Urban services (waste collection and cleaning) and waste treatment Thesis

Urban services (waste collection and cleaning) and waste treatment activities Globally (focus in Europe) - Thesis Example ries do not differ much as to their wastes disposal priorities, but Europe is more advanced in treatment because of experimentation and implementation of technologies. Landfills would remain a problem because of scarce resources and need for area developments. Outlook and trends of the waste industry is good as revenues of the players in the industry are encouraging. Waste disposal is one of the urgent environmental problems facing regions all over the world. The over consumption of resources and creation of non-biodegradable materials such as plastics, Styrofoam and chemicals are creating a mounting problem of waste disposal. People are gaining the notoriety of producing excessive wastes and dumping them as garbage on landfills and oceans. Garbage such as nuclear wastes, plastics, fast food wastes and electronic products are samples of harmful materials that can affect the health of man in particular and of the environment in general. However these wastes became a business opportunity and opened up avenues for new industries, i.e. the urban services and waste treatment, an interesting topic for discussion. This study intends to investigate the urban services and waste management activities in Europe., and in U.S. Specifically, study seeks to describe the practices done within the industry and identify the challenges and opportunities the industry face. This work would be of special concern to those who wanted to gain information on the economic opportunities of the waste disposal. This research will use observational research method wherein the researcher will study a phenomenon without interfering. Observation method is used in behavioral studies, social sciences and anthropology, and is useful when ethics is a problem. Existing literatures and researches on the subject will be used as secondary source since access to primary source is not possible. Web definition of waste management is â€Å"The  collection,  transportation, and  

The National School Lunch Program Essay Example for Free

The National School Lunch Program Essay The provision of school meals in America began, as it did in many other lands in a rather sporadic way. According to the web site about the history of the School Lunch Program, in New York The Children’s Aid Society started a program in 1853, but it wasn’t until Robert Hunter’s book ‘Poverty’ was published in 1904 that other areas really took up the challenge. Hunter felt that it was no good having a law that compelled children to go to school if they were so hungry that they couldn’t concentrate or gain much benefit. In Philadelphia the Starr Association had begun serving penny dinners in 1894 and in 1908 programs were begun in Boston by the Women’s Educational and Industrial Union. The children ate their dinners at their desks, there being at that time no school food halls. By the end of the 1910 school year 2,000 pupils were being served. Ellen H. Richards wrote in the Journal of Home Economics for December 1910, The teachers are unanimous in the belief that the luncheons are   helping the children both physically and mentally. They are more   attentive and interested in the lessons during the last hour of the morning and the result in their recitations gives the proof. The National School Lunch Program started in 1946 under the National School Lunch Act signed by the then president Harry S. Truman, though school meals had been provided for many years before that through foods and subsidies from the United States Department of Agriculture. The reasoning behind the act was not just nutrition, but national security. This was because when America entered World War II it found that many recruits were of poor physical condition, especially those who had grown up in poor families during the depression years of the 30’s. As soon as that war finished America began to think about the next wave of conscription as it expected to have to fight communism in the near future. It was mainly under the auspices of General George C. Marshall, a member of the cabinet. According to the statute book its aims were as follows:- It is hereby declared to Congress, as a measure of national security, to safeguard the health and well-being of the Nation’s children and to encourage domestic consumption of nutritious agricultural commodities and other food, by assisting the States, through grants-in-aid and other means, in providing an adequate supply of foods and other facilities for the establishment, maintenance, operation, and expansion of nonprofit school lunch programs. The federally assisted program now operates in 100,000 both public and private schools. 7.1 million children benefited in the first year and the program now provides lunches to 29 million school children each day. The cost in 1947 was $70 million, but by 2005 it was $7.9 billion – a huge investment in the future health of the nation. The aim is that meals are free or at a low cost and that they are nutritionally balanced. In 1998 the program was expanded to include young people up to the age of 18 and also to include snacks served to children at after school educational and enrichment programs. At state level it is usually under the state education authorities who operate through agreements with the school food authorities. Usually it is high schools, both public and non-profit making private ones, who participate as well as private residential child care facilities who take part in the program. I t works by giving both cash and commodities to the institutions involved, the latter, known as ‘entitlement foods’ coming from the U.S. Department of Agriculture at a value of 16.75 cents for each meal served. They may also be given extra food from surplus stocks. In return the schools must meet federal standards in the food that they serve and offer these freely or at a reduced price to eligible children. Other support is available through the USDA’s Team Nutrition who provide nutritional and technical help and also provide nutritional education for pupils. The schools may decide for themselves which foods are served, but must comply with Federal nutritional guidelines which state that no more than 30% of calories should come from fat and less than 10% from saturated fat. They should also provide at least one third of the recommended needs for protein, vitamins, iron, calcium and calories. The meals are available to all children at schools which take part in the program. Those with incomes of less than $26,000 for a family of 4 i.e.130% of the poverty level get their meals free. Those with incomes between this and $37,000 i.e.185 % of the poverty level, get their meals at the subsidised price of no more than 40 cents. These figures are valid until June 30th, 2007. Other children pay more, but the school meal services must be run on a non-profit basis. When it comes to after school snacks if more than half the children in an area are eligible for free or reduced price school meals, then snacks may be free too. Reimbursements to the schools vary a little. Those in Alaska and Hawaii receive more, as do schools with a very high percentage of poorer pupils. There are links with local producers who can provide fresh food such as salad vegetables and fruit. The USDA works with the Department of Defence to provide food purchased through the Department of Defence. The supplies are monitored for fat content and their safety. Programs such as this provide children with the possibility of at least one nutritionally balanced meal a day. This may be prepared in a central kitchen, either r private or belonging to the educational authorities and distributed to schools. Other schools have their own kitchens. What the program can’t do is ensure that the meals are eaten rather than some fast food bought in or bough tin school from vending machines.. they also cannot ensure that the rest of a child’s nutrition is balanced or indeed that he gets enough other food. They educate children about nutrition, but children are not usually the food buyers or cooks at home. It may be, especially in the case of minorities and new arrivals, that the children find school meals unpalatable simply because they are different to what they get at home. Vending machines are in schools which provide other foods at extra cost which are not necessarily nutritionally so good such as chips and soda. There will always be children who prefer these. It would be a dictator who insisted that every one ate the same food, but do these poorer foods have to be so freely available? However many schools raise much needed funds in this way, though child obesity it must be said is a growing concern. For many children their school lunch is the main meal of the day. It is easy to give in to the demands for fast foods, even when those doing so know that they are ultimately harmful. Schools can either use a Nutrient Standard or the older food Group system when choosing the foods they provide. The Nutrient Standard is more accurate in providing a balanced diet, but most schools still prefer the older system. Choice USA recommends that parents regularly review the food that their children are receiving and discuss their choices with them. The child Nutrition Act of 1966 followed on from the National School Lunch Act. Under this act free or low breakfasts could also be provided. This had been initiated by the Black Panther Party earlier. President Johnson said when he gave his signature to the act ‘Good nutrition is essential to good learning.’ There had also been a Special Milk Program which began in 1954. The United States tries to care for all its citizens and so there is also a Child and Adult Care Food Program for both children and elderly and mentally or physically impaired adults in non-residential centers, and the Food Stamp program which began in 1953, so there has been a move away from just ensuring that those called to military service are fit to serve. All this from such small beginnings in one New York school. Electronic Sources Child Nutrition Act found 30th May 2007 http://en.wikipedia.org/wiki/Child_Nutrition_Act Choice USA found 30th May 2007 at http://www.choiceusa.net/Parents_NSLP.html The history of school meal programs found 30th May 2007 at http://www.fns.usda.gov/cnd/Lunch/AboutLunch/ProgramHistory_2.htm National School Lunch Program found 30th May 2007 at http://www.fns.usda.gov/cnd/Lunch/AboutLunch/NSLPFactSheet.pdf School Nutrition found 30th May 2007 at http://www.schoolnutrition.org/uploadedFiles/ASFSA/childnutrition/govtaffairs/nsla.pdf

Hawthornes Young Goodman Brown †Point of View Essay -- Young Goodma

     Ã‚   In Nathaniel Hawthorne’s â€Å"Young Goodman Brown† how does the author present the characters, dialogue, actions, setting and events which comprise the narrative in this short story? This essay will answer these questions. R. W. B. Lewis in â€Å"The Return into Time: Hawthorne† states that â€Å"there is always more to the world in which Hawthorne’s characters move than any one of them can see at a glance† (77). In Hawthorne’s â€Å"Young Goodman Brown† this fact is especially true since the main character, Goodman Brown, is a naà ¯ve hero and since the narrator tells much of the story through the limited point of view of the protagonist. In this story the author uses a third-person narrator, who uses proper names and third-person pronouns to designate the various characteris in the tale: YOUNG GOODMAN BROWN came forth at sunset, into the street of Salem village, but put his head back, after crossing the threshold, to exchange a parting kiss with his young wife. And Faith, as the wife was aptly named, thrust her own pretty head into the street, letting the wind play with the pink ribbons of her cap, while she called to Goodman Brown.   The narrator possesses the capability of reading the thoughts and feelings of the protagonist, the young Puritan husband, Goodman Brown, only, from among all the characters. As Brown turns the corner at the meeting house, he thinks: "Poor little Faith!" thought he, for his heart smote him. "What a wretch am I, to leave her on such an errand! She talks of dreams, too. Methought, as she spoke, there was trouble in her face, as if a dream had warned her what work is to be done tonight. But, no, no! 'twould kill her to think it. Well; she's a blessed angel on earth; and after this one night, I'l... ...agonist as the character through whom the perceptions of the site are arriving to the reader. This inconsistency of viewpoint within given paragraphs may be a source for ambiguity within the tale. In conclusion, we have seen how in Nathaniel Hawthorne’s â€Å"Young Goodman Brown† the author presents the characters, dialogue, actions, setting and events which comprise the narrative in this short story, and what may be a source of ambiguity in the tale.  Ã‚      WORKS CITED Abrams, M. H. A Glossary of Literary Terms, 7th ed. New York: Harcourt Brace College Publishers, 1999. Hawthorne, Nathaniel. â€Å"Young Goodman Brown.† 1835. http://www.cwrl.utexas.edu/~daniel/amlit/goodman/goodmantext.html Lewis, R. W. B. â€Å"The Return into Time: Hawthorne.† In Hawthorne – A Collection of Critical Essays, edited by A.N. Kaul. Englewood Cliffs, NJ: Prentice-Hall, Inc., 1966.

My 70th Birthday Speech

My Seventieth Birthday Speech â€Å"The seventieth birthday! It is the time of life when you arrive at a new and awful dignity; when you throw aside the decent reserves which have oppressed you for a generation and have stand unafraid and unabashed upon your seven-terraced summit and look down and teach-unrebuked. You can tell the world how you got there. † Mark Twain Good afternoon family and friends, I am privileged to be here today to celebrate with you my seventieth birthday. Today is a day I will remember fondly if health allows me to, for seventy is a good long time to live- I should know!In addition, it is truly something to celebrate. In the presence of everyone, my husband Alexander, my sons Alexandre and Vito, my daughters Thea-Simone and Mikaela, my 13 grandchildren and my three great grandchildren. I can proudly say, you are the reason I live today. Who I am today is a product of my earlier socialization, my experiences and my ambitions. I may be described as an in trovert, as you all know; I am quiet by temperament and flourishes in my own company and space, until I met my husband.Alexander and I met when we were in high school, we were friends first, however; a few years later the friendship has grown into something more. We both got accepted into a four year college where my major was psychology and his was biology. I graduated with our bachelor’s degree and then moved on to graduate school at Harvard University to further advance my studies to doctorate’s degree. In the latter part of graduate school I found out that, we were going to have a baby. Above all things I worried about being a good mother to our baby. I looked forward to its birth amidst the support of friends and family.Understandably, I became alarmed when my doctor spoke about his concern about the hike in my blood pressure. He cautioned me about the dangers of high blood pressure levels especially during pregnancy. I immediately changed my diet as per recommend ation and did a critical self-reflection in my quest to de-stress and restore my blood pressure to normal. It was indeed a scary time for me when my blood pressure seemed beyond control and I had to be hospitalized for treatment in the latter trimester of my pregnancy. At this point, the doctor has decided t best that I await the birth of my baby within the hospital walls, luckily, it was almost time. Looking back now, I am amazed that I found the strength to take the next step. When my daughter was born, I was devastated to learn to that, she had but a fifty-fifty chance of surviving as a direct result of the dangerously high blood pressure levels during labor. She stayed with us for a couple hours before she passed on, leaving behind devastation in her wake. I was at a low place in all faucets of my life during this time. I was crippled by grief and felt as if I had come to the end of my journey.I could not help feeling that this was a personal blow to me by God. I wondered how he could have allowed something so drastic and final to happen to me. I wondered if I was being punished for some terrible wrong that I had done. I had to dig deep inside of me to hold onto my faith in God and find the strength to pick up the pieces of my life. I was encouraged to mourn my baby by not living in denial and resume University as soon as I was able, as staying at home for an extended period as was previously planned would hinder the healing process.I conceded and returned to school hoping to fill the vacuum that the baby’s death had left inside of my soul. Had it not been for the wonderful people who entered my life and embraced me as one of their own, my coping skills would have been non-existent. Together they created a very strong support system and constantly encouraged me to hold on to my dreams and aspirations, remaining focused and surmounting each obstacle as they arose. The future was unpredictable in its entirety but I tried to remain focused and continue to believe in that which I want to achieve for myself.I knew I could not do it all by myself and I am forever grateful to my wonderful husband who stood by me through happy times and sad ones and for all the assistance I have received then and now that has helped to shape who I am today. My hard work and determination has paid off, now it is time for me to have fun. I am now retired from being the CEO of the Middleton Psychiatric Hospital and has passed down the honors to my eldest son Dr. Vito Samuda. I believe I have bored you long enough with my long speech, and I can hear the stomach growling from hunger, enjoy your meal.Guest List| Name|   | Hank Aaron|   | F. Murray Abraham|   | Spencer Abraham|   | Dick Albert|   | Eddie Albert|   | Marv Albert|   | Kim Alexis|   | Debbie Allen|   | Ethan Allen|   | Gracie Allen|   | Irwin Allen|   | Joan Allen|   | Karen Allen|   | Marcus Allen|   | Peter Allen|   | Steve Allen|   | Tim Allen|   | Woody A llen|   | Bobby Allison|   | Ben Alexander|   | Jason Alexander|   | William Alexander|   | Tori Amos|   | Marie Antoinette|   | Susan Anton|   | â€Å"Tiny† Archibald|   | Benedict Arnold|   | Eddie Arnold|   | Tom Arnold|   | Bea Arthur|   | Chester Allen Arthur|   |Elizabeth Ashley|   | Laura Ashley|   | Klaus Barbie|   | Sir James Barrie|   | Dave Barry|   | Jeff Barry|   | Linda Barry|   | Marion Barry|   | Rick Barry|   | Freddie Bartholemew|   | Stan Belinda|   | Albert Belle|   | Richard Benjamin|   | Jack Benny|   | Crystal Bernard|   | Bill Bradley|   | Ed Bradley|   | Omar Bradley|   | George Brett|   | Zachary Ty Bryan|   | Kobe Bryant|   | Morgan Brittany|   | Lenny Bruce|   | Nigel Bruce|   | Robert Bruce|   | William Jennings Bryan|   | Anita Bryant|   | Kirk Cameron|   | Jim Carrey|   | Drew Carey|   | Mariah Carey|   | Eric Carmen|   |Diahann Carroll|   | Lewis Carro ll|   | Ray Charles|   | Suzette Charles|   | Warren Christopher|   | William Christopher|   | Agatha Christie|   | Doug Christie|   | Julie Christie|   | Dick Clark|   | Dwight Clark (49ers)|   | Marcia Clark|   | Roy Clark|   | Henry Clay|   | Adam Clayton|   | Jimmy Cliff|   | Sidonie Gabrielle Claudine Colette|   | Joseph Conrad|   | William Conrad|   | Jenny Craig|   | Jim Craig|   | Yvonne Craig|   | Billy Crystal|   | Jamie Lee Curtis|   | Tony Curtis|   | Michael Damian|   | Matt Damon|   | Bill Dana|   | Keith David|   | Larry David|   |Dizzy Dean|   | James Dean|   | Jimmy Dean|   | John Dean|   | Sandra Dee|   | Sandy Dennis|   | Martin Denny|   | Sandy Denny|   | Andy Dick|   | Philip K. Dick|   | Kirk Douglas|   | Michael Douglas|   | Mike Douglas|   | Sherman Douglas|   | Stephen A. Douglas|   | William O Douglas|   | Sandy Duncan|   | Reginald Dwight|   | (See â€Å"Elton Jo hn†)|   | Jakob Dylan|   | Bob Dylan|   | Steve Earle|   | Duane Eddy|   | Nelson Eddy|   | Bill Elliot|   | Bob Elliot|   | Chris Elliot|   | Cass Elliot|   | George Eliot|   | Sam Elliot|   | Sean Elliot|   | T. S. Eliot|   | Julius â€Å"Dr.J† Erving|   | Chad Everett|   | Percy Faith|   | Tammy Faye|   | Arlene Francis|   | Coleman Francis|   | Connie Francis|   | Dick Francis|   | Anne Frank|   | Barney Frank|   | Sandy Frank|   | Aretha Franklin|   | Bonnie Franklin|   | Joe Franklin|   | Benjamin Franklin|   | Peter Gabriel|   | Jennie Garth|   | Crystal Gayle|   | Phyllis George|   | Wally George|   | Johnny Gilbert|   | Melissa Gilbert|   | Sarah Gilbert|   | John Glenn|   | Jeff Gordon|   | Topher Grace|   | Billy Graham|   | Katherine Graham|   | Amy Grant|   | Hugh Grant|   | U. S. Grant|   | Judd Gregg|   |Dick Gregory|   | Gilbert Gottfried|   | Buddy Guy| | Dar ryl Hannah| | George Harrison| | Debbie Harry| | P. J. Harvey| | Paul Harvey| | Steve Harvey| | Buck Henry| | John Henry| | Patrick Henry| | Frank Herbert| | Sir Edmund Hillary| | Buddy Holly| | Lauren Holly| | Bob Hope| | Curly Howard| | Jerome Howard| | John Howard| | Moe Howard| | Ron Howard| | Victor Hugo| | Hubert Humphrey| | Janis Ian| | Amy Irving| | John Irving| | Julius Irving| | Washington Irving| | Chris Isaak| | Dennis James| | Harry James| | Henry James| | Jesse James| | Kevin James| |

Health Care Communication Methods Essay

Customer Service also known as communication, now days almost always involves several people, especially when it involves an elderly loved one. Having an elderly family member is a very sensitive topic believe it or not and although very common is still something that most still do not know how to deal with and do not quite understand. It is hard to have to face that fact that your Grandparents, parents, aunts, uncles, and sometimes siblings are faced with life threatening illnesses such as Alzheimer’s and Dementia and have forgotten who you are along with a host of other things. As an administrator of a Nursing Home you could be faced with many different situations and because patients in a nursing home are sometimes unable to understand or communicate on their own, it is important to have ways to get in contact with several different family members in the event of an emergency. Family members of these elderly patients still have lives of their own and may live in different states or countries even and then in the worst case, you have some patients in Nursing Homes who do not have family members at all. Most of the time there will be a social worker who is responsible for the wellbeing of these patients in this type of situation. There is an enormous misunderstanding of the role of communication services in healthcare. Nursing home administrators act as the patient’s liaison between staff and doctors, in the event that a Nursing Home receives notification that the organization is being purchased by a national group, and because of new policies to be implemented, many of the patients will be displaced, it is important to know the way to communicate with each individuals family members. Residents have rights and these rights being violated can cause serious issues with the law. Below is a short list of patients’ rights when concerning unfair transfer or discharge. Protection against Unfair Transfer or Discharge: You can’t be sent to another nursing home, or made to leave the nursing home, unless any of the  following are true: It is necessary for the welfare, health, or safety of you or others. Your health has declined to the point that the nursing home can’t meet your care needs. Your health has improved to the point that nursing home care is no longer necessary. The nursing home hasn’t been paid for services you received. The nursing home closes In this scenario it is important that you inform the residents that they are being displaced and that they need to approve the release of their medical information. The best way to do this, since it is concerning medical records, would be privately. HIPAA protects the privacy of individually identifiable health information and if violated you could face jail time and hefty fines so you should use the best communication method that fits the scenario. The best method of communication I thought would be best for this scenario was traditional and electronic communication because they both have some convenience to the residents. The right amount of information and the right information is needed to explain to family members and patients what is happening to this facility. Finding the right laws and rights is what needs to happen to make sure the company is not in violation of that patient. Finding the best way to communicate with each patient and their family is most important when it com es to getting the message across professionally without seeming to disregard their personal concerns. There are advantages and disadvantages of using social media, traditional, and electronic communication .Traditional, the oldest of the three some of the many advantages that tradition communication has is that you are person with the person you are communicating with, which is better because you are getting an immediate reply to whatever it is that you are trying to get. There’s a feeling of community because you’re better able to socialize and interact with one another. We quickly build a bond that sets the foundation for trust and ultimately, lasting business relationships. There are so many different issues that have to be considered when communicating with patients and their family members, in this scenario most likely there will need to be some convincing that this is best for the patient/ their loved ones. Displacing them does not have to be a â€Å"bad thing† it all depends on how it is presented to them and their reaction to the initial breaking of the news. It is important that the administrator has found a new facility that offers everything that the patients(s) will need to accommodate them completely. Communication is a part of the process to better the patient’s life and once the patient and/or their family is on board then you pretty much have â€Å"tackled the mountain†. â€Å"Forcing information on people when they are too distraught to understand it or accept it (over informing) may only heighten their stress. Philip Muskin(1998) calls this â€Å"truth dumping† and warns people against it. Health-related Information can be confusing and frightening.† It is best to not provide unnecessary information to the patients and family members, just enough for them to understand completely. (Communication About Health Pg. 196) Being and Administrator means being able to communicate effectively with your patients no matter their mental and health condition and being able to communicate with their family members too. It is important to not â€Å"over-do† anything when communicating because it could cause a reaction you don’t want to deal with. There are different ways of communicating messages and different tones and as an Administrator in this particular scenario it is important to know what tone of communication to use when letting the patients and their family members know what is going on. It is a good idea to know where the patient will be transferred to and to have a brochure and good information on where the patient is going so that maybe the family member and the patients will be comfortable about the big news. References: 1. Journal Article . (2014, Fall). People living with dementia: components of communication, (Pg.1). 2. . (2005). Communicating About Health Current Issues And Perspectives. Retrieved from, HCS/320 Health Care Communication Strategies website.

Calvin Klein Essays - Calvin Klein, Warnaco Group, Free Essays

Calvin Klein Essays - Calvin Klein, Warnaco Group, Free Essays In Back to the Future, Marty McFly goes by the name Calvin Klein after he is called that by his fifties mother because he is wearing CK underwear. On Family Guy, Klein is seen asking to use Stewie in one of his ads. When Peter feels unsure, Brian states "Peter, this is heterosexual fashion designer Calvin Klein," referencing the homosexual stereotype of male fashion designers. 1. Calvin Richard Klein born November 19, 1942, in The Bronx, New York Developed a passion for fashion and drawing at age of 14 2. EDUCATION Studied at Manhattans Fashion Institute of Technology, but never graduated Attanded the High school of Art and Design, gratuaded from it when he was 18 4. BUSINESS Launched his own clothing company with childhood friend Barry Schwartz With Kleins designs and Schwartzs financialbacking, a fashion empire was born Hes been designing sportswear since the 1970s The first Calvin Klein jeans were introduced in 1972 Started selling his own CK brand underwear when he was 40 5. PARFUMES Sinece the late 80s First: Obsession and Eternity 6. COSMETICS since the 1990s launched his own CK brand cosmetics and make-up at the age of 55 only sold in the best department stores such as Harrods, in London, and Bloomingdales in New York 7. Calvin Klein has been awarded Coty Award - 1973,1974,1975 Council of Fashion Designers of America Award - 1982,1983,1986 CDFA (Council for Fashion Designers of America) award - 1993 Americas Best Designer of 1993 Award Key Dates: 1968: The Calvin Klein brand is launched. 1973: Klein wins his first Coty American Fashion Critics Award. 1979: Calvin Klein controls one-fifth of the designer jeans market. 1982: Klein enters the underwear business. 1985: A new perfume called Obsession is launched with a $17 million advertising campaign. 1989: A Unilever Co. subsidiary purchases the Calvin Klein cosmetics/fragrance line. 1994: A unisex fragrance, cKone, is introduced; the companys underwear business is licensed to Warnaco Group Inc. 2000: Klein files suit against Warnaco Group and its CEO Linda Wachner. 2003: Calvin Klein is acquired by Phillips-Van Heusen Corporation. Quick Facts BORN IN The Bronx FATHER Flore Stern SIBLINGS Barry Klein, Alexis Klein SPOUSES Jayne Centre Klein, Kelly Rector CHILDREN Marci Klein EDUCATION Fashion Institute of Technology High School of Art and Design FOUNDER/CO-FOUNDER Calvin Klein NET WORTH $700 Million Following His graduation from the High School of Art and Design, Calvin Klein studied clothing design at Manhattans Fashion Institute of Technology. Inspired by the new and unaffected style of New Yorks city youngster, Klein was ready to start his own clothing company in 1968. With financial aid from a childhood friend Klein hired a dressmaker to make a some of his elegant womans coats and dresses. This merchandise was seen in a dirty showroom by a merchandise administrator from Bonwit Teller. The department store purchased $50,000 worth of apparel and displayed samples in eight windows, kicking of Kleins career. By 1970, Calvin Klein acquired a trademark for his infamous CK trade mark. Soon thereafter, Klein received the Coty Award, a prestigious design award, three continuous years in a row in 1973, 1974, and 1975. In addition, he added many product lines and categories and obtained models such as Brooke Shields and Mark Wahlberg. These models careers took off after their Calvin Kl ein debut because the brand has received much recognition over the years for its sleek, classic, and minimal look. By 2003 Phillips-Van Heusen purchased the company where Calvin Klein remained active within the company as a head designer. The company continues to offer a variety of products to a wide target market. The Calvin Klein brand, owned by Phillips-Van Heusen Corporation, covers a wide variety of product classifications. Designer Calvin Klein made his debut at a small New York showroom with coats and dresses for women in 1968. Kleins first designs represented a city chic style of a young woman living and working in New York. These designs were noticed in the apparel industry, and a successful brand name was founded in that small showroom. The next product line from Calvin Klein was womens sportswear, which attracted the interests of popular fashion magazines Bazaar and Vogue. Klein has included sportswear for 5 women in his seasonal lines since the original line was launched . The trademark product of the Calvin Klein brand came out in 1970 and has been the most popular

A Yellow Wallpape Essays

A Yellow Wallpape Essays A Yellow Wallpape Essay A Yellow Wallpape Essay Essay Topic: The Yellow Wallpaper I find â€Å"A Yellow Wallpaper† disturbing because of the author’s grim exploration of the dark underside of women’s subjugation in society. Gilman’s macabre attack on the story’s theme shocks readers to the kind of reality most women are faced with. On the outside, it may appear as John is genuinely concerned about his wife’s well-being but his affection turns out to be problematic and laden with hidden political underpinnings. John, along with the protagonist’s brother and Jennie all look down on her because of her unstable condition. I noticed that it is so easy for the other characters to assume that the protagonist is not mentally sound just because she is experiencing excessive emotional stress. According to the story, she has just given birth at that time. It may be that she is undergoing post partum depression which is why she is always weepy and lonely. Add that to the fact that she is kept in complete isolation and inactivit y. The curative prescription of her husband is definitely bizarre and insane to say the least. Why would you prescribe a mother, who is already suffering from sudden fits of melancholy, with prolonged confinement and passivity? That will only exacerbate her gloom a thousand times over.   Happiness is supposed to be the best medicine yet John prevented her from doing the thing she desires the most- writing. (pg 286) Despite her husband’s strict prohibitions she kept writing in her journal all the same. If anything, it is the only reason that kept her from losing her sanity. Just like a friend, the journal kept her company during all those silent and dark moments of alienation. Moreover, her journal entries give solid proof to the lucidity of her mind. Her accurate descriptions and informed narration give testament to her healthy and sound judgment. Just because the protagonist is emotionally vulnerable it is convenient for the society and the people around her to question he r sanity. Gilman demonstrates that women are misconstrued as immediate victims of madness and hysteria because of their biological make up. I also like the way Gilman also used symbolism to expose the anonymous and almost nonexistent life that women are made to undergo. The nameless protagonist shows that many women are stifled from achieving their own persons. Thus, they are oftentimes disregarded as unknown faces in society. Just like the woman lurking behind the wallpaper pattern, females are taken as shadows which blend seamlessly against the background.   The protagonist’s lack of name or identification suggests her missing identity. She never had a life of her own except from the secondary existence of a wife and mother. 1.  Ã‚  Ã‚  Ã‚  Ã‚   Why is the wallpaper colored yellow? What symbolisms does the yellow color represent? 2.  Ã‚  Ã‚  Ã‚  Ã‚   Why are there severed heads of women within the pattern of the wallpaper? What do they stand for? 3.  Ã‚  Ã‚  Ã‚  Ã‚   How did the use of journal writing as a form of story telling advanced the theme of the story?

Hue and Cry

Hue and Cry Hue and Cry Hue and Cry By Maeve Maddox The following comment set me wondering how widespread the misspelling of hue in the expression hue and cry has become: Where’s the hew and cry [in the mainstream media] about the way women are treated? A web search turned up a great many examples of â€Å"hew and cry,† but it’s not always easy to tell which are misspellings and which are intended to be humorous. For example, the Seattle Times ran the headline, â€Å"Hew and Cry Put on Hold.† The story was about a protest against the the logging of Old-Growth stands. Before 1979 and the separation of the Department of Education from the Department of Health, Education and Welfare, many newspaper headlines used the expression â€Å"hew and cry† as a play on the acronym HEW. Sometimes, however, the intended expression seems clear enough from the context. Here are some examples of hue being misspelled as hew in newspapers published in the U.S., the U.K., Australia, and Canada. Amid Hew and Cry, British Buyout Firms Stay on Message Remember the hew and cry about some ducks dying in a tailings pond? Imagine the hew and cry if GeorgeBush were President So where’s the hew and cry over the gross spending spree? Hew and cry as South run riot Modern speakers are more familiar with the hue that means â€Å"color† than with the hue that means a noise or an outcry, so it’s not surprising they might assume the hue in the expression would have a different spelling. hue: noun. Outcry, shouting, clamor, especially that raised by a multitude in war or the chase. Hue meaning â€Å"shout† came into English from French heu, which was more of an utterance like â€Å"huh† than a word. â€Å"Hue and cry† was the combined tumult of men shouting, dogs baying, and hunting horns sounding that accompanied the pursuit of a criminal. In time the expression became a legal term for such a pursuit commanded by the local constable. Men who refused to assist in â€Å"the hue and cry† were subject to legal penalties. In modern use, â€Å"hue and cry† is used figuratively as a synonym for outcry. One â€Å"raises a hue and cry† against a perceived crime or injustice. Hew, on the other hand, has to do with cutting and chopping. hew: verb. to strike, or deal blows with a cutting weapon; to strike forcibly with a cutting tool. Considering that â€Å"hue and cry† is in its ninth century of use, insisting on spelling it correctly may seem a bit picky. It’s amazing that modern speakers still have a use for it. Still, dictionaries do exist. It seems reasonable to expect people to learn to spell the words they use in publishing their thoughts. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Expressions category, check our popular posts, or choose a related post below:7 Examples of Passive Voice (And How To Fix Them)3 Cases of Complicated HyphenationIs "Number" Singular or Plural?

Structured Systems Analysis and Design Spring 20 15 Deliverable 3 Essay

Structured Systems Analysis and Design Spring 20 15 Deliverable 3 - Essay Example There are three distinct types of meeting: Phone Bridge meeting Physical meeting and Defense Connect Online. First they have to get forms from a secure shared drive which they fill with the details of meetings upon which they seek approval from their immediate supervisors. On acceptance and signing he/she hands it over to department scheduler, who may approve the meeting and schedule it or may decline. Provided that requests are approved, then they carry on the meeting but when decline one start over the process. Since the system is inefficient, it is important to implement the information management system. Implementing the new meeting management system will help NHHC to improve efficiency and productivity of the employees. In addition, it will reduce frustration of the employees, as well as the cost and procedure for schedule approval. This will make meeting scheduling easy and reduce conflicts of information. The implementation of the proposed information management system shall include various stages. In the initial levels of administration shall begin with the employees, then the immediate supervisor of a departmental scheduler. The role of each of them is illustrated in figure 1. When one downloads a file form the library, he/she has it and upload it to the system. Here, they shall identify the given departmental meeting request accordingly. Then the departmental heads shall approve or reschedule the meeting. The greatest constraint on this process is training the employee how to use the system in an effective and efficient way. At the same time they may be complacent and conservative. Coupled with the changes, the policy must be changed to take into account of changes of paper work systems to dynamic online process. The new scheduling management system will require new software, building a new management system and training the employees how to use the system. The

Business Management Essay Example | Topics and Well Written Essays - 500 words - 6

Business Management - Essay Example To keep pace with the demands, the operations team should on a high gear to develop better products or services that are more customers oriented (Lang, 2013). Secondly, the mode of relaying information to the customer is very important. Information technology has grown to enable organizations to meet individual needs of customers. In order to remain competitive and retain the customers, use of information technologies is inevitable due to the accompanying efficiency (Lang, 2013). Thirdly, customer care is very important; all issues raised by the customer should be keenly addressed. The care centers should go a notch higher in providing customized customer services. In doing so, the customer feels appreciated hence increasing their loyalty. Another important point is that the organizations should be swift to respond to customer’s opinions and trends (Slywotzky, 2007). Fourthly, the organization should have a database of its customers and keep on tracking any changes in buying trends. If a customer’s trend exhibits a negative change, an appropriate action should be taken by doing follow up geared towards understanding the cause (Slywotzky, 2007). Some companies have been successful in ensuring that customers remain loyal as well as appreciate their products. One of these companies is Coach Inc, a company that makes handbags and other fashion accessories. Coach Inc has utilized diverse ways of identifying the customer needs. It uses over $5 million in the process of testing new products, which includes several methods of reaching to the customers such as surveys, one-one interviews, as well as in-store testing. The company has a database of its customers; this has continued to grow due to the responsiveness and sensitivity to customer needs. The company endeavors to have all the customer dynamics taken care of. Aspects such as positive buying intent, lapsed customers, competitive rating, customer

Examine Wireless Communication and Bluetooth Technology Essay

Examine Wireless Communication and Bluetooth Technology - Essay Example However, wired environment is non-longer preferable because of their lack of flexibility and cost. Because of the challenges associated with wired technologies, Bluetooth and wireless technologies are increasingly becoming standards for using electronic gadgets like phones, iPhones, and laptops. Whereas Bluetooth technology and wireless communication offer users significant advantages over wired environment, wireless technology differs from Bluetooth's technology because of their complexity, security, and hardware requirements. Wireless communication is much easier to use, as compared to Bluetooth's communication (Gratton 201). The ease of use is one of the factors that differentiate the two sets of communication technologies. When compared to each other, Bluetooth is much simpler to use than wireless communication. Many users of communication equipment such as laptops report through Bluetooth are simpler to use. For instance, users of phones with a Bluetooth adapter can connect to a computer through a simple pairing process. The pairing can be accomplished through some few clicks on computers that enhance the use of the phone will be achieved. When users pair these devices, sharing of files can take place. On the other hand, wireless communication is not extremely easy to use (Morley and Parker 285). Users should have appropriate hardware, software and conduct configuration of their devices in order to transfer files. Because of this, users require to have an internet protocol address for each computer of wireless enabled phones. Moreover, users must purchase and install wireless devices such as routers to enable this communication. This process makes wireless communication challenging to use. Bluetooth's technology is more secure than wireless communication and thus, provides more security to data that users exchanged (Kartalopoulos 153). Security is critical, and users consider when it comes to evaluating technologies. Bluetooth covers a short distance as co mpared to wireless communication. Because of this reason, there are few chances of hackers getting around Bluetooth's connection. However, the fact that wireless communication allows connection over long distance is a security threat. When intruders connect to wireless communication network, most of them cannot be seen hiding or hacking the network. Just to illustrate, hackers can gain access into the wireless communication of his immediate neighbor even at the comfort of their house. Conversely, this kind of infiltration is impossible for Bluetooth's technology, as hackers have to maintain a certain distance from the victims. In addition, Bluetooth's technology has a robust level of security that is difficult to penetrate. Even when hackers succeed in gaining access into a Bluetooth connection, passwords can bar them from taking full control of the devices that they would like to compromise (Briere, Hurley, and Ferris 46). This is quite different with wireless networks where hacker s can use sniffer to detect passwords and hack into the communication lines. The fact that many users forget to protect their wireless networks using wireless pre-shared keys indicate the dangers of wireless communication Without doubt, Bluetooth's technologies are more secure than wireless communication Bluetooth technology and wireless communication have different hardware requirements that make them dissimilar (Huang and Rudolph 89).

CLOCKS Assignment Example | Topics and Well Written Essays - 500 words

CLOCKS - Assignment Example Quartz crystals can be set vibrating with an electric current with crystal vibrations ranging from 2.5 to 5 million times a second. This means that vibrations in quartz clocks allow them to get time measurement to an accuracy down to a millionth of a second. The present day quartz clock developed in the early 1900s, clock needs certain basic requirements for it to work. First, it must have a power source that will allow it to create motion. Second, the clock must have a time base which provides a periodic oscillation dictating the measurement of time. The time base is essentially the device that controls clock signals. Lastly, it must have a way to convey the information generated by the time base and be able to display this information to actually tell time. During the 19th century until the middle of the 20th century, the pendulum clock was the standard time teller. The principle of the pendulum at work is such that its swing is independent of the amplitude, or size, of the swing. In effect, the only factors affecting the amplitude are the length of the pendulum and the force of gravity. Each swing of the pendulum releases a spring-loaded ratchet in the clock mechanism, which drives the hands. If the pendulum is left alone, frictional forces would act upon it and so it will eventually stop. Thus, a pendulum clock must contain a weight-driven or electrically operated mechanism that periodically pushes the pendulum to keep it swinging. Pendulum clocks and earlier versions of watches known as chronometers are quite cumbersome because their movement stops when they are not wound. In addition, pendulum clocks are highly dependent on external forces such as the force of gravity and temperature. Thus, quartz clocks and watches are the more popular options today. Quartz clocks are battery powered with gears regulated by a tiny crystal of quartz. When the battery sends electricity to the quartz crystal through an electronic circuit, the quartz crystal oscillates at

Alternative Energy Essay Example | Topics and Well Written Essays - 2250 words

Alternative Energy - Essay Example They do not believe that alternative energy is the solution to dependence on oil. This essay presents and analyzes both sides of the debate, and critically examines its implication for sustainability. Argument for Alternative Energy Sources Numerous factors have triggered the debate over the capacity of alternative energy sources to solve dependence on oil. Some scholars claim that there is an urgent need to use alternative and renewable energy sources. Most energy scholars have the same opinion that, in the future, the world will completely drain its limited supply of oil. Scholars have the same opinion about the availability of coal in the future; as reported by the United States Energy Information Administration (EIA), supply in the U.S. alone can meet present energy demands for two centuries (Smith & Taylor, 2008, 38). The remaining supply of natural gas and oil are a much more disputed subject. Scholars vary considerably in their estimates of the peak of oil reserves, also refer red to as the ‘topping point’ (Smith & Taylor, 2008, 38-39). Oil’s topping point will occur when the world has used up precisely one-half of the total amount of remaining oil. This implies that the topping point of oil has been reached and that oil reserves will start to dwindle because oil is a nonrenewable energy source (Smith & Taylor, 2008, 39). The supply of natural gas, which is dependent on the availability of oil, is directly connected to this topping point (Podobnik, 2006). The United Nations (UN) made a decision to build the World Commission on Environment and Development in 1983. The name of the commission was eventually replaced with Brundtland Commission (Elliott, 2003, 7). Its objective was to look for sustainable environmental approaches. By raising awareness about the issues with nonrenewable, non-sustainable sources of energy, the Commission fueled and exposed the debate over the limited supply of fossil fuels and other justifications for the nec essity of using alternative and renewable sources of energy. Energy issues have been at the center of economic, political, scientific, and environmental discourses from then on. Those supporting a rapid adoption of alternative and renewable sources of energy believe that the calculated dates for the peak of oil production are mostly immaterial (Elliott, 2003, 18). Environmental issues and the likelihood of tipping points imply that continuous dependence on oil may bring about permanent harm to the natural world. The worst possible damage is a global extermination of species, as well as human beings. Since fossil fuels have to be burned to produce energy, air pollution has been a problem since the advent of the Industrial Revolution. Air pollution has largely been the outcome of burning fossil fuels to produce electricity and supply energy to transportation. Hence, air pollution contains chemicals emitted from burning of fossil fuels (Schmidt, 2007). Air pollution does not only bring about a huge number of untimely deaths annually in developed countries, it also causes environmental destructions. Bodies of water can also be damaged by the use of fossil fuel not merely through acid rain, but through contamination of surface water as well. A case in point is the Exxon Valdez oil leakage. Valdez, the oil

Initial Research, Thesis, and Case Brief Essay Example | Topics and Well Written Essays - 750 words

Initial Research, Thesis, and Case Brief - Essay Example Id.; Gallegos v. State, 776 S.W.2d 312, 316 (Tex. App.--Houston [1st Dist.] 1989, no pet.). 2. In the absence of any evidence of tampering, an objection that the State has failed to establish the proper chain of custody goes to the weight of the evidence rather than its admissibility. Bird v. State, 692 S.W.2d 65, 70 (Tex.Crim.App.1985), cert. denied, 478 U.S. 1031 (1986); Dart v. State, 798 S.W.2d 379, 382 (Tex.App.-Fort Worth 1990, pet. refd). 3. In Beck v. State, 651 S.W.2d 827, 829 (Tex.App.--Houston [1st Dist.] 1983, no pet.), the court held that proof of the beginning and end of the chain of custody will support the admission of narcotics into evidence. The court said that any gaps between the beginning and end of the chain go to the weight, rather than the admissibility, of the evidence. Id. The fact some person, other than the testifying chemist, handles the narcotics, affects only the weight of the evidence, not its admissibility. Id. Defendant was convicted of possession of cocaine with intent to deliver before the 179th District Court, Harris County, I.D. McMaster, J., and defendant appealed. The Court of Appeals, Robertson, J., held inter alia that: trial court did not err in admitting into evidence packet of cocaine found in the defendants pocket. In his third ground of error appellant contends the trial court erred in admitting into evidence the packet containing 2.5 grams of cocaine because of a break in the chain of custody of the exhibit following its removal from his coat pocket. As a basis for his contention he points to the fact that the officer who actually recovered the exhibit did not positively identify it. Prior to executing the warrant the officers agreed among themselves to have Officer Cargill, one of their number, responsible for maintaining control of evidence. Officer Clarke testified he removed the cocaine from appellants pocket and that the exhibit shown to him

Alternative Energy Essay Example | Topics and Well Written Essays - 2250 words

Alternative Energy - Essay Example They do not believe that alternative energy is the solution to dependence on oil. This essay presents and analyzes both sides of the debate, and critically examines its implication for sustainability. Argument for Alternative Energy Sources Numerous factors have triggered the debate over the capacity of alternative energy sources to solve dependence on oil. Some scholars claim that there is an urgent need to use alternative and renewable energy sources. Most energy scholars have the same opinion that, in the future, the world will completely drain its limited supply of oil. Scholars have the same opinion about the availability of coal in the future; as reported by the United States Energy Information Administration (EIA), supply in the U.S. alone can meet present energy demands for two centuries (Smith & Taylor, 2008, 38). The remaining supply of natural gas and oil are a much more disputed subject. Scholars vary considerably in their estimates of the peak of oil reserves, also refer red to as the ‘topping point’ (Smith & Taylor, 2008, 38-39). Oil’s topping point will occur when the world has used up precisely one-half of the total amount of remaining oil. This implies that the topping point of oil has been reached and that oil reserves will start to dwindle because oil is a nonrenewable energy source (Smith & Taylor, 2008, 39). The supply of natural gas, which is dependent on the availability of oil, is directly connected to this topping point (Podobnik, 2006). The United Nations (UN) made a decision to build the World Commission on Environment and Development in 1983. The name of the commission was eventually replaced with Brundtland Commission (Elliott, 2003, 7). Its objective was to look for sustainable environmental approaches. By raising awareness about the issues with nonrenewable, non-sustainable sources of energy, the Commission fueled and exposed the debate over the limited supply of fossil fuels and other justifications for the nec essity of using alternative and renewable sources of energy. Energy issues have been at the center of economic, political, scientific, and environmental discourses from then on. Those supporting a rapid adoption of alternative and renewable sources of energy believe that the calculated dates for the peak of oil production are mostly immaterial (Elliott, 2003, 18). Environmental issues and the likelihood of tipping points imply that continuous dependence on oil may bring about permanent harm to the natural world. The worst possible damage is a global extermination of species, as well as human beings. Since fossil fuels have to be burned to produce energy, air pollution has been a problem since the advent of the Industrial Revolution. Air pollution has largely been the outcome of burning fossil fuels to produce electricity and supply energy to transportation. Hence, air pollution contains chemicals emitted from burning of fossil fuels (Schmidt, 2007). Air pollution does not only bring about a huge number of untimely deaths annually in developed countries, it also causes environmental destructions. Bodies of water can also be damaged by the use of fossil fuel not merely through acid rain, but through contamination of surface water as well. A case in point is the Exxon Valdez oil leakage. Valdez, the oil

The Implementation of International Treaties (with Specific Reference Essay

The Implementation of International Treaties (with Specific Reference to the United Nations Convention for Biological Diversity - Essay Example ‘Implementation’ in legal terms refer to the different regulations, laws, policies, and various other initiatives and measures adopted for fulfilling the obligations as made mandatory under an environmental agreement (Donald, 2002). Implementation of environmental policies, at a global level, is liable to face more issues than implementing at a national level. This is owing to the fact that global implementation depends on mutual collaboration between different countries that have their own set of political, socio-economic and environmental issues, and are under voluntary obligations to follow the treaties; hence it is difficult to hold them responsible for failure in adhering to and implementing the convention guidelines. States with emerging economies may find that implementation of global environmental policies lacks feasibility. Such countries would prefer to allocate public funds for promoting socio-economic growth, instead spending money on safeguarding and regulat ing environmental resources. In developing nations (often, also observed in developed countries) increasing populations and demands for bettering the quality of life, a pressure develops on state governments to relax environmental protection norms. Keeping the challenges and the need for environmental protection in mind, the Convention on Biological Diversity (CBD) was created in 1992 for promoting worldwide sustainable environmental development. CBD is an international body that evolved from the Earth Summit (June 1992), also known as the United Nations Conference on Environment and Development (UNCED), in Rio de Janeiro. The chief aims this Convention are: â€Å"conservation of biological diversity, the sustainable use of its components and the fair and equitable sharing of the benefits arising out of the utilization of genetic resources, including by appropriate access to genetic resources and by appropriate transfer of relevant technologies, taking into account all rights over those resources and to technologies, and by appropriate funding† (Convention On Biological Diversity, 1992, p. 3). The Convention takes into account many issues that range from safeguarding natural resources, to making â€Å"use of traditional knowledge, innovations and practices relevant to the conservation of biological diversity and the sustainable use of its components†(ibid, p. 2), arranging for incentives in cases where there have been sustainable use of environmental resources, and transfer of science and modern technology. In this context, this research paper will study and analyse the 1992 Convention for Biological Diversity (CBD) in order to review the issues faced while implementing global environmental policies. In recent years, countries have become dependent on different international bodies to promote cooperation between States at a global level on various aspects (Lane, 2006). International treaties have turned into foundation stones for various multilat eral regulatory efforts along with being an institutionalised kind of global collaboration, a process based on notions of shared sovereignties (Sharma, Chettri, Gurung and Shakya, 2007). Increased institutionalised collaboration in the recent years has created a complex mosaic of agreements at the global, regional and bilateral levels (Kim, 2003). Even after 2 decades since its inception, CBD continues to be one of the most important global

The missionary outreach of the Celtic Church in Britain Essay Example for Free

The missionary outreach of the Celtic Church in Britain Essay The missionary outreach of the Celtic Church in Britain was a big success. This was mainly due to the work of a number of important peregrini. Peregrination is the pilgrimage for Christ. This follows that the peregrine were pilgrims for Christ. However, Gougaud rightly warns us against this literal translation, as it implies that they make a pilgrimage to a shrine, and then once the visit has been made, the pilgrim returns home and resumes his normal life. In this case then, the early Celtic peregrini were not, strictly speaking pilgrims, because in the vast majority of cases, they were leaving their homes, never to return, in a state of permanent, voluntary exile. The peregrini worked by either re-evangelising those who had lapsed into pagan ways, or converting the polytheists to monotheism. Colmcille turned his back on what could have been an illustrious political career in the Uà ¯Ã‚ ¿Ã‚ ½ Nà ¯Ã‚ ¿Ã‚ ½ill dynasty. He was forever faithful to religion over politics, and was first and foremost a priest and a monk, before a political leader. His Church was very much a missionary Church and he aimed to create a living and vibrant faith throughout the land. Colmcille was a man of incredible pragmatic gifts. He knew that where there was faction and political instability, his mission was impossible, and by establishing a Christian Church, he also gave peace to two tribes who were at war. Long after the death of Colmcille, Iona was the outpost of the Celtic Church in the area and the citadel and retreat of Celtic missionaries. Adà ¯Ã‚ ¿Ã‚ ½mnan, a hagiographer at the time of Colmcille, and author of Colmcilles Life, tells us that He could not pass the space of even a single hour, without applying himself either to prayer, or reading, or writing, or else to some manual labour . His desolate asceticism is well attested to in Adà ¯Ã‚ ¿Ã‚ ½mnans Life, to the extent where he even said that Colmcille used stone as a pillow. He also tells us of Colmcille, He endured hardships of fasting and vigils without intermission by day and night; the burden of a single one of his labours would seem beyond the powers of man. He was a very simple monk, and he served his people faithfully, with sincerity and humility. He used whatever ambition he possessed to the good of his people and his Church. His strong desire for peace is very evident in his final words to the monks, This, dear children, is my last message to you- that you preserve with each other sincere charity and peace. Colmcille was the pioneer of this missionary outreach. The Church he established was endured to centuries after his death. According to Bede, Columba left successors distinguished for their great charity, divine love and strict attention to disciple. The island of Iona became the mother house to a number of monasteries that were created by her sons, least of all Lindesfarne. This was mainly seen in the seventh century, which was at the height of their fame. Colmcille had spearheaded the great missionary outreach of the Celtic Church. In Kennys view, the achievement of Colmcilles followers in Christianising their Anglo-Saxon neighbours is from the viewpoint of world history the most momentous achievement of the Irish section of the Celtic Church. As the Christian faith was beginning to flourish in Ireland, with this paganism was beginning to evaporate. Britain was suffering from invasion from the Angles, the Saxons, the Jutes and other pagan tribes, from Northern Germany. While paganism had taken root in large parts of Britain, Christianity had been reduced to small pockets in Wales, Cornwall and some places in Scotland. The Christians were desolate, and their morale was too low to try and engage in evangelisation with their pagan invaders. They began to lapse into their pagan ways in the same way the people of Israel did when Jeroboam 1 was their king. However, the invaders were to receive the faith from two different sources, the mission of Saint Augustine in 597 (the year that Colmcille died); and his successors, and the missionary outreach of the Celtic monks in Iona. Unlike Colmcille, whose main evangelising took placer in Pictish territory, the monks of Iona moved south to focus on evangelising the Saxon territory. In terms of Aidans life and achievements, he can be very much composed to Colmcille. According to Finlay, Aidan marks the period of the great expansion of the Columban Church Oswald, the son of a Bernicia king was banished with his brothers after his father was slayed. Here he became Christian, and is said to have spent time in Iona. After praying for a victory, Oswald regained his fathers throne. He immediately sent for a monk who would be willing to preach the Word of God in his kingdom. Corman was initially chosen, but failed. A monk spoke up, saying that too much had been expected of the pagan Angles, and that St Pauls maxim regarding milk for the babes needed to be applied, in that before any real change could take place, they would have to be weaned and nurtured. This monk was Aidan, and after boldly speaking out, he was immediately chosen to replace Corman. Bede was filled with admiration for Aidan, and called him a man of singular meekness, piety and moderations. Although Aidan was bishop in Lindesfarne, in his heart he remained a monk, and he ruled his island foundation as an abbot. Due to Aidan, Lindesfarne was to become, in Lightfoots terms, the true cradle of Iona, after its missionaries penetrated deep into England. Gougaud agrees with Lightfoots words, saying that Lindesfarne was the most powerful centre of religious influence in England. Oswald and Aidan remained good friends, with Oswald accompanying Aidan on his mission, and acting as his interpreter. After Oswald died in battle with Penda in 642, it was a personal loss for Aidan, and it is said he even went and retrieved the head of his beloved Oswald from the battlefield, and laid him to rest at Lindesfarne. Aidan transcended the political basis of his missionand managed to cross the divide between two feuding dynasties (Charles Edwards.) This is similar to Columbanus, and how he managed to end the conflict between the Dal Riata, and the Picts. Aidan remained on excellent terms with successive Northumbria kings, without compromising himself or the gospel, which Ryan believes it was his transparent sanctity which made this possible. There is a great deal of evidence, put forward by Bede, which shows Aidans humility. Aidan travelled throughout his journey by fork, so that he could easily talk to those he met on his evangelising journey. McNeill noted that by the time of Aidans death, on the 31st August 651, the tide had definitely turned against paganism. Lightfoot said it was not Augustine, but Aidan who was the true apostle of England. Aidan and his followers restored Christianity to the areas that had lapsed, and won over the new areas that predecessors were unable to conquer. Finian succeeded Aidan to the bishopric, and abbacy of Lindesfarne. One of his achievements was rebuilding a church in Lindesfarne, which he believed to be more worthy of an Episcopal see. He succeeded in baptising the son of Penda, who slayed Oswald, and the king of the Saxons, Sigebert. Ryan tells us that in virtue, in zeal, in ability as an organiser, he was worthy of Saint Aidan, so that the church in Northumbria grew and prospered. Like Aidan, he travelled on foot, rather than horseback. Bede tells us that he was devoted to keeping the Church in truth and purity. Colman succeeded Finian and Lindesfarne. He held the episcopacy for three years, and his leadership is strongly associated with the Synod of Whitby. Colman dealt with the controversy of the date of Easter, the ordination of Bishops, the style of the tonsher, and the use of Chrism in baptism. Comgall of Bangor, who was himself a Pict, assisted Colmcille in his mission to the Picts. Canice also cooperated with Colmcille in his mission, before he founded his own Church, after which the city of Kilkenny is named. Blaan was born in 565, near Kingarth, where his uncle St Catan, had founded a monastery. Although there is some uncertainty regarding whether he was a Pict or a Briton, he trained as a monk at Bangor, under the abbot Comgall. There are numerous church dedications to him in Strathclyde, Dunblane, and in the Pictish Highlands. James Hutchinson Cockburn sees these as evidence of a correspondingly wide and effective ministry, and they are very evident to the regard in which Blaan was held. Fursa came from Ireland, and ministered to the East Anglicans. He converted many by example and teaching. Bede tells us that in his desire to be a hermit, he left his brother Foillà ¯Ã‚ ¿Ã‚ ½n in charge of his foundation. According to John Richard Green, Irish Christianity flung itself with a fiery zeal into battle with the mass heathenism which was rolling in upon the Christian world. And John Ryan acknowledges that although the conversion of Scotland was down to the Irish and the Britons, the contribution of the Irish monks far outdistanced that of the Britons. It is very evident from looking at the works of Colmcille, Aidan and many more peregrine that the contribution that Irish monks made to the missionary outreach in Britain was vital.

Assisting In Endotracheal Intubation Nursing Essay

Assisting In Endotracheal Intubation Nursing Essay An ETT is an advanced measure of airway management, where a catheter is inserted in the trachea generally through the mouth. This creates a direct passage between mechanical ventilator, which simulates breathing, and the lungs, where gaseous exchange occurs. ETT is most commonly used in unconscious or sedated patients, where the patient may lose spontaneous breathing, also bringing about benefits like protection from aspiration of gastric contents into the lungs, which lead to infection and complications. Considerable amount of attention is given to the intubation procedure, avoiding trauma and infection. Preparing a patient for intubation requires the patient to be positioned in the sniff in the morning, that being body straight with head slightly tilted to the front to obtain a straight airway. An anaesthetist will perform this procedure and the nurse prepares the necessary: an intubation set including an Ambu with face mask and other connectors and a laryngoscope with different blade sizes and muscle relaxant (Atracurium) and sedation (Propofol) medication are prepared. Once everything is checked that is in perfect working order, the anaesthetist, positioned behind the patients head, starts by giving the first IV bolus of Propofol later followed by the Atracurium. From this point onwards sedation will be administered by the nurse, and the anaesthetist will keep the head in position to maintain an open airway and bag the patient for 1-minute using the soft Ambu attached to the mask with 100% oxygen at 10-15l/min to hyper-oxygenate. After this 1-minute the first try for intubation is began and this should be no longer than 30secoonds. A laryngoscope is then inserted from the right side pushing the tongue to the side and lower, this will create physical space to see the epiglottis and the laryngoscope will be advanced slightly more to see the larynx. Once identified, the ETT is carefully advanced from the right side over the laryngoscope and straight between the larynxes. Then the tube is advanced up to 21-24cm from its markings, laryngoscope withdrawn and the soft Ambu is now connected with a specific connector to attach to the ETT. The anaesthetist will now bag and auscultate over the chest to check position of ETT, and to check that air is going into both sides of lung, or only a single side or worse the stomach. During the process the nurse may be requested to give more boluses of sedation, depending on what the anaesthetist encounters. Once the position is confirmed, the ETT is secured using a tie or a facial adhesive. The patient is then connected to the ventilator, where the anaesthetist gives the initial setting and liaises with the nurse on the aims and guidelines needed to safeguard the patients health and especially avoid unnecessary complications. Continuous sedation is as well started as now the patient is preferably left unconscious to stabilise, as a patient may extubated once semi-conscious and agitated. Parameters post-intubation are checked and charted, blood gases are taken and analysed. Shortly after insertion a chest X-ray is performed to verify positioning thanks to the radio-opaque strip incorporated in the ETT. Indications for intubation may vary from hypoxemia, loss of consciousness, airway obstruction or manipulation of the airway. In one of the cases I had the opportunity to observe clearly, the patient was suffering from pneumonia and was losing consciousness as she could not maintain a decent pO2 via a non-rebreather mask and started to get agitated and therefore continue lowering her oxygen saturation level. I took a blood gases sample and it resulted in a low enough result that the nurse decided to advise the anaesthetist to try intubation, apart from the fact that she was definitely in need to be sedated to reduce her agitation. In a pneumonia case a sedated patient may benefit more from care and obtain a healthier outcome as consciousness is then resumed when infection has started to clear. Intubation as like all the other invasive procedures carries numerous risks for the patient. To start with is the high risk of infection, which may come from lack of attention to asepsis during the procedure, and there can even be trauma to the lungs if the anaesthetist goes in too far with the ETT, or can even cause trauma to the buccal cavity, where with the use of the laryngoscope, leverage over the teeth may be exerted leading to the breaking of teeth. Moreover, if the patient takes too long to be intubated hypoxia may result, since the patient is not breathing at all. Single-sided or stomach intubation may occur as well. In the intubation procedure, precautions to prevent complications include patient sedation and muscle relaxation at the start of the procedure to avoid movements of any muscles. The patient is positioned to help the anaesthetist have an improved visualization of the larynx while using the laryngoscope. A measurement of the length of the airway is taken, to avoid inserting the ETT too much further down into the lungs. A patient is bagged for 1-minute prior to trial of intubation and no try takes longer than 30seconds, and ultimately a chest X-ray is performed to confirm ETT position. Blood sampling through an arterial catheter An arterial catheter is one of the most common lines required in ITU, indispensable for continuous intra-arterial blood pressure which is essential in a critically ill patient supported by vasoactive drugs. Moreover it aids in arterial blood sampling, being routines or ABG of an intubated patient, where if a patient doesnt have an arterial line would be pricked countless times during a single day, therefore is a benefit for the patient as well. Taking a blood sample through an arterial line requires following step by step instructions, while always keeping in mind asepsis, as although it is not actual invasive procedure, we are dealing with arterial blood and colonising a cannula imposes great risks of infection. To start with, perform hand hygiene and prepare essentials within easy reach, including alcoholic 2%chlorohexidine wipes (clinell), a packet of sterile non-woven swabs, pair of non-sterile gloves, luer lock stopper, 5ml syringe, ABG syringe, appropriate vacutainers and luer lock adaptor. Once everything is prepared and patency of line is checked by using the flushing device, perform hand hygiene once again and wear gloves. Place the open packet of sterile swabs under the area you will be working around, i.e. the 3-way tap on the arterial line. Wipe the stopper locked port at the 3-way tap for 15seconds using a clinell wipe. Now the 3-way tap OFF position should be facing the port that has just been disinfected, remove the stopper and attach 5ml syringe using a non-touch technique, turn the 3-way tap to OFF from flushing device and aspirate the first 3-5ml which will contain mostly heparinised saline. Turn the tap back to OFF from the port being used. Now, remove the 5ml syringe and start from collecting blood sample for ABG, using the same non-touch technique attach the syringe to the port, turn the stopper OFF from the flushing device. Withdraw small sample of blood (up to half of ABG syringe, approximately 1ml), if you require more blood samples turn the tap OFF to port again and remove ABG syringe while attaching its stopper at its end, connect luer lock adaptor for vacutainer use. Now turn the tap OFF to flushing device and start pressing each vacutainer until it stops filling, always changing the vacutainers using non-touch technique. It is suggested to leave for last any blood test sample that its result is affected by the amount of heparin in the sample, eg. APTT/INR. Once finished from taking the necessary blood samples, turn tap OFF to patient and flush using flushing device onto the packet of swabs. Once clear from blood, close with luer lock stopper using non-touch technique. Now turn the tap OFF to port and flush the remaining part of the arterial line. Avoiding leaving blood traces in the lines will ensure longer lifetime and patency of the arterial line itself. Patients in a critical care setting most often need several blood sampling every day, one indication may be ABG monitoring due to the patient being supported by a mechanical ventilator. ABG sampling is also needed in the weaning off process, but can also be used to monitor any acidosis or alkalosis the patient may be suffering from, due to his admitting condition. Other blood samples are mostly taken routinely in the morning and more investigations may be required throughout the day. The withdrawal of blood via an arterial line is not an invasive procedure, though it is still a manipulation of a catheter leading to the bloodstream, therefore it exposes the patient to a high risk of acquiring a nosocomial infection through the line if asepsis is not maintained throughout the procedure. The colonisation of the line without adequate disinfection may eventually lead to life-threatening septicaemia. Prevention of infection was applied using universal precautions like hand hygiene, disinfection using alcoholic 2%chlorohexidine wipes (clinell) and non-touch technique. This minimised drastically the chances of nosocomial infections. Section B INTERPROFESSIONAL COLLABORATION IN THE CRITICAL CARE SETTING Describe the role of the nurse in each of the following units: Intensive Therapy Unit (ITU) Neonatal and Paediatric Intensive Care Unit (NPICU) Burns and Plastic Surgery Unit Renal Unit Intensive Therapy Unit (ITU) An Intensive Therapy Unit (ITU) nurse is required to work in a setting where patients are experiencing or at-risk of experiencing life-threatening conditions, thus require complex assessment, high-intensity therapies and interventions, continuous nursing care and high-tech monitoring. Critical care nurses trust upon a particular organization of knowledge, skills and experience to provide care to patients and families and create healing, humane and caring environments. Patient advocacy is a major role in ITU nursing, as usually the conditions of a patient may be poor to the extent that the patient is unconscious or else is induced into unconsciousness. Therefore the nurse has to act on behalf of and in the patients best interest as the patients advocate and ensuring that the patients family are well informed about the care that the patient is receiving. The necessary information needs to be given to help make highly personal decisions about the patients care, and that the patient and familys decisions are respected in the development of any treatment plan for the patient. Advanced and continuous assessment needs to be carried out to verify patients health status; physical assessment may include Glasgow Coma Scale, eye sensitivity test, cardiac auscultation, abdominal palpation and more. Leading then to high-tech monitoring from highly specialised bedside monitors, requires critical nurses to be trained in telemetry. Telemetry is a computerized monitoring system that transmits essential information about the condition of the patient (heart and lung activity), and the nurse using this information can make healthcare judgements. Therefore with the help of telemetry in conjunction with the extensive knowledge of pathophysiology of illnesses, nurses assess the need to perform any intensive interventions that the patient might need. For instance, take arterial blood gases of a patient if oxygen saturation are getting lower, or perform suctioning if certain breathing sounds are noticed. More assessment may be done after certain interventions and therefore prevention of degrading in the patients condition is another main responsibility of the ITU nurse. This requires the nurse to be able to interpret any result and respond with an appropriate intervention, these may include; titration with inotropic substances to maintain a pre-determined arterial pressure, increase oxygen supply through the mechanical ventilator or change the mode it is set to wean off from extra support. ITU nursing in certain large-scale hospitals may be split in specialized sectors, like for instance the Cardiac Intensive Care Unit (CICU) in Mater Dei Hospital is a post-surgery intensive unit mostly dedicated to open heart surgery, leaving the ITU to take care of mostly post-laparotomy patients, serious trauma and other life-threating cases, including severe infections. Neonatal and Paediatrics Intensive Care Unit (NPICU) Nurses working in Neonatal and Paediatrics Intensive Care Unit (NPICU) require being extremely careful and vigilant, as this field requires working with neonates which may have some sort of complication from birth (or even before) to kids up to four years. As with all patients of this age group, symptoms and conditions change drastically, due to the frailty of the neonates, therefore continuous assessment is of extreme importance. As cases can differ from premature babies to post major operation neonates, the care is split into three: Intensive, High-Dependency, and Special Care. Caring for this type of population, care is adopted to support the patient medically and physically, assess and monitor but a great input in supporting psychologically the parents is a major requirement in these cases as they will be going through a really rough period, especially in the most serious cases like complications. Necessary time and information is given to the parents to understand what is going on with their child, involvement in the babys needs in special care. In intensive and high dependency cases, the patients will be connected to high tech bedside monitors; monitoring vital signs like arterial blood pressure, ECG traces, respirations, oxygen saturation and pulse. Most often patient with such frailty will be in a temperature controlled and humidified incubator to keep a stable environment, promoting recovery. The need of certain accesses may be essential as well, an umbilical line (usually arterial) is needed in cases of drug and fluid therapy, intubation may be needed in some of the cases as well. Inputs and outputs are strictly monitored throughout all levels of care provided in the unit, but as blood gases and other blood investigations may also be essential in certain intensive cases, keeping the blood volume withdrew as low as possible is of extreme importance as too much blood withdrawal in neonate may lead to serious complications. For special care there is more the usual care of a baby, therefore involving basic feeding, bathing and nappy changes, but need some extra care especially in calculation and handling due to the their small structures. Naso-gastric or oro-gastric tubes may be necessary in patients premature enough not to have a fully developed swallowing reflex or those too frail to suckle all the milk they need to maintain themselves. In this type of care, parents (especially the mother) are encouraged to handle and take care of the baby themselves as this has positive effects on both the mother and babys health. The nurse is responsible to liaise with the mother to set appointment regarding washing her baby or nappy changes which the mother may wish to do herself. Monitoring of daily weight, measurement of Occipitofrontal Circumference (OFC) and nappy weighting are some of the documentation taken by the nurse apart from the regular vital sign like temperature and heart rate. Plastic Surgery and Burns Unit Nurses working on the Plastic Surgery and Burns Unit (PSBU) may encounter the extremes of wounds through skin layers, since those present in burns cases could involve from only skin to muscles, nerves, blood vessels and even bones. On the other hand, plastic surgery is more related to the surgical grafts done post-recovery from a burns accident, or superficial level surgery like the removal of melanomas and other skin disorders. Burns nurses are responsible in fluid resuscitation given through wide-bore IV lines in severe cases of burns. In conjunction with fluid resuscitation, is a strict input and output charting to assess renal perfusion due to large volume loss from interstitial spaces due to loss of skin. Haemodynamic monitoring is another essential role, as the fluid loss from wounds may lead to hypotension, inotropic substances may be needed to support the heart muscle in extreme cases. Furthermore, the importance to keep sterility over wound and to aseptically cover using a special type of dressing containing paraffin oil, which does not allow water to transpire, is stressed in burns cases, as once the skin layer is lost, all the infection and water loss prevention which the integumentary system was responsible for, are now absent. In the plastic surgery cases, nurses are mostly responsible in post-op wound reviews and change of dressings. The nurse also advises the patients to protect fresh wounds and prevent infections. Renal Unit Dialysis Nurses on the Renal Unit work with a patient population of solely End Stage Renal Disease (ESRD), therefore their insight into the illness and its treatment needs to be well-defined. Dialysis treatment, which is the process of removing waste from the blood of a patient whose kidneys lost this function, is available in two modalities, namely; Haemodialysis (HD) and Peritoneal Dialysis (PD). Nurses in charge of PD patients conduct periodical reviews to collect blood, peritoneal fluid and swabs for investigations. Their main responsibility though, is to check progress from the personal log that the patient is encouraged to keep from the start of the treatment, this includes daily weight, oral intake, dialysate input (type and amount), dialysate output (colour/consistency and amount). Since PD is a self-care treatment at home, a high-quality nurse-patient relationship is required to assess for adherence to treatment. The nurse is responsible to liaise with patient and relatives if they are encountering any challenges during treatment. Advices about the necessity of any treatment changes and the importance of asepsis during treatment, to avoid unnecessary exposure to infection, i.e. peritonitis, are one of the key responsibilities of a PD nurse. On the other hand, nurses responsible of HD patients, unlike PD, have a more direct responsibility with the patients infection prevention. The nurse first responsibility is to inspect equipment, ensuring it is in perfect working order before use and all lines are new and sterile to minimize chance of infection. Review of the patients previous session handover and preparation of any treatment needed during the dialysis is carried out by the nurse. A typical dialysis treatment starts with morning weighting and then, the nurse, using strict aseptic technique, inserts two wide bore cannulas into the patients AV access. Finally the patient is connected to an HD machine for 4 hours, set to target weight calculated by the physician, to remove excess water and waste products from the bloodstream. Before, during and after these 4 hours, vital signs are checked and charted. Routine blood investigations are also taken and any indicated medications from previous investigations are administered and documented. The patient is advised of the possible complications and suggested to notify as soon as any abnormal feelings set on. Any pain complaint reported by the patient during the dialysis is reported in the documentation for hand over and physicians are contacted in view of treatment changes requirements. Moreover, as HD patients have to attend these sessions 3-4 times weekly, the need of a quality nurse-patient relationship is essential. The dialysis nurse spends time with the patient assessing any psychological or physical ill effects of the illness and documents an adequate handover to obtain successful treatment of this condition. Compile a list of the different types of health care workers whom you encountered during this entire placement. Physiotherapists Anaesthetists Midwives Nurses Nursing Aides Care workers Radiographers Speech Language Pathologists Occupational Therapists Audiologists Electrocardiogram (ECG) Technicians Describe the role of THREE other (non-nursing) members of the ITU team. Include key responsibilities of these persons for the patient. From your observation, what is the nature of their interaction, if any, with the critical care nurse? Physiotherapists Physiotherapists in an intensive care setting are mainly responsible for clearing secretion from chest walls using positioning, percussion, manual hyperinflation and vibration. These methods clear the peripheries of the lungs and mobilize secretions to the central airways to be easily suctioned and therefore re-establish a larger lung capacity. Apart from chest-physio, they also work with conscious patients on the early movement of limbs to resume physical function and avoid muscle waste due to being sedated and bed-bound. Whilst encouraging the patient to do these exercises on his/her own initiative as needed, the physiotherapist reports to the nurse any result of his/her actions and reminds the nurse to encourage and observe the patient doing the exercise needed for further improvement in recovery. Radiographers Radiographers in the ITU setting are not mainly responsible for diagnosis, as in critically ill patients usually the underlying conditions of illness are discovered prior to admission. Though, with the use of portable X-ray machines, their help is essential in confirming the positions of any tubes or lines inserted in the unit or theatre, whilst minimizing discomfort of unnecessary transport to the Medical Imaging. Moreover through radiography any degradation of the ITU admission health insults may be identified, for example comparisons of previous chest x-ray to analyse if consolidations increased or decreased. The radiographer-nurse relationship is usually more concerned in helping to position the patient well to get a clear shot, giving the possibility to take the most out of the X-ray taken. Once published, X-ray are seen by medical staff to verify placement of any newly inserted central venous line or endotracheal tube, and the progression of the condition is also assessed. Electrocardiogram (ECG) Technicians ECG Technicians are indispensable in cardiac related admissions in ITU, this usually would be a post-MI patient with recurrent arrests. Their main responsibilities are into attaching leads at specific sites on the patients body to the ECG machine, which in turn prints the signal it receives onto an ECG strip. Although patient in an ITU setting are generally attached to a continuous ECG monitor, this type of ECG gives a better picture of any arrhythmias and axis deviations of the pulse. The technician then analyses the result, identifies any emergencies and liaises with nursing staff and medical staff. Most often this involves cardiology staff as well, since decisions regarding treatment are usually deducted from these types of ECGs. Section C DOCUMENTATION Why is documentation important in a critical care area? Documentation in critical care, as in the all nursing field, is an essential role which enables a better continuation of care and assessment of progression or regression of the patients condition. That said, the importance of precise information in the critical area is exponential to the fragility of the critically-ill patient, therefore this gives a valid reason for the necessity of hourly vital signs, urine output, continuous IV pump rate and more. Along the various types of documentation, comes in the rationale for certain actions taken leaving a pattern to be followed and leave good ground for recommendations to be given during handover. For instance, low oxygen saturation is monitored and the nurse decides to perform suctioning and an improvement is visible in the forthcoming readings, therefore one can suggest the following nurse to try this method as it has shown good results. Moreover, importance of documentation increases as the risks for the patient increase leading to a more responsible practice. This helps to improve quality of care provided and safeguard the patient from malpractice. Documentation is critical not only for nurses in this setting, but plays quite an enormous part in any of the doctors actions, as strong and consistent rationale is needed to back up certain decisions taken in critical life-threatening moments to improve care given and obtain healthier outcomes. List all forms of documentation which nurses perform in each of these units: Intensive Therapy Unit (ITU) Neonatal and Paediatric Intensive Care Unit (NPICU) Burns and Plastic Surgery Unit Renal Unit Intensive Therapy Unit Chart (incl. Hourly Parameters, Investigation Results, I.V./Oral Intake, Ventilation (via type of Mask or Ventilator Mode (SIMV, CPaP, BiPaP) FiO2), Continuous I.V. Treatment, Output via N.G./Drains/Urinary Catheter), Handover Sheet Neonatal Abstinence Scoring System, Investigation Flow Chart, Parameters + Intake/Output Chart, Fluid Prescription Chart, Apnoea Chart Parameters + Intake/Output Chart, Chart for Estimating Severity of Burn Wound, PSBU 24hrs. Drain Output Chart Haemodialysis Chart (incl. Parameters, Actual + Target Body Weight, Blood Test Results, Handover for next session) Section D ITU PROCEDURES During your ITU placement, select one of the following procedures which you have observed and in which you have taken part: Admission of a patient to ITU Transport of a patient to the operating theatre or the medical imaging department Discharge of a patient to another ward/unit (a) DESCRIBE the nursing observations, actions and documentation during the procedure. Include a rationale for these activities. (b) How did YOU participate in this event? (c) REFLECT on what was done properly and what could have been done better. Transport of a patient to the operating theatre or the medical imaging department The transport of a critically ill patient is one of the most challenging and requires a lot of preparation, but thanks to the portable X-ray and Ultrasound (US) technology this occurs in only a few cases like Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scan, or else an essential need to transfer back to the operation theatres in case of complications. In a case I had the opportunity to take part in; we had to take a patient to MRI for a brain and C-spine scan. The nurses I was with started from contacting an anaesthetist as the patient was intubated, contacted a radiographer to take girth measurements, since the patient was obese, to check if the patient would go through the scanner and contacted the family that their relative will go for a scan and may not be there when they come. Afterwards the nurse extended IV tubing to obtain enough length during the scan, while I started to collect all the portables needed for the transport including; oxygen cylinder, portable ventilator, crash pack, Ambu bag and monitor stand. Preparation of extra sedation, other IV treatments and necessary flushing solutions was done to prevent running out of medications during this transportation. The nurse checked that the patient was stable enough on the current inotropic support and sedation. The nurse also checked the oxygen tank pressure, ventilator function and just before we left connected to portable machinery and evaluated condition of the patient again and charted the parameters. The anaesthetist gave a dose of muscle relaxant to avoid any unexpected movements from the patient while doing the transportation, which could lead to lose the airway if the patient would extubate. Extra muscle relaxant was prepared as well. Leaving off from the ITU, we continuously monitored the patients parameters on the monitor, arrived securely at the medical imaging and started discussing what needs to be removed or replaced from the patient before we enter the MRI room. Certain machinery is not MRI-compatible, therefore the exposure to that magnetic field would damage it or cause malfunction. Following advises given by the radiographer, anything that needed to be removed was removed, leaving only essential monitoring to be removed and re-attached to appropriate machinery once in the MRI room. Patient was then transferred from the bed to the MRI table going straight into the MRI room, back on essential monitoring assessment of condition was done and we aligned MRI table to the scanner to start the procedure. During all this time the nurse and anaesthetist gave necessary amount of sedation and muscle relaxation bolus to prevent accidental alertness of the patient and unexpected extubation. The moment when we were getting the patient inside the scanner, we realized he wouldnt get in because of his hands had to pass over his already enormous girth and he simply wouldnt fit. At that point we realized we made a lot of effort, but unfortunately we were still unsuccessful. Therefore all the process had to be reversed, and once out from the MRI room, settled the patient with adequate monitoring for transportation back to ITU. Once back in ITU, we removed any unnecessary tubing, placed all transport equipment back in place and documented parameters post-transportation. A note was added in the documentation regarding the failed MRI; the family was let in to see the patient and was given an explanation of what was done during the day. Looking back and reflecting on the event, I realise the amount of things that are taken in consideration prior to leaving the ITU. The importance given to sedation and muscle relaxation to avoid extubation, Ambu bag for manual ventilation in case portable ventilator stops working or needs to be disconnected. The extension of the IV tubings was something, that actually didnt even cross my mind and though so important. Preparation of extra medication, not too run without during transport. These are all things that require effective thought as if omitted, the repercussions can be terrible. I dont consider the unsuccessful try of getting the patient into the MRI has anything to do with being unprepared or unaware of something, as this fact was taken in consideration from the beginning. I do consider it as an unfortunate event, which left us all with another important lesson learned. I believe it is imprinted enough that, from now onwards when I hear that a patient is for MRI will be the first I will consider. Section E PATIENT CARE IN A CRITICAL CARE SETTING In this account I will be focusing on a case I followed during my placement on the Renal Unit at Mater Dei Hospital. The case study involves an interview with a 27-year old male patient suffering from End Stage Renal Disease (ESRD). This gentleman is to date known to have lost renal function due to Focal Segmental Glomerulosclerosis (FSGS) with onset of illness symptoms started at 17 years of age. Due to ethical reasons the patient involved in this account will have the pseudonym Mr. Frank Abdilla. Mr. Abdilla has been treating this illness for slightly more than 10 years now and is currently following haemodialysis (HD) 3 times a week. I started this interview with getting to his medical history, and to tell me more about the onset of the illness and its treatment to date. Frank expressed that he suffered from nothing prior to the onset symptoms, which he referred to them as a silent killer symptoms. I only know that I started to feel less the urge to urinate and my breath had a foul smell, then after a couple of days I had an episode of loss of consciousness,