The book YO by julia alvarez Essay Example | Topics and Well Written Essays - 750 words

The book YO by julia alvarez - Essay Example Because her family members and a couple of her friends are incapable of doing anything but rail at their depiction in the â€Å"fiction story†, they each find an opportunity to redeem their images by telling their own tales and giving their sincere opinions about Yo. They give tales about her not mincing to reveal how she was always deceitful, how she stole the plot for a story from a fellow scholar (plagiarist) and not forgetting how her professor endlessly struggled to stop her from destroying her life and talent. In Alvarez’s Yo, she narrates Yolanda’s story through different characters, while Yo is given no slightest chance to shield herself from all the â€Å"venoms† spat in her way. It is quite paradoxical in that the novel initially has Yo as the central focus and her family and close friends, who become angry when she publishes information about them, consequently uncovering private life of each one of them. Different characters are striving to set the story straight and portray the exact Yolanda Garcia they know. Yo’s mother is depicted saying that Yo’s murky tales have endangered her life. The family is quite infuriated, especially because their associates and acquaintances keep asking them which character corresponds to them in the book. Yolanda’s mother is ominous to take legal action against her while her sisters vehemently avoid talking to her. It is true that Yo-yo loves telling stories as is confirmed by her teacher but it is this attitude that glides her into trouble. With rumors of disappearing friends, house apprehension in the middle of the night, narrow escapes as well as stories of torture chambers, Yo’s family had a reason to worry about their father’s subversive activities, let alone the likelihood of snooping Yo narrating her â€Å"stories† to the authorities. Yo’s parents make known to her that her stories could end their lives. Did they imagine that telling Y o that her story could spell their destiny would be a punch line to the narrator? Even after leaving for the United States, Yo’s mother cannot disentangle her self from her worries about Yo’s stories. Why the visit by a case worker in school? Was Yo unleashing something about the family behind doors? Well, perhaps it is Yo’s strategy of making her family to bite a humble pie. Lou Castellucci is another character that exposes Yo true identity in self defense. He is Yo’s student, pursuing a writing course. In the entire course, Yo criticized Castellucci’s writing. However, she motivated and assisted him to improve. Yo was very happy by the end of the course, particularly by the stories Lou could write. She takes Lou’s story and refurbishes it by changing the characters and also altered the sport from bawling to baseball. This brings out the nature of Yo as a great plagiarist. Professor Garfield is one individual who never ditched Yo. College p rofessor is destined to reiterate the phrase â€Å"once in a career comes a student† (Alvarez 1997, pg 73) in trying to assist Yo to get through with her doctoral program in order to uncurl her already tainted life. In many occasions, Yo would ask for his approvals or any form of assistance to bring her life back on to the right track. In fact, the professor would never let her down. Garfield got inspired by Yo and had gigantic dreams for her than she held for herself. As a tradition, many teachers usually give up on students who quit

How the UK universities' tuition fees has effect on foreign students Literature review

How the UK universities' tuition fees has effect on foreign students - Literature review Example This research is an exploratory because it seeks to address the problems, which have not received serious attention. The society knows little concerning the effects of charging high tuition fees on the international students, which the research seeks to obtain an explanatory relationship. Its reliance on the qualitative methods shows that it is an exploratory research. The researcher will take a qualitative approach to collect relevant data that will help analyse the questions. It will mainly use official documents such as statistics, and the researcher will treat them with care in order to obtain credible information. Online discussion forums and blogs will be useful in the process because they contain first-hand information, which will enable the researcher to understand the views of the public concerning the UK universities’ tuition fees. The researcher will also use newspaper articles and interviews contained in the newspapers that will help to analyse the research topic. The literature review will also contribute crucial information to analyse the research topic. Sample size influences research findings that can affect conclusion derived from a research. It is important to use a representative sample in order to prevent bias that may arise, thus affecting research quality (Kotrlik & Higgins, 2001, p. 43). The researcher will use a sample size of twelve, which will comprise mainly of online discussion forums, blogs, and newspapers articles. It is important to obtain permission before carrying out research on a given topic. The researcher will also seek permission from the university before embarking on the activity. The research process will observe all the required ethical standards in order to enhance credibility of the study. The researcher will analyse data based on the credibility of the sources. The sources that contain bias will not be used

Cat Dilated Cardiomyopathy and Immune Mediated Hemolytic Anemia in Research Paper

Cat Dilated Cardiomyopathy and Immune Mediated Hemolytic Anemia in Daschunds - Research Paper Example An increased dependency on formulated cat foods produces the potential for deficiency, but the same formulations allow for the correction of this lack. Total Nutrient programs from the pet food industry are the response to this valid concern. Vision loss, as well as cardiomyopathy, can result from such dietary deficiencies. (Hayes et al. 1982), (Hills Pet Nutrition, 2011) This report outlines the pathology of feline dilated cardiomyopathy and related heart conditions, as well as contributing factors. The prognosis and treatment modalities are discussed; as well as means by which this condition can be prevented. Cats do not possess the ability to synthesize the amino acid Taurine; which is necessary for muscle growth; and proper retinal development in kittens. This is presumed to be a central factor in the evolutionary development of felines. Modern processed cat food contains nutritional supplements to alleviate this problem. Feline DCMs now relatively rare. In the past, feline dilated cardiomyopathy could be blamed on the dietary deficiency in the amino acid taurine. (Petplace Veterinarians, 2011), (Pion, et al. 1987) Taurine is an essential component of the feline diet, whereas dogs do not require it. (Pion et al. 2007) The breeds typically affected are Abyssinian, Burmese, Siamese, and mixed/mongrel housecats. The Catfood industry responds to this risk by taking steps to ensure taurine dietary supplements are included as basic nutrition in most cat foods. The feline food industry has risen to the challenge of addressing the need for nutritional supplements in a form highly palatable to the animals. At the same time, the more sedentary lifestyles that felines and canines now share with their human owners still creates its own battery of assorted health risks to all three species. (Obesity is a noteworthy factor.) In terms of diagnosis, a complete medical history should be provided to the veterinary  professional. Initially, a thorough physical examination is performed.

Career Development Case Study Example | Topics and Well Written Essays - 2000 words

Career Development - Case Study Example Analysis of the Actions of Madeleine Lagarde and Her Mentor 6 2.2. Analysis of the Actions of Eric Wong and His Mentor 7 3.0. Ways to Make Mentorship More Different 8 Bibliography 9 1.0. BCG’s Career Development and Mentorship Processes: Strengths and Weakness Boston Consulting Group is considered as the ideal place for strategy consulting as an organisation. The main objective of the organisation is to attract, develop and retain the best of the candidates in the organisation. The career development process for the professionals and mentorship program in the organisation is the best. The strengths and weaknesses of these processes are discussed in the below paragraphs. 1.1. Strength of the Career Development and Mentorship Process The career development in BCG is quite remarkable. There is a good scope for career building in the organisation, ranging from associates to officers. The associates and consultants in the firm are primarily focused on the organisational module. The project leader handles various projects in the organisation. The managers have the responsibility to handle both the project and the clients of the organisation as both are termed essential for the success of the business. The officers of BCG give much emphasis on clients and the success of the organisation. ... The incoming consultants are assigned a Career Development Consultant (CDC) advisor, as they provide guidance to the clients in their project work and help them in their success. They also provide positive and/or negative feedback to the incumbents for their improvement. Therefore, the employees can grow skills by the opportunities from staffing. Consequently, the employees need to be proactive in building their skills. The training is also conducted for the professionals for qualitative and administrative purpose. The formal training helps the employees to improve their social skills, networking skills and becoming more familiar with the working environment of BCG. With an overall point of view, the on-job training is quite productive for the professionals. The BCG officers are assigned as informal mentors for incoming consultants and CDC advisors are the formal mentors. The mentors, who are selected for the incumbents, assist them to deal with several issues and stimulate their ski lls. There is no structured time for the mentors to talk to the consultants. From the first month of their joining up to 24th month, mentors discuss and try to explore various problems that may arise with the consultants in their work and workplace. 1.2. Weaknesses of Career Development and Mentorship Process BCG gives primary focus on handling the clients rather than the growth of the people. The promotion in the organisation is decided by the senior persons depending on the skills of the professionals and not by their time period in the job. Thus, biasness is most likely to arise in the workplace. There is a criterion of voluntary exit for the professionals during their on-job training period due to poor

Knowledge Management literature review Essay Example | Topics and Well Written Essays - 2000 words

Knowledge Management literature review - Essay Example This research will use the mixed-method design, but will lean more toward the evidences that have been quoted in various knowledge management studies. Since the Knowledge management area of study is relatively new area of study not much of quantitative information is readily available in free domain. This will be the primary limitation of the research submission. The primary and most important source used for this literature review is book named 'The Handbook of Knowledge Management written by Thomas J. Beckman, a research scholar from The George Washington University, Baltimore country. The main reason for considering this book as a primary source is that it serves the role as a key reference book in integrating views of researchers in and practitioners of knowledge management. Even though the field of knowledge management is evolving and is still maturing, this book is considered as a first step in helping to formulate methodologies, techniques, and practices for making knowledge management a sound field (Beckman, 2003). Professor D. Neef of the Management Decisions (Venters W. , 2008) Institute feels that "In order to understand Knowledge Management, it is necessary to see the subject within the broader context of the enormous changes taking place in the global economic framework itself" (Neef, 1999). Alfred Marshall, a forefather of neo-classical economics (Venters W. , 2001), was one of the earliest authors to state explicitly the importance of knowledge within economic affairs; "Capital consists in a great part of knowledge and organisation knowledge is our most powerful engine of production (Marshall, 1965)." All the above stated definitions form the basis for the evolution of Knowledge Management as a separate branch of study. But this view of looking at the subject was contrasted (Nonaka, 1995) by some researchers like Nonaka and Takeuchi as they feel that neo-classical economists only consider the utilization of the existing knowledge and they are not very concerned and particular about creation of new knowledge (Venters W. , 2001). Another important material which was helpful in this research is The Blackwell Handbook of Organizational Learning and Knowledge Management (Smith M. E., 2005). It is a state-of-art international handbook about the emerging field of Knowledge Management which occupies a central position in the fields of contemporary management and organizational theory. The author of the book has drawn together analyses and critical commentary from the leading experts on organizational learning and knowledge management around the world. Links are made to existing bodies of theory in the root disciplines of economics, psychology and social theory, while the challenging implications for research and future paths of inquiry are outlined and discussed (Smith E. , 2005). The special issue on Knowledge Management and e-research technologies is another material that has been of great help in working on this paper (Venters W. , 2008). This special issue of Knowledge Management Research & Practice will focus on the role of technology within wider debates on knowledge management. Information and Communication technologies lend themselves to the capture, transfer and

The Impact of Literature Essay Example for Free

The Impact of Literature Essay It may go without saying that there are those who will never study, appreciate, or even perhaps consider literature as it is known in academic circles. There are those for whom the written word may have, at best, utilitarian purposes, and for whom any piece of writing beyond a technical manual should, at least, be a work of â€Å"non-fiction,† designed to impart a clearly stated morsel of information or worthy opinion. Part of the explanation for this may coincide with the same general reason that some people never consider religion: the proponents of literature – as is sometimes the case with the proponents of religion – sometimes themselves make their cause a used-up, weary, and trying thing, and may remove from it all the beauty and potential which it might, in the proper hands, convey. Much like religion, literature has a transcendent value, and fulfills an essentially universal need. After all, even the most ardent opponent of the usage of literature in his or her own life embraces forms which complete virtually the same need within him; that is, myths, folklore, stories, movies, television, and even song, occupy essentially the same place and function as literature in the human person, albeit in a form often immeasurably more crude. And, as hotly debated as the following may be in the milieu of post-modern and relativist academic circles, the need to convey truths and explore the human person through story and myth may reach its most sophisticated form in literature. That, of course, raises the implied debate as to just exactly what constitutes literature. Some societies view poetry and theater as â€Å"literature,† could not film, or popular songs also be literature? Along that line of reasoning could folk tales or geographically-oriented stories and Maki 2 myths constitute literature? One runs back into the post-modern worldview when considering that, if the songs of Bob Dylan or the films of Bergman can be considered in any context to be literature, then why not the songs of Madonna or the films of Clint Eastwood? These considerations are relevant as the illustrate that: â€Å"literature,† if defined as relating to the exploration of universal truths and the human person through written or performed language, is relevant in daily human experience. The American child utterly unacquainted with the tales of Little Red Riding Hood, the Three Little Pigs, or Cinderella, is at a vast disadvantage even in understanding many newspaper headlines (a business’ success story may be a â€Å"Cinderella Story;† a poorly chosen infrastructure may be a â€Å"House of Straw. † The list could go on). But, more importantly – and herein lies the great importance of literature – the child may be in danger of lacking the basic, transcendent lessons that society collectively imparts to its youth through the themes of fairy tales: there is danger in the world; stay on the path; obey your elders†¦they might just know what they’re talking about; shoddy effort will bear out a painful reward; arrogance is often misguided. Again, the list could go on. Even then, fairy tales as literature are only a baby step towards grasping the ultimate value of literature as a whole. While some literature function in a given society as a means of forming the parameters of moral uprightness and, essentially, seek to pass down answers, adult literature at its best instead seeks to ask questions that require considerations beyond the formal and accepted confines of social morality, even if at times literature may function in an effort to pull a society back to its forgotten mores. Literature as genuine art probes the human persona Maki 3 and, in order to function well, requires a reader open to growth and change, open to transformation and to a new and perhaps differing(even uncomfortable) perspective on reality. This is not to say that literature does not propose answers to the questions it asks. In fact, literature, like much psychology, may infer that the answers are perhaps inherent in the questions themselves. Literature, has often catalyzed individual change (and it is perhaps indicative of the vapid individualism of the times that the effect of literature on the individual is so much touted, even in this essay, over literature’s relevance to society at large), but of social change as well. Certainly in modern, western history, literature has helped usher in startling levels of social change, be it new considerations of race via the writings of authors like Twain and Stowe, or Upton Sinclair’s impact on something as seemingly subtle as the issue of food packaging safety. Of all the thousands of tracts circulated about communism during the early years of the cold war, what writings continue to influence readers to the degree that Orwell’s two works of utter â€Å"fiction,† Animal Farm and 1984? What political speech concerning the dangers of modernism, both as philosophy and technical practicality, had the chilling impact of Huxley’s Brave New World? What but the well-told tale could arouse sympathy for a group as collectively ridiculed and resented as Depression-era dust-bowl refugees, as in Steinbeck’s The Grapes of Wrath? If one considers artfully written non-fiction a part of the class of â€Å"literature,† the list goes on. It is not treatises but human drama that propel writings like John Hersey’s Hiroshima or Elie Weisel’s Night, to name but a few. What is most relevant about literature in such contexts is that it eschews rational argument in favor of its best representation of human experience, for it is most pointedly in the Maki 4 experience of a thing that the truth of it – the human reality of it – comes to life, and it is through experience that people are most transformed. The experiences presented in the above examples – and they are a microscopic selection of relevant examples – may not be those of the reader, but they, in a sense, become those of the reader, and enable the reader to share in some measure of the stories and experiences of â€Å"the other. † If there were no other value to literature – and certainly there is more value to it than that! – that value alone is worth the effort required of literary pursuits. It may be telling, and perhaps a bit saddening, that it is less and less true that works of literature seem to change the course of social and economic events in the world. The post-modern world is becoming less and less a literate world, and television and film – among other mediums – are replacing the written tale, and even the spoken story, as conveyers of truth and means of questioning what seems set in stone. Were it so that film and television, for example, sought to fulfill the same needs as literature – and indeed, at times they do – perhaps this would not be such a disturbing trend. But film and television, and now, following in their footsteps, much written â€Å"literature,† seek mostly to entertain, to lull viewers into a comfortable despondency and create a sense of need for consumption, all of which perpetuates the success of these mediums. A great many movies have been made based on literature. Now I am not saying that this detracts from the value of moving pictures in society, they just lose something in the translation. Movies have time constraints that do not allow them to explain the hidden meanings of cultural differences that written literature can. The vacuous lack of effort required of the viewer by television points to the factor that may simultaneously be literature’s greatest value and its most daunting hurdle to many potential Maki 5 readers. That is, literature invites readers, at its best, to learn a new set of codes and means of digesting language and tales; it may require, as in (for example) opera, learning an entirely foreign collection of meanings, linguistic cues, symbols, and, in effect, a new kind of listening. But those who seem to most appreciate opera, much like those who seem to most appreciate literature, swear that knowledge and self enlightenment is well worth the toil.

Impact of Shock on the Body

Impact of Shock on the Body Steve Powell It is important to understand by what is meant by shock. Shock in a physiological is a life threatening condition, and must be taken lightly. Shock as a definition is: â€Å"failure of the circulatory system to maintain adequate perfusion of vital organs†. (1) Mitch Taylor. (2010). Multi-Organ Dysfunction Syndrome Available: http://acls4u.homestead.com/MultOrganDysfunctionSyndromeVoiceOver.pdf. Last accessed 01/06/2014 Shock comes used to be classified as separate types: Cardiogenic Hypovolaemic Anaphylactic Neurogenic Toxic Recently this has been condensed in three types: Cardiogenic Hypovolaemic Distributive The definitions of these types of shock are: Cardiogenic –pump failure resulting in the blood cannot get to where it’s supposed to go i.e. the tissues, hence a low cardiac output. Hypovolaemic –a low volume of blood in the body as a result of major trauma or massive haemorrhage Distributive (Vasogenic) –this type of shock relates to changes in the body’s blood vessels, vascular changes, as a result of Anaphylactic, Neurogenic or toxic insult on the body.(2) Mitch Taylor. (2010). Multi-Organ Dysfunction Syndrome Available: http://acls4u.homestead.com/MultOrganDysfunctionSyndromeVoiceOver.pdf. Last accessed 01/06/2014 In Cardiogenic shock we have ascertained that it is down to pump failure and the bodies in ability to circulate adequate blood around the body to meet its metabolic needs. We have seen that it can be caused by a low cardiac output that is caused by, massive haemorrhage trough trauma or pathophysiological reason (dissected aortic aneurysm). It can also be caused by: a myocardial infarction (heart attack), dysrhythmias, and heart failure. A second cause is obstruction to the pump flow, that is to say conditions such as: valve dysfunction, pulmonary embolism, and tamponade (pericardial effusion that effects the normal action of the heart in pumping). Question 1 cont†¦. Hypovolaemic shock as the name suggests is â€Å"low volume†, causes range from massive haemorrhage through trauma or pathophysiological reasons (triple A). Burns victims are at particular risk as it affects these types of patients at a cellular level, the loss of fluid out of vascular spaces. Technically shock in burns victims a combination of distributive and hypovolaemic shock. In as much as it is seen as volume depletion within the intravascular system, lowered pulmonary artery pressure and an elevated systemic resistance, resulting in a low cardiac output. The low cardiac output is a direct result of an increased after load, a reduced contractility, and a lowered level of plasma volume. (3) Barbara A. Latenser, MD, FACS. (2009). Critical care of the burn patient: The first 48 hours Society of critical and medicine. 37 (10), p2819-p2826 Multiple organ dysfunction syndrome or MODS as it’s also known is a condition where two or more of the body’s systems have failed. MODS can be described as a â€Å"systemic activation of an adaptive host stress response to a catastrophic event†. (4) Sat Sharma and Gregg Eschun (2008) Hypotension and multiple organ dysfunction syndrome Journal of Organ Dysfunction 4 (1), p130-p144 Once a state of prolonged shock has been induced an over the top bodily response takes place. This is known as a â€Å"systemic inflammatory response†. Once this stage has started, the body releases inflammatory mediators that are intrinsic to the pathogenesis of SIRS (systemic inflammatory response syndrome. Where sepsis is not a key trigger, hypotension through hypovolaemic will contribute to the onset of SIRS and eventually MODS. The combination of these three conditions, Sepsis, SIRS, and MODS, combine conditions that have a massive impact on haemodynamic abnormalities, coagulation problems, and systemic issues.(5) Sat Sharma and Gregg Eschun (2008) Hypotension and multiple organ dysfunction syndrome Journal of Organ Dysfunction 4 (1), p130-p144 Any insult to the body and normal function (haemostasis) will initiate a cycle of metabolic chaos that includes an increase for oxygen versus an inadequate supply at a molecular level. Question 1 cont Inadequate blood supply to the tissues and cells in hypovolaemic shock and associated hypotension is the key to MODS in this instance. (6) Mitch Taylor. (2010). Multi-Organ Dysfunction Syndrome Available: http://acls4u.homestead.com/MultOrganDysfunctionSyndromeVoiceOver.pdf. Last accessed 01/06/2014 What we can say about the timeline for MODS is: The event that starts the cascade off, infection, hypoxia, trauma, in our case hypovolaemic shock via traumatic infarct trauma. Increase in levels of cytokines (immune system signalling cells). Leads to a release of ELAM and ICAM that induce leukocyte adhesion. This in turn triggers a multiple release of chemicals and compounds resulting in endothelial damage Resulting oedema eventually leading to organ dysfunction. Word count 611 References Mitch Taylor. (2010). Multi-Organ Dysfunction Syndrome Available: http://acls4u.homestead.com/MultOrganDysfunctionSyndromeVoiceOver.pdf. Last accessed 01/06/2014 Mitch Taylor. (2010). Multi-Organ Dysfunction Syndrome Available: http://acls4u.homestead.com/MultOrganDysfunctionSyndromeVoiceOver.pdf. Last accessed 01/06/2014 Barbara A. Latenser, MD, FACS. (2009). Critical care of the burn patient: The first 48 hours Society of critical and medicine. 37 (10), p2819-p2826 Sat Sharma and Gregg Eschun (2008) Hypotension and multiple organ dysfunction syndrome Journal of Organ Dysfunction 4 (1), p130-p144 Sat Sharma and Gregg Eschun (2008) Hypotension and multiple organ dysfunction syndrome Journal of Organ Dysfunction 4 (1), p130-p144 Mitch Taylor. (2010). Multi-Organ Dysfunction Syndrome Available: http://acls4u.homestead.com/MultOrganDysfunctionSyndromeVoiceOver.pdf. Last accessed 01/06/2014 Reflection As far as a reflective piece of work goes, I find myself having to reflect on skills that I learnt 10 years ago and have been employing on a regular basis. Although reflection should take place on a regular basis, it is never too late to reflect on things. Even though the skills were learnt 10 years ago there is 10 years scope to develop bad habits if not identified and rectified. The four skills in question inspection, auscultation, percussion, and palpation form part of the primary and secondary surveys for healthcare professionals worldwide. The initial primary survey should take seconds. I can remember when I first started doing patient inspections/assessments, it would be very text book orientated, not a bad thing you would have thought. However when you’ve exhausted all the text book questions you suddenly come to stand still and there is a period of silence then between yourself and the patient and sometimes the relatives. What I started to do, on the advice of a colleague, was, as i approached the patient I would assess their â€Å"colour posture and behaviour†. These three things would give me an idea of the state of the patient. If the patient answered the door and looked well and was ambulatory (as happens) then I would be off to a fairly good start. The patient had spoken to me (airway was clear); they looked well perfused and were mobile, no obvious life threatening conditions. If for instance the patient answered the door and was pale, sweaty, breathless and complained of chest pain then that would put a completely different slant on the primary survey. The patient would then have to be sat down immediately and further cardiac assessment undertaken. So by employing this little method (colour, posture, and behaviour) I was able, at a glance to do a quick assessment of the patient. Other aspects, such as scene safety etc†¦. soon became second nature as was the ability to do rapid risk assessments at the scene’s of RTC’s and other scene’s where there may be hazardous. There is a lot to take into consideration when carrying out an assessment, it is however a rolling concept where you question as you asses or treat. For non life threatening conditions then there no need to rush and miss your history taking, if you stick to the AMPLE model of: Allergies Medicine Past medical history Last meal/oral intake Events that lead to calling 999. These questions are limited and can take 1-2 minutes to ask and be answered. This is where you can expand on the history take and delve further in to the patient’s medical, social, familial history. When I first qualified I was encouraged by work colleagues to use all my extended skills. The auscultation side of the assessment was a little difficult at first because I just didn’t know what I was listening for; it wasn’t long before we started getting quite a few patients with respiratory problems. This enabled me to match the condition with what I was listening to. I remember also listening to chest sounds on the internet, a useful exercise, but not like the real thing. One thing that stick s out, and is still relevant o this day, is that its well and good listening to chest sounds on the computer and in the back of a relatively quiet ambulance, that it is at the side of a road with traffic rushing by and the sound of the fire services generators going at full tilt. Auscultation is a tool that I use frequently in my patient assessment. The percussion side of my assessment, I have to be honest and say that I do it for respiratory cases and trauma cases, but not for every patient that I see. It’s probably an area where i could do with more practise if I’m being hypercritical. Would I know a hyper/hypo-resonant chest? I believe so, however if I were to do a SWOT analysis then this would probably be in my weak box. Palpation I tend to use a lot more, whether it is because I get far more abdominal calls than critical chest’s I don’t know. The fact remains that I use palpation far more than percussion. Palpation is an extremely useful tool in the ballpark when it comes to abdominal complaints. However what I have learnt about abdominal related problems over the years, is that, as well as not being in my scope of practise to diagnose and discharge (without referring to a gp first), more analytical tools are needed. Tools such a doctor, ultrasound and bloods to name (various other scans can be utilised at DGH). Looking back or reflecting over the past 10 years, I feel i took on board the training that I received both EMT and Paramedic, and have built on them to a point where I more than comfortable treating an 80 year old gentleman in his living room with chronic emphysema to a road traffic collision where it’s quite a challenging environment. I have however identified a possible weakness in my practise that I will be address at the soonest opportunity.