Zenecas DTC Advertising of Nolvadex Essay Example for Free

Zenecas DTC Advertising of Nolvadex Essay Zeneca is largest pharmaceutical and agricultural/industrial chemical company in United States. In 1999 breast cancer was the most frequent diseases were found in American women, about 175,000 cases of breast cancer were diagnosed and about 43,500 women were died due to the breast cancer. According to the breast cancer prevention trial (BCPT), 45% reduction in breast cancer cases came through the use of Nolvadex. In November 1998 due to the new indications from the Food and Drug Administration (FDA) for the use of Nolvadex, Zeneca had decided to start direct to consumer advertisement campaign for Nolvadex. Findings In finding report will find over all performance of Zenecas advertisement campaign. This report will also look at the ethical issues which were raised in the case study, issues which were raised by activist groups and recommendations for managing the activists protests. 1. 1-Uncertainties from medical o Lack of sufficient data form breast cancer preventing trial physicians were worried about the side effects of Nolvadex, because the women who have high risk of breast cancer who might die if they do not take drug but for healthy women Nolvadex were not suitable from their point of view. According to physicians past experiences, Nolvadex lowered the breast cancer risk in women age 35 or more but increase the risk of other diseases in healthy women like endometrial cancer and other minor side effects like blood clots in the legs and lungs, hot flashes flushing, irregular menstrual periods, dizziness, headaches, fatigue, loss of appetite, vomiting and irritation of skin around the vagina. o Same studies like breast cancer preventing trial came from British and Italian studies which failed to show that tamoxifne was associated with a cancer risk reduction benefit They give assurance that women can both learn and control their risk, when, in fact, the risk model that is being promoted by Zeneca has been rightfully criticized by biostatisticians. The drug that Zeneca is promoting is one whose short tern benefits in healthy women are in question, and whose long term risks among healthy women are still unknown. o Some doctors were argued that side effect was too serious to prescribe for women who did not have breast cancer. They were asking to add more advisability of using the drug to lower the risk of breast cancer. These physicians wanted to wait for more data regarding Nolvadex and comparing trial of Nolvadex with Eli Lillys Evista which some believed that safer then Zenecas Nolvadex. 1. 2-Uncertainties from regulatory o According to Food and Drug Administration (FDA) there were some problem with exact language that contained in the new labelling e. g. Zeneca wanted to use word Prevention for describing the Nolvadex but FDA was not agree because labelling was lack of enough data on what happened to the women in the study after five years of treatment FDA was disagreed with Zenecas ads. because they were lack of brief summary regarding the risk and other information about Nolvadex. They wanted to disclose those information in advertising campaign o Zeneca had made the video for unbranded advertisement which was included full information of breast cancer and about Nolvadex but FDA had argued that video was heavily branded and lack of fair balance between benefits and risks of Nolvadex o Zeneca was required to include a four-part disclaimer (including side effects) when ever the word Nolvadex comes in video FDAs Division of Drug Marketing, Advertising and Communication (DDMAC) reviewed the information material in advertising campaign and determine that they are false or misleading and lacking fair balance and they are full of product and in violation of the Act for the above reasons o Zeneca was failed to discuss the Gail Model Risk Assessment Tool in the print advertisement or brochure which damage the importance of an accurate risk assessment and side effects. Due to lack of mortality data FDA approved the Nolvadex for women at high risk of breast cancer but did not approved it for use as a breast cancer prevention agent and they refer Nolvadex as a risk reduction therapy 1. 3-Zenecas decisions on DTC campaign When Zeneca decided to do the DTC campaign for Nolvadex, they had done some research before advertising campaign but this research only focusing on womens thinking about breast cancer. They did not involve patients, physician, advocacy group and activist groups in ad campaign. Another draw back came from The Food and Drug Administrations regulation and guide lines which were keep changing during the development of direct to consumer advertising campaign. FDAs guide lines were influencing the Zenecas decisions on advertisement campaign. They were trying to follow FDAs regulations but other side they had ignored physicians and activist groups during the development of DTC advertisement campaign and later Zenecas campaign was concern by these independent groups. They had tried to make branded ad but due to the regulatory it was required full information regarding drug. They were feared that if they disclosed the information regarding drugs benefit and risk it would affect the advertisement effectiveness. Thats why they decided not do the branded advertisement. Zenecas unbranded advertisement was less concern by regulatory in terms of disclosing drugs information but more concern by activist groups because of incomplete information. Also assumptions in advertisement were not appropriately taken into consideration e. g. women care their body shape more then health or you can only get breast cancer if you have family history which were concerned by regulatory and activist groups. In brief Zeneca had taken inappropriate decision regarding DTC advertisement campaign. They did not involved patients, physicians, distributors and advocacy groups before developing DTC campaign. They had followed the rules and regulations of FDA but failed to take physicians, patients and activist groups in confidence.

Transferring Capital Or Funds From Savers To Borrowers

Transferring Capital Or Funds From Savers To Borrowers The financial institution is the process to provide the financial service to the people. It can also say is the institution collecting the funds from the public into the financial assets. It also verifies by the government, so it is safe for the people to using. The main function of the financial institution transfers the capital between savers and those who need capital. The financial activities and function provide by the financial institution are bonds, debentures, stocks, loans, risk diversification, insurance, hedging, retirement planning, investment, portfolio management, and many other types of related functions. The way use by financial institution to transfer the fund can be defined by 3 ways; there are direct transfers, indirect transfer and financial intermediaries. The first way of a financial institution is Direct transfer can also call ask direct transfers of money and securities. Direct transfer means the organization sells its stocks or bond directly to savers and without any type of financial institution. For example, the party A and B is the relatives and the parties A want to transfer the money to invest the party B organization by using direct transfer; it is without any financial institution or financial market so this is call direct transfer. The advantage of direct transfer is saving the money, it because using direct transfer is without any taxable. Direct transfer is without any taxable because direct transfer is a process straight transfers the money to other account and is wont going through any financial institution so the government will not charge the tax because government is not know about it. The disadvantage of using direct transfer is complex. It is possible become complex because direct transfer is making by the two part y without any financial institution and it not have the professional person to help properly transfer the money and making the agreement, so in future maybe will happen conflict between the parties. The second way for transferring capital or fund from savers to borrowers in the financial market is indirect transfer by using banking house. Indirect transfer is a process to transfer the capital or funds through the financial institution such as investment banking house. Investment banking house is like the agency to help the organization to transfers the bond or stock into the money. It normally use by an organization that underwrites and distributes new investment securities to help the organization obtain their financial. An underwriter serves as a middleman and facilitates the issuance of securities to the investor. For example, an organization sells the stocks or bonds to the investment bank and investment bank sells these same securities to the savers. The advantage of this financial institution is more efficient and fast to transfer the bond or stock into the financial assets. It is because investment bank has required the professionals to given the organization accurate information and help organization to make the transfer process more efficient and wont getting problem. The disadvantage of investment banking house is need to spend more time to wait the process done by the investment banking house. It is because company need to waiting the investment banker sell the bond or stock into the money. The banker could not be estimate when can sell the bond and stock to the saver. Next, investment banking house give more confidence to the saver. Investment banker will provide fully information about company to saver review and give professional guideline about the investment to avoid wrong investment. Therefore, the investment risk will decrease and the percentages of faced loss also will be reduce by using the investment banking, but it will increase the cost because need to pay the intermediaries fees. The third way for transferring capital or fund from savers to borrowers in the financial market is indirect transfer buy using financial intermediaries. The indirect financial institution can be separated into three types such as Investment Intermediaries, Contractual Saving Institutions, and Depository Institutions. Financial intermediary is an institution that acts as the middleman between investors and firms raising funds. Financial intermediary will using the funds from the saver to purchase other securities from other organization and hold it for gain the profitability. The three major functions of the financial intermediaries are maturity transformation, risk transformation and convenience denomination. Maturity transformation is converting short term liabilities to long term assets. Risk transformation is converting risky investments into relatively risk-free ones. Convenience denomination is matching small deposits with large loans and large deposits with small loans. Financial intermediaries accept the saver to use the loan or securities to invest their funds. The financial intermediaries will provide the loan plan to the saver to properly using the loan to invest. Financial intermediaries can help to reduce the time. It is because financial intermediaries can transfer the financial assets into the money by the faster way. This is mean financial intermediaries will buy the assets from the customer and sells it in future, so it can reduce the time because some of the assets need longer of period to sell it or transfer into the money. Therefore, some of the people will use financial intermediaries to solve their emergence financial problem. Financial intermediaries can also help the saver to reduce the transaction cost such as consulting fee for getting information. In this situation, financial intermediaries will provide the completely information or professional advice to help the investors making the decision. Financial institution can be separa ted into three types such as Investment Intermediaries, Contractual Saving Institutions, and Depository Institutions. Depository institution is a channel to receive the funds from the public or manage their funds to invest other organization to gain the profit. When gain the profit Depository institution will return some interest to the people who are invest the funds in the depository institution. Depository institution can be defined in few types, there are commercial banks, savings and loan associated credit union and mutual saving bank. Commercial bank is the financial institutions provide the loan, saving, transactional, money market account, insurance, and stock brokerage service to the public. The examples of the commercial bank in the Malaysia are Affin Bank, Arab-Malaysian Banking Group, Bank Simpanan Nasional (BSN), Citibank Malaysia, Exim Bank Malaysia, Hong Leong Bank and other. The advantage of using the commercial bank is the risk is lower. It is because commercial bank has stronger financial background, so it will not easy bankrupt or facing the financial problem such as facing loss in investment. The disadvantage of the commercial bank is the percentage of interest maybe lower than other financial institution. For example, interest rate provide by the insurance institution always higher than the commercial bank. Moreover, a savings and loan association (or SL), also known as a thrift, is a financial institution that specializes in accepting savings deposits and making mortgage and other loans. Mortgage means using the something such as house, land or assets to make the loan with the savings and loan association. If the people cannot pay back the loan, the house will be taken over by the savings and loan association. The advantage of the savings and loan association is interest of saving deposit is higher than the commercial bank. Therefore, people will choose it to saving their money to gain more interest. In the additional, mutual savings bank is also a type of thrift institution. The function just seems like saving and loan associations which obtain the funds from other and make loan such as mortgage loan. Credit union is a non-profit financial institution that is owned and operated entirely by a group of members such as employee. Credit unions provide financial services for their members, including savings and lending. The condition to join a credit union is a person must ordinarily belong to a participating organization. When a person deposits money in a credit union, the person will become the member of the credit union. Last, contractual saving institution is an institution that obtains funds at periodic intervals on a basis contractual. It is normally use for the longer period of time. It is mean if the contract dead line is not yet reach, the saver cannot taking back the money from the contractual saving institution. Contractual saving institution can be defines into two types, there are insurance institution and pension institution. Insurance institution normally provide some of insurance services such as investment insurance, life insurance, endowment insurance, accident insurance and other. Examples of the insurance institution in Malaysia are Potential, AIA, Am insurance, Greaten Eastern and some more. Pension Institution is an associated that collects the funds from the retired person to help them invest the funds and getting back the interest or profit. In conclusion, using indirect transfer way is more efficient and safe then using the direct transfer way. Indirect transfers way have more benefit to the user. It also provides more service to the user. So, based on my opinion, I encourage the people to using indirect transfer way to manage money or making the loan.

Health and safety hazards to workers

Health and safety hazards to workers In Mauritius, we have five regional hospitals namely: SSRNH, Victoria Hospital, Nehru Hospital, Jeetoo Hospital and Flacq Hospital and other small specialised hospitals such as ENT Hospital, Moka Eye Hospital and Brown Sequard Hospital. Each regional hospital consists of a CSSD unit respectively which cater for the provision of sterile items to the hospital and to health centres which falls under the catchment area of that regional hospital. Although, the CSSD is a small unit in that hospital, its presence and service is of great importance to the healthcare staff, patients and to the public in general. The role of the CSSD is to prevent cross- infection and contamination of the patients, staff and visitors by sterilising all equipment and instruments which aid in providing the best care to the patients. It is time to think about the health and safety of the workers of Central Sterile Supply Department (CSSD). In order to protect and to prevent the staff of the CSSD from injuries and illnesses, it is important to identify the health and safety hazards that are present at each level and in each area of the CSSD. After identification of these hazards is carried out, appropriate preventive measures must be adopted if not to eliminate the hazards completely, but at least to minimise the exposure of the staff to these hazards so that they can work in a safer environment free from injuries, accidents and occupational diseases. For the purpose of this project, the Hazard Identification was carried out at the CSSD of SSRN Hospital. Abbreviations CSSD Central Sterile Supplies Department SSRNH Sir Seewoosagur Ramgoolam National Hospital PPE Personal Protective Equipment EtO Ethylene Oxide HIV -Human Immunodeficiency Virus OSHA 2005 -Occupational Health and Safety 2005- HBV Hepatitis B Virus MSD Musculoskeletal Disorders 1.0 INTRODUCTION Hospitals are such places where people get treatment for their illnesses, injuries and diseases. Many of these diseases are caused by biological agents such as bacteria, viruses and fungi. Thus, in hospitals there is high incidence of disease-causing micro-organisms which can spread from patient to patient or from patient to health care personnel or from the equipment and other materials that are used while giving care to the patients. It is the duty of the staff not only to cure the diseases of the patients but at the same time to prevent the transmission of diseases from one person to another. An effective measure to prevent spreading of the diseases is in making sure that all the items that are used in the care of the patients are sterile. Many of the instruments and materials used in the hospitals are quite expensive and are so designed that they can be reused. The importance of a CSSD in a hospital is to provide sterile items at the required time and place in the hospital. The CSSD of a hospital receives stores, sterilises and distributes to all the departments including the wards, outpatient department and other special unit such as the operation theatre. The main duty of the CSSD is the sterilisation of items such as catheters, tubings, surgical instruments, treatment trays and sets and dressings materials. Although, CSSD aims at providing sterile items so as to prevent the spread of infection and in some ways to protect hospital staff and patients from biological hazards, the CSSD itself is prone to various hazards. So, to be able to identify the health and safety hazards that workers face, we must first know the activities that are carried out in the CSSD. 2.0 The objectives of the CSSD: To provide sterile gauze packs cotton wool and equipment to all units of the hospital and to Area Health Centers, and Community Health Centers within the catchment area of a regional hospital. To ensure that proper cleaning, disinfecting and sterilising process of items is being carried out in the department. To keep an inventory of all supplies and equipment. To meet the demand of its customers, i.e. different units in supplying the needed amount of sterile items to them. To contribute to a great extent in preventing cross-infection by effective running of the department. To take some of the work of the nursing staff so that they can give more time to the patients. To make expensive equipment which are not used so often reusable. To provide a safe working environment for the staff. 3.0 The organisational structure of the CSSD at SSRNH: The CSSD has manpower of 26 workers: 1 Superintendent, 2 Supervisors, 17 CSSD Assistants and 6 CSSD Attendants. The Head of the Department is the Superintendent and is the one who liaises with other heads of different departments. The supervisors are responsible for monitoring the duties of the assistants and to ensure the smooth running of the unit. They are also responsible for the effective delivery of sterile items to the required units. The CSSD Assistants are those workers who perform most of the duties in the unit. The attendants are mainly concerned with manual handling, collecting and delivering items to other departments of the hospital. An organisational chart is as below: CSSD Superintendent CSSD Supervisors CSSD Assistants CSSD Attendants 4.0 CSSD Design F:ImagesP2108_26-04-10.JPG 5.0 The Sterile Supply Cycle 6.0 The different areas of the CSSD The CSSD is divided into four major areas: Sorting and Decontamination Assembly and Packaging Sterilising Sterile Storage and Distribution 1. Sorting and Decontamination Area: Here the instruments are cleaned and washed. For the purpose of cleaning and washing, chemical detergents and disinfectants such as javel, alcohol and soaps are used. The instruments are washed in basin using plenty amount of water. It is only after this process that the instruments are safe to be handled. Also, sorting of instruments is carried out, disassembling of the instruments is done when needed and the CSSD assistants inspect the items for cleanliness and damage. 2. Assembly and Packaging Area: Following decontamination, the items are further sorted, reassembled and packaged. Here, reusable linens such as surgical gowns, green sheets drapes are packed in individual special wrapping paper. Cotton wool rolls are place in carton boxes. Gauze pieces are cut into smaller sizes and are wrapped individually. Clean instruments are placed in trays (either small or large depending on the surgical intervention during which they are going to be used) and are then packed in double wrapping papers. Autoclave tapes are used to hold the surgical items packed for sterilisation intact. These tapes have white indicator lines which turn to black lines after sterilization, thus helping the user to make sure that the pack is sterile. 3. The Sterilising Area Here the packed items then undergo a process known as sterilization. This involves the killing of any potential pathogen on the items. Normally, several methods of sterilisation exit but steam and ethylene oxide sterilization are most commonly used. 4. Sterile Storage and Distribution Area The sterile items are then stored in the storage area arranged neatly on different shelves. From there, the sterile items are then distributed to respective units. 7.0 The Sterilising Process: The CSSD attendants collect used instruments and equipment, empty carton boxes for cotton wool and the CSSD book (in which the head of the unit jots down the number of each sterile items he needs) from respective units of the hospital. With the introduction of new technologies, old methods of sterilisation such as boiling and vaporization have been replaced by two main methods of sterilization namely: 1. Autoclaving, i.e. steam sterilisation 2. Gas sterilisation using ethylene oxide. The items that are sterilised in the CSSD are: Cloth, i.e. green sheets drapes Gauze Cotton wool Instruments Pre-sterilisation Prior to sterilisation, all the items must be prepared through a process known as pre-sterilisation. The pre-sterilisation process for the items that have to be sterilised is as follows: 1. Cloth The clean linen are folded, and then wrapped in a special paper. The packed linen is then sealed with autoclaves tape. 2. Gauze The gauze are cut into uniform pieces and made into either large gauze or small gauze. They are then packed in paper into individual packs and are sealed with autoclave tapes. 3. Cotton wool The cotton wool is made into small rolls from large bundles and placed in small carton boxes which are then sealed on the sides with autoclave tapes. 4. Instruments The instruments are first checked for soil, they are then washed and placed in trays or individual sets depending on the requisition of the respective unit. They are then packed in double special paper wrappers and sealed with autoclave tapes. Sterilisation It is a process used to make a medium free from micro-organisms including bacterial spores. Sterilisation can be done through heat, chemicals, irradiation and high pressure. In the CSSD at SSRNH, two types of sterilisation is being used: Gas Sterilisation Steam Sterilisation Gas Sterilisation Using ethylene oxide. This method of sterilization can be used to sterilise those items that can withstand temperatures of 50-60ËÅ ¡C. A long period of aeration is required to remove all traces of ethylene oxide. Autoclaving, i.e. Steam Sterilisation It is the most reliable process of sterilization. It sterilises with steam under pressure. The high pressure also ensures saturation of wrapped surgical packs. Autoclaving is one of the most effective methods for destruction of all types of micro-organisms. The amount of time and degree of temperature necessary for sterilisation depend on the articles to be sterilised. 8.0 LITERATURE REVIEW The aims of Occupational Health and Safety are: To promote and maintain a high degree of physical, mental and social well-being of workers in their respective workplace; To prevent adverse effects on the health of the workers that can be due to the working conditions; To protect the workers at their workplace from risks resulting from factors adverse to health; To provide the workers with such working environment that suits their physical and mental needs; the adaptation of work to humans. We can thus say that occupational health and safety englobes the social, mental and physical well-being of workers. A healthy workplace means a safe workplace where the workers will be in an environment where the hazards exposure is quite minimised if not eliminated completely. Occupational health and safety is important as: Work plays a major role in peoples lives, since most workers spend at least eight hours a day in the workplace. Therefore, work environments should be safe and healthy. But, this is not the case for many workers. Every day workers all over the world face many health hazards, such as: dusts gases noise vibration extreme temperatures. As a result of the hazards and a lack of attention given to health and safety, work-related accidents and diseases are common in all parts of the world. Appropriate and effective workplace health and safety programmes can help to protect the workers by reducing hazards and their consequences. Health and safety programmes can also have positive effects on both worker morale and productivity and can thus be beneficial to the organisation. At the same time, effective programmes can save employers a great deal of money. There are many hazards that might exist in any workplace such as: chemical hazards in the form of liquids, solids, dusts, fumes, vapours and gases; physical hazards, such as noise, vibration, unsatisfactory lighting, radiation and extreme temperatures; biological hazards, such as bacteria, viruses and fungi; psychological hazard as a result of stress and strain; hazards related to the non-application of ergonomic principles, like badly designed machinery, mechanical devices and tools that will be used by workers, improper seating and workstation design, or poorly designed work practices. Workers often get work-related health problems and do not realise that the problems are related to their work, particularly when an occupational disease, for example, is in the early stages. Besides the other more obvious benefits of training, such as skills development, hazard recognition, etc., a comprehensive training programme in each workplace will help workers to: recognise early signs/symptoms of any potential occupational diseases before they become permanent conditions; assess their work environment; insist that management to make changes before hazardous conditions can develop. Previous research on CSSD shows that: According to Linda Clement, Items processed in the decontamination areas are potentially pathogenic and pose a potential exposure risk to employees working in these areas. She also stated that to prevent cross contamination, good infection prevention processes must be put into practice. Also, the housekeeping procedures should be the same as those that are used in operation theatre and delivering rooms and that all horizontal working surfaces and the floors should be cleaned daily. The medical equipment poses a risk of exposure to blood and bodily soils, and other safety hazards before or during processing. So, appropriate personal protective equipment (PPE) should be worn by the workers, they should adopt good work practices and have to follow the manufacturers instructions. Whether it is a sterilizer, a washer/disinfector, an endoscope or a surgical instrument, it is best to follow the device manufacturers instructions found in operator manuals and other product documentation for h andling, operation, cleaning and disinfecting medical equipment. As per John Brown, All personnel working in the decontamination area should wear clean, facility-provided uniforms that are donned at the facility. Also, workers should use general purpose utility gloves, gown, a surgical face mask and goggles while working in the decontamination area. During maintenance procedures, additional PPE is necessary including eye protection and steel-toed shoes should be worn at all times to protect from sharp and heavy objects from causing injury to workers feet. Leather gloves while handling potentially sharp objects, stainless steel panels and plumbing piping gloves and heat-resistant arm sleeves must be worn while working around steam piping and face shield when using cleaning chemicals. (Infection Control Today-Jennifer Schraag April 08) 8.1 HEALTH AND SAFETY HAZARDS: 8.1.1 Safety The primary areas of potential hazards include environmental, electrical, mechanical, chemical, biological, fire and physical. The work performed in the CSSD need special attention to avoid injury to the workers and sometimes visitors such as nursing staff. Most workplace injuries and accidents are caused by neglect, carelessness or lack of understanding of the principles of safety. Safety is every workers responsibility so as protects oneself and also the equipment in the CSSD which is governments property. 8.1.2 Chemical Hazard These hazards are present when a worker is exposed to any chemicals in the workplace, be it solid, liquid or gas. Some of these chemicals are safer than others, but some workers who are sensitive to chemicals, even those that are commonly used solutions can cause illness, skin irritation or breathing problems. In the decontamination area, the use of chemicals for cleaning purposes is necessary. These chemicals are caustic soda, javel, methyl spirit, soaps and detergents. Exposure may result when the workers do not use necessary personal protective equipment (PPE) while handling these hazardous chemicals found in soaps, disinfectors and cleaners. Exposure to these substances can cause contact dermatitis, excoriation of the skin and ulcers. Prolonged and persistent exposure may end up in allergic reactions or hypersensitivity. 8.1.3Ethylene Oxide (EtO) Hazards EtO possesses several physical and health hazards that really need much attention. EtO is a liquid below 51.7ËÅ ¡ F, or a gas that has ether-like odour at concentrations above 700 parts per million (ppm) and is both flammable and highly reactive. The current OSHA Permissible Exposure Limit (PEL) to EtO is 1ppm for an 8-hour time weighted average. Normally, EtO sterilization is done for items which cannot be exposed to steam sterilization. Exposure hazards normally results from improper ventilation in ethylene oxide chamber after the sterilising process, during off-gassing of sterilized items or due to leakage from pipe connection. Hazards can also occur when removing sterilized items from the sterilizer or even when changing bottles of EtO gas. Health effects of EtO are: Eye irritation and injury to cornea, frostbite and on prolonged skin exposure, severe irritation and blistering of the skin can happen. Gastric irritation and injury to the liver can result from accidental ingestion of EtO. Inhalation of EtO vapours may cause respiratory irritation and lung injury, headache, nausea, vomiting, diarrhea, shortness of breath and cyanosis. Risk of cancer, adverse reproductive effects and chromosomal damage can result from prolonged exposure to EtO. 8.1.4 Biological Hazard In the decontamination area, workers may be injured from contaminated sharp instruments such as needles and scalpels, while sorting, cleaning and washing. Soiled, reusable instruments are considered to be contaminated with bacteria and other micro-organisms, which can cause illness to the staff. Exposure to infected material can cause diseases such as Viral Hepatitis and HIV. Contamination is liable to occur due to presence of blood borne pathogens found in soiled drapes and pointed objects, e.g needles. Hepatitis B is transmitted through contact with the blood or body fluid of an infected person on soiled drapes or surgical instruments which in turn land up in the CSSD for sterilisation. 8.1.5 Ergonomics related hazards When the physical requirements of a job and the physical capacity of a worker do not match, it can cause in work-related Musculoskeletal Disorders (MSD). Ergonomic hazards occur when the type of work, body position and working conditions put strain on the body. A worker will not notice the strain immediately .For short-term exposure, a worker can get sore muscles the next day or in the days following exposure, but long term exposure can end in serious long-term injuries. These hazards may be due to: bad lighting not properly adjusted workstations and chairs frequent lifting bad posture repetitive awkward movements too much force is needed to do a work and it has to be done quite often. In the CSSD, workers are exposed to repetitiveness of works, prolonged standing and reaching out while sorting instruments, uncomfortable sitting postures on chairs which are non-ergonomically designed during trimming of gauze and putting cotton wool rolls in boxes. The workers have to bend frequently while lifting heavy loads, need to reach high storage shelves or need to push or pull heavy carts loaded with sterile or unsterile items, all this can lead to MSD. Contact trauma to forearm can also occur if the workers the wrists are placed on hard surfaces. 8.1.6 Physical Hazards These are the most common and can be present in most workplaces at anytime. They include unsafe conditions that can cause injury, illness and death. Sometimes bad working practices are used so often that they become the routine works habits and might be not considered as hazards to workers. But still these hazards cannot be accepted in a workplace. Physical hazards include: electrical hazards constant loud noise high exposure to heat slips/trips and falls. Burns and cuts Workers are exposed to burns and cuts during handling of hot sterilised items or sharp instruments when removing them from autoclaves. Slips/Trips/Falls Exposure to slippery floors can occur to spills of detergents and presence of water on the floors while cleaning and washing of instruments is being done in the decontamination area. In the sterilizing area because of the use of steam in autoclaving processes, the environment inside the room will be humid and may cause the floor to be slippery. Electrical Hazards All electrical devices should be inspected upon arrival in the CSSD. Improper grounding and earthing facilities can prove to be dangerous. Regular maintenance and repairs of the equipment in the CSSD should be documented and proper records should be maintained. Electrical cords lying on the floors can cause workers to trip over them and the cords can also be exposed to wet floors and cause electrocution. The use of extension cords should be avoided and electrical sockets should not be installed next to washing basins or near any source of water. Unsafe electrical installations by incompetent persons can give rise to electrical hazards. All electrical installations should have protective devices such as circuit breakers, fuses, Residual Current Devices so that the electrical equipment are safe from overvoltage and excessive current. Unsafe work practices can lead to electrical accidents. Heat Exposure to hot environment can lead to heat stress, heat exhaustion, and cramps. This can happen when workers are unloading items once autoclaving is completed. As autoclaving uses steam, the atmosphere in the sterilising area becomes very moist and the temperature in that unit is quite raised when the autoclaves are in operation. The workers feel very hot and also very uncomfortable to work in such conditions. Sweaty palms, fogged-up safety glasses and dizziness caused by the heat can increase risk of injuries in workers. Burns can also occur due to accidental contact with hot surfaces of autoclaves or with accidental opening of the autoclave door or due to improper closing of the door causing steam to escape. Fire Hazards EtO is used for gas sterilising. EtO is a highly flammable gas and improper ventilation system and leakage of the gas-line can cause accumulation of EtO in the CSSD, the use of cigarettes by staff in addition to the EtO in the air may cause a fire outbreak or even an explosion. Improper storage of flammable gases and liquids can have adverse effects and may result in fire. Improper maintenance of electrical equipment and aging electrical cords, with the presence of water can be a source of static electricity, sparks or minor combustion which can ultimately lead to a fire due to presence of large amount of combustible materials such as gauze, linen cotton, boxes, and paper wrappers in the CSSD. 8.1.7 Latex Allergy Workers normally wear latex gloves during handling and sorting of contaminated instruments and equipment is done. Some workers can develop allergy to the latex. 9.0 LEGISLATION The only legislative body concerned with the health and safety of workers in Mauritius is the Occupational Health and Safety Act 2005. The Superintendent, Supervisors and all the CSSD staff should be familiar with this Act as each worker will know about his rights and what work he should or should not do as per law and what protection he should have for doing a particular task. 10.0 RECOMMENDATIONS General Recommendations: An effective measure to prevent workers from hazards exposure is regular job rotation to different areas of the CSSD. The employees should be provided with gowns, hair covers and shoe covers while at work. During cleaning and washing of equipments, the workers should be provided with rubber gloves and aprons. While removing carts and trays from the hot sterilisers leather gloves should be worn by the staff. Frequent hand washing with good hand washing techniques will contribute to a great extent in preventing cross-infection. It is highly recommended to the workers not to wear any jewels, e.g. rings and nail varnish while washing the instruments and while packing the items for sterilisation. Workers must adopt safe work practices so as to prevent accidents, injuries and illnesses. Taking the necessary safety precautions while performing the required task can practically eliminate associated dangers. It is the duty of all workers to comply with specific health and safety precautions so to protect themselves from any hazard that might be present in the CSSD. Recommendations for Chemical Hazards: Goggles must be worn when washing and cleaning instruments as there is risk of chemicals being splashed into the eyes. Appropriate PPE such as gloves, goggles, splash aprons should be worn by workers so as to protect them while using detergents and chemicals in the decontamination area. In case of splash of chemicals into the eyes, the workers should flush the eyes immediately for at least 15 mins. Thus, suitable facilities for eye flashing should e situated within the working area. Recommendations for EtO Use proper ventilation especially for the Eto Room Local exhaust ventilation system should be installed. Workers exposure to EtO should be minimised when sterilization is being carried out The door of the sterilizer should be opened no more than two inches to allow the load to off gas before transferring them to carts. Installation of a ventilated exhaust hood installation would be very useful. For changing of cylinders, appropriate PPE such as butyl apron, gloves, and a canister respirator is recommended. Recommendations for Biological Hazards: Use protective glove for cleaning and decontamination, shoes should be closed and resistant to puncture, goggles for eye, face mask or face shield and plastic apron. Training in of handling of sharp equipment should be given to the workers. Engineering and Work Practice Controls must be the primary means used to eliminate or minimize exposure to blood borne pathogens. Engineering Controls are measures (e.g., sharps disposal containers, self-sheathing needles, and safer medical devices, such as sharps injury protections) that isolate or remove the blood borne pathogens hazard from the workplace. Use of resistant puncture sharp containers with biohazard symbol. Container to be filled to the mark and the container should not have any leakage. Recommendations for Ergonomics Related Hazards Workstation need to be redesigned so packaging and equipment are within reachable levels and the elbows are maintained close to the body. The wheels for the carts should be such that they are easily rolled. Prolonged overhead activity need to be minimised (e.g. storage shelves should be lowered to shoulder height). Height-adjustable work surfaces should be used or tables have to be lifted to minimise head tilt. Repetitive tasks should be prevented by rotating workers to different work area. The edge of the working surfaces which come into contact with the elbow or forearm should be padded to prevent contact trauma. Sit/stand stools may be provided in the working area. Anti-fatigue mats have to be used. Shoes with well-cushioned insteps and soles should be worn by workers in case there is no floor mats. Foot rest bar should be provided to the staff so can they continually alter their posture by raising one foot. Padded Work Surfaces Padded Work Surfaces Recommendations for Burns and Cuts Good work practices should be established to prevent hazards: Hot items should not be removed from sterilisers until they are cooled. Handling of sharp ends of instruments should be avoided. Forceps should be used to remove sharp instruments from baskets and autoclaves Leather gloves should be provided to workers for handling of hot items. Recommendations to prevent from burning with Autoclave: Unloading Autoclave Heat-insulating gloves, safety glasses/face shield and closed toed shoes should be worn while unloading autoclaves. Workers must make sure that the pressure of the chamber is 0 before they open the door. Workers should stand back away from the door as a precaution and carefully open the door not more than 1 inch (2.5 cm) so as to allow residual steam to escape and to the allow pressure within the liquids and containers are back to normal. Sterilised items should be allowed to stand for 10 minutes. This will allow the steam to clear and also allow trapped air to escape from hot liquids, reducing risk . (Note: This is built into the operating cycle on some of the autoclaves). Containers of super-heated liquids should not be agitated and caps must not be removed before unloading. When hot items are removed from the autoclave, they should be marked with warning sign (e.g. Caution: Hot. Do not touch.) till the items cools down to room temperature.. Recommendations for Slips, Trips and Falls: Floors should be kept clean and dry. For wet floor areas warning signs should be placed. Proper drainage should be done during wet processes and floors mats, dry standing places should be available and waterproof footgear can also be worn by the workers. All working area should be kept clean and in an orderly manner. All aisles and passageways should be and free from any obstruction. Floor plugs for equipment to prevent power cords from running across pathways. All exits should be free from any obstruction. Access to exits doors should be easily reachable. Slip resistant shoes should be worn. Spills need to be reported and cleaned immediately. Uneven floor surfaces should be eliminated. Recommendations for Electrical hazard: Avoid using extension cords. All cords should have a grounded, three-prong, hospital-grade plug. A cracked cord should be replaced immediately. No accumulation of water should be allowed near an electrical outlet. According to OSHA 2005 Clause 73,all electrical apparatuses and conductors including machines, equipment and fittings shall be sufficient in size and power for the work for which they are used and shall be constructed, installed, protected, worked and maintained so as to prevent danger. Recommendations for hazards related to Heat: Since, the place of work is quite hot; workers should wear light-coloured and

Individual vs. Society in Daisy Miller and Old Woman Magoun :: comparison compare contrast essays

Individual vs. Society in Daisy Miller and Old Woman Henry James’ "Daisy Miller, A Study" and Mary Wilkins Freeman’s "Old Woman Magoun" contain morally ambiguous conflicts between individuals and society. Both of these short stories are tales in which strong, individual women directly conflict with their respective destructive male societies, attempting to uphold innocence while flouting societal rules and expectations. Freeman and James both construct strong female individuals in different guises. Freeman’s Old Woman Magoun is old, wise, and practiced in the art cooking and child-rearing, embracing a traditional feminine role and drawing power from it. She practises this art because it is her right, and, passive-aggressively, she uses her cooking lore to kill Lily, removing innocence from the world. Quite on the other side of the spectrum we have James’ Daisy: young, innocent, practised only in the art of flirting, yet drawing her powerful independence from the practise of this non-traditional feminine art. She is allowed to practise her art, but only for a while. Daisy dies of an attack of Roman Fever contracted at the Colosseum; more symbolically, her innocence is lost from society when her character is crucified on a cross of social propriety. Men and men’s desires represent societal aims in both stories. Freeman’s men are Nelson Barry and Jim Willis, both are members of old, highly placed, "degenerate" (179) American families. Their goal is to steal Lily from Old Woman Magoun and force her into a traditional societal role to satisfy their own ends, no matter that this will destroy Lily’s innocence. Barry desires "to have that girl" (184) for financial comfort; Willis desires her for more traditional domestic comfort. James embodies society in Mr. Winterbourne, a socially accepted young American who has "lived too long in foreign parts" (492). Winterbourne desires for Daisy to enter into and conform with society to satisfy his own ends, as well. He desires mental and emotional comfort: to judge her "eccentricities" (486) innocent, and that she "would flirt with me, and me only" (482). Each individual’s conflict with society is resolved in different ways and in difficult lights. Magoun directly flouts society’s rules by committing infanticide, effectively removing purity from the destructive intents of male society. Yet her actions pose a question of morality to Freeman’s audience. Was Lily’s death justified? Meanwhile, the men are left comfortless and alone. Magoun, however, is also comfortless and alone, depriving herself of Lily’s innocence to save it.

American Prohibition :: essays research papers fc

Prohibition   Ã‚  Ã‚  Ã‚  Ã‚  On midnight of January 16, 1920, one of the started around the turn of the century, when many people got the idea that most of what was wrong with America was caused by boozepersonal habits and customs of most Americans came to a sudden halt. It . They saw prohibition as the silver hammer that would decimate all of their alky-related woes. Instead, it turned out to be the lodestone that lead America into thirteen years of chaos. The eighteenth amendment was ineffective because it was unenforceable, it caused an explosive growth in crime, and it increased the amount of alcohol consumption.   Ã‚  Ã‚  Ã‚  Ã‚  The Eighteenth Amendment was put into effect to prohibit the manufacture, sale and transportation of all intoxicating liquors. Shortly afterward, the Volstead Act, named for author Andrew J. Volstead, was put into effect. This complimentary law determined intoxicating liquor as anything having an alcohol content of more than 0.5 percent, omitting alcohol used for medicinal and sacramental purposes; this act set up guidelines for enforcement as well (Altman 15). Prohibition was meant to reduce the consumption of alcohol, and thereby reduce crime, poverty, death rates, and improve the economy and general quality of life. This, however, was undoubtedly to no avail.   Ã‚  Ã‚  Ã‚  Ã‚  After the Volstead Act was put into place to determine precise laws and methods of enforcement, the Federal Prohibition Bureau was developed in order to see that the Volstead Act was enforced. Nevertheless, these laws were frequently violated by bootleggers and commoners alike. Bootleggers smuggled liquor from overseas and Canada, stole it from government warehouses, and produced their own. Many people hid their liquor in hip flasks, false books, hollow canes, and anything else they could find. (Bowen 159). There were also illegal speakeasies which replaced saloons soon after the start of prohibition. By 1925, there were over 100,000 speakeasies in New York City alone (Bowen 160). As good as the ideal sounded, prohibition was far easier to proclaim than to enforce. With only 1,550 federal agents and over 18,700 miles of extensive coastline, it was quite impossible to prevent large quantities of liquor from entering the country (Bowen 166). Barely five percent of s muggled liquor was hindered from coming into the country through the 1920s. Additionally, the illegal liquor industry was under the control of organized gangs, which subdued most authorities. Many bootleggers shielded their business by bribing the authorities, namely federal agents and persons of high political status (Bowen 160).

Clarkson Lumber Company Pro Forma Statement Essay

Assumptions. We build pro-forma statement mostly based on the assumptions given in the case. Other assumptions are following. At first, we assume that the tax rate is an average of tax rates for the past three years which is 20. 1%. We use this tax rate to calculate the provision for income taxes for following years. Next assumption is that we take Mr. Dadge’s approximation for the initial rate as the interest rate, 11%. Since Mr. Clarkson finished payment to Mr. Holtz in 1995, we assume that only the bank loan to Suburban National Bank and Northrup National Bank are the interest-bearing liabilities for 1996 through 1999. For account payable period, we calculated two numbers, 53. 62 days for 1995 and 54. 86 for the first quarter of 1996. We used the payable period for 1995 to calculate the accounts payables for the forecasted years because, as mentioned in the case, Mr. Clarkson’s business has some seasonality so hat the payable period for the only first quarter of 1996 would not fully reflect for a whole year. We decided not to include 2% discounts for early payment to the suppliers on our income statement because of the payable period. We also assume that Mr. Clarkson issued no new equities and paid no dividends during the forecasted years. Only source of the change in the net worth is the net income for the same period. New credit line. The new credit line of $750,000 would be sufficient only for 1996 and 1997. The bank loan would exceed the credit line to 858,000 and 1,109,000 for 1998 and 1999, according to our pro forma statement. Without the approval of the bank, Mr. Clarkson would not be able to expand his business at the current growth rate after 1998. With the assumption of sales growth rate of 25%, the external financing required has become double from $493,000 in 1996 to $1,109,000 in 1999. Since the new credit line is fixed at $750,000, Mr. Clarkson would have to find other ways of financing the operation such as issuing new equity.

A Midsummer Night’s Dream by William Shakespeare Essay

Fairy>. Oberon, Titania Titania displays her ability to be in love but never be ability to find true love. Her feelings for Oberon, Nick, and the changeling are swayed very easily and without notice. When Titania is obsessed with Oberon but becomes intimately attached to the changeling child. However, when Titania is again sprinkled with fairy dew, her affections turn from the child to Nick (Act IV, sc i). The fairies intervene again, and Titania finds herself once again infatuated with Oberon (Act IV, sc i). When exploring the issue love in â€Å"A Midsummer Night’s Dream† comments â€Å"Love, as interpreted by the comic spirit, is a certain fine lunacy in the brain of youth; not an integral part of life, but a disturbing element in it. The lover is a being of strange caprices and strange infidelities, beyond the control of reason, and swayed with every gust of passion. While Titania’s affections are the most intense and deeply felt of anyone’s within in the play, she is unable to maintain her love for any character and is therefore incapable of true love. Oberon seems to be a greedy brute but only a little further on in the play, he acts generously and tries to help the four hopelessly muddled lovers. His character is confusing. Though he starts out brutish, during the course of taking his revenge, he takes pity on both Helena and, later, on Titania herself, as he feels remorse that he has paired her with an ass: â€Å"Her dotage now I do begin to pity.† (4.1.45) There is not much to say about Titania’s conflicts, as she is altered for much of the play, and, therefore, does not have the chance to express her true feelings to the audience. Oberon emerges, therefore, as the centrally conflicted character in the play’s parallel imaginative world. Mortal>. Theseus, Hippolyta True love does not exist between Theseus and Hippolyta. Hippolyta approach to love seems to be indifference. Her love for Theseus does not seem to sway but she also does not make any indication that she is in love with Theseus. In all of the play she does not say a loving word or commit a loving act toward Theseus. Theseus, in the Greek myth, has acquired the love of Hippolyta by killing her family and close friends. Theseus thinks very highly of himself and thinks only of himself. He takes Hippolyta on endless hunting trips and offers the following uninspiring proof of his love, â€Å"My love shall hear the music of my hounds† (Act IV, sc i). The reader must question if Hippolyta enjoys these hunting trips or Theseus. Her general lack of interest answers both questions. Even when Hippolyta attempts to communicate, Theseus is just unwilling to listen (Ac V, sc i). This clearly shows that while Theseus attentions are focused only Hippolyta their relationship is not mutually beneficial. This one of several instances where the audience can see the power of imagination in romance as well as parody of romantic convention†¦see the pain suffered by women to whom men are foolish, insensitive, and even brutal. Young lovers>. Hermia, Lysander Lysander is supposedly in love with Hermia. However, after he is mistakenly sprinkled with dew by Puck, his attentions shift from Hermia to Helena. In Shakespeare’s Comedies, the dialog supports the point that â€Å"Shakespeare uses an ‘outside force’ which interferes in and controls the affairs of men.† He then treats Hermia cruelly with no concern for her well being or emotions. In the play his love for either women is easily switched on and off. Once the fairy love juice wears off Lysander’s attentions again fall on Hermia. The same is true of Demetrius who is also effected by the fairy love potion. He found himself in love with Hermia and his desire for her was â€Å"melted as the snow† however when the juice wears off he laments that he does not know â€Å"by what power† made him fall in love. In William Shakespeare†s a Midsummer Night†s Dream, the erotic absolute will inevitably be embodied in a successful rival. Helena cannot fail to be torn between worship and hatred of Hermia. Imitative desire makes all reciprocal rapports impossible. Demetrius and Lysander are unable to maintain they love for anyone woman calling to question their sincerity and real motives in loving either. Hermia is in love with Lysander but her father, Egeus, decides that she must marry Demetrius instead. She and Lysander decide to elope, and go to the wood outside Athens. Hermia is bewildered when Lysander deserts her, and quarrels with her friend Helena, accusing her of enticing Lysander away from her. Hermia is short and dark, in contrast to Helena. She is also hot-tempered. Helena, Demetrius Demetrius is a young man of Athens, initially in love with Hermia and ultimately in love with Helena. Demetrius’s obstinate pursuit of Hermia throws love out of balance among the quartet of Athenian youths and precludes a symmetrical two-couple arrangement. Helena is young woman of Athens, in love with Demetrius. Demetrius and Helena were once betrothed, but when Demetrius met Helena’s friend Hermia, he fell in love with her and abandoned Helena. Lacking confidence in her looks, Helena thinks that Demetrius and Lysander are mocking her when the fairies’ mischief causes them to fall in love with her. Poor, lovesick Helena pursues her Demetrius throughout the play, much to the dismay of the audience, but what is theater without drama? She is a character the audience can truly come to understand as her emotions are laid bare for all to see. Her misery and humiliation at her betrothed’s rejection and then pursuit of her childhood playmate is so unanswerable that she refuses to give her love and spends her time chasing Demetrius. Eventually, through magic, her lover is restored to her, though the audience is left to decide for themselves whether unnatural (fairy-driven) love is as good as the real thing.   Helena, who are the doubling figures, are in an unresolved situation: Helena loves Demetrius, but Demetrius has only, in the Victorian phrase, trifled with her affections. In the second part we’re in the fairy wood at night, where identities become, as we think, hopelessly confused. At dawn Theseus and Hippolyta, accompanied by Egeus, enter the wood to hunt. By that time the Demetrius-Helena situation has cleared up, and because of that Theseus feels able to overrule Egeus and allow the two marriages to go ahead. At the beginning Lysander remarks to Hermia that the authority of Athenian law doesn’t extend as far as the wood, but apparently it does; Theseus is there, in full charge, and it is in the wood that he makes the decision that heads the play toward its happy ending. At the same time the solidifying of the Demetrius-Helena relationship was the work of Oberon. We can hardly avoid the feeling not only that Theseus is overruling Egeus’s will, but that his own will has been overruled too, by fairies of whom he knows nothing and in whose existence he doesn’t believe. Mechanicals>. Pyramus, Thisbe In A Midsummer Night’s DreamThe workmen’s Lamentable Comedy can be seen as a parody (silly copy) of Romeo and Juliet. There are obvious similarities in the plot (can you say what these are?) but not in the theatrical qualities of the two pieces. In Pyramus and Thisbe we see how not to do things which are done much better elsewhere in A Midsummer Night’s Dream,in Romeo and Juliet or in other plays by Shakespeare. (These include depicting wild animals, a wall, moonlight and killing on stage). Comment on how these things are done both in Pyramus and Thisbe and in the plays proper. Comment on how hard or easy it is for actors to speak the dialogue in Shakespeare’s plays generally, and to speak the verse we meet in Pyramus and Thisbe (look at the end of the Prologue, and the dying speeches of the two lovers). The danger is always a performance like Pyramus and Thisbe, in which imagination and reality are not sufficiently balanced to create the illusion a successful play requires to work its magic. The ideal seems to be a performance in which reality is neither so openly flouted as to make the play unbelievable, nor rendered so literally as to make it ridiculous, but is balanced with imaginative pretense in such a way as to manifest the purpose of playing itself, the channeling of nature by art into harmonious and satisfactory patterns. ‘A Midsummer Night’s Dream’ by William Shakespeare Essay ‘A Midsummer Night’s Dream’ is a romantic comedy and one of Shakespeare’s most popular plays or stories. The main characters of this story are Oberon, Titania, Hermia, Lysander, Demetrius and Helena. This story deals with marriage, family, elope and comedy. Hermia elopes with her lover Lysander to get married and Demetrius who loves Hermia follows them into while Helena, Hermia’s friend and Demetrius’ lover, follows Demetrius into the forest. Meanwhile, Oberon and Titania, king and queen of the fairies in the forest, have an argument which causes tension between them. Is the forest a magical place? Yes, it is because all the characters in the forest reconcile. The story starts off with Egeus, father of Hermia, reporting to Theseus, King of Athens at that time, that his daughter refused to obey him when he commanded his daughter to marry Demetrius, a man of a noble Athenian family. There was a strict law in the city of Athens that if a daughter refused to marry the man her father had chosen, she would be put to death. Hermia had not loved Demetrius but she loved another Athenian, Lysander. She also didn’t want to marry him because her best friend, Helena, loved Demetrius and she wanted to stay loyal. Theseus could not alter the laws the rules of his country so he could only give Hermia four days to reconsider her decision or else she would be put to death. Lysander was informed about this and proposed to Hermia that they should elope to his aunt’s house outside of Athens, where the laws were not applied. Demetrius heard of this and thus, he followed them into the forest. Helena was afraid of losing Demetrius forever so therefore she followed him into the forest. Demetrius reproached Helena for following him but Helena tried to remind him of his former love and true faith to her. Demetrius, after saying many cruel things to Helena, abandoned her while Helena still raced after him. Oberon and Titania are the King and Queen of the Fairies respectively. They were having a disagreement when Titania refused to give Oberon a changeling boy. Titania dotes over this child which makes Oberon jealous. Oberon wants to make the boy part of his entourage. Titania refuses to give the boy up, hence the conflict. They lived in the magical forest. Oberon had a counsellor, Puck. Oberon observed the conflict between Demetrius and Helena. Oberon was always friendly to true lovers and felt sorry for Helena. He reported this to Puck  and commanded him to use a piece of the purple flower, which has a ‘love-juice’, and use it on Demetrius to make him fall in love with Helena. Oberon described him as wearing Athenian clothes. Puck found a man in Athenian clothes but it turned out be Lysander who was sleeping next to Hermia. Puck poured the love-juice into his eyes and the first person he saw he would fall in love with. The next morning, Helena would find Hermia and Lysander. When Lysander woke up, he saw Helena in front of him and immediately fell in love with her. Helena was confused and then she became angry with Lysander. She thought that he was pulling a sick prank on her. Oberon and Puck soon realized what happened. Oberon scolded Puck and Puck found Demetrius asleep. Puck applied the love-juice to his eyes and when Demetrius woke up, he first saw Helena and became in love with her. Ironically, what had first started out as Lysander and Demetrius chasing Hermia with Helena left behind, now had turned into Lysander and Demetrius chasing Helena with Hermia left behind. Helena outraged, thinking it was a prank, got herself into a war of words with Hermia. Oberon and Puck observed the chaos he caused and immediately attempted to fix it. Puck wearied them out by getting them lost and removed the charm from the eyes of Lysander with an antidote to reverse the effects and forget his new love for Helena. After, everything was back to normal Hermia was with Lysander and Helena was with Demetrius. Meanwhile, Oberon, longing for the changeling boy, had poured some love-juice on Titania to make her give it up. When Oberon had returned, he found a clown sleeping next to her. He put a donkey’s head on him and Titania fell in love with the clown. Oberon seized the chance and demanded the changeling boy which she unwillingly accepted. Soon, Oberon had poured some juices of another flower and had brought her back to her senses. She immediately loathed the sight of the monster. All the couples in this story reconciled. Egeus understood Demetrius not wanting to marry his daughter but Helena and Egeus accepted the marriage between Lysander and Hermia. The forest is truly a magical place because what had started as elope, disagreements and hatred turned out be union, harmony and love.