Some thing has related about ENVI Essay Example | Topics and Well Written Essays - 250 words

Some thing has related about ENVI - Essay Example Demand for products of crop farming in Indiana is ideal. There is an active growth in demand for products of crop farming. Moreover, the demand for farm products imports is also high. This indicates that the available supply of farm products does not satisfy the current demand. Indiana spends between 1-9.9 billion dollars for farm produce imports (Hicks, 2014). This raises concerns about the farm products production capacity of Indiana. Many forests have been cleared for the sake of creating agricultural farms. A big percentage of forest land in Indiana is privately owned (Our Land Our Literature, 2014). Therefore, there lacks national control measures for deforestation. Deforestation has resulted into reduced rains and thus reduced agricultural productivity. Moreover deforestation also destroys the natural habitat of animals and birds. Although organizations such as Indiana Forest Alliance and Heartwood have come out to educate people on the need to stop deforestation, there is still a lot to be done. The forest cover in Indiana has reduced by 59% in the last thirty years (Alexander, 2013). The agricultural sector is at high danger of collapsing due to poor climate. If campaigns against deforestation are not carried out, Indiana might spend more than 10 billion in imports for farm products. If nothing is done, the currently growing population is bound to experience challenges such as famine and hiked prices of farm products. Hicks,  M.  J. (2014).  Key Economic Sectors in Indiana: State Overview. Retrieved from Center for Business and Economic Research, Ball State University. website:

Project Design & Implementationect Assignment Example | Topics and Well Written Essays - 1250 words

Project Design & Implementationect - Assignment Example The field is then converted back to the electric power that then utilized. There are two categories of the power techniques (Tesla and Childress, 2010). These power techniques include radiative and non-radiative. The non-radiative techniques apply the mechanism where the power is transmitted or transferred over very short distances through the magnetic fields by use of inductive coupling techniques between the wire coils. The application of this technology is applied in chargers of toothbrush, smart cards, RFID tags, and the chargers of the medical devices that are implanted such as the cardiac peacemakers and the inductive charging and powering of vehicles. The primary focus is come up with a wireless system that can recharge the handheld gadgets and mobile devices like digital music players, cell phones, and portable computers, which are tethered, to a plug on the wall. The radiative technique is also referred to as the power beaming where the power is transferred by the mechanism of the beams of radiation of the electromagnetic. This aspect applies to the microwaves and laser beams. The technique can transmit energy to longer distances as compared to the non-radiative technique. The energy should always be aimed at the receiver. The applications that are proposed for this technique are in the use of solar power satellites and can be utilized in the drone aircraft that are wireless powered. A crucial issue that is associated with the wireless systems of the power is the limiting the peoples exposure and the living things that might come into the path of the radiation. The radiation contains potentially harmful effects. Many engineers and designers have faced significant challenges that have involved the power. Some of the challenges are the continuity of the power supply, optimizing the sensor locations, battery recharging

The Mycenaean warfare Essay Example for Free

The Mycenaean warfare Essay The Mycenaeans were a people preoccupied with war How conclusively do the various types of archaeological evidence we have for the Mycenaean warfare and defence support this statement? The Mycenaean age began around 1600 BC and came to end around 1100 BC. Although this period was distinguished by its warlike aspects, I would take issue with the statement that the Mycenaeans were preoccupied by war. The first manifestations of the Mycenaean civilisation were found in the Peleponnese, especially in the north-east and the south-west. By around 1400BC the Mycenaean civilisation had penetrated the greater part of mainland Greece and later still the civilisation seems to have expanded far beyond the main body of Greece. Excavations have revealed Mycenaean remains in southern Italy, Egypt, Sicily, the Dodecanese, the Cyclades, Cyprus, and sites in Asia Minor. Evidence of Mycenaean settlements has been beyond a doubt found in Rhodes and in Melos. These settlements may have been a general expansion of the Mycenaean civilisation yet large amounts of Mycenaean imports as found at Cyprus indicate to many archaeologists that these may be trade outposts. General expansion would make war necessary rather than a chosen pursuit as the civilisation would have to take new land whilst defending what they already had. Like all of the civilisations of the time the Mycenaean civilisation was agriculturally based, the Linear B tablets list many farmers crops and also the percentage to be given in tax to the king and the percentage to be given to the shrines of the area. The fact that both the palaces and the shrines received a percentage suggests to me that the civilisation was equally concerned with public life as well as war, which the palaces controlled. Much of the crop would be used in the local area; however, the surplus would be exported through the trading points, where a complicated form of bartering was used as payment. It is hard to understand why in a society that had such an organisational system for the listing and trading of goods, particularly agricultural goods, has no record of an organised army if they were preoccupied with war. Although Linear B tablets record lists of men assigned to military and naval duty it seems there was no permanent specially trained force; it is more likely that every man was expected to carry a weapon and use it when called up for military duty. One theory may be that the Mycenaean civilisation might have had a lack of human resources: since the original inhabitants who it has been argued could have been tribes of people who lived in Greece but were not citizens and were never trusted with military service. There are indeed records of many occupations including cabinet makers, perfume makers and even a physician is mentioned in the tablets suggesting wider career options than simply the military. Infrequently and in small numbers Followers are mentioned on the Knossos tablets who could have been the occupants of the warrior tombs found in the vicinity. They probably were specially trained leaders who would organise the recruited armies in times of war rather than the liaison officers they were first thought to be. One tablet has revealed the sectors delegated to each Follower with the concentration of the Followers being in problem areas such as the Bay of Navarino in the southern area of the west coast and the coastal end of the Kiparissia river valley in the north. This indicates small battalions of recruited soldiers led by an experienced officer in areas most likely to be attacked. Due to the general expansion of Mycenaean civilisation and the volatile times in which there were many small kingdoms around the Mycenaean borders, defence was essential in the civilisations survival. Evidence too, can be found in the defensive capabilities of the Mycenaean citadels, which on the whole were built for the possibility of attack and of sieges. All of the citadels commanded wide views: Mycenae having a view across the Plain of Argos to the sea and even Pylos has an extensive view of the coast. These views gave the citadels early warnings of approaching forces and probably the time in which to move the people who lived around the citadel into safety behind the walls, a similar tactic to the shanty towns in Troy. This cannot be proved, however, as the buildings suggest that the usual occupants of the citadels would be the royal family, priests, craftsmen and occasionally guests. Most of the citadels, excluding Pylos, were heavily fortified and built on acropoleis. The walls at Mycenae are between 5. 5m and 7.5 thick using such huge stones that the walls became known as the Cyclopean walls as peasants marvelled that they must have been built by giants. The walls of Tiryns are even more massive than Mycenae but quite different in style: all the outer walls being immensely thick and with chambers built into the south side. There are few entrances for most sites and the entrances that the sites do have are very well protected. At Mycenae both the Lion gate and the Postern gate have defences on three sides (see figure 1, page four) and in particular on the shield-less side of an approaching soldier making attacking the entrances very difficult. The main entrance to Tiryns was up a long ramp under the eastern wall which exposed the attackers all the way on their unshielded sides, this main entrance led to an opening 4. 5m wide with walls 8m thick, there were two gates beyond the first making the entrance almost impenetrable. In the case of a siege fresh water was available in both Mycenae and Tiryns through underground cisterns suggesting that sieges took place quite often at this time and the Mycenaeans wished to prepare themselves for them. Attacks could be launched from a citadel under siege implied by the sally port in Mycenae from which it would be relatively easy for small bands of men to slip in and out without being noticed. All in all the highly defended citadels suggest the Mycenaeans feared being attacked, making the overall culture at the time seem quite warlike and volatile; the Mycenaeans could simply have been fitting into the trend of the area rather than beginning one. Despite this there can be no doubt that the Mycenaeans were warlike in many respects, they are renowned for their fighting ability many scholars believe that they probably conquered Knossos in Crete and ruled there for sometime. The coming of the Mycenaeans certainly brought a dramatic change to the Cretan society, the warrior tombs around Knossos yielded large amounts of weapons and armour. Documents at Knossos also recorded lists of armour and weapons, one document listed fine linen for a tunic and on the second line mentions tunic fittings (epikhitonia) and 1kg of bronze. It has been argued that the bronze could have been a unit of exchange but it is more likely that the document is refering to a reinforced tunic. The same amount of bronze is used, as tunic fittings could have been a cape or overcoat to protect the soldiers upper arms and the shoulders. An even more detailed, incomplete series of documents describes armour in more detail: body armour, a helmet (korus) with four helmet accessories, two cheek pieces, two shoulder pieces, and an unknown number of further accessories. The helmet accessories could have been metal reinforcing plates over a leather or felt base. The accessories (o-pa-wo-ta) were probably plates of metal that were hung on to a tunic to protect the soldier, yet the arrangement of the plates is debatable with many scholars over the world disagreeing with each other. The crude ideogram from Pylos of a head-dress and corslet offers no clue to the arrangement, with there being too few plates for scale armour. We know that they did have leg and lower arm guards such as the Dendra armour, the leg guards were probably linen as shown in late Mycenaean art, but a few bronze ones have been found possibly to be worn over the linen ones. As John Chadwick states the Mycenaean warrior, however well armed, is incomplete without means of locomotion. It is probably the case that the larger part of the army moved on foot; many, we presume, travelled to the battlefield in chariots such as the one depicted in a fresco at Pylos (see figure 2, page five). Chariots can also be read of in many tablets and seen on numerous vase paintings yet due to their impressionistic style or the damage that time has inflicted it is hard to deduce what they actually looked like. The chariots had four-spoked wheels, a fixed axle and were probably very lightweight built out of wood and wickerwork. A fresco at Hagia Triada in Crete points towards there being hide-covered bodies. Two horses probably pulled them, unlike the chariots depicted in the frescoes, as we know from the remains of horses that they were very small breeds. Whether or not the chariots were used actually used in battle, due to the rough terrain and the implications of the Iliad many scholars believe that the chariots were actually used as taxis to the battlefield. Yet it is hard to believe that only soon after the chariot Battle of Kadesh in 1285 BC that no-one was using chariots in battle, the Mycenaeans neighbours, the Hittite certainly used the chariots in battle. One inventory found in armoury of Knossos lists 340 chariot bodies and 1,000 pairs of wheels, this ratio of 3:1 suggests they were intended for more strenuous duties such as fighting. A fresco in Pylos shows two youths attacking a group of men with short swords or daggers, the distinction seems as difficult to understand wen it comes to the tablets as the ideogram could show either a sword or a dagger. The word pa-ka-na could be the Homeric word phasgana but there is evidence that the word may also be a confusion of the original Mycenaean meaning. One of the main reasons for war and expansion may have been the need to secure the Mycenaeans supply of metal brought to Greece through sea-borne trade. Interruptions in the trade routes could have had a detrimental effect on the Mycenaean civilisation; it has been argued that the Greeks may have attacked Troy due to the equally strong civilisations control on the trade routes. The Mycenaeans chief metal was bronze, as they did not have the technological skill to extract and make good iron. Bronze is an alloy made from copper and tin, with the copper coming from Cyprus, the source of the tin is debatable as it could have come from Spain, what is now Czechoslovakia or even Britain. Chadwick argues that the Mycenaeans may have even had small amounts of tin in the land, this I doubt as such a source would surly been mentioned in the tablets. Where ever the metals came from to make the Bronze it was very valuable and the tablets suggest tightly controlled by the palaces who assigned the metal to specific craftsmen and weighed the goods produced. Although bronze was used for making weapons it also had other uses such as to make vessels and perhaps have been used to make various tools. It has been argued that the Mycenaeans had to expand due to the certain lack of these resources, which were used to make most tools and weaponry. The Mycenaeans imported much of these metals probably in return for large amounts of surplus crops. The Mycenaean civilisation came to an end around 1100BC in a series of disasters and fires, one of the first places to be destroyed was Pylos invaded by an unknown adversary. Writing skills disappeared, only to be rediscovered by the Greek hundreds of years later who adapted the Phoenicians techniques. Foreign trade on a large scale also halted and the population became segregated, splitting into small rural settlements rather than the cities they once inhabited. This decay of a once great society took place over an extended time period starting with the destruction of a few cities in 1250BC and has been blamed on Dorian invasions, climate changes or internal struggles. There is no evidence that proves any of these arguments but it is obvious that the volatile times in which the Mycenaeans lived in finally destroyed the civilisation. My main argument against the opinion that the Mycenaeans were preoccupied with war is that they did bring structure into the areas in which they inhabited. Although they were obviously a warlike culture they had strong systems when it came to trade, religion, craft and administration proved most finally by the fact these structures collapsed when the Mycenaean civilisation ended. Bibliography The Mycenaeans by Lord William Taylour The Mycenaean civilisation by John Chadwick http. //www. lfc. edu/academics/greece/BrzMyc. html http://www. portergaud. edu/cmcarver/myce. html.

Care for Post Elective Coronary Artery Bypass Graft Surgery

Care for Post Elective Coronary Artery Bypass Graft Surgery Assessment for the care of patient with respiratory problem  following Coronary Artery Bypass Graft 3 vessels disease and Mitral Valve Repair Introduction This essay examines a case study of a male patient with a complex history who has undergone elective coronary artery bypass graft surgery, and suffered a number of recovery complications. Coronary artery disease is a common pathology in the Western population, perhaps due to lifestyle and dietary factors, including lack of exercise and smoking. The case history will be examined in the light of nursing care and current theoretical knowledge, looking at the individual needs of the patient and the potential interventions which could be employed to address this patient’s emergent and ongoing condition. Nursing care at any stage, critical, acute or chronic, must be an holistic process which takes into account all of the social, physiological, psycholological, emotional and spiritual needs of the person. Given the critical state of this individual’s health, however, some needs can be identified as more urgent that others. The case history will demonstrate the predominant needs of this patient as those connected with his respiratory function and status, and therefore while all aspects of the case will be considered, considerable attention will be paid to his respiratory needs, treatments and potential outcomes. The focus is on nursing care, which must address the emergent clinical picture whilst considering long term, mid term and short term outcomes in a client-centred context. Discussion The patient, who shall be called Mr S to protect confidentiality, was admitted on June 6th for an elective coronary artery bypass graft procedure, plus a Mitral Valve Repair. According to UHC (2007) a coronary artery bypass graft (CAB or CABG) is a surgical procedure in which a healthy blood vessel is transplanted from another part of the body into the heart to replace or bypass a diseased vessel. In this case, it is the treatment of choice for the patient whose history of myocardial infarction and coronary artery disease made him a prime candidate for corrective surgery. Coronary artery disease is defined as the failure of the coronary arteries to deliver oxygen and fuels for myocardial work (Emery and Pearson, 1998). Coronary artery disease is a leading cause of myocardial infarction (Emery and Pearson, 1998). According to STS (2007), mitral valve repair is an open heart procedure which aims to treat stenosis or regurgitation of the mitral valve, which is the inflow valve for the left side of the heart. In normal physiology, blood flows from the lungs, where it picks up oxygen, and into the heart through the mitral valve (STS, 2007). When it opens, the mitral valve allows blood to flow into the left ventricle, which then closes to keep blood from leaking back into the lungs when the ventricle contracts to pump blood into the systemic circulation (STS, 2007). In this case, mitral regurgitation has been diagnosed, which is probably consequential to Mr S’s ischaemic heart disease (Emery and Pearson, 1998). The patient history includes the following: post lateral MI treated with thrombolysis; shortness of breath on exertion; treatment with GTN; hypertensive disease; raised cholesterol; smoker (80-100 cigarettes a day, stopped smoking in 2000); umbilical hernia repair; removal of a benign growth on the thyroid gland; left ankle oedema; distal varicosities to the left extremity. Mr S is allergic to penicillin, overweight at 115kg and has been treated for the health consequences of his lifestyle for some time. Mr S underwent the procedure as planned, with the standard postoperative care. On return to the ward from theatre he was initially on synchronized intermittent mandatory ventilation, which is a system that was developed as a method of partial ventilatory support to facilitate liberation from mechanical ventilation (CCM, 2007). In this system, a demand valve is located within the system through which patients can take spontaneous breaths, without having to breathe through the ventilator apparatus, allowing the patient to breathe spontaneously while also receiving mandatory breaths (CCM, 2007). As the patient’s respiratory function improves, the number of mandatory breaths is decreased, until the patient is breathing unassisted on continuous positive airways pressure (CCM, 2007). Non invasive forms of ventilatory support have been found to be associated with improved patient outcomes (Peter et al, 2002), in a range of acute respiratory conditions including acute respiratory fail ure. Mr S was extubated after ten hours, placed on high flow oxugen via face mask at 50%, but PA02 was only 7 with quiet lung bases on auscultation, leading to the introduction of WCPAP, with a PEEP of 7.5. He was coughing but not expectorating, and developed a number of other postoperative complications which are listed below. His CVP was on 24mmhg and stable within that range. Blood Pressure went down to 80/50 mmHg, treated with gelofusion with no response. noradrenaline was started 07mic/kg/min Frusemide 20mg /hr with good effect; on the second day urine outputtailed off to 60-70ml/hr so the frusemide was increased in 40mg/hr with good effect. Urine output increased to a ratoe of 120-150mls/hr. Mr S has has 3 chest drains: mediastinal, pleural and pericardial . Mr S is ventricularly paced at around 90 beats, with an underlying bradycardia of 44 beats /min. Blood results: urea was 4.4 on the first day, 8.3 day two post-op; creatinene was initially 102, then 164, and on the third day it was 280. Noradrenaline was used, followed by some attempt to wean MR S of this level of support, but the MAP was not stable and could not be kept at 70, and so noradrenaline recommenced. Plans for discharge were postponed due to the WCPAP, the renal complications and the blood pressure issues. Mr S was had an Epidural with plain levopuvicaine at 5mls per hourincreased to 8 mls because of pain on movement; in addition to this he had a PCA (which was being used minimally), and regular Cocodamol. As can be seen, Mr S’s condition is quite serious with a range of complications from the surgery related to his postoperative recovery. Given than cardiac surgery has been performed and there are issues with maintaining blood pressure and cardiac rhythm, the two appear to be connected. Low cardiac output due to arrythmias are of some concern, and so all observations should be closely monitored. The area of concern for this essay, however, is the area of the respiratory complications, but brief mention will be made of the nursing considerations of the other aspects of his condition Nursing care focusing on his pain relief should include regular pain management, assessment of pain scores and sedation levels, and hourly pump checks on the epidural infusion and the PCA. These should be documented contemporaneously and comprehensively, and this information should be used for ongoing care planning, evaluation and communication with colleagues. Monitoring of intravenous infusions should include checking the IV site and cannula for patency or any signs of inflammation, checking that all the infusion lines are connected, and the pumps are set at the correct rate. Fluid balance should be recorded on the appropriate chart at the appropriate hourly intervals. The colour and consistency of the urine should also be noted. Fluid management is important in respiratory disease because excess fluid intake is prone to leak through the capillary membranes into the lung tissues (Peters, 1998). Vital observations should be recorded as specified by the medical and cardiothoracic teams. Pressure area care should be carried out, nutritional status should be monitored, and responses to medications noted. All medications should be administered as charted. Further to this, the chest drains must be observed, insertion sites assessed for signs of infection, and temperature monitored for signs of systemic responses to infection. The drain contents must be included in the fluid balance measurements, and must also be reported to the doctors, and observed for signs of haemorrhage. The drains must be kept off the floor but below the level of insertion of the tubing, to prevent the contents tracking back up towards the body, which would increase the risk of infection. For this reason, if Mr S is moved at any time or repositioned, or during procedures such as bedmaking and attending to hygiene needs, the tubing of all three drains should be clamped for the duration of the activity and then unclamped again afterwards. In addition to this, Mr S appears to need considerable respiratory support. The literature shows that satisfactory oxygenation can generally be achieved in most patients by the use of continuous positive end expiratory pressure (PEEP) using a continuous positive airway pressure (CPAP) mask with a PEEP valve of 5-10 cm of water. However, it has become apparent that Mr S cannot be safely weaned from this as yet. One option to consider would be NPPV, which is a treatment which has evolved from CPAP (Peters, 1998). It has been found to be very effective in providing ventilatory support for patients with respiratory disorders, particularly long term and in the home setting (Peters, 1998). This might be one option which could support Mr S in being discharged from the intensive care facility. Positioning and physical support to maintain this are also important (Peters, 1998). Therefore, Mr S should be nursed upright or semi-upright, well supported by pillows, but giving due consideration to pressure area care. Thorens et al (1995) suggest that the quality of nursing seems to be a measurable and importantfactor in the weaning from mechanical ventilation of patients with chronic obstructive pulmonary disease. While Mr S’s condition is not COPD, many aspects of his symptoms and, obviously, the environment in which he is being nursed, are similar to those described in this study by Thorens et al (1995). They suggest that below a threshold in the available workforce of ICU nurses, the weaning duration of patients from ventilation and other forms of mechanical ventilatory support increases dramatically (Thorens et al, 1995). Therefore, very close attention should be given to the education and number of ICU nurses (THorens et al, 1995), which in this instance could be vie wed from a managerial point of view, in ensuring that the appropriately skilled and experienced nurses are those allocated to the care of Mr S, and that his case should be seen as a priority. Addressing Mr S’s emotional and psychological needs are also important. While it is an extremely invasive and potentially life threatening procedure, coronary artery bypass graft surgery and mitral valve repair surgery are associated with positive patient outcomes(Moshkovitz et al, 1993). This was also an elective rather than an emergency procedure. This may mean that Mr S was not necessarily expecting such a problematic recovery period and so will need support adjusting to this. The same could be said for his family and carers, who would perhaps be somewhat shocked to find him still in a relatively serious condition. The support mechanisms available to him should be assessed, and it should be factored into the nursing care plan that time (often the most precious resource available to nurses) is allocated to him to ensure that he has amply opportunity to communicate with the staff. Communication difficulties may be associated with his condition, state of mind, level of conscio usness and the use of CPAP, and these must be taken into consideration. Wong et al (1999) discuss risk factors of delayed extubation and prolonged intensive care unit length of stay, which suggest that such occurrences are associated with higher levels of morbidity and longer periods of recovery. Whether this is due to the nature of the underlying condition, or the nature of the environment (or both), cannot be determined. However, it would appear that it is in Mr S’s best interests to be facilitated towards a level of wellness along the illness-wellness spectrum that is sufficient to warrant his discharge from the intensive care unit. It might be appropriate to consider different medication regimes, or to allow the physiological systems of his body more time to adjust to his postoperative recovering state. Another potential action might be to remove the epidural and encourage Mr S to use the PCA more appropriately, to support his pain control as a self-managed phenomenon, and to encourage a move towards increased independence, mobility and generally improved health. There is a degree of motor block evident from the epidural. Epidurals are also associated with low blood pressure, so this might be a factor in Mr S’s condition. The epidural would need to be removed under aseptic technique, and a small dressing placed over the site. The tip of the epidural catheter must be checked to make sure it is complete, and this noted in the patient’s records. Close monitoring of the patient’s blood pressure following this might allow the nurse to assess whether this has had a positive effect on Mr S’s blood pressure. Similarly, if Mr S is more mobile and able to move a little more independently, this might increase cardiac output and improve blood pressure. He is at considerable risk of post-operative thrombosis, in particular deep vein thrombosis and pulmonary embolism, and so mobilisation will be a key factor in his recovery and in preventing these complications. Hannan et al (2003) found that post-operative recovery from coronary artery bypass graft surgery can be adversely effected if the patient suffers from 6 or more comorbidities. Given his medical history, it is unsurprising that Mr S finds himself not recovering as quickly as potentially possible, and so it is important to maximise all opportunities to promote recovery and health. The use of low molecular weight heparin as a prophylaxis against deep venous thrombosis and pulmonary embolism is common in post-operative care, and is likely to be used here. However, there is a serious consequence of anti-coagulant therapy, which is the incre ased risk of haemorrhage, and so this again will need to be monitored for very carefully. Stanley et al (2002) suggest that neurocognitive decline is a continuing source of morbidity after cardiac surgery. This may be associated with cardiac arrythmias (Stanley et al, 2002). Mr S’s underlying bradycardia may then be a contributory factor in his long-term prognosis and this is why such intensive cardio-pulmonary support is warranted. Neurocognitive dysfunction is common after coronary artery bypass graft surgery (Stanley et a, 2002), and so assessments of this should form part of the ongoing care and monitoring of his condition. The pacemaker will also be monitored for functionality, and heart rhythm observed. Any changes will be assessed by the cardiothoracic team and any improvements towards normal rhythm noted. It is also important for nurses to consider multidisciplinary team input as a part of interprofessional working and client-centred care. For example, some research has demonstrated that a multidisciplinary approach to weaning from mechanical ventilation has been associated with greatly improved outcomes in the short and long term (Smyrnios et al, 2002). Mr S, given his condition, would be a prime candidate for pulmonary physiotherapy, which has been argued by some to be useful in the recovery process. Given the respiratory assessment findings, this may be used. However, the usefulness of respiratory physiotherapy for the prevention of pulmonary complications after cardiac surgery remains unproved(Pasquina et al, 2003). Therefore it would need to be a collaborative decision in conjunction with the consultant in charge of Mr S’s case. Conclusion This examination of Mr S’s case and history has demonstrated that he is suffering from a number of post operative complications associated with his surgical status, his past medical history and the range of comorbidities he is suffering. The diagnosis of his current condition must remain the area of responsibility of the doctors who are in chargeof his case. However, nursing interventions are a vital component of his care and potential for recovery. While doctors may diagnose and prescribe, it is the nursing staff who assess, monitor, administer therapies, and engage in the majority of prophylactic activities to support optimal return to wellness. This essay has also considered the need for an holistic approach to Mr S, viewing him as a person in the context of his own life rather than simply a set of conditions which much be treated and hopefully, resolved. However, the nature of his condition is serious, and until the cardiac and respiratory function issues are resolved, there is very little that can be done other than to support him and his body systems to continue to function, whilst engaging in nursing activities aimed at minimising further complications from his continued dependent and unwell state. There are a number of actions that can be taken, including pressure area care, fluid management, engagement with the multidisciplinary team, and pain management, all of which can contribute to supportive a positive prognosis for Mr S. However, he continues to require intensive nursing care until such time as he is able to be weaned off the CPAP and the noradrenaline which is helping to maintain the blood pressure. Until that time, all his needs will continue to be met by 24 hour intensive nursing care. References CCM (2007) http://www.ccmtutorials.com/rs/mv/page7.htm Emery, C. and Pearson, S. (1998) Managing coronary artery disease. In: Shuldham, C. (1998) Cardiorespiratory Nursing Cheltenham: Stanley Thornes. Hannan, E.L., Racz, M.J., Walford, G. et al (2003) Predictors of Readmission for Complications of Coronary Artery Bypass Graft Surgery JAMA. 290 773-780. Moschovitz, Y., Lusky, A. and Mohr, R. (1995) Coronary artery bypass without cardiopulmonary bypass: analysis of short-term and mid-term outcome in 220 patients. Thoracic and Cardiovascular Surgery 110:979-987. Pasquina, P., Tramer, M.R. and Walder, B. (2003) Prophylactic respiratory physiotherapy after cardiac surgery: systematic review British Medical Journal 327:1379 Peter, J.V., Moran, J.L., Phillips-Hughes, J. and Warn, D. (2002) Noninvasive ventilation in acute respiratory failure- A meta-analysis update. Critical Care Medicine. 30(3) 555-562. Peters: R. (1998) Respiratory failure: Adult Respiratory Distress Syndrome In: Shuldham, C. (1998) Cardiorespiratory Nursing Cheltenham: Stanley Thornes. Shuldham, C. (1998) Cardiorespiratory Nursing Cheltenham: Stanley Thornes. Smyrnios, N.A., Connolly, A., Wilson, M.M. et al (2002) Effects of a multifaceted, multidisciplinary, hospital-wide quality improvement program on weaning from mechanical ventilation. Critical Care Medicine. 30(6) 1224-1230. Stanley, T.O., Mackensen, G.B., Brocott, H.P. et al (2002) The Impact of Postoperative Atrial Fibrillation on Neurocognitive Outcome After Coronary Artery Bypass Graft Surgery. Anesthesia and Analgesia 94 290-295. STS (2007) http://www.sts.org/doc/410 Accessed 28-6-07 Thorens, J.B., Kaelin, R.M., Rainer, M. et al (1995) Influence of the quality of nursing on the duration of weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease. Critical Care Medicine. 23(11) 1807-1815. UHC (2007) http://healthcare.utah.edu/healthinfo/adult/cardiac/glossary.htm Accessed 28-6-07 Wong, D.T., Davy, C., Kustra, R. et al (1999) Risk Factors of Delayed Extubation, Prolonged Length of Stay in the Intensive Care Unit, and Mortality in Patients Undergoing Coronary Artery Bypass Graft with Fast-track Cardiac Anesthesia: A New Cardiac Risk Score. Anesthesiology. 91(4) 936. Woods, S.L, Froelicher, E.S.S. and Motzer, S.U. (2000) Cardiac Nursing Philadelphia: Lippincott.

Indian Suffrage Essay examples -- essays research papers

Indian Suffrage   Ã‚  Ã‚  Ã‚  Ã‚  Before the English arrived in the New world and began creating colonies, the American Indians lived in harmony and peace with natures. The American Indians were skilled hunters, farmers and used everything in their environment for survival or for essential necessities. They shared the land together and moved about freely in search of food. The American Indians never considered the lands their property because it's belong to God and no one have the right to buy, sell, nor own it. However, Europeans has an opposite view of Indians beliefs, cultures, and use of lands. They viewed Indians as children, savage- uncivilized people in need of their protection and salvation (Carroll and Noble: 30). Therefore, they felt it is their responsibility to civilize the Indian and put their lands into good uses. Hence, American Indians suffrages and nightmares began. The impact of American expansion has turned upon the Indians and confronted them with social and economic crises never before experienced. As a result, many tribes torn apart, in many cases extinct, and their identity was lost. Indians also lost their original lands as a result of direct and indirect contact with the Europeans. The whites wanted more lands for their developments, and because of this greed, they created direct policies to clear the Indians off their lands. For example, one form of direct policy that the whites used to rob Indians of their lands was by signing treaties. Then later the whites broke these treaties and forced Indian off their lands by the Removal policy and claimed the lands as their property (Lowy: Lecture 11/96). There were many indirect methods that white used to rob Indians' lands. They use bribery, threats, and among countless other things to trick Indians into giving up their lands. They were often tricked into signing the land cession treaties that they did not understand the negotiation and the language (Lowy: Lecture 11/6).   Ã‚  Ã‚  Ã‚  Ã‚  In many ways, the United States policy toward Indian has been schizophrenic because the laws never completely nor attempted to give Indians an opportunity to progress and assimilate into American mainstream as an individual. From time to time, whites creates many policies, such as the reservation, relocation, and termination in an effort to assimilate the Indians into the Americ... ...using their own lands, while the whites over exploited the lands for profits. Whites also passed laws restricting Indians trading opportunities. Also, Indians lives were greatly affected by the extermination of buffalo. Yet, while Indians dependent greatly on buffalo for their main source of food, clothing, and many inedible by-products, the white destroyed them in massive number as hunting sport. A final form, cultural genocide, it explains how Indians' languages, religions, values, and cultures was lost or drastically swapped.   Ã‚  Ã‚  Ã‚  Ã‚  Thanks to the Red Power Movement and many other Indians movements, their efforts have strengthened the prospects for Indian self-determination in the political, economic, education and religious realm. They have helped to make Indian people more visible to the whites and whites began to realize that Indian was our first and natural citizen. However, the government in particular, owns it to the Indians to give them an opportunity to be a full participant in economic, political, and education. They need to put into practice and to bring to fruition some of the reforms and treaties with the American Indians that are long overdue.

Armstrong Helmet Company Essay

Armstrong Helmet Company manufactures a unique model of bicycle helmet. The company began operations December 1, 2013. Its accountant quit the second week of operations, and the company is searching for a replacement. The company has decided to test the knowledge and ability of all candidates interviewing for the position. Each candidate will be provided with the information below and then asked to prepare a series of reports, schedules, budgets, and recommendations based on that information. The information provided to each candidate is as follows. Cost Items and Account Balances $ Administrative salaries 15,500 Advertising for helmets 11,000 Cash , December 1 0 Depreciation – Factory Building 1,500 Depreciation – Office Equipment 800 Insurance – Factory Building 1,500 Miscellaneous expenses – Factory 1,000 Office supplies expense 300 Professional Fees 500 Property Taxes – Factory Building 400 Raw material used 70,000 Rent on production equipment 6,000 Research & development 10,000 Sales commission 40,000 Utility Costs – Factory 900 Wages – Factory 70,000 Work in process – Dec 1 0 Work in process – Dec 31 0 Raw materials inventory, Dec 1 0 Raw materials inventory, Dec 31 0 Raw materials purchases 70,000 Finished goods inventory, Dec 1 0 Production and Sales Data Number of helmets produced 10,000 Expected sales in units for December ($40 unit sales price) 8,000 Expected sales in units for January 10,000 Desired ending inventory 20% of next month’s sales Direct materials per finished unit 1 kilogram Direct materials cost $7 per kilogram Direct labour hours per unit .35 Direct labor hourly rate $20Cash Flow Data Cash collections from customers: 75% in month of sale and 25% the following month. Cash payments to suppliers: 75% in month of purchase and 25% the following month. Income tax rate: 45% Cost of proposed production equipment: $720,000 Manufacturing overhead and selling and administrative costs are paid as incurred. Desired ending cash balance: $30,000 Required: Using the data presented, do the following in your respective groups. 1) Classify the costs as either product costs or period costs using a five-column table as shown below. Enter the dollar amount of each cost in the appropriate column and total each classification. Product Costs Item Direct Materials Direct Labour Manufacturing Overhead Period Costs 2) Classify the costs as either variable or fixed costs. Assume there are no mixed costs. Enter the dollar amount of each cost in the appropriate column and total each classification. Use the format shown below. Use the format shown below. Assume that ‘Utility Costs – Factory’ are a fixed cost. Item Variable Costs Fixed Costs Total Costs 3) Prepare a schedule of cost of goods manufactured for the month of December, 2013. 4) Determine the cost of producing a helmet. 5) Identify the type of cost accounting system that Armstrong Helmet Company is probably using this time. Explain. 6) Under what circumstances might Armstrong use a different cost accounting system? 7) Compute the unit variable cost for a helmet. 8) Compute the unit contribution margin and the contribution margin ratio. 9) Calculate the break-even point in units and in sales dollars. 10) Prepare the following budgets for the month of December, 2013. a. Sales b. Production c. Direct materials d. Direct labour e. Selling and administrative expenses f. Cashg. Budgeted income statement 11) Prepare a flexible budget for manufacturing costs for activity levels between 8,000 and 10,000 units, in 1,000-unit increments.QUESTION 2 INCREMENTAL ANALYSIS (20 MARKS) Navula Company is considering the purchase of new equipment to replace the existing equipment it currently has. Details of the new equipment are tabulated below: Invoice Price $140,000 Freight Charges $ 4,000 Installation Costs $6,000 Expected useful life 5 years Salvage value 0 The new equipment is faster than the old equipment, and it is more efficient in its usage of materials. Existing equipment could be retained and used for an additional 5 years if the new equipment is not purchased and by that time the salvage value of the equipment would be zero. However, if the new equipment is purchased now, the existing machine would have to be scrapped. The current book value of the existing machine is $36,000 and the company uses the straight-line depreciation method. Navula Company’s accountant has accumulated the following data below regarding annual sales and expenses with and without the new equipment. DETAILS OLD EQUIPMENT NEW EQUIPMENT Production & Sale Output 12 000 units Increase by 10% Selling Price $100 $100 Gross Profit Rate 25% of sales 30% of sales Annual Selling Expenses $180,000 Increase by 10% Annual Administrative Expenses $100,00