Analyse the dramatic function of Mercutio in Romeo and Juliet Essay Example

Analyse the dramatic function of Mercutio in Romeo and Juliet Paper Analyse the dramatic function of Mercutio in Romeo and Juliet with appropriate reference to social context, theme, character, setting and audience. Romeo and Juliet was based on a narrative poem by Arthur Brooke. Shakespeare made the poem much more dramatic by making the events happen in five days rather than three months like the poem The play is based on two star-crossd lovers who fall in love, then take their lives. Mercutio appears to be a minor character as he only performs in four scenes. Until the death of Mercutio Romeo and Juliet could have been a comedy, however, after Mercutios death, the play changes its pace and much darker in its themes and concerns. We will write a custom essay sample on Analyse the dramatic function of Mercutio in Romeo and Juliet specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Analyse the dramatic function of Mercutio in Romeo and Juliet specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Analyse the dramatic function of Mercutio in Romeo and Juliet specifically for you FOR ONLY $16.38 $13.9/page Hire Writer The Elizabethan audience would have had a different opinion on the play than we have today. The Elizabethan males would have found Mercutio very funny as they believed they were superior to females and would have agreed with Mercutios bawdy sense of humour. We today find it funny and offensive as males and females have an equal place in todays society. Shakespeares theatre company was called the Chamberlains Men and had twelve leading actors. Shakespeare would have a particular actor in mind for each character in the play. Mercutio has a minor role in the play, but his death brings the final tragic outcome which is the death of both Romeo and Juliet. Mercutio being a very bawdy person talks about women in a very sexual way and seems to feel that women are there for a mans pleasure. I conjure thee by Rosalines bright eyes By her high forehead and her scarlet lip, By her fine foot, straight leg and quivering thigh, And the demesnes that there adjacent lie. This speech made by Mercutio implies that Romeo only wants Rosaline for her feminine parts. O that she were An open-etcetera, thou a poprin pear. Mercutio is only interested in females for their feminine parts. Whereas Romeo believes in respect for women. Benvolio stands up to Mercutio by saying And if he hear thee, thou wilt anger him. This is said after Mercutios speech about Rosaline. By remaining silent, Benvolio is showing that what Mercutio is saying about Romeo and Rosaline is wrong and rude. Benvolio sticks up for Romeo although he, also, feels that Romeo needs to get over Rosaline. Come, he hath hid himself among these trees, To be consorted with the humorous night: Blind is love and best befits the dark. The Queen Mab speech shows a different side of Mercutio. At the start of the speech he talks about a fairy (Queen Mab) giving you your dreams and how dreamers often lie. This shows Mercutio has no belief in dreams, it shows to me that he is implying that dreamers lie as it is what we would like to happen not what is going to happen in reality. As Mercutio progresses into the speech it becomes darker and more menacing. This shows that Mercutio is a more complex character than we first thought. This speech shows us a lot about Mercutios mercurial character because it appears from nowhere, other than a wish to entertain his friends in a breathless, excited manner. It also makes us identify Mercutio, so that we feel sorry for him when he is killed and it helps to explain Romeos reaction to his death. The theme of the speech is that people of that time believed that dreams fore-told the future, and that Romeo should have followed his feelings and not gone to the party. Mercutios attitude to the Nurse in Act 2 sc IV is bawdy. Everything the nurse says he replies to with a sarcastic remark. When the nurse bids him good-morrow Mercutio bids a good-den to confuse her. This shows the audience that Mercutio is very volatile and misogynistic. Shakespeare makes the tension grow by contrasting scenes of love with scenes of hate. Although many scenes in Act 2 have a comic tone, the mood of the play quickly shifts in Act 3. At first the audience are indulging in tender love scenes between Romeo and Juliet, then next their plunged back into the violence of the street brawl. Act 3 sc I is the fight scene. This shows off more of Mercutios darker character. The weather at the beginning is oppressively hot and tempers are short. Benvolio even says if they meet the Capulets they will not escape a brawl. Right from the beginning Mercutio is spoiling for a fight, even manages to argue with the peace making Benvolio. Further excitement is built up by Romeos refusal to fight Tybalt. Tybalt tries to manipulate him by calling him a villain and a boy, but this does not push Romeo. Romeo keeps his cool as he is now married to Juliet, Tybalts cousin. The fight its self is exciting as Mercutio is fighting to defend Romeos honour. Romeo stops the fight but everything escalates out of control. The drama continues with Mercutios death and the puns he made beforehand: Ask for me tomorrow and you will find me a grave man. Mercutio is saying if you want me tomorrow, I will not be here, Ill be dead. The anger of Romeo over Mercutios death also adds to the tension of when Mer cutio said a plague on both your houses. Benvolios character is completely different from Mercutios. Where as Mercutio is hot-headed and bawdy. Benvolio is a pacifist and is quiet. Benvolio tries to stop the fight by saying if we stay we shall not escape a brawl. Tybalt was introduced to the audience in Act 1 sc V as being very fiery. He admitted to the audience in a soliloquy that Romeos intrusion at the Capulets ball has caused him to feel bitter and angry, and that he is going to get his revenge on Romeo. I will withdraw; but this intrusion shall, Now seeming sweet, convert to bittrest gall. The audience already know Tybalt as the Prince of Cats because Mercutio spoke about his good fencing skills in a mocking way in Act 2 sc IV. The very Butcher of a silk button, a duellist, a duellist! A gentleman of the very first house, of the first and second cause. Ah, the immortal passado! the punto reverse! The hay! Mercutios mercurial character associates him with passion and energy. Tybalt tries to act in a more honourable way to look the bigger man in front of Romeo and his friends as they gate crash the Capulets ball. Tybalts manner shows that although he was not happy about them being there he was not going to let them see it was bothering him. Romeo does not want to fight Tybalt because in the scene before hand, Romeo had just married Juliet. Romeo says: I do protest I never injurd thee, But love thee better than thou canst devise, Till thou shalt know the reason of my love: And so, good Capulet, which made, which name I tender As dearly as my own, be satisfied. This speech by Romeo proves that he has no intention of starting or enduring in a fight, especially as Tybalt is the cousin of his wife. But after Tybalt kills Mercutio it pushes Romeo over the edge and causes him to fight Tybalt without the intention of killing him. Shakespeare makes the death of Mercutio seem tragic but comic by having him killed off in the middle of the play as everyone would have enjoyed his character. The comic part of Mercutio being killed off is conveyed by short and powerful speeches he gave before he died. Ask for me tomorrow, and you shall find me a grave man. A plague o both your houses! Mercutios last words are foreshadowing as he seems to be implying that its every one elses fault apart from his own. A plague o both your houses! is him saying its the ancient grudge fault hes dying and if they sorted out the family feud then it would not have come to his death. Ask for me tomorrow, and you shall find me a grave man. Is Mercutios way of telling everyone hes dying! But because of his mercurial side they dont believe him and think that he is joking. Mercutios death leaves the Montagues and Capulets mourning as, his death leads to the death of Romeo and Juliet. At first I thought Mercutios death had a big impact on Romeo and Juliets deaths. Now I have read and studied the play I come to believe that it was the ancient grudge that caused all the deaths in the play. Mercutios death leaded to Romeo killing Tybalt, Romeo being banished, Romeo thinking Juliet was dead, Romeo killing himself at Juliets side with her just coming round, then Juliet killing herself. If the families had left the ancient grudge in the past, it would never have been able to cause such grief. It must have been a stupid falling out between the families as neither family can remember what it is about! It has tragically separated each family from their child, The Capulets from the pretty, rather intelligent young lady Juliet, and the Montagues from the handsome rather soft and loving Romeo.

Where The Economy Is Now In Respect To At Least Coursework

Where The Economy Is Now In Respect To At Least Coursework Where The Economy Is Now In Respect To At Least – Coursework Example 15th February Where the economy is now in respect to at least Jobs In United s, the unemployment rate was 6.1 percent in September 2008, and after one year, the rate of unemployment increased up to 10 percent. The cause and the measures of United States unemployment rate are due to economic conditions, global competition, education, automation and demographics. These factors affect the workers and the society as a whole causing the rate of unemployment currently to be 7.3 percent. Despite the contribution of United States government to create jobs to the citizens, the economy still has 1.9 million fewer jobs (Robert 46). One of the solutions that United States is engaging in to prevent unemployment is keeping the economy growing and developing business cycle. This means that the government is spending money to the society to keep the economy growing and still maintaining the economy to be steady. With the recent pace of job growth, it will just take 11 months to lower the rate of une mployment thus reaching the previous peak.Economic growth In 2008, the impact of the financial crisis was cascading though the system and gross domestic product (GDP) dropped by 8.3 percent and this was during the first quarter of 2008. The country during this year dropped the gross domestic product by 0.3 percent and this kept on increasing up to 2009 which cascaded by 2.8 percent drop (James 86). Nation Bureau of Economic Research carried a research where the United States economy stood at $15,681T in 2009 comparing with $14,895T that was experienced in 2008. The pace of recovery is still being experienced since the economy has shown a growth rate of 3-3.5 percent. The country is ranked as the largest world’s single national economy estimating a GDP of $17.1 trillion in 2013.Robert, M. Labor Force And Unemployment, New York: New York Press, 1973.Print James, K. Gross Domestic Product, Big Gaps. New York: ZED Books, 2009.Print

Care Ethics Personal Statement Example | Topics and Well Written Essays - 500 words

Care Ethics - Personal Statement Example When my mother asks me to run errands for the house like picking my younger brother up from school or babysitting him while mother has gone to buy grocery, I do it not because I love doing these tasks but because as the elder child this is my responsibility. Although I am least interested in singing nursery rhymes and making cereal for my brother, I have to do it. This is because from a very young age I have been told to become a responsible individual who fulfills all the duties. Therefore this is an example of ethical action based on duty from my life. The former example illustrates the ethics of care whereby our moral actions are determined by the understanding of the importance of relationships. My enthusiasm to meet and help my grandmother is because of the special bond between us. The latter example shows that my motives to help my mother are based on the Kantian ethics of duty, according to which actions that are done due to inclination have no moral value. My efforts to help my mother are just to discharge my duties. When I help my grandmother, I look forward to the smile on her face and the faintest hint of smile on her face makes me happy and proud of myself. In other words the consequences of my act determine whether my action is morally right or wrong. However when I baby-sit my brother, I do so in reverence to the societal norms.

Harley Davidson Coursework Example | Topics and Well Written Essays - 3000 words

Harley Davidson - Coursework Example Over the years HD Motorcycle Company had to adopt many strategies in terms of marketing so that they could cope with stiff competition posed by the likes of Honda and Suzuki. According to a famous book written by Michael porter on the different competitive strategies adopted by companies and nations, we see that they may take the form of 3 basic strategies; the overall cost leadership strategy, differentiation strategy or the strategy that focuses on just a particular niche of the market. These strategies are normally used to create a platform that can be used to outperform various competitors. Harley Davidson generally uses the ‘differentiation’ strategy widely as their generic competitive strategy. The differentiation strategy is where a company chooses to counter competition by attempting to offer something unique in the existing market in terms of products or services. The HD motorcycle company offers its heavyweight brand of motorcycles through various designs which are distinctive in terms of design. The company in itself has over 100 years of existence in the motorcycle industry, more than any other motorcycle company in the world. It was because of this that the Harley Davidson brand has become an American iconic brand and nostalgia therefore it was no longer a just a motorcycle brand but also a traditional brand that has been carried on through generations. The motorcycle brand in itself consists of an American flag that represents the nice feeling of freedom to the Americans, the type of freedom only compared to that of riding. This attachment to the consumers is what has given Harley Davidson the competitive edge over other motorcycle companies. Therefore the customers owning the American made versions always perceive the Harley Davidson bikes as the only high quality products and are always demanding for the additional exclusive value that can be added without even considering the increase in price. Also still on the differentiation str ategy, the HD motorcycle company produces over 30 different models of motorcycles. This diversity has increased their reach into the 4 different units of the target market which are; Touring market, Custom market, Performance market and lastly the Standard market. Harley Davidson Company allows buyers of their bikes to customize them through the use of chromes and other custom parts that are provided by Harley Davidson dealers all over America. This has made sure that they establish an unrivaled motorcycle empire in the American market only and not the other market areas like in Europe. This was because the company’s history and reputation affected only as far as American states alone. Further differentiation of their motorcycles and accessories then proved to be a good generic competitive strategy again. This was through the development of new motorcycle design that was called the ‘V Rod’ which is a Porsche designed engine heavy motorcycle. The V Rod or the VRSC model did not just impact positively (in terms of sales volume) for Harley Davidson Company in Europe alone, it also sold very well in Japan although this strategy was not that effective as the sales

Social work- serious case review practice issues Essay

Social work- serious case review practice issues - Essay Example ppened, it would also be that such events occurred because these guardians themselves were mentally-incapacitated to provide comfort and support to the children (Lyons-Ruth, et al., 2004, p.70). In this regard other agencies could have mitigated the effects of the debilitation of the parents or caregivers of children, by having them assess the capability of these adults to provide care and support (Phillips, 1997, p.609). Most often agencies such as social welfare, schools, health practitioners and other authorities are able to give provide the necessary assistance to children in high-risk families or neighbourhoods, and the help are able to give positive results, especially when the children in question are provided with proper medical attention as well as psychiatric counselling (Faver, et al., 1999, p.90). However, there are also times when these same agencies are unable to work together in solving cases of child maltreatment or neglect, especially when the parents or guardians involved are rather resistant to any outside help, which could result to the children getting injured or even ending up dead (Rzepnicki & Johnson, 2005, p.393; Wulczyn, et al., 2010, p.5). Such events are likely to be the result of the miscommunications or the lack of correspondence among agencies, as well as not understanding how the interrelationships between welfare agencies could prevent occurrences of children getting injured inside the home. Such a case has been documented by the Birmingham Safeguarding Children Board, when a child in a rather problematic family died due to onset of infections that were attributed to lack of proper nourishment, among other things (Radford, 2010, p.5). In hindsight, the problem could have been alleviated if the agencies which were attending the family were much more proactive in truly finding out the state of the family, as well as the ability of the mother and the partner adult to care for the children. However, the communication gaps between the

The Respiratory System And Disease Health And Social Care Essay

The Respiratory System And Disease Health And Social Care Essay There are two lungs in the human chest; the right lung is composed of three incomplete divisions called lobes, and the left lung has two, leaving room for the heart. The right lung accounts for 55% of total gas volume and the left lung for 45%. Lung tissue is spongy due to very small (200 to 300  ¿Ã‚ ½ 10 ¿Ã‚ ½6 m diameter in normal lungs at rest) gas-filled cavities called alveoli, which are the ultimate structures for gas exchange. There are 250 million to 350 million alveoli in the adult lung, with a total alveolar surface area of 50 to 100 m2 depending on the degree of lung inflation (2). Conducting Airways Air is transported from the atmosphere to the alveoli beginning with the oral and nasal cavities, through the pharynx (in the throat), past the glottal opening, and into the trachea or windpipe. Conduction of air begins at the larynx, or voice box, at the entrance to the trachea, which is a fibromuscular tube 10 to 12 cm in length and 1.4 to 2.0 cm in diameter. At a location called the carina, the trachea terminates and divides into the left and right bronchi. Each bronchus has a discontinuous cartilaginous support in its wall. Muscle fibers capable of controlling airway diameter are incorporated into the walls of the bronchi, as well as in those of air passages closer to the alveoli. Smooth muscle is present throughout the respiratory bronchiolus and alveolar ducts but is absent in the last alveolar duct, which terminates in one to several alveoli. The alveolar walls are shared by other alveoli and are composed of highly pliable and collapsible squamous epithelium cells. The bronchi subdivide into subbronchi, which further subdivide into bronchioli, which further subdivide, and so on, until finally reaching the alveolar level. Each airway is considered to branch into two subairways. In the adult human there are considered to be 23 such branchings, or generations, beginning at the trachea and ending in the alveoli. Movement of gases in the respiratory airways occurs mainly by bulk flow (convection) throughout the region from the mouth to the nose to the fifteenth generation. Beyond the fifteenth generation, gas diffusion is relatively more important. With the low gas velocities that occur in diffusion, dimensions of the space over which diffusion occurs (alveolar space) must be small for adequate oxygen delivery into the walls; smaller alveoli are more efficient in the transfer of gas than are larger ones (2). Alveoli Alveoli are the structures through which gases diffuse to and from the body. To ensure gas exchange occurs efficiently, alveolar walls are extremely thin. For example, the total tissue thickness between the inside of the alveolus to pulmonary capillary blood plasma is only about 0.4  ¿Ã‚ ½ 10 ¿Ã‚ ½6 m. Consequently, the principal barrier to diffusion occurs at the plasma and red blood cell level, not at the alveolar membrane (2). Movement of Air In and Out of the Lungs and the Pressures That Cause the Movement Pleural Pressure Is the pressure of the fluid in the thin space between the lung pleura and the chest wall pleura. Alveolar pressure Is the pressure of the air inside the lung alveoli. To cause inward flow of air into the alveoli during inspiration, the pressure in the alveoli must fall to a value slightly below atmospheric pressure. Transpulmonary pressure It is the pressure difference between that in the alveoli and that on the outer surfaces of the lungs, and it is a measure of the elastic forces in the lungs that tend to collapse the lungs at each instant of espiration, called the recoil pressure. Compliance of the Lungs The extent to which the lungs will expand for each unit increase in transpulmonary pressure (if enough time is allowed to reach equilibrium) is called the lung compliance. The total compliance of both lungs together in the normal adult human being averages about 200 milliliters of air per centimeter of water transpulmonary pressure (3). Figure 2. Compliance diagram of lungs in a healthy person (3). Pathophysiology of Weaning Failure Reversible aetiologies for weaning failure can be categorized in: Respiratory load, cardiac load, neuromuscular competence, critical illness neuromuscular abnormalities (CIMMA), neuropsychological factors, and metabolic and endocrine disorders. Respiratory load The decision to attempt discontinuation of mechanical ventilation has largely been based on the clinician ¿Ã‚ ½s assessment that the patient is haemodynamically stable, awake, the disease process has been treated adequately and that indices of minimal ventilator dependency are present. The success of weaning will be dependent on the ability of the respiratory muscle pump to tolerate the load placed upon it. This respiratory load is a function of the resistance and compliance of the ventilator pump. Excess work of breathing (WOB) may be imposed by inappropriate ventilator settings resulting in ventilator dysynchrony (4). Reduced pulmonary compliance may be secondary to pneumonia, cardiogenic or noncardiogenic pulmonary oedema, pulmonary fibrosis, pulmonary haemorrhage or other diseases causing diffuse pulmonary infiltrates (5). Cardiac load Many patients have identified ischaemic heart disease, valvular heart disease, systolic or diastolic dysfunction prior to, or identified during, their critical illness. More subtle and less easily recognized are those patients with myocardial dysfunction, which is only apparent when exposed to the workload of weaning (5). Neuromuscular competence Liberation from mechanical ventilation requires the resumption of neuromuscular activity to overcome the impedance of the respiratory system, to meet metabolic demands and to maintain carbon dioxide homeostasis. This requires an adequate signal generation in the central nervous system, intact transmission to spinal respiratory motor neurons, respiratory muscles and neuromuscular junctions. Disruption of any portion of this transmission may contribute to weaning failure (5). Critical illness neuromuscular abnormalities CINMA are the most common peripheral neuromuscular disorders encountered in the ICU setting and usually involve both muscle and nerve (6). Psychological dysfunction Delirium, or acute brain dysfunction: Is a disturbance of the level of cognition and arousal and, in ICU patients, has been associated with many modifiable risk factors, including: use of psychoactive drugs; untreated pain; prolonged immobilisation; hypoxaemia; anaemia; sepsis; and sleep deprivation (7). Anxiety and depression: Many patients suffer significant anxiety during their ICU stay and the process of weaning from mechanical ventilation. These memories of distress may remain for years (8). Metabolic disturbances Hypophosphataemia, hypomagnesaemia and hypokalaemia all cause muscle weakness. Hypothyroidism and hypoadrenalism may also contribute to difficulty weaning (5). Nutrition Overweight: The mechanical effects of obesity with decreased respiratory compliance, high closing volume/functional residual capacity ratio and elevated WOB might be expected to impact on the duration of mechanical ventilation (5). Ventilator-induced diaphragm dysfunction and critical illness oxidative stress Ventilator-induced diaphragm dysfunction and critical illness oxidative stress is defined as loss of diaphragm force-generating capacity that is specifically related to use of controlled mechanical ventilation (9). Clinical Presentation of Patients Patients can be classified into three groups according to the difficulty and length of the weaning process. The simple weaning, group 1, includes patients who successfully pass the initial spontaneous breathing trial (SBT) and are successfully extubated on the first attempt. Group 2, difficult weaning, includes patients who require up to three SBT or as long as 7 days from the first SBT to achieve successful weaning. Group 3, prolonged weaning, includes patients who require more than three SBT or more than 7 days of weaning after the first SBT (5). Clinical Outcomes and Epidemiology There is much evidence that weaning tends to be delayed, exposing the patient to unnecessary discomfort and increased risk of complications (5). Time spent in the weaning process represents 40 ¿Ã‚ ½50% of the total duration of mechanical ventilation (10) (11). ESTEBAN et al. (10) demonstrated that mortality increases with increasing duration of mechanical ventilation, in part because of complications of prolonged mechanical ventilation, especially ventilator-associated pneumonia and airway trauma (12). The incidence of unplanned extubation ranges 0.3 ¿Ã‚ ½16%. In most cases (83%), the unplanned extubation is initiated by the patient, while 17% are accidental. Almost half of patients with self-extubation during the weaning period do not require reintubation, suggesting that many patients are maintained on mechanical ventilation longer than is necessary (5). Increase in the extubation delay between readiness day and effective extubation significantly increases mortality. In the study by COPLIN et al. (13), mortality was 12% if there was no delay in extubation and 27% when extubation was delayed. Failure of extubation is associated with high mortality rate, either by selecting for high-risk patients or by inducing deleterious effects such as aspiration, atelectasis and pneumonia (5). Rate of weaning failure after a single SBT is reported to be 26 ¿Ã‚ ½ 42%. Variation in the rate of weaning failure among studies is due to differences in the definition of weaning failure. VALLVERDU et al. (14) reported that weaning failure occurred in as many as 61% of COPD patients, in 41% of neurological patients and in 38% of hypoxaemic patients. Contradictory results exist regarding the rate of weaning success among neurological patients. The study by COPLIN et al. (13) demonstrated that 80% of patients with a Glasgow coma score of more than 8 and 91% of patients with a Glasgow coma score less than 4 were successfully extubated. In 2,486 patients from six studies, 524 patients failed SBT and 252 failed extubation after passing SBT, leading to a total weaning failure rate of 31.2% (5). The vast majority of patients who fail a SBT do so because of an imbalance between respiratory muscle capacity and the load placed on the respiratory system. High airway resistance and low respiratory system compliance contribute to the increased work of breathing necessary to breathe and can lead to unsuccessful liberation from mechanical ventilation (15). Economic Impact Mechanical ventilation is mostly used in the intensive care units (ICU) of hospitals. ICUs typically consume more than 20% of the financial resources of a hospital (16). A study that analyzed the incidence, cost, and payment of the Medicare intensive care unit use in the United States (US) reveled that mechanical ventilation costs a sum close to US$2,200 per day (17). One study shows that patients in the ICUs receiving prolonged mechanical ventilation represents 6% of all ventilated patients but consume 37% of intensive care unit (ICU) resources (18). Another study corroborates this numbers also showing that 5% to 10% of ICU patients require prolonged mechanical ventilation, and this patient group consumes more than or as much as 50% of ICU patient days and ICU resources. Prolonged ventilatory support and chronic ventilator dependency, both in the ICU and non-ICU settings, have a significant and growing impact on healthcare economics (19). Summary TREATMENT OPTIONS WEANING FAILURE Overview The process of initial weaning from the ventilator begins with an assessment regarding readiness for weaning. It is then followed by SBT as a diagnostic test to determine the possibility of a successful extubation. For the majority of patients, the entire weaning process involves confirmation that the patient is ready for extubation. Patients who meet the criteria in table 2 should be considered as being ready to wean from mechanical ventilation. These criteria are fundamental to estimate the likelihood of a successful SBT in order to avoid trials in patients with a high probability of failure (5). Table 2 Criteria for Assessing Readiness to Wean Clinical Assessment Adequate cough Absence of excessive tracheobronchial secretion Resolution of disease acute phase for which the patient was intubated Objective measurements Clinical stability Stable cardiovascular status (i.e. fC =140 beats*min-1, systolic BP 90 ¿Ã‚ ½160 mmHg, no or minimal vasopressors) Stable metabolic status Adequate oxygenation Sa,O2 >90% on =FI,O2 0.4 (or Pa,O2/FI,O2 =150 mmHg) PEEP =8 cmH2O Adequate pulmonary function f =35 breaths*min-1 PImax =-20 ¿Ã‚ ½ -25 cmH2O Ve < 10 l*min-1 P0.1/PImax < 0.3 VT >5 mL*kg-1 VC >10 mL*kg-1 f/VT 13 ml*breaths-1*min-1 No significant respiratory acidosis Adequate mentation No sedation or adequate mentation on sedation (or stable neurologic patient) Taken from (5) and (15). fC: cardiac frequency; BP: blood pressure; Sa,O2: arterial oxygen saturation; FI,O2: inspiratory oxygen fraction; Pa,O2: arterial oxygen tension; PEEP: positive end-expiratory pressure; f: respiratory frequency; PImax: maximal inspiratory pressure; VT: tidal volume; VC: vital capacity; CROP: integrative index of compliance. 1 mmHg=0.133 kPa. According to an expert panel, among these criteria only seven variables have some predictive potential: minute ventilation (VE), maximum inspiratory pressure (PImax), tidal volume (VT), breathing frequency (f), the ratio of breathing frequency to tidal volume (f/VT), P0.1/PImax (ratio of airway occlusion pressure 0.1 s after the onset of inspiratory effort to maximal inspiratory pressure), and CROP (integrative index of compliance, rate, oxygenation, and pressure) (20) . Minute Ventilation Minute ventilation is the total lung ventilation per minute, the product of tidal volume and respiration rate (21). It is measure by assessing the amount of gas expired by the patients lungs. Mathematicly, minute ventilation can be calculated after this formula: V_E=V_T ¿Ã‚ ½f It is reported that a VE less than 10 litres/minute is associated with weaning success (22). Other studies found that VE values more than 15-20 litres/minute are helpful in identifying if a patient is unlikely to be liberated from mechanical ventilation but lower values were not helpful in predicting successful liberation (15). A more recent study concluded that short VE recovery times (3-4 minutes) after a 2-hour SBT can help in determining respiratory reserve and predict the success of extubation (23). When mechanical ventilation takes place, this parameter is calculated monitoring flow and pressure by the ventilator in use itself or by an independent device attached to the airway circulation system such as the Respironics NM3 ¿Ã‚ ½ by Phillips Medical. Other ways to determine minute ventilation are by measuring the impedance across the thoracic cavity (24). This method though, is invasive and requires implanted electrodes. Maximal Inspiratory Pressure Maximal inspiration pressure is the maximum pressure within the alveoli of the lungs that occurs during a full inspiration (21). Is it commonly used to test respiratory muscle strength. On patients in the ICU or those not capable to cooperate, the PImax is measured by occluding the end of the endotracheal tube for a period of time close to 22 seconds with a one-way valve that only allows the patient to exhale. This configuration leads to increasing inspiratory effort measuring PImax towards the end of the occlusion period. However PImax is not enough to predict reliably the likeliness of successful weaning due to low specifity (15). The measurement of PImax can be performed by devices equipped with pressure sensors. Tidal Volume Tidal volume is the amount of air inhaled and exhaled during normal ventilation (21). Spontaneous tidal volumes greater than 5 ml/kg can predict weaning outcome (25). More recent studies found that a technique that measures the amount of regularity in a series analyzing approximate entropy of tidal volume and breathing frequency patterns is a useful indicator of reversibility of respiratory failure. A low approximate entropy that reflects regular tidal volume and respiratory frequency patterns is a good indicator of weaning success (26). Tidal volume can be measured using a pneumotachographic device. Breathing Frequency The degree of regularity in the pattern of the breathing frequency shown by approximate entropy rather than the absolute value of the breathing frequency is been proven to be useful in discriminating between weaning success and failure (26). The breathing rate or frequency is measured by counting the breathing cycles per a defined period of time. The Ratio of Breathing Frequency to Tidal Volume Yang and Tobin [18] then performed a prospective study of 100 medical patients receiving mechanical ventilation in the ICU in which they demonstrated that the ratio of frequency to tidal volume (rapid shallow breathing index (RSBI)) obtained during the first 1 minute of a T-piece trial and at a threshold value of =105 breaths/minute/l was a significantly better predictor of weaning outcomes However, there remains a principle shortcoming in the RSBI: it can produce excessive false positive predictions (that is, patients fail weaning outcome even when RSBI is =105 breaths/minute/l) [35-36] Also, the RSBI has less predictive power in the care of patients who need ventilatory support for more than 8 days and may be less useful in chronic obstructive pulmonary disease (COPD) and elderly patients [37-39]. The Ratio of Airway Occlusion Pressure to Maximal Inspiratory Pressure The airway occlusion pressure (P0.1) is the pressure measured at the airway opening 0.1 s after inspiring against an occluded airway [42]. The P0.1 is effort independent and correlates well with central respiratory drive. When combined with PImax, the P0.1/PImax ratio at a value of 13 ml/breaths/minute offers a reasonably accurate predictor of weaning mechanical ventilation outcome. In 81 COPD patients, Alvisi and colleagues [39] showed that a CROP index at a threshold value of >16 ml/breaths/minute is a good predictor of weaning outcome. However, one disadvantage of the CROP index is that it is somewhat cumbersome to use in the clinical setting as it requires measurements of many variables with the potential risk of errors in the measurement techniques or the measuring device, which can significantly affect the value of the CROP index. Clinical Treatment Profiles CONCLUSIONS AND RECOMMENDATIONS

The right to live, the right to die. Essay -- Euthanasia Essays

Euthanasia, along with all other forms of medical involvement concerning the ending of human life has been a subject of great controversy for some time, dating back to the times of Socrates, and is a topic which has long attracted the attention of both medical and legal professionals, ethicists, and is often brought up in general public debate (Huxtable & Campbell, 2003) The term euthanasia derives from the Greek 'eu', which means 'good', and 'thanatos', meaning 'death' (Ladd, 1979). In a medical context, the Hippocratic Oath popularly believed to be undertook by all practising physicians suggests all medical practitioners will endeavour to ensure all patients' well being, it is all too easy to misinterpret the oaths' meaning in order to manipulate and justify actions that would otherwise be deemed unethical; specifically for the act of euthanasia. This essay will discuss the arguments both for and against euthanasia, with careful consideration given to all aspects related to the debate. Perhaps the most well known arguments in the euthanasia debate are that of the sanctity of life, of which holds palpable religious connotations which will be further discussed; the ending of suffering or 'low quality of life'; and the respect for patient autonomy (Huxtable & Campbell, 2003). In terms of extremities of the euthanasia debate spectrum, the Church of England (2000) have published a document greatly opposing euthanasia, whilst on the other hand, Otlowski (1997) has thoroughly researched and published an analysis of the law with the ultimate aim of ensuring euthanasia as a legal option. In terms of a religious perspective, and for purposes of extended clarity; Christian views, there is much contradiction to be found regarding euth... ...ts will invariably disagree with utilitarianists, and visa-versa, thus deeming all cases as requiring ethical investigation on an individual scale. Seemingly similar cases may have entirely different circumstances altogether, and may or may not have different outcomes. Although religion can play a major role in many cases of euthanasia, it is unlikely witnessing a relative suffering chronic untreatable pain will override any alleged desire to prolong life longer than required; however, certain circumstances often provide members of some religions with no other choice, for example, as in the case of Jehovah's Witnesses, where blood transfusion is not allowed. In conclusion to the available evidence, case studies and theoretical aspects of euthanasia, it can be argued that whilst people have the inherent right to live, they also have the right to die with dignity.