NFC technology Essay

‡ The NFC Forum has identified three basic use cases for NFC: connection, access, and transactions. All three have application in transport. ‡ Public transport requires infrastructure for NFC Ticketing + NFC Payment ‡ Transportation Uses: Í » Pay Parking fee Í » Purchasing fuels Í » Links to an up-to-date weather report website Í » Location-relevant map Í » Special discounted travel offers Í » Next bus/train arrival time Í » Taxi services Í » Emergency calls Ease of use: This criterion refers to Ížthe degree to which a person believes that using a particular system would be free of effortÍŸ ‡ Cost: It regroups direct costs (e.g. cost of the technology, cost of implementation) and indirect costs (e.g. infrastructure operation and maintenance). ‡ Reliability: The purchase process should be flawless as it involves a financial transaction. ‡ User/Market Acceptance: This criterion represent the degree to which the user and the different stakeholders are already consenting to accept a technology for payments.  Ã‚‡ Security: Implicit security features (e.g. embedded encryption) and ease of securing the technology.  Ã‚‡ Flexibility: Degree to which the technology can be adapted in many different applications. ‡ Maturity: Development state of the technology. ‡ Speed: Implicit speed of the technology for payments. ‡ Scalability: Ability to grow. Usability in small and large environment. ‡ Upcoming Bluetooth 4.0 low energy protocol will be consuming even lower power than NFC as of now. ‡ NFC alone does not ensure secure communications is vulnerable to data modifications. Advantages over Bluetooth ‡ Almost instant connection (around 1/10 seconds) in comparison to pairing procedure of Bluetooth. ‡ Low power consumption and could work (alternatively) even when one of the device is powerless . ‡ NFC is compatible with existing passive RFID (13.56 MHz ISO/IEC 18000-3) infrastructures. ‡ Shorter range makes it suitable for crowded area with high interferences.

Wattie Frozen Foods Ltd

The firm†s competitive environment is in New Zealand, Australia, and the Pacific Rim. They have head quarters in Auckland and four factories located in Gisborne, Hastings, Fielding, and Christchurch. The range is frozen and dehydrated vegetable products, main products being peas, beans and frenches fried potatoes. Growers are contracted to WFF and are provided with a significant amount of technical assistance, including the availability of quality seed stock, and a wide variety of agricultural management assistance. Once crops are deemed ready they are harvested quickly and transported immediately to the branch factory, where the crop reception department tests the quality of the incoming produce. At the factory the season processing is done around the clock. I.e.) potatoes are first washed, then sliced, deep-fried, frozen and packed. Peas are washed, graded, and then frozen for bulk storage. Beans are washed, graded dried, and packed. Problems with seasonality in the business are that you may run out of stock in a non-season where that product is not being produced. To get that product in a non-season could be quite expensive. The season for that product could produce a bad crop and you would have to wait until next season to get the next crop. Work Center Management is that the organization is divided up into a set of semiautonomous work centers. Each work center will have skilled supervisors and employees who will be able to make critical decisions to manufacture a quality product in a timely manner. There is daily reporting because the information will be more useful and ownership of the information is more likely. Daily reporting will occur because is will come from the bottom and travel it†s way up. The motivation for WCM consisted of 2 things: 1. The need to change the emphasis from reporting to managing  · Shortening the time between actions and the subsequent reporting results.  · Ensure focused accountability through clearly defined responsibilities for costs and the power to act. 2. The need for staff involvement and operational involvement It is necessary to change the organizational culture because WCM made managers fully responsible for their outputs and use of inputs and resources including labor, equipment, services and inventories. Thus management has to be empowered, responsible and fully empowered. The culture change was achieved by dividing each factory into units, which were largely self-contained and small enough to ensure focused management and accountability. Each of these units, were to be known as work centers. Each work center had one manager, the site manager (factory manager) would support the work center managers to coordinate work between the work centers and solve any conflicts. The physical numbers tie into the financial accounting system by cost is assigned to processes or products at the basis of the actual consumption of physical resources. The benefits of WCM are that it is integrated with other systems and programs, which provides better managerial reporting. It doesn†t just provide cost and financial performance measures, but also provides monthly summaries of wide physical measures to evaluate the work centers. The WCM has resulted in improved control and cost reductions in difficult to control areas. Other benefits of WCM include:  · Improved focus on quality production Potential problems in operating the WCM system are that eventually staff and management will get lazy on the daily reporting aspects. There may be staff turnover, as some managers will get promoted and training will have to be given to the next line of upcoming management. WCM will have to be continuously monitored to see the cost vs. benefit analysis. The types of operations that lend themselves to daily financial reporting are labor, electricity, materials, and machinery.

The Effects of Music Technology Curriculum on Young Children's Research Paper

The Effects of Music Technology Curriculum on Young Children's Learning in Early Childhood Education - Research Paper Example When one thinks of early childhood education, they typically navigate towards the consideration of reading, writing, and arithmetic. While these core academic areas are certainly the pillars of educational necessity for children, one needs to also consider the fine arts as another area that contributes greatly to the cognitive development of an individual. One such outlet for creative expression is music. Music class has long been a part of the curriculum in early childhood education, but recent research has indicated that there are numerous benefits in terms of development that had not previously been considered. In addition, technology has enhanced the way that music can be integrated into other disciplines, making this particular area even more worthy of study. Simply put, music technology curriculum is composed of different types of technology that is directly related to the musical arts. This usually entails the use of various electronic devices, combined with computer software, that allows the playback, recording, composition, storage, analysis and performance of any given piece. While this particular curriculum can be implemented at any grade level, all the way through the university, our primary focus in this study will be on early childhood education. In particular, this paper will examine the effects that music technology curriculum has on the learning development of young children. While technology today is rapidly changing, the concept of music technology has been around since the 1980’s.... in early childhood education, but recent research has indicated that there are numerous benefits in terms of development that had not previously been considered. In addition, technology has enhanced the way that music can be integrated into other disciplines, making this particular area even more worth of study. Simply put, music technology curriculum is composed of different types of technology that is directly related to the musical arts. This usually entails the use of various electronic devices, combined with computer software, that allows the playback, recording, composition, storage, analysis and performance of any given piece (Branscome, 2012, p. 113). While this particular curriculum can be implemented at any grade level, all the way through the university, our primary focus in this study will be on early childhood education. In particular, this paper will examine the effects that music technology curriculum has on the learning development of young children. Literature Review and Propositions Development While technology today is rapidly changing, the concept of music technology has been around since the 1980’s. The concept can be interconnected across disciplines because of its focus on artistic and technological creativity in many realms (Andang’o and Mugo, 2007, p. 44). Young children can be taught to use music to express themselves through the arts, and technology has expanded in recent decades to create new devices to enable them to do just that. In essence, music technology can be said to encompass the scientific aspect of music that many individuals never consider. These components, when properly implemented in a music technology curriculum, can have an enormous and positive effect on young children (Hoffman, 1991, p. 23) Importance, Value, and

Reflection Essay Example | Topics and Well Written Essays - 250 words - 6

Reflection - Essay Example From this discussion it is clear that  as a health care provider, having spirituality assists in enhancing the confidence of the patients through meditation and prayer, which gives them, hope of healing and quick recovery. The spirituality aspect enhances the patient’s belief that the medication they are undergoing is going to be effective in curing them. It also serves to enable the health care provider, be in a position to offer pastoral counseling to the patients, which boosts their spirit and comforts them amidst their sad and lonely feeling. Being spiritual goes a long way to ensure that patients understand the connection between life and death, affording patients comfort even when they are on the verge of passing on, by making them accept death as a part of transition.  This paper discusses that the difference in dealing with acute and chronic patients spirituality is that while the acute patient’s spirituality is pointed towards accepting the fate of death, t he chronic patient’s spirituality is pointed towards giving them confidence that medication is going to restore their health. The need for spirituality in children and families is to enhance their acceptance of illnesses and find meaning in them, while evoking for their compassion and forgiveness towards each other. The reporter's vision of the role of a spiritual provider in patients spiritual needs have been changed to point to the direction of religious intercession.

Unit 6 Discussion Essay Example | Topics and Well Written Essays - 250 words

Unit 6 Discussion - Essay Example He compares General Motors to Volkswagen, the company which increased their investment in Audi and received a significant increase in their revenue (Rosevear, 2012). This is the best route for GM to take if it plans to reestablish itself amongst the world’s elite companies. Production of Cadillac may be a lucrative investment but the company already has made some other important investments that can be successful in the nearest future. This is a major challenge to the investment manager since he cannot stop an investment that is already earning the company millions. The investment is tested and, therefore, has an edge over the new one. The existing investments will, therefore, get more funds allocated to them in terms of capital. Maybe, the company has to make a painstaking anlysis to figure out what investments are the best and whatare not effective for the company. It is the only way the best investment decisions can be made. Rosevear, J. (2012). Why cadillac is crucial to GMs revival (GM). Stock Investing Advice: Stock Research. Retrieved from

Environmental Effects Statement for the proposed (Persistent Organic Research Proposal

Environmental Effects Statement for the proposed (Persistent Organic Compounds) storage and treatment facility - Research Proposal Example This article’s main aim is tooutline a few things such as how the development is likely to impact on the environment; ways in which the impacts could be identified and measures that would be put in place to mitigate the social and economic impacts of the project on the environment.Within the SEE, a suitable location for the development of the project should be suggested and details outlined. Background The development plan featured here is the setting up of POP (Persistent Organic Compound) storage and treatment facility is which is to be built near Mortlake, Victoria. The purpose of building this facility is to dispose Australia’s 500,000 tonne stockpile of organ chlorines such as DDT, Dieldrin and Endrin, polychlorinated biphenyls, hexachlorobenzene, dioxins and furans. The company that has proposed the storage and treatment facility received information that they will have to go through the environmental effect process before approval could be given for this project. With the support of both the State and Federal Governments the process will be heard under Victoria’s Environmental Effects Act (1978) and the Federal Environment Protection and Biodiversity Conservation Act (1999). Body The Queensland Environmental act protection act 1994 is a statute that provides legislations, standard procedures, codes and control approvals when setting up projects so as to monitor and manage operations on site. Given the size of the project, a lot of organisation should be done and clear-cut strategies be put in place. Some of the things the project managers should outline include how to relocate or compensate owners of the 1000 acres of land where the project is going to be built and the cost implications it will have on the stakeholders of the project. Operations involved and the estimated period of time required for setting up the project is also vital. Scrutiny of the site should also be done to verify whether there are any hindrances to the project such as underlying mining tenements. The numbers of people required to provide labour should outlined (BERTRAM, 2005, p201). There are a number of implications; either social or economic, that could arise as a result of setting up the project. For instance, looking at the topography of the land, excavators will have to dig deeper into the ground which could result in for example release of air emissions from underneath that may be hazardous to humans. It is important that both personnel working on the site and other nearby residents be informed on such dangers and protective clothing be distributed so as to mitigate the effects such dangerous chemicals could have on individuals. The dug up soil could also contain dangerous chemicals leading to contamination and it is recommended that it is disposed in the right manner. The proposed construction for all temporary landforms is also likely to cause possible erosion as the area is cleared of vegetation. Clearing or demolishing of the h ouses within the site may likely lead to stockpiles and limit access to certain pathways. In the wake of the construction, it is also likely that some parts of the neighboring land’s fertility or productivity be constrained.â€Å"JOUMARD, p34,† argues that in order to ensure that the land remain fertile or at least a little productive, the

Why has it proved so difficult to create an effective International Essay

Why has it proved so difficult to create an effective International Criminal Court - Essay Example It took several meetings between the superior nations such as France, US, UK, China and the Soviet Union to finally agree on the membership terms, bodies and other arrangements that would be necessary to set up the UN, and ensure that it met its international security, social and economic goals. It was officially formed in 1945 with 50 member states and five nations being permanent members and holding the veto power. By 2007, it had 192 member states (Hanhimaki, 2008). The terms and conditions initially set were to be later reviewed and maybe changed or revised, something that has never happened to date. Any decisions made on international security, economic development or social levels have to be approved by the nations holding the veto power first, directly or indirectly before being approved. This has led to power imbalance in the UN with other nations feeling sidelined and having no powers to disagree. The existence and operation of the International Criminal Court (ICC) is one of the issues being disagreed upon by member states. Disagreements surround charges taken to it and how it only handles cases from some states and not from others and especially those holding the veto power, leading to it lacking the impartiality necessary in a court of justice. Its operation therefore lacks consensus making it difficult to exist and perform its roles. The fact that the operation of the court from its inception seems to be controlled by a few members has brought about more questions than answers, and led to creation of issues of mistrust of the so called justice being sought in the court. The ICC comes in to deal with crimes that the national courts cannot be able to handle. This is because of lack of ability of a country to address the heinous criminal acts or because of the lack of a government. The national court may also lack capacity to prosecute their own cases and especially those of higher magnitude because of lack of resources or the lack of

Public health Annotated Bibliography Example | Topics and Well Written Essays - 500 words

Public health - Annotated Bibliography Example 438). The postoperative complications and prolonged hospitalization of the patients were analyzed in the light of these nutritional tools. The study identified that both MUST and SNAQ were equally competent in detecting malnourished patients. Malnutrition identified by both MUST and SNAQ were linked with postoperative complications, postoperative acute heart failure, prolonged ICU stay as well as prolonged hospitalization (p. 439). The study also showed that MUST is independently capable of detecting malnutrition among participants. The article is of importance as it emphasizes the need to conduct preoperative nutritional therapy among cardiac patients to identify adverse clinical characteristics. Johnson, T., Macdonald, S., Hill, S.M., Thomas, A & Murphy, M.S. 2006. Treatment of active Crohns disease in children using partial enteral nutrition with liquid formula: a randomised controlled trial. Gut. 55(3), 356–361. The article shows the effects of both Total enteral nutrition (TEN) and partial enteral nutrition (PEN) among children with active Crohns disease. The sample consisted of 50 children (26 with 50% of PEN and 24 with 100% of TEN) with a paediatric Crohns disease activity index (PCDAI) >20. During the six weeks of study the PEN group was allowed to supplement their energy requirement with an unrestricted normal diet whereas the TEN category was provided only nutrition in liquids. The results showed that both TEN and PEN contributed to significant reduction in the PCDAI. However, the research revealed that TEN was more suitable for the treatment of active Crohns disease as it could suppress inflammation, increase haemoglobin and albumin, and reduce diarrhoea whereas PEN failed to suppress inflammation and prevent disease relapse (p. 360). The study shows that nutritional supplementation is comparatively less effective a treatment in the case of children with active Crohns disease. The article makes a comparative

The Hardy-Weinberg Equilibrium Research Paper Example | Topics and Well Written Essays - 500 words

The Hardy-Weinberg Equilibrium - Research Paper Example Science claims that these changes are due to genes which are present in our cells. In order to find out how these changes are made, scientists carry out various tests with the help of cells and genes (cancer.org 1). These tests are called genetic experiments. Many different tests in this regard are been carried out in order to enhance the study of genes. Science has modified and now they are even able to create a life in laboratory or even clone living things. Whether these kinds of tests and experiments should be done or not, is an altogether a very argumentative topic thus people across the world have different views regarding it where some believe that there is no harm in it on the other hand others believe it to be prohibited. The study discusses the three common and controversial experiments ahead (Lederberg 519) Creation of Human Life Dr. Craig Venter and his team conducted an experiment in which they created an entirely new chromosome with the help of non-natural DNA which was made from chemicals. They transmitted this DNA in to a cell and observed that it was multiplying giving a real life evidence of it to be alive. This experiment was questioned by various scientists and Professors of various fields.

Insurance Claims Paper Term Example | Topics and Well Written Essays - 1000 words

Insurance Claims - Term Paper Example Today, the firms that operate in the insurance industry have to face an important challenge: the increase of claims is combined with the limitation of demand for insurance contracts; this phenomenon is probably related to the strong financial pressures in markets worldwide. This paper focuses on the claims settlement process. Emphasis is given to the recent advances that have resulted to the increase of efficiency of the claims settlement process. It is proved that claims settlement process can be quite long, especially if the level of compensation involved is high. Still, the advances developed in regard to this process have contributed in the limitation of failures and delays in completing the claims settlement process. In any case, the role of these advances in the increase of efficiency of the claims settlement process is not standardized; local regulations and social ethics can affect the performance of the process even when supportive schemes and means of technology are availab le. 2. Increase of efficiency of the claims settlement process – recent advances In the past the potentials of insurance to cover the needs of people worldwide were limited. Today, almost most of human activities and almost all types of properties can be secured through an insurance contract (Feetham 2012). In addition, the means used for accessing an insurance contract have been developed (Seltzer & Ochs 2010). ... The claims settlement process, which is a critical part of an insurance contract, has been also changed being in order to respond to the current style of life, as being affected by the advances of technology (Kearney 2010). The high level of failures related to the claims settlement process and the radical increase of sums which insurance companies worldwide are asked to pay as compensation in regard to insurance contracts have been also led to the need for the advances in all phases of the insurance process (Kearney 2010). The key advances in the claims settlement process are related to the technology involved in the various parts of the process (Kearney 2010). Due to its structure the process is highly depended on technology (Kearney 2010); for example: an appropriately customized and rapid IT system is required for introducing the information related to an insurance contract (Kearney 2010). The information described above will be of high value in the claims settlement process (Kea rney 2010). Therefore, the IT systems in which the data of insured is stored need to be continuously updated and checked as of their performance (Kearney 2010). In practice, it has been proved that using advanced IT systems can significantly reduce the time required for the completion of the claims settlement process (Feetham 2012). The last year the average time of completion of the above process has been estimated to 12 – months, an achievement related mostly to the use in the process of IT systems based on advanced technology (Feetham 2012). Two have been found to be the parts of the process that are highly depended on technology: ‘a) the retrieval of information in regard to an insurance contract/ claims file and b) the update of a claims

High income improves evaluation of life Essay Example for Free

High income improves evaluation of life Essay The premise that â€Å"Money buys happiness† is a one that is misconstrued by many in the pursuit of happiness. The perspective that having money creates happiness has been assessed by many from timely memorial but alas studies have shown that it is relative to the status and class of the individual and also the amount of money which one earns or possesses. Happiness can be defined as the state of mind or emotions based on a particular circumstance and feeling at a particular time. There are different interpretations of happiness. Contentment is a state of happiness and satisfaction or ease of mind. The well-being of an individual is a reflection of happiness and can be assessed by the subjective and emotional well-being of that individual. Money can be classified as an asset, property or resources owned by an individual or just currency which can be used to purchase goods and services. Subjective well-being is defined as a person’s cognitive and affective evaluations of his or her life. Subjective well-being (SWB) is defined as \a person\s cognitive and affective evaluations of his or her life\ (Diener, Lucas, Oshi, 2002). To truly evaluate whether money buys happiness or if there is a correlation between having money and being happy an in-depth study would need to be conducted. Studies have therefore been conducted by researchers who have done surveys to assess the socio-economic standard of living of various persons in society and also evaluating the third world versus a first world living improvement after acquiring a degree of wealth or additional income. The empirical data from the Gallup research organization using the Gallup- Healthways Well-Being index have shown that an increase in emotional well-being is exponentially related to an increase in income. However, that correlation is directly proportional to the degree of increase and size of the income. Surveys have been conducted in third world countries like Jamaica where per capita income is much lower than a first world country like the United Kingdom or Britain or the United States of America. The skilled labor force in third world countries with the requisite professional qualifications has a level of income acquisition and potential to earn and live a comfortable life which contributes to the lifestyle which has been sought after in the betterment of the professional individual’s status and quality of life. However social class and inequalities exist and the potential earning power decreases with the individual’s lack of skill and qualifications. A contradiction, however, exists where an individual from the Rural Area is compared with one from the urban townships. Many persons who have not been exposed to the urban cultures and opulent surroundings of the major cities have expressed happiness and contentment with their station and status in life as they enjoy their routines of farming lifestyles on rural plantations with their â€Å"low level† of income. One can, therefore, surmise that not experiencing another level or change in status can contribute to ones perceived the degree of subjective well-being and happiness. If one is not aware of riches he or she will not be able to recognize poverty. However, with the technological advancements and the Westernization of most countries, the United States of American and the country’s high standard of living has been portrayed as the pivotal ambivalent expression of what wealth and happiness should be. Therefore many continue to strive to achieve this pinnacle of success in the acquisition of more money to generate the peak of happiness. The resulting dilemma without insightful perspective is the unavailability of first world opportunities to achieve and acquire significantly more income to obtain the type of wealth and lifestyle portrayed by the Western Media. Research by the Gallup Healthways well-being index indicates that emotional well-being is directly proportional to the level of income one earns. The researchers theorize that beyond an annual income of $75000 there is no change in emotional well-being and therefore no increase in happiness as a result of any upward movement in income. There is, therefore, a level of satisfaction with the high degree of income but not overwhelming happiness. On the other hand, low-income earners have an exponentially low level of life satisfaction and love emotional well-being. Having a large income provides the means to afford greater luxuries in life, desired comfort, and fulfillment. It provides status in life, access to greater health care and References Kahneman, D, and A Deaton. (2010). High income improves evaluation of life but not emotional well-being. Proceedings of the National Academy of Sciences, 107 (38): 16489-16493. Diener, E. Biswas-Diener, R. Social Indicators Research (2002)

Alternative Development Possibilities for Church

Alternative Development Possibilities for Church Introduction Description of the Development The site is located in one of Corks most prestigious areas; the property is set on 0.8 of an acre of level ground overlooking the River Lee on the grounds of Our Lady’s hospital. It is ideally located on the Lee Road just 2.4kms west of Cork City adjacent to the historic University College Cork and close to the western routes leading to Blarney (8 kms) and Killarney (80 kms) which is accessible via the newly constructed Ballincollig bypass. Equally accessible, are Cork Airport and major routes to Limerick, Waterford and Wexford. The site is currently selling for â‚ ¬1,900,000 and is zoned commercial. All services including mains water, electricity and mains drainage are located adjacent to the site and are easily accessible. The church is located at the front of the site and provides an excellent development opportunity for the conversion of the existing structure into a bar/bistro. The church is of rubble limestone construction, un-rendered and with cut limestone plinths. The internal area amounts to 100 sq.m with a planned extension of a further 100sq.m at the rear, to provide additional space for the kitchen, store and staff facilities. The walls of the interior are lined with brick and there is an exposed timber truss roof. Adjacent to the church is a parking area, three developments will be considered for this site which includes the construction of a medical centre, crà ¨che or apartments. All services including water, electricity and mains drainage are located adjacent to the site and are easily accessible. Development Region The development is located in the province of Munster and in the county of Cork, which is situated in the South of Ireland. Cork is the commercial and industrial capital of the South West Region with a population of 190,384 people (2006 Census) rising to 454,850 within a 60km radius. Historic Cork The citys name is derived from the Irish word Corcach, meaning marshy place and refers to the fact that the center of Cork City is built on islands, surrounded by the River Lee, which were marshy and subjected to instances of flooding. Traditionally, Saint Finbarre has been credited with the foundation of the monastery of Cork, known to be the earliest human settlement in Cork for which historians have incontrovertible evidence. The location of this monastic settlement was on the area arnd the present-day site of Saint Finbarre’s Cathedral. However the ancestor of the modern city was founded in the 12th century, when Viking settlers established a trading community. In the twelfth century, this settlement was taken over by invading Anglo-Norman settlers. Corks city charter was granted by King John of England in 1185. Over the centuries, much of the city was rebuilt, time and again, after numerous fires. The city was at one time fully walled, and several sections and gates still remaining. During the 19th century important industries in Cork included, brewing, distilling, wool and shipbuilding. In addition, there were some municipal improvements such as gas light street lights in 1825, a local paper, The Cork Examiner was first published in 1841 and, very importantly for the development of modern industry, the railway reached Cork in 1849. Also in 1849, University College Cork opened. Lee Road Area In the early 1760s the Pipe Water Company was established to provide a water supply to the city of Cork. The architect/engineer Davis Ducart designed the Waterworks which were completed by 1768. The site, located on the lee road included a pumping house and open storage reservoirs which were constructed on the hillside to the north of the river at the same location as the present Waterworks buildings. By the late 1840’s it was felt that the water supply to the city required upgrading, as the population of the city was increasing rapidly, new suburbs developing on the city’s north side could not benefit from the existing system. In 1854, the Pipe Water Company instructed John Benson, had prepared a plan for a new Waterworks, Work began with the laying of new cast-iron mains pipes in 1857 and continued for a number of years. By February 1859 these new water pipes had reached the military barracks on the Old Youghal Road. By this time the Pipe Water Company had been taken over by Cork Corporation, who remains in charge of the municipal water supply to this day. (Lifetime Labs) Local Industry Corks main area of industry is in pharmaceuticals, with Pfizer Inc. and Swiss company Novartis being big employers in the region. Cork is also the European headquarters of Apple Inc. where their computers are manufactured and their European call centre, RD and Apple-Care is hosted. In total, they currently employ over 1,800 staff. EMC Corporation located in the area of Ovens, in the outskirts of the city is another large I.T. employer with over 1,600 staff in their 52,000 sq metre (560,000 sq. ft.) engineering, manufacturing, and technical services facility. Many of these large multinational organisations have been attracted to the area due the low corporation tax rate of 12.5%. Planning Issues and Restrictions After consultation with a Cork City Planning officer a number of issues were raised regarded the conditions of the planning. The site lies within a category A Landscape Protection Zone as per Cork Coty Development Plan 2004. This category of land is defined in Table 8.1 of the Development Plan as â€Å"Visually important land, including land forming the setting to existing buildings† According to paragraph 8.20 of the Plan â€Å"There will be a general presumption by means of a landscape assessment and appropriate landscape and building design proposals† The proposed site at the Lee Road is a visually sensitive area, the design of the structures will therefore have to be landscape rather than building orientated. As stated in Policy BE 8 of the Development Plan: â€Å"The City Council will endeavour to devise and implement policies to positively encourage and facilitate the careful refurbishment of historic built environment for sustainable and economically viable uses.† To comply with plan it will be necessary to adhere to following conditions: The development shall be carried out in accordance with the drawings and specifications submitted. A visual impact study must be conducted to determine how the how the development will affect the landscape. The redevelopment of the chapel shall be supervised by a conservation consultant with appropriate qualifications and/or experience in conservation and restoration of historic buildings in order to protect the architectural characteristics and visual appearance of this existing structure. The contractor appointed shall have an expertise and demonstrate high standards of workmanship and have previous experience in restoration of historic structures. The site is not considered suitable for a â€Å"super-pub† or for a nightclub. In order to protect the character and amenities of the area, the development is restricted to be used as a restaurant with ancillary public house. Under the Landscape Assessment Guidelines (2000) the classification of the site at the Lee Road was obtained from the following table: The site is classified as a category A as it forms part of the setting for the existing landmark building (Former Our Lady’s Hospital). The guidelines state that: There will be a general presumption against development in Landscape Protection Zones unless it can be demonstrated by means of a visual landscape assessment and appropriate building design proposal that the proposed development will enhance the overall landscape character of the site and its visual context. Factors Favouring Refurbishment In the initial feasibility for the Lee Road church, it was necessary to consider the advantages and disadvantages to its refurbishment. Consideration will be given to both the social and economic factors. Social Factors in favour of refurbishment Energy/Resource conservation – Just as there is a current growing awareness of the need to recycle domestic waste, buildings with a useable structure should also be recycled. Preservation of historic buildings – The church on the grounds of the site is listed as a protected structure, buildings which are historic merit need to be refurbished to maintain their integrity and thereby the amenity for the nation. Social resistance to change – Buildings are an integral part of an urban fabric and society may well demonstrate forceful views in restricting change. Its arguments will centre upon: retaining historical and social continuity preserving familiar landscape scenes conserving existing communities and the social fabric Economic Factors in favour of refurbishment Shorter construction period – A refurbishment scheme can usually be carried out quicker than redevelopment which results in: a prompt turnover of finance; earlier occupation of the building; quicker return on capital employed; a reduction in the effects of inflation, high interest rates and other risks. Condition of the building – In the case of the Lee Road church, the structure itself is in relatively sound condition, the savings on the building components may make a refurbishment scheme cheaper than reconstruction. Expectation of high land values – The future expectation of high land values may provoke refurbishment to create a short life use so as to occupy the building and keep the site in its present use until fully ripe for exploitation. This will avoid leaving a building empty for long periods while long term plans are being formulated. Constraints on development – site conditions and organisational constraints (e.g. Cork County Council planning restrictions) may make redevelopment unsuitable for a particular or intended use and therefore unprofitable. Limiting Factors in refurbishment One of the major factors in factors in favour of the refurbishment of the church is the cost saving from the retention of the existing materials, whilst this can reduce the total cost of the scheme, the following criteria required consideration. Diminishing returns – The economic life of a building can be said to end when a site value in a new use exceeds the value of the existing building. A building requires redevelopment when the value of the building is below the potential use value of the land and hence yields a diminishing return. Life expectancy – Property investment tends to be long-term in nature and normally a paying back of sixty year is allowed in property investment calculations. There is little doubt that a new building will last the sixty years or more, whereas a refurbished building may not have been designed and constructed with materials appropriate for long life. High cost of borrowing – In general, financial institutions are unprepared to invest in old buildings due to inherent high financial risks. If they provide finance the assumption of high risk can often lead to a higher rate of interest. Management of refurbishment – the extent of work is not predictable; hence very difficult to design, cost plan and cost control. It can often be a complex, non-repetitive and labour intensive operation and does not facilitate high productivity. Attract high tender prices- the contactor will often assume a high undefined risk element and uncertainty of cost when the pre-contract survey is inadequate. Increased cost of Health and Safety Source: Harlow (1994) Rationale for Refurbishment After taking all factors into consideration, it was felt that the benefits of refurbishment outweigh the costs of redevelopment. Also according to Harlow (1994) the emphasis is moving towards conservation leading to the search for historical and social continuity by fining ways of re-using an existing fabric rather than accelerating the cycle of replacement† The structure itself is in a reasonable sound condition with only minor restorations required; reusing the existing building will decrease construction time, reduce site overheads and retain the historical and social continuity of the Lee road area. Review of alternative development possibilities Development 1 – Medical Centre The first development to contribute to the bar/bistro development is the construction of a medium sized three storey structures; this will comprise 2 No. doctor’s surgeries, a nurse’s office and associated accommodation including waiting, reception and storage areas. It has a floor area of approx 800m2 and an overall ridge height of 8.2m. Its overall design is of a contemporary nature utilizing feature glazing and an extended limestone surround to complement the features of the adjacent church. Early Feasibility Study Project Location Item Description Cost/m2 Floor Area Total Cost 1.0 Site Clearance â‚ ¬80.00 610 â‚ ¬48,800.00 2.0 Substructure â‚ ¬150.00 610 â‚ ¬91,500.00 3.0 Superstructure â‚ ¬380.00 610 â‚ ¬231,800.00 4.0 Internal Finishes â‚ ¬270.00 610 â‚ ¬164,700.00 5.0 Fittings and Furnishings â‚ ¬150.00 610 â‚ ¬91,500.00 6.0 Service Installations â‚ ¬555.00 610 â‚ ¬338,550.00 7.0 External Works â‚ ¬163.00 610 â‚ ¬99,430.00 8.0 Preliminaries â‚ ¬110.00 610 â‚ ¬67,100.00 9.0 Contingencies â‚ ¬20,000.00 Total Estimated Cost â‚ ¬1,153,380.00 Income Rental Price Per Month 6000 Rental Price Per Annum 72000 Total Income per Annum 72000 Expenditure Maintenance 7000 Landscaping 2500 9500 Profit per annum 62500 0 -1183880 1 62500 2 68750 Rate -1.595% 3 75625 4 83188 5 91506 6 100657 7 110723 8 117366 9 124408 10 131872 Net Present Value IR £0.00 Internal Rate of Return -1.5949% Development 2 – Crà ¨che This development entails the construction a crà ¨che that will serve the 180 apartments in Atkins Hall, River Towers and The Mews. The structure will be single storey building with car parking at the rear. The crà ¨che will accommodate up to 30 children (depending on ages). Other facilities would include a fully equipped indoor play area and an out-door playground. There is no doubt that there is demand for a crà ¨che in the area, the development would cater for the residents of the nearby apartments. Students of the nearby University College Cork could also utilize these facilities. Crà ¨che Early Feasibility Study Site Clearance â‚ ¬80.00 610 â‚ ¬48,800.00 Substructure â‚ ¬150.00 610 â‚ ¬91,500.00 Superstructure â‚ ¬380.00 610 â‚ ¬231,800.00 Internal Finishes â‚ ¬270.00 610 â‚ ¬164,700.00 Fittings and Furnishings â‚ ¬200.00 610 â‚ ¬122,000.00 Service Installations â‚ ¬555.00 610 â‚ ¬338,550.00 External Works â‚ ¬163.00 610 â‚ ¬99,430.00

Musculoskeletal Case Study: Rheumatoid Arthritis

Musculoskeletal Case Study: Rheumatoid Arthritis Rheumatoid Arthritis with Hip Arthroplasty   Ã‚   S.P. is admitted to the orthopedic ward. She has fallen at home and has sustained an intracapsular fracture of the hip at the femoral neck. The following history is obtained from her: *She is a *75-year-old widow with three children living nearby. Her father died of cancer at age 62; mother died of heart failure at age 79. Her height is 5 feet 3 inches; weight is 118 pounds. She has a *50-pack-year smoking history and denies alcohol use. She has severe rheumatoid arthritis (RA), with evidence of cartilage and bone destruction, along with joint deformities. She had an upper gastrointestinal bleed in 1993, and had coronary artery disease with a coronary artery bypass graft 9 months ago. Since that time she has engaged in* very mild exercises at home. Vital signs (VS) are 128/60, 98, 14, 99 ° F (37.2 ° C), SaO2 94% on 2 L oxygen by nasal cannula. Her oral medications are *rabeprazole (Aciphex) 20 mg/day, *prednisone (Deltasone) 5 mg/day, and *methotrexate (Amethopterin) 2. 5 mg/wk. **What anatomical stage of Rheumatoid Arthritis does SP have? (1) Stage I-Early No destructive changes on radiograph, possible radiographic evidence of osteoporosis Stage II-Moderate Radiographic evidence of osteoporosis, with or without slight bone or cartilage destruction, no joint deformities (although possibly limited joint mobility), adjacent muscle atrophy, possible presence of extra-articular soft-tissue lesions (e.g., nodules, tenosynovitis) Stage III-Severe Radiographic evidence of cartilage and bone destruction in addition to osteoporosis; joint deformity, such as subluxation, ulnar deviation, or hyperextension, without fibrous or bony ankylosis; extensive muscle atrophy; possible presence of extra-articular soft-tissue lesions (e.g., nodules, tenosynovitis) Stage IV-Terminal Fibrous or bony ankylosis, stage III criteria List at least four risk factors for hip fractures. (4 pts) Age. The risk for hip fractures increases as we age. In 2010, more than 80% of the people hospitalized for hip fractures were age 65 and older, according to the National Hospital Discharge Survey (NHDS). Sex. About 70 percent of hip fractures occur in women. Women lose bone density at a faster rate than men do, in part because the drop in estrogen levels that occurs with menopause accelerates bone loss. However, men also can develop dangerously low levels of bone density. Cortisone medications, such as prednisone, can weaken bone if taken for long term. Rabeprazole (Aciphex) and methotrexate (Amethopterin) could cause dizziness and more prone to falling. Physical inactivity (very mild exercises at home). Weight-bearing exercises, such as walking, help strengthen bones and muscles, making falls and fractures less likely. Not participating in regularly weight-bearing exercise, may lead to lower bone density and weaker bones. Tobacco use. Can interfere with the normal processes of bone building and maintenance, resulting in bone loss. 2.Place a star or asterisk next to each of the responses in question 1 that represent S.P.s risk factors. (1) Case Study Progress       S.P. is taken to surgery for a total hip replacement. Because of the intracapsular location of the fracture, the surgeon chooses to perform an arthroplasty rather than internal fixation. The postoperative orders include: Chart View Why is the patient receiving enoxaparin (Lovenox) and warfarin (Coumadin)? (4 pts) In your answer, also explain how these 2 medications are used together and the rationale behind how they are used. Deep venous thrombosis (DVT) may form in leg veins as a result of inactivity, body position, and pressure, all of which lead to venous stasis and decreased perfusion. DVT, especially common in older adults and obese or immobilized individuals, is a potentially life-threatening complication because it may lead to pulmonary embolism. The most commonly used anticoagulants are unfractionated heparin (UH), low-molecular weight heparins (LMWHs), hirudin derivatives, and coumarin compounds. Unfractionated heparin (heparin sodium, commonly known as heparin) acts directly on the intrinsic and the common pathways of blood coagulation. Heparin inhibits thrombin-mediated conversion of fibrinogen to fibrin. It also potentiates the actions of antithrombin III, inhibits the activation of factor IX, and neutralizes activated factor X by activating factor X inhibitor. LMWH is effective for the prevention and treatment of DVT. LMWHs are derived from heparin, but the molecule size is approximately one third that of heparin. Enoxaparin (Lovenox), dalteparin (Fragmin), and ardeparin (Normiflo) are examples of LMWHs. LMWH has a greater bioavailability, more predictable dose response, and longer half-life than heparin with less risk of bleeding complications. LMWH has the practical advantage that it does not require anticoagulant monitoring and dose adjustment ( Hirsh , Bauer , Donati , Gould , Samama , Weitz , 2008). LMWH is administered subcutaneously in fixed doses, once or twice daily. Coumarin compounds, of which warfarin (Coumadin) is the most commonly used, exert their action indirectly on the coagulation pathway. Warfarin inhibits the hepatic synthesis of the vitamin K- dependent coagulation factors II, VII, IX, and X by competitively interfering with vitamin K. Vitamin K is normally required for the synthesis of these factors. Oral anticoagulants are often administered concurrently with heparin. Warfarin requires 48 to 72 hours to influence prothrombin time (PT) and may take several days before maximum effect is achieved. Therefore a 3- to 5-day overlap of heparin and warfarin is required. The clotting status should be monitored by activated partial thromboplastin time (aPTT) for heparin therapy and the international normalized ratio (INR) for coumadin derivatives. The INR is a standardized system of reporting PT based on a referenced calibration model and calculated by comparing the clients PT with a control value. Other tests to monitor anticoagulation may b e used. For DVT prophylaxis, low-dose unfractionated heparin, LMWH, or warfarin (Coumadin) can be prescribed depending on the clients level of risk and weight. Unfractionated heparin is typically taken by subcutaneous (subQ) route and prescribed at 5000 units q12h subQ for clients at low and moderate risk or 3500 to 5000 units q8h subQ for clients at high risk. LMWH is usually scheduled at 30 mg q12h subQ or 40 mg daily subQ. LMWH is rapidly replacing heparin as the anticoagulant of choice to prevent DVT in clients at high risk. In fact, LMWH is considered the most effective form of prophylaxis in hip surgery, in knee surgery, and following major trauma. Low-dose warfarin is usually reserved for clients with the highest DVT risk. It is quite common for a person to be taking both Coumadin and Lovenox at the same time. Lovenox begins working right away, while Coumadin does not. In fact, in the period of time when a person first begins taking Coumadin, the drug may actually increase the risk of clots for a short period of time. Therefore, Coumadin and Lovenox are often taken together. The Lovenox prevents clots while the Coumadin begins working. The Lovenox can be stopped once the INR is in the appropriate range. 4.S.P. received blood as an intraoperative blood salvage. Which statements about this procedure are true? (Select all that apply.) a.The blood that is lost from surgery is immediately re-administered to the patient (Salvaged blood should be washed. Salvaged blood that is not washed or otherwise processed (eg, centrifuged) has low hemoglobin levels (7 to 9 g/dL), residual anticoagulant, dysfunctional platelets, thrombogenic substances, free hemoglobin levels, and fat emboli that might lead to coagulation abnormalities). b.(True) The blood lost from surgery is collected into a cell saver    (Centrifuge-based RBC salvage with the intraoperative cell salvage machine (commonly referred to as a cell saver) starts with the surgeon aspirating blood from the surgical field through a suction wand. The blood is mixed with an anticoagulant as it is aspirated (eg, heparin or citrate) to prevent coagulation [16]. Typically, heparin in saline with a concentration of about 30,000 units/L is used. This solution is slowly and automatically added to the aspirated blood at a rate of 15 mL per 100 mL of collected blood [16]. During subsequent washing of the collected blood, all but a trace of heparin is removed). c.One hundred percent of the red blood cells are saved for reinfusion (other components in the blood such as platelets and contaminants can also adhere to these filters, but at least 85 percent of RBCs pass through the filter and into the patient). d. This procedure has the same risks as blood transfusions from donors. e.(True) The salvaged blood must be reinfused within 6 hours of collection. (Blood collected by intraoperative blood salvage may be stored either at room temperature for up to six hours or at 1 to 6 °C for up to 24 hours, provided that blood is collected under aseptic conditions with a device that provides washing and that cold storage is begun within six hours of initiating the collection. Such stored blood must be properly labeled). List four critical potential postoperative problems for S.P. (4 pts) Infection. Fever above 38 °C (100.4 °F) is common in the first few days after major surgery. Most early postoperative fever is caused by the inflammatory stimulus of surgery and resolves spontaneously. However, postoperative fever can be a manifestation of a serious complication. A thorough differential diagnosis of postoperative fever includes infectious and noninfectious conditions that occur following surgery. Fever may arise due to a surgical site infection (SSI), or from other hospital-related conditions, including nosocomial pneumonia, urinary tract infection, drug fever, and deep vein thrombosis. In evaluating a postoperative patient with fever, it is important to consider a broad differential, and not to assume that fever is due to infection. Fever as a manifestation of infection may be reduced or absent in immunocompromised patients including those receiving glucocorticoids, cancer chemotherapy, post-transplant immunosuppression, and also in some patients who are elderly or have chronic renal failure. Hypoxemia, specifically a PaO2 of less than 60 mm Hg, is characterized by a variety of nonspecific clinical signs and symptoms, ranging from agitation to somnolence, hypertension to hypotension, and tachycardia to bradycardia. Pulse oximetry will indicate a low oxygen saturation (below the 90 to 92% range). Arterial blood gas analysis may be used to confirm hypoxemia if the pulse oximetry indicates a low O2 saturation. Low oxygen saturation may be corrected by encouraging deep breathing and coughing or by increasing the amount of oxygen delivered. The most common cause of postoperative hypoxemia is atelectasis. Atelectasis (alveolar collapse) may be the result of bronchial obstruction caused by retained secretions or decreased respiratory excursion. Hypotension and low cardiac output states can also contribute to the development of atelectasis. Other causes of hypoxemia that may occur in the PACU include pulmonary edema, aspiration, and bronchospasm. Hypotension is evidenced by signs of hypoperfusion to the vital organs, especially the brain, the heart, and the kidneys. Clinical signs of disorientation, loss of consciousness, chest pain, oliguria, and anuria reflect hypoxemia and the loss of physiological compensation. Intervention must be timely to prevent the devastating complications of cardiac ischemia or infarction, cerebral ischemia, renal ischemia, and bowel infarction. The most common cause of hypotension in the PACU is unreplaced fluid and blood loss; thus, treatment is directed toward restoring circulating volume. If there is no response to fluid administration, cardiac dysfunction should be presumed to be the cause of hypotension. Deep venous thrombosis (DVT) may form in leg veins as a result of inactivity, body position, and pressure, all of which lead to venous stasis and decreased perfusion. DVT, especially common in older adults and obese or immobilized individuals, is a potentially life-threatening complication because it may lead to pulmonary embolism. Clients with a history of DVT have a greater risk for pulmonary embolism. Pulmonary embolism should be suspected in any client complaining of tachypnea, dyspnea, and tachycardia, particularly when the client is already receiving oxygen therapy. Manifestations may include chest pain, hypotension, hemoptysis, dysrhythmias, or heart failure. Definitive diagnosis requires pulmonary angiography. Superficial thrombophlebitis is an uncomfortable but less ominous complication that may develop in a leg vein as a result of venous stasis or in the arm veins as a result of irritation from IV catheters or solutions. If a piece of a clot becomes dislodged and travels to the lung, it can cause a pulmonary infarction of a size proportionate to the vessel in which it lodges. How will you monitor for excessive postoperative blood loss? (5 pts) Observe the dressing and incision for signs of bleeding Restlessness Confusion Anxiety Feeling of impending doom Decreased level of consciousness Weakness Rapid, weak, thread pulses Dysrhythmias Hypotension Narrowed pulse pressure Cool, clammy skin Tachypnea, dyspnea, or shallow, irregular respirations Decreased O2 saturation Extreme thirst Nausea and vomiting Pallor Cyanosis Obvious hemorrhage The rate and volume of bleeding, vital signs, and laboratory results should be closely monitored to assess the best approach to and aggressiveness of intervention. It is important to not allow the patient to become moribund before initiating life-saving measures. Post op Day 1, S.P. states that she is having 8/10 pain. List 3 thingsthat you would assess in order to determine why she is having the pain and then state 2 nursing interventions. (5 pts) Complications associated with femoral neck fracture include nonunion, AVN, dislocation, and degenerative arthritis. Postoperative pain is usually most severe within the first 48 hours and subsides thereafter. Variation is considerable, according to the procedure performed and the clients individual pain tolerance or perception. The client should be observed for indications of pain (e.g., restlessness) and questioned about the degree and characteristics of the pain. Identifying the location of the pain is important. Incisional pain is to be expected, but other causes of pain, such as a full bladder, may also be present. Pain assessments can be measured with a variety of scales such as asking a client to rate his or her pain on a scale of 0 to 10. Perform a comprehensive pain assessment to include the following: characteristic, onset and duration, quality, intensity and severity. In the early postoperative period, there is a potential for neurovascular impairment. The nurse assesses the clients extremity for (1) colour, (2) temperature, (3) capillary refill, (4) distal pulses, (5) edema, (6) sensati on, (7) motor function, and (8) pain. Provide client optimal pain relief with prescribed analgesic as ordered to relieve acute pain and to prevent pain from becoming too severe. Teach and assess clients correct use of patient-controlled analgesia to ensure effectiveness. Use nonpharmacological interventions to relieve pain, such as distraction, massage, relaxation, and imagery, for client use in lieu of or in conjunction with analgesics to obtain pain relief. According to the lateral traditional surgical approach, there are two main goals for maintaining proper alignment of S.P.s operative leg. What are they, and how are they achieved? (2 pts) The client and the family must be fully aware of positions and activities that predispose the client to dislocation (greater than 90 degrees of flexion, adduction, or internal rotation). Many daily activities may reproduce these positions, including putting on shoes and socks, crossing the legs or feet while seated, assuming the side-lying position incorrectly, standing up or sitting down while the body is flexed relative to the chair, and sitting on low seats, especially low toilet seats. Until the soft tissue surrounding the hip has healed sufficiently to stabilize the prosthesis, usually for at least 6 weeks, these activities must be avoided. Use elevated toilet seat Place chair inside shower or tub and remain seated while washing Use pillow between legs for first 8 weeks after surgery when lying on the side allowed by surgeon or when supine Keep hip in neutral, straight position when sitting, walking, or lying Notify surgeon if severe pain, deformity, or loss of function occurs Postoperative wound infection is a concern for S.P. Describe what you would do to monitor her for a wound infection. (4 pts) Redness (rubor, hyperemia from vasodilation), heat (colour, increased metabolism at inflammatory site), pain (colour change in pH; change in local ionic concentration; nerve stimulation by chemicals (e.g.,histamine, prostaglandins; pressure from fluid exudate), swelling (tumour, fluid shift to interstitial spaces; fluid exudate accumulation), edge approximation, odor, type of exudate. Vital signs, WBC. Taking S.P.s RA into consideration: what interventions should be implemented to prevent complications secondary to immobility? (6 pts) The physiotherapist usually supervises active-assistance exercises for the affected extremity and ambulation when the surgeon permits it. Ambulation usually begins on the first postoperative day. The nurse in collaboration with the physiotherapist monitors the clients ambulation status. The ambulating client should pick up the feet rather than shuffling them so that muscular contraction is maximized. When confined to bed, the client should alternately flex and extend the legs. When the client is sitting in a chair or lying in bed, there should be no pressure to impede venous flow through the popliteal space. Crossed legs, pillows behind the knees, and extreme elevation of the knee gatch must be avoided. Some surgeons routinely prescribe use of elastic stockings or mechanical aids such as sequential compressive devices to stimulate and enhance the massaging and milking actions that are transmitted to the veins when leg muscles contract. The nurse must remember that these aids are usel ess if the legs are not exercised and may actually impair circulation if the legs remain inactive or if the devices are sized or applied improperly. When in use, elastic stockings must be removed and reapplied at least twice daily for skin care and inspection. The skin of the heels and posttibial areas is particularly susceptible to increased pressure and breakdown. The use of unfractionated heparin (UH) or low-molecular weight heparin (LMWH) is a prophylactic measure for venous thrombosis and pulmonary embolism. Advantages of LMWH over UH include (1) less major bleeding, (2) decreased incidence of thrombocytopenia, (3) better absorption, (4) longer duration of action, (5) as effective or more effective, and (6) no laboratory monitoring required. A primary nursing responsibility is the identification of clients at risk for the development of pressure ulcers and implementing pressure ulcer prevention strategies for those identified as being at risk. Prevention remains the best treatment for pressure ulcers. Devices such as support surfaces, special transfer equipment, and heel boots are useful in reducing pressure and shearing force. However, they are not adequate substitutes for frequent repositioning. The clients position should be changed every 1 to 2 hours to allow full chest expansion and increase perfusion of both lungs. Ambulation, not just sitting in a chair, should be aggressively carried out as soon as physician approval is given. Adequate and regular analgesic medication should be provided because incisional pain often is the greatest deterrent to client participation in effective ventilation and ambulation. The client should also be reassured that these activities will not cause the incision to separate. Adequate hydration, either parenteral or oral, is essential to maintain the integrity of mucous membranes and to keep secretions thin and loose for easy expectoration. Deep breathing and coughing techniques help the client prevent alveolar collapse and move respiratory secretions to larger airway passages for expectoration. The client should be assisted to breathe deeply 10 times every hour while awake. The use of an incentive spirometer is helpful in providing visual feedback of respiratory effort. The nurse should teach the client to use an incentive spirometer, which involves the following: inhale into the mechanism, hold the ball for about 3 seconds, and then exhale. This procedure should be done 10 to 15 times, and then the nurse should encourage the client to cough. It is recommended that an incentive spirometer should be used every 2 to 3 hours while awake. Urinary tract infections are another risk for people who may spend long periods of time on their back. This can promote urinary stasis or stagnation in the flow of urine from the kidneys to the bladder, and thus, lead to infection. Prolonged immobility also causes an increase of minerals and salts to circulate in the blood that can promote the formation of kidney stones. Constipation is a common problem that may result from decreased physical activity. Other factors may aggravate bowel evacuation. These include loss of privacy and embarrassment if toilet assistance is needed; uncomfortable positioning while using the commode; excessive delay in elimination because of the inconvenience in going to the bathroom; and the unavailability of caregiver assistance if help is needed to use the commode. Bowel irregularity may produce abdominal discomfort, as well as cause loss of appetite. 11.In patients with RA, very often Prednisone is prescribed for a patient with an acute exacerbation. Which laboratory result will the nurse monitor to determine whether the medication has been effective?(1 pt) Blood glucose test Liver function tests C-reactive protein level Serum electrolyte levels Explain your answer (what does this test show?) Data on high-sensitivity C-reactive protein have been reported, elevated levels of C-reactive protein appear to correlate best with symptoms of pain and stiffness rather than extent or progression of disease. To detect inflammation and test for the activity of the disease; may be used to help differentiate osteoarthritis and RA; an increased level of CRP occurs in RA but not in osteoarthritis. 12.A patient with an exacerbation of rheumatoid arthritis (RA) is taking prednisone 40 mg daily. Which of these assessment data obtained by the nurse indicate that the patient is experiencing a side effect of the medication? (1 pt) The patients blood glucose is 165 mg/dL (9.2 mmol/L). The patient has no improvement in symptoms. The patient has experienced a recent 5-pound (2.3 kilogram) weight loss. The patients erythrocyte sedimentation rate (ESR) has increased. Prednisone is used as an anti-inflammatory or an immunosuppressant medication. Prednisone treats many different conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis, lupus, psoriasis, or breathing disorders. Long-term side effects include Cushings syndrome insulin resistance (especially common with ACTH production outside the pituitary), leading to high blood sugar and insulin resistance which can lead to diabetes mellitus. Insulin resistance is accompanied by skin changes such as acanthosis nigricans in the axilla and around the neck, as well as skin tags in the axilla. 13.What predisposing factor, identified in S.P.s medical history, places her at risk for infection, bleeding, and anemia? (1 pt) Medication administration rabeprazole (Aciphex) 20 mg/day, *prednisone (Deltasone) 5 mg/day, and *methotrexate (Amethopterin) 2.5 mg/wk History of upper gastrointestinal bleed in 1993, and had coronary artery disease with a coronary artery bypass graft 9 months ago 50-pack-year smoking history 14.Briefly discuss S.P.s nutritional needs. (2 pts) As a person grows older, there are decreases in lean body mass (the metabolically active tissue), basal metabolic rate, and physical activity. Combined, these factors decrease the caloric needs for energy. The older person frequently reduces the consumption of needed protein, vitamins, and minerals and may take in empty calories, such as candy and pastries. When these factors are added to already existing medical problems, it is easy to see why poor dietary practices develop. In addition, poor dentition, ill-fitting dentures, anorexia, multiple losses affecting the social setting of meals, low income, and medical conditions involving the GI tract play a role in the type and amount of foods that are eaten. Socioeconomic factors are of critical importance when assessing the nutritional status of an older adult. The nurse must be aware of common medical and psychosocial factors in the older adult and should incorporate interventions for overcoming these problems in the plan of care. Some of the physiological changes associated with aging affect the nutritional status of older adults. The following changes are of particular interest: 1. Changes in the oral cavity (e.g., change in bite surfaces of the teeth, periodontal disease, drying of the mucous membranes of the mouth and tongue, poorly fitting dentures, decreased muscle strength for chewing, decreased number of taste buds, decreased saliva production). 2. Changes in digestion and motility (e.g., decreased absorption of cobalamin, vitamin A, and folic acid and decreased GI motility). 3. Changes in the endocrine system (e.g., decreased tolerance to glucose). 4. Changes in the musculoskeletal system (e.g., decreased bone density, degenerative joint changes). 5. Decrease in vision and hearing (e.g., procurement and preparation of food are more difficult). Certain illnesses that are more prevalent in the older population are considered to be diet related. These include atherosclerosis, osteoporosis, diabetes mellitus, and diverticulosis. Multiple drugs are often required to treat these and other common chronic illnesses of the older client. These drugs often have an adverse effect on the appetite of older adults, increasing the possibility of inadequate intake caused by anorexia. Interventions: Calcium and Vitamin D Older adults need more calcium and vitamin D to help maintain bone health. Have three servings of vitamin D-fortified low-fat or fat-free milk or yogurt each day. Other calcium-rich foods include fortified cereals and fruit juices, dark green leafy vegetables and canned fish with soft bones. If you take a calcium supplement or multivitamin, choose one that contains vitamin D. Vitamin B12 Many people older than 50 do not get enough vitamin B12. Fortified cereal, lean meat and some fish and seafood are sources of vitamin B12. Ask your doctor or a registered dietitian nutritionist if you need a vitamin B12 supplement. Fiber Eat more fiber-rich foods to stay regular. Fiber also can help lower your risk for heart disease, control your weight and prevent Type 2 diabetes. Eat whole-grain breads and cereals, and more beans and peas along with fruits and vegetables which also provide fiber. Potassium Increasing potassium along with reducing sodium (salt) may lower your risk of high blood pressure. Fruits, vegetables and low-fat or fat-free milk and yogurt are good sources of potassium. Also, select and prepare foods with little or no added salt. 15.Explain four teaching points you can teach S.P. to help her protect herself from infection related to medication-induced immunosuppression. (4 pts) For older adult clients, the rate of HAI is 2 to 3 times higher than for younger clients. Age-related changes of decreased immunocompetence, the presence of comorbidities, and an increase in disability all contribute to higher infection rates. Infections common in older adults include pneumonia, urinary tract infections, skin infections, and TB (Furman et al.). Infections in older adults often have atypical presentations, and cognitive and behavioural changes appear before alterations occur in laboratory values (Furman et al.). Suspicion of disease should typically begin when changes in ability to perform daily activities or in cognitive function occur. Fever should not be relied upon to indicate infection in older adults because many have lower core body temperatures and decreased immune responses. Interventions include: 1. Handle Prepare Food Safely Food can carry germs. Wash hands, utensils, and surfaces often when preparing any food, especially raw meat. Always wash fruits and vegetables. Cook and keep foods at proper temperatures. Dont leave food out refrigerate promptly. 2. Wash Hands Often 3. Clean Disinfect Commonly Used Surfaces Germs can live on surfaces. Cleaning with soap and water is usually enough. However, you should disinfect your bathroom and kitchen regularly. Disinfect other areas if someone in the house is ill. You can use an EPA certified disinfectant (look for the EPA registration number on the label), bleach solution, or rubbing alcohol. 4. Cough Sneeze Into Your Sleeve Dont Share Personal Items Avoid sharing personal items that cant be disinfected, like toothbrushes and razors, or sharing towels between washes. Needles should never be shared, should only be used once, and then thrown away

Bilingual Education: Building Bridges Essay example -- Education

Bilingual education, as an educational program, was initially promoted by educators in the seventies (Hunger of Memory 26) and since then has been a topic of many debates in America. Some argue that bilingual education only serves as a detriment to American culture. Others argue that bilingual education is beneficial to those who come to live in America and want to become a part of the culture, but lack proficiency in the English language. Two authors, who have each taken opposite sides of the debate on bilingual education in America, are: Richard Rodriguez and Ariel Dorfman. Richard Rodriguez believes that bilingual education creates a feeling of separateness between foreign language speakers and American society; therefore, bilingual education delays the formation of a public identity. In contrast, Ariel Dorfman argues that bilingualism in America will be a bridge to better understanding other cultures. I assume the position of being neither, against or entirely in favor of bilingu al education. I am in favor of bilingual education because it can be an effective segue to learning the English language and I believe it is very important to remain connected with our family’s language and culture. However, I also recognize the negative feeling of separateness from the larger public that bilingual education can have on foreign language speaking families, which hinders my ability to fully embrace bilingual education. Ariel Dorfman is an Argentinian author who struggled throughout his life to find a balance between the Spanish and English languages. As a result of Dorfman’s â€Å"bilingual journey† (Heading South 25), he argues that bilingual education is beneficial to American society. Dorfman believes that bilingualism will serve as a ... .... ---. Heading South, Looking North. New York: Farrar, Straus, and Giroux, 1998. Print Garcia, Maria E., Ofelia Skutnabb-Kangas, Tove Torres-Guzman. Imagining Multilingual Schools: Language in Education and Globalization. Clevdon, GBR: Multilingual Matters Limited, 2006. Web. 17 Apr. 2012. Hadi-Tabassum, Samina. Language, Space and Power : A Critical Look at Bilingual Education. Clevdon, GBR: Multilingual Matters Limited, 2006. Web. 17 Apr. 2012. Rodriguez, Richard. â€Å"Aria: A Memoir of a Bilingual Childhood.† Conversations: Reading for Writing. Ed.Gack Selzer. 5th ed. New York: Longman, 2003. 153-166. Print. ---. Hunger of Memory: The Education of Richard Rodriguez. New York: Bantam Dell, 1983. Print Salomone, Rosemary C. True American: Language, Identity, and the Education of Immigrant Children. Cambridge, MA: Harvard University Press, 2010. Web. 17 Apr. 2012.

Down With The Kings :: essays research papers

When someone commits a crime, they are punished for their sin. If someone says, â€Å"go rob that store,† the man robbing the store is persecuted, not usually the instigator. Everyone, regardless of status or wealth is responsible for his actions. No one can whip out a remote control and make them do anything they want them to do. Men can be manipulated, but he is still under his own control. No one can make his decision as to whether or not he is going to be obedient to his manipulator. In the play Macbeth, Macbeth himself is most responsible because each man is responsible for his own actions and the results of those actions.   Ã‚  Ã‚  Ã‚  Ã‚  There are many parts of the play Macbeth that show Macbeth taking charge and having full responsibility of his deeds. Regardless of how much Lady Macbeth seems to push Macbeth, it is in Macbeth’s disposition to take charge and be independent as is shown in this proclamation announced by Macbeth himself, â€Å"Bring me no more reports. Let them fly all! Till Birnam Wood remove to Dunsinane, I cannot taint with fear.† (V.iii.1-3) Macbeth is mot told to ignore all of his military responsibilities by anyone. Lady Macbeth is barely alive at this time therefore there is no way that she could have influenced this decision made solely by Macbeth. Macbeth is completely confident in himself and does not think that anything can keep him from keeping his position on the throne. Macbeth’s greed and the fact that he is incredibly headstrong are also factors of his demise. Macbeth demonstrates this by saying: We will proceed no further in this business. He hath honored me of late, and I have bought Golden opinions from all sorts of people, Which would be worn now in their newest gloss, Not cast aside soon. (I.vii.35-40) Macbeth sees his compliments as actual features of himself that will live with him forever and not just once in a while characteristics being cast off quickly. Although, these people do contribute to his actions by fueling them, he still makes the ultimate choices. He sees people trying to win favor with him as his actually characteristics, and this makes his desire for status stronger. He shows that he is capable of excellent judgment but would rather do deeds that benefit him rather than do what is best for the majority and those he loves.

Life in the Colombian Cocain Trade Essay -- essays research papers

Colombian Cocaine Trade Cocaine is produced from the Coca plants usually found in the mountain climates of Colombia. The first cocaine alkaloid was not achieved until 1855. The cocaine alkaloid was first isolated by a German Chemist Friedrick Gaedcke. Cocaine was first used in the 1880’s as an anesthetic in eye, nose, and throat surgeries because of its capability to provide anesthesia as well as to constrict blood vessels and limit bleeding. Its therapeutic applications are obsolete in this day and age because of the technological advances to produce safer drugs . Cocaine is the most devastating and potent stimulant of the natural realm. In this paper I will be discussing the history of cocaine, the impact in the world, and lastly the War on Drugs. Dating back thousands of years the South American Indigenous people have chewed the coca leaf. The leaf contains important nutrients and can be life saving to a person who hasn’t eaten for days. When the Spaniards conquered South America they discovered that the claims of the leaf being nutritious were true and started taxing 10% of the value of the crop . The taxes actually became the main source of support for the Roman Catholic Church in the region. In 1999, Colombia remained the world's leading producer of cocaine. Three quarters of the world's annual yield of cocaine is produced there. In the year 2000, Columbia still remains the world's leading producer of the drug .   Ã‚  Ã‚  Ã‚  Ã‚  The coca cultivation that goes on in the Andean jungle is damaging the health of the environment in the region. The main threats to the environment are deforestation caused by clearing the fields for cultivation, soil erosion caused by several factors, and chemical pollution from insecticides and fertilizers. The process of mixing coca and poppy into cocaine and heroine has devastating effects on the environment as well. These environmental issues are difficult to address due to coca being a traditional crop and trade item, the influence and wealth of the drug traffickers opposing restrictions, and the issue of national sovereignty. Most realize the social impact of the drug trade worldwide, but few realize the environmental impact. The natives who used to live on eating the fish from the rivers no longer are able to find any edible fish.   Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Polluti... ... and a peasant. Escobar started his legacy of being a notorious ruthless cocaine distributor in the 1970’s. By the 1980’s Escobar’s cartel was responsible for over 80% of the worlds cocaine productivity. Between 1984 & 1987, fifteen judges and numerous other governmental figures were assassinated in streets of Medellin. By 1993 credited with killing more than 200 judges, an attorney general, three presidential candidates, estimated 1000 police officers, dozens of journalists, and thirty kidnappings. Escobar's killing in December 1993 ended a long terror campaign that shook Colombia to its core. The drug lord's gang set off bombs, downed an airliner and killed dozens of police officers and officials to coerce the government to not extradite drug suspects to the United States. The United States for some time has been helping Columbia with military aid, including training and intelligence gathering. Special units from the military, CIA, FBI, DEA, and half dozen other agencies, in conjunction special units of the Columbian police , were all responsible for the take down of Pablo Escobar and friends. This was also labeled one of the greatest take downs in the history of Colombia.

Compare and contrast between persepolis war and vietnam war Essay

Graphic Novels showing conflict of war can be described in different ways. These ways are determined by the target audience and the authors decision of mood.The imagery in Persepolis and the vietnam story are affected by these choices made by the author. There are differences in the style of this book in which the reader uses to show emotion such as the target age group, the emotional aspect as well as the realism of the story. The imagery which detail is displayed in a complex or simple way can both give the reader insight while portraying a different perspective at the same time. Persepolis and the vietnam imagery both use a black and white graphic weight creating a dark feeling shown by the subjective style. They use detailing in the background like the shadowed soldiers in the Vietnam images or bright flashes of gunshot in Persepolis, thus giving the reader a different perspective. The vietnam images provides a more in depth style that provides in order to show the author’ s message. However, the simple imagery used in persepolis is to get a point across using symbolic images and a straightforward style rather than in the vietnam images the sketched lines and detailing brings out a specific emotion. The target audience in which the author and/or illustrator wants to reach out to affects the type of imagery and message they want to send out,such as a story about the conflict of war to children can be subtle rather than show a harsh reality yet can both depict a mood of conflict and struggle. These two graphic styles can both get across the subjective opinion of war being undesirable by the emanata of struggle seen with the characters to the reader. They both compare the harsh reality without being too gruesome. Persepolis uses a more cartooned illustration to portray a childlike perspective thus having a target audience of young readers. In contrast, the Vietnam imagery’s perspective differs in the point of view. This shows the difference in fighting in the war rather than suffering the consequences, demonstrating an adult understanding. War can convey many emotions depending on the authors/illustrators mood they want to convey to the readers by using simple and/or complex emanata and graphic weight in similar and different ways. Persepolis and the vietnam both inflict a sympathetic emotions by showing  the struggles shown by their stressed emotions and facial styles. As well as their similar use of contrast between light and darkshows a emotional aspect of the conflict of war. To contrast the Vietnam images uses shading and shadows to add more tension and grit displaying a impactful emotion. The Persepolis imagery uses thick heavy blacks and whites without any shading making the images simple and the emotions it portrays to the reader shallow and not as complex. In conclusion these two works of graphic reading can be contrasted and compared by only three categories of realism, target age groups, and emotions. These both shared the struggles of the conflict of war as well as portraying different views and perspectives. As well as displaying an obvious age target. Even though they are similar they are both different in showing the conflict of what goes on in a war.

Nitric oxide therapy

There is not much use for the lungs during the fetal life. At such stage, the function of the lungs is carried out by the placenta through the umbilical cord. Fetal life is characterized by a high pulmonary vascular resistance (PVR) with pulmonary blood flow being restricted to a less than 10% lung-directed cardiac output. Blood vessels that connect the heart and the lungs are constricted, sending the circulating blood back to the heart through the ductus arteriosus, a blood vessel that functions only in fetuses. In other words, the lungs in the fetal stage are bypassed.At birth, when the lungs finally assume the function of gas exchange, the PVR decreases, allowing for an increase in pulmonary blood flow. The blood vessel that is previously constricted, favoring blood flow to the ductus arteriosus is now relaxed, simultaneously with the permanent closure of the ductus arteriosus. This happens as the lungs become ventilated and the alveolar oxygen tension is increased.Persistent Pulm onary Hypertansion occurs when at birth, the lung circulation fails to achieve the normal drop in PVR, preventing the transition from fetal to newborn circulation. This failure results in the continuous functioning of the ductus arteriosus which impairs the flow of blood from the heart to the lungs and limits the amount of oxygen that can be picked up by the blood to be delivered to the different parts of the body. The blood that flows back to the heart remains in an unoxygenated state which could lead to the development of refractory hypoxemia, respiratory distress and acidosis.It is only in 1987 when nitric oxide (NO) was recognized as a key endothelial-derived vasodilator molecule. From then, research has been expanded to establish the role of NO throughout the body, and to discover its therapeutic potential.   To appreciate the effects of NO in alleviating pulmonary hypertension, it is important to gain understanding of its chemistry and mechanism of action.Nitric Oxide is a g aseous compound that rapidly diffuses across membranes and has a single unpaired electron. This explains its high reactivity, especially to Hemoglobin (Hb) in the blood. This nature of the compound accounts for its noted biological significance. It has been discovered to function as stimulant in the release of hormones; as neurotransmitter; a significant participant in the magnification of synaptic actions and learning processes; and an inhibitor in platelet aggregation, which makes it a marvel in the field of cardiology.In the field of pulmonology, nitric oxide is valued for its vasodilatory effect in the blood vessels. This effect can be explained by the mechanism involving the compound's diffusion from the vascular endothelial cells to the subjacent smooth muscles of the pulmonary vessels. From here, NO activates the enzyme guanylate cyclase to change conformation to promote smooth muscle relaxation by converting GTP to cGMP.   This vasodilatory effect signals the mechanism to modulate blood flow and vascular tone.Given the mechanism of action, it is easy to surmise how NO can be utilized as a therapeutic agent in the management of blood-vessel-related diseases such as those related to the heart (hypertension), the reproductive system(erectile dysfunction) and in this case, the lungs (Persistent Pulmonary Hypertension in infants (PPHN)).Before NO, treatments used in infant PPHN are hyperventilation, continuous infusion of alkali, tube vasodilation and vasodilator drugs. A study on the effects of these various treatments was done by Ellington, Jr., et. al., (2001) showing no specific therapy clearly associated with the reduction in mortality in infants. In determining whether therapies were equivalent, the study showed that hyperventilation reduced the risk of extracorporeal membrane oxygenation (ECMO) with no oxygen increase at 28 days, while alkali infusion increased the use of ECMO as well as an increase in the use of oxygen at 28 days (Ellington, Jr., et. al., 2001). ECMO is a highly invasive procedure that requires major surgery, performed in serious cases of PPHN when patients fail to respond to treatments.It is only after post-lab studies were able to identify the role of NO-cGMP signaling in the regulation of lung circulation that NO therapy was developed for PPHN (Channick, R., et. al., 1994). Like previous treatment methods, NO therapy improves oxygenation as well as reduces the risk of ECMO in infants with PPHN (Oliveira, et. al., 2000). But because nitric oxide is capable of acting on its own upon inhalation to relax the blood vessels and improve circulation, it is considered as a less invasive procedure in the management of infants with PPHN compared to the previous treatments mentioned in the preceding paragraphs.The efficiency of the treatment procedure can be determined by observing its effect on the patient's ventilation and blood flow, which is a determinant of the efficiency of transpulmonary oxygenation and partia l pressure of oxygen in the systemic arterial blood (Ichinose, et. al., 2004). NO therapy enhances the mechanism by which blood flow is redistributed toward regions in the lungs with better ventilation and higher intra-alveolar partial pressure of oxygen (Ichinose, et. al., 2004).Other treatments used in the management of PPHN such as tube ventilation, alkalosis and intravenous vasodilators were shown to be effective in ameliorating pulmonary hypertension in some infants, but in many instances, it does not, as ECMO almost always becomes a necessity in saving the life of the infants (Ichinose, et. al., 2004). A type of hyperventilation has been proven not to increase the risk of ECMO, but unlike NO-therapy (Ellington, Jr., et. al., 2001), it is invasive as to require a tube inserted inside the infant's trachea.In patients with moderate PPHN, there is an improvement in arterial p a O 2, reduced necessity of ventilator support and low risk of progression to severe PPHN (Sadiq, et. al., 2003) and this, without the risk of increasing the incidence of adverse outcomes when the age of 1 year is reached (Clark, et. al. 2003). Inhaled NO is able to rapidly increase the arterial oxygen tension and increase the blood flow in the lungs without causing systemic hypotension (Roberts, 1992; Kinsella, 1992). No apparent increase in morbidity has been shown after one year of treatment with NO (Aparna and Hoskote, 2008). For high-risk infants with PPHN, inhaled NO has been found to lessen the risk of pulmonary hypertensive crisis (PHTC) after congenital heart surgery (Miller, et. al. 2000).Studies on the role of NO in the management of PPHM show that while it is therapeutic, it also prevents the occurrence of chronic lung disease which affects morbidity. Vascular cell proliferation and pulmonary vascular disease have been shown to decrease with NO in the newborn (Roberts, et. al., 1995). In addition, while NO treatment can be more costly, it is the most cost-effective among oth er methods because of the reduced need for ECMO (Angus, et. al. 2003). For these reasons, it is understandable why NO therapy seems to have taken over in the area of PPHN treatment.ReferencesAngus DC, Clermont G, Watson RS, et al. (2003). Cost-effectiveness of inhaled nitric oxide in the treatment of neonatal respiratory failure in the United States. Pediatrics. 112, 1351–1360.Aparna U., Hoskote, MD., et. al. (2008). Airway function in infants treated with inhaled nitric oxide for persistent pulmonary hypertension. Pediatr Pulmonol. 43, 224-235.Channick R, Hoch R, Newhart J, et al. (1994). Improvement in pulmonary hypertension and hypoxemia during nitric oxide inhalation in a patient with end-stage pulmonary fibrosis. Am J Respir Crit Care Med. 149, 811-814Clark, RH., Huckaby, JL., et. al. (2003). Low-Dose Nitric Oxide Therapy for Persistent Pulmonary Hypertension: 1-Year Follow-up. Journal of Perinatology. 23, 300.Ellington Jr, Marty, O'Reilly, et. al. (2001). Child Health S tatus, Neurodevelopmental Outcome, and Parental Satisfaction in a Randomized, Controlled Trial of Nitric Oxide for Persistent Pulmonary Hypertension of the Newborn. Pediatrics,107.Ichinose F, Roberts JD, et.al. (2004). A Selective Pulmonary Vasodilator: Current Uses and Therapeutic Potential. Circulation. 109, 3106-3111. Kinsella JP, Neish SR, Shaffer E, et al. (1992). Low-dose inhalation nitric oxide in persistent pulmonary hypertension of the newborn. Lancet.   340, 819–820.Miller O, Tang SW, et. al. (2000) Inhaled nitric oxide and prevention of pulmonary hypertension after congenital heart surgery: A randomised double-blind study. The Lancet. 356: 9240, 1464.Oliveira cac, et. al. (2000). Inhaled Nitric oxide in the management of persistent pulmonary hypertension of the newborn: a meta-analysis. Rev. Hosp. Clin. Fac. Med. S., 55 (4): 145-154, 2000Roberts JD Jr, Polaner DM, Lang P, et al. (1992). Inhaled nitric oxide in persistent pulmonary hypertension of the newborn. Lan cet. 340, 818–819.Roberts JD Jr, Roberts CT, Jones RC, et al. (1995). Continuous nitric oxide inhalation reduces pulmonary arterial structural changes, right ventricular hypertrophy, and growth retardation in the hypoxic newborn rat. Circ Res. 76, 215-222.Sadiq HF, Mantych G, et. al. (2003). Inhaled Nitric Oxide in the Treatment of Moderate Persistent Pulmonary Hypertension of the Newborn: A Randomized Controlled, Multicenter Trial. Journal of Perinatology.   23, (2).98

Jails and Prisons

The Differences of Prisons and Jails Kenitra Evans CRJ303 Instructor Martin McAuliffe March 13, 2013 There are many differences between jails and prisons. They equally both house offenders but their day to day operations are very different. There are long histories about jails and prisons both and in this paper we will describe the differences of jails and prisons including how they operate and their functions.Many people hear the words prison and or jail, and they believe that both are one in the same but in reality they are very much different. Jails are correctional facilities that house offenders before or after they are sentenced for their crimes committed. Those individuals that are confined in jails are: * Individuals pending arraignment and awaiting trial, conviction, or sentencing * Probation, parole, and bail bond violators and absconders (Seiter,2011 pg 71) There are many different other reasons jails house inmates. Jails are full service facilities that offer security, fo od service, medical care, and offender programs and are therefore different from lockups, which are commonly located in police stations and hold people only for a short period of time, usually no more than forty-eight hours. †(Seitter, 2011) Sheriff’s and local governments oversee the day to day operation of jails and there are different jails such as the regional jail which were created because the basic operations of jails were becoming complicated for small counties and the need for funding to continue operations.There are about 3,600 jails in the United States. â€Å"The size of the jail population is a product of decisions made by various law enforcement entities that the jail serves, the courts, and other segments of the criminal justice system. The size of the jail population is also affected by local, state, and federal laws; crime rates; and public attitudes about crime. †(nicic. gov) The length of stay and those admitted to jails are quite different fro m prisons. There have been almost 9 to 11 admissions to jail and the average length of stay is 15 to twenty days.Sometimes a person stays longer if they are still fighting a case thus pushing out their court dates which extends their stay provided they cannot afford bail. â€Å"During 2003, 686,437 inmates were admitted to state and federal prisons, 656,320 inmates were released, and the average length of stay for released inmates was 36 months. The jail system booking and release procedures are on a constant whirlwind with bail bonds and so forth. There are different jails as well such as state jails and county jails.In state jails an inmate can spend no more than two years maximum. Prisons Prisons are run by state governments and the Federal Bureau of Prisons. There are only about 100 federal prisons, detention centers, and correctional institutions in the U. S. Prisons were created to house inmates that are serving a sentence of one year or more that are convicted of crimes. Pri sons offer more to inmates such as work programs, Halfway houses and other educational programs that could possibly benefit the offender.These sorts of incentives are not offered in jails because inmates are usually serving shorter sentences. There are different facilities such as BOP operated prisons, long term contract facilities and jails/short term facilities. Many offenders in prison are set in place by their security levels. Some are deemed as low risk, medium risk or high risk offenders which determine where they are housed. The prison budget has been over exceeded with the operations and also building more prisons to prevent overcrowding. Corrections is the fifth-largest area of state spending after Medicaid, secondary education, higher education and transportation. State spending on prisons has swelled as the nation’s jail and prison population has climbed to 2. 3 million people, or about one in every 100 adults. But grim budget realities are forcing state lawmakersà ¢â‚¬â„¢ hand. †(pewtrusts. org) There is a difference in jails and prisons as well as how they are operated. Prisons house offenders that have been convicted of crimes whereas jails house those awaiting trial as well as those serving shorter sentences.Prisons and jails have come a long way and there will be more changes to come with the world’s crime rate as it is. References At Least 23 States Cut Funding for Prisons This Year, August 11, 2009 The Pew Charitable Trusts http://www. pewtrusts. org/our_work_report_detail. aspx? id=54481 Corrections: An Introduction; Richard P. Seiter 3rd edition 2011 Upper Saddle River New York Jail Resource Issues What Every Funding Authority Need to Know, Gary M. Bowker February 2002 http://static. nicic. gov/Library/017372. pdf Jails and Prisons The Differences of Prisons and Jails Kenitra Evans CRJ303 Instructor Martin McAuliffe March 13, 2013 There are many differences between jails and prisons. They equally both house offenders but their day to day operations are very different. There are long histories about jails and prisons both and in this paper we will describe the differences of jails and prisons including how they operate and their functions.Many people hear the words prison and or jail, and they believe that both are one in the same but in reality they are very much different. Jails are correctional facilities that house offenders before or after they are sentenced for their crimes committed. Those individuals that are confined in jails are: * Individuals pending arraignment and awaiting trial, conviction, or sentencing * Probation, parole, and bail bond violators and absconders (Seiter,2011 pg 71) There are many different other reasons jails house inmates. Jails are full service facilities that offer security, fo od service, medical care, and offender programs and are therefore different from lockups, which are commonly located in police stations and hold people only for a short period of time, usually no more than forty-eight hours. †(Seitter, 2011) Sheriff’s and local governments oversee the day to day operation of jails and there are different jails such as the regional jail which were created because the basic operations of jails were becoming complicated for small counties and the need for funding to continue operations.There are about 3,600 jails in the United States. â€Å"The size of the jail population is a product of decisions made by various law enforcement entities that the jail serves, the courts, and other segments of the criminal justice system. The size of the jail population is also affected by local, state, and federal laws; crime rates; and public attitudes about crime. †(nicic. gov) The length of stay and those admitted to jails are quite different fro m prisons. There have been almost 9 to 11 admissions to jail and the average length of stay is 15 to twenty days.Sometimes a person stays longer if they are still fighting a case thus pushing out their court dates which extends their stay provided they cannot afford bail. â€Å"During 2003, 686,437 inmates were admitted to state and federal prisons, 656,320 inmates were released, and the average length of stay for released inmates was 36 months. The jail system booking and release procedures are on a constant whirlwind with bail bonds and so forth. There are different jails as well such as state jails and county jails.In state jails an inmate can spend no more than two years maximum. Prisons Prisons are run by state governments and the Federal Bureau of Prisons. There are only about 100 federal prisons, detention centers, and correctional institutions in the U. S. Prisons were created to house inmates that are serving a sentence of one year or more that are convicted of crimes. Pri sons offer more to inmates such as work programs, Halfway houses and other educational programs that could possibly benefit the offender.These sorts of incentives are not offered in jails because inmates are usually serving shorter sentences. There are different facilities such as BOP operated prisons, long term contract facilities and jails/short term facilities. Many offenders in prison are set in place by their security levels. Some are deemed as low risk, medium risk or high risk offenders which determine where they are housed. The prison budget has been over exceeded with the operations and also building more prisons to prevent overcrowding. Corrections is the fifth-largest area of state spending after Medicaid, secondary education, higher education and transportation. State spending on prisons has swelled as the nation’s jail and prison population has climbed to 2. 3 million people, or about one in every 100 adults. But grim budget realities are forcing state lawmakersà ¢â‚¬â„¢ hand. †(pewtrusts. org) There is a difference in jails and prisons as well as how they are operated. Prisons house offenders that have been convicted of crimes whereas jails house those awaiting trial as well as those serving shorter sentences.Prisons and jails have come a long way and there will be more changes to come with the world’s crime rate as it is. References At Least 23 States Cut Funding for Prisons This Year, August 11, 2009 The Pew Charitable Trusts http://www. pewtrusts. org/our_work_report_detail. aspx? id=54481 Corrections: An Introduction; Richard P. Seiter 3rd edition 2011 Upper Saddle River New York Jail Resource Issues What Every Funding Authority Need to Know, Gary M. Bowker February 2002 http://static. nicic. gov/Library/017372. pdf