The Things They Carried By Tim O Brien - 1536 Words

The Things They Carried The Things They Carried is a fiction story about a group of soldiers in Vietnam, particularly Tim O’Brien. Tim O’Brien is the main character of the story; however, Azar shapes the story just as well as Tim. I concluded, after viewing the NPR interview, that Azar is an alter ego personality of O’Brien. Even though Azar is an alternate side O’Brien, he isn’t too fond of this aspect of himself. Azar is the unsympathetic, cruel, and joking side, whereas Tim is the nicer, quieter, and guilty side. The story is based on how the individuals dealt with the war in Vietnam and how they dealt with it when they returned home. Azar is how Tim chose to deal with the horrible aspect of war while in Vietnam, and Tim, a nice individual who felt guilty for this awful circumstance, used this more unsympathetic side of himself to be able to make it through the war. Azar first arrived into the story when O’Brien started discussing how war wasn’t all viole nce. A little boy came up to Azar and asked for chocolate. As the child departed, Azar mentioned about how he had one leg and an individual must’ve run out of ammo (O’Brien 30). He chose to focus on the negative side instead of just being able to enjoy the peace they had at the moment. Azar was the side of Tim that couldn’t imagine anything civil happening in Vietnam, and he could only see the horrific factor about the child having one leg. McDaniel 2 In this situation, the first man O’Brien killed, AzarShow MoreRelatedThe Things They Carried By Tim O Brien892 Words   |  4 PagesThe Vietnam War was a long, exhausting, and traumatic experience for all of the soldiers and those who came with them. The Things They Carried, by Tim O Brien illustrates the different affects the war had on a variety of people: Jacqueline Navarra Rhoads, a former nurse during the Vietnam war, demonstrates these effects within her own memoir in the book, The Forgotten Veterans. Both sources exemplify many tribulations, while sharing a common thread of suffering from mental unpredictability. DesensitizationRead MoreThe Things They Carried By Tim O Brien1377 Words   |  6 Pageslove to have it as good as we do. Tim O’Brien’s The Things They Carried discusses many veterans who experience the burden of shame and guilt daily due to their heroic actions taken during the Vietnam War. The book shows you how such a war can change a man b efore, during, and after it’s over.     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   As I reflect on the many conflicts America has been a part of, none can compare to the tragedies that occurred in The Vietnam war. As told in The Things They Carried (O’Brien), characters such as NormanRead MoreThe Things They Carried By Tim O Brien1457 Words   |  6 Pagesthe theme pertains to everyone regardless of their background. It conveys the same ideas to people from all across our society. Lastly, a classic is timeless, which means it has transcended the time in which it was written. In Tim O’Brien’s novel, The Things They Carried, he offers a new, intriguing way to view war or just life in general and also meets all of the crucial requirements mentioned above to qualify it as a book of literary canon. Though this book is technically a war novel, many peopleRead MoreThe Things They Carried By Tim O Brien1242 Words   |  5 Pagesâ€Å"Tim O’Brien is obsessed with telling a true war story. O Brien s fiction about the Vietnam experience suggest, lies not in realistic depictions or definitive accounts. As O’Brien argues, absolute occurrence is irrelevant because a true war story does not depend upon that kind of truth. Mary Ann’s induction into genuine experience is clearly destructive as well as empowering† (p.12) Tim O’s text, The Things they Carried, details his uses of word choice to portray his tone and bias. Tim O’BrienRead MoreThe Things They Carried By Tim O Brien1169 Words   |  5 Pagesbut are set in the past and borrows things from that time period. A story that fits this genre of literature is The Things They Carried. The story is about Tim O Brien, a Vietnam veteran from the Unite States, who tells stories about what had happ ened when he and his team were stationed in Vietnam. He also talks about what he felt about the war when he was drafted and what he tried to do to avoid going to fight in Vietnam. The Things They Carried by Tim O Brien was precise with its portrayal of settingRead MoreThe Things They Carried By Tim O Brien1004 Words   |  5 Pages Tim O’Brien is a veteran from of the Vietnam War, and after coming home from his duty he decided to be a writer. His work â€Å"The Things They Carried† is about a group of soldiers that are fighting in the Vietnam War. The first part of the story talks mostly about physical items that each soldier carries, and also mentions the weight of the items as well. Though, there is one exception to the list of physical things. Lieutenant Cross is a character of the story, and Tim O’ Brien quickly states theRead MoreThe Things They Carried By Tim O Brien896 Words   |  4 PagesTrouble without a doubt is what First Lieutenant Jimmy Cross c arried around his shoulders because he was out in war, where mistakes happen. Lost and unknown of his surroundings he had to lead his men into safety, while destroying anything they found. First Lieutenant Jimmy Cross only holds onto one thing for hope and that is Martha, the woman who he hopes is a virgin to come back to. Tim O’ Brien introduces symbolism by adding a character that has a meaning of purity and a pebble, which symbolizesRead MoreThe Things They Carried By Tim O Brien Essay832 Words   |  4 PagesSummary: â€Å"By and large they carried these things inside, maintaining the masks of composure† (21). In Tim O’brien’s The Things They Carried, the American soldiers of the Vietnam War carry much more than the weight of their equipment, much more than souvenirs or good-luck charms or letters from home. They carried within themselves the intransitive burdens—of fear, of cowardice, of love, of loneliness, of anger, of confusion. Most of all, they carry the truth of what happened to them in the war—aRead MoreThe Things They Carried By Tim O Brien1369 Words   |  6 PagesMany authors use storytelling as a vehicle to convey the immortality of past selves and those who have passed to not only in their piece of literature but in their life as an author. In Tim O’Brien’s work of fiction The Things They Carried, through his final chapter â€Å"The Lives of the Dead,† O Brien conveys that writing is a matter of survival since, the powers of s torytelling can ensure the immortality of all those who were significant in his life. Through their immortality, O’Brien has the abilityRead MoreThe Things They Carried By Tim O Brien1407 Words   |  6 Pages       Our introduction stated that in â€Å"The Things They Carried,† author Tim O’Brien tells us not directly of the soldiers of Vietnam, or the situations they find themselves in, but about the things they carry on their shoulders and in their pockets. These â€Å"things† identify the characters and bring them to life.   I find that to be true as the author unfolds the stories about war and the uncommon things one carries in to war both inadvertently and on purpose.  Ã‚  Ã‚  As it was noted: Stories about war –

Autism in the Media Essay - 2151 Words

Autism in the Media Weepinbell, w-e-e-p-i-n-b-e-l-l; Tentacool, t-e-n-t-a-c-o-o-l ; Geodude . . . , yelled Connor. We were playing his favorite game - identify and spell the names of all 156 Pokà ªmon characters. Connor is a three-year-old boy I worked with as part of the SonRise therapy that his mother organized after he was diagnosed with autism. During my thrice-weekly Connor-directed playtime visits, I entered his world instead of making him enter mine and encouraged eye contact to strengthen Connors connection with others. I begin this critique of autism depiction in mass media relating my relationship with Connor because he informs my understanding of autism and colors my critique of media†¦show more content†¦Currently, seventeen in every 10,000 children is diagnosed with autism, and reported rates of autism are increasing.3 Experts disagree about what causes autism.2 Genetics appear to play an important role-autistic individuals have a series of documented brain structure abnormalities (see Grandin, 1995)--but environment is also important. Teasing apart the specific etiology of this disorder is difficult, because genetics and environment play off one another. For example, infants with a genetic predisposition to pull away from touch and refuse eye contact tend to receive less stimulation.2 Developmental deficiencies that result could therefore be attributed to either genetics or environment because their effects are intertwined. Parents of autistic children, eager for a cure, drive much of the current research on autism. To date, research has focused on the identification of autism genes, and the furthering of the effectiveness of human gene therapy. Until such genes are fully characterized, serious questions remain about appropriate medication of autistic children and more broadly about social definitions of normal behavior.Show MoreRelatedThe Media And Its Effects On Children Essay957 Words   |  4 PagesScience Media 9455 Word Count:961 The media can be a powerful tool to get a message across. The media have been around for a while now, and in some cases it can be a useful tool to catch up with current events. In other cases it can be a total misrepresentation of the truth when it comes to controversial topics. The media use some controversial topics in order to get more and more people watch, read, and listen to their source. An example of a controversial topic, used by the media was the connectionRead MoreMedia and Its Effects on Society1437 Words   |  6 PagesMedia and its Effects on Society Media plays a crucial role in our life nowadays. It serves as a bridge that connects people to the world, leading to a global exchange of information and knowledge. Media also offers platform for people to voice their thoughts on political and social issues, providing room for different perspectives. Unquestionably, media affects our life in nearly every ways. With a turn of a magazine page, a tune on a radio, or a flip of a TV channel, media somewhat plays a partRead MoreDoes Autism Spectrum Disorder Affect A Person s Understanding Of The Environment1307 Words   |  6 PagesAutism Spectrum Disorder, also known as ASD, can affect a person’s understanding of the environment that they live in. More specifically, it refers to a person’s group of pervasive neurodevelopmental disorders that can moderately or severely disrupt their functioning in regards to their social skills, expressive and receptive communication, and repetitive or stereotyped behaviors and interests (Cu llinan, Pennington and Southern). Having analyzed both â€Å"Scientists link 60 genes to autism risk† a massRead MoreMeasles, Rubella, Vaccine, Vaccines, And Vaccines1048 Words   |  5 Pagesthere has been strong opposition to their use. Perhaps the most common belief is that vaccines—specifically the measles, mumps, rubella (MMR) vaccine, is tied to an increased risk of autism. Media coverage, based on inaccurate evidence and disproved by scientific studies, has led to a large public fear that autism can be caused by vaccines. These beliefs stem primarily from a 1998 publication by British doctor Andrew Wakefield; yet even after this paper was deemed inaccurate, these fears did notRead MoreThe Media And Health And Safety Of The Worlds Population1738 Words   |  7 Pagesmany people question the safety of them. There is a famous theory that vaccines cause autism due to the chemicals within the vaccines, even though scientific evidence denies any connection. One of the reasons that this theory still exists is due to the portrayal of information from the media. Based on the opinion of the media outlet, the depiction of the vaccine-autism link changes throughout society. The media is typically the main source of information for citizens, whether they watch a news channelRead MoreThe Anti Vaccine Movement And The Vaccine1620 Words   |  7 Pages The Anti-Vaccine Movement Although the MMR link to autism is one of the most recent anti-vaccine incidences, the anti-vaccine movement didn’t begin with the suggestion that MMR caused autism. Previous vaccine scare incidences arose prior to the 1998 study on MMR that fueled more anti-vaccine sentiments. Offit (2011) claims that the modern American anti-vaccine movement began when a documentary titled DPT: Vaccine Roulette, aired on April 19, 1982. The documentary questioned the safety and effectivenessRead MoreTechnology Has Made On Education987 Words   |  4 Pagesis individuals diagnosed with Autism Spectrum Disorder (ASD). In the first decade of the new millennium, technology has proven to be a highly effective tool for in-creasing communication, in individuals with ASD. According to Finke, Hickerson, McLaugh-lin (2012) nearly 445,000 students, between the ages of 6 and 21 years old, diagnosed with au-tism are served in schools in the United States. Hall (2012) reported the contributions by re- nowned geneticist and autism pioneer, Michael Wigler. Wigler’sRead MoreHealth Of The Medi Using The Models Of Health1349 Words   |  6 Pages Health in the Media: Using the Models of Health to Assess Media Articles about Health Topics Catherine Stratton HST209: Introduction to Health, University College, University of Toronto Table of Contents Abstract†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦...3 Paper†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.4-7 Works Cited†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.8 Abstract The effect of having constant access to media is that consumers are overwhelmed with information, whichRead MoreComparative Essay : The Night Time, By Mark Haddon, And The Curious Incident Of The Dog1021 Words   |  5 Pages(Haddon, M, p. 20.) Autism as defined by the Oxford dictionary as: â€Å"A developmental disorder of variable severity that is characterized by difficulty in social interaction and communication and by restricted or repetitive patterns of thought and behaviour.† (Oxford Dictionaries | English, 2017) This definition is a small view into the complexity of the autism spectrum. The world is finally beginning to understand autism and how it affects those who have it. As our knowledge of autism expands, the integrationRead MoreThe Prevalence Of Autism And Autism Essay921 Words   |  4 Pages2000, the prevalence of autism has increased by nearly 120 percent: According to the Centers for Disease Control and Prevention (CDC), this makes autism the fastest-growing developmental disability in the U.S. http://www.autism-society.org/what-is/facts-and-statistics/ A March 27, 2014 announcement http://www.cdc.gov/media/releases/2014/p0327-autism-spectrum-disorder.html from the CDC states that autism impact s 1 in 68 children across the nation. First Responders and Autism Awareness Every day,

Universal Health Care In Singapore Samples †MyAssignmenthelp.com

Question: Discuss about the Universal Health Care In Singapore. Answer: Introduction: Health care can be considered one of the necessities that each and every individual of the society has a right to. However, various external and internal factors continue to influence the health care provided to different sectors of the society. These elements are diverse, and they vary greatly, ranging from race to gender to age to socioeconomic status, and all the different factors facilitate health care disparities in both accessibility of care and quality of care. However there have been some strategies being implemented to reduce the disparities prevalent in the health care system by the global healthcare monitoring authorities, and universal health coverage policy is one of the robust steps that have been taken to improve the situation. Out of all the countries that have implemented universal health coverage scheme, Singapore had been the country that has achieved excellent progress in their health care system by incorporating this strategy. And that is the reason why the healt hcare system of Singapore is considered as the role model for other countries to look up to (Boerma et al., 2014). This assignment will attempt to explore how Singapore has adapted to the universal health coverage scheme and how it has contributed to overall progression in both their health care system. Overview of Singaporean health care: As per the recent statistics shared by the World Health Organization, the healthcare system in place in Singapore is ranked 6th position from the top of the global list and is considered to be the provider of 4th best healthcare standards in global comparison. Along with that, it has to be mentioned that Singapore is also deemed to have the best health care system in all of Asia, and Singapore proudly serves as the showcasing representative for providing outstanding medical technology and optimal health care standards. The island state has a population of 5.4 million and the surprising elements that attract the attention of the world towards its revolutionary health care system, is the universal coverage or accessibility that it has provided, and appreciable health benefits provided at minimal government spending. According to the Alma-Ata principle of WHO, one of the most significant components of global health improvement strategies is the universal health coverage; the health care system of Singapore entertains universal health coverage at the heart of their policies and principles (Boerma et al., 2014). The presiding health care body for Singapore is the Ministry of Health or MOH, and this authoritative entity is responsible for policies and protocols being designed and implemented in Singapore. The mission statement for the health care system in place in Singapore is to accelerate multidimensional transformation in the healthcare sector by means of introducing infocomm-enabled care delivery system. To meet this goal the MOH invested 6.6 billion dollars in the year of 2015 which is approximately 30% higher than that of 2014. Elaborating more on the history of the progress made by the MOH in the past decade, it has to be mentioned that the turning point for the health care system had been the establishment of health promotions board in the year 2001, which facilitated the disease prevention and national health programs in the nation. The health care system of the nation in the present day scenario is governed by the healthy living masterplan, that by the end of 2020 acclaims to make extensive health care services accessible and affordable for all the citizens regardless of their socio-economic standing. Regarding annual government expenditure, Singapore takes pride in the fact that it spends half of what the rest of the developed countries spend on the healthcare, roughly 4.7% GDP. There are three core principles that have been developed over the course of the past decade in the Singaporean health care system; the first principle integrates the concepts of preventative health care strategies with robust health promotional campaigns and promoting healthy lifestyles. It has to mentioned in this context, that under the guidance of Mr Khaw Boon Wan, the health minister for Singapore in the past decade, the government realized the need for integrative early and accessible primary health care services; and improvement can only be facilitated by improving both the quality and cost-effectiveness of care (Chongsuvivatwong et al., 2011). The second principle of Singaporean health care system promotes healthy living by the 3M system, Medisave, Medishield, and Medifund. Medisave can be defined as the national insurance scheme which provides the citizens with both primary hospitalization expenses and few outpatient treatments as well, by their compartmentalized savings for the medical expenses. Medishield, on the other hand, is a rather complementary scheme to the Medisave scheme, which provides the citizens with catastrophic insurance coverage. Lastly, Medifund is the endowment fund that is operated and generated by the government which is designed to help the citizens with their health care expenses is not compatible to be covered by their Medisave and Medishield. This health care coverage scheme is the key facilitator in the radically low annual government spending in the nation and yet having decent life expectancy rates (Moh.gov.sg.). Considering the progress of the healthcare delivery pattern of Singapore, it has to be mentioned that 80% of the advanced primary care is provided by the public hospitals and the entire transition in the dependency from the privatised sectors to public sectors happened in the last decade itself. The growth in the public health care services can be represented by the fact that in the year 2010, there had been 11509 hospital beds, with 8881 from public sectors and rested from privately owned facilities. Hence it can be stated that the health care system of Singapore has witnessed a progressive growth in the last decade and adhering to the idea of universal health coverage has helped it attain the place that it has in the global list (Guinto et al., 2015). Health care principles facilitating universal coverage: The primary understanding of the universal health coverage scheme is the fact that it entertains the accessibility given to each and every citizen using curative, preventative, palliative and rehabilitative health services. The principle objectives of the universal health coverage scheme are to establish and maintain equity in health care service accessibility, maintaining the quality benchmark for the services provided and protecting the citizen from the financial risk of healthy acre expenses so that all the socio-economic sectors of the society can avail similar health care coverage. It was declared by the WHO in the year of 1989 in the Alma Ata declaration for all the nations to follow. For the Singaporean context, one of the key measures taken to improve the health care services had been to adhere to the UHC scheme (Holmes, 2012). Now one of the key principles that have been followed in order to ensure optimal adherence to the UHC is a strong policy focus at promotional and preventative care pattern for the non-communicable diseases. The Singaporean health care system adapted to a philosophy that boasts a shared responsibility between the government and the citizens to ensure healthy living. Their health care policies like affordable care policy hint at compliance to this key philosophy, so that there is an informed responsibility of the patients and their families to ensure healthy living, while the government overlooks the funding and maintaining cost-effectiveness of the entire health care services. The cost-effectiveness of the healthcare expenditure is maintained in the Singaporean health care services by the help of incentivising the health care providers; so that the financial risk to citizens is mitigated effectively. Hence it can be stated that the government of the Singaporean context provides a safe ty net to the citizens while the citizens contribute financially according to their preferences for their future in a government controlled insurance scheme (Ibrahimipour et al., 2011). It has to be mentioned in this context that the main principle of the UHC is to ensure that health care services are accessible to each and every sector of the society and there should not be any disparity in the delivery of the care services. In order to maintain compliance with this key principle of UHC, a robust and sound monitoring policy is a mandate for the government. In case of Singaporean health care, there is no such monitoring framework, however it has to be mentioned that the key indicators for accessibility, quality and affordability is reported by the Key performance indicator system to the ministry of health (McKee et al., 2013). The role played by the government: he healthcare system in Singapore has seen a drastic change in the past decade, and the most of the credit for the same goes to the initiatives invested by the government. Between the window of 1999 to 2010, the Singaporean health care has seen a rapid boost in the life expectancy in general facilitated by a radical decrease in the premature mortality, coronary heart conditions, cancer and stroke. And this appreciable outcome in the healthcare sector has achieved by the Singaporean government by just spending 4% of the annual GDP. Now this has been possible for the nation to achieve only by the health care expenditure maintenance scheme introduced by the Singaporean government under the guidance of the former health minister Mr Khaw Boon Wan (Tan et al., 2014). The revolutionary steps that the government has taken to ensure the overall accessibility of the health care services distributed to the citizens with equity rather than equality is commendable. The public funding scheme introduced by the government has three different yet interconnected variables. As discussed above, these three elements are nothing hut three insurance coverage schemes that allow the citizens to invest their share in accordance to their affordability and in turn be able to access excellent hospitalisation expenses and along with that coverage for specific outpatient care services as well. Elaborating more on this context, it has to be mentioned in this context that Medisave allowed the citizens to save their own pennies so that their own future can be secured in terms of primary health care expenses, while Medishield provided coverage to the citizens for catastrophic health care needs or incidences. Lastly, the Medifund is the endowment scheme that is the proverbial safety net for the citizen from the government and for the unfortunate ones whose insurance coverage cannot cover the health care expenses they have exhausted. This public funding scheme or system incorporates the principle of equity into the entire scenario so that the support is given to the individuals who need it the most (Tangcharoensathien et al., 2014). Now it has to be mentioned in this context, that the uniqueness of the health care system established in Singapore does not provide a linear or equal health care services to all socioeconomic sectors of the society. Instead, this health care system covers the different needs of different sections of the society with justice and equity. Hence, this initiative from the Singapore government provides the essential element that ensures adherence to the UHC scheme maintaining absolute accessibility to the citizens. Along with that it also has to be mentioned that the Singapore governments deserves more appreciation for the incentivising scheme that propels the healthcare providers to adhere to the system, and along with that the monitoring indicator system also ensures that the compliance to the UHC scheme is not interrupted in any manner (Wirtz et al., 2017). Conclusion: On a concluding note, it has to be mentioned that the Singapore has been successful in presenting an illustration at a remarkable development in the extensive health care delivery for all the nations to follow. By the virtue of three pillars of progress, incentivising, coverage monitoring, and financial protection, it has been able to reduce their annual spending at health to the half of what the rest of the world pays. And yet maintain a quality standard that is truly enviable; all the while shifting the focus of the citizens to public health sectors from privatised entities. Hence, it can be hoped that the initiatives taken by the government in facilitating this revolutionary transition can be an excellent benchmark for the rest of the countries to follow in order to establish equity and uncompromised quality in health care. References: Boerma, T., AbouZahr, C., Evans, D., Evans, T. (2014). Monitoring intervention coverage in the context of universal health coverage. PLoS medicine, 11(9), e1001728. Boerma, T., Eozenou, P., Evans, D., Evans, T., Kieny, M. P., Wagstaff, A. (2014). Monitoring progress towards universal health coverage at country and global levels. PLoS medicine, 11(9), e1001731. Chongsuvivatwong, V., Phua, K. H., Yap, M. T., Pocock, N. S., Hashim, J. H., Chhem, R., ... Lopez, A. D. (2011). Health and health-care systems in southeast Asia: diversity and transitions. The Lancet, 377(9763), 429-437. Guinto, R. L. L. R., Curran, U. Z., Suphanchaimat, R., Pocock, N. S. (2015). Universal health coverage in One ASEAN: are migrants included?. Global health action, 8(1), 25749. Holmes, D. (2012). Margaret Chan: committed to universal health coverage. The Lancet, 380(9845), 879. Ibrahimipour, H., Maleki, M. R., Brown, R., Gohari, M., Karimi, I., Dehnavieh, R. (2011). A qualitative study of the difficulties in reaching sustainable universal health insurance coverage in Iran. Health policy and planning, 26(6), 485-495. McKee, M., Balabanova, D., Basu, S., Ricciardi, W., Stuckler, D. (2013). Universal health coverage: a quest for all countries but under threat in some. Value in Health, 16(1), S39-S45. Moh.gov.sg. (2017). Moh.gov.sg. Retrieved 7 October 2017, from https://www.moh.gov.sg/ Rodney, A. M., Hill, P. S. (2014). Achieving equity within universal health coverage: a narrative review of progress and resources for measuring success. International journal for equity in health, 13(1), 72. Saksena, P., Hsu, J., Evans, D. B. (2014). Financial risk protection and universal health coverage: evidence and measurement challenges. PLoS medicine, 11(9), e1001701. Savedoff, W. D., Ferranti, F. D., Smith, A. L. (2012). Transitions in Health Financing and Policies for Universal Health Coverage. Washington, DC: Centre for Global Development. Tan, K. B., Tan, W. S., Bilger, M., Ho, C. W. (2014). Monitoring and evaluating progress towards universal health coverage in Singapore. PLoS medicine, 11(9), e1001695. Tangcharoensathien, V., Limwattananon, S., Patcharanarumol, W., Thammatacharee, J. (2014). Monitoring and evaluating progress towards universal health coverage in Thailand. PLoS medicine, 11(9), e1001726. Tangcharoensathien, V., Patcharanarumol, W., Ir, P., Aljunid, S. M., Mukti, A. G., Akkhavong, K., ... Mills, A. (2011). Health-financing reforms in southeast Asia: challenges in achieving universal coverage. The Lancet, 377(9768), 863-873. Wagner, A. K., Quick, J. D., Ross-Degnan, D. (2014). Quality use of medicines within universal health coverage: challenges and opportunities. BMC health services research, 14(1), 357. Wirtz, V. J., Hogerzeil, H. V., Gray, A. L., Bigdeli, M., De Joncheere, C. P., Ewen, M. A., ... Mller, H. (2017). Essential medicines for universal health coverage. The Lancet, 389(10067), 403-476. World Health Organization. (2015). Tracking universal health coverage: first global monitoring report. World Health Organization.

Noninvasive Ventilation for Ventilator - MyAssignmenthelp.com

Question: Discuss about theNoninvasive Ventilationfor Ventilator Assistance. Answer: Non-Invasive ventilation technique is a method that entails the use of ventilator assistance in the affected patients nasal way (nasal passage way/nostril) using a mask or similar devices and not through surgical means. It may also be identified as the technique that provides and enhances alveolar ventilation without the use of an endotracheal intubation (Linda Gray-Clinical Specialist). Popularly abbreviated as NIV, it is very different from other ventilation methods. Noninvasive ventilation is majorly used to adult patients. The method does not involve the use of a tracheal tube, laryngeal mask or tracheostomy. While all other methods are considered invasive, Non-Invasive Ventilation as its name suggests is not invasive. It does not involve tubes being put in your nasal airway or body. It is divided in two ways; one is the NPV meaning negative pressure ventilation while the other is NIPPV to mean non-invasive positive pressure ventilation. This ventilation method is used to help ad ults with difficulty in gas exchange in the lungs, chronic hypercapnia respiratory failure and COPD meaning chronic obstructive pulmonary disease. In this case BiPAP or CPAP is applied. BiPAP means Bilevel Positive Airway Pressure, while CPAP means Continuous Positive Airway Pressure. Each of these models i.e. BiPAP and CPAP requires a certain machine. The machine is connected to an electrical outlet which allows air under pressure to enter into the respiratory system of the patient, with respiratory problem. The air under increased pressure passed through a tube to a patients mouth whereby a tightly fitted mask to ensure that no air is leaking to the environment, and thus all air is entering the patients respiratory system. This is done to ensure that the patients lungs do not dilate hence the live of the patient is saved. In addition to mouth mask, a nose mask is also used. In order to keep the mask tightly placed at the mouth or the nose, a string is connected to the mask and tie d at the back of the patient head Respiratory failure is the inability to maintain the required air circulation and change in gas. It mostly is characterized by abnormal tensions of gases in the arterial blood (Bourke, Bullock, Williams, Shaw and Gibson, 2011). Non-invasive ventilation has a number of benefits which includes avoiding intubation with its accompaniment of death rates and prevalent sicknesses that include pneumonia. It also allows for intermittent ventilator assistance thus allowing for gradual weaning and eating normally. When NIV is applied, they mostly consider the Continuous Positive Airway Pressure (CPAP), that is, for sick individuals who have reduced functional residual capacity (FRC), type 1 respiratory failure and acute LVF. Bilevel Positive Airway Pressure (BiPAP) can also be considered for sick individuals with type 1 respiratory failure where these patients are tiring PaCO2 TV LOC and type 2 failure with patients of acute episodes. Although it is a preferable method for ventilation, it is no t advisable for every sick individual who has respiratory failure. It should only be applied by a trained technician or physician using an optimal ventilator on appropriate clinical environment. Consider a scenario whereby adult patient at the advanced levels of neuromuscular illness that is progressive with breathlessness at arrival in hospital. Deep breathes of difficulty followed by tiring gasps (Brochard, Mancebo, Wysocki, Lofaso, Rauss and Isabey,2009). Such respiratory illnesses show some certain indications and contraindications that the medical practitioners use to determine whether to use the non-invasive techniques or use the past ventilation techniques. Non-invasive indications are conditions that satisfy or allow for use of the non-invasive ventilation techniques on patients. They mostly are like symptoms that are shown by the patient to allow for such treatment ( Confalonieri, Potena, Carbone, Porta, Tolley and Umberto Meduri, 2008). For a patient to qualify for the non-invasive ventilation method they should pass through a screening process and the indications should include; obstructive sleep apnea syndrome, which is a proper candidate for the technique, chronic obstructive pulmonary disease with exacerbation qualify for the technique, bilateral pneumonia are proper candidates. There are also other syndromes to be considered in order to determine a patient who need noninvasive ventilation. These includes, A patient with acute congestive heart failure with pulmonary edema is also a proper candidate, neuromuscular disorders, a patient with acute lung injury is a potential candidate, asthma also qualifies to be a candidate for the technique (Girou, Schortgen, Delclaux, Brun-Buisson, Blot, Lefort and Brochard, 2008). Patients with difficulty in gas exchange in the lungs accepting lung resection surgery may allow for use the non-invasive ventilation technique, patient with obesity hypoventilation syndrome is a qualified candidate for the technique, weaning from ventilator. Non-Invasive Ventilation method also has its contraindications. Contraindications are signs that disqualify the use of the Non-Invasive Ventilation method on a patient. These are the signs and symptoms that the patient portrays that make the use of this method harmful to the patients health (Gray, Goodacre, Newby, Masson, Sampson and Nicholl, 2008). There are two types of contraindications when it comes to Non-Invasive Ventilation. There is both absolute contraindications and relative contraindications. The absolute contraindications of this method are quite a number and they include; Respiratory arrest or unstable cardiorespiratory status (Hilbert, Gruson, Vargas, Valentino, Gbikpi-Benissan, Dupon and Cardinaud, 2008). In case a patient is about to go on a respiratory shock or has unstable cardio flow; it is mostly advisable to resist application of the NIV. It may result in lots of complications which may include death. Such a state may require the use of invasive techniques in order to stabilize the respiratory system. Other absolute contraindications include, uncooperative patients. Some patients may not prefer the use of Non-Invasive Ventilation equipment due to some discomfort. Most patients will refuse the use of facial or nasal masks. Inability to protect airway (Kramer, Meyer, Meharg, Cece, Hill, 2008). When the patient has impaired swallowing and coughing, that is, the food may leave the esophagus into the trachea. This may cause lots of complications. Trauma or burns involving the face. When the patient has burns or injuries involving the face, the toxic gases released by the wound may cause skin irritation or many other unintended diseases. Facial, esophageal or gastric surgery. In case the patient has had facial, esophageal or gastric surgery, it is very much advised not to use the non-invasive ventilation because it may make upsets to the unhealed wounds. This may lead to lots of complications. In addition to absolute contraindications include Patients with Apnea (poor respiratory drive) should not be encouraged to follow through on application of Non Invasive Ventilation technique. Sick individuals with reduced or low consciousness are not advisable patients to be put under such a technique because it may lead to the suffocation and choking of the patients (Shneerson and Simonds, 2009). When a patient has air leak syndrome, it is strongly advised to use invasive ventilation method and not the non-invasive method. Life threatening dysrhythmias in a patient is severe and thus the use of invasive technique encouraged over the use of its counterpart. Continuous Positive Airway Pressure (CPAP) in lung injury is also a disqualification from the non-invasive ventilation technique. The non-invasive ventilation method commonly preferred is the BiPAP which is used by individuals suffering from sleep apnea. It prevents the lungs from collapsing and allows for relaxed breathing during sleep. The comparative advantage of BiPAP is that the breaths can be timed for maximum delivery of gaseous exchange in the lungs thus providing comfort. This allows for the individual to get greater air in and out during breathing reducing clogging. An indication that BiPAP is superior to CPAP is that BiPAP is quite oftenly used when CPAP is not successful in treating a patient. BiPAP machines come in different sizes allowing for easy movement and storage and self-operation after understanding its use and operation. BiPAP is mostly referred to candidates with breathing problems. The steps to be taken or procedures to be followed while using BiPAP masks may include: Within 24 hours of initiation of therapy, a clear plan for the nursing care should be provided and documented while the patient is getting Non Invasive Ventilation (Nava, Ambrosino, Clini, Prato, Orlando, Vitacca and Rubini, 2008). The Oral hygiene of the patient should be maintained at an interval of two hours as long as the patients tolerance to cessation of the non-invasive ventilation is greater than or over five minutes. The patients eye care is to be checked at an interval of two hours by the proper clinical physicians. This should be done without hesitance or delay. A full body wash, including shaving the patients face, is to be done every single day or many times as instructed or requested and required in response to the patient diaphoresis and the patients level of tolerance. Other steps are, all patients are to receive pressure injury prevention management as instructed by the practitioners, professionals and supervisors. This is to reduce the fatality and complications that sometimes arise from the use of the non-invasive ventilation method. Every Patient is should be advised and encouraged to sit out of bed as allowed by the technique. When in bed they are to be put in an upright position to facilitate and allow for chest wall expansion to give way for comfort in the ventilation process for the patient (Murgu, Pecson and Colt, 2010. The mobility or movement of the patient should be encouraged, assessed and monitored as per the guidelines provided by the medical practitioners and the doctors of the hospital. Assistance should be provided during such exercises. On clinical presentation or initiation of therapy, Pharmacotherapies are to be noted down and implemented as required in response to patient evaluation and assessment. Any referral to an allied he alth professional is to be implemented where services are available in the clinical environment to support the patients and their significant others psychosocial wellbeing. Every human method ever invented has its pros and cons, and the Non-Invasive Ventilation method including the BiPAP machine has no exception. As much as Non-Invasive Ventilation may be used to support respiratory failure disease, it may cause problems. The use of Non-Invasive Ventilation such as BiPAP may not be 100% or even 90% accurate for solution to the health care problem. It may even result to certain complications which may deteriorates the patients health. Non-invasive ventilation technique is associated with frequent life-threatening and frequent adverse effects which are very severe. This should encourage thorough screening of patients before suggestion or referral to the technique. This will reduce the number of severe complications experienced. The complications are strongly correlated with the degree of pulmonary and cardiovascular involvement. Non-Invasive Ventilation is to be applied with great care in sick individuals with pulmonary process such as lobar pneumonia. BiPAP being a form of ventilation method that is non-invasive is very useful. One of its uses is by sick individuals with sleep apnea. Its function is very similar to the CPAP. It is of two levels that is time-pedaled to achieve maximum efficiency in its functions. These machines can be used in a controlled environment which includes hospitals and homes but with close supervision and maintenance to date of the equipment and machines. Distention of the stomach because of aerophobia aspiration following vomiting while still negative pressure ventilation (Mehta and Hill, (2010). This may cause preload reduction and hypertension. This also includes Inability to or difficulty in relieving dyspnea and Inability to or difficulty in improving gas exchange in the respiratory system. However, failure of the Non-invasive ventilation technique depends on factors such as delayed application of the Non-invasive ventilation treatment. Whereby it may worsen the patients respiratory illness and create some complications that the non-invasive ventilation cannot be useful. Other failure includes inappropriate or unwanted ventilation pressures, Low or inexperience of the clinical staff or team and also, the patients clinical state or condition which maybe be as a result of two or more organ failures. In conclusion, the application of the Non Invasive Ventilation method is widely accepted and used in many clinical environments. It has proven to reduce mortality than its invasive counterpart and still provide respiratory comfort to the patient. Despite its complications, the method is quite effective and very efficient. If every procedure for its application is followed to the latter, then the success stories will be its only tale to tell. Much improvement still needs to be implemented and that will be done with more researches as time passes. But all in all, the non-invasive ventilation method should be administered in all clinical settings. References Bourke, S. C., Bullock, R. E., Williams, T. L., Shaw, P. J., Gibson, G. J. (2011). Noninvasive ventilation in ALS Indications and effect on quality of life.Neurology,61(2), 171-177. Brochard, L., Mancebo, J., Wysocki, M., Lofaso, F., Conti, G., Rauss, A., ... Isabey, D. (2009). Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease.New England Journal of Medicine,333(13), 817-822. Confalonieri, M., Potena, A., Carbone, G., Porta, R. D., Tolley, E. A., Umberto Meduri, G. (2008). Acute respiratory failure in patients with severe community-acquired pneumonia: a prospective randomized evaluation of noninvasive ventilation.American Journal of Respiratory and Critical Care Medicine,160(5), 1585-1591. Girou, E., Schortgen, F., Delclaux, C., Brun-Buisson, C., Blot, F., Lefort, Y., ... Brochard, L. (2008). Association of noninvasive ventilation with nosocomial infections and survival in critically ill patients.Jama,284(18), 2361-2367. Gray, A., Goodacre, S., Newby, D. E., Masson, M., Sampson, F., Nicholl, J. (2008). Noninvasive ventilation in acute cardiogenic pulmonary edema.New England Journal of Medicine,359(2), 142. Hilbert, G., Gruson, D., Vargas, F., Valentino, R., Gbikpi-Benissan, G., Dupon, M., ... Cardinaud, J. P. (2008). Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure.New England Journal of Medicine,344(7), 481-487. Kramer, N., Meyer, T. J., Meharg, J., Cece, R. D., Hill, N. S. (2008). Randomized, prospective trial of noninvasive positive pressure ventilation in acute respiratory failure.American journal of respiratory and critical care medicine,151(6), 1799-1806. Masip, J. (2010). Non-invasive ventilation.Heart failure reviews,12(2), 119-124. Mehta, S., Hill, N. S. (2010). Noninvasive ventilation.American journal of respiratory and critical care medicine,163(2), 540-577. Murgu, S. D., Pecson, J., Colt, H. G. (2010). Bronchoscopy during noninvasive ventilation: indications and technique.Respiratory care,55(5), 595-600. Nava, S., Ambrosino, N., Clini, E., Prato, M., Orlando, G., Vitacca, M., ... Rubini, F. (2008). Noninvasive Mechanical Ventilation in the Weaning of Patients with Respiratory Failure Due to Chronic Obstructive Pulmonary DiseaseA Randomized, Controlled Trial.Annals of internal medicine,128(9), 721-728. Nava, S., Gregoretti, C., Fanfulla, F., Squadrone, E., Grassi, M., Carlucci, A., ... Navalesi, P. (2010). Noninvasive ventilation to prevent respiratory failure after extubation in high-risk patients.Critical care medicine,33(11), 2465-2470. Nava, S., Navalesi, P., Carlucci, A. (2009). Non-invasive ventilation.Minerva Anestesiol,75(1-2), 31-36. Ozyilmaz, E., Ugurlu, A. O., Nava, S. (2014). Timing of noninvasive ventilation failure: causes, risk factors, and potential remedies.BMC pulmonary medicine,14(1), 19. Shneerson, J. M., Simonds, A. K. (2009). Noninvasive ventilation for chest wall and neuromuscular disorders.European Respiratory Journal,20(2), 480-487. Vianello, A., Arcaro, G., Battistella, L., Pipitone, E., Vio, S., Concas, A., ... Iliceto, S. (2014). Noninvasive ventilation in the event of acute respiratory failure in patients with idiopathic pulmonary fibrosis.Journal of critical care,29(4), 562-567.