Introduction to the N.C. Department of Labor OSH Division

Introduction to the N.C. Department of Labor OSH Division

Occupational Exposure to Bloodborne Pathogens 29 CFR 1910.1030 Presented by: ETTA, OSH Division, 919-807-2875 This presentation was created by the N.C. Department of Labor for safety and health training. Objectives 1910.1030 Provide an overview of the Bloodborne Pathogens Standard

Highlight OSHAs requirements regarding bloodborne pathogens, including needlestick safety provisions Mancomm This presentation was created by the N.C. Department of Labor for safety and health training. Scope and Application 1910.1030(a) Bloodborne Pathogens Standard applies to all

employees with occupational exposure to blood and other potentially infectious materials Occupational Exposure This presentation was created by the N.C. Department of Labor for safety and health training. Scope 1910.1030(a) The standard covers many types of occupations including those in: - Healthcare facilities

- Non-healthcare facilities - Permanent and temporary worksites This presentation was created by the N.C. Department of Labor for safety and health training. Temporary Operations Trauma or rescue scene Mobile blood banks Crime scenes Collateral duties This presentation was created by the N.C. Department of Labor for safety and health training. Multi-Employer Worksites

Employment agencies Personnel services Home health services Independent contractors Independent practices This presentation was created by the N.C. Department of Labor for safety and health training. Employees Potentially At Risk Physicians and surgeons Nurses Clinical/diagnostic laboratory workers

Phlebotomists Medical technologists Medical examiners Nursing home personnel Dentists and dental Dialysis personnel workers Some laundry and

housekeeping employees This presentation was created by the N.C. Department of Labor for safety and health training. North Carolina Specific Rule 13 NCAC 07F .0207 Toxic and Hazardous Substances - "Occupational Exposure means reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of collateral first aid duties by an employee in the areas of construction, alteration, or repair, including painting and decorating

This presentation was created by the N.C. Department of Labor for safety and health training. Standard Specific Definitions 1910.1030(b) Blood Bloodborne pathogens Other potentially infectious materials (OPIM) Contaminated Occupational exposure Exposure incident Regulated waste Sharps with engineered sharps injury protections

(SESIP) Needleless system This presentation was created by the N.C. Department of Labor for safety and health training. Blood 1910.1030(b) Human blood Human blood components Products made from human blood

This presentation was created by the N.C. Department of Labor for safety and health training. Bloodborne Pathogens 1910.1030(b) Pathogenic organisms that are present in human blood, and - Can cause disease in humans Includes but not limited to: - Hepatitis B virus (HBV) - Hepatitis C virus (HCV) - Human immunodeficiency virus (HIV)

This presentation was created by the N.C. Department of Labor for safety and health training. Hepatitis 1910.1030(b) Inflammation of the liver, which may be caused by a viral infection, poisons, or the use of alcohol or other drugs Types of viral hepatitis - Hepatitis A, B, C, D, E, G Outcomes range from acute flu-like illness to jaundice,

extreme fatigue and nausea to advanced hospitalization to death Types of viral bloodborne hepatitis - Hepatitis B, C, D, G This presentation was created by the N.C. Department of Labor for safety and health training. Human Immunodeficiency Virus 1910.1030(b) HIV causes Acquired Immune Deficiency

Syndrome (AIDS) AIDS is a serious condition that affects the body's immune system; the body's natural ability to fight infection This presentation was created by the N.C. Department of Labor for safety and health training. Other Bloodborne Pathogens Malaria Arboviral infections Syphilis

Relapsing fever Babesiosis Creutzfeld-Jakob Disease Brucellosis Human T-Lymphotrophic Virus Leptospirosis Type 1 and 2 Viral hemorrhagic fevers (VHF) This presentation was created by the N.C. Department of

Labor for safety and health training. OPIM 1910.1030(b) Other Potentially Infectious Materials - Any body fluid visibly contaminated with - Semen blood - Vaginal secretions - All body fluids in situations where it is - Cerebrospinal fluid difficult or impossible to differentiate - Synovial fluid between body fluids

- Pleural fluid - Pericardial fluid - Peritoneal fluid - Amniotic fluid - Saliva in dental procedures This presentation was created by the N.C. Department of Labor for safety and health training. Contaminated 1910.1030(b) Presence or the reasonably anticipated presence of blood or other potentially infectious material on an item or surface

This presentation was created by the N.C. Department of Labor for safety and health training. Occupational Exposure 1910.1030(b) Reasonably anticipated contact with blood or OPIM - May result from the performance of an employees duties - Occurs by non-intact skin, eye, mucous membrane, or parenteral contact

This presentation was created by the N.C. Department of Labor for safety and health training. Exposure Incident 1910.1030(b) A specific contact with: - Blood or OPIM - Results from the performance of an employees duties - Contact with: Eye, mouth, or other mucous membrane Non-intact skin Parenteral contact

This presentation was created by the N.C. Department of Labor for safety and health training. Regulated Waste Items contaminated with blood or OPIM which would release these substances in a liquid or semi-liquid state if compressed Pathological and microbiological wastes containing blood or OPIM 1910.1030(b)

Items caked with dried blood or OPIM and capable of releasing these materials during handling Liquid or semi-liquid blood or OPIM Contaminated sharps This presentation was created by the N.C. Department of Labor for safety and health training. SESIP

1910.1030(b) Sharps with Engineered Sharps Injury Protections Non-needle sharp or a needle with a built-in safety feature or mechanism that effectively reduces the risk of an exposure incident This presentation was created by the N.C. Department of Labor for safety and health training. Infusion Therapy Examples This presentation was created by the N.C. Department of

Labor for safety and health training. Hypodermic Syringes Retractable Technology safety feature This presentation was created by the N.C. Department of Labor for safety and health training. Phlebotomy This presentation was created by the N.C. Department of Labor for safety and health training. Lancets Safety Lancets

NCDOL Photo Library This presentation was created by the N.C. Department of Labor for safety and health training. Disposable Scalpels Safety features This presentation was created by the N.C. Department of Labor for safety and health training. Needleless Systems 1910.1030(b)

Most direct method of preventing needle-stick injuries Device that does not use a needle for: - Collection of bodily fluids - Administration of medication/fluids - Any other procedure with potential percutaneous exposure to a contaminated sharp This presentation was created by the N.C. Department of Labor for safety and health training. Exposure Control Plan (ECP) 1910.1030(c)

NCDOL Photo Library This presentation was created by the N.C. Department of Labor for safety and health training. Exposure Control Plan 1910.1030(c)(1)(ii) Written plan designed to eliminate or minimize employee exposure that contains: - Exposure determination - Schedule and method of implementing paragraphs

(d) through (h) of the standard - Procedures for evaluating circumstances surrounding an exposure incident This presentation was created by the N.C. Department of Labor for safety and health training. Exposure Control Plan 1910.1030(c)(1)(iii)-(vi) Must be accessible to employees Reviewed and updated annually or more often if changes occur Available to OSHA and NIOSH

representatives This presentation was created by the N.C. Department of Labor for safety and health training. Exposure Control Plan 1910.1030(c)(1)(iii)-(vi) ECP must also be updated to include: - Changes in technology that reduce/eliminate exposure - Annual documentation of consideration and implementation of safer medical devices Solicitation of non-managerial employees

This presentation was created by the N.C. Department of Labor for safety and health training. Exposure Determination 1910.1030(c)(2) Employer required to identify job classifications where occupational exposure can occur: - Job classification in which ALL have occupational exposure - Job classification in which SOME have occupational exposure - List of all tasks and procedures in which occupational

exposure occurs Must be made without regard to the use of personal protective equipment (PPE) This presentation was created by the N.C. Department of Labor for safety and health training. Methods of Compliance 1910.1030(d) General - universal precautions Engineering and work practice controls

Personal protective equipment Housekeeping This presentation was created by the N.C. Department of Labor for safety and health training. Universal Precautions 1910.1030(d)(1) An approach to infection control Originated by the Centers for Disease Control and Prevention (CDC) Concept:

- All human blood and certain human body fluids are to be treated as if known to be infectious for HIV, HBV, or other bloodborne pathogens This presentation was created by the N.C. Department of Labor for safety and health training. Engineering & Work Practice Controls 1910.1030(d)(2) Selection is dependent on the employers exposure determination Employer must:

- Identify worker exposures to blood and OPIM - Review all processes and procedures with exposure potential - Re-evaluate when new processes or procedures are being used This presentation was created by the N.C. Department of Labor for safety and health training. Engineering & Work Practice Controls 1910.1030(d)(2) Employer must: - Evaluate available engineering controls (safer medical devices)

- Train employees on safe use and disposal - Implement use of appropriate engineering controls/devices This presentation was created by the N.C. Department of Labor for safety and health training. Engineering & Work Practice Controls 1910.1030(d)(2) Employer must: - Document evaluation and implementation in ECP - Review and update ECP annually - Review devices and new technologies on an annual

basis - Implement new device use, as appropriate and available - Update employee training for new devices and/or procedures and document in ECP This presentation was created by the N.C. Department of Labor for safety and health training. Examples of Engineering Controls Needleless systems such as IV 1910.1030(d)(2) NCDOL Photo Library connectors

Sharps with sharps injury protection Puncture-resistant sharps containers Mechanical needle recapping devices Biosafety cabinets Mechanical pipetting devices This presentation was created by the N.C. Department of Labor for safety and health training. Work Practice Controls 1910.1030(d)(2) Altering behaviors Function - Protection is based on employer and employee

behavior - Protection not dependent on installation of a physical device such as protective shield This presentation was created by the N.C. Department of Labor for safety and health training. Work Practice Controls 1910.1030(d)(2) Washing hands - Employers shall provide readily accessible handwashing facilities

- When not feasible, appropriate antiseptic hand cleansers shall be provided - When gloves are removed - ASAP after contact with body fluids This presentation was created by the N.C. Department of Labor for safety and health training. Work Practice Controls 1910.1030(d)(2)(vii) Do Not Bend or Break Contaminated Needles

This presentation was created by the N.C. Department of Labor for safety and health training. Work Practice Controls 1910.1030(d)(2) Place contaminated reusable sharps in appropriate container until processing Containers must be: - Puncture-resistant - Labeled or color-coded - Leak proof on sides and bottom - Stored or processed in a safe manner

Prohibiting mouth pipetting or suctioning of blood or OPIM This presentation was created by the N.C. Department of Labor for safety and health training. Work Practice Controls 1910.1030(d)(2) Using mechanical devices or one-handed techniques to recap or remove contaminated needles when necessary Prohibiting eating, drinking, smoking, etc. Food and drink must not be kept in the same

storage as potentially infectious material Performing all procedures involving blood or OPIM so as to minimize splashing, spattering, and droplet generation This presentation was created by the N.C. Department of Labor for safety and health training. Personal Protective Equipment 1910.1030(d)(3) Specialized clothing or equipment that is worn by an employee for protection against a hazard

- General work clothes (uniforms, pants, shirts and blouses) not intended to function as protection against a hazard are not considered personal protective equipment (PPE) This presentation was created by the N.C. Department of Labor for safety and health training. Types of PPE 1910.1030(d)(3) Gloves Gowns Face shields Eye protection

Mouthpieces and resuscitation devices This presentation was created by the N.C. Department of Labor for safety and health training. PPE Provisions 1910.1030(d)(3) Employer must provide appropriate PPE at no cost to the employee Employer must ensure

that PPE is worn by employees Must be accessible and in appropriate sizes for employees at the worksite This presentation was created by the N.C. Department of Labor for safety and health training. PPE Provisions 1910.1030(d)(3) PPE must be cleaned, repaired, replaced, and disposed of by employer

PPE must be removed before leaving work area and when becomes contaminated - Cannot wash PPE at home! This presentation was created by the N.C. Department of Labor for safety and health training. PPE - Gloves 1910.1030(d)(3)(ix) Gloves shall be worn when: - Potential contact with blood and OPIM, mucous

membrane and non-intact skin - Performing vascular access procedures - Handling or touching contaminated surfaces This presentation was created by the N.C. Department of Labor for safety and health training. PPE - Gloves 1910.1030(d)(3)(ix)

Disposable (single use) gloves must be replaced when contaminated, torn or punctured Disposable (single use) gloves shall not be washed or decontaminated for reuse Utility gloves may be cleaned and re-used as long as they continue to provide a barrier for employee This presentation was created by the N.C. Department of Labor for safety and health training. Housekeeping - General

1910.1030(d)(4)(i) Employer shall develop and implement a written schedule for cleaning and decontamination at the worksite Schedule is based on the: - Location within the facility - Type of surface to be cleaned - Type of soil present - Tasks or procedures being performed This presentation was created by the N.C. Department of Labor for safety and health training. Housekeeping Requirements 1910.1030(d)(4)(ii)[A]

Contaminated work surfaces shall be decontaminated: - After completion of procedures - After contact with blood or OPIM and - At end of work shift This presentation was created by the N.C. Department of Labor for safety and health training. Housekeeping Requirements 1910.1030(d)(4)(ii) All reusable receptacles such as bins, pails,

and cans that are likely to be contaminated must be inspected and decontaminated: - On a regular basis, or - When visibly contaminated Reusable items such as sharps shall be stored or processed in a safe manner This presentation was created by the N.C. Department of Labor for safety and health training. Appropriate Disinfectants Household bleach (5% NaOCl ) 2 - 1:10 - 1:100 in H2O

EPA registered disinfectants - List A: EPAs registered antimicrobial products as sterilants - List B: EPA registered tuberculocide products effective against Mycobacterium spp - List C: EPAs registered antimicrobial products effective against human HIV-1 Virus - List D: EPAs registered antimicrobial products effective against human HIV-1 and Hepatitis B virus - List E: EPAs registered antimicrobial products effective against Mycobacterium spp, human HIV-1 and Hepatitis B virus - List F: EPAs registered antimicrobial products against Hepatitis C virus - List G: EPAs registered antimicrobial products for medical waste treatment This presentation was created by the N.C. Department of Labor for safety and health training. Regulated Waste

1910.1030(d)(4)(iii)(A) Contaminated sharps disposal - Must be discarded in containers that are: Closable Puncture-resistant Leak proof (on sides and bottom) Labeled or color-coded - During use, the sharps container must be: Placed near the work area Maintained upright during use Routinely replaced

This presentation was created by the N.C. Department of Labor for safety and health training. Regulated Waste 1910.1030(d)(4)(iii)(A) - When moving, the sharps container must be: Closed immediately Placed in a secondary container if leaking - Reusable sharps containers shall not be opened, emptied, or cleaned manually or in any manner which presents a risk of percutaneous injury to employees This presentation was created by the N.C. Department of

Labor for safety and health training. Regulated Waste 1910.1030(d)(4)(iii) Other regulated waste containment - Must be put into containers that are: -

Closable Leak proof Labeled or color-coded Closed prior to removal If outside contamination occurs, it shall be placed in a secondary container that meets the criteria above This presentation was created by the N.C. Department of Labor for safety and health training. Contaminated Laundry 1910.1030(d)(4)(iv)

Contaminated laundry must be handled as little as possible with a minimum of agitation - Bagged or containerized at its location of use It cannot be sorted or rinsed there - Placed and transported in bags or containers that are labeled or color-coded - Placed in a container that will prevent soak-through to the exterior This presentation was created by the N.C. Department of Labor for safety and health training. HIV and HBV Research Laboratories and Production Facilities

1910.1030(e) Paragraph (e) applies to research laboratories and production facilities engaged in the culture, production, concentration, experimentation, and manipulation of HIV and HBV - Does not apply to clinical or diagnostic laboratories - Requirements apply in addition to other requirements in the standard This presentation was created by the N.C. Department of Labor for safety and health training. HIV and HBV Research Laboratories

and Production Facilities 1910.1030(e) HIV and HBV production facilities shall meet specific criteria as outlined in paragraph (e) HIV and HBV research laboratories and production facilities have additional training requirements for their employees This presentation was created by the N.C. Department of Labor for safety and health training. Hepatitis B Vaccination

1910.1030(f) Hepatitis B vaccination and post-exposure evaluation and follow-up including prophylaxis shall be: - Available to employees at a reasonable time and place and without cost - Performed by or under the supervision of a licensed physician or healthcare professional - Provided according to current recommendations of the U.S. Public Health Service This presentation was created by the N.C. Department of Labor for safety and health training.

No Cost to the Employee 1910.1030(f) No out of pocket expense Employer may not require employee to use his/ her health care insurance to pay for series unless: - Employer pays all of the cost of health insurance, and - No cost to employee in form of deductibles, copayments, or other expenses This presentation was created by the N.C. Department of Labor for safety and health training.

Hepatitis B Vaccination 1910.1030(f)(2)(i) Hepatitis B vaccination shall be made available: - After employee has received required training, and - Within 10 days of initial assignment to all employees with occupational exposure Exceptions - If the employee has previously completed the Hepatitis B vaccination series, or - Immunity is confirmed through antibody testing, or This presentation was created by the N.C. Department of

Labor for safety and health training. - Vaccine is contraindicated for medical reasons Hepatitis B Vaccination 1910.1030(f)(2) Participation in prescreening not prerequisite for receiving Hepatitis B vaccination Hepatitis B vaccination provided even if employee declines but later accepts treatment Employee must sign statement when declining

Hepatitis B vaccination Hepatitis B vaccination booster doses must be available to employees if recommended by the U.S. Public Health Service This presentation was created by the N.C. Department of Labor for safety and health training. Post-Exposure and Follow-Up 1910.1030(f)(3) Documentation of exposure routes and how exposure incident occurred

Identification and documentation of source individuals infectivity, if possible Collection and testing of employees blood for HBV and HIV serological status (employees consent required) Post exposure prophylaxis when medically indicated Counseling Evaluation of reported illnesses This presentation was created by the N.C. Department of Labor for safety and health training. Source Individual

1910.1030(f)(3)(ii)[C] Source individuals test results shall be made available to the exposed employee (not the employer) Employee should also be given information about applicable disclosure laws and regulations concerning source individuals identity and infection status This presentation was created by the N.C. Department of Labor for safety and health training. Exposed Employee

1910.1030(f)(3)(iii) Exposed employees blood shall be collected as soon as feasible after consent is obtained If employee consents to baseline blood collection, but not to HIV serological testing, sample shall be preserved for 90 days This presentation was created by the N.C. Department of Labor for safety and health training. Information Provided to Healthcare 1910.1030(f)(4)

Professionals A copy of the Bloodborne Pathogens Standard A description of the employees duties relevant to the exposure incident Documentation of the route of exposure and the circumstances under which the exposure incident occurred Results of the source individuals blood test, if available All appropriate medical records relevant to the employee This presentation was created by the N.C. Department of Labor for safety and health training. Healthcare Professionals Written 1910.1030(f)(5)

Opinion Within 15 days after evaluation is completed Written opinion for Hepatitis B vaccination is limited to whether the employee requires or has received the Hepatitis B vaccination Written opinion for post-exposure evaluation and follow-up includes information that the employee has been: - Informed of the evaluation results, and - Informed of any medical conditions that require further treatment This presentation was created by the N.C. Department of Labor for safety and health training.

Communication of Hazards to Employees 1910.1030(g) Warning labels and signs Information and training This presentation was created by the N.C. Department of Labor for safety and health training. Warning Labels 1910.1030(g)(1)(i)[A] Must be affixed to:

- Regulated waste containers - Refrigerators and freezers containing blood or OPIM - Other containers used to store, transport or ship blood or OPIM This presentation was created by the N.C. Department of Labor for safety and health training. Labels and Signs 1910.1030(g)(1)(i) Label shall include the following legend Labels shall be fluorescent orange or orange-

red or predominately so, with lettering and symbols in a contrasting color This presentation was created by the N.C. Department of Labor for safety and health training. Signs 1910.1030(g)(1)(ii) Must be posted at the entrance to HIV and HBV research laboratories and production facilities work area with same color scheme as labels

This presentation was created by the N.C. Department of Labor for safety and health training. Information and Training 1910.1030(g)(2) Training shall be provided: - At the time of initial assignment to tasks where occupational exposure may occur, and - At least annually thereafter This presentation was created by the N.C. Department of Labor for safety and health training.

Training Program 1910.1030(g)(2)(vii) Contents of standard Protective equipment Epidemiology of Hepatitis B vaccination bloodborne diseases program

Modes of transmission Emergency procedures Exposure control plan Post-exposure procedures Job duties with exposure Signs/labels (color-coding) Types of control Question session

This presentation was created by the N.C. Department of Labor for safety and health training. Information and Training 1910.1030(g)(2) Person conducting the training shall be knowledgeable in the subject matter covered in the training program as it relates to the workplace Employees in HIV and HBV laboratories and production facilities shall receive other initial training and demonstrate proficiency in

handling human pathogens or tissue culture This presentation was created by the N.C. Department of Labor for safety and health training. Recordkeeping 1910.1030(h) Medical records Training records Sharps injury log This presentation was created by the N.C. Department of

Labor for safety and health training. Medical Records 1910.1030(h)(1) Must contain: - Employee name and social security number - Employee Hepatitis B vaccination status - Examination results, Medical testing, and postexposure follow-up procedures - Healthcare professionals written opinion - Information provided to the healthcare professional Be maintained for employment + 30 yrs This presentation was created by the N.C. Department of

Labor for safety and health training. Training Records 1910.1030(h)(2) Training records shall include: - Training dates - Training session content and summary - Names and qualifications of trainers - Names and job titles of all trainees Be maintained for 3 years from the date of training This presentation was created by the N.C. Department of

Labor for safety and health training. Sharps Injury Log 1910.1030(h)(5)(i) Employer shall create and maintain a sharps log - For documenting percutaneous injuries from contaminated needles - Must be recorded and maintained separate from the OSHA 300 log and must remain confidential - At a minimum, for each incident the log must contain: Type and brand of device involved (if known) Department or work area of incident Description of incident

Mandatory for those keeping records under 1904 This presentation was created by the N.C. Department of Labor for safety and health training. Exemptions 29 CFR 1904, Appendix A to Subpart B: - List of partially exempt industries Not required to keep OSHA injury and illness records unless asked in writing by: - OSHA - BLS - State agency operating under authority of OSHA or BLS

Does not exempt them from responsibility to report fatalities, in-patient hospitalization, amputation, or loss of an eye This presentation was created by the N.C. Department of Labor for safety and health training. Availability of Records Training records shall be provided upon request for examination and copying to: - Employees - Employee representatives - Director of National Institute of Occupational Safety

and Health (NIOSH) - OSHA This presentation was created by the N.C. Department of Labor for safety and health training. Availability of Records Medical records shall be provided upon request for examination and copying to: - Employee - Anyone with written consent of employee - National Institute of Occupational Safety and Health - OSHA This presentation was created by the N.C. Department of

Labor for safety and health training. Summary Scope andBapplication Hepatitis vaccination and post-exposure evaluation Definitions Training Exposure control Recordkeeping Methods of compliance HIV/HBV Research

laboratories and production facilities This presentation was created by the N.C. Department of Labor for safety and health training. Thank You For Attending! Final Questions? This presentation was created by the N.C. Department of Labor for safety and health training.

Recently Viewed Presentations

  • SPM 200 Skills Lab 1 - medschool.lsuhsc.edu

    SPM 200 Skills Lab 1 - medschool.lsuhsc.edu

    Backward or regurgitant flow through an incompetent valve, septal defect, or patent ductus arteriosus. Timing of Heart Sounds. Systolic: ... Large diastolic pressure gradient - high pitched murmur (aortic regurgitation) Systolic Murmurs. Systolic murmurs can be divided into. Mid-systolic.
  • Chapter 20 Electrochemistry - OCVTS.org

    Chapter 20 Electrochemistry - OCVTS.org

    Anode- where oxidation takes place. ... If the positive battery terminal is attached to the cathode of a voltaic cell, and the negative terminal is attached to the anode, the flow of electrons will change directions. ... Chapter 20 Electrochemistry
  • Collecting, Evaluating, and Using Information Information Literacy Information

    Collecting, Evaluating, and Using Information Information Literacy Information

    The Writing Process. Prewriting: The idea stage. Discover ideas through freewriting (writing without concern for punctuation, spelling, grammar, or background) Drafting: Beginning of organization. Converting exploratory writing to a rough explanatory draft, choosing a thesis, and creating a structure. Revising:...
  • Haemoglobin its structure, functions, types and abnormalities

    Haemoglobin its structure, functions, types and abnormalities

    In adult humans, the most common hemoglobin type is a tetramer (which contains 4 subunit proteins) called hemoglobin A, consisting of two α and two β subunits non-covalently bound, each made of 141 and 146 amino acid residues, respectively. This...
  • Weather Symbols - Teacher Bulletin

    Weather Symbols - Teacher Bulletin

    These are called weather symbols. Check a weather map to see what the temperature for the day will be. More Symbols TYPICAL MEDIA WEATHER MAP Look at the symbols. What weather does Eastern England have? What is the weather like...
  • Report to Wordsworth - English Language and Literature

    Report to Wordsworth - English Language and Literature

    Poetry and piety have begun to fail, ... Sibilance adds effect and emphasis. ... sees how man is destroying it, and these beliefs are portrayed in both the poems. Also Report to Wordsworth is a summary of all the problems...
  • Quantum Theory of the Atom

    Quantum Theory of the Atom

    The principle behind this method is based on VSEPR Theory. This stands for Valence Shell Electron Pair Repulsion, which for the purposes of this diagram, keeps single electrons apart until we have to pair them up.
  • The Fall of Adam & Eve The Three

    The Fall of Adam & Eve The Three

    Now this is the way I interpret [Moses 3:16-17]: The Lord said to Adam, "Here is the Tree of the Knowledge of Good and Evil. If you want to stay here, then you cannot eat of that fruit. If you...