Voltaire and Pope

Use of Reason to Support Polarized Viewpoints During the Enlightenment great thinkers began to question all things. Rather than just believe in something because an authority (church, political authority, society) claimed it to be true, these men and women set out to find the truth through reason, to provide explanations for all actions and events. Both Alexander Pope and Voltaire discuss some of the more common questions posed during the Enlightenment: What is the nature of humanity and what is our role in the greater picture of the universe?Pope argues that everything in the universe, whether it is good or evil, is essentially perfect because is a part of God’s grand plan. In essence, Pope believed in pre-determined fate, where no matter our actions, our fate remains the same as it was decided upon before you were born. Voltaire will critique this viewpoint by exploring the negative results of the belief that blind faith will lead to the best possible result and that man doe s exercise free will.While Pope’s â€Å"Essay on Man† and Voltaire’s Candide are derived from polarized viewpoints and speak about a very different set of beliefs, they both use the same fundamental concept of reason to provide the basis of their argument. Alexander Pope set out to write his â€Å"Essay on Man† to use reason to justify his viewpoints of optimism, predetermined fate, and God’s use of both good and evil for balance in the universe.Pope begins the essay by claiming that man can only reason about things in which he has experience with and goes on to illustrate that our limited knowledge is not capable of understanding God’s systems by questioning, â€Å"What can we reason, but from what we know? † (17) He uses the reason that since man can only understand what is within the scope of his knowledge that he cannot expect to comprehend the greater systems that God knows intimately. Pope also believes deeply of in the Great Ch ain of Being and it is the foundation on which his arguments rest.This chain is a concept derived from the classical period and is a notion that all elements of the universe have a proper place in a divinely planned hierarchical order, which was pictured as a vertically extended chain (Renaissance). In its most simplistic form God would be at the top of the chain, man would be directly beneath it, and all other beings that existed would be beneath man. In the 2nd section of the essay, Pope begins by mocking men who do not know their own limits within the universe. He exclaims, â€Å"Presumptuous Man!The reason wouldst though find, / Why formed so weak, so little, and so blind? † (Pope 35-36) He goes on to say that man is not created in a perfect state and that all men have limitations by nature. He continues with the claim â€Å"say not Man’s imperfect, Heaven in fault; / Say rather, Man’s as perfect as he ought: / His knowledge measured to his state and place; / His time a moment, and a point his space† (69-72). Pope is reasoning that the limitations and imperfections in man are necessary for man’s place beneath God in the universe and the Great Chain of Being.Section III begins with Pope stating that God keeps the future fate of all creatures from them in order to protect them; that all beings are blessed to only be dealing with their present state. He reasons this by questioning if the lamb would happily †lick the hand just raised to shed his blood† (Pope 84). This symbolizes the predetermined fate that is made from God regardless of our actions and that only God is capable of knowing what the future has in store for all of the universe.In Section V, Pope reasons that God and nature have greater powers than man by speaking about the terrible effects that natural disasters, such as earthquakes, have with little resistance from man, â€Å"But All subsists by elemental strife; / And Passions are the elements of L ife. / The general Order, since the whole began, / Is kept in Nature, and is kept in Man† (169-172). He is speaking of these horrific and evil events as being a part of God’s almighty cause, that evil is always balanced by good.Pope concludes the first epistle of â€Å"An Essay on Man† with the thought that all that is within in the world is the way it should be as a result of God’s plan: All Nature is but Art, unkown to thee; All Chance, Direction, which thou canst not see; All Discord, Harmony not understood; All partial Evil, universal Good: And, spite of Pride, in erring Reason’s spite, One Truth is clear, WHATEVER is, IS RIGHT. (289-294) This belief that all that is is the best there is and that man has no control over his own destiny is a central component to the philosophical view of optimism.With an â€Å"Essay on Man† Pope uses reason to explain man’s role in the Great Chain of Being and that there is predetermined fate establ ished by God. While â€Å"An Essay on Man† is a poetic verse which uses reason to justify the viewpoints of optimism, predetermined fate, and God’s use of both good and evil for balance, Voltaire’s Candide is a satirical critique of the essay, while using reason to argue against the belief system of optimism.In Candide, the main character is raised in a home with a tutor name Pangloss who teaches Candide that â€Å"things cannot be otherwise than they are, for since everything is made to serve an end, everything necessarily serves the best end† (Voltaire 356). Voltaire is using the character of Pangloss and his teachings to symbolize Alexander Pope and is mocking Pope’s beliefs as the novel continues. Through Candide’s story, Voltaire will provide the evidence that disproves the belief that all that is, is right.The first of many terrible experiences that Candide goes through is when he is kicked out of the Baron’s castle for being ca ught kissing the Baron’s daughter Cunegonde. Upon being kicked out, a hungry, homeless, and broke Candide finds himself at a tavern where he is offered money and a drink from two strangers. Candide naively thinks back to Pangloss and that everything is for the best, that this is his fate, but is quickly transported into a cruel and violent military life where he is forced to endure physical hardships.Here Voltaire shows that the military’s giving of money to Candide was irrationally thought to be for the better, while it was really a ploy to capture Candide into being a soldier where he witnesses cruelty, violence, and evil – all reasonable evidence against Pangloss teachings. These horrible events are not fate or God’s balancing act, but this is the beginning of Candide’s witness to man doing evil to another man with no greater good in sight.Pangloss attempts to reason that catching syphilis is a part of the best of worlds by claiming that â€Å" if Columbus had not caught, on an American island, this sickness †¦ we should have neither chocolate nor cochineal† (Voltaire 361). Here Voltaire again critiques the irrational use of reason to support the belief that all that is, is for the best. After witnessing Pangloss’ hanging and being flogged himself, Candide asks himself, â€Å" If this is the best of all possible worlds, what are the others like? †¦ was it necessary for me to watch you being hanged, for no reason hat I can see? † (Voltaire 364) Here Candide is beginning to see these horrific tragedies as evidence that evidence and is using his reason to ponder that perhaps not all that happens in the world is for the best. Voltaire uses the experience of different characters in Candide to reason that evil is derived from mankind and freewill, not predetermined fate from God. One notable tragedy is that of the old woman who was born into a world of privilege and high class, but suffered through violence, rape, and slavery before meeting Candide.When the old woman asks Candide and Cunegonde to â€Å"ask every passenger on this ship to tell you his story, and if you find a single one who has not often cursed the day of his birth, †¦ then you may throw me overboard head first† Voltaire is reminding the reader of the importance of reason through investigation (373). As the story continues, Candide comes across an old and wise scholar named Martin. Voltaire uses this character to symbolize all the negative and pessimistic viewpoints that counter the optimistic ideal that all exists, exists for the best.Martin uses the evidence of his travels and experience to argue that there is nothing but evil in the world, which serves no purpose: â€Å" I have scarcely seen one town which did not wish to destroy its neighboring town, no family which did not wish to exterminate some other family† (Voltaire 389). The terrible history of Martin and his experiences are Voltai re’s evidence that not all that exists in the world is for the common good, which is contrary to Pangloss’ view that â€Å"private misfortunes make for public welfare† (Voltaire 361).While Martin may be a pessimist, he does believe in predetermined fate and by the time Candide and he are together, Candide, through his own experiences of the world, has begun to believe in free will. Through Candide’s travels Voltaire has shown the reader that not all that happens in this world happens for the greater good or is predetermined by God. At the end of many journeys that result in unjustifiably cruel tragedies, Candide, with all of the other characters, makes the choice to live simply in a garden and mind to it. While this view that one can proceed through life and make their own choices and determinations in the world is ontrary to Pope’s idea of predetermined fate according to the Greater Cause, both writers attempt to validate their claims through reas on. Works Cited Pope, Alexander. â€Å"Essay on Man. † The Norton Anthology of World Literature. 3rd Edition. Vol D. Martin Puchner ed. New York: Norton, 2012. 344-351. Print. â€Å"Renaissance. † Academic. brooklyn. cuny. edu. Brooklyn College, 30 Mar. 2009. Web. 20 Oct. 2012. . Voltaire, Francois de Arouet. Candide. The Norton Antology of World Literature. 3rd Edition. Vol D. Martin Puchner ed. New York: Norton, 20

Zoe’s Tale PART II Chapter Twelve

There was a rattle and then a thump and then a whine as the shuttle's lifters and engines died down. That was it; we had landed on Roanoke. We were home, for the very first time. â€Å"What's that smell?† Gretchen said, and wrinkled her nose. I took a sniff and did some nose wrinkling of my own. â€Å"I think the pilot landed in a pile of rancid socks,† I said. I calmed Babar, who was with us and who seemed excited about something; maybe he liked the smell. â€Å"That's the planet,† said Anna Faulks. She was one of the Magellan crew, and had been down to the planet several times, unloading cargo. The colony's base camp was almost ready for the colonists; Gretchen and I, as children of colony leaders, were being allowed to come down on one of the last cargo shuttles rather than having to take a cattle car shuttle with everyone else. Our parents had already been on planet for days, supervising the unloading. â€Å"And I've got news for you,† Faulks said. â€Å"This is about as pretty as the smells get around here. When you get a breeze coming in from the forest, then it gets really bad.† â€Å"Why?† I asked. â€Å"What does it smell like then?† â€Å"Like everyone you know just threw up on your shoes,† Faulks said. â€Å"Wonderful,† Gretchen said. There was a grinding clang as the massive doors of the cargo shuttle opened. There was a slight breeze as the air in the cargo bay puffed out into the Roanoke sky. And then the smell really hit us. Faulks smiled at us. â€Å"Enjoy it, ladies. You're going to be smelling it every day for the rest of your lives.† â€Å"So are you,† Gretchen said to Faulks. Faulks stopped smiling at us. â€Å"We're going to start moving these cargo containers in a couple of minutes,† she said. â€Å"You two need to clear out and get out of our way. It would be a shame if your precious selves got squashed underneath them.† She turned away from us and started toward the rest of the shuttle cargo crew. â€Å"Nice,† I said, to Gretchen. â€Å"I don't think now was a smart time to remind her that she's stuck here.† Gretchen shrugged. â€Å"She deserved it,† she said, and started toward the cargo doors. I bit the inside of my cheek and decided not to comment. The last several days had made everyone edgy. This is what happens when you know you're lost. On the day we skipped to Roanoke, this is how Dad broke the news that we were lost. â€Å"Because I know there are rumors already, let me say this first: We are safe,† Dad said to the colonists. He stood on the platform where just a couple of hours earlier we had counted down the skip to Roanoke. â€Å"The Magellan is safe. We are not in any danger at the moment.† Around us the crowd visibly relaxed. I wondered how many of them caught the â€Å"at the moment† part. I suspected John put it in there for a reason. He did. â€Å"But we are not where we were told we would be,† he said. â€Å"The Colonial Union has sent us to a different planet than we had expected to go to. It did this because it learned that a coalition of alien races called the Conclave were planning to keep us from colonizing, by force if necessary. There is no doubt they would have been waiting for us when we skipped. So we were sent somewhere else: to another planet entirely. We are now above the real Roanoke. â€Å"We are not in danger at the moment,† John said. â€Å"But the Conclave is looking for us. If it finds us it will try to take us from here, again likely by force. If it cannot remove us, it will destroy the colony. We are safe now, but I won't lie to you. We are being hunted.† â€Å"Take us back!† someone shouted. There were murmurings of agreement. â€Å"We can't go back,† John said. â€Å"Captain Zane has been remotely locked out of the Magellan's control systems by the Colonial Defense Forces. He and his crew will be joining our colony. The Magellan will be destroyed once we have landed ourselves and all our supplies on Roanoke. We can't go back. None of us can.† The room erupted in angry shouts and discussions. Dad eventually calmed them down. â€Å"None of us knew about this. I didn't. Jane didn't. Your colony representatives didn't. And certainly Captain Zane didn't. This was kept from all of us equally. The Colonial Union and the Colonial Defense Forces have decided for reasons of their own that it is safer to keep us here than to bring us back to Phoenix. Whether we agree with this or not, this is what we have to work with.† â€Å"What are we going to do?† Another voice from the crowd. Dad looked out in the direction the voice came from. â€Å"We're going to do what we came here to do in the first place,† he said. â€Å"We're going to colonize. Understand this: When we all chose to colonize, we knew there were risks. You all know that seed colonies are dangerous places. Even without this Conclave searching for us, our colony would still have been at risk for attack, still a target for other races. None of this has changed. What has changed is that the Colonial Union knew ahead of time who was looking for us and why. That allowed them to keep us safe in the short run. It gives an advantage in the long run. Because now we know how to keep ourselves from being found. We know how to keep ourselves safe.† More murmurings from the crowd. Just to the right of me a woman asked, â€Å"And just how are we going to keep ourselves safe?† â€Å"Your colonial representatives are going to explain that,† John said. â€Å"Check your PDAs; each of you has a location on the Magellan where you and your former worldmates will meet with your representative. They'll explain to you what we'll need to do, and answer the questions you have from there. But there is one thing I want to be clear about. This is going to require cooperation from everyone. It's going to require sacrifice from everyone. Our job of colonizing this world was never going to be easy. It's just become a lot harder. â€Å"But we can do it,† Dad said, and the forcefulness with which he said it seemed to surprise some people in the crowd. â€Å"What's being asked of us is hard, but it's not impossible. We can do it if we work together. We can do it if we know we can rely on each other. Wherever we've come from, we all have to be Roanokers now. This isn't how I would have chosen for this to happen. But this is how we are going to have to make it work. We can do this. We have to do this. We have to do it together.† I stepped out of the shuttle, and put my feet on the ground of the new world. The ground's mud oozed over the top of my boot. â€Å"Lovely,† I said. I started walking. The mud sucked at my feet. I tried not to think of the sucking as a larger metaphor. Babar bounded off the shuttle and commenced sniffing his surroundings. He was happy, at least. Around me, the Magellan crew was on the job. Other shuttles that had landed before were disgorging their cargo; another shuttle was coming in for a landing some distance away. The cargo containers, standard-sized, littered the ground. Normally, once the contents of the containers were taken out, the containers would be sent back up in the shuttles to be reused; waste not, want not. This time, there was no reason to take them back up to the Magellan. It wasn't going back; these containers wouldn't ever be refilled. And as it happened, some of these containers wouldn't even be unpacked; our new situation here on Roanoke didn't make it worth the effort. But it didn't mean that the containers didn't have a purpose; they did. That purpose was in front of me, a couple hundred meters away, where a barrier was forming, a barrier made from the containers. Inside the barrier would be our new temporary home; a tiny village, already named Croatoan, in which all twenty-five hundred of us – and the newly-resentful Magellan crew – would be stuck while Dad, Mom and the other colony leaders did a survey of this new planet to see what we needed to do in order to live on it. As I watched, some of the Magellan crew were moving one of the containers into place into the barrier, using top lifters to set the container in place and then turning off their power and letting the container fall a couple of millimeters to the ground with a thump. Even from this distance I felt the vibration in the ground. Whatever was in that container, it was heavy. Probably farming equipment that we weren't allowed to use anymore. Gretchen had already gotten far ahead of me. I thought about racing to catch up with her but then noticed Jane coming out from behind the newly placed container and talking to one of the Magellan crew. I walked toward her instead. When Dad talked about sacrifice, in the immediate term he was talking about two things. First: no contact between Roanoke and the rest of the Colonial Union. Anything we sent back in the direction of the Colonial Union was something that could give us away, even a simple skip drone full of data. Anything sent to us could give us away, too. This meant we were truly isolated: no help, no supplies, not even any mail from friends and loved ones left behind. We were alone. At first this didn't seem like much of a big deal. After all, we left our old lives behind when we became colonists. We said good-bye to the people who we weren't taking with us, and most of us knew it would be a very long time if ever until we saw those people again. But even for all that, the lines weren't completely severed. A skip drone was supposed to leave the colony on a daily basis, carrying letters and news and information back to the Colonial Union. A skip drone was supposed to arrive on a daily basis, too, with mail, and news and new shows and songs and stories and other ways that we could still feel that we were part of humanity, despite being stuck on a colony, planting corn. And now, none of that. It was all gone. The no new stories and music and shows were what hit you first – a bad thing if you were hooked on a show or band before you left and were hoping to keep up with it – but then you realized that what it really meant was from now on you wouldn't know anything about the lives of the people you left behind. You wouldn't see a beloved baby nephew's first steps. You wouldn't know if your grandmother had passed away. You wouldn't see the recordings your best friend took of her wedding, or read the stories that another friend was writing and desperately trying to sell, or see pictures of the places you used to love, with the people you still love standing in the foreground. All of it was gone, maybe forever. When that realization hit, it hit people hard – and an even harder hit was the realization that everyone else that any of us ever cared about knew nothing about what happened to us. If the Colonial Union wasn't going to tell us where we were going in order to fool this Conclave thing, they certainly weren't going to tell everyone else that they had pulled a fast one with our whereabouts. Everyone we ever knew thought we were lost. Some of them probably thought we had been killed. John and Jane and I didn't have much to worry about on this score – we were each other's family, and all the family we had – but everyone else had someone who was even now mourning them. Savitri's mother and grandmother were still alive; the expression on her face when she realized that they probably thought she was dead made me rush over to give her a hug. I didn't even want to think about how the Obin were handling our disappearance. I just hoped the Colonial Union ambassador to the Obin had on clean underwear when the Obin came to call. The second sacrifice was harder. â€Å"You're here,† Jane said, as I walked up to her. She reached down to pet Babar, who had come bounding up to her. â€Å"Apparently,† I said. â€Å"Is it always like this?† â€Å"Like what?† Jane said. â€Å"Muddy,† I said. â€Å"Rainy. Cold. Sucky.† â€Å"We're arriving at the beginning of spring here,† Jane said. â€Å"It's going to be like this for a little while. I think things will get better.† â€Å"You think so?† I asked. â€Å"I hope so,† Jane said. â€Å"But we don't know. The information we have on the planet is slim. The Colonial Union doesn't seem to have done a normal survey here. And we won't be able to put up a satellite to track weather and climate. So we have to hope it gets better. It would be better if we could know. But hoping is what we have. Where's Gretchen?† I nodded in the direction I saw her go. â€Å"I think she's looking for her dad,† I said. â€Å"Everything all right between you two?† Jane said. â€Å"You're rarely without each other.† â€Å"It's fine,† I said. â€Å"Everyone's twitchy these last few days, Mom. So are we, I guess.† â€Å"How about your other friends?† Jane asked. I shrugged. â€Å"I haven't seen too much of Enzo in the last couple of days,† I said. â€Å"I think he's taking the idea of being stranded out here pretty badly. Even Magdy hasn't been able to cheer him up. I went to go visit him a couple of times, but he doesn't want to say much, and it's not like I've been that cheerful myself. He's sending me poems, still, though. On paper. He has Magdy deliver them. Magdy hates that, by the way.† Jane smiled. â€Å"Enzo's a nice boy,† she said. â€Å"I know,† I said. â€Å"I think I didn't pick a great time to decide to make him my boyfriend, though.† â€Å"Well, you said it, everyone's twitchy the last few days,† Jane said. â€Å"It'll get better.† â€Å"I hope so,† I said, and I did. I did moody and depressed with the best of them, but even I have my limits, and I was getting near them. â€Å"Where's Dad? And where's Hickory and Dickory?† The two of them had gone down in one of the first shuttles with Mom and Dad; between them making themselves scarce on the Magellan and being away for the last few days, I was starting to miss them. â€Å"Hickory and Dickory we have out doing a survey of the surrounding area,† Jane said. â€Å"They're helping us get a lay of the land. It keeps them busy and useful, and keeps them out of the way of most of the colonists at the moment. I don't think any of them are feeling very friendly toward nonhumans at the moment, and we'd just as soon avoid someone trying to pick a fight with them.† I nodded at this. Anyone who tried to pick a fight with Hickory or Dickory was going to end up with something broken, at least. Which would not make the two of them popular, even (or maybe especially) if they were in the right. Mom and Dad were smart to get them out of the way for now. â€Å"Your dad is with Manfred Trujillo,† Jane said, mentioning Gretchen's dad. â€Å"They're laying out the temporary village. They're laying it out like a Roman Legion encampment.† â€Å"We're expecting an attack from the Visigoths,† I said. â€Å"We don't know what to expect an attack from,† Jane said. The matter-of-fact way she said it did absolutely nothing to cheer me up. â€Å"I expect you'll find Gretchen with them. Just head into the encampment and you'll find them.† â€Å"It'd be easier if I could just ping Gretchen's PDA and find her that way,† I said. â€Å"It would be,† Jane agreed. â€Å"But we don't get to do that anymore. Try using your eyes instead.† She gave me a quick peck on the temple and then walked off to talk to the Magellan crew. I sighed and then headed into the encampment to find Dad. The second sacrifice: Every single thing we had with a computer in it, we could no longer use. Which meant we couldn't use most things we had. The reason was radio waves. Every piece of electronic equipment communicated with every other piece of electronic equipment through radio waves. Even the tiny radio transmissions they sent could be discovered if someone was looking hard enough, as we were assured that they were. But just turning off the connecting capability was not enough, since we were told that not only did our equipment use radio waves to communicate with each other, they used them internally to have one part of the equipment talk to other parts. Our electronics couldn't help transmitting evidence that we were here, and if someone knew what frequencies they used to work, they could be detected simply by sending the radio signal that turned them on. Or so we were told. I'm not an engineer. All I knew was that a huge amount of our equipment was no longer usable – and not just unusable, but a danger to us. We had to risk using this equipment to land on Roanoke and set up the colony. We couldn't very well land shuttles without using electronics; it wasn't the trip down that would be a problem, but the landings would be pretty tricky (and messy). But once everything was on the ground, it was over. We went dark, and everything we had in cargo containers that contained electronics would stay in those containers. Possibly forever. This included data servers, entertainment monitors, modern farm equipment, scientific tools, medical tools, kitchen appliances, vehicles and toys. And PDAs. This was not a popular announcement. Everyone had PDAs, and everyone had their lives in them. PDAs were where you kept your messages, your mail, your favorite shows and music and reading. It's how you connected with your friends, and played games with them. It's how you made recordings and video. It's how you shared the stuff you loved, to the people you liked. It was everyone's outboard brain. And suddenly they were gone; every single PDA among the colonists – slightly more than one per person – was collected and accounted for. Some folks tried to hide them; at least one colonist tried to sock the Magellan crew member who'd been assigned to collect them. That colonist spent the night in the Magellan brig, courtesy of Captain Zane; rumor had it the captain cranked down the temperature in the brig and the colonist spent the night shivering himself awake. I sympathized with the colonist. I'd been without my PDA for three days now and I still kept catching myself reaching for it when I wanted to talk to Gretchen, or listen to some music, or to check to see if Enzo had sent me something, or any one of a hundred different things I used my PDA for on a daily basis. I suspected that part of the reason people were so cranky was because they'd had their outboard brains amputated; you don't realize how much you use your PDA until the stupid thing is gone. We were all outraged that we didn't have our PDAs anymore, but I had this itchy feeling in the back of my brain that one of the reasons people were so worked up about their PDAs was that it kept them from having to think about the fact that so much of the equipment we needed to use to survive, we couldn't use at all. You can't just disconnect the computers from our farm equipment; it can't run without it, it's too much a part of the machine. It'd be like taking out your brain and expecting your body to get along without it. I don't think anyone really wanted to face the fact of just how deep the trouble was. In fact, only one thing was going to keep all of us alive: the two hundred and fifty Colonial Mennonites who were part of our colony. Their religion had kept them using outdated and antique technology; none of their equipment had computers, and only Hiram Yoder, their colony representative, had used a PDA at all (and only then, Dad explained to me, to stay in contact with other members of the Roanoke colonial council). Working without electronics wasn't a state of deprivation for them; it's how they lived. It made them the odd folks out on the Magellan, especially among us teens. But now it was going to save us. This didn't reassure everyone. Magdy and a few of his less appealing friends pointed to the Colonial Mennonites as evidence that the Colonial Union had been planning to strand us all along and seemed to resent them for it, as if they had known it all along rather than being just as surprised as the rest of us. Thus we confirmed that Magdy's way of dealing with stress was to get angry and pick nonexistent fights; his near-brawl at the beginning of the trip was no fluke. Magdy got angry when stressed. Enzo got withdrawn. Gretchen got snappish. I wasn't entirely sure how I got. â€Å"You're mopey,† Dad said to me. We were standing outside the tent that was our new temporary home. â€Å"So that's how I get,† I said. I watched Babar wander around the area, looking for places to mark his territory. What can I say. He's a dog. â€Å"I'm not following you,† Dad said. I explained how my friends were acting since we'd gotten lost. â€Å"Oh, okay,† Dad said. â€Å"That makes sense. Well, if it's any comfort, if I have the time to do anything else but work, I think I would be mopey, too.† â€Å"I'm thrilled it runs in the family,† I said. â€Å"We can't even blame it on genetics,† Dad said. He looked around. All around us were cargo containers, stacks of tents under tarps and surveyor's twine, blocking off where the streets of our new little town will be. Then he looked back to me. â€Å"What do you think of it?† â€Å"I think this is what it looks like when God takes a dump,† I said. â€Å"Well, yes, now it does,† Dad said. â€Å"But with a lot of work and a little love, we can work our way up to being a festering pit. And what a day that will be.† I laughed. â€Å"Don't make me laugh,† I said. â€Å"I'm trying to work on this mopey thing.† â€Å"Sorry,† Dad said. He wasn't actually sorry in the slightest. He pointed at the tent next to ours. â€Å"At the very least, you'll be close to your friend. This is Trujillo's tent. He and Gretchen will be living here.† â€Å"Good,† I said. I had caught up with Dad with Gretchen and her dad; the two of them had gone off to look at the little river that ran near the edge of our soon-to-be settlement to find out the best place to put the waste collector and purifier. No indoor plumbing for the first few weeks at least, we were told; we'd be doing our business in buckets. I can't begin to tell you how excited I was to hear that. Gretchen had rolled her eyes a little bit at her dad as he dragged her off to look at likely locations; I think she was regretting taking the early trip. â€Å"How long until we start bringing down the other colonists?† I asked. Dad pointed. â€Å"We want to get the perimeter set up first,† he said. â€Å"We've been here a couple of days and nothing dangerous has popped out of those woods over there, but I think we want to be safer rather than sorrier. We're getting the last containers out of the cargo hold tonight. By tomorrow we should have the perimeter completely walled and the interior blocked out. So two days, I think. In three days everyone will be down. Why? Bored already?† â€Å"Maybe,† I said. Babar had come around to me and was grinning up at me, tongue lolling and paws caked with mud. I could tell he was trying to decide whether or not to leap up on two legs and get mud all over my shirt. I sent him my best don't even think about it telepathy and hoped for the best. â€Å"Not that it's any less boring on the Magellan right now. Everyone's in a foul mood. I don't know, I didn't expect colonizing to be like this.† â€Å"It's not,† Dad said. â€Å"We're sort of an exceptional case here.† â€Å"Oh, to be like everyone else, then,† I said. â€Å"Too late for that,† Dad said, and then motioned at the tent. â€Å"Jane and I have the tent pretty well set up. It's small and crowded, but it's also cramped. And I know how much you like that.† This got another smile from me. â€Å"I've got to join Manfred and then talk to Jane, but after that we can all have lunch and try to see if we can't actually enjoy ourselves a little. Why don't you go in and relax until we get back. At least that way you don't have to be mopey and windblown.† â€Å"All right,† I said. I gave Dad a peck on the cheek, and then he headed off toward the creek. I went inside the tent, Babar right behind. â€Å"Nice,† I said to Babar, as I looked around. â€Å"Furnished in tasteful Modern Refugee style. And I love what they've done with those cots.† Babar looked up at me with that stupid doggy grin of his and then leaped up on one of the cots and laid himself down. â€Å"You idiot,† I said. â€Å"You could have at least wiped off your paws.† Babar, notably unconcerned with criticism, yawned and then closed his eyes. I got on the cot with him, brushed off the chunkier bits of mud, and then used him as a pillow. He didn't seem to mind. And a good thing, too, since he was taking up half my cot. â€Å"Well, here we are,† I said. â€Å"Hope you like it here.† Babar made some sort of snuffling noise. Well said, I thought. Even after everything was explained to us, there were still some folks who had a hard time getting it through their heads that we were cut off and on our own. In the group sessions headed by each of the colonial representatives, there was always someone (or someones) who said things couldn't be as bad as Dad was making them out to be, that there had to be some way for us to stay in contact with the rest of humanity or at least use our PDAs. That's when the colony representatives sent each colonist the last file their PDAs would receive. It was a video file, shot by the Conclave and sent to every other race in our slice of space. In it, the Conclave leader, named General Gau, stood on a rise over-looking a small settlement. When I first saw the video I thought it was a human settlement, but was told that it was a settlement of Whaid colonists, the Whaid being a race I knew nothing about. What I did know was that their homes and buildings looked like ours, or close enough to ours not to matter. This General Gau stood on the rise just long enough for you to wonder what it was he was looking at down there in the settlement, and the settlement disappeared, turned into ash and fire by what seemed like a thousand beams of light stabbing down from what we were told were hundreds of spaceships floating high above the colony. In just a few seconds there was nothing left of the colony, or the people who lived in it, other than a rising column of smoke. No one questioned the wisdom of hiding after that. I don't know how many times I watched the video of the Conclave attack; it must have been a few dozen times before Dad came up to me and made me hand over my PDA – no special privileges just because I was the colony leader's kid. But I wasn't watching because of the attack. Or, well, I should say that wasn't really what I was looking at when I watched it. What I was looking at was the figure, standing on the rise. The creature who ordered the attack. The one who had the blood of an entire colony on his hands. I was looking at this General Gau. I was wondering what he was thinking when he gave the order. Did he feel regret? Satisfaction? Pleasure? Pain? I tried to imagine what it would take to order the deaths of thousands of innocent people. I felt happy that I couldn't wrap my brain around it. I was terrified that this general could. And that he was out there. Hunting us.

Birth Control and Abortion

Other times of birth control which are a little bit more complexes are the IUD anther more percent type of birth control is getting there tubes tied. There are other things that women can do if they do become pregnant and they choose they do not want to have a child at this time in their life. There are pills they can take five days after they have sex which can be bought over the counter at any drug store, There are also abortion pills that can be taken up to your 6th week of pregnancy, and last but not least a women has the choice to terminate a pregnancy by getting an abortion. Abortion is a big issue in today’s times and it is also a topic that can make some feel one of many different types of emotions. Abortion can happen up until the 13 week of a pregnancy. Abortion is a permit solution in terminating a pregnancy it can also be damage a female in many different ways not only physically but mentally as well. Abortions are a way to terminate pregnancies but they should not be used as a type of birth control. There are many pros and cons of both situation and everyone women should look into their options Birth Control comes in many forms for both men and women. The most common for the two would be condoms and birth control pills. Women can also seek other methods like diaphragms, Depo-Provera shots, Norplant’s, Nuvarings, or even a birth control patch however; the most powerful form of birth control would be absence (Planned Parenthood Federation of America, 2007). All these methods are proven effective but may cause some side effects in some people. Birth Control Method| Common Side Effects| Depo-ProveraLess than 1 out of 100 women a year will become pregnant by taken the shot when directed. Cost: $35 – 75Injected into the arm and last for 3 months. * Irregular bleeding especially within the first year. * Change in sex drive. * Change in appetite or weight gain. * Headaches * Nausea * Sore breast| Norplant’s (Implants)Less than 1 out of 100 women a year may become pregnant. Cost: $400-800Inserted into the arm and last for 3yrs. | * Change in sex drive. * Irregular bleeding within 6 to 12 months. * Discoloring or scarri ng where the implant was placed. * Rarely, an infection in the implant location. * Sore breast * Weight gain| Birth Control PillsFew as 1 in 100 women will become pregnant in a year if they use the pill effectively. Cost: $15-50 per monthMust take pill every day at same time to be most effective. | * Bleeding between periods. * Breast tenderness. * Nausea and/or vomiting| Condoms 2 out of 100 women may still become pregnant after using a condom correctlyCost: $1 eachCan be used by men. This device also prevent against sexual transmitted diseases. Female condoms are also available. | * Most common complaint is people are allergic to the latex which condoms are made from. * Condoms do break which forms no protection. | These are just a few of the outlined cost and complications that have been associated with different forms of birth control. Although, many have a great success record absence is the only method that is truly 100% effective. However, if women and men both actively participate in using contraceptives then they may avoid STD’s (with the use of condoms), and unwanted or unplanned pregnancies. Abortion is a medical procedure for any expecting mother to elect to have about her own body. The procedure can be performed up until the mother is in her second trimester. When a child is in the first trimester they weigh on average a 1/2 ounce and estimated to be 3 inches long (Just mommies, 2003-2012). During the first trimester the child also has a heartbeat that can be heard with ultrasonic devices. When a mother reached her second trimester the child is still growing developing more specific features. By the end of the second trimester the child will have developed all major organs (Just mommies, 2003-2012). Many people consider the abortion procedure to be immoral and wrong because it involves taking the life of an unborn child who has already developing in the womb. Over 7% of women just their reason for seeking an abortion because they were a victim of rape or incest and health concerns for the mother or baby (M, 2012). Many women who opt for this procedure may find themselves suffering from guilt or depression afterwards resulting in a life altering experience. For individual who don’t want to have children they have different types of birth control that can to prevent pregnancy. Birth control can come in a pill, patch, shot, surgical, internal, or abstinence. Birth control is not only for women but men as well. Men can use condoms to help protect them from getting women pregnant as well as protect themselves from sexually transmitted diseases. Men can also have a vasectomy which can cause them not to be able to produce children at all. Women have a similar procedure but it is called a tubal litigation. This prevents the woman from producing an egg and being fertilized. Each form of birth control comes with some type of side effect and it is best that the individual chooses what is comfortable for them. The side effects can vary depending on the individual and how their body adapts to the medication. Some women like to look at abortion as a type of birth control. There are different types of abortion and also different types of birth control. With abortion the different methods are used at each different point in pregnancy and may be performed different each time also. There are the first trimester abortions which can be suction aspiration or dilation and curettage also known as Damp;C. the suction aspiration is the most common surgical methods that is used in the first trimester abortions, this is when the cervix is numbed and stretched open. It allows the abortionist to suck the baby’s body out with a knife like plastic tube. During the suction the lining of the uterus may be torn away. The Damp;C methods are somewhat similar to the suction. The instrument used for this procedure is called a curette (a loop shaped steel knife) which is used to scrape the wall of the uterus. During this procedure the baby and the uterus if cut up into pieces and then sucked out. An abortion can also be performed with a chemical implantation. Abortions can take place in each stage of pregnancy and is performed in different ways according to the size of the baby and what stage you are at in your pregnancy. For the second trimester there is a procedure that is used that is similar to the Damp;C and it is called the Damp;E or dilation and evacuation. With this procedure the woman is given some type of sedative and the abortionist is dilates the women and use instruments such as forceps to pull the baby to pieces. There is also a late second and third trimester abortions. During the late second and third trimester abortions the abortionist uses instillation techniques which is injects lethal chemicals into the amniotic fluid by an amniocentesis, intra cardiac injections which stop the unborn heart or hysterectomies which are identical to a cesarean section and is intended to harm the child. These are only a few of the abortion techniques that are used but more exists. Birth control and abortions can help with decision making when it comes to having or not having children. Some individuals look at abortions and are totally against it and other may use it as a form of birth control. Women start out as teenagers using birth control to prevent early pregnancy or pregnancy at all. Both of these methods come with side effects and it should be strictly the individual’s choice to use either one.

Journal Type Paper Essay Example | Topics and Well Written Essays - 2500 words

Journal Type Paper - Essay Example This paper shall discuss wildlife-based tourism, its attractions, and its negative and positive impact on wildlife, on the patrons, and Mother Nature in general. It shall discuss how it has successfully drawn in a largely European, middle class and affluent group of tourists to both the benefit and the detriment of the wildlife. In recent years, African safaris have become a very attractive activity for many tourists, but never more so than for the European, middle-class, and affluent ones. Big-game hunting, which is part of the African safari experience, has attracted many middle and high-class tourists from the Western hemisphere. These affluent tourists are very much willing to spend large amounts of their money in order to have the opportunity to get away from their normally stressful lives. These tourists also seek the thrill of being immersed in wilderness adventures while being able to relax in a more natural environment. They seek these adventures in order to relieve their stress and anxiety; in some instances to experience the spiritual and profound (Newsome, 2005). The big-game hunting sport usually culminates in the awarding of trophies for the best hunter among the participants, but this achievement usually plays a secondary role to the natural adventure that they get to experience through wildl ife-based tourism. This form of wildlife-based tourism is only seen in countries and areas with strict and capable monitoring measures in place. This ensures that big-game hunting does not unnecessarily endanger ecological balance and is safe for tourists. And the most important benefit on the part of the government and the locals is that big profit is coming in from this wildlife-based tourism. â€Å"Returns to governments accrue from land leases and trophy fees, apart from the indirect economic benefits of tourism† (Roth & Merz, 1997). This income flow is very much

Genocide and crimes against humanity Essay Example | Topics and Well Written Essays - 1500 words

Genocide and crimes against humanity - Essay Example Considering all the case studies that he uses throughout his book Eric Weitz, highlights that although each of the cases has its own ‘particularities’ yet, all ‘display some notably common features’. Eric Weitz discussion concentrates on four different genocide cases, which includes the Soviet Union under Lenin and Stalin, Nazi Germany, Cambodia under the Khmer Rouge and the final case, which is the Former Yugoslavia in the 1990s. The author of this established literature applies comparative methodology to the study of genocide. In looking at the Nazis case, Weitz leaves the reader with having to accept the notion that the author concludes the chapter with avoiding the ideology of whether he places his account on an intentionalist or a functionalist perspective. Weitz cleverly manages to do this through providing a compelling narrative that balances the role of the ideology and the circumstances in that particular case. However, from reading the fourth chapt er, which details the genocide in Cambodia, the author stands at a more modern functionalist account. This is evident by the way Eric blames the French interventionism, providing few of the Khmer Rouge leaders including Pol Pot ... and states how these in particular were fortunate to be able to get the western education of which gave them the position in the communism, stating that they were born in the society that already functions like that. The author tends to rely on the race and nation to emphasize on the discussion of genocide. A Century of Genocide uses UN convention to define the term Genocide. This chapter is excellent in terms of where it covers real situation of which in turn gives the reader the ability to understand different perspectives from real situations as a appose to only write what happened without using real life characters or situations. The author successfully manages to apprehend the reader on continuing to read through using quotations from other historian s, political actors, eyewitnesses and the use of poems. Unfortunately the author fails on many accounts on making his overall book of a first authors’ establishment, he misses the opportunity on expanding the alternative methodologies of research and rather heavily concentrates on the secondary research. Thus, making ‘A Century of Genocide’ provide very little new evidence or self-interpretation of the genocide events. Having to lack in his primary research the author misses out other crucial genocide regimes including the Rwanda case. Weitz acknowledges in his introduction that throughout his 5 chapters he presents very limited primary research. Critical bibliography 2: Benjamin A. Valentino, Final Solutions: Mass Killings and Genocide in the 20th Century. – Modern intentionalist Benjamin A., Valentino an associate Professor of Government and an author of Final Solutions: Mass killings and Genocide in the 20th Century, discusses in his well-established bo ok, the different genocide regimes that occurred during the 20th century, focusing on three types of mass killings, including the communist mass killings, ethnic genocide and the â€Å"counter-guerrilla† mass killing. Valentino, focuses on particular case studies representing each type of genocide, highlighting the mass killing in Cambodia, China and the

Fed Chairman Game Essay Example | Topics and Well Written Essays - 500 words

Fed Chairman Game - Essay Example The purpose of this paper is to discuss the results of the â€Å"Fed Chairman Game.† In the game the player must choose the fed interest rates for period of four years or 16 quarters. The player must keep inflation and unemployment below 4 and 7 percent respectively. The logic that must be used to make decision is that you can lower inflation by setting federal funds well above the inflation rate, but doing so will also push unemployment upwards. You can lower unemployment by pushing up inflation by setting the federal funds rate close too or below the inflation rate. Throughout the game after each decision there is a newspaper headline that reports what is occurring in the economy based on the Fed decisions. The news must be used by the player in order to make decisions. The table below has a list of some of the newspaper headlines that I saw during the game. During the simulation I utilized the news as a point of reference to make decisions. I had to look at the impact my decisions had on inflation and unemployment at all times. The actions that I took to get reelection were geared at maintain the general public happy. I ran the simulation three times and I was not able to get reelected. The job of the chairman of the Fed is very hard. During the first two runs I was not able to keep inflation low enough to get reelected. During the third run I messed up as far as having negative inflation or deflation. I learned from the simulation that monetary policy is extremely important for the well being of the United States. People are happy with their government when there are jobs available in the marketplace and when their money has good purchasing power. Inflation decreases the purchasing power of the US

Small business Research Paper Example | Topics and Well Written Essays - 1000 words

Small business - Research Paper Example It is important to determine WHY the business is being set up and what is expected out of it. In this case of opening a restaurant we have clearly defined objectives. It is aimed at serving fresh halal food to the target community that is mostly based on students so the specialty is going to be fresh, halal food at cheaper rates. Now it is important to determine the input and output means. Input includes all the budgeting, hiring of employees and setting up the place etc an the out put is the result that is in the form of customers’ response and the profits. So first of all we need to determine the scale of this input and output. It is important to keep in mind and have a regular check on the customers’ and the suppliers’ requirements and their ease. It is important to have a smooth customer relation with the suppliers of raw materials like meat etc for the restaurant. On the other hand the customers’ requirements should be kept in mind and they should be regularly updated according to their demands. So in case of this restaurant, the customers’ response to food items is very important. Food should be cooked according to their demands and the rates should be regularized according to the customers’ pockets. Getting the employees into the process of planning is also very important. Thus they would understand the whole system better and define things according to their own ease and so that would help in running the plan smooth. Moreover, in systematized planning, clear definition of duties and process owning is very important. The employees should not be confused about their duties nor should they be over burdened. A good division of labor according to the duties is important for running the system efficiently. All the employees should be told about their duties clearly and they should be asked about those duties by the management in a constant check. A proper management and check and balance or monitoring is very

Compare ICD-9 to ICD-10 Assignment Example | Topics and Well Written Essays - 250 words

Compare ICD-9 to ICD-10 - Assignment Example There are instances where new codes have been allocated to different chapters, a factor that hinders location of all available codes. In contrast, the new edition is arranged in such a manner that character length is increased, which highly extends the quantity of available codes (Lazakidou, 2006). Its structure, flexibility, and capacity are up-to-date to capture the medical experience and technological advances. The content conveyed by the two codes is dissimilar. ICD-9 codes contain at least 3-5 digits that begin with either a letter or a number. ICD-10 codes comprise of seven digits. Some similarities can be identified in the two systems. Their organization tends to match, where both use a decimal after three characters. This means that anyone who is able to code ICD-9-CM qualifies to make a transition coding to ICD-10-CM. According to Lazakidou, the rules, conventions, and guidelines are also alike. The first three digits match with the ICD-9 code, with the third digit being followed by a decimal point. However, the digits after the decimal have a particular meaning. For instance, in surgical and medical guidelines, the digits that come later are specific to a surgical approach, body part, and other requirements for billing. Correspondingly, the ICD-10 codes follow suit with seven digits to represent diagnosis codes. The transition procedure from ICD-9 to ICD-10 will entail a conversion based on a forward and backward GEMs map offered by the CMS. There will be a process with one cluster being converted at a time to safeguard the clinical aim of the classification. Alternatively, codes may be transited through using consistent probability distribution, and the converted data be audited to validate the process (Lazakidou, 2006). ICD-9 and ICD-10 differ in sequencing, depending on the circumstances surrounding the encounter. For instance, it is notable that ICD-10 sequencing instructions for anemia

Compare a success project with a fail project Essay

Compare a success project with a fail project - Essay Example most Hong Kong citizens use this as their main mode of transport, with the trains making over 5 million rounds every working day (Mass Transit Railways 2014). The trains have specific times for each destination, which they keep no matter what because it is a part of MTR’s objectives and initiatives too. As of last year, Mass Transit Railway owned half of the public transport market share, ranking it as the top means of transport preference in Hong Kong. Unlike most of the train systems in other countries, MTR integrates the Octopus technology enabling people to pay their fares using the master cards; significantly, this has been in place since 1997 and it is one of the facilitators of the system’s success because travelling is easier with it. Essentially, a research by the Hong Kong government prompted the production of the Mass Transit Railway; typically, the research basis was the increasing problems caused by road jams because of the countries rapidly growing economy. The first construction began immediately after the government released the study and around ten years later, there was the launching of the first track (MTR Corporation 2004). Due to the multiple cases of road congestions, most of the citizens immediately switched to the trains as modes of transport. Appreciably, since then, there have been more consequent lines built, aiming to cover more land and areas with the highest populations. Through the journey, the government has faced challenges based on areas to expand the network and what strategies to apply; however, it is among the most successful railway projects in the world today, especially because it covers a very wide area moving even into China’s main land. The Miami Metrorail, also referred to as The Metro, is also a large railway transport system that covers parts of Florida, the United States and a bigger part of Miami. Miami Dade Transit governs and oversees every operation of The Metro; moreover, it is one of the core agencies of

H. pylori Research Paper Example | Topics and Well Written Essays - 500 words

H. pylori - Research Paper Example Its absence can lead affect the stomachs micro biota. The lack of H pylori mostly among kids has led to increased risk of asthma and allergies (Martin 7). Virulence factors are structures, chemicals, and metabolic functions that increase the chance an organism will cause disease. C A G (A) and V a C (A) are virulence factors of Helicobacter pylori. Explain how these two proteins mediate infection and disease. C A G (A) is a marker for strains that increase the chances of one contracting peptic ulcer disease. It symbolizes a human gastric gene. This strain contains a secretion system (type 4) that infuses D N A and proteins in the stomach. C A G (A) product S21 -S23) is in the epithelial cells in vivo and vitro form. Once inside the stream, C A G (A) associates with a tyrosine phosphate (SHP-2) that will affect the spreading of the epithelial cell. This injected C A G (A) interacts with Grb2, and it activates the ERK pathway. This leads to cell scattering and proliferation in the MDCK cells (Martin 6). V a C (A) causes vesiculation in the cell lines of the epithelial. It posses two signal region, S1 and S2, and two mid regions, M1 and M2. It affects the host by creating pores in the cell membranes leading to urea egress. It also facilitates the loosening of tight epithelial junctions allowing the crossing of nutrients through the mucosal barrier to the pylori gastric niche (Martin

The History of Chocolate Essay Example for Free

The History of Chocolate Essay Chocolate is one of the oldest treats enjoyed by many people. By a show of hands, how many people love chocolate? I have loved chocolate ever since I was a little girl. I have enjoyed the different tastes, textures, and styles of it. Chocolate has been one of the oldest treats enjoyed by many people. I want to share with you the history of chocolate, types of chocolate, and some benefits from eating chocolate. Let’s start with the History of Chocolate! Chocolates history started over 2,000 years ago. It began in the tropical rainforests of Central and South America from the seed of the cacao tree. This small tree grows best in the tropical atmosphere because it receives the best amount of rain, shade, humidity, wind, and nutrients. According to Susan J. Terrio, the author of Crafting the Culture and History of French Chocolate, the first people known to have made chocolate were the ancient cultures of Mexico and Central America. These people, including the Maya and Aztec, mixed ground cacao seeds with various seasonings to make a spicy, frothy drink. This was the very first way that chocolate was consumed. When the Spanish conquered the Aztecs, they brought the cacao seeds back home to Spain. 1. The chocolate drink was very popular in Spain. It then spread to Europe where new technologies and innovations changed the texture and taste of chocolate.2. By the mid-1700s, the blossoming Industrial Revolution saw the emergence of innovations that changed the future of chocolate.

Earth Science and Society Essay Example for Free

Earth Science and Society Essay The other four major contributors to the development of modern astronomy after Copernicus are Galileo, Tycho Brahe, Johannes Kepler, and Isaac Newton. Galileo Galilei supported Copernicus’ ideas and was the one who devised the early telescope that was able to enlarge objects up to 20 times. With the use of this telescope, he was able to prove the heliocentric theory proposed by Copernicus. Tycho Brahe is a Danish astronomer who focused on developing astronomical instruments as well as measuring and fixing the position of stars accurately before the telescope was invented. Johannes Kepler focused on determining the movement of the planets and his laws paved way to the concept of orbits as planetary paths. Isaac Newton’s laws of motion and gravitation further established how planets were able to revolve around the sun and how they moved in an orbit through the pull of gravity. It took a long time to overthrow the geocentric theory because it was backed up by the church and the existing rulers at that time. Those who deviated from the beliefs of the majority were persecuted and thrown to prisons. Only a brave few stood against these people in order to prove them wrong and discover the truth. It only tells us that society doesn’t accept the truth with open arms most of the time, as it is hard to break the preconceived knowledge about things. Discoveries such as the heliocentric theory took a very long time to be accepted by the people, especially because it replaced a more divine theory that the Earth was the center of everything in the universe. Geography is split broadly into two sub-disciplines which are human geography and physical geography. Physical geography is focused primarily on the built environment and how space is created, viewed, as well has managed and handled by man, considering the influences that humans have on the space they created and occupied. Physical geography on the other hand, deals with the natural environment and how other factors like climate, vegetation and life, soil, water and landforms are created and interact with each other. Geography can be best defined as the study of the earth and its features, including everything contained in it, like the ones inhabiting the earth and the different phenomena occurring in it. Geography’s strengths mainly rely on its different branches, as it seeks to cover most concerns regarding the earth. On the other hand, its weaknesses was that it is not able to fully explain a certain field often, which is why there is a need to study other subfields of geography in order to cover for that weakness. The weather is a set of all the phenomena of a given atmosphere considering a certain period of time. This more on a short term basis, usually for hours or days say for example today it rained, while yesterday, it was just fairly cloudy. This is in comparison to that of climate, which is the average atmospheric conditions over longer periods of time, usually months, accounting for the seasons that we experience all throughout the year. The greenhouse effect is the process wherein there is the emission of infrared radiation by the atmosphere which then warms the earth’s surface. On the other hand, global warming is the increase in the average measured temperature of the air near the surface of the earth, because of the heat trapped by various gases in the atmosphere, as caused by pollutants like burning of fuels, smoke, and more. The two concepts are not the same, but the relationship between the two is that because of the greenhouse gases (too much of it) the heat trapped in the atmosphere increases, thus causing global warming. The effect on the environment is drastic, as polar icecaps melt, thus increasing the water levels in different parts of the world. It also changes the patterns of the environment, like the seasons, and the climates at different places. It greatly affects our lives because we might be experiencing a possible cause of species extinction, not only for the animals, but also for us human beings. Pressure gradient force is the acceleration of air due to an impending pressure difference or a force per unit of mass. This usually accelerates air from a high pressure area or region towards a low pressure region thus creating wind. The coriolis effect is the apparent deflection of moving objects when it is viewed from a certain frame of reference. The effect causes air in the atmosphere and water in the ocean to flow to the right of the direction north of the equator, thus causing the rotation of large cyclones. Frictional force is the force resisting the relative motion of two surfaces which are in contact, or a certain fluid in contact with a surface (such as air on an airplane or water flowing in a pipe. California’s Mediterranean climate is characterized by hot, dry summers and cool, wet winters. On the other hand, South Carolina’s humid subtropical climate is characterized by hot humid summers and chilly to mild winters. The United States have varying climates from the eastern part because of the bodies of water surrounding it. It can be explained by the El Nino, wherein large circulations of air across the Pacific Ocean breaks down, and warmer than normal waters appears in the eastern Pacific, while colder than normal waters appears in the western Pacific Ocean.

Midwife Views on Amniotomy to Speed Up Labour

Midwife Views on Amniotomy to Speed Up Labour Abstract This dissertation considers the views of midwives on the procedure of amniotomy with the specific relevance of its use in speeding up labour. The available literature is considered in detail to try to establish the current evidence base for the assumption that amniotomy does speed up labour and it finds that the evidence is poor, both in terms of number and quality of the papers available. One of the biggest problems appears to be that it is very difficult to carry out a study that isolates the specific and unique effects of amniotomy on the speed of labour from all of the other potential confounding factors that can influence the eventual outcome. There appears to be a gap in the literature in specific regard to the midwife’s views on the subject. A proposal is therefore made for a pilot project to evaluate the midwife’s views by the means of a qualitative survey using the semi-structured interview technique. The rationale for such a study structure is discussed in detail. Acknowledgements (Client to personalise) Contents page Abstract Acknowledgements Contents Purpose of the study Literature Review What is already known? Amniotomy and induction of labour Complications associated with amniotomy What are the perceived benefits of amniotomy? Does amniotomy speed up delivery? Midwife’s views on the subject Methodology Search history. Classification of evidence levels Research question or hypothesis Study design Sample Data Collection Rigour Ethical Issues Budget Timetable. Dissemination of findings Proposed semi-structured interview questions References Purpose of the study: The research question. The procedure of amniotomy was first described in the 18th century. Despite having therefore been in constant use for over 200 years, its effect on the induction and the course of labour still remains a matter of dispute and conflicting evidence. (Greenwood C et al. 2003) Amniotomy is generally held to be the artificial rupture of intact membranes with a view to facilitating, stimulating or inducing labour. (ODriscoll K et al. 1986). This dissertation has purposely started with a definition of amniotomy that is over 20 years old. During the course of the exploration of the evidence base surrounding the procedure of amniotomy we shall consider whether this definition is still held to be true in current practice. The procedure is typically done with gloved hands and the healthcare professional ruptures the amniotic sac with an amnihook (or similar instrument) between contractions, as this reduces the risk of cord prolapse because the amniotic fluid is under less pressure. (Kirby R S 2004). The hand is kept in the vagina allowing the fluid to drain in a controlled manner and the nature (colour consistency and amount) of the fluid is noted. It would be considered good practice to assess the foetal heart both immediately prior to the procedure and again immediately after it to check for foetal distress due to cord compression. Many authorities advocate performing the procedure in the semi-sitting position in order to minimise the effects of aortocaval compression and thereby optimise the blood supply to the uterus. (Burnett A F 2000) Indications for amniotomy still include the â€Å"promotion of labour†. This can be taken to mean both the induction of labour and the speeding up of labour (Cummingham F G et al. 2005) however, hard evidence for either is difficult to find for reasons that we shall discuss. Literature Review What is already known? For ease of presentation, this section will be divided up into various sub-headings considering the different aspects of amniotomy as a procedure Amniotomy and induction of labour Amniotomy is frequently cited as a means of inducing labour particularly if the cervix is considered to be â€Å"ripe†. Unfortunately amniotomy alone is an unpredictable inducer of labour with the possibility of long intervals between amniotomy and the onset of significant contractions. The Mouldin trial considered a direct prospective comparison of amniotomy alone and amniotomy with an associated oxytocin infusion. The results showed a statistically significant difference in the two groups with the latter group having a shorter induction to delivery interval. (Mouldin P G et al. 1996) There is a huge variation in the literature concerning the ability of amniotomy to hasten the onset of labour. Some early papers suggested that the effect was only minimal (Caldeyro-Barcia R 1975) whereas the majority of others suggest a much more obvious effect. As with other areas of investigation, difficulty arises in trying to separate out the effects of the amniotomy from the myriad of other variable factors that are present when a woman goes into labour. Friedman questions whether amniotomy hastens labour at all since many of the prospective trials have considered the case when amniotomy is done in early labour when the contractions would naturally begin to accelerate in any event (Friedman, E.A 1998) Complications associated with amniotomy This is a particularly contentious area with different authorities citing not only different associations of complications but significantly differing incidences as well. If we consider the Sheiner paper (Sheiner E et al. 2000) we can show a number of significant findings when early amniotomy was compared with both premature rupture of membranes (PROM) and oxytocin induction of labour. The significant differences found between the groups included a higher rate of caesarean section with 26.7% in the amniotomy group and 11.6% in the PROM and 16.9% in the oxytocin groups. It should be noted however, the authors performed a number of subsidiary analyses and showed that when the incidence of a previous caesarean section was controlled for then the amniotomy group had a similar incidence of caesarean section to the other groups. This would imply that amniotomy is more likely to be considered an option when a previous caesarean section has occurred. The authors make no comment as to why the y believe this might be. A much larger and more rigorous survey (Segal D et al. 2000) reviewed the outcomes of nearly 2000 cases of early amniotomy performed in association with a poor cervical score (Bishop scores of Amniotomy has been shown to increase the incidence of abnormalities in the patterns of foetal heart rate.( Goffinct F et al. 1997) Again this effect is hard to isolate convincingly as the risk may be consistently underestimated because women who do not have amniotomy are more likely to be given oxytocin which also increases the incidence of abnormal foetal heart rate patterns. (Rouse D J et al. 1999) Amniotomy may also be associated with an increase in infection rates. (Ventura S J et al. 1997) What are the perceived benefits of amniotomy? A number of authoritative texts state that routine early amniotomy can shorten labour by a variable amount, usually one or two hours (viz. Vincent M (2005) and Sheiner E, et al. (2000) and Albers L L et al. (1996)), Others suggest that it may reduce the use of oxytocics and the number of women who report the most intense degrees of pain during labour. (Klaus M H (1998) This picture is however, clouded by the fact that modern practice with its use of oxytocin (which makes labour more painful) and analgesia, including the epidural, which obviously reduces the overall pain experience, makes the statistical analysis of the relationship between amniotomy and pain very difficult Amniotomy has been cited as being indicated when there is a need for closer monitoring of the foetus allowing the direct attachment of scalp electrodes and incidentally evaluating whether the baby has passed meconium into the amniotic fluid. (Thornton J G et al. 1994). The presence of meconium is a significant clinical sign and is associated with an increased foetal morbidity and mortality (Ramin K D et al. 1996) Although its observation is enhanced by amniotomy, it is only of peripheral relevance to our considerations in this dissertation and therefore will not be considered further. Other authorities observe that this is not a good indication for amniotomy as the release of the amniotic fluid may expose the umbilical cord to increased compression during contractions. (Klaus M H 1998) Amniotomy also allows the positioning of an intrauterine pressure catheter in order to measure uterine contractions. Does amniotomy speed up delivery? This is an issue that has appeared in many older papers. A significant trial of 20 years ago (Seitchik J et al. 1985) concluded that the procedure of amniotomy appeared to enhance the cervical dilatation rate in patients with already well-dilated cervices and that are already dilating at a satisfactory rate and it conversely slows dilatation in some other patients, particularly those whose cervices are less dilated. This finding is cited in a number of contemporary text books. The difficulty is that the findings in this paper are only evidence base level 3. Many other papers refer to the trophic effects of amniotomy but none have had the discriminatory power to isolate the effects of amniotomy from the multitude of other variables which are inevitably present during the process of labour. The paper by Sherman (Sherman D J et al. 2002) primarily considers the patterns of foetal heart rate during the induction of labour and, in doing so, provides circumstantial evidence that amniotomy increases the speed of labour. Amniotomy was however, only performed in this trial if the cervix had dilated to more than 3 cms. without an associated spontaneous rupture of membranes. Oxytocin was also used in a significant number of cases thereby masking any effect which amniotomy alone might have. A different view is expressed by Pozaic who considered the case proven and puts forward the view that amniotomy should only be reserved for cases where there is abnormally slow progress of labour and then amniotomy should be performed to speed up the process. Again this is little more than level 4 evidence as the author does not cite what her evidence base is for making such an assumption. (Pozaic S 2004) To present a balanced argument one can cite the work of Steer (actually written when he was a house officer but then went on to become a professor of obstetrics), who published a controlled study of two matched groups of patients, all of whom had oxytocin induced labour. One group had their membranes ruptured and the others were allowed to rupture spontaneously. Steer found that the duration of labour was shorter in all patients who had ruptured membranes although, for reasons that were not explained, the uterine contractions were found to be at their greatest when the membranes were intact. In short, there was no evidence that amniotomy increased the speed of labour and there was evidence to suggest that the uterine activity was greatest in the group with membranes intact until well into labour. (Steer P J et al. 1975) Midwife’s views on the subject In terms of determining midwife’s views on the subject, there appears to be an almost complete gap in the literature on the subject. Extensive searching reveals no definitive authoritative texts on the subject and a very few that have sought the patient’s view on the issue. The Lavender paper (Lavender T et al. 1999) considered the issue only peripherally as part of a larger exploration of patient’s views and concluded that women who had long and protracted labours welcomed virtually any type of intervention that was perceived to reduce the time in labour and this included amniotomy. Clearly it is likely that this was perceived by the women as a â€Å"labour shortening procedure† and it is very unlikely that any discussion of informed evidence base would have taken place prior to its use. These issues are explored further in the more recent and larger qualitative investigation by Hodnett who considered the experiences and evaluations of childbirth in terms of overall pain experience. The paper is long and involved and, in the main, peripheral to our considerations here other then the fact that one of the main factors that the women cited as significant in terms of their positive appreciation of the process of labour was their perception of the attitude and behaviour of the midwives and this was rated as being more significant than the actual procedures that they employed. This finding appeared to override other factors including such variables as â€Å"age, socioeconomic status, ethnicity, childbirth preparation, the physical birth environment, pain, immobility, medical interventions, and continuity of care†. (Hodnett, E D. 2002). One can only therefore speculate as to whether this finding vicariously influences the decisions made by the midwives in terms of tr ying to provide a complete service to their patients. Another paper which is peripherally relevant to this issue is the well written and thought-provoking essay and investigation by Sookhoo (Sookhoo M L et al. 2002) which considered the wider issues of how midwives learn their clinical skills and the mechanisms by which they acquire their practical knowledge. The authors devote a substantial proportion of their paper to how this knowledge actually influences their professional judgements in both the assessment and the progress of the course of labour. This particular paper is worthy of examination on several levels, not only for its actual content and results, but because it is structured on a grounded theory premise and conducts a number of semi-structured interviews and then attempts to construct theories from the results. It is very significant that a major finding in this paper was that the authors hypothesise that a major determinant of clinical activity for a midwife is the way in which she conceptualises uncertainty (which clearly is a major element in the management of labour). It is also significant that they found that one of the major techniques for avoiding uncertainty was to rely upon conventions and put trust in specific procedures â€Å"almost as a ritual†. The authors suggest that the experienced midwife tends to draw upon a much wider range of evidence and experience which has been accumulated through their clinical practice than the novice midwife who tends to rely on guidelines and strategies which they t end to see as predictive and protective. This has great relevance to the practice of amniotomy as Sookhoo et al. found that the experienced midwives tended to avoid inappropriate intrusion into the process of labour as a matter of routine. We should therefore be aware that amniotomy may be conceived as â€Å"inappropriate intrusion† by the experienced midwife and our study should perhaps be structured to evaluate this possibility. Perhaps the last word on this subject should go to the overview of the subject published by Katz Early amniotomy remained an independent risk factor for operative delivery on multiple logistic analysis controlling for confounding variables. These findings imply that caution is needed when deciding to perform early surgical induction unless it is a final option or other approaches are contraindicated. (Katz, Miriam 1999) Methodology Search history. The mechanism of the literature review was to conduct a number of literature searches through both electronic and hard copy data bases at the local University Library and the local Post Graduate Library (client to personalise). A number of search terms were used including: amniotomy; amniotomy knowledge; amniotomy indications; amniotomy benefits: amniotomy complications; amniotomy speed of labour; midwife views amniotomy; midwife procedures. The electronic databases included Bandolier and The Cochrane Library and Cinhal. These searches provided a great many texts which were accessed either electronically or in hard copy and then critically reviewed to ascertain the level of the evidence presented. The level of evidence was categorised into the following levels. Classification of evidence levels The highest level of evidence available was then used to support each point raised Research question or hypothesis It appears to be generally accepted that evidence based practice should be the â€Å"gold standard† of modern clinical practice (NMC 2004). However, many experienced healthcare professionals would attest to the fact that clinical decisions in their everyday practice is still influenced by individual experience and advice from colleagues. (Williams P R 2000). The rationale behind this study derives from the suspicion that many midwives use amniotomy to speed up labour and that there appears to be little in the way of a hard evidence base to support this view. It is the intention of this study to try to define the degree that individual midwife practice is determined (in this specific regard) by their own experience and professionally received advice and to what extent it is determined by reliance on their own independently derived evidence base. Study design This study will be qualitative in design. There are a number of different qualitative approaches that could be adopted (DeWalt, K. M et al. 1998) and brief consideration will be given to each. The phenomenological approach is primarily a philosophical mechanism which employs that technique of concentrating on the conscious and subjective experiences of the subjects. (Hammond et al, 1995). It is therefore written from the first person viewpoint. Such an approach is not without its critics however, as the classic approach is from the third person (impersonal) viewpoint (Ahmed, 2006). Hammond characterises the phenomenological genre as â€Å"unconstrained by scientific rigour† as it is simply a recording of the experience as the observer experiences and interprets it. It is therefore not purged of subjectivity and bias as many other scientific approaches are. The phenomenological approach was considered for this project and discounted as it is conceded that such an approach may give rise to a very idiosyncratic view of the subject and may not be representative of the majority view. Grounded theory may, at first sight, appear to be a suitable approach for this study. The prime element in a grounded theory study is the fact that the data is obtained and then the investigators then attempt to formulate or identify appropriate theories from the processed data. (Glaser, 1992). This approach may seem suitable by virtue of the fact that midwives could be approached and data obtained to see if there are any constant factors which motivate their particular pattern of behaviour when considering the procedure of amniotomy. A problem may arise however, because of the intrinsic need for theory formulation. Charmaz characterises the problem by stating â€Å"It compels the researcher to impose explanations were no explanations naturally exist, or indeed are necessary†. (Charmaz, K. 2006). In this study it is the intention to explore midwife’s views on whether amniotomy increases the speed of labour rather then to specifically generate theories to explain these views. For this reason grounded theory was discounted as a possible approach After much consideration it was decided to adopt an ethnographic approach to the study. This involves a hybrid approach with an analysis termed by Agar as being from the point of view of â€Å"The professional strangerâ€Å" (Agar, 1996). This approach has elements of both qualitative and quantitative analysis and is primarily carried out using the analysis of â€Å"in the field† interviews of midwives. Kottak describes the ethnographic approach (in the broadest terms) as collecting data â€Å"in the field by living among and blending in with a particular group, society or culture, observing and recording their particular habits and detailing their experiences and reactions† (Kottak, 2005). The researcher is expected to be a part of the community studied but to â€Å"retain a certain degree of detachment, impartiality and objectivityâ€Å" (Kottak, 2005). The object of this study requires the observer to record the number of times a midwife uses the procedure of amniotomy and then to obtain her views on the rationale for the procedure through the mechanism of the semi-structured interview. Sample Constraints on time and finances will largely dictate the overall size of the project (client I have no idea what potential funds you have available for this project so I have made a number of assumptions that you will have to modify if they are not correct). It is considered prudent to make a pilot study in order to test the validity of the interview questions and to also trial the analysis techniques. The initial pilot would be in the labour ward of the author’s hospital (client to personalise here) and would therefore potentially include 12 midwives. If the study were to yield potentially significant findings, then its scope could be widened to include staff from different sites and thereby include perhaps different protocols and possibly different work practices. This would have the benefit that it is possible that certain work practices may be determined by peer pressure in a specific geographical location and broadening the scope of the investigation would help to minimise the biasing effect of such practices. (Rosner B 2006). There is also considerable merit in trying to ensure that the cohort of midwives studied contains a wide spectrum of experience, ideally from the newly qualified midwife through to the most experienced, as it would be unlikely that the work practices would be the same in all groups. (Strauss, A et al. 1990). It is therefore clearly of benefit to try to structure the sample to include representatives from all of these groups in order to minimise the effects of such potential bias. (Carr L T 1994). It foll ows from this requirement that the study group will be asked to provide information relating to their years of experience in addition to other demographic markers. Analysis of the pilot study will help to determine whether purposeful sampling or general sampling will be appropriate in the final study. (Moher D et al. 1999). In the former method, subjects are specifically chosen because of the likelihood of their being able to give valuable information to the study. Patton describes this method of recruitment as â€Å"selecting only a limited number of information-rich cases for investigation, in order to obtain a particularly detailed insight into an issue. (Patton 1999). Although this may be, at first sight, useful in trying to maximise the information yield of the study, it has the obvious downside that it is a source of considerable potential bias giving rise to a small and potentially unrepresentative sample. (Patton 1999). A variation of this technique of recruitment is called snowballing whereby one key subject is asked to recommend others who may have either specialist knowledge or a specific interest in the subject in question. This te chnique is recommended by MacQueen as â€Å"being particularly suitable in qualitative studies, where detailed and in-depth understanding of a little-known subject is required† (MacQueen K M, et al. 2004). Although this clearly has the ability to optimise the collection of significant information, it does not eliminate the potential for bias apparent in the purposeful sampling technique. If we consider that amniotomy is a widely used practice amongst midwives, then neither method is sufficiently useful to outweigh the potential bias that they would engender. For these reasons it is considered appropriate to approach all of the midwives in the local unit to take part in the study. Data Collection In line with the principles of the ethnographic approach, this study will adopt the dual mechanisms of direct observation and the semi-structured interview. (Breakwell et al, 1999). The semi-structured interview technique is explored in depth by De Martino who contrasts the technique with unstructured and fully structured interviews. The former â€Å"essentially amounts to an informal conversation with no guiding principles, and structured interviews are characterised by the asking of a predetermined and fixed set of questions with strict guidelines. Semi-structured interviews however, entail asking a preset group of questions but with some flexibility, so that interesting leads can be explored further† (De Martino B et al. 2006). The semi-structured interview technique is considered to be the most useful for this type of study because of the lack of rigid constraints placed upon both interviewer and subject. The questions are designed to be â€Å"open† thereby allowing the subject to introduce appropriate topics which can then be followed up at the interviewer’s discretion. This flexibility is perhaps the most appropriate for this type of study as the interviewer does not know in advance just what factors influence the midwife’s opinions. Frey broadens the issue by suggesting that, in this context, attitudes of the subjects can be typically analysed in any of three â€Å"dimensions†, namely: emotion, cognition, and behaviour. (Frey et al. 2001). It might therefore be important to structure the semi-structured interview questions so that they cover all three of these dimensions. Typical examples in this regard might be (a)â€Å"How does performing as amniotomy on your patients make you feel emotionally?† (b)â€Å"What are your views about amniotomy and the speed of labour?† (c)â€Å"How do you actually choose to speed up your patient‘s labour?† This may not prove to be completely relevant, as one could suggest that emotional involvement is actually counterproductive in this particular circumstance. It is clear that a large element of discretion will have to be left with the interviewer as it is likely that the answers given may clearly be either carefully considered and evidence based on one extreme or superficial and unconsidered on the other. This flexibility will allow the subject to impart their own intention without being unduly hampered by rigid questioning and should allow the emergence of a detailed set of data which reflects each individual midwife‘s opinions and practices clearly. (Concato, et al. 2000) In addition to the semi-structured interviews there will also be an element of direct observation to ascertain the labours that are managed with amniotomy and to contrast them with the labours that are managed without the procedure. It may well be of considerable value to include an element of questioning in the semi-structured interview phase that asks about the rationale for performing the procedure Data Analysis Data analysis can be carried out using time-honoured methods originally developed in the social science setting with various qualitative analytical methods. (Vickers, A. J et al. 2001). The most commonly used is probably thematic analysis (Braun V et al. 2006) which involves coding the themes that are derived from the responses. The themes are initially identified during the semi-structured interview stage and are then assigned a code (or number) depending upon the frequency with which the various subjects refer to the particular theme. From reading Braun it is apparent that there is considerable flexibility in the coding and identification of the themes (which is in contrast to the mechanisms described for both grounded theory and other forms of qualitative analysis). Some authorities find that this flexibility and lack of proscription is a negative feature of the thematic approach but Braun argues that it enhances the quality of the analysis by allowing a â€Å"richness of analysi s not provided for by other methods†. (Braun V et al. 2006). This is clearly a complex exercise and it will be attempted in the pilot study by the author, but it is accepted that it may be more appropriate to enlist the help of an experienced researcher to assist in the analysis of the full project It is considered likely that the various themes will be obvious from the data obtained. Braun suggests a five stage mechanism for optimum data retrieval, namely: (1)Familiarising oneself with the data. (2)Developing a coding system and identifying bits of data consistent with specific codes. (3)Looking for and identifying themes in the data (4)Labelling or naming the themes identified, with appropriate justification (e.g. quotations from interview transcripts) (5)Writing up the report, including data extracts, in a compelling fashion. (Braun V et al. 2006). The interviews will be initially tape recorded and then transcribed in order to allow for identification of the various themes. It is clearly likely that the themes will be expressed in different terms by different subjects and therefore a degree of latitude will be needed by the interpreter to ensure that similar themes will be included and analysed together. (Berlin J A et al. 1989) Rigour The value of any study ultimately depends upon the rigor with which it is conducted. (Green J et al. 1998). It is in the very nature of a qualitative study that it does not intrinsically possess the precision of the classical quantitative study. It is therefore of great importance that attention is paid to reliability and repeatability during both the design and execution stages of the study. Triangulation is one mechanism that can help in this regard. (Piantadosi S. 1997). This requires comparison of the results obtained by one method with those obtained by another. The classic structure is to see whether the data obtained from the study matches with that obtained from subject feedback. (Leaverton PE. 1998). Berwick also suggests that any apparently aberrant or atypical cases should be examined as these will help to establish the overall validity of the study. (Berwick D. 1996) Ethical Issues It is central to the instigation of any study that the approval of a Local or National Ethics Committe

Paediatric palliative care Essay -- Health, Nurses, Health Care Provid

Paediatric palliative care is a taboo topic in today’s society. Paediatric palliative care is a topic that society avoided and does not want to deal with. The World Health Organization (WHO) defines paediatric palliative care as palliative care is the attempt to improve the quality of life in patients who are facing life-threatening illnesses and family members through the prevention and relief of suffering with early detection and treatment of pain, physical, psychosocial, or spiritual (Liben, Wolfe & Papadatou, 2008, p. 852). Some of the current issues surrounding paediatric palliative care is that health care providers, mainly nurses are feeling the burnout and frustrations of caring for a dying child. Many nurses have claimed to have moral and ethical distress which in turn, can lead to feelings of helplessness and anger (Morgan, 2009, p. 88). Health care providers may also feel personal pain during the care of a dying child (Morgan, 2009, p. 88). Many health care providers and families feel like there is a lack of communication about the disease and treatments the child is receiving, as well as the patients often feel like they do not have a voice about treatments (Hsiao, Evan & Zeltzer, 2007, p.361). The lack of education and knowledge about paediatric palliative care leads to society treating the subject of paediatric palliative as taboo and forbidden to talk about because no one wants to admit that children unfortunately die (Morgan, 2009, p. 87). Research has shown that many patients will benefit from paediatric palliative care programs and education, but studies have shown that out of 3,000 hospitals in the United States, less than ten percent have programs for end-of life care based toward children (Morgan, 2009, ... ...are of paediatric palliative child. Online resources would be beneficial for families who are in rural areas or who do not have access to many places because of the limitations on travel due to their child’s illness because everyone wants information about what is happening during this difficult time to ease some of the concerns. Inservices, IPPC, simulations, ACNs and communication are all needed in order for the health care providers to maintain and provide a therapeutic relationship with the patient and their families. With better education about paediatric palliative care, knowledge of the effects of caring for paediatric palliative care on the health care providers, communication between families, patients and health care providers about paediatric palliative care, can provide a therapeutic relationship with families and patients during a very difficult time.