State Capitol Building Free Essays

The first state capitol building in Jefferson City was built in the period of 1823-1826 and was destroyed by fire in 1837. A new capitol building had been approved at the time and was completed in 1840. The second capitol was destroyed by fire on February 5, 1911, when a bolt of lightning struck the dome. We will write a custom essay sample on State Capitol Building or any similar topic only for you Order Now The present capitol was built in the period of 1913-1917 and stands upon the same spot as the first, high atop a bluff overlooking the Missouri River. One significance in the capitol building is the Missouri State Museum, which is located on the first floor of the Missouri State Capitol Building, and run by the Department of Natural Resources and Division of State Parks. The museum contains long-term exhibits and regularly changing temporary exhibits. Also, there is a program that develops a series of traveling exhibits that can be used as educational tools by schools, civic and other groups. The Missouri State Museum is responsible for a large collection, consisting of approximately 93,000 artifacts and objects from all aspects of Missouri’s history. These artifacts and objects have been collected since the museum was first opened. One of the highlights of the collection is the collection of over 125 Missouri Civil War battle flags. Thirty-three of the flags have been conserved and eleven have been framed. The â€Å"Missouri Veterans Gallery† is in the east end of the Missouri State Museum is a new long-term exhibit. The centerpiece of the exhibit is a brass model of the USS Missouri battleship built by the U. S. Navy for research. The exhibit also includes artifacts and images related to Missouri veterans as well as excerpts from interviews with veterans. The Museum staff developed this exhibit to inform visitors about the key role of Missouri veterans in the history of the state. In 1935, Missouri native Thomas Hart Benton was summoned upon the Missouri House of Representatives to paint a mural on all 4 walls of the House Lounge, which is a large meeting room on the third floor in the Capitol’s west wing. The mural portrays bold and vivid scenes of everyday Missouri life, which at first sparked controversy among the legislators. Benton’s mural represents a source of pride and a popular stop for visitors touring the Capitol. In addition to housing the two legislative bodies, the Capitol provides office space for the Governor, Lieutenant Governor, Secretary of State, Treasurer, State Auditor and some administrative agencies. The structure is also notable for its architectural features, including its eight 48-foot columns on the south portico and six 40-foot columns on the north side; its 30-foot-wide grand stairway and its bronze front doors, each 13 by 18 feet. There are no weaknesses of the capitol building when providing a historical museum, free guided tours, and opened almost everyday of the year. The purpose of the capitol building is more to inform tourist about Missouri history than housing for two legislative bodies, the Capitol provides office space for the Governor, Lieutenant Governor, Secretary of State, Treasurer, State Auditor and some administrative agencies. The museum had excellent exhibits, including the brass model of the USS Missouri battleship. Throughout the first floor, the capitol building had exhibits about the early settlers. I would recommend to people who love to learn about history to take a tour of the Missouri State Capitol Building. How to cite State Capitol Building, Papers

Dazzling Costumes Information System

Questions: Task 1 Draw a context diagram data flow diagram for the system described above. The format should be similar to the context diagram in figure 5-13 of your textbook.Task 2 Draw the Level 0 DFD (Data Flow Diagram). All processes on this diagram should be functional primitives. The format should be similar to the context diagram in figure 5-16 of your textbook.Task 3 Draw an ERD (Entity Relationship Diagram) which represents the entities described in the case study, fully normalised to reflect all entities, relationships, cardinality and optionality. Ensure to follow the crows feet notation to indicate cardinality. The format should be similar to the figure 9-21 of your textbook.Task 4 Create a 3NF design for the system described in the case study. Provide the entity attribute list in 3rd normal form to support the ERD in Task 3. Make sure that all primary and foreign keys are identified properly. It is not necessary to provide the earlier normalisation forms (1NF and 2NF) as these will not be markedTask 5 Draw a class diagram for the system described in the case study. The format should be similar to the class diagram in figure 6-30 of your textbook. Make sure to include all relevant attributes and methods for each class.Task 6 The Manager of Dazzling Costumes is most interested in your work. She has no knowledge of Systems Analysis and Design and has asked for a brief explanation of what you have done and what these mean to her. Write - 1 page report explaining your work in Tasks 1 5.Task 7 Briefly describe various system changeover methods. Suggest a changeover method for the system described in the case study and provide specific reasons to support your choice. Answers: Task 1: Context Diagram Task 2: Level 0 DFD Task 3: ERD Task 4: 3NF Relations The list of attributes is, CUSTOMER (CustomerID, FirstName, LastName, DOB, Gender, Address) EMAIL (Email, CustomerID) ITEMS_HIRED (CustomerID, PieceItemID, HiredDate, DueDate, ReturnedDate) PIECE_ITEM (PieceItemID, ItemID, PurchaseDate, PurchaseCost, Size, Color, Status, SpclDetails) ITEM (ItemID, Name, Brand, GenDesc ) Task 5: Class Diagram Task 6 In any information system development process, there are more than one phases. System analysis and design is a phase in system development process. In the information system development process for Dazzling Costumes, the system analysis and design phase has provided following deliverables, Context diagram Level 0 DFD diagram ER diagram and 3NF database design. Class Diagram The context diagram is a functional system design diagram that gives a high level view of the system. The focus is on defining the boundaries and scope of the system and representing the same. So, the context diagram has been created for that purpose. Level 0 DFD diagram has extended the context diagram one step further towards detailed diagraming. The level 0 DFD shows the flow of data through the system and the system is represented as a set of processes. The main functional areas of the system are represented by the system. The storage of information has been shown using data stores D1 and D2. The diagram shows what data flows through which process, originates from which external entity and goes where in the system. ER diagram has been developed for the database design part. Every information system has an underlying database. The system records information about the customers, items and pieces of the items. So, the database will stores details about these entities. On the other hand there are certain relationships between different pair of these entities. Those are represented in the database also. Finally there is an attribute list of the logical relational database. The relations are in 3NF. The class diagram structures the information system. It will show how real world entities are getting manipulated in the information system. The classes, attributes of each class, the methods for each class, association between 2 classes etc. are represented graphically in the diagram. In this way, these deliverables are created. In system development process, a phase can consume and utilize the deliverables from previous phases. The next phase that is system development will use the deliverables from this phase. Task 7 After system development and testing, the newly developed system is implemented and it replaces the old system. The replacement of the old system by the new one is caller as system changeover process. There are four different types of system changeover methods. I. Direct cutover As soon as the newly developed system comes to the operational state, the old system is disposed and the new system starts working. This method of system changeover is called direct cutover method. The process is very inexpensive as at a time, only one information system runs there. But, there are a lot of risks in this method. The system can crash due to various reason, there may be more load than the system can handle, some bugs etc. in that case the there will be losses of data. II. Parallel method As the name suggests, in parallel method, the old system is used for some specific time even after full implementation of the new system. There are two information systems that runs at a time, parallel to each other. The method is very expensive. Because more resources are needed to run two information systems. But it lowers the risks of data loss, even if the new system is crashed for some issue, the old system will operate. When the new system proves itself to work efficiently in the working environment and producing similar deliverables like the old system, then the old system is retired. III. Phased Operation For big projects, there are a number of business processes and usually the whole system implementation is broken down into multiple phases. In each phase, the new system is implemented and made available to a part of the business. When it performs in an expected way, then that is integrated to the implementation of next phase and the process continues until the new system is made available to the whole business. The process has limited risks and is less expensive than parallel method. However, it is hard to implement, as there may be compatibility issues while working on new and old systems partially at a time. IV. Pilot Operation In some cases, a business have multiple sites or locations. A location is selected from those as a pilot site. The new information system is implemented to the pilot site at first. This is not phased implementation, rather it is complete implementation at a smaller location. When the system performs as per requirements, then it is implemented to the rest of the sites. This process also have lowered risks and reasonable expense. (Shelly Rosenblatt, 2011) It is suggested that Dazzling Costumes should use parallel method. In their case, the manual system and the newly implemented system will run in parallel for some time. The process will not be very expensive as only one information system will run in their case. But the risks of data loss will be low. References Shelly, G. Rosenblatt, H. J., 2011. Systems Analysis and Design., Cengage Learning.

Learning Object Repositories Evaluation of LORs

Learning Object Repositories are becoming more widespread and more popular among researchers and educators across the globe. Ochoa and Duval (2009) noted that LORs grew linearly and the popularity of such resources was growing steadily irrespective of the number of objects or quality of the objects submitted.Advertising We will write a custom critical writing sample on Learning Object Repositories: Evaluation of LORs specifically for you for only $16.05 $11/page Learn More Therefore, it is possible to note that LORs are seen as useful tools to improve and develop. People long to create communities where researchers and educators could share information. I believe that LORs make up almost an ideal community. I think LORs represent this idea community where a lot of valuable information is stored. People from different countries and having different backgrounds manage to share information. Admittedly, this fosters research and development of teaching strat egies. I have found a lot of particular ideas and resources to make my teaching more effective. There were moments when I felt stuck as I could not find ways to present material in a more effective way. I came across a variety of ideas in LORS. I suppose lots of researchers and educators have had similar moments when they did not know an answer to a question. Many answers are available at LORs now. Koppi, Bogle and Bogle (2005) pointed out that there were three aspects of LOR. According to Koppi, Bogle and Bogle (2005, p. 83) the third aspect, i.e. â€Å"the collaborative space† is the most valuable for researchers and educators from all over the world. I agree with this assumption and I think availability of different data can foster research in a variety of spheres. Nonetheless, it is necessary to note that LORs are still almost ideal as there are certain factors that prevent these resources from becoming truly ideal communities. Some argue that ideas of ‘old’ teachers make people doubt in effectiveness of LORs.Advertising Looking for critical writing on education? Let's see if we can help you! Get your first paper with 15% OFF Learn More However, the major problem is still associated with technology as many people have no access to LORs due to scarce financial support of educational and research spheres (Richards, McGreal, Hatala Friesen, 2002). I am a teacher in the UAE and I have access to the Internet and a variety of resources. However, some LORs are inaccessible for me as sometimes membership requires certain payments. I understand that many organizations have resources to be members of some LORs. At the same time, in the UAE many organizations do not have an opportunity to be members of such communities. Moreover, many teachers in this country do not have access to the Internet. Of course, this is quite a considerable limitation to the use of LORs as many really brilliant ideas are still outside the global communitie s of researchers and educators. Therefore, I’d like to note that LORs can become a really great invention of humanity as these global communities can rocket research, to a great extent. At the same time, it is necessary to remember that there is still much to be done. Governments should pay attention to the development of LORs. Development of the global communities must be one of the priorities of officials. Reference List Koppi, T., Bogle, L. Bogle, M. (2005). Learning objects, repositories, sharing and reusability. Open Learning, 20(1), 83-91. Ochoa, X. Duval, E. (2009). Quantitative analysis of learning object repositories. IEEE Transactions on Learning Technologies, 2(3), 226-238.Advertising We will write a custom critical writing sample on Learning Object Repositories: Evaluation of LORs specifically for you for only $16.05 $11/page Learn More Richards, G., McGreal, R., Hatala, M. Friesen, N. (2002). The evolution of learning object repos itory technologies: Portals for on-line objects for learning. Journal of Distance Education, 17(3), 67-79. This critical writing on Learning Object Repositories: Evaluation of LORs was written and submitted by user Gauge Burks to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

Easy Last-Minute College Halloween Costumes

Easy Last-Minute College Halloween Costumes Halloween is a highlight of the fall semester on any college campus. Its your chance to take a break, have fun with friends, and get  a little weird. What if you didnt have time to plan your Halloween costume? If youre like most college students who have  too much stress and not enough time, you probably waited until the last minute to figure out what to be for Halloween. Luckily, there are several great ideas that are quick, easy, and cheap (or free). They simply require a little imagination. Dress up as Your Roommate No matter what your roommate is into, take their signature look and amplified it (with kindness, of course). This is even better if you both go together while dressed as each other. Simply borrow your roommates clothes and an accessory or two, vamp it up a bit, and off you go. Ladies, is your roommate into bags? Grab several of her faves and head out. Guys, does your roommate always wear sports shirts? Put on several and show them off during the evening, maybe even rotating them as the night goes on.   It should go without saying that youll need your roommates permission. Its also a good idea to be sensitive to hurting any feelings because you dont want to damage your relationship. But if youre both into it, it can be a fast costume fix. Get to the Thrift Store Head down to the local thrift store and piece together a quick costume. They have all kinds of great finds and its even better around Halloween. Grab some funky, retro, or fancy clothes, it really doesnt matter and the more creative you get, the better. You can even pick up a few options without worrying about spending too much. Keep in mind, too, that you dont necessarily need to have an idea before you get to the store. Going in with an open mind might be the best way to approach things. That way, if you see something that looks interesting, youll be more likely to let your creativity flow. Go as a Group If youre going out with a group of friends, work together to find a costume. You can dress like the cast from a recent movie, a group of flight attendants and pilots, or the members of todays hottest  band. Any of these costumes are easy to put together. Its often a matter of adapting clothes you already have or running to the thrift store for a few special pieces. Since youre going as a group, you wont need as many accessories as you would if you were responsible for your own attire. Dress as a College Movie Character You may not have thought about it, but you have an entire room full of props for a college student. Vamp it up and go as a college-aged character from a movie. It can be a classic (Bluto, anyone?) or whatever is hot at the moment. Either way, its an easy fix if you dont have a costume and takes just a few minutes to put together. Cant think of a character to go as? Have fun with the college student look. Give yourself the stressed out, up all night studying look with messy hair, a backward shirt, mismatched shoes, or whatever. Get weird, have fun, and see what you come up with.

ENG DB3 Essay Example | Topics and Well Written Essays - 500 words

ENG DB3 - Essay Example The exile of the Jews by God was enough for them to believe that Jews had literally no place by their name on this world. The Zionists continued to work towards the settlement of their tribesmen irrespective of the oppositional cry. They developed the Jewish National Fund in 1901 with the help of the World Zionist Organization. With this fund they planned on buying lands in not only in Palestine but also Syria, various parts of Turkey and some areas of Sinai. These lands were carefully taken over solely for the settlement of the Jews. After purchasing the lands at very high price the Zionists were determined to keep it and also wanted it to be run by their own people instead of Arab farmers. They devised a plan of employing the Arabs in transit to another country so that they may be excavated instead of being thrown out of the land. Nearly five hundred and thousand people have been living in the West Bank against international law since 1967 despite the denial by the Israeli governme nt. The colonization of Palestinian state led to severe bloodshed. Along with Britain, the Zionist body got together to clear the land of Jerusalem. The protection of the Jews became the chief motif in this regard. A British Embassy was establish to keep track of any report which went against the protection of the Jews. Even the Ottoman Empire was requested to give room to the Jewish settlers while their permanent residence was arranged by the higher authority. All this was done under Lord Palmerston in 1839. This way the British influence over the Middle East started to grow progressively. Israel has been avoiding Arab invasion in the premises of the Green Line ever since September 1997. This problem is being attempted to be solved by moving the Bedouins away from the towns of Negev and Galilee where they are mostly populated. The Jewish population remains under scrutiny for its suspicious moves against innocent

Neighbourhood policing, is it real police work Essay

Neighbourhood policing, is it real police work - Essay Example This research paper examines that through the concept of neighborhood policing, it is clear that better solutions through cooperative efforts are being achieved. With the widespread use of these teams and the success with which they have been met, it is possible that this idea could be extended to include a greater number of community services so that through police and social services interactions, more individuals can be helped before harm comes to the community. With a wider social cooperative effort, it may be that crimes can be prevented through an understanding of events from a larger perspective. The success of this system has been through the cooperation of authoritative efforts, but this success suggests that wider use could be of service to the communities. The idea of community policing or neighborhood policing was developed in 1829 by Sir Robert Peel who was looking for a way to create a more community ideal of law enforcement. In the early 21st century, after some prelim inary efforts that started in the 1980s, Parliament has supported the idea of creating teams in communities with the intention of creating a safer nation. As a result, decreases have been seen in the crimes that specific areas have mostly been concerned about for their neighborhoods. Through cooperation, the development of these teams has put a force based on presence and interactions that have allowed for a better assessment of what is occurring so that regionally specific solutions can be developed.

Umbilical Cord Care Very Important Health And Social Care Essay

Umbilical Cord Care Very Important Health And Social Care Essay Health is the most important, sought-after thing in the world by all, no matter who we are, when well- cared for their earliest years, children are more likely to survive grow up the first month is crucial importance, in terms of health care. The health of women and children is the basis of a healthy family and a healthy nation. This is particularly true of children whose healthy future depends on proper care during the first year life (UNICEF, 2002).Newborns are the blessings for today and tomorrow. The newborns body is most supersensitive, delicate, immature and susceptible from which can easily harmed if not taken care of newborn. The birth of a baby is an event a moment which creates a great joy and wonder of gods gift, a gift of god in the life of parents. From the moment of birth, many parents are loved to involve in the care of the newborn. The first care given to a neonate include placing him/her in a warm environment , suctioning the oropharynx and nose , cleaning the eyes , clamping and cutting the cord ,checking the weight , tying the identification tag and mummifying the baby. First time the mother smiles when the newborn is cry and she forgets the pain. The newborn, once separated from the mother in the process of delivery, undergoes certain fundamental changes in which he/ she leaves the sterile environment of the uterus and moves into the outside environment .This separation occurs through the severing of the umbilical cord. After birth, the cord is no longer needed, and is cut, leaving a short stump Behind on-pathogenic bacteria such as coagulate -negative staphylococci, e-coli, and streptococci, clostrium tetani may also be present on the skin and can track up the umbilical stump causing infection (ZUPAN et a l à ¢Ã¢â€š ¬Ã‚ ¦, 2005). The UNICEF report released at the National conference on child survival and development in New Delhi, claims that out of nearly 26 million children born in India each year, 1.2 million die during the first 4 weeks .This is the 30% of the 3.9 million global neonatal deaths. According to current report (neonatal mortality) of 44/1000 live birth accounts for nearly 2/3rd of all infant deaths (death before the age of one) and nearly half of under five children deaths in India. Indias NMR significantly from 69/1000 live births in 1980-50/1000 -live births in 1990 .In recent years NMR has remained static only dropping four points from 48-44/1000 live birth in 1995 and 2000. The main causes of neonatal deaths are low birth weight and infections (Indian express, 2004). One million newborn infants die every day by multiple of organisms which often enter in to the body via the umbilicus. The other contributing causes of umbilical cord infection includes maternal factors like maternal infections e.g. amionitis, repeated vaginal examinations during labour, duration of rupture of membrane, unhygienic practice of delivery, delivery conducted by untrained dais, environment factors like cleanliness of the ward and caregiver with severe infection, upper respiratory infection and neonatal factors like small for gestational age, preterm newborns ,birth condition during labor like me conium stained liquor, umbilical cord infection had caused many neonatal death before aseptic technique were used .In developing countries umbilical cord infections constitute a major cause of Neonatal morbidity and pose significant risk for mortality, in the environment as the umbilical outbreaks of cord infection continue to occur even in developed nurseries (Zupan et al 2000). The hospitalized neonates may get infection from various sources like tube feeding, unhygienic cloth, avoidance of baby bath, using many cosmetics, etc. Environment as the umbilical cord is a means of entry for systemic infective agents that colonize the skin of the newborn. Umbilical cord is the only route of entry for microbes, because it has opening in the umbilicus, even though the cord clamp was there in the cord It is therefore essential to keep the cord clean to prevent infection and promote a normal healing until the stump dries up and falls off by giving umbilical cord care during the transition period. SIGNIFICANCE OF AND NEED FOR THE STUDY In midwifery practices, the newborn care is an important aspect and the kind of care and attention given immediately after birth and later is greatly valued. Umbilical cord care is very important since infections of the cord can be so fatal that it may even lead to the death of the neonate. Despite the importance of umbilical cord care, both traditionally and medically, there have been few randomized trials investigating the impact of different cord care regimen on rates of local or systemic infections, particularly in developing countries (Mullany et al 2003) Also, nursing studies and literature pertaining to the care of umbilical care relatively limited and the procedures adopted for umbilical cord care is varied. The present study intends to investigate the effectiveness of lukewarm water application on the umbilical cord of newborns in terms of occurrence of umbilical cord infection. Bain (1994) undertook a study to find the effect of four different cord care regimens in preterm babies. The evidence of the trail suggested that cleaning the cord with alcohol, wiping and dusting with sterzac powder resulted in less cord related infection and a shorter time for cord separation compared to any other cord care regimen. All these conclusive evidences prove that the policy of leaving umbilical cords untreated is not a safe practice. In many studies reported clean the umbilical cord with warm water compare than antiseptic solution. Antiseptic solution may cause delay in healing and form the pus (NNT 2010). Zupan and Garner (1998) carried out a study on the effectiveness of topical agents for umbilical cord care to prevent cord care infection, illness and death in newborn infants in developed countries. They have included newborns of any gestation, using any of the following interventions topical antiseptic applications. Clean with warm water, Including the newborns who were born outsides well as inside the hospital, the incidence of umbilical sepsis was2001-10 cases,2002-24case,2003- 19 cases.,2004( Jan out) -15 cases. Early onset of neonatal sepsis is clinically apparent within 72 hours of life , with an overall mortality rate of 15-50% .Late onset neonatal sepsis is usually present after 72hours of life and includes nosocomially acquired infections .The overall mortality rate of late onset sepsis is 10-20% Bobak et al (1995).The UNICEF report released at the National conference on child survival and development in New Delhi, claims that out of nearly 26 million children born in Indi a each ye1.2 million die during the first 4 weeks .This is the 30% of the 3.9 million global neonatal deaths. According to the current report (neonatal mortality) of 44/1000 live birth accounts for nearly 2/3rd of all infant deaths (death before the age of one) and nearly half of under five children deaths in India. Indias NMR significantly from 69/1000 live births in 1980-50/1000 -live births in 1990 .In recent years NMR has remained static only dropping four points from 48-44/1000 live birth in 1995 and 2000.India contributes to 20% global birth and highest number of neonatal death within a country, each year, 26 million infants are born in India of these 1.2 million die during the neonatal death period before completing the first four weeks of life. Two newborns deaths occur every minute in this vast country. The current neonatal mortality rate (NMR) is around 40/1000 live birth of less than five mortality rate. Between 1995and 2000, there was only a legible decrease 4 points in NMR from 48-44/ 1000 live birth. The tapering off the rate decline is a cause of concern requiring serious pl anning and newer strategies. The main causes of neonatal deaths are low birth weight and neonatal infections; maternal infections (Indian express, 2004). One million newborn infants die every day by bacterial infection which often enters the body via the umbilicus. The other contributing causes of umbilical cord infection includes maternal factors like maternal infections e.g. amionitis , repeated vaginal examinations during labour, duration of rupture of membrane, place of delivery, environment factors like cleanliness of the ward and caretaker with URI , technical factors like method of cord care , hand washing technique, and transfer of infant and neonatal factors like gestational age, birth condition during labor , umbilical cord infection had caused many neonatal death before aseptic technique were used. In developing countries umbilical cord infections constitute a major cause of Neonatal morbidity and pose significant risk for mortality, in the environment as the umbilical outbreaks of cord infections continue to occur even in developed nurseries (Zupan et al 2000). The traditional practices of cord care in this area include application of hot fermentation (31.5%), use of rag and latern(19.5%), use of Vaseline (9,5%), ash/charcoal(9.3%), groundnut/palm oil (8.3%), use of powder (6.5%),and red sand (3.5%), These practices are harmful because these substances are often contaminated with bacteria and spores, thus increasing the risk of infection.(Konduga local government area of born state-2005) Traditional nursing procedures are being gradually substituted by more modern Practices. As technologic advance, Nursing practices also change. As many routine procedures like predelivery perineal shave, predelivery enema are questioned, the efficacy of the antiseptic solution usage for umbilical cord care has also become a question and a study is necessitated through comparing the existing practices with the key outcomes .Therefore, the investigator strongly felt need to do study, comparing the use of antiseptic solution with lukewarm water for umbilical c ord care in order to find out the effectiveness of lukewarm water. STATEMENT OF PROBLEM An experimental study to evaluate the effectiveness of umbilical cord care using lukewarm water among newborns in selected hospital at Madurai district. OBJECTIVES To assess the umbilical cord after cord care experimental group and control group. To compare the effectiveness of cord care experimental group and control group. To find the association between experimental group with selected demographic variables To find the association between control group with selected demographic variables. HYPOTHESIS There will be significant difference between experimental group and control group after cord care. There will be significant association between experimental group with selected demographic variables. There will be significant association between control group with selected demographic variables OPERATIONAL DEFINITION Effectiveness In this study it refers to the outcome of an experimental study indentified with help of significant difference between tests among newborns. Newborn In this study it refers to the period from birth to28 days of life is called period and the infant in this period is termed as neonate or newborn baby. Umbilical cord care with lukewarm water In this study it refers to warm water with a degree of 70-97à ¢- ¦f or 26-36à ¢- ¦c to clean the umbilical cord and the cord is left dry and open. ASSUMPTION Application of lukewarm water will prevent infection of the umbilical cord. Application of lukewarm water it promotes early healing of umbilical cord. DELIMITATIONS `The study is limited to the newborn of the mothers who had LSCS. The study is confined to selected hospitals. PROJECTED OUTCOME The result of the study would help the investigator to identify the effectiveness of cord care using lukewarm water among newborns. The study will help to promote a early healing of the umbilical cord and to reduce the infections. The findings on demographic variables would help to identify the factors which affect the newborns with infection CHAPTER-II REVIEW OF LITERATURE Review of literature is an important, essential aspect of scientific treatment .It involves the systematic identification, location scrutiny and summarization of the written material that contains information on a research problem. It broadens the understanding and provides the insight necessary for the development of a broad conceptual context into which the problem fits (polit hungler, 1995). A review of related research and non- research literature was undertaken and an attempt was made to organize the materials. This includes Umbilical cord care Review on studies related to umbilical cord care using lukewarm water Review on studies related to cord care. UMBILICAL CORD CARE Umbilical cord Inspect the Umbilical cord area for the correct amount of blood vessels, two arteries and one vein. The umbilical vein is larger than the umbilical arteries. A yellow brown or green tinge to the cord indicates the me conium was released. The umbilical cord should be checked for bleeding or oozing during the early hours after birth. The clamp must be securely fastened with no skin caught and tissue injury. Pathophysiological background The umbilical cord is a tissue, which of consisting of two arteries and one vein covered by a mucoid connective tissue called Whartons jelly and a thin mucous membrane. During pregnancy, the placenta supplies all nutrients for fetal growth and development and removes waste products. Blood flowing through the cord brings nutrients and oxygen to the fetus and carries away carbon dioxide and metabolic wastes. After birth, until the placenta separates and while the cord is still pulsating, a small volume of blood may be transfused from the placenta to the newborn. The amount transfused depends on when the cord is cut and the level at which the baby is held in relation to the mother at the time of cord clamping Umbilical cord healing process The cord darkens and shrivels as it dries and falls off within 7-14 days. The cord should be dry and not have any drainage. After the cord falls, a small pink, granulating area about a quarter of an inch in diameter may remain. This should also be left clean and dry until it has healed (about 24- 48 more hours). umbcord Umbilical cord infection In umbilical cord if the ulcerous area has remained as long as one week it indicates of sign of infection. Source of infection Unhygienic environment of delivery Contaminated cord cutting instrument Infected hands of care giver or infected clothing Causative organisms Staphylococcus E-coli Clostridium tetani Signs and symptoms Swollen and moist per umbilical tissue with redness Foul smelling Serous or purulent discharge Delayed falling of umbilical cord Fever Management Umbilical cord should leave uncovered rather than application of dressing. Systemic antibiotic is given in complicated cases. Complication Jaundice Hepatitis Peritonitis Umbilical granuloma Prevention Aseptic technique and clean practices at birth. Administration of tetanus toxoid to antenatal mothers. Prognosis Prognosis depends upon the nature of infection, intiation of management and nursing care. Prevention of umbilical cord infection is more easy and important in neonates. Cord care DOs and DONTS Dos Cut the cord with a clean instrument. Tie the cord tightly with clean or sterile thread or clamp. Tie napkin or diaper below the umbilical cord. Donts Bandages are unnecessary and may delay in cord healing and introduce infection to the newborn. Alcohol cleaning may delay in healing and cause pus. Apply traditional remedies to the cord may cause infection World Health Organization,  (1999) Current standards of cord care is based on the principles of aseptic techniques. The aim of WHO to prevent the cord infections. However, the introduction of infection in neonatal care unit and well baby clinic for newborns in hospitals in the 1940s increased the risk of staphylococcal skin and cord infections by facilitating the spread of bacteria among infants in hospital. Clean the cord at birth and in the days following birth is effective in preventing cord infections and tetanus neonatrum. Clean cord care practices at birth include washing hands with clean water and soap before delivery and again before cutting and tying the cord, laying the newborn on a clean surface and cutting the cord with a sterile instrument and sterile clamp. Clean cord care in the postnatal period includes washing hands with clean water and soap before and after care and keeping the cord stump dry and exposed to air or loosely covered with clean clothes. If soiled, the cord should be washed with clean warm water (cleaning with alcohol seems to delay healing). The napkin should be folded below the umbilicus. REVIEW RELATED TO CORD CARE USING LUKEWARM WATER Kimberly Dow,(2010 ) reported news about the umbilical cord, After the umbilical cord is cut at birth, a stump of tissue remains attached to the umbilical cord. The cord will dry and shrinks. It is important to keep the umbilical cord stump and surrounding skin clean and dry. This cord care helps to prevent infection. It may also help the umbilical cord stump to fall off and the cord to heal 90% more quickly; gently clean the umbilical cord once a day. Soak a cotton swab in warm water. Squeeze out the excess water. Gently wipe around the sides of the cord and around it. Wipe away any wet, sticky, or dirty substances. Gently pat dry the area with a soft cloth. The stump usually falls off in a week or two but sometimes it takes longer. Continue to clean around the umbilical cord at least once a day until the cord has completely healed. Keeping the area Wyeth (2010) reported news about the umbilical cord. Keep the stump of the umbilical cord clean and dry until it falls off, which usually happens within a few weeks Clean the cord at each napkin change to help to dry out and to prevent entry of infection Wipe gently around the cord with a damp cotton swab .Keep the napkin folded below the navel area to keep the cord from being soaked with urine. Evidence-based clinical practice guidelines(2010) was reported about umbilical cord Sometime between five and 15 days after birth, the cord will dry up, turn black and drop off, leaving a small wound that may take a few days to heal. It must be kept clean and dry to prevent infection. Harmful bacteria that live naturally on the skin can enter in to the cord causing infection. Avoid the traditional practice of taping a coin to retract the belly button as it may encourage infection and delay the healing process. Avoid the cord stump getting urine by folding the napkin down away from it, leaving the cord exposed to the air. If the cord gets urine, wash it off using clean warm water or just water alone. When the stump falls off, it may shows of signs of little blood on the umbilical cord which is normal. In the past, cord stumps have been cleaned with antiseptic tissues or sprinkled with an antiseptic powder. Studies of the healing process have found no advantage to using antiseptics ove r simply keeping the cord clean, unless the baby is premature or in intensive care. Antiseptics also cause the cord to take longer to fall off, which causes anxiety to parents and increases the number of postnatal consultations with doctors. Satish Chandra. V.Naik etal (2009) in pune, study was to conduct impact of training of traditional birth attendants on the newborn care. The setting of the study was PHC, 45 TBAs attended 2 days training programme. Different AV- aids were used to interact the sessions by LCD, flipcharts, videoclipings. Pretest evaluation showed that there was a difference in the depth of knowledge regarding newborn care between previously trained tai and untrained tai .this difference was statistically difference p( Luke C Mullany.g.etal (2009) reported a study was to conduct cluster-randomized, community-based trial to assess the impact of three cord care regimens either A large community-based trial in rural southern Nepal conducted between 2002 and 2006 randomized babies within clusters to receive one of three cord care regimens: (1) 4.0% chlorhexidine cleansing for 7 of the first 10 days after birth or (2) soap and warm water cleansing for 7 of the first 10 days after birth, or (3) dry cord care. Overall, mortality among enrolled infants was 24% lower in the chlorhexidine group compared to dry cord care. Clinical evidence of a protective of warm water cleansing among this newborns subset was increased. Warm water cleansing reduced severe infection by 87% and mortality by 34% among those enrolled within 24 hours. Alam .M. Ali .etal (2008) in Bangladesh, the study conducted by cluster- randomized. Unstructured interview (n-60), structured interview (n=20), rating and ranking exercises (n=40),83% of umbilical cord care revolved around the bathing. Over all 40% of newborns are clean with warm water during newborn age of period only 9% of reported of infections and other application of cord care (83%) of reported of infections. Jane heiza in health and safety (2008) reported news about the umbilical cord is cut at birth, a stump of tissue remains attached umbilical cord. The stump gradually dries and shrivels until it falls off, usually between 1 and 2 weeks after birth. Gently clean umbilical the cord stump and the surrounding skin at least once a day and as needed during diaper changes or baths. Soak a cotton swab in warm water. Squeeze out the excess water. Gently wipe around the sides of the stump and the skin around it. Wipe away any wet, sticky, or dirty substances. Gently pat dry the area with a soft cloth. The stump usually falls off in a week or two but sometimes it takes longer. Continue to clean around the cord at least once a day until the cord has completely healed Medves JM, OBrien BA.etal (2008) reported study was to identify differences in time to cord separation and bacterial colonization when using alcohol or warm water to clean the cord area in healthy newborn infants. Randomized controlled trial designed was selected. 148 newborn infants who were enrolled within 3 hours of birth. Gestational age was >36.7 weeks and all infants had an Apgar score of à ¢Ã¢â‚¬ °Ã‚ ¥7 at 5 minutes. Follow up was 92%. Parents were shown a video on cord care that was developed for the study. Parents applied warm water. Cleaning with 95% alcohol did not reduce umbilical cord separation time. 95% of warm water groups had reduces the infection and early healing of cord. Khatry .C.Mullany .etal (2005) in Nepal, conducted a study on the impact of umbilical cord care. The selected sample is 15123 infants were assigned randomly selected within communities, the following 3- cord regimens: cleansing with 4.0%, cleansing with warm water. The mean separation time was shorter in warm water (4.25days) and in chlorhexidine (5.23days). Janssen PA, Dobson. R.etal (2003) reported study was to compare cord bacterial colonization and morbidity among newborns whose cords were treated with triple dye and alcohol versus warm water. The investigator was randomly allocated 766 newborns to either 2 applications of triple dye to the umbilical cord stump on the day of birth with alcohol swabbing twice daily until the cord fell off (n = 384) or warm water cord care (n = 382). hemolytic streptococcus and coagulase-negative staphylococcus. Infants in the dry care group were significantly more likely to be colonized with Escherichia coli (34.2% vs. 22.1%), coagulase-negative staphylococci (69.5% vs. 50.5%), Staphylococcus aurous (31.3% vs. 2.8%), and group B streptococci (11.7% vs. 6.0%). Community health nurses were significantly more likely to observe exudates (7.4% vs. 0.3%) and foul odor (2.9% vs. 0.7%) among infants allocated to the dry care group during the home visit. Patricia A. Barbara L .etal (2003) reported study was to compare cord bacterial colonization and morbidity among newborns whose cords were treated with triple dye and alcohol versus warm water cord care. The sample was randomly selected 766 newborns to either 2 applications of triple dye to the umbilical cord stump on the day of birth with alcohol swabbing twice daily until the cord fell off (n = 384) or dry care (n = 382). The umbilical stump was colonized with {alpha}-hemolytic streptococcus and coagulase-negative staphylococcus. Infants in the warm water group were significantly more likely to be colonized with Escherichia coli (34.2% vs. 22.1%), coagulase-negative staphylococci (69.5% vs. 50.5%), Staphylococcus aurous (31.3% vs. 2.8%), and group B streptococci (11.7% vs. 6.0%). Community health nurses were significantly more likely to observe exudates (7.4% vs. 0.3%) and foul odor (2.9% vs. 0.7%). M. Bello .j.p Ambe etal (2005) in Kondugal, the study was conducted, the survey which was cross-sectional was conducted over eighth period. Systemic random sampling method was used to select the newborns. 400 samples was selected, majority of the mothers 74.3% delivered at home have same results for other groups. Warm water 2.0% results of infection. This will go reduce in mortality and morbidity in the newborns. Andrea guala (2003) study was reported about the time of cord separation, a controlled clinical trial was carried out of healthy full- term neonates. The study was to evaluate the cord separation. According to the hospital protocol, umbilical cord cleaned with cotton soaked warm water. This was statistically difference (p Luke C Mullany.g.etal (2002 ) study was conducted to assess cord care the Within a community-based, cluster-randomized study of the effects of 4.0% chlorhexidine on omphalitis and mortality risk, we aimed to describe the distribution of times to separation and the impact of topical chlorhexidine treatment on cord-separation times infants were assigned randomly within communities in southern Nepal to receive 1 of the following 3 cord-care regimens: cleansing with 4.0% chlorhexidine, cleansing warm water, or dry cord care. In intervention clusters, field workers cleansed the cord in the home on days 1, 2, 3, 4, 6, 8, and 10 after birth. The mean separation time was shorter in dry cord care (4.24 days) and warm water (4.25 days) clusters than in chlorhexidine clusters (5.32 days; mean difference: 1.08 days). Cords of infants who received chlorhexidine were 3.6 times more likely to separate after 7 days. Facility-based birth and birth attendant hand-washing were associated with cord sepa ration after 7 days of age. REVIEW RELATED TO CORD CARE. Mullany .Katz. etal (2007) reported study was to assess to umbilical cord care trial in Nepal during (2002-2005). Newborns were evaluated in the home for signs of cord infection (pus, redness, and swelling) omphalitis was identified in 954 of 17.198 newborns (5.5%) infection risk was 29%- 62% higher in infants receiving topical application , skin-skin contact (relative risk (RR) = 0.64, 95% confidence interval (CI) =o.43,0.95) and hand washing (RR=0.73, 95% CI 0.64, 0.84). In this community, unhygienic newborn care practices lead to continued high risk for omphalitis. Ahmadpour -kacho.z.etal (2006) reported study was to compare the effect topical application of human milk, ethyl alcohol 96% and silver sulfadiazine on umbilical cord separation time in infants. This study was undertaken place at a primary- level newborn nursery at a university teaching hospital and a private hospital. Samples are randomly selected. Mothers milk, ethyl alcohol, silver sulfadiazine ointment for group 3 were applied to the days after umbilical cord separation. It was observed a significant difference in the mean cord separation time along the four groups. No significant complications were observed in any group. Breast milk could be substituted for topical agents for umbilical cord care. Gilson .k .etal (2006) reported large urban university hospital in Turkey and participant homes after discharge Umbilical cord care consisted of one of three methods: topical application of povidine-iodine twice daily, topical application of mothers milk twice daily, or dry care (keeping the cord dry and clean).Outcome was measured in terms of the presence or absence of omphalitis and the number of days elapsed before cord separation. An ongoing questionnaire was administered by telephone every other day after the participants left the hospital. There were no significant differences between the three groups in terms of omphalitis occurrence. The cultural practice of applying human milk to the umbilical cord stump appears to have no adverse effects and is associated with shorter cord separation times than are seen with the use of antiseptics.   Kelley  Evens  .j.etal (2006)reported study was to compare alcohol versus natural drying for umbilical cord care in preterm infants and to examine its effects on bacterial colonization and cord detachment randomized to receive either umbilical cleansing with 70% isopropyl alcohol at each diaper change or natural drying. Umbilical stump cultures were performed at 12 to 24 hours, 72 hours, 7 days, and 14 days of age. A total of 109 infants were enrolled; 102 completed the study. There was significantly shorter in the natural drying group compared to the alcohol group (13.0 versus 16.0 days;  p=0.003). There were no cases of local umbilical infection in either group. It appears that natural drying is a safe and effective means of umbilical cord care in preterm infants. Chamnanvanaki.S.etal (2005) conducted a randomized controlled trial was to compare time of cord separation, among 3 regimens of cord care at home1) triple dye, 2) alcohol, 3) no antiseptic solution.185 infants were recruited. Time to cord separation in infants of group1 was significantly longer than in group 2(p=0.036) and group 3 (p=0.003).The satisfaction score of group1 were significantly lower than group 2 and group 3.Triple dye delayed time to cord separation and was less satisfactory. The authors conclude that using alcohol or dry clean could be alternative ways of cord care at home Sezer.G (2005) conducted a quasi-experimental study to comparing topical human milk, Povidine iodine, and dry care.150 sample was selected, convenience sampling used, results there was no significant difference between the three groups in terms of omphalitis occurrence in the Povidine-iodine group, cord separation occurred of 9.9days. in the dry care and topical human milk groups, cord separation occurred at a mean of 7.7 days, respectively.Therewas a statistical relationship between the groups in terms of cord separation time (f=13.24, p Shoaeib Barrawy .J.etal (2005) conducted a quasi-experimental study that aimed to compare the