Thursday, October 31, 2019

Arcor Case Analysis Term Paper Example | Topics and Well Written Essays - 2250 words

Arcor Case Analysis - Term Paper Example The company was founded in the year 1951, producing a wide range of products ranging from confectioneries to personal hygiene products and also frozen goods. At present the company operates in over 120 countries worldwide and Arcor was also ranked 14th amongst the top 100 candy companies at US in the year 2009 with a revenue of US $ 2.2 billion. The company provides high quality products and on the other hand to reduce the cost of the product Arcor vertically integrated the packaging system into their system. In the year the company was nominated as the ‘best company’ in Argentina from the chamber of commerce of US. This award recognizes the company who includes management sustainability in their corporate practices. The Company also encourages in promotion of education at Argentina and Brazil. This social responsibility is aimed to minimize the problems arising at workplace and the impacts of environment at the manufacturing plants (Innovalatino, 2010). Situation analys is SWOT Analysis The growth of the company and sustainable survival in the industry the SWOT analysis is conducted by the company. It helps the company to understand the strength, weaknesses, opportunities and threats of the company identification of which can assist in the implementation of strategies according to the needs of development. Strength Arcor has a great brand name at Argentina. The company’s huge percentage in the domestic market share with around 54% in the candy and 33% at chocolate market gave the company immense popularity in the international market due to its strong base. International acquisition strategy of Arcor with small third party to reduce its price to the end user along with the vertical integration structure for manufacturing of different ingredients facilitates the process of reducing price for the company. This is the major strength of the company which keeps the price low for the firm without affecting the quality of the product. Weaknesses Th e production plants of the company are all located in domestic country thus distribution of the company is a very important aspect to look after by the company. Proper training of the distribution channel and salesperson are required by the company failing to which might create problem for the company to reach to the customers in foreign countries. Building own distribution system can help the company to cope with this problem. Opportunity New product line from the company with over 50 new candy compared to 10 from each competitor can create a huge potential for the company in developing countries where the demand for candies are growing in recent years. Demand for chocolate and confectionery are also increasing which can be a great opportunity for the firm to launch new products in this category (Ghemawt, Rukstad, Illes, 2009, p. 5). Threats Financial crisis and economical slowdown is one of the major threats for the company. While entering into new market the political factor is a lso a possible threat as change in policies of the government can increase the tax on import and export duties which might force the company to increase price for the products, thus loosing the title of being the cost leader in the market. Competitive analysis To get an extra edge in the competitive environment Arcor should analyze the external environment of the firm and understand the threats from different dimensions like new entrants, suppliers,

Tuesday, October 29, 2019

Introductory Business Law Essay Example | Topics and Well Written Essays - 1500 words

Introductory Business Law - Essay Example Observance of the Act is imposed by a sovereign government authority, the Information Commissioners Office (ICO). The ICO maintains direction pertinent to the Act.2 The Act characterizes eight principles of information-handling practice. The Data Protection Act is considered an immense Act that has a status for difficulty.3 At the same time as the fundamental principles are honored for the protection of privacy, understanding the act is not all the time simple. Numerous companies, organizations and individuals appear hesitant of the aims, substance and even principles of the DPA. Some hide behind the Act and rebuff to give even very indispensable, publicly accessible material referencing it to the Act as a restriction.4 The act also impacts the manner in which organizations carry out business in terms of who can be contacted for marketing purposes, not only through telephone and direct mail, but also by electronic means and resulted the improvement of permission which has its basis referenced to marketing strategies. The Scottish Parliament enacted the Freedom of Information (Scotland) Act 2002 (the Scottish Act) was on 24 April 2002 and received Royal consent on 28 May 2002. The Scottish Act provides a new general constitutional right of access to all types of recorded information of any age in the custody Scottish public authorities. The UK Act does is not applicable to public authorities covered by the Scottish legislation. On the other hand, the Scottish Act does not taken into account and cover the UK government departments functioning in Scotland as well across-border public authorities (for example the Ministry of Defence and the Forestry Commission). These institutions and authorities are covered by the UK Act. The Scottish Act is only applicable to public authorities and not to private entities. Public authorities are, on the other hand, generally described in the Scottish Act, and comprise not

Sunday, October 27, 2019

The environmental management

The environmental management Environmental Management is a very important component of sustainable living. The interdisciplinary and transdisciplinary nature of Environmental Management enables it to solve the complex environmental problems (pollution, erosion, flooding, deforestation, desertification, just to name but a few) that essentially characterize our landscape at the local regional and global scale. To better understand these problems, the discipline draws on a wealth of expertise in both concepts and approaches from the natural or physical and social sciences to develop this interdisciplinary. This essay seeks to explore the nature of environmental management and in particular, attention is drawn on the interdisciplinary and transdisciplinarity of environmental management. The environmental problems we face today are many and varied. From pollution, erosion, flooding, deforestation, desertification, to climate change- all present themselves in very practical terms and as such environmental management is more important than ever before. However, the field has been the subject of wide criticism. For instance Bryant and Wilson (1998) criticized the field as a result of the limitations in the understanding of root causes-political, economic or cultural issues. There is no generally acceptable definition of the subject environmental management. This is partly due to its broad scope and in part of the diversity of specialism (Barrow, 1999). However, attempts have been made by several authors to define environmental management. For example, Riordan (1995); Barrow (1999); Wilson and Bryant (1997); Bryant and Geoff (2009), have all made substantial effort to define Environmental Management. Environmental management has been defined as both a process and a field of study (Wilson and Bryant 1997). In his book, Barrow (1999 p. 5) presented an overview of some definitions of Environmental Management. Like Environmental Management, definitions and interpretations of interdisciplinarity and transdisciplinarity abound in literature. For instance, Klein, 2004; Tress and Tress, 2001; Tress et al., 2005; Jones and Macdonald, 2007; Evans and Randalls, 2008; and Wesselink, 2009. In its simplest sense interdisciplinarity is an integrative research approach that transects many disciplinary boundaries with a common goal and the aim of production of new knowledge and theory (Tress et al., 2005). As a process, Environmental Management, according to (Wilson and Bryant, 1997 p.7) can be defined   Ã‚  Ã‚  Ã¢â‚¬Å"as a multi-layered process associated with the interaction of state and non-state environmental managers with the environment and with each other. Environmental Managers are those whose livelihood is primarily dependent on the application of skill in the active and self conscious, direct or indirect, manipulation of the environment with the aim of enhancing predictability in a context of social and environmental uncertainty. † While the term state will include state officials such as Department of the Environment, DoE, and Department of Environment Food and Rural Agriculture, DEFRA, just to name a few, non-state, on the other hand includes environmental NGOs, farmers, transnational corporations(TNCs), hunter-gatherers. In this light, environmental management is a process not exclusive only to large national and international environmental actors but inclusive to a range of predominantly local level environmental actors (Wilson and Bryant, 1997). On the other hand, Environmental management, as a field of study, evolved with the growing concern about environmental degradation in the late 1960s and early 1970 (Bryant and Geoff, 2009; Wilson and Bryant, 1997) after post industrialization. According to Barrow (2006: 24-26) Environmental Management as a field can be subdivided into the following: â€Å"sustainable development issues; environmental assessment, modeling, forecasting and hindcasting;corporate environmental management; pollution recognition and control; environmental economics;environmental enforcement and legislation; environment and development institutions and ethics; environmental management systems and quality issues; environmental planning and management; assessment of stakeholders involved in environmental management; environmental perceptions and education; community participation for environmental management/sustainability; institution building for environmental management/sustainable development; biodiversity conservation; natural resources management; environmental rehabilitation/restoration; environmental politics; environmental aid and institution building†. While the list is not exhaustive, partly because Environmental Management is relatively a nascent discipline (Barrow, 2006) and is still evolving, its broad scope is readily appreciated at a glance, as it tends to techno-centric problem solving approach rather than reactive approach. Table 1 highlights some distinguishing features of traditional environmental management as it were during its early evolution and at present. Referring to interdisciplinarity, the interdisciplinary nature of environmental management is more than just integration. It is essentially a modern way of thinking that involves identification, definition as well as interpretation of studies with the view of proffering practical oriented solutions to environmental problems (ORiordan, 1995). Again, Transdisciplinary studies according to Tress et al. (2005) involves the integration of both academic and non-academic participant (stakeholders) to research a common goal with the creation of new knowledge and theory. It is explicit from the definitions above that interdisciplinarity and transdisciplinarity are both integrative, in that new knowledge and theory is created. However, a distinguishing element is that transdisciplinary research combines interdisciplinarity with a participatory approach (Tress et al., 2005) Traditional Environmental Management Modern Environmental Management Largely top-down approach Bottom-up approach Management was authoritarian participatory and much more integrative Short term plan Long term plan and therefore sustainable Exploitational in approach Emphasizes stewardship rather than exploitation. Tends to be reactive Tends to be proactive and participatory Disciplinary, at best multidisciplinary Interdisciplinary, or even holistic in approach State centric Non state factors involved in the process of EM Influence of natural science discipline Shift from the natural science to social science Tress and Tress (2001) introduced a transdisciplinary landscape concept. The transdisciplinary landscape concept, according to Tress and Tress (2001) is based on five dimensions: the spatial entity, the mental entity, the temporal dimension, the nexus of nature and culture, and the systemic properties of landscape. The significance of collaboration in interdisciplinary and trandisciplinary research in the understanding of human-environment interaction cannot be overemphasized. Although environmental management takes its root from the natural science, however there seems to be a shift from the natural science to social science (Bryant and Wilson, 1998). Figure 1 as shown in the appendix depicts the profound influence from the social sciences and again, in the words of Wilsons and Bryant (1997, p 17) Environmental Management operates at the intersection of a range of disciplines and subdisciplines. From the foregoing, It is obvious that Environmental Management is increasingly becoming interdisciplinary and applying a great deal of transdisciplinarity approaches. For example, Wesselink (2008) and Potschin and Haines-Young (2005) have emphasized the importance of applying transdisciplinarity in their studies of land use planning and landscape ecology respectively.. While the environmental problems we face today are many and varied both in scope and complexity, no one discipline can effectively provide the knowledge adequate enough to fully understand nor solve them (Tress and Tress, 2001). Modern approaches of interdisciplinary and transdisciplinarity in Environmental Management can be a panacea of all local to global environmental ills. This notwithstanding, more powerful and robust tools are needed for dealing with the problems of scaling and uncertainty which are crucial in the human-environment interaction at all scale. It is the position of this essay, therefore, that while the search for a strong and robust tools continues in order to mitigate, control and prevent environmental problems, active consultation and collaboration with local communities is a necessary ingredient for sustainable solution. References Barrow, C. J 1999. Environmental Management: Principles and Practice. Routledge, London. Barrow, C. J. 2006. Environmental Management for Sustainable Development. 2nd edition. Routledge, London. Bryant R.L and Wilson G.A 1998. Rethinking Environmental Management. Progress in Human Geography 22(3) pp 321-343 Evans, J. and Randalls, S. 2008 Geography and Paratactical Interdisciplinarity: Views from the ESRC-NERC PhD studentship programme. Geoforum 39 pp 581-592 Jones, P. and Macdonald, N. 2007. Getting it wrong first time: building on interdisciplinary research relationship. Area 39(4) pp 490-498. ORiordan, T. ed 1995 Environmental Science for Environmental Management Longman Scientific Technical, England. Potschin, M and Haines-Young, R. 2006. Rio+10, Sustainability Science and Landscape Ecology. Landscape and urban planning. 75, 162-74. Phillipson, J. and Lowe, P. 2009 Barriers to Research Collaboration across disciplines: scientific paradigms and institutional practices. Environment and Planning 41, pp 1171-1184 Klein, J. T. 2004 Prospects for Transdisciplinarity. Futures 36 pp 515-526 Tress, B and Tress, G 2001 Capitalising on Multiplicity: A Transdisciplinary Systems Approach to Landscape Research. Landscape and Urban Planning 57, pp 143-157 Tress, B., Tress, G.,Fry, G. and Opdam, P. 2005 eds. From Landscape Research to Landscape Planning: Aspects of Integration, Education and Application. Springer, Netherland. Wesselink, A 2009. The Emergence of interdisciplinary Knowledge in Problem-focussed Research. Area 41 (4) pp. 404-413. Wilson, G. A and Bryant, R.L 1997. Environmental Management: New Directions fot the Twenty-First Century.UCL, London

Friday, October 25, 2019

Essay --

Soccer Supporters Community The word community is primarily referred to our association with a neighborhood, town or city. But besides its dictionary definition, a community is also what holds a certain group of people together based on their interests, beliefs, practices and values. The world is conformed by many of these communities, but there is one that stands out because of its enormity and the passion that is shared within its members, the soccer supporters community. Soccer supporters are the most diehard fans in the sports world; their love and enthusiasm towards a soccer club is beyond normal and their distinctive practices makes them a worldwide community. This community is mainly defined by the devotion soccer fans have towards their favorite club and the things they’re willing to do to support their team at every game. This unique fanaticism makes them different from other sports supporters. The set of practices and habits that soccer supporters carry out are things like wearing the jersey of your team at all games, create banners on support, sing chants to motivate your team, travel to the away games, watch other soccer leagues, play soccer, stay tuned on what is going in the soccer world, but overall respect the game. Needless to say, every community has a sense of stability that declares what is acceptable and what is not. That stability is possible thanks to a community’s traditions and behaviors that must be followed by those who belong to them, and in this case, soccer supporters are not the exception. As Eduardo Galleano once said, â€Å"in life a man can change wives, political parties, or religions, but he cannot change his favorite football team,† and that’s is the number one principle of a soccer supporter, t... ... World Cup champions, their support and passion are going to be at the highest possible level. This amount of fervor is what holds the community together. Therefore the soccer supporters community is about love, respect, passion, loyalty, commitment and many other qualities that bring people from all round the globe together that share the same love for a sport. There are standards of behaviors and traditions that must be followed in order to have a sense of stability within the community. As I mentioned before, one of the main purposes of this community is to prevent every aspect that can spoil the image of the game, and lastly supporters must take advantage of such events like the World Cup, in order to interact and relate with supporters of other teams, so that all supporters share the love for the game, enjoy the game, respect the game and live for the game.

Thursday, October 24, 2019

Define Pneumonia And Explain Health And Social Care Essay

Pneumonia is infection that affects either one or both of the lungs. It is non a individual disease and it may hold more than 30 types of different causes, including bacteriums, Fungis and viruses. In immature kids with the age of less than 5 old ages old, viral pneumonia is the most common type of pneumonia, with its most common cause being the grippe virus. There are many other viruses that can do pneumonia every bit good, such as respiratory syncytial virus, herpes simplex virus, rhinovirus and terrible acute respiratory syndrome ( SARS ) . Community-acquired pneumonia is the most common type of pneumonia which is acquired in public countries like the school, food market shop or working topographic point. It might be caused by either bacteriums, Fungis, virus or the thorns present in the air, with the most common cause being the bacterium Streptococcus pneumoniae. Its development can besides happen following a grippe or cold [ 1 ] . Hospital-acquired penumonia which is besides known as institution-acquired pneumonia is acquired in the infirmary, peculiarly while remaining and under intervention in the intensive attention unit ( ICU ) or using a ventilator to help in take a breathing. It normally besides develops following a major surgery including thorax surgery or during dialysis in kidney dialysis centres or remaining in chronic attention centres. It has the possible to be really unsafe, peculiarly to those who are immature, aged or immune-compromised [ 1 ] .List the clinical symptoms ( systemic versus respiratory ) associated with pneumonia.Systemic symptoms [ 2 ] : – Mild or high febrility – Shaking icinesss – Concern – Loss of appetency – Fatigue, low energy – Increased perspiration and clammy tegument – Confusion ( peculiarly in the aged ) Respiratory symptoms [ 2 ] : – Cough ( may includes production of light-green or xanthous mucous secretion, even blood mucous secretion in certain types of pneumonias ) – Shortness of breath ( might merely happen while mounting up stepss ) – Stabbing or crisp thorax hurting which can decline with deep breath or coughUsing the SMART-COP tool and the information provided above calculate MR Barnes ‘ SMART-COP mark and find if Mr Barnes has mild, chair or terrible CAP.Mr Barnes ‘ SMART-COP mark is 6, which mean he has terrible CAP and has a high hazard ( 33 % ) of necessitating intensive respiratory or vasopressor support ( IRVS ) [ 3 ] . The mark might be lower than his existent mark though due to the deficiency of information sing Mr Barnes ‘ albumen concentration in plasma, bosom rate, mental position and blood pH.Complete the undermentioned intervention program for the direction of Mr Barnes ‘ CAP, as would be outlined in the patient ‘s admittance notes, utilizing the tabular array provided.Treatment programExplain the ground:– for your recommendation/responsewhen make fulling in the spaces.– the physician has ordered certain trials andobservations etcto get down the undermentioned IV empirical antibiotics ( include dosage ) : moxifloxacin 400mg IV, daily & A ; azithromycin 500mg IV, daily. Broad-spectrum antibiotics are required ab initio for the intervention of Streptococcus pneumoniae, Legionella penumophila, and enteral Gram-negative B. Since Mr Barnes is allergic to penicillin, moxifloxacin is used in topographic point of penicillin. for paracetamol 0.5 to 1g orally or aspirin 600mg orally for pleuritic thorax hurting. To supply sufficient analgesia to enable equal respiratory motions in add-on to cut downing the hazard of atelectasis and pneumonia. for auxiliary O via rhinal prongs. Because Mr Barnes ‘ O impregnation is 89 % which is rather low. for salbutamol 5mg q4h prn via atomizer. For the intervention of airflow restriction or for the betterment in mucociliary clearance. for repetition chest X ray in following 2 yearss. To do certain that the intervention is effectual for the pneumonia infection [ 1 ] . withhold Altace tablets. To forestall farther decrease in Mr Barnes ‘ blood force per unit area as he is already in hypotensive province. for day-to-day full blood scrutiny ( FBE ) , U & A ; E ‘s, Creatinine. To look into the white blood cells count and type, and besides to find the badness of Mr Barnes ‘s pneumonia infection. for QID observations ( BP, Resp Rate, Temp, O2 impregnation ) . To find whether Mr Barnes is retrieving good from the pneumonia infection. follow up blood and phlegm civilizations. To supervise the obliteration of the specific causative agents of Mr Barnes ‘ pneumonia.What changes to prove consequences, observations and patient symptoms would the medical staff and you as druggist proctor, to bespeak that the antibiotic therapy is effectual?I will supervise Mr Barnes ‘ x-ray consequence, if the x-ray consequence showed that the pneumonia infection country is cut downing so that means the antibiotic therapy is effectual. Furthermore, I will besides supervise the pulse oximetry or blood gases test consequence, if the O impregnation goes up closer to ~95 % so the antibiotic therapy is most likely effectual. Besides this, I will besides supervise the day-to-day full blood scrutiny consequence, the antibiotic therapy is effectual if the white blood cells count is returning to the normal degree. I would besides supervise the consequence of his blood and phlegm civilizations. If the figure of the causative agents of his pneumonia is continuously cut downing , that indicates that the antibiotic therapy is effectual. Besides this, I will besides supervise Mr Barnes ‘ temperature, blood force per unit area and respiratory rate as good. If all of them bit by bit returned to their several normal degrees so the antibiotic therapy is effectual. Not merely this, I will besides detect and inquire whether does Mr Barnes ‘ initial showing symptoms such as coughing that produces phlegm, pleuritic thorax hurting and feeling of unease are bettering. If they are bettering, so the antibiotic is most likely effectual.( I ) What unwritten antibiotic would you urge for Mr Barnes given all afore mentionedinformation?I would urge moxifloxacin, 400mg orally, daily for Mr Barnes [ 3 ] .( two ) What would be the recommended continuance of antibiotic intervention?The recommended continuance of antibiotic intervention is 7 yearss.( three ) In point signifier list the guidance points you would supply to Mr Barnes for thisantibiotic.Take moxifloxacin together with repasts. Avoid taking alkalizers, Fe and Zn addendums within 2 hours of taking moxifloxacin as they might interfere with the soaking up of moxifloxacin. Be certain to take moxifloxacin until finish. Moxifloxacin can ensue in giddiness, confusion or faintness, which may so take to cut down ability to drive and/or operate machinery. These effects can be exacerbated by intoxicant ingestion. If experience any tenderness of redness of sinew, discontinue moxifloxacin, do n't exert, and confer with the physician in the shortest clip as possible. It is common to see sickness, stomachic disturbance and diarrhea while taking moxifloxacin. Ensure plentifulness of fluids intake ( 1.5-2L per twenty-four hours ) while taking moxifloxacin. Avoid from utilizing urinary alkalinisers together with moxifloxacin as there is the hazard of cystalluria. Moxifloxacin might increase the caffeine ‘s effects in certain people by suppressing its metamorphosis, hence decrease in caffeine consumption might be required.For the pneumonia caused by the undermentioned pathogens, list the antibiotic ( s ) you would urge for â€Å" directed therapy † . Complete the tabular array below.Pathogen doing the pneumoniaDescription of the pathogenis it gram negative or gram positive bacteriums?is it aerophilic or anaerobiotic?is it a fungus or virus?Antibiotic recommendationNon-MRSA staphylococcal pneumonia It is a Gram-positive aerophilic bacteriums. ( facultative anaerobe if is aureus ) Di/flucloxacillin 2g IV, 4 to 6 hourly. – With penicillin hypersensitivity ( excepting immediate hypersensitivity ) : Cefalotin 2g IV, 4 hourly. Cephazolin 2g IV, 8 hourly. – With immediate penicillin hypersensitivity: Vancomycin 1.5g IV, 12 hourly. Legionella species It is a Gram-negative aerophilic bacteriums. – With mild disease: Azithromycin 500mg orally, daily for 5 yearss OR Doxycycline 100mg orally, 12 hoursly for 10 to 14 yearss. – With terrible disease: Azithromycin 500mg IV or orally, daily. PLUS Ciprofloxacin 400mg IV, 12-hourly. Pseudomonas aeruginosa It is a Gram-negative aerophilic bacteriums. Gentamycin 4 to 6 mg/kg for 1 dosage, so dosing interval is determined by nephritic map for a upper limit of either 1 or 2 extra doses. PLUS EITHER Ceftazidime 2g IV, 8-hourly. OR Meropenem 500mg to 1g IV, 8-hourly. Mycoplasma pneumoniae It is a Gram-negative facultative anaerobic bacteriums. Doxycycline 200mg orally, for the first dosage, followed by 100mg orally, daily.Mentions:FamilyDoctor.org [ home page on the Internet ] . Leawood, KS: American Acedemy of Family Physicians ; c2012 [ cited 2012 Sept 20 ] . Pneumonia ; [ about 9 screens ] . Available from: hypertext transfer protocol: //familydoctor.org/familydoctor/en/diseases-conditions/pneumonia.printerview.all.html American Lung Association [ home page on the Internet ] . Washington, DC: American Lung Association ; c2012 [ cited 2012 Sept 20 ] . Symptoms, Diagnosis and Treatment ; [ about 4 screens ] . Available from: hypertext transfer protocol: //www.lung.org/lung-disease/pneumonia/symptoms-diagnosis-and.html. eTG complete [ home page on the Internet ] . Victoria, Australia: Curative Guidelines Limited ; c2012 [ updated 2012 Jul ; cited 2012 Sept 20 ] . Available from: hypertext transfer protocol: //etg.tg.com.au.ezproxy.lib.monash.edu.au/conc/tgc.htm? id=27b1fc15b4331af2841f02ef96ddc67b Lab Trials Online [ home page on the Internet ] . Washington, DC: American Association for Clinical Chemistry ; c2001-2012 [ cited 2012 Sept 20 ] . Pneumonia ; [ about 4 screens ] . Available from: hypertext transfer protocol: //www.labtestsonline.org.uk/understanding/conditions/pneumonia/start/3 Monash University Studies Online [ home page on the Internet ] . Victoria, Australia: Monash University ; c2012 [ updated n.d. ; cited 2012 Sept 20 ] . Available from: hypertext transfer protocol: //muso.monash.edu.au/webct/urw/lc19907.tp0/cobaltMainFrame.dowebct The Ohio State University at Mansfield [ home page on the Internet ] . Mansfield, OHIO: The Ohio State University at Mansfield ; c2012 [ cited 2012 Sept 20 ] . Bacteria Binomials ; [ about 32 screens ] . Available from: hypertext transfer protocol: //www.mansfield.ohio-state.edu/~sabedon/biol4045.htm Rowlinson M. C, LeBourgeois P, Ward K, Song Y, Finegold S. M, Bruckner D. A. Isolation of a Strictly Anaerobic Strain of Staphylococcus epidermidis. J Clin Microbiol [ series on the Internet ] . 2006 March ; [ cited 2012 September 20 ] ; 44 ( 3 ) : [ about 12 screens ] . Available from: hypertext transfer protocol: //www.ncbi.nlm.nih.gov/pmc/articles/PMC1393158/Case Study 2:A definition of Epididymo-orchitis ( EO )Epididymo-orchitis is painful redness that involves either the epididymis ( epididymitis ) or the testiss ( orchitis ) or both together ( epididymo-orchitis ) [ 1,2 ] . Due to the fact that epididymis and testiss locate following to each other, distinguishing whether the redness merely affects one of these or both together can frequently be hard and therefore, epididymo-orchitis is the normally used term. Sexually transmitted infection such as gonorrhea or chlamydia is the most common cause of EO in younger work forces with the age of & lt ; 35 old ages old [ 1 ] . On the other manus, non sexually familial infection such as urinary piece of land infection is the chief cause of EO in older work forces aged 35 old ages old and above. It can normally be treated by antibiotics with full recovery in most instances without any complications [ 2 ] .( I ) Epididymo-orchitis can be acquired sexually or non-sexually ; supply a elaborateaccount of this statement.Epididymo-orchitis ( EO ) has both types of chief causes, viz. sexual causes and non-sexual causes. Sexual causes include sexually-transmitted infections, with chlamydial and gonorrhoeal infections being the most common 1s [ 2 ] . This is the most usual cause of EO in younger work forces although this can besides be the cause of EO in any work forces who are sexually active. In most instances of EO caused by sexually-transmitted infections, the urethra is normally affected and ensuing in urethritis, followed by the infections on occasion distributing down the vessel deferens and farther more to the testicle and epididymis, doing EO. Non-sexual causes include urinary piece of land infections, epidemic parotitiss virus, medicine, operations that involve the urethra or prostate, scrotum hurt and other viral infections, with urinary piece of land infection being the most common cause among thsee [ 2 ] . Urinary piece of land infections are normally caused by Gram-negative enteral bacteriums like E. coli which may on occasion distribute to the testicle and epididymis via the vessel deferens [ 2,3 ] . This affects all work forces at any age and is the most usual cause of EO in older work forces with the age of 35 old ages and supra. The ground behind this is that urine flow is normally being partly blocked with increasing age as a consequence of hypertrophied prostate or urethra narrowing, taking to higher hazard of developing urinary piece of land infection and therefore EO as complication. Mumps virus every bit good as other viruses doing viral infections may be able to make the testicles through the blood stream on occasion, and therefore, ensuing in epididymo-orchitis ( EO ) [ 2 ] . Medication such as Cordarone may besides hold the side consequence of doing EO which normally occurs with the dosage of more than 200mg. Operation which involves the prostate or urethra may present bacteriums into those sites from which the bacterium can distribute to the testicles and doing EO, although this cause is rare nowadays thanks to break surgical techniques.( two ) a list of the likely causative pathogens of EO ( sexually and non-sexuallyacquired ) and complete the following table [ 3,4,5,6,7,8,9,10 ] :Name of likely pathogenDescription of the pathogenis it gram negative or gram positive bacteriums?is it aerophilic or anaerobiotic?is it a fungus or virus?Which antibiotic ( s ) is this pathogen normally susceptible to?Sexually acquired:Chlamydia trachomatis It is a gram negative, aerophilic, intracellular bacteriums. Cefriaxone Azithromycin Doxycycline Neisseria gonorrhoeae It is a gram negative, aerophilic bacteriums. Cefriaxone Azithromycin DoxycyclineNON-sexually acquired:Escherichia coli It is a gram negative, facultative anaerobic bacteriums. Aztreonam Imipenem Mump virus It is a virus.–Haemophilus influenzae It is a gram negative, facultative anaerobic bacteriums. Chloramphenicol Doxycycline Ceftriaxone Moxifloxacin Neisseria meningitidis It is a gram negative, aerophilic bacteriums. Ciprofloxacin Ceftriaxone Penicillin Rifampin Mycobacteria TB It is a gram positive ( phylogenetically ) , stains acerb fast, aerophilic bacteriums. Isoniazid Rifampin PyrazinamideA list of the likely marks and symptoms of Epididymo-orchitisThe marks of epididymo-orchitis ( EO ) are [ 11 ] : Fever. Scrotal puffiness. Penile discharge. Groin hurting. Bloody seeds. Pain during interjection or intercourse. Tenderness and puffiness of the affected side ‘s groin country. Tenderness and puffiness of the testis associated with heavy feeling inside it. Pain in the testis exacerbated by striving or bowel motion. Pain associated with micturition. The symptoms of EO which may be seen upon physical scrutiny are [ 11 ] : Enlarged and stamp testis on the side affected. Enlarged or tender prostate secretory organ. Groin country of the affected side holding enlarged and tender lymph nodes.What other diagnostic trials would you anticipate to be hold been done or ordered for Mr Thompson to assistance in the diagnosing of EO?Other diagnostic trials which I expect to be hold been done or ordered are [ 11 ] : Testicular ultrasound Urinalysis Urine civilization ( clean gimmick ) which more than one sample might be required, inclusive of initial watercourse, midstream every bit good as following prostate massage. Screening trial for gonorrhoea and chlamydia via urethral vilification Susceptibility trial of the causative agents ( in the instance of bacterial cause ) .( I ) Which endovenous ( IV ) antibiotics would you urge for empiricalintervention of Mr Thompson ‘s Epididymo-orchitis and province the ground ( s ) for your pick?I would urge the undermentioned IV antibiotics for empirical intervention [ 12 ] : Gentamicin 4 to 6mg/kg IV, for 1 dosage, upper limit of 1 to 2 farther doses ‘ dosing interval is so determined based on nephritic map. PLUS Amoxycillin / ampicillin 2g IV, 6 hourly. The ground of taking these antibiotics is that Mr Thompson is most likely to acquire Epididymo-orchitis ( EO ) from a non-sexual cause and his EO is terrible, hence the recommended picks of antibiotics are short-run Garamycin and amoxycillin / Principen harmonizing to the eTG web site. However, as Principen can interact with Coumadin, potentially increasing the hazard of hemorrhage, amoxycillin which might merely somewhat increase the hazard of hemorrhage may be used in topographic point of it with supervising [ 12, 13 ] . Besides this, he is besides non holding hypersensitivity to penicillin and therefore, antibiotics belonging to this drug category can be used.( two ) Which trial consequences should be followed up in order to â€Å" direct † antimicrobictherapy?The trial consequences that should be followed up are [ 3,12 ] : Urine civilization Screening trial for gonorrhoea and chlamydia Susceptibility trial Testicular ultrasound of declaration of epididymo-orchitis is slow.( three ) If Mr Thompson ‘s clinical status improved and the physicians wanted to alter his IV antibiotics to an unwritten antibiotic, which one do you believe would be appropriate? List the guidance points you would supply for this antibiotic.I think cephalexin 500mg orally, 12 hoursly for the continuance of 14 yearss would be appropriate because the first-line antibiotic trimethoprim is non effectual [ 12 ] . The guidance points which I will supply are [ 14,15 ] : Try to take Keflex without nutrient, around 1 hr prior to meal or 2 hours after a repast. Take Keflex together with a full glass of H2O. It is rather common to see sickness, purging or diarrhea during intervention with Keflex. Be certain to take the full class of Keflex until finish even when experiencing better. If still see diarrhea ( watery and bloody stools ) 2 months or more after the last dosage of Keflex, contact physician in the shortest clip possible.( four ) What would be the entire continuance of intervention with antibiotics for Mr Thompson ‘s EO?Mr Thompson ‘s EO intervention with antibiotic will last for the entire continuance of 17 yearss [ 12 ] .( V ) Besides antimicrobic therapy what other therapy ( pharmacological and non- pharmacological ) should be portion of Mr Thompson ‘s intervention program?– Non-pharmacological therapy: Allow Mr Thompson to rest on bed with his scrotum elevated. Apply ice battalions to the affected scrotum country.What procedure would you set about to corroborate that Mr Thompson ‘s usual medicines are accurately prescribed on the admittance drug chart [ 16 ] ?I will transport out a Medicine Management Review. I will do verification with Mr Thompson sing to his medicine history which is obtained during his admittance to the infirmary, every bit good as with his community wellness attention supplier where appropriate. If possible, I will seek to corroborate each and every of Mr Thompson ‘s medicine history with a 2nd beginning following the undermentioned hierarchy of: Carer & gt ; Family & gt ; nursing place & gt ; ain medicines & gt ; community pharmacist & gt ; general practician ( GP ) . Beside this, I will facsimile the admittance drug chart for the intent of verification to Mr Thompson ‘s GP or community pharmacist if necessary. Furthermore, I will enter down what the physician planned for every listed medicines. I will besides do certain that all the listed medicines matches the medicines that are prescribed on the medicine chart and at the same clip, taking the physician ‘s program into history.Further informationName of drugExplanation of why you require this informationFor illustration: INR trial consequence Warfarin To look into if INR is within curative scope ; proctor for warfarin toxicity ; to find Coumadin dosage Blood force per unit area [ 17 ] Ramipril To guarantee that blood force per unit area is well-controlled within the normal scope. Serum Lanoxin degree, marks and symptoms of Lanoxin toxicity [ 17 ] Digoxin To guarantee that serum Lanoxin degree is within curative scope and to avoid Lanoxin toxicity. Heart rate [ 17 ] Amiodarone To supervise for any new marks of arrhythmia. Urine civilization / Susceptibility trial consequence [ 12 ] Gentamicin Amoxycillin / Principen Cephalexin To guarantee that the causative agents for the epididymo-orchitis is susceptible to these antibiotics and that they are suited antibiotic picks. Body weight, serum electrolytes [ 12 ] Frusemide To look into whether frusemide dose titration is required or non.There are legion possible drug related jobs in this instance ( & gt ; 10 ) . List of three ( 3 ) possible drug-related jobs associated with Mr Thompson ‘s medicine you, as the druggist, would expect and sketch how you would pull off them and/or proctor for them [ 13 ] .Digoxin and Cordarone: Problems: May take to digoxin toxicity ( such as sickness, cardiac arrhythmias and emesis ) . Management: Reduce Lanoxin dosage by around 50 % and supervise the serum Lanoxin degree every bit good as expression out for marks and symptoms of Lanoxin toxicity. If discontinuance of Lanoxin is possible so discontinue Lanoxin. Amiodarone and Coumadin: Problems: May increase the hazard of serious or even fatal hemorrhage. Management: Reduce the dosage of Coumadin by around 1/3 or 1/2 and supervise the factor II clip every bit good as INR value Amiodarone and isobutylphenyl propionic acid: Problems: May increase isobutylphenyl propionic acid ‘s plasma degree. Management: Caution with the concurrent usage of Cordarone and isobutylphenyl propionic acid. Monitor often for NSAID-related inauspicious effects and see seting the dosage of isobutylphenyl propionic acid.Mentions:Sexual Health [ home page on the Internet ] . Kingston upon Thames, Surrey: Sexual Health ; c2012 [ cited 2012 Sept 21 ] . Epididymo-orchitis ; [ about 4 screens ] . Available from: hypertext transfer protocol: //www.sexualhealthkingston.co.uk/sexual-health-information/stis/men/epididymo-orchitis Health Information and Advice [ home page on the Internet ] . England: Egton Medical Information Systems Limited ; c2012 [ cited 2012 Sept 21 ] . Epididymo-orchitis ; [ about 9 screens ] . Available from: hypertext transfer protocol: //www.patient.co.uk/health/Epididymo-orchitis.htm NZSHS [ home page on the Internet ] . New Zealand: The New Zealand Sexual Health Society Incorporated ; c2012 [ cited 2012 Sept 21 ] . Epididymo-orchitis_2009 ; [ about 3 pages ] . Available from: hypertext transfer protocol: //www.nzshs.org/treatment_guidelines/Epididyomo-orchitis_2009.pdf European Bioinformatics Institute [ home page on the Internet ] . Cambridge, UK ; c2012 [ cited 2012 Sept 21 ] . Chlamydia trachomatis ; [ about 2 screens ] . Available from: hypertext transfer protocol: //www.ebi.ac.uk/2can/genomes/bacteria/Chlamydia_trachomatis.html The Ohio State University at Mansfield [ home page on the Internet ] . Mansfield, OHIO: The Ohio State University at Mansfield ; c2012 [ cited 2012 Sept 20 ] . Bacteria Binomials ; [ about 32 screens ] . Available from: hypertext transfer protocol: //www.mansfield.ohio-state.edu/~sabedon/biol4045.htm NHS Clinical Knowledge Summaries [ home page on the Internet ] . High Holborn, London: National Institute for Health and Clinical Excellence ; c2011 [ cited 2012 Sept 20 ] . CKS Clinical Knowledge Summaries ; [ about 3 screens ] . Available from: hypertext transfer protocol: //www.cks.nhs.uk/scrotal_swellings/background_information/causes/epididymo_orchitis Chamberland S, L'Eeuyer J, Lessard C, Bernier M, Provencher P, Bergeron M. G, The Canadian Study Group. Antibiotic Susceptibility Profiles of 941 Gram-negative Bacteria Isolated from Septicemic Patients throughout Canada. Clin Infect Dis [ series on the Internet ] . 1992 Oct ; [ cited 2012 September 21 ] ; 15 ( 4 ) : [ about 15 pages ] . Available from: hypertext transfer protocol: //www.jstor.org.ezproxy.lib.monash.edu.au/stable/pdfplus/4456676.pdf? acceptTC=true Sill M. L, Tsang R. S. W. Antibiotic Susceptibility of Invasive Haemophilus influenzae Strains in Canada. Antimicrob Agents Chemother [ series on the Internet ] . 2008 April ; [ cited 2012 September 21 ] ; 52 ( 4 ) : [ about 7 screens ] . Available from: hypertext transfer protocol: //www.ncbi.nlm.nih.gov/pmc/articles/PMC2292521/ Cochrane Summaries [ home page on the Internet ] . Oxford, UK: The Cochrane Collaboration ; c2012 [ cited 2012 Sept 21 ] . Antibiotics for forestalling meningococcal infections ; [ about 2 screens ] . Available from: hypertext transfer protocol: //summaries.cochrane.org/CD004785/antibiotics-for-preventing-meningococcal-infections DUJS Online [ home page on the Internet ] . New hampshire: Dartmouth College Hanover ; c2008 [ cited 2012 Sept 21 ] . Antibiotic Resistance of Tuberculosis ; [ about 6 screens ] . Available from: hypertext transfer protocol: //dujs.dartmouth.edu/winter-2009/new-trickes-for-an-old-foe-the-threat-of-antibiotic-resistant-tuberculosis PubMed Health [ home page on the Internet ] . Bethesda, MD: National Center for Biotechnology Information ; c2012 [ cited 2012 Sept 21 ] . Orchitis ; [ about 5 screens ] . Available from: hypertext transfer protocol: //www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002259/ eTG complete [ home page on the Internet ] . Victoria, Australia: Curative Guidelines Limited ; c2012 [ updated 2012 Jul ; cited 2012 Sept 20 ] . Available from: hypertext transfer protocol: //etg.tg.com.au.ezproxy.lib.monash.edu.au/conc/tgc.htm? id=27b1fc15b4331af2841f02ef96ddc67b MicromedexA ® 2.0 [ home page on the Internet ] . U.S: Thomson Reuters ; c1974-2012 [ updated n.d. ; cited 2012 Sept 21 ] . Available from: hypertext transfer protocol: //www.thomsonhc.com.ezproxy.lib.monash.edu.au/micromedex2/librarian/ND_T/evidencexpert/ND_PR/evidencexpert/CS/5A8A78/ND_AppProduct/evidencexpert/DUPLICATIONSHIELDSYNC/75C929/ND_PG/evidencexpert/ND_B/evidencexpert/ND_P/evidencexpert/PFActionId/pf.HomePage University of Washington [ home page on the Internet ] . Seattle, Washington: University of Washington ; c2012 [ cited 2012 Sept 21 ] . Most Normally Prescribed Drugs Anti-Infectives [ about 61 pages ] . Available from: hypertext transfer protocol: //courses.washington.edu/pharm504/ABXPresentation.pdf DailyMed [ home page on the Internet ] . Bethesda, MD: U.S. National Library of Medicine ; c2012 [ cited 2012 Sept 21 ] . Keflex ( Cephalexin ) capsule [ Advancis Pharmaceutical Corporation ] ; [ about 14 screens ] . Available from: hypertext transfer protocol: //dailymed.nlm.nih.gov/dailymed/drugInfo.cfm? id=6490 # nlm34076-0 Department of Health [ home page on the Internet ] . Melbourne, Victoria: Department of Health ; c2012 [ cited 2012 Sept 21 ] . Medication Reconciliation – On Admission ; [ about 8 pages ] . Available from: hypertext transfer protocol: //www.health.vic.gov.au/sssl/downloads/qld_tool.pdf Medsafe Home Page [ home page on the Internet ] . Wellington: New Zealand Medicines and Medical Devices Safety Authority ; c2012 [ cited 2012 Sept 21 ] . Keep an Eye on Amiodarone Patients ; [ about 4 screens ] . Available from: hypertext transfer protocol: //www.medsafe.govt.nz/profs/puarticles/amiod.htm # AmiodaroneCase Study 3:A brief description of Tuberculosis ( TB ) and how it is transmitted.Tuberculosis ( TB ) is an infective bacterial disease which most often affects the lungs [ 1 ] . However it is besides able to impact other organic structure parts like the spinal column, kidney and encephalon [ 2 ] . Terbium can be fatal if it is non being treated decently. Patients with active Terbium can be treated by antibiotics intervention with the continuance of six months while patients with latent Terbium can besides be treated so that active TB will non develop [ 1,3 ] . Those patients with latent TB have a life-time hazard of 10 % to develop active TB disease and this hazard is m uch higher for those with compromised immune systems such as diabetic patients or HIV patients [ 1 ] . Terbium is transmitted from human to human via the air [ 3 ] . The TB bacterium is propelled into the air whenever a individual infected with active Terbium of the lungs or pharynx sneezings, speaks, coughs, tongues or sings [ 1,3 ] . Merely really few figure of the TB bacterium is required to be inhaled by another individual for that individual to be infected with it [ 1 ] . However, a individual who is infected with TB bacteriums but non yet manifest the disease ( latent TB ) will non convey the TB bacteriums to other individual.The likely pathogen ( s ) .The likely pathogen doing TB is the bacteriums Mycobacterium TB [ 1 ] .A list of those individuals at the greatest hazard for undertaking TB ; in peculiar in Mrs Rawat ‘s instance [ 1,2 ] .Young grownups who are in their old ages of extremum productiveness, in this instance, Mrs Rawat ‘s lone boy – Neel. Workers in installations or establishments where they are working aboard with other people who have high hazard of TB infection such as the nursing places, correctional installations and infirmaries. In this instance, Mrs Rawat herself and besides her colleagues in the local infirmary where she is working part-time. Patients who are immuno-compromised, particularly HIV patients. In this instance, certain patients ( those who have weakened immune system ) in the local infirmary where Mrs Rawat is working part-time. Tobacco users. Persons who are stateless. Injection drug users.The marks and symptoms of pneumonic TB [ 2 ] .Chest hurting Persistent bad cough that lasts more than 3 hebdomads, with blood or phlegm. Weight loss. Chills. Fatigue or failing. Loss of appetency. Sweating at dark.The diagnostic trials ( microbiological, radiological etc ) and clinical information used to corroborate the diagnosing of TB [ 2 ] .Tuberculin skin trial ( besides known as the Mantoux tuberculin skin trial ) : It is carried out by shooting a little sum of tuberculin into the lower portion of the arm ‘s tegument. After around 48 to 72 hours, qualified wellness attention worker will look for country that is raised, difficult or swollen. If such country is present, its size will be measured by utilizing a swayer. The inflammation entirely is non considered as portion of the reaction. This trial ‘s consequence is dependent on the size of such country mentioned above every bit good as the hazard of the individual being tested to be infected with TB ( TB ) bacterium and if the individual being tested is infected, the patterned advance towards TB disease. A positive trial consequence will intend that the individual being tested is infected with TB bacteriums. However, whether the infection is latent TB or active Terbium can non be determine by this trial. In add-on, this trial may give a false positive trial consequence for some people who have received the bacille Calmette-Guerin ( B CG ) vaccinum for TB disease earlier, hence extra trials may be needed in instances of positive trial consequence for this trial. TB blood trial ( besides known as the interferon-gamma release checks ( IGRAs ) ) : This trial chiefly measure the responsiveness of the immune system of the individual being tested towards the causative bacterium for TB by making blood proving in the research lab. Presently there are two IGRAs that have been approved by the U.S. Food and Drug Administration ( FDA ) which are QuantiFERONA ®-TB Gold In-Tube trial ( QFT-GIT ) and T-SPOTA ®.TB trial ( T-Spot ) . A positive trial consequence will bespeak that the individual being tested is infected with TB bacteriums. This trial nevertheless, will non be able to find the TB infection is active TB or latent TB. For people who have received the BCG vaccinum for TB disease and those who ca n't happen appropriate clip for 2nd assignment of tuberculin skin trial, this trial is the preferable trial method. Medical history: Patient ‘s TB exposure, disease, or infection history is obtained. Demographic factors such as age, origin state and business which may increase the exposure hazard of the patient to TB are besides considered. In add-on, medical conditions of the patient which may besides increase the hazard of the development of latent TB infection to active TB disease are besides determined. Physical scrutiny: This might give of import information sing the patient ‘s overall status every bit good as other factors which can alter the TB intervention program. For illustration, HIV infection position. Chest radiogram: This is for the sensing of thorax abnormalcies. In instances of TB infection, lungs lesion may appears anyplace in different form, size, denseness and cavitation. This is deficient to definitively name TB but can be used in a individual who has had positive trial consequence in the tuberculin skin trial or TB blood trial in order to govern out the possibility of that individual holding pneumonic TB. Diagnostic Microbiology: The presence of TB disease can be indicated by acid-fast-bacilli ‘s ( AFB ) presence on a phlegm vilification or any other specimen. Confirmation of the TB diagnosing can non be made based on acid-fast microscopy entirely although it is speedy and easy due to the fact that non all acid-fast-bacilli are M. TB. For this ground, civilization of all the initial samples, irrespective of their AFB vilification consequences is needed to corroborate the TB diagnosing. A positive M. TB civilization confirms the TB disease diagnosing. Drug opposition: All the initial M. TB isolated from every patients is required to undergo drug immune trial every bit early as possible so as to guarantee the most effectual intervention for the patients. For those TB patients who do non demo sufficient response to intervention or those who still have positive civilization consequences following intervention that lasted for three months or more, this trial should be repeated.Once the diagnosing of TB has been confirmed Mrs Rawat will be commenced on an anti-TB drug regimen. In your presentation address the followers:( I ) What is the handling doctor obligated to make by jurisprudence?The treating doctor is obligated by jurisprudence to describe both clinically suspected and besides confirmed TB instances to the designated section within the timeframe of 24 hours [ 2 ] . Depending on provinces, the handling doctor might be besides obligated to describe non-adherent patients with TB, where non-adherent might include intervention surcease, go forthing the infirmary against medical advice or failure in following to intervention program every bit good as other preventative steps to avoid TB transmittal [ 2 ] .( two ) List the drugs ( and the day-to-day dosage of each ) that you think Mrs Rawat will be commenced on for standard short-course therapy of TB. Using the tabular array below, for each of the four drugs used in the standard short-course therapy of TB outline the followers:Name of the drug & A ; dose [ 4 ]List the common side effects [ 5,6 ]Main guidance points you would supply to the patient about this drug- in point signifier [ 7,8,9 ] .Isoniazid 300mg orally, daily for 6 months. Peripheral neuropathy, GI upset, metabolic alterations, blood dyscrasias, hepatic alterations, vitamin B6 lack. Be certain to take all the medicine boulder clay coating. Avoid ingestion of intoxicant to forestall farther liver harm. Take on an empty tummy, at least half an hr before repasts and at bedtime. Rifampicin 600mg orally, daily for 6 months. Itching, concern, confusion, diarrhea, vision alterations, giddiness, flushing, sleepiness, behavior alterations, tummy spasms, piss, perspiration, phlegm, and cryings ruddy stain. Be certain to take all the medicine boulder clay coating. If tegument or eyes develop xanthous stain or if urine discolours to cola coloring material, contact physician every bit shortly as possible. May cause perspiration, urine and cryings to hold orange stain which is non harmful. Avoid have oning contact lenses because rifampicin can stain them for good. Avoid ingestion of intoxicant to forestall farther liver harm. Take on an empty tummy, at least half an hr before repasts and at bedtime. Ethambutol 750mg orally, daily for 2 months. Appetite loss, tummy disturbance, purging, custodies or pess numbness and prickling due to peripheral neuritis. Be certain to take all the medicine boulder clay coating. Avoid ingestion of intoxicant to forestall farther liver harm. Avoid from taking alkalizers together with ethambutol, infinite more than 2 hours apart. Pyrazinamide 1500mg orally, daily for 2 months. Stomach disturbance, weariness. Be certain to take all the medicine boulder clay coating. Avoid ingestion of intoxicant to forestall farther liver harm.( three ) Which of the four anti-TB drugs in the standard short-course therapy causes peripheral neuritis? What extra addendum is prescribed at the same time to prevent/ minimise this inauspicious consequence from happening?Isoniazid, ethambutol, rifampicin and pyrazinamide can do peripheral neuritis [ 7, 10 ] . Pyridoxine ( vitamin B6 ) can be prescribed at the same time to prevent/ minimise peripheral neuritis from happening [ 11 ] .( four ) Prior to the first dosage of the antecedently mentioned anti-TB drugs, Mrs Rawat will necessitate to undergo a series of pre-therapy trials and baseline measurings ; name these trials and briefly explain the ground for each.Name of pre-therapy trial [ 4 ]Name of drug ( where relevant )Explanation of why this information/ trial is requiredWeight Rifampicin, ethambitol, pyrazinamide [ 4 ] To find the appropriate antibiotics dose to be use [ 4 ] . Liver map trials Isoniazid + rifampicin, pyrazinamide [ 12 ] To supervise for hepatotoxicity potentially caused by the TB drugs [ 12 ] . Nephritic map trials Ethambutol [ 4 ] To supervise nephritic clearance and prevent accretion of ethambutol in the organic structure if nephritic clearance diminutions [ 4 ] . Ocular sharp-sightedness Ethambutol [ 4 ] To supervise for marks of optic toxicity [ 4 ] . Colour vision proving Ethambutol [ 4 ] To supervise for marks of optic toxicity [ 4 ] . Full blood count To supervise for anemia, neutropenia and lymphocytopenia [ 13 ] . HIV proving after appropriate guidance Rifampicin [ 4 ] To find the hazard of rapid patterned advance of TB disease / reinfection and besides possible important drug interactions with antiretroviral drugs in instance of HIV-positive [ 4, 14 ] . Screening for chronic viral hepatitis ( B and C ) Isoniazid + rifampicin, pyrazinamide [ 12 ] To find the hazard of hepatotoxicity potentially caused by the TB drugs [ 12 ] .( V ) Use the Cockcroft-Gault expression to cipher Mrs Rawat ‘s Creatinine Clearance and province the dosage ( s ) of the medicine ( s ) you would give Mrs Rawat.Ideal organic structure weight = 57.2kg Age = 60kg Height = 165cm Serum creatinine = 260 micromol / L Creatinine clearance = 0.85 = 18.38 milliliters / min – Ethambutol ‘s dose demands to be changed to 600mg orally, daily for 2 months [ 4 ] .( six )Name callings of the interacting drugs [ 15 ]Mechanism of the drug interaction & A ; clinical consequence [ 15 ]Clinical direction [ 15 ]Rifampicin – Cardizem Cadmium Rifampicin may bring on the metamorphosis of cardizem CD, doing loss of the consequence of Ca channel blocker and hence, might ensue in clinical marks and symptoms of angina or high blood pressure. Increases the dosage of cardizem Cadmium. Rifampicin – Losec Rifampicin might bring on the CYP2C19 and CYP3A4-mediated metamorphosis of Losec, ensuing in reduced Losec plasma concentrations. Avoid from utilizing Losec together with rifampicin.( seven ) If Mrs Rawat was 26 old ages old and on no regular medicines what other factors do you necessitate to see when make up one's minding on anti-TB therapy?The other factors which I need to see are whether [ 4 ] : Are the causative beings for the disease susceptible to rifampicin, INH and pyrazinamide? Is all drugs included in the regimen able to be tolerated by Mrs Rawat and that she is able to to the full adhere to the intervention? Is there grounds screening disseminated or cardinal nervous system TB? Is there presence of extended cavitation on the initial thorax X ray? Is there satisfactory response to the intervention? Is Mrs Rawat is pregnant and/or suckling?*Why is it of import to follow up these trial consequence?It is of import to follow up these trial consequence because of drug immune concern. It is of import at all clip to utilize multidrug regimens to cover the likeliness of initial drug opposition every bit good as forestalling immune beings from emerging [ 4 ] .*On obtaining these consequences, which of the four anti-TB therapy drugs could perchancebe ceased and under which fortunes?Ethambutol can be perchance ceased if the lab trial consequence showed an TB isolate which is susceptible to isoniazid and rifampicin [ 16 ] .As a druggist what could you make to promote or help Mrs Rawat ‘s conformity with all her medicines? How could you supervise patient conformity?I will explicate to Mrs Rawat about the intent of each and every of her medicines, every bit good as their name, dosing frequence, dose, common side effects and besides their timing of disposal [ 17 ] . After that, I will h old Mrs Rawat reiterating back to me the information which I have told her and besides inquire her inquiries sing what she is non able to understand. In add-on, I will seek to set up follow-up with her and inquire her about how is her medicine-taking traveling on. I will besides measure her chance of non-adherence through the usage of validated tools like the Morisky medicine attachment questionnaire if the expected clinical effects of her medicines do non look to be at that place. Following this, I will turn to every of her concerns or jobs which result in non-adherence and at the same clip, normalize and sympathize with her in order to promote her responses. I will besides supply her dose disposal AIDSs as appropriate so that it will be much easier for her to hive away and cognizing when to take her medicines every bit good as their dose. I can besides affect her household members such as her hubby or her boy in bettering her medicines attachment by reminding her to take her medic ines at the dosing clip. Last, I will stress on the effects if she fails to take her medicines as indicated, particularly on wellness effects and the ultimate impacts on her households. I could supervise her conformity by oppugning her regarding pill taking or through other methods for illustration, pill numeration and urine drug proving if appropriate and available ( urine should be discoloured to orange coloring material for the minimal continuance of 6 hours since last rifampicin dosage and may even show over 12 hours ) [ 4 ] . Other than these, the Morisky medicine attachment questionnaire can be used for this purpose [ 17 ] .Briefly list in point signifier the on-going monitoring should be undertaken whilst Mrs Rawat is on anti-TB therapy drugs? ( specific to TB drugs merely, for the intent of this instance ) [ 4 ] .Attachment to the anti-TB therapy drugs. Sputum civilization ( if phlegm is still being produced ) . Ocular sharp-sightedness and color vision monitoring every bit good as monitoring of ocular symptoms ( while she is still taking ethambutol ) . Liver map trials. Her organic structure weight. Nephritic map trials.Mentions:World Health Organization [ home page on the Internet ] . Geneva, Switzerland: World Health Organization ; c2012 [ cited 2012 Sept 22 ] . Tuberculosis ; [ about 3 screens ] . Available from: hypertext transfer protocol: //www.who.int/topics/tuberculosis/en/ Centers for Disease Control and Prevention [ home page on the Internet ] . Atlanta, GA: Centers for Disease Control and Prevention ; c2012 [ updated n.d. ; cited 2012 Sept 22 ] . Available from: hypertext transfer protocol: //www.cdc.gov/ MedlinePlus [ home page on the Internet ] . Bethesda, MD: U.S. National Library of Medicine ; c2012 [ cited 2012 Sept 22 ] . Tuberculosis: MedlinePlus ; [ about 6 screens ] . Available from: hypertext transfer protocol: //www.nlm.nih.gov/medlineplus/tuberculosis.html eTG complete [ home page on the Internet ] . Victoria, Australia: Curative Guidelines Limited ; c2012 [ updated 2012 Jul ; cited 2012 Sept 20 ] . Available from: hypertext transfer protocol: //etg.tg.com.au.ezproxy.lib.monash.edu.au/conc/tgc.htm? id=27b1fc15b4331af2841f02ef96ddc67b MIMS Online [ home page on the Internet ] . London, England: UBM Medica Ltd ; c2012 [ updated Sept 2012 ; cited 2012 Sept 22 ] . Available from: hypertext transfer protocol: //www-mimsonline-com-au.ezproxy.lib.monash.edu.au/Search/Search.aspx MedlinePlus [ home page on the Internet ] . Bethesda, MD: U.S. National Library of Medicine ; c2012 [ cited 2012 Sept 22 ] . Rifampin: MedlinePlus Drug Information ; [ about 6 screens ] . Available from: hypertext transfer protocol: //www.nlm.nih.gov/medlineplus/druginfo/meds/a682403.html HRSA HIV/AIDS Programs [ home page on the Internet ] . U.S: U.S. Department of Health and Human Services ; c2012 [ cited 2012 Sept 22 ] . Mycobacterium TB ; [ about 19 screens ] . Available from: hypertext transfer protocol: //hab.hrsa.gov/deliverhivaidscare/clinicalguide11/cg-623_mycobacterium_tb.html Sansom L. N, editor. Australian pharmaceutical pharmacopeia and enchiridion. 21st erectile dysfunction. Canberra: Pharmaceutical Society of Australia ; 2009. BC Centre for Disease Control [ home page on the Internet ] . British Columbia, Canada: BC Centre for Disease Contorl ; c2012 [ cited 2012 Sept 22 ] . Ethambutol [ about 1 page ] . Available from: hypertext transfer protocol: //www.bccdc.ca/NR/rdonlyres/F59D94C9-BDFC-4E2D-A8DB-C915F1FE8660/0/EthambutolCounsellingSheet_Field.pdf World Health Organization [ home page on the Internet ] . Geneva, Switzerland: World Health Organization ; c2012 [ cited 2012 Sept 22 ] . WHO Public Assessment Report ; [ about 2 pages ] . Available from: hypertext transfer protocol: //apps.who.int/prequal/WHOPAR/WHOPARPRODUCTS/TB180part1v1.pdf University of Pennsylvania Health System [ home page on the Internet ] . Philadelphia, PA: Penn Medicine ; c2012 [ cited 2012 Sept 22 ] . Guidelines for the Management of Adverse Drug Effects of Antimycobacterial Agents ; [ about 60 pages ] . Available from: hypertext transfer protocol: //www.uphs.upenn.edu/TBPA/treatment/managingsideeffects.pdf Thompson N. P, Caplin M. E, Hamilton M. I, Gillespie S. H, Clarke S. W, Burroughs A. K, Mclntyre N. Anti-tuberculosis medicine and the liver: dangers and recommendations in direction. Eur Respir J [ series on the Internet ] . 1995 ; [ cited 2012 September 22 ] ; 8: [ about 5 pages ] . Available from: hypertext transfer protocol: //erj.ersjournals.com/content/8/8/1384.full.pdf Jemikalajah J. D, Okogun G. A. Hematological indices in human immunodeficiency virus and pneumonic TB infections in parts of Delta State, Nigeria. Saudi Med K [ series on the Internet ] . 2009 ; [ cited 2012 September 22 ] ; 30 ( 2 ) : [ about 4 pages ] . Available from: hypertext transfer protocol: //www.smj.org.sa/PDFFiles/Feb09/13Hema20080806.pdf HIV InSite Gateway to HIV and AIDS Knowledge [ home page on the Internet ] . San Francisco: University of California ; c2012 [ cited 2012 Sept 22 ] . Tuberculosis and HIV ; [ about 30 screens ] . Available from: hypertext transfer protocol: //hivinsite.ucsf.edu/InSite? page=kb-05-01-06 # S3X MicromedexA ® 2.0 [ home page on the Internet ] . U.S: Thomson Reuters ; c1974-2012 [ updated n.d. ; cited 2012 Sept 22 ] . Available from: hypertext transfer protocol: //www.thomsonhc.com.ezproxy.lib.monash.edu.au/micromedex2/librarian/PFDefaultActionId/evidencexpert.ShowDrugInteractionsResults Heartland National TB Center [ home page on the Internet ] . San Antonio, TX: Heartland National TB Center ; c2012 [ cited 2012 Sept 22 ] . Diagnosis & A ; Medical Management of TB Disease ; [ about 76 pages ] . Available from: hypertext transfer protocol: //www.heartlandntbc.org/training/archives/tbnucama_20120718_1040.pdf American Medical Association [ home page on the Internet ] . Chicago, IL: American Medical Association ; c2012 [ cited 2012 Sept 22 ] . Tacticss to better drug conformity ; [ about 13 screens ] . Available from: hypertext transfer protocol: //www.ama-assn.org/amednews/2011/10/03/prsa1003.htmCase study 4:What is morbific endocarditis? Explain the difference between complicated and uncomplicated.Infective endocarditis ( besides known as bacterial endocarditis ) is an infection which affects that bosom ‘s interior liner ( endocardium ) or the bosom valves [ 1 ] . It happens at the damaged site of endocardium or bosom valves where there is thrombocytes and fibrin depositions. When certain micro-organisms ( most frequently bacteriums, but besides can be fungi or other bugs sometimes ) gained entry into the blood watercourse and colonise on the thrombocyte and fibrin deposition site, flora will be formed and this can take to morbific endocarditis [ 1,2 ] . The consequence from this i s holes or growings on the bosom valves or the valve tissue will hold scarring, both of which will take to a leaky bosom valve [ 1 ] . If left untreated, it may ensue in decease [ 2 ] . Complicated morbific endocarditis is when big flora or multiple emboli are involved [ 2 ] . If the morbific endocarditis patient has experienced the symptoms of morbific endocarditis for over 3 months or has experienced secondary infected events, the morbific endocarditis is besides complicated. Otherwise, the morbific endocarditis will be unsophisticated morbific endocarditis.In Simon ‘s instance what would you anticipate the likely pathogens to be?I would anticipate the likely pathogens to be Staph. aureus, unwritten streptococcus and entercococci, Gram-negative ( enteral ) rods, Fungis ( chiefly Candida ) or coagulase-negative staphylococcus [ 2 ] .List the marks ( that may be seen on physical scrutiny ) and symptoms of morbific endocarditis.– The marks of morbific endocarditis are [ 2 ] : Heart mutter Petechia Janeway lesions ( ruddy musca volitanss that are present on the thenar of custodies and pess ‘s colloidal suspensions ) Osler ‘s nodes ( painful ruddy sores that present on finger tips and toes ) – The symptoms of morbific endocarditis are [ 2, 3 ] : Fever Unusual weariness Night workout suits Loss of weight Muscle achings and strivings ( in ague morbific endocarditis ) Flu-like symptoms ( in ague morbific endocarditis ) Heart failure symptoms ( in chronic morbific endocarditis ) Joint hurting ( in chronic morbific endocarditis )Outline the diagnostic trials, blood trials, microbiological trials etc that would be used to corroborate the diagnosing of morbific endocarditis and â€Å" direct † antibiotic therapy.Patient ‘s clinical physical scrutiny and besides showing ailment ‘s history [ 2 ] . – This helps with the diagnosing and besides narrow down the range of likely causative pathogen. Using stethoscope to listen to bosom [ 2, 3 ] : – This is to enable physician to listen to the patient ‘s thorax for distinguishable sound that indicates new bosom mutter or sound alteration in old bosom mutter. The cause of bosom mutters are the defective bosom valves ‘ sound and certain bosom defects. Blood civilizations [ 2, 3 ] : – Different organic structure country ‘s blood samples are taken to find the presence of any pathogen in the blood stream. This is besides done to find the exact causative pathogen and besides the pathogen ‘s sensitiveness to different antibiotics for intervention. Echocardiography [ 3 ] : – This is used to detect valve construction and map, every bit good as bosom wall gesture and besides the overall bosom size. This trial is the most dependable diagnosing trial so far for morbific endocarditis. Chest x-ray [ 2 ] : – This is used to look out for any grounds that indicates cardiac failure. Urine dipstick [ 2 ] : – This is for the sensing of any hematuria & A ; proteinuria which are the clinical characteristics showing in 60 % to 70 % of morbific endocarditis instances. Temperature [ 1, 2 ] : – This is to look into for the presence of febrility which is one of the chief symptoms of morbific endocarditis. Serum urea & A ; electrolytes [ 2 ] : – This is to look into for any nephritic damage.What empirical endovenous ( IV ) antibiotic regimen would you anticipate Simon to be commenced while expecting the microbiology consequences? Specify the doses for each of the antibiotics.The empirical endovenous ( IV ) antibiotic regimen that I expect Simon to be commenced is [ 4 ] : Benzylpenicillin 1.8g IV, 4 hourly. PLUS Di/flucloxacillin 2g IV, 4 hourly. PLUS Gentamicin 420mg IV, for 1 dosage, followed by the finding of dosing interval for either 1 or 2 extra doses harmonizing to Simon ‘s nephritic map.At this point in clip, which antibiotic would you anticipate Simon to be prescribed? What would be the expected continuance of intervention?I would anticipate Simon to be prescribed di/flucloxacillin 2g IV, 4 hourly [ 4 ] . The expected intervention continuance is 4 hebdomads although in Simon ‘s instance, the continuance may be shorten to 2 hebdomads if there is microbiological and clinical response in the clip period of 72 to 96 hours since the beginning of the antibiotic intervention.If methicillin-resistant staphylococci aureus was the causative pathogen in Simon ‘s instance:( I ) Which IV antibiotic would you anticipate to be prescribed?I would anticipate the IV antibiotic, Vancocin to be prescribed [ 2, 4 ] .( two ) Is this antibiotic chiefly cleared by the kidneys or the liver?This antibiotic is chiefly cleared by t he kidneys [ 4 ] .( three ) At what dosage ( given that Simon ‘s creatinine clearance is 116ml/min ) ?1.5g every 12 hours [ 4 ] .( four ) How would this drug be administered and why?This drug would be administered intravenously because it has a really low unwritten bioavailability and hence, it must be given intravenously for the intervention of systemic infections such as morbific endocarditis in order for it to be effectual [ 5, 6 ] .( V ) What curative drug monitoring is involved when utilizing this antibiotic? When should the first trough degree be taken? What is the mark trough degree?The curative drug monitoring that is involved is vancomycin trough concentrations measurement [ 4 ] . The first trough degree should be taken before the 4th or the 5th Vancocin dosage and the mark trough degree is 15 3mg/L.( six ) If the consequence of the trough degree was 27mg/L, how would you construe this consequence? Would you urge a dose accommodation? If yes, what would it be?This tro ugh degree consequence is higher than the recommended mark trough concentrations for Simon [ 4 ] . I would urge a dose accommodation and adjust the Vancocin dosage to: = 0.83g = ~0.8g

Wednesday, October 23, 2019

Alternate Ending to Tangerine by Edward Bloor Essay

I haven’t been writing in a while. Then again, I’ve barely had time to do anything other than work like crazy at the new school. I swear the work load is nearly double than that of Tangerine Middle, or Lake Windsor for that matter. Or maybe its just that since I refuse to join the soccer team, I have nothing else to do with my time except school work. The kids that attend St. Anthonies treat me like I thought they would, with fear and quite a bit of respect. Identical uniforms matching identical petrified expressions. Some of the younger kids even call me Mr. Fisher, which sounds really odd. People part for me when I walk down the hallway. I’m treated as though I carry and incredibly contagious disease that could spread if everyone doesn’t cower before me. It gets old fast. But enough about that. Erik has been kicked off the football team as of yesterday. Dad had the nerve to look surprised, and even tried to bargain with the coach. It was downright embarrassing. Erik will likely not receive a single scholarship offer. That seems enough punishment for both him and dad. Arthur on the other hand has been given five years at Juvenile Hall for the murder of Luis Cruz. The phone is ringing. It must be Joey. We’d agreed to meet up and maybe kick a ball around for a bit. We aren’t as close as we once were, but were working towards that. I have to go now. I probably won’t write in here again, unless something major happens. Or something terrible. But I don’t think it will. The Erik Fisher Football Dream has come crashing to an abrupt end, and with it, I believe, have all the secrets and ill wishes in this family. After all, everything must come to an end.

Tuesday, October 22, 2019

Compost Column essays

Compost Column essays The purpose of this project was to make a comparison of two different columns using different ingredients. I made a hypothesis that two columns would decompose at a slow rate depending on the environment, heat, water, air etc. And at the end I would end up with soil in both the columns. I used several ingredients in the making of my column; I used leaves, grass clippings (fresh), and pawn water. To make the column I followed the attached instructions. Equipment used: Scratch awl, triple beam balance, P.H. tester, stirring stick, scissors and knives. For results refer to calendar attached. Differences in temperature, light and moisture had a major effect on the column. If I had too much water it would kill the microbes, If I had too little it would kill the microbes, so it was important to keep it as wet as a rung out sponge. If the temp. Was too high it would dry out and I would have to add more pond water to the column to keep it stable. If it had had any light it probably would have dried out faster but also would have given it heat to help to microbes grow. Bad odors also occurred from rotting grass, which produced an ammonia smell. During decomposition I predict the grass, and leaves will form into soil by decaying, and maybe there might be some fruit flies. The outcome was somewhat successful, there was some decomposition of the columns and I ended up with a quarter soil and 3 quarters still decaying material. It was not exactly as I predicted but it did show some relation to my hypotheses, there was some decomposition and heat and water did make a difference. I made several mistakes during this project, that may have resulted to the column not fully decomposing. I did not put the same number of air holes in both the columns to increase the air flow, did not put the exact same amount of ingredients, and the grass dried out before I could get all of the ingredients in the column. ...

Monday, October 21, 2019

Psycology Essay Example

Psycology Essay Example Psycology Essay Psycology Essay This is a psychological reflective essay to examine and gain a greater understanding of self-harm. (www. Mild. Org. UK) I shall utilities Gibbs model of reflection (1988) to structure my essay and formalism my thoughts, pollens and research. I will reference my work using the Harvard system of referencing. (www. Elbow. Angela. AC. UK) Description: Whilst working as a cycle responder in central London I was requested to attend to a patient reported to be in a collapsed state and bleeding. Feelings: As I approached the scene I was cautious and slightly apprehensive, concerned about he causes of hemorrhaging, collapse and my own safety. My patient was a late teenage female, her overall appearance was one of neglect, but overall fairly well looking, a visual primary survey indicated this was, at this point not a time critical patient. She was on her own the sleeves of her clothing were blood stained and she smelt of alcohol. She reported to me she had a history of self-harming which was the cause of the blood staining. The lacerations were deep and with her permission, I dressed the wounds, suggested she went to hospital and requested a vehicle to rainspout her. I felt pity for my patient that she was In such a state and driven to such drastic measures. I was curious to how she had managed to self-harm as the idea of deliberately harming oneself is difficult to conceptualize as we spend our time attempting to avoid harming ourselves. I was quite repulsed by the deep scaring from previous episodes which made me question her reasons and motives behind what she was doing and her state of mental health. I felt concern that self harm was evidence of an undiagnosed mental disorder and may possibly be linked to future suicide attempt. Evaluations: I was glad she had she had decided to seek help on this occasion by calling 999, It would have been better If she called before she had self harmed. I was confident we could get the help she needed though she may have felt frustration going through the accident and emergency process as it can sometimes be a slow process. I would have been happier if she had accessed the correct treatment pathways through her GAP. I was concerned she may have left the hospital before she had been assessed and self harmed again. Analysis: Eighty percent of self-harm involves stabbing or cutting the skin with a sharp object. (www. Mentholated. Org. UK). Psychological factors that affect self-harmers: Abuse during childhood, bereavement, troubled parental or partner relationships, war, poverty, and unemployment may also contribute. Its estimated 30% of individuals with an autism spectrum disorder WI self-harm though patients with other diagnoses may also self-harm, suggesting pathways to self-harm would Include those with depression, anxiety disorders, eating disorders, post-traumatic stress people who self harm have no form of mental illness and the causes may be substance misuse, dependence and withdrawal, genetics, bullying, abuse (sexual, emotional or physical), neglect, school/work pressures, family financial difficulties, housing problems, relationship troubles, family problems, bereavement, loneliness or isolation, eating disorders. Or perhaps struggling to come to terms with sexuality, or any experience or event that causes negative feelings, thoughts and tensions. For some self-harmers the relief is primarily psychological, while for others this feeling of life comes from the beta endorphins released in the brain. Endorphins are endogenous voids, (medical-dictionary. Defenestration. Com) an opiate-like substance, such as an endorphin, produced by the body. They are released in response to physical injury, they act as natural painkiller, and can induce pleasant feelings which would act to reduce tension and emotional distress. Deliberate self- harm may become a means of seeking pleasure. Many self-harmers report feeling very little or no pain while self-harming and, for some a positive pleasurable experience. Strong, M. 1999), Many self-harmers report feeling very little to no pain while self-harming. Many people experiencing various forms of mental ill-health do have a higher risk of self-harm. ( Slinky, E. D. 2007) Also self-harm can present in the high-functioning individual who have no underlying clinical diagnosis making identifying a potential self harmer difficult and making the concept of self harm difficult for other reasons. Though its common in the younger person, generally starting at puberty through until mid twenties. Self-harm in young children is fairly are but reported cases are starting to increase. Self-harm is also apparent in high- functioning individuals who have no underlying clinical diagnosis. (Slinky, E. D. 2007). Self-harming behavior is generally most common in adolescence and young adults, usually first presenting between the ages of 12 and 24. (Mental Health Foundation, 2006) Self-harm in children is considered to be relatively rare, but the rate has been increasing since the sass (Thomas B; Hardy S; Cutting P 1997). Self- harming behavior can nevertheless occur at any age, including in the elderly. (Pierce, D. 1987) . There is more risk of serious injury and suicide attempts in older people who self-harm. (National Institute for Clinical Excellence 2004), Self-harm is often described as an experience of diversification or a dissociate state. (Natal- tong, D. 2008. ) There are vari ous causes leading to self-harm, but it can affect anyone of any age, sex and state of mental health but certain groups of individuals seem to be at a higher risk. A stigma is attached to self-harm, many people will go to great lengths to hide what they are doing. The I-J ONES study reported only two motives: to draw attention ND because of anger. For some people harming themselves can be a means of drawing attention to the need for help and to ask for assistance in an indirect way. It may also be an attempt to affect others and to manipulate them in some way emotionally. However, those with chronic, repetitive self-harm often do not want attention and hide their scars carefully. Conclusion It would have been an advantage to have a greater understanding of self-harm the that understanding. Action plan The treatment I provided would be the same should a similar situation arise. Ensure he safety of my patient and myself, dress any wounds that required dressing, reassure the patient and ensure they access the appropriate treatment pathway. I would be able to provide better treatment because I would be more aware of the causes. For some individuals, an episode of self harm may be easily triggered by a significant life changing event, but for others the day to day fluctuation in their thoughts and feelings and moods can be too much to bare for them and they react with self-harm. Simple stresses such as a breaking a glass, a loud noise, or running ate for an appointment might be enough to create a tension that is so overwhelming in the individual that they self harm to cope with this. Self-harm can be a method of relieving stress. For some, self-harm can become a habit; something they routinely do to survive on a day to day basis because they dont know what else to do, simply a coping method. As a coping mechanism, self-harm can become psychologically addictive because, to the self-harmer, it works; it enables him or her to deal with intense stress in the current moment. Occasionally a positive experience can be a thaw to self-harm. I would try to tackle the deeper underlying problem by being aware that for all individuals the starting point for recovery is to become aware of their reasons for, and what drives them to self-harm. Then armed with this knowledge that they can learn to respond differently to their difficulties and recognize the pathways to self-harm. Im aware that recovery is always possible, however lost and overwhelmed the person feels. Although self-harm provides a temporary fix to a problem, the relief is short lived, and is quickly followed by other feelings like shame and guilt. Meanwhile, it keeps the self-harmer from learning more effective strategies for feeling better. Helped. Org states that; the first step is to confide in another person. It can be scary to talk about the very thing you have worked so hard to hide, but it can also be a huge relief to finally let go of your secret and share what youre going through. Deciding whom you can trust with such personal information can be difficult. Choose someone who isnt going to gossip or try to take control of your recovery. Ask yourself who in your life makes you feel accepted and supported. It could be a friend, teacher, religious leader, counselor, or relative. But you dont necessarily have to choose someone you are close to. A service I could easily provide as my role as a paramedic being first on scene after a patient has Just self-harmed. There is an uncertainty about which forms of psychosocial and physical treatments of patients who harm themselves are most effective, and further clinical studies are required. But providing support and listening to the causes is definitely the first step. Hawthorn, K. Et al. (1998), further clinical studies are required.

Sunday, October 20, 2019

The History of Spacesuits

The History of Spacesuits The pressure suit for Project Mercury was designed and first developed during 1959 as a compromise between the requirements for flexibility and adaptability. Learning to live and move within aluminum-coated nylon and rubber garments, pressurized at five pounds per square inch, was like trying to adapt to life within a pneumatic tire. Led by Walter M. Schirra, Jr., the astronauts trained hard to wear the new spacesuits. Ever since 1947, the Air Force and the Navy, by mutual agreement, had specialized in developing partial-pressure and full-pressure flying suits for jet pilots, respectively, but a decade later, neither type was quite satisfactory for the newest definition of extreme altitude protection (space). Such suits required extensive modifications, particularly in their air circulation systems, to meet the needs of the Mercury space pilots. More than 40 experts attended the first spacesuit conference on January 29, 1959. Three primary competitors - the David Clark Company of Worcester, Massachusetts (a prime supplier for Air Force pressure suits), the International Latex Corporation of Dover, Delaware (a bidder on a number of government contracts involving rubberized material), and the B. F. Goodrich Company of Akron, Ohio (suppliers of most of the pressure suits used by the Navy) - competed to provide by the first of June their best spacesuit designs for a series of evaluation tests. Goodrich was finally awarded the prime contract for the Mercury space suit on July 22, 1959. Russell M. Colley, along with Carl F. Effler, D. Ewing, and other Goodrich employees, modified the famous Navy Mark IV pressure suit for NASAs needs in space orbital flight. The design was based on the jet flight suits, with added layers of aluminized Mylar over the neoprene rubber. Pressure suits also were designed individually according to use - some for training, others for evaluation and development. Thirteen operational research suits first were ordered to fit astronauts Schirra and Glenn, their flight surgeon Douglas, the twins Gilbert and Warren J. North, at McDonnell and NASA Headquarters, respectively, and other astronauts and engineers to be specified later. A second order of eight suits represented the final configuration and provided adequate protection for all flight conditions in the Mercury program. The Mercury Project spacesuits were not designed for space walking. Spacewalking suits were first designed for Projects Gemini and Apollo. History of Wardrobes for Space The Mercury spacesuit was a modified version of a U.S. Navy high altitude jet aircraft pressure suit. It consisted of an inner layer of Neoprene-coated nylon fabric and a restraint outer layer of aluminized nylon. Joint mobility at the elbow and knees was provided by simple fabric break lines sewn into the suit; but even with these break lines, it was difficult for a pilot to bend his arms or legs against the force of a pressurized suit. As an elbow or knee joint was bent, the suit joints folded in on themselves reducing suit internal volume and increasing pressure. The Mercury suit was worn soft or unpressurized and served only as a backup for possible spacecraft cabin pressure lossan event that never happened. Limited pressurized mobility would have been a minor inconvenience in the small Mercury spacecraft cabin. Spacesuit designers followed the U.S. Air Force approach toward greater suit mobility when they began to develop the spacesuit for the two-man Gemini spacecraft. Instead of the fabric-type joints used in the Mercury suit, the Gemini spacesuit had a combination of a pressure bladder and a link-net restraint layer that made the whole suit flexible when pressurized. The gas-tight, man-shaped pressure bladder was made of Neoprene-coated nylon and covered by load bearing link-net woven from Dacron and Teflon cords. The net layer, being slightly smaller than the pressure bladder, reduced the stiffness of the suit when pressurized and served as a sort of structural shell, much like a tire contained the pressure load of the inner tube in the era before tubeless tires. Improved arm and shoulder mobility resulted from the multi-layer design of the Gemini suit. Walking on the Moons surface a quarter million miles away from Earth presented a new set of problems to spacesuit designers. Not only did the Moon explorers spacesuits have to offer protection from jagged rocks and the searing heat of the lunar day, but the suits also had to be flexible enough to permit stooping and bending as Apollo crewmen gathered samples from the Moon, set up scientific data stations at each landing site, and used the lunar rover vehicle, an electric-powered dune buggy, for transportation over the surface of the Moon. The additional hazard of micrometeoroids that constantly pelt the lunar surface from deep space was met with an outer protective layer on the Apollo spacesuit. A backpack portable life support system provided oxygen for breathing, suit pressurization, and ventilation for moonwalks lasting up to 7 hours. Apollo spacesuit mobility was improved over earlier suits by use of bellows-like molded rubber joints at the shoulders, elbows, hips and knees. Modifications to the suit waist for Apollo 15 through 1 7 missions added flexibility making it easier for crewmen to sit on the lunar rover vehicle. From the skin out, the Apollo A7LB spacesuit began with an astronaut-worn liquid-cooling garment, similar to a pair of long johns with a network of spaghetti-like tubing sewn onto the fabric. Cool water, circulating through the tubing, transferred metabolic heat from the Moon explorers body to the backpack and thence to space. Next came a comfort and donning improvement layer of lightweight nylon, followed by a gas-tight pressure bladder of Neoprene-coated nylon or bellows-like molded joints components, a nylon restraint layer to prevent the bladder from ballooning, a lightweight thermal super insulation of alternating layers of thin Kapton and glass-fiber cloth, several layers of Mylar and spacer material, and finally, protective outer layers of Teflon-coated glass-fiber Beta cloth. Apollo space helmets were formed from high strength polycarbonate and were attached to the spacesuit by a pressure-sealing neck ring. Unlike Mercury and Gemini helmets, which were closely fitted and moved with the crewmans head, the Apollo helmet was fixed and the head was free to move within. While walking on the Moon, Apollo crewmen wore an outer visor assembly over the polycarbonate helmet to shield against eye damaging ultraviolet radiation, and to maintain head and face thermal comfort. Completing the Moon explorers ensembles were lunar gloves and boots, both designed for the rigors of exploring, and the gloves for adjusting sensitive instruments. The lunar surface gloves consisted of integral structural restraint and pressure bladders, molded from casts of the crewmens hands, and covered by multi-layered super insulation for thermal and abrasion protection. Thumb and fingertips were molded of silicone rubber to permit a degree of sensitivity and feel. Pressure-sealing disconnects, similar to the helmet-to-suit connection, attached the gloves to the spacesuit arms. The lunar boot was actually an overshoe that the Apollo lunar explorer slipped on over the integral pressure boot of the spacesuit. The outer layer of the lunar boot was made from metal-woven fabric, except for the ribbed silicone rubber sole; the tongue area was made from Teflon-coated glass-fiber cloth. The boot inner layers were made from Teflon-coated glass-fiber cloth followed by 25 alternating layers of Kapton film and glass-fiber cloth to form an efficient, lightweight thermal insulation. Nine Skylab crewmen manned the Nations first space station for a total of 171 days during 1973 and 1974. They wore simplified versions of the Apollo spacesuit while doing the historic repair of the Skylab and changing film canisters in the solar observatory cameras. Jammed solar panels and the loss of a micrometeoroid shield during the launch of the Skylab orbital workshop necessitated several space walks for freeing the solar panels and for erecting a substitute shield. The spacesuit changes from Apollo to Skylab included a less expensive to manufacture and lightweight thermal micrometeoroid over garment, elimination of the lunar boots, and a simplified and less expensive extravehicular visor assembly over the helmet. The liquid cooling garment was retained from Apollo, but umbilicals and astronaut life support assembly (ALSA) replaced backpacks for life support during space walks. Apollo-type spacesuits were used again in July 1975 when American astronauts and Soviet cosmonauts rendezvoused and docked in Earth orbit in the joint Apollo-Soyuz Test Project (ASTP) flight. Because no space walks were planned, U.S. crewmen were equipped with modified A7LB intra-vehicular Apollo spacesuits fitted with a simple cover layer replacing the thermal micrometeoroid layer. Information and Photos provided by NASAModified Extracts from This New Ocean: A History of Project MercuryBy Loyd S. Swenson Jr., James M. Grimwood, and Charles C. Alexander

Saturday, October 19, 2019

Leadership In Healthcare Essay Example | Topics and Well Written Essays - 1250 words

Leadership In Healthcare - Essay Example Leadership is a dynamic process (Cooper, 2003) and there are, great variations in the definition of leadership, however, it is widely agreed that for a leader it is imperative to have a vision through which they can inspire their followers (Donnelly, 2003). The followers must have trust in the vision and mission of the leader and the leader act as the role model for them. Earlier leadership was seen as the managerial task, however, now it is recognized currently that leaders can be identified from within their team for particular tasks and cannot essentially have a responsibility of identified official within the organization ‎ (Beech, 2002) ‎.  Leadership plays a vital role in the field of healthcare also. The senior nurses have a leader role within the national health services and the healthcare organizations like NHS would not be able to provide services to the people adequately if they don’t have people working as leaders at different positions like nurses an d healthcare administrator etc. ‎ (Fielder, 1967) ‎  I strongly believe that any person could act as the leader if he has the capabilities and skills to lead a group of people. There is no need of having any university degree to become a leader but the skills can help a person to lead a group of followers.  Transformational Leadership: Transformational leadership is combined with democratic styles of leadership. ‎This relates leaders and supporters connected in a general goal. It is a leadership approach based on embracing transformation and supporting development (Dale, and Philogene, 2002).‎ in this style of leadership, the leader provides a visionary explanation for motivating the team so that they could be empowered to achieve their job.  Democratic: Democratic leadership has some resemblances to what ‎implemented to be earlier defined a ‘charismatic’ style (Department of Health, 2005).  

Friday, October 18, 2019

Position Paper - Vygotsky Essay Example | Topics and Well Written Essays - 1500 words

Position Paper - Vygotsky - Essay Example This concept is based on the idea that â€Å"cultural inheritance is carried in the meanings of artifacts and practices. Resources of knowledge and skill brought to a situation depend upon the past participation of the individual within the culture. Resources are dependent upon culture, also the stage of human development† (Golbfarb, 2000). In discovering how people learn and develop, Vygotsky suggested that children develop and gain control of their thought processes through the use of artifacts, one of the most important being the artifact of language, becoming increasingly able to incorporate their potential into inherent ability through zones of proximal development. This development takes place through various means, one of the most important being creative imitation of others. A second important means through which children develop control over their mental processes is through play and interaction with others. These theories have significant impacts upon how best to ins truct students attempting to learn a second language and attain some degree of mastery. To understand how this might be so, it is necessary to understand the importance of language in formulating thought and definition which is itself essential in bridging zones of proximal development (ZPD) to formulate true and lasting learning and development. One of the fundamental building blocks to Vygotsky’s theory is contained in the concept that individuals are only able to gain control over their naturally biologically endowed brains through the power of social and cultural means. â€Å"Thus, there is a tension, or as Vygotsky characterized it, ‘a drama’, between our natural inheritance and our sociocultural inheritance, and it is in this drama that we develop† (Lantolf, 2003: 350). The primary means of this mediation between the biological and the social or cultural is through the media of symbolic artifacts. In other words, humans understand the world around