Permit to Work Systems free essay sample

A permit-to-work system is a formal written system used to control certain types of work that are potentially hazardous. A permit-to-work is a document which specifies the work to be done and the precautions to be taken. Permits-to-work form an essential part of safe systems of work for many maintenance activities. They allow work to start only after safe procedures have been defined and they provide a clear record that all foreseeable hazards have been considered. A permit is needed when maintenance work can only be carried out if normal safeguards are dropped or when new hazards are introduced by the work. Examples are, entry into vessels, hot work and pipeline breaking. WHAT IS THE PROBLEM? An HSE survey showed that a third of all accidents in the chemical industry were maintenance-related, the largest single cause being a lack of, or deficiency in, permit-to-work systems. In a study of small and medium-sized chemical factories: I two-thirds of companies were not checking systems adequately; I two-thirds of permits did not adequately identify potential hazards; I nearly half dealt poorly with isolation of plant, electrical equipment, etc; I a third of permits were unclear on what personal protective clothing was needed; I a quarter of permits did not deal adequately with formal hand-back of plant once maintenance work had finished; I in many cases little thought had been given to permit form design. We will write a custom essay sample on Permit to Work Systems or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page While aimed primarily at the chemical industry the guidance provided may have application in other industries. 2 WHAT DO I NEED TO DO? Don’t assume that your system is a good one just because you have not yet had a serious accident. You should critically review your system and ask yourself the following questions. Information I Is the permit-to-work system fully documented, laying down: how the system works; the jobs it is to be used for; the responsibilities and training of those involved; and how to check its operation? I Is there clear identification of who may authorise particular jobs (and any limits to their authority)? I Is there clear identification of who is responsible for specifying the necessary precautions (eg isolation, emergency arrangements, etc)? I Is the permit form clearly laid out? I Does it avoid statements or questions which could be ambiguous or misleading? I Is it designed to allow for use in unusual circumstances? I Does it cover contractors? 3 Selection and training I Are those who issue permits sufficiently knowledgeable concerning the hazards and precautions associated with the plant and proposed work? Do they have the imagination and experience to ask enough ‘what if’ questions to enable them to identify all potential hazards? I Do staff and contractors fully understand the importance of the permit-to-work system and are they trained in its use? Description of the work I Does the permit clearly identify the work to be done and the associated hazards? I Can plans and diagrams be used to assist in the description of the work to be done, its location and limitations? I Is the plant adequately identified, eg by discrete number or tag to assist issuers and users in correctly taking out and following permits? I Is a detailed work method statement given for more complicated tasks? Hazards and precautions I Does the system require the removal of hazards and, where this is not reasonably practicable, effective control? Are the requirements of The Control of Substances Hazardous to Health Regulations 1999 (COSHH) and other relevant legislation known and followed by those who issue the permits? I Does the permit state the precautions that have been taken and those that are needed while work is in progress? For instance, are isolations specified and is it clear what personal protective equipment should be used? I Do the precautions cover residual hazards and those that might be introduced by the work, eg welding fume and vapour from cleaning solvents? 4 I Do the Confined Spaces Regulations 1997 apply? If so, has a full risk assessment identified the significant risks and identified alternative methods of working or necessary precautions? Procedures I Does the permit contain clear rules about how the job should be controlled or abandoned in the case of an emergency? I Does the permit have a hand-back procedure incorporating statements that the maintenance work has finished and that the plant has been returned to production staff in

Misplaced Modifiers

Misplaced Modifiers Misplaced Modifiers Misplaced Modifiers By Mark Nichol Misplaced modifiers- words or phrases that provide additional information to the main idea of a sentence but create confusing or at least awkward phrasing because of where they are placed within the sentence’s syntax- abound in writing. As explained below in the discussion of revision of sentences burdened by this problem, the solution is often simply relocating the modifier as a subordinate clause that precedes the main clause. 1. A Bill Cosby Show actress claims the comedian raped her in a new lawsuit. The sentence literally states that the rape occurred in a lawsuit. But the point is that the lawsuit states that the rape occurred, so the sentence should begin with the context: â€Å"In a new lawsuit, a Bill Cosby Show actress claims the comedian raped her.† Another option is to parenthesize â€Å"in a new lawsuit† between the subject, â€Å"A Bill Cosby Show actress,† and the predicate, â€Å"claims the comedian raped her.† (The parenthesis can also follow the verb.) 2. The attorney said that he was confident that justice would be served as he stood on the courthouse steps. Just as in the first example, this sentence features a distracting misstatement. The attorney did not claim that during the time he was standing on the courthouse steps, justice would be served, but that’s what the sentence implies. To clarify that the reference to the courthouse steps is tangential to his pronouncement, it should be moved to the beginning of the sentence as a subordinate clause: â€Å"As he stood on the courthouse steps, the attorney said that he was confident that justice would be served.† As in the previous example, the modifier can be inserted in the middle of the sentence, either before or after said. 3. The property belonged to Lance Benson twice, who lost the land in a divorce settlement and then bought it back in 2012. The antecedent, or prior reference, to who- the name Lance Benson- must appear immediately before the pronoun, with no intervening words, so twice must be relocated: â€Å"The property twice belonged to Lance Benson, who lost the land in a divorce settlement and then bought it back in 2012.† Twice could also begin the sentence, but the statement flows more smoothly when it follows the subject. 4. North Korea’s government says its military tested a bomb to widespread skepticism. This sentence suggests that widespread skepticism was an intended result of the bomb test; it appears as if a verb such as garner is missing from before â€Å"widespread skepticism.† To explicitly note that the skepticism was independent of the bomb test, the result should be introduced as a subordinate clause before the main clause: â€Å"To widespread skepticism, North Korea’s government says its military tested a bomb.† (Again, the modifier can be inserted before or after the verb instead.) Better yet, however, the result could be described with a verb inserted before it and the entire phrase set off from the main clause by a comma: â€Å"North Korea’s government says its military tested a bomb, prompting widespread skepticism.† 5. The rocks appeared to be the size of small cars in pictures posted by the National Park Service. This sentence, read literally, compares the size of the rocks to the size of small cars featured in photographs posted by the National Park Service. To clarify that the photos show rocks the size of small cars, not small cars themselves, the phrase describing the photos should precede the main clause as an introductory subordinate clause: â€Å"In pictures posted by the National Park Service, the rocks appeared to be the size of small cars.† Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Grammar category, check our popular posts, or choose a related post below:75 Contronyms (Words with Contradictory Meanings)Italicizing Foreign WordsUses of the Past Participle

Medical Malpractices Lawsuits and Their Changing Nature Essay

Medical Malpractices Lawsuits and Their Changing Nature - Essay Example D. The fourth step is establishing the causation in the medical malpractice suit. E. Finally, there is passing of judgment and the sentence based on evidence adduced. III. Discussions on the changing nature of medical malpractice suits influenced by the lack of national standards and federal government laws and statutes while using several examples in various states IV. The rising costs of damages in medical malpractice that underlines the need for further reform in medical malpractice laws. V. Conclusion and further suggestions for reforms in medical malpractice law Medical Malpractices and Their Changing Nature The law on medical malpractices and insurance has been under scrutiny and focus for many years across the United States and over the world. In recent years, Washington is realizing the need to support legislation meant to put a cap on the amount of litigation while restricting the amount of awards on damages resulting from medical malpractice suits. ... On the other hand, there are those who belief that the blame squarely lies on the insurance market for medical malpractice. This expose elucidates on the issues central to medical malpractice suits and their changing nature. Therefore, the expose begins by giving an overview on the operations of medical malpractices law and the procedure towards the awarding of damages in a medical malpractice lawsuit. After an analysis of medical malpractice law and lawsuits, the expose gives an investigation of the changing nature of medical malpractice law. Thereafter, there is an in-depth investigation of the cost factor in damages awarded to patients harmed by medical practitioners while finally the paper proposes further reforms in the tort law on medical malpractice in the concluding part of the expose. Medical Malpractice Law and Suits The jurisdiction of medical malpractice laws in the country is traditionally the preserve of state governments and not under the federal government. In this re gard, the legal rules and the operational framework that guided medical malpractices were precedents from states courts instead federal laws and statutes. Thus, medical malpractice laws were common laws since they were legal rules established by the state courts. In this effect, since the laws set in judgment and settlement from a state has no weight in another state, the laws and framework for handling medical malpractices varied, and still does to some extent today, from one state to the other state regardless of similar principles. Speiser points out that, the law on medical malpractice has its origin from English common law of the nineteenth century. However, the law that developed to medical malpractice law is an

Human nature as a struggle between reason and desire Essay

Human nature as a struggle between reason and desire - Essay Example Pictures and images are suitable to those only who lack more sophisticated expressions (Falzon 3). Plato has stated in Plato's Cave that when inside the cave, shadows on the wall are taken as real by persons not enlightened but the truth is that one need to come out in the sunlight to see reality.This prejudice against visual images is further enhanced in cinema. Since there also we sit in the dark hall and see images moving in front of us. Le Doeuff (1989 as cited in Falzon 4) stated that images are illustrative which enter deep and help form our thoughts.. Still some may argue that let films be just films. Why distort or bend these to fit into some philosophical definitions The answer to this may be, using films to interpret philosophy is just one more perspective to looking at these. One may argue that films are prejudiced in having the maker's view and thus may influence our interpretations. Certainly, but you can use the film as a base to think of presenting the story in differe nt way or find what the maker has left out. We remember longer what we have seen and that continuously constructs our thinking till our reasons satisfy the outcome. In the movie Cape Fear (Scorsese 1991), Max Cady is a vicious redneck who has just served a 14-year prison sentence for a hideout incident of rape and battery. Now, he's arrived to seek vengeance on Sam Bowden, the lawyer who defended him but was so repulsed by his client's crime that he buried a crucial piece of evidence. The latter could have reduced severity of Cady's punishment. Scorsese and De Niro are taking the sort of brutish, menacing, perversely unreasonable criminal as a phantom. If there, truly, is such a character in our life then this absolutely self-destructive person presents conflict between passion and reason. Cady begins to practice a sleek form of cat-and-mouse terrorism, and without really stepping outside the law harasses Bowdens. What's more, He feels strongly that Sam, by failing to defend him to the best of his abilities and also stepping outside the law, took it into his own hands. Cady emphasises that, now, he no longer has the right to expect that same law to protect him. Cady seems to have a good reason for his act. He is also trying to save Bowdens' from their sins by punishing them. How does philosophy explain the conduct of Cady and Sam The latter has scores of infidelities as well and thus shows weaknesses in his personality. Was Sam right in deciding that Cady's crime is too repulsive to be allowed any respite And was Cady right in being obsessed with the revenge against Sam's whole family Our reasons, feelings, thought and behaviour are controlled by different parts of minds. Both Freud and Kant consider mind as divided entity rather than a single unit. While hiding the report that could have reduced Cady's punishment, Sam was in conflict between reason and passion (to do lawyers duty well for his client), finally the reason yielded to passion that a criminal of Cady's level should be given severe punishment. It is also possible that during the course of our life, we develop many unconscious thoughts and wishes that keep on influencing our conscious decisions (Critchley et al 169). Similarly the overemphasised view of the fault of Sam, by Cady is due both to breach of trust as well as the conflicts of passion and reason. When the latter two were in harmony, he succeeded in creating fear in Bowdens family. But when these two were in conflict, he lost his own life.

Appreciation of works of art Essay Example | Topics and Well Written Essays - 750 words

Appreciation of works of art - Essay Example Asymmetry is evident in the painting because there is an imbalance of the number of people on the right and on the left sides. On the right side of the painting where a group of people are gathered, the space from which they are staying creates a sense of depth to the viewer through the use of hatching. Looking at the portrait, one could almost understand that behind the opening or door from which the people are standing; there is a deeper space wherein more people could be present, or at least it is a path where the people entered through. The lines that are used also create distance. From the viewer’s point of view, since there are no borders used on the edges of the painting, there is a distance created wherein one can see a front and a back side. The lines at the back of the three people on the center make the setting look narrower at the back, suggesting that it is farther than where the three characters are located similar to how things are seen in reality. For instance, when something is near a viewer, it is big and clear enough for someone to see the details. However, as the viewer stays farther away from the object, it becomes smaller and can only be determined largely by its shape. This is what happens in the painting. Since the back wall is shown to be bounded by width and height in contrast to the open space on the ‘front’ of the people, it appears to be farther away from the viewer and therefore, creates distance. Moreover, Pilate is shown to be nearer the viewer than the other characters. This is done by completing every detail that shows the man washing his hands, seated on his chair with all his raiment and other uncovered part of his body visible. In contrast, the man pouring the water on the basin seems to be a little farther behind Pilate because some parts of his body are covered such as his leg. The basin in front of him covers his left leg so that the illustration looks realistic creating an illusion that makes him appe ar to be located a bit farther than the main character. The same is true with the man standing behind with a green robe. His feet are not shown, suggesting that they are covered by the man seated on front of him. Consequently, space is created as well because of the distance that is portrayed by the lines mentioned earlier. Pilate seems to be sitting right in the middle of the room because there is a space left on the front which seems to be bare. This is effectively done by placing the chair of Pilate a few squares away from the bare floor. In addition, the distances between the figures such as between Pilate and the people show the spaces created in the picture as well. The placing of the people also creates the illusion of space in a similar fashion as described above. For instance, the hands of the two men behind the man in green robe on the right side of the painting show a sense of distance and space. The hand of the man in red turban does not only seem to be father behind the hand of the man in front of him but it also creates some space between them. Symbolism could also perhaps be evident in the painting. For instance, it is known that Pilate did not find any crime committed by Jesus so that he did not like to crucify him. However, since the people are becoming wild in their demands, he had to make a decision that he was not really satisfied about. To keep the peace and order of the community, he had

Handwashing Practices among Health Workers

Handwashing Practices among Health Workers BACKGROUND Hand washing or hand hygiene is the process of cleaning ones hands with or without the use of water or another liquid, or with the use of soap for the purpose of removing soil, dirt, and/or microorganisms. Handwashing involves five simple and effective steps; Wet, Lather, Scrub, Rinse and Dry. Regular handwashing, particularly before and after certain activities, is one of the best ways to remove germs, avoid getting sick, and prevent the spread of germs to others. Its simple, its quick, and it can keep us all from getting infected (CDC, 2016). The provision of healthcare worldwide is always associated with a potential range of safety problems. Yet, despite advances in healthcare systems, patients remain vulnerable to unintentional harm in hospitals (Devnani et al. 2011; Mani et al. 2010). One of the most significant, current discussions in healthcare delivery in hospitals is healthcare associated infection (HAI), sometimes called hospital acquired infection (Mani et al. 2010; Momen Fernie 2010) or nosocomial infection, which is any infection that a person develops as a result of treatment in hospital (Minnaar 2008, 2). Nosocomial infection is a global public health problem with an estimated 1.5 million suffering consequences at any given time [WHO,2009] noted that at least 25% of all hospital infections in the developing world are nosocomially acquired. The hands of health care providers are major agents of infection transmission in hospitals leading to the campaign to improve hand hygiene, Clean Care is Safer Care [WHO, 2005]. Two types of hand colonizing flora are predominant in hand skins. These are the Resident flora that are not easily removed by the simple friction associated hand washing and the Transient microorganisms which are not usually hand colonizers but they are most likely associated with infection [ Grayson, 2009]. Various types of such microbes are found on patients, instruments and other items and are important in infection transmission  [Hubner, 2006]. Improper hand washing practices serve as means of infection transmission in hospital wards (Duckro, 2005). Hand hygiene was thought to be a key factor in reducing hospital acquired infection during the initial development of healthcare systems (Akyol 2007; Ott French 2009). The battle with HAI started when the Hungarian obstetrician, Semmelweis (1847), observed that puerperal fever was more common on a maternity ward, where physicians and medical students provided care to women in labour, than it was on the ward where midwives assisted deliveries. He noted that physicians and medical students were contaminating their hands while performing autopsies and later attending the examination of women without hand washing. Arguably, he was the first to recognise the importance of hand washing in controlling the transmission of infection (Akyol 2007; Meers et al. 1992; Trampuz Widmer 2004). Equally important was the work of Florence Nightingale during the Crimean war, when she called for basic public health in a military hospital in Scutari in 1854. PROBLEM STATEMENT Hospital acquired infections has resulted in many negative impacts on health workers, patients and families over the world (WHO2012). The working environment, health workers and patients are the main reservoirs of hospital acquired related infection (weber, 2013). The transmission of infection from patient to patient mainly occurs at the hands of health workers (Ellingson K, 2014). The hands of health professionals are contaminated during patient care on a daily bases despite wearing gloves (Kendal A, 2012). Handwashing is critical in the prevention of hospital acquired infections. It is a very simple procedure and work well in the prevention of diseases as people are the carriers of pathogenic microbes. The practice is however unacceptably low among health workers (Takahashi Turale 2010; Trampuz Widmer 2004). Hand hygiene compliance rates in different developed countries rarely exceed 50% (Mani et al. 2010; Maxfield Dull 2011; Ott French 2009). For instance, figures show that in the USA it is 50%, in Switzerland 42% and in the UK 32% (Takahashi Turale 2010). Hence, poor compliance has resulted in high morbidity and mortality. In the USA, there are between 1.7 and 2 million people who contract HAI and 88 to 99 thousand deaths are attributed to HAI annually. Furthermore, HAI affects nearly 10% of hospitalised patients and presents major challenges in healthcare facilities. Consequently, annual medical expenses have increased in the USA to approximately $ 4.5 billion (Maxfield Dull 2011; Smith Lokhorst 2009; Trampuz Widmer 2004). Hand hygiene practice among HCWs is considered to be the single most clinical and cost effective measure to prevent HAI, a view recognised internationally (Momen Fernie 2010; Ott French 2009; Takahashi Turale 2010).The World Health Organisation (WHO) strongly emphasise the essential need for hand hygiene during healthcare delivery, to avoid possible infection and subsequent complications; hence, the Clean Care is Safe Care programme, launched by WHO in 2005 as part of the First Global Patient Safety Challenge. This programme offers new guidelines on hand hygiene training, observation and performance reporting in healthcare settings. Out of every 100 hospitalized patients, at least 7 in high-income and 10 in low-/middle-income countries will acquire a healthcare-associated infection. Among critically ill and vulnerable patients in intensive care units, that figure rises to around 30 per 100 (who,2014). Factors that contribute to poor hand washing compliance include absence of hand washing sinks, time required to perform hand hygiene, patients condition, effect of hand-hygiene products on the skin and inadequate knowledge of the guidelines(Larson and Kretzer, 1995; Simmons et al., 1999;Meengs et al., 1994; Doebbeling et al., 1992; Voss and Widmer, 1997). PURPOSE OF THE STUDY The purpose of this study is to determine the knowledge, attitude, and practices of healthworkers and also compare between healthworkers regarding their knowledge, attitude, and practices on hand washing. MAIN OBJECTIVE To determine hand washing practices among health workers in the Tamale West Hospital. SPECIFIC OBJECTIVES Assess the knowledge, practices and attitudes of healthworkers on handwashing Assess the differences across age groups, gender and experience regarding KAP of handwashing Compare between healthworkers regarding KAP of handwashing Assess the availability of resources for handwashing RESEARCH QUESTIONS What is the knowledge, practices and attitudes of healthworkers concerning handwashing? Are there differences across age groups, gender and experience regarding KAP of handwashing? Can KAP between healthworkers regarding handwashing be compared? Are there available resources for handwashing? SIGNIFICANCE OF THE STUDY Hand washing is considered the most important single and simple practice for preventing hospital acquired infection. An intricate problem may be caused by a number of factors if there is failure to practice effective hand washing. Understanding the factors that influence this behavior is key to change the behavior of poor effective hand washing practices. More studies are needed to identify, which of the factors contribute significantly to the problem of poor compliance with hand washing recommendation. OPERATIONAL DEFINITION OF TERMS Hand washing Hand washing is the process of cleaning ones hands with or without the use of water or another liquid, or with the use of soap for the purpose of removing soil, dirt, and/or microorganisms. Health care workers Professional personnel working in clinical setting of a health facility Veronica buckets Buckets used to store water for washing of hands Nosocomial infection/hospital acquired infection are infections gotten from the hospital setting. LITERATURE REVIEW KNOWLEDGE, PRACTICES AND ATTITUDES OF HEALTHWORKERS ON HANDWASHING Hand hygiene practice among HCWs is considered to be the single most clinical and cost effective measure to prevent HAI, a view recognized globally. Despite the relative simplicity of this procedure, adherence to hand washing recommendations is unacceptably low, usually well below 50% (Ekwere Okafor, 2013). Most nosocomial infections are thought to be transmitted by the hands of health care workers. It has long been known that hand hygiene among health care workers plays a central role in preventing the transmission of infectious agents. Hand-washing (HW) is the most effectiveway of preventing the spread of infectious diseases But despite a Joint Commission requirementthat Centers for Disease Control and Prevention hand hygiene guidelines be implemented in hospitals, compliance among health care workers remains low The reasons for low compliance to hand hygiene have not been defined in developing countries probably due to limited studies on hand hygiene. Factors that contribute to n oncompliance to HW among health careworkers are: lack of awareness and knowledge among health care workers as regard the importance, techniques, methods and quality of hand hygiene (Abd El Aziz Bakr, 2009). Alex-Hart and Opara, (2011) study on hand washing revealed that, more than halve (55.4%) of the health workers lacked the knowledge of good hand washing technique as most believed it involved the use of soapy water in a basin. This may be due to the fact that running water is not readily available, so the use of soapy water in a basin may have been the available alternative. With its repeated use over time, most health workers may have come to perceive it as the ideal hand washing technique. The NMCS Code of Standards and Conduct requires nurses and midwifes to provide a highstandard of practical care all the time. Yet, the momentum for hand hygiene, some nurses are still presenting with low compliance because they perceive it as not their problem, that it is something to do with infection control staff and they have to deal with it . Furthermore, Nazarko (2009) indicates that nurses often fail to practise hand hygiene because they are busy and they feel hand hygiene takes up precious time. In addition, nurses often perceive that gloves can be used as an alternative to hand hygiene. They usually tend to remove the gloves without washing their hands or use the same gloves to deliver intended care to multiple patients. Even when they remove their gloves, only 20% of nurses actually clean their hands (Ott French 2009). According to Canham, (2011) nurses avoid hand hygiene because they are frightened that skin problems such as dermatitis could develop, especially with alcoh ol hand-rubs. DIFFERENCES ACROSS AGE GROUPS, GENDER AND EXPERIENCE REGARDING KAP OF HANDWASHING Nurses tend to wash their hands more often than doctors and among non-health care workers, females tend to wash their hands more often than males. This study examined the influence of gender on the hand washing rates of health care workers (HCWs). The null hypotheses were that, there would be no inter-gender difference in either hand washing rates in healthcare workers across professions, or within professional groups. Although increased compliance with hand washing protocols has been shown to decrease infection rates, hand washing compliance remains poor, particularly among some professional groups. Studies of hand washing frequency have recorded hand washing rates following patient contact ranging from 10.6% to 61%, and significant differences have long been noted in hand washing frequency between professional groups such as nurses and doctors. (Van de Mortel, 2001) Van de Mortel, (2001) studies again found out found that, registered nurses (RNs) washed their hands following patient contact significantly more often than doctors in the Intensive Care Unit (ICU). The RNs washed their hands 71% percent of the time, whilst junior and senior resident doctors (RMOs) washed their hands 50% of the time and specialists washed only 25% of the time. He postulated that, failure to wash hands may be a gender-related phenomenon. The proportion of female nurses is considerably higher than the proportion of female doctors. In the above study, 90% of the nurses were female; 45% of RMOs and 6% of specialists were female. (Van de Mortel, 2001). Several studies have examined, among other variables, the influence of gender on hand washing frequency in health care workers however; these studies arrived at conflicting conclusions. Van de Mortel, (2001) found that hand washing frequency in the emergency department was lower among female nurses, RMOs and specialists tha n among males within each of those groups, however, the sample size of the study was small (n = 13 nurses, 11 RMOs, and 11 specialists). In contrast, in an extensive study of hand washing practices in two countries, it revealed that female health care workers were washing their hands more frequently than males, regardless of occupational group. However, this study was based on self-reported practices collected by questionnaire, and a degree of bias may have been introduced due to the fact that non-responders may have exhibited different behavior than responders. There is also a tendency for people to overestimate socially desirable behavior when answering questionnaires. To illustrate the latter point, Van de Mortel, collected data on hand washing frequency among doctors, both by means of questionnaires and by covert observation. He found that doctors estimated that they washed their hands 73% of the time, but the data collected by covert observation showed the percentage of doctors washing their hands following patient contact was in fact only 10.8%. METHODOLOGY This chapter describes the study area, the study design, the study population and the sampling procedure as well as the recruitment of respondents and the data collection procedure. The data entry and analysis is also outlined in this chapter. RESEARCH DESIGN This study is a cross-sectional study method designed to assess the knowledge, attitude and practices of health workers in TTH towards handwashing. Including assessing the differences across age groups, gender and experience regarding knowledge, attitude and practices of handwashing, and also, compare between healthworkers regarding KAP of handwashing RESEARCH SETTING The study will be conducted at the Tamale Teaching Hospital (TTH). It is a foremost tertiary referral centre providing patient care to residents of Tamale and neighboring towns and cities. There are 30 wards in Tamale Teaching Hospital. There are 74 doctors and 655nurses at the hospital. Hand-washing facilities are located in all the wards and clinics in the hospitals. Each ward is provided with at least a Veronica bucket for hand washing, running tap water, soap (liquid or cake) and sometimes, a towel for hand drying. TARGET POPULATION This study targets the clinical staff of the Tamale Teaching Hospital with a total population of 729. There are 31 wards in Tamale Teaching Hospital SAMPLE, SAMPLE SIZE, AND SAMPLING TECHNIQUE The sample size is 360 respondents this was arrived at by the using Cochran formula. Sample Size = [z2 * p(1-p)] / e2 / 1 + [z2 * p(1-p)] / e2 * N] N = population size z = z-score e = margin of error p = standard of deviation N= 729 Z= 1.96 (using 95% confidence interval) E=0.05 P= 0.5 Sample size = [(1.96)2*0.5(1-0.5)]/0.052 / 1 + [1.962*0.5(1-0.5)]/0.052* N Sample size = 384.16/1.076 Sample size= 357 An extra 3 was added to make it a total of 360 respondents. There are 30 wards in the hospital. 12 respondents would be sampled from each ward if they are eligible for the study. INCLUSION CRITERIA Respondents must be registered healthcare workers in the Tamale Teaching Hospital. EXCLUSION CRITERIA Medical, nursing and other clinician students are excluded from this study. DATA COLLECTION TOOL A well-structured questionnaire will be used to collect socio-demographic data, knowledge on handwashing from the respondents. PROCEDURE FOR DATA COLLECTION Probability sampling technique will be used. This is to help get an equal proportion of participants from the various wards used. The data collection will employ the use of structured questionnaire which respondents will check and will also give short answers to some questions to solicit data from respondents. All the wards will be successfully visited on a daily basis to get eligible participants for the study. These wards will be visited on a daily bases recruiting respondents until the last questionnaire is administered. The wards in the Tamale Teaching Hospital include; Purposive sampling will be used to select clinicians from the hospital who will be available during the data collection from Tamale Teaching Hospital. The study data will be collected based on the socio-demographic characteristics of respondents, general knowledge about handwashing, assess the differences across age groups, gender and their experiences regarding handwashing through the use of a structured questionnaire administered by the research assistants with minimal clarification from the research assistants. Primary data will be collected and used in the analysis. DATA ANALYSIS The data will be coded in excel and then entered into SPSS V.16 for analysis. Responses will be assigned codes in the form of numbers, which will make it easy for keying in the responses into a computer format. Univariate analysis will be done for socio-demographic characteristics of respondents and also for areas that require only descriptive statistics. Bivariate analysis will be performed to find associations or relationships between socio-demographic characteristics and level of knowledge, attitudes and practices of clinicians on handwashing. Likert item was rated on a 1-5 response scale; where strongly agree=5, agree-4, neutral=3, disagree=2, strongly disagree=1. The scores were graded into positive, neutral or negative. ETHICAL CONSIDERATIONS Ethical approval to use the hospital was from the Ethics and Research Committee of the hospital. Formal consent will also be obtained from the respondents prior to administration of questionnaire. Individual participants will be told that the study is purely for academic purpose and names as well as addresses will not be and also needed assuring them of their privacy and confidentiality. Respondents were also told that they had the right not to participate in the study. LIMITATIONS OF THE STUDY The cost and inexperience of researchers in conducting this study will be a challenge. Also, bias in the sampling procedure can also occur. REFERENCES Abd Elaziz, K.M. Bakr, I.M (2009) . Assessment of knowledge, attitude and practice of hand washing among health care workers in Ain Shams University hospitals, Cairo, Egypt J PREV MED HYG 2009; 50: 19-25 Alex-Hart A. B. and Opara, P. I. (2011). Handwashing Practices amongst Health Workers in a Teaching Hospital. American Journal of Infectious Diseases 7 (1): 8-15, 2011 Ekwere, T. A Okafor P. I (2013) Hand hygiene knowledge and practices among healthcare providers in a tertiary hospital, South West Nigeria Nazarko, L. 2009. Potential pitfalls in adherence to hand washing in the community, British Journal of Community Nursing 14:2, 64-68. Ott, M. French, R. 2009. Hand hygiene compliance among healthcare staff and student nurses in a mental health setting, Mental Health Nursing 30, 702-704. Van de Mortel, T. F. (2001) Gender Influences Hand washing Rates In the CriticalCare Unit. American Journal of Infection Control, vol. 29, no. 6, pp. 395-399.

Wildlife Corridors :: Wildlife Habitats Conservation Biology Essays

Wildlife Corridors With the continuously accelerating rate in the loss of wildlife habitat, there is a concern which greets the upcoming century. The problem with the presently remaining "untouched" wilderness is that large whole pieces of wild habitat end up manipulated to suit the needs of human populations. Often times mismanagement of land, besides the mere intrusion into a delicate habitat, exerts stress upon it’s state of equilibrium; so much so that certain species within an area become at risk for extinction. Depending on the stability and degree of interspecie dependency, the extinction of a couple of species of animals could lead to the gradual eventual degradation of that habitat. The focus of many leading conservation biologists within the last three to four decades has been on the study of different factors and dimensions that influence the extinction rate of different types of wild habitat. By understanding the factors and dimensions involved in the maintenance of habitat stability , conservationists may be able to more accurately explain how fragmentation effect specific types of habitat and population, and more accurately predict the effects of proposed conservation projects. Now as we enter a new era with frightening statistics on environmental destruction, conservationists are calling for quick action to slow down the rate of extinction and habitat fragmentation. The present popular proposed solution is for the construction of dispersal corridors, which will reconnect pieces of isolated habitat and reduce the rate of wildlife extinction. There is not enough available material to support this proposal but there is also not enough to prove it unworthy either. Although this is not the only solution to the problem, it is the most appealing to conservation biologists who desire to protect and reclaim wilderness quickly. Thus, ecological corridors is a critical topic of debate because it has become a popular concept taken very seriously by radical conservationis ts who are in a haste to implement the plan but who do not have sufficient data to prove that it might not counter their predictions and, as many skeptics fear, prove detrimental for habitat restoration. CORRIDOR ANALYSIS AND DESIGN Analysis In regions where habitat is fragmented by urbanization, cattle grazing, deforestation, etc., animals need a natural temporarily sustainable pathway for movement and migration in order to prevent either chances of inbreeding or overexploitation of prey. (1,3) Corridors act as a source of connectivity between two or more isolated habitat patches, making a natural landscape more confluent.

Airborne Express: the Underdog

AIRBORNE EXPRESS: THE UNDERDOG CASE STUDY QUESTIONS 1. Analyze the United States small package express delivery industry in the 1990’s using the Porter’s Five Force Model. Rate each of the five forces as either weak, moderate, strong or fierce. Justify your rating by using two factors under each force and describing how these factors affect the strength of the force. The Bargaining Power of Buyers The bargaining power of the buyer was somewhat moderate-to-slightly strong due to the fact that certain corporations were so high ranked that, they could manipulate their prices to their advantage.On top of that substitutions existed with the other mailing companies which gave the â€Å"buyer† choices. Low prices were taken advantage of by consumers, for if they were too expensive, they’d switch their services over to another company who would provide the same shipping, delivery and transportation system, at a more reasonable price. High-volume corporate customer s have a great deal with more bargaining power than customers who don’t buy from them frequent enough. This meant that they could allow and demand substantial discounts.IBM made a 3-year contract with Airborne Express to pay them to carry their products that were 150 pounds or less. The only downfall about that was that Airborne Express had to offer rates 84% below Federal Express’s list prices. Approx. 80% of Airborne’s revenue came from corporate accounts such as IBM. High-volume corporate companies such as IBM have the bargaining power over Airborne Express. The Bargaining Power of Suppliers The bargaining power of the suppliers, at the time, was fairly strong.When it came down to the delivering and shipping of packages in the world, there were only a few companies who operated globally. This is one bargaining power that Airborne (the supplier gained). . Data Product Corp. ; a producer of computer printers, contracted out Airborne to take care of their arrang ements and shipments of their component parts. Airborne controlled the consolidation and movement of component parts from the component part supplier through the Hong Kong assembly operation. This allowed the company to minimize inventory-holding costs for the Data Product Corp.Airborne was in control and created set prices for the company to abide by or else, they would cease to ship for the company. Airborne shipped everything by night in which they controlled when packages were delivered. They would close their drop boxes at 5pm, so any packages that weren’t ready by that time, weren’t shipped until the next day. They controlled the time of when packages were due so customers would push to get their packages put into these drop boxes before they closed. Airborne also created and built their own hub-and-spoke system capable of supporting a nationwide distribution system.They had their own planes, trucks, as well as other equipment, which meant that they didn’t have to rely on others to send out their packages. They were in control and could regulate their own price and supply levels directly. 2. List at least two strategies that Airborne implemented to strengthen each of the four building blocks of competitive advantage (efficiency, innovation, quality and customer responsiveness). Explain how the strategy strengthened the building block. r 3. Did Airborne Express have a sustainable competitive advantage? If yes, what was the competitive advantage based on.If no, why was their competitive advantage not sustainable? Yes, Airborne Express did have a sustainable competitive advantage. They provided many strategies that companies of others did not implement and/or use. One would be the usage of special drop boxes for their customers. Airborne provided multiple drop boxes in several locations for customers to send their packages along. The packages were collected from the drop boxes at 5 pm, everyday. These drop boxes were placed and located in specific locations such as; lobbies in major commercial buildings, which made access to these boxes available to many.Central drop boxes were placed in the cities as well, allowing customers up to 6 pm before collecting packages and closing the drop boxes. Another advantage that Airborne Express had over other companies was the development of their information systems. With these information systems in use, Airborne Express had improved their customer service as well as boost productivity within the company. The three information systems that were created were: the Libra II system, the FOCUS system, and also, the EDI system.Libra II was used to calculate and weigh the package at hand, while providing shipping labels and reports. The FOCUS system recorded the status of the package (such as location, shipment time, etc. ). Last but not least, the EDI system was used to â€Å"eliminate the flow of paperwork†. This meaning that forms in the form of â€Å"paper† was redu ced if not removed and instead replaced with electronic data forms. Another competitive advantage that Airborne had was the strategic alliances that were created with multiple foreign agents.These countries consisted of Thailand, Japan, Malaysia, and South Africa. With this move globally, this put Airborne into the international aspect of package shipping and delivery. 4. As Airborne Express’ customers became global, Airborne Express had to develop a network to meet their needs to deliver packages to international location. They chose a very different approach than Federal Express. Describe Airborne Express’ strategies to provide global services. Also list two advantages and two risks associated with the approach that Airborne Express adopted.

Weekâ€2 Quiz Essay Example

Week–2 Quiz Essay Example Week–2 Quiz Essay Week–2 Quiz Essay Cardiovascular System: Peripheral Circulation and Regulation Systemic blood vessels transport blood From the left ventricle through the body to the left atrium. From the left ventricle through the body to the right atrium. From the right ventricle through the body to the left atrium. From the right ventricle through the body to the right atrium. From the left ventricle to the lungs. Which of the following functions is associated with vessels that carry blood directly from arterioles to veins without passing through capillaries? thermoregulation nutrient supply to tissues removal of metabolic waste products from tissues oxygen supply to tissues pH regulation In the pulmonary circulation, the _____ carry blood to the lungs. carotid sinuses pulmonary arteries coronary arteries superior vena cava and inferior vena cava aorta The abdominal aorta divides at L5 to form the two Inferior mesenteric arteries. Common iliac arteries. Superior mesenteric arteries. Femoral arteries. Renal arteries. Blood from the posterior abdominal wall drains into the Hepatic portal vein. Inferior vena cava. Ascending lumbar vein. Mesenteric vein. Hepatic vein. A blood pressure reading of 120/80 would Indicate a diastolic pressure of 120 mm Hg. Have Korotkoff sounds at pressures above 120 mm Hg. Be considered normal for a young adult male. Indicate a systolic pressure of 80 mm Hg. Would be considered hypertensive. In the aorta, The blood pressure and blood velocity are both high. The velocity of blood flow is high, but blood pressure is low. The resistance to blood flow is high, but velocity of blood flow is low. The resistance to blood flow and the blood pressure are both low. Velocity is diminished because the total cross-sectional area is small. In capillary exchange, which of the following statements is true? Most fluid that leaves the arterial end of a capillary reenters the venous end of a capillary. Interstitial fluid normally has a higher osmotic pressure than plasma. Constriction of the precapillary sphincter will increase blood pressure in the capillary. Interstitial protein concentration is normally higher than plasma protein concentration. Most fluid that leaves the arterial end of a capillary enters the lymphatic system. Baron von Quacko, famous tag-team wrestler, has a famous sleeper hold that he uses on his opponents. Using only a single digit on each hand, he presses on his opponents neck until his opponent passes out. What are the structures on which he is pressing and what is the effect? subclavian arteries; blood flow to brain is stopped carotid chemoreceptors; blood pressure increases baroreceptors in carotid sinus; peripheral vasodilation and decreased heart rate vertebral arteries; blood flow to brain is increased jugular vein; blood flow back to heart is decreased Atrial natriuretic factor Is released in response to elevated atrial pressure. Stimulates the release of ADH. Decreases urine production. Stimulates release of aldosterone. Increases blood volume.

Help Editing

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Coursework Example | Topics and Well Written Essays - 500 words - 2

Coursework Example The two females featured in Bend it like Beckham experience their gender in different ways. Jesminder â€Å"Jess† Bhamra is infatuated with football but her parents who are Indians have forbidden her to play because she is a girl. However, Juliette â€Å"Jules† Paxton parents are okay with it yet she is still a girl. Jess family expect her to have a job that is suitable for ladies her age that’s why she pretends to have a job so that she can play with the Hounslow Harrier a local women’s team. Jules is allowed to follow her passion for female football. Both Jess and Jule’s parents become concerned when these two best friends fight and they fear that their daughters are lesbians thinking that the girls’ disagreement is a lover’s quarrel. All in all, both families expect Jess and Jules to dance at a Sikh wedding in which Jess’ elder sister is getting married. In the fifty years since television became commonplace for western civilization, this one piece of technology has had incredible impact on society and basically revolutionized the way people see themselves and the world around them. The debate as to whether the impact is positive or negative has been taking place since the inception of the TV in the late 1940’s. Television’s potential to connect, educate and inform the public is often overshadowed by the lack of individual responsibility in using this modern-day miracle, therefore causing its impact on society to be viewed as negative. Television provides viewers access to arts, music, religion, new technology and information. Such technology is a venue for inspiration and enrichment and it also allows the viewer to become engaged in issues that have personal and societal implications. Viewers have been able to witness everything from presidential debates to man walking on the moon to wars being fought right in front of them. They have discovered ways to renovate their homes, look

Minnesota Multiphasic Personality Inventory - MMPI Essay

Minnesota Multiphasic Personality Inventory - MMPI - Essay Example The MMPI has assessed in a variety of areas, such as: Criminal justice and corrections; evaluation of disorders; screen candidates for high safety positions; assess medical patients; evaluate participants in substance abuse programs; support college students and counseling; marriage and family counseling; and, screen international adoption parent. The MMPI is not sold and has been replaced by the MMPI-2 (Wikipedia, 2007). Scale 2 Depression, it identifies poor morale, the lack of hope in the future, and general dissatisfaction with ones own life. The high scores are identified as clinical depression and the low scores as unhappiness with life. Scale 5 Masculinity-Femininity was originally used to detect homosexuals but was not accurate. It is used to measure traditional masculine or feminine roles prior to 1960 and it is related to intelligence, education, and socioeconomic status. Scales 8 Schizophrenia assesses bizarre thought processes and peculiar perceptions, social alienation, poor familial relationships, difficulties in concentration and impulse control, lack of deep interests, disturbing questions of self-worth, and sexual difficulties. Hunt (2000) wanted to test that low iron status or other nutritional deficiencies are associated with symptoms of depression in premenopausal women of child bearing age. The author associated the blood indices of iron status to scores on the MMPI and responses to a mood adjective checklist. This took place during the women ´s menstrual cycle. There were 365 women who seemed healthy participants from Grand Forks, North Dakota. They found that the frequency of the elevated MMPI Depression scores did not relate to the frequency of low hemoglobin, transferrin saturation, or ferritin. The results did not support the hypothesis of low iron status contributing to symptoms of depression in women. According to Butcher et al. (ND) both the MMPI and