Comparison and differences between Conan Doyle Essay Example

Comparison and differences between Conan Doyle Essay Explore the points of comparison and differences between Conan Doyles The Adventure of the Speckled Band and Rendells Bloodlines Wider Reading  The Adventure of the Speckled Band by Sir Arthur Conan Doyle and Bloodlines by Ruth Rendell diverge in a number of ways. These two stories were written at different times during history. The Adventure of the Speckled Band was written in the late eighteenth to early nineteenth century, where as Bloodlines was written in the mid to late nineteenth century. These two stories are set about one hundred years apart. The differences in the stories can be compared in the following ways: The character and method of the detectives in each short story are not the same. In The Adventure of the Speckled Band, Sherlock Holmes is the detective and Dr. Watson is his accomplice. Holmes has appeared in many of Conan Doyles previous works of literature. He comes across to the reader as mysterious and clever. He is regarded as mysterious due to his alleged brown cape and hat. This vision of him makes the reader think that he likes to keep things to himself (which he does). He is quiet when he is not absorbed in a case, and he is calm and collected for the majority of the time. He rarely loses his temper throughout the whole of the story. We will write a custom essay sample on Comparison and differences between Conan Doyle specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Comparison and differences between Conan Doyle specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Comparison and differences between Conan Doyle specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Sherlock Holmes is also delineated as extremely clever in the way he thinks and acts. He has meritorious analytical and observatory skills. One can perceive these skills very early on in the story. I observe the second half of a return ticket in the palm of your left glove you had a good drive in a dogcart, along heavy roads, before you reached the station. From the quote, one can see that Holmes uses ratiocinative skills to come to that conclusion. Holmes works alone and does not share the information he has achieved until he is sure that it is true. From this, one can see that Holmes has pride in his work. This can be seen from the following, located at the very end of the story. I had come to these conclusions before I had entered this room The fact that Watson is telling the story keeps the reader in suspense. Due to the fact that Holmes doesnt share his clues with anyone else, not even Watson causes tension and suspense and it makes the reader become even more submersed into the story. Sherlock Holmes comes across as quite a strong character. From the following taken from the narrative, Holmes demonstrates his strength: he picked up the steel poker and, with sudden effort, straightened it out again. One can also tell that Holmes is a very placid and collected character because when Dr. Roylott confronted him, he remained composed and dignified in front of the erratic Dr. Roylott. Holmes showed that Dr. Roylott did not intimidate him by perplexing him. The following demonstrates this: But I have heard that the crocuses promise well  Ha! You put me off, do you?  Here, Holmes is demonstrating his superiority, to the reader. He shows no remorse in doing so. When Holmes straightens out the poker, he is effectively insinuating that he is just as good as Dr. Roylott, possibly even more so. He is also proving that he has equal physical strength.  Holmes tells Watson after his interlude with Dr. Roylott that he does not wish to be associated with the police. Fancy his [Dr. Roylotts] insolence to confound me with the official detective force! Again, this shows that he thinks he is better than the police as he is implicitly rude to them here. We can see that Holmes enjoys working independently from the following (at the beginning of the story): As to reward, my profession is its own reward This shows the reader that Holmes is only a detective because he enjoys the occupation. It is also saying that Holmes is not concerned about money. On the other hand, Bloodlines by Ruth Rendell is dissimilar in terms of the character and method of the detectives. In Bloodlines, there are two detectives involved. Only one main detective features in the story and that is Wexford, but the other detective, Burden, has his own place in the story as well. Wexford comes across to the reader as very persistent. He is very qualified in his job and gets on with it. One can see that he does so right at the beginning of the play when he is interviewing Arlene Heddon. You wont mind if I come back in a day or two and well have another talk. It is Wexford that takes charge throughout the story, and he voices his opinion the most. Wexford does have a personality, but Rendell doesnt show it to the readers. He does not reveal much information about himself throughout the duration of the story. One can also see that Wexford is very competent. He realises from the clues in the facts that it was Carol Fox that had killed Tom. The following is taken from the narrative towards the end of the story. From those pictures he suddenly knew who had killed Tom Peterlee and why. This is the only time in the story in which the narrative withholds information about what Wexford thinks. It is Wexford that puts all the clues together to solve the crime. Burden, the other detective, is not really involved in the murder of Tom Peterlee, but he helps Wexford out. This act shows the reader that Wexford and Burden are quite close acquaintances. Burden is a very busy man and he has other things to do. The reason why Burden does not appear to be on the same level as Wexford is because he is working on a different case to Wexford. He is very judgemental when he meets Arlene, he comments about her and he says that: Intelligent girls dont live in caravans with married welders. This quote shows that although Burdens views are very set and prejudiced, he is still observant enough to see Arlenes intelligence.

Slave Poet Phillis Wheatley - An Analysis of Her Poems

Slave Poet Phillis Wheatley - An Analysis of Her Poems Critics have differed on the contribution of Phillis Wheatleys poetry to Americas literary tradition. Most critics agree that the fact that someone called slave  could write and publish poetry at that time and place is itself noteworthy in history. Some, including Benjamin Franklin and Benjamin Rush, wrote their positive assessments of her poetry. Others, like Thomas Jefferson, dismissed her poetrys quality. Critics through the decades have also been split on the quality and importance of her poems. Restraint What can be said is that the poems of Phillis Wheatley display a classical quality and restrained emotion. Many deal with pietistic Christian sentiments. In many, Wheatley uses classical mythology and ancient history as allusions, including many references to the muses as inspiring her poetry. She speaks to the white establishment, not to fellow slaves nor, really, for them. Her references to her own situation of enslavement are restrained. Was Phillis Wheatleys restraint simply a matter of imitating the style of poets popular in that time? Or was it in large part because, in her enslaved condition, Phillis Wheatley could not express herself freely? Is there an undertone of critique of slavery as an institution beyond the simple reality that her own writing proved that enslaved Africans could be educated and could produce at least passable writings? Certainly, her situation was used by later abolitionists and Benjamin Rush in an anti-slavery essay written in her own lifetime to prove their case that education and training could prove useful, contrary to allegations of others. Published Poems In the published volume of her poems, there is that attestation of many prominent men that they are acquainted with her and her work. On the one hand, this emphasizes how unusual was her accomplishment, and how suspicious most people would be about its possibility. But at the same time, it emphasizes that she is known by these people an accomplishment in itself, which many of her readers could not share. Also in this volume, an engraving of Phillis Wheatley is included as a frontispiece. This emphasizes her color and, by her clothing, her servitude, and her refinement and comfort. But it also shows a slave and woman at her desk, emphasizing that she can read and write. She is caught in a pose of contemplation perhaps listening for her muses but this also shows that she can think an accomplishment which some of her contemporaries would find scandalous to contemplate. A Look at One Poem A few observations about one poem may demonstrate how to find a subtle critique of slavery in Phillis Wheatleys poetry. In just eight lines, Wheatley describes her attitude towards her condition of enslavement both coming from Africa to America, and the culture that considers her color so negatively. Following the poem (from Poems on Various Subjects, Religious and Moral, 1773), are some observations about its treatment of the theme of slavery: On being brought from Africa to America.TWAS mercy brought me from my Pagan land,Taught my benighted soul to understandThat theres a God, that theres a Saviour too:Once I redemption neither sought nor knew,Some view our sable race with scornful eye,Their colour is a diabolic die.Remember, Christians, Negroes, black as Cain,May be refind, and join th angelic train. Observations Wheatley begins by crediting her slavery as a positive because it has brought her to Christianity. While her Christian faith was surely genuine, it was also a safe subject for a slave poet. Expressing gratitude for her enslavement may be unexpected to most readers.The word benighted is an interesting one: it means overtaken by night or darkness or being in a state of moral or intellectual darkness. Thus, she makes her skin color and her original state of ignorance of Christian redemption parallel situations.She also uses the phrase mercy brought me and the title on being brought deftly down-playing the violence of the kidnapping of a child and the voyage on a slave ship, so as to not seem a dangerous critic of slavery, but at the same time crediting not the slave trade, but (divine) mercy with the act. This could be read as denying the power to those human beings who kidnapped her and subjected her to the voyage and to her subsequent sale and submission.She credits mercy with her vo yage but also with her education in Christianity. Both were actually at the hands of human beings. In turning both to God, she reminds her audience that there is a force more powerful than they are a force that has acted directly in her life. She cleverly distances her reader from those who view our sable race with scornful eye perhaps thus nudging the reader to a more critical view of slavery or at least a more positive view of those who are slaves.Sable as a self-description of her color is a very interesting choice of words. Sable is very valuable and desirable. This characterization contrasts sharply to the diabolic die of the next line.Diabolic die may also be a subtle reference to another side of the triangle trade which includes slaves. At about that same time, the Quaker leader John Woolman is boycotting dyes in order to protest slavery.In the second-to-last line, the word Christian is placed ambiguously. She may either be addressing her last sentence to Christians or she may be including Christians in those who may be refined and find salvation.She reminds her reader that Negroes may be saved (in the religious and Christian understanding of salvation).The implication of her last sentence is also this: the angel ic train will include both white and black. In the last sentence, she uses the verb remember implying that the reader is already with her and just needs the reminder to agree with her point.She uses the verb remember in the form of a direct command. While echoing Puritan preachers in using this style, Phillis Wheatley is also taking on the role of one who has the right to command: a teacher, a preacher, even perhaps a master or mistress. About Slavery in Wheatleys Poetry In looking at Wheatleys attitude towards slavery in her poetry, its also important to note that most of Phillis Wheatleys poems do not refer to her condition of servitude at all. Most are occasional pieces, written on the death of some notable or on some special occasion. Few refer directly and certainly not this directly to her personal story or status.

Measuring Quality of Life Based on Geography

Measuring Quality of Life Based on Geography Perhaps the most important aspect of living that we sometimes take for granted is the quality of life that we receive by living and working where we do. For instance, the ability for you to peruse these words through the use of a computer is something that might be censored in some Middle Eastern countries and China. Even our capability to walk safely down a street is something that some countries (and even some cities in the United States) may lack. Identifying areas with the highest quality of life offers an important view of cities and ​countries while providing information for those hoping to relocate. Measuring  Quality of Life By Geography One way of looking at a places quality of life is by the amount of output it produces each year. This is especially handy in the case of a country considering many countries have varying degrees of production, differing resources, and distinctive conflicts and problems within them. The major way of measuring a countrys output per year is by looking at the countrys gross domestic product, or GDP. The GDP is the amount of goods and services produced within a country annually and is typically a good indication of the amount of money flowing in and out of the country. When we divide a countrys total GDP by its total population, we get GDP per capita which reflects what each individual of that country takes home (on average) per year. The idea is that the more money we have the better off we are. Top 5 Countries with the Largest GDPs The following are the top five countries with the largest GDPs in 2010 according to the World Bank: 1) United States: $14,582,400,000,0002) China: $5,878,629,000,0003) Japan: $5,497,813,000,0004) Germany: $3,309,669,000,0005) France: $2,560,002,000,000 Countries with Highest-Ranked GDP Per Capita The five highest-ranked countries in terms of GDP per capita in 2010 according to the World Bank: 1) Monaco: $186,1752) Liechtenstein: $134,3923) Luxembourg: $108,7474) Norway: $84,8805) Switzerland: $67,236 It seems that small developed countries are ranked the highest in terms of per capita income. This is a good indicator to see what the average salary is of a country but can be a bit misleading since these small countries are also some of the richest and, therefore, must be the most well off. Since this indicator can be a bit distorted due to the population size, there exist other factors which further inform quality of life. Human Poverty Index Another metric for looking at how well-off a countrys people are is to take into consideration the Human Poverty Index (HPI) of the country. The HPI for developing countries represents quality of life by formulating the probability of not surviving to age 40, the adult literacy rate, and the average amount of the countrys population who have little to no access to clean drinking water. While the outlook for this metric is seemingly dismal, it does provide important clues as to what countries are better off. There is a second HPI that is used mostly for those countries that are considered developed. The United States, Sweden, and Japan are good examples. The aspects that are formulated for this HPI are the probability of not surviving to age 60, the number of adults lacking functional literacy skills, the percentage of ​the  population with income below the poverty line, and the rate of unemployment lasting longer than 12 months. Other Measures and Indicators of Quality of Life A well-known survey that attracts a lot of international attention is the Mercer Quality of Living Survey. The annual list places New York City with a baseline score of 100 to act as the median for all other cities to compare with. The rankings consider many different aspects from cleanliness and safety to culture and infrastructure. The list is a very valuable resource for ambitious companies looking to set up an office internationally, and also for employers to decide on how much to pay at certain offices. Recently, Mercer began to factor in environmental friendliness into their equation for cities with the highest qualities of life as a means of better qualifying what makes a great city. There exist a few unusual indicators for measuring quality of life as well. For example, the king of Bhutan in the 1970s (Jigme Singye Wangchuck) decided to overhaul the Bhutanese economy by having each member of the country strive for happiness as opposed to money. He felt that GDP was rarely a good indicator of happiness as the indicator fails to take into account environmental and ecological improvements and their effects, yet includes defense expenditures that rarely benefit a countrys happiness. He developed an indicator called Gross National Happiness (GNH), which is somewhat difficult to measure. For instance, while GDP is an easy tally of goods and services sold within a country, GNH doesnt have much for quantitative measures. However, scholars have tried their best to make some sort of quantitative measurement and have found a countrys GNH to be a function of the well-being of a human in economic, environmental, political, social, workplace, physical, and mental terms. These terms, when aggregated and analyzed, can define how happy a nation is. There are also a number of other ways to quantify ones quality of life. A second alternative is the genuine progress indicator (GPI) which is similar to GDP but instead looks to see if a countrys growth has actually made people better off in that nation. For instance, if the financial costs of crimes, environmental degradation, and natural resource losses are higher than the financial gains made through production, then the countrys growth is uneconomic. One statistician who has created a way to analyze trends in data and growth is the Swedish academic Hans Rosling. His creation, Gapminder Foundation, has compiled plenty of useful data for the public to access, and even a visualizer, which allows for a user to look at trends over time. It is a great tool for anyone interested in growth or health statistics.

Risk Factors of Culture Research Paper Example | Topics and Well Written Essays - 2000 words

Risk Factors of Culture - Research Paper Example â€Å"Business has†, Ball & Wendell submit, â€Å"entered the era of the one-world market. Increasingly, companies are going overseas to attain sales and profits unavailable to them in their home markets.† (1993:6) In addition, since technological revolution has made communication and traveling very fast and speedy, it has also become very convenient for the individuals to travel to even the remotest corners of the globe for business, education and employment purposes. Consequently, the fast means of traveling have brought the nations closer to each other and have paved the way towards the formation of diversified corporate culture particularly in the USA, China and the Western World. As a result, the individuals having different cultural backgrounds are now working shoulder to shoulder with one another under one roof in various corporate firms as workers and employees, which has given birth to the idea of cultural amalgamation and outsourcing. Thus, cultural amalgamati on has altered the entire corporate atmosphere from top to bottom, where the professionals belonging to different racial, ethnic and religious groups have to work as colleagues, bosses and sub-ordinates under one and the same environment. Not only this that the businesses have witnessed imperative boom and escalation in the aftermath of cultural diversification, and has proved extremely profitable for the companies, but also such a profound development has turned out to be beneficial for the consumers and end-users, because the incurring of the global talent has given a go to the manufacturing of innovative products and wide range of choice available for the consumers in the market. Consequently, the concept of universal co-existence has helped out in respect of mitigating the prejudices like nationalism and regionalism, and businesses observe unabated flourishing at global level. In the same way, there have appeared inevitable risks of some negative impacts too

Apply the four P's model of innovation to case studies or companies Assignment

Apply the four P's model of innovation to case studies or companies you are familiar with and critically evaluate the above st - Assignment Example ....................................................................................7 Process.........................................................................................8 Evaluation of the Quote by Gary Hamel............................................10 Conclusion...............................................................................................12 References...............................................................................................13    Apple Inc.: A Study in Innovation Introduction   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The Four Ps of innovation is defined in his paper as product, process, position and paradigm (Mobbs, 2010). Innovation, in general, consists of common words that might include the word â€Å"new,† â€Å"introduction,† â€Å"markets† and â€Å"process,† and is marked by a willingness to take some risks and celebrate the failures. Innovation also can be incremental or radical. Incremental means that something existing is made better. Radical means that the company is doing something completely different (Mitchell, 2010). Incremental innovation could be extremely beneficial to an industry   - for instance, in the television industry, the advent of flat screens and high definition has radically transformed that industry, for the better (Phi, 2012). Perhaps no company has exemplified the principles of innovation better than Apple, Inc. Its i-Tunes and i-Pod radically changed the music industry, then its i-Phone and i-Pad did the same for the computing and cell phone industries. They have led the way in developing products that could be considered radical, not just a â€Å"tweak† on a product that has already been in place. In the process, they have become one of the most, if not the most, exciting company to watch. Although there are some that might say that Apple has peaked, the company does not buy into this, and innovation continues to be their cornerstone. This paper will examine the company, then examine how the four Ps of innovation apply to it. Apple, Inc. History   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   According to Chapman et al. (2012), Apple began its life in 1976, the brain child of Steve Jobs and Stephen Wozniak. The two men were high school mates, as well as former collaborators. Wozniak had been working on combining computers with video monitors, with an idea towards making computers accessible to the masses and user-friendly. Wozniak was working at Hewlett-Packard at that time, and brought his ideas to HP. HP, however, did not think that personal computers had a future, so rejected Wozniak's ideas. Jobs, however, saw the future, and decided that he was the right partner for Wozniak to begin selling computers. Their first computer was known as Apple 1, and was built in the garage of Jobs' parents. This computer was only intended for hobbyists, as it didn't have an exterior casing, and only was a circuit board. The name of the company was Apple, because Jobs had a job in an orchard while he sought enlightenment, and neither man could think of a better name. The Apple II soon followed, and the duo was able to expand after finding new partners for their expansion plans (Chapman et al., 2012).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The Apple II was a hit, according to Chapman et al. (2012), as it was the first computer that had a sleek plastic casing and color graphics. The annual sales for the fledgling company was $10 million in 1977, and thousands of employees were added. By 1980, the company was public, and its stock increased, on the first day of trading, from $22 to $29.

The Us-Versus-Them Mentality In 2008’s Presidential Campaign Essay Example for Free

The Us-Versus-Them Mentality In 2008’s Presidential Campaign Essay The graphic novel, Maus, by Art Spiegelman, tells the story of a Polish Jew’s memories of his experience during the Holocaust. Drawn as mice, the Jews have faced a variety of psychological warfare, including xenophobia, scapegoating, dehumanization, and us-vs. -them dichotomy where the terrible events of the Holocaust were justified. The Holocaust was one of the most terrible events in human history, and decades later, scholars from many branches of academia still strive to understand such a dark historical event. Unfortunately, aspects leading up to the Holocaust still exist in the world today. While few current issues compare in magnitude to that of the Holocaust, such activities such as xenophobia, scapegoating, dehumanization, and divisive, dichotomous thought pervade populations everywhere. Although such negative sentiments always threaten negative results, in the US in the year 2008, one major historical movement and event occurred that promises a possible relief from such a divisive past. This historic movement and event is Barack Obama’s campaign, in which an African American ran for President of the United States and was the victor, becoming the first ever African American president of the country. But the campaign was not free of strife. This paper argues that while dichotomous, â€Å"us vs. them† elements in the year 2008’s presidential campaign were not systematically acted out as they were in the Holocaust, there existed similar instances of that mentality during the campaign timeframe. In the past decade, partisanship has set two major groups of Americans at odds with each other in the form of Democrat vs. Republicans. However, this past presidential campaign, or even in the past decade, the fever pitch of â€Å"us vs. them† has not escaped many people, and â€Å"Democrat† or â€Å"Republican† began to be expressed in layers of differences. Chuck Raasch of USAToday reports that: Americans fought a terrible civil war on all three fronts. A century later, Northerners saw Southerners as oppressors during struggles over civil rights, and Southerners viewed Northerners as meddlers. Even the Inside the Beltway label continues a deeply rooted, us-versus-them mentality of the nations capital. Despite the elevation of a black man and a white woman to the Democratic and Republican presidential tickets, respectively, the election of 2008 has played often to those divides. In her article Unleashed, Palin Makes a Pit Bull Look Tame, Dana Milbank of the Washington Post describes the crowd’s response, [who were] â€Å"waving thunder sticks and shouting abuse. Others hurled obscenities at a camera crew. One Palin supporter shouted a racial epithet at an African American sound man for a network and told him, Sit down, boy (p. A03). † While divisive expressions such as these seem far away from the Holocaust, one must consider Peter Suedfeld’s words regarding the genesis of anti-Semitism in the time before the Holocaust: Sherif et al. (1961/1988) demonstrated how leaders, by framing situations in terms of intergroup competition, can produce hostility and aggressive behaviour between component groups. We can see the workings of an ingrained us-vs-them mentality in experimental minimal groups (Tajfel et al. , 1971), which are composed in a completely arbitrary way and whose members never even meet each other (3). This explanation could very well describe the actions of leaders in political parties as well as group behaviors in response to leaders. Sarah Palin could be seen to â€Å"frame situations† such that â€Å"intergroup competition† occurs, as it does in the Republican furor over the Democrate presidential candidate. Partisanship was not the only exhibition of us-versus-them behavior during the past year. Dedication to one’s country came into question in which the concepts of American versus anti-American were introduced. According to Bob Lonsberry in his article â€Å"What’s Wrong With a Marxist? †, a person who is American is one who sees two irreconcilable extremes between Karl Marx and John Locke, and if a person takes into regard the writings of Karl Marx, then he or she is â€Å"anti-American. † If an American is to be truly American, they must adopt similar ways of thinking in which Marxism, communist, and other similar ontological principles must be absolutely shunned because they repudiate everything America stands for. These sentiments before the Holocaust were similar. In place of anti-Americans were the Jews. Andre Minaeu writes: To the Nazis, all things seriously afflicting Germany and the Aryan race were ultimately Jewish or Jewish-inspired. In this sense, the Jewish people were the quintessential enemy of Nazi totalitarianism. The latter elevated Jewry, so to speak, to the rank of an evil ontological principle against which struggle was to be universal (17). In this sense, anti-Americans are philosophically against everything Americans stand for and should be beaten politically, while Jews represented everything the Nazis stood for, which caused them to become an evil philosophical principle. No other dichotomy is more apparent in both Holocaust and the 2008 presidential campaign than ethnicity. The question of race—and one’s ethnicity—became a large factor due to the mixed-race heritage of Barack Obama. Historically, part of Obama’s ethnicity had been under the awful yoke of slavery and then the struggle of civil rights. One can see this in the words of Martin Luther King, Jr: I have a dream that one day, down in Alabama†¦ little black boys and black girls will be able to join hands with little white boys and white girls as sisters and brothers (60). The question of Jewsishness—both an ethnicity as well as a belief system—was subject of life and death for six million people during World War II. Historically, Jews have also been slaves, and their ethnicity and religion have played a large role in their struggles in past centuries. Paul Johnson explains this in his book The History of the Jews by quoting Dietrich Bonhoeffer, an ex-prisoner of the Nazis: We have learned to see the great events of world history from below, from the perspective of those who are excluded, under suspicion, ill-treated, powerless, oppressed, and scorned, in short those who suffer (2). It is not a subtle expression in either of these two statements that the writers and speakers felt that their world was divided in groups, and they were the â€Å"them† in the phrase â€Å"us-versus-them. † While the us-versus-them mentality might seem as if it would haunt human interaction for all time, there have always been historical figures who have sought to overcome the divisiveness by seeking common ground. Perhaps the most famous of those is Abraham Lincoln, who spoke these words: A house divided against itself cannot stand. I believe this government cannot endure permanently half slave and half free. I do not expect the Union to be dissolved I do not expect the house to fall but I do expect it will cease to be divided (Lincoln). Martin Luther King, Jr. is another figure who sought to overcome injustice and inequality through nonviolent means. Current scholars are improving and applying techniques for nonviolent conflict resolution (Suedfeld 2006, p. 7). In regards to the Holocaust, there are many studies about the tragedy in many areas of study, from psychology to politics to sociology, as evidenced by the books The Making of the Holocaust: Ideology and Ethics in the Systems Perspective by Andre Mineau and Canadian Psychology addressing Holocaust reverberations fifty years later. Lastly, the end of the 2008 campaign year drew to a close, and Barack Obama has been elected President. While he emerged from one of the two major political parties in the US, his own sentiments in his book The Audacity of Hope strive for a bipartisan rather than a divided approach: Maybe there’s no escaping our great political divide, an endless clash of armies, and any attempts to alter the rules of engagement are futile. Or maybe the trivialization of politics has reached a point of no return, so that most people see it as just one more diversion, a sport†¦ We paint our faces red or blue and cheer our side and boo their side†¦ But I don’t think so. They are out there†¦ those ordinary citizens who have grown up in the midst of all the political and cultural battles, but who have found a way†¦ to make peace with their neighbors, and themselves (pp. 50-51). Violence stemmed from rabid divisiveness is what made the Holocaust so terrible. Therefore, any attempts to heal the us-versus-them mentality would have to be the opposite: peaceful actions that strive to bring humans together. Fortunately, if one could take lessons from Mahatma Ghandhi, Martin Luther King, Jr., Abraham Lincoln, and Barack Obama, then the possibility that discordant sentiments in the human populace may never take seed. WORKS CITED Johnson, Paul. A History of the Jews. HarperPerennial (1988). King, Jr. , Martin Luther. â€Å"The Dream†. Speech. Lincoln Memorial, Washington, DC. 28 August 1963. Lincoln, Abraham. House Divided Speech. Speech. Springfield, Illinois, June 16, 1858. Milbank, Dana. â€Å"Unleashed, Palin Makes a Pit Bull Look Tame. † Washington Post. October 7, 2008: A03. Minaeu, Andre. The Making of the Holocaust: Ideology and Ethics in the Systems Perspective. Amsterdam; Atlanta, Georgea: Rodopi, 1999.

Backup Devices and Strategies Essay -- Software Computers Technology E

Backup Devices and Strategies Table of Contents Introduction †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦..3 Removable Storage †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦Ã¢â‚¬ ¦.. 3 Capacity †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 3 Media Cost †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 3 Storage Media Chart..†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦..†¦Ã¢â‚¬ ¦..4 Tape Base Systems †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦Ã¢â‚¬ ¦..4 Magnetic-Optical Systems †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦5 MO Picture†¦.†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.5 Network Storage†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦6 Backup Software †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦8 Backup Principles †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦..†¦.9 Backup Diagram.†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦10 Power Failures†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦..†¦Ã¢â‚¬ ¦.10 If you’re concerned about data integrity, it shouldn’t be news to you to back up regularly. As hard drives get larger and larger, we have more to lose if something goes wrong. Archiving is usually important in any business setting or for people heavily into document-management systems. Your PC’s data is worth a lot more than the PC itself. Spend a bit more money to protect the data with removable storage, a simple backup scheme, and a decent electric power protection. Together they don’t cost much, and they add up to data insurance. The simplest mechanism for ensuring sustained operations is to increase the ease of reproducibility. This is the reason that backups are done. Removable Storage Capacity Super-floppy drives use high-density magnetic media and an enhanced read/write head design to increase disk capacity. These drives do double duty. They read and write not only super-floppy disks, but also common 1.44MB floppy disks, examples of these are Imation’s 120MB SuperDisk (formerly the LS-120) or Sony’s 250MBHiFD drive. If you are being selective and want to archive up to 650MB of files, CD-Recordable (CD-R) and Cd-Rewritable (CD-RW) drives are a great option. CD-Rewritable (CD-RW) is another useful medium for storing up to 650MB of data. These drives allow you to overwrite data previously written to a disc, so the disks are â€Å"recyclable† you can use packet-writing software to drag and drop files to CD-RW discs or convention premastering software to write sessions to your discs, so the medium is a fairly flexible one to use. For archiving larger files, high-capacity cartridge drives, such as the Jaz and Jaz2, offer 1GFB and 2GB ... ...s F.DAT Drives G.MO Drives H.Jaz Drives 15.Matching the appropriate storage technology to an application is a balancing act between E.cost, performance, and capacity F.what you like and what you can afford G.what Packy recommends and what you want H.What your boss tells you to buy 16.To protect your documents from havoc, you simply must perform E.Regular maintenance on your PC F. regularly scheduled backups, G.format your hard drive regularly H.Spellchecker 17.Most tape manufacturers recommend E.You switch tapes regularly F.You do a combination of full backups and incremental backups G.You rely on your hard drive H.You pray that nothing will happen to your work 18.Incremental backups typically require ____________ capacity then full backups? E.More storage F.Less storage G.The same storage H.None of the above 19.Spend a bit more money to protect the data with E.Removable storage, a simple backup scheme, and a decent electric power protection. F.A better PC and a ZIP Drive G.Calling in a good electrician H.Cat 5 wiring and a Network Technician 20.Super-floppy drives use E.120MB SuperDisk F.1.44 Floppy Disk G.CD-R Disks H.Both A and B

The Funeral Mask of King Tutankhamen

Perhaps one of the most amazing finds in Egyptian archeology is the tomb of King Tutankhamen. Howard Carter, the archaeologist whose subsequent death fueled speculation of the actuality of the mummy’s curse, discovered it in 1923 (â€Å"Tutankhamun,† par. 2). Most well known because it was largely intact at the time of its opening, the site gives modern viewers a rare insight into the life and death of a pharaoh. Today, the tomb remains shrouded in fascination as people all over the world visit displays of the artifacts retrieved from the crypt. According to the National Gallery of Art, archaeologists retrieved fifty-five items from the site, and among the items, King Tutankhamen’s Funeral Mask is possibly the most recognized (par. 1). It is also the most stunning example of Egyptian art recovered from the tomb. The mask of King Tutankhamen, better known as King Tut, is a large headpiece with the face of the young king, worn over the head and shoulders of the deceased. The entire mask is made of solid gold with inlaid blue glass and stones that create horizontal lines along the right and left sides of the head, down to the shoulders. This blue and gold striped headdress, also known as a â€Å"nemes,† which is a â€Å"royal head cloth† to be worn only by the ancient kings (â€Å"Death Mask,† cap. 1). On the forehead portion of the nemes are two small statuettes, one of a vulture and another of a cobra. According to experts, the â€Å"vulture, Nekhbet, and the cobra, Wadjet, protected the pharaoh† (â€Å"Death Mask,† par 1). On the back, the lines of the nemes converge at the bottom, in the center. The piece spares no detail, including the eyeliner worn by the ancient king. As a piece of Egyptian art, the Funeral Mask shows masterful use of the elements of design. The use of color is simply exquisite. Blue, gold, red and black, which comprise the piece, are still colors representative of royalty today. The use of line and space on the sides and collar create the illusion that the young king was large and imposing. In addition, the level of symmetry and balance in the piece is textbook. However, perhaps the most overtly powerful element in the piece is the use of symbols. Iconography and symbols are key to understanding the artists and the subject. The shape of this mask itself is reminiscent of the cobra, ostensibly representative of his power and fierceness. Also, the lines along the sides of the nemes seem to reflect the image of sunrays. In fact, it appears as if the rays of the sun were radiating from the king’s face. The sun god did play a large role in ancient Egyptian religion, but it is also possible that this represents the artists’ love of their young pharaoh. The most obvious symbols on the mask are of the cobra and vulture. Other than their use for King Tut’s protection, they may also represent his adherence to the old religions. According to Britannica Encyclopedia, â€Å"†¦serpent, vulture, and sphinx are all motif symbols tied up with such religious cults as the cult of the pharaohs and the gods and the cult of the dead† (par. 2). Considering the animals’ religious affiliation, and the fact that Tutankhamen spent his short reign reestablishing the various god religions of the past, one must speculate as to the   animals’ religious significance as well (â€Å"Tutankhamun,† par. 5). Perhaps these two particular animals were representatives of the gods that the pharaoh worshiped. Above all, these artists give the impression of adoration for King Tutankhamen in the medium chosen. The entire work is comprised of precious metals and stones that are historically synonymous with wealth and power. Goldsmiths spent a great deal of time refining and molding the metal, while small stones were cut and polished by hand to fit together almost seamlessly in the piece. Today, not only would the piece be expensive to recreate, it would also be somewhat laborious. Even with the use of modern tools, the work would be tedious at best. While it must have been somewhat difficult to achieve this level of work, without these elements the image of their king would have been somewhat dimmed. Although the Funeral Mask would have been exquisite even in clay, ancient craftsmen used materials fit for a pharaoh. Furthermore, ancient artisans obviously put a great deal of care into making their pharaoh’s mask a true representation of the ruler. It appears that their hope was to represent the king accurately and powerfully in the afterlife. Although their belief was that Tutankhamen would carry all the elements of his tomb into the underworld, they fitted him perfectly for presentation to an audience thousands of years later with all the riches one would expect to accompany such a powerful man as pharaoh of ancient Egypt. Even today, the Funeral Mask awes visitors with its royal visage. While some of the elements, such as facial features, seem crude on the surface and lacking realism, they are perfect in their simplicity. Thousands of years later, the artistry of the mask is virtually unmatched. Modern artists and goldsmiths would find the exact recreation of the mask difficult, if not improbable. When combined with the use of color, line, and symbols used by the ancient Egyptians, the mask is perfect. Twenty-first century artisans could not complete such an important task more appropriately. When given the commission of designing a similar piece, with the originality of this one, most artists would fail to find such a faultless balance of elements and design, which makes King Tutankhamen’s Funeral Mask the most superb piece of ancient Egyptian artwork found in the tomb, and perhaps even the world. Works Cited â€Å"Death Mask of King Tutankhamun†. King Tutankhamun by Wysinger. 27 March 2007. . â€Å"Jewelry.† Encyclopedia Britannica. 2007. Encyclopedia Britannica Online. 27   March 2007.   . â€Å"NGA – Treasures of Tutankhamun.† National Gallery of Art. 27 March 2007. . â€Å"Tutankhamun.† 27 March 2007. Wikipedia.com. 27 March 2007. .      

The Use of Intraosseous Vascular Access

The Use of Intraosseous Vascular Access Table of Contents Title Page†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 1 Table of Contents†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 2 Executive Summary†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 3 Body of Paper†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 4 Plan†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã ¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 6 Do†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 7 Check†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 7 Act†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦8 Research to Support Change†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â ‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦8 Change Theory†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 6 Conclusion†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 18 References†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 20 Timeline†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚ ¬ ¦. 22 Executive Summary First introduced by Drinker and colleges in 1922, intraosseous (IO) vascular access was a method used during World War II for accessing the non-collapsible venous plexuses within the bone marrow cavity to provide access to a patient’s systemic circulation. This method later fell out of use after the development of intravenous catheters.Then during the 1980s IO vascular access was again introduced as a rapid way of gaining vascular access for swift fluid infusion particularly during resuscitation attempts of pediatric patients. (Tay & Hafeez, 2011) Plan-Being by implementing a policy for the use of IO vascular access within the Emergency Department of Hays Medical Center (HMC) for critically ill patients. This would expedite critically ill and severely injured patients in receiving the intravenous fluids and medications.Currently there is no policy in place for the placement of IO devices as opposed to peripheral intravenous catheters, or central veno us catheters. However, if there was a policy in place the staff would know when it was appropriate to insert an IO device, as opposed to having to make a difficult decision based on personal judgment. Do- Create a group of physicians and nurses to write a policy outlining when it is appropriate for the placement of an IO device compared to traditional techniques for gaining venous access. Once the policy has been written implement its use within HMC’s ED.Check- Keep a careful record of when an IO device is placed, in accordance to the new policy. Monitor the outcomes of these patients. Evaluate the effectiveness of the new policy and determine if any changes need to be made. Act- Based on the information obtained during the check phase of this project, management will determine whether the policy will be continued, improved, or discontinued. The Use of Intraosseous Vascular Access in Critically Ill Patients The origin of the intraosseous cavity as an access sight to the circu latory system was originally discovered during World War II.Medical personnel during this time used an IO route to resuscitate patients suffering from hemorrhagic shock. It was first documented in medical journals by Drinker and colleges in 1922. It was later rediscovered by American pediatrician James Orlowski. During his time working in India, Orlowski observed medical personnel during a cholera epidemic using IO access to save patients in whom IV cannulation was impossible and who might have died without access. He later wrote about his experiences in a paper entitled, My Kingdom for an Intravenous Line. Wayne, 2006) Since Dr. Orlowski brought the use of IO access in pediatrics back into the medical spotlight, the implications for its use within the adult population were soon being addressed. In 2005, the American Heart Association stated in its Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care that â€Å"IO cannulation was appropriate to provide acc ess to the non-collapsible venous plexus found in the bone marrow space, thus enabling drug delivery similar to that achieved by central venous access. (American Heart Association) Intravenous access can mean the difference between life and death when dealing with critically ill patients. IV access means that patients can receive fluids, blood products, and life-saving medications. During situations when time is precious, and access is critical is not when nurses should be making their fifth attempt at a peripheral intravenous catherization (PIV). It also shouldn’t be when chest compressions are stopped, so that the doctor can try for a central venous line (CVL).The average time necessary for PIV catherization is reported to add up to 2. 5-13 minutes and sometimes even up to 30 minutes in patients with difficult to access peripheral veins. (Leidel, Chlodwig & Bogner, 2009) This is one of many reasons why it is imperative to have a policy in place so that the staff knows that IO access should be a go to option rather than a last resort. There are very few contraindications when it comes to the placement of an IO device. However, to untrained medical personnel the thought of having to place an IO device is very daunting.I didn’t realize until this semester that it is within the scope of practice for a RN to place an IO device, but it is absolutely is! â€Å"It is the position of the Infusion Nurses Society that a qualified RN, who is proficient in infusion therapy and who has been appropriately trained for the procedure, may insert, maintain, and remove intraosseous access devices. † (â€Å"The role of,† 2009) There is also the fact that of having to explain the procedure to the patient and the patient’s family. The fear of needles is a real one.The thought of an intramuscular injection can send certain patients into a full blown panic attack. So the thought of actually having their bone pierced with a needle is a frightening o ne. Thankfully most patients who are critically ill enough to necessitate the placement of an IO device are unconscious. In cases where patients are not unconscious, an IO device can be placed with minimal discomfort if proper anesthetic techniques are used. These techniques should be taught along with placement so that nursing staff is aware of how to place an IO with minimal discomfort to the patient.It needs to be noted that â€Å"the pain associated with insertion of the EZ-IO needle is similar to that associated with insertion of a large peripheral intravenous needle and may be alleviate with infusion of lidocaine solution. † (Luck, Haines & Mull, 2010) Unlike PIVs and CVLs, IO access can be obtained from multiple sites with less chance of being unsuccessful. The locations include: proximal tibia, distal to the tibial tuberosity, distal end of the radial bone in the upper imb, proximal metaphysis of the humerus, distal tibia, proximal to the medial malleolus, distal femu r, above the femur plateau, the sternum, and also the calcaneus (Tay & Hafeez, 2011). However, IO access is typically obtained via the proximal tibia or proximal metaphysis of the humerus. There are currently three different ways to gain IO access. The first and oldest way is a manual insertion of the IO device. In this way the device is placed using the force applied by the clinician, and is done in a rotating motion. The second technique is the use of an impact device.In this case, a spring-loaded IO device is to insert the needle into the bone using direct force. The last technique is a powered drill. The small, handheld device drills the IO needle into the bone with a high-speed rotating motion. Plan To implement a policy within the Emergency Department at Hays Medical Center that clearly outlines when the placement of an intraosseous access device should be used as opposed to more traditional techniques for gaining venous access. A committee would be assembled to look at the re search on IO placement.This committee would consist of three physicians and three nurses, and will be given three months to write a policy for the department. This committee will determine in which situations an IO should be placed. The American Heart Association guidelines for intraosseous vascular access should play a major role in this decision. Once criteria has been chosen a checklist will be created that can be hung on the walls of the trauma rooms and handed out to staff. This checklist will aide in helping the staff to be able to more quickly determine in which situations placement of an IO is within the department’s policy.The appointed committee would also be in charge of deciding on which type of IO device the department should use. They will research the availability of the device chosen and what the cost will be to stock the department which the device. Do Once the research is gathered, the assigned research committee will reassemble to compose the policy that wi ll become implemented within the Emergency Department. After the policy has been written, a mandatory unit meeting will be called to introduce the new policy and answer any questions that the staff might have.During this meeting, a demonstration will be given on the correct technique for IO placement, depending on which type of device is chosen during the planning phase. After the demonstration the staff will then be asked to practice placing IO devices using practice bones. One member of the department will then be voted upon to keep track of which patients coming through the department have IO devices placed. They will keep track of for the next six months. The data collected will include any outcomes that the patient experiences, good or bad, in regards to their IO placement.Check The member of the department will look at the data collected from the outcomes of patients who had IO devices placed within the ED in the last six months. This data will then be taken back to the origin ally assigned committee. The committee will be responsible for analyzing the data. They will look at the outcomes and determine if changes need to be made to the original policy. They will also look at the outcomes to determine if there need to be changes made in the placement technique used by the department.For example, is the rate of successful placement higher or lower when done via the humerus verses the tibia? Or is there a problem with post procedural infection? Should the technique be changed from aseptic to sterile? Etc†¦ They will also ask staff within the department to fill out a survey indicating their comfort level in placing IO devices. Act Depending upon the findings of the committee they can either be decided to leave the policy in place, as is. The committee could find that the policy needs to be altered and then reviewed in another six months’ time to see if the changes were effective.Or they could find that within the ED at Hays Medical Center IO devic es for venous access should not be used although the review of literature will prove why this outcome is highly unlikely. Research to Support Change An article published in the Journal of Emergency Medicine, collaborated by three different physicians who work in Emergency Departments in Philadelphia talks about the technical side of intraosseous access. The article states that â€Å"intraosseous vascular access is indicated in the critically ill patient of any age when rapid and timely access via the intravascular route cannot be established or has failed. The article goes on to list conditions in which this might occur, including: cardiopulmonary arrest, shock, sepsis, major traumatic injuries, extensive burns or edema, and status epilepticus. (Luck, Haines & Mull, 2010) Indications may also include obese patients on who multiple PIV attempts have failed. Because studies have shown that IO infusions have the same onset of action, as that of intravenous infusions the authors recomm end that the dose used for IV fluids and medications should remain unchanged when using the IO route.They go one to state that other studies have shown that the results of several different blood test values drawn from bone marrow aspirates are comparable to those taken from venous samples. These include blood gas analysis, blood group typing, and electrolyte, drug, and hemoglobin levels. (Luck, Haines & Mull, 2010) The authors also talk about the relatively few contraindications for IO insertion. These include a fracture to the bone that the IO device is to be placed, an extremity with a vascular injury, placement to an area with an overlying skin infection or burn.IO insertion is also contraindication in patients with certain conditions that make their bones fragile such as osteogenesis imperfect and osteoporosis. The last contraindication is a new IO insertion where another IO needle may have recently been placed. This is because the opening left by the last needle can cause flui ds to extravasate. In their research of other studies, the authors found that success rates for IO insertion vary between 75%-100%, and successful infusion achieved within 30-120 seconds in the majority of cases. Luck, Haines & Mull, 2010) The most common complication was found to be extravasation of blood, fluids, and drugs into the soft tissues surrounding the site, but this occurred less than 1% of the time. With a 0. 6% chance of incidence, the most serious adverse complication was osteomyelitis. However, this was attributed to prolonged infusion. For this reason, it is recommended that the IO need be replaced by either a PIV or a CVL once the patient has stabilized and no longer than 24 hours after IO placement. (Luck, Haines & Mull, 2010)This article concluded that the use of IO access devices is a safe, reliable, and timely way of attaining vascular access. Although vital for critically ill and injured patients, it is also a technique that can be applied in non-emergent cases where multiple attempts at peripheral and central IV access has been unsuccessful. (Luck, Haines & Mull, 2010) In a study conducted by physicians at the University of Medicine Berlin’s Department of Emergency Medicine, they looked at ten consecutive adult patients who each received an IO device and also a CVC placement during a resuscitation situation.The results showed that the success rate on first attempt was 90% for IO access versus 69% for CVC placement. They also found that the mean time required for the IO access procedure was significantly shorter, 1-3 minutes, compared to the mean CVC placement time of 4-17 minutes. While conducting this study, one IO cannulation failed â€Å"due to operator mishandling by not selecting the correct insertion site at the proximal humerus. (Leidel, Chlodwig & Bogner, 2009) The physicians of this study also noted that four CVC cannulations failed on the first attempt at insertion and had to be reattempted. The study then went on to st ate that the failed placement of one IO cannulation was the only complication regarding the IO devices placed. There was â€Å"no malposition, dislodgment, bleeding, compartment syndrome, arterial puncture, haeatothorax, pneumothorax, venous thrombosis, and vascular access related infection observed. † (Leidel, Chlodwig & Bogner, 2009)In conclusion the researchers go on to state â€Å"IO vascular access is a safe, reliable, rapid option in the acute setting of adult patients under resuscitation with inaccessible peripheral veins in the emergency department†¦ Therefore, a change in practice from CVC to immediate IO access for the initial emergency resuscitation should be strongly considered as a reasonable bridging technique to increase patient’s safety in the emergency department. † (Leidel, Chlodwig & Bogner, 2009) Another study found was performed by physicians and researchers in the Department of Emergency Medicine of Singapore General hospital.It is a l arge urban hospital that handles nearly 120,000 patients annually. 9% of these patients are priority 1 patients, or patients that need resuscitation. The inclusion criteria for this study were â€Å"patients who presented to the ED with age greater than 16 years or >40kg body weight requiring intravenous fluids or medication and in whom an intravenous line could not be established in two attempts or 90 seconds. They also had to be seriously ill or injured and meet at least one or more of the following: altered mental status, respiratory compromise, haemodynamic instability, or cardiac arrest. (Ngo, Oh, Chen, Yong & Yong, 2009) The study ran from March 1, 2006 through July 30, 2007. During this time 24 patients were met the qualifications for this study. Of all the IO cannulations, only three attempts failed on the first attempt. No failures were recorded on the second attempt. The researchers also did a comparison between junior operators and senior operators and found that there w ere no disparity regarding success rates between the groups, they both had a 100% success rate. The average insertion time for both groups was approximately five seconds. Ngo, Oh, Chen, Yong & Yong, 2009) There were only two complications regarding the insertion of an IO device with this study. The first was when an operator’s glove was caught on the need during insertion. However, this could have been prevented if the operator was holding the drill properly. The other complication noted was that of extravasation of fluid at an insertion site. This is the most common type of complication, and is seen when the need is misplaced or there is an excessive amount of movement during or after the insertion. Ngo, Oh, Chen, Yong & Yong, 2009) The results of this study concluded that â€Å"the EZ-Io is a feasible, useful and fast alternative mode of venous access especially in the resuscitation of patients with no venous access or when conventional intravenous access fails. Flow rates may be improved by the use of pressure bags. Complications encountered such as extravasation of fluid and gloves being caught in the drill device can be easily prevented. † (Ngo, Oh, Chen, Yong & Yong, 2009)The third research article was a prospective, observational study conducted by researchers in the Department of Emergency Medicine at Singapore General Hospital in Singapore. The study was conducted on a convenience sample of 25 medical students, physicians and nursing staff. They were recruited to secure intraosseous access using the EZ-IO powered drill device. Unlike the previous two studies they only need to secure access on a plastic bone model rather than a live patient. (Ong, Ngo & Wijaya, 2009)The study participants were allowed multiple attempts in placement with the aim of ensuring success in placement. Their placement times were measured by an independent observer with a stopwatch, from the time the participant placed the need set into the driver and attempted to insert the needle with the ES-IO into the plastic bone. The participants then recorded their perception on the difficulty of insertion using a visual analog scale with 0 representing very easy and 10 representing very difficult placement. (Ong, Ngo & Wijaya, 2009) The results showed 96% success rate for placement.Twenty-three of the 25 participants only required one attempt at place the IO device, and only one participant was unsuccessful at securing placement of the device. This failure was attributed to â€Å"unfamiliarity with the equipment and procedure, and hesitating beyond the allocated time given for insertion. † (Ong, Ngo & Wijaya, 2009) The results of this study also showed that the mean placement time was 13. 9 seconds. The researchers also found that 87% of their participants reported that using the EZ-IO was easier compared to intravenous cannula. Ong, Ngo & Wijaya, 2009) The researchers of this study concluded that â€Å"the I/O access device (EZ-IO) evaluated in this study appears to be easy to use with high success rates of insertion with inexperienced participants. There is potential for use in the Emergency Department. (Ong, Ngo & Wijaya, 2009) The next piece of research was a randomized trial conducted by Dr. Reades from Methodist Hospital System, in Dallas, TX, Dr. Studnek from Carolinas Medical Center and the Center for Prehospital Medicine, Charlotte, NC, S.Vandeventer from Mecklenburg EMS Agency, Charlotte, NC, and Dr. Garrett from Baylor Healthcare Systems, Department of Emergency Medicine, Baylor University Medical Center, and Dallas, TX. The purpose of this study was to determine whether the tibial or humeral placement site was more effective for intraosseous placement during out-of-hospital cardiac arrest. â€Å"All patients eligible for inclusion in this study had their first attempt at vascular access randomized to one of 3 locations: proximal tibial intraosseous, proximal humeral intraosseous or peripheral intravenous. ( Reades, Studnek, Vandeventer & Garrett, 2011) Randomized note cards were distributed to the paramedic staff at the beginning of their shifts, and told them which access site was to be initially used if they came had a patient who met the inclusion criteria. There were two outcomes that were being monitored in this study. The first was a first-attempt success at the assigned method of vascular access. This qualified in one of two ways, either as an initial success or an overall success.The second measured outcome was the â€Å"total number of attempts required for successful vascular access, time to successful vascular access, time to first ACLS medication, and total volume of fluid infused during resuscitation. † (Reades, Studnek, Vandeventer & Garrett, 2011) Overall there were 182 patients randomized to one of the 3 vascular access methods. Fifty-one patients had humeral IO placements, 67 had PIV placements, and 64 had tibial IO placements. The results showed that first-atte mpt success was greatest in patients randomized to tibial IO access at 91%, compared to both humeral IO access at 51% and PIV access at 43%.The result of the secondary outcome was also significantly shorter in patients with tibial IO access. These patients had their devices in place and ready to use in an average of 4. 6 minutes. Those assigned to the humeral IO access site averaged a 7. 0 minute placement time, which was also the same time for a PIV access site. (Reades, Studnek, Vandeventer & Garrett, 2011) This study demonstrated that there is a significant different in the frequency of first-attempt success when placing tibial IO access devices as opposed to humeral IO access devices or even PIV catheters.The researchers go on to state that the â€Å"results from this study may help stakeholders such as EMS medical directors choose the most appropriate site for first-attempt vascular access†¦Ã¢â‚¬  (Reades, Studnek, Vandeventer & Garrett, 2011) The last article was a cons ortium on intraosseous vascular access in healthcare practice, published in a journal entitled critical care nurse. It too outlined the history of IO access, dating back to World War II. It discussed the clinical considerations for the use of IO access, and the clinical situations in which IO access should be considered.It went on to talk about the types of IO devices and how they’re used. It mentioned the contraindications for IO use, and also the possible complications. All of the aforementioned material was consistent with research already discussed. This article lends credibility in support of change because it discusses the education and training needed to implement IO device use in the clinical setting. It states that â€Å"to insert and maintain an intraosseous device in a patient, the clinician must demonstrate adequate knowledge and psychomotor skill competency in the procedure. (Phillips, Brown, Campbell, Miller, Proehl & Young-berg, 2010) The article then went on to discuss the economic considerations that must be looked at when considering implementing an IO insertion policy. It states that â€Å"the cost of intraosseous devices and needles should be compared with the cost of central catheter kits, ultrasound evaluation, and human resources required for their insertion. † (Phillips, Brown, Campbell, Miller, Proehl & Young-berg, 2010) The authors also note that â€Å"the economic factors must be weighed along with potential complications of therapeutic strategies should be considered. (Phillips, Brown, Campbell, Miller, Proehl & Young-berg, 2010) This article also brings to light the issue of risk management and patient safety. In this day and age where liability concerns continue to drive clinical decisions, it is important to note that delays in treatments are often cited as the cause of injury leading to malpractice claims. If there is an evidenced based option to safely and quickly provide fluid and drug resuscitation, when vascu lar access is not readily attainable, then it needs to be closely looked at.After reviewing the data the Consortium on Intraosseous Vascular Access in Healthcare Practice reached eight consensuses: 1. Intraosseous vascular access should be considered as an alternative to peripheral or central intravenous access in a variety of health care settings, including intensive care units, high acuity/progressive care units, general medical units, preprocedure surgical settings where lack of vascular access can delay surgery, and chronic care and long-term care settings, when an increase in patient morbidity or mortality is possible. . Intraosseous vascular access should be considered as part of an algorithm for patients treated by rapid response teams in whom vascular access is difficult or delayed. 3. A new algorithm that includes the intraosseous route should be developed for assessing the appropriate route of vascular access. 4. For patients not requiring placement of central catheters ei ther for long-term vascular access or hemodynamic monitoring, intraosseous access should be considered as the first alternative to failed peripheral intravenous access. 5.Techniques of intraosseous catheter placement and infusion administration should be a standard part of the medical school and nursing school curriculum. 6. In evaluating the economic implications of adopting intraosseous technology, the following should be considered: the expense of diagnostic tools to guide and confirm placement, the cost of human resources, the known and unknown risks to patient safety, and the cost of complications related to delayed treatment. 7. Organizational policies, procedures, and protocols that establish the responsibility of insertion, maintenance, and removal of intra-osseous access devices should be developed. . Further research should be conducted on, but not limited to, the safety and efficacy of use of intraosseous access in all practice settings, its economic impact on patient car e, and to support the use of intraosseous access in all health care settings. Change Theory The change theory focused upon in this paper is Gordon Lippitt’s Theory of Planned changed. According Lippitt, â€Å"Planned change or ‘neomobilistic’ change is defined as a conscious, planned effort which moves a system, an organization, or an individual in a new direction.This theory is applies because it can be applied at an individual, group, and institutional level. The basis for Lippitt’s theory of change is center around an agent for change. This agent should be a person skilled in the changed wanted to apply. It is this person who is in charge of planning for the change, initiates the change, and is credited for the accomplishment of change. Lippitt’s theory is centered around 7 phases of change. His phases are not set in stone, and there is no time frame on how long each phase should last. There should be a fluid movement back and forth between thes e seven phases.The first step is identification and diagnosis of the problem. In this case, the problem is HMC not having a firm policy in place recommending when the use of IO access devices should be implemented. The second step is the change agent assessing the client systems motivation and capacity for change. In this case, myself being the change agent, I would talk with the administrators of the ED department and determine if they agreed with my assessment for a policy to be implemented. The third step would be the initiator assesses his or her ability in helping the situation.In this case this flows back to the first step, because I saw the need for change and felt that I was equipped with the skills needed to bring about such a change. The fourth step is the change agent then chooses an appropriate role in the phase. In this case, I would choose to be part of the policy committee who is responsible for researching. The fifth step states that the change agent may be actively involved in the implementation of change, serve as an expert in fathering and providing data, or function as a liaison within the organization. I feel like in this case, I would function as a liaison within the policy making committee.The sixth step consists of maintenance of change. This involved the â€Å"Do† portion of the plan for change. This is where the decisions made by the policy are provided to the department, and the employees become responsible for implementing and maintaining the new policy. The final step is termination of the helping relationship. This step is accomplished when all parts of the PDCA plan have been completed. (Ziegler, 2005) Conclusion In a day and age where medical technology is advancing, the research about IO access devices proves that newer technologies are not always the best for a positive outcome.IO access applications have great potential in patients who are critically ill, injured, or are incapable of having PIV or CVL access. The fact that IO access is fast, reliable, and safe proves that competent placement of IO devices is a medical technique that all Emergency Departments should have in their repertoire. References (2009). The role of the registered nurse in the insertion of intraosseous access devices. Journal of infusion nursing,  32(4), 187-188. American Heart Association. 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2005;112(24):57-66. Leidel, B. Chlodwig, K. , & Bogner, V. (2009). Is the intraosseous access route fast and efficacious compared to conventional central venous catherization in adult patients under resuscitation in the emergency department? a prospective observational pilot study. Patient safety in surgery,  3(24), doi: 10. 1186/1754-9493-3-24 Luck, R. , Haines, C. , & Mull, C. (2010). Intraosseous access. The journal of emergency medicine,  39(4), 468-475. Ngo, A. , Oh, J. , Chen, Y. , Yong, D. , & Yong, D. (2009). Intraosseous vascular access in adults using the ez-io in an emergency department. International journal of emergency medicine,2(3), 155-160. oi: 10. 1007/s12245-009-0116-9 Ong, M. , Ngo, A. , & Wijaya, R. (2009). An observational, prospective study to determine the ease of vascular access in adults using a novel intraosseous access device. Annals of the academy of medicine, singapore,  38(2), 121-124. Phillips, L. , Brown, L. , Campbell, T. , Miller, J. , Proehl, J. , & Young-berg, B. (2010). Recommendations for the use of intraosseous vascular access for emergent and no emergent situations in various health care settings: A consensus paper. Critical Care Nurse,  30(6), e1-e7. Reades, R. , Studnek, J. , Vandeventer, S. , & Garrett, J. (2011).Intraosseous versus intravenous vascular access during out-of-hospital cardiac arrest: A randomized controlled trial. Annals of Emergency Medicine,  58(6), 509-516. Tay, E. T. , & Hafeez, W. (2011). Intraosseous access. In R. Kulk arni (Ed. ),  Medscape reference: Drugs, disease & procedures. Retrieved from http://emedicine. medscape. com/article/80431-overview Wayne, M. (2006). Adult intraosseous access: an idea whose time has come. Israeli journal of emergency medicine,  6(2), 41-45. Ziegler, S. (2005). Theory-directed nursing practice. (2 ed. , p. 204). New York, NY: Springer Publishing Company, Inc. Timeline for Change 1/20-11/27Researched the benefits of having a policy about intraosseous access within the ED at HMC 11/28Spoke with the Director of Nursing for the ED and the Director of Emergency Medicine about my research findings 12/1A committee of three physicians and three nurses is assembled to draft a preliminary policy regarding intraosseous access 12/1-3/1The committee is given three months to compose their policy 3/2-3/10The policy is given to the Director of Nursing and Director of Emergency Medicine, who present it to the board of directors for approval 3/15A mandatory staff meeting is held outlining the new policy and answering any questions or concerns the staff has 3/16-9/16The new policy is put into effect and data is collected 9/16-10/16The original committee will analyze the data, and changes are made as needed. 10/20The final committee approved policy is present to the Director of Nursing and Director of Emergency Medicine 11/1The Director of Nursing and Director of Emergency Medicine, take the final recommendations for the policy to the hospital board of directors for approval

ANTEBELLUM FINANCIAL CRISES Example

ANTEBELLUM FINANCIAL CRISES Example ANTEBELLUM FINANCIAL CRISES – Book Report/Review Example ANTEBELLUM FINANCIAL CRISES September 22, Antebellum Financial Crises, Bruchey Ch. 6 The chapter imparts enormous knowledge to the reader by providing detailed information concerning several aspects of money and banking before and partly before the civil war. Crucial information about the currency establishment among European countries is well analyzed. Basics of the origin of currencies that was the use of coins is well-discussed making one understand the origin of exchange rates. It came as a result of value of the mixture portion of the material component used to make the coins. Different nations had varied combinations thus the difference in value and exchange rates among the nations that were mainly done by merchants who were involved in imports and exports of goods that were in demand during those times.Further significance of the chapter is well-portrayed by provision of information on how the banking industry and its growth had an effect on the economy. Introduction of paper money is well-analyzed with the reasons behind the idea of bank notes. Several entrepreneurs are discussed in the chapter and the ideas they came up with which some are still used in the banking industry (Bruchey 189). For example, the transfer of money, in this case bank notes, from one individual to another was possible by an order from the customer to transfer funds to another person to the other with the amount clearly stated and record kept. The chapter also helps us understand the bank war that took place at around 1830 during the leadership of Jackson who had little concern on the second bank of America. Seldom did he mention it in his campaign and thats how he became president without questions on the same. The chapter clearly gives answers to critical questions such as the achievements of Nicholas Riddlc at around 1816 where he was trying to enact measures to maintain the value of a currency on the international market. When going through the reading, one can relate the mon etary regulatory situation. It is clear that poor regulations and allowing too much liquid cash to the public is more likely to cause inflation.

An End to Animal Abuse Essay Example for Free

An End to Animal Abuse Essay â€Å"Animals are dying all over the world and becoming endangered species mostly because of animal abuse and cruelty† (James Gorman). It is a worldwide problem that will continue unless people are concerned about it or stop doing it. There should be more laws regulating child labor. Animal abuse stops scientists from researching animals. Animals become endangered species. It also causes psychological effect. Animal abuse must be abolished. One reason animal abuse must be abolished is because it stops scientists from researching other animals. â€Å"Researching animals helped make medicines for terrible diseases.† (James Gorman). One endangered animal is the chimpanzee, which is endangered because of being trapped in cages. Another reason animal abuse should be abolished is that animals die and become endangered species. â€Å"Breeds of horses face endangerment and extinction because of animal abuse.† (www.horsetradition.com). These horses get slaughtered by people for their meat because people think horses can cure HIV. Some horses are killed because of religion. Last reason animal abuse should be abolished is that animal abuse causes psychological effect. â€Å"This means animals are shy and aggressive because of being injured and hurt. The most negative thing about animal abuse is psychological effect.† (James Gorman). As you can see, there are many reasons why there should be more laws regulating animal abuse. Animals getting injured and hurt badly causes many horrible things. It makes scientists give up on their research on animals, animals get close to endangerment or extinction, and most importantly, it will cause effects when animals are hurt. If you see animals getting abused or treated bad, call the ASPCA. They are professionals and save and find homes for animals every day. An End to Animal Abuse. (2016, Sep 30).

Individuals with disabilities education act Assignment

Individuals with disabilities education act - Assignment Example Inclusion does not merely mean to make children with disabilities participate in the general education setting; instead, it means that all students are being treated as active members of the learning environment where they can make decisions about the utilization of appropriate institutional setting with fair access and self-respect. Natalie must also be included in the fair and respectful inclusive educational practices so that she may feel that she is not being disadvantaged by any means. Providing her with a sense of self-respect will boost her individual competencies, and she will better be able to meet her individual needs as mentioned in her IEP. This can only be achieved if she will be provided with all sorts of environmental modifications in her neighboring school where her sisters are also studying. She will feel secure in this setting, and will better be able to respond to the learning process. It is a main suggestion in IDEA that children with disabilities should be provid ed with appropriate environmental modifications in their neighboring schools. These modifications include considering general physical education class as first placement option, relevant modification of equipment, and involvement of the support personnel in implementing the equipment in the most beneficial way possible. Natalie’s IEP document must be reviewed regularly so as to ensure her inclusion in the general physical education program. Natalie’s individual needs must also be assessed so that she may be able to achieve the aims and objectives mentioned in her IEP.