Schoolgirl was accepted to Yale University because of her love to pizza

Schoolgirl was accepted to Yale University because of her love to pizza How to enter one of the most popular university in the world? Decent school references and excellent certificate go without saying. Although, one can draw the attention of Admission Committee. As we have seen, some students are good at it. American high school student Carolina Williams wrote an essay about her love to Papa John’s pizza and thanks to these 196 words, she unexpectedly became a spotlight. Actually, it was the first thing that came to her mind. Admission Committee of Yale University was very pleased of the teen’s composition and accepted her in college. By the way, Yale University is considered to be one of the best educational institutions. Its graduates were Hilary Clinton, Meryl Streep, and other famous people. I laughed so hard on your pizza essay. I kept thinking that you are the kind of person that I would love to be best friends with, a member of Admission Committee wrote Carolina. For admission to Yale University, a student should write an essay about the thing you really like. Carolina Williams decided to tell about her love to pizza. She orders it every week. The girl wrote in her composition, Accepting those warm cardboard boxes at my front door is second nature to me, but I will always love ordering pizza because of the way eight slices of something so ordinary are able to evoke feelings of independence, consolidation, and joy, Williams and her friends thought it might be rather nice to tell Papa Johns about this funny story. So Carolina wrote on Twitter, â€Å"I just want @PapaJohns to know that I wrote a college essay about how much I love to order their pizza and it got me into Yale†. After that, the pizza restaurant responded her and asked to send the full text of the essay. Papa Johns offered them lots of free pizzas and training in the company. She published the essay’s text and the response from Yale University in her twitter. Admission Committee said that they were roaring with laughter because of William’s essay. The girl was boasted of her extraordinary approach choosing such topic and offered her to study in the college. Williams is going to refuse this proposal because she is planning to apply for Obern University in order not to go far from her home. Also, it is worth noting that the girl performs well at school and is included in 10 best students of her school in all the subjects. Also, Carolina visits a church, works in a library as a volunteer and is a member of several non-governmental organizations. In the future, she is going to manage a business and work in economics.

Specific Symbols Used by James Joyce in Eveline Essay Example

Specific Symbols Used by James Joyce in Eveline Essay Example Specific Symbols Used by James Joyce in Eveline Paper Specific Symbols Used by James Joyce in Eveline Paper Even though Beeline is a very short story, James Joyce n to only successfully portrays her dilemma and inner conflicts but he also lets the read ere feel his times difficulties in Dublin. He does not tell these things to reader directly but he chi shoes the words so appropriately and he depicts the characters so successfully that despite the e first impression they make on the reader, these symbols refer to different meanings. Firstly, Beeline is not just an ordinary character who is in a dilemma whether t o stay or to go but also she is a representative of all women under patriarchy (Change 01). She is a young girl who has a lot of responsibilities, especially after her mothers last w sis from her to keep the home together as long as she could Joyce 33). She is doing all the chores on her own; besides, she also works at the Stores to earn money for the expenses of the house. However, she gets no appreciation from her father, he even takes her money. When we look at the condition of Dublin in that period it can be seen easily that not only Evelyn e, but also other women experience similar hardships in their lives. Wall expresses his ideas a out the reason of this situation as following: Economic deprivation drove millions abroad. For those who remained, pope arty was widespread, jobs few and precarious, salaries meager, and opportunities for a advancement rare (33). Most girls in economically depressed Ireland, facing long delays in marrying a ND perhaps eventual spinsterhood, had to work in the home, in family enterprises, or at o outside jobs (37). We can conclude that Beeline is one of the victims of Dublin life. But she is the e lucky one who has an opportunity to escape from Dubbings patriarchal society and her d mommies life. However, she is so deeply attached to this domestic life that, even the slightest t things change her mind about going with Frank. When she is sitting at home, looking at the familiar objects (Joyce 32), she feels upset due to the possibility that she would never r see again these familiar objects from which she had never dreamed of being divided (Joyce 3 2). Beeline remembers how nice her father could be sometimes even though he almost a Sways behaves rude towards her. On the other hand, she thinks Frank would save her. He w loud give her life, perhaps love, too (Joyce 35). But it is understand from Beelines words the t male figures have an enormous effect on even the most important decision of her life. She does not want to go because she feels sorry to leave her father alone in his Old ages whereas s he thinks Could she still draw back after all he had for her? (Joyce 35). She attaches less imp rattan to what she really wants than she cares about men in her life. Another thing that is not directly told but is symbolized through the character paralysis. Paralysis means being unable to function or act. He [Joyce] said Du blinders was a lookings in which the Irish people could see themselves and their paralysis (wall 31 In those times people of Ireland lives poor, dull and unproductive lives but the eye did not make an effort to change their current situations. Jockeys description of Beeline at the e end Of the story shows us this paralysis. She set her white face to him, passive, like a heel Pleas animal. Her eyes gave no sign of love or farewell or recognition (Joyce 37). She does n to act, stays motionless, like a paralyzed person and cannot escape from her dusty house and probably turns back to her immobile position sitting at the window. Change states Nun able to choose action over paralysis, she condemns herself to the prison of her distilled little e brown house, eschewing the freedom of potentially good air for the hard life (103). The male characters in the story symbolism different meanings. For instance ,t he father of Beeline is another representative of Edibleness and Dublin life like Beeline, a symbol of that green isle [Dublin] (Florid). He is usually drunk, behaves rude to his child Rene and does not care about her family at all. He also symbolizes Beelines past. In contrast to the father, the other male character Frank symbolizes the future and a happy life for Beeline. He is a way for her to escape from her miserable life and a chance to get married and to gag n a respectable life since she thinks that being married leads people would treat her with respect t (Joyce 33). Beside of these important symbols represented by characters, there are the r minor symbols in Beeline. For instance, dust(Joyce 32), symbolizes the dusty air o f Dublin. According to Change it also represents a familiar sense that makes Beeline feel secure and comfort in contrast to Godard of Buenos Aries (102). As we can understand, B menus Aries is another symbol whose meaning is good air; in other words, good life. To sum up, Beeline by James Joyce is a story of a young girl and her dilemma between staying or leaving. However, Jockeys writing skills do not let the story tell only about this poor girl. His descriptions and usage of words are so masterful that they symbolism many different meanings in the stow, and when the readers get these hidden mean inns, they feel like they are in the story.

QI Essay Example | Topics and Well Written Essays - 500 words

QI - Essay Example Considering this, the numbers in the spreadsheets were added to get the percentage of menus picked up by 100 units. This method was the appropriate one because it facilitated the computation of percentages using an easy formula. The breakdown of the menus and the floors required a unit that ensured the percentages provided the correct outcome that would give the accurate pickup. However, some challenges emerged during the entire calculation of the menu pickup project. These challenges were later rectified by having a menu pickup policy for diet technicians in order to increase the percentages. By using the original excel document of the menu pickups, highlighting was essential for the determination of the unusual or improper pickup units. For instance, highlighted in yellow were the menu p/u averages that consisted of items by Thumas, Danielle and Aaron. The results indicate that the pickup menus changed during the days, but had a constant Monti unit of 2 in the entire project. Similarly, the employees, namely Josie, Kristen, Sebastian and Eguono also registered different menu p/u percentages. This is because the menus picked up produced separate menus printed, giving different percentages. The perceived reason for this difference was due to maybe the employees taking lunch breaks at different intervals. It is also apparent that the employees took long hours choosing the menus pickups with others going for the ones with fewer complexities. Each worker failed to have their menu pickups when required to because of the difference in time intervals taken for breaks. Some workers were good with sticking to their programs, while others were logged off at most of the times. This caused the delays and differences in the percentages, which also resulted in the different averages at each level. For instance, the averages established by Dawn, Thumas and Sebastan were higher compared to the ones by Melisa, Angela and

Euthanasia and Kants Morality Essay Example | Topics and Well Written Essays - 1500 words

Euthanasia and Kants Morality - Essay Example Legally, assisted suicide has been justified on certain grounds, for example in countries such as the Netherlands, Switzerland, Belgium and in the State of Oregon in the United States (McKean 1). This does not however change the fact that for most people the issue of euthanasia is fundamentally not about giving mercy. It is still the â€Å"killing† part that raises the hackles for most people. Mercy (or compassion) and killing (with an intent to kill, it can still be considered murder) are still clearly contradictory, i.e., posed in the very simplistic, yet lucid question: how could you possibly help someone you love or care about kill himself? How could mercy or love ever be allied with the destruction of life, no matter how little remains of it? The morality of any act according to Kant’s well-known adage of the categorical imperative only suffices if it can be raised as a universal law (Kant, Groundwork of The Metaphysics of Morals). To assist someone who wants to di e will almost never impel that unconditional sense of rightness, but instead the situation will almost always look at the conditionality of how a particular situation may be acted upon. This action is the opposite of what can be found in the morality of the categorical imperative. A thing according to Kantian morality is right because it is independent of any external cause. In the case of euthanasia, the external cause takes the forms of the mercy or a sense of â€Å"duty† to let a person die in dignity, or respect the wishes of someone who wants to end his life.... sion may be high due to a seemingly hopeless situation be trusted in deciding that life is better ended Is he or she an "autonomous" person in this case On the other hand, can a caregiver or a doctor with a close relationship with a terminally ill and suffering patient be looked at as merely performing a duty to respect the decision to die of someone he or she cares about Is it duty or is it something else The concept of autonomy or the sense of freedom and the principle of duty in Kant's theory of morality provide analytical tools to examine whether euthanasia is morally defensible. Autonomy and dignity, which are based upon the premise that a human being is free by way of reason to decide on what is wrong or right, have been used to justify euthanasia. Conversely, this line of reasoning suggests that the autonomy or dignity of a patient who expresses that life-prolonging treatments or care violate his or her sense of dignity as a human being should be respected. According to Kant, men are moral beings because by virtue of being free and capable of reason. However, he qualifies the term freedom, and explains further that there is a "negative" and "positive" sense of freedom. He wrote, "The sole principle of morality consists in the independence on all matter of the law (namely, a desired object), and in the determination of the elective will by the mere universal legislative form of which its maxim must be capable. This independence is freedom in the negative sense, and this self-legislation of the pure, and therefore practical reason is freedom in the positive sense" (Kant, Critique of Practical Reason, Book 1, chap.1, par 85). On both counts, whether in the negative or positive sense, the patient who is supposedly the originator of a decision that would

Analysis of the Film Eternal Sunshine of the Spotless Mind Essay

Analysis of the Film Eternal Sunshine of the Spotless Mind - Essay Example After a fight, during which Clementine tells him of Lacuna, and how she has had her memory erased, he is so angry that he sets this operation up for himself. Joel then takes the audience back and forth as the memories are erased, realizing that he does love her and trying to save his memories by hiding them amongst those of his childhood. Clementine supports him, trying to help him escape. When this is unsuccessful, he awakes from the operation and feels he has to go to Montauk, where they first met. Strangely, she is there searching for him. Joel could be described as a sensitive, introverted man, with some judgemental aspects to his character, but he wants to be understood and fears betrayal. In contrast, Clementine is outgoing, wants fun and enjoyment, is excitable and impulsive, yet she seeks the security of being loved for herself, and her overriding fear is of being judged. With such a combination, it would seem there is no hope for them. At this meeting, though they do not remember each other, they fall in love again.

Laminar Air Flow In Controlling Operating Room Infection Nursing Essay

Laminar Air Flow In Controlling Operating Room Infection Nursing Essay Surgical site infections (SSIs) are defined as infections occurring within 30 days after surgical operation or within one year if an implant is left in place and affecting either the incision or deep tissue at the operation site (Owens and Stoessel 2008). SSIs are reported as the major cause of high morbidity and mortality among post -operative patients (Weigelt et.al. 2010). According to UK National Joint Registry Report, during 2003 -2006 period infection was responsible for about 19 % failure of joint surgery resulting in revision procedures (Sandiford and skinner 2009). Micro-organisms in the air particles settle on the wound, dressings and surgical instruments and cause infections (Chow and Yang 2005). Whyte et.al (1982) identified that contamination from patient s skin as the cause of infection in 2% cases and from theatre personnel in 98% cases. They also found that in 30% cases, contaminants reach the wound from theatre personnel via air and in 70% cases it is via hands. Generally air quality in the operating room is maintained ventilation system. Additional improvements can be achieved by laminar air-flow system or UV lights. Laminar air-flow system is expensive and require continues maintenance. Its installation increases building cost and the operational cost (Cacciariet.al., 2004: Hansen, 2005). Studies conducted to evaluate the effectiveness of laminar flow produced mixed results and there is no consensus on its role in infection control (Sandiford 2007). In this setting, this paper reviews the recent studies to examine the effectiveness of laminar air-flow in reducing SSIs. Studies for this review were found by searching on databases such as CINAHL, PubMed, Science Direct, Ovidsp, Science Citation Index (ISI) and Google scholar. Keywords used for this search are laminar air flow , surgical site infection , operating room air quality , airborne infections + operating theatre , LMA + infection control . As laminar air-flow is used mainly in orthopaedic theatres, majority of the studies are on joint surgery. OPERATING THEATRE AIR QUALITY AND INFECTION CONTROL Indoor air in an operating theatre contains dust which consists of substances released from disinfectant and sterilizers, respiratory droplets, insect parts smoke released from cautry. Dust particles act as a carrier for transporting microorganisms laden particles and can settle on surgical wound and there by cause infection (Neil 2005). Air particles are found to be responsible for about 80% 90% of microbial contamination (CDC 2005). Modern operating theatres are generally equipped with conventional ventilation system in which filters can remove airborne particles of size >5mm about 80-95% (Dharan 2002). The efficacy of operating room ventilation is measured by the colony forming units (CFU) of organisms present per cubic meter. The conventional ventilation (Plenum) with 20 air exchanges is considered efficient if it achieves the colony count of 35cfu/m3 or less (Bannister 2002). Ventilation system with laminar air-flow directs the air-flow in one direction and sweeps the air particle over the wound site to the exits (CDC 2003). Laminar air-flow with HEPA (High Efficiency Particulate Arrestment) filters system has the capacity to remove air particles of size 0.3 m up to 99.9 % and can produce 300 air exchanges per hour in ultraclean orthopaedic theatres. (Sandiford and skinner 2009). Laminar air-flow units are generally two types; ceiling-mounted (vertical flow) or wall-mounted (horizontal flow). There are inconveniences associated with both types. Generally the major problem associated with laminar air-flow is flow disruption. With vertical laminar flow, it is the heat generated by surgical lamps creates air turbulence while with horizontal laminar flow it is the surgical team that disrupt the air-flow (Dharan 2002). LAMINAR AIR FLOW IN INFECTION CONTROLL Laminar air-flow system is mainly used in implant surgeries where even a small number of microorganisms can cause infection. In joint replacement surgeries, one of the main causes of early (within 3 months) and delayed (within 18 months to 2 years) deep prosthetic infections was found colonisation during surgery (Knobben 2006). Laminar air flow is supposed to minimize contamination by mobilizing uniform and large volume of clean air to the surgical area and Contaminants are flushed out instantly (Chow and Yang, 2004). Some studies found that this method is effective in reducing infection but some others produced contradicting results (give some reference) A recent study conducted by Kakwani et.al. (2007) found that laminar air-flow system is effective in reducing the reoperation rate in Austin-Moore hemiarthroplasty. Their study compared the reoperation rate between theatres with laminar air-flow and theatres without laminar air-flow system. A cohort of 435 patients who had Austin-Moore hemiarthroplasties at Good Hope Hospital in Birmingham between August 2000 and July 2004 were selected for this study. Of those 435 patients, 212 had operation in laminar air-flow theatres and 223 had operation in non-laminar air-flow theatres. Data were collected by reviewing case notes and radiographs. For all cases antibiotics were administrated and water impervious surgical gowns and drapes were used. In the non-laminar air-flow group it was found that the re-operation rate for all indication in the first year after hemiarthroplasties was 5.8 % (13/223), while in the laminar air-flow group it was 1.4% (3/212). Analysis found that there were no stat istically significant relation between re-operation rate and water impervious gown and drapes (p=0.15), while use of laminar air-flow found a statistically significant drop (p=0.0285) in re-operation rate within the first year after hemiarthroplasties. They found that re-operation rate in no-laminar air-flow theatres were four times greater than that in laminar airflow theatres. Even though the aim of the study was clearly described there was no review of existing studies to identify the gap in the research. Study methods and details of statistical analysis were given elaborately. The sample size seems sufficient. Results were summarized and presented using graphs and charts. Discussion of results was short and seems not adequate to address the objectives of the study. There was no attempt to explain the casual relationship. For example researches were making statements such as the introduction of water-impervious drapes and gowns did not seem to make a statistically significant improvement in the result . (p.823). Researchers failed to acknowledge any limitations of the study. Data for this study was collected by reviewing patients records. Patients records are considers as confidential and researchers didn t mention whether they received consent from the patients or ethical approval form institution to conduct the study. This can be considered as an ethica l flaw of this study. There are studies which found that laminar air-flow system is not effective in reducing infection rate. In their study Brandt C et.al (2008) found that infection rate was substantially high in theatres with laminar air-flow system. This was a retrospective cohort-study based on routine surveillance data from German national nosocomial infections surveillance system (KISS). Hospitals which had performed at least 100 operations between the years 2000 and 2004 were selected for this study. Type of ventilation technology installed in operation rooms of selected hospitals were collected separately through questionnaire from infection control teams in the participating hospitals. Surgical departments were grouped into categories according to the type of ventilation system installed. Departments using artificial operating room (OR) ventilation with either turbulent or laminar airflow was included in this study. Total 63 surgical departments from 55 hospitals were included in this study. Analysis was performed to the data set created by merging the questionnaire data on OR ventilation and surveillance data from the KISS data base. The data set analysed contained 99230 operations with 1901 SSIs. Age and gender of the patient was found a significant risk factor of SSI in most procedures. Univariate analysis conducted found that rate of SSIs was high in departments with laminar air flow ventilation. Multivariate analysis also confirmed this finding. Authors argue that it may be due to the improper positioning theatre personnel in horizontal laminar flow room. Researches provided a well-researched literature review which clearly identified gap in current research. Objectives and design of the study was properly explained. Study was based on a large sample size. Results were discussed in detail and casual relations were well explained. Enough tables were used to present results. Limitations were properly discussed. Knobben et.al (2006) conducted an experimental study to evaluate how systemic changes together with behavioural changes can decreases intra-operative contamination. This study was conducted in the university Medical Centre Groningen, The Netherlands. A random sample of 207 surgical procedures which involved total knee or hip prosthesis from July 2001 to January 2004 was selected for this study. Two sequential series of behavioural and systemic changes were introduced to ascertain their role in reducing intra-operative contamination. The control group consisted 70 cases. Behavioural changes (correct use of plenum) were introduced to the first intervention group of 67 operations. Intense behavioural and systemic changes were introduced to second intervention group of 70 operations. The systemic changes introduced was the installation of new laminar flow with improved airflow from 2700m3/h to 8100m3/h. Two samples each were taken from used instruments, unused instruments and removed bon es. Control swabs were also collected to make sure that contamination was not occurred during transport and culturing. Early and late intra-operative contamination was also checked. All patients were monitored for any wound discharge while in hospital and followed-up for 18 months to check whether intra-operative contamination affects post-operative infection. Among the control group contamination was found 32.9% while in intervention group 1 it was 34.3% and in intervention group 2 it was 8.6%. Except in Group 1 (p=0.022) late phase contamination was not significantly higher than early phase contamination. During the control period wound discharge was found in 22.9% patients and 11.4% of them had wound infection later. Deep periprosthetic infection had been found in 7.1% of them in the follow-up period. Deep periprosthetic infection was found in 4.5% cases of first intervention group and in 1.4% of cases in second intervention group in the follow-up period. But none of these decreases were found statistically significant. Contamination, prolonged wound discharge and superficial surgical site infection were found decreased after both first and second intervention. But a statistically significant reduction was found only in second intervention (contamination p=0.001, wound discharge p=0.002 and superficial SSI p=0.004). This study concluded that behaviour modifications together with improved air flow system can reduce intra-operative contamination substantially. Purpose of the study was clearly defined and a good review of the current literature has given. Gap in current research was clearly presented and justification for the study had given. Sample size seems sufficient. It is reported that .bacterial cultures were taken during 207 random operations (p. 176), but no details of the sampling method used were provided. Details of interventions were given elaborately and results were discussed in detail. But only one table and two charts used to present it. The readers would have been more benefited if more tables were used to present the results. Discussions of the results were concise and findings were specific and satisfying the objective. No information on whether they received informed consent from the patients and approval form the ethical committee of the institution was missing. This arise a serious question about the ethics of this study. It is found that laminar airflow is more effective when use in conjunction with occlusive clothing (Charnley, 1969 cited in Sandiford and Skinner 2009). While in their recent study Miner et.al (2007) compared the effectiveness of laminar airflow system and body exhaust suits found that body exhaust suits are more effective than laminar flow system in reducing infection. For their study Miner et.al (2007) selected 411 hospitals which have submitted the claim for total knee surgery (TKR) for the year 2000 from four US States were surveyed to collect the details of use of laminar air flow system and body exhaust suits. Those hospitals which were fulfilled three criteria were included in this study. The inclusion criteria were 1) returned the survey instrument, 2) using laminar air flow system or body exhaust suits for infection control and 3) was evidence of at least one Medicare claim for TKR for the study period. Total 8288 TKRs performed in 256 hospitals between 1st January and 30th August 2000 were selected. Data on patient outcomes after total knee replacement (TKR) were collected from Medicare claims. The patients who underwent bilateral TKR were not included in this study and for those who underwent a second TKR during a separate hospitalisation during the study period, only the first procedure was included. International Classification of Disea ses, Ninth Revision (ICDS-9) codes was used to identify post-operative deep infection that needed additional operation. Hospitals were grouped as users or non-users for both laminar airflow and body exhaust suits. Users were defined as those who use any of these methods in more than 75% procedures and non-users were those use any methods less than 75%. The over-all 90-day incidence of deep infection, subsequent operation was found required only in 28 cases (that is 0.34%). Analysis found that the risk ratio for laminar airflow system was higher (1.57, 95% confidence interval 0.75-3.31) than body exhaust suits (0.75, 95% confidence interval 0.34-1.62). Study found that there were no significant differences in infection between hospitals that use specific either protective measure. Other than mentioning few studies researchers failed to provide any background of the research problem. Methods used for this study were explained concisely. Even though the sample size was large, limited number of events (28) were there to be observed. Analysis was based on this small number of events; this may have affected the result. Not many variables were included in this study, and researchers didn t mention how they controlled some possible confounders. Researchers were successful in identifying the advantages and limitations of the study. Results were properly presented in tables. Instead of expensive laminar air-flow system, installation of well-designed ventilation system is found beneficial. Scaltriti et.al (2007) conducted a study in Italy to examine effectiveness of well-designed ventilation system on air quality in operation theatre. They selected operation theatres of a newly built 300 beds community hospital which have ventilation system designed to achieve 15 complete outdoor air changes per hour and are equipped with 0.3 m, 99.97% HEPA filters. All these satisfy the condition for a clean room as per ISO 7 standard. Passive samples of microbiological air counts were collected using Tripticase Soy Agar 90 mm plates left open thorough out the duration of the procedure. Active samples were also collected using a single state slit-type impactor. Total 82 microbiological samples were collected of which 69 were passive plates and 13 were active. Air dust was counted with a light-scattering particle analyser. Details of the surgery, number of people in the r oom, door opening rate and estimated total use of the electrocautery unit were also collected. It was found that there were positive correlations between particle contamination, surgical technique (higher risk from general conventional surgery), electrocauterization and operation length. Door opening rate was found negatively associated. Researchers suggest that this may because when theatre door open a turbulent air flow blows out of the operating room which may result decrease in the dust particles. No association was found between particle contamination and number of people present at the time of incision. Researchers suggest that human movement rather than human presence is the factor that determines airborne microbial contamination. It was found that average particle concentration in the theatres did not exceed the European ISO 14 644 standard limits for ISO 7 clean room, and so concluded that well-designed ventilation system is effective in limiting particulate contamination. Uncultivable or unidentifiable organisms can also be a reason for surgical site infections. It may be difficult to identify such organisms through standard culture techniques (Tunney 1998). Clarke et.al (2004) conducted a quantitative study to examine the effectiveness of ultra-clean (vertical laminar flow) theatres in preventing infections by unidentifiable organisms. They used the molecular technique, Polymerase Chain Reaction (PCR), to detect bacteria presence. Their study compared the wound contamination during primary total hip replacement (THR) performed in standard and ultra clean operation theatres. 20 patients underwent primary THR from 1999 to 2001 were recruited for this study. Patients with previous incidents of joint surgery or infection were excluded. The standard operation theatres had 20 air changes per hour and CFU count was 50 CFU/m3, while ultra-modern theatres had 530 air changes per hour and CFU count was 3 CFU/m3. For all surgeries same infection control precautions were used. Two specimens each of pericapsular tissues were collected from posterior joint capsule both at the beginning and at the end of the surgery (total 80 samples). Patients were given antibiotic prophylaxis after taking the first specimen. All these samples were underwent Gram stain and culture to detect bacterial colonies and Polymerase Chain Reaction (PCR) to detect bacterial DNA. Among the 20 specimens taken form the standard operation theatres at the beginning of the surgery only 3 were found positive with PCR, while from the ultra-clean theatres only 2 were found positive. None from both theatres found positive with culture. Samples from the standard theatres taken at the end of the surgery, 2 found positive by culture and 9 found positive by PCR. The contamination rate in the standard theatre at the end of the surgery found significantly greater than the beginning (p=0.04). Samples taken from the ultra-clean theatres, none was positive by culture while only 6 were positive by PCR. Statistical analysis found that contamination rate at the end of the surgery is not statistically different than the start (p=0.1). It was found that there were no statistically significant difference in overall contamination rate (p=0.3) between standard and ultra clean theatres. (I will add critique of this study here) NURSES ROLE IN INFECTION CONTROL Understanding the source of contamination in operating theatre and knowing the relationship between bacterial virulence, patient immune status and wound environment will help in improving the infection rates (Byrne et al 2007). Nurses are responsible to take a proactive role in ensuring safety of their patients. To improve patient outcome, it is necessary for the nurses to take lead role in environmental control and identifying hazards through environmental surveillance (Neil 2005). Non-adherence to the principle of asepsis by surgical team is identified as a significant risk factor of infections. Hectic movement of surgical team members in the operating room and presence of one or more visitors were also found as major causes of SSI (Beldi G 2009). Nurses and managers should emphasise on controlling factors like the traffic in theatre, limiting the number of staff and reinforcement of strict aseptic technique (Allen 2010). Creedon (2005) argues that infections can reduce up to one third if staffs follow best practice principles. For better outcome staffs needs additional education and positive reinforcement. Nurses have a vital role in the development, reviewing and approving of patient care policies regarding infection control. Nurses are not only responsible for practicing the aseptic techniques but also responsible for monitoring other staff for their adherence to policies. They are responsible for developing training programmes for members of staff. Educating the environmental services personnel like technicians, cleaners will not only improve their knowledge in patient care but also provide a sense of commitment in patient outcomes (Neil 2005). Perioperative nurses can contribute in research regarding theatre ventilation system through organised data collection and documenting evidences. Nurses can contribute in giving optimum and safe delivery of care in areas where environmental issues can put the patient at risk. Knowledge is changing fast, so it is important that staff must keep themselves up to date. Continues quality improvement is needed and it should be based on evidence based research and on-going assessment of information (Hughes 2009). CONCLUSION Reviews of current research shows that still there is a lack consensus on the effectiveness of laminar airflow in infection control. Studies include in this review has used either clinical outcomes (infection or reoperation rate) or intermediate outcomes (particle count or bacterial count) to evaluate the effectiveness of laminar flow. Kakwani et.al (2007) found that re-operation rate was lower in laminar airflow theatres but Brandt et.al (2008) found SSI rate was high in hospitals with laminar flow. Clarke et.al (2004) found that contamination was not significantly different in ultra clean theatres compared to standard theatres equipped enhanced ventilation system. Supporting this finding Scaltriti et.al (2007) found well designed ventilation system is effective in reducing contamination. Study by Knobben et.al (2006) found that combination of systemic and behavioural changes are required to prevent intra-operative contamination. Miner et.al (2007) found that there were no significant differences in infection between hospitals that use laminar airflow and body exhaust suits. From these studies it can be concluded that use of laminar airflow alone can guarantee infection prevention. Behavioural and other systemic changes are necessary to enhance the benefits of laminar airflow. Evidence shows that conventional theatres equipped with enhanced ventilation system can prevent infection effectively, this can be consider as an alternative for expensive as laminar flow system.

Cold Sassy Tree :: essays research papers

Cold Sassy Tree   Ã‚  Ã‚  Ã‚  Ã‚  Ã¢â‚¬Å"Cold Sassy Tree† reminds me of a soap opera, only this movie ends. â€Å"Cold Sassy Tree† and soap operas relate to our everyday lives in many ways. Soap operas are very dramatic and full of events, just like this movie. A plethora of gossip also goes around in this small community.   Ã‚  Ã‚  Ã‚  Ã‚  In â€Å"Cold Sassy Tree† the setting is your general soap opera or an everyday â€Å"Little House on the Prairie†, only with more gossip and drama. I believe that the setting affects the viewer in a way which brought the viewer in closer to the characters, almost feeling as if you were in the movie. When viewing this movie, I personally felt a sense of closeness. I felt that I knew all the gossip of the town and that the small families let me into their everyday routines only to view from an outside position. The setting also affects the character greatly. Living in a small town makes it very easy to know every ones business. When you know everybody in your town you also seem to hide things or not be around everybody all the time, which is not possible.   Ã‚  Ã‚  Ã‚  Ã‚  Briefly, â€Å"Cold Sassy Tree† is about a small community, mostly made of women who love to gossip. One young woman marries secretly and runs off to have fun with her new husband, Mr. Blackeslee. Through-out the movie little scenes happen that do not play a big role in the overall plot. Near the end, Mr. Blackeslee gets very sick and his young wife, Love, tries her hardest to get him well. Mr. Blackseslee dies and it is hard for Love to overcome his death. Before he dies Love informs her husband that she is pregnant, which shocks him, for he had always wanted a son.   Ã‚  Ã‚  Ã‚  Ã‚  Do not judge a woman by her mistakes. This is only one of the major themes portrayed in this movie. Just as everyone makes mistakes, Love also made a few mistakes, which made all the women think of her as bad. Later, after Love’s husband had died, all the women began to be friendly to her, for they figured out she was more than what they thought. Another theme portrayed is, â€Å"what’s best is not always what you expect.† I believe in this theme, for when Mr. Blackseslee died, the viewer knew it was for the best. However, Love did not think that was how everything was going to be, she thought he would recover and be ok, then later realized this probably was best.