Executive Summary Memo Assignment Example | Topics and Well Written Essays - 500 words

Executive Summary Memo - Assignment Example We also hope to become the most desired tourist destination both for the domestic and international tourists. In future, we plan to relocate to the central business development which we believe will provide us with an advantageous place. The tax incentives will give money to establish another business (Tracy, 2000). We are aggressively planning to increase the sales in the second year by about 55%. By creating a new bakery, Olympia Bakery will increase its sales volume by at least $240,000 over the next three years while maintaining the gross margin of 77%. Through the philosophy of â€Å"all is possible† regarding the products and services, Olympia Bakery will establish itself as an exceptional dessert supplier in the larger Michigan. We will gain a competitive advantage in take out. The summary outlines the concept philosophy and financial forecasted financials. Olympia Bakery is a hospitality company that is dedicated to providing high quality products in free and fair atmosphere for the clients within and without the city. Our intention is to make profit and return to our investors to continue financing our company. We strive to maintain friendly and fair relationships (Pinson, 2004). In addition we maintain creative work environment with respect to culture diversity, ideas and handwork of the members This information is necessary for the customer and the potential financier to our bakery. This information informs the customer of the company stand and is potential in the future. It can be found online at

Job stress to job performance Essay Example for Free

Job stress to job performance Essay The thesis selected for my critique which is called â€Å"A Study on Job Stress to Job Performance: Counseling as a Moderator† was written by Tseng, Yu-man in 2013. The thesis was done by a partial fulfillment of the requirements for the Degree of Master of Human Resource Management. It can be discovered on the Electronic Thesis Harvestable and Extensible System of National Sun Yat-Sen University. In this article, the overview of the thesis will be simply described followed by the critique on the research design and data analysis. A terse paragraph on the overall impressions will also be comprised with possible suggestions made in the conclusion part. Overview of the research thesis: In the thesis, the author intended to understand the relationship between job stress and job performance. According to the relationship, she explored â€Å"Is consultant a moderator between job stress and job performance. † She also examined â€Å"Is the personal demographic information as an obvious difference between job stress and job performance. † Quantitative method was applied and data was collected from the questionnaire survey. Furthermore, the thesis used some statistic method in this research, such as conducting the poll through questionnaires, factor analysis, descriptive statistic, T test, ANOVA, correlation analysis, regression analysis. However, unfortunately, there is no information to demonstrate if the consultant as a moderator between job stress and job performance. The author suggested backward researcher can apply ink to paper or depth interview more when doing questionnaire design. The results indicated that: 1. Job stress and job performance have statistically negative relationship. 2. There is no answer about if the consultant as a moderator between job stress and job performance. No one has the experience of seeking the consultant in the retrieved questionnaire materials. Therefore, it is unable to learn if the consultant as a moderator between job stress and job performance. 3. Marriage has an influential effect in the relationship between job stress and job performance. Other personal demographic information, such as gender, age, schooling record, seniority and current position within company, do not have significant difference in the relationship between job stress and job performance. Critique of the research design: (a) Problem statement/ introduction part: The introduction part consists of the pressures among our daily life and how it affects us to become stressful that threaten our lives. This is because there are differences between pressures and stresses. Pressures come from external, but stresses generate from internal. The author states particularly and precisely the causal relationships of pressures and stresses. First, she brought out a concept that suicide is a serious philosophic problem. It leads out another concept that â€Å"Should we struggle to survive? † Then, she used lots of instances for demonstration. Lastly, she said there will be less ill effects if we have moderate ways to relax when we have pressures and stresses. The author seems to have missed out specifying what the right behaviors are for releasing our pressures and stresses. This is noteworthy to tell the readers that some people relax in bad behaviors such as smoking which can produce a more aggravated problem than pressures and stresses. (b) Literature review of the study: In the literature review section of this thesis, the content is discussed systematically in the following arrangement: stress; job stress; job performance; the relationship between job stress and job performance; and consultative. The literatures represented exhaustive and related to the themes of study. The literature reviews have a few strengths that help the readers understand the contents easily. The contents described deeply with different types of diagrams appropriately. For example, it mentioned the scholars have lots of views in different years, it shows there are frequent changes in the definitions of the terms each year. Moreover, it used descriptive statistic to analyze the factors precisely. However, there are some improvements needed in the areas. It seems to be a little bit unbalanced in defining all the terms. Here are some suggestions for improvement. First, it depicted a lot in each factor of stress, job stress and job performance. The thesis is mainly focused on the relationship between job stress and job performance, but the literature reviews depicted the relationship in a very simple manner. There should be more information with instances to analyze the relationship. Therefore, the reliability of the investigation will be increased and the persuasiveness will also be enhanced. (c) Methodology of the study: The research was to investigate the practical states of the variables among the research subjects. The research subjects are the employees of manufacturing and service industry. Therefore, the author used a questionnaires method to handle the research. Firstly, she constructed the research frameworks. Secondly, she set up the research assumptions after the research frameworks. She also confirms the operational definitions and ponders what should be used as the instrument. In the first phrase, the research frameworks set up a framework of the relation between job stress and job performance, also with the other factor of counseling. Then, the research assumptions set up two assumptions as the relativity assumption and diverseness assumption. For the relativity assumption, the author assumed that there is an obvious correlation and consultant as a moderator has an influential effect in the relationship between job stress and job performance. For the diverseness assumption, the author assumed that sex, age, marriage, level of education, years of service and current duty have variant effect in the relationship between job stress and job performance. In the second phrase, the research design has used factor analysis, correlation analysis and regression analysis in operational definition, job stress measurement table and job performance measurement table among job stress, job performance and counseling. For job stress, the author used Strees’s theory (1988) which believes a person will have job stress when facing some threats from job. Also, she used the measurement table with 32 questions in 5-point likert scale: always, often, sometimes, seldom and never, published by Institute of Occupational Safety and Health in Council of Labor Affairs in 1995 to measure. For job performance, the author used Campbell’s theory (1987) which believes that job performance related to the process when a person who has the willingness to help the organization to accomplish the goals. Moreover, she used the measurement table with 24 questions in 5-point likert scale: very agree, agree, no opinion, disagree and very disagree, adopted from Yu Dak Shing’s translation with minor amendments that published by Motowidlo Van Scotter (1994) Task Performance Questionnaire the Task Performance Questionnaire (TPQ) and contextual performance questionnaire (Contextual Performance Questionnaire, CPQ) to measure. For counseling, the author defined it in a psychological perspective that a person will use the personal information to understand himself or herself and make improvements in adapting to the new environments. In addition, she used a revised measurement table with reference to Taiwan Tobacco Liquor Corporation. However, it is a doubt whether the research design can obtain the results clearly and reliably. This is because the measurement tables do not show an obvious correlation between job stress and job performance. This will make up some errors. Moreover, the author does not mention the amounts of research subjects. To increase the reliability and preciseness, the author should mention the amounts of research subjects and its responsiveness. Also, she should find more references for making the measurement table in an obvious relationship. (d) Discussion and Conclusion of the Study: In the discussion section, results were interpreted and possible explanations were given. The significance of the investigations is very low because the sample size is restricted. This has been substantiated by the researcher’s discussion that most of the factors (job stress and job performance) do not consist of any correlation with counseling. The researcher should ameliorate the methodology especially sampling. The conclusion was highly dwelt as the researcher defined it into 6 parts of different data. However, most of them did not show any correlation with each other. Therefore, the researcher’s efforts were useless. Conclusion: Overall, this research study gives us a good view on the current situation of the extent on â€Å"Job Stress to Job Performance: Counseling as a Moderator† in Taiwan. It provides extended review on both international and local literatures. The data and analysis were represented in a systematic and intelligible way so that readers can effortlessly comprehend. However, the collected data involved a broad range of different factors for examining the effects in the relationship. It should be expressed more clearly in some definitions. Otherwise, the meaning of the sentence may sometimes confuse people‘s understanding. Reference: Tseng, Yu-man (2009). A Study on Job Stress to Job Performance:Counseling as a Moderator. Taiwan: National Sun Yat-sen University, Retrieved April 1, 2013, from eThesys: http://etd. lib. nsysu. edu. tw/ETD-db/ETD-search-c/view_etd? URN=etd-1103109-054940 Cooper, C. L. , Sloan, S. J. S. Williams, (1988). Occupational stress indicator management guide, Windsor, NFER-Nelson. Brian Seaward, Job stress

Grapefruit Interactions with Drugs

Grapefruit Interactions with Drugs What is Grapefruit? Grapefruit, a relative newcomer to citrus clan, has a fascinating history. It is a large orange berry with a thick rind. It is the belief of the most botanists that grapefruit is a naturally occurring accidental hybrid between pomelo and orange. It is believed that, although its appearance is very much different from an ordinary grape, the name ‘grapefruit’ was used because they grow in clusters, and these clusters may seem as large yellow grapes. The original belief was that, the grape fruit is a kind of a pomelo. (1) But in 1837, James Macfayden, separated grapefruit from pomelo, in his Flora of Jamaica, giving it a botanical name, Citrus paradisi. After its hybrid nature was genetically identified, the botanical name was altered to Citrus X paradisi. (1) Nutritional value Grapefruit, like most of the other citrus fruits, is a great source of vitamin C, which helps the immune system. It is advantageous for the fight against, from simple cold to, asthma, rheumatoid fever, osteoarthritis, cancer, heart disease and stroke. (2) Lycopene, which gives grapefruit its red and pink colors, is a carotenoid phytonutrient, with high anti-tumor ability. Also lycopene has the highest capacity among the common dietary carotenoids to fight free radicals. (2) According to the availability of the content of phenolic compounds in the grapefruit juice, it is ranked among the highest in food products of antioxidant activity. (2) Limonoids, another phytonutrient in grapefruit, promotes the formation of glutathione-S-transferase, thus minimizing the tumor formation. Pectins, a form of soluble fiber in grapefruit is useful against the progression of atherosclerosis. (2) Also, the grapefruit juice increases urinary pH value and citric acid excretion, and significantly reduces the formation of calcium oxalate stones, thus minimizing kidney stone formation. (2) Naringenin, a flavonoid concentrated in grapefruit, helps to repair damaged DNA, especially in human prostate cancer cells. 8-oxoguanine-DNA glycosylase and DNA polymerase beta, enzymes are induced by Naringenin, which are useful in DNA base excision repair pathway. (2) Although the nutritional value of grapefruit is highly commended and proved, around a decade ago, scientists found that the availability of oral drugs can be severely reduced by grapefruit food products, especially grapefruit juice. The cytochrome P-450 3A4 system, in the intestine, which is facilitates the first pass metabolism in many drugs, can be inhibited by grapefruit. Also in the brush border of intestinal wall, there are P-glycoprotein pumps. They transport many of the substances used by cytochrome P-450 3A4. This system is also inhibited by grapefruit. Inhibition of both these systems can be dangerous. Because of these, knowledge and awareness of these interactions is massively important. These interactions can lead to severe effects and these interactions can occur very commonly as most of the times, both the drugs and grapefruit food products are used together at breakfast. (3) Mechanism of interaction Cytochrome 3A4 is a member of cytochrome P-450 enzyme system. In the endoplasmic reticulum of cells all over the body, it can be found. It is a heme-containing large multigene family. As oxidative bio-transformation of different exogenous and endogenous substances occurs in liver and intestinal wall, cytochrome P-450 is abundant in those places. In the apical brush border of enterocytes, P-glycoprotein can be found. It is a membrane transporter and a member of adenosine triphosphate binding cassette (ABC). Once lipophilic drug is taken into the enterocytes, it is pumped back into the lumen by P-glycoprotein or metabolized by cytochrome P-450 3A4. These actions limit the oral delivery of many drugs. With the intake of grapefruit juice, cytochrome P-450 system is inhibited, thus pre-systemic metabolism of drug is decreased and bioavailability of the drug increase. (4) Grapefruit juice causes massive reduction in translation of these enzymes from its m-RNA. However the transcription of m-RNA from DNA is not affected. Grapefruit also promotes the deterioration of these enzymes. These actions together, massively decline the cytochrome P-450 activity in a quick and irreversible manner. A decline of 47% of total levels of cytochrome P-450 3A4 levels can be seen within the four hours of grapefruit juice ingestion. With this decrease, increased bioavailability of the drug can be maintained for about a day. Even after that, for some time, 30% of its effect is still there. (5-7) Some studies indicate that effect on grapefruit juice on cytochrome p-450 3A4 system and P-glycoprotein system are controversial. Means grapefruit juice can activate the P-glycoprotein pumps in vitro in a way (9). This could result in massive efflux of drugs back into the lumen. This is believed to be the cause for diminished bioavailability of some particular substrates, or sometimes this can neutralize the effect of reduced cytochrome P-450 3A4 activity due to ingestion of grapefruit juice. However Digoxin, a prototypical P-glycoprotein substrate, is found as one of the substrates in P-glycoprotein pump, which is not affected by grapefruit juice (8, 10). By both inhibition of function and, down-regulation, grapefruit juice inhibits the function of P-glycoprotein pumps. Example: increased bioavailability of cyclosporine with the grapefruit juice. This is believed to be a result of P-glycoprotein inhibition, other than cytochrome P-450 3A4, since the increase of bioavailability, produced by reduced enterocyte cytochrome P-450 3A4 concentrations, are tend to differ than the obtained results (8). MRP2 (multi-drug resistant protein 2) an associated P-glycoprotein efflux protein, has also shown its inhibition of action, with the ingestion of grapefruit juice (11). In spite of all the acquired knowledge, researchers still further investigate the grapefruit and drug interactions. In vivo effect of grapefruit juice on P-glycoprotein is an area believed to be needed to investigate further more. OATPs or organic anion-transporting polypeptides also said to be potently inhibited by grapefruit juice. In the small intestine, they are involved in the process of apical to basal transport of drugs (8, 10, and 12). The knowledge and conclusions obtained with the studies carried out in vitro cytochrome P-450 3A4 inhibition by grapefruit, the likelihood of these interactions happening in a natural way (the ingestion of grapefruit food products) can be predicted. It is also believed that the reported ethnic differences and the activity of the cytochrome P-450 3A4 could be because of the dietary differences, such as consumption of grapefruit. All in all, because of the potential of grapefruit and grapefruit related food items to interact with drugs, intake of grapefruit should be carefully monitored, in order to maintain necessary drug concentrations within the body of a patient, within the therapeutic windows. Phytochemistry Another aspect that the researchers are still thoroughly studying on is knowledge about active constituents in grapefruit juice in the molecular level, which can interfere and act on P-glycoprotein pumps and cytochrome P-450 systems. Although these studies are not extensively studied or completely proven, they indicate various molecules that take part in the drug interaction process. Flavonoid glycosides such as naringin, naringinin, hesperidin, neohespiridin, narirutin, quercetin, and didymin are some of substances responsible. Also, sesquiterpen and furanocoumarins (such as 6,7-dihydroxybergamottin) are also responsible (3, 14-16). Naringin is the most abundant flavonoid contained in the grapefruit juice. Also the flavonoids in the grapefruit exist as glycosides. After ingestion, the actions of intestinal flora convert these to sugars and aglycones. These compounds can inhibit the cytochrome P-450 enzymes. Theoretically, it is believed that electron rich polyphenolic nature of these compounds is responsible for that. Most studies show the in vitro effect of these compounds on cytochrome P-450 enzyme system. But in vivo, researchers have not yet completely proven or identified their effects on cytochrome enzyme system (17). Naringinin, which is a metabolite of naringin, has a higher activity in vitro, although naringin has no visible effect. This leads to a complication and some suspicion among researchers that flavonoids may not be the main active substance in grapefruit, which is responsible for the whole drug interaction dilemma. Even though with all these debates, due to very high concentration of these compounds in grapefruit juice and the fact naringin is present only in grapefruit among the fruits in citrus clan, quest for flavonoids still continues. Recent researchers are mostly focusing on furanocoumarins. Main furanocoumarins are bergomottin and its derivative 6,7-dihydroxybergomottin(DHB)(18). Debates still going on about the extent of effect these compounds on interaction mechanism certain studies have shown that DHB and, to an average amount bergamottin are vital contributors of grapefruit-drug interaction process (18, 19). In one particular study, furanocoumarins, DHB and four others, mixed and tested. The inhibitory potency on cytochrome enzyme systems declinedeven when any one of these compounds taken out from the mixture, not just DHB. That created a complication. There are even studies supporting that perhaps DHB and bergomattin may not be the primary compounds in the inhibition process (20). With all these facts this idea also still in the process of intense research and suspicion. Drug-Grapefruit interactions Amiodarone and anti-hypertensive drugs 1,4-dihydropyridine calcium antagonists are used mostly for patients with angina pectoris and also for patients with essential hypertension. They are lipid soluble drugs, metabolized by cytochrome P-450 3A4 in vivo, and grapefruit juice can affect its bioavailability. Intensive study and research began with the effects of grapefruit juice with felodipine, another calcium channel blocker and an anti-hypertensive drug. It was found that when grapefruit juice is ingested, oral bioavailability of these drugs can increase by 112% (21). Furthermore it demonstrates that intra-venous pharmacokinetics of felodipine remains without a significant change with the grapefruit juice ingestion (21). Also the interaction frequency gradually increases with the increased grapefruit juice ingestion. Because of these reasons, it is recommended that interval of 2-3 days between administration of felodipine and ingestion of grapefruit juice. The elderly specially should be warned about this situation. Amioderone is used for cardiac arrhythmias. It is converted into N-desethylamioderone by cytochrome P-450 3A4. With the ingestion and interaction with grapefruit juice, N-desethyl amioderone production inhibits almost completely, with an overall decline in side effects produced by amiodarone (8). Furthermore benzothiazepine calcium channel antagonist diltiazem, nisoldipine, verapamil, ACE inhibitors like enalapril and aptopril also said to have effect with grapefruit juice interaction. Benzodiazepines and CNS drugs Midazolam is a drug of benzodiazepine class used for acute seizures for inducing sedation and in insomnia. Certain studies have proven that grapefruit juice has a great effect on first-pass metabolism, which reduces the metabolism efficiency badly and increase its bioavailability (22). Clinical importance is that especially for the patients with cirrhosis of the liver, intestine metabolism of cytochrome P-450 3A4 is vital. So the ingestion of grapefruit juice has to be avoided. Another use of midazolam is in pediatric dentistry. Oral midazolam is very commonly used for this. There have been incidents that because of the bitter taste acquired with the administration of oral midazolam, patients tend to take sweetened food items, sometimes grapefruit. If grapefruit was taken in after administration of oral midazolam, blood plasma midazolam levels can increase and patient may tend to have exaggerated seduction time. Triazolamand clozapine are some other drugs that can also affect. Antimicrobials Indinavir is commonly used to treat HIV in highly active antiretroviral therapy. It is a protease inhibitor. There are reports showing that ingestion of grapefruit juice can delay indinavir absorption with the increase of gastric pH, but it does not affect systemic bioavailability (23). It is believed, because primary metabolism may not take place in the intestine. Saquinavir is also another drug used for patients with HIV. It is also a protease inhibitor. It is shown that the ingestion of grapefruit juice can increase the bioavailability of saquinavir (24). Although it increased the bioavailability, the clearance of the drug won’t change. This could be an indication that inhibition of cytochrome P-450 3A4 is affected. Theoretically, because of the dose dependent nature of the saquinavir, it is possible that effectiveness can increase with the inhibition of cytochrome P-450 3A4. Artemether an anti-malarial drug, also shown its increasing oral bioavailability, when grapefruit juice is ingested. But its time dependent reduction of bioavailability does not affect by grapefruit (25). This could indicate the importance of cytochrome P-450 3A4 in the pre-systemic metabolism. Quinine, a natural drug used in broad range of aspects, seemed to be does not affected by grapefruit juice. It is because it is primarily metabolized in the liver. (Where inhibition of cytochrome P-450 3A4 with grapefruit mainly effect on the gut)(8) Its low clearance is also helpful for this. Furthermore in antibiotics, clarithromycin, show increased time for reach for its peak concentration, but pharmacokinetics seemed to be unaffected (26). While abendazole, an anti-parasitic, shows an increased bioavailability with the ingestion of grapefruit juice (27). Chemotherapeutics Cyclosporine is a widely used immunosuppressant drugs, used in organ transplants. Studies have shown that cyclosporine and its metabolites both show rapid increase in their concentrations in plasma, when grapefruit juice was administered (28). Anti-histamines and serotonin analogues Cisapride is a drug that increases the motility of the upper GI tract. It is a serotonin receptor agonist. Studies have shown that cisapride systemic bioavailability gradually increases with the administration of grapefruit juice (29), because of the inhibition of cytochrome P-450 3A4. Therefore it’s advisable, that the patients who are taking cisapride, especially with a risk of cardiac arrhythmias, should avoid drinking grapefruit juice. Terfenadine, anti-histamine, also show increased system bioavailability when grapefruit juice is taken in (30). This also play an important role, because in an electrocardiogram, increased systemic levels of terfenadine can prolong the QT interval. Statins and cholesterol-lowering drugs Simvastatin, a cholesterol lowering drug, also shown increased serum concentrations when grapefruit juice is taken (31). Also its active metabolite simvastatin acid levels and HMG-CoA reductase inhibitors also increase. Active metabolites of the grapefruit juice, Bergamottin and Naringenin are said to be responsible for this. It is also carried out from the inhibition of cytochrome P-450 3A4 and thus limiting the first pass metabolism in small intestine. Lovastatin, another cholesterol reducing drug said to have same effects as simvastatin, when the grapefruit juice is administered. Serum concentrations of lovastatin and its active metabolite lovastatin acid seem to be elevated. By the same mechanism, prevention of first pass metabolism in the small intestine by inhibiting cytochrome P-450 3A4. Conclusion Because of the vast difference of effects given by grapefruit-drug interactions, and its effects on pharmacokinetics, physicians should be vigilant about the whole procedure. And also warn their patients about the possible consequences which can happen in a drug-grapefruit interaction. Patient-to-patient variability, mostly the age of the patient, should be thoroughly remembered. And the elderly should be warned especially as they are more prone to the grapefruit-drug interactions (8). Also the knowledge about these interactions can be used for the advantage of the physician. Example: to lower the dosage. Still, because all these are mostly in a research level and safe procedures should always be followed as patients safety is the top priority.

Impact of Stroke Case Study

Impact of Stroke Case Study Introduction Jithra is now 68 years of age. Her family consists of husband, daughter, nephew and nephews wife. She has been living with left side hemiplegia caused by stroke since she was 64. As this interview went, Jithra was holding her daughters hand and slowly elaborated her word by word experience in tears. Before an episode of stroke damaged the right side of her brain and put her in bed for the rest of her life, Jithra was living a life of a healthy person. She stated that poverty and debt were the most important factors that motivated her to wake up at 4:30 am on regular basis in order to prepare food and beverage for her respective customers who kindly supported her small restaurant. A strong belief that she did not have any health issue strengthened by the fact that an annual physical check-up was so expensive disguised Jithra from realising how essential it was to have her blood pressure and blood glucose level regularly monitored when she aged. As now that she spends her activities of daily living in bed, pressure sore has become the main concern for both Jithra and her family. Though Jithra does not complain of soreness, redness on skin does indicate that some areas need attention. This essay will provide an overview understanding of stroke and its negative effects posed on Jithra. Furthermore, this essay will emphasise on the intervention and prevention of pressure ulcer in depth. Understand Stroke According to World Health Organization (2014), stroke occurs when there is an interruption of the blood supply to a part of the brain. Stroke can be divided into two major types. The first type is called haemorrhagic stroke. This type of stroke accounts for approximately 13 percent of all strokes (Brown Edward, 2012). It results from bleeding into the brain tissue. The bleeding caused by a rupture of blood vessels results in the leakage of blood into the brain impairing the delivery of oxygen and nutrients. Haemorrhagic stroke can be caused by a number of disorders affecting the blood vessels. Some of which are long-standing high blood pressure and cerebral aneurysms, a thin or weak spot on a blood vessel wall. The weak spots that cause aneurysms are usually present at birth. The development of aneurysms happens over a number of years and don’t usually cause detectable problems until they break (Stroke Foundation, 2014). Jithra’s daughter stated that Jithra complained of headache and nausea approximately 48 hours, especially during periods of activity, before an episode of stroke occurred. Headache particularly distinguishes haemorrhagic stroke from ischaemic stroke. Its other symptoms also include nausea, vomiting, decreased level of consciousness, neurological deficits and hypertension (Brown Edward, 2012). The second type is called ischaemic stroke. It accounts for approximately 85 percent of all strokes. According to Brown and Edward (2012), this type of stroke occurs as the result of partial or complete obstruction, caused by a blood clot, of a blood vessel that supplies blood to the brain. This leads to an insufficient of oxygen supply and glucose needed for cellular metabolism. A clot may be formed by means of embolism or thrombosis. Both types of clotting formations can be differentiated by their characteristics. The term embolism in relation to stroke is characterised by a condition where an embolus is created in one part of the brain or the body, circulates in the bloodstream, and eventually blocks the flow of blood through a vessel in another part of the brain (Crosta, 2009). This is called embolic stroke. On the other hand, the term thrombosis is characterised by the formation of a clot resulted from fatty deposits or plaque blocking the passage of blood through the artery. Th is type of clot remains in one area of blood vessels without being carried throughout the bloodstream. This is called thrombotic stroke (Brown Edward, 2012). Stroke risk factors There are multiple risk factors associating with stroke as according with (Brown Edward, 2012). The risk factors can be classified into non-modifiable risk factors and modifiable risk factors. Non-modifiable risk factors include age, gender, race and heredity. Modifiable risk factors include diabetes mellitus, heart disease, atrial fibrillation, heavy alcohol consumption, hypercoagulability, hyperlipidaemia, hypertension, obesity, physical inactivity, sickle cell disease and smoking. Jithra, at 68, was diagnosed with hypertension or high blood pressure and diabetes mellitus. Age, hypertension and diabetes mellitus have played a key role in contribution to stroke. ‘Stroke risk increases with age, doubling each decade after age 55 (Brown Edward, 2012, p. 1622).’ The rate of atherosclerotic development is usually increased by the stress of a constantly elevated blood pressure. The term atherosclerosis is referred to as hardening of the arteries resulting from the formation of fatty deposits or plaques. The narrowing of the blood vessels is its consequence. The carotid artery in the neck is a common site where these plaques develop and tend to break away and lodge in the vessels of the brain (Sander, 2013). Likewise, diabetes mellitus increases tendency towards the dysfunction of the inner linings of the blood vessel walls leading to an increase in the tendency towards the development of plaques. In addition, high cholesterol and triglyceride levels are highly likely among people with diabetes mellitus (Brown Edward, 2012, p. 863). Impact of Stroke According to Brown and Edward (2012), stroke is a leading cause of serious, long-term disability. Jithra has been living with left side paralysis since she was 64 as a consequence of stroke. Immobility and the weakness in Jithra’s right arm and leg are the key limitations. She relies greatly on her family members when repositioning in bed is attempted and a combination of self-care abilities and activities of daily living, such as eating or drinking, are performed. Dysarthria, a disturbance in the muscular control of speech, is also experienced. Impairment may involve pronunciation, articulation and phonation. This helps explaining why Jithra feels uncomfortable communicating with strangers. As the interview went, a sudden change in emotion was spotted. Persons who have had a stroke may have difficulty controlling their emotions. Emotional responses may be exaggerated or unpredictable (Brown Edward, 2012, p. 1628).The daughter said that Jithra sometimes cried without any reas on. The interchanging between laughing and crying took only minutes to do so. Besides pressure, shearing force, friction and excessive moisture contribute to pressure ulcer formation (Maklebust Sieggreen, 2001). As mentioned above that Jithra is bed-bound and greatly relies on her family members when repositioning is attempted, manual handling is used in order to lift and move her around the bed. However, the incorrect techniques combined with non-supportive equipment, such as sliding sheet, have put the maintenance of Jithra’s skin integrity becomes much more difficult. Pressure Ulcer According to Sydney South West (2008, p. 4), pressure ulcers are defined as â€Å"any lesion caused by unrelieved pressure when soft tissue is compressed between a bony prominence and an external surface for a prolonged period.† Factors that influence the development of pressure ulcers include the intensity of the pressure; the length of time the pressure is exerted on the skin; and the ability of the tissue to tolerate the externally applied pressure. Intrinsic factors that put Jithra at risk in developing pressure ulcers consist of advanced age, malnutrition and diabetes mellitus. Extrinsic factors include pressure, shear and moisture Sydney South West (2008). Intervention Although the skin remains intact, the appearance of persistent redness, particularly in sacrum, followed by itchy sensation indicates that stage one pressure ulcer has already developed. Stage one pressure ulcer can be intervened as referred to pressure ulcer intervention guidelines (Jones, 2013) by strictly maintaining the skin integrity. This can be done by relieving the externally applied pressure, protecting fragile skin and bony prominence, preventing friction and shearing and protecting skin from moisture. In relieving the externally applied pressure, a regime of repositioning combined with the use of pressure relieving devices has already been utilised by Jithra’s daughter. However, it might not be enough in terms of the frequency. The frequency of repositioning depends on the ability of the tissue to tolerate the externally applied pressure. In this case, Jithra should move or be repositioned frequently enough in allowing reddened area of affected skin to recover from the effects of pressure. A turn clock may be a helpful reminder of correct body positions and appropriate turning times. Additionally, a 30-degree side lying position may well be utilised for Jithra as it diverts pressure from the sacrum. Maintaining a 30-degree side lying position can simply be done by using pillow or foam positioning wedges. However, lying on the side may increase pressure on extremities, especially knees and ankles. Placing pillows between the legs helps preventing opposing knees and ankles fr om exerting pressure on one another (Maklebust Sieggreen, 2001). In protecting fragile skin and bony prominence, an appropriate support surfaces shall be used and yet its cost has to be taken into consideration. Poverty and debt make it very difficult for Jithra to afford buying or renting them. ‘Charges can range from $24 to purchase a foam overlay to a daily rental fee of $125 for a highly technical therapy bed (Maklebust Sieggreen, 2001, p. 75).’ Regardless of the variations in price, There is no scientific evidence that one support surface consistently works better than any others. Nevertheless, pressure points require protection whether at risk persons are in a bed or on a chair. Using pillows to bridge vulnerable areas, again simple, is an effective way to eliminate pressure. A regime of repositioning, together with the use of pillows has proved to be highly effective in protecting fragile skin and bony prominence. In preventing Jithra from friction and shearing, a family education on how friction and shearing occur and correct usage of manual handling techniques and appropriate equipment shall be provided. Shear is greatest when a caregiver drags an at risk person along the surface of the sheets during repositioning or allows the person to slide from high-fowler’s position. In order to minimise shearing force, the head of the bed shall not be raised exceeding a 30 degree angle, unless the patient is eating. Furthermore, friction, a precursor of shear, is commonly caused by pulling a patient across the bed linen. Rubbing the protective layer of skin away increases the potential for deeper tissue damage. Excessive moisture may be the result of sweating, wound drainage, soaking during bathing and faecal and urinary incontinence. Moist skin is five times as likely to become ulcerated as dry skin. The intervention guidelines suggested that protecting skin from moisture can be done by using continence management systems, using barrier skin cream to prevent skin maceration and keeping the site clean and dry. Living in a hot and humid country like Thailand may put Jithra at a higher risk of developing pressure ulcer due to sweating. Thailand normally has its temperature sitting at around 30 degree Celsius. Two fans, together with the application of baby powder are used in maintaining the dryness of Jithra’s skin. Recommendation According to Jones (2013), it is highly recommended that risk assessments must be done on Jithra by using the Waterlow scale. In doing so, her body mass index is required. The scale will give a score which helps identifying if Jithra is at risk, high risk or very high risk in developing pressure ulcers. Therefore, repositioning regime can be precisely arranged in order to ensure optimum pressure redistribution. Manual handling, together with the use of equipment such as hoists or slide sheets, effectively helps avoiding shear and friction. Education on the use of the mentioned equipment shall also be provided. A dietician shall be involved in discussing knowledge of healthy diet and considering the need for food fortification and nutritional supplements. Make sure that Jithra consumes adequate fibre and well hydrated as she is more prone to constipation due to immobility. Conclusion This can be concluded that the maintenance of skin integrity plays a key role in avoiding the development of pressure ulcers. Being rich or poor might not be the factors in treating and preventing pressure ulcers. This essay has shown how beneficial it is to have carers or family members who strictly put pressure ulcer intervention and prevention guidelines into practice to look after Jithra. The mattress that Jithra lays her body on might not be the best that the family can afford but frequently turning and maintaining dry skin have proved in lowering the risk of developing pressure ulcers. Only stage one pressure ulcer developed though, Jithra has been suffering from disability for 4 years. References Brown, D., Edwards, H. (Eds.). (2012). Lewiss medical-surgical nursing: assessment and management of clinical problems. NSW, Australia: Elsevier Australia. Crosta, P. (2009). What Is Embolism? What Are The Different Types Of Embolism?. Medical News Today. Retrieved from http://www.medicalnewstoday.com/articles/153704.php Jones, D. (2013). Pressure ulcer prevention in the community setting. Nursing Standard, 28 (3) 47-55. Retrieved from http://web.a.ebscohost.com.ezproxy.holmesglen.vic.edu.au/ehost/pdfviewer/pdfviewer?vid=3sid=87c6951d-c6be-44c5-8985-c35d1918eb04%40sessionmgr4004hid=4207 Maklebust, J., Sieggreen, M. (2001). Pressure Ulcers: Guidelines for Prevention and Management (3rd ed.). Pennsylvania, USA: Springhouse Corporation. ONeill, P. A. (2002). Caring for the Older Adult: A Health Promotion Perspective. Pennsylvania, USA: W.B. Saunders Company. Sander, R. (2013). Prevention and treatment of acute ischaemic stroke. Nursing Older People, 25(8), 34-39. Scott, K., Webb, M., Sorrentino, S., Gorek, B. (Eds.). (2006). Long-term care assisting: Aged care and disability. NSW, Australia: Elsevier Australia. Stroke Foundation. (2014). Types of Stroke. Retrieve from http://strokefoundation.com.au/what-is-a-stroke/types-of-stroke/ Sydney South West Area Health Service. (2007). Pressure Ulcer Prevention and Management. Retrieved fromhttp://www.sswahs.nsw.gov.au/pdf/policy/pd2008008.pdf Watkins, C., Leathley, M. (2010). Setting the scene. In Williams, J., Perry, L., Watkins C. (Eds.), Acute Stroke Nursing (pp.1-16). Retrieved fromhttp://0-onlinelibrary.wiley.com.alpha2.latrobe.edu.au/store/10.1002/9781444318838.ch1/asset/ch1.pdf?v=1t=ht43cw4ls=1791526b00be208b196d718b1c2189904267ad40 World Health Organization. (2014). Stroke, Cerebrovascular Accident. Retrieved from http://www.who.int/topics/cerebrovascular_accident/en/

Pied Beauty Essay example -- Poetry

The poem "Pied Beauty" begins by praising God for all the colorful and diverse things in nature. The speaker is thankful for everything with dots, circles, different colors, etc. He seems to be fond of nature and "the great outdoors." Many of the images in the poem made me think of camping out, or a picnic. For example, fresh fire-coal, chestnut falls, finches, skies of two colors, cows, etc. But the poem does not only speak of natures’ diversity. It also makes reference to manmade things. For example, man’s trades, tackle, and trim are also varied. The landscape plotted and pieced. The poem goes on to thank God for more things. Everything that is different, everything that is changing, everything that has dots, etc. At the end of the poem, the speaker says, "He fathers-forth whose beauty is past change." I had trouble with this line, because I did not know what the speaker meant by this. But after researching, and asking around, I came to the conclusion that it means that God, who creates change, is unchanging himself. While the beauty of the earth lies in its change, and it’s diversity†¦ the beauty of God is unchanging and timeless. So there is a bit of irony at the end. This poem seems to have no setting. However, it uses a lot of images that made me think of being outdoors, camping, on a picnic, or looking up at the sky. The poem also has a joyful tone. It also has a little religious insight. It is almost li...

Children of the Abbey by Roche Essay -- Regina Maria Roche Gothic Genr

The Children of the Abbey as a Hybrid Text Regina Maria Roche’s 1796 The Children of the Abbey is a text that crosses the boundaries of genre: it at once engages with the conventions of the Gothic novel, the pedagogical text, the national tale, the novel of Sensibility, and travel literature. As an Irish-born British woman writing this novel during the politically volatile 1790s, Roche’s historical and temporal location may provide an explanation for her development of this hybrid novel. In its employment of multiple and potentially contradictory genres, The Children of the Abbey may be interpreted as Roche’s reflection of and engagement with the instability of her time. In order to more effectively understand the political and social implications of Roche’s work, it is necessary to disentangle the various literary strands within the novel, identify how each genre functions, and consider the possible reasons why it has been woven into the text. What is Genre? From Literature as Discourse: Textual Strategies in English and History: Genre thus refers to systems of classifications of types of texts. Genre classifications are part of a broader social system of classifications, not all of which use the term 'genre', but which have the same essential characteristics and functions. Genres (or types of texts) are classified in terms of both the semiosic dimension (primarily conditions of production and reception, matching kinds of author and writing to kinds of reader and readings) and the mimetic dimension (primarily what topics, themes or meanings will be included and what will be excluded, and their modality, i.e. how they are understood to relate to the real world). Sometimes the mimetic dimension is emphasized in a definition... ...plicated by â€Å"its actual [inclination] towards emotion that exceeded utility† (89). As Regina Maria Roche’s novel may arguably be connected to both the genre of the pedagogical text as well as to the novel of sensibility, tension may arise in the text as the two potentially-conflicting genres are both engaged with. Hybrid novels, therefore, may provide both clarification as well as confusion in the interpretation they encourage of their readers. Works Cited: Hodge, Robert. Literature as Discourse: Textual Strategies in English and History. Cambridge: Polity Press, 1990. Manning, Susan. "Sensibility." The Cambridge Companion to English Literature, 1740-1830. Eds. Thomas Keymer and Jon Mee. Cambridge: Cambridge University Press, 2004. Moynahan, Julian. Anglo-Irish: The Literary Imagination in a Hyphenated Culture. Princeton, NJ: Princeton University Press, 1995.

Greek Education v.s Roman Education Essay -- essays research papers f

Similarities and Differences: Ancient Greece vs. Ancient Rome   Ã‚  Ã‚  Ã‚  Ã‚  Many qualities of the Ancient Roman civilization were undoubtedly borrowed from their predecessors of the Greek culture (Bonner 1). Roman education, however, is only a reflection of the Greek education system. Ancient Roman education tactics differ from the education methods used by Ancient Greek instruction. Nevertheless, these two different approaches contain many similarities. Although the Romans made an effort to reproduce the style of education maintained by the Greeks, their attempts failed; however Rome managed to adopt many principles of Greek education in the process. This is made apparent by comparing and contrasting Greek and Roman education methods as well as the explanation of the worldly problems and expectations each culture was facing during this era. It was not until Rome conquered the small Greek society, Tarentum, in 272 B.C. that they could see the importance of being intellectuals (Dobson 92). This contact with Greek culture allowed Romans to employ the Greek values of education that could be observed within this small culture (Dobson 92).   Ã‚  Ã‚  Ã‚  Ã‚  Prior to the creation of state maintained schools and academies in Greece, higher education was mainly reserved for the elite persons of a community (Handbook: Greece 253). Training for these citizens consisted of instruction in the areas of music, poetry, numeracy, and religious ritual (Handbook: Greece 253). Unlike the Greeks, Roman education was practically nonexistent before the development of official school systems in the Roman culture (Dobson 91). By law, early Roman education required that the father be the only schoolmaster of his son (Dobson 94). The mother would teach children basic principles until age seven (Avi-Yonah 176). Afterward, the father was in charge of the upbringing of his child (Avi-Yonah 176). Aside from teaching basic reading, writing, and arithmetic, the primary subject of instruction consisted almost entirely of battle tactics and farming procedures (Avi-Yonah 176). Ancient Greece developed the idea of school systems around mid seventh century B.C., one century after writing was introduced (Handbook: Greece 253), however, it was not until the Hellenistic age that these schools were founded or maintained by the city (Devambez 404). Before the Hell... ...p;  The basic techniques of study for these two cultures were fundamentally similar. i.  Ã‚  Ã‚  Ã‚  Ã‚  Roman children were often split into age groups for teaching, just as the Greeks had done during Hellenistic times. ii.  Ã‚  Ã‚  Ã‚  Ã‚  Music also played a role in Roman curriculum, although it was not as highly esteemed as in the Greek schools. V.  Ã‚  Ã‚  Ã‚  Ã‚  Continued education was significantly dissimilar in Greece than in Rome. A.  Ã‚  Ã‚  Ã‚  Ã‚  Most Romans that wished to continue their education were sent to Greek academies for further study, or would hire a specialist. B.  Ã‚  Ã‚  Ã‚  Ã‚  Greek academies were prevalent during Roman existence. i.  Ã‚  Ã‚  Ã‚  Ã‚  Plato’s Academy was one of the well- known Greek academies that existed sometime around 387 B.C. ii.  Ã‚  Ã‚  Ã‚  Ã‚  Aristotle’s Lyceum was another research establichment that was founded after Plato’s Academy and taught using different principles than most. VI.  Ã‚  Ã‚  Ã‚  Ã‚  Although many Romans intended to Hellenize Roman education, the attempts were failed.   Ã‚  Ã‚  Ã‚  Ã‚