High Risk Pregnancy and Women with Complex Health

High Risk Pregnancy and Women with Complex Health For this assignment I have been asked to look at the care I have seen and been involved in giving to a woman with a high risk pregnancy. I intend to identify how my practice could be developed to meet the similar needs of women in the future. To do this I am going to use a reflective approach. I am going to look at the normal anatomy and physiology and analyse the patho-physiology in relation to high risk pregnancy and birth. For most women, their midwife is their first point of contact so they have a crucial role to play in identifying any risks. Included in their extensive role is facilitating pregnancy and childbirth as a positive and fulfilling experience. This is most fundamental for those women whose childbearing experience has been categorised as high risk (Page, 2006). A pregnancy is classed as high risk if there are any factors that may adversely affect the fetal or maternal outcome. Risk factors must be identified as early as possible to increase the chances of an improved outcome (Queenan et al, 2007). When a woman is booked for her maternity care, her medical and obstetric history is taken to ascertain whether she would be suitable for midwifery led care (low risk) or consultant or obstetric led care (high risk). A woman can change from either group during her pregnancy. For example, she may start her care as low risk but then something may happen or a condition may develop so she may therefore require consultant input into her care. Factors which could mean a woman has a high risk pregnancy include epilepsy, diabetes, cardiac problems, multiple pregnancy, hypertension, obesity and previous obstetric complications, i.e. caesarean section, previous haemorrhage (whether that be antepartum, intrapartum or postpartum), recurrent miscarriages or previous intra-uterine death. Using Gibbs (1988) reflective cycle, I am going to discuss a woman I recently cared for whilst working on Central Delivery Suite, whose pregnancy had been assessed as high risk. This was due to her having had a previous emergency caesarean section and a previous ventouse delivery. In accordance with The Code (NMC, 2008) I have changed all names mentioned to respect their confidentiality. Description: Laura, aged 39 years old, was 39+1 weeks pregnant, gravida three, para two. As just mentioned, her obstetric history meant she would see an obstetric consultant during her pregnancy. As Laura was planning on having a vaginal birth after caesarean section (VBAC) this increased her risk. It was also apparent she had tested positive for Group B Streptococcus (GBS) in both her previous pregnancies. Laura had gone into spontaneous labour. Laura and her partner had both requested antibiotics to be started as soon as possible due to the previous GBS. This was not something my mentor could agree to as Laura had not tested positive for it at any point during this pregnancy. However, due to Lauras admission temperature reading being 38.1 °C and in view of the previous two pregnancies testing positive for GBS, it was decided by the obstetric consultant on duty that she would receive antibiotics during labour. We confirmed she was in established labour by performing a vaginal examination, with consent, and finding the cervix was 4-5 cms dilated, partially effaced and membranes were felt intact. After Laura was cannulated, the antibiotic Benzylpenicillin (Penicillin G) 3g was administered intravenously. Then at four-hourly intervals she was given 1.5g until delivery. Due to Lauras high risk status a cardiotocograph (CTG) was commenced to keep a trace on the fetal heart rate and the uterine contractions. Laura laboured for approximately 6 hours in total, and went on to have a normal vaginal delivery of a healthy baby boy. Postnatally, Lauras observations were taken and baby observations were also taken six hourly and observed for a minimum of twelve hours in accordance with Local Trust Guidelines (Local Trust, 2005). Feelings: This event particularly sticks in my mind due to my own curiosity about Group B Streptococcus. When Laura was showing a temperature of 38.1 °C, I recognised this was out of the normal range so I informed my mentor. I knew a high temperature could indicate a sign of infection so it was important I made my mentor aware. I felt calm at the time and knew my mentor and the obstetric consultant had the matter under control. My mentor made me feel included in the situation and explained fully what she was doing and when. She went through the process of preparing the drugs and the IV line with me. I was very happy with the outcome of the situation. At the end of the day, we all wanted a normal, natural delivery of a healthy baby and that was achieved. Evaluation: The ultimate goal of this situation was a healthy mother and baby, which was successfully achieved. I am glad the consultant made the decision that Laura would be started on antibiotics as I was aware of how anxious she was. Analysis: The final outcome was Laura had a healthy baby with no signs of GBS disease. Contributing factors to this were how I relayed important information to my mentor and how the obstetric consultant made the right choice offering Laura antibiotics, even though she had not tested positive for GBS in this pregnancy. I believe Laura should have been offered a test for GBS to confirm if it was present in this pregnancy or not. She was very anxious about the situation so I feel this would have at least helped put her mind at rest knowing either way. Her and her partner had come to CDS demanding antibiotics as a precaution anyway, and luckily for her, her high temperature meant she received them. Had she not had the high temperature that decision would have been down to the consultant. Conclusion: I learnt from this experience the correct drugs to be given in labour, and the quantities and times stages they should be given. I also learnt the drug to be given if the woman is allergic to the primary choice drug. Plus, from using this topic as my high risk assignment, the further reading I have undertaken has also taught me a lot. Action Plan: If the situation happened again, I would feel more confident in my knowledge of explaining to the woman and her family why we would advise her to have the antibiotics. In this particular situation, Laura knew a lot about GBS due to her previous pregnancies being tested for it and she was then subsequently treated during the labours. However, if a woman I was caring for had little knowledge of GBS, I feel I could explain it. Laura was classified as high risk due to her previous obstetric history. However, I am going to concentrate on the Group B streptococcus (GBS) she was concerned she had, after having it in both previous pregnancies. I also have a personal interest around GBS as this was something I tested positive for during my pregnancy and I did not really understand what it was or the complications of it. I was screened routinely as I was living in Spain at the time. Laura was only aware of her GBS, in her previous pregnancies, due to routine screening in Germany. She had not been screened here in the UK for GBS in this pregnancy, due to the uncertainty of clinical evidence and cost effectiveness of the routine screening (NICE, 2003). As mentioned in my reflection, this was something Laura was concerned about and requested she receive antibiotics during her labour as a precaution. Group B streptococcus is a common type of streptococcus bacterium. Approximately a third of men and women are carriers of GBS in their intestines and a quarter of women carry it in their vagina. Most people are unaware they are carriers as it can be difficult to detect and does not cause any symptoms. Carrying it is perfectly normal as it is one of many different bacterias that live within our bodies. Problems can arise when GBS is transmitted to the fetus. This could happen if the membranes rupture, during labour or the delivery. The fetus could come into contact with GBS if the bacterium travels upwards from the womans vagina and into the uterus due to the membranes not being there to protect the fetus. If there are prolonged rupture of membranes there is increased risk of transmission due to more time for the micro-organisms to be transported from the vagina into the cervix, and then to the uterus. According to the Group B Strep Association there is also evidence that GBS may cross intact membranes to expose the fetus whilst it is still in the womb. This could therefore cause preterm births, stillbirths or miscarriages. The fetus could also be exposed while passing through the birth canal. A preterm infant would be more susceptible as their lesser-developed bodies and immune systems are more vulnerable to GBS infection than older infants. The fetus could become infected if they swallow or inhale the bacteria (GBSA, 2011). If the fetus acquires GBS in utero this is known as early onset (Chapman, 2003). GBS can also be found on the hands and in the respiratory tract of a colonised person. So once a baby is born, GBS could be passed on to it from the hands. This is why, especially within the first 3 months of a babys life, it is so important for anyone who comes into contact with a baby, washes and dries their hands thoroughly. If the baby was to develop the disease from repeated exposure, this is called late onset (Chapman, 2003). In Lauras case, we were concerned about in utero transmission which could cause early onset GBS disease. This gave us the option for the administration of prophylactic antibiotics during labour, and at least two hours before delivery, which has been shown to reduce the frequency of neonatal GBS infection (Local Trust Guideline, 2009). Antibiotics given during labour can be very effective at preventing this transmission. A guideline written by The Royal College of Obstetricians and Gynaecologists (RCOG, 2003) state a woman should be offered intrapartum antibiotic prophylaxis if they have the following risk factors: à ¢-  previous baby affected by GBS à ¢-  GBS bacteriuria detected during the current pregnancy à ¢-  preterm labour (less than 37 completed weeks of pregnancy) à ¢-  prolonged rupture of the membranes (more than 18 hours before delivery) à ¢-  fever in labour (a temperature of more than 37.8 °C) Although Laura only had one of the above risk factors, she was offered the antibiotics at the discretion of the consultant. Women must also be reminded of the risks with taking antibiotics and be given all the information so they can make an informed choice. The antibiotics a woman receives will also depend if she has any allergies to medication. The recommended antibiotic for those allergic to penicillin is clindamycin, 900mg administered intravenously, from onset of labour and every 8 hours until delivery (GBSS, 2007, Local Trust Guideline, 2005). During my placement on the Neonatal Unit, I also cared for a baby that had to be admitted for antibiotics as its mother had tested positive for GBS during her pregnancy. She was unable to receive antibiotics as the the delivery was so fast and there was not enough time. Therefore the baby was admitted to the Neonatal Unit so he could receive antibiotics. Blood cultures from the baby were obtained and he was treated with penicillin until the culture results were available. This enhanced the importance of the woman receiving the prophylactic antibiotics during labour. In any high risk situation it is vital that maternal and fetal well being is monitored. As Laura was high risk she was placed on continuous cardiotocograph (CTG) monitoring. This gave us a recording and trace of the fetal heart rate so we could indentify any deviation from the norm, in comparison with the baseline for that baby. The primary aim of the CTG is to identify a fetus that may be hypoxic so additional assessments of fetal well-being can be used (i.e. fetal blood sampling) or the fetus being delivered by an instrumental vaginal birth or caesarean section. The use of this kind of technology is justified in being able to save the life a fetus that is shown to be in distress. The CTG detects the fetal heart rate (FHR) and the uterine activity (toco) simultaneously and displays it in the form of graph. It is important to check the maternal pulse at the same time as applying the CTG, to ensure the machine is recording the fetal heart rate, and not the mothers. The modern machines we use at my Trust have a maternal pulse sensor which the mother applies to her finger, which then records the maternal pulse rate on the graph that is printed out. The continuous electronic monitoring using the CTG is vital to get a contemporaneous recording of the fetal heart rate. It will give us the baseline heart rate (usually between 110-160 beats per minute), accelerations (momentary increases in the fetal heart rate) and decelerations (momentary decreases in the fetal heart rate). Some aspects of labour will cause natural alterations in the FHR patterns. For example, the pattern will be different when the fetus is asleep or awake. External factors, like uterine contractions and maternal movement can cause the FHR to change. The FHR can also be affected by opiate based painkillers, like pethidine. Some of these changes are quite subtle and can only be detected by continuous CTG e.g. baseline variability, temporal shape of decelerations. To be a competent midwife, it is imperative I have knowledge on how to interpret the recorded traces of a CTG. I have seen many CTG traces whilst on my hospital placement due to the high number of high risk women my Trust cares for. However, I still feel I am learning new things every time I see one, as everyone is different. I can distinguish between baseline tachycardia (where the fetal heart rate baseline rises above 160 beats per minute) and baseline bradycardia (the opposite, where the fetal heart rate baseline goes below 110 beats per minute) (Mukherjee, 2007). Baseline tachycardia could be physiological if the trace is from a preterm fetus due to immaturity or secondary to maternal pyrexia or dehydration. It could also be a sign of fetal hypoxia. The fetus would try to increase the cardiac output mainly by increasing the heart rate to supply vital organs with oxygen and nutrients. Baseline bradycardia could be physiological if the trace is from a post-term fetus or possibly a large fetus, provided there are also accelerations present and there baseline variability is above the normal range (>5 beats per minute). If it is just baseline bradycardia with no other normal or reassuring factors, this would need immediate action. Another form of technology used within Lauras pregnancy was screening. When she was initially booked for her antenatal care, her blood and urine would have be sent for screening, after she consented to this. She would also have attended ultrasound scans which are also a form of screening. This is something that is offered to all pregnant women and regardless of their risk status, it is used in both low and high risk pregnancies. It is a process which has been developed, which was not done previously due to lack of knowledge and technology. The standard screening during the antenatal period is urine; to check for any sign of infection, and blood; to check the womans blood group, her rhesus status, her iron levels, if she is immune to rubella, and to check for hepatitis B, syphilis and HIV (NHS Choices, 2011). In line with the National Institute for Clinical Excellence (2003) pregnant women should be offered evidence based information and support to enable them to make informed decisions regarding their care. This means women should be informed of all screening tests available to them. I believe this should include information about screening which is not necessarily available within the NHS but could be carried out privately, for example, GBS screening. There are arguments for and against introducing routine screening for GBS in the UK. Plumb, Holwell and Clayton (2007) argue that in the UK, GBS prevention is inadequate. They believe the NHS should offer testing for GBS in late pregnancy, thus giving women the opportunity to establish whether their baby is at higher risk of developing the GBS infection. My current Trust guideline (2005) state there is not enough evidence for it at this time. GBS awareness campaigners, Group B Strep Support, are pushing for routine testing to be introduced in the UK (Prince, 2011). According to GBSS, Western countries that routinely test, have a lower incidence of infection in new born babies, where as cases in the UK are on the rise. Even since the introduction of the Royal College of Obstetrics and Gynaecologists guideline for preventing GBS infection in newborns, in 2003, there has not been a decrease in either the number or the incidence of GBS infections in babies (GBSS, 2007). The table below shows the how the GBS infection in babies has increased throughout England, Wales and Northern Ireland. Year report published Number All cases (babies 0-90 days old Incidence per 1000 live births Number Early onset (babies 0-6 days old) Incidence per 1000 live births Number Late onset (babies 7-90 days old) Incidence per 1000 live births Number 2003/3004 311 0.48 207 0.32 104 0.16 0.48 2006/2007 409 0.61 248 0.37 161 0.24 0.61 2007/2008 421 0.61 258 0.37 163 0.24 0.61 2008/2009 470 0.66 279 0.39 191 0.27 0.66 (data published by the Health Protection Agency taken from www.gbss.org.uk/filepool/GBS_Infections_on_the_Increase.doc) Table 1 Number and rate (per 1000 live births) of group B streptococcal bacteraemia reports in infants 0à ¢Ã¢â€š ¬Ã‚ 90 days old in England, Wales and Northern Ireland: 2003-2009. The overall number of GBS infections within adults is also reported to have increased by more than 72% from 2001 to 2008: (data published by the Health Protection Agency taken from www.gbss.org.uk/filepool/GBS_Infections_on_the_Increase.doc) Table 2 Number of GBS infections in both males and females within England, Wales and Northern Ireland: 2001-2008. A better indication of the rise in GBS infections would be taken from women only, who are 35-37 weeks pregnant. I believe this would give more of an insight into pregnancy GBS infection rates. While the evidence states the increase in rates, I could not find any reasons for the increases. Some factors I believe may contribute to the rise include the lack of personal hygiene, modern living or even due to lifestyle. For example, many years ago clothing and underwear used to be boiled when washing but now people may be washing their clothes on a 40 °C wash and this may not be enough to kill all the bacteria. It may not be due to any of these factors; it may just be we have a better awareness of GBS now then what we did years ago. With the constant improvement of technology, we will also be finding out new things. Although the internet is not a form of technology we use within midwifery, it is certainly a form of technology we definitely need to be aware of. Within the last ten years or so, the internet has become increasingly popular. This means the general public can find about anything, more importantly medical information they may not have been able to access before. Therefore, we need to be aware of those women that we care for, that may have either some basic knowledge or an in-depth knowledge of a medical issue, for instance GBS. The NHS even has a website called NHS Choices (www.nhs.uk) which people can access to check symptoms and research illnesses and also pregnancy. I think this is mainly a good thing, although women may read so much into something they find online and it may make them more anxious or worried. It should not replace the direct contact with their midwife. The Nursing and Midwifery Council (NMC, 2008), state we should be delivering care based on the best available evidence. By reading the research I have found to write this assignment I am adhering to The Code by giving women evidence based advice. I may not be able to radically change my operational practice but I will definitely be more aware of what to look for and how to manage the situation. I will also ensure I am aware of those women who may have a more in-depth knowledge about GBS and understand their anxieties. From writing this assignment I have identified the risks of GBS, who the risks affect and to what degree it could affect them. I feel I would be able to recognise the signs and be aware of the treatment and management. I have acknowledged the main technology used is for the screening of GBS within the laboratory investigation systems and believe this should be carried out routinely within the UK. Final Word Count: 3,361

Find out whether or not congestion zones are a good idea

Are Congestion Zones A Good Idea? In this report I will be finding out whether or not congestion zones are a good idea, using researched data, charts and tables to back up my ideas. The conclusion of this matter relies on how accurate and reliable the information is. Congestion Zones are used in hope that traffic gets reduced. The mayor of London has recently put congestion zones into place in hopes they will reduce traffic by 15%. Critics of the scheme however, say that it is unworkable and unfair. They also claim it will probably lead to more congestion as people try to avoid the charging areas. Central London has had a dramatic cut in traffic since the introduction of the congestion charge. 40 000 less people are driving through the zone each Some people agree with the congestion charge, and can produce many facts to support their view. My source one can also provide many facts and figures. Source one says that since the congestion zone was put into place, traffic had been cut by 18%, and delays were down by 30% since the congestion zone has been bought in, the advantage of congestion zone was clear as the traffic was rapidly decreasing after the introduction of congestion zones. If the traffic is reduced then there will be no delays so not that much pollution released in to the atmosphere; which leads to climate effects for example global warming. The public transport in the city has improved dramatically by 20%, with 29,000 more people using the service- which will mean much more money towards its improvement. This also contributes to the protection of our planet against climate changes which can have social effects. If more people chose to use the bus or taxi then this would improve their health as they would walk and always go on separate cars. Source one also says that the streets of London were ‘clogged' and the heavy traffic on the roads were costing businesses approximately i2 million a week. Congestion zones are good because people only use them if they really have to, the evidence to this point is in source 1 when it states â€Å"there are 65,000 fewer car trips†, and so this means a cut down on gases being emitted into the air. So, less pollution. Source 1 also states that the costs that people pay are going towards the environment, new more environmentally friendly buses. As i50m is contributed mainly through quicker and more reliable journeys for road and bus users. This is also an advantage as the money is not going to the government but is used to help our transport. The news article declares that, Research, polls and surveys also shows that 75% of Londoners supported the scheme ‘because it works'. That factor that it really helps us as all of the congestion charge is kindly contributed to improving the public transport. Source 2 goes on saying that there research have shown that there was much urgently street works done with the help of this money, such as replacing ancient leaking water pipes. If congestion zones are reducing traffic by 21 per cent and 70,000 cars every day then it must really work. On the other hand congestion zones can also become a disadvantage. For my second source, I have a newspaper article from London Evening Standard news to support my point. In this source, Angie Bray sates that the rate of traffic rose to 2. 6 and 2. 7 minutes per kilometre. This is a disadvantage as if there is a high traffic rate then the will be more pollution caused than cars at normal speed. The number of cars that was entering the congestion zone has rapidly increased from previous years. The newspaper clearly states that â€Å"surely now is the time to start thinking about an alternative way to tackle congestion†. Evidently, the congestion charge did not really work out as the number of cars has risen. The local newspaper gave me evidence that congestion charge was a failure as it states that earlier this month their research has told them that traffic in the morning rush hour was running more slowly than before the scheme began. Angie Bray speaks that the charge has lost its main justification. Which is truly concerning as there is no change in climate. Congestion charge has a knock on effect on the environment and economically. Not many people will want to pass through the zone unless it's necessary, so they would find other alternative ways to pass the area causing more congestion in other roots. This effects the people around that area as they live in an atmosphere filled with bio-products. Thus, many would use buses to travel instead of their own cars. This again results in a disadvantage of congestion zones as there is more buses equals' huge amount of pollution made by one bus against 10 cars. Congestion charges can affect people and also businesses. This is because businesses have lost profits after the congestion zones were placed. As businesses need stock delivery which might need to cross the charging area which trails to extra costs, leading to lower profits. The workers might have to cross the congestion zone to go to work every day, resulting in quitting that job. This again affects the businesses to lose their workers. The evidence from source 1 supports my point as it states that 68% of retail businesses said the scheme would have been better without the charge. Source reliability can make all the difference, which is why I have picked three very reliable sources. My Source one is a report by BBCNEWS. I feel this makes it very reliable. This is because the BBC is a well-known and trusted organisation, backed by the government. The Source also includes exclusive interviews for the BBC by the mayor of the time, Ken Livingstone. This report was published on the 17th February 2004. Though this source is a lot years old, I think it is still reliable, because the evidence is still valid. The Source is very relevant to the question, as it provides facts supported and given by the government, but also includes opinions of Londoners. The Source also has validity, as it addresses all the factors that it claims to. My source 2 is as reliable as source one as it is a report from the local newspaper for London readers. It is well known in London so it is trusted a lot. This report contains exclusive interviews with Angie Bray. However it was published in 22th November 2007 as this means it are a couple of years old, so it is not reliable as this data is not up to date and might not be the case now. My source three holds a great importance of the reliability as it is reliable. This is because facts and figures form the article is as relevant and reliable. As it comes from a trust worthy newspaper article. Because the stats are from the government, they are going to be very reliable indeed, as they will contain no gossip, rumours or assumptions. Out of all my Sources; I feel that my Source two is most reliable. This is due to age, validity, fact, bias, author and the exclusive interviews. This Source shows both positive and negative points about the congestion charge. The congestion charge also has an impact on many other things, which I can place under Social, Economic and Environmental. The social effects are that the people that will be affected by this are local. It will mainly affect local, seeing as those in the area will either have to pay the charge, or they will be facing probable delays on alternate routes, due to the number of people trying to avoid the area. They will also benefit from the cleaner, safer air if they live around the congestion zones. If a person is caught up in heavy traffic their journey times will be unreliable, impacting on all sorts of thing such as family, work, health appointments etc. The economic effects are that for those that have no choice but to pass through the zone it is just adding to their payments. Not only do they have bills and road tax, but now they have to pay i8. 00 every time they need to get somewhere essential, such as my research shows some businesses are being affected by things such for instance stock delivery, which now costs the business more because of the charge. Finally the environmental effects are, obviously pollution plays a big part in the charge. My data shows that the pollution levels inside the zones are decreasing massively. With toxic nitrogen levels dropping quicker but still maintaining a normal level, it seems to be like the charge is working. As for the environment, if a vehicle is moving slowly or stationary, it produces more carbon emissions than if it moves at a normal speed. Thus, more global warming and other climate change which affect animals and humans. The other gases are released like sulphur dioxide, this will cause acid rain and damage the marble and other materials which costs a lot to repair. One of the negative effects of the congestion charge is its knock-on effect on the wider community; with people looking for new routes, surrounding areas could become clogged with congestion, and we would have the same problem all over again. To conclude, after considering all the evidence for both sides, I think that overall congestion charges are a good idea. That's not to say that it doesn't have its negative points though, because it does. The information that most helped me reach my decision was the data I found, and my source 1, BBCNEWS report. This is because I feel the health of the people will be improving, and you can't really argue with that. Also, the fact that the money is being spent on the public- which I think is a brilliant idea. However, like I have said, the congestion charge does not come without its negative points, such as: people paying a ‘double tax' when they have no choice, delays and congestion being created on alternate routes due to drivers trying to avoid the congestion charge area, and also, the fact that some businesses are suffering is something that I find quite unacceptable. So yes, the system does need some tweaking, but overall think it is a good idea that initially solves a problem. I think my conclusion is valid because I have considered all of the evidence and made an educated decision.

Homosexuality: Nature Versus Nurture

HOMOSEXUALITY: NATURE VERSUS NURTURE Nature; all things belong to Mother Nature; the trees, the flowers, insects, the great waters, animals, and even the human race; all following the laws of nature that we are instinctively born with. However somewhere along the line something or someone defies those laws and go against what nature intended. Whether or not this rebellion is fostered by nurture, or if there is an exception to the laws that Mother Nature has set forth is a question that psychologist and many people have encountered and most have yet to find the answer. Homosexuality has been thought of as being something that some are born with and others believe it is a learned behavior. Whether or not nature or nurture is the cause for this â€Å"abnormality† we may never definitively know the answer to. But then again that all depends on what we define as being â€Å"normal†. To begin to answer the questions that plague humanity about sexual orientation we must first ask ourselves what exactly is sexuality and what role does it play in our society and the continuation of life. Sexuality is broken down into three areas: heterosexuality, bisexuality, and homosexuality. If you look at these on a scale one’s sexuality would be measured by the degree in which ones feelings are more drawn too from one end of the scale to the other (Feldman, 2009, pg 376). There are several components that are argued to have a significant role in what a person’s sexual identity is. These components are both biological and environmental in nature (Feldman, 2009, pg 377). Biologically hormones may play a role in determining sexual orientation (Feldman, 2009, pg 377). â€Å"Research has shown that women exposed to a drug called diethylstilbestrol (DES), taken by women to avoid miscarriage, before birth were more likely to be homosexual or bisexual† (Feldman, 2009, pg 377). â€Å"There is also research suggesting that brain structure could be a factor in the determination of ones sexuality† (Feldman, 2009, pg 377). The structure of the anterior hypothalamus, an area of the brain that governs sexual behavior, differs in male homosexuals and heterosexuals; compared with heterosexual men or women, gay men have a larger anterior commissure, which is a bundle of neurons connecting the right and left hemispheres of the brain† (Feldman, 2009, pg 377). Although biological reasoning can not be a clear cut explanation for homosexuality; it leaves us room to understand the condition of homosexuals rather than boorishly passing judgment on peopl e for something they did not ask to be. Examining the notion that homosexuality is a learned behavior rather than an innate behavior has led to one very interesting yet sad life lesson for one family suffering from what one could call the effects of inadvertent child abuse. David Reimer was born Bruce Reimer, however he was raised as Brenda Reimer. When David and his twin brother Brian were just six months old their mother took them in for a routine circumcision. The babies had been having difficulty passing urine and with the suggestion of the family Doctor Mrs. Reimer took her boys in for the procedure that would ultimately change David’s life before it even began (McKenna, Kessler, Tiefer, and Schober, 2002). â€Å"The doctors had chosen an unconventional method of circumcision, one in which the skin would be burned. The procedure went horribly wrong and Bruce's penis was burned so badly that it could not be repaired surgically. † Thinking irrationally, Mrs. Reimer’s first concerns were how Bruce would cope as an adolescent lacking a penis. The decision was made; after listening to a Doctor by the name of John Money, and taking into consideration his views on sexuality, it was decided that Bruce would be raised as a female, and was renamed Brenda. Dr. John Money of Johns Hopkins University in Baltimore argues that â€Å"boys – caught early enough – could be raised to be girls; nurture and not nature determines a child's gender, the doctor argued† (McKenna, Kessler, Tiefer, and Schober, 2002). If this is to be true, that nurture is the determining factor in ones sexuality, then raising Bruce as Brenda would seemingly erase any hardship he would have to encounter growing up. However that would prove to be furthest from the truth. Growing up Brenda couldn’t understand why she liked doing things that boys were doing and why as an adolescent she became attracted to girls and not boys. Eventually Brenda would learn the truth of her true identity and what he had been going through with Dr. Money and his â€Å"experiment†; a life experience that would ultimately lead to his committing suicide (McKenna, Kessler, Tiefer, and Schober, 2002). Subjecting individuals to such traumas can prove to have a psychological hold on people who have to endure such horrific episodes in their lives. Sexual trauma and early exposure to sexual activity is another argument in the quest to determine the roots to homosexuality. There are so many young girls today that start out with sexual activity at an early age; some as early as ten years old. Over time these young ladies are exposed to sexual activity such as oral sex, group sex, and same-sex gratification. They have allowed themselves to be misused by men, for lack of guidance, and find that blaming the men for their broken hearts is an easy way to act on their curiosities about same-sex relations. With the rise of same-sex parenting it is only natural for one to assume that such behavior displayed in the home would raise questions to rather or not this type of dysfunctional display of what a family is â€Å"supposed† to look like could actually be one of the causes of homosexuality amongst pre-teens and teens. If this is all they see at home this becomes normal to them; therefore making heterosexuality an abnormality. However on the contrary studies show that â€Å"researchers looked at information gleaned from 15 studies on more than 500 children, evaluating possible stigma, teasing and social isolation, adjustment and self-esteem, opposite gender role models, sexual orientation, and strengths. Studies from 1981 to 1994, including 260 children reared by either heterosexual mothers or same-sex mothers after divorce, found no differences in intelligence, type or prevalence of psychiatric disorders, self-esteem, well-being, peer relationships, couple relationships, or parental stress†(MD, Chang, 2002). Some studies showed that single heterosexual parents' children have more difficulties than children who have parents of the same sex,† Perrin says. â€Å"They did better in discipline, self-esteem, and had less psychosocial difficulties at home and at school† (MD, Chang, 2002). â€Å"Another study of 37 children of 27 divorced lesbian mothers and a similar number of children of he terosexual mothers found no differences in behavior, adjustment, gender identity, and peer relationships† (MD, Chang, 2002). The effects of same-sex parenting seems to be equally or more effective than that of heterosexual house-holds. The one governing element in child rearing is a combination of love, discipline, and explanation of things not easily understood. There can, however, be a much darker side to the equation. Such as childhood rape; â€Å"although it is difficult to make accurate estimates of the true incidence of child sexual abuse, due to the majority of the cases going unreported, experts estimate that each year a half million children are sexually abused† (Feldman, 2009, pg 380). The short – and longer term consequences of child hood sexual abuse can be extremely damaging. Victims report fear, anxiety, depression, anger, and hostility. Long-term effects may include depression, self-destructive behavior such as drug and alcohol abuse, poor self-esteem, and feeling of isolation† (Feldman, 2009, pg 381). Children who experience same-sex sexual abuse can suffer identity issu es when it comes time for them to identify their sexual orientation. Because of the trauma this behavior fosters confusion, and uncertainty about who they are sexually. There are however those who triumph in the face of adversity; those who take negatives and make out of them their testimony and help others with the same or similar issues. Take for example the life of Mr. Donnie McClurkin; as a child Donnie was not raped once but twice by two different family members. Both family members were of the male gender. Throughout his life Donnie had to cope with the sexual trauma he had endured at such an early age; he became confused and could not understand why him (Boykin, 2002). Mr. McClurkin led a homosexual lifestyle for over 20 years until he completely gave his life over to his religion. He is now married to a woman and has children. He no longer lives a homosexual lifestyle (Boykin, 2002) In this situation his choice to lead a homosexual lifestyle was fostered by sexual and mental trauma, this does not constitute factual standing that he was born a homosexual or even that he really â€Å"choose† to have these misunderstood feelings for the same sex. So how then do we conclude whether or not sexuality is a choice or an inborn attribute people come to this world with before they even completely understand the beauty of sexual orientation? Living in a world where you are forced suppress who you really are to pacify the needs of others will always be a hindrance and in turn will keep you oppressed in your own body. Most homosexuals suffer from depression because they are hiding their true selves from the world for fear of being exiled so-to-speak by society. However in this day and age freedom to self expression has become more accepted though there are still others who have become like a recluse to their families because of their sexual preference. Is homosexuality really a sin? First of all we have to establish what the word sin really means. According to the Bible; to sin is to transgress the law. Most people who are familiar with religion and its origin know that according to Hebrew Scriptures the law is what we call today the Old Testament, or more accurately referred to as the Torah. The Torah was given to Moses in it you will find the Ten Commandments (Exodus 34:28) Though in the United States of America church and state are deemed separate, the constitution adheres to those Ten Commandments in which speak nothing of homosexuality. So, how then does homosexuality become a sin; would it be the same as saying a person afflicted with mental retardation is a sinner; they too did not ask to be that way. Being in your natural state means to be who you are; if you are a homosexual who pretends to be heterosexual to please society you are then in an unnatural state. If God makes no mistakes then why are homosexuals persecuted so harshly? Religion is a man made institution to allow for structure within a society; it has nothing to do with nature. If one can not explain the beauty of God in mere mortal words how then can they determine what is natural and what is not. Life is an expression; so is love. Therefore if it is more natural for one to express their love with someone of the same sex, then who are we to judge? The line between â€Å"normal† and â€Å"abnormal† can be as thin as the line between love and hate. To be is to exist and to have your very existence held hostage by the insecurities of someone else’s existence is an injustice imposed by a society who finds great thrill in playing the role of God. Nature is beautiful. It brings with it the beauty of mystery and the excitement of being able to acquire knowledge thereof. It can not be explained by limiting its greatness to the confines of the human psyche and the ignorance of its grace. Nature determines what is natural. If it is born of nature that it is in the state it was intended to be; so again I ask who are we to judge? References Boykin, K. , (2002) Confessions of Donnie McClurkin. Retrieved May 23, 2009 from http://www. keithboykin. om/arch/2002/11/19/confessions_of. Feldman, R. S. , (2009) Understanding Psychology. Ninth Edition. New York: McGraw-Hill. McKenna W. , Kessler S. J. , Tiefer L. , Schober J. M. (2002). As Nature Made Him: The Boy Who Was Raised as a Girl. Archives of Sexual Behavior, 31(3), 301-306. Retrieved May 25, 2009, from Research Library database. (Document ID: 121961432). MD, Chang, L. , (2002). Study: Same-Sex Parents Raise Well-Adjusted Kids. Retrieved May 24, 2009 from WebMD Health News Archive. T he Bible. King James Version.

Rose-Hulman Institute of Technology Acceptance Rate, SAT/ACT Scores, GPA

Rose-Hulman Institute of Technology is a private college with an acceptance rate of 68%. Located in Terre Haute, Indiana an hour from Indianapolis, Rose-Hulman is a science, technology, engineering, and mathematics college. Rose-Hulman is one of the few technology schools that focuses almost entirely on undergraduate education. Considering applying to Rose-Hulman Institute of Technology? Here are the admissions statistics you should know, including average SAT/ACT scores and GPAs of admitted students. Acceptance Rate During the 2017-18 admissions cycle, Rose-Hulman had an acceptance rate of 68%. This means that for every 100 students who applied, 68 students were admitted, making Rose-Hulmans admissions process competitive. Admissions Statistics (2017-18) Number of Applicants 4,471 Percent Admitted 68% Percent Admitted Who Enrolled (Yield) 16% SAT Scores and Requirements Rose-Hulman Institute of Technology requires that all applicants submit either SAT or ACT scores. During the 2017-18 admissions cycle, 69% of admitted students submitted SAT scores. SAT Range (Admitted Students) Section 25th Percentile 75th Percentile ERW 610 700 Math 660 780 ERW=Evidence-Based Reading and Writing This admissions data tells us that most of Rose-Hulmans admitted students fall within the top 20% nationally on the SAT. For the evidence-based reading and writing section, 50% of students admitted to Rose-Hulman scored between 610 and 700, while 25% scored below 610 and 25% scored above 700. On the math section, 50% of admitted students scored between 660 and 780, while 25% scored below 660 and 25% scored above 780. Applicants with a composite SAT score of 1480 or higher will have particularly competitive chances at Rose-Hulman Institute of Technology. Requirements Rose-Hulman Institute of Technology does not require the SAT writing section or SAT Subject tests. Note that Rose-Hulman participates in the scorechoice program, which means that the admissions office will consider your highest score from each individual section across all SAT test dates. Note that Rose-Hulman requires minimum SAT scores of 500 on the evidence-based reading and writing section and 550 on the math section. ACT Scores and Requirements Rose-Hulman requires that all applicants submit either SAT or ACT scores. During the 2017-18 admissions cycle, 61% of admitted students submitted ACT scores. ACT Range (Admitted Students) Section 25th Percentile 75th Percentile English 26 34 Math 28 34 Composite 28 33 This admissions data tells us that most of Rose-Hulmans admitted students fall within the top 12% nationally on the ACT. The middle 50% of admitted students received a composite ACT score between 28 and 33, while 25% scored above 33 and 25% scored below 28. Requirements Rose-Hulman does not require the optional ACT writing section. Note that Rose-Hulman superscores ACT results; your highest subscores from multiple ACT sittings will be considered. Rose-Hulman requires minimum ACT scores of 21 for the English section and 24 for the math section. GPA In 2018, the average high school GPA of Rose-Hulman Institute of Technologys incoming freshmen class was 3.98, and 80% of incoming students had average GPAs of 3.75 and above. These results suggest that most successful applicants to Rose-Hulman have primarily A grades. Self-Reported GPA/SAT/ACT Graph Rose-Hulman Institute of Technology Applicants Self-Reported GPA/SAT/ACT Graph. Data courtesy of Cappex. The admissions data in the graph is self-reported by applicants to Rose-Hulman Institute of Technology. GPAs are unweighted. Find out how you compare to accepted students, see the real-time graph, and calculate your chances of getting in  with a free Cappex account. Admissions Chances Rose-Hulman Institute of Technology, which accepts over half of applicants, has a competitive admissions pool with above average GPAs and SAT/ACT scores. However, Rose-Hulman has a  holistic admissions  process involving other factors beyond your grades and test scores. A  strong application  essay  and  glowing letters of recommendation  can strengthen your application, as can participation in  meaningful extracurricular activities  and a  rigorous course schedule. Students with particularly compelling stories or achievements can still receive serious consideration even if their grades and test scores are outside Rose-Hulmans average range. In the graph above, the blue and green dots represent students accepted to Rose-Hulman Institute of Technology. Nearly all students had high school averages of B or higher. Successful applicants tended to have combined SAT scores of 1200 or higher (ERWM), and ACT composite scores of 25 or better. Your chances are best of your scores are a bit higher than these lower ranges. Because of Rose-Hulmans engineering focus, applicants tend to have particularly strong scores in math. If You Like Rose-Hulman, You May Also Like These Schools Purdue UniversityCornell UniversityStanford UniversityRochester Institute of TechnologyIllinois Institute of TechnologyHarvey Mudd CollegeCalifornia Institute of TechnologyCase Western Reserve University All admissions data has been sourced from the National Center for Education Statistics and Rose-Hulman Institute of Technology Undergraduate Admissions Office.