The Prevalence of Microorganisms in Hospital Wards

The Prevalence of Microorganisms in Hospital Wards CONTENTS INTRODUCTION Hospital acquired infection are also known as nosocomial infection are infections acquired from healthcare services (hospitals) during treatment, which are secondary to the patients original condition. The source and spread of organisms inside the hospital are important issues, human related organisms or the body flora, also found in clothing are spread through shedding during human activities(Ekhaise et al., 2010). Although many such infections occur in patients, infections acquired at work by staff members also are considered nosocomial infections. Many factors can contribute to the acquisition of nosocomial infections, and no single factor or condition to explain why they occur. The most significant factor for determining the outcome of infection is the immunological state of the host. The nosocomial infections are often related to therapeutic and diagnostic procedures that are routinely employed in health care. For more than a century, this issue has been recognized as a critical problem which affects the quality of healthcare and a principal source of adverse outcomes. The patients who are immunocompromised are often hospitalized and undergo invasive examination and treatments thus hospital environment may facilitate the transmission of microorganisms among patients. The intense use of antibiotic promotes antibiotic resistance for the pathogenic microorganisms whereas changes in the medical practices continually present new opportunities for the development of infection (Dilip Kumar et al., 2013). According to Baveja in 2002, the term hospital acquired infection, hospital- associated infection, hospital infection or nosocomial infection(nosocomion,meaning hospital) is defined as infection developing in patients after admission to the hospital ,which was neither present nor in the incubation period at the time of hospitalization . Such infections may become evident during their stay in the hospital or sometimes after their discharge. According to Gupte in 2006, sources of hospital acquired infection are infecting microorganisms from fellow patients which may be multidrug resistant, infecting organisms from hospital staff, infecting organisms from instrument, blood products, intravenous fluid, from patient’s normal flora, etc, insects are also source multidrug infection, organism may be present in air, dust, water, antiseptic solution, food, surfaces contaminated by patient’s secretions, blood fluid, etc. In all over the world weather it is a developing or developed countries, this hospital acquired infection have assumed worrisome proportions in all healthcare scenarios (Col Shivinder Singh, et al 2015). As much as 80% of the estimated hospital deaths are related either directly or indirectly from Hospital Acquired Infection (Hughes et al, 2005). Patients are likely to get sick in hospital due to wide variety of microorganisms which are responsible for many different kinds of hospital infection. Thus during the stay of patients in the hospital it has become increasingly unsafe place. Thus infection has become a significant health hazard and requires great expense for final outcome of treatment. Infection safety (IC) is a quality standard which is essential for safety of patients, staff and visitors. It involves issues like clinical governance, risk management, quality of health and safety which affects most departments of the hospital (Dhayana Sharon Ross et al., 2014). Hospi ­tals have the potential for pathogen spread because they have contact with instruments, medical furniture, medical staff, skin, air, physical facilities and drainage. Contaminated environment are the main cause for such pathogens thus strict safety biosecurity procedures is to be applied (Mazzali M et al., 2003). The common nosocomial infections are mainly include urinary tract infections, surgical site infections, respiratory tract infections, blood stream infections, skin infections, gastrointestinal tract infections and central nervous system infections. These are mainly caused by Staphylococci, Pseudomonas, E.coli etc. And the common antibiotic resistant nosocomial infections include the Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant Staphylococcus aureus (VRSA) and Vancomycin resistant Enterococci (VRE). Many different environmental factors may either help or prevent the transmission of microorganisms. Hospital environment are the one where both infected person and persons who is at increased risk of infection assemble (Mayon et al., 1988) Today HAIs affects more than 2million patients annually, at a cost of 4.5 billion (Apostolopoulou and Veldekis 2005). The present study aimed to investigate the prevalence of microorganisms in hospital wards of National Institute of Mental Health and Neuro Sciences (NIMHANS) Bangalore. Many different wards such as female neurology ward, male neurology ward, male neurosurgery ward, female neurosurgery ward, male pshyciatry ward, female pshyciatry ward, paediatric neurology ward, paediatric neurosurgery ward, de- addiction ward, short stay ward, head injury ward and step down ward was chosen for the study due to its high patronage by patients from all over India. Labs such as clinical microbiology lab, fluorescent microscope room, NABL room, bactec room and neuromicrobiology lab was also taken into consideration in order to ascertain the nature of microorganisms present. REVIEW OF LITERATURE When we think about hospital, one thing comes to our mind is â€Å"Hospital is the place for cure†. This revolutionary idea of treating the patients under the same roof was considered to ease the job of healing. But due to lack of knowledge of sterilization and antisepsis, it turned wrong in Pre- Listerian era leading to gangrene and death of patients which were suffering from wounds. Due to this reason a new discipline was emerged called as senics which was mainly dealing with the Hospital Acquired Infection (Nosocomial Infection). Semmelwis in 1861 with the help of medical officer and students observed the association of Puerperal sepsis in patients. Thus by the introduction of hand washing with chlorinated lime, he was successful to bring dramatic reduction in infection rate. Hospital acquired infection (HAI) are infections acquired during hospitalization, which are not present at eh time of admission (Atata et al, 2006). Due to its increased mortality and morbidity in the hospital patients these HAIs are of significant cause. HAIs are also caused due to prolonged hospital stay which are inconvenient for the patient and constitute economic burden on health care (Malhotra S, et al 2014). Dancer in 1999,depicts that microorganisms which are associated with hospital acquired infection displays two important characteristics, firstly those are the pathogens of well-established medical importance and secondly they also can withstand the hospital environment which benefits them outside temperature. Thus providing an appropriate environment niche for their survival until they transfer back to patients. Some pathogens originate from patients own flora especially those who are immunocompromised whereas others can survive in human tissues and thus rely upon person to person spread in order to disseminate. The patients who are immunocompromised due to underlying diseases, medical or surgical treatment, age are typically affected by nosocomial infections. In pediatric ICU, the hospital acquired infections are approximately three times higher than elsewhere in hospitals (Weistein 2006). Pathogen transference occurs most commonly by presence of bacterial or fungi in inanimate surfaces and equipment or between the hands of health professionals and patients (Kayabas et al., 2008). The transmission of microorganisms from hands of health care workers, medical equipment and surfaces which has become contaminated with a wide variety of pathogenic and nonpathogenic organisms has become a significant proportion of hospital environment infection which ultimately results in crosscontamination (Sehulster et al., 2003). When compared to other hospital patients, the patients who are hospitalized in ICUs are 5-10 times more likely to acquire nosocomial infection. The risk of infection and the frequency of infection vary by infection site. The increasing incidence of infection is caused mainly by antibiotic-resistant pathogens leading to seriousness of hospital acquired infection (Weber 2006). Some of the common human pathogens like, Staphylococcus aureus, Acinetobacter spp, En ­ terococcus spp and Escherichia coli can survive for longer periods of time on the hospital surfaces or formites that can potentially transmit infectious organisms(Kramer et al., 2006). The primary sources of indoor air contamination are the microorganisms. When compared to outside air environment, the indoor air environment can potentially place patients a greater risk because enclosed spaces can confine aerosols and allow them to build up to infectious level. The relative humidity and/ or the moisture content of the materials determine that to what extent different micro-organisms are able to grow on indoor or outdoor materials (Dhanasekaran et al., 2009). Adebolu and Vhriterhire in 2002 reported that magnitude of hospital acquired infection is dependent upon the number and type of visitors, mechanical movement within the enclosed space, quality of hospital systems and level of hygienic conditions in hospital environment. Hand hygiene has been considered to be the most important tool in nosocomial infections control. One of the significant contributors to the outbreaks of this hospital environment infection is failure to perform appropriate hand hygiene. Resident and transient microorganisms are known to be the natural microflora of the skin of hands. The resident microorganisms survive and multiply on skin and does not cause any harm to human flora whereas transient microorganisms represent recent contamination of hands which is acquired from colonized or infected patients/clients or contaminated environment or equipment. These transient microorganisms are not isolated consistently from most of the persons. When compared to resident microorganisms, the transient microorganisms which are found on the hands of health care personnel will become as a primary source of infections. Gram negative coliforms and Staphylococcus aureus has been known to be the most common transient microorganisms (Sarmad et al. , 2009). Appropriate hand washing results in reduced incidence of both nosocomial and community infection (Kampf et al., 2004). BIBILOGRAPHY Dhyana Sharon Ross., Dr. S. Vasantha. 2014. A Study on hospital acquired infections (HAI), control and management. International journal of innovative research in science, engineering and technology. 3(1): 2319-8753. Atata, R.F., Ibrahim, Y.K.E., Akanbi II, A.A., Urinola, P.F., and Saui.A. 2006. Prevalence of nosocomial infections in a tertiary health care institution in Nigeria (2000-2002), Journal of applied and environmental sciences. 2(2): 212-215. Malhotra S, Sharma S, Hans C. 2014. Prevalence of hospital acquired infections in a tertiary care hospital in India. International journal of medicine and medical sciences. 1(7): 2315-9844. Col Shivindra Singh, Col Rakhee Goyal, Brig G.S Ramesh, Maj Gen V., Ravishankar, Gp Capt R.M. Sharma, Maj D.V. Bhargava, Lt Col S.k. Singh, Maj M.K. John, Surg Lt Cdr Anoop Sharma. 2015. Medical journal armed forces India. 71: 28-32. Hughes AJ, Ariffin N, Huat T.L., Abdul Molok H, Hashim S, Sarijo J, Abdul Latif N.H., Abu Hanifah Y, Kamarulzaman A. 2005. Prevalence of nosocomial infection and antibiotic use at a university medical center in Malaysia. Infection Control Hospital Epidemiolgy. 26:100-4. Dancer S J. 1999. Mopping up hospital infection. Journal of hospital infection. 85-90. Robert F. Boyd, J.Joseph Mare. 1990. Medical Microbiology. Little, Brown and Company Boston. 1980. (1), 701-713. C.P Baveja. 2005. Arya publication. 2. Dileep Kumar Sharma, yogendra Kumar Tiwari, Nitya Vyas, Rakesh Kumar Maheshwari. 2013. An investigation of the incidence of Nosocomial infection among the patients admitted in the intensive care unit of tertiary care hospital in Rajhastan, India. International Journal of Current microbiology and Applied Sciences. 2(10): 428-435. Adebolu, T.T. and K.J. Vhriterhire. 2002. Survery of the microbial flora of the Ondo State Specialist Hospital Environment, Akure, Nigeria. National Journal of Microbiology 16(112): 91-94. F.O.Ekhaise, E.E.Isitor, O.Idehen, A.O.Emoghene. 2010. Airborne microflora in the atmosphere of an hospital environment of University of Benin Teaching Hospital (UBTH),Benin City, Nigeria. World journal of Agriculture Sciences 6(2): 166-170. Ekhaise, F.O., O.U. Ighosewe, O.D. Ajakpori. 2008. Hospital indoor airborne microflora in private and government owned hospitals in Benin City, Nigeria. World Journal of Medical Science. 3(1): 34-38. Dutkiewicz, J. M. Augustowska. 2006. Variability of airborne microflora in a hospital ward with a period of one year. Annals of Agriculture and Environmental Medicine. 13: 99-106. Sehulster L, Chinn RY. 2003. Guidelines for environmental infection control in healthcare facilities. Recommendation of CDC and the healthcare Infection Control Practice Advisory Committee (HICPAC). MMWR Recommendation and Report. 52(RR-10):1-42. Kayabas U, Bayraktar M, Otlu B, Ugras M, Ersoy Y, Bayindir Y. 2008. An outbreak of pseudomonas aeruginosa because of inadequate disinfection procedures in a urology unit: a Pulsed-field gel electrophoresis based epidemiologic study. American Journal of Infection Control. 36(1): 33-8. Kramer A, Schwebke I, Kampf G. 2006. How long do Nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infectious Disease. 6:130. Sarmad, M.H Zeiny. 2009. Isolation of some Microorganisms from Bar Soaps and Liquid Soaps in Hospital Environments. Iraqi Journal of pharmaceutical Sciences. 18(1). 18.Muller J.H., J. Hinton. 1941. A protein-free medium for primary isolation of gonococcus and meningococcus. Proceedings of the society for Experimental Biology and Medicine. 48:3330-333. 19.M.H.Gordon, T.G.M. Hine. 1016. An experimental study of the cultural requirements of the Meningococcus. British Medical Journal. 2(2916): 678-684. 20.Baure, A.L., M.M. Kirby, J.C Sherris, M. Turck. 1966. Antibiotic susceptibility testing by a standardized single disk method. American Journal of Clinical Pathology. 45:493-896. Not Written in Referrence. Apostolopoulou, E., and Veldekis, D. 2005. Nosocomial bloodstream infections in intensive care unit: excess nursing workload, extra costs. Icus Nurs Web J.. Gupte S. The short text book of medical microbiology.Japyee brothers medical publishers (p) ltd: New Delhi; 2006. 471-473. Weinstein.A.Nosocomial infections Update.www.ftp.cdc.gov/pub/eid/ vol4no3/adobe/weinstein.pdf . March-2006. Weber. Nosocomial infections in the ICU-the growing concern of antibioticresistant pathogen. www.ncbi.nlm.nih.gov/entrez/guerv.fcgi. April- 2006. MacFaddin J.F,. 1985. Media for isolation-Cultivation-Identification-Maintenance of Medical Bacteria. Vol.1, Williams and Wilkins, Baltimore

Smartphones Are an Essential Part of Society

Smartphones are an Essential Part of Society Smartphones are helping people to be more efficient, but with some side effects. â€Å"Many colleges and universities are further pushing the boundaries of services that can be delivered on smartphones† (Gordon 2007). Even though smartphones are making the human race complacent and dependent, these mobile devices are useful tools because they make life easy and keep one organized in a fast-paced world. â€Å"Wake Forest has a MobileU (mobileu. wfu. du) pilot program focusing on mobile messaging, mobile access to information such as calendars, campus announcements, and real-time location of the campus shuttle bus† (Gordon 2007). If one were to only read, the Korean Herald, one would believe that everybody who has a smartphone; does not like to get out of their pajamas or leave the house. â€Å"The smart device boom may be a blessing for many who now have instant access to everything from emails to the nearest restaurant servi ng their favorite foods, but smart products also are making electronics companies increasingly lazy† (Herald 2011).Another example that shows that smartphones are making people lazy and too dependent is stated in, †The trend is partly blamed on technology making it easier for lazy staff to email a colleague rather than walk over to see them† (Express 2012). Smartphones are making people lazy and too dependent; they are useful tools because phones make a person’s life easier.For example, sending an Army SPOT Report message, a concise narrative report of essential information covering tactical events or conditions, requires a soldier to first enter a 12-digit date-time group and a six-digit grid coordinate, a task that takes up time in a critical situation. Smartphones, which have their own built-in clocks and Global Positioning System (GPS) receivers, automatically populate those fields in the SPOT Reports and other Army messages that require a time stamp and precise location information (Brewin 2011).Another example that shows that smartphones make a person’s life easier is â€Å"Connecting Soldiers application will help soldiers communicate in languages other than English, McCarthy said, outputting translation audibly through the smartphone speaker and by text on its screen. The project already has an Arabic language application, and he would like to find an affordable application that can translate Pashto and Dari, the main languages of Afghanistan† (Brewin 2011). Smartphones are a useful tool because these handheld devices help people to stay organized. An individual can do almost anything with a smartphone.Today with all the applications to download, it is easy to stay on track. Individuals can you use the calendar function to keep their appointments and send reminders about up and coming events. Smartphones also allow for checking emails and surfing the web. Smartphones also let people play games. The days of the old paper organizer are gone forever! Users of smartphones and even those that do not have these handheld devices can appreciate them. Although smartphones are making people lazy and too dependent, smartphones are useful tools for two main reasons.First, smartphones make a one’s life easier. Nevertheless, most importantly, smartphones help people to stay organized.References Brewin, Bob (2011). Army confirms battlefield smartphones tests began in December. Computers–Information Science And Information Theory Gordon, Rachel Singer (2007). Information Tomorrow: Reflections on Technology and the Future of Public and Academic Libraries. Medford, NJ, USA: Information Today, Inc. , doi: 10492819. P. 31 The Express. (2012) â€Å"Office work ‘makes you fat and lazy† THE KOREA HERALD, (2011): â€Å"IT industry too dependent on smart devices†

What You Dont Know About Argumentative Essay Topics on Time Travel

What You Don't Know About Argumentative Essay Topics on Time Travel The Argumentative Essay Topics on Time Travel Chronicles To defend your subject, you might recall the effect of overloaded schedule on college grades. The shortage of superior support sources will end in a decrease grade. The last point is marketers not only utilize persuasion tactics to pull tourists. Students with good academic results must secure the chance to go to college free of charge. Argumentative writings is a particular kind of a paper. There are five varieties of argumentative essays. There are three sorts of argumentative essays. Read and analyze some persuasive essay examples to find out more in regards to the structure and vocabulary employed within this kind of essay. It's a certain sort of essay that presents clear arguments about each side of a problem. Then use that information to make a paper that states at least three unique explanations for why you believe your side of the problem. Determine which side of the problem you believe in. It's important to select debatable argumentative essay topics since you need opposing points you could counter to your own points. At the exact same time, it's a wonderful persuasive essay idea. The first thing you might want to do once you've chosen your topic is to begin by writing an outline. The very best thing about an argumentative essay which contains social issues is that you may describe your individual experience on the case of the real-life case. When you must compose a freelance expository essay either as an element of your homework assignment or as an element of your research for the conclusion of term or middle of term dissertation, there is an assortment of topics you are able to research on. Your readers will need to find the entire picture, and that's what you should concentrate on. Argue not all sportsmen can get superior coaches. Another reason is to observe how well students argue on unique views and de monstrate understanding of the studied subject. Many students have a tendency to encounter the writing issues due to the shortage of appropriate comprehension. You may start looking for assorted family topics to compose your argumentative essay on in the event you find it really hard to deal with some family responsibilities. If you would like to share because many examples from your private life and experience as possible, most probably you will recall your family members and friends. Perhaps, you merely want to demonstrate how an ideal family should look like. It is preferable to grow up in a family with a great deal of brothers and sisters. Moral argumentative essay topics are a few of the simplest to get carried away with. An argumentative essay requires you to choose a topic and have a position on it. You should settle on a persuasive essay topic that enables you to present the very best possible case. Recent argumentative essay topics that are related to society is going to do. Argumentative Essay Topics on Time Travel: No Longer a Mystery School should occur in the evenings. Teachers should also need to go through professio nal tests like students. Students ought to be permitted to pray in school. School tests aren't effective. Argue the best bargain you've ever got. Droz If the money doesn't serve you, it is going to rule over you. It is preferable to search online because it will conserve a plenty of time. It is impossible to produce an actual friend online. Shopping online isn't secure or secure. Use these strategies to receive it right! Order a very good case of argumentative essay online!

Baz Luhrmanns The Great Gatsby - Free Essay Example

Sample details Pages: 5 Words: 1557 Downloads: 9 Date added: 2019/03/26 Category Literature Essay Level High school Tags: The Great Gatsby Essay Did you like this example? The Great Gatsby (2013) film directed by Baz Luhrmann is adapted from the classic 1925 novel, The Great Gatsby, written by F. Scott Fitzgerald that explores the tales of the American Dream the idea that anyone (regardless of race, class, gender or nationality) in America can achieve success and prosperity with hard work and determination. In order to illustrate this fairytale of the American Dream, Baz Luhrmann successfully and beautifully uses a formalistic approach with his entertaining and captivating eye-popping visuals and big-production sets that are grandiose and over-the-top. Don’t waste time! Our writers will create an original "Baz Luhrmanns The Great Gatsby" essay for you Create order Set in the roaring 20s, Midwest native Nick Carraway (Tobey Maguire) moves East to New York in search of the American Dream. Nick moves into a modest home in West Egg compared to his next-door neighbor. Home to the mysterious millionaire, Jay Gatsby (Leonardo DiCaprio), Gatsby purposely lives directly across the bay from the Buchanans Nicks cousin Daisy (Carey Mulligan) and her aristocrat husband, Tom (Joel Edgerton) located in East Egg with high hopes of Daisy returning to him. The Great Gatsby reflects themes and ideologies based on the American Dream, social classes and past and future, as Nick witnesses within and without the corruptness of the once mesmerizing world of the wealthy which captures a tale of impossible love, dreams and tragedy. The Great Gatsby is narrated by Nick Carraway and told in a non-linear fashion that is disrupted with his flashbacks reminiscing of the past, exemplifying themes of the American Dream, social classes, and past and future. Over time, the American Dream has evolved and divided into two versions the old and the new. The old American Dream holds a vision of building a prosperous life with a family and grand love, while the new American Dream solely pertains to getting rich. With this, Gatsby symbolizes both the old and new American Dream because his story arc resembles a complicated and immoral rags-to-riches tale. Coming from a background of poor farmers from North Dakota, an ambitious Gatsby left home at age 16 in search of something greater than himself. Along the way, he comes across millionaire Dan Cody, to which he diligently serves to, and travels alongside at sea. Unfortunately, when Dan passes, Gatsby is cheated and inherits none of his wealth, but the memories. The memories did not suffice Gatsby, and so he turned to crime in the bootlegging business in order to attain the wealth hes always dreamt of as a little boy wishing upon the stars. But even with wealth, Gatsbys vision of the American Dream is incomplete without Daisy, and so he risks everything in hopes to win her back. Its why he has a green light at the end of his dock, hoping that shell notice and come back to him. The haunting green light that is seen throughout the film symbolizes the American Dream, as it represents Gatsbys hope for a future with Daisy and his endless devotion to his dream. In the beginning and in the end of the film, there is a green light pulsating in the abstract dark. To further signify the importance of this green light, there are numerous shots of where we see Gatsbys back as he attempts to reach out for this mysteriously haunting green light. In one of the ending scenes, we see Gatsbys silhouette with an outstretched hand reaching for the green light across the bay as Nick narrates, Gatsby believed in the green light. The orgastic future that year by year, recedes before us. It eluded us then, but thats no matter tomorrow we will run faster Stretch out our arms farther And one fine morning So we beat on, boats against the current, borne back ceaselessly, into the past. Although Gatsbys dream was impossible to attain, Nick finds him admirable for his optimism and perseverance for a better life. Additionally, throughout the film, theres a glamorization of the excessive parties that is a reminder of the shallowness and vanity of the characters. All the extravagant weekly parties that Gatsby had thrown during the summer were all in hopes of Daisy coming. Baz Luhrmanns extravagant cinematic stylization, music and use of settings decor helped bring this Age of Decadence to life. The music in The Great Gatsby is influenced in Rap/RB music as it represents the genre of music that in our own time performs the political and argumentative work on probing race and class based identity. Baz Luhrmanns variety of music from Young and Beautiful, (overall love theme song) A Little Party Never Killed Nobody, (representing euphoria of the 20s) and Love is Blindness (Myrtles Death) further enhances the story telling, adding commentary on each scene. Going back to the first Gatsby party scene, the shots and angles along with the music gives us an accurate depiction of what the 20s would be li ke given the accompaniment of blaring jazz and a birds-eye view of New York City that introduces us to how colossal the size of Gatsbys parties were. Afterwards, the camera quickly pans down to the loads of uninvited people driving into the Gatsby Estate in their cars. Subsequently tailing the back of an automobile, to show the extent of Gatsbys entrance, the view then pulls out to a long shot of Gatsbys enormous Gothic mansion, to which the lush greenery and extravagant water fountain accompany it. Everyones dressed in their best attire and sequined/shiny flapper gowns and accessories with decadent pearls and headbands. Its the same faces and zero meaning that further illustrates that everything and everyone is a fasade whom holds superficial materialistic importance. Like how at the end of the night when everyones gone, the mansion is left empty again, leaving Jay, the common man, alienated and isolated. The endless summer parties and the spent confetti on the ground is a commentary on the cycle that Jay keeps repeating, and visits the ideology of future versus past. Jay is struggling to hold on to his past where 5 years ago, him and Daisy were together. Upon first meeting Daisy, Gatsby intended on having a short fling as he was infatuated with Daisys social class and wealth, but inevitably, accidentally ended up falling in love. Since day one, Gatsby was not who he claimed to be. Dressed in an officer uniform, Gatsby deceived Daisy to be someone from the same social status, but he was instead poor with no family and at the governments disposal. In attempts to restart his relationship with Daisy, along with the status hes created for himself. Jay is disillusioned believing that he can turn back time. In addition, the Outside versus Insiders ideology is shown through Jays neglect for his past, as he made up stories and put on a fasade that has essentially led him to be empty. It did not matter how hard Jay tried to fit in with the wealthy. Based off of the ideology of Democratic versus Hierarchical, the Buchanans along with the rest of the aristocrats failed to accept him. Within the hierarchy, there is emphasis on the individual and elite class entitled to a larger share of power compared to other common-dwellers. To simply put it, Daisy and Jay could never work because of Daisys aristocratic perspective of everything being handed to her, born with money and privilege, there are no consequences whatsoever. Thats why after she ends up killing Myrtle, she chooses Tom despite all her feelings towards Jay, she cannot afford to lower her standards to what she was raised in. It is also why those classified in the Hierarchy no longer have aspirations of having the American Dream, but instead attempt to maintain their social class. The four geographical locations in the film West Egg, East Egg, The Valley of Ashes and New York City further denote the Democratic versus Hierarchical. In West Egg, theres Gatsby with emergence of new money, along with the established aristocracy of the 1920s. Right across the bay from Gatsby is East Egg, where the Buchanans reside possessing social status and power, further symbolizing the old upper class that continues to dominate the rest of America. Then, there is the Valley of the Ashes, home to George and Myrtle Wilson, Toms mistress, where symbolize the moral decay of American society hidden by the glittering surface of upper-class extravagance. And finally there is New York City simply chaotic, as its associated with the depraved lies that Nick perceives in the East. In the end, Gatsbys choice to lead down an immoral path of shortcuts for wealth and materialism over the original vision of the American Dream hard work and integrity ultimately leads him to his death. Similarly to real life, Gatsbys story can easily be seen in todays society as the old American Dream succumbs and the new American Dream prevails. Like in the film, there are corrupted political people and people who make immoral choices based of their despairing desires to achieve the American Dream. If there is any moral to The Great Gatsbys version of the American Dream, its that anything short-term will never last, in comparison to the diligent hard-bearing work and integrity of long-lasting riches. And that is why there are so many people who seek out this American Dream and end up either 1) never achieving it initially or 2) fraudulently making their way up to have it all being ripped out from under.