Review of Related Literature - 1454 Words

REVIEW OF RELATED LITERATURE This investigatory project aims to make use of rambutan peeling extracts that is high in phenolic compounds such as tannin and saponin that exhibits antioxidant activity and antibacterial activity against pathogenic bacteria. Although the seeds contain such compounds the peeling exhibit greater amount of the said compounds. Rambutan is a very popular fruit cultivated in the Philippines and it is eaten in large amounts. The rambutans rind is quickly discarded and thrown out after it is cut open and peeled off. The researchers will be maximizing the use of rambutan peelings through this project before they are disposed of. Not only will the researchers maximize the use of the peelings, they would be finding†¦show more content†¦It is the most common bacteria that causes staph infections such as pimples, boils, impetigo, cellulitis folliculitis, carbuncles, scalded skin syndrome and abscesses. Examples of the more serious sicknesses are pneumonia,me ningitis, osteomyelitis, endocarditis, toxic shock syndrome (TSS), bacteremia and septicemia. Like the other listed pathogenic bacteria, Staphylococcus epidermidis is also nosocomial and facultatively anaerobic. It affects the skin and is non hemolytic, hemolytic meaning relating to the rupture or destruction of red blood cells. It infects on people with weak immune systems. The infections often start out as skin wounds caused by flexible tubes called catheters. According to Bukhari, â€Å"Catheter infections along with catheter-induced UTIs lead to serious inflammation and pus secretion. In these instances, urination is extremely painful.† Other diseases of Staphylococcus epidermidis are septicaemia and endocarditis. The study of Qarah, Cunha and Dua in 2009 stated that pseudomonal pathogens evidently inhabit nature like soil, water and surfaces of plants and animals, including us humans. Pseudomonas aeruginosa is widely infectious especially to those with problems involving their host defense mechanisms. It frequently causes nosocomial infections such as pneumonia, urinary tract infections (UTIs), and bacteremia. This pathogenic bacteria’s infectionsShow MoreRelatedReview of Related Literature1643 Words   |  7 PagesReview of Related Literature The review of related literatures of this study is made here in the Philippines and in abroad. It is acquired from the internet and unpublished theses. It is nearly related on the relationship of computer game addiction to interpersonal relationship to adolescents especially, K-12 students. To enrich the background on the subject of the researcher, the literatures that were found are here in presented. A. Foreign Studies Based from the study of Mark Griffiths (2007)Read MoreReview of Related Literature668 Words   |  3 PagesReview of Related Literature This section deals with the literature and reading related to the variable of the study. This section also aims to show previous studies of money management which served as the fundamental assumption for the methodology used in the study. Sources of information were taken from the internet, books, journals, magazines, and newspapers. The money management and financial capabilities of CBAE students in the University of Mindanao reading helps the researchers in seeing theRead MoreReview of Related Literature3694 Words   |  15 Pageshuman diseases like malaria, filariasis, Japanese encephalitis, dengue haemorrhagic fever and yellow fever causing millions of deaths every year [1]. Extensive use of chemical insecticides for control of vector borne diseases has created problems related to physiological resistance to vectors, adverse environmental effects, high operational cost and community acceptance [2]. Numerous plant products have been reported either as insecticides for killing lar vae or adult mosquitoes or as repellents forRead MoreReview of Related Literature and Studies1403 Words   |  6 PagesCHAPTER 2 REVIEW OF RELATED LITERATURE AND STUDIES Studies rely on information researched by the proponents. Review of Related Literature In exploration, we find new techniques, new knowledge, even develop new substances, gadgets, equipment, processes or procedures, imagination and skill is employed by the researcher. The commodities, new devices, services, in technology are needs of man for a better fuller life which is the concern of the research. These useful arts are the products of the technologicalRead MoreReview Of Related Literature And Studies1438 Words   |  6 PagesChapter 2 Review of Related Literature and Studies This part of the study contains related literature and studies after the thorough and in-depth research of the researcher. Related Literatures come from both Foreign and Local published literatures that became the basis for the researcher to pursue this study. Related Studies come from both Foreign and Local Studies that has relationship or in relation on her study. Foreign Literature Culture-shaping is a methodological and comprehensive approachRead MoreReview Of Related Literature And Studies Essay1585 Words   |  7 PagesCHAPTER 2 Review of Related Literature and Studies This part of the study contains related literature and studies after the thorough and in-depth research of the researcher. Related literatures come from both foreign and local published literatures that became the basis for the researcher to pursue this study. Related studies come from both foreign and local studies that has relationship or in relation on her study. Foreign Literature Culture-shaping is a methodological and comprehensive approachRead MoreReview of Related Literature and Studies1069 Words   |  5 PagesCHAPTER II REVIEW OF RELATED LITERATURE AND STUDIES LOCAL LITERATURE Josefina Estolas in the book Fundamentals of Research (1995). In exploration, we find new techniques, new knowledge, even develop new substances, gadgets, equipment, processes or procedures, imagination and skill is employed by the researcher. The commodities, new devices, services, in technology are needs of man for a better fuller life which is the concern of the research. These useful arts are the products of the technologicalRead MoreReview of Related Foreign Literature1844 Words   |  8 PagesREVIEW OF RELATED LITERATURE AND STUDIES This chapter presents the review of related literature and studies. It contains a review of books and studies on the subject matter conducted here and abroad and their relation to the present research. The researcher looked for a number of foreign and local studies and some related literatures that have either direct or indirect bearing to the study. Foreign Literature Student Retention Policy Department of Special Education, Counseling, and Student AffairsRead MoreReview of Related Literature and Studies3079 Words   |  13 PagesREVIEW OF RELATED LITERATURE AND STUDIES Several studies have been conducted here and abroad which have a direct and indirect bearing on the subject to be investigated in this study. A brief review of the related literature and studies are presented hereunder. Literature In the present educational system, studies based on the achievement levels of elementary and secondary students revealed that the equality of education has deteriorated over the years. In a recent UNESCO statistics Barsaga (2000)Read MoreReview Of Related Literature And Studies1921 Words   |  8 PagesCHAPTER II REVIEW OF RELATED LITERATURE AND STUDIES Various publications and studies related to the topic being studied were read and analyzed by the researcher to support the claims presented by this study. 2.1 Mobile Robot According to Al-Sahib (2015), the term robot is derived from the Czech word â€Å"robota† which means forced labor. Goris (2004) also said that a robot can be defined as a device that can execute automated tasks, either with the influence of direct human control, or a set of general

Military Pension Reform Military Reform - 1583 Words

Military Pension Reform Military pension reform is a subject that strikes fear in the hearts of many of those serving in the United States military and something which would make me cringe when I heard rumors of it. The current military pension system gives those service members retiring with at least 20 years of service, a monthly entitlement of 50% of their base pay for the rest of their lives. This means that someone who enlists in the military at 18 years of age can begin collecting their retirement at age 38. This percentage can also go up if the member gains enough rank to stay in the military past the 20 year mark. This is an incredible benefit, considering the full social security retirement age is now 65, and soon rising to 67. Reservists collect their retirement at age 60. For the Active Duty member, this equates to 27 years of additional income for the military retiree. The Military Compensation and Retirement Modernization Commission (MCRMC) are working to change this benefit from its cur rent status, to a blended system. The main issue with the current military pension system is an unsustainable cost to the government. While the current military pension system is great for our service members, it is costing the government too much money. â€Å"Military pay and benefits — including retirement pay for veterans — eat up about one-third of the Defense Department budget† (Harper, 2015, para. 2). As illustrated by Harper (2015) the current system cost more thanShow MoreRelatedPatrick Henrys Impact On Slavery1708 Words   |  7 Pagesthey wanted so badly. One of the ways in which blacks were awarded new opportunities was in the military. During the American Revolution, there were two sides of the war; the Loyalists who were loyal to King George III and the British government, and the Patriots who supported Thomas Jefferson’s Declaration of Independence. During this time, some slaves obtained freedom if they served in the military. Those who were not offered that opportunity were enticed to join the Loyalists in return for theirRead MoreHow Far Was Concern over National Security the Real Reason for Liberal Reforms Passed Between 1906 and 1914?1468 Words   |  6 Pagesearly twentieth century the Liberal Government was worried that Britain’s military capability and general military power was not as strong and it once was. Therefore, the Government’s concern over national security definitely influenced the decision for the reforms. However, there are three main factors that also need to be taken into account when d eciding if concern over national security was the real reason for the reforms: the Social reasons, concerns for Britain’s Empire and the Political motiveRead MorePolitical Administrators by Aminullah Chaudy915 Words   |  4 Pagesoscillation between democracy and dictatorship in Pakistan caused a serious damage to the traditional culture of Pakistan Civil Services which it inherited from Indian Civil services. AUTHOR The writer is a retired civil servant and in the realm of military coup of Pervez Musharaf he suffered a court trial in famous ‘Plane Hijacking Case’ because he supported the Prime Minister as DG Civil Aviation. The writer served on all important positions in district administration and in federal and provincialRead More Augustus and how he changed the roman Empire Essay1071 Words   |  5 Pagestotal control of Rome and tried to destroy each other. Civil war was the the only way to solve problems in politics. Consequently, the power of the military became strong. Control of Romes armies changed from the government to the generals because the soldiers began to listen to their generals rather than to the Government. On dismissal from military service, the soldiers had no farms to return to, and they depended entirely on whatever land and money their generals could provide since the governmentRead MoreFederal Budget Essay1118 Words   |  5 Pagesrestrategize the militar y force or to make defense more affordable (â€Å"15 Ways to Rethink the Federal Budget†, Brookings). National defense is a sensitive topic to most because we need it to live in our country as safe as we do, but it is a big problem in our national debt. The Washington Post showed that the United States spends 20% of its budget on defense and it has increased dramatically since the tragedy of 9/11 (â€Å"America’s Staggering Defense Budget†, Plumer). America spends more on its military thanRead MoreEssay on Fdr and Hitler Comparison1171 Words   |  5 PagesRoosevelt started his first presidential term at the lowest point in the Great Depression. Roosevelt brought this country great relief from the Great Depression. He started with what is known as the First New Deal, bringing relief, recovery, and reform to the American economy. This simple name was for a rather complex sequence of programs set to help the economy. Roosevelt’s First New Deal set out to give immediate relief to those American’s most affected by the depression. Its main method of reliefR ead MoreThe Aftermath of War and the US Healthcare Policy1045 Words   |  4 Pagesï » ¿Jpz777 04/24/2013 Order # A2092963 With the worlds largest volunteer fighting force in its service, America has long been a nation that kneels in bowed reverence to the service of our military men and women. National monuments stand as enduring testaments to the sacrifices made by ordinary citizens when political action dictates that war must be waged, and holidays commemorate the fallen who laid their lives down in defense of their homeland. Nonetheless, the storm clouds of crisis have begunRead MoreU.s. Post Office Administration1056 Words   |  5 Pagesa private postal service. With other defense civil programs, I know that this will take away military personnel’s pensions. But most people I know that served invest in retirement funds. So when they retire from the military they are making a lot of money just off of their retirement fund and they have their military pensions. Most individuals don’t serve 20 years as well. I think teaching military personnel to invest their money is a smarter ide a than the government just giving them money.Read More The Progressive Era Essay1275 Words   |  6 Pagescontrol league is now called the Planned Parenthood federation. The suffragettes wanted equality and most female reformer wanted protective laws to regulate the conditions in which women worked (Abramovitz, 2004). There were programs such mother’s pension that were created to allow widowed mothers to stay home to care for their children by providing cash public assistance. The settlement house led by Jane Addams was a movement that allowed wealthy women live among the poor for they could have an insideRead MoreEconomic Development And Development Of Welfare1640 Words   |  7 Pagescapitalist market form itself. Unfortunately, the theory based solemnly on economic development explanation does not hold when applied to real-world examples. Take for instance Britain and the United States. Why did Britain launch a full range of modern pension and social-insurance programs before World War I, while the U.S. resisted such possibility? After all, both countries experienced socioeconomic development, the rise of the industrial working class, and the rise of new liberal values. Another puzzling

The Secret of Ella and Micha Chapter 4 Free Essays

Micha â€Å"She’s already got you all hot and bothered.† Ethan sips on his soda. â€Å"Look at you. We will write a custom essay sample on The Secret of Ella and Micha Chapter 4 or any similar topic only for you Order Now Drunk after eight months of sobriety and I don’t believe it’s a coincidence it happened on the same night she showed up.† I slam another shot back and wipe my lips with the back of my hand. â€Å"I’m fine man. And I can’t blame what I do on anyone else but myself. This isn’t Ella’s fault. â€Å" Ethan laughs, tipping his head back, bumping it on the edge of the cupboard. â€Å"Who the hell are you trying to convince? You know just as well as every single person in the room knows that you two are each other’s problem and it’s never going to be fixed until you fuck and get it over with.† I punch him in the arm, harder than I planned. â€Å"Watch it. You’re walking on thin ice tonight.† He holds up his hands, surrendering. â€Å"Sorry, I forgot how you get when you’re like this.† I grab a fist full of his shirt and jerk him toward me. â€Å"Like what?† Again, he forfeits up his hands. â€Å"Micha man, calm down and go drink some coffee or something. You’re trashed out of your mind.† I release him and rake my fingers through my hair, frustrated with something I can’t grasp. â€Å"Coffee’s a myth†¦ And I need something else.† My eyes travel to the back door window, and suddenly I understand what I need. I pat Ethan’s shoulder. â€Å"Clear everyone out before my mom gets home, okay?† â€Å"Alright, man will do,† he replies confoundedly. â€Å"But where are you going?† â€Å"On a walk.† I knock people out of my way, and stumble out the back door. Regaining my balance, I trip across the grass and climb over the fence. Ella’s dad’s Firebird is parked in the driveway, so he must be home from the bar. Doesn’t matter, though. He won’t notice or care if I sneak in. I’ve been doing it since we were kids. Although, my intentions did get a bit dirtier the older we got. I stare up at her bedroom window until I reach the tree. After a drunken struggle, I make it to the top and I inch along the branch to the window. Cupping me hands around my eyes, I peek inside. The lights are off, but the glow of the moon lights a trail to her bed. She’s fast asleep. I inch open the window, slicing my finger on a rusty nail. â€Å"Mother†¦Ã¢â‚¬  I suck on my finger tip, the taste of blood and vodka bitter against my tongue as I head dive through the window and hit the floor with a soft thud. Her friend shoots upright from the bed on the floor, her eyes wide. â€Å"Oh my God.† I put my finger to my lips as I get to my feet. â€Å"Shh†¦Ã¢â‚¬  She still looks worried so I dazzle her with my most charming smile. That seems to win her over and she settles back in her bed. As carefully as I can, I step over her bed and crawl in with Ella. She’s always been a heavy sleeper and doesn’t stir. I press my chest against her back, drape my arm over her waist, and feel the rhythm of her breathing. God, I’ve missed this way too much. It’s not healthy. I burrow my face in her neck, smelling the scent of her hair, vanilla mixed with something that’s only her. I shut my eyes and for the first time in eight months, I fall into a peaceful sleep. Ella I sleep horribly for half the night, tossing and turning, like the princess sleeping on a pea. Only I am far from a princess and the pea is my guilty conscience. I don’t know why I feel guilty about blowing off Micha. I’ve done it breezily for the past eight months. Although, he wasn’t living right next door with his sad puppy dog eyes and charming sexiness. My sleep deprivation only got worse when my dad stumbled into the house in the middle of the night, bumping over cups and bottles, drunk off his ass. Later, I heard him crying in the bathroom my mom died in. It still hurts to hear because his tears are my fault. Once I fall asleep, I am out and it ends up being the best night’s rest I’ve had in ages. When I wake up in the late afternoon, I feel refreshed and calm. Until I realize why. Micha is in my bed and has me in his long, lean arms. His body is curved into mine, so every single part of him is touching me. I know it’s him by the smell of his cologne mixed with mint and something else that only belongs to Micha. I pretend to be asleep, engulfed in a wonderful dream, refusing to wake up until he leaves. â€Å"I know you’re awake,† he whispers in my ear. His voice is hoarse and his breath is stale with booze. â€Å"So open your eyes and quit avoiding me.† â€Å"You know it’s illegal to walk into someone’s house without permission,† I say with my eyes shut. â€Å"And sneaking into someone’s bed – that’s the move of a pervert.† â€Å"I didn’t walk in. I fell in,† he says, amused. I pinch his firm chest and he laughs. â€Å"Now there’s my feisty girl.† He brushes his soft lips across my forehead. â€Å"I’ve missed you, Ella May.† Opening my eyes, I wiggle in his arms. â€Å"Please don’t start. It’s too early.† His eyes are guarded and his hair is a mess. He chuckles lowly, a sound that ripples deep inside my core. â€Å"Pretend all you want, pretty girl. You and I know that deep down you’re secretly glad to be pressed up to my body.† He urges our chests together as he snakes his legs around mine. My eyelids flutter against his warmth. God, I’ve missed this so much. Way too much and so has my body, evidently. â€Å"So where did you go?† he asks, crushing my moment of bliss. â€Å"To school in Vegas? Because it kind of surprises me. You never really liked school.† My mind snaps back to reality. â€Å"I don’t want to get into this right now. I just want to have a relaxing summer and then I’m headed back to campus.† He blinks, his eyelashes fluttering against my forehead. The feel of him sends a warm tingle up my thighs and I seal my lips to keep from moaning. His eyebrows knit. â€Å"It’s like you’ve been kidnapped by a bunch of nuns or something.† â€Å"Maybe I was,† I say submissively. â€Å"It wouldn’t hurt anyone if I was.† He considers this and an artful smirk curves at his lip. â€Å"That’s not true. Nuns can’t have sex and I still haven’t fulfilled my lifelong dream of having sex with you.† I open my mouth, my tongue locked and loaded with an equally perverted comeback, but I bite down, remembering I’m not that kind of a girl anymore. â€Å"I need to wake Lila up. She’s got a long drive ahead of her.† With one swift roll, he has me pinned down beneath his body and my arms trapped above my head. His aqua eyes search mine and it’s like staring at the endless ocean. He sucks on his lip ring, lost in thought. â€Å"You’re going to tell me, pretty girl,† he asserts, tilting his head so his lips are next to my cheek. â€Å"You always tell me everything.† â€Å"Micha, please†¦.† I despise how breathless I sound. â€Å"You know why I left. You were there that night†¦ you saw me†¦ I can’t do it again.† Anxiety claws up my throat and my muscles tense beneath the weight of his body. â€Å"Please let me up. I can’t breathe.† He props up on his arms. â€Å"You could have talked to me, instead of running away. You know that.† I shake my head. â€Å"No, I couldn’t. Not that time. That time it was different. You were part of the reason I had to leave.† â€Å"Because you kissed me?† he asks, dipping his voice to a husky growl. â€Å"Or because I found you that way†¦ that night.† I swallow the giant lump in my throat. The kiss was part of it. It was an earthshattering kiss, one that stole breaths, stopped hearts, and scared the shit out of me because it surfaced feelings I’d never felt before, ones that rendered me helpless. â€Å"I don’t want to talk about it. Now get off of me.† I wiggle my arms between us and push on his chest. He sighs and rolls off me. â€Å"Fine, don’t talk about it, but it doesn’t mean you can run away from me again. I’ll chase you down this time,† he threatens with a wink as he climbs off the bed, and the chain hooked to his studded belt jingles. â€Å"Get dressed and meet me out in the driveway. You have to go visit Grady today.† â€Å"No, thanks,† I decline and tug the blanket over my head. â€Å"And I told you last night I have stuff to do today. Besides aren’t you hung over from last night? You were pretty wasted.† â€Å"Don’t do that,† he says, aggravated. â€Å"Don’t pretend like you have some deep insight into me anymore. You’ve been gone for eight months and a lot has changed.† I’m speechless. â€Å"Micha, I†¦ â€Å" â€Å"Come on, get out of bed. You’re going to see Grady, whether you like it or not.† He yanks the blanket off me and tosses it on the floor, so I’m lying there in my plaid shorts and skin-tight tank top with no bra on underneath. He gives me a prolonged once over, with a dark, lustful glint in his eyes and goosebumps sprout all over my skin. I cover myself with my arms. â€Å"I’m not going to Grady’s. I just got home and I have things to do.† â€Å"He’s got cancer, Ella.† He backs for the door, tucking his hands into the pockets of his faded jeans. â€Å"So get your bratty, split-personality ass out of bed and go see him before you can’t.† My arms fall to my sides as I sit up. â€Å"Why didn’t anyone tell me?† â€Å"If you would have told someone where you were, we would have,† he says. â€Å"Although, I’m pretty sure your father knew where you were, he just wouldn’t tell anyone.† I don’t deny it. â€Å"Besides, I told you in the voicemail I left yesterday,† he says, glancing at my phone on the desk. â€Å"But I’m guessing you haven’t listened to that?† I shake my head. â€Å"No, I was too surprised to see your number on the screen.† He bites on his lip ring, something he does when he’s nervous. â€Å"Yeah, you should probably just delete that. I don’t think you’re ready for it yet.† My gaze moves to my phone. What the hell is on it? I climb out of bed, arching my back and stretching like a cat. â€Å"How bad is Grady?† He swallows hard. â€Å"He’s dying, so you need to get dressed and let me take you to see him.† I begin to object, but rethink my initial stupidity. Grady is the one part of my past that I could never run from. At one point, he was like a father to Micha and me. I even called him from Vegas once, although I didn’t tell him where I was. I nod. â€Å"Let me get dressed and I’ll be out in a second.† â€Å"See you in a few.† He winks at me and vanishes into the hall, leaving the door wide open behind him. Lila quickly springs up from the trundle bed, clutching the sheet. â€Å"Oh. My. Hell. What was that about? I mean, he crawled in here through the window in the middle of the night, and just climbed into bed with you.† â€Å"That’s what he does.† I open the window letting in the gentle breeze. Loose pieces of my hair dance around the frame of my face. â€Å"Oh, no.† Lila stretches her arms above her head. â€Å"What’s wrong?† I reluctantly look at her. â€Å"I think someone might have confused your car for a canvas.† She jumps out of bed and elbows me out of the way to get a look at the damage done to her beautiful, nearly brand new Mercedes. â€Å"My poor baby!† I pull a skirt and a pink tank top out of my duffel bag. â€Å"Get dressed and we’ll go check out the damage.† She pouts, looking like she might cry. â€Å"I can’t drive it home like that. My parents will kill me.† â€Å"I know plenty of people who can fix it for you,† I say, opening the door. â€Å"Or I use to, but I’m sure it’s all the same.† She nods and I go to the downstairs bathroom to change, avoiding the upstairs one. I turn on the shower so the mirror will fog up and hide my reflection. I comb my hair until it flips up at the ends naturally. Then I apply a light shade of lip gloss and head out the door, but run into my dad on the stairway. â€Å"When did you get here?† His breath smells like gin and his eyes are red. His cheeks have sunken in over the last eight months and his skin is wrinkled like leather with sores. He’s in his late forties, but looks like he’s pushing sixty. â€Å"Last night,† I tell him, taking his arm and helping him up the stairs. â€Å"I was in bed before you got home.† He offers me a pat on the back. â€Å"Well, I’m glad to have you home.† â€Å"I’m glad to be home,† I lie with a smile as we reach the top of the stairs. He moves his arm away from my hand and rubs the back of his neck. â€Å"Do you need anything? Like help carrying in your boxes?† â€Å"I think I can handle it on my own, but thanks.† I decline, sticking my arm out as he teeters toward the stairs. He nods and his eyes drift to the bathroom down the hall. He’s probably thinking about how much I look like her. It hurts his eyes, at least that’s what he told me the night I went to the bridge. â€Å"I guess I’ll talk to you later then. Maybe we could go to dinner or something?† He doesn’t leave me time to answer as he zigzags down the hall to his room, slamming the door shut behind him. My dad started drinking when I was about six, a few months after my mom got diagnosed with a bipolar disorder. His drinking habit wasn’t that bad back then. He would spend a few nights at the bar and sometimes on the weekends, but after my mom died, beer and vodka took over both our lives. When I return to my room, Lila is dressed in a yellow sundress, with her blonde hair curled up and there is a pair of overly large sunglasses concealing her eyes. â€Å"I feel like crap,† she declares, putting her hands on her hips. â€Å"This place has that effect on most people.† I grab my phone, noting the flashing voicemail as I slip on my flip flops. We go outside, leaving the smoky air behind and step into the bright sunlight, surrounded by the scenery of rundown homes and apartments. The neighborhood is filled with motorcycle engines revving and far in the distance are the sounds of a lovers’ quarrel and Micha is nowhere to be seen. A long time ago, it felt like home, back when street racing and running wild felt natural, but now I just feel lost. Lila starts biting at her fingernails as she gapes confoundedly at her car. â€Å"It looks worse up close.† I circle her car with my arms folded, assessing the damage. It looks like a fruit basket, only instead of being filled with fruit it’s crammed with innuendos and colorful words. I’m on the verge of laughing for some reason. â€Å"They got you good.† She shakes her head. â€Å"This isn’t funny. Do you know how much it’s going to cost to fix this?† Lila’s dad is a big shot lawyer over in California. Her parents are always sending her things like clothes, money, cars. She has never worked a day in her life and gave me a hard time for my waitressing job at Applebee’s, begging me to take time off to go to parties. â€Å"So what do we do?† She chips at some green paint on the headlight with her fingernail. I point up the street. â€Å"There’s an auto body shop not too far from here.† She glances down the road, which is covered in potholes and lined with filthy gutters. â€Å"But this is a Mercedes.† â€Å"I’m sure painting a car, no matter who the maker is, is all the same.† â€Å"But what if they do something to it?† â€Å"Like spray paint it again after they paint it?† I say sarcastically and she scowls. â€Å"Sorry. We’ll find someone, okay? We can take it to someplace in Alpine. It’s a little nicer over there.† â€Å"I can’t drive it when it looks like this,† she complains, motioning at the car. â€Å"It’s hideous.† â€Å"I’ll drive it, then,† I offer my hand out for her to give me the keys. â€Å"Are you joking?† She pats the hood of her car. â€Å"This is my baby. No one drives it but me. You know that.† â€Å"I think your baby is in serious need of some plastic surgery.† Micha strides off the porch of his house and onto the driveway. He’s changed into black jeans, a fitted grey t-shirt, and his blonde hair hangs in his eyes. Using his long legs, he jumps over the chain-linked fence between our yards. â€Å"I know the perfect place to get it fixed and it’s here in town, so you won’t have to drive it so far.† He gives Lila a wink. â€Å"I’m Micha, by the way.† â€Å"Hi, I’m Ella’s roommate or old roommate anyway,† she says with a warm smile and slides her sunglasses down the brim of her nose. â€Å"We’re not sure if we’re sharing a dorm room next semester.† He presents her with his player grin. â€Å"Sharing a room with Ella? That had to be tough.† He shoots me a mischievous look, trying to get a rise out of me. She laughs and returns her glasses over her eyes. â€Å"No, she’s a pretty great roommate, actually. She cleans and cooks and everything. It’s like having my own house maid.† â€Å"Ella was always good at that stuff,† he agrees, knowing the real reason why. Even before my mom died, she was never good at taking care of the house. I had to learn how to take care of myself at a very young age, otherwise I’d have starved and rotted away in a rat-infested house. â€Å"So do you want me to take your car to that shop I was talking about? Like I said, it’s really close.† â€Å"Yeah, that sounds great.† She shuffles her sandals against the concrete. â€Å"I’d rather go someplace close.† I mentally roll my eyes. Leave it to Micha. He can get any woman to contradict herself if he wants to. He swings his arm around my shoulder and kisses me on the forehead. â€Å"But I have to take pretty girl over here to see an old friend first.† â€Å"Please stop calling me that,† I beg. â€Å"I’ve never liked the nickname and you know that. I never even got why you called me it.† â€Å"And that’s the appeal of it, pretty girl.† He tempts me closer to him and caresses my cheek with his lips, giving me a kiss that brings warmth to my skin. â€Å"Now are you ready to go see Grady? You can come, too, if you want†¦ is it Lila?† â€Å"Yeah, it’s Lila. Lila Summers.† She offers her hand and Micha shakes it. â€Å"And sure I’ll go. This place makes me a little nervous.† â€Å"Isn’t your family expecting you to be home tonight?† I escape from underneath Micha’s arm. â€Å"I’ll text them and tell them I’m not leaving until tomorrow.† She retrieves her cell phone and scrolls through her contacts. â€Å"The car will be done by tomorrow, right?† â€Å"It’s hard to say,† Micha says. â€Å"Ethan is the best, but a little slow.† Her head snaps up and there’s delight in her eyes. â€Å"Ethan as in Ethan from the party last night? The one with the sexy hair and the really big hands?† Micha bites down on his lip, stifling a laugh, and flicks me a sideways glance. I can’t help but smile. â€Å"Yep, that’s the one,† he says. â€Å"Do you feel better about taking your car to him now?† â€Å"Well, yeah, if you think it’s okay?† she checks. â€Å"I’m very picky about who works on my car or at least my dad is very picky about who works on it.† â€Å"It’ll be fine,† he assures her with a wink. â€Å"I’ve never disappointed a girl yet.† â€Å"Oh yeah?† Lila laughs, glancing at me uneasily, like she’s worried she’s stepping on my territory. â€Å"So are we going to go or what?† A ping of jealousy pinches inside my chest. â€Å"Yep, let’s go, beautiful.† Micha leads the way around the fence and up his driveway to the garage. When I step inside, my mouth falls open. Parked in the middle, between the walls lined with shelves and tools, is a shiny 1969 Chevy Chevelle SS. It’s painted in a smoky black with a cherry red racing stripe down the center. â€Å"You finally fixed it up?† He pats the shiny flawless hood, his eyes sparkling with excitement. â€Å"I finally got around to it, after talking about it for four years.† His eyes find mine, seeking my approval. â€Å"So what do you think?† â€Å"It’s kind of old.† Lila pulls a face at the car. â€Å"And really big.† â€Å"I thought you liked things big?† Micha teases. I punch him in the arm and he laughs. â€Å"Ow, I meant hands. Jeez get your mind out of the gutter.† I roll my eyes. â€Å"You did not, you pervert.† He shrugs, his eyes lustrous in the sunlight filtering through the gritty windows. â€Å"So what. It got you to lighten up, didn’t it?† â€Å"Are we driving it to Grady’s?† I opt for a neutral voice. He slips his keys out of his pocket and tosses them to me. â€Å"Yeah, go ahead. It’s all yours.† I swiftly shake my head and throw the keys back at him, like they’re scorching hot. â€Å"No thanks. I don’t want to.† He cocks an eyebrow, looking sexy. â€Å"What do you mean you don’t want to?† â€Å"I mean I don’t want to drive it.† It nearly kills me to say it. I walk around the front of the car, open the door, and gesture for Lila to get in. â€Å"But it has a blown 572 Big Block in it,† he says astounded with the keys hanging loosely from his fingers. â€Å"How can you not want to drive it?† My insides twitch to drive it, but I won’t buckle. â€Å"It’s fine, Micha. I’d rather be the passenger.† â€Å"What does that mean? A blown big block or whatever you said?† Lila wonders as she walks to the side of the car. â€Å"Wait, are you guys talking cars? El doesn’t like cars. In fact, she made us take the bus most of the time when we left campus.† â€Å"Oh really?† His tone implies otherwise. â€Å"That’s news to me.† â€Å"It’s a waste of gas,† I lie, attempting to mask the truth; that I miss it. The rush, the speed, the adrenaline high. Lila ducks inside the car and into the backseat. I climb into the passenger side and Micha opens the garage door. He revs up the engine, letting it rumble, teasing me, before backing down the driveway. â€Å"I’m starting to think that the Ella you knew isn’t the same one as I know.† Lila buckles her seatbelt up. He spins the tires down the road. â€Å"I think you might be on to something Lila, because the one I knew loved cars. In fact she used to hang out in the garage all day with the guys while the other girls played with their hair and makeup.† He flashes me a dangerous grin. â€Å"She used to get all excited when we’d go racing.† No matter how hard I try to hinder myself from getting energized, I can’t. Those hot summer nights, flying down the highway, neck and neck with another car, the rush soaring through my body. Micha trails his finger along my neck and rests it on my pulse. â€Å"You’re getting excited just thinking about it.† His touch spreads a longing through my body. I swat his hand away, cross my arms, and focus on the window, watching the neighborhood blur by as he cruises over the speed limit. Micha shifts the gears and the engine thunders louder, begging to burn rubber. â€Å"Is it legal to be driving this fast?† Lila asks nervously. We glance back at her and she grips the edge of the leather seat. â€Å"It just seems like we’re going really fast, especially in a neighborhood.† Micha holds my gaze resolutely as he downshifts and pumps up the rpms. â€Å"What do you think? Speed up? Or slow down?† I want to tell him to slow down, pull on my seatbelt, and look away, but a passion that was dead raves. He throttles the gas pedal, keeping his eyes on mine, venturing me to look away first. â€Å"Um†¦ I don’t think this is a good idea.† Lila’s voice is far away. The car surges faster down the narrow road and his eyes dare me to tell him to slow down and part of me wants to. Desperately. But as he shoves the shifter into the next gear, going faster and faster, my body pleads to let go. Suddenly, Lila screams, â€Å"Stop sign!† Micha’s eyes sparkle like sunlight reflecting into the ocean. He slams on the brakes, squealing the car to a halt, and throwing us all forward. My hand shoots out and I brace myself from hitting the dashboard. â€Å"Are you crazy?† Lila’s voice cracks as she situates back into the seat and realigns her dress over her legs. â€Å"What is wrong with you two?† Micha and I look at each other and my body is burning with a hidden desire that I won’t admit exists. My heart beats in my chest, rock steady and alive again. For a second, I’m back in the place I lost. Then Micha ruins it. â€Å"See, the same old Ella still lives.† He grins arrogantly as he drives through the intersection. â€Å"She just needed a little push out.† I click the seatbelt locked, proving a point. â€Å"No, she doesn’t. She’s gone forever.† â€Å"Try all you want, but I’m bringing her back.† He bites his lip, refocusing on the street as he mutters, â€Å"I won’t let that night ruin you forever.† But it did. It broke me into a million pieces and blew them away in the wind, like crumbled leaves. That night was one of the most incredible nights I’ve ever had. Then I quickly plummeted toward rock bottom. How to cite The Secret of Ella and Micha Chapter 4, Essay examples

End of Life Care free essay sample

It was recognised by Jevon (2009) that caring for the dying patient can be the most fulfilling whilst also most challenging times for nurses and healthcare professionals. This paper will introduce a case study based on personal experience within clinical placement, exploring and analysing the above statement. In accordance with the Nursing and Midwifery Council Guidelines (2008) names have been changed to protect patient confidentiality. The paper will seek to address issues relating to the case study examining relevant theory. Current policies and guidelines will be considered in relation to the patient. It will identify a framework involved looking at literature to assess the effectiveness against the case study. Finally, focusing on a specific area of care, which in this case will be communication, the paper will evaluate the care given within the case study before providing a conclusion. Mrs Jones, a 65 year old lady diagnosed with lung cancer in July 2010, lived with her husband of 29 years. They had two grown up daughters that lived close by their home. When Mrs Jones first received the diagnosis by her consultant her family were present. After discussions it was decided that the best care option for them was to care for Mrs Jones within their home. More investigative tests revealed that the cancer had spread; with this her condition seemed to deteriorate. Although appreciative of the support they were receiving within their home, Mr Jones and his daughters were finding it difficult to control Mrs Jones symptoms and pain management. Following a family discussion enquiries were made regarding the possibility of hospice care. Hospice care has been described as providing humane and compassionate care for people in the last phase of incurable disease (American Cancer Society, 2013). Within two weeks Mrs Jones was admitted into their local hospice. Symptom and pain management issues were addressed and Mrs Jones seemed relaxed and free from pain and discomfort. Mr Jones and her daughters visited frequently, towards her final days they decided to reside in the family room within the hospice. When it was no longer possible for Mrs Jones to consume food or liquids a decision was reached by the multi-disciplinary network within the hospice to commence the Liverpool Care Pathway. The hospice staff took the time to sit with the family and explain how the pathway works allowing time for any questions or objections. Within 48 hours Mrs Jones died surrounded by her family. ‘We cannot take away the whole hard thing that is happening, but we can help to ring the burden to manageable proportions’ (Cicely Saunders, as cited inEllershaw amp; Wilkinson, 2003) this was a comment made during a seminar in 1962 and is thought to be an early attempt at challenging the way in which health professionals approach end of life care. End of life care has been defined by the National Council for Palliative Care (2006) as helping ‘†¦all those with advanced, progressive or incurable illness to live as well as possible until they die. It enables the supportive and palliative care needs of both patient and family to be identified and met throughout the last phase of life and into bereavement. It includes management of pain and other symptoms and provision of psychological, social, spiritual and practical support. ’ Dame Cicely Saunders, founder of St Christopher Hospice in 1967 paved the way and had a major impact on changing people’s attitude and thinking regarding end of life care. Primarily a small sample of only four patients was chosen to experiment with drug dosages. This was to assess the impact of regular and consistent administration of medications. The results of this study indicated an improvement in quality of life. Consequently, since the work of Dame Cicely, end of life care has advanced, further studies undertaken by Professor John Hinton established a link between physical and mental distress of patients at end of life care. Professor Ann Cartwright was responsible for a large-scale epidemiological study through surveys to a random sample of patients and families in end of life care. This was a comparative study between 785 subjects in 1969 and 639 subjects in 1987. Results revealed an increase in the amount of people living longer with prolonged illness, greater awareness of death and dying alone within acute hospital settings. However, it did highlight an improvement in home help although, fewer visits where occurring (Cartwright, 1991). Referring back to Mrs Jones, the latter of the findings was evident. Although Mr Jones was appreciative for support being received within the home and community environment, he was having difficulties controlling his wife’s symptoms and pain management between health professionals visits. An implication of this is the possibility that Mrs Jones preferred place of care was compromised resulting in re-evaluation of the family’s situation, therefore, potentially meaning that Mrs Jones wishes were not met. It is from studies such as the ones stated above that progression in end of life care has evolved with the introduction of palliative care nurses such as Macmillan nurses and an increased number of hospice’s being provided worldwide. The main focus at end of life care was predominantly based on cancer patients. Initiatives such as the Comprehensive Cancer Care Programme was initiated in 1980 focusing on areas including prevention of illness, early detection, treatment and pain relief and palliative care. This programme was introduced by the World Health Organisation it is reported by Twycross (2007-2008) as prompting other associations and initiatives at global and national levels. However, after extensive work and research it was only in 2008 that a strategy was devised by the Department of Health, which aims to promote high quality care for patients receiving end of life care by giving patients the option to choose where they would like to receive end of life care (Department of Health, 2008). Nevertheless, one question that needs to be asked, is whether enough has been applied to healthcare services and nursing to manage and support patients and families in end of life care? The modern hospice movement was mainly devised from a Christian tradition, hospices are now well established within end of life care. Hospices began by being mainly focused on cancer patients altough better knowledge and understanding of other incurable desease has seen an increase in patients admitted with other conditions. An end of life care programme was formulated, consisting of six steps, within the end of life care strategy. It was recognised by the Department of Health (2008) that care pathways are useful tools within health care. Care pathways have been defined as anticipated care placed in an appropriate time frame, written and agreed by a multi-disciplinary team (Davis, 2005) it is believed that care pathways determine multi-disciplinary working by using evidence and guidelines for certain patient groups (Overill, 1998) however Kinsman, Rotter amp; Snow (2001) state that a definition is unclear and no agreement has been made. Considering the six steps of the end of life care pathway the paper will examine Mrs Jones situation. The pathway begins with discussions regarding diagnosis and recognising a patient needing end of life care support. Fallowfield, Jenkins amp; Beveridge (2002) suggest that health professionals try to protect themselves from breaking bad news to patients. This was not evident with Mrs Jones as her consultant was honest and informative when breaking the news of her diagnosis. Although, it still highlights the importance of communication, especially in the initial diagnosis as the patient deserves to have clear and factual knowledge about their prognosis. It was recognised by Watts (2009) that communictaion is a key component in end of life care, specifically in regards to psychosocial and spirtual care. Inadequate communication could prove detrimental to the care plans developed at a later stage. Step two relates to the assessment, care planning and review of care. This is where advance care planning is introduced to the patient and family. An advanced care plan allows the patient to express their wishes on care and treatment options, which can be recorded by health professionals and used when mental capacity is lost. It is believed that advanced care planning is a thoughtful process which allows for patient values and beliefs to be considered within their end of life care pathway (Schaffer, 2009). Mrs Jones discussed an advanced care plan and whilst it did not affect the outcome or care received the implications had this not have discussed could have been distressing for the family. Lynn, Schuster, amp; Wilkinson (2007) believe that without an advanced care plan a crisis situation could occur, causing conflict between family and health professionals. There could be many reasons why patient’s decline discussions on advanced care planning one of which being that they do not understand. When an advanced care plan has been recorded within patient records and transferred between health organisations coordination of care can be acheived. As the third step in the end of life care programme it ensures that patient preferences are being adhered to. The important component within this step is communication and multidisciplinary and mulitiagency working. Delivery of high quality care is covered by step four in the end of life care programme, referring back to Mrs Jones it could be argued that when being cared for within her own home high quality care was not being delivered consistently as her symptoms and pain management were not controlled adequately. A study conducted by OBrien (2010)found that poor discharge planning, co-ordination, difficulty in establishing additional quipment along with inadequate out of hours services resulted in patients care preferences not being adhered to. As was the case for Mrs Jones who was admitted into her local hospice. It is stated in the end of life programme that the same high quality of care should be received regardless of which setting. Within the hospice Mrs Jones needs were met upon arrival with analgesia which as Dame Cicely’s study revealed made an impact on a patient’s q uality of life in end of care provisions. It was recognised when Mrs Jones entered into the final phase of life, at which time the hospice staff spoke to Mr Jones and his daughters to explain about the Liverpool Care Pathway. The Liverpool Care Pathway was devised as a nurse led document to empower and provide a clear action plan when caring for patients during their final phase of life. Although the Liverpool Care Pathway is still relatively new to the National Health service, there has been much controversy due to bad media coverage. Devlin (2009) reported that a group of experts claimed patients were being wrongly judged as close to death. What media fails to report are cases where patients benefit from hospice levels of care ensuring that the patient is comfortable, without pain and having the ability to nurses to administer medications as soon as they are required without delays whilst waiting for medical staff. Once the pathway had been explained to Mrs Jones family and they was happy to proceed with the pathway it was commenced. The final step in the end of life care programme considers care after death. Last offices are performed after death when procedures are followed to prepare for transferal of the body to a chapel of rest, mortuary or undertakers (Jevon, 2009). It is important to consider the families religious and cultural beliefs when undertaking this final step as this stage focuses upon showing respect for the deceased whilst fullfilling requirements (Dougherty amp; Lister, 2004). Mrs Jones did not express any cultural or religious considerations and so a standard last offices was performed. Following last offices Mr Jones and his daughters viewed Mrs Jones body to pay their last respects and say their goodbyes. Altschuler (2004) recognises that end of life care and medical diagnosis sometimes leads to changes not only for the individual but also for the amily. Within this section of the paper, considering Mrs Jones and her family, support through end of life care will be explored. Before beginning it is important to respect that not all families function in the same way. A study by Campbell (1996) found that effective support by palliative care teams revealed more satisfied families of patients in end of life care. Hudson, Quinn, OHanl on, amp; Aranda (2008) state that communication between family, patient and health care professionals is paramount in end of life care and also integral to understanding and providing support which is required. Regarding Mrs Jones, at her initial diagnosis it can be said that individually she was well supported, surrounded by her family. Payne, Seymour, amp; Ingleton (2008) state that evidence shows most people do not require additional support as they are resilient and able to adapt to changes with the support of their own networks. It is important not to forget the people that may not have the same support networks in the community. Assumptions regarding support could be detrimental to the overall outcome of the end of life care received and also the aftermath with the family in the bereavement process. When examining literature some contridictory information was found regarding pre-bereavement support for families, whilst Field, Payne, Relf, amp; Reid (2007) found that families benefitted from such services Grande, Farquhar, Barclay, amp; Todd (2004) study indicated less helpful or beneficial results. These could be explained by the difference in expectations, services available and communication techniques. Considering Mrs Jones case study her family accessed support through the staff and services within the hospice. Also before admission into the hospice they were receiving support from MacMillan nurses and other community organisations. The hospice which Mrs Jones was admitted offerred her family bereavement support which includes councellors, and volunteers and the service is available on a self referral after the death of a relative also. Mr Jones declined this service although they did enquire about the rememberance evening held within the hospice. Rememberance evening are described as being mainly non-religious, although, there is a religious section added on for people who require it. Names of recently deceased patients are read aloud with lighting of candles, music, various readings and a chance to share experiences with others who are undergoing the same process of change as yourself(Wigan amp; Leigh Hospice, 2011). From the initial diagnosis Mrs Jones family seemed to support each other through acceptance and grief and therefore felt that it was unnecessary to use the bereavement service. It is evident from writing this paper that end of life care has evolved rapidly and seems to be of major interest at national levels. This will hopefully continue ensuring that better services can be provided in areas such as the community to ensure people like Mrs Jones can be cared for at home receiving the exact levels of treatment as would a patient within a hospice. Until this time advanced care plans can never fully be adhered to as revisions are often required for patients such as Mrs Jones, when symptom and pain management cannot be covered consistently. However it was also shown how hospice care is providing patients and their families with high standards and quality care, through physical and holistic approaches to care. Communication has been highlighted as a key component within end of life care. Overall Mrs Jones received good communication and with this the support systems were accessed as and when required by the family. It is also wise to note that good communication was received by the family regarding the Liverpool Care Pathway. This paper began with a statement by Jevon (2009) in which it was regarded that caring for somebody in their final phase of life can be the most challengin yet most rewarding experience. Further research would help to advance end of life care, making it even more widespread. Upon reflection the care which Mrs Jones received in the community could have been better although that is due to poor co-ordination such as out of hours services. The hospice still seems to provide better levels of care when comparing how Mrs Jones felt in the community compared with how she was in the hospice. Further work needs to be done in order to gather a true reflection on the difference in levels of care between settings. When looking at the end of life care programme it was impressive to see that Mrs Jones was benefitting by receiving the correct care plans. References Altschuler, J. (2004). llness and loss within the family. In P. Firth, amp; G. Luff, Loss, Change and Bereavement in Palliative Care (pp. 53-65). Berkshire: McGraw-Hill Professional Publishing. American Cancer Society. (2013, February). Hospice Care. Retrieved from Hospice Care: http://www. cancer. org/treatment/findingandpayingfortreatment/choosingyourtreatmentteam/hospicecare/index Campbell, M. (1996). Program assessment through outcomes analysis: efficacy of a comprehensive supportive care team for end of life care. AACN Clinical Issues, 156-167. Cartwright, A. (1991). Changes in life and care in the year before death 1969-1987. Journal of Public Health Medicine, 81-87. Davis, N. (2005). Integrated Care Pathways. Retrieved from NHS: http://www. wales. nhs. uk/sitesplus/Documents/829/integratedcarepathways. pdf Department of Health. (2008, 07 16). Publications policy and guidance. Retrieved from Department of Health: http://www. dh. gov. uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_086277 devlin, K. (2009, September 02). The Telegraph. Retrieved from The Telegraph: http://www. telegraph. co. uk/health/healthnews/6127514/Sentenced-to-death-on-the-NHS. html Dougherty, L. amp;. (2004). The Royal Marsden Hospital Manual of Clinical Nursing Procedures 6th Edition. Oxford: Blackwell Publishing. Ellershaw, J. , amp; Wilkinson, S. (2003). Care of the Dying: A Pathway to Excellence (Second Edition). Oxford: Oxford University Press. Fallowfield, L. J. , Jenkins, V. A. , amp; and Beveridge, H. A. (2002). Truth may hurt but deceit hurts more: Communication in Palliative Care. Palliative medicine, 297-303. Field, D. , Payne, S. , Relf, M. , amp; Reid, D. (2007). An overview of adult bereavement support in the United Kingdom: Issues for policy and practice. Social Science and Medicine, 428-438. Grande, G. , Farquhar, M. , Barclay, S. , amp; Todd, C. (2004). Caregiver bereavement outcome: relationship with hospice at home, satisfaction with care, and home death. Journal of Palliative Care,, 69-77. Hudson, P. , Quinn, K. , OHanlon, B. , amp; Aranda, S. (2008). Family meetings in palliative care: Multidisciplinary clinical practice guidelines. BMC Palliative Care, 7-12. Kinsman, L. , Rotter, T. , E, J. , amp; Snow, P. a. (2001). What is a clinical pathway? Development of a definition to inform the debate. BMC Medicine. Lynn, J. , Schuster, J. , amp; Wilkinson, A. a. (2007). Improving care for the End of Life: A Sourcebook for Health Care Managers and Clinicians (2nd Edition). Cary: Oxford