The Structural Analysis of Foreign Tax Credits Research Paper

The Structural Analysis of Foreign Tax Credits - Research Paper Example Even though foreign tax credit is accessible to people who have foreign source of income, the U.S. companies with subsidiaries overseas always take the greatest share of the foreign tax credits. Most of the U.S. companies make foreign source earnings by operating subsidiaries abroad or through investing in associates incorporated abroad. In order for the foreign associates’ income to be qualified for a foreign tax credit, the U.S. parent company is required to have at least 10 percent of ownership in each of the associates overseas. If the previous requirement is met and the foreign associate is evidenced to be incorporated overseas, then it is referred to as a foreign subsidiary. A foreign subsidiary pays dividends to the U.S. parent corporation from its income after foreign income taxes. Any income earned through foreign activities but not eligible for the foreign tax credit, i.e. income earned from a subsidiary that is less than 10% owned by US Corporation, is taxed in the same year when it is earned as specified by the U.S. Treasury. Foreign income taxes that are eligible for the foreign tax credit are given credits, and the same action is extended to other withheld taxes overseas. The foreign tax is only imposed when the subsidiary forwards earnings to its U.S. based parent company. The deductions of losses incurred by a foreign subsidiary can be made out of the parent corporation’s domestic earnings which can help to cut the company’s income tax in the Unites States. However, profits made by the same subsidiary in succeeding years are treated as U.S. source earnings.

Suburban Sprawl (Environmental Issue) Essay Example | Topics and Well Written Essays - 1000 words

Suburban Sprawl (Environmental Issue) - Essay Example These hazards being talked about refer not to only to body health issues but a rapid jump in mental health issues, prompting the former vice president of the U.S Al Gore to comment that the urban spread is like â€Å"cookie-cutter monster.†(Brooking Inst, 1998). While supporters of urban lifestyles contend â€Å"consumers prefer lower density neighborhoods and that sprawl does not necessarily increase traffic.† (Moore, Henderson, 1998). Nevertheless there is evidence that urban sprawl is one of the primary contributing factors to the specter of inner city degeneration. By pulling economic resources out of communities that are already existing and diffusing it into new and unconnected developments away from the current core, older communities get neglected and are led to ruin. These new developments are subsidized heavily to create newer roads, water and sewer infrastructure, new schools and enhanced spending on police and fire protection. While urban spread directly inf luences new lawns using ever more water and the use of chemical fertilizers as well as pesticides, it displaces native plants, which have not needed constant watering. It could be concluded that Sprawl wastes tax payers’ money With the population of the world exceeding 6 billion already and progressing toward doubling by the 22nd century, it is estimated that 95% of the new inhabitants of the planet earth will be living in urban areas. When compared to the fact that only 15% of the world lived in urban areas as recently as 1990, the task to manage urban sprawl is both vital and urgent. If not the exponential growth in urban dwellers combined with Socio-economical, geopolitical factors, with the certainty of limited land availability and in -efficient planning is certain to create cities that devour land used for other purposes historically directly influencing equally important aspects such as food security. Combating urban sprawl has two major forms of endeavor both, which i nclude detailed planning. â€Å"The first, the French/British/European tradition, considers urban planning a matter of public health and focuses on strong land- use regulation, public-sector investment, and civic design. The second tradition, born in North America, focuses on zoning and subdivision regulations within a context of strong private property rights† (Calthorpe, 2001)). Peter Calthorpe a New Urbanism thinker and architect illustrates the differences in these two styles by flavoring the European model a more ecological model and the North American planning model a more mechanically motivated model. The European model appears to be the antecedent to the concept called smart growth, and the other of developing efficiencies through zoning. The search for solutions to urban sprawl has given birth to various special-interest groups that promote a concept termed SMART growth at all levels federal, state, and local government. This might look nostalgic with a promotion of return to the city lifestyles of the last two centuries. Living in smaller apartments or smaller land plots with the emphasis on limiting transportation to bicycles or simply walking. Smart growth can be defined as the prevention of urban sprawl through meticulous planning with associated restriction to

Conservatism and Liberalism Essay Example for Free

Conservatism and Liberalism Essay While there are a multitude of political philosophies in the United States, two have emerged as the dominant and pre-eminent philosophies. They are, of course, liberalism which name derives from liberty and conservatism which derives from conserving the constitution. While there is nothing inherently wrong with either philosophy the minefield of political exclusivity has led to a bitter dispute between both factions that have raged for decades. Many of these disputes are ideological as there are pronounced differences between the two philosophies. In this essay, two major differences will be examined.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   One common difference is that liberalism prefers that a centralized government will guide the economy. Conservatism prefers that the government would play a smaller role in the economy with the hopes that the market will govern itself. In terms of public policy, this has led to a number of battles over regulation vs. deregulation, increased taxes vs. decreased taxes, etc with ach having varying degrees of success at different points in history.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In terms of foreign policy, conservatism has always stressed American exceptionalism whereas liberalism has stressed a more unified one world approach to government. The effect this has had on public policy over the years is evidenced in how often or how little American foreign policy is vetted through the United Nations or under accordance with allies overseas.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Of course, there are many more differences between the two but these two examples illustrate major differences between the two on both domestic and international levels.

Bureau of Alcohol, Tobacco, Firearms and Explosives

Bureau of Alcohol, Tobacco, Firearms and Explosives Kareem Canty Introduction The Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) is an agency within the United States Department of Justice. The Bureau of Alcohol, Tobacco, Firearms and Explosives protects American citizens from dangerous and illegal activities involving, as its name suggest, alcohol, tobacco, firearms and explosives.â€Å" The mission of The Bureau of Alcohol, Tobacco, Firearms and Explosives is to conduct criminal investigations, regulate the firearms and explosives industries, and assist other law enforcement agencies. This work is undertaken to prevent terrorism, reduce violent crime and to protect the public in a manner that is faithful to the Constitution and the laws of the United States (The Bureau of Alcohol, Tobacco, Firearms and Explosives). Though The Bureau of Alcohol, Tobacco, Firearms and Explosives is a law enforcement agency one of the primary responsibilities is tax collection. The Bureau of Alcohol, Tobacco, Firearms and Explosives is responsible for taxes on alcoh ol, tobacco, ammunition, and firearms. The Bureau of Alcohol, Tobacco, Firearms and Explosives is an important agency protecting Americans. History of the Bureau of Alcohol, Tobacco, Firearms and Explosives The Bureau of Alcohol, Tobacco, Firearms and Explosives has been the sole agency responsible for regulation and taxation of the above mention categories since July 1st 1972. However, some of the duties of The Bureau of Alcohol, Tobacco, Firearms and Explosives have existed in some form in the United States since 1789. Initially, these activities were performed by the Department of Treasury. On July 1st 1862, the Office of Internal Revenue was founded. This new agency was now responsible for all taxes, including those on alcohol and tobacco. The Office of Internal Revenue included enforcement agents to pursue those who evaded taxes. In 1919, the Volstead Prohibition Enforcement Act and the Eighteenth Amendment to the Constitution made it illegal to produce or transport alcohol. Enforcement of these policies fell on the Office of Internal Revenue. In 1920, the Prohibition Unit was created. This agency was made up of the agents focusing on liquor laws. On April 1st, 1927 the Prohibition Unit officially became a bureau under the Treasury Department. Congress established a new Bureau of Prohibition under the Department of Justice in 1930. This new bureau was now responsible for enforcing Prohibition. Then, the Treasury Department was still responsible for the tax and regulations associated with Prohibition, under the new Bureau of Industrial Alcohol. In December 1933, the Twenty First Amendment to the Constitution ended Prohibition. Shortly after, President Roosevelt created, via executive order, the Federal Alcohol Control Administration to regulate the newly legal industry. This agency was replaced in less than two years by the Federal Alcohol Administration (FAA). The FAA was founded as part of the Treasury Department, who was again responsible for supervising the alcohol industry. In 1934 the Alcohol Tax Unit was founded as part of the Bureau Of Internal Revenue. The FAA combined with the Alcohol Tax Unit. Prohibition, though over, resulted in a lasting culture of organized crime. Due to the violence resulting from organized crime, the National Firearms Act was passed in 1934 and the Federal Firearms Act passed in 1938. These Acts regulated firearms, largely via taxes. In 1942, the enforcement capacity of firearm regulation was entrusted to the Alcohol Tax Unit. Around this time, the ATU became known as the Alcohol Tax Division until the 1968 Gun Control Act. With this act, the Bureau of Alcohol, Tobacco, Firearms and Explosives was now responsible for additional substances, including explosives. In July 1972, the Treasury Department Order NO.120-1 officially shifted all activities involving alcohol, tobacco, firearms, and explosives from the Internal Revenue Services to the Bureau of Alcohol, Tobacco, Firearms and Explosives After over one hundred years of restructuring, The Bureau of Alcohol, Tobacco, Firearms and Explosives has finally achieved stability in its structure and its dut ies. One major change the Bureau of Alcohol, Tobacco, Firearms and Explosives has undergone was its adoption of anti- arson enforcement. In 1982, congress amended the original legislation that outlines the duties of the Bureau of Alcohol, Tobacco, Firearms and Explosives to include arson. Since the 1970s the Bureau of Alcohol, Tobacco, Firearms and Explosives has grown both its budget and its staff. The Bureau of Alcohol, Tobacco, Firearms and Explosives has added over a thousand employee positions. Since 1973, the Bureau of Alcohol, Tobacco, Firearms and Explosives budget has increased from $74 million to $1.07 billion (The Bureau of Alcohol, Tobacco, Firearms and Explosives). Budget In 2013 the Bureau of Alcohol, Tobacco, Firearms and Explosives total budget was $1,153,345,000. This budget covers The Bureau of Alcohol, Tobacco, Firearms and Explosives staff, operations, and programs. Though the Bureau of Alcohol, Tobacco, Firearms and Explosives collects taxes, that money does not found The Bureau of Alcohol, Tobacco, Firearms and Explosives activities. From the years 2007-2011, the ATF collected over $112 million. This money is turned over to the Treasury Department General fund. The funding from The Bureau of Alcohol, Tobacco, Firearms and Explosives comes from federal government. Before each fiscal year, the Bureau of Alcohol, Tobacco, Firearms and Explosives submits a budget draft to congress. The draft includes information about the allocation and purposes of their requested funding. Congress edits and revises the budget as they see appropriate and then grants the funding to the Bureau of Alcohol, Tobacco, Firearms and Explosives. This budget includes salar ies of The Bureau of Alcohol, Tobacco, Firearms and Explosives 4,937 staff employees (The Bureau of Alcohol, Tobacco, Firearms and Explosives, 2012). International Partners Though The Bureau of Alcohol, Tobacco, Firearms and Explosives is responsible for enforcing laws in the United States, they also work along international organizations. The Bureau of Alcohol, Tobacco, Firearms and Explosives works international to investigate and prosecute international crime. Some examples of these organizations include the United Nations, Interpol, and the G8. The Bureau of Alcohol, Tobacco, Firearms and Explosives has field offices in several other countries. They work alongside law enforcement, government officials, and policy makers in these countries. For example, The Bureau of Alcohol, Tobacco, Firearms and Explosives has offices in Canada, Mexico, Europe, Colombia, El Salvador, and the Caribbean. The Bureau of Alcohol, Tobacco, Firearms and Explosives has the most offices in Mexico, with five field offices in the country. Domestic Partners Since its beginning, The Bureau of Alcohol, Tobacco, Firearms and Explosives has worked closely with multiple other governmental agencies. Early on, The Bureau of Alcohol, Tobacco, Firearms and Explosives worked with the Treasury Department and the now nonexistent Federal Alcohol Administration. Today the bureau works closely with state and local law enforcement. The Bureau of Alcohol, Tobacco, Firearms and Explosives works with state and local law enforcement to implement laws and regulations, as well as to locate and prosecute those who break these laws. Also, the ATF’S leaders work with Congress on evaluation and budgetary matters. In â€Å"The American System† by Morton Godzins, the American government is described as very chaotic. Godzins discusses how multiple branches and agencies of government often overlap in function. He writes that successful collaboration requires agencies to openly communicate. To describe the intermingled functions of government, Godzin uses the analogy of a marble cake. This image illustrates the mixing of government functions as chaotic and unordered (Shafritz and Hyde, 2011). THE BUREAU OF ALCOHOL, TOBACCO, FIREARMS AND EXPLOSIVES Today The Bureau of Alcohol, Tobacco, Firearms and Explosives today serves the same purposes as it did when it was founded. Their scope has grown to include numerous activities that are relevant to their purpose. The Bureau of Alcohol, Tobacco, Firearms and Explosives organizes its activities into ten core functions. These functions include original objectives, such as alcohol and tobacco, the criminal firearm usage and trafficking and regulation of the firearms industry. In the 1970s, the Bureau of Alcohol, Tobacco, Firearms and Explosives began including explosives, bombs, bombing, and the explosive industry in their responsibilities. As previously mentioned, the Bureau of Alcohol, Tobacco, Firearms and Explosives began to investigate Arson in the 1980s, adding it to their core functions. The three remaining functions are more recent additions. The first of these additions is a focus on criminal groups and gangs. This activity is closely a lined with the Bureau of Alcohol, Tobacco, Firea rms and Explosives’ mission and values as criminal activity often involves the usage, purchase, or trade of the materials regulated by the bureau. The final two functions involve management activities and are also included in the strategic goals of The Bureau of Alcohol, Tobacco, Firearms and Explosives. These functions involve the Bureau of Alcohol, Tobacco, Firearms and Explosives’ workforce and modernization. The Bureau of Alcohol, Tobacco, Firearms and Explosives is constantly seeking to maintain and build a highly skilled staff. The Bureau of Alcohol, Tobacco, Firearms and Explosives seeks a diverse and talented employee base. The final function, modernization, is a focus of many government agencies today. The Bureau of Alcohol, Tobacco, Firearms and Explosives aims to improve upon its technological skills in order to remain effective and relevant in todays world. Strategic Goals In 2010, The Bureau of Alcohol, Tobacco, Firearms and Explosives published its strategic goals for 2010-2016. Four of the six goals focused on activities relating to the mission of. The Bureau of Alcohol, Tobacco, Firearms and Explosives These goals involve illegal firearms trafficking, criminal groups and gangs, explosives and bombings, and fire and arson. The remaining goals involved management activities. Those goals relate to work force and modernization. Over the past four years the Bureau of Alcohol, Tobacco, Firearms and Explosives has implemented changes where needed in order to meet these goals. All of these goals contribute to The Bureau of Alcohol, Tobacco, Firearms and Explosives vision, â€Å"We protect America. We protect your community.†(The Bureau of Alcohol, Tobacco, Firearms and Explosives) The Bureau of Alcohol, Tobacco, Firearms and Explosives two management activities, modernization and work force seek to improve the internal operations of the Bureau of Alcohol, Tobacco, Firearms and Explosives. Their modernization goal consists of modernizing business activities. This goal also involves updating procedures for information sharing and knowledge management. Finally, this goal also seeks the implementation of more innovative technology. The second management goal of the Bureau of Alcohol, Tobacco, Firearms and Explosives attempts to improve its work force by attracting, developing, and retaining a strong work force. Both of these goals aim to keep the Bureau of Alcohol, Tobacco, Firearms and Explosives operating at its full potential. Victim/Witness Assistance Program Since the Bureau of Alcohol, Tobacco, Firearms and Explosives focuses on illegal activities, the agency frequently interacts with victims. In order to guarantee victims receive their rights as specified in the Crime Victim Rights section of Federal Law 18 United States Code, Section 3771, The Bureau of Alcohol, Tobacco, Firearms and Explosives established its Victim /Witness Assistance Program in 1999. This program enables the Bureau of Alcohol, Tobacco, Firearms and Explosives to provide victims with various types of support. The Victim/ Witness Assistance Program ensures victims’ safety, as well as providing them with other resources. These resources include, but are not limited to, on financial assistance, recovery of property, and referrals to other relevant support agencies. These support agencies can provide services such as emergency housing, counseling, and support groups. The Victim/Witness Assistance Program is implemented by twenty three Victim/Witness Coordinators. These officers can be found in each of the Bureau of Alcohol, Tobacco, Firearms and Explosives field divisions located the across the country. These coordinators work closely with the United States Attorney’s Office, which has its own Victim Witness Coordinators. The Victim/Witness Assistance Program also works with the previously mentioned support agencies. These agencies can be located at both state and local levels. The program Coordinators also worked closely with local law enforcement agencies, especially concerning the safety of victims. While I found no criticism of the Victim/Witness Program, I also found no praise of the program. There seems to be little information available from other sources about this program. This is most likely due to the fact that the program is largely confidential and is only experienced by those who truly need its services, victim irrelevant crime. Conclusion The Bureau of Alcohol, Tobacco, Firearms and Explosives exists in order to protect American citizens and to keep their activities in line with the law. The bureau enforces laws and regulations intended to keep Americans safe. They are responsible for regulating the manufacture and trade of weapons and explosives and for controlling and preventing drug trade. Without The Bureau of Alcohol, Tobacco, Firearms and Explosives, the United States government would have a very difficult time regulating these trades and enforcing these policies. Bibliography â€Å"Congressional Budget Submission: Fiscal Year 2013,† The Bureau of Alcohol, Tobacco, Firearms and Explosives, accessed October 20, 2014 https://www.atf.gov/sites/default/files/assets/budget/2013-atf â€Å"Fact Sheet: ATF Staffing and Budgeting,† The Bureau of Alcohol, Tobacco, Firearms and Explosives, accessed October 20, 2014 https://www.The Bureau of Alcohol, Tobacco, Firearms and Explosives.gov/publications/factsheets/factsheet-staffing-and-budget.html Shafritz, Jay M. and Albert C. Hyde. Classics Of Public Administration, Seventh Edition. (Boston: Cengage Learning, 2011). Shafritz, Jay M.,E.W. Russell, and Christopher P. Borick. Introducing Public Administration, Eight Edition. (Boston: Pearson Education, Inc., 2013). â€Å"2004-2009 Strategic Plan,† The Bureau of Alcohol, Tobacco, Firearms and Explosives, accessed October 15, 2014, https Explosives.gov/files/publications/download/sp/2004-2009/2004-2009-strategic-plan-vision-mission.pdf

A Case Study Of Anita Brown Nursing Essay

A Case Study Of Anita Brown Nursing Essay During the last 15 years there has been a substantial rise in the number of newly diagnosed patients with acute kidney injury especially whilst an inpatient Yaklin, 2011. This is despite every effort to prevent AKI in clinical practice (Venkataraman, 2008). Anita Brown is one such patient, having been diagnosed with AKI following routine surgery. AKI occurring after surgery is associated with a significant increase in patient morbidity and mortality (Chertow, Levy, Hammermeister, Grover, Daley, 1998; Praught Shlipak, 2005). Here I will discuss the nursing management of Anita Brown over a 48 hours period. I will start by exploring the pathophysiology of AKI and identifying the type of injury Anita has sustained. Thereafter, in order to formulate an optimised, tailored 48-hour care plan, I will describe two different but complimentary assessment methods to identify Anitas priorities of care, namely the ABCDE framework (Resuscitation Council, 2010) and the Roper, Logan and Tierney (1980) model of nursing. The nursing interventions subsequently proposed will be justified in relation to Anitas pathophysiology and will be supported by professional literature. Finally, the findings will be incorporated into a 48-hour care plan based on six of Roper et al.s activities of living (ALs) and a brief conclusion presented. Background Anita Brown is a 45-year old woman who has been diagnosed with AKI as a result of severe dehydration, following insufficient fluid administration during/after her cholecystectomy operation. Anita has been experiencing intractable vomiting despite receiving nil by mouth. She is borderline hypotensive, tachycardic and tacypnoeic and has been oliguric for 6 hours. Current management includes fluid replacement. Anitas pain is being controlled by a patient controlled analgesia (PCA) pump of morphine. Pathophysiology of Acute Renal Injury AKI is an extremely complicated disorder (Martini, Nath Bartholomew, 2011). The definition of AKI is a decline in the functions performed by the kidneys resulting in increased levels of serum creatinine and urea detectable in the blood (Dirkes, 2011). Indeed, the condition is most easily recognised by a rise in serum creatinine plus a decreasing urine volume, however, these symptoms are also accompanied by other physiological changes, as will be seen later (Guidelines and Audit Implementation Network [GAIN], 2010). There are three general categories of AKI (relative prevalence shown in parentheses): pre-renal (~55%), intrinsic (~30%) and post-renal (~15%) (Marieb, 2010). Pre-renal kidney injury is the most common form and is generally reversible when renal perfusion pressure is swiftly restored. It has a number of causes, the most common being intravascular volume depletion (haemorrhage, dehydration, burns, gastrointestinal losses) or decreased cardiac output (myocardial infarction or cardiac arrhythmias) (Cheung, Ponnusamy, Anderton, 2008), all leading to hypo-perfusion within the kidneys (Gotfried, Wiesen, Raina and Nally 2012). Drugs that are vasoactive can also cause pre-renal kidney injury (Barber Robertson, 2009), since intra-renal vasoconstriction can ultimately lead to hypo-perfusion (Murphy Byrne, 2010). Anitas surgery was complicated since the planned laparoscopic cholecystectomy had to proceed to an open cholecystectomy, thus she probably suffered considerable intra-operative fluid loss. If inadequate replacement ensued, the reduced blood flow within Anitas kidneys could have caused hypovolemic or cardiogenic shock (Garretson and Malber ti, 2007). Indeed, inadequate intravascular volume arising from significant fluid/blood loss is a common cause of hypovolemic shock (Hand 2001, Bench 2004). A further cause of AKI, intrinsic kidney injury, is associated with injuries that structurally harm vessels, the glomerulus, or kidney tubules (Ali Gray-Vickrey, 2011). Prolonged or severe pre-renal hypoperfusion may lead to such injury through ischaemia. Alternatively, infectious elements or pollutants are a further cause of such damage (Murphy Byrne, 2010). Notably, tubular cells within Anitas kidneys would have been severely damaged if blood flow had been reduced to 20% of normal (Cheung et al., 2008), although the actual extent of her injury is currently unknown. This type of injury is termed acute tubular necrosis (ATN), and is a common reason for AKI in hospitilised patients (Ali Gray-Vickrey, 2011). ATN is characterised by decreased consciousness, reduced urine output resulting from tubular damage, and nausea and vomiting. Like prerenal injury, ATN is often reversible, however, early intervention and distinguishing the mechanism of damage, whether prerenal or intrinsic, is vitally important to improve patient outcome (Gotfried et al. 2012). Other less common causes of intrinsic injury are acute interstitial nephritis (AIN) arising from allergic drug reactions or systemic disease, and contrast-induced nephropathy (CIN) arising from toxicity associated with radiological contrast media administration (Fry, Farrington, 2006; Hilton, 2011; Thomas, 2008). Risk factors for CIN in patents undergoing radio-contrast include age and pre-existing renal impairment plus simultaneous administration of metformin to treat diabetes (Porth, 2007). Consequently, diabetic patients with renal impairment and taking metformin (a drug which is 100% renally excreted), when undergoing radio contrast should be closely monitored, and medication stopped 48 hours before and after the procedure (Royal College of Radiologists, 2009). Finally, post-retinal kidney injury arises from urinary tract obstruction, the resultant back-pressure inhibiting glomerular filtration rate and causing ischemia (Leach, 2009; Hsu Symons, 2010). ABCDE Approach: Airway, Breathing, Circulation, Disability and Exposure Nurses play a vital role in effectively managing acute-care patients such as Anita, with timely intervention resulting in the prevention of life-threatening complications (Clarke Ketchell, 2011). The use of a systematic approach that identifies the priorities of care is essential (Thompson, 2008). Comprehensive Clinical Assessment Guidelines exist for AKI (Lewington Kanagasundaram, 2011), which emphasise that it is essential to consider the underlying cause of AKI since certain origins, such as AIN, would need specialised therapy. Initial clinical orientation requires nurses to ensure that necessary tests are performed and relevant assessment/monitoring is undertaken swiftly (Henneman, Gawlinski, Giuliano, 2012). Antia has already been diagnosed with AKI arising from insufficient fluid replacement during surgery, thus prerenal kidney injury has arisen from renal hypo-perfusion and ischemia, due to an inadequate intravascular volume. Although the extent of the damage remains to be seen, restoring intravascular volume is key to Anitas recovery. A useful approach in assessing and managing a patient who may deteriorate, such Anita, is the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach (Resuscitation Council, 2010). This would be highly useful for Anita, as it would break down the complex assessment procedure for AKI into a systematic process, whereby assessment and treatment algorithms would allow provision of a prioritised care plan. The ABCDE framework also serves as a valuable tool in identifying/eliminating critical conditions (Thim, Krarup, Grove, Rohde, Lofgren, 2012). Anitas assessment will now be considered under the five separate headings. Airway The patency of Anitas airway would be checked, to ensure there is no obstruction. Anita is overweight and upper airway obstruction through narrowing of the airways can occur in obese patients especially during sleep (sleep apnoea) (Hillman, Platt and Eastwood, 2003). If Anitas PCA is causing sedation, she will be drowsy. Consideration should thus be given to providing adequate pillows to ensure her posture and positioning on the bed would be conducive to a patent airway, similar to a head-tilt and chin-lift position (Thim et al, 2012). Frequent repositioning would also guard against pressure sores. Breathing Assessment of Anitas breathing involves respiration rate coupled with observations regarding whether her breathing is noisy, or laboured; movements of the thoracic wall and use of auxiliary muscles are clues to look for (Thim et al., 2012). Assessing Anitas risk of post-operative sleep apnea would mean observing her when sleeping, and noting if she snores or is apnoeic (Thim et al., 2012). To alleviate such symptoms correct positioning would be vital, indeed it is known that poor positioning of obese patients in bed may impede lung expansion (Moore, 2007). Breathing difficulties could require oxygen administration or in severe cases, assisted ventilation (Thim et al., 2012). Anitas is slightly tacypnoeic (respiration rate=22/min); this needs monitoring. Anita has endured severe dehydration and the underlying cause of the tacypnoea is probably related to the ensuing reduced circulating volume, which in turn causes a numbers of associated physiological changes including increased respi ration rate (Large, 2005); other vital signs are also affected, as seen below. Circulation Anita is borderline hypotensive (BP=105/60 mm/Hg) and slightly tachycardic (pulse=108 beats/minute). The severe dehydration Anita has suffered means her heart tries to compensate for the reduced volume by pumping harder (increase in cardiac output) and faster (increased heart rate) (Large, 2005). Concurrently, the low fluid volume leads to a fall in BP. Consequently AKI-related dehydration, has resulted in adverse outcomes including hypotension, tachycardia, and tacypnoeic; weak pulse and cold hands and feet are further signs to look out for (Large, 2005). Additionally, level of mental status, dry oral mucous membranes, sunken eyes and reduced capillary refill/skin (or tongue) turgor are all secondary markers of dehydration (Merck Manuals, 2012) whilst ankle and sacral oedema are signs of fluid overload. Capillary refill time involves pressing on the pad of the middle finger for five seconds then measuring the time for normal colour to return (Large, 2005). Skin turgor involves pinch ing a fold of skin and observing if it falls back to normal position immediately (Scales and Pilsworth, 2008). Rapid restoral of Anitas circulating volume is vital, with additionally the need for close and continuous monitoring of fluid levels (input vs output) and hemodynamics (Dirkes, 2011). Anita is nil by mouth and iv fluid input is being controlled at a rate of 1000mls dextrose/saline over 12 hours. Dextrose/saline is primarily used to replace water losses post-operatively. Normally fluid intake and loss are balanced (Scales and Pilsworth, 2008), yet Anita has been oliguric for 6 hours. Normal urine output is 1ml/kg body weight per hour, the minimum acceptable being 0.5ml/kg/hr (Scales and Pilsworth, 2008). Thus Anita should have a minimum output of 50ml per hour. Obviously Anita is still suffering a fluid deficit. The kidneys can normally concentrate or dilute urine in response to fluid changes. If Anitas kidneys are conserving water any urine excreted will be concentrated and dark (Scales and Pilsworth, 2008). The colour should be noted, in addition to the actual volume, on the fluid b alance chart. Accurate records are critical in assessing Anitas fluid balance. The level of iv fluid needed to restore Anitas fluid balance depends upon an accurate assessment of her volume status, based on the following equation: Fluid required = pre-existing deficit + normal maintenance + ongoing losses. Fluid replacement calculations are challenging since Anitas precise deficit is unknown, also her frequent vomiting represents a variable, on-going fluid loss, which must be estimated and added to her maintenance fluid intake. A patient with a pre-existing deficit normally received rapid fluid resuscitation comprised of an initial large volume (~250ml) of iv saline, repeated as necessary. According to the Merck Manuals (2012) patients with intravascular volume depletion without shock can receive infusion at a controlled rate, typically 500 ml/h. Anitas fluid resuscitation status should be urgently established since Anita appears to be receiving maintenance fluids rather than rescue therapy. During Anitas recovery phase her clinical response to iv fluids will guide the rate of fluid replacement, her vital signs and urine output should return to normal once normal hydration is achieved. A urine output of > 0.5 to 1 ml/kg/h is required (Scales and Pilsworth, 2008). But in addition to urine volume, monitoring electrolyte status is a further part of patient management in the recovery phase of AKI (UK Renal Association, 2011; Abdel-Kader and Palevsky, 2009). Urea, creatinine and sodium are elevated in volume-depleted individuals but to differing extents (Thomas, Tariq, Makhdomm, Haddad Moinuddin, 2003). A full blood count is a further useful piece of information (Lewington Kanagasundaram, 2011). Disability Anitas state of consciousness has been evaluated through the Glasgow Coma Scale and is currently 15, indicating she is fully conscious and in no danger of disability pertaining to consciousness (Gabbe, Cameron, Finch, 2003). Nevertheless, her mental alertness should continue to be monitored. Nurses need to ensure Anita can communicate adequately, especially since AKI can affect mental status because of hypernatremia, as a result of low fluid volume. This happened because the vascular space becomes hypertonic and results in extracellular migration of water away from brain cells, hence accounting for neurologic symptoms (Lee, 2010). Also, Anita may be drowsy due to the morphine. Any mental status deficit should improve when Anita responds to treatment and stops opiate analgesia. Anitas repeated vomiting is disabling and is contributing to dehydration and electrolyte imbalances (Golembiewski, Chernin, and Chopra 2005; Gan, 2006), and clearly requires immediate attention. The underlying cause must be determined if appropriate interventions are to be used. Vomiting is common following anaesthesia, but is also linked to opioid treatment and also hypotension. There are a large number of drugs available to treat post-operative and opiate induced vomiting (Stevenson, 2006), however, Anitas renal status means that administering antiemetic medications  may be unwise. Anita is self-administering morphine, therefore the frequency of her usage, her level of pain control and alertness all need monitoring. In addition to sometimes causing sedation, nausea and vomiting, morphine can produce hypotension and respiratory depression, and obese patients, such as Anita, are at higher risk of these side effects. Therefore the risk/benefit of continuing PCA with this drug over n urse-controlled analgesia should be established; if continued Anitas respiration rate should be frequently assessed and she should be monitored for signs of opiate toxicity. Exposure Anitas wound must be checked regularly to ensure it is clean and there are no signs of opening or infection, especially given the trauma of her vomiting. Surgical drains and urine drains likewise must be kept patent and clean; whilst regular temperature checks would monitor pyrexia. The results of Anitas initial ABCDE assessment can now be put in to perspective by identifying key information to help devise her care plan through application of a second nursing framework. The Roper, Logan and Tierney Model (1980) Nursing Model and Care Plan The Roper, Logan and Tierney model (1980) can be applied to the case of Anita Brown in order to devise a tailored care plan. This model takes a holistic approach and allows the impact of Anitas morbidities on her activities of living (ALs) to be considered. The model identifies twelve activities ALs namely eating and drinking, working and playing, sleeping, elimination, washing and dressing, communication, breathing, expressing sexuality held in relation to lifespan and the dependence/independence continuum. The framework is simplistic, yet provides a means to develop a logical and systematic care plan that is based on teamwork and mutual coordination (Murphy et al., 2000). It allows systematic collection of information from a patients biological, physiological, sociocultural, environmental, and politico-economic, perspective (Roper, Logan, Tierney, 2000). The model is especially applicable in patients requiring acute care such as Anita, helping to highlight the priorities of care t hat must be undertaken (Murphy et al., 2000). Once assessment is complete, a plan of care can be formulated which takes into account lifespan and level of dependence but may not necessarily cover all ALs (Beretta, 2003). Here I will consider six of the most pertinent ALs which are relevant for Anitas 48-hour care. I will highlight Anitas problems in relation to the AL and describe the necessary nursing interventions and their goals as part of a 48-hour nursing care plan. Safe Environment Anitas skin should be healthy and in tact: Check integrity of wound; Anitas retching could rupture her stitches. Also check for infection or swelling following surgery using aseptic techniques. Record temperature regularly to ensure Anita remains apyrexial. Anitas vital signs are out of range: Closely monitor haemodynamic status, urinalysis and fluid balance status; these should be returned to normal through appropriate interventions. Check peripheral insertion line is patent, the fluid is running fast enough and the fluid is provided as prescribed. Accurately recording input (and output: see below). Anitas is vomiting: Anitas vomiting will be distressing. Treat the underlying cause of the vomiting, and immediately adopt simple interventions to alleviate symptoms e.g. provide adequate bowls and tissues, open a window or provide a fan. Anitas oral health may be compromised since she is vomiting and receiving nil by mouth. Offer assistance with oral hygiene. Anita is self-administering morphine: The potential for unwanted opiate side effects warrants investigation regarding level of usage and pain control. Discuss this with Anita and switched to nurse controlled non-opiate analgesia is possible. Breathing Anita respiration should be 15-20/min: Anita is slightly tacypnoeic. Regularly monitor vital signs and observations post-operatively. Since Anita is overweight she may easily get out of breath during minor exertion so encourage her to ask for nursing assistance if she needs help. Communication Anita should be coherent and respond appropriately to questions: talk to Anita about how she is feeling and ensure her AKI, post-operative status and/or analgesia is not adversely affecting her mental abilities. Be aware of non-verbal transmission of information such as facial expression of pain/discomfort. Elimination Anitas urine must be properly collected: regularly check the urine drainage bag and tubing to ensure patency and cleanliness and to record output. Similarly, if there is a wound drain in place. Provide bedpan/commode: It is unlikely that Anita will need to open her bowels, however, she should be encouraged to seek assistance and request a bedpan/commode should she need one. Anitas privacy and dignity must be respected throughout. Sleeping Anita may be sleepy: Anita may be drowsy from the morphine and want to sleep a lot. She is overweight, which may make her more prone to post-operative sleep apnea. Observe her when sleeping for signs of snoring or apnoea. Anitas posture and positioning on the bed is important, especially since she is at higher risk of pressure sores. Nurses would need to ensure Anita is not slumped but positioned in a semi-upright position and frequent repositioned. Mobilisation Anita must regain mobility: Anita is relatively young, but overweight which would hamper her everyday mobility. She should by encouraged to mobilise if possible such as assistance to a sitting position in a chair; this would reduce chances of post-operative thombosis. All of these nursing actions have been formulated in a 48-hour care plan, a proposal for which is shown in the Appendix. Although relatively young, and presumably previous to surgery largely independent, Anita is currently considerably dependent on nursing staff for many ALs. This is reflected in her care plan. The ultimate aim of the Roper model is to achieve goals that promote independence in all ALs. Achieving this objective requires regular evaluation of Anitas plan, which in turn requires accurate baseline data against which improvement or deterioration in her progress can be measured. The plan can then be adjusted accordingly (Holland, 2003). Conclusion Anita Brown has suffered AKI probably due to insufficient fluid replacement inter/post operation. The resultant drop in circulating volume has manifested in a number of adverse physiologic and haemodynamic events. Anitas symptoms are consistent with pre-renal AKI (although ATN cannot be ruled out (Cheung et al., 2008) necessitating swift intervention. The pathophysiology of AKI reveals that it is a multifaceted condition requiring complex clinical assessment (Lewington Kanagasundaram, 2010). Here I have described a simplified, logical approach to Anitas care, through the application of two systematic methodologies. The approaches advocated ensured all relevant assessments were performed and that appropriate and effective interventions were employed in the formulation Anitas 48-hour care plan. The ABCDE mnemonic was used since it represents a strong clinical tool for rapid assessment and treatment of patients such as Anita requiring swift and effective interventions. Whilst the Roper , Logan and Tierney (1980) model provided a holistic approach to patient care since it allowed assessment of the patient as a whole (OConnor and Timmins, 2002), and has thus taken into account Anitas specific needs and preferences, whilst ensuring she is treated appropriately (Clarke Ketchell, 2011). Adhering to such tried and tested formulae allowed delivery of an optimised, tailored care plan, which will improve Anitas prognosis and enhance overall outcomes.

Muromachi Period Essay -- essays research papers

The Muromachi style of Zen Buddhism has influence art and design ever since it’s beginning in the 14th century. Although it was influenced by the Chinese styles at a parallel time, they both are still influential and noticed in today’s world.   Ã‚  Ã‚  Ã‚  Ã‚  For years Japanese Ink Painting continued to be consistent with a basis on nature, and simplicity. Was the beginning of Minimalism in Japan? Was it intentional? The open composition of space and content on paper is a key of today’s design. The simplicity of monochromatic work is still appreciated in almost every art form.   Ã‚  Ã‚  Ã‚  Ã‚  This is a contrast to the Renaissance that occurred during the same time period. There was never work similar in Europe, it was mostly elaborate and colorful. This proves that the Asian styles are the origin of minimalism.   Ã‚  Ã‚  Ã‚  Ã‚  Even in architecture and landscape, there was interpretation and consistence of nature. The â€Å"Zen Garden† is a key concept that has lasted through the years. The Japanese styles of architecture were inspired by the consistency and simplicity of nature. They were the first to incorporate outside and inside, using a lot of patio space, and open surfaces, using round posts, and hinged translucent walls (Japan, 229).   Ã‚  Ã‚  Ã‚  Ã‚  The dominant styles of the Muromachi Period, Ink Painting, Landscape, and Architecture, are visible in today’s society in all cultures. Design fields incorporate the same appreciation that the Zen Buddhists did. Aesthetics, the set of principles of good taste and the appreciation on beauty, especially in the philosophy of art (Reader’s, 26). During the Muromachi Period, Sesshu (1420-1506) was known as the most famous artist in his medium of Ink Paintings. He was a monk that dedicated his life to painting. He traveled to areas of China and the natural landscape inspired his work heavily. He denied any influence from the Chinese art he saw on his journey. Like the work of Ni Zan (1308-1374), a Chinese Yuan Dynasty ink painter. (History, 842-861)   Ã‚  Ã‚  Ã‚  Ã‚  Sesshu’s most noted work was the â€Å"Winter Landscape.† This painting was done after his excursion through China, in the 1467. It is 18.25 x 11.5† in size, and was produced by rushing black ink on a paper. It is overlapped view of a landscape in the foreground, with large mountainous cliff... ...on of the arts really polluted all meaning behind it. This is a dramatic time in which the true Zen Monks doubted their faith in the work they produced. The understanding of this, left room for sarcasm, and criticism, and eventually dilution of the Zen theories of nature and serenity.   Ã‚  Ã‚  Ã‚  Ã‚  Put aside the debauchery of the art, this period has influenced so many cultures and design styles. It is key that styles like minimalism and even constructivism trace back to the monochromatic layout of image and text these monks produced.   Ã‚  Ã‚  Ã‚  Ã‚  Being a designer, it is astonishing to relate styles that I apply to work with these simple Buddhists. They lived a simple lifestyle, appreciating materials and imagery that both were provided by nature. The aesthetics applied is an important way of expressing yourself as a citizen of the world.   Ã‚  Ã‚  Ã‚  Ã‚  It is important that we as people seek to make the world better for mankind. Appreciating the elements, and applying workable solutions was a key contribution these monks made to society. Whether it is through our work or our deeds, it would be ideal that we all follow their example.

Fodor’s Misconstrual of Wittgenstein in the Language of Thought :: Philosophy Essays

Fodor’s Misconstrual of Wittgenstein in the Language of Thought In his book, The Language of Thought, Jerry Fodor claims that i) Wittgenstein’s private language argument is not in fact against Fodor’s theory, and ii) Wittgenstein’s private language argument â€Å"isn’t really any good† (70). In this paper I hope to show that Fodor’s second claim is patently false. In aid of this I will consider Wittgenstein's Philosophical Investigations (243-363), Jerry Fodor's The Language of Thought (55-97), as well as Anthony Kenny’s Wittgenstein (178-202). First I shall summarize Wittgenstein’s argument; then I will examine Fodor’s response and explain why it is fallacious. In my view, Fodor is wrong because he takes Wittgenstein to be a verificationist, and also because he makes a false analogy between people and computers. Anthony Kenny, in his book Wittgenstein, provides a concise summary and penetrating interpretation of Wittgenstein’s so-called â€Å"private language argument† (henceforth â€Å"PLA†). According to Kenny, the basic agenda of the PLA can be summed up in a quotation from Wittgenstein’s Tractatus: "Scepticism is not irrefutable, but obviously nonsensical, when it tries to raise doubts where no questions can be asked. For doubt only can exist where a question exists, a question only where an answer exists, and an answer only where something can be said." (Tractatus Logico-Philosophicus, 6.51) In making his argument, Wittgenstein addresses the belief that the knowledge we have of our own experiences can be expressed to ourselves or others, and that this expression does not assume acquaintance with the external world or other minds. Logically entailed by these beliefs is the idea that there is a private language in which words derive their meani ng by being linked with private experiences. In other words, a subject forms â€Å"internal ostensive definitions.† This means simply that the subject is exposed to and attends to an experience and associates it with a word. For Wittgenstein, this view is mistaken: experience is not private, and words do not acquire meaning by bare ostensive definition. Wittgenstein takes â€Å"private language† to mean a language in which words refer to the immediate private sensations of the speaker in this manner of private ostensive definitions. If a speaker has a certain sensation, she does not necessarily know that sensation only from her own case.