Prolonged Preservation of the Heart Prior to Trans Essays

Prolonged Preservation of the Heart Prior to Trans Essays Prolonged Preservation of the Heart Prior to Transplantation Biochemistry Prolonged Preservation of the Heart Prior to Transplantation Picture this. A man is involved in a severe car crash in Florida which has left him brain-dead with no hope for any kind of recovery. The majority of his vital organs are still functional and the man has designated that his organs be donated to a needy person upon his untimely death. Meanwhile, upon checking with the donor registry board, it is discovered that the best match for receiving the heart of the Florida man is a male in Oregon who is in desperate need of a heart transplant. Without the transplant, the man will most certainly die within 48 hours. The second man's tissues match up perfectly with the brain-dead man's in Florida. This seems like an excellent opportunity for a heart transplant. However, a transplant is currently not a viable option for the Oregon man since he is separated by such a vast geographic distance from the organ. Scientists and doctors are currently only able to keep a donor heart viable for four hours before the tissues become irreversibly damaged. Because of this preservation restriction, the donor heart is ultimately given to someone whose tissues do not match up as well, so there is a greatly increased chance for rejection of the organ by the recipient. As far as the man in Oregon goes, he will probably not receive a donor heart before his own expires. Currently, when a heart is being prepared for transplantation, it is simply submerged in an isotonic saline ice bath in an attempt to stop all metabolic activity of that heart. This cold submersion technique is adequate for only four hours. However, if the heart is perfused with the proper media, it can remain viable for up to 24 hours. The technique of perfusion is based on intrinsically simple principles. What occurs is a physician carefully excises the heart from the donor. He then accurately trims the vessels of the heart so they can be easily attached to the perfusion apparatus. After trimming, a cannula is inserted into the superior vena cava. Through this cannula, the preservation media can be pumped in. What if this scenario were different? What if doctors were able to preserve the donor heart and keep it viable outside the body for up to 24 hours instead of only four hours? If this were possible, the heart in Florida could have been transported across the country to Oregon where the perfect recipient waited. The biochemical composition of the preservation media for hearts during the transplant delay is drastically important for prolonging the viability of the organ. If a media can be developed that could preserve the heart for longer periods of time, many lives could be saved as a result. Another benefit of this increase in time is that it would allow doctors the time to better prepare themselves for the lengthy operation. The accidents that render people brain-dead often occur at night or in the early morning. Presently, as soon as a donor organ becomes available, doctors must immediately go to work at transplanting it. This extremely intricate and intense operation takes a long time to complete. If the transplanting doctor is exhausted from working a long day, the increase in duration would allow him enough time to get some much needed rest so he can perform the operation under the best possible circumstances. Experiments have been conducted that studied the effects of preserving excised hearts by adding several compounds to the media in which the organ is being stored. The most successful of these compounds are pyruvate and a pyruvate containing compound known as perfluoroperhydrophenanthrene-egg yolk phospholipid (APE-LM). It was determined that adding pyruvate to the media improved postpreservation cardiac function while adding glucose had little or no effect. To test the function of these two intermediates, rabbit hearts were excised and preserved for an average of 24.5 1 0.2 hours on a preservation apparatus before they were transplanted back into a recipient rabbit. While attached to the preservation apparatus, samples of the media output of the heart were taken every 2 hours and were assayed for their content. If the compound

Order Professional Help Annotated Bibliography Examples

Order Professional Help Annotated Bibliography Examples Annotated bibliography is a combination of the research materials citations and their summaries. It is one of the elements of a good APA, MLA or Chicago style paper. If you are searching for the examples of annotated bibliography here is a collection of samples of annotated bibliography: Chicago Style, MLA, APA. If you dont have time to write it on your own, you may read: HOW TO BUY ANNOTATED BIBLIOGRAPHY ONLINE What is an Annotated Bibliography? An annotated bibliography is a list of research materials - books, articles, and documents  - presented both as citations  and as a summary of their value. The description acts to evaluate the source as a credible document. The purpose of the annotated bibliography is to inform the reader of the relevance, accuracy, and quality of the sources cited. Annotated bibliographies are different from abstracts, the latter being purely descriptive summaries found at the beginning of scholarly journal articles, while annotations are descriptive and require critical thinking. They may take into account the authors point of view, authority, and the place and time of their piece. How to Write an Annotated Bibliography Step 1.  Choose works that provide a balanced perspective on your topic. Step 2.  Locate and cite the books, periodicals, and documents about your topic. Step 3.  Cite the source using the appropriate style for your paper: MLA, APA or Chicago Manual Style. Step 4.  Write a concise annotation that summarizes the central theme and scope of the book or article. Include one or more sentences that accomplish one of the following: qualify the authority of the author; comment on who might gain from reading this source; compare the work to other work being cited; or, explain how this work enlightened you on your topic. Step 5.  Sign up today for the annotated bibliography writing service that will change the way you finish your school assignments. Sample MLA Annotation Greene, Robert. The 48 Laws of Power. Penguin Books, 2000. Greene offers honest advice on how to conduct ones life, according to the lessons we have learned from history, its rulers and their failures. Taking a sometimes fantastical approach to the realities of societal rules and norms, the chapters in Greenes book are wry and anecdotal and offer advice on everything from avoid the unhappy and the unlucky and mastering the art of timing. In the process, Greene includes interpretations of each law and examples of when the law was carried out in reverse to someones detriment. Greene offers sober, although harsh, advice for those struggling with ones imperfect journey with flawed peers, unfair laws, and conniving rivals. Rather than a practical handbook to how to live ones life, this text takes an honest perspective with advice that only those who truly need power will end up being able to implement in their life. However, there is still some useful tips that us every man and every woman can take. Chapters in this text lend themselves to being studied out of order, or as they become necessary in the readers life. Some of the chapters would even do well as part of a history course, or a section of a course, where students were learning about the human spirit and human folly. See also: MLA Essay Format with Example Sample APA Annotation Camron, J. (1992). The Artists Way. New York: Tarcher Putnam. In this workbook of nonfiction based on the writers creative journey, Cameron attempts to guide readers through the stages of reclaiming their inner artist and bringing more art into their lives. She does so by implementing the discipline of writing morning pages each day and by answering open-ended questions throughout to help the reader gauge where and why they may be stuck creatively. An experienced writer, Cameron is aware of the limitations of her experiment, and thats why she uses this book in tandem with live talks and workshops and encouraging fans of her work to meet where they live and help each other operate more like artists. The author is forthcoming about her past struggles with alcohol and the frustrations in her shortcomings as a poet to help ease the pretense that artists are artists and those who are not yet artists are on the outside looking in. Camerons book is completely inclusive and seems to embrace all who dare to discover their dormant inner artist. See also: APA Citation Machine Referencing Format Tool Sample Chicago Style Annotated Bibliography Schwabs book provides a thorough examination of the current state of Africas countries, communities, wars, resources, and leaders and how things came to be, from colonization until the new millennium. The author discusses relevant topics, such as war, cross-border conflict, ethnic conflict, despotic leadership, predatory regimes, and economic health. The book includes chapters on the slave trade, AIDS and poverty, globalization, and a question that asks if the continent will survive. This book could be read as part of a course but it appears the intention of the writer was to create a book for the interested layman to get a brief and terrifying history lesson. See also: Chicago Style Format with Example We hope, youve found these annotated bibliography samples helpful. Use them as the examples when composing your annotated bibliography. If you have no time for writing your APA annotated bibliography or MLA annotated bibliography, etc., you may order it online.  Place an order for annotated bibliography writing help, saying write me annotated bibliography, and we will deliver to you an expertly-presented piece. If you need any other writing services, feel free to contact our writers for assistance.

The Conflict in Ukraine (2014-ongoing) Essay Example | Topics and Well Written Essays - 1500 words

The Conflict in Ukraine (2014-ongoing) - Essay Example The Conflict in Ukraine (2014-ongoing) is the greatest example of where the rule of the people cannot be respected by the running government. The government instead goes to the point compelling the people with the leadership they rejected (Lauren, Viola& Kathleen, 2015). Ukraine came back to full-scale war or conflict is very saddening. The fight begun in the 2014 April and has since raged numerous months to the eventual stage when the separatists and the Ukrainian government came to a ceasefire. The ceasefire has been used to prepare and reigniting of the fight mainly entailed capturing of the Donetsk airport that is a strategic symbol and asset from the government forces. The government troops have pulled out of the town that is the key transport hub as a new truce was established on 12 February in attempts to stage mediation process. The war has placed a cost of close to 5600 lives. The violence has placed up debilitating effects to the country as many civilians have been killed by rockets on the rebel side in the cities like Luhansk and Donetsk. Approximately thirty people were killed in the Maripaul, which is a port city under artillery attack. Rebels have since then besieged main roads and rail hub in areas of Debaltseve, which is the region i n which most Ukrainian military troops have their base. The Ukranian problem is equally shared in various other parts of the globe where poor electoral and leadership have resulted in rebels and mass killings. In the past few months thousands of Bangladesh workers died in one of the greatest workplace safety tragedy in ever recorded in memorable history. Nigeria, Iran, Russia and many other countries close to 80 countries have created a discriminatory environment for the LGBT persons. This case has been created by the design of policies and laws that deny the LGBT their human rights and respect to human dignity. The condition has created a

Critical Evaluation Of The Three Approaches To IHR Essay

Critical Evaluation Of The Three Approaches To IHR - Essay Example Thus, â€Å"globalization is a process of interaction and integration among the companies as well as the people of different nations, a process which is mainly process driven by international trade and investment for the benefit of the investor as well as the host country† (Herbig 2008, p.6). Thus, in a way the globalisation from the last decade of the 20th century has optimized the opportunities for the companies, particularly the Multinational Companies (MNCs) to enter foreign countries, give employment to the local population as well as sell their products or services at competitive prices. In addition, firms cannot keep on operating in a saturated home market to achieve success. They have to break geographical boundaries as well as their economical limits to tap those opportunities in the foreign markets or countries, by following the process of internationalisation. Thus, internationalisation is a happening concept which is being used by many firms to expand their reach g lobally. â€Å"As the global economy expands, as more products and services compete on a global basis and as more and more firms operate outside their countries of origin, the impact on various business functions becomes more pronounced† (Briscoe and Schuler 2004, p. 20).... ing, researching, applying and revising all human resource activities in their internal and external contexts as they impact the process of managing human resources in enterprises throughout the global environment† (Briscoe and Schuler 2004, p. 20). When this management of human resources or employees in the international context is focused, it can be categorized into three approaches: cross-cultural management; comparative human resource management; and multinational perspective in human resource management. The first approach of cross-cultural management focuses on understanding the cultural differences and similarities that may exist between the entering firm or the home country and the local employees or the host country. Each country will have distinct and unique cultural traditions, and so the employees will also imbue it in them and exhibit during the organizational processes. Thus, these cross-cultures of the firms as well as employees have to be managed under the auspi ces of IHRM approach of cross-cultural management. As Cieri, Fenwick and Hutchings (2005, p.588) states, cross-cultural management focuses on â€Å"identifying the likely impact of cross-culturally similar and different human behaviour on the functional elements of HRM, including recruitment and selection, training and development, performance management and reward management.† Even before the foreign firms enter new countries, the employees in those firms will not be all similar, as they could come from different background. Those employees could have been made into a unit through the formation of common organizational culture and other strategies. When these firms with their employees enter new countries, it will be more challenging for them. Most of the countries around the world will have

Analysis of Sickle Cell Disease

Analysis of Sickle Cell Disease Safiullah Barat Melissa Parker Canada is becoming more multicultural as individuals from developing countries are making Canada their home. As the rate of immigrants in Canada is rising, diseases that were uncommon are becoming more prevalent. For instance, disorders such as sickle cell disease are increasing in all regions in Canada (Neglected Conditions, 2014). Sickle cell disease is genetic disorder that causes undesired effects which decreases an individual’s quality of life. The purpose of this paper is to analyze the pathophysiology of sickle cell disease, and to research evidence based practice such as management and prevention measures. To begin, a brief explanation of the search strategy used will be discussed, followed by details on the epidemiology of sickle cell disease. Furthermore, aspects of the disorder will be discussed in the following order: risk factors, clinical manifestations, diagnostic tests, complications, evidence based treatment, and different levels of preventive measures. Accord ing to RNAO, â€Å"knowledge provides the basis for professional practice and, is a central aspect of professionalism† (Professionalism in nursing, pg. 28). It is evident that nurses need to critically analyze disorders, such as sickle cell disease, in order to apply and provide competent care. Search Strategy To help retrieve the most up to date, recent and peer reviewed articles, different search strategies have been used. Nursing databases such as ProQuest, CINHAL and MEDLINE were used to find the appropriate journal articles. After doing so, search limiters were used to narrow down the search. Peer reviewed, full text and published dates set from 2009 to 2014 were selected, as well as the availability of references was included. Boolean operators, â€Å"and† and â€Å"or†, were commonly used ; furthermore, search term â€Å"sickle cell disease† and Boolean phrases including â€Å"complications†, â€Å"treatment†, â€Å"diagnostic test†, â€Å"pediatrics†, â€Å"prevention†, â€Å"etiology†, and â€Å"Canada† were combined to narrow the search. Epidemiology Sickle cell disease is prevalent in areas where malaria is common. This includes area such as the Caribbean, Nigeria, Middle East, Mediterranean, Indian sub-continent, Greek, Turkey, India, Pakistan, Ghana, and Far East China (Brown, M. 2012). A study conducted by Lanzkron et al (2013) took a look at mortality rates with individuals who had sickle cell disease over a time frame of thirty years. Over the course of thirty years, 16, 654 sickle cell-related deaths had occurred with a mortality rate of 0.7% each year (Lanzkron et al, 2013). In Canada, one in every 2500 babies will be born with sickle cell disease, and have a one in four chance (25%) of having sickle cell disease. Furthermore, they have a one in two chance (50%) of being a carrier for sickle cell disease (Sickle Cell Disease Association of Canada, 2013). Etiology/Risk Factors Sickle cell disease is an inherited autosomal recessive condition that causes an abnormal formation of hemoglobin. Different types of sickle cell disease includes sickle cell anemia (HbSS), sickle hemoglobin-c disease (HbSC), and sickle cell thalassemia (HbS) ( Brown, M. 2012).However, the most common is sickle cell anemia (Lewis, 2014). This inheritance occurs when both the mother and father pass on the defective gene to their child (Brown, M. 2012). Therefore, being a carrier of the sickle cell trail is a major risk factor. Individuals have an increased risk of developing sickle cell disease if residing in areas where malaria is endemic. Sickle cell disease puts individuals at risk whose ancestors came from West Africa, southern Italy, northern Greece, South and Central America, Middle East, Central India, southeast coast of Turkey and Mediterranean in Sicily (Pack-Mabian, A Haynes, J.r. 2009). Clinical Manifestations Although, each individual will display different signs and symptoms of sickle cell disease, they all display one similar characteristic: when exposed to factors that decrease oxygen, the hemoglobin forms into a sickle-shaped red blood cell which blocks the flow of blood. As a result, clinical manifestations often show anemia, jaundice and severe pain (Addis, G. 2010). Often, patients are asymptomatic except when experiencing a sickling episode (Lewis, 2014). An individual with sickle cell disease may develop anemia due to the complete destruction of red blood cells or hemolysis (Addis, G. 2010). Normally, red blood cells live for 120 days in our body but sickle cells usually die within ten to twenty days (Addis, G. 2010). As a result, the body’s organs are not receiving enough oxygen. The body compensates as it increase heart rate, increase blood pressure to allow the oxygenated hemoglobin to reach the necessary organs. Furthermore, individuals will display signs and symptoms of SNS or fight or flight response. Increase pupil dilation, diaphoresis and tachypnea are evident in patients with sickle cell crisis (Tortora Derrickson, 2012). In addition, the constant breakdown of hemoglobin produces bilirubin, a byproduct of hemoglobin, which cannot be processed by the liver. As a result, the bilirubin gets stored in the blood and connective tissue which results in yellowing of the eyes and the skin (Addis, G. 2010). However, the most common manifestation individuals with sickle cell disease experience are pain as a result of vaso-occlusive crises, also known as sickle cell crisis. Pain related to sickle cell disease accounts for ninety percent of hospital admissions (Musumadi, L. et al. 2012). This is mainly due to episodes of sickling that prevents oxygenated blood reaching organs, which results in ischemia and gradual deterioration of tissue and organ function (Musumadi, L. et al., 2012). Diagnostic Tests Diagnostic tests to diagnose sickle cell disease involve blood work. Often, individuals who have sickle cell disease are best diagnosed with the use of a peripheral blood smear test which reveals sickle cells (Lewis, 2014). In addition, sickle hemoglobin tests involve taking red blood cells, and expose them to factors that deoxygenate the blood, and determines if there is hemolysis (Lewis, 2014). Furthermore, a test known as the hemoglobin electrophoresis helps to differentiate sickle cell trait between sickle cell disease. It works by identifying various types of hemoglobin within a blood specimen to confirm the diagnosis of sickle cell disease (Randolph Wheelhouse, 2012). Additionally, secondary diagnostic tests could be used to diagnose complications that arise with sickle cell disease. Individuals may require a chest x-ray, skeletal x-ray, magnetic resonance imaging (MRI), and a Doppler ultrasound (Lewis, 2014). Skeletal x-rays are used to determine bone and joint deformities whereas chest x-rays are used to diagnose chest infection (pneumonia). MRIs are used to aid in the diagnosis of a stroke caused by blocked blood vessels from sickled cells Likewise, a Doppler ultrasound may be used to diagnose deep vein thrombosis (DVT) (Lewis, 2014). Course of the disease and complications Sickle cell disease causes a wide range of complications that begin at infancy and worsen with age when not controlled. Complications develop when sickling episodes causes vaso-occlusion which leads infarction of body tissues and organs (Lewis et al., 2010), and with increasing age, causes end-organ complications (Miller Meier, 2012). At age 2, children begin to experience dactylitis, pain in small bones of hands and feet (Miller Meier, 2012). Vaso-occlusive pain involving the back, chest, abdomen, or extremities continues to occur throughout the lifespan of an individual with sickle-cell disease (Pack-Mabien, 2009). Furthermore, both pediatrics and adults encounter the difficulty of anemia as it leads to other complications such as bone marrow suppression, renal insufficiency, and splenic or hepatic sequestration (Pack-Mabien, 2009). The infarction of the spleen can begin in infancy and causes another major complication: infection. The dysfunction of the spleen and its inability t o phagocytize foreign objects can cause major infection in both children and adults â€Å"and is the leading cause of morbidity and mortality in patients with sickle cell disease† (Miller Meier, 2012). Additionally, sickling episodes can affect the pulmonary system in all affected age groups and causes acute chest syndrome, a disorder that includes pulmonary complications such as pneumonia, fat embolism, systemic infection, pulmonary infarction, and if not treated, can lead to respiratory failure (Miller Andrew, 2012). Unfortunately, children and adults are also at risk for stroke due to cerebral infarction (Miller Meier, 2012). Other complications include gallstones, kidney failure, priapism or involuntary erection, delayed sexual development, delayed growth, bone necrosis, and leg ulcers (Brown, M. 2012). Treatments The treatment of sickle cell disease involves the reduction of symptoms and complications. Treatment includes pain management involving opioid or non-opioid analgesics, anti-inflammatory drugs, and NSAIDS (Addis, 2010). Also, cognitive behavioural therapy and non-pharmacological approaches can benefit patients with chronic or acute pain (Addis, 2010). Another treatment includes RBC transfusion and is required â€Å"as an emergency measure or to prevent short or long-term complications.† (Addis, 2010). Furthermore, a medication called hydroxyurea is a major advancement in the management of sickle cell disease and is available in Canada (Canadian Association of Sickle cell†¦). Hydroxyurea increases the level of fetal hemoglobin that results in an overall decrease in circulating sickle cells (Smith et al., 2011). A clinical study conducted by Smith et al (2011), has proven a decrease in pain intensity in patients undergoing hydroxyurea therapy, as well as a decrease in analg esic use and a significantly lower reduction in crisis and mortality. Moreover, multiple studies have shown bone marrow transplant as a potential cure of sickle cell disease; however, further studies are needed for this treatment to be recommended as a standard treatment for sickle cell disease (Thompson, 2012). Preventive Measures Primary Preventive Measures Although genetic risk factors are non-modifiable, there is a preventive measure for sickle cell disease: genetic counselling. Genetic counselling should be encouraged in patients with the sickle cell trait especially when planning to have a child. This preventive measure helps patients understand and adapt to the implications of genetic contributions to the disease and offers â€Å"counselling to promote informed choices and adaptation to the risk or condition† (Lewis, 2014. p. 787). A 6-year study in Saudi Arabia, a country of high prevalence of sickle cell disease, showed a significant decrease in the genetic disease through the use a genetic counselling program as it decreased the number of at-risk marriages (Memish, 2011). Secondary Preventive Measures Prevention measures in the secondary level focuses on diagnostic tests and screening for sickle cell disease. Newborn screening is the earliest way to detect whether the child has sickle cell disease in time to prevent serious complications from occurring (Newborn Screening Ontario, 2013). According to the Newborn Screening Ontario (2013), newborn screening can prevent â€Å"infection and sepsis, growth delay, painful sickle crisis, tissue ischemia and organ damage.† Secondary preventive measures also involve previously stated diagnostic testing for complications such MRI for stroke, the use of x-rays for chest infections, etc. Also, pain is a major complication in both adults and pediatrics and should be diagnosed; however, it is challenging to detect pain in unresponsive clients such as neonates. Registered Nurses Association of Ontario recommends the use of a validated pain assessment tool for neonates called Neonatal Infant Pain Scale (NIPS) due its evidence of reliability and validity. This tool includes components such as facial express, cry, breathing patterns, arms, legs, and state of arousal component (Assessment and Management of Pain, 2013). Tertiary Preventive Measures Tertiary preventive measures involve treatments that aid in regaining patient’s functional ability and the elimination of the disease. For individuals with sickle cell disease, preventive measures at this level include medical interventions to prevent and control symptoms and complications. For example, interventions are pain management, hydroxyurea, and transfusion therapies as mentioned earlier. Furthermore, penicillin can be given to children starting at 2 months of age, and vaccinations against pneumococcal infections, flu, meningitis, and hepatitis are important to prevent infections and early death (Addis, 2010). Conclusion In conclusion, sickle cell disease is one that affects the quality of life of affected individuals. The analysis focused on different aspects of sickle cell disease such as the epidemiology in which prevalence is high in areas where Malaria is predominant. Also, due to increasing immigration, the incidence of the disease is increasing in Canada. Furthermore, known risk factors have been identified such as genetic and environmental factors. In addition, the main clinical symptoms with sickle cell disease include pain as well as symptoms of anemia. Furthermore, a variety of tests which include blood work are the determinants of the presence of sickle cell disease. Sickle cell disease potentiates of a variety of complications, most commonly vaso-occlusive pain, acute chest syndrome, anemia and other major organ complications. Unfortunately, treatment only aids in controlling the complications and does not provide a cure for the disease. It is evident that the need for further research i n stem cell transplant as a potential cure is highly needed. Lastly, genetic counseling, neonatal screening, diagnostic tests, and current evidence based treatment such as pain management, hydroxyuria and transfusion therapy, are all preventive measures of symptoms and complications of the disease. The findings in this analysis are significant for nurses to apply when having encountered a patient with sickle cell disease. Certainly, it is important for nurses to acknowledge the increasing diversity in Canada and to continue competency by constantly seeking new pertinent information to apply to everyday practice. References Addis, G. (2010). Sickle cell disease, part 1: understanding the condition. British Journal Of School Nursing, 5(5), 231-234. Brown, M. (2012). Managing the acutely ill adult with sickle cell disease.British Journal Of Nursing,21(2), 90-96. Lanzkron, S., Carroll, C., Haywood Jr., C. (2013). Mortality Rates and Age at Death from Sickle Cell Disease: U.S., 1979-2005. Public Health Reports, 128(2), 110-116. Lewis, S. M. (2010). Medical-surgical nursing in Canada: assessment and management of clinical problems (2nd Canadian ed.). Toronto: Mosby Elsevier Canada. Memish, Z., Saeedi, M. (2011). Six-year outcome of the national premarital screening and genetic counseling program for sickle cell disease and [beta]-thalassemia in Saudi Arabia. Annals Of Saudi Medicine, 31(3), 229-235. doi:10.4103/0256-4947.81527 Miller, Andrew C., and Mark T. Gladwin. (2012) Pulmonary Complications of Sickle Cell Disease.American Journal of Respiratory and Critical Care Medicine185.11 (2012): 1154-65.. Miller, J. L., Meier, E. (2012). Sickle Cell Disease in Children. Drugs, 72(7), 895-906. doi:10.2165/11632890-000000000-00000 Musumadi, L., Westerdale, N., Appleby, H. (2012). An overview of the effects of sickle cell disease in adolescents. Nursing Standard, 26(26), 35-40 Neglected conditions. (2014). Canadian Medical Association.Journal, 186(6), 452-453. Newborn Screening Ontario. (2013). Newborn screening manual: a guide for newborn care providers. Retrieved from http://www.newbornscreening.on.ca/data/1/rec_docs/795_CHO0093-NSM-Web.pdf Pack-Mabien, A., Haynes, J. r. (2009). A primary care providers guide to preventive and acute care management of adults and children with sickle cell disease. Journal Of The American Academy Of Nurse Practitioners, 21(5), 250-257. doi:10.1111/j.1745-7599.2009.00401.x Randolph, T. R., Wheelhouse, J. (2012). Novel test method (sickle confirm) to differentiate sickle cell anemia from sickle cell trait for potential use in developing countries. Clinical Laboratory Science, 25(1), 26-34. Registered Nurses’ Association of Ontario. (2013). Nursing Best Practice Guidelines: Assessment and Management of Pain. Retrieved from http://rnao.ca/ Registered Nurses’ Association of Ontario. (2007). Nursing Best Practice Guidelines: Professionalism in Nursing. Retrieved from http://rnao.ca Sickle Cell Disease Association (2013). Reterieved from http://www.sicklecelldisease.ca/ Smith, W. R., Ballas, S. K., McCarthy, W. F., Bauserman, R. L., Swerdlow, P. S., Steinberg, M. H., Waclawiw, M. A. (2011). The Association Between Hydroxyurea Treatment and Pain Intensity, Analgesic Use, and Utilization in Ambulatory Sickle Cell Anemia Patients. Pain Medicine, 12(5), 697-705. doi:10.1111/j.1526-4637.2011.01096.x Tortora, G. J., Derrickson, B. (2012). ANS Neurotransmitters and Receptors. Anatomy Physiology: Princples of Anatomy. Danvers, MA: JOHN WILEY.

Analysis of the Character of Winston in 1984 Essay

Written by the author George Orwell, 1984 gives a terrifying outlook of society. George Orwell presents a world in which society, controlled by the State, is indoctrinated in propaganda and illusion. The main character is different from the rest of the people since he decides to defy the society he lives in. From the first chapters, the author creates the image of an unsatisfied man with the people surrounding him. The character of Winston, however, seems a bit of a paradox since, whilst he tries to rebel against his society, he irrevocably loves his job. From the beginning of the book, Winston disobeys the Party’s orders (by writing a diary), showing his disapproval of the way society is. Furthermore, the fact that Winston keeps a journal, conscious of the danger he risks, is evidence that he hates his society. As the reader advances in the first chapter, he can witness Winston’s attitude towards the Party’s values and the society. His attitude seems to always differ from the other employees. Indeed during the â€Å"Two Minutes Hate† whilst everyone seems to loathe Goldstein, Winston is only faking his hate. This shows his refusal into following the Party’s rules. Moreover â€Å"Winston’s hatred was not turned against Goldstein but, on the contrary, against Big Brother, the Party and the Thought Police†. Winston has a very critical approach to the Party’s policies. Winston’s uneasiness towards the telescreen is further proof on how he feels about society. Indeed, the telescreen represents another controlling aspect of the society. Winston despises the controlling aspect of his society since the telescreen has â€Å"pushed† him into becoming paranoid. Winston’s attitude towards the telescreen shows us he hates his society for watching him all the time. Winston also hates women, a specific part of society. They represent absolute obedience and depersonalization which he completely disapproves of. Yet, his feelings towards them are presented as complex since Orwell insists on the fact that he looks down at them but also feels attracted to them. Winston is however having issues with pretty women: he feels that they are joining blindly the Party. His strong hatred for them is shown by the wish to hurt them: â€Å"flog to death†, â€Å"shoot arrows†, and â€Å"cut her throat at the climax†Ã¢â‚¬ ¦ However his apparent complicity with O’Brien shows, underneath all the hatred, that Winston is actually longing for a friend in this society he hates. This complicity is due to the fact that Winston feels closely to O’Brien as he defied Big Brother’s authority. Winston might have then felt like he was not the only one to fully despise the world he lives in. Winston’s hatred for is society has a paradoxical aspect since he reject his society’s values and deeply loves his job at the same time. This seems paradoxical because Winston despises the fact that the Party controls, modifies everything whilst his job consists in modifying documents. His job consists in modifying documents, as if he were rewriting History to make it coherent with the Party’s claims. Winston’s job requires organization skills, with special attention for dates. The reader learns that â€Å"Winston’s greatest pleasure in life was in his work†. The benefits that his job brings to his life are escaping his life and a position of power. The position of power might refer to the fact that Winston can change elements of the world he lives in and furthermore which might make Winston feel in complete control of his life and work. However, Winston is far from being â€Å"in control† of anything, but he does have a certain amount of power at the Ministry, considering he is allowed to access archives. This could explain why Winston likes his job so much. Furthermore it seems that Winston is able to interact with the past and its â€Å"real† version being closer to reality than the updated version. On the other hand, Winston expresses a sense of uncertainty concerning the exact authenticity of the version he received. In addition, it is because Winston hates his society he uses his job as a way of forgetting his sad life. His job requires a lot of concentration and dedication, which is exactly what he needs to escape his boring daily routine. Because he is so involved in his job, his life becomes easier. This means his job gives him the possibility of somewhat escaping from the horror of living under such an regime. 1984’s main character Winston is a complex man, who refuses to conform to the norms of society and chooses instead to defy it, while at the same time he very much enjoys his work at the Ministry. Winston hates his society, yet loves his job. This is coherent because the aspects of society that Winston so despises are changeable by his job.

Ted Bundy was a brutal serial killer Essay - 611 Words

Works Cited â€Å"A Condemned Man’s Last Bequest†. People 6 February, 1989 p. 44-51. Gerdes, Louise. Serial Killers. San Diego: Greenhaven Press Inc.2000. Knappaman, Edward W. Great American Trials. Detroit: New England Publishing, Associates, Inc. 1994. Ted Bundy was a brutal serial killer. He was also very charming and handsome to the ladies, which made it easier to prey on them. He admitted to killing over twenty people just before his execution. Many families were relieved when he was finally executed. Ted Bundy thought of himself as very smart, because he was able to outsmart the authorities multiple times throughout the years of being a serial killer ( Gerdes 41). His victims of choice were young, college age, women ( Gerdes 128). He†¦show more content†¦He made himself look innocent through just about anything the authorities threw at him. Bundy helped himself out by saying he had been badly represented by counsel (â€Å"A Condemned† 49). The authorities believed he had killed at least forty people, but it was very hard to prove it. Dentists analyzed bite marks on one of the Chi Omega’s victim’s buttocks, and compared them to an oversized picture of Bundy’s teeth (Knappaman 655). It was determined that there was a considerable amount of similarities, and it was used against Ted as evidence. This was the first hard evidence the authorities had against him in the trial. He sensed danger of being convicted and tried his best to cover it up, but failed. The police also innocent found knotted panty hose like those used to strangle previous victims at the Chi Omega House. They had finally found an eyewitness who was named Nita Neary, which helped a great deal. They finally proved him guilty with this evidence. After his conviction Bundy admitted to killing about twenty people, which included Debi Kent on November 8, 1974, and Nancy Wilcox on October 7, 1974. On July 23, 1978, Ted was found guilty on multiple charges (Knappaman 655). Later on in 1979, he was sentenced to death. He received his third death sentence on February 12, 1980, following his conviction of killing Kimberly Leach. He was convicted of three separateShow MoreRelatedThe Mind and Motivation of a Serial Killer Essay777 Words   |  4 PagesThe mind and motivation of a serial killer Serial killers tend to be white heterosexual males in their twenties and thirties, who are sexually dysfunctional and have low self-esteem. Serial killers generally murder strangers with cooling off periods in between each murder. Serial killers are twisted in nature. Some return to the place the murder happened or the gravesite to fantasize about their deeds. 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