What is cultural relativity Essay Paper Example For Students

What is cultural relativity? Essay Paper Cultural relativity is an important principle in anthropology since anthropology is the study of human beings in all places and at all times, anthropologists have to understand societies on their own terms and have to avoid making value judgements. Anthropology seeks to produce useful generalization about people and their behaviour and arrive at an unbiased understanding of human diversity. Keesing has defined a society as a population marked by relative separation from surrounding populations and a distinctive culture. We will write a custom essay on What is cultural relativity? Paper specifically for you for only $16.38 $13.9/page Order now A fundamental belief of anthropologists is that learned behaviour, culture plays a vital role in human life. Anthropologists learn about other societies and cultures through fieldwork and participant observation another method used is the ethnographic approach. This involves the study of small-scale societies or relatively small groups of people in order to understand how they view the world and organise their daily lives. An example of an ethnographic case study is heart distress in Maragheh, Iran this heart distress is more frequent in Iranian women and it expresses the problems they are having in their lives. It is a self-labelled folk illness that expresses a wide range of physical, psychological, and social problems at the same time. Ethnocentric is an adjective describing the condition of viewing and judging (often in pejorative terms) other cultures and societies according to the (usually-taken-for-granted) assumptions of ones own society. By way of contrast, anthropology is concerned not only to highlight our assumptions but also to show that other cultures and societies are different to our own, but not worse or better. Ethnography can be best understood by examining the theoretical assumptions, which underlie it. Blummer (1969) has stated the concepts of culture as acquired knowledge has much in common with symbolic interactions, a theory that seeks to explain human terms of meaning. To conclude anthropology is a subject, which has many benefits in the study of human culture, anthropologists have learnt to treat all cultures equally and not have a biased view; furthermore they have learnt how different cultures treat different illnesses such as herbal healers and magic men treating the ill in Nepal.

Carpenter Bees and How to Get Rid of Them

Carpenter Bees and How to Get Rid of Them Carpenter bees can be a real nuisance. They resemble large bumblebees and can be found buzzing around dwellings and other structures where they like to build their nests. Every year, they cause millions of dollars in  damage to dwellings by tunneling into decks, porches, and other wood structures. They can also be aggressive, especially during mating season, and will fly very close to human beings and even bump into them. Fortunately, they rarely if ever sting people and their nests can be removed. Carpenter Bee Basics There are several species of carpenter bee in the United States, but the most common one is the Virginia carpenter bee (Xylocopa virginica). These bugs are found throughout the Southeast but range as far as Connecticut to the north and Texas in the west. Carpenter bees range in size from about 5/8 of an inch to 1 inch and look very similar to bumblebees, but theyre not the same.   Bumblebees (genus Bombus) nest in the ground, usually in abandoned rodent nests, and live in social communities. Carpenter bees (genus Xylocopa) are solitary bees that burrow into wood. You can differentiate the two by examining the dorsal (upper) side of the abdomen. If its shiny and hairless, its a carpenter bee. A bumblebee, by contrast, has a hairy abdomen. Both are considered beneficial insects because they are  excellent plant  pollinators. Therefore, you should avoid eliminating these insects unless absolutely necessary. Carpenter bees usually live for about one year. Each new generation is hatched in the late summer, emerging from nests in August and September to grow and feed, pollinating flowers as they go  before  settling in for the winter and hibernating. Survivors emerge in April and May to mate. The female carpenter bee excavates a tunnel for her offspring. In each brood chamber, she stores food and lays an egg. Having reproduced, adult carpenter bees die off in July, leaving the new generation to continue the cycle when they emerge a month or so later. Most people encounter carpenter bees during April and May when theyve just emerged to mate. During this time, male carpenter bees tend to hover around nest openings, looking for receptive females. It can be rather unnerving being around them, as the males will also hover aggressively around people who approach the nests. They may even fly right into you. Despite this tough act, male carpenter bees cannot sting. Female carpenter bees can sting, but almost never do. How to Identify Nests If you see a bee emerging from a hole in the ground or within a structure, thats a good indication that youre looking at a carpenter bee nest. To be certain,  look at the entrance holes. A carpenter bee makes an entrance hole slightly bigger than her body, or just about  ½ inch in diameter. The first inch or two of the tunnel is usually made against the wood grain. The bee will then make a right turn and extend the tunnel another 4 to 6 inches in the direction of the wood grain. Carpenter bees will often eliminate their waste before entering their nest, so you might see yellow stains on the surface of the wood, just below the entrance hole. Stavros Markopoulos / Getty Images Though they burrow into wood, carpenter bees dont eat wood like termites do. Since their nest tunnels are limited in size, they rarely do serious structural damage. However, because such excavation requires a lot of energy on her part, a female carpenter bee will often prefer to refurbish an old tunnel to digging a new one. If carpenter bees are allowed to tunnel in the same structure year after year, however, the cumulative damage can be significant.   How to Control Carpenter Bees Your best defense is a good offense. Carpenter bees prefer to excavate untreated, unfinished wood. You can prevent carpenter bees from nesting in the first place by painting or varnishing your homes exterior. If an infestation has occurred, you will need to use an insecticide to eliminate the carpenter bees. Many professionals recommend sprays or dust, which can reach the interior surface of the entrance holes. Apply the pesticide at dusk, when carpenter bees are less active.   For the insecticide to work, the bees much come in contact with it as they crawl through the entrance hole of the nest. Apply the appropriate insecticidal dust in the spring, just before adults emerge to mate. Once you see the bees emerge, wait a few days before filling in the nest holes with wood putty or filler. If you didnt apply the insecticide before the spring adults emerged, you will need to treat the nests in the spring, and again in late summer, when the next generation of adults is foraging. In the fall, seal the nest holes with steel wool, then close off the hole with putty, wood filler, fiberglass, or asphalt.   A professional pest control service is your best choice, especially if you have a large infestation because theyll have specialized tools that can reach deep into crevices. However, if you want to do it yourself, any name-brand insecticide formulated to kill flying insects should work. If youd prefer to use a natural remedy, there are several, including boric acid,  Diatomaceous earth, and citrus spray. You can also contact  your local extension office  to find out which insecticides are effective and legal for use on carpenter bees in your area. Sources Bamabara, Stephen and  Waldvogel, Michael. Residential, Structural, and Community Pests. North Carolina State University. July 2009.Houseman, Richard. Carpenter Bees. The University of Missouri Extension.  Jacobs Sr., Steve. Carpenter Bees. Pennsylvania State University. January 2014UC Davis staff. Carpenter Bees Management Guidelines. The University of California. June 2014.13 Home Remedies to Get Rid of Carpenter Bees. HomeRemedyHacks.com. 27 January 2015.

Development of Innovative Mindset Term Paper Example | Topics and Well Written Essays - 1000 words

Development of Innovative Mindset - Term Paper Example It is imperative to note that disabled individuals have a role to play in boosting performance in contemporary society. They also have personal aspirations and professional ambitions that are only tenable through education.   As noted by Palladino (2001) the significance of education calls for the development of holistic policies that are not discriminatory. Nations should develop favorable education policies to boost disabled education. In particular, they should set up education centers for persons with extraordinary needs, provide scholarship and funds to facilitate their quest for knowledge (Cooner, Tochterman & Garrison-Wade, nd). Construction of favorable infrastructural set ups that embraces their needs are also crucial. These elements provide hope for the disabled who are being nurtured to realize their full potentials. Special education has not received proper management and strategic support systems from key stakeholders who include school leaders. The leaders have not taken the initiative to develop inclusive school programs that give every student equal chance of participation. The programs within several institutions do not favor students with various kinds of disabilities consequently hindering their performance academically and socially (Palladino, 2001). The high rate of discrimination also affects their self-esteem, ego and confidentiality. These are significant elements for holistic development. The stakeholders have also failed to develop viable policies to safeguard the rights of students equally and prioritize the special needs of the disabled students. This is because poor policies that guide operations in the education sector in several nations have been the source of failure resulting to a total neglect of the disabled. According to Palladino (2001), poor educational policies have continued to deny individuals with special needs the right to education. This may lead to high level of uneducated society members. This eventually poses a serious burden to governments. Scholars affirm that nations should align their education policies with the millennium development goals (MDG) that seek to promote universal education.

Managing the Digital Enterprise Essay Example | Topics and Well Written Essays - 1750 words

Managing the Digital Enterprise - Essay Example It demonstrates the degree of innovation of an organization and their responsiveness to the consumer needs and changes in taste preferences. With the introduction of technology, e-business models have been developed that allow businesses to demonstrate their abilities and responsiveness using web based centres. Thus, a business model whether tradition or e-business model demonstrates the approaches adopted by an organization to make profits. In this paper, the business models of Dell and Amazon companies will be analysed to demonstrate how each of the approaches have affected the performance of the businesses. In implementing the business models, these organizations have their specific community and target audience in sight, which affects the nature of their models. The target audience served by the organizations websites will also be analysed to demonstrate how the companies use their sites to attract their customers. Dell and Amazon business models The development of web dependent business models as have been done by both Dell and Amazon requires the understanding of the characteristics of web-users. Consumer behaviours constantly change and is influenced largely by the current occurrence in the market, competition and the entry of new players in the industry. Companies conduct studies on consumer behaviours to determine the nature of their web contents as exhibited by both dell and Amazon. Websites therefore incorporate business news, entertainment articles and educational activities aimed at attracting and arousing the interests of the consumers. In organizations that conduct online shopping, procurements, sales and advertising like Amazon and most recently Dell, a proper e-business model is of great significance (Kuballa, 2007). Dell Corporation launched their e-business approach in 1990s and this has enabled it to make inroads into new markets while designing products that suit the specific needs of the consumers. According to this model, the company main tains a virtual operations and sales system in which it operates without any physical outlets and intermediaries to link it with the consumers. With its sound supply chain management approach, Dell can sufficiently serve the orders of its consumers within 24 hours of receiving the order (Fife & Pereira, 2006). One of the business models used by Dell involves the employment of e-business in enhancing its supply chain management thus enabling the company to meet the consumer’s needs in time. In 1996, Dell Corporation opened its website www.dell.com for online selling purposes and designed it specifically to allow for interactive approaches with the consumers (Kha, 2000). The business model as practiced by Dell Corporation is also punctuated with consistencies in the development of new innovative products, which are availed on the company’s website for consumers to review. The innovative approach focuses on the key competencies of the company and the ability of the consum ers to make their personal inputs on the products online before making their orders (Fox, 2000). Amazon has cut a niche for itself as one of the leading online book and music seller controlling a large percentage of the total books sold online worldwide. The success of the online

Contemporary Issues in Business (Individual Report) Essay

Contemporary Issues in Business (Individual Report) - Essay Example Over long periods of geological time, the earth’s climate has been constantly changing in response to the tilt and shape of the earth’s orbit as it moves around the sun, the strength and intensity of the sun coupled with the composition of the earth’s atmosphere, the basic shape and position of the continents. There has been strong evidence that some human activities such as the use of fossil fuels are responsible for the constant emission of harmful greenhouse gases that are now causing an increase in the earths temperate in addition to other changes in climate (Richter 2010). Greenhouse emissions are currently projected to increase significantly within the next few decades which will cause an increase in global temperatures and subsequently put to great risk the human society and natural environment worldwide (Pedersen and Nordic Council of Ministers 2000). Climate Change and the Greenhouse Effect The temperature on the surface of the earth is largely determine d by the balance between the energy that is constantly re-radiated to space from the earth mostly in the form of infra-red radiation and the energy that comes from the sun which is seen to be in the form of visible radiation (sunlight). When the sunlight passes through the earth’s atmosphere, it has relatively very little warming effect but when it finally manages to come into contact with the earth’s surface, it warms it and the earth in turn warms the atmosphere by both convection and via emission of infra-red radiation which are absorbed by the greenhouse gases (R.I.C. Publications 2007). The greenhouse gases eventually return some of the infra-red radiation back to the earth’s surface which ends up further warming the earth’s surface. An analogy of this chain of events is often made with reference to greenhouses which generally allow sunshine to pass through their clear plastic or glass which in turns stop the heat that is inside the green house from escaping into the atmosphere and hence the use of the term â€Å"greenhouse effect† (R.I.C. Publications 2007). Fossil Fuels and the change in Climate System Fossil fuels are formed when the bodies of living organisms die and remain compressed and heated over extremely long periods of time to form natural gases, oil and coal. When burned, fossil fuels are seen to produce significant amounts of energy a factor which causes them to be considered as an extremely valuable energy source. However, the burning of these fossil fuels produces the emission of carbon dioxide, resulting in the introduction into the carbon cycle of carbon that would have otherwise still remained trapped in the earth’s geosphere (Downie, Brash and Vaughan 2009). It is currently estimated that the burning of fossil fuels is responsible for adding to the atmosphere an estimated 3.2 billion metric tons of carbon. Because the earth’s carbon cycle is unable to absorb all of this excess carbon bein g released into the atmospher

Postoperative Nausea and Vomiting: Causes and Treatments

Postoperative Nausea and Vomiting: Causes and Treatments Postoperative nausea and vomiting is the nausea and vomiting symptoms which occurred after a surgery, medicines intake or anaesthesia usage. Around 18 to 30 of surgical patients have PONV and the nausea and vomiting symptoms are usually self-limiting in most cases.1 Uncomplicated PONV usually resolve within 24 hours after an operation whereas intractable PONV involve various triggering factors and resist to medical treatment, making it harder to treat. Studies revealed that most patients dislike chronic PONV more than postoperative pain as it is a more distressing illness and it may lead to several serious clinical consequences if left untreated. In the case of repeated vomiting, PONV patients might suffer from dehydration and have a higher chance of developing hiatal hernia, a condition where the upper part of stomach protrudes into the thorax through the opening of diaphragm. Other than that, patients might also experience anorexia, gastrointestinal discomfort, headache, weakness, dizziness and nausea while not vomiting. Chronic vomiting can also cause complications like dental damage and sore throats due to exposure of oesophageal lining and mouth cavity to the low pH gastric acid. Moreover, PONV may induce serious problems like pulmonary aspiration, electrolyte abnormalities, wound dehiscence, increased pain and oesophageal rupture.4,5 Despite causing patients discomfort, patients also have to pay more for the delayed hospital discharge. Each incidence of vomiting has increased postanaesthetic care unit (PACU) stay duration by 20mins. Therefore, to reduce the unanticipated hospital admission and the financial burden broug ht by PONV, there is a need to understand the disease pathophysiology so that precise and mechanism-based treatment strategies can be developed to tackle the emesis problem. The vomiting centre and the chemoreceptor trigger zone (CTZ) are the two main parts of the brain controlling the vomiting action. The vomiting centre is located within the medulla oblongata and the emesis action is initiated via the stimulation of five primary afferent pathways. They are the chemoreceptor trigger zone, vagal mucosal pathway of the gastrointestinal system, neuronal pathways from the vestibular apparatus system, inputs from the periphery glossopharyngeal nerve and reflex afferent pathways from  cerebral cortex C2,3 and midbrain afferents. Next, efferent nerve impulses are sent to various place of the body such as the pharynx, larynx, diaphragm, intercostals muscles and gut to initiate the vomiting reflex. During the ejection phase of the vomiting reflex, the diaphragm and abdominal muscles  simultaneously contract and the elevated intra-abdominal pressure leads to the throw up and expulsion of gastric contents. A variety of receptors are participated in the emesis action. They are the histaminergic(H1), dopaminergic(D2), serotonergic(5-HT3), muscarinic and neurokinin-1 receptors. Consequently, pharmacological agents which target on these receptors can be utilized to treat PONV. However, the British National Formulary (BNF) had advised that antiemetic agents should only be used once the causative factor for nausea and vomiting was identified. This is because the use of antiemetic is sometimes dangerous and inappropriate in clinical cases like diabetic ketoacidosis, digoxin or antiepileptic overdose.6 Hence, the aetiology and possible causative factors of PONV should be investigated to guide the planning of the pharmaceutical management steps and the antiemetic selection for treating PONV. There are patient-specific factors, surgical factors and anaesthetic risk factors which contribute to PONV prevalence. Patients who aged 6 to 16 year old, female, non-smoker, obese or have a history of motion sickness or PONV are proven to be the high-risk patient group. Moreover, patients who have chemotherapy, migraine and gastroparesis problems are also susceptible to PONV. Other causative factors include elevated intracranial pressure, metabolic abnormalities, gastroduodenal ulcers, dehydration and infections of the gastroesophageal lining. As for the surgical factors, PONV is related to the premedication side-effect, prolong fasting, conditions of gastric inflation during mask ventilation, use of long-acting opioids, nitrous oxide, volatile anaesthetics and high dose neostigmine in surgery. In addition, frequent head movement of patient and early intake of food after surgery can also potentiate the nausea problem.1 Some types of operations have higher chance of developing PONV, they are the gynaecological surgery, ear, nose and throat operation, intra-abdominal and squint correction surgery. Furthermore, the surgical duration is also an important contributor which predisposes patients to a higher risk of PONV. Every 30 minutes extension in surgical time can increase risk of PONV by 60% as patient is taking in more anaesthetics into the body. Hence, healthcare team should control and minimize the surgery duration such that risk of getting PONV is reduced. Although it is not relevant to discuss anaesthetic techniques in this case scenario, it is important to note that regional anaesthesia should be preferred over general anaesthesia during surgical process. According to SOGC guideline, there is an 11-fold increase in the PONV risk when using general anaesthesia rather than regional anaesthesia. Apart from that, volatile anaesthesia, long-acting opioid and neostigmine should also avoid in surgery as these agents predispose patient to PONV. If the use of general anaesthesia is unavoidable in a surgery, propofol can be a suitable induction agent because it induces less PONV incidence. A thorough assessment should be carried out to serve as a rationale for the management plan of PONV. The past medical history, frequency and nature of the vomiting episode, blood electrolyte test and physical examination can be evaluated to identify the severity of disease condition and the aetiology of PONV. Subsequently, the appropriate pharmacological agents which target on the responsible pathway of emesis can be given. Many antiemetic preparations are available in the market and patients can choose between formulations of solution, buccal tablets, rectal suppository and subcutaneous (SC), intravenous (IV) or intramuscular (IM) injections when oral route is not feasible.6 As no single agent provides complete control in emesis, most hospital has adopted a multimodal approach and a combination strategy where different antiemetics which target on different receptors are utilized in the treatment of PONV.1 Combination therapy becomes the preferable way to treat PONV and the generally used combination is 5-HT3 receptor antagonists with droperidol or dexamethasone. Granisetron and ondansetron are examples of 5-HT3 or serotonin receptor antagonists. They exert their effects in the chemoreceptor trigger zone and at vagal afferents of the gastrointestinal tract. Previous studies showed that no single agent performed exceptionally well than the others of same class as all 5-HT3 antagonists illustrated similar safety and efficacy profile. Yet, a recent meta-analysis which includes 85 randomized controlled, double-blind studies with 15,269 patients involvement had established that the antiemetic effect of granisetron is significantly superior to ondansetron and dolasetron. Ondansetron was also found to be more cost effective than granisetron. 1-2mg of granisetron or 4-8mg of ondansetron can be delivered in intravascular route at the end of surgery for PONV treatment. Long-acting serotonin antagonist with higher binding affinity to 5-HT3 receptors, palonosetron, is also available in the market with a long half-life of about 40 hours. Patients receivin g these agents might experience headache, constipation and dizziness problems. Droperidol is a butyrophenone which acts competitively on central dopaminergic receptors in the chemoreceptor trigger zone (CTZ). It is applied in 0.625-1.25mg IV route at the end of surgery. A systematic review of 24 randomized studies was carried out by Schaub and team, they concluded that droperidol decreases PONV incidence regardless of the dose given to patients. However, this drug is only used as a third-line antiemetic for intractable PONV when other alternative treatments failed because droperidol can lead to adverse effects associated with QT prolongation and torsades de points, sedation, anxiety, hypotension and extrapyramidal symptoms. Due to its possibility in causing fatal arrhythmia, electrocardiographic monitoring is compulsory each time upon its usage. Nonetheless, a double-blinded randomized clinical study which included 120 patients stated that there was insufficient evidence to prove the QTc prolongation effect induced by droperidol after surgery. Dexamethasone is classified under corticosteroids and often delivered in a 4 to 5mg one-off dose via IV or IM route.19 The exact mechanism of action is unknown but it is related to the peripheral inhibition of prostaglandin synthesis and its ability to reduce 5-HT turnover in the CNS. Although dexamethasone is not licensed for the indication of PONV, this drug is as effective as other conventional antiemetic drugs like droperidol and serotonin antagonists. A single blinded, randomized-controlled interventional study had illustrated that the administration of dexamethasone is useful for the reduction of PONV episodes (30% in contrast to 70% of the placebo group).20 Moreover, Ormel et al. illustrated that the addition of dexamethasone to droperidol and ondansetron showed a profound amplification in the efficacy profile of these triple agents combination. It stands as a good alternative for PONV treatment due to the advantage of cost-effectiveness issue and its characteristic of long ac tion duration. As dexamethasone can increase plasma glucose level, it is not recommended for diabetic patient. Furthermore, unfavorable side-effect like postoperative euphoria, impaired wound healing, irritability and adrenal suppression can happen in patient taking long-term corticosteroids. Metoclopramide is a gastroprokinetic agent which acts on the D2 receptors of the gastrointestinal tract. It can accelerate the gastric emptying rate of gastroparesis and GI obstruction patients.2,6 Despite blocking the D2 receptors, it also has antagonist action on 5-HT3 receptors in the CTZ and vomiting centre when delivered in high doses. 5 to 20mg dose of metoclopramide in subcutaneous, oral or IV route is commonly taken by patient before meal and before bed.6 This medicine is commonly administered as combination therapy because there is conflicting evidence stating that metoclopramide alone is ineffective for PONV and it should not be use unless the causative factor for PONV is gastric stasis. Yet, a recent meta-analysis has proved that 10mg IV metoclopramide does well in preventing nausea and vomiting problems after the general anaesthesia surgery. As with the phenothiazines discussed below, both drugs have limited use in practice due to the adverse reactions like extrapyramidal effects and dystonia disorder particularly in pediatric and young adults population. Phenothiazines is an example of strong dopamine antagonist which also act on medullary CTZ. Promethazine, prochlorperazine and perphenazine belong to this group and take part in the prophylaxis and treatment of PONV.24 Prochlorperazine is often administered as a 12.5mg deep intramuscular injection or in a 3 to 6mg dose buccal preparation 12 hourly after the surgery. These agents show superior efficacy in treating opioid-induced PONV. However, high-dose metoclopramide and phenothiazines are now less likely used in clinical practice because of their significant side effects like acute dystonic reactions, sedation, dizziness and extrapyramidal symptoms.9,25 A systematic analysis consisting of 19 non-randomized and randomized clinical trials had demonstrated that most studies supported the effectiveness of promethazine in reducing PONV occurrence when compared to placebo and that combination therapy is always preferable and more effective than promethazine alone. Cyclizine is an antihistamine drugs which block the H1 sympathetic pathway in the vomiting centre. The antimuscarinic and antihistamine properties of cyclizine render it to become an antiemetic drug in PONV treatment. A randomised double-blinded study which involved the participations of 960 women had shown that patients who received cyclizine monotherapy showed a slightly greater antiemetic effect than granisetron alone (PONV incidence of 24% with cyclizine compare to 23% in granisetron group).26 Cyclizine can be given orally, intramuscularly or intravenously, with common antimuscarinic side-effects like sedation and dry mouth. Severe heart failure patient should avoid taking this medicine because it leads to detrimental haemodynamic effect.6 The acidic pH of cyclizine at 3.2 also causes pain and irritancy to body upon injection.10 As a result, patients usually have 50mg of cyclizine IV injection every 8 hours after proper dilution. A lower dose of 25mg in oral, IM or IV preparation s can also be applied in elderly patient. Scopolamine has anticholinergic property which inhibits the muscarinic as well as the histaminergic receptors in the vestibular apparatus and the nucleus of the tractus solitarus.3,9 Patients who undergo middle ear surgery or use opioids as postoperative anaesthetics are recommended to take scopolamine for their profound efficacy in reducing PONV.3 Scopolamine requires 2 to 4 hours for onset of duration. Hence, a fast-acting antiemetic or a loading bolus dose is needed in urgent case. It is available in transdermal form as a 1.5mg patch which can be placed behind the ear. This slow-release formulation can have sustained effect up to 72 hours. Apfel C et al. had reported that transdermal scopolamine had significantly reduced the risk of PONV when compared to the placebo group although it has the main side-effects of dry mouth, sedation and visual disturbances.28 Furthermore, a comparative study between the combination use of ondansetron plus scopolamine patch and ondansetron alone als o proved that the earlier group significantly decrease the nausea and vomiting incidence after surgery. Other than a mechanism-based approach, less conventional therapeutic agents can also be used to treat intractable PONV cases. An antidepressant with a novel indication, mirtazapine, is able to ease the nausea and vomiting symptoms because it can antagonize 5-HT3 receptors. A small scale randomized trial which compared the therapeutic outcome of mirtazapine and ondansetron had showed that patients using mirtazapine were less anxious and had fewer PONV episodes than the ondansetron group. Next, olanzapine which is recognized as an atypical antipsychotic drug also proved to have potential in treating PONV. It can inhibit several receptors such as the dopamine, acetylcholine, histamine and 5-HT3 receptors. Ibrahim M et al. had conducted a randomized controlled study which involved 82 surgical patients. The result proved the efficacy and safety profile of olanzapine against PONV especially during the late postoperative stage. Other than medications approach, non-pharmacological interventi ons also show potential therapeutic efficacy in PONV management. Acupuncture, acustimulation or acupressure serves as a good alternative or adjuvant therapy for PONV patients as it shows good tolerability and safety profile. The P6 point (Neiguan) which located at 5cm near to the ventral wrist is the target site of these alternative approaches. Transcutaneous electrical stimulation delivered to the P6 point of the pericardium meridian has been proved to be an efficient way in preventing emesis. Patients only complain of light side-effects like needle fainting, allergy, needle site pain, anxiety or lethargy problems when using this method. In order to solve the labour intensive and time-consuming issues of traditional Chinese acupuncture, the acupressure and acustimulation wristband are introduced in the market (Sea-Band and ReliefBand). Sea-Band applies steady, continuous pressure on the P6 point whereas ReliefBand is a watch-like device which conducts low current to P6 point via electrodes in contact with the skin. Based on the well-established efficacy profile and good evidence-base literature support, healthcare professionals can involve more acupuncture interventions in treatment practice as part of the multimodal approach. In this case, the intractable emesis symptoms experienced by the old woman might indicate the failure of prophylaxis treatment or the need to start a primary antiemetic treatment. Before the initiation of a rescue treatment, a bedside examination and a patient interview should be done to find out whether the PONV symptom is associated to issues such as morphine analgesia, surgical pain management, infection, intestinal obstruction, hypotension, hypoxia, blood in the pharynx, anxiety or removal and insertion of nasogastric tube. 5-HT3 antagonist is the recommended drug for patients who previously do not receive a prophylaxis treatment. Patient can start with a low dose regimen such as ondansetron 1 mg, dolasetron 12.5 mg and granisetron 0.1 mg. If drugs for prophylaxis had been given but fail, patients can then try other class of antiemetics to tackle more diverse receptor pathways. For instance, Habib et al. had found that the failure of prophylactic ondansetron or droperidol can be replaced with rescue agents like promethazine (12.5-25 mg IV), prochloperazine (12.5mg IM) or cyclizine (25-50mg IV or IM) to achieve a better outcome. This is because consensus guideline support that the repeat use of 5-HT3 antagonist within the initial 6 hours postoperative period provides no extra recovery response. If patient use dexamethasone as prevention agent, small dose 5-HT3 antagonist (25% of prophylactic dose) can then be given as a rescue approach. A study also concluded that the cost-effectiven ess of ondansetron in low dose treatment group was higher than that in the high dose prophylatic group. Moreover, in the case of the aggressive treatment failure, such as those who had taken 5-HT3 antagonist, droperidol and dexamethasone altogether but failed, repeat dosing of same prophylactic regimen except dexamethasone can only be considered 6 hours after the surgery though the optimal dosage and timing for readministration still remain unknown. Transdermal scopolamine can also be prescribed for outpatients as it is a more convenient preparation than the parenteral drugs. Prolong use of opioids for pain control after surgery should also be minimized as side-effects like nausea and vomiting are correlated to the prescribed dose. Alternative analgesics like NSAIDS can be used to substitute the causative opioids. In persisting case, pharmacist can review the prescription and anaesthetic charts to ensure adequate maintenance of analgesia, antiemetic and oxygen supply. Dose escalation under safety and therapeutic dosage range can also be worked on. However, pharmacist should be cautious on polypharmacy problem as it may aggravate nausea and vomiting in susceptible patient. Non-oral drug preparations can be considered over oral route to avoid burdening of patient with excessive pills at one time. If necessary, the acupuncture treatment can also be applied to attempt a multimodal approach. Pharmacist should also concern about the possible dehydration risk that might be encountered by chronic PONV patients. For this reason, the blood pressure, hydration and perfusion level of patients have to be checked on a regular basis. Patients should be told to report of symptoms like dry or sticky mouth, sunken eyes, reduced urination or dark yellow urine. If constipation or diarrhea happens, intravenous fluid replacement therapy, osmotic or stimulant laxative can be given to solve the issues. For the dietary measures, patients should avoid oily or spicy food which might aggravate the nausea. Small, frequent meal is preferable over big heavy meal as light meal reduce the possibility of gastric discomfort. Patients should be advised to not move around too often to avoid triggering the vomiting centre. Furthermore, in post-discharged nausea and vomiting (PDNV) case, the antiemetic efficacy profiles are different from PONVs as they have dissimilar underlying cause. Droperidol should be avoided as it is ineffective in treating PDNV.2 If the patient still not responsive to all these approaches, specialist intervention should be initiated to treat intractable nausea and vomiting symptoms. Serious causative factors like surgical complication might be suspected and further investigations are required to treat this disease. In a nutshell, the optimization management of PONV disease requires the participation of the multimodal approach. Patients should be treated accordingly after the accurate disease assessment and further modifications of treatment approaches like (dose-adjustment, introduction of new agents or alternative approaches) can be done to control patients nausea and vomiting symptoms. Lifestyle modification and non-pharmacological interventions also play an important part in treating PONV. Proper patient education about symptoms management should be delivered and follow-up session can be arranged to assess patients rehabilitation progress. Apart from that, reassurance and full supportive care from healthcare teams also play an important role in reducing patient distress and anxiety level.

Free Narrative Essay - Our Big Trip to State College :: Personal Narrative Essays

Our Big Trip to State College Overwhelming, there is simply no other way of putting the impact that my first "big trip to State College" had on me. The weekend had the potential to be an explosive one, but I had no idea that it would take the turn it did. We began our trip with a stop at Sheetz, picking up all of the necessary goods, such as gas, beef jerky, and cigarettes. One might be thinking, how can one trip to State College be any different than any other. All that college kids do when they go up to State is drink, dance, and throw-up. Well this particular trip involved my roommate Jason, myself and Jason's best friend Nick's ex-girlfriend. This is where the plot thickens. Jason and I sneaked up to State for the day and neglected to mention to Nick that we were going, due to the fact that we were planning to rendezvous with his ex-girlfriend Nicole. When we arrived in State College we met up with Nicole and a couple of her friends. We proceeded to go to her friends dorm and began playing drinking games prior to t he evening of partying. Needless to say after a couple hours of drinking games we were all a little tipsy, so we then sauntered on over to a Fraternity party, where we continued working on our inebriation. After a long night of partying and fraternizing with hundreds of drunk college kids much like ourselves, we headed back to the dorm in which the whole evening started. And just as any after-school special goes, there was one kid who had just a little too much to drink, and he proceeded to put his hand through a plate glass window. "WHAT THE HELL DID YOU JUST DO?!?!?!" were the first words out of every mouth. So Jason, myself, and Nicole decided to vacate the premises and head back to Altoona, which was both a good and bad idea. It was a good idea because the following morning we found out that the dorm room we were in had got busted and each person in the room received a 300 dollar citation for drinking, and their driver licenses were suspended. Although with the good you have to be prepared for the bad, which was

Imposing the Minimum Wages

Minimum wage is the least amount of pay that a person receives for the job that he/she performs. The minimum wage in Massachusetts is $5.50. A job that pay†s minimum wage offers little or no opportunity for improvement. Majority of the people who work for minimum wage are students, people with little education, or immigrants. Fast food restaurants such as Burger King and Mc Donald†s are examples of jobs that pay minimum wage. The minimum wage in Massachusetts is $5.50. A job that pay†s you minimum wage usually offers little or no opportunity for improvement. Such a job offers experience in the fields of, how to make a hamburger, French fries, and chicken crisps. The only true experience you get from this type of a job is dedication. In order to show that you obtained this experience you must stick with the job for some time. People will not hire you because of the experience you have fro making French fries, but they might hire you for showing dedication. It does not come to me as a surprise that the majority of the people who work for minimum wage are either students, people with little education or immigrants. Students work because they need the job, and because they have not yet obtained real experience. People with little education work for minimum wage because that is the only job they can find, in order to have a job that pays more you either need experience or education. Immigrants who come to America may have some education but they can†t find a better job because they do not speak English. Until they learn our language, minimum wage is the only way of supporting them selves. The most common place to find a minimum wage job is a fast food restaurant. Restaurants such as Mc Donald†s and Burger King are famous for it. What made them famous is not the minimum wage but the fact that low skills are required. Since low skills are required anybody can work there. It is easy to find a job in places such as these but a price does come with it. The managers show little sympathy for scheduling. In most restaurants it†s either their way or no way. In conclusion, minimum wage is only good when it is your first or second job. If you want real experience, and better pay go through a temp agency to obtain a job in a company. The work will be hard but the paycheck will be much heavier. Imposing the Minimum Wages Minimum wage is the least amount of pay that a person receives for the job that he/she performs. The minimum wage in Massachusetts is $5.50. A job that pay†s minimum wage offers little or no opportunity for improvement. Majority of the people who work for minimum wage are students, people with little education, or immigrants. Fast food restaurants such as Burger King and Mc Donald†s are examples of jobs that pay minimum wage. The minimum wage in Massachusetts is $5.50. A job that pay†s you minimum wage usually offers little or no opportunity for improvement. Such a job offers experience in the fields of, how to make a hamburger, French fries, and chicken crisps. The only true experience you get from this type of a job is dedication. In order to show that you obtained this experience you must stick with the job for some time. People will not hire you because of the experience you have fro making French fries, but they might hire you for showing dedication. It does not come to me as a surprise that the majority of the people who work for minimum wage are either students, people with little education or immigrants. Students work because they need the job, and because they have not yet obtained real experience. People with little education work for minimum wage because that is the only job they can find, in order to have a job that pays more you either need experience or education. Immigrants who come to America may have some education but they can†t find a better job because they do not speak English. Until they learn our language, minimum wage is the only way of supporting them selves. The most common place to find a minimum wage job is a fast food restaurant. Restaurants such as Mc Donald†s and Burger King are famous for it. What made them famous is not the minimum wage but the fact that low skills are required. Since low skills are required anybody can work there. It is easy to find a job in places such as these but a price does come with it. The managers show little sympathy for scheduling. In most restaurants it†s either their way or no way. In conclusion, minimum wage is only good when it is your first or second job. If you want real experience, and better pay go through a temp agency to obtain a job in a company. The work will be hard but the paycheck will be much heavier.

Dialysis essays

Dialysis essays The topic of this paper is dialysis. Throughout the paper I will discuss the alternative names given for dialysis, reasons on why the test is performed, how the test is performed, how the test will feel, how to prepare for the test, risks that may occur, and lastly, some pictures of a dialysis machine and the instruments used during dialysis. There are several alternative names used for dialysis that include artificial kidneys, AV fistula, AV graft, hemodialysis, and peritoneal dialysis. Dialysis is performed to remove contaminants from the blood that could, and eventually, result in death in the absence of kidney function. The kidneys function as filters for the blood, removing products of amino acid breakdown. More than that, they serve to reclaim and regulate body water, maintain electrolyte balance, and ensure that the blood pH remains between 7.35 and 7.45. Without the function of the kidney, life is not possible (http://content.health.msn.com/content/asset/adam_test_av_graft). Dialysis serves to replace some of the functions of the kidney. Since dialysis is not a constant ongoing process, it cannot serve as a constant monitor as do normal functioning kidneys, but it can eliminate waste products and restore electrolyte and pH levels on an as needed basis (http://content.health.msn.com/content/asset/adam_test_av_graft). The test is performed by a process called homodialysis. Hemodialysis works by circulating the blood through a machine. The blood flows across a semipermeable membrane with solutions that remove toxins. Before hemodialysis can be performed, there needs to be adequate access to the vascular system. The access needs to support a blood flow of 250 ml/minute, and a normal venous peripheral IV will not support that volume of blood flow. A special type of arterial and venous access is therefore established. The access can be either external or internal. External access involves two catheters, one th...

3 Cases of Superfluous Wording

3 Cases of Superfluous Wording 3 Cases of Superfluous Wording 3 Cases of Superfluous Wording By Mark Nichol Certain types of words that may be of no use nevertheless often stealthily make their way into sentences like gate crashers. In conversation, to mix metaphors, they serve as pothole fillers, meaningless placeholders that allow speakers to gather their thoughts and navigate an extemporaneous statement without stumbling before the finish line, but in writing they are expendable. The discussion after each sentence below describes why one or more words in the example do not contribute to the construction of the statement; revisions demonstrate how the sentences stand just as well without the omitted words. 1. More than half of all companies are currently pursuing some form of major information-technology transformation. Currently, which echoes the present-tense verbs it invariably is associated with, is rarely necessary or helpful; retain it only if it clarifies an ambiguous statement (in which case an alternative solution is to revise the statement to eliminate the ambiguity): â€Å"More than half of all companies are pursuing some form of major information-technology transformation.† 2. Management must then determine whether or not the activities for recording, accumulating, and summarizing material information are designed and operating effectively. Some writers don’t realize that the second and third word in â€Å"whether or not† should almost always be omitted. Others know this but automatically write it without noticing or don’t know when it is valid and when it is not. However, a simple test exists- if â€Å"whether or not† can be replaced by â€Å"regardless of whether,† the usage is valid, but if the phrase can be replaced by if, â€Å"or not† is extraneous: â€Å"Management must then determine whether the activities for recording, accumulating, and summarizing material information are designed and operating effectively.† 3. We have managed projects for both healthcare providers as well as medical-device manufacturers. Sometimes the solution is revision rather than omission. For example, in this sentence, â€Å"as well as† is redundant to both, so retain one or the other, but not both: â€Å"We have managed projects for both healthcare providers and medical-device manufacturers† or  Ã¢â‚¬Å"We have managed projects for healthcare providers as well as medical-device manufacturers.† Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Style category, check our popular posts, or choose a related post below:100 Beautiful and Ugly Words10 Types of Transitions48 Writing Prompts for Middle School Kids

Starbucks case study Example | Topics and Well Written Essays - 3000 words

Starbucks - Case Study Example Some grocery stores sell Starbucks branded ice cream and coffee. (Starbucks Corporation, 2007) From where it was established in Seattle, Washington, as only a local coffee bean roaster and seller, Starbucks has rapidly expanded. In the 1990s, the corporation was establishing a new store each workday, a tempo which continued into the 2000s. However domestic expansion has ever since slowed down, although Starbucks continues to spread out in foreign markets, The company's first location out of the U.S. and Canada was launched in 1996, and at present they constitute about one third of Starbucks' total stores. (Starbucks Corporation, 2007) As at November 2007, Starbucks Corporation had 8,505 company-owned coffeehouse outlets global: 6,793 of them located in the United States while 1,712 are located in other countries and the U.S. territories. Besides, the Starbucks has 6,506 joint-venture or licensed outlets, and 3,891 of them are in United States and 2,615 are in some other countries or in U.S. territories. This thus brings the total number of locations (as at November 2007) to 15,011 worldwide. (Starbucks Corporation, 2007) 2003: Starbucks concluded acquiring Seattle's Best Coffee and Torrefazione Italia from the previous owners AFC Enterprises, increasing the total number of Starbucks-operated outlets worldwide to over 6,400. In 2006 September 14, competitor Diedrich Coffee company stated that it would sell many of its company-owned retail outlets to Starbucks company. This sale included the company owned sites of the Oregon-located Coffee People chain. Starbucks company representatives were quoted as saying that they will translate the Diedrich Coffee and Coffee People sites to Starbucks stores. January 2008, Howard Schultz, chairman of Starbucks took up again his position as Chief Executive Officer, substituting Jim Donald, who earlier on in 2000 had succeeded him. Schultz's main challenge is to re-establish what he calls the "distinctive Starbucks experience" in the moment of high expansion. Industry observers believe that Schultz have to determine the manner in which to contend with soaring materials prices and increased rivalry from lower-price competitors, which includes McDonald's and Dunkin' Donuts. (Findingdulcinea, 2008) On 31 January, 2008, Schultz stated that Starbucks Company would suspend its warm food items, originally planned to launch countrywide in 2008, so as to refocus the brand on coffee. 1. Evaluation of HRM Each employee requires more learning in order to improve his /her skills, no matter how best a candidate is, he/she can not be 100% percent qualified. Thus, the human resource management should implement learning management system (Beardwell & Holden, 1997) Starbucks Corporation has understood this aspect and that is why it recognizes that its employees are one of their highly valuable resources. The very first guiding rule in their mission statement also addresses the Company's principle towards its employees: "Provide a great work environment and treat each other with respect and dignity". The management recognizes that the Starbucks employees play a foremost function in the expansion of the company. (Hoovers.com, 2007) Starbucks Corporation training can be termed as systematic enhancement of knowledge, skills and attitudes of the needed by an employee in order to perform a given task. Development is the growth of an employee in terms of capability, understanding and

The old Canadian Land Essay Example | Topics and Well Written Essays - 500 words

The old Canadian Land - Essay Example However, there are no reasons to believe that he could be a bad man looking for trouble. It was because he did not bother people along his constant travel expeditions. He travelled by water. His travel machine was a canoe that he used to tour all the waters of the rivers and seas that he came across. No water body was too scarify to make him stop a journey. The people believed that he was a brave man, who would look out for anyone in harm. Everyone in the lands knew him as a man without fear. Thus, many respected him as he was a hero amongst them all. From his appearance, it was difficult to know much about him. He carried with him everything from all the places he went to. Physically, he dressed as an Indian. One could argue that he had Indian traits in him. Apart from the manner of dressing, his character had much do with the Indian lifestyle. Indians were just as courageous men as he was. They were known to be the most troublesome people to deal with during trade. They would settle every slight issue with a fight. In fact, they were ready to die. The same characteristics could be evident in Pasquinel. It was in his nature to walk into a dangerous place without thinking. He was ready for any attack. In fact, he always fought his wars alone. Apart from being a brave man, he was a good negotiator. Negotiation is a skill important when dealing with strangers, who need to be convinced on one intended purpose. As a trader, negotiation skills were important to convince new traders on certain items. Even without speaking the language of the traders, Pasquinel could convince them on his intended purpose and avoid unnecessary confrontation. The story of Pasquinel could be real or a fiction one. The reality of the story could be because of the use of known physical places. For example, the narrator uses known water bodies and ancient places such as France and New Orleans. In addition, the trading activities outlined in the story represent the lifestyle of the