About netbook

About netbook 1. Presentation A netbook is a PC has a screen of roughly 10 crawls from corner to corner; it likewise has a more slow processor contrasted and bigger estimated PCs. They are mostly intended for fundamental errands, for example, web perusing and word preparing. 1 Somewhere in the range of 2007 and 2008, the overall offer of netbook PCs has hopped from around 400,000 to 11.4 million units. This market is unmistakably developing with this figure being conjecture to turn out to be considerably bigger with a 189% expansion to 21.5 million units in 20092. This development is principally because of the moving purchasing behavior of the general population to netbooks from scratch pad and workstations. Nokia has had enormous accomplishment with its cell phone innovation and as the market chief it has nearness in â€Å"every segment† of the cell phone market3. Nokias profoundly inventive innovative work endeavors have permitted the organization to stay in front of the opposition. It currently hopes to broaden and add to its product offering by presenting its new booklet PC, the â€Å"Nokia 3G Booklet†. The goal of this report is to dissect the three parts of the UK promoting condition concerning the Nokia 3G Booklet following the ongoing dispatch of the item. The report will finish up to whether this new class of item is likely be a triumph for Nokia in the UK. 2. Strategy The report will take a gander at the three advertising conditions: miniaturized scale condition, large scale condition and inward condition and will at that point make an end to whether the Nokia 3G Booklet is probably going to be an achievement in the UK. To complete this investigation; different foundation data was accumulated about the PC business. This data was gathered from web assets, reading material, and talk notes. The accompanying models were utilized to explain the discoveries: DEEPLIST examination Doormen Five Force Model SWOT examination 3. Examination The three parts of the advertising condition which will be investigated, with respect to Nokias presentation of the Nokia 3G Booklet, are the miniaturized scale condition, the large scale condition and the inward condition. 4.1 Macro condition The full scale condition is â€Å"The on-screen characters and powers outside showcasing that influence advertising administrations capacity to manufacture and keep up effective associations with customers†. (Harker, 2009:p602) A DEEPLIST examination has been utilized to look at the impacts of socioeconomics, financial, natural, political, lawful and mechanical variables upon the item. Socioeconomics With huge quantities of understudies requiring PCs which are lighter and more versatile than note pads to take to addresses, obviously the understudy segment is probably going to purchase netbooks. The netbooks are additionally liable to be famous with representatives who should have the option to take their work any place they go. These items may likewise turn out to be progressively mainstream with a maturing populace since they are a lot simpler to convey about than greater workstations. Furthermore, these PCs are just intended for straightforward assignments and this segment is probably not going to utilize these PCs for complex errands. Financial The world has quite recently had a monetary emergency over the previous year, anyway there are away from of recuperation, with the US, France and Germany presently in fact out of downturn. The UK is still in downturn with a GDP of - 0.3%. The administration has given a Consumer Price Index of a 1.5%. Natural The netbooks are a lot littler than most workstations and journals and in this way need less materials to make. The light weight additionally implies that there is to a lesser degree a carbon impression with respect to transportation. Netbooks are additionally incredibly effective; requiring just 30 watts contrasted and 65 watts in a note pad implying that a lot of intensity is spared if netbooks are utilized instead of greater PCs. Netbooks are presently viewed as significantly more of a dispensable innovation because of their low cost. In this way, at whatever point the innovation may turn out to be moderately out-dated, buyers are probably going to buy another, subsequent in an expanded measure of wastage of out of date items and consequently an expanded measure of ecological harm. The netbook PCs are additionally considered as a valuable PC. In spite of the fact that netbooks devour less vitality, they are additionally made with indistinguishable poisonous materials from different PCs and with no push to change this from makers, removal of the netbooks is probably going to stay hurtful to the environment.4 In this way, weighing up the expenses and advantages of the netbooks in correlation with different workstations, they are significantly more ecologically well disposed than huge numbers of their partners, for example, scratch pad and PCs. Their lighter plan and low force utilization mean they are likewise less expensive to deliver and work. Political/Legal Nokia may think that its simpler to break into the European market than America. This would be because of the way that Nokia is an European organization with solid market infiltration of its versatile communication items. The EU would almost certainly bolster the organization more than it would for Apple. Mechanical Nokia has now incorporated a 3G and GPS, permitting clients to interface anyplace and see their situation on a guide. The 3G Booklet currently additionally can send SMS messages. The Booklet is additionally one of the main PCs to incorporate windows 7. These new highlights are probably going to improve the fascination of the items for likely clients. 4.2 Micro condition â€Å"The entertainers near the organization that influence its capacity to serve its clients the organization, the providers, advertising delegates, client markets, contenders and publics†, (Harker, 2009:p602) Doormen Five Force Model (appeared in supplement 2) will be utilized to examine the smaller scale condition for the Nokia 3G Booklet. Existing Competitors The netbook showcase is incredibly serious, with the fundamental rivalry appeared in reference section 1. Nonetheless, the market is required to develop by 189% in 2009 so there ought to be space for extra items. The principle rivalry in the market is from Asus whose nearest item by correlation is the Asus EEE PC 1005HA Seashell Netbook. This item is simply over a large portion of the normal cost of the Nokia 3G Booklet and has nearly precisely the same particulars. For example, both netbooks have a 1GB of RAM memory. The significant expense tag on the Nokia 3G Booklet additionally carries the PC into rivalry with journal PCs which have a lot higher particulars even still is a significant expense by correlation. Nokia have likewise re-named their item as a â€Å"Booklet† to separate itself from the opposition. Nokia hopes to copy the accomplishment of Apple by breaking into the market as a top notch quality item. Apparently Nokia have intentionally planned the item to impersonate the highlights of the Macbook and along these lines introducing a superior quality because of the effectively seen nature of Apple. The fundamental issue for Nokia is they have focused on an exceptional market for PCs. This proposes on the off chance that the client was going to purchase a top of the line item, at that point they will spend an extra  £200 to buy an Apple Macbook, which as of now has a colossal name for itself as far as quality. Danger of new Entrants The Nokia 3G Booklet is another contestant into the scratch pad advertise. Danger of new Substitutes There have been gossipy tidbits as of late of an Apple Macbook Touch which is in a similar value district as the Nokia 3G Booklet. This item is basically a touch screen Apple Macbook. This innovation has just been executed into Apples iphone; which was an enormous merchant. For clients searching for a PC, they might be happy to trial and buy this new item from Apple in light of the quality of the brand. This would diminish the quantity of clients of Nokia generously if the item were to get on. Bartering intensity of providers Key parts which are utilized to create the Nokia 3G Booklets might be genuinely restricted, particularly since the contenders are likewise hoping to purchase similar materials. Bartering intensity of clients If the Booklets would not be as well known as recently expected, all things considered, Nokia would diminish the cost of the item. 4.3 The Internal Environment Representatives Nokia may battle sooner rather than later as late news has risen that the organization intends to lay off 550 representatives working in the innovative work branch of the organization. This could bring about the organization being substantially less inventive in delivering new items. 5. Ends The SWOT examination (see index 3) for the Nokia 3G Booklet shows that the items principle quality is its image name and faithfulness picked up from its huge nearness in the cell phone advertise. The organization can likewise be viewed as being creative with its new GPS, 3G and SMS capacities being incorporated into the machines. The quantities of netbooks being sold are anticipated to develop in the following not many years, allowing Nokia the chance to set up itself in the PC showcase. Apple, Acer and Asus are the fundamental current contenders to Nokias new item. Acer and Asus seem, by all accounts, to be focusing on the low finish of the PC market and Apple the high finish of the range. This leaves a hole in the market for Nokia to target buyers who wish a superior quality item with a superior brand name than Acer and Asus, however who would prefer not to follow through on the greater expense of a Macbook. Accordingly, from the contentions drawn up from this report for and against the reasonable hood of progress for the Nokia 3G Booklet; the item is probably going to be an accomplishment in the UK showcase, with the following area giving suggestions concerning how Nokia could expand its odds of achievement. 6. Proposals The Nokia 3G Booklet is a newcomer to the PC showcase and accordingly can't depend exclusively upon its solid image picture to succeed. This report suggests the accompanying activities all together for the item to be increasingly fruitful in the UK showcase: Nokia should bring down the cost of the pr

Sublayers of the Data Link Layer Essay Example for Free

Sublayers of the Data Link Layer Essay

Harlem Renaissance Essay

I. Presentation The Atlantic slave exchange caused the enormous development of Africans across various pieces of the world to a great extent in the Americas, Europe, and Asia. This African Diaspora realized eleven million of dark individuals in the New World (P. Larson. â€Å"Reconsidering Trauma, Identity, and the African Diaspora: Enslavement and Historical Memory in Nineteenth-Century Highland Madagascar†). The relatives of those that were acquired the Americas, predominantly those in the United States filling in as slaves in the south, later encountered another diaspora: moving from the south toward the north to get away from the hardships achieved by exceptional racial separation. A huge segment had settled in the city of Harlem, New York City which opened up a flood of phenomenal imaginative works done by blacks and became stylish for quite a while. This period came to be known as the Harlem Renaissance, likewise differently known as the New Negro Movement, or the New Negro Renaissance. This was a time of exceptional inventiveness communicated in visual expressions, works, and music during this enormous development of dark populace, wherein the African-American Diaspora has moved into bigger urban communities. It changed the character of dark American fine arts, from regular impersonations of white specialists to complex investigations and articulations of dark life and culture that uncovered and invigorated another certainty and racial pride. The development focused in the tremendous dark ghetto of Harlem, in New York City, in this way the name of the development. Harlem turned into the spot of social occasion for hopeful dark specialists, journalists, and artists, sharing their encounters and giving common consolation to each other. The term Harlem â€Å"Renaissance† is a misnomer. Whenever estimated by amount alone, it was more a birth than a â€Å"rebirth†, for at no other time had such a significant number of dark Americans created so much abstract, aesthetic, and insightful material simultaneously. Whenever estimated by quality, be that as it may, it was really a continuum, the stimulating of a vivacious stream took care of before by the significant works of artist Paul Laurence Dunbar, author and short story essayist Charles W. Chestnutt, artist and writer Hames Weldon Johnson and the articles of Du Bois. The Harlem Renaissance made a noteworthy forward leap, wherein it denoted the first run through wherein scholarly and imaginative works done by African Americans picked up in national consideration and intrigue. Entryways of chances were opened for such attempts to be promoted and introduced to the overall population, which before were unrealistic. Despite the fact that its fundamental accomplishment is found principally in writing, it likewise bore the incomparable African-American works in governmental issues and other imaginative mediums, for example, visual craftsmanship, music, and theater that investigated various parts of dark American life (R. Twombly. â€Å"Harlem Renaissance†). II. Foundation and Discussion During the early piece of the 1900s, Black Nationalism and racial awareness started to develop especially during the 1920’s. One key factor that helped this improvement was the surfacing of the dark working class, which thus were achieved by the expanding number of instructed blacks who had discovered business openings and a specific level of financial progression after the American Civil War (â€Å"Harlem Renaissance†). During World War I, a great many dark individuals left the discouraged rustic South for employments in northern protection plants. Known as the Great Migration, progressively African Americans built up themselves in urban communities, for example, Harlem, in New York City. They were socially cognizant, and turned into a focal point of political and social improvement of the dark Americans. This populace made racial pressures over lodgings and business that brought about expanded dark militancy about rights, including vivacious tumult by the national Association for the Advancement of minorities People (NAACP) and other social liberties associations. Preeminent for this dark movement’s plan, which was communicated in different mediums, is to uproar for racial correspondence. Advocating the reason were dark savvy people W.E. B. Du Bois and Alain Locke. White reactions to these advancements were both negative and positive. The Ku Klux Klan and other racial oppressor bunches arrived at their pinnacle of northern fame during the 1920’s. Simultaneously remarkable white enthusiasm for racial maters made an enormous crowd for dark creators who started to settle in the area of New York City known as Harlem. Like other dark ghettoes, Harlem was another, undiscovered wellspring of subjects and materials, which incompletely represents its prevalence among specialists and learned people, yet not at all like different ghettoes it was a recently developed, chic, private area. Working as a sort of dark mecca, Harlem’s brilliant lodging, its esteem, energy, and cosmopolitan flavor, pulled in a dark white collar class from which sprang its aesthetic and artistic set. A. General Characteristics Not all works during this development is activist in nature. Be that as it may, members and donors in the Renaissance were strongly race-cognizant, glad for their legacy of being dark, and much enamored with their locale. The greater part of them, some more unobtrusively than others, condemned racial abuse. Halfway as a tribute to their accomplishments and mostly as an impression of their racial mindfulness, the Renaissance individuals were aggregately called â€Å"New Negroes†, likewise showing that they had supplanted the (to a great extent white made) artistic picture of the comic, unfortunate manor Negro with the pleased, occupied, autonomous dark man of the northern city. The â€Å"New Negroes† were for the most part integrationists, hopefully deciphering their own individual victories as harbingers of progress in race relations. Acknowledgment from Harpers, Harcourt, Brace, Viking, Boni and Livewright, Knopf, and other bleeding edge distributers started coming through brisk progression, boosting more positive thinking among African-American supporters of the Harlem Renaissance. As opposed to delineating another development of style, the craftsmanship during the Harlem Renaissance is joined by their regular yearning of portraying and communicating in imaginative structure the African-American mind and life. Regular qualities can be found among such works, for example, the introduction of racial pride among dark Americans. This called for following its underlying foundations and cause by taking consideration and enthusiasm to the life of blacks basically in Africa and South America. Likewise, such solid social and racial awareness got a powerful urge for fairness the American culture, both socially and strategically. Be that as it may, one of the most widely recognized and critical trait of the Harlem Renaissance was the copious creation of an assortment of inventive articulations. Assorted variety was the principle particular quality, achieved by a trial soul of the development, for example, in music which went from blues, jazz, to ensemble music. B. Essential Artist of the Harlem Renaissance:â Aaron Douglas (1898-1979) The commended craftsman of the Harlem Renaissance was Aaron Douglas, who decided to delineate the New Negro Movement through African pictures which bore â€Å"primitive† procedures: artworks in geometric shapes, level, and rough edges. In his works, Douglas needed the watchers to know and perceive the African-American character. All things considered, Aaron Douglas is frequently alluded to as the â€Å"Father of African American Art†. Conceived in Topeka, Kansas, Douglas had the option to complete his B.A degree. Moving to Harlem in 1925, Aaron quickly set to work, making delineations for conspicuous magazines of the Harlem Renaissance. Douglas was impacted in his pioneer style under the tutelage of German craftsman Winold Reiss, a style which checked a large portion of his praised works and joining both African and Egyptian strokes of outline and structure. It was Reis who urged Douglas to bring African structure into his works which turned into his trademark (â€Å"The Harlem Renaissance: Aaron Douglas†). Such way of African â€Å"primitive† style grabbed the eye of the principle defenders of the Harlem Renaissance, to be specific W.E.B. Dubois and Alain Locke who discovered Douglas’ functions as a fitting exemplification of the African-American legacy. They were urging youthful specialists to portray their African inheritance through their works of art. Despite the fact that when DuBois stilled considered Henry Tanner progressively significant, Douglas has genuinely settled a notoriety for being the main visual craftsman of his time. Harlem Renaissance painters are joined by the craving to advance and depict the life and state of blacks, especially African-Americans. Be that as it may, now the similitude closes. Harlem Renaissance works of art are as changed in style as the specialists themselves. Albeit like Douglas, most painters of this period got formal trainings and all things considered, their style and strokes are the same as other non-dark specialists. What just separate the specialists of the Harlem Renaissance from others are their topics and subjects. III. End A. Closure and Significance As an end, one of the qualities of the Harlem Renaissance was likewise a genuine shortcoming. Since they were reliant on white benefactors and watchers for prevalence, dark specialists were not completely allowed to investigate the systems that executed racial bad form, nor might they be able to propose arrangements unsatisfactory to whites. Besides, when the Great Depression commanded American life during the 1930’s, the whites, who had been the heft of the Renaissance crowd, focused on financial aspects and governmental issues, neglectful of dark American torment. American expressions and letters took up new topics, and in spite of the fact that the best specialists kept on working, they at last lost notoriety. The Great Depression drove many dark specialists to dissipate; and were generally driven away from New York or to take different employments to hold them over the hard tim

Saving for College You Could Win $500!

The College Savings Foundation (CSF) is running a new contest this January and February for families who use 529 plans. To enter, simply share a video that tells your college savings story on Facebook, Twitter, YouTube or Instagram using hashtag #CSF529story. One lucky winner will be selected at random to receive a $500 GiftofCollege card to be applied to a 529 account. Januaryï ¿ ½s theme: A resolution you can keep ï ¿ ½ what changes did you make in your life in order to put money away/save regularly in a 529 plan? And what kept you going? To be eligible for the drawing, entries must be received by January 31, 2016 EST. To enter and read the official rules, visit https://new.collegesavingsfoundation.org/csf-video-contest/ Not saving with a 529 plan yet? Get started today! 529 college savings plans offer tax-free earnings and tax-free withdrawals when the funds are used to pay for qualified higher education expenses, which now include laptops. Whatï ¿ ½s more, your state may offer additional benefits such as a tax deduction or credit for contributions, or matching grants. Not sure what your child will end up doing after high school? 529 plans can be used to pay tuition at public and private four-year schools, community college, vocational schools, international schools and even some gap year programs. Find out if a school is eligible here. While your home state may offer perks for residents who invest with their 529 plan, you have the option of enrolling in almost any stateï ¿ ½s plan. Compare plan details here. RELATED: 5 simple steps to enrolling in a 529 plan. The College Savings Foundation (CSF) is running a new contest this January and February for families who use 529 plans. To enter, simply share a video that tells your college savings story on Facebook, Twitter, YouTube or Instagram using hashtag #CSF529story. One lucky winner will be selected at random to receive a $500 GiftofCollege card to be applied to a 529 account. Januaryï ¿ ½s theme: A resolution you can keep ï ¿ ½ what changes did you make in your life in order to put money away/save regularly in a 529 plan? And what kept you going? To be eligible for the drawing, entries must be received by January 31, 2016 EST. To enter and read the official rules, visit https://new.collegesavingsfoundation.org/csf-video-contest/ Not saving with a 529 plan yet? Get started today! 529 college savings plans offer tax-free earnings and tax-free withdrawals when the funds are used to pay for qualified higher education expenses, which now include laptops. Whatï ¿ ½s more, your state may offer additional benefits such as a tax deduction or credit for contributions, or matching grants. Not sure what your child will end up doing after high school? 529 plans can be used to pay tuition at public and private four-year schools, community college, vocational schools, international schools and even some gap year programs. Find out if a school is eligible here. While your home state may offer perks for residents who invest with their 529 plan, you have the option of enrolling in almost any stateï ¿ ½s plan. Compare plan details here. RELATED: 5 simple steps to enrolling in a 529 plan.

Women and the MBA

May God Have Mercy (John C. Tucker) A True Story of Crime...

A true story of how a man was tried, convicted, and sentenced to death, May God Have Mercy exposes the imperfections in the criminal justice system and how it led to the death of an innocent man. Roger Colemans case became the main story on nightly newscasts and prominent television shows such as Larry King Live, Nightline, Good Morning America, and the Today Show. Many crucial, yet harmful decisions were made that ultimately resulted in an innocent mans execution at the death house in Greensville, Virginia. The police, the prosecutor, and the Judge can all be held responsible for Colemans death. However, the reason Roger Coleman was not acquitted of the murder of Wanda McCoy in the first place and thus in a position to be executed was†¦show more content†¦Like any other criminal case, the burden of proof lies with the prosecution. They are required to prove beyond a reasonable doubt that the defendant committed the crime. Mickey McGlothlin presented an organized and persuas ive opening statement that gave the jury the impression that Roger Coleman was guilty based on the significant amount of evidence against him. The defenses opening statement should have attacked the evidence that the state provided, and also attacked McGlothlins credibility. The defenses opening statement should have consisted of a description of the friendly relationship that existed between Roger Coleman and the McCoys. It also should have also included Colemans alibi--Philip VanDyke--and the fact that VanDykes time card reinforces the time that he said he was with Coleman and the time that he clocked into his job. Arey and Jordan also had an opportunity to smear McGlothlins credibility by referring to evidence that he failed to mention in his opening argument--the pry mark on the door, the broken fingernails on the victim but no scratches on Coleman, and that the substance found on the victim was soil, not coal dust, which had been on Colemans clothes. The defense counsel didnt refer to any of those facts. No scientific evidence was brought up, and it failed to respond to McGlothins statement that there was evidence that Coleman had in fact admitted to committing the crime. The opening statement was a completeShow MoreRelatedLogical Reasoning189930 Words   |  760 Pages and the relevant page numbers (but not in any way that suggests that the book Logical Reasoning or its author endorse you or your use of the work). (2) Noncommercial You may not use this work for commercial purposes (for example, by inserting passages into a book that is sold to students). (3) No Derivative Works You may not alter, transform, or build upon this work. An earlier version of the book was published by Wadsworth Publishing Company, Belmont, California USA in 1993 with ISBN numberRead MoreOne Significant Change That Has Occurred in the World Between 1900 and 2005. Explain the Impact This Change Has Made on Our Lives and Why It Is an Important Change.163893 Words   |  656 PagesE SSAYS ON TWENTIETH-C ENTURY H ISTORY In the series Critical Perspectives on the Past, edited by Susan Porter Benson, Stephen Brier, and Roy Rosenzweig Also in this series: Paula Hamilton and Linda Shopes, eds., Oral History and Public Memories Tiffany Ruby Patterson, Zora Neale Hurston and a History of Southern Life Lisa M. Fine, The Story of Reo Joe: Work, Kin, and Community in Autotown, U.S.A. Van Gosse and Richard Moser, eds., The World the Sixties Made: Politics and Culture

Applied Research Evidence Based Practice

Question: Discuss about theApplied Research for Evidence Based Practice. Answer: Introduction The assignment deals with the infection prevention control practice. The nursing issue dealt in this study include Use of best hand hygiene practice to prevent infection. The essay provides brief background of the issue. It explains the search strategy used for selecting the articles for the study. The level of evidence for each of the article is identified. Further, for each of the articles the practical recommendations in the health care setting are discussed and it is determined in the essay if the recommendations are applicable in the health care setting of New Zealand. By effectively communicating the findings of the study it is possible to directly influence the changing behaviours of the health care workers and to promote improved hand hygiene in New Zealand. The demand for Evidence Based Practice (EBP) is accelerating over time. The purpose of this study is to develop research skills and implement EBP. EBP is the process of using current best evidence explicitly and judiciously to make decisions about individual patient care (LoBiondo-Wood et al., 2013). The purpose of EBP is to integrate clinical opinion into practice to provide high quality of services taking into account the needs, values, choices and interests of the patients (Schneider Whitehead, 2013). Integrating best evidence into the clinical expertise will assist in using modern day practices to deliver client focused care. Background of the Nursing Issue Hand hygiene practice is crucial for the heath care workers. They frequently are exposed to opportunistic pathogens such as Clostridium difficle, Candida spp. (that can survive for as long as 150 hours) which cause severe nosocomial infections (Guilhermetti et al., 2010). Presence of multi-drug resistant pathogens (S. Aureus) increases the rate of nosocomial infections and complexity of treatment. Therefore, Nurses and doctors must strictly adhere to the hand hygiene guidelines for preventing the outbreak of infectitious diseases as it is recognised to be the most effective method (Guilhermetti et al., 2010). Inaccessibility of the hand hygiene products or skin irritations acts as a barrier to maintain hand hygiene. The key problem is the use of effective hand hygiene method to prevent the infection as well as enhance the adherence to hand-hygiene practice recommendations. Therefore, the study aims to investigate how does hand?washing compare with use of gel preparation? Search Strategy The articles were selected with the objective of identifying published randomised journals and other research papers related to hand hygiene in the health care setting using gel based preparation. For the purpose of literature review the standard search strategy is used that involves use of five databases CINAHL, Cochrane Library, Google Scholar, Medline, and PubMed. Focus was mainly on the articles that gave primary data from randomised control trials and few systematic reviews were include to identify any additional information on the topic. The inclusion criteria was to consider articles published between 2006-2016 that describes prevention of infection while comparing hand washing to the gel based preparations. Articles that are published in English are selected for the study. Articles that were not meeting the inclusion criteria were excluded. Initially the articles were screened on the basis of the abstracts followed by full text review. The search terms used for article select ion are: hand hygiene, hand disinfection, hand washing, alcohol-based hand gels, nosocomial infections, health care associated infections, efficacy of hand gel in critical care unit, effectiveness of hand washing in surgical hand preparation, efficacy of soap and water in hand disinfection, compliance prevention, patient safety EBP is ranked by the way the evidence was collected. The example of a hierarchy system is given below: (Polit Beck, 2008) Level 1: Systematic reviews of randomized and non-randomized clinical trials Level 2: Single randomized and non-randomized clinical trials Level 3: Systematic review of correlational and observational studies Level 4 Single correlational and observational studies Level 5: Systematic review of descriptive, qualitative, and physiologic studies Level 6: Single descriptive, qualitative, and physiologic studies Level 7: Opinions from authorities, and expert committees Critical Analysis of the Practice Based Recommendations A total of 13 articles were selected that provides evidence supporting the clinical question related to hang hygiene. The first article, a systematic review,( in level 1) by Fung Cairncross, (2006) provided an evidence of effectiveness of hand washing in preventing the transmission of severe acute respiratory syndrome. The study provided no detectable difference in effectiveness of soap and gel based hand rub. Ejemot?Nwadiaro et al., (2008) in level 1 evaluated that the efficacy of hand washing intervention on preventing diarrhoea. This study described that hand washing practice is effective in reducing episodes of diarrhoea by about one-third. Moreover, this system is effective in low income areas. However, significant reduction is comparable to the effect of providing clean water in low-income areas. Traore et al., (2007) has conducted a prospective intervention study (in level 2) to assess the efficacy of the gel formulation in increasing hand hygiene compliance during patient care. The quantitative study compare between liquid and gel based formulation in regards to acceptability and skin toler ance among users. The findings showed that the hand washing with gel-based formulation was more effective than liquid formulations. It also demonstrated that easy accessibility to alcohol-based gel formulation increased the adherence to hand hygiene guidelines. The gel-based formulation was better accepted and had better skin condition then the other counterpart. However, it did not investigate the difference in infection rates using these formulations. These results have produced valuable information that gel based product was effective in maintaining nurses compliance to the hand hygiene. The prospective controlled, cross-over trial (level 2) by Rupp et al., (2008) conducted in two medical-surgical ICUs also monitored the efficacy of alcohol-based hand gel in preventing nosocomial infections and hand hygiene adherence. The results of this quantitative study showed a significant improvement in the rate of hand hygiene adherence (from 38% to 68% in both ICUs) among all the health ca re workers. This gel lowered the number of absolute microbes on hands. Increased number of microbes in some cases of culture study was attributed to inaccessibility to gel and longer fingernails. However, the study could not better delineate the relationship between the hand hygiene and the nosocomial infections. Guilhermetti et al., (2010) conducted a quantitative study (level 2) to investigate the efficacy of twelve of alcohol-based hand gels produced in Brazil. The gels were compared to the reference solution (2-propanol) from the EN 1500. In the study, 10 out of 12 gels were approved within application time of 60s. The study results recommend the use of alcohol based gel in the hospital settings. Among these gels, Sterillium Gel was best, with the capacity to reduce 90% of the E.coli populations within 60s more than the reference alcohol. Three of the gels were as 70% effective in removing S. Aureus and Candida albicans from highly contaminated hands. The single observational st udy in level 4 by Kampf, Hollingsworth (2008) also evaluated the bactericidal activity of sterilium (hand gel) as well as the time of its action on different microorganisms. The results showed that the gel has broad spectrum antibacterial activity and works within 15 seconds of applications. It is active against most common species under the category of causative agents of nosocomial infections as well as other emerging pathogens. The randomised trial in level 2 by Liu et al., (2010) demonstrated that liquid soap treatment and water rinse was effective hand hygiene practice in reducing the genomic copies of Norwalk virus on human finger pads. The study also demonstrated that alcohol based sanitizers were relatively ineffective in controlling the pathogen transmission particularly virus. The cluster-randomised, crossover trial in level 2 by Nthumba et al., (2010) compared the efficacy of the hand washing with soap and water versus alcohol based rub for surgery preparation. The study described the feasibility and affordability of alcohol-based hand rubs for hand preparation before surgery. It is effective in preventing surgical site infections in comparison to hand washing with soap and water in clinical settings without continuous supply of clean water. However, the study did not show any significant statistical difference in rate of infection in soap versus alcohol based rub hand washing. Gerding et al., (2008 ) in the single descriptive study (level 6) have described that hand wash using soap and water is effective in preventing and controlling the Clostridium difficile infection (CDI). It has also described that hand hygiene with gel based preparation was ineffective in controlling CDI. The randomise trial by Sasahara et al., (2014) in level 2 determined the appropriate procedure of hand hygiene for controlling nosocomial Bacillus cereus. The results demonstrated that the soap washing procedures were highly effective as it decreased the number of B. Cereus spores b y more than 2 log10. The other procedures such as use of alcohol based gel, liquid, were not as effective as soap and water treatment. Similar study was conducted by Ji Jeong, (2013) which is also under level 2 demonstrated that the efficacy of different types of alcohol gel in eliminating pathogens according to their amount and drying time. The results demonstrated that only alcohol gel hand hygiene with adequate amount of (2mL) and complete dry (30 seconds rubbing followed by 2 min air-dry),were effective in disinfecting microorganisms and it was also considered satisfactory by the U.S. FDA-TFM efficacy requirements for antiseptic hand hygiene products. Therefore the study recommends the use of this type of gels in health care setting. Erasmus et al., (2010) conducted a systematic review (level 5) on observed or self reported hand hygiene compliance rates in hospitals. The results indicated that the compliance rates were higher when nurses performed dirty tasks and were given greater access to the gel based preparation. The review by Kampf Loeffler, (2007) in level 7 on hand hygiene practices described that the low compliance rate of hand hygiene among the heath care workers is due to hand washing. Use of soap and water often causes skin irritations and dermatitis. As per the review, hand washing is less effective when compared to the gel based preparations and other alcohol based hand rubs for disi nfecting hands. Gel based and other alcohol based hand hygiene is useful to prevent irritant contact dermatitis. Thus, the literature indicates that both hand washing and use of gel-based preparation were effective in prevention of infections in healthcare setting. The studies of (Traore et al., 2007; Rupp et al., 2008 and Guilhermetti et al., 2010, Ji Jeong, 2013 in the level of evidence 2 and Kampf, Hollingsworth 2008 in level 4) have been more specific in recommending the use of gel based preparations for maintaining hand hygiene in clinical settings for their efficacy in controlling pathogen transmission. According to Polit Beck, (2008) the articles belonging to level 1 and 2 are of best quality and should be given first preference as these studies does not contain major flaws and conclusions are well drawn. Therefore, gel based preparation can be recommended for use in New Zealands health care setting. However, the study of Fung Cairncross, (2006) in level 1 on hierarchical system of evidence cannot be recommended as the quality was low and the results were not conclusive. Hand washing can be recommended in New Zealand on the other hand based on Ejemot?Nwadiaro et al., (2008) also in level 1. The information from this study suggests strict adherence to hand washing practices for preventing infections which will also be applicable in New Zealands health care setting. The study by Liu et al., (2010) and Sasahara et al., (2014) both in level 2 was contradictory to these studies as it demonstrated that hand washing soap and water is more effective in pathogen control. It showed that the hand sanitizers or alcohol based gel rub were not effective in controlling viral population on the human fingers. On the other hand, Nthumba et al., (2010) in level 2 recommends hand washing with soap and water to be more effective in disinfecting viruses. Gerding et al., (2008) in level 6 recommends hand washing with soap and water to be effective in disinfection of CDI. In addition, according to Kampf Loeffler, (2007) hand washing is associated with skin irritations and decrease in the rate of compliance to hand hygiene practice but it cannot be considered a reliable information as according to Polit Beck, (2008) the level of evidence is low for this study. In conclusion, hand wash using both the soap and water as well as gel based preparation is recommended for New Zealands health care setting. It was found from the critical review of 13 articles that both hand wash and gel based preparation are equally effective in preventing nosocomial infections. Both have the efficacy to remove viruses as well as spores. However, I would personally give a special preference to gel based hand hygiene preparation. In case of gel base preparation Sterillium is particularly recommended to be used as two high level of evidence has been found that have proved its effectiveness against broad-spectrum of bacterial activity and acts in a short span of time that is 15 secs. This short time of application and high level of efficacy of the gel if used in hospital setting would increase the compliance and adherence to hand hygiene guidelines and prevent major outbreak of infectitious diseases. Moreover, there is more evidence on recommendations for gel based ha nd hygiene practice compared to hand washing. The gel will be useful for hospitals in rural areas lacking supply of clean water. Hand washing would be better to prefer when hands are visibly soiled. References Ejemot?Nwadiaro, R. I., Ehiri, J. E., Meremikwu, M. M., Critchley, J. A. (2008). Hand washing for preventing diarrhoea.The Cochrane Library. Erasmus, V., Daha, T. J., Brug, H., Richardus, J. H., Behrendt, M. D., Vos, M. C., van Beeck, E. F. (2010). Systematic review of studies on compliance with hand hygiene guidelines in hospital care.Infection Control Hospital Epidemiology,31(03), 283-294. Fung, I. C. H., Cairncross, S. (2006). Effectiveness of handwashing in preventing SARS: a review.Tropical Medicine International Health,11(11), 1749-1758. Gerding, D. N., Muto, C. A., Owens, R. C. (2008). Measures to control and prevent Clostridium difficile infection.Clinical Infectious Diseases,46(Supplement 1), S43-S49. Guilhermetti, M., Wiirzler, L. M., Facio, B. C., da Silva Furlan, M., Meschial, W. C., Tognim, M. B., ... Cardoso, C. L. (2010). Antimicrobial efficacy of alcohol-based hand gels.Journal of Hospital Infection,74(3), 219-224. Ji, Y. J., Jeong, J. S. (2013). Comparison of Antimicrobial Effect of Alcohol Gel according to the Amount and Drying Time in Health Personnel Hand Hygiene.Journal of Korean Academy of Nursing,43(3). Kampf, G., Hollingsworth, A. (2008). Comprehensive bactericidal activity of an ethanol-based hand gel in 15 seconds.Annals of clinical microbiology and antimicrobials,7(1), 1. Kampf, G., Loeffler, H. (2007). Prevention of irritant contact dermatitis among health care workers by using evidence-based hand hygiene practices: a review.Industrial health,45(5), 645-652. Liu, P., Yuen, Y., Hsiao, H. M., Jaykus, L. A., Moe, C. (2010). Effectiveness of liquid soap and hand sanitizer against Norwalk virus on contaminated hands.Applied and environmental microbiology,76(2), 394-399. LoBiondo-Wood, G., Haber, J., Berry, C., Yost, J. (2013).Study Guide for Nursing Research: Methods and Critical Appraisal for Evidence-based Practice. Elsevier Health Sciences. Nthumba, P. M., Stepita?Poenaru, E., Poenaru, D., Bird, P., Allegranzi, B., Pittet, D., Harbarth, S. (2010). Cluster?randomized, crossover trial of the efficacy of plain soap and water versus alcohol?based rub for surgical hand preparation in a rural hospital in Kenya.British Journal of Surgery,97(11), 1621-1628. Polit, D. F., Beck, C. T. (2008) Nursing research: generating and assessing evidence for nursing practice Eighth Edition. Lippincott Williams Wilkins. Philadelphia, Pa. Rupp, M. E., Fitzgerald, T., Puumala, S., Anderson, J. R., Craig, R., Iwen, P. C., ... Sholtz, L. (2008). Prospective, controlled, cross-over trial of alcohol-based hand gel in critical care units.Infection Control Hospital Epidemiology,29(01), 8-15. Sasahara, T., Hayashi, S., Hosoda, K., Morisawa, Y., Hirai, Y. (2014). Comparison of hand hygiene procedures for removing Bacillus cereus spores.Biocontrol science,19(3), 129-134. Schneider, Z., Whitehead, D. (2013).Nursing and midwifery research: methods and appraisal for evidence-based practice. Elsevier Australia. Traore, O., Hugonnet, S., Lbbe, J., Griffiths, W., Pittet, D. (2007). Liquid versus gel handrub formulation: a prospective intervention study.Critical Care,11(3), 1.