Rate of cooling Essay Example for Free

Rate of cooling Essay The problem for this experiment is to investigate the rate of cooling in three different types of cups. They will be used as typical coffee cups for commercial purposes. The cups a polystyrene cup, a paper cup and a plastic cup. Water has a high specific heat capacity. This makes it a very useful material for storing and carrying heat energy. Its heat capacity is 4200 joules per kilogram per i C (4200J/kg i C). Heat tends to flow away from a hotter object to a cooler surroundings. Heat is mainly lost I conduction, convection, radiation and evaporation. For this experiment I will be only using convection, radiation, evaporation because conduction is mainly in solids. Convection Convection mainly occurs in gasses and liquids gases and liquids are very poor conductors so convection is usually dominant process. When convection cant occur, the heat transfer by conduction is very slow. Convection only occurs when the more energetic particles move from hotter region to a cooler region and take their heat energy with them. Convection doesnt happen in solids because there are no particles movement. Radiation Radiation travels through anything transparent. Heat radiation is given out by anything warm or hot. The amount of it that is absorbed or released depends on the colour and texture of the material. Heat radiation is also called infra-red radiation. It consists purely of electromagnetic waves of a certain frequency. All objects continually absorb and release heat radiation. The hotter the object the more heat radiation it release. Dark surfaces absorb more heat radiation than bright surfaces. Silver surfaces reflect nearly all heat radiation falling on them. Evaporation Evaporation is when water vanishes without boiling it to change into gas. This is because some liquid molecules move faster than others and the ones close to the surface may escape and form a gas. Variables These are things that may change during an experiment The independent variable: These are things that I will decide to change e. g. the material of the cup, replacing equipment. The dependent variable: This is the measurement that is effected by the independent variable e. g. the rate of cooling. The control variable: These are the things that I will try to keep the same so I can make sure that its a fair test e. g. volume of water, room temperature, size of the cups etc. Hypothesis I predict that the polystyrene cup would cool down the slowest because it has thick walls and when you go to restaurants and ask for a hot drink they give it in polystyrene cup. I think the paper cup will cool down the quickest because its made out of paper and paper has thin walls and it absorbs water.

SNPs of ABCG2 in Chinese Advanced NSCLC Patients

SNPs of ABCG2 in Chinese Advanced NSCLC Patients Introduction Lung cancer is one of the most prevalent and fatal malignant neoplasm all over the world and non-small-cell lung cancer (NSCLC) accounts for 80%–85% of all lung cancers(1). The majority of NSCLC patients, approximately 80%, presents in locally advanced (phase IIIA/B) or metastatic (phase IV) stages, which results in quite low 5-year survival rates, 8-14.1% for phase IIIA and 1-5% for phase IIIAB/IV (2). The standard treatment of advanced NSCLC, two-drug chemotherapy based on platinum, has reached a bottleneck with limited effect. Tyrosine kinase inhibitors (TKIs), a targeted drug of epidermal growth factor receptor (EGFR), have been recently introduced for the treatment of NSCLC. Clinical trials indicated that Gefitinib and Erlotinib treating advanced NSCLC patients with EGFR mutation could result a remission rate of 62.1%~84.6% and progression-free survival (PFS) of 8.4~13.1 months, which are significantly higher than that in chemotherapy group (32.2%~47.3% and 4.6~6.7 months , respectively), but not over survival(3-6). In order to implement accurate treatment of both chemotherapy and targeted therapy, it’s urgent to find other predictive targets of NSCLC patients to stratify for treatment. ATP binding cassette superfamily G member 2 (ABCG2), also known as breast cancer resistance protein, was demonstrated to be associated with the effect and prognosis of chemotherapy/targeted therapy in NSCLC (7-9). Because the single nucleotide polymorphisms (SNPs) of ABCG2 are supposed to affect the expression of ABCG2 protein and SNPs of ABCG2 in Asian population are different from other ethnicities (10), we conducted this study to evaluate the SNPs of ABCG2 in Chinese advanced NSCLC patients and its association with their prognosis of TKI therapy. Materials and methods Patients and treatment A total of 100 patients with pathology and cytology confirmed advanced or metastatic NSCLC were enrolled into this study between April 2012 and January 2014 in Hangzhou, China. The mutation of EGFR gene was assessable in 32 patients. Other patients were not assessed EGFR mutation. TKI targeted therapy was implemented in 70 NSCLC patients and other therapy was implemented in the other 30 patients. Patients with TKI targeted therapy were treated with Gefitnid (Astrazeneca pharmaceutical co., LTD) at a dose of 250 mg/day or Erlotinib (Roche pharmaceuticals co., LTD) at a dose of 150 mg/day or Icotinib (Zhejiang beida pharmaceutical co., LTD) at a dose of 375 mg/day. The patients’ characteristics were detailed in Table 1. All patients received chest CT every two months after 1 month of therapy. The efficacy of TKI therapy was clarified as complete response (CR), partial response (PR), stable disease (SD) and progression disease (PD) according to RECIST 1.1 [1]. Patients with CR or PR at more than 6 months were considered as responders. Patients with SD and PD at less than 6 months were considered as nonresponders.[A1] Progression-free survival (PFS) was defined as the duration from TKI therapy to disease progression. Overall survival (OS) was defined as the duration from diagnosis to death from any cause. All patients agreed to participate in this study and signed written informed consent. This study was approved by the Institutional Review Board of Nanjing Medical University and performed in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines[A2]. DNA extraction Blood samples were collected before chemotherapy and kept in a microcentrifuge tubes containing ethylenediamine tetra-acetic acid (EDTA). Genomic DNA was extracted using a DNA purification kit (Flexi Gene DNA Kit, Qiagen, Hilden, Germany). The concentration of genomic DNA was determined with NanoDrop 1000 (Thermo Scientific, Wilmington, USA) and then it was diluted to a standard of 25 ng/ÃŽ ¼l. Analysis of ABCG2 polymorphisms The ABCG2 34 G/A (dbSNP ID: rs2231137), 421 C/A (dbSNP ID: rs 2231142), 1143 C/T (dbSNP ID: rs2622604) and -15622 C/T (dbSNP ID: rs7699188) polymorphisms were amplified by PCR with the appropriate primers. The primers for PCR and single base extension (Table 2) were designed by the Sequenom Assay Designer 3.1 Software (San Diego, CA). The PCR reactions[A3] were performed at 95 °C for 2 min, followed by 40 cycles at 95 °C for 30 s, Tm for 30 s, and 72 °C for 60 s. After PCR amplification, single base extension reaction was performed following the method of Wiltshire et al [2]. Finally, polymorphisms of ABCG2 gene were tested and analyzed using matrix-assisted laser desorption/ionization timeof-flight mass spectrometry (MALDI-TOF MS) and Sequenom MassARRAY system (Sequenom, San Diego, CA, USA). Statistical analysis Allele frequencies of SNPs were calculated and their genotype distributions were assessed using Fisher’s exact test or chi-square test. PFS and OS were evaluated with censored survival time methods and 95% confidence intervals (CI) was obtained from multivariable logistic regression. Kaplan-Meier survival curves were plotted for OS and analyzed with log-rank test. All tests were performed 2-sided and a p-value were carried out using SPSS 18.0 (SPSS Inc., Chicago, IL, USA) software. Results ABCG2 gene polymorphisms The genotyping of ABCG2 34 G/A, 421 C/A, 1143 C/T and -15622 C/T were performed in all these 100 patients. For the ABCG2 34 G/A polymorphism, the frequencies of GG, GA and AA genotypes were 36%, 50% and 14%, respectively. The allele frequencies of G and A were 61% and 39%, respectively. The wide-type ABCG2 421 C/A genotype (CC) had a frequency of 53%, while the CA and AA genotypes were found in 43% and 4% of the patients, respectively. The allele frequencies of G and A were 74.5% and 25.5%, respectively. The frequencies of CC, CT and TT genotypes for ABCG2 1143 C/T were 66%, 29% and 5%, respectively. The allele frequencies of G and A were 80.5% and 19.5%, respectively. Regarding the ABCG2 -15622 C/T polymorphism, the TT genotype was observed in all patients. Therefore, polymorphism of ABCG2 -15622 C/T was not investigated in the following steps. Polymorphisms of ABCG2 and clinical characteristics Patients clinical characteristics were shown in Table 1, and the relationship between polymorphisms of ABCG2 and clinical characteristics were presented in Table 3. No significant correlations were found between ABCG2 polymorphisms (34 G/A, 421 C/A and 1143 C/T) and patients’ characteristics, including gender, age, smoking history, histology and EGFR mutation (p > 0.05). Although there was no significant relationship between ABCG2 421 C/A polymorphism and EGFR mutation, a trend that CA genotype was observed frequently in EGFR mutation positive patients (47.6% in positive patients vs. 18.2% in negative patients, p = 0.119). Then we calculated the allele frequency of A in these patients and a high frequency of allele A in positive patients (33.3% vs. 9.1%, p = 0.038) was observed. Polymorphisms of ABCG2 and clinical outcome of TKI The sensitivity of 70 patients to TKI treatment was shown in Table 4. NO significant correlation was found between ABCG2 polymorphisms (34 G/A, 421 C/A and 1143 C/T) and sensitivity (p > 0.05). As shown in Table 4, median PFS for carriers of the A-allele and GG genotype at position 34 of the ABCG2 gene who were treated with TKI therapy was 8.0 months (95% CI: 5.9-10.1, n = 45) and 6.5 months (95% CI: 4.1-8.9, n = 25), respectively. There was no significant difference in median PFS of NSCLC patients receiving TKI therapy between CC genotype and CA + AA genotype at position 421 of ABCG2 gene (p > 0.05). Median PFS of patients with CC genotype at position 1143 of ABCG2 gene was higher than those with CT and TT genotypes, but no significant difference was found (p > 0.05). The median OS of patients with ABCG2 34 G/A, 421 C/A, 1143 C/T polymorphisms was shown in Table 4. The median OS of patients with GG genotype at position 34 of the ABCG2 gene was 18 months (95% CI: 14.9-21.1, n = 25) and for those with other genotypes (GA and AA) was 31 months (95% CI: 22.9-39.1, n = 45). Figure 1 showed the Kaplan-Meier curve for OS for NSCLC patients receiving TKI therapy in relation to ABCG2 genotypes at 34 G/A (Figure 1A), 421 C/A (Figure 1B) and 1143 C/T (Figure 1C). There was significant difference between patients with GG genotype and those with GA + AA genotypes at position 34 of the ABCG2 gene (p difference between patients that were CC genotype regarding the position 421 of ABCG2 gene and carriers with other genotypes (CA + AA, p > 0.05). No significant difference was found in 1143 C/T polymorphism (p > 0.05). Discussion Our present study observed that three polymorphisms of ABCG2, 34G>A, 421C>A and 1143C>T occured more frequently compared with -15622C>T in Chinese advanced NSCLC patients. As for -15622C>T, all patients presented a TT genotype. Although no relationships were observed between different genotypes of ABCG2 polymorphisms and EGFR status, a higher frequency of allele A (421C>A) in EGFR mutation positive patients was observed. The other polymorphisms were not related to clinical characteristics. The sensitivity and PFS to TKI of 70 patients was not related to polymorphisms. However, the OS of patients with 34G>A mutant type (GA+AA) was significantly longer than those with wild type (GG). The ABCG2 protein is an important member of the ABC transporter superfamily, which has been suggested to be involved in multi-drug resistance (MDR) in cancer. Screening for SNPs in ethnically diverse subjects has identified more than 80 synonymous and nonsynonymous SNPs in the ABCG2 gene to date (12). The two most frequent polymorphisms identified were 34G>A (resulting in V12M) and 421C>A (resulting in a Q141K substitution) transitions (13). A novel diplotype of two polymorphic loci in the ABCG2 promoter involving -15622C>T and 1143C>T were identified recently (14). Introduction of other ABCG2 SNPs can be found in a recent review (15). Despite the similar allele frequency of 421C>A variant among East Asian populations including Chinese (34.2–35.0%) and Japanese (26.6–35.0%), the allele frequency is higher than that of Southeast Asians (15.0%), Middle Easterns (13.0%), Caucasians (8.7–12.0%) and African-Americans (2.3%) (10). Similarly, the allele frequency of the 34G>A variant in Chinese (20.0%), Koreans (19.8%) and Japanese (15.0-19.0%) is comparable. However, it is much lower than that in Southeast Asians (45%) and higher than other ethnic groups including Caucasian (1.7–10.3%), African-American (6.3%) and Middle Eastern (5.0%) populations (10). The allele frequency of 421C>A variant in our studied population was 25.5%, which was comparable to other Asian populations. However, the allele frequency of 34G>A variant was 39.0%, which was higher than other reports from Asian populations. We found that the allele frequency of 1143C>T variant and -15622C>T variant in our study was 19.5% and 100%, respectively. In Caucasians, it was reported to be 22% and 28%, respectively (16). We unexpectedly observed that all the included patients presented TT genotype of -15622C>T. As far as we known, this gene has not been investigated in other Asian populations. Future studies could be conducted to determine the polymorphism of -15622C>T in Asian po pulation and its potential impact. Physiologically, ABCG2 protein is highly expressed in the blood-brain barrier and gastrointestinal tract, where it is thought to play a role in protection against xenobiotic exposure. High ABCG2 expression has also been found in a variety of tumors and correlated with multidrug resistance and poorer clinical outcomes, as this transporter has the ability to extrude its drug substrates out of the cells, thereby decreasing their intracellular accumulation (17, 18)[16]. Primary structural variations of ABCG2 are associated with its drug-transporter function (15). Therefore, SNPs in the ABCG2 gene would influence the pharmacological effects differently in different patients. It has been demonstrated that 421C>A polymorphisms may express low amounts of ABCG2 (19-22) while the influence of 34G>A polymorphisms on ABCG2 expression remains controversial (22, 23). And regarding to 1143C>T and -15622C>T, some researchers found a decreased protein expression related to these two polymorphisms (21 ) and others found no relation between them (24). Moreover, 421C>A polymorphism has been demonstrated to be associated with ATPase activity and drug transport (18). Thus, several clinical studies have investigated the relation between ABCG2 polymorphism and clinical outcome of NSCLC. Mà ¼ller and colleagues (25) found that carriers of the ABCG2 421 A-allele treated with platinum-based drugs showed a significantly worse OS in all lung cancer patients. However, this effect was not statistically significant in the smaller subgroups of SCLC patients or NSCLC patients with platinum-based treatment. They did not found an association between 34G>A polymorphism and prognosis. Another study of 129 unresectable NSCLC cases treated with first-line platinum-based chemotherapy suggested that ABCG2 SNPs rs2725264 and rs4148149 were associated with OS (26). On the other side, there was also evidence showing that ABCG2 polymorphisms were not related to response or prognosis of NSCLC patients treated with gefitinib (24), erlotinib (27) and gemcitabine and/or platinum-based drugs and/or other drugs (28). In our present study, we found the OS of patients with 34G >A mutant type (GA+AA) was significantly longer than those with wild type (GG). However, we did not observe significant differences concerning other polymorphisms including 421C>A, which was found to be associated with prognosis of other cancer by other study (29). Interestingly, it was reported that ABCG2 34 GA/AA genotypes were associated with poor prognosis of Chinese patients with acute leukaemia (30). Polymorphisms of 34G>A seems to have an opposite impact in different types of cancer. The mechanisms are worthy to be investigated in future large studies. Moreover, ABCG2 SNPs was demonstrated not only related to TKI resistance, but also to TKI induced side effects. Cusatis and colleaguesinvestigated associations between allelic variants ofABCG2 with diarrhea and skin toxicity ingefitinib-treated patients. They found that 16 patients heterozygous forABCG2 421C>A developed diarrhea, versus only 13 (12%) of 108 patients homozygous for the wild-type sequence. However, this SNP was not associated with skin toxicity (28). A recent study found that patientscarrying anABCG2 -15622 TT genotype or harboring at least one TT copy in theABCG2 (1143CT, -15622CT) haplotype developed significantly more grade 2/3 diarrhea (23). In our present study, we did not perform the analysis on side effects. However, this is a serious concern which should be taken into consideration in future studies. In Conclusion, Our findings demonstrate a strong association between the ABCG2 34G>A polymorphism and the overall survival of NSCLC patients treated with TKIs, including Gefitnib, Erlotinib and Icotinib. Since these polymorphisms can be assessed with a simple blood test, it might potentially improve the stratification of patients for TKI treatment by identifying genetically high-response subgroups. Therefore, larger prospective trials are warranted to validate these findings. [A3]The PCR reactions were performed in 20 ÃŽ ¼l volumes on 384-well plates (cat. No. TF-0384/W, ABgene, USA) with 20 ng DNA, 10 pmol for each primer and 1 Ãâ€" PCR-Buffer (Sequenom, San Diego, CA, USA). à §Ã‚ ¼Ã‚ ºÃƒ ¤Ã‚ ¸Ã…“à ¨Ã‚ ¥Ã‚ ¿Ãƒ £Ã¢â€š ¬Ã¢â‚¬Å¡

Physical therapy management to reduce post operative CABG

Physical therapy management to reduce post operative CABG Coronary Artery Bypass Graft surgery (CABG) is a medical procedure used in the treatment of coronary artery disease (CAD). CAD is a disease that causes narrowing of the coronary arteries (the blood vessels that supply oxygen and nutrients to the heart muscle) due to the accumulation of fatty deposits called plaques within the walls of the arteries. Investigations such as electrocardiogram, stress tests, cardiac catheterization, imaging tests such as chest x- rays, echocardiography, or computed tomography (CT), and blood tests to measure blood cholesterol, triglycerides, and other substances are used to diagnose CAD. The accretion of plaques over the years causes symptoms such as chest pain, fatigue, palpitations, and shortness of breath. Some patients with CAD may be symptom free in the early stages; the disease will progress until sufficient artery blockage exists to cause symptoms and discomfort. Blockage of the coronary arteries will cause the heart muscle to weaken due to inadequ ate blood supply, leading to a condition called ischemia. If the blood flow is not restored to the particular area of the heart muscle, the tissue dies, leading to myocardial infarction or heart attack. In order to restore blood supply and treat the narrowing of the arteries, the blocked portion of the artery is bypassed or rerouted with another piece of vessel, this is called CABG surgery1. Despite the many advances and development in anesthesia, surgical techniques, and postoperative care for CABG surgery, postoperative pulmonary complications (PPCs) retain a high postoperative morbidity and mortality rate 1. The risk of PPC has increased in CABG procedure due to two factors: intra-operative and external. The intra-operative factors are factors that are associated with the surgical procedure such as general anesthesia, surgical incision, type of graft, topical cooling for myocardial protection, and cardiopulmonary bypass2. General anesthesia increases the risk of PPC when the anesthetic component is administered to the patient while lying in supine position; it results in respiratory depression leading to a Ventilation-Perfusion (VQ) mismatch. In the surgical approach, the incision site in the upper thoracic area, which is a standard 20cm incision, decreases the preservation of pulmonary function. The type of graft used such as IMA increases the risk of attaining PPC. Topical cooling also used in CABG increases the incidence of phrenic nerve injury. Cardiopulmonary bypass which is unique to this surgery causes additional lung injury and longer pulmonary recovery, which occurs due to the acute systemic and pulmonary inflammatory response which is known as à ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒâ€¦Ã¢â‚¬Å"pump lung or à ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒâ€¦Ã¢â‚¬Å"post pump syndrome 2. External factors that could increase the risk of acquiring PPC are aging, the prevalence of surgical delay, increased sickness and complex health problems. The diagnosis of PPC, requires symptomatic pulmonary dysfunction symptoms such as increased work of breathing, shallow respiration, ineffective cough, and hypoxemia 2; in addition to clinical findings such as atelectasis, pleural effusion, pneumonia etc. The most frequent types of PPC associated with CABG are atelectasis which ranges from16.6% to 88%, phrenic nerve paralysis (30 % to 75%), and pleural effusion (27%-95%) 2. Acquiring PPC leads to the increased use of medical supplies and other health care expenses. Numerous interventions have been used to treat PPC but, due to variance in opinions, no resolution has been reached to which is the most effective and efficient intervention in treating PPC. To prevent postoperative complications such as PPC, less invasive techniques are applied by physical therapists. Physical therapists are responsible for the management and rehabilitation of the patient, which includes treating and educating the patient and helping them to attain the maximum function, and satisfying level of independence; this is achieved by decreasing the level of limitation and impairment. Physical therapy treatments include mobilization and airway clearance techniques, positioning, breathing exercises, coughing maneuvers, mobility and functional exercises. Physical therapy has been known to intervene in surgical procedures such as CABG, but most of the intervention used in patients reha bilitation is performed postoperatively. Recent studies have confirmed that post-operative patients, especially in CABG can improve as much as 50% 3 by introducing pre-operative physical therapy management. The preoperative management targets patients pre-surgically and directs its rehabilitating techniques towards the reduction of a possible PPC pre-operatively. Preoperative physical therapy management includes appropriate patient selection, preoperative PT assessment, patient education, and pre-operative physical therapy treatment (PPTT). These management protocols further enhance post-operative results by training patients on post-operative techniques. Thus pre- and post- operative physical therapy management is performed to reduce post-operative CABG pulmonary complications. Literature review Pre-operative Physical Therapy Treatment Preoperative management is an early involvement of physical therapy prior to surgery. It is a method used in prevention of patient deterioration by directing its efforts towards the patients respiratory and physical condition. Preoperative physical therapy management ensures that the patient is in the best respiratory and physical condition prior to surgery, to be able to have a rapid recovery. Preoperative management mainly focuses on appropriate patient selection, patient education, pre-operative assessment, and preoperative treatment. Appropriate patient selection Patients undergoing surgery have certain characteristics which can increase or alter the risk of any surgical complications especially in CABG. These characteristics affect the outcome of surgery, therefore leading to post operative complications. Suitable patient selection in preoperative rehab is important. This allows the physical therapists to categorize patients. Patients can either be classified as low risk or high risk patients. Classifying patients in such order ensures that each patient will obtain a tailored preoperative management program according to their condition and will receive maximum benefits from the program 4. The characteristics that alter the patients risks are pre-existing respiratory problems, obesity, age, smoking, patient motivation, and nutritional status 4. Pre-existing respiratory problems is of three factors infection, restrictive defects, and obstructive defects. Infection may affect both upper and lower respiratory tracts. If the upper respiratory tract is infected, it will cause increased mucus production. And if it infects the lower respiratory tract it may initiate impaired gas exchange leading to hypoxia secondary to pneumonia, resulting in exacerbation of infection. Restrictive defects include lung fibrosis, pulmonary oedema, and pleural effusion. The restrictive may reduce lung volume, resulting in an increase of airway resistance and closing of airways following anesthesia. Obstructive defects are also known as Chronic Obstructive Pulmonary Diseases (COPD). The occurrence of COPD in patients undergoing surgery will lead to an increase in the anesthesia dose due to bronchial hyperactivity. Obesity is another characteristic that can upgrade a patient into the higher risk group. Obesity is usually detected by using the Body Mass Index (BMI). According to Selsby and Jones 1993, increase in body mass may lead to reduced lung compliance by approximately one third; this is due to the additional weight on the chest wall. As a person ages the lung loses its elasticity in recoiling and the lung volume is reduced. During aging, respiration is reduced by weakening of the respiratory muscles and stiffening of the rib cage. Smoking is the major cause of greater ventilation/perfusion (V/Q) shunt, and impaired oxygenation during anesthesia. This is because smoking results in narrowing of the airways, excessive mucus secretion and decreased mucus clearance, and irritable airways. Patient motivation is the current mental or cognitive, and emotional state of the patient. Any disturbance in such states may result in decrease patient compliance and increases the duration of the patients recovery. Preoperative PT assessment Pre-operative assessment is a technique used to establish an outline of the patients current status, and form a baseline to assess the patients progress. The pre-operative assessment includes subjective and objective assessments. Subjective assessment is an interrogation procedure used by the physical therapist to obtain information to help with the preoperative treatment program. During the subjective assessment, open-ended questions 4 are used, which allows the patient to discuss their current problems. There are five main points that need to be clarified during this type of assessment; dyspnea, cough, secretion (sputum and haemoptysis), wheeze, and chest pain. During the objective assessment, the physical therapists use their own skill in examining the patient. The physical therapists examines by observation, palpation, percussion, and auscultation. Further details may be obtained by the use of tests such as spirometry arterial blood gases (ABGs), and chest radiographs 4. When assessment is completed, the physical therapist analyzes the information obtained and integrates it with their knowledge, resulting in a problem list. According to the problem list the physical therapists addresses these problems by setting specific, measurable, achievable, realistic, and time specific goals according to the problems obtained from examination. A well designed treatment plan is set to help resolve these problems. Patient Education Patient education plays an important role in rehabilitation. The patient is educated by the staff, which includes the surgeon, physical therapists and nurses. The patient is educated on preoperative and postoperative programs or protocols. During patient education, verbal and written information is given to patients. The role of the physiotherapist in patient education is to highlight and clarify the main points of the CABG procedure, allowing the patient to become familiar with the surgery. The physical therapist also explains the main effects of surgery on the respiratory function, location of the wound, and wires and monitors attached. The instructions given before the surgery puts the patient at ease and postoperatively accelerates the functional recovery of the patient. To reinforce the verbal information, leaflets and brochures are given to help the patient. Pre-operative Physical Therapy Treatment (PPTT) PPTT is directed towards maximizing pulmonary function 4 by the reduction of PPC and the use of non-invasive PT interventions. Since PPTT is a newly emerged, few studies are found that discuss the preoperative treatment of patients undergoing CABG procedures. Therefore no precise treatment techniques or protocols are followed during PPTT. Studies have suggested that the most common types of PPC that occur following CABG surgery are atelectasis, and pneumonia. Atelectasis which is an abnormal respiratory condition causes lung collapse, therefore leading to deprivation of gas exchange. It is caused by an obstruction of major airways and bronchioles. It is a complication that is frequently seen in post-operative period and is found in the basilar region in post CABG. To treat and prevent such condition deep breathing techniques and incentive Spirometry is used 5. Pneumonia is an infection or inflammation of the lungs. It can be caused by microorganisms such as bacteria, viruses, or fungi or by a potential complication such as pleural effusion. Pneumonia is treated by pharmaceutical agents, coughing techniques, and breathing exercises 5. It was found that both PPCs are caused by the patients inability to expectorate sputum and due to insufficient diaphragmatic breathing. Therefore the most appropriate way to treat such conditions is to rehabilitate patients preoperatively. PPTT treatments are of a large variety and no precise treatment has been advised solely for treatment. During my investigation I have came upon many techniques used. The most common treatment used within the PPTT is breathing exercises (BE), respiratory muscle devices, and sputum expectoration techniques. BE are several techniques used to help increase the muscle strength and increase air entry. It is performed by inflating and deflating the lungs. There are many types of BE some are pursed lip breathing (PLB), paced breathing, diaphragmatic breathing, segmental breathing, sustained maximal inspiration (SMI), and global lung expansion. Respiratory muscle devices are instruments used to help strengthen the surrounding breathing muscle by the use of resistance as shown with the inspiratory muscle trainers (IMT) and aids the patient in air entry by visual aid, as shown with the incentive spirometer (IS). The sputum expectoration techniques are tactics used to expel secretions from the lung. One of the most common techniques used nowadays is the secretion removal technique, this is a method used to remove mucus from the lung and helps in expectorating the sputum, it is known as postural drainage. This method can be applied according to area of secretion and can be modified according to the patients condition. Other supporting or assisting techniques is coughing and the Forced Expiratory technique. Coughing is used to help the patient to expectorate sputum. The PT can teach the patient the correct method and may support the patient incision or wound when coughing if needed, or assists the patient by applying force on the abdomen, increasing the abdominal pressure therefore giving extra force. FET is less forceful technique, it is similar to coughing, and the patient huffs instead of coughing. This method brings the mucus to the upper airways and is usually followed by coughing to expel sputum. An observational follow up study was performed by Isabel Yanez-Barage. The purpose of the study was to examine the use of preoperative respiratory physiotherapy, on the incidence of pulmonary complications in CABG surgery. Two groups of patients were involved in the study. The first group was the intervention group, whom received PPTT and the second group was the control group, who had no PPTT. The apparatuses used within the study included Incentive IS and, BE. Prior to their use, uses and importance of the apparatus was explained to the patients. The techniques that was used during the study, were ten deep BE, diaphragmatic breathing, thirty long expansion maneuvers, tactile stimulation, three stages of Sustained Maximum Inspiration (SMI), ten global lung expansion, secretion removal techniques, supported or assisted coughing. The above techniques were put in a program, and all exercises were performed in two sessions per day, while the SMI was performed six times per day, five set s with 30-60 seconds rest between each set. The results of the study showed that the presence of atelectasis occurred 48hours after surgery. The PPTT group had a 17.3% of atelectasis, while the non PPT group had 36.3%. The study also showed that a relationship existed between atelectasis and patient gender, and that 21.8% was found in females while 37.5% in males 3. Another study performed by Erik H. J. Hulzebos, focused on two primary outcomes. One was post operative complications, which is pneumonia. The second outcome measure is the post-operative pulmonary complications (PPC), which include the influences of morbidity and mortality rate, the length or duration of stay at hospital, and the overall resource utilization. The interventions used in this study included such as IMT and IS, while the techniques included are patient education in active cycle of breathing techniques and Forced Expiratory Techniques (FET). The program followed within the study was the use of FET and performing it on daily basis seven times per week for duration of two weeks before surgery, and the IMT was done for twenty minutes, six times per week without supervision and once per week with PT supervision. The result of the primary outcome measure is that18% (25 of 139) of the patients from the IMT group developed PPC, while patient 35% (48 of 137) of usual care group developed PPC. The incidence of pneumonia was less in the IMT group whom had 6.5% (9 of 139). While on the other hand the usual care group had a higher incidence which was 16.1% (22 of 137).The usual care group had also another complication, where 3 of the 22 patients developed respiratory failure and died after surgery as a result of cardiac failure, while none of the IMT patients died. The study concluded that preoperative physical therapy reduced PPC by 50%. The study suggests that no a single PT techniques or intervention is better than the other in preventing PPC. Pre-operative PT has increased inspiratory force, decreased the incidence of PPC and hospitalization, and reduced morbidity 1. . Post-operative Physical Therapy Management Post operative complications are common in patients undergoing cardiothoracic surgeries. According to Agnieszka Piwoda et al, the fundamentals to a properly designed and conducted cardiac surgery, is physical therapy management 6. To minimize postoperative complications, physical therapy management is introduced. Postoperative physical therapy (POPPT) starts the instant the patient is transferred from the operating room to the intensive care unit (ICU), which lasts 1 to 2 days and is continued in the ward from 2nd day till the date of discharge which is the 7th day 6. During the patients stay at the ICU postoperative, physical therapy rehab is aimed towards the reduction of airway obstruction, increasing and enhancing ventilation-perfusion matching, which is also known as gas exchange (VQ matching), restoring normal gasometrical values which when by doing so, the patient is prevented from re-intubation 6, decreasing ventilatory failure where the patient becomes dependent to the mechanical ventilator 3, and preventing thrombo-embolitic changes altogether leading to a decrease in ICU stay. The ward rehab starts when the patient gains early extubation; this allows the patient to regain contact with reality. During this period the physical therapist is able to eradicate secretion accumulation, and rapidly mobilize or ambulate the patient 6. Maintenance of permanent and intensive mobilization will improve cardiopulmonary tolerance, leading to an increase in physical endurance and patient independence, therefore reducing hospital stay 7. Most of the studies involving a majority of patients undergoing CABG are focused on reducing basilar atelectasis and pneumonia and hypoxemia 7 by applying specific post operative physical therapy objectives such as recruiting lung tissue from shunt to zone of low ventilation in relation to perfusion 8, increasing lung capacities especially FVC and FEV8, decreasing respiratory muscle dysfunction 3, increasing respiratory muscle function diaphragm 6, restoring thoracic breathing manoeuvres by strengthening postural and respiratory muscles, and endorsing effective breathing patterns by reducing the work of breathing 7. To achieve optimum results and regain the inclusive functional independency, POPPT management should include airway clearance techniques, early mobilization, bed mobility and positioning, breathing exercises (BE), and patient education. Specific post operative physical therapy techniques such as the use of intensive deep breathing exercises and devices such as IS, and IMT should be emphasized when rehabilitating post CABG patients. Prior to POPPT, an extensive patient evaluation similar to the preoperative assessment should be performed. When assessing the patient problems, goals should be set and are treated accordingly. Airway clearance techniques A manual or mechanical procedure that assists in clearance of secretion from the airways is known as Airway Clearance Techniques (ACT) 9. ACT is indicated for impaired mucociliary transport or an ineffective and unproductive cough. When choosing an ACT the patients pathophysiology, symptoms and medical status should be taken in consideration. The techniques included in ACT are Postural Drainage (PD), manual chest clearance, and coughing. PD is a technique that drains secretion by gravity assistance, and the use of more than one body position. There are 12 positions used during PD 9, in each position the segmental bronchus is drained perpendicular to the floor. These positions can be modified according to the patients medical status. The most affected segment should be prioritized. The patient is positioned using an adjustable bed, pillows or blanket rolls, and enough personnel to assist in moving the patient safely. PD is used for approximately 5-10 minutes solely and longer if tolerated 9. Manual chest clearance technique is the application of manual supplementary techniques such as vibration, percussion, and shaking to postural drainage positions 10. Coughing technique is a forceful airstream method used to remove secretions out through the trachea and to the mouth. Coughing technique is performed in four stages, and may be applied before, during and after PD and manual chest clearance techniques. In CABG patients, the coughing technique is supported using splinting. This is done is applying pressure to the incision site either by using a pillow or a belt. This techniques helps with decreasing the pain associated with the surgery. Early mobilization Early mobilization or ambulation is the method used to set patients in motion postoperatively by using the assistance of PT. The patient mobilization process is performed gradually and according to the patients tolerance. Mobilization starts by sitting the patient from supine to a long sitting position. Then when further stability is regained the patient is positioned on the edge of the bed. The patient is then progressed to standing, and later when the patient regains more stability, walking is initiated. Positioning Positioning is a therapeutic and ventilatory movement that is used to assist the patient in regular changing of position while in bed. It is essential in the patient early stages of recovery. Positioning allows the patient to progress from dependence to independence. The technique involves the selection of certain positions to assist the patient with efficient and diaphragmatic breathing patterns. The technique is indicated for patients with diaphragmatic weakness, patients unable to correctly use the diaphragm for efficient inspiration, or who have inhibition of diaphragm muscle due to pain 9. The training usually commences in the ICU. An example used by Sadowsky et al on positioning is the performance of ROM exercise with breathing. The exercise is performed by the patient inspiring air and accompanying it with shoulder flexion, abduction, external rotation, and eyes in an upward gaze. Then the patient exhales with shoulder extension, adduction, internal rotation and downward gaze. In addition to the exercise the patient is asked to tilt the pelvis posteriorly. This allows diaphragmatic breathing pattern and optimizes the length-tension relationship of the diaphragm 9. This technique progression should be applied to transfer, ambulation, and stair climbing. This technique is highly recommended for patient patients that underwent CABG since they are likely to have 90.7% of diaphragmatic elevation 11. Breathing exercises Breathing exercises are maneuvers used for patients with signs and symptoms of decreased strength or endurance of the diaphragm and intercostal muscles 9. There are many breathing exercises one of them is known as the Active Cycle of Breathing Technique (ACBT) 10. ACBT includes a group of breathing techniques such as breathing control, thoracic expansion exercises, and forced expiration technique. Other methods that assist BE are respiratory devices such as Inspiratory Muscle Trainers (IMT) and Incentive Spirometry (IS). Respiratory devices are mechanical equipments used in attempt to reduce postoperative pulmonary complications particularly atelectasis and pneumonia. BE and respiratory devices are suggested for patients at high risk of having atelectasis such as CABG patients, whom are for 24.7% of postoperative atelectasis 9, 11. A study performed by Elizabeth Westerdahl investigated the effect if deep breathing exercise on pulmonary function, atelectasis, and Arterial Blood Gases (ABGs) after CABG. The study was performed on two groups, the first group was the deep breathing group and the second was the control group. Both groups were approached similarly in assessment, positioning, and mobility once or twice daily during the first 4 postoperative days. Chest PT was done twice in the first 4 post-op days, the therapy includes early mobilization, instructions in coughing techniques, and daily active exercises of the shoulder girdle, upper back, and assistance to turn form side to side and get out of bed. The deep BE group received an extra program, performing breathing exercises every hour during the day for four postoperative days. The exercise used is, 30 slow deep breaths with PEP blow bottle device, a 50cm plastic tube in a bottle containing 10 cm of water. The exercise was performed sitting; it is 3 sets of 10 deep breathing exercises with 30-60 seconds pause between each set. If needed, patient coughs during the pause to mobilize secretion. The result of the study illustrate that atelectasis was found in large areas at basal level close to the diaphragm and minor at the upper level near the apex. There was a significant decrease in atelectasis in deep breathing group by one half compared to the control group, and the correlation between PaO2 and atelectasis was weak. Recruited lung tissue is most likely converted from shunt regions to zones with low ventilation in relation to perfusion. In conclusion, Patients who performed deep-breathing exercises had a significant smaller atelectasis, and less reduction in FVC and FEV on the 4th post-op day. 8 Patient education Patient education which is an integral part of the post-operative physical therapy management is applied similarly to the preoperative patient education program. When educating a patient in the post-operative period, the instructions given should highlight the thought of improving quality of life by emphasizing on points such as having healthy eating habits, ceasing smoking, achieving independence, and accentuating the benefits of rehab, and returning back to ADL. Patients should also improve their physical education by participating in other therapies that have been introduced such as tai chi, PNF, NDT Bobath and music therapy 6. Conclusion As PPC has been of great concern to health professionals, the reduction of complications that accompany major surgeries such as CABG is of an important development. The main objective in physical therapy with regard to CABG is to reduce PPC by intervening with less invasive protocols. The combination of both pre-operative and post-operative physical therapy management has had effective results in managing CABG patients. The reduction of PPC by the use of preoperative physical therapy management has led to many advantages. Some of them are significant reduction in mechanical ventilators duration therefore reducing the duration of ICU stay, reduced hospitalization, decreased morbidity and mortality rate, enhanced early functional recovery, improved lung function and gas exchange. Such accomplishments are significant, but more studies have to be performed to develop PPTT programs and provide a certain protocol The reduction of PPC by the use of postoperative physical therapy has lead to the best outcome of treatment. It has decreased complications associated with surgery and reduces PPC, allowing the patient to regain maximum physical condition, reducing ICU and hospital stay by achieving physical and functional independence therefore assisting the patient in regaining better-quality of life 5. The patient can further continue physical therapy at the cardiac facility to promote additional cardiopulmonary conditioning. In Kuwait, post-operative PT management is more widely-used than preoperative. During my investigation I found out that the chest hospital is aware of the preoperative management and is applying it, but in an informal way. I would like to call attention to the use of post-operative PT management in association with pre-operative physical therapy management to help the patient have a better surgical outcome, regain maximal independence and improve the quality of their life.

Coopers Chingachgook :: essays papers

Coopers Chingachgook The Death of Chingachgook as the Apogee of the tragedy of the Indian Nation in Cooper^s The Pioneers The Pioneers, written by James Fenimore Cooper in 1823 opens the popular series of books about the adventures of an inhabitant of the New England forests Natty Bampo ^ a white man, a scout, and a hunter. However, the novelist does not merely narrate the life of Natty, his main aim is to present the whole situation on the Eastern Coast of America in the seventeenth century. In The Pioneers, in particular, Cooper writes about the new settlers in America, about their conquest of the lands, and about the tragic extinction of the Indian people, who had been proud owners of the lands of America. One of the most important moments in this book, and even in the whole cycle, is the scene of the death of Natty Bampo^s best friend Chingachgook, the last representative of the Indian tribe of Mohicans. In this scene the author presents his most important ideas about the vices of the new settlers, hypocrisy of Christianity, and the tragedy of the native inhabitants of the American lands. C! ooper actually makes the death of the Mohican sound as a final chord in the calamitous history of the Indian people, who under the onslaught of European civilization are doomed to disappear. He makes the dying Indian chief a symbol for his perishing nation, presenting him at the last minutes of his life in his national costume and believing in the Indian morals and gods. Moreover, by misspelling his name on the gravestone, Cooper redoubles the tragic implication that after the death of Chingachgook his culture is forgotten and lost, and a meaningful Indian name loses its importance for the white people who come to live in the formally Indian forests. Towards the end of The Pioneers the tragic story about the Indians who were expelled from their lands by the white Europeans, reaches its apogee. The scene of the Chingachgook^s dying is full of sadness, pain, and hopelessness. In a very meaningful way Cooper presents his Indian hero on the threshold of death, sitting "on a trunk of a fallen oak" (p.381). Thus he hints at the identity between the old chief and the tree, implying that once young and strong they both are now old and lifeless. Moreover, as the fallen tree is now disconnected from the company of the strong young forest mates, thus also Chingachgook with his "tawny visage" (p.381) is lonely among the liveliness of the newly established colonies. So Cooper writes that in place of the once virgin forests where the

Gods VS Mortals :: essays research papers

â€Å"There is only one way: Destroy them all." Lucan's burning eyes moved slowly from one god to the next, hoping his harsh decree had convinced more of them to take his side. It had seemed like an eternity (which it very well could have been) since all the gods had gathered together like this. â€Å"This can not be the way, I still believe this would be an over reaction.† Ranna said, waving her hand as if to throw away Lucan's idea. â€Å"What the mortals need is our guidance.† â€Å"You cannot be seriously talking about the, elves† Lucan scowled â€Å"How can you be so passionate about the race that yellowed your fields, up rosed and murdered your followers, even attacked you! There is nothing in their heart but the love for wealth and power.† She glared back at him. â€Å"That is your doings at work, Lucan. It was only when they broke on to the Flats of Power that you stopped enjoying their growing domination of Nithra.† â€Å"We all agree mortals have gone too far," Srill interrupted, knowing there was a need to interrupt before the argument went on further. "But the answer isn't to wipe away all of our work. It is only a few races that have gone this far. Perhaps a select cleansing instead of complete destruction." Rook shook his head. "I have to agree with Lucan on this matter. Wiping them out is the only way." "The answer is obvious," interrupted Cazil. "If my power was allowed to grow, the mortals would be in no position to challenge us. Fear will keep them in line, it always should have." Kara roared. "Absurd! It's proven that apart any one of us can be overcome by the mortals. It is our neglect that has brought this upon us. The solution must be one that we can all agree on." "can you be too blind?" Lucan growled. "How can you not see that the mortals must be punished?" "You ignore their honor," Marr countered. "They earned the right to exist. "Right to exist?" Innok cackled. "Leave them to their selfs and they will destroy themselves in greed and hate. We should not kill them, but step to the side and let them waste them selfs." "We don't have that kind of time," Ro speaks. "The planes are already weak, some have already been completely erased, our powers have grown too weary to hold them. We must strike back while we still can.

Business Resource Essay

With Examples, you are to describe the main physical and technological resources required in the operation of your selected organisation. In this assignment I will describe the main physical and technological resources required in the operation of Tesco. Physical Resources Physical resources are resources that the business needs to maintain in order to carry out its activities. They mainly include things like facilities, buildings, machinery and more. These are resources that are available to a business’s organisations in form of buildings and other machineries needed for the day to day running of the organisation. Tesco have many physical resources such as their toilets, buildings, trolleys, CCTV’s. Toilets is a good resource to have within a good organization as it can attract more customers to not feel rushed into shopping because they need to go toilet they can shop at their own paste and use the toilet when they feel to. Another physical resource for Tesco is the car park so customers can park within Tesco’s car park and not have to worry about receiving a ticket, or checking their time to get back to the car before they get a ticket, this will also attract more customers to shop within Tesco. A recent physical resource that Tesco has brought in is the self-checkouts; this is good for customers that want to quick shop as Tesco can be quite busy on some days they don’t want to wait in the long queues so they can use the self-checkout which is much quicker. Buildings Permanent or temporary structure enclosed within exterior walls and a roof, and including all attached apparatus, equipment, and fixtures that cannot be removed without cutting into ceiling, floors, or walls. Materials The matter from which something can be made. Material can include but is not limited to raw and processed material, components, parts, assemblies, sub-assemblies, fuels, lubricants, coolants, cleaning agents, and small tools and accessories that may be consumed directly or indirectly. Plant and machinery Like materials and buildings, each business has specific requirements for the type of plant and machinery. As Tesco don’t own factories to where they’re products are produced they pay for another company to produce their products or have suppliers. Most of Tesco’s products are from suppliers. This means even though they may not own the factory they have to pay the right amount to the suppliers for them to produce their products for them. Equipment Equipment is essential for a business to operate smoothly. Equipment is critical for profit and non-profit organisations like Tesco. In some organisations lack of equipment means a job or service cannot be carried out. Equipment is crucial for Tesco as they deal with selling a range of products from fresh food to technology and more. Within Tesco they will need tills so that people will be able to purchase products from their store. Tills help them to take payments from customer, without the tills they couldn’t take payments from customers or record profit or loss within all the Tesco stores. Also within a Tesco retail store they need to provide equipment like shelves to stock the products within the store, without the shelves and equipment to put the products on the store wouldn’t appeal to customers. On a staff level they have to provide the retail store staff with uniform. For Tesco it’s essential that the customer face staff have uniforms as it looks more professional and also it is a very big store so they must be and look professional. Technological Resources Intellectual Property Is the Knowledge, creative ideas, or expressions of human mind that have commercial value and are protectable under copyright, patent, trademark, or trade secret laws from imitation, infringement, and dilution. As Tesco designs different products they wouldn’t want other supermarket companies to copy what they have designed so they would hold intellectual property. It’s important that Tesco has intellectual property as the supermarket market is a big market and competition is tight. The intellectual designs aspect covers the features of decoration of products, such as colours, lines, materials, shape or texture. Accumulated experience and skills Accumulated experience means experience gained over a number of years when a person has to come across lots of different issues to do with the job. It’s important for Tesco to keep their employees happy as the longer they work in their position the more experience they get and become better people at their job. For Tesco to keep employees that have been working at the business for a long time and have good experience would be to pay them more. By Tesco paying the staff more they will feel more privileged and would want to stay with the business for longer. It’s important for Tesco to build employees skills but they do have to be careful not they have employees that are the only people or person to operate a piece of machinery or fix a piece of software. Key technological resources for the running of Tesco. This is because they would be unsure of what to do when in particular situations and they also wouldn’t continue to create new ideas for the organisation to ensure it continues to develop and make profit to survive. Software Tesco would invest a lot of money in software and its day-to-day use. Sometimes software will be spoke software will be designed for a business or they will use someone else’s software and pay a licence fee to use it. One  software which some internal office staff may use would be Microsoft office, excel and maybe publisher. http://www.tescosoftware.com/officelicenseagreement.php M1 – explain how the management of human, physical and technological resources can improve the performance of your selected organisation. The Human resources can improve the Tesco’s performance in many ways. There are two main processes which are looked at when managing human resources. The most important is to employ they correct people for the job, people that will carry out the job role correctly. Then the correct resources have to be provided for them so that they can carry this process out to the best of their standards. Treating these employees with care and sensitivity is important. They are not like physical or technological resources; humans need to be dealt in certain ways, as they are protected by legislations and laws. For example, In TESCO there will be a constant change of different demand of products that the customers wish to purchase, for this reason the staff will have to be trained for any of these occasions. This is how they improve their human resources. They also look at how many skills the employee has when they are searching for new employees. They will check whether that person can be used in more than one job position in that store, how many skills they consist of. Coordination of the teams in Tesco is very important in ensuring that they meet the targets that the company sets them. When all employees of the team complete their assigned roles the team will run more smoothly. It is also important that a manager is always there so that they can supervise the staff and also if there is a problem that they might not be able to handle the manager will be trained and know how to deal with the situation. By Tesco monitoring employees punctuality they can make sure that staff are on time to work. By making sure time are on staff to work the work could be done more quickly making it easier for the employee and even Tesco. This would improve the performance of the employee as they have more time to  complete the work that has been assigned to them, by Tesco also monitoring staff punctuality they can evaluate the people who have bad punctuality. From evaluating they can make a decision whether to get rid of them. This is because one person who has bad punctuality could be causing the team to be able to not get work completed etc. By having people who are always punctual it means teams and individuals can perform better which will help to improve the performance of Tesco’s customer service etc. Physical Resources Physical resources are resources that the business needs to maintain in order to carry out its activities. They mainly include things like facilities, buildings, machinery and more. These are resources that are available to a business’s organisations in form of buildings and other machineries needed for the day to day running of the organisation. All businesses including Tesco need premises where they can operate from as these buildings and environment can have a strong affect on the people that work there. For Tesco having their retail stores based in local areas the amount of customers they get is going to be a problem. It’s important that retail stores are located where they can attract customers, preferably in a populated place. Also the buildings are going to be commutable for staff to get to and not in the middle of anywhere so customers find it hard to find or travel which will put them off travelling to the store. The importance of the Tesco retail store layout is vital and for them successful as they draw in customers buy having products for them to try themselves and from there customers like the product and want to buy it. The correct equipment is essential for a business such as Tesco to operate smoothly and efficiently. Checkouts is a very important part of equipment as it re orders stock when it is running low so it saves a member of staff having to check when its running low and tick off that they need to re order. Tesco has a very good IT system, which consist of both hardware and software, which carry out their main jobs of looking after the amount of stock in the stores, the days cash intake, and many other important  functions that the company needs. Technological Resources To make sure that the employees are happy with the software they are using to do their work would be to gain feedback from them. By gaining feedback you can see whether there things that need improving to make it easier or better for the employee to use. Also by gaining feedback from employees you are making them feel part of the organisation as they have a say into what’s going on and what may need improving so that they don’t feel left out. By keeping staff happy they are more likely to stay for longer which means for Tesco that they have people who are good and have an understanding of how to use the software. By having employees who are good with working with the software it makes the process of doing work easier for them and this will overall help to boost the performance of Tesco as they have highly trained and good staff. M2:The importance of employability, and personal skills in the recruitment and retention of staff Telecommunication Sector (Alcatel Lucent) Employability and Personal Skills Employability is defined as a person’s own capability for acquiring and maintaining employment Employability depends factors like the knowledge, personal skills and abilities possessed by the individual and the way he presents those assets to employers. In other words it is the process of self assessment of an individual which can be done by himself or by some other person or agency. Importance of Employability and Personal Skills – In the Recruitment and Retention of staff : While in the process of hiring and selecting individuals in an organisation, the management has to identify a certain selection criteria. This selection criteria consists of a list of abilities and skills, in addition to certain education standard an individual must possess if he has to qualify for that position. An individual who has acquired certain skills like computer knowledge (hardware / software) will be more valuable for an organisation than the one who does not have this skill. The organisation will not have to train the individual who already has this capability. The organisation will get a â€Å"Ready Made† asset which can be utilized straight away on a project. The Alcatel can also short list those individuals with certain basic knowledge or skills in a specified field. The individuals can be trained on special task or assignment with minimum effort. For example if an individual has basic skills and knowledge of operations and maintenance of Computers then he can be trained quickly to operate and maintain small computer and telecom networks. That individual will have more value than an individual who does not possess such skills. The individual who is hired and has good background knowledge in a certain field and possesses various skills, can become a learning source of other employees in an organisation. That person can train other employees â€Å"On the Job†, with better knowledge and skills and can increase company’s productivity. Such employees are retained by the organisation If equal opportunities are provided to the employees in an organisation for learning and skill improvement, the employees always become loyal to the company and will remain with the company. In this way company will be able to retain its useful resources. Exceptions : There are certain areas in the Telecom sector where there is less need for  skills and knowledge. For example the employees who have to work on the Assembly lines of products manufacturing, they need minimum orientation on how to do their work efficiently. They may not need more skill to pack final products. For their case, it is not advisable to detach them from their work and send them for extra training. The organisation i have chosen to asses is the Alcatel Lucent. It is important for Alcatel Lucent to consider employability skills when recruiting and retaining staff as having a good balance of these skills in employees will make the organisation run smoothly and effectively. There are many different factor to consider when employing new recruits and keeping current staff such as training ,meeting targets, having the correct skills which match up the job recruitment , trust , qualifications , portraying a professional image and have excellent communication skills to liaise with fellow colleagues and the public .When recruiting and reviewing current staff personal skills employees need to have strong communication attributes . This would be required for any job as you need to be able to understand other colleagues and the customers/public. Alcatel need to consider this skills in employees as they need to communicate and understand colleagues and customers for tasks to be understood and carried out effectively.. Alcatel looks to see if their staff new recruits are hard working . This would be portrayed at inductions/ interviews for a job or in a trail period of vacancy. Employees need to be hard working / service they provide is of high quality and meets the company’s standards†¦ it is important that the Alcatel consider employees and recruits ability to work well as a team as well as individually. Staff need to work well as a team so they have an understanding of each other and so that projects and meetings are effective. When employees work effectively in a team it shows they understand each other and the work given therefore the Alcatel can run effectively as task given are being understood †¦Alcatel staff also need to be able to cope working on their own as in some aspects it saves time and money . rather than having two people carrying out one job, if possible one person doing the job while the other employee can go work in another area where help is needed. http://www.termpaperwarehouse.com/essay-on/M2-Business-Resource/239019

Media influence on Campaigns

In the recent past, there have been several debates about how media influences the behavior of the government and how they affect the political landscape in general. It has been said that mass media if it is not used appropriately, it can distort the country’s national agenda. In contemporary politics, mass media plays a key role in enlightening and informing people about politics.They are used in many nations which are seeking for liberal transition in their governments. They are mostly used to influence the public opinion on a particular issue. The media should remain neutral in political matters but this is not what happens in most countries. For example in America, media are what keep the political arena going. Now the questions arise; do media influence American politics or influence governmental behaviors? This is what exactly this paper will focus on. It will try to look for answers to these questions.Politics rely on mass media for liberal demands, information and mani pulation of ‘public opinion’. Media as it has been noted before, empowers citizens and is used to pressurize the government on specific areas that need to be changed. During the 2000 presidential election in USA, it was reportedly said that there were problems with the way the media covered and performed their duties. Some media starved voters with relevant information they needed to make informed choices (Wayne S. J., 2001)On 7th November 2000, some televisions and other types of media based in Florida lied that Al Gore had managed to win the majority of the votes in Florida which was a stronghold of republicans. It was unbelievable that Gore had won because this state was governed by Bush’s brother, Jeb. Media with all their ignorance went ahead to say that Gore was ahead of bush but this was later clarified at night by CNN which showed that bush had already scooped 52% of the votes while Al Gore had managed to get 46% of all the votes cast (Maisel L. S., 2002) This was organized by Gore and his camp to mobilize votes in the west. It was meant to deceive voters so that Gore would amass more votes. He knew very well that this would have a lot of significance to him. As media houses, you are not supposed to show one as the winner unless the uncounted votes are less than the number of votes that would make the following candidate to win. This is one way that media use to distort the perception of people. Though Gore was defeated, he refused to accept the results because he believed in what was announced before the recounting of votes.Most of the big media in the United States of America are owned by wealthy people who own big businesses. This is why they compromise the events coverage. Television can have a very big impact on some candidates for example when they give some candidates wider coverage than others. Also omissions, distortions and biasness in coverage are something that is common in USA media. In America it is very hard to get an objective report on the issue that is affecting people.Radio stations as well as TVs can be used to enlighten people. For example in 2000 November 4th, just a few days before the presidential polls, Radio 5’s late night presenter Hayes Brain   and Lehrer Will together with BBC held a program to straighten up the issues concerning polls with the help of guests and different live calls that were made. Basically, Bush and Al Gore differed in matters concerning foreign policy, health provision and educations. The above mentioned presenters enlightened people on the characters of a good leader and then they asked people who they would prefer between Al gore and Bush.In 2000 (Wire B., 2006) Bush and Al Gore were chosen as the presidential candidates for republican and democratic parties respectively in pre-primary elections. To make sure they emerged winners of their respective parties, both of them visited media houses, bought advertising spaces in the daily papers and were feat ured in news more than anyone else. There were no doubts that this publicity helped to sell their candidature. The media exposure made them the only key players in the political arena. There were others who lacked enough money to buy airtime, and good exposure to make themselves popular. These were candidates like John McCain and Bill Bradley who withdrew themselves from the race after they lost in the primary race on 7th march.Today party leaders have little influence on voters when compared with the latest communication technology like radios, internet-emails, satellites and televisions. They have realized that it is easier to campaign over this latest technology than organizing party followers at local, state, and national levels. An exposure of one candidate by the media do influence who people will voted for in elections. Some media rely on money that they earn on election campaigns. That is the money that politicians pay to media houses. So, it is very hard for them to avoid p olitics, they can do anything so long as they earn some money.In October 12, 2004 (Decierico R.E., 2002) newspaper vendors were using Mr. Jim Dickson, a lobbyist on the American Association of People with Disabilities. He was supposed to travel around the country to preach the benefits of electronic voting-torch screen voting over paper based voting. He agreed having received money from the vendors for that purpose.His organization received about 26,000 US dollars from the countries voting companies though at first he denied having received it. This was masterminded by the Elections Centre in August 2004 in a conference that was sponsored by vendors. Here the individuals were fed with propagandas by the vendors. Vendors then used him to influence the citizens on electronic based voting system instead of paper based voting system.Again media commentaries can woo voters into taking a particular political direction this is according to (Wire B., 2006 ) For example Jesus Esquivel; a col umnist for the most international online media argued that John Kerry the then aspiring candidate should with new strategies that would bring on halt all imperialistic and belligerent goals that were pursued by Bush’s government. Many people seemed to agree on this though the opinion polls reflected otherwise.It was alleged that he lagged behind because he was unable to articulate well how he differed with Bush. The question of who was to blame was posed. Was it the voters, unworkable USA war policies in Iraq or the car bombings, beheadings that were going on in Iraq? Some leading newspapers described Kelly as a drift who was incapable of selling his opinions outside USA, yet Bush according to them, Bush capable to sell because he had war policies. All these propagandas which were spread by media houses had profound effects on Kerry.In 2004, the time magazine tried to influence the presidential election in favor of Bush. It had written a story on the conversation it had betwe en Karl Rovel â€Å"scooter†, lebby, Cooper Matt and Novak R. It was something that could have affected Bush so much and therefore it was kept a secret. Cooper waited until elections were over so that he could talk to the jury and to the public at large. The results were released after Bush succeeded.During the 2004 elections, bush and Kerry received different backings from the corporations. It was revealed by Corp Watch Investigators such as live reports and current news disclosed that there were some details that co-operate media didn’t make public. These are stories involving big industries like tobacco and finance, about the sponsors, the profiles of the main donors, what and why they gave. This means that the information that reached the public was biased and manipulated.In 2000 and 2004 election, internet campaign was eminent and was used in transforming democracy in Washington D.C. Internet had a lot of influence on voters. Blogs, meet ups and forums are some of services that internet offered to the campaigners.Reference:Wayne S. J., 2001: The Road to the White House 2000: The Politics of Presidential   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Election. Bedford / St.Martins (Wads Worth)Maisel L. S., 2002: Parties and Elections in America. The Electoral Process,   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Rowman and Littlefield.Decierico R.E., 2002. Political Parties, Campaigns and Elections: Prentice Hall.Wire B., 2006. Lessons leaned from the 2004 Election.Wire B., 2006, April 20. Missed opportunity: Gore, Incumbency and Television in   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Election Media influence on Campaigns In the recent past, there have been several debates about how media influences the behavior of the government and how they affect the political landscape in general. It has been said that mass media if it is not used appropriately, it can distort the country’s national agenda. In contemporary politics, mass media plays a key role in enlightening and informing people about politics. They are used in many nations which are seeking for liberal transition in their governments.They are mostly used to influence the public opinion on a particular issue. The media should remain neutral in political matters but this is not what happens in most countries. For example in America, media are what keep the political arena going. Now the questions arise; do media influence American politics or influence governmental behaviors? This is what exactly this paper will focus on. It will try to look for answers to these questions.Politics rely on mass media for liberal demands, information and mani pulation of ‘public opinion’. Media as it has been noted before, empowers citizens and is used to pressurize the government on specific areas that need to be changed. During the 2000 presidential election in USA, it was reportedly said that there were problems with the way the media covered and performed their duties. Some media starved voters with relevant information they needed to make informed choices (Wayne S. J., 2001)On 7th November 2000, some televisions and other types of media based in Florida lied that Al Gore had managed to win the majority of the votes in Florida which was a stronghold of republicans. It was unbelievable that Gore had won because this state was governed by Bush’s brother, Jeb. Media with all their ignorance went ahead to say that Gore was ahead of bush but this was later clarified at night by CNN which showed that bush had already scooped 52% of the votes while Al Gore had managed to get 46% of all the votes cast (Maisel L. S., 2002) This was organized by Gore and his camp to mobilize votes in the west. It was meant to deceive voters so that Gore would amass more votes. He knew very well that this would have a lot of significance to him. As media houses, you are not supposed to show one as the winner unless the uncounted votes are less than the number of votes that would make the following candidate to win. This is one way that media use to distort the perception of people. Though Gore was defeated, he refused to accept the results because he believed in what was announced before the recounting of votes.Most of the big media in the United States of America are owned by wealthy people who own big businesses. This is why they compromise the events coverage. Television can have a very big impact on some candidates for example when they give some candidates wider coverage than others. Also omissions, distortions and biasness in coverage are something that is common in USA media. In America it is very hard to get an objective report on the issue that is affecting people.Radio stations as well as TVs can be used to enlighten people. For example in 2000 November 4th, just a few days before the presidential polls, Radio 5’s late night presenter Hayes Brain   and Lehrer Will together with BBC held a program to straighten up the issues concerning polls with the help of guests and different live calls that were made. Basically, Bush and Al Gore differed in matters concerning foreign policy, health provision and educations. The above mentioned presenters enlightened people on the characters of a good leader and then they asked people who they would prefer between Al gore and Bush.In 2000 (Wire B., 2006) Bush and Al Gore were chosen as the presidential candidates for republican and democratic parties respectively in pre-primary elections. To make sure they emerged winners of their respective parties, both of them visited media houses, bought advertising spaces in the daily papers and were feat ured in news more than anyone else. There were no doubts that this publicity helped to sell their candidature. The media exposure made them the only key players in the political arena. There were others who lacked enough money to buy airtime, and good exposure to make themselves popular. These were candidates like John McCain and Bill Bradley who withdrew themselves from the race after they lost in the primary race on 7th march.Today party leaders have little influence on voters when compared with the latest communication technology like radios, internet-emails, satellites and televisions. They have realized that it is easier to campaign over this latest technology than organizing party followers at local, state, and national levels. An exposure of one candidate by the media do influence who people will voted for in elections. Some media rely on money that they earn on election campaigns. That is the money that politicians pay to media houses. So, it is very hard for them to avoid p olitics, they can do anything so long as they earn some money.In October 12, 2004 (Decierico R.E., 2002) newspaper vendors were using Mr. Jim Dickson, a lobbyist on the American Association of People with Disabilities. He was supposed to travel around the country to preach the benefits of electronic voting-torch screen voting over paper based voting. He agreed having received money from the vendors for that purpose. His organization received about 26,000 US dollars from the countries voting companies though at first he denied having received it. This was masterminded by the Elections Centre in August 2004 in a conference that was sponsored by vendors. Here the individuals were fed with propagandas by the vendors. Vendors then used him to influence the citizens on electronic based voting system instead of paper based voting system.Again media commentaries can woo voters into taking a particular political direction this is according to (Wire B., 2006 ) For example Jesus Esquivel; a co lumnist for the most international online media argued that John Kerry the then aspiring candidate should with new strategies that would bring on halt all imperialistic and belligerent goals that were pursued by Bush’s government. Many people seemed to agree on this though the opinion polls reflected otherwise.It was alleged that he lagged behind because he was unable to articulate well how he differed with Bush. The question of who was to blame was posed. Was it the voters, unworkable USA war policies in Iraq or the car bombings, beheadings that were going on in Iraq? Some leading newspapers described Kelly as a drift who was incapable of selling his opinions outside USA, yet Bush according to them, Bush capable to sell because he had war policies. All these propagandas which were spread by media houses had profound effects on Kerry.In 2004, the time magazine tried to influence the presidential election in favor of Bush. It had written a story on the conversation it had betw een Karl Rovel â€Å"scooter†, lebby, Cooper Matt and Novak R. It was something that could have affected Bush so much and therefore it was kept a secret. Cooper waited until elections were over so that he could talk to the jury and to the public at large. The results were released after Bush succeeded.During the 2004 elections, bush and Kerry received different backings from the corporations. It was revealed by Corp Watch Investigators such as live reports and current news disclosed that there were some details that co-operate media didn’t make public. These are stories involving big industries like tobacco and finance, about the sponsors, the profiles of the main donors, what and why they gave. This means that the information that reached the public was biased and manipulated.In 2000 and 2004 election, internet campaign was eminent and was used in transforming democracy in Washington D.C. Internet had a lot of influence on voters. Blogs, meet ups and forums are some o f services that internet offered to the campaigners.Reference:Wayne S. J., 2001: The Road to the White House 2000: The Politics of Presidential   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Election. Bedford / St.Martins (Wads Worth)Maisel L. S., 2002: Parties and Elections in America. The Electoral Process,   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Rowman and Littlefield.Decierico R.E., 2002. Political Parties, Campaigns and Elections: Prentice Hall.Wire B., 2006. Lessons leaned from the 2004 Election.Wire B., 2006, April 20. Missed opportunity: Gore, Incumbency and Television in   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Election