Failure Mode Avoidance- How to design and avoid failure Essay

Failure Mode Avoidance- How to design and avoid failure - Essay Example In that line of design, engineers are able to come up with design optimization method. These methods are combined with the present technology of low-cycle fatigue, which is applied in the durability characteristic of a vehicle. This requires skillful integration of computational tools and methodologies in a car dynamics. This includes fatigue strain life evaluation, finite factors simulations and prediction techniques. The analyses of these car safety elements are important in attaining car performance of critical design in complex system. To address the problem, metal model and the slide bar process are used. In regards to Failure Mode Avoidance approach, the model and process permit the engineering group to uncover and avoid potential wheel or tire and driveline noise vibration and harshness failure modes. In the early development of the product, the team can identify and control noise factor system and decrease system level effects and avoid potential failures of noise vibration h arshness by developing appropriate countermeasures. To create a failure mode avoidance one needs to understand when and the reasons for creating potential failure modes. The aim of this paper is to understand the reason for creating better failure mode avoidance in cars. This paper focuses on the study of eleven customers and the problems they faced related with reliability in an automobile company. The interviews were done using open-ended questions that enabled the interviewees give a description of their experiences and views. The interviews took between one and two hours and secondary data collected. The case analyses all problems related to the customers meaning the failures were seen after the car was in the market. Most of the failure modes formed during the early development stages of the cars. The failure modes that affected the customers formed during the selection phase and

WGU SZT 1 Task 4 - Disaster in Franklin County Essay Example for Free

WGU SZT 1 Task 4 Disaster in Franklin County Essay The most important aspect in managing a disaster situation is preparedness. The simulation Disaster in Franklin County highlights the role of public health personnel, with emphasis on the public health nurse because the nurse is often a first responder to such a disaster. This helps to examine the roles, actions, coping methods, and techniques used by a nurse in a disaster scenario. A. Role of Public Health Personnel The role of public health personnel is to maintain the physical and emotional safety of individuals throughout the community affected by the storm. Those in the Public Health Department are responsible for ensuring the citizens of Franklin County have all the basic necessities for survival, such as clean water, food, shelter, and necessary medications. Because of the varying needs of the community, the Public Health Department is also responsible for maintaining and disseminating up-to-date information on how to obtain help, how to acquire the basic necessities, and health hazards/concerns. The public health nurse assures these needs and concerns are met within her scope of nursing practice, using her assessment and prioritization skills. While the public health nurse is assessing the needs of those affected, other members of the Public Health Department maintain operations and assume any jobs that fall outside of the nursing scope of practice utilizing each individual’s skills: the health educator is able to draft concise and easily understood directions relating to maintaining health and directing those displaced to the nearest shelter; the department bookkeeper maintains the financial records during the disaster operations; the receptionist uses her connections with vendors and general people skills to obtain what is needed to run the department; the epidemiologist’s analytical approach and organized thinking is essential in mapping out the logistics of emergency departmental operations; and the environmental health supervisor, who has the most supervisory experience, oversees all operations by the Public Health Department, attends important briefings, and delegates tasks. B. Chain of Command Establishment of a chain of command in a situation such as a severe storm or other disaster is essential. Because there may be a disruption to commonly used manners of communication, such as television, telephones, and the internet, it is important to have a clear outline of where and to whom to report, how to find answers, and who will perform necessary tasks. In the simulation, the Public Health Department is both a link in the larger, county-wide chain of command and has its own hierarchy structure. Within the scope of the county, the Public Health Department reports to the Medical/Health Branch Director who is directly under the Operations Chief. The Operations Chief, who is in charge of managing and monitoring the actions of each department, reports to the Emergency Operations Commander. The Emergency Operations commander is the highest link in the chain, not only overseeing the operations of the various governmental departments, but also the officers in charge of Safety, Public Information, and Legal. Within the Public Health Department, like in the county structure, there is an Operations Chief, responsible for all the actions taken by the department. This is someone with experience in the field, supervisory experience, and an understanding of the structure and function of the department. Under the Operations Chief, there are officers for Logistics, Planning, Finance/Administration, Public Information and Liaison. Each of these individuals is chosen according to his or her individual strengths and abilities within the department and is accountable for the actions of the Public Health Department. C. Resources Through the county-wide set up of an Incident Command System (ICS), the public health nurse has many resources available to her to aid the community. To spread information about boiling water for safe use, the nurse has the assistance of the Public Information officers of both the Public Health Department and the county. Also, because of a pact Franklin County has made with neighboring REPLACE County, the Public Health Department is able to promptly begin inspections needed to reopen restaurants, providing needed food and a sense of normalcy to the people. While conducting door-to-door interviews, the nurse has additional members of the ICS present to assist in assessing the safety of homes and to aid in the evacuation of residents in unsafe or dangerous environments. After the providing immediate needs, the nurse is able to aid those affected by the storm emotionally and/or psychologically by referring them to hotlines and other practioners in the area for assessment and treatment. D. Actions of Community Health Nurse The community health nurse is, through door-to-door interviews with residents most affected by flooding and power outages, able to intervene in unsafe situations. The nurse prepares before the interviews, benchmarks for the determination for safety. The nurse assesses these benchmarks by enquiring if residents have adequate food and medications, know how to safely consume water, have any injured, young or elderly who need assistance, have safe shelter and know of the resources available to them. When confronted with emergency situations, the nurse uses her connections in the ICS to aid citizens. After discovering a potentially hazardous chemical spill, she cautions the resident against the cleaning the spill himself and deploys an Environmental Health Specialist to assist. The nurse also intervenes to stop a situation from becoming hazardous by instructing another resident that the operation of a generator indoors requires adequate ventilation, thereby preventing a carbon dioxide poisoning. Finally, the nurse assists a resident without an adequate supply of life-sustaining medication in obtaining a resupply and further offers him help in evacuating to a shelter if preferred. In addition, the nurse is able to make referrals to other social service departments for those who will need further assistance even after basic needs are met. E. Coping with Aftermath An important part of aiding a community after such a disaster is understanding the long term effects on everyday life. The public health nurse is instrumental in assisting those affected emotionally and financially with the appropriate resources. In the scenario, the nurse is able to aid those calling the Public Health Department by recognizing the issues caused by the storm and taking steps to get help where needed. The nurse refers a woman whose family is having difficulty dealing with unemployment and anger after the storm by suggesting counseling and scheduling a home visit to further assess needs. Another way the nurse aids the community is by recognizing potential serious hazards and dispatching the appropriate members of the Public Health Department to aid in assessment and stabilization of the environment. Finally, the nurse acts swiftly in a confirmed hazardous situation by notifying Emergency Medical Services of an injury in an area with a large community presence, thereby protecting other citizens from harm and allowing the appropriate actions to be taken to neutralize the danger. E1. Techniques While interacting with the community during the post-storm phone calls, the nurse used multiple methods to calm the fears of those involved. In the first instance, the nurse was able to support the caller by using language that reflected her own concerns back to her. This allowed the caller to have her fears validated. Also, the nurse provided the caller with reassurance that her family was not alone in dealing with the consequences of the storm and resources through which she might find help. Both of these techniques were useful throughout the calls the public health nurse received as well as maintaining a professional demeanor and using her connections to other departments in the ICS to provide prompt assistance where needed. F. Preparation of Nurses Emergency situations or disasters on any scale can benefit greatly from well prepared and qualified nurses from a variety of fields. In preparations for large scale disasters, nurses must make sure to maintain current knowledge of emergency services and procedures. This can be accomplished through continuing education with community health focus. Nurses can also participate in city, county, and state wide disaster drills, learning vital skills in a safe but accurate simulation. Nurses can also make sure to understand the policies and procedures of their practice settings regarding disaster situations. Conclusion As nursing practice expands further into the community, it becomes vital to understand the roles required in a disaster situation. By examining the actions taken, methods used and interactions with other departments, the importance of the community health nurse in maintaining the safety of the public is clear. Public health nurses have the unique position to truly advocate and aid many people in emergency situations.

Free College Essays - Analysis of Sister Carrie by Theodore Dreiser :: Sister Carrie Essays

An Analysis of Sister Carrie It was 1889; Carrie Meeber, an eighteen-year-old girl, was boarding a train from Columbia City to start a new life with her sister and her family in Chicago. Columbia City was a small town that did not have much to offer to anyone who wanted to make something of themselves. But in Chicago Carrie believed she would be able to find work and get good money. Chicago, in 1889, had the peculiar qualifications of growth, which made such adventuresome pilgrimages even on the part of young girls plausible1[1]. When a girl leaves her home at eighteen, she does one of two things. Either she falls into saving hands and becomes better, or she rapidly assumes the cosmopolitan standard of virtue and becomes worse2[2]. Once Carrie arrived in Chicago and settled in with her sister and her husband she started to see that living in Chicago was not going to be as easy as she thought. She had to get a job and pay rent, not to mention buy the things that she wished to. Most women stayed at home to take care of her children, make meals, keep house, and to care for the sick in the late nineteenth century3[3]. Only five percent of married women held jobs outside the home in 19004[4]. But some did go out looking for work in order to help their family out as much as possible with their bills. Carrie wanted to go out and make something of herself. Trying to find a job was a difficult task in itself. "Well, we prefer young women just now with some experience. I guess we can't use you."5[5] Carrie heard this over and over again. Until finally finding a job that paid her three and a half-dollars a week working in a shoe factory. This was a grueling task working with leather non-stop in a hot stuffy overpopulated room. After becoming sick she lost her job at the shoe factory and so later on her very good friend Drouet got her a part in a theatrical performance at a Lodge. Theaters were a big thing at the time for entertainment. Many middle class people would go and see a matinee maybe once a week to have some fun. At this time in the late 1900's there wasn't much for people to do at night and on weekends except for staying at home.

Captain Morgan Original Spiced Rum :: essays papers

Captain Morgan Original Spiced Rum This AD is about an alcoholic beverage called Captain Morgan Original Spiced Rum. When you first see this AD you can clearly see that the focus of this ad is to make you want to drink. It jumps out and says â€Å"drinking is cool†. It’s saying not directly but indirectly. The focus of it is to make you want to buy this beer because those people are drinking it. They’re having a fun and great time, so the ad can get those people that want to have a fun and great time. The tone of this ad is pretty funny. As you can see the headline of this ad says, â€Å"take off your pants and stay a while†. You can make different interpretations of this ad which makes it even funnier. The voice is also very funny, because of that line. The language is quite funny to me, but some people that do not understand it probably would not enjoy this ad. Some people might think the language is ridiculous and inappropriate. Most young people would find this ad very natural to them. I am not saying that old people wouldn’t like this ad, but some of them might not get it or understand the humor of the ad. It all depends what your definition of humor is. The audience is mainly designed for younger people. I can conclude this by seeing that all the people in cabin are young, maybe in there 20’s. Also they could be snowboarding and not a lot of old people snowboard. So this ad is mainly to attract the younger folks. The design of this is pretty thought out. The whole logo is in red, and the ad is in black and white so they try to catch your attention by doing that. You turn the page in the magazine and all of sudden you see â€Å"take off your pants and stay a while† you probably are going to see what the ad is all about. I think its smart advertising that they have the main logo in red and the alcohol colored but the background in black and white.

About and for the death penalty Essay

The idea of your life for a life; the vast majority of our population is in favor of the death penalty. For thousands of years it has been used as a punishment for crimes. Through government for crimes against the State to churches for crimes against their religions, â€Å"Impositions of the death penalty is extraordinarily rare. Since 1967 there has been one execution for every 1600 murders or 0.06%. There have been approximately 560,000 murders and 358 executions from 1967-1996.† (UCR) As we continue the war on crime, two factors stand out: Ending all crime is impossible but controlling it is a must. Regardless of the voices of the Anti-Death Penalty Movement, the only control is deterrence, the only deterrence is control. With all the statistics on deterrence, economic ramifications and secure limitation on allowed appeals. The death penalty should remain the United States primary weapon against capital crime. Is the death penalty a successful deterrent and does it save the lives of innocent citizens? A question raised and argued for years in the past and still in the spotlight. For justice to be deterring, the severity of the punishment must outweigh the crime. With life in prison without the possibility of parole an inmate has no care if he kills again. This is very evident considering, â€Å"at the roughly 52,000 state prison inmates serving time for murder in 1984, an estimated 810 had previously been convicted of murder and had killed 821 persons and following their previous murder convictions. Executing each of these inmates would have saved 821 lives.† (41, 1 Stanford Law Review, 11/88, Pd 153) We can then look at the number of convicted murderers that are either released too soon due to cases being overturned based on past conviction. New laws brought on by judicial decisions in other cases or even escape. It’s not the executions that reduce murder rates but the reduction of the number of murders. See more: Unemployment – problems and solutions essay Many other factors are argued about the death penalty including but not limited to the cost of life without parole â€Å"LOWP† vs. the death penalty. Opponents present, as facts, that the death penalty is so expensive (at least $2 million per case), that we must choose life without parole at a  cost of $1 million for 50 years. Without a doubt the up front costs of the death penalty are higher than for an equivalent LWOP cases. There is also no question that over time â€Å"LWOP† cases become much more expensive. JFA states that in these estimates â€Å"It should be noted that we were intentionally generous in minimizing life costs within our analysis†¦JFA. As you have seen here more controversy on why opponents feel the death penalty should be abolished but when totaled up and a limitation being established for how long an inmate can stall his execution then that cost would be lower. Here it is shown that the death penalty is also an economically balanced way to deal with those who commit capitol crimes (JFA). In our United States Constitution an individual whose trial resulted in a guilty verdict has the right to appeal his case. Our system at this time has no limits on the amount of appeals an individual is entitled to, and this is why the average death row inmate sits with hopes of an overturned appeal to change their sentence to life imprisonment instead of death. What kind of deterrence is the sentence of death when a convicted felon has so many opportunities to delay or lessen the punishment for the crime they committed? In 1996 President Clinton signed the Effective Death Penalty and Anti-terrorist Bill. â€Å"It is designed to limit the appeal time frame after a death sentence verdict†Ã‚  (DeRienzo). The Opponents bring up Amendment rights in the Constitution and thus this is still under debate but what about the rights of the victim? Where is the justice giving a convicted murderer the rights they took away from another. In the years since the Supreme Court re-instituted th e death penalty through 1994, there have been approximately 467,000 homicides in the United States. Based on that number, 2.8 people will die every hour at the  hands of another person. (JFA) Death row inmates are often on death row for years, some upwards of twenty years. This is paid for with the taxpayers’ money. While in prison, inmates have many privileges, including cable television, the chance to pursue a college degree, and free health care, all at our expense. It is appalling to think these people have a life of leisure while in prison. There are even some death penalty opponents who believe that these convicts serving â€Å"LWOP† aren’t treated fair and deserve better living conditions and more rights. Lost in this passionate pursuit of human rights are the rights of the dead victim and those of that victim’s family. The appeal process is lengthy and time-consuming. The death penalty informs society that by committing capital crimes, your rights do change and you will suffer the same fate. Through out time many aspects of the death penalty have proven that it can be a deterrent for would-be murderers where by it does save lives. Not possible for all but some families get a sense of closure from the grief and anger brought forth by the loss of a loved one. â€Å"Those who commit vicious crimes destroy the basis on which a moral community rests and forfeit their rights to citizenship and even life itself† (Cauthen) Simply put locking a murderer up for life doesn’t do the trick. The laws change, people forget and parole boards’ change too, this seams to deteriorate with a life in prison sentence. As long as a murderer lives no matter how small a chance, he will probably strike again. Expediting the execution process gives the family of the victim’s closure. To have the process drawn out for years only keeps the pain fresh and life for them is on  hold until justice is served. Furthermore it is an insult to them to put the rights of a  murderer over the rights of the victim. The convict demonstrated a lack of regard for human life by taking the life of another. The basic premise of human intelligence is the  ability to reason and make decisions. This person made a conscious decision to take a life. Regret and remorse will not change the outcome of those actions. This person does not deserve the life comfort found in today’s prisons. As you have read here today’s judicial system seems to forget about the victims in these heinous crimes to humanity by criminals and almost reward them by supporting them for the rest of their lives. Justice is in the eyes of those that are law abiding not those that break the law. This is why I feel that the death penalty is the best deterrent, it is pro-economic and with limits on appeals, Innocent people will live and capitol crime will have capital punishment.

Jeffersons Presidency Essays

Jeffersons Presidency Essays Jeffersons Presidency Paper Jeffersons Presidency Paper Behind the Scenes: Jeffersons Presidency The Jeffersonian Republicans are typically considered to be stringent constructionists.The Federalists usually were considered to favor the broad constructionism.This is often just a stereotype, especially when the presidencies of our great, but misleading, Presidents Jefferson and Madison. The Jeffersonian Republicans, to only a small extent, represented what the party truly stood for, and the Federalists also to a small margin swayed from their partys ideas. The Republicans often stood for the idea of a weaker central government, not giving too much power to one man.This principle was sometimes overlooked by Jefferson.;mine tells me that the civil powers alone have been given to the President of the U.S.; (DOC A).Another policy that the Republicans deeply believed in, but Jefferson did not follow in his presidency, was strict constructionism.;laws and institutions must go hand in hand with the progress of the human mindinstitutions must advance also and keep pace with the times.;(DOC G).Jefferson also was quite afraid of the Government and the constitution, which led to ;Jefferson;s Rebellion; (1800). The Federalists were known for their desire for an all powerful central government, but sometimes the party members did not believe in this type of government.;he will at any time be able to prove quite as clearly that congress has power to create a dictator.; (DOC D). Even at the Hartford Convention many Republican-resembling resolutions were accepted.;Congress shall not have power, without concurrence of two-thirds of both houses.;(DOC E).Madison also states, in his proposal for war, that the constitution was better due to its inflexibility. Also during the Hartford there were no propositions for a change in the Constitution which is not a good representative of Federalist ideals.

hills essays

hills essays It had rained before dawn on that particular Wednesday in December of 1986, but by nine oclock sunshine spread like warm butter through the green, landscape folds of the overpriced Beverly Hills canyon. A woman stood at a bedroom window, gazing at the sunlit morning. Even unadorned with her black mane of hair pulled austerely back , a peignoir hiding here apparently felicitous curves, she was lovely. For a moment she closed her eyes and here thoughtful expression altered to one of haunted dread. Then she shrugged as if reminding here self of a task, and move briskly to a long, narrow dressing room. Behind a professional, strew of cosmetics, the front section of the Los Angels Times was folded and was propped to show a photograph of her. With her artfully tousled head throw back and her lipsticked mouth open in a breathless smile, her image on black and white newsprint appeared far tougher,that of an aggressively sensual woman. The caption read: ALYSSIA DEL MAR, THE RETURN OF THE RECLUSIVE STAR Alyssia Del Mar hadent made a film in six years. For long months at a time she vanished completely. Here reappearance were noted by television newscast and the press- the Star and the Inquire routinely sold out when they printed a rumor that she had been secluded in an exotic Katumandu palace, a Moorish castle, or a viceregal estancia in the Brazilian jungle with some billionar , Say Adran Kashoggi, or a notable like prince Rainer. Legends have never thriven on the rocky soil of truth and Alyssia del Mar had transcended her own myth. What is more intriguing than a star- an international star of the first magnitude- who quits at the height of her beauty and fame? The public who has suffered with her through illness, tradgy and lurid scandal, snatch at clues of the enigma. Alyssia switched on a surgical array of lights, leaning forward to study her reflection. Her nose and chin were rather to delicate, but in ...

inspector calls essays

inspector calls essays It was not until I had finished typing up this document that I realised it had become quite so involved and, as a result, I run the risk of losing the interest of the reader before I have even begun. However, I trust I will be forgiven this failing for I feel that despite its length there is much in it that is of interest, even importance. Certainly, I have found that by putting all my thoughts and experiences down on paper 1 have a far more structured view of what KS4 English and English literature are all about and I can now prepare a topic or piece of literature with more confidence than I would ever have thought possible. The writing of this was undertaken at various points in the six weeks it took to complete the unit and therefore it might well appear a little disjointed. I have not spent a great deal of time on its presentation, nor is the quality of the typing anything other than acceptable. However, the strength of the document lies in its common-sense approach. Within these pages lie the answers to a number of questions which many colleagues have asked in relation to the teaching of KS4. The purpose of this document is to show how the play 'An Inspector Calls' by JB Priestley can be studied as part of a combined GCSE English/Literature course, fulfilling a number of the requirements of both syllabuses. When choosing a piece of literature, the most important consideration is what area of the literature syllabus you intend to concentrate on. All literature texts should be looked at in light of one or more of the following areas of study: I have decided to concentrate on 'Plot and Structure' and ' Characterisation', although all the other categories could be covered. I always feel a little uncomfortable studying 'Style' with anything other than a top group so I would tend to steer clear of that. The group I will be preparing work for is a Division 1 group of average ability, either Year 10 or Year 11. It is hard to envisag...

Free Trade Zones in UAE and Economic Development Research Paper - 2

Free Trade Zones in UAE and Economic Development - Research Paper Example This paper focuses on two companies only i.e. Abu Dhabi Airport Free Zone and Dubai Media City Free Zone. Abu Dhabi Airport Free Zone (ADAFZ) Positive Contributions to the UAE The Abu Dhabi Airport Free Zone is a business and logistics park which is being established by the Abu Dhabi Airports Company (ADAC). The creation of ADAFZ is a milestone for Abu Dhabi to globally establish itself as a leading business centre.  Expansion of the airport will enable passenger traffic to shoot from the current 7 million to over 40 million per year. Cargo capacity will also be boosted to two million tons from the current 150,000 tons per year. (Ameifo.com, 2011). According to uaefz.com, multiple business ventures are being established ranging from logistics, aviation and aerospace, consultancy, business development, computing and information technology, electronics, express transport, medical equipment and pharmaceuticals. Various amenities have been put together under one roof and conveniently i ntegrated to provide the best services for investors (Jumeiraconsultants.com, 2011).   The free trade zone provides the locals with better goods at subsidized prices hence boosting the economy. The cheapness of goods is usually as a result of cheap production costs in addition to cheap imported labor. The UAE is freed of re-tasking its resources and instead focuses on its comparative advantages. ADAFZ and other free trade zones function as economic laboratories, which allow UAE governments, to learn what will be most beneficial to their economies over a long time (Ehow.com, 2011). Negative Contributions to the UAE Abu Dhabi Airport Free Zone may appear as an equal opportunity for everyone, but, these advantages come along with some disadvantages. The disadvantages extend for UAE is related to the technology level which means that the less industrialized emirates may suffer a disadvantage till they technologically develop. When Abu Dhabi opened its borders to the other emirates to be in the same free trade zone, it also invited fierce competition as well. This means that the whole of UAE competes with one another (Uaefz.com, 2011). The free trade area may also economically develop the area around the airport more than other regions in Abu Dhabi and UAE as a whole. This region may attract more foreign investors than other regions which may lead to economic underdevelopment of some other areas in the free trade zone. The underdevelopment may also impact the Abu Dhabi’s (Ehow.com, 2011). The issue of opening of borders brings the challenge of corporations seeking out for the lowest labor and environmental standards in order to minimize its production costs hence pressuring for low working standards. Furthermore, the transparency and absence of strict regulations of ADAFZ make it an attraction for illicit investors to launder crime proceeds and maybe finance terrorism (Fatf-gafi.org, 2011). Benefits to Investors According to Abu Dhabi (2011) an investor ha s to lease the facility in

What causes homelessness Essay Example | Topics and Well Written Essays - 500 words

What causes homelessness - Essay Example 1995). The point is that the category of homelessness is rather huge, and there are many people, who may be considered as homeless. The more important thing is that classical homeless people have some, let’s say, classical reasons to live in such way. The reasons are the following: alcoholism, mental diseases, physical disabilities and simple laziness and life weakness (Shlay, Rossi, 1992). Recent sociological researches showed that such vision of homelessness is quite typical for almost all the people, and indeed these patterns of poverty are truthful in majority of cases, but still there are some essentially different situations when it turns out that people become homeless (Lee et al. 1990). For example, such exceptional cases may be bankruptcy, mortgage delinquency (which may be a result of job loss) etc. In general, there are a lot of huge economical problems that make people homeless. Actually, these problems are on the top of the list of reasons of homelessness. Also, we can’t forget about a huge group of mentally sick people unable to function in society in adequate way, so they go on streets trying to survive. Scientific researches showed that the level of mental diseases has grown with development of big cities. Psychologists think that the reason of such tendency is that people can’t stand rapid pace of globalization, so they begin mentally â€Å"breaking† or using drugs and alcohol (Mechanic, Field, 1987). The main point is that people start feeling their weakness and negligibility in this world; they feel lonely and unable of doing anything. Another economical reason of homelessness is increasing level of prices and especially the land ones and housing costs. There are many families that cannot afford buying an expensive house that would fit their families, or even cannot afford any housing at all (Freeman and Hall, 1987). The

Critical Reading and Writing in Developing Skills Personal Statement - 6

Critical Reading and Writing in Developing Skills - Personal Statement Example I realized that part of the learning process is the acknowledgment of mistakes and the ability to reflect on the progress of my writing process. Through time, I gained the needed confidence in writing and revising essays, according to detailed instructions, until these comply with the needed requirements. From the time I wrote my first essay, which detailed my worst reading experience, I am relieved that I would never feel embarrassed, nor inept, in exhibiting advanced reading and writing skills. The progress was evident from the lesser mistakes noted by peers and in more positive comments that were noted. I realized the value of proofreading, of developing my vocabulary through the constant reading of diverse discourses, and infrequently seeking the needed support and assistance from the writing center. The course was instrumental in making the journey to a more skilled reader and writer a rewarding and successful endeavor.  I realized that part of the learning process is the ackn owledgment of mistakes and the ability to reflect on the progress of my writing process. Through time, I gained the needed confidence in writing and revising essays, according to detailed instructions, until these comply with the needed requirements.                  

Ummary of the New Testament Term Paper Example | Topics and Well Written Essays - 1250 words

Ummary of the New Testament - Term Paper Example Love, which is the focal message of the Bible is widely discussed by the different authors and explicated in various ways. Warnings are given to the audiences about the end of the world, the second life and the doom of evil men in the gospels and discuss at large the kingdom of heaven or the famous millennial reign of Jesus in the book of Revelation written by John the beloved or the apostle. The gospels written by Matthew and Luke narrate the immaculate conception of Jesus through the virgin maiden named Mary, who was at that time engaged to be married to Joseph. Thoughts of breaking away from her silently because of the shame the circumstance could bring them were not implemented by Joseph because of his vision of an angel who explained to him that the baby Mary bore was from the Holy Spirit so instead he married her. Isaiah 7:14 gives this prophecy and was reiterated in Matthew 1:23. As popularly depicted during Christmas season, Mary and Joseph had to travel to Bethlehem for the census ordered by Caesar Augustus for the entire Roman world (Luke 2:1-7). This is referred as the fulfillment of the prophecy in Micah 5:2 as echoed by Matthew in chapter 2 verse 6 saying, â€Å"But you, Bethlehem, in the land of Judah, are not the least among the rulers of Judah; for out of you shall come a ruler who will shepherd My people Israel†. The baby was borne and was named Jesus whose last record of his childhood was when he was found at the temple questioning and sharing with the teachers the word of God. While the aforementioned gospels started their narration from the birth of Jesus, Mark and John the apostle meet up with them in the start of Jesus’ ministry only giving a few lines to trace back the objective of the Savior’s coming to the world with the introduction of John the Baptist. After Jesus was baptized, He was led to the wilderness to be tempted by the devil (Matthew 4:1-10, Mark 1:9-13, Luke 4:1-13) and when he successfully overcame the t emptations, He went back to His town and started performing miracles, the turning of water to wine being the first of them (John 2:1-11). Other miracles which have been discussed as well in the four books like the healing of the sick, driving out of demons from possessed people, raising of the dead and feeding of many people. The most famous of which is the feeding of the five thousand from the lunch box of a young boy which contained two fishes and five loaves of bread, found in all the gospels (Matthew 14:13-21, Mark 6:31-44, Luke 9:10-17, John 6:5-15). The most important objective of the four gospels is the reason why Jesus came to this earth, that is, to die on the cross so that the sins of men will be forgiven. After calling his twelve disciples and training them, performing many miracles, teaching and preaching the word of God for three years, Jesus was condemned to die by the teachers of the law, accusing him of blasphemy, claiming to be God because He claimed to be the Son o f God. Judas, one of His disciples betrayed Jesus for thirty pieces of silver to the chief priests and sent the soldiers to the Mount of Olives for His arrest. Jesus was then brought to Caesar for his conviction and was sentenced to death which started His sufferings

Discuss the usefulness and problems with contingency theories in Essay

Discuss the usefulness and problems with contingency theories in understanding organisational structure. How relevant can they b - Essay Example It is relevant to consider development of contingency theory and its application to organizational structure in order organizations’ managers had an opportunity to develop flexible approaches to organizational structural development. Therefore, contingency theory is an alternative for organizations looking for solution of their current problems and tending to structural changes. A basic conceptual framework of contingency theory is a phrase â€Å"it depends† (Donaldson, 2001). Therefore, any managerial solution should be made with regard to the external factors of a certain situation in an organization. Moreover, a great role in establishing organizational structure plays nature of the environment of organization. In accordance with the contingency theory: â€Å"there is no one best way to organize; any way of organizing is not equally effective† (Galbraith, 1973). In case a perfect relation between nature of organization, external environment and organizational characteristics is established, an organization is on the right way to performance. Such kind of match is called a ‘contingency theory’ or ‘contingency perspective/view’ (Donaldson, 2001). Studies of organizational structures in relation to external conditions of organizations’ operation resulted in studies based on the contingency theory. ... In the study made by Burns and Stalker (1961) mechanistic and organic principles of organizations were discussed. In organizations, where mechanistic principles prevailed, top managers developed a policy. Such kind of organizations was characterized by inflexible policies and rigid decision making. Luthans (1973) develops the idea of relation of contingency theory to management theory. Before theory developed by Luthans management theories were not related to each other. For example, process theory was based on planning, organizing, directing, and controlling (Donaldson, 1996). In order to find a perfect balance between management theories, contingency theory was a unifying approach defining interrelatedness and mutual dependence of all integrative parts of management theories. This approach was broadened and resulted in a â€Å"theoretical model of Structural Adaptation to Regain Fit (SARFIT)† (Donaldson, 1987, 2001). This model can be interpreted in the following manner: in case an organization finds a best relation between internal and external resources, it reaches high performance levels. It is a right way to reach size growth, introduce innovations and diversification (Hamilton and Shergill, 1992). Contingency variables may lead to organizational misfit to external factors. As a result, levels of performance are decreased and structural changes are introduced (Chandler, 1962). SARFIT theory implies consideration of structural contingency theory as relation between divisionalization changes and strategic changes. Bums and Stalker (1961) are focused on â€Å"discussion about changes in mechanistic and organic structures with regard to technological and market change in the external conditions† (Bums and Stalker, 1961).

Ummary of the New Testament Term Paper Example | Topics and Well Written Essays - 1250 words

Ummary of the New Testament - Term Paper Example Love, which is the focal message of the Bible is widely discussed by the different authors and explicated in various ways. Warnings are given to the audiences about the end of the world, the second life and the doom of evil men in the gospels and discuss at large the kingdom of heaven or the famous millennial reign of Jesus in the book of Revelation written by John the beloved or the apostle. The gospels written by Matthew and Luke narrate the immaculate conception of Jesus through the virgin maiden named Mary, who was at that time engaged to be married to Joseph. Thoughts of breaking away from her silently because of the shame the circumstance could bring them were not implemented by Joseph because of his vision of an angel who explained to him that the baby Mary bore was from the Holy Spirit so instead he married her. Isaiah 7:14 gives this prophecy and was reiterated in Matthew 1:23. As popularly depicted during Christmas season, Mary and Joseph had to travel to Bethlehem for the census ordered by Caesar Augustus for the entire Roman world (Luke 2:1-7). This is referred as the fulfillment of the prophecy in Micah 5:2 as echoed by Matthew in chapter 2 verse 6 saying, â€Å"But you, Bethlehem, in the land of Judah, are not the least among the rulers of Judah; for out of you shall come a ruler who will shepherd My people Israel†. The baby was borne and was named Jesus whose last record of his childhood was when he was found at the temple questioning and sharing with the teachers the word of God. While the aforementioned gospels started their narration from the birth of Jesus, Mark and John the apostle meet up with them in the start of Jesus’ ministry only giving a few lines to trace back the objective of the Savior’s coming to the world with the introduction of John the Baptist. After Jesus was baptized, He was led to the wilderness to be tempted by the devil (Matthew 4:1-10, Mark 1:9-13, Luke 4:1-13) and when he successfully overcame the t emptations, He went back to His town and started performing miracles, the turning of water to wine being the first of them (John 2:1-11). Other miracles which have been discussed as well in the four books like the healing of the sick, driving out of demons from possessed people, raising of the dead and feeding of many people. The most famous of which is the feeding of the five thousand from the lunch box of a young boy which contained two fishes and five loaves of bread, found in all the gospels (Matthew 14:13-21, Mark 6:31-44, Luke 9:10-17, John 6:5-15). The most important objective of the four gospels is the reason why Jesus came to this earth, that is, to die on the cross so that the sins of men will be forgiven. After calling his twelve disciples and training them, performing many miracles, teaching and preaching the word of God for three years, Jesus was condemned to die by the teachers of the law, accusing him of blasphemy, claiming to be God because He claimed to be the Son o f God. Judas, one of His disciples betrayed Jesus for thirty pieces of silver to the chief priests and sent the soldiers to the Mount of Olives for His arrest. Jesus was then brought to Caesar for his conviction and was sentenced to death which started His sufferings

Adolescent Suicide Research Paper Example | Topics and Well Written Essays - 2000 words

Adolescent Suicide - Research Paper Example Even silly problems will be perceived as complicated ones and they may take decision to commit suicide to escape from such problems. In many cases, substance abuse, momentary lapse of emotional control, lack of counseling, negligence from parents and beloved ones, stressful events are motivating teenagers to commit suicide. Teenagers with family history of suicide show more tendencies to commit suicide. Nursing professionals can help teenage community immensely in preventing suicide. They can help teenagers to solve their physical as well as mental problems with the help of proper medications and counseling. This paper analyses the reasons of teenage suicide and the nursing implications with respect to this social problem. Adolescent Suicide Suicide is the third leading cause of death in 15 to 24 year olds, and the third leading cause of death in 10 to 14 year olds. According to the National Institute of Mental Health (NIMH): There are 25 attempted suicides to one completed suicide - with the ratio even higher in youth and the strongest risk factors for attempted suicide in youth are depression, substance abuse, and aggressive or disruptive behaviors (Teen Suicide, n.d). It is impossible to know the teenager who committed suicide first in this world. It is also impossible to predict who could be the last teenager to commit suicide. ... Although child death rates are decreasing steadily during the last few decades, youth suicide rate travels in the opposite direction in United Sates. Reasons for adolescent suicide and nursing implications According to Shilubane et al. (2012), â€Å"Lack of knowledge of available counselors, conflicts in interpersonal relationships, perceived accusations of negative behavior, inadequate social support, past family and peer suicide attempts and poor living circumstances were factors found to be related with suicide attempts† (Shilubane et al. 2012, p.177). As mentioned earlier, many teenagers are committing suicide because of a momentary lapse in emotional control. For example, love affairs or dating relationships are common among current teenagers all over the world and the case of America is also not an exception. Teenagers who have feeble mental power or self-confidence may think about committing suicide when their love affairs break. They may not bother too much to think ab out substituting the lost relationships with another one at that moment. For them breaking of their dating relationships is the end of the road. Nursing professionals can help teenagers to overcome the emotional catharsis at various moments in their life. Many studies have proved beyond doubt that lack of availability and access to counseling is the major reason for increased suicide rates among teenagers. Counseling should be done at individual levels and family levels to educate the public about how to overcome stressful events and avoid suicides. Family nurse practitioner (FNP) is a respected profession in America now and these professionals can help the community in general and teenage community in particular in overcoming the tendencies of suicide. Poor living condition is

Compare & Contrast Han and Rome Essay Example for Free

Compare Contrast Han and Rome Essay When Han China and Imperial Rome are compared, one can find both similarities and differences in terms of techniques of imperial administration. A similarity would be that both are bureaucracies. However, both are also different. One major difference is that Han China had the civil service exams. They also differed because Han China had a much greater emphasis on religion than the Romans. These differences led to very different futures for the two empires, both of which were among the strongest in the world at the time. The first comparison is that both Han China and Imperial Rome were bureaucracies. They had a sole ruler, but they had many others governing specific portions of the empire. This allowed for the empire as a whole to be in better shape. This is due to the fact that a more localized ruler would better know both the area and its needs. They would also be more dedicated to their job as they would be managing the area they live in, so every decision they make would impact not only their life but possibly the lives of family living in the regions they are governing. The empires would be much worse off if they had their single ruler managing everything, as they would not fully understand the needs of the areas, nor would they care as much as they would most likely have no personal ties to those regions. Due to this, both empires were much more powerful and well organized. Another comparison is that Han China had the civil service exams, while Imperial Rome had nothing similar. The exam allowed for overall better governing and management of the empire. This is because the examination filtered out those who were unqualified for those positions and instead filled them with intelligent people who could do good for the empire. If they let unqualified people in that would greatly increase poor management because they would not be knowledgeable enough to make decisions that would benefit not only that one area, but the empire as a whole. Without the civil service exams, many unqualified people entered positions of power in Rome, and so there were many problems. The final comparison is that Han China had a greater emphasis on religion than Imperial Rome. In Han China, this was found in the mandate of heaven,  the structure of family found in the government, and that to get a good job in the government one needed to be educated in Confucianism. When the Han first took power, they incorporated the mandate of heaven into Confucian values, If the ruler was a good ruler, then they were supported by the heavens. Confucianism also led to the family hierarchy becoming the basis for government structure. Subjects owed the emperor the same obedience that they gave to their fathers. Religion was also important because one needed to be knowledgeable in Confucianism to get a good job, as the tests were mainly based off of Confucian texts. Rome, on the other hand, had no real religion within the government. While both Han China and Imperial Rome were different in terms of imperial administration because of Han China’s civil service exam, as well as Han China’s focus on religion, they are still similar due to the fact that they are bureaucracies. Even so, these differences and more led to very different futures for both empires, neither of which ended very well.

Pediatric Trauma Scoring System in Predicting Mortality

Pediatric Trauma Scoring System in Predicting Mortality PEDIATRIC TRAUMA SCORE AS PREDICTOR OF OUTCOME OF PATIENTS ADMITTED TO CENTRALIZED SURGICAL INTENSIVE CARE UNIT IN A GOVERNMENT TERTIARY HOSPITAL: A RETROSPECTIVE COHORT STUDY I. Justification of the Study Intensive trauma care of pediatric patients is faced with many issues such as quality of care, efficiency and cost-effectiveness. Scoring systems such as the Pediatric Trauma Score can aid in clinical decision making through objective measurement of severity of illness in relation to a particular outcome such as mortality or morbidity. In particular, scoring systems have become the standard for intensive care unit outcome and efficiency benchmarking. Furthermore, there is considerable difference between clinicians prognostication estimates. Early identification of patients with high probability of mortality can help families with difficult decisions, prevent unnecessary suffering and help direct limited resources to a more practical use. Thus, this study will investigate the use of a simple Pediatric Trauma Scoring system in predicting mortality. II. Relationships of research objectives, data substrates, operationally-defined variables and data analyses. Objective Data Substrates Operationally-defined variables Analyses To compare the outcome of patients to pediatric trauma score Pediatric trauma score sheet Pediatric Trauma Score Mortality rate per category of Pediatric Trauma Score Rate of patients with Prolonged Hospital Stay per category of Pediatric Trauma Score Relationship of outcome of patient (mortality and prolonged hospital stay) to pediatric trauma score TOPIC BACKGROUND Intensive trauma care of pediatric patients is faced with many issues such as quality of care, efficiency and cost-effectiveness.1 Quantitative observations of severity of illness in pediatric trauma using scoring systems has the potential to impact overall evaluation from baseline presentation to case endpoints.2 Scoring systems have become the standard for intensive care unit outcome and efficiency benchmarking.1 Early identification of patients with high probability of mortality can help families with difficult decisions, prevent unnecessary suffering and help direct limited resources to a more practical use.1 A Pediatric Trauma Score (PTS) was developed with grading variables commonly seen in pediatric trauma accounting for the unique physiological and anatomical nature. The PTS consists of six variables. Each variable is scored +2 for minimal or no injury, +1 for minor or potentially major injury, or -1 for major or life-threatening injury. The total score ranges from +12 to -6 with increasing severity.3 Scoring systems such as the Pediatric Trauma Score can aid in clinical decision making through objective measurement of severity of illness in relation to a particular outcome such as mortality or morbidity.4 Several studies revealed consistently the direct linear relationship between Pediatric Trauma Score and injury severity thereby confirming that P.T.S. is an effective predictor of both severity of injury and potential for mortality.5 REVIEW OF RELATED LITERATURE Most of the scoring systems are not appropriate for pediatric trauma patients. Variables such as respiratory rate, heart rate, and systolic blood pressure differ with infancy and childhood. In addition, the verbal response as used in GCS is not applicable for young children. For these reasons, Tepas and colleagues3 created the Pediatric Trauma Score (PTS). The authors stated that weight becomes a variable because pediatric patients had fewer physiologic reserve. Systolic blood pressure, patency of airway, level of consciousness, presence of wounds or fractures were variables included. 3 The presence of these injuries suggests severe energy transfer and positively correlates with concomitant visceral injury.10 Below is the Pediatric Trauma Score. Pediatric Trauma Score +2 +1 -1 Weight >20kg 10-20 kg Airway Patent Maintanable Unmaintainable Systolic B/P >90 mmHg 50-90 mmHg CNS Awake + LOC Unresponsive Fractures None Closed or suspected Multiple, closed or open Wounds None Minor Major, penetrating or burns The assessment of severity of illness as well as mortality predictive value of the Pediatric Trauma Score (P.T.S.) was evaluated in several studies with different conclusions. In a study by Tepas, three categories of patients with probability of mortality were identified. Pediatric trauma score of greater than 8 had a 0% mortality while pediatric trauma score between 0 and 8 had an increasing mortality related to their decreasing pediatric trauma score. Score of less than 0 had 100% mortality. This study documented the direct linear relationship between Pediatric Trauma Score and injury severity validating that P.T.S. is an effective predictor of both severity of injury and risk for mortality.5 Consistent with the findings of the latter, Ramenonofsky compared the evaluation of pediatric trauma patients by paramedic in the field versus the physician in the emergency room using the Pediatric Trauma Score. There was agreement between the scores of these two individuals 93.6% of the time, correlation coefficient 0.991, r2 = 0.982. The sensitivity and specificity of Pediatric Trauma Score was computed at 95.8% and 98.6%, respectively. He described Pediatric Tra uma Scoring System as a straightforward modality for assessing the severity of injury.6 Eichelberge examined the applicability of the PTS found significant correlations with survival, Injury Severity Score (ISS) and mortality. 8 On the other hand, the use of PTS as a predictor of mortality was found to be inadequate in a retrospective study by Balik. Size classification was noted to be overemphasized because of the low mortality (7.7%) in children less than 10 kg. Forty-nine of 71 surgically treated patients with intra-abdominal organ injuries had a PTS >8. The existing variables of PTS did not have equal relationships to mortality.7 Critics have also noted that the PTS suffers from scoring ambiguity leading to misinterpretation and inadequate scoring.11 Problem also arises due to a systematic bias in scoring. For example, the assessment of a patient’s consciousness can be done at the scene or on admission to the emergency department. 12 Despite exhaustive review of the literature on Pediatric Trauma Scoring, there has been no mention of the predictive value of Pediatric Trauma Scoring done on patients upon entry to an ICU. Conclusion of studies on Pediatric Trauma Score may be less generalizable due to possible variability in settings.9 RESEARCH QUESTION Among pediatric trauma patients admitted to Centralized Surgical Intensive Care Unit in Davao Regional Hospital, what is the relationship of outcome of patients to pediatric trauma score using a retrospective cohort study? SIGNIFICANCE OF THE STUDY Investigating the reliability of Pediatric Trauma Scoring system in predicting mortality and prolonged hospital stay is important. The results of this study can be a validation of earlier studies made on this scoring system as a tool in objective measurement of severity of illness as well as an intensive care unit outcome and efficiency benchmarking. OBJECTIVES To determine the pediatric trauma score of all patients and classify as to pediatric trauma score category of greater than 8, 0 to 8 and less than 0 To determine the mortality rate per pediatric trauma score category of greater than 8, 0 to 8 and less than 0 To determine the survival rate per pediatric trauma score category of greater than 8, 0 to 8 and less than 0 To determine the rate of pediatric trauma patients with prolonged hospital stay per pediatric trauma score category of greater than 8, 0 to 8 and less than 0 among surviving patients To determine the risk for mortality or prolonged hospital stay among pediatric trauma patients per pediatric trauma score category of greater than 8, 0 to 8 and less than 0 METHODOLOGY RESEARCH DESIGN A retrospective cohort study of all pediatric trauma patients admitted to Centralized Surgical Intensive Care Unit between January 1, 2013 to December 31, 2013 in Davao Regional Hospital will be conducted. SETTING This study will be conducted in Davao Regional Hospital (DRH), a tertiary hospital with 250-bed capacity, in Tagum City. The Centralized Surgical Intensive Care Unit (CENSICU) is an intensive care unit for adult and pediatric surgical patients in Davao Regional Hospital. The Department of Surgery of Davao Regional Hospital is a member of the Mindanao Integrated Surgical Residency Training Program under the Department of Health, Region XI. PARTICIPANTS All pediatric trauma patients admitted to CENSICU in Davao Regional Hospital between January 1, 2013 to December 31, 2013 will be retrospectively included in the study. INCLUSION CRITERIA All patients admitted to Centralized Surgical Intensive Care Unit due to trauma All patients aged less than 14 years old EXCLUSION CRITERIA Patients discharged against medical advice Patients transferred to another hospital OPERATIONAL DEFINITION OF TERMS Traumaan injury to any site of the body described as multiple or single (neck, thorax, abdomen or extremeties) site caused by an extrinsic, blunt or penetrating agent Pediatric trauma patients-patients aged less than 14 years old admitted due to trauma Pediatric Non-Trauma patients- patients aged less than 14 years old admitted for surgical intervention of non-trauma cause (example: intestinal obstruction due to Hirschsprungs disease, massive pleural effusion due to malignancy) Prolonged Hospital Stay-length of hospital stay is more than 14 days with or without surgical intervention DATA GATHERING All pediatric trauma patients admitted to Centralized Surgical Intensive Care Unit (CENSICU) in Davao Regional Hospital between January 1, 2013 to December 31, 2013 will be identified from the admission logbook in the CENSICU of Davao Regional Hospital. The patients will be identified using the inclusion and exclusion criteria . The list of patients will be submitted to Medical Records Section of Davao Regional Hospital for chart retrieval. The charts will be reviewed for the following data will be gathered from each patient: age in years, sex, length of hospital stay in days, weight in kilograms, systolic blood pressure in mmHg, patency of airway, loss of consciousness, presence of fractures and wounds. After calculating the Pediatric Trauma Score of each patient, the category of Pediatric Trauma Score (PTS greater than 8, PTS between 0 to 8, or PTS less than 0) can be determined. In addition, the outcome of the patient will be determined as to: Mortality With prolonged hospital stay among surviving patients MaIN OUTCOME MEASURES AND OTHER DEPENDENT VARIABLES The primary outcome is the mortality rate of admitted patients categorized per pediatric trauma score of greater than 8, pediatric trauma score of 0 to 8 and pediatric score of less than 0, respectively. The secondary outcomes are the following: Number of pediatric trauma patients categorized per pediatric trauma score of greater than 8, pediatric trauma score of 0 to 8 and pediatric score of less than 0, respectively Survival rate of admitted patients categorized per pediatric trauma score of greater than 8, pediatric trauma score of 0 to 8 and pediatric score of less than 0 Rate of surviving pediatric trauma patients with prolonged hospital stay per pediatric trauma score category of greater than 8, 0 to 8 and less than 0 INDEPENDENT VARIABLE The identified independent variables include age, sex, weight in kilograms, length of hospital stay, patency of airway, systolic blood pressure in mmHg, level of consciousness, presence of fractures and minor or major wounds. SAMPLE SIZE COMPUTATION Sample size for this study was computed using Epi Info 7 StatCalc. Calculations were based on the assumptions that: 1) the ratio of patients unexposed to the risk factor (i.e., PTS greater than 8) to patients exposed to the risk factor (i.e., PTS 8 or less) is 3; and 2) the prevalence of the outcome (i.e., death) in the unexposed group is 15%. Estimations were done in order for the study to detect an odds ratio of 5 as statistically significant. In a computation for odds ratio carried out with 5% level of significance, a sample size of 79 patients will have 80% power of rejecting the null hypothesis (no significant increase or decrease in odds ratio) if the alternative holds. DATA HANDLING AND ANALYSIS Clinical characteristics (age in years, sex, weight in grams, length of hospital stay), systolic blood pressure in mmHg, patency of airway, loss of consciousness, presence of fractures and wounds, and Pediatric Trauma scores of patients will be compared statistically. A p value will be computed to establish whether the difference in the values were significant or not. A p value The Pediatric Trauma Score of each patient will be calculated and the category of Pediatric Trauma Score (PTS greater than 8, PTS between 0 to 8, or PTS less than 0) to which the patient belongs will be determined. The total number of patients in each category will be evaluated. Outcome (mortality rate or survival rate) of each patient belonging to a particular category will be tallied and each frequency computed. Among surviving patients, length of stay will be evaluated as to prolonged (>14 days) or not prolonged. Rate of surviving patients with prolonged hospital stay will be determined. Risk of mortality as well as prolonged hospital stay among surviving patients will be expressed in odds ratios (OR) with 95% confidence interval.

A Therapeutic Relationship Essay -- Health, Nursing

A therapeutic relationship is a key component in the nursing profession. Without therapeutic relationships, the best possible care can never be provided. The foundation in which trust is built upon is created from the nurse’s ability to truly listen and respond appropriately. Listening creates the base in developing a strong, trusting relationship. Sometimes it is simply hearing what a patient says that makes all the difference, empowering them to open up and become more comfortable with the nurse (Hawkins-Walsh, 2000). The framework for creating a therapeutic relationship is built on the nurse’s ability to show empathy towards the client. Empathy is being able to put oneself in the patient’s shoes, to feel the same things they feel and to explore what it means to them (RNAO, 2002). Without the ability to relate to Irene, a trusting relationship cannot be developed nor can mutual respect be earned. Trust is the foundation for building a relationship; once created, the client feels more comfortable opening up. Trust is established in many ways; such as keeping confidentiality, be...

Titanic Essay examples -- essays research papers fc

TITANIC This paper will be about the sinking of the R.M.S. Titanic. Some people call this sinking the greatest maritime disaster. It wasn't just the fact that the ship sank, but also all the different circumstances that caused this ship to sink and take so many lives. In the time period of 1900's-1915's many things happened. One major disaster was the sinking of the Titanic. The information will be gathered from the library, a documentary film, the Internet and personal books. From these resources the paper will explain about how the Titanic sank, some of the people who were on the ship and how it was found after over 70 years at the bottom of the Atlantic. People who read this paper should learn about the history of the Titanic. The Titanic was originally designed to have three funnels, but four were used to make it look better. The fourth funnel was actually just an air vent. The main dining room was supposed to have a large dome but it was changed to a normal ceiling. The staircase was enlarged so it fanned out at the landing of each deck, as well as adding a large glass dome above it. Also, two extra elevators were added making a total of four. "She was the most beautiful ship afloat. No ship will ever resemble her class and luxury." ("R.M.S Internet") The R.M.S. Titanic was believed to be unsinkable. Bruce Ismay was the White Star Line chairman on the Titanic; he told the captain that the ship was unsinkable because the ship could have any four watertight compartments damaged and still stay afloat. He also believed that anything big enough to sink this ship, could be seen from miles away and be avoided. Mr. Ismay said, " Not even god himself could sink this ship." ("Titanic" Internet) Originally the plan called for 64 lifeboats but only 20 lifeboats were used. There were 14 wood lifeboats that could hold 65 people each. Two woodcutters that could hold 40 people each and four collapsible boats that could hold 40 people each. These lifeboats would only be able to hold about half of the passengers in an emergency. ( Internet) Knowing the lifeboats would only be able to hold about half of the passenger's, crewmembers still only filled some of the boats with less then 30 people. These boats were hal... ...e think that they should raise the Titanic so that they could explore it and study it. I think they should leave it where it is, out of respect at least. People lost their lives on this ship and deserve a place to spend their time. Not only will they disrespect the dead, but also by raising the ship, they will disrupt everything. Once the steel hits the oxygen, it will begin to corrode. After awhile, there will be no Titanic left at all and just so they could study it. " The Titanic surely should never be raised, it is a cemetery to all those who lost their lives that nite."(Ballard "Long" 708) WORKS CITED Ballard, Robert D. "How We Found Titanic." National Geographic (December 1985): 696-718. Ballard, Robert D. "A Long Last Look at Titanic." National Geographic (December 1989): 698-727. "R.M.S. Titanic†¦the story told." Internet. http://www.titanic.cc/titanic.htm. (4 Feb. 2001). "The Titanic Tragedy." Internet. http://www.angelfire.com/ct/titanickateleo/page11.html. (4 Feb. 2001).

Religion and Ethnic Diversity Paper Essay

According to Grace Communion International, people of the black churches believed much like the European Americans. They shared the belief that God’s past dealings give light of future life. The black churches tend to see America as the land of captivity rather than the promise land. The black churches shared similar beliefs to other groups but they did not always see quite the same, black churches tend to hold church into the late afternoon and felt they should try to help all members of the church with all aspects of life, other groups did not hold church for many hours. The historically black churches took it upon themselves to care for blacks, not just spiritually but physically as well because they felt they were discriminated against. The churches made it their job to try to care for the people who had no one else to care for them. Many churches offered services to blacks and whites, even though they did this the blacks were still segregated from the whites. It was stand ard practice for things of this nature to be done before there were churches built specifically for them, some didn’t even allow their presence. The black churches received a lot of discrimination, hatred, and prejudice from the white community. Often times they were not treated equal to white people as they should have been. I feel that reading a little bit about the black churches has given me a lot more history on it but it has not really helped me to understand the religion more than I already did. I have visited a black church and while they do not believe very different they practice their religion very differently. Black of the African decent are otherwise known as African Americans differ from many other groups based on their hair, skin tones, physical appearance, and the way they talk. Black people even have beliefs about how children should be raised and cared for. They may have similar qualities of other groups but there are many more differences. African Americans have had many, many experiences with other groups and how they differ from them and what qualities they display. Blacks are often discriminated against by many groups for the choices they make and the beliefs they practice. Blacks as a group tend to keep to their own and mind their business. Blacks originally over from Africa bring many things to the American culture such as food, clothing styles, music and much more. The African decent in foods has altered spices and more, and clothing varies by pattern and style of clothing but both have made a rather large impact. For many years in history  blacks were made to be slaves and were bought, sold and bartered for in America and even other countries. They were enslaved for a very long time until the north and south finally went to war over the matter and they gained their American right to freedom. Blacks were also segregated from whites for many years. Blacks were very heavily discriminated against by many groups but especially whites. Whites made enslaving blacks very important in their lives, while whites were the main source of slave drivers, there were also very wealthy black people who chose to have black slaves. Blacks received discrimination from many directions. I feel that I already had a very fair amount of information on blacks and the discrimination and prejudice they have received in the past and continue to receive. Blacks are often not given enough credit for all that they have to put up with, but society in my opinion has lightened up tremendously. Prejudice and discrimination in historically black churches and blacks are very similar, they were made to remain segregated for many years, and they were also discriminated against by many especially the whites, both groups revolve around blacks which make the prejudice and discrimination very similar. The prejudice and discrimination that blacks and the historically black church differ in the fact that the churches were not enslaved. There are not that many differences due to the fact that the churches are for the blacks. There are far more similarities than differences in the groups. From my personal knowledge of these two groups I can conclude that blacks are mostly discriminated against by whites, especially further back in history. Other groups discriminate against blacks and the historically black church but whites much more commonly discriminate against them and are prejudice. The more time that passes the better the circumstances become between groups.

Iron Crowned Chapter 12

There was a moment of stunned silence. â€Å"That's impossible,† said Kiyo at last. â€Å"Unless you're saying she should kill all those monarchs?† â€Å"No need,† the old man replied. â€Å"Even I know how it works,† I argued. â€Å"The only way to claim a land is if its previous monarch dies or grows too weak to hold it. Otherwise, they're bound together. The monarch and the land are one.† â€Å"Aren't you listening?† he asked. â€Å"The crown changes that. The crown breaks that bond. Doesn't matter how strong they are. No killing – unless you want to. The land is freed up, allowing you to seize it if you're strong and ambitious enough, which, of course, you have to be even to possess the crown.† Ambitious enough. His words reminded me of our fight, when I'd nearly killed Kiyo in my rage. I stared down at the crown in disgust. â€Å"I don't want it. I don't want that kind of power. That was never my intention.† The crown's keeper now looked as baffled as Kiyo and I had been moments ago. â€Å"Then why did you come for it?† â€Å"Eugenie,† said Kiyo uneasily. â€Å"I don't think you should leave it. Regardless of what it truly does †¦ well, the original plan still holds. You don't actually have to use it. Just having it may still be enough to scare Katrice into peace – especially if she knows its true power.† I lifted my eyes from the crown, staring off absentmindedly at the cave's scorched walls. â€Å"Of course she knows. And so does Dorian. He's known all along.† It was a sign of Kiyo's tact and self-control that he made no scathing remarks about Dorian. â€Å"You have to take it,† exclaimed the old man, glancing back and forth between our faces. He seemed shocked and even offended that I was seriously considering leaving it. â€Å"You passed the test. No one who has done that has ever refused the crown.† The sick feeling in my stomach grew. He knew. Dorian knew. â€Å"You don't have to use it,† reiterated Kiyo. â€Å"But Katrice won't know that.† â€Å"I was an idiot,† I murmured. â€Å"An idiot to think it was just a war prize. If I accept it †¦ what happens if someone else takes it? If it's stolen?† After experiencing so many attempts at rape, I was well aware of the extent of Otherworldly ambition. â€Å"The crown will only work for its current owner,† said the caretaker. â€Å"It will only stay with the worthy. If it's taken – or if you die – it will return here, and we will wait for the next challenger.† â€Å"Hold on,† said Kiyo. â€Å"You just wait here all the time? How old are you?† I didn't wait for a response. I felt dizzy on my feet and so, so tired, both mentally and physically. I wanted to get out of this place. â€Å"Let's go,† I said. â€Å"We'll take the crown.† The old man beamed. â€Å"Excellent. I look forward to hearing of your victories.† I scowled and moved for the exit. This was hardly the situation for warm and fuzzy good-byes, so Kiyo and I simply left without any more conversation, though I could feel the caretaker's gaze burning into my back. The trek out of the mountain was quiet as well and seemed to go much more quickly. The fire barriers were gone. When we finally emerged, the light and air of that barren landscape seemed like the sweetest, most refreshing thing ever. Volusian and Deanna were exactly where we left them. Deanna's expression lit up. Volusian's didn't ostensibly change, but I sensed definite dismay. â€Å"You did it!† exclaimed Deanna. â€Å"Now you can help me and find out – â€Å" â€Å"No,† I interrupted, heading straight to my horse. â€Å"Not now. We're not dealing with that yet.† Her pale eyes widened. â€Å"But you promised to – â€Å" â€Å"Not yet,† I growled. Something about my tone and look must have been pretty intimidating because she vanished without comment. I knew she'd be back, though. I glanced at Kiyo, who was already on his horse, face troubled. â€Å"Think those snakes are regular residents or just part of the test?† I asked. He glanced around, taking in the scattered holes in the ground. â€Å"I don't think we can assume they're gone.† I made sure my pack was secure, the crown inside it. â€Å"Then let's get out of here. We're not stopping until we're out of the unclaimed lands.† Kiyo's face was lined with worry. â€Å"Eugenie – â€Å" But I was already urging my horse down the road, back in the direction we'd come. Our initial ride had been brisk but still energy-conserving. Now, I held nothing back. I let the horse run as fast as she could, half-suspecting she wanted out of this cursed place as much as I did. The speed and rush of air was almost enough to distract me from what had just happened and what was to come. Almost. Kiyo easily kept up with my hard pace, and the speed made any conversation difficult. I lost track of time but had the sense of riding for hours as the sun moved across the sky. I fell into such a lull surrounded by the dreary landscape that crossing back into the Otherworld's claimed regions was like a splash of water in the face. We'd emerged into the Honeysuckle Land and were suddenly surrounded by heat and color. Kiyo slowed his horse down. â€Å"Eugenie, we have to stop.† When I didn't react, he yelled more harshly, â€Å"Eugenie!† It snapped me from my haze, and I slowed too, eventually bringing my horse to a halt. His trotted up to us. â€Å"Eugenie, it's almost night. We have to make camp here. We'll be safe now that we're out of that place.† â€Å"Safe? I'm a war leader. This place isn't on our side yet. They could have a lot of leverage if they found and captured me.† â€Å"That's just an excuse,† he said. â€Å"It won't happen, and you can't keep up this pace without rest. The horses certainly can't either.† I didn't know much about animals, but Kiyo did. These two didn't seem ostensibly exhausted, but they were breathing a bit more heavily than when we'd left. I petted the head of mine in apology. I didn't want to stop, but Kiyo was right. The lush and beautiful land provided any number of camping spots. The trick was finding a concealed one that kept us near the road. If we strayed too far, the Otherworld's nature could very well shift us away to another location. And, despite his confident words, I think Kiyo did worry a little bit about the Thorn Queen being discovered in this kingdom. At least we had Volusian to keep watch. We finally settled for a small glade that was almost impossible to see through the trees until you were right inside it. Not far away was a small lagoon edged in stones. I was filthy from the fight but didn't have the energy to bathe fully and settled for washing my hands and face. Nonetheless, back in our camp – which really was just a place to sleep since we needed no fire here – Kiyo insisted on changing my bandages again. â€Å"You tore more stitches in the lich fight,† he said with dismay. â€Å"We can keep the blood loss down, but you have to get this treated soon.† I nodded without hearing him, my mind still wrapped around what I'd learned. Once he'd pulled my shirt back down, I turned and faced him. â€Å"Dorian knew, Kiyo. Dorian knew what this crown could do. That's why he wanted it. I wouldn't be surprised †¦Ã¢â‚¬  It killed me to say the next words. â€Å"I wouldn't be surprised if he set it up from the beginning with Masthera.† I again expected mockery from Kiyo, but his dark eyes were serious and full of sympathy. â€Å"I wouldn't be surprised either. I'm sorry.† It was true what I'd said in the cave: I was such an idiot. I should have listened to my initial instincts, the ones that said a battle prize wasn't enough to end a war. A prize that could strip Katrice's kingdom from her? Yeah. That would end a war, true, but Dorian should have told me. He should have told me what the crown's real threat was. And then you wouldn't have done it, a voice in my head pointed out. I knew it was the truth. I wouldn't have risked my life – or Kiyo's – to come after some artifact that put me one step closer to being the conqueror everyone expected me to be. â€Å"Dorian knew,† I repeated. â€Å"Dorian let me risk my life for this.† Kiyo stayed silent for a few moments, staring off into the rapidly darkening trees around us. â€Å"You said he resisted at first, though. Until he realized I could go.† â€Å"Was that an act, though?† I rested my forehead in my hands, doubting everything I'd come to believe about Dorian. I'd so, so wanted to trust him. â€Å"Did he pretend to be hesitant, knowing I'd be suspicious if he was aggressive?† â€Å"For all his faults †¦ I don't know. He does care about you, Eugenie. I don't think he'd carelessly throw you into danger. He might have seriously waited until he knew you could go in with backup.† I sighed and lifted my head back up. â€Å"You're giving an awful lot of credit to someone you hate.† A small smile crossed Kiyo's lips. â€Å"I don't hate him, not exactly. I don't trust him. I don't like him. And †¦ well, I certainly carry a grudge for his taking you from me.† I narrowed my eyes, a spark of anger flaring up in me. â€Å"No one ‘took' me. I'm not something you guys can just pass around!† â€Å"Sorry, sorry,† he said hastily. â€Å"I didn't mean it like that. I just mean that after we split up, it's been hard seeing you with him. That's petty jealousy, I admit it. But I also hate that his grand, brash action won you over and drove the final stake in our relationship.† â€Å"His ‘grand, brash action?' Do you mean killing Leith? I'll never regret him doing that,† I said fiercely. Despite how dark it was growing out here, I could see Kiyo's eyes boring into me. â€Å"Do you mean that, Eugenie? Was your personal vengeance worth all the people who've died since then?† I looked away. â€Å"He deserved it. You don't understand.† â€Å"I understand perfectly well what he did. And if I could have? I would have done a lot more than run a sword through him. Really, that was almost merciful compared to what he deserved. But the fallout †¦Ã¢â‚¬  â€Å"I know.† I sighed again. â€Å"I know what I've caused, all the upheaval in this world.† A sudden odd thought occurred to me. â€Å"Maiwenn †¦Ã¢â‚¬  Kiyo tensed, not following my jump in thoughts. â€Å"What about her?† â€Å"Dorian knew that too! She knows what the crown does; I'm certain of it. That's why he kept telling me not to let you talk to her!† I shot up, full of fury now. â€Å"Goddamnit! He played me. He's always played me! It doesn't matter if he loves me. It's his nature. He can't love without using it to his advantage. Goddamnit!† My cry rang out into the empty night as I paced irritably. In seconds, Kiyo was up too, gripping me by my arms. â€Å"Hey, hey. Calm down. He may have tricked you, but he can't make you do anything you don't want to with the crown. You're in control. No harm's done.† â€Å"No harm?† I exclaimed. â€Å"Kiyo, I almost killed you! Do you understand? Do you understand what I almost did? I lost control! How am I supposed to forgive myself for that?† He drew me into his arms. â€Å"I forgive you for that, and that's all you need to worry about. Don't beat yourself up with the guilt.† I clenched my fists. â€Å"The craziest part is that the fake-lich whatever guy thought what I did was a good thing. Me shoving my friends aside for power. That's what the crown represents. That's what I'll become.† â€Å"I won't let you,† said Kiyo fiercely. â€Å"It's in my blood,† I said weakly. â€Å"I realize that now.† â€Å"Maybe. I don't know. I used to think †¦ well, I used to think it was all just some easy decision you could make. ‘Do this, don't do this.' That was stupid of me. It's more than that, this conflict in you. And I didn't help – not in the way you needed. I will now – if you'll let me.† I peered up at him in confusion. â€Å"Why? After everything I've done?† â€Å"Because I – † Kiyo cut himself off. I could hardly see him now, but the feel of his hands was warm on my skin. â€Å"Because it doesn't matter. Because I screwed up. Because we never should have split up. I've been wanting to tell you something for a while. We should have – â€Å" I broke away and stalked off across the glade. I couldn't hear this. I couldn't hear some proclamation of love, not when my heart was still broken over Dorian's betrayal. I'd trusted him. I'd trusted him, despite all the evidence that he would go to great extremes for power. I'd thought love for me would be stronger than that ambition. I'd been wrong. Even if he loved me, his heart would always be split between me and his craving for power. It was his nature, just as my own nature was divided between human and gentry ways. â€Å"I need to sleep, Kiyo,† I said roughly. â€Å"I can't hear this right now.† â€Å"But Eugenie – â€Å" â€Å"Good night.† I turned my back to him – I knew he could see in the darkness – and curled up on the grass. It was hardly a comfortable bed, but compared to last night's discomfort, this felt like heaven. Kiyo said no more, and I eventually heard him settle down. Volusian had been put on watch, meaning neither Kiyo nor I had to stay awake. In my case, it didn't matter. Sleep wouldn't come no matter how much I willed it to. I stayed up most of the night, staring up at the clear sky and its glitter of stars. The Otherworld had the same constellations as the human world, which surely presented some sort of physics quandary, one I didn't have time to think much about right now. Dorian knew. That crown. That fucking crown. Part of me wanted to go over to my bag, grab the crown, and throw it off into night, never to be seen again. What had the old man said? It'd return to its home? No harm done. No harm except the loss of my potential to steal Katrice's land from her – hers and anyone else's who opposed me. Was that what Dorian had wanted? Would he have tried to convince me that it was the only way to win the war? And would I have believed it? Maybe. I'd been willing to risk a lot for peace by coming after the crown at all. Maybe that had just been the â€Å"gateway drug† in Dorian's eventual plan for conquest. In the end, it didn't matter what his plan was. What mattered was that he'd betrayed me. I'd opened myself to him, loved him. That was over now. It was that thought, that thought and the anger burning within me, that got me up and around early when dawn broke. Kiyo – who apparently had slept – instantly woke when he heard me stirring. â€Å"Let me guess,† he said. â€Å"You didn't sleep.† â€Å"Nope.† I took out some of the travel food from my bag, cringing when my fingers brushed against the crown. Kiyo stood up and stretched, then wandered off into the foliage. He returned several minutes later with some mangos in his arms. â€Å"Supplement your breakfast,† he said, tossing me one. He leaned against a tree and bit into one of his own. I nodded my thanks, but the fruit's sweetness was lost on me. Nothing had any taste. I was distantly aware of Kiyo's eyes on me but ignored them. â€Å"What are you thinking?† he asked at last. â€Å"How much I hate Dorian.† â€Å"What are you going to do?† This was something I'd thought about for a while, so I had a solid answer. â€Å"Go to him. Call him out. Pass him a note in class. Tell him it's over – everything. Us. Our alliance.† Kiyo's eyebrows rose. â€Å"You might not want to be so hasty on that last one.† â€Å"How can I be in a partnership with someone like that?† I exclaimed. â€Å"You can be in business with people you don't like. I wouldn't throw away his military support in the middle of this mess.† â€Å"I don't need his help,† I said obstinately. â€Å"Especially if Katrice does call a truce over the crown.† â€Å"And if she doesn't?† â€Å"I don't know.† I stood up and rubbed my sticky hands on my jeans. Kiyo was the last person I expected to be having this discussion with. â€Å"What are you getting at? Should I forgive him? Let it all go and jump back into bed?† â€Å"No. Absolutely not.† Kiyo walked over to me, almost mirroring our positions from last night when he'd been on the verge of telling me something romantic. Only, I'd since had more time to come to terms with my anger and could actually focus now on Kiyo, the concern in his eyes and the way his body always made mine feel. â€Å"But I don't think Dorian will leave the war, no matter what else happens between you. And you should take that help.† â€Å"I'm afraid †¦Ã¢â‚¬  Until those words came out of my mouth, I didn't realize I meant them. â€Å"I'm afraid when I see him, when I talk to him †¦ he'll do it again. He'll convince me of, I don't know. Whatever his plan is. He'll justify it and lure me back in.† Kiyo cupped my face between his hands. â€Å"You don't have to do anything you don't want to. You're strong. And I'll go with you, if you want.† I looked up into Kiyo's eyes, feeling lost in their depths and confused by what I saw in them. â€Å"I do want you to.† Leaning down, he pulled me close and kissed me almost before I realized what had happened. There was heat in his lips, heat and hunger and that raw, animal passion that so defined him. My body pressed against his, and I was startled at the arousal that kiss ignited within me, me who twenty-four hours ago had been sworn and sealed to Dorian. Now, the desire within me was all for Kiyo, a desire that was probably equal parts revenge against Dorian, a resurgence of my feelings for Kiyo, and the simple lust triggered by being with anyone I found so attractive. I pulled away from him, and it wasn't easy. That kiss had consumed me, taken over my reasoning. I had a feeling I was seconds away from ripping his clothes off and throwing myself at him. Some annoyingly rational part of me kept saying I shouldn't do that until I knew for sure if it'd be because I still cared about Kiyo or because I wanted to get back at Dorian. â€Å"No, don't. I can't,† I said, taking a few steps away. â€Å"I'm not †¦ I'm not ready†¦.† I knew he could tell that wasn't exactly true. He'd be able to smell the desire on me, the pheromones and other physical signs that said I wanted him. But my head and heart? No, I wasn't sure about that. â€Å"Eugenie †¦Ã¢â‚¬  His voice was husky, every ounce of him radiating that dark, primal sexuality that had always drawn me in. â€Å"I can't,† I repeated. â€Å"Please †¦ don't do that again†¦.† I hurried off blindly, into the forest, ignoring the branches and leaves whipping against me. I didn't have to go very far because something told me Kiyo wouldn't follow. He'd leave me alone for now. I sank to the ground, leaning my head back against the smooth bark of a tree I didn't recognize. My heart pounded in my chest, in turmoil from Kiyo's advances. I'd suspected he still cared, especially seeing as the breakup had been more my idea than his. He'd conceded its wisdom, true, but I'd always known he'd wished things could have been different. Hell, that made two of us. I exhaled and closed my eyes. What did I do with this? What did I do with Kiyo's feelings? What did I do with my own feelings? Because at the core of it all, my heart was still raging over Dorian. I'd meant what I said to Kiyo: I was indeed going to go back and tell Dorian we were over. I'd been disappointed in Kiyo – still was, a little – over his not taking direct action against Leith. Yet, as much as that had hurt me, Kiyo had been blunt and open about his reasons for it. That was better than someone telling you pretty lies. Pretty lies. Dorian was full of them – and not just about the crown. Suddenly, I found myself questioning why he'd even suggested Kiyo come along on this quest, rather than Jasmine. Maybe Dorian had thought this would be a convenient way to get rid of someone he'd always seen as a potential rival. I didn't know. The only thing I was certain of was that I was getting more and more worked up as I sat there. A faint splash startled me out of my emotional maelstrom, and I opened my eyes. No cry of alarm had come from Volusian back at camp, and a moment later, I realized what was going on. Rising, I headed over toward the pool in the glade's heart. Sure enough, I found Kiyo swimming laps back and forth. The lagoon was crystal clear, sparkling in the morning sunlight, and it sang to my magical senses. I wondered if he was there to clean off yesterday's battle or to work out his frustration over me. Judging from the lines on his face – maybe both. I watched him for a minute, knowing opportunities to catch him unaware were rare. The water and his mood had distracted him; he normally would have smelled and heard an observer. After a little while longer, I made my decision. I began taking off my clothes. Kiyo turned and noticed me just as I slipped into the water, easing myself down the stone edge. â€Å"Eugenie †¦ what are you doing? You're soaking your bandages.† I swam over to him, on the pool's far side. â€Å"I'm here naked with you, and that's your biggest concern?† He eyed me carefully. â€Å"Well, that was our last batch of them.† I put my hands on his chest. â€Å"We'll be home soon.† When I brought my lips to his, joining us in a deep kiss, I felt the same response as earlier. He answered me hungrily, arms wrapping around my waist as we pressed together. Now, however, it was Kiyo who broke us apart – despite the arousal in his eyes. I had a feeling there was a human versus animal war going on within him. â€Å"Wait,† he said. â€Å"Earlier †¦ you told me you couldn't †¦Ã¢â‚¬  â€Å"I changed my mind. I can do this,† I said. â€Å"Does it need to be more than that right now?† I was still going to tell Dorian I was done with him, but I didn't need to for this. I had mentally broken up with him. I was free to do whatever I wanted. I moved toward Kiyo again, slowly walking us toward the water's edge. Our top halves emerged, the morning air slightly chill against my wet skin. â€Å"I don't trust why you're doing this,† said Kiyo. But when I drew him closer, he didn't pull back. â€Å"I think you're getting back at Dorian.† I kissed him hard, cutting off whatever logical arguments he might attempt. â€Å"Maybe I am,† I said at last. He was gasping, a little surprised at the intensity. I felt empowered, filled with lust for Kiyo and – yes – anger at Dorian. â€Å"But you're the one I'm doing it with. Doesn't that mean something?† There was a pause as Kiyo's dark, smoky eyes studied me intensely. â€Å"Yes.† With one swift motion, he turned me around, pushing his body against mine. â€Å"It does. This is how it should have been anyway.† I caught my breath as he kissed my neck, teeth grazing my skin. â€Å"And I'll take back what's mine.† My body burned, both at his touch and the dangerous tone in his voice. Then, the full meaning of his words hit me. I started to turn around but his hands were on me, pinning me against the ledge surrounding the water. â€Å"Hey, I'm not yours,† I growled. â€Å"I thought I made that clear.† â€Å"You're right,† he said. â€Å"But you're not his either. Not anymore. You never should have been. We never should have been apart. And if you want this – if you want to do this – you have to tell me you feel something for me. I can't believe this is just simple revenge sex.† â€Å"Kiyo – â€Å" The hands that held me slid forward to my breasts, the roughness of his touch sending shockwaves through my body. â€Å"Tell me,† he breathed against my ear, his hands sliding along my stomach and down between my thighs. â€Å"Tell me you still feel something for me.† His body closed the miniscule space left between us, pushing me right to stone. I felt him hard and ready. â€Å"I †¦Ã¢â‚¬  I closed my eyes, lost in the way his hands touched me and stoked the sexual tension that had been building between us for days. What did I feel? For a moment, I was conflicted. Maybe this wasn't right. Maybe I did need to end things formally with Dorian before letting my emotions run away with me. â€Å"I †¦Ã¢â‚¬  â€Å"Yes?† He bent me over, hands gripping my waist, and suddenly, he was sliding into me, a low groan escaping his lips as he filled me up. I gave a small cry at the unexpected act, one that turned into a moan of pleasure as he began to move in and out of me. â€Å"Tell me there's still something, anything †¦Ã¢â‚¬  he grunted. â€Å"If not, I'll stop and let this go. Just say it.† â€Å"I †¦Ã¢â‚¬  Again, I couldn't summon the words. This time, it was simply because I was too lost in how he felt. I'd forgotten what it was like with him, the way he'd always loved to take me from behind, driven by the animal instinct within him. There was more than that to him, though. Images flashed through me, the way he'd fought by my side, the compassion when he'd seen how hurt I was over Dorian's deception. â€Å"Tell me,† he said again, a savage and hungry note in his voice. â€Å"Tell me you want me; tell me there's still something between us. That you don't want me to stop.† He felt so good, so strong and hard. â€Å"No †¦Ã¢â‚¬  â€Å"No what?† â€Å"No †¦ don't stop †¦ there is †¦ of course there's still something†¦.† I meant it. And with that, the animal within him was unleashed. I screamed as he gave me the full force of his body, my arms pushing hard to keep me from being shoved against the ledge. The sound of our bodies slapping together echoed around us as he thrust tirelessly, taking me over and over as he reclaimed my body. â€Å"I've missed you, Eug,† he managed to say. â€Å"Missed having sex with you. Missed making love to you. But especially †¦ especially missed fucking you.† His words were punctuated with a particularly sharp thrust, one that took me hard and deep as he bent me over more. I screamed again, but it was out of ecstasy, not pain. Kiyo had always been able to make me come this way, and now was no exception. I felt the nerves of my body explode, every part of me shaking. Still he kept moving in me with that primal need, pushing me into sensory overload. He'd given up on words, simply making small grunts as our bodies connected. At last his body reached its breaking point, giving me the hardest thrusts he was capable of as his climax hit. He held me tight, my body there to fulfill his need as he came in me, groaning and spasming until he'd finally given me all he had. He pulled out, and I turned around, my own breath shallow and rapid. â€Å"That †¦ maybe we shouldn't have done that †¦Ã¢â‚¬  Kiyo put an arm around my waist and pulled me to him. His lips grazed mine. â€Å"You sound like a guy the morning after. You're the one who attacked me, remember?† â€Å"True,† I admitted. With my lust sated, I was feeling slightly more coherent. But only barely. His naked body was still right against mine, and that was distracting. â€Å"Give me a few more minutes,† he murmured. â€Å"A few more minutes and we can do it again †¦Ã¢â‚¬  â€Å"We're probably just creating more problems.† He kissed my neck. â€Å"What's one more problem among all the others we have? One more time, Eugenie. I've missed you so much. Let's do this just one more time.† I could feel that he was indeed almost ready again. I lifted one of my legs up, half-wrapping it around him as my body decided it was ready again too. â€Å"And then what?† â€Å"Then?† Kiyo's mouth moved toward mine. â€Å"Then we go see Dorian.†