Shortage of Nurses in Ashford General Hospital Essay

Shortage of Nurses in Ashford General Hospital - Essay Example Moreover, Ashford Hospital together with the other affected hospitals can work together with the universities and colleges so that the student under training can help the existing nurses in the hospitals. Besides, in satisfying the shortage of the nurses, these hospitals should properly reward their nurses so as to act as motivation for the students who are willing to join the profession. It is also the duty of the human resource manager maintain age diversity in the hospitals, for instance, staff should be made of people of different ages so that when a certain group is retiring then there is new blood in the system (Nottingham, et al, 2012). Moreover, proper leadership should also be implemented so as to take care of the welfare of the nurses. In this light, cultural diversity is important because patients can feel that they are well represented. Lastly proper record keeping in the hospital is another fundamental idea that can help curb the shortage of the nurses. Record keeping en hances transparency in work, and resource management will be liable responsible for all the activities that are taking place in the hospitals.IntroductionSeveral Hospitals are victims of nurses’ shortage until the issue has become a national concern in the United States of America. The shortage does affect not only the patients, but also the administration, physicians, nurses and many other stakeholders in the system. In this paper, I have dealt with various factors that lead to the shortage of nurses in different hospitals.

Sample Turnaround Times for Three Histoprocessing Methods

Sample Turnaround Times for Three Histoprocessing Methods Introduction Turnaround time for any pathological laboratory is very important which depends upon the preparation and diagnosis of the histopathologic material. The rapidity advantages the clinician to treat acutely ill patients and influence the work practice of the pathologist. With the advent of modernization tissue processing is modified from the point of tissue removal to embedding for instant histopathological diagnosis by various techniques or methods. After the surgical removal, the tissue undergoes preparatory protocol for preparation of sections which usually involves impregnation with a suitable supporting medium. The stages of tissue processing include fixation, dehydration, clearing, impregnation and embedding for designated durations of time to ensure completion of the procedure. Culling 1974, Bancroft Gamble 2002 The reproducibility and relatively low expense attached to the most commonly employed method continues to recommend it as a valuable tool after nearly 100 years of existence. But with the demand of faster or early reporting, newer techniques like rapid manual and microwave processing are getting introduced. Each of them is unique with their own set of advantages and disadvantages. The conventional tissue processing is reliable and cost effective but time consumption, reagent toxicity and delay in providing diagnosis are the major disadvantages. The rapid manual tissue processing has major disadvantages like the use of noxious chemicals, greater degree of tissue distortion and shrinkage which led to exploration for new short processing schedules. The microwave tissue processing eliminates the use of noxious chemicals, causes lesser distortion of tissue and has shorter processing time but the cost involved in instrumentation is very high. (Panja et al. 2007) Microwaves were invented by Percy Spencer in 1945 which work on the principle of producing heat by oscillating or exciting polar molecules. The microwave irradiation forces dipolar molecules of proteins to rotate through 180Â ° at the rate of 2.45 billion cycles per second (Srinivasan, Sedmak Jewell 2002, Bancroft Gamble 2002). These excited molecules due to kinetics cause collision with adjacent molecules resulting in transfer of rotational energy. This friction causes production of heat within the material itself leading to accelerated diffusion of processing fluids hence faster processing is possible. The advantages associated with microwave processing led to the production of commercially available microwaves specifically designed for tissue processing, however, the cost involved in these is very high (Leong 2004, Rohr et al. 2001). Domestic microwaves are readily available, affordable and had been used for tissue processing with good results earlier by some authors. Thus, the aim of the present study was to compare and analyse the efficacy of three histoprocessing methods and to determine the impact on turnaround times of tissue processing by these three methods. Materials and method In the present study, 60 specimens were selected randomly. The soft tissue specimen fixed in 10% NBF for 24h were included in the study and hard tissues like cartilage, bone and tooth were not included in the study. The gross features of the specimen were recorded and tissues were cut into three pieces of approximately same size to be processed by three methods. The sections obtained after processing were subsequently stained with HE by routine and microwave staining method. The stained slides in each group processed by three techniques were randomly numbered for a blind study and circulated among four observers referred as O1-O4. The observers graded each parameter on the format given in appendix D by following specific criteria as given in appendix C. Methodology Microwave tissue processing The microwave oven was calibrated as the microwave energy is non uniform within the chamber. Thus, hot and cold spots were detected in the chamber with the use of thermal paper sheet instead of the use of extra water load as suggested by various authors. The cold spot provided the most consistent results every time. The technique was self-standardized by trial and error method in the LG domestic Microwave (Model no. MS-285SD). The microwave was operated at the maximum output power of 40% (approximately 360 W) with rotating tray and ring removed. The cut piece from a fixed tissue sample was placed in a plastic tissue cassette and water washed in running tap water so that tissue was free of formalin. The tissue was irradiated in 200ml of 100% methanol and 200ml of 100% isopropyl alcohol for dehydration at cold spot for 2 cycles of 10 minutes each respectively in the microwave. After dehydration tissue was impregnated in 200ml of molten paraffin wax for 2 cycles at cold spot of 10 min each and was embedded in paraffin wax. Conventional Tissue Processing The cut piece from a fixed tissue sample was placed in a metal tissue cassette and water washed in running tap water so that tissue should be free of formalin. The tissue was dehydrated in 70% alcohol (one change), 90% alcohol (one change) and 100% alcohol three changes of 1 h each respectively. After dehydration tissue was cleared in two changes of xylene of 1 h each. Finally, tissue was impregnated in 2 changes of molten paraffin wax for 1 h each and was embedded. Rapid Manual Tissue Processing The cut piece from a fixed tissue sample was water washed in running tap water so that tissue should be free of formalin, after that tissue was wrapped in filter paper and dehydrated in 95% alcohol, 100% alcohol for 20 min on a stir plate. The dehydrated tissue was cleared in xylene for 20 min on a stir plate 20 min on a stir plate. Tissue was impregnated in 2 changes of molten paraffin wax of 1h each and was then embedded. The microwave processed tissue were stained as given in table no. ____. Conventional and rapid manual processed tissues were stained as given in table no.___________. Statistical Analysis The values obtained from different observers after assessment of sections processed by the three techniques were subjected to statistical analysis by Kruskal Wallis Test. One way ANOVA (Analysis of variance) was used for comparing mean shrinkage in tissues processed by the three histoprocessing methods. The P value Results All observers were assumed to be reliable as the Cronbach’s reliability test was statistically significant. Complete concordance was found amongst all pathologists in most of the cases. Hence, observer 1 was randomly selected for further analysis. The histopathological evaluation of the epithelium, fibrous tissues and glandular tissue revealed that the nuclear cytoplasmic contrast was good and cellular outline was distinct in tissues processed by microwave assisted technique followed by conventional processing and rapid manual processing techniques. The stroma was good with distinct cellular outline. The secretory products can be easily appreciated and the RBCs, inflammatory cells were intact. The results were statistically non-significant as observed by Kruskal Wallis test. The colour intensity of the tissues graded by four observers revealed that the microwave sections were crisper and there was a good contrast between the hematoxyphilic and eosinophillic areas. Though some slides were not visualised up to the mark, all the three histoprocessing methods were comparable to each other. One way Analysis of Variance (ANOVA) revealed a significant value on comparison of the tissue shrinkage processed by the three techniques. The dimensions of the tissues were recorded before dehydration and paraffin embedding. The mean percentage of shrinkage in rapid manual technique was significantly higher as compared to the other two techniques whereas statistically non-significant value was obtained on comparing conventional and microwave method of tissue processing. Discussion Microwaves are electromagnetic waves(Microwave Processing Techniques for Microscopy) which causes oscillation and excitation of polar molecules which are usually dipolar molecules of proteins in tissues. The excited molecules cause collision with adjacent molecules due to kinetics producing friction and causes production of heat within the material itself. The heat produced enhances the rate of diffusion of fluids to permeate into the tissues. The rise in temperature decreases the viscosity of processing fluids that facilitates diffusion. Therefore it is theoretically possible to fasten the tissue fixation and processing. This has resulted in a substantial reduction in the basic steps of histoprocessing, thereby reducing turnaround time and providing same day diagnosis. The applications of microwaves are extensive which includes tissue fixation, stabilization of large specimens, tissue processing for light and electron microscopy, histochemical and immunohistochemical staining. Microwave tissue processing technique was introduced by Boon and Kok in 1985 (Leong 2004) but the potential application of microwave energy was first recognized by Mayers in 1970 who successfully fixed tissue with a microwave generator (Kok, Visser Boon 1988). Boon et al. (1986) reported that it was possible to produce significant acceleration of tissue processing by using microwave radiation. Visinoni et al. (1998) first described the tissue processor that completed the processing in 30-120 min, thus reducing the processing time from 24 h to just 1-2 h providing early reporting and easy patient management. Thus, the aim of the present study was to compare the cytoplasmic and nuclear details as well as staining characteristics of tissue sections processed by conventional, rapid manual and microwave techniques. The noxious chemicals used in conventional tissue processing were replaced in microwave tissue processing. In the microwave processing in contrast to conventional tissue processing, isopropyl alcohol was replaced by methanol as dehydrating agent and xylene by isopropyl alcohol as intermediate agent. Molten paraffin wax remained the impregnating and embedding medium for both the techniques. The reagent selection was in consonance with Babu, Malathi and Mangesh (2011) who also used methanol, isopropyl alcohol and molten paraffin wax for microwave tissue processing. Microwave radiation produced when enter the chamber it is reflected by the chamber walls until these gets absorbed by the material placed inside the chamber (Wong 2011). However, the spreading is not even throughout the chamber leading to formation of hot and cold spot zones. (Kok, Boon Smid 1993, Thostenson Chow 1999, Rutgers 2013). Hence, hot cold spots should be detected to achieve consistent results. Various authors have described methods for detection of hot and cold spots. Microwave processing was self-standardized by trial and error method in which the hot and cold spots were detected by using a damp thermal paper Kok, Boon and Smid (1993). All the procedures in the microwave were carried out in the cold spot zones as suggested by Sharp and Paperiello (1971), Benard (1974), Rangell and Keller (2000) in their respective studies. Microwavable plastic tissue cassettes were used for microwave tissue processing which are cheap and reusable as metallic utensils are contraindicated in the microwave because the electric fields of the waves produced by microwave magnetron are completely reflected at the same frequency by metals which can lead to sparking. (Vollmer 2004). In the present study, the staining protocol for microwave was followed as given by Babu, Malathi and Mangesh (2011) which included the stains used to be accelerated in the microwave. Kayser and Bubenzer (1990) used domestic microwave oven for acceleration of the various stains which also included HE stain. Valle (1986), Moorlag, Boon and Kok (1987) and Mathai et al. (2008) modified various special stain protocols for microwave and concluded that microwave did not produce any deleterious effects on staining. In our study, the three pieces of tissue processed by three techniques sectioned by a soft tissue microtome and stained as per their respective protocols were evaluated. We adopted the criterion for evaluation of tissue sections given by Kango and Deshmukh (2011). The overall quality of the tissue sections processed by microwave and manual methods was comparable. The microwave processed sections had same or similar cytoplasmic and nuclear details with good erythrocyte integrity and lymphocytic appearance than the manual methods. Similar results are given by Mathai et al. (2008), Morales et al. (2002), Bhuvanamha et al. (2013), Panja et al. (2007), Boon et al. (1986), Kok et al. (1988). We also observed that the stroma in some cases was slightly more condensed focally in microwave processed tissue sections which is similar to the findings reported by Boon, Kok and Ouwerkerk-Noordam (1986) This lead to the erroneous categorization of these cases as indistinct in studies by Kango and Deshmukh (2011). Since our criterion was adopted from the above mentioned study we also placed focal condensation of stroma as indistinct. In contrast Kok, Visser and Boon (1988) refuted the importance of focal condensation of stroma in diagnostic pathology. The colour intensity of the tissues graded by four observers revealed that the microwave sections were crisper and there was a good contrast between the hematoxyphilic and eosinophillic areas. The microwave processed tissues showed an increased reaction to HE. The sections stained were slightly more eosinophilic as compared to the manual techniques. Similar findings are reported by Hopwood et al. (1984), Boon et al. (1986), Chaudhari, Chattopadhyay and Dutta (2000), Leong and Price (2004), Panja et al. (2007), Mathai et al. (2008), Babu, Malathi and Mangesh (2011). Hopwood et al. (1984) suggested that this eosinophilia could be easily corrected by altering the stain composition or staining time in eosin. In contrast Leong Price (2004) observed that eosinophilia of the cytoplasm was advantageous as it produced good nuclear cytoplasmic contrast and enhancement of the cellular features. The dysplastic features i.e. hyperchromatism, pleomorphism of tumor cells and mitotic figures were easily appreciable in the microwave processed tissue sections of malignancy. There was also an easy appreciation of the giant cells in the tissues of Central Giant cell Granuloma and tubercular lymphadenitis processed by microwave processing technique. Rapid processing of histopathologic material is becoming increasingly desirable for intraoperative consultations and timely diagnosis. We found positive impact on turnaround time in microwave method as the time taken for block preparation from fixed tissue was 1h as compared to conventional method (9h) and rapid manual method (3h). In some cases, proper diagnosis could not be reached as the size of the tissue was small and the sample was not representative of the site. Similar difficulties were also encountered by Suri et al. (2006), Kango and Deshmukh (2011) in their respective studies. As assessed in our study, the effects of the three methods of histoprocessing on cytoplasmic and nuclear details of epithelial, fibrous and glandular tissue showed no statistically significant variation. The microwave technique was comparable or slightly better than the manual methods. Conclusion The applications and versatility of microwave processing methods are unattainable with conventional procedures. The method reported herein reproducibly yields similar histologic quality to that provided by conventional processing. It has many advantages including feasibility, safety and elimination of noxious chemicals that might be used for improvement in the practice of the histopathology laboratory, permitting the preparation of diagnostic material within a day. Domestic microwaves are easily available and cost effective but have certain notable disadvantages like uneven heating and inability to record and maintain temperature within the chamber. Further exploration in the field is required for development of cost effective microwave histoprocessors for histopathology which provide similar histologic material for rapid diagnosis and reporting. References

Maltese Falcon :: essays research papers

The Maltese Falcon by Dashiell Hammett takes place in the 1930s and has a variety of mysterious charactersincluding: Sam Spade, Brigid O'Shaughhnessy, Joel Cairo, Mr. Gutman, and Wilmer. When O'Shaughnessy comes to Spade and asks him to shadow Thursby, the story takes off ona rampage of events with seemingly no relevance until they are revealed in the end. The conflict that drives the story is the unknown location of the Maltese falcon, a golden falcon of immense value. All the actions and even emotinos fo the characters are driven by the desire to obtain the falcon ormoney from obtaining the falcon. While some characters are more moreal than others, all of them have at least one fault which makes them untrustworthy: greed, stupidity, or all three. The characters eliminate each other trhoguhout the story, either arrested or killed, until only Sapde is left unscathed. The book has three phases: definite misunderstanding, unknown misunderstanding and comprehension. In the first phase of the book, all the characters completely misunderstand each other. As the book progresses, the characters begin to believe that they have an understanding of each other, which complicates everyone's emotions. Finally, the characters comprehend the previous emotions of the other characters and truly understand the events and the emotions of everyone. Later, Spade decides to have a meeting ith O'Shbaughnessy and Cairo together. Befor ethe meeting, Spade notices a youngman shadowing him. HE temporarily forgets about it and goes to the meeting in his apartment. At the meeting Cairo and O'Shaughnesy briefly speak of a falcon, but the doorbell interrupts them. Sam goes to the door greets two police detectives that are investigating the deaths of Thursby and Archer. The officers demand entry when they hear a scream and a shout from within,. When they reach the room of the scream, they find Cairo with a bloody face, holding a gun at O'Shaughnessy. In an attempt to allay suspiciion, Spade says that it is a deliberate joke. The police leave Spade alone, but they take Cairo to the station for questioning. Eventually, the mysterious young man, Wilmer confronts Spade and takes him to an apartment. HE brings Spade into a room where Mr. Gutman is sitting. They botht ry to get information without giving information. Sam decides to arrange a meeting with Cairo, O'Shaughnessy, Gutman, and Wilmer. Before the meeting, the captain of the boat, La Paloma, arrives at Spade's office, injured but carrying what appears to be the Maltese falcon.

Harriet Jacobs, Slavery, The South, and the Civil War Essay

Harriet Jacobs remains one of the most important anti-slavery figures in American history. As a former slave turned author, Jacobs was very influential in shaping public opinion towards an anti-slavery sentiment. Jacobs was born into slavery in 1813. She would eventually escape into freedom in 1835. Her escape route would eventually lead her to Philadelphia where she would not have to worry about being returned to the south. (Most northern cities were sympathetic to escaped slaves) Upon moving to New York City, Jacobs would develop a personal relationship with a publisher named Nathaniel Parker Willis. Perhaps it was this relationship that inspired her to write her seminal work Incidents in the Life of a Slave Girl. Incidents in the Life of a Slave Girl detailed the horrible conditions that women faced in slavery. The stories were first published in the newspaper the New York Tribune. While the articles were well received at first, the graphic depictions of sexual abuse proved controversial and the serial was discontinued. Eventually, Jacobs work was published in book form. The book became an immediate sensation and significantly shaped an anti-slavery sentiment that surely fueled the abolitionist movement. While the north understood slavery was evil, the pure brutality of it was unknown to most. Jacobs work raised a much needed awareness. But why did the south embrace slavery in the way it did? There were a number of reasons why the south was a huge proponent of slavery. The most obvious reason centers on the enormous profits that the southern states were able to amass due to having free labor. In time, the south was eventually overly reliant on  slavery since it was a non-industrialized society. Without the presence of factories, modern machinery, and an industrialized production center, the southern states were reliant on human labor more than the north. And as previously mentioned, free labor in the form of slavery provided the mechanism for this backwards infrastructure. There were many issues that drove the notion of the south succeeding from the union. If there was a â€Å"final straw† that drove the southern states to succeed from the union, it was the election of President Abraham Lincoln. Lincoln had campaigned on an anti-slavery platform. When he was elected, he professed his assertion that no new states entered into the union would be allowed to be slave states. This led to several southern states succeeding from the union and to form the Confederacy. Obviously, President Lincoln sought to quell this succession as soon as possible. However, the tensions exploded on April 12, 1861 when the Confederacy launched an all out assault on the military base Fort Sumter in South Carolina. More than anything else, this was the inciting incident that led to an all out Civil War.   During the initial years of the Civil War, the south was seriously â€Å"hammering† the north as the north could not find a proper strategy to win the war. This situation nearly led to Lincoln’s defeat in re-election. However, Lincoln did win re-election and eventually found the right general in Ulysses S. Grant. Under Grant, the south was defeated and the Emancipation Proclamation was upheld. Slavery was no more in the United States. In the aftermath of the Civil War, the reconstruction of the devastated south began. One goal of reconstruction was to integrate the now freed slaves into society.  However, Lincoln’s assassination undermined reconstruction and African-Americans would remain disenfranchised in the south for an additional 100 years.

Defense Information System

Defense Information System (DIS) refers to a military global protected telecommunication network that simplifies the conveyance of information in a worldwide space. It is driven by transmission requirements, security demands, and geographical needs of the targeted end-user groups (Soomro 2016). Centrally, it is designed and managed to provide a long-haul information transfer. Furthermore, it is configured to provide a more sophisticated point –to-point exchanged voice and data, teleconferencing video and image services. The DIS offers an integrated operational standard user services to satisfy the connectivity requirements. It is a digital-based defense strategy, that facilitates access to vital information across the globe through efficiently designed services such as information assurance, data services, multinational sharing of information and computer hosting. Moreover, DIS forms a key spectrum of military force operations which include defensive tactics, humanitarian efforts, offensive tactics as well as counterterrorism (Stahl, 2008). The ultimate goal of Defense information system is to help in achieving information governance by providing an effective infrastructure that may be of an advantage to the user in a combat.On the other hand, ethics refers to the prescribed code of conduct which are morally justified to administer the defense information system. Major ethical issues involved herein include privacy of information, Access to information, information accuracy and right to Intellectual property. Rapid growth in information technology through its improved dimensions for communication, computation, surveillance, retrieval and storage has sounded an alarm on privacy matters (Kizza, 2007). This is to say that, the unethical retrieval of data and access to information by unauthorized persons has greatly threatened the privacy of integrated security systems networks. Therefore, principles of ethics agitates for protection of privacy policies in relation to access of every sensitive information. Information accuracy is another ethical issue of concern. Upholding to an inaccurate information is misleading hence, it is a sole responsibility of the defense information system to be vigilant in pursuing the accuracy of its information. Imperatively, they should be certain that their information are based on facts as opposed to fiction (Stahl, 2008). The final ethical issue in defense information system is the right of intellectual property. This forms the most complex right faced by many in the contemporary society and the military is not an exemption. Substantial ethical concerns surrounding this stem from the information traits which makes it transferable. Any Defense Information system information is believed to be costly (Stahl, 2008). Furthermore, once produced, it is easier to copy and transfer to others. This makes it difficult to safeguard such information due to its intangible nature. It is worth noting that several institutions such as copyrights and patents have come in to managed and protect the rights of intellectual properties. The worldwide process is narrowing the space steadily as a result of what Kant describes as the public use of reason. Information Technology has greatly improved the effectiveness of the Defense Information System. It has enabled quick decision making through enabled rapid access to functionalities of creating, finding, using and sharing of the needed information. Quicker access to information by commanders from anywhere has also improved control and commanding. Additionally, it has also accelerated the speed of actions thus heightened the ability to coordinate all security issues across the globe. Other expeditious contributions of information technology on DIS includes improved cyber security, improved information security postures, as well as the defense effectiveness. However, the state territory is privately constrained by certain interests which differ from the individual reflection concerning the general subjects in a public domain. The greater disparity therefore emanates from the free public use of internet and other media due to their enormous private control. Since information is provided on demand in our cloud computing era, access to web-based tools by users via browsers has led to abstraction of customer details, which has raised questions of privacy and transparency. Ethics in relation to privacy of information for both individuals and organizations have been heavily affected negatively as a result of technology (Mingers, 2010). On this aspect, cyberspace has posted more security threats to nation-states in a context of increased dependency of worldwide networks and computer based interactions. Cyber-attacks, scams, image manipulations, infringements to computer systems and copying particular unauthorized software demonstrates the unethical practices facing the defense information system unit. It is therefore imperative for stiff ethical measures to be put in place to hasten security of the nation states with the advancements in technology. Contemporarily, no state agency can apply control to privacy to prevent the exposure of one's close secrets to others (Zizek, 2013). Regarding to the larger size of data, computers have failed to interpret and register multi-millions of data therefore making it difficult to detect suspicious message making state communication of information more unsafe. However, the defense information system has not been much helpful due to increased illegal malpractices according to Snowden and other whistleblowers. On this regard, denouncing of the public authorities and engaging in public use of information has greatly threatened the secrecy of individuals (Snowden, 2013). In conclusion, defense information system is a telecommunication network enabled system designed to simplify the transfer of information across the globe. It was majorly implemented by the military operational forces in United States which include defensive tactics, humanitarian efforts, offensive tactics as well as counterterrorism. The ultimate goal was to achieve control of information by providing an effective infrastructure for users in a combat and to improve on the general security across the globe. However, ethical issues in defense information system include Privacy of information, accuracy of information, access to information and the Property right. Despite of the drawbacks, DIS has remained focused to work with the new technological innovations and achieve their set missions.