Commentary on John Keatss Poems Essay Example for Free

Commentary on John Keatss Poems Essay O golden-tongued Romance with serene lute! Fair plumed Syren! Queen of far away! Leave melodizing on this wintry day, Shut up thine olden pages, and be mute: Adieu! for once again the fierce dispute, Betwixt damnation and impassiond clay Must I burn through; once more humbly assay The bitter-sweet of this Shakespearian fruit. Chief Poet! and ye clouds of Albion, Begetters of our deep eternal theme, When through the old oak forest I am gone, Let me not wander in a barren dream, But when I am consumed in the fire, Give me new Phoenix wings to fly at my desire. COMMENTARY : The poem under study was written in 1818 after the completion of John Keatss 4,000-line poem Endymion. We are facing a traditional and fixed form of poem as Sitting Down to Read King Lear Once Again is an Elizabethan sonnet  composed of fourteen lines which are divided up into three quatrains, that is four-line stanzas, and a final couplet -or two lines of verse. The rhyming pattern is abba, cddc, efef, gg as, notably Lute (l.1) rhymes with mute (l.4), far-away (l.2) with day (l.3) and dispute (l.5) with fruit (l.8). Moreover, the lines are iambic pentameters since they contain five iambic feet for instance : _ / _ / _ / _ / _ / O Gol/den-tongued /Romance, /with se/rene Lute! Like most of Keatss poems, this text deals with the speakers encounter with something which incites him to meditate and alters significantly his vision of life. It is the perusal of King Lear written by William Shakespeare in 1605 which affects him this time and this is not a first reading judging by the presence of Once Again in the title. Keats was a great admirer of Shakespeare. The theme of death, which is one of Keatss main concerns, is latent in the poem. This sonnets thought can be divided into four parts. Firstly, chivalric romances are praised and put aside. Secondly, the effects they provoke are contrasted with those engendered by the reading of King Lear. Thirdly, the speaker begs Shakespeare and heaven , his sources of inspiration, to help him. Finally, he compares himself to the Phoenix, which has the power to be immortal. To begin with, the first quatrain opens with the interjection O which is by definition used to express strong feelings. Indeed, the poem is charged with lyricism, the two exclamation marks contributing to it among other things. In this way, we are conscious from the beginning that the speaker s rereading of Shakespeares tragedy makes him profoundly react. Then, the term Romance refers to medieval romance, a form of narrative which developed in the 12th century and related tales of chivalry and courtly love. Its heroes were idealized and the plot often contained  miraculous or supernatural elements such as dragons or monsters fighting for the sake of the heroine. The adjective which qualifies this genre of literature, that is Golden-tongued, means that it is wonderfully narrated. Besides, it can be paralleled with the realms of gold Keats refers to in the same first line of the sonnet Upon First Looking into Chapmans Homer, the phrase being there a metaphor for books he highly values. Next, the lute is a stringed instrument, whose music acts as an enchantment on readers and leads them to sweet thoughts. This first line is basically an apostrophe since the speaker directly addresses Golden-tongued Romance thus personifying it. The Fair plumed Syren is praised as well, the poet considering her a royal person -a Queen- who melodiz[es] (l.3). She is also present in the romance in question. A siren, in Greek mythology, is one of the three sea nymphs, usually represented with the head of a woman and the body of a bird. They inhabited an island surrounded by dangerous rocks and sang so enchantingly that all who heard were drawn near or shipwrecked. The tune produced by the lute can be compared to the bewitching one sang by the siren which irresistibly attracts the poet to like this kind of literature. But, the lexical field of pleasure including serene Lute, Fair plumed Syren and melodizing among other things is contrasted with more negative phrases such as wintry day, Shut up and mute. This indicates that the poet is willing to wander from the sweet thoughts these readings generate, the Golden-tongued Romance being a synecdote for chivalric romances in general. Moreover, the personification process is extended on line 4 since Golden-tongued Romance is addressed as though it was endowed with life and speech. Indeed, thine () Pages are the books. Moreover, the siren is used as a metonymy for the narrative insofar as the poet combines the two on line 4, the predicates Shut up and be mute referring to the nymph. Finally, the adjective olden alludes to this literatures ancient existence. In short, this first quatrain deals with the poets liking for medieval romances insisting on their enchanting power. Nevertheless, the latter wishes to dismiss them from his mind. And prosopopeia is aimed at showing that he is deeply affected by his rereading of King Lear. The second stanza is going to contrast images of beauty with what Shakespeares tragedy displays. Next, the second quatrain begins with the poet bidding farewell to pleasant meditations. But, we should first and foremost put this sonnet back in its context. We can easily presume that it is autobiographic, thus that Keats reveals us his own worries. In 1818, he is aware that he has short time left to live due to the fatal illness he is suffering from, that is tuberculosis. Moreover, we have already realized that he is scared of death, particularly in his When I have fears that I may cease to be. In the second stanza, the lexical field of hell is present through fierce, damnation and burn through. And the predicate burn through must be taken both literally and figuratively. On the one hand, it hints at Keatss future death. On the other, it indicates his agitation facing antagonistic directions as he is torn between hellish visions and sweeter meditations, designated by damnation versus impassiond clay. So, damnation is a metaphor for the thoughts the reading of King Lear provokes while impassiond clay refers to those generated by chivalric romances. The word clay probably makes reference to the Bible as the sacred book states that God made the human body with this material. So, it symbolizes fecundity and regeneration in other words life. Thus, it is tempting to infer that romances allow the poet to escape from reality whereas King Lears tragic fate reminds him of his bad condition. The second part of the quatrain deals with the poets will to concentrate on  Shaksperean fruit in other words on King Lear itself. While the first stanza introduced his liking for romances, this one gradually leads us to the subject of the poem i.e. the feelings and thoughts the reading of the tragedy trigger. King Lear is quite a sad story as it deals among other things with consequences of the fatal mistake the eponymous character makes at retirement as he divides his kingdom between two of his daughters Goneril and Regan thinking that the youngest Cordelia is the one who loves him the least. Once he realizes that his trusted girls intend to drive him away, he leaves them. Cordelia, disowned, became Queen of France. She is informed of the situation and lands on her fathers old kingdom with an army to fight the other girls. The play ends in a disaster since Goneril, ashamed because unmasked by her husband, who had not known how wicked his wife was, suicides herself after having poisoned her sister Regan, out of a spirit of jealousy. And Cordelia, defeated by her sisters, is hung in prison. Lear dies last, his dear daughter in his arms. The adjective bitter-sweet (l.8) hints at both the pleasure the speaker takes rereading the story and aforementioned sad thoughts. The death of the characters actually reminds him he is to die soon. To summarize, literature acts as a catalyst on Keats since it makes him meditate. And between the images of beauty romances trigger and the unhappy thoughts King Lear provokes, he finally chooses to concentrate on Shakespeare. The reasons of this choice are going to be given in the third stanza. The third quatrain begins in the same way as the second, with an exclamation. Chief Poet! is a characteristic attributed to Shakespeare. In fact, the speaker aims at emphasizing his admiration for the playwright. Then, Albion is the name given by elders to Great Britain because of its white cliffs -in Latin albus means white. This is also where King Lear takes place. And a theme, in a work of literature is an idea that the writer develops or  repeats. If we take into account this definition, Chief Poet! and ye clouds of Albion, Begetters of our deep eternal theme! may mean that Shakespeare and Great Britain are the poets inexhaustible inspiration. Next, the speaker identifies with Lear on line 11. When the latter realizes that what Goneril and Regan really want is to chase him away, he leaves. It is a wild and stormy night and he wanders about the fields half mad with misery. So, lines 11 and 12 allude to that very episode in the tragedy. This is an instance of intertextuality. In addition, we can perceive the presence of heaven in this stanza. First, the phrase clouds of Albion reminds us of that biblical place which is usually imagined as being high up in the sky. And spirits walking on clouds are often pictured. Moreover, the fact that Great Britain is named Albion because of its white cliffs conveys the idea of a bridge between earth and heaven or life and death. Next, the old oak forest is highly symbolical. In many traditions, the oak is a sacred tree which is vested with privileges of heavens supreme divinity. It is also considered as an intermediary between earth where it puts its roots and the vault of the sky that it touches with its top. That is probably due to its majestic appearance and because it attracts lightning. So, the oak forest can be regarded as a sacred and secluded place, in other words as a kind of sanctuary in which the poet roams waiting for his impending death. Personification is also used as the subject of the predicate Let me not wander in a barren dream is not only Chief Poet but also clouds of Albion. Keatss fear to die is perceived in that line and begging the deceased playwright to save him is a way of highlighting his sacredness. Let us remind of Keatss admiration for Shakespeare. Therefore, the Elizabethan writer and heavens importance are dealt with. They are the source of the speakers inspiration and his saviour. The final couplet is about the poets yearning to be reincarnated. Lastly, the legend of the Phoenix is introduced. In ancient Greek and Egyptian mythology, it is a bird. When it felt its death approaching -every 500 or 1461 years-, it would build a nest of aromatic wood, set it on fire and was consumed by the flames. When it was burned, a new phoenix sprang forth from the pyre. In these two lines, the poet compares himself to the mythical bird endowing himself with the same powers as its own, that is those of resurrection and immortality. Indeed, he is tormented by his impending death and yearns to be immortal, what he achieves in a way since 175 years after his death, he is still much read, valued and studied in universities. To conclude, it is pensive introspection in the form of lyric poetry on a young mans impending death. We are made aware of Keatss visionary experience rereading King Lear. His liking for romances is highlighted nevertheless he chooses to concentrate on Shakespeares masterpiece as it makes him think about his worries. Indeed, literature acts as a catalyst for meditation. Finally, we focus on the poets fear of death and yearning for immortality.

Healthcare Training in Simulated Environments

Healthcare Training in Simulated Environments Simulation Introduction â€Å"Clinical simulation is pretending for the purpose of improving behaviors for someone elses benefit (Kyle Murray, 2008, p.xxiv).† All respiratory therapists are trained to manage the airway of an unconscious patient. Endotracheal intubation is the most effective method of securing the airway but is a complex psychomotor skill requiring much practice. Historically, endotracheal intubation had been taught on patients, cadavers or animals, but this was not ideal. Mannequin training is one of the best options for instructing large numbers of students in a variety of skills (Gaiser, 2000) therefore the Respiratory Therapy program at TRU has adopted training on mannequins as a core component of their courses. Intubation trainers have been used for over 30 years (Good, 2003) but there is little published information on the relative merits of the available airway and intubation trainers. A variety of airway trainers with differing features are now commercially available from the low fidelity, part task trainer, that TRU respiratory therapy program utilizes, to the high fidelity, whole patient simulator that is becoming increasingly popular today. Training health care practitioners in a simulated environment without actual patients is a potential method of teaching new skills and improving patient safety (Issenberg et al, 1999; Devitt et al, 2001; Lee et al, 2003). pt safety Simulations are defined as activities that mimic the reality of a clinical environment and are designed to demonstrate procedures, decision-making, and critical thinking through techniques such as role-playing and the use of devices such as interactive videos or mannequins. A simulation may be very detailed and closely simulate reality, or it can be a grouping of components that are combined to provide some resemblance of reality. (Jeffries, 2005) definition of simulation Computer based simulations and part-task training devices can provide a certain degree of real-world application. These focus on specific skills or selected areas of human anatomy. High-fidelity patient simulators can provide real physical inputs and real environmental interactivity. To recreate all elements of a clinical situation, a full-scale or high fidelity simulation would be used. Costs of simulators will vary widely depending on purchasing costs, salaries, how faculty time is accounted for, and other factors. (Jeffries, 2005) simulators, high fidelity, costs Modern technology, such as high fidelity simulation offers unique opportunities to provide the â€Å"hands-on† learning. High fidelity simulation offers the ideal venue to allow practice without risk and there are an infinite number of realistic scenarios that can be presented using this technology. As an example, life threatening cardiac arrhythmias can be simulated on a life like fully computerized mannequin. Mo nitors, identical to those used in the clinical situation can replicate the arrhythmia and corresponding changes in vital signs. The ‘patient can be fully and realistically resuscitated with technical and pharmacological interventions. Viewing of videotaped performances allows personal reflection on the effectiveness of the case management. Morgan et al, 2006 example of use of high fidelity sim. High fidelity simulation provides a venue to teach and learn in a realistic yet risk free environment. The ‘patient is represented by a computer-controlled mannequin who incorporates a variety of physiological functions (e.g. heart and breath sounds, pulse, end-tidal carbon dioxide). An instrumentation computer network can replicate situations likely to be encountered in an emergency room, critical care environment or operating room. A second person controls the mannequin and the monitors. The simulator mannequin will respond on an accurate way to induced physiologic or pharmacologic interventions. The ‘patient will respond according to pre-set physiological characteristics (e.g. a young healthy adult or a geriatric patient with severe emphysema). In addition, the ‘patient has the ability to speak, move his arm, and open and close his eyes and has pupils that can dilate and constrict. The simulation room can be set up to appropriately reflect the environment, either an emergency room, a recovery room, or a fully equipped operating room. Attached monitors respond to a medical intervention. Feedback from participants in the simulated environment has attested to the ‘realism of the environment (Morgan Cleave-Hogg, 2000). Morgan et al, 2006 set up of HPS A simulator replicates a task environment with enough realism to serve a desired purpose and the simulation of critical events has been used instructionally by pilots, astronauts, the military and nuclear power plant personnel (Gaba, 2004). The fidelity, or the â€Å"realness†, of simulations can vary in many ways, such as the use of simple case studies, utilization of human actors to present clinical scenarios, computer-based simulations, and the use of high-fidelity patient simulators that respond to real-world inputs realistically (Jeffries, 2005; Laerdal, 2008; Seropian, 2003). Recently, literature has described that using full-sized, patient simulators are a way of creating â€Å"life-like† clinical situations (Fallacaro Crosby, 2000; Hotchkiss Mendoza, 2001; Long, 2005; Parr Sweeney, 2006). While simulation has been used by the aviation industry with flight training for years (Gaba, 2004), the use of a rudimentary human patient simulator in the health care fiel d was first introduced in 1969 to assist anesthesia residents in learning the skill of endotracheal intubation (Abrahamson, Denson, Wolf, 1969; Gaba DeAnda, 1988). The more realistic human patient simulators were not created until 1988 and were used primarily to train anesthesiologists (Gaba, 2004). Defining simulation in health care education The literature on human patient simulation has tried to define several of the terms used in this study. However, there is no general consensus on many of these terms, including a debate on whether the simulator is a mannequin or a manikin (Gaba, 2006). One key term that requires specific definition for this study is high-fidelity mannequin-based patient simulator. The term â€Å"fidelity† is used to designate how true to life the teaching experience must be to accomplish its objectives (Maran Glavin, 2003). Using this definition, fidelity becomes a scale where if given the objectives, a single piece of medical simulation equipment may be able to provide a â€Å"high-fidelity† experience for one objective but be â€Å"low-fidelity† for another objective. An example would be the insertion of a radial arterial catheter. If the objective were to only teach the psychomotor skills required for inserting the catheter, a relatively simple arterial blood gas access arm, part-task simulator would be adequate and provide a high-fidelity experience. But if the objective were expanded to include communication with the patient and members of the health care team, then the same device would suddenly become low-fidelity, as there is no feedback being delivered with catheter insertion and communication with the patient is not possible. Beaubien Baker (2004) noted that the term ‘fidelity is frequently documented as a one-dimensional term that forces a static classification of simulation devices. Individuals with this view would have difficulty agreeing with the use of the terms as explained in the previous paragraph. Maran and Glavin (2003) offered this definition: â€Å"Fidelity is the extent to which the appearance and behaviors of the simulator/simulation match the appearance and behaviors of the simulated system (p.23).† Yaeger et al (2004) broke fidelity down into three general classifications: low-medium-and high-fidelity and explained that low-fidelity simulators are focused on single skills and permit learners to practice in isolation while medium fidelity simulators provide more realism but lack sufficient cues for the learner to be fully immersed in the situation. High-fidelity simulators, on the other hand, provide adequate cues to allow for full immersion and respond to treatment interventions. For the purposes of this study, the following definitions will be used: 1. High-fidelity patient simulator A full-bodied mannequin that replicates human body anatomy and physiology, is able to respond to treatment interventions, and is able to supply objective data regarding student actions through debriefing software. 2. Low-fidelity simulator A part task trainer or a full-bodied mannequin that replicates human anatomy, but does not have physiologic functions (including spontaneous breathing, palpable pulses, heart and lung sounds, and voice capabilities), does not have a physiologic response to treatment interventions, and does not have a debriefing software system. Use the next two statements at the beginning of other sections on simulation: * â€Å"Simulation is a training and feedback method in which learners practice tasks and processes in lifelike circumstances using models or virtual reality, with feedback from observers, peers, actor-patients, and video cameras to assist improvement in skills (Eder-Van Hook, 2004, p.4).† * â€Å"Simulation is a technique†¦.to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner (Gaba, 2004, p.i2).† When we are looking at the use of high-fidelity patient simulators in health professions education, we have to be aware of and not confuse the simulator with the simulation. As Gaba (2004) described, â€Å"Simulation is a technique not a technology (i2).† The mannequins or other devices are only part of the simulation. Dutta, Gaba and Krummel (2006) noted a gap in the research literature, stating, â€Å"A fundamental problem in determining the effectiveness of surgical simulation has been an inability to frame the correct research question. Are the authors assessing simulation or simulators (p.301)?† Simulation has many applications. The teaching of psychomotor skills seems an obvious use for simulation but there are other areas that simulation can be utilized effectively. Rauen (2004) listed several areas in addition to psychomotor skill training where simulation has been used. Her list included teaching theory, use of technology, patient assessment and pharmacology. Rauen (2004) notes that the â€Å"emphasis in simulation is often on the application and integration of knowledge, skills, and critical thinking (para 3).† History and Development of Simulation in Healthcare education The history of simulation in healthcare has been well documented by several authors including Bradley (2006), Cooper and Taquito (2004), Gaba (2004) and Rosen (2004) and began with the use of models to help students learn about anatomical structures. Although the use of mannequins as the simulation model is relatively new (Bradley, 2006), simulation using animals as models dates back over 2000 years. Mannequins were utilized as models in obstetrical care as early as the 16th century (Ziv, Wolpe, Small, Glick, 2003). The more modern medical simulators originated in the 1950s with the development of a part-task trainer called ‘Resusci-Anne that revolutionized resuscitation training (Bradley, 2006; Gaba, 2004). Part-task trainers are meant to represent only a part of the human anatomy and will often consist of a limb or body part or structure. These low fidelity modesl were developed to aid in the technical, procedural, or psychomotor skills, such as venipuncture, catheterization and intubation (Kim, 2005), allowing the learner to focus on an isolated task. Some models provide feedback (visual, auditory or printed) to the learner on the quality of their performance (Bradley, 2006; Good, 2003). Another general classification of patient simulators that combines some of the elements of both three-dimensional models and task-specific simulators is partial or part task simulators (Kyle Murray, 2008). Issenberg, Gordon, Gordon Safford, and Hart (2001) used the term procedure skills simulator for this type of device. Maran and Glavin (2003) stated, â€Å"part-task trainers are designed to replicate only part of the environment (p.24).† and replicate anatomy and physiology of a single portion of the human body. As described by Beubien and Baker (2004), the skills taught with part task simulators â€Å"segment a complex task into its main components (p. i53).† Rather than creating complex scenarios commonly done with high fidelity patient simulation, part task trainers permit students to focus on individual skills instead of more comprehensive situations. Examples would be an arm with vascular structure to teach arterial blood gas procedures or a head with upper airw ay anatomy to practice advanced difficult airway procedures. The second wave of modern simulation, with the development of full-scale, computer controlled, mannequin based patient simulators started in the 1960s with the development of Sim One (Bradley, 2006; Gaba, 2004; Good, 2003). SimOne had many of the features found on the high-fidelity mannequin-based patient simulators used today. SimOne was quite lifelike, and fitted with a blood pressure cuff and intravenous port. SimOne was able to breath, it had a heartbeat, temporal and carotid pulse and a blood pressure (Abrahamson, 1997). Patient simulators have become very sophisticated over the years and now allow a wide range of invasive and non-invasive procedures to be performed on them, as well as enabling teamwork training (Davis, Buono, Ford, Paulson, Koenig and Carrison, 2006). When they are set up in a simulated and realistic environment, they are often referred to as high-fidelity simulation platforms (HFSP) or human patient simulators (HPS) (Kim, 2005). Components of the human patient simulator (HPS) include a mannequin and computer hardware and software. The HPS has characteristics expected in patients such as a pulse, heart and lung sounds, and blinking eyes with reactive pupils. The mannequin also supports invasive procedures, such as airway management, thoracentesis, pericardiocentesis and catheterization of the bladder (Laerdal, n.d.). Medical Education Technologies, Inc. (METI) introduced the Human Patient Simulator (HPS) in 1996. It has subsequently followed with PediaSim in 1999, a simulator utilizing the HPS software but scaled down to mimic a child. In 2005, BabySim was introduced. While being the first to enter the market with a full-bodied mannequin for patient simulation purposes in resuscitation with the Resusci Anne in 1960, Laerdal Medical did not introduce a high-fidelity patient simulator until 2000 with the introduction of SimMan. This device does not possess all the high-level functionality of METI HPS, but does provide adequate fidelity for many medical emergency situations. The Laerdal Medical SimMan also differs from the others in that it does not operate on mathematical models for simulator responses. Instead, it operates on instructor controls combined with script-based control logics. The Laerdal Medical SimMan patient simulator is the device to be used in this study. Details of the simulators functions are found in appendix ____. Aside from high-fidelity mannequin based patient simulators, there are many other types of simulation used in healthcare provider education and training. Collins and Harden (1998), Issenberg, Gordon, Gordon, Safford, and Hart (2001), and Ziv, Small and Wolpe (2000) discussed several other forms of simulation. The list includes animal models, human cadavers, written simulations, audio simulations, video-based simulations, three dimensional or static models, task specific simulators and virtual reality simulation. (Add VR reference?) Perhaps the next step in the evolution of health care teaching modalities is virtual reality (VR) simulation. Commercial VR simulators now exist to teach various trauma skills (Kaufman Liu, 2001). In a study of the effectiveness of using a VR bronchoscopy simulator, students quickly learned the skills needed to perform a diagnostic bronchoscopy at a level that was equal to those who had several years of experience (Colt et al, 2001). Simulation has been used for many years in the aviation and nuclear power industries and other highly complex working environments in which the consequences of error are costly (Bradley, 2006). A simulator designed to mimic the anesthesia patient was first developed in 1988, and since then, the number of hospitals and universities buying simulators for educational purposes is increasing (Henrichs, Rule, Grady and Ellis, 2002). The human patient simulator is used in health care education because it is a high-fidelity instrument that provides both educators and students with a realistic clinical environment and an interactive â€Å"patient† (Feingold, Calaluce and Kallen, 2004). The cost of simulation is related to the level of fidelity and the technology being used. For high fidelity patient simulators, purchase costs can range from $30,000 for the Laerdal Medical SimMan or the METI ECS to over $200,000 for the METI HPS. Optional equipment available for these simulators can make the purchase costs even higher. In addition to the simulator, it is important to create a learning environment that replicates real-world settings, complete with appropriate medical equipment. Halamek et al. (2000) stated, â€Å"The key to effective simulation-based training is achieving suspension of disbelief on the part of the subjects undergoing training, ie, subjects must be made to think and feel as though they are functioning within a real environment (para 15).† Creating this environment adds additional costs to setting up a simulation-based medical education program. Advantages of using simulation in health care education Patient simulation of all types, including high-fidelity patient simulation, is becoming more common in many aspects and levels of healthcare provider education (Good, 2003; Issenberg, McGaghie et al., 1999; leblond, Russell, McDonald et al, 2005). The reasons behind the increased use of patient simulation include the advancement of medical knowledge, changes in medical education, patient safety and ethics. For new healthcare providers it is also important to consider the changing student demographic, as todays students are more comfortable with technology. Issenberg, McGaghie et al. (1999) pointed out several advantages to the use of patient simulators, stating â€Å"Unlike patients, simulators do not become embarrassed or stressed; have predictable behavior; are available at any time to fit the curriculum needs; can be programmed to simulate selected findings, conditions, situations, and complications; allow standardized experience for all trainees; can be used repeatedly with fid elity and reproducibility; and can be used to train both for procedures and difficult management situations. (p. 862)†. Advancement of medical knowledge Medical knowledge is continually growing with new tests, medications, and technologies that all bring about innovative understandings and expertise. The problem with educating health care providers with this new knowledge is that their curriculum is of a finite length therefore innovation in the curriculum is needed in order to prepare future health care providers. Issenberg, Gordon, Gordon, Stafford, and Hart (2001) made the following comments: â€Å"Over the past few decades, medical educators have been quick to embrace new technologies and pedagogical approaches†¦ in an effort to help students deal with the problem of the growing information overload. Medical knowledge, however, has advanced more rapidly than medical education†¦Simulation technologies are available today that have a positive impact on the acquisition and retention of clinical skills. (p.16) Changes in medical education Healthcare provider education has typically been taught using a lecture/apprenticeship model (McMahon, Monaghan, Falchuk, Gordon, Alexander, 2005) that relies on observation and repetition (Eder-Van Hook, 2004). Halamek et al. (2000) noted the traditional model of medical education has three components: the learner performs a reading of the literature, the learner observes others with greater experience, and then the learner develops hands-on experience. This is the traditional medical model of education that has been in use for over 2,000 years (Current state report on patient simulation in Canada, 2005). In relation to the traditional model, Issenberg, Gordon, Gordon, Stafford and Hart (2001) observed, â€Å"This process is inefficient and inevitably leads to considerable anxiety on the part of the learner, the mentor, and at times the patient (p. 19).† McMahon, Monaghan, Flachuk, Gordon, and Alexander (2005) stated this model â€Å"is inefficient in promoting the highest level of learned knowledge, as reflection and metacognition analysis occur independently, often without guidance and only after extended periods of time when students are able to piece together isolated experiences (p. 84-85).† Customarily, this format is often referred to as the â€Å"See one, do one, teach one† model of medical learning (Brindley, Suen Drummond, 2007; Eder-Van Hook, 2004; Gorman, Meier, Krummel, 2000; Yaeger et al., 2004). Halamek et al. (2000) identified several problems with the current medical education model which includes; 1. Reading of the literature does not produce competency. More active rather than passive participation in the learning experience is needed; 2. Learners may have difficulty determining if their model for observation is a good or poor model. Just because the model may be senior does not mean they are competent. 3. The variability of experiences in the apprenticeship model is high, therefore learners experiences will not be equal, and 4. Many training settings do not fully represent the complexity of the real world resulting in an inability of the learners to adequately practice their decision-making skills in a â€Å"real† environment. Yaeger et al (2004) reinforced these points stating that healthcare education rely on two fatally flawed assumptions. The first assumption is that all clinical role models are effective and skilled, and all behaviors demonstrated by these role models are worthy of replication. The second assumption is that the end of the training period implies that a trainee is competent in all the skills necessary for successful clinical practice (Yaeger et al, 2004). Yaeger (2004) also noted that in the apprenticeship model, there is a need for a preceptor but this preceptor may not have the necessary skills to be an effective educator. Patient safety A predominant theme in many discussions of high-fidelity simulation is the concept of patient safety. In the education of healthcare providers, there are sometimes conflicting goals. As Friedrich (2002) commented in quoting Atul Gawande, â€Å"medicine has long faced a conflict between ‘the imperative to give patients the best possible care and the needs to provide novices with experiences (p. 2808).† When looking at the broader topic of medical simulation, the concept of patient safety is a frequently mentioned subject (Bradley, 2006; Cleave-Hogg Morgan, 2002; Ziv, Ben-David, Ziv, 2005). Much of the incentive behind the focus on patient safety relates back to the Institute of Medicine 2000 report To Err is Human: Building a Safer Health system (Kohn, Corrigan, Donaldson, 2000). This study reported over 44,000 people and possibly up to 98,000 people die each year in United States hospitals from medical errors. The total annual cost of these errors is between $17 billion and $29 billion. Even more alarming is the fact that these findings represent only the hospital sector of the healthcare system. The number of lives affected would be even higher if other parts of the healthcare system were included such as long term care facilities and Emergency Medical Services. In its summary of recommendations, the report specifically mentions simulation as a possible remedy, stating â€Å"†¦establish interdisciplinary team training programs for providers that incorporate proven methods of team training, such as simulation (p.14).† In Canada, it was estimated there were 70,000 preventable adverse events in Canadian hospitals with an estimate of deaths associated with those errors ranging from 9,000 to 24,000 (Current state report on patient simulation in Canada, 2005). The Canadian Patient Safety Institute supports the use of simulation as a means of improving patient safety in Canadian hospitals. In the conclusion of its report on patient simulation, the institute stated: Growing awareness of adverse events in Canadian hospitals, combined with increasing emphasis on patient safety, has changed the traditional â€Å"learning by doing† approach to healthcare education. Anecdotal evidence reveals the promising potential of simulation to fundamentally change the way healthcare professionals practice and further hone their skills, interact across disciplines, and manage crisis situations. (Current state report on patient simulation in Canada, 2005, p.23) Ethical perspective One of the strongest statements made regarding the ethical perspective of simulations was presented by Ziv, Wolpe, Small and Click (2003). Under the title â€Å"Simulation-Based Medical Education: An Ethical Imperative†, the authors presented an argument that not using simulation was more than just an education issue, it was an ethical issue. As they report, there is often an over reliance on vulnerable patient populations to serve as teaching models when other resources exist that would provide adequate and possibly, more superior replacements. The education of healthcare providers requires a balancing act between providing the best in patient care while also providing learning opportunities for the healthcare professions student (Friedrich, 2002). To protect patient safety, actual patient contact is often withheld in the healthcare provider learning process to a later period in their education. One of the principle reasons patient simulation is being indicated as a partial remedy for the medical errors crisis is its ability to impact on a particularly vulnerable time in the learning process. As Patow (2005) cited, the â€Å"learning curve† faced by many healthcare professions students is a source of medical errors. He continued, stating that the realism of many of the currently available simulators is quite high and allows for procedures to be practiced to mastery prior to being tested on real patients. But simulations offer much more than just practice. Since medical errors often result from ineffective processes and communication, simulation allows teams â€Å"to reflect on their own performance in detailed debriefing sessions† (Patow, 2005, p.39). This opportunity to review, discuss, and learn from the simulation is an important step in the learning process. The use of patient simulation in the training of healthcare providers is not limited to new students. There is also a need to maintain education in the health professions and simulation can be utilized effectively in this area as well (Ziv, Small Wolpe, 2000). As in other reports, Ziv, Small and Wolpe (2000) restated the shortcomings of the traditional model and explained that simulation was not just for the beginner but also for the expert who is expected to â€Å"continuously acquire new knowledge and skills while treating live patients (p.489).† These authors feel simulation, when used across the range of health professions education, can make an impact on patient safety by removing patients from the risk of being practiced upon for learning purposes. Gaba (2004) pointed out there are also many indirect impacts of patient simulation on patient safety. These areas of impact include improvements in recruitment and retention of highly qualified healthcare providers, facilitating cultural change in an organization to one that is more patient safety focused, and enhancing quality and risk management activities. A final point on patient safety is the ability to let healthcare providers make mistakes in a safe environment. In real patients, preceptors step in prior to the mistake being beyond the point of recoverability or if the mistake occurs (particularly for those healthcare providers who are not longer students), there is a very limited instructive value to the case. Ziv, Ben-David, and Ziv (2005) stated, â€Å"Total prevention of mistakes, however, is not feasible because medicine is conducted by human beings who err†¦[Simulation Based Medical Education] may offer unique ways to cope with this challenge and can be regarded as a mistake-driven educational method (p.194).† They continued stating that Simulation Based Medical Education is a powerful learning experience for students and professionals where â€Å"students are permitted to make mistakes and are provided with the opportunity to practice and receive constructive feedback which, it is hoped, will prevent repetition of such mistakes in real-life patients. (p.194)†. Ethical Use of Simulation (incorporate these paragraphs into previous on pt safety) Health care educators, whether from nursing, respiratory therapy, or medicine, find themselves in similar situations in deciding how to teach patient management to their students. Bioethicists have long condemned the use of real patients as training tools for physicians (Lynoe, Sandlung, Westberg, Duchek, 1998). Unfortunately there have been times in which the student learning has occurred to the detriment of patients (Lynoe et al, 1998). However, with the advent of high-fidelity human patient simulation approaches to learning, it may be time to adopt this method of instruction in the development of interprofessional education. The Institute of Medicine (IOM) recently issued a report on medical errors and recommended the use of interactive simulation for the enhancement of technical, behavioural and social skills of physicians (Kohn, Corrigan Donaldson, 1999). Numerous accounts are found in the medical literature touting the use of human patient simulation in the education of health care personnel at all levels, from student to attending physicians. Patient simulation is used for training personnel in several areas of medical care such as trauma, critical care, surgery and anaesthesiology, mainly due to the extensive skill required to perform adequately the procedures and techniques relevant to these areas. Several researchers have demonstrated the effectiveness of simulation in the skill development of medical personnel (Morgan et al, 2003; Lee, Pardo, Gaba, Sowb, Dicker, Straus, et al., 2003; Hammond, Bermann, Chen Kushins, 2002). In areas with low technology, such as internal medicine and in acute care areas providing less procedural skills but greater decision making requirements, the use of simulation in the education of its clinicians has progressed (Ziv, Wolpe, Small Glick, 2003). Despite the growing support for the use of simulation in health care education, there is not yet enough evidence to support its use. Simulation Research in Medical Education In 1998, Ali, Cohen, Gana Al-Bedah studied the differences in performance of senior medical students in an Adult Trauma Life Support (ATLS) course. This course uses simulated scenarios to both teach and evaluate students performance in trauma situations. The students were divided into three groups; 32 medical students completed a standard ATLS course, 12 students audited the course (without participating in the sessions or taking the written exam) and a control group of 44 matched students who had no exposure to ATLS. Of note is that some participants from all three groups were doing clinical hours in trauma hospitals during this study while others were not. The participants were observed while managing the standardized (live) patient in simulated trauma and non-trauma scenarios. The participants management of the sessions was scored on

Maglev Trains :: Magnet Train Trains Essays

Maglev Trains As almost any child knows, magnets have the ability to attract and repel other magnets. This knowledge is now being utilized in separate projects in Germany and Japan to propel and levitate a new and innovative type of train, the magnetic lift train. A German company called Transrapid is now able to build a train takes advantage of a magnets ability to attract magnetic materials. Upon observing the system from a distance, it looks to be composed of only T-shaped track and a train that wraps around the ledges of the track. However, the wrap-around part of the train hides the mechanisms that cause the train to levitate and to fly through the air. Ferromagnets on the underside of both of both the track’s ledges attract electromagnets on the wrap-around-the-track part of the train that is adjacent to the ferromagnets. A computer controls the amount of current flowing through the electromagnets in order to keep the train at a constant 1 cm from the track (#5). These electromagnets are powered by onboard batteries that are charged by linear generators that convert motion into electricity. In addition, the train needs more than its levitation system to maintain its proper lateral position on the track. The Transrapid syst em accomplishes this feat by creating an attractive field between magnets on both the track’s ledge’s sides and on the interior sides of both the warp-around-the-track parts of the train. The two attractive forces cancel each other out and cause the train to remain in the same lateral distance from the track.(Most of the information is form #4.) In addition to levitating the vehicles with magnetic forces, the Transrapid train’s propulsion system also uses magnetism. The forces used to propel and break the vehicle are both created with the aluminum three-phase cable winding in the ferromagnets on the track and the electromagnets on the train. The train moves forward when an alternating current, supplied by an outside source, is sent through the windings on the track. This creates an alternating magnetic field that both pushes and pulls the train along the track. In order to slow the train down the alternating current is reversed. This causes the train to be pushed and pulled in the direction opposite of its motion. Also, this system is energy efficient because instead of electrifying the entire track, the only electrified part is length where the train is traveling.

Inhaling Knowledge :: Personal Narratives Drugs Illegal Narcotics Essay

Inhaling Knowledge When I was a young girl, my dad and I would drive to Chinatown every third Saturday of the month to get his monthly dose of rice. Through the west side of Chicago we went. My dad always complained about the litter, the lack of cleanliness and how easy it would be to keep the city clean if everyone just took care of their own trash. Looking out the window, I remember seeing trash piled high on every corner, as if garbage had taken the place of grass. Graffiti covered every building we passed, broken windows everywhere. It always made me sad that people had to live in such an environment, but I can so vividly remember laughing at the sight of gym shoes tied together, hanging high above me from the telephone lines in this part of town. Every few blocks I'd see another pair, and another, and another! What a funny joke, I thought to myself. How did some one even get them up there? Little did I know that these shoes hung high in the sky, once bringing a smile to my face, would one day fil l my heart with sorrow and pain, threaten the binds that held my family so close together or almost take the life of my beloved sister. Never in my worst nightmare could I imagine something so right could go so wrong. I grew up in a family of three children, an older brother and a sister eighteen months younger, with two loving parents who would walk to the moon and back to keep us happy and healthy. I was one of the luckiest kids in the world, I used to tell myself, because when nothing else in my life was right, I always had my family to cheer me up and make my troubles disappear. I thought that is how each and every one of us felt, but I guess I was wrong. Some people have a talent of hiding how they are feeling; they keep her pain bottled up until one day when their bottle gets too full, it explodes. This is what happened to my sister, Susan. She was never one to be very open with her feelings or what she was thinking. I can still remember our weekly arguments about her not telling me what was going on in her life—school, friends, karate, boyfriends, work.

Secrets of Spanish Cuisine Essay -- essays research papers

Two of my favorite foods are Spanish rice and homemade flour tortillas. Unfortunately, I have only prepared the Rice-a-Roni version of Spanish rice and used store-bought tortillas because it less time consuming. My feelings changed yesterday when my teacher, Mrs. Hernandez, taught me how to make the rice from scratch. In order to make Spanish rice, you need the following ingredients: 2 cups of regular white rice, 1 small onion,  ¼ cup of oil, 1 small green bell pepper, 1 small tomato, 4 oz of tomato sauce, 2 cloves of garlic, 4 to 5 cups of water, 1 tbsp of salt, and a touch of black pepper.   Ã‚  Ã‚  Ã‚  Ã‚  To begin, chop the bell pepper, tomato, and onion into very small dices. Next, turn the stove burner on high and place your pan with the cooking oil added on top to pre-h...

Confucius and Plato

Confucius and Plato Editor Ken Wolf, at the beginning of the essay Confucius and Plato: A Few Really Good People, poses the question: â€Å"What is the best way to create a strong society? † (Wolf 25) It was surprising to a novice student of philosophy how similar the ideas of the ancient Chinese sage Confucius and famous Greek philosopher Plato were. Although, Confucius and Plato both made major contributions to the development of society, they showed both similarities and differences in these three subjects: ruling class, education, and faith in humanity.Confucius and Plato both believed virtue and intelligence were key components to creating a strong society. Confucius thought anyone who has been educated had the capability to develop into a ruler. Whereas Plato assumed anyone could be educated, but only a few, those in the ruling class had the ability to reason and thus were qualified to rule. In addition, Plato gave credence to the idea of being born into the ruling class , that the quality to reason was an inherited quality. Confucius and Plato were both strong believers that order was another main factor in a strong society.Although they both had laws to maintain the order, Plato had less faith in people in general to behave in a civilized manner. Both Confucius and Plato were in favor of education and were teachers themselves. Confucius’s followers were the ones who wrote the Analects, which talked about how civilization depends on â€Å"humanity† and â€Å"propriety†. Plato actually wrote The Republic which talked about his ideal â€Å"philosopher-king†. Plato established the Academy, which taught principles of ethics and government, for 900 years. Confucius attempted to teach the ruler to become a better person, but failed.The concepts put forth by Confucius and Plato begin to differ more when faith in humanity comes into play. Confucius and Plato both wanted to think there was good in everyone, but Confucius believed more in a â€Å"†¦society in which human relationships—especially those within the family—were more important than laws. † (Wolf 27) Plato concluded that the people needed to be controlled for there to be order. That control was maintained through the law. They both sought out peace and harmony, although Confucius focused more on the behavior of individuals and Plato was interested in universal truth even though it probably would not be accepted,.Plato felt that if a person tried to bring enlightenment to the masses â€Å"†¦they would probably try to kill to him for telling such tall tales, disrupting their lives and challenging their accustomed beliefs. † (Wolf 31) Even today, most people would agree with Confucius and Plato about the importance of educating people in the development of a strong society. The idea of relationships as the basis of society may be summed up in: â€Å"Do unto others as you would have them do unto you. This Golden Rule seems to be as important to Western society as it was to Chinese society. However, the idea of a better quality of citizen that is better suited to lead society smacks of elitism and would definitely not be accepted in modern democracies. However, that does not mean that the elite educated class from Harvard and Yale has not been overrepresented in American leadership. So perhaps we have a ruling elite, but not as overt as Plato would like. A final thought from the essay would be: a harmonious and orderly existence is important to all societies.

Asian Countries Essay

Many Asian countries such as Singapore, HK, and South Korea have achieved tremendous economic growth in the last forty years of development. One of the key success factors has been macroeconomic stability in these countries. Multiplier effect — population Talk aboit the characteristic of Asian countries-past 40 years –deveoping country –vast raw material 1.  Economic growth is defined as an increased in the level of production of goods and services by a country over a certain period of time. Economic growth can be in terms of real economic growth or potential economic growth. I agree with the author that one of the key factors that have allowed many Asian countries to have achieved economic growth has been macroeconomic stability such as low inflation, low unemployment rate and stable exchange rate in the currency market. However these Asian Countries have achieved tremendous economic growth are also due to other supporting key success factors such as globalisation and political stability enjoyed in these countries which I will explain in this essay. 2.Low Inflation I agree that macroeconomic stability due to low inflation is one key success factor that leads to economic growth in many Asian countries. Inflation is defined as the sustained increased in general price level. When there is low inflation in these Asian countries, it helps to ensure a competitive export industry. This implies that its exports will have a higher price competitiveness over their trading partner hence its export will increased. For example, Singapore, a small and open economy with no natural resources depends mainly on its trade for its economic growth. Hence having a low inflation allows Singapore goods to be relatively cheaper than foreign goods and this cause the net export of Singapore to increase.Low inflation protects domestic industry away from foreign goods competition as the price of the domestic goods is cheaper than foreign goods will cause the demand for imports to fall. Thus low inflation would result in an increased in net export (X-M Low inflation also leads to an increase in the investment expenditure. Since Singapore has low inflation ,it implies that Singapore tends to be more stable and there is less uncertainty, firms and foreign direct investors will find it easier to estimate the costs and revenues of  investments. Hence when inflation is low it will give a good business sentiments and this leads to an increase in investment expenditure. Since net export (X-M) and investment expenditure are components of aggregate demand when net export (X-M) increased and investment expenditure increased, AD will also increase. ( Graph figure1 ) As seen from figure 1,when AD curve shift right from AD1 to AD2 the general price level increase from p1 to p2 and real GDP increases from Y1 to Y2.Thus,Singapore experience real Economic growth as a result of macroeconomic stability due to low inflation. Thus, I agree with the author that one of the key success factors leading to economic growth in many Asian countries is due to macroeconomic stability. 3. Low unemployment Another key success factors that leads to economic growth has been macroeconomic stability due to low unemployment rate. Unemployment is defined as the number of people who is willing and able to work but is unable to find a suitable job and is contantly searching for a job. Asian countries for example Singapore have a low unemployment rate. The low unemployment rate allow the economy in Singapore to produce a larger amount of output and implies a large amount of people in Singapore have income. Thus, having low unemployment rate that the consumers in Singapore have higher spending powers due to higher disposable income and more people having the ability to spend as they holds a job. Thus consumption level in Singapore will increase. In addition, when the unemployment rate in Singapore is low, the government will be able to collect more tax revenue. Also, lesser unemployment benefits is needed to be given to the unemployed and these tax revenue and unemployment funds could be used by government to improve the infrastructure of Singapore which would attract more foreign direct investor. Since consumption( C ) ,(G) government expenditure and (I) investment which are components of AD, when C,G and I increase, AD will also increase. An initial increase in AD will leads to a more than proportionate increase in the real national income through the multiplier process. However for Asian countries like Singapore the mulitiplier size is small due to a small population size and large leakage of the circular flow of income. Hence the extent of shift of the AS curve is greater than the extent of  shift of the AD curve. As seen from figure 2 ,when AD curve shift from AD1 to AD2 and AS curve shift from AS1 to AS2 , the general price level decrease from P1 to P2 and the real GDP increases from Y1 to Y2.Thus , there is econonomic growth where hence there will be increased in real GDP thus there is in the short run there is real economic growth in the short runwhereas In the long run, the increase in investment expenditure will cause an increase in potential economic growth due to the increase in productivity and productive capacity as a result of the increase in capital goods. Hence , Asian countries like Singapore experience real economic growth in the short run and potential economic growth in the long run as a result of macroeconomic stability due to low unemployment. Thus I agree with the author that macroeconomic stability due to low unemployment is one of the key success factors that leads to economic growth in many Asian countries. 4. Stable exchange rate Another key success factors that leads to economic growth in many Asian countries like Singapore has been macroeconomic stability due to stable exchange rate. Stable exchange rate provides good business sentiments for firms and investor as the outlook of the economy is optimistic. Also, stable exchange rate is important especially to investors who depend heavily on importing raw materials for production of their goods. This is because stable exchange rate allows these firms and investors to estimate ahead the costs of operations and the returns in the long run. Thus having stable exchange rate in Asian countries like Singapore provide confidence to investors and hence stable exchange rate serve as an incentive to attract foreign director investor. Since investment expenditure is a component of AD when investment increased, AD will increased in the short run and AS will increase in the long run as investor brings in new technology and more efficient production methods which helps to i mprove the productivity and increase the productive capacity. As seen in figure 3,when AD curve shift right from AD1 to AD2 and AS curve  shift right from AS1 to AS2 ,the general price level decrease from P1 to P2 and the real gd* increases from Y1 to Y2.Since real GDP increased,it implies that there is economic growth. For Asian countries like Singapore, where we are small and open with no natural resources we depend heavily on foreign direct investment apart from trade to achieve economic growth.( Investment revenue statistic how much Investment contribute to GDP†¦Ã¢â‚¬ ¦)Thus, I agree with the author that macroeconomic stability due to stable exchange rate is one of the key success factors that leads to economic growth in many Asian countries. 5.Globalisation However, to achieve tremendous economic growth in many Asian countries based solely on macroeconomic stability is not enough, hence there are other supporting key success factors such as globalisation and political stability that helps to contribute to the tremendous economic growth in many Asian countries. Globalisation is a phenomenon where the markets of global economy become more integrated. With globalisation it also means that there will be faster diffusion of ideas, information, and technology across the world. Globalisations have led a reduction in trade barriers. Globalisation helps to increase international trade between countries which is especially important for countries like Singapore who depends heavily on export revenue for economic growth. Globalisation has allow the production costs to lower because countries specialise in goods which they have comparative advantage in producing and allow them to import the cheapest raw material helps them to lower their cost of pro duction. Singapore has no natural resources this means that Singapore import all of its raw materials. Thus, the process of globalisation helps Singapore to lower its cost of production and allow the price of its final goods and services to be cheaper. This will increase the price competiveness of Singapore exports as they are relatively cheaper than foreign goods. Since the export revenue will be higher than the import expenditure net exports(X-M) will increased. Net export is a component of AD, thus AD will also increased. As seen from figure 4,when AD curve shift right from AD1 to AD2 the real GDP increases from Y1 to Y2.Thus,Singapore experience Economic growth as a result of macroeconomic stability due globalisation. and real GDP will increased hence economic growth is achieved. Thus globalisation is undeniable playing as key success  factors that leads to economic growth in many Asian countries. 6.Political Stability Political stability provides the outlook of the economy of the country. Many Asian countries like Singapore has very good governance with strict rules and regulations together with the sound infrastructure making it a conducive place for investment. When there is political stability there will be good business sentiments as investor are able to plan ahead their expected costs of operations of the business and the returns in the long term. Politically stable country means the likelihood of civil war or political war is low hence the operation of the firms will be stable and there will be low risk of facing the possibilities of shutting down. Hence foreign direct investors are attracted to politically stable country because of the stability of the business outlook. Since investment expenditure is a component of AD an increase in Investment expenditure will lead to an increase in real GDP and help Singapore to achieve economic growth. Thus Asian countries that are politically stable acts as a key success factors to support other factors to help Asian countries like Singapore to achieve economic growth. 7.Conclusion I agree with the author that one of the key success factors has been macroeconomic stability that leads to economic growth in many Asian countries. However with macroeconomic stability alone, without globalisation and political stability in these Asian countries,it is unable to achieved tremendous economic growth.This the tremendous economic growth is achieved as these key success factors exist together and support each other.If not the tremendous economic growth if based on macroeconomic stability will only be in the short terms but globalisation and political stability allows the tremendous economic growth to last in the long run.