The Use of Intraosseous Vascular Access

The Use of Intraosseous Vascular Access Table of Contents Title Page†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 1 Table of Contents†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 2 Executive Summary†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 3 Body of Paper†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 4 Plan†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã ¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 6 Do†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 7 Check†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 7 Act†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦8 Research to Support Change†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â ‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦8 Change Theory†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 6 Conclusion†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 18 References†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 20 Timeline†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚ ¬ ¦. 22 Executive Summary First introduced by Drinker and colleges in 1922, intraosseous (IO) vascular access was a method used during World War II for accessing the non-collapsible venous plexuses within the bone marrow cavity to provide access to a patient’s systemic circulation. This method later fell out of use after the development of intravenous catheters.Then during the 1980s IO vascular access was again introduced as a rapid way of gaining vascular access for swift fluid infusion particularly during resuscitation attempts of pediatric patients. (Tay & Hafeez, 2011) Plan-Being by implementing a policy for the use of IO vascular access within the Emergency Department of Hays Medical Center (HMC) for critically ill patients. This would expedite critically ill and severely injured patients in receiving the intravenous fluids and medications.Currently there is no policy in place for the placement of IO devices as opposed to peripheral intravenous catheters, or central veno us catheters. However, if there was a policy in place the staff would know when it was appropriate to insert an IO device, as opposed to having to make a difficult decision based on personal judgment. Do- Create a group of physicians and nurses to write a policy outlining when it is appropriate for the placement of an IO device compared to traditional techniques for gaining venous access. Once the policy has been written implement its use within HMC’s ED.Check- Keep a careful record of when an IO device is placed, in accordance to the new policy. Monitor the outcomes of these patients. Evaluate the effectiveness of the new policy and determine if any changes need to be made. Act- Based on the information obtained during the check phase of this project, management will determine whether the policy will be continued, improved, or discontinued. The Use of Intraosseous Vascular Access in Critically Ill Patients The origin of the intraosseous cavity as an access sight to the circu latory system was originally discovered during World War II.Medical personnel during this time used an IO route to resuscitate patients suffering from hemorrhagic shock. It was first documented in medical journals by Drinker and colleges in 1922. It was later rediscovered by American pediatrician James Orlowski. During his time working in India, Orlowski observed medical personnel during a cholera epidemic using IO access to save patients in whom IV cannulation was impossible and who might have died without access. He later wrote about his experiences in a paper entitled, My Kingdom for an Intravenous Line. Wayne, 2006) Since Dr. Orlowski brought the use of IO access in pediatrics back into the medical spotlight, the implications for its use within the adult population were soon being addressed. In 2005, the American Heart Association stated in its Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care that â€Å"IO cannulation was appropriate to provide acc ess to the non-collapsible venous plexus found in the bone marrow space, thus enabling drug delivery similar to that achieved by central venous access. (American Heart Association) Intravenous access can mean the difference between life and death when dealing with critically ill patients. IV access means that patients can receive fluids, blood products, and life-saving medications. During situations when time is precious, and access is critical is not when nurses should be making their fifth attempt at a peripheral intravenous catherization (PIV). It also shouldn’t be when chest compressions are stopped, so that the doctor can try for a central venous line (CVL).The average time necessary for PIV catherization is reported to add up to 2. 5-13 minutes and sometimes even up to 30 minutes in patients with difficult to access peripheral veins. (Leidel, Chlodwig & Bogner, 2009) This is one of many reasons why it is imperative to have a policy in place so that the staff knows that IO access should be a go to option rather than a last resort. There are very few contraindications when it comes to the placement of an IO device. However, to untrained medical personnel the thought of having to place an IO device is very daunting.I didn’t realize until this semester that it is within the scope of practice for a RN to place an IO device, but it is absolutely is! â€Å"It is the position of the Infusion Nurses Society that a qualified RN, who is proficient in infusion therapy and who has been appropriately trained for the procedure, may insert, maintain, and remove intraosseous access devices. † (â€Å"The role of,† 2009) There is also the fact that of having to explain the procedure to the patient and the patient’s family. The fear of needles is a real one.The thought of an intramuscular injection can send certain patients into a full blown panic attack. So the thought of actually having their bone pierced with a needle is a frightening o ne. Thankfully most patients who are critically ill enough to necessitate the placement of an IO device are unconscious. In cases where patients are not unconscious, an IO device can be placed with minimal discomfort if proper anesthetic techniques are used. These techniques should be taught along with placement so that nursing staff is aware of how to place an IO with minimal discomfort to the patient.It needs to be noted that â€Å"the pain associated with insertion of the EZ-IO needle is similar to that associated with insertion of a large peripheral intravenous needle and may be alleviate with infusion of lidocaine solution. † (Luck, Haines & Mull, 2010) Unlike PIVs and CVLs, IO access can be obtained from multiple sites with less chance of being unsuccessful. The locations include: proximal tibia, distal to the tibial tuberosity, distal end of the radial bone in the upper imb, proximal metaphysis of the humerus, distal tibia, proximal to the medial malleolus, distal femu r, above the femur plateau, the sternum, and also the calcaneus (Tay & Hafeez, 2011). However, IO access is typically obtained via the proximal tibia or proximal metaphysis of the humerus. There are currently three different ways to gain IO access. The first and oldest way is a manual insertion of the IO device. In this way the device is placed using the force applied by the clinician, and is done in a rotating motion. The second technique is the use of an impact device.In this case, a spring-loaded IO device is to insert the needle into the bone using direct force. The last technique is a powered drill. The small, handheld device drills the IO needle into the bone with a high-speed rotating motion. Plan To implement a policy within the Emergency Department at Hays Medical Center that clearly outlines when the placement of an intraosseous access device should be used as opposed to more traditional techniques for gaining venous access. A committee would be assembled to look at the re search on IO placement.This committee would consist of three physicians and three nurses, and will be given three months to write a policy for the department. This committee will determine in which situations an IO should be placed. The American Heart Association guidelines for intraosseous vascular access should play a major role in this decision. Once criteria has been chosen a checklist will be created that can be hung on the walls of the trauma rooms and handed out to staff. This checklist will aide in helping the staff to be able to more quickly determine in which situations placement of an IO is within the department’s policy.The appointed committee would also be in charge of deciding on which type of IO device the department should use. They will research the availability of the device chosen and what the cost will be to stock the department which the device. Do Once the research is gathered, the assigned research committee will reassemble to compose the policy that wi ll become implemented within the Emergency Department. After the policy has been written, a mandatory unit meeting will be called to introduce the new policy and answer any questions that the staff might have.During this meeting, a demonstration will be given on the correct technique for IO placement, depending on which type of device is chosen during the planning phase. After the demonstration the staff will then be asked to practice placing IO devices using practice bones. One member of the department will then be voted upon to keep track of which patients coming through the department have IO devices placed. They will keep track of for the next six months. The data collected will include any outcomes that the patient experiences, good or bad, in regards to their IO placement.Check The member of the department will look at the data collected from the outcomes of patients who had IO devices placed within the ED in the last six months. This data will then be taken back to the origin ally assigned committee. The committee will be responsible for analyzing the data. They will look at the outcomes and determine if changes need to be made to the original policy. They will also look at the outcomes to determine if there need to be changes made in the placement technique used by the department.For example, is the rate of successful placement higher or lower when done via the humerus verses the tibia? Or is there a problem with post procedural infection? Should the technique be changed from aseptic to sterile? Etc†¦ They will also ask staff within the department to fill out a survey indicating their comfort level in placing IO devices. Act Depending upon the findings of the committee they can either be decided to leave the policy in place, as is. The committee could find that the policy needs to be altered and then reviewed in another six months’ time to see if the changes were effective.Or they could find that within the ED at Hays Medical Center IO devic es for venous access should not be used although the review of literature will prove why this outcome is highly unlikely. Research to Support Change An article published in the Journal of Emergency Medicine, collaborated by three different physicians who work in Emergency Departments in Philadelphia talks about the technical side of intraosseous access. The article states that â€Å"intraosseous vascular access is indicated in the critically ill patient of any age when rapid and timely access via the intravascular route cannot be established or has failed. The article goes on to list conditions in which this might occur, including: cardiopulmonary arrest, shock, sepsis, major traumatic injuries, extensive burns or edema, and status epilepticus. (Luck, Haines & Mull, 2010) Indications may also include obese patients on who multiple PIV attempts have failed. Because studies have shown that IO infusions have the same onset of action, as that of intravenous infusions the authors recomm end that the dose used for IV fluids and medications should remain unchanged when using the IO route.They go one to state that other studies have shown that the results of several different blood test values drawn from bone marrow aspirates are comparable to those taken from venous samples. These include blood gas analysis, blood group typing, and electrolyte, drug, and hemoglobin levels. (Luck, Haines & Mull, 2010) The authors also talk about the relatively few contraindications for IO insertion. These include a fracture to the bone that the IO device is to be placed, an extremity with a vascular injury, placement to an area with an overlying skin infection or burn.IO insertion is also contraindication in patients with certain conditions that make their bones fragile such as osteogenesis imperfect and osteoporosis. The last contraindication is a new IO insertion where another IO needle may have recently been placed. This is because the opening left by the last needle can cause flui ds to extravasate. In their research of other studies, the authors found that success rates for IO insertion vary between 75%-100%, and successful infusion achieved within 30-120 seconds in the majority of cases. Luck, Haines & Mull, 2010) The most common complication was found to be extravasation of blood, fluids, and drugs into the soft tissues surrounding the site, but this occurred less than 1% of the time. With a 0. 6% chance of incidence, the most serious adverse complication was osteomyelitis. However, this was attributed to prolonged infusion. For this reason, it is recommended that the IO need be replaced by either a PIV or a CVL once the patient has stabilized and no longer than 24 hours after IO placement. (Luck, Haines & Mull, 2010)This article concluded that the use of IO access devices is a safe, reliable, and timely way of attaining vascular access. Although vital for critically ill and injured patients, it is also a technique that can be applied in non-emergent cases where multiple attempts at peripheral and central IV access has been unsuccessful. (Luck, Haines & Mull, 2010) In a study conducted by physicians at the University of Medicine Berlin’s Department of Emergency Medicine, they looked at ten consecutive adult patients who each received an IO device and also a CVC placement during a resuscitation situation.The results showed that the success rate on first attempt was 90% for IO access versus 69% for CVC placement. They also found that the mean time required for the IO access procedure was significantly shorter, 1-3 minutes, compared to the mean CVC placement time of 4-17 minutes. While conducting this study, one IO cannulation failed â€Å"due to operator mishandling by not selecting the correct insertion site at the proximal humerus. (Leidel, Chlodwig & Bogner, 2009) The physicians of this study also noted that four CVC cannulations failed on the first attempt at insertion and had to be reattempted. The study then went on to st ate that the failed placement of one IO cannulation was the only complication regarding the IO devices placed. There was â€Å"no malposition, dislodgment, bleeding, compartment syndrome, arterial puncture, haeatothorax, pneumothorax, venous thrombosis, and vascular access related infection observed. † (Leidel, Chlodwig & Bogner, 2009)In conclusion the researchers go on to state â€Å"IO vascular access is a safe, reliable, rapid option in the acute setting of adult patients under resuscitation with inaccessible peripheral veins in the emergency department†¦ Therefore, a change in practice from CVC to immediate IO access for the initial emergency resuscitation should be strongly considered as a reasonable bridging technique to increase patient’s safety in the emergency department. † (Leidel, Chlodwig & Bogner, 2009) Another study found was performed by physicians and researchers in the Department of Emergency Medicine of Singapore General hospital.It is a l arge urban hospital that handles nearly 120,000 patients annually. 9% of these patients are priority 1 patients, or patients that need resuscitation. The inclusion criteria for this study were â€Å"patients who presented to the ED with age greater than 16 years or >40kg body weight requiring intravenous fluids or medication and in whom an intravenous line could not be established in two attempts or 90 seconds. They also had to be seriously ill or injured and meet at least one or more of the following: altered mental status, respiratory compromise, haemodynamic instability, or cardiac arrest. (Ngo, Oh, Chen, Yong & Yong, 2009) The study ran from March 1, 2006 through July 30, 2007. During this time 24 patients were met the qualifications for this study. Of all the IO cannulations, only three attempts failed on the first attempt. No failures were recorded on the second attempt. The researchers also did a comparison between junior operators and senior operators and found that there w ere no disparity regarding success rates between the groups, they both had a 100% success rate. The average insertion time for both groups was approximately five seconds. Ngo, Oh, Chen, Yong & Yong, 2009) There were only two complications regarding the insertion of an IO device with this study. The first was when an operator’s glove was caught on the need during insertion. However, this could have been prevented if the operator was holding the drill properly. The other complication noted was that of extravasation of fluid at an insertion site. This is the most common type of complication, and is seen when the need is misplaced or there is an excessive amount of movement during or after the insertion. Ngo, Oh, Chen, Yong & Yong, 2009) The results of this study concluded that â€Å"the EZ-Io is a feasible, useful and fast alternative mode of venous access especially in the resuscitation of patients with no venous access or when conventional intravenous access fails. Flow rates may be improved by the use of pressure bags. Complications encountered such as extravasation of fluid and gloves being caught in the drill device can be easily prevented. † (Ngo, Oh, Chen, Yong & Yong, 2009)The third research article was a prospective, observational study conducted by researchers in the Department of Emergency Medicine at Singapore General Hospital in Singapore. The study was conducted on a convenience sample of 25 medical students, physicians and nursing staff. They were recruited to secure intraosseous access using the EZ-IO powered drill device. Unlike the previous two studies they only need to secure access on a plastic bone model rather than a live patient. (Ong, Ngo & Wijaya, 2009)The study participants were allowed multiple attempts in placement with the aim of ensuring success in placement. Their placement times were measured by an independent observer with a stopwatch, from the time the participant placed the need set into the driver and attempted to insert the needle with the ES-IO into the plastic bone. The participants then recorded their perception on the difficulty of insertion using a visual analog scale with 0 representing very easy and 10 representing very difficult placement. (Ong, Ngo & Wijaya, 2009) The results showed 96% success rate for placement.Twenty-three of the 25 participants only required one attempt at place the IO device, and only one participant was unsuccessful at securing placement of the device. This failure was attributed to â€Å"unfamiliarity with the equipment and procedure, and hesitating beyond the allocated time given for insertion. † (Ong, Ngo & Wijaya, 2009) The results of this study also showed that the mean placement time was 13. 9 seconds. The researchers also found that 87% of their participants reported that using the EZ-IO was easier compared to intravenous cannula. Ong, Ngo & Wijaya, 2009) The researchers of this study concluded that â€Å"the I/O access device (EZ-IO) evaluated in this study appears to be easy to use with high success rates of insertion with inexperienced participants. There is potential for use in the Emergency Department. (Ong, Ngo & Wijaya, 2009) The next piece of research was a randomized trial conducted by Dr. Reades from Methodist Hospital System, in Dallas, TX, Dr. Studnek from Carolinas Medical Center and the Center for Prehospital Medicine, Charlotte, NC, S.Vandeventer from Mecklenburg EMS Agency, Charlotte, NC, and Dr. Garrett from Baylor Healthcare Systems, Department of Emergency Medicine, Baylor University Medical Center, and Dallas, TX. The purpose of this study was to determine whether the tibial or humeral placement site was more effective for intraosseous placement during out-of-hospital cardiac arrest. â€Å"All patients eligible for inclusion in this study had their first attempt at vascular access randomized to one of 3 locations: proximal tibial intraosseous, proximal humeral intraosseous or peripheral intravenous. ( Reades, Studnek, Vandeventer & Garrett, 2011) Randomized note cards were distributed to the paramedic staff at the beginning of their shifts, and told them which access site was to be initially used if they came had a patient who met the inclusion criteria. There were two outcomes that were being monitored in this study. The first was a first-attempt success at the assigned method of vascular access. This qualified in one of two ways, either as an initial success or an overall success.The second measured outcome was the â€Å"total number of attempts required for successful vascular access, time to successful vascular access, time to first ACLS medication, and total volume of fluid infused during resuscitation. † (Reades, Studnek, Vandeventer & Garrett, 2011) Overall there were 182 patients randomized to one of the 3 vascular access methods. Fifty-one patients had humeral IO placements, 67 had PIV placements, and 64 had tibial IO placements. The results showed that first-atte mpt success was greatest in patients randomized to tibial IO access at 91%, compared to both humeral IO access at 51% and PIV access at 43%.The result of the secondary outcome was also significantly shorter in patients with tibial IO access. These patients had their devices in place and ready to use in an average of 4. 6 minutes. Those assigned to the humeral IO access site averaged a 7. 0 minute placement time, which was also the same time for a PIV access site. (Reades, Studnek, Vandeventer & Garrett, 2011) This study demonstrated that there is a significant different in the frequency of first-attempt success when placing tibial IO access devices as opposed to humeral IO access devices or even PIV catheters.The researchers go on to state that the â€Å"results from this study may help stakeholders such as EMS medical directors choose the most appropriate site for first-attempt vascular access†¦Ã¢â‚¬  (Reades, Studnek, Vandeventer & Garrett, 2011) The last article was a cons ortium on intraosseous vascular access in healthcare practice, published in a journal entitled critical care nurse. It too outlined the history of IO access, dating back to World War II. It discussed the clinical considerations for the use of IO access, and the clinical situations in which IO access should be considered.It went on to talk about the types of IO devices and how they’re used. It mentioned the contraindications for IO use, and also the possible complications. All of the aforementioned material was consistent with research already discussed. This article lends credibility in support of change because it discusses the education and training needed to implement IO device use in the clinical setting. It states that â€Å"to insert and maintain an intraosseous device in a patient, the clinician must demonstrate adequate knowledge and psychomotor skill competency in the procedure. (Phillips, Brown, Campbell, Miller, Proehl & Young-berg, 2010) The article then went on to discuss the economic considerations that must be looked at when considering implementing an IO insertion policy. It states that â€Å"the cost of intraosseous devices and needles should be compared with the cost of central catheter kits, ultrasound evaluation, and human resources required for their insertion. † (Phillips, Brown, Campbell, Miller, Proehl & Young-berg, 2010) The authors also note that â€Å"the economic factors must be weighed along with potential complications of therapeutic strategies should be considered. (Phillips, Brown, Campbell, Miller, Proehl & Young-berg, 2010) This article also brings to light the issue of risk management and patient safety. In this day and age where liability concerns continue to drive clinical decisions, it is important to note that delays in treatments are often cited as the cause of injury leading to malpractice claims. If there is an evidenced based option to safely and quickly provide fluid and drug resuscitation, when vascu lar access is not readily attainable, then it needs to be closely looked at.After reviewing the data the Consortium on Intraosseous Vascular Access in Healthcare Practice reached eight consensuses: 1. Intraosseous vascular access should be considered as an alternative to peripheral or central intravenous access in a variety of health care settings, including intensive care units, high acuity/progressive care units, general medical units, preprocedure surgical settings where lack of vascular access can delay surgery, and chronic care and long-term care settings, when an increase in patient morbidity or mortality is possible. . Intraosseous vascular access should be considered as part of an algorithm for patients treated by rapid response teams in whom vascular access is difficult or delayed. 3. A new algorithm that includes the intraosseous route should be developed for assessing the appropriate route of vascular access. 4. For patients not requiring placement of central catheters ei ther for long-term vascular access or hemodynamic monitoring, intraosseous access should be considered as the first alternative to failed peripheral intravenous access. 5.Techniques of intraosseous catheter placement and infusion administration should be a standard part of the medical school and nursing school curriculum. 6. In evaluating the economic implications of adopting intraosseous technology, the following should be considered: the expense of diagnostic tools to guide and confirm placement, the cost of human resources, the known and unknown risks to patient safety, and the cost of complications related to delayed treatment. 7. Organizational policies, procedures, and protocols that establish the responsibility of insertion, maintenance, and removal of intra-osseous access devices should be developed. . Further research should be conducted on, but not limited to, the safety and efficacy of use of intraosseous access in all practice settings, its economic impact on patient car e, and to support the use of intraosseous access in all health care settings. Change Theory The change theory focused upon in this paper is Gordon Lippitt’s Theory of Planned changed. According Lippitt, â€Å"Planned change or ‘neomobilistic’ change is defined as a conscious, planned effort which moves a system, an organization, or an individual in a new direction.This theory is applies because it can be applied at an individual, group, and institutional level. The basis for Lippitt’s theory of change is center around an agent for change. This agent should be a person skilled in the changed wanted to apply. It is this person who is in charge of planning for the change, initiates the change, and is credited for the accomplishment of change. Lippitt’s theory is centered around 7 phases of change. His phases are not set in stone, and there is no time frame on how long each phase should last. There should be a fluid movement back and forth between thes e seven phases.The first step is identification and diagnosis of the problem. In this case, the problem is HMC not having a firm policy in place recommending when the use of IO access devices should be implemented. The second step is the change agent assessing the client systems motivation and capacity for change. In this case, myself being the change agent, I would talk with the administrators of the ED department and determine if they agreed with my assessment for a policy to be implemented. The third step would be the initiator assesses his or her ability in helping the situation.In this case this flows back to the first step, because I saw the need for change and felt that I was equipped with the skills needed to bring about such a change. The fourth step is the change agent then chooses an appropriate role in the phase. In this case, I would choose to be part of the policy committee who is responsible for researching. The fifth step states that the change agent may be actively involved in the implementation of change, serve as an expert in fathering and providing data, or function as a liaison within the organization. I feel like in this case, I would function as a liaison within the policy making committee.The sixth step consists of maintenance of change. This involved the â€Å"Do† portion of the plan for change. This is where the decisions made by the policy are provided to the department, and the employees become responsible for implementing and maintaining the new policy. The final step is termination of the helping relationship. This step is accomplished when all parts of the PDCA plan have been completed. (Ziegler, 2005) Conclusion In a day and age where medical technology is advancing, the research about IO access devices proves that newer technologies are not always the best for a positive outcome.IO access applications have great potential in patients who are critically ill, injured, or are incapable of having PIV or CVL access. The fact that IO access is fast, reliable, and safe proves that competent placement of IO devices is a medical technique that all Emergency Departments should have in their repertoire. References (2009). The role of the registered nurse in the insertion of intraosseous access devices. Journal of infusion nursing,  32(4), 187-188. American Heart Association. 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2005;112(24):57-66. Leidel, B. Chlodwig, K. , & Bogner, V. (2009). Is the intraosseous access route fast and efficacious compared to conventional central venous catherization in adult patients under resuscitation in the emergency department? a prospective observational pilot study. Patient safety in surgery,  3(24), doi: 10. 1186/1754-9493-3-24 Luck, R. , Haines, C. , & Mull, C. (2010). Intraosseous access. The journal of emergency medicine,  39(4), 468-475. Ngo, A. , Oh, J. , Chen, Y. , Yong, D. , & Yong, D. (2009). Intraosseous vascular access in adults using the ez-io in an emergency department. International journal of emergency medicine,2(3), 155-160. oi: 10. 1007/s12245-009-0116-9 Ong, M. , Ngo, A. , & Wijaya, R. (2009). An observational, prospective study to determine the ease of vascular access in adults using a novel intraosseous access device. Annals of the academy of medicine, singapore,  38(2), 121-124. Phillips, L. , Brown, L. , Campbell, T. , Miller, J. , Proehl, J. , & Young-berg, B. (2010). Recommendations for the use of intraosseous vascular access for emergent and no emergent situations in various health care settings: A consensus paper. Critical Care Nurse,  30(6), e1-e7. Reades, R. , Studnek, J. , Vandeventer, S. , & Garrett, J. (2011).Intraosseous versus intravenous vascular access during out-of-hospital cardiac arrest: A randomized controlled trial. Annals of Emergency Medicine,  58(6), 509-516. Tay, E. T. , & Hafeez, W. (2011). Intraosseous access. In R. Kulk arni (Ed. ),  Medscape reference: Drugs, disease & procedures. Retrieved from http://emedicine. medscape. com/article/80431-overview Wayne, M. (2006). Adult intraosseous access: an idea whose time has come. Israeli journal of emergency medicine,  6(2), 41-45. Ziegler, S. (2005). Theory-directed nursing practice. (2 ed. , p. 204). New York, NY: Springer Publishing Company, Inc. Timeline for Change 1/20-11/27Researched the benefits of having a policy about intraosseous access within the ED at HMC 11/28Spoke with the Director of Nursing for the ED and the Director of Emergency Medicine about my research findings 12/1A committee of three physicians and three nurses is assembled to draft a preliminary policy regarding intraosseous access 12/1-3/1The committee is given three months to compose their policy 3/2-3/10The policy is given to the Director of Nursing and Director of Emergency Medicine, who present it to the board of directors for approval 3/15A mandatory staff meeting is held outlining the new policy and answering any questions or concerns the staff has 3/16-9/16The new policy is put into effect and data is collected 9/16-10/16The original committee will analyze the data, and changes are made as needed. 10/20The final committee approved policy is present to the Director of Nursing and Director of Emergency Medicine 11/1The Director of Nursing and Director of Emergency Medicine, take the final recommendations for the policy to the hospital board of directors for approval

A Tale of Two Cities - Breaking Gender Stereotypes and...

nbsp;Breaking Gender Stereotypes in A Tale of Two Cities nbsp; The men and the women of A Tale of Two Cites are violent, loving, cowardly, brave, and ruthless.nbsp; Some people are weak and spoiled, while others are badly treated and vindictive.nbsp; Many contrasts between men and women can be found within this story.nbsp;nbsp; nbsp; nbsp;nbsp;nbsp;nbsp; A Tale of Two Cities clearly portrays very distinct divisions in the behavior of men.nbsp; The aristocrats, or upperclassmen, rule and control all of France.nbsp; The members of the aristocracy never have to undergo hardships; they always have everything presented to them on a silver platter.nbsp; They do whatever they want with total disregard for the†¦show more content†¦Carton and feels sympathy for him (189).nbsp; Charles Evreacute;monde, called Darnay, is loved by his wife Lucie and his daughter; he is the object of sympathy and compassion (74).nbsp; Carton and Darnay both adore Lucie Manette, but they are two very different men.nbsp;nbsp;nbsp;nbsp; nbsp; nbsp;nbsp;nbsp;nbsp; The women in A Tale of Two Cites behave in extremely opposing ways.nbsp; Lucie Manette is a frail young woman.nbsp; She constantly becomes overwhelmed and faints at even the thought of danger.nbsp; She has never been exposed to poverty nor suffered through severe hardships.nbsp; Lucie is genteel; she isnbsp; constantly pampered and always has people looking out for her.nbsp; She is constantly being treated like a small child; she softly laid the patient [Lucie] on a sofa, and tended her with great skill and gentleness (23).nbsp; Madame Defarge is a ruthless, bloodthirsty, vengeful, and poor woman.nbsp; She is best described by Ms. Pross as the wife of Lucifer (336).nbsp; She readily cuts off a mans head and she never missed [an execution] (342).nbsp; Madame Defarges sadistic nature is seen best during the execution of Foulon, an aristocrat.nbsp; She tortures him,nbsp; as a cat might have done to a mouse and his head is impaled upon a pike, with grass enough in th e mouth for all of Saint Antoine toShow MoreRelatedMedia And Its Effect On Society1951 Words   |  8 Pagesfollow. We learn what is expected form our gender identity from many sources- school. parents and also the media. We tend to copy those gender roles attributed to us and as we grow up develop different gender codes. Media provides us ways of imagining particular groups and identities. Stereotyping and representation of groups in the media industry is a very important concept in media. The essay focuses on how media creates meanings about female gender and plays a crucial role in the way we perceiveRead MoreAnalysis Of Disney Company And Its Impact On The World Of The Pockets Of Our Jeans And Hoodies1686 Words   |  7 PagesDespite nearly all forms of modern media readily available at all times in the pockets of our jeans and hoodies, influences from media on how people perceive gender and its surrounding issues is often overlooked or ignored under the premise of normaliz ation. One of the top contributors of media is The Walt Disney Company and its affiliated companies such as ABC, Pixar, Touchstone Pictures, Lucasfilm, and Marvel Entertainment, and from a young age many children grow up on the films, characters, booksRead MoreBreaking Bad And Orange Is The New Black3602 Words   |  15 PagesBreaking Bad and Orange Is the New Black (OITNB) have seemed to make breakthroughs in the entertainment world. Both shows have a vast following as they have proven how exciting and dramatic television can be. One, depicting the life of middle aged drug kingpin and the other exploring the life inside of a female penitentiary. From an entertainment perspective, both show will leave its viewers on the edge of their seats anticipating what will happen next. However, it is highly interesting to examineRead MoreStephen P. Robbins Timothy A. Judge (2011) Organizational Behaviour 15th Edition New Jersey: Prentice Hall393164 Words   |  1573 Pages—San Diego State U niversity Timothy A. Judge —University of Notre Dame i3iEi35Bj! Boston Columbus Indianapolis New York San Francisco Upper Saddle River Amsterdam Cape Town Dubai London Madrid Milan Munich Paris Montreal Toronto Delhi Mexico City Sao Paulo Sydney Hong Kong Seoul Singapore Taipei Tokyo Editorial Director: Sally Yagan Director of Editorial Services: Ashley Santora Acquisitions Editor: Brian Mickelson Editorial Project Manager: Sarah Holle Editorial Assistant: Ashlee BradburyRead MoreHuman Resources Management150900 Words   |  604 Pagesmanagement making final decisions. For example, in a firm with 1,000 employees, the Vice-President of Human Resources spends one week in any firm that is proposed for merger or acquisition to determine if the â€Å"corporate cultures† of the two entities are compatible. Two potential acquisitions that were viable financially were not made because he determined that the organizations would not mesh well and that some talented employees in both organizations probably would quit. But according to one surveyRead MoreLibrary Management204752 Words   |  820 Pages . . 302 Motivation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303 The Content Models . . . . . . . . . . . . . . . . . . . . . . . . . . 305 Maslow’s Hierarchy of Needs . . . . . . . . . . . . . . . . . . . 305 Herzberg’s Two-Factor Theory of Motivation . . . . . . . . 307 McClelland’s Need Theory . . . . . . . . . . . . . . . . . . . . . . 310 The Process Models . . . . . . . . . . . . . . . . . . . . . . . . . . . 311 Adams’s Equity Theory . . . . . . . . . . . . . .

The Different Faces Of Humanity - 2665 Words

The Different Faces Of Humanity Human suffering is a topic that has been going on for a long time all around the world but the people from our society tend to ignore it. Human suffering is something that many innocent people go through all around the world, and our society tends to become so numb on the topic that they don t even care anymore but yet do they know, with them not caring all its doing is making the enemy powerful. It is cruel to go on with your daily lives knowing innocent people are dying out there and our society does nothing. Human suffering has been going around for a long time, many Documentaries, articles and films try to highlight and show the world what s going on but many people turn their shoulders because of†¦show more content†¦This happened Oct. 18 in southern China. The report said 18 people passed by; some on foot, some steering their bicycles around her limp body as they purposely ignored the child. ’’ (The Daily Barometer). In other words, the author was explai ning and trying to demonstrate how many people in our society make such small things more significant than what the bigger problem is, just how he/she mentioned how the headlines made a toddler getting bitten by a dog more bigger than a 2 year old toddler who was hit by a car and people looking at her walking by soon after she was hit by another car as people continued to walk by not bothering to help her. This shows how our society tends to turn their heads on the bigger problem and focusing on small non-significant situations, our society doesn’t want to interfere in problems they have to do anything about, and people in our society are selfish. In the article ‘’ The Perils of Indifference’’ by a holocaust survivor named Elie Wiesel himself writes, ‘’ It is so much easier to avoid such rude interruptions to our work, our

The Importance of Eating Nutritious Food - 7345 Words

The Basic Information Of Tioman Island Tioman Island (Malay language: Pulau Tioman) is a small island located 32 km off the east coast of Peninsular Malaysia in the state of Pahang, and is some 39 km long and 12 km wide. It has eight main villages, the largest and most populous being Kampung Tekek in the north. The densely forested island is sparsely inhabited, and is surrounded by numerous coral reefs, making it a popular scuba diving spot. There are also a lot of resorts and chalets around the island which has duty free status. Its beaches were depicted in the 1958 movie, South Pacific as Bali Hai. In the 1970s, TIME Magazine selected Tioman as one of the worlds most beautiful islands. Apart from its diverse marine life, the inland†¦show more content†¦Enraptured by the charms of the place, she decided to discontinue her journey. By taking the form of an island, she pledged to offer shelter and comfort to passing travelers. Politics Tioman Island lends its name to the state constituency of Tioman, comprising the island and part of the Rompin district including the town of Kuala Rompin. Its representative to the State Legislative Assembly is YB Mohd. Johari from Barisan Nasional. Its representative to the Malaysian Parliament is former MOSTI Minister Dr Jamaluddin Jarjis, also from Barisan Nasional. Radio and Television As of May 2011, only 2 FM radio stations can be received from Kuantan, and some from Kuala Rompin, and 12 AM stations. Viewing television needs large antenna or satellites, as indoors antenna cant get the signal. Only TV3 and ntv7 can be received with antennas. Get in There is a RM5 conservation fee to enter the island, which can be paid at a little kiosk just before departing from the Mersing ferry terminal). [edit] By Ferry Most visitors arrive by ferry from Mersing on the mainland. Bluewater Express operates the ferry services and its boats are fast and comfortable taking approx 1 hour 20mins to the first jetty. This ferry is now the only option, the smaller and faster services being cancelled because of safety concerns after a tragedy. Unfortunately in countries that cannot afford to patrol their regulations well, some ferry companies overcrowd their vessels. If you ever feelShow MoreRelatedNational Instructional Pl A Health Program954 Words   |  4 PagesEmotional Health, Alcohol, Tobacco, and Other Drugs and Safety. This health education instructional plan relates to the students’ growth because it addresses health issues with age appropriate topics and materials. Students will learn the importance of eating a nutritious and balanced meal. They will also learn how to demonstrate safety. Also, emotional health is addressed. In Teaching Today’s Health, it states, â€Å"The concept tha t emotionally healthy people are in touch with their feelings and can expressRead MoreHow to Lead a Healthy Lifestyle619 Words   |  3 Pagesmaintaining a balanced and nutritious diet as well as engaging in sports or other fitness related activities. A healthy diet alone however is inadequate to ensure a healthy body as physical activity helps to keep one in shape and free of sickness and disease. According to the World Health Organization, only one in ten people exercise regularly and a majority do not follow a healthy diet. The main culprit is our penchant for junk food as can be seen from the popularity of fast food chains and other westernRead MoreBreakfast Is The Most Important Meal Of The Day900 Words   |  4 Pagesenergy that one needs to perform during the day. Skipping breakfast can lead to exhaustion, extreme hunger, and lack of focus. The importance of breakfast cannot be overlooked, but the nutritional value of one’s morning meal is equally important. My target area began as a focus on eating more in general. The food available at PSP was not always ideal, many times the food was either unhealthy or there simply weren’t enough options that I enjoyed. As a result, I noticed that my weight began to significantlyRead MoreFood Safety, Food, And Food Choice At Mcdonalds1167 Words   |  5 PagesThis represents a low-calorie food choice at McDonalds, an example of how Public Health practices continue to influence how we eat. Throughout history, advances in food science and technology have played a pivotal role in making food safer and healthier for an ever evolving society. Today, we have much greater access to an abundant, diverse food supply that is largely safe, convenient, nutritious, flavorful, and less costly than ever before. This access to such food is largely because of Public HealthRead MoreEssay about Teach Everychild About Food by Jamie Oliver1345 Words   |  6 Pagespast few decades food has took a drastic plunge towards unknown ingredients and chemicals. Most of society would agree that children are the future but surprising statistics make that hard to believe; they cannot become the future if they are being fed to death. Jamie Oliver and Ann Cooper are two of many chefs who are working hard to educate people about real food. Lectures given by each of them send the overall message that the future of humanity is within the food we are eating. Jamie Oliver’sRead MoreNutrition Is Essential For The Development Of Physical And Cognitive Health1394 Words   |  6 Pagesâ€Å"Ministry of Food†? The ministry of food was introduced in 1942 by the British government to advocate eating nutritious food’s during the time of WW2, when there was sparsity of crops and fresh produce, due to the war effort. It also educated people on ways to feed their families healthy food on a budget. However more recently in 2008, Jamie has reintroduced this concept of a â€Å"national network of food,† by spreading awareness and reminding people of the influence nourishing food can have on ourRead MoreEffects of Nutrition on Academic Performance Essay723 Words   |  3 Pagesthe expectations to graduate and pursue a career in their new field of study. Low test scores, however, are preventing this from becoming reality for some. As a student, we tend make more time to study rather than focussing on eating properly and consuming nutritious food. That is why many new students find that they gain 15 pounds during the first-year of school, referred to as freshman 15, also not do as we ll as expected in their studies when they first applied for the program. Diets of individualsRead MoreFood Medicine And Medicine Be Thy Food1544 Words   |  7 PagesRyan MacLellan Eng101H Final Paper May 1, 2015 â€Å"Let food be thy medicine and medicine be thy food† Is your well-being and health important to you? The assumed answer to this question is yes of course it is , but yet a rapidly increasing number of people in te United States are overweight and obese. If people were aware of how much of a positive impact eating healthy can have on an individual s immediate well-being, as well as their long term overall well-being, they would likely no longer seeRead MoreEating Healthy Lifestyle Is Simple1754 Words   |  8 PagesHealthy Lifestyle The reason why I chose to write this essay about healthy lifestyle is simple. I wanted to learn the benefits, disadvantages and consequences of eating healthy have in our lives. This is a very significant issue, considering that a very high percentage of the population in the United States is obese or overweight. It has been proven that several health risks are caused by being overweight, such as heart diseases, high blood pressure and diabetes. Unfortunately, thousands of livesRead MoreHelping The Elderly. Density Of Food853 Words   |  4 Pages HELPING THE ELDERLY Density of food is a major factor to those who have trouble eating, like injured soldiers or the elderly. PERonalized Food using Rapid Manufacturing for the Nutrition of elderly ConsumErs (a.k.a. PERFORMANCE) is a project for which the goal is to produce personalized meals by 3D printing that are both nutritious and appealing. The project cost more than $4 million dollars to complete, but PERFORMANCE now has a plan to help the elderly. Each elderly person in a residence

Definitions of Creativity and Innovation-Free-Samples for Students

Question: Discuss about the definitions of Creativity and Innovation are studied. Answer: Introduction Creativity and innovation are two inter-related concepts which have been defined in different ways. Though there is basic difference between the concepts of creativity and innovation but creativity is the starting point of innovation. Creativity is often the product of individualistic mind while innovation is not only about collective human interaction but also about interaction between human minds and its artificial environment. Creativity and innovation is of paramount importance for sustainable development of an organization. The world is constantly changing with technological advancement and tough competition posed by globalization. In order to adapt itself to this constantly changing environment, every organization should foster a culture and an environment of entrepreneurship where employees are encouraged to think out of the box, new ideas are appreciated and there is open communication among departments which leads to intra-departmental co-ordination and functioning of the bu siness as a single unit (Serrat, 2017). Organizations and countries should invest on research and development, else new technology of competitors can pose potential threat to business (Dawson Andriopoulos, 2014).For example, Nokia failed to sense the new technology of the android market and hence business of Nokia was potentially harmed. Similarly, the digital film and photography hampered the traditional business of Kodak .The invention of Aero plane by Wright brothers and the invention of credit cards are examples of creativity and innovation of past. The human race is constantly progressing through creativity and innovation which is depicted by modern examples like research in the field of artificial intelligence and robotics or manufacture of electric cars by Tesla. Discussion Creativity and innovation defined in several ways Creativity is the ability to present new ideas and innovation is the way the new ideas are implemented practically. Creativity emerges when an individual discards preconceived notion and looks at a matter in a way that might seem odd to others. Creativity is encouraged when a leader does not direct his subordinates but creates a supportive environment that nurtures out-of-the box thinking .This kind of environment is vital for creative people to give birth to fresh ideas and solve a problem (Auernhammer Hall, 2014). Innovation follows creativity or creativity leads to innovation (Sarooghi, Libaers Burkemper, 2015). The leaders who are innovative encourage a culture of questioning, openness to experience, risk-taking and a healthy attitude towards failure among his subordinates (?erne, Jakli? kerlavaj, 2013). People who are creative generally possess the following three qualities that make them different from others. 1) Expertise-technical knowledge and skills 2) Creative thinking skills-Thinking out of the box and ability to solve problems 3) Intrinsic motivation There are two types of methods established by psychologists to enhance creative thinking .These two methods are free association method and brainstorming Free association method This method to enhance creativity was studied by psychologist Freud and Carl Gustam Jung .This technique is often used in marketing and advertising and consists of asking questions to oneself or to others of the type This here ..what does it bring to mind? And what else? ..and? This should be continued until our mind is blank or the question is exhausted. Brainstorming Brainstorming is the allowance of free flow of ideas even though the ideas seem ridiculous or bizarre. The practical feasibility of ideas is not checked while brainstorming .Every idea is considered to be a good idea. Therefore, brainstorming allows free flow of ideas without criticism (Wilson, 2013). In 1864,Carlo Cattaneo, an Enlightenment thinker explained that when multiple human beings solve a problem together by comparing and discussing, the result is always better than the same problem being tackled by a single individual. Therefore, organizations support group-thinking or constructive conflicts among groups as this lead to creativity .However, a scientific or artistic creativity is often the product of an individual mind. For instance, writing a book, composing music, gaining scientific insight on something requires individual effort (Henry Mayle, 2016). In this context, the basic difference between innovation and creativity can be noted. Creativity in scientific or artistic discovery is individualistic but innovation by definition is a social phenomenon. Innovation is not only the result of collective human interaction but the association between human minds and artificial system like technological instruments often lead to innovation. The process of innovation has following steps: idea generation, idea screening, feasibility and implementation. Sources of new ideas for an organization can be economy, technology, customers, competitors, management, suppliers, and distribution channel and government regulations. Creativity and Innovation in Organizational context Creativity and innovation has several examples in history .One such example is of Wilbur Wright and Orville Wright, who were interested in flying in the 19th century. For doing so the Wright brothers built and tested several gliders, flaps on wings and rudders. After several tests and efforts the Wright Brother was successful in flying a plane with a man on it. The name of their fist powered Aeroplane was Flyer and in 1909, the Wright Brothers received a contract from the United States military to build fist plane from them. This example depicts how creativity and invention made the dream of flying come true for the human race (McCullough, 2016). Creativity and Innovation in light of todays organization The fashion giant Zara is one of the most innovative retail stores of the World. In 1975, the first store of Zara was opened by Amancio Ortega in Spain. The group is a part of Inditex which is worlds largest clothing and fashion company with its presence in eighty two countries. The turnover of the group in 2011 was $18 billion and Zara employs more than 100,000 people across the globe. The success of Zara is based on innovation in supply chain management which helps Zara to bring new fashion to the market at a faster rate. The innovative and creative business model of Zara is explained The design team of Zara produces more than 18,000 new designs of products every year. The design team gets their idea of design from books, magazines, fashion shows but most importantly from customer feedback. Zara never adapts its clothing to the local market but it implements the universal design of clothes in all the stores across the globe which helps Zara to achieve economy of scale. It takes less than four weeks for Zara to put their clothes on the shelves starting from the initial process of product design. This innovative concept makes Zara unique and different from the competitors. Zara is not only innovative in its product design but the company is creative and innovative in all of its business processes like inventory and supply chain management, store layouts and manpower management. At the headquarters of Zara in Spain there are 25 full-size shop windows which are equipped with different displays and lighting. This innovative visual merchandising concept helps Zara enabl es designers to figure out how the windows of various retail stores of Zara look like in different conditions like day and night, sunshine and rain. In Zara stores, staff use wireless technology to communicate the customers feedback to the team of suppliers so that the clothes which are on demand are supplied more but Zara uses the concept of creative destruction by bringing new fashion items inside the store after every four weeks(Qrunfleh Tarafdar, 2014). Even the top selling fashion items in Zara stores are replaced by new collection every four weeks .This innovative and creative concept increases the footfall of customers in all the stores of Zara across the globe because customers are interested to check the new fashion trends implemented by Zara in all the stores every four weeks. The company adopts a flat organizational structure with less hierarchical levels which makes the company more innovative with respect to its competitors (Somech Drach-Zahavy, 2013). Space X is an American aerospace company founded by Elon Musk in 2002 .It was the first private company to send spacecraft in the International Space Station (Seedhouse, 2013). Elon Musk also used his personal creativity and innovation to manufacture electric cars. He is the founder of Tesla Motors (Hardman, Shiu Steinberger-Wilckens, 2015). ISRO also known as the Indian Space Research organization is headquartered in Bangalore, India and the organization was successful in sending the Mars orbiter which entered the orbit of Mars in September 2014. With the help of innovation and creativity ISRO was able to accomplish its Mars Orbiter Mission making the organization the first in Asia and the fourth space agency in the world to enter Mars (Math, Moirangthem Kumar, 2015). ALDI is considered to be one of the top 10 Australian retailers. From the opening of its debut store in Australia in 2001, the expansion of Aldi has grown strong with the presence of more than 470 stores throughout. The corporate objective of Aldi in Australia is to deliver customers quality products at low prices, maximize sourcing only from Australian suppliers and create employment (Carpenter et al., 2013). ALDI has been trying new marketing strategy for gaining higher market share in Australia by opening trial stores of a new- style in Australia. These stores will use LED lights to reduce energy consumption, will have improved product displays and will have new layouts which will improve navigation and will shorten average check-out waiting times of customers. Thus Aldi uses innovation and creativity in its business process in Australia. Self-Reflection In the above examples, the concept of creativity and innovation was studied in organizational setting. An individual can also be creative and innovative and give birth to new ideas and implement these ideas into reality by being an entrepreneur and founding a start-up company (Drucker, 2014). I would like to open a beauty clinic and slimming center business if I had the funds.This clinic will cater to the beauty and slimming needs of clients. There will be a slimming center which will use machines to enhance the metabolism of overweight clients .Therapist will provide hand massage by hand-held machines which will target stubborn cellulite of clients body. .The clinic will have an open-air gym, hair and skin clinic which would use advanced machines like laser treatment for hair removal, chemical peels and Botox treatment for the skin. The skin clinic will provide one-stop solution to clients of Australia who are fashion and fitness conscious and will like to enhance their looks. The s limming center and clinic will first be inaugurated in cities of Australia like Sydney, Brisbane, Perth and then will expand on franchisee model. The clinic will provide customized beauty and slimming solutions to clients by making use of the modern innovative technology in the arena of slimming and beauty Mind-mapping and creativity Mind mapping is a graphical technique used to unlock the full potential of the brain. Mind map always starts from the center and spreads in different directions and this colorful graphical technique helps to solve problems more effective and enhances the creative potential of human brain. Mind map therefore has the shape of a tree that revolves around a central topic; branches of the tree can be considered as subtopics (Noonan, 2013). Figure 1 Mind Map (Created by Author) Conclusion It can be concluded from the above report that creativity and innovation is a concept that has a wide range of definitions. Creativity is the ability to generate new ideas and to solve a complex problem. Innovation is the implementation of new ideas and entrepreneur is someone who commercializes new ideas. Therefore, creative people with entrepreneurship skills are the need of the hour. The human race has evolved by using their creative thinking and innovative skills in various fields of art and science. Creativity and innovation has its application in several fields like advertising, marketing and business, science and technology, art and culture. Entrepreneurs are social reformers and famous entrepreneurs like Elon Musk of Space X and Tesla, Mark Zuckerberg of Facebook, Richard Branson of Virgin group and Amancio Ortega of Zara is well-known for their brilliant contribution to the human race. Creativity can be nurtured by every individual in his personal life. It is possible for an ordinary individual to be creative and innovative in his own small way by giving birth to small start-up companies in his home country or just by pursuing intrapreneurship within the office premises. Organizations can adopt a culture of creativity by adopting a flatter structure and building a culture of open communication. Reference Lists: Auernhammer, J., Hall, H. (2014). Organizational culture in knowledge creation, creativity and innovation: Towards the Freiraum model.Journal of Information Science,40(2), 154-166. Carpenter, J. M., Moore, M., Alexander, N., Doherty, A. M. (2013). Consumer demographics, ethnocentrism, cultural values, and acculturation to the global consumer culture: A retail perspective.Journal of Marketing Management,29(3-4), 271-291. ?erne, M., Jakli?, M., kerlavaj, M. (2013). Authentic leadership, creativity, and innovation: A multilevel perspective.Leadership,9(1), 63-85. Dawson, P., Andriopoulos, C. (2014).Managing change, creativity and innovation. Sage. Drucker, P. (2014).Innovation and entrepreneurship. Routledge. Hardman, S., Shiu, E., Steinberger-Wilckens, R. (2015). Changing the fate of Fuel Cell Vehicles: Can lessons be learnt from Tesla Motors?.international journal of hydrogen energy,40(4), 1625-1638. Henry, J., Mayle, D. (2016). Creativity and Innovation. Math, S. B., Moirangthem, S., Kumar, N. C. (2015). Tele-psychiatry: After mars, can we reach the unreached?.Indian journal of psychological medicine,37(2), 120. McCullough, D. (2016).The Wright Brothers. Simon and Schuster. Noonan, M. (2013). Mind maps: Enhancing midwifery education.Nurse education today,33(8), 847-852. Qrunfleh, S., Tarafdar, M. (2014). Supply chain information systems strategy: Impacts on supply chain performance and firm performance.International Journal of Production Economics,147, 340-350. Sarooghi, H., Libaers, D., Burkemper, A. (2015). Examining the relationship between creativity and innovation: A meta-analysis of organizational, cultural, and environmental factors.Journal of business venturing,30(5), 714-731. Seedhouse, E. (2013).SpaceX: making commercial spaceflight a reality. Springer Science Business Media. Serrat, O. (2017). Harnessing creativity and innovation in the workplace. InKnowledge Solutions(pp. 903-910). Springer Singapore. Somech, A., Drach-Zahavy, A. (2013). Translating team creativity to innovation implementation: The role of team composition and climate for innovation.Journal of Management,39(3), 684-708. Wilson, C. (2013).Brainstorming and beyond: a user-centered design method. Newnes.

The story of Romeo and Juliet Essay Example For Students

The story of Romeo and Juliet Essay The story of Romeo and Juliet is a romance story that ended in tragedy. The story consists of two lovers who were in families whos were enemies of each other. That was Romeos and Juliets lone obstacle. Their love for each other was unreal due to the fact they loved each other so much that you might think that they were meant for each other. The story ends in tragedy when Romeo and Juliet die due to their love for each other. Romeo dies by drinking poison when he saw Juliet sleeping from the sleeping potion that made her sleep for three days. We will write a custom essay on The story of Romeo and Juliet specifically for you for only $16.38 $13.9/page Order now Then Juliet kills herself by stabbing herself with a dagger when she wakes up and sees Romeo died. Romeo is the protagonist who is romantic, virtuous, and impulsive. Romeo plays a very romantic person in the play. To illustrate this point Romeo is the only son of Lord Montague, the head of a reputed and rich family of Verona that is plagued by its long-standing feud with the Capulet family. In the first scenes, Romeo appears indifferent to his familys feud. His only concern is his love for Rosaline, a love, which is overwhelming, but artificial. Romeo is really in love with the idea of love. When he does not receive love in return, he grows melancholy and brooding. Even his friend Benvolio cannot distract him. In this short passage we can distinguish that Romeo is quite romantic since his only concern was his love for Rosaline. We can also observe that Romeo contains a very romantic behavior. For example when Romeo states O, she doth teach the torches to burn bright! It seems she hangs upon the cheek of night Like a rich jewel in an Ethiops ear   Beauty too rich for use, for earth too dear! So shows a snowy dove trooping with crows As yonder lady oer her fellows shoes. The measure done, Ill watch her place of stand And, touching hers, make blessed my rude hand Did my heart love till now? Forswear it, sight! For I neer saw true beauty till this night. Another example of him being romantic is when Romeo reverently calls Juliet dear saint, and likens her hand to a shrine, and his lips to two pilgrims whove come to the shrine to be forgiven their sins. Who could resist a romantic line like that? We can distinguish from here that Romeo is a very romantic person. Nowadays the term Romeo has became universal for a romantic ladys man. Romeo is also quite virtuous. For example, Lord Capulet when he calls him, a virtuous and well-governed youth and refuses to let Tybalt bother him, this shows that even the Capulet family likes Romeo who should be their enemy. Everyone in the play likes Romeo with only one exception, Tybalt! Friar Lawrence loves Romeo so much that hell do almost anything to secure his happiness. Mercutio and Benvolio both want to get Romeos attention. Even the Nurse thinks hes honest, courteous, kind, and handsome. Romeos admirer is Tybalt, and Romeo himself tells Tybalt, Villain I am none see thou knowest me not. Romeo here states that he is a no villain and that he is a good and virtuous man. From this we can see that Romeo was a very good person, who treated people with respect since even his familys enemies liked him. When he meets Juliet and discovers his true self and becomes even more virtuous. Their love is so right that Romeos speech is transformed to poetry. The first time they talk together, their conversation effortlessly forms a sonnet. One of the factors that Juliet loved him some much is because he was such a virtuous man. Romeo was a man of good, who is caught in the claws of love.

Running Speed in Dinosaurs

Running Speed in Dinosaurs Introduction Dinosaurs refer to a wide set of animals that dominated vertebrates living on land for more than one hundred and sixty years since the end of Triassic era to the late Cretaceous era. The species of dinosaur began disappearing in the third incident of crustacean extinction event. According to reports from the fossils, avian developed from a group of dinosaurs called theropod in the Jurassic era (Paul 14). A few of the birds evaded this period including their descendants. Never the less, birds in some instances have been classified as dinosaurs.Advertising We will write a custom term paper sample on Running Speed in Dinosaurs specifically for you for only $16.05 $11/page Learn More These are a set of animals consisting of more than nine thousand avian and perciform fish. Several kinds of avian dinosaurs have been identified, ranging from those that fly to those that do not fly. Fossil remains belonging to dinosaurs have been excavated in all parts of the world. A few of the dinosaurs were carnivorous whilst others were herbivorous. Furthermore, some dinosaurs have been having two pedals, others with four pedals. Dinosaurs having two pedals assume the highest ultimate speed in running as opposed to those with four limbs. Never the less, some dinosaurs walking on fours sprint at a fast rate as opposed to their bipedal counterpartss. A case in point is the avian descendants which possess fast moving muscles of the upper arm which have evolved by time to form wings and can propel the dinosaur at very electrifying speeds especially under tension or when running after a prey. Most of the present day animals have their ancestral roots among the dinosaurs’ .The world’s main vertebrates that fly are the birds. In addition to this, most of the dinosaurs have been reduced in sizes and are said to make nests including laying eggs in the nests as well as flying at very high speeds. The first fossils were discovered in the n ineteenth century. Since the discovery, the remains have been preserved in various historic sites such as the museums. Every excavated remain has followed the same suite making museums rich of dinosaur remains. Dinosaurs have appeared in best-selling editorials as well as films expending their fast moving characteristics. New discoveries of the same have been aired by media on regular basis. More so, the eroding dinosaur image as ancient monster has attracted the use of ‘dinosaur’ into gaining entry into vernacular by describing anything that is obsolete, huge, tending towards extinction and slows in motion. Modern definition According to Phylogenic classification, dinosaurs refer to modern birds (Neortnithes), their recent ancestors’. Avian species have been characterized by presence of ostriches; these definitions encompass theropods, sauropodomorphs, ankylosaurians, stegosaurians, ceratopsians, and ornithopods (Paul 67). General description Dinosaurs can be de fined as land based archosaurian reptiles constituting of limbs erected below the body that existed during the end ofs Triassic and the end of Cretaceous periods. Most of antediluvian animals are purported to be dinosaurs (Paul 76). Dinosaurs constituted a large portion of animals living on land and which resembled mammals very closely.Advertising Looking for term paper on biology? Let's see if we can help you! Get your first paper with 15% OFF Learn More Other sets of animals were very small and limited to the size of a rodent or cat. However, Repenomamus giganticus fed on infant dinosaurs. Since 2008, various dinosaur species have been identified. One of the Dinosaurs was found to be living in aerial or marine environments despite the fact that some theropods with feathers could fly. This simply means that some of the spinosaurids constituted of temporal aquatic characteristics. Physiology Most people studying the origin and evolution processes among dinosa urs have given different opinions regarding thermal regulation which closely intertwines with speed in a given animal. Initially a hot discussion ensured with respect to the beasts ability to regulate the body temperatures. Currently studies have supported the fact that these eroding species existed in regions of low temperatures hence most of them had thermal regulatory mechanisms to counter the cooler climatic conditions. Hence, the argument concurs with those who asserted that the dinosaur’s ultimate speed during sprinting was very low; hence they were slow moving creatures. An example of this fossil is that of the polar bears found in Antarctica region. Discovery of avian fossils have also supported the thermal regulation concept among Neortnithes. The study of blood circulation among a set of avian dinosaurs is a true representation of all endothermic creatures. Theropods displayed an active lifestyle blood circulatory system that is characteristic of endothermic animals . Warm-bloodedness among many animals can result from various mechanisms. For example, Mammals and avian whose body sizes are average have been compared with endothermic dinosaurs. These birds make use of their energies to increase their body temperatures above that of the surrounding. Small sized avian have insulators in terms of presence of feathers and fat which aids in thermal regulation. Huge mammals like elephants, however, have a minute surface area compared to its volume which is in agreement with Halden’s principle. This feature enhances thermal regulation which resulting from the cooling of the body temperatures during hot seasons via flapping of the ears. This characteristic is important especially during running after a hunt. Dinosaurs speed The legs of human beings are up right with knees that are straight due to their vertical bodies that put the C.O .G (centre of gravity) in alignment with the socket of the hip. Since both the body and the head of the bipedal d inosaurs were kept level as well as ahead of the hips despite the long tail which countered the balance, the femur sloped in front in order to maintain the feet below COG.Advertising We will write a custom term paper sample on Running Speed in Dinosaurs specifically for you for only $16.05 $11/page Learn More This organization is however extremely represented in birds with short tails whose femoral bones are close to the horizontal line on walking so as to maintain the feet and knees a distant enough in front, hence during running, birds femur tends to strongly swing towards the back as opposed to the front (Martin 57). Two sets of dinosaurs namely the sauropods and the stegosaurs developed elephantine biased towards straighter-jointed columnar limbs. The knee structure was reorganized in that it maintained wholly articulated upright. More so, the mobility of the ankle was reduced whilst the hind limbs were kept short. This adaptation restrained the body fr om being pushed in to actual running irrespective of the size. For instance, young elephants always run at a slower pace as opposed to their parents in that at least one foot is always stack to the ground during high speed running. Dinosaurs with straight limbs should have been much slower in running than elephants whose speed is equal to or less than 15 meters per minute or 25kilometres per hour (Paul 245). Neither, is it an issue to ascertain that medium and small dinosaurs bearing lengthy, slender flexed hind limbs would run at similar speed to galloping mammals and terrestrial birds whose speed is between forty to sixty kilometers per hour. Challenges have been experienced in attempts to find out the highest speed in which heavy weight dinosaurs can attain. Some electronic technologies have claimed that tyrannosauras dinosaurs could attain a highest speed of approximately forty kilometers per hour equal to elephants of the same size which is the human beings sprinting speed. Sin ce large tyrannosaurus had better running adaptations as opposed to elephants, there lacks a likelihood of this kind of creatures having been slow, furthermore, some individuals indicates that enormous theropods capability to run was twice that of similar sized elephants and that this speed was equivalent to that of the non-thorough bred horses and rhinos. Till date, the electronic analysis of dinosaurs locomotion processes in addition to storage of energy in the already stretched tendons of the limbs and springing resonance effect of the tail and torso. Neither, has it occurred that the capability of the programs used in finding out the speed could successfully ascertain extreme animals’ performance as well as estimate the modalities on which extreme dinosaurs which include the supersaurapods were able to maintain an upright posture with minimal movements irrespective of their huge bodies.Advertising Looking for term paper on biology? Let's see if we can help you! Get your first paper with 15% OFF Learn More This is very important to note, however, this query has lacked answers for many decades (Lockley 12). It is even more depressing to think about all this mystery since track-ways indicate that the vast surapods were terrestrial never the less, their appearance looks irregular and their weight cannot give support to elephants whose speed is low and which bears a small body size. The supersaurapods needed super muscles and power to run across Mesozoic lands. They also needed pretty adaptations like well built fiber muscles as well as tendons that have already been tensed to undergo evolution so as to enhance movement. If their muscles were pre-tensed then it is obvious that the huge dinosaurs might have very high running speed as opposed to computer analysis results. General Anatomy and Speed The heads of the dinosaurs ranged from delicate structures to well formed structures. The sinuses or nasal passages were well constructed something that was very popular with the archosaurs. Most dinosaurs maintained prominent orbital openings, where as in others the opening was nearly closed off. As opposed to other mammals that consist of prominent face muscles, and just like avian and reptiles, dinosaurs did not have muscles of the head thus the skin was in direct contact with the skull. This adaptation makes it easier for head restoration in dinosaurs as opposed to other mammals. The outside nares are located in distant place from their nose despite the extent of the nasal cavity which extends in the exterior. Among some set of sauropods, the nasal cavity have been found extended in the anterior part of the skull, over the sockets of the eyes. Previously, it was said that this adaptation enhanced snorkeling of the dinosaurs during submerging. Recently it has been purported that retracted nasal cavities evolved so that it can protect them from irritation as they fed on cactus. Most of the vegetation constituted of soft vegetation and this adaptation really helped the dino saurs. The flabby nasal cavity extended interiorly such that nares on the exterior were positioned in normally close to the snouts tip. Nothing can proof that dinosaurs had proboscis. The skin that covers huge cavities in the orbits anterior of most of the dinosaurs smoothly extended to the exterior. The muscles of the jaw also protruded outside the cavities of the skull of the orbital sockets. Snakes constituted fangs that were trimmed sharply. Amphibians on the other hand had teeth that could be seen upon closure of the lips. The amphibians also did not have muscles that covered the mouth cavity. This adaptation seems to be satisfactory to many of the sauropods and theropods (Lockley 78). One distinct species is the spinosaurs whose arrangement resembles that of a crocodile with the front teeth spaced widely in different sockets. Hence this set of dinosaurs might have lacked lips and their ugly lips left uncovered on closure of the jaws. Ornithischians came up with embryonic teeth . In therizinosaurs and Ornithischians the beak was based on the anterior of the mouth where as in theropods including most of the avian the teeth were replaced by the beak. Most of the birds with beaks do not have lips and cheeks .Never the less; condors have diminished mouths due to the fact that their side jaws are protected by elastic tissues of the cheek which vary from muscles of the cheek covering side teeth. For sauropods and Ornithischians the side teeth were always inset, the surrounding cavities constituted smooth surfaces including the foramen which extending the soft tissues. This implies that the well structured elastic cheeks enveloped the side teeth. This adaptation is clearly spelt out in Ornithischians and the tissues of the cheeks some which underwent ossification especially among the ankysaurs where cheeks protruded towards the beak. The dinosaurs trunk vertebrae moved in various directions such as the dorsal convex or the straight line that varied from feeble to strong (Strickberger 57). The nature in which dinosaurs articulated more so during ossification of the tendons of the spinal meant that their backs were more stiff as opposed to those of lizards as well as other mammals though dinosaurs trunk vertebrae were not jointed. Dinosaur ribs seemed to be more perpendicular yet this varied from one dinosaur to another. The hips and the stomachs of the carnivorous theropods were tiny indicating the diminished digestive system and also their running abilities. Large carnivorous dinosaurs could fast during hunger and porch for prey afterwards hence their stomachs remained hollow during the time of hunting. On the other hand, herbivorous dinosaurs had enlarged hips and bellies which extended to the very extreme in that it adversely affected the fattest dinosaurs. The ankylosaurs shoulder blades were more warped along the extended axis so that it fits on the abrupt change from shoulders which were narrow to the bulged abdomen. The muscles of the trunk were made light and this adaptation enhanced their movement. The gastrointestinal system was made flexible to aid in swallowing of food. The tail and the hip inclined con the same line as they appeared in vertebral of the trunk. Amongst the sauropods and therizinosaurs, the tail and hip were upwardly flexed with respect to the vertebrae of the trunk. This enabled the trunk to be clutched strongly anchored upwards whilst the tail and hips maintained a horizontal plane thus an upright posture of the head was increased where as the dinosaurs ability to run on the hind limbs was maintained. Since most of this animal’s weight concentrated on their hind limbs apart from the tail which acted to counter the weight of the body, most the dinosaurs reared upwards including those whose forelimbs were longer than hind limbs. Assessing the speed of Dinosaur A critical aspect to note in finding out the power and speed of dinosaurs is limb muscles mass, which constitutes a bigger perc entage of the sum of mass in the high speed mammals as opposed to slow speed mammals (Paul 45). Lack of muscles on dinosaur fossils has made it difficult to accurately ascertain the exact speed of dinosaur, the best that can be done is just but finding an approximate figure which has had discrepancies from one researcher to another. The complicated muscles of the limbs of the existing mammals find their roots in the history of dinosaurs. Dinosaurs preserved the plain structure reptile muscles which are prominent till date. For instance, the main muscle which are still visible in most dinosaurs and reptiles but lacking in mammals and avian are caudofemoralis tail based muscles that aided in pulling the legs backwards at the time of propulsive stroke. Despite the fact the exact muscle dinosaur sizes cannot be identified, their comparative sizes amid various sets can be estimated. A case in point is the hips of the reptiles which consists of an undersized ilium in that the muscles of t highs are forced to be narrow restricting their size. The extended iliac of the mammals and avian hold a powerful and broad group of muscles of the thigh (Paul 56). The ancient prosauropods and herreraurs ilium was undersized hence must have consisted of very tiny muscles of the thigh. Some of the dinosaurs had deep and extended ilium holding a very large group of muscles of the thigh promoting sustaining power. To some of the dinosaurs the trend was very extreme. On the other hand, tyrannosaurids and ornithomimids which belong to the family of ostriches consisted of large pelvis demonstrating the presence of distinctively enormous muscles of the legs with the ability to produce enough power during high speed propelling. Longer hips were observed in ceratopsid dinosaurs which enhanced large hind limb muscles which promoted the fast fending off of the muscles. Surprising the large ilium lacked in saurapod dinosaur. This is due to the fact that this kind of dinosaurs did not have to m ove fast. This is the same issue with the elephants which lacked huge muscles beneath the knees due the fact that the limbs in which the shank muscles support immobile and short. This was true of stegosauras and sauropods. Fast moving animals constitute a huge stack of shank muscles that manipulate the extended long, movable limbs through the tendons. For bipedal dinosaur such as avian, huge collection of limbs that resemble the drumstick muscles beneath the knee anchoring on enemial like projections in front of the joints of the knees. Bringing back dinosaurs entirely makes their surface contours to be so simple in that their tails, limbs, and legs into to tubes that are simplified tubes and smoothing above the body topography. Among the saurapods, the neck vertebra protuberance, were prominent on the necks as they appear in giraffes. Since the oesophagus and the trachea of sauropods well held up amidst the necks and their cervical ribs, the lower part of their necks should have be en flattened. As opposed to two legged dinosaurs, four legged dinosaurs are huge with enormous body weights. The dinosaur’s skeletons were adapted to bearing heavy loads as opposed to running. The 3-toed two legged dinosaurs used to walk on twos. This is what the cursorial dinosaurs adaptation to running. This feature is important and it has been well brought gout gin the modern avian which are ancestors of coelurosaurian. Digitigrades features enhance the length of the limbs since the metatarsal bones contribute to the length of the leg increasing the animals COG. An example is the limbs of human being which are used for jumping or running, during running, the runners sprint on their toes. Estimating the Maximum Running Speed of Dinosaurs William Sellers and Phillip Manning attempted to find out the maximum running speed of dinosaurs using robot. In their finding they noted that multiple body simulations by use of approaches such as evolutionary robots seem to give steadfast estimates of the highest speeds attained by dinosaurs (Strickberger 87). For instance, multibody simulations, with minor variations in patterns of muscle activation as well as starting conditions resulted to constant estimates. The ultimate running speed in animals is very technical and poses a lot of challenges in estimating this parameter. This is because as far one might try to estimate using an animal on pace, the animal might not run as fast as it could run. Furthermore most of the estimated values of the running speed of animals are given with regard to the observation findings which were conducted under compromising situations. The ultimate speed of running among dinosaurs differs from one species to another. Whereas the situation may deem to be straight forward in humans in that the two hundred meter sprint may be above or below 0.1 of a second the maximum speed attained can exceed the normal speed by 12m/s. The situation in humans is apt for well known athletes with well b uilt muscles as opposed to the estimations (Paul 67). The above estimates concur with the biochemical techniques which estimate eighteen meters per second among ostriches and thirteen meters per second for emu. The differences in the mass of muscles affects the maximum speed and these changes have a great influence on the average speed of the dinosaurs. Another method of measuring the highest speed attained by the dinosaurs is by estimation the loading capacity of the bones and the value compared to the speed of the animals whose speed is known. Conclusion All in all, dinosaurs were ancient reptiles that existed during the reptile’s period. These creatures dominated the planet hundreds and hundreds of years ago and faded way as time went by and until now we can only see the fossils. Dinosaurs were terrestrial reptiles whose locomotion was on an erect posture. The most unique thing about the dinosaurs was the structure of their distinct hips that caused their hind limbs to pro trude beneath their bodies and not spread out from the sides (Martin 56). When these animals evolved from ancient archosaurs, they were pedaling on twos but evolved to quadric-pedals. The evolution of muscles and the hip structure an adaptation that has enhanced its locomotion and other characteristics. Dinosaurs have been purported to have been the ancient reptiles that ran at a lightning speed (Lockley 78). However, there lacks a clear evidence to ascertain this claim. Some of scientists have tried to estimate the maximum running speed of these animals using conventional robotic instrument with no success. Dinosaurs have evolved from time and time and from the distinct creatures birds, crocodiles have emerged. In evaluating the speed and power is the mass of the muscles of the limb (Martin 67). Despite the fact that the exact mass of the muscles of limb cannot be determined due to the absence of the muscles on the fossils, their comparative size amid various groups can be produced . Scientist has tried estimating the maximum speed of dinosaurs. Approximating the speeds of dinosaurs differ from one method of estimation to another. For instance, some scientists have argued that young children might out do their counterpart in running. The various methods of evaluating the ultimate speed that can be achieved by dinosaurs are the same techniques which can be put to task in evaluating the speed of the animals in today’s world. For instance, the dinosaurs walking speed range between four to six kilometers per hour to six kilometers the ultimate running speed has been purported to range between thirty seven to eighty seven kilometers per hour. The ultimate speed which has been said to be the maximum speed of the dinosaurs is the current speed of the fastest terrestrial Animals. This speed differs from one species to another and it is also dependant on the approach used. Each approach used has its own confounding factors that yield different results. Lockley, Martin. Tracking Dinosaurs: a New Look at an Ancient World. Denver: CUP achive, 1991.Print Martin, Anthony. Introduction to the Study of Dinosaurs. London: Wiley-Blackwell, 2006. Print Paul, Gregory. The Field Guides. New York: Princeton University Press, 2010.Print Strickberger, Monroe. Evolution. New York: Jones Bartlett Learning, 2005.Print