Americ's History Essay Example | Topics and Well Written Essays - 750 words

Americ's History - Essay Example Thus, the people became less empowered while the central government became more controlling and powerful. By design, when the Constitution was ratified, the states were empowered. However, over time a gradual drift toward a dominant national government has become evident. Two distinct political positions began to evolve from the colonists. Most Americans considered citizen "virtue" fundamental to any successful republican government. Because political power no longer rested with the central, all-powerful authority of the king, individuals in a republic needed to sacrifice their personal self-interest to the public good. The collective good of the people mattered more than the private rights and interests of individuals. Yet, not all Patriots agreed with this viewpoint defining republicanism. Some favored a republic ruled by a group of talented and educated elite. Republicanism for them meant an end to hereditary aristocracy, but not an end to all social hierarchy. These more conservative republicans feared that the fervor for liberty would overwhelm the stability of the social order. They watched with great concern as the lower-class in society - the poor farmers, tenants, and laboring classes in towns and cities seemed to embrace a kind of republica nism with a level playing field. Thus, two groups of people formed different political ideologies. The first weak national government, the Articl... They were eager to persuade their fellow citizens to amend the Articles of Confederation in favor of a muscular central government. But the poorer states' rights people played down the talk of anarchy from Shays rebellion. Many were debtors who feared that a powerful federal government would force them to pay their creditors. Yet, both groups agreed, the Confederation needed some strengthening. Instead of revising the Articles, the well-off delegates to the Constitutional Convention created a charter for a whole new government. In a series of compromises, the convention produced a plan that provided for a vigorous central government, a strong executive, and protection for property, while still upholding republican principles and states' rights. The American people were somewhat astonished, so well had the secrets of the convention been concealed. The public had expected the old Articles of Confederation to be patched up; now it was handed a startling new document in which, many thought, the precious jewel of state sovereignty was swallowed up. One of the hottest debates of American history forthwith erupted. The antifederalists, who opposed the stronger federal government, were arrayed against the federalists, who obviously favored it. Some of the leaders of the antifederalist camp included prominent revolutionaries like Samuel Adams, Patrick Henry, and Richard Henry Lee. Their followers consisted primarily, though not exclusively, of states' rights devotees, backcountry dwellers, and one-horse farmers - in general, the poorest classes. Large numbers of antifederalists saw in the Constitution a plot by the upper crust to steal power back from the common

An Intelligence View of Music Education Essay Example | Topics and Well Written Essays - 3250 words

An Intelligence View of Music Education - Essay Example This certainly puts a whole new perspective on music education. Parents and teachers can now understand the great potential that resides un-explored in the mind of a child and know that music holds the key to unlock that potential. The narrative style is very simple and easy to follow. That is another achievement by Dr Harvey as he has spared us the high-sounding, difficult to pronounce technical jargon associated with brain studies. Sequential details make it easy to follow the chronology of development in this field. The under-tone of the article is that after knowing the unique qualities of music education, it does not have to remain an "extra-curricular" activity. As Ives said, "Music expands my mind and challenges me to be a true individual". That is good enough reason to make music education a part of education curriculum. Research Proposal Music Education - Just Arts or Smarts "Music is about communication, creativity, and cooperation, and, by studying music in school, students have the opportunity to build on these skills, enrich their lives, and experience the world from a new perspective". These words of former President Bill Clinton sum up the point of view of music education proponents. The advocates of music education consider music education essential for development of both intellectual and aesthetic faculties. Several studies have confirmed that music directly enhances learning through increased spatial development. Math and reading are improved by learning rhythms and decoding notes and symbols. So there appears to be cross disciplinary learning in music.[1]. On the internet, www.childrenmusicworkshop.com is a strong advocate of music education. They say that, "it is...â€Å"Music is about communication, creativity, and cooperation, and, by studying music in school, students have the opportunity to build on these skills, enrich their lives, and experience the world from a new perspective†. These words of former President Bill Clinton sum up the point of view of music education proponents. The advocates of music education consider music education essential for development of both intellectual and aesthetic faculties. Several studies have confirmed that music directly enhances learning through increased spatial development. Math and reading are improved by learning rhythms and decoding notes and symbols. So there appears to be cross disciplinary learning in music.[1]. On the internet, www.childrenmusicworkshop.com is a strong advocate of music education. They say that, â€Å"it is an anomaly that while music is undermined in our public schools as a legitimate subject for serious study, there is a rise in the body of research demonstrating that music is a valuable tool for educators. Those who consider music to be an extra-curricular activity unworthy of inclusion as a core subject are overlooking the unique qualities that music instruction provides to all children†. [2]. In the words of Dr Arthur Harvey of the University of Hawaii (Manoa) :- â€Å"Three major developments in recent years have strengthened our position in promoting music as a significant and research supported discipline that ought to be the core of the curriculum.

The Victorian period Essay Example for Free

The Victorian period Essay TASK: Pip changes a lot during his time in London. As we read the second stage of the novel, we do not like what we see of Pip because he becomes more and more of a snob. Do you agree with this opinion? The hero of Great Expectations is Pip and throughout the novel, our opinions of him change drastically. During his stay in London Pip changes the most and as we go on to read the second stage of the novel, we often fail to sympathise with Pip because he becomes more and more of a snob. Prior to his arrival in London, Pip makes it quite clear that he wishes to become a gentleman so that he can ultimately win over Estellas heart and with it her hand in marriage. But what exactly is a gentleman? A modern dictionary definition of this is: A well-mannered honourable man who may have a good social position. This is not too far away from the Victorian view (which would have been adopted by Magwitch and later on by Pip) as to what would have made a gentleman. At that time, any man was high in social rank or class, had the right by birth to be called a gentleman. A gentleman was also someone who could profitably manage his finances and would eventually own their own estate. A gentleman was also honourable and chivalrous and was a person against whom moral values could be judged. In short, a gentleman was an ideal for others to strive towards. During Pips stay in London, he becomes acquainted with many people. After his reunion with the pale young gentleman (Herbert Pocket) in the Barnards Inn, he meets the rest of Herberts family. It is at this point in the novel that we are introduced to Bentley Drummle. Pip immediately takes a dislike to Drummle and believes that Drummle can never be a true gentleman at heart because he was arrogant, snobbish and neither chivalrous nor honourable hardly making him a role model in society. However, Drummles lavish lifestyle and attitudes eventually rub off on Pip who consequently decides to join a frivolous and expensive London club and to hire a servant. Like a fast spreading poison, the lavishness and carelessness of Pips lifestyle corrupts Herberts life and lands them both in heavy debt as we are told later on in the novel. Just as there are gentleman who can be considered as being true at heart, there also those in the novel mainly Drummle and Compeyson, who certainly are not. It is a principle of his [Matthew Pocket] that no man who was a true gentleman at heart, ever was, since the world began, a true gentleman in manner. They are both only gentlemen by right of birth. Drummle is a spider fellow who possesses arrogance and snobbery of the highest order, has almost no moral values and is certainly not an ideal for others to strive towards. Compeyson is far from being honourable and chivalrous (he jilted Miss Havisham twenty minutes before they were to be joined together in holy matrimony), has no moral values (is happy to manipulate people just for money) and like Drummle, is not an ideal for others to strive towards. In the novel, Compeyson represents the greed of some of the middle class society and the beginnings of middle class crime, which occurred during the Victorian period. Pip makes it clear that he does not wish to turn out like either of the aforementioned characters but when Joe comes to visit Pip, this is not the case. Upon hearing of Joes intended visit (Chapter 27), Pip explicitly expresses his feelings to reader. He admits that if the chance arose, he would pay to keep Joe away from the Inn. If I could have kept him away by paying money, I certainly would have paid money. The apparent reason for this is that he does not wish for Joe to run into Drummle who Pip quite clearly holds in contempt (e. g. his self-revelation about his self-centredness at Jaggers dinner party [Chapter 26]). He criticises Joe before he arrives on his clumsy manner and his inability to read fluently. This was somewhat a strange criticism coming from Pip as at the time of the novel, there was no compulsory State education and reading was a much more common ability than writing. The criticism itself is very reminiscent of the way Estella criticises his appearance at his first visit to Satis House (Chapter 8). After Joe arrives, Pip illicitly makes him feel unwanted. He pays more attention to others at his home, especially to news from Miss Havisham and Estella. In general, the atmosphere is tense with Pip feeling very uncomfortable until Herbert enters the room. When Herbert enters the room, there is a drastic change in the rooms atmosphere. Herbert and Joe get on quite well with each other with friendly chat and Herbert offering Joe a warm beverage. Pip is unafraid for Joe to be seen by Herbert (who Pip believes is a gentleman at heart and of the sort of company that he would want Joe to see him with). However, this pleasant warm atmosphere is short-lived when Herbert has to tend to his hat. After Herbert leaves the room, Joe gets so uncomfortable that he is forced to explain to Pip why he really came to see him.

Demographic Profile of Diabetic Patients

Demographic Profile of Diabetic Patients INTRODUCTION Background of the Study In the last few decades, the world prevalence of diabetes among adults have increased more than twice, and expected to ascend to 380 million by 2030, according to a report from the InternationalDiabetes Institute.1 About 3.4 million, roughly 4.6 percent of the total population in the Philippines are diabetics. This figure is expected to rise to 7.8 million in the next 15 years.2 Despite such high incidence, awareness on diabetes, its complications and treatment remain major challenges, particularly in developing countries such as the Philippines. Prevention through patient education is imperative because the burden of disease on healthcare and its economic implications are of great magnitude. There is a significant amount of evidence that patient education is one of the most effective way to lessen the complications of diabetes. 3,4,5,6 When coupled with appropriate medications, it is associated with decreased morbidity and mortality.3 Patient education is more likely to be effective if we know the characteristic of the patients in terms of what they know about their disease, their attitude towards it and what they practice in their medications, diet and lifestyle. Very few studies has been made on our country to find the prevailing awareness, attitudes and practices among diabetic patients, 7,8,9 which can aid in the development of future health education interventions targeting the disease. In this study, we will determine the demographic characteristics of diabetic patients consulting at the Diabetes Clinic of a tertiary hospital in Davao City and assess their level of knowledge, attitude and practices (KAP) towards Diabetes Mellitus (DM) and the relationship of KAP and glycemic control among type 2 diabetic patients in an urban health care facility. REVIEW OF RELATED LITERATURE In the Philippines, the prevalence of diabetes according to the NNHES (National Nutrition Health Survey) study is approximately 4.6-7.2%. This figure expands to 17.8% after adding those who have pre-diabetes (impaired fasting glucose or impaired glucose tolerance or both) which has a prevalence of 10.6%. 2Therefore, one out of every 5 Filipino could potentially have diabetes mellitus or pre-diabetes. As such, the increasing trend of its incidence rate is causing alarm among medical practitioners, and among affected patients as well. In the context of an alarming increase in the magnitude of type 2 diabetes mellitus in our country, the prevailing knowledge, attitudes and practices of these diabetic patients assume immense importance in the control of the disease. Across the globe, a number of studies have been done about perception and practice of diabetic patients10-14, especially in third world countries. An Indian study made by Mukhopadhyay, et al 2010, looked into the perceptions and practices of patients with Diabetes Mellitus Type II in a tertiary hospital.11 In the Philippines, a similar study was done in the rural community of San Juan, Batangas, Philippines. A total of 156 diabetic residents were included as participants of the survey. Knowledge scores were relatively low, with an overall mean of 43%. There were also poor positive responses to attitude scale. The study emphasized the importance of evaluating knowledge, attitudes and practices as crucial means to understand observed behaviors and guide behavioral change.7 According to the American Diabetic Association, self management education is defined as the process of providing the person with diabetes the knowledge and skill that is needed to perform self care, manage immediate concerns and make life style changes. 3 To achieve such effective self care, diabetic patients and their doctors should work hand-in-hand together. Some studies have shown that self-care among individuals with type 2 diabetes had improved glycemic control and reduced complications 15, 16, 17. For people with diabetes, self-management education training is vital since diabetics and their families provide most of their care themselves. It is imperative that regular patient counseling and group education at follow-up visits by health care professionals to help in improving patients’ knowledge and ultimately modify their practices. 19 However, in our setting, adequate diabetes self-management education programs are lacking or weak in most government hospitals in tertiary care. Hence, results of this study could help us design our education programs targeting certain groups or issues that needs further strengthening. Research Question What is the level of knowledge, attitudes, and practices and its association with glycemic control among persons with type 2 diabetes in the Diabetes Clinic of Southern Phiilppines Medical Center? Significance of the Study The study will contribute to the understanding of the current status of diabetes care in our local setting, and help in the implementation of programs that would address pressing needs in our patient education and management, based on their knowledge, attitude and practices. It will also help us identify the association of KAP and glycemic control, and further assess the impact of diabetes self-management in disease control. Objectives: General Objective: 1. To determine the knowledge, attitudes, and practices of patients with type 2 diabetes in the Diabetes clinic of a tertiary hospital. Specific Objectives: To determine the demographic profile of the diabetic patients in the Diabetic clinic of a tertiary hospital in Davao City, in terms of : Age Gender Highest level of educational attainment Employment status Duration of diabetes Antidiabetic medications Co-morbidities To determine the association between patient factors such as age, sex, level of education, employment status, duration of diabetes, antidiabetic medications and co-morbidities and their level of knowledge, attitudes, and practices (KAP) regarding diabetes To establish the association between the patients’ KAP and their corresponding glycemic control based on HBA1c levels METHODOLOGY Research Design: The study will employ a clinic-based, cross-sectional analytic study design. Research Setting: This study will be conducted at the Diabetes outpatient clinic of a tertiary hospital in Davao City, from May 2014 to June 2014. Participants: All patients who are diagnosed with type 2 Diabetes Mellitus type 2 (T2 DM) who are seeking consult at the Diabetes Clinic in a tertiary hospital for the period of May to June 2014. Inclusion Criteria: Patients must be a diagnosed case of Diabetes Mellitus type 2 based on the following criteria: Plasma glucose > 126 mg/dL (7.0 mmol/L) after an overnight fast Fasting is defined as no caloric intake for at least 8 hours up to a maximum of 14 hours, or Two-hour plasma glucose > 200 mg/dl (11.1 mmol/l) during an Oral Glucose Tolerance Test The test should be performed as described by the World Health Organization, using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water after an overnight fast of between 8 and 14 hours, or A random plasma glucose > 200 mg/dl (11.1 mmol/l) in a patient with classic symptoms of hyperglycemia (weight loss, polyuria, polyphagia, polydipsia) or with signs and symptoms of hyperglycaemic crisis. Patient must have informed consent. Exclusion Criteria: Patients who does not meet the criteria for T2 DM but are seeking consult at the Diabetes clinic: Impaired fasting glycemia and Impaired glucose intolerance. Patients who have intellect impairment and could not participate in the survey Sampling Procedures All the DMT2 patients visiting the diabetes centre during this period will be identified using the convenient sampling method. Assuming that the prevalence of knowledge among Filipinos is 43% 7 and estimating the proportion within 95% confidence interval with 5% error, the sample size is 168( Raosoft Sample size formula). Data Collection: The data will be collected by giving out pretested predesigned questionnaire to participants with informed consent. Pre-testing of the questionnaire will be done prior to the research proper. Relevant information from the participants will be gathered including: age, gender, highest educational attainment, employment status, duration of diabetes, antidiabetic medications and co-morbidities. Questions pertaining to their knowledge, attitudes and practices will be given in order to assess their corresponding levels. The KAP questionnaire will be adapted from a Malaysian study by Shu Hui Ng et al 15, â€Å"Reality vs Illusion: Knowledge, Attitude and Practice among Diabetic Patients†. The questionnaire has been used in previous KAP studies among diabetics and has proven to be a reliable tool. The self-administered questionnaire had a total of 25 questions (knowledge-14, attitude-5, and practice-6). Each correct answer will be given a score of ‘one’ and the wrong answ er was given a score of ‘zero’. Good knowledge attitude and/or practice will be considered if a patient attains >50% of the total score for each domain. To assess the relationship between KAP towards DM and the actual disease control, most recent(4 +/- 2 weeks) levels of HbA1c will be obtained from the patient records. HbA1C > 7% is considered to have poor control of DM. A. Independent Variables Independent Variables include: sex, age, educational attainment, current employment status, co-morbidities, latest hba1c result. B. Dependent Variables Dependent Variables include: levels of knowledge, attitude and practices Data Handling and Analysis: The principal investigator will ensure that all data collected in the study were of utmost confidential nature. Data analysis will be performed to ensure quality results using frequency, percentage, and statistical analysis. The chi-square test will be used to determine the relationship between KAP and t-test to assess the association between KAP and diabetes control. Spearman correlation test will be used to determine the association between knowledge and attitude, and between knowledge and practice. The level of statistical significance will be set at p

D.H. Lawrences Sons and Lovers Essay -- Lawrence Sons and Lovers Essa

D. H. Lawrence is considered one of the Twentieth Century's greatest and most visionary English novelists. He was born in 1885 in Eastwood, a mining community in Nottinghamshire, England (DeMott iii). His father was an uneducated miner and his mother had been a schoolteacher before she married. According to England's rigid class system, his mother's marriage to his father was considered a step down, since she came from a well-educated middle-class family. Thus the vast differences between his parents was cause for "the fabric of his parents' marriage [to be] ripped by bitterness, violence and hate" (DeMott vii). Lawrence's first great novel, Sons and Lovers, is clearly autobiographical: "there's no denying the closeness of the resemblance between Paul Morel's life and that of his creator" (DeMott vii). The novel tells the story of Gertrude Morel, a mother whose possessive love for her sons hinders their ability to establish fulfilling relationships with other women. Lawrence himself had an unusually close attachment to his mother. The novel also depicts the working class of England at the turn of the century, when industrialism was rearing its ugly head and was creeping upon the English countryside. Set in a town similar to the one where he was born, Sons and Lovers gives a detailed and realistic portrayal of the hardships and conflicts of the Morels, a mining family. Gertrude Morel, the character based on Lawrence's mother, has married below her station; she is a religious woman who is serious and believes in hard work and adherence to a strict code of morals (3). She is unhappy and disillusioned with the lower-class mining-family lifestyle and is "sick of it, the struggle with ... ...ious that Lawrence preferred the agrarian England as opposed to the dehumanizing and mechanized modern world. Lawrence addresses "the human costs" of an industrialized society in Sons and Lovers and many of his other works, including his infamous Lady Chatterly's Lover (DeMott viii). Industrial British society has turned away from its agrarian roots and is destroying England, and the old way of life is seen as much more vibrant and complete. Lawrence, a genius in his own time, prophesied "that the West is on a disaster course and that all of us must change our lives" before we destroy the beauty of our world, and in the process destroy our own souls (DeMott viii). Works Cited DeMott, Benjamin. Introduction. Sons and Lovers. By D.H. Lawrence. New York: Penguin Books, 1985. Lawrence, D.H. Sons and Lovers. New York: Penguin Books, 1985.

Media Corporations Profiting from Violence Essay -- Argumentative Pers

Media Corporations Profit from Violence      Ã‚   Whether it is a body found along the road, a school shooting, or planes flying into the World Trade Center, the images will be replayed over and over on Television ad nausea.. The most horrific acts may eventually be retold in books and movies. Packaging and selling the violence of the moment belongs to television - and television will keep reminding us of it.    The special custom-made armor covered his body from neck to toe. As the black-clad gunman wandered the street, randomly firing a high powered semi-automatic rifle at Los Angeles police, a city sat transfixed to their televisions, hypnotised by the unreal events unfolding outside their doors. When the LAPD realised that the gunman was covered with body armour, a call to aim for the head was shouted across their 2-way radios. The camera was in the perfect position to catch the shot. The black-clad bank robber firing at will suddenly jerked back, a jet of red exploding from his head. His legs buckled underneath him. His hands dropped the gun, but he was dead before they could reach for the massive wound. He never felt himself hit the ground. A few moments later, the television helicopter landed and began interviewing eyewitnesses. One middle-aged woman looked straight into the camera and deadpanned, "Things like this just don't happen in America."    In Amusing Ourselves To Death, Neil Postman states that "...The clearest way to see through a culture is to attend to its tools of conversation." If that is true, then the tool of conversation in America is television. There are more television sets in American homes than there are homes, and those sets are on for an average of six hours per day, with the average p... ...of all becomes the death of the neighbor next door.       Got the bubbleheaded bleach blond comes on at five she can tell you 'bout the plane crash with a gleam in her eye It's interesting when people die give 'em dirty laundry Don Henley             Works Cited 1. Operation Desert Storm: Outright Disinformation Scheme, David Fingrut 2. Amusing Ourselves to Death, Neil Postman, Penguin Books, 1985, pg. 8 3. Electronic Heroin, Jay Hanson 4. This statistic comes from the United Nations radio program Perspective (no. 96/52). The program was a report on the 1996 UN sponsored World Television Forum. 5. Millions of Viewers Tuned In, But Total Never Will be Known, Mike McDaniel, Houston Chronicle, 10/4/95. 6. Felons On The Air: Does GE's Ownership of NBC Violate the Law? , Sam Husseini, EXTRA!, 11/12/94

Kraske or jackknife position

IntroductionIn this variation of the prone position, the patient’s head and feet are both lower than the hips. The jackknife position is used most frequently for proctologic procedures. It is also the gold standard in anorectal surgical procedures (Kneedler & Dodge, 1994).PositioningThe patient is either anesthetized supine and turned prone, or is placed in position before spinal anesthetic is administered. The hips are on a pillow or towel directly over the table break and the table is flexed 90Â º, with the head and legs down. The patient’s arms are on arm boards with hands toward the head. The buttocks may be separated by wide tape placed at the level of the anus on both sides and secured to the table. The patient is taken out of the position by first flattening the table and then reversing the order of movements into the prone position. Arms are usually positioned over the head for turning (Bailey & Snyder, 2000).Anesthesia FactorsOne of the most common concerns ab out the prone jack knife position is the safety of the airway during anesthesia. Patients are occasionally placed in lithotomy position rather than the preferred prone jack knife position because of the concern for the airway. While patient safety is a prime concern, there are no reports of the loss of control of airway during repositioning. Although this lack of evidence does not exclude individual episodes, it does indicate that the heightened awareness has probably minimized the risk to the patient to an acceptable level (Jaffe & Samuels, 2004).Patient FactorsIndividual physical limitations of the patients occasionally prevent the use of the jack knife position. Physical factors that would prevent a patient from lying prone on the operating table, such as obesity, pregnancy, and tense ascites, may require the use of a different position. Orthopedic considerations, such as hip and knee joint problems, long leg casts, and kyphosis may be contraindications to this position. In these relatively rare circumstances, consideration should be given to the lateral position.Perhaps the single most important patient factor is the shape of the buttocks (or depth of the gluteal cleft). It was found to be an important factor in determining the patient position and type of anesthesia to be used in the procedure (Spry, 1997).Surgeon FactorsThe primary reason that many surgeons prefer the prone jack knife position is the excellent visibility provided during anorectal procedures. The exposure provided for office procedures, such as excision of thrombosed external hemorrhoids or drainage of abscesses is not equaled by other positions. In the operating room, whether the surgeon is dissecting the rectum off of the prostate or vagina in an abdominoperineal resection or preserving the internal sphincter during a mucosectomy for ulcerative colitis, visibility and lighting are key factors. Since the gluteal cleft is in horizontal rather than a vertical orientation in the prone jack knife position, illumination can be provided with overhead lights rather than headlamps. Similarly, more than one person can visualize the operating field without crowding or being in an awkward body position (Bailey & Snyder, 2000).Physiologic FactorsThe jack knife position has been described as the most precarious of surgical positions. Both respiration and circulation can be most adversely affected. Vital capacity is reduced due to restricted diaphragmatic movement and increased blood volume in the lungs, reducing lung compliance (Kneedler & Dodge, 1994).Careful positioning of patients when they are under anesthesia is crucial. Most surgeons focus on the avoiding damage to peripheral nerves from prolonged pressure when positioning patients. However, an even more significant risk to overall patient well-being can result from the unintended consequences of anesthesia that may affect patient physiology. They include compression of arteries, impairment of venous return, limitation of ventilation, and blood pooling. Many authors have examined the prone jack knife position to assess the potential physiologic impact.There are mixed reports about the cardiac effects of the prone jack knife position. If the patient is improperly positioned, transmitted pressure on the vena cava may cause blood pooling in the lower extremities and result in decreased venous return. In one study, when patients were turned from the supine to the prone position there was a temporary decrease in cardiac index; however, when the patients were placed in the prone jack knife position the cardiac index returned to the level seen in the supine position.There was no change in heart rate, mean arterial pressure, and systemic vascular resistance with change from the supine position to the prone jack-knife position, but there was a decrease in the left ventricular stroke work index and a significant increase in the pulmonary capillary wedge pressure. Overall, the effects of the jack knife positio n were comparable to other surgical positions and were believed to be manageable by experienced anesthesiologists.The effect of posture on pulmonary physiology in general and the specific effect of the prone jack knife position on vital capacity have been examined. When patients in the sitting positing are considered to be baseline, there is a 9% decrease in vital capacity in the supine position, a 12.5% decrease in the jack knife position, and an 18% decrease in the lithotomy position. The reduction in vital capacity is due to obstruction of the movement of the diaphragm and to a lesser extent to the restriction of the anteroposterior movement of the ribs. This modest decrease is tolerated by most patients but merits careful monitoring during conscious sedation and general anesthesia (Bailey & Snyder, 2000).References:Bailey, H. R., & Snyder, M. J. (2000). Ambulatory Anorectal Surgery. New York: Springer.Jaffe, R. A., & Samuels, S. I. (2004). Anesthesiologist's Manual of Surgical P rocedures (3rd ed.). New York: Lippincott Williams & Wilkins.Kneedler, J. A., & Dodge, G. H. (1994). Perioperative Patient Care: The Nursing Perspective (3rd ed.). Sudbury, Massachusetts: Jones and Bartlett Publishers.Spry, C. (1997). Essentials of Perioperative Nursing (2nd ed.). Gaithersburg, Maryland: Jones and Bartlett Publishers.