Why the troop withdrawal timeline is not a good idea Essay Example for Free

Why the troop withdrawal timeline is not a good idea Essay The withdrawal of twenty to forty thousand U.S. troops from Iraq this fall would have a great impact on November elections that are just about to take place. A new Gallup poll just released showed that Bush’s approval rating reached a new low of thirty four percent and that on average his approval rating has been dropping one point a month over the past four years because of this timeline of troop withdrawal. This withdrawal would show progress in the war in Iraq and this will have a great impact in the coming elections on who should take charge to prevent the war. The republicans state that primary goal is to get as many Iraqi soldiers trained as possible so that they can fill in for departing U.S. troops before they can withdraw the U.S. troops from Iraq. The war in Iraq has been a political issue since House and Senate leaders voted on a resolution giving the president license to use force in Iraq just weeks before the 2002 midterm election. Republicans hammered Democrats who opposed the war, as well as their unwillingness to support relaxing labor rules for employees of a newly created Department of Homeland Security. There is a notion if Iraq can forge a truly legitimate state, there is a slight assumption by some that the Iraqis can never match US troops, that training an indigenous force is politically required but operationally suspect. History indicates that counter insurgency operations are more effective if undertaken by local forces and to the degree that the deployment of Iraqi forces reduces American casualties hence it can relieve American domestic political opposition to the war.   Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   A US decision to withdraw troops under these conditions would leave an intensely corrupt, divided, dysfunctional and authoritarian regime that would affect Iraq immensely and this would be a loss of confidence to the Democrats on handling the war in Iraq. This would impact the people’s opinion on the coming election of voting for those who do not support the war on the Iraqi. The conventional criteria for the withdrawal of US troops thus come down to the capacity of US trained Iraqis to impose, enforce and maintain security. The U.S should ensure that the timeline of troop withdrawal comes when we have competent, skilled, equipped security-making and security-keeping Iraqi force that will be able to stop the war on Iraq.   Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In 2006, the American people elected a Democratic Congress to change course and end this war. It’s the whole reason the American people voted for change. Yet, 10 months after the election, we still have the status quo and Congress has still failed to do the people’s will of stopping the war on Iraq. The Republicans add that a small withdrawal of the surge will not be enough to satisfy anti-war Americans to be able to vote for the Democrats but instead will progress the war. Sectarian violence could erupt on a scale never seen before in Iraq if coalition troops leave before Iraqs security forces are ready. Supporters of al Qaeda could develop an international hub of terror from which to threaten the West.   Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   A rapid withdrawal of all U.S. troops would hurt Americas image and hand al Qaeda and other terror groups a propaganda victory that the United States could not be able to stop the war but withdraw its troop. This is a big blow to the democrats especially at this time of the elections drawing near. Sunni Muslim fighters who support al Qaeda would seek an enclave inside a lawless Iraq along sectarian lines into Shiite, Sunni and Kurdish regions hence a threat to terrorism to the Americans. The republicans want to prevent the central and western Iraq from becoming a Sunni militant state that threatens our interests directly as an international terror hub especially for the Americans. There is an increasing attempt by terrorists to establish a training sanctuary in Iraq when the U.S. troops are with drawn from Iraq because the Iraqi troops are not well train to deal with terrorist and hence require more time to be trained well. No one wants an abrupt withdrawal that produces a civil war, a bloodbath, nor a wider war in an unstable Mideast hence until Iraq troops can be able to govern their own states well without the U.S. troops. The politicians do not want a U.S that is perceived as having been badly defeated in the global war on terror or as an unreliable future ally or coalition partner thus they are all up against the withdrawal of the troops until they are confident that no more civil war can take place. This withdrawal timeline is dangerous especially for the political climate that has deep effect for the democrats to take back the position of power through elections. There is also a great anticipation of an increase of both the U.S troops’ left and Iraqi casualties if Iraq’s neighbors would be drawn into the all out civil war likely if U.S. forces left too quickly. Iran could move in to further strengthen its influence in southern Iraq, Turkey likely would move against the Kurds in the north and Saudi Arabia would be inclined to take action to protect Sunnis in western Iraq. There are also fears that an Iraq left without U.S. support could turn into a center for international terrorism and a proxy battlefield for regional powers like Iran, Syria and Saudi Arabia. All the surrounding countries will think their interests are much better maintained not by directly sending troops but by continuing to send money and weapons to the people fighting that war. I think it would cause a huge vacuum that the enemies of Iraq enemies of the government would take advantage because they U.S. will also withdraw all its support to Iraq.   Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The oil sector could also get hit hard, with Iran potentially mining the Persian Gulf and attempting to close the Straits of Hormuz thus putting a stranglehold on oil flow especially to the U.S. who also deeply depend on Iraq for oil. Thus this timeline to withdraw the troop could affect the U.S economy greatly because the oil flow could be greatly affected. Oil prices would go up perhaps changing from current prices of about $60 a barrel to more than $100 a barrel, with consequent rises at the gas pump. Saudi Arabia will not allow increasing Iranian dominance to endanger its regime and oil economy if Iran could strengthen its influence in southern Iraq. The Politicians should use US policy to combat, contain, and roll back the violent activities and destabilizing influence inside Iraq of the Government of Iran.   Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Another issues that could be dangerous for U.S interest to withdraw its troop at this time is that the U.S. have spent so much with the deployment of its troop to Iraq and the reconstruction of Iraq after the war. Withdrawing its troop now could be seen as a loss especially to the U.S. economy because they have spent so much money through their troops and in the rebuilding of Iraqi state. If the troops are withdrawn now and the country goes back to war then the U.S would have lost so much resource that they have invested to bring down the Saddam regime to far worse regime. This would be a big blow politically to President Bush for having to fail and the U.S. having lost 264 troops as the highest number of fatalities or military casualties ever in that period and more than double the number of Americans killed in Iraq in summer of 2004 on war. The American will not allow the democrats to take charge and will not vote them in the coming elections. Losing in this war would also mean loss for the Americans and for the Interest of the U.S. government. The other states or nations would also see this as a big blow especially for U.S having to start the war, bringing the Saddam regime down but having to no effort to reconstruct Iraq being a Super power nation. The families who lost their men in the army will also be affected having sacrificed their member and the government not having to accomplish their task of restoring peace but withdrawing their troops where their men dedicated their strength. Lastly this timeline withdrawal is also greatly opposed as politicians also state that the Iraq troops should also be left to form their own government and defend their nation as early as possible because they have been trained and the U.S troops will have to leave at some point. The U.S troops are also blamed to cause this civil war and if withdraw immediately peace will prevail and Iraq government will have to take control and rebuild their nation. This timeline seems dangerous for this political climate due for election hence the troops should not be withdrawn until the Iraqi troop can be able to take full charge of their government. Reference David E Michael R. (2007): Chaos Overran Iraq Plan in 2006, New York Times. Daniel B. and Kenneth P. (2006):- Explosive Affinities. Cross-Border Consequences of Civil Strife, Berlin Journal. Dahl, R. (1998): On Democracy: New Haven: Yale University Press. McKay, D. (1997):- American Politics and Society: Oxford, UK: Blackwell Publishers. Tocqueville, A. Alfred A (1999): Democracy in America: New York Publishers.

The mantle of mistakes

The mantle of mistakes A mistake is made, the consequences pour forward. For each mistake, there is the concomitant necessity to atone, but, if one corrects their mistake before it is too late, they may be able to evade that atonement. In William Shakespeares Romeo and Juliet, one is able to witness how severe mistakes that are neglected, and left unrealized, lead to the tragic destruction of the two protagonists. Romeo Montague and Juliet Capulet, the two protagonists, are from two different families, who have past rivalries and do not associate with one another. Romeo and Juliet hurriedly marry each other, but because of their ill-fate, they eventually meet their demise. Their death is caused not so much by their own flaws as by numerous obstacles in their path, which are created by other characters. The characters that induce the most dramatic and critical affect upon the young couples death, are Tybalt, the Nurse, and Friar Laurence.   Ã‚  Ã‚  Ã‚  Ã‚  The hot-blooded and furious cousin of Juliet, Tybalt, bears a grudge against Romeo, which inevitably leads to a series of misfortunes. When he confronts Romeo at the Capulets party, he is dishonoured in front of a whole debauchery because of Romeo. Later on, he pursues Romeo to take revenge, â€Å"Boy, this shall not excuse the injuries, that thou hast done to me† (Act III, sc i, ll 65-66), and erroneously slays Mercutio, Romeos friend. Romeo then slays Tybalt to avenge his friends death, and, runs away. Meanwhile, the Prince, who is the leader of the city, announces that Romeo is banished from Verona, â€Å"Immediately we do exile him hence† (Act III, sc i, ll 187). This causes Juliet to weep for her husband. Her parents assume that she is sad because of Tybalts death, and decide that she should get married to the County Paris immediately, which is a great misunderstanding. Above all, her father threatens to disown her if she does not marry Paris. T his forces Juliet to take drastic measures, and drink the potion that Friar Laurence provides her with, which is followed by the death of Romeo and Juliet. If Tybalt did not pursue Romeo and initiate the conflicts, neither Mercutio nor Tybalt would have met their end, and Romeo would not have been banished. If Romeo did not get exiled, Juliet would not have gone to such drastic measures to evade her marriage with Paris. If Juliet did not take Friar Lawrences potion, Romeo would not have killed Paris, or drank the poison, and Juliet would not have committed suicide. In other words, if Tybalt did not make the mistake of disregarding the Prince and Lord Capulets strict orders, the deaths of the innocent characters would not have occurred.   Ã‚  Ã‚  Ã‚  Ã‚  Besides the childish behaviour of Tybalt, an adult that should take responsibility for the tragedy is the Nurse. The Nurse is the person who has been taking care of Juliet since the day she was born. Unfortunately, even she makes mistakes. She helps the two marry each other. She even goes as far as to tell Romeo, that, â€Å"For the gentlewoman is young and therefore, if you should deal double with her, truly it were an ill thing to be offered to any gentlewoman, and very weak dealing† (Act II, sc iv, ll 163-166), meaning that she makes sure that Romeo knows, that he better mean that he wants to marry Juliet. The Nurse helps Juliet to get to her wedding, which is very foolish of her, since she does not even think the slightest bit about what would happen if the two were to marry. After Romeo is banished, the Nurse does not support him anymore. Moreover, she does not understand that Juliets love for Romeo is genuine, and not some childish infatuation. She be trays Juliet, even though she is a wise and experienced woman. She encourages her to forget about Romeo and marry the County Paris instead, â€Å"I think it best you married with the County† (Act III, sc v, ll 225), which discourages Juliet greatly, since the Nurse was the only person Juliet could earnestly confide in. This betrayal by the Nurse leaves Juliet alone to make her own decisions. The Nurse is supposed to be one of Juliets best friends. Now when it is important for Juliet to have someone support her, she is disheartened. She also knows of the secret marriage between Romeo and Juliet, yet she does not notify others of it. As a result, the Nurse thinks she is helping Juliet by leading her on that path, but, in truth, she is only helping her towards her death. That is an error that could have been easily resolved, but, she does not even know she made that error in the first place. Otherwise, if the Nurse continued supporting Juliet, she would have confided in her, and the Nurse could have stopped the whole tragedy from happening.   Ã‚  Ã‚  Ã‚  Ã‚  Likewise, the gullible and somewhat secretive Friar Laurence plays a big part in the death of the young couple. He is a Franciscan Friar and is well-known throughout Verona. The Friar does all his actions, without even slightly thinking about the results. He is present throughout Romeo and Juliets lives; he unites them, comes up with a plan to keep them together, and is an ally throughout their tragedies. Nevertheless, Friar Laurences foolish actions in marrying Romeo and Juliet, creating thoughtless plans, and his fear of committing sin, all contribute to the deaths of them. For instance, after the death of Mercutio and Tybalt, and Romeos banishment, Friar Laurence is still not aware of the consequences of Romeo and Juliets marriage. Instead, he continues his effort in reuniting Romeo and Juliet. The plan he concocts for reuniting them is very risky, and badly thought out. Juliet is willing to commit suicide if the Friar does not help her, so, to appease her, the Friar gives her a potion to drink, and that potion, would keep her in a death-like state for forty-two hours. Meanwhile, he sends a letter to inform Romeo of the plan, but it never reaches him. Friar John, the person who is supposed to deliver the letter, says this to Friar Laurence, â€Å"I could not send it-here it is again-† (Act V, sc ii, ll 14). This tells the reader that Friar Laurence does not tell the messenger the importance of the letter beforehand. Also, Friar Laurence does not abide by his agreement with Romeo, â€Å"Sojourn in Mantua; Ill find out your man, and he shall signify from time to time† (Act III, sc iii, ll 168-169), which means he would notify Romeo of happenings via his manservant, Balthasar. Furthermore, the Friar contributes to the death of Juliet by his cowardly behaviour in the tomb. He does not comfort her at seeing her love dead and he also does not give her hope for future life other than life among holy nuns, â€Å"Ill dispose of thee , among a sisterhood of holy nuns† (Act V, sc iii, ll 156-157). After that, he abandons her, as he does not want to be seen or caught in the midst of all the drama. This is very irresponsible, cowardly, and selfish, especially since Juliet threatens to kill herself in the presence of Friar Laurence earlier in the play. In short, because of Friar Laurences short-sightedness and mistakes that he overlooks, he dooms those he tries to help. He puts the core of the catastrophe into motion, all starting with rashness, hastiness and numerous bad decisions. He tries to please everyone, but ends up pleasing no one. Therefore, if the two did not know Friar Laurence at all, this would not have ended as a tragedy.   Ã‚  Ã‚  Ã‚  Ã‚  In brief, from the very beginning, the young couple is destined to die. Almost every decision that the three characters make, leads up to the deaths of Romeo and Juliet. The deaths are the fault of the people who do not realize their mistakes earlier, and now grieve. These characters are Tybalt, the Nurse and Friar Laurence. They assist fate in succeeding to not allow Romeo and Juliet to be together. All of them make considerable mistakes by not thinking before acting. If the Nurse had continued supporting Juliet, Friar Laurence had thought carefully and Tybalt did not hold a grudge, these deaths would not have occurred. The outcome would have been completely different. The errors and senseless decisions that they made, became the sorrow of their whole lives.

Long Bone Fractures in Children: IN Fentanyl Treatment

Long Bone Fractures in Children: IN Fentanyl Treatment Introduction The clichà © that states children are just small adults is certainly not true in the case of long bone fractures. A childs experience of long bone fractures is dramatically different from that of an adult on account of their rapidly developing physiology (Wood et al 2003). This rapid development results in biochemical and physiological differences between a childs and an adults skeleton, the mechanisms of fracture and healing, are an important component of their treatment needs and consequently crucial part of emergency care management (Bonadio et al 2001). In addition, children, from infancy through to adolescence, have common fracture patterns related to their stage of development. The structural differences between the bones of a child and an adult enable childrens bones to endure greater forces and to heal quicker a childs remodeling potential supports full recovery with limited or no long term side effects from long bone fractures (Lane et al 1998). Injuries of all types are the second leading cause of hospitalization among children younger than 15 years (Landin 1997). Musculoskeletal trauma, although rarely fatal, accounts for 10% to 25% of all childhood injuries (McDonnell 1997, Landin 1997, Lane et al 1998). Boys have a 40% risk and girls a 25% risk of incurring a fracture before the age of 16 years (Landin 1997, Ritsema et al 2007). The most common site of fracture is the distal forearm which accounts for 50% of paediatric fractures. The rates of fracture increases with age as children grow; peaking in early adolescence. Fortunately, most fractures in children are minor greenstick and torus fractures constitute approximately 50% of all fractures in children (Landin 1997, Lane et al 1998, Gasc Depalokos1999, Richards et al 2006) and only 20% require reduction. Thus, the management of paediatric fractures is often straightforward. Without exception children will experience pain at the time of injury, attending the accident and emergency department and during recovery. The most common pain management strategies involve a multi-modal approach that includes both pharmacological and non-pharmacological components delivered via the least invasive technique (Worlock et al 2000). In practice this includes oral medication, such as oramorph, paracetamol, and NSAIDs, inhaled entonox, intranasal diamorphine (IND) or intravenous opioid where necessary and distraction with age appropriate devices, such as interactive books, bubbles, music and computer games in older children. Notably, IND is currently embraced as the key route of opioid delivery for children attending AED with fracture pain in the UK British Association for Accident and Emergency Medicine (BAAM E 2002). Parents and guardians of children frequently seek care in AED for the relief of pain from traumatic injuries and as a result the field of emergency medicine has assumed a leadership role in paediatric pain management. However, despite this the literature suggests the provision of pain relief for children attending AED remains suboptimal when compared to adults with the same injuries. Further discrepancies are reported between paediatric accident and emergency departments (PAED) and district general accident and emergency departments (DGAED) (Emergency Triage 2004). One reason suggested for these differences is the geographic distribution of specialised services, which are predominantly located in large cities where they are affiliated with universities. However, a recent audit by the British Association for Emergency Medicine (BAAEM 2005) of their guideline for the management of pain in children shows inconsistencies in provision of analgesia particularly for fracture pain throughout the country with no measurable difference between PAED and DGAED. A key feature of this guideline is the algorithm which advocates the use of IN diamorphine for acute moderate to severe pain in children over the age of one year (see appendix 1). The whole topic of analgesia in the paediatric population is complex and still imperfect especially in acute moderate to severe pain requiring urgent treatment in the emergency department (Schechter et al 2002). The road to pain free suffering is still paved with impediments such as failure of pain recognition and methods of delivery of analgesia (Murat et al 2003). Oral administration can be inadequate in an emergency situation with particular limitations in potential choice of drug and delay in gastric absorption and gastric emptying. Intramuscular (IM) and intravenous (IV) administration can be distressing to children and have been shown to influence future response to painful procedures (Gidron et al 1995, McGrath et al 2000, Fitzgerald et al 2005, Walker et al 2007). Rectal administration has limited acceptability given unpredictability of onset together with occasional problems of consent (Mitchell et al. 1995). By contrast, the efficacy and safety of the IN route has been well documented for desmopression acetate (DDAVP), insulin, antihistamines, midazolam and calcitonin (Jewkes et al 2004, Loryman et al 2006). In contrast, intranasal administration has a number of advantages. It is technically straightforward, socially acceptable and demonstrably effective. The nasal mucosa is richly vascular and administration by this route avoids the first-pass metabolism phenomenon Summary Studies in the 1990s such as Yearly Ellis (1992) have also demonstrated the efficacy of administration of intranasal medication via a nasal spray rather than drops in adults, although the efficacy of this application in the paediatric population remains to be proven. Intranasal administration is possibly the ideal route of analgesic administration in children. Currently, within the accident and emergency department (AED) of Bristol Royal Hospital for Children (BRHC) intranasal diamorphine is used as the first rescue analgesia in the paediatric population presenting with acute moderate to severe pain, most frequently in patients with long bone fractures who do not require intravenous access for resuscitation. Diamorphine is a semi synthetic derivative of morphine with a number of properties that render it a desirable analgesic agent for administration via the nasal route. It is a weak base with a pKa of 7.83 and is water soluble allowing high concentration to be administered in small volume (Rook et al 2006). Unfortunately the legal use of diamorphine is limited to two European countries i.e. United Kingdom (UK) and Sweden. Furthermore periodic problems with its availability during the past few years (with further shortfalls in availability predicted by the NHS purchasing and supply agency) have resulted in an alternative efficacious analgesia being sought for this population. Fentanyl, however, is a short rapidly acting opiate has several qualities that render it useful as an IN analgesia and a potential candidate to replace IN diamorphine in the AED for acute facture pain management in children. It has a very high lipid solubility, potency and diffusion fraction, and unlike diamorphine it is not a prodrug and does not cause histamine release (Reynolds et al 1999). Assessment of a patients pain experience is not directly accessible to others, collecting and analyzing information about the processes of pain relief and pain prevention is not straightforward and presents significant challenges to health care professionals. In children, this task is further complicated by their varied stages of physical and cognitive development. Recent research by Bruce Frank (2004) however, has shown that the ability to measure pain in the paediatric population has improved dramatically and that today there now exists a plethora of age appropriate pain assessment tools for acute pain in children ranging from pre-term infants to adolescents, the majority claiming validity (strength and robustness) and reliability (consistency). However, most clinical research into pain management strategies continue to rely on the gold standard self report and visual analogy score tools (mostly 0-10) (Chalkiadis 2001, Walker et al 2007). Although these tools are reliable they are not always adapted appropriately for a childs stage of development. Childrens understanding of pain and their ability to describe pain change with increasing age in a developmental pattern consistent with the characteristics of Piagets preoperational, concrete operational and formal operational stages in cognitive development (Smith et al 2003). The quality or int ensity of the pain can be difficult to determine in children, as most tools rely upon a patients relative judgment between the intensity of present pain versus a patients worst pain experience (Murray et al 1996). These tools can therefore be unreliable where a childs age of development means they have limited or no memory of pain experience. Stevens et al (2002) recently described a conflict of understanding that resulted in a study bias and an insignificant reported power of (p=0.6). In the study an 8 year old boy had chosen the VAS (0-10) but frequently reported his score as 10, although he understood the increasing value of the scoring system further questioning identified he perceived 10 of 10 to be a good score and 0 of 10 to be poor. The boy was at a stage of development that limited his understanding of less is more. This case highlights the importance of utilizing a pain assessment technique that reliably accounts for a childs age of development. A preliminary search of literature suggests there is currently exists limited research to support for the use of intranasal diamorphine or intranasal fentanyl for the management of acute pain in long bone fracture in children as evidenced based medicine. Despite this lack of evidence it remains a key strategy within paediatric AED for the pain management of long bone fractures and is anecdotally reported as a gold standard for paediatric pain management. Therefore; its lack of availability could profoundly compromise pain management for this population. Thus, this extended literature review will examine the efficacy of intranasal fentanyl as an alternative to intranasal diamorphine for traumatic fracture pain in children attending accident and emergency departments. However, in these days of evidence based medicine, it clearly needs to be established beyond all reasonable doubt. In view of that only research into paediatrics will be included increasing the credibility of its applicat ion to practice. SEARCH STRATEGY A range of complimentary search techniques were used to capture key research including a systematic electronic literature search of the Cochrane library, Embase, CINAHL, Proquest, Medline, PubMed since 1990 up to 2009 (this has to be to year of submission). The scope of the search was extended beyond the recognised five years of current research so as to include the empirical work into the development of IN analgesia in children. Key words used included the following: pain, acute pain management, intranasal diamorphine, intranasal fentanyl, procedural, accident and emergency, emergency department, child, pediatric, paediatric, child and fracture pain, as well as various combinations. In addition, in order to ensure the completeness of the search, an internet search was completed using the Google search engine, IASP, Pain Journal, Paediatric Nursing, BAAEM, NICE, Medline, EBM; the RCN was also utilised. Backward chaining of references found was also performed to ensure all relevant papers were identified. Although this review identified twenty seven citations it should be noted that historically there are fewer Randomised Controlled Trials (RCT) in children compared to adults possibly due to problems gaining ethical approval and consent. Additionally even experienced researchers will be unable to find all relevant papers and much research is not submitted for publication. The studies identified were divided into the three modalities of IN route, IN diamorphine and IN fentanyl with the majority presenting evidence for the IN route. All papers were critiqued using a tool published by the Learning and Development Department within the Public Health Resource Unit of the NHS (www.phru.nhs.uk/casp). The tool facilitated critiquing different forms of quantitative research and is based on work by Sackett (1986), Sackett et al (1996) and Phillips et al (2008) (see appendix 2). The results of the critique process for each paper and level of evidence applied in line with the modalities they address informed understanding of current practice and development of a research proposal. STRUCTURE OF THE LITERATURE REVIEW This literature review will focus on determining whether IN fentanyl is an effective alternative to IN diamorphine for the management of long bone fracture pain in children attending an AED. The scope of the literature review considers literature from 1990 onwards although occasionally earlier research has been referenced. Given the limited available evidence on the topic the following review structure has been selected. Chapters 1, 2 3 will present the evidence sourced on each theme intranasal route, intranasal diamorphine and intranasal fentanyl with a short summary to conclude each chapter. Chapter 4 will present an in-depth discussion and conclusion on the utility of the evidence, its application to practice and the requirement for a multi-centred comparative randomised control trial to improve the credibility of the evidence base for this field of treatment. Finally chapter 5 will present a research proposal for a comparative study of these modalities. Intranasal (IN) route of medication delivery in children. Nasal administration of drugs has been reported as having several significant advantages over current practice which are predominately oral, IM, IV and rectal (Williams Rowbotham 1998). It is emerging as a low-tech, inexpensive and non-invasive first line method for managing either pain or other medical problems (Wolf et al 2006). Nasal medication delivery takes a middle path between slow onset oral medications and invasive, highly skilled delivery of intravenous medications. The nose has a very rich vascular supply, IN facilitates direct absorption to the systemic blood supply due to increased bio-availability of the drug by missing first pass metabolism, It avoids the potentially technically difficult of sterile intravenous access, is essentially painless and is considered acceptable to children when compared to other routes of administration (Shelly Paech 2006) (see table 1). a theory which will be considered when reviewing the studies within this chapter Therefore suggesting th e IN route will result in therapeutic drug levels, effective treatment of seizures and pain without the need to give an injection or a pill, furthermore; it is quite inexpensive, an advantage in this era of increasingly expensive medical technology (Shelly Paech 2006). Additionally given the complexity of the developing child and the known consequence of poorly managed pain on the future responses to pain the IN route does, if it is as efficacious and as safe as suggested offer one of the most acceptable, definitive forms of analgesia delivery in children. The degree of accuracy of the previous statements will be established within this chapter by critically reviewing the 16 studies identified on IN medications other than intranasal diamorphine or intranasal fentanyl in the paediatric population (see table 2) as these agents are considered individually in later chapters. The rigour of the studies will be addressed within this chapter and reflect the level of evidence applied according to Sackett (1986) criteria (see appendix 3). Most studies reviewed were randomised clinical trials and in some cases compared against a placebo Conversely, this does not concur with the trials discussed earlier (Lahat et al 1998, Al-rakaf et al 2001, Fisgin et al 2002, Mahmoudian and Zadeh 2004 and Holsti et al 2007) where significant dosing was applied or in Wilson et al (2004) who retrospectively studied 30 children age 2-16 years receiving 0.3mg/kg at 5mg/1ml INM and 13 patients receiving rectal 0.2mg/kg diazepam for seizures. The authors report equal efficacy for both routes. Success of these agents was considered on cessation of seizures, no reported complication and not needing to attend A+E. A total of 27/30 families who had used INM found it effective and easy to use. Although 20/24 (83%) who had previously used rectal diazepam still preferred it mostly due to the coughing and the volume of liquid administered via the IN route. Given it is generally considered that the optimum IN dose as stated above is 0.1- 0.2 ml per nostril, all but the studies discussed so far were using drug concentration and dosing regimes whic h resulted in large volumes of liquid being dripped in to the nasal cavity. This is particularly poignant in Wilson et al (2003) who compared buccal to IN midazolam in 53 children aged 3-12 years experiencing seizures lasting > 5 minutes attending AED. A key feature of this study is the mean age of the children (age 9 years), mean weight (24kg) the study drug concentration as with previous studies was of 5mg /ml. IN dosing was at a dose of 0.3mg/kg. Given these figure the average dose would have been 7.2mg = a volume of 1.4ml being administered. Since the comparative route of administration for this study was buccal there is a possibility that part of the IN dose was buccally absorbed therefore creating a flaw in this study methodology, raising questions over why this comparative route was chosen and suggesting the only real conclusion to be taken from this particular study is buccal midazolam is effective and safe in children. Furthermore although this is described as a blind RCT and the authors claim the time to cessation of seizure was quicker for the INM group 2.43 (SD 1.67) to 3.52 (SD 2.14) for buccal route there is little detail on the blinding process or data collection procedure suggesting the rigour of the study maybe flawed therefore the efficacy and safety claimed for the IN route should not be embraced without further study. On the other hand Fisgin et al (2002) and Hardord et al (2004) compared the INM with rectal diazepam. In Fisgin et al (2002) in an unblinded RCT equivalence study the authors compared INM with rectal Diazepam to ascertain the safety and efficacy of INM for the development of a clinical protocol in the management of prolonged seizure in children attending the AED. Forty five infants and children age 1 month -13years experiencing prolonged seizures > 10 minutes were either given INM 0.2mg/kg or rectal diazepam 0.3mg/kg. The authors report proven efficacy (p Intranasal Diamorphine (IND) The delivery of opioids via the IN route is perhaps one of the most valuable indications for IN medication delivery. Acute pain is a frequent experience for children whether attending an AED, hospital and hospice setting (Hamer et al 1997). Furthermore it is not unusual for them to experience frequent episodes of breakthrough pain which requires additional support from fast acting analgesic agents. Owing to the developmental and physiological difference in the paediatric population there is a need for a variety of effective treatment option from which to select and individualise the patients therapy to meet their needs. IN opioid is simply one such option available which may be useful in children. It has been suggested that the delivery of medications via the IN route results in rapid absorption with medication levels within the cerebral spinal fluid (CSF) being comparable with (IV) administration (Chien and Chang 1997). Diamorphine hydrochloride is a semi-synthetic derivative of morphine. It is extremely hydrophilic, which makes it ideal to use when preparing in high concentrations in solution, thus allowing high doses to be administered in smaller volumes via the intranasal route (Kendall Latter 2003). However, this route of administration can be a painful process as reported by adults (Henry et al 1998). Despite this the intranasal route is considered more acceptable to children and their parents and is thought to lessen the opioid side effect profile seen in IV administration (Stoker et al 2008). This concept has been well recognised throughout the UK and many centres already use intranasal diamorphine for acute pain in children, following the guidelines by the British Association for Accident and Emergency Medicine Clinical Effectiveness Committee (2002) (BAAEM). Although the administration of intranasal diamorphine is now a first line choice for moderate to severe acute pain for children atten ding AED, as is the case within our institution, there is very limited research to substantiate this practice although as noted above it has been readily accepted by the BAAEM for acute pain management in children and very successfully used within our institution A recent shortage of diamorphine evoked the search for an equally effective and acceptable alternative. Early research in animals and adults reported pharmacokinetics of nebulised inhalation and intranasal administration of diamorphine as detected morphine in plasma at six minutes (Masters et al 1988, Kendall 2001). Despite the age of this research and the fact that the later study was in adults, it is still quoted as creditable evidence to support this practice in paediatrics. However the legitimacy of this should be questioned, due to children not being just small adults but have physiological differences intrinsic to their age and stage of development which may affect the bodys absorption and level of toxicity in different ways to adults. The extensive literature search highlighted four randomized controlled trials (RCT) that demonstrate IND to be clinically superior to intramuscular morphine and inferior to IV morphine particularly in the management of acute pain in children, a case study of an 8 year old boy and clinical audit of IND for pain relief in children attending AED (see table 3). The key methodology in the RCTs by Wilson et al (1997), Kendall et al (2001), Brennan et al (2004) and Brennan et al (2005) suggest these are superiority studies where the authors hypothesised improved pain management with the IND when compared to a variety of routes. The rigour of the studies will be discussed later in the chapter. Although while the critiquing process takes place it is fundamentally accepted that RCT are considered level 1 or 2 evidence as opposed to case study or audits at Level 3b and therefore generally sourced to Latest published clinical evidence to support the use IND in the paediatric population is presented in an audit by Gahir Ranson (2006) of 54 children whose care was managed by the use of an integrated care pathway for acute pain management while attending the local AED. This integrated care pathway focused strongly on the use of IND. Data collection was on a one page performa and included consent, date, patient demographic, pain score and side effect profile. Data collection was retrospective and data analysis illustrated limited recording of side effect profile but improved pain scores. However only 60% of patients have this information documented so data collection was difficult. Despite this lack of hard evidence no clinical incident, including the side effect profiles, were reported. Thus suggesting the practice of IND for acute fracture pain management in children could be safe, effective and more acceptable to children than the more painful alternative of IM or IV administration. However there is limited strength in an audit, other than a review of practice (Bowling Ebrahim 2005) and in this case a key feature for review should be the documentation process in the department as there were facets in the care pathway administration documentation missing. Therefore this audit suggests that IND is safe and effective pain management for children, but this conclusion can not be categorically drawn from the limited data available. The potential outcome of this audit could be education on documentation, to do a more rigours prospective audit of practice. Unfortunately at this point it only offers an insight to their clinical practice which is favourable for this agent and route. Albeit as noted before IND has improved childrens pain management and over all experience of acute care in our PAED additionally as with the results of the audit we have experienced no side effects or complications, further highlighting the importance of seeking an alternative to IND which offers equally efficacy. Intranasal Fentanyl (INF) Monitoring of the usual observations and pain scoring in the child was recorded prior to the administration of fentanyl (20 micrograms for 3-7 year olds and 40 micrograms for 8-16 yrs) and continued at 5 minute intervals for the 30 minute period. Additional doses of fentanyl (20  µg) were available if required at 5 minute intervals. Pain assessment was achieved with two validated pain assessment tools, the visual analogue scale (VAS) in older children and the Wong-Baker Faces (WBF) for younger children. Both are reliable and known to support consistency in pain assessment. Though there was no mention of training for those assessing this primary end point using these tools in the paper therefore this should be considered in the overview of the standard of evidence produced by this study. Additionally although forty five patients were randomized following consent unfortunately no details on the randomization process was disclosed in the paper either. This may not be significant, but when reviewing the credibility of the authors claims these obvious omissions could be responsible for a flaw in this study and remains to be established. On the other hand, the methodology that has been disclosed in the paper appears sound as it addresses key areas of sample calculation (power of the study) as a superiority study with the sub groups size adequate to detect a significant difference (Greenhalgh 2004); demographics, blinding of the drugs, assessors and appropriate statistical analysis of the data therefore supporting the validity of the results claimed and the application of the results to the age of patient targeted that this literature review is aiming to find an analgesic alternative to IND for. The results concluded by Borland et al (2002), are a reduction in pain score at 10 minutes to 44.6 mm (95% confidence interval) 36.2-53.1 mm from 62.3 mm 53.2-69.4 mm (95% confidence interval) at assessment using the VAS and 2.2 (95% confidence interval 1.3-3.1) at 10 minutes from 4.0 (95% confidence interval 3.3-4.7) at assessment in 16 children using WBS. Visual analogue pain scores demonstrated clinically significant reductions in pain scores by 5 minutes that persisted throughout the entire study (up to 30 minutes) for both INF and IV morphine. The second primary end point of this study (side effect profile) showed no significant change in physiological parameter of the childrens pulse or respiratory rate, blood pressure or oxygen saturations, interestingly the side affect profile chosen for monitoring such as pulse and blood pressure are not considered to be one of the primary side affects of morphine, however nausea and vomiting which are was not assessed. Ultimately, there wer e no negative side-effects and the sizeable reduction in pain scores (compared to baseline assessments) was accomplished in children using INF by 10 minutes and maintained throughout the 30 minute period with the mean INF dose at 1.5 µg/kg and ranging from 0.5-3.4  µg/kg. Interestingly 35.5% of children in the INF group only required one dose. Given the clinical equivalency of these two agents and routes the authors conclusion that INF offers the benefits of a simple painless technique for treating acute pain is substantiated. These benefits suggest that the IN route could be a valuable technique not only in an AED but also for breakthrough pain by offering a fast onset of pain control in moderate to severe painful conditions. It could also provide pain relief and allow topical anaesthetics to take effect on the skin prior to IV establishment. Therefore this may be a suitable alternative to IND. A similar and more recent double blinded RCT trial by Saunders et al (2007) claimed efficacy of a larger dosing regimen with a mean dose of 2 µg/kg INF (50 µg/ml) for pain reductions in paediatric orthopaedic trauma compared with IVM at 0.1mg/kg in 60 3-12 year old children. This study reports positive outcome for INF following both patients and carers reporting very effective pain management and satisfaction using this treatment method. However there is little information in the paper of methodology and results are given in percentages rather than a P value or NTT which should be expected in a rigorous creditable RCT of two agents (Bowling Ebrahim 2005) reducing the level of evidence applied to the paper to L3. Even supposing the results are an accurate reflection of the efficacy and safety of INF, particularly the fact that no significant difference in pain score or side effect profile and INF is a way forward, the lack of detail the randomisation process and analysis of data in the study methodology merely implies that these results maybe flawed. Interestingly given the concentration of fentanyl 50 µg/ ml a dosing volume for a 25kg child would have required one ml = 0.5ml per-nostril therefore suggesting some of the administration may have been oral rather than IN and present the issues of bad taste which is put forward as a possible study limitation by the authors. Then again there are no complications or reports on taste presented in the results and the authors conclusion on the efficacy of INF for acute pain management in children may be founded. However, without sourcing more details from the authors it cannot be considered evidence to inform this dissertations aims but merely an ex ample of poor research or appropriate omission by publishers. Further suggesting there remains a requirement for more research on the topic within double blind, equivalence, RCT focused on INF efficacy and dosing with sound methodology that is transparent in publication to answer the dissertation question. Conversely an older and more rigorous study which also looked at dose related analgesic effect between routes of administration is by Manjushree et al (2002). The authors demonstrated the clinical efficacy of INF in a cohort of 32 children (aged 4-8 yrs) in a postoperative situation and with a double blind level 1 RCT. The study design gives the impression of sound methodology as blinding, assessment and analysis of data was appropriate and available for scrutiny in the paper, particularly the analysis of both nonparametric and nominal data. The only weakness is possibly the sample size of 32 patients. Although the authors performed a power calculation which identified 40 patients to show a significant affect, they only recruited 32 patients, furthermore, this appears to be an equivalency study where the authors hypothesised INF would be equal to and not inferior to IVF therefore would have needed a larger sample to de

A Scope Of Microsoft Essay -- essays research papers

There are many factors that must be considered when â€Å"scoping† out a company for a potential merger or acquisition. I being the CEO of a major competitive software manufacturing company look for many things. Things such as strategic planning, financial performance, technological advances and marketing opportunities are just some of the factors that must be looked at when considering another company for acquisition. In this case, Microsoft Corporation is our target. I will be examining the above-mentioned factors before making my decision on whether or not an acquisition will be feasible.   Ã‚  Ã‚  Ã‚  Ã‚  Microsoft Corporation was founded in 1975 by William H. Gates III. The company, which was inspired by Gates, had a vision of computers powered by software developed by the company being a way of life. The goal was to integrate computers into people’s everyday lives. The company started out in Gates’ garage with primitive technology and unlimited aspiration. Today the company has grown to be the world’s number one software developer and manufacturer. The company offers a very diverse line of products ranging from home user applications to high tech business software. Microsoft develops and manufactures a full line of games, web publishing, and most importantly, it’s number one piece of software, Windows 2000 and ever-popular Office 2000. The world basically runs on Microsoft software. The software is shipped with 70% of the world’s computers giving Microsoft a total of over 19 billion dollars in revenues for 1999. Microsoft has re cently emerged in the world of Internet Service Providers (ISP’s) to become a competitor of the well-known America Online. The Microsoft Network (MSN) as it is known offers users the same advantages of the leading ISP’s while incorporating its own technology to make the online experience more user friendly and technologically advanced than the others. MSN allows users to interface their online work with their regular operating software to allow for easier web publishing, more advanced multimedia presentations, and quicker processing time.   Ã‚  Ã‚  Ã‚  Ã‚  There have been many issues concerning Microsoft’s strategies. Many say that the company is only in the market to take over and monopolize. As a matter of fact, the United States Government is currently in a civil anti-trust case against the company. Evid... ... and manufacturer that will occupy every sector of the software industry. Our manufacturing plants can be consolidated and re-structured to cut costs, wile adapting to manufacture the new software line that my company would introduce. Our management team can be re-structured as well so that strategic planning and decision-making will better implement our new ideas and technological advances. Finally, our market share will be greatly increased because of the ability to be exposed to countries that we are not currently involved in. I feel that a combination of our companies would be probably the most beneficial event that could occur in my company. Microsoft has proven itself to be the number one software company in the world; together we would be unstoppable. One problem with this joint venture would be the matter with the pending Anti-Trust case, which would probably be further fueled by this joint venture. Whatever the outcome of the case, which by the way seems to be nearing a settlement, I feel that the newly formed company will be the best thing that has happened in software since 1975. **All factual and financial information was taken from Microsoft’s 1999 Financial Report.

Benefits and Risks of Antibiotics Essay -- Antibiotics Pills Essays

Benefits and Risks of Antibiotics Introduction There are many issues that producers face in their practices today. One of these issues concerns the widely accepted use of antibiotics in livestock feeds. There are benefits and risks associated with this use. These issues impact not only the animal industry; the repercussions are seen on a much larger scale in the general public. This paper will give an overview of both the pros and cons of this issue. Background Antibiotics have been approved for use in livestock feed for over 30 years. This includes a variety of different antibiotics that are added to the feed at sub-therapeutic levels. There are strict guidelines that limit the amount of antibiotic to no more that 200 grams per ton of feed. Each antibiotic also has a minimum and/or maximum amount set. Antibiotics are widely used in all areas of the animal industry. They are most prevalent in swine, poultry and beef rations. PRO Antibiotics are invaluable to the producer. There have been numerous studies that show growth promotion and increased feed efficiency (a.k.a.: nutrient conversion) are achieved by using antibiotics in the feed. All industries can benefit from antibiotic use. For example, 100% of poultry producers add antibiotics to their rations for increased feed efficiency in growers and increased egg production in layer hens. Feedlot cattle are fed antibiotics to reduce the incidence of liver abscesses - a major money loss at slaughter. There are many who argue that the practice of including antibiotics in feed leads to drug resistant bacteria. The research done on this topic is inconclusive. Some producers are trying to get around this problem. These producers implement a gradient-feeding regime... ...uperbugs on the hoof? Science. 2000 May 5:288(5467):792-4 Hayes, D. J., H. H. Jensen, L. Backstrom, J. Fabiosa. Economic Impact of a Ban on the Use of Over-the-Counter Antibiotics in Swine Rations. 1999. Staff Report 99SR90 Center for Agriculture and Rural Development, Iowa State University, Ames, IA. Hoogkamp-Korstanje, JA. 1999. Ned Tijdschr. Geneeskd. (translation). PubMed abstract Houndt, T., H. Ochman. Long-Term Shifts in Patterns of Antibiotic Resistance in Enteric Bacteria. Appl.Environ. Microbiol. Dec 2000 V.66:5406 Jurgens, Marshall. 1997. Animal Feeding and Nutrition, 8th Edition. Dubuque, IA: Kendall/Hunt Pub. Co. Kamphues, J. 1999. Berl Munch Tierarztl Wonchensch. (translation). PubMed abstract. Tollefson, L., M. A. Miller, Antibiotic use in Food Animals: Controlling the Human Health Impact. J. AOAC Int. 2000 March/April; 83(2):245-254 Benefits and Risks of Antibiotics Essay -- Antibiotics Pills Essays Benefits and Risks of Antibiotics Introduction There are many issues that producers face in their practices today. One of these issues concerns the widely accepted use of antibiotics in livestock feeds. There are benefits and risks associated with this use. These issues impact not only the animal industry; the repercussions are seen on a much larger scale in the general public. This paper will give an overview of both the pros and cons of this issue. Background Antibiotics have been approved for use in livestock feed for over 30 years. This includes a variety of different antibiotics that are added to the feed at sub-therapeutic levels. There are strict guidelines that limit the amount of antibiotic to no more that 200 grams per ton of feed. Each antibiotic also has a minimum and/or maximum amount set. Antibiotics are widely used in all areas of the animal industry. They are most prevalent in swine, poultry and beef rations. PRO Antibiotics are invaluable to the producer. There have been numerous studies that show growth promotion and increased feed efficiency (a.k.a.: nutrient conversion) are achieved by using antibiotics in the feed. All industries can benefit from antibiotic use. For example, 100% of poultry producers add antibiotics to their rations for increased feed efficiency in growers and increased egg production in layer hens. Feedlot cattle are fed antibiotics to reduce the incidence of liver abscesses - a major money loss at slaughter. There are many who argue that the practice of including antibiotics in feed leads to drug resistant bacteria. The research done on this topic is inconclusive. Some producers are trying to get around this problem. These producers implement a gradient-feeding regime... ...uperbugs on the hoof? Science. 2000 May 5:288(5467):792-4 Hayes, D. J., H. H. Jensen, L. Backstrom, J. Fabiosa. Economic Impact of a Ban on the Use of Over-the-Counter Antibiotics in Swine Rations. 1999. Staff Report 99SR90 Center for Agriculture and Rural Development, Iowa State University, Ames, IA. Hoogkamp-Korstanje, JA. 1999. Ned Tijdschr. Geneeskd. (translation). PubMed abstract Houndt, T., H. Ochman. Long-Term Shifts in Patterns of Antibiotic Resistance in Enteric Bacteria. Appl.Environ. Microbiol. Dec 2000 V.66:5406 Jurgens, Marshall. 1997. Animal Feeding and Nutrition, 8th Edition. Dubuque, IA: Kendall/Hunt Pub. Co. Kamphues, J. 1999. Berl Munch Tierarztl Wonchensch. (translation). PubMed abstract. Tollefson, L., M. A. Miller, Antibiotic use in Food Animals: Controlling the Human Health Impact. J. AOAC Int. 2000 March/April; 83(2):245-254

Jose Rizal’s Poem and Writings

Why did Rizal write the following poems and essays? * To the Philippine Youth. He wrote this to emphasize that the youth is the hope of our nation and that they should be educated to help in the progress of the country. He also included that Filipino should love their own mother tongue. * My First Inspiration. This was written by Rizal to teach us that our mother should be our first inspiration as our mother is the one who bear us and gives us the support from the very beginning.Our mother is also our first teacher. * Love of Country. This was written by Rizal to remind us that we must love our own motherland and as Filipinos we should somehow sacrifice ourselves for our country. * A Remembrance for My Town. This was written by Rizal for us Filipinos to be reminded that we should not forget our fatherland where we came from and the cultures we are used to and values we are taught of. * Through Education, Our Motherland Receives Life.Rizal wrote this to open our minds that as the Fili pino acquires education, he can help the country in seeking freedom and improving the life of the Filipinos. * To the Flowers of Heidelberg. Rizal wrote this while he was in Heidelberg as they were having their tour, wherein the flowers blooming in Heidelberg reminds him of his garden in Calamba * My Retreat. This poem was written in account of Rizal’s mother’s request to revive his interest in writing poems.Here, he portrayed how serene his life was while he is in exile. Rizal clearly expressed his acceptance of his fate and that justice will overcome in the end. * A Letter to Young Women of Malolos. This famous essay was written to commend the young women of Malolos for their courage to establish a school where they could learn Spanish despite the opposition of the parish priest Fr. Garcia.This essay also contains Rizal’s ultimate desire which is for the Filipino women to have the same opportunity enjoyed by men in terms of education since education will unsha ckle the women. * My Last Farewell. This poem was written by Rizal showing his spirit of fairness and justice. This is his farewell to his native land which he gladly offers his life. In this poem, it depicts that he faced his death calmly for he was aware that he is going to a place where there are no claves and God reigns supreme.

Explain religious teaching about what it means to be a human Essay

– Human has a embodied spirit who thinks, act, speaks and desires. Religious teachings say that humans are created in the image of god. They are different from animals because humans have the ability to love, be moral and have free will. Humans life is a gift from god. We must value life. God created us as intelligent beings with the ability to control our actions, urges and emotions. Christian teaches that free will is given by God. By free will, we shape our own lives. Bible says Humans are creation of God. God desired humans to exist. God gave us the ability to reason, speak and to live a moral life. Humans are mixture of earth and divine breath. Bible teaches that we are the incarnation of the divine and part of us is drawn from the earth. Everything created by god is perfect and it was intended. Of all the creatures in God’s creation, Humans are the only ones who enter into a dialouge with God which is by prayer. Most christians believe that humans are distinct from the animal word, and that the most important differences between animals and humans have is soul – a divine spark that sets them apart from other living things. This asserts that Christians do not treat animals as their equals, as only humans were made in the image of God. Christians believe in the sanctity of life, that there is something special and holy about life. Christians believe that humans have a soul which lives on after the body has died, this soul will then be judged and then can join God in heaven. God gave humans dominion over the non-human life, E.g. in Genesis ‘Let them rule over the fish of the sea and the birds of the air’ suggesting human life has a higher value than non-human life, this shows God has given humans a big responsibility to life which exempliflies the value. God made man ‘in his image’ many christians believe that God gave them the brains and the abilities to find cures for humans by experimenting on animals and not to use these abilities would be denying God’s plan for them. Some christians say that this gives them the right to use animals in  experiments because humans are of more value. As well in Genesis God said to Adam ‘Rule Over’ all living creatures suggesting animal testing is acceptable. However, Some christians may be very much against this, as when God created the world, he saw that all that was in ‘was good’. Some say this means we should not experiment on animals because they are wonderful part of God’s creation. ‘The earth is the Lord’s and everything in it, the world, and all who live in it. Human lives are special because it is a gift from God. Human lives distinct from any other creatures and are in higher positions. Humans have sanctity which relates to their dignity, which has both natural dimension, in terms of rational thought and moral decision-making powers. â€Å"Human beings have complete control over their own life and destiny.† (15 marks) How far might a religious believer agree with this statement? Everyone has a purpose of being in this universe because we all have a special position that is created by God. Humans make their own choices and lead on their life. But, God is always there to show people the right path. Only God has control over peoples lives. He decides when we die and when we born. Everything is in God’s hand as religious believer will say God created the world. God’s choices are always right. He is capable of carrying out any project to a successful conclusion without the possibility of fault or failure. Nothing in His universe happens by chance or accident. For every effect there is a cause. God is in control. We have freedom to choose within the constraints of who we are and the circumstances we find ourselves in. Yet while God controls those circumstances but does not control us. While God is able to control us, and if he wanted to he could override our freedom, he chooses not to. The concept of the control of God over everything is called the â€Å"sovereignty† of God. Nothing gives us strength and confidence like an understanding of the sovereignty of God in our lives. God’s sovereignty is defined as His complete and total independent control over every creature, event, and circumstance at every moment in history. Subject to none, influenced by  none, absolutely independent, God does what He pleases. God is in complete control of every molecule in the universe at every moment, and everything that happens is either caused or allowed by Him for His own perfect purposes. Religious believer might say that God is directing your steps down to the smallest details. He can make things happen that you could never make happen on your own. He is for you, on your side, and what He has purposed for your life will come to pass.