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Safe and hygienic practice of skin penetration
- Annabelle Merritt
- 3 years ago
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1 S O U T H A U S T R A L I A N H E A L T H C O M M I S S I O N G U I D E L I N E S G U I D E L I N E S O N T H E Safe and hygienic practice of skin penetration DEPARTMENT OF HEALTH
3 S O U T H A U S T R A L I A N H E A L T H C O M M I S S I O N G U I D E L I N E G U I D E L I N E S O N T H E Safe and hygienic practice of skin penetration ENVIRONMENTAL HEALTH SERVICE DEPARTMENT OF HEALTH 1
4 First issued: November Revised edition: September 2004 Guidelines on the safe and hygienic practice of skin penetration. Price $8.00 plus $2.00 for postage & handling. Prepared by: Environmental Surveillance Section, Strategic Planning and Population Health Department of Health. This guideline is one of a series of guidelines designed to assist Local Government in the administration of the Public and Environmental Health Act and Regulations. Should you wish to comment on the information in this guideline, written comments are welcome and should be addressed to: Presiding Member, Public & Environmental Health Council PO Box 6, Rundle Mall, Adelaide 5000 Other related guidelines available: Standards of practice for hairdressing The provision of facilities for sanitation and personal hygiene. Please telephone (08) to check availability or download from the following link: The National Library of Australia Cataloguing-in-Publication entry: South Australian Health Commission. Guidelines on the safe and hygienic practice of skin penetration. Rev ed. Bibliography. ISBN X. 1. Bloodborne infections - Prevention - Law and legislation - South Australia. I. South Australia. Dept. of Health. II. Title. (Series : South Australian Health Commission. Guideline)
5 CONTENTS FOREWORD 5 DEFINITIONS 6 1. INTRODUCTION 9 2. POWERS OF AUTHORISED OFFICERS 9 3. RISK MINIMIZATION PERSONAL HYGIENE 11 Hand hygiene 11 Hand care 12 General hygiene GLOVES 13 Gloves used for skin penetration procedures 13 Gloves used for cleaning ASEPTIC PROCEDURES 13 Equipment 13 Creams, oils, pigments and lotions CLEANING, DISINFECTION & STERILISATION OF EQUIPMENT 14 Cleaning 14 Disinfection 15 Sterilisation 15 Record keeping of sterilisation 17 Level of reprocessing 17 Ultraviolet cabinets SKIN PREPARATION 18 Skin disinfectants (antiseptics) ENVIRONMENT 19 Work area 19 Structural furnishings & fittings 19 Linen 19 Surfaces 20 Storage 20 Management of blood spills 20 Cleaning of environmental surfaces 20 Waste management 21 Sharps NEEDLESTICK INJURIES 22 Information for operator and client SPECIFIC REQUIREMENTS 23 Bleeding management 23 Knowledge of procedures 23 3
6 After care information 23 Acupuncture 23 Body piercing 24 Jewellery 25 Colonic Lavage or Colonic Irrigation 25 Electrolysis 25 Lancing 26 Micropigmentation 26 Nail manicures & pedicures 26 Tattooing 26 Waxing SKIN PENETRATION HACCP PLAN ACKNOWLEDGMENTS BIBLIOGRAPHY RESOURCE LIST 31 APPENDIX 1 32 Cleaning and sterilisation of equipment 32 APPENDIX 2 33 Suggested layout for a reprocessing area 33 APPENDIX 3 34 Blood and Body Fluid (BBF) Exposure Action Plan 34 APPENDIX 4 35 Skin Penetration HACCP Plan 35 4
7 FOREWORD This publication, Guidelines on the Safe and Hygienic Practice of Skin Penetration, has been prepared on behalf of the Public and Environmental Health Council (the Council). The Council is established under the provisions of the Public and Environmental Health Act 1987 (the Act) and is required to initiate, carry out or oversee programs and activities designed to improve public and environmental health. The Act empowers the Council to issue guidelines to assist local councils in the administration of the Act. This guideline incorporates best practice information (at the time of publication) relevant to both local councils and owners/operators of premises where the practice of skin penetration is carried out. The risk of transmission of infection can be minimised by ensuring that premises are maintained in a hygienic manner, that knowledge of and the application of infection control techniques including aseptic procedures are practised and that effective sterilisation of equipment is ensured. For the purposes of this guideline, skin penetration practices may include any process, whether intentionally or otherwise, that involves the shaving, piercing, cutting, puncturing or tearing of the skin or mucous membrane. Any successful business providing personal services must ensure that its clients receive procedures that are professional, competent, safe and hygienic. Proprietors and staff of these businesses must be aware of the possible wider consequences of the procedures they use. Unsafe or unhygienic procedures may not only affect the health of the client but could also jeopardise the health of the operator. Most seriously, where procedures involving penetration of the skin are not managed correctly, they can be the means of transmitting blood-borne infections including hepatitis B or hepatitis C or HIV. It is essential that proprietors and staff be fully aware of the potential dangers of their procedures and understand the precautions that need to be taken to minimise the likelihood of infection or spread of This guideline should be read in conjunction with the following publications: Infection Control Guideline for the prevention of transmission of infectious diseases in the health care setting Jan 2004; Department of Health and Ageing. Available from: Australian/New Zealand Standard AS/NZS Office-based health care facilities not involved in complex patient procedures and processes-cleaning, disinfecting and sterilising reusable medical and surgical instruments and equipment, and maintenance of the associated environment. (AS/NZS 4815:2001). Available from Standards Australia: Australian/New Zealand Standard AS/NZS Cleaning, Disinfecting and Sterilising reusable medical and surgical instruments and maintenance of associated environments in health care facilities (AS/NZS 4187:2003). Available from Standards Australia: Australian Standard AS Sterilisers Steam Benchtop (AS 2182:1998). Available from Standards Australia: 5
8 DEFINITIONS Acupuncture Antiseptic AS Aseptic procedure The Authority the practice of inserting sterile needles into specific parts of the body to treat disease or relieve pain. a substance that is recommended by its manufacturer for skin application to kill micro-organisms or to prevent the growth of micro-organisms to a level that may cause infection and that is not represented to be suitable for internal use. Australian Standard is a published document which sets out technical specifications or other criteria necessary to ensure that a material or method will consistently do the job it is intended to do. a procedure designed to prevent the transfer of micro-organisms, thereby reducing the risk of infection. Includes non-touch technique, sterilisation of instruments and skin disinfection. in relation to a local government area - the local council for that area. in relation to a part of the State that is not within a local government area - the Minister charged with the execution of the Act, in this case the Minister for Health. Autoclave Bacteria Body piercing Body substance Blood Cleaning Client Coagulation Cross contamination Cross infection a device that uses temperature, pressure and moisture to sterilise equipment. a single celled organism that may be capable of causing disease, and has the potential to multiply on any surface including the skin with the right conditions. the piercing of holes in parts of the body for the purpose of inserting presterile jewellery or other adornments in the opening. includes any human bodily secretion or substance other than blood. a liquid, usually red, and circulating through the heart, arteries, capillaries and veins that carries oxygen to and carbon dioxide from the tissue of the body. the physical removal of foreign material, for example, dust, soil, blood, secretions, micro-organisms and other such substances from surfaces by washing in detergent and warm water to reduce the number of microorganisms. Cleaning must be done before sterilization. any person on whom a skin penetration procedure is being or is to be carried out but not necessarily for gain or reward. clotting; the process of changing from a liquid to a solid. the process of infectious agents being transferred from one item to another via direct or indirect contact. the transfer of an infectious agent from one person to another by any means. 6
9 Decontamination Detergent Disinfectant Disinfection Electrolysis Equipment Hepatitis B Hepatitis C HIV Hygiene taps Infection Infection control Manicure Medical waste Micro-organism Minor Mucous membrane the removal of micro-organisms or foreign matter (or both) from contaminated materials or living tissue. substance that enhances the cleansing action of water or other liquid. a substance used to reduce a range of micro-organisms. a process that reduces the number of micro-organisms but may not necessarily kill all of them. involves the insertion of a sterilised needle into the individual hair follicles to the root. An electric impulse is passed through the needle to the root area to aid in the removal of hair. can include any article, instrument, item, or material that is used to penetrate the skin or assist with a skin penetration procedure. an infection of the liver caused by the hepatitis B virus and can result in long term illness including liver damage or cancer of the liver. The infection is spread when infectious body substances (blood, semen or vaginal fluids) come into contact with body tissues beneath the skin (e.g. through needle puncture or broken skin) or mucous membrane (e.g. eyes, nose, mouth or genitals). A vaccine is available. an infection of the liver caused by the hepatitis C virus which can cause long term illness resulting in liver damage and cancer of the liver. The infection is spread when infectious blood enters the blood stream (e.g. through a blood contaminated needle used for skin penetration or tattooing) or through blood splashes to mucous membranes (e.g. eyes, noise or mouth) There is no vaccine available. human immunodeficiency virus (HIV) is the blood-borne virus that causes AIDS. This virus attacks white blood cells that are a vital part of the body s immune system. HIV can be transmitted through infected blood and other body substances. There is no vaccine available. able to be operated without the use of the operator s hands. an infection occurs when micro-organisms invade the body and multiply causing illness. process that minimises the risk of spreading infection while performing procedures on clients. professional care for the hands and fingernails, including shaping and polishing. waste material that has the potential to cause sharps injury, infection or public offence. minute forms of life which can be bacterial, viral, or fungal that may be capable of causing infection or any person under the age of 18 years (Summary Offences Act). thin sheets of tissue that line various openings of the body such as the mouth, nose or genitals. 7
10 Operator Pathogenic Pedicure Reprocessing Reusable item Risk analysis Sharps Single-use equipment Skin disinfectant Skin penetration Soil Spore Standard precautions Sterilisation Tattooing Virus the person carrying out procedures in the process of skin penetration. capable of causing professional care for the feet and toenails, including shaping and polishing. all steps necessary to ensure contaminated reusable equipment is ready for its intended use. The steps include cleaning, disinfection or sterilisation. an item designated or intended by the manufacturer to be suitable for reprocessing and reuse. a process for assessing the risk posed by an identified hazard, managing (minimising) the risk and communicating risk information to all stakeholders. any objects or devices having sharp points or cutting edges capable of cutting or penetrating the skin, eg. electrolysis, acupuncture, tattoo and body piercing needles, razors, scalpel blades, etc. equipment designed by the manufacturer for single-use or single client use only. an antiseptic that is intended for the application to intact, healthy skin to prevent the transmission of micro-organisms from person to person or from the skin penetration site to the underlying tissue. Skin disinfectants include antimicrobial and antiseptic soaps, hygienic handwashes, hygienic hand rubs, surgical hand rubs and surgical handwashes. means any process, whether intentionally or otherwise, that involves the shaving, piercing, cutting, puncturing, tearing of the skin or mucous membrane. visible dirt or debris that may protect, harbour or assist the growth of micro-organisms. a resistant form of certain species of bacteria. Work practices required for the basic level of infection control. Standard precautions are recommended for the treatment of all clients, and apply to all body fluids, regardless of whether they contain visible blood, nonintact skin and mucous membranes. the process of rendering objects free from all forms of viable microorganisms, including spores. puncturing of the skin with a needle to introduce coloured pigment leaving a permanent mark or design. a microscopic organism that only multiples in living cells and can cause 8
11 1. INTRODUCTION The practice of skin penetration for decorative, health or cosmetic purposes has existed in various forms throughout history. Modern medical knowledge has made us aware of the potential dangers associated with skin penetration procedures. If precautions are not taken, blood-borne viruses such as hepatitis B, hepatitis C, human immunodeficiency virus (HIV) and a range of bacterial infections can be transmitted to clients or operators by contaminated equipment or unhygienic premises and procedures. The risk of exposure to a blood-borne virus varies for clients and operators. The larger the population who have a blood-borne virus and are involved in skin penetration procedures, the higher the risk that someone else can be exposed during tattooing, body piercing etc, unless the needles and instruments are sterile. Clients are not required to tell the practitioner if they are infected with a blood-borne virus. Operators must assume that all blood and other body substances are potential sources of infection. The purpose of this guideline is to assist relevant authorities and operators of premises where the practice of skin penetration procedures such as acupuncture, tattooing, micropigmentation, body piercing, waxing, electrolysis or other hair removal/beauty therapies are undertaken, by providing information on how infection can occur and how the risk to clients, employees and the community can be minimised. When operators are designing their premises, renovating or moving into an existing space, they should contact the local council environmental health section for further information. Occupational Health Safety and Welfare All enquiries relating to occupational health safety and welfare should be referred to Workplace Services on POWERS OF AUTHORISED OFFICERS Authorised officers are not expected to assess the skin penetration operator s technique. However, they can ensure certain levels of hygiene exist. A suitable working environment should be maintained, and no aspects of business should affect the health of the clients or those employed at the premise. Part III of the Public and Environmental Health Act provides the necessary power for an authority to serve a notice on the owner of premises (or any other responsible person) to require specified action to improve the condition of the premises. Where an activity may give rise to a risk to health and/or result in the emission of offensive material or odour, a person can be required to desist from the activity. A notice issued by an authority pursuant to the provisions of the Public and Environmental Health Act may make reference to these guidelines. Non-compliance with the requirements of this guideline does not necessarily imply a breach of the Act. Specific sections of the guideline may be incorporated into a notice under the Act, and then the person to whom the notice was issued could be liable to prosecution if the notice is not complied with. Part V of the Public and Environmental Health Act empowers Authorised Officers to: enter and inspect the premises at reasonable times make inquiries ask questions examine, inspect and test equipment 9
12 take samples take photographs and videos require records to be produced examine and copy the records. Inspections will generally be performed on a routine basis and additional inspections will occur if complaints are received or investigations are required. Random inspections may also be undertaken. A person must not hinder or obstruct an Authorised Officer. 3. RISK MINIMIZATION In developing effective infection control strategies in the skin penetration industry, operators must identify situations where there is significant risk of spread of harmful micro-organisms and intervene at the appropriate time to prevent that spread. Micro-organisms are everywhere and are continually introduced into the environment. They live on skin, in food and dirt. Microorganisms are easily spread between clients and operators and are easily transferred by contact with unwashed hands, soiled equipment or contact with blood and body substances. Operators must assume that all blood and other body substances are potential sources of infection. To minimise transfer of micro-organisms, operators must perform all procedures in a safe and hygienic manner, following all infection control techniques and procedures. The body s first lines of defence against invasion by micro-organisms are the skin and the mucous membranes. Provided they remain intact, they provide a very effective barrier against infection. Skin penetration procedures involve the penetration of these barriers thereby increasing the risk of infection. Infection can occur if equipment is contaminated, from direct person-to-person contact with blood or other body substances, or while the site is healing. The use of infection control techniques for skin penetration procedures minimizes the risk of infection. In any procedure that involves penetration of the skin, contamination of equipment with blood (or body fluids) cannot be avoided. It is possible that clients and operators may include people who are carriers of viral infections such as hepatitis B, hepatitis C or HIV. Contaminated skin penetrating equipment can transmit these blood-borne viruses to clients or to operators who may accidentally pierce themselves. Unhygienic practices and procedures may also transmit other skin and mucous membrane infections including herpes simplex virus which may result in small painful blisters that break open to form shallow painful sores, and fungal infections such as ringworm or tinea which are spread by direct skin contact or from contaminated surfaces. Common bacteria such as Staphylococcus and Pseudomonas can also cause serious infection and may prevent healing of the site. These bacteria may be transmitted by unhygienic practices. The risk minimization strategies that should be used in the skin penetration industry require the operator to: Wash hands immediately before and after attending a client and before attending the next client, or before resuming a procedure if interrupted (eg. answering the telephone) Wear clean disposable gloves when contact with blood or body fluid is anticipated Wear protective eyewear and clothing whenever there is a risk of splattering from blood or body fluids Use aseptic (non-touch) operating techniques Use fittings and equipment that have been properly cleaned and where necessary sterilised before use Maintain the premises in a clean condition Handle and dispose of sharps in a safe manner 10
13 Consider being vaccinated against hepatitis B in accordance with the Australian Immunisation Guidelines. The above strategies are referred to standard precautions (Refer to Definitions). It is recommended that operators of any skin piercing business keep a record of all client appointments, recording the date, time and details of the procedure performed eg, female, navel pierced 1:30pm 15 th March Names, addresses and phone numbers of clients will allow for easy follow-up in disease investigation and control if an outbreak of an infectious disease occurs. Further information to be recorded may include operator s name, jewellery used and what after-care advice was given. The operator is under no obligation to ask for the client s name, address and phone number, and the client is under no obligation to provide their name, address or phone number. By adopting the infection control techniques and procedures outlined in these guidelines, operators will minimise the risk of transmission of blood-borne and other infectious diseases to clients and themselves. Refer to Section 12 Skin Penetration Hazard Analysis Critical Control Point (HACCP) Plan. 4. PERSONAL HYGIENE Hand hygiene Why wash your hands? Hand washing is generally considered to be the most important measure in preventing the spread of infection Hand washing protects both the client and the operator. When should hand washing be done? For how long? Before and after contact with each client Where multiple procedures are performed on a client, wash hands before and after each procedure Before resuming a procedure if interrupted (eg. answering the telephone) Immediately prior to putting on disposable gloves Immediately after removing disposable gloves for any reason After touching the nose, mouth or handling a nasal tissue or handkerchief Before and after smoking, eating or drinking After going to the toilet After contact with blood or other body fluids. For routine hand washing, hands should be washed all over for at least 10 to 15 seconds Before commencing an aseptic procedure, hands should be should be washed all over for at least 1 minute. 11
14 How? Wet hands thoroughly preferably with warm running water and lather with a mild soap. A liquid soap is preferable, although bar soap can be used if kept dry and in good condition. Liquid soap dispensers also need to be maintained by regular washing and drying all reusable parts. Soap helps remove grease, dirt and micro-organisms. Warm water helps remove grease from hands and also encourages hand washing. NOTE: An antimicrobial soap is not necessary for routine handwashing Pay special attention to the backs of hands, wrists and spaces between fingers Rinse hands thoroughly under running water Thoroughly dry the hands on a single-use towel or in another way that is not likely to transfer micro-organisms to the hands (eg hot air hand dryer). The dryness of hands and fingertips is related to the transfer of bacteria that is, the drier the hands the less likely the hands are to transfer bacteria Turn off the tap with the used towel if hands-free taps are not available Alcohol-based hand rubs or gels offer a practical and acceptable alternative to hand washing and can be used provided hands are not dirty. The hand rub or gel must come into contact with all surfaces of the hand and the hands rubbed together until the solution has evaporated. Hand care To minimize chapping of hands, pat hands dry rather than rubbing them Moisturising hand creams should be used regularly to avoid dryness and cracking Nailbrushes should not be used for scrubbing hands as they may damage the skin Cuts and abrasions should be covered by a water-resistant dressing that should be changed as necessary and when soiled. General hygiene Operators should pay careful attention to their own personal hygiene. Clean washable clothing should be worn and changed when soiled. Clean, freshly laundered clothing carries very few micro-organisms. Aprons or other protective clothing should be worn when there is a risk of splash from body fluids. Fingernails should be kept clean and short to allow for easy cleaning. If fingernails are long, extra effort must be made to thoroughly wash under nails. Jewellery can act as a trap for micro-organisms and may make thorough cleaning of hands difficult. If jewellery is worn, extra effort is required to clean and dry under the jewellery after hand washing. Operators should not smoke or eat while attending clients. These activities allow close contact with the mouth, transferring micro-organisms to the hand, which can then be spread between the client and operator. It is recommended that animals are not allowed in rooms where skin penetration procedures are performed to prevent soiling of the premises, reduce micro-organisms and help maintain cleanliness. Companion animals used by the sight and/or hearing impaired are exempt. 12
15 5. GLOVES Gloves used for skin penetration procedures Gloves must be worn when it is likely that hands will be contaminated with blood or body fluids, or come into contact with mucous membranes. Single-use gloves are to be worn for skin penetration procedures. They act as a physical barrier to protect the wearer s hands from contamination and to prevent the transfer of microorganisms. Single-use gloves are not sterile unless labelled as such and sealed. The use of single-use gloves does not substitute, or eliminate the need for hand washing. Hands must be washed thoroughly before putting on gloves and again following glove removal. Washing hands following removal of gloves is required because: Hands become warm and moist in gloves promoting growth of micro-organisms Gloves are not perfect and may have small holes allowing contamination of hands. These holes are not always noticeable Hands can become contaminated during glove removal Washing hands or using a hand rub or gel following removal of gloves will reduce the risk of transmission of bacteria and blood-borne viruses to the client and the operator. Gloves must be removed and disposed of if the operator leaves the client for any reason such as answering the telephone. Hands must be washed and new gloves must be put on before resuming the procedure, or before starting a new procedure on the same person to prevent cross contamination. Gloves must not be washed or re-used. Some people are allergic to latex gloves. If a skin penetration operator develops a rash or skin condition it is recommended that they consult a medical practitioner. Single-use gloves are also available made of other materials eg neoprene or nitrile. Gloves used for cleaning General purpose utility gloves, e.g. rubber gloves should be used for: equipment cleaning decontamination procedures handling chemicals. General purpose utility gloves should be washed in detergent, rinsed and left to dry after each use. Gloves should be inspected before each use and discarded if damaged or in a state not able to provide protection. Hands must be washed after using general purpose gloves. 6. ASEPTIC PROCEDURES Aseptic procedures are designed to prevent the transfer of micro-organisms thereby reducing the risk of infection. Operators undertaking a skin penetration procedure must practice aseptic techniques to avoid contaminating equipment and products therefore minimizing infection. Once a sterilised item has come in contact with something that is not sterile, it also becomes unsterile. That part of the equipment which is used to penetrate the skin must not become contaminated by touching something that is not sterile. Equipment Single-use equipment should be used whenever possible. Hollow needles must be singleuse because they are virtually impossible to clean and sterilise properly Single-use equipment must be discarded immediately after use 13
16 All reusable equipment used for skin penetration must be sterilised and maintained in a sterile condition Use sterilised tongs or forceps to handle sterilised equipment Reusable equipment must be cleaned and reprocessed as soon as practicable after use. Delay will increase the opportunity of micro-organism multiplication and also increase the difficulty of removing the contamination All necessary equipment should be set up just prior to the commencement of a client procedure All equipment set up for use on a client (even if not used), is assumed to be soiled after the procedure and must be discarded or reprocessed before use on another client Sterile needles or other equipment that will penetrate the skin should never be handled directly. A sterile pair of tongs or pliers should be used to pick up or manipulate these sterile items Re-usable needles must be visually inspected for damage and repaired after sterilisation Repaired needles must be re-sterilised before use Needles must not be tested for sharpness on the operator s skin before use. Creams, oils, pigments and lotions Products (creams, oils, pigments and lotions) used in any procedure must be dispensed into a disposable container for each client. Discard the container when the procedure is finished. To prevent contamination do not return left over product to the original stock supply Where exposure to blood or bodily fluids is anticipated during application of these products (i.e. with tattooing, micro pigmentation, waxing) use a suitable disposable spatula, cotton bud or cotton wool pad for each client Where possible, use pump packs for storage of stock material. 7. CLEANING, DISINFECTION & STERILISATION OF EQUIPMENT Cleaning Cleaning is removing soiling and reducing the number of micro-organisms from equipment surfaces by washing in detergent and warm water All equipment must be cleaned between uses in accordance with: AS/NZS 4815:2001 Office-based health care facilities not involved in complex patient procedures and processes Cleaning, disinfecting and sterilising reusable medical and surgical instruments and equipment, and maintenance of the associated environment Thorough cleaning of equipment is essential before any disinfection or sterilisation process Mild alkaline detergents in the ph range 8.0 to 10.8 are preferred over neutral ph detergents in most applications, as they have improved cleaning efficiency. This type of detergent is different from the type of detergent recommended for general environmental cleaning (Refer to Section 9 Environment, Table 3). Common household detergents shall not be used to clean equipment prior to sterilisation because they can produce large amounts of foam and it can be difficult to rinse the items properly Brushes, utility gloves and other items used to clean equipment should be maintained in a clean and serviceable condition Store cleaning items in a clean and dry location. 14
17 The following cleaning method needs to be followed: 1. RINSE the equipment in warm running water to remove any blood or body fluids. Hot water used at this stage will cause matter to coagulate and stick to the instrument. Cold water will harden fats making cleaning more difficult. 2. WASH the equipment in a sink filled with warm water and a mild alkaline detergent to remove all visible soiling (strong alkaline detergents may damage some instruments). Hold the items low in the sink to limit flicking and spatter during scrubbing. Use of a non abrasive scouring pad can assist in removing stains. 3. RINSE the equipment thoroughly in warm to hot running water. 4. DRY using a lint free cloth. Drying with a cloth prevents residues from damaging equipment during sterilisation. 5. STORE under cover in a clean, dry and dust-free environment. Refer to Appendix 1 Cleaning and sterilisation of equipment. Ultrasonic cleaners Ultrasonic cleaners work by subjecting equipment to high frequency, high energy sound waves, causing soil to be dislodged from the item and drop to the bottom of the tank, or be sufficiently loosened, to be removed during the rinsing process: After rinsing the equipment, items are placed in an ultrasonic tank filled with cold water and a measured amount of recommended detergent intended for ultrasonic use. A neutral or low alkaline, low foaming detergent is suitable Process items in accordance with the manufacturer s instructions and AS/NZS 4815:2001 Office-based health care facilities not involved in complex patient procedures and processes Cleaning, disinfecting and sterilising reusable medical and surgical instruments and equipment, and maintenance of the associated environment. Disinfection NOTE: Ultrasonic cleaners clean but do not sterilise instruments Disinfection is a process used to reduce the number of harmful micro-organisms but may not necessarily kill all of them This process is not suitable for equipment used in skin penetration activities. Disinfection of surfaces may be necessary in certain circumstances Refer to Section 9 Environment. Sterilisation Sterilisation is the process of killing all micro-organisms including spores All equipment used to penetrate the skin must be sterilised. Equipment can either be presterilised single-use or, where equipment is re-used, it must be cleaned and sterilised. The method of sterilisation available to the skin penetration industry is steam under pressure. A steam steriliser (autoclave) is required for this purpose. There are a number of different types of steam sterilisers available, and each have differing requirements relating to monitoring and validation of the sterilisation process. It may be more cost effective for small operators to subcontract out their equipment sterilisation. Some contractors provide a pick-up and delivery service in the metropolitan area with a 24-hour turn around. 15
18 NOTE: Microwave ovens, pressure cookers, incubators, ultraviolet cabinets, boiling water units, ultrasonic cleaners and similar appliances will not sterilise. Wiping needles/spatulas with disinfectant before use does not sterilise the item. All staff conducting skin penetration procedures should be trained in the correct use of sterilisation equipment and the correct sterilisation procedures. The Queen Elizabeth Hospital Central Sterilising Service Department has established the Sterilising Foundation Course and this course is open to anybody wishing to gain information on the sterilisation process. Portable bench top steam sterilisers (autoclaves) Portable steam sterilisers must be operated in accordance with the requirements of AS 2182:1998 Sterilisers- Steam - Benchtop Portable steam sterilisers are not designed to sterilise liquids, therefore sterilisation of liquids should not be attempted Portable steam sterilisers with a drying cycle are appropriate for the sterilisation of wrapped items. These sterilisers achieve drying by drawing a partial vacuum and by the introduction of heat, following the sterilisation cycle Upon completion of the sterilisation and drying process, the items need to be immediately removed from the steriliser and checked for dryness. If moist, items are susceptible to contamination and are therefore not considered sterile Sterilisers without a drying cycle should only be used for unwrapped equipment Packaging and wrapping of equipment must be in accordance with AS/NZS 4815:2001 Office-based health care facilities not involved in complex patient procedures and processes cleaning, disinfection and sterilisation of re-usable medical and surgical instruments and equipment and maintenance of the associated environment Equipment that has been sterilised unwrapped must be used immediately on removal from the steriliser Correct loading of the steriliser is essential for successful sterilisation: - flexible packaging materials should be loaded on edge with paper to laminate or flat with the paper surface downwards - items should not touch the chamber walls - unwrapped items should be placed on a perforated or mesh tray and placed flat to ensure steam has access to all surfaces. Monitoring, calibration and performance testing of sterilisers: - a skilled person should carry out routine calibration checks and maintenance of all measuring devices, timers, gauges and displays. Refer to AS/NZS 4815:2001 Officebased health care facilities not involved in complex patient procedures and processes Cleaning, disinfecting and sterilising reusable medical and surgical instruments and equipment, and maintenance of the associated environment for the frequency of calibration checks and steriliser performance tests. TABLE 1: Times and temperatures for steam sterilisation C kpa mb psi Holding Time (mins) Reference: AS 4815 The times and temperatures given in Table 1 for heat sterilisation indicate the absolute minimum standards of time and temperature to be maintained throughout all portions of a load 16
19 in direct contact with saturated steam in order to accomplish effective sterilisation. All times and temperatures are based on the assumption that the items to be sterilised are thoroughly cleaned and dried. Record keeping of sterilisation When sterilising any piece of equipment for a skin penetration procedure, documentation of the process must be recorded (eg. in a log book) and available for inspection by an Authorised Officer. Where an autoclave is used to sterilise equipment on site the following information must be recorded at the completion of each batch processed: Time and date The length of time held at maximum pressure and temperature Maximum pressure and temperature achieved. It is recommended that any faults with the cycle be noted and recorded and those items be processed again. The autoclave may also need servicing or calibrating. Level of reprocessing Equipment must be reprocessed to a level appropriate for their intended use, regardless of the level of use they have had previously, or the level of contamination they have had. This can be assessed by using the categories in Table 2. TABLE 2: Level of processing required for specific items Level of risk Intended use Example Process Storage High For equipment that will penetrate the skin, enter into a sterile cavity or blood stream Needles Jewellery Sterilisation by steam steriliser Store in packages that maintain sterility, do not tear, and are kept dry and free of dust Medium For equipment that will come into contact with mucosa or non intact skin Pennington forceps (for clamping nostrils, navels, etc) Sterilisation by steam steriliser Store in packages that maintain sterility, do not tear, and are kept dry and free of dust Low For equipment that will come in contact with intact skin Nail clippers Spatula Clean with detergent and water Store in clean, dry dust free environment Ultraviolet cabinets Ultraviolet (UV) cabinets DO NOT STERILISE equipment and other articles placed in them because the radiation does not penetrate to all surfaces of the articles exposed and some viruses are not readily destroyed by UV radiation. Because of occupational health and safety concerns about the risk of eye damage to the operators, workers or clients from UV cabinets, it is recommended that they should not be used. 17
20 8. SKIN PREPARATION The client s skin should be clean and free from infection, sores or wounds. Skin penetration should not be carried out within 15 centimetres of any skin infection or rash unless a qualified acupuncturist or health care professional that is treating the area performs the procedure If shaving of the penetration site is necessary, a single unit disposable razor is recommended. Where razor blades have a detachable blade, the blade must be disposed of in a sharps container after each use. The blade handle must then be washed with water and detergent to remove contaminants and dried before reuse. A new single use razor blade can then be attached to the handle If the positioning of a piercing site is to be marked, this should be done prior to disinfection of the skin. Markers are available that are not removed by alcohol or chlorhexidine. An alternative is to prepare the skin and mark the point with a toothpick dipped in Gentian Violet, followed by disinfection with an iodine swab A skin disinfectant (antiseptic) should be applied to the area of skin that is to be penetrated immediately prior to the procedure The site must be allowed to dry before the skin is penetrated and should not be touched by the operator's hands or any other item that may contaminate it. Skin disinfectants (antiseptics) An antiseptic is a substance that is recommended by its manufacturer for application to the skin or mucous membrane of a person to kill micro-organisms, or to prevent the growth of microorganisms to a level that may cause infection: Skin disinfectants should always be used according to the manufacturer s instructions Bottled skin disinfectants: - should be labelled with the date when first opened and discarded after its designated use by date as indicated by the manufacturer s label - before use, sufficient skin disinfectant for an individual client s use should be poured into a single-use container. The container and any fluid remaining in the container should be discarded at the end of the client s procedure - check the label for the specific contact time of each skin disinfectant (time required before commencing the procedure after application of the skin disinfectant). Particular note should be taken of the flammability of the product in relation to the setting in which it is to be used Alcohol or chlorhexidine wipes may also be used. There is a wide range of skin disinfectants available. The following preparations may be used for preparation of the client s skin, but the choice should be appropriate to the nature and site of the procedure: Chlorhexidine in aqueous formulations (0.5 to 4% w/v) or in alcoholic formulations with chlorhexidine (0.5 to 1% w/v) in 60-70% isopropanol or ethanol 70-80% w/w ethanol 60-70% v/v isopropanol 10% w/v aqueous or alcoholic povidone-iodine (1% w/v available iodine) however this does stain the skin solutions containing 1% w/v diphenyl ether (triclosan). 18
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text:
Friday 31st August at 8.00pm
(pre-show supper at 7:00pm)
GEOFF SIMKINS with MIKE OUTRAM
and The NIKKI ILES Trio
Tickets £17 (£32 including pre-show supper) can be booked on 01460 54973
Here's a quintet chock full of top talent. Geoff was here early last year with Dave O'Higgins and he greatly impressed us with his fluently lyrical alto playing. Nikki has never been to Ilminster which is something for which we have no sensible explanation. She always features in the UK awards and got the top vote last year, so we are delighted to welcome her here with bassist Dave Green and drummer Steve Brown. Mike, also a newcomer to us, teaches at the Royal Academy and Guildhall music schools, and has a reputation as one of the top favourites among UK guitarists.
They will be playing a mixed programme of mainstream/modern jazz of the style best suited to our regular Meeting House audience.
Geoff Simkins has been playing jazz since his early teens originally as a drummer but quickly switching to Alto Saxophone. As a professional musician since 1977, he has played at concerts, clubs and festivals in all parts of the U.K. and has worked abroad extensively in Europe, Scandinavia, West Africa, Bahrein, Dubai, and the Far East. Recordings include albums with his own quartet, two L.P's with Danny Moss (which were voted among the top records of the year by Jazz Journal), albums with Billy Butterfield and Yank Lawson, and most recently with Dave Cliff including the much praised C.D's 'The Music of Tadd Dameron' released in 1997 and the marvellous duo and quartet recording of the previous year - 'Sipping at Bells '.
Geoff has appeared many times on B.B.C. Radio's Jazz Club and Jazz Parade and was the subject of a television documentary made by T.V.S. Geoff leads his own quartet featuring Nikki Iles, Simon Woolf and Martin France, works as often as possible with Dave Cliff in a variety of settings from duo to quintet, and is increasingly in demand as a guest at jazz clubs and festivals throughout the U.K. He often works with American musicians who are visiting this country and over the years has played with such luminaries as Art Farmer, Bobby Shew, Al Cohn, Tal Farlow, Slide Hampton, Warren Vache, Al Grey, Kenny Davern, Bill Berry, Al Casey, Howard Alden, Ruby Braff, Bill Coleman and Conte Candoli. Geoff is a respected teacher and as well as running a very successful improvisation course at Sussex University, he is a regular tutor at the famous Glamorgan Summer School. In 1994 he was invited to be a tutor at the Czech Jazz Summer School and appeared at clubs in Prague and on Czech Television. Geoff has also been involved in many of the Jazz In Education projects which have brought live music to schools throughout the South and Midlands.
Over the last few years, Bedfordshire born Nikki Iles has progressed into the front rank of British jazz musicians. From a musical family, she first became aware of jazz through her father's record collection, and began playing the harmonica and clarinet at her primary school. At eleven she won a Junior Exhibitioner's Scholarship to the Royal Academy of Music, studying piano and clarinet, and was soon a member of the Bedfordshire Youth Jazz Orchestra. It was at this time that the piano took over as Nikki's principal instrument.
During this period her involvement with jazz was deepening, prompting the decision to study at The Leeds College of Music between 1981-84 and eventually she settled in Yorkshire before finally moving back to London in September 1998.
The first platform for her own composing was the group Emanon, led by trumpeter Richard Iles, which also included the guitarist Mike Walker and saxophonist Iain Dixon. The meeting of these kindred spirits at this time was extremely significant for all of them. In addition to Emanon, they were all members of the Creative Jazz Orchestra, working with Vince Mendoza, Anthony Braxton, Mike Gibbs, Kenny Wheeler and Mark Anthony Turnage. Nikki also began playing with several London based bands including the Steve Arguelles group, Mick Hutton's Straight Face, Stan Sulzmann's Quartet and Tina May. Throughout this time up north Nikki also maintained an important musical relationship with the bass-player Steve Berry which beginning as a trio with Sheffield drummer, Pete Fairclough.
In 1996, Nikki won the John Dankworth Special Award at the BT British Jazz Awards and that same year recorded a duo CD, Treasure Trove, with Stan Sulzmann. A year later, she recorded a duo CD with Tina May, Change of Sky, and a CD with Martin Speake, The Tan Tien. These CDs were the beginning of three important ongoing musical relationships. Many nominations followed , four for the prestigious Paul Hamlyn Composition Award , two nominations for the Best Ensemble (The Printmakers) and over the last six years has been voted in the top five for the Jazz Piano category of the British Jazz Awards coming first last year.
Astonishingly, Nikki's busy performance schedule has not prevented her from developing a parallel career as a widely respected teacher and she has acted as a tutor at numerous workshops and summer schools around the world whilst maintaining active links with The Royal Academy of Music and Middlesex University. Her tireless education work was recognised through her nominations at the 2007 and 2009 Parliamentary Jazz Awards for Services to Jazz education.
Mike Outram is one of the UK's foremost guitarists who is sought after as an improviser and for his ability to contribute a unique voice to any musical ensemble. He has toured internationally, appeared on over a hundred CDs for Universal, Sony, Candid, Blue Note records and others.
He has a vast experience of working in varied, challenging and interesting settings. Some highlights include: A televised Prom from The Royal Albert Hall with The Aurora Orchestra, a 200-piece children's choir and the cast of the TV show Horrible Histories; coaching and recording with Vanessa Redgrave for the upcoming film 'Song for Marion'; international concerts with Chick Corea saxophonist Tim Garland; recording for Steven Wilson on his Insurgentes album alongside Jordan Rudess, Tony Levin and Gavin Harrison; playing classical guitar with string quartet to film at the Sao Paulo Film Festival, Brazil; recording with Danish drummer and composer Sebastiaan Cornellisen and John McLaughlin bassist Hadrian Feraud; recording Laura Rossi's film soundtrack to 'The Firm'; playing swanee whistle in a tribute to Clangers creator Oliver Postgate; playing on Theo Travis's ambient/progressive rock album with Robert Fripp and subsequent UK tour; a European tour with soul-funk legend Carleen Anderson; a completely improvised recording with bass-player Steve Lawson; concerts in South Africa with Herbie Mann; sessions with Photek and the Cinematic Orchestra, producing a comedy geek-metal band - The Banzai Buddy Band; a tour of Japan with TALC; performances and workshops all over the UK with Children's Poet Laureate Michael Rosen and The Homemade Orchestra, and recording Harvey Brough's large-scale work Requiem with Clare College Choir.
He works regularly in these UK based ensembles: Martin Speake Group, which explores contemporary jazz, Indian carnatic-influenced music and free improvised music; Asaf Sirkis' Messiaen-meets-Prog group; Issie Barratt's contemporary Big Band; Pop/country singer-songwriter Rebecca Hollweg; The Tony Woods Project, Gareth Lockrane, Dylan Howe, Tim Whitehead, Karen Street, Jacqui Dankworth, Dave O'Higgins, London Horns.
In addition to performing, Mike is a professor at the Academy. He has also taught at Middlesex University, London College of Music, The Royal Welsh College of Music and Drama, The Purcell School, and The Guildhall School of Music and Drama. He is on the faculty for the Jamey Aebersold Summer School in the UK, and has directed group workshops on improvisation, performance and composition, as well as numerous guitar-specific workshops and clinics internationally. He also penned a monthly tuition column in Guitarist Magazine for 3 years.
LICENSED BAR serving a range of wines, bottled beers and soft drinks.
PRE- SHOW SUPPER (must be booked at least 2 days before the concert).
Tonight's Menu: Cheek and Leek Gratin served with Seasonal Vegetables; Dessert; Coffee
Vegetarian option available. Please ring the Arts Centre on 01460 54973 at least 2 days before the concert

subset: commoncrawl


text:
ISH x MAHDI
My business partner and I are a dynamic duo. I'm the creative right brain, and he's the analytical left brain. Together, we provide marketing, branding, and design services to small and mid sized businesses. We do everything from strategy to execution and implementation.
THE ABCs OF MARKETING
Mahdi and I co-created an e-book covering the fundamental principles of marketing. It is the first in a series of business related e-books to come, and it's on sale now.
My editorial work has been published in a range of fashion publications, and I've created ads and promotional images for numerous companies. In addition to my commercial work, I've been hired by countless individuals and families to capture precious life moments. I'm available for: advertising, editorial, wedding, headshot, modeling, real estate, corporate, and event photography.
If you're interested in hiring me for a project, please fill out the form below.


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This cartoon shows two wheelchair users. One of them is a young white boy and also the other is a young black boy. The black boy is cringing as he is being patted on the head by a great white woman in a fur coat, fur hat and accessories. He is saying to his friend: I don't know whether I'm being patronized for being black or Disabled?!
Thursday, January 21, 2010
Two young men's patronized
Posted by clementina at 4:19 AM
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Re: Anthony s/o Anthony Agee
In reply to:
Anthony s/o Anthony Agee
Peggie Patton 1/05/02
Peggy, I just read your various postings, re the Smith Co. Agee line. A cousin recently discovered (re my posting 3/02/01) while researching Sarah Catherine Agee, born 1842 in Tennessee, that there is an 8 yr old Sarah listed in Smith County on the 1850 census--living with siblings and their mother. So far my cousin hasn't found info re Sarah's parents.
Have you run across this Sarah in your research? I am not yet a paid member on any of the search sites as I've been unable to devote enough steady research to justify membership--so have been surfing all the free info from time to time. For the time being, I am going to check out a name in one of your postings---"son of Daniel, Jonathan, b 30 Dec. 1788, d 5 April 1857, m. Sarah Williams, buried in Smith Co and see if that line turns up Sarah C. Agee.
Thanks for any help.I can be emailed at firstname.lastname@example.com


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CANALETTO ANTONIO CANAL Biography and Painting
Canaletto o, real name Giovanni Antonio Canal (1697-1768), Italian painter, known for his sparkling views of Venice.
Canaletto's technique had the traditional Venetian hallmarks of luminous light and glowing color, to which he added a Dutch-influenced attention to clear and accurate detail. His early works often feature dark, saturated colors that depict a moist, palpable atmosphere under a stormy or dark sky. Later works—after 1740, when Canaletto began to develop a somewhat looser, less precise style of brushwork—often portray bright sunlit scenes with rich colors highlighted by red and gold. He went to England in 1746 after the War of the Austrian Succession had drastically curtailed the stream of English visitors to Venice. He painted many scenes of English landscapes and country houses before returning to Venice in 1755. Canaletto was elected to the Venice Academy in 1763, but the paintings of his later years were increasingly criticized for their facile manner and mechanical repetition of overly familiar themes. The atmospheric quality of his best works was an important influence on 19th-century landscape painting.


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Maybelline Express Remover is the second nail polish remover of this kind I've ever used. This jar contains a sponge soaked in remover liquid, you dip your finger in it, rub it against the sponge a couple of times and it comes out clean.
The thing is that this works perfectly for some time, but the remover inside gets polish tinted very quickly and stains fingers while removing the polish.
I like the ease of using this kind of remover. The first one I bought was by Bourjois and it was just as good, but about twice more expensive, so the choice is obvious. I'm going to keep purchasing the Express Remover until I find something cheaper.
I recommend this kind of nail polish remover for lazy people in a hurry who do not mind the expect connected with replacing it at least once a month.
Disclaimer: I bought the product myself for my personal use and I am not affiliated with any company. I am not paid to do this review and everything I said here is my genuine opinion.


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"A No. 1" is Leon Ray Livingston (1872-1944) one of the most famous hobos who ever lived. He wrote and self-published many books on hobo culture and train travel.
He is the author of The Mother of the Hoboes, Coast to Coast with Jack London, Hobo Camp Fire Tales, The Ways of the Hobo, The Adventures of a Female Tramp, The Curse of Tramp Life, The Snare of the Road and The Trail of the Tramp.
Daniel J. Blackburn has been a journalist most of his professional life -- with brief forays into the bowels of government (for educational purposes only) where he spent time as an executive in California's water industry; a lobbyist; and a legislative aide. He's also an author; co-founder of a daily news website in California, CalCoastNews.com; and a fairly competent videographer. He's dad to three sons, Patrick, Alan, and Joey, and lives with his wife Maria amid SOME of the world's great producers of fine wines.
He is the author of Human Harvest: The Sacramento Murder Story.
Mykel Board has written dozens of freelance articles and seventeen novels under pseudonyms. Maximum Rock'n'Roll has been printing his column for more than 20 years. I, A Me-ist, a book of those columns, is scheduled for publication in 2005. His essays have appeared in several anthologies including Bisexual Politics, Hayworth Press 1995 and Good Advice for Young People, Last Gasp Press, 2005.
He is the author of Even a Daughter is Better Than Nothing.
Emmett Dedmon was vice-president and editorial director of the Chicago Sun-Times and Chicago Daily News. He authored six books.
He is the author of Fabulous Chicago.
Hugh Downs, longtime anchor of ABC Television's primetime news magazine 20/20, is one of the most familiar figures in the history of the medium. He left the program and regular broadcasting in September of 1999 to write and lecture and to pursue other activities: travel, flying, science studies, riding, sailing, composing. Downs has enjoyed a distinguished 66-year career in radio and television as a reporter, newscaster, interviewer, narrator and host. In 1985 he was certified by the Guinness Book of World Records as holding the record for the greatest number of hours on network commercial television. In the course of his career he has broadcast from every continent and both poles.
He is the author of Yours Truly, Hugh Downs.
Common Folk started off as the name for a small collective of graffiti artists but soon evolved into a philosophy for everyday life and everyday people. It's an ideology that binds together all people that approach life in creative ways, breeding a common folk atmosphere of inspiration amongst artists, writers, painters, graffiti writers, journalists, photographers, odd thinkers, d.i.y.'ers, doodlers, etc. It's about igniting a thought or sparking a smile on common people, just trying to disrupt the monotony of the all too common daily grind.
Common Folk are the creators of Common Folk Illustrated Journal.
Alison Fensterstock is a New Orleans-based music journalist. Her work has appeared in Paste, MOJO, Q, the Oxford American, Vibe, The (New Orleans) Times-Picayune and Spin.com.
She is the co-author of The Definition of Bounce.
Brandon Gentry was born in Charlottesville, Virginia and raised in nearby Rochelle. Having lived in D.C. for nearly a decade, he now lives in Austin, Texas, with his wife and two small children.
Capitol Contingency: Post-Punk, Indie Rock, and Noise Pop in Washington, D.C., 1991-1999 is his first book.
Syndicated columnist Georgie Anne Geyer is the author of several books on Latin America, Russia and the Middle East. She is the winner of numerous awards for distinguished journalism. She lives in Washington, DC.
She is the author of Guerrilla Prince: The Untold Story of Fidel Castro, Buying the Night Flight: The Autobiography of a Woman Foreign Correspondent and Americans No More: the Death of Citizenship.
Guy Gugliotta is a former national reporter for The Washington Post and foreign correspondent for The Miami Herald. He is currently based in New York, where he writes about science, history and Latin America for magazines and newspapers, among them Smithsonian, Wired, Discover and The New York Times. He is the author of Freedom's Cap, the Building of the U.S. Capitol and the Coming of the Civil War.
He is the coauthor of Kings of Cocaine: Inside the Medellin Cartel -- An Astonishing True Story of Murder, Money, and International Corruption.
A legendary magazine entrepreneur, T. George Harris turned Psychology Today from a wobbly startup into a publication widely recognized as the lifestyle magazine of the '70s. Later he launched American Health, which became the Bible of the health movement in '80s. He served as Washington correspondent for Time and as Time-Life-Fortune bureau chief in Atlanta, Chicago and San Francisco.
He is the author of Romney's Way: A Man and an Idea.
Richard A. Hawley is a lifelong teacher and writer. For nearly four decades he taught English, philosophy, and history and at Cleveland's University School. For seventeen years, until his retirement, he served as the school's Headmaster. He has published twenty five books, including several novels, selections of poetry, an opera libretto, and a number of non-fiction books, principally about children and schools. He lives in Ripton, Vermont, with his wife the painter and fabric artist Mary Hawley.
He is the author of The Headmaster's Papers.
Robert Helms has been volunteering the use of his healthy body for medical experiments since 1995. He is a self-taught historian who has worked as a house painter, a factory hand, a helper of mentally retarded adults, and a union organizer. As editor and publisher of the zine Guinea Pig Zero, he has appeared in the national media as a voice for human research subjects. In 1997 he was sued for his criticisms of a research unit near his home in Philadelphia. Helms also writes about the early anarchist movement of that city.
He is the editor/author of
Peter Hernon lives near Chicago with his wife, Janice, and two daughters. An editor for the Chicago Tribune, he has written five books and was co-author of a bestselling look at the Anheuser-Busch dynasty: Under the Influence. He worked as a journalist in New Orleans.
Hernon is the author of A Terrible Thunder: The Story of the New Orleans Sniper and 8.4.
Mickey Hess taught part-time for several universities in Kentucky and Indiana before moving to his current position as Assistant Professor of English at Rider University. His books include The Nostalgia Echo, Icons of Hip Hop: An Encyclopedia of the Music, Movement, and Culture (Greenwood, 2007), and Is Hip Hop Dead? The Past, Present, and Future of America's Most Wanted Music (Praeger, 2007). His writing has appeared in Ninth Letter, Punk Planet, and Created in Darkness by Troubled Americans: Best of McSweeney's Humor Category. He lives in Philadelphia. Follow @mickeyhess
Hess is the author of Big Wheel at the Cracker Factory.
Abram Shalom Himelstein is the co-founder of New Mouth from the Dirty South and author of the underground hit, Tales of a Punk Rock Nothing. In 2003, Himelstein published What the Hell Am I Doing Here? The 100 T-Shirt Project with Garrett County Press.
Himelstein is also co-founder of the Neighborhood Story Project, a community documentary program in New Orleans, Louisiana.
Marlon Buck Horton is responsible for hits such as "Drop and Gimmie 50," and "Faster." He is co-owner of Finger Lick'N Wings.
He is the author of The Definition of Bounce.
Lucky Johnson is CEO of Biggface Muzik and Lucky Johnson Productions. He will be appearing in the movie "Contraband." He is co-owner of Finger Lick'N Wings.
He is the co-author of The Definition of Bounce.
Jeff Kelly is a native of the Lehigh Valley in Pennsylvania and currently resides in Madison, Wisconsin. The editor of Temp Slave! Zine, his freelance work has also appeared in Isthmus, FS, In These Times, Alternative Press Review and various other publications. He is currently employed (maybe temporarily) as a process operator in a dairy ingredients plant. That's all you need to know. Thank you very much.
Kelly is the editor of Best of Temp Slave!.
Wayne Klatt has worked as a broadcast editor and reporter for the City News Bureau since 1962. He lives in Chicago.
He is the author of Freed to Kill and I Am Cain.
Gera-Lind Kolarik was a TV journalist for CBS and ABC as well as a crime reporter/investigative reporter with the City News Bureau in Chicago. In 1984, she won an Emmy Award for her coverage of the shooting of Judge Henry Gentile. Kolarik is the founder of Evidence Video. She lives in Chicago.
She is the author of Freed to Kill, I Am Cain, Prisoners of Fear.
Irv Kupcinet (1912-2003) was a top-ranked columnist at the Chicago Sun-Times and the star of the popular TV discussion program, At Random.
He is the author of Kup's Chicago.
Bill Lavender is the proprietor of Lavender Ink press, and author of Guest Chain and Look the Universe is Dreaming.
He is the author of Transfixion.
Jeff Leen is the investigations editor for The Washington Post. As a reporter or an editor, he has worked on investigations have have been honored with seven Pulitzer Prizes. He is also the author of The Queen of the Ring: Sex, Muscles, Diamonds and the Making of an American Legend.
He is the coauthor of Kings of Cocaine: Inside the Medellin Cartel -- An Astonishing True Story of Murder, Money, and International Corruption.
Bill Libby wrote numerous books on sports figures, including Reggie Jackson, Jerry West and Richard Petty. Libby was a sports editor at the Yonkers Herald Statesman and later worked at the New York Post.
He is the author of The Coaches, Parnelli, and Catfish.
Pete May is an author and journalist. Having finally clambered on to the property ladder in 2004 he now lives in north London with his wife, two daughters, a dog named Vulcan and a large collection of football programmes. As a journalist he has contributed to the Guardian, Observer and Independent and numerous other publications. He is an associate lecturer in sports journalism at the London College of Communication. Among his publications are: There's A Hippo In My Cistern, Ageing Body Confused Mind, Hammers in the Heart, West Ham: Irons in the Soul, Football and its Followers, Sunday Muddy Sunday and The Lad Done Bad.
He is the author of Rent Boy: How One Man Spent 20 Years Falling Off the Property Ladder.
Josh Neufeld is a Brooklyn-based cartoonist who works primarily in the realm of nonfiction comics. He is the writer/artist of the Eisner and Harvey Award-nominated A.D.: New Orleans After the Deluge, and the Xeric Award-winning graphic travelogue A Few Perfect Hours (and Other Stories from Southeast Asia & Central Europe). He is the illustrator of the New York Times bestseller The Influencing Machine: Brook Gladstone On the Media. He was also a longtime artist for Harvey Pekar's American Splendor, and his art has been exhibited in gallery and museum shows in the United States and Europe.
He is the coauthor of Titans of Finance.
Alan Pistorius is a writer and naturalist living in Leicester, Vermont. He received his A.B. from the State University of Iowa and his M.A. and Ph.D. from the University of California, Berkeley. He is the author of The Country Journal Book of Birding and Bird Attraction, co-author of several books, and co-editor of Treasury of North American Birdlore. He is also the author of numerous magazine articles and reviews.
He is the author of Cutting Hill.
Lawrence N. Powell is professor of history at Tulane University, where he has taught since 1978. His specialties are the Civil War and Reconstruction; Southern history; Louisiana history and politics; and the Holocaust. Among his publications are Troubled Memory: Anne Levy, the Holocaust, and David Duke's Louisiana and <New Masters: Northern Planters During the Civil War and Reconstruction.
Professor Powell wrote the introduction to the New Orleans City Guide.
Harvey Rachlin is the award-winning author of thirteen books. He has written for the New York Times and numerous other publications.
He is the author of Lucy's Bones, Sacred Stones & Einstein's Brain and Jumbo's Hide, Elvis's Ride, and the Tooth of Buddha.
Jamie Schweser is the co-author of Tales of a Punk Rock Nothing.
Vaclav Smil is the author of over 20 books and is currently a Distinguished Professor in the Faculty of Environment at the University of Manitoba in Winnipeg, Canada. A Fellow of the Royal Society of Canada (Science Academy) and the first non-American to receive the American Association for the Advancement of Science Award for Public Understanding of Science and Technology, he has been an invited speaker in more than 250 conferences and workshops in the USA, Canada, Europe, Asia and Africa.
He is the author of Oil: Resources, production, uses, impacts.
Richard Martin Stern (1915-2001) is the author of Brood of Eagles and the Johnny Oritz mystery series. The Bright Road to Fear won the 1959 Edgar Award for Best First Novel. He passed away on October 31, 2001 in Santa Fe, NM.
He is the author of Murder in the Walls.
Philip Van Doren Stern (1900-1984) was a Civil War historian, editor and author. His story, "The Greatest Gift," formed the basis for the classic film, "It's A Wonderful Life."
He is the author of Secret Missions of the Civil War.
Kevin Stone graduated with honors from Pratt Institute in 1994. He has been published in numerous periodicals and books. He runs the blog Good Design Is Good.
He is the illustrator of the Christian Conservative Coloring Book and Flatland.
Rob Walker was born in Houston, Texas. He has a B.S. in Radio-Television-Film, Critical-Cultural Studies Sequence at the University of Texas -- Austin. He has held miscellaneous reporting jobs in Texas and New York, and worked as an editor for American Lawyer, Money, and The New York Times Magazine. In 1999 he quit all that, moved to New Orleans and became a freelancer. Walker also has written for Slate, The New Republic, The Wall Street Journal, The Washington Post, GQ, Details, The Nation, Fortune, and many others.
Walker is a contributing writer to The New York Times Magazine, a regular contributor to Design Observer and author of Buying In: The Secret Dialogue Between What We Buy and Who We Are (Random House).
He is the author of Letters From New Orleans and coauthor of Titans of Finance.
828 Royal St. #298
New Orleans, LA 70116
phone: 267.760.1648
Thank you for visiting.


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- Recruitment
- Specialty Recruitment
- General Practice Recruitment
- Foundation Recruitment
- ACF Recruitment
- Dental Training Recruitment
- Recruitment Support
At Health Education England, we are focussed on your future by working in partnership with our health providers to make sure you get the highest quality education and training throughout the East Midlands, whether you are interested in training in general practice, secondary care or public health.
If you need to contact a member of the Medical Recruitment Team please email firstname.lastname@example.com, or call 0300 303 3603
Good Luck! East Midlands Recruitment Team
The recruitment round for posts commencing in August 2019 begins in November 2018. Please visit the Faculty of Public Health Website for full recruitment information The recruitment timeline for 2019 is expected to be as follows:
If you have specific queries about the programmes, please contact the Training Programme Director (TPD) in your area or in the area in which you wish to train.
For a list of frequently asked questions, please click here.


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Erweiterte Wartungsarbeiten und Patch 1.0.6a
In der kommenden Nacht finden erweiterte Wartungsarbeiten auf dem Diablo 3 Server statt. Im Zuge der Wartungsarbeiten spielt Blizzard auch den Mini-Patch 1.0.6a auf. Der Patch behebt lediglich einen kleinen Fehler für Spieler der Starter Edition von Diablo 3.
Lylirra on Scheduled Maintenance - December 11 (Source)
We will be performing scheduled maintenance for Diablo III starting tomorrow (12/11) at 1:00 a.m. PST in order to deploy our 1.0.6a fastpatch. We anticipate that maintenance will conclude and that all services will be available by approximately 11:00 a.m. PST.
Important: Please note that you will not be prompted to download patch 1.0.6a until the patch is live in your home region. If you are logging in from a European or Asian client, you will need to wait for this patch to release in that region before it can be installed. Additionally, if your home region is the Americas, you will be unable to log into Europe or Asia using Global Play after patch 1.0.6a is live until those regions have also patched.
For reference, here are the scheduled maintenance times for each region:
- The Americas: 1:00 a.m. PST to 11:00 a.m. PST
- Asia: 12:00 p.m. PST to 2:00 p.m. PST
- Europe: 8:00 p.m. PST to 10:00 p.m. PST
Please note that these times are estimated and subject to change. For time zone assistance, please visit: http://everytimezone.com
Die Patchnotes für Patch 1.0.6a sehen wie folgt aus:
Lylirra on Scheduled Maintenance - December 11 (Source)
Diablo III Patch 1.0.6a – v.22.214.171.12485
Bug Fixes
- Fixed an issue that could occur when attempting to upgrade from the Diablo III Starter Edition.