Oppressed Rights by the Oppressive Regime in Margaret Atwoods the Handmaids Tale Essay Example for Free

Oppressed Rights by the Oppressive Regime in Margaret Atwoods the Handmaids Tale Essay Margaret Atwood’s The Handmaid’s Tale delves well into the horrid nature of extreme control and immoral limitations in defining the corrupt theocratic government at large, and more specifically the effect this control has on the society’s women. In an age in which a newly emerged and merciless governmental system called the Republic of Gilead has â€Å"put life back to the middle ages,† sparked by a widespread panic of infertility, personal freedom and individuality have become unimaginably reduced (Genny 1). Handmaids selected to live in the houses of wealthy, well-respected couples go through a life entirely designed by the government for the sole purpose of bearing children. Caught between following the strict rules made for women by the Republic and breaking them in secret for the sake of her sanity, the protagonist Offred essentially but not purposefully offers close to nothing for her society’s benefit. Not allowed to read, write, speak her thoughts or even look another in the eye, the most she can offer proves to be occasional, well-monitored grocery errands and the slight possibility of providing the gift of life for an elite Commander and his Wife. Parallel to a dystopia in which Offred has been stripped of the most simplistic allowances, women in today’s various Middle Eastern societies find relatively equal difficulty in utilizing their strengths due to the severe suppression and forced structure of their daily lives. Regardless of the varying context of these two scenarios, they both present themselves problematically in light of women’s personal struggle to contribute in society—in both Atwood’s The Handmaid’s Tale and the modern Middle East, seemingly unethical yet extreme theocratic government exercises examples of such radically unformed control over its people that the exploitation and demeaning of the natural rights of women become prevalent. But on what grounds should the male citizens of the Republic of Gilead and those in today’s foreign communities be granted more liberation and opportunity while the women are held more captive of their own independence? As Offred finds herself trapped in such an unreasonably restrained living situation, she instinctively recognizes the current lack of available free will because she once knew what freedom looked and felt like. For example, in opposition of her training as a handmaid with the Aunts, she cannot help but wander her ind back to the pre-Republic days â€Å"thousands of years before,† when she and fellow females could actually go to school and watch â€Å"movies of the rest of the world† that even included â€Å"dancing[,] singing, ceremonial masks, [and music],† clearly taking place in a land where â€Å"people†¦were happy† (Atwood 118). Offred as well as other handmaids in her place inevitably suffer within their reality by trying to maintain a grasp on the memories of such privileges they once took for granted, such as real television to promote quality education. Instead of living the naturally liberal life of opportunity that was once available to Offred and existed in her home and school life, such a vision has been taken away by the government and exists now only in her memory, as the Aunts present to her and the other potential handmaids a government-approved film with â€Å"the title and [few] names blacked out†¦with a crayon so [they] couldn’t read them†Ã¢â‚¬â€another example of a ludicrous constraint, reading, that could have instilled fruitful possibilities in the mind of a woman (Atwood 119). In addition, as if the recollection of accredited education and other past events were not enough a cause of longing, Offred also recalls the fearless, empowering spirits of her late loved ones—particularly her mother whom she spots in the film, â€Å"wearing the kind of outfit Aunt Lydia told [the handmaids] was typical of Unwomen in those days† while â€Å"smiling, laughing†¦and raising [her] fists in the air† (Atwood 119). To witness such a wild and free spirit in action, that once was allowed for women but has been officially banned by the radical Christian followings of the Republic of Gilead, undoubtedly sparks a deep temptation within handmaids to rebel against this authority inflicting such â€Å"unacceptable losses of intellectual liberty†; however, such a temptation proves to be a challenge to pursue for some women today (Tolan 1). While the initial teachings of Islam attempted to improve living conditions for Muslim women by granting them some of the same rights as men in the seventh century, women become incapable of endorsing these rights when their society attempts to enforce the â€Å"laws† of the Islamic religion, described by the Columbia University professors who wrote At the Crossroads of the World: Women in the Middle East: Today, many Muslim women do not have the opportunity to enjoy rights once considered theirs by their religion. Women may be unaware of their rights or live in societies where these rights have been misinterpreted or misrepresented by individuals in power (be it the state, culture, or family). In Muslim countries around the world, there is a fundamental difference between what is prescribed by religious texts and what is actually practiced, a gulf between the ideal and the real (Esposito 1998, xiii). Often, the purportedly ‘religiously grounded’ restrictions placed on women within certain societies have little or nothing to do with the teachings of Islam. More often they are a function of socioeconomic and political factors. Recent examples of such restrictions included Taliban-controlled Afghanistan, which prohibited women from receiving medical attention from males and placed other restrictions on their movement in public (Revolutionary Association of the Women in Afghanistan)(Crocco, Pervez, and Katz 110). At most, these women are granted with the illusion that they possess legitimate freedoms, when in actuality their government prohibits this execution with the false justification that it simply conforms to the Islamic religion. The handmaids and all women alike governed by the Republic of Gilead correspondingly must follow the rules of the regime that claims to be operating in the name of the Christian faith in an attempt to validate its restrictive essence. Thus, no question exists as to how Offred becomes â€Å"increasingly reckless with her actions and behaviors,† or to why in the end â€Å"there is the strong possibility that her recklessness has cost her her life† (Genny 1). Most emphatically does Offred’s situation come off as unjust when she finally experiences a small taste of the natural freedom she once had but still deserves. Because it is obviously an â€Å"oasis of the forbidden,† she has to force herself to â€Å"hold†¦absolutely rigid† when the Commander invites her into his off-limits personal turf to play a game of Scrabble, something harmless, yet banned. Despite â€Å"[t]he fact that [she’s] terrified,† Offred still recognizes that â€Å"this is freedom[;] an eyeblink of it,† as if â€Å"he were offering her drugs† (Atwood 138-139). While Atwood implies in her novel that â€Å"feminist utopianism cannot avoid the taint of totalitarianism,† she employs the concept of defiance in that Offred can nourish her natural tendencies to actually enjoy herself through breaking the rules (Tolan 30). Similarly for the women in Iraq, the Ba’ath Party that emerged in 1963 sought provisions for women’s equality, including the liberties of education and employment; however, outside the major urban center of Baghdad, â€Å"the society still relegated Iraqi women to a very inferior position vis-a-vis men† (Brown and Romano 1). To maintain two adjacent communities with such contrasting ways of governing women is arguably contradicting and therefore, a cause for concern. Ultimately, women have simplistically natural rights that ought not to be rendered in the least, especially by illegitimate theocratic governments. Under no circumstances are the rights to thought, decision, reading, and writing, among many others, capable of being outlawed justifiably, regardless of gender. With such liberties, women carry great potential in contributing to society, despite the possibility of infertility or radically religious devotion—and in a lot of cases, that contribution can be imperative. Today in Iraq, a woman cannot own private property or hold any status, while forced to give up her education and marry a stranger. However, women still make up 65% percent of the population, and make up 70% of the agricultural workforce (Al-Jawaheri and Harris). Though they continue to fight for the equal rights and treatment they deserve while accepting their low circumstances, the crucial importance of granting women this moral blessing remains strong.

Intrusion Detection System Using Node-Predictive Attack

Intrusion Detection System Using Node-Predictive Attack Intrusion Detection System Using Node-Predictive Attack Graph Model for Cloud Ambikavathi C Dr.S.K.Srivatsa Abstract- The role of Intrusion Detection System (IDS) in security world is considered as a key requirement for any computing model. This traditional methodology can add its own contribution of security to the distributed Cloud environment. The purpose of this paper is to clarify the steps that are needed to be taken in order to efficiently implement the IDS in cloud environment. The proposed system uses node predictive attack graph to correlate the newly occurred attacks with known attacks. The prediction steps are used to later monitor the environment and control the attacks. Keywords-Attack Graph; Cloud Computing; IDS ,; I. INTRODUCTION A. What is Cloud computing? Cloud computing is â€Å"a model for enabling convenient, on-demand network access to a shared pool of configurable computing resources (e.g., networks, servers, storage, applications, and services) that can be rapidly provisioned and released with minimal management effort or service provider interaction†[1]. This cloud model is co mposed of three service models, four deploy ment models and five essential characteristics . The three service models are So ftware as a Service (SaaS), Platfo rm as a Se rvice (PaaS) and Infrastructure as a Service (IaaS). The four deployment models are private cloud, public cloud, hybrid cloud and community cloud. The five essential characteristics of cloud are on-demand self-service, broad network access, resource pooling, rapid elasticity and measured service. B. What is IDS? Intrusion detection systems are software or hardware systems that automate the process of monitoring the events occurring in a computer system or network, analyzing them for malicious activities or policy violations and produces reports to a management station. IDSs a rehost-based, network-based and distributed IDSs. Hos t based IDS (HIDS) monitors specific host machines, network-based IDS (NIDS) identifies intrusions on key network points and distributed IDS (DIDS) operates both on host as well as network [7]. IDS can be a valuable addition to the security arsenal. IDS performs the following functionalities : Monitoring and analyzing both user and system activities .Analyzing system configurations and vulnerabilities .Assessing system and file integrity.Ability to recognize patterns typical of attacks.Analysis of abnormal activity patterns.Tracking user policy violations.The extensive use of virtualization in implementing cloud infrastructure brings unique security concerns for customers or tenants of a public cloud service. Virtualization alters the relationship between the OS and underlying hardware. This introduces an additional layer virtualization that itself must be properly configured, managed and secured. Specific concerns include the potential to compromise the virtualization software, or hypervisor. So virtual machine security is essential in cloud environment. C. Attack Graph Attack graphs are used to determine how vulnerable their systems are and to determine what security measures to deploy to defend their systems. In the predictive attack graph, a node represents a host and an edge represents vulnerability. The predictive attack graph representation accurately forecasts the effect of removing vulnerabilities by removing edges from the attack graph. The predictive attack graph is the full attack graph with redundant paths removed. A path is considered redundant if the path contains the same vulnerability-host pair in two or mo replaces along the same attack path. In node predictive attack graph, a node can be host or a group of hosts, and an edge can be vulnerability or a group of vulnerabilities. The node predictive attack graph is a simplified version of the predictive attack graph. The node predictive attack graph’s purpose is to mitigate the effects of â€Å"firewall explosion.† Firewall explosion causes redundancy in the predictive gr aph. Thus, the node predictive attack graph mitigates this issue by merging nodes of the attack graph. Two nodes are merged if the attacker can compromise the two hosts from all hosts the attacker has already compromised. [16] Rest of the paper is organized as follows. Section II discusses about the related work done. Proposed system is described briefly in section III. Section IV, presents the implementation part of EIDS and section V concludes with references at the end. II. RELATED WORK In this section, we present related research to our proposed work: Intrusion detection in cloud and attack graph models. A. Anomaly based IDS Anomaly or behavior based detection [7] refers to techniques that define and characterize normal or acceptable behaviors of the system (e.g., CPU usage, job execution time , system ca lls). Behaviors that deviate fro m the expected normal behavior are considered intrusions. Generation of high false alarms is the major drawback of this type which leads to low detection efficiency. But it is able to detect new attack patterns. Here, Input parameter selection and analysis of ciphered data are tedious processes . It attains low throughput but high cost. Metrics and frame work to evaluate this IDS and compare with alternate IDS techniques is in need. Also it is poor in defending themselves from attacks. To avoid false alarms in anomaly based systems the system must be trained to create the appropriate user profiles. It requires extensive training to characterize normal behavior patterns. B. Signature based I DS Signature or Misuse based detection refers to techniques that characterize known methods to penetrate a system. These penetrations are characterized as a ‘pattern’ or a ‘signature’ that the IDS looks for. The pattern/signature might be a static string or a set sequence of actions[9]. It can only detect known attacks. Frequent updation is needed in the database for signatures of new attacks. The advantages of this IDS are, it generates less number of false alarms. A single signature can detect a group of attacks. It does not require extensive training. C. Fuzzy based IDS Fuzzy logic can be used to deal with inexact description of intrusions. It provides some flexibility to the uncertain problem of intrusion detection. Fuzzy logic techniques[5] are used for classification techniques. The classification algorithm is applied to audit data collected which learns to classify new audit data as normal or abnormal data. It allows greater complexity for IDS while it provides some flexibility to the uncertain problem of IDS. Most fuzzy IDS require human intervention to determine fuzzy sets and set of fuzzy rules . D. Artificial Neural Network based The goal of using ANNs for intrusion detection[5] is to be able to generalize data from incomplete data and to be able to classify data as being normal or intrusive. It is best because of it’s self learning capabilities , quick processing and can find small behaviour deviations. But it’s downside is it requires more tra ining sa mples and time consuming. E. Data Mining based IDS Some intrusion attacks are formed based on known attacks or variant of known attacks. To detect such signatures or attacks, signature apriori algorithm can be used, which finds frequent subset (containing some features of original attack) of given attack set. In Cloud, association rules can be used to generate new signatures. Using newly generated signatures, variations of known attacks can be detected in real time[5]. F. Profile based IDS In VM profile based IDS[12], a profile is created for each virtual machine in cloud that describes network behavior of each clouduser. The behavior gathered is then used for detection of network attacks on cloud. It detects the attacks early with robustness and minimum complexity. G. Entropy based IDS Entropy is, in general, used for measuring the data’s degree of impurity using a Threshold value. Entropy based anomaly detection system[14] is mainly proposed to prevent DDoS attacks. This is done in two steps. First users are allowed to pass through a router in network site. It detects for legitimate user using detection algorithm. Second again it passes through a router in cloud site. In this methodology confirmation algorithm is incorporated to detect the intruder by checking a threshold value. H. Multithreaded IDS Multithreading technique improves IDS performance within Cloud computing environment to handle large number of data packet flows. The proposed multi-threaded NIDS[8][4] is based on three modules named: capture module, analysis module and reporting module. The first one is responsible of capturing data packets and sending them to analysis part which analyzes them efficiently through matching against pre-defined set of rules and distinguishes the bad packets to generate alerts. Finally, the reporting module can read alerts and immediately prepare alert report. The authors conducted simulation experiments to show the effectiveness of their proposed method and compared it with single thread which presented high performance in terms of processing and execution time. However, the problem of detecting new types of attacks still needs many works to be done. I. Integrated model IDS It uses the combination two or more o f above techniques. It is advantageous since each technique has some advantages and drawbacks. Grid and Cloud Computing Intrusion Detection System (GCCIDS)[10] proposed the integration of knowledge and behavior analysis to detect specific intrusions. However, the proposed prototype cannot discover new types of attacks or create an attack database which must be considered during implementing IDS. A new integrated intrusion detection approach, called FCA NN[13] is proposed based on ANN and fuzzy clustering. Through fuzzy clustering technique, the heterogeneous training set is divided to several homogenous subsets. Thus complexity of each sub training set is reduced and consequently the detection performance is increased. J. Graph based IDS A graph is constructed in which nodes represent state of attack and edges represent the correlations between attacks. Queue graph, Dependency graph and Attack graph are the existing works done on IDS. To prevent vulnerable virtual machines from be ing compromised in the cloud, a multiphase distributed vulnerability detection, measurement, and countermeasure selection mechanism called NICE[2] is proposed, which is built on attack graph-based analytical models and reconfigurable virtual network-based countermeasures. III. PROP OSED WORK In this section, we describe how to construct and utilize node predictive attack graph model to handle vulnerabilities in cloud environ ment. Any attack has some set of predefined steps to incorporate it. An attack can only be accomplished when all its pre-conditions are met [11]. So that by keen monitoring the attack can be prevented. An attack graph is an abstraction that represents the ways an attacker can violate a security policy by leveraging interdependencies among discovered vulnerabilities. An attack graph can be generated from network configuration details and known vulnerabilities within the network. An attack path is a sequence of steps that starts from an attacker’s initial state to the attacker’s goal state (security policy violation) in an attack graph. Every virtual machine has it’s own logfile for recording the actions of that virtual machine. Th is logfile along with the knowledge base provides information for constructing attack graph. Fig. 1. Proposed Architecture IV. IMPLEMENTATION EIDS is implemented using Openebula[15] and OSSIM (Open Source – Security Information Management)[3] which comprises of traffic analyzers, vulnerability scanners. OS-SIM is embedded as a virtual mach ine in the c loud environment. The ro le of this virtual machine is to monitor all other virtual machines running in the environment. OSSIM provides a Security Information and Event Management (SIEM) solution. It is a one-stop solution and integrated the open source software’s NTOP, Mrtg, Snort, Open VAS, and Nmap. OSSIM is a cost effective solution in the area of monitoring network health and security of network/hosts compared to other propriety products[6]. A. Attack Analyzer Attack Analyzer is built on the top the traffic Analyzer of OS-SIM. It uses each virtual machine’s logfile to analyze and extract attack trace steps. Whenever an attack occurs it is added to the attack graph as a node along with its state and correlation function is invoked. Attack Graph Attack Graph Generator Alert System Knowledge Base Attack Analyzer B. Correlation function Correlation function correlates this new attack with known attacks and gives the prediction steps for this attack. These prediction steps for each attack are used to monitor the further attacks in future. C. Attack Graph Generator Each node in the graph defines an attack and the edge between nodes represent the correlation between that two attacks. V. CONCLUSION Defending distributed environment is difficult. Always prevention is better than cure. Prediction of Intrusions in prior enhances the security of cloud environment. So that predictive attack graph model is chosen for providing security to the distributed cloud environment. At any point the known attacks are correlated with each other to predict new attacks. REFERENCES: [1] NIST (National Institute of Standards and Technology ) http://csrc.nist.gov/p ublications/nistp ubs/800-145/SP800-145.p df [2] Chun-Jen Chung, Pankaj Khatkar, Tiany i Xing Jeongkeun Lee, Dijian g Huan g, â€Å"NICE: Network Intrusion Detection and Countermeasure Selection in Virtual Network Systems†, IEEE Transactions On Dependable And Secure Computing, Vol. 10, No. 4, pp. 198 – 211, July /August 2013. [3] â€Å"OSSIM †, https://www.alienvault.com/ [4] Ms. Parag K. Shelke, M s. Sneha Sontakke, Dr. A. D. Gawande, â€Å"Intrusion Detection Sy stem for Cloud Comp uting†, International Journal of Scientific Technology Research Volume 1, Issue 4, M ay 2012. [5] M odi, C., Patel, D., Patel, H., Borisaniy a, B., Patel, A. Rajarajan, M ., â€Å"A survey of intrusion detection techniques in Cloud†, Journal of Network and Computer App lications. [6] â€Å"OSSIM †, http ://www.op ensourceforu.com/2014/02 /top -10-op en-source-security -tools/ [7] Amirreza Zarrabi, Alireza Zarrabi, â€Å"Internet Intrusion Detection Sy stem Service in a Cloud† IJCSI International Journal of Computer Science Issues, Vol. 9, Issue 5, No 2, Sep tember 2012. [8] I. Gul and M . Hussain, â€Å"Distributed Cloud Intrusion Detection M odel†, International Journal of Advanced Science and Technology, vol. 34, pp. 71-82, 2011. [9] R. Bhadauria, R. Chaki, N. Chak i, and S. Sany al â€Å"A Survey on Secur ity Issues in Cloud Comp uting†, Available at: http ://arxiv.org/abs/1109.5388 [10] K. Vieira, A. Schulter, C.B. Westp hall, and C.M . Westphall, â€Å"Intrusion Detection for Grid and Cloud comp uting†, IT Professional, Volume: 12 Issue: 4, p p. 38-43, 2010. [11] X. Ou and A. Singhal, â€Å"Quantitative Secur ity Risk Assessment of Enterp rise Networks†, Sp ringerBriefs in Comp uter Scien ce, DOI 10.1007/978-1-4614-1860-3_2,  © The Author(s) 2012 [12] Sanchik a Gupta, Padam Kumar and Ajith Abraham, â€Å"A Profile Based Network Intrusion Detection and Prevention System for Secur in g Cloud Env ironment†, International Journal of Distributed Sensor Networks, Feb 2013 [13] Swati Ramteke, Rajesh Dongare, Ko mal Ramteke, â€Å"Intrusion Detection System for Cloud Network Using FC-ANN Algorithm†, Int. Journal of Advanced R esearch in Comp uter and Communication En gineeringVo l. 2, Issue 4, April 2013. [14] A.S.Sy ed Navaz, V.San geetha, C.Prabhadevi, â€Å"Entropy based Anomaly Detection System to Prevent DDoS Attacks in Cloud†, Int. Journal of Computer Applications (0975 – 8887) Volume 62– No.15, January 2013 [15] â€Å"Op ennebula†, http ://opennebula.org [16] Nwokedi C. Idika, â€Å"Characterizin g and A ggregating Attack Grap h-based Security M etrics†, CERIAS Tech Rep ort 2010

Impact of Stroke Case Study

Impact of Stroke Case Study Introduction Jithra is now 68 years of age. Her family consists of husband, daughter, nephew and nephews wife. She has been living with left side hemiplegia caused by stroke since she was 64. As this interview went, Jithra was holding her daughters hand and slowly elaborated her word by word experience in tears. Before an episode of stroke damaged the right side of her brain and put her in bed for the rest of her life, Jithra was living a life of a healthy person. She stated that poverty and debt were the most important factors that motivated her to wake up at 4:30 am on regular basis in order to prepare food and beverage for her respective customers who kindly supported her small restaurant. A strong belief that she did not have any health issue strengthened by the fact that an annual physical check-up was so expensive disguised Jithra from realising how essential it was to have her blood pressure and blood glucose level regularly monitored when she aged. As now that she spends her activities of daily living in bed, pressure sore has become the main concern for both Jithra and her family. Though Jithra does not complain of soreness, redness on skin does indicate that some areas need attention. This essay will provide an overview understanding of stroke and its negative effects posed on Jithra. Furthermore, this essay will emphasise on the intervention and prevention of pressure ulcer in depth. Understand Stroke According to World Health Organization (2014), stroke occurs when there is an interruption of the blood supply to a part of the brain. Stroke can be divided into two major types. The first type is called haemorrhagic stroke. This type of stroke accounts for approximately 13 percent of all strokes (Brown Edward, 2012). It results from bleeding into the brain tissue. The bleeding caused by a rupture of blood vessels results in the leakage of blood into the brain impairing the delivery of oxygen and nutrients. Haemorrhagic stroke can be caused by a number of disorders affecting the blood vessels. Some of which are long-standing high blood pressure and cerebral aneurysms, a thin or weak spot on a blood vessel wall. The weak spots that cause aneurysms are usually present at birth. The development of aneurysms happens over a number of years and don’t usually cause detectable problems until they break (Stroke Foundation, 2014). Jithra’s daughter stated that Jithra complained of headache and nausea approximately 48 hours, especially during periods of activity, before an episode of stroke occurred. Headache particularly distinguishes haemorrhagic stroke from ischaemic stroke. Its other symptoms also include nausea, vomiting, decreased level of consciousness, neurological deficits and hypertension (Brown Edward, 2012). The second type is called ischaemic stroke. It accounts for approximately 85 percent of all strokes. According to Brown and Edward (2012), this type of stroke occurs as the result of partial or complete obstruction, caused by a blood clot, of a blood vessel that supplies blood to the brain. This leads to an insufficient of oxygen supply and glucose needed for cellular metabolism. A clot may be formed by means of embolism or thrombosis. Both types of clotting formations can be differentiated by their characteristics. The term embolism in relation to stroke is characterised by a condition where an embolus is created in one part of the brain or the body, circulates in the bloodstream, and eventually blocks the flow of blood through a vessel in another part of the brain (Crosta, 2009). This is called embolic stroke. On the other hand, the term thrombosis is characterised by the formation of a clot resulted from fatty deposits or plaque blocking the passage of blood through the artery. Th is type of clot remains in one area of blood vessels without being carried throughout the bloodstream. This is called thrombotic stroke (Brown Edward, 2012). Stroke risk factors There are multiple risk factors associating with stroke as according with (Brown Edward, 2012). The risk factors can be classified into non-modifiable risk factors and modifiable risk factors. Non-modifiable risk factors include age, gender, race and heredity. Modifiable risk factors include diabetes mellitus, heart disease, atrial fibrillation, heavy alcohol consumption, hypercoagulability, hyperlipidaemia, hypertension, obesity, physical inactivity, sickle cell disease and smoking. Jithra, at 68, was diagnosed with hypertension or high blood pressure and diabetes mellitus. Age, hypertension and diabetes mellitus have played a key role in contribution to stroke. ‘Stroke risk increases with age, doubling each decade after age 55 (Brown Edward, 2012, p. 1622).’ The rate of atherosclerotic development is usually increased by the stress of a constantly elevated blood pressure. The term atherosclerosis is referred to as hardening of the arteries resulting from the formation of fatty deposits or plaques. The narrowing of the blood vessels is its consequence. The carotid artery in the neck is a common site where these plaques develop and tend to break away and lodge in the vessels of the brain (Sander, 2013). Likewise, diabetes mellitus increases tendency towards the dysfunction of the inner linings of the blood vessel walls leading to an increase in the tendency towards the development of plaques. In addition, high cholesterol and triglyceride levels are highly likely among people with diabetes mellitus (Brown Edward, 2012, p. 863). Impact of Stroke According to Brown and Edward (2012), stroke is a leading cause of serious, long-term disability. Jithra has been living with left side paralysis since she was 64 as a consequence of stroke. Immobility and the weakness in Jithra’s right arm and leg are the key limitations. She relies greatly on her family members when repositioning in bed is attempted and a combination of self-care abilities and activities of daily living, such as eating or drinking, are performed. Dysarthria, a disturbance in the muscular control of speech, is also experienced. Impairment may involve pronunciation, articulation and phonation. This helps explaining why Jithra feels uncomfortable communicating with strangers. As the interview went, a sudden change in emotion was spotted. Persons who have had a stroke may have difficulty controlling their emotions. Emotional responses may be exaggerated or unpredictable (Brown Edward, 2012, p. 1628).The daughter said that Jithra sometimes cried without any reas on. The interchanging between laughing and crying took only minutes to do so. Besides pressure, shearing force, friction and excessive moisture contribute to pressure ulcer formation (Maklebust Sieggreen, 2001). As mentioned above that Jithra is bed-bound and greatly relies on her family members when repositioning is attempted, manual handling is used in order to lift and move her around the bed. However, the incorrect techniques combined with non-supportive equipment, such as sliding sheet, have put the maintenance of Jithra’s skin integrity becomes much more difficult. Pressure Ulcer According to Sydney South West (2008, p. 4), pressure ulcers are defined as â€Å"any lesion caused by unrelieved pressure when soft tissue is compressed between a bony prominence and an external surface for a prolonged period.† Factors that influence the development of pressure ulcers include the intensity of the pressure; the length of time the pressure is exerted on the skin; and the ability of the tissue to tolerate the externally applied pressure. Intrinsic factors that put Jithra at risk in developing pressure ulcers consist of advanced age, malnutrition and diabetes mellitus. Extrinsic factors include pressure, shear and moisture Sydney South West (2008). Intervention Although the skin remains intact, the appearance of persistent redness, particularly in sacrum, followed by itchy sensation indicates that stage one pressure ulcer has already developed. Stage one pressure ulcer can be intervened as referred to pressure ulcer intervention guidelines (Jones, 2013) by strictly maintaining the skin integrity. This can be done by relieving the externally applied pressure, protecting fragile skin and bony prominence, preventing friction and shearing and protecting skin from moisture. In relieving the externally applied pressure, a regime of repositioning combined with the use of pressure relieving devices has already been utilised by Jithra’s daughter. However, it might not be enough in terms of the frequency. The frequency of repositioning depends on the ability of the tissue to tolerate the externally applied pressure. In this case, Jithra should move or be repositioned frequently enough in allowing reddened area of affected skin to recover from the effects of pressure. A turn clock may be a helpful reminder of correct body positions and appropriate turning times. Additionally, a 30-degree side lying position may well be utilised for Jithra as it diverts pressure from the sacrum. Maintaining a 30-degree side lying position can simply be done by using pillow or foam positioning wedges. However, lying on the side may increase pressure on extremities, especially knees and ankles. Placing pillows between the legs helps preventing opposing knees and ankles fr om exerting pressure on one another (Maklebust Sieggreen, 2001). In protecting fragile skin and bony prominence, an appropriate support surfaces shall be used and yet its cost has to be taken into consideration. Poverty and debt make it very difficult for Jithra to afford buying or renting them. ‘Charges can range from $24 to purchase a foam overlay to a daily rental fee of $125 for a highly technical therapy bed (Maklebust Sieggreen, 2001, p. 75).’ Regardless of the variations in price, There is no scientific evidence that one support surface consistently works better than any others. Nevertheless, pressure points require protection whether at risk persons are in a bed or on a chair. Using pillows to bridge vulnerable areas, again simple, is an effective way to eliminate pressure. A regime of repositioning, together with the use of pillows has proved to be highly effective in protecting fragile skin and bony prominence. In preventing Jithra from friction and shearing, a family education on how friction and shearing occur and correct usage of manual handling techniques and appropriate equipment shall be provided. Shear is greatest when a caregiver drags an at risk person along the surface of the sheets during repositioning or allows the person to slide from high-fowler’s position. In order to minimise shearing force, the head of the bed shall not be raised exceeding a 30 degree angle, unless the patient is eating. Furthermore, friction, a precursor of shear, is commonly caused by pulling a patient across the bed linen. Rubbing the protective layer of skin away increases the potential for deeper tissue damage. Excessive moisture may be the result of sweating, wound drainage, soaking during bathing and faecal and urinary incontinence. Moist skin is five times as likely to become ulcerated as dry skin. The intervention guidelines suggested that protecting skin from moisture can be done by using continence management systems, using barrier skin cream to prevent skin maceration and keeping the site clean and dry. Living in a hot and humid country like Thailand may put Jithra at a higher risk of developing pressure ulcer due to sweating. Thailand normally has its temperature sitting at around 30 degree Celsius. Two fans, together with the application of baby powder are used in maintaining the dryness of Jithra’s skin. Recommendation According to Jones (2013), it is highly recommended that risk assessments must be done on Jithra by using the Waterlow scale. In doing so, her body mass index is required. The scale will give a score which helps identifying if Jithra is at risk, high risk or very high risk in developing pressure ulcers. Therefore, repositioning regime can be precisely arranged in order to ensure optimum pressure redistribution. Manual handling, together with the use of equipment such as hoists or slide sheets, effectively helps avoiding shear and friction. Education on the use of the mentioned equipment shall also be provided. A dietician shall be involved in discussing knowledge of healthy diet and considering the need for food fortification and nutritional supplements. Make sure that Jithra consumes adequate fibre and well hydrated as she is more prone to constipation due to immobility. Conclusion This can be concluded that the maintenance of skin integrity plays a key role in avoiding the development of pressure ulcers. Being rich or poor might not be the factors in treating and preventing pressure ulcers. This essay has shown how beneficial it is to have carers or family members who strictly put pressure ulcer intervention and prevention guidelines into practice to look after Jithra. The mattress that Jithra lays her body on might not be the best that the family can afford but frequently turning and maintaining dry skin have proved in lowering the risk of developing pressure ulcers. Only stage one pressure ulcer developed though, Jithra has been suffering from disability for 4 years. References Brown, D., Edwards, H. (Eds.). (2012). Lewiss medical-surgical nursing: assessment and management of clinical problems. NSW, Australia: Elsevier Australia. Crosta, P. (2009). What Is Embolism? What Are The Different Types Of Embolism?. Medical News Today. Retrieved from http://www.medicalnewstoday.com/articles/153704.php Jones, D. (2013). Pressure ulcer prevention in the community setting. Nursing Standard, 28 (3) 47-55. Retrieved from http://web.a.ebscohost.com.ezproxy.holmesglen.vic.edu.au/ehost/pdfviewer/pdfviewer?vid=3sid=87c6951d-c6be-44c5-8985-c35d1918eb04%40sessionmgr4004hid=4207 Maklebust, J., Sieggreen, M. (2001). Pressure Ulcers: Guidelines for Prevention and Management (3rd ed.). Pennsylvania, USA: Springhouse Corporation. ONeill, P. A. (2002). Caring for the Older Adult: A Health Promotion Perspective. Pennsylvania, USA: W.B. Saunders Company. Sander, R. (2013). Prevention and treatment of acute ischaemic stroke. Nursing Older People, 25(8), 34-39. Scott, K., Webb, M., Sorrentino, S., Gorek, B. (Eds.). (2006). Long-term care assisting: Aged care and disability. NSW, Australia: Elsevier Australia. Stroke Foundation. (2014). Types of Stroke. Retrieve from http://strokefoundation.com.au/what-is-a-stroke/types-of-stroke/ Sydney South West Area Health Service. (2007). Pressure Ulcer Prevention and Management. Retrieved fromhttp://www.sswahs.nsw.gov.au/pdf/policy/pd2008008.pdf Watkins, C., Leathley, M. (2010). Setting the scene. In Williams, J., Perry, L., Watkins C. (Eds.), Acute Stroke Nursing (pp.1-16). Retrieved fromhttp://0-onlinelibrary.wiley.com.alpha2.latrobe.edu.au/store/10.1002/9781444318838.ch1/asset/ch1.pdf?v=1t=ht43cw4ls=1791526b00be208b196d718b1c2189904267ad40 World Health Organization. (2014). Stroke, Cerebrovascular Accident. Retrieved from http://www.who.int/topics/cerebrovascular_accident/en/

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A Game of Thrones Chapter Thirty-nine

Eddard He dreamt an old dream, of three knights in white cloaks, and a tower long fallen, and Lyanna in her bed of blood. In the dream his friends rode with him, as they had in life. Proud Martyn Cassel, Jory's father; faithful Theo Wull; Ethan Glover, who had been Brandon's squire; Ser Mark Ryswell, soft of speech and gentle of heart; the crannogman, Howland Reed; Lord Dustin on his great red stallion. Ned had known their faces as well as he knew his own once, but the years leech at a man's memories, even those he has vowed never to forget. In the dream they were only shadows, grey wraiths on horses made of mist. They were seven, facing three. In the dream as it had been in life. Yet these were no ordinary three. They waited before the round tower, the red mountains of Dorne at their backs, their white cloaks blowing in the wind. And these were no shadows; their faces burned clear, even now. Ser Arthur Dayne, the Sword of the Morning, had a sad smile on his lips. The hilt of the greatsword Dawn poked up over his right shoulder. Ser Oswell Whent was on one knee, sharpening his blade with a whetstone. Across his white-enameled helm, the black bat of his House spread its wings. Between them stood fierce old Ser Gerold Hightower, the White Bull, Lord Commander of the Kingsguard. â€Å"I looked for you on the Trident,† Ned said to them. â€Å"We were not there,† Ser Gerold answered. â€Å"Woe to the Usurper if we had been,† said Ser Oswell. â€Å"When King's Landing fell, Ser Jaime slew your king with a golden sword, and I wondered where you were.† â€Å"Far away,† Ser Gerold said, â€Å"or Aerys would yet sit the Iron Throne, and our false brother would burn in seven hells.† â€Å"I came down on Storm's End to lift the siege,† Ned told them, â€Å"and the Lords Tyrell and Redwyne dipped their banners, and all their knights bent the knee to pledge us fealty. I was certain you would be among them.† â€Å"Our knees do not bend easily,† said Ser Arthur Dayne. â€Å"Ser Willem Darry is fled to Dragonstone, with your queen and Prince Viserys. I thought you might have sailed with him.† â€Å"Ser Willem is a good man and true,† said Ser Oswell. â€Å"But not of the Kingsguard,† Ser Gerold pointed out. â€Å"The Kingsguard does not flee.† â€Å"Then or now,† said Ser Arthur. He donned his helm. â€Å"We swore a vow,† explained old Ser Gerold. Ned's wraiths moved up beside him, with shadow swords in hand. They were seven against three. â€Å"And now it begins,† said Ser Arthur Dayne, the Sword of the Morning. He unsheathed Dawn and held it with both hands. The blade was pale as milkglass, alive with light. â€Å"No,† Ned said with sadness in his voice. â€Å"Now it ends.† As they came together in a rush of steel and shadow, he could hear Lyanna screaming. â€Å"Eddard!† she called. A storm of rose petals blew across a blood-streaked sky, as blue as the eyes of death. â€Å"Lord Eddard,† Lyanna called again. â€Å"I promise,† he whispered. â€Å"Lya, I promise . . . â€Å" â€Å"Lord Eddard,† a man echoed from the dark. Groaning, Eddard Stark opened his eyes. Moonlight streamed through the tall windows of the Tower of the Hand. â€Å"Lord Eddard?† A shadow stood over the bed. â€Å"How . . . how long?† The sheets were tangled, his leg splinted and plastered. A dull throb of pain shot up his side. â€Å"Six days and seven nights.† The voice was Vayon Poole's. The steward held a cup to Ned's lips. â€Å"Drink, my lord.† â€Å"What . . . ?† â€Å"Only water. Maester Pycelle said you would be thirsty.† Ned drank. His lips were parched and cracked. The water tasted sweet as honey. â€Å"The king left orders,† Vayon Poole told him when the cup was empty. â€Å"He would speak with you, my lord.† â€Å"On the morrow,† Ned said. â€Å"When I am stronger.† He could not face Robert now. The dream had left him weak as a kitten. â€Å"My lord,† Poole said, â€Å"he commanded us to send you to him the moment you opened your eyes.† The steward busied himself lighting a bedside candle. Ned cursed softly. Robert was never known for his patience. â€Å"Tell him I'm too weak to come to him. If he wishes to speak with me, I should be pleased to receive him here. I hope you wake him from a sound sleep. And summon . . . † He was about to say Jory when he remembered. â€Å"Summon the captain of my guard.† Alyn stepped into the bedchamber a few moments after the steward had taken his leave. â€Å"My lord.† â€Å"Poole tells me it has been six days,† Ned said. â€Å"I must know how things stand.† â€Å"The Kingslayer is fled the city,† Alyn told him. â€Å"The talk is he's ridden back to Casterly Rock to join his father. The story of how Lady Catelyn took the Imp is on every lip. I have put on extra guards, if it please you.† â€Å"It does,† Ned assured him. â€Å"My daughters?† â€Å"They have been with you every day, my lord. Sansa prays quietly, but Arya . . . † He hesitated. â€Å"She has not said a word since they brought you back. She is a fierce little thing, my lord. I have never seen such anger in a girl.† â€Å"Whatever happens,† Ned said, â€Å"I want my daughters kept safe. I fear this is only the beginning.† â€Å"No harm will come to them, Lord Eddard,† Alyn said. â€Å"I stake my life on that.† â€Å"Jory and the others . . . â€Å" â€Å"I gave them over to the silent sisters, to be sent north to Winterfell. Jory would want to lie beside his grandfather.† It would have to be his grandfather, for Jory's father was buried far to the south. Martyn Cassel had perished with the rest. Ned had pulled the tower down afterward, and used its bloody stones to build eight cairns upon the ridge. It was said that Rhaegar had named that place the tower of joy, but for Ned it was a bitter memory. They had been seven against three, yet only two had lived to ride away; Eddard Stark himself and the little crannogman, Howland Reed. He did not think it omened well that he should dream that dream again after so many years. â€Å"You've done well, Alyn,† Ned was saying when Vayon Poole returned. The steward bowed low. â€Å"His Grace is without, my lord, and the queen with him.† Ned pushed himself up higher, wincing as his leg trembled with pain. He had not expected Cersei to come. It did not bode well that she had. â€Å"Send them in, and leave us. What we have to say should not go beyond these walls.† Poole withdrew quietly. Robert had taken time to dress. He wore a black velvet doublet with the crowned stag of Baratheon worked upon the breast in golden thread, and a golden mantle with a cloak of black and gold squares. A flagon of wine was in his hand, his face already flushed from drink. Cersei Lannister entered behind him, a jeweled tiara in her hair. â€Å"Your Grace,† Ned said. â€Å"Your pardons. I cannot rise.† â€Å"No matter,† the king said gruffly. â€Å"Some wine? From the Arbor. A good vintage.† â€Å"A small cup,† Ned said. â€Å"My head is still heavy from the milk of the poppy.† â€Å"A man in your place should count himself fortunate that his head is still on his shoulders,† the queen declared. â€Å"Quiet, woman,† Robert snapped. He brought Ned a cup of wine. â€Å"Does the leg still pain you?† â€Å"Some,† Ned said. His head was swimming, but it would not do to admit to weakness in front of the queen. â€Å"Pycelle swears it will heal clean.† Robert frowned. â€Å"I take it you know what Catelyn has done?† â€Å"I do.† Ned took a small swallow of wine. â€Å"My lady wife is blameless, Your Grace. All she did she did at my command.† â€Å"I am not pleased, Ned,† Robert grumbled. â€Å"By what right do you dare lay hands on my blood?† Cersei demanded. â€Å"Who do you think you are?† â€Å"The Hand of the King,† Ned told her with icy courtesy. â€Å"Charged by your own lord husband to keep the king's peace and enforce the king's justice.† â€Å"You were the Hand,† Cersei began, â€Å"but now—† â€Å"Silence!† the king roared. â€Å"You asked him a question and he answered it.† Cersei subsided, cold with anger, and Robert turned back to Ned. â€Å"Keep the king's peace, you say. Is this how you keep my peace, Ned? Seven men are dead . . . â€Å" â€Å"Eight,† the queen corrected. â€Å"Tregar died this morning, of the blow Lord Stark gave him.† â€Å"Abductions on the kingsroad and drunken slaughter in my streets,† the king said. â€Å"I will not have it, Ned.† â€Å"Catelyn had good reason for taking the Imp—† â€Å"I said, I will not have it! To hell with her reasons. You will command her to release the dwarf at once, and you will make your peace with Jaime.† â€Å"Three of my men were butchered before my eyes, because Jaime Lannister wished to chasten me. Am I to forget that?† â€Å"My brother was not the cause of this quarrel,† Cersei told the king. â€Å"Lord Stark was returning drunk from a brothel. His men attacked Jaime and his guards, even as his wife attacked Tyrion on the kingsroad.† â€Å"You know me better than that, Robert,† Ned said. â€Å"Ask Lord Baelish if you doubt me. He was there.† â€Å"I've talked to Littlefinger,† Robert said. â€Å"He claims he rode off to bring the gold cloaks before the fighting began, but he admits you were returning from some whorehouse.† â€Å"Some whorehouse? Damn your eyes, Robert, I went there to have a look at your daughter! Her mother has named her Barra. She looks like that first girl you fathered, when we were boys together in the Vale.† He watched the queen as he spoke; her face was a mask, still and pale, betraying nothing. Robert flushed. â€Å"Barra,† he grumbled. â€Å"Is that supposed to please me? Damn the girl. I thought she had more sense.† â€Å"She cannot be more than fifteen, and a whore, and you thought she had sense?† Ned said, incredulous. His leg was beginning to pain him sorely. It was hard to keep his temper. â€Å"The fool child is in love with you, Robert.† The king glanced at Cersei. â€Å"This is no fit subject for the queen's ears.† â€Å"Her Grace will have no liking for anything I have to say,† Ned replied. â€Å"I am told the Kingslayer has fled the city. Give me leave to bring him back to justice.† The king swirled the wine in his cup, brooding. He took a swallow. â€Å"No,† he said. â€Å"I want no more of this. Jaime slew three of your men, and you five of his. Now it ends.† â€Å"Is that your notion of justice?† Ned flared. â€Å"If so, I am pleased that I am no longer your Hand.† The queen looked to her husband. â€Å"If any man had dared speak to a Targaryen as he has spoken to you—† â€Å"Do you take me for Aerys?† Robert interrupted. â€Å"I took you for a king. Jaime and Tyrion are your own brothers, by all the laws of marriage and the bonds we share. The Starks have driven off the one and seized the other. This man dishonors you with every breath he takes, and yet you stand there meekly, asking if his leg pains him and would he like some wine.† Robert's face was dark with anger. â€Å"How many times must I tell you to hold your tongue, woman?† Cersei's face was a study in contempt. â€Å"What a jape the gods have made of us two,† she said. â€Å"By all rights, you ought to be in skirts and me in mail.† Purple with rage, the king lashed out, a vicious backhand blow to the side of the head. She stumbled against the table and fell hard, yet Cersei Lannister did not cry out. Her slender fingers brushed her cheek, where the pale smooth skin was already reddening. On the morrow the bruise would cover half her face. â€Å"I shall wear this as a badge of honor,† she announced. â€Å"Wear it in silence, or I'll honor you again,† Robert vowed. He shouted for a guard. Ser Meryn Trant stepped into the room, tall and somber in his white armor. â€Å"The queen is tired. See her to her bedchamber.† The knight helped Cersei to her feet and led her out without a word. Robert reached for the flagon and refilled his cup. â€Å"You see what she does to me, Ned.† The king seated himself, cradling his wine cup. â€Å"My loving wife. The mother of my children.† The rage was gone from him now; in his eyes Ned saw something sad and scared. â€Å"I should not have hit her. That was not . . . that was not kingly.† He stared down at his hands, as if he did not quite know what they were. â€Å"I was always strong . . . no one could stand before me, no one. How do you fight someone if you can't hit them?† Confused, the king shook his head. â€Å"Rhaegar . . . Rhaegar won, damn him. I killed him, Ned, I drove the spike right through that black armor into his black heart, and he died at my feet. They made up songs about it. Yet somehow he still won. He has Lyanna now, and I have her.† The king drained his cup. â€Å"Your Grace,† Ned Stark said, â€Å"we must talk . . . â€Å" Robert pressed his fingertips against his temples. â€Å"I am sick unto death of talk. On the morrow I'm going to the kingswood to hunt. Whatever you have to say can wait until I return.† â€Å"If the gods are good, I shall not be here on your return. You commanded me to return to Winterfell, remember?† Robert stood up, grasping one of the bedposts to steady himself. â€Å"The gods are seldom good, Ned. Here, this is yours.† He pulled the heavy silver hand clasp from a pocket in the lining of his cloak and tossed it on the bed. â€Å"Like it or not, you are my Hand, damn you. I forbid you to leave.† Ned picked up the silver clasp. He was being given no choice, it seemed. His leg throbbed, and he felt as helpless as a child. â€Å"The Targaryen girl—† The king groaned. â€Å"Seven hells, don't start with her again. That's done, I'll hear no more of it.† â€Å"Why would you want me as your Hand, if you refuse to listen to my counsel?† â€Å"Why?† Robert laughed. â€Å"Why not? Someone has to rule this damnable kingdom. Put on the badge, Ned. It suits you. And if you ever throw it in my face again, I swear to you, I'll pin the damned thing on Jaime Lannister.†