Managing Conflict Essay

Managing conflict Medicolegal issues We live in an increasingly demanding and vociferous society and incidents of conflict and aggression are sadly commonplace. Kate Taylor, Clinical Risk Manager at the Medical Protection Society offers advice on how to deal with the problem Working in general practice is busy and demanding, with increased workloads, stretched time and some patients having greater expectations of care. At times, when expectations are not met, we can find ourselves in conflict with patients – and in some situations this can turn to aggression. As nurses, how should we deal with potentially difficult situations? This article aims to increase our understanding of conflict and provide strategies to deal with it effectively. It also includes practical tips to reduce risks associated with managing conflict and aggression. DEFINITIONS Conflict means different things to different people. The Health and Safety Executive defines workplace violence as ‘any incident where staff are abused, threatened or assaulted in circumstances relating to their work, involving an explicit or implicit challenge to their safety, well-being or  health’.1 Non-physical violence can be defined as the ‘use of inappropriate words or behaviour causing distress and/or constituting harassment.'[ 2] The scale of the problem There is limited documentation relating to violence against nurses working in general practice. However, a recent survey carried out by the British Medical Association, to which 20% of doctors responded, found:[ 3] * Violence is a problem in the workplace for half of doctors (same for GPs and hospital doctors). * 1 in 3 respondents had experienced some form of violence in the workplace in the last year (same for hospital doctors and GPs). * 1 in 5 doctors reported an increase in violence in the past year, but the level remained constant for the majority. * Among doctors who reported some experience of violence, most had been the victim of verbal abuse in the past year while more than half had received a threat, and a third had been physically assaulted. Most injuries were minor, but 5% were serious. In April 2011, NHS Protect was set up. It is responsible for leading on work to protect NHS staff and resources from crime in England.[ 4] According to its statistics, physical assault against NHS staff is steadily increasing. However, these statistics do not capture the incidents where staff have been subjected to non-physical violence. In general practice, members of staff are more likely to be subjected to non-physical violence. Imagine working as a practice nurse and an unhappy patient threatens you, telling you ‘I know where you live?’ We cannot underestimate the impact that such non-physical violence can have on individuals. CONTRIBUTORY FACTORS Circumstances * Members of the general practice team are particularly vulnerable as they often consult with patients alone. Doctors and practice nurses often work in small numbers. * Home visits are usually carried out alone. System and Organisational Problems * Delays, restrictions and mistakes such as lost prescriptions or delays in test results * Lack of appointments * Patient disappointment often results from unmet expectations, whether  realistic or unrealistic. Environment * Waiting room (heating, lighting, noise and seating) * Cramped consulting rooms without easy exit for health professionals * Lack of privacy * Availability of potential weapons. Patient Factors * Increased expectations and the difficulties in meeting these demands. Dissatisfaction with the care provided is perceived as the most common cause of aggression and violence * Strong patient emotions e.g. uncertainty, frustration, stress and anxiety. Anger is often secondary to emotions such as anxiety or grief * An underlying medical condition such as hypoglycaemia or psychotic illness * Physical symptoms including pain, headache or over-tiredness * Mental health problems such as * Personal problems e.g. financial, relationship, stress at work * Drugs and alcohol. Staff Factors * Under pressure staff-working in noisy cramped rooms, unable to trace or contact staff * In adequate staff numbers * Escalating the situation by confrontation, over-reacting, poor ccmmunication, inconsistencies in handling patients, patronising behaviour, ignoring a situation or falling to apologise. COMMUNICATION SKILLS Good communication with patients is likely to reduce the risk of conflict and violence. As nurses, how we communicate with our patients can have an impact on how difficult situations develop. We need to think about what we say and how we say it. We should rely on our strong communication skills to determine with our patients what they can expect from the services we provide. A study by American psychologist, Albert Mehrabian, determined that non-verbal communication represents over 50% of an interaction.[ 5] Being aware of your own body language can be the first step to understanding how it is perceived by our patients. Listening and empathising with patients are essential skills for nurses-so how do we ensure our patients know we are listening? * Give the patient your undivided attention * Don’t trivialise the patient’s issue * How is the patient feeling – are they angry, afraid, frustrated? Respond to the emotion as well as the words * Allow the patient to finish what they are saying * Ask questions, paraphrase and reflect to ensure you understand the message. CHALLENGING INTERACTIONS Challenging interactions with patients can be a significant cause of stress for nurses, yet the nature of most clinical jobs makes these encounters unavoidable. It can be difficult to communicate your point of view effectively for fear of generating conflict, which can lead to frustration and dissatisfaction, and may affect your ability to give good care. It is vital to build a trusting relationship with the patient in these circumstances; ensure you listen attentively, empathise and avoid confrontation. Maintain eye contact and try to establish a shared understanding of the patient’s problem. Having acknowledged their perspective, respectfully inform them of your position. Then work on achieving a mutually agreeable solution or way forward rather than focussing on points of disagreement, which can otherwise degenerate into an argument. Then help and support the patient to achieve the agreed solution. After challenging interactions that have required you to state your position, ensure there is effective communication with other members of the practice clinical team, along with a clear record of the discussions held. This will ensure consistency should the patient approach a different clinician seeking to re-negotiate an alternative plan or outcome. PRACTICAL TIPS Practices should consider: * Providing a side room or separate area to deal with upset/aggressive patients or those who need more privacy. * Providing good temperature and ventilation control, adequate seating and clear signage * Providing calming measures to reduce frustration, anxiety or boredom such as distractions in waiting room e.g. toys for children, magazines for adults * Adding an agreed marker to the summary of a patient’s record who has a history of violence (and ensure it is factually accurate) * Having a protocol for involving the police and removing patients from the list * Using CCTV * Ensuring all practice staff have access to panic alarms * Providing locks for all areas where patient access is restricted CONCLUSION We can and will experience conflict in general practice due to the sheer volume of patient contacts that occur every day. The key to managing a conflict situation is to try to de-escalate it as much as possible.confidentiality is central to the trust between nurses and their patients – think how easy it may be to breach confidentiality when you have a situation with an aggressive patient. The Nursing and Midwifery Council Code of conduct clearly states ‘you must respect people’s right to confidentiality’.[ 6] As a last resort you can remove a patient from the practice list. However, this can be seen as an emotive issue, risking criticism from bodies such as the Parliamentary and Health Service Ombudsman, the GMC and the media. You can find useful information on how to go about it in the MPS factsheet, Removing patients from the practice list (September 2013).[ 7] http://www.medicalprotection.org/ uk/england-factsheets/removing-patients-from-the-practice-list. CASE STUDY Nurse E is about to start her clinic when she notices Mrs S on the list of patients for the day. Her heart sinks. Mrs S often presents with one or more complaints, talks nonstop and does not listen to advice provided. She knows from experience that interactions with Mrs S will be challenging. Mrs S is called in 20 minutes later than her planned appointment and she lets Nurse E know that she is not happy. Nurse E admits that her clinic is running late but tells Mrs S that she had an unavoidable emergency. She proceeds to take Mrs S’s blood pressure and other vital signs. Mrs S then asks Nurse E for a prescription for antibiotics as she is going on holiday and wants them ‘just in case her chest flares up’ while away. Nurse E advises her that she will need to make an appointment to see the GP. Mrs S, now increasingly unhappy, begins to raise her voice and bang her fist on the desk, demanding a prescription before she leaves. Nurse E, staying calm, advises Mrs S that she is unable to give her a prescription as she doesn’t have any active symptoms. Mrs S storms out of the consultation room pushing past Nurse E. Understandably upset, Nurse E calls the practice manager to report the incident. How could this situation have been dealt with better? * Apologise when mistakes occur or when clinics are running late. Some practices ask reception staff to inform patients when they are checking in if clinicians are behind schedule * Ensure patients are well informed about how systems at the practice work to try to reduce unrealistic expectations * Acknowledge the patient’s emotions and allow them to express them, which can take time. Ask the patient to tell you about their concerns. Listen actively using comments such as ‘I see’, or ‘go on?’, and nodding your head. Summarise their experiences, feelings and concerns back to them * Work with the patient to resolve the situation. Agree a plan for dealing with their concerns and moving forward. * Try to offer an alternative solution to demonstrate that you are keen to help them. For example, ‘I’m sorry Mrs S, but I am unable to give you a prescription. However, if you wish to make an appointment with one of the GPs you can discuss this with them’ * Consider the layout of the consulting rooms and reception area to ensure you can leave the room if the situation escalates. Aggression in healthcare settings is becoming all too common REFERENCES 1. Health and Safety Executive: work related violence www.hsegov.uk/violence 2. NHS Business Services(2012) Not part of my job http://www.nhsbsa.nhs.uk/Documents/ SecurityManagement/NP0J1 .pdf 3. British Medical Association (2008). Violence in the workplace. The experience of doctors in the UK. http://www.bma.org.uk/ap.nsf/AttachmentsByTitle/ PDFviolence08/$FILE/Violence.pdf 4. NHS Protect 2013 http://www.nhsbsa.nhs.uk/Protect.aspx 5. Mehrabian, A(1971) Silent messages Belmont, CA:Wadsworth 6. NMC(2011)The code: Standards of conduct, performance and ethics for nurses and midwives http://www.nmc-uk.org/Documents/Standards/ nmc TheCodeStandardsofConduct PerformanceAndEthicsForNursesAndMidwives%5FLargePrintVersion.PDF 7. MPS Factsheet removing patients from practices list September 2013 http://www.medicalprotection.org/uk/england-factsheets/removing-patients-from-the-practice-list ~~~~~~~~

Extraction and Evaporation Recrystallization Essay

1. To the components of a simulated pharmaceutical preparation, Panacetin, and identifying the unknown component of the mixture through extraction and separation methods. 2. To learn how to purify by recrystallization, how to dry them and how to obtain a melting point. PRECAUTION: ACETANILIDE AND PHENACETIN ARE EYE AND SKIN IRRITANTS. Minimize contact with your unknown compound. THEORY: In this experiment, Panacetin, a pharmaceutical preparation will be separated from its components by making use of their solubilities and acid-base properties. Panacetin contains aspirin, sucrose and an unknown component that may be either acetanilide or phenacetin. Of the three components, only sucrose is insoluble in the organic solvent dichloromethane (CH2Cl2 or methylene chloride). The insoluble sucrose can be filtered out if Panacetin is dissolved completely in dichloromethane by gravity filtration or centrifugation leaving the soluble aspirin, acetanilide and phenacetin in the solution. Although the acetanilide and aspirin are both quite insoluble in water at room temperature, the sodium salt of aspirin is very soluble in water but insoluble in dichloromethane. Aspirin, which is a strong acid can be converted to the salt, sodium acetylsalicylate by extraction with an aqueous solution of sodium bicarbonate . This salt will migrate from the dichloromethane layer, in which it is insoluble, to the aqueous layer, in which it is soluble. The unknown component will stay behind in the solution  and can be isolated by evaporating the solvent from the dichloromethane solution. Adding HCl to the aqueous solution restores aspirin as an insoluble white solid. In the third experiment, the identity of the unknown component of Panacetin will be purified. Purification is necessary because the separation procedure may be imperfect leaving traces of small quantities in the compound after separation or chemical reactions may occur prior to or during the separation adding new impurities. The unknown component can be purified by recrystallization, in which an impure solid dissolves in a hot (usually boiling) solvent then crystallizes from the cooled solution in a purer form. METHODS/PROCEDURES: This experiment was followed from the textbook on pages 52-53 for experiment 2 and 59-60 for experiment 3 excluding the microscale part. First, weigh approximately 3.00 g of Panacetin and transfer it to a clean, dry 125 ml Erlenmeyer flask. Add 50 ml of dichloromethane to the flask , stir the mixture with a stirring rod to break up any lumps. When it appears that no more of the solid will dissolve, filter the mixture by gravity. Collect the undissolved solid on the filter paper and set it aside to dry. Once it has completely dried, reweigh the solid. This compound separated by gravity  filtration is known as sucrose. Next, transfer the filtrate to a separatory funnel and extract it with two 30 ml portions of 5% sodium bicarbonate . For each extraction, use a stirring rod to stir the liquid layer until any fizzing subsides before a stopper is placed on the funnel and shaken. Dichloromethane will be on the bottom layer and will be drained to a different container. Transfer the dichloromethane layer back into the funnel for the second extraction. The upper layer will be transferred in an Erlenmeyer flask and will be used for recovery of acetanilide. Combine the two aqueous solutions in the same container and acidify slowly with 6M HCL to bring it to a pH of 2. Cool the mixture to room temperature or below while swirling the flask occasionally in an ice bath. Collect the aspirin by vacuum filtration. Wash the aspirin on the filter with cold distilled water. Dry the sample thoroughly before weighing and leave it in the hood for the next lab schedule. Before proceeding to recrystallization, triturate the compound with 20 ml of hexane. Crush the solid with a stirring rod and filter. Recrystallize the unknown drug component from experiment 2 by boiling it with just enough water to dissolve it completely, then letting it cool to room temperature then to 0 C. In order to induce crystallization, it would be helpful to scratch the walls of the flask so that crystals would have a surface to attach to. Use vacuum filtration to isolate the sample then dry the product to a constant mass and weigh in a tared vial. Grind a small amount of the dry unknown component to a fine powder on a watch glass using a spatula. Divide the solid into four equal portions. Combine portions 1 and 2. Mix portion 3 with an approximately equal amount of finely ground acetanilide and mix portion 4 with an approximately equal amount of finely ground phenacetin. Obtain the melting point ranges of the purified unknown (portions 1 and 2), mixture with acetanilide and mixture with phenacetin. Each melting point should be measured on two samples- more than that if melting points are imprecise or accurate. Safety Issues: (all of these are taken from MSDSonline.com) 1. Acetanilide Potential Acute Effects: Hazardous in case of eye contact (irritant), of ingestion, of inhalation. Slightly hazardous in case of skin contact (irritant). Potential Chronic Health Effects: Hazardous in case of eye contact (irritant), of ingestion, of inhalation. Slightly hazardous in case of skin contact (irritant). 2. Phenacetin Eye and skin irritant 3. Dichloromethane Potential Health Effects Inhalation: Causes irritation to respiratory tract. Has a strong narcotic effect with symptoms of mental confusion, light-headedness, fatigue, nausea, vomiting and headache. Causes formation of carbon monoxide in blood which affects cardiovascular system and central nervous system. Continued exposure may cause increased light-headedness, staggering, unconsciousness, and even death. Exposure may make the symptoms of angina (chest pains) worse. Ingestion: May cause irritation of the gastrointestinal tract with vomiting. If vomiting results in aspiration, chemical pneumonia could follow. Absorption through gastrointestinal tract may produce symptoms of central nervous system depression ranging from light headedness to unconsciousness. Skin Contact: Causes irritation, redness and pain. Prolonged contact can cause burns. Liquid degreases the skin. May be absorbed through skin. Eye Contact: Vapors can cause eye irritation. Contact can produce pain, inflammation and temporal eye damage. Chronic Exposure: Can cause headache, mental confusion, depression, liver effects, kidney effects, bronchitis, loss of appetite, nausea, lack of balance, and visual disturbances. Can cause dermatitis upon prolonged skin contact. Methylene chloride may cause cancer in humans. Aggravation of Pre-existing Conditions: Persons with pre-existing skin disorders, eye problems, impaired liver, kidney, respiratory or cardiovascular function may be more susceptible to the effects of this substance. 4. Aspirin Eye Contact: Moderate Eye Irritation: Signs/symptoms may include redness, swelling, pain, tearing, and blurred or hazy vision. Skin Contact: Moderate Skin Irritation: Signs/symptoms may include localized redness, swelling, itching, and dryness. May be absorbed through skin and cause target organ effects. Inhalation: No health effects are expected. Ingestion: May be harmful if swallowed. Gastrointestinal Irritation: Signs/symptoms may include abdominal pain, nausea, diarrhea and vomiting. Repeated ingestion may cause: May be absorbed following ingestion and cause target organ effects. Target Organ Effects: Prolonged or repeated exposure may cause: Auditory Effects: Signs/symptoms may include hearing impairment, balance dysfunction and ringing in the ears. Clotting Disorders: Signs/symptoms may include increased blood clotting time and internal bleeding (hemorrhage). Liver Effects: Signs/symptoms may include loss of appetite, weight loss, fatigue, weakness, abdominal tenderness and jaundice. Central Nervous System (CNS) Depression: Signs/symptoms may include headache, dizziness, drowsiness, incoordination, nausea, slowed reaction time, slurred  speech, giddiness, and unconsciousness. Kidney Effects: Signs/symptoms may include reduced or absent urine production, increased serum creatinine, lower back pain, increased protein in urine, and increased blood urea nitrogen (BUN). Pulmonary Edema: Signs/symptoms may include chest discomfort, shortness of breath, significant cough with frothy sputum production, bluish colored skin (cyanosis), increased heart rate, respiratory failure and may be fatal. Single exposure may cause: Immunological Effects: Signs/symptoms may include alterations in the number of circulating immune cells, allergic skin and /or respiratory reaction, and changes in immune function. 5. Sodium Bicarbonate EMERGENCY OVERVIEW Warning! May cause respiratory tract irritation. Causes eye and skin irritation. Target Organs: Blood, kidneys, heart, liver, eyes, skin. Potential Health Effects Eye: Causes eye irritation. Skin: Causes skin irritation. May be harmful if absorbed through the skin. Ingestion: May be harmful if swallowed. Causes gastrointestinal tract irritation. Inhalation: May cause respiratory tract irritation. May be harmful if inhaled. Chronic: May cause liver and kidney damage. Adverse reproductive effects have been reported in animals. Laboratory experiments have resulted in mutagenic effects. Chronic exposure may cause blood effects. 6. Hydrochloric Acid POTENTIAL HEALTH EFFECTS: Inhalation: May cause irritation (possibly severe), chemical burns, and pulmonary edema. Skin contact: May cause irritation (possibly severe) and chemical burns. Eye contact: May cause irritation (possibly severe), chemical burns, eye damage, and blindness. Ingestion: Not a likely route of exposure. Target Organs Effected: Respiratory System, Skin, Eye Chronic Effects: Repeated or prolonged exposure to dilute solutions may result in dermatitis. Discoloration of the teeth may occur as a result of long term exposure. Interaction with Other Chemicals Which Enhance Toxicity: None known Medical Conditions Aggravated by Exposure: None known OBSERVATIONS/RESULTS: In Experiment 2, the extraction of substances from one another is based on the differences in their physical and chemical properties. Approximately, 3.0029 g of panacetin was weighed and completely dissolved in 50 ml of dichloromethane and filtered. The residue was left to dry and weighed (sucrose). Then 30 ml of NaHCO3 was added to the filtrate. This solution was transferred into a separatory funnel. This formed two layers. Top layer was the organic layer (NaHCO3) described as a clear liquid. Bottom layer was the aqueous layer and was yellow in color. The filtrate was washed twice with NaHCO3. HCl was added to the aqueous solution until the pH equaled to 2.0. It was filtered through vacuum filtration and allowed to dry until the next week’s lab. This filtrate is known as aspirin. Meanwhile, the unknown in the organic layer was also allowed to settle for the next experiment. In experiment 3, before we went to do recrystallization, we first did trituration of the unknown by adding 20 ml of hexane. We crushed the solid and filtered. Even with the addition of approximately 27 ml of boiling water into the compound, it started to dissolve. That was the first clue that we have acetanilide as our unknown. We went ahead and continue heating and swirling the solution over a hot plate. There was the formation of brown oil-like globules. We were then asked to decant the clear liquid from this solution. This clear liquid was allowed to cool to room temperature then to 0 C. There was formation of white crystals at the edge of the beaker. Through vacuum filtration, we were able to filter the product, weighed and used for melting point measurement of the unknown. The solid was divided into 4 equal parts. First 2 parts were combined, 3rd part was mixed with acetanilide and the last part was mixed with phenacetin. After taking the melting points of all these 3 substances we were able to identify the unknown product to be acetanilide. No big issues encountered during this experiment. Transferring some products as well as the final crystals from watch glass and filter paper and leaving some products were crucial to get the most final product. This explains why the percent recovery for the unknown was low. Some crystals fell off or didn’t transfer to the filter paper. Even though the % recovery was relatively low (88.4079%), this experiment still produced a 0.6898 g of product. DISCUSSION/CONCLUSION: This experiment was focused on two main objectives. First, the analysis of panacetin to find out what percentages of sucrose, aspirin and the unknown component it contains. Second, to find out whether the unknown is acetanilide and phenacetin. A big part of the composition of panacetin was made up of the unknown. We were able to determine the composition of sucrose to be 17.95 %, Aspirin 26.93% and the unknown to be 55.12% After following the experiment procedures, we were able to purify through recrystallization the end product to be acetanilide. This is an odorless white crystalline solid substance which has a melting point of 114 C. Our experimental value for acetanilide’s melting point was 117 which indicates that the result had a very narrow range and close to the literature value. I would therefore conclude that we had isolated a close to pure product of acetanilide with little impurities present. 1. a. Describe any evidence that a chemical reaction occurred when you added 6 M HCl to the solution of sodium acetylsalicylate A chemical reaction took place upon the addition of 6M HCl to a solution of sodium acetylsalicylate because a precipitate formed known as aspirin. b. Explain why the changes that you observed took place. The observed change took place as a result of the acid reacting with the salt forming a compound insoluble in water. 2. Describe any explain the possible effect on your results of the following experimental errors or variations. In each case, specify the component (s) whose percentage(s) would be too high or too low. a. After adding dichloromethane to Panacetin, you didn’t stir or shake the mixture long enough Improper stirring or shaking of the mixture will result in incomplete dissolution of the panacetin mixture. There will be loss of some solid analytes during filtration. The recovered amounts will be lower than they should be leading to a final percentage to be low. b. During the NaHCO3 extraction you failed to mix the aqueous and organic layers thoroughly. If the aqueous and organic layers were not thoroughly mixed the acid would remain in the solution and the extraction would be less efficient resulting to a low percentage yield. c. You mistakenly extracted the dichloromethane solution with 5 % HCl rather than 5 % NaHCO3. If 5% HCl is used instead of 5% NaHCO3 that would protonate the aspirin and keep it in the organic solution making the aspirin, acetylsalicyclic acid. d. Instead of using pH paper, you neutralized the sodium bicarbonate solution to pH 7 using litmus paper At ph7 the bicarbonate wouldn’t be able to act as a base and extract a proton because at pH of 7 it would protonate itself so it wouldn’t be able to react with aspirin. 5. Write a balanced reaction equations for the reactions involved a. When aspirin dissolves in aqueous NaHCO3 C9H8O4 (aq) + NaHCO3 (aq) —–> C9H7O4Na (aq) + CO2 + H2O Weak acid weak base Strong Base Strong acid b. When Aspirin is precipitated from a sodium acetylsalicylate solution by HCL C9H7O4Na + HCl ————-ËÆ' C9H8O4 + NaCl Strong Base Strong acid Weak Acid Weak Base Assuming that both reactions are spontaneous under the standard conditions, label the stronger acid, stronger base, weaker acid and weaker base in each equation. Experiment 3 1. a. What is the minimum volume of boiling water needed to dissolve 0.200 g of phenacetin? b. About how much phenacetin will remain dissolved when the water is cooled to room temperature? c. Calculate the maximum mass of solid (undissolved) phenacetin that can be recovered when the cooled solution is filtered. 0.200 g-0.0125 g (amount soluble in cold water)= 0.1875 g 2. An unknown compound X is one of the four compounds listed in table 3.2. A mixture of X with benzoic acid melts at 89 C, a mixture of X with phenyl succinate melts at 120  °C and a mixture of X with m-aminophenol melts at 102  °C. Give the identity of X and explain your reasoning. X is phenyl succinate. When a compound mixes with a different compound, the melting point of the mixture will be lower than the melting points of either of the pure compounds. Basing from the table, the melting point of pure benzoic acid is 121 C but when mixed to X, it went down to 89 C. Likewise with O-toluic acid and m-aminophenol. Since the melting point of mixture X with phenyl succinate has a melting point of 120 C, the melting point of pure X must be equal or closer to 121. Mixing X with phenyl succinate did not change the melting point thus X must be phenyl succinate.

Hemodialysis In Esrd Diabetics Health And Social Care Essay

Chronic kidney disease ( CKD ) is defined as the irreversible loss of kidney map and can be categorized as symptomless kidney harm with mild nephritic disfunction or end-stage nephritic disease ( ESRD ) . ESRD finally consequences in decease without nephritic replacing therapy, which can be either nephritic organ transplant or dialysis. Nephritic replacing therapy as a intervention protocol identifies that, at end-stage nephritic disease, the optimum intervention is kidney organ transplant, as dialysis can non retroflex the biosynthetic and metabolic activities of the normal kidney ( Haller, Gutjahr, Kramar, Harnoncourt, & A ; Oberbauer, 2011 ) . End-stage nephritic diseases and its precursor CKD are globally emerging as a important public wellness job, with increasing morbidity and mortality every bit good as economic deductions for health care, ( Szucsa, Sandoza, & A ; Keuschb, 2004 ) . The World Health Organization 2002 estimation indicated that globally CKD contributes to over 850 000 deceases and over 15 million disability-adjusted life old ages, with epidemic rise of ESRD in multiple parts in the universe. The study notes that by 2010 more than 2 million people will necessitate care dialysis worldwide, ( WHO, 2003 ) . In St. Lucia, chronic nephritic inadequacy as a consequence of diabetes, high blood pressure, autosomal dominant polycystic kidney disease, and reaping hook cell disease are the chief grounds for get downing dialysis intervention in patients with kidney map failure. This is similar to the findings of PeroviA†¡ and JankoviA†¡ ( 2009 ) . Zelmer ( 2007 ) postulates that non merely is ESRD a chronic disease with important morbidity impact, but it besides involves high-cost intervention options. These options are frequently limited in developing states such as St. Lucia, where available options include haemodialysis or the aggressive direction of hazard factors to detain patterned advance of ESRD. Global estimations indicate that about 30 % of patients with ESRD are as a effect of diabetic nephropathy [ commendation ] . In St. Lucia, the figure is significantly higher, stand foring 41 % of the ESRD patients who have received haemodialysis for the period 2002-2009. At the terminal of that 8 twelvemonth period ( 2002-2009 ) mortality rate among that population was every bit high as 53 % with mean age at decease being 57 old ages. These statistical figures indicate that ESRD among diabetics is a serious wellness concern with inauspicious clinical results that straight impact quality of life while bring forthing significant medical costs. The economic force per unit areas of ESRD intervention on the corporate wellness system are good documented. Haller et Al. ( 2011 ) identifies it as resource intensifier, necessitating significant sums of finite health care financess to handle a little per centum of the population. In 2005 entirely, attention for ESRD patients in Canada represented 1.2 % of all healthcare outgo, despite an incidence of 0.092 % , ( Zelmer, 2007 ) . Less than 0.06 % of St. Lucians have ESRD, yet the disease generated direct health care cost is important compared to other diseases. In 2008, the direct health care cost of ESRD was $ 2.2 million EC, about 5 % of the health care outgo, the economic weight of which was borne chiefly by the authorities. These findings indicate that the economic sciences of ESRD therapies are a little but instead expensive section within the overall health care proviso in any state. Yet cost-effectiveness surveies of the modes of intervention are few ( Haller, 2011 ) . Cost-effectiveness is the fastest turning field in wellness research and it embodies a signifier of full economic rating that looks at cost and effect of wellness programmes or intervention ( Muennig, 2008 ) . Using the definition by Palmer ( 2005 ) that states â€Å" cost-effectiveness surveies compare costs with clinical results measured in natural units, like life anticipation or old ages of diseases avoided † , Glassock ( 2010 ) noted that the entirety of costs may non needfully be captured. However, it is a utile tool with pertinence for the enconomic anlaysis of issues within the wellness system. Cost-effectiveness analysis ( CEA ) of intercession programmes as a valuable tool employed by decision-makers can be used to measure every bit Wellss as perchance better how the wellness system operates. Its application allows policy shapers to place which intercessions provide the highest â€Å" value for money † and help in assisting to choose intercessions and programmes that maximize wellness for the available resources. Health economic experts are able to buy the most wellness under a fixed budget, prioritising services within the wellness sector. CEA hence requires information on the extent to which current and possible intercessions improve population wellness, i.e. , effectivity and the resources required to implement the intercessions, i.e. , costs, ( Muennig, 2008 ) . The inclusion of cost agencies that the design of the survey will integrate cost-unit analysis as a tool to analyze the economic impact of the proviso of the service of dialysis for terminal phase nephritic patients with diabetes and cost effectivity to find the quality adjusted life twelvemonth ( QALYs ) or wellness related quality of life ( HRQoL ) for that population. The chief result step will concentrate on costs per quality-adjusted life old ages ( QALYs ) , similar to a survey conducted in Austria ( Haller et al. , 2011 ) . QALYs were estimated utilizing the 15D, a generic standardised instrument to mensurate wellness related quality of life, ( Sintonen, 2001 ) . Cost will be viewed from the position of direct disbursement on wellness attention for dialysis, coupled with the indirect costs of productiveness losingss due to premature decease and short- and long-run disablement. The impact of mortality costs as the amount of the discounted present value of current and future productiveness losingss from premature deceases will be measured from an incident-based human capital attack, pulling from a similar survey conducted in Canada in 2000 ( Zelmer, 2007 ) . Muennig ( 2008 ) posits that because it is frequently hard to account for all cost, and the clip and resource restraints associated with micro-costing, certain premises as relates to costs are frequently made during cost-effectiveness analysis. This survey employs the usage of a authorities position to analyse the cost effectivity of dialysis for terminal phase nephritic patients with diabetes in St. Lucia. This requires that cost analysis be conducted to mensurate the repeating direct and indirect cost of supplying the service. In the part, specifically in the state under survey, wellness attention organisations seldom know the cost of the service provided and seldom employ the tools needed to measure that cost on a regular footing. In a globally runing economic society, economic tendencies have made it imperative for both net income and non-profit organisations that provide services, including authorities bureaus, to measure the cost of clinical services provided. Finance for wellness is non infinite and with significant budget cuts in the wellness service industry, there is increasing force per unit area for wellness attention installations to go more accountable and be more efficient with the financess allocated to well ness attention ( Basch, 1999 ) . Health economic sciences recognises the demand for wellness services to be provided in a mode that is non merely efficient but sustainable. Measuring, understanding and documenting the cost of services makes it easier to better cost-efficiency of these services, while foregrounding the support demands of the sector and by extension the authorities. It besides provides an chance to set up fees for clients that are based on realistic site costs. Previous surveies on cost-effectiveness of intervention options for ESRD have compared different modes of dialysis or organ transplant, [ commendation ] . The analysis of haemodialysis versus pharmaceutical direction to detain ESRD patterned advance flexible joints on the fact that the current capacity of the Renal Unit in St. Lucia can non supply dialysis for all ESRD patients. But it is rather clear that haemodialysis like pharmaceutical direction is non the optimum intervention option for ESRD as the optimum protocol is organ transplant. The wellness system in St. Lucia is mandated by its aims to better the wellness of the population and accordingly needs to guarantee that its limited resources are non devoted to expensive intercessions with little effects on population wellness, while at the same clip low cost intercessions with potentially greater benefits are non to the full implemented. While old research has been conducted to place the economic impact of the estimated health-care costs for ESRD, every bit good as the cost-effectiveness of assorted options for nephritic replacing therapies, similar surveies have non been replicated in the resource strapped Eastern Caribbean. This survey wishes to concentrate on the cost-effectiveness of haemodialysis among type 2 diabetics in St. Lucia over an 8 twelvemonth period ( 2002-2008 ) . Using the usage of CEA, it aims at comparing the cost and effects or results ( cost-effectiveness ) of haemodialysis for diabetic nephropathy utilizing the comparator of making nil, which in this instance is the pharmaceutical direction of patients with diabetic kidney diseases to detain patterned advance of ESRD. This is particularly relevant to the wellness system in St. Lucia, as concerns on the prevalence of diabetes mellitus and its rate of addition, and the determination to spread out the service to two new installations in the absenc e of research requires that a better apprehension of the range and magnitude of the entire economic load of ESRD and the cost effectivity of dialysis intervention for diabetics with ESRD. The findings will assist to inform those doing policy determinations, and may be utile in set uping a set of precedences for farther research, bar plans, and in the planning of alternate interventions to assist relieve that load.MethodologyThis survey uses a retrospective attack to data aggregation. The survey population was selected from the lone public Renal Unit which forms portion of the general infirmary, Victoria infirmary. While there is another Nephritic Unit of measurement in St. Lucia that offers dialysis, it is a portion of the private infirmary which did non wish to take part in this survey. The survey population comprised ESRD patients with diabetic kidney diseases. Patients were considered depending on whether they received haemodialysis or whose diabetes was being pharmaceutically ma naged to detain ESRD patterned advance. Of the 111 patients on dialysis, 45 were due to diabetic kidney disease and 21 were actively having organ transplant at the clip the survey was being conducted. The nephrologists identified 12 ESRD patients who were non having dialysis but were being managed pharmaceutically. All diabetics who are or have been on dialysis with end-stage nephritic disease for the period 2002-2009 and were having dialysis due to diabetic kidney diseases were included in the survey. Persons were excluded from this survey if they were on dialysis prior to being diagnosed with diabetes. The comparator group differs from the haemodialysis group merely in the signifier of intervention that they are having, dwelling of all patients with ESRD due to diabetic kidney diseases who are non having dialysis but whose diabetes is sharply managed with medicine to detain ESRD patterned advance. Chronic conditions such as ESRD require uninterrupted intervention and as a effect a cost-effectiveness of intervention options over a period of clip for a cohort of patients, employs the usage of the Markov theoretical account to look into long term costs and results. The Markov theoretical account developed for this survey describes the procedure of attention observing that patients were assigned or began their patterned advance through the theoretical account in either of two provinces, hospital haemodialysis or pharmaceutical direction of type 2 diabetes to detain ESRD patterned advance, and decease signifies the terminal of the rhythm. A systematic literature reappraisal was conducted of peer-reviewed economic ratings of dialysis intervention modes among diabetic patients. Ebscohost and PubMed were searched utilizing the keywords cost-effectiveness, dialysis, end-stage nephritic disease and diabetic kidney disease and was limited to articles published in the last 12 old ages ( 2000-2011 ) , some articles, if they fell out of the selected old ages of publication were accepted based on the strength of their findings. The inclusion standards identified articles that included the keywords in the capable headers every bit good as the usage of Renal Replacement Therapy/economics, Renal Dialysis/economics, Hemodialysis Units, or Kidney Failure. If they included the term peritoneal dialysis or haemodialysis they were besides included. Exclusion standards of articles were identified as non-English articles and those that did non compare intervention options. More than 500 articles were identified but 31 were selected for ma nual reappraisal. Data on wellness attention costs, passage to other wellness provinces and quality of life were imputed into the Markov theoretical account. Data was obtained from the Renal Unit at the Victoria Hospital, the public wellness installation. Data on quality of life was obtained utilizing the 15D, a multidimensional, standardised generic instrument to mensurate quality or health-related quality of life ( Sintonen, 2001 ) . The 15D was used since it combines the advantages of a profile and individual index mark step that describes the wellness position by measuring 15 dimensions. The mean mark value for each dimension was used to find the wellness related quality of life in the survey population. The usage of the 15D used to mensurate quality of life result was reported in QALYs, a step of the load of disease that included the quality and measure of life lived against a pecuniary value, medical intervention or intercession. The mean mark value for each dimension measured by the 15D was used to find the wellness related quality of life of the survey population utilizing the graduated table provided by Sintonen ( 2001 ) . The findings were standardized against the load of disease markers identified by the WHO ( Ref ) . Other variables were considered in the survey and a standard questionnaire was administered to the survey population to obtain informations on the socio-economic position of individuals within the survey population. The socio-demographic questionnaire was tested against a pool of eight individuals from those who are on dialysis for grounds other than diabetic nephropathy and who were as similar to the survey population in footings of gender, instruction, socio-economic position and geographic location. Contented analysis was used to measure the information obtained from the socio-demographic questionnaire. All survey participants were provided with a missive refering namelessness and confidentiality and informed consent was obtained prior to engagement. Ethical blessing was obtained from the IRB at St. George ‘s University and the moralss commission of the Ministry of Health in St. Lucia.CostssCost-effectiveness was examined from a governmental position utilizing the clinical records of the Division of Nephrology patient enrollment and charge systems at the Victoria Hospital coupled with information from published surveies on endurance and quality of life among diabetic nephropathy patients. The theoretical account used included the direct wellness service costs associated with the intervention options, and an one-year cost per patient was calculated for each wellness province in the theoretical account. Direct health care costs associated with dialysis usage included bing regular dialysis Sessionss, complications of the dialysis, such as curdling of the fistulous withers or hypo tension episodes, research lab trials and services required as a effect of dialysis and medicine usage as a consequence of intervention. Premises were made on the regularity of direct health care cost associated with dialysis, such as regularity of research lab testing and blood transfusions. Micro-costing, roll uping informations on staffing, consumables, capital, and operating expenses were used to find the cost of one session of haemodialysis ( Table 1 ) . Structured interviews were used to obtain inside informations sing staff clip allocated to dialysis activities, every bit good as the regularity of other services used as a consequence of the intervention options. The survey identified capital points as the edifice infinite allotted to the Unit for intervention, and equipment such as the dialysis machines and air conditioner unit. Costss have been reported in Eastern Caribbean Dollars ( EC ) presented at the 2008 degree and an tantamount one-year cost calculated utilizing a 3 p er centum price reduction rate over the predicted life span. Muennig ( 2008 ) argues that a governmental position can include some facets of transportantion costs. Evidence from the Minstry of Communication and Works and the conveyance board imply that there is no nationally agreed policy for conveyance costs. There are fluctuations across St. Lucia in footings of milage, hence for the intents of our analysis, conveyance costs are excluded. The survey reviewed costs over an 8 twelvemonth period ( 2002-2009 ) . This clip frame was partially determined by the handiness of the informations two old ages after the programme was initiated and the premises made with mention to the analysis were tabulated ( Table 2 ) . Incremental costs per QALY gained were calculated by utilizing the estimations of costs and QALYs for each of the two modes obtained from the theoretical account, and the findings were presented as incremental costs per QALY. A one-way sensitiveness analysis was used to look into variableness in the information, changing the price reduction rate from 3 % to 5 % the age weights and disablement weights. A concluding sensitiveness analysis of mortality rates was besides conducted since the premise was that the mortality rates for haemodialysis were the same as those of pharmaceutical direction of ESRD diabetics.Consequences[ Presentation of Results†¦ ]Discussion[ Discussion of Results and deductions†¦ ] Locke ( 1987 ) is a advocate of the position that all surveies have built-in restrictions and boundary line. Primary and secondary information was used in this survey. Jankowich ( 2005 ) warns of the restrictions of the usage of secondary informations, as the methodological analysis used in garnering secondary informations has come into inquiry. The survey was limited by the truth and quality of the informations, which Basch ( 1999 ) argues is a repeating job in developing states. The questionnaire as a tool for garnering information airss some disadvantages, as it does non supply an chance for inquiries to be clarified or to verify that replies are understood or that all inquiries are answered. In add-on it means that the individuals being surveyed must hold the pre-requisite literacy accomplishments. This restriction was minimized by pre-testing the socio-demographic questionnaire was tested against a pool of eight individuals from those who were on dialysis for grounds other than diabetic nephropathy and who were as similar to the survey population in footings of gender, instruction, socio-economic position and geographic location, ( Table 2 ) . Another restriction to the survey was the inability to prove the 15D questionnaire as it could non be altered to be more specific. Low response rate every bit good as non-response prejudice for the questionnaire may significantly skew the information as the survey population is so little. Jankowicz ( 2005 ) argues that coaction is maximized when respondents are in some sense rewarded for cooperation and that these wagess outweigh the cost in footings of money and attempt. To accomplish this, respondents were shown that their information was valued and the construction of the questionnaire would necessitate really small in footings of clip and attempt. The absence of other surveies that compared the intervention modes used in this survey serves as a restriction of this paper, but it remains the lone feasible comparator that was available to the research worker. There are restrictions and troubles in any effort to cipher the average cost of a dialysis session, particularly in public installations where cost is subsidized ( commendation? ) , as every aspect of attention and cost associated with the session must be taken into consideration. Consequently premises were made on cost for direct and indirect services related to intervention options compared in this survey, ( Muennig, 2008 ) . Premises are justified as this is a non-funded research with clip restraints and a demand to cut down cost drivers. The survey was besides limited in its position as it could non show on national costs from a social position such as the patient ‘s ability to work or the chance costs. The strength of the survey lies in the usage of triangulation to garner and analyze informations to determine their common decision, effectivity based on costs and QALYs. Decrop ( 1999 ) concurs that one of the chief ways to avoid the combative issue of cogency and dependability is the usage of triangulation. He defines triangulation as â€Å" looking at the same phenomenon, or research inquiry from more than one information beginning † ( p158 ) . Information coming from different angles can be utilised to confirm, lucubrate or clear up the research inquiry. Denzin ( 1978 ) besides claims that triangulation bounds personal and methodological prejudice every bit good as enhances the survey ‘s generalizability. The usage of the Markov theoretical account is an built-in strength of the survey. Gonzalez-Perez, Vale, Stearns, and Wordsworth ( 2005 ) argue that the theoretical account ‘s ability to predict comparative effectivity and cost overtime makes it appropriate for patterning chronic intervention options such as RRT. The usage of cost-effectiveness to find QALYs is advantage and the usage of a standardised instrument to mensurate QALY besides strengthens the survey. The 15D is recognised as by and large being a little measuring load to both respondents and research workers. As an rating tool it is extremely dependable due to its repeatability of measurings with minimized random mistake. The consequences generated are valid because of the grade of assurance that research workers can put on the illations that are drawn from the tonss. Sintonen ( 2001 ) posits that as an instrument to mensurate cost-effectiveness, it is peculiarly suited for ciphering quality-adjusted life old ages ( QALY ) . Choice prejudice is limited in this survey due to recruiting of the full mark population. This is the first survey of its sort in the part and it does non hold any concern associations, an built-in strength to this survey. It is able to function as a precursor to farther research and therefore is poised to assist steer policies on how cost-effectiveness surveies are done in the part and their application to decision-making in health care. The enlargement of haemodialysis to run into the turning ESRD population, and an increased incidence of diabetic kidney disease in St. Lucia has deductions for the findings of this survey. It is of import that focal point is directed at primary, secondary and third intercessions aimed at cut downing cost of diabetic attention and accordingly complications from diabetes, such as diabetic kidney disease. Primary intercessions are the most cost-efficient. Health publicities to cut down hazard of developing diabetes, which is a hazard factor for ESRD, needs to go portion of the authorization of the Ministry of wellness. A policy on Chronic Diseases developed within the primary health care program that presently exist, would assist steer that focal point. Mann et Al. ( 2010 ) argue cautiousness against population based testing for CKD, and recommend that testing, as a secondary intercession, should concentrate on at hazard populations. Their survey concluded that ‘targeted showing of people with diabetes is associated with an acceptable cost per QALY in publically funded health care systems ‘ . Such an attack can be adopted in the wellness system in St. Lucia. While the bulk of cost-effectiveness analysis of intervention modes for diabetic nephropathy focal points on the disease at its latent or progressed phase, Glassock ( 2010 ) noted that a survey by Gearde et Al. ( 2008 ) identified that early sensing of diabetic kidney disease and intensive pharmaceutical intercessions are non merely cost effectual but significantly reduces the hazard of ESRD among type 2 diabetics. These findings are replicated in a survey by Keane and Lyle ( 2003 ) and Szucs et Al. ( 2004 ) who found that Losartan reduced the incidence of ESRD among diabetics. They went on to reason that albuminuria which is the ‘single most powerful forecaster ‘ of in type 2 diabetes is a simple and cheap showing trial, and early sensing can take to the early disposal of drugs that have been proven to cut down ESRD incidence. Cost-effectiveness analysis is able to supply valuable penetration to prioritising within health care and so the findings of this survey is able to supply grounds to back up efficiency in the usage of limited resources. Policy-makers should utilize these findings to reexamine the determination to spread out the figure of haemodialysis centres in St. Lucia. Further research to place more cost-efficient intervention options would be the first measure to bettering efficiency of resource allotment. The domination of haemodialysis as a intervention mode for ESRD, despite the overplus of surveies that have identified it as the least cost-efficient of RRTs, ( Haller et al. , 2011 ; Just et al. , 2008, Kontodimopoulos & A ; Niakas, 2008 ) , provides the wellness sector, with the grounds needed to revise intervention protocols and an chance to improved cost-effectiveness of ESRD intervention. This can be achieved by significantly cut downing the usage of haemodialysis and introducing as an option, peritoneal dialysis which have been cited as being the most effectual of dialysis options. Just et al. cautiousness that the economic sciences of dialysis in the underdeveloped universe, where labor may be cheaper than the importing of equipment and solutions, may take to the perceptual experience that peritoneal dialysis is more expensive than haemodialysis. They go on to observe that this is non conclusive as there is a famine in economic ratings in developing states to confirm that posi tion. A good developed CKD Care Program is able to significantly cut down the chance of developing ESRD among at hazard populations, every bit good as significantly lower health care costs among ESRD patients, ( Wei et al. , 2010 ) . There is a demand to spread out the services offered by the Renal Unit every bit good as its coverage to assist accomplish that terminal.Decision[ Conclusion based on findings ]

The Z Notation Math Problem Example | Topics and Well Written Essays - 3250 words

The Z Notation - Math Problem Example COUNTER The precondition increments the value of count by one every time a value is added. The precondition indicates that the limit does not change. The precondition indicates that the number of items added cannot exceed 256, which is the limit. If the item to be added in the sequence already exists, the item should not be added to the list. The schema ALREADYADDED helps to control this. ALREADY ADDED The precondition tests if the item to be added already exists in the given sequence. If the value exists , then the system returns a value (ALREADY_ADDED) If the value is already in the sequence the resulting sequence does not change, this precondition is given by The function INFORM: is given by: Combining the three schemas gives the general expression for pushing the item onto the stack. PUSH_ITEM The item (i) becomes a subset of the ITEM The resulting count + 1 must be less than the limit value The limit value does not change The sign depicts change of state If the sequence has the item identical to one being input then, the system displays 'ALREADY_ADDED' (2)POPPING THE ITEM FROM THE STACK The schema for displaying an item isDISPLAY_ITEM For the item to be displayed it must be contained in the sequence The function takes the name of the requested item and finds it and displays all information about the given ITEM. There is no change in state of the system, this is illustrated by the symbol To prevent displaying an item not in the sequence, the system should return a NOT_FOUND result, the expression is given by; NOT_...Each piece can then be described informally with a commentary. The Z schemes describe the dynamic and static aspects of a system. The static aspect of a system includes the states the system can occupy and the relationship maintained when the system transits from state to state. The dynamic aspects include the operation that are possible, the changes that occur and the input - output relationship. (1) The list of persons name and corresponding salaries (can be used by a company to store data of the employees working in that company and also store the salaries of these people.) the reasons for using this type of data are Several people using one name may earn the same salary, the system can be coded to display number of people earning the same salary, this means that the tests data type can be subjected to various operations. To test for rotation a number (i) and the square of the number (i2) can be used. The test data comprise of different numbers and their squares, these numbers form a sequence. The elements can be arranged so that the top most elements are the first members of the given sequence and the last element is greatest number in that list. On rotating left the greatest number and its square becomes the first element of the set.

Epidemiological Principles and the Issue of Teen Pregnancy Personal Statement

Epidemiological Principles and the Issue of Teen Pregnancy - Personal Statement Example This legally mandated reporting system provides accurate data on the number of teens giving birth as well as specific demographic details such as race, legal residence, age, and the number of previous births (Martin et.al. 2006).     From this data changes, distribution patterns and trends over time can be monitored and areas for future research and causal relationships can be researched further.   This legally mandated reporting system provides accurate data on the number of teens giving birth as well as specific demographic details such as race, legal residence, age, and the number of previous births (Martin et.al. 2006).     From this data changes, distribution patterns and trends over time can be monitored and areas for future research and causal relationships can be researched further.  Ã‚   Additionally, based upon this ongoing monitoring, programs put into place to reduce or eliminate teenage pregnancy can be evaluated for effectiveness.   This is only possible t hrough this accurate data collection and just as importantly the publishing of results which allows researchers to evaluate and further investigate this serious issue.      The next area that shows the epidemiological principals are applied to the teen pregnancy problem can be found in the anonymity of data collection and studies performed.   Epidemiology focuses on groups of people as opposed to individual cases.   All the government agencies previously discussed as well as private agencies that present statistical data on teen pregnancy deal with teen pregnancy in terms of numbers, percentages and other statistics, which are further broken down into various categories such as race of mother, age, economic background, educational level, number of pregnancies and many other categories as opposed to individual case studies. Based on this ongoing data, researcher further applies principles of epidemiology by analyzing the data and through the scientific method make hypotheses based upon the data as to causal effects and contributing factors that increase the risk of teen pregnancy.   Also based on the data researchers can ascertain life-changing consequences teen mothers face.   These facts are determined by applying the epidemiological principle of studies performed by researchers.   There are according to the CDC two main types of studies observational and experimental.   In the case of teen pregnancy, various types of studies are conducted to evaluate relationships between teen pregnancy and various factors which contribute to it.   Additionally, studies are conducted to evaluate the effect of teenage mothers.  Ã‚  

Cross Cultural Communication & International Management Proposal Essay

Cross Cultural Communication & International Management Proposal - Essay Example Many of these reasons have to do with the goals of the individual. For example, if a person views monetary gain as their main purpose, they may be willing to put ethical issues aside in order to reach their goal with maximum efficiency. They may not pay attention to any code at all, leading to conflict. Existing literature focuses on communication as it is used in leadership and conflict management situations inter-culturally. â€Å"Informal conflicts may occur among coworkers, employees and supervisors, with or within between groups, and among departments within an organization. Such conflicts often occur when there are differences in values, beliefs, or opinions regarding how the work gets completed, how resources or tasks are distributed, or where priorities should be† (Montiero, 2003). Further complicating the situation, to put back the international element, what is considered ethically neutral in one country may be totally unethical in another, and vice versa. â€Å"Even if there were widespread cross-cultural agreement on the normative issues of business ethics, corporate ethics management initiatives which are appropriate in one cultural setting still could fail to mesh with the management practices and cultural characteristics of a different setting†¦ multinat ional businesses risk failure in pursuing the ostensible goals of corporate ethics initiatives† (Weaver, 2002). In other words, corporate ethics may be something that is culturally relative. In this fashion, international companies are letting their employees know that ethical behavior is expected of them, and are providing their employees with detailed information regarding ethics and international business. In terms of limitations, the proposed research realizes that it is sometimes difficult to discuss some of the more personal facets of international ethical codes, and it is still more difficult not to confuse them with morality, moral philosophy,

UNIT 3 INDIVIDUAL PROJECT Essay Example | Topics and Well Written Essays - 1250 words

UNIT 3 INDIVIDUAL PROJECT - Essay Example Preferably, all of the businesses exist for profit. Upon the conceptualization and realization of the said endeavor to put up an airline business, one must recognize the market, the competency, and the problems that are to be encountered in dealing with this kind of establishment. These illustrations points out to a certain airline which penetrate the skies and continues to soar high-the Virgin Atlantic Airlines. Wikipedia (2006), described this airline as â€Å"an airline belonging to Richard Bransons Virgin Group. It operates long-haul routes between London and North America, the Caribbean, Africa, the Middle East, Asia, and Australia. Its main bases are London Heathrow (LHR) and London Gatwick (LGW). Virgin has a smaller base at Manchester Airport (MAN) serving the USA and the Caribbean. The company holds a United Kingdom Civil Aviation Authority Type- A Operating Licence, which permits it to carry passengers, cargo, and mail on aircraft with 20 or more seats.†1 With the saturation of key markets around the globe, the airline has a promising future with regards to its navigation to the skies as well as it is regarded as one of the rising competitors of major airlines in the world. If we are to look into the history of this airline, it was set-up in 1982 by a lawyer and by the former chief pilot of the laker airline. During its beginnings, the co-owner of the airline has no thorough knowledge in running a business airliner and this prompted him to outsource and pirate employees in other airlines who has the expertise and knowledge in handling activities concerning airline operations. â€Å" One of the owners got the idea of putting up the enterprise from London to the Falkland Islands in June 1982, when the Falklands War ended and there was an apparent need for such a service†2 If we are to analyze this strategy, the owners have succeeded in heir preliminary strategy and that is to move where your market is. In such a case, the target

History of Art Art in the age of mass media Essay

History of Art Art in the age of mass media - Essay Example Some of the commonly used cultural forms are web sites, multimedia, databases, computer games and animations and to a lesser extent, virtual reality. In today's culture of information and media, there is permanence and crumbling of both old and new media. New media exists due to the foundation laid by the old media and its language. But there are instances where new media is coming on its own and breaking from its roots. The distinctive feature about new media is its capacity to create a virtual world of information that, in the case of the internet, exists in servers worldwide but visualized at a computer workstation at any corner. This illusion of reality that is organized and structured has transformed human experience. In the culture of the information society, computerization has led to developments of new forms. Old media such photography and cinema have in some ways reinvented themselves and converged into new media. The computer revolution has considerably enhanced the scope of visual culture and new avenues of expression have opened up to artists. Bolter and Grusin offer an alternate way of thinking about the new media. They present the idea of remediation and define it as "the formal logic by which technologies refashion prior media forms" (Bolter and Grusin 2000 p.273). Modern society which is increasingly turning its interests towards various entertainment and information media has fallen into preoccupations that Bolter and Grusin term as "immediacy" and "hypermediacy" which are the two strategies of remediation. Immediacy is a style of visual presentation which aims at making the viewer unaware of the presence of the medium e.g. photographic film, cinema, artist canvas, TV sports events etc. Immediacy attempts to give the appearance that the media doesn't exist. For example, anything shown "live" would fall under the immediacy category. Live sports events, live or breaking news, live car chases on TV are preoccupations that the general public appear to be interested in. Most of these visual presentations focus on the action taking place. There is no effort in creating a visual masterpiece or making it look artistic, instead, immediacy tries to flow along with the on going event. The emphasis is on the raw action and not on other characteristics of the event such as statistics, replays and in-depth analysis. Immediacy tries to create an intimate link between the event and the viewer by covering the event as smoothly as possible without interrupting the flow or introducing distractions. There is an effort to engage the viewer more directly with the event and make him or her feel as if they are there watching from the stands. Hypermediacy is contrary but closely related to immediacy and involves the use of event statistics, replays from every angle and in-depth analysis to study the event and allow the viewer to gain a better understanding of it. Multiple forms of media e.g., text, graphs, animation, film are involved in hypermediacy. It can be observed that hypermediacy is a pre-occupation the media and viewers are able to engage in after the live event. For example, a live football match which falls under the immediacy term can be scrutinized ball by ball and statistical analysis studied once the game has ended or during the half time period. Hypermediacy allows the viewer to gain a wider knowledge of various aspects of the game's details whereas

Bio On Favorite Business Leader Assignment Example | Topics and Well Written Essays - 250 words - 2

Bio On Favorite Business Leader - Assignment Example pted him to work as a mere salesman and security analyst established him to rise up and found ‘Berkshire Hathaway’ company which later expanded to a multinational firm in the 1970s (Schroeder, 2008:122). He has since grown his wealth and in 2008 he was declared the richest man in the planet. Central to Buffets business successes is the leadership strategy and styles that he embraces and deploys. As conceptualised in the Trait Theory of Leadership, the characteristics and personality of a person negatively or positively influence the outcome of their leadership (Northouse, 2010: 119). Buffet in 2006 broke the ‘world’s donation record’ by offering over 85% of his wealth to a charity program and this philanthropic gesture has since strengthened his leadership. His empathetic traits and good decision-making skills have enabled him get along well with his workers who he easily understands their plight and appropriately addresses them. Taking the example of the Contingency Theory, the manner in which Buffet handles the diverse workforce and the challenges that come along is commendable. He knows what style or strategy leads a group he has at all situations and in different companies (Buffet and Clark, 2009:98). This has seen him receive loyalty and respect from his

London Ambulance Service Essay Example | Topics and Well Written Essays - 1500 words

London Ambulance Service - Essay Example There are seventy ambulances, which serves the entire region of London. The trust is under the jurisdiction of the NHS. The NHS board meets after a period of two months to deliberate on the way forward for the trust. The board consists of a non-executive chairperson, five executive directors, and seven non-executive directors making thirteen board members. The LAS has a long history that dates way back in the 1960’s. The trust has weathered hard times to become one of the most reputable ambulance services in the world. Its formation was facilitated by the 1946 National Health services Act, which provided that ambulances were to be availed to any individual that required their services. Nine ambulance services merged in London and formed the LAS in 1965. Adjustments were made by the NHS, which resulted to the moving of LAS from the Local Government to South West Thames Regional Health Authority. It would later become a NHS trust in 1996 when the authority of South West Thames Regional Health Authority was eliminated (London Ambulance Service 2014). The operations of LAS cover a distance of up to 620 square miles. The region of operation ranges from Enfield to the north to Purley to the south while on the western is Heathrow and Upminster to the east. Seventy ambulance stations are spread across the entire region with four main headquarters at Waterloo road, Pocock Street, Loman street, Fielden House, and Bow. The trust provides an array of medical emergencies, which includes; provision of emergency responses, response to less serious calls, providing a clean environment for patient service, they do take patients for hospital appointments, they deal with major incidences, they help in finding hospital beds while making the experience of the patient to count. The services provided by London Ambulance Services stands out as a merit good. A merit good is one that the market underprovides and the forces therein do not affect the

MobilephonesPrinciples of Marketing Essay Example | Topics and Well Written Essays - 750 words

MobilephonesPrinciples of Marketing - Essay Example The formal product in mobile phone is comprised of the brand, the product code which differentiates it from other phones, the design, the packaging, the batteries and headsets which are also included together with the other features and enhancements. Recognizing the other needs of individuals aside from communication which can be integrated into the mobile phone, manufacturers continue to innovate and enhance it with new features. Starting from the core use of as a telephone, mobile phones are now also integrated with cameras, televisions, videos, calculators, planners, alarm clocks, music composers, MP3 players, flashlights, and others. These augmented features add value to the customers allowing them to use this gadget in more ways than making and receiving calls. Also, the augmented product is now tailored in order to suit the lifestyle of an individual. Thus, a mobile phone which features a higher resolution camera can be marketed to a person who is fond of taking photographs. A music lover will want to have a mobile phone with MP3 player which allows him or her to listen to his/her favorite songs while on the go. The first advertisement for a mobile phone was launched by Centel in 1989 featuring the flexibility and convenience of having a mobile phone. The succeeding commercials went beyond Centel's slogan of "Where people connect" by highlighting the new features of mobile phone. Philips targets customers by stressing that mobile phone a way to "engage" one's senses. The fast obsolescence of technology in the mobile phone industry makes manufacturers very keen in bringing state of the art technology in the market before other competitor does. Thus, most of the advertisements are geared towards capturing customers by stressing that the newly launched product is most advanced. Companies also try to appeal to the lifestyle of customers through its commercials. The commercial of Sera phone emphasizes that users of their phone are beautiful and sexy. Still other commercials are geared towards capturing the culture of the customers to be family oriented like the ones used by Nokia in the Philippine market. Also, mobile phone companies are designing products which appeals to one target group. The age of a person becomes a determinant of the type of mobile phone that he or she needs. The capacity of a mobile phone to cater to two SIM cards is geared toward individuals who want to have a different number for business and personal purposes. Thus, mobile phone is also marketed as a way of managing the complicacies of work and family life as well as gives privacy to users. Advertisements are now also infused with humorous sentiment blending technology with the natural tendencies of man. As a user of mobile phone, I can say that almost all advertisements for mobile phones are appealing considering that manufacturers are now targeting buyers through different medium and tailoring the message according to their demographics and lifestyle. APPENDIX Advert 1. http://www.cellular-news.com/tv_commercials/#http://www.cellular-news.com/tv_commercials/videos/Romania_Zapp/zie_2004_god.swf Advert 2. http://www.youtube.com/watchv=ptbJZ9HBw2k Advert 3. http://www.youtube.com/watchv=G4iGrdYAG8w Advert 4. http://www.youtube.com/watchv=K3ye7Ok8dgc Advert 5. http://www.youtu

Microsoft vs Red Hat Linux Essay Example for Free

Microsoft vs Red Hat Linux Essay As a customer, I’d prefer the system of Red Hat (despite how the program look and operate) because obviously, it’s free of charge. Also because it releases the updated version every 4-6 months as the article mentioned. However, in my opinion, in term of business model, Microsoft, the monopoly, has a more sustainable business plan. The traditional way of employing high skilled programmers is certainly ensure the persistent development of the company. Moreover, from the customer’s point of view, even though, they have to pay a fixed software package in the beginning, but there’re no other expenses such as consulting like Red Hat. Moreover, the free technical support also make Microsoft has a higher position in the market. In addition, statistically, Microsoft has outstanding profit-making revenue for the past years. Linux, on the other hand, has a possibility of getting bigger in terms of revenue. Still, as I have said, volunteer programmers are not very reliable. Not only the success is terms of revenue, Microsoft has a better brand image because it has been in the market for so long and has so many loyal customers globally. Even though, Red Hat is trying to differentiate by focusing more on the small business, but Microsoft’s strategy is still ahead of it because it provided its service/product to a larger based customers. I’m sure that Red Hat isn’t the first competitor Microsoft has ever had, but it has overcome all of them. Because of all the reason mentioned above, Microsoft will remain the Monopoly in the market for still quite a long while. Michael E. Porter Michael E. Porter is a leading strategist who has a comprehensive understanding about economy and economic development of a nation. He invented the Competitive Strategy called â€Å"Porter’s Five Forces Model†. He is now currently the Bishop William Lawrence University Professor, based at Harvard Business School. Professor Porter is generally known as the father of modern strategy field, and also identified as the world’s most influential thinker on management and competitiveness. His works included 18 books and over 125 articles published in leading newspaper and business magazine. Professor Porter was actually graduated with high honors in aerospace and mechanical engineering from Princeton University, and continued with M. B. A with George F. Baker Scholar from Harvard Business School, also a Ph. D. in Business Economics from Harvard University as well. Porter’s Five Forces Model As I have mentioned, it’s a model about the competitiveness of a company by Michael E. Porter. It is a very well-known model in order to find the environment of a firm and also factors that influence the uncertainty. It states not only to win over your competitors but also to unite and work together between firms in term of partnership. One of the reasons why this model is well recognized is that it works from small to large company. The Five Forces in the model are Rivalry among current competitors, bargaining power of suppliers, bargaining power of customers, threat of substitute products or services, and threat of new entrants.

Effects of Ketamine on the Human Body

Effects of Ketamine on the Human Body The desire to alter consciousness is a fundamental human trait. From being something impossible to finding numerous chemicals in controlling the mind, the process of discovery has also created opportunities for us to explore the effects and mind-tricks behind it. Just like any other new inventions in technology, there is always a path that leads to a wrong destination. The use of psychoactive drugs has turned into a trend amongst the younger generation, endangering both their own lives and the stability of the society. It has been said that this ingenious discover has benefited the forward of our medical industry; yet in our 21st century many have become a tool to escape from stress and reality. These so called party drugs are now produced in large amounts and distributed to young people at bars, nightclubs and house parties around the globe. The disastrous impact behind this irresponsible crime has led to thousands of innocent people condemned and forced to dwell in a living hell. Different people have their own definitions of the term abuse. It is hard to have a universal definition for the word as the bottom line of an individual is drawn upon their own decision. Therefore using the definition published by the World Health Organization, psychoactive substance abuse is defined as a maladaptive pattern of use indicated by continued use despite knowledge of having a persistent or recurrent social, occupational, psychological or physical problem that is caused or exacerbated by the use [or by] recurrent use in situations in which it is physically hazardous.  [1]  In addition, chronic abuse in this context will be defined as a relapsing disease characterized by compulsive drug seeking and use despite harmful consequences as well as neurochemical and molecular changes in the brain.  [2], in other words, chronic abuse is addiction. Addiction is mostly dependent on previously exposed rewards such as food, alcohol, sex, and in this case, on the psychoactive dru g Ketamine. http://www.tjipr.com/images/enji.jpg http://healthimpactnews.com/wp-content/uploads/2011/06/VariousPills-300225.jpg What is Ketamine? Psychoactive Drugs Before answering the above question, it is important to know how ketamine is categorized as a psychoactive drug and its evolvement in human history. The term psychoactive drug is used to describe any chemical substance that affects mood, perception or consciousness as a result of changes in the functioning of the nervous system (brain and spinal cord).  [3]  These drugs are often termed mind-altering because they change the perceptions and the behavior of the individual using them. Psychoactive drugs can be classified into seven different categories: stimulants, depressants, narcotics, cannabis, inhalants, hallucinogens and club drugs. Stimulants are mostly used to relieve tiredness and increase alertness. The most common stimulants are nicotine, which can be found in tobacco products, and caffeine, which is mixed in soft drinks and coffee. The more these drugs are consumed, the more our body will depend on it to maintain the desired effects. Cannabis acts in a similar way, only that it is a plant mainly in forms of marijuana and hashish. Depressants and Narcotics work in the opposite way. They are often used to dull senses and depress the functioning of the central nervous system. These two types of drugs are used medically as anesthetics and analgesics. Small doses of depressants may help more to relax muscles and produce calmness, while larger doses may cause difficulties with reflexes and judgement. Alcohol is a depressant which is widely found in our daily lives, and Narcotics such as opium and heroin are mostly used to relieve pain, yet a long-term dependence on these two may cause addiction and abuse. Hallucinogens and inhalants are synthetic drugs that distort the perception of reality and produce feelings of euphoria. These drugs may cause a short period of excitation and light headedness as it quickly acts on the body as it enters the bloodstream through inhalation. A good example of hallucinogenic drugs is Phencyclidine (PCP), which is mostly used as a sedative in operations before switching to Ketamine. Ketamine is the most common club drug found in the society nowadays. Club drugs have the effect of both stimulants and hallucinogens, and are most popular at party venues such as house parties and nightclubs among the younger generation. Other Club drugs include Ecstasy and Gamma-Hydroxybutryic Acid (GHB). The latter one is odorless and tasteless, therefore gaining the reputation as a date-rape drug as it may cause deep sleep a nd unconsciousness when administered with high dosage.  [4]   Ketamine As mentioned above, Ketamine was used to replace Phencyclidine (PCP) as an anesthetic medicine.  [5]  PCP  was originally tested as a surgical anesthetic in the 1950s.5 It is known as a  dissociative  anesthetic because it can make a person feel a sense of detachment, as if the mind is separated from the body.  [6]  PCP was used in veterinary medicine to anesthetize large animals, but was never approved for use in humans because many patients became agitated, delusional and irrational while recovering from their operations.  During 1960s, PCP was widely abused as it could be easily distributed in pill forms. The powdered form of PCP was developed in 1970s, commonly known as rocket fuel, superweed, etc. which is sprinkled on top of tobacco or marijuana for smoking. PCP  can be easily synthesized; as a result it is often sold off on streets as another drug such as mescaline or Lysergic acid diethylamide (LSD). Due to the worse effects illustrated by patients after the use of PCP, Ketamine was developed in 1962 to replace PCP. It was first known as Cl-581, discovered by scientist Calvin Stevens. Ketamine was then tried in humans as an anesthetic for the first time by Professor Edward Domino, and this is what he said afterwards, Our findings were remarkable! The overall incidence of side effects was about one out of three volunteers. Frank emergence delirium was minimal. Most of our subjects described strange experiences like a feeling of floating in outer space and having no feeling in their arms or legs.   [7]   The successful effects soon encouraged the drug to be patented by the company Parke-Davis for use as an anesthetic in humans and animals. Nonetheless, Professor Domino described Ketamine as a potent psychedelic drug and named it as a dissociative an anesthesia. Ketamine was first used in large quantities in the Vietnam War by the USA Army, where it was used as an anesthesia for soldiers on field. Ketamines chemical structure, mechanism of action and effects are similar to those of PCP, but it acts for a shorter duration and is less potent than PCP. The drug provides dissociative anesthesia, which is a combination of analgesia with superficial sleep. This state is characterized by spontaneous ventilation, relative preservation of airway reflexes and hemodynamic stability, and explains why Ketamine has remained the anesthetic drug of choice in the developing world and for mass casualties in the field.  [8]  Ketamine is tasteless and odorless, so it can be added to food and drinks u ndetected. Because of this, the drug is sometimes used in sexual abuse at entertainment venues and therefore referred to as drug rape. Ketamine is known on the streets as special K, K and cat tranquilizer. Ketamine has plenty of other street names that have changed throughout the years. Originally it was known as rockmesc or mean green  [9]  , and then it evolved to numerous different slang names including Jet, Super K, Vitamin K, New Ecstasy, Honey oil, Mauve, Keller, Bump and Super Acid. Uses and effects of Ketamine exposure in medicine One of the most important happenings in the modern society is our breakthrough in the development of effective medicine for clinical procedures. Advances in technology has prospered the birth of new operation methods such as laparoscopic and robotic surgeries, enabling medical practitioners to increase efficiency to max, at the same time lowering the cost and risk of the procedure. These improvements have greatly ameliorated the side effects of conventional open surgery, allowing patients to heal faster with better comfort. Medicine becomes an indispensable need in our daily lives, and the more it improves, the more we rely on it. I have attended a medical lecture over the summer holidays on the background of surgery. The professor explained the four most important factors behind all the surgeries, namely the 4As: Anesthetics, Analgesics, Antibiotics and Antiseptics. Among these four, Ketamine has already covered two of these factors. Ketamine has several clinically useful properties, including analgesia and less cardiorespiratory depressant effects than other anesthetic agents  [10]  ; in fact it causes some stimulation of the cardiovascular system. Ketamine is soluble in water and is prepared with the sodium salt benzethonium chloride as a preservative. It is a basic compound and is dissolved in a solution of pH 3.5-5. The ketamine molecule contains an asymmetrical carbon atom with two optical isomers (enantiomers). The S (+) isomer is about three times more potent and longer acting as an anesthetic than the R (-) isomer. It is believed that the R (-) isomer is the part of the molecule that is the root o f the cause of some undesirable side effects.  [11]  Studies recently have shown that the S (+) Ketamine isomer is a stronger analgesic with a faster clearance and less side effects than the R (-). It has shown to provide a more rapid motor and sensory block, shorter duration and less motor blockade in elder males.  [12]  Ketamine interacts with N-methyl-D-asparate (NMDA), opioid, monoaminergic, muscarinic receptors and voltage sensitive Ca2+ channels. However, unlike other general anesthetic agents, ketamine does not interact with GABA receptors. The NMDA receptor is a member of the glutamate receptor family. It is an example of an ion channel coupled receptor with excitatory properties which has been implicated in the mechanism of general anesthesia, analgesia and also in neurotoxicity. Ketamine is a non-competitive antagonist of the NMDA receptor which interferes with the action of excitatory amino acids  [13]  . In addition, at clinically relevant concentrations, ket amine interacts with the phencyclidine (PCP) binding site leading to significant inhibition of NMDA receptor activity. This only occurs when the calcium ion channel has been opened. Effects of Ketamine on our body We were always informed with purely the basic consequences of drug abusing. For instance, we were taught that drug abusing may cause serious damage to our body but what exactly is our body suffering from? Central Nervous System Ketamine is the only anesthetic available which has analgesic (pain relieving), hypnotic (sleep producing) and amnesic (short term memory loss) effects. When used correctly it is a very useful and versatile drug.  [14]  Clinically, Ketamine has been reported to produce not only general but also local anesthesia. Ketamines site of action is primarily in the thalamus and limbic systems. It does not suppress respiratory drive unless high doses are used, or smaller doses given rapidly. Unlike other anesthetic agents, patients who have had ketamine may have their eyes opened and make reflex actions during the operation; therefore it is not suitable for use in eye surgeries. However, use of ketamine increases the intracranial pressure, therefore patients who have recent head injuries should avoid using it to prevent further damage. The reason behind was that the rise in mean arterial pressure caused a rise in cerebral perfusion pressure and therefore intracranial pressure. Moreover ket amine is a very effective analgesia and may be used without other analgesics intraoperatively. Due to the frequent occurrence of hallucinations after operation, the patient may be in agitation during recovery. These can be reduced by premedication and by recovering the patient in a quiet area.  [15]   I recently read several medical research papers on the effect of anesthetics and sedatives for the developing brain. A study performed by Dr. John Olneys laboratory demonstrated widespread neuronal degeneration following the repeated administration of ketamine in newborn rats, as well as long-term decreases in neuronal density and impaired neurocognitive function in adulthood following an exposure to other anesthetic drugs.  [16]  It is further discovered that drugs used to provide clinical anesthesia and sedation are thought to affect proper formation of the central nervous system as it interferes the NMDA-type glutamate receptor function. Moreover, several studies have examined the effects of Ketamine on the developing brain of monkeys and have observed widespread neuronal cell death following the administration of multiple doses up to 75mg/kg.  [17]  Another study by Dr. Fredriksson and colleagues demonstrated that a single ketamine exposure of 50mg/kg in new-born mice cau sed abnormal behavior and impaired learning and memory acquisition in adolescence. Experimental data also indicate that NMDA glutamate receptor agonists and GABA receptor antagonists trigger cell death.  [18]   As laboratory investigation on humans is not allowed, scientists may only conduct their research on rats and monkeys. The potential mechanism of anesthetic neurotoxicity is still under investigation; however, it is further complicated by the lack of understanding of exact mechanisms of consciousness and anesthesia. Therefore these results may only be interpreted as a reference to the effects that relate back to ketamine abuse. Respiratory System By using ketamine, the airway is usually well maintained as the airway reflexes and skeletal muscle tone are relatively preserved. Aspiration is a potential hazard despite the retention of protective reflexes. Ketamine is an effective bronchodilator and its action may be mediated either via an increase in blood catecholamine or by its direct smooth muscle relaxant effect.  [19]  When ketamine is given slowly respiration is usually well maintained, after rapid intravenous injection the breathing may stop for a short while but usually restarts within a minute.  [20]  Because of this, ketamine becomes a very useful anesthetic agent in places where there is only limited oxygen available. Cardiovascular System Ketamine is able to increase both blood pressure and heart rate. These variables reach a peak 2-4 minutes after an intravenous injection, then slowly decline to normal values over the next 10-20 minutes. Ketamine produces its cardiovascular effects by stimulating the central sympathetic nervous system and, to a lesser extent, by inhibiting the reuptake of norepinephrine at sympathetic nerve terminals. Individual responses may vary occasionally as there can be a large rise in blood pressure. This risk is not related to a preoperative history of hypertension, but related to the usage of ketamine. This may increase the workload of the heart; hence ketamine should be avoided in those patients with ischemic heart disease. Induced bladder dysfunction Bladder dysfunction associated with ketamine abuse was first voiced out in 2007 by researchers in Canada and Hong Kong. Dr. Shahani and his team presented a series of 9 patients who are all daily ketamine users presented with dysuria, frequency, urgency and frank hematuria. The CT scans revealed a thickened bladder wall, small capacity bladder and perivescicular stranding.  [21]  Dr. Chu and his team presented a series of ten patients with severe bladder dysfunction following regular ketamine abuse. From the statistics of their research, all patients had severe lower urinary tract symptoms and small functional bladder capacity varying from 20 to 200mls.  [22]  A scan of the bladder (cystoscopy) also revealed that the epithelial layer of the bladder has inflammation.  [23]  These reports were from Hong Kong and Canada where ketamine is a popular drug. Dr. Cottrell and his team reported nine patients presenting with similar urinary symptoms and cystoscopy findings following chronic ketamine usage.  [24]  These symptoms are currently left unexplained, but with increasing popularity of the drug in the younger generation, more and more ketamine users could present with ketamine induced bladder dysfunction. As we can see from the above effects, ketamine is already able to induce a lot of problems for our body and affects the whole body system when it responses to the drug in medical uses. Some may be beneficial, but most can cause severe damage to our body, so why is ketamine still on the streets endangering our future generations? Ketamine in our society Back in Hong Kong, I often hear reports from the public media reporting that the police force discovers another drug dealing club/bar with underage drinking and drug abuse. Although we were educated with the basics of the consequences of drug abuse, one simply will not be able to know thoroughly about the essential damage that the drug does to the body. Take smoking as an example: Tobacco has existed for centuries, and people nowadays have beautifully wrapped cigarettes packed in delicate boxes. They can easily gain access to buying one of this highly toxic substance back home for their own enjoyment and pleasure. Putting aside the lack of awareness in the old days, nowadays all the education systems around the globe include the effects of smoking into our classes, no matter taught in Liberal Studies or specifically Biology, most people who have received education are equipped with the basic knowledge of the harmful effects of smoking. Even packages of cigarettes are posted with phot os of the disastrous effects of smoking, for example, a photo of a dissected lung of a chronic smoker, still does not stop smokers from getting on with their habit. In the 1970s, the drug was approved by the FDA to be used clinically on children and adults, yet at the same time it also started to flow into drug markets in public. Most of them were firstly sold by hospital staff; later on it became trendy to produce it in large amounts to divert ketamine into wider population. Over the past 20 years, Ketamine has emerged as a testing replacement for PCP to one of the most popular party drugs at underground parties and raves. In the late 20th century, the drug has already gained its reputation around the globe as one of the mainstream dance culture drugs in society. In the year 1999, The Drug Enforcement Agency in the United Sates made ketamine a schedule three drug. This means that this particular drug is illegal to buy or sell without a prescription.  [25]  Ketamine is considered to be a Class C drug in the UK and Mexico, the equivalent of a schedule three in the United States; and schedule one in Canada. It was legal to possess ketamine in England, Scotland and Wales before 2006. Most countries currently have ketamine under controlled substance act in which it can be used as a medication but not recreationally, for instance ketamine is regulated under Schedule 1 of Hong Kong Chapter 134 of Dangerous Drugs Ordinance. It can only be used legally by health professionals, for university research purposes, or with a physicians prescription.  [26]   Taking the data of ketamine abuse in Hong Kong, in recent years, it has become more common among the teens. In Hong Kong, since 2005 it has become the commonest drug of abuse among persons aged 21 years or less; compared to the first three quarters of 2005, the number of ketamine abusers among teenagers has doubled in the first three quarters of 2008.  [27]  In 2008, ketamine abuse constituted 85% of all kinds of drug abuse among persons aged below 21 years, compared to 61% in 2005. Also, data collected by the Hospital Authority Hong Kong Poison Information Centre (HKPIC) showed that ketamine abusers represented 16% of all drug abusers attending accident and emergency departments in the period of 1 July 2005 to 31 December 2005, while the proportion rose to 40% in the period of 1 January 2008 to 30 June, indicating a steep increase of the number of ketamine abusers.  [28]   Solutions? The reason I decided to put a question mark after this sub topic is because there is no concrete evidence that the treatments I list below will 100% cure the patient. To overcome the psychological dependence on ketamine, the ultimate factor during the process will be the patients endurance and willpower. Without consistency to finish the whole course of treatment is no different to receiving no treatment. Just like antibiotics, you have to finish the whole course in order to fully recover from your illness. We live in an inconsistent and contradictory society. On the bright side, we advise the society not to abuse drugs and say no to the people who sell or offer them to you; yet on the other hand, medical practitioners are encouraging us to take medicine that might cause similar effects and consequences as drugs like ketamine. While we tell young people that ketamine is illegal and dangerous for their health, we ignore to a large extent the bad effects that alcohol has on health, thus making it legal even if it has devastating effects on our body as well. The world has slowly turned into a place where benefits and money take hierarchy over the health of the public. There is an increase in frequent reports of making fake milk powder and eggs, as well as drug manufacturers such as the recent incident of Contergan taking the blame of causing Phocomelia in infants whose parents had taken the medicine. One of the main reasons that ketamine is still one of the most popular party drugs nowaday s is due to the commercial income it brings when it comes to selling and buying. Drug dealing is happening around the globe every day, and what attracts people to do it is not the drug, but the money. Values have been overthrown by the nature of human kind, where selfishness topples conscience in the business world, no matter legal or illegal. Laws and regulations are developed over time to control the extent of these shameful behaviors, yet ultimately there is no thorough solution to this problem. Most societies are uncomfortable with people going off into trance and hallucinatory intoxications, and indeed setting up the laws against the usage and possession of drugs are to discourage people from falling into those in-built worlds of their own. But innate, neuropsychological changes in a persons body cannot be controlled by legislation. Provided that they have the desire to take the drug, they will always be satisfied by themselves. Alcohol may no longer fulfill the need for teenagers to take off from reality into their virtual world of desires after they become fully exposed to it, and slowly they turn to seek stronger effects by trying out drugs like marijuana and ketamine. As they become satisfied with the effects given by the drugs, trying gradually becomes abusing. They start to develop unwise behavior as they reckon that the feeling is brought by the pills rather than from their own nervous systems getting into trouble when the pills no longer work so well. Their drug abuse becomes more frequent and compulsive, yet with less reward. This misconception is the first step to developing drug dependence, no matter whether the drug is marijuana or ketamine or if it produces physiological dependence or not. Dependence on the drug cannot be broken until the misconception is cleared. Drug abusers live on their own reasons to continue, and only those who realize that he/she has been using the drug merely as an excus e for having an experience that is superficial comes to see that the drugged state is not exactly the same with the experience he/she wants. Alternatively, they will start looking for ways that may fulfill the slight desire to lift up from reality, such as meditation and sleeping. If we look in closely to the successful examples of quitting drugs: Many drug abusers give up drugs for consciousness, but little gives up consciousness for drugs. Conclusion We see people travelling through time and going into the mind of others to retrieve thoughts and ideas in fiction and movies, and it is definitely something that I would love to do as well. Yet is it possible to live in dreams and neglect whats really happening in the world we exist in? By altering the state of our consciousness, our brain is simply sending the wrong signal back to ourselves, putting us into a world of our own desires and fantasies. Ketamine can definitely achieve this, but after the short-lived dreams disappear, we will only fall deeper into the K-hole and become more dependent on the drug. We must be clear about the severe effects and consequences that ketamine brings to the individual and the society, and reiterate these problems to the public to prevent further abuse of it. Psychoactive drugs will always be present as a part of our life. The society needs to recognize the problems caused by the misuse of ketamine and deal with them immediately in an open and realistic way. Drug abuse is now connected with other social problems as well, such as social deprivation or family issues. We actually do not know whether the people who abuse it really likes it, but all we need to know is how ketamine can vastly change a persons life when you become addicted to it. From the medical research evidence shown, ketamine can really ruin your life when you are associated with it, yet why blame the drug when it is down to you to choose the reality or to stay in the dreams built by your own desires?