Efficiency Increasing System by Using Preheating Method Essay

EFFICIENCY INCREASING SYSTEM BY USING PREHEATING METHOD METHODOLOGY The concept of increasing the fuel efficiency of a petrol engine in this project, is to pre-heat the intake air which is flowing through the carburetor. The humidity in the atmospheric air affects the petrol vapourisation in the carburettor. Therefore, by pre-heating the inlet air to the carburettor for a considerable amount, the vapourisation can be ease and in turn complete combustion is achieved. Moreover by reducing the water vapour to the engine, the steam formation in the engine can be reduced pitting of the engine cylinder, piston and exhaust pipe. Reference: http://seminarprojects.com/Thread-efficiency-increasing-system-by-using-preheating-method#ixzz2elrJlavP Most of the cars in today’s market give a maximum of 30 to 40 miles per gallon and hybrid cars giving upto 50 miles per gallon. The efficiency of Internal Combustion Engines used for this purpose is very low, about 25%. The heat generated during the combustion of fuel is converted into work to drive the car is wasted to the atmosphere, as anti-freeze(Ethylene Glycol) is used to cool the engine and circulated through a radiator which transfers the heat to the atmosphere. The heat generated by combustion of fuel such as gasoline or diesel is converted into the work because of the pressure created by the combustion process. In this invention, the heat is recovered by pre-heating/pressurizing the fresh air used for the process of combustion. The temperature of the pre-heated fresh air used for combustion is increased to above 1400 degrees Fahrenheit by passing through a heat exchanger to recover heat from combustible gases. Fresh air for combustion is heated to about 1400 degrees Fahrenheit. According to Thermodynamic Laws, by heating the air in a closed space with constant volume at room temperature to 1600 degrees F., the pressure is increased about to 50 psi. In order to have a higher pressure, the fresh air is first compressed upto 100 psi before passing through a heat exchanger. This will give the available working pressure of about 350 psi before

Medical School and Pediatrician Essay

Many job opportunities are available in different types of careers. Pediatricians like children and science; they help take care of sick patients. Becoming a pediatrician requires a lot of schooling and training; it involves many different skills for every day work. The salary of a pediatrician varies on the amount of education and on the skill level. There are many job opportunities in this profession; it is most likely to increase with openings. A pediatrician requires a generous amount of education after high school. The minimum education required to become a pediatrician is 4 years of college, 4 years or medical school, and 3 years of residency(YourPediatrician. com 1. ) The basics that most medical schools recommend are Biology; 1 course of genetics, 1 course of microbiology, and 1 course of molecular biology(2. ) Also, Chemistry, 1 -2 courses of organic chemistry, Physics, I course is basic, and Math 2 courses in calculus (2. ) A good way to get into colleges and medical schools is to have a lot of volunteer work on the applications, colleges love to see people are getting involved with your community and getting hands on training (Prerequisites for Becoming a Pediatrician 2. ) It may take a lot of schooling and be very time consuming to become a pediatrician but it defiantly pays off. Pediatricians need to have many different skills and talents. To be a successful pediatrician they need to have a strong love for children and a lot of patience (Prerequisites for Becoming a Pediatrician 1. )Children respond best to people who care about them (1. ) Students must get hands-on training and care for children with illness and their unique problems (1. ) They need to be exposed to a hospital setting as well as an office setting and be familiar with critical care issues (1. ) Some other major skills needed is to be able to instruct people on what to do, coordinating and using scientific rules to and methods to solve problems(California Career Zone 2. ) Being a pediatrician is a hard thing to do, not just talking about the education but about all the skills and experience needed.

From Bondage to Freedom (Fredrick Douglass)

From Bondage to Freedom In the early days of slavery, Frederick Douglass published a narrative that will be forever remembered in history. â€Å"Narrative of the Life of Frederick Douglass† is a recount of the harsh life on the plantations before his escape to New York. He describes the senseless acts of cruelty on the part of the masters, as well as the degraded lives of the slaves. This narrative provides a powerful description how ignorance was used as a tool for slavery, the damaging effects on slaves and slave owners, and the knowledge to the path of freedom for African Americans.Although the journey that Douglass suffered through was hard and extensive, he made his mark in the world and it is still appreciated today. Frederick Douglass was born in a slave cabin, in February, 1818, close to the town of Easton, on the Eastern Shore of Maryland. Frederick Douglass, whose full name is Frederick Augustus Washington Baily, was abandoned by his mother when he was just a baby an d then was raised by his grandparents. Douglass never knew his father and according to him and nearly everyone, â€Å"†¦opinion was also whispered that my master was my father† his father figure was a white man ( NLOFD, 1).When Douglass was around the age of six, his grandmother took him to the plantation of his master and left him there. He stayed there with his master for about two years then he was relocated around the age of eight where he was sent to Baltimore to live as a Page 2 houseboy with Hugh and Sophia Auld, relatives of his master. Not long after his arrival his new mistress taught him the alphabet. The lessons soon came to a cease when Hugh said â€Å"learning will spoil the best nigger in the world† (Chapter 6).When her husband forbade her to continue her instruction, because it was unlawful to teach slaves how to read, Frederick took it upon himself to learn. This marked the turning point when Frederick Douglass started to become a man. Frederick D ouglass’ narrative was written to expose how ignorance was used as a tool for slavery. He shows how white slaveholders maintain slavery by keeping their slaves ignorant and oblivious to society. At the time Douglass was writing, many people believed that slavery was a natural state of being.They believed that blacks were incapable of participating in civil society and thus should be kept as workers for whites. Mr. Auld, Douglass’ master, makes this evident by stating† A nigger should know nothing but to obey his master-to do as he is told to do. † Slave owners would keep slaves unaware of simple things such as birth names and birth dates. Douglass shares his grief of not knowing his age by stating â€Å"A want of information concerning my own was a source of unhappiness to me even during childhood. The white children could tell their ages.I could not tell why I ought to be deprived of the same privilege. I was not allowed to make any inquiries of my master concerning it. †(Chapter 1) The master withheld this information because things like birthdays give a person self-identity. Self-identity leads to self-worth, and this was not a desirable quality to have in a slave if you're a slaveholder. They also controlled the language of the slaves by annihilating the mother tongue. This limited the Page 3 communication between slaves and controlled interaction also kept uprising and revolt to a minimum.Literacy and formal education of slaves was not allowed . The more a slave knew about the language of another country the more he is able to move through all levels of that society. Slave owners believed that their captives would learn their secrets, and would be slaves no more. Slave owners could not fool a slave that knew their language, and being a fool is one of the basic ingredients to the conservation of the slavery system. Douglass reveals the damaging effects on slaves through various angles. He describes Aunt Hester’s brut al beating by Mr.Plummer most vividly stating â€Å"He then said to her, â€Å"Now, you d——d b—-h, I'll learn you how to disobey my orders! † and after rolling up his sleeves, he commenced to lay on the heavy cow skin, and soon the warm, red blood came dripping to the floor. † The treatment of slaves as property is another subject the author focuses on. He highlights that slave owners believed that their captives were not human and were not treated as such. He also describes how slaves were often passed between owners, and how family separation severed bonds. Douglass’ describes his own pain by expressing â€Å"I eceived the tidings of [my mother’s] death with much the same emotions I should have probably felt at the death of a stranger† (Chapter 1). Slaveholding was destructive not only to slaves but to slave owners as well since the corrupt power that the slave owner enjoyed over their slaves had a harmful effect on the slave owners moral health. Before slavery corrupts Sophia Auld’s good nature, she is a kind, affectionate person. She is corrupted by slaveholding when her husband said to her â€Å"if you teach Page 4 that nigger how to read, there would be no keeping him. It would forever unfit him to be a slave.He would at once become unmanageable, and of no value to his master† (Chapter 6). This treatment of slave led the slave masters down a path to destructive moral health that would not be accepted in today’s society. Just as slave owners deny slaves of knowledge and education, slaves must seek education and knowledge in order to chase freedom. Douglass gains this knowledge by reading a book called The Columbian Orator, which contains a philosophical discussion between a master and a slave. In the dialogue, the master lays out the argument for slavery, and the slave disproves each point, eventually convincing the master to free him.After Frederick Douglass reads The Colombian Orator, he realizes the truth about ignorance, freedom, and knowledge. Douglass writes, â€Å"It was this everlasting thinking of my condition that tormented me. There was no getting rid of it. [†¦] The silver trump of freedom had roused my soul to eternal wakefulness† (Chapter 7). Douglass also describes his path to freedom. He clarifies, however, that this section of the book does not describe the exact means of his escape. He does not want to give slave owners any information that would help them prevent other slaves from fleeing to the North.Though he does not give a physical description of how to escape from slavery, he does inspire slaves to gain the knowledge to one day seek the path to freedom. The â€Å"Narrative of the life of Frederick Douglass† shows how white slaveholders perpetuate slavery by keeping their slaves ignorant, the damaging effect of slaves, and also how slaves must seek knowledge and education in order to pursue freedom. The novel lets t he readers Page 5 feel the cruelty and hardship of Douglass’ life. Douglass’ writing reminds people of the harsh reality of slavery, and what it takes to overcome the circumstances.

The Gait Cycle In Relation To Plantar Corns Essay

The Gait Cycle In Relation To Plantar Corns - Essay Example Karl, B. 2013 (online article) asserts that corns and other plantar calluses cause limitations in walking, inability to carry out daily normal routines as well as an increased risk of falling to those affected. Corns are mainly resolved through a surgical removal that cuts them off. The feet being an organ of movement has to always be on the move with a normal person making 3 000-5 000 steps per day and an active person making 10 000 steps according to Biomechanics of walking 2012. Barney, S. 1995 in an online article asserts that gait simply refers to the style or manner of walking as opposed the actual process of walking. The gait cycle, is the time interval involved for one foot to make a step, it starts when the foot leaves the floor and ends when the same foot returns to the floor. The gait cycle encompasses two stages, the stance and swing stages Barney, S. 1995. The stance stage happens when the foot is on the floor and entails about sixty percent of the walking process. The swing stage happens when one foot is mid-air and the other foot is on the floor. The corn on metatarso-phalangeal joint affects the normal gait pattern resulting to an antalgic or abnormal gait. This leads to adjustments which Whittle, M. 1996 refers to as compensations or consequences. This is because the foot with the corn tends to avert spending the required time interval on the floor.

Discussion 5 Research Paper Example | Topics and Well Written Essays - 250 words

Discussion 5 - Research Paper Example Pain medication usage should be carefully monitored to prevent overuse, abuse, and the possibility of addiction in both groups. The control group patients especially should be watched for the necessity of a referral to other pain management methods. Pain research studies also have the possibility of issues with informed consent due to a confounding of clinical treatment with research, which may be an issue with this study. Patients may join a pain study with the intent of accessing treatment or having their pain taken seriously. This reduces their ability to truly consent to the research (Wasan et al., 2009). A separate ethical issue that is not as relevant to the study at hand but is related to the ethics of pain research is the availability of pain management medications to all study participants regardless of the group they have been placed in for the research purposes (Drummond, 2009). Research considerations specific to the community involved also exist. The researcher must be a ware of the culture of the people they are studying and the effects this has on etiquette in that culture, to avoid offending the research subjects or contaminating their results. Cross-cultural researchers must also be careful to understand the heterogenity of a foreign culture, and to interpret their findings appropriately.

Importance of Physical Education to student achievement Research Paper

Importance of Physical Education to student achievement - Research Paper Example Physical education and academic performance The direct implications of physical education on academic performance of students have been established by several researchers. One of the first studies analyzing the impact of physical activity on the academic performance of students was done by (Fourestier, 1962). This study included a small group of students from France. The sample population which underwent physical education in the afternoon after the forenoon’s sessions within the classroom was reported to have improved academic performance in comparison with the control group which didn’t undergo physical education (Fourestier, 1962). Though this study included only a small sample size and the methodology has not been detailed in the literature available, this has been indicated as one of the first studies in this research area. Another larger study which was conducted in 1970s has been recorded by Sallis et al (1999). This included 546 primary school children and confi rmed that those students who continuously engaged in five hours of physical education in a week performed better academically. This study has also analyzed the changing impacts of extent of physical education as the control population was constituted of children who had a limited exposure of 40 minutes of physical education per week Sallis et al (1999). ... Shephard (1997) reported that there was significant improvement in the mathematics score of students who underwent physical education for 5 hours a week. However, there were negative consequences in terms of scores in English. It is worth noting here that 33 minutes were reduced in the mathematics instruction while no hours were taken off from English teaching Shephard (1997). Raviv & Hectch (1999) recorded that physical movement education considerably improved the reading skills and the arithmetic test scores of students in an intervention made in an Israel school involving 92 preschool and 266 first grade children. More recent studies also suggest promising correlation between academic performance and physical education. Coe, Pivarnik, Womack, Reeves & Malina (2006) conducted an interventional study amongst 6th grade students which included fifty five minutes of physical education per day as an intervention. This intervention in terms of time was equivalent to that of the time slot for arts and computer sciences. The observations of this study indicated that these students performed as good as the control population in mathematics, science and English Coe, Pivarnik, Womack, Reeves & Malina (2006). The results of the Canadian Achievement Test revealed that even with decrease in academic time the academic performance of the sample population remained the same (Ahamed, Macdonald, Reed, Naylor, Liu-Ambrose & McKay, 2007). There are few studies which have suggested negative implications of Physical Education on academic achievements. Tremblay, Inman & Willms (2000) observed inverse association with academic performance in students of 11 years. This study is worth mentioning because of its large sample size. The research covered close to 7000 students as the

Critically analyse the challenges faced when developing and Essay

Critically analyse the challenges faced when developing and inplementing an information system - Essay Example 123-127). The essay will start from the definition of the IS which will lay down the foundation stone for the forthcoming analysis. It will also discuss the current situation in the implementation of IS. Some of the other discussions will revolve around the factors which play a part in the implementation of IS as well as various challenges that exist in developing and implementation process. Some of the previous research papers on this topic will also be the discussion grounds. Information system is the complete studies of networks of software and hardware that are used by people in an organisation to collect, filter, create and distribute the data that is obtained. The main aim of the information system is to support the operations, help the management in making decisions. In a company the IS has become an integral, interactive online tool which is present in every operation performed in the organisation (Lucey, 2005, pp. 144-147). The IS has been able to alter the economic conditions of the organisation because of its importance and presence in every step. It can help the organisation in the following ways. IS also affects the cost and the quality of the information that is transferred. It helps the company to shrink in size as it helps in reducing the transaction costs which in turn also reduces the production cost of the company (Grant et al., 2010, pp. 123-127). This essay looks towards various theories and concepts to analyse the factors which influence the implementation of IS and to identify the challenges faced when developing and implementing an information system. This particular study will enhance in better understanding of the concept of IS where the information regarding the evolution and also the importance of the IT in any organisation is studied from various articles, books and so on. This essay is

BUSINESS PROJECT MANAGEMENT Assignment Example | Topics and Well Written Essays - 3500 words - 1

BUSINESS PROJECT MANAGEMENT - Assignment Example Secondly, it was supposed to be completed in 2001 and ended up being completed in late 2004 after a prior completion period of 2005 had been rescinded and pushed back to that time in 2004. The building was to play host to a total of 129 members of the Scottish parliament and more than 1000 workers as well as civil servants. Its building and construction had been controversial right from the start. The points of controversy lay with the location choice, the design, the architect and the entire construction; everything was fully criticised. An enquiry into why the project took that long was construed and determined that the project was all flawed right from the start to the end in terms of management, finance, competence of the project management and many other aspects and issues. The location details are to it that the building was supposed to be erected on a 1.6 ha piece of land and located just 1 km east of the city of Edinburg. The Spanish architect sought a design that was representative of the national identity. This issue of design was the beginning of the project problems given that the design was delivered late and not in line with the requirements of the project previous historical requirements. Suffice is to say, what was discovered was a complex non-hierarchical low lying, organic collection of buildings that intended to integrate the environment and Scottish people. The building was later found out to be a complex of several buildings with varying designs of architecture including a section providing accommodation for the members of parliament, their staff and researchers. Many features were attached to the building and this made it very expensive attracting critical acclaim from the people and other leaders including some members of parliament t hat used it. The estimation cost of the building was put to the bar way back in 1997 before the ideal construction started. However, it was noted

U.S. HISTORY Essay Example | Topics and Well Written Essays - 500 words

U.S. HISTORY - Essay Example He went to Paris in 1919 to shape the Treaty of Versailles, the peace treaty which ended the World War 1 (Wikipedia, 2006a). Ernest Hemingway (1899-1961), started his career as a writer. Hemingway’s first important work was ‘The Sun Also Rises’ (1926). Similarly successful was ‘A Farewell to Arms’ (1929). Hemingway used his experiences as a reporter during the civil war in Spain as the background for his most ambitious novel, ‘For Whom the Bell Tolls’ (1940). Among his later works, the most outstanding is the short novel, ‘The Old Man and the Sea’ (1952), for which Ernest Hemingway was awarded the Nobel Prize in Literature (1954) (The Nobel Foundation 1954). Â  Herbert Clark Hoover (1929-1933) was the 31st President of the United States. Within eight months of his induction, the stock market crashed, signifying the beginning of the Great depression, the most severe economic crisis the United States had ever known. The Great Depression was a stern test for Hoover and one that proved difficult to manage. World War I brought Hoover to importance in American politics and thrust him into the global attention (Presidency in History, 2003a). Eleanor Roosevelt was an active First Lady during her husband Franklin D. Roosevelts presidency. She traveled, visiting relief projects, surveying working and living conditions, and then reporting her observations to the President. She became a supporter of the rights and needs of the poor, and of the disadvantaged. Even after President Roosevelts death Mrs. Roosevelt continued public life. She was appointed to the United States Delegation to the United Nations General Assembly. She was chairman of the Human Rights Commission. She was an American representative to the World Federation of the United Nations Associations. Mrs. Roosevelt received many awards for her humanitarian efforts (FDR

Literature Contrast Essay Example for Free

Literature Contrast Essay Compare between A Clear Well-lighted Place and A Rose for Emily Abstract: Hemingway and Faulkner both were winners of the Nobel Prize in literature, and had world-wide fame. Although they were close friends, they created rather distinct literary world for their readers. A Clear Well-lighted Place and A Rose for Emily are rather typical of their works. This essay aims to reveal the differences and uncover their unique appeal through analyzing these two novels from four perspectives: theme; character; characterization; writing style. Key Words:Hemingway;Faulkner; theme; character; characterization; writing style. Introduction: A Clear Well-lighted Place expresses an old man’s loneliness and despairs for life. The old man wanted to stay up in the bar and kept drinking, while the young waiter complained a lot and drove him away, but the older waiter showed more sympathy. A Rose for Emily is also a sad story about a girl named Emily who was raised by her father and forbidden to contact with outsides. she poisoned her boyfriend and kept his corpus beside her till death. . Theme The theme of a novel is its controlling idea or its central insight. Being an idea or an insight, the theme should be capable of unifying the whole novel. A Clear Well-lighted Place is the one of early works of Hemingway. The depression and hopelessness left by the world war were not easy to be erased. People may be rich, like the millionaire, but when night dawned, his loneliness and despair for this world force him to find a clear well-lighted place, for light symbolized hope. Faulkner’s work mainly depicted life in Southern slavery-based society, and try desperately to reproduce a south town around the civil war and focused on people’s stubbornness: they refused to admit the original south was gone. This story spanned about 74 years telling a life being restricted and isolated and in return try to isolate others. Character The old man’s character is complex, being depressed and wearisome, but still kept his dignity; rich, but unhappy; mature, but lost his belief. For example, â€Å"It was very late and everyone had left the cafe except an old man who sat in the shadow the leaves of the tree made against the electric light. In the day time the street was dusty, but at night the dew settled the dust and the old man liked to sit late because he was deaf and now at night it was quiet and he felt the difference. †(A Clear Well-lighted Place. Ernest Hemingway) This paragraph is at the beginning. He would rather spend the time sipping alone. Besides, he chooses to sit under the shadow instead of the light, and the shadow symbolize the gloom and despair. However, in the William Faulkner’s novel, A Rose for Emily , arrogance, mental confusion, stubbornness and a nature passion for love have all together shaped Emily, and have eventually led to her doom. Her loneliness accompanied her for her whole life. I want some poison, she said. Yes, Miss Emily. What kind? For rats and such? Id recom I want the best you have. I dont care what kind. The druggist named several. Theyll kill anything up to an elephant. But what you want is Arsenic, Miss Emily said. Is that a good one? Is . . . arsenic? Yes, maam. But what you want I want arsenic. (A Rose for Emily. William Faulkner) This is a conversation about Miss Emily. From the dialog between Miss Emily and druggist . when the druggist did not finish, Emily interrupted in and say she did not care. We can see her arrogance. When the druggist asked many times about her want, Emily pay no attention and repeated the word arsenic again and again. It showed her stubbornness. Characterization In the dramatic Characterization method the author form our opinion of the characters from what they do and say, from their environment, and from what other characters think of them. Just like the story in A Clear Well-lighted Place, Through the monologue of the older waiter, we know the old man’s loneliness and desire for light and hope. Through the old man’s own behaviour, like staying up under the shadow, we know his despairs and gloominess. In the analytic method the author comments upon the characters, explaining their motives, their appearance, and their thought. The narrator of A Rose for Emily is called first person . The author uses much comments upon the characters. For Emily, he shows more sympathy than blame, and he owe her tragedy to the unjust doings of her father. Writing Style Their images in A Clear Well-lighted Place are shown vividly with concise and plain words, and refined rhetorical skills. Ernest Hemingway advocates using the simplest and fewest words, direct description and short sentence. For example,In the daytime the street was dusty, but at night the dew settled the dust and the old man liked to sit late because he was deaf and now at night it was quiet and he felt the difference. (A Clear Well-lighted Place. Ernest Hemingway) In this excerpt, few adjectives and no difficult words are used. Also there are no long sentences and compound sentences. While Ernest Hemingway pursues the beauty of simplicity, his friend William Faulkner become a master of a rhetoric, highly symbolic style . which will employ many long complex sentences. For example, When Miss Emily Grierson died, our whole town went to her funeral: the men through a sort of respectful affection for a fallen monument , the women mostly out of curiosity to see the inside of her house, which no one save an old man-servant—a combined gardener and cook—had seen in at least ten years. (A Rose for Emily. William Faulkner) Notice the dash, commas and the clauses. In fact, clauses found in the sentence are in opposition of each other, and so Faulkner successfully depicts a sound scene within one sentence. Conclusion We have studied two classical novels from the four perspectives: theme; character; characteristics; writing style. Both novels told sad stories, but their theme are distinct. The first story lasted for one night while the second one spanned for 74 years and covered much more content. The old man and Emily shared the loneliness, but the other features varied a lot. The first story was short, simple and full of philosophical meanings, nevertheless, Faulkner’s lengthy and obscure. Despite of all these differences, they made good impression on reader. One is like the sharp mountain, clear, simple, but not easily to climb, while the other is a lengthy river, twisted, obscure, and need you to dive in to feel it. References: [1]  ·. [M]. : ,1983: 32. [2] ,. â€Å" †[J]. ( ) ,2010,( 7) : 105 107. [3] . [M]. : ,2002: 6. [4] Justus,James H. Hemingway and Faulkner: Vision and Repudiation [J]. The Kenyon Review,New Series,1985,7( 49) : 1 14. [5] Philip M. Weinstein. ———  · [M]. : ,2000. [6]  ·. [M]. : ?,2006.

Research On Methicillin Resistant Staphylococcus Aureus Nursing Essay

Research On Methicillin Resistant Staphylococcus Aureus Nursing Essay The topic for this piece of work is Methicillin-resistant Staphylococcus aureus (MRSA). This area of research was chosen due to the science and medical aspect behind this very interesting topic. MRSA is a topic of great importance for the general public but also for health professionals, e.g. nurses and doctors. Although it wasnt until recently that MRSA was named a superbug, the medical community remained calm when people found out about it, as they had been aware of the bacterium since the early 19060s. It is common knowledge that the most frequently found home of MRSA is medical health centres and nursing homes. The author of this medical journal is mostly concerned with the challenges and threats MRSA posses to her, as she works in a hospital where the majority of the patients are the elderly. [2] Firstly, MRSA was researched in depth to all aspects, e.g. symptoms, treatment, and prevention methods. The information was bulky and helpful allowing for fully detailed knowledge and understanding of the subject. Secondly, the information was collaborated and mixed together to create a full and informative graded unit on the subject of MRSA. This collaboration of information allows not only for the reader to get a detailed introduction to MRSA, but also gives the reader an idea of what MRSA is and how treatment has developed since the discovery in 1961. The use of several resources meant that the information in the text was not only the most relative but the most informative. Thirdly, and finally, the HND: Applied Science Course was used not only to aid and boost the already present science and medical aspects of MRSA, but to aid in the problem solving characteristics required in the graded unit. Such subjects as Fundamental Chemistry, Information Technology, Biochemistry, and Presentation Skills were used to better the understanding of MRSA and improve the layout and design of the graded unit. What is MRSA? Shown below is a tiny cluster of bacteria known as Methicillin-resistant Staphylococcus aureus (MRSA) seen under a microscope. MRSA is a common skin bacterium caused by Staphylococcus aureus (sometimes called, Staph) that is resistant to a wide range of antibiotics. [3], [4] [5]: MRSA under the microscope The name Methicillin-resistant means that the bacteria are not affected by the antibiotic methicillin, and a number of other antibiotics such as penicillin and cephalosporin, which used to be the common drugs to kill the Staph bacteria. There are a number of different MRSA strains, around 16, all with varying degrees of resistance to methicillin. [3] Staphylococcus aureus (SA) is a commonly occurring bacterium that has been around, for thousands of years and the discovery of MRSA in the early 1960s. Around a third of the worlds population carries MRSA harmlessly on the skin, nose or throat (especially in folds like the armpit or groin). [3], [6] MRSA is most commonly found in hospitals, due to the fact that there are higher numbers of infected surfaces and people in a hospital. The highest number of patients in a hospital or normally elderly who are sicker and weaker than the general population, which makes them more susceptible to infection due to a weaker immune system. Since around a third of the worlds population is colonizied by MRSA, the potential for infection is incredibly high. A person becomes infected when the organism invades the skin or deeper tissues and multiplies. [6], [7] During the early 20th century, 45% of the worlds population were not living beyond 65 years old, with infectious diseases being the leading factor to this low life expectancy. Due to the discovery of penicillin by Alexander Fleming in 1928, and the manufacturing of the antibiotic, the fight against infectious diseases including infections caused by Staphylococcus aureus was able to begin. Unfortunately, just a decade later Staph aureus became resistant, not only to penicillin, but also new antibiotics such as: erythromycin, streptomycin, and tetracycline. [8] In 1960, the newest and most effective chance of controlling and stopping Staph aureus was Methicillin. But this antibiotic that had once been the only weapon against Staph aureus was short lived and soon joined the other antibiotics that were now ineffective and useless in fighting Staph aureus. In the late 1970s the first outbreak of MRSA was reported in hospitals in eastern Australia, and by the 1980s MRSA had emerged all over the world. [8] It can be seen in the graph; MRSA Figures of Isolates per year in Europe; that certain countries are suffering from MRSA a lot greater than others. For example, the Nordic Countries (Denmark, Finland, Iceland Sweden) and also The Netherlands have the least outbreaks of MRSA per annum. Countries such as Malta, Greece, Ireland and the UK all suffer each year from high numbers of MRSA sufferers or colonized individuals. It can be seen from the graph that the worst outbreak of MRSA was in Malta in 2001 with more than 50% of the individuals tested being sufferers, whilst in the same year Iceland had no reports of any MRSA outbreaks. The reason for Maltas high percentage of MRSA carriers in 2001 could have been due to a lack of knowledge and understanding of the bacterium. Another possible reason for the high percentage could be that not enough procedures or policies regarding MRSA were available or even in place. The following two years MRSA in Malta declined to around 40% of tested indi viduals being carriers, which show that policies had been put into place after the outbreak in 2001. [9] [9] MRSA Figures of Isolates per year in Europe The extremely low percentages of MRSA carriers in The Nordic Countries and The Netherlands could be due to these countries having many policies advising and informing people in the community and patients and doctors in medical facilities of the dangers of MRSA and the simple methods on avoiding the bacterium. In the graph below it shows that The Netherlands tested 1238 people per annum for the bacterium MRSA, with less than 3% each year between 2000-2003 being carriers of the bacteria, which is seen to be around only 37 people. [9] The spread of MRSA throughout Europe is a serious problem that seems to affect almost all countries severely. The graph shows how easily MRSA can fluctuate from country to country, and from year to year. If more policies and better education on the subject of MRSA were available not only to hospitals but to the community in the UK then it is possible that the carrier percentage in Britain will decrease, but until such action is taken the British population will suffer not due a to lack of medical care but to lack of education. Symptoms The symptoms of an infection due to MRSA can vary greatly, all depending on what part of the body is infected. MRSA can infect a wide range of body tissues and organs, which makes MRSA the Superbug that it is. [10] Although there are a large number of symptoms of MRSA, there are only two types of infection: Skin infection and Bloodstream infection. Below is a table, of the type of symptoms common to each of the infections. [10], [11] [11]: Symptoms of MRSA related to infection type Skin Infection Bloodstream Infection Boils Endocarditis Abscesses Osteomyelitis Styes Septic Shock Impetigo Septicaemia Carbuncles Meningitis The longer that any of these symptoms continue untreated, can greatly increase the risk of a widespread infection in the body. Shown below is the damage that some of these symptoms can cause to a person. [12], [13] [12]: Impetigo [13]: Abscess Although MRSA can lead to all of the above symptoms, without treatment, it normally starts as a reddish blotch or pimple on the skin. This leads onto an MRSA lesion [14] forming, which is the first and most noticeable stage to identifying an MRSA infection. [15] [14]: MRSA lesions However all these symptoms cant be identified without certain lab tests. Usually before diagnosis of MRSA has occurred but the symptoms of a staph infection are visible, doctors and nurses will treat the patients infection as a common staph infection, and prescribe antibiotics that would have no effect on MRSA. This delay in diagnoses of MRSA could result in the patient having to stay longer in a medical facility or worse the delay could allow the infection to get worse and infect the blood and the heart. Therefore the longer it takes to diagnose MRSA, means that patients will suffer more and the problems in the NHS and other health services shall continue to be unresolved. Causes of MRSA MRSA can be transmitted by direct contact with a person carrying MRSA on their skin, e.g. individuals who are colonizied with MRSA can pass the bacteria through a variety of direct contact from a simple hand-shake to a kiss from a loved one. The transmission of MRSA can also take place through indirect contact. This form of transmission is just as common as direct if not more. A person can be infected by MRSA by touching any surface, e.g. a pedestrian walker button, which is likely to have an incredibly high number of people touching it everyday and all-day, and with around a third of the worlds population being carriers the chance of being infected is high. Hot spots for indirect contact are door handles, game controllers, keyboards, sheets and towels. The final and least likely form or transmission is by airborne infection. An airborne contaminant is the least likely form of spreading as it is more likely that a skin to skin contact will take place with the colonized or infected individual carrying MRSA. An airborne contaminant can be spread when sheets in a room are thrown around the place when making the bed. As the duvet is fanned skin particles are flown into the air causing the infection to become airborne and allows for easy transmission. The way in which MRSA can be transmitted and individuals contaminated depends on where the infection was acquired. The key areas of MRSA spread are; the health-care system and the community in any country, and because these two are the major hot spots it means they can be categorized. Healthcare-Acquired MRSA and Community-Associated MRSA are these two categories. CA-MRSA (Community-Associated-MRSA) CA-MRSA can easily be spread in any enclosed space, especially any crowded or unsanitary condition. Outbreaks of CA-MRSA are more than common in prisons around the world with American and European countries being the worse as well as in military training facilities. The high number of MRSA sufferers in any prison can be seen as a problem for any country. The over populated state and the lack of space and hygiene could be resolved by an increase in the size of prisons or a decrease in number or prisoners in a prison. Although the problem seems easy to fix the strain on any country to fix this problem can be seen as over-whelming. CA-MRSA has affected sports teams, athletes and gyms. The bacterium spreads easily through cuts and abrasions and skin-to-skin contact. Sharing towels or athletic equipment increases spreading infection among athletes. This problem can be resolved by equipment being cleaned after use and towels not being shared. CA-MRSA can be dangerous in children and young adults, causing a widespread infection when it enters the body through a cut or scrape. Children may be more susceptible to infection due to their immune systems not being fully developed. The spread of MRSA and the realities of who is most at risk of contracting the infection all come under as the Causes of MRSA, because each directly links to how the person becomes infected. The environment that a person exists in can majorly affect their chances of being infected by MRSA, for example, hospitals. If a person is spending the majority of their time or even visiting for a short period of time, their presence in an environment like a hospital will greatly increase the potential of infection. HA-MRSA (Hospital-Acquired-MRSA) The reason that hospitals are seen as the hot spot of MRSA infection is because the majority of people there are ill. For any individual that suffers from a medical condition like HIV or cancer, that weakens the immune system, the chance for infection is increased exponentially. [16] HA-MRSA can normally enter though an entry point into the body, such as a surgical wound or a catheter. This can sometimes be a major problem for some patients and can resolve in death. Abscesss normally form to control and heal the infection. For most HA-MRSA infections not much can be done to resolve the problem except to make sure that medical staff are kept constantly aware of how vital hygiene is when dealing with patients. The patients tend to be older, sicker and weaker than the general population, making them more vulnerable to infection from HA-MRSA. These are some of the few problems that nothing can be done about. The age of a person isnt a major factor unless the patient is older as their immune systems are weaker they are prone to disease and infection. Hospitals are filled by many patients, doctors and nurses, so HA-MRSA can easily be contracted, through direct contact with other patients or staff, or through contaminated surfaces and through an airborne contaminant. [17] This can be resolved by making sure contact with infected individuals is limited and the staff, made to contact is also limited. Surfaces in any medical care facility should always be sanitised and kept clean. The superbug that is MRSA can be seen as a never ending problem because MRSA infection can arise in the community, which I feel will not eliminate the stress on hospitals but instead increase it. Even if hospitals were to have better control methods and better policies addressing the problem of MRSA, the outside world could not continue to keep surfaces completely clean, with door handles being constantly used. The problem seems to be more like a never ending round-about instead of a quick sprint to resolving the spread of MRSA. Screening for MRSA Screening for MRSA is an effective and safe method to find out if a person is a carrier of MRSA. Screening for MRSA before a person enters an environment like a hospital can greatly decrease the chance for a carrier to become infected or to infect others, as the staff at the hospital can remove as much of the bacteria as possible through a simple treatment. [18] The screening process is simple and involves no injections. Instead several swabs are taken at the most common carrier sites of the bacteria; the anterior nares (nose), the axilla (armpit), and the perineum (groin) are all tested. If any skin lesions were seen or noticed they would also be tested, due to them being one of the first signs of an MRSA infection. [19] There are three ways of testing the swabs taken from a suspected carrier of MRSA. These include: Polymerase Chain Reaction (PCR) PCR is a method for producing large amounts of specific DNA or RNA fragments of defined length and sequence from small amounts of primers. The reaction is not only efficient and specific, but is also very rapid and extremely sensitive. Uses for the reaction include disease diagnosis, detection of difficult-to-isolate pathogens, and the direct detection of MRSA from nasal swab samples. [20] PCR can be seen as the quickest of the three methods as it removes all the tedious work of having to count up the colonies on an agar plate and it doesnt involve having to wait for several days for the results like an enrichment broth. PCR is also a very simple procedure. [21] PCR is also the most costly of the three, which although is a negative quality it isnt a major factor when testing to see whether someone is infected by MRSA. Enrichment Broth Cultures An enrichment culture is a medium with specific and known qualities that favors the growth of a particular micro-organism [22] The major pro with Enrichment Cultures is that they give an easy way in which to isolate pure cultures of  scarce microbial types. The two biggest cons when using Enrichment Cultures is that they very easily become contaminated, which can be seen as very big negative when trying to isolate a MRSA. [21] Direct Plating Direct Plate counting is a method used to count the number of cells in a sample. Once the cells to be counted have been isolated, they are dilute; due to the fact that too many cells will cause the Petri dish to be so populated with colonies, that it would be impossible to count. After the cells have been diluted, they are incubated on an agar medium until colonies form. It is now that the cells are counted. [21] Direct Plating can be seen as the method with the most negatives. Sampling error is the most obvious negative as it refers to the uneven spread of the sample on the agar plate. This is a serious negative as it can hinder the end results. Another negative is that it has little effect on cells that do not split, as it hinders the final count. Through all of Direct Platings negatives it is still seen as the best available method for identifying viable cells. [21] All three types of screening and testing methods are valid and useful for different end results needed. It can be seen from the information that Enrichment Cultures and Direct Plating are not as quick and effective as PCR. Though PCR is flawed by the cost the pros can easily be seen to outweigh this small negative. I believe PCR is the best method for testing for the presence of MRSA, as it gets the results quick and easily and avoids all the tedious work of counting cells. Prevention Methods Hand Hygiene By having good hand hygiene the risk of spreading MRSA can be reduced greatly. Hands and wrists should be washed thoroughly using an antiseptic hand wash or simple dispenser soap. Cross-contamination and spread of MRSA in hospitals is being tackled by using special anti-microbial hand washing products and alcohol-based antiseptic agents. Hand hygiene is essential even if disposable gloves have been worn. Hand hygiene procedures must always be performed before leaving the room (even if there has been no direct contact with the patient, e.g. when serving food, airing the room or making the bed). The diagram below shows the proper method to washing hands effectively. [23] [23]: How to wash hands properly Precautions Infection control precautions can be seen as obvious things in preventing cross contamination. The following precautions should always be carried out at all times and with all patients and medical staff. Cover all cuts, abrasions and lesions especially those on hands and forearms with a waterproof dressing. Maintain hand hygiene Before and after dealing with each patient Before handling food Following bed making After handling blood and bodily fluids and also items contaminated with blood or bodily fluids Dispose of waste safely Isolate patients with a known or suspected infection Use disposable gloves and aprons when dealing with patients, blood, bodily fluids and the making of beds. [7] Education The continuous education of all health-care staff members is an essential art of any MRSA control scheme, as well as making sure up-to-date information is always available and known. The education of patients is also vital to controlling MRSA infections. The Department of Health Services: Centres for Disease Control and Prevention (CDC) offers a link to an MRSA patient information sheet. Such information as this can be seen as extremely helpful as it answers the most common asked questions regarding MRSA. [24] All the possible prevention methods boil down to maintaining excellent hygiene. By keeping your environment, your personal care items, and yourself clean you can reduce the risk of contracting MRSA. It is imperative to follow the directions laid out by staff when you are in hospitals, nursing homes, and gyms, as these locations can carry an increased risk of MRSA infection. [25] Treatment The treatment of MRSA, in todays world is more difficult than ever. MRSA being a superbug means that it is resistant to a wide range of antibiotics. With such antibiotics as Methicillin, Penicillin and Cephalosporin being among the many antibiotics that have no affect on MRSA. When MRSA was first discovered to be resistant against methicillin a number of other treatments were devised so as to stop the outbreak of the bacteria. Although the alternative antibiotics were affected for a while, MRSA became resistant to them also. This meant that new drugs had to be made so as to control MRSA from becoming a worldwide pandemic. The manufacturer of such drugs as Chlorhexidine hydrochloride, Vancomycin Hydrochloride and Linezolid meant that MRSA had a chance of being controlled. [26]: Comparison of Vancomycin and Linezolid Vancomycin Linezolid Mechanism of Action Cell wall synthesis inhibitor Protein synthesis inhibitor Dosage Form Availability Intravenous Intravenous Oral Adverse Events Red man syndrome Rash Nephrotoxicity Ototoxicity Bone marrow suppression Mitochondrial toxicity: neuropathies and lactic acidosis Serotonin syndrome Routine Therapeutic Drugs Monitoring Performed Yes No The table above shows a comparison between two drugs that are used to treat MRSA. From the table it is clear to see that both treatments offer adverse effects. With Vancomycin only being able to be administered intravenously (IV) while Linezoid can be administered by IV or orally. The number of adverse effects is greater for Vancomycin suggesting that Linezoid is the better method for treatment of MRSA. [27]: Linezoid [28]: Vancomycin Hydrochloride The images above show the complexity of the Linezolid and Vancomycin Hydrochloride and how they are structured. Isolation of a patient/person suffering from MRSA is seen as an alternative treatment. The isolation of a person is extreme as it means confiding them to one room in a separate ward. The advantage of such an extreme treatment is that, the physical barrier between the infected and the uninfected acts as a disturbance stopping the further transmission of the bacteria. The other advantage is that the separation gives a clear psychological message to the sufferer that they are infected and have a huge potential to infect those around them. With any advantage comes a disadvantage, with isolation having one huge disadvantage. The psychological damage that isolation can have on an individual can leave them so lonely that they begin to distrust those around them. The individual can become so independent that they see no need for help form others and this can lead to a long and lonely existence. [29] Available Aid There are many sources of aid, available for those who are colonised, infected or related to someone with MRSA. MRSA sufferers and their families who are feeling the pressures of living with MRSA can retreat from their ordinary lives, of people asking things like are you ok and do you need any help, online. Through such support groups as MRSA Action UK, a registered charity with the aim of helping and supporting not only the sufferers of MRSA but their families also, the stress of being a sufferer of MRSA can be relieved. MRSA Action UK not only acts as a charity to make the general population aware of the superbug but also offers links to other sites which give information and further support for anyone who needs it. MRSA Resources is an online discussion board, where people who have MRSA, have lost someone to MRSA, or just want to talk about the subject, are able to. The discussion board allows for people to share not only the information they have found on the internet or in books and newspapers but also allows them to connect on a personal level where they can share their own personal experiences with MRSA. Conclusion The prevention and controlling methods for MRSA infections is dependent on the approach and high standards of which healthcare workers abide by, as well as, strong leadership to highlight the dangers of an MRSA infection. Standard precautions, e.g. hand hygiene, together with isolation, and education are key to the prevention and control of MRSA. The overall welfare and safety of a person is of the up most importance, and measures undertaken to control MRSA shouldnt interfere with the already established care of patients. Therefore, it can be seen that the investment in more isolation rooms in hospitals and increased hygiene care throughout the world can reduce the potential of MRSA infections. MRSA can be seen as a major problem for health services throughout the globe, as it decreases mortality rates, increases morbidity rates and causes patients to stress over the possible symptoms. It is essential to have a well-structured and clear policy on infection control in hospitals and educational facilities to stop or a t least stunt the spread of MRSA as well as other infectious bacterium. As well as a clear policy educational programmes and leaflets on infectious control should be made available at request as well for the training of nurses, all to aid in the understanding of MRSA. In any medical facility it is nurses who are in immediate contact with many patients over prolonged periods of time. With this in mind it means that the hygiene of nurses should be maintained continuously at a high standard. Not only should they keep their hygiene high when dealing with patients but also with relatives and visitors to the hospital. In spite of all the possible improvements that have been established and stated in this graded unit, the problem of MRSA control and eradication still seem to be a subject that will never be resolved. Though hospitals could improve hygiene and lower the potential of HA-MRSA, the potential threat of increased CA-MRSA is always a possibility due to community hygiene being impossible to control or establish a policy to which CA-MRSA would be effected by. Glossary (All glossary definitions were taken from the internet, from several different sites). Abscess an accumulation of pus in a body tissue, usually caused by a bacterial infection. Airborne in or carried by the air. Antibiotics a chemical substance derivable from a mold or bacterium that can kill microorganisms and cure bacterial infections. Bacteria bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and some others are good for you. Bloodstream infection a condition in which bacteria enters the blood, which can occur through a wound or infection, or through a surgical procedure or injection. Boils an inflamed, raised area of skin that is pus-filled; usually an infected hair follicle. Carbuncles skin lesion typically caused by Staphylococcus aureus, and resembling a boil with multiple heads. Catheter a hollow, flexible tube inserted into the body to put in or take out fluid, or to open up or close blood vessels. Cephalosporin any of a class of natural and synthetic antibiotics developed from Cephalosporium fungi. Chlorhexidine hydrochloride an anti-microbial agent. Colonized the presence and multiplication of microorganisms without tissue invasion or damage. The infected individual demonstrates no signs or symptoms of infection, while the potential to infect others still exists. Culture the growing of microorganisms in a nutrient medium (such as gelatine or agar). Endocarditis inflammation of the endocardium and heart valves. Endocardium lining of the interior surface of the hearts chambers. Erythematous a reddening of the skin. HIV (Human immunodeficiency virus) a retrovirus that attacks helper T cells of the immune system and causes acquired immunodeficiency syndrome (AIDS); transmitted through sexual intercourse or contact with infected blood. Impetigo a highly contagious skin infection caused by bacteria, usually occurring around the nose and mouth. Intravenous (IV) a dose of medicine administered from a drip, down through a hollow needle inserted into a patients vein. Isolation the act of isolating something; sets something apart from others. Linezolid a synthetic antibiotic used for the treatment of serious infections caused by Gram-positive bacteria that are resistant to several other antibiotics. Meninges the three membranes that surround and protect the spinal cord and brain. Meningitis inflammation of the meninges; usually caused by infection by a microorganism. Methicillin antibiotic drug of the penicillin family used in the treatment of certain staphylococcal infections. Mitochondrial toxicity a condition in which the mitochondria of a bodys cells become damaged or decline significantly in number. MRSA (Methicillin-resistant Staphylococcus aureus) a serious and potentially fatal infection caused by Staphylococcus aureus bacteria that is resistant to the broad-spectrum antibiotics commonly used to treat it. Nephrotoxicity damage to the kidneys produced by drugs or other substances. Osteomyelitis the inflammation of bones and bone marrow because of an infection, usually caused by bacteria. Ototoxicity toxic to the organs of hearing or balance or to the auditory nerve. Pandemic an epidemic that is geographically widespread; occurring throughout a region or even throughout the world. Penicillin an antibiotic used to cure or stop the spread of certain infections, due to its ability to inhibit the growth of certain bacteria. PCR method of amplifying or copying DNA fragments that is faster than cloning. Red man syndrome an infusion reaction to vancomycin, causing flushing of the skin and an erythematous rash on the upper body. Septicaemia a life-threatening condition in which bacteria multiply in the blood and produce toxic materials; commonly known as blood poisoning. Septic shock a life-threatening condition in which tissues become damaged and blood pressure drops due to bacteria multiplying and producing poisons in the blood. Serotonin syndrome a potentially life-threatening adverse drug reaction that may occur following therapeutic drug use. Skin infection (Dermatitis) inflammation of the skin. Staphylococcus aureus potentially pathogenic bacteria found in nasal membranes, skin, hair follicles, and peritoneum of warm blooded animals. They may cause a wide range of infections and intoxications. Styes a pus-filled abscess in the follicle of an eyelash; caused by a bacterial infection. Superbug a strain of bacteria that is resistant to all antibiotics. Vancomycin an antibiotic effective against some bacterial infections.