Evaluate what psychologists have discovered about substance use and abuse Essay

In discovering about substance use and abuse one issue encountered are the inevitable ethical issues that occur. In Mestel and Concar’s study for example, sensitive data was collected. Sharing this sensitive data wit hthe researchers may have caused participants unnecessary anxiety or embarrassment if for example the urine test showed that they had used cocaine. This inevitably leads to ethical issues due to the unpleasant emotions participants may have been subjected to. Similarly in Robinson et al’s study, participants may have experienced unpleasant emotions such as embarrassment and ill ease as a result of the personal nature of the questions asked. From the two studies we can see that ethics is often a factor when exploring the issue of substance use and abuse however substance abuse is, by definition, against social expectations and consequently is always likely to incur ethical dilemmas when researchers attempt to discover substance use and abuse. Another difficulty incurred when attempting to explore substance use and abuse is social desirability. Social desirability is the term given to the situation in which people give answers that are contrary or different to their beliefs because their alternative answer is more socially acceptable. In Moolchan et al’s study for example personal data was collected and in order to present themselves in abetter light people may have lied when giving their answer – responding by saying that their parent didn’t smoke when in fact they did for example. Similarly in Lando’s study baseline data was collected by asking participants to keep a diary detailing their smoking for one week. Participants may have recorded false information because they felt this false information would be more socially acceptable. Social desirability can lead to results which are invalid and resultantly lead to a lack of validity as the study will not record peoples true response. Another difficulty in discovering substance use and abuse is the issue of generalisability. Generalisability is the term used to define the extent to which results from one sample of participants can be applied to wider groups. In Griffiths study for example the findings may not be able to generalised to a country such as Australia as the sample used was not representative. Similarly Murray’s study conducted in 1988 had a sample which was exclusively composed of adolescents and consequently it could not be applied to the wider population. In reality however a study is likely to never be truly representative to a global extent and in doing so such a diverse sample may make it hard for clear results to be distinguished due to cultural differences. Research into substance use and abuse may also incur the difficulty of ethnocentric bias. This is the tendency to perceive the world from you own cultural group, such as your wthnic group. The issue of ethnocentric bias can be seen in Gomels study. Gomel looked at a workplace in which smoking had been banned and how this related to the reduction in substance use (smoking). The study can be een to be ethnocentrically biased because it was conducted in one workplace in Australia. Ethnocentric bias can result in research that is not applicable to the larger population as the results from this study may not be found to be the same if it was conducted in Australia for example. c) Many people resolve to give up smoking each new year. With middle aged women specifically in mind suggest one psychological technique which would be useful to help them in their attempts to stop smoking. Give reasons for your answer. In attempting to stop smoking one technique which may be useful is the use of self help groups. Self help groups are support circles where each member is also attempting to quit smoking. As Moolchan discovered in his study, women who smoke are likely to be socially skilled and confident and so may find a group therapy useful where they can support and gain support from other women in the group who are in a socially similar position to themselves. Group therapy may also be effective in helping a middle aged woman quit smoking as she may make friends with people in the group and thus turn to them for support as she would turn to a friend outside of the group. The clear difference however would be that the person in the group would be going through the same experience as the middle aged woman and so would be able to identify with her. Those in the support group may also acknowledge an element of competition each one wanting to continue to stop smoking so they remain in the group. For this variety of reasons a support group is likely to be the most effective strategy in supporting a middle aged woman who is giving up smoking.

Journey to Sakhalin

The Saline project was the first Russian production-sharing agreement (AS) with foreign corporations. A AS is a commercial contract between investor(s) who are willing to make a large, long term and high risk investments with the host country that has the natural recourses (usually oil and/or gas) to exploit. The terms behind AAAS are usually deferent than regular commercial contracts, as they usually bypass some of the regulations that the host country imposes on foreign Investments.The agreements also last for the Lifetime of the project. Under the terms of the AS, the investing company gets the larger share of venues at the beginning of the contract to recoup the cost of investment. As time goes by, the net revenues (revenues after the cost of operations) are shared between the investment companies and the host country, usually a 20/80 split. AAAS are controversial In Russia because they bypass some of the taxes and licenses that a foreign company would have to pay.Previous foreig n companies had worked In Russia under the regular tax system, therefore It was argued that AAAS don't treat all businesses equally and create a sense of unfairness. Furthermore, AAAS apply only to Greenfield.. Greenfield are unexploited, undeveloped large pieces of lands with exploitable resources, and some circles felt that Russia should not cheaply bargain away these coveted lands. AAAS are agreements between the foreign direct investors (FED) and the federal Russian government; thereby limiting the power of the mid-level establishment, traditionally and politically a powerful group In Russian Pollock.At the time of the agreement, the local Saline Government, led by Governor Igor Verification, was a key player in the decision, mainly because Verification was politically influential and in favor of the project. After the fall of the communist regime, Russian GAP fell by 50% and up to half of the population was living below the poverty line. Oil and gas constituted the main export earnings of Russia, whose borders encompassed the largest supply of gas In the world (30%). Attempts by Russia to privative state-owned energy firms had mixed results.The OLL Industry produced a number of vertically integrated firms such as Skidpan and Subnet, which formed the basics of a competitive environment. Conversely, prevarication of the gas industry produced a single, dominant company: Gazpacho. At times, it appeared that he Russian Government acted on behalf of Gazpacho due to the significantly higher impact this Industry had on the Russian economy, and because It was a 38% stakeholder In the company. As Gazpacho controlled 20% of the worlds gas production, tenure were gallants political Interests escalated Witt ten development of this industry in Russia.Thus far, Russian's exports were mainly to Europe, as Russia had been unable to build pipelines to East Asia and Japan. The energy sector constituted 20% of GAP, and Gazpacho alone was responsible for 8%. The growing econo mies of the Far East, combined with Russian's need to exploit its oil and gas serves (both for economic reasons, as well as for political influence) helped push Russia to seek Foreign Direct Investment (FED). Russia also required foreign expertise, as transportation of gas to Asia would require a Liquefied Natural Gas (LONG) facility; something they did not have the technical ability to create.Foreign partnerships then offered the fastest and most efficient way of developing previously inaccessible resource field as well as exporting to new markets. Previous administrative scandals (BP Amoco) showed Russia to be politically and financially risky, causing a decrease in FED. A AS agreement would prove a good faith gesture from Russia that it was ready to enter the world economy, and to overcome the bureaucratic history and corruption that has scared away foreign companies.Shell would not have invested $108 in the Saline II project [exhibit 1] without a AS. Russia needed this first AS to attract future FED, and as such would likely be most generous with the terms of its first AS. Successful execution of a AS by Shell, could create future opportunities to exploit additional Greenfield development in Russia. Despite these advantages, there were several downsides. Protectionism by members of the Russian Dumb meant that this AS was rapidly becoming politicized and might face ongoing challenges..One term of the AS was that Saline Energy Investment Company (SIC) needed to use 70% Russian labor and goods for the part of the project measured as measured man- hours and volume of material; however the oil industry in Russia was mainly functioning on ground and had very little experience with offshore activities as exampled by Russian's inability to build and maintain a Liquefied Natural Gas (LONG) plant. The terms of this part of the agreement were particularly vague, as it was roll defined what would be considered Russian â€Å"content† in the project.Additionally, enforcement of the AS would be difficult due to the geographical remoteness of the project. * Investments in Saline did not Just include the production facilities, but also contributions to the local administration. SIC was responsible for the upgrade (or construction) of the island infrastructure as well as other wish-lists of improvements. The SIC also had to provide local community sponsorships of facilities, scholarships and grants as well as maintaining good relationships with environmental activists. Saline Island is a pristine environment.In order to be successful, social and public relations have to be a priority, which could prove to be challenging since the business of exploiting oil and gas is usually brutal to the environment as well as the economic and social landscape of local communities. Care in negotiations had to be achieved in order to sponsor projects that would keep the local residents happy and friendly, and yet keep a tight control on spending for these proje cts and not inflame environmentalists. * Navigation of local politics was also a challenge.In the first stages of a project like this, good relations with local government employees are sometimes more important than relations with politicians higher up in ten unlearning as most approvals are cone locally. As ten project progressed, Ethereal authorities became more important as Putting attempted to reinstitution central authority. Another obstacle was the legal system. Difficulties and delays in obtaining approvals for the Technical and Economic Substantiation for Construction (TCO) as well as a lack of stabilization in the Russian legal system endangered the project as it would not proceed as scheduled without them.Without changes to the legal system, arms of the Saga's agreements that conflicted with current Russian laws could not be enforced and increased the risks associated with the investment. Despite these obstacles Shell should invest in Saline. There are very few Greenfield available with the production capacity of Saline. Exploitation of non-developed lands allows for the building of new technology instead of maintaining old equipment. This is more efficient and therefore more profitable. The initial costs are lower as there is no need to dismantle old facilities to build new ones.It allows Shell to gain a foothold in Russia which has a large reserves of oil and gas. When at full capacity, Saline could produce up to 5% of the world LONG needs making this a critical strategic investment for Russia. Russia needs to rebuild its economy and is now ready to offer better deals then it would in the future. It does not have the technology to build offshore platforms and LONG producing capabilities. It needs these facilities to access new markets and the location of Saline in the Arctic has great potential in these regards.The Saline II AS agreement has terms that will be difficult to match in the future and has the advantage of reducing the influence of the R ussian oligarchy in the business dealings. Russia would not Jeopardize its standing as a 68 country and is motivated to have successful foreign investments. Of course one company to watch is Gazpacho. It is a major player in Russian politics and may feel threatened to have the East Asian market closed to them. Shell should be open to the idea of having Gazpacho be part of the Consortium.To mitigate the risk, Shell should try to attract more investors to distribute the risk, at least at the beginning while costs are high, then buy the shares back once production brings in stable revenues. They should follow the given requirements very carefully and ensure that they keep maintain heir end of the bargain by hiring the requisite local contractors and labor force. Shell should behave as a good neighbor as much as possible by making sure that the environment is being taken care of.Natural resource industries require large capital investments and are politically difficult to navigate. They have such a significant geopolitical impact that the Coos of these companies do not make agreements with the heads of other companies, but rather with heads of state. Their decisions do not just affect the shareholders of the company, but also the access of energy by their win country as well. If the political climate changes with a new government hostile to the home country of the company, no commercial contract can be legally enforced.A company could lose all of its investments in the host country should they be removed from the operations while the plants and equipment remain. Depending on the level of hostility and the impact the resources of a country have on the global energy supply, escalation may involve military force to secure indispensable resources. Usually the countries with the companies that have the most technical expertise do to own the lands that contain the resources and the countries with the resources do not have the technical expertise to exploit them.It creat es a mutual (although wary) Interdependence. An 011 company cannot easily select to another site Ana move Its platforms, refineries and pipelines, while the host country cannot operate the equipment without the technical knowledge of the companies (which is the company's only leverage). Both sides need to do a a diplomatic dance, constantly negotiating give and takes on the exploitation of these resources. Exhibit 1: Saline 2 project

Environmental Proposal and Presentation Essay

For this assignment we chose the Patton-Fuller Community Hospital for our virtual organization. This facility is a non-for-profit social insurance association that has supplied an extremely wide cluster of preferred value aids and offices to the town of Kelsey and the encompassing groups since 1975. The healing center supplies centered utilities for example emergency restorative consideration, surgery, work and committal, private medicine and radiology for developed persons and youthful kids. â€Å"As one of the first facilities in Kelsey, they are besides dedicated to supplying a sort of projects that will underpin the health and welfare of their neighborhood inhabitant numbers† (Apollo Group, 2006). The prime causes for hospital’s actuality from a dissection of the task, dream, and objectives are to be the social insurance affiliation of elective for patients, human services masters and M.D.s. Other nexus explanations are to supply esteem honor scoring social insurance aids to the group by â€Å"viably treating contaminations and damages, supplying early mediation and preventive consideration,† and twofold-checking their workers embraces inventiveness, respectability, esteem, aid, teamwork and freedom (Gwinnett health Center, 2009). In this entry we will infer two strategies to make collusions between the Patton-Fuller Community Hospital and its arranged inner and outside stakeholders. We will likewise clarify how the contrasts between administration and administration influence organizing inside the Patton-Fuller Community Hospital. At long last, we will recommend a nature that is supportive of crew working and studying and that considers maintainable improvement and imaginatively inside the Patton-Fuller Community Hospital. BusinessDictionary.com (2009) describes stakeholders as: Persons, gathering, or cooperation that has immediate or digressive venture in an organization on the grounds that it can influence or be affected by the organization’s exercises, targets, and arrangements. Enter stakeholders in a venture affiliation envelop lenders, clients, heads, laborers, legislature, proprietors, dealers, mergers, and the group from which the venture portrayals its assets. In spite of the fact that stake holding is ordinarily self-legitimizing, not all stakeholders are equivalent and dissimilar stakeholders merit to unique concerns. Core stakeholders of the facility are the laborers, patients, guests, speculators, and the group. Smallwood, N., Sweetman, K. & Ulrich, D. (2007, November 11) state: â€Å"Employees longing to work in an area where they can meet their distinctive yearnings and likes. Pioneers who imagine assignments, work domains, and visions help laborers be both skilled and promised to their work.† Patients need to comprehend that they are getting the greatest consideration reasonable and be skilled to accept the forethought suppliers. Voyagers longing to grasp their friends and family are acquiring the finest forethought and that they can accept guardians. Communities need chiefs to construct affiliations that are collectively mindful, with hoe they treat the indigenous nature and how they help the greater group. Speculators-need supervisors to keep their vows, advance an influencing evolvement technique arrange focus abilities to the plan then afterward to twofold-watch that folks are promised to committing on these manufacturing. At the point that they do, gurus pay the affiliation with abnormal amounts of confidence sometime to come, which changes over into higher business worth. Controllers need chiefs to administer themselves in concurrence with heightened moral standards and in a kind predictable with master and legitimate guidelines. The difference between leadership is when it comes to a company you work for a manage needs to decide what the company can do to become better. The management has to come up with a conclusion to come together with a project that they can do to keep business flowing and customers to keep coming. Leaders can get the job done if the employees are doing their job. Some people do less work then others therefore that can bring a company down depending on what they are doing at the job. If you practice more on a job you can get more things done even if you have to ask a manager to give you more things to do. If you do less then less performance will get done. No practice will show and more improvement will be needed from that person. It is always areas that you will definite need improvement to do good and in areas that you fall short. You also can start off with what is easy to you and come back and do the hardest part later. Some people thrive on getting better while others are there just to get a paycheck. We all have to deal with different task at a job whether it is easy or hard. You can get ahead a lot quick then waiting for someone to do your job for you. People that doing well; it will better them later on down the road. This is the best time to get things done now and it will get you a better future later. Today is the best time to develop and accomplish new ideas in the company. Leaders will guide you and make sure you are getting the job done the right way. They also like to guide you to look at things in a very different way in life. Management means stay on task and gets focus on what your job is. There is room to self-develop in the work place. They would like to get and input on what makes people do the things they do. People are very different in many different ways no two people thinks alike. When good managers see you are doing a good job that really makes them feel good. They will let you know and mention to the boss. When you have a great manager they will make sure that the work they gave you has gotten done and therefore, you can move to the next task. They want employees to keep things done the right way in a straight and narrow. Sometimes it take good strong leadership to get people to pull together to get the work done. If you are motivate you can achieve your goals when you have good leadership it tends to make people wants to succeed motivation can come from growing and wanting to be successful. Managing stress in a workplace can depend on the mental or physical level of what could have happen in that people life. Tell the manager about your stress in the workplace can be very risky or very effective. Stress can affect you mental and physical in our personal lives. Too much stress can affect our jobs and getting things done that we tend to forget about in our daily lives with so much going on as far as school, children, work and other etc. Some signs of stress can include headaches making mistakes and being very forgetfulness. Make sure you are taking a break and eat lunch or talking to someone so you won’t get burnt out about things that are taking our attention. Don’t take alcohol or do drugs while you are stressing it really just adds to the problem. The best thing to do is get counseling or see a doctor to discuss your problems. It can be helpful for others to know how you are doing. Stress can also lead to depression it can get in the way of your daily routines and communication to others. Be aware of the stress you can cause up on yourself and continue to get help. Patton Fuller Community Hospital’s point is to come to be a trusted organization in the company of its clients and scratch stakeholders, by supplying worth client mind and utilities to all its patients and by helping and reckonings of nexus stakeholders. Today with the expansion of wellbeing forethought costs, the necessity for productive consideration administration is on the register of essential concerns. Patton-Fuller comprehends this requirement and accordingly centers on the viewpoints of nexus stakeholders, patients, suppliers and laborers in the team effort technique. In place for the group to relegate on its promise to be the medicinal services cooperation of decision for patients, medicinal services masters and M.D.s, Patton-Fuller comprehends the vitality of useful territory interrelationships in which organize, inspire and summon enter staff in the course of the attainment of lifelong organizational objectives and targets.

Rug maker.com Research Proposal Example | Topics and Well Written Essays - 1000 words

Rug maker.com - Research Proposal Example Rebranding is essential in improving the company’s sales and income. Ideally, the company should focus on attracting new customers while focusing on maintaining the existing customers. The Rug Company should focus on the following plan in order to create public awareness to its products and services while also improving its awareness to the interior design industry: The company should add value to its brand awareness plan by offering special packages and services to existing and potential customers. In addition, the company should hold various events in its different cities of operations in order to create awareness to customers and its industry of operations. To develop a marketing strategy, the first requirement is for the company to affirm its current position by stating what it was offering to the clients according to their needs. In addition, the company should affirm where it wants to be and what it wants to be doing at a particular point in the future (Ashcroft 2010). Communication is an important aspect of the marketing strategy (Mullins and Walker 2013). Although the conventional mix model of the 4Ps – product, price, place, and promotion (Kotler and Armstrong 2012) – are commonly used due to their familiarity, the company should adopt the 4Cs model with a focus on Customer, Cost, Convenience, Communication (Hughes and Fill 2008). The latter model focuses on direct communication with the customer as opposed to the 4Ps, which considers the product as the primary focus in marketing (Ashcroft 2002; Cheverton 2004). The company prides itself as a rug making company that focuses on delivering quality handmade products with the finest raw materials (Sharp C. and Sharp S. n.d.). In this case, the target clients are people who value the quality of handmade material and appreciate the worth of hand-woven rugs. The company should profile its clients

Quantitative Methods for Business Essay Example | Topics and Well Written Essays - 750 words

Quantitative Methods for Business - Essay Example This essay offers a comprehensive analysis of the role of the quantitative methods in ensuring economic efficiency of the management process.These methods do not just play an important role in making business decisions. There are also instrumental in estimation. Thirdly they are also a valuable tool for taking inventory of items, cost and profit. This is the unique tracking aspect of these methods. Business decision cannot be taken on a light note and hence it is absolutely that all logical and mathematical calculations are exhausted so that an optimal result can be ascertained before a final decision is implemented that will be of consequential importance to the business and the profit and or loss that subsequently endured. The process of a Quantitative Method in business is that the method gives a systematic and theoretical yet practical approach to finding solutions to pending and prospective problems. It is also important in making certain decisions that require critical thinking and analysis. This also enables an executive or a key decision maker of the business to take defining decisions that are binding on the entire business based on transparency and sound judgment through logical principles. These principles are based on a logical schematic that deals with each decision in a step by step fashion. This approach is necessary because it step of the decision making process has its own stressors and set of parameters. Quantitative methods also have an extraordinary tool in its arsenal which is numerical analysis. ... The method of quantitative analysis that is applied involves the valuation of an expected return of profit on the varying amounts of expenditures. This in turn allows one to deduce the most logical and sound method to secure the bid value and at the very same time making the most profit in the bargain. The thinking behind securing the bid value is applying linear programming to calculate the exact balance between minimum bid price and maximum profit attained using a production possibility curve as an economic function. The bid value hence must provide a profitable aspect for both the bidder and the client who requires a bid to be made. The whole aim of the Quantitative method for businesses is to foster an analytical mindset that is very important in the process of project acquisition, development, marketing, management and execution (Slater et.al, 2002, pp. 222-228). Sequelae Project management is a very volatile and demanding field of business development that requires the manager to be on the top of their game at all times. Therefore it is of paramount importance that project managers are able to utilize the complete range of skills and procedures that are prevalent in Quantitative methods for studying the business conditions. Secondly managers continuously need to associate decision making with consequential results. Thirdly they have to take a look at viable alternative. These alternatives in turn need to be assessed to see if they can be practical or theoretical and a cost benefit analysis using the Quantitative method has to be conducted. Finally the result of each alternative being theoretically applied to the projected situation has to be estimated before an

Data Collection Coursework Example | Topics and Well Written Essays - 2000 words

Data Collection - Coursework Example inesses collect data in order to, analyze their performance, know their number of clients, understand customers characteristics and behavior, conduct the market share, and have a succinct projections of the future performance of the business amongst others. Therefore it is one of the core elements within the research and development unit of a business. During our sixth lesson (organizational performance measure), we analyzed four main performance measures which includes; input (resources required in carrying out a program), process (cost of resources per the unit of the expected output), output (work completed or the services provided by the injected input), and outcome which is the whether the customer needs and the program objects are met). In providing an expanded discussion on data collection, the paper will adopt the input performance measure. Input refers to the amount of the resources that is either required or available to produce an outcome and output. It is usually expressed as the amount of funds that is needed for an implemented of a program or project. They facilitate the creation of an output. They include the equipment, cost of labor, utilities, building space, supplies, materials and overhead among others. The measures of input give information on resources such as the financial budget and the people that are available in the execution of various processes that delivers an output. This is a type of data collection used in assessing the performance of the organization. They are also used in the organizational capacity perspective by the employees. It is one of the fundamental ways in obtaining factual data and information on the changes in status and clients behavior especially after they have completed a service. Before an input is ordered for the completion of a particular task, it is important that a survey is conducted so that the best is obtained to facilitate the goal achievement. The objectives can only be achieved when the best inputs are

Material Selection Case Study Essay Example | Topics and Well Written Essays - 2750 words

Material Selection Case Study - Essay Example The outcome is that presently golf clubs have been developed that perfectly suit each of the aforementioned groups. It is now even possible to customize the manufacturing of these kits to satisfy individual taste, preferences and financial strength. Golf manufacturers have been able to satisfy their customers, largely because of the wide array of materials available for use. Through research and development, new materials or new combinations of existing ones have been unearthed to develop even better fitted kits. A recent study by Peterson (2003) has revealed the extent to which technology and material selection for that matter, has contributed in boosting golfer player performance over the past 20 years. The author found, for example, that the average driving distance of median tour players has increased by 27.3 yards from 1993 to 2003.The improvement in performance was traced to better golf equipment developed for the game by manufacturers. This report reviews commonly used materials in manufacturing golf clubs. In doing so, it gives plausible reasons why and how they were incorporated as materials into golf clubs. The report concludes with the presentation of some possible materials that could be used in future for manufacturing these equipments. Golf clubs come in various shapes, sizes and colors... The shaft of a golf club measures about 89 to 115 centimeters in length and has a diameter of about 12 millimeters towards the grip end of the club. The most common way of classifying shafts is based on the extent to which they bend when swings of a player are applied to them. On the basis of how they withstand this pressure, they are described as either being stiff or soft. Stiffer shafts facilitate relatively faster swings than their softer counterparts for a given load applied. Generally, the stiffer the shaft, the greater it can potentially impart the ball when struck. However, if it is too stiff, a golfer may not be able to apply enough swing to it for its maximum effect to be manifested. In that case, it leads to a loss of distance coverage. This problem notwithstanding, stiffer shaft gives greater accuracy than their softer counterparts. Materials used for making shafts are steel, graphite fiber, a combination of steel and graphite, among others. The grip is the end of the shaft opposite to the head. It is commonly made from materials such as rubber, synthetic leather, or derivatives of these materials. The third component of a golf club is the club head. This is that part of the club that comes into direct contact with the ball when hit. A golf club head can be made from persimmon or maple wood, metal inpregrenated woods such as titanium or iron or steel woods, among others. 3.0 Materials used in manufacturing golf clubs As already mentioned, various materials are employed in the manufacturing golf clubs. These materials possess unique properties that aid the making of superior and easy to use golf clubs. This section takes a good look at these materials and highlights some

Team based incentives Essay Example | Topics and Well Written Essays - 500 words

Team based incentives - Essay Example The installation projects assigned may have varying degrees of difficulty which can affect achievement of equal goals. Individuals, too, cannot be equally the same. They can be high performers, average or even poor performers. Unless they are all sold on the team concept, each individual may primarily look out only for himself and not for the team as a whole. The team incentive reward would be viewed as unfair if those rewarded are not deemed to be deserving of the reward, as when average performers receive exactly the same reward as high performers. This makes the reward unfair and unjust. Determine what work components will be rewarded for each individual member. This may be individual regular installation (IRI), individual difficult installation (IDI), overall regular installations (ORI), overall difficult installations (ODI). Put a percentage weight on each component. For example, IRI - 35%, IDI - 35%, ORI - 15%, ODI - 15%. This way, high performers shall be rewarded more than average performers but each team member knows that all performance contribute to overall achievement of team goals. Management would have benefited from employee involvement in the initial design an

Coyne and Messina Articles Analysis Term Paper Example | Topics and Well Written Essays - 1250 words

Coyne and Messina Articles Analysis - Term Paper Example The studies conducted by Coyne’s and Messina’s groups are similar, since they are fundamentally interested in bettering the status and quality of the healthcare industry and the services it accords. To this effect, both groups choose dependent and independent variables and then research and analyze how these variables can be harnessed in order to improve the status of the American healthcare industry and services. Specifically, on one hand, Coyne and his group consider the relevance of causative variables like the type of hospital ownership and hospital size in furthering the cause of efficiency within the framework of healthcare services provision. On the other hand, Messina and his group research and scrutinize the nexus between patient satisfaction in teaching and nonteaching healthcare organizations, which practice inpatient admission. There is no gainsaying that patient satisfaction and efficiency are principle yardsticks of determining industrial success. Both Coyne and Messina carry out an extensive reviewing of already existing literature materials, in order to explain and analyze the relationship between the (independent and dependent) variables and the research findings. The same literature materials authenticate and generate recommendations that will be later on proposed. Coyne et al. (2009) and Messina et al. (2009) incorporate identical design elements in their research activities. Apart from the fact that both works are quantitative, the same also use sampling, as a way of narrowing the demographic components that are to be analyzed. For example, Coyne and the group discard private-owned hospitals and hospitals outside the state of Washington. For Messina and his group, seven teaching and nonteaching hospitals that were renowned between 1999 and 2003 suffice. However, even as a myriad of similarities between Coyne and Messina’s works abounds, differences between the two research works also exist. At one end, Messina and his proteges are intent on confirming and divulging on the relationship between inpatient admission in teaching and nonteaching hospitals, and patient satisfaction. At the other end, Coyne and his group are interested in shedding light on how the type of hospital ownership and hospital size relate with cost and efficiency. Two fundamental problems guide the work that Messina and his group carry out. These problems are the relationships that exist between patient satisfaction and inpatient admission in teaching and nonteaching hospitals. This is unlike the work that Joseph Coyne and his groups carry out. Particularly, Joseph Coyne and his group’s research undertaking investigates a single research question- the relationship between cost and efficiency and hospital size and the type of hospital ownership. In respect to the foregoing, there is lucidity in saying that while Coyne and his proteges’ research study is a two-way study of variance that of Messina and his prote ges is a multivariate design. The variables in the two analyses are also different. The independent variables for Coyne and his group include the structure of hospital ownership and hospital size, while teaching and nonteaching healthcare institutions serve as independent variables for Messina’s group. For dependent variables, Coyne and his gr

History of Learning Theories Research Paper Example | Topics and Well Written Essays - 2750 words

History of Learning Theories - Research Paper Example A brief history of the theories of learning can provide a context for understanding social learning. The basics of three learning theories—Behaviourism, Cognitivism and Constructivism—are discussed in this section (Mergel 1998). Behaviourism took form as a learning theory when Aristotle made an essay entitled "Memory". This essay discussed associations between events such as lightning and thunder. The theory concentrated on behaviours that are overt enough to be observed and measured (Good & Brophy 1990). The illustration is that the mind is some sort of a â€Å"black box† such that the response to a stimulus can be quantified and observed. However, this assumed that the possibility that processes are running in the mind are totally ignored. Pavlov was considered as one of the key players of the development of the Behaviourist Theory together with Skinner, Thorndike and Watson. Pavlov was known for his reputation as the Russian physiologist who worked on stimulus substitution, more popularly known as classical conditioning. His experiments mainly involved food, a dog and a bell. Others who followed Aristotle's thoughts include Hobbs in 1650s, Hume in 1740s, Brown in 1820s, Bain 1860s and Ebbinghaus i n 1890s (Mergel 1998). However, when the 1920s came, the limitations in the behaviourist approach to understanding learning were noticed. It was in this time where Cognitivism was born. Specifically, Edward Tolman observed that the rats he used in his experiment seemed to have a mental map of the maze he was using for the experiment. It was noticed that when he closed a part of the maze, the rats did not bother to look for an alternative path because they seem to know that it led to the blocked path. This was the phenomenon that behaviourists were unable to explain. Certain social behaviours seemed to be out of the bounds of behaviourism.

Discussion About The Sex Industry Essay Example | Topics and Well Written Essays - 2000 words

Discussion About The Sex Industry - Essay Example Criminalization of prostitution renders the women and girls who engage in the practice vulnerable. Legalizing prostitution would make it easier for prostitutes to report criminal acts against them- especially being sexually assaulted. Prostitutes seek assistance from pimps to make up for contractual and legal help, which is denied them; pimps protect them from their customers and police. Majority of prostitutes are constantly faced with the high threat of rape and violence. One research findings indicate that on average, a prostitute is raped an average of 31 times annually. Since prostitution is a criminal offense subject to arrest and prosecution, hardly any prostitute reports such violations perpetrated to them, and even when they do the authorities fail to take them seriously or to follow up and act on the case urgently and professionally as they would with other women not engaged in prostitution. For instance, reports indicate that only four percent of women prostitutes who are violated or assaulted ever report the crime. Legalization of prostitution would get rid of the pimps and others, such as clients and purveyors, who exploit and violate those in the prostitution enterprise.Legalization of prostitution would conversely mean government regulation, taxation and a number of laws to regulate the profession. Many prostitutes would not be supportive of this. Without the government control, most prostitutes enjoy a great deal of independence; a prospect that would be taken away by the legalization of prostitution.... Legalizing prostitution would make it easier for prostitutes to report criminal acts against them- especially being sexually assaulted. Prostitutes seek assistance from pimps to make up for contractual and legal help, which are denied them; pimps protect them from their customers and police. Majority of prostitutes are constantly faced with high threat of rape and violence. For instance, one research findings indicate that on average, a prostitute is raped an average of 31 times annually (Spector 17). Since prostitution is a criminal offence subject to arrest and prosecution, hardly any prostitute reports such violations perpetrated to them, and even when they do the authorities fail to take the seriously or to follow up and act on the case urgently and professionally as they would with other women not engaged in prostitution. For instance, reports indicate that only four percent of women prostitutes who are violated or assaulted ever report the crime (Spector 21). Legalization of pr ostitution would get rid of the pimps and others, such as clients and purveyors, who exploit and violate those in the prostitutionenterprise. Legalization of prostitution would conversely mean government regulation, taxation and a number of laws to regulate the profession. Many prostitutes would not be supportive of this. Without the government control, most prostitutes enjoy a great deal of independence; a prospect that would be taken away by legalization of prostitution.Legalization would mean fixed working areas- the so-called red-light districts, registration as prostitutes, taxes and other levies charged by the government or various authorities such as local municipalities. The registration could expose the woman and

Physics Coursework Essay Example for Free

Physics Coursework Essay This systematic method was followed in the experiment to ensure accuracy and precision. Firstly fill a Pyrex beaker with 250 ml of water after washing the beaker. Construct the circuit as shown in figures 5 and 6 securing the thermistor with crocodile clips. I will use a mild abrasive paper to clean metal oxides from the connections to ensure there is not sufficient oxide build up to affect results. It is essential to make sure the thermistor is positioned centrally near to the thermometer suspended from the retort stand. The voltmeter should be set to measure voltage between 0-2V, which should give a sufficient scale. The stirrer speed should then to be set to ensure sufficient stirring but does not create a whirlpool effect. Then turn the hot plate on and begin taking temperature and voltage measurements at every 2i C. It is necessary to ensure that the experiment is conducted in a controlled manner and the thermometer is read with the users eyes looking directly at the reading in a level plane thus preventing parallax errors. The readings should be taken from 20-80 i C and recorded. After this random readings should be taken to find the temperature according to the calibration curve and then the actual temperature should be found using the thermometer and the readings compared. Results Table: Temperature i C Potential Difference/ V Run 1 Potential Difference /Random Measurements I heated the water using the normal apparatus in the standard way. Using Calibration curve 2 (reasoning explained later) I was able to use the voltage read out to work out the temperature of the water. At: Potential Difference /V Calculated Temperature From Calibration / i C Actual Temperature /Analysis: I have achieved all of the following results using the equipment stated. The two calibration curves have the general logarithmic properties as generally expected when using this set up. Firstly, I feel it necessary why I have discounted one calibration curve. Firstly I have not ignored the results from run 1, they are perfectly reasonable and fair. The only reason to have a slight reservation about the first set of the results came about when inspecting the equipment after the first experiment. It came to my attention that around the battery a rust/ acid layer had formed on the connections of the battery pack. This was then swapped for an identical battery and pack to produce the results for run 2. Run 2 gave similar results but there were far less anomalous points on the graph and nearly all points fell on the line. I believe the slight corrosion on the battery may have produced these slightly anomalous points on run 1. Also a major reason for choosing run 2 as the calibration curve is that on the random measurements the predicted temperature fell within i 2. 0i C, which I considered a good result. The gradient on both graphs are fairly balanced in that moving on down the curve the gradient did not decrease rapidly unlike the typical calibration curve described in Figure 4. This will be discussed in the overall evaluation of the sensor. Evaluation: The experiment has thoroughly tested the sensor and has proved that it is capable of doing the job what it is intended to do but some improvements need to be made. The gradient of the calibration curve is such that even at the upper limits of the sensor it has a relatively good resolution in that it can distinguish between temperatures like it did at the lower limits of the sensor. The thermistors published response time is 1. 2 seconds. It did respond very quickly to temperature change however, this fast change may not be needed in such a large volume of water that will not change temperature very quickly at all. In a hot water tank also there would not be a stirrer like in my experiment (which I felt it necessary to use to calibrate the thermistor) and thermal equilibrium would not be reached and therefore if the sensor were to be used in a hot water tank it would be necessary to consider the best position for the sensor. Alternatively a number of thermistors could be positioned all over the tank and the average temperature taken. Run 1 was not a failure, it simply showed systematic drift. The same trend was shown as in Run 2 however; the curve was closer to the X- axis. To conclude this project, I believe I have fulfilled my aim and have designed a sensor to measure the temperature inside a domestic hot water tank. The sensor may have to be re-engineered slightly to cope with the un-uniform heating inside the tank as described above. I also believe that for the sensor to work a battery would not be suitable as a power source. The battery would loose energy over time and for this sensor to work it is calibrated on the assumption that the batterys energy is not lost over time. Therefore giving a false temperature reading meaning that the sensor is rendered useless. It would be more suitable to use an adaptor from the mains converting the alternating current to direct current and also stepping down the voltage. In the lab I used a battery however, simply to test the sensor and this experiment has proves successful and shown that the thermistor could show the user the temperature of hot water inside a tank with sufficient resolution between 20-80i C. Instrumentation Coursework David Burgess 12 RJF Page 1 of 9 Show preview only The above preview is unformatted text This student written piece of work is one of many that can be found in our GCSE Electricity and Magnetism section.

Joints Bones One Health And Social Care Essay

Joints Bones One Health And Social Care Essay In both chapters six and seven we will take a detailed look at our skeleton and the joints and attachments. We will briefly introduce the skeleton here in chapter six but discuss it in greater detail and specificity in chapter seven. Thus our focus in chapter six will mainly be on our joints, how they allow us to move and how they are classified. You will notice that the various joints in our body allow different ranges of motion. In general, the more mobile a joint, the less stable it is, making it more prone to injury. The shoulder joint is a nice example. However, there are other factors that affect our mobility and stability such as ligaments, tendons, skin, cartilage and daily activity. We will look at these in greater detail over the next few chapters. But lets start by taking a simple look at the basic functions of the skeleton. Basic Skeleton Function The skeleton is our basic framework of support for all body tissues. It is our internal scaffolding that provides support for organs, allows movement, and gives us protection. The skeleton system is the name that is given to the collection of about 206 bones in addition to the joints and ligaments. The skeleton has many important functions that vary in complexity but generally includes the following: (insert simple skeleton schematic) 1. It protects the bodys vital organs such as the brain, heart, lungs and other organs. 2. It gives us our shape, posture and support. 3. It provides sites for muscular attachment that allows us to move. 4. It provides a reservoir for the storage of minerals such as calcium, phosphorus, fat, magnesium and many other minerals. 5. It is an important site for the production of blood cells, specifically red blood cells that allow us to transport oxygen. Our skeleton is a complex living system that is constantly changing. We will discuss many of these components in Chapter 7. However, at this stage we are interested in the role of the skeleton in how it allows us to move. In order to do this we need to take a look at our joint structure. The 206 bones in our body form approximately 230 joints. The joints are simply the place where two bones meet. Joints, which are also referred to as articulations, come in many different forms and not all are movable. The degree of mobility in a joint has a lot to do with its role or addition to its shape. The joints fall into three categories: synovial, fibrous or cartilaginous. They vary in movement and design. Types and Classification of Joints Joints are found anywhere that two bones meet. They have a specific and natural range of motion ranging from highly movable to unmovable. While most of our joints are freely movable, many are not. Joints are classified in several ways. For example, we classify some according to their architecture or their range of motion. Commonly, we use a mix of anatomical architecture and range of motion. In terms of movement, joints can also be classified according to the number of cardinal planes in which they can move. Therefore, joints can be non-axial (allowing no movement in any plane), uni-axial (movement in one plane of motion), biaxial (movement in two planes of motion), or tri-axial (movement in three planes of motion). Those joints that are freely movable are also referred to as synovial joints because at the end of the bone is a smooth covering layer called the synovial membrane. This membrane secretes a lubricating substance called synovial fluid which allows the joints to move in a s mooth and fluid fashion. As this membrane breaks down over time we often experience more discomfort in our joints with movement. This is a form of arthritis. (Chapter 8 in Seeley has great illustrations for all of this chapter) Joints are normally classified as belonging to one of three sub-classes. These classifications are based on several factors, including: a. the presence or absence of a joint cavity b. the shape and nature of the connection c. the degree of movement. The three sub classes are as follows: Synovial or Diarthrosis joints (freely movable). Fibrous or Synarthrosis joints (immovable). Cartilaginous or Amphiarthrosis joints (slightly movable). Synovial or Diarthrosis Joints These are the freely movable joints such as the shoulder, knee, ankle, etc. With this type of joint the articulating bones are covered with articular cartilage which is surrounded by an articular capsule which is lined with a synovial membrane. The articular surfaces are smooth and allow easy fluid movement. The synovial joint has two main functions. One is to allow movement, while the second is to transmit forces from one segment of the body to another segment, or one part of a limb to the other. The interactions between bones at an articulation are regulated by several types of structures. There include the joint capsule, synovial membrane, ligaments, bone shape, articular cartilage and pressure. However, it is the general structure of the synovial joint that permits smooth movement. Synovial joints have five characteristic features. They all contain the following which facilitates their range of motion: a. articular cartilage b. joint cavity c. articular capsule d. synovial membrane e. synovial fluid These contents and arrangements allow the bones to move and glide across each other. This synovial arrangement allows for the greater range of movement of any joint types and movements permitted include the following: gliding, hinge, pivot, circumduction. Of these movement types gliding is the most common as it occurs in every synovial joint since it allows them to simply glide over each other. In some joints, like the carpal and tarsal joints, gliding is the only movement possible. The articular end of bones in a synovial joint are covered with hyaline cartilage (articular cartilage) and a surrounding tubular capsule which we call the joint capsule. The joint capsule is composed of an outer layer of ligaments and on the inside contains a synovial membrane which secretes synovial fluid. Some synovial joints have additional features. For example the knee contains small shock absorbing pads called menisci. Menisci are actually small pieces of fibrocartilage situated between the bones t o absorb shock. Joints with menisci also have small fluid filled sacs called bursae. Bursae are also lined with synovial fluid and also help with smooth joint movement. Lets look at the synovial joints in more detail. There are six types of synovial joints. If you read different textbooks you will notice several different terms for the same type of joint. Where appropriate the other terms are also provided. (Insert Figs 8.8-8.12 from Seeley) (Also insert table 7.4 from Shier) a. Pivot Joint. This joint comprises a ring of bone that rotates around another. An example of this is found in the neck (the atlanto-axial joint). This joint is also referred to as a troichoidal or screw joint. This type of joint can also occur when two long bones fit against each other so that the bones roll around each other as with the radius and the ulnar in the forearm. The only type of movement that pivot joints allow is rotation. This movement only occurs in one plane and is therefore uni-axial. b. Ball and Socket Joint (enarthrodial, spheroidal). This joint is the most mobile and allows movements in all directions. Examples include the hip and shoulder. The high degree of mobility also causes the joint to be less stable. In this type of joint, the head of a long bone fits into a cuplike structure of the other bone. If you think about the trailer and hitch setup on a car, the joint is highly mobile and allows movements in the three cardinal planes and is therefore referred to as tri-axial. c. Hinge Joint (ginglymus). This joint allows flexion and extension (but not rotation). For this reason it is referred to as a uni-axial joint. Examples are the elbow and the knee joint. This joint structure contains strong ligaments and is therefore a very stable joint. d. Ellipsoid (condyloid, ovoid). This joint is essentially a less flexible version of the ball and socket joint. This joint has an oval surface that fits into a reciprocally shaped concave disc surface. This joint allows movements in tow planes and is therefore biaxial. It allows flexion and extension movements, and abduction and adduction and therefore circumduction as these movements can occur together. Examples include the radiocarpal joints. e. Saddle (sellar, carpometacarpal). The visual of a riding saddle is a good image to depict this joint. The bone surfaces are both shaped like a riding saddle and therefore fit over each other allowing flexion and extension, and abduction and adduction. Even though this joint has the same movement capabilities as the ellipsoidal, it has a greater range of motion. The joint is therefore biaxial. An example is the carpometacarpal joint of the thumb. f. Gliding (plane, arthrodial). In this type of joint the articulating surfaces are almost flat and so the surfaces glide over each other. This motion is fairly limited and the joint is viewed as a non-axial joint. Examples of this joint include the intercarpal and intertarsal joints. There are also other synovial type structures that are associated with the diarthrodial joints. They are called bursae and tendon sheaths. Like other aspects of the joint capsule these are susceptible to injury and breakdown over time causing discomfort and pain. The bursae are small capsules lined with synovial membranes that also contain synovial fluid. Their role is more for cushioning between the bones as opposed to providing a fluid lubrication surface (although they do that also). A primary role of bursae is to separate tendons and bone which reduces the friction during movement. Tendon sheaths are also synovial structures that surround tendons. Tendon sheaths are double layered structures and they also add an element of protection to many tendons that cross joints, such as those in the hands and wrist. Fibrous or Synarthrosis Joints These joints do not contain an articular cavity and are generally viewed as immovable. These joints are made mainly from fibrous connective tissue and can move very little. They are mostly concerned with absorbing shock. In this type of joint two bones are joined together by a fibrous connective tissue. There are two basic types of fibrous joints. a. Sutures. This type of joint is found only in the skull. They are very rigid joints designed mainly to absorb impact. The design of these joints is such that grooved or serrated bone ends are attached by tightly connected fibers. This also allows skull growth. As an adult these fibers begin to ossify and are eventually 100% replaced by bone and then are basically immovable versus somewhat movable in growing children. b. Syndesmoses. Like sutures, dense fibrous tissues bind the bones together allowing limited movement (although more than sutures). Examples in the body include the coraco-acromial joint. In this joint arrangement the bones are usually further apart than they are in sutures and are joined by ligaments. Hence, allowing some movement. The teeth are also an example of a particular type of fibrous joint. Sometimes they are called peg and socket joints. This joint is more accurately referred to as a gomphosis joint. Gomphosis literally means a bolt in Greek. A gomphosis joint is an articulation via the insertion of a conic process into a socket (hence the bolt). If you envisage the root of your tooth into an alvestus (small hollow) in your jaw, this is the form it takes. A gomphosis is not really a connection between two bones even though it is considered a fibrous joint. Cartilaginous or Amphiarthrosis Joints These joints do not contain an articular cavity but are viewed as slightly movable. They allow a twisting or bending motion. There are two basic types of cartilaginous joints differentiated on whether they joint together using hyaline cartilage (sychondroses) or fibrous cartilage (symphyses): a. Sychondroses. This literally means held together by cartilage. The bones are held together by a thin layer of hyaline cartilage. Examples include the sternocostal joints. The growth plates of bones are sychondroses. Interestingly, many sychondroses are temporary as bone eventually replaces the cartilage forming a synostoses (when two bones fuse together to form one bone). b. Symphyses. These joints are connected by fibrous cartilage which allows slight compression. In these joints a thin layer of hyaline cartilage separates a disk of fibro cartilage from the bones. Again, the joints allow limited movement. Examples include the vertebral joints. (Insert Table 8.2/8.1, Seeley) Joint lubrication The smooth movement of synovial joints is made possible by several features. We generally identify two forms of lubrication and refer to them as boundary lubrication and fluid film lubrication. The fluid film lubrication is really what allows us our day to day fluid movement as it comprises a thin film of lubricant that separates the bones. It functions for the most part under low loads with higher speeds. As an interesting side note; synovial joints can self-lubricate by shifting the synovial fluid back and forth under bone surfaces as the bones move. Boundary lubrication on the other hand is more important for higher stress loads over longer periods of time. Cartilage In the earlier section on synovial joints we introduced the terms articular cartilage and articular capsule. We also discussed the role of the synovial fluid in lubricating these joints. Like any mechanical device, be it a bicycle chain or car engine or human joint, lubrication is vital for proper functioning. In humans, a white connective tissue known as articular cartilage provides this lubrication. This white dense cartilage coats the ends of the bones in diarthrodial joints allowing movement with minimal friction, wear and pain. It also spreads the load at the joint over a wider area decreasing pressure and stress at any contact point. Estimates suggest that articular cartilage can reduce the contact stress on bones and joints by up to 50%. Articular cartilage is somewhat unique in its design as a living substance. Articular cartilage contains no blood vessels, nerves or lymph vessels. Water makes up most of the mass of articular cartilage with estimates ranging from 65-80% of th e weight of the time. Articular cartilage is also referred to as a viscoelastic tissue, sometimes this is referred to as biologically time dependent. What this means is that when you apply a constant load over time to the cartilage, its mechanical behavior (and shape) will also change over time. An example of this is an increase in the thickness of cartilage that occurs from exercise as greater volumes of fluid move in and out of the joint! Cartilage is a connective tissue that comes in several forms. There are three recognized types: a. hyaline b. articular c. white fibrocartilage Hyaline cartilage is smooth with shiny physical properties of a glue-like substance (even though it lubricates). The term hyal means glassy. Articular cartilage lines the articular (smooth) surfaces of the bones allowing for efficient smooth movement. White fibrocartilage is a strong fibrous tissue saturated with the glue-like cartilage that gives it a very strong tendon-like property. Articular fibrocartilage is found in amphiarthroses joints. This articular fibrocartilage is found as a fibrocartilaginous disc known as a menisci. This is the design in the intervertebral discs. The role of menisci are somewhat unclear but are believed to help reduce shock. The final articular component is that of articular connective tissue. Articular connective tissue includes both tendons and ligaments. The tendons connect muscle to bone and the ligaments connect bone to bone. These connective tissues are passive tissues comprised mainly of collagen and elastic fibers. These tissues are minimally extensible with no contraction ability and instead return to resting length as the muscle relaxes and the antagonist contracts. These tissues are elastic which helps them return to their original length. Ligaments Ligaments join bone to bone by inserting directly into the bone of the periosteum. Ligaments comprise fibers that are arranged in various directions. The major constituent in ligaments is the protein collagen and is very strong. The ligaments plan a major role in the stability of a joint. The arrangement of the ligaments varies according to the joint and the degree of mobility within the joint. In joints with greater mobility and larger ranges of motion there are usually multiple ligaments. The knee is a nice example in that its mobility necessitates four ligaments. This arrangement allows for a high degree of mobility while also maintaining its stability. Joint Problems and Injuries The basic shape of joints and they way they functions makes them prime targets for injuries. Some injuries are mild like a sprain or slight hyperextension while others are much more severe like shoulder dislocations or torn anterior cruciate ligaments. Sprains basically are a stretch of the ligaments and are usually very painful although not serious. While many joint injuries heal on their own, many do not and require either surgery or medications. Common joint injuries include the sprains and strains but also tennis elbow or nursemaids elbow. Nursemaids elbow occurs when the radius (one of the bones in the forearm) slips out of place from where it normally attaches to the elbow joint. It is a common condition in children younger than 4 years of age. It is also called pulled elbow, slipped elbow, or toddler elbow. The medical term for nursemaids elbow is radial head subluxation. A sudden pulling or traction on the hand or forearm causes nursemaids elbow. This causes the radius to sli p out of the ligament holding it into the elbow. It can occur when an infant rolls himself or herself over, from a fall or from pulling, or swinging a young child by the hand. Tennis elbow is also a very common injury and contrary to popular belief doesnt just result from playing tennis. Tennis elbow is a repetitive stress injury of the elbow that occurs when the muscles and tendons in the elbow area are torn or damaged. Tennis elbow is usually caused by repetitive activities that strain the tendons in the elbow area, such as using a manual screwdriver, using a hammer, gripping something repeatedly or of course hitting backhand in tennis. These types of injuries are usually acute and be treated effectively within a few days. Other conditions like arthritis are more chronic and require more long term treatment. Much joint soreness is caused by some sort of inflammation and the biggest cause of joint soreness in humans is arthritis which can affect any joint in the body. Arthritis is basically an inflammation of any joint in the body. Perhaps you have noticed that you are a little more stiff and slow when you get out of bed in the morning. Although we dont always feel it, arthritis is pretty much present in every person. As it develops it causes pain in the joints with movement especially after periods of inactivity. It is estimated to affect about 10% of the worlds population and 14% of the US population and is suggested as the leading cause of disability in people over 50 years old. There are many types of arthritis but the most common is probably osteoarthritis (OA). OA affects articular cartilage and results from the breakdown of the joint capsule and loss of synovial fluid. This means bones can end up rubbing together which cause pain an inflammation. However, it is not just the joint c apsule per se that is involved but also the ligaments, tendons and muscles. It has long been maintained that repetitive stresses caused arthritis but that is not always the case as we know that people who exercise regularly do not develop as much arthritis. It appears to be more due to trauma, age and infection. Summary In chapter six we provided a brief introduction of the general skeleton but paying particular attention to the role and classifications of articulations (or joints). We have learned that although there are many, many types of joints there are three basic classifications, namely, synovial, fibrous, and cartilaginous. The joints are classified according to their structure and also how much movement they allow. The joints that we are interested in the most in kinesiology are really the synovial joints. They are what permit the greatest range of motion. The structure of these joints is highly dependent upon synovial fluid which is a highly fluid lubricating substance permitting smooth movement. Joints vary in their range of motion whereby some joints do not allow any movement and some allow movement in all three cardinal planes. As a general rule, the more planes of movement a joint can move through, the less stable the joint, and the more likely we are to injure it. The shoulder joint i s a nice example of this relationship. Ligaments are also present in joints and they play a varying role in the stability of a joint. Ligaments join bone to bone and are highly tensile structures. Generally, we find a greater arrangement of ligaments in joints with greater ranges of motion. Research note: You may have noticed that women often become more flexible when they are pregnant. Naturally, this is to prepare for the action of childbirth and labor. However, for this increased flexibility to occur there needs to be structural changes in the joint structure. This is mediated by changes in hormones such as estrogen and progesterone. But there is another not so common hormone, relaxin, which increases and acts to improve mobility in the symphysis pubis, allowing them to stretch more. Although this action is most pronounced in the symphysis pubis, the hormone can act on all connective tissue in the body. However, while this is beneficial, it can also be problematic as this increased flexibility can cause injury such as back pain, or in worse cases torn ligaments during a fall. For the most part the hormone levels are restored to normal levels shortly after delivery. Can you now answer the following questions related to joints and joint structure? Differentiate between a fibrous joint, a cartilaginous joint, and a synovial joint! 2. Can you identify which of the synovial joints have: a. 3 degrees of freedom? b. 2 degrees of freedom? c. 1 degree of freedom? 3. In your own words describe the 3 major classifications of joints and give two examples for each classification (if possible). Also write the synonym for the terms below. a. Synarthrodial joint? b. Amphiarthrodial joint? c. Diarthrodial joint? d. Synostosis? Can you list a motion/action that is allowed for each of the six diarthrodial joints: 5. Identify 5 primary functions of the skeleton! 6. Starting with the neck and working downwards, classify each joint. Neck Shoulder Elbow Wrist Fingers (not thumb) Thumb Trunk (bottom of spine) Hip Knee Ankle 7. Identify the type of joint shown below and then identify, where possible, two locations where one may find that type of joint on your body: Insert a picture of 6 diarthrodial joints!

Cardiovascular Disease

Cardiovascular Disease Cardiovascular Disease Introduction This paper utilizes qualitative data drawn from a series of focus group discussions with patients living with coronary heart disease which explored their understanding of and adherence to a prescribed monitoring and medication regime. These findings are drawn upon in order to contextualize, from the patients perspective, the outcomes of the Departments of Healths Coronary Heart Disease National Service Framework strategy. The paper focuses attention on the consequences of this regulatory approach to clinical and risk management for those patients already living with coronary heart disease. Case Study Patient is 59 yrs old and had a myocardial infarction 2 years ago. He is obese, a smoker and poorly motivated. The case exemplifies many of the difficulties that frequently arise in managing cardiovascular disease, and suggests potential avenues for improving outcomes through the application of a disease management programme. The Coronary Heart Disease National Service Framework By the mid 1980s, it had been generally accepted by most clinicians that there was strong evidence to support the existence of a linear relationship between cholesterol levels and cardiac mortality (Shaper et al. 1985, Stamler et al. 1986), and that therefore lowering total cholesterol levels would reduce the risk of individuals developing coronary heart disease. This opened the way to the process of establishing a recommended cholesterol threshold level at which treatment should be instigated (Leitch 1989). Since then, the trend has been towards setting ever-lower threshold targets for treatment for those designated as being at high risk of developing coronary heart disease and for those already living with the disease. In 2000, the Department of Health published its Coronary Heart Disease National Service Framework which set out 12 standards for the prevention, diagnosis and treatment of the disease (Department of Health 2000). The National Service Framework standard Number 3 recommended that GPs identify and develop a register of diagnosed patients and those patients at high risk of developing coronary heart disease. Dietary and lifestyle advice (what the document terms ‘modifiable risk factors) was to be offered to these patients, and their medication reviewed at least every 12 months. It was also recommended that statins be prescribed to anyone with coronary heart disease or having a 30% or greater 10-year risk of a ‘cardiac event, in order to lower their blood cholesterol levels to less than 5 mmol/l or by 30% (which ever is greater). These recommendations were vigorously promoted when they were incorporated into the new General Medical Services contract that came into operation in 2003. The relative performance of an individual Primary Care Organization in meeting each of these indicators attracts points on a sliding scale that are then converted into payments for individual GPs. In relation to the management of patients with coronary heart disease, higher payments are received if a Primary Care Organization increases the percentage of patients with coronary heart disease who have their total serum cholesterol regularly monitored, and whose last cholesterol reading was less than 5 mmol/l (Department of Health 2004a). The most recent Department of Health progress report on the National Service Framework argues that the massive growth in statin therapy since 2000; ‘. . . is one of the most important markers of progress on the NSF, and was directly saving up to 9,000 lives per year (Department of Health 2005: 19). Statin prescriptions have been rising at the rate of 30% per year since 2000, and in 2004/5  £750 million was spent on statins, equivalent to some 2.5 million people on statin therapy in England (Department of Health 2005). In July 2004, low doses of statins became available over the counter without prescription for the first time, for those at moderate risk. The Public Health Discourse(S) Of Cardiac Risk The application of risk discourses in the field of public health (or more precisely the ascription of health risk to particular behaviours) as conceptualized within those elements of the risk literature most influenced by Foucauldian notions of governmentality, are seen as serving to construct the socially recalcitrant as distinct from the responsible citizen (Foucault 1977, Turner 1987, Lupton 1995). In a similar way, Dean (1999) argues that once risk has been attributed to particular health behaviours, the distinction is then drawn within public health policies between ‘active citizens who are perceived as able to manage their own heath risks, and ‘at-risk social groups who become the object of targeted interventions designed to manage these risks. Two distinct dimensions or approaches to the conceptualization and public health management of cardiac health risks also emerge from an examination of the ‘guiding values and principles which inform the Department of Healths Coronary Heart Disease National Service Framework (Department of Health 2000).While one approach (described below as the ‘epidemiological model of risk) largely conforms to the individualized ‘at-risk discourse, a second discourse (described below as the ‘social model of risk) which is much more concerned with health risk at a social and material level can also be discerned within the National Service Framework. These two distinct and arguably competing discourses of risk point to a complexity in current public health policy that might not be anticipated from a reading of the governmentality literature alone. The first conceptualization of cardiac risk within the Coronary Heart Disease National Service Framework is one that can be termed the ‘social model of health risk. This model essentially reflects a socio-economic understanding of the determinants of population health, and draws attention to the importance of addressing material, social and psychological risk factors in addition to the known biological factors in heart disease. In the National Service Framework, this social model is reflected in the endorsement (albeit at a rhetorical level) of an interventionist role for the state in addressing these wider determinants of the disease: ‘The Governments actions influence the wider determinants of health which include the distribution of wealth and income. A wide range of its policies will have an impact on coronary heart disease including social and legal policies and policies on transport, housing, employment, agriculture and food, environment and crime (Department of Health 2000: Section 1, Para 17). There is also an explicit acknowledgement that these risk factors disproportionately disadvantage particular sections of society, demonstrated in the higher incidence of coronary heart disease among the manual social classes. It is also acknowledged that there is inequity in health service provision; ‘. . . there are unjustifiable variations in quality and access to some coronary heart disease serv ices, with many patients not receiving treatments of ‘proven effectiveness (Department of Health 2000: Section 1, Para 13). This formal acknowledgement of the governments role in addressing the wider social and economic influences on cardiac health risk could to some degree be said to conform to Becks (1992) notion of the ‘risk society; wherein many of the health risks faced by the population are a consequence of unchecked scientific and industrial ‘progress. Beck asserts that in response a greater public awareness or ‘reflexivity of risk has emerged which reflects a shift from ignorance or private fears about the unknown to a widespread knowledge about the world we have created. The question of whether a reflexivity concerning the social and environmental factors associated with cardiac risk can be discerned in a patients own discourses of cardiac risk is something that will be explored in the discussion below. The second risk discourse emergent within the National Service Framework (Department of Health 2000) is one which reflects a predominantly epidemiological understanding of health risk. In this model, the relative risk of an individual developing heart disease is based upon a calculation of the mean values associated with certain ‘lifestyle behaviours such as smoking, diet and exercise that are drawn from aggregated population data for heart disease incidence. This is a statistical approach that all too often perceives such calculated health risk factors as being realities or causative agents in their own right, often with little acknowledgement of the social and material context of these health behaviours. Nevertheless, it is on the basis of this epidemiological model of health risk that the Department of Health has confidently set national guidelines that now require General Values and principles underlying the CHD National Service Framework Nine stated values underlying development of national policies for CHD Provision of quality services irrespective of gender, disability, ethnicity or age. Ready availability of consistent, accurate and relevant information for the public. Consideration of health impact in regard to social and legal policies and policies on transport, housing, employment, agriculture and food, environment and crime. Public health programmes led by health and local authorities to ensure targets for CHD are met. Reduction in health inequalities. Resources will be targeted at those in greatest need and with the greatest potential to benefit. Evidence-based. CHD policies are to be based on the best available evidence. Integrated approach for the prevention and treatment of CHD in health policy, health promotion, primary care, community care and hospital care. Maintenance of ethics and standards of professional practice. Recognition of the importance of voluntary organizations and carers at home in addressing CHD. Four stated principles underpinning the CHD NSF . Reducing the burden of CHD is not just the responsibility of the NHS. It requires action right across society . The quality of care depends on: ready access to appropriate services ii. the calibre of the interaction between individual patients and individual clinicians iii. the quality of the organization and environment in which care takes place. . Excellence requires that important, simple things are done right all the time. . Delivering care in a more structured and systematic way will substantially improve the quality of care and reduce undesirable variations in its provision. Practitioners to identify and monitor ‘high risk patients and to prescribe the recommended drug treatment regime. It can be argued that this regulatory or ‘managerialist approach to clinical decision-making constitutes a challenge to the discretion that has been traditionally enjoyed by general practitioners in relation to the clinical management of patients. This second ‘official discourse of health risk could be seen as indicative of the regulatory and surveillance forms of governmentality identified within Foucauldian social theory. From this perspective, those social groups whose health behaviour or lifestyle are seen to fall outside the acceptable bounds of self-management then become constructed as ‘at-risk. These are social groups who are seen to, ‘deliberately expose themselves to health risks rather than rationally avoiding them, and therefore require greater surveillance and regulation (Lupton 1995: 76); once identified these groups and individuals then become subject to various health promotion or ‘health improvement initiatives. Implicit in such forms of governmentality as applied within health policy interventions designed to manage risk are a set of assumptions about the nature of human action predicated on the notion of the ‘rational actor model. Jaeger, Renn, Rosa and Webler (2001) have argued such models of rationality operate at three levels of abstraction. In its most general form, it presupposes that humans are capable of acting in a strategic fashion by linking decisions with actions. That is, human beings are goal-orientated who have options available from which they are able to select a course of action appropriate to meeting these goals. The second level of abstraction which the authors term the ‘rational actor paradigm, and which is the level at which rationality is probably understood by policy-makers, contains the following assumptions: all actions are individual choices; individuals can distinguish between ends and means to achieve these ends; individuals are motivated to pursue t heir own self-chosen goals when making decisions about courses of action/behaviour; individuals will always choose a course of action that has maximum personal utility, that is it will lead to personal satisfaction; individuals possess the knowledge about the potential consequences of their actions when they make decisions. Finally, that rational actor theory is not only a normative theory of how people should make decisions about in this case health behaviour, but is also a descriptive model of how people select options and justify their actions (Jaeger et al. 2001: 33). Many of these rational actor assumptions underpin and inform the Coronary Heart Disease National Service Framework. Such assumptions manifest themselves in a seemingly unproblematic approach to the promotion of ‘risky health behaviour change which plays down the influence of culture, habitus and the material basis of group socialization. This uncritical rationality also threatens the sustainability of the National Service Framework strategy in other ways. The social psychological and sociological literature see the notion of ‘trust as constituted through two dimensions, the deliberative or rational and the affective or non-rational. As Peter Taylor-Gooby (2006) has pointed out in his work on the problematic of public policy reform, the rational deliberative processes associated with the achievement of greater efficiency in the provision of public services have unwittingly served to undermine the non-rational processes that contribute to the building of trust in public institutions and in public sector professionals. In this context, the National Service Framework will need to build trust both in terms of the presentation of the biomedical evidence for the effectiveness of statins and other cardiac drug interventions, as well as the more affective elements associated with the belief that the national targets are designed with the best interests of patients in mind rather than being driven by financial considerations alone. Significantly, given its centrality to a ‘disease management strategy, neither the Coronary Heart Disease National Service Framework (Department of Health 2000) nor the NHS Improvement Plan (Department of Health 2004b) which sets out the governments priorities Coronary heart disease and the management of risk 363 for primary and secondary healthcare up to 2008, attempts to define the use of the term ‘risk, and by extension ‘higher risk. Nevertheless, the conception of risk that shapes the practical interventions proposed within both these strategy documents is clearly the epidemiological one that is described above. In the past, such public health interventions have been largely concerned with bringing about health behaviour change, however now the strategy would appear to be less focused on encouraging greater responsibility for the ‘self management of cardiac risk and more on ensuring compliance with clinical management regimes of monitoring and drug treatme nt. Optimising Care Through Disease Management In the last 15 years, there have been dramatic advances in the pharmacotherapy of heart disease, most notably the introduction of angiotensin converting enzyme (ACE) inhibitors. (Jaeger et al. 2001: 33) Unfortunately, numerous studies have suggested that ACE inhibitors are substantially underutilised in heart disease patients. Moreover, there are a multitude of factors which may confound heart disease management heart disease virtually never occurs in isolation, and comorbidities such as hypertension, diabetes, coronary artery disease, chronic pulmonary or renal disease and arthritis occur frequently. The presence of these comorbid conditions may interfere with heart disease management in several ways. In PATIENTs case, pre-existing renal insufficiency may have contributed to her intolerance to ACE inhibitors. In addition, her use of NSAIDs could promote salt and water retention and antagonise the antihypertensive effects of her other medications. (Jaeger et al. 2001: 33) Multiple comorbidities may also result in polypharmacy, which, in turn, may compromise compliance and lead to undesirable drug interactions. Adherence to dietary sodium restriction is often problematic (as in patients case), particularly in older individuals who are either not responsible for preparing their own meals, or who rely heavily on canned goods and prepared foods. Depression, anxiety and social isolation are common in patients with heart disease, and each may interfere with adherence to the heart disease regimen or with the patients willingness to seek prompt medical attention when symptoms recur. Similarly, the high cost of medications may limit access to therapy in patients with restricted incomes. Physical limitations, such as neuromuscular disorders (e.g. stroke or Parkinsonism), arthritis and sensory deficits (e.g. impaired visual acuity), may compromise the patients ability to understand and comply with treatment. Finally, cognitive dysfunction, which is not uncommon in elderly heart disease patients, may further confound heart disease management. Impact on Clinical Outcomes Despite the widely publicised effects of ACE inhibitors, b-blockers, angiotensin receptor blockers and other vasodilators on the clinical course of heart disease, morbidity and mortality rates in patients with established heart disease remains very high. heart disease is the leading cause for repetitive hospitalizations in adults, and in 1997 Krumholz et al. reported that 44% of older heart disease patients were rehospitalised at least once within 6 months of an initial heart disease admission. Remarkably, this rate was no better than that reported in several prior studies dating back to 1985. (Krumholz et al. 1998) From the disease management perspective, it is important to recognise that the majority of heart disease readmissions are related to poor compliance and other psychosocial or behavioural factors, rather than to progressive heart disease or an acute cardiac event (e.g. myocardial infarction). Thus, Ghali et al. reported in 1988 that 64% of heart disease exacerbationswere attributable to noncompliance with diet, medications or both and that 26% were related to environmental or social factors. Similarly, in 1990 Vinson et al. (Vinson, 1995) found that over half of all readmissions were directly attributable to problems with compliance, lack of social support, or process-of care issues, and these authors concluded that up to 50% of all readmissions were potentially preventable. More recently, Krumholz et al, reported that lack of emotional support among older heart disease patients was a strong independent predictor of adverse outcomes, including death and hospitalization Rationale and Objectives The above considerations provide the rationale for a ‘systems approach to heart disease management. The objectives of this approach are as follows: To optimise the pharmacotherapy of heart disease in accordance with current consensus guidelines. (Vinson, 1990) To maximize compliance with prescribed medications and dietary restrictions. To identify and respond to any psychological, social or financial barriers that might interfere with compliance with the prescribed treatment regimen. To provide an appropriate level of follow-up through telephone contacts, home visits and outpatient clinic visits. To enhance functional capacity by providing an individualized programme of exercise and cardiac rehabilitation. To enhance self-efficacy by helping the patient and family understand that heart disease can be controlled, largely through the patients and familys efforts. To reduce the frequency of acute heart disease exacerbations and hospitalizations. To reduce the overall cost of care. The Disease Management Team Although the composition of a disease management team may vary both from centre to centre and from patient to patient, a suggested list of team members are given below: nurse coordinator or case manager dietitian social services representative clinical pharmacist physical therapist/occupational therapist exercise/rehabilitation specialist  · home health specialist patient and family primary care physician cardiologist/other consultants. Each team member provides their own unique expertise and/or perspective, and these are then woven into an integrated package tailored to meet each individual patients needs, expectations, and circumstances. Importantly, not all patients will require the services of all team members, and it is therefore essential to identify a team leader. In most cases, this will be the nurse coordinator or case manager, who, in addition to being the patients primary contact person and educator, is also responsible for coordinating the efforts of other team members, including the selective activation of appropriate consultations on an individualized basis. In addition to the team itself, several other components are essential for effective disease management. First, the patient and family should be provided with comprehensive information about heart disease, including common etiologies, symptoms and signs, standard diagnostic tests, medications, diet, activity, prognosis and the role of the patient and family in ensuring that heart disease remains under control. This information should be provided in a readily understandable patient-friendly format and several patient-oriented heart disease brochures are now commercially available. In addition to these materials, the patient should be given a scale (if not already owned) and a chart to record daily weights, an accurate and detailed list of medications supplemented by medication aids if needed (e.g. a pill box), and specific information about when to contact the nurse, physician, or other team member in the event that questions or new symptoms arise. In this regard, the importance of establishing an effective one-on-one nurse-to-patient relationship cannot be overemphasized, as this interaction will often be critical to the early diagnosis and effective outpatient treatment of heart disease exacerbations. Patient Perspective While the above studies indicate a beneficial effect on costs, hospital readmissions, etc., they do not address concerns related to the patients perspective on this interdisciplinary care. What issues are important to the patient, and what the advantages are to the patient of participating in an heart disease disease management programme? In recent years, it has become increasingly evident that it is insufficient to merely provide high quality medical services. In a competitive market, it is essential that the patient is also satisfied with the medical encounter, both in terms of the process of care as well as the clinical outcomes. Healthcare is an industry, and like all industries, customer satisfaction is critically important. However, unlike most industries, which deal with a tangible product, the healthcare industry deals with a multifaceted service, the myriad qualities of which are difficult to quantify. As a result, the assessment of patient satisfaction is often complex, and the development of a valid and universally accepted instrument for measuring patient satisfaction has been elusive. Despite these problems, several patient satisfaction questionnaires have been developed, (Garg, 1995) and these have been helpful in defining those issues which are important to patients, and in identifying specific concerns that patients often have with respect to current approaches to healthcare delivery. (Garg, 1995) Factors which have been consistently shown to play a pivotal role in determining patient satisfaction include: communication, involvement in decision- making, respect for the individual, access to care and the quality of care provided. (Philbin, 1996) Not surprisingly, problems in each of these areas are frequently cited as factors which diminish patient satisfaction. Several components of the heart disease disease management system will be of direct assistance in answering patients questions and helping her cope with this new and frightening diagnosis. In particular, the nurse case manager will establish an effective rapport with the patient and her family, and provide an ongoing source of information and emotional support. The patient education brochure and other printed materials will help answer many of Patients questions and assist in relieving some of her anxieties. The nurse, clinical pharmacist and physician (s) can provide detailed information and teaching about the medications used to treat heart disease, and the dietitian can directly address the dietary questions and provide an individualized diet that takes Patients current dietary practices and food preferences into account. The social service representative can assist patient with any financial concerns she may have, make provisions to ensure an adequate social support network, and serve as an additional source of emotional support. The physical therapist or exercise specialist can help in providing recommendations about activities and in the development of an exercise or rehabilitation programme. The nurse case manager, social service representative, home care specialist, and physician will provide assistance to patient in making the transition from the hospital back to the home environment, and they also will ensure a high level of follow-up care. Perhaps most importantly, the comprehensive care provided by the disease management team will reassure patient that she truly is being cared for, and that all of her needs and concerns are being met. Invariably, this will lead to a high level of patient satisfaction. In addition, in the case of patient there is good reason to believe that implementation of a disease management programme at the time of her initial hospitalization may have eliminated the need for a second hospitalization. (Young, 1995) To the extent that patient might have to pay for some of the costs of readmission (e.g. deductible or copayment), the disease management programme would also save her money, a benefit which is universally viewed in a favorable light. And finally, based on compelling data from recent clinical trials, optimizing Patients medication regimen should translate not only into an improved quality of life, but also into increased survival. Conclusion In summary, heart disease management systems provide a win-win-win situation. They are a ‘win for the providers, because they improve clinical outcomes and quality of life. They are a ‘win for the payors, because effective disease management programmes decrease health care expenditures. 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