Relationship Between Lactate Threshold Essay

Abstract Research into the relationship between physiological variables and running performance has been variable. The aim of this study was to examine the relationship between 5k running performance and a number of physiological variables in a group of 11 trained club runners (Age 21.451.63yrs, Height 175.092.77cm, Weight 67.865.12kg). The athletes underwent a laboratory treadmill test to determine their maximum oxygen uptake (VO2 max) and running velocities at lactate threshold (v-Tlac) and blood lactate concentration of 4mM (v-OBLA). Running performance was determined by a 5k time-trial on an athletics track for which the average time was 1097.09  ± 108.02 secs. The mean velocities for v-Tlac and v-OBLA were 15.18  ± 1.5km/h, 16.76  ± 1.60 km/h and mean VO2max was 59.10  ± 3.54 ml/kg/min. The best single predictors of 5k running performance were v-OBLA and VO2max (p = .003, p = .007) while v-Tlac was slightly poorer (p = .013). It is concluded that lactate variables may be valid an d reproducible predictors for 5km running performance. Introduction Research throughout history has established that a number of physiological variables relate to distance running performance, including Lactate Threshold (Tlac), OBLA and VO2 Max (Conley and Krahenbuhl, 1980; Costill, Thomason and Roberts, 1973; Coyle et al, 1983; Farrell et al, 1979; Hagberg and Coyle, 1983; Lafontaine, Londeree and Spath, 1982). The results from this research have been variable. Evidence has shown that blood lactate variables highly correlate with running performance over a variety of distances. Additionally, these variables contribute to running performance variance more than any other physiological variables (Yoshida et al, 1990, 1993). ‘Lactate Threshold’ describes the point at which exercise begins to hurt more than it should because the body’s lactate production exceeds the body’s ability to flush it away (Robergs & Roberts, 1997). It is the exercise intensity at which lactate threshold occurs that can be used as a significant predict or of endurance performance (Allen et al, 1985; Coyle et al, 1988; Farrell et al, 1979). It is considered a powerful tool for developing effective training regimes and as a method of monitoring adaptation to endurance performance, although to be effective at fulfilling these roles, the measurement of lactate threshold must be reliable. OBLA is the Onset of Blood Lactate Accumulation. OBLA is accepted as an incremental method for detecting the lactate deflection point (Australian Sports Commission, 2000). Being able to detect this point is crucial as it is an indication of when an athlete switches from a predominantly aerobic to anaerobic metabolism, which leads to hastened fatigue. It is established that a level of ~ 2 – 4 millimoles per dm3 (litre) represents OBLA. Duggan and Tebbutt (1990) examined blood lactate concentrations of non-athletes during a treadmill protocol at 12 km/h. Results suggested vOBLA to be a reproducible performance predictor. In addition to Lactate variables, sports scientists measure VO2 max to objectively evaluate a subject’s functional aerobic capacity. VO2 max is the maximum volume of oxygen that can be utilised in one minute during maximal or exhaustive exercise (Bassett & Howley 2000). The majority of research using heterogeneous groups has found that VO2 Max correlates highly with running performance (Costill et al, 1973; Thomason and Roberts, 1973; Foster et al, 1978). However, when moderately homogeneous groups were tested, low-moderate correlations were found (Conley and Krahenbuhl, 1980; Morgan et al, 1989). Saltin and Astrand (1967) discovered that high VO2 Max values in subjects have been related to successful running performance, because traditionally the oxygen cost of running is directly proportional to running speed. Grant et al (1997) conducted a study involving treadmill protocols to assess all of the variables considered above and a time trial on an indoor 200m track to determine 3km-running performance. The main findings concluded that lactate variables were the best single predictors of v-3km. Further research and development of knowledge concerning the dominant physiological contributors that underlie short-distance running performance will enable greater specificity in training methods, allowing for improved competitive performance. Therefore, this study aims to investigate the relationships between Lactate Threshold, OBLA, VO2 Max and 5km Running Performance. Experimental Hypothesis It is to be hypothesised that participants reaching higher velocities upon reaching lactate threshold will display superior 5k running performance and that there will be a significant relationship between the two variables. It is to be hypothesised that participants reaching higher velocities upon reaching OBLA will display superior 5k running performance and that there will be a significant relationship between the two variables. It is to be hypothesised that participants with a greater Vo2 Max (oxygen capacity) will display superior 5k running performance and that there will be a moderate relationship between the two variables. Null Hypothesis It is to be hypothesised that there will be no significant relationship between velocity at lactate threshold and 5k running performance. It is to be hypothesised that there will be no significant relationship between velocity at OBLA and 5k running performance. It is to be hypothesised that there will be no significant relationship between VO2 Max and 5k running performance. Method Participants A total of 11 Trained Club Athletes, who have been free from injury for the past three months, were tested (Age 21.451.63yrs, Height 175.092.77cm, Weight 67.865.12kg). All participants were asked to complete a consent form. Research design The experiment involved 2 experimental trials; a lab based test to determine Tlac, OBLA and VO2 Max and a 5k running time-trial on the athletics track, completed in a counterbalanced order with 1 week separating each trial. Both trials were conducted on the same day and at the same time of day (10:00 – 11:00 am). Laboratory conditions were 21 0.3 (C) and track conditions were 20 0.2 (C). Procedures Screening: Participants were screened prior to exercise to ensure they had an appropriate health status for exercise. Screening included taking resting heart rate using a heart rate monitor (Polar, T31, Finland), and blood pressure using a blood pressure monitor (Omron, MX3 Plus, Netherlands); Resting heart rate >90bpm; systolic blood pressure >140 mmHg; and diastolic blood pressure >90 mmHg. Participant Preparation: Prior to exercise participants were prepared and fitted with the necessary equipment. A heart rate monitor (Polar, T31, Finland) was fitted and a resting blood lactate measurement taken. Prior to blood sampling, hands were washed, gloves were worn and the area of sampling was cleansed with an alcohol wipe. A small insertion was made to the participant’s earlobe using a lancet. The first blood droplet was wiped away and blood was collected using a capillary tube. The blood was then mixed and analysed using a lactate analyser (Analox Analyser Micro-Stat, P-GM7, USA). The participant was then prepared for exercise. A nose clip, breathing pneumotach and mouthpiece (Hans Rudolf, USA) were equipped. The following equipment was then attached to an automated gas analyser (Medgraphics, CPX Cardio II, USA), allowing the measurement of oxygen uptake. Exercise Protocol: As all participants were catagorised as trained athletes, creating a homogeneous group, a warm-up speed intensity of 12km/h (Endurance Athletes) was selected, in relation to ‘The guidelines for establishing exercise intensity for the determination of TLAC during treadmill running in adults’ (Adapted from Jones and Doust in Eston And Reilly, 2001) (Appendix 1.2). Following a 5-minute warm-up on the treadmill (Woodway, ELG, Germany), the participants completed an incremental graded exercise test. Increments lasted 4 minutes, timed on a stopwatch (Fast Time, 1) and at the end of each increment the participant rested for a period of 1 minute, this allowed for the collection of a capillary blood sample. The speed was increased by 1kph per increment. Upon attaining a blood lactate value of 4 mmol.L-1, the test became incremental and continuous, continuing the 1kph increase in speed but now per 2 minutes with no resting period. The participant was ran to volitional exhaustion and then asked to complete a cool-down at a running intensity below the warm-up level. Participants lactate thresholds were determined by monitoring their 2mmol point; OBLA by monitoring their 4mmol point and VO2 Max was the participant’s maximal oxygen uptake from the protocol. Statistical analyses The dependant variables Heart Rate (HR), Rating Of Perceived Exertion (RPE), and Blood Lactate (BLa) were recorded at each of the workload intervals. Atmospheric pressure (mmHg) and air temperature (C) were recorded using a barometer and thermometer and remained constant throughout the experiment. SPSS was used to determine correlations between Velocity at Tlac (Kph), Velocity at OBLA (Kph), VO2 Max and 5k Running performance (seconds); Paired Sample T Test was used to determine the significance of relations between Mean 5k Velocity and Velocity at OBLA. Significance level was set at P ≠¤ 0.05. Results The research experiment of the 11 participants provided a number of important variable measurements of which can be analysed. Table 1. Mean and Standard Deviation of Physiological Variables. | Velocity at LT (km/h)| Velocity at OBLA (Km/h)| VO2 max (ml/kg/min) | 5k time (secs)| 5k time (mins)| 5k Running Velocity (km/h)| Mean| 15.18| 16.76| 59.10| 1097.09| 18.28| 16.55| Figure 1. The relationship between v-Tlac and 5k Running Performance. Table 1. Figure 1. Displays the Velocity at Lactate Threshold results for all 11 participants for the duration of the experiment. Participant’s averaged a Velocity of 15.18 1.5km/h upon reaching Lactate Threshold. There was a high, significant, negative correlation between Velocity at LT (mean  ± SD = 15.18  ± 1.5km/h) and 5k Running performance (mean  ± SD = 1097.09  ± 108.02sec) of the trained athletes: rho = -.664, N = 11, p = .013, (one-tailed). Figure 2. The relationship between v-OBLA and 5k Running Performance. Table 1. Figure 2. Displays the Velocity at OBLA results for all 11 participants for the duration of the experiment. Participant’s averaged a Velocity of 16.76 1.6km/h upon reaching OBLA. There was a very high, significant, negative correlation between Velocity at OBLA (mean  ± SD = 16.76  ± 1.60 km/h) and 5k Running Performance (mean  ± SD = 1097.09  ± 108.02 sec) of the trained athletes: rho = -.770, N = 11, p = .003, (one-tailed). Figure 3. The relationship between VO2 Max and 5k Running Performance. Table 1. Figure 3. Displays the VO2 Max results for all 11 participants for the duration of the experiment. Participant’s averaged a VO2 Max of 59.10 3.54ml/kg/min. There was a very high, significant, negative correlation between VO2max (mean  ± SD = 59.10  ± 3.54 ml/kg/min) and 5k Running Performance (mean  ± SD = 1097.09  ± 108.02sec) of the trained athletes: rho = -.712, N = 11, p = .007, (one-tailed). Figure 4. Relationship between Mean 5k Running Velocity and Velocity at OBLA. The dependent t-test showed that there were statistically no-significant differences between mean velocity (mean  ± SD = 16.55  ± 1.57 Nm) and velocity at OBLA (mean  ± SD = 16.76  ± 1.60 Nm); t = .692, df = 10, p = .511, (two-tailed). Discussion The main finding of the study was that v-OBLA was strongly related to 5k running performance. A simple correlation of v-OBLA and 5km running performance presented high significance (r= -.770; P < 0.01). The correlation between VO2max and 5km running performance in the present study was also highly significant (r= -.712; P < 0.01), succeeding the significance hypothesised and superseding the significance of v-Tlac (r= -.664; P < 0.05). These results agree with that of previous studies expressing high relationships between lactate variables and running performance (Allen et al, 1985; Farrell et al, 1979; Hagberg and Coyle, 1983; Kumagai et al, 1983), and closely relate to a fairly recent study performed by Yoshida et al, (1993), which conveyed simple correlation results of 0.77 and 0.78 between v-Tlac, v-OBLA and 3k running performance. Running velocities at Tlac and OBLA are subjective to a variety of factors, including muscle fibre type. Further research by Costill et al, (1976) discovered that elite endurance runners have a high proportion of Type I fibres, which have subsequently been linked to low blood lactate concentrations at given work rates (Tesch et al, 1978). The high relationship of lactate variables to 5km running performance suggests that success in distance running can be determined by performance at the highest possible running velocity that can be attained without the accumulation of blood lactate; when velocity exceeds this and lactate production rises, acidosis occurs as a result of glycolysis, which has been proven to cause decreases in force production, consequently affecting performance (Donald son and Hermansen, 1978; Fabiato and Fabiato, 1978). The correlation between VO2 Max and 5km running performance exceeded the significance found between the two variables in present studies (Hagberg and Coyle, 1983). Literature considering this topic area documents that endurance performance is habitually more highly correlated with lactate variables as appose to VO2 Max (Jacobs, 1986). Studies of well-trained athletes have evidenced that VO2 Max can remain relatively stable throughout the duration of a competitive season, despite athletes displaying changes in performance (Galy et al, 2003; Jones and Carter, 2000). This indicates that VO2 Max isn’t perceptive enough to determine transient improvements in performance, and shouldn’t be solely used as a predictor of endurance running performance. The dependent testing of mean 5km velocity and v-OBLA documented that there were no significant differences between the two (p = 0.511). This suggests participants were running at approximately the highest velocity that they could attain without the accumulation of blood lactate. The study of Usaj (2000) supports that when velocity exceeds v-OBLA, lactate fluctuations exceed steady conditions and athletes experience fatigue earlier. The variance figures between v-OBLA, v-Tlac and running performance (R2 = 59.3 per cent; R2 = 44.1 per cent) are considerably lower than previous studies, however these still suggest that blood lactate variables must contribute to running performance. Yoshida et al (1989) reported large portions on common variance between v-OBLA, v-Tlac and running performance (R2 = 88.6 per cent; R2 = 72.8 per cent). Study implications included the inefficiency of obtaining lactate measurements within the time allocation, possibly causing variable results, and an occasional equipment failure when obtaining heart rate measurements. In addition to the variables tested, previous studies have found a relationship between running economy and endurance performance (Ramsbottom et al, 1987; Grant et al, 1997). This may be an area to examine in future research. Conclusion The study concludes that in a heterogeneous group of 11 trained endurance athletes, blood lactate variables are the most highly valid and reproducible predictors for 5km running performance, strongly supported by previous research. Contrastingly, although VO2 max results were highly significant, they failed to correlate with previous research and it is to be suggested that VO2 max can only be considered as a moderate alternative predictor. References Australian Sports Commission. Physiological Tests for Elite Athletes. Champaign, IL: Human Kinetics, 2000. Allen, W.K., Seals, D.R., Hurley, B.F., Ehsani, A.A., and Hagberg, J.M., (1985). Lactate threshold and distance running performance in young and older endurance athletes. J. Appl. Physiol. 58, 1281–1284. Bassett, D.R., & Howley, E.T., (2000). Limiting factors for maximum oxygen uptake and determinants of endurance performance. Medicine and Science in Sport and Exercise. 32, 70-84. Conley, D.L., and Krahenbuhl, G.S., (1980). Running economy and distance running performance of highly trained athletes. Med. Sci. Sports Exercise. 12, 357-360. Costill, D.L., Thomason, H., and Roberts, E., (1973). Fractional utilization of the aerobic capacity during distance running. Med. Sci. Sports. 5, 248-252. Coyle, E.F., Martin, W.H., Ehsani, A.A., Hagberg, J.M., Bloomfield, S.A., Sinacore, D.R., and Holloszy, J.R., (1983). Blood lactate threshold in some well-trained ischemic heart disease patients. J. Appl. Physiol. 54, 18-23. Coyle, E.F., Coggan, A.R., Hopper, M.K., and Walters, T.J., (1988). Determinants of endurance in well-trained cyclists. J. Appl. Physiol. 64, 2622–2630. Donaldson, S.K.B., and Hermansen, L., (1978). Differential, direct effects of HI on Ca2†³-activated force of skinned fibers from the soleus, cardiac and adductor magnus muscles of rabbits. European Journal of Physiology. 376, 55-65. Duggan, A., and Tebbutt, S.D., (1990). Blood lactate at 12 km/h and vOBLA as predictors of run performance in non-endurance athletes. International Journal of Sports Medicine. 11, 111-115. Fabiato, A., and Fabiato, F., (1978). Effects of pH on the myofilaments and the sarcoplasmic reticulum of skinned cells from cardiac and skeletal muscles. Journal of Physiology. 276, 233-255. Farrell, P.A., Wilmore, J.H., Coyle, E.F., Billing, J.E., and Costill, D.L., (1979). Plasma lactate accumulation and distance running performance. Med. Sci. Sports. 11, 338-344. Foster, C., Costill, D.L., Daniels, J.T. and Fink, W.J. (1978). Skeletal muscle enzyme activity,  ® bre composition and ÇV O2 max in relation to distance running performance. European Journal of Applied Physiology. 39, 73-80. Galy, O., Manetta, J., Coste, O., Maimoun, L., Chamari, K., and Hue, O., (2003). Maximal oxygen uptake and power of lower limbs during a competitive season in triathletes. Scandinavian Journal of Medicine and Science in Sports. 13, 185–193. Grant, S., Craig, I., Wilson, J., and Aitchinson, T., (1997). The relationship between running performance and selected physiological variables. Journal of Sport Sciences. 15, 403-410. Hagberg, J.M., and Coyle, E.F., (1983). Physiological determinants of endurance performance as studied in competitive racewalkers. Med. Sci. Sports Exercise. 15, 287-289. Jacobs,I., (1986). Blood lactate Implications for training and sports performance. Sports Med. 3, 10-25. Jones, A.M., and Carter, H., (2000). The effect of endurance training on parameters of aerobic fitness. Sports Medicine. 29, 373–386. Kumagai, S., Tanaka, K., Matsuura, Y., Matsuzaka,†¨A., Hirakoba, K. and Asano, K., (1983). Relationships of anaerobic threshold and the onset of blood lactate accumulation with endurance performance. European Journal Of Applied Physiology. 52, 51-56. Lafontaine, T.P., Londeree, B.R., and Spath, W.K., (1982). The maximal steady state versus selected running events. Med. Sci. Sports Exercise. 13, 190-192. Morgan, D.W., Baldini, S.D., and Martin, P.E., (1989). VO2max among well-trained male runners. Medicine and Science in Sports and Exercise. 21, 78-83. Ramsbottom, R., Phil, M., Nute, M.G.L., and Williams C., (1987). Determinants Of Five Kilometre Running Performance In Active Men and Women. British Journal of Sports Medicine. 21, 9-13. Robergs, R.A., & Roberts, S., (1997). Exercise Physiology: Exercise, performance, and clinical applications. St Louis, Missouri: Mosby. Saltin, B., and Astrand, P.O., (1967). Maximal Oxygen Uptake in Athletes. Journal of Applied Physiology. 23, 353-358. Tesch, P., Sjodin, B., and Karlsson, J., (1978). Relationship between lactate accumulation, LDH activity, LDH isozyme and fiber type distribution in human skeletal muscle. Acta Physiologica Scandinavica. 103, 40-46. UÃ… ¡aj, A., (2000). The application of criterion OBLA in prescribing running endurance training intensity is limited. KinSI. 6, 57–62. Yoshida, T., Udo, M., Iwai, K., , Muraoka, I., Tamaki, K., Yamaguchi, T., and Chida, M., (1989). Physiological determinants of race walking performance in female race walkers. British Journal or Sports Medicine. 23, 250-254. Yoshida, T., Udo, M., Iwai, K., Chida, M., Ichioka, M., Nakadomo, F., and Yamaguchi, T., (1990). Significance of contribution of aerobic and anaerobic components to several distance running performances in female athletes. European Journal of Applied Physiology. 60, 249-253. Yoshida, T., Udo, M., Iwai, K., and Yamaguchi, T., (1993). Physiological characteristics related to endurance running performance in female distance runners. Journal of Sports Sciences. 11, 57-62.

Importance of Strategic Human Resource Management

Management in an organization and asses its purposes in the chosen organization By Assimilate 23 In present business environment â€Å"information technology' has become back bone of any business or organization, and they are integral part of day to day activities. Information technology which connects all the departments with each other which helps to increase efficiency, reduce communication time, production time, to improve, maintain the business flow. In short every industry and even companies within the industry can have different key success factors.It is important to select supply chain IT systems that are able to give us advantage in the areas most crucial to business success. Companies invest a good amount of their budget to develop new software's programs to improve their flexibility and responsiveness and competitiveness. In recent studies conducted by Food & Agricultural Organization (FAA) it was found that Food wastage across the world is alarming and $ 1 trillion of fo od is being wasted for the reason jack of technology, human error and facilities.In our pizza hut outlet Information Technology will play very important role which will connect all our operation. We being a fast food chain and products used are highly perishable and if a proper control on purchase, storage and production is not there then our business may end up in loss. As per below given diagram IT will be connecting all our departments Fig. 1 Logistics & Procurement: IT will help to collect data, tracking products inventory and reduce lifestyle which will help everybody involved in the process.Has the data will be readily available it will help to procure our raw materials as per the requirement and keep a track on the movements, storage and delivery. Operation: It will help in day to day activities by attending customers taking their orders placing them to our production and arranging to deliver. In addition to this it will help to maintain our financial track, bank accounts, pa yment schedule and other uncial obligations.Customer relationship: To improve our customer service, attend customer complaints and develop relationship with customer we need a proper IT support such as CRM

Blood Brothers Essay

My initial example is where Eddie is advising Mickey what to say when he asks Linda out. Eddie: Linda my loins are burning for you. Let me lay my weary head on your warm breast; Linda, I love you, I want you, the very centre of my being calls out for you! Eddie’s environment has obviously affected the way that he could just think of something to say which is very romantic. You could not imagine Mickey saying such things. Eddie is more confident and knows how to use his vocabulary well in order to get people to do things. When Mickey tries to, his outcome is abysmal. Mickey: Erm†¦ er, well the thing is the centre of my†¦ being cries out for†¦ erm, my knees, loins are†¦ (snaps) Linda for Christ’s sake will you go out with me? Linda agrees. Mickey cannot find the right words to say even if he is told what to say. Mickey’s vocabulary is retarded because of his environment. His school is worse than Eddie’s so he tries to copy Eddie but still cannot do that. I put this under humour because I thought it was quite funny but it could also go under language as both of the boys language has been affected by their environment. My next example is when the policewoman asks Eddie what he is doing. Eddie replies â€Å"Adolf Hitler†. Then the policewoman asks him what his name is and he says that he is waiting for the 92 bus. For one moment I think Eddie wanted to be like Mickey and tried to be cheeky to the police officer but because of his family and environment he was unable to do that and it ended up the wrong way around. This example is like my original but the other way around. Now, I am going to discuss the way that Russell uses plot to stress the point that family and environment have an effect on peoples lives and opportunities. The whole of the story is based around two males who are separated at birth. One of the twins had been told that there was a twin brother and that he died at birth, the other had been told that he was an only child. Now they are isolated from each other their lives begin to change because of their background and environment. My first example is when Mickey and Linda are married and are looking for a house from the council. They had been waiting for approximately five years for a new house and still had not got one! When Linda was passing the Council Offices she stepped into the housing officer’s office and asked to speak to him. When he arrived Linda was surprised as the man was Eddie. She pleaded once again for a house to live in, and because of Eddies environment he said that all he needed to do was to make one phone call. Then Mickey and Linda would be at the top of the list and could have a house very soon. Because of Mickey and Linda’s environment, they were forced to go to the council for a cheap or free house and considering Eddie’s status he could do this extremely quickly. My second example for plot is where Linda turns out just like Mrs Johnson, (Mickey’s mum. ) In â€Å"Educating Rita,† another of Russell’s work, Rita was expected to have a baby as soon as they got married. This is just like Linda with Mickey. In their family and environment they are expected to have a baby young and to traditionally stay around the house. This reduces their opportunities in life as they do not work once they have had a baby. The man of the house, in their environment, is foreseen to do all of the work and bring all of the money in. This is exactly what happens in this story. Now, I have completed â€Å"plot†, I will go on to analyse the staging devises Willy Russell uses to show the effect that family and environment have on the two boys lives. There was a recent performance at a local theatre, which I went to see. I found that by going to see the acted story I found how even the way you dress, your family and your environment were involved in some way. My leading example through â€Å"set† is costume. I noticed Mickey was wearing clothes too big for him which have most likely been passed down through the family. Eddie is the complete opposite to Mickey in the way that he is wearing smart, new school clothes and looks very sharp in his uniform. Russell shows how even clothes have an effect on family and environment. At the play it showed the brothers in completely different houses. One at the rough end of the village and the other at the very high end of social environment. They live in different ways and houses because of their environment. Their family either reduces the opportunity to live in a high class house or improves the opportunity. There are certain changes in the acted story, the first being where Mickey helped his brother complete a crime which went wrong. People in Mickey’s environment often resort to this as they need the money, but people in Eddie’s environment would never be constrained to doing this sort of thing as they always have money. When Mickey went to jail he had to be put on anti-depressants to help him cope with the stress and loneliness of prison. This was the final straw for Mickey because all of his life he had been pushed to the limit craving for food and money, lots of things also go wrong in Mickey’s environment. When he finally reached confinement he felted that was enough. If Eddie had been placed in jail he would probably be able to cope as he has had less to put up with than Mickey but would most likely be bailed anyway! I conclude that every little detail which Willy Russell has put into his well crafted book, and performance, has something to do with family and environment. Because of his own experiences he was able to complete the task of writing this book and include very graphic details of how family and environment effects peoples everyday lives and opportunities.

Law of succession Assignment Example | Topics and Well Written Essays - 3000 words

Law of succession - Assignment Example Browne. The deceased will of Mr. Harbottle was homemade and was formulated in the year 2010 on 22nd March. Circumstantially, Mr. Browne appointed Ms. Josie Morrison, who is a professional solicitor of Morrison and Jeffries LLP with the aim of advising him with regard to certain issues with respect to the will signed by Mr. Harbottle. To be specific, in the will, the name of the executor who is Mr. Browne has been misspelled as ‘Mr. Brown’. Moreover, the address of Mr. Browne has been inscribed wrongly in the will which has again raised confusions regarding the gains of Mr. Browne from the will by Mr. Harbottle. Furthermore, as the will was roughly torn, which damaged the date of signing the will, the specifications mentioned in the same became hardly interpretable that again increased confusions. Additionally, the last two letters of the surname of the testator was also found torn wherein Mr. Browne denied any such careless act from his end and also did not depict any si gnificant interest of the gifted amount of ?50,000 being wealthy in his own right. Sometimes back, Mr. Browne formulated his will and assigned Harriet Reid, the accountant of Mr. Browne, to be his executor. Mr. Browne further deciphered his unwillingness to accept the gift offered through the will by Mr. Harbottle in order to prevent high tax imposition. Mr. Browne has planned to provide this sum to the daughter of his gardener, Mary Stapleton for her university study. Additionally, the case scenario depicts that Mr. Browne is pleased with the service of Ms. Morrison and has therefore planned to pay her a sum of ?5000 be means of inheritance in his will. The will of Mr. Browne also specifies that if she dies before Mr. Browne, the sum will be paid to her husband. Discussion The Issues Which Are Identified In the Case Mr. Browne has observed that there are number of issues in relation to the deceased will of Mr. Harbottle. As Mr. Browne is the ultimate executor of the will, he has ra ised the issue that his name has been misspelled as ‘Brown’ instead of ‘Browne’ in the will. Moreover, Mr. Browne has also noticed that the address which has been mentioned in the will is inappropriate or wrong as Mr. Browne resides in a different place when the will was formed. Additionally, Mr. Browne and Late Mr. Harbottle were dweller of a same village but Mr. Browne could not remember to promise to execute the will of Harbottle owing to the absence of any deep relation with Mr. Harbottle. However, Mr. Browne is willing to carry out the will even though he is reluctant to accept the entire amount gifted due to tax implications and has thus planned to gift the amount to his gardener’s daughter if obtained [Wilson v. Beddard (1841) 12 Sim. 28]1. In this regard, Mr. Browne is seemed to be confused about the procedures which are required for the appropriate execution of the will. Contextually, it is important that the name as well as address of an ex ecutor or executors should be mentioned in detail taking into account the up-dated data for better validity of the will. Eventually, the misspelled name of the executor may restrict Mr. Browne from executing the will of Late Mr. Harbottle. Moreover, the address of Mr. Browne was also mentioned as incorrect. As per the ‘Inheritance (Provision for Family and Dependants) Act 1975’ the name and address of an executors or executors are required to be mentioned correctly for the appropriate execution of the will of a late person2 [Barrett v Bem [2012] EWCA Civ 52]3. Furthermore, an

Fukushima nuclear plant incident in 2011 Essay Example | Topics and Well Written Essays - 2000 words

Fukushima nuclear plant incident in 2011 - Essay Example This is the largest nuclear catastrophe recorded in the world after the 1986 Chernobyl disaster and it is believed to have released approximately 10 to 30% of radiation material of what Chernobyl incident emitted (Povinec, Hirose and Aoyama 2013, p. 9). In the event of the tsunami, the backup power equipment that was meant to cool the reactors was destroyed and this caused fuel melting, hydrogen outburst, and radioactive gases. This radioactive release at the Fukushima plant forced the neighborhoods up to 25 miles estimated at more than 100,000 residents were all evacuated away from the plant. The subsequent lack of AC power in Units 1 to three prohibited the valves and pumps from working normally which was necessary to eliminate heat and pressure that occurred due to radioactive decay from the nuclear fuel within the reactor hubs. The fuel rods therefore, overheated and in combination with the steam, huge quantities of hydrogen were generated causing an explosion. This is the explos ion that prevented the plant workers from cooling the reactors and the radioactivity spread rapidly (Elliott 2012, p.7). The Pollutant Source and Pathway The source of the Fukushima nuclear plant disaster is directly related to the earthquake of a 9.0 magnitude that hit Japan in 2011. This earthquake caused damage to the external power supply and the backup diesel emergency generators were flooded leading them to fail. After the failure of the diesel backup generators, the reactor operators initiated the emergency battery power but they run out after 8 hours of operation. The enduring heat therefore, could not be carried out and this led to fuel failure. Fuel failure occurs because of mechanical, chemical or even thermal failures when there is too much heat in the valves (Brook, 2011). The nuclear power plant workers had now to focus on managing the core while the heat was building up to allow the fuel cladding to keep going as much as possible. In reality, the reactor is made up of several independent and different cooling systems that operate to ensure smooth flow. These cooling systems include the reactor water clean-up mechanism, the decay heat exclusion, the core isolating cooling system, and also standby cooling mechanism among others. It is evident some of these cooling system failed and caused damage to the core and therefore, the disaster occurred (Elliott 2012, p.7). When the workers lost most of the cooling systems because of loss of power, they had to come up with other means of eliminating the heat. However, in a situation where the heat production is greater than its removal, the pressure immediately keeps rising as the boiling water builds steam. The operators now focused on keeping the temperature below 1200Â °C, while also maintaining a manageable level of the pressure. Maintaining a manageable pressure level is necessary to get rid of steam and this is done by pressure relief valves that are contained in the reactor (Elliott 2012, p.7). The process of maintaining pressure requires venting or emitting steam to keep the levels in a steady rate. It is important to note that steam and other gases eliminated are radioactive fission materials, which are in small quantities. In this case, when the workers at Fukushima nuclear plant were emitting steam, some form of radioactive emissions were released into the

Software updates Essay Example | Topics and Well Written Essays - 250 words

Software updates - Essay Example Most important, automatic updates allow computer operating system to be up to date at all by installing all update. Whereas automatic updates have some advantages, this feature has some drawbacks, as well. When automatic updates are turned on, users who have limited bandwidth can be inconvenienced, as their computer will download the files consuming bandwidth. Automatic updates can also nag computer users who may be forced to leave their work and attend to the automatic updater. Further, automatic update can slow down the computer when someone is using the computer. The drawbacks of automatic updates are meaningful considering the importance of automatic. Automatic updates ensure that users are well protected from threats, as well as against operating system faults. In a busy environment, automatic updating protects users at all time because of its ability to synchronize updates with computer systems (Hart-Davis, 2007). As a safe practice, I have automatic update turned on. There are many reasons why tuning on automatic updates are important to me. Using such a feature, I am always securing my computer knowing what my computer is well secure from works, but also from viruses and malware. There are some of the benefits that motivate me to use automatic

Theme Analysis Research Paper Example | Topics and Well Written Essays - 1250 words

Theme Analysis - Research Paper Example She is referred to as a â€Å"debutante† and one who has â€Å"come of age†. This generally happens in high social circles. In other rare circumstances, age is of little consequence. One may refer to a person- young or old, has having â€Å"come of age† when he has surmounted a serious problem and emerged from it victorious. It is to be understood that chronological age does not really matter; it is the mature way the person handles the situation that counts. What is important is the ability to make a wise and sane decision that could change one’s life considerably and even forever. But that choice must be in one’s best interests. This situation, however, is rare and is more the exception than the rule. The Civil War in America left the Southerners swamped with difficulties as a result of the freeing of the slaves – the direst of which was economic in nature. There was much damage to life and property. All that could have contributed to economic recovery was in ruins – plantations, farms, buildings, the transportation system – everything, resulting from the emancipation of a million slaves. The family of Abner Snopes was no exception. Snopes earned the reputation of â€Å"barn burner† simply because he was just that – a barn burner. His younger boy, Sarty was a namesake of Colonel Sartorius Snopes, appears in court with his father who is accused of the aforesaid crime recently committed. The boy hopes he will not be interrogated for he would be forced to testify against his father who is, of course, guilty as alleged. Snopes is described as a wiry figure who was often dressed in a stiff black coat. His voice was cold and harsh, level and without emphasis – a brief but fitting description for a person addicted to crime – more specifically, arson and theft. It might be mentioned here that Sarty has inherited his father’s way of thinking – foremost being that people

Singapore - Recruitment and selection Assignment

Singapore - Recruitment and selection - Assignment Example Starbucks makes an effort to recruit the best candidates who can be groomed to take up different strategic positions in the organization. The company also uses the strategy of internship to nurture talent among the people still at college. Starbucks America and Singapore are not very different since they have the same vision and they operate using the same business principles and models. Both shops strive to be equal opportunity employers and they accommodate people from diverse backgrounds to work in their shops. There are different recruitment firms and agencies in Singapore and they use their websites to headhunt for talented employees for different placements. According to BlueSteps, the Association of Executive Search Consultants (AESC) has 20 member executive search firms that operate in Singapore. This association specializes in executive recruiting across a diverse group of industrial sectors. Particular attention is paid on senior management roles and regional leaders. Firms intending to hire executive employees can use the services offered by these firms. There are also other employment agencies that offer services related to external recruitment to different organizations in Singapore. These professional recruitment firms are privately owned. ... According to HRM Asia, companies should make an effort to give first preference to locals in terms of recruitment. However, Americans can find it a bit easy to get work permits if they are going to work in American companies in Singapore. The main reason is that the Singaporean companies seek to recruit and attract the best talent from the expatriates going to work in this country. People with work permits can also apply for permits of their dependents so that they can also stay together in Singapore. The Strait Times is the best newspaper to advertise for a job or to search for different types of work available. This paper is very popular in Singapore and the employers and recruiters alike often use it to place advertisements for different jobs. It is comprised of a jobs section and it covers different types of jobs from ordinary to executive posts. The paper also uses online advertisements for different jobs in Singapore. The internet is widely used by the recruiters to search for suitably qualified candidates to fill different vacancies in various organizations. There are also websites such as jobs.com that are used by employers to recruit suitably qualified employees to join their companies. Basically, the structures of advertisements in Singapore and America are not very different. They contain similar information which is basic about a particular job being advertised. For instance, each advertisement has information like job position, tasks to be performed by the incumbent person qualifications as well as experience. The advertisements also have information such as contact details that can be used by the potential candidates to respond to. The advertisements in these two countries are designed in such as way that they are easy to

Modern philosphy Essay Example | Topics and Well Written Essays - 1500 words

Modern philosphy - Essay Example Essentially, Descartes was seen as deigning to question the dependability of science based on empiricism since scientific investigation can only be inference from by means of sensory examination. To prove his point, Descartes underwent what is commonly referred to as an intellectual rebirth and to achieve this he had to deconstruct everything he had learnt from birth since he had leant it through his senses and he wanted to prove that they could deceive. To this end, he postulated a few arguments among them the dream theory, suggested that when one dreams of say a fire, they feel warm and experience the selfsame experience they do when they are actually basking in a fire. The same argument can be extended to cover other sensation that people perceive even the absence of stimulating agents or situations. For example, one can dream they are falling and they will wake up with a sense of terror and probably break in to a sweat with fear exactly as they would have if they had actually bei ng falling. Similarly, he makes an argument about whether God actually exists or whether a deceiving demon or evil genius manipulates humans. He argues, can one know that they have no body but they simply exist in the form of a mind in which information is fed and the physical sensations are actually imagined. This concept has been demonstrated in several works of art more so films such as â€Å"inception† where the plot involves a situation in which the characters are able to move and manipulate events in the lives of others by accessing their brain while they dreamt. In the wax example, Descartes further demonstrates the unreliability of the senses by claiming that a piece of wax in its solid form will look, feel and smell very differently from itself if it were melted. Therefore, someone not familiar with wax may see two entirely different things by looking at wax in its different forms although essentially they are the same thing. At the end of the day, Descartes wishes t o invite his audience to abandon their blind, (so to speak) reliance of scientific enquiry and investigate everything from a rational point of view. In the famous cogito argument , he claims I am therefore I exist, to prove this he chooses to doubt everything including his own existence which is after all only aware of by means of sensory powers (Kaufman 12). When he figuratively scraps of all his knowledge, he remains with the only bit that is not based on empiricisms, and the fact that he doubts everything means that not everything might actually exist. Nevertheless, that he is capable of doubting is proof of the existence of his doubt and this translates into this existence since he must be existing to doubt. This argument while seeming farfetched and illogical to the non-critical eyes actually bears a point that almost everyone including his greatest critics would agree. An individual cannot know much about something else than about himself because as proved by Descartes, one do es not need to apply sensory powers to prove their own sense of being (De Marzio 312). Therefore, the most qualified way of understanding one’s self is the one that does not use empirical reasoning, why them, Descartes seems to

The Role of Promotion in Marketing Research Paper - 1

The Role of Promotion in Marketing - Research Paper Example This paper illustrates that Starbucks used to advertise in an effective manner its coffee shops. The words used to advertise Starbucks coffee shops were â€Å"Starbucks Coffee†; however, the company has created a new logo and this has changed the old perceptions and created new ones concerning the company. The company is undergoing a considerable change and it is moving away from just being a coffee company to a beverage and food company. The social media is one place that Starbucks has ventured into extensively; in Twitter and Facebook, the company has 705,000 and 5,428,000 followers respectively. The Jamaican Blue Mountain Coffee is not an exception; the company is using the internet extensively to advertise its brand. Apart from getting the coffee from the stores, the customer can purchase the product online through the many online advertisements such as igourmet.com. Advertising as a promotional mix tool is appropriate for both companies. Majority of the organizations (bot h large and small) that depend on marketing to develop consumer interest, make constant use of advertising to assist them in meeting their marketing objectives. The task entails frequent development of advertising campaigns which involve a number of decisions for creating, evaluating, planning, and delivering an advertising effort. For both companies, advertising as indicated earlier on has proved to be a beneficial tool in marketing their products and attracting customers. Direct sales entail oral communication with potential buyer. This promotion mix tool is not appropriate for both companies since it focuses is only on creating a relationship with the buyer. The method is costly and there are many hidden costs.

Strategies for effective college level writing; Essay

Strategies for effective college level writing; - Essay Example The first strategy that a college student should adopt is coming up with a sequential strategy for developing composition. The first step should be to come up with a pre-write. Writing early and often can help a student to become acquainted with writing essays. It is also important to use diagrams to develop thought pattern which will give the student a better perspective on the subject of the essay. It is also a good habit to write at least two drafts before writing the final paper. After developing the draft, the next step is revising the draft based on the advice from peers and instructors. Finally, the student should make a habit of proofreading the final draft and correcting grammatical errors and other errors before writing the final paper (Bezbatchenko, 2013). No matter the level of complexity the assignment involves, the best papers are always the ones that were as a result of a carefully planned approach. That means that one has to plan the available time carefully to avoid last minute rush and a poorly written paper. Students are advised to ensure that they have planned times to start and end writing. Therefore, one will be compelled to start writing when the time arrives. This is important since it will help the student avoid procrastination. One will also need time to do research, brainstorm ideas, organize materials, process and analyze ideas, write and re-write the paper. Students have a habit of writing shallow content in their papers. This is a result of poor research and poor time management. Unless one has been specifically instructed to write a research paper, college level writing involves more than collecting information from various sources and writing them as a college paper. It is important for a student to establish a unique perspective on the topic. As one searches for information, one should consider developing their own voices in the paper. The paper should be written with

Assessing Importance of School Factors Such as Racism Essay Example for Free

Assessing Importance of School Factors Such as Racism Essay A variety of material disadvantages that may confront ethnic minorities coming from working class backgrounds are they do not achieve the same level of education. The main achievers are Indian, Chinese and African students, but the lowest achievers are Turkish, Bangladeshi And Afro Caribbean students. The white working class students are the lowest achieving, which is peculiar because most sociologists are white who stereotype and label other students from different backgrounds. The main cause of underachievement in schools are cultural and language factors which sociologists clarify and focus on and are thought to be main cause of everything. Previously the spotlight has been put on what happens in school and racism in common As shown by Cecile Wright, which explains that, Asian students can also be the victims of teachers Cecile found out that regardless of the schools evident promise to equal opportunities, teachers still hold ethnocentric views they believe that British culture and English are greater. This prepared teachers to assume that they would have a poor pronunciation of English and left them out of class debates or used basic, childlike speech when speaking to them. Asian pupils also felt cut off when teachers spoken dissatisfaction of their behaviour or misread their names. Teachers saw them not as a risk but as a difficulty they could take no notice of. This resulted in that Asian pupils in particular the girls were hard-pressed to the limits and disallowed from play a part fully. Close at hand is proof of teacher racial discrimination and harmful labelling. Nevertheless study shows that pupils can take action in variety of ways. They may take action by becoming unsettling or withdrawn but pupils may decline to agree to the label and even choose to prove it incorrect by putting in hard work. Off-putting labels do not repeatedly twist into self-fulfilling prophecy Working class white pupils attain below standards and have lesser desires. There isn’t much parental support at home, which means there is low achievement and goals. Reports show that teachers have to deal with low level of behaviour and discipline in white working class schools. Nevertheless they had fewer kids on benefit programs teachers blame this on inadequate parental support at home and negative attitude that white working class parents have towards their children and their education. The life in the street for white working class can be tough for pupils which means they get used to getting intimidating and intimidate other which they pick up and use in school to cause disruptions and make it hard for other students to succeed at school. Underachievement of student of different is blamed on cultural deprivation. Few sociologists say that Afro-Caribbean families lack a close relationship to their family and therefore are extremely violent towards everything they do. Arguments explain that families aren’t very supportive towards their children and they don’t offer enough cultural capital for their children. Stereotypical views suggest those students are not deprived because of their class or because of their backgrounds. Factors like social class are important to certain ethnic minorities like Pakistanis, Bangladeshis and a considerable amount of Afro-Caribbean students, which are all working class backgrounds in which material deprivation play a main role because to find out why they achieve below the national standards. Sociologists say schools and curriculums made just for one specific group of ethnic minority gives priority to one particular ethnic minority while disregarding other ethnic groups. Some schools have curriculums, which are ethnocentric because they only give priority to English languages. The British curriculum has been described as exclusively British. In history Britain is thought to bring civilisation to ancient people are colonised. Black people as inferior weakens black children’s self esteem and Leads to them to underachieving and failing. It isn’t for sure what effects the ethnocentric study shows that black don’t really suffer from low self esteem. Wright’s study found some ethnic minority groups received poorer interaction from staff. Teachers perceptions were seem as stereotypical although Asian students were seen as good and black students were seen disruptive and disobedient. Study show that schools in cities which contain ethnic minority students were not benefitting in terms of O Levels entries because of being in low set and having to achieve high grade in order to get good results and become successful. Overall taking into consideration we can not split or label ethnicity from social classes and gender since this is really difficult matter as some of the main achieving students are from ethnic minorities so for that reason there isn’t a connection here so we can’t make statements or come to conclusions as to what the association among ethnic groups and schools actually are. Pupils can refuse to accept negative classing and teacher expectations. Sociologists can’t come to a conclusion to explain what occurs between teacher and students or what takes place in different ethnic groups related to education. Students live up to roles they are given but can try to resist the labels and getting put behind by carrying out what is thought of them to do or do what they want to do and achieve good education and become successful.

Case Study: Knee Injury Treatment

Case Study: Knee Injury Treatment Short case summary: 25 years old, female injured her right knee during basketball game. PCP evaluated her, gave her non-steroidal anti-inflammatory with P.T referral. Patient came 2 days after injury, with knee swelling and locking. . Patient pain and mechanism of injury are consistent with a medial meniscus injury. Diagnostic test: McMurrays test, was Positive with palpable click. Reliability of McMurrays test: Evans ET. al1 demonstrated a low level of agreement between the two examiners with inter-tester agreements ranging from poor for reproduction of a medial sensation (Kappa = à ¢Ã‹â€ Ã¢â‚¬â„¢0.10) to fair (K = +0.38) for lateral pain. Validity of McMurrays test: shortage of statistics in the literature increased the risk that the positive test criteria can change the test outcome, irrespective of whether the test was performed in the same manner on the same patient.1 I will change my first choice. McMurrays test alone is weak diagnostic tool for medial meniscus injury, the review2 has demonstrated that the inter-tester reliability and sensitivity (sensitivity ranged from 27% to 70%, specificity figures (29-96%) of the McMurrays test is relatively low. Another reading meta-analysis3,supported to use joint line tenderness test, McMurrays test, and Apleys test. I will add the other two tests to get strong diagnostic evidence for medial meniscus injury. Three special tests-McMurrays, joint line tenderness (JLT), and Apleys were included in the meta-analysis. Sensitivity of McMurrays test is 70.5 (95% CI: 67.4 to 73.4) and its specificity of 71.1 (95% CI: 69.3 to 72.9). Joint line tenderness sensitivity of 63.3 (95% CI: 60.9 to 65.7) and its specificity of 77.4 (95% CI: 75.6 to 79.1). Sensitivity of Apleys test is 60.7 (95% CI: 55.7 to 65.5) and its specificity of 70.2 (95% CI: 68.0 to 72.4). Another reading4 supported Thessaly Test at 5 and 20 degrees (Evidence obtained from high quality randomized controlled trials, prospective studies, or diagnostic studies). Intervention: therapeutic exercises to restore muscular strength and aerobic fitness. I found two evidences for therapeutic exercise intervention. I think both are strong evidences. First one4: The supervised exercise group was significantly better than the home-based group regarding Sports Activity Rating scale and hop tests (Evidence level B).the same guidelines recommended that, Clinicians should consider a clinic-based exercise program in patients following arthroscopic meniscectomy to increase quadriceps strength and functional performance(Evidence level B). The second evidence5was meta-analysis and systematic review reported that: No studies described the effectiveness of exercise therapy compared to no exercise therapy in non-surgical patients with a meniscal lesion. I will not change my previous decision about therapeutic exercise as the main choice intervention for two reasons: First, the clinical guidelines support that choice with level B evidence. Second reason: although the second study is systematic review, meta-analysis study It didnt introduce a strong alternative to my choice. Outcome measure: lower extremity function scale (LEFS SCALE): The test evaluate the impairment of a patient with lower extremity musculoskeletal condition or disorders. Test measures initial function, progress of function, and outcome to design functional goals. In my case I use the LEFS for medial meniscus injury outcomes. Questionnaire is asked about 4 level of performance in 20 task questions that patient perform in daily life. Minimal score is 0(complete disability) and maximum score is 80(complete functional level) Minimal Detectable Change (MDC)6:Various Lower Extremity Injuries (medial meniscus injury): MDC= 9 points. Minimally Clinically Important Difference (MCID)6: Various Lower Extremity Injuries: MCID = 9 points. According to, Binkley ET al6. The LEFS isvalid compared to the SF-36 in target population, and reliable. The LEFS Sensitivity to outcome change was higher than the SF-36 in this population. The LEFS is applicable for clinical situations for individual patients and research. LEFS SCALE reliability: Test-retest Reliability, Various Lower Extremity Injuries: Excellent test-retest reliability for the entire sample (r = 0.86; 95% lower limit CI = 0.80) 6. Interrater/Intra-rater Reliability: Various Injuries of Lower Extremity: Excellent interrater reliability (r = 0.84)6 LEFS SCALE validity: Construct Validity: Various Lower Extremity Injuries: Excellent correlations between the LEFS scores and the SF-36 physical function subscale and physical component summary scores (r = 0.80; 95% lower limit CI=.73) and (r = 0.64; 95% lower limit CI = 0.54), Poor correlation between the LEFS scores and the SF-36 mental component summary scores (r = 0.30; 95% lower limit CI = 0.14)6 Another reference reported that, Lower Extremity Functional Scale may be an alternative to the Western Ontario and McMaster Universities Osteoarthritis Index physical function scale. I will not change the outcomes measurement (LEFS) for knee injuries, I personally, prefer LEFS scale for its ease way and quick appliance to the patient. More than one strong study support high evidence, validity and reliability of LEFS. : The LEFS has good measurement properties: test- retest reliability and cross-sectional construct validity and it could be an alternative to WOMAC-PF If I change the outcomes measure Ill use Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).Comparison between WOMAC scale and LEFS scale showed approximate results of strong evidence according to validity and reliability to the both scales. References: Evans PJ, Bell GD, Frank CY. Prospective evaluation of the McMurray test. Am J Sports Med. 1993; 21:604-608 Hing, W.,white, S.,Reid,D.,et al. Validity of the McMurrays Test and Modified Versions of the Test: A Systematic Literature Review,. J Man Manip. Ther. 2009; 17(1): 22-35.doi: 10.1179/106698109790818250 Meserve BB, Cleland JA, Boucher TR A meta-analysis examining clinical test utilities for assessing meniscal injury, Clinical Rehabilitation 2008 Feb;22(2):143-61. doi:10.1177/0269215507080130. Logerstedt D, Mackler L., Ritter R, et al., Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopedic Section of the American Physical Therapy Association J Orthop Sports Phys Ther. 2009:39 Swart N.M. , Oudenaarde K., Reijnierse M., et al., Effectiveness of exercise therapy for meniscal lesions in adults: A systematic review and meta-analysis, Journal of Science and Medicine in Sport, 2016-12-01, Volume 19, Issue 12, Pages 990-998. Binkley JM, Stratford PW, Lott SA, et al., The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopedic Rehabilitation Research Network. Phys Ther. 1999 Apr; 79(4):371-83). Pua YH, Cowan SM, Wrigley TV, et al., The Lower Extremity Functional Scale could be an alternative to the Western Ontario and McMaster Universities Osteoarthritis Index physical function scale, Journal of Clinical Epidemiology 62 (2009) 1103e1111). Attending Residential Schools among Aboriginal People: PTSD Attending Residential Schools among Aboriginal People: PTSD Son Ian Lam Psychological Traumas of attending residential schools among aboriginal people Outline Introduction: Percentage of Indian Residential school students experienced abuse and maltreatment Psychological disorder IRS survivors frequently diagnosed with: Post traumatic stress disorder, residential syndrome, and historic trauma. Body: Post-traumatic stress disorder (PTSD): PTSD affect patients by several aspects: physical, physiological, mental, and spiritual. Defense mechanism of PTSD patients How the defense mechanism affect their relationship with family and daily life (inability to make decisions) Residential school syndrome (RSS): Definition of RSS Symptoms of RSS RSS affect intergeneration Historic trauma Definition of HT Symptoms of HT Difference between HT and RSS IRS survivors suffer more pain than other aboriginal people? Some IRS survivors did not be abuse while native people in reserve suffer from no freedom and abuse Only little part of IRS survivors did not experience maltreatment, most of them suffer from no freedom, maltreatment and depressed. Conclusion Experiences of IRS survivors lead to various mental problem which come with them the lifetime Those mental problem would affect intergeneration which would contribute to a vicious cycle To heal IRS survivors, first of all, we need to provide an environment with respect and no discrimination Introduction Indian Residential schools (IRS) are notoriously known as isolating and assimilating native people in Canada during 1800s to 1996. According to Robertson, a study of IRS attendee in British Columbia in 1991 indicated that 48% of former students had come across sexual abuse, 32% of them refused to answer, only a few of them claimed that they did not experience any abuse (2006). Along with the last residential school closed at 1996, the last cluster of students left the school and the government undertook the responsibilities of IRS, however, what had happened in IRS were irreversible. The experiences undergone in IRS were detrimental to those school attendee. The majority of IRS students were enduring psychological problems: post-traumatic stress disorder (PTSD), residential school syndrome (RSS), and historic trauma (Robertson, 2006). Post-traumatic stress disorder Post-traumatic stress disorder (PTSD) was the most common diagnosis in former IRS students, stood for approximately 64%. Symptoms of PTSD is partially similar to RSS but PTSD would influence not only psychological aspect, but also physically, emotionally, physiologically, and spiritually torture a PTSD patient. According to Sochting, Corrado, et al, the majority of IRS students conformed to the symptoms of complex PTSD: impairment in regulating affective impulses, in particular, anger directed at both self and others, chronic self-destructive behaviors, such as self-mutilation, eating disorder, or substance abuse. Some of IRS survivors also indicated that they had a chronic headache, heart problem, and arthritis (2007). Additionally, they would develop defense mechanisms to protect themselves not to experience the tragedy again, such as suppression, inability to express or acknowledge their feelings, and stopping mechanism. Suppression is a mechanism that would contribute to gap memo ries and patients would become apartness and inferior; and stopping mechanism is shutting off their feeling or bodily functions related to the experiences in IRS (Chansonneuve, 2005). These mechanisms affect PTSD patients in various ways, for example, their relationship with other: a female IRS survivor elaborated how she hurt her children because of lacking empathy after traumatized, she anticipated her children to be perfect, all the things had to be done in a particular way and time, which was the same way she was used to be taught. One of her children suffered from anorexia later which is a disorder that people is losing appetency to eat and drink (Grant, 1996). On the other hand, their apartness contributes to their inability to decide as they also did not have a chance to make decisions. Approximately all the IRS students cannot make alternatives except as one of the alternative is good for them straightly. Residential School Syndrome (RSS) The Residential School Syndrome (RSS) is the one of the consequence after the feeling of indigenous children had been tried to close off and maltreated. (Grant, 1996). According to Robertson, some expert claimed that RRS was one type of PTSD, but Charles Brasfield defined RSSs standard and recognized several differences between these two disorders. On the other hand, there were not many RRS patients were diagnosed RSS, 6.3% of former students were diagnosed in a sampling survey in British Columbia. However, the symptoms of RRS is severe. The symptoms of RSS are as follow: Addiction of drugs or alcohols at an early age and always with anger; depreciation on dominant cultural activities; undergone a panic IRS school experience or related to a person who used to be an IRS student; the attitude to IRS is passive, anxious, angry, and unassisted; Keep dreaming the lives in IRS and tendency to feel the scenario in IRS reappear again; Feel extremely dismayed when stimulate by something or someone can remind them of their memories in IRS (2006). Besides, the patients tendency to get angry easily causes much physical abuse, their arousal sometimes lead to family violence. After long-time basis, the violence would affect generation by generation. Their next generation may also suffer from RSS (Robertson, 2006). Historic Traumas Historic trauma (HT), is defined as spiritual imbalance and cumulative emotional psychological wounding over the lifespan and across generation. Besides, HT is suggested for indigenous people as they had experienced genocide through IRS (Robertson, 2006). According to Robertson, IRS students diagnosed with HT always with those symptoms: depression, self-destructive behavior, the tendency to suicide, anxiety, inferiority, wage, and lacking emotional intelligence. The historical trauma would deliver to the next generation which is a mechanism of HT as the trauma had been ingrained in the culture and peoples memories. And people in the next generation would also underlie the thought of being lessness. On the other hand, some might say that RRS is similar with HT. However, these two are focused on two different aspects: RRS is focused on the individuals psychological aspect while HT is focused on the how the cultures affect by the trauma and how people in the communities be affected (200 6). IRS students suffering more pain than other aboriginal people? Some may say other aboriginal people also experienced a tough time in reserve, IRS survivors did not experience more pain than other aboriginal people (Robertson, 2006). Virtually, some of former IRS students were living well without problems and aboriginal people in reserves were also undergone abuse and had the tendency to suicide. However, those were a rare part of people that did not experience maltreat or abuse in IRS and aboriginal people in the reserve did not suffer from the chronic stress (Elias et al, 2012). IRS survivors also lost their ability to learn and express feeling, while native people in reserve were not (Grant, 1996). Conclusion Indigenous people undergone a tragedy in IRS and these memories contributed to various problems on them, especially mental problems which cannot be erased and like a shadow following with their whole life. Although the IRS era had gone, we still can see the effect of IRS on generations. The majority of IRS survivors had diagnosed more than one psychological disorder, and most of them were alcoholic. Alcoholic parents may make their children feel shame while their children may also suffer from maltreatment. When the children grow up, they would know their culture was not being accepted in nowadays dominant culture and they would start drinking and suffer from historical traumas (Grant, 1996). Obviously, this is a vicious cycle but it is exactly what happening right now in the society. Fortunately, there is various way to heal with IRS survivors, such as their culture, language loss, and their mental health can be fixed but it does take a long time. But in the first place, we need to p rovide a safe, confidential environment with respect and no discrimination (Chansonneuve, 2005). References Chansonneuve, D. (2005). Reclaiming Connections: understanding residential school trauma  among aboriginal people. Elias, B., Mignone, J., Hall, M., Hong, S. P., Hart, L., Sareen, J. (2012). Trauma and suicide  behaviour histories among a Canadian indigenous population: an empirical exploration of the potential role of Canadas residential school system. Social science medicine, 74(10), 1560-1569. Grant, A. (1996). No End of Grief: Indian Residential Schools in Canada. Pemmican Publications, Inc., 1635 Burrows Ave., Winnipeg, Manitoba, Canada R2X 0T1. Robertson, Lloyd Hawkeye. The residential school experience: Syndrome or historic trauma. Pimatisiwin 4.1 (2006): 1-28. Sochting, I., Corrado, R., Cohen, I. M., Ley, R. G., Brasfield, C. (2007). Traumatic pasts in Canadian Aboriginal people: Further support for a complex trauma conceptualization?. British Columbia Medical Journal, 49(6), 320.

Online Technologies: Opportunities for Charities

Online Technologies: Opportunities for Charities Information Technology and developments in non profit organisations:  How online technologies offer new opportunities for growth to the charity organisations Table of Contents (Jump to) Chapter 1 Introduction 1.1 Introduction 1.2 Aims and Objectives 1.3 Overview Chapter 2 Literature Review 2.1 Introduction 2.2 Charities Chapter 1 Introduction 1.1 Introduction As Sergeant and Jay (2004, p.2) have commented, the concept of charity and their mission of raising funds to help the poor and needy has been around for centuries. However, both the numbers and complexities of charity organisations have multiplied significantly over recent decades. Sargeant and Tofallis (2000) confirmed reports from the NCVO that in the UK as of 1998, the number of NGO’s exceeded half a million, of which 40% could be designated as Charity based organisations., This group was then reported to have a collective estimated turnover of approaching  £20 billion. Both of these statistics will have grown dramatically over the past decade. The main mission of charities is to deliver practical and constructive assistance to those in need; providing information on issues such as health problems and disability or promoting the message for fairer laws. These missions can be related to human activity, preservation of the natural world environment and its wildlife or seeking justice for those that are oppressed. However, currently charities have to face up to a number of obstacles in effectively performing the task for which they have been set up, most of which arise in two particular areas. Firstly, with the increasing growth of needy causes, there is a rise in the number of charitable organisations emerging to address these issues, increasing the competition for funds proportionately. Secondly, there is little doubt from the level of research that has been undertaken, that the charity giver is becoming increasingly discerning about the impact of their donations. This concerns centres around the desire to ensure that the gi ft has the maximum impact. Therefore, it is important to the donor that the minimum amount of that gift is used for the charity’s internal administrative purposes. Despite the fact that the â€Å"mission† of a charity has in the past often been deemed more important than â€Å"economic intentions† (Hussey and Perrin 2003, p.200), the current climate within this sector is requiring them to become more efficient if they wish to sustain the objectives of their cause. This means that thy have to look for ways in which they can improve the effectiveness and the efficiency of their operations. In this regard, although somewhat belatedly when compared with the move by commercial corporations, the charity sector is increasingly studying the benefits of using information technology processes as a means of achieving the efficiencies that are required. However, as Hackler and Saxton (2007), although some charities are incorporating information within their organisations, the extent, areas of the business covered and effectiveness of these developments has not yet been perfected in a significant number of cases. In fact, in some it is considered that with some charities it can be reducing efficiency. Indeed the research conducted by Sargeant and Tofallis (2000) concluded that â€Å"the performance of many charities would appear to fall well short of the efficient frontier with no immediately obvious explanation forthcoming for why this might be so.† Indeed, they could also find no pattern to the causes of these failures either. It is the issue of information technology in particular its effective and efficient use in charity organisations that inspired this research project. Of specific interest is the intention to assess the impact that this technology has upon the duel targets of increasing financial efficiency and improving the delivery of the main services and missions of the charity. 1.2 Aims and Objectives As stated previously, the aim of this research is to identify the ways in which information technologies can be used to improve the efficiencies of charity operations. In this regard it is intended to focus the research upon the usage of IT in the online environment. Thus the research question or hypothesis that has been set for this study is as follows: â€Å"Online information technology processes can offer charities opportunities for growth and expansion in terms of the revenue and message and mission generating areas of their operations.† To assist with the achievement of this goal the research will use the following framework of objectives: Growth and maximisation of revenue It is intended to determine the extent to which a charity can make use of the IT opportunities available using the Internet to grow its revenue base and the methods by which this can be achieved. Cost reduction and efficiency Using the same premise as that included within the previous objective it is also the intention of this paper to address the issue of the appropriate IT methods that can be employed for increasing the efficiency of the charity organisation in terms of cost control and reduction where appropriate. Mission and programmes Bearing in mind the unique purpose of the charity format, which is that it has a mission to serve a specific cause, the research will also be ensure that, in addition to the financial objectives outlined above, the information processes examined are compatible with the enhancing of the message that charities need to communicate. This will be applied to both the potential and recipient of their services. The research itself will use a mixture of data to address the research question. This will include reference to the extensive range of financial statements which are available from individual charity websites or the Charities Commission (2008) online resources, although only a sample of these reports will be utilised. To address the issues and concerns of the individual charities more directly, individual interviews will be conducted with a number of representatives from this sector. 1.3 Overview The management and presentation of the research paper has followed a logical format. Chapter two presents a review of existing literature that is available and that relates to the issues being addressed by the researcher. This includes publications and comments by academics, professional observers and other interested stakeholders. Following this critical review, in chapter three it is intended to concentrate upon the methodology that has been applied to this project. It will provide an overview of the available methods and the reasons for the method that has been adopted in this instance. Chapter four provides the in-depth results of the research findings, both that which has been gathered from primary and secondary resources and these will be analysed and discussed in more detail in chapter five. Finally, the research project will reach a conclusion in chapter six and, where considered feasible and appropriate, the researcher’s recommendations will be presented and explained . Included at the end of this study, although separated from the main body of the study, will be additional information. This will include a biography of the various resources that have been referred to or used to assist with the development of the project. In addition, in attached appendices, information that is considered of further value in understanding the issues raised and the examinations undertaken, including the transcripts of interviews, have also been included. Chapter 2 Literature Review 2.1  Introduction To assess the issues of the charity use of online information technology, it is important to perform a critical review the existing literature that is available relating to various elements. In this case that will include providing a brief understanding of the charity environment. In addition, it will include a review of the information technology processes and their advantages as well as the areas where charities have been found to have deficiencies either in the usage of these technologies or the extent to which they have availed themselves of the technology itself. The chapter has been sectioned in a manner that appropriately addresses these areas. 2.2  Charities As many academics have observed, in comparison with commercial organisations, the charity is a complex organisation, not least because of its structure and mode of operations (Wenham et al 2004, Hussey and Perrin 2003 and James 1983). There are even different to the other types of non-profit organisations referred to by Hackler and Saxton (2007), such as those that are often form for regulating the decisions and objectives of various parts of nation and international political policies. An example of these would be the various organisations that have been set up in the UK to deal with the reduction of carbon emissions such as The Carbon Trust. The differences attributable to the charity organisation can be observed in many areas of the operation. For a start one of the main intentions that is needed for the organisation to qualify as a charity is for it to have a non-profit making objective (Hurray and Perrin 2003). Secondly, its mission that in the corporate sense would be classed as strategic objective is directed to the service of the external stakeholder or user (Hussey and Perrin 2003). In other words, where the purpose of the commercial organisation is to achieve financial success that will enable it to return additional value to the shareholders and potential investor, the charity’s financial aim is to utilise its funds specifically for the benefit of those whose demands and needs it is intending to address. Often, because of the break-even requirement, the charity will take on projects that are of no immediate benefit, but will have the effect of helping them to subsidise other, more highly valued activities (James 1983, p.351). Another difference in organisational processes is that the charity revenues generating activities relies heavily upon the volunteer donor (Wenham et al 2004), therefore making it difficult to predict. In addition, this places constraints upon administrative expenditure in areas such as computers and other modern equipment (Sargeanr and Jay 2004). Furthermore, because of the purpose of the charity and the need to concentrate its expenditure upon projects that are determined within its mission statement, together with the fact that funds may be limited, many charities are heavily reliant upon the efforts of voluntary employees. Many of these employees might have limited knowledge of the operational processes that are required for an efficient organisation, which can be a disadvantage (Galaskiewicz et al 2006, p.338). This is especially true if there is a sizable organisation to manage. Irrespective of these differences, to remain true to its mission statement and stated aims, every charity still has to create a strategy that allows it to address three specific operational procedures. These are the maximisation of incoming funds, minimising administrative costs to ensure the recipients of its objectives, in terms of projects and services, receive the maximum benefit and effective marketing, which is designed to attract donors and service users (Wenham et al 2004). Therefore, it is important for the charity to be organised in terms of its mission, which means having the right strategies in place (Hussey and Perrin 2003, p.215 and 218) and assessing their appropriateness. As Hackler and Saxton (2007) acknowledge, it is in these areas that the use of information technology can be considered. All charities have to be registered with the Charities Commission (2008) irrespective of their size. An integral part if this registration is the need to provide regular financial statements which Holistic Nurse Prescribing: A Case Study Holistic Nurse Prescribing: A Case Study Introduction 1 the patient and their presenting symptoms. Mr Pickles presents an interesting, complex and therapeutically challenging problem. In essence he is a gentleman with multisystem pathology who presents with an almost incidental finding which he was clearly reluctant to discuss. It is a common finding amongst experienced healthcare professionals that in any consultation it is the last 30 seconds which is the most important. As the patient stands up to go, there is the just while Im here moment when they can bring up an issue that really troubles them and may not be the real presented reason for the consultation. In this essay we shall discuss the various aspects of this situation and the measures we can take to try to help him. (Parker and Lawton 2003) 2.a holistic assessment of the pt, including any relevant medical social and psychological issues. If we start with the initial presenting symptom under discussion the impotence it is easier to work backwards from that to discuss the possible pathophysiology that can be relevant. Impotence is said to occur whenever the male fails to get an erection when it is required. This, in itself is neither unusual nor necessarily pathological. It becomes a significant symptom when the male repeatedly fails to get an erection that is sufficient for intercourse. It is quite possible to get full spontaneous erections and yet still be impotent. This is one of the major diagnostic features that distinguishes the psychogenic impotence from the purely physical. (Ackerman MD, Carey MP. 1995) There are a number of obvious physical causes of erectile dysfunction that are relevant to Mr Pickles (see on), but equally there are a number of possible psychogenic causes that may be either primary factors or possibly secondary contributory factors in the aetiology of his problems. The fact that he has recently undergone major cardiac surgery is a very relevant factor. Patients will frequently suffer from a major change in body perception when they have come to a close realisation of their own mortality. If we add to this the fact that, as the major breadwinner in the family, it is likely that Mr Pickles would have felt a major blow to his self-esteem when he was made redundant from a responsible high esteem job and forced to become a taxi driver with long working hours. This is quite apart from the anxiety and fatigue that such a job would engender.(Beck J. 1995) It is possible that the medication that Mr Pickles is taking may have a bearing on his erectile dysfunction as the male erection is dependent on the hydrostatic pressure of the blood for its maintenance. Any medication that reduces the average blood pressure, will effectively reduce the capacity to acquire and maintain an erection. In addition to this the adrenergic beta-blocker group will also selectively block the sympathetic pathways that are vital to the neurovascular control of the mechanisms of erection. Pathophysiology of diabetes and impotence Both of these topics are huge subjects, so in this essay we will restrict out considerations to those aspects which are relevant to Mr Pickles and his problems. We know that Diabetes Mellitus affects about 2% of the UK population with a specifically higher incidence in both the Asian and Afro-Caribbean communities(Nathan 1998). There is also a marked genetic component in the development of Diabetes Mellitus. Mr Pickles has Type II diabetes mellitus which is associated with a number of factors including a high BMI and increasing age. At 56 yrs. old he is currently at the peak incidence age for Type II diabetes mellitus (Gregg et al. 2003). Diabetes Mellitus is known to be associated with a number of complications. The prevalence and incidence of the complications, in general, tends to increase with the length of time that the patient has been diabetic. There is also an independent variable for complications that is directly proportional to the degree of control (as measured by the HbA1 levels). In general terms, the better the control the lower the incidence of complications (Kissebah et al. 1999) As far as Mr Pickles is concerned, there are two major complications of Type II diabetes mellitus that are directly linked with impotence and they are cardio-(macro)vascular disease and neuropathy. (Wagner et al. 1998) We can deduce that Mr Pickles has macrovascular disease by virtue of the fact that he his recovering from a CABG. And this may well be a very relevant factor in his erectile dysfunction but also there is the question of neuropathy which typically occurs in about 2.4% of the general population, but this figure rises to above 8% in the diabetic patient over the age of 60 yrs. ( Hughes 2002) Impotence tends to occur, in varying degrees, in about 10-15% of men under 40 yrs. Its incidence increases with age to the extent that 40% of men at the age of 40 yrs report a degree of impotence and this prevalence rises to 70% at the age of 70 yrs. (Gregoire 1999). If we add to this basic clinical picture the fact that there are other factors such as hypertension, smoking, cardiac neurosis, loss of self-confidence, depression and iatrogenic causes (medication etc.) all of which may well be relevant to Mr Pickles, then it can be seen that there are a plethora of potential causes of his erectile dysfunction. (Barnes, DE. 2004) Both of the first two causes (hypertension and smoking) are independent risk factors for impotence, quite apart for the fact that they are also risk factors for the development of the macrovascular complications of Diabetes Mellitus (Bowering 2001) Mr Pickles diabetic state has been recently well controlled (HbA1 of 6.5%). This is important as the incidence of development of diabetic complications is reduced by between 34-76% (depending on the particular study) for every 10% reduction in the average HbA1 reading. (Bowering 2001). In addition to all of these considerations, atherosclerosis is also a major complication of Type II diabetes mellitus, which, presumably is relevant to Mr Pickles because of his CABG, and this may be a major factor in the development of his erectile dysfunction. Management plan 3.a plan/strategy based on critical understanding of physiological and pharmaceutical issues. Any management plan must firstly be based on an accurate diagnosis. At this point in time we do not have this luxury. As we have discussed, there are anyone of a huge number of possibilities in the aetiology of Mr Pickles erectile dysfunction problem. When confronted with a problem such as this, any experienced healthcare professional may reasonably chose to manage the problem by making a rational judgement of the probabilities of any one particular cause being relevant. Implicit in such a management strategy is the fact that there are some causes that my be correctable (iatrogenic, psychological, and life style related) and there are some that may not (macrovascular damage, neuropathy and atherosclerosis). It is reasonable, in such circumstances, to discuss the situation openly with Mr Pickles and discuss with him the various treatment options. Patient empowerment and education is a vital strategy to adopt in circumstances such as this as Mr Pickles is far more likely to comply and respond if he understands the rationale behind the treatment plan.(Howe and Anderson 2003) We would suggest that an appropriate strategy would be to initially tackle the situation on two fronts. The psychological aspects of the erectile dysfunction are probably best discussed with an experienced psychologist or councillor who has expertise in this particular area. This is important because there is a considerable skill in eliciting the relevant factors from the patient. Many patients are reticent about talking openly about their imitate sexual details and there has to be a careful build up of trust and empathy on both sides. Factors such as good eye contact and a non-judgemental body stance are essential on the part of the healthcare professional if the optimal result is to be obtained Not only can the issues that are relevant be explored, but also any one of a number of psychological treatment techniques can be employed. This is a matter of considerable clinical judgement and skill and therefore probably best done by an experienced healthcare professional in that area. The pharmaceutical area can also be addressed as Atenolol is clearly not the best anti hypertensive to use as, not only will it reduce the blood pressure (which it clearly is important to do) but it also produces a counter productive beta-blockade which will not help the erectile dysfunction problem. The difficulty is that, after the CABG, Atenolol does have a degree of action on the suppression of ectopic electrophysiological foci in the myocardium which is a recognised complication of the procedure. It also is thought to have a cardioprotective effect post-myocardial infarction. It is probably a good idea to change his anti-hypertensive medication, but in the circumstances, it is probably better to seek the advice of the surgical team who performed the CABG. before making the transition. The question of Viagra has been raised by Mr Pickles. This is not as straight forward as it might initially appear. Viagra has been shown to work well in these circumstances. It has the downside that it allows sexual intercourse which is associated with increased peaks of blood pressure. As Mr Pickles is still in the postoperative recovery phase (16 weeks) it would again be sensible to consult with the surgical team as to their advice on the issue. The other problem with Viagra is that if it transpires that the long term aetiology is actually psychological rather than purely physical, then the prescription of Viagra will often breed a feeling of psychological dependence which may firstly be both inappropriate and unnecessary and secondly, very hard to break. It is probably therefore inappropriate to consider such options at this stage in the management. 4.legal and professional accountability should be discussed. The legal and professional issues are largely covered in the making of a management plan. In any area of professional competence, the best defence against criticism or censure, is the fact that a healthcare professional works from a rational evidence-based plan. It is for this reason that we have set out the rational and reasoning for the plan that we have chosen to adopt. It is actually quite permissible (legally) for a healthcare professional to be wrong on any given issue, as long as they have come to a reasoned and rational decision based on the facts that were placed before them. And behaved in a way that the majority of their professional colleagues believe is reasonable in the circumstances. It is, of course, central to these considerations, that all actions are carefully and fully recorded in the patients notes Prescribing decisions 5.a critical discussion of influences on prescribing decisions. The area of prescribing for Mr Pickles is clearly important. To some extent, we have covered the reasoning behind the change of prescription earlier in this essay. There is a common misconception amongst many members of the public (and indeed many of the less experienced healthcare professionals) that the solution to every problem comes in the form of tablets on a prescription. The whole area of patient empowerment and education is often filled with issues of lifestyle change, healthy living, self care and positive thinking which can frequently be more effective that simply giving the patient a prescription. (Boule NG et al. 2001) In the context of the NHS, it is a common observation that sometimes a prescription is given because it is the most expedient short-term measure in a given situation, (Dawes RM et al. 1974), however, time invested in an explanation to a patient as to why other measures might be equally as important is rarely time wasted., (Corrigan B. 1974) Future management 6.consider your future prescribing activity based on experience gained from this case study. In any professional area of activity, the author likes to use the mechanism of reflective practice to allow a critical assessment of a past course of action to modify future actions when faced with a similar situation. (Gibbs, G 1988) On careful reflection of this case, I believe that I may have acted rather rashly in stopping the Atenolol as a first choice. On reflection, I believe that the Atenolol did need to be changed for any one of a number of other anti-hypertensive agents but I feel that, in retrospect, I would have been wiser to take advice from the surgical team before I made that decision. Further reflection and discussion with other healthcare professionals (Marks-Moran Rose 1996), suggested that another appropriate course of action would have been to stop the antihypertensive medication altogether for a short period. This is on the grounds that his hypertension was not severe and was hitherto well controlled. If the erectile dysfunction was simply a reflection of the fact that the medication was holding his blood pressure down to a level where erection could not easily occur, a few days off the medication may allow a transient increase in his blood pressure to the point that erection could occur. As long as one was careful to monitor his blood pressure to ensure that it did not rise too far, I have been advised that this would represent a reasonable therapeutic trial to establish whether the underlying causes were mainly physical or physiological.(Wagner G et al 1998). On the face of it, this does seem reasonable but I believe that I would have to take further advice before I was fully comfortable with that decision. It follows from what has already been discussed, that I also feel that I may have been too quick to consider the pharmacological interventions before making a complete holistic assessment of the patient. There are clearly a number of lifestyle adjustments that may be relevant here such as weight loss and increasing exercise and looking for a new focus in life (to minimise any element of depression) which would be comparatively easy to achieve with appropriate empowerment and education of the patient. (Funnell R et al 2004) All in all, this is not a straight forward case. There are many elements which require careful and considered assessment. I believe that it is one of those cases that helps to point out that although there is a huge emphasis to be placed on modern scientific understanding and application of medical principles, there is also a very large element of human understanding and caring that is so very important to the successful management of patients such as Mr Pickles (Waterlow J. 1998) References Ackerman MD, Carey MP. 1995 Psychologys role in the assessment of erectile dysfunction: historical precedents, current knowledge and methods. 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Narayan (2003) Relationship of Walking to Mortality Among US Adults With Diabetes Archives of Internal Medicine, June 23, 2003; 163(12): 1440 1447. Gregoire 1999 ABC of sexual health: Assessing and managing male sexual problems BMJ, January 30, 1999; 318(7179): 315 317. Howe and Anderson 2003 Involving patients in medical education BMJ, Aug 2003; 327: 326 328. Hughes RAC. 2002 Regular review: Peripheral neuropathy BMJ, Feb 2002; 324: 466 469. Kissebah AH, Freedman DS, Peiris AN. 1999 Health risks of obesity. Med Clin North Am 1999; 73: 111-138 Marks-Moran Rose 1996 Reconstructing Nursing: Beyond Art and Science London: Balliere Tindall October, 1996 Nathan D. (1998) Some answers, more controversy, from UKPDS. Lancet 1998; 352: 832-833. Parker and Lawton 2003 Psychological contribution to the understanding of adverse events in health care Qual. Saf. Health Care, Dec 2003; 12: 453 457. Wagner G, Seanz de Tejada I. 1998 Update on male erectile dysfunction. BMJ 1998; 316: 678-682 Waterlow J. (1998) Prevention is better than cure. Nurs Times 1988; 84: 69-70 Appendix