Renovation of Bathroom of Syracuse University Residence Hall (Dat Article

Renovation of Bathroom of Syracuse University Residence Hall (Dat Hall) - Article Example Importantly of the three viable options and the three budgeting conclusions, investigations revealed that each of the viable options will not require significant pipeline changes in the plumbing system, thus reducing costs. Option one will give freshmen the opportunity to have some privacy while showering or using the facility. Option two would not be costly as option one but will still give the bathrooms modernized feel students are used to in everyday life. The last option focuses on the student’s complaints about broken showers and old tiles. This report recommends that Day Hall renovates using option two as it will give the bathrooms a modernized feel, besides installments can be completed through SU staff reducing cost. For the purpose of providing a more comfortable residence experience for incoming freshmen, the communal bathrooms in day hall are fairly old and raise concerns over privacy and cleanliness issues amongst students currently living in the dorm. Amongst the issues for improvements, privacy ranks as of greatest importance, including sinks, showers, and toilets that are very close together. The bathrooms are very open and lack the privacy many students would like when moving to college. Therefore, to provide more personal space, renovations or separation of the toilets, showers, and sinks in the bathroom area can accommodate new and old students satisfactorily. To renovate the Day Hall’s facilities will add comfortability to the student’s need for usage, besides eliminating the health risks that may arise as a result. The primary concern of this feasibility study is the cost, duration of downtime, and the availability of SU staff.  

Service Learning Project Essay Example | Topics and Well Written Essays - 750 words

Service Learning Project - Essay Example Critical analysis of the major findings obtained through the discussion and development of an action plan have also been considered as the objectives in this paper. The services that are provided by DHA with its community organization of ‘Hidden Ridge Apartment’ majorly include ‘After School Programs’ to provide educational support through home study centers for both children and parents. Another service rendered by the organization is the ‘Resident Employment Program’ which principally concentrates on boosting the employment and educational opportunities within the society as well as rendering other support services (Dallas Housing Authority, 2007). The after school program for the children and parents are effective educational support which comprises of courses from preliminary level to high school courses rendered through the home study centers of DHA and its communities. The home study center also attempts to provide an instructive education facility after their schooling hours for five days in a week. The study center associated with its cooperative partner such as Dallas Ministries in order to provide educational supports to the community members (Dallas Housing Authority, 2007). The training services that are rendered by DHA are significantly emphasized on creating employment opportunities by assuring effective communication skill development programs through assessment testing, career counseling, placement support, job readiness exercises and so on for the young generation in the community. Additionally, the housing community also facilitates other beneficial guidance in terms of wealth management skills, personality development programs, and transportation assistance along with personal life improvement assistance (Dallas Housing Authority, 2007). DHA focuses on providing housing as well as other social facilities on a

Educational Policies of Nigeria and South Korea Essay Example for Free

Educational Policies of Nigeria and South Korea Essay Education has been the corner stone of the success of every economy. In terms of those countries which have been colonized and have adopted a government that was highly repressive in nature, one could significantly argue that such would post an effect to how education was being delivered, the degree of excellence of the aforementioned, the demands of the market and the availability of jobs, and finally its effects to the economy. This paper focuses on the educational history and policies of Nigeria and South Korea in relation to the British military government of the Nigerians and the Japanese occupation and the American military government of the South Koreans. These policies and norms are then significantly related to their employment systems and its effect on their economy. The objectives of this essay are the following: 1. To establish a brief account of the educational policies and norms of Nigeria and South Korean and significantly identify its relationship to the military government. 2. To significantly identify the effects of the educational policies and norms in relation to the availability of jobs to the citizens and consequently the continuous demands of the market for such jobs; and finally 3. To know the effects of educational excellence, jobs availability and demands to the sustainable development of an economy. Review of Related Literature Education and Military Government in Nigeria One of the major constitutional changes that happened to the government of Nigeria was in 1953, a few years after the World War II. Such a change took effect through the London Conference attended by both Nigerian and Colonial officials which places the country under the rule of a Governor General, having the aforementioned the leader of the three principle regions of the country. Such a change of the name of positions was a way for the British regime to increase the autonomous powers of the country thereby making education vested at the local level, which is in accordance with the aim of unifying the region (Patterson, 1955, p. 94). Education, other than representation and taxation was one of the autonomous areas of governance that is designated to the central government. As such it is with this respect that the government had ordered that the youth of Nigeria regardless of any region should be given sound and uniform standards of performance (p. 95). The objective of this educational policy is to have the youth fully prepared on their primary and secondary education so as to enable them to take higher education both inside and outside of the country. Within the new constitution, 34 subjects or areas of concern were given to the federal government to oversee. In addition with this, 14 subject areas were also created and delegated to the federal government to be administered to individual regions. Consequently, it has also been perceived that the successful implementation of these subjects could only happen if the individuals administering these areas were competent enough, hence resulting to the very high standards were implemented by the government in terms of employee recruitment (p. 5). Such a drive for the development of skills for the Nigerian youth resulted to the perceived shortness in terms of trained senior administrators and other technicians for various government and technical posts for the country. The federal government perceived that the shortage could only be remedied through higher education and long experience of the youth. At the end of 1953, it has been perceived that 5,000 senior service positions were available in which 3,300 of them were taken by overseas personnels or the expatriates. Only 800 positions are given to Nigerians, and there were still 900 positions more that were vacant (World Bank, 1955, p. 23). The drive of the British Government to improve the education in Nigeria resulted to the establishment of a program for development for African Territories under the British Crown. The program which was called the Colonial Development and Welfare Schemes was inaugurated in 1945 in which required the British Government to contribute 23,000,000 pounds sterling for ten years that would enable the country to develop and another loan of 26-500,000 pounds sterling that would be used to fund a number of projects including education and other research facilities (Patterson, 1955, p. 97). The result of such an effort on the end of the British Government paved the way for a consuming ambition among young Nigerians to be associated with the Government and take a number of white collar jobs (p. 8). Technical Education in Nigeria Technical education is placed as one of the major projects of the Ten-Year Plan for Development and Welfare for the post-war Nigeria. Institutions that would cater to technical skills, trade, and handicrafts were created after the Second World War. For instance, the Technical Institute of Yaba, the first center that was created outside Lagos offered three full-time and two part-time programs and special short courses. These skills were those relating to junior and senior technical and also teacher training. For a four-year education, the country had been offering instructions in wood working, drafting, sub-professional engineering, commerce and printing to those students who have completed eight years of primary education and have already passed a special entrance examination. The senior technical course offered by the institute focused on courses in electrical, mathematical and civil engineering, architectural assistance and economics. Consequently, there were also teacher-training programs which offer a two-year course to prepare teachers for handicraft centers and secondary school craft courses (World Bank, 1955, p. 582-583). On the other hand, the Trade Centers at Yaba aimed to produce skilled craftsmen by offering courses which range from two to five years. The students primarily learned on an apprenticeship basis after which they have already familiarized themselves with the tools of the trade and have learned to do simple tasks; consequently academic instructions were given to the students averages one day every week. After the students have already gained the skills that are necessary, they were contacted by the trade center to go to large cities in order to work. Part of the educational system was also the refusal to accept new students until a new class graduates. As such, the intake and output for some courses happened only once in every five years. For the first five years of the operation of the Yaba Centre, there were only 85 students who had graduated while 18 were dismissed and 13 of them resigned (p. 84). The Weakness of the Nigerian Education One major weaknesses of the Nigerian education was the inclination to have all areas of the Government to have properly staffed and well-trained individuals; as such resulting in having schools to have its own standards and specializations and independence from other educational efforts. Such an act resulted at times to the replication of jobs or over specialization on some skills, which were often criticized to prevent holistic development. It has been argued by some scholars that schools that were operated by the departments of governments had the inclination to emphasize subjects that were too technical up to the extent of neglecting certain subjects such as English, Mathematics and the Social Sciences. As such, some students after graduating from departmental schools normally look for jobs that they believed will be necessary for their employment rather than their abilities and interests (Patterson, 1955, p. 7-98). In effect of this, the inclination towards education had been something that was relative to that of available employment. Outside the market, it had been perceived that education had no value and in the long run, had stimulated little demand to the public. It is with this respect that competition among available jobs had been perceived to be very keen wherein the colonial Nigeria has clustered to commercial areas within the region (Davis and Kalu-Nwiwu, 2001, p. 1). It could also be significantly noted that education for women during the post-war Nigeria had also been problematic as although there were already several domestic science centers that were established, very few of them remained in actual operation. As such, the education of women had been lagging in the country. The education that was provided to women were those solely with regard to food preparation, sewing, cleaning, general sanitation and elementary skills in nursing (World Bank, 1955, p. 588).

Electrochemical battery

Electrochemical battery HISTORY An early form of electrochemical battery called the Baghdad Battery may have been used in antiquity. However, the modern development of batteries started with the Voltaic pile, invented by the Italian physicist Alessandro Volta in 1800. In 1780 the Italian anatomist and physiologist Luigi Galvani noticed that dissected frogs legs would twitch when struck by a spark from a Leyden jar, an external source of electricity. In 1786 he noticed that twitching would occur during lightning storms. After many years Galvani learned how to produce twitching without using any external source of electricity. He started doing his experiments on frogs with metals but he replaced them with electrolyte and electrodes and named the system as voltaic cell. In 1800, Volta invented the battery by placing many voltaic cells in series, literally piling them one above the other. This Voltaic pile gave a greatly enhanced net emf for the combination. After voltaic cell, in 1836 Daniell cell came into existence. It provided more stable current and was also accepted by the industries. These wet cells were not portable as there liquid electrolyte used to spill. Therefore by the end of nineteenth century dry batteries came into existence in which the liquid electrolyte was replaced with dry paste making the dry batteries portable. Working of Batteries Electrochemical cell In this example the two half-cells are linked by a salt bridge separator that permits the transfer of ions, but not water molecules. A battery is a device that converts chemical energy directly to electrical energy. It consists of a number of voltaic cells; each voltaic cell consists of two half cells connected in series by a conductive electrolyte containing anions and cations. One half-cell includes electrolyte and the electrode to which anions (negatively-charged ions) migrate, i.e. the anode or negative electrode; the other half-cell includes electrolyte and the electrode to which cations (positively-charged ions) migrate, i.e. the cathode or positive electrode. In the redox reaction that powers the battery, reduction (addition of electrons) occurs to cations at the cathode, while oxidation (removal of electrons) occurs to anions at the anode. The electrodes do not touch each other but are electrically connected by the electrolyte, which can be either solid or liquid. Many cells use two half-cells with different electrolytes. In that case each half-cell is enclosed in a container, and a separator that is porou s to ions but not the bulk of the electrolytes prevents mixing. Each half cell has an electromotive force (or emf), determined by its ability to drive electric current from the interior to the exterior of the cell. The net emf of the cell is the difference between the emfs of its half-cells, as first recognized by Volta. Therefore, if the electrodes have emfs and, then the net emf is; in other words, the net emf is the difference between the reduction potentials of the half-reactions. The electrical driving force or across the terminals of a cell is known as the terminal voltage (difference) and is measured in volts. The terminal voltage of a cell that is neither charging nor discharging is called the open-circuit voltage and equals the emf of the cell. Because of internal resistance, the terminal voltage of a cell that is discharging is smaller in magnitude than the open-circuit voltage and the terminal voltage of a cell that is charging exceeds the open-circuit voltage. An ideal cell has negligible internal resistance, so it would maintain a constant terminal voltage of until exhausted, then dropping to zero. If such a cell maintained 1.5 volts and stored a charge of one Coulomb then on complete discharge it would perform 1.5 Joule of work. In actual cells, the internal resistance increases under discharge, and the open circuit voltage also decreases under discharge. If the voltage and resistance are plotted against time, the resulting graphs typically are a cur ve; the shape of the curve varies according to the chemistry and internal arrangement employed. As stated above, the voltage developed across a cells terminals depends on the energy release of the chemical reactions of its electrodes and electrolyte. Alkaline and carbon-zinc cells have different chemistries but approximately the same emf of 1.5 volts; likewise NiCd and NiMH cells have different chemistries, but approximately the same emf of 1.2 volts. On the other hand the high electrochemical potential changes in the reactions of lithium compounds give lithium cells emfs of 3 volts or more. Categories and types of batteries Main article: List of battery types Batteries are classified into two broad categories, each type with advantages and disadvantages. Primary batteries irreversibly (within limits of practicality) transform chemical energy to electrical energy. When the initial supply of reactants is exhausted, energy cannot be readily restored to the battery by electrical means. Secondary batteries can be recharged; that is, they can have their chemical reactions reversed by supplying electrical energy to the cell, restoring their original composition. Historically, some types of primary batteries used, for example, for telegraph circuits, were restored to operation by replacing the components of the battery consumed by the chemical reaction.[34] Secondary batteries are not indefinitely rechargeable due to dissipation of the active materials, loss of electrolyte and internal corrosion. Primary batteries Primary batteries can produce current immediately on assembly. Disposable batteries are intended to be used once and discarded. These are most commonly used in portable devices that have low current drain, are only used intermittently, or are used well away from an alternative power source, such as in alarm and communication circuits where other electric power is only intermittently available. Disposable primary cells cannot be reliably recharged, since the chemical reactions are not easily reversible and active materials may not return to their original forms. Battery manufacturers recommend against attempting to recharge primary cells. Common types of disposable batteries include zinc-carbon batteries and alkaline batteries. Generally, these have higher energy densities than rechargeable batteries, but disposable batteries do not fare well under high-drain applications with loads under 75 ohms (75 ÃŽ ©). Secondary batteries Main article: Rechargeable battery Secondary batteries must be charged before use; they are usually assembled with active materials in the discharged state. Rechargeable batteries or secondary cells can be recharged by applying electrical current, which reverses the chemical reactions that occur during its use. Devices to supply the appropriate current are called chargers or rechargers. The oldest form of rechargeable battery is the lead-acid battery. This battery is notable in that it contains a liquid in an unsealed container, requiring that the battery be kept upright and the area be well ventilated to ensure safe dispersal of the hydrogen gas produced by these batteries during overcharging. The lead-acid battery is also very heavy for the amount of electrical energy it can supply. Despite this, its low manufacturing cost and its high surge current levels make its use common where a large capacity (over approximately 10Ah) is required or where the weight and ease of handling are not concerns. A common form of the lead-acid battery is the modern car battery, which can generally deliver a peak current of 450 amperes. An improved type of liquid electrolyte battery is the sealed valve regulated lead acid (VRLA) battery, popular in the automotive industry as a replacement for the lead-acid wet cell. The VRLA battery uses an immobilized sulfuric acid electrolyte, reducing the chance of leakage and extending shelf life. VRLA batteries have the electrolyte immobilized, usually by one of two means: Gel batteries (or gel cell) contain a semi-solid electrolyte to prevent spillage. Absorbed Glass Mat (AGM) batteries absorb the electrolyte in a special fiberglass matting Other portable rechargeable batteries include several dry cell types, which are sealed units and are therefore useful in appliances such as mobile phones and laptop computers. Cells of this type (in order of increasing power density and cost) include nickel-cadmium (NiCd), nickel metal hydride (NiMH) and lithium-ion (Li-ion) cells. By far, Li-ion has the highest share of the dry cell rechargeable market. Meanwhile, NiMH has replaced NiCd in most applications due to its higher capacity, but NiCd remains in use in power tools, two-way radios, and medical equipment. Battery cell types There are many general types of electrochemical cells, according to chemical processes applied and design chosen. The variation includes galvanic cells, electrolytic cells, fuel cells, flow cells and voltaic piles. Wet cell A wet cell battery has a liquid electrolyte. Other names are flooded cell since the liquid covers all internal parts, or vented cell since gases produced during operation can escape to the air. Wet cells were a precursor to dry cells and are commonly used as a learning tool for electrochemistry. It is often built with common laboratory supplies, like beakers, for demonstrations of how electrochemical cells work. A particular type of wet cell known as a concentration cell is important in understanding corrosion. Wet cells may be primary cells (non-rechargeable) or secondary cells (rechargeable). Originally all practical primary batteries such as the Daniel cell were built as open-topped glass jar wet cells. Other primary wet cells are the Leclanche cell, Grove cell, Bunsen cell, Chromic acid cell, Clark cell and Weston cell. The Leclanche cell chemistry was adapted to the first dry cells. Wet cells are still used in automobile batteries and in industry for standby power for switchgear, telecommunication or large uninterruptible power supplys, but in many places batteries with gel cells have been used instead. These applications commonly use lead-acid or nickel-cadmium cells. Dry cell A dry cell has the electrolyte immobilized as a paste, with only enough moisture in the paste to allow current to flow. Compared to a wet cell, the battery can be operated in any random position, and will not spill its electrolyte if inverted. While a dry cells electrolyte is not truly completely free of moisture and must contain some moisture to function, when it was first developed it had the advantage of containing no sloshing liquid that might leak or drip out when inverted or handled roughly, making it highly suitable for small portable electric devices. By comparison, the first wet cells were typically fragile glass containers with lead rods hanging from the open top, and needed careful handling to avoid spillage. An inverted wet cell would leak, while a dry cell would not. Lead-acid batteries would not achieve the safety and portability of the dry cell, until the development of the gel battery. A common dry cell battery is the zinc-carbon battery, using a cell sometimes called the dry Leclanchà © cell, with a nominal voltage of 1.5 volts, the same nominal voltage as the alkaline battery (since both use the same zinc-manganese dioxide combination. The makeup of a standard dry cell is a zinc anode (negative pole), usually in the form of a cylindrical pot, with a carbon cathode (positive pole) in the form of a central rod. The electrolyte is ammonium chloride in the form of a paste next to the zinc anode. The remaining space between the electrolyte and carbon cathode is taken up by a second paste consisting of ammonium chloride and manganese dioxide, the latter acting as a depolarizer. In some more modern types of so called high power batteries, the ammonium chloride has been replaced by zinc chloride. Battery cell performance A batterys characteristics may vary over load cycle, charge cycle and over life time due to many factors including internal chemistry, current drain and temperature. Extending battery life Battery life can be extended by storing the batteries at a low temperature, as in a refrigerator or freezer, because the chemical reactions in the batteries are slower. Such storage can extend the life of alkaline batteries by ~5%; while the charge of rechargeable batteries can be extended from a few days up to several months. In order to reach their maximum voltage, batteries must be returned to room temperature; discharging an alkaline battery at 250 mAh at 0 °C is only half as efficient as it is at 20 °C. As a result, alkaline battery manufacturers like Duracell do not recommend refrigerating or freezing batteries. Hazards 1.) Explosion A battery explosion is caused by the misuse or malfunction of a battery, such as attempting to recharge a primary (non-rechargeable) battery, or short circuiting a battery. With car batteries, explosions are most likely to occur when a short circuit generates very large currents. In addition, car batteries liberate hydrogen when they are overcharged (because of electrolysis of the water in the electrolyte). Normally the amount of overcharging is very small, as is the amount of explosive gas developed, and the gas dissipates quickly. However, when jumping a car battery, the high current can cause the rapid release of large volumes of hydrogen, which can be ignited by a nearby spark. When a battery is recharged at an excessive rate, an explosive gas mixture of hydrogen and oxygen may be produced faster than it can escape from within the walls of the battery, leading to pressure build-up and the possibility of the battery case bursting. In extreme cases, the battery acid may spray violently from the casing of the battery and cause injury. Overcharging—that is, attempting to charge a battery beyond its electrical capacity—can also lead to a battery explosion, leakage, or irreversible damage to the battery. It may also cause damage to the charger or device in which the overcharged battery is later used. Additionally, disposing of a battery in fire may cause an explosion as steam builds up within the sealed case of the battery. 2.) Leakage One style of disposable battery uses zinc can as both a reactant and as the container to hold the other reagents. If this kind of battery is run all the way down, or if it is recharged after running down too far, the reagents can emerge through the cardboard and plastic that forms the remainder of the container. The active chemicals can then corrode or otherwise destroy the equipment that they were inserted into. Many battery chemicals are corrosive or poisonous or both. If leakage occurs, either spontaneously or through accident, the chemicals released may be dangerous. 3.) Environmental concerns The widespread use of batteries has created many environmental concerns, such as toxic metal pollution. Battery manufacture consumes resources and often involves hazardous chemicals. Used batteries also contribute to electronic waste. Some areas now have battery recycling services available to recover some of the materials from used batteries. Batteries may be harmful or fatal if swallowed. Recycling or proper disposal prevents dangerous elements (such as lead, mercury, and cadmium) found in some types of batteries from entering the environment. In the United States, Americans purchase nearly three billion batteries annually, and about 179,000 tons of those end up in landfills across the country. In the United States, the Mercury-Containing and Rechargeable Battery Management Act of 1996 banned the sale of mercury-containing batteries (except small button cell batteries), enacted uniform labeling requirements for rechargeable batteries, and required that rechargeable batteries be easily removable. California and New York City prohibit the disposal of rechargeable batteries in solid waste, and along with Maine require recycling of cell phones. The rechargeable battery industry has nationwide recycling programs in the United States and Canada, with drop-off points at local retailers. Battery chemistry Older batteries were mostly based on rechargeable lead-acid or non-rechargeable alkaline chemistries, with nominal voltages in increments of 2.10 2.13 and 1.5Volts respectively, each representing one individual electrochemical cell. New special battery chemistries have strained older naming conventions. Rechargeable NiCd (Nickel Cadmium) and NiMH (Nickel Metal Hydride) typically output 1.25V per cell. Some devices may not operate properly with these cells, given the 16% reduction in voltage, but most modern ones handle them well. Conversely, lithium-ion rechargeable batteries output 3.7V per cell, 23% higher than a pair of alkaline cells (3V), which they are often designed to replace. Non-rechargeable lithium-chemistry batteries, which provide exceptionally high energy density, produce about 1.5V per cell and are thus similar to alkaline batteries. Many new battery sizes refer to both the batteries size and chemistry, while older names do not. For a more complete list see battery types. This summary is only for types relating to battery sizes. Homemade cells Almost any liquid or moist object that has enough ions to be electrically conductive can serve as the electrolyte for a cell. As a novelty or science demonstration, it is possible to insert two electrodes made of different metals into a lemon, potato, etc. and generate small amounts of electricity. Two-potato clocks are also widely available in hobby and toy stores; they consist of a pair of cells, each consisting of a potato (lemon, et cetera) with two electrodes inserted into it, wired in series to form a battery with enough voltage to power a digital clock. Homemade cells of this kind are of no real practical use, because they produce far less current—and cost far more per unit of energy generated—than commercial cells, due to the need for frequent replacement of the fruit or vegetable. In addition, one can make a voltaic pile from two coins and a piece of paper towel dipped in salt water. Such a pile would make very little voltage itself, but when many of them are s tacked together in series, they can replace normal batteries for a short amount of time. Sony has developed a biologically friendly battery that generates electricity from sugar in a way that is similar to the processes observed in living organisms. The battery generates electricity through the use of enzymes that break down carbohydrates, which are essentially sugar. Lead acid cells can easily be manufactured at home, but a tedious charge/discharge cycle is needed to form the plates. This is a process whereby lead sulfate forms on the plates, and during charge is converted to lead dioxide (positive plate) and pure lead (negative plate). Repeating this process results in a microscopically rough surface, with far greater surface area being exposed. This increases the current the cell can deliver. Daniell cells are also easy to make at home. Aluminum-air batteries can also be produced with high purity aluminum. Aluminum foil batteries will produce some electricity, but they are not very efficient, in part because a significant amount of hydrogen gas is produced.

Expert Systems In Health Care :: essays research papers

A case referring to the beneficial use of the expert systems in the health sector was the attempt of the LDS Hospital in Salt Lake city,Utah to build “ the most complex artificial intelligence system ever created'; according to the words of DR David Classen.Its name was AIC or “Antibiotic Computer Consultant'; and it was part of HELP(Health Evaluation through Logical Processing), which was LDS’s hospital information system. The latter was existed, before the implementation of the Expert System. The role of AIC was to help doctors determine proper antibiotic treatment for specific patients.Achieving the specific purpose,the Expert System followed the above stages: 1) The doctor turned to the system with information on the infection type and site, and also identified the patient to the computer. 2) The system determined the pathogens, which are likely to have caused the infection. 3) The software examined the patient’s medical records( through the HELP information system) and searched for similar cases nationwide. 4) Finally, it displayed the five most likely antibiotic regimens to be effective and the cost of the prescription for each one. Altough,the system was extremely rewarding and expanded to include other cases involving antibiotics, some criticisms were made against it. It was stated that the system was unwieldy and that physicians had to enter much information, which was useless. Of course, the best answer came straightly from the physicians, who highlighted many important benefits of the AIC. The 88% of them believed that the use of AIC was very simple and they would recommend it to other colleagues. Another 85% stated that the program improved their selection of antibiotics, and 81% agreed that it enhanced patient care. Concerning its usability, doctors access into the system 3 times a day.

Dulce et Decorum est, by Wilfred Owen. Essay -- English Literature

Dulce et Decorum est, by Wilfred Owen. The First World War was an event that brought to many people, pain, sorrow and bitterness. Accounts of the war shows that no other war challenged existing conventions, morals and ideals in the same way as did World War. Many people touched by the terrror of the war have written pieces of literature about the massacre that was World War 1, wishing people to understand the horror and tragedy that befell those involved. "Dulce et Decorum est", by Wilfred Owen, is one such elegy that presents to the reader a vivid, horrifying description of World War 1, aiming to illustrate that war is not romantic and heroic, but a senseless and devastating event. In this poem, techniques such as imagery, alliteration, assonance, onomatopoeia and contrast are used to express Owen's angry and bitter view towards what happened in the war. "Dulce et Decorum Est" uses strong images to convey Owen's feelings about the war, and to force the reader to take his view. Ghastly pictures of the war occur throughout the poem, largely in the last stanza, working together to present a vivid picture of the war. These images, utilised by Owen, show the ultimate irony and the moral of the poem, that it is not in fact a sweet fate to die for one's country even though others may think it heroic. This irony is illustrated using juxtaposition at the end of the poem. The men who enlist are "innocent", they are "children" who have learned that war is full of "high zest" and this makes them "ardent for some desperate glory". These innocent boys are willing to believe the Lie but will think differently once they experience the war first hand. Descriptive language is used throughout the poem to evoke specif... ...rd "drowning" is repeated twice to imprint on the reader's mind the effect the gas had on the soldier. The language used also helps to give a stronger impact on the reader by involving the use of one of the reader's five senses. In "Dulce et decorum est", onomatopoeia is used to enhance the effect of the poem, by involving the reader's sense of hearing. Words such as "guttering", "gargling" and "choking" are used to emphasise the horrific sounds of a man dying from gas, as the sounds of the words can be likened to what they are describing. The reader's attention does not wander throughout the poem because of Owen's consistent imagery. By the end of the poem, the reader can fully appreciate the irony between the truth of what happens in the trenches and the Lie being told at home. It is this attention to form and imagery that makes the poem effective.

Diagnosis Of Acute Appendicitis Health And Social Care Essay

Among patients showing to an exigency section ague hurting of the lower venters is a frequent clinical characteristic ; really frequently taking to the intuition of acute appendicitis.The determination to execute surgery is normally based merely on research lab trials and the clinical rating by the sawbones. In order to better the diagnostic truth in these patients ultrasound and computed imaging have been used as clinical AIDSs with decreased negative laparotomy rates as a consequence. 1,2,5 Ultrasound in adept custodies can accomplish a high grade of truth 1, but the drawback of the technique is its perceiver dependence, with important differences in truth. Acute appendicitis ( AA ) is a common surgical status of the venters, the prompt diagnosing of which is rewarded by a pronounced lessening in morbidity and mortality 1. Although the determination to research a patient with suspected AA is based chiefly on disease history and physical findings, the clinical presentation is rarely typical. Therefore diagnostic mistakes are common, ensuing in a average incidence of perforation of 20 % and a negative laparotomy rate runing from 2 % to 30 % 1. During the past few old ages, there has been a turning tendency toward the usage of formal probabilistic logical thinking or quantitative informations as a usher to clinical determination devising. In this regard, several hiting systems, computer-based theoretical accounts, and algorithms 2-12 have been developed for back uping the diagnosing of AA on the footing of rating medical history, clinical symptoms and marks, and indexs of inflammatory response. Harmonizing to initial rating studies, these determination tools are cost-efficient and may supply considerable diagnostic AIDSs to doctors 13. However, the aforesaid theoretical accounts have non been routinely applied in general pattern because they have failed to accomplish equal truth in proof surveies 14-17. Roll uping grounds has suggested that US in experient custodies improves diagnostic truth in instances of suspected AA 18, 19. Therefore, sonographic imagination has been proposed as a diagnostic tool even in patients with a clinically high chance of AA, because it accurately depicts a high per centum of normal appendices and alternate diagnosings 20. However, these findings do non connote that sawboness may non use their clinical acumen to the direction of topics with suspected AA, inasmuch as series with false-negative sonographic rates of up to 24 % have been reported 21. Furthermore, merely light informations exist on the possible combination of US findings with clinical and laboratory variables as an incorporate determination tool 22. The purposes of the present survey were to develop a simple and dependable marking system that would integrate US appraisal and peculiar elements of clinical rating and research lab probe to supply high diagnostic truth in patients with suspected AA and to measure the public presentation of the derived categorization regulation as compared to that of antecedently proposed theoretical accounts in a independent database of topics with suspected AA.Patients AND METHODSThe present probe included overall 134 topics with suspected AA who were studied over a span of 2 old ages ( conducted between January 2005 and December 2006.The survey was experimental and no intercession was done except for the add-on of formalized informations aggregation. Subsequently, the public presentation of the mark in the above database was compared to that of 11 antecedently proposed diagnostic tonss for AA, which were besides calculated by utilizing informations from the population of the survey. The choice standards sing the aforesaid diagnostic tonss for AA were ( 1 ) development of each mark from patients showing with acute abdominal hurting, ( 2 ) old proof in at least one prospective survey and ( 3 ) feasibleness of each mark computation ( viz. no losing variables ) on the footing of the informations prospectively collected in our survey by utilizing a structured signifier that included a standardised questionnaire. Four independent forecasters of the presence of AA were expressed as an integer-based marking system, which were assigned a weight ( point ) to each forecaster and summed the weights of the forecasters that were present for a topic: [ figure of points = 6 for US positive for AA + 4 for tenderness in right lower quadrant + 3 for recoil tenderness + 2 for leucocyte count & A ; gt ; 12,000/?l ] identified in the analysis. Non-operated topics were assumed non to hold AA, because none of them developed appendicitis during followup of 3 hebdomads. Because the end of the present survey was to compare the new theoretical account with the legion old 1s, application of the new mark to the survey in order to cut down the negative appendicectomy rate was non possible without biasing the consequences. Hence, no score-based intercession took topographic point, and the determination to run or non was left to the judgement of the senior sawbones, who was non cognizant of the decision of each theoretical account for every person topic. All the ultrasound ( U/S ) scrutinies included in this survey were preformed by the senior graduate student occupant. In each patient the venters was ab initio examined at U/S by utilizing 2.5-5 MHz convex array transducer. This rating was supplemented with U/S appraisal of the appendix and the environing part by utilizing a 5 MHz additive array transducer and the ranked compaction techniqueStatistical AnalysisStatistical analysis was performed utilizing the Statistical Package for the Social Sciences package ( SPSS Inc, release 11.0 ) . Acute appendicitis at operation was used as the terminal point in the survey. Univariate correlativities between the presence of the aforesaid terminal point and clinical or laboratory characteristics were evaluated with the chi-squared trial, as appropriate for categorical informations, and with Student ‘s t-test for uninterrupted variables. Ninety-five per centum assurance intervals ( 95 % CIs ) were calculated for each comparing. 2 Ten 2 tab ular array was used to cipher the sensitiveness, specificity, negative prognostic value, positive prognostic value and truth. All trials of significance were two-tailed, and a p value less than 0.05 was considered to be important.ConsequenceThe above diagnostic mark was calculated for 134 indiscriminately selected patients ( 70 [ 52.2 % ] males, average age 28.7  ± 11.9 old ages [ scope ; 15-79 old ages ] ) hospitalized for suspected AA. Among the above topics, 73 ( 54.0 % ) went on to surgery and 58 ( 43.3 % ) had AA at operation. The application of the new categorization tool to the patients showed 96.5 % of topics with 8-15 points to hold AA ( Table 1 ) . The proposed dignostic theoretical account yielded a mark of & A ; lt ; 8 points for all 61 non-operated patients in the survey. The present theoretical account exceeded perceptibly the old 1s in diagnostic truth ( Figure 1 ) . The negative appendicectomy rate was 19.4 % ( 14 out of 72 operated patients ) . None of the 6 patients ( 4.5 % of entire ) who were in the subgroup with the lowest mark ( 0-4 points ) had AA, whereas in 56 ( 96.5 % ) of the patients with the highest mark ( 8-15 points ; n = 58 [ 41.8 % of entire ] ) , AA was the concluding diagnosing. Nevertheless, the proportion of topics with AA among patients with moderate tonss ( 5-7 points ; n = 70 [ 52.2 % of entire ] ) was really little ( 3 out of 70, 4.3 % ) . Therefore, utilizing the cut-off of ? 8 points for the diagnosing of AA in the survey, a really high chance of AA would hold been assigned to topics with 8-15 points ( 96.5 % , 56/58 ) as opposed to the really low chance for patients with 0-7 points ( 4.3 % , 3/70 ) .DiscussionThe theoretical account suggested in the present survey combines the diagnostic value of four variables: viz. two well-recognized clinical characteristics of AA ( tenderness in the right lower quarter-circle and bounce tenderness ) 1, US imagination, and leucocytosis, the latter reflecting the inflammatory response. The prominence of the aforesaid factors as independent correlatives of AA corroborates old studies, which have shown tonss non including the above clinical variables and leucocytosis to supply poorer favoritism 1, 15. With respect to the varied weighting of the four multivariate forecasters, a positive US happening surpassed any other factor by presenting an at least 5.5-fold addition to the chance of AA as suggested by 95 % CIs ( Table 3 ) . Harmonizing to the proposed threshold of ? 8 points, if the appendix is sonographically shown to be inflamed, the presence of at least one extra factor is required to set up AA, whereas in the absence of US showing AA, all three staying variables are necessary for the diagnosing. For illustration, the above theoretical account would propose the diagnosing of AA in a patient with leucocytosis and a positive US determination ( entire score 8 points ) , even if recoil or right lower quadrant tenderness were missing. The application of the new system to the external database yielded an impressive diagnostic truth of 96.5 % , which exceeded perceptibly the public presentation of old tonss. The high quality of the new mark could be attributed to the incorporation of an imaging mode in a formal determination tool for AA, which is the fresh diagnostic process introduced in the present survey. Although sonographic imagination of the venters has been established as a utile tool in diagnosing of AA being of peculiar value in patients with untypical presentation 23, its truth has been doubted in more recent big surveies and meta-analyses 18, 19, 21, 24-26. In this regard, it has been demonstrated that, when US is used as the finding factor for operative therapy, it can non be relied on to the exclusion of the sawbones ‘s careful and perennial rating 21. Furthermore, a prospective multicenter experimental test on 2280 patients with acute abdominal hurting reported no correlativity between the sonographic findings of the appendix and the diagnostic truth of the clinician, the rate of negative appendicectomy, and the perforation rates, therefore proposing no clear benefit of US scanning of the appendix in the everyday clinical puting 19. In add-on, echography failed to better the diagnostic truth or the negative appendicectomy rate and was even found to detain surgical aud ience and appendicectomy in a big survey that included 766 topics 24. However, it has been shown that US is unneeded when there is a high grade of clinical intuition as expressed by a positive Alvarado mark, whereas the extra information provided by US improves diagnostic truth in the instance of a negative or ambiguous Alvarado mark 25. Furthermore, a meta-analysis published in the in-between 1990s suggested that US is most helpful in patients with an undetermined chance of the disease after the initial rating and should non be used to except AA in topics with authoritative marks and symptoms because of the underlying comparatively high false-negative rate 18. Finally, a more recent meta-analysis on the value of US in the diagnosing of AA revealed dissatisfactory consequences in multi-center tests, proposing that the equal public presentation of echography in single-center surveies may non reflect surgical mundane life 26. Ultrasound is rapid, noninvasive, cheap, and requires no patient readying or contrast material disposal 23. Because it involves no ionizing radiation and excels in the word picture of acute gynaecological conditions, it is recommended as the initial imagination survey in kids 27 and in adult females 28, particularly during gestation 29. Yet, the restrictions of US include its decreased truth in corpulent or muscular topics, every bit good as in patients with pierced AA ( about 50 % ) compared to that observed in nonperforated AA ( 80 % ) 23. Furthermore, US is known to be extremely operator-dependent, the larning curve required to develop the technique for sonographically scanning the right lower quarter-circle is considerable, and there are many interpretative booby traps to be avoided 23. It has been shown, nevertheless, that even if radiology occupants or inexperient sawboness conduct the imagination, the truth of US is non lessened 30, 31. In any instance, although the standards for the US-based diagnosing of AA are well-established and dependable, the inexperient tester, working with hapless equipment and/or technique, will supply suboptimal consequences, and this possibility should be taken into history when integrating sonographic standards in the diagnostic form. The usage of US in the scene of suspected AA might be questioned in an epoch when appendiceal computed imaging ( CT ) has been demonstrated to supply an truth rate every bit high as 98 % in the diagnosing of AA, taking to improved patient attention and reduced usage of hospital resources 32. Furthermore, CT has repeatedly been shown to exhibit superior discriminatory capacity compared to US in both grownups and striplings with suspected AA 33-35, proposing that the proposed categorization system may non use to geographical countries where CT scanning is readily available on a 24-hour footing. In this survey, the inability to routinely execute CT scanning may account to a great extent for the comparatively high false positive rate of about 20 % . This figure of false positive diagnosings would be unacceptable in most Westernized states, where the appropriate CT use in community infirmaries has been shown to cut down the negative appendicectomy rate from 14 % -20 % to 2 % -7 % 36-38. H owever, because many parts of the universe wellness community may still non be able to afford CT scanning but can afford US equipment, the combined systematic execution of sonographic rating and clinical acumen could be valuable as suggested by the present survey. Because the coincident application of the preexisting theoretical accounts and the new mark to the same database has favored the latter, the several clinical deductions should be farther evaluated. A prospective interventional large-scale rating in different clinical environments, in an adequate controlled survey comparing a baseline stage without hiting to a subsequent stage with hiting would likely be the optimum attack 15, 16. To cut down prejudice with such a design, unvarying informations aggregation should be carried out harmonizing to changeless definitions, with standardised public presentation standards used to guarantee nonsubjective rating 16. Any diagnostic support for AA should be heartily welcomed if it has been proven to be clinically valuable, because intolerably high negative appendicectomy and perforation rates are still reported in many parts of the universe wellness community. However, apart from being familiar with elements non included in a quantitative theoretical account, doctors may be able to supply superior imputations of losing informations for an single patient and to incorporate the diagnostic estimation as portion of their overall patient appraisal. Therefore, including the proposed mark in the diagnostic process is deserving seeking and may heighten a sawboness prejudiced capacity, under the requirement that it will be considered as an adjunct in determination devising that can non replace careful surgical judgement. Table 1 Performance of the proposed diagnostic mark in the survey.Number of pointsNumber of patients [ n=134 ] ( % of sum )Acute appendicitis [ n=59,44.0 % ]Non appendicitis status [ n=75, 56.0 % ]Percentage of patients with appendicitis among patients with the several mark0-4 06 ( 4.5 % ) 0 06 0 % 5-7 70 ( 52.2 % ) 3 67 4.38 % 8-15 58 ( 43.3 % ) 56 2 96.5 % Table 2 Demographic, clinical, and laboratory features of the patients with suspected appendicitis.Patients ‘ features ( n = 134 )Acute appendicitis ( % ) [ n = 59, 44.0 % ]No appendicitis ( % ) [ n = 75, 56.0 % ]P valueDemographic informationsMale sex 35 ( 59.5 ) 40 ( 53.5 ) 0.292 Age [ mean  ± SD ( scope ) ] 27.2  ± 12.2 ( 15-85 ) 29.4  ± 14.7 ( 15-86 ) 0.889SymptomsAnorexia 40 ( 67.8 ) 53 ( 70.7 ) 0.675 Vomiting 28 ( 47.3 ) 28 ( 37.2 ) 0.076 Migration of hurting 36 ( 61.0 ) 25 ( 33.3 ) & A ; lt ; 0.001 Duration of symptoms & A ; lt ; 48 hours 49 ( 83.0 ) 49 ( 65.3 ) & A ; lt ; 0.001SignsTenderness in right lower quarter-circle 53 ( 89.8 ) 31 ( 41.3 ) & A ; lt ; 0.001 Rebound tenderness 36 ( 66.1 ) 19 ( 25.3 ) & A ; lt ; 0.001 Guarding 29 ( 49.1 ) 14 ( 18.6 ) & A ; lt ; 0.001 Rectal tenderness 16 ( 27.1 ) 24 ( 32.0 ) 0.321Laboratory informationsLeukocyte count & A ; gt ; 12,000/?l 36 ( 61.0 ) 8 ( 10.7 ) & A ; lt ; 0.001 Neutrophils & A ; gt ; 75 % 50 ( 84.7 ) 34 ( 45.4 ) & A ; lt ; 0.001 Temperature & A ; gt ; 37.5 & A ; deg ; C 43 ( 72.8 ) 44 ( 58.7 ) 0.008 Ultrasound positive for acute appendicitis 48 ( 81.4 ) 39 ( 5.2 ) & A ; lt ; 0.001 Table 3 Comparison of the proposed mark with the old 1s.Scoring instrumentTrue positiveFalse positiveTrue negativeFalse negativeTinSPCPPV ( 95 % CI )NPV ( 95 % CI )P ValueVan Way 71 29 85 16 81.6 74.6 71.0 ( 61.5-78.9 ) 84.2 ( 75.8-90.0 ) & A ; lt ; 0.001 Teicher 77 19 95 10 88.5 83.3 80.2 ( 71.1-86.9 ) 90.5 ( 83.4-94.7 ) & A ; lt ; 0.001 Arnbj & A ; ouml ; rnsson 71 33 81 16 81.6 71.1 68.3 ( 58.8-76.4 ) 83.5 ( 74.9-89.6 ) & A ; lt ; 0.001 Alvarado 78 27 87 9 89.7 76.3 74.3 ( 65.2-81.7 ) 90.6 ( 83.1-94.9 ) & A ; lt ; 0.001 Feny & A ; ouml ; 79 17 97 8 90.8 85.1 82.3 ( 73.5-88.6 ) 92.4 ( 85.7-96.1 ) & A ; lt ; 0.001 Lindberg 74 14 100 13 85.1 87.7 84.1 ( 75.1-90.3 ) 88.5 ( 81.3-93.2 ) & A ; lt ; 0.001 Izbicki 70 34 80 17 80.5 70.2 67.3 ( 57.8-75.6 ) 82.5 ( 73.7-88.8 ) & A ; lt ; 0.001 De Dombal 70 31 83 17 80.5 72.8 69.3 ( 59.7-77.5 ) 83.0 ( 74.5-89.1 ) & A ; lt ; 0.001 Christian 74 17 97 13 85.1 85.1 81.3 ( 72.1-87.9 ) 88.2 ( 80.8-92.9 ) & A ; lt ; 0.001 Eskelinen 72 9 105 15 82.8 92.1 88.9 ( 80.2-94.1 ) 87.5 ( 80.4-92.3 ) & A ; lt ; 0.001 Ohmann 81 19 95 6 93.1 83.3 81.0 ( 72.2-87.5 ) 94.1 ( 87.6-97.2 ) & A ; lt ; 0.001 Our Proposed mark 55 2 74 3 95.4 97.4 96.5 ( 90.2-98.8 ) 96.5 ( 91.4-98.6 ) & A ; lt ; 0.001 Tin: sensitiveness ; SPC: specificity ; PPV: positive prognostic value ; NPV: negative prognostic value ; ACR: truth ; CI: assurance interval.Figure I. Accuracy of tonss in assorted surveies