HSA 535 Week 10 DB1 and DB2 Coursework Example | Topics and Well Written Essays - 750 words

HSA 535 Week 10 DB1 and DB2 - Coursework Example Equipped with the knowledge, facilities and technology the U.S is able to conduct such activities with a lot of ease, within a short period of time and as a result they come up with the most appropriate measures to control the disease. Third World countries are countries that are still developing and facing a lot of challenges. Their practice of epidemiology is not as advanced as in the U.S hence delay in achieving results and implementing them. One of the ways that epidemiology can be improved in Third World countries, is by providing information and showing the importance of the need to learn. In a place like Africa, the population is rapidly changing and in order to understand the pattern of a disease it is crucial to get proper information from healthcare providers. Once a healthcare provider does not have the appropriate information from this population it is difficult to obtain the pattern of a disease. Skilled workforce in terms of information and knowledge is a great way to improve epidemiology practice in third world countries. Data collection is an important aspect of epidemiology. Efficient data collection and usage methods can improve epidemiology practice. Data collected through survey usually attracts a limited number of respondents making the research process not to be exhaustive. Inclusion of a large number of people in participating in this survey by assuring them of confidentiality in handling their response will attract more data collection. The more the data that is collected the more that the results established will have more meaning in handling the disease. I agree with Naa that the study of way of life of people from behavioral to social is important in learning how diseases spread and how to prevent the spread. Patterns of disease are easily established by putting into consideration the way of life of people. Once society is healthy, the quality of life will automatically

Of Mice and Men Essay Example for Free

Of Mice and Men Essay As Curleys wife lay their motionless, her golden curls draping around her petite neck while her crisp, white blouse ruffled gently as the breeze blew through the barn door. The golden sunlight of the setting sun bathed her in an orange glow; her lifeless face was lit up as Lennie sat their on his haunches muttering the same words over and over again, lady, hey lady, lady He still didnt realise that she was, dare I say it, dead. Once again a something so full of life has returned to the Earth from whence it came, and all of this was the fault of Lennie. The big guy was just sitting there, not knowing what to do he just sat there, his cropped hair and stubble looking orange in the sunlight, his big nose, eyes and mouth unknowing and not moving began to change his expression as his slow brain began to conform to what he had done. MURDERED! He began to cry out, George, George, help me George, please help me! Meanwhile George was in the local brothel setting bout a while watching the ladies dance. The sunlight was gradually fading as it dropped behind the clouds just above the horizon, George looked at his wristwatch, all battered and scratched from the many years of ranch working it had endured, and decided that it was time to leave, Slim acknowledged that he was leaving and followed him out of the door. Just as they arrived back the tip of the setting sun dropped below the horizon, the time was approaching half past eight, and the air was chilling slightly, George pulled his jacket tighter around himself as they both walked into the ranch. Lennie was sitting on his bunk, as George walked in Lennie looked up at him. Straightaway George knew that something was the matter, not knowing what was up George asked him whats the matter with you Lennie? N Nothin George, honestly, nothin . This reply indicated to George that something was definitely the matter with Lennie. Cmon Lennie, somethins up, you cant hide it from me I know you too well, Uh uh, I didnt mean to, honestly George Maybe youd better just show me huh Lennie? Lennie walked out of the door closely followed by George. As the two of them walked out Slim walked in after a game of toss the horseshoe, puzzled he followed the two of them to the barn. Lennie stood at the door of the barn and pointed inside without looking in. George and Slim looked at each other and walked inside not knowing what they would find. Wheres he gone? George cried in surprise, he was standing here not two minutes ago. While George and Slim had been inside Lennie had made a break for it! I cannot believe this, said George, hes never thought for himself before. Lennie had run into the forest and hidden in the brush right where Lennie had told him to go if anything had happened, which it had, and he had actually done it! He couldnt believe Lennie had done something off of his own back. They decided they should tell Curley as soon as possible, they knew Curley would want to kill Lennie and so they thought they should tell him so he couldnt blame them for keeping it from him. What! I cant believe it! He was both in a state of disbelief and anger. He couldnt believe his wife was dead, and yet he seemed more intent on hurting somebody else because he was hurting himself. His face was twisted and contorted with rage, his eyes were bloodshot, his lips were tight with resentment, his face was beetroot red, he wanted revenge and he was gonna get it. He got up, nobody stood in his way, they didnt see the point, he was so intent on slaughtering Lennie that he left without saying a word, he picked up his luger and headed out into the woods. He cant be far, he said, Ill get the son of a bitch, Ill get him alright , and with that he left. George and Slim decided to round everybody up to try and find Lennie before that savage beast which had erupted inside of Curley found him and slowly killed and maimed him. Where is he? said George, by this time he was getting a bit worried and thought that maybe Curley had already gotten to him. Dont worry Slim said, Im sure we can reason with Curley and try to sort it, no way! Hes so mad not even God himself could reason with him now! They ran on and eventually, thanks to Georges intuition found Lennie in the brush where he had told him to go only a few weeks earlier. Lennie, my God, hes huntin you down, but, but I didnt mean to George, I swear, Okay Lennie I believe you, but he wont listen, hes so clouded with rage he jus wont listen to anybody. Slim decided to leave George and Lennie to talk over what they should do. George went over the plans in his head while Lennie sat there, thinking of what could have been, the poor lummox thought George, he has no idea, the dumb basta suddenly it came to him, I know Lennie what George, what? George knew he couldnt tell Lennie his plan, it would take too long, especially as Lennie would have been to thick to work it all out, quick Lennie, turn around and look up to those mountains, as Lennie slowly turned around to look up to the mountains George put his plan into action. Lennie he said, in a few seconds youll be on the floor, dont move and dont say a word until I come back tonight to get you, George was unable to tell if Lennie had understood or not, but surely it would be worth a try. He kicked Lennies legs out from underneath him, as Lennie fell to the ground George pulled out a luger from under his coat and pulled the trigger. Lennie hit the ground the shot rang out around the mountains. It was completely still after the animals and birds had fled in terror. George just collapsed onto his haunches, Slim had heard the shot and was first to get to George, whats happened? he asked. Ill tell ya later he replied. As he finished his sentence Curley and the others turned up. Candy took off his hat and held it to his chest, some of the others did the same, there was a few moments silence before Curley cried out you dumb asshole! I was supposed to kill him, he killed my wife, pointing to Lennies body on the floor. George quickly began to defend Lennie saying he didnt mean to, hes just a big dumb nobody, you wouldnt have taken any pleasure from it anyhow! Curley didnt have a reply to this; he thought he had probably acted too rash causing the death of somebody else. Curley may be heartless when it comes to beating people up, but killing someone is a little harsh, even for someone like Curley. As they walked away Curley and Candy were chatting about what they couldve done on the farm, Candy was close to tears, George couldnt stand it any longer, he couldnt keep a secret from someone he had grown trust. He told Candy hes not dead whatre you talking bout replied Candy, hes not dead George insisted, how? You shot him in the head, or so you told me, did you see any blood stains or bullet holes, you underhand, sly son of a I just couldnt think of any other way, he told Candy. This cannot get out among the other ranchers, said Candy, I know, I know came Georges reply. George and Candy went into one of the other barns alone so they could talk over what to do about the undead. They decided to leave that night, Candy would clear out his bank account which he had been saving for so long and George decided to do a big heist on the ranch that night. He knew they wouldnt be able to buy a farm or ranch of their own with Candys money alone. They couldnt stay and work there any longer because Lennie would die if he were left in the forest alone. They decided to do it that night and enrol the help of a few of the old hands. George went and spoke to Slim about the possibilities of this so-called job Slim went along with it, but would Carlson. Candy went and spoke to him, he was in. Slims guilty conscience suddenly kicked in, what about the others? What about the others? Candy said. Well, if we take all the money from here then theyll lose their jobs and have no money, hes right ya know George said. Well thats it then, said Carlson, maybe not, why dont we ask them all to help out? Thats a great idea George, but what if one of them refuses and grasses us up to Curley or even the boss! I think thats a risk we should take. I agree, we might as well, we wont have enough money if we dont. What if Curley What if Curley what? What if he got jumpy and whacked one of us? Again, a risk we gotta take, now enough of the what ifs lets do this thing, said George. Yeah! Lets do it, they all said in unison. That evening there was a bustling of activity and organisation. By nine thirty they were all in, all that is except the nigger. They had to try and persuade him as well, because after all everyone deserves a chance, no matter of race, colour or creed. They entered his lone bunkhouse; he was agitated by this mass gathering and was a little jumpy, there was a bead of perspiration running over his furrowed brow, he didnt know what they wanted, he thought they may harm him in some way, but he relaxed when they told him their plan. He was in. He was so happy that someone had wanted to include him, after all, hed been dismissed as a nigger thousands of times, no-one had ever asked him to help with anything big before. They were all in! One by one they came up with suggestions and plans and ways and means of achieving their goal. By the time the plans were finalised it was one thirty. The moon was just above the horizon; it looked larger than normal, the craters and the seas were extremely bright. The whole ranch was lit up, all the stars were visible, and there was not a cloud to be seen in the night sky. What a night, said George, I just hope that Lennie hasnt run off, maybe one of us should go check on him, said Crooks, nah! Replied George, hell be just fine. And with that they began their operation. The nigger was on lookout as was Whit, one at the entrance and one by Curleys bunkhouse hidden in the bushes. George was the brains of the operation and had been secretly observing, over the few weeks he had been there, where Curley was taking the money at the end of the day. He had first had the idea of raiding the ranch when hed come back late from walking one night and saw Curley through the window putting money into the safe, he never thought that his idea would actually come of age, but quite a lot had changed since that day! Slim was Georges rear guard, because he was the most trusted member of the ranchers, who went in while George cracked the big, black safe to which nobody but Curley knew the contents of, and watched his back. There would be no guns except for one because it would be too much of a risk. Carlson was to be the only man with a gun as he was the most experienced member of the group and could handle guns sensibly and was not trigger-happy. While all this was happening the remaining members of the ranch would be ready, in case there was a problem with Curley, or anyone else for that matter, and were ready to pounce and sort out the problem, no questions asked! So the plan was sorted. No one was without a job; everyone was in place, ready and waiting. George and Slim crept out of the bunkhouse wearing their darkest clothes. George had black trousers; a black shirt with a black waist jacket and a dark brown peaked hat, slim was wearing all black with mud on his face. They could hardly be seen in the shade of the moonlight, but when they came out they were a little more suspicious. Bushes and other buildings were their only cover, and they had to creep right outside Curleys window, would he be asleep or would he still be awake planning what to do with his wifes body, it still lay where it had last come to rest at the fate of Lennie. Luckily for them Curley had drifted off to sleep in his armchair with a whiskey bottle in his hand, probably trying to drown his sorrows, poor bastard! He thought, he wont rouse til mornin for sure, but as he said that he stepped on a twig. There was a metaphorically speaking deafening cracking sound. George and Slim stopped instantly, petrified, they were stuck to the spot, not one of them dared move for fear of Curley. Neither wanted to turn around in case Curley was sanding there with a luger in his hand pointing it straight at one of their heads uttering the words what the hell dya think youre doing? It felt like an eternity passed before George turned his head and looked around his shoulder at Slim, whereas it was only a matter of a minute or two. He cant have waken, said Slim looking over the window sill to confirm this, nope, sound as a baby! Thank the lord above for that, said George. They continued their journey and eventually arrived at the office. George put his hand up to the knob and turned, he pushed the door but it wouldnt budge. What! exclaimed Slim when George told him the bad news, however the good news is that I spy a window on the other side that looks to be open, I cant be sure but its definitely worth a try, he said to Slim, lets go Slim replied. They made their way around to the other side of the office finding that the window was open he pushed it upwards causing a lot of noise in the process. Damn it George! I couldnt help it, he replied irritably. They waited to see if Curley had heard, meanwhile Whit was staring intently at Curley, he saw him stir and then drift into a deep drunken sleep again. He breathed a sigh of relief as he looked over to the office and saw George and Lennie staring transfixedly at him waiting for a signal that everything was okay, he gave them the thumbs up and they proceeded to climb in through the now open window. Inside George began the tedious operation of cracking the safe. He had managed to embezzle a stethoscope out of the doctors emergency room so he could listen to every turn of the code-wheel inside the safes portly door. Slim looked down to his watch as he looked out of each window of the office in turn he saw it was getting quite early, the time was now twenty past four, the sun would be rising soon and that meant that their cover would be blown and the game would be up. He also noticed that his ageing hairy hands were perspiring rather more than they should be. For the first time in his adult life he was nervous and was becoming very irrational. George tried to calm him down as he worked on the safe; luckily Slim sat down and calmed himself. George had made two successful turns of the knob and was onto the final and most crucial turn, he concentrated so hard that even an earthquake or tornado could not have disturbed him. The final click came to Georges ear, he pulled the lever to open the door only to find there was yet another door, this time requiring a key. George felt like screaming out but contained himself. He told Slim to stay where he was, George had come this far and he wasnt about to give up easily. He clambered out of the window making no noise at all. The sky had clouded over slightly and the moon was now gone, he noticed over the horizon the black of the night sky turning dark blue, he realised that dawn was approaching and knew he didnt have a lot of time to find that key, the key to all of their freedoms and work-free days, and also to Lennies rabbit farming plans. I cant let them down, George said to himself, especially not Lennie! He arrived at the door to Curleys bunkhouse, he slowly turned the doorknob and yes thought George to his amazement, the door clicked open and with a light push George opened the door. Curley was sitting in the same armchair as he was before. His position had changed slightly but nothing was going to put George off of finding that key, that key that was hanging round Curleys neck, it glinted in his eye almost wryly smiling at him as if it had one their metaphorical game of hide and seek. It was the biggest setback to the heist so far. George rubbed his sweat-covered hand over his stubbly chin. There was only one way to open that safe, there was only one way to get the key that would that, he would have to go right up to Curley and lift it off of his neck. He inched his way up to Curleys chair bit by bit, not making a sound, not breathing, when all of a sudden Curleys head rose, he drew breath and then lolled his head forward. Georges prayers had been answered, the key now hung loosely around Curleys neck instead of being pulled taut about his chest. George moved swiftly, he pulled the chain off and was out of there in a flash. Whit looked at him in amazement from his hideout in the bush and just gave him the thumbs up as he wiped his own sweat-covered brow. Back inside the office Slim noticed that the time had moved on quite considerably since he had last looked, it was now a quarter past six and the sun was beginning to poke its proverbial yellow head over the horizon. Slim rubbed his bleary eyes and told George who by now was loading his bag with cash. Holy cow George! Thats enough to feed a village for a month, youre telling me replied George, he must have been keeping it all for himself, greedy git! Well show him, lets take the lot and keep the key, hell never know how much we got and by the time he sobers up well be long gone. Youre right, well give him a taste of his own money, he kept our hard earned cash away from us so well keep his not so hard earned cash away from him, permanently! Yeah! Lets get out of here, said George. They both got out the window and crept their way over to the exit, Whit followed slightly behind them, he caught up to them and said, well you guys have used up at least three of your nine lives tonight, tell me about it, said Slim, I got so nervous at one stage I almost bottled-it! Anyway, how much was there in that safe, we dont know George told him, we didnt really hang around to count it! Course not, I understand, replied Whit. Lennie had stayed in exactly the same position for the whole night, when they saw him lying there they thought that something was wrong with him, but amazingly he had carried out Georges every word to the letter, he hadnt moved, not even an inch, since George told him not to, he had no idea about the raid on the safe he hadnt a clue that they all planned to help make Georges idea of buying their own ranch a reality. He couldnt believe it when they told him, he was to have a new life, new friends, new rabbits, he was overjoyed and he was speechless, probably a good thing, because nothing intelligent ever came out. All in all it had been a satisfying end to a hard nights work. They were all shocked to find out how much Curley had had stashed away in there. That mustve taken him a good few years and a good few tax evasions to rack up that much, exclaimed Carlson when he saw how much there was. There were many comments like this as the group walked down the road to their freedom, the sun had just risen straight ahead of them, George and Slim lapped up the praise as they walked into their new lives and their new-found wealth. I just feel sorry for Curley, said Candy. Nah! they all said in unison.

America Needs More Gun Control Laws Essays -- Argumentative Essays, Pe

According to James Madison in his Federalist Papers, â€Å"Americans have the right and advantage of being armed – unlike the citizens of other countries whose governments are afraid to trust the people with arms,† (Raymond). Madison may be correct about Americans having more rights than many other countries, but sometimes the government has too much trust in the American people. Taking away all privately owned guns is not the answer, because doing so would consequentially create a communist state. Instead, the best solution is to control who buys guns and for what purpose. There are over 283 million licensed guns in the U.S. (Herbert p1), which does not include the unregistered and illegal guns people own, buy, and sell from the underground economy and other sources. The Second Amendment of the U.S. Constitution provides the rights to bear arms, but when people are killing innocent people, should all Americans have that right? More than 50% of U.S. homes own one or mor e guns (White p1). It is completely unnecessary for so many men and women to own firearms and have concealed weapons to have ready for â€Å"whenever they feel necessary†. A major problem that the government also has is the horrible regulation system on checking up on gun shops and the N.R.A. Gun shops are supposed to check every person who wants to buy a gun to make sure they do not have any bad history or mental disabilities. Some stores, unfortunately, choose not to do so. The N.R.A. sometimes sells guns to â€Å"bad people† who should not be qualified to possess such a powerful weapon. Privately owned firearms should not be legal because less restrictive laws lead to illegal sale, homicides, and accidental deaths that could all be prevented. Since the Mayflower landed on P... ...k] 24 Apr. 2009, A19 sec. A Culture Soaked in Blood. New York Times. Web. 19 Jan. 2015. . New York Times [New York] 8 Apr. 2009, A26 sec. Columbine Plus 10. New York Times. Web. 19 Jan. 2015. . Spitzer, Robert J. The Politics of Gun Control. Chatham: Chatham House, 1995. Print. Waggoner, Dr. Should Federal Gun Control Laws in America Be Tightened? Fall 2007. Web. 19 Jan. 2015. White, Deborah. Pros & Cons of Gun Ownership & Use Laws for Individuals. About.com. Web. 19 Jan. 2015. .

Prophylactic Internal Iliac Artery Ligation Health Essay

Aim: to measure the function of internal iliac arteria ligation as an effectual method of commanding station partum bleeding due to sidelong uterine rupture. Subjects and methods: A randomized controlled survey was conducted on 50 pregnant adult females who were admitted to Shatby University Maternity Hospital between June 2006 and August 2008, all of them were diagnosed as station partum bleeding due to sidelong uterine rupture. The patients were indiscriminately allocated to 2 groups, the ligation group where ligation of internal iliac arteria followed by fix of ruptured uterine wall was done ( group A ) , and the fix group, where ruptured womb was repaired by conventional methods ( group B ) . Informed consent was taken from all patients. Consequences: The ligation group showed a important statistical difference when compared with the fix group sing intra-operative clip ; sum of blood transfused intra-operatively ; continuance of intensive attention unit stay, need for extra surgical intervention such as hysterectomy or extra vaginal hemostasis, and the incidence of complications as disseminated intravascular coagulopathy, and ureteric hurt. Decision ; internal iliac arteria ligation is considered an alternate effectual method to hysterectomy in instances of sidelong uterine rupture, taking to diminish maternal morbidity. Cardinal words: postpartum bleeding ( PPH ) , uterine rupture, internal iliac arteria ligation ( IIAL ) , hysterectomy.IntroductionPost partum bleeding ( PPH ) is a major cause of world-wide mortality runing from 13 % in developed states to 34 % in developing states. ( 1 ) it is responsible for over 125,000 maternal deceases each twelvemonth and is associated with morbidity in 20 million adult females per twelvemonth. ( 2 ) Traditionally, PPH is defined as hemorrhage from the venereal piece of land of 500 milliliter or more in the first 24 hr following bringing of the babe, a significant autumn in the hematocrit or the demand of blood transfusion have besides been proposed. ( 2-5 ) Uterine atonicity is the common cause of PPH that accounts for 80 % of instances ; other causes include maintained placental fragments, lower venereal piece of land lacerations and uterine rupture. ( 6 ) Uterine rupture is a ruinous obstetric complication. Although an uncommon event, it continues to be associated with a high rate of perinatal and maternal morbidity and mortality. ( 7 ) The chief hazard factor for uterine rupture is a scarred womb, normally secondary to a anterior cesarean bringing. Consequently, most of the recent reappraisals on uterine rupture have focused on adult females trying vaginal birth after old cesarean bringing ( VBAC ) . ( 8 ) Rupture of the unscarred womb is a rare obstetric complication, with an estimated incidence of 1 in 8000-15,000 bringings. ( 9 ) There are two types of uterine rupture, complete and uncomplete, distinguished by whether or non the serous coat of the womb is involved. ( 10 ) In the former the uterine contents including foetus and on occasion placenta, may be discharged into the peritoneal pit, whereas in the latter the serous coat is integral and foetus and placenta are inside the uterine pit. ( 11 ) The complete assortment appears to be more unsafe of the two assortments. ( 12 ) Rupture of womb during labour is more unsafe than that happening in gestation because daze is greater and infection is about inevitable. ( 13,14 ) When PPH continues despite aggressive medical intervention, early consideration should be given to surgical intercession. The pick of process will depend on the para of the adult females and her desire for childbirth, the extent of bleeding and, most significantly, the experience and opinion of the sawbones. In most ruinous state of affairss, hysterectomy is preferred in order to collar farther blood loss and via media with certainty. ( 15 ) Although a life-saving process, it may non be appropriate for adult females who need to continue their generative potency. Haemostatic processs that preserve the uterus include uterine pit tamponage, selective uterine arteria embolisation, uterine arteria ligation and uterine brace suturas. ( 16 ) ISSN 1110-0834Internal iliac arteria ligation ( IIAL ) for the control of profuse pelvic hemorrhage has long been recognized as a life-saving process. ( 17 ) The American College of Obstetricians and Gynaecologists continues to recommend the usage of hypogastric arteria ligation in the direction of intraoperative intractable bleeding during pelvic surgery or in instances of obstetric bleeding. ( 18 ) The construct that surcease of blood supply may do harm to pelvic variety meats has been proved to be incorrect. On the contrary, in the instance of pelvic bleeding unmanageable by conservative methods, prompt intercession may non merely salvage the life of the patient but besides her womb. There are several studies of gestations carried to full term after bilateral ligation of the hypogastric arterias. ( 19-23 ) The purpose of this survey was to measure the function of bilateral IIAL in instances of terrible station partum bleeding due to sidelong rupture womb in comparing to the conventional uterine fix merely in such instances.MethodThis survey was conducted on 50 pregnant adult females who were admitted to Shatby University Maternity Hospital between June 2006 and August 2008, all of them were diagnosed as terrible station partum bleeding due to sidelong uterin e rupture which might be extended to the vagina ( Diagnosis was confirmed during Laparotomy ) . The sample group were indiscriminately allocated into two groups: Group A=35 patients ( ligation group ) : adult females were subjected to bilateral IIAL followed by fix of uterine wall. Group B =15 patients ( fix merely group ) : adult females were subjected to conventional methods of uterine fix. All patients were counselled for the process and informed consent was obtained.Technique of internal iliac ligation was done as follow:The womb is lifted out of the pelvic girdle in order to observe the extent of the hurt. The uterine tear is inspected and examined carefully from the vertex downwards. The hemorrhage borders of the womb are held with Green Armytage clinch ( or pealing forceps ) . The vesica is dissected from the lower uterine section by crisp and blunt dissection so mobilized downwards. The external iliac pulsings are felt and followed up to the bifurcation of the common iliac arteria, and the ureter is identified. The peritoneum on the sidelong side of the bifurcation of the common iliac arteria is opened by a longitudinal scratch in such a manner that the ureter remains attached to the median peritoneal contemplation exposing the retroperitoneal anatomy. The internal iliac arteria is traced and carefully dissected off from the underlying vena. Figure ( 1 & A ; 2 ) A dual yarn of absorbable sutura ( Vicryl ) stuff is passed underneath the arteria and tied. Figure ( 3 ) Femoral arteria pulsings are identified after binding the ligatures.Statistical methods:Statistical analysis was done utilizing Statistical Package for Social Sciences ( SPSS/version 15 ) package. The statistical trials used are as follow: Arthematic mean, standard divergence, Chui-square trial and Fisher exact trial was used for categorised parametric quantities, while for numerical informations, t-test was used. The degree of significance was 0.05.ConsequenceIn the ligation group ( group A ) , the age ranged from 24 – 39 old ages with a mean of 32.85A ±6.57 and para ranged from 1-4 with a mean of 2.45A ±1.01, while in the fix group ( group B ) their age ranged from 27-42 old ages with a mean of 33.9A ±7.06 and the para ranged from 1-4 with a mean of 2.622A ±1.05, severally. There was no statistically important difference between the two groups sing age and para. Both groups were compared as respects intra-operative and, postoperative eventsIntraoperative events:The average intra-operative clip in group ( A ) was 45.5A ±4.68 proceedingss, while it was 98.5A ±8.98 proceedingss in group ( B ) . The intra-operative clip is statistically important longer in group B as P= 0.0001. The clip needed for one- sided IIAL ranged between three to seven proceedingss. The average blood volume transfused intra-operatively in group ( A ) was 1750A ±71.6 milliliter, compared to 2980A ±120.8 milliliters in group ( B ) , this difference is statistically important as P= 0.0001. In group ( A ) , Four patients ( 11.4 % ) had hysterectomy, and 6 patients ( 17.1 % ) had extra haemostatic vaginal suturas for extended vaginal cryings after IIAL. In group ( B ) seven patients ( 46.7 % ) had hysterectomy and 10 patients ( 66.7 % ) had haemostatic vaginal suturas. These difference, are statistically important as P= 0.0058 and 0.0005 severally. These findings revealed a higher incidence of extra secondary processs in group ( B ) . There was no ureteric ligation or hurt recorded in group ( A ) , on the other manus in group ( B ) the ureter was ligated on the same side during fix of the tear without exposing the ureter in 2 instances. Fortunately, both discovered intra-operatively and managed. No other complications were recorded in either group. ( Table I )Postoperative eventsAll patients were transferred postoperatively to intensive attention unit ( ICU ) the average continuance of ICU stay was 38A ±5.99 hours in group ( A ) , compared to 70A ±6.85 hours in group B, which is statistically important as P= 0.0001. On the other manus, 5 patients ( 14.3 % ) in group ( A ) which is statistically important less compared to 9 patients ( 60.0 % ) in group ( B ) were complicated with disseminated intra vascular coagulopathy ( DIC ) . The entire volume of blood collected from intra-abdominal drain over 48 hours postoperatively was 211A ±23.85 milliliter in group ( A ) , while it was 751A ±68.98 milliliter in group ( B ) . These revealed a higher incidence of station operative complications in group B. Merely one patient ( 2.9 % ) died from pneumonic intercalation in group ( A ) , and another one ( 6.7 % ) died in group ( B ) due to monolithic hypovolemia and daze. ( Table II ) Fig. 1: Lateral uterine rupture with terrible station partum bleeding Fig. 2: Retroperitoneal anatomy demoing the great vass. Fig. 3: A dual yarn of absorbable sutura stuff is passed underneath the arteria utilizing right angled artery forceps and tied. Table I: Comparison between the two studied groups sing intra-operative events.Group Aâ€Å" n=35 †Group Bâ€Å" n=15 †Trial of significanceIntra-operative clip ( min. ) 45.5A ±4.68 98.5A ±8.98 T = 4.30 P = 0.0001* Sum of blood transfused intra-operatively ( milliliter ) 1750A ±71.6 2980A ±120.8 T = 5.21 P = 0.0001* Need for hysterectomy 4 ( 11.4 % ) 7 ( 46.7 % ) X2 = 7.60 P = 0.0058* Need for extra vaginal haemostatic suturas 6 ( 17.1 % ) 10 ( 66.7 % ) X2 = 11.83 P = 0.0005* Ureteric ligation 0 ( 0.0 % ) 2 ( 13.3 % ) Field-effect transistor P = 0.085 Datas are presented as Mean + SD * P is important if & lt ; 0.05 Field-effect transistor: Fisher Exact ‘s Trial Table II: Comparison between the two studied groups sing post-operative events.Group Aâ€Å" n=35 †Group Bâ€Å" n=15 †Trial of significanceDuration of ICU stay in hours 38A ±5.99 70A ±6.85 T = 4.25 P = 0.001* Incidence of DIC 5 ( 14.3 % ) 9 ( 60.0 % ) X2 = 10.88 P = 0.0009* Entire sum of blood collected in drain over 48 hours ( milliliter ) 211A ±23.85 751A ±68.98 T = 6.21 P = 0.0001* Maternal mortality 1 ( 2.9 % ) 1 ( 6.7 % ) Field-effect transistor P = 0.524 Datas are presented as Mean + SD * P is important if & lt ; 0.05 Field-effect transistor: Fisher Exact ‘s Test DIC: disseminated intra vascular coagulopathy Intensive care unit: intensive attention unitDiscussionUterine rupture is a serious obstetric complication, with high morbidity and mortality, peculiarly in less and least developed states. The most of import defect of the information available is the deficiency of distinction between uterine rupture with and without old cesarean subdivision. Overall, most rates ranged between 0.1 % and 1 % . Maternal mortality ranged between 1 % and 13 % , and perinatal mortality between 74 % and 92 % . ( 24 ) Uterine artery ligation is a promising technique in the direction of PPH as occlusion of the uterine arteria reduces 90 % of the blood flow. It is utile in uterine atonicity, but in uterine injury, when the avulsed uterine arteria retracts into the wide ligament organizing a hematoma, it is hard to make a uterine arteria ligation and salve the womb. IIAL in such state of affairss is helpful as the force per unit area and flow of circulation lessening distal to the ligation and enabling one to readily turn up the hemophiliac and ligate it firmly. Similarly, in instances of deep forniceal cryings and hematoma, uterine arteria ligation or even hysterectomy does non halt the bleeding. In such instances, blood loss could be arrested after IIAL as vaginal arteria is a direct subdivision of anterior division of internal iliac arteria. Since it is a safe, rapid and really effectual method of commanding shed blooding from venereal piece of land, it is besides helpful in commanding postoperative bleeding after abdominal or vaginal hysterectomy where no unequivocal hemorrhage point is noticeable. IIAL was performed for the first clip by Kelly ( 25 ) with a success rate 95 % and without any major complication. Mukherjee et Al ( 26 ) performed 36 instances of IIAL with a success rate of 83.3 % in 6 old ages. The principle for IIAL as an effectual agencies of commanding intractable PPH and forestalling maternal decease is based on the haemodynamic surveies of Burchell, ( 27 ) which showed that IIAL reduced pelvic blood flow by 49 % and pulse force per unit area by 85 % , ensuing in venous force per unit areas in the arterial circuit therefore advancing hemostasis by a simple coagulum formation. However, the reported success rate of IIAL varies from 40 to 100 % , ( 28 ) and the process averts hysterectomy in merely 50 % of instances. ( 29 ) Papp et Al, ( 30 ) published aA reappraisal of indicants and results for 117 instances of bilateral hypogastric arteria ligation over 15 old ages ( 1990-2004 ) . They documented that, apart from a little lesion to the hypogastric vena, no complications were observed. Bleeding was efficaciously controlled in all 37 obstetric instances. In 13 of these instances, the womb was preserved even when there was cervical gestation, placenta previa, placental breaking off, uterine atonicity, and uterine rupture, and 4 adult females were delivered of mature babies. Bleeding was efficaciously controlled in 41 of 80 gynaecological instances. Contraceptive decrease of pelvic blood flow was the indicant for the process in 39 cases.The womb was preserved in merely a few of the 41 controlled instances, but one adult female ( so far ) was delivered of a mature baby. In our survey we evaluated the efficaciousness of ligation of internal iliac arteria in instances of rupture womb. Results showed less operative clip and sum of blood transfused for replacing in comparing to the fix group. In add-on, the womb was preserved in most of the instances, merely 4 patients ( 11.4 % ) had hysterectomy, and 6 patients ( 17.1 % ) had extra vaginal suturas for hemostasis. There were no ureteric or great vessel hurts. The post-operative events, showed short ICU stay and less incidence of complications as DIC was merely seen in 5 patients ( 14.3 % ) , besides it is fertility salvaging process. The fright of vascular hurt and return of bleeding normally deter an obstetrician from fall backing to IIAL. We observed that one time the uterine hemorrhage was controlled during surgery, it did non repeat in the postoperative period in any adult female in whom the womb was conserved. As there is free inosculation providing pelvic variety meats, vascular lack following ligature have non proved to be a job, even after bilateral IIAL. Khelifi et Al. ( 31 ) have evaluated internal iliac arterias in 13 adult females after ligation by color Doppler echography in the 4th twenty-four hours after intercession and so monthly until repermeabilization of the internal iliac arterias. In all instances, the first test showed down-side the ligature, a flow inversion with an of import pelvic indirect circulation. The following Doppler test showed repermeabilization of the hypogastric arterias after an mean interval of 5 months. Pappz et Al. ( 21 ) have reported a successful gestation after internal iliac arteria ligation with normal flow speed in uterine arterias. Wagaarachchi and Fernando ( 22 ) observed successful gestation in 50 % of the instances following bilateral ligation. Therefore, Internal iliac arteria ligation decreases the hemorrhage, clears the operative field and therefore enables the sawbones to avoid blindly clamping and ligating tissues submerged in a pool of blood. This is peculiarly helpful in cut downing the hazard of ureteric hurt. Internal iliac arteria ligation besides facilitates fix of vaginal lacerations that bleed abundantly with each sutura through the vaginal wall. It represents an option to the hysterectomy and preserves the child-bearing maps of some females because of the subsequent vascular recanalization. All accoucheurs caring for parturient adult females should familiarise themselves with this process as it should be an built-in portion of obstetric and gynaecological preparation.

2 Unit Religion – Aboriginal Spirituality.

What does Terra Nullius mean? From at least 60,000 B. C. , Australia was inhabited entirely by Aboriginal and Torres Strait Islander people with traditional, social and land rights. To the Aborigines the land was everything to them and is closely linked to their Dreaming stories. Dreaming is the belief system which explains how the ancestral beings moved across the land and created life and significant geographic features. In consideration, the Indigenous Australians are a people with a close relationship with the land, and through the land they maintain the spiritual links to the ancestral beings.The land is sacred, and for many thousand years, Aboriginal people lived in harmony on their land. After the arrival of the British colonies in 1788, Australia was declared â€Å"Terra Nullius†, which is a Latin term meaning land belongs to no one. As a result of this, Captain Cook, the British captain of the first fleet of ships to arrive at Australia’s shore, claimed that al l of the east coast of Australia belonged to Britain. The underlying argument was that Aboriginal people were so low on scale of human development that their needs were discounted.Because Aboriginal people did not farm the land, build permanent houses on it or use it in other familiar ways, the British decreed that they did not have rights over the land nor did they have any proof of land ownership. Another reason was that there was no identifiable hierarchy or political order which the British government could recognise or negotiate with. Once European settlement began, Aboriginal rights to traditional lands was disregarded and the Aboriginal people of the Sydney region were almost obliterated by introduced diseases and, to a lesser extent, armed force.First contacts were relatively peaceful but Aboriginal people and their culture was strange to the Europeans as well as their plants and animals. Consequently, Terra Nullius continued on for over 200 years. Figure 1: Eddie Mabo Figur e 1: Eddie Mabo Who was Eddie Mabo? Eddie ‘Koiki’ Mabo (seen in figure 1) was born on 29 June 1936, in the community of Las on Mer, known as Murray Island in the Torres Strait. His birth name was Eddie Koiki Sambo; however he was raised by his Uncle Benny Mabo through a customary ‘Island adoption’. During this time, the concept of â€Å"terra nullius† was legislation.When Eddie was growing up, life for the people of the Torres Strait Islands was strictly regulated with laws made by the Queensland Government. However, the Meriam people strived to maintain continuity with the past and continued to live a traditional lifestyle based on fishing, gardening and customary laws of inheritance. At the age of 16, Eddie was exiled from Murray Island for breaking customary Island law, and he set off for the mainland where a new life was waiting for him. Through university, Eddie read a speech in front of people about his people’s belief about the land own ership.A lawyer heard him and asked if he would like to argue with the Australian government about the right for Aboriginal and Torres Strait Islanders to have land rights. After this, Eddie Mabo was successful in addressing the concept of native title to the Australian government on behalf of Murray Island people. He is known for his role in campaigning for indigenous land rights and for his role in a landmark decision of the high court of Australia which neglected the legal doctrine of â€Å"terra nullius† land belong to nobody, which characterized Australian law with regards to land and title.Eddie died in 21 January 1992 and was unable to see the native title given to them. What were the Mabo case and the high court decisions? In the 1970’s, the Queensland Government took over Aboriginal land and was unsympathetic to the concept of land rights or any idea of native title to the land. On the 20th of May 1982, Eddie Koiki Mabo and four other Torres Strait Islanders c hallenged â€Å"terra Nullius† and began their legal claim for ownership to the Supreme Court of Queensland of heir lands on the island of Mer in the Torres Strait since their people had lived on the islands long before the arrival of the white settlement. Eventually, the supreme court of Queensland dismissed the case. Later, another challenge to the concept of â€Å"terra Nullius† was witnessed when Mabo and the four other islanders took the case to the High court of Australia. They requested that the court declare that their traditional land ownership and rights to the land and seas of the Mer Islands had not been extinguished. Furthermore, they claimed that the Crown’s authority over the islands was subject to the land rights of the Murray Islanders.It was not until 3 June 1992 that Mabo case No. 2 was decided. By then, 10 years after the case opened, Eddie Mabo had died. By a majority, six out of one of the judges agreed that the Meriam people did have tradi tional ownership of their land. The judges held that British possession had not eliminated their title and that the Meriam people are entitled as to possession, occupation, use and enjoyment of the lands of the Murray Islands. This decision has wiped the concept of â€Å"terra nullius† and awarded the indigenous Australians with the Native Title.Consequently, the term â€Å"Native title† is still in existence and contributed to allow the Indigenous Australians to maintain a continuous spiritual and cultural connection to the land. Therefore, this decision was important because it recognised that Australia was inhabited By the Indigenous Australians long before the White settlement and hold the native title. What is the Native title Act (1993) Commonwealth? Native title is a legal term which recognises the rights of Aboriginal and Torres Strait Islander people to the use and occupation of lands with which they have maintained a continuing, traditional connections.Eventu ally, in the 1970’s the Queensland government began to remove the land rights of people of Murray Island in the Torres Strait. One of the Meriam people, Eddie Mabo, took the Queensland Government to court to prevent this from happening. Sadly, this case failed. Moreover, Mabo and some other people took the case to the high court of Australia. The high court decided in favour of the Meriam people and recognised the principle of Native title. Ultimately, during this historical event, Eddie Mabo was dead. In 1993, The Keating Labor government passed the Native Title Act.This Act accepted the notion of Native title in law and also recognised the rights of owners of freehold property. Nevertheless, pastoralists and miners were still concerned, and many people leased land from the government. The legislation aimed to codify the Mabo decision and implemented strategies to facilitate the process of granting native title. However, it had not resolved the question of whether the granti ng of pastoral lease extinguished Native title. In this case, the High court argued that native title could co-exist with the rights of leaseholders.However, the pastoralists and the mining companies who lease lands were still concerned that the court was too much in favour of native title. In 1997, native title act passed by the Howard government. This act stated that Native title and leasehold rights could co-exist and in any conflict, the rights or the leaseholders would come first. What was the Wik Decision (1996) commonwealth? The Native title Act of 1993 had not resolved the question of whether the granting of a pastoral lease extinguished Native title.In 1993, the Wik people on Cape York in Queensland made a claim for land on Cape York Peninsula which included two large Pastoral leases. The federal court upheld the Native Title Act 1993 against the Wik people, with an argument that Aboriginal Australians had no control over land that has been leased. This case was further tak en to the High court of Australia. In December 1996, the high court ruled that the granting of a pastoral lease had not in fact extinguished native title. With reference to a letter from 1848 in which a British secretary of state for colonies wrote to governor ofNSW which stated that the leaseholders had to negotiate with the traditional owners to allow them access. Pastoralists viewed the Wik decision with great concerns, for they had always believed that they had full and sole rights to manage their leases. After the Wik decision, Pastoralists would have to negotiate with any group who could prove native title right. Unfortunately, the pastoralists and miners increased the pressure on government because they were not happy with the Wik decision and the idea that Indigenous Australians had rights to leased land.After a debate on this issue, the Howard government passed an amendment to the 1993 Native title Act. This change reduced the rights of indigenous Australians under the act and removed their right to negotiate with pastoralists and miners. This new law, made it difficult for Aboriginal Australians to make land rights claims Outline the importance of the Dreaming for the land rights movement? The Dreaming for Australian Indigenous people (sometimes referred to as the Dreamtime or Dreamtimes) refers to when the Ancestral Beings moved across the land and created life and significant geographic features.The land rights are of critical importance in relation to Aboriginal spirituality, because the dreaming is inextricably connected with the land. Since the Dreaming is closely connected to the land, the land rights movement is an important movement in helping Aboriginal people re-establish spiritual links with their sacred land which was lost as a result of the European settlement. The dreaming is essential to the land rights movement because of many reasons such as: To the Aborigines, the dreaming is the central role which land occupies in Aboriginal spirit uality, as land is the path through which the dreaming is experienced and communicated.Without the land, the dreaming cannot be communicated because it is from the land that the stories of ancestor spirits in the dreaming flow. It is through their intimate connection to the land that the foundational concept which lies at the heart of Aboriginal spirituality, that is, the dreaming can be accessed. The land therefore, acts as the mother for the Aboriginal people, and that since it is, the identity of every Aboriginal person is closely linked to the land. Therefore, the importance of the land rights movement for Aboriginal spirituality should not be underestimated.More importantly, the dreaming stories provide the entire ethical and moral basis by which Aboriginal people live on their land and relate to each other. It is known that the access to their land is fundamental to the putting into practice of Aboriginal law. This factor underlies the Aboriginal law is the knowledge and ritua l relating to sacred sites. These sites need to be cared for and this is done through ritual ceremony. Each person is linked to the spirit ancestor who created the land, and it is this which creates an Aboriginal person’s identity.Through the dreaming, Spirit connects each person with particular sacred sites, with the result that each person has a connection with specific places on the land. According to the Aboriginal belief system, individuals have clearly defined responsibilities in relation to the land, in particular the protection of sacred sites. Sacred sites may be desecrated through grazing, mining, or perhaps contact with site by people without knowledge of the necessary ritual. Access to these sites is critical for the performance of rituals and ceremonies so that the law can be taught to new generations.Another importance of the dreaming is that the dreaming connects each tribe to a totem. A totem is an emblem mainly a plant or an animal that has become a symbol fo r a group who is believed to be responsible for their existence. The totem unifies the Clan (group) under the leadership of the spirit ancestor and thereby also creates a metaphysical connection with other clans bearing the same totem. Without their access to their totems, the Aboriginal people would lose their identity and prevent the belief system to be passed on to the next generation. Also, being taken away from a totem can alienate the individual from their clan.The land rights movement can re-establish the access to the totems and belonging to the same clan under the sacred totem. Thus, the dreaming which explains the clan’s existence by their totem is essential to the land rights movement. For the purpose of land rights and spiritual fulfilment of the land, the Australian History has witnessed many land rights movement. Those include the Yolgnu people of Yirrkala in 1963 and the 1966 Gurindji people. In 1963, the Yolgnu people of Yirrkala sent a typed petition in both their own language and English to the federal parliament because the government had granted a mining company the right to mine auxite without consulting the traditional owners. The paper was fixed to a surrounding bark painting which depicted the people’s relationship with the land, and the Yirrkala people were seeking recognition of rights to their traditional lands on the Gove Peninsula. This however, was rejected in the court. To not underestimating this land rights movement, it was the first Aboriginal land rights movement and was an important step in the eventual recognition of indigenous land rights movement.Another Early land rights movement was in 1966, when the Gurindji people began a strike at the British-owned Wave Hill station in the Northern Territory to protest about intolerable working conditions and low wages. They set up a camp at Wattie Creek and demanded that some of their traditional lands to be restored to them. The protest eventually led to their being g ranted the rights to Wattie Creek by the Whitlam Government in 1975. The passing by the Fraser Government of the Commonwealth Land Rights Act northern territory, 1976, gave Aboriginal people freehold title to traditional lands in the northern territory.As shown, the land rights movements were based on the belief of the dreaming. This is because the land is closely linked to the dreaming and by restoring land rights again, the Aboriginal community could re-establish the dreaming which involves the land, sacred sites, totems and ancestral beings. How has dispossession affected Aboriginal spirituality? (seperatio Land, kinship, stolen generation). The Dispossession of the Indigenous Australians has had a major impact on their Spirituality and beliefs, including their connection to the land, kinship and explored a major effect which is the stolen Generation.When the White Settlement began in Australia in 1788, Australia was called â€Å"terra Nullius† meaning that the land belong s to no body. What was unknown to the British settlement is that the land is the home for the Aborigines and those Aborigines have been living in this land for more than 50,000 years. In the nineteenth century and much of the twentieth century the official policy towards Aboriginal Australians was called protectionism. Protectionism is the idea that Aboriginal Australians needed to be separated from the white society and be protected because they were unable to do so.As a result, they were removed from their traditional lands and placed in missions which at that time were controlled by Christian churches. This was a major factor in separating Aboriginal people from their own culture and religions. Since the Aboriginal religion is based on the dreaming which refers to the time where ancestors created the land, the dreaming is closely connected to the land because it is through the land that the stories of the dreaming emerge. Many of their rituals and ceremonies were inseparably link ed to the land and sacred sites.Consequently, many Aborigines were separated from their spiritualties and beliefs. Another major effect of dispossession from land is when separated people have later tried to gain access to their land but have no knowledge of the law and tradition and also no proof of their connection to the land. Therefore, dispossession from land has impacted on the Aborigines because the land plays a major role in their spiritual beliefs. Similarly, separation from Kinship groups has limited the Aboriginal people’s opportunity to express their religion in traditional songs and dances.The Kinship is a complex system of belonging, relationships and responsibilities within a tribe that are based on the dreaming. Due to the fact that most of Aboriginal tribes had their own language, separation from kinship made it impossible for Aboriginal people to preserve their own language and dreaming stories of their clan (tribe). It is known that each Aboriginal individu al has a responsibility within their clan. Many Aborigines as a result of dispossession lost the opportunity to participate in rituals that would gain them acceptance into the clan.Eventually, Kinship groups had the responsibility for raising and nurturing children even though they were not their biological children. When children were taken away from their clan by the white colonisation, the community lost the responsibility of taking care and nurturing the children and thus, lost the concept of kinship. Another effect of separation from Kinship groups is that the separation prevented individuals from inheriting the traditional parenting skills such as teaching the young their responsibilities and the dreaming stories.Separation from Kinship can also mean isolation from the ceremonial life. Ceremonies such as initiations or funerals are of a critical importance because they are a part of the Aboriginal life. Without these ceremonies, a person is disconnected to their kinship and th eir Aboriginal spirituality. This also limited the spread of their beliefs to the next generations. Hence, Kinship separation has led to the loss of spirituality. The so called â€Å"Stolen Generations† have also affected the Aboriginal spirituality.The term â€Å"Stolen Generation† refers to the children who were removed from their homes between 1900 and 1972 by the Government and Church missionaries in an attempt to assimilate these children into European society. Most of the children who were taken away lost contact with other Aboriginal people, their culture, beliefs and land. In addition, they also lost their own languages. As a result, the stolen generation found it difficult to restore the connection with their own people and culture. The children were only exposed to white culture, because they were told that their families had rejected them or they were dead.The contact between the children and families was rarely allowed. This lead to a lack of role models ta ught the Aboriginal beliefs. Some of the stolen Generation could not pass on the dreaming stories of the ancestral beings to their children, unlike how they were initially taught with their Aboriginal community. Many of the children were exposed to Christianity in its various forms. The children were taught the Christian religion in Christian missions, which undoubtedly contributed to the destruction of aboriginal culture and spirituality. Thus, the removing of the Aboriginal children had impacted on the Aboriginal spirituality.Therefore, the dispossession from the land, kinship and the stolen Generation has affected the Aboriginal Spirituality. ——————————————– [ 1 ]. http://www. aboriginalheritage. org/history/history/ [ 2 ]. http://www. parliament. nsw. gov. au/prod/web/common. nsf/key/HistoryBeforeEuropeanSettlement [ 3 ]. 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EntityID=775 [ 15 ]. http://www. library. uq. edu. au/fryer/1967_referendum/labour. html [ 16 ]. http://www. library. uq. edu. u/fryer/1967_referendum/labour. html [ 17 ]. http://reconciliaction. org. au/nsw/education-kit/land-rights/ [ 18 ]. http://www. library. uq. edu. au/fryer/1967_referendum/labour. html [ 19 ]. :http://www. abs. gov. au/Ausstats/[email  protected] nsf/Previousproducts/1301. 0Feature%20Article21995? opendocument [ 20 ]. http://reconciliaction. org. au/nsw/education-kit/land-rights/ [ 21 ]. http://reconciliaction. org. au/nsw/education-kit/land-rights/ [ 22 ]. http://www. library. uq. edu. au/fryer/1967_referendum/labour. html [ 23 ]. http://www. library. uq. edu. au/fryer/1967_referendum/labour. html