What is essay writing example
Eating Disorders Topics For Research Paper
Thursday, September 3, 2020
Geography and history of canada
Connection between the Geography of Canada and Its History Veronica Guerrero FarJat CDNS 101 Royal Roads University Ms. Michelle Hardy November 20, 2013 What is the connection between Canada's geology and its history? As per M. Solid, (individual correspondence, March 27, 2012) my course material (2013) sets up that Canada is a North American nation with 10 regions and 3 regions; overall named as the second biggest nation on the planet Canada, is notable by its different however interesting history! Canada battled about by the French and the British, the British won and end colonizing this one.This paper investigations the decent variety of Canada's initial history of settlement identified with its topography. So as to see the association we grasp how the native individuals initially came to Canada by following the untamed life; at that point the Europeans came to Canada on the grounds that the huge of characteristic assets; lastly permitting the French individuals to settle in Quebe c territory. This paper contends that recorded settlement of Canada was changed by its topography. Canada used to be named ââ¬Å"Kanataâ⬠: Huron-Iroquois word for town or settlement. So as to make due, as individuals we do numerous things, for example, feed, mingle, we multiply, we followâ⬠¦ t for the most part we remain together and we battle to endure. On this passage I will clarify in detail how Aboriginal individuals first settle in Canada by following the untamed life: Firstly, the earth heated up, the ice masses dissolved and retreated; which it implies: open movements courses (hallways). Following this reality, creatures were competent to cross land extensions of the Alaska-Bering. Secondly,Aboriginal individuals show up in Canada's history by spreading out into the in abi n table zones ot north-western America, everything for gigantic explanation: FOOD! They needed to procure certain abilities, for example, chasing, fishing, and so forth n request to endure. Be tha t as it may, creatures; were their ain explanation of settlement so then they remain and spread over the land. To close I might want to point that as the atmosphere and land conditions changed the land start to got rich and profitable; locals had the option to remain and that is one of the most significant reasons how those first people groups are essential for Canada's history; they speak to thousand years of culture and any place individuals these days concur or not they are Canada's first people groups. At the point when two universes meet, astounding things happen.According to my course material (2013) 1500-1791 was when Aboriginal individuals and Europeans were in contact. At the point when Europeans initially came to Canada, they ere flabbergasted on this territory due to the immense of normal assets; for instance, wood/blunder that they could use in Europe so it can help with the improvement of their nation. Right off the bat, Henry the VII financed an investigation to North America set out toward the Italian adventurer John Cabot in 1497. Be that as it may, it wasn't until 1610 when the English settlement started. As pressure set among France and England in Europe, rivalry leaded in the Americas.Subsequently, Henry IV of France doled out Samuel de Champlain to investigate the new terrains in the Americas; Champlain is a significant figure in Canada's history since he opened up the St Lawrence River nd extended French impact through the incredible lakes bowl. Also, Champlain was engaged with a gathering who were keen on the hide exchange; the French and Aboriginal individuals worked together in the tremendous hide exchange economy. The hide exchange was an exchange between the French and first country individuals for the trade on things, for example, device (beaver) and weapons. The short hairs of the beaver were utilized for making design caps and those were sended to Europe.In end, the Fur exchange had framed a significant piece of the early economies of both the English and French states and is extremely noteworthy for Canada's initial history since it's Canada's first conomy created due to the beaver; which is a characteristic asset, this one and the wood/stumble are the two biggest models why Europeans were so keen on this land so they are a piece of Canada's initial history and we see the association dependent on their choice after totally happened choosing to settle here thus they end colonizing this country.On the early long stretches of Jacques Cartier's France had been developing a province along the ST Lawrence River. Struggle among France and England had been developing from that point forward; European showdowns spilt over into the new world and in 1629 Kirke of England finished the French state of Port Royal. This set up for restriction between the English and The French in the America's as well as over the world. As I point first and foremost, Canada's is the second biggest nation in the world.So currently realizing that Canada is such a major nation individuals is required for its improvement so after all the British vanquished the previous French provinces, retaining them into their North American domains. By the by, the French settled basically in what is today known as Quebec and Nova Scotia. England permitted the French to remain on the grounds that they required them to settle this nation; s well, Britain bolstered Canada with workers and cash. At last, when Canada had become a nation, the objective was to bind together, characterize, and constructed a state.This doesn't imply that the French Canadian repudiate their attitude as Canadian or that they torgot their customs and legacy. French was made the second official language ot government so as to keep up French political help. I might want to underline that having every one of those realities and Canada being such a major nation is basically connected to its history bringing outsiders and the Europeans settling in this nation. An ompa rison of Canada's history and topography; Mexico is different and it has 3 thousand years of history.According to world history venture (2007) The Republic of Mexico is tremendous, containing about 2,000,000 square miles of coastline, desert, downpour woodland, mountains, and fruitful fields. As Canada, Mexico is named as the fourth biggest nation in the western side of the equator and is wealthy in common assets, for example, oil and gaseous petrol. From the American borderlands of the broad, agronomically rich north, the nation limits delicately as it clears south and east. Just as Canada, is flanked by the United States.In Canada's history we comprehend in some point the need of individuals while in Mexico there is a City (Mexico City) that is viewed as one of the most crowded urban communities on the planet. The populace in Mexico is around 120. 8 million people groups. Despite the fact that Mexico and Canada are altogether different nations, they share by one way or another thi ngs for all intents and purpose, for example, history of colonization. Canada was colonized by the British in the other hand, Mexico was colonized by Spain. Both, British and Spain were flabbergasted by Canada's and Mexico's scene, their magnificence and its normal resources.Finally, Canada and Mexico are two biggest nations and by one way or another their istory and riches on common assets roused different nations, for example, Britain and Spain to pick up enthusiasm on them and that is the means by which their history is comparable. All in all, Canada is a place where there is assorted variety, innovativeness and liberal perspectives. The Canadian individuals are a mosaic of ethnicities; it implies that also it's framed by different nationalities which together they structure an extraordinary home.We comprehend the association by first, chronicled settlement of native individuals in Canada by following untamed life. Besides, Europeans came and settle on account of Canada's huge of characteristic assets nvolving the hide exchange as a firs economy created lastly, settlement of French individuals over Quebec area as a result of Canada's size and need of individuals. To finish up I might want to cite something that Lorraine Monk a proofreader of ââ¬Å"Canada the Things We Hold Dearâ⬠: An Album of Photographic Memories (1999) stated: ââ¬Å"The scan for Canada is an individual Journey.The look for a national character is a Journey without an end. It started a, quite a while back. It will proceed into the far inaccessible future.
Saturday, August 22, 2020
Why You Should Plan Your Opinion Essay Topics
Why You Should Plan Your Opinion Essay TopicsIf you are planning to write an essay on opinion, it would be a good idea to plan your topic carefully. Opinion is a subject that is very subjective and difficult to study. In order to avoid a lot of wrong thoughts and conclusions, you have to plan your essay before you start writing it.First, you have to ask yourself why you want to write an essay on opinion. Is it to express your views, or are you trying to find an answer to a question that you are having? This can help you decide on what to write about. You should also consider the reason why you want to know the opinion and how you want to express it.Second, when you start researching opinion topics, it is important to determine the basis of your opinion. For example, does your opinion stem from personal experience or is it based on research? Do you want to address an existing debate or do you want to create your own answers?It would be best to determine the basis of your opinion befor e beginning your research since this will help you decide on what to write about. Doing this will also help you determine if your opinion is unique to you or if it is more common to other people.Third, find out more about the opinion that you want to discuss. In order to determine the underlying arguments, you can take a look at different opinions related to the issue that you want to write about. You can also look for expert opinions or even try to find independent research reports that prove the validity of your opinions.When you are considering opinion topics, it is best to identify the most common basis of your opinions. Then, you can determine the main idea behind your opinion. As you can see, it is not that easy to research an opinion as you may think. To write an essay on opinion, you have to first come up with your topic and then begin your research.This is why it is crucial that you research before writing your essay. Remember that writing an essay on opinion is very differ ent from writing a research paper. Even if you have a great idea, it is important to check all the facts before you begin writing.Make sure that you write your essay first so that you can always check your facts. If you start with an opinion, you will have to make sure that your facts are right or else you will end up with incorrect facts. Aside from that, it would be best to get some writing practice so that you can become a better writer when you write an essay on opinion.
Friday, August 21, 2020
Ilandes between them Essay Example | Topics and Well Written Essays - 1000 words
Ilandes between them - Essay Example Japan is an unmistakable offshoot for the US in a few international strategy subjects, particularly with regards to security needs, from countering the development ofà China inside the locale to reacting to dangers from North Korea. After the World War II, the collusion among US and Japan has for some time been a fix of the US security work inside East Asia. This union facilitates the forward tasks of about 49,000 US troops, just as different US military assets based inside Japan into the Asia-Pacific. In this way, if Japan settles on a choice of turning into an individual from the unhindered commerce understanding known as Trans-Pacific Partnership (TPP), it will end up being a considerably increasingly critical subject inside the rebalancing technique of the Obama Administration to Asia (Curtis). Over the most recent seven years, Japan has battled to accomplish political security. Since 2007, Japan has seen six men turning out to be Prime Ministers, involving the current Prime Min ister Shinzo Abe, who in 2006-2007 held a similar post. His Liberal Democratic Party (LDP) continued expert in an avalanche political race held in December 2012. Equitable Party of Japan (DPJ), for example the current restriction, had represented for three fierce years following their own watershed political race win in 2009 (Curtis). The pioneers in Japan encounterâ overwhelming obligations including a rising progressively forceful China, a weak economy and upgrading from the dangerous March 2011 seismic tremor, wave, just as atomic debacle. In the ongoing past, resistance territory over a solitary office of parliament has deflected policymaking in Tokyo, accordingly muddling the relations among US and Japan disregarding broad shared national advantages. Abe is far-fetched to seek after troublesome activities preceding the coming national races in July 2013, for the Diet, for example the Upper House of parliament (Curtis). Maybe most fundamentally, the US will be legitimately occu pied with a military conflict among Japan and China concerning the Senkaku/Diaoyu islets inside the East China Sea. Past remarks and deeds on quarrelsome chronicled worries by Prime Minister Abe together with his bureau have brought about worries that Tokyo is equipped for disturbed territorial managing in manners that could wind up hurting US interests. As a solid patriot, Abe is at present under pressure on the privilege by a recently made gathering displaying its own hawkish suppositions on national security. Accordingly, Abeââ¬â¢s way to deal with issues, for example, the claimed ââ¬Å"comfort womenâ⬠sex slaves during the World War II period, history reading material, outings to the Yasukuni Shrine, which tributes toâ war dead of Japan, just as attestations on a regional clash with South Korea, will be under investigation by the neighbors of Japan, yet additionally by the US (Curtis). Despite the fact that the colossal and momentary helpful alleviation given by the US after the ââ¬Å"triple disasterâ⬠in March 2011, reinforced the shared coalition, troublesome concerns remain particularly those connected to the situating of marines on Okinawa. Disregarding Washington and Tokyo consenting to migrate most of marines from Okinawa into Guam, just as different areas inside the district, the two organizations were unequipped for making
Friday, June 12, 2020
Dartmouth Assistant Coach
Dartmouth Assistant Coach October 5, 2012 Do you know the name Joe Moglia? If youre in the business sector you might. Joe Moglia is the current chairman of TD Ameritrade. He is also the companys former CEO. But before Joe Moglia worked his way up to the top of the business world, he was a football coach for sixteen years. His last coaching position before pursuing a career on Wall Street at Merrill Lynch was as the defensive coordinator for Dartmouth College. But Mr. Moglia faced with a family, mounting bills, and no clear path to a head coaching job at a university turned to a job on Wall Street. Fast forward through his improbably rise to leading TD Ameritrade and the former Dartmouth defensive coordinator on the eve of the 2008 collapse left his employ at TD Ameritrade to pursue his lifelong dream. His lifelong dream was to become a college football head coach. And so Joe Moglia took an unpaid internship at the University of Nebraska (TD Ameritrade is located in Nebraska) with the football team. He apprenticed under the head coach. He learned from him and refreshed his skill-set and knowledgebase. After all, hed been out of the football world for so many years. Were talking about a billion-dollar volunteer football coach here. Amazing, right? And after a couple of football jobs since that unpaid internship, Joe Moglia has landed a head coaching position at a university alas. He is the current head coach of Coastal Carolina University. And what a coach to have! Imagine the lessons you can learn from a man who has worked his way to the top in business, but ultimately chose to pursue his dream by starting at the very bottom again in sports. Joe Moglia is quite the example and we bet Dartmouth College is proud that he once roamed its sidelines.
Sunday, May 17, 2020
Pollution And Its Effects On The Environment - 1802 Words
The world is dying a little everyday and humans are the reason this is happening. The world is just like the human body. When living things are sick they will get a fever to kill or slow down infectious agents. The world is doing the same with global warming except humans are the infectious agents. Many ecosystems are being destroyed from pollution. One of which is marine life. The oceans are heating up because of pollution, and many of these ecosystems such as the Great Barrier Reef are temperature sensitive. Just a slight change in temperature could have a major effect on the marine organisms. Even though the ocean is vast and full of life, pollution needs to stop because it is harming marine life, affects the food chain by killing organisms that another marine creature might rely on for food, and it is a disruption to the cycle of coral reefs because corals are light sensitive and pollution is making it hard for them to receive the light. Polluting the ocean is a major threat to the organisms that depend on the ocean for food. The pollutants have a major affect on the aquatic food chain because pollution is making it difficult for some marine organisms to find food because of pollutants. If the organism can not find food this will start killing them off and their population will decrease creating a domino effect. This will create a domino effect because if one species starts dieing off another species will start to die and so on. The reason for this happening is becauseShow MoreRelatedPollution And Its Effects On The Environment973 Words à |à 4 Pages Pollution As a society, we have come to understand that pollution is the process of discharging harmful substances into our atmosphere, water or soil. There are campaigns all across the world educating us to the different types of pollution. Humankind has become more aware of the rising problems with pollution and recycling is constant in most households. We know about the effects that pollution has on the environment, but how do the types of pollution affect each otherRead MoreThe Effects Of Pollution On The Environment1636 Words à |à 7 PagesOur environment nowadays is becoming more polluted by the second. There are several types of pollution in the atmosphere: Air pollution, water pollution, soil pollution and many more. It is corroding away our trees and contaminating our water. People take no interest in looking after the environment because they cannot see the effects it is causing the earth. Pollution is becoming dangerously high and it is beginning to affect wildlife. Due to the water being contaminated, they have no safe drinkingRead MorePollution And Its Effects On The Environment1655 Words à |à 7 Pagesbeginning of the existence of humans on planet Earth, humans have caused the majority of pollution in the environment. It is widely accepted that pollution causes negative effects on the planet and on biological health. Humans have polluted all the the four major parts to Earth; air, water, soil, and wildlife. Many countries have taken steps to limit or remove many harmful chemicals that are released into the environment but many large countries, such as China, still don t have tight restrictions on manufacturesRead MorePollution And Its Effects On The Environment1509 Words à |à 7 PagesPollution happens when chemicals and other outside substances leech into the ground, air and water. These pollutants contain poisons that adversely affect environments and the living animals inside of them. Although natural well being and security gatherings work to build attention to the threat contamination presents, if contamination proceeds at its present rate, the future impacts could crush to human populaces and the earth. .Air pollution is a gas (or a liquid or solid dispersed through ordinaryRead MorePollution And Its Effects On The Environment1361 Words à |à 6 Pagesour resources today. Pollution is the main reason resources are becoming inaccessible and unusable. Pollution means, ââ¬Å"The presence in or introduction into the environment of a substance which has harmful or poisonous effects.â⬠Pollution mostly occurs when companies produce products at their plants or factories thus, expelling smoke for the oil burned and toxins into the water. The overall idea is that companies are winning and receiving the fortune to be made while our environment takes the fall. OilRead MorePollution And Its Effects On The Environment1415 Words à |à 6 Pagespesticides - the greater part of the waste we deliver ashore inevitably reaches the oceans, either through purposeful dumping or from keeping running off through channels and waterways. This includes oil spills, which cause colossal harm to the mari ne environment - yet actually are in charge of just around 12% of the oil entering the oceans every year. Stated by the US National Research Council, 36% descends channels and waterways as waste and spillover from urban communities and industry. Manure overflowRead MoreThe Effects Of Water Pollution On Environment And The Environment1450 Words à |à 6 PagesPollution is defined as the contamination of air, water, or soil by substances that are harmful to living organisms. Excessive levels of pollution are causing a lot of damage to plants, and human and animal health, This is a major problem in the environment today; pollution effects are certainly prominent in todays world. Without realizing it we as humans contribute to the waste and contamination to both our bodies and the environment around us. In addition there are also many other causes toRead MorePollution And Its Effects On The Environment1373 Words à |à 6 Pagesto pesticides - the greater part of the waste we deliver ashore inevitably achieves the seas, either through purposeful dumping or from keep running off through channels and waterways. This includes:Oil spills cause colossal harm to the marine environment - yet actually are in charge of just around 1 2% of the oil entering the oceans every year. By study by the US National Research Council, 36% descends channels and waterways as waste and spillover from urban communities and industry. Manure overflowRead MorePollution And Its Effects On The Environment1731 Words à |à 7 Pages As the world population continues to grow and society changes so does pollution and the reality of creating harmful, unsustainable conditions to the ecosystem. Due to human activity large amounts of pollutants and contaminants are produced each year which make their way into our environment. For millions of years nature has had itsââ¬â¢ own solution to keeping the environment clean using a natural bioremediation. Nature has used microbes, and fungi to breakdown and decompose dead plants and animalsRead MoreThe Pollution And Its Effects On The Environment1436 Words à |à 6 Pagesdoes to our environment. Motor vehicles are an important part of our society, but also an ongoing epidemic that can potentially cause long-term hazard. This negative potential arises as we use fossil fuels for vehicles, eventually releasing gases into the air contributing to ozone pollution. Ozone is emitted p rimarily through chemical reactions from industrial machinery and motor vehicles, acting as a harmful air pollutant at ground level. So, what is the number one cause of ozone pollution? Vehicles
Wednesday, May 6, 2020
What Is Information Security - 1022 Words
What is Information Security? The definition of Information Security can be put in simple and understandable words; it is a system or a process that people may use in order to ensure the safety of their information or many other properties. Specialized measures, for example, passwords, biometrics, and firewalls alone are not sufficient in relieving dangers to data. A mixture of measures is obliged to secure frameworks and ensure data against mischief. Confidentiality, integrity and availability are every now and then referred to as the CIA Triangle of information security. Computer security can be defined as a subdivision of technology identified as information security as applied to computers. It is also guaranteeing the accessibility and right operation of a machine framework. Why do we need Information Security? Many believe that the only reason that we need information security is in order to ensure no one can hack our computers and to ensure that our important information is never lost. Information security is not only that, but on the other hand there are many reasons why we need information security. The first reason is that we require data security to decrease the danger of unapproved data exposure, alteration, and decimation. That is the first and most important reason why we need information security and use it; we wouldnââ¬â¢t want everyone to know our personal information, but what about business? Do they also need information security? Data security is required inShow MoreRelatedIs Information Security An Important Issue And What Are The Sources Of Information Threats? Essay1590 Words à |à 7 PagesAccording to Eric Schmidt, CEO of Google, every two days we, as a people of Earth, ââ¬Å"create as much information as we did from the dawn of civilization up until 2003â⬠(Siegler, 2010). Each minute, Facebook users share about 2.5 million times, Twitter users tweet about 300,000 messages, Instagram users add or post about 220,000 new photos, YouTube users upload an average of 72 hours of video, Apple users download about 50,000 mobile and other device applications, Email users send and received overRead MoreWhat Are The Behaviors That Influence Information Security Compliance And Attitudes Toward Compliance In The Public School System?1723 Words à |à 7 Pagesadministrators may consider prioritizing the need for information security training to avoid disclosure of information from both students and teachers. Moreover, school administrators may implement policies that promote the protection of information among students and educators. The findings also contribute to the body of knowledge about the factors that are unknown about unauthorized disclosure of information related to information security awareness training in public schools. Furthermore, theRead MoreImportance Of Data Storage Network Security835 Words à |à 4 PagesStorage Network Security There would be no need for securing data storage network if you can save your information on the network without anyone altering the content. However, it is almost impossible for you to save your information in an unsecured data storage network and retrieve it just the way you saved it. In todayââ¬â¢s world where hackers are rampant everywhere, the need to secure data storage network becomes a major concern for security experts. Over the years, our team of security experts haveRead MoreInformation Security Essay865 Words à |à 4 Pages1. What is the difference between a threat agent and a threat? A threat agent is the facilitator of an attack however; a threat is a constant danger to an asset. 2. What is the difference between vulnerability and exposure? The differences are: vulnerability is a fault within the system, such as software package flaws, unlocked doors or an unprotected system port. It leaves things open to an attack or damage. Exposure is a single instance when a system is open to damage. Vulnerabilities can inRead MorePrinciples of Security 5th Edition Chapter 1 Review Questions814 Words à |à 4 PagesReview Questions 1. What is the difference between a threat agent and a threat? A threat agent is a specific component that represents a danger to an organizationââ¬â¢s assets. And a threat is an object, person or entity that represents a constant danger. 2. What is the difference between vulnerability and exposure? Vulnerability is a weakness is a system that leaves the system open to attacks. Exposure is the known vulnerabilities that make a system weak and open to attacks without protectionRead MorePlanning for Security945 Words à |à 4 Pages Chapter 2: Planning for Security Review Questions 1. Describe the essential parts of planning. How does the existence of resource constraints affect the need for planning? Answer: Organizational planning, described below, and Contingency planning, which focuses on planning or unforeseen events. Organizations must be able to forecast their needs relative to available resources as best they can to insure best decision making. 2. What are the three common layers ofRead MoreThe Role of Information Security Policy1107 Words à |à 5 PagesThe Role of Information Security Policy The Role of Information Security Policy The failure of organizations to implement a comprehensive and robust information security program can mean the untimely demise for some and costly setbacks for others. At the heart of information security is security policy. Without security policy there can be no security program. Without people, security policies would not exist. They would not be written, implemented, and enforced. Security policies and theRead MoreSecurity Issues And Security Risks1641 Words à |à 7 Pages Security issues are something that all employers may have to endure as long as the company is up and operating. Security risks comes in many different aspects business. Security issues can also involve employees as well as customers. Making sure that all aspects of this business is secure can seem like a difficult task to endure but there are several of preventative measures to take. Identify the various types of potential security issues an employer may have to deal with. Whether the company isRead MoreEffective Information Security Policy Elements864 Words à |à 4 PagesEffective Information Security Policy Elements In the world today technology is used everywhere, no matter if it is personal or business. Although technology has become important for so many reasons, there is also a measure of security that must be taken for protection. Policies are put into place for protection the organization from fall into a pitfall. It has also helped the organization to build better relations with personals, and build growth within the cooperate industry. There a several waysRead MorePrinciples of Information Security 4th Ed Chapter 1 Review Questions801 Words à |à 4 PagesKevin Kovack Chapter 1 Review Questions 1. What is the difference between a threat agent and a threat? A threat is a constant danger to an asset, whereas a threat agent is the facilitator of an attack. 2. What is the difference between vulnerability and exposure? Vulnerability is a fault within the system, such as software package flaws, unlocked doors or an unprotected system port. It leaves things open to an attack or damage. Exposure is a single instance when a system is open
Cardiopulmonary Resuscitation and Emergency â⬠MyAssignmenthelp.com
Question: Discuss about the Cardiopulmonary Resuscitation and Emergency. Answer: Introduction Liver transplant for a cancer patient is a matter of discussion that requires a balance between therapeutic argument and ethical standards of practice. Selection for a prospective liver transplant patient is multifaceted procedures that depend on various factors. Selection of patient for liver transplant does not, therefore, require an evaluation of past health condition for approval and in essence the disease conditions management. Addressing the issue of patient selection a clear stance has to be drawn on the importance of procedure saving the patient from this life-threatening disease. The central point of the argument is based on whether an alcoholic patient should be allowed to undergo the treatment yet their alcoholism lead to the liver cancer itself. Ethical view, on the other hand, indicates that selection should be based on disease conditions such as chronicity, mortality, morbidity and equitable health provision policy. The following paper, therefore, explores the selection criteria based on chronicity, mortality, and morbidity as the best alternative criterion. The ethical issue strain liver transplant is the selection criteria that bring two main viewpoint. The first viewpoint emphasize on selection based on stakeholder perspective that consider both patient and health professional. This has resulted in argument as health practitioner considers social factors used in selection as compared to patient that view liver transplant as medical obligation that require equities. Second perspective considers the disease conditions such as chronicity, morbidity and mortality among other as the criteria used to select patient. This implies that there is need to distinguish between the important perspective that balances between ethical perspective and therapeutic perspective (Donckier, Lucidi, Gustot Moreno, 2014). Addressing the liver cancer patient selection issue The ethical view for the selection of liver transplant patient presents the main criteria as mortality and morbidity. The selection criteria set aside the opinion about behaviours of patient especially social aggregates. There are many different ethical support principles that have set the argument for the selection of prospective liver transplant patient. These principles take into considerations both therapeutic practice and the ethical standards expected to take course. Some of the guiding viewpoints for the ethical basis of selection of patient include disease chronicity, mortality, morbidity, elimination of discrimination and Risk-benefit analysis (Organ Procurement and Transplantation Network, 2015). Disease chronicity of liver cancer is based on two main factors and these are disease mortality and morbidity chances. Liver cancer is an clinical significant condition that presents high challenge in healthcare system in Canada (Vanden, Morrison and Shuster, 2010). Disease chronicity is an important factor in it comes to selection liver transplant patient. Chronicity of the illness require critical assessment of patient to ascertain the complexity associated with the liver transplant procedure and any other factor that is most likely to result persistence of the illness. In addition, physicians need to assess the time factor that will play a critical role when performing the transplant. Chronicity offers time constraint that needs to be factored in managing the liver disease (Bobbert Ganten, 2013). Some of the selection criteria under this basis include the morbidity, mortality and Morbidity of the patient Firstly, morbidity chance of liver transplant patient is one of the main basis for selection of liver transplant patients. Based on this viewpoint, health practitioners are required to assess the morbidity of the patient to establish any likelihood that patient can develop complications. In addition, the criteria allow patient to be assessed based on the disease conditions not on social factors. For instance, the morbidity due to alcoholism can be assessed to ascertain the condition of illness and used to determine the need for transplant management. This can also be done for other liver cancer patient regardless of the casual for that illness. This criterion allows patients to have equal chance of medication irrespective of their past lifestyle or social aggregates (Addolorato, Mirijello Leggio, 2013). The disease mortality another is the major factors that set the platform for selection of prospective liver transplant patients. Under this criterion, disease mortality considers above all the disease pathogenesis and the treatment options. Based on disease mortality basis of patient selection, the main focus is on the likelihood of disease persisting and becoming injurious or life-threatening to the patient than any other factor (Watt, Burak Deschenes, 2006). One of the key considerations for patient is mortality of the disease because this gives the urgency of the treatment and benefit-risk-analysis. The ethical standard of practice requires fair treatment of patient regardless of their past lifestyle. The main guiding principle is professionalism and above all diseases mortality conditions. Patient suffering from liver cancer requires serious organ transplant and this follows the likelihood that illness will have low recovery unless the liver transfer is effected within the requi red time (Triguero, Garca, Molina, Miguel, Notario et al., 2015). The ethical perspectives also provide the need to eliminate any discrimination that may be based on social preferences. This implies that when considering a patient that is the best fit for liver transplant, the ethical codes indicates that discrimination should not be tolerated (Zarrinpar, 2012). In addition, patients either alcoholic or congenital biliary are selected based on the ethical principles and standards of practice. The guiding principle is based on the fair treatment of patient and equitable provision of healthcare service without any discrimination. In this sense, gender disparities are not considered in the selection of patient as this is just but social grouping and has minimal effect on the fairness provision of healthcare services. Moreover, social preference based on an addiction to illicit drugs or alcoholism reduces the equitable health provision policy while at the same time lowers the patient-centeredness approach to care. Therefore, discrimination based on pas t social and lifestyle events is against the ethical standard of practice (Rhodes, Aggarwal Schiano, 2011). Risk-benefit analysis is another criteria that are used to select patients considering the balance between risk and benefits of the transplant. The liver transplant requires analysis of inherent risks of surgery, recurrent disease, and long-term immune-suppression that are expected upon approval for transplant (Telles-Correia Mega 2015). Risks associated with the surgery prove that ethical standards of practice need to consider the survival likelihood of patient other than other social preference. This means that before considering patient fit for liver transplant patient need to be evaluated on the risk. There are many different strategies that have been put in place to deal with risks associated with liver transplants. These strategies consider situations such as alcoholic sobriety period and the expected medication. Therefore, there is no excuse for avoiding alcoholic patient on the basis of post-transplant risks (Lucey, 2014). Common therapeutic argument There many arguments that have been presented on the therapeutic consideration in the selection of liver patient. Liver transplant is a multifaceted treatment that does not concentrate on the as single factors as the main determinant for selection. In this sense, therapeutic perspective is also an important factor to put into consideration since the transplant must meet the standard of practice. According to Ajay, Alexandra, Welch, Deepti and Elisa (2016), ethics from therapeutic perspective gives various conditions that must be met to foster successful liver transplant. Some of the argument points for consideration that have weak ethical principles include patient assessment, comorbidities, alcoholic liver diseases and sobriety period for the alcoholic patient (Stroh, Rosell, Dong Forster, 2015). Firstly, patient selection criteria give the required threshold that includes assessment of patients for their ability to undergoes surgery. The central point of argument under patient selection main entails the risk associated with alcoholic conditions and limited ability to survive. The ethical reasoning indicates that the before surgery risk-benefit analysis is conducted that will evaluate the patient based on the benefit of operation and the likelihood of survival and not on addiction conditions (Locke, Durand Reed, 2016). Secondly, comorbidity is another therapeutic argument standpoint that provides grounds for rejecting some patient based on their ability to develop other liver-related diseases. The comorbidity issue is tackle based on the multidisciplinary approach that takes center stage during a liver transplant. This implies that multidisciplinary approach ensures there is minimal risk associated with other liver infections. Moreover, an ethical requirement at the point of medication should be based on exploring all the available options used for treatment comorbidities during liver transplant (Watt, Lyden McCashland, 2003). Thirdly, sobriety period for the alcoholic patient is one important therapeutic perspective that has also been addressed by the presence of Alcohol Addiction Unit (AAU). From this argument, some therapist indicates that least 6 months and is widely adopted a criterion for the selection of patients with an alcoholic (Rice Lucey, 2013). In contrast, Alcohol Addiction Unit (AAU) provides the guidelines that help reduce any risk associated with such alcoholic condition and should not be used to select a patient. In addition, patients require fair treatment that applies the uttermost professionalism as possible especially during this life-threatening illness (Gundle, 2004). Another point of argument among many healthcare practitioners for selecting patient involves the shortage of organ for transplant. Based on this argument, organ shortage drives the need to evaluate the patient based on their lifestyle to tackle any future demand for the organ by the patient (Griffin, 2007). This means that alcoholic patient can end up in the same condition they have been in due to addiction. The argument, therefore, sees the approving alcoholic patient as a recipe for negligence. In contrast, organ shortage cannot be compared to the mortality of illness as may be established in liver transplant. In another word, disease mortality and morbidity is the central point of selection since a good medical practice aim at saving life and not discriminating one on the basis of the cause of illness (DiMartini, Dew Day, 2010). Ethical stance Despite the above therapeutic arguments, a clear position remains that there is need to observe many ethical standards that allow liver transplant especially due to the disease chronicity. Many studies have been conducted on the ethical standards required during the selection of patients and this is based on the above discussed ethical viewpoints (Campsen, Zimmerman Trotter, 2008). In addition, many strategies have been put in place to help in dealing with various risk factors to ensure that liver patients undergo transplant despite the complexity of the treatment. One such strategy is the Alcohol Addiction Unit (AAU) that gives advice on alcoholic patients and the complexity of liver transplant in these patients. Secondly, disease chronicity and other disease-related factors such as mortality, morbidity and fair healthcare provision are given priority when selecting liver transplant prospective patients (Ahmad, Bryce, Cacciarelli Roberts, 2007). Conclusion In conclusion, selection of prospective liver transplant patient has been a matter of debate. The central argument has been on the criteria of selection that majorly focus on social preference such as alcoholism versus congenital biliary patient. The ethical standard of argument indicates the acceptable standards that are based on disease chronicity, mortality, morbidity and limited discrimination. This viewpoint allows the assessment of disease severity and risk-benefit analysis to ascertain the likelihood of treatment against the past lifestyle. In addition, some of the therapeutic argument has been based on the complexity of the procedure, risk associated with the procedure and above all the likelihood of past social conditions coming into play at post-transplant. The best ethical practice gives all patients an equal chance based on the disease severity and morbidity of the disease. References Addolorato, G., Mirijello, A. Leggio, L. (2013). Liver transplantation in alcoholic patients: impact of an alcohol addiction unit within a liver transplant center. Alcohol Clinical Exp Res, 37:1601. Ahmad, J., Bryce, C.L., Cacciarelli T., Roberts, M.S. (2007). Differences in access to liver transplantation: disease severity, waiting time, and transplantation center volume. Ann Intern Med; 146:707. Ajay, S., Alexandra, N., Welch, J.L., Deepti S., Elisa J. G. (2016). Ethical Considerations of Transplantation and Living Donation for Patients with Alcoholic Liver Diseases. AMA Journal of Ethics, 18(2): 163-173. doi: 10.1001/journalofethics.2016.18.2.sect1-1602. Bobbert, M. Ganten, T.M. (2013). Liver allocation: the urgency of need or prospect of success? Ethical considerations. Clinical Transplant, 27 Suppl 25:34. Campsen, J., Zimmerman, M.A. Trotter, J.F. (2008). Clinically recurrent primary sclerosing cholangitis following liver transplantation: A time course. Liver Transplant, 14:181-185. Donckier, V., Lucidi, V., Gustot, T. Moreno, C. (2014). Ethical considerations regarding early liver transplantation in patients with severe alcoholic hepatitis not responding to medical therapy. Journal of Hepatology, 60(4):866-71. Available at doi: 10.1016/j.jhep.2013.11.015. Epub 2013 Nov 26. DiMartini, A., Dew, M.A., Day, N. (2010). Trajectories of alcohol consumption following liver transplantation. American Journal of Transplant, 10:2305. Griffin, J. (2007). Organ donation new strategies for finding organs. The Hastings Center. Garrsion, NY. Gundle, K. (2004). Presumed consent for organ donation perspectives of health policy specialists 2004. Available at surj.stanford.edu/2004/pdfs/gundle.pdf (Accessed on April 22, 2009). Locke, J.E., Durand, C., Reed, R.D. (2016). Long-term Outcomes After Liver Transplantation Among Human Immunodeficiency Virus-Infected Recipients. Transplantation, 100:141. Lucey, M.R. (2014). Liver transplantation for the alcoholic liver disease. Nat Rev Gastroenterol Hepatol, 11:300. Organ Procurement and Transplantation Network. (2015). OPTN/UNOS Ethics Committee: ethical principles to be considered in the allocation of human organs. June 2, 2015. https://optn.transplant.hrsa.gov/resources/ethics/ethical-principles-in-the-allocation-of-human-organs/. [Accessed December 30, 2015]. Rhodes, R., Aggarwal S., Schiano, T.D. (2011). Overdose with suicidal intent: ethical considerations for liver transplant programs. Liver Transplant, 17:1111. Rice, J.P. Lucey, M.R. (2013). Should the length of sobriety be a major determinant in liver transplant selection? Current Opinion on Organ Transplant, 18(3):259-264. Stroh, G., Rosell, T., Dong, F, Forster, J. (2015). Early liver transplantation for patients with acute alcoholic hepatitis: public views and the effects on organ donation. American Journal of Transplant, 15(6):1598. Telles-Correia, D. Mega I. (2015). Candidates for liver transplantation with alcoholic liver disease: psychosocial aspects. World Journal of Gastroenterol, 21(39):11027-11033. Triguero, J., Garca, A., Molina, A., Miguel, C., Notario, P., Villegas, T., Becerra, A., Expsito, M. Muffak, K.A. (2015). Complications Associated With Liver Transplantation in Recipients With Body Mass Index 35kg/m(2): Would It Be a Poor Prognosis Predictive Factor? Transplant Proc. Nov; 47(9):2650-2. Vanden, H.T.L., Morrison, L.J., Shuster, M. (2010). Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 122:S829. Watt, K.D., Burak, K., Deschenes, M., (2006). Recurrent hepatitis C post-transplantation: Where are we now and where do we go from here? A report from the Canadian transplant hepatology workshop. Can Journal of Gastroenterology, 20:725-734. Watt, K.D., Lyden, E.R. McCashland, T.M. (2003). Poor survival after liver retransplantation: Is hepatitis C to blame? Liver Transplant 9:1019-1024. Zarrinpar, A. (2012). Hong JC. What is the prognosis after retransplantation of the liver? Advanced Surgery, 46:87.
Subscribe to:
Posts (Atom)