...practice, and utilize my chain of command. In accordance with my duty to maintain a safe environment, the use of maximum sterile barriers while placing central venous lines (CVL) and arterial lines to prevent infections will be exercised. Approximately 3 months ago, I was involved in a patient care situation that exemplified the need for accountability from professional nurses. A four year old boy came in with a ventriculoperitoneal (VP) shunt malfunction. He presented to the children’s emergency room with decreased level of consciousness, nausea, vomiting, and headache for two days. He rapidly worsened; by the time he was admitted to my unit, he was intubated, hypothermic, and hypotensive. He needed a VP shunt revision, but would have a lower chance of survival if he was not first stabilized. He came over with one peripheral IV, but it was not sufficient for the multiple boluses and vasopressors that were needed to sustain his rapidly dropping blood pressure. We needed more lines, immediately. The intensivist ordered insertion of a femoral CVL for fluids and medications and an arterial line for continuous monitoring of his blood pressure and blood draws. According to hospital policy, under patient care procedure 15.09.04, insertion of a CVL requires use of sterile technique. Statistically, femoral-placed lines come with the highest risk of infection (Henry, Jimenez, Lorente, Martin, & Mora, 2005). As the team began preparing the...
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...roadway system and provide transportation planners the basic data in the evaluation of the effectiveness of capacity improvement measures. Information on highway traffic conditions is usually collected by organising and conducting traffic surveys and studies. Traffic studies may be grouped into three main categories as inventories, administrative studies, and dynamic studies. Of these three the dynamic traffic studies involve the collection of data under operational conditions and include studies of speed, traffic volume, travel time and delay, parking and accidents. This study is made to evaluate current conditions and develop solutions on highways. In this research this type of study is made into the speed-density relationship of an arterial road in the Kumasi metropolis – the case study of the road between the Komfo Anokye Teaching Hospital Roundabout and the Bekwai Roundabout. This corridor is located at the heart of the city and connects the different suburbs of the...
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...Dear Councilor, We are a facing traffic menace that seems to get no respite from frequent traffic snarls. Local residents in the Canterbury Bankstown region are unanimously groaning under the weight of the chaotic traffic management of some of Sydney’s busiest and well known roads and without a kinetic and curated strategy the quandary will continue to choke our city. Average travel times for commuting trips by both car and public transport for Greater Western Sydney residents are on a daily basis longer than for the rest of Sydney. With a constant foot on the brake, commuters are finding it hard to keep moving . In recent findings by the Department of transport, the average commuting time of residents within this region has crawled to an intolerable 34 minutes one way only to be further delayed in ravaging weather conditions. With the transport system unravelling everywhere, projections on other vital fronts are further cause for pessimism. Not surprisingly, public transport's decline is counterbalanced by growth in car ownership and increased saturation of traffic volumes on the city's packed roads. This limited choice for intra- regional travel and the lack of key public transport linkages to employment opportunities, facilities and services exacerbates the existing traffic dilemma. The State Government had hoped its Metropolitan Strategy would guide the city's growth. Instead, the strategy has become a lightning rod for all sorts of dissidents all yearning for a new...
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...ANTECEDENTES La organización civil “México Tierra de Amaranto, A.C.” (MTA), surge de haber ganado el primer lugar de Biología en el VIII Premio Nacional Bachillerato Anáhuac, 2004. El proyecto consistía en demostrar que el Amaranto era un alimento prebiótico o funcional. Motivados por el triunfo, invitaron a Kellogg´s S.A. de C.V. a que desarrollara un producto que empleara el amaranto como ingrediente principal. Para 2005, Bimbo acepto sumarse a la propuesta, siempre y cuando garantizaran la producción y entrega optima del producto y con calidad. Se lograron algunos acuerdos con productores y apoyos por algunas entidades. Se implementaron cultivos traspatio en comunidades de escasos recursos para apoyo a productores, hubo personas involucradas en la elaboración de pan de amaranto ya que se contaba con panaderías. Se comenzó a cuestionar si el logro de las siembras debía ser responsabilidad de la Asociación ya que no contaba con la infraestructura, se encontraba limitada en maquinaria, también se cuestionaban si lograrían tener un grano de calidad y si se podían hacer compromisos con Sagarpa, Sedea, Inifap y los gobiernos municipales. DILEMA, RETO EL principal dilema es como presentar los logros obtenidos por la Asociación para seguir recibiendo apoyo de la Secretaria de Desarrollo Social de México, para el impulso de la transformación y consumo del amaranto en la entidad apoyando comunidades de escasos recursos. PARTES INVOLUCRADAS Ing.Mary Délano Frier. Iniciadora...
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...COMO AFECTA LA ALIMENTACION DURANTE LA JORNADA ESCOLAR Escrito por: López Pingarron Yazka y Pont Acosta Michelle Una mala nutrición puede reducir la inmunidad, aumentar la vulnerabilidad a las enfermedades, alterar el desarrollo físico y mental, así como reducir la productividad en la vida diaria. Según la OMS (organización mundial de la salud) la nutrición es la ingesta de alimentos en relación con las necesidades dietéticas del organismo. Una buena nutrición (una dieta suficiente y equilibrada combinada con el ejercicio físico regular) es un elemento fundamental de la buena salud. En estos tiempos, se puede ver que en la mayoría de los niños que están en edad escolar (4 a 15 años) presentan una serie de malos hábitos alimenticios: tales como el aumento en el consumo de comida chatarra y procesada, mientras que la comida casera y los alimentos de origen natural parecen estar inexistentes para ellos. Esta mala alimentación influye en el rendimiento escolar de manera negativa. Connie Crawley, especialista en nutrición infantil dice que “cuando los niños entran en la escuela, afrontan nuevas experiencias y desafíos. Uno de estas experiencias nuevas es el comer en la escuela. Los niños en esta edad y sobre todo en esta situación, toman la decisión que más les acomode, eligen que comer, cuál será la porción y a qué hora tomaran sus alimentos. En esta etapa, es bueno enseñarles la importancia de una dieta sana y balanceada, mostrarles como una mala alimentación afecta...
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... Traffic is everywhere around us. It is all around our country and state, and the world is multiplying at a rapid rate. Therefore, increasing the amount of people, and the quantity of drivers on the roads. Our city of Corpus Christi is expanding even more as well. As a result, this can be considered one of the strengths because more people means more profit for businesses and the city. According to the United Census Bureau, the last population count was taken in 2014. The results came out to 320,434. That is 15,219 additional people added to our community in 4 years since the last count in 2010. However, even though more people can be a good thing, it causes more issues. Some weaknesses of traffic is extra people means additional people driving which causes traffic jams, car accidents, and other vehicle related incidents. The congestion of traffic in our city has become so serious, it is causing a lot of issues, so some possible solutions that can help limit the congestion and make driving easier is, fixing damaged roads up, doing construction work overnight instead of during the day, adding individual red stop lights at the exits of major roads off of the freeway instead of yielding traffic, enforce the law about people utilizing their phones while driving, and the overall best solution is for more people to utilize public transportation. Initially, the first possible solution to reduce congestion is fixing up damaged roads. The roads in Corpus Christi are falling apart and...
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...Información de Pasta Base Coordinación SIDA, Gob. De la Ciudad de Buenos Aires La pasta base es un derivado del proceso de elaboración de la cocaína. La cocaína se extrae de las hojas del arbusto de la coca (Erythroxylon coca), originario de la región andina de América del Sur. Esta planta posee más de 14 alcaloides y el principal es la cocaína. Elaboración En una primera fase mezclan las hojas con carbonato potásico, o potasa, para disolver los alcaloides. Luego lo rocían con queroseno y ácido sulfúrico, y lo filtran. Agregan al producto más ácido sulfúrico que deja sobrenadando el queroseno sobre un sedimento con los alcaloides de la coca. Con más carbonato de potasio se precipitan estos alcaloides con restos de hojas maceradas. El nuevo filtrado da una pasta terrosa que se conoce como "pasta base", que aún incluye hidrocarburos y restos tóxicos de los solventes utilizados. Agregando ácido clorhídrico a la pasta base se produce clorhidrato de cocaína, el que precipita en sal agregando bicarbonato de sodio y éter es un polvo blanco “cocaína”. El crack se obtiene sobreagregando a la cocaína bicarbonato de sodio, y luego agua, calentando hasta obtener un precipitado en forma de cristales que se llaman crack , por el sonido crepitante que producen cuando se calientan para inhalar sus vapores. En latinoamérica muchas veces se le denomina crack a la pasta base ...
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...Reasons behind traffic jam in Dhaka city (a) City lay-out (master plan) and over-population: The causes of traffic congestion in Dhaka city are multifarious. Starting from the city itself, it is observed that the skeleton, structure and lay-out of Dhaka City are not well-planned and well-directed. Dhaka is also a highly populated city. More than one crore people live here and the figure is increasing day by day. This huge population acts as an auto-catalyst of traffic congestion in Dhaka City. (b) Inadequate and unplanned roads: Dhaka City has very inadequate road networks. For a standard city, where the minimum road requirement is 25%, Dhaka has only 7.5% road of its total area. 30% of this 7.5% road is also occupied by the hawkers, salesman and shopkeepers. A significant portion is occupied by construction materials and waste-containers of the City Corporation. As a result, vehicles do not get sufficient space to move on. Besides this, in most cases roads are serpentine rather than being straight. This ultimately breeds a number of unnecessary junctions where vehicles automatically slow down. Again, these roads are also not well constructed and regularly repaired. City Corporation, DESA, WASA, BTTB excavate the roads randomly without any integrated and central plan. Lack of proper maintenance causes the vehicle to stop without any prior notice. During the rainy season the situation becomes more critical while the roads go under water due to heavy rain. (c) Heterogeneous...
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...Fixing Traffic Congestion By Fixing traffic congestion is no small task. With the number of people growing, in this country and globally, the demand to reduce traffic is growing with it. There have been many proposed ideas to diminish the shear amount of traffic, such as busses, subways, and other means of public transportation. Some believe we need to add more highways or extend lanes on current highways. I have read many ideas and plans to alleviate the flow and have found some that I believe would work. One relatively inexpensive fix is using current technology to help with traffic systems. IBM is working with a few cities across the globe to add data collection and data analysis systems. The data collection systems would use camera, sensors, and possibly phone tracking to send real time information to the analysis systems. These systems would then analyze the data and use it to predict traffic flow. The traffic lights and other roadway control signal would then be able to act according to the load of traffic heading that way. Traffic lights, for example, would stay green longer if no vehicles are at the adjoining intersections. Though this would minimalize traffic congestion due to the flow of traffic, it wouldn’t be a permanent fix due to the growing amount of vehicles on the roads. Better road material and maintenance procedures would help reduce the amount of time vehicles are slowing down due to road and bridge conditions. Proper maintenance lengthens the life...
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...There are an increasing number of countries having to face with common issue: road rage. This essay will study about reasons, effects as well as solutions for each ones. The first main reason makes drivers be monsters when they are behind the wheel of a car is stress and anger. Driving long way in bad mood would make them fall into excitable state which leads to uncontrolled circumstances and regrettable consequences. Another reason for this issue is traffic congestion. It is obviously apparent that drivers stuck in crowded roads and annoying noises for hours will be easily crazy. Those causes will definitely result in negative effects to both individual and society. One of them is road accidents. There are numerous serious accidents caused by drivers or motorists when they are in pressure and tiredness. The second impact should be mentioned is the increasing of violence. When drivers make collision, they would handle problem by a hit instead of solving it by talking peacefully with each other. There are several actions that government should do to prevent road rage from becoming popular . Firsly, there is a really effective solution to handle this issue – enhancing road infrastructure which is one of the most important factor affect mainly congestion. For instance, if the road is too narrow, then street would be definitly stuck because of being oveload in the number of people and vehicles shifting in prime time…. Another effective solution make drivers stop being angry...
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...LA TERAPIA DEL LIMÓN CONGELADO (Cualquier tipo de limón sirve, el de la foto o el limón amarillo) Muchos profesionales en restaurantes y nutricionistas están utilizando o consumiendo el limón entero, donde nada se desperdicia. ¿Cómo puede usar el limón entero sin residuo? Simple ... Lavar el limón y colocar en el congelador de tu refrigerador. Una vez que el limón se congela, utiliza tu rallador y limón entero (no es necesario pelarlo) y espolvorea encima de tu alimento. Espolvorea en tus bebidas, vinos, ensaladas, helados, sopas, pasta, salsa de pasta, arroz, sushi. .. Todos los alimentos tienen un sabor inesperadamente maravilloso, algo que nunca has probado antes. Probablemente pensabas que sólo el jugo de limón contenía vitamina C. Bueno, sabemos que las cáscaras de limón contienen vitaminas 5 a 10 veces más que el jugo de limón en sí. Y sí, esto es lo que te has estado perdiendo. Pero a partir de ahora, al seguir este sencillo procedimiento para congelar el limón entero y espolvorear encima de tus platos, puedes consumir todos los nutrientes y obtener más salud. Cáscaras de limón rejuvenecen tu salud en la erradicación de los elementos tóxicos del cuerpo. genial! Aprovecha los beneficios sorprendentes de limón! Limón (Citrus) es un producto milagroso para matar las células cancerosas. Su sabor es agradable y no produce los horribles efectos de la quimioterapia. ¿Cuántas personas mueren mientras este secreto se mantiene, a fin de no poner en peligro las grandes corporaciones...
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...The worst parts in the Kansas City area is the highways. The highways get so irritating because how much rush hour we get each day. We get so many car reacts due to rush hour, and not enough exits on the highway ether, so that make it even slower than it supposed it be. Rush hour is making people be late to work, interview, and other thing people has to get on time, but they can’t because how slow the traffic is. The rush hour in traffic also waste everyone's time and effort. And if we don’t do something about it know the area would be would be nothing but traffic jams, and rush hour. I think that we need more roads to clear up most of the rush hour. If I was in a traffic jam or rush hour I would be mad and frustrated about being stuck...
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...Reasons behind traffic jam in Dhaka city (a) City lay-out (master plan) and over-population: The causes of traffic congestion in Dhaka city are multifarious. Starting from the city itself, it is observed that the skeleton, structure and lay-out of Dhaka City are not well-planned and well-directed. Dhaka is also a highly populated city. More than one crore people live here and the figure is increasing day by day. This huge population acts as an auto-catalyst of traffic congestion in Dhaka City. (b) Inadequate and unplanned roads: Dhaka City has very inadequate road networks. For a standard city, where the minimum road requirement is 25%, Dhaka has only 7.5% road of its total area. 30% of this 7.5% road is also occupied by the hawkers, salesman and shopkeepers. A significant portion is occupied by construction materials and waste-containers of the City Corporation. As a result, vehicles do not get sufficient space to move on. Besides this, in most cases roads are serpentine rather than being straight. This ultimately breeds a number of unnecessary junctions where vehicles automatically slow down. Again, these roads are also not well constructed and regularly repaired. City Corporation, DESA, WASA, BTTB excavate the roads randomly without any integrated and central plan. Lack of proper maintenance causes the vehicle to stop without any prior notice. During the rainy season the situation becomes more critical while the roads go under water due to heavy rain. (c) Heterogeneous...
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...with cars and people. At the same time, the airports are welcoming a large number of newcomers all over the world every day. Moreover, the number of roads and bridges is not sufficient to the increasing number of vehicles. In addition, in Jeddah there are approximately four million people both Saudis and expatriates who use over one million vehicles to move around the city. We also expect more. Causes of traffic congestion inside the cities Saudi Arabia is a modern Country, but it also has a modern and serious problem. Every day in the morning and evening, the roads and streets are so crowded with cars, taxis, buses and trucks. In this part will mention the causes of traffic congestion in Saudi Arabia’s major cities. In the next lines, we will speak about the several reasons for traffic problems in Saudi Arabia’s major cities. Firstly, there are many private cars in the streets because of the lack of public transportation such as buses, trains, trams, metro, etc (Putra, J). Secondly, current public transportation like buses is not well-organized. For example, bus drivers can stop anywhere they like carelessly without paying attention to the other cars on the road (Putra,j). In addition,...
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...GOAL: To alleviate traffic congestion in GTA and especially on the east-west route cost effectively and in as short a time as possible. INTERVENTION: To establish and privatize a new east-west route (407) to ease the congestion on the main route (401). The new privatized highway is intended to reduce traffic, therefore reducing the amount of time spent commuting, hence encouraging investors and stimulating the economy through productive time gained. ANALYSIS: This is a DIRECT intervention. The government is directly involved at A in supporting the decision to privatize the highway (407) to improve traffic flow and efficiency. At B: (i) the goal of reduce traffic congestion in the GTA is satisfied since another east-west route is introduced to relieve the pressure on the existing one (401). (ii) the intended goal is achieved by the government’s decision to lay the burden of developing, designing, building operating and maintaining of the new highway on the private sector. (iii) a new state of equilibrium is established because the change in government policies that allow for privatization enabled the government to share the financial burden with the private sector, resulting in quicker and more cost efficient building of highway 407. This curbed the traffic congestion problem faster and more efficiently than if the government was the only player. This intervention is COERCIVE because when the government...
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