English poetry Abandonment of Autos Essay Example

English poetry Abandonment of Autos Paper council ç â€ Ã¤ ºâ€¹Ã¤ ¼Å¡ concerned æÅ"‰å… ³Ã§Å¡â€žÃ¯ ¼Å'æÅ'‚å ¿ µÃ§Å¡â€žÃ¯ ¼Å'å… ³Ã¥ ¿Æ'çš„ abandoned è ¢ «Ã¦Å â€ºÃ¥ ¼Æ'çš„ appeal æ  ³Ã¦ ±â€š immensely æž Ã¥ ¤ §Ã¥Å" ° manoeuvring è °â€¹Ã§â€¢ ¥ dexterously æ• Ã¦  ·Ã§Å¡â€žÃ¯ ¼Å'ç  µÃ¥ · §Ã§Å¡â€ž tenderness n.柔è ½ ¯,ä º ²Ã¥Ë†â€¡,易è § ¦Ã§â€"›,æ• Ã¦â€žÅ¸ customary ä ¹  Ã¦Æ' ¯Ã§Å¡â€žÃ¯ ¼Å'æÆ' ¯Ã¥ ¸ ¸Ã§Å¡â€ž appraisal è ¯â€žÃ¤ ¼ ° merchant 商ä º º seemingly è ¡ ¨Ã©  ¢Ã¤ ¸Å Ã¥Å" ° gesture 手åŠ ¿ circumstances æÆ'…å ½ ¢ gallantry 勇æ• ¢ inventory Ã¥ ­ËœÃ¨ ´ §Ã¦ ¸â€¦Ã¥ â€¢ satisfaction æ » ¡Ã¦â€ž  sharp 锋åˆ ©Ã§Å¡â€ž bonnet æ ± ½Ã¨ ½ ¦Ã©Ëœâ‚¬Ã§â€ºâ€" frown çš ±Ã§Å"‰ discovering Ã¥ â€˜Ã§Å½ ° radiator æšâ€"æ °â€Ã§â€°â€¡ consequence ç »â€œÃ¦Å¾Å" urban éÆ' ½Ã¥ ¸â€šÃ§Å¡â€ž steed é ª Ã© © ¬ affectionate a.ä º ²Ã§Ë† ±Ã§Å¡â€žÃ¯ ¼Å'æÅ'šçˆ ±Ã§Å¡â€ž mudguard æÅ' ¡Ã¦ ³ ¥Ã¦  ¿ crowds æˆ Ã§ ¾ ¤Ã§Å¡â€ž licence plate æ ± ½Ã¨ ½ ¦Ã§â€°Å'ç… §

Article Case Law Essays

Article Case Law Essays Article Case Law Essay Article Case Law Essay University of Phoenix| Article/Case Law Search Paper| Tuberculosis-Critical Regulatory Issue| | | July 19, 2010 Article/Case Law Search Paper A critical regulatory issue in health care is a really broad subject and will always be discussed and debated on. According to The Centers for Disease Control and Prevention, â€Å"TB is an airborne, communicable disease caused by infection with the bacterium Mycobacterium tuberculosis. Infection occurs typically when a person inhales microscopic droplet nuclei containing viable bacteria, usually acquired as a result of droplet nuclei spread through coughing or sneezing by persons who have infectious TB. (Brennan, 2007) Despite the inception of modern treatments and public health interventions, tuberculosis (TB) remains a significant public health threat in the U. S. and abroad in the twenty-first century. The challenge of controlling TB in its traditional and new multidrug-resistant forms requires public health agencies at the federal, tribal , state, and local levels to develop and apply new tools. Among these tools is the use of law in support of efforts to effectively control cases of TB. In May of 2005, the World Health Organization initiated for Vaccine Research. This research was arranged to develop into a meeting of regulators, investigators, and clinicians from different countries that are in the process of developing or countries that have already been developed. Their main cause was to initiate tuberculosis vaccine regulation and research. The discussion that was made in this assembly was of the regulatory challenges for testing and introducing investigative TB vaccines into country where the disease is widespread. A particular focus of this meeting was a discussion among representatives of regulatory authorities from the Developing Countries Vaccine Regulators Network (DCVRN) with those of the United Kingdom and the United States about the important challenges that each regulatory agency will need to address if effective new TB vaccines are to be registered in their countries. The DCVRN is a new WHO initiative establishing a network of vaccine regulators from nine countries: Brazil, China, Cuba, the Republic of South Korea, India, Indonesia, the Russian Federation, South Africa, and Thailand. It provides a forum for discussion, advancement of knowledge, and exposure to policies and procedures pertaining to evaluation of clinical trial proposals and clinical trial data. † (Brennan, 2007) As new and improved vaccines are created, it is a huge benefit for those countries that are in need of the vaccine and the outbreaks that they experience very frequently. Regulatory authorities in developed countries may come into a problem with lack of adequate experience with the disease burden of the target and other associated diseases. Also, these regulatory agencies may be unfamiliar with the medical treatment norms in countries with a high number of people who have TB. Given that there are these difficulties, there would be a huge beneficial to the TB community if there was partnership between regulatory authorities worldwide. There are many things that need to be addressed during the development of effective new TB vaccines. The things that need to be addressed are the preclinical and clinical portion of development. Clinical practices that address the challenges need to be established for the regulatory agencies involved in new candidate TB vaccine development. Such practices should be part of building the regulatory capacity in these countries while addressing the different risk/benefit perspectives that are appropriate for disease-endemic countries. † (Brennan, 2007) Reviewing the results conducted to determine where the need of TB vaccines is considered necessary most in each region is crucial. The determination will help Scientists and Doctors know which Country they must resort to in testing for that region. With all the screening of individuals across the world and new tests being conducted every day, TB has become according to The Centers for Disease Control and Prevention (CDC) – through its Division of Tuberculosis Elimination (DTBE) and its Public Health Law Program (PHLP) – has identified TB to be a major global health problem. Legal preparedness has been established to help control the many public health threats, including TB. Benjamin, Moulton 2008) Despite significant efforts in many jurisdictions to enhance legal preparedness for TB control, legal issues continue to arise. These issues may stem from the application of existing TB and other communicable disease control laws that are dated, incomplete, or vague. (Gostin, Burris, Lazzarini 1999) In other instances, reliance on general communicable disease laws creates potential for litigation because they do not always provide sufficient guidance on how to balance individual rights with public health measures designed to control TB. Even with the numbers growing with this horrible disease, our Scientists are very determined to make sure all tests and individuals are protected by law. It is very important that one may continue to track, update, and inform the Scientists of the laws to protect the testing being conducted and to ensure that everyone is receiving the appropriate care. One may believe that there may be a cure for the millions of people across the world affected with this disease, and we must let the opportunities of the testing continue in order to see the results. References Benjamin GC and Moulton AD. Public Health Legal Preparedness: A Framework for Action. Journal of Law, Medicine amp; Ethics 2008; 36(S1): 13-17. Brennan, Michael J. August 2007. Development of New Tuberculosis Vaccines: A Global Perspective on Regulatory Issues. Retrieved from PLOS Medicine. ncbi. nlm. nih. gov/pmc/articles/PMC1939860/#box2 Gostin LO, Burris S, Lazzarini Z. The Law and the Public’s Health: a study of infectious disease law in the United States. Colum. L. Rev. 1999;99:59-128.

CREATING OWN CULTURE Term Paper Example | Topics and Well Written Essays - 1500 words

CREATING OWN CULTURE - Term Paper Example The lifestyle of each individual in a certain community is usually a manifestation of their culture. Culture can manifest itself in art, language, literature, religion, moral values and other community activities. Due to different manifestation, culture has caused the diversity among people inhabiting parts of the world. In most cases, culture is shared and is continually passed on to different generations. One of the most significant cultures in the world is of the pastoral communities, specifically the Gasaile People. Their settlement is in the arid and semi-arid areas. Their culture is unique simply because of their pastoral way of life. For a long period, they have raised cattle and other domestic livestock like goats and sheep in the areas stated above. Due to this, they have been able to live side to side with many wild animals hence learning their ways of life. Law Among the Gasaile people, elders form the main ruling body whereby they decide on most matters that affect the co mmunity. The Gasaile elders have laws used for ruling of the community and in most cases settle disputes accordingly. Most of these laws are oral but have a great impact on the social lives of each Gasaile individual. Unlike in most communities where execution is a major part of the law, execution in Gasaile is unknown. Payment for breaking the law is mostly done with cattle simply because of their availability. The Gasaile culture also has a way of settling disputes that is recognized as the Amitu. It involves making peace by embarking on substantial apology. Religion Although the Gasaile people have complete respect for their elders, they have complete recognition of a supreme being called Engai. They have believed that their God is made up of a dual nature that is of a black God and red God; where The Black nature is compassionate and the red nature is revengeful. The Gasaile people have set aside a holy mountain where only a few people can speak to their God. These few people us ually have special gifts like healing, prophesying, divine calling and other unusual deeds. These deeds are communication of a chosen person by ancestors to mediate between the people and their God. However, it is important to note that the culture of the Gasaile people does not recognize these religious people in the political set. It is also essential to understand that despite technological add ups into the world setting, the Gasaile people have remained Monotheistic (Halm 49). Among the Gasaile people, the chosen person was given the title Laibon and was both the ritual and spiritual leaders of the society. He had the power to officiate and direct ceremonies, offer sacrifices, and provide advice to political elders. He was also a prophet, seer, and shaman and his authority was increased by their mystical and healing powers. The Gasaile community is quite large so leading the whole community is considered a challenge. For this reason, a few age group leaders who are usually chose n before circumcision aided them. It is believed that their God owned everything including their cattle. However, a separation divided the earth and the sky causing Engai to let all the cattle among the people. His reasons are not well known but some people believe that Engai understood that the cattle needed sustenance from grass. It is exciting to know that the elders show that these cattle came to the earth via aerial roots of the sacred trees referred to as wild fig trees. They believe that the Supreme Being commanded them to look after the cattle hence the reason as to why they became pastoralists. They believe that all other cultural activities other than being pastoralists are an insult to

Rosa Parks Research Paper Example | Topics and Well Written Essays - 2500 words

Rosa Parks - Research Paper Example She was against of racial segregation. She became an icon of Civil Rights Movement in the world scenario. She worked with the NAACP on many projects or cases. These cases include murder, rape, flogging etc. but did not get so much publicity on their work. In 1979, the NAACP awarded her by its highest honor which was Spingarn Medal. Apart from that she received so many awards such as in 1980 she received Martin Luther King Jr. Award and in 1995 Academy of Achievements Golden Plate Award. Mrs. Parks spent her last few days in Detroit and died in 2005 at the age of 92. She is the one of those women whose courage has changed so many lives in the country (Parks and Haskins 28). This research study is based on an analysis that is to be conducted on the life history of Rosa Parks. The aim of a research study sets the mission that is to be achieved by the researcher through the study. The research aim should always be precise as it forms the basis on which the entire research study would be conducted. The major problem of the research that needs to be addressed by the study is to analyze the major factors that make Rosa Parks â€Å"The Mother of Modern – Day Civil Rights Movement†. The research aim of the study would be to address this research problem statement. Hence the research aim can be formulated such as – a research study that analyzes the entire life of Rosa Parks and to identify certain factors that in her that is incomparable and serves as a lesson to be learned by others. The research aim lays the foundation on basis of the objectives of the research can be formulated. The major research objectives of the study is- The research questions forms the framework that needs to be followed by the researcher so that the analysis performed through the research study can derive appropriate results for the formulated questions. This study would be revolving around the life of Rosa

Running Business in Brazil Essay Example | Topics and Well Written Essays - 1750 words

Running Business in Brazil - Essay Example Brazil is expected to invest US $18.4bn for the 2014 FIFA World Cup in 12 Brazilian host cities funding 50 projects (Portal Brasil, 2010). By the end of the 1990s Brazil was ranked tenth in global automotive producers as the nation was willing to experiment with a wide range of supply and production arrangements (Strategic Direction, 2005). Brazil is undoubtedly poised for growth ever since its foreign exchange policy is liberalized. It is moving towards becoming the fifth largest economy (Williams, 2011). However, all these pose a very glamorous image of the nation but businesses desirous of investing in Brazil need to get a complete picture of the benefits and pitfalls. Any disappointments could damage the credibility of the country that it is trying to build up. Economic situation There were more than 10 significant oil discoveries last year which has pushed the nation up in oil producer rankings (The Telegraph, 2011). Brazil is expecting a Tsunami of riches as Petrobras gets full production from the oilfields deep under the Brazilian Seas (O'Shaughnessy, 2009). This would help the nation overcome the repression and torture which impacted the living conditions. Flushed with excessive cash has its pitfalls. Its currency is the most overvalued and real-estate bubble is expected in Brazil as banks have extended risky loans (Lyons, 2011). Cost of doing business in Brazil has risen very fast. Brazil has abundance of natural resources and could be the world power but poor management and leadership have led to large debts (Balsom, n.d.). Economic growth in Brazil has been built on a very fragile structure as 10% of its population is completely illiterate and 68% functionally illiterate (The Brazil Business, 2011). Millions of students emerge from secondary schools without being able to write in English. What is astonishing is that it is socially accepted and expected that they would not learn anything in school. Unemployment in Brazil was 9.9% as of 2009 (McGladrey , 2010). However, through targeted social programs, through subsidizing house loans and raising the minimum wage the government has been able to pull more than 20 million people out of poverty (The New York Times, 2011). President Lula paved the growth that solidified the country and made it a significant player in the world. However, the next President again has not been able to win the confidence of the people. Thus, on the one hand while it has abundance of natural resources, a large industrial base, a huge population base, making the market attractive to investors, economic uncertainties make it difficult to improve its competitiveness or build a modern infrastructure (Austrade, 2001). Labor The nation has a large labor force but the workers are either unskilled or semi-skilled. There is a shortage of technical personnel. Labor unions can be militant especially in the metallurgical, automobile, banking and transport sectors (PricewaterhouseCoopers, 2005). They make a significant force in the country. Fringe benefits and social security for the laborers is not very strong. However, foreign investors do not experience problems with labor because they follow local standards and practices. and the country has been the top producer/exporter of soybeans, cattle and beef products, and poultry. Major issues in doing business in

Treatment Of Clostridium Difficile Infection Health And Social Care Essay

Treatment Of Clostridium Difficile Infection Health And Social Care Essay As a nurse working in acute medical ward for elderly, I work closely with patients with C. difficile infection. I have noticed the effect of C. difficile infection in elderly can be fatal. C. difficile is a gram positive anaerobic bacillus. They colonise in the oxygen deficient areas of the body. That can cause life threatening conditions, including diarrhoea, colitis and septicaemia and resulting death. C. difficile infection can cause serious illness and a significant cause of patient morbidity and mortality. It is a major cause of hospital acquired diarrhoea. C. difficile infection can cause serious illness and hospital outbreaks .It can cause significant financial burden on NHS. It is estimated that the increased length of hospital stay itself can cause an excess of around  £4,000 per patient. The number of death certificates mentioning C. difficile infection in England and Wales fell by 29% between 2007 and 2008 ,after increasing every year since records began in 1999(National Statistics,2008). According to Weston (2007), Clostridium difficile was first identified in 1935s, but until the late 1970s it was not identified as the cause of pseudo membranous colitis following antibiotic therapy. C. difficile infection is more common in elderly (over the age of 65). People who have a long stay in health care settings, those who have recently had gastrointestinal surgery and those who have a serious underlying illness that compromises their immune system are also at high risk to get C. difficile infection. In-patients are also at high risk if there are hospital outbreaks. Poor infection controls are also an important risk factor. Causes Antibiotics are considered as the most important cause for C. difficile infection. Any antibiotic can cause C. difficile infection, but Broad spectrum cephalosporins, broad spectrum penicillin and clindamycin are most frequently implicated. The second most commonly named antibiotic is Co amoxiclav (Health Protection Agency, 2008). The use of proton pump inhibitors such as lansoprazole, omeprazole and pantoprazole are also potential risk factor for C. difficile infection (Leonard et al., 2007). The disruption of normal harmless bacteria in the gut, because of antibiotic therapy also allows the C. difficile to multiply to greater number. The bacteria start to produce toxins. The antacids suppress the gastric acid secretion and as a result, C. difficile bacteria, including the spores are less likely destroyed. The reason for community associated C. difficile infection was unclear but it is become clear that the reasons for the majority of the infections are associated with antibiotic pr escriptions or hospitalisation (Wilcox et al., 2008). Transmission The transmission is through faecal-oral route. The infected patients acquire the organisms directly from other patients with diarrhoea. The route of transmission may be direct, via the hands of health care workers or via the hands of patients or via the environment. Asymptomatic people who are colonised with C. difficile are also can be able to transmit the disease. About 3% is the colonisation rate in healthy adults, but this increases to nearly 20 % in older people especially in chronic care wards. The spore form of C. difficile can survive in the environment for five months or more on hard surfaces. It is considered that the primary route of transmission of C. difficile infection via healthcare workers hand. Clinical features and pathogenesis The most important clinical feature is sudden onset of offensive smelling diarrhoea during a course of antibiotic or who had antibiotics with in the previous two months. Patients may pass soft or watery stool more than twice daily or in more severe cases more than 20 times accompanied by severe abdominal cramps (Weston, 2007). Abdominal distension, fever and dehydration may also be present in more severe cases. Unless C. difficile is diagnosed, the patients can be miss- diagnosed with irritable bowel syndrome. C. difficile infection is a major health problem worldwide that leads to increased morbidity and mortality. Healthy adults carry around 500 species of bacteria in the colon, 90% of which are harmless (Weston, 2007). C. difficile colitis results from the disruption of normal colonic flora and C. difficile colonises in the oxygen deficient areas of intestine. The spores are able to replicate and produce toxins that can lead to mucosal damage and inflammation. In a healthy adult t he normal colonic flora inhibit the growth and colonisation by C. difficile. The antibiotic therapy may disrupt the normal flora and allow the C. difficile to colonise very rapidly. After colonisation the organisms produces two protein exotoxins( Toxin A, an enterotoxin and Toxin B , a cytotoxin) in to the colonic lumen. These are responsible for diarrhoea and colitis. Toxin A binds to the receptors in the intestine and cause extensive tissue damage, inflammation and oedema. Both toxins posses cytotoxic activity against cultured cells by same mechanisms but they differ in cytotoxic potency, toxin B is generally 1000 times more potent than toxin A and to play a major role in activating inflammatory repose (Weston, 2007). Toxin B is more important than toxin A in the pathogenesis of C. difficile infection in man. According to lab test reports there are 100 different types of c difficile stains. The most recognised epidemic types is ribotype 027.The most important feature of ribotype 027 is hypertoxin production, 10 to 20 times more toxin than other stains. The C. difficile infection caused by ribotype 027 are more likely to be severe with increased complications such as renal impairment, severe colonic dilatation and sepsis (Freeman et al., 2007).The clinical features include increased severity of illness, failure to respond to antibiotics ,abdominal distension. Raised CRP and rising WCC particularly in patients who may have appeared to respond to antibiotics and deterioration in condition and appears to have higher mortality rate. Diagnosis Laboratory studies of stool sample will help to detect c difficile infection. Stool culture will help to detect the presence of difficile with toxin production. Stool enzyme immunoassay (ELISA)will detect both of the toxins ( A or B). For toxin B Stool cytotoxicity assay will be positive.Endoscopy may demonstrate ,but it is the least sensitive for diagnosing C. difficile as compared to stool assays., Sigmoidoscopy alone may not reveal any abnormality if the disease is confined to the right colon. Colonoscopy is more useful. Because of the risk of perforation Sigmoidoscopy and Colonoscopy is contraindicated in patients with colitis (Weston, 2007). Treatment The treatment of C. difficile infection depends on the severity of the illness. At my work place, the patient is closely monitored and isolated. A stool chart is maintained using Bristol Stool Chart. All antibiotics that are not required are stopped. This will help the normal bacteria to thrive again in the gut. If any patient develops C. difficile infection at my work place, we conduct a thorough investigation for the causes and we notify the antibiotic management team to review the patient. The team will review the patient in the ward (rounds Wed/Fri.) or via the phone. There will be a root cause analysis to find why the patient developed C. difficile infection? In some patients fluid and electrolyte replacement and nutrition review may also be necessary. In mild cases of C. difficile infection, patients are monitored for 48 hrs before starting antibiotics. In severe cases, antibiotics may need to be administered immediately. Metronidazole and Vancomycin are the two preliminary ant ibiotics used in the treatment of the infection (Weston, 2007). Usually a 7 to 10 day of therapy is required. Oral metronidazole 400mgs eight hourly for seven to ten days is the first line of treatment. It is contraindicated in women who are pregnant or who are breast feeding. The most recognised side effects of the metronidazole are an unpleasant metallic taste, nausea, vomiting, diarrhoea, abdominal pain, headache, pruritus, rashes, dizziness and reversible neutropenia. Vancomycin is known to cause the spread of vancomycin resistant bacteria. Vancomycin is used for severe, life threatening cases of C. difficile infection. It is also used for patients unable to tolerate metronidazole and failed treatment with metronidazole. Vancomycin is expensive. Oral vancomycin is not completely absorbed or metabolized in the gut and is excreted in the stool unchanged. This is ideal in the treatment of C. difficile infection. The recommended oral vancomycin doses for adults are either 125mg or 500mg four times daily. The use of a rectal vancomycin enema (500mg diluted in 1000ml of 0.9% sodium chloride injection) is also an alternative. A recurrence of symptomatic disease with re infection occurs in 5-20% cases. Management of repeated relapses is more difficult. The options include slow tapering of vancomycin or metronidazole over a period of six weeks and vancomycin combined with rifampicin for seven days. There are also case reports of successful treatments with intravenous immunoglobulin which contains antibodies to c difficile toxins. The studies shows oral administration of limited bacteria or yeast helps to reconstitute the gut flora and there is a potential to prevent infection.The ability of these organisms to colonize and also to prevent and treat the c.difficile is unclear. (Department Of Health, 2009). Surgery may be needed for small number of cases especially if C. difficile infection progress to fulminant colitis and perforation. Loperamide (anti diarrhoea drug) is contraindicated for C. difficile infection because this will slow down the clearing of toxic bacteria (Weston, 2007). Prevention Control Preventing the spread of C. difficile can be challenging as hospitals tend to have an increasing population of elderly, debilitated and susceptible persons, which naturally increases the number susceptible hosts within the environment. Isolation Isolation should be implemented in conjunction with the infection prevention and control measures to minimise the risk of spread to other vulnerable groups. Private room/side room is recommended, especially for patients who are fecally incontinent. Cohort symptomatic C. difficile associated disease patients only with other symptomatic C. difficile infected patients, to minimise environmental contamination. Patients with C. difficile infection may be moved to other rooms or bays when the diarrhoea ceases (no diarrhoea at least 48 hours) (Department Of Health, 2009 and Health Protection Agency, 2009). Hand washing Barrier nursing Contact precautions should be used for C. difficile infected patients with diarrhoea. Proper hand washing is essential. Alcohol-based hand gels are not effective in reducing the spread of the organism and are not recommended. Disposable gloves and aprons should be worn when caring for the patients. It is recommended that not to share the equipments between the patients. It is a good practice to inform healthcare workers and visitors that a patient is on contact precautions, such as labelling the door of the room, without disturbing patients privacy. Last year we (My work place) spent  £1,280.32 for soap, alcohol, gel and moisturiser. Environmental Cleaning The environment of a patient with C. difficile infection should be cleaned thoroughly at least twice per day. An approved hospital disinfectant-detergent should be used for all environmental cleaning. Terminal cleaning (stage cleaning) of ward area is essential after the discharge or transfer or death of a patient with C. difficile infection. (My ward) Decontamination of equipment Do not share equipments among patients to prevent cross infection. Commodes and bedpans are heavily contaminated with spores and are considered as vehicles of cross infection in C. difficile outbreaks. It is ideal that symptomatic patients have their own commodes or toilet facilities. Proper disinfection must be essential. Transfer of Patients Transfer of patients with C. difficile infection or disease to another ward, unit, or to the long term care facility must be informed prior to the transfer that the patient has C. difficile infection. Same notice must accompany transfer of patients with C. difficile infection to a long term care facility (Department Of Health, 2009). It is not necessary to have absence of diarrhoea or negative stool cultures before the transfer of a C. difficile patient to a long term care facility. On the patients discharge, we need to notify the primary care physician (My ward). Rectal Thermometers Since the outbreaks C. difficile in hospitals and long term care facilities, rectal thermometers are restricted to use. For the routine use Electronic tympanic thermometers are recommended (Department Of Health, 2009) Education Ward should conduct training programmes to the health care staff. Ensure that patient / family information leaflets are given out. Anti microbial management team It is the responsibility of the hospital trust to develop anti microbial management team. That should consist of a consultant microbiologist, pharmacist and prescriber. The trust also needs to develop restrictive antibiotic guidelines. These guidelines specifically need to address to avoid the use of broad spectrum cephalosporin, broad spectrum penicillin and clindamycin especially in elderly and minimise the use of fluroquinolones, carbapenems,that we follow in my work place. It is also a good practice to have an infection control link nurse to each and every ward. It is their responsibility to do proper training for staffs and auditing the clinical area. Outbreaks of C. difficile infection in Long Term Care Facilities An outbreak of C. difficile infection is defined as three or more cases of symptomatic C. difficile infection mainly in the same area of the hospital ward within a period of seven days. Infected patients should be placed in isolation room or cohorted. Patient(s) can be removed from precautions if there is no diarrhoea .There is no need to wait for negative stool culture to remove the patent from precautions. An education program regarding C. difficile infection and its transmission and prevention should be conducted to all health care workers. Need to highlight the use of gloves and aprons and moreover proper hand washing. The health care facility need to monitor for any significant episodes of C. difficile infection, and then need to liaise with local health department for further assistance (Walker K et al., 1993). Possible Solution Conducting education programmes and workshops for health care workers and public to increase the awareness of C. difficile infection can contribute a major role in reducing the number of C. difficile infection cases within the healthcare system. Need special attention to personal hygiene. The primary route transmission is via the hands of healthcare workers and other patients and residents. It is very important to perform proper hand washing and barrier nursing (gloves, gowns). Environmental hygiene is also very important factor in controlling C. difficile infection. Regular and proper cleaning of patient rooms with anti bacterial cleaning agents is essential as C. difficile toxins can stay in the environment for several months. Changing the way doctors prescribe antibiotic therapy is also an important strategy in control the C. difficile infection. Because C. difficile infection is always associated with the use of antibiotics, It is also recommended to have an antimicrobial management team for each hospital (Department Of Health, 2009). In cases of recurrent C. difficile infection experts agree that the non antibiotic treatment have a positive impact. The use of toxin binders neutralises the effect of toxin producing stains and to helps the intestinal flora to restore .Tolevamer, developed by Genzyme Corporation is the first non antibiotic treatment approved for C. difficile infection (www.mediscape.com). Mandatory surveillance of C. difficile infection in the United Kingdom When looking at surveillance reports, many of the hospitals in the UK have been affected with outbreaks of C. difficile.  We can see that the large increase in the number is between 2000 and 2007.It is the responsibility of the  hospitals in the UK has to measure and report to the Department of Health.  The surveillance should include the number of positive cases, number of severe infections, the number of required surgery cases and number of deaths. The surveillance of C. difficile infection is taking to get a target for 30% reduction from 2007/2008 numbers by 2010/2011.  In 2007-2008, there were 55,498 cases reported across England. In 2008-2009, the cases reported dropped to 36,095. i.e., cases dropped by 35%. Last year our target (My hospital and my community) was 180. The number of cases reported was 171, 98 of which are from hospital (7 cases from my ward).This year, the target is 155. Social, economic and political issues. C. difficile infection is expensive to the NHS. The total identifiable increased cost of C. difficile infection causes an excess of  £4000 per case. Such high costs can be used to justify expenditure on personnel and/or other control measures to reduce the incidence of this hospital-acquired infection. There are notable outbreaks of c. difficile infection worldwide since 2003.Outbreaks was reported in Montreal, Quebec and Calgary, Alberta, in Canada. Approximately 1400 cases affected, death count 36 89.A similar outbreak reported at Stoke Mandeville Hospital in the United Kingdom between 2003 and 2005, in which 33 patients died. In 2007 Maidstone and Tunbridge Wells NHS Trust was heavily criticized by the Commission, have heightened media and made public awareness. In 2009, four deaths reported at Our Lady of Lourdes Hospital in Ireland also thought to have links to Clostridium difficile infection. The prevention and control of C. difficile infection in health care settings is bec ome a global public health challenge.(Health Protection Agency 2009) Conclusion C. difficile infection is a major problem in hospitals that is associated with the use of antibiotics. C. difficile infection also recognised as one of the major health care associated infection. It is estimated that C. difficile infection affects between 40000-60000 people in the UK every year. The prevention and control of C. difficile infection is very important. The three main elements of prevention are: Need to restricted use of antibiotics; Strict isolation precautions and barrier nursing when looking after patients with diarrhoea and Through cleaning of clinical areas. Poor hand washing is known to play a key role in the spread of infection. Hand washing facilities in the hospitals such as the number of hand washing sinks and their position, and type of taps are also need to be inspected. Hand washing protocols is low in many hospitals. C. difficile infection needs treatment only if it is symptomatic. Most of the people make full recovery and in rare cases the infection can be fatal. Infection control teams need to develop education programmes to improve compliance and regular auditing. It is everybodys business to participate to prevent and control C. difficile infection with in the health care system. The health care workers need to follow the hospital infection control policy.

Effects of Underage Drinking on Society Essay -- Alcohol Regulation, Y

Underage Drinking Anyone who is below eighteen years of age is considered as underage and laws in many countries prohibit such a person from consuming alcohol. Alcohol happens to be the most commonly abused drug not only among the youth but also among adults. This paper explores underage drinking, its effects on the society and outlines what can be done to curb it. Young people are considered to constitute the largest number of alcohol consumers and they account for a large portion of alcohol sales. This is despite the strict drinking laws that govern many countries as regards alcohol purchase and consumption. Underage drinking, which has been on the increase, is allegedly the major cause of alcohol-related problems facing the modern society. The most severe effects of adolescent drinking include drunk driving that leads to accidents and even death, violence, poor performance in school, addiction, poor relationships and damage on adolescent brain development among others (Bonnie and O’Connell 58). The society is to a great extent affected by these effects through deaths and lost productivity among the youth. This has become a challenge to the society and government, which has been accused of doing nothing about this menace. Weak personal character, bad social states and poor cultural settings are some of the major factors that are belie ved to be behind underage drinking. Bad character among adolescents is a major factor behind underage drinking and it is caused by the personal beliefs and attitudes of the young adults towards alcohol, defiance, low commitment towards personal objectives and undue interpretation of freedom (Komro and Toomey 2). The lack of principles and autonomy, which help the youth to say no to illicit beh... ...wn to a personal decision on whether one should or should not consume it as others will still do even if all these interventions were to be put in place. The strategies above can therefore not guarantee an end to underage drinking but they can give significant and sustained reduction in adolescent drinking if efficiently implemented. Works Cited Bonnie, Richard J., Mary Ellen O’Connell, and National Research Council (U.S). Reducing Underage Drinking: A Collective Responsibility. Washington, DC: National Academic Press, 2004. Print. Ellul, Duncan Aaron Borg. Risk Perception, Awareness and Prevention Measures to Reduce Underage Drinking and the Illegal Purchase of Alcohol in Malta. Boca Raton, FL: Universal Publishers, 2005. Print. Komro, Kelli A., and Traci L. Toomey. â€Å"Strategies to Prevent Underage Drinking.† The News. 19 Jan. 2011: 1-29. Print.