Juice Concentrate Industry Essay Example for Free

Juice Concentrate Industry Essay Juice is a liquid that is naturally contained in fruit and vegetables. It is commonly consumed as a beverage or used as an ingredient or flavouring in foods. Juice is prepared by mechanically squeezing or macerating fruit or vegetable flesh without the application of heat or solvents. For example, orange juice is the liquid extract of the fruit of the orange tree, and tomato juice is the liquid that results from pressing the fruit of the tomato plant. Common methods for preservation and processing of fruit juices include canning,pasteurization, concentrating[1], freezing, evaporation and spray drying. A concentrate is a form of substance which has had the majority of its base component (in the case of a liquid: the solvent) removed. Typically this will be the removal of water from a solution or suspension such as the removal of water from fruit juice. One benefit of producing a concentrate is that of a reduction in weight and volume for transportation as the concentrate can be re-constituted at the time of usage by the addition of the solvent. Process Description The following processes concerns mainly with the fruit to juice concentrate production. Thorough process outline will be presented in the final paper. Harvesting/collection Oranges are harvested from large groves. When the mature fruit is ready to pick, a crew of pickers is sent in to pull the fruit off the trees. For higher picking rate companies on the other hand, use mechanical pickers instead of crew of pickers. The collected fruit is sent to plants for juice processing. The oranges are generally shipped via truck to juice extraction facilities, where they are unloaded by a gravity feed onto a conveyor belt that transports the fruit to a storage bin. Washing As the fruits are unloaded from the trucks, they are washed and loaded to belt conveyors proceeding inside the extraction plant. This process removes debris and dirt and reduces the number of microbes. Selection and Sizing Before extraction process, the fruits are manually selected and grouped based on size and color. Extraction Proper juice extraction is important to optimize the efficiency of the juice production process as well as the quality of the finished drink. The latter is true because oranges have thick peels, which contain bitter resins that must be carefully separated to avoid tainting the sweeter juice. There are two automated extraction methods commonly used by the industry. The first places the fruit between two metal cups with sharpened metal tubes at their base. The upper cup descends and the fingers on each cup mesh to express the juice as the tubes cut holes in the top and bottom of the fruit. The fruit solids are compressed into the bottom tube between the two plugs of peel while the juice is forced out through perforations in the tube wall. At the same time, a water spray washes away the oil from the peel. This oil is reclaimed for later use. The second type of extraction has the oranges cut in half before the juice is removed. The fruits are sliced as they pass by a stationary knife and the halves are then picked up by rubber suction cups and moved against plastic serrated reamers. The rotating reamers express the juice as the orange halves travel around the conveyor line. For massive industrial production, the most effective is the former method. The peels and pulps are collected to be used later for further steps in the production. Pasteurization Pasteurization is still required to further retard spoilage. Pasteurization also inactivates certain enzymes which cause the pulp to separate from the juice, resulting in an aesthetically undesirably beverage. This enzyme related clarification is one of the reasons why fresh squeezed juice has a shelf life of only a few hours. Flash pasteurization minimizes flavour changes from heat treatment and is recommended for premium quality products. Several pasteurization methods are commercially used. One common method passes juice through a tube next to a plate heat exchanger, so the juice is heated without direct contact with the heating surface. Another method uses hot, pasteurized juice to preheat incoming unpasteurized juice. The preheated juice is further heated with steam or hot water to the pasteurization temperature. Typically, reaching a temperature of 185-201.2Â ° F (85-94Â ° C) for about 30 seconds is adequate to reduce the microbe count and prepare the juice for filling.

Practice Nurses Role in Treating Chlamydia

Practice Nurses Role in Treating Chlamydia The practice nurses role in treating chlamydia and improving the sexual health of the nation Introduction Chlamydia treatment has been the focus of considerable research interest in the past few years. A huge proportion of what used to be called NSU, or was even undiagnosed non-specific pathology, is now recognised as being due to the chlamydia pathogen. It has now achieved the unenviable status of being considered responsible (numerically) for the greatest amount of sexually transmitted disease in the UK today (Duncan 1998) Given the fact that it is now therefore recognised as being a major contributing factor in the overall picture of sexual health, we must examine ways in which the NHS is set up to tackle the problem. (HPA 2003) As with many health related issues such as this there are a number of subsidiary issues that must be considered in relation to the main theme. These include the role of the screening process in trying to contain the prevalence of chlamydial infection, the practice nurse’s role in that screening process, the current thoughts on the treatment of chlamydia and the practice nurse’s role in not only the treatment, but also the partner tracing activity that is vital to try to stop the spread of the disease. (Fenton et al 2001) The practice nurse is generally ideally placed within the primary healthcare team to act as a central liaison point for many of these activities If we start by considering the whole issue of screening. On one level, one could be forgiven for thinking that the issues relating to screening are actually rather simple. We know that many cases of chlamydia are actually asymptomatic (see on). Given the fact that it can cause considerable damage and is eminently treatable, why not screen for it and get rid of it? Sadly, it is not as simple as that. (Simms et al 1996) The National Institute for Clinical Excellence (NICE) has set up the National Chlamydia Screening Programme (NCSP). It quotes its rationale for doing so as: Genital Chlamydia trachomatis is the commonest Sexually Transmitted Infection (STI) in England Genital chlamydial infection is an important reproductive health problem ~ 10-30% of infected women develop pelvic inflammatory disease (PID). A significant proportion of cases, particularly amongst women, are asymptomatic and so, are liable to remain undetected, putting women at risk of developing PID. Screening for genital chlamydia infection may reduce PID and ectopic pregnancy. The study itself was exemplary in design with an entry cohort of nearly 8,000 patients. The authors considered the efficacy of several different methods of screening and then compared the results of the programmes against the costs of allowing the disease to continue untreated in the community and these include all the sequelae of infertility, pelvic inflammatory disease and ectopic pregnancy in women together with the complications that can occur in the male partners (infertility again) and prostatitis. (Berry et al 1995) The paper even covered the incidence of both pneumonia and eye infections in their children. The structure of the study was quite comprehensive insofar as it compared the results of four separate groups One group received no screening at all, a second group were screened if they exhibited mucopurulent cervicitis, the third group included all women who were less than 30 yrs. old and the last group was all women irrespective of symptoms. The actual screening tool was the Polymerase chain reaction (PCR) which is a very specific and sensitive antibody based test. It was performed on either urine or direct cervical samples. (Barlow et al 2001) The study protocol then called for all positive testing patients to receive treatment with doxycycline for seven days. The analysis section of the paper is both long and complex. We shall therefore condense our examination of this part of the study into an examination of the results. The overall treatment costs of treating all of the medical complications of chlamydial infection was calculated as $676,000. Each of the positive screening strategies produced a significant reduction in the expected cost of complications that was greater than the cost of the actual screening exercise. A condensation of the tabulated results is shown here: Screening method Screening costs ($) Medical costs ($) Total cost ($) Number of PID cases PID cases prevented No screening 676,000 676,000 152 CDC criteria 55,000 390,000 446,000 88 64 Women 75,000 297,000 372,000 67 85 Universal screening 120,000 270,000 391,000 61 91 The results need little explanation, as it can be clearly seen that both the costings and the number of cases prevented argue strongly for a case for screening. The only point of contention is the decision on the population that the health care system will fund for screening. Overall, the authors state that their regime reduced the incidence and prevalence of pelvic inflammatory disease by 60% when compared to the unscreened group. The other significant factor was that, taking all groups as an average, they noted a total healthcare saving of about $50 per woman screened, and this clearly does not take any account of any associated comorbidity, pain and suffering that is caused by the chlamydia infection A further corollary can be drawn from the results. The authors went on to provide an impressive statistical analysis of the comparative costs of different community groups with different rates of prevalence. Of great importance to our considerations here was the fact that the authors concluded that the cost of screening was cost effective when the incidence of infection in a population of asymptomatic women was above 1.1%. when the incidence rose above 11% then they found that the screening of all women and their partners became the most effective strategy. To some extent, this study can be considered the â€Å"gold standard† for most of the studies in this area. It is well conceived, meticulously executed and well and thoughtfully analysed to give meaningful results which are of great practical importance. Despite such comments it should be noted that there are a number of negative points to be considered in this particular study. The universal treatment constant was the seven day doxocycline treatment. We should note (as the authors did) that there is therefore a potential for non-compliance with the whole seven day regime, and this may introduce a potential source of bias in the figures(Haddix et al.1995). We can also point to other studies that have addressed this particular problem with a one dose treatment regime (azithromycin). It is fair to note that despite the potential for bias, extrapolation to these other studies does not appear to show significant differences in the overall results (Lea et al 1997) The issue of screening, although covered reasonably comprehensively in the last paper, certainly as far as matters of cost are concerned, is examined further in the paper by (Duncan et al. 2001). This paper approaches the issues from a different perspective. It includes the issues of male screening And takes an overview of the Public Health issues from a sociological viewpoint, which makes it, (in our examination of the current literature), almost unique. We should note that we have already addressed the issues faced by the NCSP, but the other major public document in this area is the report commissioned by the Chief Medical Officer (CMO 1998). It is instructional to discuss the recommendations of this group as they differ significantly from the screening criteria used in the previous paper. The recommended groups for screening here are the following: Everyone with symptoms of chlamydia infection, All those attending genitourinary medicine clinics, Women seeking termination of pregnancy.1 Opportunistic screening of young sexually active women under 25 years Women over 25 with a new sexual partner or two or more sexual partners in the past year. In the context of our considerations here, we should note that the advisory group identified the optimum sites for screening as the primary healthcare team (family planning clinic) as well as the usual GUM clinics. (Stokes 1997) The Duncan paper is particularly well written and a major point that comes from it is in sharp contrast to that found in the Howell study. One of the criteria that they suggest for screening males in the population is that women may find that being screened has connotations of being dirty and unattractive A positive result is said to be associated with promiscuity. The authors suggest that not screening men not only fosters gender inequalities but it reduces the Public Health impact on the Man’s responsibilities for sexual health. (Pierpoint et al 2000) There is no argument that this is a valid point, but the paper does not produce any evidence to show that male screening has a positive impact on the cost-effectiveness of the screening procedure. (Stephenson et al 2000) The paper does however, contrast these statements with the accepted fact that women are actually easier to target than men, as they are generally heavier health care users than men in the major at risk age range. (Oakeshott et al 1998) The paper points to the need to tackle the issues of sexual inequality, as it could be considered that the screening programmes may have less than the desired effect if they are perceived by women to be little more than surveillance of their particular sexual habits. It draws a clear analogy between a women only screening programme for chlamydia and the well established women only cervical cytology screening clinics. The paper quotes (Holgate et al 1998) in the comment: The potentially adverse consequences of sexual intercourse a private event can be surveyed and treated through screening services a publicly based and funded system . It is women who transcend this private, public dichotomy and find their lives scrutinised in a manner alien to men . The focus is commonly upon women both as transmitters and contractors of relevant viruses as both those whose cervixes are surveyed and whose sexual activity comes under surveillance. The paper then has a long middle section which, as a critical analysis, is little more than a diatribe against women being singled out for screening. It is fair to say that all of the arguments put forward are valid, to a degree, but are presented with a strongly feminist viewpoint, which is both understandable and worthy of merit form a sociological standpoint. The arguments are not however, convincing from a scientific, financial or practical perspective. The conclusions of the paper are entirely justified in calling for a greater understanding of the woman’s point of view when organising and running screening clinics, in order to broaden their appeal to the target groups. (Santer et al 2000) With specific reference to the role of the nurse in the primary healthcare team screening for chlamydia we can now turn and examine an excellent paper by Grun (et al 1997) which looked at two different methods of screening for chlamydia in a nurse run primary healthcare setting. The study set out to try to accurately determine the prevalence of chlamydia in the North London area using the ligase chain reaction (LCR) technique which is similar to the PCR mentioned earlier. (Butt et al 2001) This particular study used the rather labour intensive cervical scrape method for sampling, which had the added benefit that cervical cytology could be assessed at the same time. The paper is quite detailed in its description of its method and appears to be rigorous in its execution. It is worthy of our consideration here because of it’s direct relevance to our prime consideration. The results and conclusions of the paper make for interesting reading One of the more significant conclusions was that, on the basis of their findings, if there was a policy of simply screening all women aged 25 and all women who had had two or more partners in the past year, they would have detected 20 out of a possible 23 positive chlamydia infections in their cohort. The authors make a salient comment that including other screening criteria such as marital status (which has been suggested by other authors [Lossick JG, et al 1996]), would have made no statistically significant impact on their detection rate. They also make the comment, in line with the other authors we have examined, that selective screening appears to be more cost effective than universal screening, although the actual cost implications were not specifically considered in this paper. In contrast to the Howell paper, it suggests that screening become a viable tool when the community prevalence rate approaches 5% The fourth paper to be reviewed is the more recent paper by Adams (et al 2004). This paper takes a more general overview of the whole issue of chlamydia in the UK. This is effectively a meta analysis of nineteen different papers (selected from 357 studies) which report the incidence of chlamydia as tested by the PCT method on urine samples. This is significant as it is the first meta analysis to be carried out on UK data. (Armitage et al 2001) The results are extremely detailed and many are only of marginal relevance to our considerations here. We shall restrict our comments to those aspects that are specifically relevant. Firstly, the authors comment on the current prevalence of 8.1% of the population testing positive in the under 20 age group, progressively diminishing to 1.4% in the over 30 group. The significance of this is that it is very much lower than other studies. For example studies set in GUM clinics put the prevalence in the under 20 age group in the region of 17% and antenatal clinics at about 12%. (Piementa et al 2003) This may therefore have relevance in targeting of specific at risk groups. It should be noted that this study gave no data with regard to the incidence of chlamydia in the male population. (Dixon et al 2002) Our comments made earlier about the asymptomatic nature of the bulk of the infections, is borne out in the fact that only 8% of those tested and found to be positive, actually volunteered that they had any genital symptoms (of any sort). Another important consequence of this study is the fact that it highlights the comparatively high detection rate to be found in attenders at primary healthcare team premises. This shows a gap in the reasoning and recommendations of the National Sexual Health and HIV Strategy for England (D of H 2002) which currently suggests targeting GUM clinics and family planning centres as prime sites for screening centres. Following on from the reasoning expounded in the last paper, we can look at a provocatively entitled article by Kufeji (et al 2003)† Who is being tested for genital chlamydia in primary care?† The paper makes the point that we already have enough evidence to clearly identify the target populations that are the most likely to give a good yield as far as screening is concerned (viz. the most â€Å"at risk† groups). The raison d’à ªtre of this paper was to compare the characteristics of the actual groups screened with the characteristics which we know to be representative of the groups most likely to be at risk. The corollary of this reasoning being that if the two groups do not match then all the calculations made about the cost effectiveness of a selective screening process do not hold water. (Kinn et al 2000) The most striking feature of this paper is the fact that we know (Adams et al 2004) that the maximum age incidence for chlamydia is in the sexually active under 20 age group and the incidence rapidly decreases with age to the over 30 age group. Kufeji and his co-workers found that the majority of the tests done (63%) were done on the over 25 yr. age group where we would expect the results to be positive only in about 1.5% of the population. Adams’ findings were confirmed with a positive rate of 13.3% found in the under 20 yr. olds tested. The paper also point to the fact that the practices studied had a comparatively high healthcare staff to patient ratio. In the practices where the ratio was lower, even less opportunistic testing was done. (Shefras et al 2002) This correlates to the finding that the Townsend score ( of social deprivation) correlated highly with both a reduction in the amount of testing and an increase in the prevalence of chlamydia. In the words of the authors the study points to the fact that screening programmes for chlamydia in primary healthcare settings suffer from â€Å"a selection bias and social desirability bias, and they do not aim to provide complete descriptive information on testing patterns across a population.† It should be noted that this particular study was not just on a small sample. The authors took as their entry cohort all of the 119 General Practices in Nottingham which collected a total of over 7,000 samples. The authors note that the number of tests done in General Practice is increasing at about 35% per year. It follows that if a significant number of these are inappropriately targeted, this has profound implications for the related costings of the exercise. One other salient point in this study was the fact that only 1 in 40 tests were done on men. (Chernesky et al 1999) The last major paper that we shall review in this section is the paper by Cassell (et al 2003) this deals with the thorny issue of partner notification when screening turns up a positive result. Hitherto contact tracing had largely been in the realms of the GUM contact tracing nurse. With the expansion of the screening role into the realms of General Practice and other clinics, the contact tracing role has also expanded and may well have lost some of it’s efficiency due to both a lack of skill, time and resources. (D of H 2002). Cassell and her colleagues have tried to investigate the extent to which this perceived reduction in contact tracing may be responsible for the relentless increase in the overall incidence of chlamydia. (Radia et al 2001). The study was done by postal questionnaire to all GPs in Nottinghamshire. They got a 56% response rate. Arguably the most significant finding of the study was the fact that 86% of respondents considered that chlamydia testing was part of the remit of the primary healthcare team, while only 40% considered that partner notification was a primary healthcare team role. The rationale for this was, that most of the non-contact tracing respondents felt that it was their role to inform the patient that they should inform their partners. Given the fact that we have evidence from the Duncan paper that women tend to equate a positive test with promiscuity and being â€Å"dirty†, it is perhaps not surprising that a substantial number of partners do not get told. If you add to this number the unknown number of chlamydia infections that may have come from clandestine or extramarital liaisons, then this number may be higher still. This is clearly both hypothesis and conjecture but it would seem to be dictated by common sense. The paper goes into considerable detail about the reasons why different primary healthcare teams have different practices, but rather worryingly a surprising 20% treat chlamydia with a dose of antibiotic which is less than the currently recommended therapeutic level recommended by the Central Audit Group for Genitourinary Medicine, (Stokes et al 1997) The difficulty of a postal questionnaire study is that there is an intrinsic bias in the study design. It is quite conceivable that the 56% of primary healthcare teams who responded were the ones who may have been sufficiently motivated to be positive about matters to do with chlamydia and may therefore have been better informed that those who did not respond. In the words of the authors â€Å"our study probably over-represents primary healthcare teams already testing for chlamydia and may exaggerate the extent of good practice.† The paradox outlined by this study is that while the majority of GPs and their teams are already willing to assume the mantle of diagnosing and managing chlamydial infection, the same majority agree that contact tracing is the main difficulty in managing these patients. The study made enquiries relating to the presence of follow up strategies which were designed to minimise the risk of further infection and found that there was â€Å"very little evidence to be found† other than by putting the onus on the patient to tell their partners. It follows from this observation, and the authors put it quite succinctly: If testing in primary care continues to increase without adequate support for partner notification, much of the resource used in testing women will be wasted. (Griffiths et al 2002) If we accept the premise that an increasing amount of chlamydia screening will be done in General Practice in the future, it is likely that an increasing proportion will fall to the practice nurse or the family planning nurse specialist. (Stokes et al 2000). If this is the case, then it is common sense to maximise the benefit of chlamydia screening by supporting the healthcare professionals with time and resources to perform proper contact tracing to minimise the risk of re-infection. (EHC 1999) Conclusions In this review we have selected six primary papers which each represent a significant contribution to the evidence base in our knowledge of the rationale for screening and treatment of chlamydia infection. (Sackett 1996) From our examinations it is clear that there is a considerable disparity in the figures pertaining to the prevalence of chlamydia infection in the community. The paper by Adams (Adams et al 2004) gives us a partial rationale for this and that is that studies done in different areas of health care practice will yield different results because they have a different clientele. It is not, perhaps, surprising that a study done in a GUM clinic will report different prevalences than a study done in a General Practice setting. The common factor that runs through all of the papers examined is the fact that it is rare to find that men are screened. Generally the figures suggest about 2-5% of men are screened when compared to the number of women. There is no evidence to suggest that they have lower infection rates than women and, according to Duncan (et al 2001), there are a number of very good sociological reasons why men should be screened as frequently as women. The fact of the matter is that women are subject to screening with much greater frequency than men and therefore bear the brunt of both the indignity and the responsibility. There is no doubt however, that the case for screening and treatment and contact tracing is made on both economic and health grounds. It is equally clear that the practice nurse has a central role in the efficient administration of all of these vectors to varying degrees. The advent of nurse prescribing (Legge 1997) will make the practice nurse as valuable in this area as they already are in both the screening and contact tracing roles. The only concern here is that according to Kufeji (et al 2003) we are collectively targeting the wrong population in terms of efficacy and efficiency. References Adams EJ , A Charlett, W J Edmunds, and G Hughes 2004 Chlamydia trachomatis in the United Kingdom: a systematic review and analysis of prevalence studies Sex. Transm. Inf., October 1, 2004; 80(5): 354 362. Armitage P, Berry G, Matthews J. 2001 Statistical methods in medical research. Malden, MA, 2001. Barlow RE, Cooke ID, Odukoya O, et al. 2001 The prevalence of Chlamydia trachomatis in fresh tissue specimens from patients with ectopic pregnancy or tubal factor infertility as determined by PCR and in-situ hybridisation. J Med Microbiol 2001;50:902–8 Berry J, Crowley T, Horner P, et al. 1995 Screening for asymptomatic Chlamydia trachomatis infection in male students by examination of first catch urine. Genitourin Med 1995;71:329–30. Butt A, McCartney R, Walker A, et al. 2001 Economic advantages of ligase chain reaction for diagnosis of genital Chlamydia trachomatis infection in GUM clinic attenders. Sex Transm Infect 2001;77:227–8. Cassell JA , M G Brook, R Slack, N James, A Hayward, and A M Johnson 2003 Partner notification in primary care Sex. Transm. Inf., June 1, 2003; 79(3): 264 265. Chernesky M, Lee H, Schachter J. 1999 Diagnosis of a Chlamydia trachomatis uretral infection in symptomatic and asymptomatic men by testing first void urine in a ligase chain reaction assay. J Infect Dis 1999;170:1308-11. CMO 1998 Chief Medical Officer. Main report of the Chief Medical Officers Expert Advisory Group on Chlamydia trachomatis. London: Department of Health , 1998. Dixon L, Pearson S, Clutterbuck DJ. 2002 Chlamydia trachomatis infection and non-gonococcal urethritis in homosexual and heterosexual men in Edinburgh. Int J STD AIDS 2002;13:425–6. D of H 2002 (I) Department of Health. The national strategy for sexual health and HIV: implementation action plan. London: DoH, 2002. D of H 2002 (II) Department of Health. Action plan for the sexual health strategy for England. London: DoH, 2002 Duncan B, Hart G. 1998 Screening for Chlamydia trachomatis: a qualitative study of womens views. Prevenir 1998; (suppl 24): 229. Duncan B, Graham Hart, Anne Scoular, and Alison Bigrigg 2001 Qualitative analysis of psychosocial impact of diagnosis of Chlamydia trachomatis: implications for screening BMJ, Jan 2001; 322: 195 – 199 EHC 1999 Effective Health Care. Getting evidence into practice. York: University of York, 1999. Fenton KA, Korovessis C, Johnson AM, et al. 2001 Sexual behaviour in Britain: reported sexually transmitted infections and prevalent genital Chlamydia trachomatis infection. Lancet 2001;358:1851–4. Griffiths C, Cuddigan A. 2002 Clinical management of chlamydia in general practice: A survey of reported practice. J Fam Plann Reprod Health Care 2002;28:149–52. Grun L Julia Tassano-Smith, Caroline Carder, Anne M Johnson, Angela Robinson, Elizabeth Murray, Judith Stephenson, Andrew Haines, Andrew Copas, and Geoffrey Ridgway 1997 Comparison of two methods of screening for genital chlamydial infection in women attending in general practice: cross sectional survey BMJ, Jul 1997; 315: 226 230 Haddix AC, SD Hillia, WJ Kassler. 1995 The cost effectiveness of azithromycin for Chlamydia trachomatis infections in women. Sexually Transmitted Diseases 1995 22:274-80. Harry T, Saravanamuttu K, Rashid S, et al. 1994 Audit evaluating the value of routine screening of Chlamydia trachomatis urethral infections in men. Int J STD AIDS 1994;5:374–5 Holgate HS, Longman C. 1998 Some peoples psychological experiences of attending a sexual health clinic and having a sexually transmitted infection. J R Soc Health 1998 Howell MR , TC Quinn, CA Gaydos. 1998 Screening for Chlamydia trachomatis in asymptomatic women attending family planning clinics. Annals of Internal Medicine 1998 128:277-84 HPA 2003 Health Protection Agency, SCIEH, ISD, National Public Health Service for Wales, CDSC Northern Ireland, UASSG. Renewing the focus. HIV and other sexually transmitted infections in the United Kingdom in 2002. London: Health Protection Agency, 2003 Kinn S, Macnaughton J, Noone A, et al. 2000 Chlamydia trachomatis in primary care: knowledge and practice in Glasgow. Br J Gen Pract 2000;50:214–15 Kufeji O, R Slack, J A Cassell, S Pugh, and A Hayward 2003 Who is being tested for genital chlamydia in primary care? Sex. Transm. Inf., June 1, 2003; 79(3): 234 236. Lea AP, HM Lamb. Azithromycin. 1997 A pharmacoeconomic review of its use as a single-dose regimen in the treatment of uncomplicated urogenital Chlamydia trachomatis infections in women. Pharmacoeconomics 1997 12:596-611. Legge. A 1997 Nurse prescribing is a success BMJ, Feb 1997; 314: 461. Lossick JG, et al. 1996 Recommendations for the prevention and management of Chlamydia trachomatis infection, 1996. MMWR 1996;42:1-37. Oakeshott P, Kerry S, Hay S, et al. 1998 Opportunistic screening for chlamydial infection at time of cervical smear testing in general practice: prevalence study. BMJ 1998;316:351–2. Pierpoint T, Thomas B, Judd A, et al. 2000 Prevalence of Chlamydia trachomatis in young men in north west London. Sex Transm Infect 2000;76:273–6. Pimenta JM, Catchpole M, Rogers PA, et al. 2003 Opportunistic screening for genital chlamydial infection. II: Prevalence among healthcare attenders, outcome, and evaluation of positive cases, Sex Transm Infect 2003;79:22–7 Radja N, Slatter E, Thin N, et al. 2001 A tale of 2 cities: a comparison of demographic details, source of referral, spectrum of infection and contraceptive practice in patients under 16 years attending genitourinary medicine clinics in London and Swansea. Int J STD AIDS 2001;12:361–4. Sackett, (1996). Doing the Right Thing Right: Is Evidence-Based Medicine the Answer? Ann Intern Med, Jul 1996; 127: 91 94. Santer M, Warner P, Wyke S, et al. 2000 Opportunistic screening for chlamydia infection in general practice: can we reach young women? J Med Screen 2000;7:175–6. Shefras J, Edmondson S, McNulty C. 2002 Countywide survey of the current practice of chlamydia detection in primary care. J Fam Plann Reprod Health Care 2002;28:145–8. Stephenson J, Carder C, Copas A, et al. 2000 Home screening for chlamydial genital infection: is it acceptable to young men and women? Sex Transm Infect 2000;76:25–7. Stokes T. 1997 Chlamydia infection in UK family planning clinics. Br J Fam Plan 1997;23:47–50. Stokes T, Bhaduri S, Schober P, et al. 1997 GPs’ management of genital chlamydia: a survey of reported practice. Fam Pract 1997;14:455–60 Stokes T, Mears J. 2000 Sexual health and the practice nurse: a survey of reported practice and attitudes. Br J Fam Plann 2000;26:89–92 Wilson JS, Honey E, Templeton A, et al. 2002 A systematic review of the prevalence of Chlamydia trachomatis among European women. Human Reproduction Upda

Spike Lee Essay -- Biography, Shelton Jackson Lee

Shelton Jackson Lee was born in Atlanta, Georgia March 20, 1957. Born to teacher Jacqueline Carroll and jazz musician William James Edward Lee, Shelton grew up in Brooklyn, New York where he was provided with a rich cultural upbringing that included plays, movies, and music (Gale 1). At a young age, Lee was nicknamed â€Å"Spike† by his mother who noticed his rough nature and the nickname stuck well into his adult life. He attended Morehouse College in Atlanta, Georgia where he gained an interest in film and then graduated with a Bachelors degree in Mass Communication. Lee went on to attend New York University’s Tisch School of the Arts where he created his first student film and graduated in 1982 with a Master of Fine Arts in Film and Television. Being one of the few black students to attend Tisch School of the Arts, the aspiring filmmaker’s first year at New York University was a particularly difficult one. Lee’s experiences, race, and upbringing have al l led him to create controversial films to provide audiences with an insight into racial issues. Spike Lee’s first student production, The Answer, was a short ten minute film which told of a young black screenwriter who rewrote D.W. Griffith’s The Birth of a Nation. The film was not well accepted among the faculty at New York University, stating Lee had not yet mastered â€Å"film grammar.† Lee went on to believe the faculty took offense to his criticisms towards the respected director’s stereotypical portrayals of black characters (1). For his final film project, Lee wrote, produced, and directed Joe’s Bed-Stuy Barbershop: We Cut Heads. The film won him the 1983 Student Academy Award for Best Director and the Lincoln Center chose the film as its first student production. The film was lo... ...d violence (Biography 1). While black oriented films have veered away from racism and focused more on humor and sex to attract the new younger audience, Lee has continued to focus on racial issues, keeping the door open for other directors to follow. One of the most original, innovative, and without a doubt controversial filmmakers in America, Lee admits he has been blessed with the opportunity to express the views of black people who otherwise don’t have access to power and media (IMDb 4). Lee uses this motivation coming from his passion of being able to express the views of many, along with Malcolm X himself and his philosophy that blacks need to build their own economic base, to continue contributing to Hollywood (Gale 4). There is no doubt that Spike Lee will continue to find ways to impact audiences with his controversial actions, statements and racial films.

Causes of the American Revolution Essay -- American War for Independen

The American Revolution was a dramatic change in the political, social, and economic system of New England. It was not a bloody revolution; on the contrary it is unique because it was not as violence as other revolutions we know (French, Russia and China). The American Revolution had many causes. Long-term social, economic, and political changes in the colonies before 1750 provided the basis for an independent nation with representative political institutions. More immediately, the French and Indian War (1754-1763) changed the relationship between the colonies and the Mother land. Finally, a decade of conflicts between the British government and the colonists that began with the Stamp Act in 1765, led to the outbreak of war in 1775 and the Declaration of Independence the 4th of July of 1776. There are both precipitating and underline causes for the revolution. The precipitating causes are the dramatic change in the circumstances like the end of the Seven-Year War (1754-1763) against the French and Indians. From this day this two groups were not a threat anymore. However, the colonists had to pay for the war England had fought and almost immediately the Parliament started levying taxes over the colonies. The colonists perceived a dramatic treat to their liberties coming from the English monarchy, a perceived for uncheck power. They agreed to pay taxes if they had a representation in the Parliament. The underline cause of the revolution was the increasing demand of in...

Werner Heisenberg and the Heisenberg Uncertainty Principle :: Physicist biography Heisenberg Essays

Werner Heisenberg and the Heisenberg Uncertainty Principle Werner Heisenberg, born in the dawn of the twentieth century became one of its greatest physicists; he is also among its most controversial. While still in his early twenties, he was among the handful of bright, young men who created quantum mechanics, the basic physics of the atom, and he became a leader of nuclear physics and elementary particle research. He is best known for his uncertainty principle, a component of the so-called Copenhagen interpretation of the meaning, and uses of quantum mechanics. Through his successful life, he lived through two lost World Wars, Soviet Revolution, military occupation, two republics, political unrest, and Hitler’s Third Reich. He was not a Nazi, and like most scientists of his day he tried not to become involved in politics. He played a prominent role in German nuclear testing during the World War II era. At age twenty-five he received a full professorship and won the Nobel Prize in Physics in 1932 at the age of thirty-two. He climbed quickly to the top of his field beginning at the University of Munich when his interest in theoretical physics was sparked Heisenberg was born the son of August Heisenberg in WÃ ¼rzburg, Germany on December 5, 1901. August Heisenberg was a professor of Greek at the University of Munich. His grandfather was a middle-class craftsman who’s hard work paid enough to afford a good education for August Heisenberg. The successfulness of August Heisenberg allowed him to support his family well. The professorship at the University of Munich put them in the upper middle-class elite, and was paid three times the salary of skilled workers. Through his life Werner Heisenberg was pestered with health problems. At the age of five, he nearly died with a lung infection which helped him get a little preferential treatment from his parents. During his early years, Werner was in constant competition with his brother Erwin which caused friction. The Heisenberg family were accomplished musicians. Every evening they would sit and practice together. August was on the piano, Erwin played the violin, and Werner played the cello. Their mother insisted that she had no musical talent as an excuse to not be involved in the male competition. Later Werner also learned the piano and used his musical talents as a social vehicle during the course of his life. This manly competition carried out in many other activities in the house. Werner Heisenberg and the Heisenberg Uncertainty Principle :: Physicist biography Heisenberg Essays Werner Heisenberg and the Heisenberg Uncertainty Principle Werner Heisenberg, born in the dawn of the twentieth century became one of its greatest physicists; he is also among its most controversial. While still in his early twenties, he was among the handful of bright, young men who created quantum mechanics, the basic physics of the atom, and he became a leader of nuclear physics and elementary particle research. He is best known for his uncertainty principle, a component of the so-called Copenhagen interpretation of the meaning, and uses of quantum mechanics. Through his successful life, he lived through two lost World Wars, Soviet Revolution, military occupation, two republics, political unrest, and Hitler’s Third Reich. He was not a Nazi, and like most scientists of his day he tried not to become involved in politics. He played a prominent role in German nuclear testing during the World War II era. At age twenty-five he received a full professorship and won the Nobel Prize in Physics in 1932 at the age of thirty-two. He climbed quickly to the top of his field beginning at the University of Munich when his interest in theoretical physics was sparked Heisenberg was born the son of August Heisenberg in WÃ ¼rzburg, Germany on December 5, 1901. August Heisenberg was a professor of Greek at the University of Munich. His grandfather was a middle-class craftsman who’s hard work paid enough to afford a good education for August Heisenberg. The successfulness of August Heisenberg allowed him to support his family well. The professorship at the University of Munich put them in the upper middle-class elite, and was paid three times the salary of skilled workers. Through his life Werner Heisenberg was pestered with health problems. At the age of five, he nearly died with a lung infection which helped him get a little preferential treatment from his parents. During his early years, Werner was in constant competition with his brother Erwin which caused friction. The Heisenberg family were accomplished musicians. Every evening they would sit and practice together. August was on the piano, Erwin played the violin, and Werner played the cello. Their mother insisted that she had no musical talent as an excuse to not be involved in the male competition. Later Werner also learned the piano and used his musical talents as a social vehicle during the course of his life. This manly competition carried out in many other activities in the house.

Equal Employment Opportunity Commission Essay

Through the years, America has made an overall improvement in eliminating discrimination, inequality and slavery and focusing more on inclusion, equal rights, and equal opportunity. Despite a considerable improvement, there are corporations and individuals that often revert to archaic means of treating employees, creating hostile environments. Consequently, different advocacy groups and laws still remain in effect and continue to evolve to protect the citizens and non-citizens of the USA. Overview of the EEOC’s Function  One particular group that exists to protect the employee is the Equal Employment Opportunity Commission (EEOC). The EEOC â€Å"is responsible for enforcing federal laws that make it illegal to discriminate against a job applicant or an employee because of the person’s race, color, religion, sex (including pregnancy), national origin, age (40 or older), disability or genetic information. (Overview, para. 1)† The EEOC is committed to holding employers accountable for benefiting from the modern day enslavement of workers from other countries. Their job is to ensure that all workers foreign and those of the U. S. , are protected under the law and have the right to complain of such employment abuses which damage the foundation of our society. Compliance Issue and Lawsuit Background The article I chose involves a US company that trafficked over 200 Thai males to work for Global Horizons, Inc. , a Beverly Hills based farm labor contractor working alongside eight farms between 2003 and 2007. The individuals were falsely informed that they would have access to high paying jobs with temporary visas allowing them to live and work in the US. Once here, the individuals realized this was a lie and quickly experienced harassment, abuse, intimidation, and unequal pay. The employers threatened to deport them if they complained of the mistreatment. In addition, the employees were forced to live in housing infested with rats and insects (Carter, 2011). They were forced to sleep in tight quarters and some didn’t even have a bed. The Thai workers had all of their identification removed from their possession; the employees were left defenseless. Eventually, the Thai Community Development Center of Los Angeles brought victims to the EEOC to file charges of discrimination. The EEOC argued that Global Horizons engaged in a pattern or practice of national origin and race discrimination, harassment, and retaliation, which violates Title VII of the Civil Rights Act of 1964 (EEOC, 2011). The EEOC sought back pay, compensatory and punitive damages on behalf of the victims, as well as injunctive relief intended to prevent further abuses at the companies and farms. This would uncover the cruel actions by Global Horizons and the farms for which they were employing these individuals. These farms, such as Del Monte Fresh Produce and Green Acre Farms, suffered reputation scrutiny and possible loss of profit after such discoveries. The EEOC’s Role The EEOC’s role in this lawsuit was to hold the employer accountable for benefiting from modern day enslavement so that companies could be aware of the ramifications of conducting such business. The EEOC first attempted to reach a pre-litigation settlement, and then filed the lawsuit in the U. S. District Court for the District of Hawaii. After no success, the EEOC quickly filed lawsuits in the U. S. District Court for the District of Hawaii and the U. S. District Court of the Eastern District of Washington. Social Impact This type of lawsuit promotes social change by making companies aware of the repercussions expected if such behavior is conducted in the United States towards citizens or non-citizens. Human trafficking is a modern day form of slavery and while it still continues to exist in modern business America, it is imperative that companies are made aware of the consequences they may subjected to should they choose to engage in such tactics. These types of lawsuits also promote healthy laws and advocate groups pushing for tougher laws so that employers cannot get away with such atrocities. It also makes employees aware of similar environments where they can quickly recognize if they find themselves in similar situations and who to go to for help. Businesses will do whatever it takes to make higher profits and quite often, they turn to illegal conduct thinking they may get away without consequence. Article Comparison In reviewing my article, I also compared it to an article from the internet published by CNN. Both articles seemed to have similarities by providing the same details and information as discussed in the EEOC article. After searching through several other articles, most included the same information as that provided by the EEOC. Management Perspective If I were a senior manager of Global Horizons, Inc. I would place tighter requirements upon hiring individual to conduct the contracting work. I would consider placing those individuals in the contracting positions in training classes to make them aware of what to do in the event they are faced with this type of situation. Because of the nature of the business involving labor work, I would enforce tighter regulations, initiate reviews, monitoring and would become more involved to avoid mistreatment of individuals. Managers and supervisors would be required to attend courses that stress inclusion, diversity, and harassment. All other employees would be required to attend the same courses, but these courses would also include information on how to report violations. Conclusion I believe that members of management from Global Horizons chose to keep quiet to reap the benefits of cheap labor. There is no excuse to have such behavior in today’s society after all the issues we have all faced as a country. Some improvement has been achieved but it is evident that there is more to be accomplished. Thanks to groups such as the EEOC, citizens and non-citizens can rest assured that there is protection available in the event of mistreatment.

Employee Engagement Essay

Designed to ensure that the employees maintain their royalty towards the organization, and commits towards the objectives of the enterprise to ascertain the success of the company and at the same time works towards achieving a sense of well being, employee engagement is all about creation of the conditions in which employee ensure to deliver the best of their capability and potential. The behavior that are focused through employee engagement: Inspire employees to higher levels of effort: Only the engaged organizations will have the strong and genuine values along with clear proof of trust and fairness which is completely based on the mutual respect and two way promises and commitments. This ensures fulfillment of the objectives. The first is the ‘participation’ that instills the traditional HR values including the communication between the staff and the managers across departments in the organization. This includes the training, identification, feedback on the performance, career planning and developing own skill sets. Energize employees to achieve exceptional results: The leaders of the organization must express that they value their employees. Employee related activities like the profit sharing and implementing a work life balance helps in energizing the employees that helps them perform to the optimal levels. De-motivated employees fail to perform and fulfill the objectives of the company. Create an atmosp here of continual improvement: Progress is dependent on various factors and of them, the work atmosphere is one of the most important. If it is not conducive to the work process, the employee will fail to deliver optimal results. Get employees to stretch for goals that go beyond what they originally thought possible: It is important that employees are constantly motivated and only with that will they be able to go beyond what was originally thought to be achievable. The meaning of employee engagement: The first person to define the term is William Kahn who told that engagement involves harnessing of the employee to designated work roles in the company. Other than this, there was a definition by Schimdt who resolved employee engagement as the involvement, commitment and satisfaction with the designated work. There is no proper definition to the term. Employee engagement and manager behavior Depending on the employee and the organization, there are differences in the attitude, behavior and outcomes. This also affects the overall outcome. Even if the employee feels proud and loyal, it is very important to maintain a dynamic role in the enterprise. According to this, the accidents are lowered and there are lesser conflicts, higher productivity and reduced sickness. Engagement occurs in two ways, organizations must work to engage with the employee, who also in turn reinforces the other. With this, the employee feels satisfied leading to higher organizational commitment, job satisfaction and feelings of empowerment. In spite of all this, there is a debate about the precise meaning of the employee engagement but what is understood, is that it is achievable, measurable, correlated with performance, and it varies from poor to great. Reference: http://classof1.com/homework-help/human-resource-management-homework-help