An Essay

'Students sometimes have problems in deciding which universities they want to apply to.Suggest 3 factors that students should consider when applying to the universities.You may include some of the following aspect:
Courses offered and facilities.You should write at least 350 words.'


      In our developed world today university education is no more a too-high-to-reach goal.Our higher education system is year after year offering a a lot of courses and  facilities  make students difficult to choose suitable university.Students also looked for available financial support which can support them in continue their study.


       In the first place, let us look at first point. Obviously,there are many institute which offered same courses.Sometimes the students ambition and qualification are not suit with the course.There is still few of institute offered for critical and advance courses. So student have to look out for choice out of the country.This can influence in make a choice.
              
      Second factor is, they have to compare which universities with the best facilities.
This can be including the transportation , library , cafe and so many more.There is an institute which still lack of  facilities such as computer lab and shuttle bus. All of these will troublesome the students.


       Financial support is the last but not least. Student really considered regarding this matter. Students who are come from poor family usually will face this problem.So it is important to enter the institute which have good financial support which is enough to pay their fees and need.
       
      In conclusions, all of the factors troublesome the students in deciding their next institution of study.  It was a lot more than to learn academically -it can do bucket load for their future.

HIV ( Human Immunodeficiency Virus) MUST READ!!

What is HIV and AIDS?

HIV stands for Human Immunodeficiency Virus. HIV is a virus that takes over certain immune system cells to make many copies of itself. HIV causes slow but constant damage to the immune system.

AIDS stands for Acquired Immune Deficiency Syndrome. AIDS is the condition diagnosed when there are a group of related symptoms that are caused by advanced HIV infection or when someone has less than 200 CD4 cells (immune cells). AIDS makes the body vulnerable to life-threatening illnesses called opportunistic infections.

How does HIV affect the body?

Normally, the human immune system is the body’s protection against bacteria, viruses, etc. It acts like a coat of armor. When HIV enters the body, it starts poking holes in the armor. Eventually, the armor becomes very weak and unable to protect the body. Once the armor is very weak or is gone, the person is said to have AIDS.

An AIDS diagnosis is generally made when either the body's protective T-cells drop below a certain level, or the HIV-positive individual begins to experience opportunistic infections. An opportunistic infection is an infection that would not be life-threatening to an otherwise healthy person. Oftentimes, it's these infections that are the cause of illness or death in HIV-positive individuals -- not the virus itself. If people do not get any treatment for HIV disease, it takes an average of 8-10 years to progress from HIV to AIDS.

How is HIV transmitted?

HIV is transmitted through four body fluids:  blood, semen (and precum), vaginal fluid, and breast milk.

In order to pass HIV from one person to another, HIV-infected fluid from one person needs to get into the bloodstream of another person. HIV is usually transmitted through sharing needles, unprotected anal, vaginal, and sometimes oral sex, and from mother to infant before or during delivery or while breastfeeding.

Special note for HIV-positive mothers:

In developed countries like the U.S., formula feeding is strongly recommended over breastfeeding for babies of HIV-positive mothers. Whether choosing breastfeeding or formula, there should be little or no switching between the two, as doing so could put the child at a higher risk of contracting HIV, since baby formula can be harsh and weaken the lining of a baby's stomach, giving a path for HIV to enter the baby's bloodstream.

How can I prevent myself from contracting HIV?

Becoming educated about HIV and understanding how it is transmitted is the first and perhaps most important way to prevent the spread of HIV. It is essential for people to make informed decisions about the level of risk they are willing to take, based on what is realistic for them.

Abstaining from sex and not sharing needles are the most effective ways for people to protect themselves from HIV and other sexually transmitted diseases (STDs). However, abstinence is not a realistic option for everyone.

Safer sex

When abstinence is not an option, the proper use of barrier protection such as latex or polyurethane condom (male or female) with a water based lubricant is the next best thing for vaginal or anal sex.

Note: Some water-based lubricants (including those already on some condoms) contain a spermicide called Nonoxynol-9 (N-9). Many people are allergic to N-9 and the resulting genital irritation can increase the risk of HIV and STD transmission by providing a direct entry point. You can test for a N-9 allergy by rubbing N-9 lubricant on the inside of the elbow the day before you plan to use the product for sex. If there is no irritation, there is likely no allergy.

What about oral sex?

The best way to reduce the risk of HIV transmission while performing oral sex is to maintain good oral hygiene. That, in addition to not flossing or brushing your teeth right before or after will also reduce the risk of transmission.

Performing oral sex on a woman ("go down", "eat pussy")

When performing oral sex on a woman, a dental dam or common kitchen plastic wrap can be used as a barrier to protect from HIV transmission. It covers the area you are performing oral sex on (vagina or anus). If you do not have a dental dam, you can also use a new, unused, non-lubricated or flavored condom by stretching it out and cutting it down the side, then stretching it out in the same way you would a dental dam or plastic wrap.

Performing oral sex on a man ("blowjob", "head")

In addition to good oral hygiene, proper use of a non-lubricated or flavored condom on a man can significantly decrease risk of HIV transmission. If a condom is not available or an option, not accepting semen into the mouth or spitting rather than swallowing will reduce the risk. You can also use the "harmonica method" by focusing on the shaft of the penis while avoiding the head.

Performing oral sex on the anus ("rimming", "eating ass")

For oral to anal contact, or rimming, a dental dam, plastic wrap, or a condom can be used in the same way described above under the heading “Performing Oral Sex on a Woman.” This can be a great barrier against not only HIV, but possible Hepatitis A exposure.

Receiving oral sex

Since HIV is not transmitted by saliva, there is generally no risk in receiving oral sex (unless there is a lot of blood in their mouth).

How do I use male and female condoms?

Most male condoms are made of latex. Since some people are allergic to latex (your doctor can test for it if you've ever experienced irritation from latex) there are also polyurethane condoms available. When used properly, both latex and polyurethane condoms are effective ways of significantly reducing the risk of HIV transmission.

Note: Lambskin (aka "natural") condoms will not protect against HIV or other sexually transmitted infections (STIs).

When using either latex or polyurethane condoms for vaginal or anal sex, water based lubricants on the outside of the condom will help to reduce friction that could cause the condom to tear. If desired, a small amount can be placed inside the tip of the condom as well.

Important Note: Use of oil based lubricants such as Vaseline can deteriorate latex condoms and significantly increase their chance of breaking. Oil based lubricants should only be used with polyurethane condoms.

When using a male condom

1. Keep it fresh! Always store condoms in a cool dry place (not a wallet) and check the expiration date.
2. Check it! Squeeze the package gently to make sure there are no punctures and be sure to not use your teeth to open the package. Your teeth could rip the condom!
3. Heads Up! Unroll the condom a little before putting it on and make sure it's able to roll easily down the penis. Squeeze the tip (so semen can collect) and roll the condom from the tip of the penis all the way to the base. If uncircumcised, pull the foreskin back before putting the condom on.
4. Don't Double Up! Be sure to never use more than one condom at a time. Doubling up can lead to friction and possibly the condom breaking. One condom is sufficient.
5. Lube it Up! Apply lots of water based lubricant to the condom to prevent friction which could cause breakage.
6. Take It Easy! After ejaculation (cumming), remove the penis from the vagina/anus/mouth while still erect and carefully unroll and remove the condom. Be careful to not spill any semen on your partner.

Never use a condom for more than one session. Always use a new condom each time you have sex, or when you switch from oral to vaginal or anal sex. This will reduce the risk of the condom breaking.

When using a female or reality condom

Although it is referred to as the female condom, it can be used by both men and women. For the female condom, make sure to put it into place before your partner's penis comes into contact with the vagina or anus. Once in place, carefully guide the penis into the condom, making sure to enter the condom and not outside of the condom's external rim.

For vaginal sex

1. Press the inner ring between your fingers to narrow it and make it easier to insert.
2. Hold the condom with its open end pointing down, and insert the closed end into the vagina, letting the wider end remain around the opening of the vagina (it's easier to insert if the knees are spread apart). You can also place the female condom on an erect penis or dildo to insert it.
3. Push the condom up into the vagina, until it is just past the pubic bone (you can tell where the pubic bone is by curving the index finger when it has gone a couple inches into the vagina).
4. When removing the female condom, squeeze the end, twist the condom to keep the semen inside, and pull out. DO NOT FLUSH.

For anal sex

1. Remove the internal ring and place the condom on the partner's erect penis or a dildo.
2. Use the penis/dildo to carefully insert the condom into the anus of the receptive partner.
3. To remove, squeeze the end of the condom, twist to hold the semen inside and remove.

Tracheostomy

Definition



Among the oldest described surgical procedures, tracheotomy (also referred to as pharyngotomy, laryngotomy, and tracheostomy) consists of making an incision on the anterior aspect of the neck and opening a direct airway through an incision in the trachea. The resulting stoma can serve independently as an airway or as a site for a tracheostomy tube to be inserted; this tube allows a person tobreathe without the use of their nose or mouth. Both surgical and percutaneous techniques are widely used in current surgical practice.






















Figure1 :Traquestomia

Indications

In the acute setting, indications for tracheotomy include such conditions as severe facial trauma, head and neck cancers, large congenital tumors of the head and neck (e.g., branchial cleft cyst), and acute angioedema and inflammation of the head and neck. In the context of failed orotracheal or nasotracheal intubation, either tracheotomy or cricothyrotomy may be performed. In the chronic setting, indications for tracheotomy include the need for long-term mechanical ventilation and tracheal toilet (e.g. comatose patients, or extensive surgery involving the head and neck).

Surgical Instrument

Tracheostomy tube

As with most other surgical procedures, some cases are more difficult than others. Surgery on children is more difficult because of their smaller size. Difficulties such as a short neck and bigger thyroid glands make the trachea hard to open^. There are other difficulties with patients with irregular necks, the obese, and those with a large goitre. The many possible complications include hemorrhage, loss of airway, subcutaneous emphysema, wound infections, stomal cellulites, fracture of tracheal rings, poor placement of the tracheotomy tube, and bronchospasm".

By the late 19th century, some surgeons had become proficient in performing the tracheotomy. The main instruments used were:

“Two small scalpels, one short grooved director, a tenaculum, two aneurysm needles which may be used as retractors, one pair of artery forceps, haemostatic forceps, two pairs of dissecting forceps, a pair of scissors, a sharp-pointed tenotome, a pair of tracheal forceps, a tracheal dilator, tracheotomy tubes, ligatures, sponges, a flexible catheter, and feathers” Haemostatic forceps were used to control bleeding from separated vessels that were not ligatured because of the urgency of the operation. Generally, they were used to expose the trachea by clamping the isthmus thyroid gland on both sides. To open the trachea physically, a sharp-pointed tentome allowed the surgeon easily to place the ends into the opening of the trachea. The thin points permitted the doctor a better view of his incision. Tracheal dilators, such as the “Golding Bird”, were placed through the opening and then expanded by “turning the screw to which they are attached.” Tracheal forceps, as displayed on the right , were commonly used to extract foreign bodies from the larynx. The optimum tracheal tube at the time caused very little damage to the trachea and “mucus membrane”.

The best position for a tracheotomy was and still is one that forces the neck into the biggest prominence. Usually, the patient was laid on his back on a table with a cushion placed under his shoulders to prop him up. The arms were restrained to ensure they would not get in the way later The tools and techniques used today in tracheotomies have come a long way. The tracheotomy tube placed into the incision through the windpipe comes in various sizes, thus allowing a more comfortable fit and the ability to remove the tube in and out of the throat without disrupting support from a breathing machine. In today’s world general anesthesia is used when performing these surgeries, which makes it much more tolerable for the patient. Special tubes have always been created to assist people in their speech. With these unique speaking tubes, people can breathe and talk through these tubes. When they exhale the air passes through the tube and vocal cords, producing sound.

The tracheotomy underwent centuries of denial and rejection as well as much failure. Finally, in recent decades, it has become a commonly accepted, crucial, and successful surgery that has saved the lives of hundreds of thousands of patients.