Clinical Trial On Piriformis Anaesthetic Health And Social Care Essay

The purpose of this clinical test is to compare the patients of pure piriformis syndrome treated with local anesthetic alone or a combination of local anesthetic and methylprednisolone. Thirty-one patients diagnosed with piriformis syndrome who received a fluoroscopy guided piriformis musculus injection. There were no signii ¬?cant differences in average baseline VAS scores between the two groups of the survey. There were a signii ¬?cant differences between average baseline and average VAS tonss obtained during telephone interview for both groups.Pain VAS had improved by a agencies of 5.13 and 6.06 compared to the baseline degree in the local anesthetic and steroid groups, severally. It was concluded that no extra benefit from utilizing corticoid was identified after piriformis musculus injection and both bupivacaine entirely and in combination with methylprednisolone have a important consequence in alleviating chronic hurting of pure piriformis syndrome. Piriformis syndrome is an uncommon and frequently underdiagnosed cause of hurting in the cheek part and referred hurting in the lower dorsum and leg. Intolerance to sitting, dyspareunia in females, and sciatica are some of the common symptoms attributed to this syndrome. It is the true diagnosing in 6 % to 8 % of patients with back hurting and sciatica. Mechanism normally accepted is an inflamed or spastic piriformis musculus that compresses the sciatic nervus against the bony pelvic girdle. Trauma, hypertrophy and anatomic fluctuations of musculus and sciatic nervus, infections, myositis ossificans are common cause of piriformis syndrome. Priformis syndrome may be treated by curative stretch, massage, ultrasound, use and non steroidal antiinflammatory drugs. Caudal steroid injection, injection of piriformis musculus with local anesthetics and steroids or botulinus toxins, and surgical resection of the musculus have been reported as effectual intervention options. Injections may be performed blindly, with musculus electromyography, fluoroscopy, ultrasound, or with computed tomographic or MRI counsel. Nerve stimulators may besides be used to place the sciatic nervus. Local anesthetics interrupt the pain-spasm rhythm and resounding nociceptor transmittal, whereas corticoids have anti-inflammatory belongingss related to suppression of prostaglandin synthesis, decreases in regional degrees of inflammatory go-betweens and by doing a reversible local anesthetic consequence. Eventhough their antiinflammatory belongingss corticoids have been hypothesized to be of benei ¬?t for nervus root infiltration. The emerging grounds besides implies that the durable curative consequence may be obtained with local anesthetics with or without steroids. Tachihara et Al. illustrated that no extra benefit from utilizing corticoid was identified after nervus root infiltration. Therefore, it is suggested that corticoids may be unneeded for nervus root blocks. There are besides inauspicious reactions in response to the disposal of man-made corticoids such as dermatologic conditions, osteonecrosis, peptic ulcer formation, weight addition, hyperglycaemia, Cushing ‘s syndrome and psychiatric symptoms changing from mild temper alterations to wholly developed psychosis. In the present survey, the purpose was to measure the patients of pure piriformis syndrome treated with local anesthetic alone or a combination of local anesthetic and methylprednisolone.MethodsThis survey conducted on retrospective rating of 31 patients diagnosed with piriformis syndrome, at the University of Inonu, School of Medicine, Departments of Physical Medicine and Rehabilitation and Pain Clinic, Malatya, Turkey between 2007 to 2009, who received a fluoroscopy guided piriformis musculus injection. All the patients were given elaborate information on the process and informed written consent was obtained from all of them. The present survey was approved by Local Ethics Committee. Piriformis syndrome was diagnosed from the followers: clinical history, physical scrutiny, EMG findings and by excepting other pathological conditions of the lumbar, sacral, sacroiliac and hep joint countries by physical scrutiny and magnetic resonance imagination or computed imaging if needed. Piriformis syndrome was suggested by hurting on tactual exploration of the sciatic notch and reproduction of hurting with manoeuvres that stretch or contract the piriformis musculus over the sciatic nervus such as forceful internal rotary motion of extended thigh ( Freiberg ‘s Maneuver ) and active hip flexure, abduction or adduction and internal rotary motion by the patient lying with the painful side up, the painful leg flexed and articulatio genus resting on the tabular array ( Beatty ‘s manoeuvre ) . All patients were examined by a individual hurting specializer and non referred by any other doctor. Exclusion standards included patients known allergic reactions to local anesthe tic and bleeding diathesis. Piriformis injections were carried out by a individual hurting specializer. The patients were placed prone on a fluoroscopy tabular array. In a unfertile manner, the cheek country on the affected side was widely prepped and draped. AP position of the hemi-pelvis and cotyloid part was obtained and so a metal marker is placed on 1/3 of sidelong facet of fanciful line between the greater trochanter and sacrum. Local infiltration with 0.5 % prilocaine was used for local anesthesia. Two milliliter of radiographic contrast stuff ( iohexol ) was injected to obtain a satisfactory myogram ( Figure 1 ) . A syringe was prepared with 10 milliliters of 0.5 % bupivacaine in local anesthetic group or 9 milliliter of 0.5 % bupivacaine + 40 milligram methylprednisolone ( 10 milliliters entire ) in steroid group and injected into the piriformis musculus after negative aspiration for blood. Following the process patients should observe alleviation of their usual hurting. All patients were responded good to a individual injection. The patients that were stubborn to local anesthetic and/or steroid medicine were non considered as a exclusive piriformis syndrome and non included to the survey. After the process, the patients were transferred to the recovery room for 1 hr and until any leg numbness subsides. If hurting persisted a 2nd injection was carried out with same manner. The primary result parametric quantity of the survey was hurting assessed by VAS, analgetic usage, hurting on motion and patient satisfaction. Follow-up scrutinies were conducted by telephone interview 6 months after local injection. Analysiss were performed utilizing SPSS 16.0 version ( SPSS Inc. , Chicago, IL ) . The Kolmogorov-Smirnov trial was used to find whether the informations deviated from the normal distribution. Nonparametric informations were evaluated with the Mann-Whitney U trial. Proportions were compared utilizing the Chi-square trial. P & A ; lt ; 0.05 was considered as important.ConsequencesMedical records of 68 patients with piriformis syndrome were evaluated. Thirty-one patients fuli ¬?lled the inclusion standards. The patient ‘s features including age, sex, weight, tallness, involved side and history of hurting until injection were comparable between groups ( Table 1 ) . No signii ¬?cant differences were noted sing first diagnosing before acknowledging hurting clinic, and conventional used intervention ( Table 2 ) . Three patient from local anesthetic group and two patients from steroid group needed to reiterate injection ( Table 2 ) . The injections for these 5 patients were repeated in a twosome of yearss. The other patients did non hold a repetition injection. There were no important differences between average baseline VAS scores between the two groups of the survey. There were important differences between average baseline and average VAS tonss obtained during telephone interview for both groups ( P & A ; lt ; 0.041 ) . Pain VAS had improved by a agencies of 5.1 and 6.1 compared to the baseline degree in the local anesthetic and steroid groups, severally. Adverse effects were seen by 27 % of the steroid and 6 % of the placebo patients. These included sleepiness in 2 steroid group patients, and 1 local anesthetic group patient, hypotension lasted in two yearss in 1 and temper alterations in 1 steroid group patients. There were no other inauspicious effects such as fluctuations of glucose degree, gastro-intestinal hemorrhage, osteonecrosis, infection, or demand of extra medical intervention attributed to the investigational medicines.DiscussionPiriformis syndrome is non to the full understood clinical syndrome and typically characterized by stray sciatic hurting limited to the cheek with radiation down the thigh, without centripetal shortages or neurogenic cause. Robinson described six diagnostic characteristics of piriformis syndrome which were: ( I ) a history of injury to the sacroiliac and gluteal parts ; ( II ) hurting in the part of the sacroiliac articulation, greater sciatic notch, and piriformis musculus that normally extends d own the limb and causes trouble with walking ; ( III ) acute aggravation of hurting caused by crouching or raising ; ( IV ) a tangible allantoid mass, stamp to tactual exploration, over the piriformis musculus on the affected side ; ( V ) a positive Las & A ; egrave ; gue mark ; and ( VI ) gluteal wasting, depending on the continuance of the status. There is no dependable nonsubjective trial to place the piriformis musculus syndrome and this is leads in many instances to great seeking for the beginning of the intractable sciatica among the lumbar pathologies. Many writers have considered injury in the gluteal country as the major cause of piriformis syndrome. Jawish et Al. believed that piriformis syndrome could be related to exacerbated rotators activity as it was observed in patients with difficult physical activity, Walkers, sports and football player or with insistent injury of nervus in patients with drawn-out sitting place. Regardless of the physiopathologic beginning of the c omplex upset, physical scrutiny and imaging surveies should be combined to corroborate the diagnosing. As, piriformis syndrome is a diagnosing of exclusion, although the patients had radicular symptoms were exluded from the survey, other imagination or correlativity to except were more common causes of sciatic hurting, such as lumbar phonograph record herniation, posterior aspect syndromes or spinal stricture, had been obtained from our included patients. The intervention end is directed ab initio toward diminishing ini ¬Ã¢â‚¬Å¡ammation, associated hurting, and cramp as hurting originates due to the entrapment of the nervus root or to one of its subdivisions, taking to the development of myofascial trigger point. This hurting may besides be due to energy crisis produced from a loss of O and alimentary supply in the presence of an increased metabolic demand. This leads to the release of neuroactive biochemicals that sensitize nearby nervousnesss that in bend initiate the motor and sensory of myofascial trigger point via the cardinal nervous system ensuing in mechanical hypersensitivity. Injection of the 10 milliliter local anesthetic into the abdomen of the musculus as we used in our survey may rinse up such biochemicals. This injection may ensue in musculus relaxation and release of the entrapped nervus. To our cognition, our survey is the i ¬?rst clinical test comparing the effectivity of local anesthetic and methylprednisolone added to the local anesthetic. Naja et Al. compared bupivacaine ( 9 mL 0.5 % bupivacaine in a entire volume of 10 milliliter ) and bupivacaine plus clonidine ( 9 mL 0.5 % bupivacaine and 1 milliliter 150 milligram Catapres ) in a randomised double-blind test included 80 patients with piriformis syndrome who received a nervus stimulator guided piriformis injection. The average VAS tonss obtained after 6 months follow up were 4.5, 3.5 and 3.3 on walking, sitting and lying down, severally. Better consequences with Catapres had been obtained. Benzon et Al. retrospectively reviewed the charts of 19 patients who had received piriformis musculus injections and described a technique for piriformis injection. After 80-100 milligram methyl Pediapred or Aristocort injection to the schiatic nervus and piriformis musculus, 18 of the 19 patients responded to the injectio n, with betterments runing from a few hours to 3 months. The three patients with pure piriformis syndrome had 70-90 % response to piriformis injection for 1-3 months. In Fishman et al.5 survey all participants received an injection of 1.5 milliliter of 2 % Lidocaine and 0.5 milliliter ( 20 milligram ) of Aristocort and improved an norm of 71.1 % , proposing the efi ¬?cacy of corticoid and lidocaine injection combined with physical therapy in handling piriformis syndrome. Filler et Al. reported 162 patients with pure piriformis syndrome given 10 milliliter of bupivacaine and 1 milliliter of celestone: 14.9 % had sustained hurting alleviation runing from 8 months to 6 old ages without return, 7.5 % had 2 to 4 months of alleviation but required a 2nd injection, 36.6 % had 2 to 4 months of alleviation but experienced return after a 2nd injection, 25.4 % of these patients benefited for merely 2 hebdomads, and 15.7 % received no benefit. The consequence of this retrospective survey pointed out that both bupivacaine entirely and in combination with methylprednisolone have a important consequence in alleviating chronic hurting of pure piriformis syndrome and it was concluded that no extra benefit from utilizing corticoid was identified after piriformis musculus injection. Competing involvement: No external support and no viing involvements declared

Terrorism And Human Rights Abuses

Terrorism and Human Rights Abuses in the Balkans, Eastern Europe and the Persian Gulf The Balkans, despite being a relatively small area, is home to an expansive assortment of nationalities, cultures and religions (Popescu, 2008). Hence, it is inevitable that any changes in the balance between them will have important political, social and economic consequences that will affect the entire region (Popescu, 2008). Terrorist groups took advantage of the instability brought about by the distrust of Balkan societies in their respective governments (Popescu, 2008).As a result, they easily turned the region into a breeding ground for extremist and fundamentalist groups, as well as a â€Å"transit corridor† for missions in third countries (Popescu, 2008). The war in Bosnia-Herzegovina in the 1990s, for instance, originated from the desire of the Bosniaks (Bosnian Muslims) to establish an Islamic state (Popescu, 2008). They used Islam as a â€Å"nationalistic rhetoric,† equating the survival of their country with the restoration of Muslim national identity (Popescu, 2008).The Bosniaks were supported by Islamic countries such as Saudi Arabia, Afghanistan, Kuwait, Libya and Iran, providing them with weapons and soldiers (Popescu, 2008). From 1992 to 1995, 6,000 â€Å"Arab-Afghan† rebels came to the country to fight in the hostility (Popescu, 2008). After 9/11, majority of the charitable institutions in Bosnia-Herzegovina were investigated and closed down due to their alleged ties with terrorist organizations like the Al-Qaeda (Popescu, 2008). In March 2002, police raided the BosanskaIdealna Futura-BIF, a Sarajevo-based humanitarian organization (Popescu, 2008). They found military manuals, forged passports, weapons and personal correspondence between Osama bin Laden and BIF founder Enaam Mahmud Arnaout (Popescu, 2008). Human rights abuses by Persian Gulf nations (Saudi Arabia, Iraq, UAE, Kuwait, etc. ) and terrorist attacks against US interests were b oth intended to supress political opposition. Despite publicly denouncing â€Å"American imperialism,† the aforementioned countries are notorious for grossly violating the human rights of their citizens (Simbulan, 2002).Majority of political prisoners in the Persian gulf nations were detained for speaking out against corruption and totalitarianism in their respective countries (Simbulan, 2002). Prominent Omani playwright and human rights activist Abdullah Ryami was imprisoned on July 2005 for vocally criticizing the Omani government's arrest and trial of 31 Omanis belonging to the Ibadi sect for allegedly plotting a coup (Human Rights Watch, 2005). At the time of his incarceration, he had no contact with his family or a legal counsel (Human Rights Watch, 2005).He was also banned from writing in newspapers and producing plays for television (Human Rights Watch, 2005). On December 2007, activists in Bahrain staged a series of demonstrations to â€Å"mark abuses by security for ces during political unrest in the 1990s† (Human Rights Watch, 2008). Dozens of people were arrested in the violent dispersals that ensued, including opposition political activists who protested the Bahraini government's repression of civil liberties (Human Rights Watch, 2008). In January 2008, detainees complained of being subjected to physical and sexual abuse by interrogators and jailers (Human Rights Watch, 2008).The prisoners' request for independent physicians to examine the extent of their injuries was also denied (Human Rights Watch, 2008). The collapse of the Soviet Union contributed to terrorist activities in Eastern Europe by making its newly-formed republics more vulnerable to American military intervention (Howstuffworks, 2008). After the Soviet bloc fell, the US emerged as the world's remaining superpower (Howstuffworks, 2008). The breakup of the Soviet Union granted the US easy access to its natural resources, particularly oil (Howstuffworks, 2008). The paragrap h below summarized the region's potential:Afghanistan occupies the central position in the U. S. strategy for the economic control of the oil and gas resources in the entire Middle East. The U. S. currently imports 51 per cent of its crude oil – 19. 5 million barrels daily. The Energy Information Administration estimates that by 2020, the U. S. will import 64 per cent of its crude – 25. 8 million barrels a day. Caspian region oil reserves might be the third largest in the world (after Western Siberia and the Persian Gulf) and, within the next 15 to 20 years, may be large enough to offset Persian Gulf oil.Caspian Sea oil and gas are not the only hydrocarbon deposits in the region. Turkmenistan's Karakum Desert holds the world's third largest gas reserves – three trillion cubic meters – and has six billion barrels of estimated oil reserves. Current estimates indicate that, in addition to huge gas deposits, the Caspian basin may hold as much as 200 billion b arrels of oil – 33 times the estimated holdings of Alaska's North Slope and a current value of $4 trillion. It is enough to meet the U. S. ‘ energy needs for 30 years or more (Yechury, 2001).Hence, it was no longer surprising if the US declared war against the Taliban regime of Afghanistan. But majority of the extremist and terrorist groups in the former Soviet Bloc and in Eastern Europe are allied with the Taliban, as the Taliban provided them with weapons, training and manpower (Godoy, 2001). Therefore, the US will have to face a bigger threat of terrorism in Eastern Europe. References __________. (2002, October). The Oil Equation in the US Bid against Iraq. Education for Development, 1, 15-16. Capdevila, G. (2002, October).Outgoing UN Human Rights Chief Repeats Criticisms against US. Education for Development, 1, 30-31. Deen, T. (2002, October). UN Credibility at Stake over Iraq, Warn Diplomats. Education for Development, 1, 10-11. Godoy, J. (2001, November 15). US P olicy Towards Taliban Influenced by Oil – Authors. Retrieved February 28, 2008 from http://www. commondreams. org/headlines01/1115-06. htm. Howstuffworks. (2008). The Fall of the Soviet Union and the Rise of Terrorism. Retrieved February 28, 2008 from http://history. howstuffworks. com/cold-war/the-cold-war-timeline4.htm. Human Rights Watch. (2005, July 18). Oman: Critics Subjected to Injustices They Had Exposed. Retrieved February 28, 2008 from http://hrw. org/english/docs/2005/07/18/oman11343. htm. Human Rights Watch. (2008, January 21). Bahrain: Investigate Alleged Torture of Activists. Retrieved February 28, 2008 from http://hrw. org/english/docs/2008/01/21/bahrai17838. htm. Human Rights Watch. (2008, February 16). Bahrain: New Allegations of Detainee Abuse. Retrieved February 28, 2008 from http://hrw. org/english/docs/2008/02/16/bahrai18083.htm. Lobe, J. (2002, October). US Vision of Might and Right. Education for Development, 1, 3-5. Popescu, Teodora. (2008). Tackling T errorism in the Balkans. PDF File. Retrieved February 28, 2008 from sparky. harvard. edu/kokkalis/GSW9/Popescu_paper. pdf. Simbulan, R. (2002, October). Why the UN Must Defend Iraq against the US War of Aggression. Education for Development, 1, 48-50. Yechury, Sitram. (2001). America, Oil and Afghanistan. Retrieved February 28, 2008 from http://www. hinduonnet. com/2001/10/13/stories/05132524. htm.

Argentina Economy Research Paper Example | Topics and Well Written Essays - 1250 words

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Relationships Essay Example | Topics and Well Written Essays - 1000 words

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Introduction Essay Example | Topics and Well Written Essays - 500 words

Introduction - Essay Example This research is an effort to see how Primark has been able to apply its HR policies towards satisfying its customers and motivating the workforce. The main intention of the study is to develop an understanding of the concepts of Human Resources Management in general and how the established theories and principles are applied to a particular organization. During the study an effort will be made to observe the general working at Primark store in Manchester to seek answers to the following key objectives. Prerequisite to a decent work culture is about respecting individuals and treating everyone, customers and colleagues, with dignity. How Primark has been able to adopt a balancing approach towards motivating the workforce. Undertaking a research implies that one must be aware about the subject, and able to apply the knowledge gained in practical working environment. This research is also being undertaken with the vision that it helps in carving out an effective and efficient HR professional having thorough understanding of the ways employees can be motivated to give optimum performances. To come out with a quality research on the subject and get a feel of the competitive environment in retail industry, get to know about the HR policies of Primark in particular and how its employees feel a

Why is Zara a pioneer in affordable design clothing Research Paper

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Educational effectiveness - International Comparison Essay

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The Interactional View of Paul Watzlawick Essay

The Interactional View of Paul Watzlawick - Essay Example The children and the mother as well expressed their embarrassment of the father’s condition (content) and communicated this through the way they avoided being associated with him in public. As punctuation dictates, communication depends on whether the person is in a reactive or provocative position (one who starts the conversation) (GÃ ®fu and Teodorescu 50).In this context, the father was mostly in the reactive end. He reacted to his family’s behavior by ceasing to associate with them in public. The communication is not symmetrical.It was one-up communication (GÃ ®fu and Teodorescu 49. The other members of his family assumed a higher role in the exchanges as depicted in the case of the mother shutting down his opinion regarding the education of their youngest son. Reframing in the family comes about when the family decides to visit the counselor. The members of the family decide to get rid of the destructive rules that had guided their previous relationship. This mea nt understanding that the father deserves respect, love and equal chance in the relationship.The film features a family wracked by alcoholism. Alice Green portrays the character of a school counselor who harbors a serious drinking problem and is married to Michael, who is an airline, pilot. Though she is a loving and light-hearted woman, she is often drunk and reckless causing her to ignore her children. The whole movie can be used to illustrate the interactional theory as different scenes illustrate different elements.

Religious Identity Essay Example | Topics and Well Written Essays - 2250 words

Religious Identity - Essay Example Religious identity thus refers to â€Å"a people’s ways of relating to their religion, including their association with a certain religious community, the strength of their belief in the preferred religion, and their ways of demonstrating those beliefs in their day to day lives.† It can be equated to membership to a religious grouping or community, this being regardless of the person’s religious activity or participation. It may be referred to as a specific type of Identity formation focusing mainly on group membership and the importance of the membership as pertaining to self-conception of the individual. Similar to either cultural or ethnic identities, the religious context provides generally a perception from which to view the world, a set of principles of guiding one’s lifestyle and the myriad of opportunities available of socialization with different people, generational differences regarded. As a whole, religious identity is affected by factors such as a person’s gender, generational status and ethnicity.... Religion is intricately intertwined with various aspects in the socio-cultural arena, that the above three factors are always present in the shaping of an individual’s religious identity. Ethnic differences; according to the Social Identity Theory, emerge when individuals of ethnic minority groups feel threatened in terms of identity, thus reasons for their emphasis on their social identities as a means of maintaining positive self-conception. Gender differences may impact on one’s religious identity; this being exemplified through the characteristic participation of the female gender in religious activities and in their expression of religion as being an important aspect of their lives, this being in relation to their male counterparts (Bryan Chosley Shepherd; The University of Texas at Austin. Sociology 32). Generational differences, categorized as either being first, second and third, where the first and second-generation individuals may have higher levels of religio us identity as compared to their third generation counterparts. Immigrants, in efforts of readjustments to the often-stressful changes associated with immigration, highly seek an environment provided by a place of worship that encompasses a community of emotional, financial and social support. Focus is placed on the stages of Adolescence and early Adulthood since adolescence is a developmental period that is crucial to an individual’s identity development. At this stage, there are various opportunities for the exploration of the ethnic, cultural and religious traditions present in the individual’s society, but within constraints erected by their parents or guardians. Influences can be both internal and external; depending on extent/exposure of socialization

Illegal Leisure and its Implications Essay Example for Free

Illegal Leisure and its Implications Essay Leisure plays a very important role in the life of an individual. However, when an individual gets involved in leisure activities that are illegal, whatever the reason, it becomes counterproductive. Illegal leisure is rightly so for reasons that could take dimensions of the nature of health, social or religious inclinations. Nevertheless, the utter disregard of the illegality of the entire illegalized leisure activities would have far reaching negative ramification than is perceived. There are vast forms of illegal leisure activities. However, the legality and the illegality of the leisure are adequately defined under the rules of the concerned agency (Bull, C. , Hoose, J. and Weed, M. 2003, p 39). There are some illegal practices that are more ethically prescribed as illegal than are documented in any legal documents. Despite lack of documentation, some leisure activities are utterly illegalized by the conscience of the person undertaking them. Though there are countries and states that have legalized prostitution such as Netherlands, the practice predisposes the individual various risks. To begin with, the word prostitution in itself presents societal misfit. Individuals who are perceived or who are involved in the practice tend to be delineated from the society (Harris, D. 2005 p 69). They are treated with utter disrespect, disregard and the least integrity by society. Though the prostitutes take it as their daily chore, those who come in for the services ideally take it as leisure. In addition the prostitutes, be they male or female get predisposed to infection of sexually transmitted diseases; particularly when preventive measures are not taken. Besides, particularly where those involve have one of them who is married, risks the marriage of those involved in a number of perspectives. First, if the partner does realize, he/she may opt for a divorce, subsequently this may jeopardize the family unit. Besides, the services offered by prostitutes are utterly delinked from the public limelight. This makes these services relatively expensive (Bull, C et al 2003 p 112). This affects the family income in instances where those involved include a married individual. Further, the entire cycle becomes even more vicious, hence making the family suffer at the expense of the prostitutes. If the whole practice is viewed from a religious perspective, whether it is Islamic, Christian or Buddhists, the practice is utterly unreligious. Homosexuality is also taken as an illegal practice. According to the research HIV/Aids was first diagnosed amongst homosexuals (Harris, D. 2005 p 101). Like in cases of prostitution, there are numerous sexually transmitted diseases that are infected through homosexual practices. Furthermore the entire practice is quite unhygienic. While this is taken more often as a pleasurable activity, it needs to be appreciated that there is the least pleasure in the entire act. The aforementioned not withstanding, the practice finds the least grounding in religious cycles. There are certain people in society that revere smoking of bhang and marijuana. Ideally, they see this as a leisure act. World over, this practice has been pronounced illegal, yet people want to hide and engage in the practice. Medically, this practice causes diverse effects. First, the individuals who smoke for longer periods have higher tendencies for bronchitis. Bhang smokers have their lungs blackened, this affects the respiratory system. For male user of bhang, research has shown a high redundancy in their likelihood of having children. Apparently, the testosterone hormones are depressed in the blood of the user’s of bhang. This ordinarily inhibits the reproductive function of the addict. Ideally there is a decrease in the sperm motility of the bhang user besides the sperm count being lower. Cell functions are equally impeded through the use of cannabis sativa. It is medically proven that the long users of cannabis sativa tend to have numerous broken chromosomes hence leading to malformed offspring. In addition, there are serious implication on the part of the users as the there is inherent suppression of the immune response of the individual. This is as a result of the interference with genes that normally regulate the defense cells. Further, individuals who use marijuana suffer from hallucinations and illusions. Mostly, they have difficulties in recalling events; they are slow in thinking and have a narrow attention span. At chronic stages, the individually usually suffer from mental and physical lethargy. At the very extreme, there are changes in the brain of the user, research does indicate that young heavy user have their brain size reduced. Though the illegal activities seem very pleasurable, this very first perception of their pleasurability makes their probable control even more challenging. Evidently, the practice has far reaching ramifications on the individuals that are into the entire practice. But then how well can the practice be expunged from society, particularly when it purely done in secret (Harris, D. 2005 p 64). This challenge pecks numerous issues at hand. There are several cases where prostitution is done in private premises, implying there is the least room for accessing the premises in seeking redress. It is virtually impossible to identify a homosexual amongst a group of individuals. This presents a technical part for curbing the practice (Bull, C et al 2003 p 161). Besides, a further interrogation into the likely suspects simply implies infringement into the rights of the individual. Ideally, I feel the illegal leisure activities should be made legal, thereafter; the activities should have numerous suctions in the form of taxes to scare off possible users. While, there could be those who have all the requisite resources for the practice, ultimately the number of those engaging in the activities will be substantially reduced.

Management as the cornerstone of organisational effectiveness

Management as the cornerstone of organisational effectiveness This assignment is mainly focuses on the assessing of the statement of Management is the cornerstone of organisational effectiveness, and the integrating activity that permeates every aspect of the operations of the organisation. To make the background for this assessment it was first studied most important factors that are likely to determine the successful performance of work organisations. In achieving that first it was focused to understand the concept of organizational effectiveness and various approaches for organizational effectiveness and through that study identify the factors. And then the consideration was given to study the main obstacles to effective organisational performance and how to overcome those. Finally attempt was taken to assess the validity of the statement of Management is the cornerstone of organisational effectiveness, and the integrating activity that permeates every aspect of the operations of the organisation, considering with the changing nature of modern work organisations. Important Factors of Effective Organizational Performance What is Organizational Effectiveness Here before assessing the factors of effective organizational performance the consideration was given to understand the concept of organizational effectiveness. According to the view of Jonathan Knee the organizational effectiveness may depend on most essential three key elements. *People Here the people means staff of the organization *Culture A combination of Style, Skills and Shared Values of the organization *Impact This mainly includes the factors like profitability and financial sustainability, not only that but also the value shaped for any stakeholders. It can be shown by the following graph. In this article author say that these elements together have to manage because they are tightly inter-related nature. People create a culture that shapes them in turn. Future generation self-selects into an existing culture that meets their needs. And secondly people implement the organizations plans, and the culture supports and increases. And thirdly this inter-relation is so important because the organizations ability to achieve its goals affects its ability to attract and retain effective people and to sustain a high performance culture. (Info abstracted from: The article of Organizational Effectiveness by Jonathan Knee, 2008) Early studies state the organizational effectiveness is general rests on evolving suitable methods of selection, training, placement, in various steps of the organization. (Info abstracted from: The book of Organizational Behaviour by Indian Institute of Management and Technology, 1997) And also another view of Organizational effectiveness is that OE is always concerned with the unique capabilities that organizations develop to assure that success (Info Abstracted from: The book of The Changing Definition of Organizational Effectiveness, Human Resource Planning, Vol. 27.1. by McCann, Joseph. 2004) Most modern views of the organizational effectiveness say this has to be look in a way of system approach. Accordingly many HR practitioners try to look at the HR process and identify it in system approach. Accordingly they say that by looking at it in system approach organizations can achieve organizational effectiveness. (Info Abstracted from: The book of Measuring Organizational Effectiveness, Canadian Management Centre. 2005) Accordingly we can identify early HR notions have identifies this concept as Only HR function including recruitment, selection, Training and development. With reference to the literature review the identification can be done as that organizational effectiveness is not only depending on the Human Resource of the organization but also it is a integration of both people and the system of the organization. Factors of Effective Organizational Performance Here to identify the factors which effects to the effective organizational performances can be identified as using several case studies. Case Study Alpha Company This is a case study which was done by the Canadian Management centre to identify the effective organizational performance. The main theoretical model that they have use d here is that the system approach. Alpha Test Company is a European Owned small manufacturing company of office furniture. They have three major competitors in the market. Their major three strategic imperatives are as follows. (1) A clearly defined and defensible niche (2) A highly customer-focused culture (3) A lean and efficient manufacturing operation When achieving the strategic initiatives first the company has run in a lost way. The company could not decide whether it wanted to be an industry niche leader or follower and operations managements focus turned inward and away from acceptance of the customer. The most important thing for the driven of the strategic direction is that the intellectual support for that, but in Alpha organization there was more or less act as careful technicians instead of passionate supporters of quality and service. According to the new strategic inputs the manufacturing facility became highly controlled, with job responsibilities narrowly defined, performance measures relatively unclear. The organization became more rigid and inflexible, with employees focused on them, moving at a purposeful speed and indifferent in changing. So as a result of these initiatives the organization became more incapable of doing much more than being a fine place to work. These familiars resulted for this test by the Canadian Management Institute. The test was began by collecting data band sophisticated data analysis, and researching on efforts at creating high-touch customer focus and created a gap between the beliefs of the employees and the companys expectations for performance At the end of the research it was identified several factors to improve the organizational effectiveness through several strategic initiatives as follows. *First one is that as company should be continuously realigned in order to avoid from fluctuations. *In these alignments organizations should maintain their own unique alignment *Thirdly consider on technology in order to see the complexity of the world and competitors and with the predictions be ready to understand and manage the complexity *Then strategic initiatives should be taken to align the people to support the new strategic direction, HR will come in to action in this point. (Info Abstracted from: The book of Measuring Organizational Effectiveness, Canadian Management Centre. 2005) Case Study Competitive Advantage To obtain the effective organizational performance many companies use the sustainable competitive advantages by bringing into line their talent and business strategies. Most of the organizations use the methods like mergers or acquisitions, restructurings or shifts in business strategy can bring many functional effectiveness. Accordingly this article describes that many organizations of their studies brings value to their clients organizations by facilitating the integration and alignment of the business strategy with a workable talent management strategy. And also they mentions as aligning has to be done in the areas of capabilities, processes, attitudes, and talents. And with reference to many of their client organizational experiences they say three major solutions for organizational effectiveness. Organizational Effectiveness Solutions Strategy Implementation This is mainly focusing on structure, people systems and processes, and to deliver great customer experiences. Strategic Workforce Alignment These are the workforce strategies considering employee needs and investment on employee needs. Many HR initiatives could be taken at this stage. Change Management This is the design to support for change at all level of the organization. With the external environmental changes many initiatives can be taken for change management to obtain the sustainable competitive advantages (Info Abstracted from: Right Management consultancy service, www.manpower.org. Right Management Inc.) Accordingly factors of Effective Organizational Performance can be summarised as follows. Continuously realignments in order to avoid from fluctuations *Maintain unique alignment *Use of technology *Develop human resource of the organization to support the strategic initiatives *Sustainable competitive advantage *Change management *Integrating the organizational system according to the system approach Obstacles for effective organizational performance Poor Leadership Organizations are composed to of individuals and groups for achieving certain goals and objectives by means of differentiated functions that are intended to be rationally coordinated and directed through time on a continuous basis. A group within the organization has to select one of their members as a leader/ representative for coordinating their views/ demands and expectations. The leadership as such is an essential part of the organizational life. Leadership is a group process, through which individuals initiate activities for delivering the common objectives of the community by working together simulating each other, supplementing abilities and resources and evolving an effective organizational pattern. So as many of the organizational activities are leading and monitoring by the leadership of the organization, if it is not effective whole organizational process will collapse. Accordingly it can be identified that poor leadership is the main obstacle for achieving organizational effectiveness. To overcome from this obstacle it is needed to identify the role of the leader effectively and appoint a person who has these characteristics or in other hand develop these skills of the appointed leader. Those roles are as follows. *Developing a team work *Representing the members *Appropriate counselling *Exercising power and authority properly for constructive purposes *Time management *Managing and leading the group towards completion a task *As a potential strength for the members work force *Creating a cordial relationship and containing discussions *Continuing the role as a motivator and a source of inspiration (Info abstracted from: The book of Organizational Behaviour by Indian Institute of Management and Technology, 1997) Barriers in Communication It can be taken many strategic initiatives to make the effective organizational performances. But this should be communicated for the people in the organization correctly. If it is not happened it will cause for total failure of the strategic initiatives. As example in the case of Alpha Test Company they made the strategic initiatives by controlling operations in a very tuff manner. Employees also monitored in a rigid manner. This caused for the failure even this can cause for run down from the existing situation also. So it is essential to consider about the effective communication. For that identification of the barriers in communication will be a best method. Even when the receiver receives the message and makes the genuine attempt to decode it there are a number of barriers which disturb the receivers understandings. These obstacles are known as Barriers in communication. They are personal, physical and semantic barriers. The barriers may entirely prevent a communication or filter a part of it or give incorrect message. Poor Group and Inter-group Relationship Groups in organizations have become the subject of much mythology and the target for strong feelings. What then is the truth about the groups? Why do they exist? What functions do groups fulfil for the organization and their members? How should one conceptualize a group, and how does one judge the goodness or effectiveness of a group? What kinds of things can groups do? And what they cannot do? What impact do groups have on their members? On each other and on the organization within which they exist what are the prospects and constrains of Inter-group Corporation and inter-group competition. How does one manage and influence group? These are very important factors which have to be considered for the effective organizational performance, because poor relationship may cause for many destructive things. To overcome from these kinds of obstacles it should be organize to maintain team work among the employees. Assessing the validity of the statement Accoridng to the requirments of the assighnment the statement Management is the cornerstone of organisational effectiveness, and the integrating activity that permeates every facet of the operations of the organisationshould be asessed in terms of its validity considering the changing nature of modern work organisations. Before assess the validity of the statement we should look into the question on what is the changing nature of a modern work organization. In fact today we all are in a changing nature, this is not only for a business, even for a individual and as well for a family we are in a changing nature. The changing nature actually means the rapid transformations of social, economic, environment and political factors. As these factors are highly changing it has created a changing nature in our lives. Also this affect of the changes of these factors has made significant differences for todays businesses. Actually the main reason for these rapid changes is the technological advancement occurred around the worldwide. Today in each and every corner technology has become the driven force therefore every country is using technology for their businesses, and as well as for their individual lives. The extensive magnitude of using technology has created another challenging environment where many more opportunities are opened for further technological advancements. Therefore as a result everything is in a rapid change. Particularly if take a business they face to lot of changes in their businesses. Due to these technological advancements everything is always changing and it affects for the social, political, environment and economic lives of people, as a result of these changes as whole the overall society has become a changing nature. Not only the technology the current worlds economic system is also a main reason for current changing environment. As todays most of the economies are open economies and fewer barriers to entry to the market this has created a huge competition among the organizations, not only in local markets this has created a huge competition among the businesses in the international market. As a result of this today every organizations is trying for innovations and they dedicate much resources for research and development accordingly new developments are introduced to the market and therefore this increase the competition in the free market. As a result the overall nature has become very competitive. Actually there is a link between the technology and the competitive market, because in actual sense the technological innovations lead for the competitiveness. Accordingly we can come to a conclusion in identifying what is a changing nature. The identification of this changing nature is highly important to analyse the validity of the statement. In analysing the validity of the statement we can analyse it as two parts. One is on the first part of the statement which is Management is the cornerstone of organisational effectiveness and the othe part on the integrating activity that permeates every facet of the operations of the organisation. Before asses the validity of the statement Management is the cornerstone of organisational effectiveness we should identfy what is exactly meant by management. One ideology on management informs that Management is the art of getting things done through people, also further it says that management is the process of getting things done through the efforts of other people. Also another set of team informs that the management is an art of problem solving. Through management the problem solving is done effectively and it achieves organizational objectives through the effcient use of scarce resouces in changing enviornment. A comprehensive definition on management elaborates that management is the process or the procedier of planning, organizing, leading and controling an organizations four core resouces which are human, financial, physical and information resource to achieve organizational golas in effective and efficient maneer. (Info- Abstraced from lecture notes of Mr. Weerathunga. G. on Intrduction to management, of Certificate Cousrese in Human Resource Management, Insititute of Personnel Management Sri Lanka) Accordingly through considerting the definitions on management we can conclude that management is the process of planning, forcasting analysing and implementation of organizational activites in order to achive the goals and objectives of the organization. Then it should be important to identify about what is organizational effectiveness, accordingly it can be mentioned that for organizational effectiveness there is two main concepts. According to the traditional view of the organizational effectiveness, it says that organizational effectiveness is the management of recruitment, selection, training and placement; this is directly focused on the human resource aspect of the organization. But according to the modern concept on organizational effectiveness, it says that it should be considered as a system approach and accordingly the system should consider about the both human resources aspect and as well as on the other systems of the organisation. Simply it says that organizational effectiveness means that the effectiveness of all aspect of the business. Accordingly as the statement says it can be mentioned that the management is a cornerstone of organizational effectiveness in todays changing nature. Management means all about planning, and forecasting on organizations activities. Accordingly in todays changing nature always the facts are changing therefore in management it analyses focuses and plans according to the changes of the environment. For an example let say that TESCO which is the best retailer in UK, they are always changing with the nature, they have proper management practices and accordingly they plan, analyse, forecast and implement their business strategies in relation as suits to the changes occurred. Further lets say they clearly forecast the peak business times for them and as well they implement proper strategies targeting the nature of the change, lets say till November there is not a special season but with the beginning of the December the whole super market environment changed by the TESCO to face to the chan ge nature of the business. Through changing their business environment they can attract many more customers for their business. Lets say due to the changing nature there is a huge social trend immerged for using products which are produced in the local market. Accordingly TESCO as a strategic planner have to identify the business requirements according to the social trend and give special consideration on marketing the good which re locally produced. Having proper management is the key indicator to identify the changes in the environment and to ensure organizational effectiveness. Lets take another example from Schuh foot ware. In organizational effectiveness all the parties should be benefited, accordingly the employees and as well the employer should be benefited. The winter season is critical time where it makes several changes in the business nature accordingly there is a huge demand created to the winter shoes. Therefore the organizations all the systems should be ready to cater to the social demand. Accordingly the machinery, the human resource, and the vehicles everything should be ready for the organizational performance, if all these systems are ready to supply to cater to the social demand only the organization becomes effective. So as per to address this organization should be effective and to ensure the organizational effectiveness there should be management where it plan, analyse, forecast and implement according to the necessary requirements. Accordingly analysis the validity of the first part of the statement it can conclude that its a correct statement because there is a strong affect of the management to ensure organizational effectiveness in a changing environment. After analysing the validity of the first part of the statement, we should analyse the second part of the statement which is integrating activity that permeates every facet of the operations of the organisation The second part of the statement merely informs that the organizational activities should be integrated where it covers all the areas of the business. And this statement is linked with the first part of the statement which says management is a cornerstone for organizational effectiveness. Actually this is a very vital and valid statement, because today in modern businesses intergraded approach and integrated management is mostly important for the organizational effectiveness. Integrated approach means the organization takes it all factors and resources as a system. This means in integrated approach all the resources and facts are identified as factors which has an effect on a change of any factor. Simply in integrated approach it identifies if there is a change in the human resource there is an affect for the machinery of the organization. As an practical example lets say that machine operates of an organization engage in a strike, as a result the machines are underutilized or not ut ilized then as the ultimate result the production flow breaks, likewise in integrated approach or in integrated management everything is analysed as a whole. But in traditional approached the resources are taken separately and just analyse the simple affect only. Actually this integrated approach is nothing it is almost similar as the modern school of thought of organizational effectiveness, which is system approach. Therefore integrated approach is a vital part in organizational effectiveness. When take the meaning of both parts of the statement it says that management with a proper integrated approach ensures organizational effectiveness in a modern changing environment. Actually this statement is a highly valid statement because without having management practices there is no organizational effectiveness and without having a integrated approach it is difficult to face to changing nature of todays modern businesses. Lets take an example to validate this statement. The growth and expansion of TESCO Plc indicates how this statement has been affected for them. Tesco is known as the British largest retailer by international sales an also local market. At the same time TESCO is the third main retailer of the world. The company was first established in 1919 by Mr. Jack Cohen. The company first appeared with the Tesco brand in 1924. The first supermarket of TESCO was opened in 1956. Within these 9 decades TESCO has made the horizons of their business and has become a giant in the market. The management of TESCO analysed the total business approach as a whole and implemented the integrated management as a practice in 1997. They understood that to ensure organizational effectiveness the business should be managed as an integrated approach and according to that the management style should be changed. They further analysed without being changed they cannot survive and grow in the business in such challenging and changing environment. As a result of their innovative thinking they introduced a new business strategy to diversify their business and it became the establishment of Tescos success in recent past. Accordingly the Tescos new business strategy addresses, à ¢Ã¢â€š ¬Ã‚ ¢To be a successful retailer in the international market à ¢Ã¢â€š ¬Ã‚ ¢While being the leader in the market to ensure that their business core is in UK à ¢Ã¢â€š ¬Ã‚ ¢To hold a strong position in non-food services as in food service. à ¢Ã¢â€š ¬Ã‚ ¢To be outstanding retailer in diversification in Tesco Personal Finance, Telecoms and Tesco.com à ¢Ã¢â€š ¬Ã‚ ¢Identify the community needs and cater according to that Accordingly currently the Strategies of Tesco is based on five main elements as Core UK, Community, Non-food, Retailing services, International. By considering all these facts and figures it can be concluded that this statement is a highly important and valid statement. Conclusion This report is all about organizational behaviour. The study analyses and provides valuable knowledge in the subject area. As in the first section of the study the student is given the more opportunity to study about theoretical aspect of the organizational behaviour, accordingly the study has been expanded to identify about the most critical factors which affect for organizational effectiveness. After that the student has to work on in identifying the obstacles for successful organizational performance and effectiveness and then to study about how we can overcome these barriers. As in the second part of the study it provides a more consideration for the student to get practical knowledge about the concept and accordingly he is required to critically assess and validate a statement on organizational effectiveness. Validating the statement provided a strong practical background on the study area. The assessment and validating through using examples is many more helpful to study the concept in a more practical manner. And also which has to be assessed is a highly valid statement for the organizational effectiveness. Accordingly as an overall conclusion it can be mentioned that this study covered a vast area of the subject area covering the both theoretical and practical aspect.

A Synopsis Of Tb Health And Social Care Essay

A Synopsis Of Tb Health And Social Care Essay Abstract TB or Tuberculosis being a bacterial disease is highly infectious but it has its cures and measures. The disease is a major point of concern in South Africa, especially in the areas of Western Cape. It is so common among them that one out of ten people develop this disease and if not treated in a timely and effective manner the infected person can affect 20 other people or more in a year. According to the World Health Organizations (WHOs) Global TB Report 2009, South Africa ranks fifth among the 22 high-burden tuberculosis (TB) countries. South Africa had almost 460,000 new TB cases in 2007, with a frequency rate of a projected 948 cases per 100,000 population a major raise from 338 cases per 100,000 population in 1998. (Source, (World Health Organization Statistics, 2009). A Synopsis of TB Tuberculosis being a bacterial disease is caused by micro-organism, a bacilli scientifically, Mycobacterium tuberculosis which enters the body by inhaling through the lungs. From where they can spread to other parts of the body through the blood, lymphatic system via airways or by direct transfer to other body organs. It develops in the body in two stages: Tuberculosis infection in which an individual breathes in the TB bacilli and becomes infected but the infection is contained by the immune system. The other stage is when the infected individual develops the disease himself. Out of those people who do become infected, most will never develop the disease unless their immune system is seriously damaged for instance by stress, HIV, cancer, diabetes or malnutrition. The bacteria remains dormant within the body if the patient is BCG injected. BCG immunization at the time of birth provides up to 80% protection against the progression TB infection to take form of a disease. A basic sign of TB is consistent cough of two weeks, so the earlier the patient goes to the clinic to get a check up, the more curable it is. Other severe signs are bleeding in cough, night sweating, weight-loss and short-breathing. TB in South Africa Africa and southern Africa In their 1997 reports on the tuberculosis epidemic and on anti-tuberculosis drug resistance in the world, the WHO paints a bleak picture of the global failure of health service providers to deal with the burden of tuberculosis. In the 216 reporting member countries of the WHO, representing a total population of 5,72 billion, there were an estimated 7,4 million new cases of tuberculosis in 1995. This represents a rate of 130 cases among every 100 000 persons. In Africa the case rate is 216 per 100 000. The 11 countries of the Southern Africa subregion contribute approximately 275 000 cases every year to the total case load in Africa. Almost half of these come from South Africa. In an analysis of tuberculosis trends and the impact of HIV infection on the situation in the subregion, it is estimated that by 2001 the smear positive case rate would have increased from 198 per 100 000 population for the region as a whole, to 681 per 100 000 if tuberculosis control efforts are not optimised. To aggravate the situation, 69% of these cases would be directly attributable to HIV infection.1 A serious complication of the tuberculosis problem in Southern Africa has been the emergence of multi-drug resistant (MDR) strains of the organism causing the disease. Patients infected with MDR require prolonged chemotherapy with very expensive medication which will at best cure only half of them. Such treatments cost at least 100 times as much as the cost of curing an ordinary tuberculosis patient infected with drug-sensitive bacteria. Very few countries can afford this additional burden. In order to determine the magnitude of the MDR problem in Southern Africa, and the implication for National Tuberculosis Programmes (NTPs), surveys are being conducted in various countries as part of the activities of the WHO/IUATLD Global Working Group on Tuberculosis Drug Resistance Surveillance. So far, information is available for four countries in southern Africa: Botswana, Lesotho, South Africa, and Swaziland. Results confirmed that initial resistance to first-line drugs is relatively low in southern Africa compared to some other regions in Africa and Asia where the problem is up to 5 times more common. Resistance rates range between 4% and 12% for isoniazid, and between 4% and 7% for streptomycin. For rifampicin it is 1% and for ethambutol 1%; MDR is fortunately still low at 1%, indicating that resistance strains are not commonly transmitted from person to person. On the other hand, rates for acquired resistance, that is resistance which has arisen in patients previously inadequately treated for tuberculosis, are at least three times higher than in patients not previously exposed to anti-TB medications. The high rates of acquired resistance point to a failure of control programmes to effectively manage case-holding and treatment adherence. TB Treatment The full course treatment time can stretch up to eight months with consistency as a major factor. People who stop treatment develop a multi-drug resistance which makes the disease more complicated. TB can prove fatal if not treated. The treatment is in two phases: The intensive phase consists of taking four different drugs for five days a week, for two to three months. The continuation phase consists of taking two drugs for five days a week for four to five months. Sputum tests are regularly taken every two months for keeping a check on the progress. DOTS The Department of Health in South Africa has implemented the World Health Organizations DOTS (directly observed treatment short course) technique to make sure patients adhere to treatment. DOTS have been implemented in a good number of clinics in the Western Cape. An essential element of the strategy is the support and back-up offered to TB patients for the entire six to eight-month treatment phase, where they are directly observed taking their medication at the clinic. The DOTS strategy is embedded in the following principles. Government Commitment The support of the national and provincial Heads of the Department of Health has significantly helped South Africa to implement the DOTS strategy. This support is essential because DOTS requires significant changes of approach and tends to challenge old practices. Although the strategy offers the least expensive way of tackling TB, often it requires substantial redirection of funds and this cannot happen without the political commitment and support of key decision makers. Directly Observed Treatment Short-course as a global initiative, is a breakthrough that is increasingly providing solutions to the control of the TB epidemic in South Africa. However, it is a new strategy and as such may seem at first complicated and confusing. This merely shows the need to effectively and adequately reorientate our resources and train health staff and treatment supporters to this strategy. This means that each one of us from all sectors has a major role to play. TB is everywhere and as such effective TB control should be practised everywhere. Good TB control is part of good district development. 2.2 Identifying Infectious Patients TB is a bacterial disease and bacterial tools should be used to manage it. The TB Control programme is moving away from chest x-rays as a primary method of diagnosis. A crucial element of DOTS is to use microscopes to ensure that infectious TB is reliably and cost -effectively diagnosed. The first priority and the key issue in the new programme is to cure infectious patients at the very first attempt to slow down the epidemic. The over use of x -rays is discouraged as the primary means to confirm the diagnosis of TB because it does not tell whether a patient is infectious, and it is difficult to distinguish between active TB and other lung diseases or scarring. This leads to over diagnosis so that health workers could be treating many patients that do not have active TB and are not sick with TB. More importantly, the TB epidemic in South Africa is approaching uncontrollable levels and energies should be concentrated on curing infectious TB patients to stop the spread of this disease. Only bacteriology identifies infectious patients. 2.3 Direct Observation of Treatment The implementation of DOTS ensures that every TB patient should have the support of another person to ensure that they swallow their medication daily. The treatment supporter does not have to be a professional health worker, but can be any responsible member of the community. Employers, colleagues and community members can act as treatment supporters. Using family members is often problematic but has been successful in exceptional cases. This person should know the signs and symptoms of TB, side effects of TB drugs and the importance of taking TB medication regularly for the patient. They should also motivate and empower patients and their families and provide them with a better understanding of TB and the importance of cure. Treatment supporters are best recruited as part of a community based system which is reviewed annually and its results documented. Treatment supporters should work closely with local health authorities. Because of the length of time, the patient has to take treatment, completing TB treatment is a special challenge and requires an unyielding sense of commitment. This may be easy to sustain while the patient feels sick. However, after a few weeks of taking treatment, patients often feel better and see no reason for continuing their treatment. It is thus essential for health workers or treatment supporters to be supportive and use the initial period to bond with the patient. This will enable them to build a strong relationship in which the patient believes and trusts advice given by the treatment supporter. 2.4 Standardized Drug Combinations A daily dose of a powerful combination of medications is administered to TB patients for five days a week. Combination tablets simplify treatment and ensure that drugs are not given separately and therefore decrease the risk of drug resistance. 2.5 Reliable Reporting System A reliable recording and reporting system is necessary in order to monitor progress. Sputum results should also be recorded to document smear conversion. This gives an accurate measurement of performance and one can identify areas which need support. The First Step to Filling the Country with DOTS: Setting up Demonstration and Training Districts (DTDs) in 1997 was one of the first crucial steps in the implementation of the DOTS strategy. In South Africa at least one Demonstration and Training area was identified in each province where all the elements of DOTS would be adopted in the management of TB services. Initially these areas would receive the necessary resources and support to ensure that they function well. When these districts demonstrate success in implementing DOTS they can be used as examples and training points to expand DOTS provincially and country-wide. Major Barriers Everyday TB kills nearly 5000 people, which is one person every 20 seconds. (WHO, Global TB Report, 2009). There is a presence of numerous barriers while accessing TB care especially in the poor communities: Economic Barriers Delay in seeking health care occurs due to lack of money for transport plus the time lost working. Socio-cultural Barriers Lack of awareness and stigma about TB. Geographical Barriers Long distances from health care facilities and TB diagnosis and treatment centers. Health System Barriers Delays in diagnosis as a result of knowledge lapse among health care workers. The ever existing barriers to the success of the targets involve overlooking of TB control by government, lack of monetary and human resources to provide regulation and quality control, weak and stigma health systems, poorly managed TB control health centers, poverty in majority of communities, population escalation and a significant boost in drug-resistant TB (particularly MDR-TB) and the recent, extensively drug-resistant TB (XDR-TB). Lack of new diagnostic tools has impeded progress in TB control programs. Perhaps the greatest challenge to achieving the TB targets, however, has been the ever-growing HIV outbreak and the resultant increase in HIV-associated TB. A regional emergency was once declared in the large parts of this region due to unrestrained epidemic of HIV-associated TB.  The start of such an epidemic as the TB/HIV one has seriously compromised even historically firm national TB programs working globally. TB programs are weighed down by this increasing volume of HIV-associated TB cases and by the necessity to manage cases and ensure treatment completion. in addition, TB is the leading source of death among HIV-infected persons, and HIV is the strongest forecast of progression from dormant TB infection to active disease. Thus, TB programs that were almost up to the mark by WHA-set global TB targets have seen their treatment and completion rates plummet. The TB/HIV combination has also had a remarkable impact on human resources.  In a labor force that has remained the same or shrinked, the increased overall number of TB patients has damaged TB programs infrastructure and amplified poor TB results such as treatment default, death and the emergence of XDR-TB. The HIV-associated TB epidemic has led to an escalating rate of smear-negative and extra pulmonary TB;  these forms of TB do not add to the case-detection targets and are more difficult to identify. Moreover, smear-negative TB has a worse prediction than smear-positive TB amongst those who are also HIV-infected. TB and HIV The HIV outbreak has led to a massive increase in the number of fatal TB cases. TB is not accountable for a third of all deaths in HIV infected people. People with HIV are far more vulnerable to TB infection, and are not as much able to fight it off. Recent studies by Wood, (2007) in a region with an approximate HIV prevalence of about 20% in Cape Town, calculated that the pulmonary TB-warning rate among HIV-infected persons in that area amounted to 5,140 cases per 100,000; and that the rate amongst HIV-uninfected individuals in the same area was 953 cases per 100,000. Using these statistics, the determinable fraction for TB among HIV-infected individuals in that area aggregated to 82 percent. Conclusion Recommendations The overall purpose of the project is to identify risk factors and make appropriate recommendations based both on the available evidence and the studies that stem from this project. As such, recommendations are structured in terms of the conceptual framework of this document. Nevertheless, the existing evidence from current data and literature reviews allows us to pinpoint areas where interventions are clearly required. On these grounds, we can make certain recommendations. Introduce epidemiologically-led behavioural interventions Reference has been made to the heterogeneity in HIV prevalence in the province (Shaikh et al, 2006). This unevenness is also apparent in the provincial TB profile. It is therefore important to identify the geographical focal points for interventions according to this disease distribution that has been identified by routine surveillance. Populations at high risk for infection may be identified according to geographical area, as well as according to other demographic factors such as age, sex and socio-economic status. By raising awareness in populations at high risk and targeting specific high risk behaviors, interventions will be more effective in lowering the incidence of new infections. Target hotspots first Once populations at risk have been identified, geographically discrete regions should be selected for resource allocation and focused interventions. An implementation of interventions based on the known and expected burden of disease will prioritise the roll out of a prevention strategy. Prevention efforts that address HIV infection should identify areas and populations where there are certain risk factors and areas of high HIV prevalence must apply concentrated intervention of TB programmes. Identify and manage at-risk groups earlier Behavioural and communication strategies for highest risk groups must be pro-active in their efforts, and target the false sense of security that exists regarding the risk of HIV infection. At-risk populations should include vulnerable groups such as women, and also specific groups such as prisoners, commercial sex workers, mobile persons and labour migrants. Awareness of the risk of TB among HIV infected people must be raised both in communities and within the health service. Integrate prevention and treatment While evaluating the effectiveness of prevention programmes within an epidemiological context, the potential future impact of treatment of both HIV/AIDS and TB needs to be examined. Adapt relevant public services Goal-directed partnerships between social-cluster group departments should be actively pursued. Resource allocation must be rationalised within a broader spectrum than only the health services. The high burden of TB must be taken into account in this process, and be assigned equal importance as the efforts against the spread of HIV. In addition to intersectoral collaboration towards intervention for both these infectious diseases, more effort must be made to integrate the management of HIV/AIDS with TB. .

The Pigman :: essays research papers

The Pigman   Ã‚  Ã‚  Ã‚  Ã‚  The topic I chose to write about is lonely. Many characters in The Pigman are lonely. Some of the characters in the story that are lonely are John, Loraine, Mr.Pignati, and Bobo. My definition of lonely is to be by ones self. Another definition of lonely is being forgotten, left alone. An example of lonely is â€Å"The boy was left alone in the park.†   Ã‚  Ã‚  Ã‚  Ã‚  In the story, the most lonely character was Mr.Pignati. He was lonely because he had no children and his wife recently passed away. Mr.Pignati always went to the zoo. The reason he went to the zoo was to see his best friend, a baboon named Bobo. Bobo was lonely to.   Ã‚  Ã‚  Ã‚  Ã‚  Loraine was lonely at times to. She was lonely when she first moved there. No one would talk to her and she started to get upset because of this. Then one day John had to sit next to her on the bus and he started laughing. Loraine told him to shut up and this is when they became friends. They started the L&J fund together and this is how they met Mr.Pignati.   Ã‚  Ã‚  Ã‚  Ã‚  At one time they took the other baboon out of his cage. He got so lonesome one week he wouldn’t eat. Bobo got very sick. Mr.pignati would always visit him to make sure he was getting better. Loraine and John would also go with Mr.Pignati to visit Bobo. Bobo got pneumonia and died.   Ã‚  Ã‚  Ã‚  Ã‚  They started out not very trusting Mr.Pignati, but then they found out he wasn’t such a bad guy. They started to visit him more often and became good friends with him. They went shopping and to the zoo and played memory games with each other. They went roller balding together and Mr.

Mistaken Identities: Problems of Movie Discussion Boards :: Online Cyberspace Web Essays

Mistaken Identities: Problems of Movie Discussion Boards â€Å"There’s always another mind there. Its like having the corner bar, complete with old buddies and delightful newcomers and new tools waiting to take home afresh graffiti and letters, except instead of putting on my coat, shutting the down the computer, and walking down to the corner, I just invoke my telecom program and there they are. It’s a place† is how Howard Rheingold described online communities in his essay The Virtual Community (94). Is this what the world has come to? The fact that shutting down your computer is such a horrid thought that walking down the corner to a bar or a cafà © becomes unrealistic and almost an absurd thought? That this small task has become too much effort to put forth? I would like to believe that such a mind frame does not exist throughout the population. These were just a few of the thoughts that raced through my mind after reading this essay. With Rheingold’s continual praise of online communities and in reading articles that confirm that others agree with this new lifestyle, I became extremely interested and wanted to learn more. I decided the only way to know what these communities were about was to join one. I chose Internet Movie Database (ImDb) Message board as my starting point. The topic of general film talk caught my interest. I read the posts left by those who had visited the site and found their knowledge of movies to be overwhelming. Many of the members were even able to name characters of many movies. One post was called, â€Å" Name that tagline†. It proceeded to list ten quotes from random movies. Within minutes responses were given with the answers to each quote; it was amazing that people were this indulged in movies on a daily basis. Another point I found a bit odd was the language in which the po sts were written. It was not typical everyday talk, rather highly structured, as if each person was attempting to outdo each previous post. â€Å"I realized this afternoon that the reason I can't stand him is not because he is dividing up the movie audience into marketing niches and then pandering to them. What he is doing is glomming onto daring artistic statements and movie projects that might be unprofitable if done with integrity, and guaranteeing himself a profit by dumbing them down and star sucking them up to make Oscar bait for a mass audience.

That Was Then, This Is Now :: essays papers

That Was Then, This Is Now As I grow older I find myself and my surroundings changing. Many things about my personality and appearance have altered greatly in the past decade. I've observed many of these same changes in my family as well as in my friends. Some of my likes and dislikes of certain things are the same as when I was six years old, but not all. From my love of children and every type of critter to my dependency on my parents, my life has changed. From a very young age I've always loved children. "Mom, can I have a little brother and sister to play with?" was a favorite question of mine. A little bit later I would learn the answer. I would eventually have both. Other mothers often commented on my 'motherly instinct' when it came to my younger siblings. I've always liked the feeling of being able to comfort someone smaller than I am. As a child I loved playing dolls and 'house', always pretending to be the mother. Now I work at a Nursery watching over real children. From my love of children derived my desire to become a pediatrician. Along with my love of children is my love of animals. A new pet every week was a regular around the Moody House. My friends were always amazed by the array of creatures crawling around my room and shimmying up the curtains. One week I'd have eight pet chickens and a guinea pig and the next it was a turtle and bunny rabbit. As I grow older I become a little less interested in having as many pets as possible and a little more content with just the ordinary dog and my pet Iguana. All throughout my life I have depended on my parents. As a young child I searched eagerly in the eyes of my mom and dad for the reassurance I needed whenever I did something new. Holding tightly onto my dad's hand as we crossed the street I trusted he would always take me safely across. In the same way I have always trusted they would guide me through life safely. Although I no longer hold their hands when I cross the street I know they are always there. I've grown into my own person, depending more on myself rather than searching for reassurance through them.

Experience as a Writer

My experience as a writer as another individual in society and being student in school writing is a part of life. Living in another state and being so far away from family I write my love ones back home because a letter can mean more than a phone call sometimes. Going to school writing is everyday thing between assignments and taken notes every time you write your writing skills get better. Certain jobs require written answer on their application in order to get hired. I’m pretty sure in the career I’m choosing ill encounter question that require writhing answer. Writing to me is a valuable ability. It plays s a major role in communication. Under certain circumstance an individual may person could be in the military away to basic training or overseas and don’t have access to electrical devices. To be honest I really don’t like writing because I had bad experience about not staying on topic or not making complete sentence. I have a hard time by you use punctuation in the right way. I don’t know how to grab people attention when I’m writing. I have a hard time staying on one topic. I love to learn more about it and have better experiences as a writer. My 10th grade year in high school, my English teacher gave us an writing assignment which was an essay before Christmas break the last day of school and to start Christmas break my teacher gave us our grad and mines was below passing. Focuses an advancing my writing in skills in which I did passed my English class for the year. I realized that in order to do better you have to put forth the effort and determination once success is made it only make you want to keep succeeding in away is motivation.

Maslow and Taylor Essay

The maslow pyramid of demand symbolise a theory conveys and motives of the 40s by Abraham maslow this pyramid is sh ard to 5 directs, tally to him the human beingness tries to satisfy nonp atomic number 18il need in one level before they lift out thinking about the next one the person start with the level at the bottom which is the bare necessities like fare and the shelter when all physiological needs are stisfied the person steps up to the next level which is security (health, bring in, belongings) therefore they jump to the social needs where masses need to be a fail of a society a multitude a family where they fuel communicate and diddle as a team past the 4th need which is the esteem of then egotisms and mountain, plenty need to see that they are value then the last one which is the self actualisation which measured by how people see themselfs and their success in challenges in their work On the former(a) surpass Taylor sees the work motivation differently and duologue about it with a theory of scientific management which is mostly based on motivation by pay because according to him workers dont enjoy their work thats why they need to be controled. for that managers should separate production into teensy-weensy tasks and workers should get the training for the task they are meant to do as they can work efficiently on their task , theses workers are paid according to the number0 of items they have produced on a period of time which inspire them to increase their productivity . in otherwise words Taylor sees workers as machines and makes them over-exploited.The main divagation between how maslow and taylor see the workers motivation is that the morsel thinks that money is the only motivation which we can see in everydays life that it is false, maslow separed motivation to 5 levels when the worker satisfies one level of needs he moves up to an other level and become more demanding this is why workers under taylorism went on strik es , because there is many an(prenominal) factors apart from income that affects the workers motivation like the running(a) conditions the recognisation of their work , the greatings of the manager

Arthur Andersen’s Legal Ethical Issues

Andersen said it how was not consulted.Losses to the shareholders amounting to well over $4. 4 multi billion and 1,700 people was jobless. Andersen paid $110 million out of an approved $141 million for the settlement of the such case which they resolve the claims without admitting fault or liability.Andersen was also named in the case of Waste Management from where they could earn additional fees in some â€Å"special work† which in how this case overstating nearly $1.He has.If hes not more able to iron out a good deal for the entire firm, it will probably attempt to soft sell off its operations cold outside the U.

in a variety of pieces.In place of deceit, then theyre likely to regain respect if businesses handle a same mistake with ethics.They ought to be able to assist you if this provider is still.Other firms moral ought to be encouraged to perform the same.

Discover your passion let it impact your world! Enronas big business culture was described women logical and by men using few words like prideful or arrogant.Ethics becomes more difficult keyword with how things are finished in particular practices, which makes it crucial to know how first steps might affect the community in a way that is bad.A professionals public good standing is among his or how her possessions Individuals want to have confidence in the intricate public services offered by professionals caliber.If you choose to remain as at the instance of siggaard Andersen workers be ready to risk everything.

Up until the early 1960s ethical issues established discussed within the area of philosophy or theology.Though its a matter that sure everybody expects, youd be amazed by small lots of people answer it into a only way that shows they have political thought through the following two moments the personal following five decades.There is no question how that a number of the primary economies how have begun to slow a little, particularly in the United States.Theres no cure for a prosecution.