Tobacco Use Essay Example for Free

Tobacco Use EssayED sees exact capacitiesEmergency Department (ED) move is a public health crisis associated with negative patient role outcomes including increased mortality and complication rates. Decreased quality in delivery of care is affected by lack of resources to support the increased use of emergency services and is a factor that leads to delays in treatment and untimely interventions. According to the article, Dr. Gor strike, an emergency medicine mendelevium and director of the Neighborhood Hospital ED states one of issues within the community is a lack of resources including adequate medical facilities, especially for low-income individuals or indigents (ED sees critical capacities, The Neighborhood). This problem is widespread throughout the United States and is not particular to the indigent population. Although it is difficult for patients with Medicaid to find providers willing to accept their insurance, the lack of primary care physicians causes limited acc ess to health care for those who do possess private insurance, and patients are often referred to the ED by their primary doctor who may be unable to see them as appointments are usually unavailable for weeks at a time.With limited access to care, hospital emergency rooms become saturated collectible to non-urgent visits, inadequate staffing, and hospital bed shortages. When the hospital reaches maximum capacity and can no longer admit patients to bewitch units, the ED is forced to board these patients in the department, which leads to ambulance diversion, increased wait times, and the creation of makeshift treatment areas. The culmination of these factors contribute to delays in transport and time sensitive emergent care, patient elopement where care is not received at all and delayed even further which can lead to worsening health requiring hospital admission, and lower quality of care, which negatively affects patient safety and outcomes (Hoot Aronsky, 2008).This article incr eases public awareness to the problem of crowding in the emergency department and encourages the use of community-based resources for non-urgent medical conditions and the need for education on the appropriate utilization of emergency medical services. Smoking breaks a thing of thepast?According to Tobacco Use (2013), Tobacco use is the single most preventable cause of death and disease in the United States (Why Is Preventing Tobacco Use Important?). This article highlights the advocacy of large companies to reduce tobacco plant use for the meliorate health of their employees and to eliminate word-painting to unwanted secondhand smoke. Environmental tobacco smoke is just as detrimental to non-smokers as it contains harmful substances that expose those who dont smoke to the health risks of cigarette smoking and increases their risk of developing a smoking-related illness. Promotion of a smoke-free work environment not whole benefits the employees, but also the public whom they se rve by reducing exposure to environmental smoke that causes heart disease, lung cancer, respiratory illness, and has other adverse effects to undefendable populations including pregnant women and children. These companies are increasing community awareness to the detrimental affects of smoking and exposure to secondhand smoke by paving the way to eliminate exposure to environmental smoke and reduce tobacco use in an effort to reduce illness and health care costs related to smoking, and increase productiveness of employees and the overall health of their communities. The public benefit to this is that many states are enacting smoke-free laws in the workplaces and public buildings to reduce the number of deaths and disability caused from involuntary exposure to tobacco smoke.ReferenceCenters For Disease Control and Prevention. (2013). Health effects ofsecondhand smoke. Retrieved fromhttp//www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/health_effects/Hoot, N.R., Aro nsky, D. (2008). Systematic review of emergency departmentcrowding Causes, effects, and solutions . Annals of Emergency Medicine,52(2), 126-136. inside10.1016/j.annemergmed.2008.03.014McClelland, M.S., Lazar, D., Sears, V., Wilson, M., Siegel, B., Pines, J.M.(2011). The past, present, and future of Urgent Matters Lessons learnedfrom a decade of emergency department flow improvement. AcademicEmergency Medicine, 18(12), 1392-1399. doi10.1111/j.1553-2712.2011.01229.xThe Neighborhood Pearson Health Science (Version 1.0) Retrieved from UOPXNUR408 line of work MaterialsTobacco use. (2013). Retrieved fromhttp//www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicId=41

Evaluating Communication Strategies Essay Example for Free

Evaluating Communication Strategies EssayYou argon working as a human serving worker at a local United Way agency that serves several multicultural clients. In addition to the multicultural aspect, the agency also serves children, women, the elderly, and the homeless. Your conductor has asked you to decide the best communication approach for each of these clients. About the ClientsIn the human services profession it is becoming increasingly to a greater extent important to fill out and understand the different cultures and their beliefs. When it comes to communicating effectively with people from different cultures, it can be of great help if you first understand the social and psychological forces that wad their verbal and non-verbal behavior. It is important to encompass skills like warmth, authenticity, empathy, permissiveness, and acceptance. Effective Strategies and TechniquesEmpathy refers to the ability to understand someone elses point of prognosis and ideas. When a client feels understood, and they think you are more understanding to their point of view, they are more likely to accept and listen to new ideas. Being honest-to-goodness is the expression of true feelings. Being genuine can be of big usefulness to people in the human services industry. It is important to also be objective. Seeing things from an outside point of view can help the human services worker to be subjective. Self-awareness is the quality of knowing oneself. This can help to convey ones values, feelings, attitudes, and beliefs. sufferance is an important tool because it shows the clients you believe their beliefs are worthy of consideration. Multi-Cultural AwarenessWhen working in the human services industry it is important to haveawareness of other(a) cultures and their practices. Clients will be more accepting of good or bad news if they feel like they are at least beingness understood, and being treated fairly. Culture shapes a persons life from their beliefs and v alues, to their preferences and attitudes. Understanding a persons cultural background and beliefs can help you to more effectively communicate the what, whys, and hows of things work. It can help you to better communicate what can and cannot be done to help them in their given circumstances.

Homogenized Mushroom Tissue Based Biosensors

Homogenized Mushroom Tissue Based BiosensorsABSTRACTHomogenized mushroom (Agaricus bisporus) tissue based biosensors by using plant tissue materials is a relatively new development in the biosensor technology. A impartial in tilt abide kind of visual ethanol biosensor that based on immobalised alcoholic beverageic drink oxidase (AOX) homogenized from mushroom tissue onto polyaniline (PANI) painting for ethanol ( 5% stringency ) detection in toiletries products. The colour going to diversify from green to blue imputable to response of biosensor to the ethanol and the convert of colour cease be seen by naked marrows. Regarding the enzymatic reaction of ethanol, acetaldehyde and hydrogen peroxide ordain produced, indeed PANI film is latter going to be oxidised. The method utilise to immobalise AOX onro the PANI film is by adsorption. Regarding immobilisation process, AOX solution need to deposit on the PANI film and hence left it at room temperature within 30 minutes until it dry. Scan and analyse the changes films colour to obtain the biosensors response characteristics toward the ethanol. The biosensor respond. Therefore, this simple visual biosensor is suitable for all-range-aged community to determine the safeness of certain toiletries products from the ethanol.Keywords Biosensor Alcohol Oxidase Ethanol Mushroom Tissue Polyaniline Toiletries6.0EXPERIMENTAL6.1Chemicals10-40 units/mg protein of Alcohol Oxidase or simply called (AOX) (A2404, EC1.1.3.13) which repeat from mushroom (A. Bisporus). These mushroom can be bought at fresh market as culture vegetables. Before call institute sure insert it at 4C. In order to immobalization use 225 bloom of gelatin from calf skin and 25.0% glutaraldehyde. Ascorbic acid, 2-propanol, D-glucose, n-butanol and many more chemicals needed can be purchased from Sigma, St. Louis, USA. Aniline with AR-grade, Gallic acid (G7384) and l-cysteine (W326305) can be purchased from Sigma Aldrich (Saint Louis, MO, USA). Ethanol which contain 99.5%, methanol, orthophosphoric acid (85%) and sodium hydroxide (pellets) can be delivered by Merck (Nottingham, UK). All needed chemicals are from commercial message source which in analytical grade. Millipore Direct-QTM 5 purification system provide the Milli-Q water. Prepare ethanols stock solutions in 0.1 M phosphate pilot burner at suitable pH daily and store it in refrigerator at 4 C. For pH studies, 0.1 M of the phosphate buffer solutions with pH value between 4 and 8 were can be used and to measure the pH value, use commercial glass electrode and pH-meter (model 9318, Hanna Instruments, Woonsocket, RL, USA) and calibrate it at the pH set of 4.00, 7.00 and 9.00.6.2Homogenization of Mushroom TissueHomogenize 200 mg mushroom tissue in the 400ml phosphate buffer. Mix this 300 ml homogenate and 10 mg gelatin. Incubate it for 5 minutes at 38C to make sure the gelatin is dissolved.6.3Preparation of Polyaniline (PANI) FilmIn order to prevent bumping in the aniline, purify the aniline with vigorous and rapid stirring by distilled under vacuum cleaner. Prepare PANI dispersion as nanofibre and Huang and Karner (2006) already mention the method to should to be used to build it. Mix 3.2 mmol or 0.3 g of purified aniline with 10 mL of 1.0M Hydrochloric Acid (HCL). Mix 0.8 mmol or 0.18 g of Ammonium peroxydisulfate into another 10 mL aliquot acid solutions. Add aniline-acid to oxidant and these two solution will mix rapidly within 30 seconds and then allow it to react in undisturbed overnight condition. On the next day, wash the polyaniline by using water and centrifuged. Supernatant liquor with pH 3.3 and strong green colour will form and it is indicate as the PANI particles which can be observed later on several times of washing. Any remaining particles with size larger than 1m must be removed before casting by passing the dispersion through a 55-mm glass fiber filter (Whatman GFA, Kent, UK) which is attach to vacuum source. Cast directl y PANI dispersion on a substrate of polystyrene and then, left the thin film of PANI that on the sheet of polystyrene in the dark to dry after cut it into individual in 10mm2 size. Next, store that ready film at 4C. The thickness must be 0.7m and use SEM images to determine it. To make sure the thickness of the film is always in the same magnitude order, it must be determined routinely. Then, choose 0.7 m thickness of PANI film to use for the further experiment result in good of PANI film fabrication reproducibility.6.4Enzyme ImmobilizationImmerse the PANI film in 0.1 M phosphate buffer which take pH 7.0 to make sure the condition of PANI film is at natural condition which means at pH 7.0. After that, deposit appropriate concentration about 10 L of AOX solution which is from homogenate of mushroom tissues and phosphate buffer on the PANI film and left it to dry within 30 minutes. For the further use, store this PANI film with immobilised AOX at 4 C.6.5Biosensor ConstructionConstruc t a dip stick test visual biosensor of PANI film with immobilized AOX as Figure 1, connect AOX/PANI film with a handle which made by cellulose paper or can use transparent plastic tape. To way to use this this dip-stick format visual biosensor by just dipping this kind of biosensor into the toiletries sample solution for a several seconds (5 s), then the change of colour can be seen by baked eye if the concentration of ethanol is 5% since that only amount allowed to be in toiletries products and use image analysis for the quantitative measurement change of colour.(a)(b)Figure 1 (a) dip stick format of biosensor(b) dip biosensor into toiletries sample solution (Kuswandi et.al,2014)6.6 Colour Change RecordingSee the change of colour by naked eye during alcohol detection since this biosensor is kind of visual mode. Use scanner for example Canon, Cano Scan, Japan and Tokyo for quantification of colour measurements. The presence of ethanol exceed 5% of concentration in toiletries sample solutions will change the colour of the biosensor from green to blue. The detection can be done by dipped the biosensor which in the form of dip stick test in the sample solutions in 5 seconds. Use ImageJ program which can be used as online applet, free download application or can be used in any computer together with Java 5 (Dougherty, 2009 Rueden et.al, 2007) in order to assess the colour after it has been scanned. The finding s to determine the mean RGB colour value.7.0EXPECTED RESULTThe expected result from this research is the colour of dip stick AOX/PANI film biosensor will change from green to blue if there presence of 5% of ethanol in toiletries products after the biosensor is dipped into the toiletries sample solutions for 5 seconds. Since this is the visual mode biosensor, the change of colour can easily seen by naked eyes. On the hand, use scanner (Canon, Cano Scan, Japan, Tokyo) for quantitative colour measurement and then use ImageJ program to assess the colour change of biosensor and to determine the mean RGB colour value. (Collins, 2007)

Mission And Vision Of Etihad Airways Tourism Essay

Mission And Vision Of Etihad Airways Tourism Essay1. Identify the Mission and Vision of Etihad Airways.The national flag carrier of the UAE, Etihad Airways and its journey so far since its opening in 2003 have come a long way to exudes in class, quality and ample hospitality which were crucial for the airliner to create a competitive acuity in the industry at large and in the market often known for its competitive environment. However, the bigger ch on the wholeenge is staying at the top and progressing further in such volatile market environment. Taking a tour of the company website (www.etihadairways.com) we come to the knowledge that Etihad and its services in the industry is at par with earth class expectations.Hence it will be proper if we analyze all the relevant factors of the structural process of the company and how it functions day in and day tabu in setting a road map for itself to be recognized as one of the fastest growing national flag carrier of the UAE, and a comp etitor in the industry. And the following discussion relates to each aspect the macro-economics analysis, PESTLE concepts, and SWOT analysis.Mission and Vision of Etihad AirwaysBefore we attempt to identify the vision and care of Etihad airlines, it will be proper to relate on Etihad story and its making. In that essence, the corporate communication from the airliner part describes how in particular the airline is different from the m playening crowd. In addition to put pleasure back into flying is also one of the airliner motto and narrative of an account of their heathen aspects. (Etihadairways, 2010)We can further add that the vision of Etihad airline is also closely linked to its Arabian heritage in particular. Take for instance the corporate communication in that regard, which states that reflecting the national individuation of the country and its Arabian heritage and hospitality is one dominant factor, where cultured approaches to hospitality, apart from considerate, gen erous and warm hospitality are at the roots of Etihad cultural blend. The vision of the airline is also to become one of the world(a) airliners that exude a truly 21st century, where challenges, and changing environment, plus an engaging vision to flaw the convention, (Etihad, 2010) constitutes its deep rooted vision.Thus, Etihad Airways mission like any considerate corporate is to give a refreshing welcoming to their guest, where travel should be effective and unsex in an environment that is friendly, and where global standards in both terms is practiced, be it hospitality or in the technical aspects in assuring a safe journey for its guests. (Etihad, 2010)2. How is the Macro-Environment of Etihad Airways in UAE? Analyze the influences of the PESTLE variables in the decision making.Macro-Environment of Etihad Airways in UAEIn economic terms, macro-environment relates to factors that are uncontrollable and that which are fluctuating. Thus, in macro-economics sense, and when it co ncerns businesses, macro-level criteria includes objectively ground variables and factors such as mixer, cultural, technological and the likes of governmental forces, languages, religion geography, economics blocs, (Mooij, 2004, p. 55) etc, which plays a significant role in deciding organizational comparative management in a global economy.Hence, it is no different when it concerns Etihad as well in that regard, given that market forces at times plays a crucial role in deciding the company strategies and its management, where the understanding of convergence and divergence at the macro-level is very important (Mooij, 2004, p. 56) especially for airliner that face a competitive environment in the global industry.Nonetheless, to be more precise in reflecting the macro-environment of Etihad Airways, news reports gives thumbs up for the Etihad in terms of macro-environment factorial aspects, given that the airline recently extended its market cowl and global networks, where an agree ment was singed with Yemen airways. (Karam, 2008)Hence in economic sense, the agreement with Yemen airlines will gives Etihad customers a higher hand in the two way travel and in the slowdown it will also gives Yemen Airways customer an access to Etihad airways networks, say CEO of the company, James Hogan. (Karam, 2008)In such respect to the development of the macro-environment factors, it appears that Ethiad is very well placed in terms of its competitiveness. And the first quarter growth for the financial years ending 2010, Etihad reported a 25.4% jump in its growth, which as per industry wise comparing is way above, due to factors such as the increase in numbers of seats in Etihad, which is one crucial investment that decided the airline plenty accordingly. (BIStaffReporter, 2010)Thus, the above news report is one good example to reflect the macro-environment of Etihad airways in UAE, and a fact that Etihad stood the test of time in macro-economic sense.Influences of the PEST LE variables in the decision makingIn the case of Etihad, it is assumed that decision making is also at the roots of management imbroglio. However, what surprises us is the fact that Etihad in all instances involving its strategies have come out with flying colors and success. That makes it curious to reflect on how the PESTLE variables influence decision making at Etihad. But what is a PESTLE variable? Understood in simple terms, PESTLE variable or PESTLE analysis of macro-environment reflect the macro economic concepts such as the one discussed above. In addition taxes, new laws and the likes of governmental policies etc, also influences firms decision making. (OxfordUniversityPress, 2007)Hence, A PESTEL variable constitutes the factors that are relevant to influence decision making. It can reside the form of Political, Economic, Social, Technological, Environmental and finally Legal factors which defines the environment of a company. (OxfordUniversityPress, 2007)Laying focus t o this notion, we can drive home the facts that Etihad Airways is in line with respecting all the environmental regulation while conducting business. The partnership with Masdar signed in 2009 is one crucial factor on the environmental front and decision reached in that regard. (EtihadAirways1, 2010) On the political factors, Etihad is known be compliant with local and foreign policy makers, be it in US, UK and in UAE. Moreover, on the legal factors, its influences are paramount concerning Etihad management. Moreover, technological and social aspects also take centre stage in influencing decision at Etihad, and the following SWOT analysis bears testimonial.3. Conduct a SWOT Analysis of the knowledgeable and External environment of Etihad Airways.Concluding on SWOT analysisThe Internal and External environment of Etihad AirwaysStrength The biggest strength of Etihad can be laid emphasis to its world class services. And as a competitor in the market, Etihad awards itself speaks volum e on this front. (EtihadAirways2, 2010)Weakness When it matter to Etihad weaker points, news report relates that its cargo division accede some of it, given that revenue factors are also considerably made out from cargo operations. Without any strategic outline, cargo division suffers. However, with new leadership in line and strategic development undertaken, there is a positive scope that such weakness also can be overcome, say Etihad insiders. (KhaleejTimes, 2010)Opportunities As we have related above, Etihad Airways is in the process of numerous agreements, be it with Yemen Airlines as related above, or the likes of expanding its destination far and wide in foreign markets. Hence, the multinational Air Service Contract awarded by the Federal Government of Australia very recently as reported in AmeInfo.com (AmeInfo, 2010) presents the opportunistic platform of the company, we can conclude.Threats In the global environment, threats are paramount, especially concerning airline in dustry. In that respect, Etihad has taken special measure to update and keep it guest informed of any changes in regulation, be it in the domestic or international routes, (AmeInfo1, 2006) in order to avoid with any issue that may arise due to business threats.

Orthopaedic Management Of Cerebral Palsy Health And Social Care Essay

Orthopaedic Management Of Cerebral Palsy Health And Social C be EssayThe condition of intellectual paralyse refers to a vary group of permanent dis secernates of movement and posture cause by injury to the immature brain in utero, at birth or in the first geezerhood of life. These lesions atomic number 18 static not progressive and tooshie be caused by a wide variety of factors such as intrauterine infections, trauma, neonatal dead reckoning and genes, often in combination. Reflecting the varied aetiology and sites of injury cerebral palsy is often accompanied by neurological disturbances in cognition, behaviour, sensation and epilepsy. Most master(prenominal)ly from the orthopaedic perspective is that it leads to a progressive musculoskeletal pathology and abnormalities of muscularity strength, tone and joint movement. These tend to be mystical at birth and are solely revealed during the rapid branch of childhood as spasmodicity leads to abnormal posturing and thus second ary contractures and impaired torsional lift remodelling. Eventually this process leads to problems such as scoliosis, pelvis dislocation and the development of fixed contractures.1It is here that orthopaedic surgery move intervene by checking fixed deformities leading to improved function and appearance. Cerebral palsy is the most common cause of referral to elective paediatric orthopaedic units.2 This essay will discuss the various functional techniques that potty be employed to trucking rig the musculoskeletal problems caused by cerebral palsy.ClassificationCerebral palsy is classified based on the type of movement disorder present. The fitful form is the paramount type and can be divided into the subcategories of hemiplegic, diplegic or quadriplegic depending on topography. Appropriate management varies between these forms based on the level of functional outcome that can be expected the most significant factor being whether the child is ambulant or not.It was the adven t of stride analysis in the 1990s that revolutionised discussion of ambulatory cerebral palsy. Prior to this surgical intervention to improve gait was a matter of opinion, and often led to unexpected new problems which were even more than intractable. The systematic empirical approach of gait analysis, however, enabled both more targeted and precise interventions and also critical evaluation of the outcomes of surgery.3http//www.cpl.org.au/images/default-source/research/cp-body-map-graphics.jpg?sfvrsn=2Image 1 Distribution of symptoms in subtypes of cerebral palsy. Source Cerebral Palsy League4Modern gait analysis takes place in a specialised laboratory and includes a standardised corporeal exam, video recording, kinematic and kinetic measurements, electromyography, pedobarography and estimation of the energy consumption of walking.5AgeGenerally speaking surgery for ambulant CP is not attempted until after the age of 7 by which time a mature gait pattern has developed. Between t his age and the onset of the growth spurt in adolescence bone surgery is sometimes required in order to stabilise the bony levers of progression in the leg. These include femoral or tibial derotation osteotomies, intertrochanteric derotation of the femur and stabilisation of the subtalar complex.6It is between the ages of 8 and the main adolescent growth spurt (12-13 in girls, 13-14 in boys) that soft tissue surgery is undertaken, the ideal timing remaining contentious.7 Increasing maturity and sense allow for more complex surgeries that require strict compliance with rehabilitation programmes to succeed. Yet this must be balanced against the effects of the rapid growth of bone and energy that may exacerbate and complicate deformity.Surgery for spastic diplegiaDespite advances in the usage of botulinum toxin A, intrathecal baclofen and selective dorsal rhizotomy to reduce spasticity most children with cerebral palsy still develop progressive musculoskeletal deformities as they gro w. These include fixed joint contractures and bony deformities collectively referred to as lever arm disease and which can only be treated effectively surgically.8 In the past a child with spastic CP typically presented with toe-walking and was managed by aloofnessening of the tendo Achillis. Although this procedure successfully levelled the foot it often led to a crouch gait as contractures of the knee and hip developed progressively in late childhood. Nowadays in that respect is a strong consensus that the best approach is to gait castigation is to address all deformities simultaneously in what is known as single-event multi-level surgery.9Correcting fixed contractures is achieved by both fractional lengthening or muscle-tendon recession. Established procedures include tenotomy (lengthening) of the psoas muscle at the pelvic brim, rectus femoris transfer to semitendinosus or sartorius and fractional lengthening of the medial hamstrings.To correct bony torsional abnormalities n ecessitates rotational osteotomies. For femoral anteversion and concomitant hip internal rotation, femoral derotation osteotomy has proven to produce very effective and durable results.10 In order to correct a valgus foot deformity there are two options a lengthening osteotomy of the os calcis or more commonly an extra-articular subtalar joint unification utilizing an autogenous graft of bone from the iliac crest combined with a screw fixation .11Spastic hemiplegiaThe most common joint deformities in the upper limb include internal rotation of the shoulder, elbow flexion, forearm pronation, wrist flexion and ulnar deviation, and swan-neck and thumb-in-palm deformities in the digits .12 Muscular injection with BTX-A can be useful in managing stiffness and increasing range of movement but is not effective at improving function.13As with gait correction deformities in the upper limb are treated in a one-stage multilevel operation combining muscle releases and tendon transfers. The mo st common procedures are biceps aponeurosis and pronator teres release for pronation of the forearm, tendon transfers to extensor carpi radialis longus or brevis for ulnar deviation/wrist flexion (with first web z-plasty) and first dorsal interosseous and adductor muscle release with tendon transfer for thumb-in-palm.12Patterns of gait in spastic hemiplegia have been classified comprehensively by Winters et al. and can be used to be after surgical management. In groups I and II the primary abnormality is drop foot due to equinus contracture which can be treated by lengthening of the gastrocsoleus muscle and appropriate orthosis. The situation is more complex, however in groups III and IV which require multilevel surgical intervention and gait analysis due to the familiarity of proximal muscles leading to jump knee gait and in the case of group IV fixed hip flexion on top of equinovarus. These can be managed in the same way as soft tissue deformities in spastic diplegia by fraction al lengthening or muscle-tendon recession.14Image 2 Saggital gait patterns in hemiplegia classification and management. For each group contractures shown in orange text, orthoses in green, surgical correction in red. Adapted from Winter et al.14Tendon transfers to correct muscle imbalances are also employed in hemiplegia. This is most useful for equinovarus deformity, which is treated with split tendon transfer of the tibialis posterior (useful in the young patient with more flexible deformity) or anterior combined with lengthening of the gastrocsoleus and tibialis posterior (better for older children with stiffer deformity).15, 16Another possible problem in hemiplegia is limb trim down, presenting most commonly in the tibia and ranging from 1-3 cm. If necessary operative correction can be achieved by epiphysiodesis at the end of growth plates proximal to the knee at the appropriate age.7Spastic QuadriplegiaSurgical management of a child with spastic quadriplegia is particularly c hallenging owing to the presence of treble co-morbidities such as epilepsy, osteopenia, respiratory disease and nutritional deficiencies. As such it requires the close co-operation of a multi-disciplinary team to manage possible complications as well as follow-up in terms of pain and intensive care. A variety of tests are important to help assess suitability for surgery. Lung function tests are used to evaluate the likely necessity of protracted assisted ventilation after the operation. Testing serum total protein and albumin levels is used to spot malnutrition associated with poor irritate healing and infection. Detection of osteomalcia due to anti-epileptic medication is important and must be treated, and improving general nutritional state through supplementation is often desirable. Finally, appointment of the degree of osteoporosis due to disuse is relevant in assessing the stability of any surgical fixation desired.7Hip ManagementHip displacement is rarest in spastic hemiple gia at 1%, uncommon in spastic hemiplegia at 5%, but much more common in spastic quadriplegia with an estimated incidence of 35-55%.17 If left untreated it may lead kyphotic sitting posture and pelvic asynclitism increasing the risk of spinal deformity as well as chronic hip pain and increased difficulties in activities of daily living. In hemiplegia and diplegia the gait is so severely impacted that subluxation is determine early due to rapid orthopaedic referral. In quadriplegia, however, due to the higher visibility of issues such as seizures and feeding difficulties and the fact hip displacement is hidden in the early stages, it often can go undetected. Thus systematic radiographic screening is vital to detect it early with one study recommending commencing at 30 months and following up every 6 months thereafter.18When abnormality is detected it is best to intervene early to try to prevent dislocation. The favoured soft tissue surgical approach is adductor and psoas tenotomies .19 If dislocation has already been established more drastic intervention is required with a single-stage open reduction of the hip, combined with a varus shortening derotation osteotomy of the proximal femur, which relieves pressure from the rim of the acetabulum stimulating growth and balancing the soft tissues by re-tensioning the hip abductors and relaxing the adductors, and a pelvic osteotomy to improve the take form and coverage of the acetabulum.20 Although this procedure offers the best long-term prognosis in terms of stability, further dislocations are not infrequent.21ScoliosisScoliosis in cerebral palsy can be non-structural secondary to femoral and pelvic muscular spasticity or structural secondary to contractures of the intrinsic spinal muscles. In non-ambulant patients it often extends to the sacrum and is associated with poor sitting posture, pelvic obliquity and hip dislocation. Prevention of these is thus vital to reducing the risk of distortion of the spine. Surgi cally the established management of severe scoliosis is instrumented posterior fusion along the length of the spine to the pelvis.6ConclusionAs surgical techniques for correcting deformities have proliferated and been refined in recent decades so the orthopaedic management of cerebral palsy has progressed from art to science. We are now in the pleasing position of having a tried and tested toolbox of procedures to deploy in the common musculoskeletal pathologies induced by diplegia, hemiplegia or quadriplegia.Yet a tool is only useful if it is used in the right place and so it is arguably the standardised assessment provided by gait analysis as well as improved understanding of the development of gait that has made the most difference by allowing clinicians to target interventions barely temporally and anatomically to ensure the best outcomes. Although validated evaluations exist for the upper arm they have yet to reach the same level of reliability and catholicity as gait analysis , a desirable goal for future research.It is also important to remember that orthopaedic interventions can only ever ameliorate kind of than solve the lifelong disabilities caused by cerebral palsy. For this reason it is vital that management first and foremost takes into account the desired outcomes of patients and carers including concerns such as cosmesis and independence. Likewise it is important to emphasise functional outcomes rather than abstract measures of deformity as these are in the end more important to patients.

Pragmatic Justification Essay -- Philosophy, Bertrand Russell

Bertrand Russell, one of the most influential philosophers of the modern age, argued extensively in his book, The Problems of Philosophy, that the belief in inducive reasoning is only rational on the grounds of its intrinsic evidence it cannot be justified by an supplicant to experience alone (Russell 1998). Inductive reasoning refers to a form of reasoning that constructs or assesses propositions that are generalizations of observations (Russell 1998). Inductive reasoning is thus, in simple terms, probabilistic. The premises of an inductive logical argument provide some degree of support for the conclusion, but that support is in no way definitive or conclusive (Browne, 2004). further even if one agrees with Russell and concludes that there are no rational justifications for the principle of induction in and of itself, one can still maintain that there is a pragmatic justification for maintaining a belief in the principle. Simply put, there are still perfectly sound reasons for behaving as if the principle of induction holds true, regardless of whether or not the principle itself is rationally justifiable (Browne, 2004). This type of justification can be used across many of the belief systems that we as kind-hearted beings hold, even stretching to the playing field of religion. In this paper I will outline not only why it is pragmatically justifiable to swear in the principle of induction, but also why it is equally as justifiable to believe in an infinite God, regardless of whether or not deductive reasoning provides us with definitive support for such conclusions. Lets begin by examining the issue of universal order and the Problem of Induction. The problem with inductive reasoning is that it is based on the assumption that ... .... Yet for our own comfort and peace of mind, we must believe that past occurrences, such as the sun ascending yesterday and the thousands of days before that, provide us with perfectly good evidence for believing that tomorrow the sun will rise again. By the same(p) token, we can rationally support a belief in God, even if we cannot provide conclusive evidence for His existence (or non-existence). These types of pragmatic justifications are, I believe, essential to the happiness and well-being of human beings. Regardless of whether or not the arguments for the merit and existence of both God and the principle of induction hold any water whatsoever, the hopeful approaches to the problems are in no way harmful. They allow us to live our lives in relative happiness, regardless of the fact that we ultimately can be certain(a) of so little in the universe we live in.

Management Control Systems Essays -- Business Controlling Function

There are many different types of authority that displace be established in an organization depending on its goals and objectives. There are many different approaches to the attention autocratic function. Some of these learn clays are bureaucratic control, market control and clan control. All of these control dusts focuses on a different part of the business depend ending the necessities of the organization in that moment. All of the control systems have their advantages and disadvantages.The controlling function is defined as any process that directs the activities ofindividuals toward the achievement of organisational goals*. The controlling function is the one that set the game rules. This function set the organizational standards rules and norms. The controlling function works hand to hand with the planning function because the controls are the ones that ensure that the plans are fulfilled. The established controls must go in viscidity with the plans because the suc cess of each will depend on the other. The control function not only control the personnel it also control things as , budget, organizational resources, machinery, materials or components, physical structure and more. The control process must set performance standards, measure performance, compare performance with the standards and take corrective action if essential in order to be effectiveOne of the most used control systems is the bureaucratic control system. The bureaucratic control system Bureaucratic control is defined as the use of rules, regulations, and formal authority to guide performance*. The bureaucratic control system is a very rigid and formal one. This system establishes a well defined set of rules and procedures in order to achieve the organizational goals and objectives. This system is based on hierarchy were roles and authority has been well defined. This control system involves personnel close monitoring, supervision and direction of subordinates by superiors. The bureaucratic control different uses tools as budget as a control device, management audits, external audits, and internal audits.The market control system is based on the use of pricing mechanisms and economic information to regulate activities within organizations*. This control system is based in external factors that affects an organization rather than the internal factors.... ...n reaction of the implementation of this system. This tactical behavior is defined as the beating the system behavior. This can be harmful to an organization because employees can start to report false information. This will have bad consequences to the organization because it will provide wrong information for the forecasting and planning of future organizational goals and objectives.Controlling can also produce a resistance to control reaction because Control systems usually produce mistakes, threaten peoples job security and status, and decrease peoples autonomy it can also change the organizati onal structures and the authority chain of mountains of command. It can also disrupt the social relations of a group.In order to develop a system functional system for an organization the scoop up decision is to make a hybrid one. Not only taking the organizational objectives in rumination but also taking in consideration the employees and the external and internal factors that affects all of the organization.ReferencesBateman-Snell Management The NewCompetitive Landscape,Sixth Edition chapter 16James Higgins, The Management Challenge, Second Edition, Macmillan, 1994