Quiz Coursework Example | Topics and Well Written Essays - 500 words - 4

Quiz - Coursework Example consumption behavior, tastes and preferences, and change behavior. The model is action oriented and is mainly used by marketers in order to improve the presence of the business in the market. Matrix Model-In economics, matrix model is a reflection of various interrelationships between different economic elements. The model brings together into a single table the balance of output distribution and that of inputs for better analysis. Virtual Model-It is a digital description of a physical object. The model is mainly used in creation of 3D features for the purpose of virtualization. This is mainly used in the film industry and architectural sector. Focus group-It is a strategy used in qualitative research which entails identifying a specific group of study to be analyzed over a specified period of time. The researcher uses the group to study their behavior, perception, or any other topic of study. On-the-job training-It is training that takes place in the normal working situation. It entails one person showing the other on how to complete a specific task more effectively. It is also referred to as direct instruction. Apprenticeship-It is a form of training the new generation of practitioners which occurs in the normal working environment. It occurs while one is working for an employer who helps the trainee (apprentice) to learn new skills. Behavioral Modeling-It is an approach to control theory which aims at reducing inconsistencies. Of importance to note about the approach is that it does not differentiate between input and output variables. Cultural diversity-It is having various cultures which respect each other’s differences. It is having different people who emanates from different cultural backgrounds but tolerates each other’s cultural aspects. Diversity Training-It is an instructional course that aims at increasing people’s awareness on diverse

Key Components in the Leisure and Recreation Industry Essay Example for Free

Key Components in the Leisure and Recreation Industry Essay Recreational activities fall into six key components, which in turn are divided into sectors. Some activities will fit into more than one category, and other activities are hard to put into any category, such as bridge clubs- are they a sport or a home based leisure activity ? The main components are: * Arts and Entertainment * Home-based Leisure * Countryside recreation * Catering * Heritage and visitor attractions * Sports and physical recreation Arts and Entertainment This is a huge industry that includes many sectors, they are: Arts The arts, apart from commercial cinema and theatre is a precarious industry where losses are easily incurred due to high costs and a very fragmented market. Sponsorship and grants play an important part in these. The public sector plays the most crucial part in funding arts. At the top is the Arts Council, which in 1999 gave out à ¯Ã‚ ¿Ã‚ ½188 million in grants. Much of this came from the National Lottery. Some of it was given out to Regional Arts Boards who then fund local projects. Much of the grant aid is given directly to organisations or individuals. The Arts Council is not the only national public sector organisation to be involved in the arts. One important group is The British Film Institute (BFI) which is responsible for supporting film makers, and the promotion of the British film industry. Local authorities play an important role as well. They employ arts development officers who promote the arts locally and will support local artists. Some larger authorities employ established artists in residence, who work in the area promoting their art and creating commissioned pieces. Local Authorities are major providers of galleries and performance space such as town hall stages or community theatres or even parish halls. In some cases, such as the Lyric Theatre at Hammersmith, London is a part owner of a commercial theatre. Voluntary sector groups also contribute to this sector. Many trusts exist to develop minority arts or provide for specialist audiences. For example, Wolf and Water in Devon is a drama trust dedicated to working with people with special needs. Entertainment Classified as entertainment are popular performing arts and spectacles. The voluntary sector is important here as nationwide participation in amateur dramatics and music is a popular pursuit. Public provision is also evident but has changed in recent years. Thirty years ago most town halls and civic entertainments programme of films, theatre and musicals. This has largely disappeared now and has been replaced by events programmes that are organised by various departments. For example, many sports centres will host travelling theatre and ballet companies such as the Royal Exchange Theatre Group, while arts officers will book in tourism exhibitions. In the streets and parks outside, groups are invited to put on events such as the hot-air balloon events in Bristols Parks. It is the private sector that monopolises entertainment. There is a flourishing small-business sector that includes pub entertainments and single artists such as party and street entertainers, but the bulk of the market is contained within three areas: 1.cinemas 2. Theatre 3. Stadia/arenas Cinema-was very popular in the first half of the 20th century. Then when colour televisions and video players appeared cinemas started to lose there appeal to the public. Cinema companies were not refurbishing their buildings, most of which were built in the 1930s, and were finding profit by selling them off as bingo halls. Some survived by aiming at niche markets(e.g. Corner House in Manchester). These art house cinemas show foreign films. The main market is for commercial English-language films. In the 1980s there was a major review of how films were presented. This resulted in multiplexes being invented. They are equipped with the following features: * Modern luxurious buildings with high-quality projection and sound * Multi screens to show move films than one * Easy access often at out-of-town centres * Good customer care The closest multiplex cinema around is the Warner Brothers Village in Longwell Green. This complex has all the features shown above Theatre-the London theatres are highly profitable with a city audience and a huge tourist market. Even then, they increasingly stick to a formula of musicals or familiar plays with big name actors. For example Chitty Chitty Bang Bang was shown at Londons Palindrome with Michael Ball starring in it. The package largely consists of touring West End shows, nostalgia and tribute bands, comedians and spectacles like circus and ice shows. The main London Theatre companies are: * Delfont Mackintosh Theatres * Ambassador Theatre Group * Really Useful Theatres * SFX (Apollo) Apollo leisure is the leading national chain Arenas and Stadia- these are large multi-purpose buildings for very large audiences. Arenas(indoor) for example are likely to put on conferences and trade exhibitions as well as concerts, while stadia(outdoor) are designed especially for sport. An example of a stadia is Ashton Gate home to Bristol City Football Club. Many arenas are owned by Local Authorities or development corporations. Good examples of this are the various halls and centres in Birmingham ,including the National Arena. Sports and physical recreation These activities can be grouped as follows: * Informal recreation(play, walking, gardening) * Competitive sport (football, tennis, golf) * Outdoor activities (sailing, climbing) * Health and fitness (jogging, yoga) Many activities can often be put into more than one category. For example, swimming in the sea is informal, swimming for a club is competitive, swimming in a conventional pool can be seen as health and fitness. Each component has a different profile in the type of facilities and services it produces. Informal physical recreation or exercise- this is the most popular activity nationally. Nobody knows the hours children spend playing or adults spend gardening. We pursue these activities because they are cheap, available and dont require a lot of skill. The enjoyment we get from them often depends on the environment we do them in. Competitive Sport-most people associate sport with the professional game. This means they are spectators, and it is the spectators money that underpins professional sport. Facilities were often run down to the extent that some were dangerous for crowds, e.g. Hillsborough 1989. Providers have found that profits increase when standards of customer care and corporate hospitality are improved. This has led to the building of a new generation of high-class stadia and race tracks and other facilities where the key services are: * Presentation of the core event * Merchandising * Catering * Safety and security Amateur sport is geared around participation and voluntary clubs. As land and buildings are expensive, many clubs use facilities provided by Local Authorities. Many outdoor sports clubs have their own facilities although there is an even greater number of players who use recreation grounds. There are about 78,000 pitches in the country. Thirty years ago amateur sport was largely centred on outdoor team games. Competitive sport means participation and developing skills and there is a sizeable industry for coaches and instructors. Despite its profile, competitive sport is on the decline and organisations like Sport England are concerned that as a nation we are losing our sporting skills and becoming less fit and healthy. For example, many governing bodies have big school-based programmes, and Local Authorities will run schemes in deprived areas where people cannot afford to play sport or go to health suites. Outdoor Activities-there are over a thousand centres in the UK which specialise in providing outdoor adventure holidays. Facility provision is also essential for outdoor sports, meaning the upkeep of the environment, and this is regulated by the organisations under the Countryside Agency umbrella, such as the Forestry Commission, Local Authorities or National Trust. For most participants activity in the natural world is occasional, and more time will be spent in training in built facilities such as pools or climbing walls. Profitable areas such as skiing, sailing, private sector companies are the main providers. Health and Fitness- there are now at least 2,500 private health and fitness clubs in the UK- it is a boom industry that many young people see as the exciting place to work in leisure. Private sector will increasingly dominate the market and eventually also manage and invest in public sector facilities on behalf of Local Authorities. The central product of these clubs is the fitness room consisting of cardiovascular equipment and perhaps free weights, and frequently areas with small pools, jacuzzis and saunas.. Heritage and visitor attractions The heritage industry concerns buildings and materials that have historical value. Thirty years ago these were largely stately homes, castles, ruins such as Stonehenge and battlefields. Heritage was often about how the rich and famous had lived or what they had collected, or about culture(e.g. Shakespeare). Now it has expanded to include a much wider interpretation of historical value. Whether the attraction is a theme park or museum, the organisers will do their best to employ all the techniques of facility management to look after the customer and make the product interesting. In a theme park the excitement of the rides is a key feature and bringing new and more exciting rides brings in more customers. The difference between a visitor attraction and a heritage site is that the latter involves considerable work behind the scenes which the public never sees. The most popular tourist attractions are: * Museums and galleries- British Museum * Theme parks- Blackpool Pleasure Beach * Historic houses and monuments- Tower of London * Wildlife parks and zoos- London Zoo Many heritage sites are owned by Trusts and limited companies that have been set up to manage individual sites, while many stately homes are owned and run by two big organisations: * English Heritage- is the national body responsible for the management, promotion and conservation of 400 archaeological sites and the historic environment * The National Trust- is a trust set up in 1895 to preserve places of historic interest or natural beauty. Its sites include a range from Paul McCartneys teenage home to stately homes like Waddesdon Manor Museums-are not usually run by the private sector, largely because of high costs. Many museums started life as private collections which were later donated to the nation or the local community. Libraries-apart from their lending their services which we will look at later, they are largely involved in the heritage sector. They have a back-room role of collecting important documents including maps, and making these available to the public. This is known as the records and archives service. Catering Leisure catering includes pubs and clubs, restaurants, cafes and takeaways. Its firmly placed in the private sector with some exceptions. A catering company provides a service according to the specification of the client and often under the clients name. Many leisure centres and theatres buy in service in this way. The catering sector has various components that make eating out an enjoyable experience: the provision of food and drink; entertainment, such as jazz at Pizza Express, games; and security in the form of door staff. Eating out is an increasingly important and available leisure experience. The fast-food business is booming with a growth rate of 30 per cent. This growth is at the expense of takeaways and cafes, and especially of pubs and clubs. Fast food tends to be run by chains that can make economies of scale by producing the same product in each outlet. Many breweries have followed this trend and operate chains like Harvester restaurants within their pubs. In contrast cafes, restaurants and takeaways tend to be run and owned by family businesses. Countryside recreation The countryside is the natural, national playground and one which is used by walkers, ramblers and those involved in more active outdoor activities. A survey in 1998 by the National Centre for Social Research showed that 1,427 million day visits to the countryside were made and a further 241 million to the coast. Like any leisure facility such usage will have an impact which in turn will lessen, and even threaten, the leisure experience itself. Organisations working in countryside recreation are therefore primarily stewards who maintain, manage and regulate the environment and also produce information and education. An important organisation funded by the Countryside Commission is the National Parks Authority. This is responsible for the regulation and interpretative service inside twelve National Parks, which are designated areas of significant natural beauty and wilderness. The Local Authority has a part to play in managing and regulating country parks. In many cases it also owns the land and will act as landlord to any tenants in the park, such as farmers. Home-based leisure This is cheap, easy and relaxing. The equipment most popularly used are: radios, videos, TV sets, gardening materials and home fitness machines is normally provided by the private sector. The main exceptions are the library lending services in the public sector. Except for broadcasting this component is retail based. As the internet is more widely used, shopping for leisure on the net is likely to increase. Free services like Tesco mean more people are using the net.

Rome, Italy :: essays research papers

My Trip to Rome, Italy I had learned I was being sent to Italy in March of 2000 for a machine tool exhibition. I found out the happy news just before leaving work. Excitedly I jumped into my car and started my journey home. As I drove home down I-95 through all of the usual evening traffic I just kept thinking about ho I was going to tell my husband we were going to Italy. That night I continuously paced the floor looking out of my bedroom window to see if my husband was home from work yet. As he drove up in our driveway I ran outside to tell him the good news. I said, â€Å"Nick guess where we are going in March?† Before he could even say where I yelled out â€Å"Italy†! Italy, he said with a puzzled look on his face. I then explained the situation with work and said to him since if I have the opportunity to go I thought it would be a great idea for you to come along with me. I suggested scheduled some time before the show for the two of us to travel around Rome. Later that night it was sett led we would schedule a couple of days to tour Rome before the exhibition. It seemed like forever before we would finally be on our way, but then before I knew it we were on the airplane and the flight attendant is announcing fasten your seatbelts and prepare for landing into Leonardo da Vinci airport.   Ã‚  Ã‚  Ã‚  Ã‚  After arriving at the airport we had to transfer to a train that would take us to the city center. It was about a 30-minute train ride. Along the ride I was getting my first look at Rome, mostly the colorful countryside with the rows of sunflowers that were so splendid with bright yellow centers, and green leaves that were so full of life. Just pass the beautiful field of sunflowers was a small farmhouse made of stone. You could see the smoke coming out of the chimney and the farmers working their land. Upon arriving at the main train station, â€Å"Stazione Termini† in Italian, the excitement was building I couldn’t wait another minute to see all the sites of Rome. The Colosseum, The Roman Forum, and the Vatican were tops on my list, and with only a couple of days to site see there wasn’t any time to waste.

Public v. Private Life Essay

In Milan Kundera’s book, Testaments Betrayed, he contends that people act very differently when they are in public compared to their private lives. Milan appropriately emphasizes the need for separation between one’s public and private life, and asserts that the real criminals are the ones who attempt to break that boundary. Logically, people will say and do things when they are alone that would be beyond the realm of appropriate behavior when they are in public. Therefore, I agree with Kundera’s claim that the curtain between these two worlds should not be tampered with and that the curtain-rippers are the actual offenders. There are many times where national chaos and embarrassment has been created through people meddling in the private lives of other people. For example, the paparazzi are constantly trying to expose the personal experiences of countless celebrities. Recently they succeeded with the infiltration of the universal picture-messaging application, Snapchat, as well as Apple’s coveted web-based storage facility, the iCloud. These hackers were able to obtain numerous explicit photographs of renowned actresses, including Jennifer Lawrence and Victoria Justice, and distribute them for the world to see. This is extremely embarrassing to those women and, much to their chagrin, those pictures meant for somebody close and important to them are now being hungrily consumed by the eyes of some 12-year old kid on their laptop. Since this barrier between private and personal life was broken by meddlers, these celebrities are now viewed as indecent, and have lost much of the admiration they had before the incident. How could the exposure of one’s private life to the entire world possibly be considered just? These ladies did nothing wrong, yet they are harshly criticized for their actions because somebody wanted to interfere in their private lives. This incident clearly demonstrates that the insatiable paparazzi, not the innocent celebrities, are the true criminals here. Our nation’s history also holds many instances of interferers meddling in the private lives of our elected officials. One such example would be Bill  Clinton’s affair with Monica Lewinsky. Yes, he did cheat on his wife, but was it really fair to let the entire world know that he did that? When the government was informed about the situation, the president’s unfortunate predicament was broadcast to the entire nation. The situation escalated to the point of unjustified impeachment hearings, but fortunately Clinton was acquitted by the Senate. Clinton nearly lost his beloved wife and his job because his private life was exposed by those who had no right to be sticking their noses into his personal affairs. The peeping Toms that yanked open the curtain between Clinton’s actions backstage and his affairs in the public’s spotlight completely ruined Clinton’s life. If these felons hadn’t intruded, Clinton would have been spared a world full of ignominy and embarrassment. Therefore, it is indisputable that the ones truly at fault are the criminals who exposed Clinton, because his lives, both private and public, were devastated by their irresponsible actions. In summary, past invasions of privacy have shown that many negative effects may result from such rash and unprovoked actions. It is therefore only just and proper that the steel grate between one’s private and public lives remain forever and eternally sealed.

The Crucible’ by Arthur Miller: A Summary

?Ben O'Connor Mr. Richards English 10 January 11th, 2009 -Crucible Essay- The Crucible written by Arthur Miller was a story in which takes place in a town called Salem, Massachusets. This story was directed towards the topic of the witch trials of 1692 and how the people were effected by the deaths and horrific torture treatments. The Crucible portrayed the perfect description of how the time of witch trials were so curropt and unfair. In this time if someone were to blame another person of something then the person blamed would immediatly be guilty and thrown in Jail or hung. Is Salem many people tried accusing people of different crimes so that they could gain power aswell as land. Thomas Putnam was greedy for land because more land meant more power. Thomas Putnam had giles killed because he wanted his land, so he simply acused him of something which would result in his death from â€Å"pressing†. Also in the text a woman named Abigail Williams loves a man named John Proctor however John is married, so Abigail accuses Johns wife Elizabeth of being in the precense of the devil. This in the mind of Abigail this will bring her and John closer togather however it only makes things worse. As many will see this time in Salem was a very terrible time and from 1692 to 2010 we have come a long way in our nation wide governmental system. In this time period there were many people accusing others of crimes so they could gain land, covet their neighbors wifes, or husbands, and much more. A man named Thomas Putnam was a greedy man and was hungry for land. Putnam rode to the farm of Giles Corey and told him that a section of GIles property was his. Of course Giles objected to this statement, and Putnam rode off. Thomas Putnam then accused Giles of a crime that would have him killed. Giles is brought in and he states â€Å"Thomas Putnam is reaching out for land. † pg. 84. however no one believes this statement and GIles is soon killed by the torture treatment called â€Å"pressing†. Fair trials in this town are completly absent and when someone is accused of something serious the odds of them being successful are very slim. During the time period of the witch trials there were not only aqusations dealing with peoples land but there was also conflicts with peoples relationships. Abigail Williams was a women who loved John Proctor however John was married to a women allready named Elizabeth. Abigail tries to seperate John and Elizabeth by accusing Elizabeth of being in the presence of the devil. Mary Warren a close person to Elizabeth and John and she states â€Å"But i said I never see no sign of you ever sent your spirit out to hurt no one, and seeing I do live closley with you, they dismissed it†. g. 59. Even with this strong statement with a women who lives with John and Elizabeth, it is still not enough evidence to keep Elizabeth safe. Abigail desperatly wants Elizabeth gone and out of the way so that she can have John, so she brings along many other women to help her cause and this shows great evidence that Elizabeth is guilty even though she isnt. Abagail's wishes go unanswered, because John ends up being exicuted due to Abigail's actions. Mrs. Putnam was a women who had 7 babies, 6 of which died extremly young. She has only one daughter living and she feels that it doesnt make sense that this many children could die all around the same age, around the same time. Mrs Putnam was sad, however grows angry and searches desperatly to put the blame on someone. â€Å"I knew it! Goody Osbourne were midwife to me three times. I begged you, Thomas, did I not ? I begged him not to call Osbourne because I feared her. My babaies always shriveled in her hands. â€Å". Goody Osbourne is desperate to place the blame on someones sholders, so she is going around and blaming everone she knows. What she did back then which was blame others for her pain i believe still exists for individuals today. Today when an individual has an issue many of them pass the blame to someone els so that they can feel better. The time of the witch trials must have been a horrible time in history, especiall for the innocent victims in the town. The way that the government ran in that time period compared to now have completly changed. In trials now there must be more evidence, and trials are longer for thought process, and time to gather evidence. In 1692 it was as simple as if you were acused of something then you were automatically looked at as bad and guilty and you would soon be thrown in jail or exicuted. The witch trials were a terrible time in history, and many great people died simply because of peoples jealousy, or their greed for land. After this time period America learned a great lesson, that all American Citzens have the full rights to a fair trial. With out fair trials, and strict rules there would be complete a narchy.

Words That Evolved from the Latin Term for Turn

Words That Evolved from the Latin Term for Turn Words That Evolved from the Latin Term for Turn Words That Evolved from the Latin Term for Turn By Mark Nichol A small group of words ending in -volve share an etymological origin of the Latin verb volvere, meaning â€Å"turn,† but they have some cousins whose family resemblance is not obvious. Here are some expected and unexpected words with that ancestor in common. The words that obviously stem from -volve include evolve, meaning â€Å"change,† â€Å"develop,† or â€Å"grow† and its noun form, evolution. That word is most familiar in reference to the scientific theory of change by natural processes over long periods of time, but it can also generically apply to any iteration. The antonym of evolution is devolution, though the word also has a neutral or positive connotation of transfer of rights or responsibilities from a central government to local authorities; the verb form is devolve. To involve is to include or envelop (the noun form is involvement), and to revolve is to turn again; revolution can refer to the repeated turning of an object (such as an engine) or to the overturning of one government in favor of another. A revolver, meanwhile, is a handgun with a rotating cylinder that positions each bullet to be fired in turn. Convolve is a rarely used word meaning â€Å"turn together,† though the noun form, convolution, is sometimes employed to refer to something with intricate turns or curves or, figuratively, something complicated, and the adjective form convoluted is common. Another unusual word, circumvolve, means â€Å"wind or wrap around†; its noun form, circumvolution, is also seldom seen. Words that also ultimately (but not obviously) derive from volvere include vault, the word for an arched or domed structure (and, by extension, any underground or similarly protected chamber), and valve, the name for a device that is turned (or, in the case of musical wind instruments, pressed) to produce a desired result. Volume, the word for a measure of sound, mass, or some other quantity (and, by extension, a collection of content), also stems from volvere, as does voluble, an adjective describing someone who speaks quickly and energetically (though it also refers to rotation), and the noun volute refers to something with a spiral or scroll shape. Volte-face is the French translation, adopted into English, of about-face, meaning â€Å"reversal† or â€Å"sudden change in attitude.† Finally, vulva, the name for the external part of female genitalia, may be related to and even descended from volvere in the sense that it appears to roll away from the vagina or to resemble a wrapper. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Vocabulary category, check our popular posts, or choose a related post below:5 Uses of Infinitives55 Boxing Idioms150 Foreign Expressions to Inspire You

Young Goodman Brown-Allegory and Symbolism

Young Goodman Brown-Allegory and Symbolism Free Online Research Papers Allegory and Symbolism Nathaniel Hawthorne is a nineteenth-century American writer of the Romantic Movement. Hawthorne was born is Salem, Massachusetts, and this is the place he used as the setting for some of his works: such as The Scarlett Letter, the Blithedale Romance and Young Goodman Brown. In writing, Hawthorne was known for his use of allegory and symbolism, which made his stories a joy for everyone to read. Hawthorne was said to be the first American writer who was conscious of the failure of modern man to realize his full capacity for moral growth. His stories contain much about the life he knew as a child being brought up in a Puritan society. As Hawthornes writing continued it was filled with the same amount of sin and evil as his first writings. Evil that was revealed through his works. Young Goodman Brown was said to be one of the best stories ever written by Hawthorne (Adams70). The Marble Faun: and the Scarlett Letter were some of the other stories written by Hawthorne, and they were said to be Young Goodman Brown grown older. In this selection there is a question of maturity for Goodman Brown and whether he is good or evil. There is also a transition from childishness to adolescence to maturity. This short story in particular has a feeling of adultery, betrayal, and deception as in some of his other works. It was said by Richard P. Adams that young Goodman Brown was a germ for nearly all his best work that followed (Adams 71). The use of symbolism in young Goodman Brown shows that evil is everywhere, which becomes evident in the conclusion of this short story. Hawthornes works are filled with symbolic elements and allegorical elements. Young Goodman Brown deals mostly with conventional allegorical elements, such as Young Goodman Brown and Faith. In writin g his short stories or novels he based their depiction of sin on the fact that he feels like his father and grandfather committed great sins. There are two main characters in this short story, Faith and Young Goodman Brown. Young Goodman Brown is everyman seventeenth-century New England the title as usual giving the clue. He is the son of the Old Adam, and recently wedded to Faith. We must note that every word is significant in the opening sentence: Young Goodman Brown came forth at sunset into the street of Sale, Village; but put his head back, after crossing the threshold, to exchange a parting kiss with his young w2ife. She begs him to put off his journey until sunrise, but he declares he cannot. [It] should not escape us that she tries to stop him because she is a similar compulsion to go on a journey herself-She talks dreams, too, Young Goodman Brown reflects as he leaves her. The journey each must take alone, in dread, at night, is the journey away form home and the community from conscious, everyday social life, to the wilderness where the hidden self satisfies or forces us to realize its subconscious fears and prompting in sleep. We take that journey with him into the awful forest. Noting the difference between the town and the forest. We see Hawthorne using the Puritan association of trees and animals. When Young Goodman associates returns to Salem Village, his eyes are opened to the true nature of his fellowmen, that is human nature; he inescapably knows that what he suspected of himself is true of all men Hawthorne has made a dramatic poem of the Calvinist experience in New England. The unfailing tact with which the experience is evoked subjectively in the more impressive concrete terms, is a subordinate proof of genius. I should prefer to stress the wonderful I control of local and total rhythm, which never falters of stackers, and rises from the quest but impressive opening to its poetic climax in the superb and moving finale. Hawthorne has imagin atively recreated for the reader that Calvinist sense of sin, that theory did in actuality shape the early social and spiritual history of New England. But in Hawthorne by a wonderful feat of translation, it has no religious significance; it is as a psychological state that it explored. Young Goodman Browns faith in human beings, and losing it he is doomed to isolation forever (Peabody 331). Young Goodman Brown is the main character and the protagonist, and Faith Brown, his wife is said to be one of the antagonists in this selection. Young Goodman Brown is a husband of three months and is still said to be immature. Brown symbolizes immaturity, goodness, and everyman. He is a very religious person, happy in his marriage, trustworthy and naà ¯ve. Young Goodman Brown is stern, sad, darkly meditative, distrustful if not a desperate man (Adams 72). Brown is said to be naà ¯ve because he goes into this evil forest even though his wife warned him of the danger that he was about to encoun ter. Brown, actually is every man, whether young or old our parents in some way try to protect us form danger and thats just what his mothers ghost was trying to do, but as we all know our fathers pushes us on even if we are going to make a mistake and thats just what his fathers ghost did. This forest represents evil and destruction. There is always an association between forests and evil because of its dark and gloomy nature. That is why the witch meetings were held in the midst of it. Faith was another character in the story; she was the wife of Young Goodman Brown. This young woman is filled with sin yet she is said to be Godly. Because Faith was so honest and Godly, Young Goodman Brown put all of his faith in her, which made heroin of his worst enemies. Faith is said to be a good wife pure and poisonous, a saint and sinner and a pretty pink ribbon-wearing woman. Hoffman writes that Faith is the forest. They both are considered to be evil (Levy 121). Faiths ribbon is a descripti on of her personality or her inner-self. The pink ribbon that Faith wears is a symbol of sin and purities. Faiths ribbon is found in the evil forest and thats when Faith is really seen as an unclear person. Faith is also said to have committed adultery not only against Young Goodman Brown but also against God because she gave in to the likes of the devil. The ribbons provide a continuity between faith as an ideal of religious fidelity and as partner in a witches Sabbath. (Levy 122). The other character in this story was the devil or the other antagonist of Young Goodman Brown. The devil figure has a double function; he encourages and frightens the next candidate up for the evil baptism or damnation. This man is seen as an old person dressed raggedly and considered to be evil in a sense because he is in the forest. He leads Young Brown through the woods with a staff. A staff to some may symbolize Godliness but this one was carved in the shape of a snake, which is associated with evil and sneakiness as in the Garden of Eden. This staff is what Young Goodman Brown carried in to the witch meeting. Even though there were some major characters, there were some flat characters also: Goody Cloyse, the minister, and the deacon. Goody Cloyse was supposed to be the holy lady that taught everyone the catechism but she was just as evil as the forest because she was also a witch. The minister and the deacon were also corrupted and evil. They all were considered to be holy and people of God, but they were just the opposite. Young Goodman Brown was a short story that dealt with the realisms of reality. There was a question asked by the author at the end of the story: was this story a dream or was it reality? Young Goodman Brown at the beginning of this story was a immature, good, loyal, trustworthy, and holy man. He lacked strength, courage, firmness, seriousness, and determination as Puritan should, but at a point in this story he became an adult and matured. The story ended with Goodman Brown becoming a stern, sad darkly meditative, distrustful, if not desperate man. Hawthorne used all the character in this story to prove that good people also contain evil aspects. Research Papers on Young Goodman Brown-Allegory and SymbolismMind TravelThe Masque of the Red Death Room meaningsHarry Potter and the Deathly Hallows EssayHip-Hop is ArtThe Hockey GameThe Fifth HorsemanAnalysis Of A Cosmetics AdvertisementCanaanite Influence on the Early Israelite ReligionNever Been Kicked Out of a Place This NiceWhere Wild and West Meet

5 Examples of Proper Style for Proper Nouns

5 Examples of Proper Style for Proper Nouns 5 Examples of Proper Style for Proper Nouns 5 Examples of Proper Style for Proper Nouns By Mark Nichol A proper noun, also known as a proper name, is capitalized to indicate that it denotes a unique entity or phenomenon. Many entities or phenomena are widely known by their names. Sometimes, however, writers misunderstand or misrepresent the label. Here are five examples of proper nouns that illustrate the importance of verifying precise nomenclature and considering the context in which it is used. 1. Big Ben This is the official nickname, specifically, of the bell in the Elizabeth Tower, the iconic structure often used as a visual shortcut to identifying London in photographs, on television, and in films. (The tower, previously called simply the Clock Tower, was renamed in 2012 in honor of the sixtieth anniversary of Queen Elizabeth II’s reign.) However, popularly, the phrase generally refers to the clock in the tower or the tower itself. 2. Centers for Disease Control and Prevention This US government agency’s official name is the Centers for Disease Control and Prevention, but it retains the initials, CDC, of its previous designation, the Centers for Disease Control; note that the first word is plural. (A similar example is the name of the National Institutes not Institute of Health.) 3. Halley’s Comet The technical name for this peanut-shaped orbiting body roughly the size of a big-league Himalayan mountain is Comet Halley. (actually, 1P/Halley is its astronomy-catalog designation.) Because of its relative familiarity, however, due to unusually frequent reappearances (roughly every seventy-five years), it is also called Halley’s Comet. The traditional pronunciation among astronomers rhymes with alley, but, perhaps as a result of contamination from the name of the seminal rock-and-roll band Bill Haley and the Comets, most laypeople pronounce it to rhyme with daily. (No one knows how discoverer Edmund Halley pronounced his name, but I’d give the odds to the stargazers’ convention.) 4. New York The largest US city is popularly called New York (the official name is â€Å"the City of New York†), but writers should determine whether, depending on the context, it should be referred to as New York City to distinguish it from New York State. (In this designation, and in â€Å"Washington State† so as not to confuse the state with Washington, DC state is capitalized even though it’s not part of the state’s official name.) 5. Sierra Nevada The name of the mountain range forming the backbone of California a name shared by several other ranges throughout the world from the Spanish phrase meaning â€Å"snowy mountains,† should not be pluralized with the letter s, and â€Å"the Sierra Nevada Mountains† is partially redundant. (The same is true of the truncation â€Å"the Sierras†; call it â€Å"the Sierra.†) Many other geographical designations are redundant: Fujiyama translates as â€Å"Mount Fuji†; the words sahara, gobi, and negev all mean â€Å"desert†; and the first word in â€Å"Rio Grande,† as well as Avon and Don the names for rivers in England and Russia, respectively means â€Å"river.† Although it’s not wrong to use the word mount, desert, or river before or after the name of a geographic feature that means â€Å"mountain,† â€Å"desert,† or â€Å"river,† the common noun can often safely be omitted (for example, â€Å"Fujiyama,† â€Å"the Sahara,† and â€Å"the Rio Grande†). Note, too, that river, when it precedes a river’s name (for example, â€Å"the river Nile†), is always descriptive and not part of the name. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Style category, check our popular posts, or choose a related post below:85 Synonyms for â€Å"Help†"Gratitude" or "Gratefulness"?Glimpse and Glance: Same or Different?

CRITICAL SYSTEMS THINKING AND PRACTICE Essay Example | Topics and Well Written Essays - 4500 words

CRITICAL SYSTEMS THINKING AND PRACTICE - Essay Example On the other hand, refugees are persons who would be persecuted within their own countries of nationality on basis of their religion, race, nationality, political stand or opinion or better still membership to a social group (Anon, 2011-12, p. 2). Immigration has been a common practice within the human culture and has been evidenced by the frameworks that have been crafted within government structures of different countries to deal with the feature. Governments acknowledge that there exists immigration into or out of these countries either legally or even illegally and thus the need for regulatory frameworks. Nevertheless, the major concern has been in manning the borders and having clear-cut boundaries between countries. However, there are international human rights that influence government decisions surrounding immigration, which are generally accepted within the international context. Such frameworks are basically meant to cater for refugees and thus covering them and their right s. However, every nation has her foreign policies as decisions that point to the future on accounts of other nations as against her internal decisions. The analysis revolves around the assessment of international as well as internal domestic political and social cultural environment. It also entails setting goals and determining the options on foreign policies regarding the level of porosity in terms of allowing people in as well as out of the country. Of much concern is a problem that has been associated with inclusion as well as exclusion in matters of boundaries in countries. This has been seen to be a critical issue in analysis of critical thinking and practices. This paper therefore intends to evaluate the issue of boundaries and inclusion within the context of Indonesia and Australia. Immigration is a common feature within these countries, though there are guidelines and frameworks that are responsible of regulating the issue within the countries. Moreover, apart from internal regulatory frameworks that govern migration of persons as refugees or even asylum seekers, there are international frameworks that work together for the good of the immigrants. The UNHCR among other UN bodies regulate the issue of migration to other countries of people who pose as refugees or asylum seekers; and thus ensure the proper handling of the persons within international frameworks, which are accented to by international community. Indonesia is a transit country to Australia and offers the cheapest way to refugees or illegal immigrants through the sea. This is because the country is well situated and is the passing point of the immigrants especially those from the Middle East countries, who are headed to Australia for settlement as well as seeking for employment. Indonesia fits transit point because she is made up of many islands and has good entry points through water transport; which proves to be cheap and affordable to the immigrants who in many instances lack enough mon ey for transport through other means. The local anglers and who indulge in the illegal business of ‘smuggling people’ offer transport services to the illegal immigrants

The Decade of the Decline of the Balance of Power Essay

The Decade of the Decline of the Balance of Power - Essay Example It is the democratic situation of the nation that has contributed to this situation as cases like the Executive and the Congress holding different positions such as receiving support from opposing political parties. The privilege doctrine of these branches of the government have proved to be timely and challenging to the judicial branch. Power allocation between coequal and separate government branches has been a major challenge in the last decade in United States. Such power gridlocks have forced the Supreme Court to step in many situations in order to resolve some of the disputes between the different government branches. When it comes to the balance of power between the White house and the Congress, the result is normally a political battle mainly regarding the law thus making such conflicts to spill over to the Supreme Court (Elliot, 2007). The power conflicts among the separate and coequal branches of the government are unavoidable especially in this decade that has been marked by partisan conflicts that have been heightened. The American constitution defines the different powers given to the existing branches of the government but lives some clauses undefined when it comes to the powers dedicated to the government branches thus. This situation is what results to the misunderstandings in the interpretation of the constitution as a means of defining the power balances. For example, the Congress is vested with the power to oversee the activities of the Executive by the constitution in the formulation of its legislation and the appropriation of funds for the executive operations. The imbalance arises when the Executive is also given the power by the same constitution to withhold some of its information regarding its duties as per the constitution. This is because the disclosure of some of the information to the Congress and the entire nation would work against the interests of the nation. However, the constitution still expects the government branches to provide other necessary information without limits. The doctrine of Executive and the Congress are mandated to shield and sought information that are sensitive from disclosure for the sake of the interest of the nation but at the same time making sure that the remainder is disclosed. The consequent of this is that the government branches conflicts force the Supreme Court to reconsider its executive privilege doctrine thus exploring constitutional waters that were unexplored. The last decade has seen a President coming from a party that is different from the party held by the Congress. This scenario has led to unbalanced power between the two resulting to the many conflicts witnessed as a result of the power shifts. The end result is the diminishing of the constitutional concept of the government’s co equal branches (Bickel, 1990). The Suprem e Court is left with the responsibility of resolving such conflicts presented before as stated in the

Dossier, Terrorism Intelligence report Essay Example | Topics and Well Written Essays - 2000 words

Dossier, Terrorism Intelligence report - Essay Example Both Al Qaeda and Jemaah Islamiya are founded on universal Islamic precepts of jihad and brotherhood. Hence, the role of their leaders is secondary to their message. For instance, even when Al Qaeda’s leader in Iraq Abu Musab al-Zarqawi was assassinated, there was no cessation in the local insurgency. Similarly, there is no conclusive evidence that Osama bin Laden is alive, yet the numbers of terror attacks targeted at western interests have seen an unprecedented rise since the events of September 11. Also, the Southeast Asian region is populated by numerous militant Islamist outfits, whose ideologies are nearly the same. The threat posed to Australian interests in Southeast Asia comes from small and marginalized groups who are spread all across the region. Alongside Jemaah Islamiah (JI) in Malaysia, Singapore, and Indonesia; â€Å"we have the Kumpulan Mujahidin Malaysia; and al-Maunah in Malaysia; the Abu Sayaff in the southern Philippines; Pattani United Liberation Organiza tion in southern Thailand; and Laskar Jihad, Majlis Mujahideen, and Islamic Defenders' Front in Indonesia.† Hence the security measures taken by the Australian government should not confine itself to a particular militant entity, but should focus on the broader phenomenon of global Jihad.The present wave of Islamic revivalism and the rise of Islamic fundamentalism across the world originated during the 1970s. The movement started as a reaction to the disillusionment and failure associated with modern neo-liberal economic policies.

Manufacturing Planning and Scheduling Techniques Assignment

Manufacturing Planning and Scheduling Techniques - Assignment Example The company also offers value creation solutions by improving productivity and reducing costs of operation through service solutions such as cutting, custom making, and kitting (Top Cable 1). The initial process of manufacturing a conductor is the process of wire-drawing. This process involves the reduction of the diameter of the copper wire slowly to its final diameter. Wire-drawing process increases conductivity and ductility of the communication cables and wires. The copper wires usually arrive at Top Cable from the foundry in huge coils each measuring 5 tonnes. This copper is known as â€Å"wire rod† in technical terms and measures 8 mm. The wire drawing method performed in these wires takes place in two methods: drawing and further reduction or annealing. Top Cable thereafter takes the wires through wiring stage where the engineers make conductors with differing cross-sections. Top Cable takes the copper wires to the next process of insulation. Insulation involves covering of the conductors to ensure that current leakages do not occur. Top Cable uses different insulation materials depending on the features of the communication cable it needs. The company considers heat resistance and insulation capacity to determine the insulation quality, and the quality of the resultant insulated cables. In some communication cables, Top Cable uses high heat resistant insulation materials to allow the wires from the previous stage to transmit a lot of power as compared to other wires that have low heat resistance. Top Cable adds the insulating material by an extrusion process that involves high temperature. This method ensures that no leakages of current occur. Various materials used in insulation include EPR, PVC, and XLPE. Once the insulation process ends, the manufacturing process subjects the insulated cables to voltage tests to make sure that the layers of insulatio n do not have any fault. Phase

First Contact, or How I had Acquired a Grown-up Friend Essay

First Contact, or How I had Acquired a Grown-up Friend - Essay Example I loved television because it introduced new ideas, new imagery, new places, new people. My parents firmly believed that home should be both the center and periphery of a child’s life and that television is an unhealthy distraction. I was kept busy in the house, or hanging out laundry in the backyard, and television was regulated at one or two hours each month. Consequently, my world stayed very small, for many years. When I came to realize that resistance was futile, I cooperated with my assimilation to this Borg-type collective, in the interest of survival. My longing for unrestricted access to a window was hidden inside me, waiting to be awakened. The day of my awakening was a summer scorcher, I dressed in the shortest shorts and the thinnest T-shirt my mother would allow, and wiggled around on a sticky kitchen chair, staring at my pancakes and syrup, looking for images and the suggestion of something more than here. Eventually, they tired of me and I was dismissed to do ch ores, I watered the potted plants, checked on the slimy avocado pit I was sprouting in the windowsill, straightened up the surfaces of my bedroom, dusted our living room bookshelf and the barely-ever-used television screen, and washed the breakfast dishes. I relieved the washing machine of its load of floral sheets and bath towels, cycled the night before. I had done my homework to its rhythm. They had a faint overnight musty smell. I wrinkled my sunburned nose and placed the laundry in the red plastic tub, which still had the sticky adhesive residue that originally held its price in place. Using dishwater-shriveled, white, poufy-fingered hands, and a skinny pre-pubescent hip to wedge the tub against, I carried the sheets and towels to the backyard, to hang on the clothesline. The birds had left white pasty souvenirs of their digestive adventures again. After washing away the abstract deposits, I looked around the backyard with some satisfaction. Hanging laundry was, by far, my favo rite chore. It provided a private world, in which I could day-dream to my heart’s content. Day-dreaming is like television, except you get to write your own story and choose your own characters and even be the star actress if you want. The best thing going for it is that nobody could see it except me, so there was no one reacting to my watching it, or lecturing me on how it’s unhealthy and ruining my mind. Sometimes I would indulge myself in repetitive plots. I had crash-landed on a remote island, with no parents at all. There was a cave with a stream running through it and lots of berries and zucchini and tomatoes and a chocolate tree outside. A lifetime supply of pasta and meat sauce had crash-landed there with me, along with cases of sliced processed cheese, so I was happy. There were many rooms in the cave and each held new wonders to explore, things like chests of jewelry and exotic costumes, boxes of books, endless art supplies, a music box.

Manufacturing Planning and Scheduling Techniques Assignment

Manufacturing Planning and Scheduling Techniques - Assignment Example The company also offers value creation solutions by improving productivity and reducing costs of operation through service solutions such as cutting, custom making, and kitting (Top Cable 1). The initial process of manufacturing a conductor is the process of wire-drawing. This process involves the reduction of the diameter of the copper wire slowly to its final diameter. Wire-drawing process increases conductivity and ductility of the communication cables and wires. The copper wires usually arrive at Top Cable from the foundry in huge coils each measuring 5 tonnes. This copper is known as â€Å"wire rod† in technical terms and measures 8 mm. The wire drawing method performed in these wires takes place in two methods: drawing and further reduction or annealing. Top Cable thereafter takes the wires through wiring stage where the engineers make conductors with differing cross-sections. Top Cable takes the copper wires to the next process of insulation. Insulation involves covering of the conductors to ensure that current leakages do not occur. Top Cable uses different insulation materials depending on the features of the communication cable it needs. The company considers heat resistance and insulation capacity to determine the insulation quality, and the quality of the resultant insulated cables. In some communication cables, Top Cable uses high heat resistant insulation materials to allow the wires from the previous stage to transmit a lot of power as compared to other wires that have low heat resistance. Top Cable adds the insulating material by an extrusion process that involves high temperature. This method ensures that no leakages of current occur. Various materials used in insulation include EPR, PVC, and XLPE. Once the insulation process ends, the manufacturing process subjects the insulated cables to voltage tests to make sure that the layers of insulatio n do not have any fault. Phase

Why the Falling U.S. Birth Rates Are So Troubling Essay

Why the Falling U.S. Birth Rates Are So Troubling - Essay Example The USA birth rates fall every year the government reported with the experts calling it a proof that the weak economy has continued to reduce enthusiasm for having children. The drop in the preceding year was just by 1 %, not as a big drop as to 3% drop which was seen in the recent years. It may be an effect of the fertility rate and the aging population. The falling birth is a new phenomenon in this state that they had been on since the late 1990s. In the last year, fewer than four million births were reckoned last year the lowermost number since 1998. They theory behind the drop of the birth rate is couples who work hard get time being together, feeling that they are no need of having children because of their busy schedules. Across the U.S, the birth rates are falling, and family is shrinking. The fertility rate is less than two children a woman. As a result, U.S populations are growing extremely slowly and are beginning to decrease. Mark R. Montgomery states that the demographic trends portend that there are difficult times ahead for the United States economy because there are not enough people for jobs (206). A workforce that does not have enough workers can decrease productivity over time for any workforce. At the same time, the growing population of the elderly individuals threatens the solvency of social insurance and pension systems (Montgomery 206). As the household decreases, because people move away or some people die, the ability to care for the elderly diminishes.

Communicable diseases Essay Example for Free

Communicable diseases Essay 95 Infectious agents and examples of diseases The organisms that cause disease vary in size from viruses,  which are too small to be seen by a light microscope to  intestinal worms which may be over a metre long. The groups  of infectious agents are listed with examples of diseases they cause. Bacteria Pneumonia, tuberculosis, enteric fever, gonorrhoea Viruses Measles, varicella, influenza, colds, rabies Fungi Ringworm, tinea pedis (athlete’s foot) Protozoa Malaria, giardia Metazoa Tapeworm, filariasis, onchcerciasis (river blindness), hookworm Prions Kuru, Creutzfeld-Jacob disease, Bovine spongiform encephalopathy (BSE) Modes of transmission Direct transmission s Direct contact with the infected person as in touching, kissing or sexual intercourse s Droplet spread through coughing sneezing, talking or  explosive diarrhoea s Faecal-oral spread when infected faeces is transferred to  the mouth of a non infected person, usually by hand. Indirect transmission  s Indirect transmission of infectious organisms involves  vehicles and vectors which carry disease agents from the  source to the host. Infectious agents Modes of transmission Definitions and terms  used Symptoms and signs General management and treatment Anthrax Cellulitis Chickenpox (Varicella) Cholera Dengue fever Diphtheria Enteric fever (typhoid and para-typhoid fevers) German measles (Rubella) Glandular fever Hepatitis (viral) Influenza Malaria Measles Meningitis Mumps Plague Poliomyelitis Rabies Scarlet fever Tetanus Tuberculosis Typhus fever Whooping cough (Pertussis) Yellow fever Sexually transmitted diseases including HIV (AIDS) NOTE. Other communicable diseases such as Lassa Fever do not fall within the competence of this book. When in doubt notify the Port Health Officer. Communicable diseases CHAPTER 6 Communicable diseases are those that are transmissible from one person, or animal, to another. The disease may be spread directly, via another species (vector) or via the environment. Illness will arise when the infectious agent invades the host, or sometimes as a result of toxins produced by bacteria in food. The spread of disease through a population is determined  by environmental and social conditions which favour the  infectious agent, and the relative immunity of the  population. An outbreak of infection could endanger the  operation and safety of the ship. An understanding of the  disease and the measures necessary for its containment and  management is therefore important. 96 THE SHIP CAPTAIN’S MEDICAL GUIDE Vehicles are inanimate or non-living means of transmission of infectious organisms. They include: s Water. If polluted, specifically by contaminated sewage. Water is the vehicle for such  enteric (intestinal) diseases as typhoid, cholera, and amoebic and bacillary dysentery. s Milk is the vehicle for diseases of cattle transmissible to man, including bovine tuberculosis,  brucellosis. Milk also serves as a growth medium for some agents of bacterial diseases such as campylobacter, a common cause of diarrhoea.  s Food is the vehicle for salmonella infections (which include enteric fever), amoebic  dysentery, and other diarrhoeal diseases, and poisoning. Any food can act as a vehicle for infection especially if it is raw or inadequately cooked, or improperly refrigerated after cooking, as well as having been in contact with an infected source. The source may be another infected food, hands, water or air. s Air is the vehicle for the common cold, pneumonia, tuberculosis. influenza, whooping  cough. measles. and chickenpox. Discharges from the mouth. nose, throat, or lungs take the form of droplets which remain suspended in the air, from which they may be inhaled. s Soil can be the vehicle for tetanus, anthrax, hookworm. and some wound infections. s Fomites. This term includes all inanimate objects, other than water, milk, food, air, and soil,  that might play a role in the transmission of disease. Fomites include bedding, clothing and the surfaces of objects. Vectors are animate or living vehicles which transmit infections in the following ways: s Mechanical transfer. The contaminated mouth-parts or feet of some insect vectors  mechanically transfer the infectious organisms to a bite-wound or to food. For example, flies may transmit bacillary dysentery, typhoid, or other intestinal infections by walking over the infected faeces and later leaving the disease-producing germs on food. s Intestinal harbourage. Certain insects harbour pathogenic (disease causing) organisms in their intestinal tracts. The organisms are passed in the faeces or are regurgitated by the vector, and the bite-wounds or food are contaminated. (e.g. plague, typhus.) s Biological transmission. This term refers to multiplication of the infectious agent during its  stay in the body of the vector. The vector takes in the organism along with a blood meal but is not able to transmit infection until after a definite period, during which the pathogen changes. The parasite that causes malaria is an example of an organism that completes the sexual stages of its life cycle within its vector, the mosquito. The virus of yellow fever also multiplies in the bodies of mosquitoes. Terms used in connection with communicable diseases A carrier is a person who has the infection, either without becoming ill himself or following recovery from it. A contact is a person who may have been in contact with an infected person. The incubation period is the interval of time that elapses between a person being infected with any communicable disease and the appearance of the features of that disease. This period is very variable and depends upon the infectious agent and the inoculum (the amount of the infectious agent). The isolation period signifies the time during which a patient suffering from an infectious disease should be isolated from others. The period of communicability is the time during which a patient who may be incubating an infectious disease following contact can communicate the disease to others. The quarantine period means the time during which port authorities may require a ship to be isolated from contact with the shore. Quarantine of this kind is seldom carried out except when serious epidemic  diseases, such as, for instance. plague. cholera, or yellow fever are present or have recently occurred on board. Chapter 6 COMMUNICABLE DISEASES Symptoms and signs In reality it is often very difficult to make an accurate diagnosis of an infectious disease without laboratory investigations. It may be possible if there are very specific features such as a rash (varicella) or cluster of suggestive features (regular fever, enlarged spleen and history of mosquito bites in an endemic area). Because of the difficulty in making an accurate diagnosis on board ship you may have to give a variety of treatments each directed at different infectious agents. Onset Almost all communicable diseases begin with the patient feeling unwell and perhaps a rise in temperature. This period may be very short, lasting only a few hours (meningococcal sepsis), or more prolonged (hepatitis). In some diseases the onset is mild and there is not much general disturbance of health, whereas in others it is severe and prostrating. During the onset it is rarely possible to make a diagnosis. The rash The diagnosis of some communicable diseases is made easier by the presence of a characteristic rash. In certain diseases (e.g. scarlet fever) the rash is spread evenly over the body, in others it is limited to definite areas. When examining an individual suspected to be suffering from a communicable disease, it is of great importance to strip him completely in order to get a full picture of any rash and its distribution. General rules for the management of communicable diseases Isolation The principles of isolation are described in Chapter 3 and Chapter 5. If you have a suspicion that the disease with which you are dealing is infectious it is advisable to invoke isolation precautions as soon as possible. Treatment An essential element in treatment is maintaining the patient’s well being. This is achieved through good general nursing and it is important to ensure that the patient does not become dehydrated. Advice on specific medical treatment for infectious diseases which are likely to respond to specific drugs is given under the sections on treatment for the individual diseases. You may also be advised to administer drugs to prevent secondary infection occurring. See Chapter on General Nursing and on how to reduce a high fever. Diet Diet will very much depend on the type of disease and severity of fever. Serious fever is invariably accompanied by loss of appetite and this will automatically tend to restrict diet to beverages such as water flavoured with lemon juice and a little sugar or weak tea with a little milk and perhaps sugar. Essential basic rules s Isolate. If anyone suffers from a temperature without obvious cause it is best to isolate him until a diagnosis has been made. s Strip the patient and make a thorough examination looking for any signs of a rash in order to try to establish the diagnosis. s Put him to bed, and appoint someone to look after and nurse the patient. s Give non-alcoholic fluids in the first instance. s If his temperature exceeds 39.4C make arrangements for tepid sponging. 97 98 THE SHIP CAPTAIN’S MEDICAL GUIDE s Arrange for the use of a bed pan and urine bottle if the patient shows any sign of prostration or if his temperature is high. s If the patient is seriously ill and if in any doubt as to the diagnosis seek RADIO MEDICAL ADVICE, failing which you should consider the need for making for port. s Treat symptoms as they arise. Do not attempt to get the patient up during convalescence if he is feeble, but keep him in bed until the next port is reached. When approaching port, send a radio message giving details of the case to enable the Port Health Authority to make arrangements for the isolation of the case and any contacts on arrival and Disinfection. Immunisation and travel advice It is important that up to date advice on immunisation and the prevalent diseases should be obtained before arrival in a foreign port. This is most easily available from the following publications: Health Information for Overseas Travel, produced by the UK Department of Health, and International Travel and Health, WHO, Geneva Anthrax French: Charbon German: Milzbrand Italian: Carbonchio Spanish: Carbon Incubation Period: 2 to 7 days, usually 2 Period of communicability: No evidence of transmission from person to person Isolation Period: No evidence of transmission from person to person Quarantine Period: None. Anthrax is an uncommon but serious communicable disease which may occur in man and animals. It occurs in man either as an infection of the skin (malignant pustule), or as an attack on the lungs or intestines, or as a widely spread infection throughout the body by means of the blood circulation. Anthrax is, in man, usually contracted by handling infected animals, skins, hides, or furs. It can also be conveyed by the consumption of infected or insufficiently cooked meat, or by the inhalation of dust containing the organism. Symptoms and signs In most cases anthrax is accompanied by severe symptoms such as fever and prostration. When it appears as a skin infection, it begins as a red itching pimple which soon changes into a blister and within the next 36 hours progresses into a large boil with a sloughing centre surrounded by a ring of pimples. Alternatively it may take the form of a painless widespread swelling of the skin which shortly breaks down to form pus in the area. The gastro-intestinal form of anthrax resembles food poisoning with diarrhoea and bloody faeces. The lung form develops into a rapidly fatal pneumonia. Treatment Should a case of anthrax occur at sea, which is unlikely unless as a result of handling animals, hides, skins, etc., all dressings or other material that come into contact with the discharge must be burnt or disposed of by disinfection. Instruments must be used to handle dressings as far as possible, and the instruments must subsequently be sterilised by vigorous boiling for not less than 30 minutes, since the spores of the anthrax germ are difficult to kill. Treatment is not easy on board and the patient should be put ashore as soon as possible. In the meantime treatment is with Penicillin No attempt at surgical treatment (incision or lancing of the sore) should be made as it does no good. Cover the sore with a dressing. Seek advice from a Port Health Authority about the treatment of cargo. Chapter 6 COMMUNICABLE DISEASES Cellulitis (Erysipelas) French: Erysipà ¨le German: Erysipel Incubation Period:1 to 7 days Period of communicability: None Isolation Period: None Quarantine Period: None Italian: Erisipela Spanish: Erisipela This disease is an acute inflammatory condition of the skin caused by a germ entering the body through a scratch or abrasion. Cellulitis occurs anywhere, but most commonly on the legs, arms and face. The onset is sudden with shivering, and a general feeling of malaise. The temperature rises rapidly and may reach about 40oC. The affected area becomes acutely inflamed and red on the first or second day of the infection and the inflammation spreads rapidly outwards with a well-marked, raised, and advancing edge. As the disease advances the portions of the skin first attacked become less inflamed and exhibit a yellowish appearance. Blisters may appear on the inflamed area which can be very painful. General treatment The patient must be kept in bed during the acute stage. Specific treatment Give the patient benzyl penicillin 600 mg followed by oral antibiotic treatment. Paracetamol can be given to ease the pain. Chickenpox (Varicella) French: Varicelle German: Windpocken Italian: Varicella Spanish: Varicela Incubation Period: 14 to 21 days, usually 14 Period of communicability: Up to 5 days before the onset of the rash and 5 days after the first crop of vesicles Isolation Period: Until the vesicles become dry Quarantine Period: None This highly infectious disease starts with fever and feeling unwell. Within a day or two the rash appears on the trunk but soon spreads to the face and elsewhere, even sometimes to the throat and palate. The rash starts as red pimples which quickly change into small blisters (vesicles) filled with clear fluid which may become slightly coloured and sticky during the second day. Within a day or two the blisters burst or shrivel up and become covered with a brownish scab. Successive crops of spots appear for up to five days. Although usually a mild disease, sometimes the rash is more severe and very rarely pneumonia may occur. Treatment A member of the crew who has had chickenpox, and therefore has immunity, could make a suitable nurse. If all of the crew have had chickenpox in the past then there is no need to isolate the patient. The patient need not be confined to bed unless he is unwell. He should be told not to scratch, especially not to scratch his face otherwise pock marks may remain for life. Calamine lotion, if available, dabbed onto the spots may ease the itching. 99 100 THE SHIP CAPTAIN’S MEDICAL GUIDE Cholera French: Cholà ©ra German: Cholera Italian: Colà ©ra Incubation Period: 1 to 5 days, usually 2–3 days Period of communicability: Usually for a few days after recovery Isolation Period: Until diarrhoea has settled Quarantine Period: 5 days Spanish: Cà ³lera Cholera is a severe bacterial infection of the bowel producing profuse watery diarrhoea, muscular cramps, vomiting and rapid collapse. Infection occurs principally through drinking infected water and sometimes through eating contaminated uncooked vegetables, fruit, shell fish or ice cream. It generally occurs in areas where sanitation is poor and where untreated sewage has contaminated drinking water. Other bacterial and viral causes of diarrhoea can sometimes produce a similar clinical picture and may be just as severe. Symptoms and signs Most cases are mild and will not be differentiated from any other form of diarrhoea. In a severe case the onset is abrupt, the vomiting and diarrhoea extreme with the faeces at first yellowish and later pale and watery, containing little white shreds of mucus resembling rice grains. The temperature is below normal, and the pulse rapid and feeble. The frequent copious watery faeces rapidly produce dehydration. Vomiting is profuse, first of food but soon changing to a thin fluid similar to the water passed by the bowel. Cramps of an agonising character attack the limbs and abdomen, and the patient rapidly passes into a state of collapse. As the result of the loss of fluid, the cheeks fall in, the eyes become shrunken and the skin loses its normal springiness and will not quickly return to its normal shape when pinched. The body becomes cold and covered with a clammy sweat, the urine is scanty, the breathing rapid and shallow,  and the voice is sunk to a whisper. The patient is now restless, with muscle cramps induced by loss of salt, and feebly complaining of intense thirst. This stage may rapidly terminate in death or equally rapidly turn to convalescence. In the latter case the cessation of vomiting and purging and the return of some warmth to the skin will herald convalescence. Treatment If there is a suspected case of cholera on board RADIO MEDICAL ADVICE ON MANAGEMENT SHOULD BE OBTAINED PROMPTLY. The patient should be isolated and put to bed at once. Every effort should be made to replace fluid and salt loss. Therefore, keep a fluid balance chart. The patient should be told that his life depends on drinking enough and he should be encouraged and if necessary almost forced to drink as much as possible until all signs of dehydration disappear (until his urine output is back to normal). Thereafter he should drink about 300 ml after each stool until the diarrhoea stops. It is best to drink oral rehydration solution (ORS), if this is not available, make up a solution from 20 gm of sugar with a pinch of salt and a pinch of sodium bicarbonate and juice from an orange in 500 ml sterile water. Give Doxycycline 200 mg first dose then 100 mg once daily. If vomiting, give an antiemetic tablet or injection before each dose. The patient must be kept in bed until seen by a doctor. Caution Cholera is a disease which is transmitted from person to person. If cholera is suspected, the ship’s water supply must be thoroughly treated to make sure that it is safe. The disposal of infected faeces and vomit must be controlled carefully since they are highly infectious. The hygiene precautions of all attendants must be of an order to prevent them also becoming infected and all food preparation on board must be reviewed. Chapter 6 COMMUNICABLE DISEASES Dengue fever French: Dengue German: Denguefieber; Siebentagefieber Italian: Dengue; Febbra dei sette giorni Spanish: Fiebre dengue Incubation Period: 3 to 14 days, usually 7 to 10 days. Period of communicability: No person to person transmission. Infective for mosquitoes for about 5 days from just before the end of the febrile period. Isolation Period: None Quarantine Period: None This is an acute fever of about 7 days’ duration conveyed by a mosquito. It is sometimes called break-bone fever. It is an unpleasant, painful disease which is rarely fatal. A severe form of the disease, dengue haemorrhagic fever, can occur in children. Features of the disease are its sudden onset with a high fever, severe headache and aching behind the eyeballs, and intense pain in the joints and muscles, especially in the small of the back. The face may swell up and the eyes suffuse but no rash appears at this stage. Occasionally an itchy rash resembling that of measles but bright red in colour appears on the fourth or fifth day of the illness. It starts on the hands and feet from which it spreads to other parts of the body, but remains most dense on the limbs. After the rash fades, the skin dries and the surface flakes. After about the fourth day the fever subsides, but it may recur some three days later before subsiding again by the tenth day. General treatment There is no specific treatment, but paracetamol will relieve some of the pain, and calamine lotion, if available, may ease the itching of the rash. Control is by removal of Aedes mosquitoes. Diphtheria French: Diphtà ©rie German: Diphterie Italian: Difterite Spanish: Difteria Incubation Period: 2 to 5 days Period of communicability: Usually less than 2 weeks, shorter if the patient receives antibiotics Isolation Period: 2 weeks Quarantine Period: None Diphtheria is an acute infectious disease characterised by the formation of a membrane in the throat and nose. The onset is gradual and starts with a sore throat and fever accompanied by shivering. The throat symptoms increase, swallowing being painful and difficult, and whitish-grey patches of membrane become visible on the back of the throat, the tonsils and the palate. The patches look like wash leather and bleed on being touched. The neck glands swell, and the breath is foul. The fever may last for two weeks with severe prostration. Bacterial toxins may cause fatal heart failure and muscle paralysis. General treatment Immediate isolation is essential as diphtheria is very infectious, the infection being spread by aerosols. Specific treatment Specific treatment is diphtheria anti-toxin which should be given at the earliest possible opportunity if the patient can get to medical attention. Antibiotic treatment should be given to all cases to limit the spread of infection but it will not neutralise toxin which has already been produced. 101 102 THE SHIP CAPTAIN’S MEDICAL GUIDE Enteric fever – typhoid French: Fià ¨vre typhoide German: Typhus abdominalis Italian: Febbre tifoidea Spanish: Fiebre tifoidea Incubation Period: 1 to 3 weeks, depending on size of infecting dose Period of communicability: Usually less than 2 weeks. Prolonged carriage of salmonella typhi may occur in some of those not treated. Isolation Period: Variable. Quarantine Period: None The term enteric fever covers typhoid and para-typhoid fevers. Enteric fever is contracted by drinking water or eating food that has been contaminated with typhoid germs. Seafarers are advised to be very careful where they eat and drink when ashore. Immunisation gives reasonable protection against typhoid but not para-typhoid. In general the para-typhoids are milder and tend to have a shorter course. The disease may have a wide variety of symptoms depending on the severity of the attack. Nevertheless, typhoid fever, however mild, is a disease which must be treated seriously, not only because of its possible effect upon the patient, but also to prevent it spreading to others who may not have been immunised. Strict attention must be given to hygiene and cleanliness and all clothing and soiled linen must be disinfected. During the first week the patient feels off-colour and apathetic, he may have a persistent headache, poor appetite, and sometimes nose bleeding. There is some abdominal discomfort and usually constipation. These symptoms increase until he is forced to go to bed. At this stage his temperature begins to rise in steps reaching about 39–40 ºC in the evenings. For about two weeks it never drops back to normal even in the mornings. Any person who is found with a persistent temperature of this kind should always be suspected of having typhoid, especially if his pulse rate remains basically normal. In 10 to 20% of cases, from about the seventh day, characteristic rose-pink spots may appear on the lower chest, abdomen and back, which if pressed with the finger will disappear and return when pressure is released. Each spot lasts about 3–4 days and they continue to appear in crops until the end of the second week or longer. Search for them in a good light, especially in dark-skinned races. During the second week,  mental apathy, confusion and delirium may occur. In the more favourable cases the patient will commence recovery but in the worst cases his condition will continue to deteriorate and may terminate in deep coma and death. Even where the patient appears to be recovering, he may suffer a relapse. There are a variety of complications but the most dangerous are haemorrhage from, or perforation of, the bowel. Where the faeces are found to contain blood at any stage of the disease the patient must be kept as immobile as possible and put on a milk and water diet. If the bowel is perforated, peritonitis will set in. General treatment Anyone suspected of having typhoid or para-typhoid fever should be kept in bed in strict isolation until seen by a doctor. The patient’s urine and faeces are highly infectious, as may be his vomit. These should all be disposed of. The attendants and others coming into the room should wash their hands thoroughly after handling the bedpan or washing the patient, and before leaving the room. The patient should be encouraged to drink as much as possible and a fluid input/output chart should be maintained. He can eat as much as he wants, but it is best if the food is light. Specific treatment If you suspect somebody has enteric fever get RADIO MEDICAL ADVICE. Give ciprofloxacin 500 mg every 12 hours for one week. On this treatment the fever and all symptoms should respond within 4–5 days. All cases should be seen by a doctor at the first opportunity. The case notes including details of the amount of medicine given should be sent with the patient. Chapter 6 COMMUNICABLE DISEASES German measles – rubella French: Rubà ©ole German: Rà ¶teln Italian: Rosolia Spanish: Rubà ©ola Incubation Period: 14 to 23 days, usually 17 Period of communicability: For about 1 week before to at least 4 days after the onset of the rash Isolation Period: Until 7 days from the appearance of the rash Quarantine Period: None German measles is a highly infectious, though mild disease. It has features similar to those of mild attacks of ordinary measles or of scarlet fever. For the differences in symptoms and signs see the table. Usually the first sign of the disease is a rash of spots, though sometimes there will be headache, stiffness and soreness of the muscles, and some slight fever preceding or accompanying the rash. The rash is absent in half the cases and lasts from 5 to 6 days. The glands towards the back of the neck are swollen and can easily be felt. This is an important distinguishing sign. This swelling will precede the rash by up to 10 days. General treatment Give the patient paracetamol, and calamine lotion, if available, for the rash. Specific treatment NOTE: Particular care should be taken to isolate patients with German measles from pregnant women: Any pregnant woman on board should see a doctor ashore as soon as possible so that her immunity to rubella can be confirmed. If a patient has seen his wife in the last week he should be asked whether his wife might be pregnant. If so, his wife should be advised to see her doctor. Glandular fever – infectious mononucleosis French: Fià ¨vre glandulaire; Mononucleose infectieuse German: Drusenfieber; Infektiose Mononukleose Italian: Febbre ghiandolare (Mononucleosi infettiva) Spanish: Fiebre glandular (Mononucleosis infecciosa) Incubation Period: 4 to 6 weeks Period of communicability: Prolonged, excretion of virus may persist for a year or more Isolation Period: None Quarantine Period: None This malady is an acute infection which is most likely to affect the young members of the crew. Convalescence may take up to two or three months. The disease starts with a gradual increase in temperature and a sore throat; a white covering often develops later over the tonsils. At this stage it is likely to be diagnosed as tonsillitis and treated as such. However it tends not to respond to such treatment and, during this time, a generalised enlargement of glands occurs. The glands of the neck, armpit and groins start to swell, and become tender; those in the neck to a considerable extent. The patient may have difficulty in eating or swallowing. His temperature may go very high and he may sweat profusely. Occasionally there is jaundice between the fifth and fourteenth day. Commonly there is a blotchy skin rash on the upper trunk and arms at the end of the first week. Vague abdominal pain is sometimes a feature. A diagnosis of diphtheria may be considered due to the appearance of the tonsils, but the generalised glandular enlargement is typical of glandular fever. General treatment Paracetamol should be given to relieve pain and to moderate the temperature. Any antibiotics which have been prescribed to treat the tonsillitis should be discontinued. There is no specific treatment. If complications arise get RADIO MEDICAL ADVICE. 103 104 THE SHIP CAPTAIN’S MEDICAL GUIDE Hepatitis (viral) French: Hà ©patite : Hepatitis German: Hepatitis Italian: Epatite Spanish: Hepatitis Incubation Period: 15 to 50 days for hepatitis A, 60 to 90 days for hepatitis B (may be much longer) Period of communicability: None after jaundice has appeared in hepatitis A, can be indefinite for hepatitis B Isolation Period: During first week of illness Quarantine Period: None This is an acute infection of the liver caused by viruses. There are two main causes of acute hepatitis: hepatitis A and hepatitis B. Two other viruses may cause hepatitis (C and E), but these are uncommon. The most likely cause will be hepatitis A and this is spread by the faecal-oral route (as is hepatitis E). Hepatitis B is spread sexually or by contaminated blood or needles. There is no way of differentiating one type of viral hepatitis from another. The urine and faeces will show the typical changes associated with jaundice. Treatment There is no specific treatment. The patient should be put to bed and nursed in isolation. Plenty of sweetened fluids should be given until the appetite returns. When the appetite returns a fat-free diet should be given. No alcohol should be allowed. All cases must be seen by a doctor at the next port. Influenza French: Grippe; Influenza German: Epidemische Influenza; Grippe Italian: Influenza Spanish: Influenza; Grippe Incubation Period: 1 to 5 days Period of communicability: 3 to 5 days (7 in children) from the onset of illness Isolation Period: Often impractical because of the delay in diagnosis. In an outbreak it would be advisable to keep all affected individuals together and away from those who are well Quarantine Period: none This is an acute infectious disease caused by a germ inhaled through the nose or mouth. It often occurs in epidemics. The onset is sudden and the symptoms  are, at first, the same as those of the common cold. Later the patient feels much worse with fits of shivering, and severe aching of the limbs and back. Depression, shortness of breath, palpitations, and headaches, are common. Influenza may vary in severity. Commonly a sharp unpleasant feverish attack is followed by a prompt fall in temperature and a short convalescence. Pneumonia is a possible complication. General treatment The patient should be subject to standard isolation. He should be watched for signs of pneumonia such as pains in the chest, rapid breathing and a bluish tinge to the lips. He should be given plenty to drink and a light and nutritious diet if he can manage it. Specific treatment There is no specific treatment for the uncomplicated case, but the patient should be given paracetamol as needed. Chapter 6 COMMUNICABLE DISEASES Malaria French: Paludisme German: Malaria Italian: Malaria Spanish: Paludismo Incubation Period: 12 days or more, depending on the type of malaria Period of communicability: The patient will remain infectious for mosquitoes until they have been completely treated Isolation Period: None if in mosquito-proof accommodation Quarantine Period: None Malaria is a recurrent fever caused by protozoa introduced into the blood stream by the bite of the Anopheles mosquito. The malaria-carrying mosquito is most prevalent in districts where there is surface water on which it lays its eggs. It is a dangerous tropical disease which causes fever, debility and, sometimes, coma and death. Malarial areas Ports between latitudes 25 ºN and 25 ºS on the coasts of Africa (including Malagassy), Asia, and Central and South America should be regarded as infected or potentially infected with malaria. Enquiries should be made prior to departure to allow appropriate prophylaxis to be arranged and treatment drugs obtained. Before arrival in port further enquiries should be made as to the current malaria situation and prophylaxis issued to the crew if necessary. Prevention of malaria The risks of attacks of malaria can be very greatly reduced if proper precautions are taken and the disease can be cured if proper treatment is given. Despite this, cases have occurred in ships where several members of the crew have been attacked by malaria during a single voyage with severe and even fatal results. The precautions are: s avoidance of mosquito bites; s prevention of infection. Avoidance of mosquito bites The best way to prevent malarial infection is to take measures to avoid being bitten. The advent of air conditioned ships has made many traditional preventive measures obsolete. However, when within two miles of a malarial shore it remains important that: s doors are kept closed at all times after dusk; s any mosquitoes which enter compartments are killed using insecticide spray; s persons going on deck or ashore after dusk wear long sleeved shirts and trousers to avoid exposing their arms and legs; s no pools of stagnant water are allowed to develop on deck or in life boats, where mosquitoes might breed. In ships which are not air conditioned other traditional measures to protect against mosquitoes should be implemented. These include: s placing fine wire mesh over portholes, sky lights, ventilators and other openings; s screening lights to avoid attracting mosquitoes; s fixing mosquito nets over beds where accommodation spaces cannot be made mosquito proof. Prevention of infection The fewer the bites, the smaller is the risk of infection but even when the greatest care is exercised it will seldom be possible entirely to prevent mosquito bites either on shore or in the 105 106 THE SHIP CAPTAIN’S MEDICAL GUIDE ship. For this reason in all cases when a ship is bound for a malarial port, Masters (in addition to taking all possible measures to prevent mosquito bites) should control infection by giving treatment systematically to all the ship’s crew. Preventive treatment (prophylaxis) does not always prevent a person from contracting malarial infection, but it will reduce the chance of disease. All persons, therefore, should be warned that they have been exposed to the chance of malaria infection and that, if they fall ill at a later date, they should inform their doctor without delay that the fever from which they are then suffering may be due to malaria contracted abroad. The most appropriate prophylaxis will vary with the location as there are different types of malaria in various parts of the world. There is also increasing resistance to anti-malarials which will affect their effectiveness. Up to date information should be obtained before departure if possible or from the local health authorities. General guidelines Start taking the prophylaxis before arrival at a malarial area in accordance with specific instructions and depending on the region. (Usually 1-3 weeks before departure).This will allow the tolerance and side-effects (if any) of the prophylactic drug to be assessed. Prophylaxis should be continued for 4 weeks after leaving the malarial area so as to ensure all stages of the parasite have been killed. No drugs for the treatment of malaria are specified in the MSN 1726 as the advice varies with destination and the pattern of disease in any given malarial area at the time. For information, the UK’s present guidelines recommend 3 different regimes depending on destination: s Proguanil 200 mg once daily and chloroquine 300 mg weekly s Mefloquine 250 mg once weekly s Maloprim (a combined tablet of dapsone and pyrimethamine) 1 tablet weekly and chloroquine 300 mg weekly Other regimes may be used in areas of high level resistance Treatment of malaria Features of the illness Malaria cannot be diagnosed with certainty without laboratory assistance. If the person has been in a potentially malarial area within the last few months and has a fever they should be assumed to have malaria. The characteristic patterns of fever associated with malaria (fever every 2 to 3 days) may not be obvious. The illness may progress rapidly without many features other than fever and sweating. There will often be a severe headache. If there is any doubt about whether to treat or not get RADIO MEDICAL ADVICE. General treatment for mild or severe malaria The patient should be put to bed in a cool place and his temperature, pulse and respiration taken four hourly. If body temperature rises to 40oC or over, cooling should be carried out. The temperature should be taken and recorded at 15 minute intervals until it has been normal for some time. Thereafter the four-hourly recording should be resumed until the attack has definitely passed. Specific treatment for mild or severe malaria Anti-malarial drugs are not specified in MSN 1726 as treatment depends on the area and patterns of resistance. If anti-malarials are to be carried seek appropriate advice on which to obtain/use. The following examples of current regimes are given for information: s Quinine 600 mg every 8 hours for 7 days followed by Fansidar (see below) 3 tablets as a single dose or s Mefloquine 500 mg (2 tablets) for 2 doses 8 hours apart Chapter 6 COMMUNICABLE DISEASES Chloroquine is not used for treatment except for proven single infections with vivax and other benign malarias because of drug resistance. If quinine, Fansidar or mefloquine are not available then chloroquine 300 mg 8 hourly for three doses then 300 mg daily for 2 days should be used. If the patient is unable to take medicine by mouth or is vomiting then quinine 600 mg should be given by intramuscular injection every 8 hours. As soon as the patient is able to swallow it should be given by mouth. Quinine may produce ringing in the ears or dizziness, but this should not normally be a reason to stop treatment. NOTE: All patients who have been treated for malaria or suspected malaria must see a doctor at the next port because further medical treatment may be necessary. Measles French: Rougeole German: Masern Italian: Morbillo Spanish: Sarampion Incubation Period: 7 to 18 days usually 10 until onset of fever, 14 days until rash Period of communicability: about 10 days, minimally infectious after the second day of the rash Isolation Period: 4 days after onset of rash Quarantine Period: None Measles does not often occur in adults. See also the sections on German measles and scarlet fever and the table of differences of symptoms. The disease starts like a cold in the head, with sneezing, a running nose and eyes, headache, cough and a slight fever 37.5 ºC–39 ºC. During the next two days the catarrh extends to the throat causing hoarseness and a cough. A careful examination of the mouth during this period may reveal minute white or bluish white spots the size of a pin’s head on the inner side of the cheeks, or the tongue and inner side of the lips. These are known a ‘Koplik spots’ and are not found in German measles and scarlet fever. The rash appears on the fourth day when the temperature increases to 39–40 ºC. Pale rose-coloured spots first appear on the face and spread down to cover the rest of the body. The spots run together to form a mottled blotched appearance. The rash deepens in colour as it gets older. In four or five days the rash begins to fade, starting where it first appeared. The skin may peel. The main danger of measles is that the patient may get bronchitis, pneumonia or middle ear infection. General treatment This highly infectious disease is conveyed to others when the patient coughs or sneezes. There is no specific treatment, but the patient may have paracetamol. Calamine lotion, if available, may be applied to soothe the rash. Meningococcal disease (meningitis and septicaemia) French: Mà ©ningite cà ©rà ©bro-spinal à ©pidà ©mique German: Epidemische Meningitis Cerebro-spinal Italian: Meningite cerebro-spinal epidemica Spanish: Meningitis cerebro-spinal epidemica Incubation Period: 2 to 10 days, usually 3 to 4 Period of communicability: Generally not communicable whilst the patient is on antibiotics Isolation Period: For 24 hours after the start of antibiotics Quarantine Period: None Infection caused by the meningococcus (a bacterium) can cause either meningitis, with inflammation of the membranes surrounding the brain and spinal cord, or a septicaemia characterised by a generalised rash that does not fade on pressure. Unless treated promptly and effectively, the outcome is nearly always fatal. It occurs in epidemics which may affect closed communities such as a ship. The infection enters by the nose and mouth. Meningitis starts suddenly with fever, considerable headache and vomiting. Within the first day the temperature increases rapidly to 39 ºC or more and the headache becomes agonising. 107 108 THE SHIP CAPTAIN’S MEDICAL GUIDE Vomiting increases and there is general backache with pain and stiffness in the neck. Intolerance of light (photophobia) is usually present. The patient may be intensely irritable and resent all interference, or may even be delirious. As the meningitis develops the patient adopts a characteristic posture in bed, lying on the side with his back to the light, knees drawn up and neck bent backwards. Unconsciousness with incontinence may develop. The septicaemia caused by the meningococcus also starts suddenly with a flu like illness. A rash develops quickly, starting with pin prick like spots which will not blanche when pressed. This rash may progress to form large dark red areas. Individual cases may vary in the speed of onset, the severity of the illness and the clinical features which are present. If meningitis is suspected get RADIO MEDICAL ADVICE and it will help the doctor if the results of the two following tests are available: The neck bending test Ask the patient to attempt to put his chin on his chest. In meningitis the patient will be unable to do so because forward neck movement will be greatly restricted by muscle contraction. Try to increase the range of forward movement by pushing gently on the back of his head. The neck muscles will contract even more to prevent the movement and the headache and backache will be increased. The knee straightening test – Figure 6.1 A. Bend one leg until the heel is close to the buttock. (A) Bend one leg until the heel is close to the buttock. B. Move the bent leg to lie over the abdomen. C. Keeping the thigh as in (B) try to straighten the lower leg. In meningitis it will be impossible to straighten the knee beyond a right angle and attempts to force movement will increase the backache. (B) Move the bended leg to lie over the abdomen. General treatment The patient should be nursed in a quiet, well-ventilated room with shaded lights in strict isolation. He should be accompanied at all times by an attendant who should wear a face mask to cover his nose and mouth. Tepid sponging may be necessary and pressure points should be treated. Usually there is no appetite but he should be encouraged to drink plenty of fluid. Ice packs may help to relieve the headache. (C) Keeping the thigh as in (B) try to straighten the lower leg. Figure 6.1 The knee straightening test. Specific treatment Give benzyl penicillin 3 g intramuscularly at once, and get RADIO MEDICAL ADVICE as to the amount and frequency of subsequent injections of benzyl penicillin. Until such advice is received, give benzyl penicillin 2.4 g at six hourly intervals. The headache should be treated with codeine. The patient should come under the care of a doctor as soon as possible. Chapter 6 COMMUNICABLE DISEASES Mumps French: Oreillons Italian: Malaria Orecchioni German: Mumps – Ziegenpeter Spanish: Orejones Incubation Period: 12 to 26 days, usually 18 Period of communicability: 7 days before glandular swelling and up to 9 days after Isolation Period: 9 days after swelling started Quarantine Period: None Mumps is a viral disease which causes the swelling of the salivary glands in front of the ears and around the angle of the jaw. The swelling usually affects both sides of the face though it may only affect one side and it may make the mouth difficult to open. The onset is usually sudden and may be accompanied by a slight fever. The swelling gradually diminishes and should disappear entirely in about 3 weeks. About 20% of men with mumps get orchitis which is the swelling of one or both testicles; when this occurs it usually happens around the tenth day. Whilst very painful, orchitis does not usually result in infertility and never in impotence. General treatment The patient should be put in standard isolation for 9 days and stay in bed for 4 to 5 days or until the fever is no longer present. He can be given paracetamol to relieve the symptoms, but there is no specific treatment. If he develops swollen painful testicles (orchitis) he should stay in bed. He should support the scrotum on a pad or small pillow. The testicles should also be supported if the patient gets up for any reason. Plague French: Peste German: Pest Italian: Peste Spanish: Peste Incubation Period: 2 to 6 days Period of communicability: As long as infected fleas are present. Person to person spread is uncommon except with plague pneumonia. Isolation Period: For 3 days after the start of antibiotic treatment Quarantine Period: 6 days Plague is a serious bacterial disease transmitted to man by infected rat fleas. It may present in three ways Bubonic in which buboes (swollen lymph nodes) are the most obvious feature. The nodes are painful and may ooze pus. Pneumonic in which pneumonia is the main feature. The type of plague is very infectious as the sputum contains the plague bacterium. Septicaemic which is rapidly fatal. The attack begins suddenly with severe malaise, shivering, pains in the back and sometimes vomiting. The patient becomes prostrated and is confused. His temperature reaches about oC C and the pulse is rapid. After about 2 days the buboes may develop, most commonly in 38 the groins. The buboes may soften into abscesses. General treatment The patient should be cared for by an attendant who should wear a face mask to cover his nose and mouth The patient should be isolated and taken as soon as possible to a port where he can be treated. He should rest in bed, be encouraged to drink as much fluid as possible and have a very light diet. If the abscesses burst they should be dressed with a simple dressing, but they must not be lanced. Soiled linen and bed clothes should be boiled for 10 minutes or destroyed. 109 110 THE SHIP CAPTAIN’S MEDICAL GUIDE Specific treatment Give Doxycycline 100 mg once daily for at least 5 days. The patient should remain on complete bed rest during convalescence. Prevention Plague should be notified to the local health authorities at the next port of call. The quarters of the patient and the crew should be treated with insecticide powder and dust to ensure the destruction of fleas. Warning Dead rats should be picked up with tongs, placed in a plastic bag, which should be sealed with string, weighted and thrown overboard; if the ship is in port, the dead rats should be disposed of in the manner required by the port medical health authority. Poliomyelitis – infantile paralysis French: Poliomyà ©lite Italian: Poliomielite German: Poliomyelitis Spanish: Poliomielitis Incubation Period: 3–21 days, commonly 7–14 days Period of communicability: Cases are most infectious during the first few days before and after the onset of symptoms Isolation Period: Not more than 7 days Quarantine Period None Poliomyelitis is an acute viral disease that occurs mostly in children. It is a disease almost entirely preventable by immunisation. The severity ranges from non-apparent infection to non-specific febrile illness, meningitis, paralytic disease and death. Symptoms of the mild disease include fever, malaise, headache, nausea and vomiting. If the disease progresses, severe muscle pain and stiffness of the neck and back, with or without paralysis will occur. The most commonly affected parts are the legs and arms, shoulders, diaphragm and chest muscles. The development of paralysis is generally complete within two days and then recovery begins. The recovery may be complete or leave some degree of paralysis Affected muscles are usually painful and tender if touched. They are always limp and movements of the affected parts are either weakened or lost by the wasting which appears very soon after paralysis. Paralysis of the respiratory muscles may cause breathlessness and blueness of the lips. General treatment There is no specific treatment but much can be achieved by good nursing. The patient should have complete rest in bed. Pain should be treated with paracetamol and/or codeine. If a limb has been affected it should be supported by pillows in such a way that the paralysed muscles cannot be stretched. The joints above and below the paralysis should be put through a full range of movement morning and evening to prevent stiffness. In all cases, as soon as paralysis appears, RADIO MEDICAL ADVICE must be sought. If the respiratory muscles are affected, breathing difficulty may ensue. Urgent steps must be taken to get the patient to skilled hospital treatment as soon as possible. Chapter 6 COMMUNICABLE DISEASES Rabies – hydrophobia French: La rage German: Tollwut Italian: Rabbia Spanish: Rabia Incubation Period: in humans the incubation period is usually 2 to 12 weeks, shortest for patients bitten about the head and those with extensive bites Communicability: Rabies is rarely, if ever, spread from human to human. Nevertheless for the duration of the illness contamination with saliva should be avoided by wearing gloves when nursing the patient Isolation Period: Duration of the illness Quarantine Period: Rabies is an acute infectious viral disease that is almost always fatal. When a rabid mammal bites humans or other animals, its saliva transmits the infection into the wound, from where it spreads to the central nervous system. Rabies is primarily an infection of wild animals such as skunks, coyotes, foxes, wolves, racoons, bats, squirrels, rabbits, and chipmunks. The most common domestic animals reported to have rabies are dogs, cats, cattle, horses. mules, sheep, goats, and swine. It is possible for rabies to be transmitted if infective saliva enters a scratch or fresh break in the skin. The development of the disease in a bitten person can be prevented by immediate and proper treatment, Once symptoms of rabies develop, death is virtually certain to result. Thus prevention of this disease is of the utmost importance. Local port authorities should be informed of possible rabid animals, so that appropriate public health measures can be instituted. Treatment As soon as an individual aboard ship Is known to have been bitten by a dog or other possibly rabid animal, RADIO MEDICAL ADVICE should he obtained at once. Usually suspected cases are sent ashore to obtain the expert treatment and nursing care needed to prevent the disease. Immediate local care should be given. Vigorous treatment to remove rabies virus from the bites or other exposures to the animal’s saliva may be as important as specific anti-rabies treatment. Free bleeding from the wound should be encouraged. Other local care should consist of: s thorough irrigation of the wounds with soap or detergent water solution; s cleansing with antiseptic solution; s if recommended by radio, giving an antibiotic to prevent infection: s administering adsorbed tetanus toxoid, if indicated. s Suturing of bite wounds should be avoided. Prevention When abroad, seamen should keep away from warm-blooded animals especially cats, dogs. and other carnivores. It is strongly advised that pets should not be carried on board ship as these may become infected unnoticed, through contact with rabid animals in ports. 111 112 THE SHIP CAPTAIN’S MEDICAL GUIDE Scarlet fever French: Scarlatine German: Scharlach Italian: Scarlattina Spanish: Escarlatina Incubation Period: 1 to 3 days Period of communicability: 3 days Isolation Period: 14 days in untreated cases, 1 to 2 days if given antibiotics. Quarantine Period: None Scarlet fever is not often contracted by adults. It has features similar to those of measles and German measles; see the table of differences of symptoms. The onset is generally sudden and the temperature may rapidly rise to 39.5 to 40 ºC on the first day. With the fever the other main early symptom is a sore throat, which in most cases is very severe. The skin is hot and burning to the touch. The rash appears on the second day and consists of tiny bright red spots so close together that the skin assumes a scarlet or boiled lobster-like colour. It usually appears first on the neck, very rapidly spreads to the upper part of the chest and then to the rest of the body. There may be an area around the mouth which is clear of the rash. The tongue at first is covered with white fur and, when this goes, it becomes a very bright red (strawberry). The high fever usually lasts about a week. As the rash fades the skin peels in circular patches. The danger of scarlet fever arises from the complications associated with it, e.g. inflammation of the kidneys (test the urine for protein once a day), inflammation of the ear due to the spread of infection from the throat, rheumatism and heart disease. These complications can be avoided by careful treatment. General treatment The patient must stay in bed and be kept as quiet as possible. The patient can be given paracetamol to relieve the pain in the throat which may also be helped if he takes plenty of cold drinks. He can take such food as he wishes. Specific treatment As scarlet fever usually follows from a sore throat or tonsillitis you may already be giving him the relevant treatment. Otherwise give the specific treatment for tonsillitis. Tetanus – lockjaw French: Tetanos German: Wundstarrkrampf Italian: Tetano Spanish: Tetanos Incubation Period: 4 to 21 days Period of communicability: No person to person transmission Isolation Period: None Quarantine Period: None Tetanus is caused by the infection of a wound by the tetanus bacterium which secretes a powerful poison (toxin). This bacterium is very widespread in nature and the source of the wound infection may not always be easy to trace. Puncture wounds are particularly liable to be dangerous and overlooked as a point of entry. In the UK immunisation against the disease usually begins in childhood but it is necessary to have further periodic inoculations to maintain effective immunity. Fortunately the disease is a very rare condition on board ship. The first signs of the disease may be spasms or stiffening of the jaw muscles and, sometimes, other muscles of the face leading to difficulty in opening the mouth and swallowing. The spasms tend to become more frequent and spread to the neck and back causing the patient’s body to become arched. The patient remains fully conscious during the spasms which are extremely painful and brought on by external stimulus such as touch, noise or bright light. The patient is progressively exhausted until heart and lung failure prove fatal. Alternatively, the contractions may become less frequent and the patient recovers, but there is a high mortality. Treatment The patient should be isolated in a darkened room as far as possible from all disturbances. Get RADIO MEDICAL ADVICE. Give antibiotic treatment and give diazepam or chlorpromazine as sedation and to control spasms. The patient must be got to hospital as soon as possible. Chapter 6 COMMUNICABLE DISEASES Tuberculosis – TB, consumptIon French: Tuberculose German: Tuberkulose Italian: Tuberculosis Spanish: Tuberculosis Incubation Period: 4 to 12 weeks Period of communicability: indefinite, 2 weeks after antibiotics Isolation Period: depends on the degree of infection, rarely necessary Quarantine Period: None This infectious disease is caused by the tubercle bacillus. Although the lung (pulmonary) disease is the most common, TB bacteria may attack other tissues in the body: bones. joints. glands, or kidneys. Unlike most contagious diseases, tuberculosis usually takes a considerable time to develop, often appearing only after repeated, close, and prolonged exposures to a patient with the active disease. A healthy body is usually able to control the tubercle bacilli unless the invasion is overwhelming or resistance is low because of chronic alcoholism, poor nutrition, or some other weakening condition. The pulmonary form of the disease is spread most often by coughing and sneezing. A person may have tuberculosis for a long time before it is detected. Symptoms may consist of nothing more than a persistent cough, slight loss of weight, night sweats, and a continual ‘all-in‘ or ‘tired-out‘ feeling that persists when there is no good reason for it. More definitive signs pointing to tuberculosis are a cough that persists for more than a month, raising sputum with each cough. persistent or recurring pains in the chest, and afternoon rises in temperature. When he reaches a convenient port, a seaman with one or more of these warning signs should see a physician. Treatment Every effort should be made to prevent anyone who has active tuberculosis from going to sea. since this would present a risk to the crew’s health as well as the individual’s. The treatment of tuberculosis by medication will not usually be started at sea, since the disease does not constitute an emergency. To prevent the spread of tuberculosis, every patient with a cough, irrespective of its cause, should hold disposable tissues over his mouth and nose when coughing or sneezing and place the used tissues in a paper bag, which should be disposed of by burning. The medical attendant should follow good nursing isolation techniques (see Isolation Chapter 3). No special precautions are necessary for handling the patient’s bedclothes, eating utensils, and personal clothing. Tuberculosis control A tuberculosis control programme has three objectives: (I) to keep individuals with the disease from signing on as crew-members; (2) to locate those who may have developed the disease while aboard ship and initiate treatment: and (3) to give preventive treatment to persons at high risk of developing the active disease. The first objective can be achieved by periodic, thorough physical examinations including chest X-rays and bacteriological examination of sputum. To identify those who might have developed active tuberculosis, a chest X-ray should be taken and a medical evaluation including bacteriological examination of sputum requested when in port, if a crew-member develops symptoms of a chest cold that persist for more than two weeks. Also, when any active disease is discovered, survey should be made of close associates of the patient and others in prolonged contact with him. Such persons are regarded as contacts and are considered at risk from the disease; they should be given a tuberculin test and chest X-ray when next in port. If they develop symptoms, full medical examination, including bacteriological examination of sputum, should be requested. 113 114 THE SHIP CAPTAIN’S MEDICAL GUIDE Typhus fever French: Typhus exanth\Aematique Italian: Tifo petecchiale German: Flecktyphus Spanish: Tifus petequial Incubation Period: 6 to 15 days, usually 12 Period of communicability: Not directly transmissible from person to person Isolation Period: not required after de-lousing Quarantine Period: 14 days This disease should not be confused with typhoid fever. Typhus is caused by a small bacterium. The disease is conveyed by lice, fleas, ticks and mites. Treatment for the various types of typhus is the same and the symptoms are very similar. The main typhi are epidemic (from lice) and murine, or ship typhus, (from rat fleas). Symptoms and signs Onset is sudden with headache, vomiting, shivering and nausea. The temperature rapidly rises and may reach 40.0 ºC to 40.6 ºC. The patient suffers great prostration, and may be delirious or confused. About the fifth day a rash appears on the front of the body, spreading to the back and limbs in the form of dusky red spots which give the skin a blotchy appearance. The disease if untreated lasts about two weeks. With tick or mite borne typhus there is usually a punched out black ulcer (eschar) which corresponds to the site of attachment. Treatment In the case of louse-borne typhus isolate the patient at once. Bedding and clothing of the patient and close contacts should be treated with a residual insecticide. The patient should receive Doxycycline until his temperature settles plus one day. The response is normally prompt. Whooping cough – pertussis French: Coqueluche German: Keuchhusten Italian: Pertosse Spanish: Tos Ferina Incubation Period: 7 to 10 days, rarely exceeding 14 days Period of communicability: 21 days, normally no more than 5 days after antibiotics Isolation Period: 5 days after antibiotics Quarantine Period: None This disease occurs among unvaccinated children; unvaccinated adults may contract it. The disease in adults has no typical features. Symptoms and signs The onset occurs as a severe cough which after about 7 to 10 days is marked by a typical ‘whoop’, with or without vomiting. The whoop is caused by a convulsive series of coughs reaching a point where the patient must take a breath. It is this noisy indrawing of breath which produces the ‘whoop’. The coughing bouts may be very distressing. Treatment Give erythromycin for 5 days. This is unlikely to affect the course of the disease unless given very early, but it will reduce the infectiousness of the patient. In children, during the bouts of coughing, feeding may induce vomiting. It is best, therefore, to give light food in between the coughing bout and to keep the child quiet in bed. Chapter 6 COMMUNICABLE DISEASES Yellow fever French: Fià ¨vre jaune German: Gelbfieber Italian Febbra gialla Spanish: Fiebra amarilla Incubation Period: 3 to 6 days Period of communicability: 6 days Isolation Period: 12 days only if stegomyia mosquitoes are present in the port or on board Quarantine Period: 6 days This is a serious and often fatal disease which is caused by a virus transmitted to humans by a mosquito. The disease is endemic in Africa from coast to coast between the south of the Sahara and Kenya, and in parts of the Central and Southern Americas. Prevention Travellers to these areas should be inoculated against the disease. Many countries require a valid International Certificate of yellow fever inoculation for those who are going to, or have been in or passed through, such areas. See also the note on prevention of mosquito bites in the section dealing with malaria. Features of the disease The severity of the disease differs between patients. In general, from 3 to 6 days after being bitten the patient fluctuates between being shivery and being over hot. He may have a fever as high as 41 ºC, headache, backache and severe nausea and tenderness in the pit of the stomach. He may seem to get slightly better but then, usually about the fourth day, he becomes very weak and produces vomit tinged with bile and blood (the so-called ‘black vomit’). The stomach pains increase and the bowels are constipated. The faeces, if any, are coloured black by digested blood. The eyes become yellow (jaundice) and the mind may wander. After the fifth or sixth day the symptoms may subside and the temperature may fall. The pulse can drop from about 120 per minute to 40 or 50. This period is critical leading to recovery or death. Increasing jaundice and very scanty, or lack of, urine are unfavourable signs. Protein in the urine occurs soon after the start of the illness and the urine should be tested for it. General treatment The patient must go to bed and stay in a room free from mosquitoes. The patient must be encouraged to drink as much as possible, fruit juices are recommended. 115