Reflection On Care Of Surgical Drains Nursing Essay

Reflection On Care Of Surgical Drains Nursing Essay The use of drains continues to be an important aspect in the management of patients postoperatively. While drains serve an important function, they are also associated with complications such as haemorrhage, tissue inflammation, retrograde bacterial migration, and drain entrapment (Walker 2007). It is therefore very essential for nurses to provide adequate monitoring and care of surgical drains and provide measures to ensure prevention of complications from arising. While working in the surgical ward, I have been exposed to patients with surgical drains. This reality pushed me to know more about surgical drains and to gain more competence in the management of these patients. In this essay, I would be reflecting on my experiences as I worked to achieve my learning outcome of becoming proficient with surgical drains. I would be utilising Gibbs (1988) model of reflection which consists of 6 stages, namely: description, feelings, evaluation, analysis, conclusion and action plan. DESCRIPTION In the past, I have been exposed to patients in the surgical intensive care unit with surgical drains. I have known how to monitor care for the drains and have seen the surgeons remove these drains. But, I have never tried removing surgical drains before. Only surgeons and surgical resident doctors were allowed to remove drains in the country where I have trained before. Thus, when I started my adaptation program in the surgical ward, I was impressed with how skilful the nurses are with surgical drain removal. This gave me the urge to become proficient with the care of drains. During the first week of the adaptation program, I started my quest for knowledge by doing a literature review about the indications, importance of drains, the different types and the risks complications involved with drains. I gathered information from my mentor about the hospitals protocol and procedures for the care of drains as well as the different surgeons preferences in the care of their patients drains. It was then that I found out that surgeons always prefer the drains of orthopaedic patients (hip and knee replacements) to be taken out after 24 hours. As cited by Tucci, et al (2005), closed suction drainage systems are commonly used in orthopaedic surgery, the rationale for its use is to theoretically reduce wound haematoma and infection. Knowing that I was already well equipped with knowledge, I then focused on enhancing my skills in this aspect. I worked hand in hand with my mentor as I observed how she monitored, re-vacuumed, and removed the drains. I observed the techniques and principles that she utilised and noted the different materials needed for each procedure. FEELINGS When I already felt ready to remove the drain for the first time, I was feeling a little bit anxious that I would do something wrong especially that my mentor would be supervising me as I perform the procedure. I knew that time that I was well prepared knowledge wise and I exactly knew what I was about to do, but there is always that feeling of nervousness when you do something for the first time. My anxiety was lessened when my mentor reassured me as she told me not to worry as she will guide me all throughout the procedure. I had all the materials ready and was all geared up with personal protective devices. After obtaining informed consent from the patient, I removed the drain without any difficulty while making sure that aseptic technique was observed. Aseptic technique is very important to prevent surgical site infections. According to the NICE guidelines (2008), the development of an SSI depends on contamination of the wound site at the end of a surgical procedure and specifically relates to the pathogenicity and inoculum of microorganisms present, balanced against the hosts immune response. Thus, proper hand washing and maintaining sterility are very important when handling drains. Aside from removing drains, I have gained more confidence in re-vacuuming drains, monitoring drainage output, documenting and watching out for complications. While taking care of these patients, I ensured that complications are prevented by providing health teachings about hygiene, proper hand washing, measures to prevent complications and early detection of any complications. EVALUATION With the entire learning process, I was able to achieve my goal of attaining positive learning outcomes. I had been more proficient with handling surgical drains. I have improved my knowledge and shared these with my patients for them to have a safe recovery. I had been very keen with minimising complications and had been more watchful of the danger signs. I have known and practiced infection control by heart as well. There was one negative incident that occurred during my adaptation experience. This incident made me more cautious whenever I took care of patients with drains. We had a patient who underwent a major breast operation who had four astra drains in situ. She developed a haematoma during our shift because of the fact that all of her drains were all clamped from the previous shift. The surgeon himself discovered the nurses error and noticed the haematoma as well. He was not happy with what happened and told us to be very cautious with his patients drains. We made an investigation and found out that the nurse who re-vacuumed the drains from the previous shift failed to unclamp the drains. We made an incident report and informed the ward sister about the incident. We regularly monitored the patients haematoma and regularly massaged the affected area. ANALYSIS This incident made me realise how quickly complications arise when a single error is done. It taught me to be more cautious when re-vacuuming drains. Ever since that incident occurred, I always double check that all the drains are unclamped and patent before leaving the patients rooms. I always check the wound drain site for any haematoma or other unusualities as well. CONCLUSION Although it was not my error that the drains were clamped, I could still say that I do have a fault in that incident. If I could have checked the drains and the wound initially at the start of the shift, that haematoma might not have occurred or if not, be minimised. I was too busy taking care of other postoperative patients and kept saying to myself during that time that I would check the drains the wound after I am settled with the other patients. If I could have managed my time well and spared a little of my time to assess that patient, the incident might not have occurred. This incident served as a lesson for me the other staff nurses in the surgical ward and taught us the importance of drains thus, they should not be taken for granted. ACTION PLAN Based on this entire experience, I plan to widen my knowledge about surgical drains by doing more research work about other types of surgical drains that I am not familiar with to enhance my knowledge and to be prepared when the time comes that I would come across these types of drains. I also intend to be always updated with my knowledge by reading recent articles from journals or other sources and grab any opportunity of attending seminars/ trainings for continuing professional development.

Essay --

World Health Organization (WHO) identified quality as crucial element in its framework for health system strengthening. Quality serves as a mediator between the six system building blocks (leadership, health care financing, health workforce, service delivery, information and medical products) and health outcomes. As such, enhancing quality of each building block could lead to improved health outcomes and efficiency. Several quality improvement (QI) approaches have been widely employed to strengthen the health systems globally. Decision making based on evidence is one of the important QI principles used by many QI models and frameworks such as the European Foundation for Quality Management (EFQM), International Organization for Standardization (ISO), the Baldrige Framework, etc. In order to make more informed decisions, it is necessary to have information about key processes, outputs, outcomes and results. Evidence is one key theme in managing health care quality. The adoption of evidence based practices in health care not only promote high standard of care but also increase client interest in quality of care. This will lead to continuous improvement of overall health system (Sax, 2014). In recent years, the results of many QI projects in developing countries are achieving widespread attention. Noticeable progress in quality could convince donors and governments that their resource are used efficiently and encourage further investment in health care (Leatherman et al., 2010). Thus, there has been growing interest on quality of these QI project results since policy makers, hospital leaders and clinicians make important decisions based on these information. Data Quality Audit (DQA) is one of the initiatives established... ...e clinics, community health centers and hospitals in three districts of the province. It is important to track every sequential steps of diagnostic and treatment services of PMTCT program. Effective monitoring could indicate the performance of the program in identifying HIV infected mothers and providing correct treatment. In South Africa, like many developing countries, health data collecting and reporting system was often stated unreliable (Garrib et al., 2008). As such, the PMTCT program introduced an intervention to improve the completeness and accuracy of the routine data collected in the DHIS. The flow of data begins at the service delivery points and the staffs at each primary care facilities combine these data monthly on paper and report to clinic supervisor. The data are transferred to electronic format by an information officer within the facility.

The Big Idea: How to Start an Entrepreneurial Revolution

In the latest Ease of Doing Business ranking from the World Bank, one country made a spectacular leap—from 143rd on the list to 67th. It was Rwanda, whose population and institutions had been decimated by genocide in the 1990s. On the World Bank list, Rwanda catapulted out of the neighborhood of Haiti, Liberia, and the West Bank and Gaza, and sailed past Italy, the Czech Republic, Turkey, and Poland. On one subindex in the study, the ease of opening a new business, Rwanda ranked 11th worldwide. You can see and even smell the signs of Rwanda’s business revolution at Costco, one of the retail world’s most demanding trade customers, where pungent coffee grown by the nation’s small farmer-entrepreneurs is stocked on the shelves. And in Rwanda itself the evidence is dramatic—per capita GDP has almost quadrupled since 1995. [pic] Rwanda: From Genocide to Costco’s Shelves This is the kind of change entrepreneurship can bring to a country. As Rwanda’s president, Paul Kagame, put it recently, â€Å"Entrepreneurship is the most sure way of development.† He is not a lone voice: Economic studies from around the globe consistently link entrepreneurship, particularly the fast-growth variety, with rapid job creation, GDP growth, and long-term productivity increases. You’ll see more palpable evidence of surprising entrepreneurial success stories on the Costco shelves. A few steps away from the Rwandan coffee, you can find fresh fish from Chile, which now ranks second only to Norway as a supplier of salmon. The Chilean fish in America’s supermarkets were supplied by hundreds of new fishing-related ventures spawned in the 1980s and 1990s. A few aisles over are memory USBs invented and manufactured in Israel, a country whose irrepressible entrepreneurs have been supplying innovative technologies to the world since the 1970s. And just around the corner, the Costco pharmacy sells generic drugs made by Iceland’s Actavis, whose meteoric rise landed it, in just 10 years, among the top five global generics leaders. Rwanda, Chile, Israel, and Iceland all are fertile ground for entrepreneurship—thanks in no small part to the efforts of their governments. Though the companies behind the products on Costco’s shelves were launched by innovative entrepreneurs, those businesses were all aided, either directly or indirectly, by government leaders who helped build environments that nurture and sustain entrepreneurship. These entrepreneurship ecosystems have become a kind of holy grail for governments around the world—in both emerging and developed countries. Unfortunately, many governments take a misguided approach to building entrepreneurship ecosystems. They pursue some unattainable ideal of an ecosystem and look to economies that are completely unlike theirs for best practices. But increasingly, the most effective practices come from remote corners of the earth, where resources—as well as legal frameworks, transparent governance, and democratic values—may be scarce. In these places entrepreneurship has a completely new face. The new practices are emerging murkily and by trial and error. This messiness should not deter leaders—there’s too much at stake. Governments need to exploit all available experience and commit to ongoing experimentation. They must follow an incomplete and ever-changing set of prescriptions and relentlessly review and refine them. The alternatives—taking decades to devise a model set of guidelines, acting randomly, or doing nothing—all are unacceptable. But the government cannot do everything on its own; the private and nonprofit sectors too must shoulder some responsibility. In numerous instances corporate executives, family-business owners, universities, professional organizations, foundations, labor organizations, financiers, and, of course, entrepreneurs themselves have initiated and even financed entrepreneurship education, conferences, research, and policy advocacy. As we shall show later in this article, sometimes private initiative makes it easier for governments to act more quickly and effectively, and all stakeholders—government and otherwise—should take every chance to show real leadership. To make progress, leaders need practical if imperfect maps and navigational guidelines. From what we know from both research and practice, here’s what seems to actually work in stimulating thriving entrepreneurship ecosystems. Nine Prescriptions for Creating an Entrepreneurship Ecosystem The entrepreneurship ecosystem consists of a set of individual elements—such as leadership, culture, capital markets, and open-minded customers—that combine in complex ways. (See the exhibit â€Å"Do You Have a Strong Entrepreneurship Ecosystem?†) In isolation, each is conducive to entrepreneurship but insufficient to sustain it. That’s where many governmental efforts go wrong—they address only one or two elements. Together, however, these elements turbocharge venture creation and growth. When integrating them into one holistic system, government leaders should focus on these nine key principles. [pic] Do You Have a Strong Entrepreneurship Ecosystem? 1: Stop Emulating Silicon Valley. The nearly universal ambition of becoming another Silicon Valley sets governments up for frustration and failure. There is little argument that Silicon Valley is the â€Å"gold standard† entrepreneurship ecosystem, home to game-changing giants such as Intel, Oracle, Google, eBay, and Apple. The Valley has it all: technology, money, talent, a critical mass of ventures, and a culture that encourages collaborative innovation and tolerates failure. So it is understandable when public leaders throughout the world point to California and say, â€Å"I want that.† Yet, Valley envy is a poor guide for three reasons. One is that, ironically, even Silicon Valley could not become itself today if it tried. Its ecosystem evolved under a unique set of circumstances: a strong local aerospace industry, the open California culture, Stanford University’s supportive relationships with industry, a mother lode of invention from Fairchild Semiconductor, a liberal immigration policy toward doctoral students, and pure luck, among other things. All those factors set off a chaotic evolution that defies definitive determination of cause and effect. Further, Silicon Valley is fed by an overabundance of technology and technical expertise. Developing â€Å"knowledge-based industry†Ã¢â‚¬â€the mantra of governments everywhere—is an admirable aspiration, but achieving it requires a massive, generation-long investment in education as well as the ability to develop world-class intellectual property. On top of that, a knowledge industry demands an enormous technology pipeline and scrap pile. Consider that top venture capitalists invest in at best 1% of the technology-based businesses they look at, and a significant proportion of that select group fails. A third limit is that although Silicon Valley sounds as if it’s a place that breeds local ventures, in reality it’s as much a powerful magnet for ready-made entrepreneurs, who flock there from around the globe, often forming their own ethnic subcultures and organizations in what Gordon Moore, one of the Valley’s graybeards, calls an â€Å"industry of transplants.† And difficult as it is to foster an ecosystem that encourages current inhabitants to make the entrepreneurial choice and then succeed at it, it is even harder to create an entrepreneur’s â€Å"Mecca.† 2: Shape the Ecosystem Around Local Conditions. If not Silicon Valley, then what entrepreneurial vision should government leaders aspire to? The most difficult, yet crucial, thing for a government is to tailor the suit to fit its own local entrepreneurship dimensions, style, and The striking dissimilarities of Rwanda, Chile, Israel, and Iceland illustrate the principle that leaders can and must foster homegrown solutions—ones based on the realities of their own circumstances, be they natural resources, geographic location, or culture. Rwanda’s government took a strongly interventionist strategy in the postgenocide years, identifying three local industries (coffee, tea, and tourism) that had proven potential for development. It actively organized the institutions that would support those industries by, for example, training farmers to grow and package coffee to international standards and connecting them to overseas distribution channels. Rwanda’s immediate priority was to provide gainful employment to millions of people. Its efforts led to about 72,000 new ventures, almost entirely consisting of two- and three-person operations, which in a decade tripled exports and reduced poverty by 25%. Chile also focused on industries where it had copious natural resources—such as fishing. As in Rwanda, the government took a powerfully interventionist approach to its entrepreneurship ecosystem in Augusto Pinochet’s early years, and the dictator’s free-market ideology made it easier for Chile’s middle class to obtain financing and licenses for fishing operations. The government also weakened labor (sometimes brutally) to reduce new ventures’ input costs and kept Chile’s currency inexpensive to maintain competitiveness in export markets. Natural resources often are not a key component of an ecosystem, however. Frequently, entrepreneurship is stimulated when such resources are scarce, requiring people to be more inventive. Taiwan, Iceland, Ireland, and New Zealand, resource-poor â€Å"islands† far from major markets, all developed ecosystems based primarily on human capital. So did Israel. In the 1970s and 1980s, its unique ecosystem evolved haphazardly out of a combination of factors, including spillover from large military R&D efforts, strong diaspora connections to capital and customers, and a culture that prized frugality, education, and unconventional wisdom. 3: Engage the Private Sector from the Start. Government cannot build ecosystems alone. Only the private sector has the motivation and perspective to develop self-sustaining, profit-driven markets. For this reason, government must involve the private sector early and let it keep or acquire a significant stake in the ecosystem’s success. Start with a candid conversation. One way to involve the private sector is to reach out to its representatives for early, frank advice in reducing structural barriers and formulating entrepreneur-friendly policies and programs. If the necessary expertise doesn’t exist domestically, it can often be found overseas among expatriates. In the 1980s the Taiwanese government engaged with the Taiwanese diaspora, consulting prominent executives in leading U.S. technology companies and establishing ongoing forums to collect their input. The government actually built programs based on the suggestions of these expats, who liked how their ideas were implemented so much that they returned home in droves in the 1990s, many of them to occupy prominent policy positions or run the new plants that were established. For example, Morris Chang, the former group vice president of Texas Instruments, came home and eventually set up and ran TSMC, Taiwan’s second semiconductor-fabricating plant. Taiwan: Bringing Expat Entrepreneurs Home Design in self-liquidation. In 1993 the Israeli government created Yozma, a $100 million fund of funds that in three years spawned 10 venture capital funds. In each one, Yozma, an Israeli private partner, and a foreign private partner with proven fund management expertise all invested approximately equal amounts. From the start, the Israeli government gave the private sector partners an option to buy out its interest in the funds at attractive terms—a fact often overlooked by other governments that copy the Yozma model. That option was exercised by eight of the 10 funds, profitably for the government, I might add. Five years after the founding of Yozma, its remaining assets were liquidated by auction. The government’s exit served as market proof that real value had been generated and is one of the reasons that the Israeli venture capital industry not only became self-sustaining but simultaneously achieved a quantum leap in growth. 4: Favor the High Potentials. Many programs in emerging economies spread scarce resources among quantities of bottom-of-the-pyramid ventures. And indeed, some of them, such as the Carvajal Foundation in Cali, Colombia, have dramatically increased income for segments of the population. But focusing resources there to the exclusion of high-potential ventures is a crucial mistake. In an era when microfinance for small-scale entrepreneurs has become mainstream, the reallocation of resources to support high-potential entrepreneurs may seem elitist and inequitable. But especially if resources are limited, programs should try to focus first on ambitious, growth-oriented entrepreneurs who address large potential markets. The social economics of high-potential ventures and small-scale employment alternatives are significantly different. Whereas 500 microfinanced sole proprietorships and one rapidly globalizing 500-person operation create the same number of jobs, many experts argue that the wealth creation, power to inspire other start-ups, labor force enrichment, and reputational value are much greater with the latter. One organization that recognizes this is Enterprise Ireland, an agency responsible for supporting the growth of world-class Irish companies. It has created a program specifically to provide mentoring and financial assistance to high-potential start-ups, which it defines as ventures that are export-oriented, are based on innovative technology, and can generate at least â‚ ¬1 million in sales and 10 jobs in three years. The global nonprofit Endeavor, which focuses on entrepreneurship development in 10 emerging economies, has to date â€Å"adopted† some 440 â€Å"high-impact entrepreneurs,† who, with Endeavor’s mentoring, are turning their successes into role models for their countrymen. Not all high-potential ventures are technology based; in fact, I’d argue that the majority are not. SABIS is a perfect example. An educational management organization founded in Lebanon many years ago as one school, SABIS now is one of the world’s largest EMOs, teaching more than 65,000 students in 15 countries, with the goal of reaching 5 million students by 2020. 5: Get a Big Win on the Board. It has become clear in recent years that even one success can have a surprisingly stimulating effect on an entrepreneurship ecosystem—by igniting the imagination of the public and inspiring imitators. I call this effect the â€Å"law of small numbers.† Skype’s adoption by millions and eventual $2.6 billion sale to eBay reverberated throughout the small nation of Estonia, encouraging highly trained technical people to start their own companies. In China, Baidu’s market share and worldwide recognition have inspired an entire generation of new entrepreneurs. Celtel’s amazing success as sub-Saharan Africa’s leading regional mobile provider and acquisition by Zain for more than $3 billion stirred the region’s pride and helped African governments fight â€Å"Africa fright† among investors. In Ireland it was Elan Corporation and Iona Technologies, listed on Nasdaq in 1984 and 1997, respectively, that served as guiding lights to a gener ation of budding entrepreneurs. Sub-Saharan Africa: Building Shareholder Value—and Better Government Early, visible successes help reduce the perception of entrepreneurial barriers and risks, and highlight the tangible rewards. Even modest successes can have an impact. Saudi Arabia, a nation with a dearth of entrepreneurial ventures (aside from the powerful family business groups), is fighting hard to tear down the numerous structural and cultural obstacles entrepreneurs face. One young Saudi, Abdullah Al-Munif, left his salaried job, tightened his belt, fought the bureaucracy, and started a business making chocolate-covered dates. He ultimately grew the business, Anoosh, into a national chain of 10 high street stores and turned an eye to overseas markets. Now when Al-Munif appears as a panelist at entrepreneurship seminars, he is swamped by aspiring Saudi entrepreneurs who take inspiration from his bravery, realizing that neither capital, nor technology, nor connections are essential to success. Overcelebrate the successes. Governments should be bold about celebrating thriving entrepreneurial ventures. Media events, highly publicized awards, and touts in government literature, speeches, and interviews all have an impact. This is not as straightforward as it may seem, because many cultures discourage any public display of success as boastful or an invitation to either bad luck or the tax collector. Whereas in Hong Kong even small-scale entrepreneurs drive black Mercedes to project their status, in the Middle East flaunting one’s success publicly can attract the envy of neighbors or, worse, the evil eye. Kenya’s first international call center, KenCall, founded by Nicholas Nesbitt and two partners in 2004, built an international presence by overcoming many bureaucratic and structural barriers, including the lack of a high-speed optical fiber hookup to the international communications grid. The Kenyan government didn’t wait until KenCall became big to sing its praises; even when it was a fledgling operation, the government brought in foreign delegations for visits, promoted the company in official publications and press releases, and hosted an international outsourcing conference. Government officials also used KenCall’s example to push for reforms, which expedited the construction of East Africa’s first undersea optical fiber link—an example of how entrepreneurial success can facilitate structural change, not just the other way around. 6: Tackle Cultural Change Head-On. Changing a deeply ingrained culture is enormously difficult, but both Ireland and Chile demonstrate that it is possible to alter social norms about entrepreneurship in less than a generation. Until the 1980s employment in government, financial services, or agriculture was the main aspiration of Ireland’s young people. There was zero tolerance for loan defaults, and bankruptcy was stigmatized. Parents discouraged their children from setting out on their own, so few nurtured dreams of starting their own business. But by the 1990s, after successful pioneers paved the way, hundreds of new software companies had been launched in Ireland. Some exported products; some went public. Many achieved healthy sales revenues. Just as important, entrepreneurs learned that it was possible to fail and regroup to try again. â€Å"If you wanted to be respected and taken seriously, you needed to be a founder with a stake in a company trying to do something,† recalls Barry Murphy, who was national software director at Enterprise Ireland’s predecessor in the 1990s. In her research, University of Minnesota professor Rachel Schurman has described how Chileans’ negative image of entrepreneurs as greedy exploiters was transformed in just one decade, as a direct result of the Chilean government’s concerted effort to liberalize Chile’s economy. Until the 1980s, Chile’s well-educated middle class wasn’t entrepreneurial, avoided opportunity-driven investment, and preferred to consume rather than save and invest. But by the 1990s, Chile’s new middle-class entrepreneurs were telling Schurman: â€Å"Today the youth, everybody, wants to be an entrepreneur. If a successful empresario is interviewed in the newspaper, everybody reads it. Why was he successful? How did he do it? It’s a model that never existed before†¦.† The media can play an important role not just in celebrating wins but in changing attitudes. In Puerto Rico, El Nuevo Dà ­a, the largest daily newspaper, supported local entrepreneurship by running a weekly page of start-up success stories. On the small island, these stories have quickly become part of the social dialogue and have raised awareness about the opportunities entrepreneurship presents, as well as the tools it requires. 7: Stress the Roots. It’s a mistake to flood even high-potential entrepreneurs with easy money: More is not necessarily merrier. New ventures must be exposed early to the rigors of the market. Just as grape growers withhold water from their vines to extend their root systems and make their grapes produce more-concentrated flavor, governments should â€Å"stress the roots† of new ventures by meting out money carefully, to ensure that entrepreneurs develop toughness and resourcefulness. Such measures also help weed out opportunists. In 2006 Malaysia’s Ministry of Entrepreneur and Cooperative Development awarded 90% of some 21,000 applicants about $5,000 each in business support, strong evidence of the government’s commitment to entrepreneurship. The program was part of an affirmative action program largely aimed at indigenous Malays, who were less entrepreneurial than the country’s business-minded Chinese immigrants. Yet Malay entrepreneurs themselves attribute the disappointing results partly to the fact that funding was too loose and even stigmatized the Malay recipients as less capable. More broadly, Malaysian entrepreneurship-development programs, considered by many, including myself, to be among the most comprehensive programs in the world, have been criticized for actually inhibiting entrepreneurship among the Malays by unwittingly reinforcing their lack of risk taking. Similarly, recent reports on South Africa’s Black Economic Empowerment program have reached the conclusion that BEE has discouraged entrepreneurship among the bulk of black South Africans and has benefited primarily the elite and well-connected. In fact, the hardships of resource-scarce, even hostile, environments often promote entrepreneurial resourcefulness. New Zealanders call Kiwi ingenuity â€Å"number 8 wire†: In the country’s colonial days, the only plentiful resource was 8-gauge fencing wire, and New Zealanders learned to fix and make anything with it. Icelandic entrepreneurship is built upon a legacy of â€Å"fishing when the fish are there, not when the weather is good.† For years incubators or entrepreneurship centers that provide financial help, mentoring, and often space to start-ups have been popular with governments. But I have seen scant rigorous evidence that these expensive programs contribute commensurately to entrepreneurship. One municipality in Latin America established 30 small incubators, but after several years only one venture out of more than 500 assisted by them had reached annual sales of $1 million. Though Israel’s renowned incubator program has helped launch more than 1,300 new ventures, relatively few of them have been big entrepreneurial successes. On the basis of my discussions with Israeli officials, I estimate that, among the hundreds of Israeli ventures that have been acquired at hefty valuations or taken public, at best 5% were hatched in incubators. And incubators definitely are not a quick fix. When well conceived and well managed, they can take 20 years or longer to generate a measurable impact on entrepreneurship. Poorly conceived and managed, they can be white elephants.

The Great Gatsby By F. Scott Fitzgerald - 1707 Words

In the United States, the pursuit of wealth through hard work is the main principle and guideline of life. Labeled as the American Dream, Americans are pressed to work hard and honest under the idea that they will have an equal opportunity to obtain riches and glory. But is the pursuit of wealth really as pure and honest as it may seem? Holding this same idea and question, in F. Scott Fitzgerald’s novel The Great Gatsby, a young man by the name of Nick Carraway begins his pursuit towards the American Dream. The novel begins with Nick arriving at his new yet shabby home in Long Island, where he is surrounded by the mansions of millionaires. As Nick settles into his new home, he begins to spend time with the wealthy residents, both new and†¦show more content†¦This idea, presented by the recurring events and acts of cheating and dishonesty by the main characters of the story, serves as a theme of Fitzgerald’s The Great Gatsby. In The Great Gatsby, cheating serves as a motif of the novel, which can be drawn from the constant events and tales of cheating which occur throughout the story. The motif of cheating serves to add the idea that purity of the people in pursuit of the American dream may be tainted with corruption. The cheating motif inlaid in the novel reveals the shallow and the dark side of the lives of the wealthy class. The constant corruption, in its many different forms and individual events, shown in The Great Gatsby by the people pursuing the American Dream show the corruption and utter hollowness of the American Dream. The motif reveals that the American Dream is a dark goal which involves cheating and betrayal. Every major character in the story presents different individual events of corruption in their pursuits. Each separate event ties back to the idea that the American dream’s goals are overwhelmed by the human greed and ability to cut each other s throat in order to move up in cl ass. The cheating motif, which reveals the darkness hidden in the American Dream, presses the idea that the American Dream is not an honest pursuit due to the corruption in which is displayed in the people which pursue it. Tom Buchanan

Nancy in Charles Dickens Oliver Twist Essay - 679 Words

Nancy in Charles Dickens Oliver Twist London in the 19th century was a heavily packed city where the rich and poor rubbed shoulders daily. Charles Dickens lived there most of his life, growing from a poor child to a publicly famous, but often privately troubled, writer. The city shaped his life it also patterns his work in complex and fascinating ways. The novels picture this great city vividly. It can also be seen to be used as a symbolic map through which human relationships of all kinds are explored. This description of Oliver Twist may also capture the haunting childhood of its author, Charles Dickens. Feeling alone in the world at the age of 12, Dickens saw firsthand the horrors Victorian†¦show more content†¦When Oliver is caught delivering books for Mr. Brownlow, Nancy and Bill Sikes take him to the hideouts that the thieves live in. There he is stripped of his clothes, money and books. Nancy fights for Olivers safety among the men in the room. Keep back the dog, Bill! cried Nancy, springing before the door and closing it, as the Jew and his two pupils darted out in pursuit. Keep back the dog: hell tear the boy to pieces. Serve him right! cried Sikes, struggling to disengage himself from the girls grasp. Stand off from me, or Ill split your head against the wall. I dont care for that Bill, I dont care for that, screamed the girl, struggling violently with the man: the child shant be torn down by the dog, unless you kill me first. With the capture of Oliver Fagin the leader of the gang and Bill were upset that Oliver had run away. Bills dog being in the room nearly tears Oliver to shreds but Nancy saves him. Having this dirty, ugly world of crime pulled over her eyes Nancy is bothered by how Oliver is treated and tries to shield him from the evil world. Nancy being beat by Sikes is victim of violence therefore doesnt think she has any other life to turn to. She has a hard time with good and evil deciding where she stands. But she is determined to take care of Oliver so he can have a better life. I wouldnt say Nancy is the most important character inShow MoreRelatedHow Charles Dickens Portrays the Murder of Nancy in Oliver Twist2542 Words   |  11 PagesHow Charles Dickens Portrays the Murder of Nancy in Oliver Twist Oliver Twist was written by Charles Dickens. He was born on February 7th 1812in Landport which is situated in Portsmouth, England. He worked in a blacking factory where shoe polish is produced and Dickens job was to paste labels to the bottles of polish. The working conditions then were dreadfully poor, He was doing this job when he was 12 years old which meant that in those days children had little childhoodRead MoreAnalysis Of Charles Dickens s Oliver Twist 1539 Words   |  7 Pages​Charles Dickens illustrates how people facing poverty are treated as criminals by the Victorian society and may cause them to be forced down the path of crime. He demonstrates this theory throughout his novel Oliver Twist. Oliver Twist is a novel about a ten year old orphan in the nineteenth century who is forced into labour at a workhouse. Dickens highlights the conditions of the workhouse to display the struggle one bares in order to survive. He uses the characters Oliver and Nancy to demonstrateRead MoreTension, Anticipation, and Suspense in Oliver Twist Essay1508 Words   |  7 PagesCharles Dickens wrote ‘Oliver Twist’ between 1873 and 1839. Oliver Twist is Charles Dickens second novel. Oliver Twist began as a sketch; later on chapter by chapter it came on magazine and became a serial and eventually the whole novel was published. Charles Dickens childhood was terribl e; he had to work in a factory for some months. The novel exposes a lot of Victorian attitudes which Dickens experienced as he was in poverty himself. Oliver Twist suffered for nine years in the baby farm treatedRead MoreNancy as the Most Important Character in Oliver Twist Essay1478 Words   |  6 PagesNancy as the Most Important Character in Oliver Twist Charles dickens wrote Oliver Twist in 1837, during the Victorian era of England, he was born in Landport, a suburb of Portsea, on February 7, 1812. He was their first child of eight siblings. John Dickens, Charless father, was not good with handling the familys money. He was then imprisoned for debt on February 20, 1824. This experience left Charles psychologically scarred. Charles had to take the role of beingRead MoreOliver Twist By Charles Dickens1644 Words   |  7 PagesIn Dickens’ Oliver Twist, Dickens frequently explains how â€Å"callous and uncaring Victorian society was (Shmoop Editorial Team),† as well as how clothing affects one’s social class. 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Air Pollution - Paper - 2324 Words

Air Pollution 20.000 liters of air is what we breathe on a daily basis. Air is something most people take for granted, you don’t see it around you and breathing goes automatically. But every time we inhale we risk inhaling dangerous chemicals which found their way in our air. Air pollution is the presence of dangerous chemicals in the air that we breathe. It is a change in the air which influences humans health and organism on the planet. Many think that `gases pollute the air, those gases go under the names of CFCs, carbon monoxide, and sulfur dioxide. Emissions of carbon monoxide are especially dangerous. Schematic drawing, causes and effects of air pollution: (1) greenhouse effect, (2) particulate contamination, (3) increased†¦show more content†¦API | Status | Areas | % | 0-50 | Good | 38 | 80% | 51-100 | Moderate | 9 | 19% | 101-200 | Unhealthy | 0 | 0% | 201-300 | Very Unhealthy | 0 | 0% | gt;301 | Hazardous | 0 | 0% | Green stands for cool summer temperatures and windy conditions. It is not harmful for people’s health. Yellow stands for rain and afternoon thunderstorms. Only those who are extremely sensitive should not be outdoors for a long time. Orange stands for a slight chance of afternoon thunderstorms, children and elderly and people with asthma should limit their time outdoor. Red stands for little chance of rainfall, especially children have to limit spending time outdoors. Dark red stands for no chance of rainfall, thunderstorm or any kind of precipitation. Active children and adults and people with asthma should not go outdoors. Global warming Global warming is the heating up of the average temperature of earth. It is said to have a large effect on weather patterns. Therefore it has a direct impact on people’s health. One of the impacts global warming has is the significant increase of heat waves, which directly leads to an increase of air pollution because of the warm vertical air. The heat waves are also bad for the poor, who mostly live in bad living conditions and do not own a air conditioning. The death rate of the poor are mostly quite high after a heat wave. Global warming also leads to extreme weather in general. Hurricanes and otherShow MoreRelatedAir and Water Pollution Paper698 Words   |  3 PagesCarbon oxide and Nitrogen oxide are one of the many air pollutants this world is having problems with. As for carbon oxide and nitrogen oxide they fall into the category of a primary pollutant, or as so I believe. 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Equality Essay Example For Students

Equality Essay EqualityIn 1890, less then one half of one percent of women were employed gainfullyoutside of the home. Over the next hundred years, women have not only gainedaccess to jobs outside of the home, but also fought for equality in the workplace. These struggles have not been easy by any means. Women have overcomemany obstacles in there journey into the work force, none grater then the viewsof their male piers. Many males thought and continue to think that there is noplace for women in the work place. Women made there strides into the work forceby not only following examples of their courageous pioneers, but also by bandingtogether to show their strength. During the mid 1800s a small number of women begin their assault on, whatwere at the time considered, male-only jobs. Fields such as teaching, preaching,medicine, and law were all jobs domenated by men. Women had made some progressin the work force before the 1850s. In the mid nineteenth century women werethe majority for grade school teachers, up from the ten percent of elementaryteachers, that were teachers in the colonial period. This can be largelyattributed not to the fact that men were more accepting of the idea that womenbelonged in the work place, but rather men were drown to the higher paying andmore socially appreciated managerial jobs brought on by the industrialrevolution. School boards did not mind these talented leaving because theycould higher a less qualified women for as low as one fifth of males salaryfor the same job. Susan B. Anthony was the first women to publicly speak out against thisgross injustice towards women. After being fired to replace a male teacherfired for incompetence,she was paid one third of the salary he hadreceived,(Reifert 74)she went to the state teachers convention of 1853 toregister a protest. After being hushed once and a half hour of debate she wasfinally allowed to speak her peace. Although nothing became of her firstencounter with the womens movement, she quit teaching and went on to become oneof the great leaders of the womens movement. Antoinette Brown was anther women that was not happy with the statusquo of women in society. She started, in 1846, by attending Oberlin college,which only nine years before had become the first co-educational college. Oberlin, although being very receptive of women in their womens department,they did not let women take any courses besides the ones offered in the womendepartment. This lead to a conflict when Brown made her intentions of obtaininga theology degree known. Brown won the battle to attend the classes she neededfor her degree, but this was by far not the last battle for equality she wouldhave to fight. Oberlan refused to grant her a students license to preach.,and after her course work was completed Oberlan would not allow her to takepart in the graduation ceremony, be licensed, ordained, or even have her nameregistered on the class roll.(Reifert 76) It took three years, of hard lookingfor Brown to find a Protestant Church that would allow her to be ordained. Finally after all of her struggles Antoinette Brown was ordained the firstprotestant female minister in America. Women in the early 1800s were discriminated against both as practitionerand as patient.(Reifert 77) Women were thought that it was wrong for them toseek help from doctors for any problems that had anything remotely to do withtheir reproductive system. It was also thought that Women were to fragile todeal with the work that goes with being a doctor. Elizabeth Blackwell saw firsthand the effects of the first problem mentioned. She watched a family frienddie because she was embarrassed to bring her problem to the attention of hermale doctor. Blackwell was not detoured by the Idea that no medical schoolwould take her, because she could not compete with males. After all almosteveryone at the time believed that the female brain was different then the malebrain.(Reifert 78) Blackwell finally gained admittance to Geneva College aftera unanimous vote of the student body to let her in. This vote should not betaken as a sign that men were becoming more accepting of women infiltrating whatwas fo rmally known as male only territory. It should be noted that most of thestudents believed that either the vote was a joke or that Blackwell would notstay around long. Blackwell proved all the skeptics wrong by graduating in thetop of her class, but still no hospital in the United States would allow her tointern. For her internship Blackwell went to Paris. When She got back to theUnited States Blackwell found that no hospital would allow her to use theirfacilities. In 1857 she secured enough money to turn facility into a hospital. .u765575b94a0e902fcf85eb4ed117c31a , .u765575b94a0e902fcf85eb4ed117c31a .postImageUrl , .u765575b94a0e902fcf85eb4ed117c31a .centered-text-area { min-height: 80px; position: relative; } .u765575b94a0e902fcf85eb4ed117c31a , .u765575b94a0e902fcf85eb4ed117c31a:hover , .u765575b94a0e902fcf85eb4ed117c31a:visited , .u765575b94a0e902fcf85eb4ed117c31a:active { border:0!important; } .u765575b94a0e902fcf85eb4ed117c31a .clearfix:after { content: ""; display: table; clear: both; } .u765575b94a0e902fcf85eb4ed117c31a { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u765575b94a0e902fcf85eb4ed117c31a:active , .u765575b94a0e902fcf85eb4ed117c31a:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u765575b94a0e902fcf85eb4ed117c31a .centered-text-area { width: 100%; position: relative ; } .u765575b94a0e902fcf85eb4ed117c31a .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u765575b94a0e902fcf85eb4ed117c31a .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u765575b94a0e902fcf85eb4ed117c31a .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u765575b94a0e902fcf85eb4ed117c31a:hover .ctaButton { background-color: #34495E!important; } .u765575b94a0e902fcf85eb4ed117c31a .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u765575b94a0e902fcf85eb4ed117c31a .u765575b94a0e902fcf85eb4ed117c31a-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u765575b94a0e902fcf85eb4ed117c31a:after { content: ""; display: block; clear: both; } READ: Teen Suicide EssaySimilar to doctors, nurses were largely male until the 1850s. Nursing followeda similar path as elementary teachers, as more higher paid jobs opened up, itleft room for women to take over less glamorous jobs. In the early nineteenthcentury lawyers were thought by apprenticeship. This was a very big problem forwomen that had an interest in this field, because no men lawyers would everdream of having a female apprentice. The emergence of law schools made the jobof a lawyer remotely accessible, but by no means easy. Such is the case of MyraBradwell, who graduated from Chicago School of law, but was refused a license topractice law by the Illinois State Bar. She took her battle to the SupremeCourt, by was ruled against. After her ruling was overturned in 1890 at the ageof 59, she became a licensed lawyer and two years latter practiced law in frontof the same court that had refused her rights 23 years earlier. Before these women had broken into these previously all male jobs womensjobs four general limitations. They are (1) that women perform work similar tothat of the home; (2) that no great skill be involved; (3) that no greatphysical strength be required; (4) that the work should not involve contactswith the rougher male sex(Riegel 135) Contrary to the Desires of theiremployers to maintain their workers femininity, the women, they provided theiremployees with very adverse working conditions. The conditions under whichmost women were described by an on looker : girls take off their street suits and put on an old skirts and waists matted with glue dirt, in which the spend ten hours a day scorning, cutting and sniping, wetting great sheets of paper and paste at a few cents a day(Cantarow xxvii)Women at time made around half of what their male counterparts made. While maleunions were proving very successful in the advancement in working conditions formen, but most unions had little interest in helping womens causes. For thisreason,in 1903 the WTUL (Womens trade Union league) was launched. This helpedWomen unite to achieve better working conditions. The WTUL was very influentialin the organization and support of the major womens strikes. Women fought many hard battles to gain access to areas that were at on timestrictly off limits to them and fought hard to improve their working conditions. With out the struggles of these women other women might not have the rights theyhave today. Social Issues