Benefits of Coffee Essay

How much coffee have you consumed already this morning? One cup? Or maybe even two? Like most college students I enjoy my cup of Joe in the morning! Coffee is one of the greatest sources of antioxidants in the global diet. Consuming large amounts is not advised, but having reasonable amounts everyday can be very beneficial to your body. Today, I would like to inform you about some of the benefits of drinking coffee. 1. Lower Chances of Death. a. Let’s face it we are all going to die. b. Appears to lengthen time for people with heart disease and diabetes c. Kristen Kirkpatrick said that a study in 2012 showed that three or more cups of coffee a day lowers the risk of death regardless of whether participants drank caffeinated or decaffeinated coffee. 2. Makes your reproductive system happy. d. Men would you like a drink that could lower your chances for prostate cancer? And ladies wouldn’t you like to lower your risk for endometrial cancer? e. Kirkpatrick also says that a 2011 study found that men consuming at least six or more cups a day reduced their risk of prostate cancer by 20 percent! Another study published in the Journal Cancer Epidemiology, Biomarkers and Prevention found that women who drank more than four cups of coffee a day had a 25 percent lower risk of endometrial cancer. 3. Lower risks of Type 2 diabetes. f. A 2012 study found that a compound in coffee can actually help block a substance in the body called human islet amyloid polypeptide that may play a role in the development of diabetes. Further studies have demonstrated that caffeinated coffee consumption is linked to decreased diabetes risk as well. 4. Protects your brain. g. When you wake up to the smell of coffee in the morning do you usually smile? h. Coffee drinkers are less likely to develop dementia and Alzheimer’s later in life according to a study done in 2009 i. The smell of coffee can help reduce stress that could be associated with loss of sleep 5. Good for skin. j. Drinking coffee may help you to ward off basal cell carcinoma So, the next time you are wondering whether you should have that second cup of coffee to perk you up, relax. At least now you know how it could help you!

How to meet the learning needs of mixed age groups in the home-based setting Essay

One of the biggest advantages of mixed age groups is that they make us really analyse the individual needs, interests, and temperaments of each child in the group. We can then plan and provide for the next steps in learning, by getting to know our group of children very well, and making careful observations on them, as individuals, what they do and how they interact with others. This knowledge can then be mapped to the EYFS Practice Guidance over the six areas of Learning and Development and used to devise individual learning plans by assessing activities, opportunities and experiences based on their individual development, interests and needs. Careful planning and organisation are critical factors in meeting the learning needs of different age groups. Each play area, including outside, must provide the maximum of learning opportunities for all ages in your care, using barriers e.g. gates and big cushions only where needed for safety so that infants and toddlers feel included whenever possible. A good idea is to go through the house looking at the room from the child’s level. What would the baby see first, what would the toddler or pre-schooler see first? What appeals to the school-age child? You can create small play areas for special activities, e.g. using a sturdy playpen or hallway as an â€Å"office† for older children when they want to colour, do a puzzle, play a board game or do something without â€Å"help† from toddlers. The little ones can then watch without interfering with the activity. A range of open-ended multiple-use resources should be used, that can be played with in different ways according to stage, such as balls and bricks and Lego. Toys that are safe for children of all ages can be kept on low shelves easily accessible, e.g. blocks, board books, dressing-up clothes,  dolls, stuffed animals, materials to play house, and a collection of heuristic play items (plastic containers, measuring spoons, funnels, etc.), which should be changed round frequently. It is possible to use the same activity to support the learning of mixed age groups, with modifications. This is differentiating the curriculum, by extending or adapting the original play into more specific areas of learning, as per the aims and targets set for each child. For example, younger children can handle gloopy paint to explore colour and texture, while older children use the same paint materials to express their feelings and ideas. Each child does the bit of the activity that he is ready and keen to do. If one child in the group is using a schema e.g. ‘Enveloping’, this can be used as the basis of a plan for the whole group e.g. to make a den, dress up or wrap up some ‘presents’. It is important to set up these activities for shared learning, as children develop socially when they have opportunities to observe and play with those who will play differently due to being older or younger. Being at different stages of their learning journey should mean that all will be able to share other viewpoints and richer experiences. This will help them be co-operative, and for the group to ‘gel’. NEC 733.000 08/516573 Ruth Dickerson The older members of the group can help to meet the younger ones’ learning needs, e.g. by ‘communicating’ pulling faces with babies, reading to preschoolers, putting on a play or a puppet show, or teaching a board game. They do often enjoy being valued for their input, but their help should be volunteered, not relied on, and they should have lots of opportunities away from the babies, since being your ‘assistant’ can be a way for older children to avoid their own age group, and a way to escape peer conflicts. Unplanned opportunities are also very useful as they can often spark off the kind of conversations and reminiscences about other experiences, and sharing of ideas, that just wouldn’t have happened unless that event had occurred.  They encourage communication and social skills which the smaller ones can pick up on and everyone can share. We can also help children to think about ways to include each other in their play, e.g. if the older children are playing house you could ask â€Å"As you are the daddy, could you read Tom and me a book?† (710)

Motivational Ideas for Sales Managers Essay Example | Topics and Well Written Essays - 500 words

Motivational Ideas for Sales Managers - Essay Example Salespersons may make out sales cheques, cash and credit payments, give change and accept receipts. They may also be able to handle exchange and returns. In addition, salespersons also need to keep the working place spick and span. To work efficiently and systematically, many stores have installed computer terminals to register sales, adjust inventory figures and perform simple calculations. The computerized system helps the salespersons to work smartly. Salespersons may help order merchandise, stock shelves or racks, mark price tags, take inventory and prepare displays. In selling things such as food, hardware, linens, and housewares, salespersons usually only take payments and bag purchase. The most important quality that makes a salesperson dependable is his patience. They should be able to deal tactfully with impatient and rude customers in order to make a sale or handle a complaint. In business industry, incentives like attractive salary, bonus, and rewards are being introduced by the management level to motivate staff morale, improve the quality of customer services, and promote team effort among staff to achieve better efficiency and productivity. The salary of some salespersons may be paid by hours. Some receive a portion of the price of what they sell, which is called a commission. Some salespersons earn only a commission and other receive a commission plus a low hourly wage. Commission sales may allow retail salespersons to increase their hourly wages. However, how much to be received depends mainly on how much has been sold by the salesperson. To increase the profit, apart from applying their sales skills effectively, they may introduce customer sales incentives to drive more business.  

Child Abuse in America I need this tonight by 1 am CST Coursework

Child Abuse in America I need this tonight by 1 am CST - Coursework Example In order to be able to tackle this problem, it is imperative that the factors responsible for the growth of this social evil are identified and eradicated from the society. To serve this purpose, this research aims at identifying the factors that play a role in the spread of child abuse at the domestic level. While there is a whole range of factors that play a role in the growth of child abuse in the American society both domestic and social, the scope of this research is limited to the identification of domestic factors. These factors can include but are not limited to divorce, lack of parental attention, and psychological problems of the children as a result of these and such other factors. This research would not only help identify the factors that cause child abuse in the American society to occur, but would also help categorize the factors according to their level of severity. This is important in order to decide which factors should be tackled at the earliest in order to halt t he spread of child abuse on immediate basis. The audience of this project is primarily the parents that have the risk of or have already suffered from child abuse. The audience also includes the law-making bodies because this research would provide them with useful information about the safety and custody of children in broken marriages, so that the laws can be modified or amended in the best interest of the children. In addition to that, this research’s audience includes all those couples that are considering breaking up because this research would make them aware of the potentially adverse impacts of their breakup that their children are likely to suffer from. This research would help create the awareness needed by the parents to minimize the risks of child abuse for their children. My role in this project would primarily be that of an advocate. On the basis of the level of severity

Outline.This is only an outline for a research paper that is going to

Outline.This is only an outline for a that is going to be written latter,so the topic is outline - Research Paper Example One major argument on the matter is with relation to scientology. Scientology has grown in contemporary years and has seen many people join the particular movement (Barth, 2007). With the absence of religion, people would grow further believing in the movement. Religion exists in current days and people still carry out heinous crimes on a daily basis. It is only right to state that with absence of religion, these crimes would increase significantly. People would invade other’s privacy stealing and committing murders. (Matlock, 2008) Society would have no rubrics and humans would lack personal rules by which to abide. Without religion, people in society would lack common grounds (Ryan, 2007). Getting together in prayer and worship is one factor that unites people of different backgrounds and social stature. Lack thereof would lead to judgment and condescending among people. Atheists portray this when looking at the manner in which most of them live their lives. People would lack a sense of unity and this would act as a sign for the beginning of societal and humanity’s

Business Policy - British Airways Case Study Example | Topics and Well Written Essays - 7000 words

Business Policy - British Airways - Case Study Example According to the International Air Transport Association, the industry lost up to $8 billion in 2008 which is even greater than what was forecasted previously. The report uses a PESTEL analysis (See PESTEL Analysis: Appendix D) to scan the external environmental structure of the company. The business cycle of British Airways includes several parameters. This is due to the fact that airline industry is characterized by longer business cycle resulting from the lower profitability and for the lower shareholder returns. (Liehr, Nd, page 1). The marketing environment is constantly changing and with every change in the last few years airlines industry is being affected. The demand for the airline industry is highly income elastic. (â€Å"An analysis of British Airways Marketing Environment†, 2008) Thus the rise in the fuel prices last year and recent economic turmoil has affected the airlines industry in huge way as the passengers are avoiding more expensive air travels. According t o a report by Air Transport association of America, the revenue generated from passenger travels for all airlines fell by 19 % during the month of February, 2009 when compared to February 2008. This is the forth consecutive month where loss is being recorded. The business sector, hit badly by the economic crisis are cutting back on their airline trips. British airways having ten flights operating daily between London and New York is among the worst hit. (â€Å"Lucrative Business class air travel hit by crisis†, 2009) The company saw a decline in 8.6 percent in premium traffic and 4.1 percent in non premium. (â€Å"Lucrative Business class air travel hit by crisis†, 2009)   Also there are other factors which are directly affecting the industry. The events like terrorist attacks in the recent past closely linked with the airplanes may be considered as an external factor affecting air traveling. This assumption is based on the fact that these events lead to the introduc tion of strict security norms and regulation from the EU and US, affecting from summer 2006 resulting in a fall of customer traveling confidence.(â€Å"An analysis of British Airways Marketing Environment†, 2008). The intervention of Government rules and regulation were present in the areas of controlling the place of flight, the pricing policy etc. Also there are restrictions in the number and types of baggage that they carry, which ultimately is becoming the restriction on the part of the customers.

Response Paper to Bagleys Shang Ritual Bronzes Essay

Response Paper to Bagleys Shang Ritual Bronzes - Essay Example According to the paper findings  the casting technique and materials used influenced the design of the models. For instance, casting the bronze rituals using clay, instead of metal, ensured that the decorations on the Shang bronze rituals were achieved while the technique used during casting was responsible for more features that are fundamental. The technique used consisted of using wax as the main material to cast the models. The wax was given the exact shape as the desired shape of the finished bronze. After the wax model, the casters created a mold around the model by packing clay around it and then melting out the wax to ensure that the core remained empty inside. In the empty inside, bronze was poured inside in the empty spaces with the mold of clay broke to reveal the final bronze model.  As the discussion stresses the clay molds also contributed to the design in different ways. Casters curved lines along the mold in order to provide the final product an aesthetic appeal. The technique, popularly known as the lost-wax technique, also produced different sections of a model after removing a mold in sections from the casting.  Metalworkers, in the Shang ritual bronzes, had considerable freedom in their artwork despite some various constraints. In regards to the artistic freedom that the enjoyed, the metalworkers had the freedom of experimenting in the casting method that they used to make the ritual bronzes, which explains the diverse methods used in casting the models.

Descarte's Philosophy of Calling Mind as a Thinking Thing Essay

Descarte's Philosophy of Calling Mind as a Thinking Thing - Essay Example Hence the essence of the existence of human beings is their mind or soul, not their bodies. Descartes’ philosophy of calling mind as a thinking thing Rene Descartes is a French mathematician come philosopher of seventeenth century who is unanimously called as 'Father of Modern Philosophy'. Born in the year 1596 & died in 1650 due to pneumonia, Descartes produced lots of useful philosophical ideas which definitely make the basis for a modern anti-scholastic philosophy. The most famous & most controversial philosophical statement given by Descartes' was "I think, therefore I am" in his publication â€Å"the discourse on the method† in the year 1637, in which he explains that the essence of our mind is thought. If we do not think about things around us & about ourselves, we don’t make enough use of our brain & thus we remain insignificant. In the year 1639, he started his work on Meditations & wrote a book named â€Å"Meditations on First Philosophy†, which w as highly criticized by most learned people of that time & by the cathedral too, as according to them Descartes gave such ideas which contradict with religion & Christian faith. Most of his publications regarding meditations contain the answers to the objections of his previously defined ideas & he tried to clarify himself about the misunderstandings which arose about his method. In his first meditation, he discussed all the way that our sensory beliefs are not always trustworthy or reliable & mind is the only thing which can be termed as reliable as it thinks. In his second meditation, he argued that the mind takes the liberty of supposing everything to be nonexistent of which it has the least doubt of existing. However, during the process, as mind is the thing which is thinking the whole situation, so it must exist itself .This is among one of the greatest use of our mind (Descartes. 1641). Descartes formally presented a theory of mind-body dualism in which he argues that our body is composed of different organs & parts & our mind has no connection with it. As in his first meditation, he says that sensory organs are doubtful thus the body itself has no particular reliability. This absolutely does not mean that in this perspective, a human does not exist or is insignificant. But as compared to mind, body is nothing but a combination of solid joints. The concept of being deceived by someone or convinced on any point directly relates through mind, not from body. Hence for such things to happen, I must exist & I am a not a rational animal but a thinking thing that doubts, understands, affirms, denies, is willing, is unwilling, and also imagines and has sensory perceptions (Descartes. 1641). The point that our mind only considers those things to be existent, which show their existence, like the mind itself, was explained by thinking of something that has a very least chance to exist. If the existence is proved, Descartes happily conclude that as the particular th ing exists so it proves itself. However, if the supposed image or thing was not found existed by him, he was more than happy to say that anything on the world can be found if it exists, like human mind about which there is no doubt of existence. Mind is a creation of god which exists & thinks all the time about the existence or non-existence of other things. Hence â€Å"I† am not simply a combination of

Critical review and comparison of 2 refereed and related journal Literature

Critical and comparison of 2 refereed and related journal articles in the field of business information management - Literature review Example 1st journal -strengths The paper ‘Customer Perspectives on E-business Value: Case Study on Internet Banking’ written by Rahmath Safeena from its title reflects an important issue in the modern banking sector exhibited by the author. Along with that the author have also used keywords like internet banking, information and communication technology (ICT); perceived usefulness, ease of use, risk, awareness which are appropriate in examining the customer’s perspective (Safeena, 2010, p.5).Before moving into the discussion of the subject matter with in depth analysis, a brief literature review has been provided by the author reflecting various aspects of internet banking (Safeena, 2010, p.6). Identification of the research methodology is a crucial factor in executing research in a rigorous manner on a particular topic and also helps to deliver robust inferences. In this paper the process of the Technology Acceptance Model (TAM) is being used for analyzing the extent of the acceptance of the internet banking system by the customers. The incorporation of the TAM model is a judicious application for reflecting the perspective of the customers related to the internet banking system (Safeena, 2010, pp. 6-7). ... Empirics also reveal that there has been a positive correlation between the above two variables in the study of internet banking (Safeena, 2010, p.7). Applying proper statistical techniques it has been also found that when the online banking is perceived as useful then the customers are prone towards using internet banking. The findings state that usefulness, ease of use and risks are the prime parameters which affect positively the acceptability of the internet banking procedures (Safeena, 2010, pp.8-11). 1st journal -Weaknesses The author have mentioned description of different types of internet banking as well as different security issues in the literature review part but have included all the references which are old in their year of publication which are majorly around the year 1999-2000 and one or two references in the recent years like 2006 (Safeena, 2010, p.7). Again, in the strength section the process of TAM is mentioned which is indeed a good method of executing the resear ch. But still this process suffers from some limitations. The first limitation is attached with the explanatory power of the model. Empirical results also found that the existing studies account for less than 60% of the variance explained especially those used by the professional users (Sun & Zhang, 2006, p.53). The sample used in for the purpose of research is students of business and economics students of an educational campus. But studying only the perspectives of the students will not provide any general conclusions about the overall public perspectives on the internet banking. (Khan & Mahapatra, 2009, p.35). The method of questionnaire has been used in carrying on the research and in the paper it is stated that relevant questions have been

MicroRNA-21 Concentrations in Breast Cancer

MicroRNA-21 Concentrations in Breast Cancer Direct Serum Assay for MicroRNA-21 Concentrations in Early and Advanced Breast Cancer Abstract Background Small noncoding RNA molecules known as microRNAs (miRs) are involved in the regulation of gene expression. The hypothesis was based on the biomarker, miR-21 present in the serum, which related to the presence and stage of breast cancer. The direct application of reverse-transcription quantitative real-time PCR (RT-qPCR) in a direct serum assay has been used for the quantification and detection of the miR-21 in breast cancer patients. Methods A total of 102 breast cancer patients with varying stages of breast cancer and 20 healthy female patients were tested by the RT-qPCR applied directly in serum assay for miR-21. Results Detection for RT-qPCR-DS was limited to 0.625 µl of serum. miR-21 levels detected in the healthy donors were comparatively lower with respect to breast cancer patients with different stage of the disease. A significantly higher levels of miR-21 was detected in patients with stage IV breast cancer compared to patients with other stages of the disease. The odds ratio was 1.796 and area under the curve was 0.721 for the distinction of loco regional breast cancers and healthy donors. Multivariate analysis confirmed that a correlation of miR-21 concentrations and stage of breast cancer existed. Conclusion- The novel RT-qPCR-DS serves as a better technique in detecting circulating miR. miR-21 proves to be a significant biomarker for breast cancer, which could also probably detect the progression of the disease. Further research could lead to improved breast cancer care by this serum biomarker as a key tool. EVALUATION Traditional methods Mammography (also known as film mammography) is a traditional method for screening breast cancer (Boyd et al., 2007). Its principle lies in the use of low-dose x-rays. Soft tissue such as fat is radiographically lucent, which appears dark on a mammogram. In contrast, stroma and epithelial tissue are radiographically dense, which is termed mammographic density, appearing light on a mammogram (Boyd et al., 2007). It has been established that the more immense the density, the more association it had with regard to the greater risk of breast cancer. A dense tissue present in 75% or more of the breast poses a risk of breast cancer (Boyd et al., 2007).   A limitation of this method revolves around the fact that expansive mammographic density may be difficult to detect by mammography, thereby indicating a false negative (Boyd et al., 2007). Cancers may be masked by surrounding dense breast tissue, limiting the sensitivity of the screening (Boyd et al., 2007), thereby increasing the risk o f breast cancer (Pisano et al., 2005). High false positive results and costs are drawbacks of mammography (Asaga et al., 2010).   An alternative breast cancer screening technique is the MRI, which is sensitive, but its limitations include the lack of cost-effectiveness and specificity (Esserman et al., 2007). Digital mammography, an upgrade to film mammography allowed the manipulation of the degree of contrast on digital images. This allowed the differentiation of dense breast tissues from malignant cells (Pisano et al., 2005). Women under 50 years of age, with dense breast tissue or those who are pre-menopausal or peri-menopausal were mostly detected by digital mammography (Pisano et al., 2005). In comparison to the film mammography method, digital mammography has an increased cost (1.5-4 times more), but is quicker at developing the image (Pisano et al., 2005). BRCA1 and BRCA2 are tumour markers used to identify individuals who are at risk of developing breast cancer via inheritance (Duffy, 2001). Only 5-10% cases of breast cancers are hereditary. 80-85% risk of developing breast cancer was reported in individuals carrying either the BRCA1 or BRCA2 gene (Duffy, 2001). Cancer antigen 15-3 (CA 15-3) is a gene product of the MUC1 gene. Overexpression of MUC1 gene in malignant breast tumours allows CA 15-3 to be used as a tumour marker for breast cancer (Kabel, 2017). False positive results were reported in benign breast and benign liver diseases (Kabel, 2017). The serum concentration of patients with elevated levels of CA 15-3 became more detectable as the size of tumour and severity of the disease increased. Therefore, this is suitable as a prognostic and pharmacokinetic biomarker (Kabel, 2017). The lack of sensitivity for women with early disease have been a main limitation of CA 15-3 biomarker (Duffy et al., 2010). Rising levels of another extensively used biomarker, carcinoembryonic antigen (CEA) indicated poor treatment or the risk of recurrence following treatment (Kabel, 2017). The lack of disease sensitivity and specificity prevents the use of CEA as predictive biomarker (Kabel, 2017). Estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER-2) serve as pharmacokinetic biomarkers (Kabel, 2017). Relevance to current article Elevated levels of miR-21 was observed in breast cancer patients (N = 102) compared to healthy females (N = 20) in the study done by Asaga et al., (2010). Detection of circulating miR by RT-qPCR-DS was robust and effective (Asaga et al., 2010). The differentiation of patients with stage I, stage II or stage III from patients with stage IV breast cancer was possible with the direct assay, but not by the standard RT-qPCR (Asaga et al., 2010). The assay had a sensitivity and specificity of 67% and 75% respectively in distinguishing loco regional breast cancer patients from healthy patients. The specificity and sensitivity in distinguishing patients with stage IV breast cancer from the earlier stages was 86% and 70% respectively (Asaga et al., 2010). The use of the novel RT-qPCR in direct serum assay reduced mechanical and human errors and minimized the time and overall cost (Asaga et al., 2010). CA 15-3 and CEA are low in sensitivity and specificity, therefore cannot be used as a diagnostic marker (Ng et al., 2013). Comparatively, miR-21 shows a better specificity and sensitivity (Asaga et al., 2010). Current methods 3D mammography is an evolution of the mammography technology (Houssami et al., 2017). 3D mammography improves cancer visibility by reducing the images of overlapping breast tissue, leading to the visualization of benign and malignant breast lesions which would have been masked in traditional mammography (Houssami et al., 2016). It may also decrease the false positive recall. Cost and time-taken to read a 3D mammography are limitations of this method (Houssami et al., 2017). A study by Ng et al., (2013) detected elevation in miR-451, miR-16 and miR-21, while a reduction in miR-145 was observed in the plasma of breast cancer patients. The combination of miR-451 and miR-145 served as the best biomarkers for breast cancer with an optimal specificity of 92% and optimal sensitivity of 90% in distinguishing breast cancer patients from control subjects of other types of cancers (gastric cancer, lung cancer) recruited in the study (Ng et al., 2013). This study by Ng et al., (2013) recognized a combination of miRNAs specific to breast cancer and not the other cancers. Drawbacks include the lack of information regarding whether these miRNAs can be used to distinguish between the subtypes of breast cancer and between sporadic and familial forms (Ng et al., 2013). The study done by Asaga et al., (2010) only focused on miR-21 as a predictive marker in breast cancer, but miR-21 has been implicated in other types of cancer too. Comparatively the study done by Ng et al. , (2013) has identified biomarkers specific to breast cancer. In conclusion, the use of miR-21 as a biomarker in breast cancer presented a correlation of circulating miR-21 with the stage of breast cancer. More research is required to establish miR-21 as an important biomarker in breast cancer (Asaga et al., 2010). A combined expression analysis of miR-21 and miR-191 increased the specificity to 100% and sensitivity to 92% (Chen and Wang, 2013). The study done by Chen and Wang (2013) proved that a combination of miRNAs were better as a predictive biomarker for breast cancer. WORD COUNT ABSTRACT 243 EVALUATION 1039 REFERENCES Asaga, S., Kuo, C., Nguyen, T., Terpenning, M., Giuliano, A. and Hoon, D. (2010). Direct Serum Assay for MicroRNA-21 Concentrations in Early and Advanced Breast Cancer. Clinical Chemistry, 57(1), pp.84-91.Boyd, N., Guo, H., Martin, L., Sun, L., Stone, J., Fishell, E., Jong, R., Hislop, G., Chiarelli, A., Minkin, S. and Yaffe, M. (2007). Mammographic Density and the Risk and Detection of Breast Cancer. The New England Journal of Medicine, 356(3), pp.227-236. Chen, J. and Wang, X. (2013). MicroRNA-21 in breast cancer: diagnostic and prognostic potential. Clinical and Translational Oncology, 16(3), pp.225-233. Duffy, M. (2001). Biochemical markers in breast cancer: which ones are clinically useful?. Clinical Biochemistry, 34(5), pp.347-352. Duffy, M., Evoy, D. and McDermott, E. (2010). CA 15-3: Uses and limitation as a biomarker for breast cancer. Clinica Chimica Acta, 411(23-24), pp.1869-1874. Esserman, L., Shieh, Y., Park, J. and Ozanne, E. (2007). A role for biomarkers in the screening and diagnosis of breast cancer in younger women. Expert Review of Molecular Diagnostics, 7(5), pp.533-544. Houssami, N., Là ¥ng, K., Bernardi, D., Tagliafico, A., Zackrisson, S. and Skaane, P. (2016). Digital breast tomosynthesis (3D-mammography) screening: A pictorial review of screen-detected cancers and false recalls attributed to tomosynthesis in prospective screening trials. The Breast, 26, pp.119-134. Houssami, N., Bernardi, D., Pellegrini, M., Valentini, M., Fantà ², C., Ostillio, L., Tuttobene, P., Luparia, A. and Macaskill, P. (2017). Breast cancer detection using single-reading of breast tomosynthesis (3D-mammography) compared to double-reading of 2D-mammography: Evidence from a population-based trial. Cancer Epidemiology, 47, pp.94-99. Kabel, A. (2017). Tumor markers of breast cancer: New prospectives. Journal of Oncological Sciences. Ng, E., Li, R., Shin, V., Jin, H., Leung, C., Ma, E., Pang, R., Chua, D., Chu, K., Law, W., Law, S., Poon, R. and Kwong, A. (2013). Circulating microRNAs as Specific Biomarkers for Breast Cancer Detection. PLoS ONE, 8(1), p.e53141. Pisano, E., Gatsonis, C., Hendrick, E., Yaffe, M., Baum, J., Acharyya, S., Conant, E., Fajardo, L., Bassett, L., DOrsi, C., Jong, R. and Rebner, M. (2005). Diagnostic Performance of Digital versus Film Mammography for Breast-Cancer Screening. New England Journal of Medicine, 353(17), pp.1773-1783.

Dietrich Bonhoeffer :: Essays Papers

Dietrich Bonhoeffer Dietrich Bonhoeffer was born on February 4th 1906, as a son of a professor of psychiatry and neurology at the University of Berlin. Throughout his early life he was an outstanding student, and when he finally reached the age of 25 he became a lecturer in systematic theology at the University Berlin. Something that is very striking is that when Hitler came to power in 1933, Bonhoeffer became a leading spokesman for the Confessing Church, the center of Protestant resistance to the Nazis. He organized and for a shot amount of time he led the underground seminary of the Confessing Church. His book Life Together describes the life of the Christian community in that seminary, and his book The Cost Of Discipleship attacks what he calls "cheap grace," meaning that grace used as an excuse for moral laxity. Bonhoeffer had been taught not to "resist the powers that be," but he came to a conclusion to believe that to do so was sometimes the right choice. In 1939 his brother-in-law introduced him to a group planning the overthrow of Hitler, and he made significant contributions to their work. (Bonhoeffer at this time was an employee of the Military Intelligence Department.) He was later arrested in April of 1943 and imprisoned in Berlin. After the failure of the attempt on Hitler's life in April of 1944, he was first sent to Buchenwald and then to Schoenberg Prison. Bonhoeffer was almost killed, but was lucky as his life was spared, because he had a relative who stood high in the government; but then this relative was himself implicated in anti-Nazi plots. On Sunday 8 Dietrich Bonhoeffer :: Essays Papers Dietrich Bonhoeffer Dietrich Bonhoeffer was born on February 4th 1906, as a son of a professor of psychiatry and neurology at the University of Berlin. Throughout his early life he was an outstanding student, and when he finally reached the age of 25 he became a lecturer in systematic theology at the University Berlin. Something that is very striking is that when Hitler came to power in 1933, Bonhoeffer became a leading spokesman for the Confessing Church, the center of Protestant resistance to the Nazis. He organized and for a shot amount of time he led the underground seminary of the Confessing Church. His book Life Together describes the life of the Christian community in that seminary, and his book The Cost Of Discipleship attacks what he calls "cheap grace," meaning that grace used as an excuse for moral laxity. Bonhoeffer had been taught not to "resist the powers that be," but he came to a conclusion to believe that to do so was sometimes the right choice. In 1939 his brother-in-law introduced him to a group planning the overthrow of Hitler, and he made significant contributions to their work. (Bonhoeffer at this time was an employee of the Military Intelligence Department.) He was later arrested in April of 1943 and imprisoned in Berlin. After the failure of the attempt on Hitler's life in April of 1944, he was first sent to Buchenwald and then to Schoenberg Prison. Bonhoeffer was almost killed, but was lucky as his life was spared, because he had a relative who stood high in the government; but then this relative was himself implicated in anti-Nazi plots. On Sunday 8

Pharmaceutical Marketing Ethics :: essays research papers

The discovery, development, manufacturing and marketing of medicines always involve questions of ethics. For example increasing pressure by governments to reduce healthcare expenditures potentially creates ethical issues for sales and marketing employees as they work to grow in the business. The healthcare industry is highly regulated and most pharmaceutical companies are committed to operating within the law. They have developed their own policies and guidance to ensure that all employees meet the highest ethical standards in their work. The Code of Conduct explains the standards that are expected from employees and is clearly communicated across each company. An Employee Guide to Business Conduct explains what the Code means in practice. Most pharmaceutical companies are committed to sales and marketing activities that are ethical, responsible, principled and patient focused. They conform to the high, ethical, medical and scientific standards that are set by governments and regulators. On top of the regulatory requirements of governments, they govern their sales and marketing activities through company policy, on Pharmaceutical Marketing and Promotion Activity, and through industry and company marketing codes. Companies believe that it is important to work with governments to contribute to constructive debate on issues surrounding pharmaceuticals and healthcare. Where legal and appropriate they make political donations as part of this engagement. All of their interactions are governed by the Code of Conduct and appropriate Corporate Policies. Most have company wide auditing in place to fully investigate suspected breaches of their company standards and take appropriate disciplinary action, including dismissal where a ppropriate. Never in the history of pharmaceutical marketing have the challenges been so intense and the stakes so high. Threats to growth and profitability have turned up the heat on pharmaceutical marketing teams to do more with less. As a result, pharmaceutical marketers must attain a new level of sophistication and precision to improve performance and maximize return on investments. At the same time, pressure is mounting on all fronts to provide greater value to all customers-including patients, providers and payers.

The Dominance of Gothic Architecture in The High Middle Ages Essay

When one sees the Notre Dame de Paris cathedral in person or in pictures they are likely to be awestruck. The twin towers of the western faà §ade rise high into the sky, seemingly in an attempt to scrape heaven. Spiky arches seem to grow out of the sides and claw at the ground. Inside it is cavernous with colored light filtering in through the large, intricate stained glass windows. All of these physical qualities make Notre Dame a prime example of Gothic architecture. It does not stand alone in that distinction. One is also likely to see several hundred examples of this style on varying scales throughout Europe. Because, despite its humble origins, Gothic architecture became the standard for religious buildings in the early 11th century thanks to innovative use of new and old design techniques which resulted in majestic buildings that symbolized the builder’s version of heaven. To understand the appeal of Gothic architecture at the time, it is critical to start in the small suburb of Paris called St. Denis. There, lived a worldly member of the monastery named Abbot Suger. When he took over as Abbot in 1122, his first priority was to â€Å"fatten the monastery’s purse† (Gilgoff 59). He was able to procure more land for the abbey through royal donations and even won favor for one of the region’s large annual trade events. Thus, with the revenues he had collected, â€Å"he felt justified in spending lavishly† (Gilgoff 59). But, in his heart, he was very religious and sought to create a welcoming environment for his parishioners and saw the need to expand the church because â€Å"The narrowness of the place forced the women to run toward the altar upon the heads of men as upon a pavement with much anguish and noisy confusion" (Gilgoff 59... ...ic lighting thanks to intricate stained glass windows. These glorious structures built by some of the humblest of men have offered a vestige of the divine for people in the past and the present and will carry on into the future. â€Æ' Works Cited Bony, Jean. French Gothic Architecture of the Twelfth and Thirteenth Centuries. Los Angeles: University of California Press, 1983. Frankl, Paul. Gothic Architecture. Yale University Press, 1962. Gilgoff, Dan. "GOTHIC GLOW. (Cover story)." U.S. News & World Report 134.23 (2003): 59. Academic Search Complete. EBSCO. Web. 12 Apr. 2010. "Gothic architecture and art." Columbia Electronic Encyclopedia, 6th Edition (2009): 1-3. Academic Search Complete. EBSCO. Web. 12 Apr. 2010. Scott, Robert. The Gothic Enterprise: A Guide to Understanding the Medieval Cathedral. Los Angeles: University of California Press, 2003.

Avian Influenza in the Media

The article that I chose to discuss is entitled â€Å"Avian Flu: Is the Government Ready for an Epidemic?† and was published on the ABC News website on September 15, 2005. The journalists name was not published. The article opens with the lines â€Å"It could kill a billion people worldwide, make ghost towns out of parts of major cities, and there is not enough medicine to fight it. It is called the avian flu.† Throughout the rest of the article, the journalist goes on about the horrors that could occur if avian flu were to mutate so that it was able to be transferred from human to human, and not just from bird to human as is now the case. The journalist quotes Dr. Irwin Redlener, the director of the National Center for Disaster Preparedness as saying â€Å"The tipping point, the place where it becomes something of an immediate concern, is where that virus changes, we call it mutates, to something that is able to go from human to human,† and then states that scientists around the world are now working around the clock as they wait for that tipping point. However, at no time does he inform the reader that all viruses mutate naturally over and over again, and that the chance of the H5N1 strain, mutating into a strain that could pass from human to human is in no way an eventuality, or even a likely outcome. He just takes quotes from various scientists around the world who are expressing a worry about what could happen in the event that H5N1 were to mutate, and uses them to imply that this is a very likely possibility. The journalist also likens an Avian Flu pandemic to Hurricane Katrina, an event that was at the foremost of people’s minds when the article was published and uses purposefully disturbing imagery that has been shown on TV about Hurricane Katrina, such as people dying in the airports and the utter helplessness of the Superbowl, to cause people to panic and worry that bird flu is likely to devastate the country at any second in order to bring to light the Government’s unpreparedness for an outbreak. He then goes on to discuss what he calls an â€Å"inadequate stockpile of medicine† and blames the Government for not having stockpiled enough Tamiflu, which he equates to a miracle drug which will stop H5N1 in its tracks. However, while he is happy to imply, in the beginning of the article, that the H5N1 virus is likely to mutate at any time, he conveniently ignores this when he talks about Tamiflu, and nowhere does he state that while this drug can help people who have contracted bird flu, it is only useful to the current strain of the virus and if it mutates, which he assures us it will, there is no guarantee that it will be of any use to those infected. I feel that these are unforgivable exaggerations of the disease and its dangers and that the journalist was simply interested in sensationalism and causing a public outcry and panic. Expert opinions on the dangers of the H5N1 virus are currently very varied and divided and a lot is still unknown about the disease, but at no time does this article bring that to light. Laura Chang, of the New York Times said it best when she said that journalists shouldn’t â€Å"write articles that might feed a sense of panic, such as telling people to stock up on Tamiflu, or dramatizing how a pandemic would spread through a particular city. Sometimes silence is the best journalism.† Website: http://abcnews.go.com/Primetime/Investigation/Story?id=1130392&page=1 MRSA in the media This article on MRSA, or the Methicillin-resistant Staphylococcus aureus, was published in the British newspaper, the Sunday Metro, under the headline â€Å"Strain of superbug ‘may be new HIV.'† The article opens with â€Å"A deadly new drug-resistant strain of the superbug MRSA could spread rapidly through the gay community, experts have warned.† It then goes on to equate MRSA to the HI virus when it says: The infection is already moving through parts of San Francisco in the same way as HIV and Aids did in the early 1980s. The bug, which can lead to a deadly flesh-eating form of pneumonia, is 13 times more prevalent among the city's gay men than other people. However, at no time does the article explain what MRSA is or that it is not in fact, anything like HIV or AIDS. MRSA is in fact caused by a bacterium, already a vast difference from the virus that causes aids, that is responsible for difficult-to-treat infections in humans. The organism can also be further classified into either Community-Associated MRSA or Hospital-Associated MRSA depending on the circumstances in which the patient acquired the disease. The article goes on to focus on one strain of the disease, a strain known as the USA300 strain and the journalist notes that â€Å"the USA300 bug, is not caught in hospitals but spreads through a community, often by casual contact† which is true, as it is a community-associated strain of MRSA that is spread by skin to skin contact. However, the journalist then goes on to suggest that this strain, which is as a particularly antibiotic resistant epidemic that is responsible for rapidly progressive, fatal diseases, is only likely to affect the gay community. However this is not the case and as MRSA is not a sexually transmitted disease there is no way it could only affect only the gay community. The USA300 strain is passed on by skin-to-skin contact and therefore cannot be liked to HIV which is transmitted only through direct contact with the bodily fluids of an infected individual. While practicing homosexuals are at risk of being affected by the USA300 strain, the disease has also been reported by people in athletic teams, correctional facilities, military recruits and newborn nurseries. I believe this article is simply an example of sensationalism in the media. It does not focus on any of the facts, and makes purposefully sweeping and false statements about MRSA and its similarity to HIV, which couldn’t be further from the truth. The two are nothing like each other, one caused by a bacteria and one by a virus. One transmitted sexually and the other just by touching someone that has been infected. It was written simply to get people to by the newspaper, and should be ignored. Website: http://www.metro.co.uk/news/article.html?in_article_id=83921;in_page_id=34;expand=true

China and India: the Challenge and Opportunity

Sources: Capell, Kerry. â€Å"IKEA: How The Swedish Retailer Became A Global Cult Brand†. BusinessWeek. 14 Nov. 2005: 96-106. Ikea. com CASE 2 CHINA AND INDIA: THE CHALLENGE AND OPPORTUNITY OVERVIEW China and India are the two nations that will transform the global economy as we now know it. China has state-of-the-art manufacturing and India is boosting its competitive edge through innovation hubs. While the United States is deciding if â€Å"Chindia† is a threat or an opportunity the massive low wage, highly educated, and forward thinking work force is transforming these two poor nations into global powerhouses.Yet, all is not perfect. While governments and business pour mass amounts of investments into the countries there are huge obstacles to continued growth. There are social, political, and environmental challenges. Important is keeping growth at a steady pace that will eliminate the unemployment lines. Pollution and environmental challenges, political backlash, de bt and currency crises, inadequate medical care, threats of epidemics, and war are continuing challenges. DISCUSSION QUESTIONS 1.Discuss the innovation implications for the leading developed nations concerning China’s and India’s rapidly escalating capabilities. 2. Examine the collaboration potential and hurdles of greater collaboration between China and India regarding innovation and other commercial ventures. 3. What are the potential market opportunities for developed nations in China and India? 4. Evaluate the evolving balance of economic power shift from the west to the east. 5. Discuss the future competitive threats of China and India for industries in developed countries.

Key Stakeholders of Sara Lee Company

Stakeholders are often considered the lifeline of a company. They share a common interest in the health and well being of a company and often support a company financially and morally. Within any organization key stakeholders include individuals and groups within the organization that have a ‘stake' in the well-being or overall success of the organization. Stakeholder's aim is to make sure a company deliver positive results and remain viable through its product and service offerings. Stakeholders often have much say in an organizations daily functioning. They may influence the products or services that a company offers and may influence programs or organizational systems. Key stakeholders at Sara Lee come primarily from within the company. They key players at Sara Lee include members of management and employees but also some external clients including suppliers. Other stakeholders that may share a vested interest in the company include community members, investors, internal and external customers and even board members. Each of these groups has a different ‘stake' in the company. For example a supplier group interested in the well being of the company include a group of roughly 5,000 farmers that provide coffee, banana, beans and vanilla to the company from Uganda (Sara Lee, 2005). These stakeholders will continue to profit as long as Sara Lee continues to do well and continues to utilize their services. Since Sara Lee's product market is so diverse and includes food, apparel and household brands (Singh, 2003) the company's stakeholder base is quite large. The multinational corporation has key stakeholders in many other countries across the globe including employees and managers in Europe possibly India in the near future. Joint ventures and acquisitions over time have also increased Sara Lee's stakeholder base to include representatives from companies partnering with Sara Lee such as Consolidated Grocers Corporation, Oxford Chemical Corporation, Adams-Mills Corporation, Nutri-Metics, and Hills Bros. and more (Singh, 2003). As Sara Lee continues to grow and acquire other companies its key stakeholder base will continue to grow. Other important members include board members and investors in the company, as well as the corporation's top managers including the CEO and COO of the company (Singh, 2003). As long as net sales continue to reach new heights, which they do, the company can rest assured that the majority of their stakeholder's interests will be met time and time again. Shareholders are also important stakeholders at Sara Lee (Singh, 2003). The company's shareholder base continues to grow as the company continues to expand into global markets. While internal stakeholders may help provide balance and insight into ongoing operations, external stakeholders including suppliers are equally important because they can information management of emerging challenges or trends within the industry that may have to be overcome. Organizations partnering with Sara Lee may also be considered stakeholders in the organization. The founder of the company Nathan Cummings is also a key stakeholder in the company that continually invests toward the companies continuing success and future (Singh, 2003). Even HP Corporation may be considered a key stakeholder in Sara Lee's success. HP Corporation currently supplies Sara Lee with services and support for more than 300 computer based systems and telecom networks (HP, 2005).

Case Study About Trust Report Essay

Trust is the ability to rely confidently, either on an individual or in this scenario the company’s product. It is judged on three dimensions; namely, the ability to be technically competent, its benevolence, that is, the interests and motives, and, finally, the integrity. Positive judgment is a good reflect on the customers’ will to take part in the organization’s dealings. This act may involve buying the company’s products, investing in its stocks, or being an employee. In case any of the attributes become questionable, it may make the customers wary and reluctant in risk taking (Kourdi & Bibb, 2007). Distrust in the organization may increase inefficiencies of innovation and damage relationships. Causes leading to the loss of trust Toyota Motor Corporation is a Japan based motor manufacturer. Its headquarters are in Aichi, Japan. This corporation was founded in 1937 and had been since among the best performing motor manufacturers and dealers in the world. With more than 3 billion yen as profit in a fiscal year, as per the financial report of 2013, Toyota could be said to be among what Forbes magazine would name the top 100 best corporations (Kourdi & Bibb, 2007). Since the year 2004 to 2010, there had been several complains on Toyota Motors concerning engines and accelerators. On 28 August 2009, a tragic accident occurred in San Diego involving a family travelling in a Toyota Lexus. The car lost control and all the passengers died. Toyota, known for its impeccable repute for reliability and quality products suddenly had to deal with trust crisis. A deficiency in attributes that lead to trust of the company’s products and services in form of a scandal can lead to instant lack of trust (Blackshaw, 2008). An effective response to a trust scandal or failure needs interventions that are aimed at curbing distrust and  rebuilding trustworthiness. Distrust regulation can be done through enforcing controls, conditions, and constraints to employees in order to rectify the failure. Intervening may require the removal of guilty parties, the change of the cultural norms of the organization, and introduction of new or the revision of incentives (Blackshaw, 2008). This is not sufficient. Statements and actions too are needed to demonstrate trustworthiness. Statements that show the company’s compelling ability, integrity, and benevolence are required. Apologies, transparency, and ethical practice are required as well. How effective do you consider the taken mitigation actions? Effective repair of trust should undergo simple steps. The first is immediate response to Toyota Corporation belated communications; belated recalls and public apologies damaged its reputation more than the original accident (Liker, 2004). The company ended up losing its sales, investors, and market share. They also lost customer confidence. Toyota Company expressed concern by realizing a statement where they apologized to the family of the victims. It also pledged to carry out investigations. However, the company, regrettably, did not point out the possible causes. This seems like an effective immediate response but it is required for a company to point out to possible causes. Later, the floor mats were suspected to be the likely cause of two accidents that had occurred earlier, but this did not prompt the company into issuing a customer warning (Liker, 2004). They acted upon the suspicions five days after the analysis of the cause was confirmed. This was nineteen days after the fatal accidents. In order to rebuild customer, employee, and investor trust, Toyota Motors released a statement assuring their customers that the floor mats were in good conditions and safe. They praised them as being among the safest mats. This statement was later challenged by NHTSA who accused the company of releasing misleading and inaccurate reports. In a bid to save itself from further downfall, Toyota Motors reacted by giving a remedy to the sticky floor mats. This action caused discretion among investors who thought of the company to have had unclear motives when they released the first statement (Liker, Hoseus, & Center for Quality People and Organizations, 2008). This further dented the trust of the shareholders. The mitigation process of the Toyota Company took  a long time, hence more damage to be controlled. It was ineffective at the beginning, which was a blow to the shareholders. Although the company founder Akio Toyoda later sent out apologies and through the wall street journal expressed his commitment to reforming the company towards better and safe products with the aim of repairing the damage that had been done (Liker, Hoseus, & Center for Quality People and Organizations, 2008). The company through the court compensated the family that had lost their relatives through the accident. This was a step to convey the company’s acceptance of the guilt. Consequences of not addressing trust issues Failure to respond to issues and address the remedies publicly can lead to severe disciplinary actions on a company. These actions may include its termination and payment of fine; Toyota Company due to its sluggish manner of responding to the claims against its products was fined $16.4million (Pelletier, 2005). This is because the company failed to warn its customers thereafter. Toyota accepted its penance. Do you believe that the company’s reputation can be re-build, or will they suffer the consequences also in the years to come? Despite the tarnishing of Toyota Corporation’s reputation, the customers’ and investors’ trust will be rebuilt. The actions that the company undertook such as restricting the company’s management team and procuring a new safety system have seen the company rise to becoming once again among the most profitable companies in the world (Pelletier, 2005). The company is rebuilding itself since the 2009 failure. It has had numerous innovations and recently announced mass hiring of employees. References Bibb, S., Kourdi, J., & Bibb, S. (2007). A question of trust: The crucial nature of trust – and how to build it in your work and life. London: Cyan. Blackshaw, P. (2008). Satisfied customers tell three friends, angry customers tell 3,000: Running a business in today’s consumer driven world. New York: Doubleday. Liker, J. K. (2004). The Toyota way: 14 management principles from the world’s greatest manufacturer. New York: McGraw-Hill.Top of Form Top of FormLiker, J. K., Hoseus, M., & Center for Quality People and Organizations. (2008). Toyota culture: The heart and soul of the Toyota way. New York: McGraw-Hill. Pelletier, R. (2005). It’s all about service: How to lead your people to care for your customers. Hoboken, N.J: John Wiley & Sons Bottom of Form Bottom of Form

Religion Essay Example | Topics and Well Written Essays - 1500 words - 4

Religion - Essay Example With such a background information, this paper goes ahead to analyze fundamentalism, by addressing aspects of its past, present, and future, incorporating its application both in Christianity and Islam. Fundamentalism, since its establishment, has had two broad perspectives; global fundamentalism and historic fundamentalism during its development in the late 19th century and establishment in early 20th century. Generic fundamentalism is a worldwide global movement with the mandate of making known institutionalized aspects that have been concealed by the modernized life. Ideally, fundamentalism plays a substantive role in minimizing the distancing of religious aspects from those of the world and state, considering that during its establishment, cultural and social patterns was rooted in the certain religious perspectives. This, therefore, provides for distinct roles for various individuals and groups such as clergies, women, and men. In historical fundamentalism, similar perspectives are shared as those of generic fundamentalism, and has gone ahead to enhance awareness among individuals such as influencing world religions (Fisher and Wise 26). Fundamentalism has its roots in the United States from where it began as an aspect of liberal and progressive views that were held by the Americans in the 19th century (Fisher and Wise 42). One of the greatest contributing views held by these individuals against the scholars who stood strong in criticizing the Bible was that Moses never authored the first five books of the Bible. Such perspectives started during the Niagara Conference in which they discussed that it was time that human went back to the social ideals as intended by God, in which every individual, be it male or female, parent or child, had distinct roles to accomplish, as such a perspective was built on God’s creation. It is based on such aspects that the name

Reflection on the Development and Application of a Fundamental Nursing Essay

Reflection on the Development and Application of a Fundamental Nursing Skill in Nursing Practice - Essay Example This is why it is very essential for nurses to be able to carry out an analysis and clearly respond to these new challenges that keep arising in a very proactive way. As such, development of critical reflective and thinking skills does assist nurses in meeting the ever emerging challenges related to giving needed care in context of a dynamic and rapid change of environment so as to develop into a critically reflective nursing practitioner. There are different approaches to critical thinking and reflective practices. My model for this paper is the Gibb’s Reflective cycle. This paper focuses on a patient with spastic quadriplegic cerebral palsy; he suffers from epilepsy and also scoliosis. Cerebral palsy is a condition whereby there is a brain damage disrupting normal functioning of the body muscles. Spastic quadriplegia is one of the nine forms of cerebral palsy and which is quite common (Banta, 2003, pp.2-18). It disables and a very serious form of cerebral palsy compared to o thers because it affects the whole body. It causes muscle stiffness or paralysis of all the four quadrants of the body. Such patients cannot walk and have impaired speech functions (Rucker, 1985, pp.206-207). Their necks are floppy due to lack of control and are prone to constant seizures. Epilepsy on the other hand is still a brain disorder that causes repeated seizures which occur as a result of episodes of disturbance to the brain. While Scoliosis is the curving of the spine away from the middle hence goes sideways (Burtner, et al., 1999, pp.748-57). During my recent nursing placement, I undertook a five week program at a learning disability care home situated on the northwest of England. It was quite an experience and worked as an eye opener in my nursing career. At the time of my placement and throughout the period, I happened to observe and took part in a program aimed at feeding the residents within the learning disability care home. In this program, I focused mainly on a res ident called James (real name withheld for patient confidentiality reasons). This patient has a medical history of spastic quadriplegic cerebral palsy; he suffers from epilepsy and also scoliosis. As a result of his health condition, James has developed dysphagia, which is a swallowing difficulty and for that reason he has to eat and drink in a way that does not harm him since he has no control of the process and relies on nursing help. About the Gibb’s Reflective Cycle I learnt about the Gibb’s reflective cycle during my nursing study practice. The cycle involves various stages starting with stage one which involves the description of a given event under study. Here, I have to describe in clear detail the kind of event under reflection. This stage includes details such as the place, whoever was there, the reason as to why I was there, what I was doing, the kind of context the event had, the happenings, my part that I played in the event, and others including the resul ts (Stephenson, 1993, pp.1-18). Stage 2 is about how I felt. Here, I try recalling the things that did go on inside my mind and try explaining why this event stuck in my mind. This could entail how I felt before the event took place, what I was thinking at that time, how the event made me feel, how others made me feel, and my take on the outcome, among others. The 3rd stage has more to do with the evaluation process where I try to make a personal judgment of what took place regarding what I felt was good or bad about my experience. This leads to the 4th stage in which case I try to carry out an analysis of the event.

Final Global Media writing task Final Exam 500 words Essay

Final Global Media writing task Final Exam 500 words - Essay Example I learnt that digital media for instance the internet, has played a major role in simplification of worldwide transmission of information. Internet is easily accessible in most parts of the world and therefore provides a platform for easy transmission of information in numerous parts of the world instantaneously. In the course Global Media Trends, I had the chance of acquainting myself with various issues pertaining global media presently. For instance, I realized that despite solving the problem of information transmission, global media continues to face challenges. The project on, â€Å"The growth in the concentration of media ownership around the world: A Case Study of Rupert Murdoch’s News Corp†, presented me with a chance to realize one of the current problems facing global media. The problem of media monopoly in the ownership of media leads to unethical practices. Media in a very critical part of the society and any unethical practices would lead to sabotage of societal rights. Through this course, I learned various ways in which developments in global media have simplified ways of sharing information throughout the world. The group assignment about online activism in particular widened my knowledge on how improvements in technology have made a great contribution in global media. Through online activism, it is possible to pass various messages to many people throughout the world. For instance, one is able to create awareness regarding an issue like pollution by publishing information online. The YouTube assignment made me realize how advancements in global media have contributed improvement of the education sector. Through YouTube, students can share education videos with their colleagues. Others get the chance of accessing scholarly videos at no cost. This course made me realize that, advancements in the global media, apart from

Should Britain Adopt the Euro Assignment Example | Topics and Well Written Essays - 1250 words

Should Britain Adopt the Euro - Assignment Example This transformation has been successful in meeting its goal. Greece has since adopted the Euro while Sweden, Denmark, and Britain, the latter of which is not considered a European country, have not. Many legislators and economists have suggested that it is simply a matter of when, not if, the UK will adopt the Euro. This discussion examines the benefits the UK will retain when this eventually happens and answers the legitimate concerns of those opposed to the transformation. Certain indisputable results have occurred following the conversion to the Euro. It has eliminated the costs and risks involved when exchanging foreign currency with other counties of the EU and made more transparent the cost of products. By adopting the Euro, Britain would be allowed a place on the European Central Bank (ECB) board thus being able to participate in the economic policy of the EU.   This would enhance the political influence of the UK which in turn would produce beneficial long-term opportunities for its economy. According to many published studies conducted regarding the effect of the Euro, using a common currency has already proven to augment trade and competitiveness within the countries that use it. One study that measured the influence of the Euro on trade discovered â€Å"countries that share a common currency trade about three times as much as countries without a common currency† (Micco et al, 2003). It is clear that trade between Britain and EU countries would escalate if the same currency was used. Differences in types of money present barriers to trade because of the cost factors involved in converting it. Large corporations would save significant amounts and open up previously unfeasible opportunities of trade to smaller companies. Reducing the cost of trade will make Britain more competitive as companies will be able to charge less for products yet yield.

Business and society. Critically analyze Joel Bakans argument in the Essay

Business and society. Critically analyze Joel Bakans argument in the book The Corporation - Essay Example by corporations include polluting and poisoning the environment, making people work like slaves by extending minimal wages, colluding with non-democratic and corrupt state governments to manipulate things in their way, using mafia to silence the voices of opposition. Bakan goes on to propose a range of reforms that could restore the real power back to the people. In The Corporation, Bakan introduces corporations as the instruments of evil and corruption, which could be tamed and restrained by pursuing a range of reforms. In the Chapter One, Bakan goes on to elaborate on the origins of the corporation in a historical perspective. The essence of Bakan’s argument is that in the hope of developing public infrastructure, the nations like the US and the UK allowed the corporations to own minimum liability while carrying on their work. This power of minimum liability extended to the corporations was further protected by bringing in the laws that supported and protected corporations. At a local level, the state governments and the courts of law supported and created legal instruments that protected corporations, to attract corporate investment. With the passage of time, these corporations evolved into organic concepts that exerted immense and uncontrollable power over the shareholders and the masses. Besides, the separation of ownership and control by extending shares to the shareholders allowed the corporations to carry on their business with much less control and restraint. The limited liability gr anted to the corporation was not only protected by the law, but also flowed out of the immense wealth owned by the corporations. Gradually, corporations evolved into self sustaining entities, which had the power to influence the society, but were independent of the society in their working. In Chapter Two to Five, Bakan unravels the harm caused to the society by the corporations in the form of environmental pollution, exploitation of the labor and manipulation of the laws

Health Care Research Paper Example | Topics and Well Written Essays - 500 words

Health Care - Research Paper Example Mainly, this assumed racial lines meant to marginalize the nonwhites thus denying some practitioners chance to enjoy the institution’s services if they so wished. Due process in most instances aligns well with the certain judicial decisions contrary to the stare decisis whereby the latter owing to the verdicts arrived at earlier; do not accommodate any alterations (Mitchell, 2011). This is especially in occasions when the court might feel the decisions made did not have viable justifications, hence entail rectifications. Due process’ verdicts draw their conclusion from the judicial considerations though in certain circumstances may prompt judges to incline to its demands. i. The Social Security Act (1965)’s legislation led to the improvement of both the aging and poor people’s healthcare through the provision of insurance (Winston, 1965). This was via the creation of Medicare besides Medicaid, which yielded to the augmenting of former policies effectiveness (Winston, 1965). The ratification of this Act sought to avail affordable healthcare especially to the poor after Truman waged a series of intense debates meant to establish national insurance plan (Loker, 2012). ii. Enactment of Emergency Medical Treatment and Active Labor Act (1986) that enabled people to receive immediate medical attention without the practitioners considering an individual’s ability to cater for the services (Kochakian, 2012). It also entailed medical centers to handle patients to the extent one on release has recuperated fully, and can make informed decisions (Cassanego, 2010). The government in passing this act aimed at availing healthcare services to the public without first inquiring any pay especially during times of catastrophes (Cassanego, 2010). iii. Medicare Prescription Drug, Improvement, and Modernization Act (2003) ratification created subsidized dispensing of drugs especially to the aging (Larsen & Lubkin, 2009). Since,

Forensic Accountants as Fraud Buggers Case Study

Forensic Accountants as Fraud Buggers - Case Study Example A forensic accountant must be equipped with investigative skills. These skills are important in gathering, evaluating and analyzing accounting data and audited information from business organizations (Ramaswamy, 2010). It is through these skills that a forensic accountant will be able to determine possible discrepancies and loopholes within audited accounting data and information (Carnes & Gierlasinski, 2001; DiGabriele, 2008). The effectiveness of a forensic accountant is measured by the ability to apply investigative skills to interpret accounting information and financial evidence to back misappropriation of resources within a business organization or company (Fleming, Pearson, Riley & Richard, 2008). Fraudsters within companies and business organizations often devise methods of embezzlement or fraud that are hard to detect. It is in this regard that a forensic accountant must have effective investigative skills to detect accounting problems which would not be determined by ordina ry auditing and accounting approaches (Bawaneh, 2011). Investigative skills also allow a forensic accountant to adhere to the ethics and regulations that govern investigations of criminal cases. Computing or technical skills are required for an effective forensic accountant. This is due to the fact that contemporary companies and business environments have adopted and implemented information technology methods in accounting and finance (Fleming, Pearson, Riley & Richard, 2008).... This is due to the fact that contemporary companies and business environments have adopted and implemented information technology methods in accounting and finance (Fleming, Pearson, Riley & Richard, 2008). Through computing skills, a forensic accountant is able to retrieve, analyzed and report financial evidence in electronic formats (Topping, 2008). More importantly a forensic accountant must be able to apply computer software and applications and other computer assisted tools to detect fraud or embezzlement of resources within companies (Fleming, Pearson, Riley & Richard, 2008). Modern business organizations are characterized by what is referred to as white collar crime in which technology is used to defraud or embezzle resources and hide evidence. It is in this sense that computing skills of a forensic accountant become significant (Carnes & Gierlasinski, 2001). Litigation skills area also required for effective forensic accountants. These skills are significant in the role of a forensic accountant as an arbitrator or mediator in legal accounting problems. These skills are also important because they enable forensic accountants to be effective experts and credible consultants who could be used by companies to detect and report fraud or embezzlement of resources. Through litigation skills, forensic accountants are able to evaluate damages and losses and find ways of resolving disputes among the disputants (Topping, 2008). Other important skills of a forensic accountant include analytical and forensic skills. Effective forensic accountants must have analytical skills that will empower them to determine the importance of the gathered financial evidence in reporting fraud (DiGabriele, 2008). Through analytical skills, forensic accountants analyze and professionally

Individuals and Their Discoveries Are Not Enough to Bring Medical Progress Essay Example for Free

Individuals and Their Discoveries Are Not Enough to Bring Medical Progress Essay Individuals and their discoveries are not enough on their own to bring medical progress. Explain how far this statement applies to Jenner and his work. Jenner’s discovery of the link between cowpox and smallpox was significant to the development of a vaccine for smallpox. However, it can be argued that Jenner and his discovery were not enough on their own to bring medical progress. The factors Scientific thinking, Government Communication and Changing attitudes played a major and important role to bring medical progress. One reason as to why the statement applies to Jenner and his work is because the Government worked in Jenners favour to bring medical progress. In 1802 and 1807, Parliament gave Edward Jenner  £30,000 to develop his work on vaccination. This clearly indicates that without the help of Parliament, Jenner’s work would not have shown as much signs of advancement; hence he would not have had the money to progress. In addition to this, fifty years later vaccination was made compulsory in Britain which led a dramatic drop in smallpox cases. This evidently shows that without the help of the Government, Jenner’s work would not have been as widely spread and used by the people as much; therefore the government did play a significant role his Edward Jenner’s development of Vaccinations. A different explanation as to why the statement is relevant to Jenner and his work is because of the communication. This factor is seen to have an impact on the medical progress of Jenner, is because without the spread of Jenner’s discoveries, people would not be aware of vaccinations. In 1798, Jenner published his own accounts of his discover, spreading the details of his methods worldwide. Consequently, that people could see his work but scientists in particular were able to see his work and they could learn from his work. This is evidence that by spreading his work worldwide, it brought medical progress; it was not just Edward Jenner alone brought medical progress to the development of a vaccine for smallpox. A different factor as to why the statement applies to Jenner and his work is because of the changing attitudes. Due to many people who had begun to think in a more scientific way, this meant that they were more open into accepting Jenner’s theory for Vaccinations. This implies that if people’s attitudes were similar to people who had supernatural beliefs, they would not have accepted the theory, therefore without the changing attitudes, Jenner’s work would not have caused a huge medical progression. Another reason which explains how the statement is relevant to Jenner and his work is because of the scientific thinking. Edward Jenner was able to use scientific method and experimentation in his research which is a clear indication his work can be considered trustworthy and it is likely to be accurate. Jenner also tested out his theory on a small boy which proved his theory to be correct but also on twenty-three other people. This shows that without the scientific methods and experiments, Jenner would not have reached the conclusion that his hypothesis was correct; therefore this is evidence for medical progress. Jenner’s scientific thinking is a key factor because without it, scientists would not have been able to see his work. Also his work would not have been as widely spread; people would not trust his work if it hadn’t been tested accurately, therefore people would not use his work. Another explanation as to why the statement applies to Jenner and his work is because of the individuals. Jenner himself had the insight to realise the link between cowpox and smallpox was important. If Jenner was not a determined individual and did not carry and publish his research, the theory of vaccination would most likely not exist today. Jenner had carried on, despite opposition and criticism which indicates with Jenner’s determination, he brought medical progress. In addition to this, Jenner also tested his theory of vaccination on twenty three people, including his six month old baby which shows he is a very dedicated individual. To conclude, there are many factors to support this statement: Government, Communication, Changing attitudes and Scientific thinking all bring medical progress, alongside the individuals and their discoveries. However, Scientific thinking caused the biggest impact on the medical progress because without whilst his methods and experiments, people would not trust his work, therefore people would not use his work.

United States Declaration of Independence and British Soldiers Essay Example for Free

United States Declaration of Independence and British Soldiers Essay 1. Examine the factors that led to the colonies’ declaration of independence from England. Make sure to explain WHY the colonies decided to break from their mother-country as well as any risks that doing so might have entailed. Also include your interpretation of whether or not breaking away from England was a good idea for the colonies. After the French and Indian War, Great Britain gained lots of territories but lost lots of money. Great Britain did not want to quickly occupy this territory so they decided to make the Quartering acts. The first quartering acts basically said that British Soldiers can board free at inns and stay at abandon houses. In order to make up for the loss of money. Great Britain put lots of taxes on imports and exports as well as other laws that limited Port Cities like Boston from making money off their ports. Taxation without representation was the main factor which led the American colonies to declare their independence from Great Britain. The Sugar Act was the first in the series of British Colonial taxation acts that provided fuel for revolutionary mood in American colonies. Shortly thereafter came the British Stamp Act. This time the new tax burden took form of official stamps that colonists had to purchase and that were required for legal contracts, newspapers, and other official paperwork. The protests in the colonies started as the news broke. This led to the creation of The Sons of Liberty. Under John Adams they organized riots and violent attacks to intimidate tax collectors. The Sons of Liberty decided to harass a couple of British Soldiers Stationed at Boston. The Soldiers had no choice but to fire on the crowd killing a few people, this was called the Boston massacre. Later a British Official decided to confront John Hancock for smuggling tea. Later the sons of liberty destroyed an entire shipment of British tea. This Caused Great Britain to bring in even harsher laws. These included the following, British soldiers and officials are to be tried in a British Court and not in the colonies. British Soldiers are to quarter any houses they want and board in them without the permission of the owner. The Colonies were prohibited from having their own town council meetings. This caused the Colonist to form the Continental Congress. John Adams, who represented Massachusetts, tried to convince the rest of the colonist to fight but he had trouble convincing other colonies, mostly Pennsylvania. A few meetings later with the help of Benjamin Franklin and John Adams, Thomas Jefferson Wrote the Declaration of Independence. After years of fighting the Parliament and the King finally recognized the colonies as their own separate country. Although, breaking from their mother-country would make The British Empire, the largest in the world at the time, become their enemies, the Colonies would be free of obeying any laws set out by the British, could create their own democracy and get France as an ally.

Active or Passive Third Stage of Labour: Pros and Cons

Active or Passive Third Stage of Labour: Pros and Cons Introduction This dissertation is primarily concerned with the arguments that are currently active in relation to the benefits and disadvantages of having either an active or passive third stage of labour. We shall examine this issue from several angles including the currently accepted medical opinions as expressed in the peer reviewed press, the perspective of various opinions expressed by women in labour and theevidence base to support these opinions. It is a generally accepted truism that if there is controversy surrounding a subject, then this implies that there is not a sufficiently strong evidence base to settle the argument one way or the other. (De Martino B et al. 2006). In the case of this particular subject, this is possibly not true, as the evidence base is quite robust (and we shall examine this in due course). Midwifery deals with situations that are steeped in layers of strongly felt emotion, and this has a great tendency to colour rational argument. Blind belief in one area often appears to stem from total disbelief in another (Baines D. 2001) and in consideration of some of the literature in this area this would certainly appear to be true. Let us try to examine the basic facts of the arguments together with the evidence base that supports them. In the civilised world it is estimated that approximately 515,000 currently die annually from problems directly related to pregnancy. (extrapolated from Hill K et al. 2001). The largest single category of such deaths occur within 4 hrs. of delivery, most commonly from post partum haemorrhage and its complications (AbouZahr C 1998), the most common factor in such cases being uterine atony. (Ripley D L 1999). Depending on the area of the world (as this tends to determine the standard of care and resources available), post partum haemorrhage deaths constitutes between 10-60% of all maternal deaths (AbouZahr C 1998). Statistically, the majority of such maternal deaths occur in the developing countries where women may receive inappropriate, unskilled or inadequate care during labour or the post partum period. (PATH 2001). In developed countries the vast majority of these deaths could be (and largely are) avoided with effective obstetric intervention. (WHO 1994). One of the central argumen ts that we shall deploy in favour of the active management of the third stage of labour is the fact that relying on the identification of risk factors for women at risk of haemorrhage does not appear to decrease the overall figures for post partum haemorrhage morbidity or mortality as more than 70% of such cases of post partum haemorrhage occur in women with no identifiable risk factors. (Atkins S 1994). Prendiville, in his recently published Cochrane review (Prendiville W J et al. 2000) states that: where maternal mortality from haemorrhage is high, evidence-based practices that reduce haemorrhage incidence, such as active management of the third stage of labour, should always be followed It is hard to rationally counter such an argument, particularly in view of the strength of the evidence base presented in the review, although we shall finish this dissertation with a discussion of a paper by Stevenson which attempts to provide a rational counter argument in this area. It could be argued that the management of the third stage of labour, as far as formal teaching and published literature is concerned, is eclipsed by the other two stages (Baskett T F 1999). Cunningham agrees with this viewpoint with the observation that a current standard textbook of obstetrics (unnamed) devotes only 4 of its 1,500 pages to the third stage of labour but a huge amount more to the complications that can arise directly after the delivery of the baby (Cunningham, 2001). Donald makes the comment This indeed is the unforgiving stage of labour, and in it there lurks more unheralded treachery than in both the other stages combined. The normal case can, within a minute, become abnormal and successful delivery can turn swiftly to disaster. (Donald, 1979). chapter 1:define third stage of labour, The definition of the third stage of labour varies between authorities in terms of wording, but in functional terms there is general agreement that it is the part of labour that starts directly after the birth of the baby and concludes with the successful delivery of the placenta and the foetal membranes. Functionally, it is during the third stage of labour that the myometrium contracts dramatically and causes the placenta to separate from the uterine wall and then subsequently expelled from the uterine cavity. This stage can be managed actively or observed passively. Practically, it is the speed with which this stage is accomplished which effectively dictates the volume of blood that is eventually lost. It follows that if anything interferes with this process then the risk of increased blood loss gets greater. If the uterus becomes atonic, the placenta does not separate efficiently and the blood vessels that had formally supplied it are not actively constricted. (Chamberlain G et al. 1999). We shall discuss this process in greater detail shortly. Proponents of passive management of the third stage of labour rely on the normal physiological processes to shut down the bleeding from the placental site and to expel the placenta. Those who favour active management use three elements of management. One is the use of an ecbolic drug given in the minute after delivery of the baby and before the placenta is delivered. The second element is early clamping and cutting of the cord and the third is the use of controlled cord traction to facilitate the delivery of the placenta. We shall discuss each of these elements in greater detail in due course. The rationale behind active management of the third stage of labour is basically that by speeding up the natural delivery of the placenta, one can allow the uterus to contract more efficiently thereby reducing the total blood loss and minimising the risk of post partum haemorrhage. (ODriscoll K 1994) discuss optimal practice, Let us start our consideration of optimal practice with a critical analysis of the paper by Cherine (Cherine M et al. 2004) which takes a collective overview of the literature on the subject. The authors point to the fact that there have been a number of large scale randomised controlled studies which have compared the outcomes of labours which have been either actively or passively managed. One of the biggest difficulties that they experienced was the inconsistency of terminology on the subject, as a number of healthcare professionals had reported management as passive when there had been elements of active management such as controlled cord traction and early cord clamping. As an overview, they were able to conclude that actively managed women had a lower prevalence of post partum haemorrhage, a shorter third stage of labour, reduced post partum anaemia, less need for blood transfusion or therapeutic oxytocics (Prendiville W J et al. 2001). Other factors derived from the paper include the observation that the administration of oxytocin before delivery of the placenta (rather than afterwards), was shown to decrease the overall incidence of post partum haemorrhage, the overall amount of blood loss, the need for additional uterotonic drugs, the need for blood transfusions when compared to deliveries with similar duration of the third stage of labour as a control. In addition to all of this they noted that there was no increased incidence of the condition of retained placenta. (Elbourne D R et al. 2001). The evidence base for these comments is both robust and strong. On the face of it, there seems therefore little to recommend the adoption of passive manage ment of the third stage of labour. Earlier we noted the difficulties in definition of active management of the third stage of labour. In consideration of any individual paper where interpretation of the figures are required, great care must therefore be taken in assessing exactly what is being measured and compared. Cherine points to the fact that some respondents categorised their management as passive management of the third stage of labour when, in reality they had used some aspect of active management. They may not have used ecbolic drugs (this was found to be the case in 19% of the deliveries considered). This point is worth considering further as oxytocin was given to 98% of the 148 women in the trial who received ecbolic. In terms of optimum management 34% received the ecbolic at the appropriate time (as specified in the management protocols as being before the delivery of the placenta and within one minute of the delivery of the baby). For the remaining 66%, it was given incorrectly, either after the delivery of the placenta or, in one case, later than one minute after the delivery of the baby. Further analysis of the practices reported that where uterotonic drugs were given, cord traction was not done in 49%, and early cord clamping not done in 7% of the deliveries observed where the optimum active management of the third stage of labour protocols were not followed. >From an analytical point of view, we should cite the evidence base to suggest the degree to which these two practices are associated with morbidity. Walter P et al. 1999 state that their analysis of their data shows that early cord clamping and controlled cord traction are shown to be associated with a shorter third stage and lower mean blood loss, whereas Mitchelle (G G et al. 2005) found them to be associated with a lower incidence of retained placenta. Other considerations relating to the practice of early cord clamping are that it reduces the degree of mother to baby blood transfusion. It is clear that giving uterotonic drugs without early clamping will cause the myometrium to contract and physically squeeze the placenta, thereby accelerating the both the speed and the total quantity of the transfusion. This has the effect of upsetting the physiological balance of the blood volume between baby and placenta, and can cause a number of undesirable effects in the baby including an increased tendency to jaundice. (Rogers J et al. 1998) The major features that are commonly accepted as being characteristic of active management and passive management of the third stage of labour are set out below. Physiological Versus Active Management . . Physiological Management Active Management Uterotonic None or after placenta delivered With delivery of anterior shoulder or baby Uterus Assessment of size and tone Assessment of size and tone Cord traction None Application of controlled cord traction* when uterus contracted Cord clamping Variable Early (After Smith J R et al. 1999) physiology of third stage The physiology of the third stage can only be realistically considered in relation to some of the elements which occur in the preceding months of pregnancy. The first significant consideration are the changes in haemodynamics as the pregnancy progresses. The maternal blood volume increases by a factor of about 50% (from about 4 litres to about 6litres). (Abouzahr C 1998) This is due to a disproportionate increase in the plasma volume over the RBC volume which is seen clinically with a physiological fall in both Hb and Heamatocrit values. Supplemental iron can reduce this fall particularly if the woman concerned has poor iron reserves or was anaemic before the pregnancy began. The evolutionary physiology behind this change revolves around the fact that the placenta (or more accurately the utero-placental unit) has low resistance perfusion demands which are better served by a high circulating blood volume and it also provides a buffer for the inevitable blood loss that occurs at the time of delivery. (Dansereau J et al. 1999). The high progesterone levels encountered in pregnancy are also relevant insofar as they tend to reduce the general vascular tone thereby increase venous pooling. This, in turn, reduces the venous return to the heart and this would (if not compensated for by the increased blood volume) lead to hypotension which would contribute to reductions in levels of foetal oxygenation. (Baskett T F 1999). Coincident and concurrent with these heamodynamic changes are a number of physiological changes in the coagulation system. There is seen to be a sharp increase in the quantity of most of the clotting factors in the blood and a functional decrease in the fibrinolytic activity. (Carroli G et al. 2002). Platelet levels are observed to fall. This is thought to be due to a combination of factors. Haemodilution is one and a low level increase in platelet utilisation is also thought to be relevant. The overall functioning of the platelet system is rarely affected. All of these changes are mediated by the dramatic increase in the levels of circulating oestrogen. The relevance of these considerations is clear when we consider that one of the main hazards facing the mother during the third stage of labour is that of haemorrhage. (Soltani H et al. 2005) and the changes in the haemodynamics are largely germinal to this fact. The other major factor in our considerations is the efficiency of the haemostasis produced by the uterine contraction in the third stage of labour. The prime agent in the immediate control of blood loss after separation of the placenta, is uterine contraction which can exert a physical pressure on the arterioles to reduce immediate blood loss. Clot formation and the resultant fibrin deposition, although they occur rapidly, only become functional after the coagulation cascade has triggered off and progressed. Once operative however, this secondary mechanism becomes dominant in securing haemostasis in the days following delivery. (Sleep, 1993). The uterus both grows and enlarges as pregnancy progresses under the primary influence of oestrogen. The organ itself changes from a non-gravid weight of about 70g and cavity volume of about 10 ml. to a fully gravid weight of about 1.1 kg. and a cavity capacity of about 5 litres. This growth, together with the subsequent growth of the feto-placental unit is fed by the increased blood volume and blood flow through the uterus which, at term, is estimated to be about 5-800 ml/min or approximately 10-15% of the total cardiac output (Thilaganathan B et al. 1993). It can therefore be appreciated why haemorrhage is a significant potential danger in the third stage of labour with potentially 15% of the cardiac output being directed towards a raw placental bed. The physiology of the third stage of labour also involves the mechanism of placental expulsion. After the baby has been delivered, the uterus continues to contract rhythmically and this reduction in size causes a shear line to form at the utero-placental junction. This is thought to be mainly a physical phenomenon as the uterus is capable of contraction, whereas the placenta (being devoid of muscular tissue) is not. We should note the characteristic of the myometrium which is unique in the animal kingdom, and this is the ability of the myometrial fibres to maintain its shortened length after each contraction and then to be able to contract further with subsequent contractions. This characteristic results in a progressive and (normally) fairy rapid reduction in the overall surface area of the placental site. (Sanborn B M et al. 1998) In the words of Rogers (J et al. 1998), by this mechanism the placenta is undermined, detached, and propelled into the lower uterine segment. Other physiological mechanisms also come into play in this stage of labour. Placental separation also occurs by virtue of the physical separation engendered by the formation of a sub-placental haematoma. This is brought about by the dual mechanisms of venous occlusion and vascular rupture of the arterioles and capillaries in the placental bed and is secondary to the uterine contractions (Sharma J B et al. 2005). The physiology of the normal control of this phenomenon is both unique and complex. The structure of the uterine side of the placental bed is a latticework of arterioles that spiral around and inbetween the meshwork of interlacing and interlocking myometrial fibrils. As the myometrial fibres progressively shorten, they effectively actively constrict the arterioles by kinking them . Baskett (T F 1999) refers to this action and structure as the living ligatures and physiologic sutures of the uterus. These dramatic effects are triggered and mediated by a number of mechanisms. The actual definitive trigger for labour is still a matter of active debate, but we can observe that the myometrium becomes significantly more sensitive to oxytocin towards the end of the pregnancy and the amounts of oxytocin produced by the posterior pituitary glad increase dramatically just before the onset of labour. (GÃ ¼lmezoglu A M et al. 2001) It is known that the F-series, and some other) prostaglandins are equally active and may have a role to play in the genesis of labour. (Gulmezoglu A M et al. 2004) >From an interventional point of view, we note that a number of synthetic ergot alkaloids are also capable of causing sustained uterine contractions. (Elbourne D R et al. 2002) chapter 2 discuss active management, criteria, implications for mother and fetus. This dissertation is asking us to consider the essential differences between active management and passive management of the third stage of labour. In this segment we shall discuss the principles of active management and contrast them with the principles of passive management. Those clinicians who practice the passive management of the third stage of labour put forward arguments that mothers have been giving birth without the assistance of the trained healthcare professionals for millennia and, to a degree, the human body is the product of evolutionary forces which have focussed upon the perpetuation of the species as their prime driving force. Whilst accepting that both of these concepts are manifestly true, such arguments do not take account of the natural wastage that drives such evolutionary adaptations. In human terms such natural wastage is simply not ethically or morally acceptable in modern society. (Sugarman J et al. 2001) There may be some validity in the arguments that natural processes will achieve normal separation and delivery of the placenta and may lead to fewer complications and if the patient should suffer from post partum haemorrhage then there are techniques, medications and equipment that can be utilised to contain and control the clinical situation. Additional arguments are invoked that controlled cord traction can increase the risk of uterine inversion and ecbolic drugs can increase the risks of other complications such as retained placenta and difficulties in delivering an undiagnosed twin. (El-Refaey H et al. 2003) The proponents of active management counter these arguments by suggesting that the use of ecbolic agents reduces the risks of post partum haemorrhage, faster separation of the placenta, reduction of maternal blood loss. Inversion of the uterus can be avoided by using only gentle controlled cord traction when the uterus is well contracted together with the controlling of the uterus by the Brandt-Andrews manoeuvre. The arguments relating to the undiagnosed second twin are loosing ground as this eventuality is becoming progressively more rare. The advent of ultrasound together with the advent of protocols which call for the mandatory examination of the uterus after the birth and before the administration of the ecbolic agent effectively minimise this possibility. (Prendiville, 2002). If we consider the works of Prendiville (referred to above) we note the meta-analyses done of the various trials on the comparison of active management against the passive management of the third stage of labour and find that active management consistently leads to several benefits when compared to passive management. The most significant of which are set out below. Benefits of Active Management Versus Physiological Management Outcome Control Rate, % Relative Risk 95% CI* NNT 95% CI PPH >500 mL 14 0.38 0.32-0.46 12 10-14 PPH >1000 mL 2.6 0.33 0.21-0.51 55 42-91 Hemoglobin 6.1 0.4 0.29-0.55 27 20-40 Blood transfusion 2.3 0.44 0.22-0.53 67 48-111 Therapeutic uterotonics 17 0.2 0.17-0.25 7 6-8 *95% confidence interval Number needed to treat (After Prendiville, 2002). The statistics obtained make interesting consideration. In these figures we can deduce that for every 12 patients receiving active management (rather than passive management) one post partum haemorrhage is avoided and further extrapolation suggests that for every 67 patients managed actively one blood transfusion is avoided. With regard to the assertions relating to problems with a retained placenta, there was no evidence to support it, indeed the figures showed that there was no increase in the incidence of retained placenta. Equally it was noted that the third stage of labour was significantly shorter in the actively managed group. In terms of significance for the mother there were negative findings in relation to active management and these included a higher incidence of raised blood pressure post delivery (the criteria used being > 100 mm Hg). Higher incidences of reported nausea and vomiting were also found although these were apparently related to the use of ergot ecbolic