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Given Name and Passport Information Booklet Essay

Is Alcoholism A Disease?

Is Alcoholism A Disease? This paper explores ten published articles that report about alcoholism. There are two sides: alcoholism is a disease or not a disease. Most of articles agree with a statement alcoholism is a disease. However, some argue that alcoholism is just a treatable addiction and a choice. Also, people think alcoholism was named to help people recognize alcoholism is a serious problem. It can be compared to diabetes in a equal way that over eaters have a reaction to food and alcoholics to liquor. It is time to examine what the alcoholism really is and explains the reason of the result for people who believe that alcoholism as an addiction, not a disease. Alcoholism: Is Alcoholism a Disease? One of the serious problems in the United States is alcoholism. It is the concept of drinking a large amount of an alcoholic beverage and those people who cannot control themselves become alcoholics. Alcoholics should learn how to manage themselves from alcohol to live healthy and to avoid alcoholism. Alcoholism can cause bad habits and it may build to a more serious health problem later such as cancer. Some people argue that alcoholism is a disease concept and other believes alcoholism is a choice. According to Hobbs, the debate on whether alcoholism is a disease or a personal conduct problem has continued for over 200 years (2000). Now, lets discover what alcoholism really is. What is Alcoholism? To intelligently talk about the topic of whether alcoholism is a disease, the definition of alcoholism is necessary. When people talk about disease, they use the following three terms: disease, disorder, and syndrome. Mitchell (2001) explains the definition, symptoms of alcoholism and important way of recovery from alcohol. People who drink and do not become addicted to alcohol wind up suffering more devastating with the abuse of alcohol. According to Gorski, many experts and laypersons disagree about whether alcoholism is a biological disease or merely a bad habit (1998) but he argued that most alcoholics undoubtedly suffering from a biological disease and should to be treated accordingly by the management industry. Mitchell (2001) defined alcoholism as alcohol dependence syndrome and a disease characterized by loss of control, cravings, tolerance, and physical dependence. Glatt (1976) also said in Jellineks view, of his sense because physiopathological changes were involved: the lo ss of control and the inability to abstain varieties. These definitions are founded from Glatt (1976). Loss of control is the inability of stop drinking once it has begun. Craving means a strong need or urge to drink and tolerance is the require drinking greater amounts of alcohol to get high. Physical dependence means withdrawal symptoms. These symptoms were identified before the 20th century and people have been researched ever since. Alcoholics frequently are aware of the disrupting effects that they cannot or not willing to give up the strong physical and emotional dependence on alcohol. Mitchell further states, alcoholism is a treatable disease, the sooner a person is able to acknowledge a need for help, the better are his or her chances for recovery (2001). However, there is no guarantee people will quit drinking but will prove to struggle with alcohol in their everyday life. Alcoholism is a Disease Due to the alcoholism being defined as a fatal and continual disease characterized by physical dependence, tolerance, and pathological organ changes, it is a disease. The disease is many times fatal and progressive. Disease is characterized by uncontrollable over drinking, and alcohol use regardless of any consequence. National Institute on Alcohol Abuse and Alcoholism explained, the craving that an alcoholic feels for alcohol can be as strong as the need for food or water and an alcoholic will continue to drink despite serious family, health, or legal problems (2008). Equal to other diseases, alcoholism is considered to be chronic. According to Gorski (1998), there are few different types of alcoholism. In the modern day, Dr. Benjamin Rush medical researcher studied alcoholism. The idea was discover an alcohol related syndrome of medical problems as a disease. His explanation of the symptoms was unfinished though. However, the inquiry began a procedure of alcoholism medical examination as a disease. In the middle of 1950, the medical examination concluded with the Yale and Rutgers schools of alcohol studies projects. These projects finally ended in a great significant part of information which created a convincing argument that alcoholism was in fact a disease. Congress of the United States seemed to be convinced and created the National Institute of Alcohol Abuse and Alcoholism to implement treatment programs all over the country. Overall, many people treating alcoholics never went back to the original source which clearly demonstrated an understanding of alcoholism; they divided alcoholism into five different subtypes: alpha, beta, gamma, delta, and epsilon. Not all of alcohol problems are with the disease of alcoholism. These definitions are from Gorski (1998). Alpha alcoholics normally depend on psychological but without physical. Beta alcoholics are not physically addicted to the alcohol but related to physical health problems like liver damage. Gamma alcoholics are both physically and psychologically dependent on alcohol. Delta alcoholics are also physically and psychologically dependent on alcohol but drinking intensity does not increase. The epsilon alcoholics are same as the periodic alcoholic, one may have a period of relapses and a binge stays for a long time. Overall, gamma, delta, and epsilon alcoholics are disease. In past three years, the disease concept of alcoholism reviewed by Jellinek. According to Jellineks topology, gamma, delta, and epsilon alcoholisms met the criteria for disease. Therefore, not all but some of alcoholisms are consider as a disease. Alcoholism contains symptoms and the danger of increasing alcoholism is influenced by his or her genes and by lifestyle. According to Pace (2001), Dr. Charles Lieber treated a patient for pancreatitis and a heart problem. If the patient did not experienced from the alcoholism for years, he would not have these problems in his life. Doctors definitely could seek the medical consequences, even though the patient has been through treatment. Dr. Lieber always explains about the metabolism of alcohol to his patients. There are many different ways of breaking down alcohol used by the patient when alcoholic develops to alcoholism. We know that alcohol is eliminated from the body through the liver, which breaks down the alcohol to carbon dioxide and water. A normal liver cell produces two main enzymes. One is called alcohol dehydrogenase; it breaks the alcohol down to acetaldehyde, which is a poison. A good liver takes that acetaldehyde and with the help of a second enzyme called aldehyde dehydrogenase, further oxidizes it, breaking it down with a very complicated metabolic process, to carbon dioxide and water. Thats how the normal liver breaks down alcohol. As long as this system is working there is no problem. (Pace, 2001) Dr. Lieber explained that the enzyme is produced by the nucleus of the liver cell, cytochrome, when anyone develops alcoholism (Pace, 2001). Cytochrome allows the liver to break the alcohol faster but the enzyme produces infinite number of the acetaldehyde which is very toxic to the liver and cannot clear from the body. As the result, not enough second enzyme is available to continue the process of breaking alcohol. Therefore, alcoholics should be educated of how alcohol affects their liver. Patients should realize that they are having metabolic defects which affect their livers due to alcohol. Once a liver loses the ability to breakdown, nobody can put it back to a workable liver. The brain is another organ in our bodies that is very involved with alcohol. According to Waldo, when alcohol or other addictive drugs are introduced into a body predisposed by inherited genetics to addiction, permanent biological changes occur in the brain (2000). Nerve cells that drive messages to the brain about feelings, thoughts, and learning are obstruct by alcohol. Also, alcohol interrupts the neurotransmitters that lead to brain shrinkage and it causes increased tolerances like aggressiveness. Animal studies showed that many brain chemicals intake depletes and those chemicals causes feeling of pleasure. Alcohol looses the chemicals that cause depression and stress at the same time. The imbalance of chemical in the brain may be responsible for alcoholism. Swartzwelder, a professor of psychology and psychiatry at Duke University Medical Center, said alcohol may retard teenagers mental growth (2001). Because teenagers brains are vulnerable, still growing and developing, alcohol is especially dangerous to them if they drink alcohol in that age. Many people believe that the brain stop developing after the birth but the newest research founded the result that the brain keep develops during adolescence until the age of twenty. In experiments of studying brain circuits, alcohol was effective to brain even after the age of twenty. Alcohol was effective on the function of a brain chemical which is critical for mental function. Therefore, alcoholics should understand how unique and important their brains are for themselves and everyone else surrounded them. However, instead of calling it a brain disease, it is more than that because the whole body is affected. For example, if anyone is drunk, his or her cerebellum gets interfered because of alcohol. Some of long-term effects are going on the nervous system. Hepatoma is very widespread on the alcoholic; colon and liver cancer are rare primary diseases. Therefore, Pace is saying that, à ¢Ã¢â€š ¬Ã‚ ¦ alcoholism is a disease that affects not only the brain but also the liver, stomach, kidney, intestines, and pancreas (2001). Alcoholism is not a disease Some people argue that alcoholism is not a disease. Dreyfus said, alcoholism was originally termed a disease in order to help people understand that it is a serious problem for which they should seek help (2003). Now, it is overused to the extent in the world that alcoholics wrongly assume that they have ill physically and require medical help to overcome alcoholism. The following research showed that alcoholism is a choice. According to the Baldwin Research Institute in the following viewpoint, the disease concept, alcoholism is based on fraudulent research and has no scientific basis. This theory has been spread by an alcoholism treatment industry that earns billions of dollars from treatment programs, insists the institute; however, it actually creates a reduced chance of sobriety for alcoholics. In reality, alcoholism is a choice; the best way for alcoholics to recover is to take responsibility for their alcoholism. The BRI is a nonprofit organization that conducts research and develops programs to facilitate recovery from problems associated with alcohol and other drugs. (Baldwin Research Institute, 2007) In addition, science and history proved that the disease of alcoholism is pure speculation. America medical professionals and culture embraced the concept of disease and they related it to all credible behavior from alcohol abuse to lecturing. However, the disease concept was a panacea. Therefore, researchers founded that alcoholism is a choice. According to Fingarette, the alcoholic is a tragic figure and deserves our compassion but the idea that alcoholism is a disease is a harmful myth (2001). The most persistent myth of the disease concept of alcoholism is that when a sober alcoholic gets a first drink, the effect causes a physical inability to quit. This is totally wrong. Alcoholics were deceived on what they are drinking. Those people who drink alcohol in reality, but were think that their beverage was non-alcoholic, got no effort to drink much. None of them drank uncontrollably even after they got alcohol. There is few myths related alcoholism. Hanson explained several myths about drinking alcohol and causes of alcoholism in the following. According to Hanson, alcohol is the cause of alcoholism (2008). The fact is that the governmental alcohol agency clarified, alcohol does not cause alcoholism and he continued. If alcohol causes alcoholism, then all of drinkers would become alcoholics. Additionally, the members of Alcoholics Anonymous (AA) are people who born in alcoholic who never caused by alcohol in their lives. In fact, anyone cannot become an alcoholic without alcohol but the members of Alcoholics Anonymous said that most people born and die alcoholics without having had any of alcohol. Thus, Hansons viewpoint is that alcoholism may present to someone who never had alcohol but alcoholism is a disease that caused by alcohol. Another myth is about the brain cells. Hanson explained the myth: alcohol destroys brain cells. In fact, the alcohol does not destroy brain cells. Alcohol is related with improved mental (cognitive) functioning. Therefore, those myths explained by Hanson might confuse everyone. However, alcohol originally brings bad health overall and one fact that people should know is that alcohol historically used for antiseptic, medicinal, and analgesic properties. Further, people who have emotional difficulties were saying the effects are sick and suffering from calling it a disease. Alcoholism and compulsive overeating are diseases like diabetics react to sugar in a same way as overeaters have a reaction to all kind of food and alcoholics to alcohol. Therefore, the individuals must carefully watch for intake. If people do not rigidly care the respective diets, they will get dire results. For example, if a person does not monitor for food intake, then there will be a chemical imbalance that might take to unmanageable health. Therefore, the theory explained that over eater is not normal but rather a person has a disease, is sick. The diabetic disease is something that the bodys failure to produce sufficient insulin. It is not the individuals fault to continue on the diabetic diet. It is manner of the bodys metabolizing alcohol which may be the disease, leading to the need for dietary control, the substance abuse, and abstinence. There might be a chemical or biological basis for compulsions; the disease model does not count as the compulsive behavior itself. It is accountable for the specific substance. Conclusions Numerous number of scientists and organizations continued work on alcoholism over two hundred years to find out what it is. Some people say that alcoholism was originally named a disease to help people recognize that it is as serious problem in the world for which alcoholics should seek help; however, alcoholism is an alcohol dependence syndrome and a disease characterized by loss of control, cravings, tolerance, and physical dependence. If a person cannot control the amount of drinking alcohol, he or she will get to alcoholism. Alcoholism brings very affective health problem to alcoholics. The brain disease may occur because there are important nerve cells that may destroy due to alcohol. The liver is another organ that is related to alcohol. In fact, not only the brain and liver may devastate, alcohol will spread out into the whole body and an alcoholics health will get worse overall. Alcoholism is a treatable disease though but alcoholics should realize having the alcoholism and s tart the treatment as soon as possible to have an excellent result. Therefore, there is no guarantee that people will deny drinking alcohol but the treatment probably will confirm to struggle with alcohol. Because alcoholism is increasing in the world and causes bad health, everyone should endeavor to prevent people who are reaching alcoholism. The disease concept of alcoholism needs to be over. All the alcoholics should take the best treatment for themselves to make the alcoholism not exist in the world anymore.

If you can not decieve, you can not lead :: essays research papers

"The morals of the prince", written by Machiavelli in 1513 has unique and informative points of view. In order to uphold, and / or maintain power, deception is required, regardless of whether it is deemed right or wrong. All political parties, enter into office with the belief that they will do whatever is in the best interest of the people. They intend on being fair, honest, and well liked by those they reign above. However, once elected, they discover that compromise is necessary to achieve anything worth while. For example, naturalists, want land and animals to be protected by those who set out to abuse or disrupt the natural flow. But, on the other hand, hunting and fishing industries bring about a vast amount of revenue, into areas where it is permitted. Therefore, those in power, must compromise the needs and / or wants of their people to keep all parties involved happy, or at least content. Both groups must feel their desires have been accommadated. Hence, state parks, state recreational land, and wildlife refuges are established. Both groups have what they value, the naturalists have the wildlife refuges that are untouched, as close as possible to earth in the beginning of time., and some sta te parks and recreational areas have regulated statutes that permit hunting and / or fishing. Compromise, may be looked upon as deceit to many. Really, they do have similar meanings, but, compromise is a much friendlier word. Would you rather think, your boss, compromised with you or deceived you? When dealing with power, love is also a deception. As long as people love you, they will follow you. As long as you tell the people what they long to hear, they will love you. You can not love what you do not know, nor can you love what you can not trust.

Death Penalty :: essays research papers

  Ã‚  Ã‚  Ã‚  Ã‚  The death penalty or as it is formally called capital punishment should be totally abolished for many reasons. First and foremost no one should have the right to take anyone else’s life, â€Å" neither individually nor as a society representative, has the right to take another man’s life, even apart from the seriousness of his guilt.† (Thinkquest,). Killing is a sin under God. â€Å"Thou shall not kill† is one of the ten commandments. Although not everyone in this country is Christian our constitution was founded on the principle that we are one country under God.   Ã‚  Ã‚  Ã‚  Ã‚  Throughout history there have been a number of arguments in favor of capital punishment. These arguments include the deterrent argument, the retribution argument and the protection of the public argument.   Ã‚  Ã‚  Ã‚  Ã‚  The deterrent argument claims that the death penalty serves as a deterrent to criminals because it instills fear sufficiently to stop criminals. However, statistically this has been found not to be true. â€Å"None of the many studies about the matter has been able to show the death penalty is more deterrent than other punishments.† (EZ,). Most people who commit the most serious crimes do so under unnatural circumstances. Fear is not even present. â€Å" Most serious crimes such as murders†¦are committed when the criminal is blinded with passion, when emotions prevail over reason.† (Collegain,). Even those who plan crimes such as murders do so thinking that they are not going to be discovered. â€Å"Criminologist assert that the best way to discourage murderers isn’t by increasing the severity of punishment but by increasing the possibility of discovering the crime and condemning the culprit.†(Thinkquest,).   Ã‚  Ã‚  Ã‚  Ã‚  Retribution as a reason for capital punishment assumes that the public wants revenge. Although victims of crimes and their relatives deserve to know that the criminal is being punished for their crime, our country beliefs in rehabilitation. Penalties do not â€Å"have to tend to the revenge or the mere punishment of the criminal, but must reeducate him and rehabilitate him morally and humanly; and what rehabilitation would be possible towards a dead man.†(EZ).   Ã‚  Ã‚  Ã‚  Ã‚  To protect the public from dangerous criminals it is not necessary to kill them. Again, the idea is that our penal system is supposed to rehabilitate people. In fact, in order to carry out justice and fearing the neglect of details â€Å"and legal means to which the sentenced can apply, protracts trials and postpones the execution, so the condemned its often changed from the man who committed the crime with the result of executing pe3ople different from the condemned ones.

A Comparison of Heroes in Beowulf and A Lesson Before Dying :: comparison compare contrast essays

Everyday Heroes in Beowulf and A Lesson Before Dying Ernest Gaines novel, A Lesson Before Dying, is a story about, Jefferson, a black man who is wrongfully charged with a crime he did not commit. He cannot get a fair trial because he is a black man in the south. He is sentenced to be executed, but before he dies Grant, an educated black man, teaches him how to walk like a man, so people do not think of him as a hog. "Beowulf" is an epic poem over one thousand years old, which was told from one generation to another. It is about, Beowulf, a great hero who defeats three different monsters to save the kingdom. In his last battle he is much older than before and is killed by a dragon. A hero does something that other people do not do and he does things for others, and other people look to a hero for guidance. Grant does something that other blacks can not do he goes to college. Most blacks do not get the opportunity to go to college, but Grant went as soon as he was old enough. When he returned he was a well-educated man, but he was still treated the same way as he was before he went to college. Grant is able to teach Jefferson how to be a man, and Jefferson learns that he is somebody. " ... I cry cause you been so good to me mr wigin an nobody aint never been that good to me an make me think im somebody"(Gaines 232) No one else is qualified to help Jefferson they all depend on Grant to teach him, and Jefferson appreciates it so much it brings him to tears. Beowulf is able to do something that no one else has ever done even though many people have tried. He is able to kill Grendel because he uses Grendels own size to hurt him. Beowulf grabs Grendels arm and pulls it until Grandel finally escapes. "He twisted in pain, And the bleeding sinews deep in his shoulder Snapped, muscle and bone split And broke"(Beowulf 34). Grendel was so big that when Beowulf pulled his arm there was too much pressure on it and it started to tear.

Leonardo Da Vinci Research Paper

Once there lived a man who was gifted with the power of looking at the same object in many different fashions sometimes as a painter would look at it, sometimes as a naturalist, sometimes as a physicist, at other times as a poet and not one of those fashions was superficial (Valley. 1958). With all the technical advances from today, most artist and inventors are inspired by this man. Leonardo exemplified the resurgence, living, view, and producing art and technology that still characterizes that age of discovery.When people think of Leonardo dad Vinci, usually the first thing that comes to mind is The Dad Vinci Code with Tom Hanks. But in reality people would say he was one of the finest artistic and scientific men of the Italian Renaissance Age. â€Å"The Last Supper† and the â€Å"Mona Lisa† are among one of his finest works of art. These art pieces were way ahead of Dad Vine's time. Leonardo was not Just a painter or artist but he was an inventor responsible for prod ucing designs ranging from early tanks and submarines to the revolutionary â€Å"flying machine. His study and mastery of a wide range of disciplines, including sculpture, philosophy, and engineering, made Leonardo a humbly of the spirit of his age, and the personification of the term â€Å"Renaissance man. â€Å"(Ryan & Adagio, 2005) We could start back when Dad Vinci first was born to see the intellect of a brilliant mind. April 15th, 1452 Leonardo was born in Vinci, Italy. Who knew on that day an infant would grow up to be known as the universal genius. He was raised by his father Piper dad Vinci, a notary in Florence.At an early age Leonardo exhibited a considerable artistic talent so when he was fifteen Leonardo moved to Florence, Italy, this is when is life started to blossom, he was Andrea del Veronica's apprentice. Overarching was a well-known artist for his time and began to show and develop Leonardo in painting and completing sculptures (Goldman. 1997). Leonardo stayed working with Veronica's until he turned 25. He then moved on and spent the next five years painting many different paintings with many different artists. When he reached the age of 30, he moved to Milan, Italy and became a court artist for Duke Alluding Oxfords.Becoming a court artist made Leonardo a Jack-of-all-trades. Not Just known or an artist, Leonardo also was an inventor; there are three tiny little notebooks that house a collection of his works also called the Codex Forester, which are now kept in the Victoria and Alberta Museum in London, England. They are believed to have been written between 1495 and 1497 (Mills, 2008). First let me talk about one of his most famous paintings, â€Å"Last Supper† he began to paint this piece in 1495 and this piece was commissioned by the Duke for the convent of Santa Maria dell Gracie.He tried to complete this painting as a mural on the wall using oil-based paint, but unfortunately the paint did not adhere to the wall and was a comp lete failure. However this brings me to the fabulous painting â€Å"The Mona Lisa†, this painting represents elegance and pure beauty. Leonardo worked on this painting for four years until 1506. In 1506 Dad Vinci abandoned work on the â€Å"Mona Lisa† to be the artistic advisor to the city's French governor â€Å"Charles demise's† at the request of King Louis XII of France . (Ryan & Adagio, 2005) In 1513 Leonardo left Milan and traveled to Rome, Italy at the request of Pope Leo X.Once he arrived he was presented with a spacious art studio to complete more of his work. Dad Vinci remained in Rome for four years, while there he completed only one major piece and that was a series of drawings which were titled â€Å"The Deluge†. Later on in 1517, King Francis I asked Leonardo to France and was going to make him the royal painter, architect, and mechanic to the king. He accepted and was given a salary and a place to live in the palace at Cloud. While he was th ere he became a teacher to a number of young inspiring artists to help them move on into their career.It was a very sad day on the 2nd of May 1 519, this is the day that Leonardo Dad Vinci left this earth to return to our heavenly father in the sky. He was surrounded by the kings court in Cloud when he passed away. Leonardo will always be known for the great artist he was and teacher he has instilled on many of us. I think everyone has a little of Leonardo in them whether it be painting or from inventing to woodworking. When people write they write with their hearts, I know when Leonardo painted it was from his heart.People knew Leonardo dad Vinci as a great painter, but my research also discovered the many different talents this great man had. Being one of the top inventors in the world he was responsible for many of the innovations that had transpired during the renaissance period. He was as much an inventor as an artist. Though he never built many of the inventions he designed, s ome of the things he envisioned in the late sass are in use today, including helicopters and parachutes. Dad Vinci was obsessed with war, and he sketched an armored vehicle that could carry eight men inside and allow them to fire weapons through holes in its walls.He drew ND wrote about what we today call tanks more than 400 years before they were first used in combat during World War l. (Grant, 2010) Leonardo Dad Vinci is the key personality that enlightened the Renaissance with its outstanding talent. Other major figures, such as Francesco Did Giorgio, have left a rich legacy, especially in architecture and machinery design. Now when you close your eyes and picture an airplane or even a bird you could envision yourself in a way that Leonardo Dad Vinci did when he thought out his inventions.

Hospital Waste Management Essay

Introduction Hospital waste management is one of the most critical and yet underrated kind of waste management .The growing number of hospitals and the unhealthy eating habits of the people has contributed to the rising number of patients in hospitals. Wastes that are improperly disposed lead to spreading of infection. This will lead to the unhealthy society as a whole. Modern day societies place high importance on preventing the manufacturing of plastic and its By-products but they overlook the importance of collecting and disposing the existing plastic products that are in circulation. This is applicable for the hospital waste management as well. Hence it is imperative to focus and understand the procedures used for hospital waste management. Functions The hospital waste management process contains the following stages. Stage 1: [Acquiring the contract] The hospital invites tenders from prospective waste management agencies via newspaper agencies. Hospital follows a strict selection procedure which includes the experience of the agencies eco friendliness and regulatory constraints. Some of the constraints are * Number of workers deployed in the site of waste management * The precautionary measures taken by each worker deployed * Removal of waste on weekly basis * Proper reusability of waste Stage 2: [Resource Allocation] Resource will be allocated based on the waste generated by the hospital on day to day basis. Now generally the agency calculates the amount of waste based on the bed capacity on the respective hospitals. Ex: St.John’s medical college hospital which is located in Hosur main road, Koramangala is  one of the biggest hospitals in Bangalore and it has 2500 beds and generates a lot of hospital waste. Stage 3: [Collecting the waste] Hospitals give a separate area in their premises to the agency to segregate the waste generated by them. The ward boys collect the waste on an hourly basis. The collected waste is disposed into two distinctive bags namely red color for Bio-hazardous waste and yellow for non- hazardous waste. The agencies collect the waste from this segregated area. Stage 4: [Segregation] The waste collected in Red and Yellow bags will be further segregated based on the composition of that particular waste. Bio-hazardous waste such as needles, amputated limbs and any other material that was contaminated by blood are first sorted and packed in special containers. These containers are sent to a place located in the outskirts of the city for final disposable. State authorities in India have made several strategic decisions pertaining to HCW management. One decision was how to refine the technology options included in the Biomedical Waste Rules. Although the rules list incineration as an option for certain categories of BMW, concerted efforts by NGOs—including Srishti, Toxic Link, and Jyotsna Chauhan Associates—and the press have convinced some SPCBs to rule out the use of onsite incineration. In the State of Andhra Pradesh, for example, where most health care facilities are in the heart of cities, the Andhra Pradesh Pollution Control Board prohibited incineration at health care facilities in the entire state after considering the potential adverse impacts of pollutant emissions from substandard incinerators. The Kerala Pollution Control Board recently opted for autoclaving and deep burial of BMWs instead of incineration. The Tamil Nadu Pollution Control Board has banned incineration of BMWs—except for body parts and human tissues— in favor of autoclaving and sanitary land filling. National and state authorities have made some technology choices  for HCW management taking into account human health impacts in urban and rural areas. The Biomedical Waste Rules specify that incineration is the disposal scheme required for human anatomical and animal wastes for cities with population greater than 500,000, and deep burial is the disposal scheme required for such wastes for smaller cities and rural areas. In the State of Karnataka, however, because of the poor performance of incinerators at health care facilities, on-site incineration has been prohibited within the limits of six city municipal corporations and in all district headquarters. Of these locations in Karnataka, where the population exceeds 500,000, destruction of human anatomical and animal wastes is to be accomplished by incineration only at CWTFs to comply with both the Biomedical Waste Rules and state requirements. Bangalore, Hubli- Dharwad, and Mysore comply with this requirement, but in Mangalore, human anatomical and animal wastes are currently disposed of by deep burial. In Andhra Pradesh, state authorities have selected deep burial as the disposal scheme for biodegradable infectious wastes in areas with a population less than 500,000. This approach is not in compliance with the Biomedical Waste Rules, which require local autoclaving, microwaving, or incineration instead of deep burial, but it is in accordance with the 1999 WHO guidelines for the safe management of wastes from health care activities. Another strategic decision for state authorities in India was whether to opt for on-site treatment of BMWs or common treatment of BMWs. Common treatment of BMWs offers several advantages. 1. CWTF can be located away from hospital premises and urban areas, significantly reducing the potential adverse human health impacts. 2. CWTF reduces treatment and disposal costs by treating large quantities of wastes collected from many facilities (that is, it offers economies of scale), although the savings must be balanced by the additional transportation costs from all the facilities to the CWTF. 3. CWTF can employ specially trained personnel who could not be easily supported by individual health care facilities, resulting in better and more efficient operation. 4. The permitting, monitoring, and enforcement efforts by regulatory agencies of one CWTF are likely to be fairly effective. Nonetheless, there are challenges associated with a common treatment of BMWs. A CWTF approach imposes a direct financial burden on the operators of health care facilities, who previously paid minimal amounts for services associated with waste management. It also requires operational and behavioral changes by the operators of health care facility operators, who must properly segregate wastes into the types of BMW accepted by the CWTF operator. A more important concern is the difficulty of ensuring continued involvement of the private sector in a CWTF when the market is uncertain because of the absence of a culture of compliance and a weak enforcement regime. India’s central government views common waste treatment as the most appropriate approach to the treatment of BMWs generated in urban areas. Andhra Pradesh was the first state to devise and implement a CWTF scheme. Initially, resistance to the scheme arose from doctors who were unwilling to accept a CWTF approach for the â€Å"Twin Cities† area of Hyderabad and Secunderabad and objected to the charges required for BMW treatment and disposal. Workshops were held with doctors and other facility staff to overcome their resistance, and mass awareness campaigns were conducted in Andhra Pradesh about the need for safe BMW treatment and disposal. Two privately owned CWTFs were set up in the state to treat BMWs from Hyderabad and Warangal Districts, using the same types of technologies (incineration and autoclaving). The successful model for a privately owned and operated CWTF used in Andhra Pradesh was subsequently emulated in other states—including Karnataka, Maharashtra, Punjab, Rajasthan, Tamil Nadu—and plans for similar CWTFs have recently been adopted in the States of Gujarat, Kerala, New Delhi, Uttar Pradesh, and West Bengal. †¢ Karnataka: In Karnataka, two CWTFs—one in north and the other in south Bangalore— have been operating using incineration and microwave technologies to serve about 6,000 beds in the city. Another CWTF in Mysore, which uses the incineration and autoclave technologies, was commissioned for 67 health care facilities with 7,000 beds. Two additional CWTFs, both based on the incineration technology, were com-missioner recently in Belgaum and Hubli- Dhardwad. Three additional CWTFs are going into place in Karnataka at Gulbarga, Mangalore, and Shimoga. All the CWTFs in Karnataka are located away from the  city limits, with transportation of BMWs provided by the CWTF operator. Stage 5: [Selling the waste to the Wholesaler] The segregated scrap is then sold to the wholesaler .There are 3 types of wholesalers namely * Glass based * Paper based * Plastic based * Glass based: Once the glass based wholesaler receives the bottles, he segregates the bottles which can be reused and sends it back to the respective companies and the bottles which cannot be reused are crushed and then melted and made into different glass products . * Paper based: Once the paper based wholesaler receives the segregated papers the cotton boxes are crushed and treated then it is converted to a carton box again . The papers are separated on the basis of their color and then treated for ink removal and then sent to paper mills. * Plastic based: The sorted plastic is first washed with chemicals to remove all hazards and then it is grinded and it is made into powder so that it loses its original shape. Then this particular powder is sold to the factories, they melt it and make it into different products. Materials and methods There are a few amenities required by the waste management agencies to function in effective manner. 1. The yard provided by the hospital should have a roof .The yard should be ventilated properly .Otherwise most of the products are wet, they start emitting bad odor .This may cause infection to the workers in the yard. 2. Each and every worker should be provided with a pair of surgical gloves .He also has to wear proper footwear. There are chances of infected material coming to the yard, so this will prevent them from getting infected. 3. The burning of the hazardous waste material should be done outside the city limits where the population is minimal and the ashes should be buried minimum 20 feet below the ground. There should be a minimum of 50 feet chimney to let the smoke outside .The ashes should not be buried anyway next  to ground water irrigation. 4. The glass and plastic wholesaler should take extra care to see to that the materials are washed properly with the right chemicals to prevent any kind of infection. 5. The workers in the yard and the wholesaler’s warehouse should follow strict precautionary measures and they should be provided with hand sanitizer. Marketing plan The marketing strategy of hospital waste management varies depending on their operational capabilities. Large scale operators like Maridi based in Hyderabad and Synergy based in Delhi use advertising campaigns to attract prospective customers while small players like Sathya Eco-Management based in Bangalore, follow variant of direct marketing by approaching hospitals to collect Hospital waste Financing and Incentives The following table describes approximate revenue of Sathya Eco-Management The revenues in 2008 were boosted by The Beijing Olympics where large quantities of scrap were exported from India to China. This year was unusual as compared to other years where the revenues fluctuated within the range of 12 to 16 lakhs. The financial cycle begins with the invitation of the tenders from the hospitals. Prospective bidders who satisfy the selection criteria pay the required amount in demand draft. The waste management agencies would then sell the procured material to the wholesalers. The wholesaler then sells his product to the different factories. The factories convert the procured material into the product and sell it back to the consumers. The wages are made every week on a daily rate basis. Regulatory framework India was the first country in South Asia to establish a legal framework for the management of health care wastes. The development of  India’s legal framework began in 1995.At that time; the scope of the HCW problem was rather large. According to the Central Pollution Control Board (CPCB)—the technical arm of India’s Ministry of Environment and Forests—an estimated 150 tons/day of biomedical waste generated from health care facilities were being mixed in with communal wastes without adequate attention to proper waste management procedures (CPCB 2000). In 1995, India’s Ministry of Environment and Forests drafted rules for managing BMWs that proposed (a) Each health care facility with more than 30 beds or serving more than 1,000 patients per month installs an incinerator on its premises. (b) Smaller health care facilities set up a common incinerator facility. Shortly thereafter, in March 1996, the Supreme Court directed the Government of India to install incinerators at all hospitals in the New Delhi area that had more than 50 beds. Sixty incinerators were installed in the New Delhi area, and 26 of them are still in service. Only one of these incinerators meets today’s national norms—an incinerator at RML Hospital that was re engineered by CPCB. Meanwhile, in 1995, Srishti, a nongovernmental organization (NGO), had taken a survey that revealed unsanitary practices and associated risks in dealing with HCWs in India. In 1996, Srishti initiated public interest litigation against the government that led the Supreme Court to revise its initial position for incineration at health care facilities by ordering India’s Central Pollution Control Board (CPCB)—the technical arm of the Ministry of Environment and Forests—to consider alternative and safer technologies in HCW management rules and to set up technology standards. A major drawback of incineration is that it produces toxic air emissions. The principal pollutants in terms of public health are heavy metals (such as cadmium, mercury, and lead), hazardous by-products from combustion (such as dioxins and furans), and particulate matter. Srishti asked the Supreme Court to require alternative and safer technologies in the  rules and the setting up of standards for these alternative technologies. At Srishti’s urging, India’s Supreme Court revised its initial position and ordered CPCB to consider alternative BMW treatment and disposal technologies. Between 1996 and 1998, while CPCB was evaluating alternative technologies, there were intensive consultations among government officials, health care representatives, scientists, members of the industry, and NGOs. The culmination of all these efforts was the preparation and publication by India’s Ministry of Environment and Forests of the Biomedical Waste (Handling and Management) Rules of 1998.Those rules are discussed further below. The Biomedical Waste Rules of 1998 India’s Biomedical Waste Rules of 1998, which were amended twice in 2000, are based on the principle of segregation of communal waste from BMWs, followed by containment, treatment, and disposal of different categories of BMW .The rules classify BMWs into 10 categories and require specific containment, treatment, and disposal methods for each waste category. An overview of the BMW treatment and disposal technologies specified in the Biomedical Waste Rules. BMW treatment options include autoclaving, microwaving, incineration, and chemical treatment; in addition, hydroclaving has been approved by CPCB as an alternative treatment technology. BMW disposal options include deep burial and secure and municipal land filling for solid wastes, and discharge into drains (after chemical treatment) for liquid wastes. India’s Biomedical Waste Rules are similar to those in international practice, although they have some internal inconsistencies and deviate in some respects from the procedures the World Health Organization (WHO) recommends for managing HCWs. National Guidelines for Implementing the Biomedical Waste Rules Each state or territory in India is responsible for implementing India’s Biomedical Waste Rules, and State Pollution Control Boards in states or Pollution Control Committees in the territories are designated as the prescribed authorities. Although environmental standards and guidelines for the management of BMWs were developed by India’s CPCB in 1996 (CPCB 1996), these were merely technical  standards for technology options for health care facilities. In 2000, CPCB published a manual on hospital waste management that provided technical guidance for carrying out India’s Biomedical Waste Rules in the areas of HCW segregation, storage, transport, and treat ment (CPCB 2000). The CPCB manual gave special emphasis to BMW incineration, covering incinerator emissions, maintenance requirements, operational problems and solutions, and pollution control systems. Suggestions regarding common waste treatment facilities (CWTFs) for BMW treatment were also included in the manual. CPCB’s manual was informative, but it was not comprehensive enough to cover all aspects of India’s Biomedical Waste Rules, such as sharps management, handling of infectious liquid wastes, minimization of BMW generation, training of health care facility employees, and recordkeeping and monitoring procedures. As discussed below, a positive development is that CPCB has recently issued two sets of draft guidelines, one set pertaining to the treatment of BMWs at CWTFs (CPCB) and the other pertaining to the design and construction of BMW incinerators. CPCB’s recent draft guidelines on CWTFs set out requirements for the location, land size, coverage area (in terms of the maximum number of beds served), treatment equipment, and infrastructure setup of the CWTF; collection and transportation of BMWs, and disposal of treated BMWs; and other operational issues. The listed technologies in the draft guidelines include those prescribed in the Biomedical Waste Rules, plus hydroclaving. The draft guidelines’ prescriptions are not always well justified. For example, the minimum coverage of each CWTF is set at 10,000 health care facility beds, without consideration for local conditions such as the geographical dispersion of the health care facilities; the suggested land area for each CWTF is 1 acre, but no basis for this suggestion is presented. In addition, the draft guidelines propose a 150-km-radius operational area, which would cover health care facilities in rural areas. This proposal becomes more important in the current debates around sharps wastes from immunization in India as the new types of auto disposable plastic syringes are being characterized as safer options than glass syringes. Moreover, CPCB’s draft guidelines appear to be prescriptive on the waste management charge scheme instead of letting the optimum scheme develop on the basis of experience gained in India. CPCB’s recent draft guidelines for BMW incinerators include requirements for the incinerator design and its air pollution control device, physical structures (incineration and waste storage rooms), operator qualifications, personal protection equipment, and emergency procedures. These guidelines restrict incineration of BMWs only at CWTFs, with the exception of on-site incineration upon special approval by CPCB. The draft guidelines’ strong bias against on-site incineration at health care facilities is a major deviation from the Biomedical Waste Rules, which are equally applicable to the on-site and CWTF incinerators. It is clear that the new emphasis reflects the recent findings about the poor design and operating conditions of on-site incineration equipment at health care facilities in India vis-à  -vis the requirements of the Biomedical Waste Rules. Conclusion There is no denying that hospital waste management plays a crucial role in the sustainability and growth of a healthy society. So it is imperative all the stakeholders involved in the hospital waste management industry follow the best possible, environmental friendly, effective and efficient practices. In conclusion, everything boils down to the long term health and sustainability of our earth and it is important to keep in mind that we do not inherit the earth from our ancestors but we borrow it from our children. References * Sathya Eco-management, Bangalore. * Raja plastic, Mysore Road, Bangalore. * Maridi Bio-Waste Management (www.maridibmw.com). * â€Å"Health Care Waste Management in India† by BEKIR ONURSAL .