Explain Paleys Argument for the Existence of God

4a. Explain Paleys argument for the existence of God (25) William Paleys argument for the existence of God is an important aspect of the Design argument, which argues that the universe is being directed towards an end purpose due to the a posteriori (subject to experience) evidence of an intelligent designer, who is God. This is because it is perhaps arguably the most famous version, and the theory which modern-day theories for the Design argument are built upon. The first version of the Design argument came from Plato, a Greek philosopher, who developed it to address the universes apparent order. Plato proposed in his book Timaeus that a â€Å"demiurge†, a divine being of supreme wisdom and intelligence, was the creator of the†¦show more content†¦B. The universe has no purpose. Discuss. (10) It has often been a long-running debate between scholars over whether or not the universe has no purpose. I personally believe it does not, for a variety of reasons. One reason is in regards to Paleys argument, which is that it depends on having one view of the world, whereas it realistically is more subjective. If you perceive the world as having order and happiness within this order then there is no issue. However, if you have been greatly effected by the evil and suffering in the world of are a pessimist, you would be more inclined to believe the world to be flawed, or as the 18th century philosopher David Hume put forward, the idea that it was the first flawed work of some infant deity. Also, as the 18th century philosopher Immanuel Kant put forward, it is possible that there is no order in the world at all, and that we humans have simply imposed order on our surroundings due to our minds categorizing it as such. Another reason I do not believe that the universe has a purpose i s due to the brutality of nature, rather than peaceful harmony. As put forward by Herbert Spencer, a 19th centuryShow MoreRelatedThe Design Arguments For The Existence Of God1401 Words   |  6 PagesThe design arguments for the existence of God center on the principle that an intelligent designer, in this case God, has crafted our world so that each item has a purpose and significant meaning. Additionally, the world is a complex and sometimes enigmatic system of elements which work together to sustain life in a way that some argue is unlikely to have occurred by pure chance alone. Therefore, some philosophers credit a divine being as the source of this order and purpose in the universe. FurthermoreRead MoreEssay on The Argument from Design, by William Paley1089 Words   |  5 Pageswrote the essay The Argument from Design. In The Argument from Design, Paley tries to prove the existence of a supreme being through the development of a special kind of argument known as the teleologi cal argument. The teleological argument is argument by analogy, an argument based on the similarities between two different subjects. This essay purposefully attempts to break down Paley’s argument and does so in the following manner: firstly, Paley’s basis for the teleological argument is introduced; secondlyRead MoreWilliam Paley And David Hume1260 Words   |  6 Pagesthe most prominent philosophical arguments that remains today is the debate on the existence of God or an Intelligent Designer. This debate dates back a time of many Gods and deities during the era of Socrates, Plato and their students, including Aristotle. This discussion will focus on the differing works of authors William Paley and David Hume and I will argue that there is an Intelligent Designer for our universe. William Paley believes in the existence of God and that through his watchmakerRead MoreEssay The Teleological Argument1368 Words   |  6 PagesWilliam Paley and David Hume’s argument over God’s existence is known as the teleological argument, or the argument from design. Arguments from design are arguments concerning God or some type of creator’s existence based on the ideas of order or purpose in universe. Hume takes on the approach of arguing against the argument of design, while Paley argues for it. Although Hume and Paley both provide very strong arguments, a conclusion will be drawn at the end to distinguish which philosophiser holdsRead MoreExamine the Key Features of the Teleological Argument?1491 Words   |  6 PagesExamine the key features of the Teleological argument. The word teleological comes from the Greek word ‘Telos’ which means purpose. The teleological argument is a posteriori and like the cosmological argument, attempts to prove the existence of God. It claims that certain phenomena within the universe appear to display features of design and are perfectly adapted to fulfil their function. Therefore, if features of the universe are so perfectly designed, for example the structure and function ofRead MoreWilliam Paley, An English Clergyman And Philosopher1026 Words   |  5 Pagesbelieve that there is no difference between how the stone and watch came to be on this planet. Using the comparison of the watch and the world, it is arguable that there is an omni-god that created nature and everything that resides in it. It, therefore, stands to reason, that since a watchmaker made the watch, an omni-god made the stone, we can conclude that both were created. For something to be considered to have been created there is a set of criteria it must follow: it must have a creator, itRead MoreEssay about The Existence of God1795 Words   |  8 PagesThe Existence of God No one can think the opposite of that which is self evident#8230;But the opposite of the proposition God Exists can be thought#8230;therefore the proposition that God existence is self evident.( Thomas Aquinas) Some people may say that God is an omnipotent, omniscient being that the universe revolves around. In other words, God is all-powerful, all knowing, and runs the universe, but the mere claim, to prove Gods existence, seems to invite ridicule.Read MoreGod Is Our Benevolent Creator1790 Words   |  8 PagesPaley’s Natural Theology argues that in order for something to exist, there has to be a creator. A well-known passage from his book includes someone noticing a watch on the ground and anyone would assume that the watch was made by someone else. He connects this to the creation of life and everything we know, to God’s creations. That God made humans and everything else in this world, maybe as explained in the Biblical text of Genesis. According to Paley, God is our benevolent creator, but what ifRead MoreAn Argument for Design1784 Words   |  8 Pagesto the existence of God. First I must explain what an argument for design is and then we will look at Paley ’s Watchmaker Theory to give us better insight on this argument. Then I will point to Betty and Cordell’s argument that the things of our universe lead us to a belief in God (intelligent designer) and that the Big Bang theory is not the best explanation alone for the existence of God, and that a multiverse is not the best explanation for the existences in our universe. Design arguments mostRead MoreThe Theory Of The Design Argument1201 Words   |  5 Pagesmakes of the design argument that are described in this chapter, Hume presents a third. He says that even if the design argument succeeds in showing that a designer made the universe (or the organisms in it), the argument does not succeed in establishing what characteristics that designer has. For this reason, the argument does not show that God exists. Is Hume’s claim correct? How seriously does this undermine the design argument? I think that Hume’s claim that the design argument does not succeed

The Diversity Of A Multicultural Organization - 1224 Words

The multicultural organization Historically, diversity in the workplace was seen as an employment equity issues. As the years passed by, it all changed. The surge of globalization has needed the collaboration among people of different backgrounds and cultures. Nowadays, organizations are now creating a diverse workforce beyond just gender, race, ethnicity, and nationality. Many U.S. organizations are embracing women, ethnic minorities, and foreign-born employees more than ever before in history. Diversity calls for organizations to recognize individuals for themselves, regardless their designated groups. This paper will be focusing in three different parts of diversity in the workforce: type of organizations, the benefits cost, and measurements taken by CEOs to promote diversity. In today’s society, due to the great diversity, organizations should be multicultural to allow all members of different cultural backgrounds to contribute and achieve their full potential. According to Cox (1991), there three different types of organizations including monolithic, plural, and multicultural organization. The monolithic organization is demographically and culturally homogeneous. According to Cox, the most important fact about this type of organization is that there is minimal structural integration. For example, most Chinese companies are monolithic from a cultural and ethnic perspective. The majority of their workers are ethnically Han Chinese. However, from a gender perspectiveShow MoreRelatedPotential Problems When Using Multicultural Diverse Team in Global Organization994 Words   |  4 Pagesmust be overcome when using the multicultural diverse team in global organization? As for 2006 and above, there are many problems regarding multicultural diverse team in global organization. Ironically, Presidents and CEO of the organization are willing to talk about diversity when their managers do not have much confidence in implementing diversity workforce in an organization. Managers are afraid that they may fail in terms of productivity when multicultural diverse team is applied. TheRead MorePotential Problems When Using Multicultural Diverse Team in Global Organization984 Words   |  4 Pagesthat must be overcome when using the multicultural diverse team in global organization? As for 2006 and above, there are many problems regarding multicultural diverse team in global organization. Ironically, Presidents and CEO of the organization are willing to talk about diversity when their managers do not have much confidence in implementing diversity workforce in an organization. Managers are afraid that they may fail in terms of productivity when multicultural diverse team is applied. The problemsRead MoreThe Multicultural Workforce Essay1653 Words   |  7 PagesThe Multicultural Workforce: Inside Worldwide Telecommunications Inc. Introduction Telecommunication is a vital element within a growing company. But it is the diversity of a multicultural workforce that is the actual drive of the business. Telecommunication is the fastest way businesses are conducted all over the world. Employees would be lost without the aide of their computers, fax machines, and cellular phones. These machines not only make the work load process smoother and fasterRead MoreL Oreal Company Background1041 Words   |  5 PagesGroup Worldwide( source: â€Å"Beauty’s Top 100† WWD, August 2014. (2) Like-for-like.). The organization is composed of 78,600 employees with an International portfolio of 32 complementary brands. The Breakdown of 2014 Sales was registered as 2.6% Africa, Middle East 7.3% Eastern Europe 8.6% Latin America 21.1% Asia, Pacific 24.9% North America 35.5% Western Europe, and New Markets Total 39.6% Multicultural Company Professionals with different backgrounds and cultures work in new-product developmentRead Moreworkplace diversity paper1115 Words   |  5 Pagesï » ¿ Benefits of Workplace Diversity In the 21st century, workplace diversity has enhanced organization performances and communication skills which benefited the organizations to become successful businesses. Increasing adaptability in the workplace, having to value diversity, and executing more effectively are three benefits of workplace diversity. Organizations most definitely have the ability to embrace their workplace diversity by helping their employees realize the benefits that enhances the businessRead MoreCulture Diversity And Diversity1639 Words   |  7 PagesIn today’s society the words culture, diversity and multicultural environments are used to support the idea of an inclusive organization. Adhering to federal and state mandates, in addition to maintaining a politically correct appearance with regards to culturally diverse organizations is the new normal. The purpose of this paper is to examine the definitions of culture, diversity and multiculturalism as well as provide some insight into the curre nt standings around these topics as a nation and withinRead MoreOur Culture is Defined by those Around Us745 Words   |  3 Pagesfeelings. For most of organizations nowadays have to face with an increasing of a diversity of employees which are multicultural employees especially for multinational corporation (MNC) (Fitzsimmons 2013). To deal with different cultures and nationalities, the companies and managers have to learn and understand their employees such as common language, knowledge sharing and performance (Lauring Selmer 2011) then see how multicultural individuals can help and contribute the organizations (Fitzsimmons, MiskaRead MoreEssay about Improving Education through Cultural Diversity1087 Words   |  5 Pagestoday’s society, cultural diversity is important as it was many centuries ago. According to dictionary, cultural diversity is the coexistence of different culture, ethnic, race, gender in one specific unit. In order, for America to be successful, our wo rld must be a multicultural world. This existence starts within our learning facilities where our students and children are educated. This thesis is â€Å"changing the way America, sees education through cultural diversity, has been co existing in manyRead MoreImportant Element For Employee s Career Growth913 Words   |  4 PagesSummary: Some multicultural characteristics that can cause individuals to sell themselves short and lack of confidence. Women are actually more likely to express their lack of confidence. The feeling of â€Å"I don’t belong here† is a mental barrier that is part of the multicultural characteristics that hold people back. Their competence and performance were never an issue. All employees want to be included in communicating inclusiveness, multicultural employees tend to feel as though they are not includedRead MoreThe Value of Multiculturalism and Diversity in Business Essay1111 Words   |  5 PagesThe Value of Diversity and Multiculturalism in Business Diversity and Multiculturalism are two topics that, themselves, are not new. To start off with a uniform basic understanding, what are diversity and multiculturalism? According to Merrium-Webster, Diversity is ‘the condition of having or being composed of differing elements, especially the inclusion of different types of people (as people of different races or cultures) in a group or organization’. Whereas, Merrium-Webster defined multiculturalism

The Vampire Diaries Dark Reunion Chapter Nine Free Essays

string(81) " talk about that now\?† â€Å"Because maybe you can answer this question\." â€Å"†¦ And so, ladies and gentlemen, I give you the class of ’92!† Bonnie threw her cap into the air along with everyone else. We made it, she thought. Whatever happens tonight, Matt and Meredith and I made it to graduation. We will write a custom essay sample on The Vampire Diaries: Dark Reunion Chapter Nine or any similar topic only for you Order Now There had been times this last school year when she had seriously doubted they would. Considering Sue’s death, Bonnie had expected the graduation ceremony to be listless or grim. Instead, there was a sort of frenzied excitement about it. As if everyone was celebrating being alive-before it was too late. It turned into rowdiness as parents surged forward and the senior class of Robert E. Lee fragmented in all directions, whooping and acting up. Bonnie retrieved her cap and then looked up into her mother’s camera lens. Act normal, that’s what’s important, she told herself. She caught a glimpse of Elena’s aunt Judith and Robert Maxwell, the man Aunt Judith had recently married, standing on the sidelines. Robert was holding Elena’s little sister, Margaret, by the hand. When they saw her, they smiled bravely, but she felt uncomfortable when they came her way. â€Å"Oh, Miss Gilbert-I mean, Mrs. Maxwell-you shouldn’t have,† she said as Aunt Judith handed her a small bouquet of pink roses. Aunt Judith smiled through the tears in her eyes. â€Å"This would have been a very special day for Elena,† she said. â€Å"I want it to be special for you and Meredith, too.† â€Å"Oh, Aunt Judith.† Impulsively, Bonnie threw her arms around the older woman. â€Å"I’m so sorry,† she whispered. â€Å"You know how much.† â€Å"We all miss her,† Aunt Judith said. Then she pulled back and smiled again and the three of them left. Bonnie turned from looking at them with a lump in her throat to look at the madly celebrating crowd. There was Ray Hernandez, the boy she’d gone to Homecoming with, inviting everybody to a party at his house that night. There was Tyler’s friend Dick Carter, making a fool of himself as usual. Tyler was smiling brazenly as his father took picture after picture. Matt was listening, with an unimpressed look, to some football recruiter from James Mason University. Meredith was standing nearby, holding a bouquet of red roses and looking pensive. Vickie wasn’t there. Her parents had kept her home, saying she was in no state to go out. Caroline wasn’t there either. She was staying in the apartment in Heron. Her mother had told Bonnie’s mother she had the flu, but Bonnie knew the truth. Caroline was scared. And maybe she’s right, Bonnie thought, moving toward Meredith. Caroline may be the only one of us to make it through next week. Look normal, act normal. She reached Meredith’s group. Meredith was wrapping the red-and-black tassel from her cap around the bouquet, twisting it between elegant, nervous fingers. â€Å"Be careful with that; you’ll ruin it,† she said aloud. Meredith’s look of thoughtful melancholy didn’t change. She went on staring at the tassel, kinking it up. â€Å"It doesn’t seem fair,† she said, â€Å"that we should get these and Elena shouldn’t. It’s wrong.† â€Å"I know; it’s awful,† Bonnie said. But she kept her tone light. â€Å"I wish there was something we could do about it, but we can’t.† â€Å"It’s all wrong,† Meredith went on, as if she hadn’t heard. â€Å"Here we are out in the sunlight, graduating, and there she is under that-stone.† â€Å"I know, I know,† Bonnie said in a soothing tone. â€Å"Meredith, you’re getting yourself all upset. Why don’t you try to think about something else? Look, after you go out to dinner with your parents, do you want to go to Raymond’s party? Even if we’re not invited, we can crash it.† â€Å"No!† Meredith said with startling vehemence. â€Å"I don’t want to go to any party. How can you even think of that, Bonnie? How can you be so shallow?† â€Å"Well, we’ve got to do something †¦Ã¢â‚¬  â€Å"I’ll tell you what I’m doing. I’m going up to the cemetery after dinner. I’m going to put this on Elena’s grave. She’s the one who deserves it.† Meredith’s knuckles were white as she shook the tassel in her hand. â€Å"Meredith, don’t be an idiot. You can’t go up there, especially at night. That’s crazy. Matt would say the same thing.† â€Å"Well, I’m not asking Matt. I’m not asking anybody. I’m going by myself.† â€Å"You can’t. God, Meredith, I always thought you had some brains-â€Å" â€Å"And I always thought you had some sensitivity. But obviously you don’t even want to think about Elena. Or is it just because you want her old boyfriend for yourself?† Bonnie slapped her. It was a good hard slap, with plenty of energy behind it. Meredith drew in a sharp breath, one hand to her reddening cheek. Everyone around them was staring. â€Å"That’s it for you, Bonnie McCullough,† Meredith said after a moment, in a voice of deadly quiet. â€Å"I don’t ever want to speak to you again.† She turned on her heel and walked away: â€Å"Never would be too soon for me!† Bonnie shouted at her retreating back. Eyes were hastily averted as Bonnie looked around her. But there was no question that she and Meredith had been the center of attention for several minutes past. Bonnie bit the inside of her cheek to keep a straight face and walked over to Matt, who had lost the recruiter. â€Å"Good.† â€Å"Do you think the slap was too much? We didn’t really plan that; I was just sort of going with the moment. Maybe it was too obvious†¦Ã¢â‚¬  â€Å"It was fine, just fine.† Matt was looking preoccupied. Not that dull, apathetic, turned-in look of the last few months, but distinctly abstracted. â€Å"What is it? Something wrong with the plan?† Bonnie said. â€Å"No, no. Listen, Bonnie, I’ve been thinking. You were the one to discover Mr. Tanner’s body in the Haunted House last Halloween, right?† Bonnie was startled. She gave an involuntary shiver of distaste. â€Å"Well, I was the first one to know he was dead, really dead, instead of just playing his scene. Why on earth do you want to talk about that now?† â€Å"Because maybe you can answer this question. Could Mr. Tanner have got a knife in Damon?† â€Å"What?† â€Å"Well, could he?† â€Å"I†¦Ã¢â‚¬  Bonnie blinked and frowned. Then she shrugged. â€Å"I suppose so. Sure. It was a Druid sacrifice scene, remember, and the knife we used was a real knife. We talked about using a fake one, but since Mr. Tanner was going to be lying right there beside it, we figured it was safe enough. As a matter of fact†¦Ã¢â‚¬  Bonnie’s frown deepened. â€Å"I think when I found the body, the knife was in a different place from where we’d set it in the beginning. But then, some kid could have moved it. Matt, why are you asking?† â€Å"Just something Damon said to me,† Matt said, staring off into the distance again. â€Å"I wondered if it could be the truth.† â€Å"Oh.† Bonnie waited for him to say more, but he didn’t. â€Å"Well,† she said finally, â€Å"if it’s all cleared up, can you come back to Earth, please? And don’t you think you should maybe put your arm around me? Just to show you’re on my side and there’s no chance you’re going to show up at Elena’s grave tonight with Meredith?† Matt snorted, but the faraway look disappeared from his eyes. For just a brief instant he put his arm around her and squeezed. D..j. vu, Meredith thought as she stood at the gate to the cemetery. The problem was, she couldn’t remember exactly which of her previous experiences in the graveyard this night reminded her of. There had been so many. In a way, it had all started here. It had been here that Elena had sworn not to rest until Stefan belonged to her. She’d made Bonnie and Meredith swear to help her, too -in blood. How suitable, Meredith thought now. And it had been here that Tyler had assaulted Elena the night of the Homecoming dance. Stefan had come to the rescue, and that had been the beginning for them. This graveyard had seen a lot. This graveyard had been the beginning, and the end as well. And maybe there would be another end tonight. Meredith started walking. I wish you were here now, Alaric, she thought. I could use your optimism and your savvy about the supernatural-and I wouldn’t mind your muscles, either. Elena’s headstone was in the new cemetery, of course, where the grass was still tended and the graves marked with wreaths of flowers. The stone was very simple, almost plain looking, with a brief inscription. Meredith bent down and placed her bouquet of roses in front of it. Then, slowly, she added the red-and-black tassel from her cap. In this dim light, both colors looked the same, like dried blood. She knelt and folded her hands quietly. And she waited. All around her the cemetery was still. It seemed to be waiting with her, breath held in anticipation. The rows of white stones stretched on either side of her, shining faintly. Meredith listened for any sound. And then she heard one. Heavy footsteps. With her head down, she stayed quiet, pretending she noticed nothing. The footsteps sounded closer, not even bothering to be stealthy. â€Å"Hi, Meredith.† Meredith looked around quickly. â€Å"Oh-Tyler,† she said. â€Å"You scared me. I thought you were-never mind.† â€Å"Yeah?† Tyler’s lips skinned back in an unsettling grin. â€Å"Well, I’m sorry you’re disappointed. But it’s me, just me and nobody else.† â€Å"What are you doing here, Tyler? No good parties?† â€Å"I could ask you the same question.† Tyler’s eyes dropped to the headstone and the tassel and his face darkened. â€Å"But I guess I already know the answer. You’re here for her. Elena Gilbert, A Light in Darkness,† he read sarcastically. â€Å"That’s right,† Meredith said evenly. † ‘Elena’ means light, you know. And she was certainly surrounded by darkness. It almost beat her, but she won in the end.† â€Å"Maybe,† Tyler said, and worked his jaw meditatively, squinting. â€Å"But you know, Meredith, it’s a funny thing about darkness. There’s always more of it waiting in the wings.† â€Å"Like tonight,† Meredith said, looking up at the sky. It was clear and dotted with faint stars. â€Å"It’s very dark tonight, Tyler. But sooner or later the sun will come up.† Just like he showed Elena, Meredith thought. In a way she was enjoying this verbal fencing, but she never lost sight of what she had come here for. Her cold fingers dipped into her jacket pocket and found the tiny sprig of vervain there. â€Å"That’s all right, Tyler. I think I’d prefer to stay here.† â€Å"You sure about that? A cemetery’s a dangerous place to be alone.† Unquiet spirits, Meredith thought. She looked right at him. â€Å"I know.† He was grinning again, displaying teeth like tombstones. â€Å"Anyway, you can see it from here if you have good eyes. Look that way, toward the old graveyard. Now, do you see something sort of shining red in the middle?† â€Å"No.† There was a pale luminosity over the trees in the east. Meredith kept her eyes on it. â€Å"Aw, come on, Meredith. You’re not trying. Once the moon’s up you’ll see it better.† â€Å"Tyler, I can’t waste any more time here. I’m going.† â€Å"No, you’re not,† he said. And then, as her fingers tightened on the vervain, encompassing it in her fist, he added in a wheedling voice, â€Å"I mean, you’re not going until I tell you the story of that headstone, are you? It’s a great story. See, the headstone is made of red marble, the only one of its kind in the whole graveyard. And that ball on top-see it?-that must weigh about a ton. But it moves. It turns whenever a Smallwood is going to die. My grandfather didn’t believe that; he put a scratch on it right down the front. He used to come out and check it every month or so. Then one day he came and found the scratch in the rear. The ball had turned completely backward. He did everything he could to turn it around, but he couldn’t. It was too heavy. And that night, in bed, he died. They buried him under it.† â€Å"He probably had a heart attack from overexertion,† Meredith said caustically, but her palms were tingling. â€Å"You’re funny, aren’t you? Always so cool. Always so together. Takes a lot to make you scream, doesn’t it?† â€Å"I’m leaving, Tyler. I’ve had enough.† He let her walk a few paces, then said, â€Å"You screamed that night at Caroline’s, though, didn’t you?† Meredith turned back. â€Å"How do you know that?† Tyler rolled his eyes. â€Å"Give me credit for a little intelligence, okay? I know a lot, Meredith. For instance, I know what’s in your pocket.† Meredith’s fingers stilled. â€Å"What do you mean?† Meredith backed away a step. â€Å"You think that’s going to help you, don’t you? But I’m going to tell you a secret.† Meredith’s eyes measured the distance between herself and the path. She kept her face calm, but a violent shaking was beginning inside her. She didn’t know if she was going to be able to pull this off. â€Å"You’re not going anywhere, babe,† Tyler said, and a large hand clasped Meredith’s wrist. It was hot and damp where she could feel it below her jacket cuff. â€Å"You’re going to stay right here for your surprise.† His body was hunched now, his head thrust forward, and there was an exultant leer on his lips. â€Å"Let me go, Tyler. You’re hurting me!† Panic flashed down all Meredith’s nerves at the feel of Tyler’s flesh against hers. But the hand only gripped harder, grinding tendon against bone in her wrist. â€Å"This is a secret, baby, that nobody else knows,† Tyler said, pulling her close, his breath hot in her face. â€Å"You came here all decked out against vampires. But I’m not a vampire.† Meredith’s heart was pounding. â€Å"Let go!† â€Å"First I want you to look over there. You can see the headstone now,† he said, turning her so that she couldn’t help but look. And he was right; she could see it, like a red monument with a shining globe on top. Or-not a globe. That marble ball looked like†¦ it looked like†¦ â€Å"Now look east. What do you see there, Meredith?† Tyler went on, his voice hoarse with excitement. It was the full moon. It had risen while he’d been talking to her, and now it hung above the hills, perfectly round and enormously distended, a huge and swollen red ball. And that was what the headstone looked like. Like a full moon dripping with blood. â€Å"You came here protected against vampires, Meredith,† Tyler said from behind her, even more hoarsely. â€Å"But the Smallwoods aren’t vampires at all. We’re something else.† And then he growled. No human throat could have made the sound. It wasn’t an imitation of an animal; it was real. A vicious guttural snarl that went up and up, snapping Meredith’s head around to look at him, to stare in disbelief. What she was seeing was so horrible her mind couldn’t accept it†¦ â€Å"I told you it was a surprise. How do you like it?† Tyler said. His voice was thick with saliva, and his red tongue lolled among the rows of long canine teeth. His face wasn’t a face anymore. It jutted out grotesquely into a muzzle, and his eyes were yellow, with slitlike pupils. His reddish-sandy hair had grown over his cheeks and down the back of his neck. A pelt. â€Å"You can scream all you want up here and nobody’s going to hear you,† he added. Every muscle in Meredith’s body was rigid, trying to get away from him. It was a visceral reaction, one she couldn’t have helped if she wanted to. His breath was so hot, and it smelled feral, like an animal. The nails he was digging into her wrist were stumpy blackened claws. She didn’t have the strength to scream again. â€Å"There’s other things besides vampires with a taste for blood,† Tyler said in his new slurping voice. â€Å"And I want to taste yours. But first we’re going to have some fun.† Although he still stood on two feet, his body was humped and strangely distorted. Meredith’s struggles were feeble as he forced her to the ground. She was a strong girl, but he was far stronger, his muscles bunching under his shirt as he pinned her. â€Å"You’ve always been too good for me, haven’t you? Well, now you’re going to find out what you’ve been missing.† I can’t breathe, Meredith thought wildly. His arm was across her throat, blocking her air. Gray waves rolled through her brain. If she passed out now†¦ â€Å"You’re going to wish you died as fast as Sue.† Tyler’s face floated above her, red as the moon, with that long tongue lolling. His other hand held her arms above her head. â€Å"You ever hear the story of Little Red Riding Hood?† The gray was turning into blackness, speckled with little lights. Like stars, Meredith thought. I’m falling in the stars†¦ â€Å"Tyler, take your hands off her! Let go of her, now!† Matt’s voice shouted. Tyler’s slavering snarl broke off into a surprised whine. The arm against Meredith’s throat released pressure, and air rushed into her lungs. Footsteps were pounding around her. â€Å"I’ve been waiting a long time to do this, Tyler,† Matt said, jerking the sandy-red head back by the hair. Then Matt’s fist smashed into Tyler’s newly grown muzzle. Blood spurted from the wet animal nose. The sound Tyler made froze Meredith’s heart in her chest. He sprang at Matt, twisting in midair, claws outstretched. Matt fell back under the assault and Meredith, dizzy, tried to push herself up off the ground. She couldn’t; all her muscles were trembling uncontrollably. But someone else picked Tyler off Matt as if Tyler weighed no more than a doll. â€Å"Just like old times, Tyler,† Stefan said, setting Tyler on his feet and facing him. Tyler stared a minute, then tried to run. He was fast, dodging with animal agility between the rows of graves. But Stefan was faster and cut him off. Stefan was dragging Tyler back. â€Å"I always knew you were a jerk,† he said, shoving Tyler against a headstone, â€Å"but I didn’t know you were this stupid. I’d have thought you would have learned not to jump girls in graveyards, but no. And you had to brag about what you did to Sue, too. That wasn’t smart, Tyler.† Meredith looked at them as they faced each other. So different, she thought. Even though they were both creatures of darkness in some way. Stefan was pale, his green eyes blazing with anger and menace, but there was a dignity, almost a purity about him. He was like some stern angel carved in unyielding marble. Tyler just looked like a trapped animal. He was crouched, breathing hard, blood and saliva mingling on his chest. Those yellow eyes glittered with hate and fear, and his fingers worked as if he’d like to claw something. A low sound came out of his throat. â€Å"Don’t worry, I’m not going to beat you up this time,† Stefan said. â€Å"Not unless you try to get away. We’re all going up to the church to have a little chat. You like to tell stories, Tyler; well, you’re going to tell me one now.† Tyler sprang at him, vaulting straight from the ground for Stefan’s throat. But Stefan was ready for him. Meredith suspected that both Stefan and Matt enjoyed the next few minutes, working off their accumulated aggressions, but she didn’t, so she looked away. In the end, Tyler was trussed up with nylon cord. He could walk, or shuffle at least, and Stefan held the back of his shirt and guided him urgently up the path to the church. Inside, Stefan pushed Tyler onto the ground near the open tomb. â€Å"Now,† he said, â€Å"we are going to talk. And you’re going to cooperate, Tyler, or you’re going to be very, very sorry.† How to cite The Vampire Diaries: Dark Reunion Chapter Nine, Essay examples

Psychology Piaget and Skinner Sample Essay Example For Students

Psychology: Piaget and Skinner Sample Essay The cognitive position is a theory that attempts to explicate human behavior by understanding our thought procedure. Our information procedure is compared to that of a computing machine: Inputting. storing and having informations. One of the most celebrated cognitive psychologists was a scientist called Jean Piaget ( 1896-1980 ) . Harmonizing to Piaget. understanding comes in the signifier of ‘schemas’ ( Fritscher. 2011 ) . Schemas are cognitive constructions that represent certain facets of the universe ( pre-conceived thoughts for things ) . Schemas develop through at least two procedures: assimilation and adjustment. Assimilation is merely adding new information into an bing scheme but maintaining the general thought the same. Adjustment is the procedure in which we change our bing scheme. The individual will seek to suit the old scheme round the new information but in the terminal they merely suit a new scheme ( Atherton. 2011 ) . Through detecting and listening to h is ain kids. Piaget proposed that their thought does non develop swimmingly ; alternatively they go through phases. â€Å"Each phase is characterized by an overall construction in footings of which the chief behavior forms can be explained† ( Gross. page 739 ) . Stage one is called ‘The sensorimotor stage’ ( 0 – 2 old ages old ) . At this age. kids use centripetal and motor information to do scheme. They becomes self cognizant and they see object permanency ( McLeod. 2010 ) . Phase two is called ‘The pre-operational stage’ ( 2 – 7 old ages old ) . The kid is now get downing to speak and can interact with others utilizing address and other signifiers of communicating. They start organizing their ain point of views from what they know but they are egoistic and don’t adapt good to others point of views. Piaget’s most celebrated experiment ‘the three mountains task’ ( 1940’s ) demonstrated such egoism. The experiment consisted of a kid sitting at a tabular array in forepart of three different mountains. One had snow on to p. one had a hut at the top and the other had a ruddy cross on the top. The kid was allowed to travel around the theoretical accounts and take a side to sit. Piaget would so put a doll at assorted topographic points around the tabular array. The kid is so shown 10 exposure of different point of views and has to indicate out the exposure that indicated the dolls point of position. Egoism is proven when the kid picks out the exposure that shows their point of position. non the dolls. The consequence was that a four twelvemonth old would ever take the incorrect exposure whereas a seven twelvemonth old was able to believe more logically and be able to take the right point of view. Piaget came to the decision that this was because Children in the preoperational phase are able to concentrate on merely one facet or dimension of a job. If a kid is playing with four ruddy and four blue edifice blocks and you ask them to split them every bit. they will automatically group all the ruddy 1s together and all the bluish 1s together. Stage three is called ‘The concrete operational stage’ ( 7 – 11 old ages old ) . At this phase the kid is now get downing to believe logically about objects and events. Intuition is replaced by confident thoughts but the kid can merely work with ‘concrete’ thoughts instead than conjectural 1s. Piaget believed th is was a major turning point in a child’s acquisition development. Stage four is called ‘The formal operational stage’ ( 11+ old ages old ) . This is the concluding cognitive phase. When a kid hits this age. they can get down utilizing abstract thoughts and are confident plenty to inquire inquiries and research the unknown. Compare and Contrast Essay About Two FriendsOn the other manus Skinner besides showed how negative support worked by puting a rat in his ‘Skinner box’ and so subjecting it to an unpleasant electric current. As the rat moved about the box it would by chance strike hard the lever. Equally shortly as it did so. the electric current would be switched away. The rats rapidly learned to travel directly to the lever after a few times of being put in the box. The effect of get awaying the electric current ensured that they would reiterate the action once more and once more. Looking at all the information on both classical and operate conditioning. it is clear to see that our environment has a major influence on human behavior. Operant conditioning is still widely used and is frequently applied in schoolrooms and the workplace ( Tuckman. 2003-2009 ) . It can look in many signifiers: * Consumable ( e. g. Henry sweets )* Social ( e. g. Praise )* Activity ( e. g. Time utilizing computing machines. excess clip for interruption ) * Exchangeable ( e. g. Spines for good behavior. virtues for good work ) Psychologists who pattern the operant conditioning theory believe that larning merely occurs through support. This is one of the biggest unfavorable judgment from experts as they believe that it is wrong. Another unfavorable judgment is that operant conditioning is inhumane as it takes off a person’s free will. Carl Rogers ( 1902-1987 ) . a psychologist who patterns the humanistic position. believed in unconditioned positive respect ( psychandsensibility. wordpress. com ) . Rogers debated that Skinner’s universe is one without freedom or significance. Another ruin in Skinners theory is that kids with autism may necessitate an intense behavioral programme that includes a lower limit of 20 hours a hebdomad for one person. This would non be possible in most p ublic schools ( Forti. Sollner 1999 ) There is no uncertainty that operate conditioning is a great pillar of learning kids incorrect from right. but portion of being human is larning from your errors. Mentions: * Alberto. P. A. . A ; Troutman. A. C. ( 2006 ) . Applied behaviour analysis for instructors ( 7th edition ) . Pearson. page 12 * Atherton. J S. ( 2011 ) . Learning and Teaching ; Piaget’s developmental theory hypertext transfer protocol: //www. learningandteaching. info/learning/piaget. htm * Castella. Claire. ( 2011 ) . Jean Piaget’s Theory on Child Language Development ] hypertext transfer protocol: //www. ehow. com/about_6587239_jean-theory-child-language-development. hypertext markup language

Postpartum Hemorrhage free essay sample

For these reasons, various authors have suggested that PPH should be diagnosed with any amount of blood loss that threatens the hemodynamic stability of the woman. The diagnosis of PPH is usually reserved for pregnancies that have progressed beyond 20 weeks’ gestation. Deliveries at less than 20 weeks’ gestational age are spontaneous abortions. Bleeding related to spontaneous abortion may have etiologies and management in common with those for PPH. Epidemiology - Frequency United States and industrialized countries The frequency of PPH is related to the management of the third stage of labor. This is the period from the completed delivery of the baby until the completed delivery of the placenta. Data from several sources, including several large randomized trials performed in industrialized countries, indicate that the prevalence rate of PPH of more than 500 mL is approximately 5% when active management is used versus 13% when expectant management is used. We will write a custom essay sample on Postpartum Hemorrhage or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page The prevalence rate of PPH of more than 1000 mL is approximately 1% when active management is used versus 3% when expectant management is used. [7, 8]  See eMedicine article  Management of the Third Stage of Labor. Developing countries The increased frequency of PPH in the developing world is more likely reflected by the rates given above for expectant management because of the lack of widespread availability of medications used in the active management of the third stage. [2]  A number of factors also contribute to much less favorable outcomes of PPH in developing countries. The first is a lack of experienced caregivers who might be able to successfully manage PPH if it occurred. Additionally, the same drugs used for prophylaxis against PPH in active management of the third stage are also the primary agents in the treatment of PPH. Lack of blood transfusion services, anesthetic services, and operating capabilities also plays a role. Finally, the previously mentioned comorbidities are more commonly observed in developing countries and combine to decrease a womans tolerance of blood loss. Etiology PPH has many potential causes, but the most common, by a wide margin, is uterine atony, ie, failure of the uterus to contract and retract following delivery of the baby. PPH in a previous pregnancy is a major risk factor and every effort should be made to determine its severity and cause. In a recent andomized trial in the United States, birthweight, labor induction and augmentation, chorioamnionitis, magnesium sulfate use, and previous PPH were all positively associated with increased risk of PPH. [9] A recently published, large population based study supported these findings with significant risk factors, identified using a multivariable analysis, being: retained placenta (OR 3. 5, 95% CI 2. 1-5. 8), failure to progre ss during the second stage of labor (OR 3. 4, 95% CI 2. 4-4. 7), placenta accreta (OR 3. 3, 95% CI 1. 7-6. 4), lacerations (OR 2. 4, 95% CI 2. 0-2. 8), instrumental delivery (OR 2. 3, 95% CI 1. 6-3. ), large for gestational age (LGA) newborn (OR 1. 9, 95% CI 1. 6-2. 4), hypertensive disorders (OR 1. 7, 95%CI 1. 2-2. 1), induction of labor (OR 1. 4, 95%CI 1. 1-1. 7) and augmentation of labor with oxytocin (OR 1. 4, 95% CI 1. 2-1. 7). [10] PPH is also associated with obesity. In a study by Blomberg, the risk of atonic uterine hemorrhage rapidly increased with increasing BMI; in women with a BMI over 40, the risk was 5. 2% with normal delivery and 13. 6% with instrumental delivery. [11] As a way of remembering the causes of PPH, several sources have suggested using the â€Å"4  T’  s† as a mnemonic: tone, tissue, trauma, and thrombosis. 12] - Tone Uterine atony and failure of contraction and retraction of myometrial muscle fibers can lead to rapid and severe hemorrhag e and hypovolemic shock. Overdistension of the uterus, either absolute or relative, is a major risk factor for atony. Overdistension of the uterus can be caused by multifetal gestation, fetal macrosomia, polyhydramnios, or fetal abnormality (eg, severe hydrocephalus); a uterine structural abnormality; or a failure to deliver the placenta or distension with blood before or after placental delivery. Poor myometrial contraction can result from fatigue due to prolonged labor or rapid forceful labor, especially if stimulated. It can also result from the inhibition of contractions by drugs such as halogenated anesthetic agents, nitrates, nonsteroidal anti-inflammatory drugs, magnesium sulfate, beta-sympathomimetics, and nifedipine. Other causes include placental implantation site in the lower uterine segment, bacterial toxins (eg, chorioamnionitis, endomyometritis, septicemia), hypoxia due to hypoperfusion or Couvelaire uterus in abruptio placentae, and hypothermia ue to massive resuscitation or prolonged uterine exteriorization. Recent data suggest that grand multiparity is not an independent risk factor for PPH. - Tissue Uterine contraction and retraction leads to detachment and expulsion of the placenta. Complete detachment and expulsion of the placenta permits continued retraction and optimal occlusion of blood vessels. Retention of a portion of the placenta is more common if th e placenta has developed with a succenturiate or accessory lobe. Following delivery of the placenta and when minimal bleeding is present, the placenta should be inspected for evidence of fetal vessels coursing to the placental edge and abruptly ending at a tear in the membranes. Such a finding suggests a retained succenturiate lobe. The placenta is more likely to be retained at extreme preterm gestations (especially lt; 24 wk), and significant bleeding can occur. This should be a consideration in all deliveries at very early gestations, whether they are spontaneous or induced. Recent trials suggest that the use of misoprostol for second trimester termination of pregnancy leads to a marked reduction in the rate of retained placenta when compared to techniques using the intrauterine instillation of prostaglandin or hypertonic saline. [13]  One such trial reported rates of retained placenta requiring Damp;C of 3. 4% with oral misoprostol compared to 22. 4% using intra-amniotic prostaglandin (p=0. 002). [14] Failure of complete separation of the placenta occurs in placenta accreta and its variants. In this condition, the placenta has invaded beyond the normal cleavage plane and is abnormally adherent. Significant bleeding from the area where normal attachment (and now detachment) has occurred may mark partial accreta. Complete accreta in which the entire surface of the placenta is abnormally attached, or more severe invasion (placenta increta or percreta), may not initially cause severe bleeding, but it may develop as more aggressive efforts are made to remove the placenta. This condition should be considered possible whenever the placenta is implanted over a previous uterine scar, especially if associated with placenta previa. All patients with placenta previa should be informed of the risk of severe PPH, including the possible need for transfusion and hysterectomy. Finally, retained blood may cause uterine distension and prevent effective contraction. - Trauma Damage to the genital tract may occur spontaneously or through manipulations used to deliver the baby. Cesarean delivery results in twice the average blood loss of vaginal delivery. Incisions in the poorly contractile lower segment heal well but are more reliant on suturing, vasospasm, and clotting for hemostasis. Uterine rupture is most common in patients with previous cesarean delivery scars. Routine transvaginal palpation of such scars is no longer recommended. Any uterus that has undergone a procedure resulting in a total or thick partial disruption of the uterine wall should be considered at risk for rupture in a future pregnancy. This admonition includes fibroidectomy; uteroplasty for congenital abnormality; cornual or cervical ectopic resection; and perforation of the uterus during dilatation, curettage, biopsy, hysteroscopy, laparoscopy, or intrauterine contraceptive device placement. Trauma may occur following very prolonged or vigorous labor, especially if the patient has relative or absolute cephalopelvic disproportion and the uterus has been stimulated with oxytocin or prostaglandins. Using intrauterine pressure monitoring may lessen this risk. Trauma also may occur following extrauterine or intrauterine manipulation of the fetus. The highest risk is probably associated with internal version and extraction of a second twin; however, uterine rupture may also occur secondary to external version. Finally, trauma may result secondary to attempts to remove a retained placenta manually or with instrumentation. The uterus should always be controlled with a hand on the abdomen during any such procedure. An intraumbilical vein saline/oxytocin or saline/misoprostol injection may reduce the need for more invasive removal techniques. [7] Cervical laceration is most commonly associated with forceps delivery, and the cervix should be inspected following all such deliveries. Assisted vaginal delivery (forceps or vacuum) should never be attempted without the cervix being fully dilated. Cervical laceration may occur spontaneously. In these cases, mothers have often been unable to resist bearing down before full cervical dilatation. Rarely, manual exploration or instrumentation of the uterus may result in cervical damage. Very rarely, the cervix is purposefully incised at the 2- and/or 10-o’clock positions to facilitate delivery of an entrapped fetal head during a breech delivery (Duhrssen incision). Vaginal sidewall laceration is also most commonly associated with operative vaginal delivery, but it may occur spontaneously, especially if a fetal hand presents with the head. Lacerations may occur during manipulations to resolve shoulder dystocia. Lacerations often occur in the region overlying the ischial spines. The frequency of sidewall and cervical lacerations has probably decreased in recent years because of the reduction in the use of midpelvic forceps and, especially, midpelvic rotational procedures. Lower vaginal trauma occurs either spontaneously or because of episiotomy. Spontaneous lacerations usually involve the posterior fourchette; however, trauma to the periurethral and clitoral region may occur and can be problematic. Thrombosis In the immediate postpartum period, disorders of the coagulation system and platelets do not usually result in excessive bleeding; this emphasizes the efficiency of uterine contraction and retraction for preventing hemorrhage. [5]  Fibrin deposition over the placental site and clots within supplying vessels play a significant role in the hours and days following delivery, and abnormalities in these areas can lea d to late PPH or exacerbate bleeding from other causes, most notably, trauma. Abnormalities may be preexistent or acquired. Thrombocytopenia may be related to preexisting disease, such as idiopathic thrombocytopenic purpura, or acquired secondary to HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count), abruptio placentae, disseminated intravascular coagulation (DIC), or sepsis. Rarely, functional abnormalities of platelets may also occur. Most of these are preexisting, although sometimes previously undiagnosed. Preexisting abnormalities of the clotting system, such as familial hypofibrinogenemia and von Willebrand disease, may occur and should be considered. An expert panel recently issued guidelines to aid in the diagnosis and management of women with such conditions. [15]  An underlying bleeding disorder should be considered in a woman with any of the following: menorrhagia since menarche, family history of bleeding disorders, personal history of notable bruising without known injury, bleeding from the oral cavity or GI tract without obvious lesion, or epistaxis of longer than 10 minutes duration (possibly requiring packing or cautery). If a bleeding disorder is suspected, consultation is suggested. Acquired abnormalities are more commonly problematic. DIC related to abruptio placentae, HELLP syndrome, intrauterine fetal demise, amniotic fluid embolism, and sepsis may occur. Fibrinogen levels are markedly elevated during pregnancy, and a fibrinogen level that would be in the reference range in the nonpregnant state should be viewed with suspicion in the aforementioned clinical scenarios. Finally, dilutional coagulopathy may occur following massive PPH and resuscitation with crystalloid and packed red blood cells (PRBCs). Risk factors and associated conditions for PPH are listed above; however, a large number of women experiencing PPH have no risk factors. Different etiologies may have common risk factors, and this is especially true of uterine atony and trauma of the lower genital tract. PPH usually has a single cause, but more than one cause is also possible, most likely following a prolonged labor that ultimately ends in an operative vaginal birth. Prevention High-quality evidence suggests that active management of the third stage of labor reduces the incidence and severity of PPH. 8]  Active management is the combination of (1) uterotonic administration (preferably oxytocin) immediately upon delivery of the baby, (2) early cord clamping and cutting, and (3) gentle cord traction with uterine countertraction when the uterus is well contracted (ie, Brandt-Andrews maneuver). The value of active management in the prevention of PPH cannot be overstated (see  Management of the Third Stage of Labor). The use of active versus expectant management in the third stage was the subject of 5 randomized controlled trials (RCTs) and a Cochrane meta-analysis. 16, 7, 8]  These trials included more than 6000 women, and the findings are summarized in Table 1. Table 1. Benefits of Active Management Versus Expectant Management  (Open Table in a new window) Outcome| Control Rate, %| Relative Risk| 95% CI*| NNT  Ã¢â‚¬  | 95% CI| PPH of 500 mL| 14| 0. 38| 0. 32-0. 46| 12| 10-14| PPH of 1000 mL| 2. 6| 0. 33| 0. 21-0. 51| 55| 42-91| Hemoglobin lt; 9 g/dL| 6. 1| 0. 4| 0. 29-0. 55| 27| 20-40| Blood transfusion| 2. 3| 0. 44| 0. 22-0. 53| 67| 48-111| Therapeutic uterotonics| 17| 0. 2| 0. 17-0. 25| 7| 6-8| *CI: Confidence interval †  NNT: Number needed to treat The findings show a conclusive benefit for active management, with an approximate 60% reduction in the occurrence of PPH greater than or equal to 500 mL and 1000 mL, hemoglobin concentration of less than 9 g/dL at 24-48 hours after del ivery, and the need for blood transfusion. An 80% reduction in the need for therapeutic uterotonic agents was noted. These results were all highly significant as indicated by the 95% confidence interval figures. The results indicate that for every 12 patients receiving active rather than physiological management, one PPH would be prevented. For every 67 patients so treated, one patient would avoid transfusion with blood products. One concern regarding active management is that retained placenta may occur more frequently. This concern is not supported by the trials. This is especially true if oxytocin is used as the uterotonic. [17, 18]  The US RCTs mentioned above compared the use of active management protocols in which the oxytocin was administered either immediately after delivery of the baby or immediately after delivery of the placenta. The authors stated that no statistically significant difference was noted in the PPH rate and that delaying administration until after placental delivery was justified. Noteworthy is the finding that early administration of oxytocin (before placental delivery) did not increase the rate of retained placenta. Additionally, the trial showed trends toward a benefit for early administration of oxytocin, including a 25% reduction in PPH and a 50% reduction in the need for transfusion. [9]  These findings are clearly consistent with the previous RCTs and the early administration of oxytocin with delivery of the baby is strongly recommended. They also stated that administration with delivery of the baby did not increase the rate of retained placenta, but they did not point out that this finding clearly supports early administration. Additionally, the trial showed trends toward a benefit for early administration of oxytocin, including a 25% reduction in PPH and a 50% reduction in the need for transfusion. [9]  These differences may be due to chance, but, given the results of the previous RCTs, the administration of oxytocin with delivery of the baby would seem to be strongly warranted. Following delivery, administering a uterotonic drug that lasts at least 2-3 hours is reasonable. [3]  This could be 10 U of oxytocin in 500 mL of intravenous fluid by continuous drip, 200-250 mcg of ergonovine intramuscularly, or 250 mcg of 15-methyl prostaglandin F2-alpha (carboprost [Hemabate]) intramuscularly. The use of misoprostol and a long-acting oxytocin analogue (carbetocin) is being studied for this use. [19]  It has been suggested that distribution of misoprostol ahead of childbirth in communities where home birth is unavoidable can be an effective approach. However, there is insufficient evidence to support this and there are concerns that the drug might be used for starting labor or terminating pregnancy. [20] The presence of significant antepartum or intrapartum risk factors warrants delivery in maternity units that have readily available resources to deal with massive obstetric hemorrhage. All medical facilities should have protocols for dealing with PPH and obstetric hemorrhage. Pathophysiology Over the course of a pregnancy, maternal blood volume increases by approximately 50% (from 4 L to 6 L). The plasma volume increases somewhat more than the total RBC volume, leading to a fall in the hemoglobin concentration and hematocrit value. The increase in blood volume serves to fulfill the perfusion demands of the low-resistance uteroplacental unit and to provide a reserve for the blood loss that occurs at delivery. [6] At term, the estimated blood flow to the uterus is 500-800 mL/min, which constitutes 10-15% of cardiac output. Most of this flow traverses the low-resistance placental bed. The uterine blood vessels that supply the placental site traverse a weave of myometrial fibers. As these fibers contract following delivery, myometrial retraction occurs. Retraction is the unique characteristic of the uterine muscle to maintain its shortened length following each successive contraction. The blood vessels are compressed and kinked by this crisscross latticework, and, normally, blood flow is quickly occluded. This arrangement of muscle bundles has been referred to as the living ligatures or physiologic sutures of the uterus. [5] Uterine atony is a failure of the uterine myometrial fibers to contract and retract. This is the most important cause of PPH and usually occurs immediately following delivery of the baby, up to 4 hours after the delivery. Trauma to the genital tract (ie, uterus, uterine cervix, vagina, labia, clitoris) in pregnancy results in significantly more bleeding than would occur in the nonpregnant state because of increased blood supply to these tissues. The trauma specifically related to the delivery of the baby, either vaginally in a spontaneous or assisted manner or by cesarean delivery, can also be substantial and can lead to significant disruption of soft tissue and tearing of blood vessels. Presentation Although the presentation of PPH is most often dramatic, bleeding may be slower and seemingly less noteworthy but may still ultimately result in critical loss and shock. This is more likely to be true of bleeding secondary to retained tissue or trauma. Nursing practices for routine care in the postpartum period should include close observation and documentation of maternal vital signs and condition, vaginal blood loss, and uterine tone and size. The uterus should be periodically massaged to express any clots that have accumulated in the uterus or vagina. 21] The usual presentation of PPH is one of heavy vaginal bleeding that can quickly lead to signs and symptoms of hypovolemic shock. This rapid blood loss reflects the combination of high uterine blood flow and the most common cause of PPH, ie, uterine atony. Blood loss is usually visible at the introitus, and this is especially true if the placenta has delivered. If the placenta remains in situ, then a significant amoun t of blood can be retained in the uterus behind a partially separated placenta, the membranes, or both. Even after placental delivery, blood may collect in an atonic uterus. For this reason, the uterine size and tone should be monitored throughout the third stage and in the so-called fourth stage, following delivery of the placenta. This is accomplished by gently palpating the uterine fundus. If the cause of bleeding is not uterine atony, then blood loss may be slower and clinical signs and symptoms of hypovolemia may develop over a longer time frame. Bleeding from trauma may be concealed in the form of hematomas of the retroperitoneum, broad ligament or lower genital tract, or abdominal cavity. The clinical findings in hypovolemia are listed in Table 2. Table 2. Clinical Findings in Obstetric Hemorrhage[22]  (Open Table in a new window) Blood Volume Loss| Blood Pressure (systolic)| Symptoms and Signs| Degree of Shock| 500-1000 mL (10-15%)| Normal| Palpitations, tachycardia, dizziness| Compensated| 1000-1500 mL (15-25%)| Slight fall (80-100 mm Hg)| Weakness, tachycardia, sweating| Mild| 1500-2000 mL (25-35%)| Moderate fall (70-80 mm Hg)| Restlessness, pallor, oliguria| Moderate| 2000-3000 mL (35-50%)| Marked fall (50-70 mm Hg)| Collapse, air hunger, anuria| Severe| Two important facts are worth bearing in mind. The first is that caregivers consistently underestimate visible blood loss by as much as 50%. The volume of any clotted blood represents half of the blood volume required to form the clots. The second is that most women giving birth are healthy and compensate for blood loss very well. This, combined with the fact that the most common birthing position is some variant of semirecumbent with the legs elevated, means that symptoms of hypovolemia may not develop until a large volume of blood has been lost. 23] Rapid recognition and diagnosis of PPH is essential to successful management. Resuscitative measures and the diagnosis and treatment of the underlying cause must occur quickly before sequelae of severe hypovolemia develop. The major factor in the adverse outcomes associated with severe hemorrhage is a delay in initiating appropriate management. Contraindications Other than nonconsent, absence of surgical expertise or allergy to specific agents, the techniques used in the management of PPH have no absolute contraindications. The vast majority of cases (gt;99%) are handled without what would traditionally be considered surgical intervention. In most cases, surgical intervention is a last resort. An exception is those cases in which uterine rupture or genital tract trauma has occurred and surgical repair is clearly indicated. Transfusion of packed RBC and other blood products may be necessary in the management of severe PPH. Some women may refuse such an intervention on personal or religious grounds. The most widely known group that does not accept blood transfusion are Jehovah’s Witnesses. The wishes of the patient must be respected in this matter. Significant increased risk of maternal mortality due to obstetric hemorrhage has been noted in the Jehovah’s Witness population. The increased risk of death was found to be 6-fold in a recent national review of 23 years experience in the Netherlands and 44-fold in a much smaller study of 391 deliveries in a US tertiary level center. 24, 25]  Discussion regarding the implications of such prohibitions should be undertaken early in the pregnancy whenever possible and subsequently reviewed. In almost all cases in which surgical management is chosen after medical management has failed, not attempting surgery would lead to maternal death. Even an unstable condition cannot be considered a true contraindication. One type of surgery may be chosen over another, but when medical management has failed, surgery is most likely the o nly life-saving option. Proceed to  Workup READ MORE ABOUT POSTPARTUM HEMORRHAGE ON MEDSCAPE RELATED REFERENCE TOPICS * Postpartum Hemorrhage in Emergency Medicine * Hypogastric Artery Ligation * Bakri Balloon Placement| RELATED NEWS AND ARTICLES * Haemostatic Monitoring During Postpartum Haemorrhage and Implications for Management * Dose and Side Effects of Sublingual Misoprostol for Treatment of Postpartum Hemorrhage * Uterine Balloon Effective for Post-Partum Hemorrhage in Developing Countries| About Medscape Reference References 1. Berg CJ, Atrash HK, Koonin LM, Tucker M. Pregnancy-related mortality in the United States, 1987-1990. Obstet Gynecol. Aug 1996;88(2):161-7. Medline]. 2. Abouzahr C. Antepartum and postpartum haemorrhage. In: Murray CJ, Lopez AD, eds. Health Dimensions of Sex and Reproduction. Boston, Mass: Harvard University Press; 1998:172-4. 3. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician-Gynecologists Number 76, October 2006: postpartum hemorrhage. Obstet Gynecol. Oct 2006;108(4 ):1039-47. [Medline]. 4. Lutomski J, Byrne B, Devane D, Greene R. Increasing trends in atonic postpartum haemorrhage in Ireland: an 11-year population-based cohort study. BJOG. Feb 2012;119(3):306-14. [Medline]. 5. Baskett TF. Complications of the third stage of labour. In:  Essential Management of Obstetrical Emergencies. 3rd  ed. Bristol, England: Clinical Press; 1999:196-201. 6. Cunningham FG, Gant NF, Leveno KJ, et al, eds. Conduct of normal labor and delivery. In:  Williams Obstetrics. ed. New York, NY: McGraw-Hill; 2001:320-5. 7. Rogers J, Wood J, McCandlish R, Ayers S, Truesdale A, Elbourne D. Active versus expectant management of third stage of labour: the Hinchingbrooke randomised controlled trial. Lancet. Mar 7 1998;351(9104):693-9. [Medline]. 8. Prendiville WJ, Elbourne D, McDonald S. Active versus expectant management in the third stage of labour. Cochrane Database Syst Rev. 2000;CD000007. [Medline]. 9. Jackson KW Jr, Allbert JR, Schemmer GK, Elliot M, Humphrey A, Taylor J. A randomized controlled trial comparing oxytocin administration before and after placental delivery in the prevention of postpartum hemorrhage. Am J Obstet Gynecol. Oct 2001;185(4):873-7. [Medline]. 10. Sheiner E, Sarid L, Levy A, Seidman DS, Hallak M. Obstetric risk factors and outcome of pregnancies complicated with early postpartum hemorrhage: a population-based study. J Matern Fetal Neonatal Med. Sep 2005;18(3):149-54. [Medline]. 11. Blomberg M. Maternal obesity and risk of postpartum hemorrhage. Obstet Gynecol. Sep 2011;118(3):561-8. [Medline]. 12. Society of Obstetrics and Gynecology of Canada. Postpartum hemorrhage. In:  ALARM Manual. 15th Ed. 2008. 13. Rogers MS, Yuen PM, Wong S. Avoiding manual removal of placenta: evaluation of intra-umbilical injection of uterotonics using the Pipingas technique for management of adherent placenta. Acta Obstet Gynecol Scand. 2007;86(1):48-54. [Medline]. 14. Marquette GP, Skoll MA, Dontigny L. A randomized trial comparing oral misoprostol with intra-amniotic prostaglandin F2alpha for second trimester terminations. J Obstet Gynaecol Can. Nov 2005;27(11):1013-8. [Medline]. 15. [Guideline] James AH, Kouides PA, Abdul-Kadir R, et al. Von Willebrand disease and other bleeding disorders in women: Consensus on diagnosis and management from an international expert panel. Am J Obstet Gynecol. May 28 2009;[Medline]. 16. Khan GQ, John IS, Wani S, Doherty T, Sibai BM. 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In:  ABC or Tran sfusion. London, England: BMJ Publishing; 1998:49-52. 33. Hughes DB, Ullery BW, Barie PS. The contemporary approach to the care of Jehovahs witnesses. J Trauma. Jul 2008;65(1):237-47. [Medline]. 34. Atoyebi W, Mundy N, Croxton T, Littlewood TJ, Murphy MF. Is it necessary to administer anti-D to prevent RhD immunization after the transfusion of RhD-positive platelet concentrates?. Br J Haematol. Dec 2000;111(3):980-3. [Medline]. 35. Franchini M, Franchi M, Bergamini V, Salvagno GL, Montagnana M, Lippi G. A critical review on the use of recombinant factor VIIa in life-threatening obstetric postpartum hemorrhage. Semin Thromb Hemost. Feb 2008;34(1):104-12. [Medline]. 36. Ahonen J, Jokela R, Korttila K. An open non-randomized study of recombinant activated factor VII in major postpartum haemorrhage. Acta Anaesthesiol Scand. Aug 2007;51(7):929-36. [Medline]. 37. Franchini M, Manzato F, Salvagno GL, Lippi G. Potential role of recombinant activated factor VII for the treatment of severe bleeding associated with disseminated intravascular coagulation: a systematic review. Blood Coagul Fibrinolysis. Oct 2007;18(7):589-93. [Medline]. 38. Gibbins KJ, Albright CM, Rouse DJ. Postpartum hemorrhage in the developed world: whither misoprostol?. Am J Obstet Gynecol. Aug 1 2012;[Medline]. 39. OBrien P, El-Refaey H, Gordon A, Geary M, Rodeck CH. Rectally administered misoprostol for the treatment of postpartum hemorrhage unresponsive to oxytocin and ergometrine: a descriptive study. Obstet Gynecol. Aug 1998;92(2):212-4. [Medline]. 40. Lokugamage AU, Sullivan KR, Niculescu I, et al. A randomized study comparing rectally administered misoprostol versus Syntometrine combined with an oxytocin infusion for the cessation of primary post partum hemorrhage. Acta Obstet Gynecol Scand. Sep 2001;80(9):835-9. [Medline]. 41. Vaid A, Dadhwal V, Mittal S, Deka D, Misra R, Sharma JB. A randomized controlled trial of prophylactic sublingual misoprostol versus intramuscular methyl-ergometrine versus intramuscular 15-methyl PGF2alpha in active management of third stage of labor. Arch Gynecol Obstet. Mar 11 2009;[Medline]. 42. Gulmezoglu AM, Forna F, Villar J, Hofmeyr GJ. Prostaglandins for preventing postpartum haemorrhage. Cochrane Database Syst Rev. 2007/07;18;(3):CD000494. 43. [Best Evidence] Winikoff B, Dabash R, Durocher J, Darwish E, Nguyen TN, Leon W, et al. Treatment of post-partum haemorrhage with sublingual misoprostol versus oxytocin in women not exposed to oxytocin during labour: a double-blind, randomised, non-inferiority trial. Lancet. Jan 16 2010;375(9710):210-6. [Medline]. 44. [Best Evidence] Attilakos G, Psaroudakis D, Ash J, Buchanan R, Winter C, Donald F, et al. Carbetocin versus oxytocin for the prevention of postpartum haemorrhage following caesarean section: the results of a double-blind randomised trial. BJOG. Jul 2010;117(8):929-36. [Medline]. 45. Criscuolo JL, Kibler MP, Micholet S, et al. [The value of antibiotic prophylaxis during intrauterine procedures during vaginal delivery. A comparative study of 500 patients]. J Gynecol Obstet Biol Reprod (Paris). 1990;19(7):909-18. [Medline]. 46. Hallak M, Dildy GA 3rd, Hurley TJ, Moise KJ Jr. Transvaginal pressure pack for life-threatening pelvic hemorrhage secondary to placenta accreta. Obstet Gynecol. Nov 1991;78(5 Pt 2):938-40. [Medline]. 7. Maier RC. Control of postpartum hemorrhage with uterine packing. Am J Obstet Gynecol. Aug 1993;169(2 Pt 1):317-21; discussion 321-3. [Medline]. 48. Seror J, Allouche C, Elhaik S. Use of Sengstaken-Blakemore tube in massive postpartum hemorrhage: a series of 17 cases. Acta Obstet Gynecol Scand. Jul 2005;84(7):660-4. [Medline]. 49. Akhter S, Begum MR, Ka bir Z, Rashid M, Laila TR, Zabeen F. Use of a condom to control massive postpartum hemorrhage. MedGenMed. Sep 11 2003;5(3):38. [Medline]. 50. 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Doumouchtsis SK, Papageorghiou AT, Arulkumaran S. Systematic review of conservative management of postpartum hemorrhage: what to do when medical treatment fails. Obstet Gynecol Surv. Aug 2007;62(8):540-7. [Medline]. 57. Plauche WC. Peripartal Hysterectomy. In: Plauche WC, Morrison JC, OSullivan MJ, eds. Surgical Obstetrics. Philadelphia, Pa: WB Saunders; 1992:447-65. 58. OLeary JA. Uterine artery ligation in the control of postcesarean hemorrhage. J Reprod Med. Mar 1995;40(3):189-93. [Medline]. 59. AbdRabbo SA. Stepwise uterine devascularization: a novel technique for management of uncontrolled postpartum hemorrhage with preservation of the uterus. Am J Obstet Gynecol. Sep 1994;171(3):694-700. [Medline]. 60. Clark SL, Phelan JP, Yeh SY, Bruce SR, Paul RH. Hypogastric artery ligation for obstetric hemorrhage. Obstet Gynecol. Sep 1985;66(3):353-6. [Medline]. 61. Floyd RC, Morrison JC. Postpartum Hemorrhage. In: Plauche WC, Morrison JC, OSullivan MJ, eds. Surgical Obstetrics. 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Khrushchev and the 1956 hungar essays

Khrushchev and the 1956 hungar essays The overlapping crises in Hungary and Poland in the autumn of 1956 posed a severe challenge for the leaders of the Soviet Communist Party (CPSU). After a tense standoff with Poland, the CPSU Presidium (as the Politburo was then called) decided to refrain from military intervention and to seek a political compromise. The crisis in Hungary was far less easily defused. For a brief moment it appeared that Hungary might be able to break away from the Communist bloc, but the Soviet Army put an end to all such hopes. Soviet troops crushed the Hungarian revolution, and a degree of order returned to the Soviet camp. Newly released documents from Russia and Eastern Europe shed valuable light on the events of 1956, permitting a much clearer and more nuanced understanding of Soviet reactions. This article will begin by discussing the way official versions of the 1956 invasion changedand formerly secret documents became availableduring the late Soviet period and after the Soviet Union disintegrated. It will then highlight some of the most important findings from new archival sources and memoirs. The article relies especially heavily on the so-called Malin notes, which are provided in annotated translation below, and on new materials from Eastern Europe. Both the article and the documents will show that far-reaching modifications are needed in existing Western accounts of the 1956 OFFICIAL REASSESSMENTS BEFORE AND AFTER 1991 The advent of glasnost and new political thinking in the Soviet Union under Mikhail Gorbachev led to sweeping reassessments of postwar Soviet ties with Eastern Europe. As early as 1987, an unofficial reappraisal began in Moscow of the Soviet-led invasion of Czechoslovakia in August 1968. Initially, these reassessments of the 1968 crisis did not have Gorbachevs overt endorsement, but the process gained a...

Risk management Essay Example | Topics and Well Written Essays - 2500 words - 1

Risk management - Essay Example Even it is also consisted of implementation of a program for assessing the effectiveness. Therefore, it can be said that risk management is an ongoing process. There are four ways to deal with the risk. The first method consists of just rejecting the risk hopping that it will be resolved automatically. Accepting the risk and initiating appropriate actions against the risk can be another option. Transfer of the risk is another measure which indicates the acceptance of alternative risk, higher than the reasonable risk. Lastly, to mitigate the risk i.e. to implement the physical, administrative and technical controls in order to reduce the risk is the another way. Risk assessment is a process or examination through which it can be understood that what can be harmful for the workplace and how it can be prevented in advance. It is important because it gives the authority an advanced alert for the risk that may occur in future so that the future accidents can be avoided. Apart from accident, risk assessment is also useful for reducing insurance cost and damages in machineries. This is a part of risk management and can be better understood by the following diagram. The main objective of the risk assessment is to determine the risk associated with a particular asset. In order to assess risk successfully, few more steps have to be followed, firstly the critical information regarding the assets have to be gathered and possible threats attached with the asset should be identified. Then, the vulnerabilities of the threats and possibility of exploitation are assessed. For assessment of risk, quite a few steps have to be taken. At the outset, identification of risk is necessary. The assessor must visit each and every corner of the work place to have a better understanding with the present condition of the plants and equipments attached in it along with the premises. They may also take advice of the employees. Then, it has to be made out that who are the

The Media and its Impact on the Range of Understanding Identity in Essay

The Media and its Impact on the Range of Understanding Identity in Adolescents - Essay Example One should consider the gratuitous nature with which sex and sexual relations are discussed within the media. It is nearly impossible to turn on primetime television or read a magazine that does not seek to cheaply engage the reader with a type of frivolous and non-consequential understanding of human sexuality. A series of negative implications are glossed over to include the ever-increasing risk of STDs, pregnancy, emotional/psychological trauma, and the inability to form lasting and meaningful physical relationships due to a high premium being placed upon sex (Samson et al 283). Such common interpretations are no doubt one of the reasons that HPV is represented in one out of every 4 women between the ages of 14-30 within the United States. Likewise, it does not take a specialist to note that there is an ever-increasing incidence of violence in all forms of media. This cannot only be understood as a function of entertainment but also as a function of news programming which takes particular interest in some of the more gruesome elements of violence that exist within society. The representation of violence within the media in all its forms serves to relate an unrealistic view of the world model as it currently exists and no doubt has a profound effect on the way that adolescents view their surroundings. One study put forward that the average child will have viewed around 8,000 murders on television prior to finishing elementary school (Nelson 1). This fact in and of itself gives the reader pause when realizing the sheer size of the problem and demands a response to such an issue.

Economics Essay Example | Topics and Well Written Essays - 500 words

Economics - Essay Example Taking into this account, how might my personal behavior patterns show a different type of decision process? I was at a fast food place once grabbing a burger to eat. Inevitably, â€Å"upselling† at the end of the transaction occurs where they offer fries and a drink. I almost instinctivey said â€Å"Yes†, then began to do marginal analysis. I would save money, but how much? Looking at the menu, I found that the a la carte cost would be thirty cents more. I didn't really want fries and a drink, I would only have purchased it out of an irrational desire not to miss a deal even when the deal is not necessary. I ended up changing my mind and saying no and was very glad to have saved the two dollars. The marginal benefit of the additional food and the beverage did not eclipse the marginal cost, even though I had lost an opportunity and therefore incurred opportunity cost by not pairing the meal. Normally, I would have chosen such a meal: I just happened to be thinking about it. I might even have ingested the calories happily, not realizing I actually hadn't been that hungry, causing me to eat more than my plan for the day. The fast food place thus already has a powerful incentive: The desire for people to avoid a missed opportunity combined with a nominal discount on associated items.

A Critical examination of leaders create organizational culture

A Critical examination of leaders create organizational culture Introduction In area of Management and leadership, one of the most crucial and effective factors that determine the performance and position of an organization in public sector is the organizational culture. Organizational culture has been studied extensively for the past 30 or more years (Schein E. H., 1985). Lots of books have been written and much research has been done about it, and also wide range of words applied to describe this notion. Although much different definitions have been presented on this keyword, most of them place their emphasis on common key aspects. Three comprehensive definitions have been gathered in table below: Definitions of organizational culture The pattern of shared beliefs and values that give members of an institution meaning and provide them with the rules for behaviour in their organizations. (Davis, 1984, p. 1). The set of important understandings (often unstated) that members of a community share in common. (Sathe, 1985, p. 6) A set of understandings or meanings shared by a group of people. The meanings are largely tacit among the members, are clearly relevant to a particular group and are distinctive to the group (Louis, 1985, p. 74) According to these definitions, two features of organizational culture seem bolder; first shared meanings and values among organization members and second introducing clear rules and behaviours in organization. Although, some argues that culture cannot be managed (Rabin, T Wachhaus. A, 2008, p. 1) , a correlation between culture and leadership has been identified (Frontiera, 2010). Schein announced this fact in his famous book-Organizational culture and leadership (2004): Culture is a dynamic phenomenon that surrounds us at all times, being constantly enacted and created by our reactions with others and shaped by leadership behaviour. So, attentions have been paid to culture aiming to manage and improve it in order to achieve defined goals. Leaders as persons who have crucial role in improving performance found it vital in organizational discourse. Schein introduced the mutual relation and effect between leadership and culture by the term intertwined (1992) .While culture can be affected by various factors, Senge pointed out that leaders have the most influence on organizational culture (2002, p. 24) : Building an organizations culture and shaping its evolution is the unique and essential function of leadership In this paper the focus is on the influence of leadership on organizational culture to examine to what extent the view that leaders create organizational culture is true. The approach that has been applied in this paper is studying the ways and channels through which leader creates and affects the culture of organization. Four major states have been studied in this area; model leader, strategist leader, ruling leader, and performance changing. Also, the other factors that create culture have been studied and the effect of culture on leadership has been analyzed. The conclusion shows the indirect role of leader in creating culture except through becoming model. In addition, other factors have decisive role in shaping culture. Before the start of this study, clearing the concept of leadership is required. What is leadership? Who is a leader? The concept of leadership has been defined in various ways. Some stated it as a process, for instance Northouse believe that it is a process whereby an individual influences a group of individuals to achieve a common goal (2007, p. 3). Also, Stogdill analyzed it as influencing the activities of an organized group in its efforts toward goal setting and goal achievement (1974). By these two types of definitions, leader can be known as a person who makes decisions, sets directions, makes things happen and often He is recognisable at the top of organization. Leader carries out this process by applying their leadership knowledge and skills. (Jago, 1982) Hence leader is placed at top of organization and clarifies strategies and directions, has most effects on the culture of organizations. In following next parts some ways by which leader affects culture have been examined. Leader; as a model In an organization the leadership and the behaviours of leader become an ideal pattern for followers, and a stream of organizational deportment would flow from top (leader) to down (followers). This case often happens in transformational type of leadership in which leader has charismatic features (Harms, p Crede, M, 2010). Bass and Avolio described transformational leader as able to motivate others to do more than they originally intended and often more than they thought possible (1993). As the organizational culture is made of behaviours and manners, charismatic leader cultivates a particular method of comportment in climate. Culture of an organization consists of different areas; competitiveness, social responsibility, innovation, stability, performance orientation, and supportiveness. So, the manner of leader affects every area of organizational culture and this top-down influence can lead to affirmative or mortal outcomes in performance (Sarros, J. Gray, J and Densten, I, 2002). By way of illustration, this can be studied in realm of Innovation and change; Fishman and Kavanaugh claimed that the culture of an organization and how people respond to change and innovation is shaped substantially by the behaviours of the leader (1989). Smith revealed that leaders behaviours can be followed by employees (2010); Leaders are the role models and when they walk the talk long enough, fairly soon these values become standard procedure. Leaders are lent very crucial and decisive position by which they influence the culture of organization through leading motivation, attendance and attitude of followers in organizational operation. This can be found in Amabile suggestion (1998): By influencing the nature of the work environment and organizational culture, leaders can affect organizational members attitude to work related change and motivation. Schein assumed culture begins from leaders who impose their own values and assumptions on a group (2004, p. 2). Leader as a ruler Leaders externalize their own assumptions and embed them into structures, mission, goals and working procedures gradually and consistently (Schein E. H., 2004, p. 406). In one hand, a leader make decisions and determine rules, and in the other hand organizational culture is described as a set of structures, routines, rules and norms that guide the constrain behaviour (Schein E. H., Organizational Culture and Leadership, 2004). So, leadership manipulates organizational culture through ruling in organization. Dull reflected this fact in the other way (2010): Public sector leaders attempt to cultivate organizational culture as a means of controlling administrative behaviour and building organizational competence, defined as the skill and capacity to accomplish necessary tasks Here the culture described as a tool for improving procedures to facilitate achieving goal. This case can be examined when leader feels sure about a needful innovation in organization. For promoting change, beside other necessities, leader has to provide a firm ground for implementing innovation; this ground is formal procedures and actions. As Armenakis et al. claimed leaders can modify formal structures, procedures, and human resource management practices (1999). So, leader initiates change and clarifies orientation of organization; he arrives to alter proceeds for reaching ends. In reality, changing procedures interpreted as changing culture. Leader as strategist Stewart declared that the strategy of an organization gives it identity based on its functions, Also it clarifies what an organization is and what it is doing (2004). Strategy forms culture of through highlighting tasks, directions, positions and behaviours . The change management strategy or approach selected by leaders will result in shifts in organizational culture. (Kavanagh, H Ashkanasy, N, 2006) By understanding the importance of strategy and its relation with culture, leader enters this relation and influence culture in two ways; first standing between strategy and culture, second use the strategy as a tool for modifying culture. Fernandez and Rainey interpreted strategy as a course of action for implementing changes (2006). Despite strategy plays a crucial role in organization, this is the role of leader to translate it into a course of actions. Goldsmith explains to CEO (chief executive officer) how leaders are needed to communicate and execute an organization s strategy. (2009) When leaders and their executive teams take an active role in implementing strategies, this is a commitment to ensure the ideas or strategies become part of the organisation. Insightful leaders realise that for strategies to be successfully integrated into their organisations, they must align, measure, market and package the strategy to their business, customers and investment community as they would with any marketing campaign. While strategy introduces direction of an organization, it is just on the paper. The best-planned strategy is no more than wishful thinking if it cannot be translated from concept to reality (Hsieh, T and Yik, S, 2005) .Here it is leader who translates it from language of paper to a course of actions. Speculand has studied the decisive role of leadership and placed his special emphasis on leaders in success and failure of implementing strategies (2009). So, leader as a median interprets strategy into organization procedure, role, and belief. This action forms the culture; in this area culture is set of behaviours and procedures that are defined by strategy. In this process leader injects strategy into the body of organization. In reality, leader makes strategy feasible, and at the same time forms culture. But it is not whole the story about relation of strategy and culture. Leader alters climate of organization by applying strategy as a tool too. In other words, leader stands at the top and place strategy between him and culture; actually, leader applies strategy as a means to influence organizational culture. This is deducted from the role of leader in designing strategies, Where Abramson and Lawrence claimed (2001): Managerial leaders must develop a course of action or strategy for implementing change. Convincing the members of an organization of the need for change is obviously not enough to bring about actual change. The new idea or vision must be transformed into a course of action or strategy with goals and a plan for achieving it Changing performance The performance of an organization is effective factor through which leader influence the culture. Wikipedia defined Performance defined as the activity of a unit (be it individual, team, department, or division) of an organization intended to accomplish some desired result (2011). This item is evaluated by measuring outputs and outcomes. There is a multilateral and at the same time mutual relation among leadership, culture and performance. In other words, they are interdependent (i.e. leadership and climate are subject to affect by the status of performance of organization). To understand this linkage a circle of relation between leader, climate and performance should be studied. It can be understood from this circle that leader can affect culture through changing performance. In this network of linkage leader affects culture and alter its elements through changing performance and informing employees about it. This influence occurs through the Feedback. Feedback typically consists of information provided to an individual for the purpose of an increase in performance (Kluger, A. N. Denisi, A., 1996). There is variety of feedback forms, which are described by different aspects. One kind of feedback is outcome feedback in which information concerning performance outcomes. (Balcazar, F., Hopkins, B. L., Suarez, Y, 1986) It seems positive and constructive, to inform employees about high performance and improvement of outcomes. Geister et al. concluded in their case study that information and feedback about the team situation is crucial to improving the motivation, satisfaction, and performance of members in virtual teams. (2006) Leader affects the culture of organization indirectly through improving performance and diffusing information about it, an action which leads to a healthy, motivate and more evolutionary climate. If decisions and policies leader applied led to quality performance, it encourages atmosphere of hardworking, competition, integration and responsibility but in fragile situation and poor performance culture would collapse. Culture creates leader, a challenge While the impact of leader on culture is a considerable fact and has been studied and proved in many cases, some opinions challenged it. In an attempt to address this theoretical disagreement, Sarros et al. surveyed over 1,900 managers in Australia and found that leadership was a far more prominent predictor of culture than culture was of leadership. (2002) As it has been mentioned there are an interdependent relations among leadership, culture and performance, so it is a noticeable reality that leader is affected by culture too. Hatch claimed that it is difficult for leaders to have any impact on culture, as culture has a larger influence on leaders. (1993) Schein asserted that while leaders create culture in the early stages of an organization, culture creates leaders as an organization matures. He claimed that culture is deep, broad, and stable. It can be an unconscious determinant of who gets hired, who gets promoted and rewarded, and indeed, how the vision, mission, and strategy are lived. (2004) Culture of organization is a very decisive factor, so leader has to apply appropriate way of leading which does work in that climate. Smith et al. have sought for a proper model of leadership in China by regarding effects of cultural backgrounds (1997), which reflect the crucial role of culture in determining leadership style. It seems imperfect and naÃÆ'Â ¯f to study the relation of leader and climate unilaterally. The relation is mutual and should be studied in this way to achieve a perfect view. Other factors as actors While leadership plays a core role in creating organizational culture, other factors affect climate and even can take it out of control of leader. Culture can be affected by different internal and external factors. As the culture has defined as meanings and behaviours of members, the organizational members are effective actors. Krizek views culture as patterns of meaning and interpretation-whether these patterns emerge among management or employees. So, before leader creates culture, it has been constituted by members beliefs and thoughts as internal actors (2005). As another internal factor, type of function and business of organization conducts the elements of culture. (Schein E. H., Organizational Culture and Leadership, 1992) In other words the mission of organization is a set of beliefs about its core competences (Schein E. H., Organizational Culture and Leadership, 2004, p. 89). External forces may or may not influence the communicative and cultural makeup of an organization. (Cheney, 2001) Examples of external forces include, but are not limited to, economics, education, family, law, media, politics, religion, and technology. External environment and constraints have a considerable role in determining climate of organizations. As, leader has to make situation and organization ready to cope with external environment, any change in environment leads to change policies, behaviours and routines and finally innovates the culture. Schein pointed out that if the environmental context is changing such conflict can be a potential source of adaption and new learning. (2004, p. 108) Organizational culture is influenced by social and national culture of the area in which it is situated. National beliefs, stories, type of thinking and values affect the climate of organization. So, leader is situated in a set of actors that shape culture and is not exclusive actor. Conclusion In this paper the view that leaders create organizational culture has been examined critically. At the first the culture defined as a set of routines, behaviour, meanings and understandings that is shared among members of an organization. Leader defined as who make decision, determine directions and make things happen or not to happen. It has been proved that leaders have a noticeable role in creating organizational climate. The first way through which culture forms by leader is by the stream of meaning, behaviour and beliefs as an ideal method or pattern from top (leader) to down (employees). In this statement employees are assumed as followers who are affected by the nature of leader. As a short explanation, Leadership consists of attributes and skills that determine not only the nature of enterprise, in all its manifestations, but the overall nature of society and the world (Sarros, J. Gray, J. Densten, I, 2002). In this way leaders are charismatic persons by whom followers behaviours consciously or unconsciously are affected. The second conduit for influencing culture is ruling. Leader is top ruler in organization who directs routines, structures and procedures. It has been assumed that by doing these affairs, leader is manipulating culture or changing its elements. In this statement changing culture described as changing procedures and formal administrative process. In third way the focus has been put on strategy. Strategy is the manifestation of mission, directions, tasks and rules and has a strong correlation with culture. It has been expressed that leader affects culture through strategy in two ways. First way is attempt to codify and provide strategy. In this state leader as a strategist inject beliefs and preference into strategy and determine culture through it. The second channel is to standing between strategy and culture in order to interpret and implement it in preferred way. The other area which has been studied is performance. It assumed that leader plays remarkable role in changing performance and the status of outcomes of organization affect the culture directly. The impact of high performance in healthy culture and poor one in weak climate mentioned in this paper. These four ways illustrate the crucial role of leadership in creating culture. But in last two sections of paper this role has been challenged in two statements. First is that while leader creates culture, culture creates leader too. As mentioned, culture is stable and has elements that determine which style of leadership is required and who can be the organizational leader. As, Schein assumes leadership and culture as two sides of one coin, cultural norms define how a given nation or organization will define leadership. (2004) In addition, some factors like external environment, employees beliefs, business of organization, and national culture introduced as factors which affect organizational culture. In conclusion, it should be claimed that the effects of leadership in shaping culture is noticeable and can be realized by studying it through different ways. But the more crucial point is that the effect is not directly except in first way in which leader becomes a pattern for followers. In all conditions leader can apply some policies by which affects culture. Employees play decisive role in changing climate, and leaders dont change culture, they merely invite their people to change the culture (Hillis). So, leader is not the exclusive actor in influencing culture. Other factors should be studied so that an effective innovation and successful change in culture can be achieved.