Active or Passive Third Stage of Labour: Pros and Cons

Active or Passive Third Stage of Labour: Pros and Cons Introduction This dissertation is primarily concerned with the arguments that are currently active in relation to the benefits and disadvantages of having either an active or passive third stage of labour. We shall examine this issue from several angles including the currently accepted medical opinions as expressed in the peer reviewed press, the perspective of various opinions expressed by women in labour and theevidence base to support these opinions. It is a generally accepted truism that if there is controversy surrounding a subject, then this implies that there is not a sufficiently strong evidence base to settle the argument one way or the other. (De Martino B et al. 2006). In the case of this particular subject, this is possibly not true, as the evidence base is quite robust (and we shall examine this in due course). Midwifery deals with situations that are steeped in layers of strongly felt emotion, and this has a great tendency to colour rational argument. Blind belief in one area often appears to stem from total disbelief in another (Baines D. 2001) and in consideration of some of the literature in this area this would certainly appear to be true. Let us try to examine the basic facts of the arguments together with the evidence base that supports them. In the civilised world it is estimated that approximately 515,000 currently die annually from problems directly related to pregnancy. (extrapolated from Hill K et al. 2001). The largest single category of such deaths occur within 4 hrs. of delivery, most commonly from post partum haemorrhage and its complications (AbouZahr C 1998), the most common factor in such cases being uterine atony. (Ripley D L 1999). Depending on the area of the world (as this tends to determine the standard of care and resources available), post partum haemorrhage deaths constitutes between 10-60% of all maternal deaths (AbouZahr C 1998). Statistically, the majority of such maternal deaths occur in the developing countries where women may receive inappropriate, unskilled or inadequate care during labour or the post partum period. (PATH 2001). In developed countries the vast majority of these deaths could be (and largely are) avoided with effective obstetric intervention. (WHO 1994). One of the central argumen ts that we shall deploy in favour of the active management of the third stage of labour is the fact that relying on the identification of risk factors for women at risk of haemorrhage does not appear to decrease the overall figures for post partum haemorrhage morbidity or mortality as more than 70% of such cases of post partum haemorrhage occur in women with no identifiable risk factors. (Atkins S 1994). Prendiville, in his recently published Cochrane review (Prendiville W J et al. 2000) states that: where maternal mortality from haemorrhage is high, evidence-based practices that reduce haemorrhage incidence, such as active management of the third stage of labour, should always be followed It is hard to rationally counter such an argument, particularly in view of the strength of the evidence base presented in the review, although we shall finish this dissertation with a discussion of a paper by Stevenson which attempts to provide a rational counter argument in this area. It could be argued that the management of the third stage of labour, as far as formal teaching and published literature is concerned, is eclipsed by the other two stages (Baskett T F 1999). Cunningham agrees with this viewpoint with the observation that a current standard textbook of obstetrics (unnamed) devotes only 4 of its 1,500 pages to the third stage of labour but a huge amount more to the complications that can arise directly after the delivery of the baby (Cunningham, 2001). Donald makes the comment This indeed is the unforgiving stage of labour, and in it there lurks more unheralded treachery than in both the other stages combined. The normal case can, within a minute, become abnormal and successful delivery can turn swiftly to disaster. (Donald, 1979). chapter 1:define third stage of labour, The definition of the third stage of labour varies between authorities in terms of wording, but in functional terms there is general agreement that it is the part of labour that starts directly after the birth of the baby and concludes with the successful delivery of the placenta and the foetal membranes. Functionally, it is during the third stage of labour that the myometrium contracts dramatically and causes the placenta to separate from the uterine wall and then subsequently expelled from the uterine cavity. This stage can be managed actively or observed passively. Practically, it is the speed with which this stage is accomplished which effectively dictates the volume of blood that is eventually lost. It follows that if anything interferes with this process then the risk of increased blood loss gets greater. If the uterus becomes atonic, the placenta does not separate efficiently and the blood vessels that had formally supplied it are not actively constricted. (Chamberlain G et al. 1999). We shall discuss this process in greater detail shortly. Proponents of passive management of the third stage of labour rely on the normal physiological processes to shut down the bleeding from the placental site and to expel the placenta. Those who favour active management use three elements of management. One is the use of an ecbolic drug given in the minute after delivery of the baby and before the placenta is delivered. The second element is early clamping and cutting of the cord and the third is the use of controlled cord traction to facilitate the delivery of the placenta. We shall discuss each of these elements in greater detail in due course. The rationale behind active management of the third stage of labour is basically that by speeding up the natural delivery of the placenta, one can allow the uterus to contract more efficiently thereby reducing the total blood loss and minimising the risk of post partum haemorrhage. (ODriscoll K 1994) discuss optimal practice, Let us start our consideration of optimal practice with a critical analysis of the paper by Cherine (Cherine M et al. 2004) which takes a collective overview of the literature on the subject. The authors point to the fact that there have been a number of large scale randomised controlled studies which have compared the outcomes of labours which have been either actively or passively managed. One of the biggest difficulties that they experienced was the inconsistency of terminology on the subject, as a number of healthcare professionals had reported management as passive when there had been elements of active management such as controlled cord traction and early cord clamping. As an overview, they were able to conclude that actively managed women had a lower prevalence of post partum haemorrhage, a shorter third stage of labour, reduced post partum anaemia, less need for blood transfusion or therapeutic oxytocics (Prendiville W J et al. 2001). Other factors derived from the paper include the observation that the administration of oxytocin before delivery of the placenta (rather than afterwards), was shown to decrease the overall incidence of post partum haemorrhage, the overall amount of blood loss, the need for additional uterotonic drugs, the need for blood transfusions when compared to deliveries with similar duration of the third stage of labour as a control. In addition to all of this they noted that there was no increased incidence of the condition of retained placenta. (Elbourne D R et al. 2001). The evidence base for these comments is both robust and strong. On the face of it, there seems therefore little to recommend the adoption of passive manage ment of the third stage of labour. Earlier we noted the difficulties in definition of active management of the third stage of labour. In consideration of any individual paper where interpretation of the figures are required, great care must therefore be taken in assessing exactly what is being measured and compared. Cherine points to the fact that some respondents categorised their management as passive management of the third stage of labour when, in reality they had used some aspect of active management. They may not have used ecbolic drugs (this was found to be the case in 19% of the deliveries considered). This point is worth considering further as oxytocin was given to 98% of the 148 women in the trial who received ecbolic. In terms of optimum management 34% received the ecbolic at the appropriate time (as specified in the management protocols as being before the delivery of the placenta and within one minute of the delivery of the baby). For the remaining 66%, it was given incorrectly, either after the delivery of the placenta or, in one case, later than one minute after the delivery of the baby. Further analysis of the practices reported that where uterotonic drugs were given, cord traction was not done in 49%, and early cord clamping not done in 7% of the deliveries observed where the optimum active management of the third stage of labour protocols were not followed. >From an analytical point of view, we should cite the evidence base to suggest the degree to which these two practices are associated with morbidity. Walter P et al. 1999 state that their analysis of their data shows that early cord clamping and controlled cord traction are shown to be associated with a shorter third stage and lower mean blood loss, whereas Mitchelle (G G et al. 2005) found them to be associated with a lower incidence of retained placenta. Other considerations relating to the practice of early cord clamping are that it reduces the degree of mother to baby blood transfusion. It is clear that giving uterotonic drugs without early clamping will cause the myometrium to contract and physically squeeze the placenta, thereby accelerating the both the speed and the total quantity of the transfusion. This has the effect of upsetting the physiological balance of the blood volume between baby and placenta, and can cause a number of undesirable effects in the baby including an increased tendency to jaundice. (Rogers J et al. 1998) The major features that are commonly accepted as being characteristic of active management and passive management of the third stage of labour are set out below. Physiological Versus Active Management . . Physiological Management Active Management Uterotonic None or after placenta delivered With delivery of anterior shoulder or baby Uterus Assessment of size and tone Assessment of size and tone Cord traction None Application of controlled cord traction* when uterus contracted Cord clamping Variable Early (After Smith J R et al. 1999) physiology of third stage The physiology of the third stage can only be realistically considered in relation to some of the elements which occur in the preceding months of pregnancy. The first significant consideration are the changes in haemodynamics as the pregnancy progresses. The maternal blood volume increases by a factor of about 50% (from about 4 litres to about 6litres). (Abouzahr C 1998) This is due to a disproportionate increase in the plasma volume over the RBC volume which is seen clinically with a physiological fall in both Hb and Heamatocrit values. Supplemental iron can reduce this fall particularly if the woman concerned has poor iron reserves or was anaemic before the pregnancy began. The evolutionary physiology behind this change revolves around the fact that the placenta (or more accurately the utero-placental unit) has low resistance perfusion demands which are better served by a high circulating blood volume and it also provides a buffer for the inevitable blood loss that occurs at the time of delivery. (Dansereau J et al. 1999). The high progesterone levels encountered in pregnancy are also relevant insofar as they tend to reduce the general vascular tone thereby increase venous pooling. This, in turn, reduces the venous return to the heart and this would (if not compensated for by the increased blood volume) lead to hypotension which would contribute to reductions in levels of foetal oxygenation. (Baskett T F 1999). Coincident and concurrent with these heamodynamic changes are a number of physiological changes in the coagulation system. There is seen to be a sharp increase in the quantity of most of the clotting factors in the blood and a functional decrease in the fibrinolytic activity. (Carroli G et al. 2002). Platelet levels are observed to fall. This is thought to be due to a combination of factors. Haemodilution is one and a low level increase in platelet utilisation is also thought to be relevant. The overall functioning of the platelet system is rarely affected. All of these changes are mediated by the dramatic increase in the levels of circulating oestrogen. The relevance of these considerations is clear when we consider that one of the main hazards facing the mother during the third stage of labour is that of haemorrhage. (Soltani H et al. 2005) and the changes in the haemodynamics are largely germinal to this fact. The other major factor in our considerations is the efficiency of the haemostasis produced by the uterine contraction in the third stage of labour. The prime agent in the immediate control of blood loss after separation of the placenta, is uterine contraction which can exert a physical pressure on the arterioles to reduce immediate blood loss. Clot formation and the resultant fibrin deposition, although they occur rapidly, only become functional after the coagulation cascade has triggered off and progressed. Once operative however, this secondary mechanism becomes dominant in securing haemostasis in the days following delivery. (Sleep, 1993). The uterus both grows and enlarges as pregnancy progresses under the primary influence of oestrogen. The organ itself changes from a non-gravid weight of about 70g and cavity volume of about 10 ml. to a fully gravid weight of about 1.1 kg. and a cavity capacity of about 5 litres. This growth, together with the subsequent growth of the feto-placental unit is fed by the increased blood volume and blood flow through the uterus which, at term, is estimated to be about 5-800 ml/min or approximately 10-15% of the total cardiac output (Thilaganathan B et al. 1993). It can therefore be appreciated why haemorrhage is a significant potential danger in the third stage of labour with potentially 15% of the cardiac output being directed towards a raw placental bed. The physiology of the third stage of labour also involves the mechanism of placental expulsion. After the baby has been delivered, the uterus continues to contract rhythmically and this reduction in size causes a shear line to form at the utero-placental junction. This is thought to be mainly a physical phenomenon as the uterus is capable of contraction, whereas the placenta (being devoid of muscular tissue) is not. We should note the characteristic of the myometrium which is unique in the animal kingdom, and this is the ability of the myometrial fibres to maintain its shortened length after each contraction and then to be able to contract further with subsequent contractions. This characteristic results in a progressive and (normally) fairy rapid reduction in the overall surface area of the placental site. (Sanborn B M et al. 1998) In the words of Rogers (J et al. 1998), by this mechanism the placenta is undermined, detached, and propelled into the lower uterine segment. Other physiological mechanisms also come into play in this stage of labour. Placental separation also occurs by virtue of the physical separation engendered by the formation of a sub-placental haematoma. This is brought about by the dual mechanisms of venous occlusion and vascular rupture of the arterioles and capillaries in the placental bed and is secondary to the uterine contractions (Sharma J B et al. 2005). The physiology of the normal control of this phenomenon is both unique and complex. The structure of the uterine side of the placental bed is a latticework of arterioles that spiral around and inbetween the meshwork of interlacing and interlocking myometrial fibrils. As the myometrial fibres progressively shorten, they effectively actively constrict the arterioles by kinking them . Baskett (T F 1999) refers to this action and structure as the living ligatures and physiologic sutures of the uterus. These dramatic effects are triggered and mediated by a number of mechanisms. The actual definitive trigger for labour is still a matter of active debate, but we can observe that the myometrium becomes significantly more sensitive to oxytocin towards the end of the pregnancy and the amounts of oxytocin produced by the posterior pituitary glad increase dramatically just before the onset of labour. (GÃ ¼lmezoglu A M et al. 2001) It is known that the F-series, and some other) prostaglandins are equally active and may have a role to play in the genesis of labour. (Gulmezoglu A M et al. 2004) >From an interventional point of view, we note that a number of synthetic ergot alkaloids are also capable of causing sustained uterine contractions. (Elbourne D R et al. 2002) chapter 2 discuss active management, criteria, implications for mother and fetus. This dissertation is asking us to consider the essential differences between active management and passive management of the third stage of labour. In this segment we shall discuss the principles of active management and contrast them with the principles of passive management. Those clinicians who practice the passive management of the third stage of labour put forward arguments that mothers have been giving birth without the assistance of the trained healthcare professionals for millennia and, to a degree, the human body is the product of evolutionary forces which have focussed upon the perpetuation of the species as their prime driving force. Whilst accepting that both of these concepts are manifestly true, such arguments do not take account of the natural wastage that drives such evolutionary adaptations. In human terms such natural wastage is simply not ethically or morally acceptable in modern society. (Sugarman J et al. 2001) There may be some validity in the arguments that natural processes will achieve normal separation and delivery of the placenta and may lead to fewer complications and if the patient should suffer from post partum haemorrhage then there are techniques, medications and equipment that can be utilised to contain and control the clinical situation. Additional arguments are invoked that controlled cord traction can increase the risk of uterine inversion and ecbolic drugs can increase the risks of other complications such as retained placenta and difficulties in delivering an undiagnosed twin. (El-Refaey H et al. 2003) The proponents of active management counter these arguments by suggesting that the use of ecbolic agents reduces the risks of post partum haemorrhage, faster separation of the placenta, reduction of maternal blood loss. Inversion of the uterus can be avoided by using only gentle controlled cord traction when the uterus is well contracted together with the controlling of the uterus by the Brandt-Andrews manoeuvre. The arguments relating to the undiagnosed second twin are loosing ground as this eventuality is becoming progressively more rare. The advent of ultrasound together with the advent of protocols which call for the mandatory examination of the uterus after the birth and before the administration of the ecbolic agent effectively minimise this possibility. (Prendiville, 2002). If we consider the works of Prendiville (referred to above) we note the meta-analyses done of the various trials on the comparison of active management against the passive management of the third stage of labour and find that active management consistently leads to several benefits when compared to passive management. The most significant of which are set out below. Benefits of Active Management Versus Physiological Management Outcome Control Rate, % Relative Risk 95% CI* NNT 95% CI PPH >500 mL 14 0.38 0.32-0.46 12 10-14 PPH >1000 mL 2.6 0.33 0.21-0.51 55 42-91 Hemoglobin 6.1 0.4 0.29-0.55 27 20-40 Blood transfusion 2.3 0.44 0.22-0.53 67 48-111 Therapeutic uterotonics 17 0.2 0.17-0.25 7 6-8 *95% confidence interval Number needed to treat (After Prendiville, 2002). The statistics obtained make interesting consideration. In these figures we can deduce that for every 12 patients receiving active management (rather than passive management) one post partum haemorrhage is avoided and further extrapolation suggests that for every 67 patients managed actively one blood transfusion is avoided. With regard to the assertions relating to problems with a retained placenta, there was no evidence to support it, indeed the figures showed that there was no increase in the incidence of retained placenta. Equally it was noted that the third stage of labour was significantly shorter in the actively managed group. In terms of significance for the mother there were negative findings in relation to active management and these included a higher incidence of raised blood pressure post delivery (the criteria used being > 100 mm Hg). Higher incidences of reported nausea and vomiting were also found although these were apparently related to the use of ergot ecbolic

Butler Lumber Essay

After thorough review and analysis of Butler Lumber’s financial reports, I believe that it is in the best interest of Northrup National Bank to not only approve the requested $465,000 loan, but look to increase the loan amount. A review of the 5 C’s will show in more detail the decision to approve this loan: 1. Capacity/Cash Flow: Butler runs a lean operation that has allowed them to have success due to competitive pricing. They have met their financing needs by increasing their debt (notes payable) in order to keep up with the demand. However, their borrowing had led conjunctly to an increase in sales. Net sales have increased 59% over the 1988-1990 timeline and have been projected to increase by another 34% in 1991. From 1988-1990, for every $1000 borrowed, net sales increased by $4,278.96. By utilizing leverage, they have been able maintain their free cash flow and maintain their current ratio over 1.0. Although Free Cash Flow and current ratio have dropped over the past year, Butler has made large investments which have proven able to give a higher return, which will have significant payoff in the long run. By doing this, they will continue to have the ability to pay interest to debtholders, repay debtholders, and buy short-term investments. As business continues to grow, debt obligations will decrease and their current ratio will be back on the rise. (See Exhibit 1 and Exhibit 2). Based on this analysis, I believe the estimate for the loans requirements is light. I believe it would be in the best interest to pursue rolling the $247,000 owed to Suburban National Bank onto this line of credit. With the increased projection in sales, you are also seeing an increase in cost of goods sold. However, that number could be dramatically reduced if Butler had the appropriate capital or credit line to take advantage of the 2% discount for payments made within 10 days of the invoice date. If total cost of goods sold will be roughly $2 million in 1991, you could reduce that by over $40,000.00 simply by taking advantage of the 2% discount. Having quick access to capital will allow Butler to run their business more efficiently. 2. Capital: Butler has a good level of net worth compared to total assets. This has been continuously increasing from 1988-1990 and will be even higher in 1991. The reason for this is going back to their use of leverage. They increased notes payable from nothing to $247,000 in the three year span. By doing this they have been able to increase total assets at a much faster pace than their borrowing. Butler will be able to continue to increase its capital ratio with their new line of credit. Even with an increase in liabilities, Butler should have no problem repaying their debts, even if there were to be an economic downturn. They hold very little long term debt, so even with a decrease in sales they should be able to meet their financial obligations. They have equity in their plants and land and could utilize that if need be. Also, they have the ability to weather a crisis because of the amount of business that they have in home improvements. If there is a housing boom, people will lo ok to build new houses, where as if there is a backup in the housing market, people will stay in their house and do improvements. 3. Collateral: With rolling the almost $250,000.00 loan into this line of credit, and pursuing the increase in the total line of credit, I believe that this loans should be secured. I would keep the loans secured by the assets of the company and do not see the need to pursue personal collateral. We know that Mr. Butler currently has objections to using collateral, but if we can show him how having a large credit limit would be able to have a substantial positive impact to his bottom line, he should be comfortable with putting up company collateral and nothing personal. I would secure this using the company’s property as well as their inventory. At the end of the first quarter of 1991, Butler’s inventory was valued at $556,000 and its property at another $162,000. Because it would be such a large line that could help Butler Lumber, it needs to be understood that when working with that level of volume, some sort of collateral needs to be put up. We will be able to show how taking advantage of the 2 net 30 option, you can decrease cost of goods sold and increase net income with no strategic changes to business. Using this collateral would be a good way to recover some of the funds to reduce the loss if the company were to go bankrupt. However, when evaluating the performance of the company, it is believed that this company should be able to continue to produce strong results regardless of the economy and that the securitizing of the loan is an added safety precaution due to the increase size of this line of credit. 4. Conditions: The first thing that needs to be determined is the limit on the credit line. It was originally requested to obtain a limit of $465,000. However, it is recommended that we, as part of the approval process, refinance the current $247,000 loan to Suburban National Bank. If there were to be an issue, we do not want there to be a conflict on who needs to be paid first. Mr. Butler has had a working relationship with Suburban National Bank, but we do not see this to be an issue due to the fact they are capping him at $250,000. It is recommended that the limit exceed $750,000.00 but be no greater than $1,000,000.00. There needs to be enough capital infusion that they can meet all needs, take advantage of supplier discounts, and take advantage of short term opportunities. However, we do not want to exceed $1,000,000.00 because we do not want the company to become overly aggressive and invest more an inventory then can be sold, leaving them overleveraged and at bigger risk of de fault due to economic downturns. Next, we need to determine an appropriate interest rate for this line of credit. Based on economic outlook, it would be in the best interest of Northrup to make this a fixed loan based on the prime rate of interest. From February of 1989 to January of 1991, the prime rate of interest has dropped almost 2% and we believe it is going to be downward trending for the next three to four years before going back up (See Exhibit 3). Therefore, we believe we should do a prime plus 1% loan, giving an interest rate of 10%. As rates continue to drop, the value of this loan will continue to increase. If at any point we fear that this loan maybe paid off through an outside bank refinance, we can look to restructure this line of credit to a lower rate. Because this is a lower rate, we can pursue adding the balance of the loan to payoff the obligation of buying out Henry Stark. This is at roughly a $70,000 balance, which is secured by land and buildings with an 11% interest rate. This will lower Butler’s current debt obligations and will result in an increase in profit. Because this business appears to be in a growth phase, controls operations costs effectively, and has the ability to weather economic crisis better than others, this would be a good company to invest in. Next, we need to determine the duration of this line of credit. We need to clearly state that this will be reviewed every two to three years to revisit creditworthiness as well as ability to repay. If need be, the limit could be lowered. However, if the company continues to grow we can also evaluate the possibility of a credit limit increase. When determining fees, we need to realize that this is a competitive situation and they should be somewhat minimal. The commitment fee should be .50% per year. This falls right in line with the average. We will keep the closing fees at .25% in order to ensure they are on the low end and we can keep his business. We want to establish a working relationship with Mr. Butler so that we will be his only source of borrowing. We will not put a prepayment fee on this line of credit, but should continue to keep his business with reviews and potential changes and increases every two to three years. We also need to negotiate in appropriate covenants into this loan agreement. This will carry forward the reps and warrants that we have Mr. Butler sign. By adding the following covenants, we will be able mitigate risk for the bank and allow us to detect any signs for potential default early, allowing us time to evaluate our next steps before it is too late. The following covenants should be documented: * Notification of borrowing outside of our bank * Detailed description of usage of loan proceeds * Quarterly Financial Reporting sent to Northrup * Maintain ethical and legal responsibilities * Notification of any major business impacts such as mergers, acquisitions, and business model changes. By installing these conditions, it will allow us to properly forecast and negative business impacts and allow us to make appropriate modifications. We believe that because over 55% of Butler’s business is in home improvement, economic downturns should not impact them as much as other businesses. Also, by now being able to take advantage of the 2 net 30 discount, the company will be able to instantly lower expenses and increase net income. 5. Character: The character of Mark Butler is strong and it is believed that he would be a conscientious borrower. He is an extremely hard worker and takes a lot of pride in his business. He knows the business inside and out and possesses sound judgment. He is well respected by his peers. All of this things make him a strong candidate for lending, because it appears that he will do everything in his power in order to pay this loan back and on time. This includes tapping into personal equity form his home, his life insurance policy, or the interest that his wife has in a separate property.

Is college For Everyone Essay

Since the first GI Bill was passed after World War II universities have been steadily increasing. Currently there are more than 4000 college like institutions in the United States. Public policy has been making higher education more reachable for example by creating federal student loan programs so everyone has a chance to attend college. But recently we have seen the cost of a four year degree drastically increase because Americans are seeing college as an obligation. â€Å"On â€Å"Real Education†Ã¢â‚¬  Robert T. Perry argues that we need more university and community college graduates. â€Å"Is College for Everyone† Pharinet is arguing that college is not for everyone. He states that there is too many students enrolled in school that don’t belong there. Roberts’s essay â€Å"On â€Å"Real Education†Ã¢â‚¬  is more persuasive because, not only did his writing appear on InsideHigherEd. com making him a more credible author but also because he argues his stance on college is for everyone using statistics and a believable explanation to back them up. The US Department of Labor has reported that America needs more college graduates to keep up with all the other nations in the global economy. Robert states that by the end of the presidents first term, which is already over, that The US will have 3 million more jobs that require bachelor’s degree and we don’t have enough college graduates to fill them. We need more health care workers, teachers, software engineers and manufacturing jobs, all of which require college. Those whom choose not to go to college have much fewer employment options. Robert makes a strong point when he says that American companies are looking for new ways to compete, and because of this without some sort of secondary degree you will have consistent struggle to pay for just the basic to live. Robert grabs the reader’s consideration through the use of pathos, saying that additionally people with postsecondary degrees tend to be more healthy, more engaged in their community, a decreased chance of being involved in crime, more productive throughout there working life, and even more philanthropic. Pharinet thinks that the most common issue with college is that students are not yet ready for the academic and financial challenges. He claims that students find themselves trying to work full time and do to school full time and before long students decide they need to work and drop their status to a part time student. Through the use of pathos Pharinet asks his readers to consider a very valid point, if college is for everyone then why do we rely on SAT scores and high school transcripts? And why doesn’t every school have an admissions policy? Then followed those questions with the answer that college is not for everyone. There is no real desire for learning. Individuals just go to college to earn a degree to settle down into a job with decent pay. Using pathos again Pharinet explains that when this kind of person enters the work force are they going to lack motivation in there career because of the only reason for wanting the career was for the money. When comparing these to essays, you can clearly see that there are two completely different beliefs. Robert believes that college is for everyone where Pharinet believes that college is not for everyone. Robert had a more persuasive argument because he established a good ethos, Robert uses facts and professional opinions to back his argument, whereas Pharinet uses his own personal opinions to create his blog. Robert uses much more logos then he does pathos, Pharinet used much more pathos then he did logos. Neither of the writings use firsthand experience, we don’t know whether or not Pharinet and Robert went to college. I found both the organization and use of evidence effective in both essays. Both essays use good strong points to back up their arguments and both essays were persuasive.

Biography of Mary Livermore Civil War Organizer

Mary Livermore is known for her involvement in several fields.  She was a lead organizer for the Western Sanitary Commission in the Civil War. After the war, she was active in the women’s suffrage and temperance movements, for which she was a successful editor, writer and lecturer. Occupation:  editor, writer, lecturer, reformer, activistDates:  December 19, 1820 – May 23, 1905Also known as: Mary Ashton Rice (birth name), Mary Rice LivermoreEducation: Hancock Grammar School, graduated 1835; Female Seminary of Charlestown (Massachusetts), 1835 - 1837Religion:  Baptist, then UniversalistOrganizations:   United States Sanitary Commission, American Woman Suffrage Association, Women’s Christian Temperance Union, Association for the Advancement of Women, Women’s Educational and Industrial Union, National Conference of Charities and Corrections, Massachusetts Woman Suffrage Association, Massachusetts Womans Temperance Union, and more Background and Family Mother: Zebiah Vose Glover AshtonFather: Timothy Rice. His father, Silas Rice, Jr., was a soldier in the American Revolution.Siblings: Mary was the fourth child, though all three older children died before Mary was born. She had two younger sisters; Rachel, the older of the two, died in 1838 of complications of a congenital curved spine. Marriage and Children Husband: Daniel Parker Livermore (married May 6, 1845; Universalist minister, newspaper publisher). He was Mary Rice Livermores third cousin; they shared a 2nd great grandfather, Elisha Rice Sr. (1625 - 1681).Children:Mary Eliza Livermore, born 1848, died 1853Henrietta White Livermore, born 1851, married John Norris, had six childrenMarcia Elizabeth Livermore, born 1854, was single and living with her parents in 1880 and with her mother in 1900 Early Life of Mary Livermore Mary Ashton Rice was born in Boston, Massachusetts, on December 19, 1820. Her father, Timothy Rice, was a laborer.  The family held strict religious beliefs, including Calvinist belief in predestination, and belonged to a Baptist church.  As a child, Mary pretended at times to be a preacher, but she early began to question the belief in everlasting punishment. The family moved in the 1830s to western New York, pioneering on a farm, but Timothy Rice gave up on this venture after just two years. Education Mary graduated from Hancock Grammar School at age fourteen and began studying at a Baptist women’s school, Female Seminary of Charlestown. By the second year she was already teaching French and Latin, and she remained at the school as a teacher after her graduation at sixteen.  She taught herself Greek so that she could read the Bible in that language and investigate her questions about some of the teachings. Learning About Slavery In 1838 she heard Angelina Grimkà © speak, and later recalled that it inspired her to consider the need for women’s development.  The following year, she took a position as a tutor in Virginia on a slave-holding plantation.  She was treated well by the family but was horrified at a slave beating she observed. It made her into an avid abolitionist. Adopting a New Religion She returned to the north in 1842, taking a position in Duxbury, Massachusetts, as a schoolmistress. The following year, she discovered the Universalist church in Duxbury, and met with the pastor, the Rev. Daniel Parker Livermore, to talk over her religious questions.  In 1844, she published A Mental Transformation, a novel based on her own giving up of her Baptist religion. The next year, she published Thirty Years Too Late: A Temperance Story. Married Life Religious conversation between Mary and the Universalist pastor turned to mutual personal interest, and they were married on May 6, 1845. Daniel and Mary Livermore had three daughters, born in 1848, 1851 and 1854.  The eldest died in 1853.  Mary Livermore raised her daughters, continued her writing, and did church work in her husband’s parishes.  Daniel Livermore took up a ministry in Fall River, Massachusetts, after his marriage. From there, he moved his family to Stafford Center, Connecticut, for a ministry position there, which he left because the congregation opposed his commitment to the temperance cause. Daniel Livermore held several more Universalist ministry positions, in Weymouth, Massachusetts; Malden, Massachusetts; and Auburn, New York. Move to Chicago The family decided to move to Kansas, to be part of an antislavery settlement there during the controversy over whether Kansas would be a free or slave state.  However, their daughter Marcia became ill, and the family stayed in Chicago rather than proceeding on to Kansas.  There, Daniel Livermore published a newspaper, New Covenant, and Mary Livermore became its associate editor.  In 1860, as a reporter for the newspaper, she was the only woman reporter covering the Republican Party’s national convention as it nominated Abraham Lincoln for president. In Chicago, Mary Livermore remained active in charity causes, founding an old-age home for women and a women’s and children’s hospital. Civil War and the Sanitary Commission As the Civil War began, Mary Livermore joined the Sanitary Commission as it expanded its work into Chicago, obtaining medical supplies, organizing parties to roll and pack bandages, raising money, providing nursing and transportation services to wounded and sick soldiers, and sending packages to soldiers. She left her editing work to devote herself to this cause and proved herself to be a competent organizer.  She became co-director of the Chicago office of the Sanitary Commission, and an agent for the Northwest Branch of the Commission. In 1863, Mary Livermore was the chief organizer for the Northwest Sanitary Fair, a 7-state fair including an art exhibition and concerts, and selling and serving dinners to the attendees.  Critics were skeptical of the plan to raise $25,000 with the fair; instead, the fair raised three to four times that amount. Sanitary Fairs in this and other locations raised $1 million for the efforts on behalf of Union soldiers. She traveled frequently for this work, sometimes visiting Union Army camps at the front lines of battle, and sometimes going to Washington, DC, to lobby. During 1863, she published a book, Nineteen Pen Pictures. Later, she recalled that this war work convinced her that women needed the vote in order to influence politics and events, including as the best method to win temperance reforms. A New Career After the war, Mary Livermore immersed herself in activism on behalf of women’s rights – suffrage, property rights, anti-prostitution and temperance. She, like others, saw temperance as a womens issue, keeping women from poverty. In 1868, Mary Livermore organized a woman’s rights convention in Chicago, the first such convention to be held in that city.  She was becoming more well-known in suffrage circles and founded her own women’s rights newspaper, the Agitator.  That paper was in existence just a few months when, in 1869, Lucy Stone,  Julia Ward Howe, Henry Blackwell and others connected with the new American Woman Suffrage Association decided to found a new periodical, Woman’s Journal, and asked Mary Livermore to be a co-editor, merging the Agitator into the new publication.  Daniel Livermore gave up his newspaper in Chicago, and the family moved back to New England.  He found a new pastorate in Hingham, and was strongly supportive of his wife’s new venture: she signed on with a speakers’ bureau and began lecturing. Her lectures, from which she soon was making a living, took her around America and even several times to Europe on tour.  She gave about 150 lectures a year, on topics including women’s rights and education, temperance, religion and history.   Her most frequent lecture was called â€Å"What Shall We Do With Our Daughters?† which she gave hundreds of times. While spending part of her time away from home lecturing, she also spoke frequently in Universalist churches and continued other active organizational involvements.  In 1870, she helped found the Massachusetts Woman Suffrage Association.  By 1872, she gave up her editor position to focus on lecturing. In 1873, she became president of the Association for the Advancement of Women, and from 1875 to 1878 served as president of the American Woman Suffrage Association. She was part of the Women’s Educational and Industrial Union and the National Conference of Charities and Corrections. She was president of the Massachusetts Woman’s Temperance Union for 20 years.  From 1893 to 1903 she was president of the Massachusetts Woman Suffrage Association. Mary Livermore also continued her writing.  In 1887, she published My Story of the War about her Civil War experiences.  In 1893, she edited, with Frances Willard, a volume they titled A Woman of the Century. She published her autobiography in 1897 as The Story of My Life: The Sunshine and Shadow of Seventy Years. Later Years In 1899, Daniel Livermore died.  Mary Livermore turned to spiritualism to try to contact her husband, and, through a medium, believed that she had made contact with him. The 1900 census shows Mary Livermores daughter, Elizabeth (Marcia Elizabeth), living with her, and also Marys younger sister, Abigail Cotton (born 1826) and two servants. She continued lecturing almost until her death in 1905 in Melrose, Massachusetts. Papers Mary Livermore’s papers can be found in several collections: Boston Public LibraryMelrose Public LibraryRadcliffe College: Schlesinger LibrarySmith College: Sophia Smith Collection