Occupational Hazards among Sanitary Staff in Hospital

Occupational Hazards among Sanitary Staff in Hospital Occupational Hazards among Sanitary Staff Working at Tertiary Care Hospitals of Karachi Abstract Improper waste management increases the risk of occupational hazard among staff working in hospital. The aim of this cross-sectional study was to identify awareness and practices associated with occupational hazards among the sanitary staff working at tertiary care hospitals. The study was conducted at 2 government hospitals in Karachi, from October 2012 to January 2013. An anonymous, self-descriptive questionnaire was used to collect data. Among 106 participants, only 39% (n=41) received training on managing hazardous waste. Moreover, only 51% (n=54) were able to differentiate between hazardous and non-hazardous waste. Around, 69% (n=73) respondents had provision of Personal Protective Equipment (PPE) whereas; only 36% (n=38) were compliant with it. Two third of the participants reported that they have encountered injury from hospital waste. Fisher’s Exact Test revealed that use of PPE is associated with education, experience, training and awareness. The study revealed great need of awareness about health hazards among sanitary staff working at hospitals along with provision of facilities. Keywords: Occupational Hazards, Personal Protective Equipment, Waste Management, Sanitary Staff. Hospital waste serves to be the most hazardous waste material which can lead to life threatening infectious diseases. Poor and improper handling of waste increases the risk of exposure to pathogenic organisms.1 Waste material generated from hospitals are considered as hazardous hence, it needs to be treated cautiously.2 In developing countries, there is scarce awareness and knowledge about proper management of hospital waste.3 All staff working at hospital is prone to acquire infections. However, sanitary staffs are at greater risk.4 A number of diseases can be transmitted via contact with hazardous hospital waste including Acquired Immunodeficiency Syndrome (AIDS), hepatitis B, and hepatitis C.5 Therefore, training of sanitary staff working at healthcare facilities is essential.4 All healthcare facilities needs to prepare their own policies to ensure proper management of hospital waste and provision of staff safety.6 Appropriate management of hospital waste is based upon hospital administration, policies, finance, staff training, and active participation of staff.7 The staff responsible for handling hospital waste needs to be provided with all essential PPE.8 This study focuses on awareness of occupational hazards among sanitary staff working at government hospitals in Karachi. The study was conducted at two tertiary care government hospitals of Karachi from October 2012 till January 2013. It was a cross sectional survey conducted on 106 participants that had given consent and who had minimum of 3 months of experience. The survey was conducted through a structured questionnaire and data was analyzed through SPSS. Among 106 participants 71% (n=75) were male and 29% (n=31) were females. Mean age of participants was 40.23 (+ 9.5 SD). As displayed in Table 1, among all participants 62% had work experience of more than 5 years. Majority (n=36, 34%) of the participants had received secondary education. Participants who had done intermediate (n=23, 22%) were working as shift supervisors. Job responsibility of participants included dusting and cleaning wards (n=41, 39%), collection of hospital waste (n=32, 30%), segregation of hospital waste (n=18, 17%), and disposal of waste material (n=15, 14%). Table 1 Demographic Profile of Study Participants 15 25 32 34 24 23 36 23 41 32 18 15 14 24 30 32 23 22 34 22 39 30 17 14 During job tenure, only 41 (39%) staff received formal training on handling hospital waste and preventing health hazards by following standard precautions. However, 54 (51%) of the respondents were aware about hazardous and non-hazardous waste products. Among all participants, only 19 (18%) underwent medical inspection and 67 (63%) of them received Hepatitis-B vaccination. However, among recipients of Hepatitis-B vaccine, only 37 (35%) received complete vaccination i.e. all 3 doses of Hepatitis-B. On inquiring about availability of PPE, 73 (69%) responded that PPE are provided by hospital whereas, only 38 (36%) of the respondents were using PPE. Among all participants, 87 (82%) were compliant with hand washing. With regard to separate collection of hazardous waste from non-hazardous waste, 47 (44%) of the respondents said that they collect waste separately. However, only 21 (20%) of the participants reported that they carry hazardous and non-hazardous waste separately. Majority (n=88, 83%) were using open containers for carrying waste material. Around 69 (65%) of the participants responded that they have encountered injury from hospital waste. Among them, 2 (2%) encountered needle stick injury, 30 (28%) experienced sharp injuries, 24 (23%) came in contact with blood and body fluids, and 14 (13%) got other types of injury. Only 18 (17%) of the participants didn’t experienced any illness, however 21 (20%) experienced gastrointestinal tract problems, 28 (27%) suffered from respiratory disorders, 14 (13%) got eye infections, 11 (10%) came in contact with skin diseases, and 14 (13%) encountered blood borne diseases. With regard to compliance of using standard precaution 34 (32%) of the participants always use gloves, only 7.5% of the participants always use apron, and 31 (29%) always use masks. The Fisher’s Exact test revealed a significant association between experience and use of PPE (P=0.027). Similarly, highly significant association has been identified between training and compliance with use of PPE (PPPP=0.078), was found to be insignificant (see Table 2). Table 2 Association between Compliance with Use of PPE and Demographic Characteristics * Significant ** Fisher’s Exact Test applied due to low cell count Generation of waste at hospitals demands for it proper disposal to avoid hazardous consequences associated with it. It is the prime responsibility of hospital to maintain clean and healthy environment to reduce infections associated with hospital wastes.6 Therefore, it is essential to provide appropriate training to ensure staff safety.9 In current study, less than half of the respondents received training and around half of the respondents displayed awareness about hazardous waste material. The study also displayed an association between training as well as awareness about hazardous waste with compliance to PPE use. Similarly, available evidences in the field also suggests that training of staff along with regular follow-ups can foster compliance with appropriate waste management practices.10 Available literature also suggests that for appropriate management of hospital waste and safety of hospital staff, continuous training programs needs to be organized.8 Current study revealed that only 18% of the sanitary staff went through medical inspection and around 35% of the staff received complete doses of hepatitis B vaccination. In contrast, previous study on sanitary staff working in tertiary care hospital of Rawalpindi reported that none of the sanitary staff went through medical checkup or received any vaccination before or during job tenure.4 The findings of current study revealed that availability of PPE was inadequate. However, it is essential to provide continuous supply of PPE and to bring change in attitude of staff towards use of PPE. The efforts of providing training, creating awareness, and providing personal protective equipment will not be of worth if staff will not comply with the appropriate waste handling and management strategies. Our study also demonstrated that only one third of the respondents were using available PPE. However, non-compliance with appropriate management of hospital waste makes sanitary staff prone to infections.10 Hence, efforts need to be made for providing training and creating awareness among sanitary staff for handling hazardous hospital waste. Moreover, organization should develop relevant policies and protocols to ensure appropriate handling and disposal of hospital waste. Organizations should also take initiatives for conducting medical inspection and vaccinating all hospital staff including sanitary staff. Availability of PPE should be adequate and staff needs to be encouraged to use PPE. Evidence based interventional research can be conducted to ensure appropriate handling of hazardous hospital waste for preventing sanitary staff from infectious diseases. References Hossain MS, Santhanam A, Nik Norulaini NA, Omar AK. Clinical solid waste management practices and its impact on human health and environment-A review. Waste Manag 2011; 31:754–6. Ross DE. Safeguarding public health, the core reason for solid waste management. Waste Manag Res 2011; 29:779–80. Janjua NZ, Khan MI, Mahmood B. Sharp injuries and their determinants among health care workers at first-level care facilities in Sindh Province, Pakistan. Trop Med Int Health 2010; 15:1244–51. Ahmed I, Farooq U, Rabia M, Naheed A, Maryum A, Asia A. Awareness among sanitary workers regarding their job: A survey at tertiary care hospital. Medical Forum Monthly: A Journal for all Specialties. Retrieved from http://www.medforum.pk/index.php?option=com_contentview=articleid=467:awareness-among-sanitary-workers-regarding-their-job-a-survey-at-tertiary-care-hospital. Hayashi Y. Proper disposal of medical wastes infection prevention and waste management at Hiroshima city, Asa Hospital. Rinsho Byori, 2000 (Suppl 112):26-31. Hashmi SK, Shahab S. Hospital and biomedical waste management. In: Iliyas M, Editor, Community medicine and public health. 4th ed. Karachi: Time Publishers, 2003, pp. 426-37. Yadav M. Hospital waste-A Major Problem. Hospital Today 2011; 8: 276-282. Pandit NB, Mehta HK, Kartha GP, Choudhary SK. Management of biomedical waste: Awareness and practices in a district of Gujarat. Indian J Public Health 2005; 49:245-7. Al-Khatib IA, Al-Qaroot YS, Ali-Shtayeh MS. Management of healthcare waste in circumstances of limited resources: a case study in the hospitals of Nablus city, Palestine. Waste Manag Res 2009; 27:305–12. Ikram A, Hussain Shah SI, Naseem S, Absar SF, Ullah S, Ambreen T, et al. Status of hospital infection control measures at seven major tertiary care hospitals of northern punjab. J Coll Physicians Surg Pak 2010; 20:266–70.

Franchising †Fast food Essay

Now a days, fast food is becoming a cheap and yet a popular way for people who are too busy to cook. But the cheap price of the fast food is nothing in comparison to the true price that these people are paying. Every 4 out of 10 adults in the USA will become obese in the next 5 years if they keep eating this food the way they are. Eating fast food like this is causing major health risks. Since this food is so cheap, it makes it convenient for people to go out and get food instead of staying home to cook. In addition, fast food companies are trying to target kids. If the companies get to the kids at a young age, they will get hooked on the food. Because of all this, people need to stop eating fast food before it gets out of hand. This fast food world has spread tremendously around the globe, and obesity has shortly followed. In addition to this it has also brought heart disease, arthritis, diabetes and many other types of illnesses. Fast food isn’t only making people fatter, but its also increasing people’s chances of obtaining type two diabetes. People’s muscles and fat cells that have type two diabetes lose the ability to take in a sugar called glucose from their blood. The glucose builds up and reaches very high levels and because of this they get damage to the eyes, neuropath (loss of feeling), kidney disease and heart disease. Most of the people who have type two diabetes are obese or overweight. A long-term study between the link of fast food, obesity and diabetes were tested. It compared the people who would eat fast food at least twice a week to the people who ate it less than once a week. The results showed that the people who are more fast food gained about 10 pounds more then the people who are it less than once a week over a fifteen-year period. Eating fast food can cause many diseases such as Hypertension, Heart Disease, Cancer, Gall Bladder Disease and E. coli, which is one of the worst forms of food poisoning. E. Coli is spread through undercooked burgers and it is very difficult to cure. 4 % of the people who have this poison develop hemolytic uremic syndrome and close to 5 % of the kids who develop this die. E. Coli is now becoming the major reason for renal failure for American kids. People would rather spend their money on a cheap burger that tastes good compared to a burger that tastes just as good for six times the price. The great thing about fast food is that over these many years their products taste hasn’t changed. â€Å"The whole experience of buying fast food, has become so routine, so thoroughly unexceptional and mundane, that it is now taken for granted, like brushing your teeth or stopping for a red light. † Says Eric Schlosser, author of Fast Food Nation. Millions of people a day are buying fast food because it’s so convenient to get to. Today’s economy is also dropping and because of this going out to buy fast food has become easier to feed people’s families. Instead of a family going out to a restaurant to feed the family for 60 dollars, they can go to a fast food restaurant and spend about one third of that. These fast food restaurants are making a lot of money off this cheap food With the money they make, they spend some of it for advertising to grab people’s attention Since most kids watch TV they are the ones that are affected most by this McDonald’s spends billions of dollars on advertising each year. Most of the kids know Ronald McDonald more than they do their own president. Just about 30% of all children each day eat fast food according to a Harvard study. This is part of the reason why America is the fattest country in the world. According to Alan Green, on average, kids who eat fast food gain an extra 6 pounds in weight each year. â€Å" The numbers, though alarming, are not surprising since billions of dollars are spend each year on fast-food advertising directed at kids, â€Å" said lead author Dr. David Ludwig, director of the obesity program at children’s Hospital Boston. Borzekowski says that most people prefer the branded fries compared to unbranded fries and the same results were found about branded chicken nuggets and non-branded chicken nuggets. â€Å" Its no surprise that branding works,† says Borzekowski. In another test done by Borzekowski, they took two burgers from McDonalds and put one in a non branded wrapper, Borzekowski had the kids try both and astonishingly most kids tasted a difference in the two burgers. The majority of the preferred the McDonalds wrapped burger. McDonalds also finds ways of getting to the kids, because in Seminole County, the kids are rewarded with Happy Meals if the have a nearly perfect attendance or it they do well on their report cards. In fact, Stuart Elliot of the New York Times says that the Florida schools are â€Å"using children’s report cards to help stimulate sales { at McDonalds }. † Kids can get a number of Happy meal choices such as four chicken McNuggets, a Hamburger and small fries or a cheeseburger with apple dippers. These kids are being rewarded with fast food, which is part of the reason that they are becoming obese. The concepts of conformity and organizational homogenization, while repugnant in a democratic society, can actually aid big businesses and more specifically franchises in promoting quality assurance and brand loyalty. Large corporations, such as McDonald’s, are able to maintain stability and control by removing any factors that may create unfamiliarity for their customers. The goal of McDonald’s is to create a fast food empire founded on conformity to ensure a common experience. For example, everything from the menu, to the restaurant facade, to the golden arch flag waving proudly beside our American flag, demonstrates their efforts to create a sense of comfort through familiarity. McDonald’s target market expects the same service, experience, and product whenever they enter a franchise location. Large corporations recognize the power of consistency and the importance of conformity within their ranks. When Ray Kroc says, â€Å"We have found out [†¦ ] that we cannot trust some people who are nonconformists. [†¦ ] The organization cannot trust the individual; the individual must trust the organization†, Kroc was trying to emphasize the importance of conformity and need for trust in the organization’s goals. Kroc had created a successful formula and needed his employees to share his vision. The American fast food industry has made a significant impression on our social and economic landscape. The concept of â€Å"flipping burgers† has become synonymous with entry level employment for teens and other unskilled laborers. The industry employs hundreds of thousands of people at all levels. The industry also occupies a prominent place in our popular culture. From commercials on television, to the ads on the side of the bus, to the billboard on the side of highway 95, the fast food industry has made itself a visible force in the American economy and pop culture. The fast food industry’s size also allows it to play a significant role in our political system. Companies such as McDonald’s have a keen interest in labor, tax and trade policy. While Ray Kroc’s vision of conformity and trust in the collective over the individual contradicts our concept of a free society, it is essential to the success of a company using the franchise business model. Consistency and organizational trust are the keys to ensuring customer familiarity and brand loyalty.

Balancing Chemical Equations

Balancing chemical equations 1. Complete the following sentences, using the words or groups of words in the box below. You may use some words more than once. †¢ as small as possible |†¢ decrease |†¢ molecules |†¢ quantities | |†¢ balance |†¢ different |†¢ nature |†¢ rearranging | |†¢ bonds |†¢ equal |†¢ never |†¢ release of a gas | |†¢ characteristic properties |†¢ heat |†¢ new elements |†¢ rules | |†¢ check |†¢ increase |†¢ nuclear |†¢ signs | |†¢ chemical |†¢ law of conservation |†¢ nucleus |†¢ state | |†¢ chemical equation |of mass |†¢ physical |†¢ stoichiometry | |†¢ coefficient |†¢ mass of products |†¢ precipitate |†¢ subscript symbols | |†¢ colour |†¢ mass of reactants |†¢ products |†¢ transformed | |†¢ counting |†¢ molar mass |†¢ proportions |†¢ whole numbers | a)There are three types of changes in matter: ________________________ changes, chemical changes and ________________________ changes. b)A physical change occurs when the form or the ________________________ of a substance is changed. For example, when liquid water is cooled, it becomes ice.Whether water is in liquid form or in the form of ice, the ________________________ that form water remain the same. The ________________________ of water do not change. c)A ________________________ change alters the ________________________ of a substance. The very nature of the ________________________ is altered: they are no longer the same after the change. This transformation involves ________________________ the bonds between the atoms and forming new molecules. d)A ________________________ transformation involves changes that occur in the ________________________ of the atom. The transformation causes the atoms to split and form ________________________. ) Chemical changes occur when the ________________________ between reactants (initial substances) are broken to form new ________________________ (final substances), whose characteristic properties are ________________________. During this process, the quantities of reactants ________________________, and the quantities of products ________________________. f) We can recognize that a chemical change has taken place by certain ________________________: the ________________________, the emission or absorption of ________________________, the emission of light, a change in ________________________, and the formation of a ________________________. ) A chemical change, or chemical reaction, can be represented by a ________________________, which shows how the change took place. It is useful to identify the ________________________ of the substances (solid, liquid, gas or aqueous solution) with ________________________ in parentheses to the right of the substance. h) The scientist Antoine Laurent de Lavoisier made this famous statement that expla ins the________________________: â€Å"Nothing is lost; nothing is created; everthing is ________________________. † This means that the ________________________ before the chemical reaction is equal to the ________________________ after the reaction. ) To follow the law of conservation of mass, we must ________________________ chemical equations by ________________________ the number of atoms of each element on the reactants side and on the products side of the equation. The appropriate ________________________ must be placed in front of each substance so that the number of atoms on each side of the equation is ________________________. j) Certain ________________________ must be followed when balancing a chemical equation. The coefficients must be ________________________, and they must be ________________________. New substances must ________________________ be added, nor existing substances removed.Subscripts in chemical formulas must ________________________ be changed. Finally, we must ________________________ the equation by comparing the number of atoms of each element on either side. k) When a chemical equation is properly balanced, we can find the ________________________ of reactants needed for a reaction and predict the resulting quantities of products. ________________________ is the study of these proportions. It is essential to maintain the ________________________ of the substances throughout the reaction. We can use ________________________ to convert moles into grams. 2. What kind of change is described by each of the following examples? |a) a worn tire | | | |b) limewater that turns white | | | |c) a bracelet that tarnishes | | | |d) the fission of a uranium nucleus | | | |e) rusting iron | | | |f) mercury that expands in hot weather | | | |g) the fusion of the nuclei of several atoms | | | |h) food being transformed into energy | | | |i) salt dissolving in water | | | |j) radium emitting radiation | | 3.For each of the following exam ples, name at least one sign that a chemical change is occurring. a) A match burns. | | | b) A yellow substance appears when NaI is mixed with Pb(NO3)2. | | | c) Bubbles form when chalk is mixed with hydrochloric acid. | | | d) A bright light appears when a piece of magnesium is burned. | | 4. Write a chemical formula to represent the following situation. Aluminum oxide (AlO), commonly called alumina, is formed by the reaction between aluminum (Al) and oxygen (O2). Balance the equation. | | | | | | 5. Balance each of the following chemical equations by indicating the number of atoms in each molecule involved in the reaction. a) C(s)+ H2(g) + O2(g) ( CH3OH(g) | | | | | | | | | | | | | | | | | | | | | b)Al(s) + O2 (g) ( Al2O3(s) | | | | | | | | | | | | | | | | | | | | | c)C(s) + Cl2(g) + H2(g) ( CHCl3(g) | | | | | | | | | | | | | | | | | 6.The decomposition of 10 g of copper oxide is represented by the following equation: 2 CuO(s) ( 2 Cu(s) + O2(g) If you obtain 8 g of copper, what am ount of oxygen was released? Explain your answer. | | | | | | | | | | | | 7. Calculate the mass and the number of moles of silver produced if you make 10  mol of zinc react with sufficient silver nitrate. (The equation is not balanced. Zn(s) + AgNO3(aq) ( Ag(s) + Zn(NO3)2 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 8. What mass of glucose will be formed if you make 32  mol of hydrochloric acid react with sufficient carbon? (The equation is not balanced. ) HCl(l) + C(s) ( C10H16(aq) + Cl2(g) | | | | | | | | | | | | | | | | | | | | | | | | | 9. Given the reaction for the synthesis of ammonia: N2(g) + 3 H2(g) ( 2 NH3(g) How many moles of hydrogen are needed to produce 50  g of ammonia? | | | | | | | | | | | | | | | 10. Given the following equation: 2 Na(s) + 2 H2O(l) ( 2 NaOH(aq) + H2(g) How many moles of hydrogen will be produced by the complete reaction of 75  g of sodium? | | | | | | | | | | | | | | | | | ———â€⠀Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€Ã¢â‚¬â€œ Support activities – Second Year of Secondary Cycle Two |EST | | student BOOK: Chapter 4, pages 108–113 | | Related Handout: Concept review 15 | ACTIVITY 15 EST EST EST EST EST ———————–  ©ERPI Reproduction and adaptation permitted solely for classroom use with Observatory. Observatory / Guide 11129-B

Vertical Shift Material Used In Manufacturing Machines ...

Several manufacturing sites around the United States still to this day manually pick material required for orders. It would be beneficial if most of these sites switched to a system that brings the material to the workers, such as vertical lifts or carousels. Despite the fact vertical lift modules can be quite costly, they can bring quite a lot of positive transformations to these manufacturing companies in addition to numerous other companies not specifically in the manufacturing area. These machines can change the way these companies function on a day to day basis, bringing these companies to an advanced level of operations. Automated parts retrieval systems such as Vertical lift modules, are automatic storage system for parts or goods†¦show more content†¦Lastly also guaranteed performance with technician’s ready to be sent out around the clock for any issues that may perhaps occur. However, the most common issue is simply a human error with the computer, once operators are more familiar with the device those errors perish. But nevertheless, the technicians are always available for the customers desire or needs twenty-four hours a day. Vertical lift modules are worthwhile for numerous reasons. A few of the main points that I believe are supporting evidence are as such, these vertical lifts assist with reducing human errors in parts picking, reducing injuries on staff from changing the method parts are picked, saving hours of time throughout the picking process, space savings for warehouses allowing better utilization of the site, in addition to providing smarter picking. Smart picking is delivered since the machine evaluates all the orders the operator or material planner inputs for the day. It then figures out the best method of pulling material, in addition to evaluating the likeness of requests and pairing those similar orders. For instance, if the program sees there is multiple orders of the same shelf, model, program or parts, it will bring those at the same time instead of re-queuing it later. The difference isShow MoreRelatedPROC 5820 Tours C and D Essay2539 Words   |  11 Pagescontrolled movement of ma terial through the factory and assisted in coping with irregularities There were thousands of piece rates to be established and many parts of production to be managed. For instance parts of coats were worked on separately in various areas of shop and there were special projects to work in. Factory costs had to be calculated, deliveries to stores and catalogs had to be figured, sales had to be monitored, and production had to be adjusted based of analysis of those sales. LocationRead MoreStudy on Peekay Steel Castings Ltd9554 Words   |  39 Pages 4.11 Human Resource Department†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 39 4.12 Stores Department†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦... 45 4.13 Quality Assurance and Quality Control Department†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 47 4.14 Safety Department†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦... 51 4. SWOT ANALYSIS†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 53 5. 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