsolete in leading media by circa 1900. In the 1930s, technology started to work in the photojournalists favor. The Leica camera, invented in 1914 and marketed in 1925, gained popularity first with photographic luminaries such Robert Capa and Henri Cartier-Bresson, and then slowly with the rest of the industry. Thwarted by military censors from reporting the â€Å"what, where, and how† of World War I, journalists engaged the â€Å"who† the human interest stories that were already a staple of early 20th century media. These were cheaper and easier to file than hard news and analysis. they were also encouraged by the new light weight cameras and faster lenses introduced in the mid-1920s. These easily handled cameras performed in low light and could be used surreptitiously. If they did not give birth to the paparazzi as well as â€Å"street photographers those nimble observers of lifes odd encounters and human comedies they helped make spontaneous, sharp-eyed photojournalism a key language of modern vision. They changed the approach of photo reporters: no longer official observers beholden to those in power, photojournalists could be the eyes of the public prying, amused, or watchdog eyes. The split in U.S. society over the war in Vietnam and the controversy about it worldwide were reflected in media coverage, which in turn helped sharpen opposition to the war from around 1968. Photojournalism itself changed. The issues were too complex for neat photographic embodiments, and the war itself had few triumphs. While posing photos and staging news events had been taboo for some time, there was little precedent to inform photographers as to how and whether to render aid to their subjects during active combat. On one hand, helping a wounded soldier might have saved his life. On the other hand, â€Å"helping out† made photographers complicit with their subjects, and removed some of the distance necessary for journalistic objectivity. As photographic technology continued to evolve into the 1980s and 1990s, so too did photojournalistic ethics. The early 1990s saw the dawn of purely digital news photography. In the 1980s, magazines and newspapers started to experiment with incorporating digitized images into their layouts. Though some photojournalists were carrying laptops to remote places, setting up makeshift darkrooms, and scanning and transmitting film photos, the digital switchover did not start in earnest until 1992. With digital technology came digital photo manipulation. While the tenets of ethical news photography still held, there were notable breaches. Throughout photographys history, an unsuspecting public has been fooled by manipulated images. What is of concern to modern media watchers is the justifications used to alter images through computer technology not the fact that such alterations can be published without detection. The difference between todays â€Å"citizen photojournalism† and the aforementioned examples is the ubiquity of the imaging devices in modern society. In 2004, consumers bought 257 million camera-equipped mobile phones. By comparison, during the same time only 68 million digital cameras were sold.69 Millions upon millions of people are walking around with cameras in their pockets, waiting to become accidental photojournalists. Unfortunately, the vast majority of people in the general public are not aware of the nuances of photojournalistic ethics. Worse yet, there are people who actively try to dupe or trick the mainstream media into using ethically questionable (or flat-out fake) images. Not only can faked photos be misleading, they can have dramatic real-world consequences. During the 2004 election, it was briefly but widely reported that Senator John Kerry and activist Jane Fonda spoke at the same anti-Vietnam war rally. The accompanying photograph depicts Fonda and Kerry s tanding together at a podium. Nowhere was the power of citizen photojournalism more clearly demonstrated than in the summer of 2005 during the London subway bombings. On July 7, 2005, three bombs exploded on London subway cars, and a fourth detonated on a bus. Fifty-two people died, and some 700 were injured.74 Within minutes of the blasts, citizens began chronicling the aftermath using both standalone cameras and cameras embedded in mobile devices. While working photojournalists and other members of the press responded as quickly as they could, their still images were not as intimate or immediate as those taken by the affected passengers. Some of those passengers who took pictures with their mobile devices later uploaded them to photo-sharing websites like flickr.com. The next day, in a journalistic first, both The New York Times and the Washington Post ran front-page camera phone images that were taken by citizens, not by photojournalists.75 In describing the emerging citizen journalism trend, Dennis Dunleavy o f The Digital Journalist writes, â€Å"The future is here, now. The future came with the Abu Ghraib prison scandal, the devastation of the tsunami in the Pacific late last year, and now without question, London. The digital camera phone is the future and we have much to learn from this emerging technology.†76 Conclusion The great challenge here is to deconstruct previous templates so that they not be relied upon to continue the generic typecasting of journalism famine, flood, bombing, crime wave, accident, power figures, etc. A conversational media will begin with the humanity of the person (the subject), not their social ranking. Rather than being looked at by the journalist, it will be generally better to think of the subject as potentially becoming involved in the conversation. Since photography itself is only about 150 years old, this was not always the case. It would be impossible, of course, for â€Å"photojournalistic ethics† to predate photojournalism itself. While the concept of â€Å"ethics† has been around since the dawn of recorded history, photography has not. As of this writing, photography is still less than two hundred years old. It is fairly obvious that no ethical system could exist for any sort of photojournalism before photography was invented. This might appear to suggest an acceptable date from which to begin studying ethics in American photojournalism why not start at the beginning of photography? Even after Nicà ©phore Nià ©pce fixed the first permanent photographic images in 1826, it took several decades (and several inventors) before mankind had the technology to marry photography with text on the printed page. Photojournalism is a large and diverse field with very little consensus regarding ethics, even within small sub-genres (community newspaper photojournalism, for example). While most working press photographers should be aware of the consequences of ethical breaches, there is no â€Å"Photojournalists Hippocratic Oath,† no common Ten Commandments of ethics in photojournalism, nor are there standard â€Å"punishments† for ethical violations. Each publication and news organization sets its own ethical standards, which may simply come down to what it will tolerate, or what will sell more papers, in terms of pushing the ethical envelope. Sometimes these rules are written down in concrete codes of ethics, and sometimes they are simply the empirical sum of what is acceptable to the staff or a particular editor at a particular publication. Images in our pages that purport to depict reality must be genuine in every way. No people or objects may be added, rearranged, reversed, distorted or removed from a scene (except for the recognized practice of cropping to omit extraneous outer portions). Adjustments of color or gray scale should be limited to those minimally necessary for clear and accurate reproduction, analogous to the burning and dodging that formerly took place in darkroom processing of images. Pictures of news situations must not be posed. In the cases of collages, montages, portraits, fashion or home design illustrations, fanciful contrived situations and demonstrations of how a device is used, our intervention should be unmistakable to the reader, and unmistakably free of intent to deceive. Captions and credits should further acknowledge our intervention if the slightest doubt is possible. The design director, a masthead editor or the news desk should be consulted on doubtful cases or proposals for exceptions . After tracing the history of ethics in photojournalism and examining the state of those ethics today, one cannot help but wonder where photojournalistic ethics are going. Since nobody can confidently predict the future, the only option is to examine current trends and extrapolate. Certain issues are on the cutting edge of the present photojournalistic ethics discussion, and those issues are likely to play significant roles in shaping tomorrows photojournalism. Of course, without a crystal ball there is no way to be sure. From the invention of flash powder that made it possible for Jacob Riis to document the hideous conditions in New York tenements, to the Adobe Photoshop software that Brian Walski used to doctor his image, technology has certainly played a part in the evolution of todays ethical system. One might even say that technology has been the predominant influence in the evolution of todays ethical system (at the very least, but for the technology of photography itself, there would be no photojournalism). Likewise, technology will almost certainly be the driving influence regarding ethics in the future. Multiple factors will drastically change the ethical landscape. These include the further assimilation of digital photography work-flows into the newsroom, the improvement of consumer photo technology, and the omnipresence of photo technology including cameras in portable devices such as cell phones and PDAs. The shift away from printed material and towards electronic media for image consumption will also leave its own mark on photojournalistic ethics. Digital photography is the predominant means of image capture for American newspaper and magazine photojournalism today. Not only has it been that way for several years, the rate at which it has taken over is astounding. This bitwise blitzkrieg of sorts has brought with it new and difficult ethical challenges. In the â€Å"old days† before digital photography, images had a definite physicality. Photographs were fixed on pieces of film acetate coated in a chemical emulsion and developed in chemical baths. A photograph was something that could be held in ones hand. While not impossible, it was far more difficult to pull off a convincing photo fake. Twenty years ago, Brian Walski could never have doctored his image in the field. What might have taken minutes on his laptop would have taken hours, or even days, in a darkroom. Though the news cycle has sped up considerably since then, even two decades ago most newspapers and magazines couldnt afford that sort of delay before publication.65 Using Adobe Photoshop, the software with which Walski effected his fake, is more convenient, more effective, and easier than altering photos in a wet darkroom. Newer cameras and more powerful editing software both impact photojournalistic ethics, however sometimes that impact can be surprising. Since so much of the substance of journalistic ethics is about the process rather than the result, technology that enables new (or old) processes will automatically impact the ethical landscape. One recent example is the release of the Nikon D2x camera. The D2x is a professional caliber SLR with a unique feature it allows the photographer to create multiple-exposure images in the camera itself.66 Before digital imaging, most SLR cameras came with a switch that allowed the photographer to cock the shutter without advancing the film. This allowed the photographer to expose the same frame of film multiple times. One frequent use for this feature was to couple it with a motor drive, and take a sequence of photos that showed motion throughout a single frame. With the advent of the digital SLR, photographers lost the ability to use this technique in-camer a. For a similar effect, photographers could take a series of images and overlay them with digital editing software. Most publications, however, insisted upon labeling these images as â€Å"photo-illustrations† because of the ex post facto manipulation. The Nikon D2x restored the photojournalists license to create multiple exposure images. In addition to professional equipment, consumer and â€Å"prosumer† camera technology is also improving, and cameras included in mobile devices are starting to become more popular. Many of these mobile devices are networked (cell phones, for example), and are capable of transmitting images in near real time. During major news events, some photo editors are inundated with images from â€Å"citizen photojournalists.†67 Citizen journalism, of course, is nothing new. This widespread citizen media production and consumption raises an important question. With more and more people carrying cameras in their pockets, will the future have a place for the â€Å"professional† photojournalist? At first the question seems compelling for two reasons access and tools. In terms of access, it is impossible for a small cadre of trained photojournalists to be everywhere and to photograph everything that is newsworthy. There were no working photojournalists aboard the London bus and trains that were bombed, but there were people with camera phones. With each successive generation of camera phone improving in resolution and quality, the gap between the professionals tools and the citizens tools is closing, just as the ubiquity of those tools is increasing. â€Å"Professionalism,† however, connotes more than being in the right place at the right time with the right camera. In the photojournalism industry, professionalism means technical skill, news gathering experience, and of course ethics. Photojournalist Nancy L. Ford writes: A photojournalists job is to go out and experience life for others, to capture an event on film, and hopefully capture the emotion that was experienced, so the readers can see and feel what it was like to be there. The photojournalist must capture the truth, too. This means the photographer must only photograph what has happened, when it happened and not recreate a situation because they didnt get there on time. They must not move things around on the scene of an event to make the pictures look better. They must not alter their photographs on the computer or in the darkroom, like take an ugly telephone pole out of a picture. The photojournalist must also tell the truth, just like the reporter.77 [The] unsupervised approach may be even more of a problem with photography, because the meaning of an image can be manipulated through use in a false context, or no context at all. In the looting that followed the fall of Saddam Husseins regime there were photographs of US soldiers with arms full of money taken off the looters they had arrested, and which they were returning to an appropriate location. The same photographs could represent responsible people attempting to restore law and order, or ruthless invaders plundering the country that was their victim, your choice, depending on who you are and where you are. With technology enabling even the most unskilled amateur to take good quality photographs such misrepresentations are likely to occur more frequently. Not only will there be a greater number of images of any given event, but once theyre on the Internet they will be readily available to anyone with an agenda. Furthermore, amateur photographers dont have the same training as professional photojournalists, nor have they acquired the same experience and instincts.78 This professionalism, experience, and instinct is what ensures the existence of the photojournalist well into the future. Reportage has occured since the dawn of printed news, yet seldom is the place of the professional print journalist questioned. This is in spite of the fact that ordinary citizens sometimes have greater or more immediate access, and that many people carry pencils and paper (the tools of the print journalists trade). In the world of written journalism, professional journalists (who are bound by their own ethics) cull quotations from non-journalists. Absent blogs, nobody asks citizens to write whole news articles about what they witness. In other words, though recently The New York Times ran a camera phone image that was taken by a â€Å"citizen photojournalist† on its front page, it is doubtful that they