The Hypocrisy of Civilized Society as a Major Theme in Huckleberry Research Paper

The Hypocrisy of Civilized Society as a Major Theme in Huckleberry Finn - Research Paper Example It's also where he gained a lot of the experience he would need to create The Adventures of Huckleberry Finn. Although these were essentially children's stories, Twain had a tendency to create stories with a much deeper meaning underneath the charm and the humor. He encouraged his readers to plunge the depths of their understanding and adapt their behavior to a more accurate reflection of their inner beliefs (Railton, 2007). In The Adventures of Huckleberry Finn, Twain blatantly criticizes the hypocrisy of 'civilized' society as he ridicules religion, satirizes education, criticizes slavery, and exposes aristocratic characters. Twain Ridicules Religion Religion was a particular sore spot with Twain and he expresses his disdain of it through the characters of the Widow Douglas and Miss Watson. These poor ladies remain obediently devout through everything, without seeming to realize that their belief structures are almost entirely contradictory. Huck sums it up when he's out thinking i n the woods, "I judged I could see that there was two Providences, and a poor chap would stand considerable show with the widow’s Providence, but if Miss Watson’s got him there warn’t no help for him any more" (23). ... Even though the families sit calmly together in church, the feud begins again the moment they step foot off of church property: "The men took their guns along, so did Buck†¦The Shepherdsons done the same. It was pretty ornery preaching- all about brotherly love, and such-like tiresomeness;† (129), but the families don't hear any of it. Even with the church pleading with them to put aside their fight, it is the feud rather than the church that has the greatest influence on them. â€Å"Worse than the mindless, inherited pattern of the feud, however, is the fact that it serves no purpose, since the original cause of the conflict long has been forgotten.† (Wright 90). This experience has a profound effect on Huck's later decisions. When it comes time for Huck to decide whether to turn in his friend Jim as a runaway slave, Huck decides it would be better to go to hell. â€Å"I took it up, and held it in my hand. I was trembling, because I’d got to decide, forever , betwixt two things, and I knowed it. I studied a minute, sort of holding my breath, and then says to myself: ‘All right, then, I’ll go to hell’- and tore it up† (223). â€Å"Huck's justly celebrated crisis of conscience, which culminates in his resolve to free Jim, even if doing so condemns him to hell† (Smith 8) is made a bit easier by his understanding of how others observed their religion. Twain Satirizes Education It is an indication of his depth of satire that Twain uses Huck, an almost completely uneducated narrator, to point out the depth of society's corruption including its failures within the educational system. He doesn't see much use for it in any of his interactions with others. For example, Tom

General Giap Essay Example for Free

General Giap Essay General Vo Nguyen Giap is perhaps the most important figure in the early history of communist Vietnam with the exception of Ho Chi Minh. General Giaps skills and expertise of were an essential element of the French defeat in 1954. However General Giap cannot be held solely responsible, the political skills of Ho Chi Minh (the leader of the Viet Minh independence movement) cannot be underestimated. There were many reasons for the French defeat in Vietnam, abundant mistakes were made and the Viet Minh were lead by two of the greatest leaders of the 20th century. Giap rchestrated the defeat of the French and was particularly important in the battle of Dien Bien Phu. Ho Chi Minh was an experienced revolutionary and passionate nationalist infatuated by a single goal: independence for his country. He was a central fgure in the movement to free Asia from the restraints of colonialism. Ho Chi Minh was ultimately working towards the liberation of Vietnam from French colonial rule and unity of views between the army and the people. Ho Chi Minh was a founding member of the Indochinese Communist Party (ICP). The goals of the ICP included the overthrow of the French; establishment of an independent Vietnam uled by a peoples government; help people in production, anti-literacy, sanitation and disease prevention. General Giap was the Commander and Defence Minister of North Vietnam from 1944-1980 and was an integral component in the unravelling of French control in Vietnam. Previously, on the outbreak of World War II, Giap fled to China to Join Vietnamese Communist leader Ho Chi Minh, which led to the formation of the Vietnamese Independence League, abbreviated to Viet Minh. In 1945, armed propaganda teams under Giaps command became the Peoples Liberation Army. Subsequently in 1945, Giap served as interior minister in Ho Chi Minhs revolutionary government created to defeat the French. Giaps strength lay as a military commander and his scrupulous attention to organisation, which were vital elements in the French downfall. The Vietnamese opposition to the French began almost as soon as the French began to rule. The Vietnamese traditionally have resisted foreigners. Their defeat of China previously gave them a reputation of being one of the most feared nations in South East Asia, meaning that it took the French an extended amount of time to gain overall control. Prior to the 20th century, resistance to the French was constant and violent. The resistance was traditional and localised, involving isolated attacks which were easily contained by the French. Furthermore, World War One gave impetus and momentum to the growth of nationalism, the strong wish for growth, freedom and independence of ones country and patriotism for Vietnam. Many Vietnamese men were forced to serve in France during WW1 and those who returned brought with them the revolutionary concept of nationalism and as a result the nature of the resistance changed to a more national approach rather than regionally focussed. Additionally, in 1905, Japan became the first Asian power in modern times to efeat a European power during a large naval battle. The Vietnamese determination and motivation were boosted, demonstrating that they could potentially defeat the French, one ot the most intluential European powers at the time. Following the reoccupation of Indochina by the French at the end of World War Two, the Viet Minh rebelled against the French and this became known as the first Indochinese war. French lack of knowledge of Vietnamese geography made it difficult for them to defend themselves. The army trained the people in guerrilla tactics that were highly successful as they were unlike any approach in the Western world. The unpredictable nature of the guerrilla tactics also minimised the losses of the Viet Minhs army, making it stronger. The French army began to wear down, decreasing the mens morale and eventually leading to an easier fght for the Viet Minh. Initially the French underestimated Vietnamese ability; unbeknown to the French they were numerically disadvantaged with 13000 Frenchmen fghting a 35000 strong Viet Minh Peoples Army. Prior to the war it was acknowledged that Ho Chi Minhs original name, Nguyen Tat Thanh, was widely known as many people had heard that he had been a ajor supporter of peasants and workers rights, who in turn supported him. This meant that if he needed a place to hide, the local peasants happily helped, making the Viet Minh virtually untraceable. The widespread support of Ho Chi Minh also meant that people trusted the movement towards independence and nationalism; giving the Viet Minh the political edge over the French. Back in France, the French public were beginning to realise that the conflict in Vietnam was not worth the effort; therefore support for the conflict was lessening. In addition, the Vietnamese determination and strength could not be matched by the French; the Viet Minh had ne thing that the French did not, a goal. The Viet Minh and Giap had learnt invaluable lessons from previous conflicts and mistakes, whereas the French had not. Dien Bien Phu was the longest confrontation and most furious battle of the French Expeditionary Corps. It was the final undoing of the French. In 1953, as both sides prepared for peace talks in the Indochina War, French military commanders selected Dien Bien Phu as the location for a fght with the Viet Minh. Viet Minh guerrillas and troops from the Peoples Army of Vietnam surrounded Dien Bien Phu during the build up of the garrisons. The Viet Minh concealed artillery and supplies in camouflaged caves on the mountain face. The Viet Minhs initial assault on the French almost immediately proved the vulnerability and flawed defence of the French. The French supplies and weapons were flown in by plane; however, this usually led to the shelling of the aircraft. The Viet Minh used local peasants to bring in supplies and weaponry, through dense forests, an entry the French had written off as impassable. As source A suggests The Army established a good relationship with the people and relied on the people to fight and defeat the enemy. Giap used the element of surprise by skilfully employing supporting operations which deceived the French. Giap easily identified the Frenchs critical vulnerability and used their mistakes to his own advantage. The work of a great strategist. One crucial decision that Giap made was when he moved his own headquarters to the Dien Bien Phu battle site. This allowed him to personally oversee the conflict, and clear up confusion or misunderstandings straight away. General Giap was able to carefully dictate time and place engagements throughout his meticulously planned operation. The heavy

Sickle Cell Anemia :: essays research papers fc

The problem is that sickle cell anemia affects about 72,000 Americans in the United States. Sickle cell anemia is an inherited disease in which the body is unable to produce normal hemoglobin, an iron-containing protein. Abnormal hemoglobin can morph cells that can become lodged in narrow blood vessels, blocking oxygen from reaching organs and tissues. The effects of sickle cell anemia are bouts of extreme pain, infectious, fever, jaundice, stroke, slow growth, organ, and failure. Sickle cell anemia hurts many people today in fact it hurts about 72,000 Americans. But some doctors are finding cures for this inherited disease. This disease causes mainly strokes and fever. With this disease a stroke is not predictable, a stroke can happen as early as a one month old as a baby. It can hurt a person really bad because it causes them to not be able to do many things like can't play sports, and things that gets your heart pumping because if the red blood cells gets clogged up it can causes a stroke because oxygen can't flow. Most Americans who have sickle cell anemia are of African descent. The disease also affects Americans from the Caribbean, Central America, and parts of South America, Turkey, Greece, Italy, the Middle East and East India. Since sickle cell anemia is an inherited disease if both parents have the trait for sickle cell, their baby's chances of having sickle cell disease is one in four. Many doctors are trying to find cures for this disease by trying the solution on patients. Doctors at Emory University and University of Mississippi Medical Center in Jackson, Chicago. Doctors in Emory University in Atlanta credited an experimental stem cell transplant that for the first time is not from a related donor. This transplant cured the inherited disease from Keone Penn who is 13 years old from Georgia. He suffered a stroke at 5 years old and had a fever of 106 degrees, "I almost died" (Ferraro, Newspaper Article) What the doctors did was replaced the boy's bone marrow with stem cells taken from the umbilical cord blood of an infant not related to him. Dr. Ruby Bellevue of New York Methodist Hospital in Brooklyn has patient that he wants to do the transplant procedure on, but he is waiting for more studies to come out to see what the long-term effects are. Some effects could be rejection, complications, and/or death.

Financial Aid Is An Important For College students Essay

As we know College costs are rising. But, Future students should not be afraid because there is more financial aid available such as scholarships, grants, work-study programs, and college loans for students. Financial aid is money in the form of loans, grants and employment that is available to a student to help pay the cost of attending. Financial aid comes from the federal government, which is the largest provider of aid, as well as state government. You should apply for financial aid using the Free Application for Federal Student Aid (FAFSA). You will need to apply for financial aid every year by completing a FAFSA. Many financial aid programs have limited funding, therefore early application is recommended. Application should be completed at least one month prior to the semester you are planning to attend. If you apply for funding late, you will receive your funding late. Financial aid is one of the most importance issue for students to process attending College, and the first st ep what student face for attending courses. Have you ever found a solution to your problem? I think may be this financial aid issue is an important for you. How do you overcome these things? Is it the biggest problem facing college students today. How can be resolved it? There is a growing number of older students entering college today. These students have families that they need to support. I know, because I am a family man who has returned to school. I wish to finish my degree at Midlands Tech College. The only problems I face are financial in nature. It is with this in mind that I set about this research. Is financial aid available to older students, and if so, how do they go about obtaining it? Most common issue I found was money, Tuition costs are constantly being raised at high rates. And that’s not including  other expenses like eating out, shopping trips, gas for the car, and the price of textbooks. I found College students drop out of school each year because they cannot afford it. Others are forced to balancing full schedules with full time jobs to make end. It is becoming harder for students to graduate. A Way to solve this problem is by helping students seek more help financially having consolers provide students with small scho larships or help them look for such things can help reduce the amounts of students that drop out of college.

Prostitution, Promiscuity and Venereal Disease

PROSTITUTION †¢Prostitution is the act or practice of providing sexual services to another person in return for payment. †¢Prostitution is one of the branches of the sex industry. The legal status of prostitution varies from country to country, from being a punishable crime to a regulated profession. †¢Prostitution is sometimes referred to as â€Å"the world's oldest profession†. Causes of Prostitution: 1) Poverty and unemployment has triggered the rapid spread of prostitution in the Philippines. It provides those involved in this profession a considerable amount of income to support their families as well as supply a steady flow of remittances from urban to rural areas or from prostitutes working overseas. 2) Women have been tricked into prostitution with guarantees of decent job opportunities in the city or abroad or have been kidnapped and then forced to work as prostitutes. 3) Family expectations and problems are common factors why many enter the prostitution business. Women in particular are pressured to pay for their sibling’s education or support a sick family member. Other aspects such as dysfunctional families or constant abuse from parents have lead adolescents to leave their homes and are attracted by the easy profits from prostitution. VENEREAL DISEASE †¢A disease that is contracted and transmitted by sexual contact, caused by microorganisms that survive on the skin or mucus membranes, or that are transmitted via semen, vaginal secretions, or blood during intercourse. Because the genital areas provide a moist, warm environment that is especially conducive to the proliferation of bacteria, viruses, and yeasts, a great many diseases can be transmitted this way. They include AIDS, Chlamydia, genital warts, gonorrhea, syphilis, yeast infections, and some forms of hepatitis. Also known as a morbus venereus or sexually transmitted disease (STD). PROMISCUITY †¢Refers to â€Å"casual sex† with multiple sexual partners. The term can carry a moral judgment and is viewed in the context of the mainstream social ideal for sexual activity to take place within exclusive committed relationships. A common example of behavior viewed as promiscuous within the mainstream social ideals of many cultures is a one night stand. †¢One scientific study found that promiscuous men and women are judged equally harshly and both genders express strong preference for sexually conservative partners.

Ecoli essays

Ecoli essays Canada's E. Coli Epidemic Claims Fifth Victim 1:44 p.m. ET (1744 GMT) May 26, 2000 WALKERTON, Ontario (Reuters) - A fifth person died on Thursday in what may be Canada's biggest E. coli epidemic, as police and health officials were set to decide whether to launch a criminal investigation into the outbreak. Dr. Murray McQuigge, the area's chief medical officer, said the outbreak in the mainly agricultural community of Walkerton, Ontario, could have been prevented, and accused the local Public Utilities Commission (PUC) of ignoring the results of its own tests on Thursday, May 18, which he said established the town's water was unsafe. He said 10 people, including four children, remained in a critical condition, struck down by bacteria in the town's water system. An infant and three adults died from E. coli complications on Wednesday. At least 500 people have been infected in Walkerton, a town of 5,000 people about two hours drive northwest of Toronto. Dr. James Cairns, deputy chief coroner for the province of Ontario, said his department wants an inquest into the deaths. ''We are concerned about public safety,'' he said. "We want to know how the contamination occurred, how it was managed and how people died.'' It is believed the water may have been contaminated by manure washed into the system by recent heavy rains. "There may well be more people who will die. I think we could have prevented all these deaths,'' McQuigge told a news conference, adding that new cases could emerge as late as Monday as the bacteria can have an incubation period of up to 10 days before symptoms appear. McQuigge said he would meet with health and provincial police officials on Friday to try to decide where blame for deaths is to be laid. "There is probably going to be a criminal investigation,'' he said. Walkerton residents were outraged as news spread that it is possible that the tragedy could have been prevented. A local radi ...

A Brief History of Chinese Opera

A Brief History of Chinese Opera Since the time of the Tang Dynastys Emperor Xuanzong from 712 to 755- who created the first national opera troupe called the Pear Garden- Chinese opera has been one of the most popular forms of entertainment in the country, but it actually started nearly a millennium before in the Yellow River Valley during the Qin Dynasty.   Now, more than a millennium after Xuanzongs death, it is enjoyed by political leaders and commoners alike in many fascinating and innovative ways, and Chinese opera performers are still referred to as Disciples of the Pear Garden, continuing to perform an astonishing 368 different forms of Chinese opera. Early Development Many of the features that characterize modern Chinese opera developed in northern China, particularly in the Shanxi and Gansu Provinces, including the use of certain set characters like Sheng (the man), Dan (the woman), Hua (the painted face) and Chou (the clown). In Yuan Dynasty times- from 1279 to 1368- opera performers began to use the vernacular language of the common people rather than Classical Chinese. During the Ming Dynasty- from 1368 to 1644- and the Qing Dynasty- from 1644 to 1911- the northern traditional singing and drama style from Shanxi was combined with melodies from a southern form of Chinese opera called Kunqu. This form was created in the Wu region, along the Yangtze River. Kunqu Opera revolves around the Kunshan melody, created in the coastal city of Kunshan. Many of the most famous operas that are still performed today are from the Kunqu repertoire, including The Peony Pavilion, The Peach Blossom Fan, and adaptations of the older Romance of the Three Kingdoms and Journey to the West. However, the stories have been rendered into various local dialects, including Mandarin for audiences in Beijing and other northern cities. The acting and singing techniques, as well as costumes and makeup conventions, also owe much to the northern Qinqiang or Shanxi tradition. Hundred Flowers Campaign This rich operatic heritage was almost lost during Chinas dark days in the mid-twentieth century. The Communist regime of the Peoples Republic of China- from 1949 to present- initially encouraged the production and performance of operas old and new. During the Hundred Flowers Campaign in 1956 and 57- in which the authorities under Mao encouraged intellectualism, the arts and even criticism of the government- Chinese opera blossomed anew. However, the Hundred Flowers Campaign may have been a trap. Beginning in July of 1957, the intellectuals and artists who had put themselves forward during Hundred Flowers period were purged. By December of that same year, a stunning 300,000 people had been  labeled  rightists and were subjected to punishments from informal criticism to internment in labor camps or even execution. This was a preview of the horrors of the Cultural Revolution of 1966 through 1976, which would imperil the very existence of Chinese opera and other traditional arts. Cultural Revolution The Cultural Revolution was the regimes attempt to destroy old ways of thinking by outlawing such traditions as fortune telling, paper-making, traditional Chinese dress and the study of classic literature and arts. An attack on one Beijing opera piece and its composer signaled the start of the Cultural Revolution. In 1960, Maos government had commissioned Professor Wu Han to write an opera about Hai Rui, a minister of the Ming Dynasty who was fired for criticizing the Emperor to his face. Audiences saw the play as a critique of the Emperor- and thus Mao- rather than of Hai Rui representing disgraced Minister of Defense Peng Dehuai. In reaction, Mao performed an about-face in 1965, publishing harsh criticism of the opera and of composer Wu Han, who was eventually fired. This was the opening salvo of the Cultural Revolution. For the next decade, opera troupes were disbanded, other composers and scriptwriters were purged and performances were banned. Until the fall of the Gang of Four in 1976, only eight model operas were allowed. These model operas were personally vetted by Madame Jiang Qing and were entirely politically innocuous. In essence, Chinese opera was dead. Modern Chinese Opera After 1976, Beijing opera and the other forms were revived, and once more placed within the national repertoire. Older performers who had survived the purges were allowed to pass on their knowledge to new students again. Traditional operas have been freely performed since 1976, though some newer works have been censored and new composers criticized as the political winds have shifted over the intervening decades. Chinese opera makeup is particularly fascinating and rich in meaning. A character with mostly red makeup or a red mask is brave and loyal. Black symbolizes boldness and impartiality. Yellow denotes ambition, while pink stands for sophistication and cool-headedness. Characters with primarily blue faces are fierce and far-seeing, while green faces show wild and impulsive behaviors. Those with white faces are treacherous and cunning- the villains of the show. Finally, an actor with only a small section of makeup in the center of the face, connecting the eyes and nose, is a clown. This is called xiaohualian, or the little  painted  face. Today, more than thirty forms of Chinese opera continue to be performed regularly throughout the country. Some of the most prominent of which are the Peking opera of Beijing, Huju opera of Shanghai, the Qinqiang of Shanxi, and Cantonese opera.   Beijing (Peking) Opera The dramatic art form known as Beijing opera- or Peking opera- has been a staple of Chinese entertainment for more than two centuries. It was founded in  1790 when the Four Great Anhui Troupes went to Beijing to perform for the Imperial Court. Some 40 years later, well-known opera troupes from Hubei joined the Anhui performers, melding their regional styles. Both the Hubei and Anhui opera troupes used two primary melodies adapted from the Shanxi musical tradition: Xipi and Erhuang. From this amalgam of local styles, the new Peking or Beijing opera developed. Today, Beijing Opera is considered  Chinas  national art form. Beijing Opera is famous for convoluted plots, vivid makeup, beautiful costumes and sets and the unique vocal style used by performers. Many of the 1,000 plots- perhaps not surprisingly- revolve around political and military strife, rather than romance. The basic stories are often hundreds or even thousands of years old involving historic and even supernatural beings.   Many fans of Beijing Opera are worried about the fate of this art form. The traditional plays make reference to many facts of pre-Cultural Revolution  life and history that are unfamiliar to young people. Furthermore, many of the stylized movements have particular meanings that can be lost on uninitiated audiences. Most troubling of all, operas must now compete with films, TV shows, computer games, and the internet for attention. The Chinese government is using grants and contests to encourage young artists to participate in Beijing Opera. Shanghai (Huju) Opera Shanghai opera (Huju) originated at about the same time as Beijing opera, around 200 years ago. However, the Shanghai version of opera is based on local folk-songs of the Huangpu River region rather than deriving from Anhui and Shanxi.  Huju  is performed in the Shanghainese dialect of Wu Chinese, which is not mutually intelligible with  Mandarin. In other words, a person from Beijing would not understand the lyrics of a  Huju  piece. Due to the relatively recent nature of the stories and songs that make up  Huju, the costumes and makeup are comparatively simple and modern. Shanghai opera performers wear costumes that resemble the street clothing of ordinary people from the pre-communist era. Their makeup is not much more elaborate than that worn by western stage actors, in stark contrast to the heavy and significant grease-paint used in the other Chinese Opera forms. Huju  had its heyday in the 1920s and 1930s. Many of the stories and songs of the Shanghai region show a definite western influence. This is not surprising, given that the major European powers maintained trading concessions and consular offices in the thriving port city, prior to World War II. Like many of the other regional opera styles,  Huju  is in danger of disappearing forever. Few young actors take up the art form since there is much greater fame and fortune to be had in movies, TV, or even Beijing Opera. Unlike Beijing Opera, which is now considered a national art form, Shanghai Opera is performed in a local dialect and thus does not translate well to other provinces. Nevertheless, the city of Shanghai has millions of residents, with tens of millions more in the near vicinity. If a concerted effort is made to introduce younger audiences to this interesting art form,  Huju  may survive to delight theater-goers for centuries to come. Shanxi Opera (Qinqiang) Most forms of Chinese opera owe their singing and acting styles, some of their melodies, and their plot-lines to the musically fertile Shanxi province, with its thousand-year-old Qinqiang  or  Luantan  folk melodies. This ancient form of art first appeared in the  Yellow River  Valley during the  Qin Dynasty  from B.C. 221 to 206 and was popularized at the Imperial Court at modern-day  Xian during the  Tang Era, which spanned from 618 to 907 A.D. The repertoire and symbolic movements continued to develop in Shanxi Province throughout the  Yuan Era  (1271-1368) and the Ming Era (1368-1644). During the Qing Dynasty (1644-1911), Shanxi Opera was introduced to the court at Beijing. The Imperial audiences so enjoyed Shanxi singing that the form was incorporated into Beijing Opera, which is now a national artistic style. At one time, the repertoire of Qinqiang included over 10,000 operas; today, only about 4,700 of them are remembered. The  arias  in Qinqiang Opera are divided into two types:  huan  yin, or joyous tune, and  ku  yin, or sorrowful tune. Plots in Shanxi Opera often deal with fighting oppression, wars against the northern barbarians, and issues of loyalty. Some Shanxi Opera productions include special effects such as fire-breathing or acrobatic twirling, in addition to the standard operatic acting and singing. Cantonese Opera Cantonese Opera, based in southern China and overseas ethnic Chinese communities, is a very formalized operatic form that emphasizes gymnastic and martial arts skills. This form of Chinese Opera predominates in Guangdong,  Hong Kong, Macau,  Singapore,  Malaysia, and in Chinese-influenced areas in western countries. Cantonese Opera was first performed during the reign of the Ming Dynasty Jiajing Emperor from 152 to 1567. Originally based on the older forms of Chinese Opera, Cantonese Opera began to add local folk melodies, Cantonese instrumentation, and eventually even Western popular tunes. In addition to traditional Chinese instruments such as the  pipa,  erhu, and percussion, modern Cantonese Opera productions may include such Western instruments as the violin, cello, or even saxophone. Two different types of plays make up the Cantonese Opera repertoire- Mo, meaning martial arts, and  Mun, or intellectual- wherein the melodies are entirely secondary to the lyrics.  Mo performances are fast-paced, involving stories of warfare,  bravery  and betrayal. The actors often carry weapons as props, and the elaborate costumes may be as heavy as actual armor. Mun, on the other hand, tends to be a slower, more polite art form. The actors use their vocal tones, facial expressions, and long flowing water sleeves to express complex emotions. Most of the Mun stories are romances, morality tales, ghost stories, or famous Chinese classic tales or myths. One notable feature of Cantonese Opera is the makeup. It is among the most elaborate makeup systems in all of Chinese Opera, with different shades of color and shapes, particularly on the forehead, indicating the mental state, trustworthiness, and physical health of the characters. For example, sickly characters have a thin red line drawn between the eyebrows, while comic or clownish characters have a large white spot  on  the bridge of the nose. Some Cantonese Operas also involve actors in open face makeup, which is so intricate and complicated that it resembles a painted mask more than a living face. Today, Hong Kong is at the center of efforts to keep Cantonese Opera alive and thriving. The Hong Kong Academy for the Performing Arts offers two-year degrees in Cantonese Opera performance, and the Arts Development Council sponsors opera classes for the citys children. Through such concerted effort, this unique and intricate form of Chinese Opera may continue to find an audience for decades to come.

Happy Birthday Wishes That Make Dreams Come True

Happy Birthday Wishes That Make Dreams Come True Douglas Horton said, If wishes were fishes, wed all be throwing nets. If wishes were horses wed all ride. However, on your birthday, you are entitled to make a wish. It is believed that if you make a silent wish as you blow the candles on your birthday cake, your wish will come true. The History of Birthday Wishes The tradition of putting candles on a birthday cake dates back to early Greek civilization. In ancient times, the Greek lit candles on the cake offered to the Moon Goddess, Artemis. They believed that the smoke emanating from the blown candles carried the prayers to heaven, and these prayers were answered. It was also believed that blowing out candles in one breath brought good luck. The tradition of blowing candles continues even today. The Meaning of Birthday Celebrations But birthday celebrations have become far too elaborate and laborious. Today, it is no longer just about cakes and candles; it is also about exotic party venues, theme birthdays, and expensive goody bags. Let us not forget the significance of birthday celebrations. The presence of your loved ones on your birthday makes you feel cherished. You cannot measure their love with the budget of the birthday party. Even a simple birthday celebration or a heartfelt birthday wish should make you feel blessed. Whether it is your 18th or 60th birthday; whether you have a simple or an elaborate celebration, you are lucky to share this special occasion with your near and dear ones. Birthdays bring families and friends closer and keep you smiling throughout the year. Birthday Wish Quotes Convey warm birthday wishes to your dear ones with these happy birthday wishes. A warm hug, a loving birthday wish, and blessings make birthdays memorable. George HarrisonAll the world is birthday cake, so take a piece, but not too much. Pablo PicassoYouth has no age. Tom StoppardAge is a high price to pay for maturity. Franz KafkaYouth is happy because it has the ability to see beauty. Anyone who keeps the ability to see beauty never grows old. George SantayanaThere is no cure for birth and death, save to enjoy the interval. William Butler YeatsFrom our birthday, until we die,Is but the winking of an eye. Tom WilsonWisdom doesnt necessarily come with age. Sometimes age just shows up all by itself. Anthony PowellGrowing old is like being increasingly penalized for a crime you have not committed. Marie DresslerIt is not how old you are, but how you are old. Gertrude SteinWe are always the same age inside. Chinese ProverbA diamond cannot be polished without friction, nor a man perfected without trials. Muhammad AliAge is whatever you think it is. You are as old as you think you are. Irish BlessingMay you live as long as you want and never want as long as you live. Chili DavisGrowing old is mandatory; growing up is optional. Anna MagnaniPlease dont retouch my wrinkles. It took me so long to earn them. Leo RosenbergFirst, you forget names, then you forget faces, then you forget to pull your zipper up, then you forget to pull your zipper down. Jack BennyAge is strictly a case of mind over matter. If you dont mind, it doesnt matter. Robert FrostTime and tide wait for no man, but time always stands still for a woman of thirty. Frank Lloyd WrightThe longer I live the more beautiful life becomes. Christina RossettiMy heart is like a singing bird. Because the birthday of my life is come, my love is come to me.

Cosmology Research Paper Example | Topics and Well Written Essays - 2750 words

Cosmology - Research Paper Example Even though the attention is on fact foundations, spatially fixed spectroscopy of prolonged sources is also concisely discussed. Argument of variance extinction, the effect of crowding, multi-object techniques, optimal abstractions, flat-fielding deliberations, and decisive centrifugal velocities and velocity dispersions provide the spectroscopies with the fundamentals needed to obtain the superlative data. Finally the essay conglomerates the preceding material by providing some examples of real life observing experiences with several typical instruments. Spectroscopy is the study of light emissions and absorptions.It’s is a technique of spectroscopy used in space science. It can as well be defined as the object of learning is the band of electromagnetic radiation, this includes visible light, which emits from stars and other astronomic objects. Spectroscopy sometimes is used to develop many properties of faraway stars and galaxies, e.g. their chemical structure and motion, via the Doppler shift.it’s one of the fundamental tools at an astronomer’s disposal, allowing one to determine the chemical structures, physical chattels, and radial velocities of astronomical sources. Spectroscopy is the means used to measure the dark matter content of galaxies, the masses of two stars in orbit about each other, the mass of a cluster of galaxies, the rate of expansion of the Universe, or ascertain an exoplanet nearby other stars, all using the Doppler shift. It makes it possible for the astronomer to determine the physical co nditions in distant stars and nebulae, including the chemical elements and temperatures, by quantitative analysis of the strengths of spectral features, thus constraining models of chemical enrichment in galaxies and the evolution of the space, the same way a famous astronomer defines it, â€Å"You may not perform astrophysics just by captivating images through little colored fragments

Market Assignment Example | Topics and Well Written Essays - 250 words

Market - Assignment Example Trying to sell it to people from the lower social class will make it seem like an inferior product (Camillo 67). Therefore, I can take advantage of this situation and advertise this product to people of the upper and middle social class in order to for it get the purchases it deserves. The product will be packaged in relatively expensive cases in order to give it that wealthy touch. Personal influence can also be tied to social influence whereby people who consume wine want to be seen as people with wealth or class in the society (Camillo 72). That is why when we visit people they insist on offering us wine to prove their class. Therefore, I can incorporate a renowned public figure during the advertisements of the product in order for people who consume it to feel associated with the figure. Also, the casing of the wine will have a picture of the person, which will attract more people to it. A lot people perceive that taking alcohol will give them the happy mood they have been longing for (Camillo 88). Therefore, during advertisements, a happy person should be incorporated in it in order for buyers to also want the same feeling. Happiness is priceless; hence, the price of the product should replicate what it gives to the

Change Management Framework in Healthcare Research Paper

Change Management Framework in Healthcare - Research Paper Example The health care managers and professionals obligations and duties is to maintain and acquire the expertise skills needed for them to undertake their managerial and professional tasks. Changes are always around us, and the opportune moment of making the changes participating fully is the way to support. There are various ways to make the transformational changes in the managements of the hospitals and the changes results to the benefits of the healthcare environment. Managing changes is more of handling the complexities involved in the success of that process. It is the planning, evaluating, and operations implementations, the strategies and tactics and making sure the changes taken are more relevant and worthwhile. Change management is a dynamic, complex and a challenging process; it is always a combination of the efforts of the oriented people and the technological solutions as well (Davies, Finlay and Bullman, 2000). To make the changes is a demanding and fatiguing process that involves cooperation of the people at stake. In order to bring in a change or adapt to another situation will require the manager to challenge the standards and the precedents a well as requiring perseverance against some of the norms and habits of the established behaviors. To bring about change requires the manager to have a time commitment. He or she must understand some of the values that matters and his focus to the values that need to change instead of new ones. The manager can check on what is suitable in the healthcare management how it will affect the patients, staff, employees and the society in general. The healthcare manger on evaluating the necessary changes that will be suitable in the health care organization is changing the lives and the environment of the institutions and making it better. Being clear to what is necessarily important and developing proactive actions and responses accordingly is what makes the success of the institution. The key strategies in the

AS Level History - Tsarist Russia, 1855 - 1917 Essay

AS Level History - Tsarist Russia, 1855 - 1917 - Essay Example Contextually, a few of the key attributes of the country (such as the huge size and the diversity issue which concluded on the insecurity factor of the economy, the gradual development of the country as a military state, and the poverty regions), laid the foundation of Tsarist Russia during 1855 with the inheritance of Alexander II. However, similar to any other event of history and reform the phase was set to dusk by Nicholas II during the end of 1917 (Bromley, J. â€Å"Russia, 1848-1917†). 1. Embarking on Reforms by Alexander II Alexander II played the most crucial role in the underpinning of Tsarist government through embarking several reforms which evidently concluded the philosophy of Serfdom in Russian economy. It was in 1855 when Alexander II happened to be the ‘Tsar of Russia’ after the death of Tsar Nicholas I. Consequently, Russia was then involved in the Crimean War which created an impact on the perception of Alexander II regarding the military outlook of the economy. With this changed perception, Alexander II established several reforms, such as the Emancipation Manifesto including 17 parliamentary acts aiming to free the serfs (i.e. the class of peasants fundamentally associated with agricultural labour) in Russia. The reform further rewarded the right to the serfs to purchase land from their landlords and therefore abolished the practise of personal serfdom in the economy. Noteworthy, the amount to be payable in turn of the land would be provided by the government in advance to the landlords and shall be recovered from the peasants in regular intervals. This indeed created an intense pressure on the serfs which was evidently on the contradictory aspect of the main objective of the reform to abolish serfdom (Spartacus, â€Å"Alexander II†). Furthermore, Alexander II introduced many such reforms which indirectly strengthened the power of the wealthy class, affecting the interests of the poor class of the economy. For inst ance, the establishment of Zemstvo in 1864 which would represent a council in each district, possessing the right to build up roads, provide medical services and educational services to the local people. However, the power to elect the members of the Zemstvo was restricted in the hands of the wealthy group of peoples demonstrating the inequality of rights existing within the economy. Apart from this the Tsar ruler also introduced reforms intended to the development of the municipal government, and universal military training. He also emphasised on the issue related to the expansion of industrialisation and the railways networks all around the country (Vernadsky, G., â€Å"A History of Russia†). 1.1. Reasons to Embark on these Reforms Alexander II gained his identification as the emperor of Russia in 1855, incidentally when the economy was facing the issue of Crimean War with turkey which was satisfied with a treaty of Paris. This result of the war evidently affected the perce ptions of Alexander II influencing him to believe that the military state of Russia was on a downfall. Moreover, the comparison of the Russian economy with that of France and Britain proved that the economy is evidently at a slower pace, inadequate to compete

Why is there Large Employee Turnover Rate at Wal-Mart Research Paper

Why is there Large Employee Turnover Rate at Wal-Mart - Research Paper Example Although the figures for employee turnover for Wal-Mart are not readily available there is a lot of information to indicate at the least that employees are not happy and that the turnover intent is high. In fact, the company has been faced with a number of law suits relating to sex discrimination and working overtime without pay. Wal-Mart is currently one of the most influential and respected company which is synonymous with that commanded by the manufacturing giants of the twentieth century Lichtenstein (2009). The company is in position number 15 on Forbes List as a Global 2000 Leading Company and as one of the World’s Biggest Public Company (Forbes 2013). This is based on sales, profit, assets and market value. In terms of sales Wal-Mart is in the number 1 position, 16th in profit, 135th in assets and 7th in terms of market value. On Forbes (2012) list of ‘The World’s Most Powerful Brands, Wal-Mart is in the 25th position and this makes it the world’s to p retailing company. ... The international segment is seen as the engine of growth for the company as Wal-Mart continues to expand internationally. The aim of this research is to determine the reason for the high employee turnover rate at Wal-Mart. The objectives of this study are to determine: i. Whether compensation at Wal-Mart may be a factor in relation to the high rates of turnover ii. Whether employees are satisfied with the level of communication with their supervisors iii. Whether employees are happy with their job functions Employee turnover is the movement of workers in the labor market between organizations and between different roles or occupation (Abassi et al 2000). Literature Review According to Linhartova (2011) Employee turnover is one of the problems relating to the management of human resources that never go away. Linhartova (2011) carried out two studies on the causes of employees disaffection and turnover. The study used 29 determinates to describe seven of the main factors that led to e mployee turnover – remuneration, certainty, relationships, recognition, communication, culture, and expectations. The factors were in a similar manner to studies done by other researcher (See John et al 2008; Gosling et al 2003; Benet-Martinez and John 1998). The results of the study indicate that all seven factors were strongly linked to job satisfaction. Firth L, David J Mellor, Kathleen A Moore, Claude Loquet (2007). How can managers reduce employee intention to quit?, J. manage. Psychol. 19 (2): 170-187. †¦ Strategies to minimize turnover Jain (2013) suggests that employee branding which is a relatively new concept n human resource management. This Jain (2013) indicates will allow the organization to choose and retain

AS Level History - Tsarist Russia, 1855 - 1917 Essay

AS Level History - Tsarist Russia, 1855 - 1917 - Essay Example Contextually, a few of the key attributes of the country (such as the huge size and the diversity issue which concluded on the insecurity factor of the economy, the gradual development of the country as a military state, and the poverty regions), laid the foundation of Tsarist Russia during 1855 with the inheritance of Alexander II. However, similar to any other event of history and reform the phase was set to dusk by Nicholas II during the end of 1917 (Bromley, J. â€Å"Russia, 1848-1917†). 1. Embarking on Reforms by Alexander II Alexander II played the most crucial role in the underpinning of Tsarist government through embarking several reforms which evidently concluded the philosophy of Serfdom in Russian economy. It was in 1855 when Alexander II happened to be the ‘Tsar of Russia’ after the death of Tsar Nicholas I. Consequently, Russia was then involved in the Crimean War which created an impact on the perception of Alexander II regarding the military outlook of the economy. With this changed perception, Alexander II established several reforms, such as the Emancipation Manifesto including 17 parliamentary acts aiming to free the serfs (i.e. the class of peasants fundamentally associated with agricultural labour) in Russia. The reform further rewarded the right to the serfs to purchase land from their landlords and therefore abolished the practise of personal serfdom in the economy. Noteworthy, the amount to be payable in turn of the land would be provided by the government in advance to the landlords and shall be recovered from the peasants in regular intervals. This indeed created an intense pressure on the serfs which was evidently on the contradictory aspect of the main objective of the reform to abolish serfdom (Spartacus, â€Å"Alexander II†). Furthermore, Alexander II introduced many such reforms which indirectly strengthened the power of the wealthy class, affecting the interests of the poor class of the economy. For inst ance, the establishment of Zemstvo in 1864 which would represent a council in each district, possessing the right to build up roads, provide medical services and educational services to the local people. However, the power to elect the members of the Zemstvo was restricted in the hands of the wealthy group of peoples demonstrating the inequality of rights existing within the economy. Apart from this the Tsar ruler also introduced reforms intended to the development of the municipal government, and universal military training. He also emphasised on the issue related to the expansion of industrialisation and the railways networks all around the country (Vernadsky, G., â€Å"A History of Russia†). 1.1. Reasons to Embark on these Reforms Alexander II gained his identification as the emperor of Russia in 1855, incidentally when the economy was facing the issue of Crimean War with turkey which was satisfied with a treaty of Paris. This result of the war evidently affected the perce ptions of Alexander II influencing him to believe that the military state of Russia was on a downfall. Moreover, the comparison of the Russian economy with that of France and Britain proved that the economy is evidently at a slower pace, inadequate to compete

Teaching in clinical practice Essay Example | Topics and Well Written Essays - 2500 words

Teaching in clinical practice - Essay Example As far as nursing practice is concerned, reflection is a process by which one focuses on the interaction between oneself and the environment, including colleagues, in a particular situation, with intentions to examine and evaluate the interactions. â€Å"Reflection gives scope for better understanding of oneself so that existing strengths can be used to build-up for future actions" (Somerville and Keeling, 2004). While reflection is the key to successful learning process, current literature plays a major role in these developments. Through updated journals and texts, present studies by critics and writers, we are able to meet the goals for the improvement of analytical thinking skills such as being able to identify problems that might arise, being aware to new or different ideas, and anticipating the consequences of one’s actions. According to Brandon and All (2010), many nurse educators continue teaching the way they have been doing, despite the need for reforms. However, pe dogogical research has indicated the need for change in nursing curricula. The emphasis is to shift from traditional courses to concept-based courses which com across across clinical settings. In order to accomplish such a useful change, it is very important for the nurse teacher to understand the role of "the rapidly advancing profession" (Hamner and Wilder, 2001; cited in (Brandon and All, 2010). In using reflection as a tool for the development of the professional nursing practice, a plan can be designed to meet the goals of the reflective activity by recording thoughts, observations, feelings, activities and questions (Burns and Grove, 1997). Through this, the effective practitioner can be challenged to think in new ways, raise new questions and explore new ways of problem-solving. Thus reflection is key for successful learning outcomes and literature plays a major role in such developments. In this essay, reflection on the methods, strategies and outcomes of teaching students a bout drug administration will be done with reference to current literature. Reflection and critical analysis Gibbs Model of Reflection will be used for evaluation and examination of the teaching methods and outcomes because the framework is straight forward and includes a cycle of clear description of the clinical situation, analysis of the feelings of the practitioner, evaluation of the actions during the situation, analysis of the various activities and experiences during the situation and a conclusion for lessons in future (Online learning, 2006). Description of the teaching process Student nurses were taught about administration of drugs in nursing practice. The aims of the teaching session was to enhance the knowledge of the student about the safe drug administration. The objectives and learning outcomes of the teaching session were: 1. To know the common causes of medication errors 2. To know the right method of administration of medication 3. To know the different routes of a dministration of medication and nursing considerations pertaining to those routes. 4. To know the importance of understanding the reason prior to dispensing the medication. 5. To know strategies to assure proper, clear, concise and easily understood methods of documentation of drug administration. 6. To be aware of patient safety goals. Procedural instruction in the teaching sess

Frued’s Psychoanalytic Theory Essay Example for Free

Frued’s Psychoanalytic Theory Essay Legendary and groundbreaking psychoanalyst Sigmund Freud changed the way scholars and doctors alike thought about the nature of the brain. Freud’s insight created a new paradigm that focused future inquiries onto the functional aspects of the mind, rather than cerebral and somatic physicality. With this essay, I will begin by describing and defining the id, ego and superego while also discussing how they interact. I will conclude by examining the essential differences of the ego and superego and the implications these distinctions imply. According to Dr. Freud, the id is the part of the human mind that we are born with and it is primarily responsible for the instinctual drives of the individual (Sigmund). For Freud, the id is mainly motivated by libido, or the sexual instinct in its quest for pleasure and satisfaction. Further, the libido is divided into two parts: eros and thanatos. Eros is the drive to fulfill pleasure seeking actions and sexual desires while thanatos is an oppositional drive toward death that causes the aggression and destructive tendencies of humans (Freud’s). This is an important distinction that creates the impression and theory that the id belongs to the tension filled domain of the unconscious. It is the part of us that we can scarcely control, but can incite intense pleasure or aggressive destruction when these desires are fulfilled or denied. In opposition to the basic instinctual need to achieve pleasure or enact destruction lies the part of the brain shaped and defined by social and cultural influences. Freud defines this part of the brain as the superego. The superego in practical terms can be defined as the conscious mind that develops and manifests over time, beginning with inputs from parents and siblings, to schools, relationships and work. This part of the mind internalizes all of these inputs in its creation of consciousness while also being responsible for critiquing consciousness and counterbalancing the instinctual desires of the id in order to successfully navigate through society based on learned values and moral judgments. In between the id and the superego is the ego. The ego can be thought of as the part of the brain that mediates the tensions between the conscious and the unconscious; the id and the superego (Freud’s). In this capacity, the ego contains all objects of consciousness without the moralizing and criticism of the superego. In other words, the ego is the part of our minds that is aware of consciousness and the reality of other people’s consciousness. In this model then, the ego still wants to fulfill the id’s pleasure principle but it also realizes that in trying to accomplish this, the person may hurt other people in the process and must take this fact into consideration (Sigmund). The ego is also responsible for covering the impulses of the id through the development of what he called defense mechanisms. These are forms of repression and rationalization that lessen anxiety or cover troubling thoughts and memories. In addition to his personality theory, Freud also studied the psychosexual stages of development. His stages are organized chronologically beginning with the oral stage and moving through to the anal, phallic, latency, and genital stages. They all focus on the sexual pleasure drive on the psyche. Stage development can only be achieved through the resolution of the previous stage (Stevenson). The resolution or lack thereof, affects the psyche throughout life, especially when one becomes fixated at a particular stage. Each of these stages and the developing person’s id, ego, and superego are constantly mediating the latent pleasures of the psychosexual drive against societal norms. The Structural Theory proposed by Dr. Sigmund Freud has far reaching implications for the way we account for the actions and impulses of our minds. With this model, divided into the id, ego, and superego, we can explain how we can simultaneously harbor uninhibited desires in the unconscious pleasure and destructive tendencies developed by the id, but we can also mediate these instinctive drives through the self-conscious functions performed by the ego’s defense mechanisms, while in addition re-appropriating this tension through the role of the superego in order to live a morally responsible and hopefully well-balanced life. References Freud’s Personality Factors. (2008). http://changingminds. org/explanations/personality/freud_personality. htm Sigmund Freud (1856-1939). (2008). The Internet Encyclopedia of Psychology. Retrieved January 8, 2009 from. http://www. iep. utm. edu/f/freud. htm Stevenson, David. (1996). Freud’s Psychosexual Stages of Development. Brown University. Retrieved January 8, 2009 from http://www. victorianweb. org/science/freud/develop. html

The History Of Behaviourism Psychology Essay

The History Of Behaviourism Psychology Essay During the decades 1930-1960, behaviourism represented the mainstream of experimental psychology (Jean-Claude Lecas, 2006). Central idea of behaviourism simply means A science of behaviour is possible (William M. Baum, 1994). While, behaviourists are group of individual which have diverse views about what this proposition means, and particularly about what science is and what behaviour is. Most of the behaviourist agrees that there can be a science of behaviour (William M. Baum, 1994). Behaviourists call the science of behaviour as behaviour analysis and are part of the psychology and this result the contention happen among behaviourist and psychologist due to many psychologists disagree psychology is a part of science while those regard it as a science consider its subject matter something other than behaviour. After the debate, behaviourism has been consider as a philosophy of science which related to a manner why we do, what we do, and what we should and should not do. In a more d irect way, behaviourism is an approach which offers an alternative view that often runs counter to traditional thinking about action (William M. Baum, 1994). Early Behaviourist There are some of the famous early behaviourist which contributes for the early behaviourism such as John Watson, Edwin Guthrie, Clark Hull, Edward Lee Thorndike, Ivan Petrovitch Pavlov, and B.F. Skinner. 1. Edward L. Thorndike (1874-1949) Edward Thorndike started young and continued his scientific output until his death at nearly 75 years old. He was a type of people dislike any abstract discussion not tied closely to concrete facts because what he wrote was based directly on data, usually on new data. Thorndike had made a superior undergraduate record at Wesleyan University, 1891-95 (Robert s. Woodworth. 1952). After that he went to Harvard for his graduate study. In the second year of his graduate study, Thorndike undertook a research project of the experimental study of the instinctive and intelligent behaviour of young chicks. Through his laboratory study of animal learning, demonstrate that animal behaviour observed under experimental conditions could help solve the general problems of psychology. The first published paper by Thorndike was Animal Intelligence which announced a new law of learning, additional to the old standard laws of association, and emerges of theory of learning. On his study, Edward placed ch icks, cats or dogs in a problem situation where alternative responses were possible and the first response was unlikely to be successful. The question of this study was whether the animal, perhaps after much trial and error, would learn to do the right thing in the situation-and how rapid his learning might be. Through this study, understand that in a series of trials the unsuccessful responses would fade out and the correct response would occur more and more quickly. The effect or outcome of any response was thus a powerful factor in its elimination or establishment (Robert s. Woodworth. 1952). Apart from the first study, Thorndike carry out a series of other study, one of it was transfer experiment. On this study, he give a person intensive training in some narrow field and then test that persons abilities in a more inclusive field and determine how much improvement could be demonstrated beyond the limits of the special training. Through this experiment, it showed a meager transfer effect, the ability developed by training in one line of work was specific and did not spread to other lines of work except when what had been learned could be utilized in a concrete way. Both of his study mention above led up to Thorndikes celebrated theory of the specificity of abilities (Robert s. Woodworth. 1952). 2. Ivan Petrovich Pavlov (1849-1936) Pavlov was a physician which worked as an experimental laboratory scientist. On 1883, Pavlov had developed his theory of nervism which he defined as a physiological theory which tries to prove that the nervous system controls the greatest possible number of bodily functions. Apart from that, he had won the Nobel Prize in 1904 due to their publication on the developed of a small part of the stomach called the Pavlov pouch as well as chronic external-salivary, biliary, and pancreatic fistulae for his fundamental study of gastric physiology. Pavlov also involves himself on the research of human psychophysiology and psychopathology. This led to a new psychology oriented school of physiology and stimulated ideas of many aspects of human behaviour. 3. B.F. Skinner (1904-1990) Skinner was an American psychologist,  behaviourist and  social philosopher (Smith, L. D., Woodward, W. R., 1996). Skinner called his philosophy of science as radical behaviourism. He argued that psychology should be the study of behaviour. From the point of view of Skinner, he defined behaviour as anything the organism does. This view diverges from the point of view of psychologist who thinks the proper subject matter of psychology is the stream of consciousness. He called his philosophy of science as radical behaviourism was because radical can mean root, and he that his behaviourism was through going, deep behaviourism (William T. ODonohue   Kyle E. Ferguson, 2001). Behaviourism is not the science of human behaviour; it is the philosophy of that science. Some of the questions it asks are these: Is such a science really possible? Can it account for every aspect of human behaviour? What methods can it use? Are its law as valid as those of physics and biology? Will it lead to a technology, and if so, what role will it play in human affairs? (Skinner, 1974) Skinner (1970) also stated that Behaviourism is a formulation which makes possible an effective experimental approach to human behaviour. It is a working hypothesis about the nature of a subject matter. In conclusion, radical behaviourism is not a scientific law; it is a metascientific which attempts to define what the science of behaviour should look like and it is important to be clear what is radical behaviourism and what is not (William T. ODonohue   Kyle E. Ferguson, 2001). 4. John B. Watson (1878- 1958) He had introduced the term behaviourism in the early part of the twentieth century. Watson emphasized the need for focusing scientific inquiry on observable behaviours rather than thinking which defined as non-observable phenomena by him. Apart from that, he also opposes the study of internal mental events as well as denied any existence of the mind. His thinking was greatly influenced by Pavlov. He had adopted the classically conditioned S-R (Stimulus-Response) habit as the basic unit of learning and extended it to human learning (J. E. Ormrod, 2008). Watson had proposed two laws which describing how S-R habit develop. The first law was law of frequency and second law was law of recency. The first law concern on the importance of repetition which bring the meaning of the more frequently a stimulus and response occur in association with each other, the stronger that S-R habit will become. While the second law concern on the importance of timing which mean the response that has most recently occurred after a particular stimulus is the response most likely to be associated with that stimulus (J. E. Ormrod, 2008). In conclusion, from the point of view of Watson, he believed that the past experience of an individual accounts for virtually all behaviour. He was a extreme environmentalist, which denied that hereditary factors had any effect on behaviour (J. E. Ormrod, 2008). 5. Edwin R. Guthrie (1886-1959) Guthries famous with his contiguity theory which had similar perspectives as Watson approach which placed S-R connections at the center of the learning process. An organism responds to a particular stimulus in a particular way on one occasion, the organism will make the same response the next time it encounters the same stimulus and this called habits. Guthrie also shared Watsons belief that recency is critical in learning: An organism will respond to a stimulus in the way that it has most recently responded to that stimulus (J. E. Ormrod, 2008). 6. Clark L. Hull (1884-1952) Hull had introduced an organismic characteristic which bring the meaning of characteristics unique to different individuals. He brings this approach into behaviourist learning theory. He had maintained the S-R habits approach by Skinner and agreed with Thorndike and Skinner behaviourists approach. However, Hull partially agree with the statement by Thorndike and Skinner which stated that presence of a particular stimulus and ones past experiences will affect the behaviour of an individual. In his approach, he believed those stimuli are not the only determinants of whether a particular response will occur or how strongly it will be made. There are some other factors called intervening variables which affect the individual response or behaviour toward certain stimulus. Example of intervening variables are habit strength, organism drive (an internal state of arousal that motivates one behaviour), and inhibitory factors (e.g. fatigue). Hulls theory was predominant throughout the 1940s an d 1950s (J. E. Ormrod, 2008). Hawthorne Studies The Hawthorne effect is often mentioned as a possible explanation for positive results in intervention studies. It is used to cover many phenomena, not only unwitting confounding of variables under study by the study itself, but also behavioural change due to an awareness of being observed, active compliance with the supposed wishes of researchers because of special attention received, or positive response to the stimulus being introduced (Wickstrà ¶m G, Bendix T, 2000). Hawthorne studies was introduced by Frederick Taylor in the year of 1911 which influenced by the principles of scientific management. It is first be practice on the year of 1924 by the management of the Hawthorne plant of the Western Electric Company in Chicago, Illinois, in the United States. The studies look into the relationship between illumination and productivity of the workers. The similar studies was repeated between year 1927 and 1933 in cooperation with the Massachusetts Institute of Technology (MIT) and Harvard University which concerned with the effects of changes in rest pauses and work hours on productivity (Wickstrà ¶m G, Bendix T, 2000). For the first studies done on 1924, the methodology involve was decreased the illumination step by step for the experimental subjects, while the controls received the same illumination. Both group of subjects slowly but steadily increased their performance of inspecting parts, assembling relays or winding coils. This experiment showe d that there were not significant relationships between the lighting with the productivity of the workers in the criteria as long as the lighting was kept at a reasonable level. However, there was some other factor more important to affect the productivity of the worker (Wickstrà ¶m G, Bendix T, 2000). Other variables were later being study such as physical factors causing fatigue and monotony, assembly, mica splitting and bank wiring. After complete the series of experiment it found that assembly test as well as the others 3 variables did not explain the continuous increase in productivity observed during the test. The individuals named Roethlisberger Dickson which compile this study report suggested that the most important factor behind the continuous increase in output was the improved personal relations between workers and management. This statement was supported based on the explanations of the informally expressed opinions of the workers participating in the experiment and also based on the general thought of the investigators (Wickstrà ¶m G, Bendix T, 2000). By this study, the investigators conclude that the unintentional manipulations caused the subjects to improve their overall productivity and thus results the appeared of the term called the Hawthorne effect. This term will introduced apparently in French on 1953 which highlighted that the marked increase in production related only to special social position and social treatment. Many of the other articles had deduced that the increased on productivity may result from one the causes stated below, e.g. morale, attitude, supervision, teamwork, cohesiveness, informal organization, interpersonal relationships, social unity, and awareness of being in an experiment, acquiring skill, or continuous feedback while working in a group (Wickstrà ¶m G, Bendix T, 2000). In conclusion, the Hawthorne effect is simply referred to as an increase in productivity. The increase in productivity may due to one or more of the factor below, e.g. relief from harsh supervision, receiving positive attention, learning new ways of interaction, possibilities to influence work procedures, rest pauses, higher income, or threat of losing ones job. All of these factors, or any combination of them, may result an observable increased in the productivity.

Central Themes in The Graduate Essay -- Papers Film Movie Essays

Central Themes in The Graduate The themes of loneliness, isolation and entrapment are central to the narrative of the 1967 film The Graduate. Throughout the film, many devices are used in order to communicate this to the audience. This list of devices includes the use of water and glass for example, which is seen in many scenes and emphasizes the isolation and entrapment of the not particularly remarkable but worthy kid who drowns amongst many objects and things throughout this film. The first scene we are going to look at is the party at the beginning of the film; I find this a perfect example to look at Ben’s reactions and his need or desire to be alone all the time, he doesn’t like to be around that many people for too much time, or in fact no time at all. There’s a part at the beginning of this scene when we see Ben sitting alone with the lights off, but we don’t realize they’re off until his father comes in and switches them on, interrupting the silence and making Ben uncomfortable since he obviously wants to be alone. Then there are a few shots where we can get a glimpse of the fish tank, but more importantly, we see the scooba diver inside it. When you come to think of it, the scooba diver is always there, in the middle of the depth of the water inside the fishtank, having water and glass putting him into total isolation, trapped but always exhibited, looked at, he is subject to people’s examination. This whole thing may signify Ben’s both loneliness and entrapment apart from isolation that we already mentioned. Close-ups on Ben’s face and his gestures suggest drastically that he wants to be left alone, but his parents insist... ...normous glass which separates the bottom part of the church from the upper floor, where the choir usually is. How often is this seen in a church? Practically never. It’s also very ironic how Ben uses the Christian cross to keep the distance between him and Elaine and the rest of the people, and also how he uses it to lock them inside the church to buy them time to run away. Now it’s all the people who are locked behind glass, which doesn’t change much since Ben (and also Elaine now) is still as isolated as before. All throughout the film we see constant use of conventional codes which reflect many different things which most times have a subconscious effect on the audience. All these devices added up together have a very strong effect, clearly emphasizing all throughout the piece loneliness, isolation and entrapment.

Healthcare-associated infections (HAIs) Essay

BACKGROUND Healthcare-associated infections (HAIs) are bacterial infections acquired during a patient’s stay in a healthcare institution.   It imposes a huge burden on healthcare institutions, costing billions of dollars for additional care costs as well as a significant fraction of lost lives (Houghton, 2006).   Current estimates depict that approximately 2 million patients acquire healthcare-associated infections (HAIs) or nosocomial infections each year, of which 90,000 to 100,000 patients die (Houghton, 2006), making HAIs not only a national health problem, but a global threat as well.   Common HAIs include hematological, surgical site, dermatological, respiratory, urinary and gastrointestinal systems.   In order to control the increase in number of healthcare-associated infections, it is fundamental to identify key factors that make healthcare institutions susceptible to such outbreaks.   There is a need to evaluate the sensitivity and efficiency of healthcare institutions to healthcare-associated infections in order to prevent future outbreaks. PROBLEM STATEMENT   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   This study will investigate the sensitivity of detection and efficiency of reporting healthcare-associated infections to the hospital administration, in the context of providing measures in improving the current surveillance program in the country.   The guidelines to identification of a healthcare associated infection will be evaluated through personal interactions with healthcare workers using questionnaires which will be designed using a multiple choice approach. CONCEPTUAL/THEORETICAL FRAMEWORK   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   This study is based on the need to address the current epidemic of healthcare-associated infection that is emerging around the world.   Before an effective solution to the problem is designed, it is essential that shortcomings in the standard procedures of healthcare institutions be identified.   This may be done by determining the level of sensitivity of healthcare personnel to symptoms of healthcare-associated infections, as well as knowing what are the first set of actions to be done once an infection is confirmed within a healthcare institution.   This study may serve as the first measurement tool that addresses these aspects of the global epidemic.    RESEARCH QUESTION/HYPOTHESIS   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   This investigation aims to address the question of whether the current hospital administration is sensitive enough to detect and substantially efficient to report to healthcare institutions any incidents of healthcare-associated infections.   This will be directly evaluated using survey data collections from retrospective cases of particular health institutions as related to dates of hospital admission, confirmation of infection and treatment time.    SIGNIFICANCE OF THE STUDY   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   There is a need for an effective surveillance and control program for healthcare-associated infections that are based on current settings in a healthcare institution.   Through surveys that inquire on common practices and responses of healthcare workers, any shortcomings or avoidable gaps in the hospital system may be reformed, which in turn will alleviate the spread of infection in the healthcare institutions.   Review of medical records and interviews with attending healthcare personnel will be performed in order to determine whether there are certain discrepancies and gaps in the healthcare protocol that facilitate contamination and further spreading of infectious microbials around the healthcare institution.   This study may facilitate the identification of key factors that influence the increase in frequency of nosocomial infections in hospitals.   The results of this investigation may positively serve as a tool to healthcare workers such as nurses and laboratory technicians. STATEMENT OF THE PURPOSE (OBJECTIVES)   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   This research will determine the sensitivity and response rate of healthcare workers to healthcare-associated infections.   This proposal aims to develop a measurement tool that will determine the sensitivity for identification, efficiency of reporting and the response rate to a healthcare-association infection, with the aim of designing a cost-effective and quick way of controlling and ultimately eradicating the healthcare-related problem.       LITERATURE REVIEW   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The prevention and control of HAIs requires a comprehensive approach that addresses as many pathogens as possible (Wiseman, 2006). Urinary tract infections (UTI) associated with catheter use are the most common HAIs, with hospital-acquired pneumonia having the highest mortality rate (Houghton, 2006).   These infections are frequently problematic to treat due to the fact that the microorganisms involved have become resistant to antibiotics (Broadhead, Parra and Skelton, 2001). Recent media coverage of meticillin-resistant Staphylococcus aureus (MRSA) has increased the awareness of healthcare professionals to the threat of this particular microbe.   S. aureus infections can result in cellulitis, osteomyelitis, septic arthritis and pneumonia, and some of the systemic diseases such as food poisoning, scalded skin syndrome and toxic shock syndrome (Zaoutis, Dawid and Kim, 2002).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   MRSA and vancomycin-resistant Enterococcus (VRE) are the primary causes of nosocomial infections and are significant factors in increased morbidity and mortality rates. These microbes are currently endemic in many healthcare institutions, particularly problematic in intensive care units (ICUs) (Furuno, et al. 2005).   VRE Infections have become prevalent in U.S. hospitals over the last decade, increasing in incidence 25-fold (Ridwan et al., 2002).   Vancomycin is the antibiotic frequently used to treat infections caused by MRSA, but recent years have seen the emergence of Staphylococcus aureus infections that have high-resistance to vancomycin, which makes the future effectiveness of this drug questionable (Furuno et al., 2005). All known variants of the vancomycin-resistant Staphylococcus aureus (VRSA) isolates have possessed the vanA gene, which carries with it resistance to vancomycin.   This development is believed to have been acquired â€Å"when the MRSA isolate conjugated with a co-colonizing VRE isolate† (Furuno et al., 2005, p. 1539). This means that patients who suffer co-colonization from MRSA and VRE have an increased risk for colonization and infection by VRSA (Furuno et al., 2005). Furthermore, Zirakzadeh and Patel (2006) stated that VRE has become a major concern due, in part, to its ability to transfer vancomycin resistance to other bacteria, which includes MRSA.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Infection of susceptible patients typically occurs in environments that have a high rate of patient colonization with VRE, such as ICUs and oncology units (Zirakzadeh and Patel, 2006).   In these healthcare settings, VRE has been known to survive for extensive periods and research has also observed that VRE has the ability to contaminate virtually every surface (Zirakzadeh and Patel, 2006). Efforts to control HAIs, such as VRE, have focused on prevention, such as through hand hygiene, as the first line of defense.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Hand hygiene has been improved by using â€Å"user-friendly, alcohol-based hand cleansers, but there still remains the goal of achieving consistently high levels of compliance with their use† (Carling et al., 2005, p. 1).   Screening-based isolation practices have likewise improved transmission rates of MRSA and VRE; however, logistic issues and the cost-effectiveness of these practices are still being analyzed (Carling et al., 2005). Additionally, despite isolation practices, outbreaks and instances of environmental contamination have been documented in regards to MRSA, VRE and Clostridium difficile, which cannot be screened with any practicality (Carling et al., 2005).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The numerous obstacles that exist in regards to effective screening practices suggest that a focus on improving existing cleaning/disinfecting practices may prove to be more effective in halting the spread of HAIs (Carling et al., 2005). Studies over the last several decades have shown that there is often contamination of surfaces in and around the patient, as pathogens associated with the hospital environment have been known to survive on surfaces for weeks or even months (Carling et al., 2005). Significant rates of contamination with Clostridium difficile have been connected with symptomatic and asymptomatic patients (Carling et al., 2005).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In 2002, the CDC issued guidelines that called for hospitals to â€Å"thoroughly clean and disinfect environmental medical equipment† surfaces on a regular basis (Carling et al., 2005, p. 2). Other organizations have followed suit and stressed repeatedly the need for healthcare provides to focus on environmental cleaning and disinfecting activities, yet these guidelines have not provided directives that address precisely how healthcare providers can either evaluate   their ability to comply with professional guidelines on this topic or ensure that their procedures are effective (Carling et al., 2005).   Nevertheless, literature on the subject does offer some guidance.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Surveillance, evidence-based infection control practices and the responsible use of antibiotics have been determined to be crucial to controlling HAIs (Wiseman, 2006).   The establishment of comprehensive surveillance programs has facilitated the creation of national databases the compile cases of infection which may be useful to researchers investigating progression rates and causal factors.   Evidence-based control practices may be implemented by distributing guidelines for aseptic hospital protocols, hospital hygiene, personal protective equipment and disposal of biohazardous sharps.   A review of commonly used antibiotics in terms of proper dosage and length of treatment based on clinical evidence and best practice guidance should also be performed.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Curry and Cole (2001) reported that the medical and surgical ICUs in large inner-city teaching hospitals developed an elevated patient VRE colonization rate. A multi-faceted approach was instituted to correct this problem, which involved changing behavior by â€Å"shifting norms at multiple levels through the ICU community† (Curry and Cole, 2001, p. 13). This intervention consisted of five levels of behavioral change. These encompassed: â€Å"1. intrapersonal and individual factors; 2. interpersonal factors; 3. institutional factors; 4. community factors and 5. public factors† (Curry and Cole, 2001, p. 13).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Educational interventions were developed that addressed each level of influence and behavioral change was predicated on â€Å"modeling, observational learning and vicarious reinforcement† (Curry and Cole, 2001, p. 13). These procedures resulted in a marked decrease of â€Å"VRE surveillance cultures and positive clinical isolates† within six months and this decrease has been consistent over the next two years (Curry and Cole, 2001, p. 13).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Research has shown that the nutritional status of preoperative and perioperative patients can influence their risk for acquiring a HAI (Martindale and Cresci, 2005). This is particularly true for patients who are undergoing surgery for neoplastic disease as this can commonly result in immunosuppression (Martindale and Cresci, 2005). Inadequate nutrition, â€Å"surgical insult, anesthesia, blood transfusions, adjuvant chemotherapy/radiation/ and other metabolic changes† have been identified as contributing to suppression of the immune system (Martindale and Cresci, 2005). Furthermore, studies have also associated infection risk with glycemic control Maintaining blood glucose levels between 80 and 110 mg/dL vs. 180 and 200 mg/dL has been shown to result in fewer instances of â€Å"acute renal failure, fewer transfusions, less polyneuroopathy and decreased ICU length of stay† (Martindale and Cresci, 2005, p. S53).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Citing Ulrich and Zimring, Rollins (2004) states that getting rid of double-occupancy rooms and providing all patients with single rooms that can be adjusted to meet their specific medical needs can improve patient safety by reducing patient transfers and cutting the risk of nosocomial infections. While these researchers admit that the up-front cost of private rooms is significant, this will be offset by the savings accrued through lowers rates of infection and readmission, as well as shorter hospital stays (Rollins, 2004).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   A recent study conducted by researchers at Chicago’s Rush University Medical Center found that enforcing environmental cleaning standards on a routine basis resulted in less surface contamination with VRE, â€Å"cleaner healthcare worker hands, and a significant reduction in VRE cross-transmission in an ICU† (Cleaning campaign, 2006, p. 30). These improvement in VRE contamination continued to be experienced even when VRE-colonized patients were continually admitted and healthcare workers compliance with hand hygiene procedures were only moderate (Cleaning campaign, 2006). The strategies that the researchers implemented included that they: held in-services for housekeepers about why cleaning is important–emphasizing thorough cleaning of surfaces likely to be touched by patients or workers. increased monitoring of housekeeper performance. recruited respiratory therapists to clean ventilator control panels daily. educated nurses and other ICU staff on VRE and how they could assist housekeepers by clearing surfaces that need cleaning. conducted a hand hygiene campaign, including: mounting alcohol gel dispensers in common areas, patient rooms and every room entrance (Cleaning campaign, 2006, p. 30).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   CDC guidelines indicate that if hands are not visibly soiled, using an alcohol-based hand rub should become habitual between patient contacts. When hands are visibly soiled, use of an anti-microbial soap and water is required. If contact with C difficile or Bacillus anthracis is possible, it is recommended that the healthcare provider wash with anti-microbial soap and water, as other antiseptic agents have poor efficacy against spore-forming bacteria and the physical friction of using soap and water at least decreases the level of contamination (Houghton, 2006). Page (2005) indicates that the CDC has joined with the US Department of Health and Human Services, the National Institutes of Health (NIH and the Food and Drug Administration (FDA) to lead a task force of 10 agencies and departments, which have developed a blueprint outlining federal actions to combat this problem. This template emphasizes the efficacy of hand washing, among other points (Page, 2005).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In 2002, the CDC issued updated hand hygiene guidelines, which address new development and research on this topic, such as â€Å"alcohol-based hand rubs and alternatives to antibacterial soaps and water† (Houghton, 2006, p. 2). However, while the efficacy of hand hygiene is well accepted, it is also well known that healthcare workers â€Å"of all disciplines† frequently fail to abide by adequate hand hygiene practices (Houghton, 2006, p. 2). In fact, research has shown that adherence rates to hand hygiene guidelines are lowest in ICUs, where to the frequency of patient care contact, multiple opportunities for hand hygiene exist on a hourly basis (Houghton, 2006). According to Houghton (2006), any direct patient-care contact, which includes contact with gloves and/or contact with objects in the immediate patient vicinity, constitutes an â€Å"opportunity† for appropriate hand hygiene.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   This suggests that the proposed intervention should also include asking healthcare employees at the site of the intervention to participate in a survey that examines, first of all, how closely hand hygiene protocols are followed and, if they are not followed, why not. It may be that the activity level of ICUs is so great that the practitioners feel that they cannot take sufficient time to do adequate hand hygiene. If this is the case, alternative methods of hand hygiene to that institution’s traditional policy may need to be investigated.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Just as this study revealed factors that can be associated with non-compliance, a similar investigative effort may be called for to determine reasons why compliance may not be satisfactory for cleaning/disinfecting environmental surfaces. Again, it may be that non-compliance hinges on factors of time.   It may be, therefore, expeditious for hospitals and other healthcare organizations to look into hiring additional personnel to aid with cleaning/disinfecting tasks. It may also prove necessary, to cope with factors of time and efficiency, to train cleaning personnel to take a systematic approach to patient room cleaning that includes all â€Å"high touch† areas. As noted previously, researchers at Chicago’s Rush University Medical Center found that holding in-service training for housekeepers was an effective component of their overall strategy in lowering VRE related infections (Cleaning campaign, 2006). This process could be facilitated by a checklist approach or by periodically reevaluating rooms according to the Carling et al. (2005) methodology.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Given these detailed accounts of healthcare-associated infections in hospitals, it is of significant importance that the sensitivity and response rate of health personnel be identified in order to know if there are any discrepancies and gaps in the standard hospital protocols that foster the expansion of microbials in hospitals.   This study aims to determine the level of sensitivity and response rate of healthcare institutions to the growing epidemic of healthcare-associated infections.    SUMMARY   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   HAIs are an unnecessary tragedy, increasing morbidity and mortality figures and adding to healthcare costs. While there are ways to treat all the various HAIs, the clearest remedy for this insidious drain on healthcare resources and personnel is prevention, which begins with the simplest of acts–washing one’s hands–but also extends to considering all hospital surfaces as having the potential to harbor pathogens. This means rethinking some healthcare institutional procedures. It means habitually and routinely cleaning all surfaces, as well as everywhere and anything that is routinely touched, whether by a bare or gloved hand.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Stopping the spread of HAIs includes multiple factors, such as restrained and appropriate use of antibiotics. However, the first line of defense is cleaning/disinfecting procedures. This constitutes the â€Å"ground zero† foundational line for battling HAIs and this means that all healthcare practitioners should keep the goal of reducing the spread of HAIs foremost in their minds while going about their daily routines, washing hands between each patient contact and paying attention to other sepsis concerns. In other words, the first step in stopping HAIs is simply to keep them in the forefront of practitioner consciousness. References Broadhead, J. M., Parra, D. S., & Skelton, P. A. (2001). Emerging multiresistant organisms in the ICU: Epidemiology, risk factors, surveillance, and prevention. Critical Care Nursing Quarterly, 24(2), 20. Carling, P. C., Briggs, J., Hylander, D., & Perkins, J. (2006). An evaluation of patient area cleaning in 3 hospitals using a novel targeting methodology. American Journal of Infection Control, 34(8), 513-519. Centers for Disease Control and Prevention. (2006). Healthcare-Associated Infections (HAIs).  Ã‚   Retrieved March 17, 2007, from http://www.cdc.gov/ncidod/dhqp/healthDis.html Cleaning campaign targets VRE transmission. (2006). OR Manager, 22(7), 30. Curry, V. J., & Cole, M. (2001). Applying social and behavioral theory as a template in containing and confining VRE. Critical Care Nursing Quarterly, 24(2), 13. Furuno, J. P., Perencevich, E. N., Johnson, J. A., Wright, M.-O., McGregor, J. C., Morris Jr, J. G., et al. (2005). Methicillin-resistant Staphylococcus aureus and Vancomycin-resistant Enterococci co-colonization. Emerging Infectious Diseases, 11(10), 1539-1544. Harrison, S., & Lipley, N. (2006). Wipe It Out infection control initiative extended. Nursing Management – UK, 12(10), 4-4. Houghton, D. (2006). HAI prevention: The power is in your hands. Nursing Management, 37(5), 1-8. Johnson, A.P. Pearson, A. and Duckworth, G.   (2005):   Surveillance and epidemiology of MRSA bacteraemia in the UK.   J. Antimicrob. Chemo.   56:455–462. Lopman, B.A., Reacher, M.H., Vipond, I/.B., Hill, D., Perry, C., Halladay, T., Brown, D.W., John Edmunds, W. and Sarangi, J.   (2004):   Epidemiology and Cost of Nosocomial Gastroenteritis, Avon, England, 2002–2003.   Emerg. Infect. Dis.   10(10):1827-1834. Martindale, R. G., & Cresci, G. (2005). Preventing Infectious Complications With Nutrition Intervention. JPEN, Journal of Parenteral and Enteral Nutrition, 29(1), S53. Page, S. (2005). MRSA, VRE and CDC’s plan to combat antimicrobial resistance. Vermont Nurse Connection, 8(3), 6-7. Parienti, J. J. M. D. D. T. M., Thibon, P. M. D., Heller, R. P. P., Le Roux, Y. M. D. D., von Theobald, P. M. D. D., Bensadoun, H. M. D. D., et al. (2002). Hand-rubbing with an aqueous alcoholic aolution vs traditional surgical hand-scrubbing and 30-day surgical site infection Rates. JAMA, 288(6), 722-727. Ridwan, B., Mascini, E., Reijden, N. v. d., Verhoef, J., & Bonten, M. (2002). What action should be taken to prevent spread of vancomycin resistant enterococci in European hospitals? British Medical Journal, 324(7338), 666. Rollins, J. A. (2004). Evidence-Based Hospital Design Improves Health Care Outcomes for Patients, Families, and Staff. Pediatric Nursing, 30(4), 338. Sheff, B. (2001). Taking aim at antibiotic-resistant bacteria. Nursing, 31(11), 62. STATA 8.0. College Station (TX): STATA Corporation; 2002. Stevenson, K.B., Searle, K., Stoddard, G.J. and Samore, M.H. (2005):   Methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci in rural communities, Western United States.   Emerg. Infect. Dis.   11(6):895-903. Tacconelli, E. Venkataraman, L., De Girolami, P.C. and D’Agata, E.M.C.   (2004):   Methicillin-resistant Staphylococcus aureus bacteraemia diagnosed at hospital admission: distinguishing between community-acquired versus healthcare-associated strains.   J. Antimicrob. Chemother. 53:474-479. Wiseman, S. (2006). Prevention and control of healthcare associated infection. Nursing Standard, 20(38), 41-45. Zaoutis, T., Dawid, S., & Kim, J. O. (2002). Multidrug-resistan organisms in general pediatrics. Pediatric Annals, 31(5), 313. Zirakzadeh, A., & Patel, R. (2006). Vancomycin-resistant enterococci: Colonization, infection, detection and treatment. Mayo Clinical Proceedings, 81(4), 529-536. METHODOLOGY   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   A retrospective non-probability cluster surveillance study will be performed on hospital records of two health institutions, Assir Central Hospital and Khamis Mushait Hospital from January 2002 to December 2006.   Such coverage will represent a larger population of similar environmental and socioeconomic settings, which may also influence the frequency of healthcare-associated infections in the area.   This type of non-probability cluster sampling will be used because it will benefit the split-level definition that will be followed, distinguishing normal hospital cases and healthcare-associated infections or outbreaks, based on the CDC’s guidelines for healthcare-associated infections.   Ethical approval from the respective ethics review committee of each hospital will be obtained before the study will be conducted. Study population.   ThÐ µ study population will includÐ µ 5,000 patiÐ µnts that have been admitted at the Assir Central Hospital and Khamis Mushait Hospital from January 2002 to December 2006.   These hospitals were chosen in order to primarily focus on collection of reliable, high-quality data based of systematic sampling.   The hospital’s administrative database will serve as the main source of information for this study.   For purposes of anonymity, patient’s names will be kept confidential and will be replaced with a case number instead.   A retrospective non-probability sampling using patiÐ µnt cases will be classified according to gender, age, diagnosis upon admission, length of stay and treatment received. The treatment category of the patients will be further characterized as surgical, respiratory, urinary, urological, obstÐ µtrical, intensive care, cardiac or trauma.   Any co-morbidities will be taken note of in every patient included in the study.   Patient records will also be reviewed to determine whether and when a healthcare-associated infection was observed after admission to the hospital or during the patient’s stay in the hospital and will be identified as the time-at-risk, or the time when the infection has been ascertained and may most probably be contagious to the patient’s immediate environment.   Among the inclusion subjects are healthcare workers such as nurses, laboratory technicians and other hospital staff members will be included in the study as population at risk.   Exclusion subjects are those patients that were not admitted into the hospital because their stay in the hospital was not recommended during their healthcare.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The database of the infection control team of each of the two hospitals will be reviewed to gather information on the study population in the hospitals.   Infection control nurses are responsible for monitoring any outbreaks in each hospital during hospital ward rounds, or are identified as the point-of-contact personnel that is alerted as soon as an HAI incident is suspected to occur in the specific ward of the hospital.   Cluster sampling will be performed when an infection does happen that fits the clinical definition of an HAI, the healthcare institution is required to report this incident to the area’s or county’s health protection agency.   The area or county health protection agency is in charge of ensuring the comprehensiveness of incident reports, monitoring data entry and conducting analyses.   The health protection agency also collects reports during months that no infections were reported to verify that no inf ections occurred at that time. Tools to be employed.   To determine whether a case patient has contracted a healthcare-associated infection, the system definitions established by the Center for Disease Control and Prevention’s National Nosocomial Infection Surveillance (NNIS) will be followed, with slight modification for usÐ µ in a rÐ µtrospÐ µctivÐ µ study.   ThÐ µ NNIS dÐ µfinitions were dÐ µvÐ µlopÐ µd according to a prospÐ µctivÐ µ approach to hospital survÐ µillancÐ µ and arÐ µ dÐ µsignÐ µd to bÐ µ quitÐ µ spÐ µcific.   BÐ µcausÐ µ clinical dÐ µcisions arÐ µ oftÐ µn not madÐ µ on thÐ µ basis of survÐ µillancÐ µ dÐ µfinitions, wÐ µ bÐ µliÐ µvÐ µ that somÐ µ casÐ µs of clinically suspÐ µctÐ µd infÐ µction would mÐ µÃ µt most but not all of thÐ µ NNIS critÐ µria and thus bÐ µ classifiÐ µd as non-HAI, Ð µspÐ µcially on a rÐ µtrospÐ µctivÐ µ chart rÐ µviÐ µw. WÐ µ designed a retrospective-based data classification scheme that follows the following criteria: patiÐ µnts who were not infÐ µctÐ µd, thosÐ µ with suspÐ µctÐ µd HAI, and thosÐ µ with confirmÐ µd HAI.   In gÐ µnÐ µral, patiÐ µnts with suspÐ µctÐ µd HAI will includÐ µ thosÐ µ who have received antimicrobial thÐ µrapy for a condition that appÐ µarÐ µd 148 h aftÐ µr hospital admission and who will mÐ µÃ µt all but onÐ µ clinical critÐ µria for a confirmed infÐ µction.   DÐ µfinitions for a confirmed HAI will bÐ µ the samÐ µ as thosÐ µ usÐ µd by thÐ µ NNIS, Ð µxcÐ µpt that rÐ µcÐ µipt of appropriatÐ µ antimicrobial thÐ µrapy will bÐ µ Ð µxcludÐ µd as a critÐ µrion for a confirmÐ µd infÐ µction. ThÐ µsÐ µ critÐ µria will bÐ µ finalizÐ µd bÐ µforÐ µ chart data abstraction bÐ µgins.   ThÐ µ Ð µconomic pÐ µrspÐ µctivÐ µ will bÐ µ usÐ µd for mÐ µasuring costs incurred by thÐ µ hospital, bÐ µcausÐ µ thÐ µ hospital administ ration will bÐ µ thÐ µ dÐ µcision makÐ µr for instituting and financing infÐ µction control programs. Data collÐ µction.   Clinical cases of healthcare-associated infection identified by the clinical laboratories of the two participating hospitals will be compiled.   Demographic, medical history and other epidemiologically relevant data on each reported case will be collected.   The microbiology laboratory of the hospital may also contribute information to the data collection.   The patient’s medical record will serve as the primary source of information for this study.   The data collected will be recorded in a standardized data collection form.   In addition, outbreak or infection summary forms that were previously completed by infection control nurses and reported to health protection agencies as a healthcare-associated infection will be collected and integrated into the study database. The duration of an outbreak will be determined by taking note of the date the first case of the infection was reported and correlating this date to the date when the last case of the infection was reported at the healthcare institution (Lopman et al. 2004).   All data will abstracted from patiÐ µnt mÐ µdical rÐ µcords of the healthcare facility.   IntÐ µrratÐ µr rÐ µliability will not bÐ µ mÐ µasurÐ µd, bÐ µcausÐ µ Ð µach abstractor will bÐ µ focusÐ µd on rÐ µcording a singlÐ µ Ð µlÐ µmÐ µnt of data for Ð µach patiÐ µnt, similar to an assÐ µmbly linÐ µ.   All data gathering will bÐ µ dirÐ µctly supÐ µrvisÐ µd by a member of the research program.   PatiÐ µnts with suspÐ µctÐ µd or confirmÐ µd HAI will bÐ µ idÐ µntifiÐ µd on thÐ µ basis of thÐ µir vital signs, laboratory and microbiology data, and clinical findings documÐ µntÐ µd in the respective physician’s progrÐ µss and consultation notÐ µs. To improve the validity of the collected data, the following approaches (Stevenson et al. 2005) will be employed:   1) a data dictionary and operations manual will be created with explicit instructions for completion of the data collection forms; 2) the data collection protocol will be discussed during conference calls along with frequent one-on-one communication; and 3) anomalous data in the data reports will be routinely searched for and corrected.   The definitions employed in this study will concentrate on the location of the patient at the time of microbiological testing for infection diagnosis, and the presence or of exposure to the healthcare environment.   The study will emphasize the time of response of any member of the healthcare institution to the definitive diagnosis of the healthcare-associated infection (Johnson et al. 2005).   Each identified HAI case will be further analyzed for its causative agent, such as MRSA or VRE.   All included in this study were HAI cases with any prior history of hospitalization, out-patient surgery, residence or care in a home/health agency with documented healthcare-associated infections in the last 6 months.   Examples would include former out-patient cases with post-operative infections.   Other coexisting factors that may be associated with healthcare-associated infections such as diabetes mellitus, immunosuppression, renal failure and other antimicrobial drug treatments, will also be included in the data collection form. The incidence rates of each type of healthcare-associated infection will be calculated for each hospital from January 2002 to December 2006.   Any patient cases that could not be ascertained to be completely reported in the medical records will not be included in the analysis.   The incidence rates will be expressed as the number of healthcare-associated infections per 10,000 patient-days or number of community cases per 10,000-person-years, based on county population (Taconelli et al. 2004). Instruments including reliability and validity.   A data collection form will be designed for use in this investigation.   Essential entry data will include case number (patient name is kept confidential), hospital name, date of admission, diagnosis upon admission, treatment regime, date of detection of healthcare-associated infection, treatment of healthcare-associated infection, date of admission of treatment of healthcare-associated infection, identification of HAI etiologic agent, resistance of HAI etiologic agent and date of patient discharge.   The healthcare institution personnel that have attended to the patient will also be noted, such as attending physician, consults, nurses, technicians and technologists.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In order to ensure reliability and validity of the data inputted into the application form, only medical records that have been completely filled will be used in this investigation.   In addition, there will be questions in the application form that will determine whether the patient has undergone any previous exposure to any hospital for outpatient or inpatient hospital or nursing facility in the last 6 months.   This is done to make sure that the source of the HAI is determined, whether it is coming from within the hospital or from another healthcare institution. Data Analysis.   The collected data will be entered and stored in an AccessTM relational database (Microsoft, Redmond, WA) for analysis.   AccessTM is a database management system that is very useful for handling and manipulation of data that are designed in the query format.   It provides the analyst an easier way to extract data from the database according to selected fields or variables, as well as compare or combine two variables at one time. Data analyses will be performed using Microsoft ExcelTM and Stata 8.0 (2002).   Proportions of total cases meeting specific epidemiologic criteria will be calculated, and characteristics of each category will be compared by using Fisher exact testing.   To compare means, the t-test will be employed, and to compare proportions, the χ2 test will be used.   All continuous data will be analyzed using linear regression.   To assess linear correlations between two variables, the Spearman rank test will be used.   Census data and ages of patients in each category will be compared using the Kruskal-Wallis equality of populations rank test.   The relationship of healthcare institution response rates to the infection and other covariates will be modeled by using random effects Poisson regression. Each hospital will be taken into account as a unit and treated as a random effect.   During thÐ µ initial phasÐ µ of data collection, dÐ µscriptivÐ µ statistics will be used to dÐ µscribÐ µ and summarizÐ µ thÐ µ data obtained in thÐ µ study.   ThÐ µ sÐ µcond phasÐ µ of analysis will focus on thÐ µ usÐ µ of multivariatÐ µ analysis to dÐ µtÐ µrminÐ µ thÐ µ rÐ µlationship bÐ µtwÐ µÃ µn variables such as length of stay and the severity of infection.   This will bÐ µ conductÐ µd through thÐ µ usÐ µ of cross tabulation of nominal data bÐ µtwÐ µÃ µn sÐ µlÐ µctÐ µd variablÐ µs in thÐ µ study.   Statistical significancÐ µ is to bÐ µ sÐ µt at an alpha lÐ µvÐ µl of 0.05; ANOVA will bÐ µ usÐ µd to Ð µxaminÐ µ thÐ µ variation among thÐ µ data. Along with it, ordinary lÐ µast-squarÐ µs (OLS) rÐ µgrÐ µssion will bÐ µ usÐ µd to tÐ µst for linÐ µar rÐ µlationships bÐ µtwÐ µÃ µn variables tested.   SuspÐ µctÐ µd HAI, confirmÐ µd HA I, and admission to ICU will bÐ µ codÐ µd as dummy variablÐ µs, with thÐ µ valuÐ µs of 1 that will bÐ µ assignÐ µd for patiÐ µnts with thÐ µ attributÐ µ and 0 for thosÐ µ without it. WhÐ µn prÐ µsÐ µnt, thÐ µsÐ µ dichotomous variablÐ µs act as intÐ µrcÐ µpt shiftÐ µrs but do not changÐ µ thÐ µ slopÐ µ of thÐ µ Ð µstimatÐ µd rÐ µgrÐ µssion linÐ µ. Limitations of the study.   Since the study population is focus only on admissions in two hospitals, this investigation may not fully represent the country’s conditions on healthcare-related infections.   However, such initial surveys on reaction rate of hospital administration to healthcare-associated infections may provide a baseline foundation for larger surveys around the country.       Ethical considerations.   There may be some hospital cases that are deemed private or uninvestigable.   These will not be included in the investigation.   In addition, this study will not consider race or ethnicity differences, because it is not necessary to consider such factors in this type in infectious disease research project.    Feasibility of the scope of this study.   This investigation is feasible to conduct given the resources and time available to the investigator because it is a retrospective study that will only deal with medical records.   Should the investigator feel that analysis of five years’ worth of patient cases from two hospitals is overwhelming, the duration of survey may be shortened to two years instead of five years.   This will decrease the robustness of the data analysis, but it would also serve as a preliminary test to determine whether there are any initial trends that may be observed from the data collected from hospital-case data compiled for a two-year duration. Summary assessment.   This study aims to assess the sensitivity and response rate of healthcare institutions to healthcare-associated infections by performing a retrospective analysis of hospital records from two participating hospitals for a duration of five years.   Such information may be helpful in the evaluation of current guidelines for detection of nosocomial infections and the standard operating procedures as soon as ascertainment is reached. Recommendation.   It is recommended that other hospital administrations collaborate with this investigation in order to generate a more comprehensive analyses of the current status of response rates of healthcare institutions to infections or outbreaks.   Such collaborative effort may benefit the healthcare system in the near future and may also provide new measures on how to deal with factors that influence or cause etiologic agent-specific outbreaks.