Mark and his Attacking Janet Essay Example | Topics and Well Written Essays - 500 words

Mark and his Attacking Janet - Essay Example For Mark, there are several laws that can be used to give advice to him. As by law, he can remain silent and not disclose his whereabouts during the night Janet was attacked. Silence is instructed by Criminal Procedure and Investigations Act 1996 and CJPOA 1994 s.34 and 37. The right to silence is given to Mark, through this law. The Right to Silence indicates that the accused does not have to answer questions during trial and hearing or before it in order to avoid self-incrimination.As by law, he can remain silent and not disclose his whereabouts during the night Janet was attacked. Silence is instructed by Criminal Procedure and Investigations Act 1996 and CJPOA 1994 s.34 and 37. The right to silence is given to Mark, through this law. The Right to Silence indicates that the accused does not have to answer questions during trial and hearing or before it in order to avoid self-incrimination. â€Å"[†¦] it is not the compulsion to answer questions which creates the breach of Art. 6, but the subsequent use of the evidence so obtained. In any event, for the most part, a suspect cannot be prosecuted for refusing to answer questions.† (KeyZone, Public Law). â€Å"(d) to examine or have examined witnesses against him and to obtain the attendance and examination of witnesses on his behalf under the same conditions as witnesses against him† (European Convention on Human Rights) This means that Mark has the right to cross-examine the witnesses that are testifying against him for the attack on Janet.

Assess the impact of Byzantine and Sassanian cultures on Umayyad Essay

Assess the impact of Byzantine and Sassanian cultures on Umayyad secular architecture and its decoration, with reference to spec - Essay Example Previous to the ascend of the Islam culture in the earliest ADS- 5th and 6th Centuries- the persons, according to Blair & Bloom (2009) who lived in the Arab peninsula, had a main responsibility in shaping the present day Islam art. The then inhabitants of the Arab peninsula are comprehensive of the Byzantine in the Northwest whilst the Sassanian Empire was situated in the North East (Blair & Bloom, 2009). This paper shall evaluate the surfacing of the Islam world in relation to the Sassanian and Byzantine Empires, via an examination of the then cultures, the adjustments and adoption of the same to the Islam world. The paper shall also attempt to give clear instances such as Qusayr Al-Hayr East, Khirbat Al Mafjar, and Qusayr Amra amongst others. 2.0. The Byzantine Empire This empire as seen in the thoughts compiled by Ekhtiar (2011) was born out of the Roman Empire, and had Constantinople as its midpoint. The empire comprised of the Balkans - Palestine, Syrians, Egyptians, and Asia mi nors- and had Christianity as its major faith (Blair & Bloom, 2009). Nevertheless, the empire was also open to a Jewish population and other Christian sects. In relation to art, the empire has strong Roman roots that saw the empire have a great influence from pagan classical inheritance (Blair & Bloom, 2009). ... The then emperor, Justinian reconstructed the city of Antioch at Syria by dividing it into streets, by constructing sewers, fountains, and water channels (Ekhtiar, 2011). At the same time, the emperor built baths, theaters and other buildings to a great city (Ekhtiar, 2011). However, with time the city faced frequent tests ranging from inadequate funds to develop the city, but one would argue that the broad avenues and ‘modern’ buildings replaced the classical monuments and the general lifestyle of the town life (Blair & Bloom, 2009). On the other hand, Ekhtiar (2011) indicates that the Sassanian Empire was also developing gradually to urban civilization. 3.0. The Sassanian Empire Founded in the 208-40 AD by Ardashir, the empire became Rome Byzantine’s empire major challenger (Irwin, 1997). The empire stretches to the Far East from the Indus and Oxis rivers, and had had numerous conflicts with the Byzantine at the time of Justinian rule (Irwin, 1997). In the compi lation of Irwin (1997), the empire is said to practice the Zoroaster faith, though the Manichaenism was gaining root in the territory as well which used paintings to explain its message as seen in the Islam art, by its founder Mani (Irwin, 1997). The Sassanian is said to have a huge relationship with the Byzantine architecture, an explanation of the type of drinking cups used by the Sassanian portray a huge percentage of Dionysian imagery (Irwin, 1997).The Sassanian also used the scrolling vine from the Byzantine art, and the same is replicated in the then Islamic culture. The Sassanians are also indicated to have their motifs as the peacock, the winged crown and the palm that were

Nuclear proliferation Essay Example | Topics and Well Written Essays - 2000 words

Nuclear proliferation - Essay Example Since campaigning for office, Barack Obama has frequently mentioned that, â€Å"in an ideal world, there would be no nuclear weapons†. The main goal of this essay is to evaluate this and explain why I agree or disagree with it.What I will argue is that the possession of nuclear weapons has in fact deterred and stopped a nuclear war. In fact, nuclear proliferation does not increase the risk of war, it prevents it. Based on what I will argue there is, even more, chance of a major war between states if there are no nuclear weapons.In the first section of this essay, I will analyze the theories that relate to this argument of further spread of nuclear weapons. To do that I will look into Kenneth Waltz’s theory of neo-realism and his thought on nuclear proliferation. I will also look into the theories like security dilemma, Mutual assured destruction and nuclear deterrence. In the second section I will analyse these theories in relation to the theoretical background. After t hat I will give my concluding remarks. The reference in this essay are in a Chicago style, both in the bibliography and footnotes.Neo-realism or structural realism is a theory which places emphasis on that ideology that the international system is anarchic. What is meant by this is that there is no higher government or an international police. The result of this is that states constantly try to increase their security and that is done with more power. The theory assumes that statesmen think and act in terms of self-interest defined as power.

How to Play Texas Holdem Essay Example for Free

How to Play Texas Holdem Essay As a hobby for my spare time, I play poker. Texas Hold’em to be precise a game of skill, chance, and luck. This game can be a compotation, or just a way to have some fun with some friends. There are many different places to play holdem you can play at home, city leagues, or at the casino. Here are some basic rule and tips to playing the game; The game starts out by selecting a dealer, either by draw or setting posion. Once the dealer is picked and the cards are shuffled, and ready to start the deal. The two players to the left of the dealer put out blind bets. The first person to the left is the small blind while the second person from the dealer is the big blind. Every player is dealt two cards, face down. These cards are called hole or pocket cards. The first move, or action, falls on the player to the left of the big blind. This person can call the big blind, raise it or fold. This process continues around the table, clockwise. After the betting is completed, one card is placed face down this is called the burn card, three cards are then dealt face up in the center of the table, which is called the board. The first three cards in Texas Holdem are called the flop. These cards â€Å"community cards† meaning everyone can (and will) use them in combination with their own hole cards to make the best hand. From the flop on, betting begins with the player to the left of the dealer, who can check or bet. A forth card is dealt face up after the burn, is placed on the board. This is called the turn card. Another round of betting. A final card is dealt face up. This card is called fifth street or the river. A final round of betting occurs. The remaining players show their cards and the person who make the best five cards hand by combining their pocket cards with the cards on the board wins. In some rare cases in Texas Hold’em, the five cards on the board will actually be the best hand, in which case everyone left in the hand divides up the pot. Now you know how to play and all the Texas Hold’em rules. Have fun.

Comparison of Normal Saline and Heparin Flush

Comparison of Normal Saline and Heparin Flush Review of literature is an essential component of the research process. It aids the researcher in the formulation of the research plan or proposal and condition of the study. It aids in relating the outcomes of the study to the findings of other investigations Review of literature is defined as a critical summary of research on a topic of interest, often prepared to put a research problem in contest (Polit and Beck, 2006). The current study and review of various associated literature and review study, topics can divide as follows; Section A: Literature related to comparison of normal saline and heparin flush  to maintain the patency of intravenous line. Section B: Literature related to cost effectiveness of normal saline flush in  maintenance of peripheral intravenous catheter. Section C: Literature related to complications of using heparin solution for  maintaining patency. Section A: Literature Related to Comparison of Normal Saline and Heparin Flush to Maintain the Patency of Intravenous Line. Elsevier (2009) did a randomized double blind controlled trial to investigate the efficacy of normal saline versus heparin saline in maintaining the patency of intravenous catheter among 150 children of pediatric unit at United States. In that, Group I received normal saline flush (n=77) whereas Group II received heparin saline flush (n=73). The result showed that 72% of children were recovered from blockage during normal saline flush. Thus researcher concluded that the normal saline flush was effective in maintaining the patency of intravenous catheter. Klieiber (2008) conducted prospective, randomized double blind study to determine the efficacy of saline versus heparin flush to maintain the peripheral intravenous lock in pediatric populations among 140 children. The sample was selected randomly into two groups. Group I received normal saline flush whereas Group II children flushed with heparinized saline. The findings revealed that there was no significant difference between the groups in maintaining the patency of catheter and reduces incidence of complications. A randomized controlled double-blind trial was conducted by Esther Mok, Tany KWong (2007) for maintaining peripheral intravenous lock among 123 children of age from one to ten years. The objective of this study was to evaluate the effectiveness and safety of three flush solutions: normal saline, one unit/ml of heparin saline and ten units/ml of heparin saline for maintaining peripheral intravenous locks in children, and to establish a research-based practice in the study hospital. Group I received one unit/ml of heparin saline, Group II received ten units/ml of heparin saline and Group III received normal saline. The group that received one ml of normal saline demonstrated the highest rate of survival and the mean length of catheter showed (49.8 hours) was seventeen hours longer than the group that received one unit/ml of heparin saline (32.5 hours). The result showed that there was no significant difference among the three types of flushing solution in terms of the catheter longevi ty and incidence of intravenous complications. A study was conducted by Visanu Thamlikitkul Artit Indranoi (2006) on switching from heparinized saline flush to normal saline flush for maintaining peripheral venous catheter patency in the patients hospitalized to medical ward at Sir raj Hospital, Thailand. The study sites were ten medical wards containing two hundred and forty beds. Group I received heparinized saline as a flushing agent whereas Group II received normal saline as a flushing agent. The information on using flush fluids was collected from the physicians order sheets in the medical records at baseline, every two to four weeks during the intervention periods, and at six months after launching intervention. The results showed that the children received heparinized saline flush in February 2005, switched on to a practice with normal saline flush in June and November 2005. Hence the researcher concluded that normal saline was effective and implemented as evidence based clinical practice. Janet Pettit (2003) performed a randomized double blind study to identify the efficacy of saline versus heparin flush to maintain the peripheral intravenous lock in pediatric populations among 124 infants over twenty eight days of age in pediatric ICU at Doctors Medical Centre, Modeto. The findings revealed that saline flush had longer period of patency. Thus the researcher concluded that saline was efficacious and safest flush in maintaining the peripheral intravenous catheter. Nelson (2002) conducted a randomized double blind study to assess the use of 0.9% normal saline flush with or without heparin for maintaining peripheral indwelling intermittent infusion devices among fifty eight children up to one year with twenty four gauge needle. Group I received ten units per ml of heparin solution (n=26) and Group II received 0.9% normal saline flush (n=32). The result showed that there was no significance between 0.9% normal saline flush with or without heparin solutions in maintaining patency of twenty four gauge peripheral intermittent intravenous devices in children younger than one year. Schultz, Drew Hewitt (2002) investigated a randomized double blind study on comparison of normal saline and heparinized saline flushes for patency of intravenous locks among forty nine neonates at Maine Medical Center, Portland. The objective of the study was to determine the efficacy of patency of intravenous locks maintained with normal saline solution compared with heparinized saline solution. Group I received 0.5 ml of heparinized saline flush containing two units/ml of heparin (n=20) whereas Group II received 0.5 ml of normal saline flush (n=29). There were no significant difference (p =0.841) between mean scores for heparin flushed catheters (M = 41.5 hours, SD = 44.0) and saline-flushed catheters (M = 30.4 hours, SD = 20.8). The researcher concluded that catheter failure was significantly longer for catheters flushed with heparinized saline compared with those flushed with normal saline. A study was conducted by Harahan Berends (2000) to evaluate the efficacy of saline versus ten units/ml heparin for peripheral intravenous flushes among 240 neonates of Special Care Nurseries at a Level III Large Mid Western University Teaching Hospital. Here an experimental group design was used to compare the longevity of heparin and saline intravenous locks. Data were collected from a convenient sampling technique. Group I received ten units per ml of heparin (n=123) whereas Group II received preservative-free normal saline solution (n=117). The result showed that there was no significant statistical difference in intravenous catheter longevity between intravenous locks flushed with ten units/ml heparin and those flushed with normal saline. Krista Brown, Tay-Uyboco Douglas McMillan (1999) did a randomized controlled trial to determine the relative efficacy and safety of peripheral intravenous locks maintained with heparin saline solutions compared with those maintained with normal saline among 186 neonates at Foot Hills Hospital, Calgary, Alberta. Group I received normal saline (n=93) whereas Group II received heparin saline (n=93). Patients were chosen to receive either heparinized saline with five units/ml or 0.3 ml of normal saline, in the intravenous catheter every six hourly, administered by nursing staff in a blinded manner. The result showed that there was no difference in catheter lifespan (39 ±24 hour for the heparinized saline group; 34 ±22 hour for the normal saline group) and no difference in the number of intravenous catheters per patient (1.9 heparinized group, 1.6 normal saline group). The researcher concluded that there was no difference between heparinized normal saline and normal saline flush in neonates in maintaining the patency of twenty four gauge peripheral intravenous locks. Heilskov, Kleiber Johnson (1998) did a randomized double blind controlled 3-arm trial of heparin and saline for maintaining intravenous locks among ninety neonates at University of Iowa Hospitals and Clinics, USA. The purpose of this study was to determine the effects of saline, heparin two units (U) per ml saline, and heparin ten units per ml saline flush solutions on the duration of intravenous locks and the incidence of intravenous infiltration in neonates. Group I received heparin two units/ml saline (n=27), Group II received heparin ten units/ml saline flush (n=28) and Group III received normal saline (n=25). Catheter flushed at least every six hourly. The outcome measures total hours from the time the intravenous was inserted to the time the intravenous was removed; hours from the time the intravenous was first flushed to the time the intravenous was removed; number of intravenous removed because of infiltration. The result showed that there was no statistical or clinical dif ference between the three groups for duration of intravenous therapy or for incidence of complications. Bridget Mudge, Dion Forcsier Mary Jo Slattery (1998) conducted a comparative study on heparin and saline flush solutions regarding patency of 24-gauge peripheral intermittent infusion devices. A prospective, non-randomized, sequential, blinded study design was conducted on a pediatric and a neonatal were similar for age, peripheral intermittent intravenous devices (PIID) placement site, irritating substances infused, and initial IV function. The median duration of catheters flushed with normal saline was 42 hours and with heparin was 35.3 hours. Kaplan-Meier Survival Analysis indicated that the duration of catheters flushed with saline was significantly longer than those flushed with heparin (p = .02). More catheters flushed with heparin were removed because of problems (p = .027). Results of this study suggested that normal saline was more effective than heparin in maintaining the patency of small, 24-gauge catheter. Kotter (1996) conducted a randomized double blind study on heparin versus saline to maintain the patency of intermittent intravenous device maintenance among fifty one neonates including premature neonates, less than one month of age admitted to a Level II Neonatal Intensive Care Unit. Group I received ten units/ml heparin (n=27), whereas Group II received normal saline flush (n=24). Catheter was flushed every fourth hourly with heparin or normal saline solutions. The researcher concluded that there was no statistically significant difference in average duration of patency between normal saline-flushed catheters and heparinized saline-flushed catheters. Phlebitis, occlusion, infiltration, and leaking occurred with equal frequency for both solutions. Kulkarni, Elsner, Ouellet Zeldin (1994) investigated a randomized double blind study on heparinized saline versus normal saline in maintaining patency of the radial artery catheter among seventy eight adults in the surgical intensive care unit of Toronto East General Orthopedic Hospital. The objective of the study was to compare the ability of normal saline versus heparinized saline infusion to maintain patency of the radial artery catheter used for monitoring blood pressure or multiple blood sampling. Group I (n=40) patients those who were admitted on odd numbered dates received heparinized saline two units per ml and Group II (n=38) admitted on even dates received normal saline, both as continuous flush solutions. At 96 hours of cannulation, 92% of the catheters in the heparinized saline group were patent compared with 74% in the normal saline group. The result showed that there was no significant difference between flushing with normal saline and heparinized saline in the mainte nance of radial arterial line patency. A comparative randomized controlled trial was conducted by Robertson (1994) on the intermittent intravenous therapy to determine whether heparinized saline solution was a superior flushing agent to normal saline among152 children between the ages of two months to eighteen years. Group I were allocated with heparinized saline as a flushing agent, and Group II were allocated with normal saline as a flushing agent. Each day intravenous sites were examined for signs of phlebitis and on removal of each cannula was flushed to check for fibrin. On Chi-square testing, highly significant associations emerged between the incidence of phlebitis and the use of the intravenous antibiotics such as Tobramycin (p=0.05) andor Timentin (p=0.008). Young children were found to have a significantly higher incidence of blocked cannulae regardless of the flushing solution used. The researcher concluded that there was no significant difference detected in either the duration of intravenous therapy, the pate ncy of the intravenous line or the incidence of phlebitis when normal saline was used to flush the intravenous cannula. Kleiber, Harahan, Fagan Zittergruen (1993) conducted a double-blind study to determine the efficacy of saline versus heparin flush solution to maintain peripheral intravenous locks in a pediatric population among 124 infants over twenty eight days of age. Group I received normal saline as a flushing agent, whereas Group II received normal saline with heparin as a flushing agent. The result revealed that the heparin and saline groups were comparable for total hour duration of the intravenous and for incidence of complications. Hence the researcher concluded that saline was efficacious in maintaining patency of intermittent intravenous peripheral intravenous locks in children. A comparative study was conducted by Rob, Kelly Trish (1992) on normal saline or heparinized saline flushing on function of arterial lines among sixty-five patients in most New Zealand intensive care units. Group I received normal saline (n=35) where as Group II received three ml/hour as a continuous flush. The scores for the intravascular line for each patient were summed, and the percentage of the total possible score was calculated. Mean study duration was 5.8 and 6.6 days for the normal saline and heparinized saline groups, respectively. Mean percentage scores were 83% with normal saline group and 82% with heparinized saline group. The statistical findings showed that there was no difference between the groups at 95% confidence interval. Thus researcher concluded that heparin as a continuous flush at three units/hour does not improve the function of arterial lines compared with a continuous normal-saline flush. A quasi-experimental study was conducted by Tuten Gueldner (1991) on the efficacy of normal saline versus diluted heparin for maintaining the patency of peripheral intermittent intravenous devices in hospitalized medical-surgical patients among seventy seven children. Group I received normal saline solution, whereas Group II received diluted heparin. The statistical findings revealed that there were no incidence of site loss due to coagulation in either group, moreover no significant difference in the incidence of site loss associated with phlebitis (p=0.708) or infiltration (p=0.910). The researcher concluded that normal saline may be an effective alternative to heparin, for maintaining the patency of peripheral intermittent intravenous devices. Ashton, Gibson Summers (1990) conducted a randomized double-blind study on the effects of heparin versus saline solution on intermittent infusion device irrigation at Shawnee Mission Medical Center among thirty two patients. The purpose of this study was to compare the effectiveness of one ml of 0.9% normal saline with ten units of heparin in one ml normal saline solution, in maintaining patency and reducing the incidence of phlebitis in patients with intermittent infusion devices. The statistical findings revealed that there was no significant difference between the groups in phlebitis or patency variables. The researcher suggested that 0.9% normal saline was as effective as ten units per ml of heparin in normal saline solution in maintaining intermittent infusion device patency and preventing phlebitis. Hamilton, Plis, Clay Sylvan (1988) conducted a randomized double-blind study on heparin saline versus 0.9% normal saline injection for maintaining patency of indwelling intermittent infusion devices in the Department of Pharmacy practice, Albany College among 307 adult patients. Group I received one ml of heparin saline as a flushing solution (n=170), whereas Group II received 0.9% normal saline flush solution (n=137). The result revealed that heparin offers no advantage over 0.9% normal saline injection in maintaining the patency of intermittent intravenous devices. The researcher concluded that there was no significant difference in the duration of catheter patency or incidence of phlebitis was observed between the groups. Epperson (1984) did a randomized study on the efficacy of 0.9% normal saline with and without heparin for maintaining indwelling intermittent injection sites in the medical and surgical units of an acute-care hospital among 412 patients. Three different solutions were used to flush intravenous catheters. Group I were flushed with 0.9% normal saline alone, Group II were flushed with heparin 10 units/ml in 0.9% normal saline and group III were flushed with heparin 100 units/ml in 0.9% normal saline. Heparin locks were flushed after each medication administration and every eight hours when medications were not being given. Using a standardized evaluation form, one of five intravenous therapists evaluated each site daily for the presence of phlebitis and loss of patency. Length of catheter placement and the percentage of patient days during which patients received cephalosporin and penicillin antibiotics were examined for each group. Rates of site loss caused by phlebitis or loss of pate ncy were compared in each group. The result showed that there was no significant differences were found among the three groups in the mean duration of heparin-lock placement, the percentage of patient days during which antibiotics were prescribed, or the rate of site loss caused by phlebitis or loss of patency. Section B: Literature Related to Cost Effectiveness of Normal Saline in Maintenance of Peripheral Intravenous Catheter. Hephzibah Alexander (International Journal for the Advancement of Science Arts, 2010) conducted a systematic review of the study on heparin versus normal saline as a flush solution. The electronic database of Ovid, Pub-Med, the Cochrane Library and the Cochrane Database of Systematic Reviews (CDSR) was searched for heparin or normal saline (either singly or in combinations). Relevant studies were critically appraised and evidence obtained was graded according to the modified Catalan Agency for Health Technology Assessment scale (CAHTA). In terms of safety, the findings indicate that it might be safer to use normal saline as it does not have the risks associated with heparin. Cost analysis studies proved that without any doubt the use of normal saline flush results in a significant amount of cost savings. For arterial catheters, majority of the available data suggest that heparin saline given as a continuous flush at low doses improved catheter patency. The result of the study reveal ed that normal saline should be used as an alternative to heparin in intravenous catheters. Low-dose heparin with 0.25 units per ml normal saline should be added to the infuscate to maintain patency of arterial catheters. The researcher concluded that heparin as an intermittent flush was ineffective and normal saline was just as effective as and more efficacious than heparin. Karen Le Duce (1997) investigated a prospective, randomized, double blind controlled trial on the efficacy of normal saline solution versus heparin solution for maintaining patency of peripheral intravenous catheters in children at the emergency department of childrens hospital, USA among 150 children. The purpose of this study was to establish the effects of heparin flush and saline solution flush solutions in maintaining patency of infusion devices in the pediatric population, and to establish cost-saving implications related to normal saline solution versus heparin flush for PIIDs in terms of pharmacy costs and costs related to nursing time to both procedures. Group I (n = 77) received 3 ml of a ten units heparin/ml normal saline solution intravenous flush whereas Group II (n = 73) received three ml of normal saline solution for the intravenous flush. Descriptive and correlation statistics were used to analyze the data. The result showed that there were no significant differences between the two groups for demographics or complications. Annual cost savings were computed with an estimated annual savings of nursing time and unit cost of solutions equaling $27,594. The researcher concluded that the normal saline solution should be used as an alternative to heparin solutions for the maintenance of peripheral intravenous devices. Jerri Shoaf Sandra Oliver (1997) did a study on the efficacy of normal saline with and without heparin for maintaining intermittent intravenous site in the coronary care unit of Scott and White Memorial Hospital among two hundred and sixty surgical patients. Group I received normal saline with heparin as a flushing agent, whereas Group II received normal saline without heparin as a flushing agent. The researcher concluded that heparinized saline was not needed to maintain the patency of an intermittent intravenous site, and the use of saline solution alone was less irritating, causes less occurrence of phlebitis, less expensive to patients, and saves nursing time. A randomized comparative study conducted by Paisley et al (1997) on the use of heparin and normal saline flushes in neonatal intravenous catheters among eighty seven preterm and term infants ranging from 33 weeks to 44 weeks of gestation in the University of Missouri-Columbia Childrens Hospital. Data were collected between February 1994 and March 1995. The majority of infants were thirty eight to forty weeks gestation (M = 38.46 weeks, S.D. = 2.48). Group I (n=33) infants received 0.6 ml of heparin solution containing 10 units/ml of heparin and Group II (n=54) received 0.6 ml of normal saline as flushing agent. The frequency of flush was 0.6 ml flush every fourth hourly. The researcher concluded that the normal saline was much cheaper than heparin. Nursing time was saved using a single solution and physician spends time in writing order was saved by standing orders. If only normal saline was used, the chance for error, over dosage, heparin-associated drug incompatibilities and hepari n induced thrombocytopenia would be eliminated. Section C: Literature Related To Complications Of Using Heparin Solution For Maintaining Patency. Mitchell et al (2009) conducted a study on a systematic review of heparin flushing and other interventions to maintain patency of central venous catheters. The objective of this study was to assess clinical studies comparing the effectiveness of different means of maintaining central venous catheter patency. A search was conducted using the MEDLINE, CINAHL, EMBASE, Cochrane, National Guideline Clearinghouse and University Health System Consortium databases. The method was a systematic review of effectiveness using grade criteria to assess the strength of evidence for each intervention. Flushing with heparin was a routine part of central venous catheter maintenance, but it presents risk, including heparin-induced thrombocytopenia. Other techniques used to prevent occlusion of catheters include saline flushes, heparin-bonded catheters and pressure caps. The result showed that flushing catheters with saline solution was more effective than flushing with heparin. A study was conducted by Stephens et al (1997) on normal saline versus heparin flush for maintaining central venous catheter patency during aphaeresis collection of peripheral blood stem cells (PBSCS) among seventy eight cancer patients. The purpose of this study was to examine the incidence of thrombotic occlusions in central venous catheters using heparin compared to saline flushing. Group I (n=29) received saline flushes and Group II (n=49) received heparin with 100 units per ml of saline flushes. Numerous studies comparing heparin to saline flushing in peripheral devices suggested equal rates of thrombotic occlusions. The outcome of the study suggested that serious complications including drug interactions and heparin induced thrombocytopenia and thrombosis syndrome in association with heparin flushing. The researcher concluded that saline was as effective as heparin for maintaining patency of central venous catheters. Triolo, Pamela Goode (1991) conducted a study on meta-analysis to estimate the effects of heparin flush and saline flush solutions on maintaining patency, preventing phlebitis, and increasing duration in peripheral heparin locks. The researcher concluded that saline was as effective as heparin in maintaining patency, preventing phlebitis, and increasing duration in peripheral intravenous locks. Quality of care can be enhanced by using saline as the flush solution, thereby eliminating problems associated with anticoagulant effects and drug incompatibilities. In addition, an estimated yearly savings of $109,100,000 to $218,200,000 U.S. health care dollars could be attained. Barrett Lester (1990) did a double-blinded, cross-over study on heparin versus saline flushing solutions for a period of two months in a small community hospital at Aroostook Medical Centre, Presque Isle. Floor nurses were used as observers and observe catheter failures, as either loss of patency or phlebitis. Data revealed a statistically significant advantage to using saline flushes when both loss of patency and phlebitis were combined (p

The Stranger (The Outsider), Nausea, and Death on the Installment Plan :: comparison compare contrast essays

The Stranger (The Outsider), Nausea, and Death on the Installment Plan      Ã‚  Ã‚  Ã‚   The Stranger, by Albert Camus, Nausea, by Jean-Paul Sartre, and Death on the Installment Plan, by Louis-Ferdinand Celine, all contrast themselves with internal texts that fail to represent the world competently. The Stranger includes the prosecutor's narrative of the murders as an incompetent text by refusing to support the motives he assigns. It contrasts itself with the prosecutor's narrative in view of the excessive language of the prosecutor versus the simple reporting of Meursault. The Stranger similarly positions comments by Marie and Raymond as incompetent by contrasting their pity with the text's own view that no event is truly pitiable. Nausea positions a text by Balzac as incompetent because it assigns cause to events by using psychology and past time. The novel includes paintings of a wayward bachelor and bourgeois grandfather as incompetent texts. Nausea also positions the Self-Taught Man's description of adventure as incompetent by arguing t hat adventure is a social construct. Death on the Installment Plan marks an effusive letter to Courtial as incompetent, in contrast with Ferdinand's stance of reporting. It also positions Courtial's pamphlets promoting an outdoor education as incompetent by showing that they misrepresent Courtial's intentions and ability. Death also uses Auguste's letter to Ferdinand as an attempt to bend Ferdinand to the values of the bourgeoisie, which he questions. Each of the three texts increase its own verisimilitude through its implicit comparison with inadequate internal texts.    The Stranger contrasts its narrative of the murder of the Arab with the prosecutor's narrative, in terms of the faulty motives that the prosecutor ascribes to Meursault. The prosecutor provides a cause for each of Meursault's actions. Meursault summarizes the prosecutor's case: "I had asked [Raymond] to give me his gun. I had gone back alone intending to use it. I had shot the Arab as I planned . . . And to make sure I had done the job right, I fired four more shots" (99). However, the text does not assign these causes to the murder. As Meursault approaches the Arab, he realizes that "[as] far as I was concerned, the whole thing was over, and I'd gone there without even thinking about it" (58).

Adinkra

Adinkra symbols, like many other visual symbols, have been used over many years to communicate, represent and characterize a myriad of ideas, beliefs and concepts. Originally created by the people of Gyaman, Adinkra has grown to become the most extensively used and widely known traditional symbolic art in Ghana and to an appreciable extent, West Africa. By carefully considering the depth of wisdom in the meanings of these symbols, is not surprising that they are often linked with a host of several proverbial maxims.The very essence of the word ‘Adinkra’ is ‘farewell’; as such, every symbol that is encapsulated in the whole body of Adinkra communicates or corresponds to a unique message or idea. Documented history has it that, as far back as the nineteenth century, unique Adinkra symbols were used in customary and traditional rites of society to depict the ideological stance of that society as regards to the ceremony or event in question. The art was showcase d in various forms during festivals, funerals, marriages among others.Today, the use of Adinkra has been widely extended to cover almost every facet of life. In recent times, Adinkra symbols have become a suitable choice of branding the modern, competitive, and trendy Ghanaian clothing lifestyle. Over the years, Adinkra has gone beyond traditional cloth-making designs and has been fashionably incorporated into the designing of t-shirts, buttons, linen fabric clothes. Today, young people would prefer t-shirts with screen-printing inscriptions like ‘Me firi Ghana’, with an Adinkra like ‘Gye Nyame’ boldly designed beneath.Indeed, some acclaimed Ghanaian fashion designers like Mawuli Okudzeto, Kofi Ansah among others, have received international recognition by carving such niches for themselves, with popular brand names like MKOGH and PKOG, just to mention a few. Beyond that, apparels like footwear have also had a taste of Adinkra art. Artisans who make local f ootwear like sandals, slippers and ‘ahenema’ have also included these symbols in their designs. For instance, a locally made ‘ahenema’ has a carefully designed Adinkra symbol of three concentric rings encircling each other, known as ‘adinkrahene’ at the nose of each slipper.One other art is the design of bags with Adinkra symbols woven or sewn on the surface with fabric, (often kente pieces). The most popular addition to this art collection is the use of these designs in making jewellery and other fashion accessories. It is popular to see rings, pendants, earrings, necklaces, anklets, beads and many others designed with symbols like ‘ohene aniwa’, ‘epa’, ‘nkonsonkonson’, etc. In Ghana, the Precious Mineral Marketing Company (PMMC) is a typical example of an enterprise in this regard.Thus, on the international stage, Adinkra symbols have been employed as one of, if not the best indigenous symbols that give all manner of clothing, a unique fashion identity easily recognisable as truly Ghanaian. Quite apart from clothing, these symbols have formed part of locally designed fine and visual art. This has been such that, in creation of several Ghanaian sculptures, Adinkra has been one of the most recognisable themes. There many instances of metal and wooden sculpture designed into Adinkra. More often than not, these visual and fine arts have been used by individuals for decorative purposes.It is now commonplace to see a wall hanging in someone’s home, at the lobby of a corporate institution or in the sitting area of an afro-centric restaurant with the caption ‘welcome’ and a popular symbol like ‘Gye Nyame’ underneath it. Without a shred of doubt any Ghanaian who sees this in any institution in any distant part of the world, feels quite homey and comfortable, to some extent, immediately. Moreover, the designs of wooden plaques lately have also adopted Adinkra symbols. For instance, African institutions of late present Adinkra-designed plaques to individuals and entities, as gifts and awards for splendid performances.Woodcarvers as at today, still design stools for domestic as well as traditional purposes with these popular symbols. In Akan traditional homes, stools often known as ‘asesedwa’ are carved out of wood with these designs. Today as a unique of catching up with the west, local artisans have modernized their design of home furniture placed in areas like the living room, dining room and the study. Beautiful and attractive-looking sets are being carved daily. A common example is wooden coffee-table, which has an Adinkra symbol like ‘sankofa’ at the base with a glass plane on the surface.Hence it is ordinary to see the prolific use of Adinkra in fine and visual art because of the inherent artistic merits they possess. In present day, the use of symbols for trademarks and emblems cannot be over-emphasized. In corporate branding and marketing, many institutions have resorted to the use of symbols, both tactile and visual, as a mark of exclusivity and Adinkra are symbols of no exception. There are countless examples of institutions of all sorts who have adopted these symbols as logos, emblem, etc.In Ghana, for instance, a corporate institution like HFC Bank uses the symbol ‘ebankese’ as its corporate logo. Interestingly, Vodafone Ghana has designed their recharge cards such that whichever denomination has a long strip Adinkra symbols in front of the card. A popular plastics company by name ‘Strong Plast Ltd’ also uses the popular symbol, ‘Gye Nyame’ as a brand name for its plastic chairs. A very popular flour mill also uses ‘sankofa’ as the brand name of it flour. On a lighter side, along the coastal area it is fun to see fishermen decorate their canoes with these symbols as an interesting way of ownership.