Team Reflection Essay Example for Free

Team Reflection Essay Novelty products for retail sale Capital expenditure purchases of large equipment that are used for the business. Kitchen Equipment (Grill, Refrigeration, Dishwasher) Air Conditioning Unit Copy or Fax Machines Computers Weekly Topics Related to the Common Contracts This week we reviewed how the statute of frauds apply to common law Contracts that involve the sale of an interest of land Contracts that cannot be performed in under one year. Contracts to pay the debt of another (such as a loan surety) Contracts made in consideration of marriage (such as a prenuptial) We also discussed contract performance and the obligation of the parties to perform within the requirements or agreement of a contract. The parties agree on terms and perform the contractual obligations in good faith in order to complete the contract. Topics Comfortable With How the UCC Article 2 can be applied on a contract for the sale of goods between two merchants. Understanding the different types of contracts. Identifying the appropriate source of law for each contract type. The duty to mitigate, It was surprising to learn that the law imposes an obligation to take appropriate steps in order to avoid incurring damages and losses. As long as one can avoid the damages with reasonable effort, without undue risk or expense, they may not be able to sue the other party. Topics Struggled With Anticipatory Repudiation – how is the non-breaching party entitled to a remedy The IRAC method is still a topic most of us are still struggling with.

Balanced scorecard is strategic planning

Balanced scorecard is strategic planning INTRODUCTION Balanced scorecard is strategic planning and management system used for business and industry, government, non profit organizations worldwide. it is used for business activities like vision and strategy of organization to improve internal and external communication to monitor organizations performance against goals. Balanced scorecard is designed by Drs. Robert Kaplan and David Norton for performance measurement in their series of articles in Harvard Business review. It is designed for executives and managers to get balanced view of organizational performance. In early balanced scorecard was only used for simple performance measurement system. The new system transforms an organizations strategic plan from attractive document into marching orders for organizations on a daily basis. The balanced scorecard system is totally works on:- -Companys Mission Companys Strategic Plan -The financial status of organization The level of expertise in the organization. -Customer satisfaction level. In the past, the organizational growth was measured in financial measures only, which were not adequate to measure the performance. However, to look into future with great value, companies must have to invest through customers, suppliers, employees, processes, technology and innovation. The balanced scorecard has emerged as a effective tool in the process to allow organizations to implement different strategies successfully. Organizations all around the globe has benefited by balanced scorecard like increased financial returns, employee alignment in with overall growth, improved collaboration and focus on strategy. BALANCED SCORECARD PERSPECTIVES Balanced scorecard divided into mainly four perspectives. Learning and Growth Perspective The Business Process Perspective The Customer Perspective The Financial Perspective VISION AND STRATEGY LEARNING AND GROWTH FINANCIAL CUSTOMER INTERNAL BUSINESS PROCESSES BALANCED SCORECARD PERSPECTIVES 1. LEARNING AND GROWTH PERSPECTIVE:- This perspective mainly includes training and growth of employee potential as well as their practical skills. Now days, there is a rapid changes in new Technologies, so the employee must be in the continuous learning mode, so that they can learn new technologies and apply it. In this perspective, it is searched that, is there correct level of expertise for the job? Employee turnover ratio analyzed in this perspective, so that job satisfaction among the employees can be measured and corrective action can be taken. The learning and growth perspective concentrate on learning rather than training, because it includes tutors and mentors in the organization so that there will be easy flow of communication and problems can be solved within organization. 2. THE BUSINESS PROCESS PERSPECTIVE:- This perspective consists of internal business processes. By using this perspective managers can know that how well their business is running, whether its products meet to customer needs and demands or not. The process alignment is checked that it is right department. The process should carefully design to meet standards of product that meets customer requirements. 3. THE CUSTOMER PERSPECTIVE:- In recent studies, it has been seen that customer satisfaction and customer focus are important for success of any business. If customer is not satisfied then they will find any other supplier who satisfies their needs. These will surely the failure of the business that doesnt meet to the customer needs. Delivery performance, quality performance, customer satisfaction, customer percentage in market and customer retention rate are some of the important aspects of customer perspective. 4. FINANCIAL PERSPECTIVE:- Financial perspective is very important to measure success of any company. When financial objectives reached, only then organization can exist successfully in the long run. This perspective expressed in the terms of budget and target achievements. This perspective focuses on the quarterly or yearly financial results, return on investment, cash flow, etc. Q. 1. Why change and how balanced scorecard approach different? The business environment in now days is very competitive in terms of product quality, market share, customer satisfaction and volatile than ever been. In order to survive in the market, organizations need to be far more efficient in the use of their resources, should understand needs of their customers, should organize their internal system and procedure, and have employees who have a far level of interpersonal skills than in the past. The financial system was mainly backward looking, focusing upon reporting achievements rather than upon the attainment and pursuit of objectives. The financial system was paying attention to fulfill short term objectives rather to fulfill long term objectives. This system need to in corporate data capture and analysis of non-financial measures, such as customer profiles, customer satisfaction, employee performance, employee satisfaction, product quality, service quality, organizational transformation and development. So, organizations need to think beyond the historical perspective of their traditional financial reporting systems. The financial system has limitations because of considering limited factors. To improve performance evaluation, there was a need to change old financial system with the more balanced and which bridges strengths of the traditional financial measures of past performance with the benefits of measuring factors that impact upon or drive future performance. Q.2) Discuss in general terms the information which would be required by a manager to implement this approach to measuring performance. The balanced scorecard approach is mainly consists of four approaches: financial, customer, internal processes and learning and growth. The balanced scorecard focuses mainly towards common goal. The process of developing balanced scorecard gives an organization a clear picture of future and path to reach there. To implement balanced scorecard, manager need to implement its four perspectives and also needs information of its key elements as follows:- Financial perspective: Financial objectives are used to represent long term goals of organization. In this perspective of balanced scorecard, a manager need to identify financial objectives of an organization and develop measures that indicate how successful the organization achieving those objectives. In this aspect of balanced scorecard, manager needs information of following measures: return capital employed return on net assets Bad debts of company Account receivables Gearing rate. Customer perspective: The customer perspective is designed to measure how well the company is meeting the demands of customers and market. The major goal of an organization is to supply for the demands of customers. In todays environment company must provide a quality product, and also timely delivery, and customer service following the sale. There are some more information which also to be considered like, The very important price of the product Customer satisfaction Customer retention Increasing customer base Delivery times Rate of goods returned by customers Customer relationship. The Internal business processes perspective: This perspective focuses mainly on internal processes to deliver the goals of customers and shareholders. This aspect works within the company. The information needs is related to: Quality control rejection rate Production lead times Level of production capacity utilization. Learning and growth perspective: This perspective identifies human relations and works to improve the Skills of employees, infrastructure and innovation. Employees are very important part of the organization and key to innovation. re Sources must be allocated to educate them on the processes of company and mission of company. This education should be coupled with the motivation. This starts with autonomy to employee so that they can suggest changes in organization. The manager should know information of this aspect: Employee capabilities Information system capabilities Level of spending per head on employee training Employee absenteeism rate Staff turnover rate Range of products This information is very important to implement the balanced scorecard approach within the organization. By having this information, manager can implement this approach in the organization to measure performance. Q.3) Comment on three specific examples of performance measures which could be used in service industry. 1. Balanced scorecard in the Hotel industry: The balanced scorecard derives its name primarily from the way it provides a structured focus upon the main organizational performance dimensions: the financial, customer, internal processes and learning and growth. Balanced scorecard thinks far beyond the traditional financial system, so that hotel appears the appropriate setting for implementation of the balanced scorecard. The first step in developing a balanced involves is determining a mission or vision. A vision outlines the purpose of an organization. After vision, we need to determine what strategy will be employed to achieve the mission. After strategy we need to translate this strategy into specific strategic objectives. If the strategic objective of staff is to be regarded among most friendly, appropriate performance measures could include: hours s pent to train staff on politeness and friendly customer engagement, customer survey ratings with respect to perceived friendliness of staff. As strategic objectives and performance measures would need to be developed for each of four balanced scorecards key perspectives. a] Financial perspective in hotel: The financial perspective contains strategic objectives that are developed from shareholders perspective. Kaplan and Norton suggest these objectives can be developed by answering the question: To succeed financially, how should we appear to our shareholders! Once these objectives have been developed, a set of financial measures generated. The financial measures includes departmental cost, cost of providing a room night, hotel profit, profit of market segment, revenue per available room, share price, revenue growth compared to budget, sales mix, operating profit compared to prior year, ROI, etc. b] Customer perspective: This comprises strategic objectives that are developed by customer point of view. To achieve our objectives, how should we appear to our customers! Once these objectives developed, a set of customer related performance measures can be developed. This includes: customer loyalty, proportion of returning customers, customer complaints, customer profitability, new customer acquisition, market segmentation, market share etc. These factors are considered while measurement of customer related performance. c] Internal process perspective: This perspective concerns the development of process related objectives that are consistent with achieving financial and customer objectives. These objectives can be developed by responding to question, to achieve our internal objective which types of processes should we undertake! A set of performance related measures are: customer billing errors, time taken to check-in, restaurant service errors, workplace safety, customer database availability, internal control practices, etc. d] Learning and growth perspective: This perspective concerns the development of organizational capability goals that are consistent with achieving financial and customer objectives. Possible learning and growth measures includes: training investment per employee, absenteeism, employee motivation index, employee satisfaction, personal growth of staff, internal promotion levels, staff retention, staff empowerment, frequency of training, etc. The balanced scorecards group-wide application has greatly increased opportunities to use the achievements of best practice hotels. Balanced scorecard provides focused approach towards the common objectives of a hotel. By using above all performance measures, we can use balanced scorecard successfully in the hotel. Refrence online book:- Accounting essentials for hospitality managers by Mr. Chris Guilding 2) Balanced scorecard in the Insurance sector:- Now days insurance sector is very competitive industry among the service industries. There are different types of insurance like car insurance, general insurance, medical insurance, etc. this sector is totally customer oriented sector and totally depends upon needs of customers. The performance Measurement of this sector by balanced scorecard is consists of measurement of its four perspectives. The mission and strategy of an insurance company is determined by board of director of company. After the strategy, the objectives and targets are set by management for the particular period of time. Then the company operates to fulfill those objectives. The measures of the insurance sector according to four perspectives are as follows: 1. Financial perspective:- The major financial perspective in the insurance sector is the share holders perspective because share holders are the important part to provide capital for the business. The measures contain cost of employees, incentives as percentage of salary, annual salary, increase in training cost, the cost per insurance, total profit earned, operating costs, total sales, share price, Etc. 2. Customer perspective:- Customer perspective focuses totally towards customer satisfaction and customer retention. Customer is leading indicator in the insurance sector, if he satisfied then only company can earn profit. The customer perspectives measures are number of referrals generated from the customers, number of customer focused products developed, decrease in customer complaints, and percentage of upgraded policies, etc. 3. Internal process perspective: This perspective works totally on developing internal processes to meet customer needs and demands, so that customer can be satisfied with the service. It improves on negative aspects of the internal system and try to improve it. The possible measures can be percentage of renewed policies to the number of policies sold, number of sales targets achieved, percentage of decrease in employee turn over, types of insurance policies generated. 4. Learning and growth perspective:- This perspective works on the employee development and corporate cultural attitudes related to both company and self improvement. It works on improving sales efficiency of the sales force. The possible measures comes under this perspective can be number of training sessions, number of brain storming sessions, number of motivational sessions, number of quality feedback from the employees, etc. 3) Balanced scorecard in the banking industry:- Balanced scorecard received a wide range of use and promotion by global business organizations and some international banks have successfully implemented this approach to measure and increase their performance. In response to different problems faced by the global banking industry like the recession of the year 2008, balanced scorecard research helps to solve those problems effectively and results in the profit. In the rapid innovation and development of financial sectors, the banking industry facing intense competition. The measures of banking Industries according to the four perspectives of the balanced scorecard are as follows:- 1. Financial perspective:- Balanced scorecard is not only indicator of appraisal system but also strategic management tool. The balanced scorecard breaks the traditional financial measurement system. It adds future value to the financial measures. The measures of the financial perspective can be improvement of product quality, time to complete orders, productivity, new product development, customer satisfaction into increased sales, reduction in operating cost, economic value, added bank profits, the per capital profit, net interest income, marketing cost, income ratio, office expenses, labor costs, loan, etc. 2. Customer perspective:- Due to intense competition, customer has become very important aspect of the banking industry. Attracting customers towards bank is very important so that the strategy of the bank should be customer focused. The possible measures of bank performance according to customer perspective can be: Market share, customer retention rate, rate of new customer, customer satisfaction, customer profitability level, customer complaints, etc. 3. Internal processes perspective:- In order to retain target customers and to meet the requirements of shareholders about financial returns, managers need to focus on customer satisfaction and improve internal processes and establish measurable indicators. In this perspective balanced scorecard not only paying attention to a simple process to improve but also confirms request of customers and shareholders as a starting point to satisfy both customers and shareholders. Measures are: product and service innovation, new product and service revenue, the new loan rate and increasing rate, the number of internal regulations, responsibility of accidents, etc. 4. Learning and growth perspective:- It includes an investment which the organization must be carried out to achieve long term performance in the future, like ability of employees, organization information system, employee satisfaction, staff violation rate, pass rate of status examination, professional development program, staff training sessions, etc. These are measures of a bank for performance measurement on the basis of the balanced scorecard approach. We can evaluate the performance of the bank by using these measures. Refrence: www.academypublisher.com REFRENCES:- www.google.com ( google books ) Magna Cara College online Library University of Wales online library Frank Wood and Alan Sangster Business Accounting 2 Chris Guilding Accounting essentials for Hospitality Managers www.magnacartacollge.org (moodle) www.academypublisher.com ( article)

Imaging Techniques for Intestinal Obstruction

Imaging Techniques for Intestinal Obstruction The small intestine is the only part of the gastrointestinal tract that is essential for life. It serves a neuroendocrine function, a digestive function (propulsion, mixing and absorption of food), and a secretory function. The liver, gallbladder and pancreas are accessory organs of the digestive system that is closely associated with the small intestine. The villous surface improves absorption by increasing the overall surface area. In addition to absorption nutrients, it is responsible for most water reabsorption in the GI tract (Edward, 1998). The small intestine is made up of three segments, which form a passage from stomach (the opening between stomach and small intestine is called the pylorus) to large intestine. It is duodenum, jejunum and ileum. The duodenum is this short section is the part of the small intestine that takes in semi digested from stomach through the pylorus and continues the digestion process. The duodenum also uses bile from the gallbladder, liver and pancreas to help digest food. The jejunum is the middle section of the small intestine carries food through rapidly, with wave-like muscle contractions, towards the ileum. The last segment is ileum. The ileum is the longest part of small intestine. It is where most of the nutrients from food are absorbed before emptying into the large intestine (UPMC, 2010). By the time food reaches small intestine, it has already been broken up and mashed into liquid by stomach. Each day, small intestine receives between one and three gallons (or six to twelve liters) of this liquid. The small intestine carries out most of the digestive process, absorbing almost all of the nutrients get from foods into bloodstream. The walls of the small intestine make digestive juices or enzymes that work together with enzymes from the liver and pancreas to do this. Although the small intestine is narrower than the large intestine, it is actually the longest section of the digestive tube, measuring about 22 feet (or seven meters) on average, or three-and-a-half times the length of body (UPMC, 2010). 1.2 Large Intestine The large intestine is larger in diameter than the small intestine. It begins at the ileocecal junction, where the ileum enters the large intestine and ends at the anus. The large intestine consists of the colon, rectum and anal canal. Its primary function is to secrete mucin and form stool for excretion. It reabsorbs water and electrolytes but to a much lesser extent than the small intestine. It does not have sodium cotransport system (Edward, 1998). Unlike small intestine, the large intestine produces no digestive enzymes. The wall of the large intestine has the same types of tissue that are found in other parts of the digestive tract but there are some distinguishing characteristics. The mucosa has a large number of goblet cells but does not have any villi. The longitudinal muscle layer, although present, is incomplete. The longitudinal muscle is limited to three district bands, called teniae coli that run the entire length of the colon (National Cancer Institute, 2012). The rectum continues from the sigmoid colon to the anal canal and has a thick muscular layer. It follows the curvature of the sacrum and is firmly attached to it by connective tissue. The rectum and ends about 5 cm below the tip of the coccyx at the beginning of the anal canal. The last 2 to 3 cm of the digestive tract is the anal canal, which continues from the rectum and opens to the outside at the anus. The mucosa of the rectum is folded to form longitudinal anal columns. The smooth muscle layer is thick and forms the internal anal sphincter at the superior end of the anal canal (National Cancer Institute, 2012). 1.3 Intestinal Obstruction Intestinal obstruction, also called ileus (from the Greek eilo, meaning to roll up) (Ivan, 1996). Intestinal obstruction is refers to a lack of movement of the intestinal contents through the intestine. Because of its smaller lumen, obstructions are more common and occur more rapidly in small intestine, but they can occur in large intestine as well. Depending on the cause and location, obstruction may manifest as an acute problem or a gradually developing situation. For example, twisting of the intestine could cause sudden total obstruction, whereas a tumor leads to progressive obstruction (Barbara, 2002). Obstruction of the intestine causes the bowel to become vulnerable to ischemia. The intestinal mucosal barrier can be damaged, allowing intestinal bacteria to invade the intestinal wall and causing fluid exudation, which leads to hypovolemic and dehydration. About 7L of fluid per day is secreted into the small intestine and stomach and usually reabsorbed. During obstruction, fluid accumulates, causing abdominal distention and pressure on the mucosal wall, which can lead to peritonitis and perforation (Unbound Medicine, 2011). Intestinal obstruction is most common on elderly individuals, due to the higher incidence of neoplasm and other causative diseases in this population. In neonates, intestinal obstruction may be caused by imperforate anus or other anatomic abnormalities. Obstruction may also be secondary to meconium ileus. In paediatric population, Hirschsprung disease can resemble intestinal obstruction (Christy, 2011). Intestinal obstruction occurs in two forms. Mechanical obstructions are those resulting from tumor, adhesions, hernias or other tangible obstructions. Functional, or adynamic, obstructions result from neurologic impairment, such as spinal cord injury or lack of propulsion in the intestine and are often referred to as paralytic ileus. Adynamic or paralytic ileus usually related to inflammation or the disruption of innervation (Barbara, 2002). 2 CAUSES OF DISEASE Intestinal obstruction can be caused by many different things. It occurs in two basic types which is mechanical obstruction and paralytic ileus. Functional obstruction or paralytic ileus is one of the major causes of the intestinal obstruction in infants and children. It is common in the following situations: after abdominal surgery, in which the effects of the anesthetic combined with inflammation or ischemia in the operative area interfere with conduction of nerve impulses in the initial stage of spinal cord injuries (spinal shock) with inflammation related to severe ischemia in pancreatitis, peritonitis, or infection in the abdominal cavity with hypokalemia, mesenteric thrombosis or toxaemia kidney or lung disease Mechanical obstruction may result from the following: Scar tissue in the belly, often called adhesions. This tissue can wrap around a piece of bowel. The contents of the bowel are prevented from moving normally through the intestine Bowel that twits on itself or develops a bad kink. This is called volvulus Fecal impaction or hard stool that cannot pass through the bowel Cancer such as colon cancer or cancer of the pancreas Hernias is protrusion of the abdominal contents through the abdominal wall (Barbara, 2002) 3 PATHOPHYSIOLOGY When mechanical obstruction of the flow of intestinal contents occurs, a sequence of events develops as follows. First, intestinal obstruction occurs when gases and fluids accumulate in the area proximal to the blockage, distending the intestine. Gases arise primarily from swallowed air but also from bacterial activity in the intestine. Second, increasingly strong contractions of the proximal intestine occur in an effort to move the contents onward. The increasing pressure in the lumen leads to more secretions entering the intestine and also compresses the veins in the wall, preventing absorption, as the intestinal wall becomes edematous. The intestinal distention leads to persistent vomiting with additional loss of fluid and electrolytes. With small intestinal obstruction, there is no opportunity to reabsorb fluid and electrolytes, and hypovolemia quickly results (Barbara, 2002). If the obstruction is not removed, the intestinal wall becomes ischemic and necrotic as the arterial blood supply to the tissue is reduced by the pressure. If twisting of the intestine (e.g.: volvulus) has occurred or if immediate compression of arteries (e.g.: intussusception or strangulated hernia) results from the primary cause of obstruction, the intestinal wall becomes rapidly necrotic and gangrenous. Ischemia and necrosis of the intestinal wall eventually lead to decreased innervation and cessation of peristalsis. A decrease in bowel sounds indicates this change. Usually, the obstruction promotes rapid reproduction of intestinal bacteria, some of which produce endotoxins. As the affected intestinal wall becomes necrotic and more permeable, intestinal bacteria or toxins can leak into peritoneal cavity (peritonitis) or into the blood supply (bacteremia and septicemia). In time, perforation of the necrotic segment may occur, leading to generalized peritonitis (Barbara, 2002). For functional obstruction or paralytic ileus usually results from neurologic impairment. Peristalsis ceases and distention of the intestine occurs as fluids and electrolytes accumulate in the intestine. In this type of obstruction, reflex spasms of the intestinal muscle do not occur, but the remainder of the process is similar to that of mechanical obstruction (Barbara, 2002). 4  SIGN AND SYMPTOMS With mechanical obstruction of the small intestine, severe colicky abdominal pain develops as peristalsis increase initially, nausea and constipation characterizing small bowel obstruction. It may also cause drowsiness intense thirst, malaise and aching may dry up oral mucous membranes and the tongue. Borborygmi are audible rumbling sounds caused by movement of gas in the intestine and intestinal rushes can be heard as the intestinal muscle forcefully contracts in an attempt to propel the contents forward. These are loud enough to be heard without stethoscope. Palpation elicits abdominal tenderness with moderate distention; rebound tenderness occurs when obstruction has caused strangulation with ischemia. The signs of paralytic ileus differ significantly in that bowel sounds decrease or are absent and pain is steady. Vomiting and abdominal distension occur quickly with obstruction of the small intestine. Vomiting is recurrent and consists first gastric contents and then bile-stained duodenal contents. No stool or gas is passed. Restlessness and diaphoresis with tachycardia is present initial. As hypovolemia and electrolyte imbalance progress, signs of dehydration, weakness, confusion and shock are apparent (Barbara, 2002). Signs and symptoms of large bowel obstruction develop more slowly because the colon can absorb fluid from its contents and distend well beyond its normal size. Constipation may be only clinical effect for days. Colicky abdominal pain may then appear suddenly, producing spasms that last less than 1 minute each and recur every few minutes. Continuous hypogastric pain and nausea may develop, but vomiting is usually absent at first. Large bowel obstruction can cause dramatic abdominal distention; loops of the large bowel may become visible on the abdomen. Eventually, complete large bowel obstruction may cause fecal vomiting, continuous pain or localized peritonitis. Patients with partial obstruction may display any of the above signs and symptoms in a milder form. However, leakage of liquid stool around the obstruction is common in partial obstruction (Lippincott Williams Wilkins, 2007). 5  IMAGING MODALITIES 5.1 Laboratory Test Laboratory evaluation of patients with suspected obstruction should include a complete blood count and metabolic panel. Hypokalemic, hypochlomeric metabolic alkalosis may be noted in patients with severe emesis. Elevated blood urea nitrogen levels are consistent with dehydration, and haemoglobin and hemotocrit levels may be increased. The white blood cell count may be elevated if intestinal bacteria translocate into the bloodstream. It can cause the systemic inflammatory response syndrome or sepsis. The development of metabolic acidosis especially in a patient with an increasing serum lactate level, may signal bowel ischemia (Patrick G. Jackson Manish Raiji, 2011). 5.2 Plain Radiography The initial imaging study of choice for confirming bowel obstruction with clinical signs and symptoms of intestinal obstruction should include pain upright abdominal radiography. This radiography can quickly determine if intestinal perforation has occurred. The free air can be seen above the liver in upright films or left lateral decubitus films. Radiography is 60-70% sensitivity for detection of small bowel obstruction and it performs better in high-grade obstruction. Radiography can be find the diagnosis of small bowel obstruction include distended loops of small bowel, collapsed colon, the à ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒâ€¦Ã¢â‚¬Å"string of pearls sign resulting from small amount of residual air compared with the large amount of retained fluid and pseudotumour related to distended fluid filled loops. In large bowel obstruction, it is important to note the degree of caecal distension on the plain abdominal films, since marked distension will point to the need for urgent decompression to prevent caecal perforation. In patients with small bowel obstruction, supine views show dilation of multiple loops of small bowel with a paucity of air in the large bowel (Figure 4). Those with large bowel obstruction may have dilation of the colon with decompressed small bowel in the setting of the competent ileocecal valve. Upright or lateral decubitus films may show laddering air fluid level (Figure 5). These findings show in conjunction with a lack of air and stool in the distal colon and rectum are highly suggestive of mechanical intestinal obstruction (Patrick G. Jackson Manish Raiji, 2011). Limitations: Fails to diagnose the cause of obstruction in most cases In obstruction of ileocaecal region, it may be difficult to determine whether the level in the proximal large bowel or distal ileum Cannot reliably detect the presence of ischaemic complication 5.3 Computed Tomography 5.3.1 Small bowel obstruction Generally, it is considered the imaging modality of choice when plain abdominal radiography and the clinical features suggest an acute small bowel obstruction. CT is sensitive for detection of high-grade obstruction (90-96%). Although CT is highly sensitive and specific for high-grade obstruction, its value diminishes in patients with partial obstruction. In these patients, oral contrast material may be seen traversing the length of the intestine to the rectum with no discrete area of transition. It useful in: Confirming or excluding small bowel obstruction (versus pseudo-obstruction) Defining the degree and site of obstruction Identifying the cause of small bowel obstruction (73-95% sensitivity) Confirming or excluding the diagnosis of ischaemia (>90% sensitivity and specificity) The advantages are: Superior to enteroclysis in showing extraluminal masses, revealing abscesses, malignancy, anterior adhesions as well as features of strangulation. It is ability to depict other causes of an acute abdomen The limitations: Lower sensitivity (approximately 50%) for the detection and location of low-grade small bowel obstruction (Diagnostic Imaging Pathways, 2009) 5.3.2 Large Bowel Obstruction It indicated as an alternative to contrast enema in evaluation of large bowel obstruction, particularly with elderly and immobile patients. CT findings in patients with intestinal obstruction include dilated loops of bowel proximal to the site of obstruction with distally decompressed bowel. The presence of discrete transition point helps guide operative planning (Figure 6). Absence of contrast material in the rectum is also an important sign of complete obstruction. For this reason, rectal administration of contrast material should be avoided (Patrick G. Jackson Manish Raiji, 2011). The advantages are: Does not require insertion of rectal tube and contrast and is therefore better tolerated than a contrast enema In one study, successfully diagnosed colonic obstruction in 96% of patients and pseudo-obstruction in 93% of patients The limitations for this are false negative and false positive results and limited diagnostic with partly obstructing lesions (Diagnostic Imaging Pathways, 2009). Figure 6: Axial computed tomography scan showing dilated, contrast- filled loops of bowel on the patientà ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢s left (yellow arrows), with decompressed distal small bowel on the patientà ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢s right (red arrows). The cause of obstruction, an increased umbilical hernia, can also be seen (green arrows), with proximally dilated bowel entering the hernia and decompressed bowel exiting the hernia (Patrick G. Jackson Manish Raiji, 2011). 5.4 Contrast Fluoroscopy Contrast studies, such as small bowel follow-through, can be helpful in the diagnosis of a partial intestinal obstruction in patients with high clinical suspicion and in clinically stable patients in whom initial conservative management was not effective. The use of water-soluble contrast material is not only diagnostic, but may be can use for therapeutic in patients with partial small-bowel obstruction. Contrast fluoroscopy may also be useful in determining the area of intestine that need for surgery (Patrick G. Jackson Manish Raiji, 2011). There are several variations of contrast fluoroscopy. In the small bowel follow-through study, the patient drinks contrast material, then serial abdominal radiographs are taken to visualize the passage of contrast through the intestinal tract. The advantage of small bowel follow-through is does not require nasointestinal intubation, and compared to enteroclysis, it is easier to perform and does not require additional expertise. The limitations for this procedure are they take time for contrast to reach the obstruction and barium is diluted because of excess residual intraluminal fluid resulting in non-uniform small bowel filling (Diagnostic Imaging Pathways, 2009). Enteroclysis involves naso- or aro-duodenal intubation, followed by the instillation of contrast material directly into the small bowel. Although this study has superior sensitivity compared with small bowel follow through, it is more labor-intensive and is rarely performed. The advantage enteroclysis are it has ability to gauge the severity of obstruction objectively. The limitations are it need for nasoenteric intubation and demonstration of extrinsic causes is sometimes difficult. Rectal fluoroscopy can be helpful in determining the site of a suspected large bowel obstruction (Patrick G. Jackson Manish Raiji, 2011) 5.5 Magnetic Resonance Imaging (MRI) Magnetic resonance imaging (MRI) may be more sensitive than CT in the evaluation of intestinal obstruction. MRI enteroclysis, which involves intubation of the duodenum and infusion of contrast material directly into small bowel. It can more reliably determine the location and cause of obstruction. However, MRI is not universally available and very expensive (Patrick G. Jackson Manish Raiji, 2011). 5.6 Ultrasonography In patients with high-grade obstruction, ultrasound evaluation of the abdomen has high sensitivity for intestinal obstruction, approaching 85 percent. However, because of the wide availability of CT, it has largely replaced ultrasonography as the first-line investigation in stable patients with suspected intestinal obstruction. Ultrasonography remains a valuable investigation for unstable patients with an ambiguous diagnosis and in patients that contraindication with radiation exposure, such as pregnant women (Patrick G. Jackson Manish Raiji, 2011).

The History of Modern Women and Body Art Essay -- Art Tattoos Arts Ess

The History of Modern Women and Body Art I chose to do this field report on body art because I, personally, find the topic very complex and interesting. It is for this reason that I decided to narrow the scope of my field research. I am focusing this report on the trends and evolution in body art as relating to modern women. When I say modern women I am referring to the women from about the 18th century to the current day. I chose to focus on women imparticular because of the strong societal pressure that is specifically place upon them to fulfill a certain role and aesthetically look a particular way. I wanted to research the history of body art and how it related to these pressures and stigmas. In my research I found everything from information on tattooing practices to body modification through clothing. As De Mello noted in her book, Bodies of Inscription, "Contemporary tattooing has evolved from a practice that was originally imported from the islands of Polynesia and later transformed into a form of working-class folk art" (p10). The credit should be duly given to the original tattoo artists of Polynesia, but the art form also existed in North America within Native Tribes. James Swan sights a specific tribe known as the Haida who practiced the cultural tradition of tattooing (Gilbert, 94-5). Both women and men were tattooed, but as common in many cases, the markings were different for each. The women more commonly had tattoos on their hands and forearms. Most had tattoos also on their breast and legs below the knee. These markings are very culturally significant. They allow the tribe identification on the basis of the design which tells the family name of the wearer (Gilbert, 94-5). The popularization of tattooin... ... to be. I was looking for more information that gave details on societal views and how that influenced women in particular in the way they modified their bodies. I did find a wide variety of ways in which women modified their bodies, but perhaps not as many specifics about the society and their reaction to that particular method of adornment. I think I could've probably found much more detailed sources had a looked hard enough for them. In the future I will try to find more detailed information on a variety of subtopics within a main topic to better guide my research. Works Cited Brain, Robert. 1979. The Decorated Body. New York: Harper & Row, Publishers, Inc. De Mello, Margo. 2000. Bodies of Inscription: A cultural history of the modern tattoo community. Durham: Duke University Press. Gilbert, Steve. 2000. Tattoo History. New York: Juno Books.

Hamlet -- the Characterization Essay -- GCSE English Literature Course

Hamlet -- the Characterization      Ã‚  Ã‚   The beautifully developed characters within Shakespeare’s dramatic tragedy, Hamlet, are manifestations of genius. Let us in this essay tour the gallery of the Bard’s characters in this most famous play.    George Lyman Kittredge, in his book, Five Plays of Shakespeare, describes the Bard’s excellent characterization of Claudius:    King Claudius is a superb figure – almost as great a dramatic creation as Hamlet himself. His intellectual powers are of the highest order. He is eloquent – formal when formality is appropriate (as in the speech from the throne), graciously familiar when familiarity is in place (as is his treatment of the family of Polonius), persuasive to an almost superhuman degree (as in his manipulation of the insurgent Laertes) – always and everywhere a model of royal dignity. His courage is manifested, under the most terrifying circumstances, when the mob breaks into the palace. His self-control when the dumb show enacts his secret crime before his eyes is nothing less than marvelous. (xviii)    The genius of the Bard is revealed in his characterization. Brian Wilkie and James Hurt in Literature of the Western World examine the universal appeal of   Shakespeare resulting from his â€Å"sharply etched characters†:    Every age from Shakespeare’s time to the present has found something different in him to admire. All ages, however, have recognized his supreme skill in inventing sharply etched characters; it frequently happens that long after one has forgotten the exact story of a play one remembers its people with absolute vividness. It is true, paradoxically, that many of Shakespeare’s characters represent universal types.[. . .] Scores of them are fu... ...stitute of Technology. 1995. http://www.chemicool.com/Shakespeare/hamlet/full.html    West, Rebecca. â€Å"A Court and World Infected by the Disease of Corruption.† Readings on Hamlet. Ed. Don Nardo. San Diego: Greenhaven Press, 1999. Rpt. from The Court and the Castle. New Haven, CT: Yale University Press, 1957.    Wilkie, Brian and James Hurt. â€Å"Shakespeare.† Literature of the Western World. Ed. Brian Wilkie and James Hurt. New York: Macmillan Publishing Co., 1992.    Wilson, John Dover. What happens in Hamlet. New York: Cambridge University Press, 1959.    Wright, Louis B. and Virginia A. LaMar. â€Å"Hamlet: A Man Who Thinks Before He Acts.† Readings on Hamlet. Ed. Don Nardo. San Diego: Greenhaven Press, 1999. Rpt. from The Tragedy of Hamlet, Prince of Denmark. Ed. Louis B. Wright and Virginia A. LaMar. N. p.: Pocket Books, 1958.         

Effects on plastic surgery

Purpose: The audience will know about the effects of the plastic surgery. Thesis: Effects on plastic surgery. Introduction A. Plastic surgery is a medical specialty concerned with the â€Å"correction† or restoration of form and function. B. There are many types of plastic surgery such as cosmetic surgery, reconstructive surgery, hand surgery, microsurgery, and the treatment of burns. C. However, plastic surgery can have positive and negative effects. Transition: Let me start explaining about the positive effects on plastic surgery. Body 1. Re-contouring A.This is the process of plastic surgery that includes procedures such a liposuction, which involves the removal of fat from the body. B. Not only does this make you look more attractive, but controlled liposuction can remove safe amounts of fat from your body to aid in overall health. Transition: Another positive effect of plastic surgery is†¦ 2. Confidence A. This is a big benefit that comes along with plastic surgery. B. Confidence makes people psychologically fit and happy, and generally improves their style of life. Transition: Now let me turn to the third effects which are†¦ . Wounds & Accidents A. Many people go to a plastic surgeon because they have been in some kind of accident. B. In order to reduce major scarring, plastic surgery is required Transition: Lastly, the positive effects on plastic surgery are†¦ 4. Age-Deflance A. The affects of aging can be prolonged or reversed with plastic surgery. B. Wrinkles can be removed as well as age spots and sagging skin. C. When kept toa minimum, plastic surgery can take years off your apparent age. Transition: Now, let me proceed to the negative effects on plastic surgery. 1.Cost A. When people decide to undergo cosmetic surgery, they often consult a rofessional who gives them an estimate as to the cost. B. This estimate isn't a binding contract, but a guess as to how much the procedure will cost. C. The actual cost can rise dramatically over this estimate, leading patients to suffer pressure to pay the entire amount even if they cannot afford it. D. When the cost is spread out over a payment plan, it can cause more stress. Transition: Now, let's turn to a second negative effects on plastic surgery†¦ 2. Emotional Effects A.The emotional effects on patients' well-being are one of the negative effects of osmetic surgery. B. While they go under the knife to fix a problem they see on the outside, this sometimes only serves as a bandage on the larger problem. C. After the surgery they continue to sutter trom a body image distortion . D. A small number ot patients continue to go back to the surgeon to fix other problems they see instead of trying to find a real solution to the problem. Conclusion Before I end my speech, I would like to review that†¦ Plastic surgery can have either negative or positive effects. We should know how to evaluate it wisely.

Lady Macbeth and Her Gender Essay

In Shakespeare’s time women were considered to stay ay home, do the housework and to look after the children after they were married. The role of women was just to please men. Women had no right and no choices because men defined women. A young women’s future was defined by their father and they had no choice to refuse. In Shakespeare’s time, which was the Elizabethan period, there were no actresses and men played women in plays. To women in those times the play ‘Macbeth’ would seem very strange as Lady Macbeths character is nothing like women in then, even to men the character would seem strange. Lady Macbeth is an ambiguous character as she has two sides to her, one side is that she is fiendlike and the other is that she is not fiendlike. The first time we meet lady Macbeth, is when she was reading a letter that Macbeth had written to her telling her about the witches prophecy. She reads the letter and says ‘yet I do fear thy nature, it is too full o’th’ milk of human kindness’. She thinks that Macbeths is too kind to do anything to become king, she says that he is ‘too’ kind, but no one can be too kind to kill anyone. She then says a spell, ‘pour my sprits in their ear’ and she wants to give her evil sprits to him and she has to take away the human kindness and fill it up with evil. This was the very first encounter with Lady Macbeth and this will make the audience think that she is evil, which would shock the audience. Lady Macbeth’s understanding of ambition is evil. ‘Without illness should attend it’. The word illness actually means evil so she is saying without evil you can’t be ambitious. The verb ‘should’ indicate that Lady Macbeth feels that evil must always accompany ambition. Lady Macbeth has just heard that the king, Duncan is coming to stay at their castle. Lady Macbeth say’s a soliloquy and calls on evil sprits to assist her murderous plans. ‘The raven himself is hoarse†¦Ã¢â‚¬â„¢ Lady Macbeths knows that she’s a woman and can’t commit the crime so she says ‘unsex me here’. If she is unsexed then she would not be a woman but a man and her feminine side would be taken away. Lady Macbeth wants to be filled with ‘direst cruelty’ so that she can kill the king with hesitating. This soliloquy is actually a spell. We know this is a spell because she is calling on sprits to unsex her. To an Elizabethan audience and to our modern audience it is still odd for some one casting a spell. In the scene there are many mood changes from excitement to fury. This has a dramatic effect on the audience as the scene started off with a lot of excitement from lady Macbeth and then changed to a furious state towards Macbeth. ‘Look like th’innocent flower, but be serpent under it’. Here lady Macbeth is telling Macbeth to look innocent but be evil inside. This is like Adam and Eve where Adam is Macbeth and eve is Lady Macbeth and the serpent tempted them. This also spoiled their stay in paradise and to Macbeth and lady Macbeth it will spoil the whole existence of the world, as they will be breaking the chain of being. This shows us that lady Macbeth is fiendlike and doesn’t care about the rest of the world. Two scenes later lady Macbeth says something very shocking, which may have just changed Macbeth’s mind. ‘Have plucked my nipple from his boneless gums and dashed the brains out, had I sworn as you have done this’, here lady Macbeth is telling Macbeth that she would kill her own child and throw it on the floor and let it die than break a promise she had made. This is pure evil and again to an Elizabethan audience and to our modern audience this is odd, as no one would say that. After Macbeth kills the king and two guards are saying their prayers and he couldn’t say ‘amen’. This worried Macbeth and all Lady Macbeth could say was ‘consider it not so deeply’. She didn’t care about his feelings and what he was going through and just simply forgot about it. Lady Macbeth is meant to look out for Macbeth, but she really has more control over Macbeth and he does not say anything to her as men in those days would. Lady Macbeth orders him to put the dagger back but he still in shock so she does it her self. In the play lady Macbeth is also not fiendlike towards Macbeth, and tries to support and help him. The first place where lady Macbeth is not fiendlike is when she was calling Macbeth a coward, which was in act 1 scene 7, just before Duncan is murdered. Lady Macbeth may have looked like she was being fiendlike towards Macbeth, when she was calling him a coward. ‘ And live a cowed in thane own esteem’, Macbeth could be saying this to him so that his dream of being king would come true and not for her to be queen. She called him all these names like a ‘coward’, ‘spineless’ and ‘lack of manliness’ to make him say no he’s not and so he would prove her wrong. Lady Macbeth also said ‘but screw your courage to the sticking-place’, and this means be a man and this finally got him and he gave in. I think that it actually worked and it was the turning point and then murdered Duncan. In the second scene of act two lady Macbeth shows a week side in her as she say’s ‘had he not resembled my father as he slept, I had done’t. This shows us that she has some compassion in her and is not all evil. This has a bit of a effect on the audience as they now know she isn’t all evil. After the deed is done Macbeth says this is a ‘sorry sight’ and lady Macbeth replies with ‘a foolish thought, to say a sorry sight’, she is saying its too late now you’ve done it and your dreams will come true. She is keeping his hopes up and is also trying to forget about it. When Macduff tells Duncan’s son of their father’s murder, Macbeth has to depend himself and to help him out lady Macbeth faints in order to bring the attention away from Macbeth so that he would not be questioned. If she did not care about Macbeth she would have not done this. So this shows that she does love Macbeth. Lady Macbeth has her times when she is pure evil but she also cares about Macbeth and about his well-being. She was very strong and kept her emotions inside her until the end and it drove her to sleep walk and then at the end to suicide. She kept it all inside for Macbeth so he would not get worried and so therefore I can’t say she is fiendlike or not.