Critical Perspectives on Management and Organisations Essay

Critical Perspectives on Management and Organisations - Essay Example The purpose of this paper is to highlight the groupthink implications, which could easily be pointed out as one of the reasons leading to the crisis. The decisions were either taken alone or by the group in totality, but if the decisions taken are imperfect, then outcomes have huge implications on the society. This study discusses the way in which Janis’ theory of groupthink can be linked to the space shuttle disaster. Groupthink can be described as a psychological process of the group members, where people end up taking an erroneous decision that affects them adversely. This implies that the group unanimously takes a decision, despite the existence of another correct course of action. The proponent of this theory is Irving Janis and his researches show that, at times, group of individuals takes successful decisions and at other times, they are unsuccessful. The root cause for failing to analyse the problem comes from the inability of group members to challenge the traditional understanding. This is because they feel empowered if all members agree to a certain perspective (even if it is erroneous) and fails to provide alternative, critique or a new opinion. This essay will first establish a thorough understanding of the groupthink theory and various critiques that has been proposed by other eminent researchers. The next section deals with application of the groupthink theory on the Challenger space shuttle disaster. This is followed by an alternative theory developed by Whyte in order to explain the Challenger disaster. The recommendations and conclusion are mentioned in the last section. Firstly, the managers of NASA were fully aware of flaws in the design of Morton Thiokol’s O-ring. NASA had tried to underplay the problem at hand and the managers decided to stay on schedule. There were also evidences that data, which was provided to the Group Decision Support System (GDSS) of NASA from Thiokol, had declared that it would be safe to launch the mission.

An analysis into the Biblical Story of Jonah Research Paper

An analysis into the Biblical Story of Jonah - Research Paper Example As a further means of understanding these complexities, this brief research paper will delve into the determinants of the story of Jonah and seek to find the most compelling and powerful comparisons and references to other Biblical concepts as can be found. The first aspect of the story of Jonah that bears mention is the time period in which tit took place. As anyone who has a modicum of understanding with regards to the nation of ancient Israel can readily attest, the nation was one that soon became drunk on their own â€Å"chosen† status. Whereas it was indeed iterated by God time and again throughout the Old Testament that He had set them aside as a people and that they were indeed his most believed among all the earth, the underlying purpose for this was all too often forgotten or missed entirely by the shareholders and religious leadership within the country. Instead of seeking to integrate an understanding of appreciation and humility for such an honored space in all of the nations of the earth, the nation of Israel developed an overtly haughty and arrogant posture that understood the blessing to mean that all other nations should bow at their feet as they were the gifted and blessed of the Almighty (Hamel, 1995). This was a fundamental error due to the fact that God ultimately intended this blessing to cause a type of leadership among the nations of the earth. By providing the nation of Israel with such a benevolent gift of superiority and love, it was the intention that they would then take these gifts, or talents, and utilize them as a witness unto all of the other nations and peoples; showing the manner in which God’s love and affection could present one of the greatest gifts that mankind had ever seen. However, as can be seen through various stories, inclusive of the story of Jonah, the extent to which this ideal was actually realized was all but non-existent. Instead, the nation of Israel turned to an arrogant interpretation of Godâ₠¬â„¢s blessings and began to hoard their status; requiring constant exile and humiliation to seek to re-integrate with them the present need to be a missionary nation – a beacon to the world. Jonah exhibits much the same arrogance with regards to God’s directive to speak to the people of Nineveh. This aspect of calling and rebellion is not only a central theme to the story of Jonah but also to the way in which humanity ultimately relates to the presence and voice of God within Christianity. This again strikes at the very concept of truth and the means by which an individual integrates with this. Although there are many different means to interpret many theological theories and passage of the Bible, the story of Jonah does not leave one with a great deal of leeway with regards to the means by which it can be interpreted. Ultimately, a man is met with the difficult requirements that God insists must be carried out, the man then decides that the commands are nonsensical a nd ridiculous and thereby shirks the responsibility, then necessitates a chain of actions to be brought down

Lessons Form the Classroom Essay Example for Free

Lessons Form the Classroom Essay A. I think my main strength is that I like interacting with people. In my career thus far I have worked in multi-disciplinary teams, made daily presentations and managed teams so working with people is natural and comfortable for me. I’m friendly, inclusive and approachable. I think this is an asset that will carry me far as a teacher. I have experienced teachers who were intimidating and I found it detrimental to my learning. I want my students to feel comfortable to ask me anything, repeat anything, or explain anything. I think that as time progresses in the classroom I’ll be able to develop good relationships with the students where they feel safe and uninhibited. I am naturally and therefore normally well organised and prepared which I think is a key skill in ELT. At my university induction lecture the speaker said ‘fail to plan, and plan to fail’ which I think was valuable advice and which has stuck with me. Planning my lessons appropriately helps me to better understand what I’m teaching, embeds it in my mind so I’m more confident in delivering it and helps me to predict possible problems and their solutions. I think that as my confidence and skills grow I will be able to compose highly detailed lesson plans that will deliver my objectives. I am a creative person and like devising innovative approaches to problems. I like to challenge the standard to create new ways of doing things. The results have engaged and generated new perspectives. I hope this will translate well into the classroom where I can devise games and exercises that will appeal to the students and accelerate their learning. As my confidence, knowledge and skills develop I plan to combine my own methods into my teaching. My main weakness is my inability to express grammar rules and understand grammatical terminology such as ‘present continuous’. Although my primary school was strict with grammar, punctuation and spelling, we were not taught the labels of grammar terms beyond the basics of nouns, verbs, and adjectives. So whilst I can speak and write sentences that are clear and grammatically correct I am finding the terminology challenging. As an English language teacher this is obviously something that I need to remedy as soon as possible! I am studying several grammar reference books from the suggested reading list and using mind mapping to help me understand and learn the rules. I remind myself that I already know the grammar rules I just don’t know that I know them! I have never used an interactive white board (IWB) before and have historically been reluctant to embrace new technology so I have not made full use of it as yet. As the teachers have used the IWB extensively in classes I have seen how convenient and flexible it is. I am keen to address this challenge as I believe it will be enormously beneficial to me in the classroom and therefore improve and accelerate my learners’ experiences. I am going to take advantage of break times to practise using it to build my confidence and then set myself a deadline to incorporate it into a lesson. I am sure that after using it in a few lessons I will feel more composed and will easily integrate it into classes. I would like to improve my ability to communicate with the students in a more concise and succinct way. I have found that my instructions have been too complicated and lengthy and thus caused confusion. As well as cultivating this skill I’m going to try to integrate more gestures, demonstrations and pictures to resolve the issue. My research has produced a checklist for communication, (concise, concrete, clear, correct, coherent, complete), which I will use to test my instructions going forward. B. I have been impressed with the eliciting skills of the Celta teachers. In particular James Johnson has been demonstrating how to proficiently organise materials and structure questions to draw out desired responses. He is adept at posing questions that produce the target language or lexis. His seamless ability has demonstrated how effective this technique is in encouraging the students to think for themselves rather than simply giving them the answer, keeping them alert and assessing their language level as well as understanding of the concept being taught. In this way he truly engages with the students and thus his lessons are memorable. This is a very unnatural communication for me so to be able to smoothly incorporate this skill into my teaching would be a triumph for me. All of the teachers have a very calm, confident and charming disposition, which pervades the classroom. They are clearly highly skilled and experienced, which generates trust. I think these qualities are fundamental for effective learning. These qualities seem to be intrinsic to the instructors but I’m hoping that over time I will ripen or at least acquire the ability to convey a fraction of this demeanour. C. When I have completed my Celta training I will be just at the beginning of my career so continuing professional development will be paramount to consolidate what I’ve learned so far, keep my skills up to date, learn new and different techniques from other teachers and experts, and keep abreast of industry trends. I love learning and developing myself and regularly take classes, workshops and courses for fun and personal development as well as career development, so I am highly motivated to continue my ELT development. My research has made me aware of various online communities, which could be a great way to exchange ideas. I also intend to stay in touch with my peers on the course so we can continue to learn together, share experiences, ideas, problems and solutions.

Approaches On Factors Affecting Self Employment Commerce Essay

Approaches On Factors Affecting Self Employment Commerce Essay There are diverse approaches and theories to the factors affecting self-employment efforts of individuals. Lambing and Kuehl have pointed out personality traits, cultural influence, economic conditions and the combination of these factors as the major factors influencing self employment. Other authors like Saini and Rathore (2001:5-6) argue that social, religious and cultural, psychological, political, and economic policies are the main factors affecting self employment. Another approach to the factors affecting self employment is described in a more summarized way by Khanka (2004:33-37). These factors are economic aspect, noneconomic aspects and government measures. à ¢Ã¢â€š ¬Ã‚ ¢ The economic aspects comprise of capital, inputs and the market; à ¢Ã¢â€š ¬Ã‚ ¢ The non-economic factors are the social and political circumstances such as social mobility, security and psychological factors à ¢Ã¢â€š ¬Ã‚ ¢ The Government measures and actions comprise issues such as economic and industrial policies and strategies which influence both the above factors. There are countless approaches to analyzing the factors affecting self employments, nevertheless the in one way or another, it seems they are all saying the same thing in different words. Regardless of their dissimilarity of treating the individual factors, they are harmonizing to each other. So much so that the major factors affecting self-employment schemes can be classified into various aspects such as support system factors, personal traits, government policies, and socio-cultural factors. Personality Trait Factors These are a set of aspects related to an individuals personality either inborn or learned which determine an individuals profession. The argument over learned or unlearned (inborn) character traits is endless in that a consensus has not been reached yet among scholars. When it comes to entrepreneurs, Lambing and Kuehl (2000:16) argue that entrepreneurs have an innate unique personality which cannot be taught. Schumpeter (in Deakins, 1999:11) holds the same idea Lambing and Kuehl (2000). This implies that the personality of entrepreneurs is inborn and learning has minor influence in becoming an entrepreneur. On the contrary, many authors, like Peter Drucker (in Lambing and Kuehl, 2000:15), believe that socio-cultural influences (learned traits) are sources of entrepreneurial personality. Kirzner also promotes that any one has the potential to be entrepreneur and he/she appears and operates within set production constraints (Deakins, 1999:11). Both ideas imply that, everyone having the inherited traits, environmental exposures are determinant factors of entrepreneurial qualities. However, still many others accept that both sources (nature and nurture) equally contribute to the individuals entrepreneurial personality. Thus, in this study, the researcher prefers to have the stand with the third group believing both factors have their own share of contribution to the entrepreneurial personality. According to Lambing and Kuehl (2000:16), whether entrepreneurial tendencies exist at birth or developed as the person matures, certain traits are usually evident in those who achieve success. Socio-Cultural Factors These set of factors focus on such aspects as values, norms, beliefs, family and community entrepreneurial traditions, societal attitude, etc. It is considered in terms of social behavioral approaches, which stresses the influence of the social environment. It has been identified that different cultures have varying values and believes (Lambing and Kuehl, 2000:18-19). That is, some culture encourages entrepreneurship whereas others discourage, some promotes achievement whereas others give low value to entrepreneurship. For example, the Japanese have been known to have an achievementoriented culture which helps entrepreneurs persist until they succeed. That is, they give high value to entrepreneurship and encourage entrepreneurs to succeed. With respect to this, McClelland (Deakins, 1999: 18) has identified that the historical role models influence of heroes on subsequent generation induced a high motive of achievement on the population. On the contrary, in some cultures, entrepreneur ship may be conceived as an occupation for low self-esteemed persons. For example, it is well described in Lelissa (2006:17) and UNESCO (2002:132) the negative social image held on the TVET program which discourages entrepreneurial ideas of TVET graduates (this will be discussed further in this section later). The entrepreneurial tradition of the family has the most significant impact on the early development of entrepreneurial personality. Young (in Batra, 2003:26) maintains that entrepreneurial activity is generated by a particular family background and experience as a member of certain kinds of group and as a reflection of general cultural values. In respect to this, Saini and Rathore (2001:5-6) described that entrepreneurial traditions of the family as well as the community are important factors within which the entrepreneur grows and internalizes the values and norms. In addition, Batra and Dangwal (2003:13) have stated that caste and community are the most important socio-cultural determinants of entrepreneurial supply and performance. With regard to societal attitudes, the TVET program itself is victim of negative image held by the society in Ethiopia. According to a research finding (Lelissa, 2006:17), it has been discovered that trainees of TVET institutions are considered as low achievers or failures of grade ten (national examination) students who are forced to attend TVET which discourages the potentially motivated students. This image of the society at large and the view of the graduates in particular is a barrier to have confidence and envision in their vocational career in general and starting new venture in particular. That is, the graduates feel inferior of their friends who joined the degree program and strive for higher education after a period of wage employment service which is a government requirement as a path way to higher education. This path way may force the TVET graduates to work on a paid employment for the sake of getting a two-year work experience which is levied by the government policy as a requirement. The negative images has been found to be global that a UNESCO monograph on perceived status of TVET stated as TVET is often seen as a poor alternative to university or college courses, and the career paths resulting from TVET programs are often seen as less desirable as far as the career success of young people is concerned (Hiebert and Borgen in UNESCO, 2002:132). Thus, the graduates are highly occupied by the drive to achieve higher education opportunity rather than thinking of job creation (self-employment). Demographic factors such as gender may also contribute to graduates entrepreneurial success as a result of the influence of backward social and cultural environment. Though in the relatively long past times women are confined in the four walls of houses performing household activities, currently they are emerging as successful entrepreneurs (Khanka, 2004:18). This is due to educational equity and technological advancement that helped women to come out of the four-wall confinement and enabled them currently to run their own enterprises successfully. Likewise, religion as one component of social factors, the performance of individual entrepreneurs is directly or indirectly inspired by religious ideas (Khanka, 2004: 14). That is, in some religions high profit and interests are considered as a sin deeds. Thus, the social and cultural environment at which the entrepreneur emerged is important source of entrepreneurship as well as entrepreneurial personality. Government Policies and Ations Under this category, factors that influence entrepreneurial success include governments economic and industrial policies, trade laws and legitimacy, promotion of free market, individual freedom, economic stability, introduction of new technology, etc. The economic and political environment includes various factors that either facilitate or inhibit the would-be entrepreneur the undertaking of a business venture which are necessary conditions for the success of the business. Among the economic factors lack of capital, working place, facilities and market are at the forefront. The week availability of credit services and the very limited accessibility of financial institutions is a barrier to start a new venture. A World Bank report (2005) has identified that some of the graduates are not interested to be self-employed due to lack of capital, lack of training and lack of national policy which favored self-employment. The problem of capital and inadequate provision of micro-credit services are therefore central to the TVET graduates to start new micro and/or small enterprises. Hence, government economic policies which encourage new entrepreneurs in the provision of credits, availability of facilities, presence of technical assistance (consulting personnel), establishment of entrepreneurial incubation centers, facilitation of infrastructures, arrangement of working places and market are some of them just to mention few. With respect to the policy that favors new entrepreneurs, the training areas (sectors) affect the extent to which graduates are self-employed. That is, in relation to the governments 70/30 (hard/soft skills) proportion training direction, soft skill training s such as business fields may not be benefitted from incentives and encouragements. There is a tendency to discourage soft skills (occupations) training areas and, as a result, low access to the opportunities to soft skills graduates, as experiences of entrepreneurial efforts of the soft skills graduates showed. In this regard, for example, an attempt of establishing a small firm on auditing service by accounting graduates was inhibited by a concerned governments Audit Office until related guideline is prepared but not realized and the graduates effort has been discouraged so that the group was banned. In addition, with respect to government actions and policies favoring new entrepreneurs, economic regulations and taxation benefits are also important factors. Political stability, freedom of entrepreneurs, promotion of free market, absence of corruption, guarantee of security, etc. are also influential factors connected to the political environment (Dollinger, 1999:57). Support System Services Factors related to available support services include a number of services such as the quality of training institutions, on the job training provision of companies, financial and commercial institutions, research findings, entrepreneurial personnel support, consultancy services, etc. These support services have their share to the success of TVET graduates in venture creation efforts. Some scholars generally assume that entrepreneurs are born and support services are less important. However, it is proved that with the right type of training, follow up support and assistance, one can develop oneself as an entrepreneur (Batra, 2003:35). It is clear that the latent potentials can be cultivated and developed through wellconceived and integrated type of training including entrepreneurial skills. With this respect, Batra has stated that the right type of entrepreneurial training helps to identify and develop the natural, inherent and potential virtues of the human being which are lying dorm ant. From this we understand that the type and quality of training offered in a TVET institution is vital for the TVET graduates entrepreneurial venture. Institutions (schools) with exciting courses in entrepreneurship and innovation tend to develop entrepreneurs and an entrepreneurial environment (Hisrich Peters, 2002:13). This shows that the institutions ability to equip the trainees with the necessary skills, knowledge and attitude paves the way to the idea of entrepreneurship and realization of a venture. In relation to the role of training, the quality of trainers in their entrepreneurial skills and awareness about the expected output (entrepreneurial capability of graduates) is also one pivotal input. Encouragement to self-employment is further stimulated by trainers (teachers), who can significantly influence individuals to regard entrepreneurship as a desirable and viable career path (Hisrich Peters, 2002:13). In addition to the trainers role for the entrepreneurial development of the trainees in training institutions, career guidance and counseling support is another contributing component of the quality of the TVET graduates. Hiebert and Borgen (in UNESCO, 2002:131) have well stated that guidance and counseling services are essential for the goals of TVET to be fully realized and that they should for that reason be fully integrated with all TVET programming. These services should be provided beginning at the time of enrollment in orienting their occupational choice, inculcating positive attitude through out their training and showing direction of their career path through the provision of career information including entrepreneurship. Another aspect of education and training background of the entrepreneur is experience of a previous business. This experience may be expressed in terms of any kind of exposure to a business environment be it free service ( practices in the form of apprenticeship or internship) or wage employment for a specific period of time. Some graduates choose wage employment because they acquire experiences without incurring cost such as know how to run a business, identify the way in which things operate in a business environment, learn skills of leadership and coordination, had a network of contacts, etc. In this respect, a research finding (Lambing Kuehl, 2000:90) in a survey on source of business ideas of 500 successful entrepreneurs revealed that most of them (nearly half) (43%) of the respondents said they got the idea for their business from the experience they gained while working for wage in the same industry or profession. Therefore, it is clear that work integrated training methods such as apprenticeship, internship, cooperative training and free practice programs are of paramount importance. In addition to the above factors, support services such as financial and commercial institutions, micro and small enterprise development personnel support, consultancy services, research findings, etc., have their own role for the entrepreneuri

Pathophysiology of sepsis | Case Study

Pathophysiology of sepsis | Case Study Thomas, a 70-year-old man, admitted to hospital with a five-day history of coughing with yellow-green sputum, pyrexia, rigors, poor appetite, mild chest pain and increasing difficulty of breathing. The initial observations are: Neurological: Altered neurological status, GCS 11/15. Agitated and confused. Cardiovascular: Sinus tachycardia, HR 135bpm. Hypotension, 90/45 mmHg. Respiratory: Tachypnoeic, RR 35bpm. Decreased saturation while receiving 6L O2 through Hudson mask. Metabolic: Febrile, 39 degree Renal: Oliguric with 20ml/hr urine output. Indwelling catheter (IDC) was inserted. The blood test revealed that the patient was suffering from hypernatremia, hyperkalaemia, hyperglycaemia, elevated urea, poor creatinine, increased WCC and low platelet count. The ABG indicated that Thomas was experiencing combined respiratory and metabolic acidosis. Thomas was finally diagnosed as sepsis complicated by the right middle lobe streptococcus pneumonia. He required intubation and invasive ventilation support. In this case study, the pathophysiology of sepsis will be discussed and the mechanism of synchronised intermittent mandatory ventilation (SIMV) volume control ventilation mode will be explained. Sepsis is defined as the dysregulated inflammatory response caused by severe infection (Neviere 2015). It has the interchangeable definition as Systemic inflammatory response syndrome (SIRS) while the SIRS is resulted by a suspected or confirmed infectious source (Neviere 2015). The concept of SIRS was first introduced by the American College of Chest Physicians (ACCP) and Society of Critical Care Medicine (SCCM) in 1992 (Kaplan 2014). It is characterised by two or more following symptoms. They are fever of high than 38 degree or hypothermia; tachycardia; tachypnoea or partial pressure of arterial carbon dioxide (PaCO2) less than 32 mmHg; deranged white cell count of more than 12,000/Â µL or less than 4,000/Â µL (O’brien et al. 2007). Associated with Thomas’s symptoms, it is clear to see that he was definitely experiencing sepsis. It is because that he was febrile up to 39 degree, tachycardic with heart rate of 135 bpm, and had increased respiratory rate of 35bpm as w ell as the elevated leucocytes count of 14,000 per microliter. The clinical signs are related to the inflammation process which is activated by the body immune system. Due to the severe infection, a large number of proinflammatory mediators are released which in turn result in the serial inflammatory reaction and extensive tissue damage (Neivere 2015). It is reported that SIRS can lead to high mortality rate because of high occurrence of SIRS induced multiple organ dysfunction syndrome (MODS) (Singh et al. 2009). In the following paragraphs, the pathophysiology of sepsis/SIRS will be more comprehensively examined. The pathophysiology of SIRS is complex. There are a few elements that need to be emphasised. They are acute stress response, inflammatory process and cytokine storm. Firstly, stress response is the acute phrase reaction when the body tries to defence against the threatening triggers. Those triggers are also known as ‘stress’. Stress can be caused by daily life events, environmental factors or physical illness (Better Health Channel 2012). In Thomas’s case, the stress response is initiated by infection. Under the influence of stress, the body steady state is disrupted. To maintain the homeostasis, the stress response is activated to reverse the body balance and redistribute the oxygen and energy to maintain the function of vital organs (Kyrou et al. 2012). Hypothalamus plays a vital role in processing the distress signals (Seaward 2015). Once it senses the stress, it triggers the activation of sympathetic nervous system. The sympathetic nervous system then stimulates the adrenal gland to produce epinephrine. It is also known as adrenaline. The adrenaline can lead to increased heart rate and myocardial contractility; dilated pupils and bronchi; peripheral vasoconstriction; accelerated respiratory rate; decreased digestive activity and increased production of glucose from liver (Seaward 2015). In addition, stress can also activate another pathway of stress response. That is the hypothalamic-pituitary-adrenal (HPA) axis (Seaward 2015). It means the stress triggers the release of corticotrophin-releasing factor (CRF) from anterior hypothalamus. The CRF then promotes the pituitary gland to produce adrenocorticoid trophic hormone (ACTH). The ACTH stimulates the production of cortisol and aldosterone through the adrenal cortex. Those corticosteroids can result in increased metabolism, sodium and water retention (Seaward 2015). Therefore, it is obvious that Thomas was under the effect of stress. He was tachycardic, tachypnoeic and slightly hyperglycaemic due to the effect of sympathetic nervous response. He was oliguric because of the acute kidney injury secondary to the vasoconstriction. His hypernatremia status can be contributed by the impact of aldosterone. He had poor oral intake can be cause by the suppressed digestion function. Secondly, the inflammatory cascade plays an essential role in the pathophysiology of systemic inflammatory response syndrome. Sagy et al. (2013) summarised the inflammation mediator related mechanisms in the systemic inflammatory response. It is indicated that the excessive release of pro-inflammatory mediators result in the inflammation, inhibit the function of compensatory anti-inflammatory response, and compromise the immune system eventually (Sagy et al. 2013). Cytokines are the essential components of immune system. Bone et al. (1992) explained that the local cytokines are activated immediately after an insult in order to repair the wound and initiate the innate immune system. Because of the release of local cytokines, a small amount of cytokines go into the circulation. This promotes the production of growth factor and adhesion of macrophages and platelets to help with the recovery of the local damage. However, when the infection is severe and the homeostasis is unable to be restored, cytokine storm occurs. More specifically, cytokine storm is formed from a complex progression. Cytokines are made up by macrophages, monocytes, mast cells, platelets and endothelial cells, which are the initial immune defensive components (Plevkova 2011). The multitude of cytokines can soon induce the cytokine tissue necrosis factor-alpha (TNF-a) and interleukin-1 (IL-1). Those two elements result in the removal of nuclear factor-KB (NF-KB) inhibitor. This in turn prompts the production of more proinflammatory mediators, such as IL-6, IL8 and interferon gamma (Plevkova 2011). In other words, cytokines stimulate the production of immune cells, which in turn induce more cytokines in the circulation. The cytokines have a great impact on the body, including direct or indirect contribution of mortality in SIRS. TNFa is discovered causing fever, abnormal haemodynamic values, low white cell count, increased liver enzymes and clotting problems (Jaffer et al. 2010). IL-1 is reported having connection with fever, haemodynamic abnormality, loss of appetite, general weakness, headache and neutrophilia (Jaffer et al. 2010). IL-6 is found having strong relationship with fever and impaired lung function as well as acting a determinant of severity of SIRS and mortality rate (Jaffer et al. 2010). The massive accumulation of cytokines can cause widespreading vasodilatory effect. It is because the cytokines stimulate the release of vasodilators such as nitric oxide (Sprague and Khalil 2009). Additionally, cytokines promotes adhesion of the immune cells and the endothelial cells, which in turn leads to leaky endothelium and loss of fluid from intercellular space to extracellular space (Sprague an d Khalil 2009). Moreover, the cytokines cascade can also lead to the clotting disorder. It is because of the high concentration of fibrinogen in the inflammation process (Esmon 2005). The fibrinogen is converted from thrombin, which is generated by tissue factor. Tissue factor is a substance that is expressed by the surface of white cell. It can also be induced by TNFa and endotoxin from the infection (Esmon 2005). The fibrinogen can be transferred into fibrin which in turn forms clots. As the excessive amount of fibrin in the inflammation status, it can result in extensive clotting disorder. To sum it up, it can be concluded that Thomas’s fever is highly likely related to the release of TNFa, IL-1 and IL-6. IL-1 could be one of the contributors of his poor appetite and elevated white cell count. IL-6 could worsen Thomas’s existing affected lung function. Thomas had increased white cell count can be contributed by the immune response and IL-1. The hypotension is related to the vasodilation effect. Due to the hypotensive, the kidney perfusion dropped and then led to the acute kidney failure and poor urine output. The acute kidney injury may affect the elimination of potassium so that Thomas was found having high potassium level. The low platelet count could be related to the massive production of cytokines and damaged endothelium. In the next section, the synchronised intermittent mandatory ventilation volume control will be explained as Thomas’s mechanical ventilation management. The synchronised intermittent mandatory ventilation (SIMV) is commonly used in ICU. With the volume control mode, the patient is given the ventilation support with a set tidal volume during the mandatory breaths (Deden 2010). To provide the effective ventilation support, there are a few specific values that need to be set up for the SIMV volume controlled mode. They are tidal volume and respiratory rate. The tidal volume refers to the amount of oxygen delivered by the ventilator or the amount of oxygen the patient breathes voluntarily. The respiratory rate is set up for mandatory breaths. In the SIMV volume controlled mode, the ventilation is trigger by the ventilator or patient self. It means the actual respiratory rate can be upon the preset rate (Goldsworthy and Graham 2014). There is a window of time for the ventilator to sense the patient’s inspiratory effort. This trigger window helps avoid the ventilator deliver the oxygen when the patient exhales (Deden 2010). If the p atient is able to trigger the ventilation within the time frame, the patient-triggered mandatory breath is induced. After reaching the demand tidal volume, the inspiratory phrase ends and expiratory starts. Between each mandatory breaths, the patient is able to initial own spontaneous breath, the breathing volume and length depend on the patient’s respiratory effort (Pierce 2007). If the patient is heavily sedated and unable to initiate the spontaneous breath within the trigger window, the machine-triggered mandatory breath will be activated to provide constant ventilation support according to the set respiratory rate and tidal volume (Deden 2010). Once the ventilator delivers the demand tidal volume, the inspiratory cycle ends and expiratory phrase starts until the next scheduled inspiratory cycle. If the patient’s attempt of breathing is not strong enough to trigger the patient-triggered mandatory breath, the assisted synchronised breath will be provided to achieve t he desired the tidal volume. Like the other mode, the inspiratory cycle ends once the set tidal volume is delivered (Deden 2010). It is believed that Thomas would be beneficial from the SIMV volume controlled mode. It is because that SIMV mode could help him reduce the work of breathing, especially when he was in the high energy-consuming septic status. In addition, due to the SIMV mode, the ventilator allows him to have extra breath to blow off the accumulative carbon dioxide. This can improve his acidosis. Moreover, because of the systemic inflammatory response syndrome and severe pneumonia, his lungs could be stiff and fragile secondary to the inflammation effect and accumulation of cytokines. The volume controlled ventilation acts as a protective strategy to avoid the ventilator related complications, such as volutrauma. It is recommended not to set the tidal volume more than 8-10ml/kg (Deden 2010). In conclusion, sepsis is a systemic inflammatory response syndrome resulted by the infection. The stress response, inflammation reaction and cytokines play essential roles in the progression of SIRS. As SIRS can cause high mortality rate, it is vital to control the infection and manage the widespreading inflammation as well as providing appropriate support to treat the symptoms. In Thomas’s case, the volume controlled synchronised intermittent mandatory ventilation would be the better option of managing his severe pneumonia and respiratory distress. Reference Better Health Channel 2012, Stress, viewed 12th March 2015, http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/stress Bone, RC, Balk, RA, Cerra, FB, Dellinger, RP, Fein, AM, Knaus, WA, Schein, RM Sibbald, WJ 1992, ‘Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine’, Chest, vol. 101, no. 6, pp. 1644-1655. Deden, K, 2010, Ventilation modes in intensive care, Dragerwerk AG C0. KGaA, Germany Esmon, CT 2005, ‘The interactions between inflammation and coaulation’, British Journal of Haematology, vol. 131, no. 4, pp. 417-430. 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Kaplan, LJ 2014, Systemic inflammatory response syndrome, viewed 19th March 2015, http://emedicine.medscape.com/article/168943-overview#a0101 Kyrou, I, Chrousos, Kassi, E Tsigos, C 2012, Stress, Endocrine physiology and pathophysiology, viewed 12th March 2015, http://www.endotext.org/chapter/stress-endocrine-physiology-and-pathophysiology/#h23 Neviere, R 2015, Sepsis and the systemic inflammatory response syndrome: Definition, epidemiology and prognosis, viewed 19th March 2015, http://www.uptodate.com/contents/sepsis-and-the-systemic-inflammatory-response-syndrome-definitions-epidemiology-and-prognosis O’brien, JM, Ali, NA, Aberegg, SK Abraham, E 2007, ‘Sepsis’, The American Journal of Medicine, vol.120, no.12, 1012-1022. 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Medical Miracles On The Horizon :: essays research papers

Medical Miracles on the Horizon The world and its inhabitants will face a multitude of problems in the 21st Century, including drug addiction, deadly disease, violent crime, warfare and hostility, hunger, and homelessness to name a few. All of these critical issues have been present to some extent in the 20th Century and, left unsolved, will continue to plague society and mankind as we enter the new millennium. As we rapidly approach the next era, new issues of equal or even greater importance for mankind will almost certainly arise. I personally envision health issues, concerns related directly to medicine, as the central, most critical and comprehensive problem facing leaders of the 21st Century.   Ã‚  Ã‚  Ã‚  Ã‚   In my opinion, physicians and others associated with the medical profession will participate in one of the most vital and urgent roles entering into the new era. This is one of the reasons that I intend to pursue a career in the medical field after I graduate from The University of Tennessee. Of all occupations in the next millennium, medicine will be perhaps the most important and influential in combating the problems of mankind and in solving them.   Ã‚  Ã‚  Ã‚  Ã‚   People in the field of medicine will continue, as they have in this century, to address and participate in almost all concerns. For example, methadone is currently being used as a therapeutic intervention for some drug addictions. In addition, various medications are now being given in the treatment of criminals, like anti-psychotic drugs to curb aggressive or violent behavior in schizophrenics. A new and improved group of antidepressants is also being used to treat and reduce the growing rate of suicide in all ages of our society. Because a very high percentage of homeless people suffer from psychological problems and/or drug addictions, doctors may also eventually play a larger role in prescribing medication for these individuals. Concerning warfare that may be present into the 21st Century, the medical community will be required to detect and treat a variety of injuries and illnesses, just as they have had to decipher and work on patients who fell victim to the Gulf War Syndrome. Any future wars may have even more insidious side-effects due to the use of lethal chemicals. Cures have been found for many illnesses, such as polio, smallpox, and various childhood diseases in the present century, but other health concerns are manifesting rapidly. One of the most important task doctors and research scientists may face is to fight new strains of deadly diseases in the coming years. Outbreaks of eboli and the emergence of diseases that are drug-resistant to antibiotics threaten the survival of mankind.

Agency essay for email :: Business Management Studies

Agency essay for email Text Box: The Client/Agency Relationship Prestige Nursing & MKH Advertising What are marketing and advertising agencies The purpose of this report is to evaluate the relationship Prestige has with its marketing agency MKH Advertising. There are 4 basic types of agency:  · Full Service Agencies who carry out the full range of advertising & marketing activities for clients  · Media Independents who specialize in buying media space  · Creative Specialists who focus on developing creative ideas  · Production Specialists who specialize in producing work in a certain format or medium MKH is a large agency offering a full range of advertising-related services. They assist in planning and executing advertising programmes and in all stages of the marketing and advertising process to assist Prestige in getting the best from their advertising by providing Prestige with the services of skilled & specialist individuals. The core services MKH provides for Prestige are creating ideas for campaigns and selecting and buying the media in which they will appear. MKH are also able to advise on marketing strategy, public relations and integrated advertising campaigns involving above and below the line media buying. Their staff include an account manager, artists, writers, media analysts, researchers, and others with special skills, knowledge and experience that can help market Prestige’s services. Why Prestige uses MKH  · They are communication specialists who understand integrated marketing communications and the consumer buying process.  · MKH provides an objective viewpoint of the market, enabling Prestige to achieve advertising objectivity & to maintain an independent and unbiased view of the marketplace.  · Have an extensive range of experience of the healthcare advertising industry & have worked on the accounts of our competitors, therefore giving an insight into the industry and possibly the competition.  · Have the experiences and contacts to put the Prestige business ahead in the marketing communications field by effectively engaging and informing companies’ customers about the services or products.  · Enables Prestige to stand apart from the competition by retaining corporate identity reminding customers reminded of the services  · Helps Prestige business reach its marketing goals.  · Helps strategically position Prestige services in the market  · Generates revenue by building awareness of their product or service and therefore increasing sales. Key personnel & their roles in the MKH/Prestige relationship. MKH employs hundreds of people but the roles & departments within MKH cover the same basic job functions as most other full service agencies, each performing various advertising functions such as;  · Marketing  · Communications  · Promotions services (planning, creating and producing the