Friday, November 29, 2019
Magic and Mischief In Shakespeare's A Midsummer Night's Dream, reality blends with imagination. For example, the fact that there are fairies with magical powers is very far-fetched, yet makes for an entertaining story. This comedy is mainly focused on the troubles of three groups of people: the two dedicated lovers, the bumbling actors, and the gleeful fairies. When these three groups collide, magic and mischief are created. Egeus, a nobleman, wants his daughter, Hermia, to marry a man named Demetrius, but she and Lysander, her fianc?, are in love, and that is the basis of the plot. Because Hermia's father is so attracted to the idea of her marrying another nobleman, he becomes angry with her and threatens to either have her killed or to force her to become a nun. Also, Demetrius is, in fact, in love with Hermia. However, the lovers' love and dedication toward each other forces them to run from the real world and enter the enchanted world of fairies and magic. There, they plan to get married and live somewhat of a peaceful life. Before she leaves for her journey, Hermia tells one of her trusted friends, Helena, the secret plan. Helena is deeply in love with Demetrius, so she tells him, knowing that he will follow Hermia anywhere and she could follow along. At the same time of the eloping: "Nick Bottom, an actor, and his comical friends are rehearsing a foolish play they plan to present at the duke's wedding" (Shakespeare). Nick Bottom is the comic relief in this play. He is an actor, who is intent on acting out a play by the moonlight of the night in the same forest that the two lovers are eloping. Bottom and his friends: Arrive in the woods for their rehearsal, and Peter Quince is ready to start immediately. But Bottom has been brooding over the script and has decided that it needs some changes. It is possible that the ladies in the audience may become upset by the bloody death of Pyramus, and therefore the play needs a prologue to assure everyone that Pyramus is not really dead at all (Shakespeare). As the men rehearse, Puck, an assistant to the king and queen of the fairyland, puts a donkey's head on the unsuspecting Bottom. Bottom, then, walks out on cue and frightens the other actors. In the midst of the acting, the lovers and their curious followers fall asleep in the woods nearby (Shakespeare). Among the people present in the forest, there are fairies, who: "...Were so delicate in their form that a dewdrop, when they chance to dance on it, trembles, indeed, but never breaks" ("Fairy and Fairy Tale"). These fairies only come out at night. Oberon, king of the fairies, and his wife, Titania have been arguing over their son, who Oberon wants to make his servant. Titania disagrees, which leads the argument on through the night. Oberon's other servant, Puck, is called to go on a mission to find a flower called love-in- idleness for Oberon to put on his wife's eyelids, which, in turn, casts a spell that makes her love the first person she sees when she awakens (Shakespeare). Puck then claims: "I know a bank where the wild thyme blows, where oxlips and the nodding violet grows..." (Shakespeare). He, then, flies around the world to search for this flower, and when he returns, is inclined to sprinkle the flower's juice on an Athenian, preferably Titania. Seeing that it is night and dark, Puck mistakenly goes to the sleeping lovers and sprinkles the juice onto Lysander's eyelids (Shakespeare). When morning comes, Lysander awakens, and the first thing he sees is Helena, therefore, he falls in love with her. Seeing this whole mess, Oberon instructs Puck to go and find some more juice to put on his wife's eyelids. When Puck returns, Oberon insists upon doing it himself. He sprinkles the juice on Demetrius, who, when he awakens, sees Helena and falls in love with her. The irony is: "Demetrius and Lysander attempt to woo Helena, who is naturally convinced that they are making fun of her, while Hermia is appalled to find that both suitors have forsaken her and is
Monday, November 25, 2019
drug testing1 essays Precision Machine Tool is a machine tool company that primarily manufactures for the automobile industry. The machine tool industry is self-sufficient in that they use their resources to manufacture products; that is, they use their own tools. Precision Machine tool uses big machines to build parts for lathes, which are sold in the automobile industry for use in factories. Precision has always had a reputation of quality, though it has declined because of aging technology and machines. The aging of the technology is because of a decline in their capital caused by a recession in the automotive industry. During the late 1970s, the American automotive industry was at its apex. Americans fell behind during this boom because of inadequate production capacity. The Japanese had identified the machine industry as a growing industry and invested in modernization of technology. Consequently, Japanese technology was better and costs were lower. When a recession hit in 1980-1981, American firms had little capital to invest, and thus could not modernize their equipment. The industries that are going to survive in the future are those that have the most efficient computerized operations and that produce the cheapest, most reliable products. The Japanese have this edge and the American machine tool manufacturers are reluctant to change their ideologies of buying only American made products. John Garner and Tom Avery created precision Machine Tool. John Garner is the president of Precision Machine Tool, and is a financial conservative. He prefers to invest in the company using only its profits. Tom Avery is an expert tool design engineer. He is in charge of the manufacturing and management end of the business. Both men are very critical of selling out to the Japanese and want to keep Precision American. One of the main problems plaguing Precision is the aging of its technology and equipment ...
Friday, November 22, 2019
Multimedia Networking - VoIP (Communications and Networks) - Essay Example Moreover, it enables the companies to perform complimentary telephone calls that make IP-PBX extremely well-known these days. Thus, distant or international phone-calls are becoming a great deal less expensive at this time thus companies are saving a large fraction of expenditures that they had to spend on worldwide and long distance phone calls. Furthermore, IP-PBX presents less costly telecommunication facility that enable businesses to stay in touch with the people in the different areas on the earth. In this scenario, with the adoption of IP-PBX hundreds of businesses have controlled to reduce their operating cost as well as become more beneficial. However, the main need of IP PBX is the accessibility of broadband internet link. In addition, IP-PBX is extremely proficient with respect to its cost and technology. Furthermore, at present Telecom corporations present many IP-PBX technological facilities so that clients could be able to regulate IP-PBX according to their requirements (CallingTools., 2011; TechTarget, 2005). This paper presents a detailed analysis of the IP-PBX technology. This paper also outlines the facts due to which the use of this technology is growing rapidly. This paper will assess main advantages and architectural confines of IP-PBX technology and present its main SIP (Session Initiation Protocol) technology that is a significant promise to provide tighter incorporation between business processes, desktop applications, plus collaboration tools. IP-PBX and Its Principal Characteristics A Private Branch Exchange (PBE) is a userÃ¢â¬â¢s site telephone framework that has the capability to handle telephone calls coming to the corporation as well as works as a door for the outside voice communication networks. In this scenario, a network router or switch transmits coming data packets to the suitable data communication network. Conventionally, two different communication networks are required in order to perform this procedure: one network is required for voice and other network is required for data transmission. Moreover, in place of 2 different networks, simply one communication network is preferred when voice data is divided into packets (VoIP) and transmitted on communication network. Furthermore, an IP-PBX is a merger of a router/ switch and a PBX that manages Voice over IP (Silicon Press, 2010). As shown in below given image: Figure 1IP-PBX Working, Source: http://www.silicon-press.com/briefs/brief.ippbx/brief.pdf In an IP-PBX, systems could be connected in a shared LAN (local area network) that is usually connected to the IP-PBX. In this scenario, telephones have to be straightly linked to the IP-PBX. So this configuration eludes QoS (Quality of Service) concerns that could take place if both telephones and computers are configured on a joint LAN. In the same way, communication voice packets will need to struggle with data packets intended for the network based joint LAN. Thus, less effective telephone voice featu re will take place if network voice packets are not broadcasted in a suitable way (Silicon Press, 2010). An IP-PBX works like a gateway that offers voice links (for example voice lines, T1s) to a LEC, a large scope business, etc. as well as data links (DSL, cable, E1, ISDN) to a LEC, a cable operator, an Internet Service Provider, etc. In addition, IP-PBXs
Wednesday, November 20, 2019
United States and education - Essay Example Education for all is the most important thing to be achieved by nation as a whole.Thomas Jefferson,the third president of United States of America pioneered the plan that could be implemented upon to make education available to every single citizen while considering right to education equivalent to fundamental rights and would also get over the inequality factor.He elaborated his views about education as a tool not only to make better personalities but also a better nation.His work as mentioned above have envisioned learning not just along the old philosophy of what the students are learning but also on how are they learning. The vision of learning skill is what an educator would wish to see. This is because of the rise in number of students that will provide better results. The incorporation of improved theory into regular administrative schedules and classroom will help the educators and students in concentrating on teaching and learning process and then infusing another wave of dy namicity with reference to real world context. Learning in the classroom will generate a new relationship between the world and the student thereby engaging and modernizing various methods for assessment as well as study. The broader relation between the educators and the students will give real time information to the teachers about the performance of the students. Through this they can search for newer methods to help their students. These processes will ensure more compact relationship and the students will learn in a very few period rather than the months.... Increasing reliability in the classroom can be achieved through the use of Positive teaching methods. Constructivism has been an important ingredient of Jefferson learning theory proposing learners to create their own understanding as they combine what they already believe to be true based on their past experiences with new experiences. Though modern education may consider constructivism as a philosophy of learning which has its roots primarily to the work of John Dewey (1916) and Jean Piaget (1973). Vygotsky's work (1978) also contributed to the movement toward constructivism. Jefferson emphasized that theories of learning should be shifted from orientation based on observable phenomenon to an orientation that emphasize internal cognitive processing. This shows significant shift toward constructivism. The belief that learning comes from inside continues to grow. Knowledge could only gain on which circumstance it comes from that had meaning to the learner. The learning context must be a social context in which students work together to build knowledge. The children should be encouraged to develop concepts and derive their own ideas from those introduced to them. A social learning perspective should be developed through which children learn through interaction with others. Critical thinking is one of the areas where over the decades both educators & policy make argued about schools. Much of this debate has not been based on empirical data. Even though students, right from primary schools must learn facts and basic skills, the data suggest that emphasis on advanced reasoning skills promotes higher student performance. Jefferson pedagogical models promotes this meaningful type of learning process, a process in which learning helps students make sense of new
Monday, November 18, 2019
Latin America News Review - Essay Example Cubans are portrayed as conservative people who are firmly attached to their cultures and practices. However, the young generation is embracing new and modern life. This results in a significant generation gap since the old still hold on to what they believe is their sovereignty. A country full of high economic growth potential is what Cuba portrays itself to be. Tourism is doing immensely strong with a record of 3.4 million visitors last year; the tourism sector represents only 10 percent of the economy thus it is apparent that this country has an enormous potential for economic growth. Positive returns can be seen for those who agree to leave and work elsewhere. Through an informative research conducted by Marla Dukharan (Mc Williams 2015), it is anticipated that the remittances of the Cubans working out of Cuba increases to more than 3.5 billion biannually. Cubans are appreciating involvement in small-scale trading, and this is manifested in increased small and medium enterprises such as cafes and bars (Mc Williams 2015).1 The political structure of Cuba has significantly evolved, comparing Fidel Castro regime, and the present time situation, changes such as an increase in the number of political parties are evident. Cubans feel that this is a revolution and an active political reform (Moore 2015). Previously, the country was categorized as a communist society. Critical analysis, however, portrays high levels of individual self-interest amongst the wealthy. Mc Williams, David. 2015. Irish Independent : Cuban Society Is Full Of Contradiction, Now The People Must Pick Their Part Of Change. Ireland, February 11,
Saturday, November 16, 2019
Audit of Syphilis Screening in Pregnancy Tables Table 1:Syphilis confirmatory test results for forty nineÃ pregnant woman 18 Table 2:Syphilis screening results of eleven new-borns ofÃ positive syphilis mother 24 Table 3: Positive syphilis confirmatory test results for sixteenÃ pregnant woman 30 Figures Figure 1: The laboratory turnaround time of syphilis screeningÃ for mothers 28 Figure 2: The laboratory turnaround time of syphilis screeningÃ for new-borns 28 Tables Table 1: Syphilis confirmatory test results for forty nine pregnant woman 18 Table 2: Syphilis screening results of eleven new-borns of positive syphilis mothers 24 Table 3: Positive syphilis confirmatory test results for sixteen pregnant woman 30 Figures Figure 1: The laboratory turnaround time of syphilis screening for mothers Figure 2: The laboratory turnaround time of syphilis screening for new-borns ABSTRACT Objective: A re-audit of syphilis screening in pregnancy was carried out to ensure that the improvements in laboratory and clinical aspects of management for the antenatalof pregnant women with positive syphilis screening and their new-born babies fully met were in accordance with the UK National Guidelines on the Management of Syphilis (Kingston et al., 2008) and the Guidelines for the Management of Syphilis in Pregnancy and the Neonatal Period (Stringer et al., 2013). Methods: PatientsÃ¢â¬â¢ data were collected via query of the three databases: Clinisys Labcentre, Telepath and EuroKing. The n the data were analysed using Microsoft Access 2013. Results: Samples from Forty nine49 pregnant woman with positive syphilis results serology were referred to a reference laboratory laboratory were sent to MRI for syphilis serological confirmatory testing. Sixteen pregnant woman with of these women were confirmed to have had had positive syphilis were identified. Ten pregnant woman were re-tested screened at least twice during their pregnancy and six pregnant woman were only screened tested once during pregnancy. Over-testing of for treponemal IgM were seen in nineteen patients[h1] with non-reactive RPR titre. Only eleven babies born to mothers with syphilis were followed-up with serial serological tests for syphilis. Only four new-borns were fully screened. Some of the new-borns were not tested with treponemal IgM due to sample insufficiency. Conclusion: There were some improvements seen since the first audit which includes the changes of the confirmatory testing schedule in MRI, lower screening false positive rate, and increased follow-up of the new-borns. There were also things to improve in the management of syphilis in pregnancy and the new-borns of positive syphilis mothers. Treponemal IgM test should be performed only when the RPR test were reactive to prevent over-testing of patients. The test algorithm for screening of syphilis in new-borns should give priority to RPR test and treponemal IgM to prevent under-testing[h2]. In-house confirmatory testing should be considered to allow reduction of test turnaround timeÃ¢â¬â¢s thereby aiding patient management.Improvements[h3] should be made in the management of syphilis in pregnancy and the new-borns of positive syphilis mothers. Treponemal IgM test should be performed only when the RPR test were reactive to prevent over-testing of patients. The test algorithm for screening of sy philis in new-borns should give priority to RPR test and treponemal IgM to prevent under-testing[h4]. 1.0Ã INTRODUCTION 1.1Ã Syphilis Syphilis is an infectious disease caused by Treponema pallidum (T.pallidum) subspecies pallidum. The disease is transmitted from human to human, and humans are its only known natural host (Woods 2005). Epidemiologically, in the UK, cases of syphilis have increased in England since 1997 led by a series of outbreaks reported from Manchester, London and Brighton (Health Protection Agency 2009). Since 1999, diagnoses of infectious syphilis have been made in heterosexuals where the outbreaks are linked to sex work, students and young people. But, there was a changing pattern of infection between 1999 and 2008, when seventy three percent of new diagnoses of infectious syphilis were reported in men who have sex with men (Health Protection Agency 2009). The transmission is primarily by sexual activity (Zeltser Kurban 2004) (vaginal and anal intercourse) and by direct contact with active primary or secondary lesions (Lafond Lukehart 2006) for example through oral sex and kissing at or near an infectious lesion (Kent Romanelli 2008). T.pallidum may invade the host through normal mucosal membranes and also through minor abrasions in the skin (Zeltser Kurban 2004) such as from sexual trauma, causing an inflammation, ulcer and then spreading through the blood stream to other parts of the body (Goh 2005). 1.2Ã Syphilis in Pregnancy Mothers with untreated syphilis may seriously complicate their pregnancy. Vertical transmission of T.pallidum across the placenta (Singh Romanowski 1999) can occur at any time during pregnancy (Vaules et al., 2000; Oswal Lyons 2008), this leads to wide dissemination of the spirochete in the fetus (Woods 2005). Fetal infection resulting in spontaneous abortion, still-birth, premature delivery, non-immune hydrops fetalis and also congenital infection (Singh Romanowski 1999; Vaules et al., 2000; Ledger 2000). Vertical transmission may occur at any stage of syphilis infection. However, the transmission is more common in mothers with primary and secondary stage of syphilis (Singh Romanowski 1999; Vaules et al., 2000; Oswal Lyons 2008) as the risk of transmission depends on the levels of spirochaetemia which are higher in these stages compared to other stages (Vaules et al., 2000). Syphilis may also be transmitted during birth by contact of the new born with the motherÃ¢â¬â¢s genita l lesion (Ledger 2000; Berman 2004). 1.3Ã Congenital Syphilis Signs of infection for early congenital syphilis may appear within the first two years of the infantÃ¢â¬â¢s life with clinical manifestations include hepatosplenomegaly, rash, fever, and signs of neurosyphilis, especially bulging fontanel, seizures, and cranial nerve palsies (Mattei et al., 2012; De Santis et al., 2012). As for late congenital syphilis, the sign of infection may only be seen over the first two decades with clinical manifestations such as frontal bossing, nasal cartilage destruction, and dental abnormalities (Mattei et al., 2012; De Santis et al., 2012). Congenital syphilis leads to multiple organ infection because of the widespread haematogenous dissemination (De Santis et al., 2012) that will further cause death in the fetus or new born. However, the disease is almost preventable if mothers with syphilis are treated early in pregnancy (Walker Walker 2007). 1.4Ã Serologic Test Diagnosis of syphilis is made based on clinical signs and symptoms, microscopic examination and serologic tests (Little 2005). Two types of serologic testing were available; non-treponemal specific tests and treponemal specific tests (Clyne Jerrard 2000). Non-treponemal tests are widely used for testing and screening for syphilis as they are rapid, simple and inexpensive (Ratnam 2005). The example ofÃ non-treponemal tests include the Venereal Disease Research Laboratory (VDRL) test and the rapid plasma reagin (RPR) test (Kent Romanelli 2008). Due to the rate of false-positive results which present in about one to two percent for these tests, the positive results have to be confirmed by sets of treponemal-specific tests such as the T.pallidum particle agglutination (TPPA) test, T.pallidum haemagglutination (TPHA) test and treponemal enzyme immunoassay (EIA) test (Kent Romanelli 2008). 1.4.1Ã Antenatal Screening The detection and treatment of infectious syphilis are extremely important in preventing congenital syphilis (Chakraborty Luck 2007; Simms Broutet 2008). An effective antenatal screening programme can have a huge impact in the way of managing both mother and baby. All pregnant women should be screened for syphilis at their first antenatal appointment (French et al., 2009) and the test should be repeated early in the third trimester (Goh Thornton 2007). Also, all infants born to seropositive mothers should be examined at birth and at monthly intervals for three months until it is confirmed that serological tests are and remain negative (Oswal Lyons 2008). The primary screening tests recommended (Kingston et al., 2008) are either treponemal EIA or TPPA/TPHA. If the screening test is positive, it must be confirmed by either one of the opposite tests. VDRL or RPR will be performed when the confirmatory test gives positive results (Kingston et al., 2008). 1.5Ã Audit on Diagnostics of Syphilis in Pregnancy The diagnosis of infectious syphilis in women in the UK increased between 1999 and 2007. The increase of syphilis cases in women has also led to the re-emergence of congenital syphilis in the UK which may suggest sub-optimal management of patients with syphilis (Health Protection Agency 2009). In 2011, an audit on diagnosis of syphilis in pregnancy was performed at the Pennine Acute NHS Trust (PAHT) to ensure the syphilis screening in pregnant women and also the serological diagnostic of their new-born babies followed the UK standard for Microbiology Investigations in Serological Diagnosis of Syphilis which were introduced by Public Health England in 2007 (Public Health England 2014b). The purpose of introducing the standard was to assure equivalence in the investigation strategies in different laboratories across the UK (Public Health England 2014b). The audit reveals the concerns about the delays in syphilis confirmations and insufficient follow-up for new-borns of positive syphilis mothers. At least eighteen percent of positive syphilis cases took more than one month for confirmation and the turnaround time for eleven percent of the syphilis screening cases out of forty five cases took more than one week. It is also found that there was inconsistency in performing treponemal IgM test where fifty three percent of cases (twenty four cases out of forty five cases) were not tested for treponemal IgM. For the management of neonates, only four new-borns were followed-up and among four new-borns, only one have been followed up according to the guidelines. Recommendations made from the audit includes the improvement of time to confirmation of specimens, changes of confirmation test by using treponemal IgM to all pregnant woman, referral of all pregnant woman with inconclusive syphilis confirmation to Genitourinary Medicine (GUM) clinic and management of new-borns where follow-up should be completed according to the guidelines provided (Vladana et al., 2011). 1.6Ã Re-audit of Syphilis Screening in Pregnancy A re-audit of syphilis screening in pregnancy at the PAHT was performed to discover if changes made after the first audit recommendations have led to the improvement of services. The re-audit was carried out three years after the first audit done in 2011. The re-audit aimed to ensure that the improvements in laboratory and clinical aspects of management for the antenatal women with positive syphilis screening and their new-born babies were in accordance with the UK National Guidelines on the Management of Syphilis (Kingston et al., 2008) and the Guidelines for the Management of Syphilis in Pregnancy and the Neonatal Period (Stringer et al., 2013). 2.0Ã METHODOLOGY 2.1Ã Background The PAHT comprises four major district general hospitals; North Manchester General, Fairfield General Hospital, Rochdale Infirmary and The Royal Oldham. Some 12,000 women annually present for antenatal care. Women usually attend for antenatal care at one of three antenatal clinics or one of several General Practice Clinics within the community. In the UK antenatal infectious disease screening is usually performed at three months gestation (http://www.screening.nhs.uk/). Women are offered screening for rubella immunity, hepatitis B virus infection, human immunodeficiency virus infection and T.pallidum (syphilis) infection. Among 12,000 women screened within the PAHT in the period 1st January 2013 to 31st December 2013, a series of forty nine pregnant woman with positive syphilis serology were identified. To determine whether syphilis screening and follow up care of babies born to these mothers followed the UK Guidelines of the Management of Syphilis (Kingston et al., 2008) and the Gui delines for the Management of Syphilis in Pregnancy and the Neonatal Period (Stringer et al., 2013), a retrospective study was performed. 2.2Ã Diagnosis of Syphilis Pathway PatientsÃ¢â¬â¢ blood sample was collected with informed consent at the antenatal clinic and laboratory test requests were made. The patientsÃ¢â¬â¢ information was recorded in the maternity information system database; Ã¢â¬Å"EuroKingÃ¢â¬ (Euroking, Chertsey, Surrey, UK). Samples were transported to The Royal Oldham Hospital (TROH) microbiology laboratory via the hospital transport system to be tested. Patient demographic information was recorded in the laboratory data system Clinisys Labcentre (Clinisys, Chertsey, Surrey, UK). If the syphilis screening test was negative, a report was generated and then posted to the antenatal clinics where the sample came from. If the syphilis screening test was positive, the sample was sent to a reference laboratory, Manchester Medical Microbiology Partnership Laboratory at Manchester Royal Infirmary (MRI) for confirmatory testing. Testing at the MRI comprises two treponemal enzyme immunoassay tests for total treponemal antibody; a T.pallidum specific assay (EIA); the T.pallidum particle agglutination assay (TPPA); the reagin precipitin assay (RPR) and where appropriate a T.pallidum specific IgM enzyme immunoassay (IgM) in accordance with national guidelines (Kingston et al., 2008). These results were recorded in the MRI laboratory database system, (Telepath; CSC Healthcare, Banbury, Oxfordshire, UK) and a printed copy of the patient test results was sent back to TROH microbiology laboratory. The reference laboratory report was transcribed onto the Clinisys Labcentre system and a printed report was generated to be to the antenatal clinics. Finally, the patientsÃ¢â¬â¢ report received by the antenatal clinics was recorded in the patientsÃ¢â¬â¢ notes and updated in the EuroKing system. 2.3Ã Data Collection Data collection for the study was accomplished via query of the three databases: the PAHT laboratory database system, Clinisys Labcentre, the MRI database system, Telepath and the maternity information system database, EuroKing. The data gathered including the patientsÃ¢â¬â¢ hospital number, NHS number and specimen number, date of birth, the date of sample collection and report, and also the syphilis serology data which includes the patientsÃ¢â¬â¢ treponemal EIA, TPPA, RPR and treponemal IgM results. The sample collection and sample reported data were obtained to investigate the turnaround time taken for the diagnosis within the laboratory. 2.4Ã Analysis of Data The laboratory system data was presented as Microsoft Excel spreadsheets (Microsoft Corporation, Seattle, USA). All the patientsÃ¢â¬â¢ data were then imported and assembled in Microsoft Access 2013 (Microsoft Corporation, Seattle, USA). The data for the forty nine pregnant woman with positive syphilis serology were analysed using Microsoft Access 2013 (Microsoft Corporation, Seattle, USA). 2.5Ã Clinical Audit This was conducted under the Clinical Audit provision of the NHS National Research Ethics Committee (National Research Ethics Service 2008). The work was registered and approved as a Clinical Audit with the Clinical Audit Department of the PAHT. Data analysed was anonymised before release from the Trust to comply with Data Protection Guidelines (Caldicott Committee 1997). The clinical audit used the UK National Guidelines on the Management of Syphilis (Kingston et al., 2008) as a standard. 3.0Ã RESULTS Fifty positive syphilis serology results were identified from forty nine pregnant woman undergoing routine antenatal infectious disease screening at TROH microbiology laboratory. All specimens were screened with Chemiluminescent Microparticle Immunoassay test using the Abbott Architect Syphilis TP Assay (Abbott Diagnostics, Chicago, USA). The fifty specimens were also sent to the Manchester Medical Microbiology Partnership Laboratory, MRI which acts as a reference laboratory for syphilis serological confirmatory testing. 3.1Ã Confirmation Methods by MRI The reference laboratory confirms syphilis screening with two treponemal EIAs, a semi-quantitative TPPA, a semi-quantitative RPR, and where appropriate a T.pallidum specific EIA for IgM antibody in accordance with national guidelines (Kingston et al. 2008). The first treponemal EIA test was the same Abbott Architect Syphilis TP Assay (Abbott Diagnostics, Chicago, USA) used at TROH for syphilis serological testing; the second treponemal EIA test used the DiaSorin Liaison XL System (DiaSorin S.p.A, Saluggia, Italy), the semi-quantitative TPPA was the Serodia TPPA Assay (Fujirebio Diagnostics, Inc., Tokyo, Japan), the semi-quantitative RPR was the Abbott Syfacard Ã¢â¬â RR card test (Abbott Diagnostics, Chicago, USA), and the T.pallidum specific EIA for IgM were run using CAPTIA Syphilis-IgM Assay (Trinity Biotech, Ireland, UK). Where necessary, further testing using T.pallidum specific immunoblotting and/or T.pallidum specific polymerase chain reaction testing are also used in confir mation testing. All specimens were confirmed using treponemal EIA, TPPA and RPR but only about twenty nine specimen out of fifty specimen were tested using treponemal IgM. There were seventeen positive screening with syphilis and thirty three negative screening with syphilis. Negative screening was defined by having negative results for either one or both treponemal EIA, TPPA titres of less than 1:80 and RPR titre of less than 1:2; positive results were defined by having positive results for both treponemal EIAs, a TPPA titre of greater than or equal to 1:160, RPR titre greater than or equal to 1:2 and positive results of treponemal IgM (Table 1). Table 1: Syphilis confirmatory test results for forty nine pregnant woman. Patient numbers with symbol Ã¢â¬Å"*Ã¢â¬ are pregnant woman with positive syphilis results. Patient Test TEIA1 TEIA2 TPPA RPR IgM EIA InterpretationResult 1 1 Positive Negative Negative Negative Not Done Negative *2 1 Positive Positive 1:640 Negative Not Done Positive 2 Positive Positive 1:320 Negative Negative 3 1 Positive Negative Negative Negative Not Done Negative 4 1 Positive Negative Negative Negative Not Done Negative *5 1 Positive Positive 1:5120 1:64 Not Done Positive 2 Positive Positive 1:5120 1:64 Not Done 3 Positive Positive 1:2560 1:8 Not Done Patient Test TEIA1 TEIA2 TPPA RPR IgM EIA Result 6 1 Positive Negative Negative Negative Negative Negative *7 1 Positive Positive 1:640 Negative Not Done Positive *8 1 Positive Positive 1:1280 Negative Not Done Positive 2 Positive Positive 1:2560 1:1 Not Done 9 1 Negative Negative Negative Negative Not Done Negative 10 1 Positive Negative Negative Negative Negative Negative 11 1 Positive Negative Negative Negative Not Done Negative 2 Positive Negative Negative Negative Not Done *12 1 Positive Positive 1:5120 1:4 Negative Positive 2 Positive Positive 1:5120 1:4 Not Done Patient Test TEIA1 TEIA2 TPPA RPR IgM EIA Interpretation *13 1 Positive Positive 1:640 1:64 Not Done Positive 14 1 Positive Negative Negative Negative Negative Negative 15 1 Positive Negative Negative Negative Not Done Negative 16 1 Positive Negative Negative Negative Not Done Negative 17 1 Positive Negative Negative Negative Negative Negative 18 1 Positive Negative Negative Negative Not Done Negative 2 Positive Negative Negative Negative Not Done *19 1 Positive Positive 1:640 Negative Not Done Positive 2 Positive Positive 1:1280 Negative Not Done 20 1 Positive Negative Negative Negative Not Done Negative Patient Test TEIA1 TEIA2 TPPA RPR IgM EIA Result 21 1 Positive Negative Negative Negative Not Done Negative *22 1 Positive Positive 1:640 1:4 Not Done Positive 2 Positive Positive 1:1280 1:4 Not Done 23 1 Positive Negative Negative Negative Not Done Negative 24 1 Positive Negative Negative Negative Not Done
Wednesday, November 13, 2019
Question 1 Psychology is defined as the scientific study of the behavior and mental processes of individuals. Before psychology, people did not know why we feel the things we feel or think the things we think. So psychology began with some goals in mind. The first goal is to observe behavior and describe what is happening. This allows for the next goal which is to explain what is happening. It is important to be able to explain how and why behavior happens. It is necessary to find motives or triggers that will cause outcomes. By knowing what causes behaviors to occur we can then predict what will happen in the future. We can then know what to expect and intervene to control the outcome of behavior. Predicting behavior will allow psychologists to better help people by being able to control the outcome of their behavior. There have been a few pioneers that have paved the road for modern psychology. In Leipzig, Germany, a scientist by the name of Wilhelm Wundt became one of the largest contributors to the development of psychology. Wundt created a laboratory strictly for the study of psychology. Another key player is Edward Titchener who founded the first experimental psychology lab in the United Sates. One of the most important documents written in psychology, The Principles of Psychology, was written by William James. With all of these great minds at work an argument arose. The argument was about the right subjects to study and the correct methods to use while studying them. One side of the argument was structuralism. Structuralism uses the idea that all mental processes could be explained by knowing what the mind is made of. The other side of this argument was functionalism. Functionalism asks not so much what the mind is made of but how and why it operates. Functionalism states that the mind depen ds on itÃ¢â¬â¢s adjustment to the environment and that it will be an ever-changing entity. In psychology, there are many different perspectives that are employed. The psychodynamic perspective was made famous by Sigmund Freud. Freud exclaimed that behavior motivated by internal forces such as instincts or heredity. The behaviorist perspective declares that behavior is determined from reactions to environmental occurrences. Another perspective is the humanistic perspective which believes that no matter what inheritance or environment provides people are still able to make a choice as to how we behave. The cognitive perspective states that a human is designed to think and imagine.