A Policy in Healthcare that was Implemented as a Result of Regulatory Research Paper

A Policy in Healthcare that was Implemented as a Result of Regulatory or Legislative Requirement - Research Paper Example This bill went into effect on January 1, 2007. This bill states that all acute, psychiatric and special hospitals must make patients aware of charity care, payment discounts, and government-sponsored health insurance. It also requires hospitals to standardize its billing and collection procedures (California Assembly Bill 774). Basically, this law requires transparency in hospital billing, as all hospitals must have detailed information about their charity policies, including who is eligible and what procedure must be taken for eligibility, and a written description of how the hospitals collect the debts. Also required is a written disclosure of the hospital billing practices and debt collection procedures for everybody (California Assembly Bill 774). Analysis The rationale for this particular change in the way California Sutter Health is doing business is rather simple – health care costs are spiraling out of control, and uninsured patients contribute much to the ever-burgeon ing cost of health care to this country. As of 2005, some $45 billion worth of medical care is not being paid by uninsured patients (Families USA, 2005). What this means is that those with insurance pick up the tab for the people who cannot pay in the form of higher premiums. Another rationale for implementing this scheme is to encourage uninsured patients to get the care that they need, when they need it. Prior to the California Sutter Health scheme, many individuals did not visit the doctor when it was necessary, for fear that they would be hit with high medical bills (Families USA, 2005). This is because there was a great deal of uncertainty going in how much a certain procedure or visit would cost. What California Sutter Health did was show the patient, up front, what the costs would be, and this greatly empowers patients. The reason why this empowers patients is that they can see how much they will pay for something in advance. Then, they could either decide to get the procedur e done, at that time, if they had the money for it, or they could decide to put the procedure off until they had the chance to save up the money that was needed. Therefore, everybody wins – the patient is allowed to know, up front, how much a procedure might cost, which helps the patient, and the hospital itself does not find itself stuck with uncollectible bills that makes the cost of health care higher for everybody. This scheme allowed CSH to reduced its account receivables by $78 million in just three months (Souza & McCarty, 2007). These are some of the benefits of the program. Which is not to say that the policy is without its costs. There were a few bugs that needed to be worked out before the policy was implemented. For instance, the patient financial services staff member, and the Central Business Office could not access real-time financial information and management could not generate detailed reports (Souza & McCarty, 2007). Moreover, there was the costs of properl y training the patient financial services (PFS) staff, for they had to be trained in spotting errors and correcting them, such as when the occurrence code is incorrectly filed or accident information is missing from the claim (Souza & McCarty, 2007). Further training had to be done with registration employees, who were never accustomed to asking for money; they had to be tr

International Law - war on terrorism Essay Example | Topics and Well Written Essays - 2000 words

International Law - war on terrorism - Essay Example Second, the role of the Italian government in the transfer of the prisoners. Third, the role of the Italian prosecutors in indicting members of its own government and fourth, the degree to which the United States should acquiesce to the Italian prosecutors and turn over the CIA agents for trial. Dealing with the first section, it should initially be stated that the United States does have a duty to obey international law and treaties that it is a signatory to (Shaw, 2003). The fact that the United States is seen as the world's only super-power with supposedly overwhelming power (although the current Iraq debacle would put this in a problematic light) does not imply that it should ignore international laws because it can. Indeed, the very idea of "international law" was created in order to stop countries from doing what they wanted to when they had the power to do so - the prime examples being Germany and Japan during WWII. The more powerful the country, the more it should be seen to adhere to both the letter and the spirit of the law. It is with this background that the role of the United States should be seen. The United States is a signatory to the United Nations Universal Declaration of Human Rights, signed in 1948. This may be seen as the overarching "treaty" (even though it is not officially one) under which international agreements under human rights have been signed and enforced since this time. The Declaration is quite specific on a number of matters that directly relate to the case of the radical Muslim cleric, most notably article 3, which states that "everyone has the right to life, liberty and security of person", Article 5, which states that "no-one shall be subjected to torture, or to cruel, inhuman or degrading treatment or punishment" and Article 6, which states that "everyone has the right to recognition everywhere as a person before the law" (UN, 1948). It seems quite clear that the kidnapping of a prisoner and his transport to a country where the CIA knows that he is going to be tortured by the authorities, and indeed, the fact that he is specifically being transferred to that country in order to be tortured is a contravention of the Declaration that was signed in 1948. The United States has, more specifically, signed the United Nations Convention against Torture and Other Cruel, Inhuman or Degrading Treatment (UNICAT), which came into effect in 1987. The definition of torture according to the Convention is "any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from or a third person information or a confession" (United Nations, 1987). The question which arises in cases such as the one here is whether the movement of a person from one jurisdiction to another, commonly known as "rendition" within the law (Higgins, 2000). Rendition has normally occurred, at least until recently, through legal channels such as extradition, which occurs between countries or from state to state within a single country that has a federal system. The problem that appears with so-called "extraordinary rendition", which occurs without any visible legal

Reading Theories Essay Example for Free

Reading Theories Essay Reading theories Of the two approaches mentioned in reading research and literature, the bottom-up approach focuses on language elements such as grammar, vocabulary and cohesion, while the top-down approach includes a focus on background knowledge about content and organization, generally referred to as content and formal schemata respectively. A combination of these two approaches is generally known as the Interactive Model of Reading. The pedagogy in this study was based on the Schema Interactive Model of Reading (Simonsen and Singer, 1992). 7 able 1: Approaches and strategies Approaches Top Down Strategies # Generating questions from title Skimming questions Bottom Up for content, based generated# Skimming # on for writer’s thesis # Guessing meanings of words from context (vocabulary) use of modals, tenses Schema discourse) Interactive (text as # Concepts of cohesion and coherence and connections between paragraphs Text purpose and purpose at paragraph level # the # Understanding how language functions in context. E. g. Metaphorical models of reading Specific models of reading. Bottom-up models Top-down models Interactive models Interactive compensatory model( nature inner knowledge) if there’s lack u should compensate it Word recognition model Simple view of reading model Dual coding model (2languages) Psycholinguistic guessing game: activate prior knowledge .. student is giving an aim for reading Reading strategies : . specifying a purpose for reading ? Planning what to do and what steps to take ? Previewing the text ? Predicting the contentes of the text or section of text ? Reflecting on what has been learned from the text ? Checking prdictions ? Posing questions about the text ? Finding answers to posed questions ? Connecting test to background knowledge ? Summarizing infor ? Makin interferances ? ? ? ? ? ? ? ? ? ? ? Connecting one part of the text to another Paying attention to text structure Rereading Guessing the meaning of new word from the context Using discourse makers to see relationships Checking comprehension Identifying difficulties Taking steps to reapir faulty comprehension Critiquing the author Critiquing the text Judging how well purposes for reading were met (where you reached the aim of reading or not ) Reading is not decoding but building concepts Read is to acquire lge in order to know special notes In order to write u need positions + definitions Learning can happen without reading There is implicit relationship betwwen l1 and l2 It is natural to use L1 in L2 reading.. L1 IS The basis of L1 To accomplish this goal, instructors focus on the process of reading rather than on its product. ? ? ? They develop students awareness of the reading process and reading strategies by asking students to think and talk about how they read in their native language. They allow students to practice the full repertoire of reading strategies by using authentic reading tasks. They encourage students to read to learn (and have an authentic purpose for reading) by giving students some choice of reading material. When working with reading tasks in class, they show students the strategies that will work best for the reading purpose and the type of text. They explain how and why students should use the strategies. ? ? ? ? They have students practice reading strategies in class and ask them to practice outside of class in their reading assignments. They encourage students to be conscious of what theyre doing while they complete reading assignments. They encourage students to evaluate their comprehension and selfreport their use of strategies. They build comprehension checks into in-class and out-of-class reading assignments, and periodically review how and when to use particular strategies. They encourage the development of reading skills and the use of reading strategies by using the target language to convey instructions and course-related information in written form: office hours, homework assignments, test content. They do not assume that students will transfer strategy use from one task to another. They explicitly mention how a particular strategy can be used in a different type of reading task or with another skill. By raising students awareness of reading as a skill that requires active engagement, and by explicitly teaching reading strategies, instructors help their students develop both the ability and the confidence to handle communication situations they may encounter beyond the classroom. In this way they give their students the foundation for communicative competence in the new language. ‘ SLA: Second-language acquisition or second-language learning is the process by which people learn a second language. Second-language acquisition (often abbreviated to SLA) also refers to the scientific discipline devoted to studying that process. Second language refers to any language learned in addition to a persons first language; although the concept is named second-language [1] acquisition, it can also incorporate the learning of third, fourth, or subsequent languages. Secondlanguage acquisition refers to what learners do; it does not refer to practices in language teaching. The academic discipline of second-language acquisition is a subdiscipline of applied linguistics. It is broad-based and relatively new. As well as the various branches of linguistics, second-language acquisition is also closely related to psychology, cognitive psychology, and education Is to acquire lg without effort : classroom/real life.. in natural way L2 reading is a reading problem. is not letter decoding†¦when you read l2 text you activate your prior knowledge †¦l2 readers who are able to turn a txt into paragraph are better reader==) read faster/remember more There is no reading without : -phonological representation /guess meaning/ prior knwldge Implicit knowledge That we learn unconsciously Automatic knowledge The explcit will turn into implicit Output: what u speak input: what u read learn Explicit knowledge we can verbelize.

Effect Of Tailor Made Technique Nursing Essay

Effect Of Tailor Made Technique Nursing Essay Children are members of families, communities, populations and overall society, which shape the context, experiences, and opportunities of their lives. Thus, their wellbeing is inextricably linked to the well-being of their families, communities and the society in which they live. Hospitalization of children is for acute or chronic conditions. Many factors contribute to the distress of young children during hospitalization, and existing fears and emotions may be intensified with prolonged hospitalization. Children become anxious and normal fears are exacerbated when they think about being in pain, harmed, or mutilated in some way or being separated from parents (Nicki and Barbara, 2007). Cannulation causes moderate or severe pain and fear in a substantial number of children and adults. Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage (Merskey and Bogduk, 1994). Pain relief is a human right, yet pain in children is an under-recognized problem around the world. Children not only have pain from injuries, surgery, burns, infections, and the effects of war, terrorism, and violence, but also undergo pain from many procedures and investigations used by doctors and nurses to investigate and treat disease. Fear can be explained as a state of dread, apprehension or trepidation related to the future. Fear is a major stressor among hospitalized children. According to children, insertion of needle is one of the most fearful experiences. For many people, the needle can only be a source of fear to the extent that a needle is a necessary part of the procedure that initiates a terrifying involuntary reaction of ones body. For some the fear may extend up to needle phobia,  who has thought about the nature and origin of their condition, they actually have no fear of needles at all, but may have an extreme fear of suffering the physical effects of a needle phobia reaction. Thus, these problems of a hospitalized child can be alleviated by the nurse who is directly responsible for their protection and guidance. Nurses are at high risk for liability with regard to the under treatment of pain and fear. Of all the members of the health care team, nurses spend most of the time with patients and are recognized as the patients primary pain managers. The nurse is concerned not only with providing nursing interventions to children, but also with obtaining cooperation of children to the procedures to them. This is possible for a nurse with the skill in wide variety of interventions such as therapeutic play and the use of the arts and humanities as music, drama, television etc. Some institutions have procedures for minimizing the predictable pain and fear of cannulation, especially in children. Current advances are being made to control pain by integrating both the science of pain medications and the science of the human mind. According to Brunner and Suddharth (2004), distraction is thought to reduce the perception of pain by stimulating the descending control system, resulting in fewer painful stimuli being transmitted to brain. Distraction techniques may range from simple activities, such as watching TV or listening to music, to highly complex physical and mental exercises. Topical analgesics have been one important tool in reducing and preventing pain during minor procedures. As elicited by Potter and Perry (2005), the anesthetic cream which is thickly applied is placed on the skin 15 minutes before local anesthetic infiltration or minor procedures, e.g., IV start. The Lidocaine patch is a topical analgesic effective in cutaneous pain. Three patches are placed on and around the pain site using a 12-hour on, 12-hour off schedule to avoid Lidocaine toxicity. According to Sr. Nancy (2005), hot applications can be dry heat applications or moist heat applications which may be applied either locally or generally. Hot applications have many local physiological effects on the body. One among the many local physiological effects of hot application is vasodilatation. Dilatation of vein aids in reducing the number of phlebotomy attempts. Also, the chief therapeutic use of local hot application is that it decreases pain due to ischemia, local congestion and muscle spasm. Injections of any kind can hurt! Children know this pain is predictable. How they respond to an injection depends in part of their developmental age and their previous experience. Intravenous and intramuscular injections should be given in such a manner that the children do not have time to build up their anxiety about the procedure. Tailor-made means, it has been specially designed for a particular purpose. Thus the researcher uses tailor-made technique for preschool and school-aged children who enjoy active play, during the injection the nurse can suggest distraction activities along with local analgesics agent and hot application. NEED FOR THE STUDY The leading health indicators, the healthy people 2010 provides a framework for identifying essential components of child health promotion programs, designed to prevent future health problems in our nations children (Department of health and human service, 2007). The present total population of children in the world is 2.2 billion where in India, 13.1 percent of the population that is 15, 87, 89,287 are children (Census, 2011). The Paediatric ward of Sri Ramakrishna hospital receives an average of 1414 admissions per year. Almost all of them ought to have venipuncture since it is an integral part of performing diagnostic procedures and administering therapy during a patients hospitalization. Each hospitalized child has to undergo at least a single venipuncture within every three days of hospital life. Thus, attention in relieving such pain and fear is a must. Pain is the primary complaint for which people seek medical treatments. Sr. Callista Roy (1991), defined pain within the psychological mode, as a sensory experience of acute and chronic nature, coded into the somatosensory pain pathways. Acute pain, according to Sr Callista Roy, refers to Discomfort which is intense but relatively short and reversible. Using principles from neuropsychology; Roy stated that a sensory experience such as pain involves the transmission of information from sensory pathways to the cerebral cortex. The theoretical explanation for the effectiveness of distraction lies in its ability to divert attention away from the painful stimulus. McCaul and Malott (1984) hypothesize that the brain has a limited capacity to focus attention on stimuli. Therefore, using up attentional resources while engaging in a distracting task leaves little capacity for attending to painful stimuli. The Gate Control Theory of Pain proposed by Melzack and Wall (1965, 1995) offers a physiological explanation of the effectiveness of attention diversion. In brief, the Gate Control Theory explains that pain perception can be affected by factors other than the stimulus itself. This theory suggests that pain perception is controlled by a neural mechanism or gate in the spinal cord. Depending on how the mechanism is activated, the gate can be opened or closed. When the gate is open, 8 pain signals are transmitted to the brain, and when the gate is closed, they are not. Melzack originally proposed this theory to exp lain why physically stimulating an area can lead to reduced pain perception, but later modified his theory to suggest that cognitive factors can also open or close the gate. Cognitive and behavioral processes, such as distraction, Lamaze, and self hypnosis, cartoons can close the gate to subsequent pain perception by diverting attention away from the painful stimulus and toward focal points. Neglected pain erodes a patients trust in the health care system. In 1995, the American pain society challenged all health care systems to make pain as the fifth vital sign. James Campbell, the societys President noted that, if pain were assessed with the same zeal as other vital signs, there would be a much better chance of its being treated properly .Failure to appropriately assess and treat pain is a liability issue for facilities and members of the health care team . Pain is always a source of anxiety, as well as a constant companion. Furthermore about 10% of adults in the United States have needle phobia, as intense fear of needle that triggers immediate anxiety in the most severe cases, vasovagal response can lead to shock. The phobia may intensify for most people with the minimal pain of venipuncture. The fear usually begins in childhood and it may lead to avoidance of medical care. According to Journal of Anxiety Disorders (2006), the tendency to experience pain, disgust, and  fear  of fainting during injections was associated with anxious responding to the venipuncture and a probable diagnosis of  needle  phobia. A local anesthetic, Lidocaine blocks the conduction of pain impulses and stabilizes the neuronal membranes, thereby relieving pain. The drug penetrates the skin to act locally on the damaged or dysfunctional nerves and soft tissues, underlying the site. The benefit of local mechanism of action is that, with appropriate use, there is minimal systemic absorption of Lidocaine and adverse effects such as central nervous system depression or excitation are averted .Local absorption, also results in fewer drug interactions , an important consideration ,because many people with chronic pain requires opioids, nonopioids or adjuvant analgesics. A study was conducted by C V Bellieni et al., in 2006 conducted to the children, the results of is reported in the November 28 issue of the Archives of Disease in Childhood.In this study, 69 children aged 7 to 12 years undergoing medical procedure were randomized to receive no distraction procedure (controls), active distraction by their mother, or passive distraction by a television cartoon. Both the mothers and childrens rating scores suggested that procedures performed during television watching were perceived as being less painful than procedures performed during active or no distraction. Many studies have tested the effectiveness of Eutectic Mixture of Local Analgesics (EMLA) and Lidocaine gel .Since the application of Lidocaine is one quarter the cost of EMLA cream, significant saving can be obtained if it is proven to be effective as a topical anesthetic agent. It was seen in earlier studies that, IV cannulation was easier with Lidocaine gel as compared to EMLA cream. A randomized, double-blinded, placebo-controlled study by J.B.Rose et al., (2002) of Lidocaine Iontophoresis for Paediatric venipuncture among 59 children aged 6-17 years suggested that lidocaine iontophoresis is safe in children, reduces discomfort associated with venipuncture, and increases satisfaction when compared with the placebo. Hot applications promote vasodilation. A study was conducted on effect of EMLA Cream and Application of Heat to Facilitate Peripheral Venous Cannulation in Children by Lori Huff et al., (2009). There was a significant increase in vein visualization from pre-application of heat to post application of heat with a success rate of 80% with the first time attempt of IV insertion. Therefore, application of heat counteracts the adverse effect of vasoconstriction that occurs with EMLA cream application, potentially increasing peripheral venous cannulation success rates. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO, 2003) has approved revised standards for pain assessment and management in hospital ambulatory and home care settings .The American pain Societys Quality improvement recommendation provides excellent foundations for meeting JCAHOs expectations which includes recognizing and treating pain properly and promising patients attentive analgesic care. On the investigators personal experience, it is observed that children are having increased pain and fear during needle-related procedures performing in Paediatric ward. This motivated the researcher to conduct a study to make venipuncture a total painless procedure. Hence Tailor-made technique was selected for the research. 1.2 STATEMENT OF THE PROBLEM EFFECT OF TAILOR-MADE TECHNIQUE ON PAIN PERCEPTION AND FEAR AMONG CHILDREN UNDERGOING VENIPUNCTURE AT SRI RAMAKRISHNA HOSPITAL, COIMBATORE. 1.3. OBJECTIVES To administer Tailor-made technique among children before venipuncture. To assess the pain perception among children after administering Tailor-made technique in experimental and control group. To assess the fear among children after administering Tailor-made technique in experimental and control group. 1.4. OPERATIONAL DEFINITION 1.4.1. Effect Effect refers to the change in the level of pain perception and fear during venipuncture among children after Tailor-made technique. 1.4.2. Tailor-made Technique Tailor-made technique refers to the combination of three interventions, such as exposure of the child to cartoon animations, application of 2 % Xylocaine gel for 10 to 15 minutes and application of local heat for 2 minutes over the planned site, before venipuncture. 1.4.3. Pain Perception Pain perception means the level of pain experienced by a child during venipuncture, expressed in terms of behavioral responses in face, legs, activity, cry and consolability. 1.4.4. Fear Fear is an unpleasant feeling due to frightened situation during venipuncture among children expressed as responses in face. 1.4.5. Children Children refer to those who are between the age group of 4-12 years, who need to undergo venipuncture at the Paediatric ward of Sri Ramakrishna hospital. 1.4.6. Venipuncture Venipuncture is a needle-related procedure, in which a vein is punctured for medication administration, fluid infusion or blood sampling among children between 4 to 12 years of age at Sri Ramakrishna hospital. 1.5. CONCEPTUAL FRAME WORK Modified Weidenbachs Helping Art of Clinical Nursing Theory Modified Weidenbachs Helping Art of Clinical Nursing Theory (1964) was adopted for developing conceptual framework. The theory views nursing as an act, based on goal oriented care and closely parallels the assessment, implementation and evaluation steps of nursing process. This theory is composed of three basic elements: Identification. Ministration. Validation. 1.5.1. Identification. It involves individualization of the patient, his experiences and recognition of the patients perception of his condition. The researcher identifies the children who need to undergo venipuncture from the medical records, collects the demographic data and then plans for Tailor-made technique. 1.5.2. Ministration. It is providing the needed help. It requires the identification of the need-for-help, the selection of a helping measure appropriate to the need, and the acceptability of the help to the patient. In this study, the researcher administers the Tailor-made technique before venipuncture to the experimental group, whereas no intervention is given to the control group. 1.5.3. Validation. It is the evidence that the patients functional ability was restored as a result of the help given. In post test, the researcher assesses the level of pain and fear after the administration of Tailor-made technique and compares the effect of Tailor-made technique on pain perception and fear during venipuncture in experimental group with the level of pain perception and fear during venipuncture without Tailor-made technique in control group. 1.6. PROJECTED OUTCOME Application of Tailor-made technique reduces the pain perception and fear among children undergoing venipuncture. Review of literature Literature review refers to the activities involved in identifying or searching for information on the topic (Polit and Hungler, 1999). Literature review is an essential component to the researcher for the greater understanding of the research problem and its aspects. It provides the researcher with an opportunity to evaluate many different approaches to the problem. Thus the literature review has organised and presented under three headings. 2.1. Literature related to pain and fear during venipuncture. Cavender et al., (2004) done a study to determine the effectiveness of parental positioning and distraction on the pain,  fear, and distress of pediatric patients undergoing  venipuncture. An experimental-comparison group design was used to evaluate 43 patients (20 experimental and 23 comparisons) who were 4 to 11 years old. Experimental participants used parental positioning and distraction. All participants rated their pain and  fear; parents and  child  life specialists (CLS) rated the  childs  fear, and CLS rated the  childs distress. Self-reported pain and  fear  were highly correlated (p Anil Agarwal et al., (2005) conducted a study to evaluate the efficacy of the valsalva maneuver on pain during venous cannulation among children. In this study 75 samples were randomly assigned to 3 groups respectively. Group I was control group without intervention, group II was instructed to blow into a sphygmomanometer tubing and raise the mercury column up to 30 mm of Hg for 20 seconds and group III was instructed to press a rubber ball. After 20 seconds peripheral venous cannulation was performed. Venous cannulation pain was graded by a 4 point scale. Results showed a significant reduction in the incidence of pain in group II (72 %), whereas other two groups experienced 100 % pain. Researcher concluded that, the valsalva maneuver performed at the time of venous cannulation greatly decreases venipuncture pain. Gupta et al., (2005) carried out a prospective, randomized controlled study to evaluate the efficacy of balloon inflation on venous cannulation pain among children by Devendra. The study was conducted among 75 children aged 6-12 years who were randomly divided into three equal groups. Group I was control group with no intervention, group II was provided with distraction like pressing a ball and group III with balloon inflation. Visual analogue scale was used to assess the venipuncture pain and there was a significant reduction observed in group II and group III, when compared with group I. Visual analogue score in group III was decreased when compared with group II (p Farion et al., (2006) conducted a randomized control study to determine the effect of vapocoolant spray on pain during intravenous cannulation by among 80 children between 6-12 years. The children received either vapocoolant spray or placebo before cannulation. Children rated their pain using a 100-mm colour visual analogue scale. Parents (p = 0.04), nurses (p = 0.01) and child life specialists (p Movahedi et al., (2006) conducted a study to examine the effect of local refrigeration prior to venipuncture on pain related responses among school age children. 80 children aged 6-12 years were selected by purposive sampling. In experimental group the injection site was refrigerated for three minutes using an ice bag before venipuncture and in control group venipuncture was performed according to routine procedure. Physiological responses, behavioral responses, and subjective responses were assessed in both groups. Results showed no significant difference between two groups for physiological responses, whereas behavioral responses (p = 0.0011) and subjective responses (p = 0.0097) showed that, the test group had lower score in behavioral and subjective responses compared to the control group. The researcher concluded that the use of local refrigeration prior to venipuncture can be considered as an easy and effective intervention for reducing pain related to venipuncture. Kennedy et al., (2008) reported in an article that pain  during venipuncture and intravenous cannulation is an important source of paediatric  pain  and has a lasting impact. Older children have reported greater  pain  during follow-up and cancer-related  procedures,  if the pain  of the initial procedure was poorly controlled. Fortunately, both pharmacologic and non pharmacologic techniques have been found to reduce childrens acute  pain  and distress and subsequent negative behaviours during venipuncture. This review gives the evidence for the importance of managing paediatric procedural  pain  and methods  for reducing venous access  pain. Nilsson et al., (2008) evaluated the concurrent and construct validity and the interrater reliability of the Face, Legs, Activity, Cry and Consolability (FLACC) scale during procedural  pain  among 80 children of 5-16 years age. Children scheduled for peripheral venous cannulation of a venous port were included in this study. In 40 cases, two nurses simultaneously and independently assessed  pain  by using the FLACC scale and in 40 cases one of these nurses assessed the child. All children scored the intensity of  pain  by using the Coloured Analogue Scale (CAS) and distress by the Facial Affective Scale (FAS). Concurrent validity was supported by the correlation between FLACC scores and the childrens self-reported CAS scores during the procedure (r = 0.59, P Hess and Hall (2009) conducted a prospective study to evaluate the effect of a near-infrared light vein viewing device on the success rate of venipuncture performed by staff nurses on a paediatric surgical unit. The number of attempts, age of the patient, and time required to establish successful vascular access were recorded for 91 children and this data was compared to baseline data (n=150) previously collected on the same unit prior to the implementation of the device. The first attempt success rate for the control group was 49.3%, and for the experimental group 80.2% (p Harrison et al., (2011) conducted a randomized controlled study to assess the efficacy of sweet tasting solutions or substances for reducing needle-related procedural pain in  children  beyond one year of age. A sweet tasting solution or substance was given to 330 children  between 1 to 16 years of age randomly in experimental group. Control conditions included water, non-sweet tasting substances, pacifier,  distraction, no treatment, positioning or breastfeeding. Results for the toddlers or pre-school  children  show that in the sucrose group in one study had significantly lower cry duration and behavioral pain scores, compared with the no intervention group, while crying time did not differ between the sucrose and the no intervention group in the other study. For school-aged  children, chewing sweet gum either before, or during the procedure, did not significantly reduce pain scores.   2.2 Literature related to distraction strategy, local anesthetics and local heat. Halperin et al., (1989) conducted a double-blind, placebo-controlled study was conducted by to evaluate the effect of topical  skin anesthesia (EMLA, eutectic mixture of prilocaine and  lidocaine)   for venous, subcutaneous drug reservoir and lumbar punctures in children. Venipunctures were performed on 18  children  (6.1 to 12.2 years of age) equally divided in the study and control groups. . Pain intensity was scored by the  children  themselves, using a visual analogue scale. EMLA cream was associated with lesser pain scores than those with placebo (means +/- SD: 2.8 +/- 2.4 versus 6.8 +/- 2.1, P less than .01). A crossover trial was used in the studies of subcutaneous drug reservoir and lumbar punctures, eight  children  (6.1 to 15.1 years of age) were tested for subcutaneous drug reservoir punctures. Pain induced by this procedure was rated at 3.9 +/- 2.2 with placebo compared with 1.2 +/- 1.8 with EMLA cream (P Peretz et al., (2002) conducted a random crossover study to assess  childrens reactions while receiving a warmed  local  anesthetic solution for dental procedures (37o C; W) and to compare with one at room temperature (21o C; RT). 44 children  between the ages of 6 to 11 years were randomly assigned to receive either a W or a RT  local  anesthesia on the first visit and the alternate  local  anesthesia on the second visit. The modified Behavioral Pain Scale (BPS) was used during the injection. For subjective evaluation, the Wong-Baker FACES Pain Rating Scale (FPS) was used. Using the FPS, 19 boys ranked the experience of  local  anesthesia as a positive experience , 4 boys and all 21 girls ranked it as negative for both types (W and RT). No significant difference was found in the mean VAS scores between the room-temperature group and the warm group (23.4 +/- 21.8 and 20.8 +/- 18.9, respectively). Thus there is no advantage to  warming  local  anesthetic solu tion prior to injection. Biswas, D. (2005) conducted a study on effectiveness of four modalities (hot fomentation, glycerine Magnesium Sulphate application, and Ichthamol Magnesium Sulphate and Ichthamol Belladonna) of nursing interventions on phlebitis pain was evaluated. Ichthamol Belladonna along with hot fomentation was effective in reducing pain, erythema, swelling, induration, palpable venous cord at 0.01 as compared to Ichthamol Belladonna dressing, glycerine Magnesium Sulphate dressing and glycerine Magnesium dressing with hot fomentation. Tools included the demographic data to know the sample characteristics, phlebitis measurement chart, observation check list and visual analogue scale. The pre test mean pain score related to peripheral IV infiltration were 61.23 and post test mean pain scores were 13.27 in treatment with Ichthamol Belladonna dressing with fomentation which was found to be the most effective out of all the 4 interventions. Thus the study concluded that Ichthamol Belladonna dressing with fomentation was effective. Vangoli et al., (2005) conducted a study to investigate the presence of clown doctors on a  childs preoperative anxiety during the induction of anaesthesia and on the parent who accompanies them until he/she is asleep. There were 40 samples of 5-12 years of age who were assigned randomly to the clown group in which the  children  were accompanied in the preoperative room with the clown doctors and a parent and to the control group in which the  children  were accompanied by only 1 of his/her parents. The anxiety of the  children  in the preoperative period was measured through the Modified Yale Preoperative Anxiety Scale instrument and the anxiety of the parents was measured using State-Trait Anxiety Inventory. Also, a questionnaire was developed for health professionals to obtain their opinion about the presence of clowns and a self-evaluation form was developed to be filled out by the clowns themselves about their interactions with the  child. This study shows that the presence of clowns during the induction of anaesthesia with the  childs parents was an effective intervention for managing  childrens and parents anxiety during the preoperative period. Anjum. S (2007) conducted a study on hot fomentation versus cold compress, to reveal that the pre-treatment mean score of degree of infiltration was 7.1667 and it was decreased to 0.7071 on the third day of treatment with hot fomentation. In cold compress group, pre-treatment mean score of degree of infiltration was reduced from 6.9333 to 0.7571 on the third day of cold compress treatment. The intensity of pain was reduced from severe [56.66%] to no pain [93.4%] in hot fomentation group. In cold compress group, the intensity of pain was reduced from moderate [60.0%] to no pain [86.6%]. The mean score of hot fomentation group was 6.5067 in reducing the degree of infiltration while cold compress the mean score was 6.6. The study concluded that hot fomentation better than that of cold compress. Lee (2008) done a randomized cross-over study to determine the effect of  heat  and duration of stretching on the extensibility of hamstring muscles and their electromyographic responses to passive stretch in  children  with hypertonia and severe mental retardation. There were 29 participants with ages from 4 to 13 years who randomly received 4 treatment sessions as (A)10-second stretching, (B)30-second stretching, (C) hot  pack followed by 10-second stretching, and  (D) hot  pack followed by 30-second stretching each consisting of 5 repetitions of stretching and successive treatments were separated by at least 24 hours. The distance between greater trochanter and lateral malleolus and hamstring electromyographic (EMG) activity during passive knee extension stretching were measured. Two-way ANOVA showed a larger increase in hamstring extensibility in conditions C and D (1.3 +/- 1.1 cm) than conditions A and B (0.7 +/- 0.9 cm) (P Warming  local  anesthetics has been proposed as a cost-free intervention that reduces injection pain. Hogan et al., (2011) conducted a study to determine the effectiveness of warming  local  anesthetics to reduce pain in adults and  children  undergoing  local  anesthetic infiltration into intradermal or subcutaneous tissue. 29 studies were retrieved for close examination and 19 studies met inclusion criteria. A total of 18 studies with 831 patients were included in a meta-analysis. 17 studies had

Nuclear Power :: essays research papers

The world's natural resources are being consumed at an alarming rate. As these resources diminish , people will be seeking alternative sources by which to generate electricity for heat and light . The only practical short term solution for the energy-crisis is nuclear power. Nuclear power, however is not as safe as burning coal, gas or oil in a factory it is in fact, much more dangerous, There are dangers associated with a nuclear power plant which far out weigh the benefits to society as a whole and in part to the community living and working around the power plant . About 20 percent of our nation's total electrical consumption per year is supplied by nuclear power from the 100 or so nuclear power plants throughout the country . Even though atomic power has been in use for over 50 years it was primarily a tool of war and destruction when the war ended need for atomic bombs diminished . The scientists who created the weapons were out of jobs . They then turned this destructive power into huge plants generating "clean and cheap " electricity for the country . It was called progress. Progress also brought with it sickness , mutations , cancer and eventually death to those exposed to high levels of radiation . Government declared that nuclear power is safe and efficient . Also have big Oil corporations who have a lot of money invested in nuclear power and want to see as many plants as possible put into and kept in operation . The truth is that accidents do happen at nuclear power plants and at other facilities all the time . An accident at a nuclear power plant has the potential to be much more devastating than an accident at a coal or gas plant because of the radiation that could be released . An example of this is Three Mile Island in Pennsylvania where there was a partial core meltdown in march of 1979 and an "acceptable" amount of radiation escaped into the atmosphere . However no amount of radiation is acceptable if released as a result of an accident at a nuclear power plant . Is Nuclear Power necessary ? Today many Americans adopt lifestyles that are based on energy in-efficient devices . These include large automobiles and electric appliances that require electricity from energy-intense industrial processes . The public is doing all it can to force nuclear power plants

Peer Reviewed Article Summary

Peer-reviewed Articles Kimberly Winkler Psy/500 October 8, 2012 Bridgette Jenkins Abstract Resilience in any human being is vital but it also is important because it is the human capacity to face, overcome and strengthen by or even transformed by the adversities of life (Grotberg E. , Unknown). Every individual faces some sort of adversities which means that no one is exempt (Grotberg E. Unknown). Children are no exception to adversities so they must form resilience so they can overcome trauma (Grotberg E. , Unknown).Articles that will be discussed will show different mother-child interaction and resilience in children with early developmental risk and also using the resiliency scales for children and adolescents who are in the school settings. An article which discusses the comparison of maternal and paternal influences on young children’s behavior and resilience will also be deliberated upon. Mother-Child Interaction and resilience in children with early developmental risk M other Child interaction and resilience in children with early developmental risk speaks about a study which tests 50 children with early developmental delays.The article focused on the contributions of child characteristics and mother-child interaction to the prediction of formal intellectual disability (ID) among children with identified early developmental delays (Fenning & Baker, 2012). Children become resilient in certain situations and the study that was performed showed that children remain at risk for learning difficulties and teaching them resilience tools will help the children at risk for ID (Fenning & Baker, 2012).This article was extremely informative because it showed that mother-child interaction are very important to a child’s wellbeing and if not appropriately followed through with during preschool period they can be at risk for ID which increases resilience. Mother-child interaction is essential to resilience and this article portrays the importance of this. Fenning, R. M. , & Baker, J. K. (2012). Mother–child interaction and resilience in children with early developmental risk. Journal Of Family Psychology, 26(3), 411-420. doi:10. 1037/a0028287Assessing Personal Resiliency in the context of school settings: using the resiliency scales for children and adolescents Resiliency Scales for Children and Adolescents (RSCA) is a method to measure resiliency in students that is applicable for schools private use to utilize within the classroom environment (Embury, 2011). The RSCA will test students and pay attention to the strengths and limitations in personal resiliency (Embury, 2011). Resiliency interventions are then put into place depending on the results of the RSCA test and can be used in the school setting.School settings are just as significant as a child’s environment at home and when testing the children it will only set a foundation to better a child’s personal resiliency tools. The RSCA is easy to use and has ta ken studies pertaining to resilience and put them into a test form for the benefit of children in the school setting. Prince-Embury, S. (2011). Assessing personal resiliency in the context of school settings: Using the resiliency scales for children and adolescents. Psychology In The Schools, 48(7), 672-685. doi:10. 1002/pits. 20581The Comparison and Interdependence of Maternal and Paternal Influences on Young Children’s Behavior and Resilience We all go through tough times in our life and more people than others suffer with bouts of depressions and that does not exclude mothers and fathers. Systematically it has been understood that a mother-child relationship and a mothers depressed mood will affect children more so that a father-child relationship and a fathers depressed mood (Malmberg & Flouri, 2011). Research was done to decipher how depression affects young children’s behavior and their resilience to situations.I was intrigued to discover that economic deprivatio n and family stress have a negative effect on the mother-child relationship and in turn have a poor child outcome. Also, it was stated that during the research there was little evidence that showed the quality of father-child relationships promote resilience ( Malmberg & Flouri, 2011). As important as parent-child relationships are we can learn from them to promote positive behavior and form a positive resilience which is a natural part of young children.Malmberg, L. , & Flouri, E. (2011). The Comparison and Interdependence of Maternal and Paternal Influences on Young Children's Behavior and Resilience. Journal Of Clinical Child ; Adolescent Psychology, 40(3), 434-444. doi:10. 1080/15374416. 2011. 563469 References Edith H. Grotberg, Ph. D. (Unknown). Early Childhood Development: Practice and Reflections. In Guide to Promoting Resilience in Children: Strengthening the Human Spirit. Retrieved October 8, 2012, from http://resilnet. uiuc. edu/library/grotb95b. html.

Lamb: The Gospel According to Biff, Christ’s Childhood Pal Chapter 31

Tuesday We all slept that night in the upper room of Joseph's house. In the morning Joshua went downstairs. He was gone for a bit, then came back up the stairs. â€Å"They won't let me leave,† he said. â€Å"They?† â€Å"The apostles. My own apostles won't let me leave.† He went back to the stairway. â€Å"You're interfering with the will of God!† he shouted down. He turned back to me. â€Å"Did you tell them not to let me leave?† â€Å"Me? Yep.† â€Å"You can't do that.† â€Å"I sent Nathaniel to Simon's to fetch Maggie. He returned alone. Maggie wouldn't talk to him, but Martha did. Temple soldiers had been there, Josh.† â€Å"So?† â€Å"What do you mean, so? They were there to arrest you.† â€Å"Let them.† â€Å"Joshua, you don't have to sacrifice yourself to prove this point. I've been thinking about it all night. You can negotiate.† â€Å"With the Lord?† â€Å"Abraham did it. Remember? Over the destruction of Sodom and Gomorrah. He starts out getting the Lord to agree to spare the cities if he can find fifty righteous men, but by the end, he talks God down to ten. You can try something like that.† â€Å"That's not completely the point, Biff.† Here he came over to me, but I found I couldn't look him in the eye, so I went to one of the large arched windows that looked down on the street. â€Å"I'm afraid of this – of what's going to happen. I can think of a dozen things I'd rather do this week than be sacrificed, but I know that it has to happen. When I told the priests that I would tear the Temple down in three days, I meant that all the corruption, all the pretense, all the ritual of the Temple that keeps men from knowing God would be destroyed. And on the third day, when I come back, everything will be new, and the kingdom of God will be everywhere. I'm coming back, Biff.† â€Å"Yeah, I know, you said that.† â€Å"Well, believe in me.† â€Å"You're not good at resurrections, Josh. Remember the old woman in Japhia? The soldier in Sepphoris, what did he last? Three minutes?† â€Å"But look at Maggie's brother Simon. He's been back from the dead for months now.† â€Å"Yeah, and he smells funny.† â€Å"He does not.† â€Å"No, really, when you get close to him he smells spoiled.† â€Å"How would you know? You won't get close to him because he used to be a leper.† â€Å"Thaddeus mentioned it the other day. He said, ‘Biff, I believe this Simon Lazarus fellow has spoiled.'† â€Å"Really? Then let's go ask Thaddeus.† â€Å"He might not remember.† Joshua went down the steps to a low-ceilinged room with a mosaic floor and small windows cut high in the walls. Joshua's mother and brother James had joined the apostles. They all sat there against the walls, their faces turned to Joshua like flowers to the sun, waiting for him to say something that would give them hope. â€Å"I'm going to wash your feet,† he said. To Joseph of Arimathea, he said, â€Å"I need a basin of water and a sponge.† The tall aristocrat bowed and went off to find a servant. â€Å"What a pleasant surprise,† Mary said. James the brother rolled his eyes and sighed heavily. â€Å"I'm going out,† I said. I looked at Peter, as if to say, Don't let him out of your sight. He understood perfectly and nodded. â€Å"Come back for the seder,† Joshua said. â€Å"I have some things I have to teach you in the little time I have left.† There was no one home at Simon's house. I knocked on the door for a long time, then finally let myself in. There was no evidence of a morning meal, but the mikveh had been used, so I guessed that they had each bathed and then gone to the Temple. I walked the streets of Jerusalem, trying to think of some solution, but everything I had learned seemed useless. As evening fell I made my way back to Joseph's house, taking the long route so I didn't have to pass the palace of the high priest. Joshua was waiting inside, sitting on the steps to the upper room, when I came in. Peter and Andrew sat on either side of him, obviously there to ensure that he didn't accidentally skip down to the high priest and turn himself in for blasphemy. â€Å"Where have you been?† Joshua said. â€Å"I need to wash your feet.† â€Å"Do you have any idea how hard it is to find a ham in Jerusalem during Passover week?† I said. â€Å"I thought it would be nice, you know, some ham on matzo with a little bitter herb.† â€Å"He washed us all,† Peter said. â€Å"Of course we had to hold Bart down, but even he's clean.† â€Å"And as I washed them, they will go out and wash others, by showing them forgiveness.† â€Å"Oh, I get it,† I said. â€Å"It's a parable. Cute. Let's go eat.† We all lay around the big table, with Joshua at the head. Joshua's mother had prepared a traditional Passover supper, with the exception of the lamb. To begin the seder, Nathaniel, who was the youngest, had to ask a question. â€Å"Why is this night different from every other night of the year?† â€Å"Bart's feet are clean?† said Thomas. â€Å"Joseph of Arimathea is picking up the tab?† said Philip. Nathaniel laughed and shook his head. â€Å"No. It's because other nights we eat bread and matzo, but tonight we only eat matzo. Jeez.† He grinned, probably feeling smart for the first time in his life. â€Å"And why do we only eat the matzo on this night?† asked Nathaniel. â€Å"Skip ahead, Nate,† I said. â€Å"We're all Jews here. Summarize. Unleavened bread because there was no time for it to rise with Pharaoh's soldiers on our tail, bitter herbs for the bitterness of slavery, God delivered us into the Promised Land, it was swell, let's eat.† â€Å"Amen,† said everyone. â€Å"That was pathetic,† said Peter. â€Å"Yeah, was it?† I said angrily. â€Å"Well, we sit here with the Son of God, waiting for someone to come and take him away and kill him, and none of us is going to do a damn thing about it, including God, so forgive me if I'm not peeing all over myself about having been delivered out of the hands of the Egyptians about a million years ago.† â€Å"You're forgiven,† said Joshua. Then he stood up. â€Å"What I am, is in you all. The Divine Spark, the Holy Ghost, it unites you all. It is the God that is in you all. Do you understand that?† â€Å"Of course God is part of you,† James the brother said, â€Å"he's your father.† â€Å"No, in all of you. Watch, take this bread.† He took a matzo and broke it into pieces. He gave a piece to everyone in the room and took a piece himself. Then he ate it. â€Å"Now, the bread is part of me, the bread is me. Now all of you eat it.† Everybody looked at him. â€Å"EAT IT!† He screamed. So we ate it. â€Å"Now it is part of you, I am part of you. You all share the same part of God. Let's try again. Hand me that wine.† And so it went like that, for a couple of hours, and I think that by the time the wine was gone, the apostles actually grasped what Joshua was saying to them. Then the begging started, as each of us pleaded for Joshua to give up the notion that he had to die to save the rest of us. â€Å"Before this is finished,† he said, â€Å"you will all have to deny me.† â€Å"No we won't,† said Peter. â€Å"You will deny me three times, Peter. I not only expect this, I command it. If they take you when they take me, then there is no one to take the good news to the people. Now, Judas, my friend, come here.† Judas went to Joshua, who whispered in his ear, then sent him back to his place at the table. â€Å"One of you will betray me this very night,† said Joshua. â€Å"Won't you, Judas?† â€Å"What?† Judas looked around at us, but when he saw no one coming to his defense, he bolted down the steps. Peter started after him, but Joshua caught the fisherman by the hair and yanked him back off of his feet. â€Å"Let him go.† â€Å"But the high priest's palace isn't a furlong away,† said Joseph of Arimathea. â€Å"If he goes there directly.† Joshua held his hand up for silence. â€Å"Biff, go directly to Simon's house and wait. Alone you can sneak by the palace without being seen. Tell Maggie and the others to wait for us. The rest of us will go through the city and through the Ben Hinnon valley so we don't have to pass the priest's palace. We'll meet you in Bethany.† I looked at Peter and Andrew. â€Å"You won't let him turn himself in?† â€Å"Of course not.† I was off into the night, wondering even as I ran whether Joshua had changed his mind and was going to escape from Bethany into the Judean desert. I should have known right then that I'd been had. You think you can trust a guy, then he turns around and lies to you. Simon answered the door and let me in. He held his finger to his lips, signalling me to be quiet. â€Å"Maggie and Martha are in the back. They're angry with you. All of you. Now they'll be angry with me for letting you in.† â€Å"Sorry,† I said. He shrugged. â€Å"What can they do? It's my house.† I went directly through the front room into a second room that opened off to bedchambers, the mikveh, and the courtyard where food was prepared. I heard voices coming from one of the bedchambers. When I walked in, Maggie looked up from braiding Martha's hair. â€Å"So, you've come to tell me that it's done,† she said. Tears welled up in her eyes and I felt as if I would break down with her if she started sobbing now. â€Å"No,† I said. â€Å"He and the others are on their way here. Through Ben Hinnon, so it will be a few hours. But I have a plan.† I pulled the ying-yang amulet that Joy had given me out of my tunic and waved it before them. â€Å"Your plan is to bribe Joshua with ugly jewelry?† asked Martha. I pointed to the tiny stoppers on either side of the amulet. â€Å"No, my plan is to poison him.† I explained how the poison worked to Mary and Martha and then we waited, counting the time in our imaginations, watching in our mind's eyes as the apostles made their way through Jerusalem, out the Essene gate, into the steep valley of Ben Hinnon, where thousands of tombs had been carved into the rock, and where once a river had run, but now was only sage and cypress and thistles clinging to the crevices in the limestone. After several hours we went outside to wait in the street, then when the moon started down and the night made way into early morning, we saw a single figure coming from the west, not the south as we had expected. As he got closer I could tell from heavy shoulders and the moon shining on his bald pate that it was John. â€Å"They took him,† he said. â€Å"At Gethsemane. Annas and Caiphais came themselves, with Temple guards, and they took him.† Maggie ran into my arms and buried her face in my chest. I reached out and pulled Martha close as well. â€Å"What was he doing at Gethsemane?† I said. â€Å"You were supposed to be coming here through Ben Hinnon.† â€Å"He only told you that.† â€Å"That bastard lied to me. So they arrested everyone?† â€Å"No, the others are hiding not far from here. Peter tried to fight the guards, but Joshua stopped him. Joshua negotiated with the priests to let us go. Joseph came too, he helped talk them into letting the rest of us go.† â€Å"Joseph? Joseph betrayed him?† â€Å"I don't know,† said John. â€Å"Judas was the one that led them to Gethsemane. He pointed Joshua out to the guards. Joseph came later, when they were about to arrest the rest of us.† â€Å"Where did they take him?† â€Å"To the palace of the high priest. That's all I know, Biff. I promise.† He sat down hard in the middle of the street and began to weep. Martha went to him and cradled his head to her breast. Maggie looked up at me. â€Å"He knew you would fight. That's why he sent you here.† â€Å"The plan doesn't change,† I said. â€Å"We just have to get him back so we can poison him.† John looked up from Martha's embrace. â€Å"Did you change sides when I wasn't here?† Wednesday At first light Maggie and I were pounding on Joseph's door. A servant let us in. When Joseph came out from his bedchamber I had to hold Maggie back to keep her from attacking him. â€Å"You betrayed him!† â€Å"I did not,† said Joseph. â€Å"John said you were with the priests,† I said. â€Å"I was. I followed them up to keep them from killing Joshua for trying to escape, or in self-defense, right there at Gethsemane.† â€Å"What do you mean, ‘in self-defense'?† â€Å"They want him dead, Maggie,† Joseph said. â€Å"They want him dead, but they don't have the authority to execute him, don't you understand that? If I hadn't been there they could have murdered him and said that he'd attacked them first. The Romans are the only ones who have the authority to have someone killed.† â€Å"Herod had John the Baptist killed,† I said. â€Å"There were no Romans involved in that.† â€Å"Jakan and his thugs stone people all of the time,† Maggie said. â€Å"Without Roman approval.† â€Å"Think, you two. This is Passover week. The city is crawling with Romans watching for rebellious Jews. The entire Sixth Legion is here, plus all of Pilate's personal guard from Caesarea. Normally there'd only be a handful. The high priests, the Sanhedrin, the Pharisee council, even Herod will think twice before they do anything outside the letter of Roman law. Don't panic. There hasn't even been a trial in the Sanhedrin yet.† â€Å"When will there be a trial?† â€Å"This afternoon, probably. They have to bring everyone in. The prosecution is gathering witnesses against Joshua.† â€Å"What about witnesses for him?† I asked. â€Å"That's not how it works,† said Joseph. â€Å"I'll speak for him, and so will my friend Nicodemus, but other than that Joshua will have to defend himself.† â€Å"Swell,† Maggie said. â€Å"Who is prosecuting him?† â€Å"I thought you'd know,† Joseph said, cringing slightly. â€Å"The one who started the Sanhedrin plots against Joshua the other two times, Jakan bar Iban.† Maggie whirled around and glared at me. â€Å"You should have killed him.† â€Å"Me? You had seventeen years to push the guy down the steps or something.† â€Å"There's still time,† she said. â€Å"That won't help Joshua now,† said Joseph. â€Å"Just hope that the Romans won't hear his case.† â€Å"You sound as if he's already convicted,† I said. â€Å"I'll do my best.† Joseph didn't sound very confident. â€Å"Get us in to see him.† â€Å"And let them arrest the two of you? I don't think so. You stay here. You can have the upper rooms to yourselves. I'll come back or send word as soon as anything happens.† Joseph hugged Maggie and kissed her on the top of the head, then left the room to get dressed. â€Å"Do you trust him?† Maggie said. â€Å"He warned Joshua before when they wanted to kill him.† â€Å"I don't trust him.† Maggie and I waited all day in the upper room, jumping to our feet every time we heard footsteps going by in the street, until we were exhausted and shaking from worry. I asked one of Joseph's servant girls to go down to the palace of the high priest to see what was going on. She returned a short time later to report that the trial was still going on. Maggie and I made a nest of the cushions under the wide arched window in the front, so we could hear the slightest noise coming from the street, but as night started to fall, the footsteps became fewer and farther between, the distant singing from the Temple faded, and we settled into each other's arms, a single lump of low, agonizing grief. Sometime after dark we made love together for the first time since the night before Joshua and I left for the Orient. All those years had passed, and yet it seemed familiar. That first time, so long ago, making love was a desperate way to share the grief we felt because we were each about to lose someone we loved. This time we were losing the same person. This time, we slept afterward. Joseph of Arimathea didn't come home. Thursday It was Simon and Andrew who stormed up the steps to wake us Thursday morning. I threw my tunic over Maggie and jumped to my feet in just a loincloth. As soon as I saw Simon I felt the heat rise in my face. â€Å"You treacherous bastard!† I was too angry to hit him. I just stood there screaming at him. â€Å"You coward!† â€Å"It wasn't him,† screamed Andrew in my ear. â€Å"It wasn't me,† said Simon. â€Å"I tried to fight the guards when they came to get Joshua. Peter and I both did.† â€Å"Judas was your friend. You and your Zealot bullshit!† â€Å"He was your friend too.† Andrew pushed me away. â€Å"Enough! It wasn't Simon. I saw him face two guards with spears. Leave him be. We don't have time for your tantrum, Biff. Joshua is being flogged at the high priest's palace.† â€Å"Where's Joseph?† Maggie said. She'd dressed while I had been railing at Simon. â€Å"He's gone on to the praetorium that Pilate set up at the Antonia Palace by the Temple.† â€Å"What the hell's he doing there if Joshua is being beaten at the palace in this end of the city?† â€Å"That's where they'll take Joshua next. He was convicted of blasphemy, Biff. They want a death sentence. Pontius Pilate is the ruling authority in Judea. Joseph knows him, he's going to ask for Joshua's release.† â€Å"What do we do? What do we do?† I was starting to get hysterical. Since I could remember, my friendship with Joshua had been my anchor, my reason for being, my life; now it, he, was running toward destruction like a storm-driven ship to a reef, and I couldn't think of a thing to do but panic. â€Å"What do we do? What do we do?† I panted, the breath refusing to fill my lungs. Maggie grabbed me by the shoulders and shook me. â€Å"You have a plan, remember.† She tugged on the amulet around my neck. â€Å"Right, right,† I said, taking a deep breath. â€Å"Right. The plan.† I grabbed my tunic and slipped it over my head. Maggie helped me wrap the sash. â€Å"I'm sorry, Simon,† I said. He forgave me with the wave of a hand. â€Å"What do we do?† â€Å"If they're taking Joshua to the praetorium, that's where we go. If Pilate releases him then we'll need to get him out of there. There's no telling what Josh will do to get them to kill him.† We were waiting along with a huge crowd outside the Antonia Palace when the Temple guards brought Joshua to the front gates. The high priest, Caiaphas, wearing his blue robes and with a jewel-encrusted chest piece, led the procession. His father, Annas, who had been the high priest previously, followed right behind. A column of guards surrounded Joshua in the middle of the procession. We could just see him amid the guards, and I could tell that someone had put a fresh tunic on him, but there were stripes of blood soaking through the back. He looked as if he was in a trance. There was a great deal of posturing and shouting between the Temple guards, and from somewhere in the procession Jakan came forward and started arguing with the soldiers as well. It was obvious that the Romans were not going to let the Temple guards enter the praetorium, so the transfer of the prisoner was going to take place there at the gate or not at all. I was measuring whether I could sneak through the crowd, snap Jakan's neck, and sneak back out without jeopardizing our plan when I felt a hand on my shoulder. I looked around to see Joseph of Arimathea. â€Å"At least it wasn't a Roman scourge they lashed him with. He took thirty-nine lashes, but it was just leather, not the lead-tipped whip that the Romans use. That would have killed him.† â€Å"Where were you? What took so long?† â€Å"The prosecution took forever. Jakan went on half the night, taking testimony from witnesses who had obviously never even heard of Joshua, let alone seen any crime.† â€Å"What about the defense?† asked Maggie. â€Å"Well, I put forth a defense of good deeds, but it was so overwhelmed by the accusations that it was lost in the noise. Joshua didn't say a word in his own defense. They asked him if he was the Son of God and he said yes. That confirmed the blasphemy charge. It's all they needed, really.† â€Å"What happens now? Did you talk to Pilate?† â€Å"I did.† â€Å"And?†