Why Are You So Picky About Buprenorphine - 772 Words

Why are you so enthused about buprenorphine? Buprenorphine works so well with so few serious side effects that I rank it as one of my all-time favorite medications. For the treatment of mental health and substance abuse illnesses, a few medications stand out as groundbreaking: Thorazine ®, Tofranil ®, Dolophine ® (methadone), Prozac ®, Clozaril ®, Ability ®, and now Suboxone ®. What is on the horizon to treat opioid addiction? Research is ongoing and at a fast pace. One of the most promising options is immunotherapy, where antibodies bind to the opioid before it can enter the brain, rendering the opioid ineffective (http://bit.ly/1NK1NEt). Where can I learn more about recommendations to physicians on how best to treat opioid addiction? In May 2015, The American Society of Addiction Medicine published practice guideline for physicians in a 170-page document. You can review this document at http://bit.ly/1UGL2Kq. Can you recommend patient-oriented books or articles describing family struggles with addiction? There are many to choose from. Some are first-person accounts of addiction: †¢ Beautiful Boy: A Father’s Journey Through His Son’s Addiction, David Sheff, 2008, Mariner Books †¢ The Joey Song: A Mother’s Journey of Her Son’s Addiction, Sandra A. Swenson, 2014, Central Recovery Press †¢ The End of My Addiction, Oliver Ameisen, MD, 2009, Sarah Crichton Books †¢ How to Raise a Drug Free Kid, Joseph A. Califano Jr., 2014, Simon and Schuster †¢ Moments of Clarity, Christopher Lawford,

Baby Shoes, Never Worn Free Essays

Baby shoes, never worn The watch that hang over the table was ticking loudly in the silence. The two of them were standing muted in front of each other. They had been together for three years and each year she would ask him the question. We will write a custom essay sample on Baby Shoes, Never Worn or any similar topic only for you Order Now She thought it was about time they started trying, but he still felt too young for the commitment. She said her biologically watch was ticking, but he maintained his opinion and told her to stop being anxious. He believed they still had plenty of time. One day she walked along the sidewalk and all she saw on her way was little people. She looked at Jumpsuits, diapers and perambulators. She got to a place with tiny shoes. She picked up a pair and caught herself in a mirror as she turned around. Something wet ran down her cheek and she could hear herself. Coming to her senses she stormed out to her car and drove home. She stayed up that night thinking about her misfortune. She decided to wake him up to convince him that the right moment was now. Luck was not with her. Wanting to put herself out of her misery and rage she discovered her hand moving to give him a red mark on the side of his head. She had never worried this much about anything before and he had never seen her this way before. The chaotic atmosphere had filled up the entire apartment. He tried to catch her before she got to the doorknob but failed. Her mind was empty for everything but her wish. She kept driving into the night not stopping at any point. The tank was almost empty when the first light hit the windscreen. A petrol station was the first place she saw and it was about time to stop. She sat on the bench looking at a newspaper with wet eyes when she saw the advertisement. It said â€Å"For Sales: Baby Shoes. Never Worn†. Looking at the address she drove fast across town. The picture of the baby shoes hang from the ceiling. She bulled over when she reached the right block. The young Mrs. opened the door to the apartment. She was home alone. They greeted each other. They had a noiseless clock over their table in the kitchen. The needle went from number to number, silently. She looked around not saying anything, not complimenting anything. The Mrs. observed her walking through the apartment, but stopped her when she came to the room at the far back. She barely got to see the room, but it was plenty. She looked at the Mrs. expression, turned around and walked down to her car on the street. The car was empty when she drove home to him. The clock was still ticking over the kitchen table however not as fast as it used to tick. How to cite Baby Shoes, Never Worn, Papers

Lake Tahoe and The Growing Importance for Environm Essay Example For Students

Lake Tahoe and The Growing Importance for Environm Essay ental PreservationLake Tahoe, an enormous expanse of clear, blue, fresh water surrounded by meadows and dense forests and rimmed by snow-capped peaks, is one of the worlds great scenic and ecological wonders. Tahoes water is world famous for its amazing clarity. Even today, one can see objects 70 feet below the surface, a clarity matched almost nowhere in the world. The Tahoe Basin had a slowly evolving and essentially balanced environment for thousands of years, with surrounding forests, meadows and marshlands helping to maintain the clarity and purity of the lake. This pristine environment also provided habitat for great diversity of plants and wildlife. Hundreds of species of native plants thrived in forest, marsh, and meadow. But now, in scarcely a century, an equilibrium that endured for thousands of years is rapidly being lost due to environmental degredation and resource values are steadily deteriorating because of human activities. While there is an appearent lose of wildlife and environment that exists in The Lake Tahoe Basin, there is also an insurgance of environmental conservation that has become increasingly powerful in the attempt at stopping these adverse affects on the environment from happening in the hope that the beauty of Lake Tahoe will continue to exist for generations and generations more. The first major change in the environment came with the logging of the 1860s, when much of the basins forest was clear-cut. The logging tapered off with the collapse of the mining boom, but not before most of the Tahoes virgin forest was gone. By the 1920s, cars and better roads made Tahoe accessible to the ordinary visitor, and landholdings began to be subdivided for summer homes, especially along the southern and western portions of the basin. The urbanization of the Tahoe Basin remained a relatively slow process until the 1950s, when the opening of Highway 50 and the completion of Interstate 80 brought the San Francisco Bay area within a four-hour drive. Year-round access to the lake encouraged expansion, as modest clubs designed for seasonal business were transformed into towering casinos packed with visitors throughout the year. The new access in winter also attracted thousands to the basins ski slopes, and in addition to this increase due to accessability, the 1960 Olympics were held in the Lake Tahoe Basin, at the Squaw Valley Ski Resort. This event created an explosion of rapid expansion of the ski and service industry. Today, recreation has become the centerpiece of a one and a half billion dollar economy which employs more than 20,000 people. Between 1960-1980, as the number of businesses and their visitors grew, the permanent population of the region increased tremendously. These permanent residents in turn have needed homes, stores and services. In the meantime, second-home development has boomed, as more and more people have found themselves with the desire and the means to enjoy the amenities of the Tahoe Basin. In this same period, the number of houses grew from 500 to 19,000. By 1970, more than 49,000 subdivided lots had been created and more than 600 miles of roads had been built to serve the new subdivisions. Sometime in the early 70s, a bi-state agency backed by California and Nevada and with the federal governments blessing, was formed. The Tahoe Regional Planning Agency as it is known today was originally intended to stop the rapid development and improve water and air quality and to preserve the lake for future generations, but with the first Compact that was created the agency had little control over any environmental regulations they posed, and thus the original compact had to be revised. The Compact, as revised in 1980, gave TRPA authority to adopt environmental quality standards, called thresholds, and to enforce ordinances designed to achieve the thresholds. The TRPA Governing Board adopted the thresholds in 1982. The Governing Board adopted a long-range regional plan in April of 1984. After three years of negotiations, the TRPA Governing Board adopted the 1987 Regional Plan in effect today. Additional supporting organizations have made TRPA possible. The League to Save Lake Tahoe has made an impact in its Keep Tahoe Blue campaign in getting out the word about threats to Lake Tahoes health. The California Tahoe Conservancy and the US Forest Services land buyout programs helps in the removal of highly sensitive lands from the real estate market, and thus the conservation of Lake Tahoe. California Tahoe Conservancys land banking program helps with the continued economic growth of the region by finding a way to both preserve sensitive lands and develop areas that TRPA has deemed as capable of such land useTable 1Socioeconomic Data for the Lake Tahoe Basin Socioeconomic195019601950-1960 Change (in %)19701960-1970 Change (in %)2000PopulationBasin Totals110,331174,90958.5249,57342.762,891Summer Population133,000 200,000Housing:19902000Housing units total:43,66246,122N/AN/AN/AN/ATotal vacant housing:22,50920,574N/AN/AN/AN/AVacant housing for seasonal, recreational, occasional u se:14,73118,257N/AN/AN/AN/AMedian single-family housing prices:$119,000 $285,000 N/AN/AN/AN/AMailing address of homeowner: Outside of area (in %):54N/AN/AN/AN/A Greater Tahoe area (in %):28N/AN/AN/AN/A Lake Tahoe region (in %):18N/AN/AN/AN/A^Includes Placerville and Carson City data. Sub-county data not available before 1990. Believe, Inspire and Follow Your Dreams EssayWildlife has also suffered from urbanization. The basin provides habitat for more than 290 species of birds, animals, and fish, plus more than a thousand species of plants. Their preservation has been increasingly difficult as development and other human activities degrade or destroy more and more of their habitat. The basins original marshlands have been reduced by 75%, its meadows by 50% and its riparian areas by 35%. As a result of the loss of habitat, the huge flocks of migratory geese and other waterfowl that once visited every year no longer use the basin as a resting place. Ducks and geese have trouble finding nesting areas free from human disturbance. Bald eagles and ospreys lack undisturbed perching and nesting sites. Fish find it difficult to migrate up streams to spawn. The forests that many wildlife species and Lake Tahoes clarity depend upon have suffered from a number of problems since most of the original mixed forest of pines and firs was logged off for the Comstock mines. The existing stands are overstocked and lack species and age diversity due to the lack of management and fire suppression. The problems have now become acute, however, as much of the basins forest is dead or dying as a result of a seven-year drought and accompanying insect invasion. With tree mortality varying between 25% and 40%, there are serious concerns about the possibility of wildfires and other threats to public safety. On the positive side, as the Conservancy and other land-managing agencies put extra effort into fire hazard control, they also have an opportunity to improve long-term forest health through measures ranging from revegetation of disturbed soils to the thinning of dense small trees. Faced with the task of trying to balance economic and community growth with protecting valuable natural resources, TRPA is said to have done commendable work. The Agency says they have not been able to meet their own environmental threshold carrying capacities and may never do so; however, this task in the face of a growing population with increasing demands seems nearly impossible without returning the area to an untouched habitat. TRPA states that even in that impossible case, the lake would probably see some continued clarity degradation before returning to clarity. The fact that TRPA has been able to slow degradation of clarity in Lake Tahoe is impressive. The challenge of the future is to accommodate our human activities to the natural system that has maintained the Tahoe Basin for thousands of years. Only then can we enjoy the lake without destroying the very qualities that make it so uniquely valuable. To meet this challenge, a comprehensive basin-wide effort is being undertaken by a wide range of federal, state, regional and local agencies and private organizations. Two primary resource management strategies are being employed. One is an extensive regulatory and planning system administered by various agencies such as the bi-state Tahoe Regional Planning Agency (TRPA). The second strategy is a massive public acquisition and site improvement effort involving numerous organizations. While there are constraints on the allowable amount of development in the area, there are many pressures for expansion to accommodate the high numbers of people. There is a notable need to balance environmental protection with the overall well-being of those who enjoy the area. However, the health of this precious environment should not be compromised by an increase in population or an increase in the demands of that population. Lake Tahoes clarity depends on the overall health of the surrounding forests and wetlands, and to achieve a healthy environment we must conserve the land that has remained untouched. For this reason, the TRPA organization and many other environmental protectionist groups of the Lake Tahoe Basin, support redevelopment as an alternative to new development, and we strongly believe all development should be contained within the existing urban boundaries. Redevelopment allows for many environmental improvements to be made. BibliographyLeague to Save Lake Tahoe, Lake Tahoes Annual Clarity Chart, South Lake Tahoe, California. Douglas Strong, Tahoe: An Environmental History. (Lincoln, NE: University of Nebraska Press, c1984), pp 22-31. Tahoe Regional Planning Agency, About TRPA: Mission Statement. Online. Available: http://www.trpa.org/Mission.htm. Accessed: June 1, 2005. U.S. Forest Service, Lake Tahoe Basin Management Unit, Lake Tahoe Federal Advisory Committee. Online. Available: http://www.fs.fed.us/r5/ltbmu/local/ltfac/. Accessed: June 1, 2005. U.S. Census Bureau. California Population of Counties by Decennial Census: 1900 to 1990. Online. Available: http://www.census.gov/population/cencounts/ca190090.txt. Accessed: June 1, 2005.

Overview of London Ambulance System (Las) Disaster, 1992 Essay Example

Overview of London Ambulance System (Las) Disaster, 1992 Essay The London Ambulance Service (LAS) is world’s largest free ambulance service covering an area of more than 600 square miles with a population of 7 million people. On any given day, LAS transported more than 5,000 patients and handled more than 2,000 telephone calls. LAS employed over 2,700 people, including an operational staff of roughly 2,000 people. (Cited http://bobpinchbeck. com/College/Work/Papers/DispatchingFailure. htm) In the mid-1980s, the LAS emergency despatch system was run completely manually. The details of a call, such as the location and type of incident, were noted on paper and sent to a central collection point where duplicate incidents will be eliminated. Call details were then given to an allocator who selected which vehicle and crew to send. The details were next passed to a dispatcher who contacted the ambulance driver by radio or phone. Problems arise when paper details are lost, they were not able to track incident and there are difficulties in tracing how the original call had been dealt with. In order to improve the quality of the service, they introduced a Computer Aided Dispatch (CAD) system in 1992. We will write a custom essay sample on Overview of London Ambulance System (Las) Disaster, 1992 specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Overview of London Ambulance System (Las) Disaster, 1992 specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Overview of London Ambulance System (Las) Disaster, 1992 specifically for you FOR ONLY $16.38 $13.9/page Hire Writer It was developed by two companies, Apricot Computers, a UK based hardware manufacturer, and System Options, a small UK software developer. CAD is a method of dispatching services assisted by computer. The idea of the CAD system is that people from the dispatch centre are able to view and understand the status of all the units being dispatched and provides tools and mechanisms for monitoring the dispatcher so calls can be handled more efficiently. The system consists of several modules that provide services at multiple levels in a dispatch centre and in the field of public safety. These services include the following; †¢Call input, dispatching, status maintenance †¢Handling incident details and locations †¢Field unit status and tracking †¢Call resolution and disposition It also include interfaces that permits the software to provide services to dispatchers, call takers and field personnel with respect to control and use of analogue radio and telephony equipment. (Cited www. erichmusick. com/writings/06/las_failure. html) The London Ambulance Service decided to put their new CAD system in to operation on October 26th, 1992. After a few hours into operation it became observable to the ambulance crews and control room staff that there is something wrong with the new system. The crisis was a high event in the UK news during that time, which claimed a number of patients have died as a result of the system. The following problems occurred within the CAD system when it was first in operation: †¢Patient’s emergency calls that were accepted appeared to be getting lost in the system caused an increasing number of call duplications. †¢Rise in number of calls led to the callers being held by the call-queuing system for up to 30 minutes before they were dealt with. At some point earlier calls were overwritten by newer emergency calls coming into the system, leaving a large number of unanswered calls which caused a number of exception messages. †¢The ambulance allocation system failed to recognize certain roads. Staffs had to revert to using a map and telephone to deal with ambulance dispatches, which ultimately led to more delays. †¢There was a communication failure between the ambulances and the system. Ambulance either arrived late, did not arrive at all or arrive two at the same time. (Cited www. comp. lancs. ac. uk/computing/resources/IanS/SE7/CaseStudies/LondonAmbulance/LASFailure. pdf)

Free Essays on Tess

Chance and coincidence – whole theme of fate is largely communicated through this. This narrative technique highlights the inevitability of her fate and her tragedy. Such as the cock crowing thrice on the wedding night. Irony – title and subtitle. Narrative is ironic – especially last chapter. The development and interest of the plot relies heavily on the irony in Tess of the D’Urbervilles . The title and sub-title are just the beginning of the irony in the narrative. The fact that Hardy refers to Tess as being part of the D’Urbervilles rather than Durbeyfield is ironic we find out because she is actually more of a D’Urberville than Alec is. The sub-title â€Å"A pure women† is ironic because it leads us to question whether she actually is a â€Å"pure† woman in terms of convention. Unwittingly through Hardy’s irony we are questioning aspects of the plot that through his clever use of technique and language we are noticin g and questioning the greater social questions that Hardy so cunningly disguised. Uses the microcosmic to demonstrate the general Tess is on numerous occasions directly representative of not only the women of the time, but also of the pastoral community as a whole. Hardy does this by way of graphic imagery and significant symbolism. For example where Tess and Izz are returning to work at Flintcome-Ash Farm, Hardy cleverly portrays them all as being of the same kind. â€Å"Tess, with the other women workers, in their whitey-brown pinners†¦Ã¢â‚¬  By presenting them as a â€Å"concourse† all attired alike they represent an entire league of women, all the women of the era. In this passage a man, an â€Å"indistinct figure: this one black†, represents the enemy, the devil, and the evil of industrialization. His appearance described as a creature of â€Å"Trofet† – or hell is sent to â€Å"discompose its aborigines† or Tess and the other â€Å"na tives†. Hardy has generalized this small-scale industrialization and mankind ... Free Essays on Tess Free Essays on Tess Chance and coincidence – whole theme of fate is largely communicated through this. This narrative technique highlights the inevitability of her fate and her tragedy. Such as the cock crowing thrice on the wedding night. Irony – title and subtitle. Narrative is ironic – especially last chapter. The development and interest of the plot relies heavily on the irony in Tess of the D’Urbervilles . The title and sub-title are just the beginning of the irony in the narrative. The fact that Hardy refers to Tess as being part of the D’Urbervilles rather than Durbeyfield is ironic we find out because she is actually more of a D’Urberville than Alec is. The sub-title â€Å"A pure women† is ironic because it leads us to question whether she actually is a â€Å"pure† woman in terms of convention. Unwittingly through Hardy’s irony we are questioning aspects of the plot that through his clever use of technique and language we are noticin g and questioning the greater social questions that Hardy so cunningly disguised. Uses the microcosmic to demonstrate the general Tess is on numerous occasions directly representative of not only the women of the time, but also of the pastoral community as a whole. Hardy does this by way of graphic imagery and significant symbolism. For example where Tess and Izz are returning to work at Flintcome-Ash Farm, Hardy cleverly portrays them all as being of the same kind. â€Å"Tess, with the other women workers, in their whitey-brown pinners†¦Ã¢â‚¬  By presenting them as a â€Å"concourse† all attired alike they represent an entire league of women, all the women of the era. In this passage a man, an â€Å"indistinct figure: this one black†, represents the enemy, the devil, and the evil of industrialization. His appearance described as a creature of â€Å"Trofet† – or hell is sent to â€Å"discompose its aborigines† or Tess and the other â€Å"na tives†. Hardy has generalized this small-scale industrialization and mankind ...

Fun Ideas for Last Day of School Activities

Fun Ideas for Last Day of School Activities On the last day of school, the kids have mentally checked out, the teachers arent far behind, and theres no more time for long-term projects. But, we still need to fill the day with something productive in order to keep the natives from getting ridiculously restless and out of line. If youre wondering how to organize the last day of the school year so that its as fun and memorable as possible, consider these ideas. Write a Letter to Next Years Students Ask your students to write a letter to the students you will teach next year. The kids can offer tips for success in your classroom, favorite memories, inside jokes, anything that a new student in your room might need or want to know. Youll get a kick out of seeing what the kids remember and how they perceive you and your classroom. And you have a ready-made activity for the first day of school next year. Make a Memory Book   Design a simple little book for the kids to fill out on the last day(s) of school. Include sections for my favorite memory, a self-portrait, autographs, what I learned, a drawing of the classroom, etc. Get creative and your students will appreciate a memory book of their year in your room. Clean, Clean, Clean Use the power of youthful energy and elbow grease to lessen the  load you face in closing down and cleaning up your classroom. Kids will love to scrub desks, take down posters, straighten up books, whatever you ask them to do. Write all of the tasks on index cards, pass them out, turn up the music, and supervise. A cute idea is to play The Coasters Yakety Yak while they clean. It sings, Take out the papers and the trash, or you dont get no spending cash! Dare them to finish their jobs before the song is over. Assign Impromptu Speeches Think of 20 quick speech topics and have the kids choose them from a jar. Give them just a few minutes to prepare mentally and then call them up for spur-of-the-moment speeches. Fun topics include Convince us to buy the shirt you are wearing now or How would the school be different if you were principal? Click here for a complete list of topics. The audience loves to watch and the speakers will love getting creative in front of the class. Play Outdoor Games Dust off that outdoor games book that you never had time to use this year and pick a few activities for the last day of school. A great choice is Guy Baileys The Ultimate Playground and Recess Game Book. The kids will be antsy anyways so you might as well put their energy and excitement to good use. Organize Learning Game Centers   The children wont even realize theyre learning. Pool together all of the educational games in your classroom. Split the class into small groups and designate centers in the room for each game. Set the timer and give each group a certain amount of time with each game. Give the signal and then the groups rotate around the room so everyone gets a chance to play all of the games. Focus on Next Year Give the kids time to write, draw, or discuss how things will be different in the next grade level. For example, third graders will love to imagine what they will learn, look like, act like, and feel like when they are finally in the world of fourth grade. Its only a year but to them, it seems a universe away. Hold a Spelling Bee Hold a traditional Spelling Bee using all of the spelling words from the whole school year. This one can take quite a while, but its certainly educational. Go Back to Back Use a safety pin to attach a large index card or thicker piece of paper to each childs back. Then, the kids go around and write nice comments and memories on each others backs. When youre all done, each child gets to keep his or her note with compliments and fun times written on it. Teachers, you can jump in, too. You just might have to bend down so that they can reach your back. Write Thank You Notes Teach your children to recognize and appreciate those individuals who helped make them successful this school year - the principal, secretary, food service workers, librarian, parent volunteers, even the teacher next door. This may be a good project to start a few days before the last day of school so that you can really do it right. Edited By: Janelle Cox.

Midwifery Code of Conduct Essay Example | Topics and Well Written Essays - 1500 words - 2

Midwifery Code of Conduct - Essay Example The healthcare industry is making efforts to offer and continue offering quality care and increase the credentials that enhance the competitiveness of organizations. Â  Scholars Lundy and Janes in their research argued that the main objective of healthcare administration is to ensure that the delivery of healthcare reaches residents in the efficient ways, to the required standards. Governments ensure that the provision of healthcare ensures continued support in the growth of the economies. This cannot be delivered if the administration and the organization as a whole do not prioritize work-life balance and team building among its employees as well as other stakeholders. Enhancing work-life balance is therefore very crucial to ensuring the success and stability of these organizations, and the companies should invest in promoting and building work-life balance for increased productivity and service delivery. This is a decisive move, applicable in building management and leadership to move in the leadership capacity of the health management and practitioners (Site, 2012). There are three potential models for healthcare organizations. These models a re corporate/business models, the orchestrator and the community model. These models represent the different ways in which hospitals conduct their operations. The corporate model is for hospitals, which are operated as financial entities. These hospitals’ main aim is making profit just like any other business. The orchestrator model is for hospitals, which are operated, similar to airports or malls. In this model, hospitals are looked at as providers of infrastructure for specialized and independent health providers. The final model is the community model where the needs of people come before the finance issues (Site, 2012). Â