The Eruption of Toba

Introduction The largest volcanic explosion in the late Pleistocene occurred in Lake Toba, approximately 72,500 (+- 3000) years ago. The super eruption of Toba has attracted a lot of scientific disrepute due to various reasons. When viewed from space, the caldera is observed as one of the biggest volcanic craters on earth, since it measures over 100km.Advertising We will write a custom research paper sample on The Eruption of Toba specifically for you for only $16.05 $11/page Learn More On the steep was of the caldera is lake Toba. This lake is said to be the largest volcanic lake on earth. Various scientists including Gasparotto, Spadaforab, Summac, Tateoc, Spadafora and Summa (567) and Jones, Gregory and Stott (725) sugest that the eruption resulted in a massive volcanic winter that caused a human population bottleneck. Super-volcanoes are colossal eruptions that are referred to as super-eruptions, and they vary from other catastrophes like tsunamis or earthquakes since their environmental outcomes threaten global civilization (Buhring and Sarnthein 277). These super eruptions are known to occur once in about 500,000 years, like the largest Yellowstone eruption in the USA, or the Toba eruption in Indonesia. Figure 1: Distribution of volcanic ash from the 73 ka Toba super-eruption showing location of marine cores and sections sampled in India According to Ninkovich, Sparks and Ledbetter (5), super-eruptions occur in areas of the earth where the tectonic plates collide. Ambrose, Williams and Chattopadhyaya (167) also suggest that super-eruptions can occur in areas where hot material wells up from the deep earth interior below a continent.Advertising Looking for research paper on geography? Let's see if we can help you! Get your first paper with 15% OFF Learn More According to Williams and Clarke (633), there are many regions on earth that are suspected of volcanic activity, like Andes and Japan. A cause for concern i s the location of super-volcanoes within or near continents, which impies that these vents are situated in areas that have crowded populations (Lang, Leuenberger Schwander 934). This paper looks at the eological setting of Toba, in an effort to understand the super eruption and its probable effects. In doing this, this study seekd to validat that the eruption resulted in the putative bottleneck. Table 1:  Particle size distribution of the YTT ash at the Rehi section, Son valley, India. Geological Setting of Toba Toba is located in western Indonesia, in the island of Sumatra, in the north province. It is found in the Barisan Mountains as shown in figure 1. Fig. 2: Tectonic setting and location map (inset) of the Toba Caldera. Tectonic map modified from Simkin et al. (2006).Advertising We will write a custom research paper sample on The Eruption of Toba specifically for you for only $16.05 $11/page Learn More These mountains comprise metamorphic rock s, Quaternary volcanic and Miocene sedimentary rocks (Ambrose 274). De Silva (671) suggests that Indian-Austrlain plate located beneath the continental Eurasisn subdues a the rate of aproximately 5.5cm.year, towards the Sunda trench, which has resulted in the formation of an active volcanic (Gathorne-Hardy and Harcourt-Smith 228). Sadler and Grattan (186) suggest that the crust is about 30 to 39 km thick under Toba, with a visible depth of around 125 km (De Silva 671). This is an indication of a 30 degrees subduction angle, which has caused the formation of two parallel faults that lie between the trench and vulcanic arc. One of the faults, the vertical Sumatran, marks the border between the Eurasian plate and most of the Volcanic arc and fore arc basin on the north east and south west respectively. The other fault, Mentawai, forms the division between the fore arc basin and the fore arc accretionary sridge complex in the southwest direction (Erwin Vogel 894). According to Westgate , Shane and Pearce there is a dxtral displacement aong the Sumatran Fault. The displacement extends for about 150 km. It is referred to as the Investogator Ridge Fracture Zon (IFZ), with a subduction that is directly nelow Toba. The results of a geometry assessemt of the subduction slab beneath Toba by Chesner et. al. (201) suggest that there is a bend in the slab that coincides with Toba.Advertising Looking for research paper on geography? Let's see if we can help you! Get your first paper with 15% OFF Learn More The study also showed high seismicity along the subducted portion of the IFZ, which suggests the probability of IFZ concentrating volatile release into the mantle wedge beneath Toba (Chesner et. al 201). Figure 3: Bathymetric map of Lake Toba. Depth is represented by isochromes; 100 m contour lines are plotted for reference. The Toba Super eruption The single event of the Toba eruption resulted in a minimum magma eruption of 2,800 km. The magnitude of the eruption was noted as 8.8, which made it one of the largest eruptions in the Quaternary geologic period. The super eruption caused an injection of over 1015 kg of fine ash into stratosphere, while the pyroclastic flows extended for an area of approximately 105 km2 with lava reaching both the Malacca straits and the Indian Ocean. Kelly, Jones and Pengqun (550) suggest that there are layers of tephra in India, at a location that is over 3000 km away from Toba. The ignimbrite extended from one coast to the next, causing a wide area o f the North Sumatra to be drowned. Moreover, there was an aerosol cloud and dust cloud that covered the globe. The possible effects of the cataclysmic eruption include the total obliteration of both flora and fauna in North Sumatra by the ignimbrite, considerable effects on flora and fauna by ash fall in Southeast Asia, as well as, the regional or global change in temperature and effects on the environment. The Toba Catastrophist Theory The Toba catastrophe theory suggests that the super-eruption resulted in the population decline. Scientists suggest that the super-eruption is the worst disaster that human beings have ever been faced. The volcano eruption in Toba resulted in the exhaustion of large amounts of fine ash and aerosols into the atmospheres. The expulsion of these fumes is compared to nuclear-winter situations (Samuel, Harbury, Bakri, Banner Hartono 350), since the global land temperatures fell by 5-15 degrees Celsius, and the surface of the ocean, and other low altitude s, cooled by 2-6 degrees Celsius. This scenario is thought to have prolonged for several years. As a result, the persistence of soot in the atmosphere for 3 years or so may have resulted in a cooling of the climate (Pattan, Shane Banakar 244). This climatic change is though to have extended for several decades, due to the climatic feedbacks such as increased snow cover and sea ice, resulting in less solar radiation reaching the earth’s surface. Consequently, the earth’s temperature remained low since the ground and atmosphere were not heated up. Researchers suggest that the human population faced a bottleneck during this period, due to the rapid decline in the number of females by about 500, in a population that was thought to have only 4000 individuals (Hawks, Hunley, Lee Wolpoff 18). Data suggests that the eruption caused a peak in sulfur aerosol levels in the GISPs ice core, in addition to the global climatic change. According to ice core data, the weather was coo ler for several centuries after the eruption of Toba. Based on the estimates, the Toba eruption resulted in the near extinction of modern humans. Ambrose, Williams and Chattopadhyaya suggest that this led to the human population, though Oppenheimer (1593) provides an alternative hypothesis, arguing that the Toba super-eruption did not have a significant effect on human existence. Oppenheimer (1593) suggests that human beings should not have been the only ones facing termination. According to Rose and Chesner (913), the Toba induced winter should have resulted in an environmental catastrophe resulting in a population crash of more specialised ecological flora and fauna, causing them to be extinct, in a similar manner that it affected human population. In support of this notion, Gates and Ritchie suggest that the Toba super-eruption did not lead to the extinction of any mammal. In adtion to this, studies by Gathorne-Hardy and Harcourt-Smith (228), on the effects of super-eruptions on flora and fauna suggest that they do not result in mass extinctions, which disapproves the Toba catastrophe theory. According to Gasparotto, Spadafora and Summa (569), a bottleneck in human populations would have assumed the shape of an hour glass, causing the human population to crash at 73.5 Ka and then expand again later. According to Schulz, Emeis and Erlenkeuser (22), the studies on human genome that analyse nuclear sequences suggest that the Y chromosome and mitochondrial DNA support the existence of a bottleneck. Consequently, Robock, Ammann and Oman (114) support the possibility of a bottleneck, though they raise concerns about the time when the bottleneck is expected to have occurred. Some research suggests that the phenomena occurred over 2 million years ago (Petraglia, Clarkson and Ditchfield 114), while other researchers provide evidence of a long period of stasis that was followed by a population expansion around 75,000 years ago. The different opinions with regard to t he bottleneck differ on the timing of the event, which raises concerns as to whether it was caused by the super-eruption at Toba. Differences also arise based on the shape of the bottleneck, in terms of an hourglass model or a short bottle with a long neck. The hourglass model suggests a short period of human population decrease, followed by an expansion, while the long neck period indicates a proonged period of winter, and low population density (Rampino and Ambrose 274). However, the hourglass shaped bottleneck is dispreuted due to its timing of the expansion, which is proposed to have a minimum range of 50,000 years. Consquently, the super-eruption of Toba was unlikely to have resulted in the bottleneck (Rampino and Self 75). In addition to this, studies by McBrearty and Brooks on the Middle and Late Pleistocene human sites in Africa show that by 73.5 Ka, modern humans occupied a variety of habitats around the African continent. The human beings were also noted to be considerably adaptable and resourceful, with the ability to hunt and perform other tasks requiring skill (Westgate, Shane and Pearce). Conclusions In conclusion, it has been established that the super-eruption of Toba resulted in a severe climate change; however, there is inadequate evidence to support the notion that it caused a bottleneck in human population. Studies suggest that the effects were localized. In addition to this, research shows that the super-eruption had negligible effect on the Asian population, and none in Africa. During the time, human beings were adaptable, mobile and well equipped, which made them fully capable of handling the effects of the Toba phenomena. Moreover, the studies suggest that the super-eruption did not result in the extinction or decline of any fauna. Consequently, it is evident that the super-eruption of Toba did not result in human, flora or fauna bottleneck (Thornton 34). Figure 4: Sonar profiles along selected transect lines. Works Cited Ambrose, Stan ley H., Martin Anthony J. Williams and Umesh Chandra Chattopadhyaya. â€Å"Environmental impact of the 73 ka Toba eruption reflected by paleosol carbonate carbon isotope ratios in central India.† Quaternary International. 1.8 (2007): 167 –168. Print. Ambrose, Stanley H. â€Å"Did the super-eruption of Toba cause a human bottleneck? Reply to Gathorne-Hardy and Harcourt-Smith.† Journal of Hu man Evolutio. 45 (2003): 231 – 237. Print. Buhring, Christian and Michael Sarnthein. â€Å"Toba ash layers in the South China Sea: Evidence of contrasting wind directions during eruption ca. 74 ka.† Geology. 28 (2000): 275–278. Print. Chesner, C.A., Rose, W. I., Deino, A., Drake, R., Westgate, J.A. â€Å"Eruptive histo ry of earth’s largest Quaternary caldera (Toba, Indonesia) clarified.† Geology. 19 (1991): 200– 203. Print. De Silva, Shanaka. â€Å"Arc magmatism, calderas and supervolcanoes.† Geology. 36 (2008): 671 – 67 2. Print. Erwin, Douglas H. and T. A. Vogel. â€Å"Testing for causal relationships between large pyroclastic volcanic eruptions and mass extinctions.† Geophysical Research Letters. 19.9 (1992): 893–896. Print. Gasparotto, Giorgio, Elena Spadaforab, Vito Summac and Fabio Tateoc. â€Å"Contribution of grain size and compositional data from the Bengal Fan sediment to the understanding of Toba volcanic event.† Marine Geology. 162.2-4 (2000): 561 – 572. Print. Gates, Alexander E. and David Ritchie. Encyclope dia of Earthquakes and Volcanoes, 3rd edition. New York: Facts on File. 2007. Print. Gathorne-Hardy, F.J. and W.E.H Harcourt-Smith. â€Å"The super-eruption of Toba, did it cause a human bottleneck?† Journal of Human Evolution. 45 (2003): 227– 230. Print. Hawks, John, Keith Hunley, Sang-Hee Lee and Milford Wolpoff. â€Å"Population Bottle necks and Pleistocene Human Evolution.† Molecular Biology and Evolution. 17.1 (2000): 12–2 2. Print. Lang, C., M. Leuenberger and J. Schwander. â€Å"Rapid temperature variation in Central Greenland 70,000 years ago.† Science. 286 (1999): 934–937. Print. Jones, G.S., R.S.J.,Sparks and P.J. Valdes. â€Å"An AOGCM model of the climate response to a volcanic super-eruption.† Climate Dynamics. 25 (2005): 725 – 738. Print. Jones, M.T., R.S.J. Sparks and P.J. Valdes. â€Å"The climatic impact of supervolcanic ash blankets.† Climate Dynamics. 29 (2007): 553– 564. Print. Kelly, P.M., P.D. Jones and J. Pengqun. â€Å"The spatial response of the climate system to explosive volcanic eruptions.† International Journal of Climatology. 16 (1996): 537 – 550. Print. McBrearty, Sally and Alison S. Brooks. â€Å"The revolution that wasn’t: a new interpretation of the origin of modern human behavior.† Journal of Human Evolution. 39.5 (2000): 453–563. Print. Ninkovich, D., R.S.J. Sparks and M.T., Ledbetter. â€Å"Th e exceptional magnitude and intensity of the Toba eruption, Sumatra: an example of the use of deep-sea tephra layers as a geological tool.† Bulletin Volcanologique. 41.3 (1978): 1 –13. Print. Oppenheimer, C. â€Å"Limited global change due to the largest known Quaternary eruption?† Quaternary Science Reviews. 21.14-15 (2002): 1593 –1609. Print. Pattan, J.N., Phil Shane and V.K. Banakar. â€Å"New occurrence of youngest Toba tuff in abyssal sediments of the central Indian Basin.† Mar. Geol. 155 (1999): 243–248. Print. Petraglia, M., R., Korisettar, N., Boivin, et al. â€Å"Middle Pleistocene assemblages from the Indian subcontinent before and after the Toba super-eruption.† Science. 317 (2007): 114 –116. Print. Rampino, M.R. and S. Self. â€Å"Climate-volcanism feedback and the Toba eruption of 74 000 years ago.† Quaternary Research. 40 (1993): 269– 280. Print. Rampino, M.R. and S.H Ambrose. â€Å"Volca nic winter in the Garden of Eden: The Toba supereruption and the late Pleistocene human population crash.† Volcanic Hazards and Disasters in Human Antiquity: Geological Society of America. 345 (2000): 71 – 82. Print. Robock, A., C. Ammann, L. Oman, D. Shindell, S. Levis, and G. Stenchikov. â€Å"Did the Toba volcanic eruption of 74 ka B.P. produce widespread glaciation?† Journal of Geophysical Research (2009): 114. Print. Rose, W.I. and C.A. Chesner. â€Å"Dispersal of ash in the great Toba eruption, 75 ka.† Geology 15.10 (1987): 913– 917. Print. Sadler, J.P. and J.P. Grattan. â€Å"Volcanoes as agents of past environmental change.† Global and Planetary Change. 21.1-3 (1999): 181 – 196. Print. Samuel, M.A., N.A.Harbury, A. Bakri, F. Banner and L. Hartono. â€Å"A new stratigraphy for the islands of the Sumatran Forearc, Indonesia.† Journal of Asian Earth Sciences.15 (1997): 339–380. Print. Thornton, Ian.W.B. Krakatau, the destructio n and reassembly of an island ecosystem. Cambridge, Massachusetts and London: Harvard University Press. 1996. Print. Schulz, H., et al. â€Å"The Toba volcanic event and interstadial/stadial climates at the marine isotope stage 5 to 4 transition in the northern Indian Ocean.† Quaternary Research. 57 (2002): 22 – 31. Print. Westgate, J.A., et al. â€Å"All Toba tephra occurrences across peninsular India belong to the 75, 000 yr B.P. eruption.† Quaternary Research. 50 (1998): 107 –112. Print. Williams, M.A.J. and M.F. Clarke. â€Å"Late Quaternary environments in north central India.† Nature. 308 (1984): 633– 635. Print. Zielinski, Gregory A. â€Å"Use of paleo-records in determining variability within the volcanism-climate system.† Quaternary Science Reviews. 19.1-5 (2000): 417–438. Print. List of illustrations Tables Table 1: Particle size distribution of the YTT ash at the Rehi section, Son valley, India Figures Figure 1: Dist ribution of volcanic ash from the 73 ka Toba super-eruption showing location of marine cores and sections sampled in India Fig. 2: Tectonic setting and location map (inset) of the Toba Caldera Figure 3: Bathymetric map of Lake Toba. Depth is represented by isochromes; 100 m contour lines are plotted for reference. Figure 4: Sonar profiles along selected transect lines This research paper on The Eruption of Toba was written and submitted by user Nakia to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

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It is still good practice to provide parents with information however, consent needs to be sought from the child and the extent of information shared should be deliberated (Quality Care Commission, 2016). In regard to safeguarding concerns, information can be shared with parents without consent. Decisions made in the best interest for the individual, regarding care and treatment can be made anyone involved in caring for them, re latives, friends, and any attorney appointed (NHS Choices, 2016). As soon as I had consent from Anna or both Anna and her parents I would take a detailed history from her such as, when the pain started, pain score, characteristics of the pain, whether it is radiating anywhere, any allergies, medical conditions, current medication and social factors (appendix one). A thorough history is critical as it helps establish; potential treatment plans, possible safety netting features, rules out red flags or differential diagnosis (appendix two) which are all grounded on the findings from the physical assessment and special tests (Kavanagh, S, 2015). From observation, examination and palpation; it was recognised that her tonsils red and swollen, her head was inclined to right but was walking normally, otoscopy reviled that the tympanic membrane was cloudy and bulging slightly and her palatine and pre-auricle lymph nodes appeared tender (Douglas et al, 2013, p. 297 -314). The baseline observations showed that she had no significant temperature and all others observations were with normal parameters (appendix one). To support my diagnosis and exclude potential red flags indefinitely I would carry out some special auditory tests. The first type of hearing loss is conductive; this is a problem conducting sound waves along the path of the ear. It can occur anywhere from the outer ear, middle ear or, tympanic membrane (Munir and Clarke, 2013, p. 11). Sensorineural is the other type of hearing loss, in which the cause is situated in the inner ear, the cochlea or in the vestibulocochlear nerve (cranial nerve VIII), (Munir and Clarke, 2013, p. 11). A simple test to establish the level of hearing loss is the Voice test. By observing and engaging in conversation with the patient it is easy to recognise if you need to raise your voice to be heard clearly. A whisper test would help you gain greater perception of their hearing loss (Munir and Clarke, 2013, p. 13). A more complex and effective test that is greatly used is the Tuning fork test (Burkey et al, 1998). Within this there is two further tests, the first is called the Weber test (appendix three). This is where the tuning fork is hit on a surface to make it vibrate, then the base is placed on the middle of the patients forehead and then ask the patient where they hear this sound. It is normal for the patient to hear it in both ears except those with conductive hearing loss or unilateral sensorineural hearing loss, then it is better heard in one ear (Douglas et al, 2013, p. 303). The Rinnes test (appendix three) should conclude that the sound was louder beside the external aud itory meatus than on the mastoid process this is because air conduction is greater than bone (Rinnes positive), (Munir and Clarke, 2013, p. 13). This test is conducted by placing the vibrating fork on the mastoid process and then the patient reports when they can no longer hear it. The fork is then placed approximately two centimeters away from the external auditory meatus and asked if they can hear it, the patient then reports when they can no longer hear anything (Douglas et al, 2013, p. 303). However, if the patient informs you that the sound is louder on the mastoid process this means bone is the better conductor of sound (Rinnes negative) and applies to conductive deafness (Munir and Clarke, 2013, p. 13). A false negative Rinnes test can occur when hearing is very poor in one side, when the fork is placed on the mastoid process of the poor ear the sound can be conducted through the skull and projected to the good ear (Douglas et al, 2013, p. 303). To manage people with initial presentations of AOM paracetamol or a nonsteroidal anti-inflammatory drugs for instance, ibuprofen is used to treat pain and fever. It is evidenced that both of them are effective in relieving pain in children with AOM, and have few adverse effects when the suggested doses are used (Nair and Peate, 2015, p. 157). For the majority of people with AOM a non-antibiotic method is used, this is where they assure patients that antibiotics are not needed and that they make little difference to symptoms. Antibiotics may also have adverse effects and contribute to antibiotic resistance (Munir and Clarke, 2013, p. 23). A delayed antibiotic prescribing strategy could also be utilised, where they advise patients to commence antibiotics if within four days their symptoms do not improve or if they get substantially worse (Johnson and Hill-Smith, 2012, p. 34 -35). Immediate antibiotics should be given to people that have AOM and are; systemically unwell but admission is not needed, at the risk of complications due to existing diseases, those whose symptoms have continued for four or more days and not getting better, children under the age of two with infection in both ears and children with discharge in the canal or tympanic perforation (National Institute for Health and Care Excellence, 2015). A five-day co urse of amoxicillin is the first-line of treatment if antibiotics are required. Whereas, people that are allergic to penicillin have erythromycin or clarithromycin as alternatives (Munir and Clarke, 2013, p. 23). Amoxicillin is shown to be more effective than erythromycin or clarithromycin against the probable pathogens involved in AOM (National Institute for Health and Care Excellence, 2015). A Cochrane systematic review showed that was no respectable evidence for the routine use of antibiotics in the treatment of AOM in children (Venekamp et al, 2013). Although antibiotics showed to have a statistically significant decrease of children experiencing pain with AOM between day two and seven compared the placebo, eighty-two percent of the childrens symptoms spontaneously improved. It was concluded that the benefits and potential harms of antibiotic treatment must be evaluated, taking into account adverse effects and the possibility of resistance (Venekamp et al, 2013). However, the evidence exposed that they were the most effective against children under two with bilateral AOM, or with both discharge and AOM regardless of age. For the majority of children with mild AOM, an observational method seems acceptable (Venekamp et al, 2013). Another systematic review of the treatment of AOM in children found that compared with short course antibiotics, long courses reduced short-ter m treatment failure, but had no advantages in the longer term in comparison with short courses (Kozyrskyj et al, 2015). Consequently, to manage and treat Annas AOM I would treat her pain with paracetamol or ibuprofen taking into consideration of any allergies and her asthma. I would establish if she has taken ibuprofen before and whether there were any problems. The evidence above shows this condition to be self-limiting and that antibiotics have no significant effect in this condition. It is shown that the public have the most contact with the NHS via general practices, NHS England estimated that approximately one million people access their general practice each day (Comptroller and Auditor General, 2015). The number of direct and telephone contact with patients grew (15.4 percent) throughout all clinical staff in general practices between 2010 and 2015. During that period, the average patient list expanded by ten percent (Baird et al. 2016). It is evident that the non-emergency services like these are being sought by those with conditions that are not serious or life threatening. NHS Direct received roughly 4.4 million calls in 2011 and 2012, 2.7 million calls were made between 2012 and 2013 to NHS 111 and in 2007 and 2008, around 8.6 million calls were received by the GP out-of-hours services (National Institute for Health and Care Excellence. 2014). In Annas case of AOM it is evident that she is asymptomatic, the spread of infection has clearly tracked down from the nasopharynx, Eustachian tube, throat, tonsils to the palatine and pre-auricle lymph nodes. It directly corresponds with the physical assessment and the initial history of the conditions presentation therefore, ruling out a differential diagnosis. The no antibiotic framework above is evidently effective, I have concluded that an analgesic (paracetamol) or nonsteroidal anti-inflammatory (ibuprofen) approach would be adapted and advised to manage Annas pain. This also demonstrates the importance of history taking as Anna has only had these symptoms for two days, indicating that this treatment is the most appropriate. It is apparent that Anna does not require hospitalisation so I would need to leave her with the appropriate safety netting in place. Thus, if she was at home or at school when the incident occurred and her parents or teacher were present and content with mo nitoring her, I would leave the same advice as shown above. I would also advice Anna to go and see her GP if her symptoms worsen or persist for four or more days. It is documented that general practices are well-versed in the management of these non-urgent conditions if they develop or worsen. Similarly, it is evidence that the public are aware of which service to pursue if they experience any similar acute conditions. These actions would only be taken once the red flags were ruled out through the tests and assessments conducted above. In summary acute otitis media is usually a self-limiting condition that resolves by itself without the input of antibiotics subsequently, it is likely that Anna will not need any further involvement form any other healthcare professional. References (2017). Differential Diagnosis. Available: https://online.epocrates.com/diseases/3935/Otitis-media/Differential-Diagnosis. Last accessed 25-01-17. Baird, B., Charles. A., Honeyman. M., Maguire, D. and Das, P. (2016). Understanding pressures in general practice. Available: https://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/Understanding-GP-pressures-Kings-Fund-May-2016.pdf. Last accessed 25-01-17. Burkey, J, Lippy, W, Schuring, A and Rizer, F. (1998). Clinical Utility of the 512-Hz Rinne Tuning Fork Test. Available: https://www.mm3admin.co.za/documents/docmanager/6e64f7e1-715e-4fd6-8315-424683839664/00023361.pdf. Last accessed 17-01-17. Comptroller and Auditor General. (2015). Department of Health and NHS England: Stocktake of access to general practice in England. Available: https://www.cqc.org.uk/sites/default/files/20151008%20Brief%20guide%20-%20Capacity%20and%20consent%20in%20under%2018s%20FINAL.pdf. Last accessed 27-01-17. Department of Health. (2009). Reference guide to consent. Available: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/138296/dh_103653__1_.pdf. Last accessed 23-01-17. Douglas, G., Nicol, F and Robertson, C (2013). Macleods Clinical Examination. 13th ed. Edinburgh: Elvsevier. P. 297 -308. Edwards, C and Stillman, P (2006). Minor Illness or Major Disease? The clinical pharmacist in the community. 4th ed. London: Pharmaceutical Press. p. 129 -137. GOV UK. (2005). Mental Capacity Act 2005. Available: http://www.legislation.gov.uk/ukpga/2005/9/pdfs/ukpga_20050009_en.pdf. Last accessed 28-01-17. Johnson, G and Hill-Smith, I (2012). The Minor Illness Manual. 4th ed. London: Radcliffe Publishing Ltd. p. 25 -41. Kavanagh, S. (2015). History Taking. Available: http://patient.info/doctor/history-taking. Last accessed 28-01-17. Kivi, R and Yu, W. (2016). Acute Otitis Media. Available: http://www.healthline.com/health/ear-infection-acute. Last accessed 19-01-17. Kozyrskyj, A., Klassen, T., Moffatt, M and Harvey, K. (2015). Short-course antibiotics for acute otitis media. Available: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001095.pub2/full. Last accessed 29-01-17. Ministry of Ethics. (2014). Common Law: Gillick V West Norfolk AND Wisbech Area Health Authority 1984-5. Available: http://www.ministryofethics.co.uk/index.php?p=7q=2. Last accessed 20-01-17. Munir, N and Clarke, R (2013). Ear, Nose and Throat at a Glance. Oxford: Wiley Blackwell Publishing Ltd. p. 22 -27. Nair, M and Peate, I (2013). Fundermentals of Applied Pathophysiology: An essential guide for nursing and healthcare students. 2nd ed. Oxford: Wiley Blackwell. p. 565 -566. Nair, M and Peate, I (2015). Pathophysiology for Nurses at a Glance. Oxford: Wiley Blackwell Publishing Ltd. p.155 -157. National Institute for Health and Care Excellence. (2014). NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE SCOPE: Service delivery and organisation for acute medical emergencies. Available: https://www.nice.org.uk/guidance/gid-cgwave0734/resources/acute-medical-emergencies-in-adults-and-young-people-service-guidance-final-scope2. Last accessed 18-01-17. National Institute for Health and Care Excellence. (2015). Otitis media acute: Scenario: Acute otitis media initial presentation. Available: https://cks.nice.org.uk/otitis-media-acute#!scenario. Last accessed 20-01-17. National Institute for Health and Care Excellence. (2015). Otitis media acute Summary. Available: https://cks.nice.org.uk/otitis-media-acute#!topicsummary. Last accessed 20-01-17. NHS Choices. (2015). What is the Mental Capacity Act? . Available: http://www.nhs.uk/Conditions/social-care-and-support-guide/Pages/mental-capacity.aspx. Last accessed 30-01-17. NHS Choices. (2016). Consent to treatment Children and young people . Available: http://www.nhs.uk/Conditions/Consent-to-treatment/Pages/Children-under-16.aspx. Last accessed 21-01-17. Quality Care Commission. (2016). Brief guide: capacity and competence in under 18s. Available: https://www.cqc.org.uk/sites/default/files/20151008%20Brief%20guide%20-%20Capacity%20and%20consent%20in%20under%2018s%20FINAL.pdf. Last accessed 20-01-17. Venekamp, RP., Sanders, S., Glasziou, PP., Del Mar, CB and Rovers, MM. (2013). Antibiotics for acute otitis media in children (Review). Available: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000219.pub3/pdf. Last accessed 18-01-17. Waseem, M. (2016). Acute Otitis: Pathophysiology. Available: http://emedicine.medscape.com/article/994656-overview. Last accessed 25-01-17. Appendix 1 Patient: 16-year-old woman called Anna PC: Pain in right ear HPC: Anna has had pain in her throat and right ear for the last two days and describes feeling under the weather. SOCRATES- Site Pain in throat and right ear. Onset last 2 days. Character- sharp pain in ear throat feels scratchy. Radiation some radiation down towards neck. Associated symptoms No systemic signs. Ear feels full and patient describes difficulty hearing. Timing constant. Exacerbating/Relieving factors- none. Severity- 4/10 PMH: Mild asthma, brought on by exertion. Anna had a number of ear infections when she was younger but hasnt had any for at least two years. DH: Salbutamol PRN Allergies: Elastoplast- Contact dermatitis Alcohol/Smoking: Anna reports drinking occasionally with her friends but does not smoke. Occ H: Student SH: Lives at home with her parents and younger brother (12). O/E: OBS: T: 37.2C, P: 85 reg, RR: 12, BP: 110/75, SpO2: 98% room air Walking normally, with head inclined to the right. Examination of the external ear is normal; palatine and pre-auricle lymph nodes tender; tonsils red and swollen; tympanic membrane cloudy and bulging slightly. In analyse and evaluate the case by discussing the pathophysiology of the condition and how this relates to the history-taking, clinical presentation and likely examination findings, including any special tests that may be required to diagnose the condition. You should then formulate a treatment plan and referral decision justified by critical analysis, taking the ethical, medico-legal and professional responsibilities of the case into account. Appendix 2 Differential Diagnosis of Otitis media Disease/Condition Differentiating Signs/Symptoms Differentiating Tests Otitis media with effusion Typically, the middle ear effusion is asymptomatic. On otoscopy these patients have an effusion of any color, air fluid levels, or bubbles with normal tympanic membrane landmarks. Myringitis These patients may have no symptoms attributable to the middle ear. On otoscopy there is erythema and injection of the tympanic membrane in the neutral position without other features of otitis media Mastoiditis There is edema, erythema, and tenderness over the mastoid process. Diagnosis is clinical based on history and examination. A CT scan may be warranted if symptoms are severe (to exclude abscess formation) or if the diagnosis is uncertain. Cholesteatoma Patients may present with painless otorrhea and hearing loss. Opacification of the tympanic membrane may lead to a misdiagnosis of AOM. Diagnosis is based on the history and clinical findings. Imaging is rarely necessary. (2017). Differential Diagnosis. Available: https://online.epocrates.com/diseases/3935/Otitis-media/Differential-Diagnosis. Last accessed 25-01-17. Appendix 3 Special Auditory Tests (2015). Rinne-Weber. Available: http://wikige.wikia.com/wiki/Rinne-Weber. Last accessed 25-01-17.

English: Good and Evil and Television Essay

Assalam O Aliakum all of you after that today is my presentation and my presentation is about Television you know that television is getting very popular and increasing day by day because of connecting the world. There are some advantages and disadvantages and now I am describing about advantages. Advantages 1) First advantage is that you know Karachi bad low and situation is increasing day by day that’s why many people before going to office they switch on the television for knowing about situation that what is going, situation is good and bad and which area is suitable for going to office. 2) Second is that when you have laser time and you are filling dull/boring and if you want passing the time so you can early by watching television because many channels are available on cable for your entertainments like watching movies and watching song and most of peoples like sports channels. 3) Third advantage is that with passing your time you can get knowledge easily because many channels are available which is providing good platforms for you. Like national geographical and discovery channels are most famous in the world. And also Islam channel are available like QTV, MADANI and PEACE for our information. 4) Forth advantage this is very importance for us because now we are student of English language and we do not know how to speak English and how to perform the word with better ascend when we will watch English channels on daily basic so we can easily get. Disadvantages. 1) The first disadvantage is that some people prefer to watch television and do not prefer to work they most of time spend it. 2) Second disadvantage is that a lot of people suffering in desperation and afraid because you know that boom are blasting on daily basic different areas and news channels telecast live. 3) Thirty disadvantages are that some people are going to bad way due to watching television. This type of people do not like to do work hard and they do street crime and robbery etc.

Gatto Against Schools Critique

Jamille Coy â€Å"Against School: How public education cripples our kids, and why â€Å", is a piece written by John Taylor Gatto which was published in the Harpers Magazine September 2003 issue. Gatto was a New York City public school teacher for about thirty years , who after all this time teaching came to a conclusion that public schooling was nothing but, a system created by the high powers to create a large labour force and to keep the general public under some level of control.He believed that schools stifled a child maturing process and the only way to curb this issue way to educate our own children. Gatto opens his piece speaking about his personal experiences within the public school systems in Manhattan, where he says he became an expert in boredom. His expertise in this area of boredom he claims came from the kids he taught, who always complained about being bored in the class room and being taught by teachers who were also bored and uninterested in their subject.He then said we are to blame for our boredom and the only person obligated to amuse you ways one’s self. He said he learnt this remedy of amusing one’s self to cure boredom from his grandfather. The use of these personal or firsthand experiences were very effective because it tells the reader that the writer isn’t just writing from pure opinion but from something more, which allows you to trust him. He follows by saying that he believes people who didn’t know they were responsible for their own amusement were childish and should be avoided and definitely not trusted.He claims that he often defied custom and bent laws just to help kids to get out of the trap of boredom and childishness. He said teachers had a choice either help kids take an education or help them receive it and he was one who wanted to help kids receive it. Consequently he explains that he was fired after childish adults plotted against him and after nine months of tormented effort and his family having to suffer he was able to reacquire his teachers’ license.In this part of Gatto’s piece he uses a lot of strong words (avoided, not trusted, defy, trap, plotted, tormented) which can be both positive and negative. In one instance it may get scare the reader into believing him and in another it can be seen as terribly biased and cause paranoia. He end off the introductory paragraph quoting Gorge W Bush saying what if when he said â€Å"leave no child behind† he accidentally spoke the truth, was our schools designed to make sure not one child ever grows up?This quotation was the introduction to the main idea of his article and it was very effective because he used authority in using G W Bush and also ended it off with a rhetorical question to leave the reader thinking and preparing him/her for what is about to follow. In the opening to his main argument or body he asks three rhetorical questions which he follows by indirect answers â€Å"Do we really need school? Is it really necessary? If so for what? He then answers all these questions indirectly saying that 2 million happy homeschoolers showed that we didn’t need it.Then he mention some popular Americans who weren’t schooled such as Abraham Lincoln ,Thomas Jefferson, Carnegie and Rockefeller, saying that these people achieved a circumstantial level of success and wealth without schooling. He makes sure and points out that he is just saying school isn’t needed but that he totally agrees that education is, maybe just not the formal system that we all know today. He explains that’s the system (schooling) has made us to believe that school is in direct proportions with success, which he says historically isn’t true both financially and intellectually.The question and answer technique he use was very effective because it first makes the writer think and then by following with answering we unknowing accept and believe his argument. His use of popular A mericans who weren’t schooled is somewhat effective in that once can without a doubt see that some people without school can achieve success but at the same that time can argue that it was a different time and the world has changed and education is much more crucial part of life than it was in the time of Rockefeller and Washington.He used a list to explain that mass schooling was believed to make good people, good citizens and to make each his personal best but this was definitely not so. This list which is actually very effective because its helps the reader to remember and understand main points. He then quotes H. L. Mencken who said the aim of public education is not to fill the young of spices with knowledge and awaken them but it is to simply reduce as many individuals as possible to the same safe level, to breed and train a standardize citizenry to put down dissent and originality .From this quote Gatto wants us to take what Mencken said seriously but coming from a sat irist, it lacks effectiveness. Gatto then goes on to speak about James Bryant Conant who was the president of Harvard for twenty years, world war two poison gas specialists the principal of Colubine High Colorado and the person who introduce standardized testing into the school system. He mention Conant to show a man who had very little background on education influenced it in a big way which was somewhat effective but at the same time could have been considered confusing and misplaced.Another reason for mentioning Conant was to introduce Inglis who believes the reason for school was to stem mass, incurable division so that the underclass’s can never integrate as a dangerous whole. Gatto list what Inglis found to be the purpose of schooling which was: the adjustive or adaptive function, the integrating function, the diagnostic and directive function, the differing function, the selective function and the propaedeutic function. This list was as said before very effective becau se it goes in depth and explains to the reader giving the reader more insight on what the writer is trying to delineate.He starts off his closing points of his argument with the words â€Å"There now you have it. Now you know. † Which somewhat disparages the reader and give a cocky and conceitedness about the writer which can push the reader away from agreement with what he is saying. In this closing argument he says that mandatory schooling had no other objective but to; dumb people down, separate us by classes, encourage us to be lazy not to think at all and to create non-stop consumers.He said that school has turned our children into addicts and it is no accident he quotes Plato and Rousseau to show this. They described our schools as factories in which the raw products (children) are to be shaped and fashioned and built to specification laid down. He said it is obvious what these specifications are; lack of maturity, easy divorce laws, easy credit and easy questions. He u sed very effective rhetorical strategies by comparing children to raw products and schools to factories which gave us images and made his writing more understandable.He concludes by saying that the good news is now that we understand the logic behind modern schooling, its tricks and traps are fairly easy to avoid. He said the answer is to teach own to be leaders and adventurers. He says before we can do this we have to understand that’s schools are laboratories of experimentation on young mind, drill centers for the habits and cooperate society demands. He said that mandatory education serves children only accidentally and the real purpose is to make them servants.He said that the answer is just to let children manage themselves. This closing paragraph was very ambiguous, it was effect in the imagery give with his metaphors but at the same time the answer to the entire thing was bland. After all that he had to say it seems no real solution was given to the problem, which show s he is not very solution oriented and causes his entire article to lose effectiveness. Works Cited Gatto, John Taylor. â€Å"Against School. † Harper's Magazine Sep. 2001: 35-38. Print. MLA formatting by BibMe. org.