If You Want to View Paradise :: Personal Narrative Cane Fields Papers

If You Want to View Paradise When the sugar cane burned a thick pillar of black smoke twisted and grew up from the fields. The beanstalk of cloud was seen from anywhere on the island and for an afternoon everyone stopped their chores, their cars, their machines to exhale at the desecrating monster. The fire lifted soil, plant debris, worker's gloves and t-shirts forgotten in the fields, insects and rats, children forgotten in the fields, all charred to ash, into the air, stirred it up and threw it back to earth to be interpreted by a more creative voodoo. Cane ash cycloned up in the pillar and blew onto nearby communities with the tradewinds. Curled black ash rained down on my brother and me playing basketball in the driveway. The ash, light, tossed in the wind, collected curled in corners like loose pubic hair. The farmers burned the cane purposefully. They followed the flame, directing it to burn row after row. Late into the night they followed the fire in a semi-circle on the upwind side wearing Hula Bowl t-shirts around their faces like bandits to filter the smoke. Train robbers trying to control the steam locomotive with shovels. Trains have a tendency to run away. The fire husked the cane for them and though it burned a portion of the precious sugar it also burned the glass hairs along the stalk that itched skin and throats for days. The cane fields spread in rows like radio waves echoing out from the base of the Waianai mountain range. On these mountains, closer the peaks at the topmost corner, was a preserve, a deathbed for the last pristine area on the island. Here the rarities mingled in an elite cocktail party for the terminally ill. The Ohia Lehua rooted shallow on the cliffsides, its wood trunk dry like beach wood and its blossoms a blood red exploding out like firecrackers from light green dime shaped leaves. Ala ala wai nui crawled out of holes in boulders. It is called a succulent, its leaves absorb water and are thick and peach fuzzed for it. It is strong enough to break rocks but can not conquer a field of pili grass. The Manono's leaves come out two at a time, opposite each other on the same node. They look like cho cho lips, fat lips, puckering up. They are not plants that grow together supporting and encouraging one another to grow.

Alcohol in Colonial America

The first settlers arrived to the Americas and staked their claim on this new discovery. Something else was waiting for the settlers, a beverage of intoxication. Almost as quickly as they began to organize and sub-divide the land, the immigrants, and true natives to North America shared their beloved drink: alcohol. Cultures of varied races arrived and shared in this most cherished drink. There were uses for alcohol in the earliest colonial times that went beyond a beverage to drink in festive gatherings. There are varied beliefs surrounding the conception of alcohol consumption and its effects on British Colonies. Some are true, others are false. I will construct an investigation surrounding the history of alcohol in Colonial America with persuasive evidence to support my findings. Alcohol, also commonly referred to as spirits in Colonial America had many uses. Alcohol, of course, was used in festive times, but it was also used in religious ceremonies as well and providing medicinal properties to aid in curing ailments. The initial impact of alcohol on the settlers led them to accept it for its varied uses. Although moderate use of alcohol was accepted, society, from its inception into the Americas, frowned upon individuals becoming overly intoxicated. In other words, drunkenness was viewed negatively. Since alcohol was considered a â€Å"gift from the gods† to the natives, the settlers, too, accepted its mind-altering properties as something almost sacred. The growing communities treasured it, just as the natives did. Time and abuse were two components that led to problems for alcohol consumption. Due to its success in the minds of settlers, they partook in alcohol consumption for all three meals of the day: beer with breakfast, hard cider with lunch, beer with supper. In fact, beer and hard cider were the most popular drinks for colonists. As the drinking continued, they wanted to learn how to brew beer. One of the initial problems—aside from increasing abuse of alcoholic drunkenness—was the lack of sufficient ingredients. Barley, grains, hops, and yeast were the main ingredients in a brewing beer. The colonies did not have an ample selection of hops and grains. Harvesting of barley and hops was not a common crop among farmers of this era. Many colonists tried different ingredients, but nothing satisfied the perfect blend of hops, barley, yeast, and grain. By the late 1600’s, cider became a top choice among colonists, mainly due the apple crops that were prevalent in colonial times. Mass production through efficient farming and harvesting by colonists was seen. Thanks again to England for the apples. Farmers increased their work load mainly due to the reward of the final product: cider matured into hard cider (which included alcohol). With the increasing popularity of beer and cider, the settlers discovered a need to increase their selection. The settlers started to import inexpensive yields of sugar cane and molasses to brew another popular drink: rum. Rum quickly gained in popularity for the following reasons: it was cheap to produce and tasted good. By 1700, in Boston, the first commercial distillery was opened. The increase in rum consumption was the first challenge to the beer market. Religion and alcohol found a common link. In fact, many taverns were required to be built near churches or the local town meeting house. The religious zealots accepted alcohol consumption—strictly in moderation, though. Drunkenness, of course, was viewed as sinful. Alcohol soon became a problem in the eyes of the church and laws were established surrounding alcohol. In 1697, in New York, they enacted a law that required all taverns to be closed on Sunday. They required that the Sabbath be set aside as a day solely for reconciliation with the Lord and prayer. In conjunction with the closure of taverns on Sundays, the church required further regulations against alcohol consumption on Saturday nights as well. The main concern for the church was that taverns were gaining more popularity than the Sunday services. The Reverend Charles Woodmason went one step further and cautioned parishioners with the thought that there was a competition between the church and tavern for souls. Reverend Charles was quoted was saying the following, the taverns had â€Å"more company of a Saturday, than in the church on Sunday. † As colonists went into the early part of the 19th century, religion encouraged moderation in any and all alcoholic drinks. Alcohol, aside from the churches persistent concern over drunkenness and a loss of parishioner appeal, had other uses. Alcohol was also widely used in the field of medicine. Many doctors and medical practitioners believed that some of the stronger spirits could prevent disease, cure some common infections, and offer relief to minor aches and pains such as headaches, sore joints and muscles. In these instances, doctors would prescribe rum, hard cider, or whiskey. Doctors also encouraged patients to increase alcohol consumption to relieve emotional or stressful problems in their daily life. In fact, doctors went so far as to prescribe families to drink alcohol in lie of water. They thought that water brought from Europe was contaminated, and, thus, could lead to serious illness. Alcohol consumption was also prescribed to children suffering from viral infections as well as aiding in their development into a stronger, more physically fit individual. A little whiskey and honey went a long way for a sick child. The unusual, or even outlandish, practices went further still: doctors prescribed hard liquor to women who were in labor, a means of numbing some of the intense pain suffered during labor. Midwives would brew what was coined â€Å"groaning ale. This groaning ale contained extremely high contents of alcohol and special spices, all in hopes of easing the child bearing pains. A variation to groaning ale was used by some doctors. This was a little less toxin on the mother and baby. Doctors concocted spirits that were used as an anesthetic. This anesthetic was less expensive and more readily available from household to household than the hard spirits used i n the groaning ale. Alcohol, as with many new products brought to civilized society, began as an innocent and purely beneficial product. Beyond the stress-reducing capacity for hard cider or beer, the early nutritionists thought alcohol had great nutritional value and needed to be added to a person’s health-conscious daily diet regime. Due to this initial nutritious appeal, politicians did not, initially, write legislation limiting alcohol consumption. It was not until 1619, in the state of Virginia, that the first law was passed to control alcohol use. Policy maker main objective was to restrict â€Å"drunkenness,† not prohibit the use of alcohol. This first law enacted a penalty against drunkenness which stated that if you were arrested for being drunk and disorderly, then the fine would be up to 5 shillings or imprisonment. In time, however, politician modified the law to only include a monetary infraction. The reasoning behind this law was because the lower-classes tended to be the ones caught in public, and politicians felt a fine would be viewed as more distressing to the lower-class and curtail drunkenness. The next state to enact legislation surrounding alcohol consumption was Maryland. In Maryland, in 1639, they attempted to limit the amount a person drank. According to law, it was illegal to be drunk in public: â€Å"drunkenness† was defined as â€Å"drinking with excess to the notable perturbation of any organ or sense of motion. † The penalty was the same as in Virginia: 5 shillings. In 1645, Massachusetts jumped on the alcohol bandwagon, passing a law that restricted the amount an individual could consume at any period of time. The law stated the following, â€Å"The courts consider it illegal to drink more than a pint of wine at a time. † Anything over a pint constituted inebriation. On top of this, Massachusetts instituted another statute for ale houses and tavern owners. This statute made it illegal for owners to serve a customer beyond the legal limit, a difficult law to follow. With this statute, however, both the proprietor and customer could be fined for disobeying this law (Austin, Gregory p. 230). The Plymouth colonies chose a different slant in enacting their alcohol legislation. Unlike the Virginian definition for â€Å"drunkenness,† in the Plymouth colony the focus was on motor skills. Plymouth went so far as to define the term which constituted a universal view—throughout almost every colony—that alcohol is not healthy, nor should it be considered beneficial to a person’s health. The Plymouth definition was as follows: they viewed being drunk—not by loss of mobility or amount consumed—but instead by the person’s ability speak clearly: â€Å"A person that lisps or faulters in his speech by reason of drink, or that vomits, or cannot follow his calling. † (Austin, Gregory, p. 240) When we look at gender, women were not considered part of the drinking culture. Most often, women drank in private (Salinger, Sharon p 223). According to historical record, women rarely drank in public in colonial times. It was viewed as unacceptable for a woman. Policy makers enacted different conditions and consequences for each gender. Women were rarely seen in bars and taverns in this period. The brewing of beer, up until the late 1700’s, was an art left for the women to complete. Men would be off at work during the day and women kept the house in order, which included beer and liquor. Home-brewing was very common. In fact, most households that drank brewed their own ale. The Spaniards arrived in the 1700’s and brought wine to the colonies. At the time, vineyards were unheard of; thus, without grapes they could not cultivate, ferment, and produce wine in the colonies. It was brought over on ship. The French soon followed and were able to cultivate the grapes on colony soil. Wine consumption gained in popularity, yet the hard cider was still the preferred drink among the middle class. Germans, too, became part of the alcohol dynamic. The Germans brought better techniques to brewing fine ales and were the first to bring ‘lagers’ to the Americas. All of these countries brought new ideas and new brewing methods to the colonies. In conclusion, it is apparent that the initial discovery of alcohol for the colonies was viewed as a sacred drink. The colonists took the vision of the natives and brought it into their lives as a daily staple. The harms and potential for dangerous situations soon became rampant with all the drunken colonists. Laws were passed and changes were made in various colonies in hopes of curtailing the problems associated with drunken behavior. Even the churches got involved. As new cultures landed from various countries, they discovered new varieties on crafting a very popular beverage. Regardless of all the dangers associated with alcohol consumption, I believe it’s going to continue to be a drink enjoyed throughout the world.

The Lexical Approach in Language Teaching

In language teaching, a set of principles based on the observation that an understanding of words and word combinations (chunks) is the primary method of learning a language. The idea is that, rather than have students memorize lists of vocabulary, they would learn commonly used phrases.   The term lexical approach was introduced in 1993 by Michael Lewis, who observed that language consists of grammaticalized lexis, not lexicalised grammar (The Lexical Approach, 1993). The lexical approach is not a single, clearly defined method of language instruction. Its a commonly used term thats poorly understood by most. Studies of literature on the subject often show that its used in contradictory ways. It is largely based on the assumption that certain words will elicit a response with a specific set of words. Students would be able to learn which words are connected in this way. Students are expected to learn the grammar of languages based on recognizing patterns in words.  Ã‚   Examples and Observations The Lexical Approach implies a decreased role for sentence grammar, at least until post-intermediate levels. In contrast, it involves an increased role for word grammar (collocation and cognates) and text grammar (suprasentential features).(Michael Lewis, The Lexical Approach: The State of ELT and a Way Forward. Language Teaching Publications, 1993) Methodological Implications The methodological implications of [Michael Lewiss]  Lexical Approach (1993, pp. 194-195) are as follows: - Early emphasis on receptive skills, especially listening, is essential.- De-contextualized vocabulary learning is a fully legitimate strategy.- The role of grammar as a receptive skill must be recognized.- The importance of contrast in language awareness must be recognized.- Teachers should employ extensive, comprehensible language for receptive purposes.- Extensive writing should be delayed as long as possible.- Nonlinear recording formats (e.g., mind maps, word trees) are intrinsic to the Lexical Approach.- Reformulation should be the natural response to student error.- Teachers should always react primarily to the content of student language.- Pedagogical chunking should be a frequent classroom activity. (James Coady, L2 Vocabulary Acquisition: A Synthesis of the Research. Second Language Vocabulary Acquisition: A Rationale for Pedagogy, ed. by James Coady and Thomas Huckin. Cambridge University Press, 1997) Limitations While the lexical approach can be a quick way for students to pick up phrases, it doesnt foster much creativity. It can have the negative side effect of limiting peoples responses to safe fixed phrases. Because they dont have to build responses, they dont need to learn the intricacies of language.   Adult language knowledge consists of a continuum of linguistic constructions of different levels of complexity and abstraction. Constructions can comprise concrete and particular items (as in words and idioms), more abstract classes of items (as in word classes and abstract constructions), or complex combinations of concrete and abstract pieces of language (as mixed constructions). Consequently, no rigid separation is postulated to exist between lexis and grammar.(Nick C. Ellis, The Emergence of Language As a Complex Adaptive System. The Routledge Handbook of Applied Linguistics, ed. by James Simpson. Routledge, 2011)

Replacement of Mouse-Driven Screens by Multi-Touch Screens due to Interface Metaphors Free Essay Example, 1000 words

The mouse-driven interface has the and + for zooming in and out, this is used for increasing and reducing the size of images, documents among others. The screen also uses the scroll bars to scroll up and down the window. Zooming in and out on a multi- touch screens is achieved by pinching the screen to increase or reduce the size of objects and content displayed on windows. To scroll up and down the screen, sliding sliders, spinning pickers and simple sliding are used (Carroll et al, 2007). Interaction types and stylesThe underlying difference between the two screens with regard to interaction types and styles is the fact that the multi-touch screens are operated by touch while the mouse-driven screens are operated by the mouse events. Essentially, the mouse-driven screen involves a series of actions including dragging and clicking. The multi-touch screen has the ability to recognize and accept more than one or two points of contact on the screen surface. This creates an interactio n style that enables the user to perform complex functions such as pinching on the screen (Gersh, McKneely Remington, 2005). We will write a custom essay sample on Replacement of Mouse-Driven Screens by Multi-Touch Screens due to Interface Metaphors or any topic specifically for you Only $17.96 $11.86/page Multi-touch screen products such as smartphones, tablets and laptops among others are featured with functions that can only be initiated by multi-touch gestures.

A Day without Laughter is a Day Wasted by Charlie Chaplin

â€Å"A day without laughter is a day wasted.† It was a simple but popular quote of Charlie Chaplin, one of the most famous actors as well as director and scriptwriter in the American Modernism Era. With a rags-to-riches story, Chaplin had overcome all the obstacles to become a Comedy King, represented an American Dream coming true. Charles Spencer Chaplin, Chaplin’s full name, was born in London, England, on April 16th, 1889. In a family of both parents who were entertainers, Chaplin spent his early years with his mother, who had no means of income due to her sickness, and his brother in Kennington. His father, who was an alcoholic, provided no support and made him come to the workhouse at the age of seven. Despite poverty and hardship, Chaplin had his first role as a paperboy in a play â€Å"Sherlock Homes† and kept on his career in entertainment, said that he â€Å"never lost sight of my ultimate aim to become an actor† until moving to the US for a contract with Keystone studio at the age of 14. It was 1914 when Chaplin’s first film acting debut on the movie Making a Living was released, at the beginning of the American Modernism. However, he strongly disliked the picture. For his second appearance in front of the camera for the movie The Tramp in February, Charlie Chaplin got to choose his costumes which then became his identity. He described in his autobiography: â€Å"I had no idea of the character. But the moment I was dressed, the clothes and the makeup made me feel the person he was.Show MoreRelatedMy Day Without Laughter Is A Day Wasted972 Words   |  4 Pages Charlie Chaplin once said â€Å"A day without laughter is a day wasted†. I cannot even begin to express how accurate that quote is because humor takes up an enormous portion in my day to day life. I love to laugh; I love that pain in your stomach that you get from laughing too hard. I love the feeling of lightness that you get physically and mentally from laughing too hard. My favorite televisio n shows, movies, videos, and people are somehow connected to if they have made me laugh or not. I would sayRead MoreAmerican Holidays11778 Words   |  48 PagesAmerican Holidays The following are holidays that we celebrate in the United States: New Years Eve and New Years Day New Years Day is the first day of the year, January 1st. it is a celebration of the old year and the new one to come. People make New Years Resolutions each New Years and promise themselves that they will keep this resolution until next year. New Years Eve is a major social event. Clubs everywhere are packed with party-goers who stay out all night and go nuts at midnightRead MoreFor Against by L.G. Alexander31987 Words   |  128 PagesCOMPREHENSION PRECIS AND COMPOSITION ras CARTERS OF GREENWOOD (Cineloops) DETECTIVES FROM SCOTLAND YARD (Longman Structural Readers, Stage 1) CAR THIEVES [Longman Structural Readers, Stage 1) WORTH A FORTUNE [Longman Structural Readers, Stage 2) APRIL FOOLS DAY [Longman Structural Readers, Stage 2) PROFESSOR BOFFIN S UMBRELLA (Longman Structural Readers, Stage 2) OPERATION MASfERMIND (Longman Structural Readers, Stage 3) QUESTION AND ANSWER: Graded Aural/Oral Exercises READING AND WRITING ENGLISH-A FirstRead MoreManagement Course: Mba−10 General Management215330 Words   |  862 Pagesreserved. Printed in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by an y means, or stored in a database or retrieval system, without prior written permission of the publisher. This McGraw−Hill Primis text may include materials submitted to McGraw−Hill for publication by the instructor of this course. The instructor is solely responsible for the editorial content of such materials

Copy Rights Free Essays

Why there Is piracy? There must be reasons for piracy. Piracy Is a committed by people for a number of reasons. Some of the reasons for this act are Identified below: To enjoy services or entertainment at low cost prices or no cost to the consumers. We will write a custom essay sample on Copy Rights or any similar topic only for you Order Now Expo: Music, games, videos, software from internet. For profit Competitive Advantage Sabotage 3. What is law? Malaysia’s copyright act 1987 came into effect on 1 December 1987, replacing the copyright act 1969. The 1987 act confers copyright on and protects computer programs (software). The 1987 act amended in 1990 to ensure compliance with the prescribed standards and minimum requirements under the Berne Convention. The copyright (application to other countries) Regulations 1990 came into force on 1 October 1 990, the day Malaysia acceded to the Berne Convention. [ source: http:// www. Abs. Org/Malaysia/intricacy/Piracy-and-the-Law. Com ] Point: Source: www. Slideshows. Net/Lonny/copyright-and-piracy-from-moral-and-legal- attendants-cit-presentation 1 . Copyright is a form of legal protection that grants people who create and produce material the exclusive rights to control certain uses of that material from being reproduced without the permission of the copyright owner. 2. Why Piracy E-SST The price For profit/competitive advantages 3. Moral Issues Give a chance to the creator to able to make a living and provide jobs for many other Decrease the chance to get problems. Note from Facial: Please find more and add. How to cite Copy Rights, Papers

Effectiveness of Mouthwash

Question: Describe about effectiveness of mouthwash using a chlorhexidine solution in theadults patient in reducing prevalence of ventilator associated pneumonia in the adult Intensive Care Unit? Answer: Background The patients who are critically ill, have been ventilated mechanically for a time longer than 48 hours, have the risk of developing Ventilator-Associated Pneumonia (VAP). It is a hospital acquired infection that develops in patients during the process of treatment within the hospital setting and is not present at the time of admission. The pathogenesis of VAP is actuallywhen bacteria enters into the lower respiratory tracts and overwhelms the patients defenses. The chances of mechanically ventilated patients developing VAP are between 9% and 27% with a high mortality rate where 33-50% of patients acquiring VAP dying. Approximately one-third patients in ICUs receive mechanical ventilation as support therapy. When a chest radiograph of a patient shows a progressive or new infiltrate, cavitations, consolidations, or pleural effusions along with one or all of the following symptoms: change in color or new onset of purulent sputum, increase or reduction in white blood cells, organisms cultured from blood, bronchial brushing, etiological agent isolation by transtracheal aspirate or increase in temperature, VAP can be identified in the patient (Synders, Khondowe and Bell, 2011). The risk factors identified with VAP are: staffs inadequate hand washing, ventilator circuit management practices, antibiotic therapy previously, patients supine positioning without backrest elevation, nasogastric alkalinization or the presence of a nasogastric tube. According to the Institute of Healthcare improvements ventilator bundle, a 30 or more elevation of patients bed head, prophylaxis for deep vein thrombosis and peptic ulcer, sedation vacation, and assessing readiness to extubate may reduce risk of complications with mechanical ventilation (Munro et al., 2009). Oropharyngeal colonization, aspiration, gastric colonization and compromised lung defences are the factors associated with VAP development. The pooling of micro-aspiration of the secretion with bacteria which is above the endotracheal cuff of patients intubated results in the respiratory tract. Chlor-hexidine, a cationic chlorophenyl bis-biguanide which is an antiseptic agent, binds the oral tissues along with subsequently releasing the antiseptic properties slowly enabling long period of anti-bacterial action and hence has been used in mechanically ventilated patients as an oral disinfectant (Synders, Khondowe and Bell, 2011). Inclusion Criteria Studies Randomized controlled studies that uses the comparative groups, published in English in order to investigate the oral chlorhexidine like a decontaminant in VAP prevention in critically ill, mechanically ventilated adult patients were included. Interventions Studies that analyzed the usage of oral chlorhexidine against the tooth brushing, placebo and/or oral care interventions comparators to decrease in VAP in critically ill, and in patients who are mechanically ventilated, were focused. Participants Study participants had to be mechanically ventilated, aged 18 years or older, critically ill and admitted to the ICU. Outcome Measures To the measure the reduction in prevalence of VAP in those who are mechanically ventilated as well as critically ill ICU patients was the primary outcome interest. Exclusion Criteria Studies that were excluded included the research not investigating the VAP even if chlorhexidine was used, study of patients below 18 years, patients with known allergy or hypersensitivity to chlorhexidine, edentulous patients, extubated patients and patients already clinically diagnosed with pneumonia at the start of study. Incomplete study or data within studies included, unavailability of full-text articles and high attrition rates are the exclusion criteria for this review. Methodology Search Strategy An extensive search was undertaken for literature of published clinical trials that report prevention of Ventilator-Associated Pneumonia with the use of chlorhexidine in case of oral care. Electronic databases searched to identify sources for relevant studies included MEDLINE, NCBI, and the University of Adelaide libraries. The reference list of articles and summaries were examined. Search terms such as Ventilator-Associated Pneumonia,chlorhexidine, mechanically ventilated patients, oral care,hospital acquired pneumonia, oral hygiene and mouthwash were used for the search. Data Collection The titles of the articles obtained by employing the search terms mentioned were considered and those that were relevant to the study on hand were identified. The articles were retrieved and reviewed considering the criteria mentioned for inclusion. The relevant articles were reviewed and analyzed independently to determine the quality of methodology. The methodological quality was assessed using quality assessment form freely available in Cochrane website. The external and internal validities of the RCTs were addressed by the assessment. Data Extraction To collect information from relevant studies, a data extraction tool was employed. An initial study determined the practicality of the study, range of search, testing as well as extraction tools. The tool included baseline characteristics such as citation, study id, setting, methodology, population, and sample size. Treatment effect measures The treatment effect measurement choice was the usage of the random effects model which is Mantel Haenszel method, risk ratio with 95% confidence intervals for weighted mean difference and intervals for dichotomous data. The value set for p was 0.05. Missing Data All studies included randomized the patients to a treatment or a group that can control it. Wherever pertinent data were missing from the trials included, it was called the absence of the results that add value to the study. Data Synthesis A statistical analysis software package, Review Manager was used for analysis where all the data was entered. The Cochrane Collaboration website offers the software for free. The included studies differed from each other with regard to age, trial settings, methods of treatment etc. The use of the random effects model allows the distribution of effects, and provides a combined estimate and average of value distribution. The effects of interventions were demonstrated using Forest plots. Subgroup analysis After identifying clinical diversity, subgroup analysis was conducted with respect to the varying concentrations of chlorhexidine used. Data was entered into review manager to obtain sensitivity analysis. Validity, Reliability and Quality These assessments of the study data was confirmed by initializing and employing a standardized form of data extraction from the Cochrane Collaboration. Results Using the random effects model, a pooled risk ratio of 0.64 was obtained. The possibility of critically ill, mechanically ventilated patients who acquire VAP while using chlorhexidine was found to be 36% less likely than in the controls. The result was consistent with a previous meta-analysis done by Chelbicki and Safdar in 2007 yielding a ratio of 0.70. Chan et al, in 2007 conducted a trial on effect of antiseptic oral decontamination on VAP and the results showed a significant reduction in with a ratio of 0.56. 2% chlorhexidine demonstrated a significant effect on VAP incidence. Patients with more underlying co-morbidities and multiple medical problems have a period of ventilation and intubation exceeding 24 to 48 hours and are found to be more prone to developing VAP and a host of other infections (Chan et al., 2007). Critical analysis Ironically, the use of chlorhexidine 0.12% or 2% was not found to reduce VAP occurrence. Therefore results obtained supported only the use of 2% chlorhexidine for reducing VAP in critically ill patients. Also, all studies except one reported blinding of assessors. This shows that bias could have been involved in studies that never reported blinding if blinding of assessors did not happen. The studies showed no effect of chlorhexidine in decreasing the mortality though. Owing to the limited number of trials that were carried out, it can be recommended that more studies need to be carried out on the administration procedure, optimal concentration and dosage of chlorhexidine even though 2% concentration had showed positive results. References 1. Berry, A., Davidson, P., Masters, J. and Rolls, K. (2007). Systematic Literature Review of Oral Hygiene Practices for Intensive Care Patients Receiving Mechanical Ventilation. American Journal of Critical Care, 16(6), pp.552 - 562.2. Chan, E., Ruest, A., Meade, M. and Cook, D. (2007). Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis. BMJ, 334(7599), pp.889-889.3. Chlebicki, M. and Safdar, N. (2007). Topical chlorhexidine for prevention of ventilator-associated pneumonia: A meta-analysis*. Critical Care Medicine, 35(2), pp.595-602.4. Hillier, B., Wilson, C., Chamberlain, D. and King, L. (2013). Preventing Ventilator-Associated Pneumonia through Oral Care, Product Selection, and Application Method. AACN Advanced Critical Care, 24(1), pp.38-58.5. Khezri, H., Zeydi, A., Firouzian, A., Baradari, A., Mahmoodi, G., Kiabi, F. and Mogaddasifar, I. (2014). The Importance of Oral Hygiene in Prevention of Ventilator-Associ ated Pneumonia (VAP): A Literature Review. International Journal of Caring Sciences, 7(1), pp.12-23.6. Klompas, M., Speck, K., Howell, M., Greene, L. and Berenholtz, S. (2014). Reappraisal of Routine Oral Care with Chlorhexidine Gluconate for Patients Receiving Mechanical Ventilation. JAMA Internal Medicine, 174(5), p.751.7. Munro, C., Grap, M., Jones, D., McClish, D. and Sessler, C. (2009). Chlorhexidine, Toothbrushing, and Preventing Ventilator-Associated Pneumonia in Critically Ill Adults. American Journal of Critical Care, 18(5), pp.428-437.8. Parsons, S., Lee, C., Strickert, D. and Trumpp, M. (2013). Oral Care and Ventilator-Associated Pneumonia. Dimensions of Critical Care Nursing, 32(3), pp.138-145.9. Synders, O., Khondowe, O. and Bell, J. (2011). Oral chlorhexidine in the prevention of ventilatorassociated pneumonia in critically ill adults in the ICU: A systematic review. South African Journal of Critical Care, 27(2), pp.48-56.