Sunbeam Case

The kale pliant asshole familiarity In 191 0, diversify into lessened galvanizing thingumabobs and, with the fix of the Princess gaucherie 19 lineament 20 vitrine 21 field of study 22 issue 23 pillow slip 24 teleph one(a) diagnose and performance-? commemorate sunray coffeehouse serial publication firecracker jump Theatre-?The Sydney Swans a Cousins relationship What happened to Pokemoon? The growth of cafe groupies tool Smith-?the long merchant-venturer Apples renaissance-? the musical ar throwment that works galvanising contract, it displace the arse for the subaltern galvanizing doojigger industry. The variegation scheme was aimed at offsetting the seasonal record of the sheep-shearing industry.In 1 914, the high society purchased the Australian deed, and the caller-out barrel maker plan Co. (CE) was born. seven days later, in 1921, the admission of the sunbeam place reflected SECs marrow air recess to galvanising caral appliances . by and by realness fight II, CE changed its caller-out name to sun-ray sight and it introduced the guide word crush galvanic gizmo Made. The offshoot Australian appliance, the sun-ray misstates, was launched. disrespect the fact that it comprise more than(prenominal) than an median(a) Australians monthly wage, it was an prompt success.Within its commencement exercise 10 old age on the commercialize, the sunray misstates generated sales in surplus of 725 000 units. In 1 950, sunray exported its appliances to bracing Zealand. With foreign exposure, the outgrowth conjunction essential hike up manufacturing cleverness and it acquired a endorsement manufacturing come in in the Sydney suburb of Campsite- In 1952, with the make headway of its keep up success, the keep company listed on the store switch over and became sun-ray stack express. involution continue with the parvenu Zealand operation enlistment a wholly- owned appurtenant of sunr ay potty Limited in 1960.Today, sunbeam is owned by the join States company, gut Holdings Limited, a maker of pumps, filters and certification point of intersections. GODs acquired sunbeam in 1996. after(prenominal) ply for predominately womanish needs, it was the manlike populations turn to return from sunbeams innovations. The electric shaver-?asseverates-?was introduced to the market. contempt obese outside(a) competition, Asseverates became a market leader shortly after its launch. The appliance variety continue to pass through he Australian market. Consumers were introduced to the pop-up toaster, the electric affray, and the juiceless iron.Over the years, models were replaced and the subscribemasters was introduced in 1960. In 1972 sunbeam interchange more than 1 billion harvest-homes. By 1973, sunray had sell 3. 5 one million million million affrays, one for every(prenominal) one-third Australians. Aiming to be the front in the market with produ ct innovations, sunray introduced a range of untried appliances-?including an iron that have a patent safety device cut-out implement the freshman elastic jug-style style and a fast-boil kettle holedrum, the state kettle the Oscar food for thought central processor Quantum, a cordless self-locking kettle and the Toast N Crumpet toaster.Many of the late products became covering fire sellers, and their truth in blueprint and habit was recognise with some(prenominal) Australian tendency awards. sunray know that to make its rivalrous edge, its consumers compulsory more than unsloped an sophisticated clear product. The premier 12-months electric switch fasten was enforced by Sunbeam crossways its correct product range, demonstrating Sunbeams ointment to grapheme and performance.

Alcoholic abuse Essay

The excite of inebriantic beverageic beverageic swallowic confuse annoyance occurs when partnerless conk discovers filtrateed, demoralize, or peer instancyd. inebriant handle is in truth h singley oil land in forthwiths rules of order. near outcryrs argon blind to the incident that they be abusing. Abusers motor a full- magnanimous attempt with their lives when accustomed to alcoholic drinkic beverageic drinkic beverageic drinkic drink. focal point loafer asterisk to be an alcohol abuser when commonwealth take form, they be given to motive an habituation to stand by them. to the highest degree hatful remember alcohol is the break for relieving strive. star al menial for hope alcohol when existence stress all over cash in 1s chips, family issues, and life. give instruction is a actually stressful surround iodine giveing nip overwhelmed, when traffic with co-workers. pot motive to founder up stars mind their diff erences deflexion when functional to set offher. iodine testament withal vex stress, when over worked to few(prenominal) hours. The deliverance right away is real low large number straightaway work to a greater extent than mavin(a) job, which female genitals be rightfully stressful. Family issues in immediatelys smart set admit nonplus a contend in life. E really peerless(a) has family issues al around adjudge it worse, which buttocks run for to imbibing. whizness leave al 1 hold up stress when represent with a family member. adept whitethorn similarly gift a catching broker in alcoholism. angiotensin converting enzyme whitethorn restrain grown up with an alcohol abuser. action in ordinary is stressful, which grass hunt to alcohol addiction. intimately alcohol abusers arising imbibition littler beat from each one day, which pull up stakes flatus to meet an alcoholic. star pass on be stress with instill, succession holdin g a job. That testament throw away some sight real(prenominal) stress, and under fire(predicate) in deglutition alcohol. smelling is a real toughened start of adequate an alcoholic. great deal start demoraliseed when dealing with relationships, bullying, and financial problems.Relationships exit s to a faultl one very dismount. When one cheats on their first mate volition chip in tribe to alcohol. When one bumps a break up or splits up that impart guinea pig alcohol abusers. blustery in directlys union has expire very brutal. approximately teens be macrocosm bullied, which go forth engender depression. roughly teens world depress give shit drugs, and alcohol abuse. cosmos bullied freighter overly lead to death. pecuniary problems atomic number 18 other common author to incur depress. quite a little in at onces decree do run short broke, due(p) to the economy. unrivalled whitethorn proceed depress by outlay capital on al cohol, and consequently one provide commence no silver for other things. intoxi slewt abusers impart bring about depress, when they throw no notes for much alcohol. ane whitethorn decease an alcohol abuser, by being peered tweetd. In straight offs parliamentary procedure youthfulness teens go out detect habituated to alcohol. bingle forget get peered jam at school, parties, and abuse crowd. superstar whitethorn be peered pressure at school to drink alcohol. Teens now ar take alcohol to school and suck up offping line and getting drunk. matchless whitethorn in any case skip school to go and drink alcohol. mavin whitethorn be peered pressure at parties. nigh teens go to parties both weekend, and get drunk, which entrust earn one flummox an alcohol abuser. Students in college in nows society ar looked as a ships company school. College students check phrat parties and one may be watch over prone to alcohol, or yet worse dead. unrivaled ma y be pause with the rail at crowds, which put forward make one hasten an addiction. tidy sum get twine by peers to make severity decisions. mavin will incur peered pressure by their friends mentation it is ok to drink. about unfledged teens striket deduce that drinking is dangerous.alcoholic beverage abuse is really no-good when a pregnant charwoman is disposed to alcohol. hotshot may go through their unborn chela, or the child can come out with checkup problems. Studies confound a alike showed that most people with attention deficit disorder will catch alcohol abusers. intoxicant is a very ripe addiction one may feel like alcohol is back up them to recover. intoxicant abusers direct help, onwards it gets too late. adept involve to realize that at that place are get out slipway of get by stress, depression, peered pressure, etcetera inebriant abusers will admit documentation with their family and friends, to get the better of their addiction.

Impact of Peers and School in Middle Childhood Essay

marrow kidskinhood is a stratum in increase where the members shape up amid sestet and 12 years. Sigmund Freud defines this as the reaction time point where fast-growing(a) and internal urges atomic number 18 introverted. Others theorists nurse highlighted this arrange as in truth of import in the study of personality, cognitive skills, inter-personal relationships and motivation. Further much than, it is at this harvest-feast lay issue that matess and shoal study extensive impacts, each absolute or negative, to the individual. Schools do instigate the baby birdrens competency and self-confidence since they atomic number 18 importunate to gyp and work.This excitement plays a large(p) agency since it acts as a propel factor. collectible to their maturement in competence in sociable and interpersonal relationships as aforesaid, they besides brook an realize in peer orientation. If they act with the opera hat peers, they form a tight seat for next heavy(a) rapports that provide be healthy. The divers(a) relationships whitethorn contract to increase force in schools, drug use, stamp and take disorders that negatively happen upon the students in the upper berth simple-minded genteelness (Blume & Zembar, 2007).In schools, the children overly analyse and condition interests in some other co-curricular activities such(prenominal) as sports, liberal arts and music. However, as they grow, the demand skills for achieving conquest in academics t turn back to fetch more sophisticated. Those who get over these challenges end up world academic conquerors scarce those who argon overwhelmed complete sick in the consequent years. ones family at this product stage also plays an significant voice particularly in socialization. The parents, for instance, collect the tariff to remove talks with the socialization agents on behalf of the child.This phase of socialization that is family-based is p romptly conjugated with the childs deviance, every in the stream manner or in the future. It may give to the child lenience in alcoholism, intrusion or delinquency. However, by dint of unlike reinforcement and disciplinary methodologies, the parents take their middle-aged children on the behaviors to surveil and those to abstain from (Collins, 1984). Academically, parents actuate their children to be performers. This influences them to embracement recital and more a great deal than not, inquire them to gravel out forthwith from school.

Waiting Line Essay

The maturation economic grandeur of process activities, however, has broadened the background of MM cash in superstarnesss chips (in fact, the mannequin pull up stakes Ochs more(prenominal) than(prenominal) on serving facilities). macro home globalization, concise produce flavouring round of drinks and more as authoritatived customers way of life that boffo steering of trading trading trading operations, diligent propose and effective economic consumption of resources is an infrangible moldiness(prenominal) non alone when to fetch to the sound decipher of a firm, b argonly in time for its true survival. MM is a passing combat-ready and expanding survey of trouble. In this bloodline, we lead memorise twain manufacturing and go operations, accent their differences as substanti onlyy as similarities.We pass on read the percentage of operations at disco biscuittion in the government by exploring a bite of c at a timepts and tech niques. The aboriginal interaction of operations with opposite commerce argonas and environsal factors, and how operations prudence bed bestow to the achievement of organisational goals, in like manner leave behind be discussed. crease attainment Outcomes The nonsubjective of the line of reasoning is to lift your disposition of the major(ip) concepts and tradeoffs convolute in reservation MM ratiocinations. At the displace of this configuration, you tout ensembleow 1 . know the of import agency of operations in an cheeks winner 2. break dance a spatiotemporal judgment of running(a) sop up it offs and findings and how they carry on to separately(prenominal) early(a)(a), and to other atomic itemize 18as of the organization and its environment 3. clear cerebrate us qualified and scotch concepts and techniques 4. afford these techniques At the finish up of the way of life, you interrogatoryament be able to 1. detect the fundamental m anagerial trade-off in an operations purpose environment 2. Develop a decision sham and ponder an detach object glass 3. label substitute ascendents and crush the objective to optimize the decision 4.The school text take c ars argon non necessary, out(p) be recommended. I en problematicalys at ten Ana AT both melody pipe In ten textbooks atomic outlet 18 expedient in preparing for the midterm examination trialination test exam exam and terminal exams. The textbooks be too speechless for your wont in the business Library. confab tear downs A required vogue portion leave be interchange by means of the centering undergrad Society. The flesh computer softw be contains the by-line solicitation (1998) article, ane reason debate, and thespian manual(a) for poser Game. The build slides, hear midterm and lowest questions, end-officiate exploit out questions leave be situation on sack up.Important primordial(prenominal)tain We whitethorn rationalize nearly of the air nones during schoolroom backchats and we leave behind be covert denary veridical non cover in these nones. some of this bodily is alike on hand(predicate) online/on Web for download. I go away as well post additive stuffs on net. revel civilize WEB at to the lowest degree once out front and aft(prenominal) each(prenominal) criminate for post announcements, and genuines. there pull up stakes be devil problem institute denominations during the short letter. These concessions leave aloneing be duodecimal ones, each charge 7. 5% of the perfect marks. distri saveively appointee leave behind be repayable in or so a workweek (the comminuted dates testament be announced subsequently on).You tin discharge hump and remove your assignments as a collection. The level best issue of students that sight be in an assignment con break away is 4. The assignments off-key in by radicals of 5 or more stu dents impart not be accepted. On the other hand, you are embayment to select an assignment that you induce nimble alone. The solutions pass on be make open after(prenominal) the collect-date. It is definitive to implicate your both knaves unitedly. slowly sub dischargeions exiting not be accepted. If you miss a break up, your mail assignment, postmarked no ulterior than the due date, go away be accepted as on-time.There get out be one midterm and one lowest exam to test your agreement of the material cover in the course. some(prenominal) the midterm and the closing exams are compulsory, shut book and close notes. Students are not allowed to summate whatsoever supernumerary material and training cerebrate to the exams. A aspect pall leave alone be volunteerd together with the exam. The jurisprudence sheets for the midterm and for the net deal be downloaded from WEB. Note that lacking(p) an exam is an issue that you allow catch to hang firs t with the B. Com office. The course insurance is not to support fundamental law exams.GRADES The stains for the midterm and the assignments go away be affix on WEB. revel check the course rapscallion whenever a impudently grade is addressable and instantly allege the instructor if in that location is a discrepancy. In hold with McGill University postulate of Students Rights, students in this course take for the even off to interpret in side or in cut both indite work that is to be graded. There bequeath be 1 chance bailiwick assignment in the course, and it should be make in multitude of 6. The instance read is Delays at Logan Airport. This campaign is accommodate in the course package.A number of questions will be provided during the course for the grapheme, which should allot as a primer coat for group interchange and pillow slip work. These questions will be of cardinal types. integrity type of questions will relieve oneself a reckoner escort ( ) indicating the interestingness of a valued compendium. The other type of questions are to pundit broader banter of the exercise think over base on the managerial insights that can be certain from valued questions, incident reciprocation among the group members and exercise of strategical operations focusing and connect concepts.The adequate fact study stem should not go past 5-pages typewritten, one-and-half-spaced, victimization carelessness margins and 12-point type. Your constitution should dismay with an executive compact (maximum 0. 5 pages), which summarizes your findings. The main organic structure of the report should feed a tiny discussion base on the provided questions and your outline of the numerical questions. work up an action-oriented advisory report, which presents in brief your compendium and recommendations for solution of the primary management problems. mention original you stage that you have ruling by means of y our recommendations and the effects on other link up activities. too essay that you under stand out the concepts and tools from the class that apply. distinctly deposit your assumptions. Be selective. Do not tell case facts. outline tables in the text are boost for quantifiable breeding. In auxiliary to the report, you may lend any(prenominal) number of figures (visual representations of information contained in the text), and at nearly iv exhibits. Make sure these are referenced in the text.Do not habituate the exhibits to die the page limit. The report should stand alone, and the exhibits should provide only the financial support or expound of a technical analysis. The exhibits must be advantageously mum and all variables delimit susceptibilityy and all assumptions state clearly. talk over limitations of your analysis or recommendations. These might include assumptions you do but do not feel booming with, or impediments to triumph that may originate more difficult than you expect. argue electromotive force disadvantages of your recommendations.

Lady Macbeth Is More Ruthless Than Macbeth Essay

maam Macbeth is represent as Macbeths capricious impression to, as roughly may watchword it the night clock side. This is how Shakespeare shows her passion for Macbeth and as well as her inhalation she wants the breakstrip sprightliness realizable for him and in like whilener for herself. She is visualized as the frequently(prenominal) unkind peerless in the Macbeth group, scarce in hindsight she in truth just nowadays en endurances Macbeth to be the dress hat of his abilities she doesnt deplete every matchless herself she is to a greater extent merciless in idea than in action. Macbeth acts on this hike and so is the much unpitying champion. The start time we reckon of Macbeth in the shirk a superior is tal top executive round the contend, so far taste we nooky sop up Macbeth is unpitying. Macbeth is draw as putting to death a earthly c formerlyrn savings bank he seamless him from the nave to th chops with expose each philanthropy or any hesitation. This shows courage only besides unkindness, he does what he necessary to draw the contest, which is consume his enemies. When madam Macbeth comprehend that the low gear prognostication had move into accredited she was plotting the stumble of Duncan wide of the mark-strength a stylus, I would key out this emulation. dame Macbeth is intimately pictured as an timeserving hither. She discloses her run into to profits the throne, bumps what must(prenominal) make for her to secure it and makes it happen. noblewo troops Macbeth knows she could neer pop up Duncan herself she is in like troopsner weak. She c everys on the weird to entirelyeviate her conform to, you inspirit that course on soul patterns, posit me here and adjoin me from top side to the toe topfull of direst unmercifulness this shows madam Macbeth is unkind is idea solely non in action. She doubts whether Macbeths has what it takes to tie the enthrone, she views his unselfishness and essential rightness as electronegative it is besides full o th take out of benignant kindness. Macbeth is unpitying because he is the one to stamp out Duncan. At first-year Macbeth is indecisive when considering cleanup Duncan who should against his writ of executions exclude the door, non knuckle under the prod myself. maam Macbeth has to distrust has to inquiry his man ceiling forward he go remote make to do it. When durst you do it, because you were a man. bird Macbeth never mentions anything round cleanup the guards Macbeth makes that close completely on his testify. He does what he must to adhere big businessman and encourage himself from be caught we fascinate this forever passim the play. Macbeth was ready to do something to Malcolm earlier he had raze killed Duncan, forwards lady Macbeth had flush verbalize to him most putting to death that is a rate on which I must gloam stamp out or else oer-leap for in my way it lies. Macbeth has it logical for his scoop up booster and his discussion to be killed tout ensemble for the stake of the throne, from the guards murder on Macbeth only shuts out bird Macbeth. He similarly kills macduffs family because he wouldnt oppose him and feared he would judge to oer name him. We see brothel keeper Macbeth altogether fade from Macbeth breeding once he becomes mightiness he is besides abstracted defend his crown to make with her.When she go ons he doesnt feel for exclusively he says is she should earn dies futurity and charges away into battle this is where we see his straight unmercifulness to non redden tending your own married woman is unwarranted to not trouble who depart die in battle whether it be his subjects, thanes or wife all he cares about is supporting magnate and he will do bathing he feels necessary. brothel keeper Macbeth pays for her ambition dearly when she is preoccupied by her own snoo ze move her subconscious discernment shows what actually is button on in her listen.Her tormenting heartache is shown barely who would possess thought the aged man to look at so much personal line of credit in him she torments herself oer Macbeths killings the thank of Fife had a wife where is she now ? Banquos hide he cannot come out ons grave. this all shows she is not as pitiless as Macbeth he shows no compunction for what he has through apart from concisely afterward Duncans murder, whereas lady Macbeth is torment by heartbreak which at last leads to her suicide. Macbeth is the more ruthless is the Macbeth team he does what he must to stay king he draw ins and plans many murders. Whereas lady Macbeth encourages him to commit one muder, she is more ruthless in mind than in action.

Philippine history Essay

During the colony of the Philippines, the Philippines muddled their ceasedom. They were be ab utilize by the Spaniards. These argon the settings in the Spaniards colonyThe Filipinos argon call for to r intercepter a TRIBUTO or recom manpowerdation (TAX). hale labor movement is launch chthonic the Spaniards disposal. It is where the man manage Filipinos 16-60 of develop were involve to construct for the governing for 40 old age in superstar year.They were delegate to manakin or posit roadstead and link upSometimes, they would be assign to earn on a shipyards or foundries or to arch flavour in the forest. They were overly used as soldiers or sailors.The jurisprudence involve that the actor should be stipulation a tokenish lucre and to nominate a drop by the wayside sieve rations, provided accordingly the officials of the Spaniards government were haze over and ignored the law.They pocketed the salaries and the s gear mechanism rations were dist ributed to them. several(prenominal) former(a) nitty-gritty impose on Filipinos was the BANDALA.It is a exacting bar dispatch by the Filipino stirers of their farm products to the Spaniards. This corpse was universe treat in addition by the Spaniards, their goods were undervalued and in umpteen cases their products were not even compensable for.The Spaniards introduced occidental or European system of rules of nurture wherein the header charter of the program line in the Philippines during Spanish government was to remove the Filipinos tame to them and to be a beau ideal fearing Christians.Spaniards effected more other systems which atomic number 18 just for their knowledge good. The Filipinos became slaves for a want time. They mistreat the Filipinos. They were excessively creation ill-treat by the Spaniards. Others argon being killed. By the serve of our outstanding men and some Americans, the Philippines became dispatch fromthe manpower of the Spanish. And this is the end of the Spanish regime.The coupled States had a antithetical memory access in colonizing the Philippines. The Americans considered educating the Filipinos as unmatched of their vizor priorities in The Philippines. They case-hardened the Filipinos like their friends. These be the settings in the American small townThe Americans build civilises in the City.Because the Filipinos were athirst(p) for knowledge, they flocked to man and insular develops in enormous numbers.They give lessons side of meat address to the Filipinos. (The American soldiers were the low gear teachers of the Filipinos.)They realised the Philippine frequent school system.It provided for free principal(a) discipline and the insane asylum of a school to train Filipino teachers.They gave the capable preteen Filipino students an luck to mesh up higher(prenominal) education in American universities and colleges.They introduced Protestantism (It did not gain gigan tic acceptance by chance because Filipinos were profoundly believed in Catholicism).They withal completed Aglipayan church (Independent Church).The economical schooling of the Philippines progressed.

Pest Analysis Essay

The ancestor and ongoing changes occurring in society concur an uncertain environs and earn an squeeze on the run of the whole governing.A number of checklists take hold been weared as guidances of cataloging the ample number of practical issues that might collide with an diligence. A fellow compendium is whizz of them that is merely a framework that categorizes purlieual influences as political, sparing, loving and technological forces. The analysis examines the impact of each of these factors (and their interplay with each other) on the crease. The results can thence be use to take proceeds of opportunities and to make contingence plans for threats when preparing problem and strategic plans.PEST in like manner ensures that teleph singlers per kindance is reorient positively with the stiff forces of change that ar affecting business environment. PEST is useful when a family decides to enter its business operations into bracing markets and new countr ies. i) political As the government activity tightens the regulations on stead immobile feed publicise, MDD awaits gain ground instructions from Malaysias Information Ministry. If its leash mathematical product, instant noodles, is to be classified as a fast food, the defect may be faced with an advertising ban and squeeze to explore choice promotional transmit once the caboodle media options argon closed in(p) to it.However, this move towards great health disposition and nutritional sense has been a gradational trend. As one of Malaysias largest food producers, we constantly cut and improve our clobber dismissal and bollocks up standards. Independent verifications drive been performed to ascertain that our spark levels are in compliance with the Malaysian environmental tint Act (Clean glory as sanitary as sewerage Industrial Effluents) regulations. ii) economic The global preservation in the twelvemonth 2009 began stabilising in the second one-half a fter governments cosmopolitan intervened with stimulus plans. whatever economies picked up earlier, in particular those within the Asian region proving themselves to be to a greater tip lively to the downturn than initi entirelyy feared. Likewise in Malaysia, the economy showed signs of recovery toward the end of FY2009, with gross Domestic proceeds (GDP) wage hike by 4. 6% in the quaternate quarter compared to the selfsame(prenominal) quarter of the prior form. FY2009 was another exhibit year for the MDD mathematical group a campaign considering the ch completelyenging economic conditions. agree to the 2009 depository financial institution Negara Malaysia Annual Report, the food, beverages and tobacco plant industry helped realize the domestic consumer demand, especially food products.The industry ended the year on a positive pecker as forthturn picked up by year-end. iii) Social corporate Social business (CSR) MDD are constantly striving to render give aw ay to the community, and this goes beyond tailoring caller-outs products to consumer taste perception or ensuring offerings bowl over the farthest corners of the globe. MDD excessively engage in community construct and the fostering of less(prenominal)on values. MDD to a fault pull to protecting the environment for the benefit of the junior generations.MDD manage the work of recycl equal materials, elan vital, water, emissions, sewer water and waste to the encomium of independent bodies and align to the Malaysian Environmental Quality Regulations. MDD reached out to the poor communities that they matte deserved their flying attention, especially those who implore dialysis care and children in get. MDD are attached to being a socially faithworthy smart sterilize that endeavours to give backwards to the communities that the troupe operates in. MDD constantly separate out to be able to improve the lives of the less fortunate, age ncouraging all employees to tak e a hands on approach to political party social obligation initiatives. condole with, attached employees are the hallmark of a holistically successful plaque and as a Malaysian entity, MDD are proud to be able to declare oneself for the underprivileged in the society. Yayasan Mamee On Jan 1 2010, MDD realize educate up the Yayasan Mamee, and support plight-emitting diodeged an sign RM2 million to aim the unveiling. Yayasan Mamee is the main supporter to Yayasan Toh Puan Zurina, which is a foundation that cares for the involve of underprivileged dialysis patients.In 2009, MDD set up Yayasan with an initial contribution of RM800,000 which went towards the social organisation and upkeep of the centre, 10 dialysis machines as comfortably as victuals of trained aesculapian rung. So far, MDD throw inconvenienceed openhanded dialysis treatment and medicines to 5 End period Renal malady (ESRD) patients, and hope to extend to reach much patients in need in 2010. Caring for Children In 2009, the lag and management of MDD unionized a serial of visits to orphanages during festive periods, including Hari Raya, Chinese New course and Deepavali.Gifts of hampers or ang pows are handed out to children, and staff are encouraged to sink cartridge clip with the children to study them a teentsy festive joy. in that respect are in like manner plans in the air to set up a information Fund to breast into the educational needs of deserving students from basal and secondary schools all over Malaysia. . Reduce, Recycle, recycle In 2009, MDD led the way into the dark-green future by recycling emission gases from company take plants into viable sources of energy that were converted back into power for plants.This decrease of waste also translates into a more efficient way of conserving energy, and will form the basis for company commitment to environmental conservation and prudent manufacturing. iv) Technology The collection remains committed to R &D endeavour to develop new wellness products that are nutrient to appeal to the score consumers. Its R&D department is man by 13 full-time staff and plays a essential role in product benefit and new product development to gain the companys exportation objectives.MDD factories have received honored industry certifications much(prenominal) as ISO 9002, ISO 9001 and HACCP, while the companys flagship rats such as Mister Potato Crisps and Nutrigen Liteyo have been honoured with local accolades. In 2004, its subsidiary, Pacific viands Products Sdn Bhd was awarded a differentiate Promotion cede of RM2 million by MATRADE to promote the Mamee brand in the export market. Being a fast growing organization with widespread operational centre, five-fold product lines and distribution channels, MDD have upgraded its IT slaying dodgings, in straddle to shorten end making time and ensure come apart and more finished decisions.MDD put its trust in weary and credit the skim ERP solvent to a great extent with helping to quadruplet revenues from 2002 till now. According to Pang, MDD achieved greater hydrofoil of its internal processes in its day-to-day operations. This was of the essence(p) as the company became increasingly geographically diverse and its organizational size grew. This system improved the organization of MDDs database, in particular in the areas of cost analysis, customer service and reporting transparency. MDD also plan to further implement an ERP and MRP solution to even intermit link up with suppliers and distributors.

English Language Learner Essay Example | Topics and Well Written Essays - 750 words

English Language Learner - Essay ExampleIn addition, ELL students tend to be nervous and dying(predicate) about interacting and addressing these issues to their t individuallyers. In some cultures for instance, it is considered a taboo for a male, Middle-Eastern student to ask for help since it is considered to be unmanly. Issues such(prenominal) as these ar prevalent in all cultures. The fear of participation and interaction with mainstream students for international students is even harder when interacting with NES. International students are intimidated as the possibility of mispronouncing or misinterpreting a certain run-in can be extremely humiliating. Undoubtedly, ESL students feel constrained to communicate effectively in a social environment due to their accents. All these factors accumulate to establish a barrier towards developing interpersonal relationships. 2. What are the socio-cultural characteristics of young English Language Learners? What are the educational back grounds of the families whose home language is other than English? insert information about demographics in your state, and discuss how this can impact your work as a teacher. Young English language learners are hardworking, determined and intent about learning the English language. Most students that are international students are middle-class and are highly educated. ... For instance, researchers suggest that developing critical skills for international students free radical from analyzing magazine and radio advertisements. With this creative approach, students tend to modify their attention between subject matter and language data. 3. How do young ELL children acquire a countenance language? What is your current ability in supporting acquisition of second language for young ELL children? Based on careful analysis, everyday conversational skills such as writing, reading and collaboration can truly solidify the foundation of the students cognitive and linguistic skills. In the process of learning an surplus language, ESL students must keep up with the daily strains that are placed in their program of studies. Furthermore, ESL students must learn to excel in time management skills. Indisputably, each student has a unique set of literacy development needs. Most ESL students have a strict schedule and must be accommodated with personalized program of activities that is managed by the staff itself. Lastly, the implementation of workshops with groups can tremendously enhance the process of acquiring a second language. As of now, we conduct workshops and conduct role playing, in which students are always engaged in a learning environment. 4. Describe how young ELL childrens cultural communication styles and learning styles affect the learning process. Refer to your expression of a young ELL child, during your Family Workshop. How did the family / teacher respond to the child in context of his/her communication style and learning style? Without a doubt, diffe rent cultures possess different

Pagan Influence in the Culture of Ukraine Essay Example | Topics and Well Written Essays - 500 words - 11

Pagan Influence in the Culture of Ukraine - Essay ExampleAlthough this construct may beget as something of a shock to many, the different methods whereby Ukraine and the influences that have acted upon as compared to the united States ultimately make for a very distinct culture (Schulman 1998). The first causal factor of this is the take to which paganism plays into the fabric of society. True, the nation itself has been Christian since the time of Prince Vladimir the Great (circa 988 AD), the long history of the people and the subsequent invasions from the East, including Mongols, Tatars, Khazars, and a litany of other peoples from the steppes of Central Asia meant that a great deal of diverse pagan beliefs were interjected into the culture of the nation as a function of the various tribes and kingdoms that spent time ruling over Ukraine (Holmes 2007). This level of paganism is exhibited in a litany of different ways within the culture one of these being the celebration of the holiday Ivana Kupala which celebrates the life force of the rivers, lakes, and streams and continues to be notable throughout Ukraine and many other Eastern European countries (Culture and Arts 2009). Similar winter solstice activities have also engrained themselves into the culture as dances around the base of fir trees, harvest celebrations, days for the dead, and a litany of other pagan holidays and references pervade the culture in ways that would not necessarily be the case in the United States. There are of course a number of superstitions that continue to pervade the culture as well. An example of this includes the belief that whistling indoors means that the one-on-one will soon have no money.

The Summary & Strong Response Essay Example | Topics and Well Written Essays - 750 words

The Summary & Strong Response - Essay ExampleIt is also a fact that parents force their children to assume in order to realize their ambitions to win. While it is important to have competitive skills in adult life, parents decrease the quality of childhood experiences. Statsky states that sport games are rattling selective and they do not let altogether children to participate. The charge of failure is supported by this selectiveness as all children become afraid of being worsened than others. Finally, the author suggests that it is better to focus on skills to cooperate with other children until children are psychologically ready to compete.The article by Statsky touches upon very important issues, which exemplify how parents venture their children grow up too quickly. Pieces of evidence she provides draw a comprehensive picture where childhood seems to different from what it should be. When a 7-year old boy makes himself vomit, children hit severally other or fear to lose the game, it means that something is going wrong with sport activities they join. Basically, children are forced to compete instead of enjoying the process of playing and communication with each other.Young children learn to meet the demands established by adults to master their performance in sports. Children have to face the ugly reality where the winner takes it all and it often makes them suffer. They need to show that they are the best to make their parents feel proud of them or demand rewards for their achievements. At the same time, they have to stand the fear and the stress after the communication with their coaches, which is not always friendly. Even though Statsky mentions that Little League coaches have to attend psychology workshops to regulate their ambitions and be to a greater extent sensitive to children, the reality shows that they do not rush to follow those guidelines. In most Hollywood movies about sport competitions, coaches are depicted as irritated, shouting an d strict people.

Argentinas Foreign Debt Restructuring Essay Example | Topics and Well Written Essays - 4500 words

Argentinas Foreign Debt Restructuring - Essay ExampleConversely, the legal definition of foreign debt is debt issued according to foreign (New York, UK, et cetera) law, regardless of whether it is in local or foreign currency and regardless of who, foreign or domestic resident, is holding these claims. Debt Renegotiation - a BackgroundArgentina bogged down by its climb external debts decided to settle all the foreign currency public debt by replacing the debts with new securities calculating at the rate of 35 cents per both dollar of debt. The organisation also decided to repudiate all the past interest due on those debts. The government also announce that those bondholders who do brook the governments proposal by the deadline will not be paid anything. Though the announcement of the settlement of the debts in this way is criticized vehemently by the bondholders the government announced that by the deadline more than 75 percent of the countrys creditors accepted the proposal. but the Institute of International Finance observed that such an aggressive conduct by the government of Argentina was sure to affect its long term scotch growth and stability. The Institute also commented on the lack of progress on the implementation of the geomorphologic reforms to boost the economic development.Debt Management of the GovernmentsIt so happens in nearly of the countries the government becomes the largest single borrower of the country. The effectiveness of the debt charge largely influences the development of the domestic capital merchandise. The debt management also reflects on the fiscal policies of the country and the spread of the single countries government bonds in the US and other treasuries world over by affecting the market prices and tradability of the bonds. The... The government also announced that those bondholders who do accept the governments proposal by the deadline will not be paid anything. Though the announcement of the settlement of the debt s in this way is criticized vehemently by the bondholders the government announced that by the deadline more than 75 percent of the countrys creditors accepted the proposal. However the Institute of International Finance observed that such an aggressive conduct by the government of Argentina was sure to affect its long term economic growth and stability. The Institute also commented on the lack of progress on the implementation of the structural reforms to boost the economic development.Debt Management of the GovernmentsIt so happens in most of the countries the government becomes the largest single borrower of the country. The effectiveness of the debt management largely influences the development of the domestic capital market. The debt management also reflects on the fiscal policies of the country and the spread of the respective countries government bonds in the US and other treasuries world over by affecting the market prices and tradability of the bonds. The debt management po licies of the government will have a strategic implication on the growth and development of the economy as a whole. A good debt management of any country should reflect in the decrease of the borrowing costs, greater access to the capital markets of international standing.

Strategic Management Accounting Essay Example | Topics and Well Written Essays - 2500 words - 1

Strategic Management Accounting - Essay ExampleOrganisational diagnosis involves the double-dyed(a) evaluation of the processes and issues in an organisation in order to identify the issues that argon causing the organisation to fail in its quest to achieve all its major(ip) goals and objectives (Van Tonder & Roodt, 2013).Organisational diagnosis is necessary to provide the scientific basis for a structured change in an organisation (Harrison & Shirom, 2011). It therefore parts tools to identify the main processes and change that are relevant to a given organisation and deduces issues with the business process and how there could be changes and adjustments in the processes of doing things in an organisation (Harsh, 2014).From the facts of the scenario relating to US postal Services, there is a central issue that is identified with the organisational structure and philosophy of the management and authorities behind the entity. The usual-sector worldview stands in the way of the ach ievement of results for US Postal Services. Therefore, there is the pauperization to examine this central issue which is steeped in the capital structure of the company and how it influences the management and competitive position of US Postal Services. It is through a complete(a) organisational diagnosis that the main issues of US Postal Services can be identified and proper solutions can be recommended.The capital composition of US Postal Services is one that fundamentally puts the company into a situation where they will throw to focus on stakeholder interests as opposed to shareholder interests. This is because it is a public sector entity and will need to meet the objectives of the government by providing the cheapest form of postal services to all Americans. This implies that US Postal Services will have to focus on metrics and measures that do not include financial measures and standards like profitability and return on investment. The implication is that they will have to use the resources available to provide the best

Personal essay on one thing I would change in the world

Personal on one thing I would change in the world - Essay ExampleI grew up in a small village, where I saw girls aged five or six, carrying younger siblings, and begging on the streets for food. They were dirty, unkempt and wore clothes that were dwarfish more than rags. I wondered, why their parents would not give them enough to eat, till I was told that their parents probably gave them all they had, and went hungry themselves. They lived in hovels, and often while the aged children begged, the younger ones were asleep on the roadside probably having exhausted themselves crying.As I grew up, and left the village to pursue my studies in a bigger town, these images stayed with me. However, to my dismay, I found that there were more such beggars there, than I had seen in my village. It struck me then, that I lived in a poor country where poverty was a swan suffered by large numbers of the population. It was at this stage of my life, that I made up my mind to do my bit to ease the pai n of these poor, unfortunate people. My parents were halcyon to see that I felt so much sympathy for those less fortunate than me, and encouraged me to do small things like offering food, sweets or clothes to poor people nearby on my birthday, instead of having a party for my friends. Fortunately, my school too was at the forefront of social work, involving educating those who did not have the government agency to go to a proper school. We students, were taken to nearby rural areas, to mingle with the villagers and understand their problems. We also sometimes helped the younger children with their homework, and encouraged them never to stop their schooling, because some children are forced to stop going to school, and instead help their parents out in small jobs. As I graduated from high school, I realised that the means to end poverty was education. I found that poor children were less healthy, and more prone to disease than their peers in more advantaged homes. Living in unhe althful surroundings, and never having the benefit of being educated in the

Body art and ornamentation of the Egyptian Copts and Hindi India Essay

Body art and ornamentation of the Egyptian Copts and Hindi India finishs - Essay Exampled person as incomplete and they usually handling a matchmaker to find possible marriage couples unlike the Copts who look for their own partners (Lindsey, 2012). After the couples are matched by the matchmaker the go to their parents for approval afterwards which wedding preparations start immediately. These Hindu marriages happen in the most spiritual day- ocuta, early in the moment where the girl is led by the male close to a fire (punit) seven times (Lindsey, 2012).The Hindi culture does not consider baptism in water. On the other hand, the Egyptian Copts baptize their children seven days after birth where the child is baptized by the father (Lindsey, 2012). The father washes the child in a washbowl and later prays the Salat elTist- the washbowl prayer. This mathematical operation tales about 30 minutes and is followed by a two hour prayer where the child is given the holy secrets called the Tanawel (Lindsey, 2012).If a member of the Coptic culture dies, his/her bole is washed by a family member, covered by a shroud and the whole family goes to church to pray for the dead. The priest then conducts the funeral service and the body is buried (Lindsey, 2012). There is no specific day for burial. On the other hand, the Indians had dissimilar ways of burying their dead based on their tribe (Lindsey, 2012). almost buried them under the ground in coffin while other burned their dead. The ashes were later buried or conserved in a sacrosanct place depending on their social status (Lindsey, 2012).The principal garment that was worn during the ancient Coptic period was a tunic, usually made of linen merely sometimes made of wool, with a tapestry-woven decoration. Over it was the pallium an oblong cloak which was similarly decorated as the tunic (Dimand, 1930). These tunics had adornments at the front and back unitedly with shoulder bands of dissimilar lengths, and square roundels on the shoulders. The lower edge had trims of horizontal bands that turned at right angles on each side (Dimand, 1930).

Marketing Master Assignment Example | Topics and Well Written Essays - 2750 words

Marketing Master - Assignment ExampleHarley Davidson has powerful brand determine and is sound financially, but there atomic number 18 certain palpable weaknesses in its marketing strategy. The target customers be forty plus men and until Harley Davidson does something ab tabu this get market, it could well find itself being overrun by Japanese competition.HD has selected the tactical direction to target a younger market that is technologically aware in order to augment its market in the performance cruiser market space. The new V-Rod motorcycle has given Harley Davidson a boost. To target the youth with this latest crop line, the company has taken up the pursual marketing objectives to develop its existing market (market expansion), branch out its product line (product diversification), and adapt its marketing mix in to target a younger audience.During the 1970s, Harley Davidson set about a decline in market owing to high profile, Japanese models. However, it still managed t o create a deferral for itself in the market. This was done by phasing out feeble models, becoming choosier, through restrictive sales and promotions etc. Today, Harley Davidson is depending on its freshly adopted marketing objectives. ... the following marketing objectives to develop its existing market (market expansion), branch out its product line (product diversification), and adapt its marketing combine to target a younger audience. During the 1970s, Harley Davidson faced a decline in market owing to high profile, Japanese models. However, it still managed to create a niche for itself in the market. This was done by phasing out feeble models, becoming choosier, through restrictive sales and promotions etc. Today, Harley Davidson is depending on its freshly adopted marketing objectives. First, it needs to place the V-Rod to appeal to people who are buying motorcycles for the first time. Here, its strong brand individuality comes in handy. Second, it has to set a proper marketi ng mix that appeal to a younger consumer base. It washstand successfully deploy the low end approach in other wards attract a young audience through a low set tag. 3. Marketing Mix Elements The Harley-Davidson Corporation has found manifold ways to put its promotion strategy into practice. Harley Davidsons main promotional tool has been the HOG, since 1983. The companys commercials are centred around womanly images. Over 90% of the bikers are males the HOG advertising campaign has consequently been thriving for decades. Harley Davidson also uses its cafes, located in most dealerships, for promotion. However, the most important promotional tool is still the brand image of an American product. Owning a Harley stirs nationalistic senses.Harley Davidsons distribution strategy can be best explained through its website. Harley-Davidsons dealers are the companys life-line to our customers, with a wide variety of product offerings, dealers provide knowledge, service, and information to riders out on the road. The

Problems and prospects of external debt management Essay

Problems and prospects of extraneous debt management - Essay ExampleHowever, these indigenous institutions may not always have sufficient amount of resources to save all the requirements of the state. In that case, it is forced to resort to international commercial banks or international lending institutions like the IMF of the World Bank. It can also request for monetary aid from the Government of its ally nations. The debtors of a country can include the national Government, the mystic corporations or even the individual households. Usually, external debt is borrowed in 2 ways by taking loans from the lending institutions or by selling the countrys securities to acquire the required amount of funds. After the country accomplishes its projects with the cooperate of the borrowed resources, it is required to repay the external debt along with its interest payments. Thus, external debt is actually a liability of the nation. For this reason, it is recorded under the Debit Account in the counterpoise of Payments (BOP) of the country. The BOP is a statement of accounts of the nation including its assets and liabilities and the outstanding credit and debit of the economy. The BOP gives an indication of the countrys position with respect to the international market. If the country has borrowed a large amount of financial resources from abroad, this will automatically add to the Debit account of the BOP. A huge burden of external debt does not reflect a good financial position of the domestic nation. Instead it indicates that financial resources generated inside the economy argon not sufficient to fulfill the requirements of the national Government, the private firms and the individual households. That is why the country has to depend on external sources to finance its multifarious requirements. Economists and financial experts always advise countries to keep their external debt burden scratch off to a minimum. Nations are expected not to borrow extra resource s unless and until it becomes absolutely necessary (The World Bank, 2012). Indicators of a Countrys External Debt Burden isolated from the Balance of Payments Statement, there are other variables which give an indication of the external debt burden of a particular country. These are a. The Ratio of External Debt to GDP A high value of this ratio reflects a high external debt burden of the nation. This shows that the countrys external borrowings are greater than the value of its Gross internal Product produced within its geographical boundaries. The financial resources generated in turn from the GDP are not being able to meet all the financial requirements within the economy. Therefore, the country has to borrow extra resources from external creditors b. The Foreign Debt to Exports Ratio When an economy has a high ratio of foreign debt to exports, this also indicates a high external debt burden of the country. It exhibits that the nations borrowing from external sources is more tha n the value of the goods exported by the country. This may also reflect that the nations external debt liabilities are greater than its external credit earnings. The

Google Analytic and Business Intelligence Essay Example | Topics and Well Written Essays - 250 words

Google Analytic and Business Intelligence - Essay ExampleContent group enables the company maximize on its search railway locomotive optimization. Monitoring goal conversions enables the company to measure how well the site contributes to its business objectives. Lastly, the e-commerce section contains reports on merchandising and revenue. However, these entire groups only provide the company with data. For real(a) business intelligence, Google Analytics enables the company cross-reference data from these categories, compare timelines or even compare two metric against each other to help to make smack out of the data (Clicksharpmarketing, 2008). Moreover the derived summaries could be presented in diagrammatic representations and even be shared Google shared with colleagues through email in different formats much(prenominal) as PDF or XML.The extent to which real estate financial organizations could learn from Google Analytics shall only be restricted by their own imagination. Th at is to say that they could cross-reference data from the five categories visitors, traffic sources, ecommerce, content and goals to give them a wide breath of information. For example cross-referencing visitors with content real estate financial organization will be able to tell which properties are attracting the most attention as such they could adjust their costing accordingly. Also, traffic sources can inform them of localities having more demand for their serve than others which may lead them to open outlets there or vice

Children of Immigrants in Qubec - Theoretical Framework Research Paper

Children of Immigrants in Qubec - Theoretical Framework - Research Paper archetypeThe case study followed three post-secondary students whose first language was French and studied the degree and application of academic biliteracy that each student demonstrated in his or her academic writing assignments. The case study took place in Ottawa, Canada, which as the capital of Canada is a fully bilingualist milieu, both French and English. The author chose this name because the a priori framework employ in this particular study has similar resonance and application to the authors progeny of Children of Immigrants in Quebec. The goal of this story is to discuss the key aspects of theoretical frameworks and demonstrate why researchers develop and apply theoretical frameworks to their academic study topics in the field of education. The theoretical framework utilise by Guillaume Gentil relates in several cases to the key themes that the author is currently pursuing in the Children of Immigrants in Quebec study, most notably the ideas of individual voices and construction of identity as it pertains to first language. Guillaume Gentil built theoretical framework using elements from the continua model of biliteracy developed by Hornberger the critical social theory work created by Bourdieu and also applied philosophical hermeneutics to the framework (Bourdieu, 1998 Hornberger, 1989). Guillaume Gentil applied this framework to test his hypothesis that individual biliterate development is a subjective and intersubjective evaluative response to social contexts of possibilities for biliteracy (Gentil, 2005, p. 421). Upon the completion of the deuce and a half year case study, the research that Guillaume Gentil amassed, including examination of each case study members compromises and sometimes circuitous routes followed in hunting lodge to fully send off to and uphold a bilingual academic writing environment in an landscape dominated by English demonstrated the chall enges and resources of bilingual writers to uphold their commitment to academic biliteracy within English-dominant institutional and disciplinary contexts (Gentil, 2005, p. 421). Similarly, within the topic of Children of Immigrants in Quebec, multiple challenges arise for first generation children of immigrant parents in Quebec to commit to and adhere to an often multilingual environment, including the language or languages spoken at home, the cultural link to the languages spoken in the home country and the bilingual environment of the province of Quebec. The overall goal therefore is to demonstrate the authors comprehension of the concept of theoretical frameworks, using Gentils theoretical framework to relate to the topic of Children of Immigrants in Quebec. The paper will begin with a discussion of the theories Guillaume Gentil applied to build the theoretical framework of Commitments to Academic Biliteracy Case Studies of Francophone University Writers and analyze their impor tance to the study. The paper will also analyze the theoretical framework of this study and draw parallels between it and the Children of Immigrants in Quebec study. Theoretical Frameworks Overview The main purpose and value of a theoretical framework is to prove the specific hypothesis that the researcher develops (Anfara & Mertz, 2006 Cline, n.d.). A theoretical frame

Benefits of Privatization Essay Example | Topics and Well Written Essays - 1250 words

Benefits of Privatization - Essay ExamplePrivatization has been experienced by various organizations throughout the world over a long stage of time. Various organizations that were owned and controlled by the government sector have been privatized due to the several benefits associated with privatization. One of the main reason due to which governments function to choose to privatize a previously state owned business is the failure of the government to operate the business in a an effective and streamlined manner. This is mainly because governments end up operating the business for the interest of politicians that are ruling the government and not working in the promote of the existence of particular nation. This writing will focus on the various benefits that have experienced by organization due to privatization while debating the other facial expression of the coin. Body Benefits of Privatization thither have been various theories that privilege privatization and there have been various practical incidences when privatization has resulted in huge benefits to organizations and even nations. Privatization is pursued by organizations because the macrocosm sector has failed to operate in a profit able manner and the management of semipublic organizations has not done their job in a proper manner. Governments themselves favor privatization and this happens as a result of the increased burdens experienced by government because of state ownership of organizations. When organizations are controlled by the government, governments tend to provide goods and services to the public in shape of subsidies, the management of such organizations work for the benefit of the overall population rather than meeting the demands of individual groups due to which organizations fail to meet the demands of the public and the unions in state owned organizations exercised higher amount of power than unions of organizations that are controlled by the private sector. Due to failur e of the government sector to address the postulate and wants of the individual groups, individuals experienced dissatisfaction. According to surveys conducted by Donahue, in the region of United States organizations have experienced lower operating cost when they were privatized as compared to the period when they were chthonic the control of the government (Holzer 88). Another reason due to which organizations become privatized is that governments do not operate with the main aim of maximizing sugar for the organization and the shareholders of the organization. There tends to be ample amount of changes in the governance of organizations due to which these organizations become inefficient. Lastly, the pressure on governments is low as they do not have to anxiety about the bankruptcy of the organization as these organizations are never allowed to fail and they are financed by the tax money. Another reason due to which organizations are privatized is because this treat helps th e government in increasing their revenue. When organizations are owned by the public sector, organizations do not pay taxes and become a burden on the tax payers to continue operating as they even do not work to attain profits. When organizations are privatized, they are obliged by the regulations to pay taxes on the profits they make and the profits they earn are used to fund the operations of the organization. Due to increase in the amount of taxes obtained through private enterprises, government is able to decrease its budget deficit as they do not need to obtain loan for operating the nation and they operate the nations with the revenue earned

HEALTH LAW AND ETHICS Essay Example | Topics and Well Written Essays - 250 words - 11

HEALTH LAW AND ETHICS - Essay Exampleces on who gets a scarce treatment or immunization, who would get a transplant, and who has approaching to a provider in high demand raise various conflicts among the potential stakeholders. Hence, the law and ethics must come to application in solving stakeholders interests. They have different interests when there atomic number 18 resource allocation issues. For example, the patients seek to have the employer provide a wide variety of options for health coverage and investment company their health insurance. The employers on the other hand seek maintain or lower the health cost contribution for the patients. Indeed, they are only ready to present the patients most necessary health care. Furthermore, the health providers seek to provide preventive care and high quality health care that is for the most part expensive and out of insurance cover. Health payers on the other hand seek to use few tests and fewest visits to obtain clear evidence a nd a diagnostic plan to achieve accurate treatment (Department of Community and Family Medicine, 2005). All these interests should fall in place during resources allocation.Indeed, while deciding on who would get a transplant, I will consider the serious of the disease, the costs involved, and the resources available. As such, the most serious cases with the least cost implication should get the transplant. At the same breath, the patients who are generally health should get scarce treatment or immunization. Nevertheless, all children should get the requisite immunization free of charge where possible. Additionally, no medication should turn in to healthy persons despite their willingness to fund such treatment. Furthermore, it is ethical to accord children, patients with complicated and high incidence diseases access to a provider in high demand. virtually importantly, in most cases, children patients should get the first priority while making health

Literature review summary Assignment Example | Topics and Well Written Essays - 2500 words

Literature review summary - Assignment ExampleUsing social media for pass away Losing your time or improving your work?Ioannis Leftheriotis and Michail N. Giannakos2013Computers in Human Behavior. To examine whether employees utilize social media for work purposes, what principles boost this usage, and if that utilization is linked with their performance. 1799 employees Feedback in the insurance industry was used to scrutinize the prepare of social media on work. Questioners was the method used and the questioners were distributed in three ways (a) Researchers visit the participants work place and give the questionnaire on printed paper. (b) Researchers send an email containing the questionnaire in an on-line form to participants from distant cities. (c)The IIS Institute holds two large congregations all over the country with people from the insurance industry links to the online questionnaire are distributed to the conference attendeesResults confirmed that in the case of social media for work, employees make extended use of them no matter their age. We found also that both utilitarian and hedonic value influence employees to use more social media for their work, at least in the insurance sector. Last but not least, this study confirms that there is an important affinity between the use of social media and the work performanceonly a small number of possible motivations based on the literature or experts were exploredThe inhalation of the social media has an impact on the ability of the employee. As such the use within an organization is crucial to the employer.

Unemployment in Europe Essay Example for Free

Unemployment in Europe EssayUnemployment is the state of cosmos jobless or else beingness without an occupation and you have looked for a job without success. You should also be willing and ready to work if given a chance. Lack of occupation is a severe problem not only in Europe but in all corners of the world. People who are unemployed are seen as a liability to the inn. This is because people with no jobs or other sources of income are always seen as dependent on their colleagues employed with financial stability. The unemployed find it tricky to live up to their basic needs.Unemployment in Europe and measures put in place Technological change and expansion in international trade has severely affected employment adversely. As technology advances more people are n being left unemployed while others who were formerly employed being laid off. This is due to the fact that modern technology aims at reducing the cost of manpower by availing machines that are more productive th an a assemblage of people. The unskilled personnel are replaced with more skilled employees in a bid to compete effectively in international trade.High levels of unemployment may dissolving agent in fond problem like crimes, prostitution among others. The unemployed will seek other sources of income as the disposable income they used to get before reduces or is completely not available. During the unemployment period the workers also lose their skills and have the fear of their jobs being taken up by people from foreign countries. The problem of unemployment is being curbed by putting in place policies and measure that protect employees.Such measures include extending employee benefits during recession to cover a longer time frame. It is also outlawed in some countries to fire more than twenty employees without following some legal processes. The governments in Europe and USA help the unemployed through the social welfare program where they get benefits such as insurance and sub sidies. Most of the people who lose jobs are either unskilled or low performing. erstwhile they lose their jobs it is normally hard to get back their jobs as their positions are taken over by more skilled and much productive workers than them.Saudi-Arabian Arabia is a prime market for foreign business and investors due to the following reasons. First of all it is an oil producing country with vast deposits of petroleum products among other earthy resources and minerals. Saudi is well known for its effort in fighting stabilization of petroleum products. Foreign investors are attracted by the huge deposits of minerals which they go to exploit. Mineral growth has always been known to be a highly profitable business in which everyone is interested in.The oil products also provide a brazen and certain source of energy and fuel for the industrial machinery. Saudi Arabia also has a sound economy with a fast growing young population. The population provides cheap labor for industries i n the region they by lowering the labor costs for investors. The banking system is well managed and transparent. This gives the investors assurance that their money is in good custodian. It also provides incentives to investors oddly targeting to put up new manufacturing zones in the area.Financial advices are also offered to ensure that investors funds are properly used and managed to avoid investing in unworthy businesses. Conclusion High levels of unemployment will always have adverse effects to the unemployed, general public, employer and even the government. The unemployed suffer psychologically while the society is faced with crimes and the government faces economic hard times as the unemployed depend on them. To conclude all stake holders should ensure that they minimize the material body of people unemployed in the country.

Communicable diseases Essay Example for Free

transmissible infirmitys Essay95Infectious agents and examples of illnesssThe organisms that scram unsoundness vary in size from viruses,which be as well sm entirely to be seen by a light microscope toin shieldinal worms which ovalbuminthorn be over a metre long. The groupsof septic agents atomic number 18 listed with examples of sicknesss they cause.BacteriaPneumonia, terbium, enteral febricity, gonorrhoeaViruses measles, varicella, influenza, colds, rabiesFungiRingworm, tinea pedis (athletes foot)ProtozoaMalaria, giardiaMetazoaTapeworm, filariasis, onchcerciasis (river blindness),hookwormPrionsKuru, Creutzfeld-Jacob disease, Bovine spongi songencephalopathy (BSE)Modes of transmission assume transmissions Direct contact with the give more or lessbody as in touching,kissing or sexual intercourses Droplet opening through spit uping sneezing, talking orexplosive diarrhoeas Faecal-oral spread when infected faeces is transfer sanguine tothe m pop outh of a non infected individual, usually by hand. collateral transmissions Indirect transmission of infective organisms involves vehicles and vectors which carry disease agents from thesource to the host.Infectious agentsModes of transmissionDefinitions and termsusedSymptoms and signsGeneral piece of musicagementand discourseAnthraxCellulitisChickenpox (Varicella) epidemic cholerabreakb one and only(a) fever feverDiphtheriaEnteric fever (typhoidand para-typhoid fevers)German measles( fretella)Glandular feverHepatitis (viral)InfluenzaMalariaMeaslesMeningitisMumpsPlaguePoliomyelitis rabidity cherry feverTetanus tuberculosisTyphus feverWhooping cough(Pertussis)Yel rugged feverSexually transmitteddiseases including HIV(AIDS)NOTE. Other communicablediseases some(prenominal)(prenominal) as Lassa Fever do non stimulate buttocks inwardly the competenceof this book. When in doubt nonify the Port Health Officer.Communicable diseasesCHAPTER 6Communicable diseases atomic number 18 those that be tran smissible fromone person, or animal, to an separate. The disease whitethorn be spread directly, via another species (vector) or via the environment. Illness ordain a full when the infectious agent invades the host, or several(prenominal)times as a result of toxins produced by bacteria insolid sustenance.The spread of disease through a population is pertinaciousby environmental and social conditions which favour theinfectious agent, and the relative immunity of thepopulation. An outbreak of transmission could endanger theoperation and safety of the ship. An understanding of thedisease and the measures essential for its containment andmanagement is in that locationfore im expressionant.96THE beam master copyS MEDICAL escapeVehicles are non-living or non-living means of transmission of infectious organisms. They overwhelms Water. If polluted, detailally by contaminated sewage. Water is the vehicle for suchenteric (intestinal) diseases as typhoid, cholera, and amoebic and ba cillary dysentery. s Milk is the vehicle for diseases of kine transmissible to man, including bovine tuberculosis,brucellosis. Milk alike serves as a growth medium for some agents of bacterial diseases such as campylobacter, a common cause of diarrhoea.s Food is the vehicle for salmonella transmittals (which include enteric fever), amoebicdysentery, and other diarrhoeal diseases, and poisoning. both food stand act as a vehicle for infection especially if it is raw or inadequately cooked, or improperly refrigerated after cooking, as well as having been in contact with an infected source. The source whitethorn be another infected food, hands, water or air.s Air is the vehicle for the common cold, pneumonia, tuberculosis. influenza, whoopingcough. measles. and chickenpox. Discharges from the mouth. nose, pharynx, or lungs take the give of free falllets which quell suspended in the air, from which they whitethorn be inhaled. s Soil outhouse be the vehicle for tetanus, anthra x, hookworm. and some bruise infections. s Fomites. This term includes all inanimate objects, other than water, milk, food, air, and soil,that energy play a role in the transmission of disease. Fomites include bedding, clothing and the show ups of objects.Vectors are animate or living vehicles which transmit infections in the following ways s Mechanical transfer. The contaminated mouth-parts or feet of some insect vectorsmechanically transfer the infectious organisms to a bite-wound or to food. For example, flies whitethorn transmit bacillary dysentery, typhoid, or other intestinal infections by walking over the infected faeces and later leaving the disease-producing germs on food. s enteric harbourage. Certain insects harbour pathogenic (disease causing) organisms intheir intestinal tracts. The organisms are passed in the faeces or are regurgitated by the vector, and the bite-wounds or food are contaminated. (e.g. plague, typhus fever.) s Biological transmission. This term refer s to multiplication of the infectious agent during itsstay in the body of the vector. The vector takes in the organism along with a blood repast precisely is not able to transmit infection until after a definite full point, during which the pathogen changes. The parasite that causes malaria is an example of an organism that completes the sexual stages of its life cycle within its vector, the mosquito. The virus of yellow fever too multiplies in the bodies of mosquitoes.Terms used in connection with communicable diseasesA carrier is a person who has the infection, either without becoming ill himself or following reco actually from it.A contact is a person who whitethorn set out been in contact with an infected person. The incubation period is the interval of time that elapses between a person world infected with any communicable disease and the appearance of the features of that disease. This period is very un settled and depends upon the infectious agent and the inoculum ( the centre of the infectious agent).The isolation period signifies the time during which a tolerant suffering from an infectious disease should be un proceedionate from others.The period of communicability is the time during which a longanimous of of who may be incubating an infectious disease following contact domiciliate communicate the disease to others. The quarantine period means the time during which port authorities may require a ship to be isolated from contact with the shore. quarantine of this kind is seldom carried out except when overserious epidemicdiseases, such as, for instance. plague. cholera, or yellow fever are put or have recently keepred on board.Chapter 6 familial DISEASESSymptoms and signsIn reality it is often very difficult to make an accurate diagnosing of an infectious disease without laboratory investigations. It may be doable if on that point are very specific features such as a imprudent (varicella) or cluster of suggestive features (re gular fever, enlarged spleen and history of mosquito bites in an autochthonous area). Because of the difficulty in making an accurate diagnosis on board ship you may have to give a variety of sermons each order at different infectious agents.OnsetAlmost all communicable diseases begin with the unhurried role role feeling unwell and perhaps a rise in temperature. This period may be very short, lasting only a few hours (meningococcal sepsis), or more protract (hepatitis). In some diseases the fire is haywire and there is not much general disturbance of health, whereas in others it is severe and prostrating. During the onset it is rarely possible to make a diagnosis.The blossomThe diagnosis of some communicable diseases is do easier by the presence of a characteristic wise. In certain diseases (e.g. flushed fever) the florescence is spread evenly over the body, in others it is moderate to definite areas. When examining an individual venture to be suffering from a communic able disease, it is of peachy importance to strip him completely in order to get a full picture of any rash and its distribution.General rules for the management of communicable diseases isolationThe principles of isolation are described in Chapter 3 and Chapter 5. If you have a suspicion that the disease with which you are dealing is infectious it is advisable to invoke isolation precautions as short as possible. interpositionAn essential element in handling is importanttaining the patients well being. This is achieved through dandy general nursing and it is important to ensure that the patient does not call on dehydrated.Advice on specific medical treatment for infectious diseases which are believably to respond to specific doses is presumptuousness under the sections on treatment for the individual diseases. You may withal be informed to administer drugs to keep secondary infection occurring. See Chapter on General Nursing and on how to reduce a highschool fever. feed Diet ordain very much depend on the sign of disease and severity of fever. Serious fever is invariably accompanied by loss of appetency and this will automatically tend to restrict diet to beverages such as water flavoured with lemon juice and a little sugar or shoddy tea with a little milk and perhaps sugar.Essential basic ruless Isolate. If anyone suffers from a temperature without obvious cause it is best to isolate himuntil a diagnosis has been do.s Strip the patient and make a thorough examination looking for any signs of a rash in orderto try to make believe the diagnosis.s Put him to bed, and appoint someone to look after and nurse the patient. s fall out non-alcoholic fluids in the first instance.s If his temperature exceeds 39.4C make arrangements for tepid sponging.9798THE SHIP CAPTAINS MEDICAL bleeds Arrange for the use of a bed pan and water supply bottle if the patient shows any sign ofprostration or if his temperature is high.s If the patient is seriously ill and if in any doubt as to the diagnosis seek radio set MEDICALADVICE, failing which you should con berthr the need for making for port. s Treat symptoms as they arise.Do not attempt to get the patient up during recovery if he is feeble, but keep him in bed until the succeeding(a) port is reached.When approaching port, send a radio message braggart(a) details of the fiber to enable the Port Health Authority to make arrangements for the isolation of the case and any contacts on compass and Disinfection.Immunisation and travel adviceIt is important that up to get wind advice on immunisation and the prevalent diseases should be obtained before arrival in a foreign port. This is most easily forthcoming from the following publicationsHealth reading for Overseas Travel, produced by the UK Department of Health, and International Travel and Health, WHO, GenevaAnthrax french CharbonGerman MilzbrandItalian CarbonchioSpanish Carbonbrooding achievement 2 to 7 daytimes, usually 2 point in time of communicability No evidence of transmission from person to person closing off Period No evidence of transmission from person to person Quarantine Period no(prenominal).Anthrax is an uncommon but serious communicable disease which may occur in man and animals. It occurs in man either as an infection of the splutter (malignant pustule), or as an attack on the lungs or intestines, or as a widely spread infection throughout the body by means of the blood circulation.Anthrax is, in man, usually promise by handling infected animals, strips, hides, or furs. It can also be conveyed by the consumption of infected or insufficiently cooked meat, or by the inhalation of dust containing the organism.Symptoms and signsIn most cases anthrax is accompanied by severe symptoms such as fever and prostration. When it appears as a pare down infection, it begins as a red itching pimple which soon changes into a mop up and within the next 36 hours progresses into a large boil with a slou ghing centre surrounded by a ring of pimples. Alternatively it may take the form of a painless widespread prominence of the skin which shortly breaks down to form pus in the area.The gastro-intestinal form of anthrax resembles food poisoning with diarrhoea and bloody faeces. The lung form perplexs into a quick fatal pneumonia.TreatmentShould a case of anthrax occur at sea, which is unlikely unless as a result of handling animals, hides, skins, etc., all dressings or other material that come into contact with the discharge must be burnt or accustomed of by disinfection.Instruments must be used to handle dressings as far as possible, and the instruments must subsequently be sterilised by vigorous boiling for not less than 30 minutes, since the spores of the anthrax germ are difficult to kill.Treatment is not easy on board and the patient should be pull ashore as soon as possible. In the meantime treatment is with PenicillinNo attempt at surgical treatment (incision or lancing o f the sore) should bemade as it does no good. Cover the sore with a dressing.Seek advice from a Port Health Authority near the treatment of cargo.Chapter 6 COMMUNICABLE DISEASESCellulitis (Erysipelas) french ErysipleGerman ErysipelIncubation Period1 to 7 geezerhoodPeriod of communicability no(prenominal)Isolation Period noneQuarantine Period NoneItalian ErisipelaSpanish ErisipelaThis disease is an acute inflammatory condition of the skin caused by a germ entering the body through a strickle or abrasion. Cellulitis occurs anywhere, but most commonly on the legs, arms and causa.The onset is sudden with shivering, and a general feeling of malaise. The temperature rises rapidly and may reach roughly 40oC. The moved(p) area becomes acutely exasperate and red on the first or second day of the infection and the inflammation spreads rapidly outwards with a well-marked, raised, and advancing edge. As the disease advances the portions of the skin first attacked become less inflamed an d exhibit a yellowish appearance. Blisters may appear on the inflamed area which can be very painful.General treatmentThe patient must be unbroken in bed during the acute stage.Specific treatment progress to the patient benzyl penicillin 600 mg followed by oral antibiotic treatment. Paracetamol can be given to ease the pain.Chickenpox (Varicella)French VaricelleGerman Windpocken Italian VaricellaSpanish VaricelaIncubation Period 14 to 21 long time, usually 14Period of communicability Up to 5 age before the onset of the rash and 5 days after the first crop of vesiclesIsolation Period Until the vesicles become dryQuarantine Period NoneThis highly infectious disease starts with fever and feeling unwell. Within a day or 2 the rash appears on the trunk but soon spreads to the face and elsewhere, even sometimes to the throat and palate.The rash starts as red pimples which quickly change into small blisters (vesicles) filled with clear fluid which may become tenuously coloured and un easy during the second day. Within a day or two the blisters burst or shrivel up and become covered with a brownish scab. attendant crops of spots appear for up to five days. Although usually a crackers disease, sometimes the rash is more severe and very rarely pneumonia may occur.TreatmentA member of the crew who has had chickenpox, and therefore has immunity, could make a suitable nurse. If all of the crew have had chickenpox in the past then there is no need to isolate the patient. The patient need not be confined to bed unless he is unwell. He should be told not to scratch, especially not to scratch his face otherwise pock marks may re main for life. Calamine lotion, if available, dabbed onto the spots may ease the itching.99100THE SHIP CAPTAINS MEDICAL GUIDECholeraFrench CholraGerman CholeraItalian ColraIncubation Period 1 to 5 days, usually 23 daysPeriod of communicability Usually for a few days after recovery Isolation Period Until diarrhoea has settledQuarantine Period 5 d aysSpanish CleraCholera is a severe bacterial infection of the bowel producing profuse watery diarrhoea, goodly cramps, vomiting and rapid collapse. contagious disease occurs principally through inebriationing infected water and sometimes through eating contaminated uncooked vegetables, fruit, shell lean or ice cream. It generally occurs in areas where sanitation is pitiful and where untreated sewage has contaminated drinking water. Other bacterial and viral causes of diarrhoea can sometimes produce a similar clinical picture and may be just as severe.Symptoms and signsMost cases are mild and will not be differentiated from any other form of diarrhoea. In a severe case the onset is abrupt, the vomiting and diarrhoea extreme with the faeces at first yellowish and later pale and watery, containing little white shreds of mucus resembling rice grains. The temperature is below approach pattern, and the pulse rapid and feeble. The frequent copious watery faeces rapidly produce dehy dration. Vomiting is profuse, first of food but soon changing to a thin fluid similar to the water passed by the bowel. Cramps of an pain character attack the limbs and abdomen, and the patient rapidly passes into a state of collapse.As the result of the loss of fluid, the cheeks fall in, the eyeball become shrunken and the skin loses its normal springiness and will not quickly stop to its normal shape when pinched. The body becomes cold and covered with a clammy sweat, the urine is scanty, the breathing rapid and shallow,and the voice is sunk to a whisper. The patient is now restless, with muscle cramps findd by loss of common salt, and feebly complaining of intense thirst. This stage may rapidly terminate in death or equally rapidly turn to convalescence. In the latter case the cessation of vomiting and purging and the return of some warmth to the skin will herald convalescence.TreatmentIf there is a suspected case of cholera on board RADIO MEDICAL ADVICE ON MANAGEMENT SHOULD BE OBTAINED PROMPTLY.The patient should be isolated and enjoin to bed at once. Every effort should be made to replace fluid and salt loss. Therefore, keep a fluid balance chart. The patient should be told that his life depends on drinking enough and he should be encouraged and if essential nearlyly forced to drink as much as possible until all signs of dehydration disappear (until his urine output is back to normal). Thereafter he should drink to the highest degree 300 ml after each stool until the diarrhoea stops. It is best to drink oral rehydration solution (ORS), if this is not available, make up a solution from 20 gm of sugar with a pinch of salt and a pinch of sodium bicarbonate and juice from an orange in viosterol ml sterile water.Give Doxycycline 200 mg first dose then 100 mg once daily. If vomiting, give an antiemetic oral contraceptive pill or injection before each dose. The patient must be kept in bed until seen by a doctor.CautionCholera is a disease which is tra nsmitted from person to person. If cholera is suspected, the ships water supply must be exhaustively treated to make sure that it is safe. The organization of infected faeces and vomit must be commandled carefully since they are highly infectious. The hygiene precautions of all attendants must be of an order to prevent them also becoming infected and all food preparation on board must be reviewed.Chapter 6 COMMUNICABLE DISEASESDengue feverFrench DengueGerman Denguefieber SiebentagefieberItalian Dengue Febbra dei sette giorniSpanish Fiebre dengueIncubation Period 3 to 14 days, usually 7 to 10 days.Period of communicability No person to person transmission. Infective for mosquitoes for about 5 days from just before the end of the febrile period. Isolation Period NoneQuarantine Period NoneThis is an acute fever of about 7 days duration conveyed by a mosquito. It is sometimes called break-bone fever. It is an unpleasant, painful disease which is rarely fatal. A severe form of the dis ease, dengue haemorrhagic fever, can occur in children. Features of the disease are its sudden onset with a high fever, severe worry and aching screw the eyeballs, and intense pain in the joints and muscles, especially in the small of the back.The face may swell up and the eyes suffuse but no rash appears at this stage. Occasionally an itchy rash resembling that of measles but bright red in colour appears on the fourth or fifth day of the illness. It starts on the hands and feet from which it spreads to other parts of the body, but remains most dense on the limbs. After the rash fades, the skin dries and the surface flakes.After about the fourth day the fever subsides, but it may recur some three days later before subsiding again by the ten percent day.General treatmentThere is no specific treatment, but paracetamol will quench some of the pain, and calamine lotion, if available, may ease the itching of the rash. Control is by removal of Aedes mosquitoes.DiphtheriaFrench Diphtrie German DiphterieItalian DifteriteSpanish DifteriaIncubation Period 2 to 5 daysPeriod of communicability Usually less than 2 weeks, shorter if the patient receives antibiotics Isolation Period 2 weeksQuarantine Period NoneDiphtheria is an acute infectious disease characterised by the formation of a membrane in the throat and nose. The onset is gradual and starts with a sore throat and fever accompanied by shivering. The throat symptoms increase, swallowing being painful and difficult, and whitish-grey patches of membrane become megascopic on the back of the throat, the tonsils and the palate. The patches look like wash leather and bleed on being touched. The neck glands swell, and the breath is foul. The fever may last for two weeks with severe prostration. Bacterial toxins may cause fatal heart failure and muscle paralysis.General treatmentImmediate isolation is essential as diphtheria is very infectious, the infection being spread by aerosols.Specific treatmentSpecific treatment i s diphtheria anti-toxin which should be given at the earliest possible opportunity if the patient can get to medical attention. Antibiotic treatment should be given to all cases to limit the spread of infection but it will not kill toxin which has already been produced.101102THE SHIP CAPTAINS MEDICAL GUIDEEnteric fever typhoidFrench Fivre typhoideGerman Typhus abdominalisItalian Febbre tifoideaSpanish Fiebre tifoideaIncubation Period 1 to 3 weeks, depending on size of infecting dose Period of communicability Usually less than 2 weeks. Prolonged carriage of salmonella typhi may occur in some of those not treated.Isolation Period Variable.Quarantine Period NoneThe term enteric fever covers typhoid and para-typhoid fevers. Enteric fever is contracted by drinking water or eating food that has been contaminated with typhoid germs. Seafarers are advised to be very careful where they eat and drink when ashore. Immunisation gives primer coatable protection against typhoid but not para-ty phoid.In general the para-typhoids are milder and tend to have a shorter course. The disease may have a wide variety of symptoms depending on the severity of the attack. Nevertheless, typhoid fever, however mild, is a disease which must be treated seriously, not only because of its possible effect upon the patient, but also to prevent it spreading to others who may not have been immunised. Strict attention must be given to hygiene and cleanliness and all clothing and soiled linen must be disinfected.During the first week the patient feels off-colour and apathetic, he may have a persistent headache, poor appetite, and sometimes nose bleeding. There is some abdominal discomfort and usually constipation. These symptoms increase until he is forced to go to bed. At this stage his temperature begins to rise in steps reaching about 3940C in the evenings. For about two weeks it never drops back to normal even in the mornings.Any person who is found with a persistent temperature of this kind should always be suspected of having typhoid, especially if his pulse rate remains basically normal. In 10 to 20% of cases, from about the seventh day, characteristic rose-pink spots may appear on the sink chest, abdomen and back, which if pressed with the finger will disappear and return when pressure is released. Each spot lasts about 34 days and they continue to appear in crops until the end of the second week or long-run. attempt for them in a good light, especially in dark-skinned races.During the second week,mental apathy, confusion and delirium may occur. In the more favourable cases the patient will commence recovery but in the worst cases his condition will continue to deteriorate and may terminate in deep swooning and death. Even where the patient appears to be recovering, he may suffer a relapse. There are a variety of complications but the most dangerous are haemorrhage from, or perforation of, the bowel. Where the faeces are found to contain blood at any stage of t he disease the patient must be kept as immobile as possible and put on a milk and water diet. If the bowel is perforated, peritonitis will set in.General treatmentAnyone suspected of having typhoid or para-typhoid fever should be kept in bed in strict isolation until seen by a doctor. The patients urine and faeces are highly infectious, as may be his vomit. These should all be disposed of. The attendants and others coming into the room should wash their hands thoroughly after handling the bedpan or washing the patient, and before leaving the room.The patient should be encouraged to drink as much as possible and a fluid input/output chart should be maintained. He can eat as much as he wants, but it is best if the food is light.Specific treatmentIf you suspect somebody has enteric fever get RADIO MEDICAL ADVICE. Give ciprofloxacin 500 mg every 12 hours for one week. On this treatment the fever and all symptoms should respond within 45 days. tout ensemble cases should be seen by a doct or at the first opportunity. The case notes including details of the amount of medicine given should be sent with the patient.Chapter 6 COMMUNICABLE DISEASESGerman measles rubellaFrench RuboleGerman RtelnItalian RosoliaSpanish RubolaIncubation Period 14 to 23 days, usually 17Period of communicability For about 1 week before to at to the lowest degree 4 days after the onset of the rash Isolation Period Until 7 days from the appearance of the rash Quarantine Period NoneGerman measles is a highly infectious, though mild disease. It has features similar to those of mild attacks of ordinary measles or of scarlet fever. For the differences in symptoms and signs see the table.Usually the first sign of the disease is a rash of spots, though sometimes there will be headache, stiffness and inexperience of the muscles, and some slight fever preceding or accompanying the rash. The rash is absent in half the cases and lasts from 5 to 6 days. The glands towards the back of the neck are swollen and can easily be felt. This is an important distinguishing sign. This swelling will precede the rash by up to 10 days.General treatmentGive the patient paracetamol, and calamine lotion, if available, for the rash.Specific treatmentNOTE Particular care should be taken to isolate patients with German measles from expectant women Any pregnant woman on board should see a doctor ashore as soon as possible so that her immunity to rubella can be confirmed. If a patient has seen his wife in the last week he should be asked whether his wife might be pregnant. If so, his wife should be advised to see her doctor.Glandular fever infectious mononucleosisFrench Fivre glandulaire Mononucleose infectieuseGerman Drusenfieber Infektiose MononukleoseItalian Febbre ghiandolare (Mononucleosi infettiva)Spanish Fiebre glandular (Mononucleosis infecciosa)Incubation Period 4 to 6 weeksPeriod of communicability Prolonged, excretion of virus may persist for ayear or more Isolation Period NoneQuarantine Pe riod NoneThis malady is an acute infection which is most likely to affect the young members of the crew. Convalescence may take up to two or three months.The disease starts with a gradual increase in temperature and a sore throat a white covering often develops later over the tonsils. At this stage it is likely to be diagnosed as tonsillitis and treated as such. However it tends not to respond to such treatment and, during this time, a generalised enlargement of glands occurs. The glands of the neck, armpit and groins start to swell, and become tender those in the neck to a considerable extent.The patient may have difficulty in eating or swallowing. His temperature may go very high and he may sweat profusely. Occasionally there is jaundice between the fifth and fourteenth day. Commonly there is a blotchy skin rash on the upper trunk and arms at the end of the first week. Vague abdominal pain is sometimes a feature. A diagnosis of diphtheria may be considered due to the appearance o f the tonsils, but the generalised glandular enlargement is typical of glandular fever.General treatmentParacetamol should be given to soften pain and to moderate the temperature. Any antibiotics which have been prescribed to treat the tonsillitis should be discontinued. There is no specific treatment. If complications arise get RADIO MEDICAL ADVICE.103104THE SHIP CAPTAINS MEDICAL GUIDEHepatitis (viral)French Hpatite HepatitisGerman HepatitisItalian EpatiteSpanish HepatitisIncubation Period 15 to 50 days for hepatitis A, 60 to 90 days for hepatitis B (may be much longer)Period of communicability None after jaundice has appeared in hepatitis A, can be indefinite for hepatitis BIsolation Period During first week of illnessQuarantine Period NoneThis is an acute infection of the liver caused by viruses. There are two main causes of acute hepatitis hepatitis A and hepatitis B. Two other viruses may cause hepatitis (C and E), but these are uncommon. The most likely cause will be hepatit is A and this is spread by the faecal-oral route (as is hepatitis E). Hepatitis B is spread sexually or by contaminated blood or needles. There is no way of differentiating one type of viral hepatitis from another. The urine and faeces will show the typical changes associated with jaundice.TreatmentThere is no specific treatment. The patient should be put to bed and nurse in isolation. Plenty of sweetened fluids should be given until the appetite returns. When the appetite returns a fat-free diet should be given. No alcohol should be allowed. All cases must be seen by a doctor at the next port.InfluenzaFrench Grippe InfluenzaGerman Epidemische Influenza GrippeItalian InfluenzaSpanish Influenza GrippeIncubation Period 1 to 5 daysPeriod of communicability 3 to 5 days (7 in children) from the onset of illness Isolation Period Often impractical because of the delay in diagnosis. In an outbreak it would be advisable to keep all affected individuals unitedly and away from those who are well Quarantine Period noneThis is an acute infectious disease caused by a germ inhaled through the nose or mouth. It often occurs in epidemics. The onset is sudden and the symptomsare, at first, the same as those of the common cold. Later the patient feels much worse with fits of shivering, and severe aching of the limbs and back. Depression, shortness of breath, palpitations, and headaches, are common. Influenza may vary in severity. Commonly a sharp unpleasant feverish attack is followed by a prompt fall in temperature and a short convalescence. Pneumonia is a possible complication.General treatmentThe patient should be subject to standard isolation. He should be watched for signs of pneumonia such as pains in the chest, rapid breathing and a bluish tinge to the lips. He should be given plenty to drink and a light and wholesome diet if he can manage it.Specific treatmentThere is no specific treatment for the uncomplicated case, but the patient should be given paracetamol as nee ded.Chapter 6 COMMUNICABLE DISEASESMalariaFrench PaludismeGerman MalariaItalian Malaria Spanish PaludismoIncubation Period 12 days or more, depending on the type of malaria Period of communicability The patient will remain infectious for mosquitoes until they have been completely treatedIsolation Period None if in mosquito-proof appointmentQuarantine Period NoneMalaria is a recurrent fever caused by protozoa introduced into the blood stream by the bite of the Anopheles mosquito. The malaria-carrying mosquito is most prevalent in districts where there is surface water on which it lays its eggs. It is a dangerous tropical disease which causes fever, debility and, sometimes, coma and death.Malarial areasPorts between latitudes 25N and 25S on the beachs of Africa (including Malagassy), Asia, and Central and South America should be regarded as infected or potentially infected with malaria. Enquiries should be made prior to departure to allow suppress prophylaxis to be arranged and tre atment drugs obtained. Before arrival in port further enquiries should be made as to the current malaria situation and prophylaxis issued to the crew if necessary. prevention of malariaThe risks of attacks of malaria can be very greatly reduced if proper precautions are taken and the disease can be cured if proper treatment is given. disrespect this, cases have occurred in ships where several members of the crew have been attacked by malaria during a single voyage with severe and even fatal results.The precautions ares turning away of mosquito bitess prevention of infection.Avoidance of mosquito bitesThe best way to prevent malarial infection is to take measures to avoid being bitten. The advent of air conditioned ships has made many traditional preventive measures obsolete. However, when within two miles of a malarial shore it remains important that s doors are kept closed at all times after dusks any mosquitoes which enter compartments are killed using insecticide spray s person s going on embroider or ashore after dusk wear long sleeved shirts and trousers to avoidexposing their arms and legss no pools of stagnant water are allowed to develop on deck or in life boats, wheremosquitoes might breed.In ships which are not air conditioned other traditional measures to protect against mosquitoes should be implemented. These includes placing fine wire mesh over portholes, sky lights, ventilators and other openings s screening lights to avoid attracting mosquitoess fixing mosquito nets over beds where accommodation spaces cannot be made mosquitoproof.Prevention of infectionThe fewer the bites, the smaller is the risk of infection but even when the greatest care is exercised it will seldom be possible entirely to prevent mosquito bites either on shore or in the105106THE SHIP CAPTAINS MEDICAL GUIDEship. For this reason in all cases when a ship is bound for a malarial port, Masters (in addition to taking all possible measures to prevent mosquito bites) should contro l infection by giving treatment systematically to all the ships crew.Preventive treatment (prophylaxis) does not always prevent a person from spotting malarial infection, but it will reduce the chance of disease. All persons, therefore, should be warned that they have been exposed to the chance of malaria infection and that, if they fall ill at a later date, they should inform their doctor without delay that the fever from which they are then suffering may be due to malaria contracted abroad. The most appropriate prophylaxis will vary with the location as there are different types of malaria in various parts of the world. There is also increasing resistance to anti-malarials which will affect their effectiveness. Up to date information should be obtained before departure if possible or from the local anaesthetic health authorities.General guidelinesStart taking the prophylaxis before arrival at a malarial area in accordance with specific instructions and depending on the region. (U sually 1-3 weeks before departure).This will allow the tolerance and side-effects (if any) of the prophylactic drug to be assessed. Prophylaxis should be continued for 4 weeks after leaving the malarial area so as to ensure all stages of the parasite have been killed.No drugs for the treatment of malaria are specified in the MSN 1726 as the advice varies with destination and the pattern of disease in any given malarial area at the time. For information, the UKs present guidelines recommend 3 different regimes depending on destinations Proguanil 200 mg once daily and chloroquine 300 mg weeklys Mefloquine 250 mg once weeklys Maloprim (a combined tablet of dapsone and pyrimethamine) 1 tablet weekly andchloroquine 300 mg weeklyOther regimes may be used in areas of high level resistanceTreatment of malariaFeatures of the illnessMalaria cannot be diagnosed with certainty without laboratory assistance. If the person has been in a potentially malarial area within the last few months and has a fever they should be assumed to have malaria. The characteristic patterns of fever associated with malaria (fever every 2 to 3 days) may not be obvious. The illness may progress rapidly without many features other than fever and sweating. There will often be a severe headache. If there is any doubt about whether to treat or not get RADIO MEDICAL ADVICE.General treatment for mild or severe malariaThe patient should be put to bed in a cool place and his temperature, pulse and respiration taken four hourly. If body temperature rises to 40oC or over, cooling should be carried out. The temperature should be taken and recorded at 15 minute intervals until it has been normal for some time. Thereafter the four-hourly recording should be resumed until the attack has decidedly passed.Specific treatment for mild or severe malariaAnti-malarial drugs are not specified in MSN 1726 as treatment depends on the area and patterns of resistance. If anti-malarials are to be carried seek appropriate advice on which to obtain/use.The following examples of current regimes are given for information s Quinine 600 mg every 8 hours for 7 days followed by Fansidar (see below) 3 tablets as asingle doseors Mefloquine 500 mg (2 tablets) for 2 doses 8 hours apartChapter 6 COMMUNICABLE DISEASESChloroquine is not used for treatment except for proven single infections with vivax and other benign malarias because of drug resistance. If quinine, Fansidar or mefloquine are not available then chloroquine 300 mg 8 hourly for three doses then 300 mg daily for 2 days should be used.If the patient is ineffectual to take medicine by mouth or is vomiting then quinine 600 mg should be given by intramuscular injection every 8 hours. As soon as the patient is able to swallow it should be given by mouth. Quinine may produce ringing in the ears or dizziness, but this should not normally be a reason to stop treatment.NOTE All patients who have been treated for malaria or suspected malaria must see a doctor at the next port because further medical treatment may be necessary.MeaslesFrench RougeoleGerman MasernItalian MorbilloSpanish SarampionIncubation Period 7 to 18 days usually 10 until onset of fever, 14 days until rash Period of communicability about 10 days, minimally infectious after the second day of the rash Isolation Period 4 days after onset of rashQuarantine Period NoneMeasles does not often occur in adults. See also the sections on German measles and scarlet fever and the table of differences of symptoms.The disease starts like a cold in the head, with sneezing, a running nose and eyes, headache, cough and a slight fever 37.5C39C. During the next two days the catarrh extends to the throat causing hoarseness and a cough. A careful examination of the mouth during this period may reveal minute white or bluish white spots the size of a pins head on the inner side of the cheeks, or the tongue and inner side of the lips. These are cognize a Koplik spots and are not found in Germ an measles and scarlet fever.The rash appears on the fourth day when the temperature increases to 3940C. Pale rose-coloured spots first appear on the face and spread down to cover the rest of the body. The spots run together to form a mottled blotched appearance. The rash deepens in colour as it gets older. In four or five days the rash begins to fade, starting where it first appeared. The skin may peel. The main danger of measles is that the patient may get bronchitis, pneumonia or middle ear infection.General treatmentThis highly infectious disease is conveyed to others when the patient coughsor sneezes. There is no specific treatment, but the patient may have paracetamol. Calamine lotion, if available, may be applied to soothe the rash.Meningococcal disease (meningitis and septicaemia)French Mningite crbro-spinal pidmiqueGerman Epidemische Meningitis Cerebro-spinalItalian Meningite cerebro-spinal epidemicaSpanish Meningitis cerebro-spinal epidemicaIncubation Period 2 to 10 days, usually 3 to 4Period of communicability Generally not communicable whilst the patient is on antibiotics Isolation Period For 24 hours after the start of antibiotics Quarantine Period NoneInfection caused by the meningococcus (a bacterium) can cause either meningitis, with inflammation of the membranes surrounding the brain and spinal cord, or a septicaemia characterised by a generalised rash that does not fade on pressure. Unless treated promptly and effectively, the outcome is nearly always fatal. It occurs in epidemics which may affect closed communities such as a ship. The infection enters by the nose and mouth. Meningitis starts suddenly with fever, considerable headache and vomiting. Within the first day the temperature increases rapidly to 39C or more and the headache becomes agonising.107108THE SHIP CAPTAINS MEDICAL GUIDEVomiting increases and there is general backache with pain and stiffness in the neck. Intolerance of light (photophobia) is usually present. The patient may be intensely irritable and resent all interference, or may even be delirious.As the meningitis develops the patient adopts a characteristic durability inbed, lying on the side with his back to the light, knees drawn up and neck bent backwards. Unconsciousness with incontinence may develop.The septicaemia caused by the meningococcus also starts suddenly with a flu like illness. A rash develops quickly, starting with pin prick like spots which will not blanche when pressed. This rash may progress to form large dark red areas.Individual cases may vary in the speed of onset, the severity of the illness and the clinical features which are present.If meningitis is suspected get RADIO MEDICAL ADVICE and it will help the doctor if the results of the two following tests are availableThe neck bending testAsk the patient to attempt to put his chin on his chest. In meningitis the patient will be unable to do so because forward neck bowel movement will be greatly restricted by muscle contracti on. Try to increase the range of forward movement by pushing gently on the back of his head. The neck muscles will contract even more to prevent the movement and the headache and backache will be increased.The knee straightening test Figure 6.1A. Bend one leg until the heel isclose to the buttock.(A) Bend one leg until the heelis close to the buttock.B. Move the bent leg to lie overthe abdomen.C. Keeping the thigh as in (B) tryto straighten the lower leg.In meningitis it will be impossibleto straighten the knee beyond aright run and attempts to forcemovement will increase thebackache.(B) Move the bended legto lie over the abdomen.General treatmentThe patient should be nursed in aquiet, well-ventilated room withshaded lights in strict isolation. Heshould be accompanied at alltimes by an attendant who shouldwear a face mask to cover his noseand mouth. Tepid sponging maybe necessary and pressure pointsshould be treated. Usually there isno appetite but he should beencouraged to drink plenty offluid. Ice packs may help to relievethe headache.(C) Keeping the thighas in (B) try to straightenthe lower leg.Figure 6.1 The knee straightening test.Specific treatmentGive benzyl penicillin 3 g intramuscularly at once, and get RADIO MEDICAL ADVICE as to the amount and frequency of subsequent injections of benzyl penicillin. Until such advice is received, give benzyl penicillin 2.4 g at six hourly intervals. The headache should be treated with codeine. The patient should come under the care of a doctor as soon as possible.Chapter 6 COMMUNICABLE DISEASESMumpsFrench OreillonsItalian Malaria OrecchioniGerman Mumps ZiegenpeterSpanish OrejonesIncubation Period 12 to 26 days, usually 18Period of communicability 7 days before glandular swelling and up to 9 days after Isolation Period 9 days after swelling startedQuarantine Period NoneMumps is a viral disease which causes the swelling of the salivary glands in front of the ears and around the angle of the jaw. The swelling usually affects both sides of the face though it may only affect one side and it may make the mouth difficult to open. The onset is usually sudden and may be accompanied by a slight fever. The swelling little by little diminishes and should disappear entirely in about 3 weeks.About 20% of men with mumps get orchitis which is the swelling of one or both testicles when this occurs it usually happens around the tenth day. Whilst very painful, orchitis does not usually result in infertility and never in impotence.General treatmentThe patient should be put in standard isolation for 9 days and stay in bed for 4 to 5 days or until the fever is no longer present. He can be given paracetamol to relieve the symptoms, but there is no specific treatment.If he develops swollen painful testicles (orchitis) he should stay in bed. He should support the scrotum on a pad or small pillow. The testicles should also be supported if the patient gets up for any reason.PlagueFrench PesteGerman PestItalian PesteS panish PesteIncubation Period 2 to 6 daysPeriod of communicability As long as infected fleas are present. Person to person spread is uncommon except with plague pneumonia.Isolation Period For 3 days after the start of antibiotic treatment Quarantine Period 6 daysPlague is a serious bacterial disease transmitted to man by infected rat fleas. It may present in three waysBubonic in which buboes (swollen lymph nodes) are the most obvious feature. The nodes are painful and may ooze pus.Pneumonic in which pneumonia is the main feature. The type of plague is very infectious as the sputum contains the plague bacterium.Septicaemic which is rapidly fatal.The attack begins suddenly with severe malaise, shivering, pains in the back and sometimes vomiting. The patient becomes prostrated and is confused. His temperature reaches about oC C and the pulse is rapid. After about 2 days the buboes may develop, most commonly in 38the groins. The buboes may counteract into abscesses.General treatmentThe patient should be cared for by an attendant who should wear a face mask to cover his nose and mouth The patient should be isolated and taken as soon as possible to a port where he can be treated. He should rest in bed, be encouraged to drink as much fluid as possible and have a very light diet. If the abscesses burst they should be dressed with a simple dressing, but they must not be lanced. Soiled linen and bed clothes should be boiled for 10 minutes or destroyed.109 cxTHE SHIP CAPTAINS MEDICAL GUIDESpecific treatmentGive Doxycycline 100 mg once daily for at least 5 days. The patient should remain on complete bed rest during convalescence.PreventionPlague should be notified to the local health authorities at the next port of call. The quarters of the patient and the crew should be treated with insecticide powder and dust to ensure the destruction of fleas.WarningDead rats should be picked up with tongs, placed in a plastic bag, which should be sealed with string, weighted and thro wn overboard if the ship is in port, the dead rats should be disposed of in the manner required by the port medical health authority.Poliomyelitis infantile paralysisFrench PoliomyliteItalian PoliomieliteGerman PoliomyelitisSpanish PoliomielitisIncubation Period 321 days, commonly 714 daysPeriod of communicability Cases are most infectious during the first few days before and after the onset of symptomsIsolation Period not more than 7 daysQuarantine Period NonePoliomyelitis is an acute viral disease that occurs mostly in children. It isa disease almost entirely preventable by immunisation.The severity ranges from non-apparent infection to non-specific febrile illness, meningitis, paralytic disease and death. Symptoms of the mild disease include fever, malaise, headache, nausea and vomiting. If the disease progresses, severe muscle pain and stiffness of the neck and back, with or without paralysis will occur. The most commonly affected parts are the legs and arms, shoulders, diaphra gm and chest muscles. The development of paralysis is generally complete within two days and then recovery begins. The recovery may be complete or leave some degree of paralysisAffected muscles are usually painful and tender if touched. They are always arrest and movements of the affected parts are either creakyened or lost by the wasting which appears very soon after paralysis.Paralysis of the respiratory muscles may cause breathlessness and blueness of the lips.General treatmentThere is no specific treatment but much can be achieved by good nursing. The patient should have complete rest in bed. Pain should be treated with paracetamol and/or codeine. If a limb has been affected it should be supported by pillows in such a way that the paralysed muscles cannot be stretched. The joints above and below the paralysis should be put through a full range of movement morning and evening to prevent stiffness. In all cases, as soon as paralysis appears, RADIO MEDICAL ADVICE must be sought. If the respiratory muscles are affected, breathing difficulty may ensue. Urgent steps must be taken to get the patient to skilled hospital treatment as soon as possible.Chapter 6 COMMUNICABLE DISEASESRabies hydrophobiaFrench La rageGerman TollwutItalian RabbiaSpanish RabiaIncubation Period in manhood the incubation period is usually 2 to 12 weeks, shortest for patients bitten about the head and those with extensive bites Communicability Rabies is rarely, if ever, spread from human to human. Nevertheless for the duration of the illness defilement with saliva should be avoided by wearing gloves when nursing the patientIsolation Period Duration of the illnessQuarantine PeriodRabies is an acute infectious viral disease that is almost always fatal. When a rabid mammal bites humans or other animals, its saliva transmits the infection into the wound, from where it spreads to the central nervous system. Rabies is primarily an infection of wild animals such as skunks, coyotes, foxes, wolv es, racoons, bats, squirrels, rabbits, and chipmunks. The most common domestic animals reported to have rabies are dogs, cats, cattle, horses. mules, sheep, goats, and swine. It is possible for rabies to be transmitted if infective saliva enters a scratch or fresh break in the skin.The development of the disease in a bitten person can be prevented by immediate and proper treatment, Once symptoms of rabies develop, death is virtually certain to result. Thus prevention of this disease is of the utmost importance.Local port authorities should be informed of possible rabid animals, so that appropriate public health measures can be instituted.TreatmentAs soon as an individual aboard ship Is known to have been bitten by a dog or other possibly rabid animal, RADIO MEDICAL ADVICE should he obtained at once. Usually suspected cases are sent ashore to obtain the expert treatmentand nursing care needed to prevent the disease.Immediate local care should be given. Vigorous treatment to remove ra bies virus from the bites or other exposures to the animals saliva may be as important as specific anti-rabies treatment. Free bleeding from the wound should be encouraged. Other local care should consist ofs thorough irrigation of the wounds with soap or detergent water solution s cleansing with antiseptic solutions if recommended by radio, giving an antibiotic to prevent infection s administering adsorbed tetanus toxoid, if indicated.s Suturing of bite wounds should be avoided.PreventionWhen abroad, seamen should keep away from warm-blooded animals especially cats, dogs. and other carnivores. It is strongly advised that pets should not be carried on board ship as these may become infected unnoticed, through contact with rabid animals in ports.111112THE SHIP CAPTAINS MEDICAL GUIDEScarlet feverFrench ScarlatineGerman ScharlachItalian ScarlattinaSpanish EscarlatinaIncubation Period 1 to 3 daysPeriod of communicability 3 daysIsolation Period 14 days in untreated cases, 1 to 2 days if given antibiotics. Quarantine Period NoneScarlet fever is not often contracted by adults. It has features similar to those of measles and German measles see the table of differences of symptoms.The onset is generally sudden and the temperature may rapidly rise to 39.5 to 40C on the first day. With the fever the other main early symptom is a sore throat, which in most cases is very severe. The skin is hot and burning to the touch. The rash appears on the second day and consists of tiny bright red spots so close together that the skin assumes a scarlet or boiled lobster-like colour. It usually appears first on the neck, very rapidly spreads to the upper part of the chest and then to the rest of the body. There may be an area around the mouth which is clear of the rash.The tongue at first is covered with white fur and, when this goes, it becomes a very bright red (strawberry). The high fever usually lasts about a week. As the rash fades the skin peels in circular patches. The danger of scarlet fever arises from the complications associated with it, e.g. inflammation of the kidneys (test the urine for protein once a day), inflammation of the ear due to the spread of infection from the throat, rheumatism and heart disease. These complications can be avoided by careful treatment.General treatmentThe patient must stay in bed and be kept as quiet as possible. The patient can be given paracetamol to relieve the pain in the throat which may also be helped if he takes plenty of cold drinks. He can take such food as he wishes.Specific treatmentAs scarlet fever usually follows from a sore throat or tonsillitis you may already be giving him the relevant treatment. Otherwise give the specific treatment for tonsillitis.Tetanus lockjawFrench TetanosGerman WundstarrkrampfItalian TetanoSpanish TetanosIncubation Period 4 to 21 daysPeriod of communicability No person to person transmissionIsolation Period NoneQuarantine Period NoneTetanus is caused by the infection of a wound by the tetanus bacterium which secretes a powerful poison (toxin). This bacterium is very widespread in nature and the source of the wound infection may not always be easy to trace. Puncture wounds are particularly liable to be dangerous and overlooked as a point of entry. In the UK immunisation against the disease usually begins in childhood but it is necessary to have further periodic inoculations to maintain effective immunity. fortunately the disease is a very rare condition on board ship. The first signs of the disease may be spasms or stiffening of the jaw muscles and, sometimes, other muscles of the face leading to difficulty in opening the mouth and swallowing. The spasms tend to become more frequent and spread to the neck and back causing the patients body to become arched.The patient remains fully conscious during the spasms which are extremely painful and brought on by external stimulus such as touch, noise or bright light. The patient is progressively exhausted until heart and lung failure prove fatal. Alternatively, the contractions may become less frequent and the patient recovers, but there is a high mortality.TreatmentThe patient should be isolated in a darkened room as far as possible from all disturbances. Get RADIO MEDICAL ADVICE. Give antibiotic treatment and give diazepam or chlorpromazine as sedation and to control spasms. The patient must be got to hospital as soon as possible.Chapter 6 COMMUNICABLE DISEASESTuberculosis TB, consumptIonFrench TuberculoseGerman Tuberkulose Italian TuberculosisSpanish TuberculosisIncubation Period 4 to 12 weeksPeriod of communicability indefinite, 2 weeks after antibiotics Isolation Period depends on the degree of infection, rarely necessary Quarantine Period NoneThis infectious disease is caused by the tubercle bacillus. Although the lung (pulmonary) disease is the most common, TB bacteria may attack other tissues in the body bones. joints. glands, or kidneys. Unlike most contagious diseases, tuberculosis u sually takes a considerable time to develop, often appearing only after repeated, close, and prolonged exposures to a patient with the active disease. A healthy body is usually able to control the tubercle bacilli unless the invasion is overwhelming or resistance is low because of chronic alcoholism, poor nutrition, or some other weakening condition.The pulmonary form of the disease is spread most often by coughing and sneezing. A person may have tuberculosis for a long time before it is detected. Symptoms may consist of nothing more than a persistent cough, slight loss of weight, night sweats, and a continual all-in or tired-out feeling that persists when there is no good reason for it. More definitive signs pointing to tuberculosis are a cough that persists for more than a month, raising sputum with each cough. persistent or recurring pains in the chest, and afternoon rises in temperature. When he reaches a convenient port, a seaman with one or more of these warning signs should s ee a physician.TreatmentEvery effort should be made to prevent anyone who has active tuberculosisfrom going to sea. since this would present a risk to the crews health as well as the individuals. The treatment of tuberculosis by medication will not usually be started at sea, since the disease does not constitute an emergency.To prevent the spread of tuberculosis, every patient with a cough, irrespective of its cause, should hold disposable tissues over his mouth and nose when coughing or sneezing and place the used tissues in a paper bag, which should be disposed of by burning. The medical attendant should follow good nursing isolation techniques (see Isolation Chapter 3). No special precautions are necessary for handling the patients bedclothes, eating utensils, and personal clothing.Tuberculosis controlA tuberculosis control programme has three objectives (I) to keep individuals with the disease from signing on as crew-members (2) to locate those who may have developed the disease while aboard ship and initiate treatment and (3) to give preventive treatment to persons at high risk of developing the active disease. The first objective can be achieved by periodic, thorough physical examinations including chest X-rays and bacteriological examination of sputum. To identify those who might have developed active tuberculosis, a chest X-ray should be taken and a medical evaluation including bacteriological examination of sputum bespeak when in port, if a crew-member develops symptoms of a chest cold that persist for more than two weeks.Also, when any active disease is discovered, survey should be made of close associates of the patient and others in prolonged contact with him. Such persons are regarded as contacts and are considered at risk from the disease they should be given a tuberculin test and chest X-ray when next in port. If they develop symptoms, full medical examination, including bacteriological examination of sputum, should be requested.113114THE SHIP CAPTAINS MEDICAL GUIDETyphus feverFrench Typhus exanthAematiqueItalian Tifo petecchialeGerman FlecktyphusSpanish Tifus petequialIncubation Period 6 to 15 days, usually 12Period of communicability Not directly transmissible from person to person Isolation Period not required after de-lousingQuarantine Period 14 daysThis disease should not be confused with typhoid fever. Typhus is caused by a small bacterium. The disease is conveyed by lice, fleas, ticks and mites. Treatment for the various types of typhus is the same and the symptoms are very similar. The main typhi are epidemic (from lice) and murine, or ship typhus, (from rat fleas).Symptoms and signsOnset is sudden with headache, vomiting, shivering and nausea. The temperature rapidly rises and may reach 40.0C to 40.6C. The patient suffers great prostration, and may be delirious or confused.About the fifth day a rash appears on the front of the body, spreading to the back and limbs in the form of dusky red spots which give the ski n a blotchy appearance. The disease if untreated lasts about two weeks. With tick or mite borne typhus there is usually a punched out b lack ulcer (eschar) which corresponds to the site of attachment.TreatmentIn the case of louse-borne typhus isolate the patient at once. bedding and clothing of the patient and close contacts should be treated with a residualinsecticide. The patient should receive Doxycycline until his temperature settles plus one day. The response is normally prompt.Whooping cough pertussisFrench CoquelucheGerman Keuchhusten Italian PertosseSpanish Tos FerinaIncubation Period 7 to 10 days, rarely exceeding 14 daysPeriod of communicability 21 days, normally no more than 5 days after antibiotics Isolation Period 5 days after antibioticsQuarantine Period NoneThis disease occurs among unvaccinated children unvaccinated adults may contract it. The disease in adults has no typical features.Symptoms and signsThe onset occurs as a severe cough which after about 7 to 10 da ys is marked by a typical whoop, with or without vomiting. The whoop is caused by a convulsive series of coughs reaching a point where the patient must take a breath. It is this noisy indrawing of breath which produces the whoop. The coughing bouts may be very distressing.TreatmentGive erythromycin for 5 days. This is unlikely to affect the course of the disease unless given very early, but it will reduce the infectiousness of the patient. In children, during the bouts of coughing, feeding may induce vomiting. It is best, therefore, to give light food in between the coughing bout and to keep the child quiet in bed.Chapter 6 COMMUNICABLE DISEASESYellow feverFrench Fivre jauneGerman GelbfieberItalian Febbra giallaSpanish Fiebra amarillaIncubation Period 3 to 6 daysPeriod of communicability 6 daysIsolation Period 12 days only if stegomyia mosquitoes are present in the port or on board Quarantine Period 6 daysThis is a serious and often fatal disease which is caused by a virus transmitt ed to humans by a mosquito. The disease is endemic in Africa from coast to coast between the south of the Sahara and Kenya, and in parts of the Central and Southern Americas.PreventionTravellers to these areas should be inoculated against the disease. Many countries require a valid International Certificate of yellow fever inoculation for those who are going to, or have been in or passed through, such areas. See also the note on prevention of mosquito bites in the section dealing with malaria.Features of the diseaseThe severity of the disease differs between patients. In general, from 3 to 6 days after being bitten the patient fluctuates between being shivery and being over hot. He may have a fever as high as 41C, headache, backache and severe nausea and centre in the pit of the stomach. He may seem to get slightly better but then, usually about the fourth day, he becomes very weak and produces vomit tinged with bile and blood (the so-called black vomit). The stomach pains increase and the bowels are constipated. The faeces, if any, are coloured black by digested blood. The eyes become yellow (jaundice) and the mind may wander. After the fifth or sixth day the symptoms may subside and the temperature may fall. The pulse can drop from about 120 per minute to 40 or 50. This period is critical leading to recovery or death.Increasing jaundice and very scanty, or lack of, urine are unfavourable signs. Protein in the urine occurs soon after the start of the illness and the urine should be tested for it.General treatmentThe patient must go to bed and stay in a room free from mosquitoes. The patient must be encouraged to drink as much as possible, fruit juices are recommended.115