Contemporary Design trend Essay Example | Topics and Well Written Essays - 1500 words

Contemporary Design trend - Essay Example This building is part of a 2km development initiative of the Dubai central business district (Galindo, 23). It is always referred to as the Downtown Dubai, and it is found along the Sheikh Zayed Road. The architectural drawings and designs of this building were performed by Adrian Smith, as the lead architect, Bill Baker as the lead structural engineer, Skidmore, and Owings and Merrill. The main contractor of this building was Samsung Company, through its department of construction and technology. Samsung is a South Korean company that has interests in the construction and the electronics industry. The design of Burj Khalifa was meant to be a centerpiece for a variety of uses, which includes residential homes, offices, hospitals, shopping malls. Its design was able to carter for an approximate number of 30,000 homes, and nine international hotel chains. This building has an approximate number of 7.4 acres of parkland lands, and 19 residential towers. It has a very big mall that carte r for the shopping needs of its residents, and 30 acres of manmade lake. This lake is referred to as the Burji Khalifa Lake. Courtesy of this building, it is possible to denote that the honor of having the tallest structure in the globe has returned to the Middle East. ... This in turn will promote tourism and thus the development of the Dubai economy. Currently, the building stands at around 823 meters. However, this is not the original height as per according to the initial designs and architectural drawings. The building was to stand at about 560 meters. However, Skidmore, Owings and Merrill re-designed the building in 2006, at placed it at a height of around 808 meters. Smith, who was the design architect, felt that this height made it impossible for the upper most section of the Burj Khalifa building to elegantly culminate with the rest of the structure. On this basis, he sought permission to increase the structure of this building to 823 meters. However, it is important to denote that these changes in height did not encompass a change in the addition of the buildings floors. On this basis, the intention of Smith was to make the building a little bit slender and thin. It is also important to denote that this building experienced a lot of challenge s, and one of the challenges were delays in its construction and development. For example in 2008, the contractors of this building denoted that its construction was delayed because of the upgraded finishes. On this basis, the building will be completed in the periods of September 2009. According to Emaar properties, part of the owners of the building denoted that the original plan was to install luxurious finishes within the building. This was contained in the 2004 architectural design and drawings of the building. However, in 2008, the designers of the building decided to upgrade these finishes, and that was the reasons for the delay in completion of the project.

The Effects of Merger and Acquisitions on the Recent Worldwide Assignment

The Effects of Merger and Acquisitions on the Recent Worldwide Financial Crisis - Assignment Example Mergers occur when two or more entities come together (in a form of partnership) to form a single trading unit- the entities cease to exist and form a new firm. A good example is the merger of two banks Lloyds TSB and HBOS, following the global financial crisis, to form Lloyds TSB-HBOS (Rosenbaum, 2009). Acquisitions on the other hand, refer to one entity, the bidding company, taking over a target entity, by acquiring, through purchase, of its stakes that could include shares, stocks (majority control of its capital) or assets. For example, Lehman Brothers was declared bankrupt (at a debt of 613 Billion Dollars) due to the recent global financial crisis was bailed out by the American Federal Government (Mihm, 2010). Therefore, the major distinction between mergers and acquisition is the position of the shareholders. In mergers, the shareholders exchange their shares for shares of the new entity, while in Acquisitions; the target company is bought out, with shareholders paid in cash o r debt. Objectives of Mergers and Acquisitions The current wave of M&A began in 2005. A report by the International Monetary Fund indicates that, during this time, the world’s real GDP grew by 4.8%. ... Many business firms opt for M&A due to many reasons. To state briefly, it is argued most firms, go for M&A, to cut on production costs; that, it is cost effective in the long run to merge with or acquire a firm producing a raw material for the larger firm. This saves on market exchange costs while the synergy due to M&A cuts on departmental and running costs, compared to an increased revenue stream from a large market share and a centralized management. Secondly, M&A is seen to achieve competitive advantage, due to new market knowledge and goodwill acquired, territorial advantage of the native firm acquired. A firm will merge or acquire another, and excel in the new market, due to the knowledge and experience of the target entity, as opposed to efforts of the bidding company going to it alone, in the foreign market (Shan & Hamilton, 1991). Another reason for M&A is the financial advantage of tax reliefs. It is argued that a company which reports loses, is more likely to be bought off by another profitable one, as the target company’s reported loss will be utilized in reducing tax liability. However, most governments like the United States have legislations that limit and check against this practice (Mihm, 2010). A statistical study by Emirates Centre for Strategic Studies & Research indicated that, the Arabian banks and Companies, which are smaller in size compared to similar foreign institutions needed to merge so as to remain globally competitive. Also, indicated in the report is because, in the first three quarters of 2008, there were 48 mergers in the Middle East only (Emirates Centre for Strategic Studies and Research, 2009). Shan & Hamilton in their article â€Å"country-specific advantage and

Mother Tongue-Based Multi-Lingual Education in Philippine Schools Essay Example for Free

Mother Tongue-Based Multi-Lingual Education in Philippine Schools Essay Scenario: A Waray-speaking couple from Samar decided to relocate in Cebu for job opportunities. Tagging along with them is their first-grader girl. Deficient of finances, they decided to enroll the kid in a public school. It so happened that the Philippine Department of Education (DepEd) has introduced the Mother Tongue-Based Multi-Lingual Education (MTB-MLE) program. This is a program that uses your mother tongue (language at home) as a medium of instruction inside the classroom. Will the girl be given special attention knowing that she speaks Waray and be separated from the rest of her Cebuano-speaking classmates? If the language at home will be the medium of instruction from Kinder to Grade 3, how will this affect a multi-language group? According to DepEd, 12 major Philippine languages will be introduced beginning this school year 2012-2013 to improve literacy and instruction: Tagalog, Kapampangan, Pangasinense, Iloko, Bikol, Cebuano, Hiligaynon, Waray, Tausug, Maguindanaoan, Maranao, and Chabacano. The objectives of the program include: l. anguage development which establishes a strong education for success in school and for lifelong learning; 2. cognitive development which focuses on Higher Order Thinking Skills competencies in each of the learning areas; and 3. academic development which prepares the learner to acquire mastery of language and culture. 4. socio-cultural awareness which enhances the pride of the learner’s heritage. The program hopes that by using the mother tongue (first language or L1) as a medium of instruction inside the classroom in the early grades, it will hasten the basic communication skills of the students. When students develop fluency in speaking, reading and writing in the first language, the L1 can then be utilized as a bridge or transitional to learning the second (L2) and third (L3) languages (e. g. Filipino and English). The introduction of languages in this method will give students confidence in learning academic concepts. From DepEd Order No. 74, 3c: â€Å"In terms of cognitive development, and its effects in other academic areas, pupils taught to read and write in their first language acquire [educational] competencies more quickly. † Director Yolanda Quijano of DepEd’s Bureau of Elementary Education stressed in a press release, â€Å"[These] studies proved that learners who begin in their first language have more efficient cognitive development and are better prepared for more cognitively demanding subject matter. In other words, a learner tends to be smarter if he starts his education using the mother tongue. † How will DepEd implement the program? Below, I tabulated a progression plan for teaching and using the three languages (mother-tongue, English, Filipino) based on how I understood the program. Basically, the program starts with pupils learning their lessons through the use of their mother-tongue — first orally and then in written form. It finishes with kids being fluent in (or at least learning fast) English and Filipino when they finish grade 6. Will this kind of plan succeed? I believe so, if planned properly. Even UNESCO endorses the use of Mother Tongue Multilingual Education and highlights the important features of the process: 1.  Education begins with what the learners already know, building on the language and culture, knowledge and experience that they bring with them when they start school; 2. Learners gradually gain confidence in using the new (official) language, before it becomes the only language for teaching academic subjects; and 3. Learners achieve grade level competence in each subject because teachers use their home language, along with the official school language, to help them understand the academic concepts. Also, MTB-MLE has long been used by other developing countries. Here are benchmark studies from UNESCO: 1. Modiano’s (1973) study in the Chiapas highlands of Mexico found that indigenous children efficiently transferred literacy skills from the L1 to the L2 and out-performed monolingual Spanish speakers. 2. The Six-Year Yoruba Medium Primary Project (Fafunwa et al. 1975; Akinnaso 1993; see Adegbiya 2003 for other references) demonstrated unequivocally that a full six-year primary education in the mother tongue with the L2 taught as a subject was not only viable but gave better results than all-English schooling. It also suggested that teachers should be allowed to specialize in L2 instruction. 3. The Rivers Readers Project, also in Nigeria, showed how mother tongue materials of reasonable quality could be developed even where resources were scarce and even for previously undeveloped languages with small numbers of speakers (Williamson, 1976). Communities themselves provided competent native speakers and funds for language development, producing over forty publications in fifteen languages. 4.  Large-scale research on Filipino-English bilingual schooling in the Philippines (Gonzalez Sibayan, 1988) found a positive relationship between achievement in the two languages, and found that low student performance overall was not an effect of bilingual education but of other factors, especially the low quality of teacher training (see also Dutcher 1995). If the program works in other developing countries, I believe, it should also work in the Philippines. But this isn’t easy. Getting to the goal takes a lot of groundwork. Look at the figure below. For the program to achieve long-term success, DepEd must go through each and every step. It looks like DepEd has already done the necessary research and already raised awareness about the program through its Region, Division, District, and School Heads, as well as through Local Government Units (LGUs). But what about the rest of the steps? Do we have enough teaching and learning materials ready that are built specifically for a particular language? Next, have we trained enough teachers and staff to efficiently implement the program? Most importantly, do we have the funding and full support from the government to sustain this effort? Now, let me go back to the challenge I mentioned in the first paragraph. How will the program resolve classrooms with multiple home languages spoken by pupils? What is the solution when teachers that are available to teach do not even speak the pupils’ mother-tongue? Should we place books and reading materials written in different home languages in each classroom? While I support mother tongue-based education, I think DepEd must spend some more time to resolve some lingering questions and prepare the materials needed to facilitate effective classroom interaction with this new approach to basic education. Success stories in Papua New Guinea (Klaus 2003), and the Rivers Readers project in Nigeria (Williamson 1985) should become inspirations for the Philippines. More time is also needed for human resource development. To remedy this situation, the case of the bilingual intercultural education in Bolivia must be looked into (refer to ETARE 1993, Albo Anaya 2003). Are you one with the DepEd in the implementation of the Mother Tongue-Based Multi-Lingual Education (MTB-MLE) program this coming school year? Leave some comments below.

Study On Hand Hygiene In Optometry Nursing Essay

Study On Hand Hygiene In Optometry Nursing Essay Hand hygiene is a term used to describe any act of hand cleansing. There are various methods of decontamination each with their own level of efficacy (Lucet et al., 2002; Kampf, Là ¶ffler and Gastmeier, 2009). It is an essential practice among health care workers (HCWs) to prevent the transmission of microorganisms and spread of nosocomial infections in a clinical setting. Despite this knowledge, compliance among HCWs remains low averaging 40% which increases the risk of patients contracting hospital acquired infections (Boyce and Pittet, 2002). The World Health Organisation (2005) recognise hospital acquired infections as being a major cause of death and mortality in hospital bound patients, averaging 5000 deaths a year in England. Improving hand hygiene practice among HCWs is the cornerstone in reducing nosocomial infections such as methicillin-resistant Staphylococcis aureus (MRSA) and Clostridium difficile (C. diff.). However, implementing this change in behaviour is complex and difficult to achieve. An integral factor for improved hand hygiene compliance relies on HCWs educational training and the introduction of motivational programmes designed specifically to influence behaviour. Monitoring and encouragement will be necessary for these procedures to be successful (Boyce, 2008; Saint et al., 2009). 1.2 Hand hygiene in Optometry There is an apparent lack of research into hand hygiene practice in a primary and community care setting; optometric practice included. Currently there are no evidence based studies directly linked with Optometry to support the recommended guidelines set out by The College of Optometrists. Instead these guidelines are based on expert opinion with little conclusive evidence of efficacy in primary care. The importance of effective hand hygiene in the prevention and control of infection is stressed. They have adopted recommendations set by The National Institute for Health and Clinical Excellence (NICE 2003), which are for the use of professionals in primary and community care. A minimum standard of hand hygiene practice would be to decontaminate hands before each and every episode of patient contact and after any procedure or contact that would cause hands to become contaminated. The College of Optometrists (2009) expand upon this stipulating that there is no set regularity in hand was hing episodes and that instead it should be adhered to in circumstances such as contact lens insertion and removal, after going to the toilet, when hands appear visibly unclean, before and after contact with ocular surfaces or the adnexa, before and after administering topical ointments or drops, after any possible microbial contamination, after handling soiled or contaminated materials and before wearing and after removing gloves. Furthermore, an instruction of appropriate hand hygiene technique in clinical practice is suggested: Wet hands under running water. Dispense soap/antiseptic into cupped hand (N.B. bar soap should not be used). Rub hands vigorously and thoroughly for 10-15 seconds without adding more water. Ensure all surfaces of the hands are covered. Rinse hands thoroughly under warm running water. Dry hands with a disposable paper towel. The use of non disposable towels is not good practice. Advisory recommendations for optometrists regarding hand hygiene in the community setting remains at a robust level. To improve standards, further research must be conducted as it is widely regarded that sound clinical practice requires conclusive clinical evidence (Smith, 2009). Optometrists in a primary care setting could benefit from adopting higher standards of hygiene expected in hospital environments. 1.3 Hand hygiene guidelines and technique Due to the clinical and economic implications of health-care associated infection the World Health Organisation (WHO) and the US Centers for Disease Control and Prevention (CDC) have formulated guidelines to promote improved hand hygiene adherence among health care workers (Boyce and Pittet, 2002; Pittet, Allegranzi and Boyce, 2009; Sax et al., 2009). These guidelines include specific indications for hand washing and hand antisepsis episodes. A detailed description of appropriate hand hygiene technique is also included. The recommendations are categorised on the basis of published scientific data, theoretical knowledge, applicability in a clinical setting and economic involvement. The CDC/HICPAC created a system for categorising hand hygiene recommendations. These categories are shown in Table 1 Table 1 showing the CDC/ HICPAC categorisation of guidelines (Boyce and Pittet, 2002) Category Criteria IA Strongly recommended for implementation and strongly supported by well-designed experimental, clinical or epidemiologic studies IB Strongly recommended for implementation and strongly supported by certain experimental, clinical, or epidemiologic studies and a strong theoretical rationale. IC Required for implementation, as mandated by federal or state regulation or standard II Suggested for implementation and supported by suggestive clinical or epidemiological studies or a theoretical rationale or a consensus by a panel of experts. No recommendation Unresolved issue. Practices for which insufficient evidence or no concensus regarding efficicacy exist. Sections 1, 2 and 6 of the CDC/HICPAC recommendations advise specifically on handwashing and hand antisepsis indications, hand-hygiene technique and other aspects of hand hygiene. Each guideline is given a classification category relevant to Table 1. These recommendations are as follows: 1. Indications for handwashing and hand antisepsis A. When hands are visibly dirty or contaminated with proteinaceous material or are visibly soiled with blood or other body fluids, wash hands with either a nonantimicrobial soap and water or an antimicrobial soap and water (IA). B. If hands are not visibly soiled, use an alcohol-based hand rub for routinely decontaminating hands in all other clinical situations described in items 1C-J (IA). Alternatively, wash hands with an antimicrobial soap and water in all clinical situations described in items1C-J (IB). C. Decontaminate hands before having direct contact with patients (IB). D. Decontaminate hands before donning sterile gloves when inserting a central intravascular catheter (IB). E. Decontaminate hands before inserting urinary catheters, peripheral vascular catheters, or other invasive devices that do not require a surgical procedure (IB). F. Decontaminate hands after contact with a patients intact skin (e.g., when taking a pulse or blood pressure, and lifting a patient) (IB). G. Decontaminate hands after contact with body fluids or excretions, mucous membranes, nonintact skin, and wound dressings if hands are not visibly soiled (IA). H. Decontaminate hands if moving from a contaminated-body site to a clean-body site during patient care (II. I. Decontaminate hands after contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient (II). J. Decontaminate hands after removing gloves (IB). K. Before eating and after using a restroom, wash hands with a non-antimicrobial soap and water or with an antimicrobial soap and water (IB). L. Antimicrobial-impregnated wipes (i.e., towelettes) may be considered as an alternative to washing hands with non-antimicrobial soap and water. Because they are not as effective as alcohol-based hand rubs or washing hands with an antimicrobial soap and water for reducing bacterial counts on the hands of HCWs, they are not a substitute for using an alcohol-based hand rub or antimicrobial soap (IB). M. Wash hands with non-antimicrobial soap and water or with antimicrobial soap and water if exposure to Bacillus anthracis is suspected or proven. The physical action of washing and rinsing hands under such circumstances is recommended because alcohols, chlorhexidine, iodophors, and other antiseptic agents have poor activity against spores (II). N. No recommendation can be made regarding the routine use of nonalcohol-based hand rubs for hand hygiene in health-care settings.(Unresolved issue). 2. Hand-hygiene technique A. When decontaminating hands with an alcohol-based hand rub, apply product to palm of one hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry (IB). Follow the manufacturers recommendations regarding the volume of product to use. B. When washing hands with soap and water, wet hands first with water, apply an amount of product recommended by the manufacturer to hands, and rub hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers. Rinse hands with water and dry thoroughly with a disposable towel. Use towel to turn off the faucet (IB). Avoid using hot water, because repeated exposure to hot water may increase the risk of dermatitis (IB). C. Liquid, bar, leaflet or powdered forms of plain soap are acceptable when washing hands with a nonantimicrobial soap and water. When bar soap is used, soap racks that facilitate drainage and small bars of soap should be used (II). D. Multiple-use cloth towels of the hanging or roll type are not recommended for use in health-care settings (II). 6. Other Aspects of Hand Hygiene A. Do not wear artificial fingernails or extenders when having direct contact with patients at high risk (e.g., those in intensive-care units or operating rooms) (IA). B. Keep natural nails tips less than 1/4-inch long (II). C. Wear gloves when contact with blood or other potentially infectious materials, mucous membranes, and nonintact skin could occur (IC). D. Remove gloves after caring for a patient. Do not wear the same pair of gloves for the care of more than one patient, and do not was gloves between uses with different patients (IB). E. Change gloves during patient care if moving from a contaminated body site to a clean body site (II). F. No recommendation can be made regarding wearing rings in health-care settings. Unresolved issue. These guidelines were developed for the use of health care professionals in a clinical setting and were not specifically designed with optometric practice in mind. However, many of these recommendations remain highly relevant when adopted to an optometric environment and are strongly supported by The College of Optometrists. The World Health Organisation have extended the recommendations on hand-hygiene technique and produced a visual publication poster detailing the hand hygiene technique for use with alcohol-based formulations and the handwashing technique for use with soap and water. These are shown in Figures 1 and 2 respectively. Figure 1 showing recommended hand hygiene technique with an alcohol-based formulation (World Health Organisation 2006) ***online access reference 2 Figure 2 showing recommended handwashing technique using soap and water (World Health Organisation 2006) **online access reference 1.4 Hand hygiene practices among health care workers Hand hygiene practice among health care workers is poor with many observational studies reporting low compliance rates in a number of indicative areas. Hence, understanding current trends among health care workers is critical in planning and implementing the necessary modification in behaviour (Allegranzi and Pittet, 2009). Hand hygiene adherence can be investigated over a range of parameters such as duration spent cleansing or disinfecting, frequency of hand washing episodes over a given time and observing the variations in performance with regard to clinical setting, physician status and gender (Boyce and Pittet, 2002). Employing the appropriate hand hygiene technique is essential. Consider the situation in which hand hygiene episodes per hour compliance is high. If insufficient hand hygiene technique is being performed e.g. inadequate coverage of hand surfaces and a short cleansing time, then the overall standard of compliance will decrease. This confirms that hand hygiene practic es among health care practitioners involves both multimodal strategies and multidisciplinary approaches to improve adherence (Pittet, 2001; Dierssen-Sotos et al., 2009). Multiple factors are associated with the suboptimal hand hygiene performance among health care practitioners and they vary in relation to resources available and the setting involved. For example, the lack of appropriate infrastructure, equipment and materials will hinder good hand hygiene practice, the cultural background and perhaps even religious beliefs can also affect performance (Ahmed et al., 2006; Allegranzi et al., 2009). The most commonly reported causes of poor hand hygiene compliance are: (i) physician or nursing status, (ii) clinical care setting e.g. ICU, AE, surgery units (iii) understaffing and overcrowding (iv) male (rather than female) gender and (v) inaccessible hand hygiene supplies (Pittet, 2000). (Erasmus et al., 2010) conducted a systematic literature review of studies based on observed or self-reported hand hygiene compliance rates in hospital practice, mainly intensive care units. The median compliance rate was low at 40%. Physician status was found to be a factor affecting adherence, lower among doctors (32%) than nurses (48%). In general, a lower compliance rate was found in physicians reporting a high level of activity in clinical practice. Compliance rates improved in situations whereby physicians or nurses associated the task as being visibly dirty or unhygienic, alcohol-based hand rubs or gels were available, feedback performance was introduced and when materials and facilities were easily accessible. Hand hygiene compliance among optometric practitioners is an area yet to be investigated. Opticians are encouraged to follow the recommended guidelines set by organisational bodies such as the World Health Organisation and The College of Optometrists. 1.5 Hand hygiene behaviour Hand hygiene behaviour can be investigated in relation to factors such as social cognitive determinants. A number of situations trigger a hand cleansing episode to occur and therefore affect compliance e.g. knowledge and perception of the risks associated with cross contamination, social expectations for adequate hygiene, self evaluation of the perceived advantages against the existing hindrances and the initial motivation to perform the hand hygiene action (Pittet, 2004; Whitby et al., 2007). This cognitive behavioural response falls into two categories (Whitby, McLaws and Ross, 2006). Inherent hand hygiene behaviour arises in circumstances when individuals deem hands to be visibly soiled, sticky or gritty. This type of intrinsic hand washing behaviour is initiated when a task is recognised as being unhygienic or has a potential risk factor involved to the individual concerned. The other component of hand hygiene behaviour is denoted as elective hand hygiene behaviour. This type of behaviour is represented in situations such as tactile social contact e.g. shaking hands to greet someone. This will not induce a response for many individuals to wash their hands and instead it becomes an elective response. Similarly, health care workers may partake in non-invasive impersonal contact with patients when taking pulses or touching inanimate objects in their surroundings. This type of social contact is not perceived to be a danger and does not drive a hand cleansing episode to take place. Instead an elective response has to be made. However, hand cleansing or disinfection after such contact in a hospital setting is crucial, because failure to do so may lead to microbial hand contamination, with the increased risk of cross-infection. 1.6 Relation of hand hygiene with the acquisition of nosocomial infections Hand hygiene reduces the transmission of microbial contamination and the spread of health-care associated pathogens from one patient to another via the hands of health care workers (Pessoa-Silva et al., 2007; Pittet et al., 2007; Allegranzi et al., 2010). Hand hygiene is the cornerstone in securing adequate patient safety. Failure to comply with this standard prolongs duration of hospitalisation, causes unnecessary suffering, increases costs as well as mortality rates (World Health Organisation, 2009). Thus, to raise awareness and combat the problem of health care associated infections, (Sax et al., 2007) produced an evidence-based, user-centred design to promote improved hand hygiene adherence termed My Five Moments for Hand Hygiene, shown in Fig.3. This highlights the five most common routes of transmission which HCWs are exposed to in daily clinical practice. The model is based on the World Health Organisations hand hygiene guidelines. It recommends hand washing episodes to occur before touching a patient, before clean/aseptic procedures, after a body fluid exposure risk, after patient contact and after touching patient surroundings. Although designed specifically for HCWs in a clinical setting, this model could be adopted for use in community practice to include an optometric environment. Optometrists should be aware of the risks of cross contamination and demonstrate an understanding of appropriate infection control methods (Lakkis et al., 2007). Figure 3- My 5 moments for hand hygiene model 1.7 Infection control in optometry Modern optometric practitioners are offering an expanding area of services and care with regards to the treatment and management of eye diseases and eye injuries. Therefore, more specialised procedures and techniques are being carried out in the primary care setting which have the potential to spread infection and disease via blood borne and air borne transmission. Hence, practitioners have an obligation to carry out adequate infection control measures to ensure a high standard of patient safety and protection (Tyhurst and Hettler, 2009). The majority of optometric procedures are considered low risk for the spread of disease and infection. However, in a few occasions the risk increases e.g. when instruments come in direct contact with an infected patient and when blood, cuts or abrasions are exposed (AOA Primary Care and Ocular Disease Committee, (1993). Other procedures which have the potential for infection include the collection of eye culture samples, foreign body removal, contac t lens fitting, lacrimal lavage and the treatment of patients exhibiting ocular trauma. 1.7.1 Hand hygiene and protective barriers to infection A basic measure of infection control begins with effective hand hygiene. Many eye diseases and infections are spread manually, and it is the responsibility of the optometrist to minimise this transmission to patients by adhering to appropriate hand washing techniques before and after examinations and procedures. Appropriate hand hygiene technique refers to the standard described in section 1.2. In addition, the use of protective barriers such as disposable medical gloves, gowns, masks and protective eyewear has been suggested in specialised circumstances as a precautionary control to minimise the transmission of microorganisms (Lakkis et al., 2007). 1.7.2 HIV, Hepatitis B and Hepatitis C Diseases can be spread by direct contact between individuals, via blood or other bodily fluids and as a result of airborne transmission. Considerable awareness has been directed towards the transmission of the human immunodeficiency virus (HIV) and the Hepatitis B and C viruses, (HBV) and (HBC). HIV has been isolated from tears, contact lenses and ocular tissues, but there is no evidence to support transmission of the disease through these medians (Cantrill et al., 1988; Tillman, Klotz and Maino, 1992). Studies have reported the detection of the hepatitis B surface antigen in tears and aqueous humour, suggesting that optometrists must take all necessary precautions in clinical practice (Temel, Seber and Gunay, 1990; Tsai et al., 2009). Although these are areas of concern, the risk of transmission in an optometric setting is remote. 1.7.3 Influenza A (H1N1) virus In 2009, the emergence of the influenza A (H1N1) virus in humans has led to the first global pandemic in 41 years. It is more commonly referred to as swine flu and is made up of porcine, avian and human genes. Although a potentially fatal disease, the mortality rate is expected to be less than previously known influenza pandemics and is more likely to cause harm to young people and individuals with compromised health (CDC 2009). In order to contain the spread of this infection, health care personnel were advised to heighten infection control measures. (Kiely et al., 2009) discussed specific infection control guidelines applicable in an optometric environment. A basic measure of infection control begins with frequent handwashing. Due to the close proximity to patients throughout the eye examination, in a more extreme guideline, it was recommended that optometrists should wear personal protective equipment such as surgical masks, goggles, gowns and gloves when treating a suspected infe ctious individual. It was indicated that influenza A (H1N1) should be treated like any other form of influenza. 1.7.4 Creutzfeldt Jacob Disease The theoretical transmission of prions, implicated in Creutzfeldt Jacob Disease (CJD) and variant Creutzfeldt Jacob Disease (vCJD) is an area of concern in optometric practice (Lakkis et al., 2007). These diseases are degenerative neurological conditions that are incurable and invariably fatal. Reusing ophthalmic devices such as RGP trial lenses and contact tonometer heads has been identified as a possible risk factor in spreading this disease from one patient to another but has been described as highly improbable (Armstrong, 2006). 1.7.5 Summary of infection control in optometric practice Due to the potential risk factors in an optometric environment, practitioners must abide by the recommended guidelines in order to control the spread of infection and disease. Lack of motivation and insufficient knowledge of expected protocol will lead to non-compliance among optometrists. Hence eye care personnel are advised to develop and implement a suitable infection control policy within practice (Seewoodhary and Stevens, 1999; Stevens, 2008). 2.0 Aim The purpose of this survey was to examine the typical hand hygiene practice among optometrists in a primary care setting. It investigates the level of compliance among practitioners to include the type of hand products used, hand hygiene technique and the hand hygiene facilities available in various optometric environments. 3. 0 Method 3.1 Survey design In order to determine the role of hand hygiene in optometric practice, a questionnaire was designed to gain an insight into hand hygiene product use, hand hygiene technique, facilities and general compliance among practitioners. The questionnaire was split up into three sections, All About You, Facilities and Hand Hygiene Technique. It consisted of 28 questions, the majority being mandatory to answer. The format of questions was either on a yes-no basis, multiple choice, tick box and rating of answers using a scale based response. Questions were designed on the basis of international guidelines regarding hand hygiene. A detailed literature review was conducted to ascertain appropriate hand hygiene technique, hand hygiene facilities and reported barriers to hand washing. The questions from the survey are shown in the Appendix. 3.2 Survey circulation The questionnaire was launched using Bristol Online Surveys. This is a site used by over 200 UK organisations in order to develop, distribute and analyse web-based surveys. It was sent to volunteers via e-mail using a webpage link. 3.3 Volunteers A total of 124 individuals responded to the survey which included optometrists working in university, hospital, multiple, franchise and independent optometric practice around the UK. If an individual worked in a combination of practices, they were instructed to answer questions based on the place they worked most of the time. All participants were asked to answer honestly as the survey would remain anonymous. 3.3 Survey analysis Results were recorded online within the Bristol Online Surveys (BOS) site. Key features of the BOS results section included the option of statistical investigation, cross tabulation of answers, looking at individual responses and the export of data to a spreadsheet document on Microsoft Excel. The data was analysed and arranged into a variety of tables, graphs and pie charts for easier interpretation of results. 4.0 Results 4.1 All about you A total of 124 optometric practitioners took part in the study. An almost even distribution of gender was found totalling 61 males and 63 females, with an average age  ± SD of 41.4  ± 15.5. The majority of individuals who responded to the questionnaire were Cardiff University graduates totalling 26%, followed by City University, Aston University , The University of Bradford , The University of Manchester and Glasgow Caledonian. The remaining sector of individuals were grouped in the category other and included graduates from Auckland University, Bradford College, Dublin Institute of Technology, Northampton Polytechnic, Rand Afrikaans University, Southern College of Optometry, University of Durban and the University of Ulster. This is shown in Figure 4. Figure 4. University attended by each participant The number of years qualified as an optometrist was investigated and is shown in Fig. 5. Most respondents have been qualified for 21-30 years, followed by participants who have been practicing for less than 5 years. A small minority of individuals have been qualified for more than 40 years. Figure 5. Years qualified as an optometrist Over half of respondents work in independent practice, with a smaller proportion working in a variety of practices such as multiples, hospital based settings, a combination of practices and franchises. The minority fall into the category named other e.g. domiciliary practitioners, retired optometrists and University based optometrists who no longer practice. This is shown in Fig. 6. Figure 6. Type of practice participants work in Figure 7. Gender related response regarding hand washing or disinfection between each patient episode Fig. 7 illustrates that more females than males wash or disinfect hands between each patient episode. 71.1% of the male and female optometrists who wash or disinfect hands between each patient episode, do so in front of the client. Table 2. Reasons for not washing or disinfecting hands between each patient episode Reasons Male response as a % Female response as a % Busy clinic 24 57 Forget 20 43 Unnecessary 48 76 Lack of facilities 4 5 Sore skin 8 19 Other 12 14 Practitioners who do not wash or disinfect hands between each patient episode (25 males and 21 females) were asked their reasons for not doing so. More than one answer could be selected and is shown in table 2. The majority of these individuals deemed hand washing or disinfection an unnecessary practise. Twice as many females compared to males report that the busy clinic prevents such behaviour occurring, they forget or blame sore skin as reasons for not washing hand between each patient episode. Refer to Table 3 for Other responses. Table 3. Other reasons for not washing or disinfecting between each patient episode Other responses from optometric practitioners: Never been part of routine Was never stressed during University or Pre-reg Only recently became an issue Wash hands for each contact lens patient, but not all refraction patients Hand wash during the appointment and not between Figure 8. Practitioner response as a percentage regarding patient greeting with a handshake Fig. 8 illustrates that just under half of respondents do not greet patients with a handshake. The remaining individuals answered yes or sometimes to this form of patient contact. 39.5% of male optometrists and 44% of female optometrists who greet patients with a handshake, wash or disinfect their hands after this contact. Figure 9. Satisfaction of hand hygiene practises The vast majority of individuals have a high level of satisfaction with the hand hygiene practices currently employed at the practice where they work. Collectively, 8.9% of individuals are fairly unsatisfied or unsatisfied with current hand hygiene practises. Results are illustrated in Fig. 9. 4.2 Practice facilities and structure The questionnaire investigated the number of staff members in each individual practice to include optometrists, locum optometrists, dispensing opticians, optical assistants and receptionists. These results were calculated as a median function to include the range and are shown in Table 4. The frequency of patient appointments in an average working day were investigated and appointment duration. Practice facilities were reported upon such as number of consulting rooms and number of bathrooms. Results were averaged or calculated as a median function to include the range and are illustrated in Table 5. Table 4. Number of staff members in practice Position held (Median, range) Optometrist (1, 1-20) Locum Optometrist (0, 0-5) Dispensing Optician (1, 0-6) Optical assistant (1, 0-35) Receptionist (2, 0-8) Table 5. General practice statistics and available facilities Average ±SD (Median, range) Number of patients seen per day per optometrist 13.8 ±3.74 (14, 10-25) Appointment length (in minutes) 30.7 ±6.21 (25, 15-60) Number of consulting rooms (2, 1-12) Number of bathrooms (1,1-5) In regard to practice facilities, greater than half of all participants are assigned to their own personal consulting room and report that the hand washing facility is separate from the toilet Three quarters of individuals said that there is at least one wash basin in each consulting room. Fig. 10 illustrates these findings. A large proportion of individuals reported that the practice they worked in did not display a poster detailing official recommendations on the hand washing and hand rubbing technique. Just under half of participants were aware of the poster being displayed in practice. The minority were unsure and this is shown in Fig. 11. Figure 10. Practice facilities Figure 11. Guidance poster detailing the advised handwashing and hand rubbing technique 3.3 Hand hygiene products Figure 12: The gender related practitioner response as a function of hand hygiene product use. A variety of hand hygiene products were listed. Participants rated how often they used each product in relation to the scale provided (always, most of the time, occasionally, very rarely or never). Results were plotted as a function of gender. Fig. 12(a) illustrates that the majority of male

Hamlet theme of appearance vs. reality Essay -- essays research papers

Shakespeare examines the theme of appearance and reality in his book-Hamlet. The dilemma of what is "real" is established at the very beginning of the play. Hamlet doesn’t know what to believe and devises a plan to find out. The old king Hamlet appears to be bitten by a snake, but in reality he was poisoned, the ghost appears as an apparition, but it’s actually real, and the play-with-in-a-play strongly depicts the theme of appearance vs. reality. The dead King appears to have been bitten by a snake. In reality, he has been poisoned. Everyone believes that the king died from snakebite, but once Hamlet knows the truth he is unsettled by the revelation. When Hamlet's dead father directs his son to, â€Å"Avenge him of his foul and most unnatural murder† (1.5. 25), Hamlet's response shows determination to act and a curiosity to know all the facts surrounding the murder: (1.5. 29-31) "Haste me to know't, that I, with wings as swift, as meditation or the thoughts of love may sweep to my revenge.† Hamlet's choice of image is significant here. A person who wants to take revenge rarely has "thoughts of love" but only concentrates upon thoughts of revenge, but Hamlet's thirst for revenge is immediate and deep. Shakespeare also develops the theme of appearance vs. reality when Hamlet resents his mother's insinuation that he is putting on a show of being grief-stricken. Strangely, he is the only one in th e family who is truly mourning ...

Economy and Society in Europe During 1848 Essay -- European History Ec

Economy and Society in Europe During 1848 The revolutionary year of 1848 was an extraordinary period in which popular disturbances brought down the government of many countries. The revolts were very widespread, seriously affecting about fifty countries in Europe.1 It ranged from an enormous area, ranging from the Atlantic to the Ukraine, from the Baltic to the Mediterranean. Factors that contributed to these revolts included: the potato crop had been destroyed, food riots broke out, and financial crises sprung about due to the high rate of unemployment.2 The development of major cities, such as Prague, Berlin, Liepzig, etc. contributed to the creation of the revolution. Also, anger arose over political issues because the middle class was taking control, and the peasants were starving due to this. Another point that caused rage was tax collection. People threatened to beat tax collectors and burn down revenue offices. Europe, at this time, was fighting a battle that would last many years and change many different aspects of European countries. For the most part, the revolts were due to the bourgeoisie (upper class citizens) and how they controlled everything, including factories, machines, and people. The proletariat (working class that consisted of the factory laborers) were dominated by the bourgeoisie and began to look for a social change.3 The different changes in Europe in 1848 resulted in economic revolts, the Industrial Revolution, and how Karl Marx had an impact on society. The economic revolts took place right before 1848. This economic crisis resulted from the agricultural failures, which set off a serious industrial and commercial crisis, as high food prices would not let people buy anything else. Due to thes... ...ompany Inc, 1970), 198-206. 6. Breunig, 226. 7. Jones, 24. 8. Hugh McLeod, Secularisation in Western Europe, 1848-1914 (London: MacMillian Press Ltd., 2000), 31. 9. Jones, 15. 10. Priscilla Robertson, Revolutions of 1848: A Social History (New Jersey: Princeton University Press, 1952), 6. Bibliography Breunig, Charles. The Age of Revolution and Reaction, 1789-1850. New York: Norton and Company Inc., 1970. Goldstein, Robert Justin. "The European Revolutoin of 1848 and 1989." 24 February 1999. http://cscwww.ohiou.edu/~Chastain/dh/eurorev.htm (22 October 2001). Jones, Peter. The 1848 Revolutions. New York: Longman Inc., 1991. McLeod, Hugh. Secularisation In Western Europe, 1848-1914. London: MacMillian Press Ltd., 2000. Robertson, Priscilla. Revolutions of 1848: A Social History. New Jersey: Princeton University Press, 1952.

Eu Enlargement

EU Enlargement Background The European Union (EU) is an economic and political union of 27 member states which are located primarily in Europe. The EU traces its origins from the European Coal and Steel Community (ECSC) and the European Economic Community (EEC), formed by six countries in 1958. In 1967 they merged into European Community. The Maastricht Treaty established the EU under its current name in 1993. The EU has grown its size by the accession of new member states. For example, on May 1st 2004, 10 new members joined the EU and EU-15 became EU-25. In 2007 it became EU-27 when Romania and Bulgaria joined.It seems that the enlargement will continue and many people begin to consider whether the EU should admit more members. Countries should obey the accession rules if they want to join the EU. According to the ‘Copenhagen Criteria’, a member state must be a stable democracy, respect human rights and have the rules of law and the protection of minority. In terms of t he economic aspect, it should have a functioning market economy. In addition, the country needs to adopt the common rules, standards and policies that make up the body of EU law. Body Commission: regarded enlargement as the â€Å"Union’s most successful foreign policy instrument. Following? the? enlargements? of? 2004? and? 2007,? the? EU? is? now? the? largest? integrated? economic? area? in? the? world,? accounting? for? more? than? 30%? of? world? GDP? and? more? than? 17%? of? world? trade. New members can benefit more from enlargement than existing member states (Neuder, 2003) * Benefit of new members * Strong economic growth: * Benefit from the EU budget and access? to? EU? funds? * The 10 new members can expect to receive up to 4% per annum of their GDP from the EU’s structural and cohesion funds for projects aimed at improving their economic tructures. * e. g.? net? inflow? of? structural? funds? to? help? finance? infrastructure? projects and? environmental? projects. * Increase in GDP from 3. 7% to 5% on average in the first two years since accession. * In the long time, the acceding states could enjoy a rate of growth some 2% higher than that of the existing states (Neueder, 2003). * East slowly catch up with the west. * Increase in trade * Most? of? the? new? EU? countries? were? already? closely? linked? in? trade? and? investment? terms? with? their? western? European? neighbors.? Joining? the? single? market? as? deepened? this in? 2007,? almost? 80%? of? exports? of? the? new? EU? states? went to? the? rest? of? the? EU. * Increase in Foreign Direct Investment * For the new member states, FDI is a key factor in the process of economic modernization. New members can receive funds from foreign countries and use the money to boost economy. * Enlargementlarger market and openness to trade. * Baldwin, Francois and Portes (1997) argue that joining the EU will make the region substantially less risky from the point of view of domestic a nd foreign investors. * 191 billion euro by 2004 However, they seem to over rely on FDI. FDI accounts for too large part (e. g. Hungary: 70%). Once there is something wrong with some investors and do not invest them, for instance the financial crisis, they will suffer tremendously. * The? 2009? crisis? may? persuade? Central and East European? Countries? to? reduce? their? dependence? on? foreign? direct? investments and? build? an? economic? growth? model? on? different? grounds. * Welfare * Farmers began to receive agricultural subsidies * Structural funds directed towards poorer regions (investment in infrastructure) * Benefit of existing members Enlargementmore people more consumersobtain more than 450 million consumers from Single European Marketcompanies could expand their businesses and benefit from experience and location economies scale * Larger labor market fill labor shortage in existing states with low-cost and highly-skilled workforce, for example, UK and Ireland Howeve r, these skilled workers may replace the indigenous employeesincrease the unemployment * High growthincrease the purchasing powerstimulate the import demand of acceding states and export of member states * Imports and exports between new and existing members have increased considerablethe EU15 share of total EU12 trade increased from 56% in 1993 to 62% in 2005 * Because of theseGDP increase * Costs of enlargement * Drawback for new member state * Difficulties in complying with EU law restrict development of business especially Small and Medium-size Entrepreneurs * Push many producers out of business due to their incompliance with EU environment policies * Tax harmonization e. g.Estonia: was forced to introduce new tariff against imports from outside of the EU, adopt a number of non-tariff barrierssuch protectionisms increase the food price and lowered Estonians’ standard of living * High unemployment still exists in many new member states (8% EU-15; 14% EU-10, 2005) * Some hi gh skilled workers or people with higher degree will move from east to the west, this brain drain damages the host countries. * Drawback for EU-15 * Volume of enlargement costs will amount to about 15% of the EU budget (Germany: 2. 3bn from its federal budget) * Migration: Concern about too much migration from east to west social problems and pressure on social/medical/educational services. (e. g. ome countries even carried out policies to limit the volume of migration) * Actually: the percentage of EU-12 nationals and the resident population of each EU-15 Member state were relatively stable before and after enlargement. * Too many countries will decrease the efficiency of EU. * Conclusion Enlargement of EU has been the most successful policy. Although it has some negative effects on both existing and new member states, its positive influences far outweigh its negative aspects. Process EFTA (European Free Trade Association) afraid that the Single Market Program would increase compet itioncreate EEA (European Economic Area)1995, Austria, Sweden, Finland opted for European Accession, joined (growth+, unemployment-, inflation- Finland(1991-2000, 2006,%): growth 2. 0-5. 0; unemployment 12. 5-7. 7; inflation 2. 1-1. 3 †¦